The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
August 16, 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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 31 - June 6

 FRIDAY, JUNE 6, 2003

Vitamin D May Aid Breast Cancer Treatment

By Colette Bouchez
HealthScoutNews Reporter

HealthScoutNews

Friday, June 6, 2003

FRIDAY, June 6 (HealthScoutNews) -- Vitamin D could hold a clue to more effective breast cancer (news - web sites) treatment.

That's the suggestion put forward by a group of Dartmouth researchers in a report in the June issue of the Journal of Clinical Cancer Research.

The study, which involved the treatment of breast cancer tumors in mice, adds to a growing body of evidence that a derivative of vitamin D known as EB1089 may yield some powerful anti-cancer properties, particularly when combined with radiation therapy.

"When compared to other cancer treatments, the vitamin D analog is much less toxic and, at least preliminarily, it appears to aid radiation therapy in impacting the growth of tumor cells," says lead author Sujatha Sundaram, a research assistant professor at Dartmouth Medical School.

An analog is a synthetic, laboratory-made derivative of a parent compound -- in this case vitamin D -- that is genetically engineered by adding or removing certain chemical elements. In the instance of EB1089, it was necessary to modify vitamin D because "at the dose you need to give to have an effect on cancer, it could cause some side effects," Sundaram says. Those side effects would include an overload of calcium, a condition known as hypercalcaemia.

The analog used in the study, Sundaram says, has little or no toxic reaction, even in high doses.

Adding the vitamin D to the treatment regimen is thought to enhance the ability of the radiation to bring about apoptosis -- or cell death. It also reduces the proliferation, or growth of cancer cells, in the tumor itself, Sundaram explains.

"These are all things that radiation therapy can accomplish on its own. But the EB1089 appears to make the treatment more effective, possibly reaching pockets of cells that might otherwise be missed, or in encouraging apoptosis in cells that for one reason or another might be stubborn or resistant to the effects of the radiation," Sundaram says.

While the finding in this particular study is unique, previous research on vitamin D found it was effective against both prostate and breast tumors. Currently, a large European trial is testing EB1089 on human cancer patients.

For radiation oncologist Dr. Victor Ayzenberg, the study results and the compound offer hope.

"It's a very good study, with important information. It would be great if we can use it with patients," says Ayzenberg, a clinical professor of medicine at the Mount Sinai School of Medicine in New York City.

It's a simple idea, he adds, but it clearly has merit.

The new study was small, involving just eight mice, each implanted with human breast cancer cells. When tumors reached approximately 200 millimeters in size, half the mice received an infusion pump with a continuous flow of EB1089 for eight days. The other mice received a pump containing a harmless solvent solution.

After a few days rest, both groups of mice received three "fractions" -- or doses -- of radiation therapy over the course of three days. The tumors were then monitored for 25 to 30 days, checking for both size and spread.

The result: The mice treated with EB1089 had a far faster rate of tumor regression, with tumors shrinking to a much smaller size. In the final analysis, the tumors in the mice receiving EB1089 plus radiation were approximately 50 percent smaller than those receiving radiation alone.

In addition, Sundaram says, there was less cancer cell proliferation -- or cell growth -- in the mice treated with the vitamin D analog. This, she says, indicates that EB1089 not only helped encourage apoptosis of the tumor cells, it also blocked new tumor cell growth.

As encouraging as the findings are, Sundaram stresses cancer patients should not assume that vitamin D supplements will have the same effect. And she warns that overloading on supplements could be dangerous.

More information

To learn more about radiation therapy, visit The American College of Radiology. For more on breast cancer, check with the National Institutes of Health.

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Human Arteries Grown in a Lab

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Friday, June 6, 2003

FRIDAY, June 6 (HealthScoutNews) -- By finding a way to keep smooth muscle cells dividing indefinitely, scientists have managed to fashion the first-ever human arteries from non-embryonic tissue in a laboratory.

The hope is that, eventually, these engineered human arteries will be available for routine use in coronary artery bypass surgery.

"This had never been done before. We took a task that was previously thought to be impossible and now put it in the realm of the possible," says Chris Counter, co-senior author of a paper appearing in the June 6 issue of EMBO Reports, the journal of the European Molecular Biology Organization.

Dr. Augustus O. Grant, incoming president of the American Heart Association (news - web sites) and a professor of medicine at Duke University School of Medicine, says the feat is "without a doubt" a big step in heart research.

The search for a way to grow functioning human arteries has been on for quite some time.

The majority of coronary artery bypass grafting in the United States use blood vessels that have been harvested from somewhere else on the patient's body, usually from the legs. This is far from a limitless supply. Every year, some 100,000 people who need small-vessel grafts can't get them because their own veins are unsuitable.

"There are a lot of technical problems with securing appropriate vessels on the patients' themselves," Grant says. "We need them."

One major obstacle has been the fact that smooth muscle cells, which form the outer wall of the vessels, have not survived long enough in culture to be able to develop a sturdy artery. "Before you can get a strong, sturdy vessel, the cells have undergone a large number of replications," Grant explains. "They become senescent. They become old."

The authors of the current study borrowed from cancer biology to ameliorate this problem.

Each cell chromosome has a section called a telomere. Each time a cell divides, the telomere shortens until, after a certain number of divisions, the telomere becomes so short it sends a signal to the cell to stop dividing. It's sort of the biological equivalent of planned obsolescence.

The authors of this study found a way (by inserting a gene called hTERT) to shut off a portion of one of the enzymes involved in the process of cell division. Shutting this down essentially made the cells immortal. Longer-living cells meant the scientists had time to construct their arteries. After the vessel walls were created, the lining of endothelial cells was added.

"The catch behind it is one had to make sure that you aren't creating cancerous cells because in essence this is one of the principles that cancer cells could use to propagate," Grant says. "That does not seem to have happened with these cells."

The authors estimate that it could take as long as a decade before these arteries are in routine use in operating rooms.

More long-term studies are needed to show the durability of these vessels. Scientists also want to make the entire vessel out of one person's cells (this artery was constructed out of cells from different people) and to do this many times over. Counter says his group has already submitted a paper for publication that repeats the accomplishment, using cells from one person.

Also, once real people involved, the researchers want to make sure the enzyme can be turned off again. "We want to erase all signs that we manipulated the cells before it goes back into the patient," Counter says.

More information

For more on coronary artery bypass surgery, visit the University of Michigan or the American Heart Association.


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Early Prenatal Diabetes Testing Not Necessary

 

By Colette Bouchez
HealthScoutNews Reporter

HealthScoutNews

Friday, June 6, 2003

FRIDAY, June 6 (HealthScoutNews) -- Getting tested for diabetes during your first prenatal doctor visit is often considered routine pregnancy care, but the test may not be necessary.

That's the conclusion of researchers from the Kaiser Foundation Hospital in California, where studies found the test has such a high rate of false positive results that it does little in the way of predicting who is really at risk.

"Traditionally, the prenatal exam includes a fasting plasma glucose screening, which measures the level of sugar in the blood after a period of fasting," explains Dr. Michael Silverstein, an assistant clinical professor of obstetrics and gynecology at New York University Medical Center.

What this new study shows, Silverstein adds, is that the screening may serve little purpose -- other than uncovering a hidden insulin problem that may have existed before the pregnancy.

"According to the research, the screening does not appear to be that accurate in predicting gestational diabetes," Silverstein says.

Much like regular diabetes, gestational diabetes impairs the ability of the hormone insulin to properly move sugar from the blood to the tissues and organs where it is needed to produce energy.

In the beginning of a pregnancy, a woman's natural insulin production overpowers the placental hormones, so sugar levels don't soar. However, experts say that as a baby grows, so much of the insulin-destroying placental hormones is made that they eventually overpower the mother's insulin production.

When this occurs, gestational diabetes develops -- usually somewhere around the 24th week of pregnancy. According to the American Diabetes Foundation, it's a problem that affects 200,000 women a year.

Although a fasting plasma glucose screening administered during the first prenatal visit was always thought to help identify those women at risk for this problem, the new study shows testing this early may be a waste of time.

In the new report, study author Dr. David Sacks says the high false positive rate "makes it an inefficient screening test."

The study, published in the June issue of Obstetrics and Gynecology, involved 4,507 women, all of whom were tested for diabetes using the fasting plasma glucose screening early in their pregnancy. Those whose tests revealed sugar levels greater than 126 milligrams/deciliter of blood were re-tested. If sugar levels remained high, they were automatically referred for high-risk pregnancy diabetes care.

In the final analysis, 302 women were diagnosed with gestational diabetes. Of those, 12 were in the first testing group, where blood sugar levels initially measured 126 or higher. An additional 34 women were identified before their 24th week of pregnancy after a fasting glucose test revealed levels between 100 and 126.

However, the study also found a high false positive rate of some 57 percent among the women who tested early on. This, say researchers, reduced the "sensitivity" of the test to just 80 percent, a relatively low number in terms of accuracy.

The final conclusion: Fasting plasma glucose screening early on in pregnancy is not sensitive enough to identify those at risk for this problem.

"I believe that this is an important finding and one that we need to consider very carefully when deciding the right time to screen a pregnant woman for gestational diabetes," Silverstein says. He also believes that, unless risk factors are present, screening early in the third trimester would be the best time to reflect the most accurate diagnosis.

Risk factors for gestational diabetes include obesity, family history of diabetes, previous birth of a large baby or a stillbirth, or previous birth of a child with birth defects.

Normally, gestational diabetes is controlled via diet and exercise, and sugar levels usually return to normal shortly after delivery.

However, even when controlled, babies born to mothers with gestational diabetes can be larger than normal -- a condition known as "macrosomia," often making a Caesarean delivery necessary. In addition, these babies may have an increased risk of low blood sugar following birth, as well as an increased risk of jaundice and an increased risk of respiratory distress syndrome, a disorder that can make it hard for them to breathe. Later in life, they may also have a higher risk of diabetes and obesity.

More information

To learn more about blood sugar testing, visit Your Family Doctor. To find out more about gestational diabetes, check out The National Institute of Child Health and Human Development.

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Smokers More Likely to Develop Allergy to Earrings

By Alan Mozes

Reuters Health

Friday, June 6, 2003

NEW YORK (Reuters Health) - Smoking may increase the risk of developing allergies to a wide variety of materials, including metal found in earrings and in the buttons of blue jeans, a group of Danish researchers has found.

In the study of more than 1,000 men and women ages 15 to 69, such allergies were more common in people who smoked or used to smoke, according to a report in the May issue of the Journal of Allergy and Clinical Immunology.

So-called contact allergies are reactions -- such as red itchy skin -- that occur in response to touching a particular substance.

Dr. Allan Linneberg at Glostrup University Hospital in Copenhagen found that contact allergies to nickel -- which is found in earrings and in the buttons to blue jeans -- were more common among smokers. Although allergies to nickel sometimes develop in people who wear earrings, smokers had an increased risk of nickel allergy whether or not they wore earrings.

"I think it is safe to say that this study points out yet one more reason for people not to start smoking, and if they smoke, to quit," said Dr. Kathleen A. Sheerin of the Atlanta Allergy and Asthma Clinic in Georgia, who was not involved with the study. She is the vice chair of the public education committee of the Milwaukee-based American Academy of Allergy, Asthma, and Immunology.

Sheerin told Reuters Health that as this appears to be the first study of its kind to explore the relationship between smoking and contact allergy, more research will be needed to understand the reason for the connection.

The researchers note that they do not yet know exactly how smoking might lead to the apparent elevated allergy risk.

If future research supports the link between smoking and an increased allergy risk, smokers might find that kicking the habit may prevent some cases of allergies, according to the report.

Source: Journal of Allergy and Clinical Immunology 2003;111:980-984.

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Study: Women Pregnant With Boys Eat More

 

By Emma Ross

AP Medical Writer

The Associated Press

Friday, June 6, 2003

LONDON - Women pregnant with boys tend to eat about 10 percent more calories a day than those carrying girls but don't gain more weight, new research indicates.

The study, published this week in the British Medical Journal, appears to explain — at least in part — why newborn boys are heavier than girls and suggests that signals between the fetus and the mother drive the appetite during pregnancy.

Boys are on the average 3.5 ounces heavier at birth than girls. The study by researchers from the Harvard School of Public Health and the Karolinska Institute in Stockholm, Sweden, is the first to examine whether that difference could be due to the mother eating more.

The scientists assessed the diets of 244 American women one week before they came to the hospital for a routine prenatal checkup at 27 weeks of pregnancy. All the women later gave birth to normal-weight babies at full term.

The researchers found that women who gave birth to boys were consuming about 10 percent, or 200, more calories per day than those who went on to bear girls.

Yet the amount of weight mothers gained during pregnancy did not differ between those who had girls and those who had boys.

"This sounds undoubtedly driven by the fetus," said Kent Thornburg, a fetal physiologist at Oregon Health Sciences University who was not connected with the study.

Thornburg said the findings do not necessarily mean that boys are heavier solely because their mothers eat more.

"That would lead to the conclusion that the more a pregnant woman eats the bigger her baby will be and that female babies would be larger if only their mothers ate more," he said. "A more realistic hypothesis is that fetuses stimulate the appetite in their mothers in proportion to their requirement for optimal growth."

Scientists do not understand exactly what causes appetite to increase during pregnancy, but the study's findings suggest there is a chemical communication between mother and fetus so that males can grow faster than females, with the mother being signaled to eat more to enable that growth, Thornburg said.

Thornburg said the findings could be relevant to the recently discovered relationship between growth in the womb and the risk in adulthood of illnesses such as heart disease and diabetes.

"A decade ago, we thought that the primary risk for chronic disease in any apparently healthy baby was solely the result of genetic endowment from parents," Thornburg said. "We now know that the access to nutrients by the fetus is important in determining prenatal growth rate and thus lifelong health."

The study's authors said their results indicate that male fetuses may be more vulnerable than female ones to problems linked to fetal nutrition.

On the Net:

The British Medical Journal: http://www.bmj.com

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Music Preferences Linked to Personality: Study

By Natalie Engler

Reuters Health

Friday, June 6, 2003 

NEW YORK (Reuters Health) - The music you listen to may say more about you than you think, according to new research findings that suggest that our choice in music reflects our personalities.

Do you enjoy blues, jazz, classical and folk music? You may be intelligent, tolerant and politically liberal, researchers report.

Meanwhile, country and religious music fans tend to be cheerful, outgoing, reliable and conventional, while alternative and heavy metal music lovers tend to be physically active, curious risk-takers.

As for rap/hip-hop and dance music fans? They are often outgoing, agreeable people who generally eschew conservative ideals, according to a report in the June issue of the Journal of Personality and Social Psychology (news - web sites).

The findings help explain why people who meet at parties often ask one another about their favorite music or bands, study author Dr. Peter J. Rentfrow told Reuters Health. "It assumes that knowing the answer tells you something about who they are" and whether or not to pursue a relationship, added Rentfrow, a psychologist at the University of Texas at Austin.

The results, noted Rentfrow, could have implications for not just dating and friendships, but for marketing, too. Already advertisers use music to entice certain types of people to buy their products.

"We might come up with typologies comprised of music preferences, socioeconomic status, and age," he told Reuters Health.

Online merchant Amazon.com, among other Web sites, tracks customers' purchasing history and browsing patterns and compares their habits with those of others in order to come up with product recommendations. While the company chose not to disclose data indicating the success of this approach, a spokesperson told Reuters Health that it is "well suited to music, where tastes don't change much over time."

Common sense? Perhaps. On the other hand, said Rentfrow, the study may reveal insights into "the mundane."

"Sometimes the most obvious things are hardest for researchers to see," he told Reuters Health. "That's why there's so little research on music preferences and personality. Because it's something we take for granted."

To look at the relationship between music preferences and personality traits, Rentfrow and Texas colleague Dr. Samuel D. Gosling conducted six studies on over 3,500 students. They examined the students' beliefs about music, their music preferences, self-perceptions and cognitive abilities.

Their findings suggest that personality, self-perception and cognitive ability each play a role in the "formation and maintenance of music preferences," they write.

Source: Journal of Personality and Social Psychology 2003;84:1236-1254.

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Drug Eases Pain of Arthritis in Spine

HealthScoutNews

Friday, June 6, 2003

FRIDAY, June 6 (HealthScoutNews) -- The drug etanercept eases the painful and debilitating inflammation caused by a form of arthritis called ankylosing spondylitis (AS).

That's what a German study in the June issue of Arthritis & Rheumatism found.

AS is characterized by inflammation of the joints of the spine. It can affect both men and women, but the majority of people with AS are young men who begin to develop chronic low back pain and general stiffness in their 20s and 30s.

AS can fuse the spine and cause serious problems of the hip and other joints. This may occur gradually, but it can also happen rapidly. Because the disease can occur at a young age and because the early symptoms of AS are often overlooked, the condition can be difficult to treat.

The common current therapy consists of nonsteroidal anti-inflammatory drugs and physiotherapy. But this approach has limited success in relieving AS-related pain or improving quality of life for people with the disease.

This study included 30 males with active AS. They were randomly divided into two groups. For the first six weeks, 14 of them received 25 milligrams of etanercept twice a week while the other 16 received a placebo. For the final six weeks of the study, all 30 men received etanercept.

The study found that treatment with etanercept resulted in at least a 50 percent regression of AS activity in 57 percent of the AS patients by the sixth week, compared with 6 percent of the men treated with placebo.

After the men receiving the placebo were switched to the drug, 56 percent of them had significant improvement of their AS symptoms.

More information

Here's where you can learn more about ankylosing spondylitis.

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Clot, Inflammation Factors Higher in Smokers

By Linda Carroll

Reuters Health

Friday, June 6, 2003

NEW YORK (Reuters Health) - Cigarette smokers have higher blood levels of three clotting and inflammation factors that have been linked to a greater risk of heart disease, a new study shows.

A heart expert unaffiliated with the study said that the new results may help explain why smokers are at higher risk of having heart attacks -- and why that risk diminishes fairly quickly after a smoker quits.

"It's been clear for a while that smoking is a risk factor for heart disease," Dr. Daniel J. Rader, director of preventive cardiology at the University of Pennsylvania School of Medicine in Philadelphia, said in an interview. "But there's still a big question as to why smoking is a risk factor."

In the new study, which included more than 17,000 smokers, non-smokers and former smokers, current smokers had the highest levels of C-reactive protein, fibrinogen and homocysteine.

Former smokers had only slightly elevated levels of all three markers compared to non-smokers, according to the report published this week in the Annals of Internal Medicine.

The study, conducted by Dr. Lydia A. Bazzano, of the Tulane University School of Public Health and Tropical Medicine in New Orleans, and colleagues, included participants in the National Health and Nutrition Examination Study (NHANES).

The study may help explain why the risk of heart disease and heart attack go down quickly after a smoker kicks the habit, Rader said.

"If smoking promoted atherosclerosis, you would expect that if someone smoked for 20 years that the elevated risk would still persist," Rader explained. "So that suggests that the impact of smoking is not so much on plaque buildup itself but on factors that promote plaque rupture."

A heart attack occurs when fatty plaques inside arteries rupture and the body forms a clot to help repair the damage, Rader explained. If any of the clots make their way to the heart's arteries, they can block blood flow to the organ.

Fibrinogen and C-reactive protein are both related to inflammation, Rader said.

"And that's definitely a key component of plaque rupture," he added. "Fibrinogen and homocysteine are key components in the development of (clots)."

There are other, more important, markers of clots, Rader noted. And, he added, "It would have been a more complete study if those other markers had also been measured."

Still, the new study underscores the importance of quitting smoking to protect the heart, Rader said.

"It's a little known fact that in ex-smokers the risk of heart disease goes back to baseline within about two years, as compared to lung cancer, for which the markedly increased risk remains at least a couple of decades after a smoker quits," he said.

Source: Annals of Internal Medicine 2003;138:891-899.

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Remembering the Good Times

HealthScoutNews

Friday, June 6, 2003

FRIDAY, June 6 (HealthScoutNews) -- As you get older, your memory just naturally seems to focus on the positive and dispose of the negative.

So says a report by University of California and Stanford University psychologists that appears in the June issue of the Journal of Experimental Psychology: General.

The psychologists found that, compared with younger adults, older adults recalled fewer negative than positive images. The older people were, the more they displayed the memory bias favoring the recall of positive images.

It was previously found that older people are able to regulate their emotions more effectively than younger people by maintaining positive feelings and lowering negative feelings.

The University of California and Stanford University psychologists wanted to understand how older people do that. The researchers decided to focus on the role that memory plays in the process.

They did two studies that examined age-related differences in peoples' memories of positive, negative and neutral images of people, animals, nature scenes and inanimate objects.

The first study included 144 people in age groups of 18-29, 41-53 and 65-80. It found the older adults recalled fewer negative images than positive or neutral images.

The second study included 64 people in the age groups of 19-30 and 63-86. In this study, the researchers ruled out mood as a factor by testing the study subjects for mood and depression before they viewed the images. Mood affected younger and older people alike, ruling it out as a factor.

This study also found the older people recalled fewer negative images than the younger people.

"With age, people place increasingly more value on emotionally meaningful goals and thus invest more cognitive and behavioral resources in obtaining them," the study authors write.

More information

Here's where you can learn more about the brain and aging.

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Sepsis Infections May Be Underestimated in Newborns

Reuters Health

Friday, June 6, 2003

NEW YORK (Reuters Health) - Current estimates of the frequency of group B streptococcal infection among newborns -- a leading cause of death in this group -- may be flawed due to testing inaccuracies, UK doctors announced Thursday.

While group B streptococcus (GBS) rarely makes healthy young adults sick, the bug can cause health problems for pregnant women and babies. GBS can also sicken elderly people or those with existing medical problems.

Infection in newborns can cause neonatal sepsis -- a massive immune response that can be fatal -- and meningitis, an inflammation of the membranes surrounding the brain that can be fatal or lead to brain damage.

Now, lead author Dr. Alison Bedford Russell, of St. George's Hospital in London, and colleagues report that the standard methods of detecting the bacteria in newborns -- testing blood or spinal fluid -- may often result in false negative results.

In their study, the team of researchers screened 413 babies for sepsis and infection during the first 72 hours of life. Besides tests of cerebrospinal fluid or blood or both, screening also included deep-ear swabs, chest x-rays and other routine diagnostic tools.

A diagnosis of definite early onset GBS sepsis was made if spinal fluid or a blood test was positive and the infant had symptoms of sepsis, pneumonia or meningitis, according to a research letter in The Lancet.

The researchers calculated a "definite" rate of early onset GBS infection of 1.1 per 1,000 newborns based on the four cases that they identified, according to the report.

However, nine other cases of early onset GBS infection were deemed "probable" according to deep-ear swabs.

This resulted in a rate of 3.6 cases of definite or probable early onset GBS infection per 1,000 infants born, according to the researchers. This rate suggests, "that the burden of disease is much higher than previously estimated in the UK," according to the authors.

The results of the study "confirm our previous findings that relying on blood or cerebrospinal cultures alone to assess the incidence of early-onset group B streptococcal sepsis results in underestimation of the true burden of this disease in (newborns)," the authors write.

The authors advise that maternity wards conduct "active surveillance of both definite and probable early onset group B streptococcal sepsis infection" and plan and implement appropriate prevention guidelines.

Source: The Lancet 2003;361:1953-1954.

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Few Doctors Counsel Pregnant Women on Smoking

HealthScoutNews

Friday, June 6, 2003

FRIDAY, June 6 (HealthScoutNews) -- While they recognize the harmful health effects caused when pregnant women smoke, many doctors in the United States don't take advantage of opportunities to help those women stop smoking.

That's the finding of a new national survey in the May-June issue of Nicotine & Tobacco Research.

The survey of 793 doctors covered 5,622 office visits by pregnant women. It found that doctors identified the women's smoking status at 81 percent of the office visits but provided counseling to quit smoking only 23 percent of the time.

"Although physicians frequently identified the smoking status of pregnant women, they did not often counsel smokers about quitting," study author Dr. Susan Moran, of Harvard Medical School (news - web sites) and the Tobacco Research and Treatment Center at Massachusetts General Hospital, says in a news release.

Smoking while pregnant can result in pregnancy complications, low baby birth rate, and an increased risk of birth defects.

The survey found doctors identified the smoking status of white women more often than other women. But once pregnant smokers were identified, they received the same rate of counseling regardless of race.

Doctors in rural areas and southern states were less likely to counsel pregnant smokers. The survey also found that doctors were more likely to determine whether or not a pregnant woman smoked on a return office visit than on a first visit.

The authors suggest that may be because doctors may want to avoid a confrontation with a patient during initial attempts to establish a rapport with the patient.

But determining a patient's smoking status at an early stage is important to begin prompt counseling to quite smoking. That's especially important with pregnant women, because smoking during pregnancy often indicates alcohol and drug use as well, the authors note.

More information

Here's where you can learn more about smoking and pregnancy.

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Head Injuries May Go Undetected in Abused Children

By Jacqueline Stenson

Reuters Health

Friday, June 6, 2003

NEW YORK (Reuters Health) - Head injuries in some abused babies may not be detected by doctors because certain screening tests aren't routinely performed, researchers report.

Their study involved 51 children under the age of 2 who were admitted to a hospital with suspected abuse injuries, such as rib fractures or facial bruising, but no signs or symptoms of head injury.

When they underwent detailed CT or MRI head scans, 19 were found to have head injuries, including skull fractures, brain injuries or scalp swelling.

However, a standard "skeletal survey" would have missed five of those 19 cases, according to results published in the June issue of Pediatrics.

During a skeletal survey, doctors perform X-rays of a child's body, including the head, searching for any signs of injury, explained study author Dr. David M. Rubin, an assistant professor of pediatrics at the University of Pennsylvania in Philadelphia.

"One-quarter had injuries that you wouldn't have seen with just the X-ray," Rubin told Reuters Health.

"Skeletal survey is not enough," he said.

The results have important implications, he noted, because head injury is the leading cause of death among abused children under age 2.

"The presence of head injury is a marker that the child has an increased risk of dying from child abuse," Rubin said.

If physicians detect head injuries, they can take steps to prevent these kids from being returned to an abusive home, he said.

In the report, Rubin and colleagues say they hope the findings will influence screening guidelines for young children suspected of abuse so that more undergo CT or MRI scans to detect head injuries.

Source: Pediatrics 2003;111:1382-1386.

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Race Affects Uterine Cancer Odds

HealthScoutNews

Friday, June 6, 2003

FRIDAY, June 6 (HealthScoutNews) -- More white women develop uterine cancer, but more black women die from it.

A study just released in the online issue of Cancer also found black women have much higher rates of rare, aggressive kinds of uterine cancer. Black women were 1.85 times more likely than whites to develop serous/clear cell, 2.33 times more likely to develop carcinosarcomas, and 1.56 times more likely to develop sarcomas.

Survival and death rates were much worse for black women compared to white women for every type of uterine cancer, regardless of stage, grade or age at the time the cancer was diagnosed, the study found.

For example, the five-year survival rate for common, indolent types of endometrial adenocarcinoma was 89.9 percent for whites and 69.1 percent for blacks.

The study found that rare, aggressive cancers accounted for 53 percent of tumor-related deaths among black women, compared to 36 per cent for white women.

However, overall incidence of uterine cancer was much lower in black women and white Hispanics than in white, non-Hispanic women.

The study authors analyzed data from more than 20,000 women with uterine cancer reported in the Surveillance, Epidemiology and End Results (SEER) program between 1992 and 1998.

More information

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

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Flu Drugs Expensive and More Evidence Needed-Study

By Patricia Reaney

Reuters

Friday, June 6, 2003

LONDON (Reuters) - Influenza drugs are effective in treating and preventing the illness but they are expensive and there is not enough evidence showing they work in high risk groups such as children and the elderly, doctors said on Friday.

Oseltamivir, which is produced by Swiss healthcare group Roche Holding AB under the brand name Tamiflu, and GlaxoSmithKline Plc's zanamivir or Relenza, are drugs known as neuraminidase inhibitors.

They work by blocking the action of viral enzymes.

In an analysis of clinical trials of the drugs, researchers at the University of Leicester in England found they reduced the likelihood of getting flu by about 70-90 percent and cut the duration of the illness by about a day.

But annual vaccination is still regarded as the best way to prevent flu epidemics which affect between three million and five million people each year and kill as many as 500,000.

"The drugs are both effective at reducing the length of symptoms and incidence if properly administered. They have to be given within 48 hours of onset," Alexander Sutton, a researcher at the university, said in an interview.

But he added that more research is needed into the effect of the drugs in the very young and old and in other high-risk people with heart problems and asthma to see if they can prevent deaths or other serious outcomes.

In a commentary in the research reported in the British Medical Journal, Klaus Stohr, the project leader of the World Health Organization (news - web sites) Global Influenza Program, said the drugs cannot replace annual influenza vaccination.

"Neuraminidase inhibitors are clinically effective complements to the current influenza intervention tools," he said.

"However, costs and lack of data on their effectiveness in the groups most severely affected by influenza limit their use in many industrialized countries and make them largely unaffordable in developing countries," he added.

The drugs, which cost about 24 pounds ($39.23) in Britain for a course of treatment, are used mostly in Japan and the United States.

Only about 50 countries, most in the industrialized world, have influenza immunisation policies. The WHO is urging countries to increase their vaccination coverage to all people at high risk to at least 50 percent by 2006 and 75 percent by 2010.

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Why Time Slows the Heart

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Friday, June 6, 2003

FRIDAY, June 6 (HealthScoutNews) -- Even if you are healthy, your heart slows down with age. Its pumping power declines, and the maximal heart rate -- the highest number of times your heart can contract in a minute -- decreases.

Researchers have long known that some of these changes are due to a decline in the sympathetic nervous system's control of the heart. But in a new study, they have zeroed in on how the parasympathetic nervous system's control of the heart also decreases and what the effects of that decline mean.

The two branches of the autonomic nervous system, which control muscles in the heart and elsewhere, complement each other, with the sympathetic involved in the "fight-or-flight" response and the parasympathetic involved in relaxation.

What that means, in real life: If you see a thug in a dark alley, the sympathetic nervous system convinces you to run. Once you're out of harm's way, the parasympathetic calms you down.

"We took away the parasympathetic nervous system activity and observed what the heart did without it," says Dr. John Stratton, a staff cardiologist at the Veterans Administration Puget Sound Health Care System and lead author of the study, published in this week's Journal of the American College of Cardiology.

To "turn off" the parasympathetic system and speed up the heart rate, Stratton and his colleagues gave the drug atropine to 22 younger people, average age 26, and to 28 older ones, average age 70. All were healthy, but sedentary.

"The impact of [speeding up the heart rate] was much more deleterious in older than younger subjects," Stratton says.

The withdrawal of the parasympathetic system caused less of an increase in heart rate in the older people and less of an increase in their systolic blood pressure.

"The most important finding is that the older heart is under less parasympathetic nervous system control than the younger heart," Stratton says. Put another way, the responsiveness of the older heart to the parasympathetic control is diminished.

As heart rate increases, the amount of time the heart has to fill gets shorter, Stratton explains. And in the study, the negative impact of that was greater for older people.

Next, Stratton wants to see if these effects of aging can be positively affected by exercise. He is assigning personal trainers to both young and old people and having them start a supervised cardiovascular exercise program; then he will perform the atropine experiment again.

"We hope that the training will increase the resting parasympathetic tone. We hope that exercise might prove to lessen the decline in the heart's activity," he says.

Phyllis K. Stein, an expert in the field who reviewed the study for the journal, calls the research interesting and says it has applications down the road.

Once you determine the effects aging has on the autonomic nervous system, she says, "then you can separate out normal and abnormal aging, and maybe identify people who are at high risk of something because their physiology is aging faster than it should be."

Stratton's study is one of the few to focus on the role of the parasympathetic nervous system and how its regulation and the body's response to it change with age, she says.

"The sexy question is, 'Can you do anything about this?'" she asks.

While it's not known for sure how to maintain parasympathetic tone, Stein says, among the list of lifestyle behaviors that might help are: regular exercise, weight control, a healthy diet, good stress management and avoiding or stopping smoking.

More information

For details on the autonomic nervous system, visit the National Dysautonomia Research Foundation. For more on exercise, check out the American College of Sports Medicine.

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Hospital IV Can Pose Strangulation Risk for Baby

Reuters Health

Friday, June 6, 2003

NEW YORK (Reuters Health) - Hospital workers should not overlook the potential strangulation dangers that IV tubes pose to young children, according to a team of Canadian researchers.

Although considered rare in hospitals, accidental self-strangulation of children with loose wires or cords can happen, according to the report published in the June issue of the journal Pediatrics.

"The force necessary to asphyxiate a child seems relatively small, therefore, they are particularly vulnerable," writes a team led by Dr. Daniel Garros at the University of Alberta in Edmonton.

Now, the researchers report two separate cases of accidental strangulation involving two infants who became entangled in IV tubing during a hospital stay.

"We believe that these are the first two cases of IV tubing strangulation described in the health literature," the authors write.

In the first case, an 11-month-old boy was hospitalized after a diagnosis of pneumonia and dehydration. The child became entangled in IV tubing and was found with the tubing wrapped three times around his neck. Although resuscitation was attempted, the child died.

"During the 24 hours before this fatal strangulation, the nurses and mother had noted ... the child (became) entangled in IV tubing three or four times around either the abdomen or the legs," the authors report.

In the second case, an 8.5-month-old boy receiving IV antibiotics for an infection was discovered by a nurse with IV tubing wrapped tightly around his neck. The boy recovered after being resuscitated.

Garros' team advises hospitals to consider encasing tubes and wires with a rigid plastic sleeve that helps prevent entanglement.

In cases where continuous IV therapy is not needed, but the use of an IV is anticipated, the authors suggest that hospitals use a device that allows the tubing to be removed temporarily.

Other prevention tactics may include increasing the level of staffing so children can be frequently monitored or moving children to a location where they can be more readily observed, the authors write.

Source: Pediatrics 2003;111:e732-e734.

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Victims of Bullying More Often Depressed, Suicidal

By Linda Carroll

Reuters Health

Friday, June 6, 2003

NEW YORK (Reuters Health) - Bullied youngsters, especially girls, are far more likely than other children to be depressed or even suicidal, a new study from the Netherlands shows.

More than 40 percent of girls who were frequently hit, kicked, threatened or called names said they were depressed and almost 25 percent said they thought about suicide, according to the study published in the journal Pediatrics.

The numbers were only slightly lower when bullies used more indirect means -- such as ignoring, excluding and backbiting -- to torment their victims.

Among girls who were often the target of indirect bullying, 35 percent said they were depressed and 21 percent said they had suicidal thoughts.

Among girls who said they were almost never bullied directly, only about 6 percent reported depression and 4 percent said they thought about suicide.

The new results show that teachers and other school personnel need to pay more attention to the various forms of bullying, according to the study's lead author, Marcel F. van der Wal, a researcher in the department of epidemiology and health promotion at the Municipal Health Service in Amsterdam.

"They especially need to pay more attention to indirect forms of bullying," van der Wal said in an interview with Reuters Health. "Teachers do not always consider social exclusion to be a form of bullying. Or, they consider this form of bullying to be less harmful."

Bullying also caused distress to boys, but not as frequently.

Among boys who were frequent victims of more direct forms of bullying, 22 percent said they were depressed. Just under 28 percent of those who were indirectly bulled reported depression. About 3 percent of the non-bullied boys felt depressed.

Just over 13 percent of boys who were often the target of direct bullying and almost 18 percent of those who were often the target of indirect bullying said they thought of suicide.

The researchers also looked at the psychology of the bullies. Just over 10 percent of boys who bullied -- whether it was direct or indirect bullying -- said they thought about suicide. This is compared to approximately 3 percent of boys who didn't bully their classmates.

For the new study, van der Wal and his colleagues surveyed 4, 811 school children who were aged 9 to 13.

Source: Pediatrics 2003;111:1312-1317.

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Vegetarian Diets Get Green Light

HealthScoutNews

Friday, June 6, 2003

FRIDAY, June 6 (HealthScoutNews) -- A well-planned vegetarian diet can be a healthy alternative to meat-based diets for people of all ages.

That blessing comes in a joint statement from the American Dietetic Association (ADA) and Dietitians of Canada, which appears in the June issue of the Journal of the American Dietetic Association.

The statement cites numerous health benefits of a vegetarian diet such as lower intakes of saturated fat and cholesterol and higher intakes of carbohydrates, fiber, magnesium, potassium, folate and antioxidants such as vitamins C and E.

An estimated 4 percent of Canadian adults and 3 percent of American adults follow vegetarian diets and interest in them is on the rise, the statement says. Many restaurants and caterers offer vegetarian meals, and there's been a substantial increase in the sales of vegetarian foods in recent years.

"Vegetarians have been reported to have healthier body weight than non-vegetarians, as well as lower rates of death from heart disease, lower blood cholesterol levels and lower rates of high blood pressure, type 2 diabetes and prostate and colon cancer," ADA spokeswoman Cynthia Sass says in a news release.

Planning a vegetarian diet doesn't need to be complicated, but it should be nutrient-dense. The key to ensuring the body receives all its nutritional needs is to eat a wide variety of foods, Sass says.

The best way to do that is to get advice from a nutrition expert.

More information

Here's where you can learn more about vegetarian eating.

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Head Lice Are Basically Harmless, Says UK Report

By Patricia Reaney

Reuters

Friday, June 6, 2003

LONDON (Reuters) - They're annoying and persistent and end up in the itchy scalps of countless schoolchildren every year, but head lice are essentially harmless and chemical treatments normally kill them, researchers said on Friday.

Despite their frequency, confusion and misconceptions surround the sesame-seed size, six-legged parasites that grasp hair strands and feed on human blood.

"It stems from a fundamental lack of knowledge," said Ian Burgess, the director of Insect Research and Development Ltd, a private consultancy firm in Cambridge, England.

There is also an emotional element involved because many people are reluctant to deal with creepy insects.

"The idea of creepy-crawlies on your body is repugnant," Burgess added in an interview.

One of the leading misconceptions about head lice is that it is possible to pick them up from inanimate objects.

"This is a parasite that requires frequent blood meals," said Burgess.

Head lice are spread by head-to-head contact, usually by people who know each other well. Lice seen on chairs, pillows or hats are dead and cannot infect anyone so it is pointless to spray things like sheets or furniture.

Although most common in children, adults can also get lice, which attach their eggs to hair shafts and lay five to six a day. The bugs are usually found at the back of the neck and behind the ears and are probably more common in girls, who are more likely to have close contact during play.

Cutting hair, or tying it back, does nothing to help get rid of lice, Beth Nash, a physician and editor said in a review in the British Medical Journal.

She also warned that hatched eggshells, or nits, may be confused with dandruff and said school policies, such as banning children with nits, are ineffective because fewer than 20 percent of children with nits will develop an infestation within 14 days.

"Head lice are harmless. If detached from their host they are vulnerable and effectively dead," she said.

A variety of products are available to deal with lice, including chemical lotions, creams and shampoos.

Burgess said: "We need to improve education for professionals and the public so that whatever we do have to treat them is used efficiently and with the least exposure and risk to the public."

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Antidepressant May Ease Apnea

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews

Friday, June 6, 2003

FRIDAY, June 6 (HealthScoutNews) -- A small study of a dozen people with sleep apnea has found that an antidepressant taken an hour before bedtime significantly reduces their sleep interruptions.

The antidepressant mirtazapine cut in half the number of times breathing stopped or slowed during sleep and reduced the number of times sleep was disrupted by 28 percent among study participants, and is the first time such improvement has been shown using a drug, say study authors David Carley and Dr. Miodrag Radulovacki, who are researchers at the University of Illinois at Chicago.

"Our study shows the largest and most consistent improvement in patients with sleep apnea demonstrated by a drug treatment to date," says Carley, who is director of research at the University of Illinois at Chicago Center for Sleep and Ventilatory Disorders.

The results of the study were presented June 5 at the annual meeting of the Associated Professional Sleep Societies in Chicago.

Carley says this small study is the first to use the antidepressant to treat humans for sleep apnea, and followed a decade of animal studies suggesting that serotonin antagonists could help reduce sleep apnea symptoms.

"A multi-center study would be the next necessary and logical step," he says, to further determine the efficacy of the drug to treat sleep apnea.

One larger study of 154 people that reported some improvement in sleep patterns using mirtazapine was recently completed in Belgium. That study, looking at insomnia among those suffering from depression, found that sleep efficiency increased by 7 percent in both depressed and healthy people who took evening doses of mirtazapine compared to those who took a placebo or another antidepressant called temazepam, which is sold as restoril. Researchers planned to present the results of that study at the sleep association meeting.

Mirtazapine, sold under the trade name Remeron, is manufactured by NV Organon, of Roseland, N.J., which sponsored the study. Remeron is currently approved by the U.S. Food and Drug Administration (news - web sites) (FDA) only for treatment of depression, and as yet the company has not applied for FDA approval for Remeron to treat sleep apnea, Carley says.

"There is no medical therapy for sleep apnea, so the concept of treating it medically is very attractive, but a study that small is very limited, and no conclusions can be drawn," says Dr. Eric Genden, surgical director of the Program for Sleep Disorders at the Mount Sinai Hospital in New York City.

Sleep apnea is a disorder characterized by brief interruptions of breathing during sleep, as many as 60 interruptions an hour, according to the National Institutes of Health (news - web sites). Approximately 18 million Americans suffer from the disorder. Signs of sleep apnea are heavy snoring, disruption of sleep and noticeable lapses in breathing, the last often discovered by the spouse of a person with sleep apnea.

Current therapy for sleep apnea is a mask placed over the nose that is attached to an air blower, which keeps pressure on the air passages to remain open. Surgery is also sometimes done to remove adenoids, tonsils or other soft tissue at the back of the throat to help the breathing passages stay clear.

"The mask is difficult to tolerate over a long period of time, so compliance rates drop approximately 50 percent over the long run, and that's a problem," Carley says.

"People know they have sleep apnea, have tried the mask and given up, so an equally effective but easier to tolerate treatment like a drug would be a major step forward," he adds.

For the study, researchers divided the participants into three groups. Each group took, on alternate weeks, a weeklong prescription of a nightly pill of either a 4.5-milligram tablet of Remeron, a 15-milligram tablet of the drug or a placebo. On the last night of each week, participants spent the night in the sleep lab, where they were monitored throughout the night for disordered breathing, duration of the different stages of sleep, and sleep position.

Carley and Radulovacki found the drug at both doses reduced the number of breathing disorders by an average of one half, and that the 15-milligram dose reduced the number of times sleep was disrupted by an average of 28 percent. The lower dose of the drug did not reduce sleep disruption.

More information

For information about sleep apnea, you can visit the National Institute of Neurological Disorders and Stroke or the American Medical Association.

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THURSDAY, JUNE 5, 2003

 

Chubby Babies at Risk for Staying That Way

 

By Eric Sabo

Reuters Health

Thursday, June 5, 2003

NEW YORK (Reuters Health) - Fat babies may be happy babies, but infants who put on pounds too quickly are more likely to be overweight as adults, according to a new study.

Research published in the American Journal of Clinical Nutrition (news - web sites) suggests that newborns who have bulked up by 4 months of age are twice as likely to tip the scales 20 years later when compared to babies who gain weight more slowly.

Dr. Nicolas Stettler, the lead author of the report, cautions that it is too early to tell if a chubby infancy represents the start of a growing problem. But given the clear-cut advantages of preventing obesity rather than fighting it later, Stettler explained to Reuters Health that good habits are best instilled early on.

"This could be a critical time in the development of obesity," said Stettler, a nutrition specialist at the Children's Hospital of Philadelphia. "Gaining weight rapidly at such a young age is associated with permanent changes that may make it harder to regulate appetite and energy balance."

Stettler's team followed several hundred African American children who were born in Philadelphia around 1960. Obesity rates continue to soar for every age group and race, but the risks of heart disease and other obesity-related problems are particularly hard felt by minorities, especially African Americans.

Researchers collected weight-related information on the children at birth, 4 months, 1 year, and 7 years of age. Nearly two decades later, Stettler and his colleague took a fresh set of measurements and then compared them to what the study participants weighed in the past.

The now grown-up participants were considered obese if they had a body mass index of 30 or greater, plus a substantial amount of body fat. Body mass index is a measure of weight that takes height into consideration.

Infants who gained more than eight to 10 pounds in the first four months of life doubled their chance for being obese by the time they turned 20 years of age. After controlling for other possible causes, such as a heavy birth weight or a mother who weighed more than normal during pregnancy, the researchers estimate that one third of adult obesity was directly related to the rapid weight gain of early childhood.

In an editorial that accompanied the paper, Dr. Jack Yanovski, a growth and obesity expert at the National Institutes of Health (news - web sites), argues that the small study size makes it hard to draw firm conclusions. When Stettler's team included stout 7 year olds in their analysis, for example, infant weight gain did not appear to be a significant cause of adult obesity.

But the results "may ultimately help us to identify children at unusual risk of adult obesity," Yanovski concluded.

Stettler suggests there could be a solution already. The participants in his study mostly grew up on baby formula, which has been linked to faster weight gain compared with infants who are breast fed.

"If you breast feed the child will stop when it's had enough, while a mother may overfeed with formula," said Stettler. "This may override the internal cue that causes individuals to overeat later in life."

Stettler does not discount the fact that many other important factors can lead to obesity, such as a sedentary lifestyle and too many visits to fast food restaurants. But mothers who breast feed their children for the first six months, a practice that has been endorsed by pediatrician groups, might prevent their kids from eventually leaving the house severely overweight.

"Breast feeding can help teach a child how to regulate food intake," said Stettler.

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 Boys Are More Demanding, Even in the Womb

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Thursday, June 5, 2003

THURSDAY, June 5 (HealthScoutNews) -- The battle of the sexes may start in the womb.

A mother-to-be carrying a male fetus eats significantly more than one carrying a female because the male fetus somehow sends out signals requiring more calories, says a report in the June 7 issue of the British Medical Journal.

"Boys are more demanding, so women suffer more," says study leader Dr. Dimitrios Trichopoulos, a professor of epidemiology at the Harvard School of Public Health.

A meal-by-meal survey of 244 women seen during pregnancy at Beth Israel Hospital in Boston shows that those carrying a male embryo had an 8 percent higher intake of protein, a 9 percent higher intake of carbohydrates, an 11 percent higher intake of animal fats, and a 15 percent higher intake of vegetable fats than those carrying a female, the report says.

The finding helps explain why boy babies are generally larger than girls, says Rulla Tamimi, an epidemiologist at Harvard and a member of the research team. "In almost all populations, they average about 100 grams [roughly four ounces] heavier," she says.

It's not clear how the male fetus makes its demands on the mother, Tamimi says. "One possible mechanism is that baby boys secrete testosterone, which is a signal that the mother should eat more," she says. Testosterone is the male sex hormone, secreted by the testicles.

Trichopoulos speculates the root cause is a survival-of-the-fittest thing, going back to prehistoric times.

"There were too many men competing for select women," he says. "Competition for those women was important in those days. Power depended on weight, so selection favored men who were bigger."

While the difference in food intake is scientifically significant, it isn't great enough to tell a woman the sex of the unborn child, Trichopoulos says. As for nutrition during pregnancy, "it certainly makes sense for a woman to eat more," he adds.

More information

Guidance on good nutrition during pregnancy is offered by the National Women's Health Information Center. Meanwhile, the March of Dimes has plenty of tips on how to take care of yourself during pregnancy.

Source: American Journal of Clinical Nutrition 2003;77:1350-1351,1374-1378.

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A Revolution in Migraine Care

By Gary Gately
HealthScoutNews Reporter

HealthScoutNews

Thursday, June 5, 2003

THURSDAY, June 5 (HealthScoutNews) -- Not long ago, migraine sufferers had no choice but to head for darkened bedrooms to wait out the pain. Or they could down powerful painkillers that could lead to ferocious "rebound" headaches and, ultimately, addiction.

Often, doctors couldn't -- or wouldn't -- help much. As recently as a decade ago, many of them dismissed migraines as psychologically based ailments, essentially telling patients, "It's all in your head."

But dramatic breakthroughs in recent years have led to better understanding of migraines, which produce intense, throbbing pain, typically on one side of the head, sometimes accompanied by nausea and sensitivity to light and sound. And new treatments have vastly improved the prognosis for sufferers.

That's a message specialists are hoping to convey during National Headache Awareness Week, June 1-7.

Dr. Lisa K. Mannix, a neurologist who has been treating headaches exclusively for seven years since completing her residency, says migraine care has been "revolutionized" in the past decade.

"I often joke that I didn't have to practice in the dark ages, which makes some of my [older] colleagues a little jealous," says Mannix, who's in private practice in Cincinnati. Unlike her predecessors, she says, "I know I have treatments that are very effective for the majority of patients."

A huge advance in the treatment of migraines came in 1993 when the first triptan medication hit the market. Sumitriptan, also known as Imitrex, mimics the neurotransmitter serotonin, whose supply drops off during migraines. Sumitriptan causes blood vessels to constrict, which soothes the inflammation of nerve endings in the brain and eases pain.

Over the past decade, six other triptans have hit the market. Like other classes of drugs such as antidepressants and antibiotics, different triptans might work for some people, but not others. So more choices mean more hope for migraine sufferers.

Other new treatments appear to help prevent migraines or reduce their frequency and severity. These include Botox, better known for its ability to smooth away facial wrinkles, as well as beta blockers and calcium-channel blockers, both used to treat high blood pressure and coronary artery disease, experts say.

Antidepressants that affect serotonin levels can help prevent migraines. And anti-seizure medications, used to treat epilepsy and bipolar disorders, also have shown promise for their ability to prevent migraines.

And more new treatments seem likely. Dr. Seymour Diamond, executive chairman of the National Headache Foundation (news - web sites), says he knows of 14 studies now under way on migraine treatments.

"There's a lot of hope," Diamond says. "There's going to be more and more help and better drugs and drugs suitable to more people."

Still, millions of sufferers aren't getting the newer, proven medications for their migraines. One reason: Experts say about half of the estimated 30 million Americans with migraines are never properly diagnosed.

"It's an awareness issue, and I do think people are suffering needlessly," says Diamond, founder and director of the Diamond Headache Clinic in Chicago.

On a more positive note, the number of doctor visits for migraines nearly doubled from 9.4 people per 1,000 to 18 per 1,000, from 1990 to 1998, a recent Wake Forest University study says. This jump in visits may reflect the newer treatment options.

However, the study also found that many migraine sufferers rely on too many addictive painkillers that provide only short-term relief instead of more effective drugs, such as triptans.

What's more, many migraine sufferers remain unaware of the triptans and other newer treatments, including the preventive drugs, experts say. This ignorance stems in part from earlier, failed treatment for migraine sufferers, relatives or acquaintances, says Mannix, a member of the headache foundation's board of directors.

"People may not come back to the medical system because they may not realize we have better drugs," she says. "People say, 'I went 10 or 15 years ago and got side effects and [treatment] didn't work.' Or they say, 'It didn't work for my mom so why should it work for me?'"

Mannix says that about 25 percent of migraine patients could benefit from preventive medications, such as anti-seizure drugs, but only 5 percent take them. "So there's some serious under-treatment going on here," she says.

Primary-care doctors -- the front line in treatment of most migraines -- typically don't have the time necessary to assess the headache patient thoroughly and decide the best treatment, Diamond explains.

Besides medication, practical steps such as eating and sleeping well, exercising regularly, and reducing stress can help fight migraines, specialists say.

But for persistent migraines, Mannix says, "The big thing is you don't have to suffer. We've sort of unraveled some of the mystery, and there's a lot of good treatment available."

As part of Headache Awareness Week, the National Headache Foundation has introduced a new tool for sufferers called MAP, or Migraine Attack Profile.

By tracking the duration of individual headache attacks with MAP, doctors can learn which aspects of a migraine affect a patient most, how long each phase of an attack lasts, and what tends to make them get better or worse. Eventually, a pattern appears and doctors can use this information to help select the most appropriate medication for the patient, as well as identify the best time to start treatment for individual attacks, the foundation says.

For a free copy of the Migraine Attack Profile, contact the headache foundation at 1-888-NHF-5552 or visit www.headaches.org.

More information

For more on migraines and their treatment, visit the Mayo Clinic the Migraine Awareness Group, and the National Headache Foundation.

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Obese Young Adults More Likely to Have Gum Disease

 

By Martin F. Downs

Reuters Health

Thursday, June 5, 2003

NEW YORK (Reuters Health) - A new study adds yet another item to the long list of health problems associated with obesity: gum disease.

Dr. Elaine Borawski and colleagues at Case Western Reserve University in Cleveland, Ohio, found that obese young adults had a 76 percent higher risk of periodontal disease -- a bacterial infection of the gums that can lead to tooth loss -- than those with normal weight.

What's more, young adults who had larger-than-normal waistlines (40 inches plus for men and 34 for women) were about twice as likely to have gum disease as their slimmer counterparts.

The correlation between obesity and periodontal disease was only seen in the 18-34 age group, and not in older adults.

"It's not that this is a demonstration that it only happens in young people," Borawski told Reuters Health. "The disease itself is mostly an older-adult disease."

Overall, 14 percent of the 13,665 people over age 18 who were studied had periodontal disease. Just eight percent of the young adults had it, compared to 17 percent of middle-aged people, and 20 percent of older adults, according to the report published in the Journal of Periodontology.

The data the researchers analyzed came from the National Health and Nutrition Examination Survey III (NHANES III), a U.S. survey conducted from 1988-1994.

Another recent study in Japan came up with similar results. But Borawski said it is too early to say for certain why such a high rate of periodontal disease is seen in obese young adults.

"The next step is to begin exploring," she said.

In general, it's believed that diet plays a role in gum disease. Certain types of foods and the amount consumed may help disease-causing bacteria thrive in the mouth.

Eating fiber-rich foods like fruits and vegetables may reduce the accumulation of dental plaque -- the sticky substance in which bacteria live. A "softer" diet, however, may promote plaque build-up.

It's also possible that obese young adults consume too little of things that are important for good oral health -- namely vitamin C and calcium.

The study findings are worrisome because periodontal disease, in addition to causing tooth loss, may contribute to other diseases.

"We know for sure -- it's confirmed -- that treatment of periodontal disease will reduce the need for treatment of diabetes," said study co-author Dr. Mohammad Al-Zahrani in an interview with Reuters Health.

Periodontal disease may also contribute to heart disease.

"This is not proven," Al-Zahrani said. But he said that doctors are working under the assumption that it's true. Some studies have suggested a link.

In addition, it's well known that obesity puts people at risk for heart disease. Taken all together, "you start to see a bigger picture," Borawski said.

Source: Journal of Periodontology 2003;74:610-615.


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Migraine Sufferer Finds Relief at Last

 

By Gary Gately
HealthScoutNews Reporter

HealthScoutNews

Thursday, June 5, 2003

THURSDAY, June 5 (HealthScoutNews) -- Sometimes, Nancy Chappel would lie on a pillow on the bathroom floor for hours, crippled by pain that felt like an "ice pick" in her eye.

She'd stay near the toilet in case the nausea that accompanied her migraine headaches made her throw up.

Her mother, who'd come to care for her, would stand by helplessly, crying.

"My life was consumed by migraines," says Chappel, who lives in suburban Philadelphia. "I don't know how I endured it. Years ago, you'd just grit your teeth and bear it. There was nothing you could do."

The headaches began 30 years ago, soon after the birth of the youngest of her three daughters.

Chappel, now 60, prayed that God would give her the strength to cope with the headaches. And she searched futilely for effective medications.

First, she went to general practice doctors and neurologists in Pittsburgh, then in the Philadelphia area when her family moved there in 1991. She downed painkillers regularly. She tried the antidepressant Elavil, which put her to sleep. She even tried a so-called preventive drug that never worked.

Chappel finally found some relief in 1993 from injections of the first triptan, Imitrex, which mimics the action of the neurotransmitter serotonin and causes blood vessels to constrict. She'd inject the drug into her leg, and the migraine would disappear within 20 minutes.

The rebound headaches returned, however, and she found she had to inject the drug more and more -- up to four times weekly -- to try to block the pain.

"It was getting to the point where I didn't even want to tell my husband and kids anymore that I was going upstairs taking shots," she recalls. "It was just like I was on a roller-coaster of just trying to get rid of these headaches, and I just kept rebounding and rebounding."

But she continued praying for strength and relief and clung to her hope for a lasting cure. "I fought it, I wouldn't give into it," she says. "I had a family to raise and I thought, 'I can't give into this.'"

When a friend mentioned a well-known headache clinic in Chicago about six years ago, Chappel soon boarded a plane. She doesn't remember much from the weeklong trip, but recalls returning home with "a bunch of medications."

She remained on six different drugs for about a year. One of them, Nardil, a drug used for depression, finally provided the relief she had sought for so long. Last year, her doctor added Topamax, an anti-convulsive drug that has proved successful in preventing migraines.

Today, Chappel needs a shot of Imitrex only every three months or so.

Her persistence paid off, she says, and her prayers have been answered.

Now, she hopes her success inspires other migraine sufferers. "I try to talk to them and tell them there are meds, there is help out there," she says. "I'm living proof. Don't sit home and think you're a migraine sufferer and have to suffer because you really don't."

More information

To learn more about migraines, visit the National Institutes of Health or the National Institute of Neurological Disorders and Stroke.


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Study Suggests Parkinson's More Common in Hispanics

 

By Martin F. Downs

Reuters Health

Thursday, June 5, 2003

NEW YORK (Reuters Health) - New U.S. statistics on Parkinson's disease (news - web sites) suggest that Hispanics have higher rates of the disease compared with people in other ethnic groups.

This study is unique from previous research in that it directly assessed the rate of Parkinson's disease in Hispanics, said Dr. Stephen Van Den Eeden.

An earlier study conducted in Upper Manhattan, New York, looked at blacks, whites, and "other" racial and ethnic groups. The "others" were largely Hispanic, but there were no detailed data on them.

"We found that Hispanics appear to have the highest rates of Parkinson's disease," Van Den Eeden told Reuters Health.

Van Den Eeden and colleagues in the research division of the Kaiser Permanente Medical Program studied 588 people newly diagnosed with Parkinson's in 1994 and1995.

Kaiser Permanente is a health management organization (HMO) that serves the San Francisco bay area of northern California. The patients in the study were all HMO members.

Hispanics had the highest rate at 16.6 cases per 100,000, followed by non-Hispanic whites at 13.6 per 100,000. Asians had a rate of 11.3 per 100,000 followed by blacks, who had a rate of 10.2 per 100,000, according to the report in the American Journal of Epidemiology.

These findings contradict the Manhattan study, which found that blacks had the highest rate of Parkinson's disease. The rate in that study, which looked at 83 Parkinson's patients, was more than twice as high as that seen in the new study.

As was expected, the disease was most common in older people. Only 0.5 percent of cases in the study were diagnosed before age 40, while about three percent were diagnosed before age 50. More than 60 percent of the Parkinson's patients in the study were diagnosed between the ages of 65 and 79.

The researchers also report that in all groups except Asians, men had rates about twice as high as women. Rates were slightly lower in Asian men.

The size of the study is notable because the largest previous study looked at only 154 patients. "It's a difficult disease to capture in a defined population," Van Den Eeden said.

To do a large study in a particular area requires all healthcare providers in the area to report every case, which can be surprisingly difficult, Van Den Eeden said. It's easier to collect data where all providers are part of a single system. For example, an early study in Carlisle, England took advantage of the country's nationalized healthcare system to gather data on Parkinson's cases.

"In ours, we have a large HMO, which has about 3 million members, and when they go to see someone we can capture them," Van Den Eeden said.

"It's like a little nationalized healthcare system," he said, because the HMO employs its own doctors and has its own facilities.

Now the researchers have turned their attention to figuring out why some groups have higher disease rates than others do.

"The two major breakdowns, of course, are going to be environment -- and I use that fairly generically -- and genetics," Van Den Eeden said.

Environmental factors include smoking, which may actually reduce the risk of Parkinson's, exposure to some metals used in industry, which may increase the risk, and exposure to pesticides, which is also believed to increase the risk.

"Most of our pesticide exposure came from childhood and young adulthood, as opposed to current exposure. So it may be that Hispanics when they were younger used more pesticides than the average non-Hispanic white in our study. We don't know that, but we are looking into it," Van Den Eeden said.

About 90 percent of the 588 patients agreed to take part in a more detailed follow-up study.

"If they agreed, we went out to their house and did an extensive interview, which included a very detailed occupational history," he said.

Results from analyzes of various risk factors are forthcoming. "We'll come up with a slightly better answer for all this in about a year from now," Van Den Eeden said.

The present study was funded by a grant from the National Institute of Neurologic Disease and Stroke.

Source: American Journal of Epidemiology 2003;157:1015-1022.

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To Bulk Like a Hulk

HealthScoutNews

Thursday, June 5, 2003

(HealthScoutNews) -- Beware of boys who want to build muscles to look like the Incredible Hulk.

According to American Journal of College Health, researchers in Saskatchewan, Canada, studied 197 muscle builders. They found that boys who simply wanted to firm up were emotionally healthy. But those who wanted to look like a comic book super-hero usually suffered from depression and low self-esteem.

By contrast, by the way, girl muscle builders didn't show significant emotional problems.

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U.S. Airlines Lack Air Quality Data, Lawmakers Told

 

By Todd Zwillich

Reuters Health

Thursday, June 5, 2003

WASHINGTON (Reuters Health) - Experts called for systematic testing of air quality aboard U.S. passenger jets on Thursday, saying there is a lack of data to explain ongoing health complaints among airline workers and some passengers.

Several government researchers urged Congress to order the testing, as an ongoing debate continues between flight attendants and airline companies over whether cramped conditions and hours of breathing recirculated air pose a risk of exposure to toxic chemicals, infectious diseases and other problems.

Meanwhile, recent outbreaks of SARS (news - web sites), some of which have been blamed on airline passengers traveling abroad from endemic areas, have inflamed concerns about health quality aboard planes.

"Establishing a causal connection between cabin air quality and the health complaints of flight crew and passengers is extremely difficult since there is no surveillance system in place," said Dr. John Howard, director of the National Institute for Occupational Safety and Health at the Centers for Disease Control and Prevention (news - web sites).

While some studies of plane air quality have been done, they amount to experiments in "perhaps a few hundred flights, measuring some contaminants," said Dr. William B. Nazaroff, a professor of environmental engineering at the University of California at Berkeley.

The call comes as lawmakers consider legislation authorizing operations at the Federal Aviation Administration (news - web sites) (FAA) for the next few years.

The agency -- known for a rich body of regulations that govern everything from aircraft beacon lights to preflight seatbelt instructions by flight attendants -- currently has relatively few standards governing air quality aboard commercial planes.

Some studies have suggested there are higher-than-average levels of carbon dioxide, ozone, and cosmic radiation on aircraft. Others have suggested, inconclusively, that flying elevates the risk of respiratory infections by up to 400 percent for passengers and crew.

"On aircraft, there is no ventilation standard, despite the fact that aircraft are the most densely occupied of any environment," the Association of Flight Attendants told a House Transportation and Infrastructure subcommittee in a written statement.

The organization has kept a running record of health complaints from working flight attendants, including frequent dizziness, disorientation and respiratory distress.

Experts currently suspect there may be four cases in which severe acute respiratory syndrome was spread between passengers. Airline officials attacked recent reports suggesting that dry airplane air and crowded conditions were a contributing factor to the spread of SARS.

"Study after study has concluded that the cabin environment does not contribute to the spread of disease," said James C. May, CEO of the Air Transport Association.

FAA officials also downplayed health concerns, noting there is no hard evidence of a link between air quality and illness complaints.

"We face the same risks in an aircraft that we would face in crowded movie theater, restaurant, or office," said Dr. Jon L. Jordan, the agency's federal air surgeon.

The National Academy of Sciences (news - web sites) recommended a program of widespread environmental testing as part of a report it issued last year.

FAA officials said they have already begun moving to implement the measure and several other of the report's recommendations. The agency is helping to finance an air quality study that is being conducted by the American Society of Heating, Refrigerating, and Air-Conditioning Engineers, a private industry group.

Data from the study are expected in late 2006 or 2007, according to the FAA.

But Nazaroff, who was a member of the NAS committee that issued last year's report, criticized the private study as too limited and called for a government-run air testing program that takes routine samples aboard randomly selected flights.

That view was backed by subcommittee ranking member Rep. Peter DeFazio, D-Ore., who said that the group had "no medical expertise."

About 75 percent of passenger planes in service use high-performance air filters that mix recirculated air with outside air, according to the FAA.

The agency does not track filter use since it is not required by federal regulations, said Ronald T. Wojnar, an official at the agency.

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Trying a New Food

 

HealthScoutNews

Thursday, June 5, 2003

(HealthScoutNews) -- Are you tired of your kid deciding that fish sticks are the only food worth eating?

Here's some guidance from a study at Penn State University, where researchers did some tests to see what would induce a preschooler to try something new.

As reported in the journal Appetite, most children will try a new food -- once. It seems children do like novelties, but then quickly revert to their old habits.

The best role model to get children to try new foods is the teacher. Assuming the teacher makes the necessary statement that she likes the food, a child may try it as many as five times.

But the whole thing can be ruined if another child makes a negative comment. Peer comments seem to have more effect on girls than boys, the study finds.

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Flu Season Was Milder Than Year Ago – CDC

 

Reuters

Thursday, June 5, 2003

ATLANTA (Reuters) - Federal health experts on Thursday described the 2002-2003 flu season in the United States as mild, noting that deaths due to pneumonia and influenza had likely declined from last year.

Influenza, which is marked by respiratory inflammation, fever, muscular pain and intestinal tract irritation, kills about 20,000 Americans and hospitalizes 114,000 every year.

The Centers for Disease Control and Prevention (news - web sites) said data collected from state and local health authorities indicated that the percentage of flu-related deaths never exceeded epidemic thresholds in any week during the past flu season.

In comparison, deaths rose above epidemic levels for five consecutive weeks at the height of the 2001-2002 flu season.

Flu season generally runs from October until April.

"The kinds of viruses that circulated this year tend to cause milder flu seasons," said Scott Harper, a flu expert with the CDC's National Center for Infectious Diseases.

The CDC also said on Thursday that it had strengthened its influenza surveillance and recommendations to help doctors and health-care providers distinguish between the flu and emerging infectious diseases such as SARS (news - web sites) and avian influenza.

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New Options for 'Morning After' Pill

HealthScoutNews

Thursday, June 5, 2003

THURSDAY, June 5 (HealthScoutNews) -- The "morning after pill" -- emergency contraception used after intercourse -- has more options than ever before, say two new reports in the June issue of Obstetrics and Gynecology.

In the first of two studies conducted by researchers from the United States, England and South Africa, doctors found women can safely increase the time frame in which they use the "morning after pill" -- also known as the "Yuzpe" regimen -- from the normal 72 hours after intercourse to up to 120 hours, and possibly longer.

According to the new research, the failure rate -- 2 percent with perfect use and 2.5 percent with typical use -- was virtually the same when the pills were taken anywhere within this time span. The finding, experts say, may be especially important for rape victims, who often are too distraught or sometimes physically unable to seek medical counseling for several days.

In the researchers' second study, the options of the "morning after pill" were expanded even further. Typically, the "Yuzpe" regimen involves using a specific combination of hormones -- levonoregesterel, a type of synthetic progesterone, and ethinyl estradiol, a synthetic estrogen. Traditionally, one dose is taken within 72 hours of unprotected intercourse, followed by a second pill some 12 hours later.

Focusing on the same group of 111 women used in the first study, the researchers tried randomized treatment to include either a standard two-dose pill regimen, or a two-dose regimen that substituted norethindrone (a different type of synthetic progesterone) for levonoregesterel, or a one-dose regimen of the original formulation.

The result: Perfect use failure rates were nearly identical in all three groups.

Women who took the single-dose treatment reported half the amount of vomiting, a significant side effect with the original two-dose treatment.

The bottom line: The researchers concluded that birth control pills containing the norethindrone-ethinyl combination work as well as the levonoregesterel-ethinyl formulation, that a one-dose regimen works as well as the two-dose formula, and that either treatment is safe and effective when used up to 120 hours following intercourse.

More information

To learn more about birth control pill options, visit Planned Parenthood.

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Cancer Group Spurs Tanning Salons to Self-Regulate

 

By Nigel Glass

Reuters Health

Thursday, June 5, 2003

LONDON (Reuters Health) - Dr. Eva Kalbheim from the German cancer charity Deutsche Krebshilfe (DKH) would like a sign at the entrance of every tanning studio saying: "This causes cancer."

But for now, she is moderately happy with an agreement that the charity has negotiated with the organizations that supply and operate most of the country's 90,000 tanning studios. The industry has agreed to self-regulate, using a voluntary certification program.

"This agreement is better than nothing," Kalbheim told Reuters Health.

Considering that Germans are Europe's biggest users of sun beds, spending around five billion euros and suffering a seven percent increase in skin cancer every year as a result, DKH thinks any improvement will help.

"Hardly any other tumor can be identified so closely with a risk factor, and hardly any other factor of risk is as easy to avoid as artificial UV radiation," said Gerd Nettekoven, head of DKH.

The industry was goaded into action by DKH's campaign against sun beds in 2001, and now agrees to take part in a voluntary certification, approved by the Federal Office for Radiation Protection and the dermatology-interest-group Arbeitsgemeinschaft Dermatologische Praevention e.V.

The certification covers automatic timers, hygiene, education of personnel and enlightenment of customers, and the quality of lamps. DKH says that the emissions of 80 percent of the lamps in use are "not judged to be safe."

Ewald Kaesler, head of Kaesler Braunungstechnic of Regensberg, a medium-sized supplier of sun beds in southern Germany, thinks the measure will help the industry to be seen as more reliable.

"It is very necessary that something happens, there were all sorts of problems coming from the coin-operated self service studios and my business is suffering. This agreement should encourage people to go to the properly managed studios," he told Reuters Health.

But even with the most enlightened attitude, operators would find it difficult to make sure their lamps and filters were safe, according to a report prepared for the European Union (news - web sites) in 2000 by the photobiology unit at the University of Dundee in Scotland.

It points out that because of a lack of manufacturer's information there "is no easy and in general reliable way for a sun bed owner to select replacement lamps from different other lamp manufacturers -- or even from the same manufacturer -- without disregarding the original exposure schedule from the sun bed manufacturer."

"Every time you go into a studio you create more and more skin damage, and while we try to help with technical recommendations, it's a bit like rearranging the deck chairs on the Titanic," Dr. Harry Moseley, the author of the report, told Reuters Health.

France, Norway and Sweden have achieved some specific legal control over their tanning industries, but most of Europe's industry is as unfettered as its German counterpart -- which employs 28,000 and was praised for its world leadership in pursuit of "the largest, most glorious light-box" at a world summit of manufacturers at New York in February 2003.

The American Medical Association called for a ban on the use of suntan parlor equipment for cosmetic use in 1994, to no effect.

"It would take years to get legislation here, we'd have to fight it through at least seven ministries. Meanwhile sixteen million Germans use sun beds, and you have to try to give them at least some safety measures now," Kalbheim said.

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A Dip in Drug Spending

HealthScoutNews

Thursday, June 5, 2003

THURSDAY, June 5 (HealthScoutNews) -- The mild flu season and increased use of cheaper generic drugs caused the growth of prescription drug spending to slow to 11.3 percent in the first quarter of 2003, says a report by pharmacy benefit manager Express Scripts.

Safety concerns raised by studies last year also resulted in lower use of estrogen drugs during the first quarter, the report notes.

In the first quarter of 2002, drug spending increased by 16.9 percent. The drug spending data was presented recently at Express Scripts annual research Outcomes Conference held in St. Louis.

During the first quarter of 2003, 47 percent of all prescription claims processed by Express Scripts were for generic drugs, an increase of 43 percent over the first quarter of 2002.

The report also says that during the first quarter of this year, there was a sharp increase in the use of some common drugs. For examples, use of blood pressure medications increased 10.6 percent, drugs to treat high cholesterol increased 14.1 percent and diabetes medications increased 14.5 percent.

Other research presented at the conference said doctors rely on information given to them about potential safety hazards involving prescriptions they've written. The research found 38 percent of doctors said they changed or modified patient therapy as a result of such information.

More information

Here's where you can learn more about your medicines.

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Housework Can Help Prevent Cancer, Say Scientists

 

Reuters

Thursday, June 5, 2003

CANBERRA (Reuters) - Housework is good for you.

According to a new Australian-Chinese study, dusting and vacuuming could help prevent ovarian cancer.

The study, published in the International Journal of Cancer this week, found moderate exercise such as housework decreased the risk of ovarian cancer with the benefits increasing the harder the work.

Head researcher Colin Binns from Perth's Curtin University on Australia's west coast said the two-year study of 900 Chinese women found the risk of ovarian cancer declined with increasing physical activity. Housework was on the list.

"If you are only doing the housework 20 minutes a week ... it does not really count, but if you are doing three to four hours a day, this is fairly vigorous exercise and increases protection from ovarian cancer," Binns told Reuters.

The study was carried out at Xhejiang University Hospital in Hangzhou in Xhejiang Province just south of Shanghai.

Binns said the study backed the previously disputed idea that exercise helped stave off ovarian cancer and, possibly, other hormone-related female cancers such as of the cervix and uterus.

He said the reason was unknown but suggested it could be because exercise prevented excess fat storage, which influenced hormonal activity. The immune system may also be enhanced through exercise, he said.

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Do Flu Drugs Work in High-Risk Groups?

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Thursday, June 5, 2003

THURSDAY, June 5 (HealthScoutNews) -- Two popular flu-fighting drugs each treat and prevent the infection in a wide range of people. But not enough is known about how well they work in those at greatest risk of serious illness, a new study argues.  

The two drugs, Relenza and Tamiflu, bottle flu virus inside infected cells and prevent it from migrating to healthy ones, thereby reducing the duration of the attack. Although Relenza, sold by GlaxoSmithKline, and Tamiflu, from Roche, are similar products, only Tamiflu has been approved in this country for both the treatment and prevention of flu.

"It is the healthy for whom we've got the most information," says study author Nicola Cooper, an epidemiologist at the University of Leicester, England. "It's the high-risk groups that need the most attention." These include the very elderly and those with chronic diseases such as diabetes, heart disease and lung problems.

Flu claims 20,000 lives each year in the United States alone, and sends 110,000 people to the hospital each infection season. Health officials urge vaccination in everybody, and especially those at high risk of contracting serious illness. But while the shots are the best defense against influenza they're not guaranteed protection, and roughly 25 percent of people who receive the vaccine wind up with the flu.

Tamiflu, which is a pill, and the inhaled Relenza have been shown to shorten flu bouts in people who contract the virus, and Tamiflu has also been approved in this country as a means of preventing infection.

The latest study appears in the June 7 issue of the British Medical Journal.

Cooper and her colleagues reviewed 17 previous treatment trials and seven prevention studies with the two drugs that had been published before 2002. The studies they included, out of a pool of 80 published reports, looked at the medications in three groups: children 12 and under, healthy people between the ages of 12 and 65, and high-risk people -- the elderly or those with heart, lung or other chronic ailments.

Both drugs were effective at trimming the duration of flu symptoms -- by about a day or so, on average -- and both slashed the risk of developing the infection by between 70 percent and 90 percent.

But most of the studies didn't include elderly subjects or people at high risk of complications from flu.

Barbara Freund, of Eastern Virginia Medical School's Glennan Center for Geriatrics and Gerontology in Norfolk, helped conduct one study of Tamiflu's effectiveness in nursing home residents. Since 2001, researchers have conducted other trials with the drug and Relenza in older people, Freund says, but much of that work remains unpublished.

"We certainly know more than we did and I think the experience in the older population is probably now greater with Relenza," she says. "But certainly we need to do more in those high-risk populations."

Dr. Paul Drinka, medical director of the Wisconsin Veterans Home, in the town of King, says he agrees that relatively little is known about how the two drugs treat flu in the frail elderly. However, he adds, it would be ethically troubling to conduct the most rigorous study possible -- one that included people who got sugar pills instead of real drug -- in sicker subjects.

"Morally, I could not participate in such a study, to withhold a treatment that's proven effective in younger people. I don't know that such a study will ever be done," says Drinka, who also holds a faculty position at the University of Wisconsin Medical School.

Meanwhile, Drinka says, doctors are prescribing Tamiflu and Relenza to high-risk patients despite the dearth of data. "To me it's logical that those who are at the greatest risk of adverse events like pneumonia or death would have the most to gain from an effective treatment." Evidence shows that not only can the drugs shorten flu symptoms but they can also reduce the risk of pneumonia, a serious complication in older flu sufferers, he says.

Daniel Perry, executive director of the Alliance for Aging Research, calls the failure to include the elderly in clinical trials "ageism." Older Americans consume about 40 percent of the prescription drugs in this country each year, Perry says, "but it is the rare clinical trial that includes people over the age of 65 or 70. And it's almost unheard of to include people with multiple chronic conditions. But that is really the profile of the people who will be using the drug."

The elderly metabolize drugs differently and retain their effects longer than do younger patients. The various drugs they take can interact, sometimes in dangerous ways. While it's true that designing robust studies in people with several illnesses on several medications is tricky, Perry says, "we're going to have to do that."

More information

To learn more about flu, visit the Centers for Disease Control and Prevention. And try the U.S. Food and Drug Administration (news - web sites) for more on Tamiflu and Relenza.

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Drug Counseling Helps Reduce HIV Risk

 

Reuters Health

Thursday, June 5, 2003 

NEW YORK (Reuters Health) - People who are addicted to cocaine who undergo drug counseling reduce their cocaine use and significantly decrease their HIV (news - web sites) risk, according to a new report.

"Drug abuse treatment can have important positive public health benefits even if the outcomes are less than perfect," lead study author Dr. George Woody told Reuters Health. "The 12-step oriented combination of group and individual counseling worked the best, though all patients reduced their risk."

Woody urged everyone to "support substance abuse treatment. It can do a lot of good both in the short and long term."

In an article in the Journal of Acquired Immune Deficiency Syndromes, Woody, who is at the University of Pennsylvania in Philadelphia, and his colleagues report on changes in HIV risk among 487 people undergoing treatment for cocaine addiction.

Treatment was associated with an average reduction of cocaine use from 10 days per month to one day per month after six months, the authors report, with participants who received both individual and group drug counseling faring best.

Treatment participation was also associated with significant reductions in risky sex and the total risk of HIV infection, the report indicates.

Those who completed treatment showed a trend toward less sex risk and significantly less total risk than did patients who dropped out before completing their program, the researchers note.

HIV risk reduction corresponded to reductions in drug use and to improvements in psychiatric symptoms, the results indicate. This improvement was similar regardless of race, gender, sexual orientation or the presence of antisocial personality disorder.

"The fact that all treatments consisted of no more than three weekly outpatient sessions that included risk reduction counseling is worth noting," the authors conclude, "because it suggests that reductions in cocaine use and HIV risk can be achieved at a relatively low cost, at least for a portion of the patients who seek treatment for cocaine dependence."

Source: Journal of AIDS (news - web sites) 2003;33:82-87.

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Air Pollution May Worsen Asthma Attacks

HealthScoutNews

Thursday, June 5, 2003

THURSDAY, June 5 (HealthScoutNews) -- Children may be at greater risk of severe asthma attacks if they're exposed to nitrogen dioxide air pollution before they suffer a viral infection from flu or the common cold.

That's the conclusion of a British study in the June 7 issue of the journal The Lancet.

Sources of nitrogen dioxide pollution include vehicle exhaust and gas cookers. Previous research suggested a link between respiratory disease and exposure to air pollution nitrogen dioxide. And it's known that viral infections exacerbate asthma.

The new study by researchers at St. Mary's Hospital in Portsmouth, England, included 114 asthmatic children, ages 8 to 11 years, from families where there were no smokers. The researchers made daily records of the children's upper respiratory tract symptoms, such as runny nose, sneezing and headache.

They also kept daily track of the children's asthma symptoms -- coughing, wheezing, and shortness of breath -- and measured their weekly exposures to nitrogen dioxide.

The study found that children who had more exposure to nitrogen dioxide were more likely to report more severe respiratory tract symptoms which, in turn, were associated with exacerbated asthma symptoms the week after the children had a viral infection.

The findings suggest that health costs associated with treating acute asthma exacerbations could be reduced by controlling nitrogen dioxide pollution, the study says.

More information

Here's where you can learn more about asthma.

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C-Section Best for Breech Babies but Not for Moms

 

By Richard Woodman

Reuters Health

Thursday, June 5, 2003

LONDON (Reuters Health) - Planned caesarean section may be best for breech babies but this should be weighed against the significant risk to the mother, Dutch researchers said on Thursday.

The team compared the outcome of 33,824 infants born in the breech position in Holland from 1995 to 1999 according to whether they were delivered by planned caesarean section, emergency caesarean or vaginal delivery.

The findings, published in the British Journal of Obstetrics and Gynaecology, show that vaginal delivery and emergency caesarean section resulted in a sevenfold increase in low Apgar score -- a measure of newborn health that takes into account heart rate, respiration and other factors -- a threefold increase in birth trauma and a twofold increase in infant deaths compared with planned caesarean section.

Dr. Christine C.Th. Rietberg of Vlietland Hospital in Vlaardingen and colleagues note that the findings confirm the results of a previous study that was published in the journal The Lancet in October 2000.

But they warn that the benefits to the infants should be weighed against the results of other studies showing that caesarean section is associated with two to 11 times the risk of maternal death.

They add: "Maternal morbidity associated with caesarean section might be up to five to 10 times that of vaginal birth, most commonly manifest by infection, followed by blood transfusion."

The researchers also point out that "infection is less likely following planned surgery than after an emergency ... caesarean section but is still significantly higher than after vaginal birth.

Source: British Journal of Obstetrics and Gynaecology 2003;110:604-609.

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Everybody Out of the Pool

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Thursday, June 5, 2003

THURSDAY, June 5 (HealthScoutNews) -- Now that the summer swimming season has arrived, here's something you might want to know before heading to your local pool:

More than half of America's public pools inspected last year failed state and local reviews designed to protect bathers. And many of the violations involved problems with the chlorine that's crucial to killing germs that cause illness, health officials say.

"Chlorine is our single greatest barrier to the spread of illness" in pools, says Michael Beach, an epidemiologist at the U.S. Centers for Disease Control and Prevention (news - web sites) (CDC), which released a report on the findings Thursday. "If we don't maintain it [chlorine], we don't adequately protect people."

Health regulators often demand that pool operators receive safety training. But the report found that such instruction was often wanting. In one area of the country, nearly 36 percent of operators required to have training failed to get it.

"We really need to improve the training and vigilance of pool operators regarding pool maintenance," Beach says.

A CDC report last year showed dramatic increases during the last decade in water-borne infections, such as E. coli and Shigella. Anytime one of those bugs is behind an outbreak in a pool, Beach says, inadequate maintenance is likely to blame.

However, other germs, such as certain forms of Cryptosporidium, can resist chlorine. So taking steps to keep them out of pools -- showering before swimming; staying out of the water if you have diarrhea; changing diapers in the bathroom, not the side of the pool --are key.

"Swimming is a shared water experience," Beach says.

The new report, published in the CDC's June 6 Morbidity and Mortality Weekly Report, covers more than 22,000 inspections of U.S. pools made between May and September of last year. The bulk of the inspections were done in Florida, but California, Minnesota, Pennsylvania and Wyoming were also included. In addition to municipal pools, those at hotels and motels, schools and a few private clubs and apartments also were covered by the inspections. (Home pools are not inspected.)

About 46 percent of pools inspected passed muster, officials say, turning up no violations. But the rest tallied more than 21,500 demerits, of which 8.3 percent warranted the immediate closing of the pool.

Water chemistry trouble accounted for nearly 39 percent of the violations. These included inappropriate chlorine levels as well as flawed pH, a problem most common in wading pools for children. Filter and circulation-system infractions were next, and most likely to affect municipal pools.

Roughly one-quarter of the violations involved operation and policy errors, such as inadequate operator training, failure to have a test kit, poor record-keeping and lack of a current license.

Despite the frequency of infractions, most are relatively minor and result in no action taken against the facility, says Bart Bibler, chief of the bureau of water programs for Florida's Department of Health.

"The violations are not so major as to warrant the immediate closure of the pool," notes Bibler, a co-author of the report. But 8 percent of the cases reviewed led to a shutdown of the pool, he adds.

Florida officials inspect the state's approximately 30,000 public pools twice a year. "There's a huge importance that pool operators ensure proper operation and maintenance the rest of the year," Bibler says.

More information

For more on pool hygiene and safety, try the Water Quality and Health Council, or the University of Michigan.

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Women Benefit More Than Men from Quitting Smoking

 

By Linda Carroll

Reuters Health

Thursday, June 5, 2003 

NEW YORK (Reuters Health) - While men and women both benefit from quitting smoking, women see bigger improvements in lung function, a new study shows.

Researchers found that women's breathing improved more than twice as much as men's after kicking the habit, according to the study published in the American Journal of Epidemiology.

Women may benefit from quitting more than men because they seem to be more susceptible to damage from cigarette smoking in the first place, according to Gail Weinmann, director of the Airway Biology and Disease Program in the Division of Lung Diseases at the National Heart, Lung, and Blood Institute, which sponsored the study.

"The message people should take from this study is that it's never too late to quit," Weinmann said in an interview with Reuters Health. "Quitting helps everyone."

For the multi-center study, researchers led by John Connett of the University of Minnesota, in Minneapolis, followed more than 5,300 middle-aged smokers for five years. All the participants in the study had mild or moderate chronic obstructive pulmonary disease (COPD).

COPD, which includes emphysema, is a gradual, progressive disease that makes breathing increasingly more difficult with time, Weinmann explained.

"Sometimes there is obstruction in the lungs, sometimes it's in the airways," she added.

COPD is the fourth most common cause of death in the United States. And smoking is the leading cause of COPD.

During the course of the study, 611 men and 313 women permanently quit smoking. Another 916 men and 592 women quit intermittently.

In the first year after quitting, women's lung function improved more than twice that of the men's. That difference leveled out some during the five years of the study.

Compared to smokers, those who quit lost less lung function during the course of the study. Women, though, actually gained lung function during the five years of study.

Source: American Journal of Epidemiology 2003; 157:973-979.

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WEDNESDAY, JUNE 4, 2003

 

Cosmetic Surgery Catching on with Men: U.S. Study

 

By Ellen Wulfhorst

Reuters

Wednesday, June 4, 2003

NEW YORK (Reuters) - What looks good on the goose looks good on the gander too, a new survey shows.

Men are turning to plastic surgery and cosmetic procedures to brighten up their appearances at a faster rate than women, according to a survey released on Wednesday.

Men's use of fat injections to soften deep wrinkles leaped 497 percent last year from the previous year. Women's use of the injections fell 36 percent, according to the American Academy of Facial and Plastic Reconstructive Surgeons survey.

Men's use of Botox injections to eliminate frown lines rose 88 percent, while women's Botox use fell 8 percent, it said.

And for smoothing skin, use of microdermabrasion among men rose 79 percent and use of laser resurfacing rose 13 percent, the survey showed.

Meanwhile, women's use of microdermabrasion dropped 13 percent and their use of laser resurfacing dropped 38 percent during the same time period, the survey showed.

The number of men getting rhinoplasty -- more commonly known as nose jobs -- rose 47 percent, while the number of women doing so rose 5 percent, it said.

Typically, men and women visiting plastic surgeons for cosmetic reasons were age 40 to 59, it said.

The study said 44 percent of men and 57 percent of women tell their doctor that looking younger is the reason they are choosing cosmetic surgery.

By 25 to 10 percent, men are more likely than women to say they want facial cosmetic surgery for work-related reasons, it said.

The study was conducted by written questionnaires from January 20 to March 3 among the more than 2,600 members of the association, who focus on treatment of the face, head and neck.

By comparison, in the prior year, women's use of Botox rose 60 percent while men's fell 14 percent; women's use of laser resurfacing rose 13 percent while men's fell 19 percent; women's use of fat injections fell 17 percent and men's fell 54 percent; and women's use of microdermabrasion fell 46 percent and men's use fell 78 percent, the survey said.

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Study Suggests Puberty-Breast Cancer Link

By Stephanie Nano

Associated Press Writer

The Associated Press

Wednesday, June 4, 2003

A study of twins suggests early puberty may trigger the development of breast cancer (news - web sites) in women who are already at unusually high risk because of their genetic makeup.

 

 

A women's risk of breast cancer is believed to be linked to her lifelong exposure to the sex hormone estrogen, with slight increases for those who start menstruating early, reach menopause late, never have children or have them late.

However, the new study suggests that going through puberty early may be especially ominous for some women.

For women genetically predisposed to get the disease, the rush of hormones at puberty alone — rather than long-term exposure — may result in breast cancer later in life, according to the study from the University of Southern California at Los Angeles.

"There's a lot we don't know about the causes of breast cancer, but what we need to know ... is where to look," said researcher Ann S. Hamilton. "This provides some more clues about a different approach in looking for genetic factors."

The findings appear in Thursday's New England Journal of Medicine (news - web sites).

The study looked at 1,811 sets of identical and fraternal female twins. In each set, one or both twins had breast cancer. The researchers asked about their age at puberty and menopause, pregnancies and other risk factors and looked for patterns.

One thing stood out: For identical twins with cancer, the first twin to reach puberty was five times more likely to get the disease first. The link was even stronger when menstruation began early, before the age of 12. Other factors — a later age at menopause, fewer children and a later first pregnancy — made no difference.

Since identical twins share genes, the researchers assume there was a hereditary reason behind the vulnerability to the onset of hormones. Scientists so far have discovered a few gene mutations that increase the risk of breast cancer.

While the focus has been on genes related to estrogen levels, Hamilton said, the study suggests also looking for genes that affect the sensitivity of immature breast cells at puberty.

Patricia Hartge of the National Cancer Institute (news - web sites), who wrote an accompanying editorial, said the study was provocative but its conclusions would have to be repeated in other studies. The study was partly funded by the institute.

"If we begin to understand how the hormone and gene go together to later increase the risk of breast cancer ... we probably could figure out how to intervene," she said.

Dr. JoAnn Manson of Harvard's Brigham and Women's Hospital said the implications of the study are worrisome given the gradual decline in the age of puberty in the United States and the rise in childhood obesity. Body fat can stimulate hormones.

If the findings are correct, "There's even more impetus to try to reverse this epidemic of obesity in children," Manson said.

On the Net:

New England Journal: http://www.nejm.org

National Cancer Institute: http://www.nci.nih.gov

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Heart Transplant in HIV+ Man Raises Ethics Issues

 

By Keith Mulvihill

Reuters Health

Wednesday, June 4, 2003 

NEW YORK (Reuters Health) - A 39-year-old Harvard scientist previously diagnosed with AIDS (news - web sites) has survived two years after a heart transplant, according to a report released Wednesday, which suggests that other HIV (news - web sites)-infected patients may be possible candidates for heart transplant.

Because donor hearts are in such short supply, the medical community will need to decide if HIV-infected patients -- once considered ineligible for transplant due to a poor expected prognosis -- should routinely be put on transplant waiting lists, according to the report in The New England Journal of Medicine (news - web sites).

"This was a benchmark kind of study," said Dr. Gregory Curfman, executive editor of the journal. Curfman said that publication of the report should get the medical community thinking about the issue of organ transplantation in HIV-infected individuals.

The new study, along with preliminary results from studies of liver and kidney transplants, "provides hope" that some HIV-infected patients can benefit from a transplant, according to an editorial by Drs. Michelle E. Roland and Diane V. Havlir of the AIDS Division of the Positive Health Program at the University of California, San Francisco.

The National Institutes of Health (news - web sites) is currently conducting a study of 150 kidney transplants and 125 liver transplants in HIV-infected individuals, they note.

"Originally that study was to include heart transplantations, but its design was revised to focus on those organs for which there is greater need," they write. "It is hoped that funds will become available to add heart transplantation if the preliminary results are positive."

Many transplantation centers have been hesitant to allocate donor organs to HIV-infected patients because it was believed that immune system-suppressing drugs -- which must be taken by transplant patients for the rest of their lives -- might further damage an HIV patient's already embattled immune system.

However research has begun to suggest that HIV infection does not necessarily affect how well the patient responds to the new organ. Furthermore, therapies that suppress the immune system do not appear to increase an HIV-infected patient's susceptibility to infections.

To date, the bulk of organ transplants among HIV-infected individuals have involved kidney and liver transplants.

Indeed, the study's lead author Dr. Leonard H. Calabrese of the Cleveland Clinic Foundation in Ohio and colleagues note that the need for heart transplantation among HIV-infected individuals is much lower than the need for liver or kidney transplants. This is because there is a higher rate of other illnesses such as hepatitis B or C and HIV-related kidney disease.

The 39-year-old transplant patient, Dr. Robert Zackin, a researcher at the Harvard School of Public Health, was infected with HIV in 1986 and diagnosed with an AIDS-defining infection in 1992. Zackin, who also happens to be a senior author of the report, also developed Kaposi's sarcoma, a type of cancer often found in AIDS patients. Zackin underwent a battery of treatments to fight infections in addition to chemotherapy for the cancer. However, he later developed heart failure, perhaps as a result of his anti-cancer treatment.

He underwent a heart transplant in February 2001. Now, more than two years after the surgery, Zackin reportedly has experienced no new or reactivation of opportunistic infections and anti-HIV therapy continues to keep levels of the virus low. What's more, he continues to work full-time and exercise regularly, the study indicates.

Still, Zackin's recovery has not been without complications, according to the report. He underwent several episodes of organ rejection, including other complications that now require that he receive blood transfusions every two or three weeks.

Commenting on the unusual circumstances in having an author of a case study also be the patient in a report, Curfman told Reuters Health that as far as he could remember this was the first time that the journal experienced such a situation.

"We felt that it was important that if (Dr. Zackin) was to be an author, he needed to be identified (as the patient)," said Curfman.

Moreover, Curfman added that the editorial team felt strongly that the study was important since few, if any, previous studies have documented an HIV-infected person with advanced disease getting a heart transplant.

"Given the assumption that (Zackin) had a legitimate place on the recipient list there is no reason to suggest that he is a less eligible candidate based only on his HIV status," said Dr. Holly Taylor, of the Berman Bioethics Institute at Johns Hopkins University in Baltimore, Maryland.

"All of the people on the list have a fatal illness given that they all need a new heart," Taylor said in an interview. "The fact that (Zackin) has HIV doesn't mean that he won't benefit any less."

Source: The New England Journal of Medicine 2003;348:12323-2328.

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Wyeth Promotes Hormone Therapy in Ads

By Linda A. Johnson

AP Business Writer

The Associated Press

Wednesday, June 4, 2003

TRENTON, N.J. - Stung by a series of studies showing its key hormone replacement drug has more health risks and fewer benefits than previously believed, Wyeth launched an ad campaign saying the therapy remains helpful for many menopausal women.

In full-page newspaper ads appearing this week, the Madison, N.J.-based pharmaceutical company states that hormone therapy is proven to ease menopause symptoms such as hot flashes, night sweats and vaginal dryness, but is not right for all women. Prempro, a combination of the hormones estrogen and progestin, and Wyeth's estrogen-only pill Premarin, together are the company's No. 2 revenue source.

"Wyeth continues to support the valuable role of hormone therapy in appropriate women," the ad reads, saying also that it should be used for the shortest time and at the lowest dose possible.

Company spokesman Doug Petkus said Wyeth chose newspapers — 180 of them in 20 major U.S. markets — so it could give women and their doctors a detailed message.

"We wanted to state clearly and unequivocally our view of hormone replacement therapy" and its appropriate use, Petkus said. He would not disclose the ads' cost

The ad lists many negative findings reported in studies over the past year: increased risk of heart attack, stroke, breast cancer (news - web sites), blood clots and dementia. Those are now listed on the package insert.

The findings upended doctors' long-held belief that hormone supplements benefited the heart by mimicking the effects of natural estrogen, which helps keep cholesterol at healthy levels, and that they warded off some effects of aging.

Sales of Wyeth's hormone replacement medicines have been sliding since three negative studies appeared in July 2002. Wyeth's stock also plunged, from about $54 a share to below $30.

The biggest of the three, the Women's Health Initiative, reported that women taking Prempro had reduced risk of hip fractures and colon cancer, but higher-than-expected incidence of breast cancer, heart attack, stroke and blood clots. While the risks to an individual woman were still relatively low, the findings were striking enough to halt the 16,600-patient study early. In addition, the National Institutes of Health (news - web sites), which sponsored the study, urged the 6 million women taking estrogen-progestin pills to consult with their doctors.

Quarterly revenues from Prempro in the United States fell by 61 percent between last June and this March, to $73.4 million, according to market research company IMS Health. Premarin sales are down about 18 percent over that period, to $269.4 million.

Wyeth's ad does not mention that study, but cites one published last week finding that estrogen-progestin pills doubled the risk of Alzheimer's disease (news - web sites) in women 65 and older. The ad notes that the study focused on women past menopause and examined potential uses of hormone therapy besides treating menopausal symptoms.

Other studies — including one in March that showed estrogen and progestin pills don't make older women feel better by improving their memory, sleep or sex lives — have also dampened enthusiasm for Prempro.

Dr. Wulf Utian, executive director of the North American Menopause Society, said Wyeth could have done a more thorough job summarizing the therapy's risks and benefits, given the size of the ads.

"I'm disappointed they didn't," Utian said, "because the public is incredibly confused."

Independent pharmaceuticals analyst Hemant Shah, of HKS & Co. in Warren, N.J., said such advertisements are rare.

"This is a very good sign that Wyeth is becoming proactive," Shah said. "This can significantly not only build consumer confidence, but also remove or delay or limit liability" for Wyeth.

On Wednesday, Wyeth shares closed up 94 cents, or 2.2 percent, at $44.72 in trading on the New York Stock Exchange (news - web sites).

On the Net: http://www.wyeth.com

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Pediatricians Call for More Action on Phthalates

 

By Keith Mulvihill

Reuters Health

Wednesday, June 4, 2003

NEW YORK (Reuters Health) - An organization of U.S. pediatricians is calling for further research into the effects on children of chemicals used to make fragrances last longer and soften plastic in toys and medical tubes.

The chemicals, known as phthalates, have been linked in previous studies to birth defects and other harmful effects in animals, according to the report, published in the June issue of Pediatrics, the journal of the American Academy of Pediatrics (AAP).

The AAP's Committee on Environmental Health notes in the report that "no studies have been performed to evaluate human toxicity from exposure to these compounds."

The impetus to do the report was a study published by the Centers for Disease Control and Prevention (news - web sites) (CDC) that found that some people have very high levels of phthalates in their blood, explained Dr. Michael W. Shannon, a member of the AAP committee.

Shannon also noted that media attention about phthalates is likely to have parents asking questions and expressing concern.

"We wanted to make sure that pediatricians are educated and are able to advocate for children's health," Shannon said in an interview with Reuters Health.

In the report, lead author Dr. Katherine M. Shea and other members of the committee note that two phthalates, DEHP and DINP, are of particular concern "because of their known toxicities and the potential for significant exposure in sensitive populations."

Specifically, concern is especially high for premature infants in intensive care units, where they may be exposed to DEHP in plastic medical tubing and bags, explained Shannon, who noted that these infants are immature both developmentally and physiologically.

As such, Shannon said, "we very much want to see more research conducted."

Commenting on the report, Marian Stanley, manager of the Phthalate Ester Panel at the American Chemistry Council said, "the report ... is incomplete and unjustifiably alarmist, because the report does not include significant recent research findings."

But Shea countered that she and the members of the committee took into account all published information available at the time the report was being written.

In response to the criticism of being alarmist, Shea said, "nowhere in the document do we say or imply that parents should take any specific actions. Rather we suggest that pediatricians should become educated and participate in the process of determining what is safe for children."

And she notes that a main goal in writing the report was to educate pediatricians about the complexity of determining and quantifying risks to children from chemical exposures, using phthalates as examples, and to prepare them to be active participants in the process.

"So far the exposure data on phthalates in young children is incomplete and while the toxicity data is pretty good, it's in animals not babies," said Shea.

"I don't think anyone knows all the answers, but we need to be health protective and eliminate unnecessary exposures and, when possible, minimize medical exposures, especially in premature infants in intensive care," Shea told Reuters Health.

In December last year the U.S. Food and Drug Administration (news - web sites) (FDA) told medical professional societies that certain devices may expose people to a toxic dose of DEHP. The agency said at the time DEHP might be found in IV bags and tubing, blood bags, nasogastric tubes, dialysis bags and tubing, and other tubing used to support and feed premature infants.

The FDA advised that, if available, alternatives to phthalates should be should be used to keep plastics soft.

So far, the U.S. government has declined to ban the use of phthalates. The European Union (news - web sites) banned their use in some products, including baby toys, in 1999. In the U.S. and Canada all phthalates have been voluntarily removed from infant bottle nipples, teethers and toys intended to go into an infant's mouth.

Source: Pediatrics 2003;111:1467-1472.

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Smoke More, Quit More

HealthScoutNews

Wednesday, June 4, 2003

(HealthScoutNews) -- If you're ready to give up smoking, will it be easier if you're a pack-a-day smoker or someone who only puffs a few cigarettes a day?

The answer, according to the journal Public Health Review, may surprise you.

Researchers at Ben-Gurion University in Beer Sheva, Israel, looked at the traits of people who were able to stop smoking successfully. And they found that those who had smoked more than 25 cigarettes a day were more likely to quit than those who smoked less.

When they looked at other factors, there were no differences between quitters and relapsers in marital status, age, education or nationality.

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Early Kidney Damage in Diabetics May Regress: Study

 

By Jacqueline Stenson

Reuters Health

Wednesday, June 4, 2003

NEW YORK (Reuters Health) - Contrary to common medical belief, patients with type 1 diabetes who have a condition marked by slightly elevated levels of protein in their urine are not necessarily destined to develop kidney failure years later, according to new study findings.

In fact, during the study's six-year follow-up period, the condition, known as microalbuminuria, actually regressed in nearly 60 percent of patients with this form of diabetes, who must take insulin to live.

"Microalbuminuria has this label as a dire finding, that kidney disease is inevitable," said study author Dr. Bruce A. Perkins of the Joslin Diabetes Center in Boston, Massachusetts.

But the new findings "give hope that with the right medical care people can get rid of this condition" before it progresses, he told Reuters Health.

When the kidneys, which filter blood, become damaged by diabetes, protein from blood can leak into urine. While doctors have thought this damage was irreversible, Perkins said, the new results indicate it may be repaired in patients who have small protein elevations in the urine that are suggestive of lesser amounts of damage.

Extensive damage leads to kidney failure, which requires that a patient undergo regular dialysis or a kidney transplant.

In the study, published Thursday in The New England Journal of Medicine (news - web sites), microalbuminuria was most likely to regress in patients who had their blood sugar under tight control and had healthy levels of cholesterol, triglycerides and blood pressure.

The findings suggest that quality medical care that detects microalbuminuria early and addresses these other factors may afford the kidneys an opportunity to heal, Perkins said.

"If one develops microalbuminuria, there are still measures that can be taken to try to reverse it," he said.

The study involved 386 patients who had microalbuminuria during a two-year evaluation period and were then followed for the next six years to see whether the condition persisted. While microalbuminuria regressed in 58 percent of patients, 19 percent developed a more advanced condition called proteinuria, which is marked by higher levels of protein in the urine that signal greater kidney damage.

Statistics show that about half of patients with type 1 diabetes will develop microalbuminuria at some point in their lives, and the odds are even greater for those with type 2 diabetes, according to Perkins.

He said that while the study did not include people with type 2 diabetes, which is the more common form of the disease, the findings could possibly apply to them as well.

"It's likely, but it definitely should be studied," Perkins said.

In an accompanying editorial, Dr. Eberhard Ritz of the University of Heidelberg in Germany writes that the study provides "welcome documentation that a widely accepted surrogate marker for the progression of (kidney) disease can be favorably influenced."

Source: The New England Journal of Medicine 2003;348:2285-2293,2349-2352.

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Widespread Pain Could Warn of Cancer

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Wednesday, June 4, 2003

WEDNESDAY, June 4 (HealthScoutNews) -- Could widespread pain be a warning sign of cancer?

British researchers think it might be.

After following more than 6,000 people for nine years, researchers from the University of Manchester found those who reported having widespread pain at the start of the study were much more likely to have been diagnosed with cancer by the end of the study.

They were also less likely to survive their cancer, according to the study, published in the June issue of Arthritis and Rheumatism.

"We found that those who originally had widespread pain had a 60 percent increased risk of getting cancer and, if they did get cancer, their survival was poorer," says study author Dr. Gary Macfarlane, an epidemiology professor at the university.

But, Macfarlane cautions, this could be a "chance" finding. He says the results need to be duplicated before a link between pain and the development of cancer can be confirmed.

During 1991 and 1992, the researchers recruited 6,331 people between the ages of 18 and 85 who had never been diagnosed with cancer for the study.

Fifteen percent of the group reported having widespread pain, such as persistent, achy joints all over. About 48 percent reported having regional pain, and 37 percent of the study participants said they had no pain.

The average age of those with widespread pain was 55 years, and 66 percent were female. Of those reporting regional pain, 58 percent were female, and the average age was 49 years. Fifty-four percent of the no-pain group was female and the average age was 42.

At the end of the nine-year period, 395 people had developed cancer -- 90 from the widespread pain group, 198 from the regional pain group and 107 from the no-pain group.

According to the study, people with regional pain are about 20 percent more likely than people with no pain to develop cancer and people who reported widespread pain were 60 percent more likely to develop cancer.

The association between widespread pain and cancer was strongest for breast cancer (news - web sites), but was also significantly increased for prostate, lung and large bowel cancer.

People with widespread pain who went on to develop cancer also had poorer outcomes than those without pain. They were more likely to die from their cancers, especially breast and prostate cancer (news - web sites).

Macfarlane says the researchers don't know how to explain these findings.

Dr. Todd Schlifstein, an attending physician at the Hospital for Joint Diseases at New York University School of Medicine in New York City, has one theory.

"People with chronic pain may be at a higher risk for other problems, because chronic pain affects all aspects of your life," he says.

They often have trouble sleeping, can't exercise and suffer from depression or social isolation, he says. And chronic pain may also dampen the immune system, which might play a role in the development of cancer, he adds.

Schlifstein points out that people with widespread pain were probably seeking medical care for their pain. That means, he says, they probably underwent more diagnostic tests than most people do, and their cancers may have simply been picked up incidentally while doctors were searching to pinpoint the cause of the pain.

Macfarlane adds it's important for people to realize that not everyone in the study with widespread pain developed cancer. Most, in fact, did not.

So, if you're suffering from chronic pain, he says, you don't need to be worried that it's a sign you will develop cancer.

"This is an isolated finding at present and would need to be replicated before we believed that there may be a link," Macfarlane says.

More information

To learn more about cancer and pain, visit CancerPain.org or the American Cancer Society.

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Strict Diabetes Control Cuts Risk of Heart Disease

 

By Linda Carroll

Reuters Health

Wednesday, June 4, 2003

NEW YORK (Reuters Health) - When it comes to patients with type 1 diabetes, tight control of blood sugar may help stave off heart disease, a new study shows.

Patients who received intensive therapy to keep blood sugar very close to normal levels had less thickening of the arteries than those who had standard therapy, according to the study published Thursday in The New England Journal of Medicine (news - web sites).

Previous studies showed that intensive therapy to maintain normal levels of blood sugar led to reductions of other complications of diabetes, including eye, kidney and nerve disease, according to the report's lead author, Dr. David M. Nathan, a professor of medicine at the Harvard School of Medicine and director of the Massachusetts General Hospital's Diabetes Center.

"What we haven't known till now is whether the same type of intensive therapy -- that is, trying to maintain blood glucose levels as close to the non-diabetic range as possible -- would affect heart disease," Nathan said in an interview with Reuters Health. "Heart disease is the major killer of people with diabetes.

This study shows that intensive therapy can, indeed, slow the development of atherosclerosis, Nathan said.

Nathan and his colleagues followed 1,229 patients with type 1 diabetes, who must take insulin injections to stay alive. The patients had all been part of an earlier study to examine the effects of intensive therapy on complications of diabetes: 611 had been assigned to receive conventional glucose control therapy, while another 618 received the intensive therapy.

At the end of that study, all patients were put on the intensive blood sugar control therapy, Nathan said. This therapy includes at least three injections of insulin per day, he explained.

For the new study, Nathan and his colleagues looked at the thickness of the carotid artery in the neck in the two groups of patients. The patients' arteries were viewed with ultrasound at the beginning of the study and again six years later.

The researchers also looked at artery thickness in a group of non-diabetic patients for comparison.

At the beginning of the study, artery thickness was similar in the three groups of people. At the end of six years, both groups of diabetic patients had thicker arteries than did the non-diabetic patients. But diabetic patients who had initially received standard therapy had thicker arteries than those who received the intensive therapy.

What is interesting, Nathan said, is that researchers could see an effect from the initial differences in therapy.

"We still see a large benefit from the original intensive therapy," he said. "And that effect seems to carry forward."

Two of the researchers have received honorariums or have a financial interest in several pharmaceutical companies.

Source: The New England Journal of Medicine 2003;348:2294-2303.

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Common Antibiotic May Discolor Gums

HealthScoutNews

Wednesday, June 4, 2003

WEDNESDAY, June 4 (HealthScoutNews) -- The antibiotic minocycline, commonly prescribed to treat acne and rheumatoid arthritis, can cause teeth and bone to discolor.

That's what Mayo Clinic researchers found, and their finding appears in the June issue of the Journal of Periodontology.

This discoloration of the teeth may make gum tissue appear blackish-blue in color, something that doctors who prescribe minocycline and people who take it should be aware of, the study says.

The Mayo study focused on a 29-year-old white woman who had a dramatic blue appearance of her gum tissue and bone surrounding her teeth. When researchers reviewed her medical history, they found she had been taking 50 milligrams of minocycline four times a day for the previous 17 months.

The study notes that about 3 percent to 6 percent of long-term users of minocycline develop dental staining. The discoloration doesn't harm the teeth, bone or gum tissue.

"This case definitely 'drives home' the importance of collaboration between medical and dental professionals. Periodontists have known for awhile that medical drugs can affect a person's oral health, and this is a reminder for patients to inform their dental professionals of all medications they are taking," Gordon Douglass, president of the American Academy of Periodontology, says in a news release.

For example, more than 400 medications cause dry mouth, which can damage gum tissue. Other drugs can cause gingival overgrowth.

More information

Here's where you can learn more about minocycline.

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FDA Urged to Limit Acrylamide Levels in Food

 

By Alicia Ault

Reuters Health

Wednesday, June 4, 2003 

WASHINGTON (Reuters Health) - A public advocacy group on Wednesday petitioned the Food and Drug Administration (news - web sites) to force manufacturers to limit how much acrylamide is in food.

The Center for Science in the Public Interest (CSPI), best known for its damning nutritional assessments of pizza, Chinese food and movie popcorn, said that acrylamide in foods may be causing as many as several thousand cancers a year in the U.S.

Acrylamide first came to public notice last April, when a group of Swedish researchers contended that the substance formed when foods were fried, baked or roasted at high temperatures, and was likely responsible for causing thousands of cancers.

Washington D.C.-based CSPI is urging the FDA to require manufacturers to meet temporary acceptable levels of acrylamide in food, at least until more is known about the substance. CSPI executive director Michael Jacobsen noted that German authorities are already urging companies to stop marketing foods with high acrylamide content.

Since last April, scientists have learned how acrylamide is formed. It was already known that high levels of exposure can cause neurological problems and cancer in animals. But researchers still do not know what constitutes a safe or acceptable level of acrylamide in people.

Jacobsen said, however, "There is no safe level."

"When it comes to carcinogens, the less, the better," he added.

His nonprofit group is urging Americans to eat less of the "non-nutritious" foods that have been found to have high acrylamide levels, such as potato chips, French fries, baked goods, pastries and coffee. Jacobsen said consumers should not be as worried about nutritious foods, such as cereals and whole grain breads, which have also been found to have acrylamide.

Those foods have far less of the substance and make up a much smaller proportion of the average American's diet, said Jacobsen. According to FDA data cited by CSPI, Pringles BBQ Sweet Mesquite Flavored Potato Crisps, for instance, contain 2,510 parts per billion of acrylamides, compared to 102 parts per billion for Arnold Bakery Light 100 percent whole wheat bread.

Food manufacturers have been conducting their own tests to see how much acrylamide is in food and how to reduce or eliminate them. Jacobsen contended that manufacturers can reduce levels of the substance by changing the variety of potato or other food used, preparing ingredients differently before cooking, or cooking at a lower temperature or for a shorter time.

He lauded the food industry and the FDA for "taking the acrylamide issue very seriously." But, said Jacobsen, since it takes years for the agency to institute new rules or policies, it should take steps toward limiting acrylamide levels before all of the scientific research is complete.

Rick Jarman, vice president for regulatory affairs at the National Food Processors Association, said that while acrylamide is a known neurotoxin and carcinogen, it's not clear if it is at the levels found in food.

"We don't know the significance of these numbers," said Jarman. The industry is working with the FDA "to get firm answers and not just speculation," he told Reuters Health.

A study conducted by scientists at the Harvard School of Public Health in Boston, Massachusetts, and the Karolinska Institute in Sweden -- the first to look at acrylamide in terms of human diet and cancer risk -- suggested it may not be as dangerous as people have been led to believe. Those findings were published in January.

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Breast Cancer Survivors May Face Fewer Heart Troubles

By Colette Bouchez
HealthScoutNews Reporter

HealthScoutNews

Wednesday, June 4, 2003

WEDNESDAY, June 4 (HealthScoutNews) -- There may be good news for women who survive breast cancer (news - web sites): Your risk of heart attack is potentially much lower than women who are cancer-free.

What's more, the reason could hold the clue to helping all women reduce their risk of heart disease, contends new research that is not without its critics.

"Women who have survived breast cancer have had plenty of bad news in their life. Now, for once, there is something good to report," says study author Dr. Elizabeth Lamont, an assistant professor of medicine at the University of Chicago.

That "something," says Lamont, is very early evidence that either having breast cancer or taking one type of breast cancer treatment (SERM drugs such as Tamoxifen) might have some cardio-protective effects.

"Our study has identified a subset of women with a one-third reduction in the risk of heart attack. And with heart disease being the single most significant cause of death in elderly women, this protective effect is definitely significant," says Lamont, whose research appears in the July issue of Cancer.

While Lamont believes the link is estrogen -- either naturally higher concentrations in women who had breast cancer or the result of the SERM drugs that act like estrogens in the body -- not all experts agree.

New York University oncologist Dr. Julia Smith finds the new study provocative, but she's not quick to embrace the thought that either estrogen or SERMS are offering the protective effect.

"What this study tells us is that women who have breast cancer have a reduced risk of heart attack. But it really doesn't offer any solid evidence as to why. And I would not jump to any conclusions about either the protective effects of estrogen or that of SERMs," says Smith, an clinical assistant professor at NYU's School of Medicine.

One reason, she says, is because the research conclusions were drawn using data from a much larger study -- one that identified women with breast cancer but did not indicate the type of tumors found.

"So, we don't really know if these women had estrogen-positive tumors or if excess estrogen even played a role in their breast cancer," Smith says. It's not known for sure if the cardio-protective effects were hormone-driven, she adds.

Smith also points out the data does not indicate which women took SERM drugs or how many did -- another factor that she says makes it impossible to link cardio-protective effects to this medication, or to estrogen in general.

"Perhaps most important is that other major studies of estrogen and SERMs have not found even a hint that this protection exists. So you have to wonder how this new study came to these conclusions," says Smith, who adds it's certainly worth further investigation to learn more.

Lamont concedes she can only estimate that "about half" of the women in the study took SERMs and the rate of estrogen-positive tumors was unknown.

Still, she says, "We don't believe any of the women in the control group had any SERM exposure." And, Lamont adds, other studies have hinted of some cardio-protective effects of SERMS, including not only Tamoxifen but also Raloxifene, which is used to treat osteoporosis.

"So, I don't think the chapter is closed on estrogen, or at least estrogen receptors, just yet," Lamont says.

The study was based on data from the National Cancer Institute (news - web sites)'s large Surveillance, Epidemiology, and End Results (SEER) study, conducted between 1993 and 1998. For the new research, doctors evaluated data on 5,980 women with a history of early-stage breast cancer, for heart attack risks, and then compared them to a group of 23,165 women who were cancer-free.

The result: Breast cancer survivors showed a 34 percent decreased risk of first acute heart attack when compared to women without breast cancer. This remained true even after the researchers accounted for socioeconomic factors, as well as geographic location and other health factors that could influence the outcome.

"Clearly, the news is good for women who have breast cancer: You are less likely to face cardiac problems, particularly a heart attack, " Lamont says.

Although the authors hint at the idea that estrogen, or the use of SERM drugs, may hold the key to cardio-protection for all women, they admit more studies are needed before any solid conclusions can be drawn.

Smith offers another possibility, pointing out that perhaps women who survive breast cancer are simply a hardier stock, better able to cope with the factors that might otherwise cause you to have a heart attack.

"These are women who have survived the psychological trauma and stress of diagnosis, and the physical and emotional traumas of cancer treatment, at an advanced age. So these are strong women," she says. Strong enough, perhaps, to also overcome the factors that lead to heart disease.

More information

To learn more about the potential benefits of SERM drugs, visit the National Cancer Institute. For more on women and heart disease, check with the National Heart, Lung, and Blood Institute.

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USDA Issues New Rules to Prevent Listeria in Meat

 

By Christopher Doering

Reuters

Wednesday, June 4, 2003 

WASHINGTON (Reuters) - The U.S. Agriculture Department on Wednesday announced new rules for meat plants to help keep potentially deadly listeria bacteria from hot dogs, deli meats and sausage.

The USDA stepped up its fight against the bacteria after being criticized by Democrats and consumer groups for a series of massive food recalls last year. Listeria monocytogenes, which thrives in a cool, damp place like a refrigerator, can be deadly for the elderly, those with weak immune systems and the unborn babies of pregnant women.

The new USDA rule requires U.S. meat plants that produce ready-to-eat products exposed to the environment after cooking to develop a plan to prevent listeria, then to verify the effectiveness of the plan through testing.

"This rule is tough; it's fair; it's based on science," said Elsa Murano, USDA undersecretary for food safety. "It will require plants to share their testing data."

About 2,500 U.S. meat plants produce ready-to-eat meat products, which do not have to be cooked by consumers.

Listeria is killed when foods are heated to a steaming hot temperature. However, many consumers do not cook ready-to-eat meat products like cold cuts.

Pilgrim's Pride Corp., the nation's third-largest poultry producer, recalled more than 27 million pounds of its ready-to-eat turkey and chicken products last October after inspectors found plant floor drains tested positive for listeria.

Federal health officials linked its poultry to a listeria outbreak that caused eight deaths, three miscarriages and at least 45 illnesses, mainly in the Northeast.

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Americans Confused About Cancer Prevention: Survey

 

By Megan Rauscher

Reuters Health

Wednesday, June 4, 2003

CHICAGO (Reuters Health) - Most Americans know there are ways to lower their risk of cancer, but many are confused about how to do it, according to a survey released at a major cancer meeting this week.

Among the 1,000 adults surveyed, the majority recognized that diet may play a role in cancer, but only 38 percent "strongly" agreed that they could reduce their cancer risk by eating a diet high in vegetables, fruits and fiber -- even though there's evidence that such healthful eating habits can cut the risk of some cancers.

Only about half of Americans surveyed agreed that they could reduce their risk of developing certain cancers with exercise.

"There is good evidence that exercise may play an important part in some cancers such as colon and breast," Dr. Bernard Levin, head of the American Society of Clinical Oncology (news - web sites)'s (ASCO) Cancer Prevention Committee, told Reuters Health.

Results of the survey, a joint effort by ASCO and the Cancer Research and Prevention Foundation, were released at ASCO's annual meeting here this week.

Only one-third of respondents felt that maintaining a healthy weight was important in cancer prevention.

On the contrary, maintaining a healthy weight is one of the best ways to reduce the risk of a number of cancers, including those of the colon, pancreas and breast, according to Levin. Recent research suggests that as many as one-third of all cancers may be related to obesity.

But Levin was particularly disturbed by the survey findings on sunscreen. Only about one-third of respondents said they always put on sunblock before going to the beach or pool.

"We know that skin cancer is one of the most preventable cancers and, in some parts of the country, one of the fastest growing," Levin said.

Thirty-four percent of those surveyed strongly agreed that they are at increased risk of developing cancer if a family member has had cancer, and nearly two-thirds said they or an immediate family member has had cancer.

On the vitamin front, nearly 30 percent felt strongly that taking vitamins or herbal supplements will reduce their risk of getting cancer.

"But, in fact, there are no scientific studies on herbal supplements that show they have any effect on reducing cancer risk," Levin said. "In general, the best way to get these nutrients is from their natural source, which is in the diet."

When it comes to tobacco, the vast majority of respondents knew that tobacco plays a role in causing cancer. However, 39 percent of those who said they have smoked continue to do so.

This shows a clear "discrepancy between belief and practice," Levin said.

Overall, according to Levin, the survey shows that "Americans need clear information on what they can do to reduce their risk of cancer."

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Study Finds Airport Detectors OK for Heart Devices

 

Reuters Health

Wednesday, June 4, 2003

NEW YORK (Reuters Health) - People who have a pacemaker or implanted heart-shocking device shouldn't worry too much about interference from airport security devices, German researchers reported Tuesday.

They studied 348 patients with either a pacemaker or implantable cardioverter defibrillator (ICD), a device that delivers a shock to the heart if an abnormal rhythm is detected.

They found that a standard airport metal detector did not cause pacing or sensing abnormalities, or reprogramming of the devices, even when patients were closer-than-normal to the gates or had their heart device set at the highest sensitivity.

There have been cases in which anti-theft surveillance devices in stores or digital cellular phones have interfered with the function of pacemakers and ICDs. Such interference can cause inappropriate pacing of the heart or cause a shock to be delivered to the heart when it is not needed.

However, the risk posed by routine metal detectors used in airports is not known, according to the new report, published in the Journal of the American College of Cardiology.

Dr. Christof Kolb of the Deutsches Herzzentrum Munchen in Munich said he conducted the study because his patients were concerned they would have to go through airport metal detectors despite having medical cards that cite their pacemaker or ICD -- particularly in countries in which they didn't speak the language.

"Especially after Sept. 11 patient questions concerning this topic increased a lot. I was not able to give a definite answer," Kolb said in a statement. "This prompted me to test whether or not there is a hazard for those patients."

In the study, Kolb's team used a metal detector commonly found in airports in the U.S., Canada and Europe. In patients with ICDs, the heart rhythm-sensing portion of the device was turned up to maximal sensitivity, but the shock-delivering portion of the device was turned off. For pacemakers, the sensitivity of the device was unchanged.

Patients were asked to stroll through the gates at a leisurely pace and, in a "worst-case scenario," were asked to spend 20 seconds within the gate or place their chest as close to the transmitting side of the gate as possible.

No interference was observed, the authors report.

"Testing a lot of different pacing devices, we have not seen any interference. Currently, patients are not obliged to walk through the metal detector gate (at airports), but if they did, it would not harm their health or their device," said Kolb.

"Whether the results of this study mean that pacemaker or implantable cardioverter-defibrillator patients should generally be allowed to cross airport metal detector gates has to be determined by government authorities," the researcher added.

Source: Journal of the American College of Cardiology 2003;41:2054-2059.

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TUESDAY, JUNE 3, 2003

 

Antidepressant Helps Relieve Hot Flashes: Study

 

Reuters

Tuesday, June 3, 2003

CHICAGO (Reuters) - A popular antidepressant helped reduce the frequency of hot flashes in menopausal women, a drug company-funded study said on Tuesday, though an independent researcher said the drug's effectiveness was limited.

Alternative treatments to hormone replacement therapy for menopausal symptoms such as hot flashes, night sweats and memory and sleep problems will be looked at more closely because of studies showing long-term hormone therapy increases women's risks of cancer, strokes and dementia.

The drug paroxetine, sold under the brand name Paxil by GlaxoSmithKline Plc, halved the number of hot flashes suffered by women in the study, which was company funded and published in the Journal of the American Medical Association (news - web sites).

Women who took an inert placebo also had fewer hot flashes, though the improvement was not as great as with the drug, which cut hot flashes to a median of 3.8 per day from 7.1 per day in women taking a relatively low daily dosage of 12.5 milligrams of Paxil.

Some women taking the drug suffered headaches, dizziness and nausea -- though those effects were reduced in women who took the lower dose, wrote study author Vered Stearns of the Johns Hopkins School of Medicine in Baltimore.

Paxil and other antidepressants known collectively as selective serotonin reuptake inhibitors have been shown to help relieve hot flashes in earlier studies.

But Steven Goldstein, a gynecologist at New York University Medical Center, said the improvement in menopausal symptoms from antidepressants was not nearly as great as with treatment with the hormone estrogen, which restores roughly 80 percent of his patients who suffer debilitating symptoms.

"For women who cannot, should not or will not take hormone therapy this (antidepressants) may be a possible option, but in no way, shape or form is it a substitute for estrogen for people with disruptive symptoms," Goldstein said in a telephone interview.

"I would probably only think of something like this in women who absolutely cannot consider short-term low-dose estrogen therapy: women with breast cancer (news - web sites), women on (the breast cancer drug) tamoxifen. (For) that subgroup, this is a nice thing to be able to offer them," he said.

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Two Painkillers Fail to Slow Alzheimer's

By Lindsey Tanner

AP Medical Writer

The Associated Press

Tuesday, June 3, 2003

CHICAGO - Two popular pain relievers failed to slow the progression of Alzheimer's disease (news - web sites) in people with mild to moderate mental decline, a study found, dampening hopes that widely used anti-inflammatory drugs might be an effective treatment.

After a year on the prescription drug Vioxx or over-the-counter Aleve, known generically as naproxen, patients were no better off than those taking dummy pills.

The results "are not encouraging for those who are in need of an effective immediate intervention," said Georgetown University's Dr. Paul Aisen, who led the study.

Despite the disappointing findings in people already diagnosed with Alzheimer's, nonsteroidal anti-inflammatory drugs such as those studied could still prove effective in preventing the disease in the first place, said Neil Buckholtz, chief of the National Institute on Aging's division of dementias in aging. The institute helped pay for the study and is sponsoring continuing research on the theory.

Some previous studies have suggested that certain pain relievers might slow or prevent Alzheimer's. The theory is based in part on evidence that some people who use a lot of anti-inflammatory medication, such as those with arthritis, seem to be less prone to Alzheimer's.

Researchers believe that inflammation contributes to the neurological damage found in the mind-robbing disease.

But the earlier studies were less rigorous than Aisen's research, which compared anti-inflammatory drugs and dummy pills head-to-head.

His study involved 351 men and women about 74 years old on average with Alzheimer's symptoms. The findings appear in Wednesday's Journal of the American Medical Association (news - web sites).

NIA researcher Lenore Launer said in an accompanying editorial that it might be that when Alzheimer's has progressed to the point of causing symptoms, it is too far advanced to be affected by anti-inflammatory drugs.

"Full-blown Alzheimer's disease exhibits extensive brain pathology," Launer said, adding, "Slowing the progression at that stage may be too late."

Many people hoping to reduce Alzheimer's symptoms take drugs such as Vioxx and Aleve but should stop because they can cause serious gastrointestinal problems, Aisen said. Six people in the study developed serious gastrointestinal bleeding.

Patients took 25 milligrams once daily of Vioxx — a standard dose — or 220 mgs twice-daily of Aleve — a relatively low dose — for a year. They were compared to patients taking a placebo.

Northwestern University professor Linda Van Eldik said it is possible that higher doses would have a beneficial effect and that other anti-inflammatory drugs would have better results.

"It would have been great if it had worked, but I don't think it's closing the door" to the use of such drugs against Alzheimer's, said Van Eldik, a member of the Alzheimer's Association's scientific advisory council.

Naproxen and other older nonsteroidal anti-inflammatory drugs target two enzymes involved in inflammation. Vioxx is a newer painkiller called a cox-2 inhibitor that targets only one of the enzymes.

On the Net:

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

Alzheimer's Association: http://www.alz.org

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Nurses' Night Shifts Linked with Colon Cancer

 

By Maggie Fox, Health and Science Correspondent

Reuters

Tuesday, June 3, 2003

WASHINGTON (Reuters) - Sunshine may be good for you, and nurses who work regular night shifts have a higher risk of colon cancer, U.S. researchers reported on Tuesday.

The study by researchers at Harvard Medical School (news - web sites) and Brigham and Women's Hospital in Boston supports earlier research that found women who work night shifts have a higher risk of breast cancer (news - web sites).

"Because night-shift work has become very common in developed countries, future studies should assess the relationship of light exposure to the risk of other cancers and consider the risks in men," they wrote in their report, published in the Journal of the National Cancer Institute (news - web sites).

The U.S. Bureau of Labor Statistics estimates that about four percent of adults work rotating night shifts. Shift work disrupts normal melatonin production and increases levels of other hormones such as estrogen.

Women's cancers are often linked with estrogen, but Dr. Eva Schernhammer, who led the study, said melatonin may play a more important role.

"While this finding needs to be replicated in future studies, the data is beginning to show that it may be melatonin, not estrogen, that is influencing cancer risk," she said in a statement.

"If melatonin's anti-cancer properties are the source of our observed effects, this research opens a whole new arena of potential associations between exposure to light and a variety of cancers."

The researchers studied 78,586 women taking part in a long-running program called the Nurses' Health Study. The nurses who worked night shifts at least three times a month for 15 years or more had a 35 percent greater risk of colon or rectal cancer.

Melatonin is produced at night and regular exposure to sunlight affects the production cycle, which peaks in the middle of the night. Artificial light suppresses melatonin production.

"Melatonin has well established anticarcinogenic properties, and a link between exposure at night and cancer risk through the melatonin pathway could offer one plausible explanation for the increased risk we observed," the researchers wrote.

They noted, however, that they could be missing something and urged further study.

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Predicting Breast Cancer on a Molecular Level

HealthScoutNews

Tuesday, June 3, 2003

TUESDAY, June 3 (HealthScoutNews) -- The Mayo Clinic will lead a national study to search for molecular predictors of breast cancer (news - web sites).

The scientists intend to research biomarkers that may help identify women with benign breast disease who are at risk for developing breast cancer. Women who have a breast biopsy with benign findings are defined as having benign breast disease.

"We know that some women with benign breast disease have an increased risk of eventually developing breast cancer and that the cancer can occur in either breast," principal investigator Dr. Lynn Hartmann says in a news release.

"What we lack are good research studies that identify these women so they can receive the necessary screening and risk-reduction strategies," Hartmann says.

Each year, more than 200,000 women in the United States are diagnosed with benign breast disease. But few tests can pinpoint which women have a greater risk of developing breast cancer.

This study will examine benign tissue specimens taken from 700 women who had breast biopsies at the Mayo Clinic between 1967 and 1991 and later developed breast cancer. Their tissue samples will be compared to benign tissue samples taken over the same time period from 700 other women who didn't develop breast cancer.

The researchers will compare molecular tissue markers in the tissue samples from the two groups of women.

More information

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

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Low-Dose Tamoxifen May Be Effective: Study

 

By Linda Carroll

Reuters Health

Tuesday, June 3, 2003

NEW YORK (Reuters Health) - It may be possible to give women a lower dose of the breast cancer (news - web sites) drug tamoxifen without dampening its effectiveness, according to a pilot study released Tuesday.

Low doses of tamoxifen had the same impact on an important marker of breast cancer spread as did higher doses, according to the study published in the Journal of the National Cancer Institute (news - web sites).

However, experts say it's far too early to conclude that lower-dose tamoxifen would be as effective as standard doses of the drug.

Tamoxifen acts like estrogen in some parts of the body and like an anti-estrogen in others. It has been shown to decrease the risk of death in women who have estrogen-responsive breast cancer -- meaning estrogen helps fuel the cancer's growth -- and can also help prevent the disease in high-risk women.

Doctors are interested in lower doses of tamoxifen because the drug has been linked to an increased risk of uterine cancer and dangerous blood clots.

A researcher unaffiliated with the new study said the results underscore the importance of tailoring drug dose to the individual.

"It shows that the standard dose may not be right for everyone," Dr. Guiseppe DelPriore, a gynecological oncologist at the New York University Medical Center and an associate professor at the NYU School of Medicine, said in an interview with Reuters Health. "What may be good for one woman may be too strong for another."

For the study, researchers led by Dr. Andrea Decensi of the European Institute of Oncology in Milan monitored the effects of various doses of tamoxifen on 120 women with estrogen receptor-positive breast cancer.

All the women were slated to have surgery to remove tumors from their breasts and went through four weeks of tamoxifen treatment before surgery. The patients were randomly assigned to receive either one, five or 20 milligrams (mg) per day of tamoxifen. The current standard dose of tamoxifen is 20 mg.

Before treatment and at the time of surgery, tumor and blood samples were taken to look for several cancer markers and for markers of osteoporosis and heart disease, such as high cholesterol.

An additional group of 63 women used as "controls" received no tamoxifen, but were tested both before and after surgery for levels of cancer markers.

At the end of the study, researchers determined that one important cancer marker, known as Ki-67, showed a similar decrease -- of about 15 percent -- in all the treatment groups, as compared to an increase of 12.8 percent in the group that got no tamoxifen.

Ki-67 is a marker of tumor-cell proliferation.

But when it came to several other tumor markers, the amount of decrease appeared to be dependent on the dose of tamoxifen.

For this reason, DelPriore said more studies need to be done before doctors start using lower doses of tamoxifen to treat patients.

A reduction of Ki-67 across all the tamoxifen-treated groups is good, DelPriore said, but until longer-range trials are done with low doses, researchers won't know if this translates into longer life for breast cancer survivors.

Source: Journal of the National Cancer Institute 2003;95:779-790.

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Smoking as Harmful as Drugs to Fetus

By K.L. Capozza
HealthScoutNews Reporter

HealthScoutNews

Tuesday, June 3, 2003

TUESDAY, June 3 (HealthScoutNews) -- In a discovery that could change the way health officials view smoking during pregnancy, Brown University researchers show nicotine has the same impact on fetuses as cocaine and heroin.

Babies exposed to nicotine during pregnancy were more excitable and tense, the researchers say, and they showed signs of central nervous system and gastrointestinal stress.

The report, published in the June issue of Pediatrics, suggests the infants experienced "neonatal withdrawal" from nicotine, although the finding was not conclusive.

"Because we evaluated the babies at one to two days following birth, we don't know if it's actually withdrawal we're seeing or the effects of [the mother's] cigarette smoking," says study author Karen L. Law, a third-year medical student at Brown.

What's clear is that nicotine may have the same toxic effect as illegal drugs, Law adds. Ideally, the finding might motivate the 18 percent of pregnant women who smoke to quit.

The study compared the behaviors of 27 nicotine-exposed newborns and 29 unexposed newborns 48 hours after birth. The researchers measured the nicotine intake of mothers by asking them how many cigarettes they smoked per day and then verifying their answers by measuring a biological marker of nicotine called cotinine, which is found in saliva.

They found that a mother's cigarette intake correlated with an increase in symptom severity in her newborn.

"The present study is the first to establish that the predictions from animal models are indeed true -- behavioral abnormalities akin to those associated with illicit drugs used during pregnancy, are equally, or perhaps even more, detectable in the offspring of women who smoke during pregnancy," says Theodore Slotkin, a professor of pharmacology and cancer biology at Duke University Medical Center.

"This is an important, even essential, contribution to the field, especially as many of the women in the study were smoking fairly low numbers of cigarettes," he adds.

The results also suggest there may be legal grounds for removing children from mothers who smoke during pregnancy, say the researchers.

Given that nicotine is showing the same effects as an illegal substance for which protective services will remove babies from their mothers, policy makers ought to reconsider how they evaluate a fit mother, writes senior study author Barry Lester, a professor of psychiatry and human behavior at Brown.

"To have these results in which these nicotine-exposed babies have a similar profile as cocaine-addicted infants makes us take a step back and ask what's appropriate behavior during pregnancy. Somehow smoking is still acceptable," Law says. "We need to take a look at why one substance over another is not controlled during pregnancy."

The study did not look at the long-term impact of nicotine exposure during pregnancy, but the researchers say previous studies suggest the impact of smoking on newborns can be mediated if the family provides appropriate attention and care throughout childhood.

More information

For more on the dangers of smoking, see the U.S. Centers for Disease Control and Prevention, and here are the reasons why expectant moms should quit smoking.

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For Teens, Dinner with Family Means Healthier Diet

 

By Charnicia E. Huggins

Reuters Health

Tuesday, June 3, 2003

NEW YORK (Reuters Health) - Teenagers who eat dinner with their parents are more likely to eat fruits, vegetables and dairy foods than those who usually dine without the company of mom or dad, study findings show.

Prior research has shown that children who do not eat dinner with their families are more likely to eat so-called TV dinners that require little or no preparation and that may be less nutritious.

The current findings suggest that family mealtimes may help adolescents eat healthier fare.

"Parents should make a concerted effort to coordinate schedules and bring the family together for mealtimes," Dr. Tami M. Videon told Reuters Health. "Family mealtimes are an opportunity to provide healthful choices as well as an example of healthful eating."

Now a professor at Albert Einstein College of Medicine in New York and Montefiore Medical Center, Videon conducted the research while at Rutgers University in New Jersey.

Videon and co-author Carolyn K. Manning analyzed dietary information from more than 18,000 adolescents who were involved in the ongoing National Longitudinal Study of Adolescent Health.

Twenty percent of the adolescents said they usually skipped breakfast, the researchers report in the Journal of Adolescent Health. More than 70 percent said they had eaten fewer than two vegetable servings the previous day; 55 percent said they had eaten fewer than two servings of fruits; and 47 percent said they had eaten fewer than two servings of dairy foods.

Those who reported eating more than three meals a week with at least one parent present, however, were more likely to eat breakfast regularly and more likely to report healthier eating habits, the study findings indicate.

The U. S. Department of Agriculture and the Department of Health and Human Services (news - web sites) recommend that older children and adults eat three to five servings of vegetables, two to four servings of fruit and two to three servings of dairy foods every day.

Adolescents who reported eating four or five weekly meals with their parents were about 20 percent less likely than their peers to skip fruits, vegetables and dairy foods.

And, the researchers note, their fruit, vegetable and dairy consumption increased along with their number of family meals.

Nearly 70 percent ate at least four family meals per week, but about 30 percent of the teens said they ate fewer than three meals with a parent present, the report indicates.

In other findings, teenagers who were allowed to make their own decisions about what they ate were 25 percent more likely to skip breakfast, but they were no more likely than their peers to report a poor intake of fruits, vegetables or dairy products.

"Therefore, parents should not control what food adolescents are allowed to eat, but instead offer healthful options at mealtimes and be an example of good eating," Videon said.

Source: Journal of Adolescent Health 2003;32:365-373.

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Diet Daze

HealthScoutNews

Tuesday, June 3, 2003

(HealthScoutNews) -- A large part of weight control is estimating portion sizes -- so you have some idea of how many calories you've eaten. But how well do people do this?

Not very well, according to a study by researchers at the University of Albany in New York.

As reported in the journal Eating and Weight Disorders, the researchers gave 41 women samples of chocolate ice cream and asked them to estimate the number of calories they ate, and the portion size.

All the women underestimated the number of calories -- but they also incorrectly estimated the number of cups of ice cream they'd eaten.

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Rapid MRI No Better Than X-Ray for Back Pain: Study

By Alison McCook

Reuters Health

Tuesday, June 3, 2003

NEW YORK (Reuters Health) - An imaging technique known as rapid MRI may offer no benefit beyond conventional X-rays in diagnosing many cases of lower back pain, according to a report released Tuesday.

U.S. researchers found that one year after either test people who had rapid MRIs reported the same levels of pain and physical functioning as people who received X-rays to diagnose the cause of their low back pain.

And of the 380 study participants, 10 people who received rapid MRI also underwent back surgery, versus four of those who got X-rays. All the patients had a similar type of back pain when the study began.

Moreover, the cost associated with the rapid MRI technique -- such as the price of the technique, the prescriptions patients filled, and the number of doctor visits they scheduled after the screening -- was an average of $321 more per patient than the cost associated with X-rays.

And given the large number of people who suffer from low back pain, that difference in cost can quickly add up, study author Dr. Jeffrey G. Jarvik of the University of Washington in Seattle told Reuters Health.

"Any slight change you make in the diagnosis or treatment of low back pain results in a big impact on society," he said.

The findings appear in the June 4th issue of the Journal of the American Medical Association (news - web sites).

In an interview, Jarvik explained that MRIs capture images of the body that are much more detailed than those seen from X-rays. Rapid MRI is a modified form of standard MRI that produces images more quickly and with less expense.

Jarvik said doctors have both wondered whether MRIs might both help patients -- by picking up conditions missed by X-rays -- and harm them, by finding abnormalities that are not the cause of back pain, leading to further invasive tests or treatments, which may result in only hurting patients more.

The current study "means that one diagnostic test doesn't result in patients doing better than the other diagnostic test," Jarvik said.

The researcher noted that "it's somewhat reassuring that patients (who receive rapid MRI) didn't do worse."

"Of course," he added, "they didn't do better, either."

Interestingly, Jarvik and his colleagues discovered that patients, when reporting about their experience, appeared more satisfied with the rapid MRI technique. More MRI patients, for example, said they were "reassured" by the test results.

However, that reassurance comes with extra costs and no apparent physical benefit, Jarvik noted. "It just becomes a question of how much you're willing to pay for that reassurance," he said.

To compare X-rays to rapid MRIs, Jarvik and his colleagues randomly assigned 380 adult patients to undergo one of the procedures, and then interviewed them 12 months later. All had been referred by their primary care doctor for evaluation of their lower back complaints.

Jarvik noted that the findings may pertain only to people going to their primary care physicians for low back pain because many such patients are reporting the problem for the first time, and the majority of people with new back pain get better relatively soon.

In contrast, people who go to an orthopedic surgeon or another specialist as a result of back pain have likely had the problem for some time, and may have different outcomes with diagnostic tests, Jarvik said.

Dr. Nortin M. Hadler of the University of North Carolina at Chapel Hill, who wrote an accompanying editorial, said that it may be difficult for patients to understand that images of their spine cannot always pinpoint the cause of their low back pain -- or why some conditions found in those images are not the cause of the pain, and are best left alone.

"What patient can imagine that imaging studies are not likely to elucidate the cause of their backache, or that 'findings' on imaging studies are not meaningful?" Hadler said.

However, this and other studies suggest that, when faced with low back pain, less is sometimes more, Hadler told Reuters Health.

For instance, although more people in the rapid MRI group underwent back surgery, one year later, both groups were doing equally well.

"There is absolutely no data to support the assertion that surgery of any sort will alter the natural history of regional low back pain," Hadler said.

Source: Journal of the American Medical Association 2003;2810-2818,2863-2865.

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Yet Another Gender Difference

HealthScoutNews

Tuesday, June 3, 2003

TUESDAY, June 3 (HealthScoutNews) -- Exercise prompts different responses in the skeletal muscle capillaries of men and women, says a Duke University Medical Center study.

While women seem to start out with a lower density of these capillaries, this density seems to increase at a greater rate in women than in men when they exercise. Capillaries are tiny blood vessels that carry oxygen-rich blood to muscle and other body tissue.

The study also found overweight men and women had similar increases in exercise capacity after 24 weeks of supervised exercise training.

The Duke researchers believe their findings indicate the skeletal muscles in men and women respond differently to exercise. They also suggest that improved skeletal muscle capillary density may play a greater role in women than men in improving exercise capacity.

The study was recently presented at the annual scientific sessions of the American College of Sports Medicine in San Francisco.

"Based on the results of our study, it appears that the skeletal muscle of men and women may adapt differently to exercise and therefore rely on different mechanisms to increase their peak exercise capability," researcher Brian Duscha says in a news release.

More information

Here's where you can learn more about exercise.

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Many Autopsies Still Find Doctors' Mistakes

 

By Alison McCook

Reuters Health

Tuesday, June 3, 2003

NEW YORK (Reuters Health) - Despite recent improvements in the rate of missed diagnoses, at least eight percent of autopsies still detect potentially serious conditions that were not found by the patients' doctors, according to new findings released Tuesday.

In the report, published in the Journal of the American Medical Association (news - web sites), U.S. researchers estimate that between eight and 24 percent of autopsies currently pick up a condition that the patient's doctor missed, and one that may have been the actual cause of death.

Furthermore, they write that between four and seven percent of autopsies currently performed may detect the most serious type of medical error -- meaning that, if the doctor had properly diagnosed the condition, the patient may have lived. These errors are known as class I errors.

In fact, the authors estimate, among the 850,000 people who die each year in a U.S. hospital, around 34,850 may have survived if an important diagnosis had not been missed.

However, study author Dr. Kaveh G. Shojania of the University of California, San Francisco cautioned that people should not fear that their doctors are always missing life-threatening illnesses.

These errors occur among people who have died, Shojania said, and the current study results say nothing about the vast majority of people who come to the hospital, are treated and released.

"The point here is not that there are huge numbers of patients being misdiagnosed, but it is fair to say that physicians should not be diagnostically complacent -- there is still substantial room for improvement," Shojania told Reuters Health.

To obtain their findings, the researchers reviewed previous research conducted between 1966 and 2002 that investigated autopsy-detected diagnostic errors.

The researchers found that the rate of class I errors decreased by 33 percent every decade, while the rate of major errors -- defined as missed diagnoses of conditions that could have been a cause of death -- dropped by 19 percent every decade.

Shojania said that the decrease in autopsy-detected errors since the 1960s may be a result of improvements in medical technology, enabling more accurate diagnoses.

But despite these improvements, "error rates remain surprisingly high," Shojania noted.

The researcher explained that some experts believe that the high rate of missed diagnoses detected in autopsy stems from the fact that relatively few deaths are investigated by autopsy -- currently, around 1 in 20. Consequently, deaths investigated by autopsy likely represent those that doctors regarded as "diagnostically challenging," the researcher said, and their autopsies are therefore more likely to uncover mistakes.

If this explanation were correct, Shojania reasoned that an increase in the rate of autopsy would include less challenging cases, subsequently causing a decline in the rate of diagnostic errors.

However, the researcher said that some of the studies included in the current report had autopsy rates as high as 100 percent. And while the results suggest that the high rate of errors is, in part, due to the fact that doctors struggled with a diagnosis when the patient was alive, this theory is "not enough to explain away the findings of persistent error discovered at autopsy," Shojania said.

Instead, "the answer is probably a combination of true errors and tough cases," the researcher noted.

Interestingly, many of the missed diagnoses involved well-known conditions, in which the symptoms are very general or perhaps resemble something else, Shojania said. For instance, some diagnostic errors picked up by autopsy include cancer that turns out to be an infection, or an infection that turns out to be cancer.

Shojania added that the current study findings highlight the importance of heeding autopsy results.

"If clinicians paid more attention to autopsy findings, some of today's 'tough cases' might come to recognized as tomorrow's textbook cases," Shojania said.

Source: Journal of the American Medical Association 2003;289:2849-2856.

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The Socioeconomics of Heart Disease

HealthScoutNews

Tuesday, June 3, 2003

TUESDAY, June 3 (HealthScoutNews) -- Low-income people are more likely to die or suffer a heart attack after being discharged from the hospital following treatment for a heart attack or unstable chest pain, even though they receive a level of care similar to people with higher incomes.

So says an American study in the June 4 issue of the Journal of the American College of Cardiology.

The study of 2,464 people hospitalized with a heart attack or unstable angina (news - web sites) was done by researchers from the Duke Clinical Research Institute in North Carolina, the Cleveland Clinic Foundation and the St. Luke's-Roosevelt Medical Center in New York.

The researchers compared the rates of death within 30 days of hospital discharge and the rates of death or heart attack within six months of leaving the hospital. The people were defined as low-income (less than $20,000 annual household income), middle-income ($20,000 to $60,000), and high-income (more than $60,000).

"When we adjusted for all the potential confounders, we could find no disparity in the way those patients were treated," researcher Dr. Sunil V. Rao, Duke Clinical Research Institute, says in a news release.

"But then when we looked at outcomes, there was a trend toward the low income patients doing worse. They had a higher rate of short and intermediate term death or recurrent myocardial infarction. None of the estimates was statistically significant, because our data set wasn't large enough, but even after adjustment, the point estimates were pretty consistent that low-income patients did worse than patients in the middle-income or high-income categories," Rao says.

Rao suggests low-income patients may have more difficulty paying for medications, they may go back to smoking at a higher rate, or they may have more trouble finding heart-healthy foods and safe places to exercise.

While the study doesn't identify the cause of the higher death rate among low-income heart patients, it does highlight the threat, Rao says.

More information

Here's where you can learn more about heart attack.

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Personality Doesn't Influence Cancer Risk: Report

 

By Alison McCook

Reuters Health

Tuesday, June 3, 2003

NEW YORK (Reuters Health) - Despite the ancients' belief that melancholy can lead to cancer, new research released Tuesday suggests that your personality has no influence on whether or not you develop the disease.

Japanese researchers discovered that people who fit certain personality types -- as in people who were especially extraverted, neurotic, tough-minded or prone to lying -- were no more likely than others to develop cancer over a seven year period.

Study author Dr. Yoshitaka Tsubono of Tohoku University told Reuters Health that these findings show that people who want to reduce their risk of cancer should focus on factors that have shown to have a significant impact on the disease: namely smoking, heavy drinking, obesity and lack of exercise.

"Although further studies are needed, our results indicate that we do not have to worry about changing our personality to prevent cancer," Tsubono said.

The researcher noted that theories regarding personality's effect on the risk of cancer date back to 200 AD, but recent reports have shown mixed results, and suggested that the potential influence personality has on cancer may not be so straightforward.

"Although modern studies have been conducted since the 1960s, there have been controversies as to whether personality causes cancer, or cancer causes change in personality," Tsubono said.

To investigate the question themselves, the researchers asked 30,277 residents in Japan to complete personality tests and describe their health behaviors, then followed those residents for seven years to determine who developed cancer.

Almost 700 people were already diagnosed with cancer when the study began, and another 986 developed the disease during the following seven years.

The researchers focused on certain personality traits: extraversion, neuroticism and psychoticism -- described as liveliness, emotional instability and coldness, respectively -- as well as a trait marked by lying and social conformity.

Overall, people who had strong tendencies toward each of the four personality types were no more likely than others to develop any type of cancer, nor did they show higher risks for individual cancers -- namely, cancer of the stomach, lung, colorectum and breast.

The lack of relationship between cancer risk and personality remained even when the authors removed the influence of other factors, such as smoking, body weight and family history of cancer.

People who had a tendency toward neuroticism were more likely to have already been diagnosed with cancer before the study began, and more likely to develop cancer during the first three years of the study. However, the increased risk of cancer among overly neurotic people eventually disappeared.

Neurotic individuals are more prone to worrying and anxiety.

Writing in the Journal of the National Cancer Institute (news - web sites), the authors suggest that people's neuroticism may be a result of a cancer diagnosis, rather than the cause.

Early cancer may have caused some people to become more neurotic, they note, and people whose cancer was diagnosed during the first years of the study may have already had symptoms of the disease when the study began. These early symptoms, even without a diagnosis, could also have caused people to become more neurotic over time, the authors write.

Source:  Journal of the National Cancer Institute 2003;95:799-805.

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Antibiotic Approved for Chronic Prostate Infection

HealthScoutNews

Tuesday, June 3, 2003

TUESDAY, June 3 (HealthScoutNews) -- The U.S. Food and Drug Administration (news - web sites) has approved Levaquin (levofloxacin) to treat recurrent infection of the prostate gland known as chronic bacterial prostatitis (CBP), according to the drug's marketer, Ortho-McNeil Pharmaceutical Inc.

CBP is among the top reasons for men visiting urologists, and as many as 35 percent of men over 50 may have the condition, the drug maker says.

CBP can be caused by a number of bacteria, including Escherichia coli, Enterococcus faecalis or Staphylococcus epidemidis. Accounting for some 2 million outpatient visits every year, the condition's symptoms include increase in the urge to urinate, difficulty or pain while urinating, chills, fever, and lower-back pain.

Levaquin, first marketed in 1997, is also FDA-approved to treat several types of pneumonia, urinary tract infections, sinusitis, and bronchitis.

Visit the Levaquin Web site for more information about the drug. For more about CBP, check the National Library of Medicine.

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MONDAY, JUNE 2, 2003

 

Achy Back? Studies Say No Single Therapy Stands Out

 

By Keith Mulvihill

Reuters Health

Monday, June 2, 2003

NEW YORK (Reuters Health) - Spinal manipulation, the back pain treatment most commonly offered by chiropractors, is no better or worse for treating low back pain than conventional treatments, such as exercise, pain killers and physical therapy, a team of doctors announced Monday.

Massage appears to be effective for persistent back pain, researchers report, but they say that more study is needed to determine what benefit, if any, acupuncture offers for treating back pain.

All of the methods seem to be relatively safe, the authors say.

"No therapy can lay claim to being 'the best,"' said lead investigator Dr. Paul G. Shekelle, of RAND in Santa Monica, California.

So what's a person suffering from back pain to do?

According to Shekelle, most back pain gets better even without treatment. "It is very rare for back pain to permanently disable you (but) recurrences are common," he said.

While there is no magic bullet to treat or prevent back pain, Shekelle advises that staying active is probably the best way to prevent the problem.

"All advocated therapies -- exercises, spinal manipulation, etcetera -- are about the same on average in terms of efficacy, although on an individual basis it is clear that some therapies work better than others," he said. "Find one that works best for you."

The findings are based on two new studies published in the journal Annals of Internal Medicine.

According to the researchers, more than 50 percent of Americans experience back pain each year, and many seek out chiropractors, massage therapists and acupuncturists to relieve this pain.

But little scientific research has been conducted to see how these methods stack up to more conventional methods, Shekelle explained in an interview with Reuters Health.

To investigate, the researchers combined previously published studies that compared alternative back pain treatments -- spinal manipulation, massage therapy and acupuncture -- to traditional remedies, such as medications, physical therapy, exercise and educational material about prevention and pain management.

The first study focused on spinal manipulation and evaluated the results of 39 previously published studies.

Spinal manipulative therapy was defined as any treatment that included the movement of the vertebrae of the spine by applying force through the hands of the practitioner in order to relieve pain and improve function. Specially trained individuals such as chiropractors, osteopathic physicians or physical therapists commonly give this treatment.

"For the purposes of our study, it included (both) spinal mobilization -- which is more gentle -- and spinal manipulation, which is more forceful and produces the audible 'popping' noise patients commonly associate with this treatment," Shekelle said.

"The reason we did not try and distinguish between the two ... in our paper is that in many of the reports we reviewed it was unclear which type of therapy was being given," he added.

Based on this analysis, "there is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain," the researchers report.

"Previous work has shown spinal manipulation to be better than a sham manipulation -- similar to a placebo -- and better than bed rest, the use of a corset ... or to a collection of these types of therapies loosely designated as 'medical therapy,"' said Shekelle.

"These findings were interpreted by advocates of manipulation as indicating that spinal manipulative therapy was 'the' choice of therapy for patients with back pain," said Shekelle.

"Our study should temper some of this enthusiasm by demonstrating that, on average, there is no difference in outcomes for patients treated with spinal manipulative therapy compared to other recommended care, like analgesics, exercises, or physical therapy," he said.

In the second study, the researchers evaluated studies that assessed the effectiveness, safety and cost effectiveness of spinal manipulation, massage therapy and acupuncture.

The team concluded that spinal manipulation was neither better nor worse than conventional treatments, and the effectiveness of acupuncture was unclear. Massage therapy seemed to be effective for persistent back pain.

Of the three alternative back pain treatments, only massage "may reduce the costs of care after an initial course of therapy," the authors conclude.

Source: Annals of Internal Medicine 2003;289:871-881,898-906.

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Study: Statins May Help Kidney Patients

By Emma Ross

AP Medical Writer

The Associated Press

Monday, June 2, 2003

LONDON - New research indicates that kidney transplant patients could reduce their risk of heart attacks by about a third by taking popular cholesterol-lowering drugs.

 

 

Experts say the study, published Tuesday on the Web site of The Lancet medical journal, provides important evidence that statin drugs can improve the health of kidney transplant patients, who are often vulnerable to heart trouble.

A total of 1,788 kidney transplant patients completed the international study led by scientists at the National Hospital in Oslo, Norway. About half were given the statin drug fluvastatin, or Lescol, and the other half got a fake pill.

After five years, there were 70 heart attacks in the statin group, compared with 104 among those taking the placebos.

The risk of a fatal heart attack was 38 percent lower among those taking the drug, compared with those taking the dummy pill, while the risk of a non-lethal heart attack was 32 percent lower in the group taking the statin.

Dr. Jules Puschett, an American Heart Association (news - web sites) spokesman, said the findings weren't surprising because many doctors already prescribe statins to kidney transplant patients based on evidence of the drugs' benefits in other types of patients vulnerable to heart trouble.

However, "any evidence that we can marshal in favor of what we're doing is always helpful," he said.

"The issue of the problems that these patients encounter, even if they have a very well-functioning transplant, has now come to the fore and it's about time that we have paid attention to that," said Puschett, chair of the Department of Medicine at Tulane University, who was not connected with the study.

Kidney transplant patients face an increased risk of premature cardiovascular disease; many of them have heart disease at the time of their transplants. Immune system suppressing drugs — necessary to prevent the body rejecting the transplant — may aggravate existing heart disease risk factors such as high cholesterol or promote their development.

Previous research has shown that statins can reduce the risk of heart trouble in a broad range of people, including those with normal cholesterol levels and people with mild kidney failure.

"This new multi-center study shows yet another patient group that will benefit from statins," said Sir Charles George, medical director for the British Heart Foundation, also not connected with the research. "This study shows that some kidney patients can ... benefit from a statin and reduce their risks from coronary heart disease, without dangerous side effects."

On the Net:

The Lancet: http://www.thelancet.com

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Tattoos Source of Hepatitis Without Symptoms: Study

 

Reuters Health

Monday, June 2, 2003

NEW YORK (Reuters Health) - People who become infected with the hepatitis C virus when getting a tattoo may be less likely to develop obvious symptoms than people who become infected in other ways, according to Texas researchers.  

In a small study, both people with tattoos and those with a history of injection-drug use were more likely than others to be infected with hepatitis C.

But unlike people who had injected drugs, individuals who had a tattoo were not more likely to develop acute hepatitis symptoms, such as jaundice, vomiting and fatigue.

The hepatitis C virus causes chronic infection and disease in over 70 percent of infected people, but only 10 to 15 percent of people with the virus are believed to develop acute symptoms soon after infection.

According to Dr. Robert W. Haley, the lead author of the study, a tattoo needle carries a smaller amount of virus and does not inject the virus directly into the bloodstream, as opposed to needles used to inject drugs.

As a consequence, in the case of tattooing, it takes longer for the disease-causing agent to enter the bloodstream and make its way to the liver and cause symptoms, Haley, a professor of internal medicine and chief of epidemiology at the University of Texas Southwestern Medical Center in Dallas, told Reuters Health in an interview.

But Dr. Miriam Alter, the associate director for science in the division of viral hepatitis at the Centers for Disease Control and Prevention (news - web sites) (CDC) in Atlanta, told Reuters Health that Haley "misinterpreted" the data. According to Alter, the risk of being infected with hepatitis C from a tattoo needle is small.

"Overall we would not recommend that people who get tattooed get tested for hepatitis C because they are unlikely to have a higher rate of infection than anyone else in the general population," said Alter.

In an interview, Alter also disputed Haley's contention that those people getting a smaller dose of the virus were less likely to develop acute symptoms of HCV.

To minimize one's risk of contracting and spreading a blood-borne pathogen, both Alter and Haley advise making sure that any procedure that pierces the skin is performed safely. For instance, needles, gloves and towels should be used once and then either discarded or sterilized.

In the study, Haley and a colleague, Dr. R. Paul Fischer of Presbyterian Hospitals of Dallas, re-analyzed data collected in the early 1990s on 626 patients seeing a physician for back problems. Patients were asked about risk factors for hepatitis C, and were screened for the virus after the interview.

The latest results were published in the journal Archives of Internal Medicine (news - web sites).

Researchers found that those who had a tattoo had an almost 7-fold higher risk of testing positive for hepatitis C. However, they were not at greater risk of having experienced acute hepatitis symptoms, according to the report.

In contrast, people with a history of IV drug use were 7 times more likely to be infected with the hepatitis C virus and 6 times more likely to have experienced acute hepatitis symptoms.

In the interview, Haley urged regulation and inspection of tattoo parlors to reduce the risk of hepatitis infection from tattoos.

Source: Archives of Internal Medicine 2003;163:1095-1098.

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Antioxidants May Help Brain Vs. Alcohol

By Randolph Schmid

Associated Press Writer

The Associated Press

Monday, June 2, 2003

WASHINGTON - Antioxidants, already widely promoted as cancer-fighters, also may help protect the brain from chronic alcohol damage.

Chronic alcoholism damages parts of the brain used in learning and memory, but giving rats an antioxidant protected them from the damage, according to researchers working in the United States and Spain.

The findings are reported in Tuesday's online issue of Proceedings of the National Academy of Science.

Antioxidants are chemicals that inhibit the oxidation of a substance to which they are added. Oxidation can stress or damage cells.

The team, led by Dr. Daniel G. Herrera of Weill Medical College of Cornell University, fed rats a liquid diet containing alcohol for six weeks.

They found a 66 percent decrease in the number of new cells in crucial parts of the brain and an increase in cell death of more than 227 percent.

But in rats that also received injections of the antioxidant ebselen, the damage to developing cells did not occur, the researchers said. Those rats had the same brain characteristics as a group that received no alcohol.

Alcohol also kills liver cells, and the researchers knew that this can be reduced with the use of antioxidants, Herrera said. They decided to see if the same held for the brain.

The antioxidant ebselen was used because it is known to have protective effects in the liver and digestive tract and has few side effects in humans.

Finding ways to improve mental function in people, particularly the elderly, might increase positive results of alcohol treatment programs, Herrera said in a statement.

Dr. Antonio Noronha, chief of the neuroscience and behavior branch of the National Institute of Alcohol Abuse and Alcoholism, said this is the first study to show the effects of antioxidants on chronic alcohol damage.

Noronha, who was not part of the research team, said similar findings have been reported in studies at the University of North Carolina, but those focused on binge drinking and used a different antioxidant.

The mechanism by which alcohol damages portions of the brain is still not fully understood, he said. Oxidative stress seems to be part of it, and the antioxidants appear to be protective.

Other reports in the same issue of Proceedings included:

·       RU-486, the chemical used to induce abortions, may extend the life of brain cells. Abdel Ghoumari, of the National Institute of Health and Medical Research in France, and colleagues collected brain cells from mice in a laboratory experiment. The cells normally undergo a programmed cell death in culture. But when RU-486 (news - web sites) was added to the culture, the life of the cells was extended. The team said the finding may lead to future treatments for brain-damaging diseases.

·       A team of English and American researchers has engineered tobacco plants to produce the human antibodies that are used to prevent rabies. The group, led by Hilary Koprowski of Thomas Jefferson University in Philadelphia, developed a genetic insert to the tobacco plants that codes them to produce the human antibody. The antibody administered to prevent rabies now can be obtained from horses and humans, but some people have adverse reactions to horse proteins, and isolating the material from humans is expensive. The tobacco-produced antibodies prevented development of rabies in hamsters exposed to the disease.

On the Net:

Proceedings of the National Academy of Sciences (news - web sites): http://www.pnas.org

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'Bust-Enhancing' Pills Are Bogus: Researcher

 

By Keith Mulvihill

Reuters Health

Monday, June 2, 2003

NEW YORK (Reuters Health) - Women who turn to herbal supplements with the desire of achieving a bust size that rivals Pamela Anderson (news - web sites)'s shouldn't get their hopes up, according to the author of a new report.

"There is no scientific evidence that shows these products work," said Dr. Adriane Fugh-Berman during a telephone interview with Reuters Health.

"Plus they are really quite expensive," said Fugh-Berman, who says she doesn't want to see young women throw their hard earned money away. A month's supply can cost more than $100, she noted.

But aside from wasting money, Fugh-Berman said she believes that there may be long-term health issues at stake since some of the herbal ingredients may mimic the hormone estrogen.

Fugh-Berman said she is concerned that one possible long-term effect of using estrogen-mimicking supplements is an increased risk of breast cancer (news - web sites). "But that's only theoretical at this point," she stressed.

"I would rather see women spend their energy on improving their self-esteem," said Fugh-Berman, who is at the George Washington University School of Medicine in Washington, D.C. Fugh-Berman said she became interested in the products after seeing advertisements and listening to several young women express an interest in purchasing such products.

In her review, Fugh-Berman evaluated existing scientific literature about the ingredients often found in "bust-enhancing" dietary supplements, including hops, black cohosh, dong quai, fennel, kava, saw palmetto, chaste-tree berry and many others.

"No clinical trial of a bust-enhancing herbal product has been published," Fugh-Berman writes in the June issue of the journal Obstetrics and Gynecology. "It is unlikely that any of these products, if they contain what their labels say that they contain, would cause breast enlargement."

What's more, Fugh-Berman stressed that there are no long-term safety data on any of these herbs, either alone or in combination. The herb kava, for example, has been linked to liver toxicity, she told Reuters Health.

Doctors should discourage women from using pharmacologically active substances that have unknown safety risks for the purpose of making their breasts bigger, the author concludes in the report.

 

Source: Obstetrics & Gynecology 2003;101:1345-1349.


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Eye Surgeons Excited About New Procedure

 

By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, June 2, 2003

WASHINGTON - Consider it an ocular fingerprint: A new generation of laser eye surgery is beginning that maps subtle irregularities in the cornea before it's zapped — in hopes of crisper vision and fewer side effects.

Just how much better this new "wavefront-guided LASIK" works isn't proven yet, but it's causing excitement among eye surgeons who say the three-dimensional maps let them customize treatment in a way never before possible.

Still, it comes with an important consumer warning: This new surgery isn't risk-free, making it crucial to undergo proper exams to determine if you're a good candidate.

That includes a key measurement to be sure your cornea's thick enough to withstand zapping — wavefront-guided LASIK can remove about 10 percent more tissue than regular LASIK does.

"This is a significant development that will allow us to have better outcomes than we have had in the past," says Dr. Doyle Stulting of Emory University, who oversees laser developments for the American Society for Cataract and Refractive Surgery.

But consumers must understand "there is never a 100 percent guarantee they'll get the perfect result," cautions Dr. Douglas Koch of Baylor College of Medicine, who helped test a wavefront system developed by Visx Inc.

Americans undergo more than a million LASIK procedures a year, mostly to correct nearsightedness. Doctors use a laser to zap away tissue from the cornea, reshaping it for sharper sight.

The vast majority of patients get better vision. But a small proportion — nobody knows just how many — suffer side effects, such as glare and other night-vision trouble, and painfully dry eyes. Some people can't see as well even with glasses or contact lenses after LASIK as they could before.

The new wavefront-guided LASIK can't help the dry-eye problem, but the hope is that it will lessen other side effects — and perhaps help salvage vision in patients harmed by earlier conventional LASIK.

Regular LASIK is based on the person's glasses prescription.

Wavefront-guided LASIK adds a measurement of more subtle corneal distortions, called higher-order aberrations. Based on technology that helps astronomers see twinkling stars more clearly, they send waves of light into the eye and measure how they bounce back, forming a 3-D map of each person's unique wave patterns.

Higher-order aberrations can blur fine detail enough that someone whose quantity of vision measures a perfect 20/20 on an eye chart still has trouble driving, especially at night. LASIK itself can cause or worsen those distortions, essentially leaving a little ridge where the laser treatment ends.

But seeing the aberrations before surgery allows doctors to adjust, shaving off a little more tissue here and a little less there — leaving a smoother surface and crisper vision, explains Dr. Stephen Brint of Tulane University, who helped test Alcon Laboratories' system.

The Food and Drug Administration (news - web sites) recently approved both Alcon and Visx's wavefront-guided LASIK systems after studies showed about 80 percent of patients treated saw 20/20 without glasses. It adds $350 to $1,000 to LASIK's $1,000- to $2,000-per-eye cost.

"It is life-altering," says Beth Matthews of Gulfport, Miss., who had the surgery two weeks ago. "Can you tell I'm giddy?"

Her longtime eye doctor wouldn't let her have regular LASIK. Matthews had so many higher-order aberrations that, even with strong contact lenses, she squinted at road signs and could barely see at night through the glare. After wavefront-guided surgery, her vision measures a crisp 20/16 — better than perfect, with no glare or squinting.

But wavefront-guided LASIK still causes new aberrations, just fewer of them, cautions FDA's Everette Beers.

And it doesn't eliminate the need for careful screening — not everyone's a candidate, adds Ron Link, who runs a Web site, www.surgicaleyes.com, for LASIK-injured patients.

Take David Dutton of Canada. He can barely see out of his left eye at night after wavefront-guided LASIK in November, and suffers dry eyes so painful he must insert eyedrops in the middle of the night.

Dutton, a teacher in British Columbia, now knows he wasn't a good candidate for any type of LASIK. His corneas were so thin originally that surgery left less than the required 250 microns of thickness needed for good vision.

Check the latest LASIK guidelines at www.eyesurgeryeducation.org — and check out the surgeon's track record.

"So much of the outcome has to do with patient selection ... and physician experience and competence," says FDA's Beers.

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

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Cholesterol Drugs May Protect Against Cancer: Study

 

Reuters Health

Monday, June 2, 2003

CHICAGO (Reuters Health) - Cholesterol-lowering drugs called statins that are known to reduce the risk of heart attack and other complications of heart disease may also help prevent cancer, according to new research presented here on Sunday.

In a study comparing more than 3,000 cancer patients with more than 16,000 people who did not have cancer, the overall risk of cancer was 20 percent lower in people who took statins than in those who did not take the drugs. All of the participants were receiving at least one medication for cardiovascular disease.

Importantly, lead investigator Dr. Matthijs Graaf of the Academic Medical Center at the University of Amsterdam in the Netherlands said, only people who took statins for more than four years had a significant cancer risk reduction.

"People who used statins for less than four years did not have a significant risk reduction," Graaf said. The risk of cancer was 36 percent lower in people who took the cholesterol-lowering drugs for at least four years than in people who did not take the drugs.

The findings were presented at a press briefing during the 39th Annual Meeting of the American Society of Clinical Oncology (news - web sites).

Similarly, only statin users of more than 1,350 "defined daily doses" of statins had a significant risk reduction of 40 percent. A defined daily dose is an estimate of the amount of drug that is required for the daily treatment of an adult patient. Those that used less than this specific daily amount did not lower their cancer risk appreciably.

In the study, the researchers took into account several factors that could have affected the results, including diabetes, medical history and the use of several other types of medications. However, they were unable to take into account lifestyle factors, such as smoking.

Cancer risk returned to normal within six months of halting statin treatment.

The majority of statin users, about 80 percent, were taking simvastatin (Zocor) and since the effect of the different statins is not equal, "the results of this study may not be generalized to the use of other statins," Graaf said.

Graaf emphasized that more studies are needed and that, for now, it is not advisable that people start taking statins solely as a means of decreasing their risk of cancer.

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Study Backs Chemotherapy for Lung Cancer

By Daniel Q. Haney

AP Medical Editor

The Associated Press

Monday, June 2, 2003

CHICAGO - A large international study has shown for the first time that offering chemotherapy after surgery can modestly improve the survival of people with early-stage lung cancer.

Even though the benefit is small, doctors say the discovery is important, both because lung cancer is such a grim diagnosis and because it is so common. It is the No. 1 cancer killer, diagnosed in 1.2 million people around the world each year, and 85 percent of victims die of the disease.

Chemotherapy after surgery is standard for treatment of breast and colon cancer. But until now, there has been no convincing evidence that it changes the course of lung cancer. Doctors do offer chemotherapy to patients, but the treatment is typically intended to ease symptoms rather than delay death.

The latest study, released Monday, suggests lung cancer patients do have another treatment option, if their tumors are found early and can be removed with surgery. A follow-up round of chemotherapy improves their survival by several months.

Dr. Thierry Le Chevalier, who directed the study, said the results mean chemotherapy should be a routine option for patients who have surgery for early lung cancer.

"The benefit reported could prevent annually around 7,000 deaths worldwide," he said at a meeting in Chicago of the American Society of Clinical Oncology (news - web sites).

Several doctors agreed that the results will have a major impact, although some questioned whether the change will be immediately embraced by all specialists.

"This will change the way lung cancer is treated," predicted the society's president, Dr. Paul Bunn, a lung cancer specialist at the University of Colorado.

Dr. Bruce Johnson of Harvard's Dana-Farber Cancer Institute said, "I will go home and discuss the study with patients and offer them this therapy."

However, Dr. Nassar Hanna of Indiana University noted that several smaller studies have tried and failed to prove that chemotherapy does any good after lung cancer surgery.

"I don't think there will be an across-the-board change in practice, although many will be swayed," Hanna said.

The study was conducted on patients with non-small-cell lung cancer, by far the most common kind, that was confined to the lungs or had spread only to nearby lymph nodes. About one-third of such patients are considered good candidates for surgery. Many patients cannot have surgery because they are not well enough to tolerate the operation, which typically takes out 20 percent of the lung, or the disease has already spread to the lymph nodes in the neck and opposite side of the chest.

Doctors enrolled 1,867 patients at 148 hospitals in 33 countries. They were randomly assigned to get an operation alone or surgery plus chemotherapy. The treatment regimens included the drug cisplatin plus a variety of other standard chemotherapy medicines.

After five years, 45 percent of patients getting chemotherapy were still alive, compared with 40 percent of those getting only surgery. Average survival was 51 months for the chemotherapy patients and 44 months for the comparison group.

Cisplatin can carry serious side effects, including a drop in white blood cells that leaves patients open to infection.

Another study presented at the meeting Monday raises the possibility that people taking cholesterol-lowering drugs to keep their hearts working smoothly may also lower their risk of cancer. Millions already take the drugs, called statins, and the latest work suggests they may be getting an unexpected benefit.

Matthijs Graff, a pharmacist at the University of Amsterdam, compared statin use in 3,219 people with cancer and 16,976 without. The data were drawn from pharmacy and hospital records in eight Dutch cities.

He found that those taking statins had a 20 percent lower risk of cancer. However, the benefit did not show up until people had taken the pills for at least four years.

Some other studies have shown similar results. However, Graff cautioned that people should not take the prescription drugs solely to lower their cancer risk until more research is done to prove statins truly do this.

Editor’s Note: Medical Editor Daniel Q. Haney is a special correspondent for The Associated Press.

On the Net:

Conference site: http://www.asco.org

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Some Diabetic Patients OK Without Insulin: Study

 

Reuters Health

Monday, June 2, 2003

WASHINGTON (Reuters Health) - Twelve diabetic patients who have taken part in a transplant trial no longer need to take insulin shots, according to early data released here Monday.

The patients have all had at least one transplant of pancreatic islet cells, which are meant to replace their own non-functioning cells. Islets are clusters of cells in the pancreas that contain insulin-producing beta cells.

The hope is that these patients, who have type 1 diabetes, will never have to be insulin-dependent again, and that they won't experience the disease's common complications, such as blindness, and heart and kidney disease, said James Shapiro, the trial's principal investigator and director of the islet transplant program at the University of Alberta in Edmonton, Canada.

Shapiro and colleagues at nine sites around the world began transplanting islet cells into diabetic patients in late 2001, and have reported on a few patients before. They gave an update Monday at a briefing held in conjunction with the American Transplant Congress.

Twelve patients have stopped taking insulin, and 16 others are showing good donor islet function, but are still taking some insulin.

One of the patients, Anthony Pecora of Ashland, Virginia, has been insulin-free for almost a year. "On July 7, 2002, at 7 p.m., I took my last dose of insulin," Pecora told reporters.

He had been taking insulin for 29 years, and no longer had good control of his blood sugar when he was accepted into the study at the University of Minnesota. Pecora was given two islet cell transplants.

In the procedure, patients receive an infusion of islet cells into their main liver vein. After a two-day hospital stay, they are put on a regimen of immune-suppressing drugs.

Most of the side effects have come from the drugs, not the procedure itself, said Shapiro.

Eighty-three percent of the patients had severe mouth sores, and a majority also had low white blood cell counts. Almost forty percent of the patients had to start taking cholesterol lowering drugs to counteract the increase brought on by the anti-rejection medications, said Camillo Ricordi, another lead investigator from the University of Miami.

The transplants seemed to work best at centers that had more experience -- Miami, Edmonton and Wisconsin. "That was expected somewhat," said Shapiro, noting that it is difficult to prepare islet cells for transplant and to figure out proper dosing of anti-rejection drugs.

The researchers will report final results when all 36 patients being studied have had a chance to respond to up to three transplants. That could be a year from now, said Shapiro.

It is not easy to find donor islet cells because they have to come from donor pancreases that can't be transplanted whole. The researchers are hoping that rules will be issued by the United Network for Organ Sharing to set aside a certain percentage of pancreases for islet cell harvesting.

That policy is under consideration now.

"I think we could do much better and move forward faster if we had access to better pancreases," said Bernhard Hering, another investigator who directs the islet transplant program at the University of Minnesota.

Type 1 diabetes is sometimes called juvenile diabetes because it usually strikes at a younger age than the more common type 2 diabetes. In type 1 diabetes, the immune system launches a misguided attack against insulin-producing cells in the pancreas. This leads to low or nonexistent levels of the sugar-regulating hormone. People with this type of diabetes must take daily insulin injections to survive.

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The Misery of Itchy, Watery Eyes

HealthScoutNews

Monday, June 2, 2003

MONDAY, June 2 (HealthScoutNews) -- Allergy sufferers are more likely than others to accept having itchy, red, watery eyes, says a new survey by the American College of Allergy, Asthma and Immunology (ACAAI).

The survey found that four out of five Americans said they wouldn't put up with such uncomfortable eye conditions for more than a day. But almost half of eye allergy sufferers said they endure these symptoms for weeks or longer and don't bother to talk about it with their doctor.

Eye allergies affect most of the 50 million Americans who suffer from allergies.

This survey of 2,000 adults found that 37 percent reported having nasal allergies. The majority of those people (82 percent) also reported suffering itchy, red, watery eyes.

More than half (58 percent) of the eye allergy sufferers said they don't discuss their eye allergies with a doctor. That's despite the fact that 41 percent of them said their current treatment for eye allergies isn't effective or only somewhat effective in treating their symptoms.

The survey also found that for every eye allergy sufferer using prescription eye drops, there were two using non-prescription medications that offer only short-term relief.

"It's very common for people with eye allergies to just put up with their symptoms and not discuss them with their physician. But no one should have to suffer because there are a variety of treatment options that provide safe and effective relief from this irritating and annoying condition," Dr. John Winder, chairman of the ACAAI's eye allergy awareness campaign, says in a news release.

The ACAAI has a public education brochure about eye allergies. It answers questions about the problem and includes a self-quiz about eye allergy symptoms. Here's where you can find the eye allergy quiz.

More information

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

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Transplant Patients Vulnerable to West Nile Virus

 

Reuters Health

Monday, June 2, 2003

WASHINGTON (Reuters Health) - People who have received organ transplants may be especially vulnerable to the West Nile virus (news - web sites), doctors reported here Monday.

The University of Cincinnati treated two transplant patients for the virus last summer, but detected the virus too late in one patient to help him, said Debby DeSalvo, lead author of the study.

She presented her data at the American Transplant Congress, the largest annual gathering of transplant surgeons and researchers in the U.S.

Both patients were white men in their 40s, and both had received a kidney from a living donor. Neither appears to have been infected by the transplanted organ.

The first patient came to the university with what appeared to be a viral gastrointestinal infection and fever. Within days, the man had symptoms of brain swelling, but an initial CT scan showed nothing abnormal, said DeSalvo.

He quickly began showing signs of severe neurological problems, and was treated for bacterial and viral meningitis, and his anti-rejection drugs were reduced, but he still did not respond. An MRI showed that he had massive swelling in his brain, which the Cincinnati doctors realized was characteristic of West Nile virus, even though blood tests they had conducted before were negative for the mosquito-borne illness.

Before they could treat him any further, the man died, two weeks after being admitted.

A month later, another man came in, seeming to have a gastrointestinal infection. Because of the earlier case, the physicians tested for West Nile, but results were negative. An MRI, however, showed the brain swelling associated with the illness.

Doctors stopped his immune-suppressing drugs completely, and enrolled the man in a trial of alpha interferon, a drug being tested for West Nile.

Within days, he recovered, and was continued on the drug for two weeks, said DeSalvo. Ten months later, he's doing well, she said.

She and her colleagues recommended that physicians keep an eye out for West Nile in their transplant patients, and to not trust initial blood test results. Patients should be taken off immune-suppressing drugs, and tried on alpha interferon, said DeSalvo.

Several physicians in the audience said that they, too, had discovered West Nile in transplant patients, and that it had been hard to detect. One physician said her patient, a 63-year-old woman, recovered with normal supportive care.

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Travel Risks Include Disease

HealthScoutNews

Monday, June 2, 2003

MONDAY, June 2 (HealthScoutNews) -- Many people don't realize the risk of contracting serious diseases they face when they travel abroad and fail to get appropriate medical advice before they leave, says a new survey.

The survey included more than 8,000 people traveling to areas with a high risk for infectious disease. It was conducted at 14 major international airports in Europe, Asia and the United States. The results were presented at the recent conference of the International Society of Travel Medicine.

It's estimated that each week about 1 million people worldwide travel between the borders of developed and developing countries, where there are high rates of tropical and infectious diseases.

But many travelers don't bother to learn about the health risks of their destinations.

The survey found 66 percent of Asian-Pacific travelers, 64 percent of American travelers and 48 percent of Europeans didn't bother to get travel advice before going to an area with a risk for infectious disease.

It also found that 83 percent of Americans, 72 percent of Europeans and 69 percent of Asian-Pacific travelers underestimated the risk of contracting hepatitis A, which is the most common vaccine-preventable disease among travelers.

Many of the people traveling to malaria-endemic areas were unaware of the risk of malaria and did not carry anti-malarial medication.

Travel-related illnesses not only affects the traveler, he or she can unknowingly infect family, friends and other people when they return home.

More information

You can learn more about destination-specific health risks at the World Health Organization.

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Study Tags Danger Zones for Children's Injuries

 

Reuters

Monday, June 2, 2003

CHICAGO (Reuters) - The most common injuries children suffer vary by age almost month by month, with the most dangerous time coming at 15 to 17 months, according to a U.S. study published on Monday.

The University of California report, based on a review of more than 23,000 childhood injuries, 636 of them fatal, from 1996 to 1998, was designed to alert parents and doctors to the most common hazards at any given point.

During the first year of life, the study found that unspecified falls were the main source of injury before 3 months, battering by parents or caregivers at 3 to 5 months, falls from furniture at 6 to 8 months, swallowing foreign objects at 9 to 11 months and hot liquid or hot vapors at 12 to 17 months.

In general, the overall injury rate for all causes, everything from fires to ingestion of drugs, rapidly increased with age starting at 3 to 5 months and peaked at 15 to 17 months, said the study published in the June issue of Pediatrics, the journal of the American Academy of Pediatrics.

"This coincides with developmental achievements such as independent mobility, exploratory behavior and hand-to-mouth activity," the report said. "The child is able to access hazards but has not yet developed cognitive hazard awareness and avoidance skills."

The study, which tracked statistics up until age 4, found that the most common cause of injury after 3 came from moving vehicles hitting children on foot.

Across all ages medication poisoning was the single highest cause of injury, peaking at from 18 through 35 months.

"A remarkable finding was the high rate of battering injuring among infants," the study said, "suggesting the need to address potential child maltreatment in the perinatal period."

Source: Pediatrics 2003;111:e683-e692.

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Pediatricians Raise Concern About Plastic Softener

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Monday, June 2, 2003

MONDAY, June 2 (HealthScoutNews) -- A panel of child health experts wants more research into the possible harmful effects of plastic softeners used in kids' toys and a wide range of other products from perfumes to flooring.

The substances, a group of chemicals called phthalates, can cause cancer, harm fetal development and affect reproduction in rodents. Whether they do the same damage in people isn't clear. The Centers for Disease Control and Prevention (news - web sites) has found traces of the chemicals in blood, but the significance of that discovery isn't clear.

"The big piece of the puzzle that's missing is having a good understanding of how much of this stuff gets into people," says Dr. Katherine Shea, a pediatrician in Chapel Hill, N.C., and the leader of the panel that wrote the report for the American Academy of Pediatrics (AAP).

The report calls for more study on the toxicity of phthalates to infants from exposures across the placenta, in breast milk, and from medical and non-medical sources. That includes whether the chemicals can harm human reproduction, especially the healthy formation of the testes in boys.

A Harvard-led study released late last year found that the presence of one kind of phthalate in urine was associated with DNA damage to sperm in men. A study released in May found that some phthalates may lower sperm count, stunt their motility, and harm their shape, problems that could affect fertility.

The new report appears in the June issue of the AAP's journal Pediatrics. It focuses on two phthalates, diethylhexyl phthalate (DEHP) and diisononyl phthalate (DINP), although the family of fat-loving chemicals contains many more members.

Medical devices are the source of the greatest exposures to phthalates in humans, and people who work in the industry can possibly have the levels linked to harm in animals, Shea says. Exposures from diet -- through food production, processing, and packaging -- and other routes are generally far below that from medical goods, such as IV and blood bags.

"The dietary exposures are the highest general exposures, but we don't believe they are of a magnitude that's worrisome," Shea says. "But the only data that we have says the models may not be adequate" to extrapolate the risk from animals to humans.

The European Commission (news - web sites) banned phthalates in soft children's toys in 1999. Toy makers in the United States voluntarily stopped using DEHP in their chew products. Some are also substituting DINP, which is thought to be less toxic, for DEHP.

However, Shea says hand-me-downs and other toys not specifically designed for the mouth but which, kids being kids, find their way there may still contain DEHP.

But Dr. Gil Ross, medical director of the American Council on Science and Health, a New York City public health education group, criticized the new report.

"There are thousands of chemicals to which we are exposed in trace levels in the environment. Why focus on DINP and DEHP? These are highly beneficial, and there are no substitutes with a proven track record of safety and efficiency," Ross says. "It seems to me to be a waste of time, effort and scarce resources to evaluate exposures to these substances."

His group released a report in 1999, which claimed that phthalates weren't a threat to human health. That document, headed by former U.S. Surgeon General C. Everett Koop, came under sharp criticism from consumer watchdogs as a sop to the chemicals industry.

Dr. Ted Schettler, science director for the Science and Environmental Health Network, a public health group based in Ames, Iowa, says it makes sense to avoid phthalates whenever possible, such as in cosmetics and certain medical devices.

"I think some are clearly more problematic than others, and we should look at the places where we're using them where we don't need to be using them," says Schettler, a staff physician at Boston Medical Center who was among those who publicly took issue with the Koop report.

Last year, the U.S. Food and Drug Administration (news - web sites) encouraged hospitals to minimize the use of devices with DEHP in patients considered most at risk of being harmed by the substance. These include premature babies in intensive care, babies requiring multiple blood transfusions, young boys undergoing kidney dialysis, and other select groups.

More information

For more on phthalates, try the U.S. Food and Drug Administration or the American Chemistry Council.

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Plant Estrogens Don't Cool Hot Flashes: Study

 

By Linda Carroll

Reuters Health

Monday, June 2, 2003

NEW YORK (Reuters Health) - Advised to avoid hormone replacement therapy, breast cancer (news - web sites) survivors often look to herbal remedies that contain estrogen-like chemicals called phytoestrogens to quell menopausal hot flashes.

But these plant-derived substances are no more likely than a placebo to cool hot flashes, according to a study published in the June issue of Obstetrics and Gynecology.

In theory, phytoestrogens would seem to be the perfect choice for breast cancer survivors, according to the new study's lead author, Dr. Eini Nikander, a researcher in the department of obstetrics and gynecology at Helsinki University Central Hospital in Helsinki, Finland.

That's because the estrogens from plants don't bind well to receptors in the uterus, breasts or ovaries, Nikander said in an interview with Reuters Health.

But they do lock on to estrogen receptors in a variety of other spots in the body, including the brain and the bones.

"That's why they shouldn't have, at least in theory, much effect on breast cancer cells," Nikander said.

For the new study, Nikander and her colleagues followed 56 women who had been treated for breast cancer. The women were randomly assigned to either a group that received phytoestrogens or one that received placebo tablets.

After three months the groups received no therapy for two months and then switched treatments for the next three months.

During the study, the researchers interviewed the women about menopausal symptoms, including hot flashes.

When the researchers compared the effects of placebo and phytoestrogen on menopausal symptoms, they found no difference.

Some might argue that it takes longer than three months for phytoestrogens to quell hot flashes, Nikander said. But traditional hormone replacement therapy improves hot flashes within days, she added.

The new results leave breast cancer survivors with few choices to help them deal with menopausal symptoms.

"The only healthy alternatives are less alcohol, stress and coffee and more sleep and exercise," Nikander said.

Nikander said that some medications may relieve hot flashes in some women, including beta-blockers and antidepressants called SSRIs, or selective serotonin reuptake inhibitors. SSRIs include Paxil (paroxetine), Prozac (fluoxetine) and Zoloft (sertraline).

Source: Obstetrics and Gynecology 2003;101:1213-1220.

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Sperm Defects May Explain Some Miscarriages

By Colette Bouchez
HealthScoutNews Reporter

HealthScoutNews

Monday, June 2, 2003

MONDAY, June 2 (HealthScoutNews) -- New research reveals important new links between sperm defects and recurring miscarriage, an association doctors long suspected but could not prove.

"In the last several decades, there have been several studies looking at the link between sperm and recurring miscarriage, but nobody actually found a correlation -- mainly because they were only looking at general semen analysis," says the study's author, Dr. Harry Hatasaka, medical director of the Utah Center for Reproductive Medicine at the University of Utah.

"As far as I know, this was one of the first studies to look at the genetic side of things in much more detail," Hatasaka adds, "which is why, I believe, the correlation has finally been made."

Whether occurring just one time or repeatedly, the majority of miscarriages are caused by chromosomal abnormalities -- genetic defects within the embryo that affect its ability to thrive. In the past, it was believed that only a defective egg could lead to this event.

More recently, however, experts have come to believe that a defective sperm may also contribute to faulty conception, and in doing so become a cause of miscarriage. But doctors say this study was the first to prove it can happen.

"It is something we always suspected, but now this is one of the strongest pieces of information we have to indicate that it is a definite possibility in a subgroup of patients -- and the study adds an important dimension to the investigation of what is behind a couple's recurring pregnancy losses," says Dr. Peter Schlegel, acting chairman of urology at New York Presbyterian at Weill Cornell Medical Center in New York City.

Indeed, Schlegel says, preliminary information shows that sperm abnormalities can play a significant role in either getting pregnant or maintaining a pregnancy. This study, he says, adds to this growing body of knowledge.

The new study, published in the June issue of Obstetrics and Gynecology, focused on a small group of just 24 men, whose partners all had at least one unexplained pregnancy loss. According to Hatasaka, all of the women underwent what he says was "state of the art testing," including genetic screenings, and were found to be normal.

To check the men, researchers obtained semen samples from each partner, along with samples from 26 sperm donors with a history of at least one successful pregnancy within the previous two years. Sperm was also collected from a general population of 42 men. The age range for all the men in the study was between 26 and 36.

After the samples were retrieved, the semen was liquefied, isolated and then subjected to a series of highly detailed tests. This included checking for motility (the ability of the sperm to move or swim), concentration (the number of sperm in a selected sample), viability (general health), morphology (form, structure and genetic material), plus the way the sperm would react in fluids that approximate what is found in the female reproductive system.

"We were primarily looking for evidence of breaks in the DNA that would indicate a genetic defect that would result in a defected embryo, which would eventually result in pregnancy loss," Hatasaka says.

The result: While some of the tests showed similar results among all the men, in those whose partners had a history of miscarriage, researchers identified some specific differences, including the presence of chromosomal abnormalities.

"Even though it may not manifest in a simple semen analysis, this study shows that there must be some genetic defect that halts the process of embryogenisis [the creation of life] at some point and leads to recurrent pregnancy loss," Hatasaka says.

The good news is that "at least some potential causes of abnormal sperm are treatable conditions that might also increase pregnancy odds," Schlegel says.

Hatasaka adds that environmental factors, particularly cigarette smoke, can cause some of the cell changes capable of altering the DNA, resulting in the kind of genetic breaks in the sperm that are now linked to miscarriage.

"If your partner is having recurring miscarriages, clearly, stopping smoking might make an important difference," Hatasaka says.

Currently, there is no U.S. Food and Drug Administration (news - web sites) test specifically approved for evaluating sperm for genetic defects linked to miscarriage.

However, experts say most major fertility centers or genetic laboratories should be able to perform the tests.

More information

To learn more about the causes of recurrent miscarriage, check out: The American College of Obstetricians and Gynecologists. For more on male fertility, visit this page at the University of Utah School of Medicine.

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New Respiratory Virus Found in U.S. Kids

 

By Martin F. Downs

Reuters Health

Monday, June 2, 2003

NEW YORK (Reuters Health) - A new virus continues to show up wherever investigators look for it -- and it isn't SARS (news - web sites). It's the human metapneumovirus (hMPV), which has now been discovered in American children.

Researchers at the Yale University School of Medicine found that 19 out of 296 New Haven, Connecticut, children who had respiratory infections of unknown cause were infected with hMPV. Symptoms included wheezing, cough and fever.

"I think this virus probably accounts for a small but significant portion of respiratory tract illness in children," study author Dr. Jeffrey S. Kahn told Reuters Health.

The findings appear in the latest issue of the journal Pediatrics.

In children, 15 to 34 percent of cases of pneumonia and a lung infection called bronchiolitis have no known cause. The most common causes are flu viruses, parainfluenza viruses and respiratory syncytial virus (RSV). Samples screened in the study were negative for these viruses.

"If you step back and look at pneumonia in general, about 50 percent of the time we can identify a cause," Kahn said. "Obviously, in the other 50 percent we don't know what causes it. So that suggests that there are unknown pathogens out there."

Human metapneumovirus came to light in 2001, when researchers in the Netherlands identified the virus in children.

"When it was first reported, everybody said, 'wow, that's very interesting,' and everybody started going back to their freezers where they kept samples, and started to probe samples. Now it's been found in many countries," Kahn said.

In March of this year, researchers reported finding hMPV in adults in Rochester, New York. That was the first indication that it is circulating in the United States. It has also been found in the UK, Canada, Australia, Japan, Finland, and France.

The implications of these discoveries are not yet fully understood. "The disease caused by this virus is really just beginning to be explored," Kahn said.

It's certain that hMPV can make people sick enough to land them in the hospital. But Kahn said that the severity of the illness it causes may change from year to year. More research will be needed to find out how the virus behaves and the extent of its impact.

The existence of hMPV may answer some nagging questions for pediatricians. "We see otherwise healthy kids getting very bad lung infections," Kahn said. It's possible that hMPV interacts with other viruses to cause more serious infections.

Before scientists determined that a new kind of coronavirus causes SARS, or severe acute respiratory syndrome, they thought that hMPV might play a role. Six out of eight SARS patients in Canada had both hMPV and the coronavirus, leading researchers to wonder if one of the viruses worsened the effects of the other. Later, they found that the coronavirus alone causes SARS.

Source: Pediatrics 2003;111;1407-1410.

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Panel: Routine Dementia Screening Unnecessary

By Steven Reinberg
HealthScoutNews Reporter

HealthScoutNews

Monday, June 2, 2003

MONDAY, June 2 (HealthScoutNews) -- A U.S. government advisory panel says there is no evidence that supports screening older patients who do not show signs of dementia.

"We have failed to find sufficient evidence to recommend for or against routinely screening older adults for dementia," says Dr. Alfred O. Berg, chairman of the U.S. Preventive Task Force.

The task force is an independent panel of private-sector experts who assess evidence for a wide range of preventive services. The panel's recommendations are considered the standard of care. Its work is sponsored by the Agency for Healthcare Research and Quality, a division of the U.S. Department of Health and Human Services (news - web sites).

Unfortunately, Berg cautions, doctors are going to have to decide on their own what to do without having clear scientific evidence.

The medical evidence for the task force recommendation comes from a report from a team led by Dr. Malaz Boustani, an assistant professor of medicine at the Indiana University School of Medicine.

Boustani's team reviewed all the literature on dementia screening from 1994 onward. "We found that there was not enough data to decide whether the benefit of screening outweighed the potential harms of screening," Boustani says. Their report appears in the June 3 issue of the Annals of Internal Medicine.

Routine screening of patients with no signs of dementia can be risky, Berg says. Patients might test positive for dementia but not actually have the problem, which can have a devastating psychological effect. And patients with dementia could have normal test results, he says.

Boustani adds that patients with no signs of dementia but who are diagnosed with dementia might suffer consequences such as canceled health insurance or revoked driver's licenses.

Boustani says that randomized trials are going on to see whether routine screening might be beneficial. He notes that in one trial, most of the patients who were screened positive for dementia did not want to come back for further evaluation. He suspects that fear may be the reason.

Should the results of these trials show a significant benefit from screening, the recommendations of the task force might change, Boustani says.

The only benefit that Boustani sees from screening is that patients and their families can begin to make health-care arrangements and decisions about finances and other personal matters.

Boustani stresses that if family members or your doctor notes signs of memory loss or other cognitive problems, the patient should be tested for dementia.

"There is no effective cure for dementia even when you find it," Berg adds. "Treatments may slow progression but they do not reverse the condition." If there were treatments, routine screening might be worthwhile, he notes.

However, Berg says, doctors should be alert for signs of cognitive disorders among their patients. But as a patient, "you should not expect that your physician should be giving you a routine mental status exam."

Dr. Sharon Inouye, a professor of medicine specializing in dementia from Yale University, calls the new recommendations "disappointing." She says she "would like to see more screening done in the older population because dementia is so often missed, particularly in its early stages."

"These guidelines don't increase the recognition of the problem, but I understand the problem that the evidence in the literature is not good. Geriatric investigators need to concentrate on getting better evidence so we can document the need for more widespread screening," Inouye says.

She also says there is need to document the value of early treatment. There is some good evidence, Inouye notes, that medications can slow the progression of dementia for several months. "The benefit is mild, but if patients are not diagnosed early than they lose out on this benefit altogether. I would hate to deny a significant number of people this potential benefit," she says.

More information

To learn more about dementia and other elderly afflictions, visit the National Institute on Aging or the American Geriatrics Society.

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Prenatal Smoking May Affect Newborn's Behavior

 

Reuters Health

Monday, June 2, 2003

NEW YORK (Reuters Health) - Smoking during pregnancy appears to affect a newborn's behavior in ways similar to infants whose mothers used heroin or other illegal drugs, new study findings suggest.

Smoking between 6 and 7 cigarettes per day -- less than half a pack -- throughout pregnancy was associated with infants that were more excitable, less consolable and more rigid, according to the report published in the journal Pediatrics.

"The smoking effects in our study underscore the importance of smoking cessation programs, particularly for women of childbearing age," writes lead author Karen L. Law of Brown Medical School in Providence, Rhode Island.

Stacks of previous research show that women who smoke while pregnant are twice as likely to have a low-birth weight infant compared to their non-smoking peers. But, according to the new report, few studies have examined how prenatal cigarette exposure may affect an infant's behavior.

To investigate, the team of researchers evaluated the behavior of 27 infants born to mothers who reported that they smoked an average of 6 to 7 cigarettes a day during their pregnancy. Smoking habits were verified by measuring cotinine, a breakdown product of nicotine, found in the saliva. The babies were compared to 29 infants born to non-smoking mothers.

Babies born to mothers who smoked showed more signs of stress in their central nervous, gastrointestinal and visual systems, required more handling and were more rigid than other babies, the authors report.

The findings suggest the babies may have been undergoing nicotine withdrawal, they said.

What's more, Law's team reports that the levels of behavioral stresses that were observed were on par with those seen in infants born to mothers who use heroin and other opiate drugs, and the babies had stress behavior similar to those seen in preterm infants.

"The findings require us to take a step back," said Law in a prepared statement. "What are the Surgeon General warnings doing to stop smoking, given that the percentage of smokers is similar in the pregnant and general populations (about 18 percent and 25 percent respectively)? It is a huge public health concern that so many people are suffering the costs of smoking, including newborns."

Source: Pediatrics 2003;111:1318-1323.

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Young Cancer Survivors Face Heart Threat

By Randy Dotinga
HealthScoutNews Reporter

HealthScoutNews

Monday, June 2, 2003

MONDAY, June 2 (HealthScoutNews) -- Chemotherapy and radiation turn many young cancer patients into cancer survivors, but the treatments also appear to boost their risk of heart disease just a few years later, researchers report.

The findings add more weight to theories that successfully treated cancer is "probably the equivalent of a lifelong chronic illness. You shift from one phase to another," says study co-author Dr. Steven Lipshultz, chief of pediatric cardiology at the University of Rochester.

He adds that children who survive cancer should get regular cardiovascular checkups to make sure their hearts are not deteriorating.

According to Lipshultz, researchers have become increasingly concerned about heart disease risks as cancer in children has become less deadly thanks to chemotherapy and radiation.

Consider leukemia, the most common childhood cancer. In 1970, only about 10 percent of children survived the illness. Now, about 90 percent do, Lipshultz says.

But while cancer treatments "are terrific for killing leukemia cells in young children, they're not specific for just leukemia cells," Lipshultz says. "They can damage other cells in the body."

Those cells include those of the heart, which cannot easily regenerate itself, he explains. In some cases, the heart ends up with fewer muscle cells and must work harder.

While doctors have known about heart problems in young cancer survivors for about 20 years, the new studies examine how soon the damage begins. The studies were to be released Monday at the American Society of Clinical Oncology (news - web sites)'s annual meeting in Chicago.

In one study, researchers examined 176 young adults who had survived various types of cancer -- including leukemia, lymphoma, and Hodgkin's disease, among others -- as children. The researchers compared the subjects to 64 of their healthy brothers and sisters.

The cancer survivors, who were typically 18 to 21 years old and about 15 years from treatment, generally reported feeling healthy. Those who had undergone radiation and chemotherapy had higher heart rates -- a bad sign -- and higher cholesterol levels. All the cancer survivors were more likely than their siblings to show signs of heart disease.

As a group, the cancer survivors got less exercise than their siblings and had higher levels of body fat. Those latter two factors put them at higher risk of high blood pressure.

In the second study, researchers examined 48 adults from the Boston area who were treated for Hodgkin's disease under the age of 25. All had been treated with radiation at some point between 1970 and 1991, and four had also received chemotherapy.

Even though they felt healthy and most were in their 30s, 65 percent of the subjects showed signs of mild to moderate heart valve defects and 58 percent had problems with the electrical systems of their hearts.

"The evidence of cardiovascular disease was there, but these people hadn't noticed it, yet," Lipshultz says in a statement.

The findings will help doctors be more alert about the potential health problems facing survivors of childhood cancer, he says. "Knowing that heart problems occur and place patients at risk allows us to monitor patients who are at risk."

It's still unclear whether adults who undergo cancer treatment face the same future heart disease risks as children, he says.

However, researchers have found that adult cancer survivors do suffer from higher levels of fatigue and "difficulty trying to maintain normal activities," says Dr. Len Lichtenfeld, deputy chief medical officer of the American Society. Women who get treatment for breast cancer (news - web sites) may be at special risk from radiation treatment because it targets an area near the heart, he says.

"We're recognizing more and more that having long-term survivorship [of cancer] comes at a price," he says.

More information

Learn more about childhood cancers from the Pediatric Oncology Resource Center. Or try kidshealth.org.

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Kids' Risk of HIV After Accidental Exposure Is Low

 

By Alison McCook

Reuters Health

Monday, June 2, 2003

NEW YORK (Reuters Health) - Doctors should not automatically give HIV (news - web sites) drugs to every child who may have been accidentally exposed to the virus that causes AIDS (news - web sites), according to the American Academy of Pediatrics.

Although quickly starting treatment with HIV drugs -- an approach called post-exposure prophylaxis -- may reduce the risk that the virus takes hold after a suspected exposure, doctors need to first consider whether the risk of infection is greater than the risks associated with taking the drugs, they said.

For instance, Dr. Peter L. Havens of the Medical College of Wisconsin told Reuters Health that the risk of getting HIV after accidentally sticking yourself with a needle used on an HIV-positive person is actually quite low -- around 3 in 1000.

When a child finds a needle by accident, the HIV status of its last user is not known, Havens said. And the longer HIV is exposed to air, the less likely it is to cause infection.

"You only recommend postexposure prophylaxis if you know that the person is infected with HIV and that there was a true high-risk exposure," he said in an interview.

"So when you get right down to it, the number of times that this would be recommended in actual practice is really quite low."

The drugs used to prevent HIV in potentially exposed people are expensive, and typically cause a host of side effects, including upset stomach, diarrhea, headache and fatigue, Havens said.

"There's no reason to do all of that if you're not really at risk of HIV," Havens said.

In the journal Pediatrics, Havens and his colleagues reviewed information about the risks of getting HIV from different accidental exposures, such as blood transfusions, unprotected sex and needle sharing.

Certain types of accidental exposures tend to occur more commonly in children, such as when children prick themselves with a used needle, or when infants become exposed to the breast milk of an HIV-positive woman.

Havens stressed that while the report cautions against automatic treatment after every possible accidental exposure in children, doctors should not hesitate to give medicine to children who they believe have a real risk of getting HIV, such as children who have been sexually abused by an HIV-infected person.

But in all cases, doctors should first determine the risk that each exposure will lead to infection, and the chance that the person the child is exposed to actually has HIV, Havens said.

Once those factors are taken into account, it becomes clear that most accidental exposures in children are unlikely to cause HIV, he added.

"In many ways, this can help people be reassured that they don't need to give postexposure prophylaxis for many of the most common community exposures," Havens said.

Source: Pediatrics 2003;111:1475-1489.

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A Bad Cycle

HealthScoutNews

Monday, June 2, 2003

(HealthScoutNews) -- Bicycling as your only exercise is not a good idea for your bones.

In fact, no exercise might be better than just bicycling, based on a bone density study reported in The Washington Post.

Scottish researchers compared bone density among three groups of males, all about the same age and body size: competitive cyclists, competitive runners and non-exercisers. The runners and cyclists had competed for at least three years and trained for at least four hours a week.

Compared with the non-exercisers, runners had greater bone mineral density in their spines and cyclists had less, say the University of Edinburgh researchers. The report advises young athletes, whose bone density has not yet peaked, not to engage in cycling exclusively, but to include other load-bearing exercises and sports.

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Rat Healing Raises Hope for Spinal Cure

 

By Corinne Amoo

Reuters

Monday, June 2, 2003

LONDON (Reuters) - Scientists said on Monday they were closer to finding a cure for people paralyzed by spinal cord damage, following the successful healing of an adult rat.

Pilot trials for human patients will begin within three years, research team leader Dr. Geoffrey Raisman told Reuters.

"This is ground-breaking evidence because it will help people with spinal cord injury who have previously had no hope of recovery," he said.

The trials will involve transplanting cells from other areas of the body into the spinal cord so they can provide a bridge over the spinal cord blockage and provide it with a channel to repair itself.

Currently there is no cure for patients who suffer spinal and brain cord injuries, which, depending on the severity of injury, leaves them paralyzed, without control over their bowels, bladder, blood pressure and with no sexual function.

Scientists healed the injured spinal cord of a rat by growing a bridge of olfactory nerve cells across scar tissue, which acted as a guide so the severed nerve fibres were able to find their way to the right targets in the rat's brain.

If the human pilot trials are successful, patients will be able to make important movements like reaching for and picking things up. The restoration of other functions like bladder control require further research, Raisman said.

The pilot trials will involve transplanting cells from the patients' nasal lining into the spinal cord.

"Until we carry out the tests in humans we do not know if it will work, but the organization of the rat's spinal cord and its control mechanisms that we have looked at are essentially similar to those found in humans," said Raisman.

The trials will take at least three years to be carried out because the research team needs to be sure that the cells used for repair are present and in the right numbers, he said.

Details of Raisman's findings are published in the June Journal of the Royal Society of Medicine.

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Nightmare Dιjΰ vu

HealthScoutNews

Monday, June 2, 2003

(HealthScoutNews) -- Do your nightmares leave you wondering whether you are suppressing serious problems?

Here's a simple explanation from the American Family Physician to help you figure that out.

Dreams can occur at any point of the sleep cycle, and even frequent bad dreams don't indicate psychiatric or psychological problems. That applies to children, who may have night terrors, as much as to adults. Just relax and go back to sleep.

But if you have the same bad dream over and over, you might think about getting professional help. It's one of the common symptoms of post-traumatic stress disorder.

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UK Breast Cancer Cases at Record Levels

 

Reuters Health

Monday, June 2, 2003

LONDON (Reuters Health) - The number of British women diagnosed with breast cancer (news - web sites) each year has reached its highest level ever, topping 40,000 for the first time, according to new figures released on Monday by a leading charity

Cancer Research UK said the number of cases would keep increasing for some time, but screening and improved treatments meant more women are being successfully treated than ever before.

Currently, three out of four women diagnosed with the disease survive for five years or more, and annual death rates have dropped 21 percent over the past 10 years to around 13,000 in 2001.

"Tamoxifen has been in use for 20 years and the screening program has been up and running for the last 15. These two advances alone account for significant improvements in survival," said Professor Jack Cuzick, head of Cancer Research UK's epidemiology, mathematics and statistics department at the Wolfson Institute for Preventive Medicine in London.

He said the reasons for the increasing number of cases were harder to understand, but were related to levels of the female hormone estrogen.

"We know that obesity in post menopausal women is a risk factor and that it can raise the levels of estrogen. We also know that levels of obesity have been rising steadily in the past decade and this may be contributing to the upward trend."

Genes also play a role, as do late menopause and the early onset of periods, which can also increase exposure to the hormone, he said.

The charity's clinical director Professor Robert Souhami said research was beginning to uncover the factors that affect risk.

"In the meantime, early detection remains very important in preventing deaths from breast cancer and it is essential that women are aware of this and attend for screening when they are invited."

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SUNDAY, JUNE 1, 2003

 

Taming Tennis and Golf Elbow

 

HealthScoutNews

Sunday, June 1, 2003

SUNDAY, June 1 (HealthScoutNews) -- Tennis and golf elbow are painful conditions that affect different areas of the elbow.

Tennis elbow causes pain on the outside of the elbow, while golf elbow affects the inside of the elbow.

Both disorders are cause by repetitive movements and overuse of the muscles in the arm. Overusing the muscles causes slight tears in the tendons, according to the American Academy of Orthopaedic Surgeons. If you keep doing the activity without giving the injury time to heal, the tendons become inflamed and cause pain. The pain may travel down your arm and get worse when you grab onto something or extend your wrist.

The first line of treatment is to stop doing the activity that caused the pain, whether it was tennis, golf, painting, raking, or some other repetitive activity. Time off gives the muscles a chance to heal. To decrease swelling, treat the area with ice. And if you have a lot of pain, take ibuprofen or another anti-inflammatory medication.

If the pain lasts for several weeks, it's time to check in with your doctor. Your physician may have you wear an arm brace for a while. If the pain is intense, your doctor may also give you a cortisone injection.

If the injury is sports-related, once you're feeling better, check your technique to make sure you're swinging properly. Strength and flexibility training might help prevent future injuries.

More information

To learn more about tennis and golf elbow, visit the Mayo Clinic.

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Back Pain? Join the Crowd

SUNDAY, June 1 (HealthScoutNews) -- If you suffer from an ache low down in your back, you're certainly not alone.

Low back pain is a common problem -- four out of five Americans will have significant low back pain at some point in their life, says the American Academy of Orthopaedic Surgeons (AAOS).

And lower back pain is second only to the common cold as the leading cause of lost work days for adults under the age of 45.

Common causes of low back pain include sprain and strain, wear and tear associated with age, osteoporosis and fractures or a protruding disk.

Most low back pain can be treated by medication and activity modification. That doesn't necessarily mean you have to stop doing everything. While rest can be helpful, most research finds that light activity speeds healing and recovery, the AAOS says.

Once the pain decreases, a rehabilitation program may be recommended to help increase muscle strength in your lower back and abdomen and to improve your muscle flexibility.

Long-term treatment may include active prevention such as staying in good physical condition and adhering to proper lifting and posture guidelines to prevent another low back injury.

Achieving and maintaining proper body weight and not smoking are other ways to prevent low back pain.

Some people say that weather conditions can affect low back pain. A study published in the Oct. 1, 1998, issue of Spine examined the connection and concluded that weather conditions may have a significant influence on people's self-reporting of low back pain.

The study said the weather effects on low back pain may be small, but should be considered by doctors when treating people with chronic, non-specific low back pain.

More information

The U.S. National Institutes of Health (news - web sites) has more about back pain.

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Inducing Labor Doesn't Always Result in C-Sections

By Colette Bouchez
HealthScoutNews Reporter

HealthScoutNews

Sunday, June 1, 2003

SUNDAY, June 1 (HealthScoutNews) -- Doctors have traditionally believed that inducing labor on or around a pregnant woman's due date would increase the chance of a Caesarean birth.

Now, a new meta-analysis of 16 studies challenges that thinking, with evidence that a Caesarean may not be necessary if labor is induced in pregnancies that go beyond the normal nine months.

"Intuitively, we have always thought that because inducing labor before 41 weeks resulted in a higher rate of Caesarean delivery, that inducing at 41 weeks would have the same effect. But we were very surprised to find the opposite was true," says study author Dr. Luis Sanchez-Ramos, a professor of obstetrics and gynecology at the University of Florida in Jacksonville.

The new research appears in the June issue of Obstetrics and Gynecology.

When compared to labor management -- a process of wait-and-see -- inducing labor on or near a woman's due date was less likely to lead to a Caesarean delivery than if doctors simply let nature take its course, Sanchez-Ramos says.

"We think that perhaps something occurs during the waiting period that results in problems that ultimately end up requiring a Caesarean-section birth, whereas inducing labor seems to help avoid some of those problems and consequently reduces the need for a Caesarean section," Sanchez-Ramos says.

But critics of the study charge the difference in the number of women involved in the research who required Caesareans was small, and the method of analysis used to obtain the information might be flawed.

"Based on this review, I don't believe there is enough evidence to create a hard-and-fast rule about inducing labor," says Dr. Steve Goldstein, a professor of obstetrics and gynecology at New York University Medical Center. "The difference in Caesarean rates was small, and the method of review can easily omit specific information on each pregnancy that might definitely influence the outcome."

The best approach, Goldstein says, is to treat every pregnant woman on an individual basis.

"I certainly would not change the way I deal with my overdue patients based on this study," he says.

Sanchez-Ramos says his findings back up conclusions of a large Canadian-based study that found similar results.

"I believe the difference in Caesarean section rates is significant and that these findings should change our way of thinking about labor induction in women who are past due," he says.

The meta-analysis -- a systematic review of literature on induced labor -- took into account 16 studies on labor induction published between 1969 and 1992. This included one large Canadian study of some 1,900 women, bringing the total number of patients included in all the research to 6,588. All of the women were pregnant for at least 41 weeks, and considered to be at least one week past their due date.

The result: When compared to women whose doctors took a wait-and-see approach, those women who had labor induction had a 2 percent lower rate of Caesarean-section delivery. What's more, the babies of these women had a lower prenatal mortality rate, though the researchers believe the difference was not statistically significant.

"Overall, the studies show that inducing labor in women who are past due can result in fewer Caesarean sections, and it's something that doctors should consider when making labor-management decisions," Sanchez-Ramos says.

In a second study also published in the June issue of Obstetrics and Gynecology, doctors from the University of Texas Medical Branch at Galveston report on a new procedure known as transabdominal uterine electromyography. When administered on or near a due date, it can predict whether labor will start within the next 24 hours.

For women at risk of a premature delivery, it can predict whether labor will begin within four days.

The test, which measures how a muscle fiber responds to electrical nerve stimulation, was used to calculate the electrical activity of the uterus, which grows more robust as delivery time draws near. By watching for peaks in the electrical activity, doctors were able to predict delivery times with surprising accuracy, the study says.

The test can be used to more accurately evaluate preparedness for labor, the researchers say. It can also be used to prevent unnecessary hospital admissions and improve perinatal outcomes, including prevention of pre-term labor and better use of labor-inducing medications.

More information

To learn more about post-term pregnancies, visit The Medical Center of Central Georgia. For more information on labor induction, check The Family Doctor.

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SATURDAY, MAY 31, 2003

Commitment to Heart Health Must Start in Childhood

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews

Saturday, May 31, 2003

SATURDAY, May 31 (HealthScoutNews) -- When should people start taking the steps necessary to ward off heart disease?

Try childhood.

So says the American Heart Association (news - web sites), which has just released a comprehensive summary of heart disease prevention guidelines for pediatricians to use with their patients.

"Many studies have shown an association between atherosclerosis and high cholesterol, high blood pressure and obesity beginning in children as young as 5 years old," says Dr. Rae-Ellen Kavey, lead author of the guidelines.

But while guidelines have existed for preventive care for adults at risk for heart disease, there were no similar, overall guidelines for children, adds Kavey, who is chairwoman of cardiology at the Children's Memorial Hospital, Northwestern University-Feinberg School of Medicine in Chicago.

"There are pre-existing guidelines for children about cholesterol, blood pressure and weight, and now we have put all the information together into one place for pediatricians -- it is aimed at primary-care providers," Kavey says.

Preventing heart disease can't begin too early. The guidelines, a year in the making, reflect the latest information that suggests that early intervention in adopting a healthy lifestyle can be enormously effective in delaying the onset of heart disease.

The guidelines, contained in a simple format that pediatricians can stick to their bulletin board, are divided into three sections:

  • recommendations for heart-healthy behavior for all children and teens;
  • information on how to identify those children at risk for future heart problems due to factors like excess weight, high blood pressure or cholesterol;
  • and recommendations for intervention for children and adolescents with identified risk factors.

For otherwise healthy children and teens, the guidelines suggest regularly assessing a child's heart health by checking weight, blood pressure and lipid levels, if necessary. The guidelines also ask doctors to recommend healthy food choices, such as eating more fruits and vegetables, to restrict intake of saturated fats to less than 10 percent of a child's daily caloric consumption, and to keep sugar intake low.

The guidelines also emphasize the importance of daily physical activity and limiting sedentary activity -- for instance, no more than two hours of television and/or sitting at a computer each day. The dangers of smoking are also discussed.

The second part of the guidelines identifies those children or teens already at high risk of cardiovascular disease. These include kids with a Body Mass Index (BMI) above the 85th percentile for their age, height and weight; a blood pressure reading in the 90th percentile for age, sex and height; and a cholesterol reading of 170 or higher.

Other factors that put children at higher risk is a family history of heart disease, particularly if male relatives had heart disease before age 55 and female relatives before 65.

Finally, the guidelines recommend treatments for those children already at risk for heart disease, including dietary changes such as lowering salt intake, losing weight or prescribing medications if needed.

Dr. Nancy Halnon is a pediatric cardiologist at the University of California, Los Angeles Medical Center. She says that while the guidelines are helpful, it may prove hard for pediatricians to introduce another layer of information into their already crowded agendas.

"Doctors have a five-minute visit where they have to cover toilet training, allergies, using seat belts and treating ear infections," she says, remembering her residency in pediatrics. "This is another thing on their plate."

But Kavey says the guidelines were written with time constraints in mind.

"These things can be integrated with the normal practice," she says.

For example, she says, "Parents have major questions about food, when to start solids, what are good snacks, which kinds of formula, so the doctors are giving advice about diet. With these guidelines, they have an opportunity to give specific information about low-fat diets at the get-go."

"It's much easier to establish healthy eating and physical activity patterns than to change unhealthy patterns," she adds.

More information

More information about the children's heart disease prevention guidelines can be found at the American Heart Association. Visit the U.S. Food and Drug Administration for a suggested heart-healthy diet for all ages.

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