The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
August 20, 2002




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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 August 10 -- 16

FRIDAY, AUGUST 16, 2002 

Report: Water Diseases On Rise

By Colleen Valles

Associated Press Writer

The Associated Press

Friday, August 16, 2002

As many as 76 million people — mostly children — could die from water-related diseases by 2020 if changes aren't made worldwide, according to a California think tank.

The United Nations ( news - web sites) has set a goal of 2015 for cutting in half the number of people who can't reach or afford safe drinking water. Even if that goal is met, 34 million to 76 million people could die of water-related illnesses, said a report for release Friday by the independent Pacific Institute for Studies in Development, Environment and Security.

More people die of diarrheal diseases, such as dysentery, than other water-related diseases, and children are extremely vulnerable to them.

"All of these diseases are associated with our failure to provide clean water," said Dr. Peter Gleick, director of the institute. "I think it's terribly bleak, especially because we know what needs to be done to prevent these deaths. We're doing some of it, but the efforts that are being made are not aggressive enough."

The problem is many people, especially those in developing countries in sub-Saharan Africa and southern Asia, don't have access to clean water or basic sanitation, Gleick said.

While most of the deaths are projected to occur in developing nations, Joan Rose, professor of water microbiology at the University of South Florida, said every country is vulnerable. She pointed to a recent deadly outbreak of E. coli in Canada that came from a contaminated well.

"We look at our political agreements like NAFTA, and they've been economically beneficial to South America because we have allowed them to export their vegetables to the United States," she said. "But none of that finance has been reinvested in sanitation, and in fact, we may be getting vegetables — we already have — that bring diseases into the United States."

The United Nations says 1.1 billion people worldwide live without access to safe drinking water and 2.5 billion lack proper sanitation.

The institute will send the report to the World Summit on Sustainable Development being held Aug. 26 through Sept. 4 in Johannesburg, South Africa.

On the Net:

Pacific Institute for Studies in Development, Environment and Security:


CDC Team Gauges Risk of West Nile Spread Via Blood

By Mary Beth Nierengarten

Reuters Health

Friday, August 16, 2002

NEW YORK (Reuters Health) - West Nile virus ( news - web sites) infection, the mosquito-borne illness now spreading across the US, could be transmitted through blood transfusions, researchers from the Centers for Disease Control and Prevention ( news - web sites) (CDC) report.

But the risk--while relatively high--would only exist for blood donated during peak times of infection, they conclude.

West Nile virus is carried by certain birds, and can be passed to humans via mosquitoes. The virus--which originated in Africa and was first spotted in the United States in New York in 1999--has quickly spread west and south across the US.

West Nile risk would be highest for blood donated at times and places when the infection was most common--for example the northeastern US in late August, the CDC researchers say. If patients given blood that was donated during such periods exhibit West Nile virus-like symptoms, they add, doctors should consider the possibility that the patient has contracted the infection from the blood donation.

It is particularly important to determine if West Nile could be spread by transfusion, Dr. Brad J. Biggerstaff from the CDC's National Center for Infectious Diseases in Fort Collins, Colorado and Lyle R. Petersen note, because people infected with the virus usually don't have symptoms. But among those who do develop severe illness, fatalities range from 3% to 30%, with the highest death rate among the elderly. There is no cure for the infection.

To investigate the theoretical risk that West Nile virus could be spread by donated blood from infected individuals, Biggerstaff and Petersen conducted a statistical analysis of the 1999 outbreak in Queens, New York. They report the findings in the August issue of the journal Transfusion.

The researchers examined the date of onset for people infected with the West Nile virus during the 1999 epidemic and estimated the number of people who had the virus in their blood throughout the outbreak. To infer the transfusion-transmission risk based on these data, the investigators then estimated the inapparent-to-apparent infection ratio, the proportion of asymptomatic infections, and the size of the population.

The minimum risk of a donor transmitting the West Nile virus through his or her blood during the 1999 outbreak was found to be 1.8 in 10,000 donations, with a maximum risk of 2.7. The risk of transmission was time-limited, peaking during the months of August and September, the period in the northeastern US with the highest rate of infections. Estimates of infection entering the blood supply before August or after September fell to nearly zero.

Elsewhere in the US, the time of highest activity of West Nile virus may start earlier, Biggerstaff noted, "as with the current outbreak in Louisiana. In other parts of the US where West Nile virus is new, we just don't know yet."

Although the estimates indicate a theoretically low risk of transmitting the West Nile virus through transfusion, they are relatively high compared to transfusion-transmitted viruses regularly screened for, such as HIV ( news - web sites). Estimates for HIV, for example, range from 1 per 200,000 to 2 million.

"While the estimates we give are relatively high," explained Biggerstaff, "it's important to remember that the average rate we give is during the outbreak only and for the area of the outbreak only, and that the rate is lower outside this time frame and locale."

Implications of this study suggest that doctors should consider the possibility of transfusion-transmitted West Nile virus in patients with unexplained symptoms suggestive of this virus, particularly if the blood donation was obtained when the activity of the virus is highest. "But they should also be aware of the level of risk or chance of such an occurrence when making a clinical decision," Biggerstaff added.

Source: Transfusion 2002;42:1019-1026.  


Smoking During Pregnancy Increases Kid's Asthma Risk


Friday, August 16, 2002

FRIDAY, Aug. 16 (HealthScoutNews) -- Children whose mothers smoked during pregnancy have an increased chance of getting asthma if they don't have a certain type of enzyme.

The enzyme also exists as a variation, and the variation is so common in children that it affects the ability of the lungs to protect themselves, according to a study in the latest edition of the American Journal of Respiratory and Critical Care Medicine. And if mothers were smoking while they were pregnant, their children were more susceptible to asthma and other respiratory illnesses, the researchers conclude.

The variation involves a gene called glutathione S-transferase M1 (GSTM1), which creates an enzyme that helps the lungs protect themselves from pollutants. The enzyme detoxifies some tobacco pollutants and defuses oxidants before they can damage lung tissue.

Children with the GSTM1 null genotype who were exposed to cigarette smoke while in the womb were much more likely to have asthma, wheezing and breathing-related emergency room visits compared to children with the GSTM1 present genotype, the study says.

Researchers at the Keck School of Medicine at the University of Southern California studied 2,950 children in grades 4, 7 and 10. Their parents were asked about whether the mother smoked when she was pregnant, and whether their kids had suffered breathing problems.

More than 16 percent of the children had mothers who smoked during pregnancy, and more than 45 percent of the children had the GSTM1 null genotype.

When the researchers looked at the children with the null genotype whose mother smoked during pregnancy they found:

  • Almost a four-fold increased risk for emergency room visits within the past year.
  • More than a double risk for wheezing with exercise and wheezing requiring medication.
  • An 80 percent increased risk for a lifetime history of wheezing.
  • 70 percent and 60 percent increased risks for asthma with current symptoms and early onset, asthma, respectively.

There was no increased risk for respiratory problems in children with the GSTM1 present genotype who were exposed to cigarette smoke in the womb.

"Findings show that exposure to smoke in the womb for certain genetically susceptible children may have long-term health effects," says study author Dr. Frank D. Gilliland, professor of preventive medicine.

"Maternal smoking is common, and the null genotype is found in nearly half of the population, so this high-risk group might be an important population to target for prevention," he says.

More information

Nicotine addition is one of the hardest habits to kick. But if ever there was reason to quit, pregnancy has to be at the top of the list.

This useful question-and-answer page from the American Lung Association explains the risks a woman runs by continuing to smoke during pregnancy.


Stimulation Boosts Brain Cells in Aging Mice: Study

Reuters Health

Friday, August 16, 2002

NEW YORK (Reuters Health) - A stimulating environment in middle to late life may be just the trick to bolster a region of the brain associated with memory and learning, according to the results of a study in mice.

"It is common sense and backed by epidemiological data that to lead an 'active' life is beneficial for mind and brain," report Dr. Gerd Kempermann of Humboldt University in Berlin, Germany and colleagues.

However, the study authors note that there is a dearth of scientific evidence about what's happening at a cellular level in the stimulated brain.

In their study, published in the August issue of Annals of Neurology, the research team studied 10- to 20-month-old mice. The animals were middle-aged to elderly, as most mice go through menopause at 10 to 13 months of age and generally have a life span of 2 years.

One group of mice lived in standard cages and the other lived in "enrichment housing"--cages filled with running wheels, tunnels, toys and choices of food.

After 10 months, mice living in the enriched environment were found to have five times the number of new brain cells in their hippocampus--a region of the brain associated with memory and learning--as mice living in bland surroundings. What's more, the mice in the standard cages had 50% more cells containing aging-related deposits as rodents living in the enriched environment.

The results, according to the authors, suggest that enriched environments may help the brain maintain a certain level of plasticity, which in turn could keep memory and mental function intact as a person ages.

Nonetheless, Kempermann and colleagues note that "the concept of environmental enrichment in studies with inbred rodents cannot be easily applied to the human condition."

Source:  Annals of Neurology 2002;52:135-143.


Mohs Surgery: Gold Standard for Skin Cancer

By Irene S. Levine
HealthScoutNews Reporter


Friday, August 16, 2002

FRIDAY, Aug. 16 (HealthScoutNews) -- It's called the Mohs procedure, and it's considered the gold standard for treating many skin cancers, but few people have ever heard of it.

Some doctors think the painstaking procedure is not always necessary, but surgeons trained in the practice note it's critical to remove tumors completely the first time around since they're tougher to treat if they return.

According to the American Cancer Society ( news - web sites), about 1.3 million cases of non-melanoma skin cancer are diagnosed each year. In 2002 alone, 2,200 people will die of these cancers.

The good news is this type of skin cancer is almost 100 percent treatable when found early. The goal of treatment is to remove or destroy the cancer completely, with as small a scar as possible.

Options include surgery, curettage and electrodessication, cryosurgery, laser therapy, radiation and topical chemotherapy and Mohs surgery.

Over the past 30 years, a growing number of patients and doctors are opting for the Mohs technique, which was first developed by Dr. Frederic Mohs at the University of Wisconsin in 1936.

"It's a relatively new surgical procedure in medicine, but it has now become the standard of care for certain tumors," says Dr. Matthew Brett Quan, a Mohs surgeon at the Center for Dermatology, Cosmetic and Laser Surgery in Mount Kisco, N.Y. Quan spent a year studying the procedure, and has been a Mohs surgeon since 1996.

The Mohs procedure is used when a doctor doesn't know the shape or depth of a tumor; when the tumor is in a hard-to-treat area such as the nose, eyelid or face; or when the tumor is a recurrence. In these instances, many insurers will cover the costs of the procedure.

Surgery generally takes place in an outpatient setting. After applying a local anesthetic to the affected area of the skin, the Mohs surgeon removes a thin layer of skin, marks its location, and examines it under a microscope.

The tissue is mapped on a color-coded grid so the surgeon can pinpoint the corresponding location on the wound. If cancerous tissues are still found, the process is repeated until the slides are cancer-free.

Because it can take up to an hour to examine each slide, the procedure can take half a day or more to complete. If the tumor is extensive, it may take more than a day.

The major difference between the Mohs technique and conventional surgery is the precision achieved by using the microscope to inspect samples of skin. This conservative approach maximizes the saving of healthy tissue, resulting in faster healing and better cosmetic results. Reconstructive surgery isn't needed unless the wound is very large.

However, unless a patient has had skin cancer before or knows someone who has, how likely are they to find a Mohs surgeon or look for one?

"Unfortunately you totally rely upon your dermatologist, your family practitioner, or whoever did your biopsy to tell you where to go and what to do," Quan says.

He suggests patients educate themselves through the Internet, and cautions that some dermatologists are doing the procedure with only minimal training.

Dr. Robert Greenberg is a dermatologist in Vernon, Conn., and a member of the American Academy of Dermatology. He believes the surgery is appropriate under certain circumstances and refers patients, as necessary, to qualified Mohs surgeons. However, he says many non-melanoma skin cancers can be treated adequately with conventional techniques.

"These procedures are much less costly, less invasive and easier on the patient," Greenberg says.

Moh's is time-consuming, labor-intensive and generally costs more than twice the price of any treatment except radiation, leading some critics to call the procedure "fee-effective."

Quan disagrees: "You get a smaller scar and a higher cure rate. Why not do it? They're harder to get out the second time around."

What To Do

Visit the Mohs College of Surgeons for more on the procedure and how to find Mohs surgeons.

The American Academy of Dermatology has more on skin cancer.


Alcohol Initially Packs Bigger Punch for Some

By Keith Mulvihill

Reuters Health

Friday, August 16, 2002

NEW YORK (Reuters Health) - People with a family history of alcoholism may respond more intensely to alcohol's initial intoxicating effects and develop a tolerance within a few hours, new study finding suggest.

This may cause them to drink more alcohol so they can get back the initial buzz they were feeling when they first started drinking, explained Dr. Sandra L. Morzorati of the Indiana University School of Medicine in Indianapolis, in an interview with Reuters Health.

In the current investigation, Morzorati and colleagues wanted to know how people with a family history of alcoholism respond to feelings of intoxication compared to those from families without the drinking disorder. Their study results are published in the August issue of the journal Alcoholism: Clinical and Experimental Research.

To do so, the team looked at 58 adults who had at least two members of their family--be it a parent, sibling, cousin, aunt or uncle--that were alcoholics and compared them with 58 adults from non-alcoholic families. None of the participants were alcoholics themselves.

The researchers administered alcohol directly into the participants' blood and gave them breath tests that measured the amount of alcohol in their system. Blood alcohol levels were held constant at 0.06, slightly below the legal limit of 0.08.

After 20 minutes, those with a family history of alcoholism reported "more intense levels of intoxication" compared to the other group, Morzoroti explained. "At 2 hours, when they had adapted to the alcohol, they were not feeling as big of a punch as they were after just 20 minutes," she said.

The experiment, noted the researcher, revealed that people with a greater risk of alcohol dependence appear to have a distinct response to moderate alcohol consumption.

"It's been known for some time that people with a family history of alcohol (abuse) are more likely to have a genetic predisposition for alcoholism. The findings of our study support that further," she said.

Source: Alcoholism: Clinical and Experimental Research 2002;26:1299-1305.


How Much Water Should You Drink?

By Adam Marcus
HealthScoutNews Reporter


Friday, August 16, 2002

FRIDAY, Aug. 16 (HealthScoutNews)-- The mantra on daily water consumption may be a washout.

When you ask for advice on how much of the clear, cool liquid you should swig each day, there's a good chance you'll hear the following: At least eight 8-ounce glasses, or 64 ounces, of water each day.

But a New Hampshire doctor says that advice is hogwash, a national myth with no basis in physiologic fact.

Dr. Heinz Valtin, of Dartmouth Medical School, has researched the matter of adequate water intake and found a desert of evidence in support of the "8 x 8" theory.

Instead, Valtin says, those 64 ounces a day will get you little farther than the bathroom. In rare cases, people who drink too much may suffer "water intoxication" by overloading their kidneys. This phenomenon has been seen in athletes, Ecstasy users and even healthy people.

True, some of us may indeed need that half-gallon of water on some days -- when we're working out in the heat or flying for long distances in a dry airplane cabin. However, those situations appear to be the exceptions, not the norm.

"I have found no scientific proof that absolutely every person must drink at least eight glasses of water a day," says Valtin, a kidney specialist, in a statement. His review of the subject appears in the latest Internet edition of the American Journal of Physiology.

Valtin says the 64 ounces-a-day figure might have been a bastardization of recommendations from the National Research Council ( news - web sites)'s Food and Nutrition Board, which in 1989 called for roughly a milliliter of water coming in for every calorie of energy expended.

However, the guidelines go on to state that most of that amount -- 64 ounces to 80 ounces, on average -- can be obtained in prepared foods that are rich in fluids.

Items like juice, milk, soda and coffee are almost entirely water and may be reasonable substitutes for glasses of the plain stuff, Valtin says.

Yet, while the origins of the 8 x 8 myth are murky, the booming bottled water industry is clearly a driving force behind its promotion. Witness, which boasts of being "the first e-commerce site for the purchasing and delivery of high quality spring water."

A "Live Healthy" section of the site, part of the Suntory Water Group in Atlanta, declares that "most experts agree that eight 8-ounce glasses is a good rule of thumb. But every individual has his or her own needs, and the amount of water needed from person to person varies, depending on their weight and level of activity."

However, it seems the only variable is how much more than 64 ounces a day you need. On a water intake calculator provides, a 160-pound person who got no exercise is advised to drink 80 ounces, or between six and seven 12-ounce glasses, a day. Adding a 20-minute workout to the routine ups that figure to 84 ounces.

Stephen Kay, a spokesman for the International Bottled Water Association, says the 8 x 8 recommendation "certainly was not invented by the bottled water industry, nor is it a bottled water issue only. The issue overall is really water and water consumption" for proper hydration.

While a variety of foods have fluids, Kay says water is the "most direct source" of, well, water. It also happens to be free of calories, caffeine and other potentially undesirable substances. A statement on the group's Web site in response to Valtin's paper says it "remains supportive" of the 8 x 8 guidelines.

The Food and Nutrition Board is now reviewing daily water consumption. Its recommendations should be released in March 2003, says Paula Trumbo, a nutritionist who's in charge of the project.

Trumbo says her group is not relying on Valtin's paper, since it's a review not a study. However, she adds she agrees so far with his conclusion that there's little data supporting the conventional water wisdom.

"No one really knows the scientific basis for" the 8 x 8 rule, Trumbo says. "It's kind of hard to say whether it's credible or not."

The panel is conducting a study to clear up the question of how much water a person needs. Whatever answer emerges is sure to vary by weight or climate, for example, she says.

They're also looking at how, if at all, water intake affects certain health outcomes, from kidney stones to heart ailments, and whether the fluid in foods such as fruits and vegetables is an adequate source of H2O.

"We will be very specific in saying what this value is for," Trumbo says.

What To Do

For more on water and health, try the University of Iowa. For the water industry's perspective, visit the International Bottled Water Association.


Obesity Linked to Increased Breast Cancer Rates in Hispanic Women


Friday, August 16, 2002

FRIDAY, Aug. 16 (HealthScoutNews) -- Obesity may be a contributing factor to increasing cases of breast cancer ( news - web sites) among Hispanic women.

While Hispanic women have been known to be at lower risk than most other women for developing breast cancer, the rates are climbing, according to a study in the August issue of the Annals of Epidemiology. The increasing risk of breast cancer for Hispanic women before and after menopause may be due to the weight they gain in adulthood and their percentage of body fat, the research suggests.

It was done by scientists from the University of Southern California (USC), the University of New Mexico and Johns Hopkins University.

This is the first study to examine the relationship between weight and breast cancer risk in Hispanic women.

"We know that breast cancer incidence and mortality have been rising in Hispanic women, but no one knows why," lead investigator Dr. Frank D. Gilliland, assistant professor of medicine, USC's Keck School of Medicine, says in a statement.

"The thought was that perhaps these women were starting to have fewer children, have having them later in life, which may increase risk. But we looked at all the major reproductive factors, and they explained only 5 percent of the increase in risk. Something else must be going on," Gilliland adds.

The study included more than 1,500 Hispanic and non-Hispanic white women with breast cancer in New Mexico in the early 1990s. The researchers collected information about the women's current weight, their weight at age 18, menopausal status and use of hormone replacement therapy.

They found that obese Hispanic women had nearly twice the risk of breast cancer, and that risk was greater regardless of whether they had gone through menopause. Obese non-Hispanic white women had increased breast cancer risk only after menopause.

Hispanic women whose weight at the time of the study was more than 30 pounds heavier than their weight at age 18 more than doubled their risk of breast cancer.

The study also found that breast cancers linked to weight gain in Hispanic women and post-menopausal non-Hispanic white women mostly were estrogen- and progesterone-receptor positive. Also, breast cancer risk was higher in women who never used estrogen and who gained the most weight.

Obesity in Hispanic women increased 80 percent from 1991 to 1998, the study says, with about 25 percent of that population being classified as obese.

More information

Weight gain among Hispanic women also poses a risk for polycystic ovarian syndrome, as this article from Columbia University indicates.  


Epidurals Don't Cause Long-Term Back Pain

By Kathleen Doheny
HealthScoutNews Reporter


Friday, August 16, 2002

FRIDAY, Aug. 16 (HealthScoutNews) -- Epidurals, used for pain relief during labor, don't seem to cause the back problems later on that many women fear.

British researchers have found no significant differences in self-reported low back pain or disability in women who received epidurals and those who got other kinds of labor pain relief. The report appears in tomorrow's issue of the British Medical Journal.

The researchers assigned 369 first-time mothers-to-be either to a group that received an epidural for pain relief or to a group that got various other forms of pain relief. An epidural is a local anesthetic, delivered in the small of the back, just outside the spinal canal. It lets a woman remain conscious during childbirth.

Then, they asked the women to participate in a follow-up study to track back pain and other problems; 151 from the epidural group and 155 from the non-epidural group participated. The researchers say they were prompted to do the study because several studies on back pain and epidurals have produced inconsistent results.

"We found no real surprises, and the study merely confirmed what we already suspected: that there was no causal association between epidurals for labor and long-term backache," says lead author Dr. Charlotte Howell, a consultant anesthetist at the North Staffordshire Hospital Trust, in Stoke on Trent, Staffordshire.

"But it was interesting to see how similar the groups were in terms of the results," Howell adds.

Back pain, however, was common in both groups, who were interviewed an average of 26 months after giving birth. More women in the epidural group reported severe pain, the researchers found. However, pain lasting more than a year was more common among the women who did not receive an epidural, with 64 women in the non-epidural group having pain for more than a year and 47 of those in the epidural group having pain that long.

"It is highly likely that long-term backache following pregnancy is due to the pregnancy itself," Howell says. "But this is difficult to establish because many women have back pain and many women also use epidurals. They tend to associate the two, and this will probably continue to be the case."

Women wondering what pain relief is best for them during labor should consult their anesthesiologist. "There is rarely a good reason to advise a woman against an epidural for labor, and no evidence to suggest that epidurals make established back pain worse," Howell adds.

Anesthesia experts have mostly praise for the study.

"This is an obvious finding for those of us who practice in this arena," says Christopher Stein, president of the California Association of Nurse Anesthetists who works in pain management and has experience in obstetrical pain relief.

Still, he says the study may help dispel misconceptions about epidurals that persist among some women, who may avoid them due to what they mistakenly think is a higher risk for lower back pain.

"The study has a good random sample," Stein adds.

However, he does see a few flaws. "They didn't control for who was doing the epidural," he says, although he concedes that would be difficult to do. Still, the skill of the operator, he adds, can make a difference. Also, they didn't ask about preexisting back pain.

"Epidurals are very safe," adds Dr. Michael Ferrante, an anesthesiologist at Santa Monica-UCLA Medical Center and co-director of the UCLA Spine Center. "There is no trauma, except to the soft tissue and that heals within two weeks or so."

He often hears concerns about epidurals raising the risk of low back pain, but tells patients it is "pure superstition."

The latest study, he says, "is nice, though a little bit flawed." He, like Stein, points out the researchers did not control for preexisting back pain.

What To Do

For information on different forms of pain relief during childbirth, see The American Association of Nurse Anesthetists or the"; American Society of Anesthesiologists.


Nothing Corny About It -- It's Good For You


Friday, August 16, 2002

FRIDAY, Aug. 16 (HealthScoutNews) -- Here's a kernel of good news about sweet corn you can share with friends and neighbors at your next corn roast.

Whether you eat it on the cob, steam it, or cream it, cooking sweet corn unleashes beneficial nutrients that can substantially reduce your risk of heart disease and cancer, Cornell University food scientists report in the current issue of Journal of Agriculture and Food Chemistry.

When you cook sweet corn, you actually boost its antioxidant activity, their study says.

"There is a notion that processed fruits and vegetables have a lower nutritional value than fresh produce," says lead author Rui Hai Liu, assistant professor of food science. "Those original notions seem to be false, as cooked sweet corn retains its antioxidant activity, despite the loss of vitamin C."

Liu and his colleagues cooked sweet corn kernels in batches at 239°F for 10, 25 and 50 minutes. They found the antioxidants in the corn kernels increased by 22, 44 and 53 percent, respectively.

Antioxidants are substances that protect you against free radicals, which cause damage to your body from oxidation. Free radicals increase the risk of cancer and heart disease and have been linked to age-related diseases such as cataract and Alzheimer's disease ( news - web sites).

More information

This article from the BBC's Web site explains why vegetables sometimes are more beneficial cooked than raw.


Need a Specialist? Chance of Referral Higher in US

Reuters Health

Friday, August 16, 2002

NEW YORK (Reuters Health) - Patients are twice as likely to receive referrals to see a medical specialist in the US as in the UK, new study findings show.

Dr. Christopher B. Forrest of Johns Hopkins University in Baltimore, Maryland, and his colleagues found that, overall, between 30% and 37% of Americans received referrals to see a specialist, relative to only 14% of patients in the UK.

These results do not reflect nationwide differences in how sick people are, the authors note; factoring the severity of a patient's illness into the comparison did not change the result. Specifically, the sickest patients in the UK were still half as likely to receive referrals as US patients with an illness that was just as severe.

There are many more medical specialists in the US than in the UK, Forrest's group notes, a trend that may play a large role in these results.

"The low availability of specialists, and resultant long waiting lists, in the United Kingdom is an important explanation for these differences," the authors write.

Forrest and colleagues obtained their results from the percentage of patients who received new referrals to visit a medical specialist during 1996 in the US, and 1997 in the UK. In the UK, general practitioners would record if a patient received a referral, while in the US, the investigators measured referral rates by the percentages of patients who visited a specialist for the first time at least once.

The data are based on a sample of 384,693 Americans and 757,680 people from the UK.

With relatively few specialists in the UK, patients often need to wait for long periods of time before receiving treatment, an aspect of medical care that may discourage UK physicians from giving patients referrals, the authors suggest. As an illustration, only 1% of US patients wait at least 4 months for elective surgery, an experience forced on 33% of patients in the UK.

"Absence of waits is likely to have lowered the US physicians' referral thresholds," Forrest and his team write.

In addition, the researchers note, many UK physicians may also have a "less intensive" style of practicing medicine than those in the US, a trait that may help explain why they are less likely to write referrals. Americans are also more likely than UK patients to refer themselves to a specialist, without seeking their doctors' permission, Forrest and his colleagues point out.

Source: British Medical Journal 2002;325:370-371.


MSG Myths


Friday, August 16, 2002

 (HealthScoutNews) -- If you think Chinese takeout causes you headaches because of all the monosodium glutamate (MSG) that's used to bring out the flavor of various foods, you'll be surprised at this Harvard study.

According to the Journal of Nutrition, MSG may not cause headaches after all.

University researchers found 130 people who complained of MSG headaches and got them to try foods with and without MSG. They also gave them samples of plain MSG.

Some of the people who had reported MSG headaches did react when they were given pure MSG. But none of them had any reaction when the MSG was mixed with food.


Depression May Worsen Age-Related Vision Loss

Reuters Health

Friday, August 16, 2002

NEW YORK (Reuters Health) - Depression is common among older adults whose vision is impaired by macular degeneration, and it may make their vision seem worse than it is, researchers report.

The investigators found that one third of the patients with age-related macular degeneration (AMD) they studied had symptoms of depression. And worsening depression over time was related to a decline in self-reported visual functioning, regardless of actual loss of vision, according to the report published in the August issue of the Archives of Ophthalmology.

AMD is a common cause of deteriorating vision in older adults. Over time there is a breakdown in light-sensitive cells in the macula, the tissue in the center of the retina. AMD can make it difficult to read, drive or perform other activities that require sharp vision.

In the new study, Dr. Barry W. Rovner and colleagues at Thomas Jefferson University in Philadelphia, Pennsylvania followed 51 older patients with recent vision deterioration due to AMD.

At the study's start, 33% were diagnosed with depression. These patients also tended to have worse corrected vision and more general disability than the other AMD patients, the report indicates.

When Rovner's team examined the patients again 6 months later, they found that those whose depression had worsened also had a decline in vision function--meaning they reported more problems with daily activities such as reading newsprint, recognizing faces and watching TV.

However, there was no evidence that this decline in functioning was actually related to worsening visual acuity, the researchers note. They speculate that depression, without actual changes in vision, may spark a functional decline in AMD patients.

"The psychological and (physical) symptoms of depression probably account for its adverse effect on vision function," the study authors write. "Discouragement and helplessness drain inner resolve and resiliency."

However, Rovner and his colleagues add, their findings also suggest that treating AMD patients' depression might help.

"Recognizing that depression is not simply an understandable consequence of vision loss but rather a distinct, treatable disorder is a necessary first step," they conclude.

Source: Archives of Ophthalmology 2002;120:1041-1044.



Of Mouse and Man and Cancer


Thursday, August 15, 2002

THURSDAY, Aug. 15 (HealthScoutNews) -- A new finding about a cancer-causing gene called Ras may offer researchers a new target for anti-cancer drugs.

The study appears in today's issue of Genes and Development.

Duke Comprehensive Cancer Center researchers say they've found that Ras uses different pathways to cause cancer in mice than it does to cause cancer in humans.

The Duke researchers say Ras activates an obscure group of proteins in humans, an action that turns normal cells malignant. Ras doesn't do the same thing in mice, but many cancer treatments are based on data taken from experiments with mice.

"Our study highlights a little-known pathway that appears to play a critical role in the ability of Ras to transform human cells, but not mouse cells, to become tumorigenic," says cancer biologist Christopher Counter.

"This pathway could present a new protein target for anti-cancer drugs in humans, and it reinforces the inherent differences between human and mouse cancers in terms of how they evolve," he says.

Ras is activated in a third of all human cancers and in 90 percent of some forms of cancer, such as pancreatic cancer.

In this study, the researchers genetically modified human and mouse cells to express mutated forms of Ras. The scientists then tracked how the protein produced by the Ras gene caused those cells to transform.

More Information

Here is an overview on how mice have been used in research from the University of California.


Smoking, Coffee May Up Risk of Rare Type of Stroke

By Merritt McKinney

Reuters Health

Thursday, August 15, 2002

NEW YORK (Reuters Health) - Results of a new study suggest that smoking, coffee drinking and high blood pressure increase the risk of having a subarachnoid hemorrhage, a type of stroke caused by bleeding in the brain.

Although giving up cigarettes or getting your blood pressure under control is never a bad idea when it comes to improving health, it would be premature to say that cutting back on coffee will reduce the risk of stroke, according to Dr. W. T. Longstreth, Jr., of the University of Washington in Seattle, who was not involved in the study.

"No recommendations are warranted based on this single study," Longstreth told Reuters Health.

Subarachnoid hemorrhage is a type of stroke caused by sudden bleeding into the space between the brain and its covering. It usually occurs when a weakened blood vessel in the brain bursts. Although this type of stroke can occur at any age, it is most common among people between the ages of 25 to 50. Still, subarachnoid hemorrhages are rare, affecting about 10 out of every 100,000 people.

Risk factors for this type of stroke have not been well documented. To determine what these risk factors might be, a team at Tromso University Hospital in Norway identified cases of subarachnoid hemorrhage in a large population-based health study that is designed to identify risk factors for disease, particularly cardiovascular disease.

From a sample of more than 27,000 people, Dr. Tor Ingebrigtsen and colleagues compared 26 people who had suffered a subarachnoid hemorrhage and 104 healthy individuals matched by age and sex.

People who had a subarachnoid hemorrhage were more likely to smoke, to drink more coffee and to have high blood pressure, the researchers report in the Journal of Neurology, Neurosurgery, and Psychiatry.

The risk of subarachnoid hemorrhage was more than quadrupled in current smokers and more than doubled in former smokers. People who drank five or more cups of coffee per day were almost four times as likely to have this type of stroke. And for each increase of 20 points in blood pressure, the risk of subarachnoid hemorrhage more than doubled, the report indicates.

In contrast, other risk factors, such as being overweight or having high cholesterol, did not influence the risk of subarachnoid hemorrhage, the authors note.

Despite the findings, the jury is still out on the link between coffee consumption and the risk of subarachnoid hemorrhage, Longstreth states.

"Is the association a coincidence?" he asks in an editorial that accompanies the study. It could be, according to Longstreth, that some other characteristic of coffee drinkers, such as a greater propensity to drink alcohol, may explain the apparent link. He also points out that the study included only a small number of participants who had subarachnoid hemorrhage.

If coffee does increase the risk of subarachnoid hemorrhage, exactly how it does so is uncertain, Longstreth notes. Caffeine increases blood pressure, which could in turn raise the risk of subarachnoid hemorrhage, but Longstreth points out that the researchers did not know whether participants drank regular or decaffeinated coffee.

"So for now, sip your coffee, but with some lingering concern about this unresolved issue," Longstreth writes.

Source: Journal of Neurology, Neurosurgery, and Psychiatry 2002;73:112, 185-187.


Unlocking Key to Nerve Cell Death


Thursday, August 15, 2002

THURSDAY, Aug. 15 (HealthScoutNews) -- Scientists at the Burnham Institute in California have uncovered new information about nerve cell death in people with stroke and neurodegenerative disorders such as Alzheimer's disease ( news - web sites).

Their report in this week's issue of the journal Science outlines a new enzyme pathway to nerve cell death. It involves an ephemeral gas called nitric oxide, which is found in the body and is also an air pollutant.

Nitric oxide can activate enzymes on the outside of nerve cells that leads to the death of the nerve cells during stroke and diseases such as multiple sclerosis, AIDS ( news - web sites) dementia and Alzheimer's.

The enzymes activated by the nitric oxide belong to a group called matrix metalloproteinases (MMPs). When these enzymes are activated in excess, they chew up the outside of the nerve cells and kill them, the report says.

"The new work uncovers the mechanism of activation of an enzymatic pathway that leads to nerve cell death," says research team head Dr. Stuart A. Lipton, a neurologist and director of the Center for Neuroscience and Aging at the Burnham Institute.

This is the first study to clearly identify this kind of enzyme pathway outside, rather than inside, the nerve cells. It's the first time that scientists have identified the ability of nitric oxide to activate MMPs.

"Now that we know about this new pathway to nerve cell death that occurs outside of the cells, we can design drugs to interrupt it, and this is where this work will go in the future," Lipton says.

More information

Find out about nitric oxide's other roles in the body .


Smoking Just a Few Cigarettes Ups Heart Attack Risk

Reuters Health

Thursday, August 15, 2002

NEW YORK (Reuters Health) - Smokers who think they will cheat death by puffing away on fewer cigarettes or not inhaling the noxious smoke better think again.

New research from Denmark suggests that women who smoke as few as 3 to 5 cigarettes a day may double their risk for a heart attack. And men may suffer the same fate smoking 6 to 9 cigarettes a day, according to the report published in the August issue of the Journal of Epidemiology and Community Health.

Although the adverse health effects of smoking are well known, some smokers assume that smoking just a few cigarettes or smoking without inhaling "is not hazardous," write Dr. Eva Prescott of the Institute of Preventive Medicine in Copenhagen, and colleagues.

While most previous studies have uncovered a host of health problems associated with smoking as many as 10, 15 and 25 cigarettes a day, few have examined the adverse health effects attributed to lighting up just a few times a day.

To investigate, the team evaluated the health and smoking habits of over 12,000 men and women over a 22-year period. During this time, 476 women and 872 men had a heart attack and 2,305 and 2,883, respectively, died.

Women who smoked 3 to 5 cigarettes per day were 2.14 times as likely to have a heart attack and 1.86 times as likely to die from any cause during the study than nonsmokers, the authors report.

Men who smoked 6 to 9 cigarettes per were 2.10 times as likely to have a heart attack and 1.76 times as likely to die of any cause during the study period than nonsmokers.

Risks of having a heart attack were also increased for those who puffed on cigarettes but said they didn't inhale the smoke.

"The study emphasizes the importance of recognizing that even very limited tobacco consumption has detrimental effects," the authors conclude.

Source: Journal of Epidemiology and Community Health 2002;56:702-706.


Eating Disorders Rooted in Childhood

By Janice Billingsley
HealthScoutNews Reporter


Thursday, August 15, 2002

THURSDAY, Aug. 15 (HealthScoutNews) -- As early as age 11, girls are more worried than boys about their weight.

Even worse, while boys shed their concerns about being overweight as they mature, girls become more even more worried that they're too fat, new research shows.

The study looked at more than 2,000 students in Glasgow, Scotland, at ages 11, 13 and 15. The researchers found the percentage of boys worried about being overweight dropped from 30 percent to 23 percent from the ages of 11 to 15. Meanwhile, the percentage of girls worried about their weight jumped from 40 percent to 70 percent over the same period.

Yet during this time, the prevalence of being overweight among all the students went up only one percentage point.

"People have known this anecdotally, but it is interesting to see it in the data," says University of Glasgow researcher Helen Sweeting, lead author of the study. "And to have tracked so many children through three ages adds weight to the results."

The study appears in today's issue of the Journal of Epidemiology and Community Health.

"This seems to be a significant validation of previous, smaller studies on attitudes towards weight," adds Connie Diekman, head of the nutrition department at Washington University in St. Louis, who treats college women with eating disorders.

"It is clear that the college women exhibit effects of eating disorders that started well before they came here," Diekman says. "This study provides a lot of insight to see how their processes of thought begin."

For the study, the researchers used data from a large health survey of schoolchildren in the Glasgow area. School nurses examined the students at ages 11, 13 and 15 to determine their body mass index (BMI), a measure of body fat based on height and weight. The children also filled out questionnaires that asked them if they were worried about putting on weight and if they were on a diet.

Predictably, the average BMIs increased as the children got older. The girls' BMIs increased slightly more than the boys' because girls gain more fat during adolescence. However, the girls' worries about weight mushroomed while the boys' concerns diminished.

At age 11, for instance, 30 percent of both boys and girls who were overweight said they were dieting. But by age 15, only 16 percent of the overweight boys were on a diet, while 48 percent of the overweight girls were dieting.

Similarly, even those girls in the "medium-weight" brackets were much more likely to be dieting than the boys as they got older. At age 11, 8 percent of medium-weight girls were on diets, while 4 percent of medium-weight boys reported dieting. By age 15, 26 percent of medium-weight girls were on diets, compared to only 3 percent of medium-weight boys.

Sweeting says the data show the need for more education about appropriate weights, especially for girls. "I wonder if we've lost sight of what's OK, and what's normal for weight," she says.

"Girls need to get the message as to what's healthy. They do need more body fat than boys. It's important," agrees Diekman, who's also a spokeswoman for the American Dietetic Association.

What To Do

For information about eating disorders, visit the National Eating Disorders Association. To calculate your body mass index, see the Centers for Disease Control and Prevention.


Marriage Keeps Men Alive Longer: Report

Reuters Health

Thursday, August 15, 2002

LONDON (Reuters Health) - Marriage seems to be so good for men's health that married men are less likely to die in a given period than their single counterparts, according to British researchers.

Professor Andrew Oswald and Dr. Jonathan Gardner from the department of economics at Warwick University looked at data on more than 12,000 adults from the British Household Survey and the British Retirement Survey.

Factoring out influences such as smoking and drinking, married men were 6.1% less likely to die over a 7-year period than single men, they found. Women benefited less from marriage, with their death risk dropping just 2.9%.

Researchers have often found that married men and women are healthier than singles, and the Warwick researchers speculate that a spouse might reduce a man's stress and encourage a healthy lifestyle.

But that does not seem to be the only factor, they note in their report, which is published online at

"Exactly how marriage works its magic remains mysterious," they write in their report. "Perhaps a strong personal relationship improves mental health and helps the individual to ward off physical illness. More research here is certainly needed."

Oswald said the findings debunk the idea that wealthier people live longer.

"Forget cash. It is as clear as day from the data that marriage, rather than money, is what keeps people alive," he said in a statement.


One Drug May Be Best for Ovarian Cancer

By Adam Marcus
HealthScoutNews Reporter


Thursday, August 15, 2002

THURSDAY, Aug. 15 (HealthScoutNews) -- Women with ovarian cancer can expect the same benefit from a single drug as they can from combination therapy, yet with fewer side effects, a new study has found.

The drug, called carboplatin, is often used in combination with paclitaxel, or Taxol, to treat ovarian tumors, the sixth leading cancer killer of women in the western world. However, the new research found carboplatin alone is no less effective than the combo therapy or another multi-drug blend, while causing fewer serious adverse reactions.

Even so, neither carboplatin -- sold as Paraplatin by the U.S. drug firm Bristol-Myers Squibb -- nor the joint regimens could stave off recurrences of ovarian cancer for more than about 1.5 years, on average. Five years after starting treatment, more than half of the 2,074 women treated in the trial were dead.

"The results of the study are a huge disappointment," says study co-author Dr. Christopher Poole, a cancer expert at the University of Birmingham in England. "The benefits of Taxol used in this way are much smaller than we'd hoped or imagined."

Poole says he and his fellow researchers were initially "incredulous" at the results of the trial, so much so that they delayed writing them up until they could be sure of what they'd found. A report on the findings appears this week in The Lancet.

The research project involved 130 clinical centers in eight nations, a massive undertaking. The initial group of 2,074 women was split into three groups for their first-line treatment: one received Paraplatin and Taxol, also a Bristol-Myers Squibb product; one received Paraplatin alone; and members of the last group were given a standard three-drug cocktail known as CAP.

Paraplatin is approved in this country for advanced ovarian cancer, and as part of a combination regimen. It does not have official U.S. Food and Drug Administration ( news - web sites) sanction for use as a first-line treatment.

After an average of 51 months of follow-up, 1,265 women had died. The rates of survival in the three groups were effectively identical. The therapies performed equally, too, when it came to three-year survival, running between 35 percent and 36 percent. Nor were there differences in how long it took for the tumors to relapse.

However, women who received Paraplatin alone generally reported fewer serious side effects, such as hair loss, fever and loss of sensation in their skin, than those on combination therapies. That, the researchers say, is a strong enough argument for choosing the single injection over the multi-drug regimens if survival differences aren't an issue.

Poole says the findings suggest combination therapies may somehow interfere with the action of platinum-based drugs like Paraplatin. He and his colleagues are now trying to learn if using Paraplatin followed by Taxol might not prove a better treatment for ovarian tumors.

Experts in the United States, however, are skeptical of the study's conclusions. Judith Hopkins, a cancer nurse at the University of California, Irvine, says the latest results probably wouldn't change clinical practice in this country, which is to offer the combination of Taxol and Paraplatin.

"Certainly if somebody can show that there truly is no difference [between one drug and two or more] and we all believe that, it would be reasonable to consider" the single medication regimen. "But right now we are not going to jump on the bandwagon," Hopkins says.

Dr. Maurie Markman, director of the Cleveland Clinic Cancer Center, had even stronger words: "I reject the idea totally that a single drug is equivalent to two drugs."

Markman says the latest study is vulnerable to a major criticism that might be fatal to its conclusions: It took place at so many clinics that controlling the quality of both the pathology tests and the cancer surgeries at each was impossible.

"What people are going to do in Great Britain [and other countries from the study], I don't know," Markman says. "But in the U.S., I would hope that no one takes it seriously."

However, Poole defended the trial, and said the quality control criticism may in fact be a strength of the study design. Most cancer drug trials are conducted at elite academic institutions, he says, and therefore don't reflect the typical doctor's practice.

The fact that the latest study was so large, international and included so many clinics "ought to increase your confidence in the robustness of the data," Poole says.

What To Do

For more on ovarian cancer, visit the National Ovarian Cancer Coalition or the National Cancer Institute.


Laser Vision Correction Can Worsen Dry Eyes: Study

Reuters Health

Thursday, August 15, 2002

NEW YORK (Reuters Health) - People with dry eyes can get better vision with laser eye surgery--but at the risk of making their dry eyes worse, according to researchers.

LASIK eye surgery can often correct the common vision problems of near- or far-sightedness, but there are side effects--one of them being eye dryness.

Now a new study shows that LASIK patients who have dry eyes going into surgery, while benefiting from it, may also have more-severe eye dryness after the procedure than other patients.

Dr. Ikuko Toda, of the Minamiaoyama Eye Clinic in Tokyo, Japan, and colleagues report the findings in the August issue of the Archives of Ophthalmology.

During LASIK (for laser-assisted in situ keratomileusis), a doctor attempts to clear blurry vision by removing a thin layer of tissue from the cornea in order to reshape it.

While the procedure is generally safe and often successful, it is not for everyone. And recent guidelines from the American Society of Cataract and Refractive Surgery call patients with dry eyes "less-than-ideal" candidates for LASIK because of the risk of worsening the problem.

Still, Toda's team notes in the new report, patients with dry eyes often want to try LASIK because they cannot comfortably wear contact lenses. To see how well such patients fare after LASIK, the researchers followed 290 patients who underwent the procedure, a majority of whom had "definite" or "probable" dry eye before surgery.

They found that in the year after LASIK, dry-eye patients saw as much vision improvement as the other patients did. However, their dry-eye symptoms were more severe throughout the year after surgery, according to the report.

Patients who had not had dry eyes before surgery did complain of dryness in the month afterward, but the problem was only temporary, Toda's team found.

"These data," they write, "may indicate that preoperative dry eye is a risk factor for severe postoperative dry eye."

They note that dry-eye patients who expect the problem to get better with LASIK because it will free them from contact lenses should be warned that their dry eyes may instead persist.

Source: Archives of Ophthalmology 2002;120:1024-1028.


FDA Approves Lexapro as Newest Antidepressant

By Bruce Sylvester
HealthScoutNews Reporter


Thursday, August 15, 2002

THURSDAY, Aug. 15 (HealthScoutNews) -- From one antidepressant a more powerful one has sprung.

The U.S. Food and Drug Administration ( news - web sites) (FDA) today approved the drug Lexapro as a treatment for major depression. Interestingly, this latest entry into the antidepressant market resulted from a molecular re-engineering of the popular antidepressant Celexa.

Lexapro (escitalopram) is the first antidepressant to get the FDA's nod since Celexa (citalopram) won approval four years ago. Both are made by Forest Laboratories of New York City and both are SSRIs (selective serotonin reuptake inhibitors) like their cousins Prozac, Zoloft and Paxil.

"Lexapro is a more potent version of Celexa, in that the component that fights depression has been isolated," says Talia Puzantian, a clinical pharmacist in psychiatry at San Francisco General Hospital.

This means patients will only need 10 milligrams to 20 milligrams a day of Lexapro, half of what is generally used with Celexa, Puzantian adds.

The Celexa molecule contains two "mirror" parts called isomers, but only one isomer helps fight depression. Researchers created Lexapro by removing the inactive isomer.

Celexa's patent does not run out until late 2005. However, the company decided to seek FDA approval for Lexapro and market it as soon as possible.

"Forest is taking a successful $1.4 billion dollar-a-year drug, Celexa, out of active marketing three years before the patent expires," says Andrew Farah, a psychiatrist and medical director of High Point Regional Hospital in High Point, N.C. "They are replacing it with a drug that is costing them more to make, but for which they plan to charge less."

"Lexapro is stronger, starts working faster and appears to have a lower side-effect profile. They could have held off on Lexapro, and made their billions off of Celexa first. But that isn't happening here, and the implications, especially in terms of potency, side effects and costs, could be huge for patients," he adds.

Farah notes the decision was driven by Howard Soloman, chief executive officer of Forest, whose son, Andrew, suffered from debilitating depression. The Solomans have publicly discussed the impact of the disease on their family life and on their business priorities, mot notably in a Business Week cover story in May.

Andrew Soloman emerged from the worst of his depression after several months of treatment with Cipramil, the European version of Celexa. He wrote a book about his struggle with the disease, The Noonday Demon: An Atlas of Depression, which was published in June 2001 and won the National Book Award for nonfiction.

"This will probably be a successful business decision by Forest, but it wouldn't be happening at all if Howard Solomon hadn't gone to Europe in the mid-1990s, searched for a better drug for his son, found the European version of Celexa, licensed it for the U.S. market and introduced it here," Farah says.

Three European and U.S. studies presented at the Anxiety Disorders Association of America annual meeting in March also suggest that today's FDA approval could herald future indications for Lexapro.

A Duke University clinical study reported that, "Escitalopram (Lexapro) treatment significantly improved anxiety symptoms relative to placebo treatment. The reliable anti-anxiety effects of this new drug suggest that it should be useful in the treatment of generalized anxiety disorder."

A study conducted at the University Hospital of Vienna concluded, "Escitalopram (Lexapro) 10-20mg/day is effective and well-tolerated in the treatment of social anxiety disorder."

Finally, a University of California at San Diego study reported that, "Escitalopram (Lexapro) in comparison to placebo significantly reduced panic attack frequency and severity, anticipatory anxiety and phobic avoidance, and significantly improved overall clinical status and quality of life. The results of this study suggest that escitalopram is efficacious and well-tolerated in the treatment of panic disorder."

Approximately 19 million adult Americans suffer from a depressive illness each year. One of every four women and one in 10 men in the United States will be diagnosed with depression during their lifetime. The World Health Organization ( news - web sites) predicts depression will become the leading cause of disability by the year 2020.

Forest Laboratories expects Lexapro to be available in pharmacies by Sept. 5.

What To Do

Business Week has more on Howard and Andrew Solomon's story. And the National Institute of Mental Health has more on depression.


Past Lead Exposure Boosts Adult Blood Pressure

Reuters Health

Thursday, August 15, 2002

NEW YORK (Reuters Health) - Young adults exposed to lead as children may be at risk of developing high blood pressure later in life, new study findings suggest.

"The potential impact of these results on public health is substantial," according to the report. "Elevated blood pressure is a known risk factor for atherosclerosis, stroke and (heart attack), all major public health problems in the United States."

In the study, Dr. Fredric Gerr of Emory University in Atlanta, Georgia, and colleagues looked at men and women aged 19 to 29 who lived near a lead smelter in Silver Valley, Idaho as children. Records for the smelter show high levels of lead output into the air during the late 1960s and early 1970s, according to the report.

The researchers measured bone lead concentrations--a measure of past lead exposure--in the 568 men and women and compared them with 287 people the same age who did not live near a lead smelter.

Those with the highest bone lead concentrations (greater than 10 micrograms of lead per gram of bone) had a systolic blood pressure 4.3 points higher than those with the lowest level--less than 1 microgram of lead per gram of bone. Systolic pressure is the first number in a blood pressure reading and reflects pressure when the heart is contracting.

Diastolic blood pressure--the second number in a blood pressure reading--was 2.8 points higher in the lead-exposed individuals than in those with low lead exposure.

Both groups had low levels of lead in the blood, which is used to indicate current exposure.

"These findings, therefore, appear to demonstrate long-term effects of past environmental lead exposure rather than effects of current lead exposure," Gerr and colleagues write in the August issue of the American Journal of Industrial Medicine.

Some studies have linked high blood pressure with lead exposure, but they mostly consisted of exposures in the work environment and lead in the blood, according to the report. The authors note that this is the first study to find an association between past lead exposure and blood pressure in young adulthood.

While US children today are not as likely to be exposed to the same levels of lead as children 25 years ago, the researchers point out that many children around the world are exposed to such high levels.

Even low-level lead exposure can cause neurological and developmental problems in children, and elevated blood pressure, kidney dysfunction and anemia in adults. The gradual elimination of some of the most obvious sources of environmental lead, such as lead-based paint and leaded gasoline, has reduced overall blood lead levels in western populations over the past few decades.

Source:  American Journal of Industrial Medicine 2002;42:98-106.


New Pain Meds Treat Spread of Colon Cancer in Mice

By Alison McCook

Reuters Health

Thursday, August 15, 2002

NEW YORK (Reuters Health) - COX-2 inhibitors, a newer class of painkillers designed to circumvent side effects associated with older drugs, may also treat colon cancer that has spread to the liver, according to new study findings.

Nobuya Yamada of the Osaka City University Graduate School of Medicine in Japan and colleagues found that giving COX-2 to mice with colon cancer that had spread to their livers shrank the animals' liver tumors.

In addition, when they added the COX-2 inhibitor to a Petri dish containing a strain of colon cancer cells, the researchers found that the treatment prevented the multiplication and spread of the malignant cells.

Based on these results, Yamada told Reuters Health that he and his colleagues suspect that COX-2 inhibitors may help prevent the recurrence of cancer that has spread to the liver.

"We recommend patients with colon cancer to take COX-2 inhibitors after surgical (removal of part of the) colon," Yamada said.

COX-2 inhibitors are designed to specifically suppress the activity of the COX-2 enzyme, while inducing fewer side effects than older pain medications such as aspirin, which block both COX-1 and COX-2 enzymes. Both enzymes produce molecules called prostaglandins that are often elevated in cancer.

Previous research has found that nonsteroidal anti-inflammatory drugs (NSAIDs), a class of pain medications that block prostaglandin production, may cut the risk of colon cancer by up to one half. COX-2 inhibitors are one type of NSAID, as is aspirin.

In addition, Yamada noted that other COX-2 inhibitors have been shown to prevent the spread of colon cancer. This paper demonstrates this effect with a particular COX-2 inhibitor, known as JTE-522.

During the study, reported in the recent issue of the International Journal of Cancer, the investigators tested the effect of JTE-522 on colon cancer cells in a Petri dish, which were extracted from a particular strain of colon cancer that is likely to spread to other organs. Yamada and colleagues also administered the drug five times a week for 4 weeks to mice that had been injected with colon cancer cells, which had then spread to their livers.

At the end of the experiments, the authors found that JTE-522 helped reduce the amount of colon cancer present in the animals' livers, and also prevented the multiplication and spread of the malignant cells within the Petri dish.

In an interview with Reuters Health, Yamada said that this particular COX-2 inhibitor has also been shown to prevent the spread of colon cancer to the lungs. As such, "we expect JTE-522 to prevent the spread of colon cancer to other organs," Yamada noted.

Previous reports have also found that JTE-522 can prevent other cancers from spreading throughout the body, such as gastric cancer, and head and neck cancers. Given these findings, "we expect JTE-522 to prevent the spread of other cancers," the researcher added.

Source:  International Journal of Cancer 2002;100:515-519.


Healthy Weight Loss a Low Priority for Teen Boys

By Alison McCook

Reuters Health

Thursday, August 15, 2002

NEW YORK (Reuters Health) - Overweight boys are just as likely as their female peers to try to shed weight at age 11, but seem to stop trying as they get older, Scottish researchers report.

By age 15, only 16% of overweight boys are trying to lose weight, compared with nearly 50% of girls with excess pounds. At age 11, 30% of both boys and girls who are overweight are trying to shed pounds.

Overall, teenage girls were more likely to diet and be concerned about their weight than their male peers, regardless of age and whether the girls were actually overweight.

Over time, the gap between the sexes only widens, Dr. Helen Sweeting of the University of Glasgow in Scotland and her colleague found. Their study, which ended when the teens turned 15, found that, at that age, overweight girls are three times as likely as their overweight male peers to be on a diet, while girls considered to have low weights for their heights were a full 16 times as likely as slim boys to be dieting.

"I wonder if we've lost track a bit about what sort of body is normal, healthy and 'OK,"' Sweeting told Reuters Health. "We hear that being extremely thin isn't good for us--but look how good it is for the models--and we know that being fat isn't good either. But where do we draw the line between what's OK and what isn't?"

She added, "Maybe there needs to be much more emphasis on what's OK, and on the best way to achieve that--a sensible balance of exercise and eating."

Sweeting and her colleague, Patrick West, obtained their results from surveys they collected from students when they were 11, 13 and 15 years old. The researchers re-surveyed the same students each time in order to track changes in their weights and behaviors, and ended up with dieting and health information from 2,196 students submitted at all three survey periods. Sweeting and West report their findings in the Journal of Epidemiology and Community Health.

The investigators found that girls were more likely than boys to both be concerned about their weight or to be trying to shed pounds at all ages and within all weight groups. The one exception to this finding occurred among overweight girls and boys, who appeared to be equally as likely to be dieting at age 11. The difference between boys and girls in weight concerns and dieting widened significantly over time, the authors report.

Of equal concern, noted Sweeting, was the finding that around one out of six students included in the surveys was classified as overweight.

"That's not good news for their future health, given the strong association between childhood and adult (weight patterns), together with the adult health problems such as heart disease, hypertension, diabetes and arthritis, which are linked with being overweight," Sweeting said.

Given their future health risks, Sweeting added that overweight teens should worry about their weight and be trying to shed pounds. "For this group, weight concerns aren't inappropriate," she said.

Girls are likely encouraged to lose weight more than their male peers as a result of media images, which can equate extreme thinness with beauty and success, Sweeting said. However, the finding that overweight boys were often less concerned about their weight than overweight girls is somewhat puzzling, she added.

Perhaps, Sweeting suggested, teenaged boys who are bigger than their friends think themselves to be stronger, as well. "A lot of past research has shown that early maturing boys are more athletic and more likely to be chosen as leaders, whereas thin boys and those who go through puberty later are more likely to be perceived as 'childish,' and want to be bigger," she said.

Sweeting added that anecdotal evidence suggests that teens who are have concerns about their weight--justified or not--may be more likely than others to grow up to be adults who are also dissatisfied with their weight. However, she noted, the current study did not examine this question.

Source: Journal of Epidemiology and Community Health 2002;56:700-701.


New U.S. Government Web Site Has Detailed Food Info


Thursday, August 15, 2002

WASHINGTON (Reuters) - Got a craving for more details about your favorite food than the ones printed on the package label?

A Web site launched on Thursday by the US Department of Agriculture tries to satisfy that hunger by providing a breakdown of dozens of fatty acids, amino acids, vitamins, minerals, protein, fiber and calories for more than 6,000 foods.

The database lists 117 nutrient categories for each food, including tryptophan, retinol, glycine and others that are not typically included on food package labels.

The data was collected from USDA researchers, food industry sources and other scientists.

Consumers can look up their favorite foods ranging from cheese crackers to chicken patties, choose a serving size, and see details about the 117 nutrients.

The USDA said the food database includes brand-name breakfast cereals, candies and even ostrich and emu meat.

The Web site is at:


Gel Form of Chemotherapy May Help Head, Neck Tumors

Reuters Health

Thursday, August 15, 2002

NEW YORK (Reuters Health) - A gel that contains a commonly used chemotherapy drug helps shrink head and neck cancers in some patients when directly injected into tumors, often without causing the body-wide side effects that occur when the drug is given intravenously, US researchers report.

Led by Dr. Barry L. Wenig of Northwestern University Medical School in Evanston, Illinois, the investigators found that 29% of patients with tumors originating in the head and neck who received the chemotherapy gel experienced a shrinking of their tumors that lasted at least 28 days. A similar improvement was noted in only 2% of the patients given an inactive form of the gel.

In addition, more than half of those who benefited from the chemotherapy gel, which contained the commonly used drug cisplatin along with the chemical epinephrine, saw their tumors disappear completely for at least 28 days.

Although the treatment did produce certain side effects near the site of injection--most commonly, pain--the chemotherapy gel did not cause body-wide effects such as nausea and vomiting nearly as often as when the liquid form of the drug is injected into a vein, the authors note.

The patients in this study had already tried and failed numerous treatment regimens, Wenig and his colleagues write, and similar patients may also benefit from the drug.

The chemotherapy gel "was shown to be effective in producing clinically meaningful response and palliative benefit in a group of patients with advanced (head and neck cancers) who had few, if any, remaining therapeutic options," they write.

During the trial, the results of which are reported in the August issue of Archives of Otolaryngology -- Head and Neck Surgery, the investigators tested the gel in 178 patients who had a type of cancer known as squamous cell carcinoma that originated in the head or neck. A total of 119 patients received the cisplatin gel, while the others were given an inactive form of the treatment, or placebo.

Along with a shrinking of the tumors, treated patients also met more of their pre-established treatment goals than those given placebo. The goals included improvements in pain control, better wound care, and looking and feeling better.

Wenig and his colleagues note that many patients who received the cisplatin gel experienced side effects at the site of the injection, with one quarter of those treated reporting pain. Other symptoms included inflammation or bleeding at the site of the tumors, all of which occurred more commonly in those given the gel than in the patients who received placebo.

The trial was sponsored by Matrix Pharmaceutical, Inc. of Fremont, California, the company that distributes the gel used in the study.

Source:  Archives of Otolaryngology -- Head and Neck Surgery 2002;128:880-885.



Girls Oppose Parental Notification

By Todd Richmond

Associated Press Writer

The Associated Press

Wednesday, August 14, 2002

MADISON, Wis. (AP) - Nearly half of the young girls surveyed in Wisconsin said they would quit going to Planned Parenthood ( news - web sites) if their parents had to be told they wanted prescribed contraceptives, according to a study.

The study suggested that parental notification could lead to more teen pregnancies, abortions and the spread of sexually transmitted diseases.

Congress and 10 states, including Wisconsin, have considered legislation requiring that parents be informed if their children are seeking prescribed contraceptives, the study noted.

The study, appearing in Wednesday's edition of the Journal of the American Medical Association ( news - web sites), was funded by grants from the University of Wisconsin-Milwaukee's Center for Urban Initiatives and Research, the Society for the Psychological Study of Social Issues and Planned Parenthood of Wisconsin Inc.

Researchers surveyed 950 girls ages 12 to 17 at 33 Planned Parenthood clinics around Wisconsin in 1999. The girls were asked to complete a confidential survey as they waited for appointments.

The study found 47 percent said they would stop using all sexual health care services at Planned Parenthood if their parents were notified they were seeking birth control pills or devices.

"If a teen thinks that their access to medical services is compromised in one area, they are making the assumption it could apply to other areas as well," Planned Parenthood of Wisconsin spokeswoman Lisa Boyce said.

Ninety-nine percent of the girls said they would have unprotected sex or use condoms if they couldn't get prescribed contraceptives, the study found.

On the Net:

Planned Parenthood of Wisconsin:

Journal of the American Medical Association:


Findings Offer Clues to Caffeine's Long-Lasting Kick

By Alison McCook

Reuters Health

Wednesday, August 14, 2002

NEW YORK (Reuters Health) - A group of researchers have uncovered evidence for why caffeine's stimulating effects stay with us long after we down the day's last cup of coffee. They have also identified a protein that appears to play a key role in how caffeine exerts its long-lasting effect.

Dr. Gilberto Fisone of the Karolinska Institute in Stockholm, Sweden, and his colleagues found that mice genetically engineered to lack the protein, dubbed DARPP-32, did not experience as long a period of stimulation from caffeine as other mice.

Fisone told Reuters Health that DARPP-32 may therefore represent the means by which one cup of coffee can perk people up for more than the few minutes it takes to drink it down.

"We have found a mechanism, a molecule, which mediates the ability of coffee to cause a prolonged stimulant effect," Fisone said.

Fisone noted that some people believe themselves to be addicted to caffeine, and understanding more about how the substance acts on the body may help explain why they get hooked. Other substances of abuse--including cocaine and amphetamines--also interact with DARPP-32, the researcher added, increasing the possibility that this protein plays an important role in the development of addiction.

Previous research has shown that coffee helps stimulate the body by blocking receptors that would otherwise be activated by adenosine, a chemical that has depressant effects. In the study, published in this week's issue of the journal Nature, Fisone and his team show that blocking the adenosine receptors sets off a chain of chemical reactions, part of which includes activating the DARPP-32 protein.

Once activated, the protein then helps to amplify the effects of caffeine on the body, the researchers demonstrate, enabling caffeine's initial stimulating effect--produced by blocking adenosine receptors--to last for a few hours.

In the current study, Fisone and his colleagues developed their theories based on studies with mice, in which some were engineered to produce no DARPP-32. When these mice were given caffeine, they initially responded to the stimulant, but the effect was much more short-lived than that seen in mice with normal amounts of the protein.

In an interview with Reuters Health, Fisone explained that these results might help explain variations in how people respond to caffeine. While he said he is not aware of people who, like the mice used in this study, do not produce DARPP-32 naturally, Fisone said that individuals are more or less sensitive to caffeine, and the interaction between the substance and DARPP-32 could be a factor.

"The ability of a person to respond more or less to caffeine could depend on this (process)," he said.

Over time, habitual coffee drinkers can also develop a "tolerance" for caffeine, Fisone added, after which a cup of coffee will have less of an effect on them than on first-time drinkers. Again, he suggested DARPP-32 may play a role in this change in response to caffeine over time.

Furthermore, Fisone noted that caffeine also blocks receptors present in a group of nerve cells involved in neurodegenerative disorders such as Parkinson's disease ( news - web sites). This condition is marked by the loss of brain cells that produce the chemical dopamine, resulting in a variety of physical symptoms such as tremor, rigidity and stiffness. Other researchers have shown that caffeine can make it more difficult for these nerve cells to degenerate, perhaps keeping dopamine available to the brain.

The more researchers understand about caffeine, Fisone said, the more likely they may be able to use the substance to help patients with Parkinson's and similar disorders.

"It's important to know about the molecular mechanisms by which substances such as caffeine work," he said.

Source: Nature 2002;418:734-736, 774-778.


All Forms of Arthritis Aren't the Same


Wednesday, August 14, 2002

(HealthScoutNews) -- Just the thought of having arthritis can be painful. For osteoarthritis -- the kind caused by wear and tear -- surgery and medications to relieve inflammation and pain might be your only options.

But the Medical College of Wisconsin says there are actually more than 100 types of the painful joint condition, many caused by bacteria and viruses. These types can usually be treated by draining the joints and by using antibiotics or other medications to attack the root causes.


High Fats May Boost Alzheimer's Risk

By Lindsey Tanner

AP Medical Writer

Associated Press Writer

The Associated Press

Wednesday, August 14, 2002

CHICAGO (AP) - A diet high in calories and fat may increase the risk of Alzheimer's disease ( news - web sites) in people who are genetically susceptible to the mind-robbing disorder, new research suggests.

The study found that people who consumed the most calories and fat faced double the risk of developing Alzheimer's.

The findings, which are reported in this month's Archives of Neurology, are the latest evidence that lifestyle factors including diet may play a role in Alzheimer's.

Some researchers believe that restricting calories may slow the aging process by reducing production of cell-damaging oxygen molecules called free radicals, formed during the body's breakdown of food. The latest study, though preliminary, suggests that for some people, calorie restriction might lower Alzheimer's risks by curbing nerve-cell death in the brain.

Lead author Dr. Jose Luchsinger, an Alzheimer's researcher at Columbia University, said it would be premature to recommend specific diets for reducing Alzheimer's risks.

Study participants whose diets increased the risk had one or two copies of the apolipoprotein-E gene variant known as apoE e-4. People with the e-4 variant are thought to be already prone to the disease.

About 20 percent of the U.S. population has one copy and even fewer have two, said William Thies, vice president of medical and scientific affairs for the Alzheimer's Association. In the study, 28 percent of participants had one or two copies of the variant.

The gene is involved in transporting cholesterol in the blood. Not everyone with the e-4 variant develops the disease, and the study suggests that diet may influence which people with the variant become afflicted, Thies said.

A study published in the same journal earlier this year linked high cholesterol levels with Alzheimer's and suggested that cholesterol-lowering drugs could reduce the risk. That research did not examine whether a low-fat diet would achieve the same results.

The new study involved 980 Medicare patients aged 75 on average in New York who were asked to recall their food intake during the first year of the four-year study. They also underwent annual exams.

Alzheimer's was diagnosed during the study in 242 people.

Patients with the gene variant who reported the highest consumption of fats and calories faced double the risk of developing Alzheimer's, compared with those who reported the lowest amounts.

Because the average reported daily amounts were quite low — about 1,300 calories and 38 grams of fat — Luchsinger said the overall trend is much more significant than the actual amounts.

The lowest reported amounts — about 758 calories daily and 16 grams of fat — likely would be considered unhealthful for many people and should not be used as a blueprint for avoiding Alzheimer's, he said.

Luchsinger said it's possible that some participants had faulty memories and inaccurately reported their food intake, while others may have even started developing undetected Alzheimer's that could have influenced their memories or food choices.

Still, he said the study "certainly points in a direction" favoring the diet theory.

Thies said the findings suggest fats may play some sort of role in Alzheimer's that needs more study. But he also said the study is in line with general recommendations for a healthy diet — avoiding overeating and too many fat-rich foods.

On the Net:

Archives of Neurology:

Alzheimer's Association:


Look Ma, No Exercise! Molecule Builds Muscle Type

Reuters Health

Wednesday, August 14, 2002

NEW YORK (Reuters Health) - Researchers working with mice have identified a molecule that can convert easy-to-tire muscles into the high-endurance muscles that enable runners to finish marathons.

Increasing the levels of this molecule in muscle fibers could one day be used to help bedridden or otherwise weakened patients bulk up without having to undergo the long process of training, note Dr. Jiandie Lin of the Dana-Farber Cancer Institute and Harvard Medical School ( news - web sites) in Boston, Massachusetts, and colleagues.

However, these findings do not indicate the same technique can be used to increase endurance in professional athletes, the authors add.

The molecule in question is called PCG-1, the active form of which is found in skeletal and heart muscle, as well as in the liver, where it regulates the production of the body fuel glucose.

In their study, Lin and colleagues created mice that carried the PCG-1 gene throughout the skeletal muscles, along with additional genetic material that triggered the production of the molecule's active form. Their findings are published in the August 15th issue of the journal Nature.

The mice were engineered to carry PCG-1 in both types of skeletal muscle, known as "slow-twitch" (type 1) and "fast-twitch" (type 2) fibers. Type 2 fibers--which get most of their energy from metabolizing sugar--make up much of the bulky mass found in weight-lifters, and are typically easily fatigued. In contrast, type 1 muscle fibers--which rely on oxygen for fuel--are the lean muscles that allow people to continue aerobic exercise for long periods of time.

Previous research has found that PCG-1 produces certain proteins needed by high-endurance muscle fibers, and helps trigger the production of mitochondria, structures in cells that enable slow-twitch muscles to contract efficiently for long periods.

In the current study, the investigators discovered that mice with PCG-1 in both types of muscle fibers appeared to have higher than normal levels of type 1 fibers, and were able to contract their muscles for 7 minutes during endurance tests, while untreated mice lasted only 2 minutes.

Certain medical conditions can deplete patients of type 1 muscles, Lin and colleagues note, and boosting their supply of the active form of PCG-1 could allow these individuals to bulk up on the muscles needed for endurance without requiring them to go through physical training.

Source: Nature 2002;418:797-801.


New Bacteria Triggers Lung Ailments

By Janet McConnaughey

Associated Press Writer

The Associated Press

Wednesday, August 14, 2002

Life-threatening flare-ups of emphysema and chronic bronchitis are often triggered by infections from newly encountered strains of common germs, a study found.

Such flare-ups are blamed for many deaths from chronic obstructive pulmonary disease, which is marked by irreversible damage that restricts the flow of air in the lungs.

The disease, called COPD, is the nation's fourth-deadliest killer. It caused 119,000 deaths and hospitalized 729,000 people in 2000, according to the Centers for Disease Control and Prevention ( news - web sites).

For the study, doctors at the Veterans Administration hospital in Buffalo, N.Y., had 81 patients check in once a month over 56 months to give a sputum sample. There were 1,975 visits in all.

Flare-ups were diagnosed in 33 percent of the visits when the phlegm carried a new strain of bacteria, senior author Timothy F. Murphy reported in Thursday's New England Journal of Medicine ( news - web sites).

That compared to 15.4 percent of the visits at which the lab did not find any new strains, said Murphy, chief of infectious diseases at the VA Western New York Health Care System.

Other studies have found that people can get infected over and over by the same bacteria, but DNA analysis now allows scientists to determine one strain from another.

Dr. Norman Edelman, the American Lung Association's consultant for scientific affairs, said the study suggests COPD flare-ups are more likely to be caused by bacteria than had been thought. But he said it doesn't indicate that antibiotic treatment should be increased.

Current standards already call for doctors to use antibiotics for patients who have particular difficulty breathing, more phlegm than usual or green phlegm, a sign of infection.

"At the moment it doesn't change medical practice. But it opens a number of doors in terms of potential research approaches," said Dr. Alan Fein, chief of pulmonary and critical care medicine at Northshore-Long Island Jewish Health System.

The bacteria with new strains most often found during COPD flare-ups were Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae.

Researchers said all three may hit the same inflammation trigger in humans. That could allow treatment which targets a particular molecule on the bacteria, the way some newer painkillers target the enzyme which causes arthritis.

H. influenzae, which once was thought to cause the flu and one form of which caused childhood meningitis before vaccinations became common, is found in the throat of 75 percent of healthy adults and children.

Although there is a vaccine against the strain which causes meningitis in children under 2, there is a huge number and wide variety of strains, Murphy said.

"H. influenzae as a species is incredibly genetically diverse," Murphy said.

The immune system "recognizes" a protein which makes up about half of the bacterium's surface. The protein varies from strain to strain, so a person immune to one strain can get sick from another, Murphy said.

Other, smaller molecules are the same on all or most of the strains, and Murphy and other researchers are trying to use them to create a vaccine.

On the Net:




Dirty Air Linked to Diabetes


Wednesday, August 14, 2002

WEDNESDAY, Aug. 7 (HealthScoutNews) -- A dramatic statistical correlation between diabetes cases and air pollution shows the need to take a closer look at the link between the two.

That's the opinion of a University of Buffalo researcher, whose work appears in the August issue of Diabetes Care.

"The significance of this relationship demands attention," says Dr. Alan Lockwood, a professor or neurology and nuclear medicine at the University of Buffalo's School of Medicine and Biomedical Sciences.

"The correlation between the two was striking. The probability that these two variables are not related is approximately five chances in 100,000," he says.

He says his statistical analysis doesn't prove a cause-and-effect relationship between diabetes and air pollution. However, the correlation he found is significant enough to merit more research.

For his analysis, Lockwood took data from the Toxic Release Inventory (TRI) for each state, and compared that with diabetes prevalence data from each state. Heavily industrialized states with high TRI emissions also had more people with diabetes.

For example, Ohio had 147 million pounds of TRI emissions and a diabetes rate of 7.5 percent. Alaska had 2.6 million pounds of TRI emissions and a diabetes rate of 4.4 percent.

Lockwood's analysis appears in the "Letters: Observations" column of Diabetes Care.

More than 15 million Americans have diabetes, and about a third of them are undiagnosed. Diabetes accounts for one of every seven health-care dollars spent in the United States.

More information

Here's more on diabetes and pollution.


Prescriptions for Elderly Often Inappropriate: Study

Reuters Health

Wednesday, August 14, 2002

NEW YORK (Reuters Health) - As many as 12.5% of Finnish seniors may be taking an inappropriate drug, a new study has found.

"Multiple drug use is common in elderly patients because of an increase in the number of medical conditions as one ages," write lead author Dr. Kaisu H. Pitkala of the Helsinki University Hospital in Finland and colleagues.

This increases the risk of harmful drug interactions and adverse side-effects, as well as the likelihood that patients won't comply with their prescribed drug regimen, the researchers note in the August 12/26 issue of the Archives of Internal Medicine ( news - web sites).

A panel of experts has established criteria for appropriate drugs for elderly patients, as well as inappropriate drugs for those with certain medical conditions. These criteria were updated in 1997.

To investigate how often elderly patients were prescribed drugs that these criteria deemed inappropriate, the researchers mailed questionnaires to 3,921 people aged 75, 80, 85, 90 and 95.

"Of the respondents, 12.5%, 1.3% and 0.2% were taking at least 1, 2, or 3 inappropriate drugs, respectively," the authors write.

Dipyridamole, an anti-clotting medication, and long-acting benzodiazepines, a type of sedative, topped the list of inappropriately prescribed medicines. Nearly 4% of patients reported taking dipyridamole, while almost 3% had been prescribed benzodiazepines.

And among patients with chronic obstructive pulmonary disease, Pitkala and colleagues found, 27% were taking beta-blockers, which could further impair breathing. Nineteen percent were taking potentially breath-suppressing sedatives.

Roughly 32% of diabetics ( news - web sites) taking oral medications to bring down blood sugar or insulin also took beta-blockers, which may hide symptoms of low blood sugar. Nearly 38% of patients with blood vessel disease in their extremities, or peripheral vascular disease, were also taking beta-blockers, which have the potential of intensifying leg pain.

"Compared with previous surveys, the use of inappropriate medications in our home-dwelling, elderly population is conspicuously low," the researchers report. "In contrast, use of certain drugs considered inappropriate with different medical conditions was relatively high."

Pitkala and colleagues conclude their report by noting that the prescribing of inappropriate medications may be a result of physicians using "inflexible and explicit" criteria to make their decisions.

Source: Archives of Internal Medicine 2002;162:1707-1712.


Botox Helps Stroke Victims

By Ed Edelson
HealthScoutNews Reporter


Wednesday, August 14, 2002

WEDNESDAY, Aug. 7 (HealthScoutNews) -- The wrinkle-removing use of Botox gets all the ink, but its real medical value is to help relieve some major neurological problems, ranging from facial spasms to writer's cramp.

Now neurologists are reporting another success -- relief of the wrist and finger difficulties that plague many stroke patients.

"This is the first study to show that Botox improves function and quality of life for these patients," says Dr. Allison Brashear, an associate professor of neurology at Indiana University School of Medicine and lead author of the report in tomorrow's issue of The New England Journal of Medicine ( news - web sites). "Until this, people thought, 'It just loosens muscles. So what?' The important statistic in our study is that 62 percent of the patients had improvement in the goal they wanted to achieve."

The patients, 126 of them, had suffered strokes that created painful and impairing spasticity of their hands and fingers. The tightness was so bad that many patients had trouble with the menial things in life, such as dressing themselves. Drugs such as diazepam give some relief, but they affect the entire body and cause side effects, most notably sleepiness. In the multi-center study, half the patients got an injection of 240 units of Botox -- at least 12 times greater than the dose used for wrinkles -- and half got a placebo.

Over the next 12 weeks, the participants were asked to rate their progress on one of four criteria they picked for themselves: improvement in personal hygiene, dressing, limb position or pain. It was a clear win for Botox: 62 percent of Botox patients reported improvement, compared to 27 percent of those who got the placebo.

Officially, Botox -- the brand name for botulinum toxin A, which relaxes muscles by inactivating the nerves that control them -- is not approved by the U.S. Food and Drug Administration ( news - web sites) (FDA) for this purpose. "It is an off-label use, but Medicare and most insurance programs cover the treatment," Brashear says.

Among the neurological uses of Botox that do have FDA approval are relief of spasms of the face, neck, back and feet, says Dr. Mark F. Gordon, an associate attending physician in the neurology department of Long Island Jewish Hospital who took part in the study.

"I have been injecting it for those problems for more than 10 years," Gordon says. There is a standard technique, he says, with an initial injection whose effect usually lasts about three months, followed by more injections to renew the effect.

The new study describes its use in what is "a relatively common problem after motor strokes," he says. "If a limb is paralyzed after a stroke, spasticity can develop months or years after the stroke."

There is one potential problem from repeated Botox injections, Gordon says. "It is possible to develop antibodies that cause resistance to the medicine, so that the body fails to respond to it. It is probably a risk in a few percent of patients. I haven't seen it yet in injections for stroke."

That problem is trivial compared to the benefit of Botox injections, he says. "The advantage of using Botox is that you can locally target the muscles that need treatment," Gordon says. "That avoids the systemic side effects, especially brain-related effects such as dizziness and sleepiness."

So while wrinkle relief may be the attention-grabber, "most Botox used in this country is for neurological problems," Brashear says. "You can put it right where the problem is."

The study was supported by Allergan, the maker of Botox, and many of the researchers have or had financial ties to the company.

What To Do

You can get a briefing on Botox for wrinkles and neurological problems from the U.S. Food and Drug Administration. Learn more about brain attacks and their aftermath from the National Stroke Association.


Womb May Influence Blood Pressure

By Emma Ross

AP Medical Writer

The Associated Press

Wednesday, August 14, 2002

LONDON (AP) - New research adds to a growing body of evidence that adult health is set to a significant degree by conditions in the womb and suggests the programming may start earlier in pregnancy than previously believed.

A study published this week in the Journal of Epidemiology and Community Health found that fetuses with shorter thigh bones at 24 weeks had higher blood pressure at the age of 6 than those with longer thigh bones.

Understanding how life in the womb influences later health has become a hot area of medical research. It has focused mostly on the effect of birth weight on health and the subsequent development of illnesses such as heart disease, high blood pressure, diabetes and osteoporosis. But the latest study is among the first to find evidence earlier in human life.

Scientists believe that when a fetus is undernourished, it diverts resources to areas it really needs at the time, such as the brain, at the expense of organs it will need later in life. That may permanently change the baby's structure, functioning and metabolism, experts believe.

"There's a lot of work about the size at birth," said Dr. David Barker, an epidemiologist who pioneered fetal programming research but was not involved in the latest study. "Birth weight is a crude measurement. It tells you very little because babies can reach the same birth weight by many different paths of growth.

"Now, because of technology advances, people are able to study children who have had serial measurements of size in (the uterus) that follow their growth, and these observations take us back into early pregnancy," said Barker, director of the epidemiology unit at the University of Southampton in England. "It looks as though blood pressure may be set fairly early."

The study, led by Dr. Kevin Blake at the University of Western Australia, involved ultrasounds done at 18, 24, 28, 34 and 38 weeks of pregnancy on 707 women with normal pregnancies. During each scan, doctors measured the circumference of the head and abdomen and the length of the babies' thigh bones.

Blood pressure was measured in about 300 of the resulting children at age 6.

The researchers found that for every one-tenth of an inch deviation from the typical thigh bone length at key stages in the womb, systolic blood pressure — the higher of the two numbers — was changed by about 2 points. Shorter thighs meant higher blood pressure.

That effect was first seen at 24 weeks of pregnancy.

Neither head nor abdomen circumference was linked to later blood pressure.

"We don't know whether a very small change in blood pressure at age 6 has any value in predictability of disease, but it's still a move forward in understanding what kind of factors we can look at before birth and use as predictors for potential signs of disease," said Kent Thornburg, a fetal physiologist and director of the Heart Research Center at Oregon Health Sciences University who was unconnected with the research.

The thigh bone is easy to measure and skeletal growth is a good measure of the rate a fetus is growing, said Mark Hanson, director of the Center for the Fetal Origins of Adult Disease at England's Southampton University.

"Skeletal growth is not just determined by how tall the parents are. There's a complex interaction between the fetal genetic drive to grow — inherited from the parents — and the environment in the womb in early gestation," said Hanson, a fetal physiologist who was not involved in the study.

"This study is focusing our attention on early gestation. It's making it clear that it really is fetal growth we're talking about here, not just some funny thing linked to birth weight itself. And it's pointing a finger very clearly that in the fetal growth process there's an interaction between the (genes) and the environment," he said. Rat studies have previously indicated the womb environment, influenced by the mother's nutrition, is important for later disease.

One study showed that pregnant rats given a low-protein diet for the first four days of pregnancy — before the embryo even implants in the womb and before the placenta is formed — produced offspring with high blood pressure.

"There are extensive experiments in animals which show that fetal programming is a universal biological phenomenon," Hanson said.

The risk of disease in adulthood builds up over a lifetime and experts don't know to what degree fetal programming influences the eventual likelihood of disease, but they believe it is considerable.

"The sort of calculations that have been done would suggest that it's certainly a bigger effect than smoking. It's certainly an effect at least of the magnitude of obesity and lack of exercise," Hanson said.

On the Net:

Center for Fetal Origins of Adult Disease,


Regular Exercise Helps Keep Colds at Bay: Study

By Alison McCook

Reuters Health

Wednesday, August 14, 2002

NEW YORK (Reuters Health) - People who exercise regularly appear to be less likely than couch potatoes to catch colds, US researchers report.

"Our research provides evidence that being active may actually reduce the number of colds people get in a year," lead author Dr. Charles E. Matthews of the University of South Carolina in Columbia told Reuters Health.

Given that colds are a leading cause of visits to the doctor and missed work days, Matthews added that employers might do well to encourage their workers to get off their duffs on a regular basis.

"While getting a cold is generally a minor nuisance for the individual, the wider public health implications are that being active may also reduce healthcare costs and increase productivity in the workplace by reducing the number of individuals getting a cold," he said.

Matthews and his colleagues obtained their findings from surveys of 547 healthy adults, administered at regular intervals over the course of a year. During the study period, the participants noted how many colds they had experienced, and how often they engaged in moderate physical activity.

For the purposes of the investigation, exercise considered moderate or vigorous included anything that people engaged in during their daily lives that was more strenuous than a walk, including household, occupational and leisure activities.

The average adult develops between two and five colds each year. However, the investigators report in the August issue of Medicine & Science in Sports & Exercise, people who reported being the most active had 25% fewer colds over the course of a year, relative to those who were the least active.

In an interview with Reuters Health, Matthew explained that previous studies have suggested that extremely low or high levels of activity can have negative effects on the immune system, thereby increasing the risk of developing colds. For example, he noted, people who run a marathon appear to have a significantly higher risk of a cold during the week after the race than non-runners.

In contrast, he added, "moderate levels of activity have been hypothesized to be associated with enhanced immune function, and our data--indicating a reduced risk for infection--are consistent with this hypothesis."

Source: Medicine & Science in Sports & Exercise 2002;34:1242-1248.


US Officials to Reassess Value of Hormone Therapy

By Ori Twersky

Reuters Health

Wednesday, August 14, 2002

WASHINGTON (Reuters Health) - US healthcare officials are planning to reassess the benefits of estrogen-containing hormone replacement products in response to a recently halted study that unveiled potentially serious side effects in postmenopausal women.

Performed as part of the US government-sponsored Women's Health Initiative (WHI), the study was halted 3 years earlier than expected because of emerging evidence showing a small yet statistically significant increase in the risk of heart disease, breast cancer ( news - web sites), stroke and blood clots.

In that study, women were taking Prempro, a combination of estrogen and progestin. An estrogen-only drug, Premarin, is being evaluated in a second branch of the WHI in women without a uterus. That study is ongoing and results are not yet available.

It is not yet clear if the WHI results also apply to lower doses of Prempro, or different combinations of estrogen and progestin, according to the US Food and Drug Administration ( news - web sites) (FDA).

Government officials said the reassessment would begin with several public forums to be held this fall and would be led by the National Institutes of Health ( news - web sites), the FDA, and the Agency for Healthcare Research and Quality.

"Consideration will be given to the extent to which the WHI results might be extrapolated to other combination estrogen/progestin products and doses, an assessment of known benefits for approved indications in the light of these new data, and the WHI's implications for future clinical trials of hormonal therapy," according to the FDA.

"Our collective goal is to keep the public informed so that doctors and patients can make sound decisions about use of hormonal products. Ultimately there may need to be additional research to answer some questions, but until there is a full review of the WHI data, what that would entail can't be determined," an FDA spokesperson said.

The brief announcement made on Tuesday followed a separate announcement by the FDA that it would also push for immediate revisions to the label of drugmaker Wyeth's Prempro.

The FDA said the immediate revisions would center on incorporating the study results on the drug's label.

But the larger federal effort could lead to greater changes in how such combination drugs are prescribed for millions of women.

Federal officials said among their goals was to determine if menopause is even a condition that merits treatment.

FDA officials added that the government-approved label for these drugs eventually could be altered to recommend limited treatment for a limited amount of time as well as to carry a black-box warning to warn about the side effects.

The FDA is expected to pose these questions before an expert advisory committee this fall or winter for independent evaluation.

Similar debates concerning how these drugs might now be used and prescribed are also ongoing among professional organizations such as the American College of Obstetricians and Gynecologists.

The current recommendation is that women should discuss their individual situation with their physician until a consensus opinion can be formulated.

In the meantime, drugmaker Wyeth has promised to cease advertising its drug directly to consumers.

The Madison, New Jersey-based drugmaker has also said that it would increase visits to physicians to outline and explain the results of the landmark study.


US Data Show Not All Surgery Getting Safer

By Charnicia E. Huggins

Reuters Health

Wednesday, August 14, 2002

NEW YORK (Reuters Health) - The idea that risky heart- and cancer-related surgeries have grown increasingly safe over the years may not be entirely true, new study findings suggest.

The death rate for certain high-risk heart-related surgeries has decreased, but it has not greatly changed for other cardiovascular or cancer-related surgeries, and has even increased for at least one type of cancer surgery, researchers report.

"Despite the common belief among many patients and providers, high-risk surgery is not necessarily becoming safer over time," write study author Dr. John D. Birkmeyer, chief of general surgery at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, and his colleagues.

"Patients should be reassured that medical science is moving forward in some areas of cardiovascular surgery," Birkmeyer told Reuters Health. However, "in other areas the risks are still high."

Birkmeyer and his team investigated national trends in surgery-related deaths in a study of roughly 2.5 million Medicare patients who underwent one of 14 high-risk heart- or cancer-related surgeries from 1994-1999.

Overall, death rates ranged from as low as 2% for patients undergoing carotid endarterectomy to remove plaque from clogged neck arteries to 16% for patients undergoing esophagectomy, or esophagus removal surgery, the investigators found.

There was an 11% to 15% decline in death rates for patients undergoing coronary artery bypass, carotid endarterectomy or heart valve replacement surgeries during the 6-year study period. But no similar decline was observed among patients undergoing cancer-related surgeries, the researchers report in the Journal of the American College of Surgery.

What's more, for one cancer-related procedure--colon removal surgery--death rates increased by 13% over the study period, the report indicates.

"We believe that risks associated with heart surgery could be falling as a result of public scrutiny," particularly for coronary bypass surgery, Birkmeyer said. With heart surgery, there has been "heavy emphasis on improving quality," but there has been "no such scrutiny associated with cancer-related surgery," he noted.

"A lot of research and funding emphasis for cancer care has been on pushing the envelope"--for example finding new ways to treat cancer, the researcher added. "What our findings suggest is that we need to improve what we're already doing."

Source: Journal of the American College of Surgery 2002;195:219-227.



Miss. Reports 2nd West Nile Death

The Associated Press

Tuesday, August 13, 2002

JACKSON, Miss. (AP) - A second death in Mississippi has been linked to the West Nile virus ( news - web sites), which has now been found in every state from Texas to the Atlantic.

The latest death, announced Tuesday, was recorded in Madison County, in central Mississippi. Officials previously had announced a death in neighboring Hinds County.

The mosquito-borne virus also has killed seven people this year in Louisiana, where at least 85 people have contracted the virus. According to the Centers for Disease Control and Prevention ( news - web sites), 145 people have been infected this year in six states and the District of Columbia.

Also Tuesday, Florida reported its first human case of West Nile, but health officials said the patient probably got the disease during a recent visit to Louisiana.

The number of states that have found the virus in humans, animals or mosquitoes this year rose to 37 on Tuesday, when South Carolina health officials announced they had found West Nile in a dead bird.


Does Your Child Have an Ear Infection?


Tuesday, August 13, 2002

(HealthScoutNews) -- Parents of young children might wonder how to tell if a child has an ear infection. After all, most kids who get them are too young to tell mommy or daddy what's wrong.

According to the National Institute on Deafness and Other Communication Disorders, there are a few signs to watch for. They include: unusual irritability; difficulty sleeping; tugging or pulling at one or both ears; fever; fluid draining from the ear; loss of balance; unresponsiveness to quiet sounds, or any other sign of hearing difficulty.

Parents who observe any of these symptoms should consult the family doctor immediately.  


Hepatitis C May Cause Erectile Dysfunction

Reuters Health
Tuesday, August 13, 2002

NEW YORK (Reuters Health) - Infection with the hepatitis C virus may increase the risk of erectile dysfunction, the results of a new study suggest.

The virus itself may play a direct role in causing erectile dysfunction, the findings suggest, since investigators took into account liver failure and treatment for hepatitis C, both of which are suspected of increasing the risk of erectile dysfunction in men with hepatitis C.

Nearly 4 million American have hepatitis C, making it the most common chronic viral infection in the US. Chronic inflammation of the liver develops in many patients, and about 20% of people with hepatitis C will develop cirrhosis, a severe and sometimes fatal scarring of the liver. Cirrhosis increases the risk of liver cancer.

Hepatitis is spread through contact with blood and other body fluids, but the route of transmission remains undetermined in a substantial percentage of infections. People who share needles to inject drugs have a high risk of contracting the disease.

Cases of erectile dysfunction in men with hepatitis C have been reported, but it is unclear whether the blame should be placed on the virus itself or on poor liver function caused by the infection. A drug used to treat hepatitis C, interferon alfa, is another prime suspect.

A team led by Dr. Clodoveo Ferri of the University of Pisa in Italy, compared the frequency of erectile dysfunction in 207 men with hepatitis C and 207 healthy men. Among men with hepatitis C, 39% had erectile dysfunction, compared with 14% of healthy men, according to a report in the August 14th issue of the Journal of the American Medical Association ( news - web sites).

But neither the presence of liver failure nor interferon alfa therapy seemed to affect a man's odds of having erectile dysfunction, according to the researchers.

"Nonetheless, both liver failure and interferon alfa may also contribute to erectile dysfunction, and treatment should be individualized," Ferri's team writes. Suggesting that antiviral treatment may relieve erectile dysfunction, the researchers recommend that this approach be studied in clinical trials. They also advise physicians to consider hepatitis C infection when diagnosing erectile dysfunction.

Source: Journal of the American Medical Association 2002;288:698-699.


FDA Warns About Chinese Diet Pills

The Associated Press

Tuesday, August 13, 2002

WASHINGTON (AP) - Americans should avoid two Chinese diet pills because they may contain a drug banned for causing dangerous side effects, the Food and Drug Administration ( news - web sites) warned Tuesday.

The Chinese products are among several linked to hundreds of illnesses and several deaths in Asian countries this summer, but FDA officials said they had information on only the two in the United States. If others come to their attention the warning will be extended, said spokesman Brad Stone.

The pills are called Chasu Jianfei Diet Capsules and Chasu Gempi, and typically are sold in small markets as alternatives to Western medicine, the FDA said.

The pills apparently contain fenfluramine, a once-popular prescription diet medicine banned in the United States in 1997 after it was linked to a dangerous heart problem.

China's health ministry has banned about a dozen different diet products this summer because they illegally contained fenfluramine. Some of the products have been linked to 560 cases of liver or thyroid illnesses in Japan, and at least eight deaths in Japan, China and Singapore.

Products such as traditional Chinese pills can be sold in this country without approval of the FDA, which usually determines if drugs are safe or work as advertised. But the FDA can crack down if such normally unregulated products are found to be unsafe, so it ordered its agents to watch for any new imports of the Chasu products.

The FDA urged consumers not to take any of the pills already sold, and to notify the agency if they see the products for sale. The FDA may be reached at (888) INFO-FDA.

On the Net:

Food and Drug Administration:


Teens Shun Sexual Health Care if Parents Get Report

By Alison McCook
Reuters Health

Tuesday, August 13, 2002

NEW YORK (Reuters Health) - More than half of teenaged girls who attend family planning clinics say they would stop or delay using certain or all services--including testing and treatment for sexually transmitted diseases--if practitioners were required to inform their parents that they had sought prescription contraceptives, US researchers report.

The paper comes at a time of debate over the benefits of requiring doctors to inform parents when their children seek prescription contraceptives. Some believe such requirements would help parents educate their children and protect them from harm.

However, Dr. Carol A. Ford of the University of North Carolina in Chapel Hill, who wrote an accompanying editorial, told Reuters Health the current study demonstrates how removing confidentiality could do more harm than good for teens.

"This research helps to determine the risk of mandating parental notification," she said.

Doctors and nurses who are required to report back to parents may lose the trust of some of their teenaged patients, Ford said, leading young patients to seek health care for sexual concerns less often, and to reveal less when they do. "This means adolescents who need health care won't receive it," Ford added, putting them at risk of acquiring a condition they could have avoided. Although parents may want to be informed, she noted, they also likely don't want to put their teens at risk.

Recently, legislators have proposed regulations that would require all family planning clinics in the US that receive certain public funds to notify parents before giving teens prescription contraceptives, such as birth control pills or diaphragms. Similar legislation has been introduced in at least 10 states.

To investigate the potential effect of such laws, Dr. Diane M. Reddy of the University of Wisconsin-Milwaukee and her colleagues surveyed 1,118 girls under 18 who were seeking services at Planned Parenthood ( news - web sites) family planning clinics throughout Wisconsin. The researchers asked the girls whether they would change their behavior if the clinics had to notify their parents when the teens requested prescription birth control.

Although the survey specified that parents would only find out about birth control, 59% of the teens surveyed said they would stop or delay seeking services for many sexual health concerns, such as pregnancy counseling and testing, contraceptives, and treatment or testing for HIV ( news - web sites) or other sexually transmitted diseases.

In an interview with Reuters Health, Ford noted that many of the girls included in the survey would not give up seeking sexual health care even if their parents knew they were receiving prescription contraceptives.

However, she added, there are always going to be some teens discouraged from seeking treatment by a variety of concerns, including fear of abuse at the hands of their parents, or simply the emotional costs of telling their parents they are sexually active.

In some ways, the reasons behind the fears surrounding parental notification don't matter, Ford said, "because it's their fears that may be keeping them from getting the health care."

Ford added that she hopes the current findings help reaffirm the importance of confidentiality for adolescents seeking sexual health care services, and convince lawmakers that confidentiality should be available in a variety of settings, including family planning clinics, hospitals and doctors' offices.

Furthermore, she noted that the fact that so many teens are afraid to inform their parents about their sexual health suggests that parents and children should try to communicate more with each other.

The study was funded in part by Planned Parenthood of Wisconsin, Inc.

Source: Journal of the American Medical Association ( news - web sites) 2002;288:710-714.


Wisconsin Boy Dies of Encephalitis

The Associated Press

Tuesday, August 13, 2002

ROCKFORD, Ill. (AP) - A 12-year-old boy has died of a rarely fatal form of mosquito-borne encephalitis, health officials say.

Tests confirmed that Albert Stahl's death on Friday was caused by one of several strains of a California encephalitis family, said Debbie Siegenthaler, director of health for LaFayette County, Wis.

Given that the boy seems to have contracted the disease in or around his home town of Gratiot, Wis., the strain is likely La Crosse encephalitis, she said.

The virus causes flu-like symptoms including nausea, vomiting and lethargy.

The emergence of West Nile virus ( news - web sites) in the Midwest has focused attention on killing mosquitoes and preventing bites. But Siegenthaler said La Crosse encephalitis has been a problem for years.

According to the Centers for Disease Control and Prevention ( news - web sites), there were 82 cases of La Crosse encephalitis in Wisconsin between 1990 and 1997; there have been 53 cases in Illinois.

Siegenthaler said the illness generally afflicts children 16 and younger, and is fatal in only about 1 percent of cases.

The boy died at a hospital near the Wisconsin line.


Preemies at High Risk of Attention, Mental Problems

By Alison McCook
Reuters Health

Tuesday, August 13, 2002

NEW YORK (Reuters Health) - Children born prematurely appear to have a higher risk than full-term babies of scoring low on tests of mental function and having certain behavioral problems, including attention-deficit/hyperactivity disorder (ADHD), US researchers report.

However, according to study author Dr. K.J.S. Anand of the Arkansas Children's Hospital in Little Rock, parents of premature infants should not feel their child is doomed to behavioral or mental problems. While on average their risk is higher, not every premature baby will have the same difficulties.

"It is entirely possible or highly probable for the child to have a normal cognitive score, and be able to do everything that the full-term child does," Anand told Reuters Health.

More and more babies are being born before the full 37-week gestation period, and medical interventions have become better, allowing more tiny infants to survive. As such, many babies born prematurely are now surviving into adulthood, and researchers have sought to determine whether these children suffer long-term problems as a result of their early births.

A great number of studies have examined this question. However, note Anand and his co-authors, led by Dr. Adnan T. Bhutta of the University of Arkansas for Medical Sciences in Little Rock, many of these studies have been criticized for including only a small number of participants or other problems. And much of the research into this question has produced conflicting results.

In a new analysis, Bhutta and colleagues gathered data from 31 well-designed studies and followed the infants until they were at least 5 years old. Their analysis included 1,556 children born prematurely and 1,720 of their full-term peers, and is published in the August 14 issue of the Journal of the American Medical Association ( news - web sites).

Bhutta and colleagues found that children born prematurely were more likely than their full-term peers to have low scores on tests of mental function. Low scores on these tests may indicate that the child has any of a variety of problems, such as impaired memory, difficulty riding a bike or trouble with subjects related to reasoning, such as math.

Furthermore, the authors found that the risk of low test scores was directly linked to birth weight and length of gestation. Preemies with longer gestation periods and higher birth-weights had relatively higher test scores.

Pre-term babies also proved to have an increased risk of behavioral problems as children, which included both "acting out" and spending large amounts of time isolated from their peers. In addition, they showed a more than two-fold higher risk than their full-term peers of developing ADHD.

In an interview with Reuters Health, Anand explained that premature babies must often undergo a series of painful procedures to prevent complications, and are also separated from their mothers for long periods. Previous research has shown that both of these factors can lead to death of nerve cells, the researcher noted, which may affect the infants' later development.

For this reason, he suggested that doctors treating premature infants consider using "creative" ways to prevent complications without causing unnecessary pain, and help mothers interact and be intimate with their babies whenever possible.

He added that these findings could be upsetting to parents of pre-term babies, but emphasized that it is better that they know the long-term risks of their children's condition. "From these precise estimates of cognitive and behavioral development, we think that both professionals and parents will realize that the impact of prematurity goes well beyond the neonatal intensive care unit," Anand and Bhutta told Reuters Health.

Source: Journal of the American Medical Association 2002;288:728-737.


Female MDs Talk More With Patients

By Lindsey Tanner

AP Medical Writer

The Associated Press

Tuesday, August 13, 2002

CHICAGO (AP) - Female primary-care doctors spend more time with their patients than male doctors and engage in more patient-oriented, emotion-focused talk during office visits, a study found.

The results suggest that gender differences noted in conversational styles also occur in the medical arena, researchers said in Wednesday's Journal of the American Medical Association ( news - web sites).

Whether the differences have any impact on patient health is not known, but the results suggest that female doctors may offer "a relatively more health-promoting therapeutic milieu," health policy specialist Debra Roter of Johns Hopkins University and colleagues reported.

They reviewed and pooled results from 26 studies involving an average of more than 3,000 doctors and doctors-in-training. Included were internists, family and general practice doctors, pediatricians, obstetrician/gynecologists and medical residents.

On average, women doctors spent 23 minutes with patients, compared with 21 minutes for men. They also spent more time talking about health-related lifestyle and social issues, engaging in positive, emotionally supportive talk and involving patients in their care.

The exception was male ob/gyns, who spent slightly more time overall with patients than their female counterparts and more time in patient-oriented, emotion-focused talk.

Co-author Judith Hall, a Northeastern University psychology professor, said the gender-based differences "are a product of our society, but they are not unchangeable."

Patient-centered communication can be taught and both genders "can benefit from this instruction and improve their skill level," Roter said.

Dr. J. Edward Hill, a family practice doctor from Tupelo, Miss., and chairman of the AMA's board of trustees, said the study confirms "what we already know — men and women are a little bit different in their personal style. I don't think it has any bearing on the quality of medicine."

Still, he said the traits noted in female physicians are desirable and said many residency training programs try to teach better communication skills.

On the Net: JAMA:


Vitamin E May Worsen Elders' Respiratory Infections

Reuters Health
Tuesday, August 13, 2002

NEW YORK (Reuters Health) - A daily dose of vitamin E does not help older people ward off respiratory infections and may even exacerbate symptoms in those who do get a cold, researchers report.

Their study found that adults aged 60 and older who took 200 milligrams (mg) of vitamin E daily for two years were more likely to have a fever and tended to be sick longer when they got a respiratory tract infection than their peers who did not take vitamin E.

Overall, taking a daily multivitamin/mineral pill or a vitamin E supplement did not lower the risk of developing the infections in the first place, according to the report in the August 14th issue of the Journal of the American Medical Association ( news - web sites).

The finding seems to contradict previous studies that found taking a daily multivitamin/mineral supplement boosted immune system factors in elderly adults. It may be that individuals in the current study were well nourished as a group and therefore, people with deficiencies of certain nutrients might benefit, the researchers suggest.

However, few studies have looked at the effects of vitamins and minerals on respiratory tract infections. According to the researchers, led by Dr. Judith M. Graat from Wageningen University in the Netherlands, an estimated 50% of elderly people use some types of dietary supplements, most commonly multivitamins and minerals and vitamin E.

The study included more than 600 healthy adults, aged 60 and older, who were divided into four groups. One group took multivitamin pills plus vitamin E; another group took only multivitamins; a third group took only vitamin E; and another group took placebos or sugar pills.

About 70% of adults taking a multivitamin developed a respiratory tract infection at least once during the study period, compared with 68% of those in the vitamin E group, 66% of those taking both supplements, and 67% of those taking placebos.

Those who took vitamin E and developed a respiratory tract infection were sick for about 19 days, compared with 14 days among those who did not take vitamin E. Vitamin E users reported a greater number of symptoms and more severe symptoms associated with their infection. Nearly 37% of vitamin E users developed a fever, compared with 25% of those who did not take the vitamin supplement.

It is not clear why vitamin E was associated with more severe infections but the researchers suggest that more severe symptoms might reflect more vigorous immune activity. Alternatively, symptoms might become more severe when there is an imbalance of certain nutrients in the body.

Whatever the reason, more research is needed into the effects of multivitamin/mineral supplements, and specific supplements, on elderly adults who are not well nourished at the outset.

"If our results are confirmed and vitamin E exacerbates respiratory tract infections, elderly people, especially those who are already well-nourished, should be cautious about taking vitamin E supplements," the study concludes.

Source: Journal of the American Medical Association 2002;288:715-721.


Report: Big Tobacco Urged Drug Cos.

By Lindsey Tanner

AP Medical Writer

The Associated Press

Tuesday, August 13, 2002

CHICAGO (AP) - Drug companies toned down marketing campaigns for smoking-cessation products like nicotine-based gum and a skin patch in the 1980s and 1990s because of pressure from the tobacco industry, according to a medical journal report.

The report is based on documents posted on a tobacco industry Web site offering public access to materials involved in the 1998 national tobacco settlement. That case ended states' lawsuits filed over smoking-related health costs.

The documents provide an inside view of tobacco industry efforts to influence drug company campaigns involving two nicotine-based products designed to help people stop smoking: gum and the skin patch.

In Wednesday's Journal of the American Medical Association ( news - web sites), Lisa Bero and Bhavna Shamasunder, health policy researchers at the University of California at San Francisco, say their report highlights ethical concerns about tobacco companies' historical ties to drug companies.

In one instance, a Dow Chemical pharmaceutical subsidiary that made Nicorette chewing gum scaled back educational materials encouraging doctors to urge their patients to quit.

This happened in the early 1980s, after executives at Philip Morris, a major purchaser of Dow's tobacco crop chemicals, objected to the materials' anti-smoking tone, according to the report.

In 1984, Philip Morris suspended purchases from Dow, the report says, citing a Philip Morris memo from May of that year.

"Dow was informed that the recent spate of activity can only be interpreted as a conscious corporate decision that Nicorette is more important than the Philip Morris (and other tobacco) business. That is, they cannot realistically expect a customer to spend millions of dollars for materials, when the profits from those sales ... are used to attack that customer's product," the memo says.

Another Philip Morris memo details how it resumed purchases after Dow changed its practices.

Dow Chemical eventually sold its pharmaceutical division and Nicorette is now made by GlaxoSmithKline. GlaxoSmithKline spokeswoman Malesia Dunn said the company has not been pressured by tobacco companies.

Dow Chemical said the JAMA report reflects company management in the 1980s and that despite the alleged pressure, Nicorette sales thrived.

Since Dow provides thousands of products, "there are occasions when diverse interests require that we effectively manage our customer relationships within ethical bounds," Dow said in a statement.

The report also cited tactics involving the nicotine patch Habitrol sold by Ciba-Geigy, which also made tobacco pesticides. The company introduced Habitrol in 1991 in a campaign titled "Smokebusters."

After Philip Morris complained that the campaign "bordered on being anti-tobacco," Ciba-Geigy eliminated the title and agreed that the campaign would not have an anti-smoking theme, memos from both companies show.

Ciba-Geigy became Novartis in a 1996 merger and Novartis spun off its agribusiness division two years ago. In a letter to JAMA's editor, company President Terry Barnett said Novartis "has acted consistently in placing patient health first."

Philip Morris USA spokesman Brendan McCormick said the documents cited are old and "speak for themselves." He said the documents do not reflect the company's current beliefs that cigarette smoking "causes serious health effects in smokers and is addictive."

He said Philip Morris does not try to influence drug companies that sell anti-smoking products and agrees that to reduce health risks from smoking "the best thing to do is to quit."

On the Net:


Philip Morris memos:


Low-Carb Diets Tax Kidneys, May Weaken Bones

Reuters Health
Tuesday, August 13, 2002

NEW YORK (Reuters Health) - Diets that are heavy on protein-rich foods and skimp on carbohydrates can increase the risk of kidney stones and reduce the body's ability to absorb calcium after just 6 weeks, researchers report.

Their findings come at a time when an increasing number of Americans, seduced by anecdotal accounts of fast weight loss, are turning to low-carbohydrate, high-protein (LCHP) diets. With an estimated 50% of American adults either overweight or obese, many are looking for a surefire way to shed pounds.

But while LCHP diets have been shown to get the pounds off in the near term, these diets are less successful over the long run and may even be hazardous to health, researchers warn.

For one, protein-rich foods can be high in fat, which increases the risk of heart disease and type 2 diabetes. A dearth of carbohydrate-rich foods such as fruits and vegetables can leave the body hungry for essential vitamins and minerals, while insufficient glucose (sugar) from carbohydrates, the body's preferred fuel source, can lead to fatigue and dizziness.

And according to the new study, 6 weeks on an LCHP diet increased the acid load to the kidneys, raising the risk of kidney stones. Animal protein has been shown to boost urinary excretion of oxalate, a compound that combines with calcium and other compounds to form the deposits commonly known as kidney stones.

At the same time, adults in the study had higher levels of calcium in their urine, suggesting a decreased absorption of the bone-building mineral and an increased risk of osteoporosis, according to the report in the August issue of the American Journal of Kidney Diseases.

"Consumption of an LCHP diet for 6 weeks delivers a marked acid load to the kidney, increases the risk for stone formation, decreases estimated calcium balance, and may increase the risk for bone loss," write Dr. Shalini T. Reddy from the University of Chicago, Illinois, and colleagues.

Their study included 10 healthy adults aged 21 to 52 who consumed their usual diet for 2 weeks, followed an LCHP diet for 2 weeks, and then followed a diet that restricted carbohydrates only moderately for 4 weeks. The protein-restricted diets included 3 liters of fluid a day.

Study volunteers lost an average of 9 pounds, but most developed ketones--compounds that are formed when the body uses its own fat as fuel and can raise acid levels in the blood. Acid excretion, a marker of acid levels in the blood, rose by 90% in some volunteers but none of the dieters developed metabolic acidosis, a potentially life-threatening condition caused by excessive breakdown of fats, the report notes.

There was also a sharp rise in urinary calcium levels during the LCHP and maintenance diets despite only a slight decrease in calcium intake. Urinary citrate, a compound that inhibits kidney stone formation, decreased.

While it is not clear from the study whether bone mass was affected, the findings indicate that such diets may increase the risk of bone loss over the long term.

"We already know that osteoporosis is going to be a major issue as the population ages, and if people are going to eat this kind of diet on a long-term basis, it's unknown what the implications would be for your bones," Dr. Chia-Ying Wang, a study author, said in a prepared statement.

Source: American Journal of Kidney Diseases 2002;40:265-274.


Zoloft Seen Safe for Heart Patients

By Lindsey Tanner

AP Medical Writer

The Associated Press

Tuesday, August 13, 2002

CHICAGO (AP) - The popular anti-depressant Zoloft appears to be safe and effective for heart attack patients, a company-sponsored study suggests.

Researchers found that Zoloft caused no more chest pain, heart rate abnormalities or irregular heartbeats than dummy pills. Zoloft patients even appeared to have fewer life-threatening events such as recurrent heart attacks, heart failure and strokes, though those results were not statistically significant.

The drug, as expected, also reduced depression. Researchers said its effects in heart attack survivors had not been demonstrated previously.

Zoloft maker Pfizer Inc. helped fund the study, and a Pfizer employee was involved in the study design and analysis. The results appear in Wednesday's Journal of the American Medical Association ( news - web sites).

Older drugs known as tricyclic antidepressants in some patients have been linked with heart problems including arrhythmia and heart attacks, especially in high doses. Some tricyclics, including imipramine and amitriptyline, are not recommended for use in patients with recent heart attacks.

Enrollment in the latest study began in 1997, a year after the Food and Drug Administration ( news - web sites) warned Pfizer against marketing Zoloft for heart attack patients because of concerns that it might cause chest pain and a rapid heartbeat.

The findings are significant because about 20 percent of the more than 1 million Americans who have heart attacks each year will also experience major depression.

Those who do develop depression are nearly three times more likely to die prematurely than heart attack survivors who aren't depressed, said lead researcher Dr. Alexander Glassman of the New York State Psychiatric Institute.

The study included patients who'd had heart attacks an average of about four weeks before starting the drug.

It excluded severely medically ill patients and those for whom drugs like Zoloft are not recommended. Thus, the results cannot be generalized to all heart attack patients, according to an accompanying editorial by Drs. Robert Carney and Allan Jaffe.

Still, they called the study "a major step forward in the care of depressed patients with coronary heart disease."

Carney, of Washington University School of Medicine, and Jaffe, of the Mayo Clinic, were not involved in the research.

The study involved 369 depressed patients in the United States, Canada, Europe and Australia. All had suffered recent heart attacks or severe chest pain called unstable angina ( news - web sites) and took Zoloft or a placebo for 24 weeks.

American Heart Association ( news - web sites) spokesman Dr. Sidney Smith said larger studies confirming the results should be done before Zoloft is routinely recommended for depressed heart attack survivors.

Zoloft belongs to a newer class of antidepressants called selective serotonin reuptake inhibitors, which also include Prozac and Paxil. Whether the results apply to SSRI drugs other than Zoloft is not known, the editorial says.

On the Net:


American Heart Association:


Bush Says U.S. Needs Medical Malpractice Reform

Reuters Health
Tuesday, August 13, 2002

WACO (Reuters) - President Bush ( news - web sites) said on Tuesday that US health care costs were being inflated by "frivolous" lawsuits and that the United States needed to reform medical malpractice laws.

"The liabilities of these lawsuits drive up the cost of medicine, it drives up the cost of medicine for the federal government as well," Bush told an economic forum.

"So therefore I believe the federal government ought to act, and we ought to have medical malpractice reform across the board," he said. "The other thing people have got to understand is these frivolous lawsuits--and there's a lot of them--not only run the cost of medicine up, they deny people the chance to get their day in court."

The high cost of medical malpractice lawsuits, along with economic security and pension protection, are issues on the Republican agenda as the November congressional election approaches.


Flee Fleas, Please


Tuesday, August 13, 2002

(HealthScoutNews) --Fleas and ticks transmit diseases to people as well as pets.

Lyme disease is by far the most prevalent tick-borne disease in humans in the United States, with 8,257 and 13,083 cases -- mostly in the northeast and north central regions -- in 1993 and '94, successively.

Symptoms include fatigue, chills and fever, headache, muscle and joint pain, swollen lymph nodes, and a red, circular skin rash.

The next most prevalent tick-borne disease is Rocky Mountain spotted fever, characterized by fever, headache, rash, and nausea or vomiting. It affects more than 500 people each year, according to the Centers for Disease Control and Prevention ( news - web sites) (CDC).

Fleas or an infected animal can transmit bubonic plague. Seven cases, including one death, were reported to CDC in 1995, in Arizona, California, New Mexico, and Oregon. Another 13 cases, also including one death, were reported in 1994, in Arizona, California, Colorado, New Mexico, and Utah.

Early diagnosis and treatment give humans the best chance of recovery from these and other flea- or tick-transmitted diseases.


People with Autism Lack Self-Consciousness: Study

By Alison McCook
Reuters Health

Tuesday, August 13, 2002

NEW YORK (Reuters Health) - While most people have an easier time remembering words they feel might describe themselves, people with autism don't attach any added significance to such words, researchers have found.

The finding may shed light on how those with the disorder view themselves and help explain the lack of self-consciousness often seen in patients, according to Dr. Motomi Toichi of Case Western Reserve University and University Hospitals of Cleveland in Ohio and colleagues.

Researchers have already provided "ample" evidence that people with autism may have an altered sense of self, Toichi told Reuters Health. For instance, he noted, autistic patients often speak about themselves as if talking about others, or may take off all of their clothes in public.

During the study, Toichi and colleagues presented 18 autistic patients and 18 others with 30 words and then asked them a question--did the word rhyme with another? Did it have a meaning similar to another word? Or did it describe their personality?

While some people with autism are incapacitated by their condition--a psychiatric disorder marked by impaired communication and abnormal behavior--all the patients in the study were "high-functioning" autistic adults of normal intelligence.

The investigators then presented the study participants with a list of 90 words and asked them to identify the words they had seen before.

According to the report in the August issue of the American Journal of Psychiatry, Toichi and colleagues found that most people were better able to remember words if they first had to determine whether or not the word described themselves.

This was not true for autistic patients. In contrast, those with autism were more likely than others to remember words when asked about rhyming qualities in the first test.

The finding suggests that autism may affect how well people know and understand themselves, the authors explain.

In an interview with Reuters Health, Toichi noted that helping autistic patients will likely involve more than trying to teach them to be self-conscious.

In fact, "it seems to be very difficult to help them gain self-consciousness," he said. "An important point is, however, to overcome maladaptation and gain social skills, rather than to try to develop self-consciousness," Toichi added.

Source: American Journal of Psychiatry 2002;159:1422-1424.


Growing Old IS What It Used To Be


Tuesday, August 13, 2002

(HealthScoutNews) -- Anti-aging products that promise to turn back the clock do not deliver, and may even be hazardous to your health.

"Don't waste your money on anti-aging products," says S. Jay Olshansky, a Professor in the School of Public Health at the University of Illinois at Chicago and a senior research scientist at the university's Center on Aging.

He and 50 other top human-aging researchers warned consumers in a recent position statement that such anti-aging products as growth hormone and antioxidant supplements are not proven to work for people.

Dr. James Dillard, Clinical Advisor to the Rosenthal Center for Complementary and Alternative Medicine at Columbia-Presbyterian Medical Center, agrees with Dr. Olshansky.

"Anti-aging is a great field for product marketers, because it's almost impossible to prove or disprove the claims," he explains. "Unlike natural remedies for heartburn or joint pain, the results of taking these supplements could only be known after many years, if at all."

Not only do these products not deliver what they tout, Olshansky says, but "some of these products are likely to be dangerous. In animal models, animals given growth hormone have shorter life spans. Short-term, the animals appear younger, but they die sooner."


Massachusetts Woman Contracts West Nile in Missouri

Tuesday, August 13, 2002

BOSTON (Reuters) - A 38-year-old Massachusetts woman suffering from West Nile virus ( news - web sites), which authorities believe she contracted while visiting Missouri, remained hospitalized on Tuesday, state officials said.

"Her symptoms, beginning with headache, progressing to fever, chills, meningitis and encephalitis, reportedly began on August 2, shortly after her return to Massachusetts," the Massachusetts Department of Public Health ( news - web sites) said in a statement.

"To date this season, no confirmed human cases of West Nile virus disease have been acquired in Massachusetts," the statement said.

A spokeswoman said the patient's condition was improving, but declined to give details.

Seven people have died of the disease this year in Louisiana, where about 85 confirmed cases and another 90 suspected cases of the illness have been reported. Cases have been reported in Alabama, Illinois, Mississippi, Texas and Washington, DC.

About 66 birds carrying the virus have been found dead in Massachusetts, while Missouri has reported West Nile virus in mosquitoes, birds and horses.


Get Early Start on Kids' Dental Care


Tuesday, August 13, 2002

TUESDAY, Aug. 13 (HealthScoutNews) -- It's never too soon to begin your children's dental care.

Start looking after their teeth before the first tooth arrives. That's because, by the time you notice decay on your children's teeth, it may be too late, says pediatric dentist Leo D. Morton, of Advocate Lutheran General Children's Hospital in Park Ridge, Ill.

Morton offers some suggestions on how to ensure good dental health in children. Expectant mothers need to eat a well-balanced diet. Parents can begin oral hygiene in an infant's first few months.

"Use gauze or a soft cloth with water to clean the gum tissues before the teeth have erupted. Gently wipe and massage the gums after feeding and right before bed," Morton says.

This early massaging and cleaning will help with teething, and will get your child used to regular oral hygiene and possibly create a healthy habit for life.

Start using a small baby toothbrush as teeth erupt, Morton says. Use a "baby toothpaste" that doesn't contain fluoride. Use a pea-sized amount of toothpaste, and begin to floss your child's teeth.

A condition called nursing bottle mouth can be caused by improper feeding methods. Sugar in formulas and juices can mix with plaque, causing the formation of acid that attacks tooth enamel. This acid will attack the teeth within 20 minutes of feeding if you don't clean your children's teeth immediately.

"Never allow your infant to fall asleep with a bottle in their mouth," Morton says.

He explains that when babies sleep, there's reduced saliva flow in their mouths. That makes it easier for sugary liquids to pool around the teeth.

"I've seen children who have extensive decay from the bottle that requires full mouth rehabilitation," Morton says.

He suggests you fill the feeding bottle with water or use a clean orthodontic pacifier if your child needs the comfort.

Here are some other suggestions:

  • Pacifiers are OK until the age of 2 or 3. That habit is easier to break than thumb sucking.
  • When your baby starts to stand and/or walk, be alert for any dental injuries she may suffer when she falls. Dental trauma requires immediate attention.
  • Make routine visits to the dentist. Your child's first visit should take place before her first birthday, followed by a visit every six months.

More information

When they're old enough, your kids may enjoy this explanation of a cavity.



A Ripe Observation

Monday, August 12, 2002

(HealthScoutNews) -- Ethylene gas, the ripening agent that many fruits and vegetables produce naturally, causes them to ripen -- then over-ripen.

Careful comparisons of three tomatoes -- one kept on a windowsill in the sun, another set nearby in a closed paper bag, and the third placed in a refrigerator -- can demonstrate how temperature, refrigeration, light and containment of the ethylene gas affect ripening and taste.

Refrigeration and humidity slow the effects of ripening, but they don't stop the production of ethylene gas. The more the tomato ripens, the more ethylene gas it makes. This has a big effect on how -- and when -- farmers harvest their fruits and vegetables for market.

Most commercial tomatoes are picked before ripening is completed, so the fruit won't spoil before it gets to your market. But picking early also means the tomato spends less time on the vine, where ethylene would help build more of the sugars and acids that create tip-top tomato flavor.


States Push Meningitis Vaccination

By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, August 12, 2002

It started like a mere stomach bug: John Kach felt fine one day but spent the next throwing up. By day's end the 19-year-old college freshman was in a coma — and spent almost four months in the hospital, surviving only after doctors amputated one foot and all his fingers and toes.

Patrick Kepferle wasn't so lucky. The freshman at Towson University in Maryland died less than 24 hours after the first symptom.

This is bacterial meningitis. While rare, it can sicken and kill with terrifying swiftness. And college freshmen who live in dormitories are one of the prime targets.

Now some states have begun mandating that most students who live on campus get vaccinated against meningococcal meningitis — and a group of mothers is making public their children's battles with the infection in hopes that even more students will get the often ignored shot that costs $65 to $85.

"One of these sweet children walking onto campus their freshman year may never catch it, but yours could be the one," says Paige Kach of Carmel, N.Y., whose son was infected while at Rhode Island's Salve Regina University. "Why as a mother would you ever take that chance?"

It can be a tough sell. Many people have never heard of this tough-to-pronounce form of meningitis — say muh-NIN-ja-ka-kul. Many primary care physicians don't carry the shot, leaving busy students to track it down at campus health centers, and must pay out of pocket for it.

About 3,000 Americans a year get meningococcal meningitis, a contagious bacterial infection of the membranes around the brain and spinal cord. About 300 of them die, and another 450 who survive suffer permanent disabilities including lost limbs, deafness or mental retardation.

Fast medical care is crucial. The germ can cause a blood-poisoning reaction, called meningococcemia, that causes organs to shut down and gangrene to set in within hours.

"It's one of the few remaining infectious diseases in the United States where you can take someone who's perfectly healthy one day, and they can be dead in 24 to 48 hours," said Dr. Nancy Rosenstein, meningitis expert at the Centers for Disease Control and Prevention ( news - web sites).

Ten percent of the population carries the bacteria harmlessly in their nose and throat, spreading it to others by coughing, kissing, even sharing drinking glasses — particularly in crowded conditions like dormitories that expose people to strains of the germ they may never have encountered before.

The meningococcal vaccine is very safe and about 85 percent effective at preventing four of the five strains of infection. But it doesn't work in babies, the age group at highest risk; the protection lasts only a few years; and it doesn't wipe out the germ in carriers. So vaccinating everybody makes no sense.

Then the CDC discovered college freshman in dorms — not just students that age, but those in the crowded housing — had six times the risk of the average population, and began recommending that incoming students be told they can choose vaccine protection.

Why not require it? Because mysteriously, the vast majority of meningococcal infections are sporadic — only one person gets sick and nobody knows where or why they got it. Despite the higher freshman risk, in most years college students account for only 150 infections and 15 deaths.

The CDC is anxiously awaiting a new meningococcal vaccine now sold in Europe and Canada that — while not effective against all strains — works in babies, appears to last for decades and might even wipe out the germ in many carriers. It could be offered here in several years, eventually making the college vaccination question moot.

But for now, some states and colleges are heeding victims' calls to go further.

Pennsylvania last month began requiring that students moving into campus housing get vaccinated or sign a waiver stating they have some objection. Maryland, Connecticut, Virginia and Florida have passed similar legislation. Other states require that incoming students be informed of the risk, per CDC's recommendation.

Many colleges are holding fall vaccination days. Check the Meningitis Foundation of America's Web site for a list:

And a mothers' group, Moms on Meningitis, is teaching students about vaccinations and the need to see a doctor fast if they have meningitis symptoms: high fever, headache, stiff neck, confusion, vomiting and — an often late sign — a rash. Early symptoms unfortunately are flulike, but one warning sign is if illness strikes fast.

"We really need to grab kids and parents" and show them "our beautiful kids who died, or are alive but can't play basketball anymore because they have no legs," says Deb Kepferle of Lexington Park, Md. "Because nobody knows."

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


A Flaky Experiment

Monday, August 12, 2002

(HealthScoutNews) -- Are there different amounts of iron in different breakfast cereals? You can find out by using a strong magnet and a good scale.

The iron in ready-to-eat breakfast cereals is sprayed on the outside of cereal flakes. If it's drawn away from the cereal with a magnet, you can weigh samples and compare different products.

You'll need a fairly sensitive laboratory scale for this procedure; a bathroom scale won't cut it!

Here's what to do:

  • Crush a half cup of cereal in a baggie, until the flakes are half their original size. Pour into a bowl.
  • Add 1 cup of hot water and mix with a wooden spoon.
  • Get a strong, 3-inch bar magnet that is not grey or black (so the iron filings will show up). Don't use a horseshoe magnet.
  • Put the magnet into the cereal mix and stir gently in a circle for a fixed amount of time, say 5 minutes. Try not to bump the bottom or sides of the bowl.
  • Take out the magnet. Remove the iron filings that it pulled from the cereal, and weigh them on the laboratory scale.


Gene Behind Down Syndrome-Linked Cancer

By Keith Mulvihill

Reuters Health

Monday, August 12, 2002

NEW YORK (Reuters Health) - Scientists announced Sunday they have discovered a gene abnormality that appears to be associated with a rare form of leukemia that occurs in people with Down syndrome.

Down syndrome is a genetic disorder that causes mental retardation and certain physical abnormalities. The disorder arises from an error in cell division that results in a fetus having an extra copy of chromosome 21.

"Children with Down syndrome have 10- to 20-fold elevated risk of developing leukemia," according to Dr. Joshua Wechsler of the University of Chicago, Illinois, and colleagues.

During an interview with Reuters Health, co-investigator Dr. John D. Crispino explained that he and his colleagues have been interested in the function of a gene called GATA1, which plays a role in blood cell development. Mice that lack the gene, he said, have defects in blood cells. Specifically, a type of cell called a megakaryocyte, which is involved in making blood-clotting platelets, starts to proliferate out of control.

Intrigued, the researchers wondered if there was any connection between GATA1 and a rare leukemia called acute megakaryoblastic leukemia (AMKL).

To investigate, the research team evaluated the DNA from blood samples from 75 people with various types of leukemia. They then compared the findings with blood samples from 21 healthy people. The results were released August 12 in the advance online publication of the journal Nature Genetics.

The investigators found that among six people with Down syndrome and AMKL, all had an abnormality in GATA1. None of the other study participants had a defect in GATA1, Crispino pointed out.

"Our best guess is that mutations in the GATA1 gene are essential in the progression of this type of cancer," Crispino told Reuters Health.

"The discovery is important in that it now defines this leukemia. The diagnosis will be improved, and it opens doors to understanding the precise molecular events that convert a normal cell to a malignant one," he added.

Crispino also noted that there is an additional component to AMKL, which is contributed by the extra chromosome 21, the genetic cause of Down syndrome. People with Down syndrome are already at increased risk of leukemia, and the GATA1 gene mutation may increase the chance of AMKL, in particular.

The researchers plan to use the new insights into AMKL to define the nature of this other gene defect (having an extra chromosome 21), as well as study other types of leukemia associated with Down syndrome, Crispino said.

Source: Nature Genetics 2002;10.1038/ng955.


Expert: Flu Vaccine a Must for the Elderly

Monday, August 12, 2002

MONDAY, Aug. 12 (HealthScoutNews) -- Universal flu vaccines for elderly people could drastically reduce deaths and hospitalizations, but doctors and health-care systems need to do more to make that happen, says Mayo Clinic vaccinologist Dr. Gregory Poland.

In an editorial that appears in the current issue of Clinical Infectious Diseases, Poland cites a study that found influenza vaccinations of elderly people in three HMOs over two flu seasons cut the death rate by 38 percent to 50 percent.

However, Poland criticizes doctors and health-care systems for failing to introduce universal influenza vaccination.

"Sadly, the data at hand lead to the undeniable conclusion that health-care providers as a whole may actually be a barrier to preventing death and hospitalization due to complications from influenza," Poland writes.

"Physicians and health-care systems have been aware of the benefits of the influenza vaccine, as the advantages have been repeatedly demonstrated in high-quality clinical and population-based studies for at least two decades. Despite long-standing national recommendations that make influenza immunization the standard of care, progress in improving influenza coverage rates has been unacceptably slow at best, taking decades to achieve coverage rates of 60 percent."

Poland offers some suggestions on how to achieve universal influenza vaccination for elderly people. They include:

·         Standing-order programs in hospitals that let nurses screen and immunize people for influenza and pneumococcal disease without a physician's order.

  • Development of clinic office systems to increase immunization rates. These could include reminder systems, flu clinics and standing-order programs.
  • Reimbursement by Medicare and other third-party payers for the cost of both the vaccine and administering it.

More information

The University of Maryland School of Medicine has these basic facts on the flu vaccine.


FDA OKs Advanced Colon Cancer Drug

By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, August 12, 2002

The government approved a new treatment for the nation's second-leading cancer killer Monday — after a record-setting seven-week review — a last-ditch chemotherapy for advanced-stage patients who have exhausted today's standard drugs.

Eloxatin's effects at first glance seem small: When taking it together with older drugs, about 9 percent of treated colon cancer patients saw their tumors shrink significantly and they gained about two extra months before the cancer started growing again.

But until now these incredibly hard-to-treat patients have had no other alternative once standard treatment failed — and the FDA ( news - web sites) is anticipating soon data that could prove whether Eloxatin works better when given in earlier stages of the disease.

"We felt it was important for the American public to have access to this drug," said FDA cancer drugs chief, Dr. Richard Pazdur. "These patients don't have any treatment options available to them."

The drug, made by the French pharmaceutical company Sanofi-Synthelabo, was approved faster than any other cancer treatment; only AIDS ( news - web sites) drugs have passed through the FDA faster.

It marks the first good news for patients with advanced colorectal cancer since the implosion of the biotechnology company ImClone, which had touted its own colon cancer drug Erbitux as a miraculous treatment right up until the FDA rejected it last December.

The FDA has told Congress that ImClone performed shoddy science that failed to tell if Erbitux has any effect, leaving patients in limbo. ImClone's former chief executive pleaded innocent Monday to charges of insider stock trading.

FDA's Pazdur pointedly told the pharmaceutical industry Monday to follow Sanofi's example — not ImClone's — in testing cancer drugs.

"We want to send a message," he said, saying FDA employees worked overtime and canceled vacations to speedily review Eloxatin because the science behind the drug was so strong. "We're willing to do that if we think the drug is worth that."

Sanofi followed FDA's advice in designing a 463-patient study that promised, and delivered, some of the cancer industry's most statistically solid results. Participants were divided into thirds, getting either standard therapy, Eloxatin alone or a combination.

Combining Eloxatin with the standard drugs 5FU and leucovorin made it work much better, something scientists may never have known had Sanofi performed a cheaper but less rigorous study. The latter is the kind of research that frustrated FDA officials have recently seen "a rash of" as companies have tried to rush medications to the market, Pazdur said.

Eloxatin was approved under a special FDA program that allows promising cancer drugs to be sold before there's proof they actually prevent or delay death. But Pazdur said FDA should soon evaluate a study presented at a recent cancer meeting suggesting Eloxatin can help survival when given earlier in the disease.

Colorectal cancer strikes about 150,000 Americans a year, and kills about 56,000 of them.

Eloxatin, known chemically as oxaliplatin, will be available by the end of the month. Sanofi refused to reveal a price, but said it will be comparable to other chemotherapies.

The injected therapy, given once every two weeks, does cause side effects. About 75 percent of patients suffer some degree of peripheral neuropathy, a numbness and tingling of the hands and feet as nerve endings there are damaged, said FDA medical reviewer Amna Ibrahim. The condition, worsened by cold temperatures, typically improves once treatment is ended.

Very rarely, patients suffer a life-threatening allergic reaction. Like other chemotherapies, it also can cause vomiting, diarrhea and anemia.

On the Net:



Asthma In Kids Can Be Controlled

By Serena Gordon
HealthScoutNews Reporter


Monday, August 12, 2002

MONDAY, Aug. 12 (HealthScoutNews) -- Parents and health-care professionals have the tools they need to control most cases of childhood asthma, but one nursing expert says those tools often go unused.

In the August issue of the American Journal of Nursing, registered nurse Carolyn Gallagher says many asthmatic youngsters aren't being diagnosed or treated properly.

"Most kids with asthma can have a completely normal life," Gallagher says. "A child doesn't need to miss school or play because of asthma."

According to Gallagher, asthmatic children should expect to have no or only minor symptoms; be able to sleep through the night without symptoms; not miss school because of asthma; be able to participate fully in peer and sport activities; and not have to visit the emergency room or hospital because of their asthma.

The first step, she says, is getting the correct diagnosis. Wheezing and shortness of breath are classic symptoms of asthma, but Gallagher says sometimes the only symptom might be a persistent nighttime cough.

"Asthma is not necessarily an obvious struggle with breathing. It can be as simple as coughing and not having endurance to run for a long time," she adds.

Parents need to keep a diary of their child's symptoms to help their doctor correctly assess the problem.

The next step is assessing the severity of the asthma. Depending on the child's symptoms and the results of a test -- known as spirometry -- that measures lung function, your child's asthma will be classified as mild, moderate or severe. Within those categories, it will be either persistent or intermittent.

After getting a diagnosis, the most important step is coming up with an asthma management plan. A written plan provides parents with guidelines to follow. For example, it should include details such as what symptoms call for the use of a bronchodilator or "rescue" medication. It should include a place for parents to track symptoms and responses to medications, so parents and health-care professionals can see what's working and what isn't.

Unfortunately, "half of physicians don't use a written asthma management plan," says Gallagher, who adds that many doctors also aren't conducting necessary follow-up visits with their asthma patients. She recommends seeing a doctor at least quarterly to assess a child's asthma plan.

Steroid inhalers are one of the biggest advances in asthma treatment, and when used preventively they can reduce the severity of symptoms. Yet, according to Gallagher's article, some physicians hesitate to prescribe these medications because of concern they might slow a child's growth. However, she says, studies have shown these medications are safe in children older than 1 year, and they don't "deter growth significantly."

Dr. Marianne Frieri, director of allergy and immunology at Nassau University Medical Center in East Meadow, N.Y., says Gallagher brings up a lot of good points in her article and agrees that asthma is often missed or undertreated. She cautions, however, that asthma can be overtreated as well.

"It's true that a lot of times primary-care pediatricians, because they're so busy dealing with acute problems, may not use the tools," Frieri says.

She recommends seeing an asthma specialist, and adds that nurses are very important in helping to educate parents and children.

One aspect Gallagher didn't address in detail in her article that is very important for parents is trigger management, Frieri adds. Asthma flares are caused by triggers, and these vary from child to child, but some common ones are mold, dust, pet dander and cockroach excrement. Limiting your child's exposure to these triggers will help keep the asthma under control, Frieri says.

What To Do

For more information on managing childhood asthma, visit these pages from KidsHealth and the American Academy of Allergy, Asthma and Immunology. Your children might want to read this article for kids on asthma, also from KidsHealth.


Natural Substance May Hold Key to Asthma Therapies

By Linda Carroll
Reuters Health

Monday, August 12, 2002

NEW YORK (Reuters Health) - A chemical that naturally occurs in the body may help scientists find better treatments for asthma.

The chemical, called lipoxin A4 (LXA4), appears to quiet hyper-responsive airways, researchers report this week in the advance online publication of the journal Nature Medicine.

In the new study, researchers gave asthmatic mice a synthetic compound that is similar to LXA4, but longer lasting, study co-author Dr. Charles N. Serhan explained in an interview with Reuters Health.

People with asthma often experience attacks during which airways narrow. Attacks can range from occasional periods of wheezing, mild coughing and slight breathlessness to more severe episodes that can lead to total blockage of the airways.

"LXA4 is rapidly formed and rapidly broken down by the body as a way of regulating cellular traffic," according to Serhan, director of the Center for Experimental Therapeutics at Brigham and Women's Hospital and a professor of anesthesia, perioperative and pain medicine, biochemistry and molecular pharmacology at Harvard Medical School ( news - web sites), both in Boston, Massachusetts.

Basically, Serhan said, LXA4 acts to quiet inflammation by knocking down levels of cells that cause it.

In the new study, Serhan and his colleagues looked at the effect of LXa, a substance that mimics the naturally occurring molecule, but doesn't break down as quickly, in mice with asthma.

An hour after the mice were given LXa, they were exposed to substances that might normally cause airways to narrow and become inflamed. LXa not only kept the airways open, but also appeared to reduce inflammation, Serhan said.

To further test to see if LXA4 might be the key to new medications in humans, Serhan and his colleagues used genetic engineering techniques to produce mice that expressed the human version of the LXA4 receptor. Again, LXa kept airways from narrowing and reduced inflammation.

Serhan is hoping that the new research will catch the eye of a pharmaceutical company looking to develop new therapies for asthma.

"That would not be something we do," Serhan said. "But we're hoping that this research will be encouraging enough to draw that kind of attention."

With asthma on the rise, especially in children, new treatments are needed, Serhan said. "The agents available today have limited use and they don't work for everyone," he added. "A lot of testing needs to be done to figure out which medication is best for which patient. And that takes a long time. Besides, some of the classic therapies have side effects."

Serhan suspects that because LXA4 is produced by the body, that an analog to the molecule will have fewer side effects than drugs developed in other ways.

The new study was funded, in part, by grants from the National Institutes of Health ( news - web sites).

Source: Nature Medicine 2002;10.1038/nm748.


Chelation Therapy's Mettle to Be Tested

By Amanda Gardner
HealthScoutNews Reporter


Monday, August 12, 2002

MONDAY, Aug. 12 (HealthScoutNews) -- Much like tattoos and body piercing, chelation therapy may be poised to move from the margins of medicine into the mainstream.

The National Center for Complementary and Alternative Medicine and the National Heart, Lung, and Blood Institute, both part of the National Institutes of Health ( news - web sites) (NIH), are launching the first large-scale clinical trial to see if chelation therapy is a safe and effective treatment for people with coronary artery disease, the leading cause of death for both men and women in the United States.

Chelation therapy was originally developed in the 1930s to combat heavy metals such as arsenic, which were expected to be used in chemical warfare. Patients receive EDTA (ethylene diamine tetra-acetic acid), a synthetic amino acid, intravenously. The EDTA then binds to the molecules of the metal in the blood, and the two are expelled from the body in the urine.

"Arsenic warfare" never materialized, but chelation therapy has been FDA ( news - web sites)-approved to treat lead poisoning and other heavy-metal toxicities. According to the NIH, more than 800,000 patient visits were made for chelation therapy in the United States in 1997. Cost ranges for the course of therapy run between $2,000 and $4,000.

While chelation therapy was being used for metal toxicities, a number of clinicians noticed some patients with heart disease and angina ( news - web sites) seemed to be improving as well. Word spread, and chelation therapy became a common, off-label procedure for people with angina, atherosclerosis and other conditions in the 1960s and 1970s.

Then, various small studies appeared to discredit the technique, and mainstream cardiology moved away from the treatment.

Alternative medicine practitioners, however, stuck with it.

"Chelation, or EDTA, became almost an underground movement in medicine and cardiology," says Dr. Gervasio A. Lamas, director of cardiovascular research and academic affairs at Mount Sinai Medical Center and Miami Heart Institute. Lamas heads up the current NIH study.

Scientists now feel the earlier studies were not conclusive. Meanwhile, a spate of more recent studies has renewed interest in chelation therapy, though these are also largely inconclusive.

There are still, however, thousands of case reports testifying to chelation therapy's success with cardiovascular disease.

The NIH study intends to settle the matter once and for all.

Study leaders have lined up a list of heavy-hitting medical institutions such as Brigham and Women's Hospital in Boston and Duke Clinical Research Institute to participate.

"For me to be able to gather the team we have on this, I think that's really a sea change," Lamas says. "People are really interested in settling this question."

"I was very pleased to see that the NIH is going to support a very large-scale study to answer the question once and for all. I think it's very important to do this work," says Dr. Woodson Merrell, executive director of the Continuum Center for Health and Healing at Beth Israel Medical Center in New York City.

"If it shows that chelation does work, then that would certainly add something to our armamentarium. If it shows it doesn't work, then people spending a lot of money could better spend it elsewhere," Merrell adds.

The trial, scheduled to last five years and to be carried out at 100 sites, will involve 2,372 patients, all 50 years or older, who have had a heart attack. People will be randomly assigned to receive either a standardized chelation solution or a placebo. Each group will also be randomly assigned to receive high-dose or low-dose vitamin/mineral supplements.

The chelation therapy will be administered by IV over about three hours, first once a week and then afterwards every other month for a total of about 40 infusions; rare side effects, if it's given too fast, can include cramping in the arms or jaw or some tingling.

The researchers will be looking to see if the patients suffer additional heart attacks, stroke, hospitalization for angina, coronary revascularization or death.

The study is not specifically intended to ferret out why chelation therapy works -- only if it works.

Nevertheless, Lamas and other scientists have some theories. One hypothesis holds that EDTA may reduce oxidized LDL, or "bad," cholesterol in the blood. Oxidized LDL is extremely toxic.

Another explanation is that EDTA may bind with calcium from the fatty plaques that block arteries and lead to coronary artery disease.

"I honestly don't know what mechanism it is. And from my past experiences of looking at the mechanisms of cardiovascular therapies, it's often what you expect least," Lamas says. "We're embarking on a large trial without knowing which one it is and, at end of it all, we may have a therapy that works and we will then have to retrace our steps and figure out why."

At the very least, clinicians should have an answer.

"We just don't have a comfort level now whether it works or doesn't work," Merrell says. "It'll be really good to know."

What To Do

Patient enrollment for the NIH trial does not start until March 2003, but interested individuals should call 305-674-2162.

For more information on the upcoming trial, visit the National Center for Complementary and Alternative Medicine. For more details about chelation therapy, visit the American Heart Association, which does not approve of the process for heart ailments.


Ore. Measure Aims at Modified Foods

By Brad Cain

Associated Press Writer

The Associated Press

Monday, August 12, 2002

SALEM, Ore. (AP) - The food industry is mounting a major effort to scuttle the first attempt by a state to require labels on genetically engineered foods.

A measure that will be on the November ballot in Oregon would require labeling of all modified food and food additives sold in stores and restaurants, and any such food produced in the state.

"If this ballot measure passes, it would set a dangerous precedent that would result in significant costs to taxpayers and consumers," said Gene Grabowski of the Alliance for Better Foods, based in Washington. The national coalition of food producers and retailers, biotech companies and agricultural groups has hired a Portland consulting firm to put together what promises to be a multimillion-dollar campaign.

They are pitted against activists who worry that genetic engineering could cause unintended or harmful side effects.

"We could be creating something we can't control," said Donna Harris, a chief sponsor of the measure. "They haven't done any human testing of this in the United States."

Labeling requirements already exist in Japan and parts of Europe, but there are none in the United States so far. Oregon has broken new ground before, including its unique laws allowing doctor-assisted suicides and statewide voting by mail.

Based on the overall amount of genetically modified crops, industry and environmental groups estimate that 70 percent of processed foods on U.S. supermarket shelves contains some genetically engineered components.

The main crops that come from genetically altered seeds are soybeans and corn, along with canola that is turned into oil, according to the Agriculture Department.

Products made from modified soybeans include bread, candy, cereal, chocolates, crackers, flour, frozen yogurt, ice cream, infant formula, margarine and pasta, according to the Seattle-based Campaign to Label Genetically Engineered Foods.

Proponents say genetic engineering can boost the nutritional content of food or allow farmers to grow more pest-resistant crops that require less chemical treatment.

Grabowski, the food industry spokesman, also said there is already plenty of government regulation of food quality and that fear of harm by genetically modified foods is unfounded.

"It's in all kinds of food, and there's never been a single case of illness or any other problem," he said.

Backers of the labeling measure say too little is known about the long-term health effects of genetically engineered foods.

"It's like little kids playing with a chemistry set in a back bedroom. You hope they don't burn down the house," said Craig Winters, head of the Seattle campaign.

The group has been leading a national effort to get Congress to pass a federal labeling requirement, but has made little headway. Winters said passage of the Oregon measure would send a strong message to Washington.

All sides agree that requiring labels would be expensive.

"The food manufacturers themselves often don't know if the ingredients they are using have been genetically modified," said Mike Rodemeyer, executive director of the nonpartisan Pew Initiative on Food and Biotechnology.

Such companies would have to track down that information, he said, "but the question is, who pays for the cost of doing those things?"

Rodemeyer said various polls and opinion surveys he's seen make it clear that most Americans support the labeling requirement.

"People think it's important to know if the foods they are buying in the grocery store contain genetically modified ingredients," he said. "They feel strongly they have a right to know about a product's attributes."

On the Net:

Alliance for Better Foods:

Campaign to Label Genetically Engineered Foods:

Pew Initiative on Food and Biotechnology:


Peer Influence Top Factor in Teen Smoking

By Serena Gordon
HealthScoutNews Reporter


Monday, August 12, 2002

MONDAY, Aug. 12 (HealthScoutNews) -- Teens start smoking for a lot of reasons, but one of the biggest influences on whether they become regular smokers is their friends, concludes a new study.

Kids who had at least three friends who were regular smokers were 24 times more likely to become regular smokers themselves, according to the study, which is published in the current issue of the Journal of Consulting and Clinical Psychology.

"This study confirms what most parents already knew -- if you're around kids who are a bad influence, you pick [their habits] up," says child psychologist Alan Hilfer from Maimonides Medical Center in New York City. "Smoking has always been an attempt to look cool and more sophisticated to your peers," he adds. Hilfer was not involved in the study.

Past research has indicated that almost 35 percent of high school students smoke at least one cigarette a month, and that nearly one quarter smoke every day, according to the study.

The researchers, from Brown University Medical School, interviewed almost 21,000 teen-agers in seventh through 12th grades two times. The teens were classified as "never smokers," "experimental smokers," "intermittent smokers" and "regular smokers." Experimental smokers said they hadn't had a cigarette in the past 30 days, but didn't disapprove of smoking. Intermittent smokers had smoked between one and 29 out of the previous 30 days, and regular smokers reported smoking on a daily basis.

Having friends who smoked was far and away the biggest risk factor for the progression of teen smoking from experimental to intermittent or regular smoking. Other important factors were alcohol use, parental smoking, depression and feeling alienated from school.

Teens who drank alcohol more than twice a month were nine times more likely to start smoking than abstinent kids. Teens with fathers who smoked had a 26 percent higher risk of becoming smokers themselves. Interestingly, maternal smoking only seemed to have an effect on daughters, increasing their risk of smoking by 36 percent.

Several factors emerged as protective against smoking. Kids from close families were 9 percent less likely to smoke. Another protective factor was being African-American, Hispanic or Asian.

The authors say that by knowing which kids are most at risk, prevention efforts can be better targeted to the kids who need it most.

"Parents have to know their kids and monitor this stuff," says Hilfer. He says parents need to know who their kids' friends are and they need to talk to the other parents as well.

If parents see any signs of their teen smoking, they need to "make an attempt to help kids stop smoking before it becomes too pernicious a habit," he adds.

What To Do

For more information on what makes teens more likely to smoke, go to Kid' Or you might want to have your teen read this article, also from Kid's Health, that talks directly to teens about the realities of smoking. The U.S. Centers for Disease Control and Prevention ( news - web sites) also offers information for parents and kids on preventing smoking.


Consumer Group Slams Imitation Meat Product

By Anne Marie Kelly

Reuters Health

Monday, August 12, 2002

WASHINGTON (Reuters Health) - A consumer group is calling on the US Food and Drug Administration ( news - web sites) (FDA) to have the makers of Quorn, an imitation chicken- and meat-substitute, recall the product because some people may get sick from eating it.

The Center for Science in the Public Interest (CSPI), a nonprofit consumer group, said more than 90 American and European consumers contacted the group to report their adverse reactions to eating Quorn products. Two-thirds reported vomiting, sometimes with diarrhea. Others reported suffering from stomach pains or nausea while others said they passed out after eating Quorn.

"To knowingly let people get sick is a perfectly sick policy," said Michael F. Jacobson, CSPI executive Director. "It wasn't appropriate for Olestra, and it isn't appropriate for Quorn."

Quorn products, which are made from a fungus, include imitation chicken nuggets, patties, and cutlets and imitation ground beef.

After eating a Quorn chicken patty, Victor Stanwick, 42, of Staten Island said he experienced severe nausea and vomiting three hours later.

"My ribs were hurting like I was boxing and I missed two days of work. It was miserable," said Stanwick, who is a diabetic but has not suffered any other illnesses and hadn't vomited in more than a decade. "The government has to do something about this. Warning: you will get sick after eating this."

Last January, the FDA allowed the manufacturer to sell the ingredient as a Generally Regarded As Safe (GRAS) substance, and the agency is reviewing whether to approve it as a food additive. Quorn has been commercially available in Britain and in other European countries since 1994.

According to its producers, Marlow Foods, a division of the pharmaceutical company AstraZeneca, Quorn is described as a healthy alternative to meat that is derived from an edible fungi, such as mushrooms and truffles, which the company states is a "mycoprotein."

The CSPI claims that the producers of Quorn have falsely labeled the products, identifying mycoprotein as "mushroom in origin" and as an "unassuming member of the mushroom family."

This is CSPI's third complaint to the FDA about Quorn.

A spokesperson for Marlow Foods was unable to comment before deadline.


Many Teens Still Can't Tell HIV Fact from Fiction

By Charnicia E. Huggins

Reuters Health

Monday, August 12, 2002

NEW YORK (Reuters Health) - Despite AIDS ( news - web sites) education classes, many junior and senior high students may still have difficulty sorting HIV ( news - web sites) fact from fiction, according to US researchers.

A small survey of New York students showed some were unaware that HIV is the virus that causes AIDS, and some students were unaware that the virus is transmitted through the exchange of bodily fluids.

In fact, some students referred to HIV and AIDS as two different diseases, and thought that one was more dangerous than the other, study findings indicate.

Part of the problem may be that HIV education classes address HIV risks and prevention, but don't address the actual biology of the body's immune system and the virus--leaving students vulnerable to misinformation, according to Drs. Alla Keselman, and Vimla L. Patel of Columbia University in New York City.

Students get 6 hours of HIV education every year in the New York City school system.

"With biology taught separately from factual HIV education and introduced in later grades, adolescents have little understanding of the concepts of virus and immune system, which are critical to building accurate conceptual models of HIV," according to Keselman and Patel.

"School science instruction can and should play an important role in preparing adolescents for dealing with HIV and other real world issues around sexuality and health," Keselman and Patel told Reuters Health in an e-mail interview.

In the study, the researchers interviewed 20 junior and senior high school students from two inner-city New York schools.

Altogether, 11 students were categorized as naive in their scientific knowledge of HIV, six students were categorized as having intermediate knowledge and three students were categorized as having advanced HIV knowledge.

Nine of the naive-level students did not seem to have even a basic understanding of the immune system and did not know that HIV was a microorganism that attacked immune system cells, Keselman and Patel report. Two students mentioned dirt as a cause of AIDS and thought that not washing after sex was a risk factor.

On the other hand, five of the students with intermediate HIV knowledge and all three of the students with advanced HIV knowledge understood the virus' effect on the immune system and recognized it as the precursor to AIDS.

However, even those with intermediate knowledge had a tough time determining between an HIV myth and the truth.

For example, four of the intermediate knowledge students went along with a myth that HIV could be rid from the body through urine and sweat, as did nine of the naive-level students.

"Myths are very difficult to dispel and one (can) hold on to these beliefs as long as one has no other strong foundation to hold on to, such as a scientific foundation," the researchers add.

Students with advanced knowledge, however, rejected the notion that one's HIV risk could be minimized if he or she expels the virus through urine and sweat.

Overall, these findings point to "the importance of biological (and) scientific knowledge in dealing with everyday health issues, evaluating dubious health information from uncertain sources, dealing with fad advertisements, street myths, etc," Keselman and Patel said.

"This is likely to be relevant in many health issues, and seems to be very important in issues around HIV," they added. For this reason, "'Just say no' campaigns are likely to have minimal effect; maybe it should be 'Say no and know why."'

The study findings were presented on Friday during the 24th annual meeting of the Cognitive Science Society in Fairfax, Virginia.


West Nile Called Emerging Epidemic

The Associated Press

Monday, August 12, 2002

NEW ORLEANS (AP) - West Nile virus ( news - web sites) is an "emerging, infectious disease epidemic" that could be spread all the way to the Pacific Coast by birds and mosquitoes, the director of the Centers for Disease Control said Sunday.

The Northeast and the South have been hardest hit by the virus since it was first identified in the United States in 1999, but Dr. Julie Gerberding said birds and mosquitoes infected with West Nile are now in most states east of the Mississippi River and some to the west of it.

West Nile is "a problem that is having an unusually high human toll this year. So it is serious, and we have to continue our public health action to combat it," Gerberding said on CBS' "Face the Nation."

Seven people with West Nile virus have died in Louisiana this year, and Mississippi officials are investigating a death they say appears to be linked to the virus. The virus has been detected in 35 states and Washington, D.C.

In Louisiana, state and local workers are spraying insecticide in residential areas where the Asian tiger mosquito and the Southern house mosquito typically lay eggs, under the assumption that the two species are the most likely carriers of West Nile.

"We have made an assumption about which species are involved in transmission of the disease here based on what has happened in other parts of the United States," said Dawn Wesson, a medical entomologist at the Tulane University School of Public Health and Tropical Medicine.

Gerberding said Louisiana's experience last year with the deaths of four people from St. Louis encephalitis, a mosquito-bourne virus similar to West Nile, has helped officials deal with this year's outbreak.

"I think the investments that we've made over the past several years in this kind of public health response have really paid off," she said.


Study Links Depression, Alzheimer's in Elderly

By Suzanne Rostler

Reuters Health

Monday, August 12, 2002

NEW YORK (Reuters Health) - Elderly adults who report symptoms of depression may be more likely to develop Alzheimer's disease ( news - web sites) than their less-depressed peers, US researchers suggest.

Their study involved more than 650 men and women aged 65 years and older, and found that the risk of developing Alzheimer's disease rose in tandem with the number of depressive symptoms reported, such as feeling lonely or being unable to sleep, over a 7-year period.

In fact, the risk of developing the disease rose by nearly 20% with each depressive symptom after accounting for age, education and gender, according to the report in the August 13th issue of Neurology.

However, it is not clear from the study whether depressive symptoms actually increased the risk of Alzheimer's disease or if people who are developing Alzheimer's disease are more prone to depression. People with Alzheimer's often report feeling depressed, the authors note.

"It is possible that depressive symptoms are an early sign of Alzheimer's disease pathology or some other neurodegenerative condition, such as stroke, or that depressive symptoms somehow make a person more vulnerable to the clinical effects of Alzheimer's disease pathology," Dr. Robert S. Wilson, the study's lead author, told Reuters Health.

He noted that the study is ongoing and that all volunteers agreed to have a brain autopsy at death, which could shed some light on this medical mystery.

"Our study provides strong evidence that depressive symptoms in old age are related to risk of Alzheimer's disease. Further research is needed to understand the basis of this association," said Wilson, from Rush-Presbyterian-St. Luke's Medical Center in Chicago, Illinois, in an interview.

The results of the report are based on a written questionnaire and neurologic evaluations of Catholic nuns, priests and brothers. None of the volunteers had evidence of Alzheimer's disease at the outset but over the next 7 years, 108 people were diagnosed with the disease, the report indicates.

The researchers cite several limitations to their study, including the failure to measure symptoms of depression more than once. Also, the group of adults in the study is not representative of US adults in education and lifestyle. Therefore, studies should try to replicate the results in other groups, Wilson and colleagues suggest.

Source: Neurology 2002;59:364-370.


Low Potassium Intake Linked to Stroke: Study

By Suzanne Rostler

Reuters Health

Monday, August 12, 2002

NEW YORK (Reuters Health) - Older individuals who do not eat enough potassium-rich foods may be more susceptible to stroke, preliminary study findings suggest.

The study of more than 5,600 men and women over 65 years of age found that those with the lowest dietary intake of potassium--a mineral found in bananas, tomato sauce and orange juice--were 1.5 times more likely to have a stroke over the next 4 to 8 years than their peers with higher intakes of potassium.

Among individuals taking diuretics, the risk of stroke was 2.5 times higher when blood levels of potassium were low. The risk of stroke was 10 times higher among diuretic users with an irregular heart rhythm known as atrial fibrillation and low potassium intake, compared with those with a normal heart rhythm and high intake of potassium, the researchers report.

Atrial fibrillation has long been known to increase the risk of stroke, Dr. Deborah M. Green and colleagues point out in their report in the August 13th issue of Neurology.

Diuretics, or "water pills," lower blood pressure and reduce stroke risk but can also lower levels of potassium in the blood. Therefore, they may be more effective when dietary potassium intake is high.

However, the study does not imply that using diuretics raises the risk of stroke, the authors emphasize. Rather, it indicates that the pills may play a role among some patients, including those with diabetes and high blood pressure, according to an editorial by Dr. Steven R. Levine from The Mount Sinai School of Medicine in New York and Dr. Bruce M. Coull from the University of Arizona in Tucson.

In an interview with Reuters Health, Green noted that the study is observational and does not prove the low potassium level is the cause for the higher stroke risk. It is possible that some unknown factor may reduce potassium level and raise stroke risk. Nor do the findings support any recommendations regarding dietary potassium intake, she added.

"People taking diuretics may benefit from potassium supplementation and periodic monitoring of their potassium level. My advice for all my patients is to eat a balanced diet that includes plenty of fruits and vegetables," said Green, from The Queen's Medical Center in Honolulu, Hawaii.

Levine agreed.

"People need to be more cognizant of potassium intake, especially people with high blood pressure and/or on diuretics, as they probably have the most to benefit from increasing their potassium intake," he said in an interview.

The investigators measured levels of potassium in the blood of healthy individuals who had never suffered a stroke, and recorded dietary potassium intake. High potassium intake was defined as more than 4 grams a day and low potassium intake was defined as less than 2.4 grams a day, roughly the amount in 1 cup of tomato sauce.

The average dietary intake of potassium was 3.3 grams at the outset and the average age of study volunteers was nearly 73 years.

Source: Neurology 2002;59:302-303, 314-320.


Stress Ups Heart Disease Risk Among Japanese

By Suzanne Rostler

Reuters Health

Monday, August 12, 2002

NEW YORK (Reuters Health) - Women who feel stressed on a day-to-day basis are more likely to die from stroke and heart disease than their more mellow peers, even when they do not have other risk factors, researchers report.

The results are based on data from more than 73,000 people aged 40 to 79 enrolled in a Japanese study on cancer. The findings confirm the results of numerous studies on the relationship between mental stress and heart disease and stroke among white men. In the current report, participants were asked to rate the level of stress in their daily lives.

According to the results, Japanese women reporting high levels of mental stress were more than twice as likely to die from stroke and heart disease than women reporting low stress levels, over the following 8 years.

Stressed-out women were on average younger, more educated, less active and thinner, and were more likely to have a history of high blood pressure and diabetes. They also smoked more and were more likely to have a full-time job compared with more relaxed women, according to Dr. Hiroyaso Iso from the University of Tsukuba in Ibaraki-ken, Japan, and colleagues.

The association between mental stress and death from heart disease and stroke was weaker among men for reasons that are not clear. Stressed out men were more likely to die of a heart attack, but there was no association between stress and stroke or coronary heart disease, Iso and colleagues report in the August 13th rapid access issue of Circulation: Journal of the American Heart Association ( news - web sites).

Nonetheless, the findings add evidence that stress can affect the body in a way that raises the risk of chronic disease. Mental stress can raise blood pressure and heart rate, increase the risk of developing blood clots, cause blood vessels to constrict, and make the body less sensitive to insulin. All of these factors may make a person more susceptible to chronic disease.

"The present study provides...evidence that perceived mental stress has the potential effect of increasing the risk of stroke and coronary heart disease," they conclude. "Although the underlying mechanisms are not well established, individuals with high mental stress should be regarded as a high-risk group for stroke among women, and individuals with coronary heart disease should be regarded as a high-risk group for stroke among men and women."

In an interview with Reuters Health, Hiroyaso expressed hope that his study would stimulate other researchers to investigate the effect of stroke in different races and age groups. He also recommended that studies investigate different stress reduction interventions in women.

Source: Circulation 2002;106.


Portable Defibrillators May Help Police Save Lives

Reuters Health

Monday, August 12, 2002

NEW YORK (Reuters Health) - People suffering cardiac arrest may be more likely to survive if police officers are equipped with automated external defibrillators (AEDs)--the compact and consumer-friendly version of devices doctors use to jump-start patients' hearts in the hospital, new study findings suggest.

AEDs automatically analyze heart rhythms and, if necessary, instruct the user to deliver an electric shock to normalize the rhythm. They are used to treat ventricular fibrillation, a condition in which the heart quivers in a series of uncoordinated contractions and requires an electric shock to begin pumping blood again.

When a person suffers such a cardiac arrest, which occurs when the heart suddenly stops beating, there is only a narrow window of time--about 10 minutes--for use of AEDs to have any benefit.

Over the years, AEDs have been increasingly kept on hand at airports, stadiums, and shopping malls to reduce response time to individuals in desperate need.

In the current investigation, health experts in Miami-Dade County, Florida, wondered if police officers equipped with AEDs might affect survival rates of cardiac arrest victims. The county implemented a new system in which both the police and emergency medical services were dispatched in the event of a cardiac arrest.

There, as in most places, emergency rescue teams--such as ambulances, the fire department and paramedics--are already equipped with the potentially life-saving devices. However, some experts believe that police officers might have a quicker response time compared with other types of emergency response teams.

"The theory is that police are already on the road when the call comes in, so there is the potential for faster response," said lead author Dr. Robert J. Myerburg of the University of Miami School of Medicine in a prepared statement.

To investigate, AED use by police was monitored between February 1999 and April 2001. During that time, 432 calls were made for cardiac arrests and the police were the first to arrive to the scene in 56% of the cases, according to the report published in the August 13th issue of the Circulation: Journal of the American Heart Association ( news - web sites).

"A 17.2% survival rate was observed for victims with ventricular fibrillation or pulseless ventricular tachycardia, compared with 9%" for standard emergency medical rescue measured before police started carrying AEDs, the authors write.

However, about 61% of the cardiac arrest victims in the study had non-shockable heart rhythms and they derived no benefit from the AEDs. As result, the absolute survival benefit was reduced to 1.6%, with 7.6% survival with AEDs compared with 6% for those treated by emergency medical services.

"Because sudden cardiac arrest victims have only a 10- to 12-minute window to be successfully resuscitated, more people must learn to recognize a cardiac emergency and call 9-1-1 immediately so an appropriately equipped first responder can treat them in time," Dr. Vinay Nadkarni of the American Heart Association explained in a statement.

Source: Circulation 2002;106:1058-1064.


Catch Your 40 Winks to Boost Performance

By Merritt McKinney

Reuters Health

Monday, August 12, 2002

NEW YORK (Reuters Health) - Want to improve your tennis game or play that tricky guitar chord? Sleep on it, new research from Germany suggests.

In the study, people who slept after learning a new motor skill were better able to perform the task than people who were kept awake after learning the finger exercise. Sleep after practice improved speed by about 34% and reduced errors by roughly 30%, according to a report in the early edition of the Proceedings of the National Academy of Sciences ( news - web sites).

It may seem obvious that sleep-deprived people would be more sluggish, but Dr. Stefan Fischer and colleagues at the University of Lubeck found that sleepiness did not explain the differences in performance. In a second round of testing, after all participants had a chance to catch up on their Z's, people who had slept after first learning the task still did better.

When people learn new motor skills, such as playing sports, performing surgery and playing a musical instrument, Dr. Jan Born, a co-author of the study, told Reuters Health, "Sleep on the night after a learning session will optimize the formation of long-lasting memories for the newly acquired skills."

But in the study, sleep only improved participants' skills on the specific task that they learned, not on other similar motor skills, according to the report.

"The data add to our understanding of sleep," Born said. "Why do we sleep? Apparently sleep serves to form memories, thereby helping the organism to develop long-term strategies of behavioral adaptation."

Previous research has shown that sleep helps the brain consolidate memory, particularly the type of memory needed to learn facts and events. But recent studies have suggested that sleep also helps build procedural memory, the "how to" kind of memory.

Born said that the researchers are now trying to understand exactly how the brain consolidates the learning of motor skills during sleep, including trying to find out which chemicals in the brain are involved. Another question for future research, Born said, is whether it is possible to use sleep drugs to modify, improve or suppress the consolidation of motor memories.

Source: Proceedings of the National Academy of Sciences Early Edition 2002;10.1073/pnas.182178199.


People Programmed to Sniff Out Cheaters: Study

By Alison McCook

Reuters Health

Monday, August 12, 2002

NEW YORK (Reuters Health) - People appear to have an innate ability to determine when someone is cheating them out of a deal, US researchers suggest.

In one recent report, a group of investigators demonstrate that humans from widely different cultures--US college students and members of an Amazonian society--can identify when someone is reneging on some type of social agreement, suggesting this ability may be an aspect of being human.

In another related article, the authors report the experience of a man who suffered damage to one portion of the brain in a bicycle accident and lost the ability to detect a cheater. However, he remained able to reason and express emotions, demonstrating that the ability may be linked to a particular region of the brain.

The research centers on the principle of social contracts, in which one person offers to do something for the other, who then offers something in return. The process, known as a social exchange, includes situations such as when people hold potlucks, or when a buyer pays $5 for a sandwich.

Researchers have spotted this behavior in a variety of species besides humans, ranging from bats to baboons. Although it is often in the interest of animals to help blood relatives without the promise of a return reward, in other cases, indiscriminately performing favors for others can hurt chances of survival, said study author Dr. John Tooby of the University of California, Santa Barbara.

According to Tooby, individuals who enter into social exchanges without determining whether the participant will cheat them out of the return favor will become exploited over time, and are less likely to reproduce and pass on their tendencies.

Consequently, those who try not to let themselves become exploited during social exchanges are more likely to live long enough to reproduce and distribute their genes to the next generation. But in order to do that, "you have to notice when you're being exploited," Tooby said.

In two articles published in the early edition of the Proceedings of the National Academy of Sciences ( news - web sites), Tooby and his colleagues offer evidence to support the theory that humans are born with the capacity to identify people who cheat during social exchanges.

In one study, Tooby and his team demonstrate that members of the Shiwiar, who live in a remote region of the Ecuadorian Amazon and do not read or regularly contact outsiders, are just as able to detect when people might cheat in social exchanges as Harvard undergraduates.

In the other article, the investigators describe the experience of a patient dubbed R.M., who suffered damage to a particular area of the brain during a bike accident. Thereafter, the man performed poorly during tests of the nature of social exchanges, but lacked neither emotions nor the ability to complete tests that targeted other types of reasoning.

In an interview with Reuters Health, Tooby explained that, taken together, these results demonstrate that the ability to notice when you are being cheated on social exchanges may be linked to a particular area of the brain, and that people can develop that ability regardless of their own cultural experiences.

"If (detecting cheaters in social exchanges) were all culturally specific, then you should find some cultures where people don't do it. We don't think that's the case," Tooby said.

He cautioned that the results from R.M. do not necessarily indicate that proficiency in assessing social exchanges resides wholly in the patient's damaged brain region. The man had damage to the limbic system, which is associated with emotion.

"But the fact that damage to that area knocks something out indicates that region plays a role," he noted.

Source: Proceedings of the National Academy of Sciences Early Edition 2002;10.1073/pnas.122352699.



Summer Scourges: Poison Ivy, Oak and Sumac

By Janice Billingsley
HealthScoutNews Reporter

Sunday, August 11, 2002

SUNDAY, Aug. 11 (HealthScoutNews) -- Summer is a feast for the senses. The smell of freshly cut grass. The sound of waves breaking on a beach. The taste of garden fresh vegetables.

And the maddening itch that comes courtesy of a brush with poison ivy, oak or sumac.

It's the rare person who doesn't have to worry about these summer scourges: Approximately 85 percent of people are allergic to the toxin -- called urushiol -- found in all three plants, health experts say.

"And about two-thirds of the population have had or will get poison ivy, oak or sumac. It depends on exposure," says Dr. Larry Millikan, chairman of the department of dermatology at Tulane University.

Poison ivy and poison oak are more common than poison sumac, but all three are found in most parts of the country. While poison ivy usually grows east of the Rocky Mountains, poison oak is most often found in western states. Poison sumac is primarily limited to eastern states, according to the American Academy of Dermatology.

However, the symptoms they unleash are the same -- spots, rashes, blisters, terrible itchiness.

Most people fall victim after contact with the plants themselves, usually while walking in woods or a garden.

"People brush up against the plant, bruising the plant leaves, which releases the urushiol that is located in little channels just under the surface of the leaf," says Dr. William L. Epstein, professor emeritus of dermatology at the University of California, San Francisco.

Urushiol, an almost colorless substance, is then absorbed by the skin. A few days later red spots appear, then a rash and blisters, then the itchiness.

Because urushiol doesn't break down easily, it can remain on clothes and shoes, only to be spread elsewhere -- say a chair someone else might sit in, or a car's steering wheel, Epstein says.

"You can get it from a shirt sleeve, or from pet fur if your pet has brushed up against it," Millikan adds.

Often, people don't know they've been exposed to poison ivy, oak or sumac until the telltale rash appears. However, if you know you've been in contact with the plants, you can save yourself if you act quickly.

"Once it's on your skin, you have about 45 minutes to an hour to wash off," Millikan says.

Washing gets rid of urushiol before it's absorbed into the skin. If you're hiking near water, such as a stream, where the plants are often found, get wet and wash off your skin and clothes, both doctors say.

Another quick remedy is to bring along some rubbing alcohol and thoroughly wipe exposed skin. Don't use a Handi-Wipe or similar cleaning cloth, Epstein says, because there's not enough alcohol in them to kill the urushiol. All you'll wind up doing is spreading the irritant around your skin.

If you don't know you've been exposed, it will become apparent, usually within 12 to 48 hours, when some spots appear on your skin, and then a rash breaks out, and "it itches like the dickens," Epstein says.

"Most people know what it is as soon as it starts," he says. "They don't confuse it with insect bites, even before they see a rash."

Cool showers and over-the-counter preparations like calamine lotion are effective for mild cases. So are lukewarm baths with an oatmeal or baking soda solution, the American Academy of Dermatology says.

For more severe cases, see a doctor, who can prescribe effective medicines.

"There are all kinds of steroids that soothe the skin and reduce the inflammation," Epstein says.

"There are topical cortisone creams and systemic cortisone given by pills or shots that you can use for about 10 days. And it's safe," Millikan says.

One comforting thought, both doctors say, is that scratching doesn't spread poison ivy, oak or sumac, no matter what your mother may have told you.

You can only get the allergic reaction where urushiol has touched your body. The reason it appears on some parts of the body first and other parts later reflects the level of initial exposure to the toxin -- less exposure means the reaction will show up later. Also, the blisters don't contain urushiol, Epstein says.

Even so, you shouldn't scratch anyway because you could get a secondary infection by breaking the skin and exposing it to bacteria, Epstein says.

Epstein adds it's also important to clean the clothes and the shoes you wore when you were exposed.

"If you come in the house and sit down with your boots and clothes on the chaise lounge, the urushiol will transfer to the furniture," he says.

What To Do

To see what poison ivy looks like, visit To learn more about poison ivy, oak and sumac, see the American Academy of Dermatology.


Backpacks Stress the Spine

Sunday, August 11, 2002

SUNDAY, Aug. 11 (HealthScoutNews)-- Backpacks can take their toll on a child's back and neck, recent research finds.

"There's a fairly high incidence of back pain in children, and it appears to be greatest during the period of rapid growth -- ages 11 to 16. One U.S. study reported a back pain prevalence of 36 percent in adolescents," says Dr. Mary Ellen Franklin, a physical therapist and exercise physiologist at the Medical College of Georgia.

She recently supervised a study in which physical therapy students assessed how much backpacks, or book bags, contribute to that problem.

In the study, children aged 10 to 13 stood on a platform that measures force. The children stepped from the platform onto a high step and back down to the platform.

The children did this three times -- once without a book bag, once with the book bag carrying a load equaling 15 percent of the child's body weight, and another time with a load equaling 20 percent of the child's body weight.

The heavier the book bag, the greater the force children exerted to step up. There was also a trend toward greater impact forces when they stepped back down, the study found.

"Your body tries to keep the center of mass between the feet, so with a backpack, the trunk is in a more forward position, placing abnormal forces on the spine," Franklin explains.

"This requires shifting the head forward ... but this would mean looking down. You compensate by bringing the head up, which makes part of the neck curve to a greater extent. It's very stressful on the neck."

Franklin offers several suggestions on how to avoid problems caused by overweight backpacks:

  • Lighten the load. Children should carry loads no heaver than 15 percent of their body weight.
  • Rolling book bags are a good choices. But the extra weight and bulk of rolling book bags can cause problems when children lift them out of a bus or car.
  • Backpacks used as book bags should have two padded shoulder straps. The worst thing for you child is a single-strap bag held on one shoulder or in one hand.
  • Children should know the proper way to wear a backpack. They should use both shoulder straps and snug the pack as close as possible to their body. Backpacks that have belts that fasten at the waist or chest help with that.
  • Backpacks should be appropriate for the size of the child. A backpack that's too large will sag towards the buttocks, stressing the child's lower back and shoulders.
  • Look for signs -- pain, red marks from straps, poor posture -- that a backpack fits poorly or is overloaded.

More Information

Go here to learn more about backpacks.



Keeping Kids Kinetic

Saturday, August 10, 20002

SATURDAY, Aug. 10 (HealthScoutNews) -- Don't depend on a school's physical education program to keep your children in shape. You have to do your bit to pump them up.

"Parental involvement is key not only in a child's academic development, but in their physical development as well," says Jack C. Kern, an associate professor of kinesiology at the University of Arkansas.

"In fact, children who engage in regular physical activity are better able to focus on their academic work. Physically active children demonstrate increased alertness and attention spans, which can lead to improved academic performance," Kern says.

He offers the following suggestions for parents:

  • Be active with your children. Take family walks and bike rides. If it's hot, wait until evening when it's cooler.
  • Encourage your children to try different sports and activities. They may find one they really enjoy.
  • Contact your friends who have children, and bring your youngsters together on a regular basis. Children who are alone or stay at home are more likely to be sedentary.
  • Scout out parks and recreation facilities in your area to see if they have hiking trails, bike paths and places to go swimming or canoeing.
  • Talk to your children regularly about the activities they're doing in school physical education classes. Encourage them to practice the skills they learn there. It's even better if you practice with them.

More Information

Here is some Health Advice for Kids.


Rare Bacterium Kills Fisherman

The Associated Press

Saturday, August 10, 2002

BOSTON (AP) - A rare flesh-eating bacterium has been blamed for the death of a fisherman, state public health officials said.

Al Holt, 69, died Aug. 1 as a result of infection by Photobacterium damsela, which lives in fish. State officials said they could find only 17 cases of illness caused by the bacterium reported in U.S. medical literature.

Contracting the disease would require being gouged by an infected fish or by a hook that had been in an infected fish. Authorities and family members believe Holt had a cut on his hand that allowed bacteria to infect him when he went fishing July 15.

"It's really extremely unlikely to happen in normal circumstances," said Dr. Bela Matyas, medical director of the Department of Public Health ( news - web sites)'s epidemiology program.

The fast-moving infection destroyed tissue in Holt's left arm by July 16, then spread to his major organs.


Shedding Light on Pain Management

By Dennis Thompson Jr.
HealthScoutNews Reporter

Saturday, August 10, 20002

SATURDAY, Aug. 10 (HealthScoutNews) -- Infrared light has been used for years to ease aches and pains, and now proponents say a federally approved device known called a Photonic Stimulator is providing more effective and safer light therapy than was available before.

The Photonic Stimulator is a hand-held device that emits low-level infrared light that penetrates the skin to stimulate blood flow and circulation, easing aches and pains, says Dr. Curtis Turchin, director of clinical sciences for Computerized Thermal Imaging Inc., the company that sells the device.

Proponents of the therapy say the light enters the body as photons that are absorbed by photo receptors within cells. Photons strike damaged tissue, including skin, muscle and bone, and create a cellular response that reduces pain and jump-starts the healing process.

Turchin says the device is much more powerful than the laser equipment previously used for infrared light therapy. The stimulator emits some 400 milliwatts of power during treatment, while the average laser emits 20 milliwatts.

However, it's also safer, he says, because the light is diffused over an area rather than focused, like a laser.

"When you have a less-focused light, it provides a margin of safety," Turchin says. "There's less danger of eye or skin damage."

Turchin says there are about 100 to 150 Photonic Stimulators in use across the country. They can be found in a wide variety of places, including hospitals, physical therapy clinics, doctors' offices and chiropractors' offices. Sports teams use them as well, he says.

The U.S. Food and Drug Administration ( news - web sites) has approved infrared light therapy for treating aches and pains, and some studies have shown wounds and cancer cells also respond to the treatment, health experts say.

The therapy is becoming somewhat popular in athletics. The San Diego Padres pro baseball team has been using the Photonic Stimulator for two seasons, with the team's trainer employing it to treat players' muscle injuries, including pulled hamstrings from running, overextended elbows from throwing, and muscle tightness from weight lifting. The U.S. Track and Field team also used the Photonic Stimulator at the 2000 Summer Olympic Games ( news - web sites) in Sydney, Australia.

It's not a universally accepted method of treatment, however.

The Aetna health insurance company refuses to cover the cost of infrared light therapy. "Because of a lack of adequate evidence in the peer-reviewed published medical literature, infrared therapy is considered experimental and investigational," the company's Web site says.

Dr. Len Saputo, director of the Health Medicine Institute in Lafayette, Calif., is a proponent of the therapy who says he has successfully treated hamstring pulls and tennis elbows within a week using the Photonic Stimulator.

"It's effective. It's simple. It's inexpensive. And it's safe. You can't say that about many medical therapies in this day and age," Saputo says.

A practitioner holds the Photonic Stimulator just above the skin's surface, where the treatment is needed. The amount of light emitted can be adjusted for the patient's age, weight and muscle mass.

Saputo says it took some time to learn how to use the device most effectively, especially in conjunction with the Thermal Image Processor, another device by Computerized Thermal Imaging that scans the body for "hot spots" where injury and pain are located.

"It's just knowing where to put the light and where to do the imaging so you know where the problems are, and you can get the maximum effect," Saputo says.

What To Do

To learn more about infrared light therapy, visit Computerized Thermal Imaging. For Aetna's take on the treatments, check this policy statement from the company.