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.
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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.
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Mohs
Surgery: Gold Standard for Skin Cancer
By Irene S. Levine
HealthScoutNews Reporter
HealthScoutNews
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.
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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.
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How
Much Water Should You Drink?
By Adam Marcus
HealthScoutNews Reporter
HealthScoutNews
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 water.com,
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
water.com 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.
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Obesity
Linked to Increased Breast Cancer Rates in Hispanic Women
HealthScoutNews
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.
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Epidurals
Don't Cause Long-Term Back Pain
By Kathleen Doheny
HealthScoutNews Reporter
HealthScoutNews
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 http://www.asahq.org/PublicEducation/childbirth.pdf";
American Society of Anesthesiologists.
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Nothing
Corny About It -- It's Good For You
HealthScoutNews
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.
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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.
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MSG
Myths
HealthScoutNews
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.
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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.
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THURSDAY,
AUGUST 15, 2002
Of
Mouse and Man and Cancer
HealthScoutNews
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.
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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.
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Unlocking
Key to Nerve Cell Death
HealthScoutNews
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 .
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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.
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Eating
Disorders Rooted in Childhood
By Janice Billingsley
HealthScoutNews Reporter
HealthScoutNews
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.
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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 http://www.warwick.ac.uk/fac/soc/Economics/oswald/.
"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.
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One
Drug May Be Best for Ovarian Cancer
By Adam Marcus
HealthScoutNews Reporter
HealthScoutNews
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.
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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.
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FDA
Approves Lexapro as Newest Antidepressant
By Bruce Sylvester
HealthScoutNews Reporter
HealthScoutNews
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.
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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.
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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.
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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.
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New
U.S. Government Web Site Has Detailed Food Info
Reuters
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: http://www.nal.usda.gov/fnic/foodcomp/Data/SR15/sr15.html
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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.
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WEDNESDAY,
AUGUST 14, 2002
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: http://www.plannedparenthoodwi.org/
Journal
of the American Medical Association: http://www.jama.com/
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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.
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All
Forms of Arthritis Aren't the Same
HealthScoutNews
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.
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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: http://www.archneurol.com
Alzheimer's Association: http://www.alz.org
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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.
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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:
Disease: http://www.lungusa.org/diseases/copd_factsheet.html
CDC: http://www.cdc.gov/nccdphp/index.htm
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Dirty
Air Linked to Diabetes
HealthScoutNews
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.
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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.
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Botox
Helps Stroke Victims
By Ed Edelson
HealthScoutNews Reporter
HealthScoutNews
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.
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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,
http://www.som.soton.ac.uk/research/foad/centre
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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.
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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.
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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.
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TUESDAY,
AUGUST 13, 2002
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.
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Does
Your Child Have an Ear Infection?
HealthScoutNews
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.
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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.
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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: http://www.fda.gov
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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.
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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.
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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.
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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: http://jama.ama-assn.org
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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.
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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:
JAMA: http://jama.ama-assn.org
Philip Morris memos: http://www.pmdocs.com
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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.
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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:
JAMA: http://jama.ama-assn.org
American Heart Association: http://www.americanheart.org
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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.
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Flee
Fleas, Please
HealthScoutNews
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.
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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.
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Growing
Old IS What It Used To Be
HealthScoutNews
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."
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Massachusetts
Woman Contracts West Nile in Missouri
Reuters
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.
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Get
Early Start on Kids' Dental Care
HealthScoutNews
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:
More information
When they're old enough, your kids may enjoy this explanation
of a
cavity.
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MONDAY,
AUGUST 12, 2002
A
Ripe Observation
HealthScoutNews
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.
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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: http://www.musa.org/clinics.html.
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."
Editorss Note: Lauran Neergaard covers health and medical
issues for The Associated Press in Washington.
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A
Flaky Experiment
HealthScoutNews
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.
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Expert:
Flu Vaccine a Must for the Elderly
HealthScoutNews
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.
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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:
FDA: http://www.fda.gov
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Asthma
In Kids Can Be Controlled
By Serena Gordon
HealthScoutNews Reporter
HealthScoutNews
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.
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TO TOP
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.
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Chelation
Therapy's Mettle to Be Tested
By Amanda Gardner
HealthScoutNews Reporter
HealthScoutNews
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.
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TO TOP
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."
