The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
January 23, 2004

 

 

 

Important Medical Disclaimer: The content displayed in Personal Health is designed to educate and inform. Under no circumstances is it meant to replace the expert care and advice of a qualified physician. Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate. Accuracy cannot be guaranteed. Personal Health assumes no responsibility for how information presented is used.

Personal Health for the Week of January 3 - 9

PERSONAL HEALTH

 

Friday, January 9, 2004

  1. Widespread Genetic Link to Sudden Cardiac Death is Found
  2. Chile Salmon Farmers Say U.S.-Bound Fish Safe
  3. Toenail Fungus
  4. Tiny Markers May Point to Arthritis Progression
  5. Sugar Problems During Pregnancy May Up Cancer Risk
  6. Lifting Legs While Running Drains More Energy Than Thought
  7. Genetic and Environmental Factors Trigger Allergy
  8. Study Roasts Medical Meeting Menus
  9. Asthma Doesn't Mean Poor Pregnancy Outcomes
  10. New Weapon for Diabetic Foot Infections

    Thursday, January 8, 2004
  11. Gene May Be Target for Osteoporosis Treatment
  12. Tobacco consumption to increase until year 2010
  13. Farmed Salmon Loaded with Chemicals, Study Finds
  14. Food Poisoning
  15. Study: Low-Tar Cigarettes Do Not Cut Cancer Risk
  16. Kids and Computer Strain
  17. Protein Level Could Be Clue to Miscarriage –Study
  18. Catering to the Atkins Craze
  19. Study Shows Handset Radiation Within Limits
  20. Depression Common Following Brain Injury
  21. Low Blood Pressure Linked to Dementia in Elderly
  22. Seeking Sound Slumber for Children
  23. Report: Obesity Epidemic Means More Are Disabled
  24. Adult Asthma Differs From Childhood Asthma
  25. Travelers Urged to Get Vaccinated for Diphtheria
  26. The Genetics of Allergies

    Wednesday, January 7, 2004
  27. Cancer at Record High in UK
  28. Diet Consumers Boost Designer Eggs Sales
  29. Hollywood Special Effects Help Fight Surgery Scars
  30. Methadone Overdose Deaths on Rise in Md.
  31. Fast Food Tied to Higher Calorie Intake in Kids
  32. Gyms Push Nutrition As Weight Loss Aid
  33. Nerve Receptor for Pungent Foods Identified
  34. Hormone Rates Well Vs. Cardiac Arrest
  35. Tap Water Danger for Contact Lens Wearers -Expert
  36. Immune System Attack Tied to Birth Defects
  37. Bladder Cancer Responds Best to Dual Therapy
  38. 'Silent' Heart Arrhythmias More Common Than Thought
  39. Eye Injuries Unforeseen Danger of Drinking Alcohol
  40. Interferon a No-Go for Pulmonary Fibrosis
  41. Second Ectopic Pregnancy Hard to Prevent
  42. Strict Blood Sugar Control Key for Diabetic Heart Patients
  43. Weight Loss Signals Severe Cystic Fibrosis in Adults
  44. Depressed Mind Responds Differently to Different Therapies
  45. For-Profit Health Plans Aren't Miserly About Care -Study
  46. New Drug Combo Battles Malaria
  47. Ask for 'Vasopressin' if Heart Stops
  48. Genetic Link Found for Insulin Resistance
  49. Safe Water Handling Key in Controlling Cholera
  50. Healthy Diets for Diabetics

    Tuesday, January 6, 2004
  51. Child Biting
  52. Breast Mutation Not Linked with Colon Cancer-Study
  53. Disease Management: The New Face of Managed Care
  54. McDonald's Suggests Low-Fat Menu Options
  55. Nearly 40,000 chickens killed by mystery virus in Vietnam
  56. Smokers Have Higher Breast Cancer Risk - U.S. Study
  57. Experts hope new illness etiquette emerges from SARS and nasty flu season
  58. Synthetic Venom May Relieve Cancer Pain
  59. Hormone Replacement Drug Use Tumbles, Study Says
  60. CDC Warns Flu Season Still Hasn't Peaked
  61. Research Raises Hope for New Meningitis Vaccine
  62. 38 States Get Fs on Tobacco Prevention
  63. FDA Warns Campbell Unit on Unsafe Soup Procedures
  64. Doctors Do Respond to Latest Info on Drugs
  65. Fitness Lowers Overweight Diabetics' Death Risk
  66. Pancreatic Cancer Tied to Long-Term Aspirin Use
  67. Britain Launches New Antidepressant-Suicide Probe
  68. Maternal Smoking Linked to Low Sperm Counts
  69. Steroid Use Does Not Affect COPD Outcome
  70. Severely Obese Face Major Depression Risk
  71. Survey: Most Americans Think Food Is Safe Despite Mad Cow
  72. Physician, Heal Thyself

    Monday, January 5, 2004
  73. Pregnancy Alert
  74. Study Says U.S. Teens Are Fattest
  75. Broken Bone?
  76. Deliveries May Be Better Handled by Academic MDs
  77. Smart People Need Tougher Alzheimer's Testing
  78. Study: Coffee May Lower Diabetes Risk
  79. Tiniest Babies Fare Best at Specialty Hospitals
  80. Zoloft Eases Depression After Heart Attacks
  81. Nasal Flu Vaccine Safe for Kids
  82. Leprosy exists in Canada but doctors often fail to spot it, study warns
  83. Disease Management: The New Face of Managed Care
  84. Paintball: More Dangerous Than Meets the Eye
  85. Therapy May Not Help Early Rheumatoid Arthritis
  86. Radiation Therapy Can Impair Intelligence

    Sunday, January 4, 2004
  87. Study: Football Hits Similar to Crashes

 

Friday, January 9, 2004

Widespread Genetic Link to Sudden Cardiac Death is Found

HealthDayNews
Friday, January 9, 2004

FRIDAY, Jan. 9 (HealthDayNews) -- Genetic variants associated with instances of sudden cardiac deaths are far more prevalent and diverse than first thought, especially among minorities.The findings could mean physicians need to show greater care in diagnosing patients, taking into account that each of the many genetic variants will require different -- and possibly conflicting -- treatments.Researchers at the Mayo Clinic came to this conclusion while studying long QT syndrome, a specific cardiac disorder that may kill as many as 3,000 teenagers and young adults in the United States each year.During a comprehensive DNA analysis of 744 healthy volunteers from four ethnic groups, the researchers found 49 distinct variants of long QT syndrome. Of those, 36 variants -- 73 percent -- were previously unknown.Further, one in three blacks and one in seven whites studied were found to harbor at least one variant. Previous studies had estimated the syndrome should be expected in only one out of every 10,000 people.Researchers do not yet know whether the higher frequency of variance means an increased risk of heart attack.

The findings are reported in the December issue of Mayo Clinic Proceedings.

More information

Here's where you can learn more about long QT syndrome.

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Chile Salmon Farmers Say U.S.-Bound Fish Safe

Reuters
Friday, January 9, 2004

SANTIAGO, Chile (Reuters) - Chile's salmon farming industry, the world's second largest, said on Friday its fish were among the safest to eat and increasingly free of potentially harmful chemicals, accusing a U.S. study into the health risks of eating farmed salmon of confusing consumers. A study published in this week's issue of the journal Science found far more toxic chemicals in farmed salmon than in wild salmon, suggesting fish eaters should limit how much they eat. Industry group SalmonChile said Chilean farmed salmon, most of which is consumed in the United States and Japan, had the lowest level of contaminants of all the samples analyzed and contained the least harmful types of toxins of the 13 chemicals researchers looked for. "The Chilean fish contain -- in very reduced quantities -- the least relevant elements of all those considered in the analysis," SalmonChile said in a statement.

The chemicals include polychlorinated biphenyls, or PCBs, dioxins and others, some of which are pesticides, industrial by-products or suspected cancer-causing agents.

The PCBs found in salmon cultivated in North and South America were 80 times lower than the allowable level set by the U.S. Food and Drug Administration (news - web sites), SalmonChile said.

Health experts have recommended salmon for its high level of the Omega-3 fatty acids which can reduce the risk of heart attacks, among other benefits. The South American country's salmon exports, which totaled $989 million in January-November 2003, have soared in the past 10 years and now represent 35 percent of the world's total, compared with Norway's 37 percent. Salmon is Chile's fourth largest export after copper, wood pulp and fruit but the product has come under fire in recent months for using more antibiotics than their northern peers and for testing positive for the anti-fungal malachite. SalmonChile said the sample used by researchers at the University of Indiana were obtained two years ago and the industry has improved its feeding methods since then. "The industry has made constant efforts to reduce the presence of PCBs, which is reflected in a reduction, according to the FDA, of 28 percent between 1998 and 2001," it said.

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Toenail Fungus

HealthDayNews
Friday, January 9, 2004

(HealthDayNews) -- Ugly, discolored toe nails may be a sign of a fungal infection. Besides being embarrassing, untreated fungal infections can spread. Guard yourself against toenail fungus with these foot health tips from the American Podiatric Medical Association:

  • Wash your feet regularly with soap and water. Dry them thoroughly. Make sure your shoes fit properly. Wear shower shoes in public areas. Change socks, hosiery, even shoes, daily. Clip toenails straight across so the nail doesn't extend past the tip of the toe. Use a recommended foot powder talcum, not starch.
  • Wear socks made of synthetic fiber.

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Tiny Markers May Point to Arthritis Progression

By Steven Reinberg
HealthDay Reporter
HealthDayNews
Friday, January 9, 2004

FRIDAY, Jan. 9 (HealthDayNews) -- Finding biomedical markers that indicate progressive arthritis is key to determining which patients need aggressive therapy and which ones don't, says a new study."We still are very poor at profiling who needs aggressive therapy and who is going to have progressive disease and who is not," says Dr. Eric L. Matteson, a professor of medicine at the Mayo Clinic College of Medicine.To try to find markers that might indicate progressive arthritis, Matteson's group studied 111 patients who had early-stage rheumatoid arthritis, according to their report in the January issue of Arthritis and Rheumatism.All the patients were started on hydroxychloroquine, a mild treatment, and progressed to more dramatic treatment with methotrexate or other drugs, depending on how their symptoms improved, Matteson notes.The researchers took blood tests and X-rays and looked at clinical symptoms to find markers that might indicate the odds for disease progression.The patients were followed for two years. Matteson's team found 52 percent of the patients had their symptoms controlled by methotrexate and NSAIDs and did not need more aggressive therapy. In addition, 48 percent of the patients did not develop progressive disease.Matteson says that clinical markers, such as functional status, the number of joints involved, joint pain and swelling were not helpful in determining disease progression.The things that predicted progression were positive rheumatoid factor -- an antibody found in a blood test -- and some genetic variations, particularly one called HLADRB1*04, he says.They also found some novel markers that were promising in predicting disease progression. These are high levels of CD4 and CD28 null T-cells, which are indicators of premature aging of the immune system, Matteson notes.In addition, Matteson's team discovered a different form of a gene of uteroglobin, a protein, appears to protect against joint damage."There are a lot of people who have mild disease and do well with mild therapy," Matteson says. "There are some genetic markers that are predictive of progressive disease, and maybe we should think about using these markers in clinical practice for guiding our therapy."Right now treatment is guided by clinical presentation, Matteson says. But in the future these markers might be used to identify people who will have good and bad treatment outcomes. "If we knew early which patients were going to have more severe disease, we could treat them more aggressively at the outset."Dr. John Klippel, president and chief executive officer of the Arthritis Foundation, says that "trying to improve our ability to predict the outcome of rheumatoid arthritis is important and the findings of this study are an important step."Klippel says these findings add to the understanding of the basic mechanisms of arthritis. For example, the findings raise the knowledge of the influence of genetics and the aging of the immune system on arthritis."In addition, the understanding of the importance of uteroglobin as a protective pathway in rheumatoid arthritis has the potential for developing therapies," Klippel says.

"These findings will allow rheumatologists to be more accurate in predicting joint damage, and as a consequence it will help in making decisions about appropriate therapy," he says.

More information

To learn more about arthritis, visit the Arthritis Foundation or the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

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Sugar Problems During Pregnancy May Up Cancer Risk

Reuters Health
Friday, January 9, 2004

NEW YORK (Reuters Health) - Many women have difficulty maintaining normal blood sugar levels during pregnancy and now new research suggests that this problem may raise their long-term risk of cancer, especially breast cancer. Previous reports have suggested a link between diabetes and cancer risk, study author Dr. Shelagh I. Dawson, from the University of Otago in Christchurch, New Zealand, notes. However, it was unclear if other forms of disease, such as mild sugar problems during pregnancy, were also associated with an elevated risk of cancer. To investigate, Dawson assessed the 20-year cancer outcomes of 753 women who were enrolled in a study looking at the effect of a mother's sugar levels on the developing baby. Various data were analyzed to determine if any of the subjects were admitted to the hospital with a cancer diagnosis during the study period. The researchers' findings are reported in the medical journal Cancer. Thirty-four women--4.5 percent of the entire group--were diagnosed with cancer and in 18 cases this was a breast cancer, Dawson notes. The more impaired women were in controlling sugar levels during pregnancy, the greater their risk of cancer, the findings indicate. In fact, women with the worst control were up to 5- and 11-times more likely to develop any cancer and breast cancer, respectively, than women with the best control.

"These results are in keeping with studies that suggest that many (cancers) are associated with altered (sugar) metabolism," Dawson states. However, as far as she knows, no study published to date has "examined a continuum of risk across the full spectrum of (sugar) tolerance."

Source: Cancer, January 1, 2004.

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Lifting Legs While Running Drains More Energy Than Thought

HealthDayNews
Friday, January 9, 2004

FRIDAY, Jan. 9 (HealthDayNews) -- The movement of your legs in the air when you run may consume more energy than you suspect.Northeastern University researchers say they've demonstrated that, contrary to previous findings, swinging your legs in the air while running requires a significant amount of energy. Previous research concluded the force produced when the foot is on the ground is the only way to determine energy cost when a person runs.However, the Northeastern researchers found significant energy is used to fuel muscles that move the leg while it is off the ground.In their study, the researchers estimated energy use by measuring blood flow to the hind leg muscles of guinea fowl. They concluded that movement muscles consume 26 percent of the energy used by limbs while running. Standing muscles consume the remaining 74 percent of the energy.The study appears in the Jan. 2 issue of Science.

This method of using blood flow to estimate energy consumption offers a technique to provide information about other aspects of energy consumption during running. That could help researchers better understand which specific muscles are used to support weight and how differences in body size and speed affect energy use, which may improve knowledge of rehabilitative medicine.

More information

Here's where you can learn more about physical therapy.

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Genetic and Environmental Factors Trigger Allergy

Reuters Health
Friday, January 9, 2004

NEW YORK (Reuters Health) - The presence of common gene mutations can increase the allergic response in sensitive patients who are exposed to diesel exhaust, investigators in California report in The Lancet. While these findings explain why some individuals are more susceptible to the effects of air pollution, they also suggest that antioxidants, such as vitamins A, E and C, may prevent the effects that air pollution have on allergic inflammation, lead investigator Dr. Frank D. Gilliland told Reuters Health. Gilliland of the University of Southern California in Los Angeles and his colleagues examined genes that encode for glutathione-S-transferases (GSTs), enzymes that metabolize reactive oxygen species and detoxify chemicals present in diesel exhaust. Mutations of these genes, which occur in up to 20 percent of the general population, are associated with airway hyperresponsiveness and asthma. To investigate the mechanism driving the effects of air pollution on allergic responses, Gilliland's group evaluated GST genes in 19 patients who were allergic to ragweed and had a history of allergic rhinitis. The subjects with GST mutations had significantly higher levels of nasal IgE and histamine--markers of allergic response--to diesel exhaust particles than to the allergen alone. In the subjects with the most GST mutations, "diesel exhaust had a huge adjuvant effect on the allergic response to allergens," increasing response up to 20 times greater than allergen exposure alone, Gilliland said. In the past, the presence of these GST mutations would not have made much difference to human health, he explained. "But now that we have new and increasing levels of pollutants, that's at least partially what is bringing on some of the increases in allergy susceptibility." He noted that in some populations, 50 percent to 60 percent of individuals have allergies, "and that's very different from what it was 50 or 100 years ago." "We now have ways to identify individuals susceptible to air pollution, and, because this sensitivity seems to be regulated by genetic and dietary factors, new approaches are emerging that might help protect these individuals from ambient pollution," Drs. F. J. Kelly and Thomas Sandstrom remark in a related commentary.

Kelly is on staff at King's College in London, and Sandstrom is at University Hospital, Umea, Sweden.

Source: The Lancet, January 10, 2004.

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Study Roasts Medical Meeting Menus

HealthDayNews
Friday, January 9, 2004

FRIDAY, Jan. 9 (HealthDayNews) -- When it comes to medical meetings, doctors don't have to eat their words.An American study in the current issue of Disease Management found the food served to and eaten by doctors at their conferences doesn't reflect their leadership role in teaching patients about good nutrition and may actually impair the doctors' performance at the meetings.The research team was led by Dr. John La Puma of the Santa Barbara Institute for Medical Nutrition and Healthy Weight.The researchers interviewed people planning annual meetings in 2000 for 13 major medical professional societies. The meetings included more than 250,000 doctors and more than 2 million meals and snacks.While 61.5 percent of the meal planners rated nutritional guidelines as "very important," the meals failed to reflect that. The food served at the 13 meetings was rich, sweet and high in calories. Desserts were served at every lunch, and dinner and soda pop was offered at every snack break.None of the meal planners identified any specific nutritional guidelines and no doctors were involved with the planning of any of the menus. None of the meetings included a planned vegetarian meal, and they all included potato chips, snack mixes or candies during breaks."The food served to and consumed by physicians at medical meetings does not appear to meet current nutritional guidelines. We believe that food at medical meetings should be delicious and special, but that special can mean something other than highly caloric and sedating meals," the study authors write.They offer the following suggestions for improving menus at medical meetings:

  • Substitute fish for red meat as an entree. Offer olive oil on the table instead of butter. Eliminate sugared soda and energy drinks.
  • Eliminate deep fried foods, especially those fried in hydrogenated oils, which contain trans fats.

More information

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

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Asthma Doesn't Mean Poor Pregnancy Outcomes

Reuters Health
Friday, January 9, 2004

NEW YORK (Reuters Health) - Even when asthma patients experience worsening of their disease during pregnancy, they are no more likely than healthy women to have a premature delivery or other poor outcomes, new research shows. Previous studies have yielded inconsistent results regarding asthma's effects on pregnancy, Dr. Mitchell P. Dombrowski, at St. John Hospital in Detroit, and colleagues note in their paper, published in the medical journal Obstetrics and Gynecology. They attribute these contradictory findings to various flaws in each study. The new study involved 873 pregnant women with mild asthma, 866 with moderate-to-severe asthma, and 881 without asthma. Patients were treated using national recommended guidelines. The rate of asthma flare-ups ranged from 13 percent in the mild asthma group to 52 percent in the severe group. The authors observed no significant differences between groups in rates of preterm delivery. However, women in the severe asthma group were more likely than others to develop diabetes during pregnancy and to undergo c-section rather than vaginal delivery. The only difference in newborn outcomes was an increase in severe infection rates in the mild asthma group compared with the healthy group. Still, the real risk of this problem in either group was very low.

Although these outcomes were "excellent," Dombrowski and associates note that "these findings do not contradict the possibility that suboptimal control of asthma during pregnancy is associated with increased risk to the mother or baby."

Source: Obstetrics and Gynecology, January 2004.

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New Weapon for Diabetic Foot Infections

HealthDayNews
Friday, January 9, 2004

FRIDAY, Jan. 9 (HealthDayNews) -- The new antibiotic linezolid (Zyvox) is at least as effective as some older therapies for treating diabetic foot infections, says new research. The findings from the study, which included 371 people at 45 centers in eight countries, suggest the new drug may provide an alternative for treating diabetics with antibiotic-resistant foot infections.Foot infections are one of the most serious diabetes-related complications and a leading cause of hospitalization for people with diabetes. Lower limb amputation may be necessary in cases where treatment fails to cure the infection.

"The complication of diabetes that patients fear most is leg amputation, and infection is often the final pathway that leads to this tragic, if often preventable, outcome," study author Benjamin A. Lipsky, director of the General Internal Medicine and Antibiotic Research clinics at the VA Puget Sound Health Care System, says in a prepared statement.

Linezolid was approved in 2000 by the U.S. Food and Drug Administration (news - web sites) to treat a variety of infections.

In this study, published in the Jan. 1 issue of Clinical Infectious Diseases, linezolid produced a clinical cure for 81 percent of patients, compared with 71 percent for patients taking a current standard combination therapy.The study was funded by VA and Pharmacia, now part of Pfizer Inc., the maker of linezolid. Lipsky has served as a consultant and speaker for Pharmacia and Pfizer.

More information

Here's where people with diabetes can learn more about how to take care of their feet and skin.

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Thursday, January 8, 2004

Gene May Be Target for Osteoporosis Treatment

By Ed Edelson
HealthDay Reporter
HealthDayNews
Thursday, January 8, 2004

THURSDAY, Jan. 8 (HealthDayNews) -- A gene that plays a role in heart disease now appears to be a potential target for treatment of osteoporosis, the bone-thinning condition that affects many older women.The gene, dubbed Alox15, is part of a pathway that determines whether cells in marrow become either bone or fat, explains Dr. Robert F. Klein, lead author of a paper describing the finding in the Jan. 9 issue of Science.The research, which involves mice, already has at least one pharmaceutical company working on drugs aimed at altering activity of the gene to combat osteoporosis.Dr. Gary Peltz is director of genetics at Roche Palo Alto, a division of Hoffmann-La Roche Inc., and is also an author of the Science paper. He calls the research a good example of how basic science can point the way to the development of new disease treatments."We developed the technology to analyze this mouse model of human disease," Peltz says. "Then we try to utilize that model for therapeutic purposes."The osteoporosis research started with a genetic analysis of inbred mice, comparing their physical characteristics with their genetic makeup, Klein says. That analysis showed bone density in the mice was related to the activity of the Alox15 gene."Animals that had overexpression of the gene had the lowest bone density," Klein says. "Knockout mice, which do not have the gene, have very high bone mass."In mice, Alox15 lies on chromosome 11. The same gene is found on chromosome 17 in humans, Klein says.At Roche Palo Alto, Peltz and his colleagues are using a two-pronged approach to develop possible osteoporosis treatments. They are reviewing a large library of chemicals to see whether any of them affect activity of the gene. They're also trying to design molecules that might help build bone mass by inhibiting the gene's activity.Klein, who is an associate professor of medicine at the Oregon Health & Science University and the Veterans Affairs Medical Center in Portland, is pressing ahead with research aimed at "understanding how this pathway evolved in normal mice.""This is teaching us a lot more about the complexity of bone physiology," he says. "It is pretty much basic science."But that science already is being applied to possible treatments for osteoporosis, and not only by the Roche group, Klein says. "Others are studying human populations, to see whether this genetic pathway in humans is responsible for osteoporosis," he says.

An estimated 10 million Americans -- 80 percent of them women -- have osteoporosis, and 18 million more have low bone mass, placing them at risk for the disease, U.S. health officials report.

More information

To learn more about osteoporosis, visit the National Library of Medicine or the National Osteoporosis Foundation.

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Tobacco consumption to increase until year 2010

Agence France Presse
Thursday, January 8, 2004

ROME (AFP) - Tobacco consumption will continue to increase worldwide until the year 2010 especially in developing countries, with China topping the list, according to a report released by the UN Food and Agriculture Organization (news - web sites).

"The number of smokers is expected to grow from 1.1 billion in 1998 to around 1.3 billion in 2010," according to the FAO report, which attributes the increase to population and economic growth. The FAO noted, however, that despite the overall increase of tobacco use, consumption per adult should drop by around 10 percent by 2010. The figure could even reach 20 percent if countries adopt aggressive anti-smoking policies, the report said. It said that while tobacco consumption in developed countries was projected to be only 29 percent by 2010 -- as opposed to 34 percent in 1998 --, the share of developing countries will be 71 percent. With its 320 million smokers, China is the biggest consumer with India coming in second, the report said. "The share of China in total world tobacco demand is likely to remain around 37 percent in 2010, the report said. In Latin America, demand is expected to increase modestly until 2010 with Brazil having the largest number of consumers, the report said. In Africa, where total tobacco demand increased in the 1990s to a record 3.5 percent per year, growth was expected to continue at a similar rate until 2010, the report said. "Supply is expected to increase in countries where production costs are low, there are no production restrictions, and good transportation systems and access to international markets are available," it said. With that in mind, it added, cigarette manufacturing could increase in developing countries which are already surpassing the production level of developed countries. About 100 countries produce tobacco with China, India, Brazil, the United States, Turkey, Zimbabwe and Malawi the biggest producers. China alone accounts for over 35 percent of world production. "World tobacco production is projected to reach over 7.1 million tonnes of tobacco leaf in the year 2010, up from 5.9 million tonnes in 1997-1999," the report said. It said the increase was linked to demand and the fight against tobacco consumption should focus on demand rather than supply.

"Reducing demand in the developing countries would be rather difficult given projected population and income growth trends," it said. "Mitigating these trends, however, and reducing consumption per adult using a combination of tax and direct restriction policies, would also be an important achievement."

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Farmed Salmon Loaded with Chemicals, Study Finds

By Maggie Fox
Health and Science Correspondent
Reuters Health
Thursday, January 8, 2004

WASHINGTON (Reuters) - Farmed salmon contains far more toxic chemicals than wild salmon -- high enough to suggest that fish-eaters limit how much they eat, U.S. researchers said on Thursday. The culprit is "salmon chow" -- the feed given to the captive fish, the researchers report in this week's issue of the journal Science. Many health experts urge people to eat fish such as salmon because it contains healthy fats, especially the omega-3 fatty acids that can lower the risk of heart disease and perhaps have other health benefits, too. But the researchers, as well as environmental groups, said the findings in Science indicate that people should choose their fish carefully. They should also demand that salmon be clearly labeled to indicate whether it is farmed or wild so they can make informed choices about which fish to eat. The team at Indiana University, University at Albany, Cornell University and elsewhere analyzed toxic contaminants in 700 farmed and wild salmon taken from markets in 16 cities in Europe and North America. "We think it's important for people who eat salmon to know that farmed salmon have higher levels of toxins than wild salmon from the open ocean," environmental affairs professor Ronald Hites of Albany, who led the study, said in a statement. They looked for 13 different chemicals known to build up in the flesh of fish, including polychlorinated biphenyls or PCBs, dioxins, toxaphene, dieldrin, hexachlorobenzene, lindane, heptachlor epoxide, cis-nonachlor, trans-nonachlor, gamma-chlordane, alpha-chlordane, Mirex, endrin and DDT.

Some are pesticides, others are industrial by-products, and many are known or suspected cancer-causing agents.

Eat Once A Month or Less

Farmed salmon taken from markets in Frankfurt, Edinburgh, Paris, London, Oslo, Boston, San Francisco, and Toronto had the highest levels, and the researchers said consumers should eat no more than one-half to one meal of salmon per month. A meal was eight ounces (one-quarter of a kg) of uncooked meat.

Farmed salmon from supermarkets in Los Angeles, Washington, D.C., Seattle, Chicago, New York and Vancouver had toxins high enough to suggest that people eat no more than two salmon meals a month, based on Environmental Protection Agency (news - web sites) standards.

In contrast, it would be safe to eat up to eight meals a month of wild salmon, they said. Other groups note that walnuts, flaxseeds and other non-fish sources are rich in omega-3s. Many chemicals can build up in the body, staying for years or even a lifetime. But the body also processes some out, so experts can figure out a safe or acceptable level of intake. The study fits in with other research on chemicals in salmon. Two studies published in the journal Chemosphere last year found elevated levels of PCBs, certain pesticides, and flame retardants in farmed salmon. And last year the Environmental Working Group said it found elevated PCB levels in farmed salmon filets taken from 10 U.S. grocery stores. "This unquestionably large, new study strongly confirms earlier research, and it leaves little room for the farmed fish industry to argue away the problems of polluted farmed seafood," the Environmental Working Group's Jane Houlihan said.

But Charles Santerre, a food and nutrition expert at Indiana's Purdue University, said the study in fact showed that farmed salmon is safe.

"The study demonstrates that farmed salmon is very low in contaminants and meets or exceeds standards established by the Food and Drug Administration (news - web sites) and the World Health Organization (news - web sites)," Santerre said in a statement.

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Food Poisoning

HealthDayNews
Thursday, January 8, 2004

(HealthDayNews) -- You usually know when you've eaten contaminated food because the vomiting and diarrhea that follow seem relentless.In most cases, once the vomiting and diarrhea subside, you can stop worrying. But sometimes medical attention is necessary.The University of California, Davis, advises you see a doctor if there is:

  • Diarrhea lasting longer than 24 hours. Vomiting lasting longer than 12 hours. Blood in the stool. Fever. Vomiting and diarrhea that are so intense severe muscle cramping occurs.
  • An inability to keep down any liquids for 12 hours.

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Study: Low-Tar Cigarettes Do Not Cut Cancer Risk

By Patricia Reaney
Reuters
Thursday, January 8, 2004

LONDON (Reuters) - Low-tar cigarettes do not reduce a smoker's risk of developing lung cancer and are as deadly as regular brands, researchers said Friday. In the first study to compare the odds of developing cancer between smokers of low, ultra-low and conventional cigarettes, scientists in the United States found a similar raised risk in all groups.

People who smoked non-filter cigarettes had the highest rate of the deadly disease.

"Our study is the strongest evidence yet that the design changes in cigarettes marketed as light and ultra-light have not made them less deadly," said Dr Michael Thun, an epidemiologist at the American Cancer Society (news - web sites).

"The only approach that reliably reduces risk is to quit -- and to quit as soon as possible." There are about 4,000 chemicals in tobacco smoke, over 50 of which are proven carcinogens. The majority of them are in tar. Cigarettes described as light, mild, ultra and low tar produce low tar readings on machines that measure smoke intake because filters on the cigarettes dilute the damaging toxins. But health experts and anti-smoking groups have always maintained they are no safer than regular cigarettes because smokers compensate by either taking bigger or more frequent puffs or inhaling more strongly. Tim Lord, chief executive of the Tobacco Manufacturers Association in London, said low-tar cigarettes were never advertised or promoted as healthier. "At the end of the day the only safe cigarette is no cigarette," he told Reuters.

But Amanda Sandford of the anti-smoking group ASH (Action on Smoking and Health (news - web sites)) said the promotion of low-tar cigarettes, particularly to women, had health implications even if it was not overtly saying they were safer.

"The level of tar in a cigarette doesn't matter. It is still going to cause cancer if you continue to smoke for many years," she added. Thun and Dr Jeffrey Harris, of Massachusetts General Hospital in Boston and their colleagues, studied the relation between tar ratings of cigarettes smoked in 1982 and deaths from lung cancer over six years in more than one million men and women. "The increase in lung cancer risk is similar in people who smoke medium tar cigarettes (15-21 mg), low tar (8-14 mg), or very low tar cigarettes (less than seven mg)," the scientists said in a report in The British Medical Journal. All the people in the study who smoked, regardless of the tar level of the cigarettes, had a substantially higher chance of suffering from lung cancer than people in the study who had quit or had never smoked.

Non-filter cigarettes, which have the highest cancer risk, comprised about one percent of cigarettes sold in the United States but 20 percent in China, 15 percent in France and six-20 percent in Eastern Europe in 1996.

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Kids and Computer Strain

HealthDayNews
Thursday, January 8, 2004

(HealthDayNews) -- When kids spend hours in front of computer screens, it can cause physical problems.Help your kids avoid computer-related woes with these tips from the American Physical Therapy Association:

  • Feet must touch the ground or rest on a stool when sitting. Keep an upright posture. Hold eyes level with the screen. Forearms should be parallel to the floor. Relax shoulder blades. Rest the eyes by looking away from the screen as often as possible. Take a break at least every 20 minutes. Stretch and move in the seat, or preferably, when standing.
  • Watch for warning signs, such as headaches, fatigue, muscle pain or cramping.

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Protein Level Could Be Clue to Miscarriage –Study

Reuters
Thursday, January 8, 2004

LONDON (Reuters) - A protein involved in immune response could be a possible marker to identify women at high risk of having a miscarriage, Australian scientists said on Friday. Miscarriage occurs in about 10-15 percent of pregnancies, usually in the first 12 weeks. There is no treatment to prevent it or to predict if it will occur. But researchers at Monash University, Victoria, Australia think levels of a protein known as MIC 1 could hold clues about predicting and possibly preventing miscarriage. "If a causal link between low MIC 1 and miscarriage is confirmed, then MIC 1, or its synthetic analog, might be useful in prevention of miscarriage," said Stephen Tong, the author of the study published in The Lancet medical journal. Tong and his colleagues noticed that levels of MIC 1 were about a third lower in pregnant women who later had a miscarriage, compared to women who did not. In most cases, low concentrations of the protein in blood samples taken during the first 6-12 weeks of the pregnancy were followed by a miscarriage several weeks later. But the scientists said more research was needed to confirm MIC 1 as a marker for miscarriage. In a commentary on the study, Galit Sarig and Benjamin Brenner of the Ramban Medical Center in Haifa, Israel said the research suggested the protein could be a possible predictor of early miscarriage. "If Tong and colleagues' results can be confirmed, the way is open to develop novel therapies to prevent pregnancy loss," they added.

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Catering to the Atkins Craze

By Kathleen Doheny
HealthDay Reporter
HealthDayNews
Thursday, January 8, 2004

THURSDAY, Jan. 8 (HealthDayNews) -- There once was a time -- say 2002 -- when cheeseburger fans who were trying to shed a few pounds would order their burger without cheese. Or mayonnaise. Or both.These days, they have another option: Hold the bun, but pile on the mayo and cheese.And remember when party guests would ask, "May I bring something, perhaps an appetizer?" Now they're likely to say, "I'll bring something with protein in it. Got to balance out all those carbs."All of that was "B.A." -- or Before Atkins -- the hugely popular weight-loss plan popularized by the late Dr. Robert Atkins, who encouraged people to go very light on the carbs, and heavier on the proteins and fats, to lose weight.If you've shopped or eaten out anytime in the past six months, you've probably noticed how the food industry is now catering to the Atkins crowd in a big way.Many restaurants have created "low-carb" corners of their menus. Predictably, they include endless offerings of meat, although it's too soon to say if the mad cow scare will deflate that demand. But there are also bun-less burgers, pizzas made from whole wheat crusts, even low-carb cheesecakes.Meanwhile, such high-carb staples as pasta and breads have become forgotten culinary cousins.Even fast-food chains are catering to the high-protein, low-carb movement.Carl's Jr., with outlets throughout the western United States, has just unveiled what it calls "The Low-Carb Six Dollar Burger." It's a bundle of beef wrapped in lettuce, with just six grams of carbohydrates, 55 fewer than the original "Six Dollar Burger," the company says.Subway Restaurants has just introduced two low-carb wrap sandwiches. And some McDonald's outlets are promoting salads and low-fat sandwiches -- and exercise suggestions, to boot.But will the trend last?

The Atkins diet -- and related high protein, low-carbohydrate plans -- has won unexpected respect in medical circles in recent months.

In May, the New England Journal of Medicine (news - web sites) published two studies suggesting the Atkins diet is more effective than a traditional low-fat approach at helping people drop unwanted weight.

What's more, the Atkins plan doesn't boost cholesterol levels, as might be expected, the studies found."The results are very surprising and at the same time very preliminary," Gary Foster, clinical director of the University of Pennsylvania's Weight and Eating Disorders Program and leader of one of the studies, told HealthDay. "The take-home message is that this diet deserves further study."Such findings are cold comfort to groups like the National Bread Leadership Council, which says 40 percent of Americans are eating less bread than a year ago.But the industry group has just released some new research that should reassure members that things aren't as bad as they might fear. The research found that 54 percent of Americans haven't changed their bread-consumption habits during the past year, and 6 percent are actually eating more bread. The survey also revealed that 41 percent of those questioned quit the Atkins diet because they missed their carbs too much to continue.Shelby Weeda, president of King's Hawaiian Baking Company in Torrance, Calif., isn't prepared to surrender to the low-carb trend. "It's a passing fancy," says the food industry veteran, who adds that he has seen many popular diets come and go.Besides, he says, his Hawaiian sweet breads are "an indulgent product" that people won't want to give up.Alicia Moag-Stahlberg, a dietitian and weight loss expert from Skokie, Ill., calls the food industry's budding alliance with the Atkins camp "marketing at its best."In her review of the medical literature studies, Moag-Stahlberg says the majority of the research shows "no huge weight loss advantage long term" with a low-carb, high-protein plan.Weight loss, she adds, is inextricably tied to caloric intake and expenditure -- an old refrain that many people trying to shed pounds are tired of hearing."Some people do have greater satiation on the high-protein diets and can stick to them," she says." But there is nothing magic about the protein."Too many people, she adds, are looking for a magic weight-loss bullet.So, when faced with the low-carb, high-protein blitz at supermarkets, fast food outlets, and restaurants, what should a consumer with weight to spare do?"If you are going to go the high-protein route, be sure you are being careful about your protein choices," suggests Anne M. Fletcher, a Minnesota dietitian and author of the book Thin for Life.That means not overloading on bacon and high-fat cheese, for instance, but healthier protein choices. Some veggie burgers, for instance, have 10 grams or more of protein per patty but are low in fat, she says.Fletcher also recommends these other ways to control weight:

  • Eat a well-balanced diet. Pick whole-grain breads. Eat plenty of fruits and vegetables. You need them for fiber, vitamins and minerals.
  • Consider upping your water intake. "There's no scientific evidence that water is of value in weight loss," Fletcher says. "However, when you talk to people who have lost weight and kept it off, they will tell you they drink a lot of water."

More information

For nutrition tips, see the American Dietetic Association and the Center for Nutrition Policy and Promotion.

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Study Shows Handset Radiation Within Limits

By Brett Young
Reuters
Thursday, January 8, 2004

HELSINKI (Reuters) - A survey of some of the world's most popular cell phones found they emit radiation well below agreed limits and largely in line with the data published by manufacturers, a Finnish regulator's study showed Thursday.

The survey by Radiation and Nuclear Safety Authority Finland (STUK) covered 12 models made by the world's top handset makers, including Finland's Nokia (news - web sites), Motorola of the U.S. and South Korea (news - web sites)'s Samsung.

The publication comes at a time that global demand for mobile phones is booming but concern also is rising among consumers and some in the scientific community that mobile phone use can lead to problems ranging from headaches to tumors. Nokia, the world's top player, has forecast 2003 global industry sales of 460 million handsets alone, and some of its rivals expect an even higher number. It foresees 1.6 billion mobile subscribers by 2005. All models tested showed the radiation emitted, or the specific absorption rate (SAR), was well below the agreed level in Europe of two watts per kilogram. Mobile phones are essentially tiny radios that send and receive signals over the airwaves. "What is encouraging is that our tests and those of the manufacturers are largely in line with each other," said Kari Jokela, a researcher at STUK, which sets and verifies radiation safety standards. "All levels are below two watts per kilogram, and that is very important." The study did not look at possible harmful effects of the radiation. Despite worries about possible negative health effects of mobile phone use, various studies over the past few years have proved inconclusive. There is no scientific evidence that second-generation mobile phones cause brain tumors, while a long-term study by the International Agency on Research on Cancer is still underway. A Dutch study released in September did show that radio signals emitted from third-generation mobile base stations can cause headaches and nausea. These base stations, which are the high radio towers that connect to the handsets on the ground, were also associated with boosts cognitive functions, such as memory and response times. "There are scattered results of some tests showing effects on cells and so on, but we still don't have any good evidence that would give cause for worry," Jokela said. Jokela said STUK aims to test 20 more models this year and by end-2004 will have tested over half of all phones commonly used in Finland, one of the world's most mature mobile markets. He said STUK could start testing high-speed 3G phones next year.

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Depression Common Following Brain Injury

HealthDayNews
Thursday, January 8, 2004

THURSDAY, Jan. 8 (HealthDayNews) -- Many people who suffer a traumatic brain injury experience major depression or other psychiatric illnesses within a year afterward, say two articles in the January issue of The Archives of General Psychiatry.Researchers at the University of Iowa studied 91 patients who had experienced traumatic brain injury, evaluating their condition at three, six and 12 months after the injury.They found 33 percent of the patients suffered major depression during the first year after their injury. Researchers also found the patients who suffered from depression were more likely to have a history of mood and anxiety disorders.Of those with depression, about 76 percent also had anxiety and 56 percent exhibited aggressive behavior.In a related study, researchers at the University of Washington, Seattle, studied 939 members of a health maintenance organization who had suffered a traumatic brain injury.

They found psychiatric illness in about 49 percent of patients who suffered moderate to severe injuries, 34 percent of patients who suffered mild injuries and 18 percent of the control group.

More information

Here's where you can learn more about traumatic brain injury.

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Low Blood Pressure Linked to Dementia in Elderly

Reuters Health
Thursday, January 8, 2004

NEW YORK (Reuters Health) - A low blood pressure is associated with an increased risk of dementia in people over 75 years of age, according to a new report. This risk seems to pertain only to Alzheimer's type dementia and is highest in subjects with persistently low pressures. The findings, which are reported in the medical journal Neurology, are based on a study of 406 community-dwelling elderly subjects who were dementia-free at study entry and were followed for up to 21 years. Systolic and diastolic blood pressures, the first and second numbers, respectively, in a blood pressure measurement, were determined in all subjects. During the study, 122 subjects developed dementia, lead author Dr. J. Verghese and colleagues, from Albert Einstein College of Medicine in New York, note. The authors found that a diastolic blood pressure below 70 raised the risk of dementia. Specifically, for each 10-point drop in pressure, the risk of dementia increased by 20 percent. Low pressures were only linked to an increased risk of Alzheimer's type dementia, not the type that occurs as a result of blocked blood vessels in the brain. Further analysis revealed a decreased risk of Alzheimer's type dementia for patients with moderately high systolic pressures. However, this association was not very strong. Compared with other subjects, people with consistently low blood pressures throughout the first two years of the study were twice as likely to develop dementia.

"Our results suggest that low blood pressure may be both the cause and the consequence of dementia," the researchers state. "If our results are replicated, intervention studies are required to study whether maintaining blood pressure at optimal levels reduces the risk of dementia in elderly individuals."

Source: Neurology, December 23, 2003.

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Seeking Sound Slumber for Children

HealthDayNews
Thursday, January 8, 2004

THURSDAY, Jan. 8 (HealthDayNews) -- A new way to identify obstructive sleep apnea in children has been developed by researchers at McGill University Health Centre.The Canadian scientists report on their work in the January issue of Pediatrics.The test uses dips in blood oxygen levels associated with sleep-related airway blockage to detect the worst cases of sleep apnea. Those children can then be fast-tracked for surgery to correct the condition."This new method of diagnosing sleep apnea and of prioritizing treatment schedules is a significant advance. Now we can detect, treat and cure the worst cases of sleep apnea in just a few days where previously children had to wait months, if diagnostic facilities were even available," Dr. Robert Brouillette, a professor of pediatrics at McGill, says in a prepared statement.

About 1 percent to 3 percent of children have sleep apnea, which can cause growth problems and delay development. Once diagnosed, it can be usually be treated by removal of the tonsils and adenoids. Diagnosis usually requires a detailed evaluation and considerable waiting time.

More information

Here's where you can learn more about sleep apnea.

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Report: Obesity Epidemic Means More Are Disabled

By Maggie Fox
Health and Science Correspondent
Reuters
Thursday, January 8, 2004

WASHINGTON (Reuters) - The U.S. obesity epidemic may be causing another, quieter epidemic of disability, including back trouble and diabetes, health experts reported on Thursday. Younger Americans are becoming disabled more often, many with back pain, according to the study, published in the journal Health Affairs. Although there was no direct proof, the researcher believed obesity was mostly to blame. "Obesity is the only trend that is commensurate in size with what we found happening with disability," said Darius Lakdawalla, an economist at the RAND research institute who helped write the study. "It's the only suspect. We found that there is something going on with people's health and that the increase is not just a case of people dropping out of the workforce and going on the public dole," the economist said. More than 60 percent of Americans are overweight or obese. In 2000, 38.8 million Americans or 31 percent of the adult population were classified as obese, meaning their health was seriously at risk. Obese people are more likely to suffer heart attacks, strokes, several forms of cancer and less-deadly disability such as back ache. Lakdawalla and colleagues at RAND and at Stanford University in California analyzed data from the National Health Interview Survey, an annual nationwide government survey of about 36,000 households. They looked for disability trends among people aged 18 to 69 between 1984 and 2000. They found substantial growth in reported disability rates among those under 50 but not among the elderly. Among those aged 50 to 59, disability rose only among those who were obese, the study found. "Obesity accounts for about half the increased disability among those ages 18 to 29," they wrote in their report. Much of the time, diabetes and back pain was to blame and the researchers said the links with obesity were clear. This will end up costing money, the researchers said. "People who are disabled generally use a lot more medical services so in the long run this trend could add a lot of costs to the nation's health care bill," said Dana Goldman, director of health economics at RAND Health, who worked on the study. The federal government reported, also on Thursday in Health Affairs, that the country's health spending bill rose to $1.6 trillion in 2002. In addition to obesity, some of the increase in disability rates may be explained by disability insurance incentives and new medical technology that saves the lives of people who would have died even a few years ago, the researchers said.

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Adult Asthma Differs From Childhood Asthma

HealthDayNews
Thursday, January 8, 2004

THURSDAY, Jan. 8 (HealthDayNews) -- People who develop asthma as adults may have a different disease than those who develop asthma as children, says a study in the January issue of the Journal of Allergy and Clinical Immunology.The study of 80 people with severe asthma also found the presence of inflammatory cells called eosinophils helps distinguish differences between asthma patients.This new research adds to the growing body of evidence that, instead of single disease, asthma is a group of syndromes with different origins and biological characteristics. This information could lead to improvements in diagnosis and treatment of people with asthma."We found that patients whose asthma began in childhood were more frequently allergic than those whose asthma began as adults, while adult-onset asthma was associated with more rapid loss of lung function," research team leader Dr. Sally Wenzel, a pulmonologist at the National Jewish Medical and Research Center, says in a prepared statement."We were surprised to find that many patients showed no signs of inflammation, generally considered a hallmark of asthma, yet they still had severe airflow limitation and many asthma symptoms," Wenzel says.

This is the first time that researchers have combined biological data with detailed questionnaires to define subsets of asthma patients.

More information

Here's where you can learn more about asthma.

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Travelers Urged to Get Vaccinated for Diphtheria

By Paul Simao
Reuters
Thursday, January 8, 2004

ATLANTA (Reuters) - A Pennsylvania man who died of diphtheria last year likely contracted the disease in Haiti, according to U.S. health officials, who urged American travelers on Thursday to stay vaccinated against the disease. Diphtheria, which typically causes soreness in the throat and difficulty breathing but in serious cases paralysis, coma and heart failure, was common in the United States until the advent of mass vaccination programs in the 1940s.

The disease is still active in more than 80 countries, mostly in the developing world, where it kills up to 20 percent of its victims.

The unidentified 63-year-old Pennsylvania man died of cardiac complications about three weeks after first complaining of a sore throat during a volunteer mission to Haiti in October, 2003, according to an investigation published on Thursday by the Centers for Disease Control and Prevention (news - web sites).

U.S. lab tests eventually confirmed the presence of diphtheria-causing bacteria in the man, the CDC report said. The man had not been vaccinated against the disease when he traveled with seven others to help build a church in the Caribbean nation. None of the others in the group have developed the disease. "The case highlights the need for all international travelers to be up-to-date with all recommended vaccinations, including a primary series of diphtheria toxoid-containing vaccine," the CDC said. The United States recommends that all travelers, regardless of age or destination, receive a primary series of three or more doses of the diphtheria vaccine, including a booster within the preceding 10 years before going abroad. Most Americans are vaccinated against tetanus and diphtheria as children. Protection against the diseases, however, drops to less than 50 percent by the age of 20, according to the National Foundation for Infectious Diseases, a nonprofit group that promotes infectious diseases research.

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The Genetics of Allergies

HealthDayNews
Thursday, January 8, 2004

THURSDAY, Jan. 8 (HealthDayNews) -- Allergy sufferers with certain genetic traits may suffer significantly worse symptoms when they're exposed to diesel engine air pollution.That's the finding of a new study from the University of Southern California (USC) and the University of California, Los Angeles. Their report appears in the Jan. 10 issue of The Lancet."We've known that diesel exhaust particles worsen symptoms in individuals who respond to allergens, such as pollen, but this study suggests a direct way that pollution could be triggering allergies and asthma in a large number of susceptible individuals, and perhaps a new route of intervention," study author Dr. Frank D. Gilliland, a professor of preventive medicine at USC's Keck School of Medicine, says in a prepared statement.The study included 19 people who were allergic to ragweed. Their DNA was tested to determine which forms of the GSTM1 and GSTP1 genes they had. These genes are responsible for producing enzymes that help the lungs detoxify pollutants and defuse oxidants before they can cause damage.The GSTM1 gene occurs in two common forms -- present and null. The null form of the gene can't produce the protective enzymes. About 50 percent of people have the null form of the gene.The GSTP1 gene can occur with a variation that causes it to produce a less effective enzyme. This gene variation occurs in about 40 percent of people.It's estimated that 15 percent to 20 percent of people have both the null form of the GSTM1 gene and the GSTP1 gene variation.Over a few months, the study subjects were twice given two treatments: nose spray with either a dose of ragweed allergen and diesel exhaust particles or spray with ragweed allergen and a placebo. The amount of diesel particles given was equal to the amount a person would inhale during a period of 40 hours in southern California.

The study found people who had the null form of GSTM1 had a larger allergic response to the diesel particles than others in the study. An even greater allergic response was observed in those who had both the null form of GSTM1 and the GSTP1 gene variation.

More information

Here's where you can learn more about air pollution and your health.

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Wednesday, January 7, 2004

Cancer at Record High in UK

By Richard Woodman
Reuters Health
Wednesday, January 7, 2004

LONDON (Reuters Health) - The number of cancer cases has hit a new high in Britain, with particularly big increases skin, uterine and prostate cancers, according to figures released on Wednesday. Cancer Research UK said more than 270,000 cases were diagnosed in the UK in 2000, 3,000 more than the previous year and 14,800 more than five years previously. "Cancer mainly affects older people and as our population ages, we are inevitably seeing more cases," said Professor David Forman, chairman of the UK Association of Cancer Registries which compiled the figures. Only Scotland, which has higher rates of cancer than the rest of the UK, bucked the trend with a fall in cases, thanks to success in curbing high smoking rates, the charity added in a statement. However across the UK, cases of malignant melanoma leapt to 7,000, up 16 percent in a year and 24 percent over five years, providing a stark warning of the dangers of over-exposure to the sun. Cancer of the uterus increased to 5,600 cases, up 8 percent in a year and 22 percent over five years, possibly linked to rising rates of obesity and use of hormone treatments like tamoxifen by women with breast cancer.

Cases of breast cancer increased by 12 percent over the five years to 40,700, although between 1999 and 2000 there was actually a fall of 600 cases.

Prostate cancer (news - web sites) increased by 25 percent cases over five years to 27,200, reflecting increased use of the PSA blood test, which often picks up cancers that are not life-threatening.

The charity said the big increases in malignant melanoma, uterine cancer and prostate cancer were partly offset by falls in the numbers of stomach and cervical cancers. Stomach cancer has been decreasing for the past 30 years, as improved hygiene has reduced infection with Helicobacter pylori, one of the main causes of the disease. Screening has cut the incidence of cervical cancer, by picking up and treating precancerous conditions. There were 2,991 cases of the disease in 2000, a fall of 13 percent in five years.

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Diet Consumers Boost Designer Eggs Sales

By Daisy Nguyen
Associated Press Writer
The Associated Press
Wednesday, January 7, 2004

LOS ANGELES - In their relentless pursuit of a healthy diet, many consumers are turning to a new breed of egg. Produced by chickens fed with sea kelp, flax seed and other nutritious ingredients, the designer eggs are finding their way to more and more markets and menus. Sales are booming as health-conscious shoppers opt for their increased nutrients and lower saturated fat. Some say they taste better. "It's like the kind of eggs I had when I was a kid," shopper Liz Sigel, 56, said while buying a dozen large Organic Omega-3 eggs at a Santa Monica market. "It's more dense than regular eggs." The trend is due in part to the popularity of low-carb regimens like the Atkins or South Beach diets and also to recent studies that suggest eggs are healthier than previously thought when it comes to cholesterol. Eggland's Best Eggs, the nation's largest producer of designer eggs, saw a 25 percent jump in those sales in 2003, compared to 2002, said Laura Finlayson, a spokeswoman for the company. In the past 18 months, the Pennsylvania-based company sold over a billion specialty eggs nationwide, with many coming from its two farms in California, she said. Chino Valley Ranchers Farms, based in Arcadia, doubled its production of low-fat eggs in 2003, said David Will, general manager of the company. "A lot of what's pushing the sales is the protein diets, and people are more health conscious," he said. Designer eggs now comprise nearly 5 percent of the $3 billion national egg market. The increased sales come at a time when overall egg prices are at an all-time high. In November, the average price of a dozen large eggs was $1.44, said Don Bell, a consultant for the United Egg Producers, a national cooperative. On average, designer eggs cost about $1 more per dozen than regular eggs. The price surge came after Exotic Newcastle Disease thinned chicken flocks last year and lowered production. Along with kelp and flax seed, chickens that lay low-fat eggs are fed canola oil or other types of non-animal fats. Hens raised on the special diet produce eggs with lower saturated fat that are fortified with omega-3 fatty acid, iodine and vitamin E. If marigold extract is added to their diet, they lay eggs high in lutein, a nutrient that helps maintain the health of the eye. The higher prices don't discourage buyers like Sigel, who paid $3.49 for a dozen of designer eggs. She has been on the Atkins diet for five months and tries to eat as many organic products as possible. "Food quality is not based upon price, it's based upon quality," she said.

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Hollywood Special Effects Help Fight Surgery Scars

Reuters
Wednesday, January 7, 2004

LONDON (Reuters) - American computer technicians have developed software to improve facial surgery and minimize scarring using techniques designed for special effects in Hollywood studios. The software uses a three-dimensional scan of the patient's face to determine what will happen to the skin when it is cut by a surgeon's scalpel, a science magazine reported. It is designed to help minimize the disfigurement some patients suffer after a major operation as skin can bunch up or stretch unpredictably after an incision is made. "The system allows the user to see the results of a particular wound closure and edit the cutting path to explore different options," Steve Pieper, a computer scientist at the Brigham and Women's Hospital's Surgical Planning Laboratory in Boston, told the magazine New Scientist. The software can be used to map out how to re-attach skin flaps during surgery to minimize scarring, the magazine said in its latest issue. Pieper, who had been working on the problem for 10 years, developed the software with Digital Elite, a Los Angeles-based firm specializing in facial modeling for the film industry, New Scientist said. There are still a few hitches. Pieper told the magazine the technique does not yet account for the differing elasticity of old and young skin, nor for such after-effects as the impact of sagging skin on scarring.

Those complications will be factored into future versions of the software, the magazine reported.

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Methadone Overdose Deaths on Rise in Md.

The Associated Press
Wednesday, January 7, 2004

BALTIMORE - Methadone overdose deaths have shot up dramatically in Maryland over the past six years, the state medical examiner's office said. Methadone is used to alleviate heroin addiction and is a powerful painkiller. In Maryland, 29 people have died from methadone intoxication through November 2003, according to figures from the state Office of the Chief Medical Examiner. That's compared to three deaths in 1998. While the deaths represent 4 percent of the 662 deaths caused by illegal and abused prescription drugs during the period, officials said they are concerned by the emerging trend. "We're paying attention to it," said Peter Luongo, director of the state's Alcohol and Drug Abuse Administration. Clinics that distribute methadone to drug addicts have been a source of dispute, often igniting fierce opposition from communities. But health care officials say they doubt such clinics are the source of the abused methadone. The distribution of methadone is subject to tight controls at the 45 drug treatment clinics in Maryland, said Luongo and other state and local officials. "We have had no diversion from any methadone clinics that would cause us to have any concerns that drug treatment is a source" of these deaths, Luongo said. Health officials and researchers concede that more research must be been done to determine whether those who died in Maryland were enrolled in addiction treatment programs, used methadone legitimately for pain treatment or illicitly obtained and abused the drug. In addition to Maryland, Maine, Virginia, North Carolina and Florida have also dealt with rising cases of methadone-related overdose deaths. The trend is part of a nationwide increase in the abuse of powerful painkillers over the past decade, statistics show. From 1994 to 2001, the number of emergency department visits involving abuse of narcotic painkillers more than doubled, from nearly 42,000 to more than 90,000, according to the federal Drug Abuse Warning Network, which monitors emerging drug threats.

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Fast Food Tied to Higher Calorie Intake in Kids

By Amy Norton
Reuters Health
Wednesday, January 7, 2004

NEW YORK (Reuters Health) - Almost one third of U.S. kids eat fast food on any given day, downing extra calories, sugar and fat in the process, a national study shows. Researchers say their findings give weight to the notion that Americans' love of fast food has contributed to the nation's obesity epidemic. "This supports a possible link between the two," said Dr. Cara B. Ebbeling, a research associate at Children's Hospital Boston and co-author of the study. The study, based on national nutrition surveys from the 1990s, found that on a typical day, more than 30 percent of U.S. kids ages 4 to 19 ate burgers, fries and other fast-food fare. "That's a really large percentage," Ebbeling said. On any given day, children who ate fast food consumed an average of 187 more calories than did those who didn't eat such food. And, on average, a child ate 126 extra calories on the days he ate fast food, compared with fast food-free days. These extra calories could translate into an additional 6 pounds of weight gain in a year, the study authors estimate. The findings are published in the January issue of the journal Pediatrics. The study included a nationally representative sample of 6,212 children and teens. It found that boys, older kids and children who were black, of higher-income families, or from the South were most likely to eat fast food. However, children of all races, incomes and U.S. regions commonly had fast-food meals. Overall, children who ate fast food ingested more calories, added sugars, "bad" fats, and carbohydrates, while getting less fiber, fruits and vegetables, and milk than other children. According to Ebbeling, researchers have known that excess weight and obesity in the U.S. have risen in parallel with consumption of fast food. For example, in the late 1970s, children got about two percent of their overall calories from fast food; by the mid-1990s, that figure had jumped to 10 percent. But, she said, there's been surprisingly little hard data tying fast-food consumption to the nation's weight problem.

Her advice to parents is to emphasize fruits and vegetables in their children's diets and to limit sugary beverages, a major source of empty calories. If the family does go on a fast-food outing, she said, parents should limit portion sizes--no "super-sizing"--or choose salads or more healthful fare over burgers and fries.

In an accompanying editorial, Dr. Kelly D. Brownell of Yale University points out that last July, the U.S. National Chamber of Commerce (news - web sites), a group that includes fast-food and soft-drink companies, released a study that found "fast food restaurants are not a chief culprit in the fattening of America."

But, Brownell writes, "mounting science" is making such a stance ever harder to defend.

Source: Pediatrics, January 2004.

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Gyms Push Nutrition As Weight Loss Aid

By Kristen Wyatt
Associated Press Writer
The Associated Press
Wednesday, January 7, 2004

ATLANTA - Nothing against juice and granola bars, but health clubs across the country are hiring chefs, giving cooking classes and teaching nutrition to help their clients drop the weight and keep it off. Herbed salmon, anyone? "People want to see results when they join, and we have to teach them they're not going to get results if they don't have an eating strategy," said Nanette Pattee Francini, co-founder of The Sports Club/LA chain. The Sports Club hands out nutrition books to all new members. "Fully 50 percent of fitness is how you eat," said Francini. A gym in downtown Atlanta has added a teaching kitchen, complete with subzero freezer and overhead TV monitors. And it's passing out more than smoothie recipes — visiting local chefs whip up citrus herb salmon and seared foie gras right alongside the freeweights and spinning classes. A few gyms will even cook for you when you're not working out. Some health clubs in New York are delivering low-cal meals to well-heeled clients. Two-thirds of health clubs nationwide now offer some sort of nutrition guidance, industry experts say, with nutrition lessons thought to help members make sense of confusing diet news. Low carb? Low fat? Gym dietitians are stepping in to answer the questions. In the crowded health club market, nutrition classes can give gyms a membership edge. About 36.3 million Americans belonged to health clubs last year, up from 17.3 million in 1987, according to International Health, Racquetball and Sportsclub Association. Gym owners say innovative lifestyle classes — from cooking to smoking cessation — can bring in new clients when the traditional gym market is just about saturated. "There are only so many memberships you can sell, so this is where the market is going," said David Jamison, general manager of HFC Health Fitness Centers in Atlanta, which holds $35 cooking classes twice a month in its show kitchen. People who don't want to join the gym can come just for the cooking lessons. Another gym in Atlanta, this one for Emory University employees, pairs up club members with students studying to be dietitians. They dine out and go grocery shopping. The students-in-training show their partners how to read nutrition labels and answer common questions about food: Are fresh vegetables healthier than frozen ones? What's the leanest cut of meat? For a restaurant primer, students take members to a tough assignment — a Mexican restaurant — where they point out the healthiest menu options. "Everybody's interested in food. It's becoming more and more recognized that what you eat really does have an impact on performance. But the nutrition component can be so confusing in the real world," said Liz Kustin, a clinical nutrition specialist who oversees the Emory students. "There is so much misinformation out there." The investment in nutrition also can pay off with higher fitness club retention rates. At Flagship Athletic Club in Eden Prairie, Minn., employees say an in-house restaurant and varied nutrition classes keep members coming back. There are wine tastings, classes by cookbook authors, even a call-ahead service where clients can order hot, healthy meals to carry home after working out. "If they're not eating right, they're sabotaging all that exercise," said Sue Masemer, director of Flagship's Lifestyle Department. "You can put 'em with a personal trainer, but it's like, two steps forward, one step back." It's a lesson Natalia D'Angelo knows well. A native of Russia, the Atlanta telecom analyst knew she needed to change her homeland cooking habits — lots of sour cream and pancakes. So D'Angelo joined the HFC club, took a class on making paella and a tutorial about easy ways to prepare chicken breasts. She's so happy with the cooking classes she plans to sign up for more. "I loved to cook, but not when I'm tired because I just got home from work," D'Angelo said. "Now I have learned it's not so hard to cook healthy. And it's important. You can't rely on working out only — you have to eat healthy, too."

On the Net:

American Dietetic Association: http://www.eatright.org

International Health, Racquetball and Sportsclub Association:

http://www.ihrsa.org

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Nerve Receptor for Pungent Foods Identified

By Amy Norton
Reuters Health
Wednesday, January 7, 2004

NEW YORK (Reuters Health) - It's hard to miss the distinctive taste of horseradish, mustard and Brussels sprouts, and now scientists know why. They've pinpointed the nerve receptor that allows us to taste these pungent foods. The discovery could eventually aid in the treatment of certain types of pain, the study's lead author, Dr. David Julius of the University of California San Francisco, told Reuters Health. The journal Nature published the findings Wednesday on its Web site. Condiments like mustard and wasabi, as well as cabbage, Brussels sprouts and other strong-tasting vegetables long shunned by children, all owe their pungency to compounds called isothiocyanates. In the new study, researchers identified the receptor on sensory nerve cells that is activated by these compounds. The receptor, called ANKTM1, is a member of a family of cellular channels known as the transient receptor potential (TRP) family. Past research has shown that another member of this family is a receptor for both capsaicin--the chemical that puts the "hot" in chili peppers--and heat. Last year, scientists found that still another TRP family member helps us detect cold temperature, as well as menthol--the ingredient that puts "coolness" into a range of products, from topical anesthetics to mint candy. Researchers believe that the identification of these receptors will allow a better understanding of how the body senses thermal sensations and sends the information to the brain. This could be useful in finding ways to treat conditions marked by nerve damage, such as diabetic neuropathy. Similarly, Julius said there is evidence that ANKTM1 is involved in activating pain-sensing nerve cells in response to inflammatory agents. Knowing that isothiocyanates send ANKTM1 into action, he explained, could give a "starting point" from which to develop drugs for inflammatory pain, which marks conditions such as arthritis. "Of course, this is still speculative," Julius added. In another finding, the researcher and his colleagues found that THC, the active ingredient in marijuana, also activates ANKTM1. The significance of this is not yet clear, according to Julius. But he said the finding broadens the "classical view" of how THC and cannabis-like compounds act on the nervous system.

Julius noted that two other known receptors for cannabinoids are still clearly the most important "sites of action," especially in the brain.

Source: Nature, online January 7, 2004.

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Hormone Rates Well Vs. Cardiac Arrest

By Linda A. Johnson
Associated Press Writer
The Associated Press
Wednesday, January 7, 2004

A hormone called vasopressin is clearly better at saving the lives of patients whose hearts have stopped than the drug doctors have been using for the past 100 years, according to a study that could transform the treatment of sudden cardiac arrest. For a century, cardiac arrest victims have been given epinephrine, a synthetic adrenaline that constricts blood vessels and boosts blood pressure. It is often administered when shocking the heart with a defibrillator fails to revive the patient.

Using vasopressin instead improved the chances of reaching a hospital alive by about 40 percent, and tripled the chances of going home from the hospital, in patients with the most deadly type of cardiac arrest, asystole, where all heart activity has stopped. Still, only 5 percent who got vasopressin made it home.

The large European study was reported in Thursday's New England Journal of Medicine (news - web sites).

The finding should soon change international guidelines for treating people in cardiac arrest outside a hospital, predicted lead researcher Dr. Volker Wenzel, associate professor of anesthesiology and critical care medicine at Leopold-Franzens University in Innsbruck, Austria.

In an accompanying editorial, Dr. Kevin M. McIntyre of Harvard Medical School (news - web sites) and Brigham and Women's Hospital in Boston called the findings "an important breakthrough." He noted that vasopressin does not appear to have the risks of epinephrine.

"These advances should be translated into a new standard of care immediately," he said. Vasopressin, a synthetic hormone that narrows blood vessels, has been around for decades. A few years ago, the International Liaison Committee on Resuscitation revised its guidelines to add vasopressin as an alternative first drug. That was partly because epinephrine sometimes increases irregular rhythms and decreases oxygen supply to the brain after resuscitation. Each year, more than 600,000 people die of sudden cardiac arrest in North America and Europe, usually because of a heart attack or a heart rhythm disturbance. When medical personnel arrive, nearly 70 percent of victims have ventricular fibrillation, in which the heart's main pumping chambers flutter wildly and pump little blood. Less than 20 percent of these patients survive to go home. About 30 percent of victims, usually patients who have been down longer, have asystole, and nearly all die. The study involved 1,186 cardiac arrest patients treated in 33 communities in Austria, Germany and Switzerland from 1999 to 2002. After ambulance crews tried defibrillation, half the patients not resuscitated then got one or more injections of vasopressin and the other half got epinephrine. Patients in asystole did much better with vasopressin, but among other victims, outcomes were similar for the two drugs. Wenzel, co-chairman of the advanced cardiac life support committee of the European Resuscitation Council, said he expects that group and its counterparts in several nations to issue a joint position paper in several months recommending vasopressin as the first drug for patients in asystole. Wenzel will try to persuade his colleagues to go one step further and recommend injecting both vasopressin and epinephrine, because that showed the most benefit and saved eight crucial minutes. "If truly confirmed by another study it would be a major advancement in the treatment of asystole," said Dr. Muhamed Saric, director of echocardiography and cardiac stress testing at University of Medicine and Dentistry of New Jersey in Newark. One possible drawback, Saric noted, was that vasopressin patients might have been more likely to end up in a coma or vegetative state, because their brains were deprived of oxygen for too long before they were resuscitated.

On the Net: http://www.nejm.org

http://www.americanheart.org

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Tap Water Danger for Contact Lens Wearers -Expert

Reuters
Wednesday, January 7, 2004

LONDON (Reuters) - Contact lens wearers risk their sight by washing their faces in tap water, with people in Britain in greatest danger, a leading eye specialist said on Wednesday. People who wear lenses are most susceptible to a rare and painful condition caused by an amoeba that lives in tap water. The condition -- Acanthamoeba keratitis -- causes ulcers to form on the cornea and can lead to blindness. "It's a ghastly disease. It's very resistant to treatment and difficult to eradicate," John Dart, a specialist at Moorfields Eye Hospital in London told New Scientist magazine. Rates of infection in the UK are only around one in 30,000, but this is 15 times higher than in the U.S. and seven times as high as in the Netherlands. Until recently all homes in the UK had to have a cold-water storage tank and the stagnant water in them provides an ideal breeding ground for the amoeba.

Dart said he believes the greatest risk comes from washing while wearing lenses and handling lenses with wet hands. He recommended people keep tap water away from their eyes when they are wearing lenses.

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Immune System Attack Tied to Birth Defects

By Ed Edelson
HealthDay Reporter
HealthDayNews
Wednesday, January 7, 2004

WEDNESDAY, Jan. 7 (HealthDayNews) -- A misguided immune system attack that prevents the activity of a chemical required for normal development of a fetus could be one cause of the birth malformations called neural tube defects, researchers say.

Antibodies that prevent the chemical, folic acid, from reaching cells in the developing fetus have been found in 75 percent of women with current or past pregnancies affected by neural tube defects, a team at the State University of New York (SUNY) Downstate Medical Center in Brooklyn reports in the Jan. 8 issue of the New England Journal of Medicine (news - web sites).

The finding reinforces the standing advice that women who might become pregnant should take folic acid supplements, experts say. A neural tube defect prevents the brain or spinal cord from developing normally. Defects such as spina bifida and anencephaly occur in about one of every 1,000 pregnancies in the United States.More than a decade ago, a number of studies showed folic acid is needed for proper development of the central nervous system. Flour and other grain products have been fortified with folic acid in the United States since 1998, and women of childbearing age are advised to take folic acid supplements.The SUNY researchers say they began looking for immune system molecules called antibodies that could block the receptors for folic acid in fetal tissue because many women with pregnancies affected by neural tube defects have normal blood levels of folic acid.They found such antibodies in nine of 12 women with affected pregnancies, compared to only two of 20 women with current or earlier normal pregnancies, the researchers say. "The good thing is that we have developed something that can help women avoid neural tube defects," says Dr. Sheldon P. Rothenberg, a professor of medicine and biochemistry at SUNY and leader of the research team.The finding could lead to a test for the antibodies, to help identify women at high risk of neural tube defects. "Companies may well want to develop such a test for clinical use," he says.But the journal paper cautiously adds that more studies are needed to be sure the activity of these antibodies does in fact cause the birth defects.Dr. Nancy Green, medical director of the March of Dimes Birth Defects Foundation, has a less cautious interpretation."What this paper does is add to the list of conditions for which women need more than the standard amount of folic acid," Green says. "The list is growing."A supplement containing at least 400 micrograms of folic acid should be taken every day by any woman who has had a pregnancy affected by a neural tube defect, Green says. Other conditions calling for supplementation include diabetes and obesity, she says.Women of childbearing age who take medications for seizures should also be taking the supplements, Green adds.Indeed, it does no harm if "any woman who is pregnant or trying to become pregnant takes folic acid," she says.An accompanying editorial by Dr. Nicholas J. Wald of the University of London notes that about 250,000 pregnancies with neural tube defects occur worldwide every year."Half of these cases could be prevented simply and safely through adequate fortification, and 85 percent of them could be prevented if all women took a 500-microgram folic acid supplement before pregnancy and during the first trimester," Wald writes.

More information

An overview of neural tube defects and folic acid can be found at the National Library of Medicine and the March of Dimes.

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Bladder Cancer Responds Best to Dual Therapy

Reuters Health
Wednesday, January 7, 2004

NEW YORK (Reuters Health) - Applying local microwave heat therapy at the same time mitomycin C is administered is better than chemotherapy alone in preventing the recurrence of superficial bladder cancers following surgery, new study findings indicate. Even after bladder surgery and chemotherapy or immune therapy, there is a high rate of recurrence of transitional cell carcinoma (TCC) of the bladder, Dr. Renzo Colombo and colleagues report in the Journal of Clinical Oncology. They note that thermotherapy has been shown to be safe and effective as an alternative to surgical removal of the bladder. Colombo, at University Vita-Salute in Milan, Italy, and associates enrolled 83 patients with primary superficial TCC or recurrent TCC following surgical removal of the bladder. Forty-one patients were randomly assigned to treatment with mitomycin C alone and 42 to thermotherapy using the Synergo 101-1 system (Medical Enterprises, Amsterdam) plus mitomycin C. Patients underwent an induction cycle of eight weekly sessions. These were followed by a maintenance regimen of four monthly sessions, in which mitomycin C was administered for one hour, with or without thermotherapy. Among the 75 remaining patients who completed the two-year study, there were 25 recurrences in the chemo-only group and six in the combination group. Patients who underwent thermotherapy experienced more pelvic pain during treatment, but none of the patients dropped out of the study because of pain. In an accompanying editorial, Dr. Donald L. Lamm notes that thermotherapy plus chemotherapy "may represent a major improvement in the management of superficial bladder cancer."

Lamm, a urologist at Mayo Clinic in Scottsdale, Arizona, notes that current optimal chemotherapy techniques were not administered in this study, so it remains to be seen how combining hyperthermia with best practice will ultimately impact the outcome of patients with superficial bladder cancer.

Source: Journal of Clinical Oncology, December 2003.

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'Silent' Heart Arrhythmias More Common Than Thought

By Kathleen Doheny
HealthDay Reporter
HealthDayNews
Wednesday, January 7, 2004

WEDNESDAY, Jan. 7 (HealthDayNews) -- Episodes of atrial fibrillation, a dangerous heart condition found in 2 million Americans, are more common than experts thought in patients for whom drugs seemed to correct the problem.Drug treatment with warfarin, an anticoagulant, should be continued in these patients who have these so-called "silent" episodes of atrial fibrillation, conclude a team of German researchers who report their finding in the Jan. 7 issue of the Journal of the American College of Cardiology.The researchers recommend that doctors continue treatment with warfarin (known under the brand name Coumadin) even if patients appear to be free of heart rhythm problems for more than three months. Standard practice is to treat episodes of atrial fibrillation with rhythm-correcting drugs and with anticoagulants -- usually warfarin -- and to halt the therapy when a patient has not had a repeat occurrence of atrial fibrillation for three months.In atrial fibrillation, the heart's two small upper chambers, called the atria, quiver instead of beating effectively. The blood isn't pumped completely out of the chambers and may pool and clot, and if a piece of the clot travels to an artery in the brain, a stroke results.In the German study, researchers followed 110 patients with the condition who had implantable pacemakers that recorded their heart rhythms constantly. They found that 38 percent of those who did not report any symptoms of atrial fibrillation (which can include an irregular or rapid heartbeat felt by the patient) actually had a recurrence of atrial fibrillation lasting longer than 48 hours.This so-called silent fibrillation should be treated, according to the researchers, if the patient has one other risk factor for stroke, such as high blood pressure, diabetes or advanced age.The new study confirms what several previous studies have also suggested, according to an expert who co-authored an editorial accompanying the study. "This is one of several recent studies suggesting that patients put on anti-arrhythmia drugs who their doctors think are OK have 'silent' episodes of atrial fibrillation," says Dr. Albert L. Waldo, the Walter H. Pritchard professor of cardiology and professor of medicine at Case Western University in Cleveland."With silent episodes of atrial fibrillation, the risk of stroke returns," Waldo adds.

Warfarin is not an easy drug to stay on, he notes, because it interacts with foods and medications such as antibiotics. It's also difficult to keep the blood level of warfarin steady enough to be constantly effective, Waldo says.

But he and other experts expect a new medication to be approved soon by the U.S. Food and Drug Administration (news - web sites) that will do the same job as warfarin but be easier to take.

Meanwhile, even with its downsides, "warfarin is very, very effective," Waldo says. "It impacts the risk of stroke." Patients on it must be monitored closely by their doctors, he emphasizes.Waldo offers this advice for patients: "If they have a history of atrial fibrillation and are at risk for stroke, they need to take an anticoagulant."

More information

To learn more about atrial fibrillation, click on the American Heart Association. For frequently asked questions about the condition, go to the British Heart Foundation.

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Eye Injuries Unforeseen Danger of Drinking Alcohol

By Alison McCook
Reuters Health
Wednesday, January 7, 2004

NEW YORK (Reuters Health) - Some champagne drinkers may have rung in the New Year with eye injuries, new research reports. After reviewing international databases of almost 13,000 reported eye injuries, investigators found that 90 injuries stemmed from accidents involving carbonated drinks contained in glass bottles, such as champagne or beer. Although most people who suffered these types of eye injuries eventually recovered fully, 26 percent became legally blind. Study author Dr. Ferenc Kuhn of the American Society of Ocular Trauma in Birmingham, Alabama said he hopes these results help people "realize that there is a danger" associated with drinking pressurized beverages. Kuhn recommends that people avoid shaking the bottle before opening it, aim the closed bottle away from their eyes or the eyes of others, and open it only with extreme caution. "Be aware. If you are careful, then the risk of injury is greatly reduced," he told Reuters Health. During the study, Kuhn and his colleagues reviewed records from eye injuries reported in the U.S., Mexico and Hungary. The types of injuries varied considerably from region to region, the authors write in the British Journal of Ophthalmology. For instance, champagne corks caused 20 percent of carbonated drink-related eye injuries in the U.S, and more than 70 percent of these types of injuries in Hungary. Overall, almost 4 out of 10 of the eye injuries from carbonated drinks stemmed from broken glass, which can occur when someone mishandles the bottle--perhaps shaking it or dropping it--or when the bottle develops a minute crack and explodes, Kuhn explained. "There is incredible pressure that can build up inside the glass, and it can really blind the eye," he said. Amazingly, champagne bottles contain almost three times the amount of pressure that's in a car tire, Kuhn noted. When that pressure is released, the cork can travel 60 miles per hour, reaching people standing nearby in as quickly as 1/20th of a second. Put in those terms, champagne bottles become "almost a weapon," Kuhn said in an interview. The risk of injury was not confined to people handling the beverages--more than one quarter of the injuries included in the study occurred in bystanders.

Kuhn said he hopes these findings encourage bottle manufacturers to include a warning label on all bottles that contain carbonated beverages.

Source: British Journal of Ophthalmology, January 2004.

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Interferon a No-Go for Pulmonary Fibrosis

By Amanda Gardner
HealthDay Reporter
HealthDayNews
Wednesday, January 7, 2004

WEDNESDAY, Jan. 7 (HealthDayNews) -- A once hopeful treatment for pulmonary fibrosis, a fatal disease of the lungs, appears to have little or no effect on progression of the disease or on quality of life, a new study has found.

There remains some optimism, however, that the treatment, interferon gamma-1b, might benefit patients with mild to moderate symptoms of the disease. The authors of the study, which appears in the Jan. 8 issue of the New England Journal of Medicine (news - web sites), are launching a new trial to test this hypothesis.

The median survival time for patients diagnosed with pulmonary fibrosis is only two to three years. The disease results in a scarring of the lungs that eventually prevents the lungs from fulfilling their primary mission of delivering oxygen to the body. The only effective treatment is lung transplantation, although many people are treated with anti-inflammatory and immunosuppressive drugs, both of which have side effects."There are some medicines which have anecdotally improved patients, [but] for the vast majority of patients this is a devastating illness," says Dr. Alvin S. Tierstein, a professor of medicine at Mount Sinai School of Medicine in New York City and author of an accompanying editorial in the journal."It just progresses and progresses, and nothing that we have helps," he adds. "A huge number of patients are on the transplant list waiting for lung transplants, which usually take about two years to come through, and most of the patients die on the list waiting."A study published in 1999 reported that nine patients treated with interferon gamma-1b and prednisolone did experience improvements.Those results essentially provided the impetus for the current study, which was funded by InterMune Pharmaceuticals Inc., maker of interferon gamma-1b. Dr. David Schwartz, one of the principal investigators on the new study and chairman of the pulmonary allergy and critical care division at Duke University Medical Center, has been a paid consultant for InterMune since 2000.Scientists thought interferon might have an effect by decreasing the production of collagen, which is a key component of the scarring, Schwartz says. "The concept was that interferon gamma would downregulate the disease-causing factors that perpetuate this process in the lungs," he explains.Schwartz and his colleagues randomly assigned 330 patients with idiopathic pulmonary fibrosis -- whose cause is unknown -- to receive either interferon gamma treatment or a placebo. The participants were located at medical centers in the United States, Europe and South Africa. Treatment was administered three times a week for just over a year.The interferon treatment did not slow the progression of the disease, nor did it have a significant effect on lung function or quality of life. "There was no change at all. So in those terms this is a negative study and it has to be represented that way," Tierstein says. "I don't think we should fool anybody and say this medicine makes you better."Still, there are some potential silver linings in this cloud. For one thing, over the course of the study, only 10 percent of the patients in the interferon gamma group died, compared to 17 percent in the placebo group."It is conceivable that interferon is affecting other things," Tierstein says. "We know that interferon is important in the control of infections and it may be that we're preventing infections from carrying these patients off."Also, patients with milder symptoms lived longer when receiving interferon gamma than similar patients in the placebo group. Among participants with mild pulmonary fibrosis, 3.5 percent receiving the drug treatment died versus 12.5 percent in the placebo group."It may be, since all the medicines we have are toxic, we tend not to treat until we have no choice and pulmonary function is really bad," Tierstein says. "Maybe we're waiting too long. Maybe we should treat earlier."Adds Schwartz: "There is some hope that it [interferon gamma] still will work. In fact, we're in the process of launching a major study to look at the effect of this drug in individuals with mild to moderate disease. If anything, it looks like we focused on everyone with pulmonary fibrosis when we should have focused on those with mild to moderate disease."That study, which will follow participants for up to four years, will be looking primarily at survival rates.

More information

For more on this disease, visit the Pulmonary Fibrosis Foundation or the American Lung Association.

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Second Ectopic Pregnancy Hard to Prevent

Reuters Health
Wednesday, January 7, 2004

NEW YORK (Reuters Health) - Researchers have identified several factors that predict a woman's chances of experiencing repeat episodes of ectopic pregnancy, a condition in which the fertilized egg ends up outside the womb. Unfortunately, aside from not becoming pregnant again, there is little a woman can do to reduce her risk. Still, the factors identified in the new study may help doctors predict which patients are at increased risk for the potentially serious problem, and to counsel them appropriately. "Our study suggests that...prevention of recurrent ectopic pregnancy in those actively trying to conceive is not feasible," senior author Dr. Kurt Barnhart and colleagues, from the University of Pennsylvania in Philadelphia, note. The findings, which are reported in the medical journal Fertility and Sterility, are based on a study of 306 women who experienced one ectopic pregnancy and 61 women who experienced two or more such pregnancies. Risk factors for recurrent ectopic pregnancy included a history of surgery, a previous live birth, and a history of spontaneous miscarriage. In contrast, risk factors that the patient might have some control over, such as a sexually transmitted disease, were not tied to an increased risk of recurrence. In both the recurrent and single ectopic pregnancy groups, the initial results of ultrasound tests usually didn't help doctors diagnose the problem. Although pain was an equally common complaint in both groups, bleeding was less common in women with recurrent ectopic pregnancies.

While the results are disappointing in terms of prevention, they can be used "to adequately counsel patients who are at risk for recurrent ectopic pregnancy," the authors state.

Source: Fertility and Sterility, December 2003.

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Strict Blood Sugar Control Key for Diabetic Heart Patients

By Karen Pallarito
HealthDay Reporter
HealthDayNews
Wednesday, January 7, 2004

WEDNESDAY, Jan. 7 (HealthDayNews) -- Heart patients with diabetes are likely to fare better after having procedures to open blocked vessels if they maintain strict control of their blood sugar levels, a new study finds.People with diabetes are known to be at greater risk than non-diabetics of suffering "restenosis," or a re-narrowing of an artery after an angioplasty or stent procedure. Yet there's been little research into the role blood sugar plays in that, the study's authors report."No one has really looked at outcomes after angioplasty," says study author Dr. Roberto A. Corpus, an interventional cardiology fellow at Mid America Heart Institute in Kansas City, Mo. The findings appear in the Jan. 7 issue of the Journal of the American College of Cardiology.He hopes the study will provide an impetus for physicians to better manage blood sugar in their diabetic patients.About 16 million people in the United States and 176 million people worldwide suffer from diabetes, a disease in which the body does not produce or properly use insulin, resulting in elevated blood sugar levels. Of the estimated 1.5 million revascularization procedures performed globally each year, a quarter involve diabetic patients, the study authors note.In an editorial in the same journal, Drs. Ran Kornowski and Shmuel Fuchs of Rabin Medical Center in Petach-Tikva, Israel, state that 30 percent to 40 percent of patients who experience re-clogging of the arteries are diabetics. Reducing that rate would have a favorable impact on angioplasty and stenting results, they say.The study at William Beaumont Hospital in Royal Oak, Mich., involved 239 patients having balloon angioplasty or stenting to open clogged arteries, including 179 people with type 2 diabetes. Sixty non-diabetic patients were randomly selected as a control group.Each patient's hemoglobin A1c, a test that measures average blood sugar levels over the past two to three months, was taken before catheterization. The study used the American Diabetes Association's definition of optimal blood sugar control -- an A1c of 7 percent or less.Diabetic patients with strict blood sugar control had a significantly lower rate of repeat procedures within a year of the initial angioplasty or stenting, compared with diabetics whose blood sugar levels exceeded 7 percent. Just 15 percent of patients with optimal blood sugar control required revascularization, compared to 34 percent of the group with suboptimal A1c levels.The well-controlled group also had lower rates of recurrent angina and cardiac-related rehospitalizations at the 12-month follow-up.

Diabetics should be better managed, agrees Dr. Om Ganda, an associate clinical professor of medicine at Harvard Medical School (news - web sites) and director of the lipid clinic at the Joslin Diabetes Center in Boston. But he questions the study's methodology, noting several "serious limitations," such as the failure to record follow-up blood sugar levels and the absence of data describing how long patients in the poorly controlled group had suffered from diabetes.

"Even though the conclusions are valid, they are not based on a good scientific study," Ganda says.

More information

For more information on diabetes, visit the American Diabetes Association or the Joslin Diabetes Center.

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Weight Loss Signals Severe Cystic Fibrosis in Adults

Reuters Health
Wednesday, January 7, 2004

NEW YORK (Reuters Health) - Adults with cystic fibrosis who experience weight loss that does not involve fat tissue, or loss of "fat-free mass," have more severe overall disease, according to a report in the December issue of Chest. Investigators also found that the loss of fat-free mass that is not obvious correlates with increased loss of bone mineral density and systemic inflammatory activity. "Weight loss is associated with reduced survival in patients with cystic fibrosis," Dr. Dennis J. Shale, of the University of Wales College of Medicine Academic Center, South Glamorgan, UK, and colleagues write. They hypothesized that some adult patients with a normal body mass index (BMI) may have "hidden" fat-free mass loss and bone mineral density depletion that is related to more severe disease. To investigate, the researchers measured bone mineral density and fat mass in 56 adults with cystic fibrosis and in 20 age-matched healthy control subjects. The team recorded lung function, physical activity, blood C-reactive protein (a marker of inflammation), and the number of exacerbations in the previous year. Total fat-free mass was lower in patients that in healthy controls. However, no difference in fat mass was observed between the groups. Among the 56 cystic fibrosis patients, 30 had a normal BMI. Of these 30 subjects, 12 had a hidden loss of fat-free mass. In addition, this group had lower scores on lung function tests, more frequent exacerbations, and higher circulating C-reactive protein, Dr. Shale and colleagues report.

The investigators conclude that it is "clinically relevant" to determine body composition in adults with cystic fibrosis, "and to identify all patients with loss of fat-free mass as an indicator of disease severity."

Source: Chest, December 2003.

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Depressed Mind Responds Differently to Different Therapies

By Kathleen Doheny
HealthDay Reporter
HealthDayNews

WEDNESDAY, Jan. 7 (HealthDayNews) -- Patients who engage in cognitive or "talk" therapy to recover from depression show brain changes that differ from what occurs with drug therapy, new research finds.The study shows for the first time with imaging evidence that the depressed brain responds differently to different treatments -- and the results may help doctors understand why one treatment works for one patient but not another, says study author Dr. Helen Mayberg. Her report appears in the January issue of the Archives of General Psychiatry.Mayberg, an associate scientist at the University of Toronto's Rotman Research Institute at Baycrest Centre for Geriatric Care, and her team looked at 14 adults with clinical depression who received 15 to 20 sessions of outpatient talk therapy without any drug treatments. They gave the patients brain scans before and after therapy using positron emission tomography (PET), which pinpoints the areas where the most changes in brain metabolism occur. They compared the results to typical changes that have been found with drug therapy.They found both therapies affected many of the same regions in the brain, but in different ways."One [treatment] isn't better than the other," says Mayberg, who is also a professor of psychiatry and neurology at Emory University School of Medicine in Atlanta. "Different treatments work on the brain in different ways."In drug therapy, the brain chemistry is altered in the bottom regions of the brain, such as the limbic region, areas that drive basic emotional behaviors, according to Mayberg. It's considered a "bottom-up" approach.Talk therapy is termed a "top-down" approach because it focuses on changes in the cortical -- or top -- areas of the brain, regions associated with thinking functions, to change abnormal mood states.With drug therapy, experts know that blood flow decreases in the bottom regions and increases in the top areas. But with talk therapy, blood flow increased in the bottom regions and decreased in the top regions.Mayberg says the reverse pattern can be explained this way: As talk therapy patients learn to shut off the thinking patterns that lead them to dwell on negativity, activity in areas of the cortical or top regions decrease as well.Dr. Aaron Beck, one of the originators of cognitive therapy and a professor of psychiatry at the University of Pennsylvania in Philadelphia, praises the new study. "It demonstrates that cognitive therapy does have a serious impact insofar as there are brain changes," he says."Clinically, we have documented the changes in depression [with talk therapy]," he says. Now, he adds, the study provides the subjective evidence that there are neurophysiological changes.The findings, he adds, are consistent with the top-down theory of how cognitive therapy works. "You do get a kind of confluence between the two approaches in terms of the brain changes," he adds.The findings may help doctors better decide how to treat depression, says Mayberg, using a combination of approaches. "The areas that cognitive therapy work in are areas that drugs don't touch," she says.

More information

For information on cognitive therapy, try the Beck Institute for Cognitive Therapy. Read about depression from the National Institute of Mental Health, and find a therapist at the American Psychological Association.

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For-Profit Health Plans Aren't Miserly About Care -Study

By Gene Emery
Reuters

BOSTON (Reuters) - Medicare recipients whose benefits are administered by for-profit companies are just as likely to receive expensive procedures such as heart surgery as people in not-for-profit plans, according to a study in Thursday's New England Journal of Medicine (news - web sites).

The findings seem to disprove widespread fears that for-profit insurers may deny services to maximize profits. About 4.5 million Medicare recipients are currently in either for-profit or not-for-profit managed care programs. Eric Schneider of the Harvard School of Public Health and his colleagues found that for-profit plans actually authorized more gall bladder surgeries and partial removals of the colon than nonprofit plans. The rates for 10 other operations, such as total hip replacement, cleaning out clogged arteries, or hysterectomy were essentially the same, regardless of the type of plan. "We found no evidence that enrollees in for-profit plans were less likely to receive" expensive operations, regardless of whether the decision to operate was strongly indicated or not, Schneider and his team concluded. The editors of the Journal characterized the findings as "unexpected." Instead of trying to avoid authorizing surgery as a way of save money, the Schneider team said, for-profit companies may be more focused on saving money by getting price discounts. Alternatively, "they may also be more sensitive to adverse publicity or legal liability that might arise if they restrict the use of high cost procedures," they said. But it was also possible, the researchers warned, that for-profit insurers are denying needed care, but not-for-profit companies are doing it just as aggressively as both types of companies fight to keep their own costs down. The study canvassed 254 programs.

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New Drug Combo Battles Malaria

HealthDayNews
Wednesday, January 7, 2004

WEDNESDAY, Jan. 7 (HealthDayNews) -- Combination drug therapy using a common Chinese herbal medicine may offer the best hope for tackling malaria, claim two articles and a commentary in the current issue of The Lancet.Drug resistance is the main barrier for effectively treating the millions of people worldwide who are affected by malaria.Extract of sweet wormwood, also called artemisinin, could solve the problem. Researchers say a derivative of artemisinin was found to be highly effective in treating the disease when added to other antimalarial drugs.The derivative, artesunate, decreased treatment failure by around 80 percent and doubled the rate of successful treatment when compared with patients given standard malaria treatment, according to the International Artemisinin Study Group's research.The study involved about 6,000 patients in 16 randomized trials: 12 from sub-Saharan Africa, three from Thailand and one from Peru.

Artemisinin combination treatment could help reduce the incidence of malaria and prevent the emergence and spread of drug-resistant parasites in Africa and elsewhere, the researchers concluded.

More information

Here's where you can learn more about malaria.

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Ask for 'Vasopressin' if Heart Stops

Reuters Health
Wednesday, January 7

NEW YORK (Reuters Health) - If a person could ask for drugs when their heart stops, they might want to ask for a drug called vasopressin, new research suggests. Starting CPR with this drug, instead of the old standard, seems to improve survival for some patients. When the heart stops, powerful drugs are given in an attempt to get the organ running again. Currently, a shot of adrenaline, also called epinephrine, is recommended as the first drug to be given. Due to a lack of research, vasopressin is only considered a secondary alternative to epinephrine in present CPR guidelines, senior author Dr. Karl H. Lindner, from the Leopold-Franzens University in Innsbruck, Austria, and colleagues note.

As reported in The New England Journal of Medicine (news - web sites), Lindner's team assessed the survival outcomes of 1186 cardiac arrest patients whose CPR began with an injection of vasopressin or epinephrine.

In cases where the heart was quivering rapidly, known as ventricular fibrillation, or where heart electrical activity was seen without a pulse, starting with either drug resulted in similar survival. However, when there was no evidence that the heart was pumping, treatment with vasopressin first seemed to raise a person's odds of survival.

In a related editorial, Dr. Kevin M. McIntyre, from Harvard Medical School (news - web sites) in Boston, comments that the new findings should stimulate an immediate change in current CPR guidelines.

Given that such changes usually occur at meetings held every 5 years, "the best approach to optimizing survival as soon as possible would be to have the appropriate committees of the American Heart Association (news - web sites) and the American College of Cardiology convene in order to issue an interim guideline incorporating these important new therapeutic advances," he notes.

Source: The New England Journal of Medicine, January 8, 2004.

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Genetic Link Found for Insulin Resistance

HealthDayNews
Wednesday, January 7, 2004

WEDNESDAY, Jan. 7 (HealthDayNews) -- Scientists have found a gene that causes insulin resistance in Mexican-Americans, the ethnic group with the highest prevalence of the condition.Insulin resistance is a syndrome in which the body does not respond as well as it should to insulin, and it's linked to the development of heart disease, diabetes, high blood pressure, obesity and polycystic ovary syndrome.Researchers at Cedars-Sinai Medical Center in Los Angeles have found lipoprotein lipase (LPL), a gene that controls the delivery of fatty acids to muscles and tissues, is linked to insulin resistance in Mexican-Americans.The findings, reported in the January issue of Diabetes, may let scientists design therapies that target LPL to prevent insulin resistance, a condition that affects one of four adult Americans."This is the first study to definitively show that LPL is a gene for common insulin resistance," says Dr. Jerome I. Rotter, director of the Common Disease Genetics Program at Cedars-Sinai.Future studies will focus on exactly how the LPL gene influences insulin resistance.

More information

Here's where you can learn more about insulin resistance.

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Safe Water Handling Key in Controlling Cholera

Reuters Health
Wednesday, January 7, 2004

NEW YORK (Reuters Health) - While a safe water source is important to prevent the transmission of cholera, a recent outbreak in the Marshall Islands shows that handling and storing the water safely is also critical. Cholera, an infectious disease that produces severe diarrhea, is caused by a microbe that can contaminate water supplies. Although adding chlorine to the water can kill the microorganism, in the current study, the outbreak occurred despite the use of this cleansing measure.

In December 2000, the first known outbreak of cholera in the Republic of the Marshall Islands was reported on Ebeye Island. A new study of the outbreak, reported in the medical journal Clinical Infectious Diseases, focuses on 53 patients with cholera and 104 similar subjects without the disease.

In tracking down the source of the outbreak, Dr. Mark E. Beatty, from the Centers for Disease Control and Prevention (news - web sites) in Atlanta, and colleagues found that cholera patients were eight times more likely than unaffected people to have drunk water that was transported to Ebeye from a US military installation on a nearby island.

Interestingly, the military water came from a chlorinated source that was considered to be safe from cholera contamination. Moreover, none of the residents on the island where the water originated developed cholera. These findings led researchers to consider that contamination occurred while the water was being sent to Ebeye. In support of this hypothesis, the authors found that drinking water transported in a cooler with a tight-fitting lid reduced the risk of cholera infection, presumably because the secure seal slowed the loss of chlorine that occurs with evaporation. Other factors tied to a reduced risk of infection included drinking bottled water, boiled water, or water mixed with powdered flavorings.

"Providing a safe water source can be insufficient to prevent cholera transmission if the means for safe transport and storage of water are not available," the investigators emphasize.

Source: Clinical Infectious Diseases, January 2004.

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Healthy Diets for Diabetics

HealthDayNews
Wednesday, January 7, 2004

(HealthDayNews) -- If you have diabetes, healthy eating should be an integral part of managing your disease. A good diet can help control your weight and blood sugar level.The Methodist Health Care System in Houston offers these healthy eating tips:

  • Use vegetable spray instead of oil, shortening, or butter. Steam vegetables using a low-fat broth or water. Season foods with herbs and spices, vinegar, lemon juice, or salsa. Use low or sugar-free jams instead of butter or margarine. Use low-fat or fat-free cottage cheese, or nonfat yoghurt. Eat chicken or turkey without the skin. Buy only lean meats and broil, roast, stir-fry or grill them. Use canola or olive oil rather than vegetable oils.
  • Buy whole-grain breads and cereals.

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Tuesday, January 6, 2004

Child Biting

HealthDayNews

Tuesday, January 6, 2004

(HealthDayNews) -- Does your toddler go around biting other people? Many young kids bite for reasons ranging from frustration to curiosity.Prevent your child from gnawing his peers with these suggestions from the American Academy of Pediatrics:

  • Provide teething toys if your child is experimenting with biting. Give plenty of positive attention for appropriate behavior. If your child is a biter, stay close to him when others are around, and intervene early before conflict occurs.
  • Help your child identify his feelings.

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Breast Mutation Not Linked with Colon Cancer-Study

Reuters
Tuesday, January 6, 2004

WASHINGTON (Reuters) - People with mutations that raise their risk of breast and ovarian cancer do not seem to have a higher risk of colon cancer, U.S. and Israeli researchers reported on Tuesday. They found that people with mutations in the BRCA1 and BRCA2 genes -- named for breast cancer -- were not any more likely to develop colorectal cancer than the average person. "People carrying BRCA1 or BRCA2 mutations already have their plates full managing a high risk of breast and ovarian cancer," Dr. Stephen Gruber, a cancer geneticist who helped lead one study at the University of Michigan, said in a statement.

"The good news in our study is that they don't have to deal with an increased risk of colorectal cancer, as well."

Two separate reports published in this week's issue of the Journal of the National Cancer Institute (news - web sites) showed the same results.

In one study, Gruber and colleagues looked for BRCA mutations in 1,422 Israeli patients with colorectal cancer and 1,566 healthy patients without colon cancer. Ashkenazi Jews -- those of Eastern European descent -- are more likely than other groups to have BRCA mutations. They also carry several different genetic mutations linked with colon cancer. But the volunteers found to have BRCA mutations were no more likely to have colon cancer than those without the mutations, Gruber's team found. "We found no strong common genetic basis between colorectal and breast cancer," Gruber said. "They are different diseases with different genetic factors." In another study, Tomas Kirchhoff, Dr. Kenneth Offit and their colleagues at the Memorial Sloan-Kettering Cancer Center in New York compared 586 Ashkenazi Jewish patients with colorectal cancer to 5,000 patients without the cancer. They also found no association between the BRCA mutations and colon cancer. A study published last October showed Jewish women with BRCA mutations had a more than 80 percent risk of developing breast cancer.

In the United States, colon cancer is the second leading cause of cancer death after lung cancer, killing 57,000 people last year. Colorectal cancer is the leading cause of deaths from cancer in Israel.

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Disease Management: The New Face of Managed Care

By Karen Pallarito
HealthDay Reporter
HealthDayNews
Tuesday, January 6, 2004

TUESDAY, Jan. 6 (HealthDayNews) -- If you suffer from a chronic problem such as diabetes, heart disease or asthma, chances are your health plan is offering a "disease management program" to prevent your condition from worsening.Now, sponsors of these programs are beginning to target a wider array of medical conditions -- from migraine to lower back pain to lupus. These new efforts take aim at common health problems that add significant costs to the U.S. health-care system and often are poorly managed by patients."I think the concept is beginning to resonate," says Robert Stone, executive vice president of American Healthways, a national provider of disease management programs.The Nashville-based company added 11 new programs in 2002. It now offers services for conditions ranging from acid-related stomach disorders and irritable bowel syndrome to osteoarthritis and urinary incontinence.Disease management is growing in popularity as employers grapple for new tools to control costs and improve the quality of patient care, says a recent report from the Center for Studying Health System Change, a Washington, D.C.-based think tank.But not everyone is buying into the concept."I think the hesitancy from employers relates to the fact that these programs are not free to implement," says Glen Mays, a senior health researcher at the center and one of the authors of the report.Employers must make an up-front investment, with very little evidence the programs are going to be effective, he says, "so it's really a leap of faith."Then there's the turnover issue. If an employee leaves the company or switches insurers before the disease management initiative has produced results, there's little incentive for employers or health plans to invest in those programs in the first place."Some plans have actually backed off on some of their investments in disease management, particularly those programs that take a very long time to realize a return," Mays adds.What's more, many of the traditional disease management programs, such as cardiovascular care and diabetes, target conditions affecting an older population. The programs don't always fit a younger workforce.That's one of the reasons health plans and disease managers are now beginning to offer a broader array of programs targeting more conditions affecting working-age individuals.While evidence of longer-term cost savings and improved quality remains limited, an increasing number of employers and health plans are moving ahead for lack of better options for squeezing costs.Geisinger Health Plan, a 240,000-member health maintenance organization (HMO) in Danville, Pa., is planning to roll out an expanded program for women and men who are at risk of osteoporosis or who have had a previous bone fracture. The revamped program will tailor services to a member's risk for the disease.Nurses will encourage low-risk members to exercise, get recommended levels of calcium, quit smoking and avoid safety hazards, such as throw rugs in the home, that could cause someone to slip and fall. High-risk individuals, with a history of fracture, will be urged to get their doctor to perform a bone mineral density test and to prescribe a bone-strengthening drug."I think we've really finally recognized that osteo is a significant health problem [and] appropriate interventions can really make a difference," says Janet Tomcavage, a registered nurse and manager of Geisinger Health Plan's Care Coordination Department. An estimated 44 million Americans aged 50 and older suffer from osteoporosis or low bone mass, according to the National Osteoporosis Foundation. Preventing bone loss should cut costly hospitalizations and reduce potentially deadly medical complications, Tomcavage says. Nashville-based American Healthways is another HMO expanding care to more members to hold down costs. Early results of a pioneering program it runs with Blue Cross and Blue Shield of Minnesota seem to bear that out.Under the program, nurses help coordinate care for 140,000 participating Blue Cross members with 17 chronic health problems. Eleven conditions, including osteoporosis and low back pain, are ones American Healthways recently added.In the first six months of the program, the St. Paul-based insurer saved $4.23 for every $1 spent on the 11 new categories of care. It expects a slight decrease in savings over the first 18 months, to $3.70 for every $1 of investment."The results are beyond any of our expectations," says Dr. Bill Gold, chief medical officer and vice president of the 2.6 million-member health plan.

Buoyed by the experiment's success, Blue Cross and its disease management partner are considering the next group of conditions to be added to the program. Depression and cancer-related diseases are possible targets, Gold says.

More information

To learn more about disease management programs, visit the Center for Studying Health System Change or Cedars-Sinai Health System of Los Angeles.

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McDonald's Suggests Low-Fat Menu Options

By Ula Ilnytzky
Associated Press Writer
The Associated Press
Tuesday, January 6, 2004

NEW YORK - With Americans fattening up and fast food on the defensive, McDonald's this week began telling dieters in the New York area how much fat and carbs are in some of its meals. New posters and brochures, prominently displayed in restaurants in New York, New Jersey and parts of Connecticut, tell customers how to modify McDonald's existing menu — by leaving out the bun or cheese, for example — to reduce their intake of fat, carbohydrates and calories. "We are trying to educate our customers that the foods they love at McDonald's can fit into the diet they're on," said Cristina Vilella, marketing director for the fast food company's New York metro region office in Roseland, N.J. "If they're watching fat, carbs or counting calories, they can take the menu and fit it into the lifestyle that they're leading." But Vilella said there is no immediate plan to make such information available outside the tri-state area. "Different regions adopt different programs," she said. Officials at McDonald's headquarters in Oak Brook, Ill., did not respond to phone calls requesting further comment. The fast food industry has been under pressure by consumer groups and the government to provide more nutritional information about their food. McDonald's and a few others have previously made calorie count brochures available. Jeff Cronin, a spokesman at the Center for Science in the Public Interest, called McDonald's new initiative "a step in the right direction." But he said "if McDonald's really wants to give consumers good information about their choices, they would at least put calorie counts on menu boards right alongside the price, where consumers could see them at the point of decision-making." Legislation pending in the New York State Assembly and Congress would require fast food chains to put calorie counts on menu boards, and would make table service chains list calories, saturated and trans fats, carbohydrates and sodium counts on printed menus, Cronin said. The new Real Life Choices program was developed by nutritionist Pam Smith, author of "Eat Well, Live Well," in partnership with McDonald's franchisees. It was kicked off Monday at 650 McDonald's in New York City, on Long Island, in most of New Jersey and in Connecticut's Fairfield County. Real Life Choice selections are created from existing menu items and carry the same price — even if you tell McDonald's to hold the cheese. For example, a reduced-fat breakfast of less than 8 grams of fat might be an Egg McMuffin minus the cheese and butter. For the low-carb dieter, a breakfast with less than 5 grams of carbohydrates could be a platter of double meat or eggs without the English muffin, biscuit or hash browns. For those only counting calories, a breakfast of 300 calories or less could be an Egg McMuffin, a snack-size Fruit 'n Yogurt Parfait or scrambled eggs with a plain English muffin. "I think there are a lot of people who don't know how much fat or calories there are in a sauce or in mayonnaise or in salad dressing, no awareness that ketchup ... adds sugar," Smith said. "So if you're trying to cut carbs, that would be an example to leave it off." Diners trying out the Choices approach in the community of Carle Place on Long Island approved. "I think it's great," said Joseph Randazzo of Valley Stream. "It's always nice to know what you're eating." Mike Zat of Levittown said the changes might improve the restaurant's reputation.

"McDonald's usually has a fast-food, kind of greasy connotation to the name," he said. "I guess it opens new ideas for people. Maybe they'll see McDonald's in a different light."

Dr. Alan Rulis, senior adviser for the Center for Food Safety and Applied Nutrition at the Food and Drug Administration (news - web sites), said the chain is giving consumers more information. "We encourage that, even if it's an incremental step."

He said the FDA is discussing America's obesity problem and possible solutions with food processors and the restaurant industry. A report on the subject is expected next month. "People don't go to McDonald's looking for diet food," said Smith, "but what Real Life Choices does is it gives them a chance to have food that will fit within their diet but still with that flavor that they're seeking." McDonald's is also test-marketing an adult version of its Happy Meal called Go Active. Instead of a burger and a toy, the meal will include a salad and an exercise booklet. Other fast-food chains also have started offering healthier fare. Burger King, the No. 2 hamburger chain, for example, has a new line of low-fat, baguette-style chicken sandwiches. Last year, a federal judge in New York dismissed two class-action lawsuits blaming McDonald's for making people fat. On the Net:

www.mcdonalds.com

www.fda.gov

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Nearly 40,000 chickens killed by mystery virus in Vietnam

Agence France Presse.
Tuesday, January 6, 2004

HANOI (AFP) - Nearly 40,000 chickens have died from a mystery virus in two provinces in southern Vietnam but as many as 400,000 are thought to be infected, officials said. The disease, which first emerged last week, has triggered panic selling of chickens among local farmers in Tien Giang and Long An, raising concerns that it could spread among poulty across other parts of the Mekong Delta region. "We are taking urgent measures because this epidemic could threaten all the Mekong Delta," said Nguyen Duy Long, an official from the Long An provincial government's veterinary department.

"The virus causes a quick death among infected chickens. It is a very dangerous virus that could also affect other domestic animals," he added.

Long refused to speculate on whether the virus could be the highly contagious bird flu that killed six people in Hong Kong in 1997, and which triggered panic in South Korea (news - web sites) following an outbreak there last month.

"We plan to send blood samples to overseas laboratories to determine the type of virus but first we are awaiting a decision from the Ministry of Health," he said. Health ministry officials could not be contacted for further comment. "I don't think this is linked to outbreaks of bird flu overseas," said Bui Quang Anh, director of the veterinary department in the Ministry of Agriculture and Rural Development. "We are investigating carefully the situation and if necessary we will ask for help from foreign specialists. Our first priority at the moment is to prevent any further transmission." Long said local markets in the two provinces were being strictly monitored and that all dead chickens were being confiscated. Measures have also been put in place to prevent the transportation of chickens to other provinces. However, he said preventing transmission of the virus beyond the borders of the two provinces was proving difficult. "The problem is that many local people are trying to sell their remaining chickens to traders in Ho Chi Minh City."

Authorities in Vietnam's southern business capital have asked local people to avoid buying, selling or eating chickens from the Mekong Delta.

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Smokers Have Higher Breast Cancer Risk - U.S. Study

Reuters
Tuesday, January 6, 2004

WASHINGTON (Reuters) - Women who smoke may have a far higher risk of breast cancer than those who do not, or those who once smoked but quit, U.S. researchers reported on Tuesday.

California women who said they were current smokers had a 30 percent greater incidence of breast cancer than non-smokers, the researchers reported in this week's issue of the Journal of the National Cancer Institute (news - web sites).

Peggy Reynolds and colleagues at the California Department of Health Services studied 16,544 women between 1996 and 2000. During that time, 2,005 of them were diagnosed with invasive breast cancer. Women who described themselves as current smokers had a 30 percent higher risk of being among the cancer patients. Those who started smoking before age 20, who began smoking at least five years before their first full-term pregnancy, and who smoked the most or the longest all had higher risks. Women who had once smoked but quit did not have a higher risk of breast cancer, Reynolds' team found. Passive smoking also did not seem to raise breast cancer risk in the California study.

Breast cancer is the third most common cause of cancer death in the United States, after lung cancer and colon cancer. It killed 40,000 women in 2003, according to the American Cancer Society (news - web sites).

The researchers said their study helps shed light on an area where studies have had conflicting results. They now plan to run genetic tests on the women in the study to see if a genetic mutation may make certain women more susceptible to the cancer-causing effects of tobacco smoke. Tobacco smoke carries several known carcinogens, and elements of tobacco smoke have been found in the breast fluid of smokers, they noted.

But tobacco could also affect estrogen in ways that, theoretically at least, could lower breast cancer risk. The study tends to refute that notion.

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Experts hope new illness etiquette emerges from SARS and nasty flu season

Canadian Press
Tuesday, January 6, 2004

TORONTO (CP) - Most of us are used to soldiering on when we get sick, reporting for work when we're fighting a nasty cold or the achy onset of influenza. We think it's what we're supposed to do.

But if the concept of ribbons for perfect attendance isn't dead, it ought to be, public health authorities insist. You and your woolly brain and virus-filled respiratory tract aren't doing anyone any favours - in fact, you're only spreading misery.

In the wake of SARS (news - web sites) and this year's full-on flu season, medical authorities are hoping a new illness etiquette emerges. They'd like people to finally twig to the fact that when they're sick, staying home is the socially conscious thing to do.

"The whole idea of staying home - in a work ethic like we have in this country and in the U.S. where you go to work at all costs - is a very different mind-set. But I think SARS has made us really look at that, and made employers look at that," says Dr. Bonnie Henry, associate medical officer of health for the City of Toronto. "Particularly when you have a fever, you need to be aware that the world will get by without you for the time that you might be possibly infectious to others." It's a hard message to get across. Who hasn't shared a bus or other public space lately with someone who was hacking and sneezing? Or wondered why a runny-nosed colleague dragged his or her sorry butt into the office, only to spend most of the day spewing germs while recounting how awful they feel? Henry admits there's still work to be done to get the idea across. Some of the worst offenders, she says, are health-care workers. "We give people in hospitals awards for perfect attendance. Well, that doesn't support the notion that sometimes you're going to get illnesses that are beyond your control and you should - it's your responsibility - to stay home, rather than to potentially infect other people." The same goes for sick children. Sending a sick kid, especially one who is feverish, to school isn't good for the child and isn't good for the rest of the kids either, says Dr. Joanne Embree, an expert in pediatric infectious diseases at the University of Manitoba. "They aren't learning anything under those circumstances," Embree says. And parents who justify their actions by figuring the illness is probably running rampant through the school anyway are letting themselves off too easily, she suggests. "So I think there may be some ... self denial, that by sending their child to school sick their child is not actually going to continue the chain of transmission," she says. "(But) it does amplify things." Some employers are more open-minded than others about sick days, notes Dr. David Butler-Jones, past president of the Canadian Public Health Association. Those employers understand that the short-term pain of having a person off sick equals long-term gain - protecting the rest of the work force and perhaps clients from the same illness. "If you're working at Starbucks and you've got this drippy nose and you're rubbing your nose . . . every cup you handle, the next person's got the flu," says Butler-Jones, medical officer of health for Sun Country health unit, in southeastern Saskatchewan. But not every boss sees the world this way. Some workers don't have paid sick days; some can't afford to stay home and forego a day or two or three's salary. Some bosses are none-too-thrilled when healthy parents stay home with sick children either. For those who must work while sick, Butler-Jones suggests steering clear of watercooler gatherings or communal lunches as a means of trying to protect your colleagues from what you're spreading. Call a co-worker from your desk rather than visit theirs. "Whatever contact you have, if you're washing your hands frequently, you're not having direct contact, you're not face-to-face, you're going to minimize the risk to other people," Butler-Jones says. Embree advises that parents should have a contingency plan in place for when children get sick, because they will inevitably need one. There are other rules of illness etiquette the experts would like us to take on board. Don't visit elderly relatives when you or your children are sick. Seniors are more vulnerable to flu and colds - and the pneumonia they can trigger - because the immune system weakens with age. Wait till you're well to visit. Remember your mother's advice. Cover your mouth when you sneeze or cough - and then wash those hands. In fact, washing your hands frequently is the best way to protect you and the people around you from getting ill or from spreading it if you are. Butler-Jones says the chain of transmission is pretty easy to see - and to stop. "I rub my nose, I shake your hand. You rub your nose, you have my cold. So washing hands frequently during the day is really important." Public health authorities hope a new illness etiquette is emerging in the wake of SARS and this year's nasty flu season. Here's some advice on what to do if you or your children are coming down with a cold or influenza: - Don't go visit an elderly relative, especially one living in a seniors home. The elderly are more vulnerable to flu and the pneumonia it can cause because the immune system weakens with age. Ditto people with chronic illness such as kidney disease or cancer. Wait till you're well to visit. - If you have a fever, stay home from work. You are probably infectious and could end up spreading your misery to colleagues. Children who have fevers should not go to school. - If you must go to work, try to minimize contact with colleagues and clients. Don't hang out in the lunch room or take part in a communal coffee break. They won't thank you for giving them your bugs. - Follow Mum's advice. Cover your mouth when you cough or sneeze. - Wash your hands. Frequently. Teach your kids to as well.

- Have a contingency plan for keeping your child out of school when he or she is sick. It's going to happen and you need to be prepared.

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Synthetic Venom May Relieve Cancer Pain

By Lindsey Tanner
AP Medical Writer
The Associated Press
Tuesday, January 6, 2004

CHICAGO - A synthetic form of sea snail venom can ease pain in cancer and AIDS (news - web sites) victims who get no relief from morphine or other conventional painkillers, a study found.

Laboratory research has found evidence that the venom that the snails inject to immobilize their prey might have beneficial effects on some heart problems, strokes, central nervous system disorders and other ills. The latest study involved the experimental drug ziconotide, a laboratory-made equivalent of a compound in the venom of the small Conus Magus cone snail, which lives in shallow tropical saltwater. The infusions produced significant relief in patients whose pain did not respond to more conventional drugs such as morphine. Side effects, including dizziness and confusion, were common but can be reduced by fine-tuning the drug dose, said co-author Dr. David Ellis, a medical director of Elan Pharmaceuticals, which makes ziconotide and helped fund the study.

"This is a new, promising kind of treatment," said Dr. Jerome Yates, vice president for research at the American Cancer Society (news - web sites). Yates, who was not involved in the study, said thousands of cancer patients suffer from intractable pain and might benefit from the new drug.

Elan is seeking federal approval for the drug, and one of the researchers said he expects it to become commercially available within the year.

The study appears in Wednesday's Journal of the American Medical Association (news - web sites). Medtronic, which makes infusion pumps for delivering painkillers, co-funded the study.

Seeking human uses for animals' defense mechanisms is not new. Other recent efforts include an experimental drug derived from snake venom that has shown promise in treating strokes. The snail-venom research involved 111 patients ages 24 to 85 in the United States, Australia and the Netherlands. All were treated with a small, battery-operated pump implanted in their abdomens and attached to a catheter that delivered continuous medication or a dummy drug into fluid surrounding the spinal cord. Treatment lasted about 10 days; most patients were not hospitalized during that time. The patients rated their pain. Pain relief was moderate to complete in 53 percent of ziconotide patients, compared with about 18 percent of the placebo group. Serious side effects occurred in 22 ziconotide patients and four placebo patients. Subsequent research has shown that starting patients on lower doses reduces the risks, and many have remained on treatment for more than a year, Ellis said. "This gives us another weapon to help deal with those patients who don't respond to the normal, conventional treatments," said Dr. Steven Charapata, a co-author and director of the Pain Institute at Research Medical Center in Kansas City, Mo. On the Net:

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

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Hormone Replacement Drug Use Tumbles, Study Says

Reuters
Tuesday, January 6, 2004

CHICAGO (Reuters) - Studies showing that hormone replacement therapy raises the risk of heart disease, cancer and blood clots have knocked U.S. prescriptions for the drugs back to where they were nine years ago, a report said on Tuesday. The finding shows that doctors "may rapidly abandon well-established therapies when studies demonstrate harm" and that "patients also played a major role" in the reversal, said the report from the Stanford University School of Medicine. The study said the number of hormone therapy prescriptions rose to 90 million in 1999 from 58 million in 1995 and remained stable through June 2002. Estrogen/progestin combinations, primarily Wyeth's Prempro, accounted for most of the growth, the study said. Studies released starting in July 2002 triggered an avalanche of bad news about the therapy, and a sharp drop in prescriptions followed.

If prescription rates seen through July 2003 continue, the report said, there were probably 57 million written last year, close to the rate in 1995.

The U.S. Food and Drug Administration (news - web sites) recommends that post-menopausal women preferring hormone therapy for hot flashes or vaginal dryness take the lowest possible dose for the shortest possible time.

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

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CDC Warns Flu Season Still Hasn't Peaked

By Daniel Yee
Associated Press Writer
The Associated Press
Tuesday, January 6, 2004

ATLANTA - The flu season has yet to reach its peak, despite a drop-off in cases in some states, health officials warned on Tuesday.

At least five states — Kansas, Kentucky, Nebraska, Washington and West Virginia — no longer have widespread outbreaks of flu, but 42 others still do, the Centers for Disease Control and Prevention (news - web sites) said.

The flu season in the United States got off to an unusually early and harsh start, raising fears that this could be one of the deadliest seasons in years, especially among children. "If you look at overall data from nationwide surveillance, it doesn't look like it's peaked yet," said Dr. Scott Harper, a CDC flu expert. "Nationwide, influenza-like illnesses are still on the rise." Child deaths from the flu also are increasing, Harper said. The CDC said it would not release details on such deaths until Thursday. But late last month, the agency said 42 children had died from the flu, about half of them under the age of 5. About 92 children under age 5 typically die each flu season, according to the CDC. Nationally, more people are visiting the doctor for flu-like illnesses. About 9.4 percent of all outpatient visits surveyed by the federal agency last week involved flu-like illnesses, up from 7.7 percent in the previous week and the highest rate so far this season. In addition, pneumonia and influenza accounted for a season-high 9 percent of deaths, up from 7.8 percent the previous week, in a survey of 122 U.S. cities. The states listed as having widespread flu activity are: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Wisconsin, and Wyoming. City health departments in New York City and the District of Columbia also have reported widespread activity.

On the Net:

CDC flu info: http://www.cdc.gov/flu/weekly/

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Research Raises Hope for New Meningitis Vaccine

By Louise Knowles
Reuters Health
Tuesday, January 6, 2004

LONDON (Reuters) - British scientists said on Tuesday they have made a breakthrough in meningitis research which could lead to the development of a vaccine against all forms of the potentially deadly disease. Experiments at the University of Surrey used genetic engineering to make mice immune to a broad range of strains of the disease, including group B strains for which there are currently no vaccines. "This is the first time I am aware of that an experiment has been able to demonstrate protection against multiple strains of meningitis," said Professor Johnjoe McFadden, who led the research team. "There are still many years work to do but we are hopeful that it is going to give us a route toward developing a broad vaccine," he said. Meningitis, an inflammation of the lining of the brain and spinal cord which affects hundreds of thousands of people worldwide, has historically been difficult to treat because it has so many different strains. In the UK there are between 2,000 and 3,000 cases each year and one in ten people who contract the disease die. "The unique thing about this research is that it provides hope for a complete vaccine protecting people against all types of the meningococcal bacteria -- the most common cause of meningitis worldwide," said Will Guyatt, spokesman for the Meningitis Trust, which contributed quarter of a million pounds to the research.

"Whilst there is already a vaccine available to protect against group C meningitis, it is important to find a vaccine for group B as it continues to kill hundreds of people in the UK every year," Guyatt said.

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38 States Get Fs on Tobacco Prevention

By Jennifer Friedlin
Associated Press Writer
The Associated Press
Tuesday, January 6, 2004

NEW YORK - Most states have failed to pay for tobacco-prevention programs and protect people from second-hand smoke despite receiving billions of dollars in settlement money to take such measures, according to a report. The American Lung Association's report, released Tuesday, gave 38 states grades of F for failing to fund tobacco prevention and control programs. Thirty-five states received Fs for their smoke-free air laws. The annual report also found that 23 states received failing marks because of their inability to keep tobacco out of the hands of minors. "How many more preventable deaths must occur and how many more children must become addicted to cigarettes before we say enough?" ALA chief executive John L. Kirkwood said. The report said there were some bright spots. Fifteen states received grades of A in at least one of the four categories, and five states — California, Connecticut, Delaware, Maine and Rhode Island — got As in two categories. New York was the only state to receive As in as many as three areas. The American Lung Association says that 440,000 people die each year from tobacco-related illnesses, while smoking costs the United States about $75 billion in direct medical costs and $82 billion in lost productivity each year.

On the Net:

American Lung Association: http://www.lungusa.org

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FDA Warns Campbell Unit on Unsafe Soup Procedures

Reuters
Tuesday, January 6, 2004

CHICAGO (Reuters) - U.S. regulators have warned Campbell Soup Co. that its refrigerated clam chowder soup under the StockPot label was prepared in unsanitary conditions that could pose a risk to consumers, the U.S. Food and Drug Administration (news - web sites) said on Tuesday.

A warning letter was sent to the soup maker's StockPot unit, part of its food service division, on Dec. 22 but posted on Tuesday on the FDA's Web site. It requires StockPot to implement new safety and testing standards to ensure that the refrigerated, ready-to-use clam chowder soup is safe. The soup is primarily sold to institutions such as restaurants and hotels. The FDA said a September inspection of StockPot's single plant in Woodinville, Washington, turned up "serious deviations" from seafood safety regulations. Regulators cited inadequate temperature and cooling time to prevent the dangerous botulinum toxin, which can result in a type of food poisoning. The company sent a response letter to the FDA on Oct. 8. "Following the inspection by the FDA in September, StockPot responded in a timely manner," Campbell spokesman Jerry Buckley told Reuters. "We determined that StockPot's processing procedures and products are safe. We will continue our discussions with the FDA on the specifics of their letter." The FDA in its December letter recommended ways to implement corrective actions. Campbell has 15 days to respond to the most recent letter. "We may take further action if you do not promptly correct these violations," the inspectors wrote. "For instance, we may take further action to seize your product(s) and/or enjoin your firm from operating." Camden, New Jersey-based Campbell acquired StockPot in August 1998.

Shares of Campbell rose 15 cents to close at $27.07.

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Doctors Do Respond to Latest Info on Drugs

By Amanda Gardner
HealthDay Reporter
HealthDayNews
Tuesday, January 6, 2004

TUESDAY, Jan. 6 (HealthDayNews) -- Doctors are paying attention to the results of clinical trials and changing their prescribing patterns accordingly.

That's the conclusion of two studies in the Jan. 7 issue of the Journal of the American Medical Association (news - web sites).

Since recent reports have revealed hormone replacement therapy and alpha blockers might have detrimental effects, prescriptions for both have declined significantly, the researchers note."Physicians are human, occasional self-delusions to the contrary notwithstanding," says Dr. David Naylor, author of an accompanying editorial in the journal and dean of medicine at the University of Toronto. "The neat thing about these two studies is that they both give us a window on what happens when there are negative findings in clinical trials. They look at how physician prescribing changes when there's bad news about what were apparently good drugs. These studies do provide a reassuring message to the public about professional responses."Hormone replacement therapy had increased dramatically over the past 20 years due to beliefs about its health benefits for postmenopausal women. Much to consumers' and physicians' surprise, recent randomized trials found the therapy involved an increased risk of breast cancer, cardiovascular disease and other problems.Using two databases, the study authors determined that annual hormone therapy prescriptions in the United States increased from 58 million in 1995 to 90 million in 1999, then stayed level through June 2002. But after the disturbing results of the Women's Health Initiative were published in July 2002, prescriptions started declining significantly. Between January and June 2003, prescription for Prempro, the most popular product, declined 66 percent, and for Premarin, 33 percent.Prescriptions of doxazosin, an alpha blocker, a class of drugs designed to lower blood pressure, followed a similar trajectory, albeit less dramatically.In the spring of 2002, the doxazosin arm of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was terminated early after finding the risk of "cardiovascular events" was 25 percent greater in patients receiving doxazosin than in patients being treated with a thiazide diuretic. Steady increases in new alpha blocker prescriptions turned into a decrease of 26 percent between 1999 and 2002.A research letter in the same issue of this week's journal found an increase in prescriptions of thiazide-type diuretics to treat high blood pressure after the halting of the ALLHAT arm.Why the difference in the level of prescription responses to hormone therapy and to alpha blockers?"[The hormone study] received an incredible amount of media attention, really unprecedented. And, to me, that indicates that for physicians to really fully respond to clinical evidence, the discussion of the issues needs to leave the professional arena and become a topic of public conversation," says Dr. Randall S. Stafford, an author on both of the latest studies."The role of the media and the public in facilitating this sort of change is often underestimated," adds Stafford, an assistant professor at Stanford University Medical School's Stanford Prevention Research Center.The two new studies do raise questions about how physicians obtain their information on the current state of scientific research."It's incredibly hard for physicians to stay up on all the areas they're expected to have expertise in, and that may be one of the explanations as to why a change of the magnitude observed for hormone therapy almost had to leave the professional arena," Stafford says.Another issue is the difference between negative and positive study results in clinical trials. The tendency in medicine, as in the pharmaceutical industry, is to focus on what is new and positive."We want to do what is best for patients," Naylor says. "There is an optimistic bias built in to being a physician."Needless to say, most drug companies also prefer to focus on positive results. "The marketing forces at work here are formidable, and that's why [these new findings about prescribing patterns are] good news for the general public," Naylor adds. "Here's evidence that physicians make changes when the tide turns against what were thought of as good drugs."

More information

For more on hormone therapy, visit the National Women's Health Information Center. The American Heart Association has more on alpha blockers and other drugs that lower blood pressure.

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Fitness Lowers Overweight Diabetics' Death Risk

By Amy Norton
Reuters Health
Tuesday, January 6, 2004

NEW YORK (Reuters Health) - Being fit can lower a diabetic man's risk of dying, even if he is significantly overweight, new research suggests. Investigators found that diabetic men who were physically fit were less likely than their less-fit peers to die of any cause over about 15 years. What's more, men who were heavy yet fit had death risks similar to those of fit normal-weight men. "This is a testament to the power of being physically active," said lead study author Dr. Timothy S. Church, medical director of the Cooper Institute in Dallas. "Essentially, fitness totally negated the effects of being overweight," he told Reuters Health. Church and his colleagues report the findings in the January issue of the journal Diabetes Care. The study involved nearly 2,200 men who were followed for an average of just under 15 years. All had undergone a range of health assessments, including treadmill tests to gauge their fitness levels, upon entry. Church's team found that, with all health factors considered, greater fitness meant a lower risk of death over the years, regardless of weight. The biggest difference in risk was seen among obese men, where those who were only moderately fit had a much lower risk of death than those who were the most out of shape. This is significant, according to Church, because it doesn't take a grueling exercise regimen to achieve such a level of fitness. Thirty minutes of walking five times a week should do it, he noted. Excess weight and obesity are major factors in type 2 diabetes, and weight loss can often help control the disease and its complications, which include heart disease and stroke. The new findings do not minimize the importance of weight control in managing diabetes, according to Church and his colleagues. However, Church said they do point to the power of physical fitness even in the absence of weight loss. And, looking at the findings from a different perspective, thinness did not protect study participants from the ill effects of being out of shape. Among normal men, those who were the least fit were nearly seven times more likely to die than the most fit. Doctors, Church said, should talk to all patients about getting and staying physically active.

Exactly why fitness cut death risk in this study is not fully clear, but better cardiovascular health almost certainly factored in, according to Church. However, the Cooper Institute researchers have also found that fitness is related to a lower risk of cancer death.

Source: Diabetes Care, January 2004.

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Pancreatic Cancer Tied to Long-Term Aspirin Use

By Adam Marcus
HealthDay Reporter
HealthDayNews
Tuesday, January 6, 2004

TUESDAY, Jan. 6 (HealthDayNews) -- Could people who take aspirin for prolonged periods be putting themselves at greater risk of pancreatic cancer?Maybe so, says a new study asking that question of more than 88,000 nurses. Aspirin has long been thought to suppress tumors of the digestive tract and other organs. And recent research has found no evidence that aspirin users are more likely to suffer pancreatic cancer, even offering hints the drug may protect the insulin-secreting gland from tumors.But the latest work suggests that people who take the drug consistently over a period of decades have a nearly 60 percent higher risk of developing pancreatic cancer than those who take aspirin less regularly.

"It seems to be consistent use that counts," says study leader Dr. Eva S. Schernhammer, a cancer researcher at Harvard Medical School (news - web sites) in Boston. She is quick to caution that while the study is the largest of its kind to date, it turned up only 161 cases of pancreatic cancer among the entire pool of volunteers over an 18-year period.

"There is not much data available to investigate such associations," says Schernhammer, whose findings appear in the Jan. 7 issue of the Journal of the National Cancer Institute (news - web sites).

Although the evidence is murky, the researchers say their study suggests women who took more aspirin each week over time increased their odds of developing pancreatic cancer. However, that trend couldn't be confirmed with statistical certainty.The line from aspirin to pancreatic cancer, if it exists, may run through obesity. Not only were obese women more likely than their thinner peers to develop the cancer while taking aspirin, but the heavier they were, the greater their risk, Schernhammer says. "We did see that the effects in the overall cohort seemed to be restricted to women who were more obese," she says. Previous research has linked obesity with pancreatic tumors.Millions of Americans take low doses of aspirin every day to prevent heart attacks and strokes, problems that kill far more people each year than pancreatic cancer. "Overall, the prevalence of cardiovascular disease is so much higher than the prevalence of pancreatic cancer that the benefits would probably still outweigh the risk," Schernhammer says.Dr. John Baron, an epidemiologist at Dartmouth Medical School and author of an editorial accompanying the journal article, calls the findings "provocative" and says they should force doctors "to think carefully about the actions of aspirin and other [non-steroidal anti-inflammatory drugs] and the mechanisms underlying pancreatic cancer."But Baron says the results may be misleading. The research seems to suggest that, at least in some cases, pancreatic tumors triggered aspirin use and not the other way around.Kirsten Moysich, an epidemiologist at the Roswell Park Cancer Institute in Buffalo, N.Y., has looked at aspirin and various cancers, including pancreatic tumors (she found no harm or benefit). In general, Moysich says, the drug appears to protect against cancers, most notably in the colon and rectum, and possibly the lung and breast.However, she says, contrary evidence "shouldn't be ignored. We cannot make global public health recommendation about regular aspirin use if we don't know the whole picture." And while aspirin "seems to be a wonderful drug," it does have known side effects, including a propensity to cause potentially serious gastric bleeding.More than 29,000 Americans will be diagnosed with pancreatic cancer this year, according to the National Cancer Institute. The disease is the nation's fifth leading cancer killer, behind tumors of the lung, breast, colon and rectum, and prostate gland.

More information

For more on pancreatic cancer, check out Pancreatica or the National Cancer Institute.

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Britain Launches New Antidepressant-Suicide Probe

By Richard Woodman
Reuters Health
Tuesday, January 6, 2004

LONDON (Reuters Health) - Britain's medicines' agency announced on Tuesday a new study to find out if people taking antidepressant drugs are at increased risk of suicide. The Medicines and Healthcare Products Regulatory Agency said the study would estimate the risk of suicide, suicidal thoughts, non-fatal overdose and self-laceration in patients taking selective serotonin re-uptake inhibitors (SSRI) and tricyclic antidepressants (TCA). Britain has taken the lead in reviewing the safety of the newer SSRI class of drugs following reports that some depressed patients turn violent or suicidal after starting medication. A safety review in children last year resulted in the UK agency advising doctors not to prescribe the majority of SSRIs to under-18 year-olds as the risks of treatment were found to outweigh the benefits. The new study will follow patients of all ages up to 90 years old who were diagnosed with depression between 1995 and 2001. Relative risks of suicide and other adverse events will be calculated for SSRI and TCA treatment versus no drug treatment, SSRI versus TCA treatment, and for each SSRI compared with GlaxoSmithKline's SSRI Seroxat/Paxil (paroxetine). Officials were not immediately available to explain why the Glaxo product had been singled out, though one possible explanation is that it is the most commonly prescribed SSRI.

Drug companies insist that millions of patients have been prescribed SSRIs without suffering major adverse events and that any suicidal thoughts are the result of their depression rather than the treatment.

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Maternal Smoking Linked to Low Sperm Counts

By Randy Dotinga
HealthDay Reporter
HealthDayNews
Tuesday, January 6, 2004

TUESDAY, Jan. 6 (HealthDayNews) -- As if the dire warnings on cigarette packs weren't enough, pregnant women may have yet another reason to avoid tobacco.A new study suggests smoking during pregnancy could reduce the fertility of baby boys when they grow up.The adult sons of women who smoked during pregnancy were more likely to have lower sperm counts and smaller testes than other men, Danish researchers found.The sperm counts and other measures of fertility were still within normal ranges. However, the diminished levels are worrisome, says study co-author Dr. Tina Kold Jensen, a reproduction researcher based in Copenhagen."Smoking is dangerous not only to the infant but also carries a risk into adulthood," she says.Maternal smoking has been linked to a variety of health problems. Babies of mothers who smoke are more likely to have smaller lungs and develop asthma, says Dr. Norman H. Edelman, consultant for scientific affairs with the American Lung Association. Studies also have linked maternal smoking to other ills in children, including birth defects, colic, diabetes, mental retardation and obesity, along with premature labor for the mothers.Scientists suspect adult males who smoke may suffer from fertility problems. But there's been little research into how smoking by pregnant women can influence the reproductive health of their children.From 1995 to 1999, Jensen and colleagues enrolled young male military recruits from five European countries for a study of male reproductive health. More than 1,700 men volunteered from Denmark, Estonia, Finland, Lithuania and Norway.The findings appear in the Jan. 1 issue of the American Journal of Epidemiology.The sperm counts of the men whose mothers had smoked during pregnancy were 24.5 percent lower than the other men. (Sperm counts refer to the amount of sperm in a single ejaculation.) Although the number of sperm in each millimeter of semen was less among the men of mothers who smoked -- 41 million -- it was still within the normal range, Jensen says.The researchers also found the men's testes -- the glands inside their testicles -- were smaller, a factor that could contribute to the lower sperm counts, Jensen says.Edelman says the study was well done, and its findings are "very dramatic.""I'd love to see follow-up studies" to determine if maternal smoking lowers testosterone levels as well, he says. "If that turns out to be true, you're reducing not only fertility but masculinity. It opens up an incredibly interesting area of study."

More information

Need to quit smoking? Visit the U.S. Surgeon General or the National Institutes of Health.

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Steroid Use Does Not Affect COPD Outcome

Reuters Health
Tuesday, January 6, 2004

NEW YORK (Reuters Health) - The findings of a new study indicate that the regular use of inhaled steroids does not improve survival or prevent disease flare-ups in patients with chronic obstructive pulmonary disease (COPD), contrary to some reports. The new study was conducted to address possible bias in previous research. The benefits of inhaled steroids for COPD is a controversial topic, lead author Dr. Vincent S. Fan, from the University of Washington in Seattle, and colleagues note. While some studies have suggested an improvement in survival, others have failed to demonstrate this. Fan's team suggests this disparity may arise from study bias that can arise if the effects of inhaled corticosteroids are assessed after some of the subjects have died, so that the surviving patients have a greater amount of time to receive these drugs. To avoid this type of study bias, they conducted a study using "time-dependent" methods. Specifically, the authors wanted to determine if using inhaled steroids for at least 80 percent of the time reduced death rates and prevented flare-ups in COPD patients. Of the 8,033 patients included in the study, nearly 2,700 were prescribed an inhaled steroid for at least 80 percent of a three-month interval. There was no evidence that average steroid use at low or high/medium doses reduced the risk of death, the authors note. Similarly, recent steroid use was not associated with a survival benefit. Inhaled steroid use also did not appear to affect hospitalizations or flare-ups due to COPD, the researchers report in the American Journal of Respiratory and Critical Care Medicine. The findings suggest that the previously reported protective effects of inhaled steroids on death may have been influenced by confounding factors, the investigators note.

Because other studies have used a decline in lung function as the primary outcome, the current results further support performing a larger trial in which COPD patients are randomly assigned to inhaled corticosteroids or placebo to see if inhaled steroids influence disease survival or flare-ups, they add.

Source: American Journal of Respiratory Critical Care Medicine, December 15, 2003.

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Severely Obese Face Major Depression Risk

By Randy Dotinga
HealthDay Reporter
HealthDayNews
Tuesday, January 6, 2004

TUESDAY, Jan. 6 (HealthDayNews) -- In a variation on an age-old question, researchers have long asked themselves which comes first -- obesity or depression?A new study doesn't resolve the debate, but it does suggest the risk of mental illness is a major problem for the severely obese, and less of a threat for the merely overweight.Women of average height who weighed more than 240 pounds and men of average height who weighed more than 278 pounds -- defined as morbidly obese -- were five times more likely to be depressed than people of average weight.However, women who were overweight, but not obese, were also more likely to be depressed."It's good news for the general population because it means the depression burden might be lower among the obese than we worry it is," says study co-author Dr. Chiadi U. Onyike, a psychiatric researcher at Johns Hopkins Hospital in Baltimore. "But it's not good news for people who are morbidly obese."The suspected link between depression and obesity is nothing new. "It seems an obvious connection," Onyike says. But why? Do fat people get depressed because of social stigma, or because of the chemical makeup of their bodies? Or does depression cause a chemical reaction in the body that leads to obesity?In the new study, the researchers examined statistics from a 1988-94 federal study of the health and nutrition of Americans. They looked at 8,410 people who responded to a psychological questionnaire. The findings appear in a recent issue of the American Journal of Epidemiology.The people most likely to be depressed -- five times more so than those of normal weight -- were those with a body mass index of more than 40, making them morbidly obese. The index, a ratio of height to weight, is a measurement of obesity.For people who are 5-foot-4, their BMI will reach 40 when they hit 240 pounds. For those who are 5-foot-10, their BMI will reach that level at 278 pounds.Among women, simply being obese, a step above being overweight, spelled trouble, but not as much as among the morbidly obese, the study found. The risk of depression doubled among those women who had BMI of 30 or more. That translates to a weight of 180 or more for someone who is 5-foot-5. But the same was not true for men.The study reveals the importance of screening severely obese patients for signs of depression, says Onyike. "Depression can undermine their compliance with weight-reduction treatments," he says.But what of the perception that fat people are the life of the party?Some obese people do indeed seem happy, but that's because they're successfully using food -- a "natural antidepressant" -- to treat their depression, says Dr. Albert Ray, an obesity expert and physician advisor with the Kaiser Permanente Health Plan's Positive Choice Wellness Center in San Diego."What a physician normally does is throw a diet at them, [tell them to] go out and exercise and lose weight and come back in a month," Ray says. "It doesn't happen that way. The doctor hasn't gotten to the underlying problem, which is depression or some inner psychological problem."Once obese people come to terms with their depression, often related to childhood traumas such as abuse, they can begin losing weight, he says. Counseling and medication are often very useful in treating the depression, he adds.But "there's a lot of denial," Ray says. "These patients don't want to recognize that they're depressed, that they grew up in homes with heavy levels of dysfunction."

More information

To calculate your body mass index, visit this National Institutes of Health (news - web sites) site. To learn more about depression, check with the National Institute of Mental Health.

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Survey: Most Americans Think Food Is Safe Despite Mad Cow

Reuters
Tuesday, January 6, 2004

NEW YORK (Reuters) - Most Americans believe the food they buy at their local supermarket is safe despite last month's discovery of the first case of mad cow disease in the United States, according to a survey. Of 537 adults polled in the week following the Dec. 23 mad-cow announcement, 70 percent said they were confident that the foods purchased from supermarkets are safe, market research firm NPD Group said on Tuesday. That compares to just 64 percent in NPD's mid-December survey of the same topic.

But at the same time, 72 percent of American consumers surveyed said they were concerned about mad cow disease, compared to 57 percent of consumers questioned earlier in the month.

Scientists believe humans can contract the deadly brain-wasting disease, variant Creutzfeldt-Jakob disease (news - web sites) (vCJD), by consuming beef products from cows with bovine spongiform encephalopathy, or mad cow disease.

When asked about food safety in restaurants, 53 percent of those surveyed said they felt foods sold in restaurants were safe, up from 48 percent in the previous survey. Meanwhile, NPD found sales at restaurants for the week ending Dec. 29 were up 5 percent, the strongest increase in 18 months.

"Americans eat out at fast-food restaurants more than at any other restaurant, so this is telling us that fast food is not seeing an impact from the latest news," NPD Group Vice President Harry Balzer said in a statement.

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Physician, Heal Thyself

HealthDayNews
Tuesday, January 6, 2004

TUESDAY, Jan. 6 (HealthDayNews) -- Doctors who complain about malpractice reform should first take steps to improve patient safety, claims an article in the Jan. 6 issue of the Annals of Internal Medicine.Physicians involved in the debate over soaring malpractice insurance have focused solely on capping damage awards without considering the larger problem of patient injury, say the article's authors, Dr. Stephen C. Schoenbaum of The Commonwealth Fund and Randall R. Bovbjerg of the Urban Institute."Physicians must use their abilities to make care safer and injuries rarer by developing, evaluating and implementing safety improvements," Schoenbaum says. "More active work on the part of physicians to improve care and reduce harm is clearly in the best interest of the public and physicians."The article also calls for other changes to the current medical liability system, in which steep increases in malpractice premiums have lead to physicians practicing "defensive medicine."The proposed changes include risk management training for doctors; premium discounts on malpractice insurance for physicians with good track records; subsidies from health plans in return for specific safety enhancements; and tools for doctors such as electronic prescribing aids and automated systems for the tracking of tests.

The Urban Institute is a nonprofit, nonpartisan policy research group, while The Commonwealth Fund is a private foundation supporting independent research on health and social issues.

More information

Here's where you can learn more about improving patient safety.

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Monday, January 5, 2004

Pregnancy Alert

HealthDay Reporter
Monday, January 5, 2004

(HealthDayNews) -- Some discomfort during pregnancy is normal. Many women experience mild nausea, dizziness, fatigue or heartburn, according to Baystate Health System.But other symptoms may be signs of more serious trouble. These include:

  • Severe nausea and vomiting. Bleeding from the vagina. Severe abdominal pain. A temperature of more than 99.5 Fahrenheit. Leaking of amniotic fluid from the vagina.
  • Strong, regular contractions before the due date.

If you experience any of these symptoms, call your doctor immediately.

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Study Says U.S. Teens Are Fattest

By Lindsey Tanner
AP Medical Writer
The Associated Press
Monday, January 5, 2004

CHICAGO - Teenagers in the United States have higher rates of obesity than those in 14 other industrialized countries, including France and Germany, a study of nearly 30,000 youngsters ages 13 and 15 found. Among American 15-year-olds, 15 percent of girls and nearly 14 percent of boys were obese, and 31 percent of girls and 28 percent of boys were more modestly overweight. The findings are based on school questionnaires given to youngsters in the 15 countries in 1997 and 1998. The study was led by Inge Lissau, a researcher at the National Institute of Public Health in Copenhagen, Denmark, and was published in the January issue of Archives of Pediatrics & Adolescent Medicine. The heaviest countries, based on data from 15-year-olds, also included Greece, Portugal, Israel, Ireland and Denmark. U.S. teens were more likely than those in other countries to eat fast food, snacks and sugary sodas and were more likely to be driven to school and other activities, contributing to a more sedentary lifestyle, said co-author Mary Overpeck of the U.S. Maternal and Child Health Bureau. "The rest of the world may be catching up, but we're still in first place in a race that unfortunately we shouldn't want to be winning," said Dr. David Ludwig, an obesity researcher at Children's Hospital Boston who was not involved in the study. He led a study published Monday in another journal, Pediatrics, that found that nearly one-third of U.S. youngsters eat fast food on any given day. Lithuania had the lowest obesity rates in the latest study. Among Lithuanian 15-year-olds, about 2 percent of girls and 0.8 percent of boys were obese, and 8 percent of girls and 5 percent of boys were overweight. That is probably because Lithuania has fewer fast-food restaurants and its teens have less money to buy snacks and fast food, Overpeck said. In some countries, such as Ireland, Portugal and Sweden, 13-year-old girls were more likely than 15-year-old girls to be obese. Among French 15-year-olds, 4 percent of girls and almost 3 percent of boys were obese, and nearly 13 percent of girls and 10 percent of boys were overweight. Among German 15-year-olds, about 5 percent of girls and boys were obese, and nearly 15 percent of girls and 14 percent of boys were overweight. The other countries studied were Austria, Czech Republic, Flemish Belgium, Finland and Slovenia.

Overpeck said preliminary data from more recent surveys show little if any change in rates among the countries studied.

The World Health Organization (news - web sites) last year said obesity is no longer mostly an American problem but is an increasing concern in Europe and other developed nations because people are abandoning traditional dietary habits and adopting more sedentary lifestyles.

Weight calculations were based on teens' body-mass index, a height-weight ratio. Countries with some of the heaviest youngsters after the United States, based on data from 15-year-olds, were:

  • Greece: 5.5 percent of girls were obese and about 16 percent were overweight; nearly 11 percent of boys were obese and almost 29 percent were overweight. Portugal: nearly 7 percent of girls were obese and almost 21 percent were overweight; about 5 percent of boys were obese and 14 percent were overweight. Israel: about 6 percent of girls were obese and 16 percent were overweight; nearly 7 percent of boys were obese and 20 percent were overweight; Ireland: nearly 5 percent of girls were overweight and 14 percent were overweight; almost 3 percent of boys were obese and 19 percent were overweight.
  • Denmark: 6.5 percent of girls were obese and 18 percent were overweight; about 3 percent of boys were obese and 10 percent were overweight.

On the Net:

Archives: http://www.archpediatrics.com

World Health Organization: http://www.who.int/hpr/NPH/docs/gs_obesity.pdf

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Broken Bone?

HealthDay Reporter
Monday, January 5, 2004

HealthDayNews) -- After a fall, some kids cry out that they've broken a bone in their arm or leg. But how do you tell whether a bone actually is broken?According to The Nemours Foundation, a break may have occurred if your child heard a snapping sound when he fell, if there is swelling, bruising, and tenderness, or if it's painful to bear weight on the injured area.If you suspect a bone's been broken, here's what to do:

  • Remove clothing from the injured part. Apply a cold compress. Place a splint on the injured area by keeping the limb in the same position in which you found it. Position soft padding around the injured part; place something firm next to it; keep the splint in place using first aid tape.
  • Get medical help and don't let your child eat -- in case surgery is needed.

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Deliveries May Be Better Handled by Academic MDs

Reuters Health
Monday, January 5, 2004

NEW YORK (Reuters Health) - Obstetricians in private practice are much more likely than their academic counterparts to perform episiotomies, despite current evidence that favors restricted use of this procedure, according to a report in the journal Obstetrics and Gynecology. Overall, the use of an episiotomy, a surgical procedure used to prevent tearing of vaginal tissue during the birth of an infant, has declined over the past few years. The procedure involves surgical incision into the vulva to prevent tearing of the vagina during delivery. During the last decade, multiple studies have shown that episiotomy is associated with increased rates of severe lacerations, more pain, and slower return to sexual function, Dr. Nancy L. S. Howden and colleagues at the University of Pittsburgh Health Sciences Center explain in their report. Their study was designed to examine trends in episiotomy use at their facility since 1995, comparing episiotomy use by residents and faculty compared with private practitioners. Included in the study were nearly 28,000 women. Overall, the rate of episiotomy declined from 59.7 percent in 1995 to 45.0 percent in 2000. However, the average rate of episiotomy use was 17.7 percent among 38 residents and faculty practitioners, versus 67.1 percent among the 141 private practitioners. After adjusting the data for factors, such as maternal age, race, infant birth weight and history of cesarean section, which could contribute to the need for this procedure, the authors found that private practice physicians were seven times more likely than academic practitioners to use episiotomy. They suggest this disparity may be related to the period in which doctors were trained.

"An ideal rate of episiotomy, if there is one, has yet to be defined," Howden and associates maintain. "Future studies should determine how to choose a candidate for episiotomy."

Source: Obstetrics and Gynecology, January 2004.

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Smart People Need Tougher Alzheimer's Testing

HealthDay Reporter
Monday, January 5, 2004

MONDAY, Jan. 5 (HealthDayNews) -- Smart people need to be held to a higher testing standard if they're to be correctly diagnosed for early signs of Alzheimer's disease (news - web sites), says a new study.

Researchers found raised standards better predicted future mental decline in intelligent people than did comparing their responses against normal standards. The finding is reported in the January issue of Neuropsychology.Past studies have found very smart people have shown clinical signs of Alzheimer's much later than the general population. Once they do, they decline much faster.This was thought to reflect their greater mental reserves, but this study indicates their intelligence might be making it harder to judge their mental processes.

"Highly intelligent elders are often told their memory changes are typical of normal aging when they are not," lead author Dorene Rentz, a clinical psychologist with the department of neurology at Brigham and Women's Hospital and Harvard Medical School (news - web sites), says in a prepared statement. "As a result, they would miss the advantages of disease-modifying medications when they become available."

The researchers believe the findings also could help people at the other end of the scale, with lower standards reducing the chance that someone with below average intelligence would be misdiagnosed as demented.

More information

Here's where you can learn more about Alzheimer's disease.

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Study: Coffee May Lower Diabetes Risk

By Joann Loviglio
Associated Press Writer
The Associated Press
Monday, January 5, 2004

PHILADELPHIA - Drinking more coffee may reduce the risk of developing the most common form of diabetes, a study found. Compared to non-coffee drinkers, men who drank more than six eight-ounce cups of caffeinated coffee per day lowered their risk of type 2 diabetes by about half, and women reduced their risk by nearly 30 percent, according to the study in Tuesday's issue of Annals of Internal Medicine. Nevertheless, experts said more research is needed to establish whether it really is the coffee — or something else about coffee drinkers — that protects them. "The evidence is quite strong that regular coffee is protective against diabetes," said one of the researchers, Dr. Frank Hu of the Harvard School of Public Health. "The question is whether we should recommend coffee consumption as a strategy. I don't think we're there yet." Type 2 diabetes, formerly called adult-onset diabetes, typically shows up in middle-aged people. The disease is on the rise and is striking more and more young people as Americans become fatter and less active. People with type 2 diabetes either do not make enough insulin or their bodies don't use it properly. It leads to higher blood sugar levels, which over time can cause blindness, heart disease, kidney failure and nerve damage and can lead to amputations. Caffeine has previously been found to reduce insulin sensitivity and raise blood sugar — both bad news for the body. But the researchers note that coffee, whether it is regular or decaffeinated, also contains potassium, magnesium and antioxidants that might counteract those negative effects and improve the body's response to insulin. In the latest study, every two to four years over a period of 12 to 18 years, more than 126,000 people filled out questionnaires reporting, among other things, their intake of coffee and tea. Researchers adjusted the data for risk factors such as smoking, exercise and obesity. There was a more modest effect among decaf drinkers: a 25 percent risk reduction for men and 15 percent for women. There was no statistically significant link between diabetes and tea. The results are in agreement with those from a 2000 study of 17,000 Dutch adults, which concluded that people who drank at least seven cups of coffee a day were half as likely to develop type 2 diabetes than people who drank two cups or less. Dr. Nathaniel Clark of the American Diabetes Association expressed concerns that such reports divert public attention toward illusory quick-fixes and away from proven diabetes-stoppers: diet, weight loss and exercise. "While we're always happy when there's research looking at what people can do to reduce their risk," he said, "I'm often frustrated by this type of research because the public is bombarded with these stories and they don't know what they're supposed to do." The study's co-author stressed that no one should conclude that coffee is a "magic bullet."

"It's important to emphasize that by far the most important preventions are maintaining a healthy weight and exercising," said Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women's Hospital.

The Centers for Disease Control and Prevention (news - web sites) estimates that 18.2 million Americans, or more than 6 percent of the population, have diabetes. Type 2 diabetes accounts for between 90 percent and 95 percent of the total.

On the Net:

Annals of Internal Medicine: http://www.annals.org

American Diabetes Association: http://www.diabetes.org

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Tiniest Babies Fare Best at Specialty Hospitals

By Steven Reinberg
HealthDay Reporter
HealthDay Reporter
Monday, January 5, 2004

MONDAY, Jan. 5 (HealthDayNews) -- Babies born extremely underweight fare best at hospitals that specialize in their care, a new study shows."In the past, there has been an emphasis on regional care for very low birthweight infants," says lead researcher Dr. Barbara Warner, a neonatologist at Cincinnati Children's Hospital Medical Center. However, recently there has been a trend to expand specialty care to more hospitals, she adds.This expansion has been fueled by competition for patients between hospitals. Greater numbers of specialists and technological advances have also made this expansion possible, Warner adds.The increased numbers of specialists has led hospitals to expand into this lucrative area. In this way, hospitals increase their reputation and add to their marketing effort, she says.The problem is that most of these hospitals provide only some of the know-how necessary. "If you don't have the depth of expertise or a sufficient volume of patients, you cannot provide the complete in-depth care needed," Warner says.To determine whether expanding care for these infants affected their outcome, Warner and her colleagues collected data on 848 births of very low birthweight infants from 19 hospitals in the Cincinnati area between 1995 and 1997.These infants weighed approximately 1 pound to 3 pounds. The researchers looked at deaths and illness, including lung disease, bleeding in the brain and deterioration of the retina, according to their report in the January issue of Pediatrics."We found that these infants had a twofold increase of either dying or in having a major handicapping condition if they are born at a hospital that does not have high levels of specialty care," Warner says.These findings support the recommendations of the America Academy of Pediatrics that say that if a mother is delivering at less than 32 weeks of gestation, the delivery should be done at a specialty hospital, she adds.

"If you have a term pregnancy and no complications, then many hospitals can meet your needs," Warner says. "But if you have a high-risk pregnancy with the potential of delivering a very low birthweight infant, then you should be at a hospital that provides high-level care for these infants."

Dr. Charles Safran, an associate clinical professor of medicine at the Harvard Medical School (news - web sites), says these findings are not surprising.

"Caring for a 1-pound baby is a miracle of modern American medicine, but this advancement has come at huge cost," Safran says.Such small infants require specialized care in neonatal intensive care units (NICUs) for prolonged periods -- typically two to three months. "We have only about 800 level 3 [the highest level] NICUs capable of caring for very low birthweight infants in the U.S., and many of these units run at capacity," he adds.According to Safran, new units and additional NICU space is expensive to build and even harder to staff. "While the article by Warner argues strongly for birthing very low birthweight infants at hospitals with level 3 NICUs, the vast majority of these infants are not identifiable in advance," he notes.Safran says about 40 percent of very low birthweight infants are the result of poor prenatal care, and about 30 percent are of unknown causes. "The remaining third result from twins and triplets, many of whom are the result of fertility technologies.""Mothers who are carrying twins or higher-order multiples should deliver at hospitals with Level 3 NICUs, or at least hospitals with neonatologists on staff. These hospitals should also be ready to transport the infant to affiliated centers," Safran advises.Dr. Marilyn B. Escobedo, a pediatrician at the College of Medicine at the University of Oklahoma, adds "this is new data that supports a long-held tenet of neonatal-perinatal medicine." "Mother and unborn baby should be treated as one patient who needs a continuum of expertise," Escobedo says. "Maternal transport is better medicine than neonatal transport, and fewer, larger obstetrical services with high-level neonatal services benefit the very premature more than many smaller obstetrical services that have less experience with the very premature babies."

More information

To learn more about low birthweight infants and child care, visit the Mayo Clinic. Get tips on a healthy pregnancy from the March of Dimes.

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Zoloft Eases Depression After Heart Attacks

Reuters Health
Monday, January 5, 2004

NEW YORK (Reuters Health) - Treatment with Zoloft (sertraline) can improve the quality of life in patients hospitalized for heart disease and who have developed recurrent depression--a condition that affects one in five of these patients.In the American Journal of Cardiology, an international team led by Dr. J. Robert Swenson of the Ottawa Hospital in Ontario, reports on a study conducted with 369 patients who were experiencing a major depressive episode after a recent hospitalization for a heart attack or unstable chest pain related to heart disease. The patients were randomly assigned to receive either 50 to 200 mg of Zoloft per day for 24 weeks, or to receive a sugar pill (placebo). The researchers used the Quality of Life, Enjoyment, and Satisfaction scale (Q-LES-Q) and the Medical Outcomes Study SF-36 to assess patients' quality of life and functional status. Approximately half the patients had experienced at least one major depressive episode in the past, the authors note. Treatment with Zoloft was associated with significantly greater improvement compared with treatment with placebo on the total Q-LES-Q score, the SF-36 mental component summary score, and the SF-36 subscale scores for role limitations, emotional, and mental health factors.

"Depression has a substantial negative impact on quality of life and functioning in patients," the investigators write. Zoloft treatment led to "clinically meaningful improvement in multiple quality-of-life domains," they conclude.

Source: American Journal of Cardiology, December 1, 2003.

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Nasal Flu Vaccine Safe for Kids

HealthDay Reporter
Monday, January 5, 2004

MONDAY. Jan. 5 (HealthDayNews) -- Here's some good news for parents who have to drag their kids kicking and screaming to get their annual flu shot.It turns out an influenza virus vaccine delivered as a nasal spray protects healthy children against certain strains of influenza, says a report in the January issue of The Archives of Pediatrics & Adolescent Medicine.Doctors at the Scott & White Memorial Hospital and Clinic in Temple, Texas, found children who received the nasal vaccination were protected against influenza infection during the 2000 flu epidemic.The study involved 2,794 healthy children aged 1.5 to 18 years who received the nasal vaccine at least once from 1998 to 2000. Their health was compared to 9,325 healthy local children who didn't get the vaccine and 16,264 children from other areas.That is the kind of evidence that has led the American Academy of Pediatrics (AAP) to announce that nasal flu vaccines are safe for kids older than 5.The announcement came as the AAP issued its 2004 childhood immunization schedule for the United States.

The AAP says the nasal vaccine is an acceptable alternative to the inactivated influenza vaccine for healthy people aged five to 49.

The AAP is currently considering joining the Advisory Committee on Immunization Practices and the American Academy of Family Physicians (news - web sites) in recommending universal influenza immunization of all children between 6 months and 23 months old, as well as routine influenza immunization of all household contact and out-of-home caregivers of children younger than 24 months.

Previously, the academy has encouraged such immunizations but has not taken the step of formally recommending them. If such a change happens, the three groups will release an updated immunization schedule that reflects the new recommendations.

More information

Here's where you can learn more about the 2004 childhood immunization schedule.

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Leprosy exists in Canada but doctors often fail to spot it, study warns

By Helen Branswell
Canadian Press
Monday, January 5, 2004

TORONTO (CP) - It's not on the radar screens of most Canadians or their family doctors. But leprosy does exist in this country - and unless doctors are on the lookout for cases, the disease can spread, a new study suggests. In fact, a number of people here who were in close contact with some of the patients - several of whom worked as domestic help - were assumed to have been incubating leprosy and chose to be treated for it, senior author Dr. Kevin Kain said in an interview. "We don't talk about transmission of leprosy in Canada but it's just an infectious agent. And if you put people together with infectious agents, they can transmit," said Kain, director of the tropical medicine unit at Toronto General Hospital, part of the University Health Network. "It's just not more rocket science than that." Over the past 23 years, 184 cases of leprosy have been referred to the unit Kain heads, he and three colleagues from the University of Toronto's medical school report in a study published Tuesday in the Canadian Medical Association Journal. Nearly all were from the Toronto area. All those cases were contracted abroad, virtually all by people who later immigrated to Canada. (The sole Canadian-born case contracted leprosy while studying in India.) Though cases came from 23 countries, most patients had emigrated from the Indian subcontinent, the Philippines and Vietnam. Leprosy's lengthy incubation period - an average of three to five years, but it can stretch as long as 40 - means most of those people had no clue they had the disease. Neither did the doctors from whom they sought help. Despite being one of the most dreaded ailments in the history of human disease, few doctors in the developed world are likely to consider leprosy as a diagnosis when faced with an unexplained skin lesion. "We saw huge delays in recognition of people who had leprosy, sometimes to the point where they could have been left with very serious and irreversible incapacitation," Kain said, noting the mean referral time to his unit was 4.8 years after the onset of symptoms. A University of British Columbia infectious disease specialist who sees leprosy patients in Vancouver agreed that doctors need to keep the disease in mind when attempting to diagnose unusual, chronic skin problems. "These cases, the presentation could be quite variable so it can be easily missed," noted Dr. Anthony Chow, who said he sees upwards of 10 cases of the disease a year. "And I think the issues are that the appropriate investigations be done and that this diagnosis be considered, particularly for immigrants and people from other places where leprosy is endemic." Leprosy, or Hansen's disease, is rare in the developed world but is more common in tropical climates. It's estimated that fewer than a million cases are registered globally each year. Most of the world's population is not susceptible to the bacteria that causes leprosy and among those who are, three quarters will spontaneously heal after contracting it. But for the few who don't, leprosy can lead to chronic maiming and intense social stigmatization. Few diseases are so reviled; the words leper and leprosy are routinely used to signify social outcasts. That stigma harks back to a time when the disease could not be treated. Those with the disease were relegated to leper colonies, dying grounds for people missing digits, noses, limbs. Though the disease can now be cured, the stigma remains. "It gets hugely in the way of treating them," Kain admitted. "Because we've had terrible situations where people have just been completely alienated from their cultures and even from their kids and their spouses, because of the fear that it imparts." Early detection and treatment is crucial. In part that's because of the need to avoid transmission. The disease is infectious, though not as contagious as one might think. Casual contact is not thought to be sufficient to spread leprosy; it requires prolonged contact of the type one has by sharing a household, Kain said. More imperative is the need to arrest the progress of the disease in the patient. Leprosy can provoke an aggressive response from the immune system, which attacks the virus. Because the virus likes to rest in the nerves of extremities, that response can knock out all sensation in a hand, for example. "All of a sudden, in the space of a few days, they can lose function of a hand or a foot. And it's pretty catastrophic. And if that isn't managed urgently, that can be permanent," Kain noted.

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Disease Management: The New Face of Managed Care

By Karen Pallarito
HealthDay Reporter
Monday, January 5, 2004

MONDAY, Jan. 5 (HealthDayNews) -- If you suffer from a chronic problem such as diabetes, heart disease or asthma, chances are your health plan is offering a "disease management program" to prevent your condition from worsening.Now, sponsors of these programs are beginning to target a wider array of medical conditions -- from migraine to lower back pain to lupus. These new efforts take aim at common health problems that add significant costs to the U.S. health-care system and often are poorly managed by patients."I think the concept is beginning to resonate," says Robert Stone, executive vice president of American Healthways, a national provider of disease management programs.The Nashville-based company added 11 new programs in 2002. It now offers services for conditions ranging from acid-related stomach disorders and irritable bowel syndrome to osteoarthritis and urinary incontinence.Disease management is growing in popularity as employers grapple for new tools to control costs and improve the quality of patient care, says a recent report from the Center for Studying Health System Change, a Washington, D.C.-based think tank.But not everyone is buying into the concept."I think the hesitancy from employers relates to the fact that these programs are not free to implement," says Glen Mays, a senior health researcher at the center and one of the authors of the report.Employers must make an up-front investment, with very little evidence the programs are going to be effective, he says, "so it's really a leap of faith."Then there's the turnover issue. If an employee leaves the company or switches insurers before the disease management initiative has produced results, there's little incentive for employers or health plans to invest in those programs in the first place."Some plans have actually backed off on some of their investments in disease management, particularly those programs that take a very long time to realize a return," Mays adds.What's more, many of the traditional disease management programs, such as cardiovascular care and diabetes, target conditions affecting an older population. The programs don't always fit a younger workforce.That's one of the reasons health plans and disease managers are now beginning to offer a broader array of programs targeting more conditions affecting working-age individuals.While evidence of longer-term cost savings and improved quality remains limited, an increasing number of employers and health plans are moving ahead for lack of better options for squeezing costs.Geisinger Health Plan, a 240,000-member health maintenance organization (HMO) in Danville, Pa., is planning to roll out an expanded program for women and men who are at risk of osteoporosis or who have had a previous bone fracture. The revamped program will tailor services to a member's risk for the disease.Nurses will encourage low-risk members to exercise, get recommended levels of calcium, quit smoking and avoid safety hazards, such as throw rugs in the home, that could cause someone to slip and fall. High-risk individuals, with a history of fracture, will be urged to get their doctor to perform a bone mineral density test and to prescribe a bone-strengthening drug."I think we've really finally recognized that osteo is a significant health problem [and] appropriate interventions can really make a difference," says Janet Tomkavich, a registered nurse and manager of Geisinger Health Plan's Care Coordination Department. An estimated 44 million Americans aged 50 and older suffer from osteoporosis or low bone mass, according to the National Osteoporosis Foundation. Preventing bone loss should cut costly hospitalizations and reduce potentially deadly medical complications, Tomkavich says. Nashville-based American Healthways is another HMO expanding care to more members to hold down costs. Early results of a pioneering program it runs with Blue Cross and Blue Shield of Minnesota seem to bear that out.Under the program, nurses help coordinate care for 140,000 participating Blue Cross members with 17 chronic health problems. Eleven conditions, including osteoporosis and low back pain, are ones American Healthways recently added.In the first six months of the program, the St. Paul-based insurer saved $4.23 for every $1 spent on the 11 new categories of care. It expects a slight decrease in savings over the first 18 months, to $3.70 for every $1 of investment."The results are beyond any of our expectations," says Dr. Bill Gold, chief medical officer and vice president of the 2.6 million-member health plan.

Buoyed by the experiment's success, Blue Cross and its disease management partner are considering the next group of conditions to be added to the program. Depression and cancer-related diseases are possible targets, Gold says.

More information

To learn more about disease management programs, visit the Center for Studying Health System Change or Cedars-Sinai Health System of Los Angeles.

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Paintball: More Dangerous Than Meets the Eye

By Janice Billingsley
HealthDay Reporter
HealthDayNews
Monday, January 5, 2004

MONDAY, Jan. 5 (HealthDayNews) -- Paintball, an increasingly popular sport modeled on military maneuvers that involves "shooting" your opponents with pellets containing water-soluble paint, can be deadly to your eyes.Because the pellets are small, about the size of marbles, they can hit the eyes dead-on without being deflected by the surrounding bones in the socket, a new study reports.That small size, combined with a muzzle velocity of up to 300 feet per second, about the speed of some bullets, means if the paint pellet hits the eye directly, it can cause serious damage, even vision loss, the researchers say."It's the only thing that you shoot that quickly that's made to be shot at a person," says study author Dr. David Listman, a pediatrician who works in emergency room medicine at St. Barnabas Hospital in the Bronx, N.Y. "No one would think of using a BB gun, for instance, against a friend."After treating two teenage boys who suffered serious injuries after being shot in the eyes on Halloween several years ago, Listman began to study the incidences of eye injuries attributed to paintball. The results of his study appear in the January issue of Pediatrics.The number of eye injuries treated in emergency rooms caused by paintball accidents more than doubled, from 545 in 1998 to 1,200 in 2000, Listman found. Nearly half of the accidents involved children aged 15 or younger, almost all boys. The injuries included bleeding between the lens and the iris, called hyphema; detached retinas; scratches to the cornea; and cataracts, he says.Listman and his colleagues did find safety equipment has improved significantly in the last few years. Those who participate in the sport at designated sites must wear specially designed face masks that protect their eyes. However, he says, children and teens often play the game without the protective equipment."Kids and teens are much less likely to play in organized places and more likely to play in backyards or the woods and either don't think they're going to get hurt or don't have the foresight to use protection," he says."They should know that even though the paintballs are made to shoot at people, they can cause serious harm. Parents should insist that children always wear an approved face mask," he says.Dr. C. Bernadino, recently named an assistant professor of ophthalmology at the Emory Eye Center in Atlanta, treated half a dozen severe eye injuries caused by paintball when he worked at Massachusetts Eye and Ear Hospital in Boston. At his new practice, one of his partners recently treated a woman who was blinded in one eye when her son mistakenly shot her with a paintball."We see damage directly to the eyeball and also to the eye socket, which can be fractured," he says.Bernadino himself played paintball in college and says eye protection is a must.

"When you get hit, it hurts. You can get bruises on bare skin, so imagine what it does to your eyes," he says.

More information

A review of paintball safety can be found at The Nemours Foundation. For recommendations on eye protection for a variety of sports, visit Vanderbilt University.

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Therapy May Not Help Early Rheumatoid Arthritis

Reuters Health
Monday, January 5, 2004

NEW YORK (Reuters Health) - Occupational therapy has been shown to help people who have had rheumatoid arthritis for several years or longer, but the results of a new study suggest that people in the early stages of the disease do not achieve any functional benefits. "This study suggests that rheumatology departments should think twice before providing early secondary preventive intervention to everyone with rheumatoid arthritis," Dr. Alison Hammond of Derbyshire Royal Infirmary in London and colleagues report in the January issue of the journal Annals of the Rheumatic Diseases. In rheumatoid arthritis, the immune system attacks the tissues that line the joints, leading to pain, inflammation and deformity. The disease affects more women than men, and it may attack other organs in the body. Occupational therapy includes both therapeutic and educational interventions that are designed to help people adjust to rheumatoid arthritis and improve or maintain their daily activities. One of the aims of occupational therapy for rheumatoid arthritis is to help people maintain hand function. Occupational therapy has been shown to be beneficial in people who have had rheumatoid arthritis for 8 to 10 years. Whether this type of intervention is helpful to people with early disease, in which symptoms tend to be less severe, is uncertain. Despite this uncertainty, there has been a move toward providing occupational therapy and education to people with early rheumatoid arthritis, according to the report. To test the effectiveness of such a strategy, Hammond's team studied a group of people who had been diagnosed with rheumatoid arthritis for less than 2.5 years. About 300 people were randomly assigned to receive conventional treatment with or without occupational therapy. On average, participants in the occupational therapy group received more than 7 hours of occupational therapy. By the end of the 2-year study, people in the occupational therapy group were more likely to "self-manage" their disease. Examples of self-management include performing hand exercises and wearing splints or other joint protection. Other than self-management, though, researchers did not observe any significant differences between the groups in terms of health status. Hammond and her colleagues suggest several explanations, including that drugs used to treat rheumatoid arthritis might have "erased" any of the benefits of occupational therapy early in the disease process. They also point out that the study might not have been long enough to detect any differences in the occupational therapy group.

"Research is needed to determine the best choices of occupational therapy interventions for whom and when in this group of patients with early disease," Hammond and her colleagues conclude.

Source: Annals of the Rheumatic Diseases, January 2004.

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Radiation Therapy Can Impair Intelligence

HealthDay Reporter
Monday, January 5, 2004

MONDAY, Jan. 5 (HealthDayNews) -- A person's intellectual capacity can be harmed by low-dose exposure to radiation as an infant, Swedish researchers have The researchers studied a group of 3,094 men who had received radiation therapy before they were 18 months old during the years 1930 to 1959.They found the proportion of boys who attended high school decreased with increasing doses of radiation to both the front and back parts of the brain.The scientists also found radiation had affected the men's learning ability and logical reasoning, but not their spatial recognition. The study appears in the Jan. 3 issue of the British Medical Journal.

They concluded doctors should reconsider the practice of using CT scans or X-rays to assess minor head trauma in children.

More information

Here's where you can learn more about CT scans.

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Sunday, January 4, 2004

Study: Football Hits Similar to Crashes

By Chris Kahn
Associated Press Writer
The Associated Press
Sunday, January 4, 2004

BLACKSBURG, Va. - Football players were struck in the head 30 to 50 times per game and regularly endured blows similar to those experienced in car crashes, according to a Virginia Tech study that fitted players' helmets with the same kinds of sensors that trigger auto air bags. University researchers are compiling a database of blows to the head their starting players endured this year, with plans to study how much trauma the brain can take. The study adds to a growing body of research into concussions, the blows to the head that helped end the careers of quarterbacks Troy Aikman of the Dallas Cowboys and Steve Young of the San Francisco 49ers, among others. The data so far surprised team physician P. Gunnar Brolinson, who said he didn't realize players were absorbing so many serious hits, especially since only about five came off the sidelines this season with concussions. "There are probably factors that we don't fully understand that make players better able to withstand higher accelerations (football hits) than other people," he said. It's possible that some players can withstand stronger blows because they have stronger neck and shoulder muscles or that they're simply more robust genetically than others, Brolinson said. The researchers recorded 3,312 hits during 35 practices and 10 games this season, rotating eight specially fitted helmets among 38 players. Project leader Stefan Duma said offensive linemen endured the most hits, followed by defensive linemen, running backs, linebackers, wide receivers and defensive backs. Quarterbacks recorded the fewest hits. "If you ask somebody what kind of head injury are you going to worry about, everybody thinks of the receiver running down the sideline getting popped by the safety," Duma said. "But to me, the interesting part is going to be these lower speed but high frequency hits we're seeing on the (offensive and defensive) line. The fact that these players are getting headaches all the time after every game, there's something going on there." Duma, an engineer who specializes in car crashes and safety equipment, plans to use the data to improve protective gear for players. The data also could help researchers understand and prevent concussions, a common condition in college football that can be hard to diagnose. The helmets measure hits in multiples of the force of gravity. Half of the hits recorded this season were greater than 30 Gs, Duma said. The hardest hits measured more than 130 Gs. "An impact of 120 Gs would be like a severe car accident, which you could survive if you were wearing a seat belt," Duma said. Duma said Tech plans to expand the program using more helmets next year. With enough monitoring, he said, medical staffs should be able to reduce football concussions by accurately predicting the number and degree of blows a player can handle. The monitoring helmets were developed by SIMBEX, a New Hampshire company that develops safety equipment. The system transmits the angle and severity of impacts from the helmets to a laptop Duma monitors from the sidelines. SIMBEX founder and owner Rick Greenwald said his company will begin selling the monitoring system this year. Equipping a team of 50 to 75 players would cost $165,000 to $195,000, Greenwald said.

On the Net:

Virginia Tech Center for Injury Biomechanics: http://www.ibl.vt.edu

SIMBEX: http://www.simbex.com

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