The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
February 21, 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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 17-23

PERSONAL HEALTH

 

Friday, January 23, 2004

  1. Poison Prevention for Adults
  2. CDC: 2003 West Nile Outbreak Largest Yet
  3. Pour a Little Milk on Your Wheat Field
  4. Hair Dye May Raise Cancer Risk, U.S. Study Shows
  5. Test-Tube Babies at Higher Risk at Birth
  6. Some Question Health Care on Cruise Ships
  7. Heart Patients Want More From Their Doctors
  8. Strength Training Urged for Elderly
  9. The Slow Unfolding of Hepatitis C
  10. Botox Cousin Curbs Parkinson's Drooling
  11. West Nile Mosquitoes Show Signs of Resistance
  12. Flu Shots Reduce Deaths After Heart Attack
  13. Cumulative Stress Ups Risk of PTSD
  14. Nitrate for Heart May Damage the Hip
  15. Healthy Habits Big Part of Home Schooling
  16. Asthma Can Flare Up Despite Doubling Inhaler Dose
  17. Medication Allergies

    Thursday, January 22, 2004

  18. Study: Cancer Patients No Better Off in Trials
  19. Investigators Urge Tighter Painkiller Control
  20. Study Supports Prenatal Testing for All Women
  21. Study: Sedentary Life Starts in Toddlers
  22. U.S. Agent Orange Study Finds Raised Cancer Risks
  23. Study: Mom's Diet May Affect Baby's Life
  24. Rare Rabies Death Prompts U.S. Bat Warning
  25. Growing Interest Seen in Bison Meat
  26. Not Sure if Cellphones a Health Hazard, Study Finds
  27. K.C. Vows to Get Fit, Shed Fat Stigma
  28. Blood Pressure Drugs Differ in Female Sex Effects
  29. Research on Children May Confuse Parents
  30. Hidden Hepatitis B Infection Still Promotes Cancer
  31. What Prompts College Kids to Drink?
  32. Acarbose Reduces Diabetics' Risk of Heart Attack
  33. Oral Piercing
  34. Risk Control Still a Problem for Diabetics
  35. Exercise-Induced Asthma
  36. Puerto Rican Kids at Risk for Multiple Allergies
  37. Depressed Holocaust Survivors at Risk of Suicide
  38. Constipation, Soiling Linked to Kids' Behavior
  39. New Way to Spot Periodontal Disease
  40. Age Bias May Affect Treatment for Prostate Cancer
  41. Keeping Third Heart Attack, Stroke at Bay
  42. Dreyer's New Process to Revive 'Light' Ice Cream

    Wednesday January 21, 2004

  43. New Clue to Why Younger Women Face Lower Stroke Risk
  44. Radiation Urged After Breast Conserving Surgery
  45. Study: Sleep Essential for Creativity
  46. Winter Nosebleeds
  47. Orange Growers Irked by Low-Carb Diets
  48. Yeast Infections
  49. Survival Improving for Recurrent Breast Cancer
  50. New Study Finds Inflammation a Bad Actor
  51. Study: Boys Raised as Girls Find Male Identity
  52. Panic Disorder May Have Biological Basis
  53. New Imaging Agent Could Help Diagnose Alzheimer's
  54. Instability Can Dampen Your Outlook
  55. Study: Sleeping on It Helps in Problem Solving
  56. Keeping Diabetes at Bay After Transplant
  57. Study: Learning to Juggle Causes Changes in Brain
  58. Study Backs Chemo for Lung Cancer
  59. New Clues May Help Battle Against Dengue Virus
  60. Unraveling the Monkeypox Mystery
  61. US Group Sees No Suicide-Antidepressant Link
  62. New, Old Alzheimer Drugs Work Together

    Tuesday, January 20, 2004

  63. U.S. Probing Dietary Supplement Safety
  64. Governments Back WHO's Anti-Obesity Plan
  65. Parents Increasingly Question Vaccine Wisdom
  66. Avoid Undercooked Meat
  67. Fat, in Moderation, Helps Immune System-Scientists
  68. Childhood Seizures
  69. Study: U.S. Spent $75 Billion to Treat Obesity in '03
  70. Nicotine Plays on Emotions
  71. Study: Cutting Back Doesn't Cut Toxins in Smokers
  72. Erectile Dysfunction May Signal Heart Disease
  73. Iron from Red Meat May Raise Diabetes Risk
  74. Panel Hedges on Routine Thyroid Screening
  75. Virus Found in Men with Prostate Cancer
  76. Few Sessions on the Couch Can Lead to Improved Sleep
  77. Teen Obesity Tied to Adult Death Risk
  78. Stress Taxes Your Health
  79. C-Section Lowers Odds of Future Normal Delivery
  80. Tamoxifen Underused for Early Breast Cancer
  81. Radiation Decreases Cancer Recurrence Post-Lumpectomy
  82. New Drug Cuts Angina Attacks
  83. Study: Seat Belt Use Key to Other Passengers' Safety
  84. Treatment Boosts Survival Rate for People With Amyloidosis
  85. EU commissioner denies strict food standards a barrier to trade

    Monday, January 19, 2004

  86. Vitamin E, C Supplements May Prevent Alzheimer's
  87. Workplace Anger Widespread
  88. McDonald's Canada to Offer Lighter Menu
  89. When a Good Gene Turns Bad
  90. Growth Hormone Helps the Failing Heart
  91. Detecting Head and Neck Cancers in Time
  92. Working Through Back Pain Reduces Missed Days
  93. Snapshots of Skin Could Catch Cancer
  94. Asthma Not Worsened by Continued Trigger Exposure
  95. Prostate Cancer Treatment Increases Osteoporosis Risk
  96. Simple Sugar Curbs Huntington Disease, in Mice
  97. Eating Chicken May Boost Arsenic Exposure
  98. Melatonin Seems to Reduce High Blood Pressure
  99. Modified Gene Therapy Better for Heart
  100. Call for diabetics to better curb blood sugar, check leg health

    Saturday, January 17, 2004

  101. When to Screen for Cancer
  102. NYT: Atkins Advises Dieters to Eat Smaller Steaks
  103. Sometimes, a Healthy Weight is the Way to Go
  104. Keep Kids Active in Winter

 

Friday, January 23, 2004

Poison Prevention for Adults

HealthDayNews
Friday, January 23, 2004

(HealthDayNews) -- You've probably taken steps to protect your kids from accidental poisoning. But children aren't the only ones who need protection. Adults, too, can become victims of unintentional poisonings.

The American Association of Poison Control Centers offers these prevention tips:

  • Read and follow the directions and caution labels on household products before using them.
  • Never mix household and chemical products together. A poisonous gas may be created when mixing chemicals.
  • Turn on fans and open windows when using household and chemical products.
  • Pesticides can be absorbed through the skin and can be extremely poisonous. So stay away from areas that have recently been sprayed.
  • Never sniff containers to discover what's inside.
  • Discard old or outdated household and chemical products.
  • Keep the number of your local poison control center near the phone.

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CDC: 2003 West Nile Outbreak Largest Yet

By Daniel Yee
Associated Press Writer
The Associated Press
Friday, January 23, 2004

ATLANTA - Last year's outbreak of West Nile virus (news - web sites) was the largest yet, but fewer people died or had serious brain damage from it compared to 2002, federal officials said Friday.

The 9,006 cases of the mosquito-borne virus last year were more than double the 4,156 cases in 2002, although officials at the Centers for Disease Control and Prevention (news - web sites) said the larger number of cases may reflect more testing.

CDC officials still consider 2002 to be the worst year for the United States because of 284 deaths and 2,944 cases of severe brain damage. Last year, 220 people died and 2,695 suffered severe neurological disease, the CDC said.

The agency has already begun preparations for this year's season and is sending money to state health departments to help track the virus and educate people on how to avoid getting infected.

"We are fully prepared to have another large outbreak," said Dr. Lyle Petersen, acting director of the CDC's division of vector-borne diseases. "We can't predict what will happen, so we need to be prepared."

The virus is spread to people from mosquitoes that have fed on infected birds, the virus' main host.

West Nile first appeared in the Western Hemisphere when it showed up in New York in 1999. Since then, it has spread across the United States, with Oregon and Washington the only continental states free of West Nile virus.

The 2003 outbreak revealed holes in health preparations. Even in hard-hit areas, people still were reluctant to take protective measures such as wearing long-sleeved clothing or using bug spray.

Officials still don't know why the disease erupts in some areas yet leaves others unscathed. Chicago had large outbreaks in 2002 yet hardly any last year. Areas such as New England, where West Nile has appeared for five years, suddenly had more cases last year than ever, Petersen said.

Rural America was hard-hit last year. "I think it's going to be quite a challenge to try and figure out how to do prevention in rural areas," Petersen said. "People are spread out."

On the Net:

CDC West Nile info: http://www.cdc.gov/ncidod/dvbid/westnile/index.htm

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Pour a Little Milk on Your Wheat Field

HealthDayNews
Friday, January 23, 2004

FRIDAY, Jan. 23 (HealthDayNews) -- Got milk? Then you won't have powdery mildew on your wheat crop.

Spraying milk on wheat plants helps cure mildew disease, says a British study in the current issue of Tests of Agrochemicals and Cultivars.

Previous research showed milk can help combat mildew on squash plants. Some organic gardeners use milk to treat mildew and milk is also used by some grape growers in Australia.

In this study, researchers at Harper Adams University College found spraying milk on wheat can greatly reduce powdery mildew.

"Our results show that milk could potentially be used to improve plant health of wheat if disease becomes severe, especially on organic crops where chemical fungicides are not permitted," researcher Peter Kettlewell says in a prepared statement.

Nearly all wheat crops suffer some infection from the fungus that causes powdery mildew disease, which can reduce growth and harvest yields.

More information

Here's where you can learn more about powdery mildew.

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Hair Dye May Raise Cancer Risk, U.S. Study Shows

Reuters
Friday, January 23, 2004

WASHINGTON (Reuters) - Women who have been coloring their hair for 24 years or more have a higher risk of developing a cancer called non-Hodgkin lymphoma, U.S. researchers reported on Friday.

They said their study of 1,300 women could help explain a mysterious rise in the number of cases of the cancer that affects the lymphatic system.

Writing in the American Journal of Epidemiology, they said women who dyed their hair starting before 1980 were one-third more likely to develop non-Hodgkin lymphoma, or NHL, and those who used the darkest dyes for more than 25 years were twice as likely to develop the cancer.

"Women who used darker permanent hair coloring products for more than 25 years showed the highest increased risk," Tongzhang Zheng, associate professor of epidemiology and environmental health at Yale School of Medicine, said in a statement.

Cancer experts note that a person's absolute risk of developing lymphoma is very low, so doubling that risk still means a woman who dyes her hair is very unlikely to develop lymphoma.

Non-Hodgkin lymphoma will affect an estimated 54,000 Americans this year and will kill 19,000, according to the American Cancer Society (news - web sites). It affects slightly more men than women.

The incidence of NHL has doubled since the mid-1970s and no one knows why. Experts suspect exposure to chemicals can be a factor. The lymphatic system is part of the immune system, so people with immune weaknesses are at special risk -- notably AIDS (news - web sites) and organ transplant patients.

Zheng and colleagues studied 600 Connecticut women who had NHL. They were asked to specify what hair coloring products they might have used and when.

They were compared to 700 healthy women.

The Yale University researchers did not find any larger risk of cancer in women who started using hair dye in 1980 or later.

"This could reflect the change in hair dye formula contents over the past two decades, or indicate that recent users are still in their induction and latent period," said Yawei Zhang, who also worked on the study.

"Hair coloring products have undergone tremendous change over the last 20 years," added Zheng. "Since 1980, many carcinogens have been removed from some formulas, which vary depending on whether the dye is permanent, semi-permanent, darker or lighter."

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Test-Tube Babies at Higher Risk at Birth

By Andrew Conaway
HealthDay Reporter
HealthDayNews
Friday, January 23, 2004

FRIDAY, Jan. 23 (HealthDayNews) -- Nearly 26 years after the first in-vitro fertilization baby, a new study finds a much higher risk of birthing problems among newborns whose conception was medically assisted.

The study found the problem to be "significantly worse" for single births, but less so for twins. Compared to naturally conceived babies, singleton babies born following medically assisted conception are three times likelier to have a low birth weight, 3.27 times likelier to be born very premature, and 1.68 times likelier to die during delivery, Dutch researchers say.

Assisted-conception singleton babies also faced an increased risk of stillbirth, being delivered by Caesarean section, and being admitted to a neonatal intensive care unit.

The problems don't end at birth, the study found: Extremely premature and low birth-weight babies tend have a higher chance of developing complications later in life.

The research, a review of 25 other studies, appears in the Jan. 24 issue of the British Medical Journal. Another expert cautioned, though, that while the relative risk was higher, the absolute risk was small.

"Now we know that there is really an assisted reproduction problem which affects birth weight and the duration of pregnancy," says study author Dr. Frans M. Helmerhorst, an expert in reproductive medicine at Leiden University Medical Center in The Netherlands. "Thus there is now a clear message to the researchers: Try to identify the problem."

But the report found the risks for assisted twin births were not as high as with naturally conceived twins, and even showed less risk at in some problem areas -- most notably, a 40 percent lower risk of dying during childbirth.

The review found that twins conceived with medical assistance also had a 5 percent higher rate of intensive care admissions, a 21 percent higher rate of premature and Caesarian delivery rates, and a 27 percent increased risk of being small for gestational age. The differences, however, were far less marked than between groups of single births.

Another expert says that a lot of factors are at work, and the problem has to be kept in proportion.

"It's not something the public should focus on," says Olga Basso, a professor at the University of Aarhus Epidemiology Science Center in Denmark. "One thing that has to be kept in mind is that in developed countries like ours with good neonatal care, the background risk -- even a doubling of that risk -- doesn't imply a high number." It "still is actually quite a small number," she says.

"Is it the treatment itself that could be the problem, or the background issues as to why she couldn't conceive in the first place?" Basso adds.

"Morbidity and mortality in those children are predominantly associated with very preterm singletons and very low birth weight -- a small group," Helmerhorst says.

"So far, reproductive medicine has concentrated on conception, but the focus should now shift to achieving a successful birth," the study states. "Women undergoing assisted reproduction programs should also be made properly aware of these risks. And more work should be done on reducing risks for babies conceived with medical help."

Thomas D'Hooghe, director of the fertility clinic at Belgium's Catholic University at Leuven, says the study is one of the first summarizing all the evidence currently available.

He offers several suggestions for reducing the risks. They include investigating for infertility early (after a year and a half of problems conceiving); treating possible causes by surgery, hormones or intrauterine insemination; and, if those therapies fail, resort to assisted reproduction as a last resort. He also says more women should consider conceiving before they turn 30.

"The end point should indeed be the delivery of a healthy child," D'Hooghe adds.

More information

Read more about infertility and assisted reproduction at the National Infertilty Association or the Centers for Disease Control and Prevention.

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Some Question Health Care on Cruise Ships

By John Pain
AP Business Writer
The Associated Press
Friday, January 23, 2004

MIAMI - The man in his 40s was thrilled when he hit a big jackpot at one of a cruise ship's slot machines. Ten minutes later, his jubilation was abruptly ended by chest pains.

Dr. John Bradberry performed an electrocardiogram and quickly determined the Carnival Cruise Lines passenger was having a heart attack. Bradberry gave him a thrombolytic, a clot-busting drug that increases the survival chances for heart attack victims.

"We treated him with all the basic treatments he would have in an emergency department on land," Bradberry said. "He subsequently did well."

Cruise companies point to such stories as examples of the high-quality medical care they provide at sea, on ships that carry nearly 5,000 people. But critics say that despite recent improvements in care, passengers are still at risk if they become seriously ill.

Some doctors say onboard care has a long way to go, pointing out that most ships only have one or two physicians with up to four nurses and that most infirmaries don't have surgical equipment.

"The facilities are as good as they can be for a ship but it's not an emergency department," said Dr. Marshall Silk, a former cruise doctor for two decades who now has a private practice in Fort Lauderdale.

The vast majority of the more than 9 million people who take cruises each year never need medical care. If passengers need help, it's usually for treatment of minor injuries such as cuts, cruise companies say.

But the three biggest cruise companies Carnival Corp. and PLC, Royal Caribbean Cruises Ltd. and Star Cruises PLC have all been sued over alleged shoddy care on ships that led to passenger deaths or permanent health problems. Many of those cases have been quietly settled, while others are still pending. U.S. law generally favors cruise companies, which argue they should not be held liable because most doctors are independent contractors.

One pending case was filed in 1998 by the parents of Elizabeth Carlisle, of Ann Arbor, Mich. They claimed a Carnival doctor diagnosed the girl's abdominal pains as flu when she actually had a ruptured appendix. She underwent surgery and was left sterile by infection, the lawsuit said.

Dr. Arthur Diskin, medical director of Carnival Cruise Lines, said many of the passengers who have sued either came aboard already sick or did not inform ship doctors of their health problems, which can make treating them difficult.

"The majority of the cases I've seen have resulted from unrealistic expectations of the passengers," he said.

Medical care on cruise lines was also questioned when gastrointestinal viruses struck ships recently, sickening hundreds of people.

Bradberry, who has been a full-time cruise doctor for about three years, said those outbreaks were blown out of proportion, but he acknowledged that they can be a challenge:

"It certainly can overload the health care system on a ship. You end up working 'round the clock," he said.

The average shipboard doctor's salary is about $50,000 a year, according to the International Council of Cruise Lines, an industry group. That's less than half of what the average general practitioner makes on land.

Still, Bradberry said he enjoys working on a cruise ship, with perks that include free travel to vacation spots. It's also satisfying to help people who might have to wait days to see a doctor on land, he said.

Bradberry and others contend medical care is better because of the industry's self-imposed improvements.

In the 1990s, the American Medical Association unsuccessfully tried to get Congress to regulate medical care in the cruise industry. Most cruise lines are incorporated outside the United States and most ships fly foreign flags, which shields them from U.S. law.

Since then, the International Council of Cruise Lines has created nonbinding guidelines to have better trained doctors and to put modern X-ray machines, medications and other equipment on board.

"Our ability to police ourselves as an industry in the medical profession has increased and is more than adequate at this point," said Diskin, who is also chairman of the emergency department at Mount Sinai Medical Center in Miami Beach.

Two Florida doctors who found many problems with cruise ship health care in a 1996 study now say the industry has made great strides with its medical guidelines. At the time, the study found many doctors lacked emergency training and ships lacked equipment and medicine for treating problems such as heart attacks.

"The guidelines are excellent. The only challenge is that's all they are guidelines. There is no outside agency looking to make sure that they're doing that," said Dr. Bradley Feuer, of West Palm Beach, who co-authored the study with Dr. Richard S. Prager, of Miami.

Diskin acknowledged that one flaw is that there is no residency program for cruise line medicine. Silk agreed that was a problem, but said more important was that some older ships have outdated infirmaries and medical equipment.

Critics believe the industry needs government oversight.

"I wouldn't want to get sick on a ship," said Charles Lipcon, a Miami attorney who has represented passengers in lawsuits against cruise companies and doctors. "I've just seen too many horror stories, although I do think it's improving."

But one passenger thought the care she received on board was as good as what she would have received on land.

Jennifer Campana, 31, of Los Angeles, was several months pregnant when she started bleeding heavily on a Royal Caribbean cruise in fall 2002, leading her to think she was having a miscarriage. She went to the infirmary, and the doctors calmed her down and gave her medicine to stop the bleeding until the ship reached Cozumel, Mexico.

An ultrasound at a hospital showed she and her baby were fine. She said she felt so comfortable under the care of the ship's two doctors that she decided to stay on board.

"I honestly believe that I have my daughter today because of those doctors on the cruise ship," she said.

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Heart Patients Want More From Their Doctors

By Norra MacReady
HealthDay Reporter
HealthDayNews
Friday, January 23, 2004

FRIDAY, Jan. 23 (HealthDayNews) -- Many heart patients want more guidance from their doctors, a new survey finds.

Women were especially dissatisfied with the information they did get, says Dr. Donna E. Stewart and her colleagues at the University of Toronto. To arrive at that conclusion, the researchers tallied up responses from 522 people who had been hospitalized for a heart attack or unstable angina. The survey results appear in the January/February issue of Psychosomatic Medicine.

"I think we can do a better job of having material available for patients to take home, and tell them to call or bring any questions with them to their next appointment," Stewart says.

Many patients assume a passive role when talking to their doctors and don't ask for all the information they want, adds Dr. Sharon Sweede, former chairwoman of the Commission on Public Health of the American Academy of Family Physicians (news - web sites). Also, doctors are often too pressed for time to answer questions as fully as patients would like. The doctors "are reimbursed for 'doing something,' not for talking with patients," she says.

"In my experience, women ask more questions only when encouraged to do so," Sweede says. "Men ask more often for what they want, but also don't want much information. They often bring their wives along to ask questions."

She suggests it's up to doctors to encourage their patients to ask more questions and learn interviewing techniques that would draw out concerns.

The survey results certainly seem to suggest that approach is needed.

Six months after the heart patients returned home, they completed a survey that measured how well-informed they felt about their cardiac condition and topics on which they wanted more information. Six months after that, the subjects answered another survey that asked about their satisfaction with their medical care and which health-care providers had best met their needs for more information.

In the first survey, the patients' mean score for the amount of information they wanted was 4.3 on a scale of 1-5, with 5 being as much information as possible. There was no difference between the sexes.

But when asked about the amount of information they'd actually received, the mean rating from men was 3.7, compared with a mean of 3.5 from women, a statistically significant difference that suggests men were happier than the women on that point.

In the 12-month survey, men were 30 percent more likely than women to report they got helpful information about their test results from their family physicians, and 23 percent more likely to say those physicians had given them information on cardiac rehabilitation.

When it came to topics on which patients felt they hadn't received enough information, the top five for men and women alike were future treatment choices, how their families could support their lifestyle changes, the future course of their condition, the role of each type of doctor in treatment, and cardiac rehabilitation. However, men said they wanted more information on how their illness affected sexual function, while women desired more information on angina and hypertension.

Men and women who felt better-informed were more satisfied with their health care, felt more in control and less depressed, and were more likely to follow good health habits such as exercising more, smoking less and engaging in cardiac rehabilitation.

Many patients also indicated their doctors frequently made their health-care decisions for them despite their wish to have a role in those decisions. Here again, there was no difference between the sexes.

These findings suggest that recovering heart patients feel "only moderately well-informed" about their condition, and they want more information than they're getting on many topics, Stewart says.

They also reflect a gender gap in expectations when it comes to receiving information from health-care providers and making decisions.

"Women in general endorse statements such as, 'I want all the information possible about my condition,' while men endorse statements indicating they're satisfied with less information," Stewart says.

Women also seem to prefer making their health-care decisions on their own or in partnership with their physicians, while men more often say they trust their doctors to do the right thing.

More information

Johns Hopkins Bayview Medical Center has more information on heart health. The American Heart Association (news - web sites) also has lifestyle tips for heart patients.

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Strength Training Urged for Elderly

By Merritt McKinney
Reuters Health
Friday, January 23, 2004

NEW YORK (Reuters Health) - More older adults should be participating in weight training and other strength-building exercises, experts say.

A nationwide survey shows that only about 11 percent of people aged 65 and older regularly perform any sort of strength training. That's far short of the 30 percent of older adults who public health officials would like to see performing strength-building exercises by 2010.

"We're less than half way to that goal," Dr. Judy Kruger of the Centers for Disease Control and Prevention (news - web sites) (CDC) in Atlanta told Reuters Health in an interview.

Many older people may never consider lifting weights, but performing exercises to build strength can provide important health benefits, according to Kruger. Strength training can reduce the risk of falls and fractures and make it easier for older people to carry out their activities of daily living, she said.

Besides making muscles stronger, strength training has also been shown to increase endurance, boost bone density and improve the body's sensitivity to the sugar-processing hormone insulin.

But strength training does not necessarily mean pumping iron, Kruger said.

"People need to feel comfortable with what they are doing," according to Kruger. She encouraged people to "start slow and to build up" when beginning a strength training program.

Although some people may start with light weights, people do not have to go to a gym, Kruger said. A few simple exercises using an ordinary chair can help boost muscle strength she said.

A complete guidebook for starting an exercise program is available at the Web site of the National Institute on Aging (NIA): http://www.nia.nih.gov/exercisebook/

Although weights are not necessary for strength training, if older people choose weight training, they should start with light weights - one to two pounds - and then gradually increase the weight, the NIA advises.

Most older adults in the U.S. are not doing enough to keep their muscles strong, Kruger and her colleagues note in the latest edition of the Morbidity and Mortality Weekly Report, published by the Centers for Disease Control and Prevention.

By 2010, health experts would like for 30 percent of people aged 65 and older to be performing strength exercises at least two times a week. But in a national survey conducted in 2001, only 12 percent of people aged 65 to 74 met this goal. Just 10 percent of people aged 75 and older performed strength exercises at least twice a week.

Men were more likely than women to participate in strength training. The odds of meeting the strength training guidelines decreased with age but were higher in more educated people.

People who were obese or who reported being in fair to poor health were less likely to participate in strength training.

Source: Morbidity and Mortality Weekly Report, January 23, 2004.

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The Slow Unfolding of Hepatitis C

HealthDayNews
Friday, January 23, 2004

FRIDAY, Jan. 23 (HealthDayNews) -- People infected with hepatitis C through blood transfusions they received shortly after being born had remarkably slow disease progression after 35 years, says an Italian study in the January issue of Hepatology.

The study included 31 people born in 1968 who received blood transfusions from a donor later found to carry hepatitis C antibodies. The study subjects were tested in 1998 for hepatitis C virus (HCV) and had their liver function evaluated.

Among the 31 subjects, 18 had anti-HCV antibodies and 16 tested positive for the virus. All had the same viral genotype as the infected donor.

Eleven of the 16 people who tested positive for HCV agreed to liver biopsies. The study found inflammatory activity was minimal in one person and mild in the other 10. Most of the biopsies indicated that fibrosis was mild or nonexistent in most of the subjects. But two of them did have discrete or marked fibrosis.

The subjects with HCV were followed for five years to track their liver health.

"The findings in this study indicate that a 35-year span of HCV infection has not, in itself, been the cause of significant liver disease," the study authors write.

More information

Here's where you can learn more about hepatitis C.

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Botox Cousin Curbs Parkinson's Drooling

Reuters Health
Friday, January 23, 2004

NEW YORK (Reuters Health) - Botulinum toxin B, a close relative of the anti-wrinkle drug Botox, appears to safely improve the drooling experienced by some patients with Parkinson's disease (news - web sites), new research indicates.

Recent reports have suggested that Botox, also known as botulinum toxin A, is an effective treatment for sialorrhea (i.e., drooling) in patients with Parkinson's disease (PD). Although there is evidence that toxin B has a "particular predilection" for the saliva glands, its use for sialorrhea has not been well studied.

To investigate, Dr. William G. Ondo and colleagues, from Baylor College of Medicine in Houston, assessed the outcomes of 16 PD patients with drooling who received injections of toxin B or inactive "placebo" into their saliva glands. Symptom questionnaires and special x-rays were used to evaluate drooling before and one month after the injections were given.

The researchers' study, which is reported in the medical journal Neurology, was funded by Elan Pharmaceuticals, which markets botulinum toxin B under the trade name Myobloc.

Treatment with toxin B produced significantly greater improvements in all drooling scores than did placebo. Tests also suggested a greater reduction in saliva secretion with toxin B, but the difference was not statistically significant.

Treatment with toxin B did not worsen overall PD disease score or swallowing, in particular, the investigators note. Side effects possibly related to the toxin were mild and included dry mouth, worsened walking, diarrhea and neck pain.

The findings suggest that botulinum toxin B is a safe and effective treatment for PD-related drooling, the authors state. Further studies are needed to determine if it is also useful against the drooling seen with other neurologic diseases, they add.

Source: Neurology, January 13, 2004.

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West Nile Mosquitoes Show Signs of Resistance

HealthDayNews
Friday, January 23, 2004

FRIDAY, Jan. 23 (HealthDayNews) -- A species of mosquito that spreads the West Nile virus (news - web sites) has shown the first signs of resistance to pyrethroid insecticides, says a California study in the current online issue of Pest Management Science.

The resistance was detected in a population of Culex pipiens complex mosquitoes breeding in pools of water below ground, beneath an apartment. The researchers couldn't determine whether these below-ground mosquitoes breed with above-ground mosquito populations.

If they do, that raises the possibility they might spread their pyrethroid resistance.

This kind of resistance has been detected among mosquitoes of the same species in Africa and Asia. But this is the first time it's been reported in North America.

Pyrethroids are commonly used agricultural pesticides.

More information

Here's where you can learn more about West Nile virus.

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Flu Shots Reduce Deaths After Heart Attack

Reuters Health
Friday, January 23, 2004

NEW YORK (Reuters Health) - Vaccination against influenza significantly reduces the 1-year risk of death among people who have survived a heart attack and those with heart disease requiring angioplasty, according to Argentinean investigators.

The research group at Foundation Favaloro in Buenos Aires previously found a 6-month-long benefit from flu vaccination in such patients. Their latest report in the European Heart Journal describes a continuing benefit during a year following this group, after the flu season had passed.

Dr. Enrique P. Gurfinkel and his colleagues originally enrolled 200 patients admitted to hospital with a heart attack, along with 101 patients with heart disease who were being scheduled for angioplasty and placement of stents.

Altogether, 151 subjects were randomly assigned to have a flu vaccination and 150 to have no vaccination.

The death rate after one year was 6 percent in the vaccination group and 17 percent in the control group. Also, fewer in the vaccinated group had a heart attack or needed to be hospitalized during the year.

Flu vaccination was a particular benefit for nonsmokers and those older than 65.

It seems unlikely that protection against catching flu was the reason why vaccinated patients did better, Gurfinkel's team notes. Rather, they suggest, the vaccine may give a non-specific boost to the immune system, which in turn helps people overcome the effects of a heart attack or heart procedure.

"However," the investigators conclude, "larger trials are needed to evaluate the real impact on flu vaccination" in this situation.

Source: European Heart Journal, January 2004.

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Cumulative Stress Ups Risk of PTSD

HealthDayNews
Friday, January 23, 2004

FRIDAY, Jan. 23 (HealthDayNews) -- The amount of stress young adults have experienced in their lives may influence their susceptibility to post-traumatic stress disorder (PTSD) after a traumatic incident.

That finding comes in a Florida State University study in the current issue of the American Journal of Orthopsychiatry.

The researchers conclude that cumulative stress, even relatively ordinary problems that occur years before a traumatic event, is a factor in a person's risk for PTSD. Parental divorce or failing a grade in school are examples of life adversities that may affect a person's future risk for PTSD.

The study may help explain why only about a quarter of people who suffer traumatic experience develop PTSD.

"This finding is unprecedented, and it has important implications for the prevention of PTSD and for intervention in cases of traumatic stress exposure," researcher and sociology professor Donald Lloyd says in a prepared statement.

"For example, it could help us triage children for intervention in the wake of a school shooting or bus crash," Lloyd says.

The study included about 1,800 young adults, most between the ages of 19 and 21, who were all former Miami-Dade public school students. They were asked whether they had experienced any of 41 adverse life experiences.

The accumulation of nonviolent experiences along with witnessing violence were significant factors in determining which people might develop PTSD after experiencing a traumatic event.

More information

Here's where you can learn more about PTSD.

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Nitrate for Heart May Damage the Hip

Reuters Health
Friday, January 23, 2004

NEW YORK (Reuters Health) - Elderly women taking nitrate medications for a heart condition seem to be at heightened risk of developing hip osteoarthritis, according to researchers at the University of California at San Francisco.

Dr. Nancy E. Lane and colleagues note that as part of a 10-year study, they analyzed pelvic x-rays obtained when they enrolled nearly 6,000 white women aged 65 or older in the study, and again eight years later.

Information on whether the participants were using nitrate medication was obtained at years 6 and 8. A total of 343 (7 percent) of women reported such use on one or both occasions. Under-the-tongue nitrates accounted for more than 70 percent of the total nitrate usage.

During follow up, 566 women developed new osteoarthritis in one or both hips, based on their x-rays, Lane's team reports in the medical journal Arthritis and Rheumatism. These women were significantly older than women who did not show changes on their x-rays.

However, after taking in account their age, height, weight, bone mineral density and estrogen use, women who used nitrates were nearly twice as likely to show narrowing of the hip-joint space -- indicating a loss of cartilage lining the joint -- than women reporting no nitrate use.

Similarly, based on joint-space narrowing and bony changes, nitrate users had an 84 percent increased likelihood of new, moderate-to-severe hip osteoarthritis.

This study, the researchers conclude, provides "some evidence to support the hypothesis that nitrates increase nitric oxide production in the (joint) cartilage," which leads to more rapid erosion of the cartilage and consequently osteoarthritis.

Source: Arthritis and Rheumatism, December 15, 2003.

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Healthy Habits Big Part of Home Schooling

HealthDayNews
Friday, January 23, 2004

FRIDAY, Jan. 23 (HealthDayNews) -- Health education is an important topic for home-schooled students, says a Ball State University survey of Indiana parents who instruct their children at home.

The survey of 74 home educators who teach children in kindergarten to Grade 12 found that 87 percent of them teach health education, and 88 percent felt it was "very important" to include that topic in their curriculum.

First aid, fitness, and nutrition were taught more often than violence prevention, suicide prevention, consumer health, and sexual health. Less than half the survey respondents taught their students about prevention of sexually transmitted diseases, immunization, and vaccinations, environmental health and sexuality.

"Differences certainly exist in lifestyles of home-school families when compared to families nationwide," researcher Jeff Clark, a physiology and health science professor, says in a prepared statement.

"Many parents home-school their children for religious reasons. One of the respondents said sexuality is not needed to be formally discussed because of the family's lifestyle or beliefs," Clark says.

It's estimated that about 1.2 million American students are schooled at home.

The survey found about 75 percent of home-school educators had completed some college work. About 71 percent said they had received formal training in first aid, and about 50 percent said they'd been educated in nutrition and diet, fitness, and cardiopulmonary resuscitation (CPR).

The average time the home-school educators in this survey had been in the profession was one to three years.

This study indicates a need for public school systems to consider addressing the health education needs of all the students in their communities, Clark says.

More information

Here's where you can learn more about home schooling.

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Asthma Can Flare Up Despite Doubling Inhaler Dose

Reuters Health
Friday, January 23, 2004

NEW YORK (Reuters Health) - Doubling the dose of inhaled steroids is widely advocated to prevent asthma exacerbations, but it seems to be ineffective, UK doctors have found.

They studied 390 patients with asthma who were randomly assigned to add a steroid or an inactive placebo inhaler dose to their usual steroid inhaler dose for 14 days if they saw that peak flow testing or a worsening of symptoms suggested that a flare-up was imminent.

During the 12-month study period, 207 patients used the extra inhaler dose, Dr. T. W. Harrison and colleagues, from Nottingham City Hospital, report in the medical journal The Lancet.

The need for further oral steroid treatment was used to determine whether the flare-up was successfully avoided.

Overall, 46 patients used oral steroid therapy during the study period. Because the percentage of patients in each group who required oral steroids was nearly the same -- about 12 percent -- there was no evidence that a double dose of inhaled steroids prevented exacerbations.

Moreover, compared with placebo, doubling the inhaled steroid dose had no effect on "lowest peak flow recorded, rise in symptom scores, highest symptom score recorded, or time to recovery for peak flow and symptom scores," the investigators say.

Although the findings suggest no benefit to doubling the inhaled steroid dose, the authors note that further studies are needed to determine whether a larger dose increase might be effective in averting flare-ups.

Source: Lancet, January 24, 2004.

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Medication Allergies

HealthDayNews
Friday, January 23, 2004

(HealthDayNews) -- Allergic reactions to medications can occur with drugs you've taken before without incident -- or to a drug that your doctor hasn't prescribed to you before.

According to Health Canada, most allergic reactions occur within one hour of taking the medication.

Signs of an allergic reaction include:

  • Hives, which are itchy, red and swollen patches on the skin.
  • A skin rash.
  • Itching of the lips, tongue and possibly face.
  • Sensitivity of the skin to sunlight.

If you experience anything unexpected after starting a medication, tell your doctor immediately.

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Thursday, January 22, 2004

Study: Cancer Patients No Better Off in Trials

By Amanda Gardner
HealthDay Reporter
HealthDayNews
Thursday, January 22, 2004

THURSDAY, Jan. 22 (HealthDayNews) -- Popular perception to the contrary, cancer patients who participate in clinical trials may not actually have better treatment outcomes than those who don't take part in such trials, a new study says.

This is not to say patients are worse off, but experts don't really know one way or the other. "That's a question that can't be answered," says Dr. Joel Horovitz, director of general surgery at Maimonides Medical Center in New York City.

Somehow, though, the idea that patients in trials benefit has become part of the common lore.

"A lot of people in oncology have said that you're better off being in a clinical trial, either randomized or single arm, than being treated outside a clinical trial," says Dr. Steven Joffe, senior author of the study. Joffe is a pediatric oncologist at Dana-Farber Cancer Institute, Children's Hospital Boston, and Harvard Medical School (news - web sites), all in Boston.

The research appears in the Jan. 24 issue of The Lancet.

It's not entirely clear where that supposed benefit, commonly known as a "trial effect," come from. It could possibly be from new drugs (thought to be better than old ones), from being more closely monitored by medical professionals, or, perhaps, from doctors more carefully following standard treatment plans.

"People haven't really, for the most part, been clear about whether the supposed benefit comes from new treatments or just better administration of standard treatments," Joffe says. "It's all lumped together."

Even the fact of a benefit apparently has not been well documented.

Joffe and his colleagues reviewed 26 published studies that compared the health outcomes of cancer patients in trials with outcomes of those not in trials. While 14 of the studies did indeed suggest a better outcome, the authors conclude that most of the studies did not control well for bias.

Studies that showed positive outcomes were more likely to involve children and patients being treated earlier in their disease process.

"If there is a benefit from being in a clinical trial, then you would expect those within the clinical trial to do better, to survive longer," Joffe says. "We found some evidence to support that, but those studies are really hard to do because you have to make sure the two groups are the same."

If the group receiving the new treatment is five years younger or just a little bit healthier, then it's not a fair comparison and the results will be skewed. "You don't know if the differences reflect the treatment or the fact that they were different to start with," Joffe points out. "Maybe they're going to a better treatment center, so the message is not necessarily get yourself into a trial but go to a good treatment center."

But another message that Joffe wants to stress is that people should still sign up for clinical trials. "I want people to sign up, but I don't want them to sign up on the basis of a statement that I can't substantiate," he says. Rather, participants should think of themselves as part of a larger, valiant effort to improve medicine for future patients.

"I encourage patients and parents on the basis of this -- of how we can make things better [for everyone]," Joffe says.

This new altruistic bent may go against how many people currently make their decisions.

"I think the real reason patients enroll in a trial is that they feel their only shot is if they get access to some experimental drug that turns out to work," Horovitz says. "Most of my patients want to do it because they feel that's the only shot they're going to get for themselves, not that they're going to benefit mankind."

More information

For more on cancer trials, visit the National Cancer Institute or CenterWatch.

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Investigators Urge Tighter Painkiller Control

By Maggie Fox
Reuters
Thursday, January 22, 2004

WASHINGTON (Reuters) - The U.S. Food and Drug Administration (news - web sites) should work more closely with companies making narcotics and other drugs to make sure they are not abused like OxyContin was, congressional investigators said on Thursday.

The official General Accounting Office (news - web sites) report on OxyContin spreads the blame evenly - noting that the FDA failed to aggressively regulate the popular painkiller and that its makers pushed too hard in marketing it.

But now, it said, the company, federal and state regulators were working to get the problem under control and were putting into place plans that can help prevent such problems in the future.

OxyContin was introduced in 1996 and while it contained high levels of narcotic, it was formulated for time-release and drugmaker Purdue Pharma said its formulation made it unlikely anyone could abuse it.

But the labeling on the pills clearly told how to circumvent controls - by crushing the tablets. The drug quickly became a favorite of narcotics abusers.

More than 100 people across the country have died from abusing OxyContin, according to the Drug Enforcement Administration.

At the same time, Purdue was aggressively promoting the drug to doctors. By 2001 OxyContin, known generically as oxycodone, was the most prescribed brand-name narcotic for moderate-to-severe pain.

The DEA and the Food and Drug Administration have both expressed concern about how Purdue markets OxyContin and the FDA has acted twice against the company for violating advertising standards.

The GAO, the official investigation arm of Congress, was asked to sort out what happened.

"The active ingredient in OxyContin is twice as potent as morphine, which may have made it an attractive target for misuse," the GAO said it its report released on Thursday.

"Further, the original label's safety warning advising patients not to crush the tablets because of the possible rapid release of a potentially toxic amount of oxycodone may have inadvertently alerted abusers to methods for abuse."

The drug also became highly available because of its popularity, the GAO noted in the report, available on the Internet at http://www.gao.gov/cgi-bin/getrpt?GAO-04-110.

And the FDA did not work hard to see the promotional videos Purdue used to market the drug - some of which were later recalled and destroyed by the company.

The GAO said federal and state agencies were working with Purdue to address the problem. For instance, the FDA approved a revised label in 2001 that stresses the dangers of OxyContin. It also worked with Purdue on a plan to identify potential abusers and to prevent illicit sales and use.

"Purdue has also taken disciplinary action against its sales representatives who improperly promoted OxyContin and has referred physicians who were suspected of misprescribing OxyContin to the appropriate authorities," the GAO said.

The GAO said it had suggested to the FDA that when approving future drugs that could be abused, the agency encourage the makers to come up with a plan for preventing abuse.

But it said only 15 states had prescription drug monitoring programs and most were not comprehensive.

The GAO said the FDA and Purdue mostly agreed with its findings but noted that Purdue also laid some blame on the media, which publicized how to crush and abuse the pills.

"We are firmly committed to combating the abuse of our product, and we appreciate the GAO's acknowledgment of our efforts in this regard," Howard Udell, Purdue's chief legal officer, said in a statement.

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Study Supports Prenatal Testing for All Women

By Karen Pallarito
HealthDay Reporter
HealthDayNews
Thursday, January 22, 2004

THURSDAY, Jan. 22 (HealthDayNews) -- Doctors in the U.S. generally reserve prenatal testing for Down syndrome and other chromosomal abnormalities for mothers-to-be who are 35 or older.

That threshold, established in the 1970s, was chosen largely because it represents the approximate age at which a woman's risk of miscarriage from having amniocentesis -- a needle extraction of amniotic fluid -- is roughly equal to her chance of giving birth to a child with Down syndrome.

But a study in the Jan. 24 issue of The Lancet finds prenatal diagnostic testing is cost-effective and should be available to all women, regardless of their age or risk of bearing a Down syndrome child.

"Women should receive the information about what their risks are," says Miriam Kuppermann, an associate professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco, and primary investigator on the project.

Down syndrome is among the most common genetic birth defects, affecting about one in 800 to 1,000 babies, according to the March of Dimes. An extra chromosome generally causes it. The disorder is a combination of birth defects; among them, some degree of mental retardation.

Amniocentesis is generally performed sometime during the 15th to 18th week of pregnancy, according to the U.S. Centers for Disease Control and Prevention (news - web sites). The procedure involves the insertion of a thin needle into the mother's abdomen to extract a small amount of amniotic fluid for testing.

Chorionic villus sampling, or CVS, is performed earlier in the pregnancy, typically during weeks 10 to 12, and involves extracting a tiny sample of placental tissue.

Both procedures are believed to increase the risk of miscarriage.

The current 35-and-older standard for amniocentesis and CVS testing assumes that women are equally concerned about procedure-related miscarriage and Down syndrome.

But women don't weigh those outcomes equally, according to Kuppermann, whose previously published research examined women's preferences. Some feel it would be more burdensome to have a Down syndrome child, she says, while others are more burdened by the threat of miscarriage.

The current study, which uses data from previously published randomized trials and other studies, compares the costs and benefits of performing amniocentesis and CVS for women of all ages and risk levels against having no invasive testing.

The tests themselves are pricey, at $1,220 for CVS and $1,120 for amniocentesis.

But the value they provide is worth the cost, at less than $15,000 per "quality-adjusted life year gained," the authors conclude.

That economic yardstick measures the costs of testing, including any miscarriages or elective abortions, against outcomes -- good or bad -- associated with the procedures, such as avoiding a Down syndrome child or having a miscarriage.

According to the study, prenatal testing falls well within the range that economists consider cost-effective for medical interventions. Anything above $50,000 per quality-adjusted life year gained becomes questionable.

So should women demand these tests?

Dr. Nancy S. Green, medical director of the March of Dimes, doesn't take a stand on whether more testing should be done. By the time most couples must decide whether to undergo an invasive test for birth defects, they already have several bits of information in hand, she explains. The maternal serum screening, a blood test administered without any age restrictions, can help predict the risk of birth defects, for example. Parents also have ultrasound results, maternal age, and other risk factors to consider.

Still, giving women the option to have diagnostic information is a good thing, Green agrees.

"Sometimes it's really hard to get, say, an amniocentesis paid for by your insurer. You have to be high risk if you're under 35," she says.

Whether this particular study is enough to convince insurers to remove that barrier and pay for testing regardless of age and risk level remains to be seen.

In an editorial accompanying the study, Stavros Petrou of the University of Oxford in England says the cost-effectiveness of testing all pregnant women should be weighed against other competing demands on health-care resources.

"A positive decision to offer prenatal testing to all pregnant women may have broader consequences, for obstetric and other health services," Petrou writes.

More information

Visit the National Library of Medicine to learn more about amniocentesis. The March of Dimes has more on chorionic villus sampling.

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Study: Sedentary Life Starts in Toddlers

By Emma Ross
AP Medical Writer
The Associated
Thursday, January 22, 2004

LONDON - New research suggests even 3-year-olds aren't getting enough exercise, raising concerns over their weight, future disease risk, psychological well-being, behavior and learning ability.

In the first study to rigorously track the movements of preschoolers, scientists found that the average 3-year-old is physically active for just 20 minutes a day, well short of the recommended hour a day for that age.

In The Lancet study published this month, scientists from the University of Glasgow in Scotland recruited 78 children. Each 3-year-old wore an "accelerometer," a matchbox-sized monitor clipped to the waistband, for a week.

The device, worn from the time the children woke up until they went to bed, gave minute-by-minute readings of the children's pattern of physical activity and the number of calories burned.

The toddlers were burning about 1,300 calories a day less than the 1,500 calories recommended.

While the problem is one of an imbalance of calories eaten and burned up, experts believe the main reason is that children are not getting enough exercise.

"There are really only two possibilities, reduced activity or increased intake. None of the dietary assessment data indicate that children are eating more. Adolescents may be eating more but young children are eating less," said the study's leader, John Reilly, a physiologist at the University of Glasgow.

"A 3-year-old 25 years ago was eating 25 percent more than a 3-year-old today," he said. "But physical activity levels have dropped quite dramatically over the last 15 or 20 years."

In the study, the children were spending between nine and 10 hours of their waking day hardly moving at all.

"They may well have been doing a bit of fidgeting, they may have been speaking to their parents or among themselves, but they were just not moving enough to put up the number of calories burned beyond what it would be if they were just resting or sleeping," Reilly said.

The children spent 20 minutes a day in moderate to vigorous activity the type of activity that would get them feeling slightly warm and slightly out of breath, such as running around, walking to keep up with an adult and most types of outdoor play.

All-day television and recorded videos are a major culprit, Reilly said. Outside the home, children are also much less active than they used to be.

"Many more journeys are made by car and among the 3-year-olds, a fair number of them are being taken around in strollers when they could arguably have been walking," Reilly said.

Another element is recent concerns over safety. Some local authorities in Britain have banned children from bringing balls into playgrounds while others prohibit tree-climbing.

"There needs to be a balance. Perhaps we've taken the health and safety agenda a bit far," Reilly said.

The dangers of a sedentary childhood go beyond obesity, experts said. More active children tend to be better behaved and scientists suspect that more active children learn more effectively, perhaps because physical activity is a stimulus to brain development.

"The increasingly sedentary nature of U.K. children is not unique and is being seen in most countries around the world," said James Hill of the Center for Human Nutrition at the University of Colorado.

Small changes in behavior are all that is needed, said Hill, who was not connected with the study.

In the days before videos and TV, young children didn't sit for hours staring at the wall, Reilly said. "They were perfectly capable of finding other ways to amuse themselves. They had imaginations. They still have imaginations," he said.

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U.S. Agent Orange Study Finds Raised Cancer Risks

Reuters
Thursday, January 22, 2004

WASHINGTON (Reuters) - Air Force veterans exposed to Agent Orange during the Vietnam War have a higher-than-average risk of prostate and skin cancer, military researchers reported on Thursday.

The ongoing study of 2,000 Vietnam veterans shows for the first time an elevated risk of melanoma, the deadliest form of skin cancer. Previous studies have found increased risks of prostate cancer, chronic lymphocytic leukemia and also diabetes.

"A new analysis of cancer incidence among Air Force veterans of the Vietnam War found increased risks of prostate cancer and melanoma in those who sprayed Agent Orange and other herbicides," the Air Force Surgeon General's office said in a statement.

It does not find the veterans are any more likely to die of these cancers than the general population.

"It's just because we have new numbers, new exams," a spokesman said. "The guys are getting older, so we are seeing higher incidences."

Between 1962 and 1971 an estimated 20 million gallons of herbicides, including Agent Orange, were used to strip Vietnam's thick forests to make bombing easier.

Veterans exposed to the powerful pesticides have complained for years about a variety of health problems, and in the late 1970s the government started to investigate them systematically.

The latest study, to be published next month in the Journal of Occupational and Environmental Medicine, is not the last word on cancer and Agent Orange, the Surgeon General's office warned. It has many weaknesses and must be studied along with other research.

For this particular study veterans called the Ranch Hand group are being examined regularly. Operation Ranch Hand was the unit responsible for the aerial spraying of herbicides and medical experts say they got the highest exposure to Agent Orange, which contains dioxins and other toxic chemicals.

Starting in 1986, their blood was tested for dioxin, a chemical that builds up in the body and that can cause cancer and birth defects.

"The dioxin determinations were accurate but were measured 15 to 30 years after service in the Ranch Hand unit," the surgeon general's statement said.

"The study interpretations are limited because other environmental exposures were not measured."

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Study: Mom's Diet May Affect Baby's Life

By Alicia Chang
Associated Press Writer
The Associated Press
Thursday, January 22, 2004

Experiments with mice suggest that life span may be related to what your mother ate during pregnancy. The new study at Cambridge University in England shows that pregnant mice fed a well-balanced diet had babies that lived longer, healthier lives.

Mice that were undernourished in the womb and ate a poor diet as adults died prematurely.

Researchers caution the mouse results cannot be directly applied to human health. But they said the results published in Thursday's issue of the journal Nature bolster the notion that low-birth weight babies are more likely to develop life-threatening cardiovascular disease and other illnesses as they mature.

"Growth during prenatal life has a very powerful impact on longevity," said Kent Thornburg, a fetal physiologist at Oregon Health Sciences University who did not contribute to the new study.

However, other researchers said they remain unconvinced.

Rachel Huxley of the Institute for International Health in Sydney, Australia, said a mother's diet is likely to have very little effect on how long her offspring lives when compared to known health risks in adulthood, such as cigarette smoking.

"Even if a causal association could be demonstrated between diet in early life and longevity, its actual influence is likely to be small when compared with known environmental determinants of longevity," Huxley said.

Pregnant mice in the study were fed either a protein-rich diet or a low-protein regimen. After the babies were born, researchers swapped the mothers so that undernourished babies were nursed by mothers on a standard diet to catch up on their growth, and vice versa.

The control animals had mothers that were fed a standard diet and they nursed normally after they were born. They lived for about two years.

Mice that were well-nourished in the womb lived on average two months longer than the control group, the researchers reported. The mice that were undernourished in the womb died six months earlier than the control group.

In a second round of experiments, half of the babies from each litter were weaned at 21 days on a high-calorie, high-sugar diet, similar to a diet that contributes to obesity in humans. The rest were fed a standard diet.

Mice that had poor maternal nutrition in the womb and weaned on the unhealthy diet survived only a year, or about half as long as other mice in the study.

The high-calorie diet did not have a noticeable effect on the life span of well-fed mice weaned on a restricted diet after birth, the researchers reported.

In the late 1980s, David Barker of the University of Southampton in England published research demonstrating that low-birth weight babies are more likely to develop heart disease and high blood pressure in later stages of life, leading some scientists to believe that poor nutrition in the womb restricts the normal fetal development.

In the latest study, the Cambridge researchers suspected that the mice may have permanently increased appetite when forced to catch up on nutrients after birth. Critical organs such as the kidneys may also be damaged in cases where mice are not given the necessary nutrition in the womb, they said.

Over a lifetime seven or eight decades in the case of humans those differences become magnified, they suggested.

"There is, after all, a significant difference between living to be 50 years old and reaching the age of 75," the researchers wrote in Nature.

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Rare Rabies Death Prompts U.S. Bat Warning

Reuters
Thursday, January 22, 2004

ATLANTA (Reuters) - A rare rabies fatality involving a bat prompted U.S. health officials on Thursday to urge Americans to avoid direct contact with the winged mammals and seek prompt medical care if bitten by one.

The warning comes four months after a 66-year-old California man died of rabies contracted when he was bitten in bed by a bat, according to a report by the Centers for Disease Control and Prevention (news - web sites).

The unnamed man washed his wound but did not seek medical care for more than a month, by which time he was suffering from drowsiness, chronic headache, malaise and severe pain shooting through his right arm and across his chest.

He received two rabies shots while hospitalized, but died on Sept. 14, according to the CDC report. Tests confirmed that he had been infected with a rabies strain carried by the silver-haired bat.

Linda Demma, an epidemiologist with the CDC's National Center for Infectious Diseases, said the man would have lived had he sought medical treatment right after being bitten.

The report did not specify how the bat had entered the house but said the man released after it bit him.

Rabies is a fast-spreading, incurable and fatal disease usually transmitted through an animal bite or contact with the secretions of infected animals with open wounds.

The only documented survivors received a rabies vaccine before the onset of the illness. The vaccine usually consists of five separate jabs administered over four weeks.

"It is extremely effective. I don't think there has been a single vaccine failure," Demma said.

Bats, which often live in caves, abandoned buildings and attics, accounted for 24 of the 32 human rabies cases reported in the United States between 1990 and 2000. About 10 percent of the nocturnal creatures typically carry rabies.

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Growing Interest Seen in Bison Meat

By Jon Sarche
Associated Press Writer
The Associated Press
Thursday, January 22, 2004

DENVER - A bison boomlet is under way as Americans look for an Atkins diet-friendly and mad cow-proof alternative to beef.

Although the bison industry is just a baby when it comes to U.S. meat production, there are signs of heightened interest as producers recover from a mid-1990s slump brought on by overproduction.

"People see it more, probably sample it more and they like it," said Roy Rozell, who manages a bison ranch in Colorado.

A good indicator of the bison industry's turnaround is Ted's Montana Grill, a national chain of 18 restaurants co-founded by media mogul and bison ranch owner Ted Turner. The chain is expected to double in size by the end of the year.

Standing outside a Ted's in downtown Denver, attorney Tom Franklin shrugged off the mad cow scare and said he had just enjoyed a bison burger lunch. Another customer, businessman Mitch Zatz, said he likes the taste and the fact that bison meat is leaner than beef.

"It's kind of cool, a change of pace. I feel like, we're in Colorado, we should eat bison," he said.

The National Agricultural Statistics Service reported that in 2002, the latest year for which figures are available, 25,340 bison were slaughtered at federally inspected plants, compared with 35 million head of cattle.

Bison meat, higher in iron than beef, can be difficult to find on store shelves and commands a premium in restaurants and supermarkets compared to a similar cut of beef. At Denver-area grocery stores, ground bison was selling for $5.99 per pound, compared to $4.69 per pound for 93 percent lean ground beef.

A recent poll conducted by the National Cattlemen's Beef Association (news - web sites) indicated most Americans still believe the beef supply is safe. Bison producers, fearing a chilling effect for their product, say they wouldn't want that to change.

Agriculture officials believe that feed containing protein or bone meal from cows with mad cow disease is the most likely source of infection. Such feed was banned in 1997.

There have been no known cases of mad cow disease in bison, and the animals' natural characteristics make it useless for ranchers to give them extra protein from animal byproducts, said Martin Marchello, an animal sciences professor at North Dakota State University.

Bison haven't been bred for centuries, like beef cattle, to be "a meat wagon," said Dave Carter, executive director of the National Bison Association based in Westminster, Colo.

"The animal just doesn't do well with a real high-protein feed, so there's less tendency to even want to move in the direction of supplementing feed," he said.

Many of the plants where bison are slaughtered and butchered have had long-standing policies against using sick or injured animals for human food, Carter said. The Agriculture Department recently banned use of such animals by beef processors for human consumption.

Carter also said bison are processed in smaller plants that handle far fewer animals than large beef-processing plants about 25,000 animals per year compared with about 130,000 head of beef slaughtered daily.

It's not a guarantee against disease-causing organisms, Marchello said, but it means workers can take more time and care with each animal and to ensure cleanliness.

"Everybody searches for a healthy product and we have that," said Rozell, the Colorado bison rancher. "I think the American public, they are going to try stuff and when it's good, they're going to come back to it."

On the Net:

National Bison Association: http://www.bisoncentral.com

National Beef Cattlemen's Association: http://www.beef.org

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Not Sure if Cellphones a Health Hazard, Study Finds

By Peter Starck
Reuters
Thursday, January 22, 2004

STOCKHOLM (Reuters) - Research in the past three years, while mobile phone use has boomed around the world, has failed to determine whether talking on a cellphone is bad for your health, a study showed on Thursday.

The findings -- compiled by the Swedish state Radiation Protection Authority's (SSI) independent expert group on electromagnetic fields -- were released on the day Finland's Nokia (news - web sites), the world's leading mobile phone maker, said it expected global handset sales to grow by over 10 percent this year to more than 500 million units.

SSI's study covered international research on exposure to radio frequency fields used by mobile phones and any links with cancer, the blood-brain barrier -- a mechanism preventing toxic substances in the blood from entering the brain -- and heat shock proteins, which protect the structure of proteins exposed to stress.

"In none of these areas have there been breakthrough results that have warranted firm conclusions in one way or the other," SSI's expert group said in a report.

"None of the available studies has enough power to study the effect of long-term mobile phone use on the risk of developing specific types of brain tumors or other cancers," it said.

Consumer groups and some in the scientific community have expressed concern that the electromagnetic microwave radiation from mobile phones and base stations, which relay signals between phones, could cause headaches, nausea and even tumors.

SSI Director-General Lars-Erik Holm said the study gave no grounds for the agency to revise its recommendation to people worried about potential health hazards associated with mobile phones to reduce their radiation exposure with the help of hands-free devices.

Two weeks ago the Finnish Radiation and Nuclear Safety Authority published a survey showing that 12 cellphone models made by top handset makers such as Nokia, U.S. Motorola and South Korea (news - web sites)'s Samsung emit radiation well below maximum levels agreed in Europe.

SSI's electromagnetic fields expert group is due to report its findings once a year. Today's report was the group's first.

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K.C. Vows to Get Fit, Shed Fat Stigma

The Associated Press
Thursday, January 22, 2004

KANSAS CITY, Mo. - Tired of being taunted about its weight, Kansas City has decided to slim down.

Mayor Kay Barnes and Research Medical Center launched a yearlong citywide fitness campaign Tuesday after Men's Fitness magazine again ranked the city as one of the nation's fattest No. 14 in this year's list.

Participants in the campaign, called "Get Moving KC," can pledge to adopt healthier habits by losing weight, quitting smoking, eating better and exercising more.

Barnes said she too would try to eat better and get more exercise.

"Not only is it the right thing to do, but it makes all the difference in how you feel," she told the crowd gathered at the hospital. "Let's keep moving, Kansas City."

During the event, about 170 hospital staff and community members milled about the information booths, picking up health tips. Some got their blood pressure checked, while others tested their body fat content. There were high-energy mini workout, and organizers urged participants to chart their progress with the fitness startup kits provided.

The folders were packed with diet and exercise tips, as well as an in-home workout CD.

The hospital, which is underwriting the fitness program, is encouraging others to sign up.

Additional exercise tip sheets will be mailed out to participants over the next year. The hospital also will sponsor walks and other activities to keep participants on track.

At year's end, organizers plan to release a survey to reveal the results.

The Men's Fitness rankings are based on date compiled from such resources as the U.S. Census Bureau (news - web sites), almanacs, transit studies and weather reports, which the magazine uses to rate the habits of those living in the nation's 50 largest cities.

The rankings have encouraged other cities to get fit.

Philadelphia Mayor John Street launched a series of programs after the city was dubbed the fattest in America in 1999. Philadelphia dropped to No. 7 on the list of fattest cities this year.

"It feels really great," said Gwen Foster, the city's health and fitness czar. "I feel like we earned it. Even though this survey isn't exactly scientific, at least it served as a motivating factor for us. We wanted to put our dukes up and fight."

On the Net:

Research Medical Center: www.getmovingkc.com

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Blood Pressure Drugs Differ in Female Sex Effects

Reuters Health
Thursday, January 22, 2004

NEW YORK (Reuters Health) - The day may come when doctors decide which blood pressure drugs to give women based on the drug's sexual effects. In a new study, Diovan provided controlled blood pressure as well as Tenormin, but with fewer adverse sexual effects.

Drug-induced sexual problems are recognized in men, lead author Dr. Roberto Fogari and colleagues note in the American Journal of Hypertension. Some types of blood pressure drugs seem worse than others and some, known as angiotensin II antagonists, may actually improve sexual function.

Fewer studies have addressed these issues in women, and there appears to be no data on the effects of angiotensin II antagonists in females. Fogari's group, based at the University of Pavia, compared the effects of Tenormin (atenolol), a beta-blocker, and Diovan (valsartan), an angiotensin II receptor antagonist, among 104 women who were starting treatment for high blood pressure.

The drugs were equally effective in lowering blood pressure, the authors found.

At baseline and after 16 weeks of treatment, subjects completed questionnaires rating 10 aspects of sexual desire.

Diovan was associated with significantly improved scores for items related to sexual interest/desire, changes in sexual behavior in response to partner asking for sexual relations, and sexual fantasies.

In contrast, sexual functioning appeared to have worsened in the Tenormin group with respect to sexual desire and sexual fantasizing. Scores for sexual behavior were also much lower in the Tenormin group.

The authors suggest that the differences could be due to effects of the drugs on plasma testosterone. Diovan does not seem to affect levels of this hormone, whereas Tenormin reduces levels.

Source: American Journal of Hypertension, January 2004.

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Research on Children May Confuse Parents

By Lindsey Tanner
AP Medical Writer
The Associated Press
Thursday, January 22, 2004

CHICAGO - Sick children who participate in medical research often do so without their parents adequately understanding that the youngsters are randomly assigned to get either the standard treatment or the experimental one being tested, a study found.

Such research generally is undertaken in hopes that experimental treatment will be more effective than standard therapy.

Parents' failure to understand the process probably reflects a lack of effective communication between doctors and parents rather than any ethical lapses, the study authors said.

The study involved 137 parents of children with leukemia treated at six children's hospitals nationwide.

Most youngsters with leukemia become participants in so-called randomized studies, in which children are randomly assigned to receive differing types of treatment or standard care, the study authors said.

Randomization was explained to most parents studied, but half of them did not understand the concept, and those who did not understand were more likely to allow their children to participate.

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

The results raise concerns about whether parents were able to give true "informed consent" for their children to participate, the authors said.

Some parents did not grasp that some treatment options would be unproven and that a computer rather than a doctor would decide which treatment each child would receive, said Dr. Eric Kodish, the lead author and director of the Rainbow Center for Pediatric Ethics at Rainbow Babies & Children's Hospital in Cleveland.

"I don't think it's a risk of kids being harmed; it's more of a `right to know' issue," Kodish said.

Holly Rupnow, a Madison, Ohio, mother whose 3-year-old daughter was diagnosed with leukemia in 1999, said part of the problem is parents often are still reeling from the shock of learning their child has cancer when they are asked to participate in research.

"You're so overwhelmed, you're taking so much in," she said. "Sometimes you're just not listening, not comprehending."

The family ultimately allowed their daughter to participate in a study, and she was given an approved drug in higher-than-usual doses. Her cancer is now in remission, though she has liver damage believed to be a side effect from the drug, Rupnow said.

She said she does not regret allowing her daughter to be a study subject. Still, Rupnow said doctors should encourage parents to ask questions and make someone "who's a good communicator" available to answer.

"If there's anything we can do to minimize the shock and enhance parental understanding, we should do it," she said.

On the Net:

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

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Hidden Hepatitis B Infection Still Promotes Cancer

Reuters Health
Thursday, January 22, 2004

NEW YORK (Reuters Health) - Infection with hepatitis B virus (HBV) promotes liver cancer even when there is no evidence of the virus in the blood, findings from a new study suggest.

Unlike the usual situation with HBV infection when the virus can be detected in blood samples, hidden or "occult" infection occurs when HBV is only detectable in liver tissues. Previous studies have linked the usual HBV infection with liver cancer, but it was unclear if the same held true with occult infection.

To investigate, Dr. Teresa Pollicino, from the University of Messina in Italy, and colleagues tested for HBV in liver tissue obtained from 107 patients with liver cancer and 192 patients with other liver diseases. None of the patients had any evidence of HBV in their blood.

The researchers' findings are reported in the medical journal Gastroenterology.

Liver HBV was detected in 64 percent of liver cancer patients compared with just 33 percent of patients with other diseases. Moreover, the apparent link between liver HBV and cancer held true after accounting for age, sex, and co-infection with hepatitis C virus.

"Our study definitively shows that HBV also maintains its (cancer-promoting) role in the case of occult infection," the researchers state. Therefore, patients with worsening liver disease but no evidence of HBV in their blood should probably be tested for liver HBV to assess their risk of cancer.

Source: Gastroenterology, January 2004.

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What Prompts College Kids to Drink?

HealthDayNews
Thursday, January 22, 2004

THURSDAY, Jan. 22 (HealthDayNews) -- Perceptions about friends' drinking habits affect college students more than marketing campaigns that encourage them to abstain or use alcohol responsibly.

That's the conclusion of a University of Iowa study in the latest issue of Health Communication.

"Social-norms" ads and poster campaigns use facts or statistics to correct student misconceptions about the drinking habits of their fellow students. The message is that most students are moderate drinkers or non-drinkers.

While social-norms campaigns are all over college campuses, the authors of this new study contend there are flaws in this approach to reducing student drinking.

"These campaigns are based on the assumption that students don't really know what the correct norm is, that they are likely to underestimate how many people are really drinking responsibly, and that a 'correct' message will change their behavior," Shelly Campo, an assistant professor of community and behavioral health at the university, says in a prepared statement.

"These campaigns also assume that students want to be like the typical college student, which is difficult to define, particularly at a college or university with a large or diverse student population," Campo says.

For this study, she and her colleagues surveyed 550 students at a medium-sized northeastern university where social-norms campaigns had been used for three years. The study found the students' perceptions about their friends' drinking had a significant impact on drinking behavior.

The drinking behavior of male friends had the greatest impact on both male and female college students.

But the study found students' perceptions about the drinking behavior of a "typical' student did not seem to affect their drinking behavior, a finding contrary to the social-norms model.

More information

Here's where you can learn more about the issue of college drinking.

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Acarbose Reduces Diabetics' Risk of Heart Attack

Reuters Health
Thursday, January 22, 2004

NEW YORK (Reuters Health) - Patients with diabetes treated with acarbose, also known by the brand name Precose, have reduced odds of having a heart attack. The benefit even applies to those already being treated for cardiovascular disease, German researchers report.

Acarbose is used to control the spike in blood sugar levels after meals. The drug has also been shown to improve lipid levels, blood pressure, and the propensity of blood to clot, Dr. M. Hanefeld, at Technical University in Dresden, and colleagues note in the European Heart Journal.

The investigators therefore reviewed seven placebo-controlled studies evaluating the effects of acarbose. Overall, 1248 patients with diabetes were treated with acarbose and 932 were given an inactive placebo. Between a half and two-thirds of both groups also received cardiovascular medication.

Acarbose treatment significantly prolonged the time to a newly diagnosed cardiovascular event such as a heart attack or episode of severe angina.

Events were experienced by 6.1 percent of those in the acarbose group and 9.4 percent in the placebo group--a significant relative risk reduction of 35 percent.

The authors found that acarbose reduced the risk of having a heart attack by 64 percent.

Source: European Heart Journal, January 2004.

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Oral Piercing

HealthDayNews
Thursday, January 22, 2004

(HealthDayNews) -- If your child is into body piercing and is talking about having his or her tongue pierced, make sure he or she knows the risks.

According to the University of Manitoba, they include:

  • The transmission of diseases such as hepatitis, HIV (news - web sites), herpes simplex virus, and tetanus.
  • Prolonged bleeding if blood vessels are punctured.
  • Blockage of the airway if the tongue swells.
  • Loss of taste, mobility, and numbness of the tongue.
  • Constant irritation to the oral tissues.
  • Difficulty with chewing, speech and swallowing.

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Risk Control Still a Problem for Diabetics

By Anthony J. Brown, MD
Reuters Health
Thursday, January 22, 2004

NEW YORK (Reuters Health) - Comparison of data from two U.S. health surveys reveals that in the last decade little progress has been made in improving the control of certain disease risk factors among people with diabetes.

The only optimistic finding is that fewer patients now have total cholesterol levels above the recommended limit.

Diabetics are at increased risk for a variety of blood vessel problems. To reduce the odds of developing these vascular diseases, diabetics are advised to keep tight control of their blood sugar, blood pressure, and cholesterol levels.

From the early to late 1990s, "there was no improvement in the control of blood (sugar) levels or blood pressure," senior author Dr. Catherine C. Cowie, from the National Institutes of Health (news - web sites) in Bethesda, Maryland, told Reuters Health.

"I had hoped for a better public health message, since we have programs out there stressing the importance of controlling the ABCs: HbA1C (a blood sugar test), blood pressure, and cholesterol level," Cowie said. "I had expected greater improvements...but I guess it could have been a worse message too."

In the new study, Cowie's team compared data from the Third National Health and Nutrition Examination Survey (NHANES III) conducted in 1988 to 1994 with that from NHANES performed in 1999 and 2000. Data from 1265 NHANES III participants and 441 NHANES 1999-2000 participants were included in the analysis. All of the subjects were at least 20 years of age with previously diagnosed diabetes.

The researchers' findings are published in the Journal of the American Medical Association (news - web sites).

In NHANES 1999-2000, about 37 percent of subjects achieved the target HbA1C goal of less than 7 percent, but a similar proportion had values above the recommended 8 percent "take-action" level. Neither of these figures were a significant change from those recorded in NHANES III.

In the 1999-2000 survey, 36 percent of subjects achieved target blood pressures, but 40 percent of subjects had high blood pressure, the authors note. Like sugar control, blood pressure control did not change significantly between the two survey periods.

Control of total cholesterol levels, by contrast, did improve during the study period. In NHANES 1999-2000, 52 percent of subjects had levels above the recommended 200 cutoff, a significant drop from the 66 percent identified in NHANES III.

"This may be due to a higher proportion of patients now using cholesterol-lowering drugs," Cowie said.

Further analysis of NHANES 1999-2000 data revealed that only 7 percent of subjects had HbA1c values, blood pressures, and cholesterol levels at or below the recommended limits.

Cowie said that a follow-up study is currently in the works that will hopefully shed light on why control of vascular disease risk factors has not improved.

Source: Journal of the American Medical Association, January 21, 2004.

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Exercise-Induced Asthma

HealthDayNews
Thursday, January 22, 2004

(HealthDayNews) -- If you suffer from exercise-induced asthma (EIA), the winter months can be especially trying.

The cold air combined with physically demanding winter sports can cause airways in the lungs to constrict, according to National Jewish Research and Medical Center in Denver.

Here's how you can tame EIA:

  • Wear a mask or scarf to warm cold air before inhaling it.
  • Take asthma medication 15-30 minutes before outdoor winter activities including skiing, snowboarding and ice skating.
  • Warm up 30-60 minutes beforehand -- long enough to break a light sweat.

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Puerto Rican Kids at Risk for Multiple Allergies

Reuters Health
Thursday, January 22, 2004

NEW YORK (Reuters Health) - In a study of children with asthma, those of Puerto Rican descent were at increased risk for multiple indoor and outdoor allergies compared with white children, new research shows.

To a lesser extent, African-American children were also at increased risk.

"Asthma is a significant public health problem among Puerto Ricans, but the extent to which this population is affected by allergies is not completely understood," lead author Dr. Juan C. Celedon, from Brigham and Women's Hospital in Boston, said in a statement.

The new findings, which are reported in the medical journal Chest, are based on a study of 791 children with asthma who received medical care in Hartford, Connecticut. Skin testing for several indoor and outdoor allergy-triggers was performed in all children.

Compared with white children, Puerto Rican children were at increased risk for several indoor and outdoor allergies. In particular, Puerto Rican children were three times more likely to be allergic to cockroaches than white children.

African-American children were also at increased risk for allergies, primarily outdoor allergies. Such children were at least twice as likely as white children to be allergic to mixed tree pollen, mixed grass pollen, ragweed, and mugwort/sage.

Among all children, the authors found an outdoor allergy predicted the degree of allergen sensitization. For example, grass pollen-allergic children were much more likely than nonallergic children to have at least four positive skin tests to other allergens.

"The high frequency of positive allergy test results in Puerto Rican and African American children with asthma suggests that these groups should be tested for allergies more often," Celedon noted.

"However, historically, these minority groups have had limited access to skin testing," he pointed out.

Source: Chest, January 2004.

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Depressed Holocaust Survivors at Risk of Suicide

By Randy Dotinga
HealthDay Reporter
HealthDayNews
Thursday, January 22, 2004

THURSDAY, Jan. 22 (HealthDayNews) -- Depressed survivors of Nazi death camps are nearly twice as likely to consider suicide as other emotionally troubled Jewish seniors are, new research suggests.

For the depressed survivors, the lingering trauma of the Holocaust appears to "tax their ability to cope with the stress of life in general," says study author Diana E. Clarke, a research coordinator at the University of Toronto.

The finding appears in the February issue of the American Journal of Geriatric Psychiatry.

Another study in the journal reveals that one of every five depressed seniors surveyed had at least one handgun in his or her home. The finding indicates that doctors aren't doing a good enough job of convincing depressed patients to get rid of their guns, a mental health expert says.

While the problem of adolescent suicide gets far more attention in the media, elderly Americans are more likely to kill themselves than teens, researchers say. Suicide is the 15th leading cause of death among Americans aged 65 to 74, making it nearly as deadly as Alzheimer's disease (news - web sites) in that age group, according to 2001 federal statistics.

The reasons for the high risk aren't entirely clear, but no one single challenge of growing old appears to be responsible, Clarke says.

"Most studies have pointed out that it is a combination of factors -- having experienced a traumatic event in life combined with social isolation, the experience of other negative life events, and one's state of health," she says.

In her study, Clarke and her colleagues looked at questionnaires filled out by 530 depressed Jewish seniors who had sought mental health counseling from a hospital program at Toronto's Baycrest Centre for Geriatric Care. A third were Holocaust survivors.

The seniors who survived the Holocaust were 87 percent more likely to say they were thinking about or actively planning to take their life. Very few had been diagnosed with post-traumatic stress disorder.

Clarke suspects the horrors of the Holocaust set off a cascade of events -- including dislocation and loss of family -- that affected the survivors' lives for years. "The psychological scars do not go away for many survivors," she says. "They have to deal with these experiences over their lifetime, and that can affect how well they will cope with present challenges, such as losing a spouse or developing health problems."

Doctors and mental-health workers need to be aware of the potential emotional aftershocks of the Holocaust and keep them in mind when they evaluate elderly patients, Clarke says. Any Holocaust survivor who's depressed should be checked for signs of suicidal thoughts, she adds.

In the other study in the journal, researchers at the University of Pennsylvania report that about one-fifth of depressed seniors have guns at home.

The researchers surveyed 1,023 seniors at a clinic in the Pittsburgh area and found that 28 percent kept a firearm in their home and 20 percent owned a handgun.

"Most people said they had them for protection," says study author Dr. David Oslin, an assistant professor of psychiatry at the University of Pennsylvania. "They weren't rusty old handguns from World War II."

That's troubling, given the fact that 80 percent of suicides among elderly men are accomplished with firearms, the researchers add.

The rate of handgun ownership was the same among mentally healthy seniors and among those who reported being depressed or thinking about suicide.

The study is apparently the first of its kind. "We were shocked to realize that nobody knows how many older adults have firearms," Oslin says.

The findings suggest mental-health workers at the clinic weren't doing a good job of convincing their depressed patients to get rid of their firearms, at least temporarily, Oslin says.

"If we had been doing our job right in terms of treating these folks for depression, they would have fewer guns available," he says. "We should be asking about firearm ownership and getting them to get rid of it or locking it up while we're treating their depression."

More information

Get more details about the elderly and suicide from the U.S. Department of Health and Human Services or the Institute on Aging.

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Constipation, Soiling Linked to Kids' Behavior

Reuters Health
Thursday, January 22, 2004

NEW YORK (Reuters Health) - Children who are often constipated or frequently soil their pants seem to be more likely to have mild behavioral problems, according to a new study from the Netherlands.

But since few of these behavioral problems are severe, most children with constipation and other defecation disorders should be seen by a pediatrician rather than a mental health professional, the researchers say.

Why some children who have been potty-trained experience frequent constipation or bowel problems is uncertain. Some experts believe that psychological factors, including unconscious anger, play a role. Coercive toilet training is sometimes blamed for children's defecation disorders.

Dr. Marc A. Benninga from the Academic Medical Center in Amsterdam and colleagues studied 215 children who had frequent constipation, who soiled their pants or who had recurrent abdominal pain. The children's parents filled out an extensive questionnaire to evaluate each child's behavior.

Children also underwent testing to see whether "colonic transit time" - how long it takes food to move through the colon - was related to behavior problems.

Colonic transit time did not seem to be related to specific behavioral problems, Benninga's team reports in the journal Archives of Disease in Childhood. The study also found that children with recurrent abdominal pain were not more likely to have behavioral problems than children in the general Dutch population.

But children who frequently soiled their pants or were constipated were more likely to have behavioral problems, according to the report. These problems tended to be mild, however.

Instead of referring children with these defecation disorders to psychiatrists, Benninga and his colleagues advise that they receive ordinary pediatric care. Besides treating the defecation disorder, a physician may use a behavior modification program to treat a child's behavioral problems, the researchers suggest.

The relationship between children's defecation disorders and behavioral problems remains a bit of a chicken-or-the-egg question, according to Benninga and his colleagues. The researchers point out, however, that in a previous study, behavioral problems cleared up in most children who were treated for defecation disorders.

Source: Archives of Disease in Childhood, January 2004.

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New Way to Spot Periodontal Disease

HealthDayNews
Thursday, January 22, 2004

THURSDAY, Jan. 22 (HealthDayNews) -- Signs of periodontal disease may be detected with a routine blood test, says a Japanese study in the current issue of the Journal of Periodontology.

Researchers examined and measured the oral health of 7,452 people and tested their blood for 37 items used in general blood tests. These items included cholesterol and C-reactive protein, commonly linked to heart disease.

The blood test results were compared against the oral health scores of the study volunteers.

"In this study we found that generally if the blood was 'healthy,' the oral health was also healthy. Conversely, if the blood test detected certain 'red flags,' the person also had serious symptoms of periodontal disease," researcher Dr. Yuko Takami, of the School of Dentistry at AichiGakuin University, says in a prepared statement.

"We also found that males were reported to have more serious symptoms of periodontal diseases than females of the same age group," Takami says.

"These findings mean that in the future when patients visit their medical doctors for a routine check-up and annual blood work, they may also be referred to a periodontist for a periodontal screening if their blood indicates systemic abnormalities," Michael P. Rethman, president of the American Academy of Periodontology, says in a prepared statement.

More information

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

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Age Bias May Affect Treatment for Prostate Cancer

By Will Boggs, MD
Reuters Health
Thursday, January 22, 2004

NEW YORK (Reuters Health) - Age bias among urologists and other doctors may account for the undertreatment of older men with early prostate cancer, new research suggests.

Several previous studies have reported that older men receive potentially curative therapy less often than do younger men, the authors explain, but none of these studies determined whether age or other diseases were appropriately considered in the treatment decisions.

Dr. Shabbir M. H. Alibhai, from University Health Network, Toronto, and colleagues evaluated the influence of age, other diseases, tumor severity, and remaining life expectancy on the treatment received by 379 men with prostate cancer. The results are published in the medical journal Cancer.

Men under age 60 years were more likely to receive potentially curative surgery rather than radiation therapy, the authors report, whereas those between 60 and 69 years were more likely to receive radiation therapy than surgery.

Men in the age 70 to 79 age group were likely to receive no therapy, the report indicates, and virtually all men over age 80 years received no therapy.

An increasing number of co-existing diseases decreased the likelihood of receiving curative surgery but did not influence receipt of radiation therapy in patients up to age 69, the researchers note.

As remaining life expectancy increased so did the chances of receiving potentially curative treatment. However, older men were less likely than younger men to receive such therapy when both shared the same remaining life expectancy. Similar findings were noted when older and younger men had tumors of comparable severity.

The educational experience of the urologist also seemed to influence the decision to offer potentially curative surgery. Docs who graduated from training more than 22 years ago were less likely to recommend such surgery than more recent graduates.

Doctors "may be systematically undertreating older patients with localized prostate cancer that are not consistent with ... expert recommendations," Alibhai told Reuters Health.

Doctors "need to realize that many older patients who are otherwise healthy and in their early or mid seventies have an excellent life expectancy and should be considered for aggressive treatment," the investigator said.

"Even though there is only one randomized trial that has demonstrated that potentially curative therapy is better than conservative management, we are trying to emphasize that (doctors) must be consistent when thinking about treatment," Alibhai concluded.

Source: Cancer, January 1, 2004.

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Keeping Third Heart Attack, Stroke at Bay

HealthDayNews
Thursday, January 22, 2004

THURSDAY, Jan. 22 (HealthDayNews) -- The anti-clotting drug clopidogrel appears more effective than aspirin in preventing another heart attack or stroke in people who have survived more than one heart attack or stroke caused by a blood clot.

The finding appears in the Jan. 22 online issue of Stroke.

The study of 4,496 high-risk patients found those who took clopidogrel had a 14.9 percent lower relative risk. After one- and three-year follow-ups, the people taking clopidogrel were less likely than those taking aspirin to have been hospitalized or to have died from a cardiovascular event (CVE).

A year after their second CVE, 16.1 percent of the people taking clopidogrel and 18.5 percent of those taking aspirin had suffered another stroke or heart attack or had been hospitalized again for CVE. After three years, 32.7 percent of the patients taking clopidogrel and 36.6 percent of those taking aspirin had another CVE.

The study also found that, at three years, 20.4 percent of the people taking clopidogrel and 23.8 percent of those taking aspirin had died from a CVE.

"Basically, if a patient has a history of multiple cardiovascular events, they are better off being treated with clopidogrel rather than aspirin," study co-author Dr. Deepak L. Bhatt, director of the Interventional Cardiology Fellowship at the Cleveland Clinic Foundation in Ohio, says in a prepared statement.

More information

Here's where you can learn more about heart attack and stroke.

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Dreyer's New Process to Revive 'Light' Ice Cream

Reuters
Thursday, January 22, 2004

NEW YORK (Reuters) - Dreyer's Grand Ice Cream Holdings Inc. is betting on a new process to make ice cream that is lower in fat and calories taste more like the real thing and revitalize the stagnant light ice cream market.

The Oakland, California company on Thursday announced that, beginning next month, Dreyer's and Edy's brands of light ice cream will be made using a new process of "slow churning." By churning the ice cream for longer at a lower temperature, Dreyer's said, fat molecules are stretched and distributed more widely, making the ice cream taste like it contains more fat.

According to Dreyer's Chief Executive Gary Rogers, sales of its light ice cream brands have surged 75 percent in the 9 months since the "slow churned" products were introduced in test markets. And in blind taste tests, 80 percent of tasters thought the "slow churned" ice cream was either premium or superpremium ice cream.

Rogers expects sales of light ice cream, which have been flat for the past 3 years due to consumer concerns about taste, to soar because of the new process.

"Light products to date have disappointed over time," Rogers said in an interview. "This is a true innovation."

Dreyer's, which owns the U.S. frozen dessert business of both Dreyer's and Nestle, plans to launch a "heavy" television ad campaign to promote the new products, Rogers said. The "slow churned" ice cream will be rolled out in most supermarkets by May.

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New Clue to Why Younger Women Face Lower Stroke Risk

HealthDayNews
Thursday, January 22, 2004

THURSDAY, Jan. 22 (HealthDayNews) -- Women seem to differ from men in the way that plaque collects in their neck arteries, a process linked with increased stroke risk.

So claims a Canadian study in the Jan. 22 online issue of Stroke.

While the study found women tend to have more narrowing of the neck arteries than men, it also found they had less build-up of artery-clogging plaque. Less plaque means lower risk of stroke.

The study of 1,686 women and men found that, between ages 35 and 39, women had an average of 40 percent apparent narrowing in the carotid arteries while men had an average of 20 percent narrowing in those arteries.

Women in that same age group had about 0.1 centimeters squared (cm2) of plaque build-up and men had about 0.2 cm2.

Between the ages of 55 and 59, women had an average of 0.58 cm2 of plaque build-up and men had an average of 1 cm2. By ages 70 to 74, women had an average of 1.24 cm2 of plaque build-up and men had an average of 1.88 cm2. In this same age group, narrowing of the neck arteries was 55 percent for both men and women.

The researchers say this indicates that, beginning in their 50s, women start to "catch up" to men in plaque build-up. That's consistent with increased risk of cardiovascular risk as women age.

More information

Here's where you can learn more about the signs of stroke.

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Wednesday, January 21, 2004

Radiation Urged After Breast Conserving Surgery

By Andrew Conaway
HealthDay Reporter
HealthDayNews
Wednesday, January 21, 2004

WEDNESDAY, Jan. 21 (HealthDayNews) -- Radiotherapy should routinely be considered as a treatment option after breast-conserving surgery for women diagnosed with early breast cancer, a new study says.

Researchers in Belgium say the procedure may reduce the chances of relapse and boost overall survival rates.

In a review of 15 studies in Europe, Canada and the United States, researchers found that when radiation was omitted, women were three times more likely to suffer relapses and faced a reduced chance of overall survival. The studies looked at recurrence rates for 9,422 women and mortality rates for 8,206 women.

Many of the studies showed women with early-stage breast cancer who have breast-conserving surgery followed by radiotherapy have similar survival rates as women who have a mastectomy. Moreover, they are also spared the disfiguration of losing a breast.

A team led by Dr. Vincent Vinh-Hung, a radiotherapist at the Oncology Center at Academic Hospital in Jette, Belgium, performed a pooled analysis of the randomized clinical trials of women with early-stage breast cancer who had breast-conserving surgery alone, or surgery followed by radiotherapy.

The study appears in the Jan. 21 issue of the Journal of the National Cancer Institute (news - web sites).

"Until now, almost all studies saw a reduction in relapse," Vinh-Hung says. "But now we think we are seeing the beginnings of an answer to the question of survival rates. We have been studying populations associated with radiotherapy, and are seeing better survival rates overall in Western countries."

The researchers calculated that, after eight years, omitting radiotherapy resulted in an 8.6 percent higher rate of unnecessary deaths. And for small tumors, it saw a positive survival rate of 1 percent to 3 percent in absolute terms in that same period.

In three clinical trials conducted in Canada and Denmark, the study saw a 9 percent to 10 percent improvement rate in overall survival in women who underwent radiotherapy following surgery.

"This is important because if there is no effect seen on survival, then the person with cancer might say, 'OK, I will wait,' and do a do-nothing strategy," says Vinh-Hung. "'I have 30 percent risk of relapse, so why not wait and then irradiate immediately if I relapse? If I do nothing, I have a two-thirds chance of no relapse.' So now on top of that we can add this little amount of knowledge to a do-nothing strategy. We are always looking for how to optimize treatment, so we can learn how to do better."

Radiotherapy is a highly localized daily therapy that begins after surgery to remove the tumor and lasts generally from 30 days to six weeks, but the procedure is not without drawbacks.

It can be a complex, extensive and labor-intensive procedure. Radiation also prolongs the length of treatment and has side effects that range from skin problems to breast hardening and heart and lung complications.

In an accompanying editorial, Drs. Katherine A. Vallis and Ian F. Tannock of Princess Margaret Hospital in Toronto noted that although there may be a small subset of women with good prognostic factors who do not need radiation after surgery, this analysis "reinforces the view that the large majority of patients undergoing breast-conserving surgery should also receive radiotherapy."

"The survival rate is a small advantage, really. But it is significant if you consider the number of women who have breast cancer in this country and elsewhere, it is quite a significant number of lives that could be saved," says Dr. Margaret F. Spittle, a consultant clinical oncologist at Middlesex Hospital and St. John's Centre for Diseases of the Skin. Spittle was familiar with some of the studies in the pooled analysis.

More information

Learn more about breast cancer from the American Cancer Society, while the National Cancer Institute discusses treatment options.

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Getting the Blood Flowing to Diabetic Feet

HealthDayNews
Wednesday, January 21, 2004

WEDNESDAY, Jan. 21 (HealthDayNews) -- Transdermal L-Arginine cream increased impaired blood flow in the feet of people with diabetes, says a study in the January issue of Diabetes Care.

The study found the cream improved circulation by 33 percent at the metatarsal and 35 percent at the Achilles. The cream increased temperature by 5 degrees at the metatarsal and by 8 degrees at the big toe.

L-Arginine is a naturally occurring amino acid that is the biochemical precursor of nitric oxide. Nitric oxide controls local blood flow by relaxing the smooth muscle lining of blood vessels. L-Arginine is classified as a dietary supplement and has long been available in oral form.

Impaired blood flow in the feet is a major cause of such diabetes-related complications as cold, painful feet and ulcers. This impaired blood flow can eventually lead to amputation. It's believed that restoring blood flow in the feet of people with diabetes may prevent ulcers and amputations. More research is required to confirm that.

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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Study: Sleep Essential for Creativity

By William McCall
Associated Press Writer
The Associated Press
Wednesday, January 21, 2004

For the first time, scientists say they have proved what creative minds have known all along: that our sleeping brains continue working on problems that baffle us during the day, and that the right answer may come more easily after eight hours of rest.

The German study is considered to be the first hard evidence supporting the commonsense notion that creativity and problem-solving appear to be directly linked to adequate sleep.

Some researchers said the study provides a valuable reminder for overtired workers and students that sleep is often the best medicine.

"A single study never settles an issue once and for all, but I would say this study does advance the field significantly," said Dr. Carl E. Hunt, director of the National Center on Sleep Disorders Research at the National Institutes of Health (news - web sites). "It's going to have potentially important results for children for school performance and for adults for work performance."

Sleep has long been thought to improve creativity. Rolling Stones guitarist Keith Richards said the riff in "(I Can't Get No) Satisfaction" came to him in his sleep, while the 19th-century chemist Dmitri Mendeleev literally dreamed up the periodic table of elements.

Scientists at the University of Luebeck found that volunteers taking a simple math test were three times more likely than sleep-deprived participants to figure out a hidden rule for converting the numbers into the right answer if they had eight hours of sleep. The findings appear in Thursday's issue of the journal Nature.

Jan Born, who led the study, said the results support biochemical studies of the brain that indicate memories are restructured before they are stored. Creativity also appears to be enhanced in the process, he said.

"This restructuring might be occurring in such a way that the problem is easier to solve," Born said.

Born said the exact process in the sleeping brain for sharpening these abilities remains unclear. But it appears that memories start deep in an area of the brain called the hippocampus, and are eventually pushed outward to the neocortex to be consolidated.

The changes leading to creativity or problem-solving insight occur during "slow wave" or deep sleep, which typically occurs in the first four hours of the sleep cycle, he said.

The findings also may explain the memory problems associated with aging, because older people typically have trouble getting enough sleep, especially the kind of deep sleep needed to process memories, Born said.

History is rife with examples of artists and scientists who have awakened to make their most notable contributions. Samuel Taylor Coleridge wrote the epic poem "Kubla Khan" after a long night of rest. Robert Louis Stevenson credited a good night's sleep with helping him create scenes in "The Strange Case of Dr. Jekyll and Mr. Hyde." And Elias Howe came up with his idea for the sewing machine after waking up.

Other researchers have long suspected that sleep helps to consolidate memories and sharpen thoughts. But until now it had been difficult to design an experiment to demonstrate it.

Born and his team "have applied a clever test that allows them to determine exactly when insight occurs," Pierre Maquet and Perrine Ruby at the University of Liege said in an accompanying commentary.

Some 70 million Americans are believed to be sleep-deprived, contributing to accidents, health problems and lower test scores.

Maquet and Ruby said the study should be considered a warning to schools, employers and government agencies that sleep makes a huge difference in mental performance.

The results "give us good reason to fully respect our periods of sleep especially given the current trend to recklessly curtail them," they said.

On the Net:

National Institutes of Health: http://www.nih.gov

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Winter Nosebleeds

HealthDayNews
Wednesday, January 21, 2004

(HealthDayNews) -- If you're susceptible to nosebleeds, the dry winter air may bring them on more frequently, according to the Medical College of Wisconsin. A dry environment can make the lining in your nose thinner and more vulnerable to minor irritations.

Reduce the likelihood of your nose bleeding by:

  • Drinking more water.
  • Using a salt-based nasal spray as frequently as necessary.
  • Gently applying a small amount of petroleum jelly to the lining of your nose.
  • Using a home humidifier.
  • Avoiding regular use of aspirin and other anti-inflammatory medications. They diminish the blood's ability to clot.

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Orange Growers Irked by Low-Carb Diets

By Mike Schneider
Associated Press Writer
The Associated Press
Wednesday, January 21, 2004

LAKELAND, Fla. - Tired of losing orange juice drinkers to low-carb diets, Florida's citrus growers are fighting back.

The state Department of Citrus on Wednesday changed its marketing strategy to convince consumers that orange juice can be compatible with the Atkins diet as well as the popular weight-loss plan pushed by television talk show host Dr. Phil McGraw.

The department's lawyer also is reviewing legal options against some books, such as "The South Beach Diet," that discourage orange juice for dieting purposes because of its high sugar levels.

About $1.8 million will be spent on a marketing campaign to combat the bad image caused by low-carb diets. The department is abandoning a marketing campaign that targeted moms and young professional women.

"There are powerful, negative messages against us," said Bob Crawford, executive director of the Florida Department of Citrus. "We're not going to stand and take it."

Florida's $9 billion citrus industry has reason to be concerned. Orange juice consumption has fallen from 888 million gallons during the 2000-2001 growing season to an expected 844 million gallons in the current season.

Citrus officials said a noticeable drop occurred last March when low-carb diets began to reach a critical mass.

"People are dropping out of the market," said Dan Gunter, a consultant for the Department of Citrus.

Crawford said the Atkins diet and Dr. Phil's diet leave room for orange juice consumption. But he said lawyers were reviewing claims against orange juice made in "The South Beach Diet" and other publications.

"I think if people write things that aren't true about our product, we'll first talk about it with them and hopefully avoid litigation," Crawford said.

In "The South Beach Diet," Dr. Arthur Agatston urges readers to eat fruits rather than drink fruit juice.

"Again, fruit juices are a big source of trouble, in part because we've come to associate them with healthy habits," Agatston writes in the best-selling book. "But they also bring with them high levels of fructose, which can be the undoing of any effort to lose weight."

The publisher, Rodale Inc., said it stands by the book's "sound nutritional advice."

Most of Florida's oranges are processed into juice. Florida is the nation's largest producer of oranges and second in the world to Brazil.

On the Net:

Florida Department of Citrus at http://www.floridajuice.com

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Yeast Infections

HealthDayNews
Wednesday, January 21, 2004

HealthDayNews) -- Yeast infections, while uncomfortable, are not dangerous. They're caused when the balance between the yeast organisms normally present in the vagina and other organisms is upset, according to Baystate Health System.

Common triggers are:

  • Lowered resistance as a result of infection, stress, or illness.
  • Diabetes.
  • Pregnancy or birth control pills.
  • Drugs or antibiotics taken for other infections.

Symptoms of a yeast infection include:

  • Severe burning and itching.
  • Swelling in the vulva.
  • A white discharge.
  • Painful intercourse.

If you think you have a yeast infection, see your doctor. The condition can be cured with antifungal medications taken over a period of three to seven days.

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Survival Improving for Recurrent Breast Cancer

American Cancer Society
Wednesday, January 21, 2004

Although a recurrence of breast cancer is discouraging, it isn't the death sentence it once was, according to researchers from M. D. Anderson Cancer Center in Houston. They found that with the introduction of new drugs, the survival of women with recurrent breast cancer has improved by about 1% a year since 1974.

They reported their findings in the journal Cancer (Vol. 100, No. 1: 44-52).

The researchers reviewed the records of 834 women who had been treated for breast cancer at M. D. Anderson since 1974. All of the women had received chemotherapy after surgery, but had developed a recurrence of their cancer despite that treatment. The women were divided into 5 groups according to their recurrence date: 1974-1979, 1980-1984, 1985-1989, 1990-1994 and 1995-2000.

In each succeeding period, survival improved. In the 1974-79 time period, only 10% of the women lived 5 years. But by the 1995-2000 period, the 5-year survival rate had risen to 44%.

Although these numbers are encouraging, there were some qualifications attached. Each group differed somewhat in where the first recurrence showed up, and that could affect survival rates. For example, women whose first recurrence was found in lymph nodes or on the skin had a better outcome than women whose cancer came back in the liver or lung. And, more women in the earlier years had liver and lung recurrences and fewer skin or lymph node recurrences.

Better Drugs May Make the Difference

Still, the researchers felt that this difference alone couldn't explain their good results. Instead, they pointed to the explosion in new drugs to treat breast cancer. In the 1970s, only 7 drugs were approved by the U.S. Food and Drug Administration (news - web sites) to treat breast cancer. In the 1990s this number had risen to 25.

Examples of newer drugs include the taxanes such as paclitaxel (Taxol) and docetaxel (Taxotere); aromatase inhibitors such as anastrozole (Arimidex), letrozole (Femara) and exemestane (Aromasin); and the anti-HER2 protein drug, trastuzumab (Herceptin).

"Improvement in survival over time would suggest that? new therapies are helping women with recurrent disease live longer," they wrote.

The researchers couldn't prove conclusively that the new drugs are the primary reason women with recurrent breast cancer are surviving longer. Better diagnostic tools that allow recurrences to be found earlier may also play a role, for instance. More studies are needed to determine just how much of an effect the new treatments have had, they said.

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New Study Finds Inflammation a Bad Actor

By Serena Gordon
HealthDay Reporter
HealthDayNews
Wednesday, January 21, 2004

WEDNESDAY, Jan. 21 (HealthDayNews) -- Aortic valve disease has long been linked to an increased incidence of heart attacks and death from cardiovascular disease, but a new study says inflammation may really be the culprit.

While the study found people with aortic sclerosis -- a narrowing of the aortic valve in the heart that can lead to aortic stenosis -- were more than twice as likely to suffer a heart attack or to die, the authors believe aortic disease alone isn't to blame. Instead, a history of coronary artery disease or other heart disease, high levels of the inflammation marker C-reactive protein (CRP), and age were the highest risk factors for heart attack and death.

"In the past, aortic sclerosis was always associated with worse outcomes, but no one understood why," says study co-author Dr. William O'Neill, corporate chief of cardiology for Beaumont Hospital System in Royal Oak, Mich. "What we found was that when we measure CRP, those with the highest levels were the one with the worst outcomes."

O'Neill says these results suggest that anyone with aortic sclerosis should be screened for CRP and should actively try to reduce inflammation and cholesterol levels.

The findings appear in the Jan. 21 issue of the Journal of the American College of Cardiology.

For the study, O'Neill and his colleagues followed 425 people who had been treated in the emergency room at William Beaumont Hospital for chest pain. The average age of the study participants was 68, 54 percent were male, and 84 percent were white.

All of the patients were given electrocardiograms (ECG) and cardiac enzyme tests. They also had echocardiography, which is an ultrasound of the heart, to determine if they had aortic sclerosis. No one with aortic stenosis, a more severe narrowing of the aortic valve, was included in the study.

Forty-nine percent of the study participants had some degree of aortic sclerosis. The researchers found that people with aortic sclerosis were much more likely than people without the valve disease to have a heart attack or die in the year following the study -- 16.8 percent vs. 7.1 percent.

But, according to the study findings, having aortic sclerosis alone was not an independent predictor of a heart attack or death. What did affect the risk, according to the study, was a history of coronary artery disease, having had a heart attack at the start of the study, high levels of CRP, a history of congestive heart failure, and advanced age.

In an accompanying editorial in the same journal, Dr. Catherine Otto from the University of Washington in Seattle says other factors besides inflammation explain why people with aortic sclerosis have a higher risk for cardiovascular problems.

Dr. Dan Fisher, a cardiologist from New York University Medical Center, agrees. "We still have a lot to learn. CRP is a predictor of bad events, but we don't know if inflammation is part of the disease process or if it's merely a marker."

Fisher also points out there is a selection bias in this study because only people who came to the hospital with chest pain were studied.

O'Neill says there may well be other factors that contribute to heart disease. But he suggests CRP levels be monitored in people with aortic sclerosis because those with the highest levels were most likely to have problems.

"We had almost a 40 percent event rate for people with aortic sclerosis and a high level of CRP," says O'Neill.

More information

To learn more about how your heart works, got to the American Heart Association. For more information on aortic stenosis, a condition that can be caused by aortic sclerosis, visit the National Library of Medicine.

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Study: Boys Raised as Girls Find Male Identity

By Gene Emery
Reuters
Wednesday, January 21, 2004

BOSTON (Reuters) - The author of a new study on males born with a deformity of the penis known as cloacal exstrophy suggested on Wednesday that the children should be brought up as boys, not girls as doctors have recommended in the past.

Many children with the condition had surgery to make them look like girls, and parents were told by doctors to treat them like girls and never reveal that, genetically, they were male.

Study author, John Gearhart of Johns Hopkins Medical Institutions in Baltimore, called for a re-examination of those recommendations, saying: "We suggest (doctors) strongly consider counseling families to raise the children as males, and recommend penile reconstruction at a later age."

Children with cloacal exstrophy may be born with little or no penis. The condition appears in one out of every 400,000 births.

The study, published in the New England Journal of Medicine (news - web sites), followed 16 cases and found that most of the children began behaving like boys no matter how they were raised. Of the 14 raised as girls, many resisted being dressed like girls after age 4.

Four of the 14 declared themselves male between the ages of 7 and 12, before they learned they were born male. In three of the four cases, study co-author William Rainer told Reuters, the attitude shift took place within hours, sometimes minutes.

One child whose first and middle name had a male variant immediately began using the male version of his name, said Rainer of Johns Hopkins and the University of Oklahoma.

Four other children began thinking of themselves as males after being told they were genetically male, at ages ranging from 5 to 18.

"They said, 'When mom and dad said I was a boy, it all made sense. Then I realized it was true. Then it just happened,"' Rainer recalled. "Children transition extraordinarily rapidly."

Friends also seemed to have little trouble adapting to the shift because, in many cases, they already recognized that the child acted like a boy, said Rainer, a child psychiatrist and urologist. However, parents had a harder time, he said.

In two of the four children who spontaneously declared themselves to be boys, their parents rejected their declarations.

The remaining six children either regarded themselves as female or, in one case, would not discuss gender issues.

Rainer said the decision by doctors to remove the testicles at birth and perform reconstructive surgery to make the child appear female was based on the belief that children are sexually and psychologically neutral at birth, and that gender is based on what the genitals look like and how they are raised.

"Those are enormous assumptions," he said, noting that newer research suggests hormones released before birth have a major influence on subsequent sexuality.

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Panic Disorder May Have Biological Basis

HealthDayNews
Wednesday, January 21, 2004

WEDNESDAY, Jan. 21 (HealthDayNews) -- An important receptor that helps regulate emotional health is deficient in three brain areas of people with panic disorder.

That what researchers at the National Institute of Mental Health report in the Jan. 21 issue of the Journal of Neuroscience.

The study included 16 people with panic disorder and 15 healthy people used as control subjects. Brain scans revealed the people with panic disorder have nearly a third less of the serotonin receptor 5-HT1A in three structures -- anterior cingulate, posterior cingulate and raphe -- that straddle the center of the brain.

This research is the first done on living people to show that this receptor, which is vital to the action of widely prescribed anti-anxiety drugs, may be abnormal in people with panic disorder. The finding, along with evidence from recent animal research, suggests genetics may increase the risk for panic disorder.

Each year, about 2.4 million American adults suffer panic attacks, which include feelings of intense fear and physical symptoms that may be confused with a heart attack. Panic disorder runs in families, and scientists have long suspected there's a genetic component to it.

More information

Here's where you can learn more about panic disorder.

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New Imaging Agent Could Help Diagnose Alzheimer's

Reuters
Wednesday, January 21, 2004

WASHINGTON (Reuters) - A new imaging agent that homes in on the gummy plaque believed to destroy the brains of Alzheimer's patients may finally allow the disease to be diagnosed before it kills, researchers said on Wednesday.

The agent, a radioactive dye called Pittsburgh Compound B, can also be used to test new drugs being developed to fight Alzheimer's, which affects an estimated 4 million Americans, the researchers said.

The hallmark of Alzheimer's is the buildup of protein clogs called amyloid beta. These eventually destroy the brain, robbing patients of their memory and eventually their ability to care for themselves. There is no cure for the disease.

Using the new agent, "we will likely be able to follow the progression of the disease and speed the development of promising new therapies aimed at halting the build-up of amyloid in the brain," Dr. William Klunk of the University of Pittsburgh, who led the study, said in a statement.

Writing in the Annals of Neurology, Klunk and colleagues said the imaging agent allowed the use of positron emission tomography, or PET, to view the plaque in the brains of 16 Alzheimer's patients. They also used the method on nine healthy volunteers.

"We will not only find out when plaques begin to form, we will be able to see directly if a medication is preventing or reversing plaque formation over the long term," Klunk said.

The Alzheimer's Association, which helped fund the study, said it was an important step forward.

"We now have a tool to detect one of the hallmarks of Alzheimer's disease (news - web sites) in the brains of living patients. Until now, this could only be shown at autopsy or by brain biopsy," said the Association's William Theis.

Chet Mathis, a chemist and professor of radiology who worked on the study, said the imaging compound uses a dye that homes in on plaque, attached to a radioactive carbon "tag."

The dye, an adjusted version of the dye used by pathologists to find Alzheimer's in brain samples from dead patients, is harmless, Mathis said. "In two hours it is gone from the body," he said in a telephone interview.

He said the compound, patented by the university, had been licensed to Amersham, a British healthcare firm that makes imaging agents. General Electric is about to take over Amersham.

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Instability Can Dampen Your Outlook

HealthDayNews
Wednesday, January 21, 2004

WEDNESDAY, Jan. 21 (HealthDayNews) -- Just like humans, rats apparently can be plagued by pessimism.

Researchers at the University of Bristol in England found that rats that were housed in unpredictable conditions seem to be burdened with a more negative outlook than rats that live in settled, stable circumstances.

In this study, published in the Jan. 22 issue of Nature, the rats were trained to associate a particular sound pitch with a positive event, the arrival of food. They were also trained that a different sound pitch predicted a negative event -- no food and a short noise.

The rats were then presented with sounds of intermediate pitch to determine whether they believed these ambiguous sounds indicated a good or bad event.

The rats kept in unpredictable housing conditions were more likely to regard these ambiguous sounds as heralds of negative events than the rats in stable environments.

"Studies have shown that anxious people seem to be particularly on the look-out for negative and threatening things, even at a subconscious level. We now have evidence that other animals may behave in a similar way, and this is an important finding for animal welfare," researcher Liz Paul, of the Centre for Behavioral Biology at Bristol University, says in a prepared statement.

She and her colleagues say their research provides a new way to measure the emotional state of animals. That may help scientists better understand the effects of lodging conditions on animal emotion and welfare.

More information

Here's where you can learn more about maintaining your emotional health.

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Study: Sleeping on It Helps in Problem Solving

By Patricia Reaney
Reuters
Wednesday, January 21, 2004

LONDON (Reuters) - Advice to "sleep on it" could be well founded, scientists said Wednesday.

After a good night's sleep a problem that seemed insurmountable the night before can often appear more manageable, although the evidence until now has been anecdotal.

But researchers at the University of Luebek in Germany have designed an experiment that shows a good night's sleep can improve insight and problem-solving.

"If you have some newly acquired memories in your brain sleep acts on these memories, restructures them, so that after sleep the insight into a problem which you could not solve before increases," said Dr Jan Born, a neuroscientist, at the university.

To test the theory, they taught volunteers two simple rules to help them convert a string of numbers into a new order. There was also a third, hidden rule, which could help them increase their speed in solving the problem.

The researchers, who reported their findings in the science journal Nature, divided the volunteers into two groups, half were allowed to sleep after the training while the remainder were forced to stay awake.

Born and his team noticed that the group that had slept after the training were twice as likely to figure out the third rule as the other group.

"Sleep helped," Born said in a telephone interview.

"The important thing is that you have to have a memory representation in your brain of the problem you want to solve and then you sleep, so it can act on the problem."

But Born admitted that he and his team don't know how restructuring of memories occurs or what governs it.

Pierre Maquet and Perrine Ruby of the University of Liege in Belgium said the experimental evidence supports the anecdotal suggestions that sleep can stimulate creative thinking.

"The authors (of the study) have applied a clever test that allows them to determine exactly when insight occurs in the time-course of learning," they said in a commentary.

Although the role of sleep in human creativity will still be a mystery, the research gives people good reason to fully respect their periods of sleep, they added.

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Keeping Diabetes at Bay After Transplant

HealthDayNews
Wednesday, January 21, 2004

WEDNESDAY, Jan. 21 (HealthDayNews) -- In research with mice, a new anti-inflammatory drug called lisofylline prevented diabetes recurrence after transplantation of insulin-manufacturing pancreatic islet cells.

University of Virginia Health System researchers report their finding in the Jan. 20 issue of Transplantation.

In recent years, pancreatic islet cell transplantation has become a promising treatment for people with type 1 diabetes. However, without powerful immunosuppressive drugs, those transplanted islet cells would be destroyed by the body's immune system.

This study suggests lisofylline may have the potential to help prevent this destruction by preserving insulin secretion by pancreatic beta cells in the presence of autoimmune attackers called inflammatory cytokines.

"Our findings are very encouraging and we are excited that lisofylline worked so well in this animal model," Dr. Jerry Nadler, chief of the University of Virginia's division of endocrinology and metabolism and director of the Diabetes and Hormone Center of Excellence, says in a prepared statement.

"We have discovered a potentially new way to protect islet cells in a clinical transplant setting. It's possible this research could form a basis for additional studies to use [the drug] or related anti-inflammatory compounds in humans to limit the need for more toxic immunosuppressant drugs in islet cell transplant patients," Nadler says.

More information

Here's where you can learn more about islet cell transplantation.

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Study: Learning to Juggle Causes Changes in Brain

Reuters
Wednesday, January 21, 2004

LONDON (Reuters) - It's a great party trick and useful for circus performers but scientists said Wednesday that learning to juggle can cause changes in areas of the adult brain.

Mastering the skill increases the amount of gray matter in areas of the brain that process and store visual information, proving what was not thought possible -- that new stimuli can alter the brain's structure.

A comparison of brain-imaging scans of non-jugglers and other volunteers before they learned to juggle and three months later, revealed an increase in gray matter in certain areas of the newly trained jugglers' brains.

"Our results challenge our view of the human central nervous system. Human brains probably must be viewed as dynamic, changing with development and normal learning," said Arne May, of the University of Regensburg in Germany, who headed the research team.

Gray matter refers to parts of the brain and spinal cord that are comprised of the tightly packed nuclei of nerve cells. In the brain it is mainly found in the outer layers of the cerebrum which is responsible for advanced mental functions.

In a report in the science journal Nature, May and his colleagues said brain scans done three months after the new jugglers had stopped juggling showed the increase in gray matter had been reduced.

"I believe the challenge we face is...to be able to adapt and modulate this knowledge into disease management," May added in an email interview.

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Study Backs Chemo for Lung Cancer

By Ed Edelson
HealthDay Reporter
HealthDayNews
Wednesday, January 21, 2004

WEDNESDAY, Jan. 21 (HealthDayNews) -- European researchers are reporting the first evidence that chemotherapy after surgery can improve the chances of survival for people with lung cancer.

To an untrained eye, the increased survival rate does not appear striking. Of the 932 patients who had chemotherapy after the cancer was removed surgically, 44.5 percent were alive after an average of 56 months, compared to 40.4 percent of the 932 patients who did not receive the drug treatment, says a report in the Jan. 22 issue of the New England Journal of Medicine (news - web sites). The research was conducted by the International Adjuvant Lung Cancer Trial Collaborative Group.

But, notes Dr. Ronald H. Blum, author of an accompanying editorial, "In terms of relative risk reduction, that does represent the same order of magnitude we see for other standards of care -- for breast cancer and colon cancer, for example."

A key finding of the study is that a two-drug combination is needed and one of the drugs should be cisplatin, a well-established cancer drug, Blum says.

One reason why such results have not been reported until now is that "clinical studies done in the past have not been large enough," Blum says. The newly reported study included patients at 148 medical centers in 33 countries.

But the results also show that "chemotherapy for lung cancer has improved," says Blum, who is director of cancer centers and programs at Beth Israel Medical Center and St. Luke's- Roosevelt Hospital Center in New York City.

Newer cancer drugs that are more effective are now available, he says, and "we need to confirm this study and do additional ones to take advantage of the newer agents."

The European results will affect the way he treats lung cancer patients, Blum says, adding, "This is a new standard of care."

He even uses the word "cure," noting that 39.4 percent of the patients who were given chemotherapy were alive and free of disease five years later, compared to 34.3 percent of those who did not.

But the chemotherapy is not without danger, the report adds. Seven patients died because of the toxic effects of the cancer drugs.

Because preliminary results of the trial were reported last year, chemotherapy already is being offered to many lung cancer patients, says Dr. Naiyer A. Rizvi, an assistant attending physician at Memorial Sloan-Kettering Cancer Center in New York City. But toxicity is an important concern in selecting patients for the treatment, he says.

"The median age of the patients in the study was 58," Rizvi says. "The mean age of patients in this country is 68. Chemotherapy is inherently a more toxic program that can be hard to deliver to an elderly patient, particularly one who has undergone a large surgical procedure."

But the increase in survival for those patients studied is clear, he says. And Dr. Julie Brahmer, an instructor in oncology at the Johns Hopkins Kimmel Cancer Center in Baltimore, says the finding "is exciting for lung cancer, because now we have something to offer to patients. Until now we didn't have anything."

For selected patients, Brahmer says, "chemotherapy is now standard treatment if a patient recovers properly from surgery."

Lung cancer is the leading cause of cancer deaths in the United States. The American Cancer Society (news - web sites) estimates that there will be nearly 174,000 new cases of lung cancer diagnosed in this country in 2004, and more than 160,000 deaths. The overwhelming majority of cases are attributed to smoking.

More information

What you need to know about lung cancer is explained by the National Cancer Institute, which also has a page on chemotherapy.

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New Clues May Help Battle Against Dengue Virus

Reuters
Wednesday, January 21, 2004

LONDON (Reuters) - U.S. scientists have gained new insights into how the dengue virus infects cells and spreads across countries, discoveries that could help combat a mosquito-borne disease which affects 50 million people a year.

Dengue, which occurs in the tropics, was first identified in the 1950s along with a potentially lethal complication called dengue haemorrhagic fever.

One study reported in the science journal Nature shed light on how authorities can contain dengue outbreaks.

Researchers at Johns Hopkins University in Maryland used a mathematical technique developed by NASA (news - web sites) to show that dengue cases in Thailand radiate in waves from Bangkok and infect areas throughout the country.

According to an analysis of infections in Thailand between 1983 and 1997, dengue travels in waves at about 148 km (92 miles) per month and takes about eight months to spread throughout the country.

The scientists suspect the waves are linked to the movement of people in Thailand.

"Our results suggest that high priority should be placed on surveillance and control systems in urban areas of Southeast Asia," said Professor Donald S. Burke, a co-author of the study.

In a separate study reported in Nature, researchers in Boston discovered how the virus infects cells in the body.

They used X-ray images of the virus's envelope protein, or membrane, to study the way it fuses with the cell and identified two points at which drugs or vaccines could interfere with the fusion process, the final step of infection.

"Infectious disease is a moving target, and understanding the mechanisms of viral entry is one of the ways that we can be forearmed against these viruses," said Stephen Harrison of Howard Hughes Medical Institute, who worked on the study.

The scientists believe their research could be adapted for other viruses including West Nile and hepatitis C.

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Unraveling the Monkeypox Mystery

By Amanda Gardner
HealthDay Reporter
HealthDayNews
Wednesday, January 21, 2004

WEDNESDAY, Jan. 21 (HealthDayNews) -- When a 3-year-old Wisconsin girl was hospitalized last year with a fever and a lesion on her finger where she had been bitten by a prairie dog, Dr. Kurt D. Reed knew he was dealing with an infection of some type.

It quickly became clear, however, that the girl had no ordinary bacterial infection, which is most common after an animal bite. Nor did her mother and father, both of whom also fell ill.

Doctors ruled out plague and tularemia, two types of bacteria that are known to infect prairie dogs and could possibly be transmitted to humans. And the symptoms didn't match up with rabies, which can also be acquired from an animal bite.

When bacterial cultures turned up negative, the doctors turned their attention to finding some type of virus.

A sample from a lesion found on the mother was put under an electron microscope and diagnosed as a pox virus.

"Then it got to be very confusing right away," says Reed, lead author of an article detailing this novel investigation that appears in the Jan. 22 issue of the New England Journal of Medicine (news - web sites). "There wasn't much in the medical literature about prairie dogs having pox viruses at all."

At the time, Reed and his colleagues also thought they were dealing with isolated cases. "By that time, the child was out of the hospital recovering, the mother was never in the hospital and they had a relatively mild illness," Reed says. "We were thinking this is really an interesting, unusual case, but we didn't feel we had an outbreak on our hands."

In fact, Wisconsin and other Midwestern states did have an outbreak -- of monkeypox spread by contact with pet prairie dogs. In all, there were 72 suspected cases and 37 confirmed cases in humans during May and June of 2003. All were linked to one distributor who had received a shipment of prairie dogs that had traveled with a Gambian giant rat that originally came from Africa.

"That's when a very unclear picture came into sharp focus over the course of just a couple of hours," Reed says. The geographical range of the Gambian rat matched that of monkeypox.

Monkeypox was first recognized in 1958 in monkeys. The first human cases were reported in Zaire in 1970, and there have been sporadic outbreaks since then, all of them in Africa.

Last year's Midwestern outbreak was notable not only because it was the first instance of humans being infected outside of Africa, but also because of what it might portend for the future.

"This is another reaffirmation of what we see time and time again when we introduce animals into a new area that they've never been in," says Dr. John Zaia, chairman of virology at the Beckman Research Institute at City of Hope National Medical Center in Duarte, Calif.

"Here we actually import animals that are potentially infected, introduce them into a population that is totally naive in terms of infection, and see not only the potential [for] spread [of disease] in indigenous animals in the area, but also [in] humans... It is the shrinking world that allows this sort of thing to happen," he says.

"If we continue to import animals from parts of the world that have these infections, then, of course, this could happen again. That's why they made state and federal bans on importing rodents from Africa," Reed adds.

But it's not only imports that could be a problem. What happens if native North American species, such as mice or squirrels, become infected and start passing the disease on?

There's no evidence that this has happened, but it is a concern. "We have put a lot of effort into trying to determine if that actually took place," Reed says. "This is a virus that our animal species in North America haven't been exposed to, so certain species would have a high fatality rate. If you had enough viral activity, there would be continued potential exposure to humans."

More information

For more on monkeypox, visit the U.S. Centers for Disease Control and Prevention and the World Health Organization.

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US Group Sees No Suicide-Antidepressant Link

By Lisa Richwine
Reuters
Wednesday, January 21, 2004

WASHINGTON (Reuters) - Antidepressants such as Prozac and Paxil do not raise the risk of suicide in children and teenagers, a group of pharmacologists said on Wednesday in a preliminary report released amid a review by U.S. regulators.

Health officials in the United States and Britain are probing a possible link between antidepressants and suicide. A U.S. Food and Drug Administration (news - web sites) advisory panel is scheduled to discuss the topic at a public meeting Feb. 2.

British drug safety experts said in December that most selective serotonin re-uptake inhibitor, or SSRI, antidepressants should not be used by children or adolescents.

In response to the concerns, the American College of Neuropsychopharmacology, or ACNP, said it evaluated all published clinical trials on treatment of children with SSRIs. The group acknowledged, however, that it did not have access to "a substantial amount of data" available to regulators and pharmaceutical companies.

The pharmacologists' group said research it reviewed showed evidence of a connection was "weak."

"We don't see this as a compelling problem" based on current data, Dr. J. John Mann, chief of neuroscience at New York State Psychiatric Institute and co-chair of the ACNP task force that studied the issue, said at a news conference.

"The evidence, if anything, favors of positive effect," Mann said, noting that those treated with the antidepressants were less likely to voice suicidal thoughts or exhibit suicidal behavior.

Drug makers say millions of patients have taken SSRIs without problems and that any suicidal thoughts are the result of depression rather than treatment.

The task force reviewed clinical trials involving more than 2,000 youth and found no significant increases in suicide attempts or suicidal thinking related to the antidepressants. No deaths by suicide were reported in the trials.

One shortcoming, however, was that people most likely to commit suicide generally were not included in the studies, Mann said.

Only Eli Lilly and Co.'s Prozac, also sold generically under the name fluoxetine, is approved by U.S. regulators for use in treating children with depression. But doctors may prescribe any approved drug for youth depression.

Other SSRIs include GlaxoSmithKline's Paxil and Pfizer Inc.'s Zoloft.

ACNP is a nonprofit group that receives some unrestricted grants from pharmaceutical companies, but no industry funding was used to pay for the report, said Dr. Joseph Coyle, ACNP's past president.

Thee UK's Committee on Safety of Medicines last year advised that GlaxoSmithKline Plc's Seroxat/Paxil and Wyeth's Efexor/Effexor should not be prescribed to under-18s, after a review found they were associated with an increased rate of self-harm and suicidal thoughts.

Only fluoxetine, or Prozac, had been shown in clinical trials to have a favorable balance of risks and benefits for the treatment of major depressive disorder in under-18s, the UK committee said in a statement.

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New, Old Alzheimer Drugs Work Together

By Serena Gordon
HealthDay Reporter
HealthDayNews
Wednesday, January 21, 2004

TUESDAY, Jan. 20 (HealthDayNews) -- When it comes to treating Alzheimer's disease (news - web sites), two drugs may be better than one.

A new study appearing in the Jan. 21 issue of the Journal of the American Medical Association (news - web sites) found the combination of the recently approved drug, memantine, with an older medication, donepezil, slows the progression of cognitive decline in people with moderate to severe Alzheimer's disease.

"This is the first medicine in a brand new class. We now have a second treatment option that can buy people time, and in some cases improve their cognitive ability," says study author Dr. Pierre Tariot, a professor of psychiatry, medicine and neurology at the University of Rochester Medical Center in Rochester, N.Y. But, he adds, this medication is not a cure.

Another new Alzheimer's study finds that a state-of-the-art brain scan has detected, for the first time, a key protein in the brain closely associated with Alzheimer's. Having such a scan can help diagnose the disease much earlier. Typically, Alzheimer's is diagnosed through characteristic symptoms, but is confirmed only after an autopsy.

Alzheimer's disease is a degenerative disease of the brain that causes memory loss, difficulty learning, loss of language skills, difficulty performing routine tasks, disorientation and personality changes. More than 4 million Americans currently have the disease, according to the Alzheimer's Association. During the next 50 years, it's estimated that more than 11 million people in the United States will develop the disease.

Treatment options for the disorder are limited. Until recently, the only class of medications available to treat the memory problems of Alzheimer's was cholinesterase inhibitors, such as donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl). These drugs work by increasing the levels of a neurotransmitter in the brain called acetylcholine, which aids in memory and learning.

The U.S. Food and Drug Administration (news - web sites) approved memantine (Namenda) in October 2003. Memantine works by regulating levels of glutamate, a neurotransmitter that also aids in learning and memory, because too much glutamate can be damaging.

Tariot and his colleagues gave 322 people with moderate to severe Alzheimer's disease either the memantine-donepezil combination or a placebo. The study participants were from 37 different areas across the United States, they were mostly white, and their average age was 75.

The researchers administered function tests at four, eight, 12, 18 and 24 weeks. One test is called the Severe Impairment Battery (SIB), and it measures cognitive dysfunction in people with Alzheimer's. Scores on this test range from 0 to 100. Another test the researchers administered was the Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory (ADCS-ADL), which measures how a person can perform daily tasks and scores range from 0 to 54.

At the end of the study, people in the drug combination group had increased nearly one point on the SIB scale, while those in the placebo group had dropped 2.5 points. On the ADCS-ADL scale, those receiving the combination treatment dropped two points compared to 3.4 points for the placebo group.

While the differences may not look large, Tariot says the group treated with memantine-donepezil performed statistically better than the placebo group. He adds that if your loved one has Alzheimer's, any improvement in cognitive function can offer some relief or hope.

He says the treatment was very well tolerated and, in fact, there were fewer side effects reported by the treatment group than the placebo group.

William Thies, vice president for medical and scientific affairs for the Alzheimer's Association, says the drug combination "had about the kind of effect we expected."

He says this study is a good start, and eventually the drug will likely be tested for use in people with mild Alzheimer's disease as well.

"There continues to be progress in the battle against Alzheimer's disease, and we will eventually beat this disease," Thies says. "We're just not done yet."

Another progressive move comes from the second new study, in which University of Pittsburgh researchers tested an amyloid-imaging positron emission tomography (PET) with a new tracer they dubbed Pittsburgh Compound-B. Amyloid is the protein that is deposited in the brains of Alzheimer's patients.

Though the study was small -- 16 patients with diagnosed mild Alzheimer's got the novel scan, and there were nine healthy control patients -- the researchers found a "robust" difference in the amount of amyloid present in the brains of the Alzheimer's patients.

Dr. John C. Morris, a neurologist at Washington University in St. Louis and a board member of the Alzheimer's Association, says the scanning study "has enormous implications."

The scans could be used to track the performance of drugs, vaccines and other therapies that break down amyloid or prevent it from forming, Morris says. The technology could also help diagnose Alzheimer's in living people and possibly predict who's likely to get the disease based on their brain chemistry.

"Those are all big ifs, but now we have the tool with these imaging molecules," he says.

More information

Learn more about the disease from the Alzheimer's Association, which also has a page on treatment options.

HealthDay reporter Adam Marcus also contributed to this report.

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Tuesday, January 20, 2004

U.S. Probing Dietary Supplement Safety

By Lisa Richwine
Reuters
Tuesday, January 20, 2004

WASHINGTON (Reuters) - U.S. regulators who decided to ban the weight-loss herb ephedra are studying whether other dietary supplements are too dangerous to be sold, the head of the Food and Drug Administration (news - web sites) said on Tuesday.

FDA Commissioner Mark McClellan singled out bitter orange, aristolochic acid and usnic acid as ingredients under increased scrutiny. All have been used in supplements promoted for weight loss.

The FDA warned consumers in April 2001 that aristolochic acid had been linked with kidney damage, but some supplements on the market may still contain the ingredient, McClellan said. In November 2001 the agency warned that usnic acid may lead to serious liver toxicity.

"While most supplements are probably safe in the dose people take them, we are concerned about a number of other dietary supplements that are currently on the market," McClellan said during a speech at the University of Mississippi.

"We will be doing more work in the coming months to more closely evaluate the potential safety risk of these products, and we could take further action to remove unsafe dietary supplements from the market," McClellan added.

Michael McGuffin, president of the American Herbal Products Association, said the industry welcomes closer FDA oversight, hoping it will help boost public confidence in supplements.

"We don't want to be ignored. We want the agency to be activist. We want the bad players removed," McGuffin said.

Makers of dietary supplements such as vitamins, herbs and minerals do not have to prove the products are safe and effective before they can be sold. The government must show a supplement presents an "unreasonable" risk to order it off the market.

The FDA last month said it would ban ephedra, an herbal stimulant, after determining it was linked to heart attacks, strokes and deaths. Ephedra makers insist the herb is safe when used as directed.

The ban will take effect 60 days after the FDA publishes its final rule on ephedra. The rule may be released as early as next week, a senior FDA official said.

Industry groups said they agreed aristolochic acid can be toxic and already had called for removal of the ingredient in dietary supplements.

The Council for Responsible Nutrition, which represents supplement makers, supports additional study of usnic acid and bitter orange, said John Hathcock, vice president of scientific and international affairs.

"We would always support more research," Hathcock said.

Bitter orange is chemically similar to ephedra but has weaker biological activity and "ought to be safer" than ephedra, Hathcock said.

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Governments Back WHO's Anti-Obesity Plan

By Jonathan Fowler
Associated Press Writer
The Associated Press
Tuesday, January 20, 2004

GENEVA - Governments gave cautious backing Tuesday to a United Nations (news - web sites) plan to promote healthier lifestyles, part of a global effort to reduce obesity and help battle heart disease and diabetes.

Countries, including the United States, seen by campaigners as a holdout said they approved broadly of the World Health Organization (news - web sites)'s draft Global Strategy on Diet, Physical Activity and Health.

"We need a strategy to take us out of the comfort zone, because more of the same is clearly not an option," New Zealand delegate Gillian Durham told Tuesday's three-hour meeting.

The 18-page document, presented at a meeting of the 32-country WHO executive board, aims to guide international efforts to fight illnesses related to bad diet and lack of exercise.

The Bush administration has faced criticism for allegedly kowtowing to the food industry and trying to dilute the document, which includes pushing industry to make deeper cuts in sugar and fat in food and changes to advertising and tax policy to promote healthier diets.

Some 300 million people worldwide are obese and 750 million more are overweight, including 22 million children under age 5, according to the International Obesity Task Force. Once largely a problem of industrialized nations, obesity now is hitting developing countries too.

Diseases, including cardiovascular problems and diabetes, kill 34 million people a year, or around 60 percent of annual deaths worldwide. Most deaths are in poor countries.

Unlike a landmark tobacco control accord brokered last year by WHO, the document would not lead to a binding treaty obliging WHO members who accept it to respect its provisions.

Still, the food industry has criticized some of the suggestions, particularly recommendations on sugar, saying they are based on flawed science.

However, in a joint statement, the Grocery Manufacturers of America the world's largest association of food and drink companies, with members including PepsiCo Inc. and Hershey Foods Corp., said they were pleased with the move Tuesday.

U.S. officials have said their concerns with the document were based on science, not on the views of industry.

Earlier this month, campaigners slammed U.S. delegation head William Steiger after he challenged WHO director-general Dr. Lee Jong-wook about a WHO study used to draft the obesity strategy.

Steiger, special assistant for international affairs at the Department of Health and Human Services (news - web sites), said the WHO report did not adequately address an individual's responsibility to balance one's diet with one's physical activities. He also objected to singling out specific types of foods, such as those high in fat and sugar.

"This is all about how do we motivate people, how do we change attitudes and how do we change behavior," Steiger told the WHO board Tuesday. "If this strategy is not relevant to individuals, nothing's going to happen."

Campaigners stressed the need for government action.

"Public good, not corporate benefit, should be paramount in government advice and policies," said Julian Edwards, head of the London-based group Consumers International.

The WHO executive also accepted a U.S. proposal allowing governments more time to suggest changes to the document before it is presented to the 192-nation World Health Assembly in May for final approval. Countries including Pakistan, South Korea (news - web sites) and the Philippines backed the U.S. proposal. But Canada, European nations and New Zealand said the draft was fine.

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Parents Increasingly Question Vaccine Wisdom

By Maggie Fox, Health and Science Correspondent
Reuters
Tuesday, January 20, 2004

WASHINGTON (Reuters) - The posting on an Internet Web site sounded plaintive. Marianna Toce Gerstein wondered whether as a pregnant woman she should get a flu shot.

Although influenza vaccines are recommended for pregnant women, she was worried because she knows the vaccine contains a mercury-based preservative called thimerosal. She fears it could injure her unborn child.

"Has anyone else struggled with this?" she asked.

Gerstein's gynecologist told her to get the vaccine but her other doctor, an internist, told her not to take the risk with her baby's health. Gerstein is aware of the advice from the Centers for Disease Control and Prevention (news - web sites): Pregnant women in their second and third trimesters should get the shot because their immune systems are suppressed.

But she does not want to blindly follow anyone's advice.

She is not alone. A survey published this month suggests a growing number of U.S. parents are beginning to question either the need for vaccines for their children, or the need to follow the recommended schedule of multiple shots between the ages of 3 months and 3 years.

"We found that a large number of both pediatricians and family physicians had experienced at least one parent vaccine refusal in the last year," Dr. Gary Freed of the University of Michigan said in a telephone interview.

The survey of nearly 1,500 doctors found that 93 percent of pediatricians and 60 percent of family physicians had seen at least one parent who refused a vaccine for his or her child in the past year.

Worries About Side-Effects

Writing in the January issue of the American Journal of Preventive Medicine, Freed and colleagues said 19 percent of doctors reported the parents feared the vaccines could affect their babies' immune system.

Sixteen percent said the parents wondered whether children really needed all the vaccines recommended by the CDC.

"A growing number of parental concerns were relating to unproven or disproven concerns about childhood immunization such as whether mercury was harmful or the now disproven speculation about an association between the MMR (measles, mumps and rubella vaccine) and autism," Freed said.

The CDC is clear: Vaccines save lives, are extremely safe and are still necessary.

For instance, measles makes as many as 40 million people around the world sick every year and kills 745,000, according to the World Health Organization (news - web sites).

"If vaccinations were stopped, each year about 2.7 million measles deaths worldwide could be expected," the CDC says.

In Britain a growing anti-vaccine movement means just 84 percent of children are immunized against measles by age 2 -- a level that leaves the population vulnerable to an epidemic. Last year, 308 cases of measles were reported in Britain.

Gerstein appreciates the benefits of vaccines, but says no one can tell her the risk-benefit trade-off of getting herself vaccinated against flu. Adding to the confusion are recent Food and Drug Administration (news - web sites) advisories that some tuna contains high levels of mercury and that pregnant women should limit how much they eat.

Fish Warnings

"You see signs around the doctor's office all the time telling you not to eat (certain) fish," she said in a telephone interview. "And at same time there is this whole thing with thimerosal and vaccines."

Vaccine experts were confused, too -- so much so that the Environmental Protection Agency (news - web sites) bases its limits for mercury exposure on what is known about damage done by methyl mercury contamination.

Methyl mercury is the form found in fish. But the mercury in thimerosal is ethyl mercury.

"These two molecules are very different," said Dr. Paul Offitt, an immunization expert at Children's Hospital of Philadelphia.

"They are just biologically very different agents. The problem is the word mercury is at end of both of them and there is no way that mercury ever sounds good."

But Offitt and colleagues at the National Partnership for Immunization recently completed a review of mercury studies and concluded that the very small dose of mercury contained in thimerosal-preserved vaccines is cleared by the body before it can do any damage.

"The mercury ... from thimerosal -- it is eliminated from the body much more quickly than methyl mercury," said Dr. Polly Sager of the NPI and a researcher at the National Institute for Allergy and Infectious Diseases.

In any case thimerosal has been removed from all childhood vaccines.

Gerstein was relieved to hear about the group's findings but is still worried that she could not find any details about the risks and benefits of a pregnant woman getting a flu shot. She ended up not getting one, and plans to wash her hands frequently and avoid situations where she may get flu.

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Avoid Undercooked Meat

HealthDayNews
Tuesday, January 20, 2004

(HealthDayNews) -- Meat that hasn't been cooked properly can harbor dangerous bacteria.

The University of California, Davis, suggests you use a food thermometer to determine meat's readiness. Here are a couple of temperature tips:

  • Red meats should be cooked to 160 degrees Fahrenheit.
  • Ground meat and hamburgers should be cooked all the way through until the center is at least 160 to 165 degrees F.

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Fat, in Moderation, Helps Immune System-Scientists

Reuters
Tuesday, January 20, 2004

CHICAGO (Reuters) - Based on studies of pigs, researchers said on Tuesday that fat helps fend off illness.

Besides keeping a body warmer, fat cells, or adipocytes, produce hormone-like proteins in reaction to invading toxins, behaving much like immune cells that fight disease.

"Adipocytes can be functional and beneficial without creating obesity," said Michael Spurlock, an animal sciences professor at Purdue University in West Lafayette, Indiana.

Writing in the American Journal of Physiology, Spurlock and colleagues from the university's veterinary school said fat cells play a role in helping insulin regulate blood sugar levels and can aid the immune system's response to cancerous cells.

However, too much fat in pigs -- and presumably their relatively close cousins, humans -- upsets the body's hormonal balance. As fat cells accumulate an excess of fatty acids, called lipids, they secrete too much of some biochemicals and too little of others, creating abnormalities that can lead to diseases such as diabetes.

Foreseeing an advancement in the fight against diabetes, cancer and other illnesses, Spurlock said the goal is to find the biochemical triggers for fat cells, immune cells, and the body's metabolism so they can be manipulated.

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Childhood Seizures

HealthDayNews
Tuesday, January 20, 2004

(HealthDayNews) -- Children have seizures for reasons ranging from high fevers to underlying medical conditions.

While they can be terrifying, seizures usually last only a few minutes, according to The Nemours Foundation.

If your child has a seizure, here's what to do:

  • Gently place your child on the floor and remove any nearby objects.
  • Loosen clothing around his or her head or neck.
  • Don't try to prevent the shaking.
  • Don't put anything in your child's mouth.
  • Roll your child onto his side. If he vomits, keep him on his side and clear his mouth out with your finger.
  • Don't give your child anything to drink until he is fully alert.
  • Call the doctor immediately.

Seek emergency medical care if your child:

  • Has a seizure lasting more than five minutes.
  • Has difficulty breathing.
  • Turns a bluish color on the lips, tongue, or face.
  • Falls or hits his or her head during a seizure.

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Study: U.S. Spent $75 Billion to Treat Obesity in '03

By Paul Simao
Reuters
Tuesday, January 20, 2004

ATLANTA (Reuters) - The cost of treating health problems caused by the U.S. obesity epidemic reached an estimated $75 billion last year, with taxpayers picking up about half the tab, according to a study released on Tuesday.

That conclusion, which is described by the study's lead author as "conservative," would mean that Americans spend almost as much on obesity-related health care services as they do to treat the illnesses caused by cigarette smoking.

Obesity, which increases the likelihood of heart disease, diabetes, some types of cancer and arthritis, has become twice as common in the nation since 1980. About 39 million Americans were obese in 2000, according to the U.S. government.

"The $75 billion number is about 5.7 percent of annual health care expenditures. Estimates for smoking are about 6 or 7 percent," said Eric Finkelstein, the study's lead author and an economist with North Carolina think tank RTI International.

RTI did the study in cooperation with the Centers for Disease Control and Prevention (news - web sites).

The study, which will be published in this month's issue of Obesity Research, were based on a statistical analysis of government data collected for the 1998 to 2000 period. Researchers used the data to project obesity spending in 2003 dollars.

Their analysis found that government-funded Medicare and Medicaid programs, which help millions of seniors and poor residents get access to health care, paid out an estimated $39 billion for obesity-related medical costs in 2003.

The study was made public on the same day that the United States succeeded in stalling a global obesity-control plan promoted by the World Health Organization (news - web sites).

Backed by its powerful food industry, the United States called on Tuesday for more study of the U.N. agency's plan, which urges cutting the intake of sugar, salt and artery-clogging trans-fatty acids and suggests governments promote healthier eating through subsidies and the tax system.

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Nicotine Plays on Emotions

HealthDayNews
Tuesday, January 20, 2004

TUESDAY, Jan. 20 (HealthDayNews) -- Nonsmokers experience negative emotions when given a laboratory dose of nicotine, while smokers feel a sense of satisfaction, says a University of Pittsburgh study in the current issue of Nicotine & Tobacco Research.

The study, which examined links between nicotine and mood, also found that ex-smokers felt more energized than others after receiving a nicotine dose, and that nonsmokers experienced more of a "head rush" than the others.

The 93 people in the study were asked to rate their feeling on 23 measures of emotion after they were given a dose of nicotine. Those 23 measures were then grouped into five major categories.

The researchers say this kind of scale may help researchers better understand the link between the emotional effects of nicotine and individual genetic, personality or sensation-seeking traits.

More information

Here's where you can learn more about nicotine addiction.

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Study: Cutting Back Doesn't Cut Toxins in Smokers

By Maggie Fox, Health and Science Correspondent
Reuters Health
Tuesday, January 20, 2004

WASHINGTON (Reuters) - Smokers who cut back the number of cigarettes they smoke may not be reducing the cancer-causing chemicals in their bodies as much as they had hoped, according to a report published on Tuesday.

The study, published in this week's issue of the Journal of the National Cancer Institute (news - web sites), suggests that cutting back is not nearly as good for the health as completely quitting, experts said.

When smokers smoke less, they probably drag longer and harder on every cigarette, the researchers said.

"The results indicate that some smokers may benefit from reduced smoking, but for most the effects are modest, probably due to compensation," they wrote.

The scientists, led by Stephen Hecht of the University of Minnesota Cancer Center, tested 92 smokers over six months.

They looked specifically for the remains of NNK, one of the best-known carcinogens in tobacco smoke.

The smokers, who had enjoyed an average 23.7 cigarettes a day, agreed to systematically cut back how much they smoked 25 percent fewer in the first two weeks, 50 percent fewer in the next two weeks and then by 75 percent, or more, if they could.

Urine tests showed that smokers who cut back by 55 percent to 90 percent reduced NNK by only 27 percent to 51 percent. Even smokers who were able to cut back to just two cigarettes a day reduced their NNK indicator levels by only 46 percent.

In a commentary, Scott Leischow and Mirjana Djordjevic of the Tobacco Control Research Branch at the National Cancer Institute said the study showed that completely kicking the habit is the only way to escape the damage done by cigarettes.

Dr. Michael Thun of the American Cancer Society (news - web sites) agreed.

"These results support other evidence that when smokers reduce the amount they smoke or switch to reduced tar cigarettes, they modify the way they smoke in order to extract more nicotine and tar from each cigarette," Thun said in a statement.

"The study complements other lines of evidence that suggest that quitting smoking is far more beneficial than reducing the number of cigarettes smoked. At least for lung cancer, the number of years spent smoking is far more important than the number of cigarettes smoked per day," he added.

"Furthermore, even very low amounts of smoking are associated with substantial increases in the risk of heart attacks."

Smoking causes 90 percent of all lung cancer cases and is the leading cause of heart disease, the No. 1 killer in the developed world

The study also showed how hard it is to quit. Six months into the study, 56 percent of the smokers had relapsed and were back to a pack a day or more.

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Erectile Dysfunction May Signal Heart Disease

By Ed Edelson
HealthDay Reporter
HealthDayNews
Tuesday, January 20, 2004

TUESDAY, Jan. 20 (HealthDayNews) -- Erectile dysfunction might be an early warning sign of blood vessel problems that can lead to heart attack or stroke, a new study finds.

The researchers found subtle problems in the arteries of men in their mid-40s who had erectile dysfunction but otherwise appeared to be healthy, says a report in the Jan. 21 issue of the Journal of the American College of Cardiology.

The finding has implications for the treatment of both erectile dysfunction and prevention of heart disease and stroke, says study leader Dr. Alan J. Bank, medical director of research at the St. Paul Heart Clinic in Minnesota.

"If they have erectile dysfunction, they should be treated more aggressively for high blood pressure, smoking and other risk factors for cardiovascular disease," Bank says. An added benefit is the drugs used for those risk factors might also improve sexual function.

Bank and his colleagues have started another study in which drugs such as statins, which reduce blood cholesterol levels, and ACE inhibitors, given for high blood pressure, can improve sexual performance of men with erectile dysfunction who have not responded well to Viagra, the first drug marketed for treatment of the problem.

"It will take a while to get results, but we are getting early indications that they might be effective," Bank says.

Some large epidemiological studies have pointed to a link between erectile dysfunction and cardiovascular conditions such as heart attack and stroke, Bank says. His study made a detailed examination of the brachial artery in the arms of 30 men with erectile dysfunction and a control group of 27 age-matched men without the problem. All were free of known risk factors for cardiovascular disease, such as high blood pressure, diabetes and smoking.

The arteries of men with erectile dysfunction had a worse response to measures to make them expand, such as nitroglycerine tablets. That failure to increase blood flow, a known factor in erectile dysfunction, can also affect arteries in the heart and other parts of the body, Bank explains.

"There is something abnormal about the smooth muscles in the artery walls," he says.

The finding "offers a lot of hope for improvement" for treatment of both cardiovascular disease and erectile dysfunction," Bank says. "We know a lot about blood vessel walls."

To provide a unified approach, a panel of five cardiovascular specialists and five urologists met last August and developed a set of guidelines about "how to approach erectile dysfunction -- what tests to do, how to handle the problem," Bank says. The guidelines have been submitted for publication in a medical journal.

"These results need confirmation and more explanation," says Dr. Melvin D. Cheitlin, professor emeritus of medicine at the University of California, San Francisco. Nevertheless, he says, "this is the first time as far as I can tell that someone is saying that people with erectile dysfunction may have problems with smooth muscle relaxation."

The "important message" of the study is that "erectile dysfunction can be a sign that an individual is at risk of arterial disease that can affect the coronary arteries," he says.

"A flagging penis should raise the red flag of warning to evaluate the patient for arterial disease elsewhere," Cheitlin concludes in the editorial.

More information

A description of erectile dysfunction and its treatment can be found at the National Institute of Diabetes & Digestive & Kidney Diseases or the Endocrine Society.

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Iron from Red Meat May Raise Diabetes Risk

Reuters Health
Tuesday, January 20, 2004

NEW YORK (Reuters Health) - There may be another reason to be wary of eating too much red meat. High intake of iron from red meat may raise a person's risk of diabetes, new research suggests.

Iron from other sources does not seem to have this effect, however.

The results of several studies have suggested a link between excessive body levels of iron and the development of diabetes. However, there has been little evidence from forward-looking studies to support this association.

To investigate, Dr. Rui Jiang, from the Harvard School of Public Health in Boston, and colleagues assessed the link between iron intake and type 2 diabetes in 38,394 men who participated in the Health Professionals' Follow-up Study. The subjects were free of diabetes, heart disease, and cancer when the study began in 1986.

During the 12-year study period, 1168 men developed type 2 diabetes, the researchers note in the American Journal of Clinical Nutrition (news - web sites).

The risk of type 2 diabetes increased as heme-iron intake from red meat sources rose. Heme-iron is a type of iron found in red blood cells.

In contrast, total iron intake, heme-iron intake from non-red meat sources, and receiving blood transfusions were not associated with diabetes risk.

"Heme-iron intake from red meat appears to be associated with an increase risk of type 2 diabetes, but our study was unable to determine whether this association was due to heme iron per se or to other components of red meat," the investigators state.

"Further cohort studies are needed to examine iron intake and direct measures of body iron stores in relation to the risk of diabetes," they say

Source: American Journal of Clinical Nutrition, January 2004.

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Panel Hedges on Routine Thyroid Screening

By Karen Pallarito
HealthDay Reporter
HealthDayNews
Tuesday, January 20, 2004

TUESDAY, Jan. 20 (HealthDayNews) -- There isn't enough evidence to support routine testing for thyroid disease among adults who have no symptoms.

That's the recommendation contained in a new report from the U.S. Preventive Services Task Force. The expert panel found no convincing studies to show that asymptomatic patients do better if they begin treatment before symptoms of thyroid disease develop.

"We don't have sufficient evidence to say it isn't beneficial; we don't have sufficient evidence to say it is," says Dr. Bruce Nedrow Calonge, the panel's newly appointed chairman.

The preventive services task force, convened by the federal Agency for Healthcare Research and Quality, makes recommendations on a range of clinical preventive services. Its latest report appears in the Jan. 20 issue of the Annals of Internal Medicine.

Its core recommendation remains unchanged from 1996, when it last weighed the scientific evidence on screening for thyroid disease.

But the panel's view conflicts sharply with that of the American Thyroid Association. That group recommends measuring thyroid function in all adults beginning at age 35 with follow-up testing every five years.

The thyroid is a gland in the base of the neck that produces hormones that regulate key body functions. Almost 15 million Americans suffer from thyroid disease, according to the Thyroid Foundation of America. The most common disorders include hyperthyroidism, a condition in which the thyroid gland makes too much hormone, and hypothyroidism, when it doesn't make enough.

Women are much more likely to develop a thyroid disorder than men, according to the National Women's Health Information Center. When the thyroid isn't functioning properly, it can affect weight, energy level, muscle strength, skin health, menstrual cycle, memory, heart rate and cholesterol level, the center says.

Symptoms of an underactive thyroid include weakness and fatigue, weight gain, dry hair and skin, and increased sensitivity to the cold.

An overactive thyroid, most commonly caused by a disorder known as Graves' disease, is marked by fatigue, weight loss, nervousness, and increased sensitivity to heat. It can also cause bulging of the eyes.

Not all patients develop symptoms, especially early on, and doctors disagree about the need to identify and treat patients.

There is fair evidence, says Calonge, that the test for thyroid disease -- the thyroid stimulating hormone (TSH) test -- can detect disease in people without symptoms. But, he adds, the evidence is poor that treatment improves "clinically important outcomes."

So, is it worthwhile or not for primary-care physicians to test thyroid function in patients who have no specific symptoms or history of problems?

Dr. Mark Helfand, director of the Evidence-based Practice Center at the Oregon Health & Science University in Portland, compiled and reviewed existing studies to help the task force answer that question.

What's lacking, he says, is good data from controlled trials showing that early treatment reduces cholesterol levels, symptoms, or the risk for cardiovascular disease in patients with mild thyroid dysfunction detected by screening.

While there is plenty of evidence to show that early diagnosis and treatment of women with low bone density, for example, prevent fractures, the same standard of proof is lacking for thyroid disease, he says.

Of the studies that focus on thyroid disease, he adds, "most of them don't include asymptomatic patients at all."

More information

To learn more about the thyroid gland, visit University of Maryland Medicine. For more about thyroid diseases, check with the National Library of Medicine.

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Virus Found in Men with Prostate Cancer

By Anthony J. Brown, MD
Reuters Health
Tuesday, January 20, 2004

NEW YORK (Reuters Health) - Up to 40 percent of men with prostate cancer have a virus in their blood that, until now, has been linked to relatively rare cancers, new research shows.

Previous reports have tied human herpesvirus 8 (HHV-8) to Kaposi's sarcoma, a cancer usually seen in AIDS (news - web sites) patients, and to a rare type of lymphoma. This latest report is the first to link HHV-8 in the blood with prostate cancer -- a very common type of cancer.

Still, senior author Dr. Frank J. Jenkins, from the University of Pittsburgh, Pennsylvania, was quick to emphasize that "this does not mean that HHV-8 causes prostate cancer." Previous studies looking for the virus in the prostate gland itself have yielded conflicting results, he added.

The findings, which are reported in The Journal of Infectious Diseases, are based on a study of 452 men in Tobago and Trinidad and 376 men from the United State. In each group, about a third of the men had prostate cancer and the remainder did not.

In the West Indies group, nearly 40 percent of men with prostate cancer had evidence of HHV-8 in their blood, nearly double the rate seen among men without this cancer, the researchers found.

In the US group, the rate of HHV-8 infection among men with prostate cancer was 20 percent, about 15 percent higher than the rate among male blood donors and about 7 percent higher than the rate among men with non-HHV-8-related cancers.

HHV-8 could serve as a co-factor for the initial development of prostate cancer or for the advancement to higher-grade lesions, Jenkins told Reuters Health. Alternatively, "HHV-8 could simply represent a marker for some other infection that" directly causes cancer.

Currently, Jenkins said, his team is looking at links between HHV-8 and genetic mutations that have been tied to prostate cancer. "If you assume that the virus is causing the cancer, the next question becomes how."

Source: The Journal of Infectious Diseases, January 1, 2004.

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Few Sessions on the Couch Can Lead to Improved Sleep

HealthDayNews
Tuesday, January 20, 2004

TUESDAY, Jan. 20 (HealthDayNews) -- Cognitive behavioral therapy may be a better choice than sleeping pills for elderly people with insomnia, says a British study in the current issue of Sleep Medicine Review.

The researchers reviewed previous research to assess the effectiveness of cognitive behavioral treatments (CBT) for people older than 60 and found consistent sleep improvements for people who had CBT.

Cognitive behavioral therapy helps people change poor sleep habits and challenges negative thoughts, attitudes and beliefs about sleep. For example, people are taught to improve their sleep habits by: reducing caffeine intake after 4 p.m.; taking the proper steps to prepare for sleep; or practicing muscle relaxation skills.

Helping people overcome anxiety about insomnia is another CBT intervention shown to be effective.

"Older people are often prescribed a range of drugs for their health problems, many of which have side effects," Dr. Paul Montgomery, a researcher at Oxford University, says in a prepared statement.

"Such side effects are just one reason why there is an argument to be made for clinical use of non-pharmacological treatments. Further research into which elements of cognitive behavioral therapy are most useful is needed. To increase long-term effect, it may be necessary to do 'top-up' sessions at regular intervals. Cognitive behavioral therapy may also be useful in preventive education for sleep disorders," Montgomery says.

More information

Here's where you can learn more about how to get a good night's sleep.

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Teen Obesity Tied to Adult Death Risk

By Amy Norton
Reuters Health
Tuesday, January 20, 2004

NEW YORK (Reuters Health) - A large study links adolescent obesity to an increased risk of death by middle-age, though the connection seems to be largely explained by the tendency of obese teens to remain so as adults.

This persistence of obesity did not fully account for the higher death risk among women who were obese as teenagers, however. The finding suggests that adolescent obesity may in the long run be more harmful for women than men, the study's lead author, Dr. Anders Engeland, told Reuters Health.

Engeland, a senior researcher at the Norwegian Institute of Public Health, and his colleagues gleaned their findings from data on more than 128,000 residents of Norway surveyed over four decades.

Because these individuals were followed only into middle age, only a small percentage had died by the end of follow-up. Still, people who had a "very high" body mass index (BMI, a measure of weight in relation to height) as teenagers had a 30 to 40 percent higher mortality rate, the researchers report. The average age at death was 46.

The findings appear in the January issue of the journal Epidemiology.

According to Engeland, adolescent obesity in this study usually lasted into adulthood, and this persistence accounted for most of the relationship between high teenage BMI and premature death.

There was some evidence, he noted, that obese boys who eventually lost the weight had death risks similar to men who were normal weight as teens. He added, though, that the data were "sparse" on this point.

As for women, persistent obesity partially explained the link between high teenage BMI and premature death -- but not to the extent seen in men. Even when adult BMI was factored in, women who were obese as teens were about 30 percent more likely than those with an average teenage BMI to die by middle-age.

Engeland had no explanation for the different findings for men and women. Whatever the reason, he said the findings suggest that adolescent obesity might have relatively more harmful long-term effects in women than in men.

Obesity in adulthood is known to increase the risk of a number of serious medical conditions, including diabetes and heart disease. The health effects of teen obesity are less clear, but the rate of type 2 diabetes among U.S. children and teens has risen in tandem with high BMI.

It's estimated that anywhere from 50 to 80 percent of obese teens become obese adults.

Source: Epidemiology, January 2004.

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Stress Taxes Your Health

HealthDayNews
Tuesday, January 20, 2004

TUESDAY, Jan. 20 (HealthDayNews) -- Social and behavioral factors, such as stress, contribute to more than half of all deaths in the United States.

That's the contention of a Vanderbilt University researcher who reviewed a century's worth of psychological literature on stress, disease and behavioral medicine.

Psychologist Oakley Ray's findings, published in the January issue of American Psychologist, add to the growing body of evidence about the impact of non-biological factors on health.

Recent research has found that stresses that affect the brain can hurt the body at the cellular and molecular level, resulting in diminished health and quality of life. On the other hand, maintaining a positive frame of mind can help people fend off some of these stress effects, combat disease and live longer.

Ray says the challenge is to introduce this new knowledge into the health-care system.

"Knowing how the brain influences peoples' health and susceptibility to illness can bring important changes to the health-care system. Understanding how the mind, the endocrine system, the nervous system and immune system all interact is crucial in helping people conquer the stress in their lives and stay healthy," Ray says in a prepared statement.

As an example, he cites a study that found a large number of medical students became ill with upper respiratory tract infections close to their exam period.

"This study shows how stress levels can overwhelm a person's ability to cope and increase their risk for infectious disease," Ray says.

More information

Here's where you can learn more about how stress affects the body.

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C-Section Lowers Odds of Future Normal Delivery

Reuters Health
Tuesday, January 20, 2004

NEW YORK (Reuters Health) - As a treatment for delayed labor, c-section is tied to lower vaginal delivery rates in future pregnancies than is non-surgical delivery with special instruments, British researchers report.

The findings are based on a study of 393 pregnant women who underwent either c-section or instrument delivery for delayed labor. Three years after this initial delivery, the women were given a questionnaire to assess their subsequent pregnancies.

The report is published online by the British Medical Journal.

Of the 283 women who responded to the survey, 150 had a c-section and 133 had an instrumental delivery during their first pregnancy. A subsequent pregnancy was reported by 140 of the respondents.

Women who had an instrumental delivery were about 16-times more likely than women who had a c-section to aim for a vaginal delivery in future pregnancies, senior author Dr. Deirdre J. Murphy and colleagues, from the University of Dundee in the UK, note. The likelihood of future vaginal delivery was about 10-times higher in such women compared with their c-section-treated peers.

Still, the authors found that the rate of future vaginal delivery was 94 percent for c-section-treated women who attempted such delivery.

Nearly one third of women wished to avoid further pregnancy after their initial delivery. In both patient groups, a fear of childbirth was among the most common reasons cited for wanting to avoid pregnancy.

The results indicate that the type of delivery has a strong impact on future delivery outcomes, the investigators state.

"Although morbidity issues need to be considered with instrumental vaginal delivery, we must continue to offer choice when difficulties are encountered in the second stage of labour," they advise.

Source: British Medical Journal, January 14th online issue, 2004.

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Tamoxifen Underused for Early Breast Cancer

By Amanda Gardner
HealthDay Reporter
HealthDayNews
Tuesday, January 20, 2004

TUESDAY, Jan. 20 (HealthDayNews) -- Despite its strong track record against breast cancer, many women with the earliest form of the disease are not turning to tamoxifen as a treatment.

A study in the March 1 issue of Cancer finds women with ductal carcinoma in situ (DCIS) and their physicians appear reluctant to use the breast cancer drug, perhaps because of some of its side effects.

This is despite evidence that the drug has a proven benefit in women with DCIS: The 1999 National Surgical Adjuvant Breast and Bowel Project found it reduced the absolute risk of cancer recurrence by about 5 percent for these women.

"Despite a well-published, randomized trial, the adoption of what the trial stated has not been as universally accepted as thought," says Dr. Jay Brooks, chief of hematology/oncology at the Ochsner Clinic Foundation in New Orleans.

Dr. Henry M. Kuerer is the new study's senior author and director of the Breast Surgical Oncology Training Program at the University of Texas M.D. Anderson Cancer Center. "As part of giving any patient a treatment we have an informed consent process," he explains. "But in this particular situation, it's more appropriate to call it informed refusal."

Kuerer and his colleagues analyzed data on almost 300 women with DCIS who were treated at M.D. Anderson between July 1999 and June 2002.

Only 60 percent of the patients were offered tamoxifen and, of those, only 54 percent opted to take the drug.

In general, doctors were less likely to recommend the drug to women who had had a total mastectomy, and more likely to recommend it to women who had smaller tumors and who had undergone a lumpectomy.

Twenty of the 94 patients who received tamoxifen (21 percent) discontinued it because of side effects or complications.

The main reason women refused treatment with tamoxifen was for its potential side effects, which can include endometrial cancer and hot flashes. These same side effects also led a number of women to stop using the medication, the study found.

"In most cases, the benefits of tamoxifen outweigh the risk for patients with invasive breast cancer," says Dr. Susan K. Boolbol, an attending physician in the department of surgery and at the cancer center of Beth Israel Medical Center in New York City.

Reducing the risk of recurrence, for many women, is reason enough to go on tamoxifen. "We cannot underestimate the emotional impact of a local recurrence in a breast cancer patient," Boolbol adds. Also, a recurrence could be invasive [outside the milk duct], which is that much more dangerous.

Kuerer says: "It's such a personal decision. The patient needs to hear the potential benefits as well as the risks. Although it is a complex decision-making process, the patients are making their own decision. They're not universally taking a pill just because on the surface it sounds like they are going to decrease their chance of getting cancer again."

The study results caused physicians at M.D. Anderson, where the research was conducted, to reassess their practices.

"We saw that about 40 percent of us were not offering it [tamoxifen], and now we have made a conscious decision that we owe it to our patients to discuss the potential of this medication," Kuerer says. "Even though we perceive the risk [of side effects] might be very tiny for individual patients, we have to let them know that there are these drugs that they might want to take."

More information

The National Cancer Institute (news - web sites) has more information on tamoxifen and on ductal carcinoma in situ.

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Radiation Decreases Cancer Recurrence Post-Lumpectomy

By Anthony J. Brown, MD
Reuters Health
Tuesday, January 20, 2004

NEW YORK (Reuters Health) - As an addition to breast-conserving surgery, radiation treatment decreases the risk that breast cancer will recur and may improve survival, new research indicates.

"Although radiotherapy is generally added to breast-conserving surgery, recently some researchers have questioned its benefits," study co-author Dr. Claire Vershraegen, from the University of New Mexico in Albuquerque, told Reuters Health.

Therefore, Vershraegen and her associates analyzed data from several studies "to hopefully sort this out."

The investigators identified 15 appropriate clinical trials, which included a total of 9422 patients, that were available for analysis. The results of the pooled analysis are reported in the Journal of the National Cancer Institute (news - web sites).

Compared with lumpectomy plus radiotherapy, surgery alone was tied to a threefold increased risk of tumor recurrence in the same breast. Moreover, omitting radiotherapy was associated with an estimated 8.6-percent excess number of deaths.

"It was clear that radiation decreased the risk of cancer recurrence," Vershraegen noted. "The survival benefit, however, was less obvious," she added.

"There are some patients with rare disorders ... who possibly shouldn't receive radiotherapy," Vershraegen said. "But, our findings support the view that most women who undergo breast-conserving surgery should receive radiotherapy."

Source: Journal of the National Cancer Institute, January 21, 2004.

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New Drug Cuts Angina Attacks

By Ed Edelson
HealthDay Reporter
HealthDayNews
Tuesday, January 20, 2004

TUESDAY, Jan. 20 (HealthDayNews) -- A drug that uses a unique tactic to lessen the workload of the heart can help people with the chronic chest pain of angina when other medications fall short, a new study says.

The drug, ranolazine, prevents heart cells from metabolizing fatty acids, their usual energy source. The cells then get their energy from glucose in a metabolic process that is easier on them. The result is improved exercise capacity and decreased pain.

More than 6 million Americans have chronic angina, which is caused by partial blockage of the coronary arteries. Angina can be relieved by bypass surgery or angioplasty to increase blood flow, but many patients must take drugs to limit the number and severity of angina attacks.

A report in the Jan. 21 issue of the Journal of the American Medical Association (news - web sites) on a large-scale study says that adding ranolazine to existing drug regimens brought significant benefits to patients with chronic angina.

The trial was sponsored by CV Therapeutics Inc., the company that developed ranolazine. It included 823 people with chronic angina who were taking nitroglycerin, the basic medication for angina, and other cardiac drugs such as beta blockers or calcium channel blockers.

"We report the first evidence that ranolazine can reduce both angina frequency and nitroglycerin consumption when added to a standard dose of one of three frequently prescribed anti-anginal drugs," the researchers write.

Ranolazine probably will be used in addition to existing drugs when it comes on the market, says study leader Dr. Bernard R. Chaitman, a professor of medicine at Saint Louis University School of Medicine. He is also a paid consultant to CV Therapeutics.

"The drug would be effective in patients who also are on a beta blocker or calcium channel blocker," Chaitman says. How it will be used in clinical practice depends in part on the labeling authorized by the U.S. Food and Drug Administration (news - web sites), he adds.

But, Chaitman says, "I would be comfortable in using it for some patients without another agent." An earlier trial showed it to be effective as a single agent, he says.

For example, ranolazine would be good alternative to a patient who could not take a beta blocker because of a very low heart rate, he says. Beta blockers slow the heart rate even further.

Candidates for ranolazine treatment are those "who have chronic angina that does not respond to the usual kind of therapy," he says. "These are patients with four or five attacks of angina a week."

Even after angioplasty or bypass surgery to improve blood flow and existing drug treatments, about a quarter of all angina patients experience persistent attacks, the journal report notes.

Ranolazine is in the final stages of the process leading to approval by the FDA for its use as an angina treatment. The agency has issued a letter saying the drug appears to be effective in a step that usually leads to approval for general use in medical practice.

"There was a recent advisory meeting in December to discuss the application," says John Bluth, spokesman for CV Therapeutics. "The next step is for us to talk to the FDA and map out a path for potential approval. The company is engaged in a dialogue with the FDA, which has expressed an interest in more data."

More information

A review of current drug treatments for angina can be found at the American Heart Association, while the National Heart, Lung, and Blood Institute has a primer on the disorder.

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Study: Seat Belt Use Key to Other Passengers' Safety

Reuters
Tuesday, January 20, 2004

CHICAGO (Reuters) - Fastening the seat belt protects motorists in a crash, but the risk of dying in a wreck rises if fellow passengers do not buckle up, researchers said on Tuesday.

"A car occupant could be killed if struck by another occupant who was catapulted forward, backward, or sideways in a crash," wrote study authors Peter Cummings and Frederick Rivara in this week's issue of the Journal of the American Medical Association (news - web sites).

In crashes where a back seat passenger was not wearing a seat belt, the risk of death to the belted passenger in the front seat rose 20 percent, the study said. Similarly, a back seat belted passenger faced a 22 percent greater risk if the passenger in the front seat was not buckled up.

Examining 12 years of U.S. crash data, the researchers from Harborview Injury Prevention and Research Center in Seattle concluded that one in six deaths of front seat passengers wearing a seat belt might be prevented if the back seat passenger was also strapped in.

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Treatment Boosts Survival Rate for People With Amyloidosis

HealthDayNews
Tuesday, January 20, 2004

TUESDAY, Jan. 20 (HealthDayNews) -- Treating primary amyloidosis patients with high-dose chemotherapy and autologous stem-cell transplantation increased survival rates from one year to nearly five years.

And many people who received the treatment experienced a complete remission of the disease, says a Boston University School of Medicine study that appears in the Jan. 20 issue of the Annals of Internal Medicine.

People with amyloidosis experience extracellular accumulation of chemically diverse proteins in various tissues and organs. This results in progressive disability and death. There is no known cause. Left untreated, people with amyloidosis usually die within a year.

In this study, researchers reviewed the results of 312 people with AL amyloidosis who were treated with high-dose melphalan stem-cell transplantation, which was pioneered at Boston University School of Medicine in 1994.

Half the patients survived more than 4.5 years, and 40 percent experienced complete remission after treatment. Of those who remained in complete remission one year after treatment, 8 percent had relapses within two years, but none had relapses after two years.

"Patients who receive this treatment may not only improve their quality of life and length of survival, but may also experience a complete remission of this devastating disease," study lead author Dr. Martha Skinner, a professor of medicine, says in a prepared statement.

More information

Here's where you can learn more about amyloidosis.

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EU commissioner denies strict food standards a barrier to trade

Agence France Presse
Tuesday, Janaury 19, 2004

BANGKOK (AFP) - European Union (news - web sites) health commissioner David Byrne dismissed charges that stringent food safety restrictions were hampering exports to the world's largest single market from Thailand and other developing nations.

"I insist that the EU fully respects its international obligations in relation to trade in food products," Byrne told a luncheon for the Thai and foreign business communities in Bangkok.

"While I will not compromise on safety, I will not allow it to be used for protectionist ends," he added Tuesday.

Developing nations including Thailand have argued that tight restrictions imposed by developed markets like Europe and the United States on agriculture and food products are measures to protect domestic industries.

"I accept that our standards are very high. But that is what European consumers demand. Clearly it is a challenge to meet these standards yet it is well worth the investment to do so," Byrne said.

The health commissioner's visit to Thailand comes during a serious outbreak of fowl cholera and bronchitis which has seen more than 850,000 chickens die or be culled to prevent the disease spreading further.

Thailand has said however that it is free of the bird flu which has hit several Asian nations including Vietnam where five human deaths have been reported.

The EU is Thailand's second largest chicken market after Japan. Correcting an earlier figure, an EU official said Thai poultry exports in 2002 were valued at 36 billion baht (923 million dollars), of which 13.3 billion baht worth was exported to the Eurozone.

The kingdom raises about 1.1 billion chickens per year, two thirds of which are for export, industry sources said.

Despite Byrne's assurances that Europe was playing fair, Thai exporters voiced their frustrations over the EU regulations and said Europe should coordinate with other in major markets to formulate a single standard on food safety.

"How safe is safe?" Kiat Sittheeamorn, chairman of the International Chamber of Commerce (news - web sites) in Thailand, asked Byrne during the meeting.

"We have been fighting this for a long time," he told AFP afterwards. "For the moment we have one set of rules to Australia, another set of rules to the US, another set of rules to the EU, and the EU is very tight."

Concern was also raised that the EU was stepping beyond the guidelines of Codex Alimentarius, the international commission created to coordinate global food standards and ensure fair trade practices, to impose stricter safety guidelines.

In 2002 Thailand suffered a 57.64 percent plunge in exports of shrimp to Europe after the EU imposed systematic checks due to traces of cancer-linked chemicals found in Thai shrimp.

The checks were lifted after Thailand demonstrated "major improvement", EU safety experts said.

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Monday, January 19, 2004

Vitamin E, C Supplements May Prevent Alzheimer's

By Megan Rauscher
Reuters Health
Monday, January 19, 2004

NEW YORK (Reuters Health) - A study involving more than 4700 participants strongly suggests that the combination of vitamin C and E lowers the risk of developing Alzheimer's disease (news - web sites).

As the lead investigator Dr. Peter P. Zandi told Reuters Health, properly conducted prevention trials are needed to confirm the results.

However, "because vitamins E and C are relatively non-toxic and are believed to have wide-ranging health benefits, they may offer a very attractive strategy for preventing Alzheimer's disease."

The findings come from the Cache County Study, which looked at the prevalence of Alzheimer's disease and other dementias in terms of genetic and environmental risk factors. As part of the study, people aged 65 and older were assessed for dementia between 1995 and 1997 and again between 1998 and 2000.

The participants were categorized as "vitamin E users" if they took an individual vitamin E tablet or a multivitamin containing more than 400 international units of vitamin E every day. They were classified as "vitamin C users" if they took at least 500 milligrams per day of vitamin C as a stand-alone tablet or in a multivitamin. If they took multivitamins containing lower doses of these two vitamins, they were categorized as "multivitamin users."

Zandi, at The Johns Hopkins University Bloomberg School of Public Health in Baltimore, and colleagues identified 200 cases of Alzheimer's disease between 1995 and 1997 and 104 new cases during follow-up of 4740 participants.

According to the team's analysis, reported in The Archives of Neurology, use of vitamin E and C supplements in combination lowered the odds of having Alzheimer's disease at the start of the study by about 78 percent, and the odds of developing the disease by about 64 percent during the follow-up period.

There was also a trend toward reduced Alzheimer's risk among people who took vitamin E and multivitamins containing vitamin C.

In contrast, there was "no evidence of a protective effect with the use of vitamin E or C supplements alone, with multivitamins alone, or with vitamin B-complex supplements."

Currently, the recommended daily allowance for vitamin E is 22 IU (15 mg) and for vitamin C, 75 to 90 mg, the team points out. Although multivitamin preparations typically contain approximately these levels, individual supplements commonly contain doses up to 1000 IU of vitamin E and 500 to 1000 mg or more of vitamin C.

"Our findings suggest that vitamins E and C may offer protection against AD when taken together in the higher doses available from individual supplements," the researchers conclude.

Zandi also pointed out that there may be a biological reason why the two vitamins together produce a benefit, related to the different duration of their antioxidant effects.

"Vitamin E is a lipid-soluble vitamin that sticks around in fat tissues of the body for a relatively long time," he explained. "In contrast, vitamin C is a water-soluble vitamin and is rapidly excreted from the body. Vitamin C may act to 'recharge' the antioxidant capacities of vitamin E so that the vitamin E can sustain its job of soaking up free radicals and relieving oxidative stress in the body."

Source: Archives of Neurology, January 2004.

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Workplace Anger Widespread

HealthDayNews
Monday, January 19, 2004

MONDAY, Jan. 19 (HealthDayNews) -- There's a lot of anger just below the surface in the workplace, and you'd be well-advised not to incur the wrath of a colleague, says a British study.

The University of Lancashire study, which included in-depth interviews with 24 men and women in management and non-management positions in a variety of job sectors, found anger is widespread at work. It most often erupts over immoral behavior (cheating, lying, stealing) or when people feel they've been unfairly treated (unjust criticism or heavy workload).

Other common triggers of workplace anger include incompetence, disrespect, failure to communicate or exclusion.

You may suffer unpleasant consequences if you anger a co-worker. In retaliation, that person may gossip or spread lies about you or assign you undesirable tasks. The person you angered may end up feeling chronically angry about the incident, may leave their job, or allow their anger to affect their home life, the study says.

People who were angry at work used a variety of coping mechanisms such as talking to others, letting off steam, negotiating a resolution, or giving the offender the cold shoulder.

The study concludes that anger at work may have both long- and short-term consequences for individuals and their companies. It's worthwhile for employers to identify and reduce causes of anger.

The study was presented at the recent British Psychological Society conference.

More information

Here's where you can learn more about anger management.

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McDonald's Canada to Offer Lighter Menu

Reuters
Monday, January 19, 2004

TORONTO (Reuters) - With fast food coming under fire from groups as diverse as documentary film makers, health advocates and the overweight, McDonald's Restaurants of Canada Ltd. said on Monday it will list the calories in all the food it sells and offer Canadians a new, lighter menu.

The move to embrace healthier eating comes amid growing concerns over the links between obesity and fast-food meals like hamburgers and French fries, and in the wake of U.S. lawsuits that blame McDonald's Corp. (NYSE:MCD - news) for customers' weight problems.

By March, McDonald's Canada expects to carry items like grilled cheese sandwiches and apple slices with caramel sauce as options for children. At least two new salads and more grilled chicken items will be added to menus in some 1,300 restaurants across the country.

But the biggest change will be the decision to provide nutritional details on posters at counter and on the back of every tray-liner.

Everything from a package of ketchup, which has 2.4 grams of carbohydrates, to a bacon double cheeseburger, which has 25 grams of fat and 36 grams of carbohydrates, will be listed.

"We want consumers to have the information to make better choices," said Richard Ellis, a spokesman for McDonald's Canada.

Similar nutrition listings are now offered at Canadian sandwich and doughnut chain Tim Hortons, a unit of Wendy's International Inc. (NYSE:WEN - news).

McDonald's will also cater to the popularity of low-carbohydrate meals, popularized by the high-protein Atkins diet, and will offer protein platters -- basically meals without bread.

In New York, McDonald's tested a low-carbohydrate plan that it said would help customers customize meals on its menu within three dieting styles: low fat, low calorie, and low carb.

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When a Good Gene Turns Bad

HealthDayNews
Monday, January 19, 2004

MONDAY, Jan. 19 (HealthDayNews) -- Wound-healing genes actually promote the spread of some types of cancer, says a Stanford University study in the Jan. 19 issue of Public Library of Science Biology.

The Stanford scientists found some tumors activate these wound-healing genes, something that makes the tumors more likely to spread.

This finding could help researchers develop new ways to treat cancer and may also help doctors determine which cancers need more aggressive treatment.

"This is a feature we can find early on in the disease and it could change the way cancer is treated," study author Dr. Howard Chang says in a prepared statement.

He and his colleagues found that prostate and liver cancers always activated wound-healing genes, while there were mixed responses in breast, colon and prostate tumors.

Tumors with active wound-healing genes were highly aggressive and more likely to spread to other tissues.

More information

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

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Growth Hormone Helps the Failing Heart

Reuters Health
Monday, January 19, 2004

NEW YORK (Reuters Health) - Growth hormone treatment may do more than its name implies. According to Greek researchers, growth hormone seems to benefit people with heart failure by improving the functioning of their heart, enabling them to be more active.

The team says it may even reverse the progressive nature of the condition.

Writing the European Heart Journal, Dr. Stamatis Adamopoulos and colleagues at the Onassis Surgery Center in Athens, note that abnormal immune reactions may contribute to chronic heart failure. To see if the immune-modulating effects of growth hormone might be helpful, they studied 12 patients with moderate to severe chronic heart failure.

All the participants were being treated with angiotensin-converting enzyme (ACE) inhibitors and diuretics. The team compared the effects of supplementary treatment with 4 international units (IU) of growth hormone every second day over a period of 12 weeks, to that of no treatment over a further 12-week period.

Growth hormone therapy led to a significant reduction in blood levels of various inflammatory factors and a rise in an anti-inflammatory compound.

There was also a significant improvement heart function and a better uptake of oxygen during exercise testing.

The researchers conclude that the use of growth hormone may become an "important" option for treating heart failure, "by attenuating or even reversing its progression."

Source: European Heart Journal, December 15, 2004.

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Detecting Head and Neck Cancers in Time

HealthDayNews
Monday, January 19, 2004

MONDAY, Jan. 19 (HealthDayNews) -- Newly discovered signature protein patterns may enable earlier detection of certain head and neck cancers, says a study in the January issue of the Archives of Otolaryngology.

Despite advances in treating head and neck squamous cell cancer (HNSCC), there has been little progress in improving survival rates. One reason for this is that HNSCC is usually diagnosed at an advanced stage. Early diagnosis is essential for successful treatment, but there is no accepted screening test for HNSCC.

The new technology rapidly screens blood samples for multiple protein biomarkers of disease. Researchers from Eastern Virginia Medical School tested with this new technology, and it could help identify protein signatures specific to people with HNSCC.

They screened 99 people with HNSCC, 25 "healthy" smokers, and 102 healthy people used as a control group.

The researchers identified several protein profiles that were more common in people with HNSCC than in the healthy smokers or the control group.

Using these protein patterns to develop a classification system, the researchers distinguished with high accuracy (80 percent to 92 percent) between people with HNSCC and people in the other two groups.

"We propose that this technique may allow for the development of a reliable screening test for the early detection and diagnosis of HNSCC, as well as the potential identification of tumor biomarkers," the researchers write.

More information

Here's where you can learn more about head and neck cancer.

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Working Through Back Pain Reduces Missed Days

By Merritt McKinney
Reuters Health
Monday, January 19, 2004

NEW YORK (Reuters Health) - A treatment approach that uses graded activity and teaches people with low back pain that they can function in spite of their pain reduces the number of days missed from work, Dutch researchers report.

In a 6-month study, employees with low back pain who underwent a program of gradually increasing exercises missed significantly fewer days from work than people who received conventional treatment. An important component of the program was aimed at helping people unlearn their responses to pain.

The study shows that people with low back pain can still be active and return to work despite the pain, the study's lead author, Dr. Willem van Mechelen of the VU University Medical Center in Amsterdam told Reuters Health.

"Hurt doesn't mean harm," van Mechelen said.

For anyone who suffers from low back pain, that may be hard to believe, but the approach seemed to be safe and effective at reducing lost work days, according to a report published in Tuesday's issue of the journal Annals of Internal Medicine.

Although most cases of low back pain improve after a short period, sometimes people with low back pain for which there is no obvious cause may miss weeks of work. In addition, they may be at risk for more permanent disability.

Some research has shown that a so-called graded activity approach that encourages people with low back pain to gradually resume their normal activities may help people return to work sooner.

In the current study, van Mechelen and his colleagues put this approach to the test. Employees of KLM Royal Dutch Airlines who had experienced low back pain for at least 4 weeks were randomly assigned to a behavior-oriented graded activity program or ordinary treatment with an occupational therapist. The study included 134 employees.

People in the graded activity group participated in two 1-hour sessions per week for an average of about 7 weeks. During each session, the airline employees performed strength and endurance exercises, as well as exercises that mimicked their on-the-job duties. For example, someone who reported experiencing back pain while moving suitcases at work might be instructed to practice lifting a suitcase.

Participants were also asked to set a date when they thought they would be ready to return to work.

Both treatment groups experienced similar improvement in pain severity and functioning during the study, according to the report.

But, on average, people in the graded activity group missed 58 days of work compared with 87 days in the conventional treatment group, van Mechelen's team reports.

"This study is important because it represents research into treatments that may help reduce the economic and societal cost of low back pain," Dr. James Weinstein of Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, notes in a related editorial.

The study is not the final word on the treatment of low back pain, according to Weinstein, but this method of treatment does teach patients that it may be safe to work despite back pain.

"We should avoid harmful interventions but also tell our patients that 'hurt doesn't mean harm,"' Weinstein writes.

The study was funded by the Dutch Health Insurance Executive Council.

Source: Annals of Internal Medicine, January 20, 2004.

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Snapshots of Skin Could Catch Cancer

HealthDayNews
Monday, January 19, 2004

MONDAY, Jan. 19 (HealthDayNews) -- Using photographs of their own skin as reference could allow people to better detect new or changed moles that may indicate skin cancer, says a study in the January issue of the Archives of Dermatology (news - web sites).

The study included 50 people with at least five moles that had changed shape or had irregular borders. Digital photographs of the patients' backs, chests and abdomens were taken during visits to the Memorial Sloan-Kettering Cancer Center in New York City.

The patients were given copies of these "baseline" photographs.

The researchers then changed the appearance of the patients' existing moles and created "new" moles using cosmetic eyeliner pencil in a color that most closely matched the color of the moles. The new and altered moles accounted for about 10 percent of each patient's total mole count.

Patients who used digital photographs along with skin self-examinations (SSE) correctly identified new or changed moles 72.4 percent of the time, compared to 60.2 percent for people who used SSE alone.

"Access to baseline photography improved the diagnostic accuracy of SSE on the back and chest or abdomen and improved detection of changing and new moles," the study authors write.

"Our results suggest that baseline digital photography in tandem with SSE may be effective in improving the diagnostic accuracy of patients performing SSE," they add.

More information

Here's where you can learn more about spotting skin cancer.

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Asthma Not Worsened by Continued Trigger Exposure

Reuters Health
Monday, January 19, 2004

NEW YORK (Reuters Health) - You might think that people with asthma that's triggered by a specific environmental compound would have to avoid that environment, otherwise their asthma would get worse and worse.

Not so, it seems.

Asthma does not appear to worsen in patients with continued exposure to the causative agent -- as long as treatment with steroids and long-acting bronchodilators is maintained, physicians in Italy report.

Changing jobs is not an option for many people who develop occupational asthma, Dr. Alessandra Marabini and colleagues at the University of Perugia note in their report, published in the medical journal Chest. They therefore conducted a study to examine what happens with continued exposure while asthma patients are being treated.

Marabini's team followed 20 patients with mild to moderate work-related asthma, treated with the inhaled steroid beclomethasone dipropionate and the bronchodilators salmeterol. During three years of follow-up, six patients retired and four changed jobs for reasons other than worsening asthma.

The 10 subjects remaining in the study saw no significant changes in lung function or asthma symptoms, the authors report.

Therefore, Marabini and colleagues suggest that "an attempt be made to encourage workers to retain their employment rather than just advising them to leave their jobs" -- while recommending reduced exposure to the agent that causes their asthma, use of appropriate personal protection devices, and continued treatment.

However, they add, such patients should be monitored frequently "and removed from exposure in case of respiratory deterioration."

Source: Chest, December 2003.

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Prostate Cancer Treatment Increases Osteoporosis Risk

By Steven Reinberg
HealthDay Reporter
HealthDayNews
Monday, January 19, 2004

MONDAY, Jan. 19 (HealthDayNews) -- Men taking hormones to control prostate cancer need to be monitored and treated for osteoporosis, a new study says.

Although osteoporosis is most often associated with postmenopausal women, men also lose bone density as they age. And for men with prostate cancer, one of the most common therapies can speed up bone mineral loss and lead to osteoporosis and bone fractures, the new research confirms.

Prostate cancer (news - web sites) is the most common cancer in men, and hormone therapy is a very important risk factor for developing osteoporosis, says lead researcher Dr. Terrence H. Diamond, an associate professor of medicine at the University of New South Wales in Australia.

Diamond notes this type of hormone therapy, called androgen deprivation therapy (ADT), which blocks the production of testosterone, is now commonly used in elderly men who have advanced or high-risk prostate cancer that is not suitable for more aggressive treatment.

In their study, Diamond and his colleagues reviewed all the literature related to ADT and osteoporosis and fractures from 1986 to 2000. Their conclusions are based on nine studies that included a total of 208 patients, according to their report in the Jan. 19 online issue of Cancer.

Diamond notes that, in some studies, bone mineral density measurements were up to 17 percent lower in men with prostate cancer treated with ADT than in men not receiving the hormone therapy.

And in other studies, after only 12 months of ADT therapy, ADT contributed to bone loss of up to 8 percent from the mid-spine and up to 6.5 percent from the neck of the femur -- the thigh bone. These losses in bone density may increase with time, Diamond says.

In addition, the researchers found fractures were more common among men receiving ADT compared with men not receiving ADT.

However, Diamond's team found drugs that prevent bone breakdown, called bisphosphonates, such as pamidronate and zoledronate can prevent bone loss and may even increase bone mass in these patients.

Diamond advises that since osteoporosis is usually a silent disorder, patients should request a full osteoporotic evaluation from their doctor before starting ADT. The evaluation should include bone density tests and X-rays. If necessary, patients should be treated with bone-building drugs, he adds.

Diamond's team is beginning a study of 1,000 men with prostate cancer receiving ADT. In the study, the men will be given either zoledronate or a dummy drug.

"This study will determine the 'true' fracture risk in these high-risk patients, as well as the efficacy of zoledronate for preventing bone loss and fractures," Diamond says.

Dr. Clifford Rosen, a professor of nutrition at the University of Maine, agrees that "fractures due to rapid bone loss from ADT is a significant cause of problems in men with prostate cancer."

Preventive therapy with bone-building drugs and calcium and vitamin D is essential to prevent painful fractures, he says.

"Although more work needs to be done, it is conceivable that the bisphosphonates may also reduce the risk of subsequent bone cancer, another serious complication of prostate cancer," he adds.

However, Rosen cautions there is clearly a need for more studies.

"This study provides some solid evidence for the need to have disease recognition and treatment," he says. "However, the number of studies and the number of subjects under investigation has been quite small. More research is desperately needed to better understand the risks of ADT and to clarify the best treatment approaches."

More information

To learn more about prostate cancer, visit the National Library of Medicine. For more on osteoporosis and men, check with the National Osteoporosis Foundation.

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Simple Sugar Curbs Huntington Disease, in Mice

By Megan Rauscher
Reuters Health
Monday, January 19, 2004

NEW YORK (Reuters Health) - Huntington disease is an inherited condition caused by a genetic mutation that invariably leads to dementia and death, usually in adulthood. For people in families with the disease, a genetic test can tell if they have inherited the mutation -- but many prefer not to be tested, because there is no cure.

Now comes a ray of hope.

In mice that develop a form of Huntington disease, a non-toxic sugar compound called trehalose, given by mouth, significantly extends life, according to Japanese researchers.

These results "make trehalose promising as a therapeutic drug or lead compound" for the treatment of Huntington disease, Dr. Nobuyuki Nukina and colleagues from the RIKEN Brain Science Institute in Saitama write in this week's online edition of Nature Medicine.

There is considerable evidence that clumping in the brain of an abnormal, insoluble protein called "huntingtin" causes Huntington disease. Nukina's team found through lab experiments that a number of sugars -- disaccharides -- inhibit this aggregation.

"Trehalose has the strongest effect," he told Reuters Health.

Mice with Huntington disease given trehalose in drinking water had substantially fewer huntingtin protein aggregates in the brain, less motor dysfunction, and lived significantly longer than untreated animals.

However, although trehalose appears to prevent the formation of new aggregates, it does not seem to reverse existing formations.

"The protection of aggregation formation is important to block the disease cascade," Nukina explained.

Trehalose, which is turned into glucose in the body, did not alter blood levels of glucose in the animals. This is notable, the researchers say, because people with Huntington disease are prone to develop diabetes.

"It is necessary to evaluate the effectiveness, dose and safety of trehalose in human trials," Nukina concluded.

The researcher pointed out that trehalose may also have potential against other neurological disorders caused by similar aggregation of proteins such as Alzheimer disease, Parkinson disease, prion disease (such as the human version of mad cow disease), and Lou Gehrig disease.

Source: Nature Medicine, online edition January 18, 2004.

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Eating Chicken May Boost Arsenic Exposure

By Karen Pallarito
HealthDay Reporter
HealthDayNews
Monday, January 19, 2004

MONDAY, Jan. 19 (HealthDayNews) -- Indulging in your favorite chicken dish may expose you to higher levels of arsenic than you think, government researchers say.

Arsenic levels in young chickens, or "broilers," may be three to four times greater than in other poultry and meat, they report in the January issue of Environmental Health Perspectives.

While the amount of arsenic people ingest by eating chicken appears to be well below tolerable daily intake levels, it is higher than previously recognized and may require government agencies to reassess total arsenic exposure, the authors conclude.

The study is the first to assess average levels of arsenic in chicken and then calculate how much of the substance people are ingesting when they consume different amounts of chicken.

Arsenic is an approved feed supplement that farmers use to control intestinal parasites in chickens, particularly young chickens.

"If we're taking in more in chicken, then there's, in a way, less room to take in arsenic through the water," explains study author Tamar Lasky, a former U.S. Department of Agriculture (news - web sites) epidemiologist now with the National Institutes of Health (news - web sites).

Chicken is a staple of the American diet. Between 1970 and 2000, per capita consumption nearly doubled -- from an average of 40 pounds per year to about 78 pounds a year, reports the National Chicken Council.

Arsenic is a naturally occurring element found in food, drinking water and the environment. But exposure to high levels of the inorganic form, such as that found in wood preservatives, insecticides and weed killers, can be deadly.

Studies have linked long-term arsenic exposure in drinking water to cancer of the bladder, lungs, skin, kidney, nasal passages, liver and prostate, according to the U.S. Environmental Protection Agency (news - web sites). It is also associated with cardiovascular, pulmonary, immunologic, neurologic and endocrine problems.

"This study appears to be much ado about nothing," says Richard Lobb, a spokesman for the National Chicken Council. The paper makes numerous assumptions -- not based on data in the study -- about arsenic levels in chicken livers and muscle tissues as well as the relationship between organic and inorganic arsenic, he says.

Arsenic in poultry feed, which represents the less toxic organic form, "is used responsibly and safely by poultry producers," Lobb adds.

Lasky and colleagues from the Agriculture Department's Food Safety and Inspection Service used national data measuring arsenic in chicken liver samples to estimate the amount present in muscle tissue, the part of the chicken that is most frequently consumed.

From 1994 to 2000, average arsenic concentration in young chickens ranged from 0.33 to 0.43 parts per million.

The authors multiplied their estimates of arsenic in chicken muscle tissue by different levels of chicken consumption.

A person who eats an average amount of chicken -- about 2 ounces a day -- might ingest 3.6 micrograms to 5.2 micrograms of inorganic arsenic and 5.6 micrograms to 8.1 micrograms of total arsenic a day, they found.

By contrast, the top 1 percent of the population that consumes about 12 ounces of chicken a day would get much more of the substance: some 21 micrograms to 31 micrograms of inorganic arsenic per day and 33 micrograms to 47 micrograms of total arsenic per day.

For someone weighing 154 pounds, that's 0.30 to 0.44 micrograms per kilogram per day of inorganic arsenic -- well below the tolerable daily intake of 2 micrograms per kilogram per day, but still a sizable portion of the total.

An expert committee administered jointly by the Food and Agriculture Organization (news - web sites) of the United Nations (news - web sites) and the World Health Organization (news - web sites) determines the tolerable daily intake for arsenic.

"This article is really meant to raise a bunch of questions for further investigation," Lasky says. "It's reasonable for consumers to say, 'We want to know more about this.'"

More information

Learn about arsenic at the U.S. Environmental Protection Agency, while you can learn to eat safely at the U.S. government's FoodSafety site.

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Melatonin Seems to Reduce High Blood Pressure

Reuters Health
Monday, January 19, 2004

NEW YORK (Reuters Health) - Melatonin taken at night over a prolonged period lowered blood pressure in people with hypertension, according to the results of a trial conducted in The Netherlands.

Melatonin is known to regulate circadian rhythm, and some people find it helpful in adjusting to jet lag.

As Dr. Frank A. J. L. Scheer, currently at Harvard Medical School (news - web sites) in Boston, and his associates note in the journal Hypertension, the internal clock appears to be disturbed in people with high blood pressure, and they theorized that melatonin could improve regulation of blood pressure.

The team enrolled 16 men with mild to moderate untreated hypertension, who were given 2.5 milligrams of melatonin or an inactive placebo 1 hour before bedtime. Compared with placebo, melatonin reduced blood pressure significantly after 3 weeks of treatment.

A single dose of melatonin did not significantly change blood pressure, and long-term treatment did not affect daytime readings or heart rate.

Given these findings, Dr. Scheer and his team call for further studies to see if melatonin taken at night could be "a gentle alternative or supplement to regular antihypertensive medication."

In a press statement from the American Heart Association (news - web sites), Dr. Dan Jones cautions that "patients with high blood pressure should consult their own health care provider for specific advice, but no one should begin melatonin therapy for blood pressure management for the time being." Dr. Jones is dean of the University of Mississippi Medical Center School of Medicine in Jackson.

Source: Hypertension, February 2004.

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Modified Gene Therapy Better for Heart

By Ed Edelson
HealthDay Reporter
HealthDayNews
Monday, January 19, 2004

MONDAY, Jan. 19 (HealthDayNews) -- Scottish researchers report a promising step toward solving a major challenge in the budding field of gene therapy for heart disease by discovering how to get the gene to the cells that need the help.

"One problem with using this technology is that the virus that carries the gene go predominantly to the liver," says Andrew H. Baker, a reader in molecular medicine at the University of Glasgow. "We want to get the virus to home in on target cells in the heart."

Baker and his colleagues are working with adeno-associated virus (AAV), which is harmless to humans and is commonly used as a carrier in gene therapy work. When injected into the body, most AAV ends up in the liver, whose job is to clean the body of such foreign material.

The Scottish researchers report in the Jan. 20 online issue of Circulation that they have redesigned the surface of the virus so that it includes two peptides that bind with the cells that form the inner lining of blood vessels. These vascular endothelial cells are logical targets for gene therapy aimed at preventing arteries from clogging.

"What we are publishing is proof of principle, studies which show that if you select the proper peptides, you can incorporate those into the virus coat protein. In our mouse model, these viruses accumulate at target cells in the heart," Baker says.

While the work now is being done with heart cells, the technique is potentially applicable to other kinds of gene therapy, he says.

"If you incorporate peptides that target specific cells, you can use it for the kidneys, liver or what have you," Baker says. "If you are targeting cancer, you can treat cancer that is disseminated throughout the body."

In the animal trials, almost all unmodified AAV ended in the liver, while liver uptake of the modified virus "was significantly lower than with native AAV," the report says.

And the modified virus remained active in the heart for a long time. Tests showed the experimental gene carried by the virus was still active four weeks after it was injected, so that even a single injection of the modified virus might provide effective treatment, Baker says.

"This is very exciting work," says Dr. Jeffrey S. Borer, who heads the Division of Cardiovascular Pathophysiology at Weill College of Cornell University. "It is potentially an important paper."

A lot of work remains to be done, Borer says. "Now one needs to design a therapeutic gene, put it into an appropriately targeted AAV and use it for treatment," he says. "In theory, it should make a difference. But the important thing is that they have proved the principle that you can affect the viral coat."

The technique also raises the possibility of reducing the adverse side effects of gene therapy, Borer says. Researchers now must inject large amounts of gene-carrying viruses to make sure that enough reaches the target cell, and those injections can cause fever and other problems. Much smaller amounts of targeted viruses may achieve the goal, he says.

More information

The whys and wherefores of gene therapy can be found at the American Heart Association or the Human Genome Project.

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Call for diabetics to better curb blood sugar, check leg health

By Lauran Neergaard
The Associated Press
Monday, January 19, 2004

WASHINGTON (AP) - There's grim news on the diabetes front: Nearly two-thirds of diabetics aren't properly controlling their blood sugar. And one in three older diabetics likely also has a serious leg disease that could cost their limb - or their life.

This year, specialists for the first time are urging every diabetic over 50 to get tested for the leg disease, called peripheral arterial disease or PAD.

Testing is simple - just check blood pressure in the ankle. If it's significantly lower than blood pressure in the arm, PAD may be narrowing leg arteries and slowly choking off blood flow.

Severe PAD can lead to amputation. Worse, if leg arteries are clogged and stiff, heart arteries are too. Having PAD quadruples the risk of a heart attack or stroke.

Anybody can get PAD. But diabetes damages the blood vessels in ways that make patients especially susceptible to cardiovascular disease, meaning diabetics are most at risk, concludes an expert panel brought together by the American Diabetes Association.

Studies suggest one in three diabetics over age 50 may have PAD. So the diabetes association panel wants all diabetics that age to get screened for PAD. If results are normal, get rechecked every five years, say the recommendations, published last month in the journal Diabetes Care.

"This is news to a lot of people, even within the diabetes community, that this is really a very prevalent condition that to this point has been under-addressed," says Dr. Peter Sheehan, director of the Diabetes Foot & Ankle Center at New York University School of Medicine, who authored the testing recommendations.

Consider testing younger diabetics if they have other risk factors for PAD: smoking, high blood pressure, high cholesterol, or they've had diabetes for more than a decade, the recommendations say.

Anyone with symptoms of PAD - legs that hurt or tire easily while walking - should seek testing, too. But most people with PAD never report symptoms, plus diabetes causes nerve damage that can blunt those patients' ability to feel the warning pains.

Treatment includes exercise and blood thinning medicine for the legs plus therapy to reduce the heart-attack risk. For severe leg blockages, surgery to bypass the clogged artery can save the limb.

Diabetics may have to ask for the PAD test, called an ankle brachial index. It's unlikely that primary care physicians have added it to the list of tests for diabetics.

Another exam, the A1C check, given every three months, shows blood-sugar averages, the best measure of how well diabetes is controlled.

A normal A1C level is a score of 6. U.S. diabetics average a 9, minimal control. Specialists recommend striving for at least 7, because every point-drop lowers the risk of severe diabetes complications by 40 per cent.

Yet 13.5 per cent of diabetics have A1C levels that surpass the very dangerous 9.5, the U.S. government says.

Dr. James Gavin, head of the National Diabetes Education Project, says more lives could be saved if more diabetics aimed for optimal instead of minimal control, but too few doctors push that message.

So what should patients do when their A1C comes back above 7?

"This is something you should not really tolerate without taking some action for more than, say, a six- to eight-week period," Gavin says.

Knowing when you exceed those levels shows where to adjust treatment, such as diet, a dose increase of oral medicine, or adding some form of insulin.

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Sunday, January 18, 2004

When to Screen for Cancer

HealthDayNews
Sunday, January 18, 2004

SUNDAY, Jan. 18 (HealthDayNews) -- Providing cancer screening information in public brochures and on Web sites may help people make appropriate decisions about whether they get the screening, says a report in the January issue of the American Journal of Preventive Medicine.

The report, by the Task Force on Community Preventive Services, says there is an increasing need for this kind of publicly accessible information. That's because it can be difficult for doctors to effectively communicate the science of cancer screening to patients during office visits.

In addition, many people at high risk for cancer don't have regular health care and are forced to make health-care decisions on their own.

The report says brochures and Internet information may help people make informed decisions about whether and when to have cancer screening and what is the most appropriate form of screening for them.

"We know that making decisions about cancer screening can be difficult for individuals and their families. These findings from the Task Force provide important insight about how public health can communicate effectively about the risks, benefits and other outcomes associated with screening," Dr. Julie L. Gerberding, director of the U.S. Centers for Disease Control and Prevention (news - web sites), says in a prepared statement.

More information

Here's where you can learn more about cancer screening and testing.

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NYT: Atkins Advises Dieters to Eat Smaller Steaks

Reuters
Sunday, January 18, 2004

NEW YORK (Reuters) - Promoters of the popular low-carbohydrate, high-fat Adkins diet are saying that people should limit their intake of saturated fat by cutting back on Atkins staples such as meat, cheese and butter, The New York Times reported on Sunday.

Responding to criticism from scientists that Atkins could lead to heart disease and other health problems, the director of research and education for Atkins Nutritionals, Colette Heimowitz, is telling health professionals that only 20 percent of a dieter's calories should come from saturated fat, the paper said.

Beef, pork, lamb and butter were on the list of "foods you may eat liberally" in diet founder Dr. Robert C. Atkins' book "Dr. Atkins' New Diet Revolution," first published in 1992. Atkins, who died last year, always maintained that people should eat other food besides red meat, but had trouble getting that message out, the paper said.

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Sometimes, a Healthy Weight is the Way to Go

By Kathleen Doheny
HealthDay Reporter
HealthDayNews
Sunday, January 18, 2004

SUNDAY, Jan. 18 (HealthDayNews) -- When overweight clients ask Los Angeles dietitian Cindy Wong what a healthy weight is, she tells them it's not necessarily as low as they might think.

In light of the obesity epidemic that has spread across America in recent years, that news might make a sizable difference to the two-thirds of people who are overweight and the one-third who are obese.

Some experts define healthy weight as a body mass index under 25 (a person 5-foot-5 who weighs 150 pounds has a BMI of 25). Others say a person is allowed 100 pounds for the first five feet of height and five pounds for every additional inch.

Wong advises people to take those formulas as guidelines and to think about healthy weight a little differently.

If someone's weight is close to those guidelines and the person doesn't have blood pressure problems, cholesterol problems, aches and pains and other health concerns, they're probably at a fairly healthy weight, she says.

And with January 18 to 24 declared Healthy Weight Week, experts hope more Americans will try to shed pounds and get to a healthier weight, if not a healthy one.

Currently, many Americans put on a pound or two a year as they move from early adulthood to middle age. So when their 40th or 50th birthday rolls around, they're officially overweight or even obese.

"Exercise is one key," Wong says. She tells her patients to exercise at least 30 minutes a day.

Buying a pedometer can help you keep track, especially if you've been sedentary and need some extra motivation. Most experts suggest starting by trying to get in 2,000 extra steps a day. That's the equivalent of about a mile and will burn an extra 100 calories.

When it comes to food, pay attention to portion control, as well as calories. For weight loss, figure you need to eat 500 fewer calories a day to achieve a slow, reasonable weight loss of a pound a week; maybe less of a calorie deficit if you are increasing your exercise.

While slow and steady can be frustrating if you need to lose a lot of weight, experts say cutting back even just 50 calories a day and expending an extra 50 in activity will at least keep you from getting heavier.

Diet and exercise aren't the whole story, says another expert, Anne M. Fletcher, a Minnesota dietitian who has written several books, including one in which she interviewed people who shed pounds and kept them off.

"If you lose weight by diet and exercise alone, and you don't change anything else in your life, you are probably going to gain it back," she says.

What's missing from that equation? "It's the whole head thing," she says.

"Look at why you overeat, and what is your motivation to change, which is where I think the real solution lies," she says.

Instead of considering your new eating plan a diet, look at it as a healthier approach to eating that you will probably follow the rest of your life if you want to keep off the pounds.

And, a final question worth asking, Fletcher says, is: "How can you get pleasure from life from stuff other than food?"

Curling up with a good book, catching a flick (without the popcorn) and even shopping can be very satisfying, she notes.

"Learn how to get more out of life so food isn't your only reward that you have for yourself," Fletcher says.

More information

For information on staying physically active, see America on the Move. For healthy eating tips, visit the American Dietetic Association.

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Saturday, January 17, 2004

Keep Kids Active in Winter

HealthDayNews
Saturday, January 17, 2004

SATURDAY, Jan. 17 (HealthDayNews) -- The weather outside may be frightful, but that doesn't mean it's OK for your children to sit around and play video games all day.

During the winter, kids burn about half as many calories a day as they did in the summer, according to a Montana State University expert. But with childhood obesity skyrocketing, it's not a good idea to let your children develop sedentary habits. Children should exercise at least 20 to 30 minutes three to five times a week, says the Nemours Foundation.

If the snow's piling up outside, how can you keep them moving?

Winter sports are an obvious answer. If there's snow, get the kids out to play. Sledding, building snow forts and throwing snowballs all count as exercise. Skiing, ice skating and snowboarding are also great activities if your children are interested in them.

There are also plenty of activities the kids can do indoors or in the garage or basement. Turn off the TV and encourage your children to:

  • Jump rope
  • Play hopscotch
  • Dance
  • Do jumping jacks
  • Challenge each other -- who can hop longest on one foot?

Don't forget to check out what your local recreation department has available , too -- they may offer swimming, indoor tennis or indoor basketball for youngsters.

More information

To read more about keeping kids active in the winter, go to the Children's Hospital of St. Louis.

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