The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
August 5, 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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 24 - 30

FRIDAY, MAY 30, 2003

  1. TV May Encourage Teen Smoking: Italian Survey
  2. Menorrhagia: When Your Time of the Month is Too Much
  3. Obesity Drug Cuts Risk Factors for Heart Disease
  4. Treating Minor Burns at Home
  5. Levels of Carcinogen Higher in Marlboro Cigarettes
  6. Vinegar Good Medicine for Some Burns
  7. Sleep Disorder Ups Risk of Heart Problem Recurrence
  8. Staving off a Second Stroke
  9. 'Good' Bacteria May Thwart Allergies in Toddlers
  10. Herb May Help Heal Herpes
  11. Europeans Nations Failing Obese Patients Survey
  12. How Much Exercise?
  13. Side Effect Risk from Drug Higher in Epileptics
  14. Goodbye, Flu Shots?
  15. Protein Could Slow Degenerative Brain Diseases
  16. Nursing Helps Undo Smoking's Damage to Baby
  17. Mystery Fatigue Often Not Chronic Fatigue Syndrome

    THURSDAY, MAY 29, 2003

  18. Study Questions Popular Fertility Surgery for Men
  19. Cell Phone Speakers in Front of Driver May Be Safer
  20. Childhood Obesity Often Missed
  21. European Initiative Launched to Tackle Obesity
  22. New Ways to Treat Allergies
  23. New Drug Approach to Irritable Bowel Syndrome
  24. Scientists Grow Insulin-Producing Liver Cells
  25. Chronic Headaches May Predict Men's Stroke Risk
  26. Bacteria Beats Eczema
  27. Study: Laziness Makes for Dangerous Fat
  28. Does Adult Diabetes Trace Back to the Womb?
  29. Obesity Epidemic Set to Get Worse
  30. A Dose of Their Own Medicine

  31. WEDNESDAY, MAY 28, 2003

  32. Smoking Speeds Up Memory Loss in Middle Age
  33. 'Rapid Detox' Breaks Drug Habits Quickly
  34. To Psychopathic Murderers, Violence Is Not So Bad
  35. Laziness Makes for Dangerous Fat - U.S. Study
  36. Angry Children Hurt Their Heart Health
  37. Breast Feeding May Counter Maternal Smoking Harm
  38. No Java Cold Turkey
  39. Heart Effects of Impotence Pill Under U.S. Review
  40. Exercising for Fun Better for the Heart
  41. Blood Doping Rampant Among Top Cross-Country Skiers
  42. Men May Need Second Prostate Cancer Test

  43. TUESDAY, MAY 27, 2003

  44. Sunburn by Gender
  45. Young Children Served Large Portions May Overeat
  46. Fish Oil Prevents Irregular Heartbeats
  47. Hormone-Taking Is Linked to Dementia
  48. Apnea Tied to Atrial Fibrillation
  49. Diabetics' Education Level May Sway Death Risk
  50. Setting an Example by Kicking the Habit
  51. Full-Term Fetus Knows Mom's Voice: Study
  52. Many Prostate Biopsies Unnecessary
  53. Laser Eye Surgery Claims Soaring in UK
  54. Two Clot Busters Boost Stroke Recovery
  55. Families Sought in Hunt for Male Cancer Genes
  56. Testing for Stomach Bacteria Doesn't Help With Peptic Ulcers
  57. Wine Tasting Takes Brains, Italian Study Finds
  58. Surgery Beats Drugs for Fixing Blood Flow to Heart

    MONDAY, MAY 26, 2003

  59. Pamphlet with Your Pasta?
  60. Study: Smallpox May Spur Malaria Defense
  61. Vitamins May Cut Risk of Birth Defects in Diabetics
  62. Trust Your Instincts, Skin Cancer Survivor Urges
  63. Youthful Hostility Linked to Adult Heart Disease
  64. Skin Cancer: More than 1 Million New Cases in U.S. This Year
  65. Coffee Shop Workers Have High Blood Pressure Risk
  66. Handling the Heat When You Have Heart Pain
  67. Demand for Endocrinologists Outstrips Supply
  68. Obesity Surgery Success Depends on Surgeon
  69. For Preservative-Free Flu Shot, Ask in Advance
  70. Weekend Exercise Does a Heart Good - German Study

    SUNDAY, MAY 25, 2003

  71. A Look at Dry Eye
  72. If It's Not Colic, It Might be GERD

    SATURDAY, MAY 24, 2003

  73. Unclogging Your Nose
  74. Ear Pain on Airplanes

FRIDAY, MAY 30, 2003

TV May Encourage Teen Smoking: Italian Survey

Reuters Health
Friday, May 30, 2003

FLORENCE (Reuters Health) - Italian teenagers may take up smoking to imitate actors and TV stars, according to a survey by the National Health Institute presented in Rome on Friday.

The survey, released at the Fifth Conference on Tobacco and the National Health Service, involved 498 teenagers between 13 and 17 years old. The survey found that 12 percent of the teens were smokers, with 16- and 17-year-olds most likely to smoke.

Teens smoke an average of seven cigarettes per day, and 35 percent buy them at vending machines, the survey found.

At the meeting, public health experts heard that Italian television stations Rai, Mediaset, La7 and MTV show someone smoking every 32 minutes.

In films, cartoons and videos, 62 percent of smoking acts are associated with "winning" personalities and 38 percent with "losers," according to the report. Moreover, 71 percent of smoking took place in "sexy and convivial situations" while 29 percent was associated with anxiety, said the report.

The survey monitored programs between 11:30 a.m. and 11:30 p.m. during three weeks in October and December 2002 and January 2003.

In a landmark ruling this month, Italy's State Council banned indirect cigarette advertising in films and TV programs.

Also this week, an agency that oversees government industries, the Autonomous Administration of State Monopolies, announced that beginning in January 2004 cigarette vending machines will be shut between 7:00 a.m. and 11:00 p.m. in an effort to make cigarettes less accessible to teenagers.

The measure comes five months after Italy passed a milestone law that bans smoking almost anywhere indoors except private homes and specially designated smoking areas.

According to the latest report by the statistics agency Doxa, more than one quarter of Italy's 58 million citizens are smokers.

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Menorrhagia: When Your Time of the Month is Too Much

By Kathleen Doheny
HealthScoutNews Reporter
HealthScoutNews
Friday, May 30, 2003

FRIDAY, May 30 (HealthScout News) -- For most women, the average loss of blood during a menstrual period is a little more than one ounce.

But an estimated 10 million American women lose much more because they suffer from a condition called menorrhagia. And most don't realize there are treatments that can help ease the problem.

Traditionally, a hysterectomy -- removal of the uterus -- has been the only option available to doctors to treat the condition. But in recent years, researchers have pioneered alternatives so the heavy bleeding can often be eliminated or greatly reduced without radical surgery.

Dr. Philip G. Brooks, a Los Angeles gynecologist and clinical professor at UCLA's David Geffen School of Medicine, says menorrhagia is much more than just an annoying period.

The condition can be disabling, causing women great difficulty working or doing other daily activities because the flow is so great. "They wear towels, not menstrual pads," Brooks says.

About 600,000 hysterectomies are performed each year in the United States, according to the U.S. Centers for Disease Control and Prevention (news - web sites), and about one-fifth are done to treat menorrhagia, health experts say.

But in recent years, Brooks and other physicians have turned to less drastic measures. They include various types of ablation, procedures in which the lining of the uterus -- called the endometrium -- is destroyed to control the excessive bleeding.

Even before ablation is recommended, however, there are other steps that can be considered, says Dr. William Parker, a gynecologist at Santa Monica-UCLA Medical Center in California. He often uses a hysteroscope, a tiny telescope-like device, to do a visual inspection of the uterine cavity.

"We look to see if there are any fibroids, polyps and lesions," he says, adding the early stages of pregnancy can also lead to heavy bleeding.

Many women with menorrhagia are in the 40- to 50-year-old age bracket, and lack of ovulation during cycles is a main reason for the bleeding.

If a follow-up test -- such as an ultrasound -- of the uterine lining shows it's normal, Parker might prescribe low-dose birth control pills or other medication to slow the excess bleeding.

If medical treatments fail after three months or so, Parker says he offers the option of ablation.

The U.S. Food and Drug Administration (news - web sites) has approved four methods of ablation in recent years, says Brooks, who lectured on the topic at the recent annual meeting of the American College of Obstetricians and Gynecologists.

Earlier techniques required a doctor to have specialized training. However, the newer treatments are easier for doctors to master, Brooks and Parker agree.

One of the newest, called hydrothermablation, is done on an outpatient basis, and involves the insertion of an hysteroscope to view the cavity during the procedure. A hot saline solution is delivered into the uterus through a tube inserted into the cervix. The water destroys the lining of the uterus, or most of it, in 10 minutes or so. The type of local anesthesia and other pain relief used varies, depending on the woman.

Ablation "destroys the blood vessels and endometrial glands that build up and shed," Brooks says. Basically, it destroys the uterine lining enough to solve the bleeding problem but sometimes not enough to stop periods.

He says about 50 percent of women who undergo ablation no longer have periods; the other 50 percent continue to have periods, but they are much lighter.

The results of hydrothermablation are very effective. "We have a 94 percent success rate -- either no period or scant periods," says Brooks, who teaches courses to train other doctors in the technique.

Women who have ablation should have completed their childbearing because the uterine lining is no longer capable of sustaining a pregnancy, doctors say. But because most women affected by menorrhagia are nearing the end of their reproductive years, motherhood isn't usually a concern.

Yet even with the high success rates of ablation techniques, says Parker, some women say to him, "I don't want a 10 percent risk." And they opt instead for a hysterectomy.

While a traditional hysterectomy requires about four to six weeks recovery time, ablation is usually a day or so, Parker says.

More information

For information on menstruation, see the American College of Obstetricians and Gynecologists. To learn more about menorrhagia, visit the University of California, Davis Medical Center.

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Obesity Drug Cuts Risk Factors for Heart Disease

By Patricia Reaney
Reuters
Friday, May 30, 2003

HELSINKI (Reuters) - An obesity drug is twice as effective as dieting in reducing weight in obese patients and cuts their risk of heart disease, according to new results from a long-running study reported on Friday.

Orlistat (news - web sites), produced by Switzerland's Roche Holding AG under the brand name Xenical, works by hindering the body's ability to absorb fat.

In the longest clinical trial to assess the effectiveness and safety of an obesity drug, patients taking orlistat had fewer symptoms of metabolic syndrome -- a cluster of three or more factors that increase the risk of heart disease.

Those factors include overweight or obesity, high blood pressure, early indications of diabetes, abnormal cholesterol levels and high waist measurement -- or typical beer belly.

"We know that we are in the middle of an obesity epidemic. We are definitely in a global epidemic of type 2 diabetes and as a third consequence we are facing an epidemic of patients having multiple risk factors known as the metabolic syndrome," said Dr. Jarl Torgerson, head of the obesity unit at Sahlgrenska University Hospital in Gothenburg, Sweden.

The Xendos study, led by Torgerson, mainly aimed to see if it would be possible to prevent or postpone type 2 diabetes in obese patients. The biggest risk for type 2 diabetes is excess weight.

"We could show that Xenical plus lifestyle treatment had a better diabetes prevention effect than lifestyle alone," Torgerson said in an interview.

Nearly 14 percent of people in the diet group developed type 2 diabetes but only 9.8 percent taking the drug suffered from the disease.

"These study results show that Xenical boosts the beneficial effects of weight loss in people with metabolic syndrome," said Torgerson, who presented the results at the 12th European Congress on Obesity.

In the study of 3,304 patients over four years, people taking the drug lost 14.08 pounds in weight, compared to 6.38 pounds among those who were just dieting.

The drug group also reduced their waistlines by 2.44 inches, compared to 1.52 inches for the dieters, and had a greater reduction in blood pressure.

More than a billion people worldwide are overweight or obese, according to the World Health Organization (news - web sites). It is a serious risk factor for heart disease, high blood pressure, stroke, diabetes, muscle and respiratory problems and certain types of cancer.

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Treating Minor Burns at Home

HealthScoutNews
Friday, May 30, 2003

FRIDAY, May 30 (HealthScoutNews) -- If you're not certain what you need to do to help extinguish the pain of minor burns, here's a refresher from the Mayo Clinic.

Generally, you can provide treatment at home for first-degree burns -- where the skin is reddened -- and small second-degree burns -- where a blistered area is no larger than two inches.

Here's what you need to do:

  • For chemical burns, make sure the chemical and any clothing or jewelry in contact with the chemical are removed.
  • Cool the burn under running water long enough to reduce the pain. It usually takes about 15 to 20 minutes. If you can't use running water, immerse the burn in cold water or cover it with cold compresses. Don't put ice directly on the burn. Ice can cause frostbite and further damage.
  • Once the burn is cooled, apply a lotion or moisturizer to soothe the area and prevent dryness. Don't apply butter because it holds the heat in the tissues and may cause more damage.
  • Cover the burn with a loosely-wrapped sterile gauze bandage. This keeps air off the burn and reduces the pain.
  • Take an over-the-counter pain medication, unless your doctor has told you not to take these kinds of medications.
  • Don't break blisters on burn areas. If a blister does break, wash the area with an antibacterial soap and water, apply an antibiotic ointment and cover it with a bandage.

More information

Here's where you can learn more about burns.

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Levels of Carcinogen Higher in Marlboro Cigarettes

By Paul Simao
Reuters
Friday, May 30, 2003

ATLANTA (Reuters) - Marlboro, the world's No. 1 selling brand of cigarettes, contains significantly higher levels of a cancer-causing agent than its rivals when purchased in many of the largest markets overseas, U.S. scientists say.

Tests by the U.S. Centers for Disease Control and Prevention (news - web sites) found that the U.S. brand contained higher amounts of tobacco-specific nitrosamines (TSNAs) than other locally available cigarettes in 11 of 13 countries.

In 10 countries, including Japan and Germany, Marlboro cigarettes purchased locally had at least twice the amount of TSNAs, one of the major classes of carcinogens found in tobacco products, than competitor brands.

The findings, published in the latest edition of Nicotine & Tobacco Research, come at a time when worldwide demand for American-style, blended cigarettes is outpacing demand for other types of cigarettes.

David Ashley, a CDC tobacco expert and the lead author of the article, said it was not known whether higher levels of TSNAs would lead to a greater prevalence of cancer and other smoking-related diseases.

Ashley did, however, note that reducing TSNAs in tobacco products would not make cigarette smoking any safer.

The World Health Organization (news - web sites) has estimated that there are more than 1.2 billion smokers on the planet and that 4 million people die each year from cancer and other smoking-related diseases.

Philip Morris USA, which markets Marlboro cigarettes, said the CDC findings were not surprising since the levels of TSNAs found in American cigarettes were traditionally higher because of differences in curing and processing.

Philip Morris USA is a unit of Altria Group Inc.

"We're aware of these higher TSNAs and have worked to reduce them," Philip Morris USA spokesman Brendan McCormick said. He added that the company had spent $35 million to lower the levels of this type of carcinogen in its products.

But anti-tobacco activists said the tobacco giants had done precious little to strip harmful contaminants from cigarettes.

"Today's study is just the most recent example of the tobacco industry's reckless disregard for the health of smokers and yet another compelling reason why cigarettes need to be regulated by the federal government," said Matthew Myers, president of the Campaign for Tobacco-Free Kids.

About 440,000 people in the United States die each year from lung cancer and other diseases caused by smoking, making it the leading preventable cause of death in the nation. There are about 46.5 million smokers in the United States.

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Vinegar Good Medicine for Some Burns

HealthScoutNews
Friday, May 30, 2003

FRIDAY, May 30 (HealthScoutNews) -- Vinegar can minimize alkaline burn injuries caused by household cleaners, plumbing products and industrial grade solvents.

A study in the May issue of Plastic and Reconstructive Surgery says vinegar and other weak acids can neutralize alkaline burns faster than water and significantly reduce damage to skin and tissue.

That's contrary to the common myth that neutralization should be avoided when a person suffers an alkaline burn, study co-author Dr. Stephen Milner says in a news release.

About 15,000 skin burns are caused by alkaline agents each year in the United States. Alkaline agents are found in many common cleaning supplies used in homes.

The first few minutes after the skin comes into contact with an alkaline substance are the most important in managing the burn, Milner says. Once alkalis penetrate the skin, they react with fat in the skin and progressively kill the tissue.

The study found that vinegar and other weak acids neutralized alkalis more than 15 minutes faster than water alone. But Milner says people who suffer alkaline burns do need to wash the area off with water before they apply vinegar.

"I've had patients with such severe alkaline burns that they needed skin grafts to help repair the damage. Unfortunately, these types of burns happen much more often than we think. Through this study, we now know we may be able to reduce the severity, some of the pain and debilitating effects of alkaline burns," Milner says.

More information

Here's where you can learn more about different kinds of burns.

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Sleep Disorder Ups Risk of Heart Problem Recurrence

By Alison McCook
Reuters Health
Friday, May 30, 2003

NEW YORK (Reuters Health) - People who have a common heart-rhythm disorder may be more likely to experience a recurrence after treatment if they also have an untreated sleep disorder known as sleep apnea, new study findings suggest.

Researchers at the Mayo Clinic in Rochester, Minnesota, found that, among people treated for a heart rhythm irregularity known as atrial fibrillation, more than 8 out of 10 patients who also had untreated sleep apnea experienced a return of their atrial fibrillation within one year.

In contrast, only around 4 out of 10 people treated for atrial fibrillation who had sleep apnea but received treatment for the condition saw their heart rhythm problem return.

Atrial fibrillation is a relatively common form of arrhythmia. Although not the most deadly type of irregular heart rhythm, atrial fibrillation puts patients at risk of potentially life-threatening blood clots, due to the pool of blood that slowly gathers in the atria when those chambers become unable to contract regularly.

According to the report published in the American Heart Association (news - web sites)'s journal Circulation, approximately 50 percent of people treated for atrial fibrillation who were sleep apnea-free experienced a recurrence of their heart problem one year after treatment.

"If you've got sleep apnea and you've had atrial fibrillation in the past, chances are your risk of getting it again is higher," study author Dr. Virend K. Somers told Reuters Health.

Somers noted that both sleep apnea and atrial fibrillation can pose problems for the cardiovascular system, and having both conditions may be worse than having each alone.

Although this question has not yet been investigated, "it's likely that when you put them both together, the effects may at least be additive," he said.

Study participants with sleep apnea had the most common form of the condition, known as obstructive sleep apnea. This type of sleep apnea is caused by a collapse of the throat during sleep, leading to an interruption of breathing.

During the study, Somers and his team followed a group of patients who had been treated for atrial fibrillation for one year after treatment to determine if their arrhythmia recurred. Thirty-nine of the patients had obstructive sleep apnea, but only 12 were receiving appropriate treatment for the sleep disorder.

One year after treatment for atrial fibrillation, the researchers found that the heart arrhythmia had returned in 82 percent of patients with untreated sleep apnea, 42 percent of treated sleep apnea patients, and in one-half of a group of 79 patients without sleep apnea.

In an interview, Somers explained that there are many reasons why sleep apnea may increase the risk that atrial fibrillation will occur.

During episodes of sleep apnea, the body may not get enough oxygen, and this situation can stress the heart into developing an arrhythmia, Somers said. In addition, a sleep apnea episode often increases blood pressure and causes the body to release adrenaline-like substances, both of which can lead the heart to adopt an abnormal rhythm, he noted.

Many people have atrial fibrillation, Somers said. While it would be nice to know who among them has sleep apnea, as well, diagnosing the sleep disorder can be very expensive.

However, he suggested that doctors faced with a patient with atrial fibrillation who also has some common risk factors for sleep apnea -- such as obesity, loud snoring, and excessive daytime sleepiness -- should consider the possibility of an additional problem.

"These are signs there's a reasonable chance of coexisting sleep apnea," Somers said.

Source: Circulation 2003;107:2589-2594.

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Staving off a Second Stroke

HealthScoutNews
Friday, May 30, 2003

FRIDAY, May 30 (HealthScoutNews) -- Stroke is the third leading cause of death in the United States and the leading cause of debilitation, but there's a big gap between Americans' understanding of stroke and their efforts to prevent it.

That's the claim of a recent survey by the National Council on the Aging.

The survey found that although many Americans know people who have had a stroke are at increased risk of suffering another one, stroke survivors don't take all the possible steps to protect their health.

A third of all strokes are recurrent ones. Lifestyle changes and medications can help reduce the risk of recurrent strokes.

The telephone survey of 992 people found that 88 percent of respondents said they knew that someone who has had a stroke has an increased risk of having another one.

However, the survey found that many stroke survivors were not exercising regularly (32 percent), quitting smoking (19 percent) or watching their diet (18 percent), even though these simple steps are known to prevent a future stroke.

Medications can also reduce the risk of recurrent stroke. For example, some stroke patients are put on medications that prevent clotting. That helps reduce the risk of stroke.

After surviving a stroke, men have a 42 percent chance of having another one within five years. Women stroke survivors have a 24 percent chance of recurrent stroke over the same time period.

The survey also found many respondents incorrectly identified excessive stress (87 percent), overexertion while exercising (56 percent), dehydration (38 percent), asthma attacks (24 percent) and wearing constrictive clothing (16 percent) as risk factors for stroke.

Many also mistakenly said shortness of breath (53 percent) and heart palpitations (50 percent) were symptoms of stroke. Nearly two-thirds of the survey respondents couldn't identify the age range (age 65 and older) of those most affected by stroke.

More than 700,000 Americans suffer a stroke each year. That's one person every 45 seconds. About 168,000 Americans die from strokes each year.

More information

The National Council on Aging offers a stroke tip sheet.

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'Good' Bacteria May Thwart Allergies in Toddlers

By Keith Mulvihill
Reuters Health
Friday, May 30, 2003

NEW YORK (Reuters Health) - Giving soon-to-be mothers and newborns doses of "good" bacteria may help prevent childhood allergies up to age four, continuing research suggests.

The findings, a follow-up from a study that initially looked at allergies in newborns up to age two, may offer evidence that harmless bacteria can train infants' immune systems to resist allergic reactions, according to the report in the journal The Lancet.

In the ongoing study, researchers in Finland used a type of bacteria found naturally in the gut -- called Lactobacillus rhamnosus strain GG -- to try to prevent allergy development in at-risk infants.

Lactobacillus bacteria have long been used in food fermentation and are commonly found in items such as yogurt. Some forms of the bacterium dwell normally in the human intestines. Lactobacillus-laden foods and supplements -- commonly referred to as "probiotics" -- have grown increasingly popular because they are believed to promote good gastrointestinal health.

In the original study, Dr. Marko Kalliomaki and colleagues at Turku University Hospital gave a group of pregnant women either probiotic capsules or placebo capsules every day for a few weeks before their due dates. For 6 months after delivery, women who breast-fed continued on the probiotics or placebo, while bottle-fed infants were given probiotics or placebo directly. All of the babies were considered to be at high risk of developing allergies because a parent or sibling was affected.

Kalliomaki's team originally published results of the study when the children were two years old. Now, the researchers report that the youngsters in the probiotic supplement group were less likely at age 4 to have developed an allergic skin condition called atopic eczema.

"The main finding is that administration of probiotics (shortly before and after birth) may prevent the development of atopic eczema during the first 4 years of life in high-risk children," Kalliomaki told Reuters Health. Children at high risk, he said, are those whose mother, father or older sibling has asthma, atopic eczema or allergic rhinitis.

"The new finding is that the preventive potential of Lactobacillus GG may extend beyond infancy ... to the age of 4 years," the researcher added.

Probiotics have been shown to have favorable effects on the gut, according to Kalliomaki. Moreover these agents have clear effects on the developing immune system, he explained.

By the age of four years, 25 of 54 children in the placebo group had developed allergic eczema, a condition in which the skin becomes irritated, red and itchy. But just 14 of the 53 children who had received probiotics developed the skin condition -- a 43-percent reduction, according to report.

The study was funded by the Academy of Finland and Turku University Hospital.

Source: The Lancet 2003;361:1869-1870.

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Herb May Help Heal Herpes

HealthScoutNews
Friday, May 30, 2003

FRIDAY, May 30 (HealthScoutNews) -- A cream derived from the common herb called self-heal helps prevents herpes in laboratory animals, says a study by researchers at Dalhousie University in Nova Scotia.

The researchers extracted a lignin-carbohydrate compound from the self-heal plant (Prunella vulgaris) and put it in a cream they tested on mice and guinea pigs with experimental herpes simplex virus-1 (HSV-1) and herpes simplex virus-2 (HSV-2).

The guinea pigs receiving the cream had a significant reduction in the number of skin lesions compared to guinea pigs that received no treatment. Mice receiving the cream also had a much better survival rate than mice that didn't get the cream treatment.

"The anti-HSV compound form P. vulgaris is a novel lignin-carbohydrate complex with potent activity against HSV-1 and HSV-2 and has a different anti-herpes mechanism than acyclovir, the current clinical anti-herpes drug," researcher Song Lee says in a news release.

"Given the high incidence of herpes infection and the emergence of acyclovir-resistant strains of herpes viruses, the Prunella lignin-carbohydrate complex may prove to be a useful new anti-herpes drug," Lee says.

Self-heal is commonly found in North American, China, Europe and the British Isles.

The study was presented at the recent meeting of the American Society for Microbiology in Washington, D.C.

More information

Here's where you can learn more about herpes.

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Europeans Nations Failing Obese Patients Survey

By Patricia Reaney
Reuters  
Friday, May 30, 2003

HELSINKI (Reuters) - No country in Europe is providing a satisfactory level of care for obese patients, although an estimated 135 million people may need professional advice on how to lose weight, doctors said on Friday.

A survey of medical professionals in 24 countries presented at the 12th European Congress on Obesity revealed a lack of specialists to treat the growing number of obese patients in Europe and wide variations in the facilities provided for them.

The number of patients per obesity specialist ranged from 9,000 to 100,000 patients depending on the country.

"This is a massive problem throughout Europe," said Professor Vojtech Hainer of the European Association for the Study of Obesity (EASO).

Although family doctors, or general practitioners, are the first medical professionals people with weight problems usually consult, the survey said most of them had poor knowledge of obesity and some failed to recognize it as a disease.

"The care of obese patients is not very good in any country. There is a lack of knowledge about obesity among GPs, dietitians and psychologists and there are only minor reimbursements by insurance companies," Hainer said in an interview.

Only five European countries reimburse patients for weight-reducing drugs, which could cost 70 percent of a mean monthly salary in poorer countries like Romania and Bulgaria.

Hainer said that although the survey was conducted in Europe, he believes the situation is the same around the globe.

"There are no unique differences," he said. "We need educational systems in every country and for the long-term."

More than a billion adults worldwide are overweight or obese, according to the World Health Organization (news - web sites). About 10-20 percent of men and 10-25 percent of women in Europe are obese.

Being overweight increases the risk of illnesses such as heart disease, type 2 diabetes, high blood pressure, stroke and certain types of cancer. In some developed countries, where the problem is most serious, obesity accounts for an estimated seven percent of total health care costs.

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How Much Exercise?

HealthScoutNews
Friday, May 30, 2003

(HealthScoutNews) -- Ever wondered what the bare minimum is for exercising to stay healthy?

The Danish-language journal Ugeskrift For Laeger includes a report from Kobenhavns Universitet in Denmark, which recommends 30 minutes of moderate exercise each day. The researchers note that the exercise can be in the form of routine activities -- such as walking, cycling and gardening.

Not only that, but you don't have to exert yourself all at once. The 30-minutes a day can be divided into 5- to 10-minute segments, the report says.

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Side Effect Risk from Drug Higher in Epileptics

By Alison McCook
Reuters Health
Friday, May 30, 2003

NEW YORK (Reuters Health) - New research suggests that people with epilepsy who receive an anti-seizure drug may be more likely to experience certain side effects than patients with anxiety and dementia who are sometimes treated with the same medication.

The investigators found that, among people who received the drug levetiracetam (Keppra), feelings of depression, hostility, anxiety and nervousness appeared more commonly in people with epilepsy than in people with dementia or anxiety.

This finding "suggests that people with epilepsy have a higher rate of side effects than patients with disorders that you would expect to have these problems," study author Joyce A. Cramer of Yale University in Connecticut told Reuters Health.

Cramer noted that research suggests other anti-epilepsy drugs besides levetiracetam can also produce similar side effects in people with epilepsy.

She cautioned, however, that the rate of anxiety, depression and other similar side effects was very low, even in epileptics. Furthermore, for anyone who experiences these side effects, their doctor can often change the dose or tell them to stop taking the drug, she noted.

She said that any doctor who treats a patient with epilepsy is likely very careful, and probably needs to take no extra precautions when prescribing anti-seizure drugs to a patient with epilepsy than when offering the medications to other patients.

"What the data showed is that these things are very rare," Cramer said in an interview.

"I think the vast, vast majority of (epileptics) have no trouble starting any drug," Cramer said.

To obtain their findings, Cramer and her colleagues reviewed past studies that compared the effects of levetiracetam to a placebo in patients with epilepsy, anxiety and cognitive disorders -- primarily, dementia.

The current report, published in the journal Epilepsy and Behavior, includes information collected from 2,416 epilepsy patients, 1,510 people with an anxiety disorder and 719 people with cognitive disorders.

Pooling this data, Cramer and her team saw that between two and four percent of people with epilepsy reported feelings of depression, nervousness, hostility and anxiety, rates that exceeded those found in placebo-treated patients and patients with anxiety or cognitive disorders who received levetiracetam.

Cramer said that levetiracetam-treated epileptic patients also showed a slightly higher risk of psychotic or suicidal behaviors, but that the rates of these behaviors were very low.

In terms of why epileptics might experience more side effects, Cramer suggested that the brains of people with epilepsy might contain differences that allow medications to bring out certain side effects more strongly.

Epileptics "seem to be more sensitive to these drugs," she said.

The study was supported by UCB Pharma, which makes Keppra.

Source: Epilepsy and Behavior 2003.

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Goodbye, Flu Shots?

By Kathleen Doheny
HealthScoutNews Reporter
HealthScoutNews
Friday, May 30, 2003

FRIDAY, May 30 (HealthScoutNews) -- For all you needle phobics who hate to get your annual flu vaccine, how does the prospect of a once-in-a-lifetime shot sound?

A prototype vaccine developed by researchers at the Wistar Institute in Philadelphia, delivered not by injection but by nasal spray, worked well in animal studies. The researchers suspect it may prove effective for several flu seasons.

If further research bears fruit, there's a chance for the same kind of vaccine for humans, the scientists say.

Their approach was to target a protein within the flu virus that doesn't mutate as often as others.

"Current vaccines target two proteins [within the flu virus] that mutate frequently," says Laszlo Otvos Jr., an associate professor of chemistry at the Wistar Institute and a co-author of the report, published in the June 2 issue of Vaccine.

For that reason, public health officials are always faced with the problem of updating the vaccine so it will protect against the virus that's expected to be prevalent in an upcoming flu season.

But the Wistar researchers focused instead on the M2 protein, which is a more stable protein portion of influenza viruses that mutates less frequently.

The experimental vaccine includes an engineered peptide built by Otvos that mimics this M2 protein. The vaccine, in nasal spray form, was given to the mice twice. After they received it, a steep rise in antibodies to M2 was found in blood samples, and the mice resisted replication of the virus in their respiratory tracts.

Those mice that got the M2 protein had much less virus in their respiratory tracts than those who didn't get it, Otvos says.

The mice also had a more powerful antibody response to the engineered vaccine than to infections by the flu virus itself, the researchers found.

Every year, about 114,000 people in the United States are hospitalized with influenza, a viral respiratory infection, according to the U.S. Centers for Disease Control and Prevention (news - web sites) (CDC). About 20,000 people die because of it, most of them elderly. While the flu vaccine is not 100 percent effective, if you get a flu shot you're likely to be far less sick than without it, the CDC says.

Of the new vaccine, Dr. James C. King, a professor of pediatrics at the University of Maryland School of Medicine, says, "The idea is wonderful." His research focuses on live, intranasal vaccines.

"People have been talking for years about using some of the internal proteins [such as the M2] within the virus that don't mutate as fast" to make a vaccine, he says.

What makes the Wistar research exciting, King adds, is the scientists were not only able to make the mice's immune systems recognize the M2 protein pieces, but "the mice made antibodies and it also protected them from symptoms."

As exciting as the research is, King offers a caveat: "It's a good five to 10 years -- minimum -- before we'll see this in humans."

Otvos agrees it will take time to answer some important questions, such as: Are antibodies against M2 enough to protect you from the flu? Is the response long-term? Will subsequent flu strains have a mutated M2 structure?

If it all bears out, he says, the flu vaccine may become a once-in-a-lifetime preventive measure.

More information

For myths and facts on flu shots, see the U.S. Centers for Disease Control and Prevention's National Immunization Program. For information on the flu virus vaccine, check the U.S. Food and Drug Administration.

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Protein Could Slow Degenerative Brain Diseases

By Stephen Pincock
Reuters Health
Friday, May 30, 2003

LONDON (Reuters Health) - A type of protein that helps cells respond to heat, cold and other environmental stresses could one day be used to slow down degenerative brain diseases like Alzheimer's, Parkinson's and Huntington's, British researchers said on Friday.

Early research suggests that so-called heat shock proteins could also help against conditions such as motor neurone disease and stroke damage, said Professor Jacqueline de Belleroche from Imperial College London.

"At present, there is no cure for neuro-degenerative diseases, such as Alzheimer's and Parkinson's, but the discovery of the beneficial effects of this protein in the brain may provide us with a way to at least slow down the disease process," she said.

In the Journal of Biological Chemistry, de Belleroche and colleagues report that the naturally occurring heat shock protein Hsp27 was able to reduce brain cell death in animal experiments.

Mice engineered to have high levels of the protein throughout the brain, spinal cord and other tissues had lower rates of death and brain cell death after they were injected with a toxic substance that damages cells. The protective effect was seen in the hippocampus, a part of the brain affected by neurological diseases.

In earlier studies, the researchers achieved similar results when they injected Hsp27 directly into the brain.

"Although this is unlikely to provide a cure for neuro-degenerative disorders, it could be vital in slowing their progress," de Belleroche said. "Eventually it may be possible to use a drug to increase levels of Hsp27 in the brain which could be given to those suffering from neuro-degenerative diseases."

All cells contain a range of heat shock proteins and the proteins are produced in response to environmental stresses like heat, cold and low oxygen levels. Under normal conditions they act like "chaperones" to make sure a cell's proteins are in the right place and shape at the right time.

"It's one of the systems we think is a natural defense system," de Belleroche told Reuters Health. "We're looking at trying to boost the natural system and hopefully translate it into treatment."

The heat shock proteins might achieve their effects by stopping the buildup of solid structures or aggregates within brain cells, a process that characteristically triggers cell death in neuro-degenerative diseases, she said.

"What this and other heat shock proteins do ... is stop those insoluble aggregates (from) forming, and they help to re-fold the protein so it can arrest the process."

The next step is to pin-point exactly when the heat shock protein acts in the chain-reaction of events leading to cell death, and develop drugs to affect that process, she said.

"It's a line that we're hoping to pursue," de Belleroche said. "We're testing out a few compounds but we haven't got any results yet."

Source: Journal of Biological Chemistry 2003;278.

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Nursing Helps Undo Smoking's Damage to Baby

By K.L. Capozza
HealthScoutNews Reporter
HealthScoutNews
Friday, May 30, 2003

FRIDAY, May 30 (HealthScoutNews) -- Smoking during pregnancy has been shown to cause learning deficits in developing babies, but a new study suggests that breast-feeding may cancel out the negative impact of the mother's cigarette habit.

By age 9, children of smoking mothers perform at par with their classmates if they are breast-fed, according to the study by Dutch researchers at the University Hospital Groningen. However, babies of cigarette-smoking mothers tend to score poorly on standardized tests if they are bottle-fed.

"Babies are already being put in a compromised position when the mother smokes, and then to bottle-feed on top of that is like a double negative for the child," says Carol Huotari, manager of the Center for Breast-Feeding Information at La Leche League International.

Data for the study were culled from the experiences of 570 children born at one Dutch hospital between 1975 and 1978. Nine years after their birth, the children's scores on math, spelling and reading tests were collected by researchers and compared with information on the smoking and breast-feeding habits of their mothers.

To ensure that the mothers' self-reported feeding method was accurate, the team interviewed them at their time of discharge from the hospital, when their children were 9, and again when their children were 25.

The results support the new recommendations adopted by the American Academy of Pediatrics in 2001, which advise that smoking mothers should breast-feed because the benefit of nursing their child far outweighs the potential negative health effects of nicotine exposure through breast milk.

Nicotine is easily absorbed through lungs but is actually poorly transferred through the digestive system and mouth, causing babies to be only minimally exposed to the drug through breast milk, says Dr. Beth Lawrence, a professor of pediatrics and obstetrics at the University of Rochester School of Medicine.

The Dutch findings, published in the June issue of the Journal of Epidemiology and Community Health, do not provide any answers on how breast-feeding might protect infants from the cigarettes' impact.

One theory is that the long-chain polyunsaturated fatty acids found in breast milk promote brain development, say the authors.

"It's the fatty acids in human milk that enhance the brain development," agrees Huotari, which is why formula companies are now trying to harness the benefits of these unique fats by putting them in baby formula to make them more like mother's milk.

Another way that mother's milk might help an infant's cognitive development is through the nurturing act of breast-feeding itself, which may offer psychological benefits to the child, hypothesize the researchers.

But whatever the mechanism, one message is clear from the findings: Pregnant women who smoke should be encouraged to breast-feed their infants, says Lawrence.

"This suggests that for mothers who continue to smoke, it's better to breast-feed than not, and this study further confirms that," she says.

More information

Visit the American Academy of Pediatrics or the La Leche League International to get more information on breast-feeding.

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Mystery Fatigue Often Not Chronic Fatigue Syndrome

Reuters Health
Friday, May 30, 2003

LONDON (Reuters Health) - Two out of three people presenting to British family doctors with unexplained fatigue do not meet the criteria for chronic fatigue syndrome, but the condition still significantly affects their life, researchers said on Friday.

Medical researcher Lucy Darbishire and colleagues from Guy's, King's and St. Thomas's School of Medicine in London collected data from 22 general practices in and around London on patients with unexplained fatigue lasting more than six months.

Applying the U.S. Centers for Disease Control Prevention criteria for chronic fatigue syndrome, the researchers found that 69 percent of patients did not have the condition.

Several symptoms, including fatigue and distress, were higher in the chronic fatigue syndrome group. People with the condition were also more likely to be depressed and more than twice as likely to be unemployed, Darbishire and colleagues write in the June issue of the British Journal of General Practice.

Nevertheless, 11 out of 12 symptoms assessed by the researchers were reported by more than 60 percent of the patients who did not have chronic fatigue syndrome, although those symptoms were less severe, the researcher told Reuters Health.

"I don't think we really found a characteristic difference. It really looked as if everything was just more severe in the CFS group. It supports that theory, really, that it's just another end of the spectrum," she said.

"I think the take home message is to remember that there are these two-thirds of patients that present with fatigue that don't meet criteria for CFS because they don't seem as severe, but they do actually have quite distinct illness."

Chronic fatigue syndrome is characterized by a range of symptoms including fatigue, headache, sleep problems, muscle pain and difficulty concentrating.

Patients with the condition, which can strike suddenly, often experience a marked increase in symptoms after only minor bouts of exertion.

The cause of chronic fatigue syndrome is uncertain.

Source: British Journal of General Practice 2003;53:441-445.

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THURSDAY, MAY 29, 2003

Study Questions Popular Fertility Surgery for Men

By Adam Marcus
HealthScoutNews Reporter
HealthScoutNews
Thursday, May 29, 2003

THURSDAY, May 29 (HealthScoutNews) -- A much performed surgery to relieve tangled blood vessels in the testes isn't the fertility fix it's intended to be, new research shows.

The problem can raise the temperature of the scrotum by a couple of degrees, impairing normal sperm function. The procedure, called varicocele repair, is designed to restore healthy blood flow to the organs and bring their temperature down into the normal range. But the latest findings suggest that the operation doesn't deliver.

However, some experts say the latest research focused on versions of the technique -- the most common fertility operation among men in the United States -- that are now obsolete and which may in fact lower the odds of conception.

"I would expect many of these operations to make the patient worse," says Dr. Marc Goldstein, a urologist in New York City and an expert in varicocele repair.

Goldstein, a professor of reproductive medicine and urology at Weill Medical College of Cornell University, helped pioneer a less-invasive form of the surgery in the 1980s that he says has much better outcomes than the conventional approach.

Varicoceles (pronounced vahr-ih-co-seals) are the same as varicose veins in the legs. They occur in about 15 percent of men. Many have no fertility problems as a result, but the swollen veins are believed to play a role in as many as 40 percent of cases of impaired fertility (also known as subfertility). Some men with the problem have slower sperm with abnormal shapes that may have trouble fertilizing an egg.

Removing the offending vessels can correct these problems -- or so the theory goes.

In the new work, appearing in the May 31 issue of The Lancet, researchers in Holland and Canada analyzed seven earlier studies on varicocele repair conducted between 1979 and 2002. Compared with untreated men, those who had the operation were no more likely to conceive.

The researchers say the limited number of patients might have obscured small effects in various sub-groups of men. Still, they say, "varicocele repair does not seem to be an effective treatment for male or unexplained subfertility."

Dr. Joel Marmar, who invented the microsurgery form of varicocele repair, says the new study has deep flaws. Some included men whose varicoceles didn't meet more recent criteria for who is most eligible for the procedure, he says. And almost none of the previous trials had any information about the woman's age or the nature of her fertility problems, if any -- information that's vital when pregnancy is the desired outcome.

"With pregnancy you're introducing a totally different variable: the wife," says Marmar, a professor of urology at the Robert Wood Johnson Medical School in Camden, N.J.

More information

To find out about varicocele repair, try the Cornell Institute for Reproductive Medicine or LaGrange Memorial Hospital.

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Cell Phone Speakers in Front of Driver May Be Safer

By Keith Mulvihill
Reuters Health
Thursday, May 29, 2003

NEW YORK (Reuters Health) - Although chatting on a cell phone while driving ups the risk of an accident, new research suggests that cell phone speakers mounted in front of drivers may help them stay better focused.

That's because it's easier for people to look and listen at the same time when all the information is coming from the same direction, UK researchers say.

Recent concerns about the safety of driving while dialing and talking into hand-held cell phones have led some U.S. states to ban their use in moving vehicles. In response, millions of cellular users have made the switch to hands-free devices.

But studies also suggest that such hands-free technology may not reduce the risk of car accidents among chatty drivers -- suggesting that a driver's attention, rather than problems with physically handling a cell phone, is the more important factor in safe driving, according to the new report, published in the journal Psychological Science.

In the study, Drs. Charles Spence and Liliana Read had eight people "drive" in a simulator that mimicked driving on suburban and city roads. While they drove, they listened to a person's voice broadcast alternately from one of two loudspeakers placed in different positions -- in front of them and off to their side.

Participants were asked to repeat the words spoken to them.

The researchers found that overall, participants were able to repeat more words correctly when they were listening to the audio and not driving -- 77 percent versus 56 percent when driving.

But when the researchers compared the two different driving conditions, they found that participants correctly repeated 85 percent of the words when the speaker was in front of them, compared with 49 percent when the speaker was placed to the side.

According to the researchers, the brain might be better able to process visual and auditory information when both come from the same direction.

"By presenting the speaker from the direction in which drivers typically look -- straight ahead -- they will find it easier to combine talking and driving," Spence, a researcher at Oxford University, told Reuters Health in an e-mail.

"This could be achieved most simply by mounting the loudspeaker on top of the dashboard in front of driver, or else by use of transparent loudspeaker mounted on the (windshield) of the car," he said.

Still, Spence pointed out that "it is best not to use a mobile phone while driving."

"However," he added, "if you are going to use one, you can combine driving with talking on the mobile phone more safely if the person you are listening to speaks from directly in front of you --where you tend to look while driving-- and not from the side."

Source: Psychological Science 2003;14:251-256.

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Childhood Obesity Often Missed

HealthScoutNews
Thursday, May 29, 2003

THURSDAY, May 29 (HealthScoutNews) -- Despite the increased focus on childhood obesity in the United States, few doctors or other health-care professionals are diagnosing obesity and related health problems in young patients.

A Michigan State University study found that between 1997 and 2000, obesity was identified in fewer than 1 percent of children visiting a doctor's office or an urgent care center.

That's despite the fact that about 15 percent of American children aged 6 to 19, and almost 11 percent of preschool children, are considered obese. A child is defined as obese when her body mass index (BMI) is at the 95th percentile or above.

The study also found that only about 7 percent of obese children actually received a diagnosis of obesity. It also revealed that almost 20 percent of the children diagnosed as obese were younger than 5.

The findings were presented at the recent annual meeting of the Pediatric Academic Societies.

For their study, the researchers analyzed more than 45,000 ambulatory care visits by children aged 17 and under between 1997 and 2000. The data was provided by the National Center for Health Statistics.

Lack of time was the main reason that doctors and other health providers failed to diagnosis obesity in children, the researchers say.

"To address obesity in the office setting takes a little more time. In addition, we found that if a child was obese, the visit took longer than if the child was not," researcher Ihuoma U. Eneli, an assistant professor of pediatrics and human development, says in a news release.

Childhood obesity can lead to a number of health problems such as diabetes. And children who are obese tend to grow into obese adults. That's why it's important that obesity be diagnosed as early as possible.

More information

Here's where you can learn more about childhood obesity.

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European Initiative Launched to Tackle Obesity

By Patricia Reaney
Reuters
Thursday, May 29, 2003

HELSINKI (Reuters) - Medical experts launched a new initiative on Thursday to train doctors and nurses in Europe to cope with obesity, which afflicts at least 20 percent of adults.

Rates of obesity in Europe have doubled or tripled in some countries in recent years creating a serious public health problem because excess weight is a risk factor for heart disease, stroke, diabetes and certain cancers.

Obesity and related conditions are second only to smoking as a cause of preventable death.

"Wherever we go in Europe patients and people are desperate for help and it has become very clear that they have been missing out because doctors in Europe do not know how to tackle obesity," said Professor Philip James, the chairman of the International Obesity TaskForce (IOTF).

"We have decided to take a radical new step to try to cope with this problem," he told a medical conference in Finland.

The IOTF and the European Association for the Study of Obesity (EASO) are collaborating on a program called SCOPE which will identify obesity experts in Europe and provide training programs for doctors, nurses and pharmacists to improve treatments for obese patients.

"Most doctors are poorly prepared to manage obesity," said Professor Peter Kopelman of EASO.

SCOPE, or Specialist Certification of Obesity Professionals in Europe, will also provide guidelines on obesity management.

Obesity is measured by using body mass index (BMI), which is calculated by dividing weight in kilograms by height in meters squared. A BMI of 30 or more is considered obese.

The first pilot program to train family doctors in weight management will be held at the 12th European Congress on Obesity under way in Helsinki. About 1,700 doctors, nutritionists and researchers are attending the four-day meeting.

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New Ways to Treat Allergies

HealthScoutNews
Thursday, May 29, 2003

THURSDAY, May 29 (HealthScoutNews) -- Doctors need to educate patients about dangerous side effects such as sedation and impairment that can be caused by first-generation antihistamines, say new recommendations from an expert panel.

The panel recommendations conclude that allergies, including seasonal ones, should be treated with second-generation, non-impairing antihistamines instead of over-the-counter, first-generation antihistamines such as Benadryl.

Those older generation antihistamines are often dosed and selected inappropriately. That can lead to dangerous side effects such as sedation and impairment, which can increase the risk of injury, as well as reduced quality of life.

The panel's recommendations were developed at a recent consensus conference and appear in the May issue of the Journal of Allergy and Clinical Immunology.

Even though these first-generation antihistamines can cause impairment and sedation, the panel says that 47 percent of people with allergies take them. The panel says people with allergies need to avoid these first-generation medications and discuss the use of non-impairing antihistamines with their doctor.

More than 40 million Americans have allergies, but only 20 percent see a doctor for diagnosis and treatment of their symptoms. Allergy symptoms, if left untreated, can mask more serious chronic conditions such as asthma or sinusitis.

More information

Here's where you can learn more about allergies.

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New Drug Approach to Irritable Bowel Syndrome

By Maggie Fox, Health and Science Correspondent
Reuters
Thursday, May 29, 2003

WASHINGTON (Reuters) - A drug currently used to treat alcoholics and drug overdoses may also offer relief in a surprising quarter -- people with irritable bowel syndrome, corporate researchers said on Thursday.

A small trial of 50 patients with the painful disorder showed that three-quarters of them got relief from the drug, known best as naltrexone, the company said.

South San Francisco-based Pain Therapeutics Inc. said tiny doses of naltrexone, which is available generically, eased the bloating, pain, constipation and diarrhea that mark irritable bowel syndrome (IBS) in both men and women.

"Seventy-six percent of patients on our drug had a positive response," Remi Barbier, president and chief executive officer of Pain Therapeutics, said in a telephone interview.

One in five Americans has IBS, making it one of the most common disorders diagnosed, according to the National Institute of Diabetes and Digestive and Kidney Diseases. More common in women than in men, it is not a true disease and does not cause disease, but creates a great deal of discomfort and distress.

Barbier said judging the effectiveness of the drug is subjective. "It's like antidepression drugs or pain drugs -- yes, it is subjective, but believe me, the symptoms of IBS are so severe that if you are better, you know it," he said.

Two drugs are approved by the U.S. Food and Drug Administration (news - web sites) (FDA) to treat IBS -- GlaxoSmithKline's Lotronex and Novartis AG's Zelnorm. But they are only approved for women and for short-term use.

Experts also recommend stress-reduction and relaxation measures, such as meditation, walking, yoga and getting enough sleep, as IBS seems to be aggravated by stress.

Naltrexone, which Pain Therapeutics is testing under the name PTI-901, takes a new approach to treating IBS.

"The traditional view of IBS is that the flusher is broken -- it is either flushing too quickly or not quickly enough, causing diarrhea or constipation," Barbier said.

"We disagree with that point of view. We don't think the flusher is the problem. We think it is an imbalance of opioids in the gut. We provide the patient with an external source of opioid antagonists to restore bowel function."

The current, Phase II study was designed mostly to assess safety, and the company now plans to start a larger, Phase III efficacy trial -- the last step before seeking FDA approval.

"We believe a safe and effective drug to treat both men and women who suffer from IBS represents a $1 billion market opportunity in the United States alone," Barbier said.

Barbier said scientists working with his company stumbled on the opioid-IBS connection when they compared notes on patients who had overdosed on morphine or heroin, both opiate drugs.

"Patients who overdose on morphine lean over and hang on to their stomach," Barbier said. "The light bulb went on. Maybe opioid withdrawal and IBS are one and the same symptoms, which is an imbalance of opioids in the gut."

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Scientists Grow Insulin-Producing Liver Cells

By Amanda Gardner
HealthScoutNews Reporter
HealthScoutNews
Thursday, May 29, 2003

THURSDAY, May 29 (HealthScoutNews) -- Scientists have managed to "grow" insulin-producing cells from human liver cells, a feat that holds promise for treating -- or perhaps curing -- type 1 diabetes.

"For me, this is one of the most exciting things to come across in terms of a cure," says Dr. Henry Anhalt, director of the division of pediatric endocrinology at Infants and Children's Hospital of Brooklyn at Maimonides Medical Center.

"Taking care of kids with diabetes is all about the cure. No matter how good we do managing them, ultimately we can't do as good a job as a cell that is capable of sensing glucose and responding," adds Anhalt, who was not involved with the new research.

Those with type 1 diabetes -- formerly called juvenile-onset diabetes -- have an autoimmune disorder that destroys the insulin-producing beta cells of the pancreas. As a result, the body's ability to produce insulin, which is essential for transporting and storing glucose, or blood sugar, is shut down. There's no cure for the disease and patients have to manage their condition by injecting insulin before they eat.

For a longer-term solution, researchers are pursuing ways to get the body to start producing insulin again. One approach would be to transplant healthy beta cells, a nice idea but one that is hampered by the severe shortage of donated pancreases. As a substitute, scientists are looking for ways to actually create their own cells through, for example, genetic manipulation.

Scientists have already shown that inserting certain genes into liver cells prompted those cells to produce insulin. The liver and pancreas are closely related organs and come from the same type of cell during embryonic development.

In the new study, the researchers used fetal human progenitor liver cells (FH), a type of stem cell obtained from fetuses that had been aborted due to medical necessity. The cells were "precursor" cells, meaning they were on their way to becoming a specific type of cell -- in this case liver cells -- but had not fully developed yet.

The researchers first added a gene called pdx-1, which is essential for beta cell development. Once the gene was inserted into the liver cells, it caused the cells to switch on other genes that are normally found in pancreatic beta cells. The gene then prompted the liver cells to secrete insulin in response to glucose.

To produce large quantities of the cells, the researchers "immortalized" them by inserting a gene for telomerase, which repairs the ends of chromosomes and prevents chromosomes from shortening and being unable to divide.

When the cells were transplanted into diabetic mice, the cells brought blood-sugar levels down within the normal range and kept them there for several months.

"There's been a lot of interest in trying to use stem cells to make a variety of mature products, one of which is insulin-producing cells to treat diabetes," says the study's co-author, Dr. Norman Fleischer, director of endocrinology and co-director of the Diabetes Research Center at the Albert Einstein College of Medicine in New York City.

"Here we are taking cells that are much further along. They're already differentiated and are on their way to becoming [liver cells]," he says.

"Other people have shown that you could get some expression of insulin in [liver cells]... but what's new here is combining a developing cell line which, because it has been expressing two genes, made it develop into a functional cell line," Fleischer adds. "It took on a number of characteristics of beta cells, including the production of insulin."

Part of the excitement surrounding the discovery, which appeared in a recent online edition of the Proceedings of the National Academy of Sciences (news - web sites), lies in the fact that the cells actually work within a "context." In other words, they respond to glucose within a living creature. "Being able to insert genes into strange cells and make them make insulin is incredible," Anhalt says.

One big advantage of this technique is that the cells used are human ones. Also, the "immortalization" procedure didn't lead to the development of tumors, which has happened in other cases of genetic engineering with mice. Finally, the liver cells had a higher insulin content than cells produced in different ways, the researchers say.

One big disadvantage is that the research is still in its early stages. "It's not the first time somebody has found cells to correct diabetes in mice," Fleischer says. "[But] there's a long way to go before these are available. This is just a beginning."

Another potential drawback is a political one. "The biggest fear is that these [liver cells] are obtained through 'medically necessary abortions,' " Anhalt points out. "That's the political hot potato that's going to make a difference as to whether the technology blossoms."

More information

For more on type 1 diabetes, visit the Juvenile Diabetes Research Foundation or the American Diabetes Association.

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Chronic Headaches May Predict Men's Stroke Risk

Reuters Health
Thursday, May 29, 2003

NEW YORK (Reuters Health) - Men who suffer from chronic headaches may be at increased risk of having a stroke, Finnish researchers report.

They say that chronic headaches could be a marker for the underlying disease process that leads to stroke.

In the study, Dr. Pekka Jousilahti of the University of Helsinki followed more than 35,000 Finnish men and women for up to 23 years and compared self-reports of headache at the start of the study with rates of first-time stroke during the follow-up.

One year into the study, the researchers found, men with chronic headaches -- defined as those who said they suffered headaches "often" -- were four times more likely to have a stroke compared with men without headaches.

As time went on, though, the stroke risk tied to chronic headache declined, according to the report in the Archives of Internal Medicine (news - web sites). Five years into the study, men with chronic headaches were less than twice as likely as those with no headaches complaints to suffer a stroke.

Among women, who reported chronic headaches at nearly twice the rate of men -- 17 percent, versus nine percent -- there was only a "weak" relationship between headache and stroke risk, the researchers report.

According to the researchers, the association between chronic headache and stroke in men may, in part, be related to vascular damage caused by artery disease. Besides raising the risk of stroke, diseased, inflamed arteries might irritate sensitive nerves, leading to headache.

A limitation of the study, however, is that participants were not asked about symptoms of migraine, but only unspecified symptoms of headache, according to the researchers.

Previous studies have implicated migraine headaches in stroke risk.

"Thus we cannot estimate the proportion of stroke risk observed with headache that might be due to migraine," the authors note.

But the new findings do confirm those observed in another study conducted in the United States, according to Dr. Marc Fisher of the University of Massachusetts Medical School in Worcester.

"These two studies raise the intriguing likelihood that headache in general is associated with an increased stroke risk," he writes in an accompanying editorial.

"What remains uncertain is the explanation for this increased risk," Fisher adds.

He notes that the "most likely explanation" is that chronic headaches and stroke share a common underlying disorder.

But, he concludes, this and other possibilities "will need to be explored in further studies that carefully evaluate the type of headache patients have, (co-existing) conditions and medications consumed."

Source: Archive of Internal Medicine 2003;163:1005,1058-1062.

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Bacteria Beats Eczema

By Serena Gordon
HealthScoutNews Reporter
HealthScoutNews
Thursday, May 29, 2003

THURSDAY, May 29 (HealthScoutNews) -- Probiotics, bacteria thought to be beneficial to your health, may stop kids from getting eczema when given during pregnancy and early infancy.

In a Finnish study appearing in the May 31 issue of The Lancet, researchers conclude that children exposed to probiotics before birth were 40 percent less likely to have eczema, an allergic skin disease. They didn't lessen the chances of developing allergies or asthma, however.

"Early modification of the immune system by probiotics may have a preventive effect on the development of atopic eczema, at least in high-risk children," says study author Dr. Marko Kalliomaki, a resident in pediatrics at Turku University Central Hospital in Turku, Finland.

The findings add another piece to support the "hygiene hypothesis" in the ongoing debate about what is causing the rise in allergic diseases such as asthma and eczema. The hygiene hypothesis is a theory, originally proposed about 10 years ago, that blames the increase in allergic disease on cleaner living. Because children's bodies don't have to fight off as many bacteria as they did in the past, their immune systems start mistakenly attacking harmless substances, such as pet dander or pollen, causing allergic diseases.

For this study, the researchers hoped that if they introduced a "good" bacteria, they could stimulate the immune system properly and lessen allergic reactions.

Kalliomaki and his colleagues recruited 159 mothers-to-be in Turku for the study. All of the women had a personal or family history of asthma, allergies or eczema.

Beginning two to four weeks before delivery, the mothers were randomly assigned to take either two capsules containing the probiotic Lactobacillus rhamnosus GG or two capsules of a placebo daily until their babies were 6 months old if they were breast-feeding. Babies who weren't breast-fed were given the contents of the capsules mixed with water until they were 6 months old.

The researchers saw the children again at 2 and 4 years of age to look for signs of allergic disease. One hundred and seven children completed the full four years.

Of those, 14 out of 53 who received probiotic treatment were diagnosed with eczema, compared to 25 out of 54 children who had received a placebo.

"Early probiotic supplementation may have profound and long-lasting effects on the development of eczema," Kalliomaki says.

There was no significant difference between the groups when it came to the development of asthma and allergies, however.

Dr. Michael Wasserman, a pediatrician at Ochsner for Children in New Orleans, says this study provides "fairly good statistical evidence that the early introduction of Lactobacillus has some benefit."

But he cautions that probiotics have not been well studied in children. Though there don't appear to be any side effects from the treatment, he says safety can't be assumed, especially because this study was done on a small and relatively homogenous group of people.

The probiotic treatment used in this study looks "promising and safe," Wasserman says, but he adds there needs to be a larger study done confirming the benefits and safety.

Wasserman recommends talking with your health-care provider before making any major changes in your child's diet.

"Just because something is natural doesn't mean it's safe. Remember, arsenic and cyanide are natural," Wasserman says.

More information

To learn more about probiotics, visit the American Dietetic Association. For more information on eczema, read this article from the American Academy of Pediatrics.

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Study: Laziness Makes for Dangerous Fat

Reuters
Thursday, May 29, 2003

WASHINGTON (Reuters) - Everyone knows that lazing around can lead to a growing potbelly, but U.S. researchers say that couch potatoes build up dangerous pockets of fat more quickly than anyone thought.

But the good news -- or perhaps the bad news -- is that vigorous exercise can take it off pretty quickly, the team at Duke University in North Carolina reported Wednesday.

The team of experts looked at visceral fat -- that hidden flab tucked in among the organs. It is often invisible, but unlike an obvious paunch or heavy thighs, it is linked with insulin resistance -- pre-diabetes -- and heart disease.

Speaking to a meeting of the American College of Sports Medicine in San Francisco, Cris Slentz said he was surprised at how rapidly fat accumulated deep in the abdomens of patients who did not exercise.

Volunteers who did no exercise had an 8.6 percent increase in visceral fat after eight months, while those who exercised the most lost 8.1 percent of their visceral fat, Slentz said.

"The results of our investigation show that in sedentary overweight adults, who continue to choose a sedentary lifestyle, the detrimental effects are worse and more rapid than we previously thought," Slentz said in a statement.

"We probably should not have been surprised since this simply mirrors the increasingly rapid rise in obesity prevalence seen in the U.S., where at present two out of three adults are overweight or obese."

Women gained fat twice as quickly as the men did, Slentz said.

Exercise takes the fat away quickly, but it has to be pretty vigorous, Slentz and colleagues found.

"Participants who exercised at a level equivalent to 17 miles of jogging each week saw significant declines in visceral fat, subcutaneous abdominal fat and total abdominal fat," Slentz said.

"While this may seem like a lot of exercise, our previously sedentary and overweight subjects were quite capable of doing this amount."

They studied 170 volunteers, putting them into four groups who got no exercise, small amounts of moderate exercise equivalent to walking 11 miles a week, low amounts of vigorous exercise equivalent to jogging 11 miles a week and a lot of vigorous exercise equivalent to jogging 17 miles a week.

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Does Adult Diabetes Trace Back to the Womb?

By Ed Edelson
HealthScoutNews Reporter
HealthScoutNews
Thursday, May 29, 2003

THURSDAY, May 29 (HealthScoutNews) -- The seeds of adult diabetes may sometimes be sown in the womb, a new French study suggests.

The link is far from certain, the researchers stress. However, their small study found that adult children of mothers with type 1 diabetes, in which the body produces no insulin, show a weakened response to sugar that could be a precursor of type 2 diabetes. Type 2 is the kind of diabetes that often develops in adulthood due to poor nutrition and lack of exercise, says the report in the May 31 issue of The Lancet.

"We are writing a proposal to follow a larger sample of children born to mothers with type 1 diabetes to see if they develop type 2 diabetes," says study author Dr. Eugene Sobngwi, a diabetes specialist at Saint-Louis Hopital in Paris.

It's not genetics, but something in the environment of the womb that might be responsible, the researchers say. They demonstrated that point in an ingenious way: the control group they used consisted of people whose fathers had type 1 diabetes.

"The main endpoint in our study was insulin secretion," Sobngwi says. "Twenty percent of the children born to mothers with type 1 diabetes had glucose intolerance, but none of the offspring of fathers with type 1 did."

Glucose intolerance is caused by inadequate production of insulin in response to sugar in the bloodstream. A glucose tolerance test can be used to diagnose type 2 diabetes or whether people are at risk for the disease.

When that test was given to 15 adults whose mothers had had type 1 diabetes during pregnancy, five of them showed glucose intolerance. But none of the 16 offspring of fathers with type 1 diabetes did, the researchers say.

Both genetic and environmental factors are known to contribute to the onset of type 2 diabetes. What happens in the womb could be one of those environmental factors, Sobngwi says.

There could be an effect on the parasympathetic nervous system, which regulates the activity of fetal organs, including the pancreas, which produces insulin, the researchers speculate.

Dr. Richard Jackson, an assistant professor of medicine at Harvard Medical School (news - web sites)'s Joslin Diabetes Center, calls the new theory "interesting," but he remains unconvinced.

What Jackson does find significant is that none of the people tested showed a decrease in insulin sensitivity, another significant warning sign for diabetes risk. "If what they are saying is true, you would expect that to show up," Jackson says.

Epidemiological studies haven't found a link between type 1 and type 2 diabetes, Jackson says, but those studies have not looked at the kind of relationship proposed by the French study.

And while children of mothers with type 1 diabetes are at greater risk of type 1, that risk does not depend on whether the mother's diabetes was diagnosed before or after the pregnancy, he says.

More information

To learn more about diabetes, visit the Joslin Diabetes Center or the American Diabetes Association.

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Obesity Epidemic Set to Get Worse

By Patricia Reaney
Reuters
Thursday, May 29, 2003

HELSINKI (Reuters) - Obesity has spiraled into a worldwide epidemic affecting 250 million adults but a leading nutritional expert believes the worst is still to come.

Overweight adolescents are on course to fuel an even bigger global health problem as they mature into obese adults, he says.

"The younger generation, the generation after us, will be even more obese than we are, which doesn't make the future look very promising," Dr. Mikael Fogelholm said in an interview.

The chairman of the 12th European Congress on Obesity, which begins in Helsinki on Thursday, said the prevalence of obesity among adolescents has increased more rapidly than among the middle-aged population.

"We can't expect that the present generation will die and we will have a lean generation," added Dr. Fogelholm, who is also the director of the independent UKK Institute for Health Promotion Research in Finland.

A steady, and in some cases life-long, diet of high-fat fast foods and idle hours in front of the television and computer, has taken its toll on children.

"Most obese adults now had not been obese children," Fogelholm said. "They obtained their extra kilos (pounds) after they were 25 or 30 years old. But now we have more and more people who are already obese at the age of 10, 15 or 20.

"If the trend goes on, the future doesn't look better. It looks worse unless we can find a way to prevent obesity."

Along with expanding waistlines, being overweight or obese increases the risk of type 2 diabetes, heart disease, stroke and certain cancer. In the United States, where over half of the adult population is obese or overweight, obesity costs about $93 billion a year in medical expenses.

Elsewhere obesity rates range from two percent in some developing countries, to 80 percent on remote Pacific Islands and about 20 percent in Western countries.

Fogelholm believes the solution to the problem must begin with changes that encourage people, and particularly youngsters, to get more exercise and to make healthy food choices. But he stressed that must include changes in how city centers are planned, how food is marketed and the sizes of portions in which it is served.

Ministries of transport, environment and education should be involved in health policies, he added.

"It's a complex phenomenon especially from a behavioral viewpoint," he said.

"If you think of smoking -- people either smoke or they don't smoke. But everyone has to eat and what they eat, how much and the amount of exercise they get make weight control a very complex behavior."

About 1,500 doctors, nutritionists, researchers and geneticists are attending the conference which runs to June 1.

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A Dose of Their Own Medicine

HealthScoutNews
Thursday, May 29, 2003

(HealthScoutNews) -- "Take this medication exactly as prescribed."

That sort of warning accompanies most prescriptions, but it seems that even doctors themselves ignore it some of the time.

According to the Southern Medical Journal, doctors are more compliant than the average patient. But they're still not perfect.

Researchers at New York Medical College in Valhalla, N.Y., surveyed 301 physicians and nurses on the way they comply with instructions on taking medication.

For short-term drugs like antibiotics, the adherence rate was about 77 percent. And for long-term medications, such as those for high blood pressure or high cholesterol, the rate was 84 percent.

Older physicians and nurses are better at taking medications than younger ones, and everyone fares better with medications that require one or two doses a day than with drugs that need three or four daily doses, the survey found.

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WEDNESDAY, MAY 28, 2003

Smoking Speeds Up Memory Loss in Middle Age

By Alison McCook
Reuters Health
Wednesday, May 28, 2003

NEW YORK (Reuters Health) - Cigarette smokers who continue the habit through middle age may see their memory suffer as a result, according to new study findings released Wednesday.

UK researchers found that, from their 40s to their 50s, smokers showed a faster decline in their scores on tests of word memory, relative to non-smokers.

Furthermore, people who smoked in their 40s did worse on tests that measure how fast they could pick out certain letters from a page than non-smokers of the same age, the authors write in the American Journal of Public Health.

The relationship between smoking and memory loss appeared strongest in people who smoked more than 20 cigarettes each day, and persisted even when the authors controlled for the influence of socioeconomic status, gender and a range of medical conditions.

Just why smoking may speed up age-related memory loss is not yet clear, study author Dr. Marcus Richards of University College London told Reuters Health.

He said that he and his colleagues suspected that smoking may accelerate memory loss by increasing the risk of high blood pressure, which can damage the brain. However, the relationship between smoking and brain functioning may be slightly more complicated, Richards said.

"Our results for memory still held up after taking blood pressure into account, but smoking could have been causing changes in the brain's blood supply that we were not able to measure," he said.

Alternatively, chemicals in cigarette smoke could also damage the brain directly, Richards added.

Whatever the reasons for why smoking accelerates memory loss, the message from these results should be clear, Richards said.

"This is yet another reason to quit smoking," he said. "If you can't, then cut down as much as you can."

During the study, Richards and his team reviewed information collected from 5,362 people born in 1946. Study participants were contacted 21 times by the time they turned 53.

Researchers measured people's mental functioning via a series of tests. In one test, which looked at verbal memory, the investigators showed people 15 words for two seconds each, then asked them to write down as many as they could remember.

During tests of speed and concentration, people had to look for and cross out as many Ps and Ws they could find in a page of other letters within one minute.

Although smokers in their 40s performed just as well as non-smokers in the verbal memory tests, puffers' performance deteriorated much faster from their 40s to their 50s.

And people who said they smoked while in their 40s scored worse during speed tests conducted in their 40s than non-smokers.

But the findings also suggest that quitting may help, for the researchers discovered that people who stopped smoking before age 53, and especially those who stopped before age 43, tended to exhibit a slower decline in memory.

"Our results suggest that quitting may slow down the negative impact of smoking on cognitive function," Richards said.

Source: American Journal of Public Health 2003;93.

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'Rapid Detox' Breaks Drug Habits Quickly

By Jennifer Thomas
HealthScoutNews Reporter
HealthScoutNews
Wednesday, May 28, 2003

WEDNESDAY, May 28 (HealthScoutNews) -- Errol Dodson's drug addiction began with a prescription for Vicodin to help treat pain in his shoulder, knees, ankles and ribs caused by weightlifting and wrestling injuries.

A few years later, Dodson realized he was hooked. He was spending $400 a week buying Vicodin, Lortabs and OxyContin on the black market. In the morning, he felt like he had the flu until he popped a pill.

"I hated myself for letting this happen," says the 33-year-old industrial mechanic from Greenwood, Ind. "I was so ashamed. I was isolating myself from friends and family. I knew I had to get help."

Dodson checked himself into a two-week drug detoxification center. A few days after getting out, he gave into his cravings and started taking the painkillers again.

In February, Dodson decided to try a new and controversial drug treatment called "rapid detox," which promises to get you through drug withdrawal in a mere 48 hours. It also promises far less pain and discomfort because you're under general anesthesia during the worst of it.

Rapid detox is touted as a way to kick opiates, including heroin, morphine and methadone, as well as opiate prescription painkillers such as OxyContin, Percocet, Vicodin and Lortabs. Practitioners estimate there are about a dozen rapid detox centers around the country.

"I have detoxed attorneys and doctors on a Friday and they are back at work on a Monday and seeing patients or clients on Tuesday," says Dr. Rick Sponaugle, chief of anesthesiology at Helen Ellis Memorial Hospital in Tarpon Springs, Fla. and director of Florida Detox, located in the hospital. "We take them through the detox in a more humane way and what I believe is a less dangerous way."

While advocates say the procedure is highly effective, skeptics caution that little research has been done comparing the effectiveness of rapid detox versus traditional methods.

Critics also point out the high costs of the procedure -- Dodson paid about $10,000 -- which is not covered by most insurance companies, and the risk posed by general anesthesia.

"Rapid detox is providing a service which has some dangers, so it's kind of hard to justify something that is so expensive," says Dr. Michael Miller, medical director of the NewStart Program at Meriter Hospital Program in Madison, Wisc.

Here's how rapid detox works:

At Florida Detox, the patient is admitted into the hospital, where they undergo psychological testing and a urine test to determine what drugs are in their system.

The client is then given general anesthesia for about three hours, during which time he or she is given a dose of Naltrexone, a non-addictive drug.

When a person takes opiates, the drug attaches to receptors in the brain, leading to the feeling of being "high." Naltrexone, known as a narcotic antagonist, blocks the opiates from attaching to receptors.

Patients are then given a sedative intravenously to help them sleep through the night. By the following afternoon, they are usually ready to go home, though Sponaugle often keeps them in the hospital for another day.

After the detox, patients continue to take Naltrexone tablets daily for several weeks to two years. Sponaugle highly recommends that patients get involved with a 12-Step program or other therapy to help them remain drug-free.

"Ongoing psychological treatment is so important," he says. "Unless they receive that spiritual healing, they will probably relapse."

During the six years Florida Detox has been in business, Sponaugle has detoxed about 400 patients. According to company information, about 75 percent of patients stay drug-free for six months. About 50 percent to 60 percent stay clean for one year or more.

After the rapid detox, Dodson, like other patients, felt somewhat achy and nauseous, but the withdrawal symptoms weren't nearly as severe as in traditional detox.

In traditional detox, a drug addict often has to endure two to 10 days of abdominal pain, tremors, vomiting and severe muscle aches that comes with drug withdrawal.

Dodson recalled two weeks of sheer agony. "It was a horrible experience," he says. "It felt like snakes were trying to crawl out of my body. I had uncontrollable leg movement. I couldn't get out of bed."

Miller, secretary of the American Society of Addiction Medicine, says that not every addict undergoes so much discomfort. There are new drugs to take the edge off during ordinary detox -- drugs that cost significantly less and are less risky than Naltrexone.

Naltrexone has been known to cause side-effects including delirium and confusion in some people. And there is always some risk when a person is put under general anesthesia.

But Miller says is the more important issue is not the detox method, but what kind of treatment people are able to access afterwards to help them stay off drugs.

"Detox is only the first step, and detox in and of itself resolves no cases of addiction," he says. "The controversies which surround rapid detoxification methods miss the basic point, that regardless of the method of detoxification used, patients with opiate dependence face great challenges, and they need to have their addiction treated not simply their withdrawal treated."

After two days in Florida, Dodson returned home to Indiana feeling more hopeful than ever. Since he had the procedure done in early February, he says he's had no desire to take drugs.

Sponaugle says he would like to eventually wean him off the Naltrexone, because the drug interferes with the ability to experience a "natural" high from the body's own endorphins.

"If you have the willingness to put the drugs behind you and bury it, then rapid detox will work for you," Dodson says. "Rapid detox saved my life."

More information

To learn more about drug addiction, visit the National Institute on Drug Abuse. Read more about Naltrexone by clicking here.

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To Psychopathic Murderers, Violence Is Not So Bad

By Alison McCook
Reuters Health
Wednesday, May 28, 2003

NEW YORK (Reuters Health) - Psychopaths who have committed murder do not equate violence with something that is unpleasant, UK researchers said Wednesday.

This relatively positive attitude toward violence was not seen in either murderers who were not psychopaths or other men with personality disorders who had committed different crimes, the authors write in the journal Nature.

Psychopaths, despite evidence of charm and skill, are commonly unable to maintain affectionate relationships with others, while routinely engaging in impulsive, amoral and hostile behavior unhampered by guilt.

And while psychopaths who commit murder may often claim to think violence is wrong, the current findings stem from the results of tests designed to measure people's underlying attitudes toward a concept, and not simply what they say they believe, the researchers note.

Indeed, the test, known as the Implicit Association Test, has also been used by researchers to identify test-takers' hidden prejudices.

Although psychopaths' relatively positive attitude toward violence could either cause or result from repeated acts of violence, study author Dr. Robert Snowden of Cardiff University said some research supports the former.

As a result, Snowden said that it might one day be possible to use a similar -- and much more developed -- test to predict whether a person is likely to commit crimes, such as when evaluating offenders who are up for parole.

Researchers could also use the test to try to understand a person's motives for committing a violent act, and determine whether treatment programs have helped criminals change their attitudes toward crimes, Snowden added.

Snowden and his colleagues administered the Implicit Association Test to 121 male criminals who were admitted to a secure, therapeutic facility. The group included 13 psychopathic murderers, 17 murderers who were not psychopaths, and 39 psychopaths who had not committed murder and 52 non-psychopathic men who had committed other types of crimes.

During the test, the men were shown an all-uppercase word (such as "UGLY") on a screen, and were asked to press a button marked either "unpleasant" or "pleasant," according to which best described the word.

In one scenario, the button marked "unpleasant" also contained the word "violent," and the "pleasant" button also read "peaceful." In another scenario, "violent" and "peaceful" switched buttons.

When test-takers were shown a lowercase word on the screen (such as "kill"), they were asked to indicate whether the word is more violent or peaceful, rather than whether it was pleasant or not.

Normally, when shown a word on the screen, people take longer to figure out which button to press when non-related words -- such as "violent" and "pleasant" -- are on the same button, Snowden said.

However, psychopathic murderers responded differently, and completed the test "as if they do not associate violence and unpleasant," Snowden said.

Snowden said that he would expect to find the same results in psychopathic women. However, most psychopaths are men, and research into psychopathology tends to focus on men, so he added that he couldn't say for sure if the results apply to both sexes.

Although the test used in the current study could offer great benefits to law enforcement, the researcher cautioned that it is not yet ready for prime time.

"We must emphasize that this is the very first study of its kind, and much more research needs to be completed before (the test) could be used for any real-life purpose," Snowden said.

Source: Nature 2003;423:497-498.

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Laziness Makes for Dangerous Fat - U.S. Study

Reuters
Wednesday, May 28, 2003

WASHINGTON (Reuters) - Everyone knows that lazing around can lead to a growing potbelly, but U.S. researchers said Wednesday that couch potatoes build up dangerous pockets of fat more quickly than anyone thought.

But the good news -- or perhaps the bad news -- is that vigorous exercise can take it off pretty quickly, the team at Duke University in North Carolina reported.

The team of experts looked at visceral fat -- that hidden flab tucked in among the organs. It is often invisible, but unlike an obvious paunch or heavy thighs, it is linked with insulin resistance -- pre-diabetes -- and heart disease.

Speaking to a meeting of the American College of Sports Medicine in San Francisco, Cris Slentz said he was surprised at how rapidly fat accumulated deep in the abdomens of patients who did not exercise.

Volunteers who did no exercise had an 8.6 percent increase in visceral fat after eight months, while those who exercised the most lost 8.1 percent of their visceral fat, Slentz said.

"The results of our investigation show that in sedentary overweight adults, who continue to choose a sedentary lifestyle, the detrimental effects are worse and more rapid than we previously thought," Slentz said in a statement.

"We probably should not have been surprised since this simply mirrors the increasingly rapid rise in obesity prevalence seen in the U.S., where at present two out of three adults are overweight or obese."

Women gained fat twice as quickly as the men did, Slentz said.

Exercise takes the fat away quickly, but it has to be pretty vigorous, Slentz and colleagues found.

"Participants who exercised at a level equivalent to 17 miles of jogging each week saw significant declines in visceral fat, subcutaneous abdominal fat and total abdominal fat," Slentz said.

"While this may seem like a lot of exercise, our previously sedentary and overweight subjects were quite capable of doing this amount."

They studied 170 volunteers, putting them into four groups who got no exercise, small amounts of moderate exercise equivalent to walking 11 miles a week, low amounts of vigorous exercise equivalent to jogging 11 miles a week and a lot of vigorous exercise equivalent to jogging 17 miles a week.

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Angry Children Hurt Their Heart Health

HealthScoutNews
Wednesday, May 28, 2003

WEDNESDAY, May 28 (HealthScoutNews) -- Hostile children may end up aggravating their health, says a new U.S.-Finnish study.

The study by University of Pittsburgh and University of Helsinki researchers found children and adolescents who respond with anger to life events have a greater risk of developing metabolic syndrome, a precursor to heart disease.

Indications of metabolic syndrome include high blood pressure, weight gain, insulin resistance and elevated cholesterol levels.

The researchers examined hostility levels and cardiovascular risk in 134 American children aged 8 to 10 and 15 to 17. They found children who had high scores on hostility tests were more likely to exhibit metabolic syndrome three years later than children who didn't have high hostility scores.

Obesity and insulin resistance were the two highest risk factors found in hostile children in the follow-up, the study says.

Unhealthy lifestyles such as physical inactivity, poor diet, smoking and alcohol use can be a way that hostile children and adolescents cope, behavior that can contribute to development of metabolic syndrome, the authors suggest in the May issue of Health Psychology.

They say the study findings could be used to evaluate youngsters' behavioral risk to developing these potential health problems.

"There is a need for interventions designed to reduce hostility in young people to prevent the precursors to cardiovascular disease, like obesity or type 2 diabetes, which has become a huge health problem in children in the U.S.," researcher Karen A. Matthews says in a news release.

More information

Here's where you can find advice for teens on dealing with anger.

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Breast Feeding May Counter Maternal Smoking Harm

Reuters
Wednesday, May 28, 2003

LONDON (Reuters) - Breast feeding may counter the harmful affects that smoking during pregnancy can cause to a baby's development, Dutch researchers said Thursday.

Scientists at the University of Groningen in the Netherlands studied school results of 570 nine-year-old children who had been born in a Dutch hospital between 1975 and 1978 and whose mother had smoked during the pregnancy.

They found that only children who had been bottle-fed performed poorly on the school tests.

"Our results indicate that negative effects of maternal smoking on children's cognitive performance were limited to those who had not been breast fed," Dr Laura Batstra said in a report in the Journal of Epidemiology and Community Health.

Batstra and her colleagues said psychological or other factors could be involved but suggested that ingredients in breast milk may promote brain development and counteract the negative effects of maternal smoking.

"This notion has important practical implications, especially for nicotine-addicted future mothers," Batstra said.

"Apart from helping these mothers to stop or diminish their tobacco consumption, they should be encouraged to breast feed," she added.

Medical studies have shown that breast feeding offers tremendous benefits for babies. It reduces their risk of ear infections, allergies, vomiting and diarrhea .

Norwegian scientists have also found a positive association between the duration of breast feeding and the child's mental development. The longer the child was breast fed, the greater the benefit, even after adjusting for maternal age, education, intelligence and smoking at the time of conception.

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No Java Cold Turkey

HealthScoutNews
Wednesday, May 28, 2003

(HealthScoutNews) -- You could see this one coming.

Caffeine seems to be the in stimulant these days. But if you decide to cut your caffeine intake, there's a period of withdrawal -- and it can feel awful.

That's the official word from researchers at the Royal Bournemouth Hospital in Dorset, United Kingdom, who studied caffeine withdrawal in 11 women, and published the research in Pharmacology and Biochemistry of Behavior.

The women, all suffering from caffeine deprivation, were given a candy bar and a diet soda. Some got a regular diet cola, while others got a caffeine-free dose. Then they were asked how they felt.

As you'd expect, the ones who drank the soda with caffeine felt better than the women who'd had the caffeine-free cola.

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Heart Effects of Impotence Pill Under U.S. Review

By Lisa Richwine
Reuters
Wednesday, May 28, 2003

WASHINGTON (Reuters) - An advisory panel on Thursday meets to discuss potential heart-related side effects from a drug vying to become the first U.S. competitor to Pfizer Inc.'s popular impotence pill Viagra.

Levitra, by Germany's Bayer AG and Britain's GlaxoSmithKline Plc, was launched in Europe in March. U.S. regulators last summer said Levitra was "approvable" but asked for more information on the drug's impact on a key heart measurement.

On Thursday, a panel that advises the Food and Drug Administration (news - web sites) will hear and discuss data on that issue related to Levitra and also a Sanofi-Synthelabo drug called alfuzosin for treating an overgrowth of cells in the prostate. Alfuzosin also has been ruled approvable by the agency.

The panel is not expected to vote on whether either product should be approved, an FDA spokeswoman said. The FDA will ask committee members for input on how to assess drugs' impact on the "QT interval," a measurement of electrical activity in the heart. A prolongation of the QT interval can at times lead to dangerously abnormal heart beats that can be fatal.

The panel "is being asked to discuss what all this data in the heart area might mean, what is the best way to collect it and interpret it," the FDA spokeswoman said.

Various drugs have been shown to prolong the QT interval, and regulators have been watching the issue closely to determine when the prolongation may be hazardous. A few drugs, such as heartburn treatment Propulsid, were pulled from the market after being linked with prolonged QT intervals and dangerous heartbeat irregularities.

Ira Loss, an analyst with Washington Analysis, said he did not think the issue would keep either Levitra or alfuzosin off the market. He said he thought regulators' concerns centered on how to describe the issue on the product label.

Loss said he believed "the QT interval prolongations with these two products were within a comfort zone that didn't make them pariahs in their class."

GlaxoSmithKline spokesman Michael Fleming said the Levitra makers "believe our data further support the safety profile of this compound."

Sanofi-Synthelabo, in a summary posted on the FDA Web site, said alfuzosin's effect on the QT interval "is not indicative of a prolongation of QT interval that could be associated with ventricular arrhythmia," a type of abnormal heart beat.

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Exercising for Fun Better for the Heart

By Janice Billingsley
HealthScoutNews Reporter
HealthScoutNews
Wednesday, May 28, 2003

WEDNESDAY, May 28 (HealthScoutNews) -- Engaging in exercise in your leisure hours can decrease your risk of a heart attack by as much as 60 percent, a German study has found.

If your exercise comes in the form of physical strain at work, however, the opposite is true -- your risk of heart disease goes up.

These are among the findings of a study at the University of Ulm Medical Center in Germany, that studied 781 middle-aged men and women, 312 of whom had heart disease.

"The study provides additional evidence that leisure time physical activity (LTPA), but not work-related physical strain (WRPS) is associated with a decreased risk of coronary heart disease," the authors write.

The findings appear in the May 26 issue of the Archives of Internal Medicine (news - web sites).

By asking participants to fill out questionnaires about their physical activity during the summer and winter, both at work and at leisure, and taking blood samples, the researchers found nonwork-related physical activity was associated with a lower risk for heart disease.

Also significant was that those who reported more leisure time activity had lower levels of various biomarkers in the blood that are involved in the inflammatory response, which is thought to be involved in the buildup of plaque in the blood vessels.

"This study was well done for the completeness of the inflammatory markers. The authors looked very carefully at more markers," says Dr. Richard Stein, a spokesman for the American Heart Association (news - web sites) and chief of cardiology at Brooklyn Hospital Center.

Stein says this is important because these inflammatory markers -- such as C-reactive protein (CRP) and interleukin 6 (IL-6) -- could be increasingly important in determining the causes for heart attacks.

"Coronary events are not due to how much coronary disease you have, but to the fracturing of the plaque that blocks the heart vessel," he says, and while you can't say now that having high levels of inflammatory markers can predict coronary events, research is suggesting the likelihood of these events are associated with these markers.

In the study, there was a clear relationship between leisure time physical activity and a decrease in risk of heart disease, with the benefits accruing dramatically as the amount of exercise increased. Those who exercised for an hour or less a week reduced their heart disease risk by 15 percent compared to those who did no leisure time exercise.

People who exercised between one and two hours a week had a 40 percent reduction in heart disease risk, and those who exercised for more than two hours weekly reduced their risk for heart disease by 61 percent.

"The single, most proactive thing you can do for yourself to reduce the risk for heart disease is to exercise regularly three or more times a week," Stein says.

Conversely, study participants who reported work-related physical strain (WRPS) had a much higher risk of heart disease, from a doubling of the risk for those who reported light WRPS to more that four times the risk for those who had heavy WRPS.

One reason for this difference, the authors suggest, could be that work-related physical activity is probably long-lasting and static, while leisure time activity is mainly short-lasting and dynamic in nature. But, they add, it also may be due to other, unknown risks.

Stein says that previous studies report the same discrepancy between different types of exercise but that the cause for the differences is unknown.

"It may be a mind-body connection, but it's not clear," he says.

More information

Get suggestions for increasing your physical activity from the American Heart Association. An article explaining the biomarker C-reactive protein (CRP) can be found at the National Library of Medicine.

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Blood Doping Rampant Among Top Cross-Country Skiers

By Gary Gately
HealthScoutNews Reporter
HealthScoutNews
Wednesday, May 28, 2003

WEDNESDAY, May 28 (HealthScoutNews) -- Blood doping can boost performance enough to propel a cross-country skier from 30th place to the medal podium in elite international competition.

And the practice appeared to be rampant among top skiers in the 2001 Nordic World Ski Championships, a new study concludes.

The research, published in the May issue of the Clinical Journal of Sport Medicine, found that more than a third of the top 50 finalists in the cross-country skiing competition -- and half the medal winners -- showed evidence that suggests illegal blood doping.

University of Alberta researchers analyzed blood samples from the top 50 competitors in nine races to test for abnormally high levels of oxygen-carrying cells in the blood. Athletes can use erythropoietin -- or EPO, a hormone that stimulates red blood cell production -- so the blood can carry more oxygen, an important factor in endurance, the study says.

International athletic federations now follow the Olympic Committee medical code, which recognizes only the presence of a banned substance in urine as proof of doping, the study's authors say. But current testing procedures are often ineffective in detecting EPO use, the study says.

So, detecting doping will require relying on measures such as blood tests measuring oxygen-carrying cells, the study concludes.

"Blood doping is both prevalent and effective in cross-country skiing, and current testing programs for blood doping are ineffective," the authors write. "The new formulations of erythropoietin leave athletes ... with the choice of competing 'clean' or doping to be able to compete with 'those other cheaters' who will not be caught by existing controls."

And it's unlikely blood doping is less common in endurance sports other than skiing, the study adds.

The world ski championships in Lahti, Finland, came the year before the Winter Olympics (news - web sites) in Salt Lake City, Utah, where three cross-country skiers tested positive for blood doping, the study notes.

The researchers analyzed 203 blood samples from 146 of the skiers at Lahti. Overall, 36 percent of the top 50 finishers had abnormal blood test results indicating blood doping. Among medal winners, half had "highly abnormal" results, as did a third of those finishing from fourth to 10th place, the researchers found.

By contrast, among skiers finishing from 41st to 50th place, only 3 percent had "highly abnormal" results. And in the general population, that level would be expected in less than 1 percent, the researchers report.

In a World Cup or Olympic cross-country race, the top 50 skiers typically finish within 10 percent of the winning time, the researchers say. Blood doping can provide up to a 10 percent improvement in performance, "making it by far the most effective way to manipulate results in endurance sports," the study says.

Dr. Gary Wadler, a sports medicine specialist and an expert on doping, says the study highlights the need for better testing to detect cheating among athletes.

Elevated EPO levels show up in tests for only a few days, Wadler says, but the beneficial results -- improved performance -- can last for weeks. This raises a key question, he says: "Are the athletes learning to play the calendar rather than the game of sports?"

Wadler, a fellow of the American Academy of Sports Medicine and a medical adviser on performance-enhancing drugs to the White House Office of National Drug Control Policy, says use of EPO to improve performance is dangerous and can be fatal. The hormone, used medically to treat anemia, makes the blood unnaturally thick, leading to increased risk of heart attack and stroke, he says.

"It's a very serious health issue as well as an issue of unfair athletic advantage," Wadler says.

More information

For more on EPO, visit the University of Florida. To learn more about doping in sports, check out the World Anti-Doping Agency.

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Men May Need Second Prostate Cancer Test

By Keith Mulvihill
Reuters Health
Wednesday, May 28, 2003

NEW YORK (Reuters Health) - Men who undergo prostate specific antigen (PSA) testing for prostate cancer (news - web sites) should undergo a second test to confirm the results if the first is positive, according to a report released Tuesday.

It seems the test results can vary, and an elevated result on the first test -- a sign of prostate cancer -- may be lower on a second test.

Indeed, the study suggests that roughly 40 to 50 percent of men with an elevated PSA level may have a lower result the next time they are tested. This means some men may undergo an unnecessary biopsy, a test in which a needle is inserted into the walnut-shaped prostate to collect cells for further testing.

"What we found was that PSA levels tend to fluctuate over time," said the study's lead author, Dr. James A. Eastham of Memorial Sloan-Kettering Cancer Center in New York, in an interview.

"A single PSA test result should be taken with a grain of salt," said Eastham.

The findings are published in this week's issue of the Journal of the American Medical Association (news - web sites).

In the study, Eastham and colleagues went back and tested blood samples from 972 men ages 35 to 89 who had originally enrolled in a study on preventing colon polyps.

A total of five consecutive blood samples collected during a four-year period were tested for each man.

Roughly 20 percent of the group had a PSA level that would have called for a biopsy, depending on the criteria used to trigger a test. About 50 percent of this group later saw their PSA drop to levels that would not have called for a biopsy, Eastham told Reuters Health.

PSA is a protein produced by the prostate gland. PSA levels above 4 nanograms per milliliter (ng/mL) of blood can signal prostate cancer, but not always -- sometimes a rise in PSA is due to another cause, and sometimes cancer can occur without a rise in PSA.

About 20 percent of aggressive prostate tumors are found in men with normal PSA levels.

Men with PSA levels that warrant further testing such as a biopsy for the presence of cancer should undergo another PSA test between four and six weeks after their initial test, advised Eastham.

"This would save men from having unnecessary biopsies," he said.

The researchers said their study is somewhat limited because some of the men in the study might have had dropping PSA levels because they were being treated for prostate cancer. However, they said this is unlikely because the men filled out healthy surveys annually, which asked about newly diagnosed conditions.

Blood testing for PSA levels has been used as a cancer detection tool since the early 1990s, but experts still debate whether such tests offer any additional value to other prostate cancer screening methods. PSA tests have not yet been shown to increase lifespan.

A number of prominent groups, including the U.S. Preventive Services Task Force and the National Cancer Institute (news - web sites), are opposed to routine PSA screening, saying that the risks of follow-up tests and the side effects of treatment may outweigh the possible benefits for some men.

Because prostate cancer often progresses slowly, the disease can sometimes go without immediate treatment. In some cases -- particularly when a man is elderly or in poor overall health -- it may not be worth asking the patient to risk the side effects of surgery, radiation or other therapy.

Given the controversy over PSA screening for early cancer, the American Cancer Society (news - web sites) and other test supporters urge men to discuss the pros and cons of the test with their doctors.

"While PSA testing does lead to the early detection of prostate cancer, a single abnormal PSA level should be viewed with caution," according to the new report. "A newly elevated level should be confirmed before expensive or invasive tests, such as a prostate biopsy, are recommended."

About 75 percent of men who have a prostate biopsy after an elevated PSA test are found to be cancer-free.

Source: Journal of the American Medical Association 2003;289:2695-2700.

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TUESDAY, MAY 27, 2003

Sunburn by Gender

HealthScoutNews
Tuesday, May 27, 2003

(HealthScoutNews) -- A day at the beach can be fun for the kids, but it will be safer for them if there's a woman along.

That's because researchers at Loyola University in Chicago say women seem to better understand the importance of sun protection.

As reported in the Journal of the American Academy of Dermatology, the researchers studied the influence of adult supervision on sunburn in children. After interviewing 503 families, they concluded that most cases of child sunburn are associated with having too much confidence in sunscreens.

Moreover, men are more likely to allow their children to become burned or tanned, and are more likely to compliment a child on how good he or she looks with a tan.

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Young Children Served Large Portions May Overeat

By Charnicia E. Huggins
Reuters Health
Tuesday, May 27, 2003

NEW YORK (Reuters Health) - Giving young children meals that outsize their age may lead to overeating -- but when left to their own devices, kids tend to choose age-appropriate serving sizes, new study findings show.

Researchers found that super-sizing preschoolers' entrees generally led the children to take bigger bites and consume more calories. But when kids were allowed to serve themselves, they naturally selected more age-appropriate portions.

"Given the alarming and growing problem of child obesity, the capacity of large portions to encourage overeating among young children is concerning," study author Dr. Jennifer Orlet Fisher told Reuters Health.

"The results of the study imply that minimizing children's exposure to excessive portions may prevent overeating," said Fisher, of the U.S. Department of Agriculture (news - web sites)'s Children's Nutrition Research Center at Baylor College of Medicine in Houston.

One recent study found that meal portion sizes in the home and restaurants have jumped since the late 1970s in the U.S.

In the current study, Fisher and her team studied 30 preschool-aged children.

During two series of lunches the children were served either an age-appropriate portion of a macaroni-and-cheese entrée or a portion twice as large.

The researchers found that, overall, the children ate about 25 percent more of the entrée when they were served a larger portion than when they were served an age-appropriate amount.

Children took bigger bites when presented with the bigger entrée and did not compensate by eating significantly less of the other foods served with it, Fisher and her colleagues report. The children's overall calorie intake at lunch was 15 percent higher when served the large entrée.

In addition, the children's bite size increased along with increasing body mass index, a measure of a person's weight in relation to their height.

In another part of the study the children were allowed to serve themselves from bowls containing individual servings of the larger portion sizes. They were told to eat as little or as much as they wanted.

This time, the children did not overeat, the researchers found. They instead chose smaller portions and ate less than when they were served the larger portion size.

In light of the findings, Fisher suggested that children be served or encouraged to select "small 'first portions' with additional helpings if (they) are still hungry."

"Also avoid the temptation of 'super-sizing"' when eating out, she added. "Such deals appear not to represent a good value for health."

Source: American Journal of Clinical Nutrition (news - web sites) 2003;77:1164-1170.

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Fish Oil Prevents Irregular Heartbeats

By Amanda Gardner
HealthScoutNews Reporter
HealthScoutNews
Tuesday, May 27, 2003

TUESDAY, May 27 (HealthScoutNews) -- For years, scientists have known that eating such oily fish as salmon, tuna or bluefish regularly could prevent sudden cardiac death.

The reason for that may just have become clearer.

According to new research appearing in the June 3 issue of Circulation, fatty acids in this type of fish are stored in individual heart cells and serve to prevent irregular heart rhythms (also known as arrhythmias) by working through the heart's calcium and sodium channels.

Sudden cardiac death causes at least 250,000 deaths each year in the United States alone, says the American Heart Association (news - web sites) (AHA). As its name implies, this type of death occurs unexpectedly and in people who may or may not have diagnosed heart disease. Most cardiac arrests occur as a result of life-threatening arrhythmias.

The body requires two types of polyunsaturated fatty acids (PUFAs) in order to function: n-6 and n-3. Both must come from the diet, because the body does not produce them. Since 2000, AHA dietary guidelines have recommended that healthy adults eat at least two servings a week, especially fish high in omega-3 fatty acids, such as mackerel, lake trout, herring, sardines, albacore tuna and salmon.

The first study to show a benefit to the heart from n-3 PUFAs was in 1989. Since then, a number of additional studies have also shown beneficial effects, but no one knew what the specific mechanisms at work were.

For this study, the researchers removed the hearts from several one- to two-day-old rat pups, then separated and cultured the cells and placed them under a microscope for observation. By the second day, the heart cells had clumped together and were beating spontaneously, rhythmically, and simultaneously -- just like a whole heart would.

The video camera taped the heart cells as different agents were applied, including PUFAs.

"The heartbeat itself is due to electrical activity which, in turn, results from small ions -- sodium, calcium, and potassium -- moving through specific ion channels in the cell membrane of heart cells. These channels recognize the specific ions," says Dr. Alexander Leaf, lead author of the study. Leaf is a professor emeritus of clinical medicine at Harvard Medical School (news - web sites) and former chief of medicine at Massachusetts General Hospital, both in Boston.

When a person has a heart attack, the cells in the area that is no longer receiving blood tend to die. There remain a few cells in the peripheral area between the dead cells and the remaining normal heart muscle, which become "mischief makers," Leaf says.

"They are much more ready to shoot off an electrical signal that causes a contraction of the heart, and they do this out of the normal electrical cycle that produces the regular rhythm of the heartbeat," he says. "It can produce arrhythmia."

The fatty acids eliminate the mischief makers by blocking excessive sodium and calcium currents in the channels of the heart. "By modulating these two ion channels, they preserve the normal electrical activity of the heart," Leaf explains.

And the benefit takes place very quickly. "The effect comes on very soon if one starts eating these fatty acids regularly," Leaf says. "It takes just a small amount."

Leaf recommends fresh or frozen fish, but says that canned tuna will suffice if it is water-packed. He also advises sticking with the AHA's recommendations of having at least two meals of oily fish per week. "That certainly will protect most people from cardiac death, [but] about 20 percent of the American public doesn't eat any fish oil at all," he says. Anyone with a family or personal history of coronary heart disease should talk to his doctor about a supplement.

While saying the research is interesting, other experts call for prospective, randomized studies in humans.

"I do not think what they've said is very conclusive. There is no prospective, double-blind study that shows the efficacy in the prevention of sudden death," says Dr. J. Anthony Gomes, professor of medicine and director of cardiac electrophysiology and electrocardiography at the Mount Sinai School of Medicine in New York City.

Gomes also says that drugs that work on sodium and calcium channels aren't always the answer. "They do not necessarily prevent sudden cardiac death," he says. "That's why we went to defibrillators."

But fish does deserve extra attention, he admits.

"It might be something very interesting and very useful," Gomes says. "After all, it is something one can eat. It may even be pleasurable."

More information

The American Heart Association has pages on dietary guidelines, on arrhythmias, and fish and fish oil.

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Hormone-Taking Is Linked to Dementia

By Lindsey Tanner
AP Medical Writer
The Associated Press
Tuesday, May 27, 2003

CHICAGO - Women who take hormones for years run a higher risk of Alzheimer's or other types of dementia, according to yet another startling study that turns upside down what doctors have long believed about supplements.

"It's another nail in the coffin" for the use of hormones during and after menopause, said St. Louis gynecologist Dr. Robert Blaskiewicz, a Saint Louis University professor.

The study appears in Wednesday's Journal of the American Medical Association (news - web sites).

The findings in women 65 and older challenge the long-held notion that estrogen-progestin supplements can help women keep their minds sharp a belief that was based on smaller, less rigorous studies.

Last summer, a government study was abruptly halted after finding an increased risk of breast cancer (news - web sites), heart attacks and strokes in women who took one type of combined hormone pill.

That finding shattered the conventional thinking about the health benefits of hormones and prompted millions of American women to stop taking supplements.

Some experts say that based on what is now known about supplements, women past menopause should not take hormones at all. Other experts say that women needing relief from night sweats and other menopausal symptoms should take the lowest possible dose for the shortest time.

The new findings on dementia come from a subset of participants in last summer's study. Despite those earlier findings, many women have continued using supplements to relieve menopausal symptoms and in hopes of preventing memory loss and other mental decline, said Sally Shumaker, a public health professor at Wake Forest University who led the latest research.

Women in the study who took hormones for an average of more than four years faced double the risk of developing Alzheimer's or other forms of dementia, compared with those on dummy pills. That means that in one year, for every 10,000 women taking hormones, there will be 23 more cases of dementia.

Researchers also found that hormones did not protect against less severe mental decline, such as mild memory loss.

One possible explanation for the confounding new findings is that hormones raise the risk of strokes and strokes are known to cause brain damage and contribute to dementia, the researchers said.

Nevertheless, the increased risk of dementia is very small, said Marilyn Albert, head of the Alzheimer's Association's scientific advisory council and a Johns Hopkins University neurology professor.

Age remains the single greatest risk factor for dementia, and the study suggests that a 65-year woman on estrogen-progestin pills "would have the increased risk profile of a 70-year-old woman not taking hormone replacement therapy," Albert said.

Dr. Judith Salerno, deputy director of the National Institute on Aging, said the results indicate older postmenopausal women should not use estrogen-progestin supplements in hopes of keeping their minds sharp.

"There is no benefit, and possible harm, for older women taking this therapy," she said.

Cindy Yeast, a 50-year-old Washington-area publicist, called the findings disappointing. She started taking supplements two years ago partly to stave off mild dementia that affects her elderly parents. Still, she said she is not sure the new findings will change her mind.

"Every time a new study comes out, you can't just react," Yeast said. "You have to weigh what is this doing for me now."

The results come from the Women's Health Initiative Memory Study, which involved 4,532 women who used Prempro estrogen-progestin pills for an average of more than four years. It was funded in part by Prempro maker Wyeth Pharmaceuticals.

Probable dementia was diagnosed in 61 women 40 in the hormone group and 21 taking placebo pills.

The notion that hormone supplements are good for the mind has been around for at least a decade. Doctors have speculated that estrogen protects against cell damage and improves blood flow.

Wyeth estimates that 1.2 million women are still taking Prempro pills, down from about 3.4 million before the study was halted last summer. Other types of hormone supplements include patches and creams.

Wyeth's Dr. Victoria Kusiak said it is unclear whether the disappointing results would apply to younger patients. Still, she said she agrees with those doctors who say that hormones should be used only to treat menopause symptoms such as night sweats and hot flashes "for the shortest duration and the lowest dose."

An arm of the Women's Health Initiative study involving estrogen-only supplements in women who have had a hysterectomy is continuing. Estrogen alone is not recommended for women with intact wombs because it increases the risk of uterine cancer.

A new study that says hormones can increase the risk of Alzheimer's and other forms of dementia has raised new questions for women deciding whether to take supplements. Here is what some experts say:

  • Wake Forest University researcher Sally Shumaker, the study's lead author, says the results suggest women 65 and older should not take estrogen-progestin supplements for any reason. Those who strongly feel that they would benefit should consult with their doctors, Shumaker says.
  • The National Institute on Aging says the findings show that combined supplements should not be prescribed for older postmenopausal women to maintain or improve mental function. The mental risks and benefits from hormone supplements in younger women are unknown, the NIA says.
  • The Food and Drug Administration (news - web sites) notes that hormone use remains approved for younger women to relieve menopausal symptoms such as hot flashes and night sweats. Younger women should consult with their doctors about hormone use and, if it is deemed appropriate, should take the lowest possible dose for the shortest duration, the FDA says.

Agency officials are reviewing the hormone-dementia data to determine whether additional warning labels are needed. The FDA earlier this year issued requirements for new labels highlighting the increased risk of heart disease, heart attacks, strokes and breast cancer.

On the Net:

JAMA: http://jama.ama-ssn.org

Women's Health Initiative: http://www.whi.org

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Apnea Tied to Atrial Fibrillation

By Ed Edelson
HealthScoutNews Reporter
HealthScoutNews
Tuesday, May 27, 2003

TUESDAY, May 27 (HealthScoutNews) -- If you often wake up gasping in the middle of the night, talk to your doctor about seeing a cardiologist.

That gasping wakeup is a sign of sleep apnea, in which the lungs are not getting enough air. And a new study finds a close association between sleep apnea and atrial fibrillation, a heartbeat abnormality that can be fatal.

The risk of recurrent atrial fibrillation is doubled in people with untreated sleep apnea, says a Mayo Clinic study reported in the May 27 issue of Circulation.

In the Mayo study, obstructive sleep apnea, in which there is a blockage of the airway, was the single factor most closely associated with recurrence of atrial fibrillation.

"To our knowledge, this is the first study showing that untreated obstructive sleep apnea is associated with an increased risk of recurrent atrial fibrillation and that the risk is not explained by other factors," says a statement by Dr. Virend Somers, the Mayo Clinic cardiologist who led the study.

Atrial fibrillation makes the upper chambers of the heart flutter uselessly, rather than pumping blood. It can cause heart failure, heart attack or stroke. Drugs or CPAP -- constant positive airway pressure, using a machine to force air into the nasal passages -- can help treat it, but it comes back in more than half of all patients within a year.

"Cardiologists are now awakening to the importance of identifying and treating sleep-disordered breathing in their patients," says Dr. Barbara Phillips, director of the University of Kentucky Sleep Disorders Center and a spokeswoman for the National Sleep Foundation.

The Mayo study followed 79 people treated for atrial fibrillation who had not been diagnosed with sleep apnea and 39 patients with both fibrillation and sleep apnea. Of the 39 apnea patients, 27 got either no treatment or inadequate treatment for the condition. After a year, fibrillation recurred in 22 (or 81 percent) of the apnea patients with untreated apnea and five (or 42 percent) of the apnea patients who got adequate treatment.

This is an important study because it is the first to describe the results of treating sleep apnea in atrial fibrillation patients, Phillips says. "CPAP made a big difference for those patients who used it," she says.

Somers says the results are particularly important because obesity increases the incidence of sleep apnea, and Americans are getting fatter. The epidemic of obesity in this country could be behind the rising incidence of sleep apnea, which "may contribute to the dramatic increase in atrial fibrillation, which has nearly tripled in the past three decades," Somers says in the statement.

"Appropriate treatment for those with both conditions is CPAP first," Phillips says. "Not only can it help a fibrillation, it improves blood pressure, reduces the risk of heart attacks, reduces other cardiac arrhythmias, and improves heart function in patients with heart failure."

Many patients with atrial fibrillation should be screened for sleep apnea, Somers says. Leading candidates for screening are those who are obese, whose spouses say they snore loudly, or have been seen to stop breathing at night or are constantly sleepy during the day.

More information

You can learn a lot more about sleep apnea from the National Sleep Foundation. Learn more about atrial fibrillation from the American Heart Association.

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Diabetics' Education Level May Sway Death Risk

Reuters Health
Tuesday, May 27, 2003

NEW YORK (Reuters Health) - Type 2 diabetics (news - web sites) with a college degree may have a lower risk of premature death than those with only a high school diploma, a new study suggests.

The findings support the idea that education level makes a difference in how well people with type 2 diabetes are able to control their blood sugar -- and, therefore, prevent diabetes complications, according to the report in the May issue of Diabetes Care.

People with type 2 diabetes do not metabolize glucose, or sugar, efficiently because their bodies do not properly respond to the glucose-regulating hormone insulin. Uncontrolled blood sugar can eventually lead to diabetes complications such as heart disease, stroke, kidney problems, blindness and nerve damage that can lead to amputations.

Overall, diabetics have a higher risk of death compared with non-diabetics their age. But research also suggests that among people with diabetes, socioeconomic status -- which is related to education -- influences death risk.

To look at the relationship between education and death risk among diabetics, Dr. Ronald P. Wilder of the University of South Carolina in Columbia analyzed data on nearly 2,400 men and women with type 2 diabetes. Participants were about 62 years old, on average.

He found that death risk appeared to decline as education level rose -- participants who graduated college or pursued post-grad education had a lower death rate than high school graduates.

Family income, Wilder found, was not related to death risk, nor was race or marital status. As expected, he notes in the report, increasing age and duration of diabetes did raise the odds of death.

According to the researcher, the findings support the idea that education increases a person's ability to "invest" in his or her health.

"Education may also be a factor in the relatively poor health status and outcomes of adults with diabetes," he writes.

Source: Diabetes Care 2003;26:1650.

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Setting an Example by Kicking the Habit

HealthScoutNews
Tuesday, May 27, 2003

TUESDAY, May 27 (HealthScoutNews) -- Where there's no parental smoke, there's less chance children will get fired up about cigarettes.

A study by researchers at the Fred Hutchinson Cancer Research Center found parents who quit smoking before their kids reach the third grade greatly reduce the risk that the kids will become smokers by the time they're seniors in high school.

If one parent quits smoking by the time the child is 8 or 9 years old, the child's odds of becoming a daily or monthly smoker by age 17 or 18 is reduced by 25 percent. If both parents quit when the child is 8 or 9 years old, the child's odds of becoming a smoker declines by almost 40 percent.

For the study, which appears in the May issue of the journal Addiction, the researchers analyzed data from more than 3,000 children and parents in 20 school districts in Washington state.

"Statistics show that if a child reaches age 18 without becoming a smoker, his or her odds of remaining smoke-free are around 90 percent. Therefore, our results indicate that if all smoking parents were to quit by the time their children were around age 8, it could prevent 136,000 young people in the United States from becoming daily, long-term smokers," researcher Jonathan B. Bricker says in a news release.

The study found mothers weren't more influential than fathers in this regard and girls were no more susceptible than boys. The study also found those least likely to smoke were children of parents who never smoked.

Among senior high school students, the rates of smoking were 14 percent for those whose parents had never smoked, 37 percent among those whose parents both smoked, and 26 percent among those whose parents had both quit smoking by the time the child was in third grade.

More study is needed to determine the benefits when parents stop smoking after their children reach age 8 or 9, the researchers note.

More information

Here's where you can learn more about smoking cessation.

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Full-Term Fetus Knows Mom's Voice: Study

By Alison McCook
Reuters Health
Tuesday, May 27, 2003

NEW YORK (Reuters Health) - New study findings suggest that shortly before birth, a fetus may be able to distinguish mom's voice from others.

U.S. researchers found that heart rate in full-term fetuses increased when a recording of their mothers' voices was played, but decreased in response to the voice of a female stranger.

This shows that the fetus can distinguish between the voices of its mother and other women before it is even born, study author Dr. Barbara S. Kisilevsky of Queen's University in Canada told Reuters Health.

"It is not the increased heart rate per se, but the different ways in which the fetuses responded to the two voices ... that tells us that the fetus had to recognize its own mother's voice," she said. "If not, then the response to both voices would have been the same."

These results add to a body of research suggesting that biology prepares the fetus to bond to its mother after birth and take on the daunting task of learning language, Kisilevsky noted.

Furthermore, showing that a fetus can distinguish its mother's voice adds credence to the theory that both genes and experience help a fetus understand speech, because the tendency to respond differently to different voices "had to occur through experience," Kisilevsky said.

During the study, reported in the May issue of the journal Psychological Science, Kisilevsky and her colleagues played a tape recording through speakers held around 10 centimeters over the mothers' abdomens.

The tapes consisted of two minutes of silence followed by two minutes of either the mother or a female stranger reading the same poem, then two more minutes of silence.

On average, the fetuses had spent about 38 weeks in the womb, and so were full-term. Thirty fetuses were exposed to tapes of their mothers speaking, and another 30 the voices of a female stranger.

Although mothers' voices did not appear to elicit significantly more body movement in the fetuses than did the voices of female strangers, fetal heart rate increased when listening to their mothers, and appeared to decrease in response to a recording of a female stranger.

In terms of why a stranger's voice might lower a fetus's heart rate, Kisilevsky said that a decrease in heart rate is often a sign of attention, and the fetus may have paid more attention to a voice it didn't recognize.

"I think it already knew its mother's voice, and was now learning about other voices," she said.

Source: Psychological Science 2003;14:220-224.

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Many Prostate Biopsies Unnecessary

By Adam Marcus
HealthScoutNews Reporter
HealthScoutNews
Tuesday, May 27, 2003

TUESDAY, May 27 (HealthScoutNews) -- As many as half of biopsies for prostate cancer (news - web sites) may be unnecessary, suggests a new study that says blood tests that prompt the tissue exams can swing freely from abnormal to normal.

The test looks for a protein called prostate-specific antigen, or PSA, which is often elevated in men with prostate cancer. However, the new study shows that men whose PSA value is abnormally high one day frequently have a normal result on a later retest.

Since PSA levels in blood may vary from day to day, "it's probably prudent to recheck a level" at least six weeks later before advising a patient to have a biopsy, says study author Dr. James Eastham, a surgeon at Memorial Sloan-Kettering Cancer Center in New York City. Biopsies are costly and carry the risk of bleeding, infection and discomfort.

PSA is a protein in blood that surges in men with prostate cancer, as well as those with other, benign prostate conditions. In about 10 percent of men with cancer, the protein remains in the normal range. Although PSA testing is often encouraged for men over 50, its value as an early-detection tool isn't certain, and evidence is mixed about whether the exam can prevent deaths from prostate cancer.

"Even with flaws, it is a very useful tool. You just have to use it in an appropriate way," says Eastham, whose research appears in the May 28 issue of the Journal of the American Medical Association (news - web sites).

More than 220,000 American men will be diagnosed with prostate cancer this year, and nearly 29,000 will die of the disease, according to the American Cancer Society (news - web sites). The tumors are typically slow-growing, however, and most men with prostate cancer die of other causes.

In the latest research, Eastham's group followed 972 men, whose average age was 62, enrolled in a seven-year colon cancer prevention study. Each had five separate PSA tests drawn over a four-year period.

About one in five men had a PSA level considered high -- over 4 nanograms per milliliter of blood -- on at least one reading. Yet on a subsequent test, roughly half of them had fallen back into the normal range for the protein, suggesting the spike wasn't a signal of prostate cancer.

"A single abnormal PSA level should be viewed with caution," the researchers write. Doctors should confirm the reading "before expensive or invasive tests, such as a prostate biopsy, are recommended."

More information

To learn about prostate cancer, try the University of Michigan or the National Cancer Institute.

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Laser Eye Surgery Claims Soaring in UK

Reuters Health
Tuesday, May 27, 2003

LONDON (Reuters Health) - The number of medical negligence claims relating to laser eye surgery has more than doubled over the past six years in the UK, the largest insurer of British doctors said on Monday.

The Medical Defense Union (MDU) said that the number of laser surgery claims reported by its members rose 166 percent, and now account for one in three of all ophthalmology claims.

Laser eye surgery, used to correct common vision problems, is often thought of as a low-risk, straightforward procedure, said Dr. Matthew Robson, clinical risk manager at the MDU.

"But our experience shows that although ophthalmology as a whole has traditionally been a low risk specialty, negligence claims in this particular area are increasing rapidly," he said in a statement.

He said that some of the claims resulted from poor surgical technique, but the underlying problem is patients' unrealistic expectations about what the surgery can achieve.

"It is important for the doctor who is performing the surgery to counsel possible patients about the risks of the procedure and the possibility of an imperfect result and other complications in order to obtain proper consent," Robson said.

The average cost of litigation against laser eye surgeons is triple that of ophthalmic surgeons who do not carry out laser eye work, the MDU noted..

Earlier this year, the insurer increased its subscription rates for laser eye surgeon members, with a new top rate of 22,000 (US$ 36,173) per year.

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Two Clot Busters Boost Stroke Recovery

By Serena Gordon
HealthScoutNews Reporter
HealthScoutNews
Tuesday, May 27, 2003

TUESDAY, May 27 (HealthScoutNews) -- When doctors began treating strokes with the clot-busting drug tissue plasminogen activator (tPA), survival and recovery rates jumped, but not all patients respond well to the therapy.

That may be because blood clots re-develop in as many as one in five patients after initial treatment with the clot-dissolving medication, says a new South Korean study.

In a report appearing in the May 27 issue of Neurology, researchers from Yonsei University in Seoul found that in 22 percent of the stroke patients studied, clots formed again as soon as 20 minutes after the arteries had been cleared by tPA. But when the researchers added another blood-thinning medication, abciximab, to the treatment, the new clots were dissolved.

"Reappearance of blood clots after initial successful treatment occurred frequently," says the study author Dr. Ji Hoe Heo, an associate professor of neurology at Yonsei University. "This study is promising because simple but careful observation for occurrence of reappearance of clots may improve the rate significantly by giving abciximab in those patients."

Abciximab works specifically on the platelets in the blood. Platelets are the blood cells that cause clots to form, normally to stop bleeding.

Stroke is the third leading cause of death in the United States, killing more than 700,000 people every year, according to the American Stroke Association.

For this study, the researchers studied 18 stroke patients who were treated with tPA. Standard treatment in the United States is to give tPA through an intravenous line, but for this study, the researchers administered the drugs through a catheter placed in the artery.

Dr. Keith Siller, director of the Comprehensive Stroke Care Center at New York University Medical Center, says administering the drugs this way may lessen the chance for side effects, but more importantly it lets the treating physician see exactly what is going on. He says it's similar to the way cardiologists break up blockages in coronary arteries. The drawback to this method, especially when treating arteries in the brain, is the risk of causing bleeding. Plus, it is only done in specialized hospitals, not in most community hospitals.

The researchers found that in four of the patients treated with tPA, clots formed again soon after the original clot was dissolved. They treated these patients with abciximab through the arterial catheter. Two of the patients had no symptoms after the second treatment and one only had minor symptoms. These three were able to return to their previous activities and jobs. The fourth patient had a slight hemorrhage that the researchers didn't believe was caused by the treatment.

Heo says that none of the patients suffered any serious side effects in this study, but adds that any type of clot-busting drug carries the risk of unwanted bleeding.

Siller says this study shows why tPA doesn't work for all patients. "Stroke is a very complicated event. It's not just a simple clot. It can change as you start treatment," he says.

That's why "controlling risk factors will always be more effective than treating a stroke," he says. And, he adds, most patients don't come in early enough for any of these treatments to be effective. If you have any of the following symptoms, call 911 right away:

  • Sudden numbness or weakness of the face, arm or leg, especially if it's one-sided;
  • Sudden confusion or trouble speaking or understanding;
  • Sudden vision problems;
  • Sudden dizziness, loss of balance or coordination;
  • Sudden trouble walking;
  • Or sudden and severe headache with no known cause.

Finally, Siller points out this study was very small and no definitive conclusions can be drawn from it yet.

More information

To learn the major risk factors for brain attacks, visit the American Stroke Association. You could also go to the National Institute on Aging to learn more about preventing stroke.

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Families Sought in Hunt for Male Cancer Genes

Reuters
Tuesday, May 27, 2003

LONDON (Reuters) - British scientists launched a national hunt on Tuesday for families with a history of testicular or prostate cancer (news - web sites) to help in the search for genes related to the diseases.

They are looking for men who have three or more relatives who developed prostate cancer before the age of 70 or who have two or more family members with testicular cancer.

By examining the genetic profiles of men with the disease, they hope to identify genes that increase a man's risk of developing the cancers.

"Fifteen percent of prostate cancer and up to 30 percent of testicular cancer may be due to an inherited predisposition," Professor Colin Cooper of the Institute of Cancer Research (news - web sites), told a news conference.

"Genes are important because they provide targets for new drugs and they help to determine the course of the disease," he added.

Scientists have discovered genes involved in breast cancer (news - web sites), but the search for male cancer genes has lagged behind.

Six possible sites for prostate cancer genes and one for testicular cancer have been identified, and researchers are hoping the genetic studies will help them pinpoint the culprits.

Cooper said testicular is the most genetic of all cancers. A man with a brother who has testicular cancer has an eight to 10-fold increase in the chances of getting it himself.

Men with a family history of either testicular or prostate cancer can contact their family doctor or a specialist at the Institute for Cancer Research (www.icr.ac.uk) if they want to take part in the study.

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Testing for Stomach Bacteria Doesn't Help With Peptic Ulcers

HealthScoutNews
Tuesday, May 27, 2003

TUESDAY, May 27 (HealthScoutNews) -- Routine testing and treatment for the Helicobacter pylori bacteria in people with suspected peptic ulcers doesn't do much to help their symptoms, but it does increase treatment costs.

So says a study in the May 26 issue of the Archives of Internal Medicine (news - web sites).

The study also found most people with doctor-diagnosed peptic ulcer disease(PUD) who are treated in community settings do not have H. pylori infection.

Current guidelines recommend antibiotic treatment for people with HP-positive PUD who have been receiving long-term acid-suppression therapy, the study notes. Those guidelines assume PUD has been diagnosed and that eliminating HP will make further treatment unnecessary and reduce medical costs.

But the prevalence of HP infection and the impact of treating it has not been studied in people receiving acid-suppression therapy for one or more years.

In this study, researchers of the Kaiser Permanente Medical Care Program looked at 650 people who had received acid-therapy suppression for at least a year after being diagnosed with PUD. The study participants were randomly assigned to be tested and treated for HP or to usual care.

The people in the usual care group did not receive routine testing or treatment for HP infection. They did continue to receive medical care and/or medication for PUD.

The study found that only 17 percent of the people had PUD confirmed by X-ray studies or endoscopy. It also found that only 38 percent of the test-and-treat group tested positive for HP.

After a year, people in the test-and-treat group were less likely to report ulcer-like symptoms or use acid-reducing therapy. But 75 percent of them used antacids during the second half of the 12-month follow-up.

Over the course of the year-long study, the people in the test-and-treat group had higher total medical costs related to treatment of PUD symptoms than the people in the usual care group.

More information

Here's where you can learn more about peptic ulcer.

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Wine Tasting Takes Brains, Italian Study Finds

By Estelle Shirbon
Reuters
Tuesday, May 27, 2003

ROME (Reuters) - Wine-tasting takes more than a perfect palate and a fruity vocabulary -- you have to use your brains.

That's the finding of a study undertaken by a team of researchers at a Rome hospital.

"We wanted to find out whether there was a difference at brain level between a trained and an untrained person drinking wine," said Gisela Hagberg, a Swedish bio-physicist, at the study's presentation at the Wine Academy in Rome on Tuesday.

"What we found is that the training does not just educate your palate, it also affects how your brain responds to the taste of wine."

Researchers conducted brain scans on seven sommeliers and seven casual drinkers while they sampled wines.

The scans showed strong activity in the amygdala, a part of the brain that reacts to sensations of pleasure, in both groups.

But the sommeliers also displayed a burst of activity in parts of their frontal cortexes, an area of the brain used for thinking, while the amateurs showed no reaction there at all.

"Both groups were asked to pay close attention to what they were drinking, so it's not that the control subjects weren't thinking," said Hagberg.

The difference appears to be that while both groups' brains processed the sensory aspects of drinking, the taste of wine triggered a rational, even intellectual response in the experts.

Andrea Sturniolo, one of the sommeliers who participated in the experiment at the Santa Lucia research hospital, was thrilled with the results.

"This is fantastic. This proves the reasoning, the intellectual effort that goes into breaking down the many tastes of a wine and assessing its full flavor," he said.

"It's not that sommeliers are superior beings of course, it's all in the training and the experience."

Sturniolo's only objection to the whole experience was having to drink wine lying down and through tubes inserted in his mouth -- a technique necessary for the brain scan to be conducted even as the subjects tasted the wine.

"It certainly didn't do much for the seeing and smelling parts of wine-tasting," he said. "I wouldn't recommend it."

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Surgery Beats Drugs for Fixing Blood Flow to Heart

HealthScoutNews
Tuesday, May 27, 2003

TUESDAY, May 27 (HealthScoutNews) -- Correcting moderate to severe blood flow restriction to the heart using surgery or angioplasty reduces the risk of cardiac death more than medication alone.

The observational study by researchers at Cedars-Sinai Medical Center in Los Angeles found that people who had coronary artery bypass or angioplasty had a lower death rate (2 percent) than people who received drug therapy (6.7 percent) to improve blood flow to the heart.

But people with little or no blood flow restriction to the heart had better results on medication alone.

Their research appears in the May 26 issue of Circulation.

Narrowed arteries can reduce the flow of blood and oxygen to the heart during stress (ischemia). People with this kind of stable coronary artery disease have the choice of using medication or surgery or angioplasty to prevent a heart attack.

The researchers reviewed data on 10,627 people with reduced blood flow to the heart who received treatment. None of them had a history of heart attack. During follow-up, there were 146 cardiac-related deaths in the entire group.

Women -- particularly the elderly and those with diabetes -- had greater overall death rates as well as lives saved per 100 people treated with surgery or angioplasty.

More than 17 percent of diabetic women with large parts of their heart affected by ischemia were predicted to die if they took drugs compared to 4.4 percent if they had surgery or angioplasty, the study says.

More information

Here's where you can learn more about ischemia.

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MONDAY, MAY 26, 2003

Pamphlet with Your Pasta?

By Lauren Weber
Reuters Health
Monday, May 26, 2003

CHICAGO (Reuters) - Consumers wondering how much fat is in the fettuccine Alfredo they ordered will soon find that information easier to come by.

Restaurant goers, concerned about obesity and other health issues, want to know what's in their meals, and restaurants are starting to accommodate them with brochures, Web sites and waiters armed with information.

Nutrition breakdowns are required for packaged foods, but it's relatively new for restaurants. And it's not just about keeping customers happy, say some in the food industry; it's also about being ahead of the curve on a wave of laws that would require nutrition labeling at restaurants.

"They're hoping it won't be a law, but they're also feeling pressure from consumers," said Ann Diesen, the sales manager at Minneapolis-based Medallion Labs, which offers nutrient analysis and has seen rising interest from restaurateurs.

According to the National Restaurant Association, four state legislatures -- Maine, New York, Texas and California -- are considering labeling requirements for chain restaurants. "And I bet there'll be at least 20 bills next year," the NRA's chief lobbyist, Lee Culpepper, said in a speech on Saturday at the NRA trade show in Chicago.

Big chains like McDonald's have provided this information for years, through brochures and Web sites, partly in response to criticism about the high fat and calorie content of their foods.

Other chains are positioning themselves as concerned purveyors of good-for-you meals. Olive Garden, a unit of Darden Restaurants Inc., offers a "Garden Fare" menu, with nutritional breakdown available in a pamphlet.

'Demand Out There'

Now smaller chains are getting in on the trend. Max & Erma's Restaurants Inc., a Columbus, Ohio-based chain with 85 units, offers four "no guilt" items. A tear-off sheet details nutritional content.

"There's demand out there, from guests on strict diets and those who are trying to eat healthier," Rob Lindeman, vice president of franchising, said.

At Pasta Pomodoro, a California-based chain part-owned by Wendy's International Inc., waiters are receiving more queries about calorie content, according to Rodney Morris, director of training and human resources.

The company is figuring out how to meet that need. "We know we have to move in that direction," Morris said.

But nutrient analysis can be a complex, expensive process. At Medallion Labs, a workup costs about $658 per menu item.

It's not a pretty process: a few servings of eggplant parmigiana, for example, get sent out to a laboratory to be blended up, sampled and analyzed for things like fat, carbohydrate, protein and calorie content.

If restaurants are required to do the testing, it will open up a vast market for food technology labs like Medallion and Q Laboratories, Covance Inc. and Silliker, which traditionally offer those services to packaged food companies.

"Restaurants know the consumer is more knowledgeable about food and health. They want to see what's in the products," said Mark Goins, director of marketing at Cincinnati, Ohio-based Q Laboratories.

Diets have also become more specialized, he said. "There's low-carb, low-fat. People also want to know about allergens."

Nutrition labeling is nothing new. Almost all packaged foods have to list things like sodium, fat, and protein since Congress passed the Nutrition Labeling and Education Act in 1990. But restaurants were exempted from the law.

Even as they move toward nutrient testing, restaurateurs argue that it's harder for them to provide the information since both chefs and patrons customize meals -- adding extra salt here and there, or ordering salad with more dressing. The NRA opposes labeling laws, saying they are impractical.

"Looking for quick fixes like labeling can be very problematic," Steven Anderson, CEO of the National Restaurant Association, told Reuters.

But restaurants can use that information to stand out from the competition, Goins said. "The more you know about your product, the better a salesman you are."

Medallion, a division of General Mills Inc. has gotten inquiries from both chains and independent restaurants. At this point, it's mainly been questions, not contracts.

"They want to know what the costs are, what's involved. A lot of restaurants are talking about it," Diesen said.

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Study: Smallpox May Spur Malaria Defense

By Randolph E. Schmid
Associated Press Writer
The Associated Press
Monday, May 26, 2003

WASHINGTON - A one-two punch of malaria DNA virus and the virus used to vaccinate against smallpox spurs the human immune system to mount a powerful defense against malaria, researchers report.

This approach might provide a basis for preventive and therapeutic vaccination in people, scientists said in a paper that appears in Monday's online issue of the journal Nature Medicine.

The research team led by Adrian V.S. Hill of the Oxford University in England tested the combination on 63 volunteers the first human trials of this prime-boost approach and found the body's response far surpassed either vaccine on its own.

The treatment did not induce complete immunity to malaria, but it provided partial protection. Researchers hope it will perform even better in field tests in Africa, where U.N. agencies say the mosquitoborne disease infects 300 million people a year and has become increasingly resistant to drugs.

Smallpox vaccine virus used in the tests is a modified form that researchers said is safer than one that has caused problems in recent vaccination programs.

The human tests were conducted after the idea was successfully tested in mice, Hill said.

Using a strain of the smallpox vaccine known as MVA, the researchers found it had "a rare ability to selectively boost" T-cells critical immune cells that attack invading disease that have been primed in advance by the malaria protein, Hill said.

Thus, Hill said, "the immunization order is critical."

The DNA vaccine induces T-cells to respond to a malaria antigen called thrombospondin-related adhesion protein, or TRAP; the modified smallpox virus also produces a response to TRAP. As a result, the T-cells react strongly to the malaria parasite, delaying its release from the liver into the bloodstream and reducing the number of released parasites.

Programs to immunize millions of Americans against smallpox have run into problems because of worries about side effects from the vaccine. Hill said the MVA strain of vaccinia is a safer strain of the smallpox vaccine.

"MVA was used in Germany in the 1970s as a smallpox vaccine," he said. Recently, he said, the United States has begun looking at it as a next generation vaccine. The government began research in February to develop a safer vaccine.

Along with its benefits in boosting response to malaria, Hill said, "It very likely protects against smallpox to some degree." Since naturally occurring smallpox has been eliminated, no data are available to prove that.

MVA is also being used in trials in Africa in an effort to boost the immune response to AIDS (news - web sites).

Mark James, a professor of tropical medicine at Tulane University in New Orleans, welcomed the report.

Even though the complete immunity sought by the scientists was not achieved, they reported a 70 percent to 80 percent reduction in parasites in the bloodstream, said James, who was not part of the research team.

In addition, James said, the vaccine would be relatively cheap to produce, is stable and has been found to be safe.

Besides Oxford, the team included researchers from Imperial College, London; Walter Reed Army Institute of Medical Research in Maryland; PowderJect Pharmaceutical Plc, in Madison, Wis.; and Oxxon Pharmaccines in England.

On the Net: Nature Medicine: http://nature.com/nm

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Vitamins May Cut Risk of Birth Defects in Diabetics

By Lois Barrett
Reuters Health
Monday, May 26, 2003

NEW YORK (Reuters Health) - Regular use of multivitamins may reduce the risk of birth defects in infants born to mothers with diabetes, results of a new study suggest.

Women of childbearing age are already advised to take supplements containing folic acid to protect against certain birth defects, but this study highlights the need for diabetic women to take multivitamins, researchers say.

"We were interested in seeing if the benefit against birth defects could also be seen in offspring of women with diabetes," lead author Dr. Adolfo Correa of the Centers for Disease Control and Prevention (news - web sites) in Atlanta, Georgia, told Reuters Health.

Researchers were not able to isolate which nutrients may be producing a beneficial effect. But in the study, diabetic women who reported regular use of multivitamins were just as likely to have a healthy baby as non-diabetic women who also supplemented regularly.

In contrast, women with diabetes who did not take a multivitamin were almost four times more likely to have a child with a birth defect than non-diabetic women who did not take a multivitamin.

"This study will help educate patients, rather than changing patterns of practice among physicians and nurses, who are already recommending use of multivitamins with folic acid to women in their childbearing years," said Dr. Gene Barrett, the president-elect of the American Diabetes Association.

The report emphasizes the importance of multivitamin use during periconception, which is defined as the three months prior to conception and the first three months of pregnancy. It is in the first weeks of pregnancy, when women often do not know they are pregnant, that the major organs and systems of the body are being formed.

Women who have poorly controlled diabetes in the first months of pregnancy are two to four times as likely to as non-diabetic women to have a child with birth defects, according to the March of Dimes. It is not known why diabetic women are at greater risk for having children with birth defects, but meticulous prenatal care has been effective in minimizing risks during these pregnancies.

"Good prenatal care that includes diabetes control, before and during early pregnancy as well as other factors such as adequate nutrition are advised to all diabetic women," Correa said. "And the study indicates that it would be prudent to recommend that diabetic women take multivitamins during pregnancy."

Birth defects of the brain, spinal cord and heart are more common in the children of diabetic women than in other women.

The group studied consisted of 3,278 women who had children with birth defects and 3,029 women who had healthy children in Atlanta between 1968 and 1980.

Regular supplementation was defined as taking multivitamins three or more times a week, and use had to occur during the three months prior to conception, as well as the first three months of pregnancy.

Correa is planning another study, scheduled to begin next year, in which data from more recent births and from a broader population will be analyzed. The research effort will include isolating multivitamin ingredients and assessing their benefits in protecting against birth defects.

Source: Pediatrics 2003;111:1146-1151.

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Trust Your Instincts, Skin Cancer Survivor Urges

By Kathleen Doheny
HealthScoutNews Reporter
HealthScoutNews
Monday, May 26, 2003

MONDAY, May 26 (HealthScoutNews) -- When Kim Fahnley first noticed the bumpy patch of skin on the side of her thigh, it was about a half inch in diameter.

She might not have given it a second thought, except it was irritating. And, as a blue-eyed blonde of northern European descent, she was well aware that skin changes can spell cancer.

So she showed it to her dermatologist, who wasn't initially concerned. However, he biopsied the tissue, just in case.

The bumpy area turned out to be malignant melanoma, the most virulent form of skin cancer.

Fahnley had surgery to remove the growth and eventually recovered just fine.

But the going was rough for a while. At the time of the surgery, she was just 29 and newly married. "They told me to hold off having kids," Fahnley remembers. "They wanted to be sure it wasn't going to reoccur."

Fortunately, it didn't. And since that scare 13 years ago, Fahnley has survived a bout with another type of skin cancer, opened her own sun-protective clothing business online and given birth to two children.

Equally important, she's learned to trust her gut instincts.

More than 1 million people in the United States get a diagnosis of skin cancer each year, according to American Cancer Society (news - web sites) estimates. And Fahnley is convinced that most of these patients could spot their cancers themselves, as she did.

"My advice is, when you notice a change on your own body, to trust your own instincts," she says.

When her second cancer surfaced six years ago, she again brought it to the attention of her doctor. "When I'd go to kiss my kids, it hurt," Fahnley recalls of the squamous cell cancer on her lip.

She told her dermatologist something just wasn't right. "He detected a small tumor on the inside of my lip," Fahnley says. Once more, surgery removed the cancer.

Always active outdoors, Fahnley had grown up with a passion for horseback riding and, later, gardening.

But after her surgeries, she found it difficult to keep her sun exposure to a minimum. "At my three-month checkups, my dermatologist would say, 'You are still getting sun,'" Fahnley says, "and I was using sunscreen."

So she launched Sun Solutions, a line of sun-protective clothing -- jackets, pants, hats, beachwear and other attire for adults and children -- to make it easier to ward off the sun while enjoying the outdoors.

Her children, now 11 and 9, are walking advertisements for the company, wearing her gear to outdoor activities and educating others about the benefits of sun protection. Her husband, Joel, also wears the clothes.

But the best advice, Fahnley insists, is to follow through with medical care if you notice a change on your skin -- even if a doctor reassures you it's nothing.

"You know your body best," she says.

More information

To learn more about protecting yourself from the sun, visit the Skin Cancer Foundation. For more on skin cancer, check with the National Cancer Institute.

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Youthful Hostility Linked to Adult Heart Disease

By Alan Mozes
Reuters Health
Monday, May 26, 2003

NEW YORK (Reuters Health) - Children and adolescents who approach the ups and downs of life with a hostile attitude might be at a heightened risk of developing health complications that can progress to adult heart disease, according to U.S. and Finnish researchers.

"There is a need for interventions designed to reduce hostility in young people to prevent the precursors to cardiovascular disease, like obesity or type II diabetes, which has become a huge health problem in children in the U.S.," the study's lead author, Dr. Karen A. Matthews of the University of Pittsburgh in Pennsylvania, said in a statement.

Parents, Matthews told Reuters Health, should try to address any conflicts their children might be having in order to ease hostile feelings.

Among the children and teens her team studied, the researchers found that anger, cynicism and aggression were associated with several cardiovascular risk factors, including obesity, high blood pressure and a condition called insulin resistance that can be a precursor to type 2 diabetes.

Such chronic conditions -- grouped together under the heading of "metabolic syndrome" -- have been shown to promote cardiovascular disease, the researchers note.

Matthews and her colleagues examined 134 children and adolescents in the Pittsburgh area who had no history of heart disease, mental illness or drug and alcohol abuse. The children were between the ages of 8 and 10, while the adolescents were between 15 and 17. The participants were divided roughly equally between male and female, and black and white.

Blood samples -- to assess the presence of the metabolic syndrome factors -- were drawn at the start of the study, and then again three years later. The children also underwent psychological testing to measure hostility levels.

Children and adolescents who had a clean bill of health at the start of the study but who had high hostility levels were more likely than other children to develop at least two components of the metabolic syndrome during the next three years, the researchers found.

Hostility was most strongly associated with the later development of obesity and insulin resistance, Matthews and her team report in the May issue of Health Psychology.

The researchers stress that the study did not explore all the variables that might contribute to hostile attitudes or to the development of the metabolic syndrome among young people.

For example, they suggest that future studies might focus on the role played by hormonal changes during puberty. They also note that diet, unhealthy lifestyle, stress and poverty might all have an impact on the association between hostility and heart disease.

Still, the authors conclude that taking steps to reduce kids' hostility -- in conjunction with promoting other lifestyle changes -- might end up reducing the risk of future heart disease.

"Parents can encourage their children to avoid over-eating (and to) exercise, and discuss areas of conflict as a way to prevent the development of the metabolic syndrome," Matthews told Reuters Health.

Source: Health Psychology 2003;22:279- 286.

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Skin Cancer: More than 1 Million New Cases in U.S. This Year

By Kathleen Doheny
HealthScoutNews Reporter
HealthScoutNews
Monday, May 26, 2003

MONDAY, May 26 (HealthScoutNews) -- More than 1 million Americans will learn this year they have skin cancer.

That's more than twice the number who will hear they have prostate or breast cancer (news - web sites), making skin cancer the most common cancer in the United States.

While prostate and breast cancers kill far more people, skin cancer -- usually caused by excess sun exposure -- can be deadly, too. The American Cancer Society (news - web sites) expects about 7,600 deaths this year from melanoma, the most virulent of skin cancers.

Dermatologists like Dr. David J. Goldberg, who practices at the Mt. Sinai School of Medicine in New York City, are worried because their skin cancer patients are younger and younger when first diagnosed.

"I've been in practice 17 years," he says. "Seventeen years ago, I saw people in their 50s. Now, I see fair-complected women in their 30s."

As discouraging as the news may sound, there are encouraging developments to note as Americans kick off the unofficial start of summer with Memorial Day.

Blocking out the sun's harmful rays has never been easier, thanks to new forms of sunblock as well as sun-protective clothing such as hats specially treated to filter the sun.

And, if caught early, skin cancers are highly curable.

Also, new treatments for skin cancer promise to be less disfiguring than surgery but just as effective, cancer experts say.

Fair-skinned, freckled, light-eyed persons who burn easily are most at risk for skin cancer, although others can get it as well. Changes on the skin are the most common warning sign of skin cancer, according to the National Cancer Institute (news - web sites). Not surprisingly, the most common skin cancers -- called basal and squamous cell -- are found mainly on areas often exposed to the sun, such as the face, neck, hands, arms and head.

Melanomas, so named because they develop in the pigment-producing skin cells called melanocytes, are most often found on the trunk of men and the lower legs of women, although they can appear on other sites as well.

Any change on the skin, especially in the color or size of a mole, should be checked by a dermatologist, experts say. The dermatologist may then decide to biopsy the area, taking a small sample of skin to examine it under a microscope for cancerous or pre-cancerous cells.

Standard treatments include removing the cancer with surgery, laser therapy, radiation or chemotherapy drugs in lotion or cream form applied to the skin, experts say.

A newer approach, says Goldberg, is photodynamic therapy. First, a light-activated drug that targets cancer cells is applied or injected. A day or so later, a laser light is aimed at the cancerous tissue and "switches on" the drug, which destroys the cancer cells but does not affect healthy cells, he says.

So far, the approach is only approved by the U.S. Food and Drug Administration (news - web sites) for treating other forms of cancer -- such as esophageal cancer -- and for pre-cancerous skin lesions. But some doctors are now trying it for skin cancers.

Another new approach being tested for some skin cancers is a so-called immune modifier, says Dr. Martin A. Weinstock, a professor of dermatology at Brown University and chairman of the American Cancer Society's skin cancer advisory group. A drug called imiquimod (Aldara) is applied topically; it works by triggering an immune response, causing the body to attack the malignant cells, he says.

Increasingly, doctors are also using digital photography to monitor people with suspected melanomas, to track and quantify how much the growth changes from visit to visit.

Even with these advances, Weinstock says, "the most important thing people can do is look carefully at their skin once a month."

An annual skin exam by your physician or dermatologist is also wise, says Dr. Diane Berson, an assistant professor of dermatology at the Weill Medical College of Cornell University in New York City and a spokeswoman for the American Academy of Dermatology. It's crucial, she says, if you have a family history of skin cancer or are at high risk.

Sunblocks are also vital, and an array of new products is making it easier to follow that recommendation, says Goldberg. Sunblocks and screens now come not only in cream form but gels and sprays, minimizing the "ick" factor of greasy creams. Clothing specially treated with sunblocking agents can help, too.

Despite all that has been said about skin cancer and the need for sunscreens, some people still don't bother to read the directions or know how to use the products properly, Goldberg says. Among the most common mistakes: People wait to apply a sunscreen after they've gone outdoors.

"Put it on a half hour before you go out," he says. And use a product with a sun protective factor (SPF) of at least 15. "And reapply SPF 15 every two hours," Goldberg adds.

More information

For information on basal and squamous cell cancers, see the American Cancer Society. For information on melanoma, click here.

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Coffee Shop Workers Have High Blood Pressure Risk

By Stephanie Riesenman
Reuters Health
Monday, May 26, 2003

NEW YORK (Reuters Health) - Workers in campus coffee shops are more likely to have high blood pressure than other people their age, possibly because they dine on the same salty and high fat foods that they serve to students, according to Venezuelan researchers.

In a small study, the researchers found that long-time workers in coffee shops located on a campus were more likely to have high blood pressure than their peers. They found that 18 percent of workers under age 30 and 41 percent of those over age 30 had high blood pressure, as did 48 percent of workers who were in the occupation for more than five years.

"It is alarming that the people in charge of alimentation in the university suffer a high prevalence of high blood pressure and elevated risk for cardiovascular disease, which means that the students are certainly at high risk for suffering the same consequences," said Dr. Napoleon Gabriel Macias.

Macias, along with colleagues at Universidad Central de Venezuela in Caracas, measured the blood pressures of 64 workers at six different coffee shops on the school campus.

"People who have worked for many years at a coffee shop having this unhealthy nutrition have more pronounced high blood pressure because they have been exposed to the risk factors for more time," said Macias.

Macias and his colleagues recommend that schools and universities incorporate nutritional education into job training. He says schools should create menus under a nutritionist's supervision to help employees and students eat a balanced diet and lower their risks for cardiovascular disease.

The findings were presented recently at a meeting of the Inter-American Society of Hypertension in San Antonio, Texas.

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Handling the Heat When You Have Heart Pain

HealthScoutNews
Monday, May 26, 2003

MONDAY, May 26 (HealthScoutNews) -- As the summer season unofficially kicks off today, the millions of Americans who have angina (news - web sites) need to be aware that hot weather can spell trouble for them.

Summer heat can raise the body temperature and result in increased blood pressure and heart rate, which can be harmful for someone with angina, says the Preventive Cardiovascular Nurses Association (PCNA).

If you have angina, the PCNA has some advice on how you can cope with the hot weather.

When it comes to exercise, start slow. Exertion can bring on angina. When the weather warms up, people with angina who already have an exercise program should avoid overexertion and should move slowly from their indoor winter exercise program to an outdoor summer program.

People who are new to regular exercise should start an exercise program in the spring before it gets too hot. For example, add short 10-minute walks each day. If you want to start exercising, you may also want to make an appointment with a local cardiac rehabilitation program for advice.

Make sure you keep your cool. Heat and humidity make your heart work harder and bring on angina symptoms. Wear loose-fitting and light clothing. Don't exercise in midday and drink enough water.

Keep your nitroglycerin handy so you can find it quickly if you do suffer angina symptoms. If you're traveling, remember to keep all medications and prescription information in a carry-on bag.

Keep the fun in family fun. Getting together with relatives can be fun, but it can also be stressful. People with angina need to avoid both physical and emotional overexertion.

Angina affects about 6.6 million people in the United States. About 400,000 are diagnosed each year. Symptoms include shortness of breath, fatigue and pain or discomfort in the chest, arm, neck and back.

More information

Here's where you can learn more about angina.

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Demand for Endocrinologists Outstrips Supply

By Stephanie Riesenman
Reuters Health
Monday, May 26, 2003

NEW YORK (Reuters Health) - With a greater proportion of the American population aging and becoming more obese, experts are concerned that there will be a shortage of doctors who specialize in treating diseases associated with these conditions.

"As people get older, these endocrine-related conditions, like diabetes and osteoporosis, are going up, so we just have to keep our eye on the ball," said Dr. Robert A. Rizza, a professor of medicine at the Mayo Clinic and Foundation in Rochester, Minnesota.

In an interview with Reuters Health, Rizza explained that he and his colleagues developed a mathematical calculation to track the needs of endocrinologists in the U.S. for the next 20 years.

By using the Kaiser Permanente Mid-Atlantic States HMO as a benchmark, it was determined that the U.S. population would need about one endocrinologist per 100,000 people.

As of 1999, the national supply of these specialists was about 12 percent lower than needed to care for patients with conditions such as obesity, diabetes and thyroid-related problems. This is a concern, according to the researchers, because the number of office visits to endocrinologists increased dramatically in the 1990s.

Snagging one of these visits is not easy, according to the report.

The study found that waiting times for non-urgent visits with endocrinologists were significantly longer on average than for other doctors. It took patients 37 days to get an appointment with an endocrinologist, but only about 10 days to see a general practitioner.

The graying of the U.S. population may increase the demand for endocrinologists even more, according to the report, since the risk of osteoporosis, diabetes and other endocrine-related diseases increases with age.

The study, published in the current issue of Endocrine Practice, said there was a 14 percent decline in the number of physicians enrolled in endocrine training programs in 1999. Fellowships in other internal medicine specialties, with the exception of nephrology and geriatrics, were also down in 1999 -- by an average of 13 percent.

If the number of endocrinologists remains at 1999 levels, Rizza and his colleagues estimate that demand for the specialists will continue to exceed the supply at least through 2020.

But the good news is the numbers of practicing endocrinologists has started to turn around, according to Rizza, as health experts have started to acknowledge the benefits of being treated by a specialist.

"We don't want to seem like we are clamoring for all these patients because these diseases are increasing," Dr. Robert Vigersky told Reuters Health.

"We're just saying that we know they're increasing and we are already see a certain percentage of them, to see the same percentage of them 10 and 20 years from now, there's going (to) have to be many more endocrinologists," he said.

Vigersky is the chair of the Clinical Affairs Committee for the Endocrine Society, which sponsored the study along with the American Diabetes Society and the American Association of Clinical Endocrinologists (news - web sites).

The researchers say this study shows that the specialty of endocrinology needs to have a long-term plan that includes training a sufficient amount of new physicians to meet the needs of the population.

Source: Endocrine Practice 2003;9.

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Obesity Surgery Success Depends on Surgeon

By Dana Frisch
Reuters Health
Monday, May 26, 2003

NEW YORK (Reuters Health) - Laparoscopic stomach bypass surgery, a minimally invasive operation performed on obese people to promote weight loss, is more likely to result in complications if the surgeon has performed few such operations, according to a new study.

Laparoscopic Roux-en-Y gastric bypass (RYGB), a form of stomach bypass surgery, restricts the amount of food the stomach can hold by making it smaller, into a "pouch." It also reduces the amount of nutrients absorbed because the pouch bypasses parts of the small intestine.

Laparoscopy involves making a small incision and inserting a tube and a camera into the abdomen to perform the surgery instead of opening up the entire abdomen. It is less invasive than open surgery and is associated with less post-operative pain and a shorter recovery period.

Researchers led by Dr. Richard A. Perugini, an assistant professor of surgery at the University of Massachusetts Medical School in Worcester, reviewed the cases of 188 patients who underwent laparoscopic RYBG between July of 1999 -- when surgeons first began performing the surgery at the medical center -- and January 2002.

They found that almost 27 percent of patients developed complications that required "invasive therapeutic interventions" to correct. The most common complication, occurring in 27 of this group of 50 patients, was a narrowing at the junction where the stomach, now a pouch, was attached to the loop of the small intestine.

Endoscopy to remove the narrowing was successfully performed the first time around in more than 90 percent of those patients. Other complications included bleeding where the staples were attached and bowel obstructions, both in about three percent of cases.

Perugini's team found that the rate of complications went down after the surgeon performed 120 operations.

Perugini told Reuters Health that there is a "learning curve" associated with any surgery, but that it was steeper in laparoscopic RYBG because it is such a complex surgery.

Patients might want to go to surgeons who have specialty training in weight-loss surgery to reduce their risk of complications further, Perugini said in an interview.

According to the study, published in the May issue of the Archives of Surgery, other independent predictors of complications were high blood pressure and sleep apnea.

Another finding of the study is that diabetic patients who underwent the surgery tended to lose less weight than those patients who did not have diabetes.

Perugini said that despite diabetics (news - web sites) losing less weight, they are likely to "reap the greatest benefits from the surgery" in terms of improvements in qualities of life, like lowering their mortality rates.

Source: Archives of Surgery 2003;138:541-546.

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For Preservative-Free Flu Shot, Ask in Advance

By Keith Mulvihill
Reuters Health
Monday, May 26, 2003

NEW YORK (Reuters Health) - Parents who wish to provide their young child with a thimerosal-free flu vaccine next flu season are being advised to let their pediatrician know now so it can be ordered in advance.

Thimerosal has been used for over 60 years to prevent microbial contamination in vaccines, but health officials have begun phasing it out because it contains mercury.

While the bulk of influenza shots given in the U.S. still contain at least some thimerosal, the U.S. Food and Drug Administration (news - web sites) has approved preservative-free flu vaccines. Previously, the pharmaceutical company Evans Vaccines was granted approval for a thimerosal-free flu vaccine for use in children over the age of 3.

Last September Aventis Pasteur got approval for its Fluzone preservative-free vaccine, which can be used in children 6 months and older. It became available to children in late November 2002.

Still, parents may need to ask their health care provider in advance about thimerosal-free flu vaccines to ensure that they have it on hand come next flu season, explained Dr. Walter Orenstein, director of the Centers for Disease Control and Prevention (news - web sites)'s National Immunization Program.

Most health care providers order their flu vaccine supplies in the spring before the fall and winter flu season.

"Parents have to ask their health care professional for a thimerosal-free flu vaccine," said Orenstein. "There is a limited supply since it is more difficult to produce, as I understand."

Nonetheless, Orenstein stressed the fact that thimerosal-containing flu vaccines pose no danger to youngsters.

"There has been controversy about thimerosal and there has been some concern that some parents might not want to give their child the flu vaccine unless they were offered a thimerosal-free version, explained Orenstein during an interview with Reuters Health.

"This was offered for those who wanted it as a potential alternative," he added.

Currently, Orenstein noted, the CDC's advisory panel says the preservative-free vaccine is equivalent in efficacy and safety to the one that contains thimerosal.

As such, the CDC has seen no reason to promote the options, Orenstein noted.

Orenstein also stressed that parents need to be aware of the risk influenza poses to very young children.

"Influenza disproportionately affects young children," he said. "The hospitalization rate for young children -- and the younger the child the higher the risk -- approaches that of adults over the age of 50 who are hospitalized," said Orenstein.

In 2001, the vaccine advisory committee of the CDC "encouraged" parents to have children 6 to 23 months old vaccinated for influenza starting in the 2002-2003 flu season.

Children in this age group are at "substantially increased risk for influenza-related hospitalizations," the CDC's Advisory Committee on Immunization Practices noted at the time.

The CDC is expected to make a full recommendation sometime in the near future that these children receive the flu vaccine annually but are still looking into the logistics of recommending the annual vaccination.

So, for the time being, flu vaccination for young children remains an "encouragement," Orenstein said.

According to the CDC, vaccination is most important for people who are at increased risk of complications from the flu. These include pregnant women, adults 65 and older and anyone over the age of 6 months with a chronic medical condition such as diabetes, asthma, or heart, lung or kidney disease. People are strongly advised to get flu shots at the start of flu season, generally in October and November.

Because of the late release of the thimerosal-free vaccine -- the flu season kicks off each October and parents are encouraged to have youngsters inoculated around that time -- demand for Fluzone was not very high last year, according to Aventis Pasteur spokesman Len Lavenda.

"Usage of Fluzone was low last flu season due to the timing of availability," Lavenda, who is based in Swiftwater, Pennsylvania, told Reuters Health.

Many pediatricians most likely did not have an opportunity to order the newer alternative.

"Our hope is that this year, with more advanced notice we will see interest in the vaccine pick up," said Lavenda.

"Our current challenge is for doctors to place orders as soon as possible to ensure timely delivery," he added.

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Weekend Exercise Does a Heart Good - German Study

Reuters
Monday, May 26, 2003

CHICAGO (Reuters) - Getting up from the couch and exercising even an hour or two a week can help stave off heart trouble, but strenuous job-related tasks may do more harm than good, a German study said on Monday.

Taking two hours of leisure time per week to exercise can cut the risk of heart disease by more than half compared to a sedentary lifestyle, the study said.

But work-related physical activity may lead to a less-healthy cardiovascular system, said study author Dr. Wolfgang Koenig of the University of Ulm Medical Center in Ulm, Germany.

Even less than an hour a week of exercise reduced the risk of heart disease by 15 percent compared to those who did not exercise during their leisure time, the study found. Between one and two hours of exercise a week cut the risk by 40 percent and more than two hours of exercise reduced the risk by 61 percent.

"Even simple activities such as low-intensity walking may lead to considerable reductions in mortality," Koenig wrote in the Archives of Internal Medicine (news - web sites), a journal published by the American Medical Association.

In contrast, work-related physical activity often consists of short bursts of exercise that do not confer cardiovascular benefits, the report said.

But it said the higher heart risk may be related to the lower class of many physical laborers.

Cardiovascular diseases are the leading cause of death and disability in developed countries, and half of all such cases are attributable to coronary heart disease.

In the study of nearly 800 Germans aged between 40 and 68, 312 of whom suffered from heart disease, the damage from lack of leisure-time exercise reported in summer and winter was evident in elevated levels of certain markers in the blood.

For instance, higher amounts of a type of protein involved in the immune system's inflammatory response can form harmful plaque that builds up in blood vessels and results in narrowing and hardening of the arteries.

"The present study provides additional evidence that leisure time physical activity, but not work-related physical strain, is associated with a decreased risk for coronary heart disease seen even at moderate levels," the study said. "These data therefore strongly support the recommendation of leisure time physical activity in the general population for the prevention of coronary heart disease."

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SUNDAY, MAY 25, 2003

A Look at Dry Eye

HealthScoutNews
Sunday, May 25, 2003

SUNDAY, May 25 (HealthScoutNews) -- If your eyes feel irritated, dry or scratchy on windy days, it may be a sign that you have dry eye syndrome.

It's a condition in which your eyes fail to produce enough tears or produce tears that don't have the proper chemical composition, says the Saskatchewan Association of Optometrists.

It's estimated about 10 million Americans suffer from dry eye syndrome.

In many people, dry eye is a natural part of growing older. However, it can be caused by other things, such as blinking or eyelid problems, or medications including antihistamines, oral contraceptives and antidepressants.

Other possible causes of dry eye include: chemical or thermal burns to your eyes; health problems such as arthritis or Sjogren's syndrome; general health problems; a dry climate; and wind and dust.

Symptoms of dry eye syndrome include irritated, dry, red or scratchy eyes. There may be a burning sensation, blurred vision or the sensation that there's foreign material in your eyes.

Excessive dry eye can cause damage to eye tissue, corneal scarring, impaired vision, and make it difficult to wear contact lenses.

If you suspect you have dry eye, see an eye specialist for an examination. There is no cure for dry eye, but there are treatments to keep your eyes healthy and forestall eye damage and vision problems.

They include blinking more often, increasing humidity levels at home and/or work, and using artificial tears and moisturizing ointment.

In some cases, eye doctors will insert small plugs in the corner of the eyes to slow tear drainage. Another treatment is surgery to close tear drainage ducts.

More information

Here's where to go to learn more about dry eye syndrome.

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If It's Not Colic, It Might be GERD

By Jennifer Thomas
HealthScoutNews Reporter
HealthScoutNews
Sunday, May 25, 2003

SUNDAY, May 25 (HealthScoutNews) -- Carolyn McGraw was beside herself. Her newborn daughter, Lauren, seemed like she was in constant misery.

She howled through the day and night. She spit up so often that at 4 weeks old, she was severely underweight.

"I felt helpless," says McGraw, who lives in southern California. "I was a new mom, and despite all the comforting and holding my child, she was still writhing in pain."

Lauren endured test after test until finally, doctors diagnosed her problem -- gastroesophageal reflux disease, or GERD. It occurs when a valve in the esophagus malfunctions, allowing the acidic contents of the stomach to flow back into the esophagus.

Once thought to be an adult disease, there's increasingly awareness among pediatricians and parents that GERD is a relatively common childhood ailment that appears anytime between the first few weeks of life and the teen years.

According to a recent study in the Archives of Pediatrics and Adolescent Medicine, GERD "is a common disease of infancy with a prevalence as high as 18 percent in [otherwise] healthy children."

Dr. Bill Sears, a pediatrician in San Clemente, Calif., says, "For a child with GERD, it hurts them to eat and it hurts them to sleep, so they learn to associate eating and sleeping with pain rather than pleasure. But they're too young to describe the feeling. When I see them in my office, the parents say, 'I know my child hurts somewhere.'"

GERD is often dismissed as mere colic, which really isn't a medical condition at all, but mainly a description for a fussy baby who cries a lot, he says.

"GERD is one of the most commonly missed diagnoses," Sears says. "Many so-called colicky babies really have GERD and nobody knows about it."

What makes GERD easy to miss is that it's normal and common for infants to spit up several times a day, says Dr. William Cochran, chairman of the American Academy of Pediatrics' section of gastroenterology and nutrition.

"I call them the 'happy spitters,'" Cochran says. "All babies have reflux. It's OK if the baby spits up once a day or 10 times a day, as long as the baby is happy and if there are no other problems. About 90 to 95 percent of them will outgrow it by 1 year of age."

It's only when the vomiting is accompanied by pain and other problems that it becomes a disease. Severe GERD can lead to everything from bleeding in the esophagus to sinus and respiratory ailments. GERD that goes unchecked for many years can even increase the chances of esophageal cancer, Cochran says.

"If the baby is distressed, if the baby is not eating and not gaining weight, if they're not sleeping well and are irritable, that's when it becomes a disease," he says.

The respiratory problems occur because the openings to the trachea, also known as the windpipe, and the esophagus, which carries food to the stomach, are next to each other. When the baby regurgitates, tiny food particles can get into the lungs and the sinuses.

In a study of children with chronic sinus problems, Cochran and his colleagues found treating the reflux improved the sinus condition in about 80 percent of the children.

There are many degrees of reflux, Sears says. Some children have mild cases that can be relieved by making simple lifestyle changes.

When Sears suspects GERD, among the first things he advises are:

  • Position your baby on the left side when you put him or her to sleep. This lets gravity help keep the food down. Also, keep your child upright for at least half an hour after eating.
  • Feed a child smaller, more frequent meals. In older children, avoid fatty foods, caffeine, tomato/citrus products, carbonated beverages, spicy foods and junk food.
  • Elevate the head of your child's bed.
  • Protect the child from secondhand cigarette smoke.

If these changes don't provide relief, Sears says parents can try several types of medication, including:

  • H2 blockers, prescription medicines that partially block the production of stomach acid to let the esophagus heal. One brand name: Zantac.
  • Proton pump inhibitors, prescription acid suppressant medications that block the final stage of acid production in the stomach. One brand name: Prevacid.

For those children with a serious form of the disease who aren't helped by any of these treatments, surgery is an option.

By age 5, Lauren was so ill she needed an operation called a fundoplication, in which surgeons wrap a band of muscle around the lower esophagus to tighten the malfunctioning valve.

The causes of GERD are not known, although a study of five families who had more than one child with severe pediatric GERD found what appeared to be a genetic marker on chromosome 13. The study was published in 2000 in the Journal of the American Medical Association (news - web sites).

The McGraws, one of the five families that took part in the study, are pretty sure if there is a GERD gene, they have it. Their second daughter, Kristen, was born with mild reflux. They later had twin boys, Ian and Shaun, who were both born with severe reflux.

And at 8, Lauren needed a second lifesaving surgery.

"It was very, very difficult on me and my husband," McGraw says. "We went for years where we only got a few hours of sleep a night."

Seeing the agony her children went through, McGraw got involved with the Pediatric/Adolescent Gastroesophageal Reflux Association (PAGER), an organization dedicated to raising awareness of GERD. She served as co-director for several years before resigning a few months ago to focus more on raising funds for genetic research.

"No child should have to suffer and no child should have to be in pain," she says.

The McGraws' children, now 16, 14 and 10, are doing better. Lauren, Ian and Shaun take proton pump inhibitors, but they still struggle with reflux-induced asthma, chronic sinus problems, sleepless nights and bouts of pain. The whole family eats a special diet to minimize stomach acidity.

"GERD can affect the whole family, physically, financially and emotionally," McGraw says. "Raising awareness is not only going to help heal the child, which is so important, but it can help heal the whole family."

More information

To read more about GERD in children, visit the PAGER Web site, Reflux.org. Or check the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Web sites at KidsAcidReflux.org or TeensAcidReflux.org.

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SATURDAY, MAY 24, 2003

Unclogging Your Nose

HealthScoutNews
Saturday, May 24, 2003

SATURDAY, May 24 (HealthScoutNews) -- When you're nosing around drug store shelves for a nasal spray to blast through those clogged nostrils, it can be difficult to decide which one is best for you.

When it comes to over-the-counter (OTC) nasal sprays, you should know there are different kinds: non-medicated nasal saline sprays and medicated nasal decongestant sprays.

Nasal saline sprays can be used for all types of nasal problems, says the American Academy of Otolaryngology-Head and Neck Surgery. Saline nasal sprays create added moisture, which reduces thick nasal secretions and helps remove infection-causing agents.

Apply the nasal saline spray as a mist to your nose up to six times a day. You can't get addicted to nasal saline, which you can make at home. Talk with your otolaryngologist for details on how to do that.

The other kind of nasal sprays are medicated nasal decongestant sprays. These sprays decongest swollen nasal membranes and clear nasal passages almost immediately after you use them. They're useful for treating the early stages of the common cold or viral infection.

They're also effective in stopping the progression of sinus infections that may appear after you have a cold. Medicated nasal decongestant sprays also prevent problems in your eustachian tube, which connects your middle ear and pharynx, when you're flying.

Nasal decongestant sprays are safe but should only be used for three to five consecutive days. Prolonged use of these sprays can cause rebound congestion and/or you may get hooked on them.

More information

The American Academy of Family Physicians (news - web sites) has information about the correct use of nasal sprays that come in pressurized canisters and pump bottles.

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Ear Pain on Airplanes

HealthScoutNews
Saturday, May 24, 2003

SATURDAY, May 24 (HealthScoutNews) -- Even on the smoothest of flights, a discomfort most flyers can count on is ears that pop as the plane is landing.

The American Academy of Otolaryngology-Head and Neck Surgery reports that ear problems are the most common medical complaints of airplane travelers.

The culprit behind such problems is a part of the middle ear called the Eustachian tube, a tiny but important passageway that connects the middle ear to the back of the nose.

Under normal circumstances, the Eustachian tube does its job of maintaining an equal balance of air pressure on both sides of the eardrum.

However, when the body is subjected to rapid changes in air pressure, such as flying on an airplane, the Eustachian tube must open frequently and wide enough to try to equalize the quick change in pressure.

One of the best ways to help with that process is simply swallowing, which activates the muscle that opens the Eustachian tube. The traditional technique of chewing gum or sucking on mints is also effective, because both make you swallow more often, and yawning is an even better trick.

Since you don't want to give gum to babies and you probably can't tell them to yawn, experts advise instead letting them suck on bottles or pacifiers to facilitate swallowing and don't let them sleep while landing.

Adults also should avoid sleeping while landing to prevent ear problems, and many experienced travelers take nasal decongestants before landing to shrink the nasal membranes and help the ears pop more easily.

If none of the methods succeed in opening your ears, or if you're experiencing ear pain after landing, medical help should be sought.

More information

The Hearing Alliance of America offers more information on ear pain and flying.

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