The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
October 8, 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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 June 28 - July 4

FRIDAY, JULY 4, 2003

  1. Sleep Apnea Linked to Bed-Wetting in Kids
  2. Some Smokers Cut Down Before Quitting
  3. Diabetes More Common in Snorers, Problem Sleepers
  4. Different Sun Rays, Different Damage
  5. 'Pre-Diabetes' May Raise Risk of Dying from Cancer
  6. Vegetarian Alert
  7. Sniffing, Snorting Drugs May Raise Hepatitis C Risk
  8. The Bugs of Summer
  9. Study: Gum Disease Raises Death Risk in Diabetics
  10. Very Few Quit Smoking, Even Fewer Stay Smoke-Free
  11. Stronger Boots Needed to Kick the Habit
  12. Case Pinpoints Possible Happiness Center in Brain
  13. Worrying May Hamper Psoriasis Treatment: Study

    THURSDAY, JULY 3, 2003

  14. Summer: A Feast -- and Threat -- for the Eyes
  15. A Better Beta Blocker For Heart Failure
  16. Bug Spray Basics
  17. Equine Encephalitis Worries Southeast
  18. Radical Cancer Surgery for High-Risk Women Questioned
  19. West Nile-Infected Blood Donation Found
  20. Endometriosis Linked to Certain Cancers
  21. Study Shows Germs Stay in Urinary Tract
  22. New Understandings of Ovarian Cancer
  23. Body Clock Rings Up Afternoon Nap
  24. MRI Predicts Course of Rheumatoid Arthritis

    WEDNESDAY, JULY 2, 2003

  25. New Proteins Could Aid Cancer, Heart Treatments
  26. Kraft Foods to Make Snacks Healthier
  27. Headache Help
  28. Your Body May Be Worth More Than $45 Million
  29. Sucking Satisfaction
  30. Study Shows in Vitro Children Healthy
  31. Anesthesia May Be Fatal in Those with Rare Disorder
  32. CDC: Pets With Monkeypox Should Be Killed
  33. U.S. Businesses Target Fast-Food Lawsuits
  34. Studies Challenge Breast Cancer Treatment
  35. Drug Lessens Morphine Withdrawal in Mice
  36. Too Much Zinc Ups Prostate Cancer Risk
  37. Millions of Americans Suffer Sports Injuries
  38. Epinephrine Doesn't Work on Very Young
  39. Bicycling Shouldn't Affect Prostate Cancer Test
  40. Hodgkin's Disease Therapy Doesn't Have to Trigger Breast Cancer
  41. Genome Survey Finds Depression Genes
  42. Milk Fat May Protect Against Childhood Asthma

    TUESDAY, JULY 1, 2003

  43. 'Mutated Gene' May Hold Clue to Parkinson's
  44. Study Says Feeding Tubes May Be Overused
  45. Mixed Meds: A Dangerous Prescription for Heart Patients
  46. Great Husband? Thank Your Mother-In-Law
  47. Colon Cancer Screenings Spark Debate
  48. FTC Takes Action Against Three Ephedra Marketers
  49. Panel Seeks to Shield Kids From Dioxins
  50. Obesity Hikes Risk of Acid Reflux, Study Finds
  51. Soy Much Goodness
  52. Schoolkids Choose Unhealthy Lunches, Study Finds
  53. Ivy Itch

    MONDAY, JUNE 30, 2003

  54. Pre-Diabetic Condition More Common in Obese Girls
  55. Why Stress Strains Health of Elderly Caregivers
  56. Eating Disorders Among Hispanic Women Up
  57. Power Bars, Power Calories
  58. Gene Therapy Uses Virus, Shows Promise
  59. U.S. Panel on Fence About Supplements
  60. Implant Saves Kids' Legs From Bone Cancer
  61. Mental Tasks Distract Drivers
  62. Panel Recommends 12 Steps for Cutting Cancer Deaths
  63. Magnets and Athletes May Not Mix
  64. Extra Stress Stresses Immune System, Too
  65. When Abuse Stops, Depression Eases
  66. Scientists Close in on Mouse Model for HIV

    SUNDAY, JUNE 29, 2003

  67. Acupuncture Helps Children Handle Pain
  68. Heat and Humidity a Deadly Combination
  69. ACL Injuries in the Young Take Extra Time

    SATURDAY, JUNE 28, 2003

  70. Easing Back Pain

FRIDAY, JULY 4, 2003

Sleep Apnea Linked to Bed-Wetting in Kids

By Jacqueline Stenson
Reuters Health
Friday, July 4, 2003

NEW YORK (Reuters Health) - Children who snore may be more likely than their peers to wet the bed, new study findings suggest.

Snoring is a symptom of obstructive sleep apnea, a sleep disorder that causes people to temporarily stop breathing many times a night and appears to also promote bed-wetting in children, said Dr. Lee J. Brooks, a clinical associate professor of pediatrics at the University of Pennsylvania in Philadelphia.

In a study of 160 kids ages 4 to 17 who were referred to a sleep-disorders clinic for suspected breathing problems at night, 66 children (41 percent) were also bed-wetters.

Breathing assessments conducted while the children slept at the clinic showed that 47 percent of those who experienced more than one breathing pause per hour of sleep had a bed-wetting problem, compared with 27 percent of those who had no breathing disturbances per hour, or just one.

Previous sleep research has indicated that one breathing disturbance per hour is the "upper limit of normal" in children, the study authors note in their report, published in a recent issue of The Journal of Pediatrics.

The findings show that "children with sleep apnea are at greater risk for nocturnal enuresis (bed-wetting) than children without sleep apnea," Brooks said.

About 10 percent of kids snore, he said, and 10 percent of those who snore have sleep apnea.

Bed-wetting is so common among preschool children, it is not considered a concern. By school-age, it becomes much less prevalent, with about five percent of 7 year olds still repeatedly wetting the bed. Most children "outgrow" the problem without treatment.

The reasons for chronic bed-wetting in school-age children are not fully clear.

According to Brooks, children with sleep apnea may wet the bed because they do not get restful sleep and therefore have a decreased arousal response that prevents them from awakening when their bladders are full.

Other possibilities are that the disordered breathing puts excess pressure on the bladder or maybe even leads to increased urine production, he said.

Dealing with the sleep apnea might also help remedy bed-wetting, according to Brooks.

Treatments include surgery to remove enlarged tonsils and adenoids, he said, as well as wearing a pressurized mask at night that keeps the throat from closing off and obstructing breathing.

Source: The Journal of Pediatrics 2003;142:515-518.

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Some Smokers Cut Down Before Quitting

By Charnicia E. Huggins
Reuters Health
Friday, July 4, 2003

NEW YORK (Reuters Health) - Rather than abruptly kicking the habit, many smokers seem to prefer a step-down approach -- first cutting down to fewer than five cigarettes each day and then quitting altogether, study findings suggest.

"Many established smokers are trying to cut down their cigarette consumption, and a number are able to," study author Shu-Hong Zhu, of the University of California in San Diego, told Reuters Health.

"If established smokers cut down to five or fewer cigarettes per day, they significantly increase their chances of quitting entirely in the future," the researcher added.

Five cigarettes per day is a "unique cut-off point," Zhu and colleagues note in the journal Health Psychology. At this low level of smoking, people are no longer dependent on nicotine, according to the researchers.

As far as cancer prevention, however, the meaning of the findings is still uncertain, Zhu said.

"It's clear that cutting down to five or fewer cigarettes per day, if it leads to quitting entirely in the future, is a positive step toward preventing lung cancer," Zhu said. "But we have no data showing that there is any cancer-prevention benefit to cutting down without quitting entirely."

It is also not known whether people who smoke only a few cigarettes per day are able to maintain that low level of smoking.

To answer that question, Zhu and colleagues examined the stability of low-rate smokers in comparison to people who smoked more cigarettes on a regular basis.

Their findings are based on three California surveys, all of which were conducted between 1990 and 1996 and involved up to 25,500 people each. The researchers targeted their study to data from people who were at least 25 years old and reported smoking for a minimum of five years.

Overall, most (82 percent) of the self-identified regular smokers and many (44 percent) of the occasional smokers reported that they were still smoking regularly or occasionally 20 months after the initial survey.

The low-rate smokers, however, were less likely to say they had maintained their smoking habit.

Only 36 percent of adults who initially reported smoking fewer than five cigarettes per day said they had maintained that smoking habit nearly two years later. Twenty-one percent said they had increased their cigarette smoking, but 37 percent had quit smoking by follow-up, the report indicates. Six percent had become occasional smokers.

In fact, people who said they puffed on just a few cigarettes each day were three times as likely to have quit smoking by follow-up than those who smoked more cigarettes each day, the researchers note.

They add that "tobacco control efforts that increase the proportion of low-rate smokers among current smokers will lead to a higher cessation rate in the population."

Source: Health Psychology 2003;22:245-252.

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Diabetes More Common in Snorers, Problem Sleepers

Reuters Health
Friday, July 4, 2003

NEW YORK (Reuters Health) - New research shows that a pre-diabetic condition and full-fledged diabetes occur more frequently in people who snore or who have a sleep disorder called sleep apnea.

Sleep apnea is associated with a higher-than-average risk of cardiovascular disease, and these findings suggest that the relatively high prevalence of diabetes and a pre-diabetic condition known as insulin resistance among people with the sleep disorder may be to blame.

Obstructive sleep apnea, the most common form of sleep apnea, is caused by a collapse of tissues in the throat during sleep, leading to numerous, brief interruptions in breathing.

The condition has been linked to high blood pressure and increased risks of heart attack and stroke, and is more common among overweight and obese individuals.

Besides loud, heavy snoring, symptoms of sleep-disordered breathing include daytime sleepiness, morning headaches and energy loss.

During the current study, reported in the European Respiratory Journal, Dr. Nicole Meslier of the University Hospital in Angers, France, and colleagues tested 595 men suspected of having obstructive sleep apnea to determine whether they, in fact, had the disorder.

The researchers then performed additional tests to see whether participants had insulin resistance or full-blown type 2 diabetes -- the most common form of diabetes, often associated with obesity.

In insulin resistance a person loses his or her ability to use this key blood-sugar-regulating hormone effectively.

A total of 494 men suspected of having sleep apnea did have the condition, while another 101 men were simply diagnosed as snorers. Among men with sleep apnea, 30 percent were diagnosed with type 2 diabetes, and 20 percent showed signs of being resistant to insulin.

Among the snorers, 14 percent had type 2 diabetes, and another 14 percent were resistant to insulin.

In France, where the study was conducted, only four to nine percent of adults between ages 45 and 74 are diagnosed with type 2 diabetes, according to the report.

Insulin resistance "may contribute to the cardiovascular morbidity and mortality associated with obstructive sleep apnea syndrome," the authors write.

Source: European Respiratory Journal 2003;22:1-5.

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Different Sun Rays, Different Damage

HealthDayNews
Friday, July 4, 2003

FRIDAY, July 4 (HealthDayNews) -- The summer sun produces different kinds of rays -- two of which can cause severe skin damage and even skin cancer.

According to University Health Services at the University of California, Berkeley, the most dangerous kind of exposure comes from UVB rays, which have shorter wavelengths and are primarily responsible for sunburn. Repeated exposure to UVB over a lifetime can alter the immune system and can lead to melanoma and basal and squamous cell carcinoma, three forms of skin cancer.

UVB primarily affects the skin's outer layers and tend to be more intense during the summer month, at higher altitudes, and as you get closer to the equator.

Less harmful are UVA rays, which are longer-wavelength rays that can damage the skin's connective tissue, leading to premature aging as well as playing a role in causing skin cancer.

UVA rays, the type used in tanning salons, also increase the risk of cataracts and retinal damage. Although experts still believe UVB is responsible for much of the skin damage caused by sunlight -- especially sunburn -- UVA may be an important factor in other types of sun damage, including photo aging and the development of skin cancers.

Most sunscreens do a good job blocking UVB but are less effective against UVA wavelengths, which may also contribute to skin cancer.

With approximately 65 percent of melanomas and 90 percent of basal and squamous cell skin cancers attributed to UV exposure, scientists must still figure out how best to formulate sunscreens to provide effective protection against both UV wavelengths.

More information

Shedding more light on the topic is the American Cancer Society.

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'Pre-Diabetes' May Raise Risk of Dying from Cancer

By Natalie Engler
Reuters Health
Friday, July 4, 2003

NEW YORK (Reuters Health) - Previous studies have shown that people who have difficulty processing blood sugar are at risk of diabetes and heart disease. Now new research suggests they may also be at increased risk of dying from cancer.

The blood-sugar condition, known as impaired glucose tolerance, is closely tied to excess weight and lack of exercise.

And for the estimated 15 percent of U.S. adults older than 40 who have it, the new study provides yet another reason to modify a sedentary lifestyle, lead author Dr. Sharon H. Saydah told Reuters Health.

"The finding may also explain why overweight people are more likely to develop cancer, especially colon cancer," said Saydah, who was a researcher at the Johns Hopkins Bloomberg School of Public Health in Baltimore at the time of the study.

In a study of more than 3,000 adults, she and her colleagues found that people with impaired glucose tolerance were nearly twice as likely to die from any type of cancer than were those with normal blood sugar levels. Their risk of dying from colon cancer, specifically, was more than quadruple that of those without impaired glucose tolerance.

Impaired glucose tolerance is marked by elevated blood sugar levels as a result of resistance to insulin, a hormone that helps convert sugar from food into energy for the body's cells. Because it often precedes type 2 diabetes, it is also called pre-diabetes.

Current recommendations suggest that everyone older than 50 receive regular colon cancer screenings, noted Saydah, who will join the Centers for Disease Control and Prevention (news - web sites) (CDC) in July. But this new study suggests that people with pre-diabetes should undergo such screening routinely, regardless of their age.

The findings are based on a nationwide sample of 3,054 adults ages 30 to 74 who were followed between 1976 and 1980.

After adjusting for age, sex and other factors associated with cancer risk, "abnormal glucose tolerance remained strongly associated with cancer mortality," the researchers report in the American Journal of Epidemiology.

The reason for the linkage is unclear. Previous studies have suggested that having too much insulin in the blood may promote cancer production, since insulin has been shown to stimulate cell growth, especially in cells that line the colon.

However, people with actual diabetes -- diagnosed or not -- were no more likely to die of cancer than were people with normal blood sugar levels. Again, the reasons are uncertain, but Saydah offered several possible explanations.

"As a person moves from normal glucose tolerance to impaired glucose tolerance to diabetes, their insulin levels increase rapidly and then gradually decline," she said. This decline "may slow the cancer growth since there is not as much insulin or associated growth factors available for the cells."

Another potential reason, Saydah pointed out, is that given that cardiovascular disease is the leading cause of death among people with diabetes, it may be that people with diabetes have undiagnosed cancer and are simply dying from cardiovascular disease first.

Offering yet a third possibility, Saydah said that diabetes might offer some type of protective effect.

"The theory behind this is that the blood vessels of individuals with diabetes are stiffer ... possibly making it more difficult for cancer cells to spread throughout the body," she explained. "If the cancer stays more localized it may be easier to treat and less likely to cause death."

She points out, however, that this observation is based on just a few patients and "other potential factors have not been fully considered."

Source: American Journal of Epidemiology 2003;157:1092-1100.

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Vegetarian Alert

HealthDayNews
Friday, July 4, 2003

(HealthDayNews) -- Vegetarian diets are often touted as healthier alternatives to meat and fish diets. However, vegetarians can risk low iron levels unless they make a conscious effort to seek out good sources of iron.

The University of Toronto Health Service suggests these iron-rich foods:

  • tofu
  • lentils
  • chick peas
  • beans
  • nuts
  • grains and cereals
  • green leafy vegetables
  • seaweeds
  • dried fruit

Also note that some products like the tannins in teas -- not in herbal teas -- can decrease the body's iron absorption.

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Sniffing, Snorting Drugs May Raise Hepatitis C Risk

By Theresa Waldron
Reuters Health
Friday, July 4, 2003

NEW YORK (Reuters Health) - People who snort or sniff heroin in combination with cocaine may be at increased risk of developing the liver infection hepatitis C, according to a new study.

But transmission of the hepatitis C virus (HCV) could be easily prevented if people simply did not share implements used to sniff or snort drugs, experts said.

"The study suggests that sniffing or snorting heroin with cocaine is a risk factor for HCV infection," lead author Dr. Beryl A. Koblin of the New York Blood Center told Reuters Health.

"Further study is necessary to clarify the role of heroin and cocaine use in (the) acquisition and transmission of HCV infection," Koblin said.

Dr. Thomas Kresina, a spokesman for the National Institute on Drug Abuse in Bethesda, Maryland, which funded the study, said in an interview that any of the drugs might actually cause bleeding in the nose. HCV can be transmitted when objects such as straws used to sniff or snort drugs are shared.

"Obviously, the more drugs you put in intranasally, the more you're going to irritate your (nasal) vascular wall, and that's going to result in a little bleeding in the nose," he explained.

"Then that blood goes on the instrument you use (to sniff or snort), and you transfer that to the next person. That's where the risk occurs."

Kresina added that no matter what drug a person sniffs or snorts, the practice will irritate the capillaries in the nose.

He said many people sniff or snort drugs because they are trying to avoid acquiring HCV and other viruses, such as HIV (news - web sites), that can be transmitted by syringes. But when implements are shared to sniff or snort drugs, there is still a risk of acquiring HCV.

"Any time you have bodily fluids being transmitted, you have a risk of transmission of hepatitis C," Kresina said, adding that "the prevention message here is not to share" drug instruments.

It's already known that HCV can be transmitted through injecting illegal drugs when syringes are shared. The virus can also be transmitted sexually, although it is spread mainly through contact with infected blood. Until the blood supply started to be routinely screened for HCV in the mid-1990s, people could acquire HCV from a blood transfusion.

Up to 80 percent of people infected with HCV have no signs or symptoms. However, HCV eventually leads to chronic liver disease in about 70 percent of infected people, and it is the most common reason for liver transplants, according to the CDC.

In the study of 276 people who had ever smoked crack or who sniffed or snorted cocaine or heroin, 4.7 percent were infected with HCV.

Participants who sniffed or snorted heroin and cocaine together were most likely to be infected with HCV. The reason for the increased risk of HCV infection among those participants may be related to the damaging effects of the drugs on the delicate nasal mucosal lining.

Kresina noted that there is a difference between sniffing and snorting drugs. Sniffing involves inhaling a drug into the lower part of the nostril, while snorting sucks the drug into the upper part of the nostril. Usually, straws or rolled up dollar bills are used to snort drugs.

Source: Journal of Medical Virology 2003;70:387-390.

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The Bugs of Summer

By Janice Billingsley
HealthDay Reporter
HealthDayNews
Friday, July 4, 2003

FRIDAY, July 4 (HealthDayNews) -- Ah, the sounds of summer: steaks sizzling on the grill, soda cans popping open, laughter at the pool -- and the loud smacks of hands slapping arms, legs and necks, trying to kill the insects that are a seasonal scourge.

Mosquitoes, bees, yellow jackets and, in the south and west, fire ants are all out enjoying the summer, along with the rest of the nation.

For most people, bug bites and stings are more an annoyance than anything else, causing swelling or itchy rashes at the site of the infection. And simple precautions such as repellents, bug zappers and long-sleeved tops and pants can cut your chances of serving as an unwitting snack, according to the American College of Allergy, Asthma and Immunology (ACAAI).

"Don't look like a flower, smell like a flower or act like a flower," says Dr. Richard D. deShazo, director of the Division of Allergy at the University of Mississippi Medical Center in Jackson. "Bees are attracted to flowers and they'll be attracted to you if you dress in bright colors, wear strong perfumes and walk barefoot in the clover that bees like."

Around the house, the ACAAI recommends keeping window and door screens in good repair, and making sure garbage cans stored outside have tight lids.

For picnics, keep the food covered and avoid drinking from soda cans because stinging insects are attracted to the sweetness and may crawl inside.

"Don't swat at yellow jackets," deShazo adds. "It makes them angry and more likely to sting."

Most people will weather their stings and bites with few ill effects. But an estimated 2 million Americans are allergic to various insects, and are prone to potentially serious health problems.

The key, says deShazo, is to recognize the difference between a local reaction to a bite or sting, which is what happens to most people, and a systemic response, which means the whole body is reacting.

Symptoms of a systemic response can include generalized itching, hives all over the body, shortness of breath, difficulty swallowing, and a sudden drop in blood pressure. In severe cases, loss of consciousness or cardiac arrest can occur.

Get help immediately if any of these symptoms are present, deShazo says.

"In 75 percent of the cases, these symptoms occur within 20 minutes of the bite or sting," he says. "And once these reactions get rolling, they are difficult to control."

While the majority of allergic reactions aren't severe, about 40 to 50 Americans die each year from untreated bites and stings, deShazo says.

It's important that people allergic to insects take advantage of the medical options available to prevent illness.

Allergy shots are 97 percent effective in protecting people from severe reactions to stings and bites. And everyone who is allergic should always carry an emergency kit containing epinephrine (adrenaline), which can be injected immediately to stop allergic reactions, deShazo says.

More information

The West Virginia University Extension Service has a thorough rundown on bees and bee stings. For tips on avoiding mosquito bites, check with the U.S. Centers for Disease Control and Prevention.

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Study: Gum Disease Raises Death Risk in Diabetics

By Jacqueline Stenson
Reuters Health
Friday, July 4, 2003

NEW YORK (Reuters Health) - Severe gum disease may hasten death in people with diabetes, new study findings suggest.

"Diabetic people with periodontal disease had increased death rates due to cardiovascular disease and renal (kidney) failure, which are two major complications of type 2 diabetes," said study author Dr. William C. Knowler.

The findings underscore the need for good oral hygiene in diabetics (news - web sites), who are particularly prone to periodontitis, or gum disease, Knowler said in an interview with Reuters Health.

Gum disease, characterized by red, swollen gums, is caused by a bacterial infection. And studies have indicated that infections and inflammation can promote blood-vessel damage in the heart and kidneys, said Knowler, chief of the diabetes and arthritis epidemiology section of the National Institute of Diabetes and Digestive and Kidney Diseases in Phoenix.

While gum disease might not be diagnosed until mid-life or later, infection with the bacteria that cause it can occur decades earlier. Combined with years of inadequate oral hygiene, infection can result in gingivitis, an early form of gum disease characterized by inflamed gums that often bleed easily. This form of the disease can usually be reversed with more careful brushing and flossing.

But as the more aggressive periodontitis develops, the gums and bone surrounding the teeth can become seriously damaged, and teeth may loosen or fall out.

The new study involved 549 Pima Indians ages 45 or older with type 2 diabetes, the most common form of the disease. At the beginning of the study, the prevalence of severe gum disease, marked by the loss of bone and often teeth, was roughly 60 percent.

During a follow-up period of about 10 years, 172 participants died of natural causes, according to findings presented at a recent meeting of the American Diabetes Association in New Orleans.

Overall, the rate of death from natural causes was 42 per 1,000 people per year among participants with severe gum disease, compared with 26.6 per 1,000 people per year among those who did not.

The extra deaths among those with severe gum disease were due to heart disease and diabetic nephropathy, and not to other causes such as cancer or liver disease, Knowler and colleagues concluded.

Diabetic nephropathy is a condition in which diabetes damages the kidneys, which then progressively lose their ability to function normally and eventually fail.

After adjusting for factors such as age, sex, duration of diabetes, obesity and cholesterol levels, the researchers found that diabetics with severe gum disease were twice as likely as those without it to die from either heart disease or kidney failure.

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Very Few Quit Smoking, Even Fewer Stay Smoke-Free

By Alison McCook
Reuters Health
Friday, July 4, 2003

NEW YORK (Reuters Health) - Around one-half of people who manage to stop smoking for one year after using nicotine patches eventually start smoking again, researchers said Friday.

As part of the new report, the investigators revisited a group of people who had tried to quit smoking eight years prior during a study of the benefits of nicotine replacement therapy.

In the original study, only nine percent of people were able to stop smoking for one year. And the UK investigators discovered that around one-half had begun lighting up once again during the following eight years.

As a result, only five percent of the people who participated in the original study succeeded in butting out for good, the researchers write in the British Medical Journal.

These findings reinforce the idea that smoking is a habit that is extremely hard to give up, study author Patricia Yudkin of the Institute of Health Sciences in Oxford told Reuters Health.

"As would be expected from the way it works, (nicotine replacement therapy) is helpful in breaking the addiction cycle, but it cannot substitute for all the pleasures associated with smoking," Yudkin said.

She noted that nicotine replacement therapy, including patches, can help people quit, but some people are more successful than others. For instance, smokers who are older, have social support and are less addicted to cigarettes typically find it easier to stop using nicotine replacement therapy, Yudkin said.

These results suggest that the most effective quitting techniques may be those that take an individual's needs and personality into account, she noted.

"We need to tailor treatments to the individual, and realize that different people will respond to different types of therapy," she said.

The current findings are based on follow-up data from 1,686 smokers who had participated in a 1991-1992 study, in which they helped investigate how well 12 weeks of nicotine replacement therapy helps people quit. All original participants were between 25 and 64, and reported smoking at least 15 cigarettes each day.

Half of the participants wore a nicotine patch, which delivers the addictive ingredient in cigarettes continuously through the skin, producing roughly the same steady level of nicotine present in the blood of a smoker. The other half wore an inactive, or placebo, patch.

Only 153, or nine percent, of all participants -- including those using the placebo patch -- had butted out for at least one year during the original study.

Eight years later, Yudkin and her colleagues re-contacted the same group of people, and found that only 83 of the first group of quitters had stayed smoke-free, demonstrating that 46 percent of people who quit smoking for one year will start again within the next few years.

Despite the somewhat discouraging news, Yudkin said the results also demonstrate that many people can stop smoking for good, for half of the people who stopped smoking originally had not started again for eight years. "We can assume that these people have stopped permanently," she said.

Source: British Medical Journal 2003;327:28-29.

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Stronger Boots Needed to Kick the Habit

HealthDayNews
Friday, July 4, 2003

FRIDAY, July 4 (HealthDayNews) -- More effective methods need to be developed to help people quit smoking, concludes new research.

The researchers checked the smoking cessation success of a group of people eight years after they took part in a nicotine patch trial in 1991-92.

It found more than half the people who quit smoking for a year during the nicotine patch study were still not smoking eight years later. But those successful quitters represented only 5 percent of all the people who took part in the nicotine patch trial.

The original trial included 1,625 people who smoked at least 15 cigarettes a day and 840 of them completed a follow-up questionnaire about their smoking in 1999-2000. The researchers assumed those who didn't respond to the follow-up were still smoking.

The study, in the July 5 issue of the British Medical Journal, found that of the 153 people who stopped smoking for a year in the nicotine patch trial, 83 were still not smoking. The nicotine patch increased the odds of quitting for eight years by 39 percent, but the researchers say that figure is not statistically significant.

Of the 1,472 people who did not quit smoking during the original nicotine patch trial, 89 said they had not smoked for a year or more when they filled out the follow-up questionnaire.

Overall, the follow-up study found that 11 percent of the original trial participants had not smoked for a year or more, 2 percent had quit for less than a year, and 88 percent were still smoking.

More information

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

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Case Pinpoints Possible Happiness Center in Brain

By Alison McCook
Reuters Health
Friday, July 4, 2003

NEW YORK (Reuters Health) - Researchers found the tickle spot on one epileptic woman's brain when they realized that stimulating a specific brain region caused her to feel happy and laugh.

The finding strongly suggests that, at least in this woman, laughter and "mirth" are linked to this zone of the brain, the authors note.

The brain region, known as the inferior temporal gyrus, has also been linked to language and memory, study author Takeshi Satow, of the Kyoto University Graduate School of Medicine in Japan, told Reuters Health.

The researchers made their discovery in a 24-year-old woman who was about to undergo surgery to help control her epileptic seizures.

Before surgery, Satow and colleagues applied electric stimulation to the surface of her brain to determine the "functional areas" of that layer, which should be avoided during surgery.

When they applied a slight amount of stimulation for one second to the woman's inferior temporal gyrus, the patient reported feelings of "mirth." At the same time, she said a melody she remembered from childhood popped into her head.

The longer the investigators applied the stimulation, the longer she felt happy. And after five seconds of stimulation, she smiled.

The case report appears in the Journal of Neurology, Neurosurgery & Psychiatry.

Explaining why the childhood melody accompanied the woman's happy feelings, Satow speculated that stimulating that brain region simultaneously elicited pleasant memories -- in this case, a favored childhood song.

When the researchers applied stronger stimulation to the inferior temporal gyrus, the woman's feelings of happiness progressed to laughter. However, when the authors asked her to read sentences aloud while applying the stimulation, she did not laugh "because she paid strong attention to the task itself," Satow said.

Satow added that previous research has linked laughter to other regions of the brain, which suggests that applying stimulation to one region -- such as the inferior temporal gyrus -- ends up stimulating other brain sites as well.

"Several different (brain) areas can be responsible for mirth and laughter, independently," Satow said.

Source: Journal of Neurology, Neurosurgery & Psychiatry 2003.

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Worrying May Hamper Psoriasis Treatment: Study

Reuters Health
Friday, July 4, 2003

NEW YORK (Reuters Health) - Psoriasis patients who worry excessively may experience a slower response to light therapy treatment, new study findings suggest.

Psoriasis is a sometimes-painful skin disorder thought to be caused by an abnormal immune response. The disease is marked by patches of red, raised skin covered with silvery scales, and affects about two percent of the world's population.

In the study, Dr. Donal G. Fortune of the University of Manchester in the UK and colleagues assessed psychological distress and disease severity among a group of 112 patients undergoing light therapy for psoriasis.

The findings are published in a recent issue of the journal Archives of Dermatology (news - web sites).

During the treatment, known as PUVA, patients are given the photosensitizing drug psoralen and exposed to ultraviolet A light.

Patients who were classified as "high-level" worriers took about twice as long to get an improvement in symptoms as those who were "low-level" worriers, the authors report.

Excessive worrying has a "significant and detrimental" effect on treatment outcome in patients with psoriasis, they conclude.

As a result, Fortune's team suggests that patients seeking psoriasis treatment who tend to worry a lot may benefit from psychological therapy.

In another psoriasis study, published in the same journal, an international team of researchers reported that a drug that blocks the effects of certain immune system cells may be a safe and effective treatment for the chronic skin condition.

"We now have a therapy that is quite effective and safer than some of the other treatments available for psoriasis," said lead author Dr. Mark Lebwohl of the Mount Sinai School of Medicine in New York City.

The new drug, alefacept, is made by Biogen Inc., which funded the study. The drug was approved by U.S. regulators in January as the first biologic agent to combat psoriasis.

The authors have served as investigators for Biogen, and Lebwohl is a consultant for the company.

Mild cases of psoriasis can be treated with topical medication, but more serious cases, in which lesions cover more than 10 percent of the body, require treatment with ultraviolet radiation or immunosuppressive drugs. These therapies cannot be used over the long term, however, due to an increased risk of cancer.

Alefacept binds to immune system cells called T lymphocytes and prevents their activation. Studies have shown that these cells play an important role in causing the skin abnormalities, or lesions, that are characteristic of psoriasis.

The study included 507 adults with a common form of psoriasis.

Drugs were administered by injection into the thigh once a week for 12 weeks and patients were monitored for an additional 12 weeks after treatment. The participants received either 15 milligrams (mg) or 10 mg of alefacept or a placebo.

Psoriasis severity was reduced a maximum of 46 percent, 41 percent and 25 percent for the 15 mg, 10 mg and placebo groups, respectively. Symptom improvement remained even twelve weeks after treatment ended, the authors add.

Three months of treatment provide about seven months of remission, Lebwohl told Reuters Health.

The drug did not cause any serious side effects, he noted.

The current findings show that a shot of alefacept in the thigh is effective and that the drug provides patients with "a duration of remission that exceeds most treatments we have," said Lebwohl.

"Since treatment with alefacept clears disease in only about one third of patients and its onset of action is slow, it will be important to study the efficacy, time until onset of clearance and safety of alefacept in combination" with other drugs, Dr. Alice Gottlieb of the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School in New Brunswick writes in an accompanying editorial.

Gottlieb is an investigator, consultant or speaker for several companies, including Biogen, Amgen, Wyeth, Novartis, Centocor Inc., Genentech Inc. and Xoma Corp.

Source: Archives of Dermatology 2003;139:719-727,752-756,791-793.

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THURSDAY, JULY 3, 2003

Summer: A Feast -- and Threat -- for the Eyes

Dennis Thompson Jr.
HealthDay Reporter
HealthDayNews
Thursday, July 3, 2003

THURDAY, July 3 (HealthDayNews) -- Summer's the season of long, sunny days, tall, cool drinks -- and eye injuries.

An estimated 2.4 million eye injuries occur in the United States each year, with the bulk of them coming during summer. As a result, nearly 1 million Americans have permanent visual impairment, and more than 75 percent of these people are blind in one eye, according to the U.S. Eye Injury Registry.

July has been designated Eye Injury Prevention Month by the American Academy of Ophthalmology. So, as you work, play, clean or simply savor the sun, take precautions to protect your eyes.

Sunglasses are the most important tool in your eye-protection arsenal, says Betsy van Die, media relations director for Prevent Blindness America.

"They don't have to cost a fortune, but the important thing is that they are marked to block UV rays," van Die says.

Ultraviolet rays can cause sunburned corneas, cancer of the eyelid and increased risk of eye diseases such as cataracts and macular degeneration, she says.

The rays also can cause pterygium, a benign tissue growth that begins in the white of the eye but can extend into the cornea.

"When that happens, vision can become blocked and surgery is then necessary," says van Die, noting that tennis player Jennifer Capriati had surgery on both eyes for pterygium last fall.

For the best protection, you should wear sunglasses that block 99 percent to 100 percent of UV radiation. When buying sunglasses, look for a sticker on them that offers that measure of safety. Don't buy sunglasses that just say they "block harmful UV," van Die says.

"Everybody is at risk [of UV damage]," adds van Die, "whether it's a child or an adult. Anybody who spends time in the sun and exposes their eyes to the sun without wearing sunglasses or a hat is at risk."

If you don't like sunglasses, hats aren't a bad alternative. "Wide-brimmed hats by themselves will give some protection from UV rays," she says.

Summer's also the season when handymen and women really get to strut their stuff. But doctors urge the use of safety glasses, tight-fitting goggles or a face mask to ensure you don't suffer serious damage.

Goggles or safety glasses should be used whenever you're working with power equipment to do yard work. You also should be sure that anyone who's nearby when you operate a lawnmower, power trimmer or edger is similarly equipped.

"If kids are watching you, they should also wear goggles even if they're not doing any work," van Die says. "Even sunglasses are better than nothing at all, because they will prevent things from flying up into your eyes."

To further reduce your chances of injury, always check for stones, twigs or other debris before using yard equipment. They can become dangerous projectiles after shooting out of a lawnmower's blades or off a weed trimmer's cord.

Goggles also should be worn when using household chemicals, many of which can burn the eye's delicate tissues. These include cleaning solutions, pool chemicals or garden sprays. Similar precautions should be taken when jump-starting a car -- battery acid, sparks or debris flying from a damaged auto battery can cause severe damage.

Dr. Ron Danis, a professor of ophthalmology at Indiana University, also recommends that you -- and your children -- consider wearing protective gear when playing summer sports.

Baseball and softball games result in a surprising amount of eye damage, Danis says, noting that every one in 20 serious eye injuries are related to the two sports.

"There are so many kids playing ball over the summer that if you look at the numbers, they add up," Danis says.

The batter is most at risk for injury, he says. Batters already wear a protective helmet, but Danis thinks an extra step could further trim the chance of eye injury.

"I strongly endorse the use of a face plate on the helmet, which is a minor modification of equipment they have to wear anyway," Danis says.

Paintball is another summertime pastime that has been linked to an increasing number of eye injuries, Danis says.

Back in the early 1990s, when paintball equipment was expensive and not easily obtainable, it "wasn't even on our radar," Danis says. The guns, which shoot high-velocity paint capsules, were used only in well-supervised paintball courses, which required people to wear protective gear and goggles.

Now, more people are buying paintball guns for home use, and the number of eye injuries is rising, he says.

"In the backyard situation, everyone's Rambo and thinks they're immortal," Danis says.

The same goes for BB and pellet guns, which continue to be a factor in 5 percent to 6 percent of accidental eye injuries, Danis says. "Most of these injuries are, of course, in children, and most involve a person who didn't shoot the gun," he says.

Eyewear approved by the American National Standard Practice for Occupational and Educational Eye and Face Protection provides the best defense. Look for the "ANSI Z87" mark on the frames or lenses. Goggles approved by the American Society for Testing and Materials also provide good eye protection for people playing sports.

More information

For more on eye injuries and eye safety, visit Prevent Blindness America, or the National Library of Medicine.

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A Better Beta Blocker For Heart Failure

By Ed Edelson
HealthDay Reporter
HealthDayNews
Thursday, July 3, 2003

THURSDAY, July 3 (HealthDayNews) -- A newer member of the beta blocker drug family saves more lives of patients with heart failure than an older version does, a major European study finds.

In the study, which enlisted more than 3,000 heart failure patients in seven countries, the death rate over a five-year period for patients given the newer drug, carvedilol, was 5.7 percent lower than for those treated with an older beta blocker, metoprolol, says a report in the July 5 issue of The Lancet.

Extrapolating from the study results, the researchers estimate that patients on carvedilol survived for an average of eight years, compared to 6.6 years for those on metoprolol, the report says. There was no difference in the incidence of side effects, which was low.

The report not only solidifies the value of beta blocker treatment for heart failure, in which the heart gradually loses its ability to pump blood, but also "suggests that carvedilol may be a superior drug," says Dr. Richard A. Stein, associate chairman of medicine at Beth Israel Hospital in New York City and a spokesman for the American Heart Association (news - web sites).

"It is now clear that beta blockers are now the standard of treatment for heart failure in which the ventricle does not have an adequate ejection fraction," Stein says.

The left ventricle is the chamber of the heart that pumps blood to the body, and the ejection fraction is the amount of blood it can pump. An estimated 5 million Americans have heart failure, and about 60 percent have this form of the condition. More than 550,000 new cases are diagnosed each year, the American Heart Association estimates, and heart failure plays a role in some 260,000 deaths a year.

Stein's slight note of caution about carvedilol reflects lingering medical conservatism. He says he uses the drug regularly to treat heart failure in his practice, in a standard combination drug treatment that can include a diuretic, an ACE inhibitor and digitalis.

Beta blockers have emerged as a treatment for heart failure only in the last few years, a development that took many cardiologists by surprise. The condition has traditionally been treated with drugs that stimulate the activity of the heart, while beta blockers slow the heart rate.

"It's counter-intuitive," Stein says, but several studies have shown that starting with a low dose of a beta blocker and gradually increasing it can help keep patients alive.

Cost is a potential issue. Carvedilol, marketed as Coreg, is expensive compared to metoprolol, often sold as Toprol-XL, which is available as a generic. But the extra money is worth it, Stein says.

"A typical heart failure patient will have 1.8 hospital admissions a year, and the average cost of an admission is $20,000," he says. "If you can reduce the number of admissions, the cost of the drug is beside the point."

So far, no medical insurance plan has objected to the use of carvedilol, he adds.

Another report by British researchers in the same issue of the journal suggests carvedilol works by activating heart muscles that are healthy but "hibernating."

More information

You can learn about heart failure from the American Heart Association or the Texas Heart Institute.

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Bug Spray Basics

HealthDayNews
Thursday, July 3, 2003

(HealthDayNews) -- The emergence of West Nile virus (news - web sites) means that infected mosquitoes may leave behind more than an itchy skin bump. Applying insect repellant before you head outdoors can help keep the pests at bay.

The most effective insect repellants contain DEET. A higher percentage of DEET translates into longer lasting -- not necessarily better -- protection.

According the US Centers for Disease Control and Prevention (news - web sites):

  • A product containing 23.8 percent DEET provides an average of five hours of protection.
  • Repellants with 20 percent DEET gives almost four hours of protection.
  • A product with 6.6 percent DEET offers two hours of mosquito defense.
  • Products with 4.75 percent DEET and 2 percent soybean oil provides roughly an hour and a half of protection.

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Equine Encephalitis Worries Southeast

By Daniel Yee
Associated Press Writer
The Associated Press
Thursday, July 3, 2003

ATLANTA - Health officials on alert for the return of West Nile virus (news - web sites) are concerned about the re-emergence of another mosquito-borne disease in the Southeast: eastern equine encephalitis.

A Georgia man died June 21 in the nation's first human case of the disease this year.

Florida, Georgia, North Carolina and South Carolina have seen the highest number of horse cases of eastern equine encephalitis in years. The disease, which has existed in the United States for decades, kills nearly all unvaccinated horses.

"It's kind of going up the coast," said Laurel Garrison, epidemiologist for the Georgia Division of Public Health.

Although it rarely affects people, it can be more deadly than West Nile. Since 1964, there have been only 153 confirmed human cases of the disease.

"Eastern equine encephalitis has been an exceptionally infrequent disease," said Dr. Anthony Marfin of the Centers for Disease Control and Prevention (news - web sites). "If you saw five or six (human) cases a year, that was a big year."

But the virus kills up to 50 percent of people who catch it, compared with up to 15 percent for West Nile.

"It's such a serious disease that we've been sending press releases to warn people against this virus," said Nolan Newton of the North Carolina Department of Environment and Natural Resources. "I see no reason why it shouldn't just keep on going up the East Coast."

Florida has had 99 horse cases in 31 counties this year. The virus was confirmed in 11 Georgia horses and two birds. North Carolina has had four horses test positive and South Carolina 17 horse cases.

Virginia hasn't had any, but officials have sent e-mails warnings across the state. It's been detected in a pair of birds in West Virginia and has been found in Mississippi horses and even emus in Alabama.

"We sort of should have expected it," said Dr. Venaye Reece, equine programs coordinator with Clemson University's livestock and poultry health programs office. "It's a cyclic disease and runs in 10 year cycles."

Concern over West Nile and recently improved detection methods for that virus may have led to better detection of eastern equine encephalitis, Marfin said.

"If you're collecting mosquitoes and are testing them for (West Nile) virus, you might as well test them for St. Louis encephalitis," Marfin said. "It's raised awareness for mosquito-borne viruses everywhere."

Health officials urge people to use similar precautions against eastern equine as they would against West Nile: wearing protective clothing and using insect repellent while outdoors and getting rid of mosquito habitats, such as standing water, around the home. Horses should be vaccinated against both diseases.

On the Net:

www.cdc.gov/ncidod/dvbid/arbor/eeefact.htm

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Radical Cancer Surgery for High-Risk Women Questioned

HealthDayNews
Thursday, July 3, 2003

THURSDAY, July 3 (HealthDayNews) -- While removing breasts and ovaries of women at high risk for breast and ovarian cancers greatly reduces their chances of disease, it's actually unclear exactly how much the radical surgery helps.

That opinion comes in a commentary in the July 2 issue of the Journal of the National Cancer Institute (news - web sites).

The Dutch authors say studies examining the value of prophylactic surgery to prevent breast or ovarian cancer in these women may have overestimated or underestimated the benefits because of potentially unrecognized biases in study design.

Recognizing and understanding these biases may help scientists improve the design of future studies and better evaluate the results of previous studies, the authors say.

Women with certain mutations in the breast and ovarian cancer susceptibility genes BRCA1 and BRCA2 have an increased risk of developing breast and ovarian cancer.

Previous studies found prophylactic bilateral breast removal is associated with an 85 percent to 100 percent reduction in breast cancer (news - web sites) risk. Other studies concluded that surgery to remove the ovaries is associated with a similar risk reduction for ovarian and breast cancer.

But these studies contain a number of potential biases, according to the commentary. These include familial-event bias, survival bias, detection bias, testing bias and confounding by other risk factors for breast and ovarian cancer.

These biases need to given serious consideration and warrant critical discussion about their potential impact on study results.

"Only in this way can BRCA1/2 mutation carriers, clinical geneticists and treating physicians obtain more accurate information about the true extent of cancer risk reduction from prophylactic surgery. This valid estimate of risk reduction may become even more crucial in the future when data become available regarding the efficacy of new surveillance methods, such as magnetic resonance imaging, and new chemoprevention agents, such as raloxifene," the authors write in a news release.

More information

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

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West Nile-Infected Blood Donation Found

The Associated Press
Thursday, July 3, 2003

WASHINGTON - Testing the nation's blood supply for West Nile virus (news - web sites) began just days ago and already has uncovered the first infected donation in Texas letting health workers stop the blood from reaching any patients, the Food and Drug Administration (news - web sites) said Thursday.

The donor was a 46-year-old woman in Harris County, Texas, who was allowed to give blood because she displayed no West Nile symptoms, the FDA said.

While confirmatory testing is still under way, the discovery does signal that "blood is much safer than last year," said Hira Nakhasi, FDA's chief of transfusion-spread diseases.

West Nile virus is spread mostly by infected mosquitoes. But about 13 of last year's record 4,000 West Nile cases are believed to have been caused by a blood transfusion.

Last year, the only way to guard the blood supply was to turn away potential donors with telltale flulike symptoms. But while West Nile can kill it's especially risky for the elderly the majority of people infected have such a mild case they don't experience symptoms.

So blood specialists raced to adapt a technology that detects low levels of other viruses in blood, called nucleic acid testing or NAT, hoping it could find West Nile, too.

On July 1, blood banks began using experimental West Nile NAT tests made by two competitors, Roche Molecular Diagnostics and Chiron Corp., to screen all donations before they're shipped to hospitals.

Thursday, Roche reported the first positive test result.

So far this year the government has counted no people with West Nile symptoms, but has found the virus in mosquitoes and animals in 28 states. Health officials urge that people wear insect repellent while outdoors and regularly dump water in containers, where mosquitoes breed.

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Endometriosis Linked to Certain Cancers

HealthDayNews
Thursday, July 3, 2003

THURSDAY, July 3 (HealthDayNews) -- Women with endometriosis are at increased risk of developing ovarian cancer, non-Hodgkin's lymphoma, endocrine and brain cancers.

So says a Swedish study presented July 2 at the annual meeting of the European Society of Human Reproduction and Embryology in Madrid, Spain.

But researcher Dr. Anna-Sofia Berglund adds women shouldn't be alarmed by the finding because the increased risk is small and involves relatively rare cancers.

The study found endometriosis seems to reduce the risk of cervical cancer in comparison to the general population. It also concluded that women with endometriosis who had a hysterectomy do not have an increased risk of ovarian cancer.

The study looked at 64,492 women discharged from hospital with endometriosis between 1969 and 2000. While there was no overall increased risk of cancer in these women, there was a slightly increased risk of certain kinds of cancer.

The risk of developing ovarian cancer increased by just under half during a lifetime, by about a third for endocrine tumors, by about a quarter for non-Hodgkin's lymphoma, and by about a fifth for brain tumors.

The study also found women who developed endometriosis between the ages of 20 and 40 had a higher risk than other age groups of developing ovarian cancer and that the cancer developed earlier in their lives than in other women in the general population.

Berglund says in a news release that the study does not show that endometriosis causes cancer. The true connection between endometriosis and cancer is not known.

More information

Here's where you can learn more about endometriosis.

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Study Shows Germs Stay in Urinary Tract

By Paul Recer
AP Science Writer
The Associated Press
Thursday, July 3, 2003

WASHINGTON - A germ that causes stubborn urinary tract infections may be resistant to antibiotics because it invades the bladder cells and builds a fort-like colony that is impervious to drugs and attack from the body's own immune system, researchers say.

In a study appearing Friday in the journal Science, scientists at Washington University in St. Louis report using an electron microscope to discover that E. coli bacteria (news - web sites) form a biofilm inside cells of the bladder cells of mice.

This biofilm is composed of bacteria unified into a colony to resist attack, said Dr. Joseph J. Palermo, a Washington University researcher and a co-author of the study.

"The bacteria rest in a matrix like eggs in a carton," said Palermo. He said this is the first time that a biofilm structure has been found within a cell, and the discovery explains why many patients are unable to ever become completely free of urinary tract infections.

"In a biofilm, thousands and thousands of bacteria work together as sort of a multicellular organism," said Gregory G. Anderson, a co-author of the study.

Anderson said the biofilm "is a slimy type of mesh" similar to the slick coating often found on submerged rocks in a stream or pool of water.

Although the study was of mouse bladders, Palermo said the animal is a commonly studied model for urinary tract disease because the tissue, cells and infection response of the rodent bladder are very similar to that of humans.

Dr. Josephine P. Briggs, head of group studying urinary tract disease at the National Institute of Diabetes and Kidney Research, one of the National Institutes of Health (news - web sites), said the discovery of an E. coli biofilm is "very intriguing." She said it explains why some bladder infections are so difficult to control in some patients.

"This study demonstrates this in mice, but there is no reason to think the process is not occurring in people," said Briggs. "That needs to be documented, but it is very likely."

If biofilm formation is confirmed in humans, she said, then it adds a new sense of urgency to the need to develop alternate ways to treat stubborn urinary tract infections.

The Washington University researchers said their studies show that individual E. coli bacteria assume different roles within the biofilm, acting like members of a multi-cell organism. Bacteria on the edge of the biofilm can burst out of the host cell and colonize other cells within the bladder wall.

Because the bacteria are within the cells of the bladder, they often are not detected by routine medical tests, said Palermo.

"When you check a urine sample for the presence of bacteria, all you are looking for are free floating bacteria," he said. "If there are bacteria in the bladder tissue itself, you are not going to pick them up. Having sterile urine doesn't really give you a picture of what the bacteria state of the bladder is. It makes diagnosis more difficult."

Recurring or highly resistant urinary tract infections are a major medical problem, particularly among women. The infections cause frequent and painful urination, fever and can lead to more dangerous kidney infections.

About 8 million urinary tract infections are diagnosed annually, second only to respiratory infections in the United States.

Antibiotics usually knock out the infections, but for many it becomes a problem returning time after time.

On the Net:

Science: www.sciencemag.org

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New Understandings of Ovarian Cancer

By Colette Bouchez
HealthDay Reporter
HealthDayNews
Thursday, July 3, 2003

THURSDAY, July 3 (HealthDayNews) -- There is important news for younger women diagnosed with the most common type of ovarian cancer: Your chances of survival may be much better than older women.

In a new study published in the July issue of Obstetrics and Gynecology, researchers found women under age 45 diagnosed with advanced epithelial ovarian cancer were more than twice as likely to reach the critical five-year survival point than women over 45.

"If all other things being equal, the younger patients still have better survival," says study author Dr. John Chan, now an assistant clinical professor at Stamford University.

In fact, says Chan, even when researchers considered factors that could impact the study outcome, such as other health problems, the younger patients still fared better.

Epithelial ovarian cancer is the most common form of the disease. It develops in the cells on the outer surface of the ovary and accounts for up to 90 percent of all ovarian malignancies.

According to the American Cancer Society (news - web sites), 25,000 new cases of ovarian cancer will be diagnosed this year -- a rate that has been slowly declining since 1991.

While researchers say they aren't certain why younger women fared better, Chan says some possibilities may include "differences in tumor biology (such as hormonal milieu, growth factors, angiogenesis and growth regulators) and immunological response between the younger and older patients."

The study, conducted at the Chao Family Comprehensive Cancer Center of the University of California at Irvine, involved 104 women with advanced epithelial ovarian cancer. Fifty-two were under age 45, and the rest were older.

After examining patient records, the researchers found the five-year survival rate for the older group was 22 percent, with a median survival time of just 34 months. Odds changed significantly for the younger group, however, where the median survival rate was 54 months, with 48 percent reaching the five-year survival point.

What also made a difference: The stage of the cancer (stage III versus stage IV) at diagnosis, and the type of surgery that was performed, which affected survival rates in both groups.

Meanwhile, in another study of ovarian cancer, scientists at Pacific Northwest Research Institute in Seattle report the discovery of a new biomarker for the cancer. That could lead to a new blood test that might allow an earlier diagnosis and a subsequent boost in cure rates.

The biomarker, HE4, is measured in the blood and appears to be associated with the presence of ovarian cancer cells. It's said to be up to 40 percent more sensitive than CA125, the current biomarker used to detect ovarian cancer in blood samples. Tests involving HE4 are also said to have a lower false positive rate, and may be able to predict the cancer at an earlier stage. Currently, CA125 detects later stage cancers and the presence of tumor cells after cancer treatment.

Researchers, publishing their findings in the July issue of Cancer Research, say further testing is necessary before deciding if a clinical blood test based on HE4 will be possible.

More information

To learn more about ovarian cancer, visit The National Ovarian Cancer Coalition. For the latest news on ovarian cancer research, check out the The National Institutes of Health.

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Body Clock Rings Up Afternoon Nap

HealthDayNews
Thursday, July 3, 2003

THURSDAY, July 3 (HealthDayNews) -- Your desire for an afternoon snooze doesn't necessarily mean you're lazy.

You may just be following instructions from your body clock, says an American study in the July 4 issue of Science.

The study of mice found the circadian clock that controls the body's daily rhythms may have two main components. One is for light-controlled rhythms and the other is for sensory-controlled rhythms.

The researchers say their findings indicate the interplay between these components is responsible for daily cycles of sleep and activity and may let mammals be more adaptable to changing environmental conditions.

This interplay may also be responsible for your tendency to become tired at midday, the researchers say.

The study notes it's long been believed the brain's suprachiasmatic nucleus (SCN) houses the body's master clock, which is regulated in part by a protein called CLOCK in response to light-related information delivered from the eyes.

While other parts of the body have their own circadian clocks, the clock in the forebrain is unusual in that it's regulated by a protein called NPAS2 instead of CLOCK.

In this study, the researchers knocked out the NPAS2 gene in a strain of mice. The scientists found these mice were less sensitive to changes in daily light cycles than normal mice. The altered mice were also less able to adapt to a restricted feeding schedule. Normal mice are able to do that by changing the time they eat.

More information

Here's where you can learn more about the biological clock.

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MRI Predicts Course of Rheumatoid Arthritis

By Serena Gordon
HealthDay Reporter
HealthDayNews
Thursday, July 3, 2003

THURSDAY, July 3 (HealthDayNews) -- When patients are first diagnosed with rheumatoid arthritis (RA), it's often difficult for doctors to predict what their future holds: Some will have only mild symptoms, while others will be disabled by the disease.

But a new study now says magnetic resonance imaging (MRI) may predict who will have an aggressive form of RA, letting doctors target the strongest medicines to the patients who really need it.

The six-year study, which appears in the July issue of Arthritis and Rheumatism, found patients who had bone swelling at the start of the project were 6.5 times more likely to have serious joint damage at the end of the study.

"MRI is proving to be a useful tool with which to investigate disease processes in RA," study author Dr. Fiona McQueen, from Auckland Hospital in New Zealand, says in a news release.

Rheumatology experts aren't so sure, however. Both Dr. Robert Quinet, chairman of rheumatology at Ochsner Clinic Foundation in New Orleans, and Dr. Martin Pevzner, chairman of rheumatology at Beaumont Hospital in Royal Oak, Mich., feel MRIs are too expensive to be used as screening tools.

"The problem is MRIs are so expensive, insurance companies often won't cover them," Pevzner says. And Quinet echoes that thought, adding there are other, less expensive tests that can be used to predict what course an individual's RA might take. These include blood tests, X-rays and functional assessment questionnaires.

But, Pevzner concedes, those tests are not "an exact science" and there currently is no "definitive predictor."

Rheumatoid arthritis affects 2.1 million Americans, according to the Arthritis Foundation. Nearly three times as many women as men are affected by the disease. Its symptoms include joint pain, stiffness, swelling and redness, and it usually appears in middle age, but can begin earlier. In some people, rheumatoid arthritis is so severe it actually destroys the bone and cartilage in affected joints.

For this study, McQueen and her colleagues recruited 42 people who were in the early stages of RA. All of the volunteers had an MRI and an X-ray of the wrist in their dominant hand. The tests were repeated at one year and at six years. At the six-year follow-up, only 31 of the original participants were able to be included.

MRI is an imaging technique that uses magnetic field and radio waves to produce precise images of the body; it gives doctors more detailed images than X-rays.

The people who showed signs of bone swelling in the first MRI scan were the most likely to have developed bone erosion by the end of the study.

The study also found MRIs were more effective at picking up bone erosion than X-rays. The first MRIs showed bone erosion in 45 percent of the study participants, compared to only 15 percent found in X-rays.

"There are some innovative aspects to this study," says Quinet, who cites the long follow-up of patients and the way the researchers correlated their MRI findings with X-rays. But he adds, "In terms of its application, I don't think it will have a major impact now. It has potential for the future."

Pevzner agrees, saying, "In the future, it may provide another clue to who needs aggressive treatment."

That's important, he adds, because early intervention helps control the disease and limits its damage.

More information

To learn more about rheumatoid arthritis, visit the Arthritis Foundation. For more on MRI, go to the National Library of Medicine.

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WEDNESDAY, JULY 2, 2003

New Proteins Could Aid Cancer, Heart Treatments

HealthDayNews
Wednesday, July 2, 2003

WEDNESDAY, July 2 (HealthDayNews) -- California cancer researchers have discovered a new class of proteins that spurs the development of blood vessels -- a finding that could aid in the treatment of cancer, heart disease and more.

Newly named as "angiomatrix" proteins, they promote angiogenesis, the process by which the body forms new blood vessels, the researchers say.

A report on their finding, in the July 1 issue of the Journal of Clinical Investigation, describes how one such protein, the Del-1 protein, initiates angiogenesis by locking onto a cell membrane using a previously unknown cell adhesion receptor, the alpha-v-beta-5. It then activates a transcription factor called Hox D3, which initiates a chain of events that changes the cell profile -- and makes it angiogenic.

"In the cancer setting, you want to inhibit angiogenesis," writes lead researcher Judith Varner, an associate adjunct professor of medicine at the University of California, San Diego. "Knowing the mechanism will help us design therapies that can inhibit Del-1."

On the other hand, researchers looking for new ways treat heart disease want to know how to promote angiogenesis.

More information

Here's where you can learn more about genetics.

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Kraft Foods to Make Snacks Healthier

By Brandon Loomis
Associated Press Writer
The Associated Press
Wednesday, July 2, 2003

CHICAGO - Kraft Foods, responsible for such goodies as Oreos, Mallomars and Chips Ahoy cookies, says it plans to fight obesity by changing its recipes, reducing portions and encouraging healthier lifestyles.

The nation's biggest food manufacturer also will eliminate promotions in schools, including posters and free samples. Its snacks will still be stocked in school vending machines.

"We're making these commitments first and foremost because we think it's the right thing to do," said Michael Mudd, a spokesman for the company, based in Northfield, Ill.

Kraft said Tuesday a 10-member advisory panel of experts on behavior, nutrition, health and communications, will review Kraft's products and recommend changes in its single-portion packages of cookies, crackers and other snacks.

The company said it hopes to develop its standards by the end of the year and put them into effect over two to three years.

Some observers see the effort as a first defense against lawsuits in an age when personal injury lawyers have turned their attention from cigarettes to Big Macs and even Kraft's own Oreo cookies. A California attorney sued to ban Oreos because of their artery-clogging trans fat, but later withdrew the lawsuit, satisfied with the publicity.

Mudd said the company is health-conscious.

"If it also discourages a plaintiff's attorney or unfair legislation, that's just fine with us," he added.

Dr. Henry Anhalt, a pediatric endocrinologist at New York's Maimonides Medical Center, said Kraft may be covering itself in court, but the result could be healthier children.

Anhalt said children typically treat a 20-ounce soda as one serving, while it actually contains 2 1/2 servings.

"What people eat is ultimately a matter of personal choice, but we can help make it an educated choice," said Roger Deromedi, co-chief executive at Kraft. "And helping them get more active is every bit as important as helping them eat better."

Kraft, whose other products include Oscar Mayer meats, Post cereals, Ritz crackers, and Maxwell House coffee, may also be able to tap into the growing market for healthier foods with reduced fat, salt or sugar. Those products account for $5 billion in sales a year in the $500 billion grocery business, said Grocery Manufacturers of America spokesman Gene Grabowski.

Food and Drug Administration (news - web sites) Commissioner Mark McClellan said Kraft's initiative could start an important trend.

"That's the kind of thing that FDA ought to be encouraging," he said during a diet conference in Cambridge, Mass. "It can have an important public health impact."

On the Net:

http://www.kraft.com.

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Headache Help

HealthDayNews
Wednesday, July 2, 2003

(HealthDayNews) -- If you're a migraine sufferer, keeping a headache diary can help you discover what usually triggers an attack.

According to Marion County Medical Center, common migraine triggers include:

  • Stress.
  • Use of oral contraceptives.
  • Certain foods, such as chocolate, aged cheese, citrus fruits, dairy products, nuts, high-fat foods, picked and cured foods, and an increase or decrease in caffeine consumption.
  • Low blood sugar caused by skipping meals or stringent dieting.
  • Excessive exercise.
  • Alcohol, especially red wine.
  • Too much or too little sleep.
  • Weather and pressure changes.
  • Loud noise, strong smells and exposure to smoke.

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Your Body May Be Worth More Than $45 Million

By Bill Berkrot
Reuters
Wednesday, July 2, 2003

NEW YORK (Reuters) - It may be illegal, immoral and certainly ill-advised, but selling every usable part of your body could fetch upward of $45 million, according to a survey in the August issue of Wired magazine.

Even an overweight, out-of-shape body could bring millions when broken down to its valuable fluids, tissues and germ-fighting antibodies.

There is, of course, a major catch: Many of the valuable human body parts are those a person could not live without.

But it does lay to rest the old concept that the human body, when broken down to its basic elements, is only worth pocket change.

Wired Editor-In-Chief Chris Anderson said the price tag gives an idea of the progress of medicine and biology, and shows how much more sophisticated we have become at understanding the complexity of the human body.

"We tried to find some number through which you can quantify the magnitude of the change in technology that we are all experiencing," Anderson said.

The prices, Wired warned, are based on maximum dollar values for some of the most marketable substances, and makes the unlikely assumption that every trace of those substances could be extracted from living tissue for sale.

To avoid issues such as illegal black market trade in organs, the survey was based on projected prices in the United States and did not take into account potential differences in poverty stricken Third World countries.

Due to advances in science and biotechnology, vital organs are no longer the most valuable body parts, the survey demonstrated. That distinction now belongs to bone marrow at $23 million, based on 1,000 grams at $23,000 per gram.

DNA, found in every cell, could fetch $9.7 million at $1.3 million per gram, while extracting antibodies could bring $7.3 million. The accompanying article did point out that the cost of living in a sterile plastic bubble could eat up a lot of the profit from immune system sales.

By comparison, a lung was priced at $116,400, a kidney at $91,400 and a heart was worth a mere $57,000, based on research of cost estimates from hospitals and insurance companies.

On the reproductive front, the survey found a fertile woman could sell 32 egg cells over eight years for a grand total of $224,000. To approach that amount, a man would have to make 12 sperm donations a month for 20 years.

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Sucking Satisfaction

HealthDayNews
Wednesday, July 2, 2003

(HealthDayNews) -- If your baby is constantly looking for something to suck on, offer him a pacifier.

According to Harvard Medical School (news - web sites), sucking is a normal way for babies to calm themselves. And many infants soon find their fingers, fists or thumbs to suck on.

Pacifiers allow babies to satisfy their sucking instincts. They also help infants prone to spitting up to continue digesting their feedings.

But be sure you're not shoving the pacifier in a hungry baby's mouth. Know when your child needs to feed or merely wants to suck.

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Study Shows in Vitro Children Healthy

By Emma Ross
AP Medical Writer
The Associated Press
Wednesday, July 2, 2003

MADRID, Spain - The longest study of children born from in vitro fertilization and similar treatments is reassuring on intelligence scores and psychological health, but raises concerns the rate of birth defects may be higher than normal, researchers said Wednesday.

The study, funded by the European Union (news - web sites), involved more than 1,500 children from Britain, Belgium, Sweden, Denmark and Greece tracked up to age 5.

Other studies have hinted that children conceived by a technique that involves injecting the sperm directly into the egg may have a higher rate of malformations, but experts say neither those, nor the latest study, are robust enough to draw conclusions on birth defects.

However, they said the findings on intelligence and psychological health were convincing.

The researchers, who presented the results Wednesday at the annual meeting of the European Society of Human Reproduction and Embryology, assessed the physical development, family relationships and intellectual, psychological and social development of the children.

The children included 440 conceived by in vitro fertilization, where the sperm and egg are placed in a dish together and fertilization takes place before the resulting embryo is implanted in the womb.

An additional 535 were created by injecting sperm directly into an egg outside the woman's body, a technique known as intracytoplasmic sperm injection, or ICSI.

The rest of the children in the study were conceived naturally.

Birth weight and height were similar among the three groups, said one of the study's leaders, Dr. Christina Bergh, a professor of obstetrics and gynecology at Sahlgrenska University Hospital in Goteborg, Sweden.

The occurrence of illnesses was similar across the board, Bergh said,

Hospital admissions were higher for the IVF and ICSI children than for the others, and ICSI children needed more surgery than the naturally conceived children, she said.

There were no differences in intelligence, language skills, motor skills or behavior and temperamental difficulties. Parental stress was the same across the groups.

"I think we can feel very reassured about children's social, emotional and cognitive development up to age 5," said Susan Golombok, a professor of psychology at City University in London who was not connected with the study.

"If they are doing all right up to age 5, you wouldn't necessarily expect things to get worse as they grow older. By that time they are starting school and if they are doing OK, there would be no particular reason to expect problems would suddenly start to manifest."

The rate of birth defects was measurably higher among children conceived by sperm injection compared with those naturally conceived.

The malformation rate among ICSI children was 6.2 percent, compared with 2.4 percent for the comparison group.

The defects mainly were those that needed surgery or functional impairments, such as kidney abnormalities that lead to more frequent urinary tract infections. Skin lesions and digestive system defects were also found.

It is unclear whether the increased malformation rate among children born from ICSI is due to the technique.

Dr. Arne Sunde, chairman of the fertility society, said the most likely explanation is that the comparison group of naturally conceived children was skewed heavily in favor of healthy children because they were recruited from schools, and severely handicapped children do not usually go to ordinary schools.

The results could also be due to the mothers who underwent fertility treatment being about two years older than the mothers who conceived naturally, said Sunde, who was not connected with the research. The risk of birth defects is known to increase with a mother's age.

Experts say larger studies tracking thousands of children and comparing groups with similar characteristics are needed to detect real differences.

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Anesthesia May Be Fatal in Those with Rare Disorder

By Linda Carroll
Reuters Health
Wednesday, July 2, 2003

NEW YORK (Reuters Health) - A common form of anesthesia, nitrous oxide, may cause serious harm to patients with a rare metabolic disorder, researchers say.

People who are born with certain mutations in the gene responsible for the breakdown of folate may be at risk for neurologic damage, and even death, if they are given nitrous oxide, according to a report published in The New England Journal of Medicine (news - web sites).

The disorder, known as 5,10-methylenetetrahydrofolate reductase deficiency (MTHFR), is quite rare, according to report co-author, Dr. Kirk Hogan, an associate professor of anesthesiology at the University of Wisconsin in Madison.

"I think there have been fewer than 50 children reported to have it," Hogan said in an interview with Reuters Health. "But there is a concern about children with the more common mutations of this gene that are associated with depressed enzyme activity. Those mutations occur in up to 10 percent of us. The unanswered question is whether people with those mutations, when given nitrous oxide might experience more subtle injury."

Hogan hastened to add that people who were going to have surgery -- and who don't have MTHFR -- shouldn't be overly worried if they are to receive nitrous oxide.

"It's really important that kids with this disorder don't get nitrous oxide," he added. "For others, who have the more common mutations, I don't see any cause for panic. Nitrous oxide has been in use for over 100 years. If there was a serious problem with it, I expect we would have seen it by now."

Still, Hogan said, further research on the effects of nitrous oxide on people with the more common mutations, might explain why some people have delayed recovery from surgery.

For the new study, Hogan and his colleagues re-examined data on the 1983 death of an infant. When the baby was three months old, he underwent anesthesia to have a leg growth biopsied and later was anesthetized again to have the leg tumor removed.

Though healthy when released from the hospital after surgery, the baby started having seizures and breathing problems 17 days later. He died 46 days after surgery.

In 1985, when Hogan first looked at the infant's anesthesiology records, no one knew what caused the child to suffer brain damage, which eventually killed him.

"This little guy's been on my mind for 15 years," Hogan said. "Then, several years ago the mutations of the genes that encode for this disorder were found."

And new research on the disorder pointed to a possible link between the baby's damaged brain and anesthesia.

Nitrous oxide, when given to people with MTHFR, blocks the production of methionine. And methionine plays an important role in DNA synthesis of neurotransmitters and myelin, the insulating material covering nerves.

"Methionine is important for everyone, but especially those with developing brains," Hogan said. "This little guy was in the first few weeks of life at a time when his body was busily making brain cells."

Source: The New England Journal of Medicine 2003;349:45-50.

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CDC: Pets With Monkeypox Should Be Killed

By Mark Niesse
Associated Press Writer
The Associated Press
Wednesday, July 2, 2003

ATLANTA - Any pets feared infected with monkeypox should be destroyed, and other animals, including cats and dogs, that may have been exposed to the disease should be quarantined for up to six weeks, federal health officials said Wednesday.

The announcement from the Centers for Disease Control and Prevention (news - web sites) represents a stepping-up of its efforts to control the outbreak.

There have been no confirmed U.S. cases of monkeypox in cats and dogs, but such pets could get the virus from close contact with an infected animal and spread it to humans, the CDC said.

"The goal is to protect people, pets and wildlife in the United States, by preventing the monkeypox virus from spreading or becoming established permanently," said Martin Cetron, deputy director of the CDC's global migration and quarantine programs.

The CDC also said laboratory tests confirmed that the monkeypox outbreak in the United States came from six African rodents that arrived on a ship from Ghana three months ago.

The CDC earlier had recommended quarantine for animals suspected of having monkeypox, but raised the order to kill those animals once it confirmed the source of the outbreak.

Monkeypox has been confirmed in 32 people, mainly in Wisconsin, Indiana and Illinois. The illness in humans is not usually fatal but causes rashes, fevers and chills. Most Americans who caught monkeypox got it from infected pet prairie dogs.

The 800 or so African rodents that arrived on the ship also should be destroyed, the CDC said. The animals have been quarantined for weeks by pet shops and other distributors.

Pet stores that comply with the new euthanasia and quarantine orders may reopen when health officials determine they are safe, the CDC said.

The government has banned imports of African rodents and halted the sale and movement of prairie dogs and some similar rodents.

People who suspect their pets have monkeypox should call state health officials, said Stephanie Shain of the Humane Society.

"If you're at all concerned, it's worth a phone call," she said. "It's difficult because the symptoms they're describing could be a number of problems not necessarily monkeypox."

On the Net:

Centers for Disease Control and Prevention: http://www.cdc.gov/ncidod/monkeypox/index.htm

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U.S. Businesses Target Fast-Food Lawsuits

By Todd Zwillich
Reuters Health
Wednesday, July 2, 2003

WASHINGTON (Reuters Health) - A U.S. group took aim at lawsuits against the fast-food industry Wednesday, claiming that McDonald's and other restaurants that sell high-calorie food are not to blame for the country's growing obesity epidemic.

The group blasted trial lawyers for the suits, even though just one has been filed to date. In a suit that was later dismissed, a New York man sued four leading fast-food chains last July claiming that they failed to disclose the unhealthy content of food that helped lead to his and others' obesity.

"Even if fast-food critics are well meaning in their intentions, they are trying to fix a legitimate problem -- obesity -- through illegitimate means," said Lisa A. Rickard, president of the U.S. Chamber Institute for Legal Reform (ILR). The ILR is an affiliate of the U.S. Chamber of Commerce (news - web sites) that aims to reduce excessive and frivolous litigation. The U.S. Chamber of Commerce promotes American business interests.

The group is backing legislation on Capitol Hill designed to bar obesity-related class action lawsuits against restaurant chains.

"Fortunately or unfortunately, Americans' freedom of choice includes the freedom to overeat. Lawsuits against fast-food firms won't change that," Rickard said.

Health officials have identified obesity as a major epidemic in the U.S., where more than 60 percent of the adult population is now classified as overweight. Economic estimates have put the direct cost of obesity-related disease, including heart disease, diabetes, cancers, and disability, at more than $175 billion per year.

"We cannot deny that people are eating more and getting bigger," Todd G. Buchholz, an author and former White House economic advisor, stated in a report on obesity lawsuits commissioned by the U.S. Chamber of Commerce. However, the analysis claims that fast-food restaurants have increased portion sizes, fat, and calorie content no more than Americans have when cooking at home.

A plaintiff's lawyers' group responded to the report, saying that the U.S. Chamber of Commerce is trying to remove the rights of juries to hear cases against the fast-food industry.

"It would rather have everything decided in the board rooms of Fortune 500 companies," said Carlton Carl, a spokesman for the Association of Trial Lawyers of America (news - web sites).

"Every judge in America has a right to throw out suits that lack merit, and they do that every day," he said.

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Studies Challenge Breast Cancer Treatment

By Stephanie Nano
Associated Press Writer
The Associated Press
Wednesday, July 2, 2003

An aggressive and grueling treatment for breast cancer (news - web sites) that uses doses of chemotherapy so high that it destroys the patient's bone marrow offers little or no benefit over standard chemo for women who run the risk of a recurrence, two studies show.

The research could signal the end for the expensive and controversial treatment, though some believe it may eventually prove superior in some women.

Ultrahigh-dose chemotherapy employs many times the normal level of cancer drugs. Because the treatment also kills the bone marrow, the patient has to get a transplant of blood-forming stem cells collected from her own body.

The approach became widely used for advanced breast cancer when preliminary studies suggested it was better than the conventional chemotherapy offered to women after surgery.

But more rigorous studies in the 1990s found that the intensive treatment did not improve the outcome for women whose cancer had spread to other parts of the body. Because of those disappointing results, the approach is seldom used now outside of medical studies.

The research in Thursday's New England Journal of Medicine (news - web sites) looked at the treatment in patients whose cancer had spread only to their lymph nodes, putting them at high risk for a relapse.

In both studies, there was little difference between the two approaches in survival after five or six years or in the rate of cancer recurrence.

"I think the evidence of benefit is so minimal ... and the toxicity is so substantial and the cost so high that by and large people are going to say this approach is now no longer worthy of pursuing in any major way," said Dr. Harmon Eyre, chief medical officer of the American Cancer Society (news - web sites).

The high-dose regimen costs at least $150,000, while standard chemo is $8,000 to $10,000, according to Eyre. He said the future of breast cancer treatment may be drugs designed to kill only cancer cells and not healthy cells and regimens tailored for each patient.

Insurance companies initially balked when women desperate for a cure demanded they pay for the intensive but unproven treatment. But many later relented under pressure from lawsuits and state laws mandating coverage.

Dr. Martin S. Tallman of Northwestern University Feinberg School of Medicine, who led one of the studies, said the results could make it difficult to pursue the high-dose technique.

"It will be hard to generate enthusiasm and resources when, in general, the results have been disappointing ... and there are other alternatives people are enthusiastic about," he said.

But another researcher, Dr. Sjoerd Rodenhuis, said he is not giving up on high-dose treatment. His study, done in the Netherlands, suggests the treatment may work better in the three-quarters of patients whose tumors test negative for a defect in a certain gene. The gene, called HER2-neu, plays a role in regulating cell growth; excess copies of the gene cause cells to reproduce out of control.

Patients without the defect seemed to respond better to the high-dose treatment, but Rodenhuis said that needs to be independently confirmed.

"We believe that high-dose chemotherapy is going to be back but obviously not for all patients," said Rodenhuis of the Netherlands Cancer Institute.

In an accompanying editorial, Dr. Gerald J. Elfenbein of Roger Williams Medical Center in Providence, R.I., said there may be other groups of women who could benefit from high-risk chemotherapy, noting that neither study looked at race or ethnic groups.

The Dutch study involved 885 women with four or more cancerous lymph nodes, while the 511 women in the U.S. study had 10 or more. Some of the Dutch patients received five cycles of standard chemotherapy; others got four standard cycles, plus one cycle of high-dose chemo and a stem cell transplant. The U.S. women all got six cycles of standard chemo; those in the high-dose group then received high-dose chemo and a transplant.

While there was no survival difference overall, when the Dutch researchers looked only at the patients with 10 or more cancerous nodes, they found a slightly better relapse-free survival rate for those in the high-dose group, 61 percent, compared with standard chemo, 51 percent.

Five deaths in the Dutch study were caused by the high-dose treatment and nine in the U.S. study were transplant-related, mostly from bone marrow transplants early in the study. Side effects included nausea, vomiting, mouth sores and infection.

Tallman said it was initially difficult to get patients to take part in the U.S. study when it started in 1991 because of the belief that high-dose chemo worked better. But the latest findings illustrate how important it is to do controlled studies to prove whether promising-looking approaches really do work.

On the Net:

New England Journal: http://nejm.org

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Drug Lessens Morphine Withdrawal in Mice

By Keith Mulvihill
Reuters Health
Wednesday, July 2, 2003

NEW YORK (Reuters Health) - A drug that mimics a common brain chemical may one day help ease symptoms of morphine withdrawal, a new study in mice suggests.

Morphine is widely used to treat severe pain, but one of its drawbacks is that patients can become addicted to the drug.

In the study, morphine-addicted mice given a dose of a drug called galnon exhibited less severe symptoms of withdrawal than other animals, Marina Picciotto, of Yale University in New Haven, Connecticut, explained in an interview.

The drug mimics the function of a brain peptide called galanin, which stimulates eating and is important in memory and learning and is believed to play a role in addiction, according to Picciotto.

The findings, published online in the Proceedings of the National Academy of Sciences (news - web sites), suggest that patients prescribed morphine might one day get combination therapy with a drug, such as galnon, that mimics galanin, explained the researcher.

"That would increase the effectiveness of morphine as an analgesic and would decrease the addictive-like properties and withdrawal symptoms that are associated with taking an opiate chronically," she told Reuters Health.

The problem now is that pain is often under-medicated and opiates are under-prescribed because of fears about abuse, addiction and liability, she explained.

"You've probably read in the news about celebrities who go into rehab because they have become addicted to their pain medication, so it certainly does happen," said Picciotto. "Galanin agonists (mimicking agents) could be expected to decrease that liability."

In other findings, Picciotto's team found that mice that lacked the gene that codes for the production for galanin showed more severe signs of withdrawal compared to normal mice addicted to morphine. And, mice that were genetically altered to over-produce galanin showed decreased symptoms of withdrawal to the pain killer, according to the report.

Source: Proceedings of the National Academy of Sciences 2003;10.1073/pnas.1533224100.

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Too Much Zinc Ups Prostate Cancer Risk

By Ed Edelson
HealthDay Reporter
HealthDayNews
Wednesday, July 2, 2003

WEDNESDAY, July 2 (HealthDayNews) -- Men who overdose on zinc supplements more than double their risk of prostate cancer (news - web sites), a government study finds.

The researchers looked at 46,974 men who were involved in the Health Professionals Follow-Up study, and the increased risk was seen in those who took more than 100 milligrams a day of zinc supplements or used zinc supplements for more than 10 years.

The report appears in the July 2 issue of the Journal of the National Cancer Institute (news - web sites).

It's an important finding because prostate cancer is the second leading cancer killer for American men, taking 30,000 lives a year. And 30 percent to 40 percent of all men take one supplement or another, says study author Dr. Michael F. Leitzmann, an epidemiological investigator at the National Cancer Institute.

Zinc has long been a target of prostate cancer research because it is found in high concentrations in the prostate, but studies of its effects on malignancy have gotten mixed results. One study released four years ago found an association between daily doses of zinc and a reduced risk of the cancer.

There isn't necessarily a conflict between the two trials, says Dr. Janet Stanford, a research professor of epidemiology at the Fred Hutchinson Cancer Research Center in Seattle and a leader of the earlier study.

"Our study was not designed to assess supplement use," Stanford says. The new study is "intriguing," she says, and "does raise a question about the role of zinc in prostate cancer. But it is not the basis for making decisions."

Leitzmann agrees, noting his results might not conflict with those from the earlier study, in part because the two trials used entirely different methods. The older study asked men with prostate cancer if they had taken zinc supplements and compared their answers with cancer-free men. The new study followed men who started out cancer-free for 14 years, asking about their zinc intake.

The important point is that the risk was concentrated in men who took the largest amounts of zinc for the longest time, Leitzmann says. No increased risk was found in men who took up to 100 milligrams a day. But those who took more than that amount daily were 2.29 times more likely to develop the cancer than those who took less. And the risk was 2.37 times greater for men who took zinc supplements for 10 or more years.

Zinc is known to increase blood levels of insulin-like growth factor and testosterone, both of which are directly related to prostate cancer, Leitzmann says. It's possible malignancy occurs because high levels of zinc increase the growth rate of slow-growing prostate cancers, he says.

Not much is known about modifiable risk factors for prostate cancer, Leitzmann says. The best known risk factors are increasing age, a family history, and race, with blacks at higher risk.

Even with the latest findings, the evidence that avoiding zinc supplementation might reduce prostate cancer risk "overall is not very compelling," Leitzmann says. "This one study cannot conclusively answer that question."

But one obvious implication is that men "should avoid supplements that contain multiple amounts of the recommended dietary amounts," Leitzmann says.

More information

You can get an overview of what is known about prostate cancer from the National Cancer Institute. For more on the risk factors for prostate cancer, go to the Fred Hutchinson Cancer Research Center.

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Millions of Americans Suffer Sports Injuries

Reuters
Wednesday, July 2, 2003

ATLANTA (Reuters) - About 7 million Americans receive medical attention for sports-related injuries each year, underscoring a need to use safety gear, U.S. health researchers said on Wednesday.

The Centers for Disease Control and Prevention (news - web sites) said a study of data from 1997 to 1999 found that those aged 5 to 24 years old had the highest number of sports injuries that required medical advice or treatment.

Twenty percent of injured students missed at least one day of school, while more than 25 percent of U.S. employees lost one or more workdays due to such injuries.

The agency said basketball was the lead sport for injuries among teens and young adults, while those 25 or older were frequently hurt in activities such as biking, golfing, bowling or racket sports. Among children, cycling was a common cause of injury.

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Epinephrine Doesn't Work on Very Young

By Amanda Gardner
HealthDay Reporter
HealthDayNews
Wednesday, July 2, 2003

WEDNESDAY, July 2 (HealthDayNews) -- A popular inhalation treatment for bronchiolitis, the most common lower respiratory tract infection in children under the age of 1, does not work.

That's the conclusion of Australian researchers who found that epinephrine, a bronchodilator used to open up the air passages, did not significantly reduce the length of hospital stays or other indicators for infants.

The finding, published in the July 3 issue of the New England Journal of Medicine (news - web sites), is not startling to many clinicians.

"The level of surprise is extremely low," says Dr. Giovanni Piedimonte, director of pediatric pulmonology at the University of Miami School of Medicine. "We have known that bronchodilators have limited efficacy."

"This study really looked at [the issue] critically to say, 'Why are we giving these kids these medications if it doesn't help?'" says Dr. Harriet Boxer, chief of neonatology at Nassau University Medical Center in East Meadow, N.Y.

According to the researchers, about 1 percent of all healthy infants are hospitalized with acute viral bronchiolitis each year. And according to an accompanying editorial in the journal, the estimated number of admissions of children under the age of 1 for this condition increased from 1.3 percent in 1980 to 3.1 percent in 1996. The number of children under the age of 6 months hospitalized during the same time frame surged by 239 percent.

The problem is that there is no effective treatment for the infection. "With bronchiolitis, we have nothing. It's just supportive," Piedimonte says. That means making sure the child doesn't get dehydrated and providing oxygen and ventilatory support if needed.

Despite being controversial, bronchodilators are widely used, report the study authors. Up to 96 percent of infants with bronchiolitis are treated with bronchodilators at pediatric centers in Canada and almost 90 percent of Australian physicians reported that they used bronchodilators in some infants with bronchiolitis.

The current study involved 194 infants who had been admitted to four hospitals in Queensland, Australia, with a diagnosis of bronchiolitis. After parental consent was obtained, the children were randomly assigned to receive either three doses of inhaled epinephrine or three doses of a saline solution as a placebo.

There were no significant differences between the two groups in length of hospital stay or time until the child was ready for discharge (the study authors made this distinction because sometimes the stay can be prolonged for non-health reasons). Nor were there significant differences in respiratory rate or blood pressure.

Some clinicians may resort to bronchodilators because the patient is wheezing and they think it might be asthma.

"We have pretty good evidence that [episodes of bronchiolitis] are very different from actual asthma. However, the main symptom is still wheezing and the child looks the same so it's perfectly understandable that they do it," Piedimonte says.

Other physicians may simply want to do something, anything. "Most of the time they are quite well aware of the literature that shows it doesn't work but, nevertheless, they use it," Piedimonte says. "The fact that the child is extremely sick and very, very young with a family looking on makes many physicians believe that they have to at least try some intervention."

Generally speaking, short courses of bronchodilators are not harmful, although they can speed up the heart rate.

"I don't think [the study] is going to stop people from using it," Boxer says, adding that doctors would be better off using their clinical skills and doing a family history of asthma and whether the child has ever been on a ventilator. "I don't think it will stop because there are people who are convinced that it will help," she says.

More information

For more on bronchiolitis in children, visit the American Academy of Pediatrics or the Nemours Foundation.

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Bicycling Shouldn't Affect Prostate Cancer Test

Reuters Health
Wednesday, July 2, 2003

NEW YORK (Reuters Health) - It's good news for middle-aged male bike riders: riding to your doctor's appointment will not affect the results of a blood test for prostate cancer (news - web sites), new research suggests.

European investigators found that levels of the protein prostate specific antigen (PSA) did not vary in blood samples taken before and after men completed a 13-mile bicycle course.

PSA is a protein produced by the prostate gland, and elevated levels in the blood can signal prostate cancer.

However, the PSA test is somewhat unreliable: an increase in PSA does not always indicate cancer, and cancer can occur without a rise in PSA.

PSA blood levels also rise and fall as a result of numerous factors, such as age or inflammation of the prostate. Indeed, research suggests that the concentration of the protein in the blood of a healthy man can vary by as much as 30 percent.

The current study, published in the journal Urology, suggests, however, that the combination of exercise and pressure placed on the prostate -- features of bike riding -- should not be added to the list of factors that influence PSA levels in the blood.

"According to the results of our study, cycling has no impact on PSA-based screening for prostate cancer," write Dr. Hans-Joachim Luboldt of the University Hospital Essen in Germany and colleagues.

During the study, the researchers measured PSA levels in 33 men between the ages of 50 and 74 right before a bike ride and one hour after.

They found there were no significant changes in the levels of PSA from before and after the bike ride.

Source: Urology 2003;61:1177-1180.

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Hodgkin's Disease Therapy Doesn't Have to Trigger Breast Cancer

By Adam Marcus
HealthDay Reporter
HealthDayNews
Wednesday, July 2, 2003

WEDNESDAY, July 2 (HealthDayNews) -- Doctors have long known that radiation therapy increases the risk that people with Hodgkin's disease might develop other forms of cancer, including blood malignancies and solid tumors.

In young women with Hodgkin's disease, the threat of breast cancer (news - web sites) is a particular concern following radiation.

But new research suggests this hazard can largely be avoided with careful attention to the hormones of women undergoing treatment for Hodgkin's disease. In particular, drugs that interfere with the sex hormone estrogen -- such as the cancer drug tamoxifen -- may help.

"Tamoxifen has not been used in this population, but it might be something that we should consider," says research leader Flora van Leeuwen, an epidemiologist at the Netherlands Cancer Institute in Amsterdam.

A report on the findings appears in the July 2 issue of the Journal of the National Cancer Institute (news - web sites).

Hodgkin's disease, also known as Hodgkin's lymphoma, is a blood-related cancer that affects some 7,000 people a year in the United States, according to the Leukemia and Lymphoma Society. Treatment advances since World War II, including radiation and a variety of drug combinations, have greatly improved the odds for patients with the disease, and five-year survival rates hover around 90 percent.

Still, the threat of "secondary" cancers brought on by treatment clouds the successes of Hodgkin's therapy. Although many of these secondary malignancies aren't especially serious, some can be life-threatening.

The new study made two important findings, says van Leeuwen.

First, it showed that a woman's risk of breast cancer after radiation treatments for Hodgkin's disease climbed based on the dose she received. Women who got the most radiation -- at least 38.5 grays to their breast -- had 4.5 times the risk of developing breast cancer as those who got less than 4 grays.

"In Hodgkin's disease treatment, the mediastinal lymph nodes are irradiated and various portions of the breast receive different doses" in the process, van Leeuwen says. "Calculating this dose was a labor-intensive part of the study, but crucial."

The chances that radiation for Hodgkin's disease would promote breast cancer dropped sharply, though not back to normal, in women whose treatment also called for chemotherapy, van Leeuwen says. Compared with women who received radiation alone, those who also underwent chemotherapy had about a 60 percent smaller risk of breast cancer, the study found.

The likely reason: Chemotherapy can hasten the onset of menopause, van Leeuwen says. Since menopause is a hormone-suppressed state, and many cases of breast cancer are sparked by the female sex hormone estrogen. Inducing menopause may blunt the ability of radiation to trigger breast tumors, she says.

"We already knew that radiation produces breast cancer," van Leeuwen says. "We now know with this study that with higher [doses], the risk is higher, but we now see that there is a way to substantially reduce the risk of these cancers."

More information

For more on Hodgkin's disease, visit the National Institutes of Health or the Leukemia and Lymphoma Society.

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Genome Survey Finds Depression Genes

Reuters
Wednesday, July 2, 2003

WASHINGTON (Reuters) - U.S. researchers using the newly published human gene map said on Wednesday they had identified 19 different genetic regions linked with depression.

The findings could eventually lead to better treatments and screening for depression and related conditions, such as addiction, a leading cause of disability in the United States.

Dr. George Zubenko, a professor of psychiatry at the University of Pittsburgh School of Medicine, and colleagues screened 81 families with members suffering from recurrent, early-onset, major depressive disorder, which runs in families.

They found 19 regions on chromosomes that seem to be involved in the condition, they reported in the American Journal of Medical Genetics. Further work should be able to pinpoint the actual genes involved.

The information could eventually lead to tailored treatments for depression, Zubenko said.

"For example, individuals with particular genetic markers in these regions may respond better to particular current treatments than others," he said in a statement.

Zubenko's team found some mutations seem to be sex-specific -- some for women and at least one for men.

"Women are twice as likely as men to develop depression, and genetic differences appear to account for some of that disparity," Zubenko said.

These could help explain why women seem more vulnerable to depression during puberty, pregnancy and childbirth and menopause, Zubenko said.

They also noticed that people in families with these genetic changes tend to live shorter lives.

People who had died in the 81 families were eight years younger when they died than the average for the general population, the researchers found.

They found a five-fold increase in the proportion of babies who died in the first year of life and several-fold increases in deaths by suicide, murder and liver disease, although most of the deaths were from heart disease, cancer and stroke.

The National Institute of Mental Health reported last month that 16 percent of Americans -- more than 30 million people -- will suffer major depression at some point in their lives, costing employers more than $30 billion in lost productivity.

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Milk Fat May Protect Against Childhood Asthma

HealthDayNews
Wednesday, July 2, 2003

WEDNESDAY, July 2 (HealthDayNews) -- Young children who regularly eat full cream milk, butter and other products that contain milk fat are less likely to develop asthma.

That's the finding of a Dutch study in the July issue of Thorax.

The researchers examined the food consumption of 2,978 Dutch children when they were 2 years old. The children were later checked for asthma symptoms when they were 3 years old.

The study found rates of asthma were lower in children who consumed full cream milk and butter each day compared to children who didn't eat those products daily. Children who consumed milk products -- including yogurt and chocolate milk -- and butter each day had less wheezing than children who did not.

Children who ate brown bread daily also had lower rates of asthma and wheezing.

The study also found children who consumed fruit juice and vegetables daily had lower asthma rates than other children, but those differences weren't statistically significant.

The authors write the study results offer evidence that daily consumption of products containing milk fat may help reduce the development of asthma and wheezing in young children. Fatty acids, antioxidants and other micronutrients in those foods may play a role.

More information

Here's where you can learn more about asthma.

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TUESDAY, JULY 1, 2003

'Mutated Gene' May Hold Clue to Parkinson's

By Randy Dotinga
HealthDay Reporter
HealthDayNews
Tuesday, July 1, 2003

TUESDAY, July 1 (HealthDayNews) -- New research suggests a single defective gene caused a young woman to develop Parkinson's disease (news - web sites) -- even though her family had no history of the illness.

The finding could help unravel some of the mystery surrounding the inheritability of the brain disease.

An estimated 1 million to 1.5 million Americans have Parkinson's, which causes tremors, difficulty walking and rigid muscles. In severe cases, patients can develop dementia and die, but medications have let many lead fairly normal lives.

The causes of Parkinson's aren't clear, although many experts think environmental contamination, especially from pesticides, may be at least partially responsible.

In a tiny number of cases, however, Parkinson's appears to be inherited. Researchers have found that the illness runs in two Dutch and Italian families. A mutated gene appears to cause the disease to appear in some members of the families, especially the young.

Inherited Parkinson's disease "is considered a scientific curiosity as it is thought to be rare," explains Dr. Paul Tuite, an assistant professor of neurology at the University of Minnesota.

To better understand the mutated gene, an international team of researchers decided to investigate whether the gene could cause the disease in other families, including those that had not encountered the illness. The researchers looked for mutations in the gene, known as DJ-1, in 107 Parkinson's patients who had developed the illness before the age of 50. Only 38 had a family history of the disease.

The researchers -- from Canada, Italy, the Netherlands and the United States -- report their findings in a study that will appear in an upcoming issue of the journal Annals of Neurology. The journal published the study online June 29.

The researchers found a mutated gene in a single 29-year-old patient, a Hispanic woman, who developed the disease at the age of 24 and has responded well to medication. Her family had no history of Parkinson's or other brain illnesses.

"As we understand more about genetics and the Human Genome (news - web sites), it's clear that a disease doesn't need to run in families to be genetic," says study author Andrew Singleton, a researcher at the Molecular Genetics Section of the Laboratory of Neurogenetics at the U.S. National Institute on Aging. "A recessive disease, which requires one faulty gene from each parent, can often appear in a patient without any affected relatives."

So far, the full meaning of the defective gene isn't clear. "What remains to be seen is if this mutation is a limited phenomenon, or does [it] play a more insidious role in other patients throughout the world," Tuite says.

Either way, more understanding of the gene in question could help scientists studying Parkinson's disease, he says. They could tinker with the genes of animals -- even a fly -- to give them forms of Parkinson's disease and study how treatments work, he says.

For now, there's no way to prevent Parkinson's. Once people get the disease, it's too late to turn back the brain damage, although medications can keep it from getting worse, Singleton says.

But determining that a patient is susceptible to the disease in the first place -- perhaps because of a defective gene -- could let doctors recommend preventative treatments before the disease appears, says Dr. Irene Litvan, director of the Movement Disorder Program at the University of Louisville. Those may include antioxidants, which have shown promise in research, or the simple avoidance of pesticides, she says.

More information

Learn about the symptoms of Parkinson's disease from the Parkinson's Disease Foundation or the National Parkinson Foundation.

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Study Says Feeding Tubes May Be Overused

By Linsey Tanner
AP Medical Writer  
The Associated Press
Tuesday, July 1, 2003

CHICAGO - One-third of U.S. nursing home patients in the final stages of Alzheimer's and other forms of dementia are given feeding tubes, despite evidence that the practice serves no benefit and may even cause harm, a study found.

People with advanced dementia are generally incapacitated, have trouble swallowing and are near death. Recent studies have shown that feeding tubes do not prolong their lives and may sometimes cause discomfort and infections.

Many geriatric specialists recommend comfort care for such patients, including attempts at spoon-feeding, unless they indicated while still competent that they would prefer aggressive attempts to keep them alive.

The study, which involved 1999 data from al1 15,135 licensed U.S. nursing homes at the time, suggests that some of these patients are given feeding tubes because the practice is seen as less costly and time-consuming than spoon-feeding, said Dr. Susan Mitchell, an assistant professor at Harvard Medical School (news - web sites) who led the study.

In addition, many patients do not have advanced directives or living wills, leaving medical decisions up to relatives who may not understand the severity of the dementia and may assume that feeding tubes are warranted, Mitchell said.

Whether to use feeding tubes "is a very complicated decision that really necessitates health-care providers sitting down with families ... going over pros and cons," Mitchell said.

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

It found that 63,101 out of 186,835 patients with advanced dementia 34 percent had feeding tubes.

For-profit nursing homes were more likely to have patients on feeding tubes, supporting the idea that some institutions believe the practice saves money.

The Alzheimer's Association's guidelines on patients in the final stages of the disease say that it is ethically permissible to withhold feeding tubes and that spoon-feeding should be continued if needed for comfort.

Sandra Fitzler of the American Health Care Association, which represents over 12,000 nursing homes and other institutions, disputed the suggestion that some places may be inappropriately using feeding tubes for patients with advanced dementia.

Fitzler said the study underscores the importance of living wills and advanced directives, so that health care providers and families are not left guessing about patients' preferences.

On the Net:

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

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Mixed Meds: A Dangerous Prescription for Heart Patients

By Amanda Gardner
HealthDay Reporter
HealthDayNews
Tuesday, July 1, 2003

TUESDAY, July 1 (HealthDayNews) -- Patients with diabetes and heart failure seem to be routinely receiving medications that may aggravate one condition even if they help the other.

Specifically, metformin (brand name Glucophage) and a class of medications called thiazolidinediones -- both of which help control glucose levels in diabetics (news - web sites) -- may cause serious complications in patients with heart failure.

The findings are detailed in a study in the July 2 issue of the Journal of the American Medical Association (news - web sites).

"The number of patients with diabetes has increased dramatically in the country over the last 10 years and increasingly these medications are being used as part of their therapy," says Dr. Sid Smith, director of the Center for Cardiovascular Science and Medicine at the University of North Carolina.

"Because of the observations of fluid retention and weight gain [in the case of thiazolidinediones], it's very important that they not be used in patients with known heart failure or, if necessary, that possible problems be monitored very carefully," adds Smith, who is a past president of the American Heart Association (news - web sites).</< p>

Part of the problem is that so many patients, especially patients with diabetes, have other health conditions as well.

"The typical heart failure patients are patients who have many concurrent illnesses and complications and can end up on a lot of different medications," says study author Dr. Harlan M. Krumholz, a professor of medicine and epidemiology and public health at Yale University School of Medicine.

"As people end up going to a specialist, there's often not a lot of cross-talk. We need to pay a lot more attention to the integration of our approaches and taking into account a variety of conditions," Krumholz says.

But there's also the issue of whether physicians are paying attention to U.S. Food and Drug Administration (news - web sites) (FDA) "black box" warnings on medications. Such warnings are the most serious category of health side effects.

"There's a discordance between what the FDA is saying and what's going on in practice," Krumholz says. "We're potentially undermining the entire system."

The black-box warning for metformin indicates the drug could lead to lactic acidosis -- or acid in the blood, a potentially life-threatening problem for people with heart failure. And thiazolidinediones may cause fluid retention, again a serious condition for heart failure patients.

"Good care of a chronic condition of heart failure entails getting people into the right balance. And if they're on medications that cause them to retain fluid, it may turn them in the wrong direction and tip them over and cause them to be hospitalized," Krumholz says.

For this study, Krumholz and his colleagues pored through the medical records of Medicare beneficiaries who had been hospitalized with heart failure and diabetes from April 1998 to March 1999 and July 2000 to June 2001.

The earlier sample consisted of 12,505 patients, 7.1 percent of whom were discharged with a prescription for metformin, 7.2 percent with a prescription for a thiazolidinedione, and 13.5 percent with a prescription for one or the other.

In the second sample, which consisted of 13,158 patients, 11.2 percent got metformin, 16.1 percent got a thiazolidinedione, and 24.4 percent one or the other.

The study authors did not look at how many people had adverse reactions, simply how many patients were prescribed the drugs.

It's not entirely clear why this disconnect is happening, the researchers say. Physicians may simply not be aware of the dangers or they may think the benefits outweigh the risks. Or they may have decided that the risks aren't as high as advertised.

"We have a problem when the FDA is saying one thing with respect to the safety of a medication and clinicians are so frequently doing something else," Krumholz says.

"We need to determine the best way to treat patients," he says. "It is a problem when the FDA's black-box warning is not being heeded. Either the FDA has overreacted or clinicians are exposing their patients to unnecessary risk, and we [have] to know which it is."

And it's not just an issue for heart failure patients with diabetes, although this is a group that warrants more attention.

"It raises the issue about the way that we deliver health care in this country," says Dr. Kenneth Hupart, chief of endocrinology, diabetes and metabolism at Nassau University Medical Center in East Meadow, N.Y.

"Are we either having doctors who are generalists taking care of these complicated illnesses too much, or are we balkanizing it too much and having super-specialists taking care of [patients] and sometimes lacking the broad picture? We have to reexamine the way we provide health care to people in this country. We can hypothesize but we can't really know from a study like this. It invites further studies."

More information

Both the American Diabetes Association and the American Heart Association have information on the connection between heart disease and diabetes.

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Great Husband? Thank Your Mother-In-Law

By E. J. Mundell
Reuters Health
Tuesday, July 1, 2003

NEW YORK (Reuters Health) - Stereotypes of the nagging, critical mother-in-law may need some revising: A new study suggests that good husbands or boyfriends are often the product of great moms.

Researchers interviewing 33 young couples found "significant" correlations between men's ties to their mothers and their partners' satisfaction with the relationship.

"If he's very close to his mother he may feel very close to his partner, probably very affectionate," explained researcher Sarah Roberts, of Ferrum College in Virginia.

Roberts co-authored the study with psychologist Sharon Stein while an undergraduate at Ferrum. She presented the findings at the recent annual meeting of the American Psychological Society, in Atlanta.

Although much research has been conducted into the parent-child relationship, Roberts and Stein say the impact of the mother-son relationship on a son's significant other has been "overlooked."

In their study -- titled "Mama's Boy or Lady's Man?" -- the two researchers had each male and female partner in 33 couples fill out separate questionnaires.

"The questionnaire that was given to the women was about relationship satisfaction," Roberts said, "and that given to the men was about their perceived closeness to their mothers."

The researchers found that, in general, men who said they had moms who "understood their needs" had mates who described them as "affectionate." Men who had a strong love for their mothers also tended to date women who described them as not only their lover, but also "their best friend," the authors report.

Finally, men who said they sought to "make their mother proud" ranked high in terms of their ability to communicate with their female partner.

How might mothers mold the attitudes and conduct of their male offspring when it comes to adult romantic relationships?

"In traditional homes, the mother is the very first person that the children have (as their) introduction to femininity," Roberts said in an interview with Reuters Health. "Their mother is, for the male child, their first study of what a woman is. So of course they watch her behaviors, they watch certain things coming from her, and of course are influenced by everything she may teach them."

Besides influencing him to be more open and gentle with others, an attentive mother may even influence her son's choice of mate in later life.

"If the mother is very loving, very caring, and displays this to her son, he may be in a position where he's thinking, 'Well, I want a woman like my mother,' or 'I don't want a woman like my mother,"' Roberts said.

But of course this influence can go overboard, too. For example, in a surprise finding, men who claimed mom as "their best friend" or said they "enjoyed spending time with mom" also tended to be labeled as less-than-considerate by many of their mates.

So a mom's love can backfire, too.

"I think it's clear it can go either way," Roberts said. "There's the question of 'how much is too much?' If he's too close to his mother, might not that be an obstacle for his spouse?"

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Colon Cancer Screenings Spark Debate

By Lindsey Tanner
AP Medical Writer
The Associated Press
Tuesday, July 1, 2003

CHICAGO - Getting a colorectal screening test every three years instead of the recommended five can detect potentially dangerous tumors earlier, but not enough to warrant a switch to more frequent exams, a study suggests.

The findings, however, raise concerns about a move by some doctors toward less frequent screenings for colon cancer, the nation's third leading cause of cancer deaths.

The study looked at sigmoidoscopy, in which a flexible, lighted tube is inserted in the rectum to examine about half of the large intestine, where most dangerous tumors form. Medical guidelines recommend this exam every five years after age 50 along with a yearly test for blood in the stool.

Recent studies have shown that a more thorough and costly test, the colonoscopy, does a superior job of detecting tumors because it examines the entire large intestine. It is generally recommended every 10 years after age 50, and some doctors say this alone should be the routine screening method.

The new study involved 9,317 men and women with an average age of about 66 who had a repeat sigmoidoscopy exam three years after receiving normal results. The findings appear in Wednesday's Journal of the American Medical Association (news - web sites).

Cancer or precancerous tumors called adenomas were found in 292 people, or 3.1 percent. Seventy-two people had advanced adenomas tumors that had grown to a potentially dangerous stage and six had full-fledged cancer, for a combined rate of 0.8 percent.

That rate is similar to previous estimates and is not high enough to warrant changing the current recommendations for sigmoidoscopy, said lead author Dr. Robert Schoen of the University of Pittsburgh.

But he said the study raises serious concerns about switching solely to colonoscopies every 10 years. The findings suggest potentially dangerous tumors would be found in at least 2.5 percent of people returning for a repeat colonoscopy after 10 years.

In an accompanying editorial, Dr. Robert Fletcher of Harvard Medical School (news - web sites) agreed that the results do not support changing current recommendations for five-year intervals between normal sigmoidoscopies partly because the exams themselves carry a slight risk of perforating the colon and also because not all precancerous tumors will develop into cancer.

On the Net:

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

American Cancer Society (news - web sites): http://www.cancer.org

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FTC Takes Action Against Three Ephedra Marketers

Reuters
Tuesday, July 1, 2003

WASHINGTON (Reuters) - U.S. regulators said on Tuesday they had sued one marketer of the weight-loss supplement ephedra and settled charges against two others, accusing them of making bogus claims about the controversial stimulant.

The Federal Trade Commission (FTC) said it had challenged claims that the companies' ephedra-containing supplements would allow users to lose substantial weight without diet or exercise, and that the products were "perfectly safe" or had no side effects.

Ephedra is a stimulant that has been marketed as a weight-loss aid, energy booster and sports-performance enhancer.

Earlier this year U.S. health officials warned against taking dietary supplements containing ephedra after it was cited in the death of a professional baseball player.

On Tuesday the FTC said it had settled cases against Health Laboratories of North America Inc. and USA Pharmacal Sales Inc. after the companies promised to stop making false and deceptive advertising claims.

FTC officials estimated that Health Laboratories sold about $35 million worth of weight-loss and other supplements, while Pharmacal sold about $9 million.

The companies also agreed to include warnings about the health risks of ephedra and certain other products, and to pay $370,000 in consumer redress, the FTC said.

Representatives of USA Pharmacal were not immediately available for comment. An attorney for Health Laboratories director Marc Kaplan called the settlement "fair." He said Kaplan had admitted no wrongdoing.

"Mr. Kaplan believes that he can move forward really with a true sense that he's cooperated with the FTC," said Kaplan's attorney, James Prochnower.

Meanwhile, FTC attorneys are pressing ahead with a lawsuit against two California men and three companies they control, charging that they also made false or unsubstantiated claims about ephedra-containing supplements sold under the names Zymax and MillinexES.

The FTC said it is seeking monetary civil penalties from Michael Levey and Gary Ballen and their companies. It's also seeking an injunction and consumer redress from all the defendants.

Levey and Ballen were not immediately available for comment.

Ephedra, derived from the Chinese herb ma huang, is an adrenaline-like stimulant affecting the heart and nervous system.

Manufacturers of the supplement have insisted their product is safe when taken as directed, but some consumer groups are lobbying to have ephedra products banned completely.

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Panel Seeks to Shield Kids From Dioxins

By Emily Gersema
Associated Press Writer
The Associated Press
Tuesday, July 1, 2003

WASHINGTON - To protect babies from harmful dioxins, the government should help women and girls reduce the fats they consume in meat, poultry, fatty fish and whole milk years before they become pregnant, a scientific panel recommended Tuesday.

The Institute of Medicine (news - web sites) of the National Academies recommended in a report that the government target women and girls in particular because they can pass dioxins to their offspring through the placenta and breast milk.

The government could help prevent the problem by urging women and others to follow the national dietary guidelines, which recommend a diet low in saturated fats, the panel said.

"Perhaps the most direct way for an individual or a population to reduce dietary intake of DLCs is to reduce their consumption of dietary fat, especially from animal sources that are known to contain higher levels of these compounds," the panel said.

Dioxins, or dioxin-like compounds, are pollutants found in air, soil and water, which can be released when industrial waste is burned. They build up in fatty tissues of animals, and scientists believe that humans are exposed to them when they eat animal fats. Breast-feeding infants and unborn children are at risk of suffering harmful effects like behavioral disorders and cancer if they are exposed to high levels.

Indigenous groups in Canada and the United States also are vulnerable because they frequently eat fish and wild game, exposing them to higher than average levels of dioxins, the scientists said.

The scientists did not determine what levels are considered unsafe because current tests for checking dioxins in food are too expensive for widespread commercial use, costing about $1,000 for each test, said Robert Lawrence, chairman of the panel.

"We refrained from setting any risk tolerance limits or mandatory cutoff points for dioxins in the food supply because it would have been cost-prohibitive with current methods," said Lawrence, an associate dean of the Bloomberg School of Public Health at Johns Hopkins University.

The panel also suggested that the Agriculture Department help the 28 million children in the national school lunch program reduce exposure to dioxins by serving them lowfat and skim milk.

The current law for the program supports giving pupils whole milk, although nutritionists have said that drinking it regularly may contribute to heart disease.

Susan Acker, a department spokeswoman, said the agency has been urging Congress to change the national lunch program law to encourage schools to serve children lowfat and skim milk, and many schools already do. Congress could change the law this year because the program is up for renewal.

Despite the panel's fears that animal fats carry dioxins, the food industry said the panel wasn't warning anyone against eating certain foods.

"This report does not recommend that consumers make radical changes to their diets or avoid particular foods because of dioxins," said Rick Jarman, a vice president for the National Food Processors Association.

The panel also recommended that the government:

  • Work with food manufacturers and farmers to develop a plan to curb dioxin levels in food.
  • Start new efforts to reduce dioxins in animal feed and grasses so they will be less prevalent in animals.
  • Make a database to monitor exposure while doing more studies on the effects of dioxins on breast-feeding infants and fetuses.

On the Net: Institute of Medicine: http://www.iom.edu/

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Obesity Hikes Risk of Acid Reflux, Study Finds

By Jacqueline Stenson
Reuters Health
Tuesday, July 1, 2003

NEW YORK (Reuters Health) - Obese people -- particularly women -- have a substantially greater risk of developing chronic acid reflux than their trim counterparts, a Norwegian study released Tuesday shows.

The findings also suggest that the hormone estrogen may promote the condition, said Dr. Magnus Nilsson of the Karolinska Hospital in Stockholm, Sweden, and colleagues.

While many people experience acid reflux occasionally, such as after a spicy meal, those with persistent heartburn and acid regurgitation have a more serious condition known as gastroesophageal reflux disease, or GERD.

In patients with GERD, a muscular valve between the esophagus and stomach weakens or relaxes inappropriately, allowing acidic digestive juices in the stomach to flow back up, or "reflux," into the esophagus. The acid can irritate and burn the esophagus, and in rare cases cause cancer.

The new study, based on a survey conducted in Norway, compared 3,113 people who said they had recurrent, severe heartburn or acid regurgitation during the prior 12 months with another 39,872 people who reported no such symptoms.

Results showed that the link between obesity and GERD was greatest in women, according to the report in the July 2nd issue of the Journal of the American Medical Association (news - web sites).

Those with a body mass index (BMI) over 35, which is considered severely obese, were more than six times as likely to have GERD as women with a BMI below 25, which is deemed normal.

BMI is a standardized measure that takes into account weight and height.

Among men, those with a BMI over 35 were more than three times as likely to have GERD as those with a BMI below 25.

And, suggesting that estrogen may play a role in GERD, the association between obesity and reflux was stronger among premenopausal than postmenopausal women. However, use of estrogen replacement therapy among postmenopausal women strengthened the link.

"Our large, population-based study provides evidence of a dose-dependent association between increasing body mass and the risk of gastroesophageal reflux symptoms," the researchers conclude.

Source: Journal of the American Medical Association 2003;290:66-72.

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Soy Much Goodness

HealthDayNews
Tuesday, July 1, 2003

(HealthDayNews) -- Soy is rich in protein and when eaten instead of meat, it should cut the amount of calories, saturated fat and cholesterol you consume.

The Mayo Clinic suggests some ways to include soy in your diet:

  • Use tofu, a soy product, in stir-fry dishes or scramble it like an egg.
  • Try a soy burger -- it looks and tastes much like ground beef.
  • Snack on roasted soy nuts.
  • Use soy milk in your coffee or cereal.
  • Substitute soy flour for up to 20 percent of the total flour in baked goods.

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Schoolkids Choose Unhealthy Lunches, Study Finds

By Maggie Fox
Reuters
HealthDayNews
Tuesday, July 1, 2003

WASHINGTON (Reuters) - Schools that offer students pizza and fries as alternatives to healthier lunch fare are not only encouraging children to eat high-fat foods during lunch hour -- but after school and at home as well, U.S. researchers said on Monday.

They said schools need to think about whether the money they earn on "a la carte" programs is worth the toll they take on children's health.

Consumer and parents' groups have recently begun complaining about the a la carte programs and availability of vending machines, which offer children more "popular" foods alongside the traditional, and carefully balanced, school lunch.

But little scientific research has been done into the actual effects of offering children such a choice, said Martha Kubik of the University of Minnesota.

"This is probably the first paper that looks at the a la carte programs in schools and their influence on student dietary behavior," said Kubik, a registered nurse.

Her team collected data on 16 middle schools, three of which did not offer a la carte alternatives that include pizza, fries and sweet snacks.

They also took details on what the teenagers ate for the previous 24 hours.

Reporting in the American Journal of Public Health, Kubik said the children who were allowed to choose food outside the standard school lunches ate more fat and fewer fruits and vegetables than the government recommends.

"We weren't just looking necessarily at food they ate at school. We looked at food they ate outside of school as well," Kubik said in a telephone interview.

"That suggests how important the school environment is. If they were at these schools that offered a la carte, they were not making up for choices made at school by eating healthier foods out of school. It shows how powerful the school influence is -- not only are they exposed to their own choices -- they are exposed to the choices of their peers."

Nine out of 10 U.S. schools offer the a la carte programs, which do not have to meet the U.S. government's nutritional recommendations, according to the U.S. Department of Agriculture (news - web sites) (USDA).

These call for eating at least five servings a day of fruits and vegetables and getting no more than 30 percent of calories from fat.

Kubik said she did not believe school districts would easily give them up. "The a la carte programs have become an important revenue source for school food services programs and that's across the country," she said.

The USDA says average a la carte program sales generated $913 per year per 1,000 students in the 1998-1999 school year.

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Ivy Itch

Reuters Health
HealthDayNews
Tuesday, July 1, 2003

(HealthDayNews) -- Poison ivy can be an unpleasant side effect of outdoor romping during the summer months. According to the Tulsa Medical Center, about 85 percent of Americans are sensitive to the resin urushiol, which laces the surface of poison ivy, oak or sumac plants.

A rash caused by contact with poison ivy can be extremely itchy and irritating.

These home remedies may provide relief:

  • Use soap and water or rubbing alcohol to thoroughly wash the exposed area within 10 minutes of contact.
  • Apply cold compresses on any weeping blisters.
  • If the rash is widespread, sprinkle Aveeno in your bathwater.
  • Plain calamine lotion will soothe itching and help dry blistering lesions.
  • Oral antihistamines may help the itching.
  • Keep the area clean, especially after the blisters have broken.
  • Wear loose, breathable clothing.

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MONDAY, JUNE 30, 2003

Pre-Diabetic Condition More Common in Obese Girls

By Matías A. Loewy
Reuters Health
Monday, June 30, 2003

BUENOS AIRES (Reuters Health) - Obese girls are more likely to suffer from a pre-diabetic condition than their male counterparts, putting them at higher risk of adult-onset type 2 diabetes, according to a study presented at the recent annual meeting of the American Diabetes Association in New Orleans.

Dr. Valeria Hirschler and colleagues at the Durand Hospital in Buenos Aires studied a sample of 68 obese boys and 66 obese girls who were about 12 years old, on average.

None of the obese children had type 2 diabetes, but 4.5 percent had glucose intolerance, a precursor to diabetes marked by elevated blood sugar levels. Insulin resistance, a related pre-diabetic condition in which the body fails to efficiently respond to insulin, was significantly more common in girls than boys.

"As far as we know, this is the first time that such gender difference is proven in a pediatric obese population," Hirschler told Reuters Health.

Researchers looked for a relationship between insulin resistance and the children's sexual maturity, based on stages of breast development in girls and genital development in boys. "Girls happened to be more insulin-resistant than boys across all stages of puberty," Hirschler said.

Besides increasing the risk of diabetes, childhood obesity and insulin resistance have also been associated with adult-onset cardiovascular disease. "It is a serious public health problem," Hirschler warned.

Reasons for the gender difference are unknown, said co-author Dr. Mauricio Jadzinsky, head of nutrition at the Durand Hospital. "You could think of hormonal factors, but it has not been scientifically proven yet," he told Reuters Health.

Type 2 diabetes arises when the body can no longer properly use insulin, and the condition is closely linked to obesity.

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Why Stress Strains Health of Elderly Caregivers

By Ed Edelson
HealthDay Reporter
HealthDayNews
Monday, June 30, 2003

MONDAY, June 30 (HealthDayNews) -- Researchers say they have found a molecular reason why a stressful old age can lead to bad health.

Looking after a spouse with Alzheimer's disease (news - web sites) or another form of dementia causes a marked increase in blood levels of interleukin 6 (IL-6), a molecule that weakens the immune system and causes inflammation that can lead to heart disease and a wide range of other illnesses, says a report in this week's issue of the Proceedings of the National Academy of Sciences (news - web sites).

A Ohio State University study found IL-6 levels rose steadily and steeply in 117 caregivers for spouses with dementia, at a much greater rate than that seen in 106 older people not giving care.

And those high levels and lower immune system functions lingered, even up to three years after the ill spouse had died, the researchers found. Some earlier studies had indicated there could be a rebound after a period of bereavement.

IL-6 is a cytokine, a member of a large family of proteins that regulate many cell functions. IL-6 has been connected with heart disease because it stimulates production of C-reactive protein, an inflammatory molecule identified as a cardiovascular risk factor. It is also known to attack immune system cells, reducing the body's defense against disease. Previous studies have linked elevated levels of IL-6 with diabetes, osteoporosis, some forms of cancer and general frailty.

The study ran for six years and started with the participants completing a series of tests for levels of stress, depression and loneliness. Blood samples were also taken and tested at least twice a year.

IL-6 levels normally go up with age. But a persistent difference between the two groups soon emerged.

"We found that the caregivers' average rate of increase in IL-6 was about four times larger than that of the control group," says a statement by study leader Janice Kiecolt-Glaser, a professor of psychology and psychiatry at Ohio State.

The study found "no evidence that the difference in IL-6 patterns between caregivers and controls were simply a function of chronic health problems, medications or health habits," the report says. That "suggests that a chronic stressor is capable of substantially augmenting normal age-related increases, effectively prematurely aging the immune system."

"The most disturbing finding," says Dr. S. Mitchell Harmon, director of the Kronos Longevity Research Institute in Phoenix, "was that even after the caregivers were at least in theory relieved of their burden by the death of a spouse, they didn't recover as people do after a sudden death."

More must be done, but at the moment "we don't know what we can do to help these people," Harmon says. "The bottom line is that we need to do more to relieve the stress of caregiving, or we will have a group of people in the population who are prematurely aged and are most likely to get sick. That is truly a disturbing thought."

More information

You can learn about stress and how to control it by visiting the National Library of Medicine and the American Institute of Stress.

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Eating Disorders Among Hispanic Women Up

By Ananda Shorey
Associated Press Writer
The Associated Press
Monday, June 30, 2003

PHOENIX - Melissa Roman's skin was yellow, her nails were chipping off, her hair was falling out. She had migraines and was frequently fainting.

But the 25-year-old Miami woman didn't think anything was wrong.

"I hit rock bottom," Roman said. "I never thought I was sick, and I was completely in denial."

Roman, a recovering anorexic, is among a growing number of Hispanic women who are developing eating disorders which, until recently, had been typically thought of as a white, suburban problem.

Some health officials say eating disorders started affecting an increasing number of Hispanic women as Latin culture began surging in popularity in recent years. The women are feeling pressure to be thin as they strive to mirror stars who appear to be shrinking as their reputations grow, experts say.

"The dominant culture believes that thinness is beauty and gets you success," said Catherine Shisslak, a professor at the University of Arizona College of Medicine.

Roman, who is trying not to be pressured by such beliefs, is learning to love her body. She posts affirmation notes around her house, sees a nutritionist and a therapist and avoids magazines with unrealistic images of women.

But many Hispanic women seem to be critical of their own bodies.

A study presented at the 2002 International Conference on Eating Disorders in Boston shows that women of color have many of the same abnormal eating patterns as white females, said Shisslak, the study's principal investigator.

The study involving 173 Hispanic, black and white teenagers found that in seventh grade, Hispanic girls were more likely to report the most frequent weight loss attempts over the previous year. Frequent binge eating in the seventh grade was highest among Hispanic girls, according to the study, which was part of a larger 10-year study involving 2,000 girls.

Hispanic women were once thought to be immune to these disorders because they had better body images and different cultural expectations than white women, Shisslak said. But with the high visibility of Hispanic celebrities like Penelope Cruz and Jennifer Lopez, their cultural expectations are changing, she said.

"The more you see Hispanic role models, whether on TV or in movies or from music, emulating a thin body weight, the more you are going to see young girls trying to achieve that," Shisslak said.

Driving the desire to be thin are peer pressure and low self-esteem often the top factors in developing eating disorders, which, besides anorexia nervosa (news - web sites), include bulimia and compulsive overeating, according to health officials.

Anorexia is characterized by fear of weight gain, starvation dieting, excessive exercising and below-normal weight. Bulimia manifests itself in episodes of dieting, bingeing and vomiting.

Shisslak said the university expects to submit another study to the New England Journal of Medicine (news - web sites) that looks at 2,000 girls in fourth through 12th grades.

"The thing that is very disturbing is that, regardless of age, we see this pattern of unhealthy weight loss cutting across all ethnicities," Shisslak said.

Lisa Rubin, a doctoral student in clinical psychology at Arizona State University, said she has found similar rates of eating disorders among Hispanic and white adolescents. Recent research reflecting an increase in the prevalence of eating disorders among Hispanic women doesn't necessarily reflect a new trend, she said.

It may not be so much that more Hispanic women are developing eating disorders now, but that researchers and the media have just started focusing on them, Rubin said.

Also, the number of eating disorders among Hispanic women is unclear because many of them don't seek treatment because of the associated stigma, said Jennifer Nardozzi, a psychologist at the Renfrew Center, a national, nonprofit treatment center where Roman received care.

The reasons behind why Hispanic women are contracting these disorders are also disputed.

Rullina Acra, a nutritionist at the center's Miami facility, said she believes the media are causing more Hispanic women to have eating disorders, but the complex disorders go beyond just wanting to look like a celebrity.

"They don't come in saying I want to look like Jennifer Lopez," Acra said. "It is more complex than that."

The center works to teach patients like Roman that personality factors, the environment and families can also contribute to their developing the disorders.

Roman said she knows now that if she is focusing too much on food, something else is bothering her. But knowing what's going on is only half the battle.

"I still think that I am huge," she said Roman, who is 5-foot-7 and wears size 2. "My mind plays so many tricks.

"I know I have a long way to go, but I do have hope."

On the Net:

Renfrew Center: http://www.renfrewcenter.com/

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Power Bars, Power Calories

HealthDayNews
Monday, June 30, 2003

(HealthDayNews) -- Power bars and energy drinks may make handy snacks but they are often less nutritious than they purport to be, says The Johns Hopkins Hospital.

While they're fortified with vitamins and minerals, power bars are also loaded with calories. According to recent studies by consumerlab.com, the labels on 65 percent of energy bars claimed they contained less carbohydrates, fat and sodium than they actually did.

And sports drinks sometimes contain ingredients that haven't been approved by the US Food and Drug Administration (news - web sites), such as gingko biloba and echinacea (news - web sites).

As an alternative for a quick snack, try regular water, fresh fruit and other whole foods.

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Gene Therapy Uses Virus, Shows Promise

By Paul Elias
AP Biotechnology Writer
The Associated Press
Monday, June 30, 2003

SAN FRANCISCO - Scientists have worked for years to harness the power that viruses have to invade cells, replacing unwanted elements of herpes and other viruses with disease-fighting genes in hopes the new genetic payload would correct a targeted illness.

Such genetic therapies have found limited success so far.

But a team of 12 Japanese and Belgian scientists says it has found promise with the hepatitis B virus, using it as a tool to temporarily treat hemophiliac mice.

The researchers reported Sunday in the online edition of the journal Nature Biotechnology that their technique using a small, hollow fragment of the hepatitis B virus enables the inserted genes to be more narrowly focused than other viral delivery systems.

Engineered viruses sometimes deliver good genes to bad places, setting unintended cellular changes in motion. That's what happened recently to two boys who got leukemia after being successfully treated for the immune disorder commonly called "bubble boy" disease.

Those other viruses have the potential of entering a wide variety of cells, but the researchers said in their report that their hepatitis B method targets only liver cells.

The researchers aren't using the whole hepatitis B virus, but instead are inserting disease-fighting genes inside "nanoparticles," tiny fragments of the virus.

Those nanoparticles dumped their genetic payload of blood-clotting genes almost exclusively in the liver.

Using that technique, the researchers said, their test produced measurable amounts of blood clotting proteins for about 40 days.

The nanoparticle is "a safe vehicle for delivering both genes and drugs," the researchers concluded. The lead author of the study was Tadanori Yamada of Osaka University.

Gene therapy has been controversial since the 1999 death of 18-year-old Jesse Gelsinger, who was given a different type of gene therapy for another disease at the University of Pennsylvania in Philadelphia. He developed an immune response to the virus being used.

French researchers rejuvenated the field last year when they reported curing four boys of severe combined immunodeficiency, or SCIDs, and better known as "bubble boy disease." But that excitement was tempered months later because some of the inserted genes that cured the SCIDS also ended up in the wrong place and caused two of the boys to develop leukemia.

The new technique may better protect against such unintended consequences, the researchers said Sunday.

"Delivery is the big issue in gene therapy," said Dr. Mark Kay, director of Stanford University's Human Gene Therapy Program." This is encouraging. It's the kind of stuff we need in the field."

However, Kay said the latest work had limitations, highlighted by the fact the gene therapy stopped working in the mice after a brief period. Injecting more of the gene-carrying virus will cause the body to build up resistance to the therapy, Kay said.

Another problem arises with the use of the hepatitis B virus because many people are vaccinated against the disease, said gene therapy scientist Inder Verma of the Salk Institute of Biological Studies. The vaccine will kill the therapy as well, Verma said.

"It's exciting and interesting," Verma said. "But now what?"

On the Net:

Nature Biotechnology: http://www.nature.com/nbt

Kay's lab: http://www.med.stanford.edu/kaylab/

Verma's lab: http://www.salk.edu/faculty/faculty/details.php?id54

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U.S. Panel on Fence About Supplements

By Adam Marcus
HealthDay Reporter
HealthDayNews
Monday, June 30, 2003

MONDAY, June 30 (HealthDayNews) -- Earlier this month, researchers reported they couldn't find enough evidence to support claims that vitamin supplements reduce the risk of heart disease.

Now comes a new study from a panel of prevention experts who say they can't recommend supplements to ward off heart disease or cancer.

The quasi-governmental group, called the U.S. Preventive Services Task Force, found insufficient evidence to either promote or discourage taking supplements to prevent cancer and cardiovascular ailments such as strokes and heart attacks. The fence-sitting covers antioxidants such as vitamins A, E and C alone or in combination with each other; multivitamins; and multivitamins that contain the nutrient folic acid.

But the absence of good data doesn't necessarily mean the benefits of supplements are there for the discovery. In one case, solid evidence led the panel to caution against taking extra beta carotene, which the body converts into vitamin A, for cancer or heart disease. Not only do the supplements fail to protect against these illnesses, but they appear to do more harm than good in smokers by raising the risk of lung cancer and premature death.

"With the exception of vitamins for which there is compelling evidence of net harm (e.g., beta-carotene supplementation in smokers)," the report says, "there is little reason to discourage people from taking vitamin supplements. Patients should be reminded that taking vitamins does not replace the need to eat a healthy diet."

The panel, which reviewed 38 published studies, also cautioned consumers from loading up on megadoses of vitamins in the hopes that if a little is good a lot is better. "Some vitamins, such as A and D, may be harmful in higher doses; therefore, doses greatly exceeding the recommended dietary allowance (RDA) or adequate intake (AI) should be taken with care while considering whether potential harms outweigh potential benefits," the report says.

The prevention task force is a group of private health experts convened by the government's Agency for Healthcare Research and Quality. The new report appears in the June 30 issue of the Annals of Internal Medicine. It marks the first time the group has looked at the issue of supplements.

Janet Allan, vice chairwoman of the panel and dean of the school of nursing at the University of Maryland, says the report's conclusions don't rule out the possibility that supplements lower the risk of cancer and heart and vessel diseases. That just hasn't been proved yet.

"The research is young in this area," says Allan, who notes the studies she and her colleagues reviewed were typically short. Longer studies might better tease out the benefits of diet aids (news - web sites) if they exist.

Researchers are now conducting at least eight prevention trials of vitamin supplements and cardiovascular disease, and four prevention trials of the nutrients and cancer, she says: "In the next decade, we'll have a lot better evidence to look at."

John Hathcock, vice president for nutritional and regulatory science at the Council for Responsible Nutrition, a Washington, D.C.-based supplement industry group, says the latest report provides no new information. "It doesn't tell us anything different from what we already know."

Still, Hathcock says his group doesn't dispute the thrust of the report, that dietary supplements haven't been proven to reduce the risk of cancer or cardiovascular disease. If such an effect does exist, he adds, it's likely to be rather small.

However, Hathcock says evidence supports taking supplements to guard against specific tumors -- vitamin C and stomach cancer, for example, and vitamin E for prostate and colon tumors.

More information

Try the U.S. Preventive Services Task Force or the Council for Responsible Nutrition.

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Implant Saves Kids' Legs From Bone Cancer

By Lauran Neergaard
AP Medical Writer
The Associated Press
Monday, June 30, 2003

WASHINGTON - Four-year-old Domonique Patton was a weekend away from having her leg amputated the only solution, her surgeon insisted, for bone cancer in someone so young. Then her mother found a leg-saving alternative: the first bone-replacing implant that doesn't require more surgery to lengthen as a child's other leg grows.

Leitia Patton checked her daughter out of the hospital and drove from Michigan to Chicago hunting a surgeon willing to try the new technology. Then engineers raced to custom-make the "growable" metal rod to fit Domonique their youngest patient yet in the week doctors were able to postpone removing her tumor.

Now two months after surgery, Domonique walks like any preschooler, a narrow scar by her knee the main sign of the struggle to save her leg and her life.

The implant, called Repiphysis, marks a huge advance for children with bone cancer, says Dr. Steven Gitelis, the orthopedic oncologist who operated on Domonique. As the child grows, doctors simply beam painless electromagnetic rays that make the rod slowly expand, instead of repeatedly cutting into the leg as other limb-lengthening devices require.

"There's more enthusiasm I've seen about this device than any prosthetic development over the 23 years I've been doing this," says Gitelis, who heads the limb-preservation department at Rush-Presbyterian-St. Luke's Medical Center in Chicago.

It won't completely end Domonique's trips to the operating room she'll one day need a bigger replacement. But to her mother, who spotted mention of Repiphysis during a late-night, last-ditch Internet search, that's a small price.

"Think if I'd not gone on the computer," says Patton from her Battle Creek, Mich., home, where Domonique is finishing post-surgery chemotherapy. Domonique "still questions it: 'Do I have a bone in there?' She calls it a new leg."

Bone cancer is rare, with only about 1,900 U.S. cases each year. But it is most common in children and young adults, where it usually strikes near the knee. With surgery and chemotherapy, 70 percent are cured.

Amputation once was the only hope. Then surgeons devised ways to cut out the leg tumor and bridge the 6- to 8-inch gap with metal rods, reconnecting thigh and shin bones, new knee included.

That worked for adults, but children were still growing and cutting out the tumor also removed the thigh's growth plate, leaving a salvaged leg painfully shorter than their healthy one.

So next came expandable rods: Surgeons could reopen the leg to periodically add a longer length, or, with minimally invasive versions, slice a small hole in the leg and turn a screw to slide out an extension. Suddenly, 8- to 10-year-olds were having their legs saved.

But the younger the patient, the more surgeries they'd need which is why very young children usually get amputations, Gitelis explains.

Enter the Repiphysis, invented in France in the late 1990s and quietly approved by the Food and Drug Administration (news - web sites) for U.S. sale in December.

Consider a toilet-paper holder: A spring inside adjusts two overlapping ends to the right length. Repiphysis has a similar spring, held by a polymer sleeve hooked to an antenna. Beam harmless electromagnetic rays at the leg and the antenna heats, softening the polymer sleeve until the spring loosens and the rods' ends slowly extend. Turn off the beam and in seconds the polymer hardens, freezing the rod at its new length.

The rod expands a few millimeters at a time, so surrounding skin and muscle aren't damaged and can grow to match. It's done in the doctor's office, no sedation required.

Manufacturer Wright Medical Group of Arlington, Tenn., customizes the $20,000 to $30,000 implant to fit each patient 40 to date. Most are for preteens hoping to avoid at least three additional surgeries they'd need with standard limb-salvage devices, says Brian McDaniel, Wright's custom orthopedics chief. The work normally takes five weeks, done during pre-surgery chemotherapy Domonique's was a special rush job.

It's not for everyone standard limb-lengtheners do work well, particularly for teens, and patients will need an adult-sized replacement when they finish growing. But Wright says 25 of the nation's 100 orthopedic oncologists have begun offering Repiphysis to their youngest patients.

Editor's Note: Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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Mental Tasks Distract Drivers

By Kathleen Doheny
HealthDay Reporter
HealthDayNews
Monday, June 30, 2003

MONDAY, June 30 (HealthDay News) -- If you're one of the millions of Americans heading out for summer vacation by car, the findings of this small study are meant for you: Complicated mental tasks and driving just don't mix.

That's the bottom line from Spanish researchers, whose work is published in the June issue of Journal of Experimental Psychology: Applied.

The researchers evaluated 12 adults, average age 23, as they drove for about four hours on the highway north of Madrid. They were asked to perform various tasks as they drove, and the researchers used an eye-tracking system that helped them study the drivers' gaze for signs of attention and distraction.

Doing complicated mental tasks while driving -- such as tallying up your vacation bill and dividing it by the number of days -- can greatly reduce your performance and lead to accidents, says study co-author Luis Miguel Nunes Gonzalez, a researcher at Spain's Public Administration for Traffic Safety.

The drivers were asked to perform many tasks, such as responding to spotlights periodically flashed into their visual field by pressing buttons near the steering wheel. They were asked to listen to recorded audio messages with information of varying difficulty and to recap what they had heard.

Drivers also received phone calls using hands-free and voice-operated technology. They were asked to calculate in their head how to convert Euros to Spanish pesetas and to relate from memory where they were and what they were doing at a specific day and time.

If you do tasks that involve demanding mental calculation, Gonzalez says, "you are incapacitated to detect visual stimuli [such as the spotlights]." Not detecting the spotlights in time in the study, he says, would be akin to not seeing the car in front of you activate a turn signal.

With complex mental tasks, drivers did more poorly on detecting targets and giving correct responses. Sometimes their performance was 30 percent poorer than compared to control conditions, Gonzalez says.

While many studies have confirmed that external distractions impair drivers, the new study, the authors say, focuses on the dangers of internal distractions -- those produced by the driver's thoughts or cognitive activity -- such as mathematics that is unrelated to driving.

When mentally distracted, Gonzalez says, drivers just don't see objects well or fast enough to use their driving skills.

Another expert who has researched driver distraction says the results seem reasonable to him. They are "quite consistent with UMTRI research," says Barry Kantowitz, director of the University of Michigan Transportation Research Institute and a veteran researcher in the field.

"It is very likely that these results apply to U.S. drivers," he adds.

Even though the drivers in the study were young, Gonzalez says he thinks the same would apply for more experienced drivers. "We compared the same individual against himself in different conditions," he adds.

Based on the study, Gonzalez has lots of advice for drivers. "Distraction affects everybody," he says. "If you do tasks that are demanding [as you drive], such as mental calculations, you are incapacitated to detect visual stimuli."

More information

For information about another kind of distraction, drowsy driving, see National Sleep Foundation.

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Panel Recommends 12 Steps for Cutting Cancer Deaths

By Alicia Ault
Reuters Health
Monday, June 30, 2003

WASHINGTON (Reuters Health) - If more Americans quit smoking, lost a little weight and started eating better, at least 60,000 cancer deaths could be avoided each year, according to a report issued Monday by a government advisory panel.

The Institute of Medicine (news - web sites) (IOM) report recommended 12 steps that could increase cancer prevention and detection, including enforcing laws to reduce tobacco use, developing a national strategy to decrease obesity and encourage a healthy diet and improving the public's understanding of cancer prevention.

"To save the most lives from cancer, health care providers, health plans, insurers, employers, policy makers and researchers should be concentrating their resources on helping people to stop smoking, maintain a healthy weight and diet, exercise regularly, keep alcohol consumption at low to moderate levels and get screened for breast, cervical and colorectal cancer," according to the report.

At a day-long symposium discussing the recommendations and cancer prevention efforts, Dr. Tim Byers, an epidemiologist at the University of Colorado and lead author of the IOM report, said that "just applying what we know" would lead to a 19 percent decline in new cancer cases, and a 29 percent decrease in deaths by 2015. That translates into prevention of 100,000 new cancer cases and 60,000 deaths from cancer each year, he said.

"Many of the behaviors placing people at increased risk for cancer are well recognized, and calls for change are not new," said John Seffrin, CEO of the American Cancer Society (news - web sites). "What is new, however, is the growing body of evidence confirming the effectiveness of interventions helping people improve their health-related behaviors."

Seffrin cited several examples where behavioral changes have led to a decrease in cancer. Declining tobacco use, for instance, has been correlated with a decrease in lung cancer deaths, he said.

"Promoting healthy behaviors is critical to cancer prevention and early detection," said Seffrin, who added that the rising "epidemic of obesity is deeply troubling," and may be harder to address than tobacco use.

The American Cancer Society is starting a new push for more physical activity and better nutrition, he said, noting that epidemiologists from his organization published a study in late April showing a link between obesity and increased risk of 14 types of cancer.

The National Cancer Institute (news - web sites) (NCI) has also begun a new emphasis on prevention and early detection, with a goal of eliminating "the suffering and death due to cancer" by 2015, said NCI director Andrew von Eschenbach.

The agency has $1.76 billion budgeted for those efforts in this fiscal year, he said.

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Magnets and Athletes May Not Mix

HealthDayNews
Monday, June 30, 2003

MONDAY, June 30 (HealthDayNews) -- Slipping magnets in your sneakers apparently won't make you run faster or jump higher.

A new study, published in the current issue of The Journal of Strength and Conditioning Research, reports that magnetic therapy -- in the form of shoe insoles -- did not improve physical performance.

In fact, some scores actually dropped.

Proponents of magnetic therapy claim it helps athletes perform at their best by relieving pain and fatigue -- an idea that has appealed to athletes always searching for ways to improve their performance.

Using 14 male soccer players from the University of Central Arkansas, researchers put the young men through a battery of tests to measure their performance in the vertical jump, 40-yard sprint and bench press, as well as an array of soccer-specific tests. Then, half the athletes wore shoes with magnetic insoles during practice and games for seven weeks.

Scores for those whose shoes contained magnetic insoles showed no significant improvement compared with scores for those without the magnets. Vertical jump and 40-yard sprint scores decreased.

The best way to increase athletic performance and decrease injuries is through a strength-and-conditioning program, according to the National Strength and Conditioning Association.

More information

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

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Extra Stress Stresses Immune System, Too

By Jacqueline Stenson
Reuters Health
Monday, June 30, 2003

NEW YORK (Reuters Health) - Research has indicated that chronic stress can take a hefty toll on a person's health, and a new study offers one potential reason why.

Investigators found that older people under chronic stress had higher-than-normal elevations of interleukin-6 (IL-6), an immune-system protein in the blood that promotes inflammation. IL-6 has been linked with various age-related conditions such as heart disease, diabetes, osteoporosis, frailty and certain cancers.

"This is how chronic stress can really affect health," said study author Dr. Janice K. Kiecolt-Glaser, a professor of psychiatry at Ohio State University in Columbus.

"The take-home advice from this study is that it's really important to try to deal with stress," she told Reuters Health. "The older you are, the more it really matters."

Over the course of the six-year study, IL-6 levels increased an average of four times faster among men and women who were caring for spouses with dementia than among people who were not caring for ill spouses. The study participants ranged in age from 55 to 89 at the beginning of the study, with an average age of 71.

The 119 caregivers reported spending about 10 hours a day on average caring for a spouse when the study began, Kiecolt-Glaser and colleagues note in the online early edition of the Proceedings of the National Academy of Sciences (news - web sites).

Tests conducted periodically throughout the study period showed that the caregivers experienced consistently higher levels of stress and loneliness than the 106 non-caregivers.

In the cases where spouses died during the study, caregivers continued to have high IL-6 levels, even several years later.

All of the study participants were healthy at the outset of the study, and the caregiving and non-caregiving groups had similar levels of chronic health problems during the follow-up period.

However, it's likely that the caregivers would go on to develop a greater number of illnesses due to their higher IL-6 levels, Kiecolt-Glaser said.

"These data provide important evidence of a key mechanism through which chronic stressors may have potent health consequences for older adults, accelerating risk of a host of age-related diseases," the researchers conclude in their paper.

Source: Proceedings of the National Academy of Sciences 2003/doi/10.1073/pnas.1531903100.

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When Abuse Stops, Depression Eases

HealthDayNews
Monday, June 30, 2003

MONDAY, June 30 (HealthDayNews) -- Increased risk of depression appears to be a consequence of spouse or partner abuse rather than a character trait of victims.

Evidence of that comes from a study of 397 women in Seattle who had reported abuse during a 14-month period from 1997 to 1998, the researchers say. They monitored the women for symptoms of depression, checking in three months, nine months and two years after the initial report of abuse, and they also surveyed them on subsequent physical, psychological and sexual abuse.

As the violence decreased or stopped, the women's risk of depression fell as well, says lead researcher May Kernic, an assistant professor of epidemiology at the University of Washington. It dropped 35 percent when abuse ceased altogether and 27 percent when physical or sexual abuse stopped but psychological abuse continued. The findings appear in the current issue of Violence and Victims.

About 1.8 million women are abused by a male partner each year, according to the National Violence Against Women Survey, and previous studies have shown that such violence increases the likelihood of depression and other psychological problems.

More information

Here's where you can learn more about domestic violence.

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Scientists Close in on Mouse Model for HIV

By Linda Carroll
Reuters Health
Monday, June 30, 2003

NEW YORK (Reuters Health) - For more than a decade, scientists have been trying to develop a mouse that could be infected with HIV (news - web sites) so that the disease could be studied in an animal that is readily available and reproduces quickly.

In a step that brings researchers closer to that goal, scientists have shown that mouse cells can be modified to allow the virus to penetrate and reproduce in them, according to a new study published in the journal Nature Cell Biology.

An AIDS (news - web sites) researcher unaffiliated with the new study said that while the research may not immediately yield a mouse that can be used to study HIV, it identifies a crucial step in the process.

"From the beginning, people have been looking for a mouse model," said Dr. James Hoxie, a professor of medicine at the University of Pennsylvania School of Medicine and director of the Penn Center for AIDS Research, both in Philadelphia.

"So far, the only model available has been non-human primates. And they are expensive and increasingly hard to get," Hoxie said in an interview with Reuters Health.

A mouse model would "be a boon to many areas of HIV research, especially vaccine research" Hoxie said.

In earlier studies, researchers found that cells from mice modified to carry human receptors for the virus could be infected with HIV, Hoxie explained. But the virus was not able to reproduce in those mouse cells. That's because the virus-infected mouse cells weren't able to produce an important building block needed to make new viral particles, Hoxie said.

For the new study, Dr. B. Matija Peterlin and colleagues at the University of California at San Francisco tweaked mouse cells to carry not only the human receptors that allowed infection, but also two key proteins, CycT1 and hp32, that appear to support replication of the virus.

After infecting these mouse cells with HIV, the researchers were able to show that the cells produced both the building blocks for the virus and new viral particles.

"This is an interesting and promising model," Hoxie said. "But just because it works in mouse cells, doesn't mean it will work in a mouse. This is an exquisitely regulated system. You need just the right amount of (hp32). Too much could be just as bad as too little."

Source Nature Cell Biology 2003;5:611-618.

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SUNDAY, JUNE 29, 2003

Acupuncture Helps Children Handle Pain

By Kathleen Doheny
HealthDay Reporter
HealthDayNews
Sunday, June 29, 2003

SUNDAY, June 29 (HealthDayNews) -- The boy was just 8, but he suffered from Crohn's disease, a painful intestinal inflammation. He was on medication, but struggled with frequent headaches, one of the potential side effects of the treatments.

So Dr. Lixing Lao, a licensed acupuncturist and director of the traditional Chinese medicine research program at the University of Maryland's Center for Integrative Medicine, suggested acupuncture to the boy and his parents.

They agreed to try it and after a series of weekly treatments, the child noted a dramatic drop in pain. "In the beginning, it was done once a week for several months," Lao remembers. "When the condition was controlled, it was less frequent." Eventually, the boy didn't need acupuncture to control the pain.

Lao is one of a growing number of acupuncturists and other health-care providers who offer the ancient Chinese therapy to children. Increasingly, pediatricians are embracing the idea -- acupuncture is now an option at about one third of the 43 pediatric pain clinics nationwide, according to the American Academy of Pediatrics.

"It's becoming more accepted in the U.S.," says Lao, who learned the therapy as part of his medical training in China.

The American Academy of Pediatrics thus far has no official policy on acupuncture use on children.

But in 1997, the National Institutes of Health (news - web sites) (NIH) issued a general consensus statement that acupuncture can help relieve certain conditions, such as nausea and vomiting that accompany chemotherapy and post-operative dental pain. The NIH statement also said acupuncture may be effective as an adjunct therapy or alternative therapy for other conditions, such as asthma, headache, low back pain, menstrual cramps and other problems.

Lao says acupuncture shows promise for a number of childhood health problems, including asthma, diarrhea, loss of appetite, eating disorders -- even attention-deficit hyperactivity disorder.

Acupuncture -- inserting fine needles into the skin -- relies on the premise that the body has up to 2,000 "points" that are connected by meridians (lines) of energy known as Qi ("chi"). When Qi flows well, the body stays healthy. Acupuncture restores the balance of the energy flow, or Qi.

While Lao says it's best to use acupuncture on a child no younger than 5 or 6, other experts start earlier.

Dr. Lonnie Zeltzer, director of the pediatric pain program at the David Geffen School of Medicine at the University of California, Los Angeles, says she has used acupuncture on infants.

Combining acupuncture with other complementary medicine techniques works well, too, Zeltzer says. In a recent study, she and her colleagues evaluated the use of acupuncture and hypnosis together to treat chronic pain.

They evaluated 31 children, aged 6 to 18, who had a variety of health problems, such as gastric pain so severe they were doubled over or migraine headaches that a pediatric neurologist could not treat successfully.

After the needles were in place, a psychology intern performed hypnosis during the 20-minute acupuncture sessions. Then another researcher helped the child imagine a "favorite place," Zeltzer says.

"The overall improvement was pretty impressive," Zeltzer says. Both parents and the children reported significant improvements in pain after the sessions, according to the study, which appeared in the October 2002 issue of the Journal of Pain Symptom Management.

"I actually think any pain condition is amenable to acupuncture," Zeltzer says, "especially those that aren't easily fixed [by other treatments]."

The experts' advice to parents: "If their children have a common disorder and they are concerned about side effects of medication, they should consider acupuncture," Lao says. "They can also combine acupuncture with conventional medicine."

Requirements for practicing acupuncture vary state by state. To be sure an acupuncture practitioner -- whether he or she is an acupuncturist or a physician -- is qualified, experts suggest getting a referral from your child's pediatrician or inquiring at a pediatric pain clinic.

More information

For more information on acupuncture, see the American Academy of Medical Acupuncture. For the National Institutes of Health's consensus statement on acupuncture, click here.

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Heat and Humidity a Deadly Combination

HealthDayNews
Sunday, June 29, 2003

SUNDAY, June 29 (HealthDayNews) -- The discomfort of hot and humid weather is obvious to anyone who's suffered through it.

However, you may not be aware that it's a potentially deadly combination that can cause heat exhaustion and heat stroke.

About 175 Americans die from extreme heat during a normal weather year, says the U.S. National Oceanic & Atmospheric Administration (NOAA).

The people most likely to be victims of heat-related death are young children, elderly people and those who are sick or overweight. Men are more susceptible than women because they sweat more and therefore become more quickly dehydrated.

Your body sheds heat in different ways: by varying the rate and depth of blood circulation; by sweating; and even by panting. However, once the air temperature reaches 95 degrees Fahrenheit, your body relies on sweating to control its internal temperature, NOAA says.

High humidity gums up your sweating cooling system. Sweating relies on evaporation to remove the moisture from your skin and cool you down. When there's high humidity, there's a great deal more water vapor in the air. That reduces the amount of evaporation that can take place to keep you cool.

If you want to stay safe and healthy when it's hot and humid, check out the following advice from NOAA.

  • Avoid the heat if you can by spending time in air-conditioned settings such as shopping malls. Just two hours a day in air conditioning greatly reduces the risk of heat-related illness. If you have to stay in a home where there's no air conditioning, stay on the lowest floor of your home out of the sunshine. li>Wear loose-fitting clothing that covers as much skin as possible. The clothing should be lightweight and light-colored so that it reflects heat and helps you maintain normal body temperature. Wear a wide-brimmed hat and avoid too much sunshine.
  • Drink lots of water and natural juices, even if you're not thirsty. Avoid coffee, tea, cola and alcohol, all of which increase dehydration. Eat small meals more often and avoid foods high in protein, which increase your body's metabolic heat.
  • Slow down. If you have to do outdoor exercise or yard work, do it in the early morning or late evening hours. Take cool baths or showers.

More information

The American Red Cross (news - web sites) has information on how to cope with a heat wave.

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ACL Injuries in the Young Take Extra Time

HealthDayNews 
Sunday, June 29, 2003

SUNDAY, June 29 (HealthDayNews) -- To operate or not to operate? That is the significant question when it comes to treating anterior cruciate ligament (ACL) injuries in adolescents.

Traditional surgical procedure for an ACL tear involves drilling tunnels in the bone through the growth plate, which is located very near the knee joint in the ends of the femur (thighbone) and the tibia (shinbone). This isn't a problem for adults because the growth plate closes at the time of skeletal maturity -- when you're around 14 years old. But a child's bones are still growing, so damage to the growth plate can cause the tibia or femur to grow at an incorrect angle and produce a skeletal deformity.

According to Theodore Ganley, the orthopedic director of sports medicine at Children's Hospital in Philadelphia, the prevailing wisdom for dealing with injured kids in the 10-13 age range is the following: activity modification, counseling, exercises to strengthen the quadriceps and a brace, if necessary. Most important, the child needs to avoid high-level athletic activities that involve running, jumping and changing direction quickly, such as soccer and football. However, it's essential to prevent repeat injuries, and if this can't be done in a non-operative manner, surgical intervention might be considered.

"We hold kids off from surgery until they reach a bone age of 13 in girls and 14 in boys. That's just about a mandatory thing," Ganley said. "If your hand is forced and you have to do surgery, we use a procedure called 'going over the top,' which means you go around the back of the femur instead of going through a tunnel."

More information

For additional insight into ACL injuries and surgery, visit this informational site.

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SATURDAY, JUNE 28, 2003

Easing Back Pain

HealthDayNews
Saturday, June 28, 2003

SATURDAY, June 28 (HealthDayNews) -- Osteoporosis, a disease that affects more than 10 million Americans, can cause bones to thin so dramatically that even a minor trauma can cause a spinal fracture known as a vertebral compression fracture.

Most of the 700,000 vertebral compression fractures that occur annually in the United States are minor, reports Dr. Laura Paré, an associate clinical professor of neurological surgery at the University of California, Irvine. The main symptom is back pain, but it's often hard for older people to distinguish between the pain from a fracture and the everyday aches and pains of arthritis, says Paré.

In fact, she explains, the reason many people with osteoporosis have a hunched posture is because they have suffered repeated compression fractures.

X-rays, CT scans and magnetic resonance imaging (MRI) can all quickly diagnose a compression fracture. For less severe fractures, Paré says doctors usually treat patients with a brace, extra calcium, vitamin D and medications if necessary.

Treatment for more serious fractures is usually a surgical procedure known as vertebroplasty. Using X-rays for guidance, surgeons thread tubes and wires through the skin to the fractured vertebrae, and they then inject bone cement and antibiotics at the fracture site to strengthen it and reduce pain.

Another surgical procedure, known as kyphoplasty, is also available and is similar to vertebroplasty. The big difference is in kyphoplasty a small balloon is also placed into the vertebrae to help straighten out the area that was fractured. Paré notes vertebroplasty is a quicker and easier procedure.

More information

For more information on compression fractures and their treatment, go to the National Library of Medicine.

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