The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
March 12, 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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 31 - February 6



Friday, February 6, 2004

  1. Mercury Damage Seen in Children of Fish Eaters
  2. New Therapy Shows Promise Against Cerebral Palsy
  3. New Ultrasound Shows Sharper, Earlier Fetal Images
  4. 'Stroke Belt' Applies to Kids, Too
  5. Ephedra Diet Supplement Ban Set for April
  6. Genetic Condition Could Lead to Strokes During Pregnancy
  7. Anti-Epileptic Drugs Can Affect Men's Fertility
  8. Metabolic Syndrome Ups Stroke Risk
  9. Resistance Exercise Curbs Diabetes in Pregnancy
  10. Looking at Links to Brain-Wasting Disease
  11. Many Cancer Patients Have Untreated Depression
  12. A Newborn's Night Routine
  13. Arthritis Patients' Fracture Risk Overestimated

    Thursday, February 5, 2004

  14. USDA Sees Little Risk of More Mad Cow Cases
  15. Chemotherapy After Lung Cancer Surgery Can Save Lives
  16. Iron Helps Build Bones
  17. CDC Says Carbs to Blame for Rising Calorie Intake
  18. Heavy Women Who Become Pregnant Face Greater Health Risks
  19. Study Shows Why 1918 Flu Epidemic Was So Deadly
  20. Toxins Linked to Autism, ADHD
  21. Study: Cooling Helmets May Prevent Stroke Damage
  22. Predicting Preeclampsia
  23. Food Poisoning Bugs Lurk in Body, Study Shows
  24. Angioplasty an Option for Clogged Brain Arteries
  25. FDA Panel Supports Advanced Medial Optics Lens
  26. Vampire Bat Saliva Holds Key to Stroke Treatment
  27. Lung Cancer Risk May Be Higher in Female Smokers
  28. Quick Tests Can Assess Stroke Risk
  29. Simple Test Points to Diabetics' Heart Risks
  30. Senior Spills
  31. Tiny Corkscrew Removes Clots, Reverses Stroke Damage

    Wednesday, February 4, 2004

  32. Minorities Have Better Odds for Kidney Transplants
  33. Trimming Trans Fats
  34. Hospitals No Place to Get Rest, Noise Study Shows
  35. Coating Intestines Protects Against Deadly Infection
  36. New Women's Heart Guidelines Stress Early Action
  37. Heart Paradox Found in Blacks
  38. Location Determines Heart Attack Survival-US Study
  39. Scientists Create Mice That Produce Heart-Healthy Compounds
  40. US FDA Wants Ads for Medicine to Highlight Risks
  41. Cystic Fibrosis Linked to Fatty Acid Imbalance

    Tuesday, February 3, 2004

  42. Study: Blood Test May Indicate Colon Cancer Risk
  43. Multiple Sclerosis and Fatigue
  44. Antibody Could Block SARS Infection Study
  45. Catching the Culprit in Colon Cancer
  46. Vitamins Do Not Prevent Recurring Stroke, Study Finds
  47. Women Heeding Message on Hormone Therapy
  48. FDA Panel Backs Lung Nodule Screening Tool
  49. Black Youths Likelier to Quit Smoking
  50. Computer-Aided Mammograms Not Better, Study Shows
  51. Breast-feeding Produces Trimmer Kids
  52. Vaccines Containing Aluminum Appear Safe
  53. What Triggers Type 1 Diabetes
  54. Brain Receptor May Be Lacking in Panic Disorder
  55. New Dietary Clue to Colon Cancer
  56. Government Advisers Seek Stronger Antidepressant Warning
  57. Heart Disease Marker Now Tied to Colon Cancer
  58. Very Elderly Can Benefit from Heart Procedures
  59. Soaring costs add new urgency to debate over US health care reform
  60. British Surgeons Close Wounds with Paperclips

    Monday, February 2, 2004

  61. Detecting Changes in Multiple Sclerosis
  62. High Aspirin Doses Best at Preventing Colon Cancer
  63. Good Bacteria Never Take a Day Off
  64. Pizza Makers Consider Low-Carb Dough
  65. When a Cut is Deep
  66. Testosterone Drop in Men Can Cause Depression, Study Finds
  67. Detect Vision Problems Early
  68. Blood Patterns May Help Spot Cancer Early
  69. Antidepressant Use by Moms-To-Be May Affect Baby
  70. First Lady Warns Women on Heart Disease
  71. Tyson Foods Taking Trans Fat Out of Some Products
  72. Another Trial Ties HRT to Breast Cancer
  73. New Therapy for Cerebral Palsy Helps Kids Move Arms
  74. 'Designer' Estrogen Shows Promise for Menopausal Problems
  75. Study: Breast-Feeding May Prevent Weight Problems
  76. Program Keeps Kids Away From TV
  77. Study: Fat-Fighting Drugs Could Raise Cancer Risk
  78. Moms' Blues Bad News for Their Kids
  79. Colon Cancer Screening Low Among African Americans
  80. Birth Risks Higher on Weekends
  81. FDA Panel to Consider Lung Nodule Screening Tool
  82. Eye Disease May Steal Sound Sleep

    Sunday, February 1, 2004

  83. Study: Fat-Fighting Drugs Could Raise Cancer Risk

    Saturday, January 31, 2004

  84. That Cough May Be More Than Just Annoying

Friday, February 6, 2004

Mercury Damage Seen in Children of Fish Eaters

By Maggie Fox, Health and Science Correspondent
Friday, February 6, 2004

WASHINGTON (Reuters) - Children whose mothers eat seafood high in mercury while pregnant can suffer irreparable brain damage, researchers reported on Friday.

The report comes the same week as the U.S. Environmental Protection Agency (news - web sites) doubled its estimate of how many newborns had unsafe levels of mercury in their blood.

The study, done by an international group led by researchers at the Harvard School of Public Health, also showed that children exposed to mercury in the womb may suffer permanent damage to their heart function.

"We found that both prenatal and postnatal mercury exposure affects brain functions and that they seem to affect different targets in the brain," Philippe Grandjean, who led the study, said in a statement.

Grandjean and colleagues studied more than 1,000 mothers and children living in Denmark's Faroe Islands. Residents there eat large amounts of fish, much of it contaminated with mercury.

They measured mercury in umbilical cord blood taken from the children at birth and then in hair samples taken at ages 7 and 14.

Most of the mothers were suffering from mercury contamination, with their own hair levels at childbirth on average above 1 microgram per gram, the limit recommended by the EPA and the independent, nongovernment National Research Council (news - web sites).

Brain Signal Irregularities

Writing in the Journal of Pediatrics, Grandjean and colleagues in Denmark and Japan said they put electrodes on the heads of the children to measure electrical signals in the brain. They found delays in brain signaling, and the higher the mother and child's mercury load at birth, the more distinct the irregularities.

They also found these neurological changes affected heart function. The children with the most mercury in their blood were less capable of maintaining the normal variability of the heart rate needed to secure proper oxygen supply to the body, Grandjean's team found.

Earlier this week an EPA researcher published a report doubling the estimates of how may U.S. infants have unsafe levels of mercury in their blood.

The researcher, Kathryn Mahaffey, estimated that 630,000 infants were born in a 12-month period between 1999 and 2000 with blood mercury levels higher than 5.8 parts per billion, the EPA's level of concern. This is more than double the previous estimate of 300,000 infants.

"It is important to note that this estimate is preliminary in nature, and is based on recently available information about mercury in umbilical cord blood versus maternal blood," Mahaffey said in a statement.

"EPA is still reviewing these new studies and their potential implications."

Her full study is available on the Internet at onday/mahaffey.pdf.

Jane Houlihan of the Environmental Working Group said the study showed the government needs to limit emissions by coal-burning power plants, which are the top source of mercury contamination in the United States.

Her group called for the Food and Drug Administration (news - web sites) to issue a list of fish that are lower in mercury and thus safer for pregnant women to eat, such as wild salmon and haddock.

The EPA says the most contaminated fish include shark, tilefish, king mackerel and swordfish.

Sources of healthy omega-3 fatty acids other than fish include walnuts and flaxseed oil, and some fortified foods.

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New Therapy Shows Promise Against Cerebral Palsy

By Steven Reinberg
HealthDay Reporter
Friday, February 6, 2004

FRIDAY, Feb. 6 (HealthDayNews) -- A form of physical therapy used successfully on stroke patients shows promise in treating children with a type of cerebral palsy called spastic hemiparesis, researchers report.

Cerebral palsy describes a group of chronic conditions that affect body movement and muscle coordination. It is caused by damage to one or more areas of the brain, and usually occurs in the womb.

Spastic hemiparesis affects an arm or leg on one side of the body. Spastic cerebral palsy is the most common type of cerebral palsy, accounting for 70 percent to 80 percent of the cases. Spastic hemiparesis makes up some 20 percent to 30 percent of these cases.

The new treatment technique, called constrained-induced movement (CI) therapy, was pioneered by Edward Taub, director of the Taub Therapy Clinic and a professor of psychology at the University of Alabama at Birmingham. It was first developed to treat stroke patients.

Generally, stroke patients lose normal function on one side of the body. In CI therapy, the strong arm or leg is immobilized, forcing the patient to use the weaker limb. Studies have shown repeated exercises restore substantial function in the weaker limb. It works by "rewiring the brain," Taub explains.

Now Taub's team has extended its research to children with spastic hemiparesis. A study on the work appears in the February issue of Pediatrics.

Like stroke, spastic hemiparesis affects one side of the body, and Taub speculated the same mechanisms at work in stroke were involved in this form of cerebral palsy.

In the new study, 18 children, ranging in age from 7 months to 8 years, were divided into two groups. One group was started on CI therapy, while the other children were given standard rehabilitation.

Taub believes children with spastic hemiparesis learn not to use their weak arm because it doesn't work very well. CI therapy is designed to teach them to use the weaker limb.

To do this, children in the CI group had their strong arm placed in a light cast. The cast extended from the shoulder to just beyond the fingertips. The children remained in the cast for 21 days. Every day for six hours, they received intensive therapy disguised as play.

During CI therapy, the children were forced to do things that were just at the limit of their motor ability, says Taub. "And through reward and encouragement we kept them improving just beyond the point that they were capable of. This is called shaping -- getting improvement in small increments," he explains.

Before and after the trial, the researchers used standardized questionnaires and evaluations of videotaped sessions to chart the children's progress.

"The results were dramatic," Taub says. All the children in the CI group showed substantial improvement. "The younger the child, the more dramatic the improvement, with entirely new patterns of movement and behavior that the child had never exhibited before," he adds.

For example, children used their weaker arm to crawl, pick up objects and pop soap bubbles with a single finger. "Their movement isn't normal," Taub notes. "But it is substantially improved."

The lesson is that "the central nervous system of children is enormously plastic and is capable of reorganizing itself to adapt to impairments if a treatment procedure like CI therapy is applied," Taub says.

Taub's group followed the children for six months and saw the gains in motor ability remained. Taub is starting another study with a new group of children and intends to follow them for two years.

"This technique offers parents and their children hope," Taub says.

Jack Engsberg, director of the Human Performance Laboratory at Washington University, says "if CI can be shown to help these kids with cerebral palsy, I'm all for it."

Engsberg adds "the CI concept is clever, and the application to cerebral palsy is encouraging for this disability and potentially other neurological disorders. I hope the long-term follow-up study shows that these children continue to use their more involved limb."

Dr. Murray Goldstein, medical director of the United Cerebral Palsy Research and Educational Foundation, adds that most of the evidence from animal and stroke studies shows this technique improves performance.

"I think there is evidence that CI is helpful in spastic hemiparesis, and it is potentially an important contribution to physical therapy. But there is more research needed before it becomes standard therapy," Goldstein says.

Goldstein's concern is whether the improvement seen after therapy will remain significant over a long period. However, it is a very promising beginning, he adds.

More information

For more on cerebral palsy, check with United Cerebral Palsy or the National Institute of Neurological Disorders and Stroke.

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New Ultrasound Shows Sharper, Earlier Fetal Images

By Toni Clarke
Friday, February 6, 2004

NEW YORK (Reuters) - New technology that could allow doctors to view fetuses earlier and in sharper focus could help women identify abnormalities in their unborn children only weeks into development.

"What you see is the same organs, or anatomy of the embryo or the fetus, but a week or two earlier than we can see today," said Ilan Timor, professor of Obstetrics and Gynecology at the New York University Medical School.

Eagle Ultrasound AS, a small private company in Norway that developed the technology, said it provides sharper images at all stages of a pregnancy, and has the potential to diagnose other conditions, including cancer, at earlier stages.

"That's the first thing I would use it for," said Timor, who is also division director of OB/GYN ultrasound at New York University and has no financial or other ties to the developers.

The technology was developed in conjunction with the National Center for Fetal Medicine at the Norwegian University of Science and Technology, Trondheim.

It provides clear images of embryos as young as 7.5 weeks, counted from the last menstrual period; images that even a layman can recognize.

Karl Hofer, chief executive of Eagle, said it has a prototype of the ultrasound probe and is now considering its options for commercializing it. The first application, he said, will be in obstetrics and gynecology.

The company said it has already been approached by, and is in discussions with, several of the biggest companies in the field.

While Hofer did not divulge their names, the market leaders are General Electric Co. , Siemens AG (news - web sites) and Philips Electronics . Hofer said Eagle is considering all possibilities, including selling a stake in the company, licensing the technology and bringing on board a large investor while Eagle further develops the product.

"We're discussing a license with a large company that has top technology," Hofer said. "They don't want to see someone coming onto the market with something better."

It is difficult to value technology like Eagle's while it is such early stages, said Hofer, who believes it has potential for use in myriad ultrasound applications.

Pregnant women in the United States, unlike their counterparts in Europe and elsewhere, are not given ultrasounds as a matter of course, Timor said. U.S. obstetricians, however, are increasingly finding reasons to provide them.

The most accepted gestational age at which ultrasounds are given in the U.S. is 18 to 22 weeks of age, Timor said.

Experts are increasingly pressing for earlier scans. While there is no reason to routinely give ultrasounds to women at seven, eight or nine weeks, in cases where there may be a genetic disposition to a condition, or if a previous child has a malformation known to be hereditary, such a scan could be valuable.

"There has been a steady improvement in ultrasound image quality over the past 20 years," said Sturla Eik-Nes, professor and director of the National Center for Fetal Medicine in Norway, and until recently president of the international society of ultrasound in obstetrics and gynecology.

"But the kind of details you see with this technology have never been seen before," he said.

Still, it could be several years before the technology reaches the offices of average physicians, and like most new technologies it will likely be adopted first by academics and research laboratories.

"I am convinced that slowly it will be on every single good machine as an individual probe. This is a development that's important. I think its a breakthrough," Timor said.

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'Stroke Belt' Applies to Kids, Too

Friday, February 6, 2004

FRIDAY, Feb. 6 (HealthDayNews) -- A study that found children living in the "stroke belt" of the United States face an increased risk of stroke may challenge a current theory on why adult stroke deaths are significantly higher in those southeastern states than in the rest of the country.

The findings were presented Feb. 6 at the American Stroke Association's annual meeting in San Diego.

The increased risk in the stroke belt -- Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Virginia -- has been linked to atherosclerosis, the accumulation of fat-containing deposits inside arteries.

It's been suggested that adults living in these states have more risk factors for atherosclerosis -- high blood pressure, smoking, diabetes, high cholesterol and high triglycerides in the blood -- which are related to lifestyle habits such as diet and exercise.

In this new study, researchers from the University of California, San Francisco, examined whether there was a stroke belt for children. Overall, stroke is rare in children.

"By studying children, a group whose stroke rates are not affected by atherosclerosis risk factors, we can address the question of whether these risk factors are enough to explain the stroke belt," researcher Dr. Heather J. Fullerton, a clinical instructor of neurology and pediatrics, says in a prepared statement.

She and her colleagues analyzed death certificates for the period 1979-1998. They found that people under age 20 in stroke belt states had a 21 percent greater risk of death from stroke compared with people the same age in other states.

Over that same period, the risk of death from stroke among people over age 25 was 20 percent higher in stroke belt states than in other states.

"This means that we should look at stroke risk factors that are applicable to both children and adults when attempting to explain the stroke belt," Fullerton says.

"We might look predominately toward environmental or cultural factors, such as differences in water or soil, diet, socioeconomic status and genetics," she says.

More information

Here's where you can learn more about stroke.

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Ephedra Diet Supplement Ban Set for April

Friday, February 6, 2004

WASHINGTON (Reuters) - The ban on dietary supplements containing ephedra will officially take effect in April, the U.S. Food and Drug Administration (news - web sites) said on Friday.

The agency, which first announced the ban in December 2003, has said ephedra is a stimulant that raises blood pressure and stresses the circulatory system, effects that have been linked to serious heart problems, strokes and deaths.

"Until the final rule prohibiting the sale of ephedra-containing dietary supplements takes effect, FDA reiterates its warning to consumers: 'Do not take these products. They are simply too risky'," FDA Commissioner Mark McClellan said in a statement.

While stores can still legally continue to sell ephedra-containing products until April 12, officials warned companies to comply with the rule.

"We intend to take swift action against anyone who puts consumers at risk by continuing to sell such products after the prohibition takes effect," Health and Human Services (news - web sites) Secretary Tommy Thompson said.

Some retailers such as NBTY Inc., CVS Corp. and General Nutrition Centers halted sales of ephedra-based diet products this year. Many manufacturers also stopped using ephedra and started promoting alternative diet products.

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Genetic Condition Could Lead to Strokes During Pregnancy

Friday, February 6, 2004

FRIDAY, Feb. 6 (HealthDayNews) -- Pregnancy increases the risk of mini-strokes in women with an inherited condition called arteriopathy with subortical infarcts and leukoencephalopathy (CADASIL), says a Finnish study.

The study found that CADASIL, which can cause headaches, recurrent ischemic attacks, cognitive decline and dementia, poses a special risk during pregnancy.

The researchers studied 19 pregnancies and post-birth periods, in which there were complications, of 12 women with the CADASIL gene mutation. The study found that transient neurological complications occurred in 17 (90 percent) of the pregnancies.

Of those, neurological deficits occurred during the post-birth period in 11 (65 percent) of the pregnancies. Symptoms included headache, vision problems, impaired speech, and numbness.

Preeclampsia-like symptoms occurred in six of the 19 problem pregnancies.

"Pregnancy increases the risk of transient ischemic symptoms and preeclampsia in CADASIL in all age groups, but especially in older (over 30) females," the study authors write.

The study was presented Feb. 6 at the American Stroke Association's annual meeting in San Diego.

More information

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

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Anti-Epileptic Drugs Can Affect Men's Fertility

Reuters Health
Friday, February 6, 2004

NEW YORK (Reuters Health) - Men with epilepsy often have fertility problems, which can be worsened by drugs used to prevent the seizures, according to two new reports.

"If fertility problems emerge in men with treated epilepsy, semen analysis should be conducted," Dr. J. I. T. Isojarvi, of the University of Oulu in Finland and associates advise in the medical journal Neurology. "If abnormalities are found, alternative drug treatment should be considered."

However, measuring hormone levels in individual patients is probably of little use, according to a German team, led by Dr. Jurgen Bauer at the University of Bonn.

Epilepsy is associated with reduced fertility, hormone disorders and sexual dysfunction, Bauer's team points out. Their goal was to tease out the effects due to epilepsy and those due to antiepileptic drugs.

The investigators studied 200 men with epilepsy treated with no more than one antiepileptic drug, and compared them with 105 healthy "control" subjects.

Although total testosterone levels were not significantly affected by epilepsy, free testosterone levels were higher in control subjects. Both forms of the hormone were lower in those with temporal lobe epilepsy than in those with other forms of the condition.

The anti-epileptic drug carbamazepine was tied to significantly lower levels of testosterone than those seen with another anticonvulsant drug, valproate. "Carbamazepine may therefore have the potential to aggravate the negative effects of temporal lobe epilepsy on testicular testosterone production," they write.

Valproate treatment appeared to have no effect on sperm cell function in those with temporal lobe epilepsy, but carbamazepine was associated with abnormal levels of hormones involved in sperm production.

"Epilepsy, especially temporal lobe epilepsy, adversely affects testicular endocrine function," Bauer's team concludes. But how much this reflects an impairment of fertility remains unclear.

Meanwhile, the Finnish group evaluated the reproductive health of 60 men with epilepsy treated with valproate, carbamazepine or oxcarbazepine, and a comparison group of 41 men.

Abnormal sperm were more frequently seen in those with epilepsy.

"Carbamazepine or partial epilepsy may affect sperm concentration, morphology, and motility," they report. "Valproate or generalized epilepsy may be associated with a high number of spermatozoa with abnormal morphology and motility, and oxcarbazepine may be associated with abnormal morphology of sperm."

Valproate was also linked to reduced testicular volume, which was associated with abnormal sperm but not with serum hormone levels.

In an accompanying editorial, Dr. John R. Gates, at the University of Minnesota in Minneapolis, commends this research, writing: "These two studies give us a strategic direction for further research in the area of sexual function in men with epilepsy."

Source: Neurology, January 27, 2004.

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Metabolic Syndrome Ups Stroke Risk

Friday, February 6, 2004

FRIDAY, Feb. 6 (HealthDayNews) -- Metabolic syndrome greatly increases the risk of stroke.

That's the finding researchers from Boston University School of Medicine will present Friday at the American Stroke Association's annual meeting in San Diego.

The study suggests that treating the risk-factor components of metabolic syndrome may reduce stroke risk before the onset of type 2 diabetes.

"Before it become necessary to begin aggressive treatment of diabetes and other predisposing factors for stroke, it might be possible to take steps that can prevent these serious conditions from developing," study author Robert M. Najarian, a third-year medical student, says in a prepared statement.

He and his colleagues found women with metabolic syndrome have more than double the risk of stroke than women who don't have the syndrome. Men with metabolic syndrome have a 78 percent greater chance of stroke than men without the syndrome.

Metabolic syndrome is defined as the simultaneous presence of at least three of five metabolic abnormalities: abdominal obesity; high fasting levels of sugar; high triglycerides levels; low levels of HDL ("good" cholesterol); and high blood pressure.

People with metabolic syndrome, often regarded as a pre-diabetic condition, have a greatly increased risk of developing type 2 diabetes. Both metabolic syndrome and diabetes increase a person's risk of coronary heart disease. Diabetes is also a risk factor for stroke.

More information

Here's where you can learn more about metabolic syndrome.

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Resistance Exercise Curbs Diabetes in Pregnancy

Reuters Health
Friday, February 6, 2004

NEW YORK (Reuters Health) - Women who develop diabetes during pregnancy can reduce their need for insulin treatment by participating in a resistance training program, investigators in Canada report.

According to their study results, overweight women seem to benefit more than their lean counterparts from such an exercise program.

The research team, based at the University of Alberta, Edmonton, notes that resistance exercise may be preferable to aerobic exercise, which is also recognized as a means of treating so-called gestational diabetes. Resistance training improves strength and posture, which could alleviate some of the discomfort of advanced pregnancy, and may be more easily performed than aerobic exercise.

In the study, led by Gabrielle Brankston, 32 women were randomly assigned to a standard diabetic diet alone or to a diabetic diet plus exercise. The participants were at approximately 29 weeks into their pregnancies.

The exercise regimen involved eight resistance exercises in a circuit-type training set-up, three times per week. The amount of insulin needed to control diabetes was significantly lower in the diet-plus-exercise group, the investigators report in the American Journal of Obstetrics and Gynecology (news - web sites).

Among women who were overweight before becoming pregnant, only 3 of 10 in the exercise group required insulin therapy, versus 8 of 10 in the diet-alone group.

Despite this benefit, pregnancy outcomes -- gestational age at delivery, rate of caesarean deliveries and birth weight -- were similar in the two groups.

The authors suggest that the results could be improved further. They point out that those in the exercise group participated in an average of two sessions per week rather than the recommended three weekly sessions. Beginning an exercise program earlier in pregnancy and improved compliance with the exercise regimen may eliminate the need for insulin altogether, Brankston's team suggests.

They recommend an investigation with more women and a direct comparison between aerobic and resistance training.

Source: American Journal of Obstetrics and Gynecology, January 2004.

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Looking at Links to Brain-Wasting Disease

Friday, February 6, 2004

FRIDAY, Feb. 6 (HealthDayNews) -- The link between blood transfusions and transmission of the human version of mad cow disease is examined in two studies in this week's issue of The Lancet.

The studies highlight the public health implications of blood transfusion as a possible route for infection by the prion protein that causes variant Creutzfeldt-Jakob disease (news - web sites) (vCJD).

The first study examines the case of a British man who died of vCJD in December 2003. The man developed symptoms of the disease 6.5 years after receiving a transfusion of red cells donated by a donor 3.5 years before the donor developed symptoms of vCJD.

"Our findings raise the possibility that this infection was transfusion-transmitted. Infection in the recipient could have been due to past dietary exposure to the BSE (news - web sites) agent. However, the age of the patient was well beyond that of most vCJD cases, and the chance of observing a case of vCJD in a recipient in the absence of transfusion transmitted infection is about one in 15,000 to one in 30,000," researcher Robert Will, of the National CJD Surveillance Unit in Edinburgh, Scotland, says in a prepared statement.

The second study compares the degree of tissue infectivity among macaque monkeys that were given, orally or intravenously, tissue containing the BSE agent. The study found the degree of organ infection in the macaques was similar, regardless of the route of entry.

The finding that intravenous transmission of BSE is highly effective means that intravenous transmission should be regarded as a likely route of transmission for vCJD patients who had received a blood transfusion, the study authors say.

More information

Here's where you can learn more about Creutzfeldt-Jakob disease.

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Many Cancer Patients Have Untreated Depression

By Alison McCook
Reuters Health
Friday, February 6, 2004

NEW YORK (Reuters Health) - One in 12 cancer patients may have depression, which often goes untreated, new research shows.

After screening more than 5,000 cancer patients, UK investigators estimated that 8 percent were depressed. However, only half of diagnosed patients had ever discussed their low mood with their doctors, and only 15 percent were receiving proper treatment for depression.

Depression is often tackled with a combination of therapy and prescription drugs. In an accompanying study, however, the researchers demonstrate that many cancer patients with depression also appeared to benefit from weekly visits with a specially trained nurse who encouraged them to adopt a positive and proactive approach to their problems and to seek help for their depression.

Although doctors may be well aware that cancer patients are at risk of depression, many factors can prevent them from focusing their attention on that aspect of care, study author Dr. Michael Sharpe of the University of Edinburgh told Reuters Health.

For instance, patients may hesitate to mention their mood, oncologists may be too busy to ask, and general practitioners may believe a cancer patient's needs are all being met by a cancer doctor, Sharpe explained.

Furthermore, even when doctors notice a patient is depressed, they may consider it to be an "understandable" side effect of cancer, and fail to take it seriously, the authors write in the British Journal of Cancer.

"The common factor is that the focus of all concerned is on the cancer - and the depression gets ignored," Sharpe said.

He added that he and his colleagues hope that, one day, treatment for depression will become a standard aspect of cancer patients' care, receiving the same attention as other symptoms like pain and fatigue.

During the studies, Sharpe and his colleagues screened 5,613 patients attending an oncology clinic for depression, and asked those diagnosed with the condition about the care they had received. Most of the participants were outpatients with inactive cancer, who were no longer receiving treatment for their disease.

In addition, Sharpe's team asked 30 cancer patients diagnosed with depression to participate in weekly discussions with a nurse about depression and how they can get treatment, and compared their progress to another 30 depressed cancer patients treated by their general practitioners.

Over the course of six months, 90 percent of nurse-treated patients but only half of the others were prescribed an antidepressant.

By the end of the study, the researchers found that only 5 percent of patients who participated in weekly sessions still had depression, compared with 57 percent of patients whose treatment was left up to their general practitioners.

Although there are many possible reasons why patients benefited from speaking with a nurse about their depression, Sharpe suggested that the most important factor may stem from being encouraged to take charge of their lives and problems.

"Being helped to get back a feeling of being in control of their lives is a key factor in their recovery," Sharpe noted.

Source: British Journal of Cancer, January 26, 2004.

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A Newborn's Night Routine

Thursday, February 5, 2004

(HealthDayNews) -- If you've recently had a baby, you're probably already asking, "How long before my infant sleeps through the night?"

While there are no hard and fast rules for when a baby should achieve a "normal" sleep routine, most infants sleep through the night at around age six months, according to the University of Texas Health Science Center.

How long your baby lasts between feedings often determines his or her ability to sleep through the night. Most newborns need about 14 hours sleep a day. At between six and 12 months, this decreases to 12 hours a day.

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Arthritis Patients' Fracture Risk Overestimated

Reuters Health
Friday, February 6, 2004

NEW YORK (Reuters Health) - People with rheumatoid arthritis are thought to be liable to break bones as a result of bone-thinning osteoporosis, but that may not be generally true, it seems.

With the exception of hip fractures, women with rheumatoid arthritis (RA) do not have substantially more non-spinal fractures than women without RA, researchers from Norway report in the Annals of the Rheumatic Diseases.

Dr. Ragnhild Orstavik, of Diakonhjemmet Hospital in Oslo and colleagues compared the rate of self-reported fractures (excluding vertebrae) in 249 women with RA and equal number of matched controls. In both groups, the subjects were about 63 years old and about the same weight.

Overall, fifty-three RA patients (21 percent) reported a total of 67 fractures while fifty control subjects (20 percent) reported 60 fractures.

"The similarity between the two groups in the number of subjects who reported a previous fracture...was striking," the team writes. This was totally "unexpected," Orstavik told Reuters Health, "as RA patients are known to have an increased frequency of osteoporosis, which was also the case in this study."

They were also surprised to find no increase in wrist fractures in patients with RA compared with controls (23 versus 28), "fractures that are common in this age and sex group, and considered one of the classic osteoporotic fractures," Orstavik explained.

However, because of the small number of subjects in this study, no strong conclusions can be drawn about individual fracture types, except hip fractures, the team reports. Confirming prior studies, hip fractures occurred significantly more often in RA patients than controls (10 versus 2).

Source: Annals of the Rheumatic Diseases, February 2004.

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Thursday, February 5, 2004

USDA Sees Little Risk of More Mad Cow Cases

By Randy Fabi
Reuters Health
Thursday, February 5,2004

WASHINGTON (Reuters) - One day after a government-appointed expert panel warned the United States was likely to have more cases of mad cow disease, U.S. Agriculture Secretary Ann Veneman said on Thursday there was little risk because there were safeguards already in place.

"I don't anticipate that we have a significant issue in this country," Veneman told reporters when asked if there could be more cases of the brain-wasting disease. She spoke after addressing a lunch for farm and agribusiness lobbyists.

The first U.S. case of mad cow disease was announced by the USDA on Dec. 23. Since then, the government has tightened regulations for livestock feed and banned crippled "downer" cattle from the human food supply.

On Wednesday, an international panel of experts appointed by the USDA issued a report that said there was a "high probability" of more cases of mad cow disease in American cattle. The report gave no estimate of how many animals, but said contaminated material from them "has likely" already been rendered into U.S. cattle feed.

Mad cow disease is believed to be spread through livestock feed contaminated with the brain, spinal cord or nervous system tissue of infected animals.

The panel recommended the U.S. government ban all barnyard animal remains from cattle food as a precaution, and ban cattle brains and spinal material in animal feed and pet food.

A USDA animal health advisory committee, which oversees the international panel of experts, was expected to issue final recommendations to Veneman in the next few days.

Veneman declined to say if the government would adopt any of the panel's suggestions.

Reconciling Differences

The panel's findings went far beyond the conclusions of a three-year Harvard study, which said there was a minimal risk of mad cow disease occurring in the United States.

Ulrich Kihm, a Swiss veterinary expert who led the panel, on Wednesday said the Harvard study was no longer relevant, and the U.S. feed ban adopted in 1997 was insufficient to prevent mad cow disease.

Veneman late Wednesday met with authors of both reports to reconcile differences in the findings.

"Turns out there was a simple misunderstanding by some of the members in the (panel)," George Gray, co-author of the Harvard study, told Reuters. "We are not in disagreement."

Both studies concur there could be more cases of mad cow disease in the United States, but because of tough U.S. safeguards the outbreak would not be widespread, Gray said.

Gray agreed the new recommendations would reduce the risk of mad cow disease, but said there might not be a need.

"How much is the risk now and how much further down do you want to go is the question," he said. "The steps (the United States) have taken were enough to keep the risk very low."

The panel's report has caused an uproar among U.S. cattle and feed groups

"Perhaps, its most glaring error was to focus on the BSE (news - web sites) scenario in the United Kingdom in arriving at some highly questionable, unscientific conclusions," the American Feed Industry Association said in a statement.

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Chemotherapy After Lung Cancer Surgery Can Save Lives

American Cancer Society
Thursday, February 5, 2004

Chemotherapy can help lung cancer patients live longer, according to a group of international researchers, if it's given after surgery has completely removed the tumor. Writing in the New England Journal of Medicine (news - web sites) (Vol. 350, No. 4: 351-360), the International Adjuvant Lung Cancer Trial Collaborative Group (IALT) reported that chemotherapy with the drug cisplatin improved the 5-year survival of these patients by 4%.

Although this is the first large trial to find a significant benefit from chemotherapy after lung cancer surgery, it could change the way doctors treat a disease that is expected to claim more than 160,000 lives in the United States this year alone.

"This study" represents a new standard of care," said Ronald Blum, MD, in an accompanying editorial. Blum is associated with cancer centers at Beth Israel Medical Center and St-Luke's-Roosevelt Hospital Center, both in New York.

Benefit Small, But Significant

Lung cancer is the deadliest cancer in the United States and most of the world. The most common form, non-small cell lung cancer, is treated with surgery whenever possible. The operation can cure some patients, but in many cases the disease has already spread by the time it is found. The cancer eventually returns, either in the lung or some distant site such as bone or liver. (Small cell lung cancer is much less common and is generally not treated with surgery.)

Chemotherapy after surgery has not been very helpful in preventing this relapse; most studies have found no benefit from the drugs. A few studies that used the drug cisplatin showed promise, but they were too small to serve as anything but a stepping-stone for a larger study.

To better judge the value of cisplatin-containing chemotherapy, the IALT researchers studied more than 1,800 lung cancer patients whose tumors had been completely removed by surgery. Half the patients received chemotherapy with cisplatin and a second drug, while the other half had no chemotherapy after surgery.

By the end of the study, 469 people in the chemotherapy group had died, and 504 people in the control group had died. This translated into a 4% improvement in 5-year survival for patients on chemotherapy -- a figure similar to the survival benefit seen from chemotherapy given for other cancers.

Although the benefit is small, it could affect a large number of people. The researchers estimate that about 180,000 people worldwide would be eligible for treatment each year, and that 7,000 of them would live longer because of the therapy.

Side Effects a Potential Problem

While this new treatment regimen holds promise, both the IALT researchers and Blum caution that it shouldn't be considered the only option.

Chemotherapy with cisplatin can be toxic, causing nausea, vomiting, kidney failure, infections, and occasionally, death. Doctors need to discuss the pros and cons with their patients before beginning this treatment. No chemotherapy might be more appropriate for some patients.

Additional studies, some of which are already underway, may help doctors determine which patients would make the best candidates for chemotherapy after lung cancer surgery. Advances in imaging and staging techniques could also help narrow the field, Blum says. The results should yield "rich rewards" for future lung cancer patients, he concludes.

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Iron Helps Build Bones

Thursday, February 5, 2004

(HealthDayNews) -- It's widely known that calcium helps build strong bones. But according to Tufts University Health & Nutrition Letter, iron is another important nutrient associated with bone health because it helps produce an integral component of bone called collagen.

However, iron is only effective in bone building when the recommended 800-1200 milligrams of calcium are consumed as well.

A recent study of menopausal women found that those who consumed about 18 milligrams of iron a day, along with adequate calcium, had the greatest bone mineral density.

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CDC Says Carbs to Blame for Rising Calorie Intake

By Paul Simao
Thursday, February 5,2004

ATLANTA (Reuters) - Americans, especially women, are consuming far more calories than they did three decades ago, and the increasingly dreaded carbohydrate food group is to blame, according to a federal study released on Thursday.

The finding, revealed in a report by the Centers for Disease Control and Prevention (news - web sites), comes amid repeated government warnings of a growing obesity epidemic in the nation as well as an explosion in the popularity of low-carbohydrate diets.

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.

CDC researchers found that women between the ages of 20 and 74 consumed an average 1,877 calories per day in 2000, 22 percent more than in 1971. The average intake for males in the same age group was up 8 percent to 2,618 calories in 2000.

The percentage of daily calories that came from carbohydrates, which include rice, bread and pasta, rose to 51.6 percent from 45.4 percent in women and to 49 percent from 42.4 percent in men during the period.

The study did not examine the reasons for the increase in carbohydrate intake, though the CDC noted that previous research had linked it to consumption of pizza, salty snacks and take-away foods as well as bigger portions.

Jacqueline Wright, the lead author of the study, noted that the findings should not be seen as supporting the Atkins diet or any other food regimen that stressed low or no consumption of carbohydrates.

"I think we need to focus on total calorie intakes," said Wright, an epidemiologist with the CDC's National Center for Health Statistics.

The study also found that consumption of fat, including saturated fat, which can clog arteries and lead to heart disease, represented a smaller percent of daily calories by the end of the 30-year period.

The actual number of fat grams consumed per day, however, changed little between 1971 and 2000 due to the rising calorie consumption, Wright said. Protein intake for both men and women remained about the same.

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Heavy Women Who Become Pregnant Face Greater Health Risks

By Colette Bouchez
HealthDay Reporter
Thursday, February 5,2004

THURSDAY, Feb. 5 (HealthDayNews) -- There are new reasons to control your weight both before and after you conceive -- particularly if you're heavy before you even try to have a baby.

Obesity promotes not only severe pregnancy complications in the mother, it also places the baby at high risk of health problems, including an increased chance of neonatal death.

That's the sobering news from a group of Swedish researchers who say that not only is it important to control weight gain during pregnancy, but to also get your level of body fat under control before you attempt to conceive.

"[We are hopeful] that knowing the problems concerning pregnancy and delivery associated with obesity could possibly motivate young women to prevent excessive weight gain," says study author Dr. Marie Cendergren. She is an obstetrician in the division of obstetrics and gynecology at Linkoping University, where the research was conducted.

The findings appear in the February issue of Obstetrics and Gynecology.

Although Cendergren believes that reaching as close to a "normal" weight as possible before conception is the best way to avoid problems, she acknowledges this would be difficult for most women suffering from obesity.

However she adds that "a BMI below 30 significantly reduces risks," and she encourages women to aim for that goal. A BMI, or body mass index, is an indication of the level of body fat. A "normal" BMI ranges from 19 to 26, depending on height, Cendergren says.

Among the pregnancy problems cited by the study was an increased risk of preeclampsia, a potentially fatal form of maternal high blood pressure. Other problems include increased likelihood of Caesarean-section delivery; greater risk of shoulder dystocia (damage to the baby's arm and shoulder during delivery); fetal distress; stillbirth; and death of the child shortly after birth.

Although losing weight before pregnancy would help reduce the risk of all these problems, Cendergren suggests that for even greater insurance, all obese women should be under the care of a high-risk pregnancy expert.

"We must look upon these pregnancies and deliveries as high-risk pregnancies -- particularly the doctors dealing with them," Cendergren says.

New York University obstetrician Dr. Michael Silverstein says the study underscores the importance of watching your weight both before and after pregnancy. But, he adds, this is information most physicians have known for a long time.

"Whether the weight gain occurs before pregnancy or after conception takes place, if you are very overweight it is going to cause a litany of problems affecting both the mother and the baby," Silverstein says. Even something as routine as a pregnancy ultrasound -- to check for fetal growth and development -- can be difficult or impossible to accurately read when the mother is very overweight.

"I'm not certain if the excess weight is causing these birthing complications, or if the weight is keeping us from properly diagnosing certain conditions that we might otherwise normally see -- particularly those involving fetal distress," Silverstein says.

While he agrees that some obese women do require the care of a high-risk pregnancy expert, he also believes every pregnancy should be viewed in an individual light.

"A lot depends on the overall health of the mother. A very overweight woman who is in good physical condition may be of less concern than a woman who is moderately overweight but is in poor physical condition or is carrying more than one baby," he says.

The Swedish study looked at nearly 3,500 pregnancies in morbidly obese women -- defined as a body mass index over 40. An additional 12,698 women with a BMI between 35.1 and 40 were also part of the study. All were compared to pregnant women with a normal BMI, falling between 19.8 and 26.

The result: Women with a BMI greater than 40 were at significantly heightened risk for preeclampsia; stillbirth; Caesarean delivery; instrument delivery, (such as forceps); shoulder dystocia; meconium aspiration (a newborn breathing-related procedure), fetal distress; early neonatal death; and large-for-gestational-age -- a problem that can lead to other birth complications.

Although women with a BMI between 35.1 and 40 also were subjected to the same risks, the incidence was notably lower. Indeed, researchers say the lower a woman's BMI, even by just a few points, the lower her risk of problems.

According to Cendergren, the risk of gaining excessive amounts of weight during pregnancy is as detrimental as being very overweight going into the pregnancy.

More information

To learn more about obesity and pregnancy, visit The March of Dimes. Or visit the National Heart, Lung, and Blood Institute for the very latest guidelines on controlling obesity.

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Study Shows Why 1918 Flu Epidemic Was So Deadly

By Maggie Fox, Health and Science Correspondent
Thursday, February 5,2004

WASHINGTON (Reuters) - The 1918 flu virus, which killed 20 million people around the world, was probably so deadly because of a unique bird-like protein, U.S. and British scientists reported on Thursday.

Like a current outbreak of bird flu in east Asia, the 1918 influenza appears to have jumped from birds to people with little change, they wrote in this week's issue of the journal Science.

But unlike the 1918 flu, the current bird flu, which has killed 16 people, so far has not developed the mutation that allowed influenza to decimate human populations 80 years ago.

"What (this study) says is this transmission between birds and humans seems to be able to happen in more than one way," John Skehel of Britain's Medical Research Council, who led one study, said in a telephone interview.

Two teams of researchers analyzed samples of the virus from the 1918 outbreak and said it bears the clear hallmarks of a bird virus that mutated very little before jumping from birds to people.

Health officials in China, Thailand, South Korea (news - web sites) and Vietnam are scrambling to control the current outbreak of avian influenza, known as H5N1. It is lethal to people, which is often the case when viruses leap from one species to another.

In 1997 when it first appeared in Hong Kong it was contained very quickly because it did not spread from human to human, but only from birds to people.

So far this year only 16 people have been killed, but there is some evidence it may have begun spreading from person to person. If that happens, experts fear the virus has the potential to be as bad as the 1918 epidemic.

Understanding just what it is about the viruses that makes them deadly, and what makes them able to live and spread among humans, will be key to controlling or pre-empting future epidemics, the researchers noted.

Dug Up From The Past

Skehel's team and another led by Ian Wilson at the Scripps Research Institute in La Jolla, California looked at bits of the virus extracted from the bodies of victims, some buried in Alaska permafrost and others saved in laboratory jars.

They looked specifically at a part of the virus called hemagglutinin, which is a protein the virus uses to infect cells. Each strain of virus has a unique hemagglutinin structure, and scientists believe small mutations of the protein are what allows the virus to infect new species.

The 1918 virus was an H1 virus -- different from H5N1.

They found it had some unique structures that may have given it "novel mechanisms" for infecting people, Wilson and colleagues wrote. This may explain why the 1918 epidemic killed so many young, healthy adults.

And this explains why the current avian flu outbreak has, so far, not lived up to fears, said Skehel.

"Presumably, what's blocking this current flu from spreading person-to-person is that its hemagglutinin structure has not yet evolved such that it can efficiently infect humans," Skehel said in a statement.

"This tells us more about the transmission of infections from birds to humans," he added.

"However, it will not have an immediate impact on the situation currently unfolding in the Far East with the chicken flu known as H5, since, from our previous work, we know that the 1918 and the H5 hemagglutinins are quite different."

He said scientists should be testing birds for various forms of influenza to see what else may be lurking out there with the potential to infect people.

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Toxins Linked to Autism, ADHD

Thursday, February 5,2004

THURSDAY, Feb. 5 (HealthDayNews) -- Exposure to certain neurodevelopmental toxins, including the vaccine additive thimerosal, may increase the risk of autism and attention-deficit hyperactivity disorder, says a study in the April issue of Molecular Psychiatry.

This research is the first to offer a possible explanation for possible causes of these two increasingly common childhood disorders.

The researchers found that exposure to toxins such as ethanol and heavy metals (including lead, aluminum and the ethylmercury-containing preservative thimerosal) interrupt growth factor signaling. This adversely impacts methylation reactions such as the transfer of carbon atoms. Methylation is critical to proper neurological development in infants and children.

"Scientists certainly acknowledge that exposure to neurotoxins like ethanol and heavy metals can cause developmental disorders but, until now, the precise mechanisms underlying their toxicity have not been known," researcher and pharmacy professor Richard Deth of Northeastern University says in a prepared statement.

"The recent increase in the incidence of autism led us to speculate that environmental exposures, including vaccine additives, might contribute to the triggering of this disorder," Deth says.

Starting in 2000, the United States and Europe largely phased out thimerosal, often used as a preservative in multi-dose units of vaccines for diseases such as hepatitis, whooping cough, tetanus and diptheria.

Now, most vaccines in the United States and Europe contain only trace amounts of thimerosal. However, multi-dose flu vaccines still contain thimerosal. The same is true of many larger, multi-dose vials of vaccines shipped to and used in developing countries.

More information

Here's where you can learn more about autism and ADHD.

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Study: Cooling Helmets May Prevent Stroke Damage

Thursday, February 5,2004

WASHINGTON (Reuters) - Helmets that cool the brain may slow down the spreading damage caused by a stroke, buying precious hours for patients, researchers reported on Thursday.

Such a helmet might be used by ambulance crews to stabilize stroke victims while getting them to hospitals for brain-saving treatment, the researchers said.

Stroke is the third leading cause of death in the United States, with most caused by blood clots cutting off blood flow to the brain. The longer the clot lasts, the worse the damage.

Clot-busting treatment can minimize damage but must be given within hours, usually three hours, of the stroke.

Cooling patients has been found to help prevent the damage of a heart attack and now two teams told the American Heart Association (news - web sites)'s annual International Stroke Conference it may work for stroke, too.

The problem has been how to cool the brain without affecting the rest of the body.

Dr. Kentaro Yamada of the National Cardiovascular Center in Osaka, Japan and colleagues said they tested a "helmet-type cooling apparatus" on 17 patients with severe stroke.

His team put the cooling helmet on patients three to 12 hours after their strokes and left it on for up to a week.

Some patients shivered mildly and had elevated potassium levels, mild skin damage and infections, but none had serious adverse effects, Yamada said.

A similar U.S. study used liquid cooling technology developed by NASA (news - web sites) scientist William Elkins for space suits, said Dr. Huan Wang, a neurosurgeon at the University of Illinois in Peoria.

His team used tiny fiber optic probes inserted in the brain to monitor the temperature.

The patients' brains cooled an average of 6 degrees F (2.5 degrees C) the first hour, without dropping body temperature significantly. Patients tolerated it for an average of six to eight hours before body temperature dropped below healthy levels, they said.

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Predicting Preeclampsia

By Amanda Gardner
HealthDay Reporter
Thursday, February 5,2004

THURSDAY, Feb. 5 (HealthDayNews) -- Abnormal levels of certain molecules in the blood may predict the development of preeclampsia in pregnant women, new research has found.

Preeclampsia is a potentially life-threatening condition that affects up to 5 percent of all pregnancies in the United States. The condition involves dangerously high blood pressure and protein in the urine.

"Preeclampsia is not uncommon, and both the mother and fetus are at risk for serious complications and even death," says Dr. Caren G. Solomon, author of a perspective article that accompanies the study in the Feb. 12 issue of the New England Journal of Medicine (news - web sites).

The article is being released early to coincide with a presentation Thursday at the annual meeting of the Society for Maternal-Fetal Medicine in New Orleans.

So far, any precise cause or causes of preeclampsia have eluded scientists (although some risk factors, such as obesity, are known) and, while individual symptoms can be treated, the "cure" is to deliver the baby.

Such a cure only works well if the woman is near term, however.

"If a woman gets preeclampsia and it's very early in the pregnancy, if you deliver the baby, the baby won't be able to survive," says study leader Dr. Richard J. Levine, a research medical officer in the epidemiology branch of the National Institute of Child Health and Human Development. "Even if it's a little older, it may be at risk for all kinds of problems in later life."

The hope is that these findings might one day lead to screening tests for preeclampsia and maybe even some treatment options, but it will take more research.

"These are intriguing data, but this cannot tell us that this molecule is the cause of preeclampsia," says Solomon, who is deputy editor of the journal and an associate physician at Brigham and Women's Hospital in Boston. "We don't know yet what [the role of the molecules] is going to be in identifying women who will develop preeclampsia or potentially in the development of a therapy. It's a very interesting observation and paves the way for a lot of follow-up studies that can help answer those questions."

Investigators had already zeroed in on the placenta as a central player in the onset of preeclampsia.

Study co-author S. Ananth Karumanchi had already discovered that a molecule called sFlt-1 is present in large quantities in women with preeclampsia. When injected into rats, sFlt-1 also caused an illness similar to preeclampsia. SFlt-1 is an anti-angiogenic compound, meaning it interferes with blood supply.

For this study, the investigators compared blood from 120 women who had developed preeclampsia with blood from 120 women who had had normal pregnancies. Some of the blood samples were taken before the diagnosis of preeclampsia was made.

The women who eventually developed preeclampsia had three times the blood levels of sFlt-1 as the women with normal pregnancies. At the beginning of their pregnancies, however, blood levels of sFlt-1 in both groups of women were similar. Levels began to rise steeply about five weeks before the onset of preeclampsia.

Conversely, levels of Placenta Growth Factor (PIGF) and Vascular Endothelial Growth Factor (VEGF), which both promote blood supply, were present in inverse proportions to sFlt-1.

Specifically, sFlt-1 seemed to be binding the PlGF and the VEGF, Levine says. "Both PlGF and VEGF are required to maintain the health of endothelial cells, which line blood vessels throughout the body," he says. "These cells become dysfunctional."

"The high levels of sFlt-1 are thought to interfere with appropriate blood flow in the placenta, and also might account for other abnormalities in preeclampsia, including high blood pressure and protein in the urine in the mother," Solomon explains.

One issue that remains to be resolved is whether levels of these compounds can distinguish women who will get preeclampsia from women who will get gestational hypertension, a less serious condition. Figuring that out is the next step, Levine says.

More information

For more on preeclampsia, visit the Preeclampsia Foundation or the American Academy of Family Physicians.

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Food Poisoning Bugs Lurk in Body, Study Shows

Thursday, February 5,2004

WASHINGTON (Reuters) - Listeria, a common food poisoning bug, may be able to lurk in the body and perhaps even spread without causing symptoms, U.S. researchers reported on Thursday.

It may re-emerge from hiding weeks or months after infection to make a victim sick again or to spread to someone else, they report in Friday's issue of the journal Science.

The finding by researchers at Stanford University School of Medicine suggests that an unwitting food worker could transmit the bacteria -- in a way reminiscent of Typhoid Mary, an Irish-born cook who caused several outbreaks of typhoid in the United States nearly 100 years ago.

The researchers infected young mice with Listeria monocytogenes bacteria and used a special imaging method to see where the bacteria went.

By 18 hours after infection the mice seem to have largely rid themselves of the bacteria. "After three to nine days, depending on the dose, the signals reappeared in different locations in many of these animals and persisted for two or three days before waning again," the researchers wrote.

The mice did not get ill with the second appearance.

When the mice were killed and dissected, the bacteria were found in the gallbladders -- where the Salmonella typhosa bacteria that cause typhoid are also known to hide out.

This suggests the same thing may go on in people, said Jonathan Hardy of Stanford and colleagues there and at imaging company Xenogen.

Listeriosis can make some people very sick and can kill those with weakened immune systems. It kills about 500 people a year in the United States and can cause miscarriage.

"Twenty to 40 percent of people with listeriosis die even after antibiotic treatment," Hardy said in a statement.

It can thrive in refrigerated foods and especially likes soft cheeses and deli meats.

"The most striking thing about all of this research is that we get tremendous amounts of growth without disease," said Hardy. "This represents a new face of the pathogen -- growing in a different place and a different way."

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Angioplasty an Option for Clogged Brain Arteries

Thursday, February 5,2004

THURSDAY, Feb. 5 (HealthDayNews) -- Angioplasty clears clogged brain arteries and prevents stroke in people who fail to respond to medication.

The finding is being presented Feb. 5 at the American Stroke Association's annual meeting in San Diego.

Angioplasty uses a tiny balloon that's inserted into the area of blockage in an artery. Once it's at the blockage point, the balloon is inflated and expands, forcing fatty plaque against the artery wall and opening the artery. While commonly used to open blocked heart arteries, angioplasty is not widely used to clear neck and brain arteries.

The Stanford University Medical Center study included 36 people with significant narrowing of a brain blood vessel (intracranial stenosis). All the patients had failed to respond to medication.

Before angioplasty, stenosis in these patients averaged 84.2 percent. After angioplasty, average stenosis was 43.3 percent. One patient suffered ischemic stroke during the angioplasty but recovered.

Two of the patients died within a month of the angioplasty, one due to vessel perforation and one due to reperfusion hemorrhage. Among the 34 remaining patients, the annual stroke rate in the areas of angioplasty was 3.36 percent and the annual rate for all strokes was 5.38 percent.

"One would expect 8 percent to 10 percent of these patients to have suffered a stroke in the territory of angioplasty annually had they been treated with medication," study author Dr. Michael P. Marks, an associate professor of radiology and neurosurgery and chief of interventional neuroradiology at Stanford, says in a prepared statement.

More information

Here's where you can learn more about stroke.

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FDA Panel Supports Advanced Medial Optics Lens

Thursday, February 5,2004

GAITHERSBURG, Md. (Reuters) - A U.S. regulatory panel on Thursday narrowly backed an application from Advanced Medical Optics and Ophtec USA for a new implantable lens that treats nearsightedness.

The Food and Drug Administration (news - web sites) advisory panel voted 7-6 to recommend the agency approve the device, called Verisyse, which could be the first lens of its kind to reach the U.S. market. The FDA usually approves products supported by its advisory panels.

Panel members urged the FDA to impose conditions that would limit the approved use to older patients and those with the most severe nearsightedness.

Advanced Medical Optics has exclusive rights to sell the lens in North America and Japan and can sell it globally along with other distributors.

Privately-held OPHTEC USA, which makes the device, is a subsidiary of Netherlands-based OPHTEC B.V. The lens is already marketed under the name Artisan in other countries.

Nearsightedness, or myopia, is a common refractive disorder that makes it difficult to see distant objects. About 30 percent of Americans suffer from it, according to the American Optometric Association.

The Verisyse lens is surgically attached to the eye's natural lens to correct vision and is designed for patients with higher levels of sight problems.

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Vampire Bat Saliva Holds Key to Stroke Treatment

Thursday, February 5,2004

THURSDAY, Feb. 5 (HealthDayNews) -- A synthetic drug derived from the saliva of vampire bats holds promise for treatment of acute stroke.

Believe it or not, that's what researchers are reporting at the American Stroke Association's annual meeting in San Diego on Feb. 5.

The drug, called desmoteplase, appears to extend the time window for treatment of acute ischemic stroke. The study found the drug prevents stroke-related brain damage if it's given to patients between three and nine hours after the onset of stroke symptoms. Currently, three hours is the standard window.

Desmoteplase is a genetically engineered version of a blood clot-dissolving protein found in the saliva of the vampire bat. The drug can issolve a blood clot without affecting the rest of the body's clotting system and without increasing the risk of intracranial bleeding, the study says.

The study included patients in Europe, Australia and Asia. An ongoing twin U.S. study is being conducted to identify the appropriate dosage and effectiveness of desmoteplase.

"This new approach to acute stroke treatment is novel in two ways: it uses an improved clot-dissolving drug and also takes advantage of new MRI (magnetic resonance imaging) techniques to help select the right patients for treatment," Howard Rowley, an associate professor of radiology at the University of Wisconsin Medical School, says in a prepared statement.

Rowley is lead radiologist for the U.S. study.

"The results of the [international] study are even more exciting, as they show specifically how the use of the drug significantly extends the time during which treatment can begin after the onset of stroke symptoms, from three hours to nine hours," Rowley says.

More information

Here's where you can learn more about stroke prevention.

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Lung Cancer Risk May Be Higher in Female Smokers

By Amy Norton
Reuters Health
Thursday, February 5,2004

NEW YORK (Reuters Health) - Female smokers may be more likely to develop lung cancer than men who smoke a similar amount, new study findings suggest. The investigators found that of nearly 2,500 men and women age 40 and older screened for lung cancer, women had more than twice the risk of being diagnosed with the disease.

If further research confirms this higher risk, it will be particularly important to stop girls and young women from taking up the smoking habit, the researchers say.

There's not yet a clear reason why women might face a higher lung cancer risk than men, according to the study's lead author, Dr. Claudia Henschke of New York-Presbyterian Hospital/Weill Cornell Medical Center in New York.

It's possible, she noted in an interview, that women are less able than men to metabolize, or "clear," the toxins from tobacco smoke, but more research is needed to answer that question.

Other possibilities -- such as sex differences in the aggressiveness of lung tumors, or underreporting of smoking levels by women -- do not appear to explain the findings, according to Henschke.

She and colleague Dr. Olli S. Miettnen report their results in the journal Lung Cancer.

In the study, 1,202 women and 1,288 men underwent computed tomography (CT) scans to screen for lung cancer. All had smoked for at least 10 "pack-years" -- meaning, for example, one pack a day for 10 years, or two packs a day for five years.

Follow-up testing confirmed 45 cases of lung cancer among women, and 20 among men.

After the researchers factored in participants' age and smoking history, women were more than twice as likely as men to be diagnosed with lung cancer.

Some past research has suggested female smokers might be more susceptible to developing lung cancer, but other studies have failed to find such evidence. If further research confirms the current findings, it will be especially important for anti-smoking efforts to reach women and girls, according to Henschke.

"The key thing," she said, "is that girls and young women don't start smoking."

Source: Lung Cancer, January 2004.

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Quick Tests Can Assess Stroke Risk

Thursday, February 5,2004

THURSDAY, Feb. 5 (HealthDayNews) -- Three inexpensive, quick and simple tests for stroke risk could save lives and billions of dollars in health-care costs in the United States.

That's what researchers will tell those attending the American Stroke Association's annual meeting in San Diego on Feb. 5.

The study says these tests, which can be done in four minutes and cost about $20, may help assess the risk of stroke in elderly people and the appropriate treatment. That could reduce the number of strokes each year and result in huge savings.

The three tests include: a "quick scan" of the carotid arteries in the neck; electrical measurement of heart rhythm using electrocardiogram; and blood pressure measurement.

Using these tests, researchers screened 2,532 people over age 60 in central California. The tests found: neck artery blockages obstructing more than 50 percent of the artery in 7.5 percent (189) of those tested; atrial fibrillation in 5 percent (128); and high blood pressure in 29.5 percent (746).

Researchers tried to prevent strokes in these people either by surgical removal of the carotid blockages or with drug treatment.

The study says that if all 40 million Medicare recipients in the United States received similar stroke prevention screening, more than 200,000 strokes and 30,000 deaths could be prevented each year. That would result in savings of more than $12 billion in health-care costs a year, the authors suggest.

More information

Here's where you can learn more about stroke risk factors.

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Simple Test Points to Diabetics' Heart Risks

By David Douglas
Reuters Health
Thursday, February 5,2004

NEW YORK (Reuters Health) - A "cold pressor" test, which involves immersing hands in ice water for 2 minutes, can tell doctors if a person with type 2 diabetes is likely to experience heart problems, even when there are no other risk factors presents, French researchers.

As lead investigator Dr. Alain Nitenberg told Reuters Health, the "cold pressor test is a very simple method" to show if arteries are functioning properly or not.

Nitenberg, of University Hospital Jean Verdier in Bondy, and colleagues note in the January issue of Diabetes Care that the test causes coronary arteries to expand in healthy people, while in diabetics it constricts coronary arteries.

To determine whether this might be a useful means of detecting increased cardiovascular risk, the researchers studied 72 diabetes patients without other major coronary risk factors and a comparison group of 56 "control" participants.

The average change in the diameter of the coronary arteries was an increase of 17.2 percent in controls. In diabetics, the corresponding response was a 14.4 percent decrease.

No changes were seen in 8.9 percent of controls and none showed constriction. No changes were seen in 26.4 percent of diabetics and none showed dilation.

After 45 months, there were 26 cardiovascular events -- heart attack, severe angina or stroke, for example -- in 18 diabetic subjects, but only one cardiovascular event in the control group.

Furthermore, 23 of the events in diabetic patients occurred in 16 of the 53 who showed coronary artery constriction. The remaining three occurrences were in 2 of the 19 diabetic patients who had had no diameter change.

Thus, the researchers conclude, constriction of seemingly normal coronary arteries in response to the cold pressor test predicts cardiovascular problems.

Nitenberg added that the method "does not require drug administration or an intravascular device." It also might be used as "an easy means to evaluate the efficiency of therapy in high-risk patients."

Source: Diabetes Care, January 2004.

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Senior Spills

Thursday, February 5,2004

(HealthDayNews) -- Slippery tubs and water-splashed bathroom floors are common reasons for senior spills.

The Canadian city of Ottawa suggests you take these steps to skid-proof your bathroom:

  • Make sure the bathtub plug is easy to reach and to use.
  • Use a rubber mat every time you take a bath or shower.
  • Make sure anti-slip decals on the bottom of the bathtub are no more than two inches apart.
  • Install at least two grab bars in the tub area.
  • Check that portable grab bars don't move when used for climbing out of the tub.
  • Use a rug with a rubber backing outside the tub.

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Tiny Corkscrew Removes Clots, Reverses Stroke Damage

Thursday, February 5,2004

CHICAGO (Reuters) - A tiny corkscrew-shaped device threaded through the body and into the brain can remove blood clots in cerebral vessels and reverse damage caused by the most common type of stroke, researchers said on Thursday.

Each year, about 700,000 Americans suffer a stroke and 88 percent of those strokes are caused by a blood clot that blocks the blood supply to the brain.

Blood clots can be dissolved using a clot-busting drug, but if it is not given intravenously within three hours of the stroke, it will not be effective. It typically takes up to two hours for the drug to dissolve the clot and open a vessel.

In the first report testing the safety and effectiveness of the nickel and titanium corkscrew, researchers at the American Stroke Association's Stroke Conference in San Diego said it restored blood flow in 61 of 114, or 54 percent, of patients in early human trials. Researchers studied patients up to eight hours after the initial stroke symptoms who were not eligible for standard drug therapy.

Restoring blood flow in the trials reversed paralysis and other stroke symptoms, said Sidney Starkman, a physician and the co-director of the UCLA Stroke Center.

"How often do we get a chance to reverse a patient's stroke on the table? We have had patients completely paralyzed on one side of their body, who were made normal almost instantaneously when the clot was retrieved," he said.

Of the 61 patients whose arteries were unblocked with the device, called the Concentric Merci Retrieval System, 23 have no disability or have minor disability, such as hand writing problems, Starkman added.

The device is inserted into an artery in the groin, and then guided via standard angiography into the brain until it reaches the blood clot.

Once the device "captures" the blood clot, the device and clot are withdrawn into a larger catheter with a balloon. During the evacuation process, the balloon is briefly inflated to momentarily stop blood flow so the clots can be safely removed.

The 114 patients were from 25 centers and had an average age of 70. Forth-six percent were women. The study was funded by Concentric Medical Inc., which is trying to get U.S. regulatory approval for the device.

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Wednesday, February 4, 2004

Minorities Have Better Odds for Kidney Transplants

By Gene Emery
Wednesday, February 4, 2004

BOSTON (Reuters) - A federally mandated change in the way doctors test for compatibility in kidney transplants has increased the number of organs going to minorities by about 7.2 percent, a New England Journal of Medicine (news - web sites) study reported on Wednesday.

Under the previous system, whites were twice as likely to receive a donated kidney than non-whites.

The policy calls for ignoring part of the scoring system that determines whether a donated kidney and a would-be recipient are a good match.

The scoring criteria was changed last May by the U.S. Department of Health and Human Services (news - web sites) after it received advance results of the New England Journal of Medicine study.

The study, led by John Roberts of the University of California at San Francisco, predicted that a small change would increase the transplant rate for non-whites by 6.3 percent while lowering the chance of a transplant for whites by 4 percent.

The study also concluded the new rule would increase the failure rate for each transplant, regardless of race, by 2 percent.

"This has been a delicate balance. Should we give up a perfect match in return for reducing the imbalance over who gets a transplant?" said Friedrich Port, who co-authored the study. "We were happy to see that the price for improving the balance was very small."

Data from the first four months after the new scoring system was adopted showed a 7.2 percent increase in transplants for minorities. There have not been enough cases to provide a good breakdown among individual races, Port said.

Roberts said it's probably too early to gauge the full impact of the change.

Blacks At A Disadvantage

"It will probably take a few years for it to work its way through the system, but it's one step to getting rid of the disparity," he said.

Blacks, for example, are at a disadvantage for getting a kidney transplant because they are more likely than whites to develop serious kidney problems. Finding a good match for a black patient also is more challenging because blacks are more genetically diverse than whites, Roberts said.

"The white population tends to be more homogeneous so they're a relatively easy match," he explained.

Transplant rules are controversial because there are not enough transplantable kidneys available to meet the demand.

Whether someone gets a kidney depends on the amount of time they spend on a waiting list and whether they have a correct tissue match, which is determined through special blood tests called Human Leukocyte Antigen (HLA) typing.

To develop its recommendation, the Roberts team used success rates for 32,609 transplants that were done from 1995 to 2001. They studied what would happen if certain HLA types were ignored.

They found that by not caring about matching HLA type B, minorities would have a better chance for a new kidney.

"We said, 'Let's eliminate B. It doesn't matter much and it hurts blacks,"' Roberts said.

The study "is an important step toward the formulation of a just and scientific system of distributing kidney allografts," according to an editorial in the Journal by Jon van Rod of the Europdonor Foundation in Leiden, Netherlands.

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Trimming Trans Fats

Wednesday, February 4, 2004

(HealthDayNews) -- Recent research has left little doubt about the link between trans fats and heart disease.

Reduce your intake of these dangerous fats with these suggestions from the Harvard Men's Health Watch:

  • Avoid fried foods, chips, crackers, and other fatty snack foods.
  • Eat fewer commercially baked pastries, cookies, cakes, muffins and breads.
  • Try cooking with canola or olive oil instead of margarine, hardened vegetable shortening, or butter.
  • Read food labels carefully. Reduce consumption of products containing partially hydrogenated vegetable oils.
  • Eat your bread dry or use honey or jam in the morning and olive oil in the evening.

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Hospitals No Place to Get Rest, Noise Study Shows

Wednesday, February 4, 2004

WASHINGTON (Reuters) - Patients who have complained they cannot get any rest in noisy hospitals were vindicated on Wednesday with a report confirming that the racket on hospital wards can be as loud as a rock concert.

Nurses who volunteered to sleep in hospital rooms found out that rest can be almost impossible -- especially during staff shift changes.

"We wanted to experience the patient's perspective, so we became patients for one night," said Cheryl Cmiel of the Mayo Clinic in Rochester Minnesota, who helped lead the study.

"We got an earful."

Noise readings reached as high as 113 decibels -- about as much noise as a rock concert or chain saw makes, Cmiel and colleagues report in the February issue of American Journal of Nursing.

The worst ruckus came at the morning shift change, around 7 a.m., although the 11 p.m. shift change also was noisy.

This is obviously not good, Cmiel said.

"Adequate sleep is important to the healing process, and sleeping in the hospital is notoriously difficult," she said in a statement.

But they did find ways to cut down the noise, including moving staff conferences at shift change to an enclosed room, instead of at the open nurses' desk, putting foam rubber padding in the chart holders outside patient rooms, and simply closing the doors to patients' rooms.

Nurses were also advised to follow some common-sense measures such as doing nightly x-rays at 10 p.m. instead of waking patients at 3 a.m. and using flashlights instead of overhead lights when entering patients' rooms at night.

After these changes were made, the noise level fell to 86 decibels at shift change, Cmiel's team reported. That is an 80 percent reduction in noise levels, but still equivalent to the noise made by a power lawn mower, according to the American Academy of Audiology

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Coating Intestines Protects Against Deadly Infection

Wednesday, February 4, 2004

WEDNESDAY, Feb. 4 (HealthDayNews) -- Injecting a protective coating into the intestines to pacify bacteria there -- instead of relying on antibiotics -- helped protect mice from otherwise lethal post-operative infections, says a University of Chicago study in the February issue of Gastroenterology.

The high-molecular-weight polyethylene glycol coating protected mice that had had major surgery from infection with Pseudomonas aeruginosa. It's a virulent pathogen that is lethal in 100 percent of untreated mice.

This kind of infection is one the most dangerous for people after they have major surgery. This study may offer a way to deal with such hospital-related infections without having to use antibiotics.

Pseudomonas is found in the intestines of about 3 percent of healthy people. In the bowel, this kind of bacteria can be harmless. But it can also become a potentially deadly threat.

The researchers say that the bacteria can detect an ill host's vulnerability by sensing chemicals that indicate stress. The bacteria respond by mounting an aggressive attack, boring through the bowel wall and into the blood stream.

The germ can evade and even disable the host's immune system, resists antibiotics and secretes toxins similar to those used by diphtheria or anthrax. People with widespread infection can die within days.

This study found that, in mice, the protective coating forms a surrogate bioshield in the intestine that stops this whole process before it begins. It prevents the chemical signals of stress from reaching the bacteria and triggering the deadly response.

The coating also acts as a buffer between the bowel wall and the bacteria.

More information

Here's where you can learn more about microbes.

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New Women's Heart Guidelines Stress Early Action

By Maggie Fox, Health and Science Correspondent
Wednesday, February 4, 2004

WASHINGTON (Reuters) - The American Heart Association (news - web sites) released new guidelines for preventing and treating heart disease in women on Wednesday and said most women still did not realize heart disease was more likely to kill them than anything else.

The new guidelines, available on the Internet at, stress lifestyle as the first line of attack -- stopping smoking, losing weight, exercising every day and eating a healthy diet. But they also call for aggressive use of drugs to lower cholesterol and blood pressure in high-risk women.

Although surveys show women consider cancer to be their No. 1 health risk, cardiovascular disease is the leading killer of women globally, the Heart Association said. It takes the lives of nearly 500,000 U.S. women each year -- one every minute.

In 1997 the Heart Association found that 30 percent of women listed heart disease as the leading cause of death among women. But the latest survey of more than 1,000 women found that 46 percent now know the risk -- an improvement, but still fewer than half of those surveyed.

"However, when asked what they consider their own greatest health risk, only 13 percent of respondents cited heart disease," Dr. Lori Mosca of Columbia University and New York Presbyterian Hospital, who headed the guidelines committee, told a telephone briefing.

The committee took a hard lesson from the hormone replacement therapy disaster, in which doctors had to make an about-face in the strongly held belief that HRT would prevent heart disease in menopausal women.

Scientific studies showed that in fact HRT raises the risk of heart attack and stroke. It is no longer recommended except as a short-term treatment for severe menopause symptoms such as hot flashes.

Based On Evidence

The new recommendations incorporated more than 7,000 separate studies and divide women into three general groups -- those at high risk of a heart attack or other "event," those at medium risk and those at low risk.

A high-risk woman, for instance, already has heart disease and has had a heart attack or stroke, or has diabetes. A woman considered at moderate risk may have high blood pressure and high cholesterol, while a woman at low risk may be at a healthy weight with healthy blood pressure and cholesterol readings.

The guidelines say low-risk women should not take daily aspirin to thin the blood because the risks of aspirin -- it can cause stomach bleeding -- outweigh the benefits. Also, women are more likely than men to have a hemorrhagic stroke, one marked by bleeding instead of a blockage.

Instead, if a low-risk woman has slightly elevated cholesterol she can try to lower it with diet and exercise.

But the recommendations call for using statins or other cholesterol-lowering drugs in high-risk women even if their cholesterol is at normal levels.

The experts said a woman should think 50-100-150 -- and seek a high-density lipoprotein or HDL reading of 50. This goal for so-called good cholesterol is higher than previous guidelines. LDL or bad cholesterol should be below 100 and triglycerides should be below 150.

ACE inhibitors and beta-blockers are recommended for all high-risk women -- even those whose blood pressure is normal.

And unlike in men, women with heart disease should be checked for depression, as the two often go hand-in-hand, the Heart Association said.

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Heart Paradox Found in Blacks

By Andrew Conaway
HealthDay Reporter
Wednesday, February 4, 2004

WEDNESDAY, Feb. 4 (HealthDayNews) -- While black heart failure patients tend to fare worse than their white counterparts, researchers have found that, paradoxically, they also have significantly lower rates of a dangerous heart condition.

A new study by researchers at the Kaiser Permanente medical system and the University of California at San Francisco (UCSF) found blacks have sharply lower rates of the most common form of the condition, known as atrial fibrillation (AF), which is a disturbance in the electrical signals that tell the heart when to beat.

Since AF is linked to more severe heart failure, researchers thought higher rates of the disorder might be seen among blacks, which in turn might help explain why blacks with heart failure tend to have poorer outcomes than whites.

Their results, however, showed just the opposite, since the black patients in the study were much less likely to suffer from AF.

The finding appears in the Feb. 4 issue of the Journal of the American College of Cardiology.

"It is a little surprising," acknowledges Dr. Alan S. Go, a UCSF professor of epidemiology, "especially since we have seen higher risk factors for AF in that group, and then found they had such lower rates -- 50 percent lower."

The researchers combed through information on 1,373 heart failure patients treated at 16 Kaiser hospitals in northern California, including 223 blacks and 1,150 white patients.

All of the patients had similar health care insurance coverage and were treated by Kaiser Permanente providers using similar methods, to minimize socioeconomic and treatment differences.

"We found that even after you accounted for those differences, blacks with heart failure had about a 50 percent lower risk of atrial fibrillation. It was a very robust finding; no matter what we adjusted for, it remained consistent," Go says.

Typically, AF is a kind of an electrical storm that travels in spinning wavelets across both atria (the upper chambers of the heart), causing them to vibrate, or fibrillate, at 300 to 600 times per minute, instead of beating effectively. The disturbances can last anywhere from a few seconds to a lifetime.

Some specialists say the findings, while intriguing, are part of a complex issue and caution should be used when interpreting them.

"I think AF is very much population-dependent and it's all complicated, too. There are multiple factors that can influence AF," says Dr. Roosevelt Gilliam, clinical director of cardiac electrophysiology at Duke University Medical Center. "You have to ask: how do the populations compare, is the sample size big enough, is 223 enough. Maybe this group got to treatment later than other groups. What about the ones who didn't get to the trial at all?"

The study shows that "we have a lot to learn about this condition," Gilliam adds. "There may be something. Maybe there is a difference, and once you can understand the ethnic differences maybe you can exploit those differences. Maybe there is some genetics in this, but it's hard to say at this point."

In an accompanying joint editorial in the journal, Drs. Edward P. Havranek and Frederick A. Masoudi of the Denver Health Medical Center and the University of Colorado Health Sciences Center stress the need to address the socioeconomic and cultural issues of race.

"Most papers in the medical literature don't address that issue properly," they wrote. "They tend to assume that there are big biological or genetic differences between blacks and whites, but there really aren't."

But they praised the study, writing that it did a "reasonably good job of controlling for those socioeconomic factors" and "maybe this is one of those unusual situations where there really is some genetic reason" for the differences."

More information

Learn about atrial fibrillation and arrhythmias from the American Heart Association or the National Heart, Lung, and Blood Institute.

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Location Determines Heart Attack Survival-US Study

Wednesday, February 4, 2004

WASHINGTON (Reuters) - Patients who live close to a hospital are much more likely to survive a heart attack than people who live farther away, U.S. researchers reported on Wednesday.

For every five minutes more that it takes a patient to get to a hospital, his or her probability of survival falls by 1.25 percent, the team at Cornell University in New York found.

"With prompt medical attention, a person's blockage to the heart, which causes a heart attack, can often be dissolved," Liam O'Neill, an assistant professor of policy analysis and management at Cronell, said in a statement.

"That reduces damage to the heart," he added.

"But as hospitals close and services and staff are reduced, the time that heart attack victims must travel to get to a hospital may be increasing, especially in rural areas.

"This puts patients at a much greater risk in the event of a cardiac or other emergency."

O'Neill's team looked at the records of 22,000 heart attack patients from 228 hospitals in Pennsylvania. Writing in the journal Health Care Management Science, he said the statistics back up what common sense might dictate -- getting help quickly saves lives.

He said he hopes the study will help policymakers decide whether to close less-profitable hospitals.

"In deciding whether to allow these closures, regulators must balance cost considerations with the need to ensure minimum levels of hospital access for rural residents.

"Hospital markets are already stretched thin in rural areas, however, and further capacity reductions would likely jeopardize patient safety in these days of managed care," O'Neill said.

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Scientists Create Mice That Produce Heart-Healthy Compounds

By Amanda Gardner
HealthDay Reporter
Wednesday, February 4, 2004

WEDNESDAY, Feb. 4 (HealthDayNews) -- Scientists may have devised a way to give mammals the ability to produce heart-healthy omega-3 fatty acids on their own.

While the discovery has so far only been applied to mice, if it were transferred to farm animals, humans could one day be eating eggs, milk and meat fortified with these acids.

"The actual translation of this mouse model to what could be available to humans remains to be established, but the principle of enriching the diet is one most of us in the cardiology world would endorse," says Dr. Ronald M. Krauss, a spokesman for the American Heart Association (news - web sites) and director of atherosclerosis research at Children's Hospital Oakland Research Institute in California.

Omega-3 fatty acids are known to prevent heart disease in humans but are only produced by microorganisms such as bacteria and algae. Humans get most of their omega-3 supply from fish.

"Fish get them from microorganisms [algae] and then we get them from fish," explains Dr. Jing X. Kang, lead author of a study appearing in the Feb. 5 issue of Nature and an associate professor of medicine at Harvard Medical School (news - web sites). "That's the food chain."

The American Heart Association recommends eating fish twice a week to get the requisite supply of omega-3 acids. Salmon and trout have particularly high amounts of these acids.

Many farmed fish and livestock are fed special meals to make sure they get these compounds, but this method is expensive and recent research has found that farm-raised salmon have high levels of the chemical contaminant PCB. One way around these issues might be to engineer farm animals to produce omega-3 on their own.

Paradoxically, while mammals, including humans, have a paucity of omega-3 fatty acids, they also have an abundance of omega-6 fatty acids -- or polyunsaturated fats -- that do not have health benefits.

"On the one hand, we have too much omega-6 and, on the other, too little omega-3. Can we convert to the other? That's the question," Kang says.

Kang and his colleagues reasoned that if they could transfer a gene from one of those microorganisms into a mammal, they might solve this human nutrition problem.

To this end, they transferred a gene from a roundworm, which can produce omega-3 oils on its own, into laboratory mice. The gene codes for an enzyme that converts omega-6 acids into omega-3 acids.

The mice appeared to stay healthy even in the absence of omega-3 from dietary sources. Their tissue was also high in omega-3 acids.

By contrast, wild mice who received an identical diet were deficient in omega-3 fatty acids.

The next question is whether scientists can do this in farm animals, to produce meat, milk and eggs rich in omega-3 fatty acids.

"Now that we have had the success in the mice, then we are confident that we can do this in livestock, and that's what we really want to do," Kang says. "That's the application of this technology in the future. We're trying to do this in fish."

However, the real obstacle may not be technology but public and political opinion.

"We are not worried about the technical part. We can do that in the near future," Kang says. "Politics and public opinion, that's the part we cannot control."

Still, Kang is optimistic.

"I think that this option is easier for the public to accept than any other genetically modified food because it increases their nutrients," he says. "It is unlike other methods that try to increase productivity or disease resistance. The overall chance looks good."

More information

For more on omega-3 fatty acids, visit the American Heart Association. The National Heart, Lung, and Blood Institute has heart-healthy recipes.

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US FDA Wants Ads for Medicine to Highlight Risks

By Lisa Richwine
Wednesday, February 4, 2004

WASHINGTON (Reuters) - Prescription drug advertisements should highlight key risks rather than just list a string of possible side effects in tiny print, U.S. regulators said in new guidelines unveiled on Wednesday.

"Consumers want and deserve information presented in a way that's clear, accurate and understandable," Food and Drug Administration (news - web sites) Commissioner Mark McClellan said.

The FDA guidelines encourage companies to use less-cluttered formats and easy-to-understand language for magazine and newspaper advertisements, and to focus on the most important and most common side effects.

For example, key risks may be set apart by bullet points instead of a lengthy text in small type, a format that many consumers complained was hard to read, the FDA said.

The rules also are intended to clarify criteria for "reminder" ads that name a drug or medical device but do not present claims of safety or effectiveness, the FDA said.

Some companies have run reminder ads close to disease awareness campaigns as "bookends," which concerns regulators.

Consumers may perceive the two ads together as a product advertisement, but neither alone is subject to FDA rules requiring disclosure of risks.

The new guidelines outline how the FDA will decide if particular bookend ads should be subject to regulation. The agency will look at whether the two promotions are "perceptually distinct" and "separated in space or time," an agency statement said.

The FDA also set forth rules for broadcast medical device ads, which have become increasingly common, McClellan said.

The new guidelines are in draft form, and the FDA said it welcomed public comments.

Dr. Sidney Wolfe, head of Public Citizen's Health Research Group, said the new rules may not make a difference if the agency fails to step up enforcement against misleading ads. The FDA has issued fewer warnings in recent years and allowed some companies to repeatedly run improper ads, Wolfe said.

"If they continue with their non-enforcement record, industry will continue putting out a lot of false and misleading ads and may not take these (guidelines) seriously," Wolfe said.

McClellan said the FDA had limited resources to police the many television commercials and print ads drug makers run. But by making clear what is permissible, the new rules should lead to better compliance with FDA regulations, he said.

The guidelines "are intended to help reasonable companies comply, for the benefit of the public health. If they don't, we now have an even stronger basis for pursuing enforcement action," McClellan said.

He also said the ads provided clear benefits by prompting patients to discuss untreated conditions with their doctors.

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Cystic Fibrosis Linked to Fatty Acid Imbalance

By Serena Gordon
HealthDay Reporter
Wednesday, February 4, 2004

WEDNESDAY, Feb. 4 (HealthDayNews) -- People with cystic fibrosis (CF), and even people who are just carriers of the cystic fibrosis gene, have an imbalance of fatty acids.

In the Feb. 5 issue of the New England Journal of Medicine (news - web sites), researchers report that the cystic fibrosis gene is linked to an overabundance of arachidonic acid (AA) and too little docosahexaenoic acid (DHA) in the body's tissue.

Fatty acids, such as AA and DHA, are essential to the development of healthy cells. They are important in many biological functions, including helping the body regulate inflammation.

"We've found at least one pathway by which mutations in the CF gene can lead to disease, and it will hopefully give rise to at least one new treatment," says one of the study's authors, Dr. Steven Freedman, director of the Pancreas Center at Beth Israel Deaconess Medical Center in Boston, Mass.

However, he adds, "It probably won't be a cure-all."

Dr. Preston Campbell, executive vice president of medical affairs for the Cystic Fibrosis Foundation, says that lung function in people with cystic fibrosis decreases by about 2 percent to 3 percent a year. So if a powerful anti-inflammatory therapy could be developed from this discovery that could "reduce the decline by 1 percent a year, you could add decades to CF patients' lives," he says.

About 30,000 people in the United States have cystic fibrosis, according to the CF Foundation. That means they inherited the cystic fibrosis gene, CFTR, from both parents. Another 10 million people are believed to be carriers of the disease, which means they inherited the CFTR gene from only one parent.

Cystic fibrosis causes mucus to collect in the lungs, resulting in wheezing, coughing and a susceptibility to serious infections. The pancreas is also often involved, which often results in malabsorption of the nutrients in food. The average life span for someone with cystic fibrosis is 33 years, according to the CF Foundation.

Freedman and his colleagues had previously studied fatty acid levels in mice that had been given cystic fibrosis. They found that the mice didn't have adequate DHA levels and had too much AA. When given DHA supplements, the mice improved, says Freedman.

For this study, the researchers tested tissue samples from 38 people with cystic fibrosis, 13 people who carried the CF gene, 11 people with inflammatory bowel disease, nine people with an upper respiratory infection, and 16 people with asthma.

The reason they tested people with other illnesses was to determine whether inflammation, a common finding in all of these disorders, was the cause of the fatty acid abnormalities, or if the abnormalities were present only in people with CF.

"What we found in mice, we found in humans," says Freedman: too little DHA and too much AA.

The researchers also found these changes, though to a lesser degree, in people who carried the CF gene but didn't have the disease. They did not, however, see these fatty acid abnormalities in people with other inflammatory diseases, such as asthma or inflammatory bowel disease.

"This is an interesting study that shows cystic fibrosis is a very complex disease," says Dr. Jan Larsen, head of the Ochsner Children's Research Institute in New Orleans. "No one has been able to make a specific correlation from the CFTR gene and the mechanism that produces symptoms of the disease."

"CFTR is like a master switch that probably turns on several different mechanisms. This study isolates one of those mechanisms," says Dr. Gregory Pastores, a geneticist at New York University Medical Center in New York. "This may open a window to rational therapeutic approaches."

The finding that humans have this fatty acid change means that "it's a new target for therapies," adds Freedman.

However, both Freedman and Campbell caution against supplementing with large doses of DHA, which is available over the counter. They point out that there is no direct evidence that it will be helpful in humans, and the doses used in mice were large enough that the equivalent dose in humans would make a person feel bloated and sick, according to Freedman.

More information

To learn more about cystic fibrosis, visit the National Library of Medicine or the CF Foundation.

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Tuesday, February 3, 2004

Study: Blood Test May Indicate Colon Cancer Risk

Tuesday, February 3, 2004

CHICAGO (Reuters) - An inflammation-related blood protein that can signal an increased risk for heart disease can also tell who may be at risk for colon cancer, a study said on Tuesday.

But researchers at the Johns Hopkins Medical Institutions in Baltimore said more research was needed before it could be determined what benefit the findings may have in helping prevent the second-leading cause of cancer death in the United States.

The study looked at the medical records of more than 22,000 adults from one Maryland county who gave blood samples in 1989 and were followed through December 2000.

The researchers found 172 colorectal cancer cases in the group. Those who had the highest levels of C-reactive protein, or CRP, in their blood at the start of the study were more likely to have developed colon cancer than those with low levels, the authors said.

Overall, people with the highest levels had twice the risk of developing colorectal cancer, and 2.5 times the risk of developing colon cancer as those with the lowest levels, according to the study.

"Higher levels of C-reactive protein are linked to an increased risk of several apparently distinct, chronic diseases: heart disease, stroke, diabetes, and now colon cancer," said Dr. Thomas Erlinger, the study's chief author.

"However, it's not clear yet how or whether measuring C-reactive protein would fit into current screening and prevention strategies for colorectal cancer," he said.

CRP is produced primarily in the liver and is a marker for inflammation, the study said. Scientists have theorized that inflammation could play a role in the development of colorectal cancer, though the mechanism is unclear.

Colon cancer will affect nearly 150,000 people in the United States this year and kill 57,000, according to the American Cancer Society (news - web sites).

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Multiple Sclerosis and Fatigue

Tuesday, February 3, 2004

(HealthDayNews) -- If you have multiple sclerosis, you may be experiencing disabling fatigue, which is a common symptom.

Harvard Medical School (news - web sites) offers these fatigue-relieving tips:

  • Exercise regularly. This can improve your cardiovascular fitness, muscle strength, and help you feel more awake.
  • During the warm months, exercise early in the morning or in the late evening, when it's coolest.
  • A low-fat diet rich in whole grains and fresh fruits and vegetables will help keep your energy level up.
  • Don't be shy to ask for help when you need it.
  • Speak to your doctor about medication that may provide some relief.

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Antibody Could Block SARS Infection Study

Tuesday, February 3, 2004

WASHINGTON (Reuters) - U.S. researchers said on Tuesday they had found an antibody that could help prevent infection with the SARS (news - web sites) virus.

They found the monoclonal antibody -- a specialized immune system protein -- by looking through a library of existing antibodies.

They said their approach, described in this week's issue of the Proceedings of the National Academy of Sciences (news - web sites), might be used against other newly emerging diseases as well.

"This is really a proof of principle for responding to emerging infectious diseases," Dr. Wayne Marasco of the Dana- Farber Cancer Institute and Harvard Medical School (news - web sites) in Boston, said in a statement.

"If the international community works together, it can make a serious dent in the time it takes to develop protective treatments against these threats."

SARS first was seen in November 2002 in southern China and between then and June 2003 infected more than 8,000 people globally and killed nearly 800. This year, four people have been diagnosed with SARS in China.

Severe Acute Respiratory Syndrome is caused by a new virus from the family of coronaviruses that cause the common cold and a range of animal illnesses.

Marasco and colleagues at Dana-Farber, Brigham and Women's Hospital, the U.S. Centers for Disease Control and Prevention (news - web sites), and Children's Hospital Boston tested the antibody in lab dishes of cells and found it blocked the virus from infecting cells.

"It was one of those Eureka experiences," Marasco said. 'It was pretty dramatic."

Antibodies are proteins that either flag or outright destroy invaders such as viruses and bacteria.

Monoclonal antibodies are used to treat disease, including cancer, but have not been developed to protect against disease. It would take years more work to develop this protein as a weapon against SARS, but the researchers said studying its structure may offer a shortcut to developing a drug or vaccine to fight SARS.

Passive immunization -- in which antibodies are infused into a patient's blood -- may also offer a short-term treatment for those sickest with SARS, they said.

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Catching the Culprit in Colon Cancer

Tuesday, February 3, 2004

TUESDAY, Feb. 3 (HealthDayNews) -- The activation of a particular cellular receptor greatly increases the development of precancerous polyps in the intestine, says a Vanderbilt-Ingram Cancer Center study in Feb. 2 online edition of Nature.

This is the first time that scientists have found evidence of this activation process. The findings may suggest a new strategy for preventing colorectal cancer by preventing activation of this cellular receptor.

The results also raise caution about a possible increased risk of colorectal cancer among people who take drugs that activate this receptor. Such drugs are currently in clinical development to treat obesity and atherosclerosis.

In this study, researchers found that mice with a specific genetic mutation - one that's found in 80 percent of people with colorectal cancer - had a fivefold increase in the number of larger colon polyps when they were given a compound that binds to the peroxisome proliferator-activated receptor delta (PPAR-delta).

"This is extremely significant because it is these larger polyps that are most likely to develop into intestinal cancer," Dr. Raymond N. DuBois, associate director of cancer prevention, control and population-based research at Vanderbilt-Ingram, says in a prepared statemnent.

More information

Here's where you can learn more about colorectal cancer.

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Vitamins Do Not Prevent Recurring Stroke, Study Finds

Tuesday, February 3, 2004

CHICAGO (Reuters) - High doses of vitamins do little to prevent a second stroke in patients who have already had one, according to a study published on Tuesday.

The vitamins used in the study -- B6, B12 and Folic acid -- are believed to help lower blood levels of homocysteine, an amino acid thought to contribute to heart disease.

To test whether vitamins would have an impact on recurring strokes researchers at Wake Forest University Baptist Medical Center looked at 3,680 people who had already suffered a non-disabling stroke and were being treated at 56 medical centers in the United States, Canada and Scotland.

Half were given daily high doses of the vitamins and half were given low doses.

"High-dose vitamin therapy had no effect on stroke prevention, coronary heart disease events or death in this study, which was disappointing," said James Toole, a physician and director of the school's Stroke Research Center.

During the study, 8.1 percent of patients on the low dose and 8.4 percent on the high dose had a second stroke.

The study was stopped in December 2002, when its monitoring board told the U.S. National Institute of Neurological Disorders and Stroke, which was paying for it, that there was no chance of showing any difference between the two treatment groups during the remaining follow-up time.

The report, published in this week's Journal of the American Medical Association (news - web sites), did find that in both the low dose and high dose groups those who had a high homocysteine level at the start of the study were most likely to suffer a second stroke.

"Because of the consistent findings of an association of total homocysteine level with vascular risk, further exploration of the hypothesis is warranted and longer trials in different populations with elevated total homocysteine may be necessary," the paper concluded.

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Women Heeding Message on Hormone Therapy

Tuesday, February 3, 2004

TUESDAY, Feb. 3 (HealthDayNews) -- Findings from two long-term studies on hormone replacement therapy led to a decline in its use, says a report in the Feb. 3 issue of the Annals of Internal Medicine.

Researchers studied the use of hormone therapy, both before and after the study results were released, among women in San Francisco who had mammograms between 1997 and 2003.

One 1998 study found hormone replacement therapy did not protect against heart disease. The second study, in 2002, found women who took hormone therapy had a higher risk for breast cancer and heart disease than women who did not take it.

There was a temporary, modest decline in hormone therapy use following the release of data from the HERS study in 1998. Before that, the use of hormone therapy was about 41 percent in the study group, and was increasing by a rate of 1 percent per quarter. After publication of the HERS study, hormone therapy use decreased by 1 percent per quarter.

Following release of the second study, hormone replacement therapy (HRT) use among the study group declined by 18 percent per quarter.

The study didn't answer why this decline occurred. But the authors and an editorial in the journal suggest that widespread news coverage of the findings of the two studies may have been a factor.

On Tuesday, Swedish researchers reported they had halted the latest major HRT trial, this one involving women who had had breast cancer. The trial was stopped because the risks of a recurrence of cancer were judged to be too great, the researchers said.

The finding prompted the head of the American Cancer Society (news - web sites) to say it would be "unwise" to provide HRT to women with a history of breast cancer.

More information

Here's where you can learn more about hormone replacement therapy.

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FDA Panel Backs Lung Nodule Screening Tool

Tuesday, February 3, 2004

GAITHERSBURG, Md. (Reuters) - A U.S. Food and Drug Administration (news - web sites) advisory panel on Tuesday backed privately held R2 Technology's computer-aided tool that screens for lung nodules, which can be an early indication of lung cancer.

The panel unanimously recommended approval with several conditions for the California-based company's ImageChecker CT-LN 1000 software system. The FDA usually follows the advice of its advisory panels and is expected to make a final decision within months.

R2 Technology's tool uses computer-aided detection, or CAD, to automatically scan and mark chest images for suspicious areas as small as four millimeters wide that could signal early-stage lung cancer.

Members of the advisory panel urged the FDA, as a condition of approval, to require the company to re-analyze its data to reflect the technology's impact on each patient. The data was grouped by the number of lung quadrants examined.

"I'm just concerned about how the data will look with actual patients," said panel member Elizabeth Krupinski, a professor in the radiology department at the University of Arizona in Tucson.

"I think this could be a wonderful tool ... but I really need that data," she said.

According to the American Cancer Society (news - web sites), 157,200 American adults died from lung cancer last year, accounting for 28 percent of all cancer deaths.

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Black Youths Likelier to Quit Smoking

By Gary Gately
HealthDay Reporter
Tuesday, February 3, 2004

TUESDAY, Feb. 3 (HealthDayNews) -- Most black teens try smoking cigarettes, but they're much less likely than whites and Hispanics to become regular smokers as adolescents and young adults, new research finds.

The Rand Corp. study, published in the February issue of the American Journal of Public Health, found 62 percent of black youths had lit up by age 13, compared with 69 percent of Hispanics, 52 percent of whites and 36 percent of Asian-Americans.

But by age 15, just 7 percent of blacks in the study had become regular smokers, compared with 20 percent of whites and Hispanics and 8 percent of Asian-Americans.

Rand researchers attribute the drop-off in smoking among blacks to factors including parental disapproval, communication with parents about personal problems, having fewer friends who smoke, and receiving fewer offers of cigarettes from peers.

"What we find really intriguing is that this parental disapproval of smoking really seems to have an impact that African-American kids really pay attention to," says study author Phyllis L. Ellickson.

Ellickson, director of the Rand Center for Research on Maternal, Child and Adolescent Health, says the results suggest steps such as getting parents to talk to their children about smoking, improving family bonds and dampening peer pressure to smoke might help keep youths from becoming regular smokers.

For the study, researchers tracked more than 6,000 blacks, whites, Hispanics and Asian-Americans for 10 years, from ages 13 to 23. Rand recruited the study participants from 30 California and Oregon middle schools for a study on substance abuse.

Students completed surveys about substance abuse, smoking and psychological, social and behavioral factors.

By age 23, the survey showed, 19 percent of blacks smoked regularly, compared with 32 percent of whites, 29 percent of Hispanics and 16 percent of Asian-Americans.

Along with influence of peers and parents, researchers looked at risk factors that could be related to decisions on whether to smoke, such as school grades and "problem behavior" such as rebelliousness and marijuana or alcohol use.

Asian-Americans did well in school and were less likely than others to drink alcohol, smoke marijuana, or be exposed to "pro-smoking influences," Ellickson says.

Blacks, by contrast, had significantly worse grades than whites throughout middle school and high school. "But," Ellickson adds, "it appears to be counteracted by positive influence from parents and less exposure to smoking."

For example, the proportion of black youths with a best friend who smokes dropped after age 13 or 14, the study says.

Edwin Fisher, a professor of psychology, medicine and pediatrics at Washington University in St. Louis, says parents play a crucial role in keeping kids from becoming smokers.

"An overlooked aspect of preventing smoking in adolescents is parental involvement and parental wisdom in treating smoking as a health problem, not a discipline problem," says Fisher, a spokesman for the American Lung Association.

"So it's not a matter of simply saying, 'You don't smoke because you're my child and it's my house.' It's a matter of explaining to young people why smoking is so dangerous, and providing them opportunities for showing independence in doing things their own way in healthy ways without needing to show their independence by doing things like smoking."

Preventing smoking during the teen years is critical. Tobacco use typically begins by age 16, and the first smoke almost always occurs before high school graduation, the American Lung Association says. At least 4.5 million American adolescents smoke, and each day 6,000 U.S. children under 18 smoke their first cigarette, the association says. Moreover, smoking-related diseases kill about 430,700 Americans each year.

Adolescent smoking has been linked not only to significant health problems, but also involvement in fights, carrying weapons, engaging in high-risk sexual behavior and using alcohol and other drugs.

Four decades after the landmark Surgeon General's Report on Smoking and Health provided the first official U.S. recognition that smoking causes cancer and other serious diseases, other new studies also have looked at the demographics of those who smoke.

The Dana-Farber Cancer Institute, a teaching affiliate of Harvard Medical School (news - web sites), found that occupation is a significant factor in determining which adults smoke. People in working-class, non-supervisory positions, including blue-collar and service jobs, had the highest smoking rates. The study also showed those with less education and lower income smoked more than others.

The findings appear in the same issue of the American Journal of Public Health, along with results of a separate Dana-Farber study on one of the first workplace programs to successfully reduce smoking rates among blue-collar workers. The study concluded that smoking cessation combined with broader occupational safety and health worked much better than smoking cessation offered alone.

Researchers tested the two approaches at 15 Massachusetts manufacturing firms for two years. Smoking quit rates for those who had smoking cessation as part of the broader health-promotion efforts were more than twice that of those who underwent only smoking cessation.

In an analysis of national survey data from 1999 to 2001, the U.S. Centers for Disease Control and Prevention (news - web sites) found 8.2 percent of blacks aged 12 to 17 had smoked during the preceding month. That compares with 29.5 percent of American Indians and Alaska natives, 14.9 percent of white youths, 11.4 percent of Hispanics and 8.8 percent of those from Asian ethnic groups, according to the survey, which appears in the Jan. 30 issue of the CDC publication Morbidity and Mortality Weekly Report.

More information

Get help on how to quit smoking from the American Lung Association or the CDC's Tips 4 Youth.

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Computer-Aided Mammograms Not Better, Study Shows

Tuesday, February 3, 2004

WASHINGTON (Reuters) - Computer aided mammograms do little to enhance the breast cancer screening process, according to a study issued on Tuesday.

While many companies make and market such systems, the study, published in the Journal of the National Cancer Institute (news - web sites), shows they do not help radiologists find breast tumors any more accurately.

David Gurand and colleagues at the University of Pittsburgh studied more than 100,000 mammograms interpreted either with or without the results of a computer-aided detection system.

The computer-enhanced devices did not affect how many breast tumors were detected, they found. In both cases, tumors were seen in about 3.5 cases per 1,000 mammograms.

Their results contradict other studies that show computer-aided detection may increase the breast cancer detection rate by as much as 20 percent.

But this is the largest study done yet that looks at the real-life use of such devices in a working clinic.

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Breast-feeding Produces Trimmer Kids

By Karen Pallarito
HealthDay Reporter
Tuesday, February 3, 2004

TUESDAY, Feb. 3 (HealthDayNews) -- The longer women breast-feed their babies, the less likely the children are to become overweight, a new study says.

That's true, at least, for non-Hispanic white children. Breast-feeding did not protect against excessive weight gain in some black and Hispanic children, the U.S. researchers add.

The study, appearing in the February issue of Pediatrics, provides the most conclusive evidence to date that prolonged breast-feeding can help reduce the risk of obesity.

"There are continued benefits to continuing breast-feeding," says study author Laurence Grummer-Strawn, chief of the U.S. Centers for Disease Control and Prevention (news - web sites)'s Maternal and Child Nutrition Branch.

The CDC researchers based their conclusions on an analysis of 177,304 children up to 5 years old, and a subset of 12,587 mother-child pairs, making it the largest breast-feeding study to date. Previous studies have yielded contradictory results.

By highlighting a key benefit of prolonged breast-feeding, the study also bolsters recommendations that mothers breast-feed their babies for at least a full year. The American Academy of Pediatrics, for one, encourages breast-feeding for at least 12 months to provide the fullest benefits for baby.

"If you breast-feed your babies, your children are more likely to have a reduction in illness, and one of those is obesity," says Dr. Lawrence Gartner, chairman of an American Academy of Pediatrics' panel on breast-feeding.

Obesity has become a worrisome problem in the United States. An estimated 15 percent of children and teens aged 6 to 19 are overweight, according to a 1999-2000 federal survey. The growing girth of America's youth poses serious health consequences, placing kids at higher risk of diabetes, hypertension, cardiovascular disease and certain types of cancer.

To examine the possible connection between prolonged breast-feeding and reduced risk of overweight, the CDC researchers looked at information from the Pediatric Nutrition Surveillance System. This survey captures data from children seen at public health clinics across the United States.

The team examined how long children nursed and their body mass index (BMI) -- a measure of weight in relation to height -- at 4 years of age. Children with a BMI that topped the 95th percentile for their age were considered overweight.

More than two thirds of children in the study -- 71.1 percent -- were never breast-fed, and only 6.1 percent were breast-fed for six months or more.

Kids who were never breast-fed or who were breast-fed for less than one month were most likely to be overweight at age 4, the study found. With increased breast-feeding duration, the rate of overweight kids declined.

For example, 13.6 percent of those who were never breast-fed and 13.7 of those who were breast-fed less than a month were overweight at age 4. By contrast, among those who were breast-fed for more than 12 months, 11 percent were overweight.

Breast-fed children were also less likely to be underweight, the study found.

Mothers-to-be might be asking themselves why the big fuss over a couple percentage-points difference between prevalence of overweight among bottle-fed kids and those who were breast-fed more than a year.

"It is a small difference," Grummer-Strawn admits, but it is significant. "What we're talking about is 'What are the things we can do to prevent overweight?'" he says. Breast-feeding is clearly one of those things.

How long-term breast-feeding protects against obesity isn't clear, although studies suggest several possible explanations. One is that a breast-fed child can self-regulate his or her caloric intake better than a bottle-fed child, whose parents may insist the baby finish off a pre-measured amount of formula.

Breast-feeding, of course, is only one factor influencing a child's risk of obesity. The study authors note that Hispanic children are nearly twice as likely to become overweight as non-Hispanic children "probably because of different dietary and physical activity patterns."

Parents' introduction of solid foods or exclusive reliance on breast-feeding may also differ along racial and ethic lines. For example, many Hispanic mothers combine breast-feeding with bottle feeding, and that may explain the weaker effect of breast-feeding in that group, Gartner says.

Still confused about whether to breast or bottle feed? For many moms, this study seems to provide another piece of evidence that the breast is best for baby.

"You can't beat Mother Nature," Gartner quips.

More information

A guide to breast-feeding can be found at the American Academy of Pediatrics and La Leche League International.

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Vaccines Containing Aluminum Appear Safe

Reuters Health
Tuesday, February 3, 2004

NEW YORK (Reuters Health) - While mercury compounds used to preserve some childhood vaccines has been a worry for many parents, aluminum compounds added to vaccines have also raised concern.

Now, however, the results of a review of studies looking at this question suggest that the aluminum salts found in DTP (diphtheria-tetanus-pertussis) vaccines cause no serious or lasting adverse effects.

Although aluminum salts have been used for decades to boost vaccine effectiveness, there have been reports linking them to various problems, including a progressive disorder involving muscle wasting and fatigue, according to a report in The Lancet Infectious Diseases medical journal.

Determining the safety of aluminum is important because replacing the compound would be a huge undertaking requiring numerous safety trials before new vaccines become available, the researchers note.

To investigate the safety of aluminum-containing DTP vaccines, Dr. Tom Jefferson, from Cochrane Vaccines Field in Rome, and colleagues reviewed eight studies that recorded patient outcomes following vaccination and the amount of aluminum in the vaccine.

Immunization with an aluminum-containing vaccine was tied to an increased risk of redness at the injection site in young children, and with prolonged local pain in older children. However, there was no evidence in either age group linking such vaccines to serious or lasting adverse effects.

"Despite a lack of good-quality evidence we do not recommend that any further research on this topic is undertaken," the authors conclude.

Source: Lancet Infectious Diseases, February 2004.

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What Triggers Type 1 Diabetes

Tuesday, February 3, 2004

TUESDAY, Feb. 3 (HealthDayNews) -- A study by King's College London researchers may lead to a better understanding of the autoimmune response in people with type 1 diabetes.

For more than 25 years, scientists have been trying to identify an environmental agent or event that triggers immune-mediated destruction of insulin-secreting pancreatic beta cells, which results in type 1 diabetes.

Previous studies suggested that T-cells that react to islet beta cells may contribute to this autoimmune response and may also be a factor in self-tolerance in healthy people. But this line of research has been hampered by inadequate technology and the rarity of these cells.

In this new study, the King's College London researchers suggest a mechanism for the specificity of this immune regulation. The researchers say it may explain why the same peptides present on pancreatic b cells that activate T-cells in people with type 1 diabetes and healthy people cause an autoimmune response in people with diabetes.

The study appears in the Feb. 2 issue of the Journal of Clinical Investigation.

More information

Here's where you can learn more about diabetes.

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Brain Receptor May Be Lacking in Panic Disorder

By Amy Norton
Reuters Health
Tuesday, February 3, 2004

NEW YORK (Reuters Health) - People who suffer panic attacks might be deficient in a brain receptor key in regulating emotion, new research suggests.

In a small study, researchers at the U.S. National Institutes of Health (news - web sites) found that compared with healthy participants, those with panic disorder showed fewer serotonin type-1A receptors in three brain regions.

The chemical serotonin is important in regulating mood, and many drugs used to treat anxiety disorders and depression act on serotonin. Exactly why people with panic disorder might be lacking in the 1A receptor for the chemical is unclear, but researchers suspect genes are the reason.

Certain variations in the gene for 1A may result in lower numbers of the receptor, and thereby make people more susceptible to developing panic disorder, the study's lead author, Dr. Alexander Neumeister, explained in an interview.

Neumeister, of the National Institute of Mental Health in Bethesda, Maryland, and his colleagues report their findings in the Journal of Neuroscience.

Estimated to affect more than 2 million Americans in any given year, panic disorder involves repeated bouts of intense fear that come out of nowhere. These panic attacks are marked by physical symptoms that may seem like a heart attack -- including chest pain, shortness of breath and dizziness.

Because the disorder can run in families, experts have suspected that certain genetic variations might make people more vulnerable to developing it. The new research gives weight to that idea.

"This is the first study that shows a very clear biological difference in patients and controls," Neumeister said.

He and his colleagues used brain scans to visualize serotonin type-1A receptors in various brain regions of 16 adults with panic disorder and 15 healthy people the same age.

They found that in three brain areas -- the anterior and posterior cingulates, and the raphe-- panic disorder patients had significantly fewer 1A receptors.

Both the anterior and posterior cingulates are key regulators of mood and anxiety, Neumeister said. Past research has shown that people with depression may have fewer serotonin type-1A receptors in these two regions, but the reduction did not match that found in these panic disorder patients, according to the study authors.

They now plan to scan the brains of first-degree relatives of people with panic disorder to see if there's a reduction in serotonin type-1A receptors in these "at risk" individuals, Neumeister said.

They will also scan people who are in remission from the disorder to see whether the receptor deficiency might be only temporary.

Drugs called selective serotonin reuptake inhibitors, or SSRIs, are commonly used to treat depression and anxiety disorders, including panic disorder. Neumeister said that research such as this, in pinpointing what's happening in the brains of people with mood disorders, could help in developing more specific SSRIs that might carry fewer side effects.

Source: Journal of Neuroscience, January 21, 2004.

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New Dietary Clue to Colon Cancer

Tuesday, February 3, 2004

TUESDAY, Feb. 3 (HealthDayNews) -- A high dietary glycemic load may increase the risk of colorectal cancer in women, says a Harvard Medical School (news - web sites) and Brigham and Women's Hospital study in the Feb. 4 issue of the Journal of the National Cancer Institute (news - web sites).

Glycemic load is a measure of how quickly the body turns carbohydrates in foods into sugars (glycemic index) in relation to the amount of carbohydrates per serving of a particular food. White breads, white rice and some pastas are examples of foods with high glycemic load.

In this study, researchers examined the association between dietary glycemic load, overall dietary glycemic index, carbohydrate, fiber, non-carbohydrate, sucrose and fructose with the subsequent development of colorectal cancer.

The study concluded that high dietary glycemic load was associated with an increased risk of colorectal cancer. Fructose, non-fiber carbohydrate and total carbohydrate were also associated with increased risk of colorectal cancer.

"A diet with a high glycemic load may increase the risk of colorectal cancer by affecting insulin and insulin-like growth factors or by exacerbating pro-inflammatory responses, either locally or systemically. Further work is needed to elucidate these mechanisms," the study authors write.

More information

Here's where you can learn more about colorectal cancer.

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Government Advisers Seek Stronger Antidepressant Warning

By Lisa Richwine
Tuesday, February 3, 2004

BETHESDA, Md. (Reuters) - U.S. government advisers on Monday urged regulators to issue stronger warnings about possible risks of suicidal behavior among children and teenagers taking antidepressant drugs.

U.S. health officials are studying whether antidepressants can make children and teenagers suicide-prone but have not yet reached a conclusion. A Food and Drug Administration (news - web sites) advisory panel said the agency needs to raise awareness of its concern while the probe proceeds.

"Our sense is that we would like, in the interim, the FDA to go ahead and issue stronger warning indications to clinicians regarding possible risks of these medicines." said Dr. Matthew Rudorfer, a psychiatrist with the National Institute of Mental Health.

"We think such warnings are required to elevate the level of concern and attention that practitioners use in prescribing them," said Rudorfer, chair of the FDA advisory panel.

New warnings also should go out to parents, other panelists said.

FDA officials said data showed millions of prescriptions for antidepressants were written for children and teenagers each year.

Questions about a possible link with suicidal behavior arose last year when regulators were reviewing clinical trials of children who took GlaxoSmithKline Plc's Paxil.

The other antidepressants the FDA is evaluating include Forest Laboratories Inc.'s Celexa, Solvay's Luvox, Akzo Nobel's Remeron, Bristol-Myers Squibb's Serzone, Pfizer's Zoloft, Eli Lilly and Co.'s Prozac, and Wyeth's Effexor.

Only Prozac, sold generically as fluoxetine, is approved for treating pediatric depression.

The FDA already has urged doctors to carefully watch children or teenagers taking the drugs. British health authorities have gone further by advising doctors not to prescribe most of the drugs known as SSRIs, or selective serotonin reuptake inhibitors, to anyone under 18.

At the panel meeting, tearful parents of suicide victims urged U.S. officials to ban pediatric use of antidepressants or place explicit warnings on them about a suicide risk.

Sara Bostock said her daughter became unusually frightened and jumpy within two weeks after she started taking Paxil. One night she fatally stabbed herself twice in the chest with a kitchen knife, her mother told the panel.

"To die in this violent and unusual fashion ... led me to believe Paxil must have put her over the edge," Bostock said.

An autopsy showed a high level of Paxil in her daughter's bloodstream, which indicated her body had trouble breaking down the medicine, Bostock said.

Others told the panel antidepressants were life-saving. Sherri Walton said drug treatment helped lessen her daughter's frightening, obsessive thoughts.

"There is no doubt in my mind the SSRI she is taking saved her life," Walton said. "Please urge the FDA not to take away these tools."

Wyeth, maker of Effexor, last year sent a letter telling doctors the drug was not recommended for use in children and noted reports of hostility and suicidal behavior in pediatric studies. GlaxoSmithKline Plc has promised to work with the FDA to interpret the data.

FDA officials said they will consider the panel's recommendations. They said they plan to hold another meeting on the issue in late summer.

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Heart Disease Marker Now Tied to Colon Cancer

By Adam Marcus
HealthDay Reporter
Tuesday, February 3, 2004

TUESDAY, Feb. 3 (HealthDayNews) -- A blood chemical that predicts heart attacks and strokes also seems to foretell who is likely to develop colon cancer, new research shows.

Irritation in the intestines, such as that associated with inflammatory bowel disease (IBD), has long been known to increase a person's risk of colon and rectal cancer. The new study "puts forward the idea that low-grade inflammation could be a risk factor for colon cancer" in people without severely aggravated intestines, says study leader Dr. Thomas Erlinger, an internist and epidemiologist at Johns Hopkins Medical Institutions.

The substance, C-reactive protein (CRP), is a marker of general inflammation throughout the body. People who developed colon cancer during the study had a higher CRP count at the start than those who were free of the disease.

The study didn't find a direct connection between CRP and rectal tumors, though the number of rectal cancer cases was small. A report on the findings appears in the Feb 4 issue of the Journal of the American Medical Association (news - web sites).

CRP was discovered in 1930 in the blood of patients with serious pneumonia. More recently, scientists have learned that people with more of the protein in their blood are at greater risk of heart attacks, strokes and several other major illnesses.

In the latest work, Erlinger and his colleagues compared CRP levels and colorectal cancer risk in nearly 23,000 residents of Washington County, Md., participating in a long-term study of heart disease and cancer. A blood test for the protein was included in a battery of exams at the start of the project, which ran between 1989 and 2000.

By the end of the study, 131 men and women were diagnosed with colon cancer, and 41 got rectal cancer. The risk of colon cancer for people in the top quarter of initial CRP levels was about 2.5 times higher than for those in the bottom quartile.

Smokers and people with bowel diseases such as Crohn's and colitis are known to have increased odds of developing colon cancer. But even after accounting for these risk factors, the link between elevated CRP and colon tumors persisted, Erlinger says.

If colon cancer is related to inflammation, aspirin and other anti-inflammatory drugs could in theory prevent the disease. And indeed, the researchers did see some hints that people who took these medications were less likely to develop colon tumors. "They did have a lower risk but we really didn't have good data there," Erlinger says. More studies are need to address the question, he adds.

Dr. Boris Pasche, director of the cancer genetics program at Northwestern University, calls the results "an interesting first study" that should encourage further research into the health effects of simmering inflammation.

"Maybe the same people with a higher risk of cardiovascular disease also have a higher risk of colorectal cancer," says Pasche, co-author of an editorial accompanying the journal article.

But it's not yet clear that elevated CRP predicts colon cancer or simply reflects tumors that are already present but too small to generate symptoms.

Erlinger's group tried to account for this possibility, but since they had only one reading of the protein they weren't able to fully exclude it in their analysis. "If you argue that there is a relationship [between CRP and cancer] you would expect that the CRP value may increase over time prior to the diagnosis of colon cancer," Pasche says.

More information

For more on colon cancer, visit the Colon Cancer Alliance. For more on C-reactive protein, try the National Library of Medicine.

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Very Elderly Can Benefit from Heart Procedures

By Karla Gale
Reuters Health
Tuesday, February 3, 2004

NEW YORK (Reuters Health) - Many people over age 80 with heart disease do as well as 70-year-olds when they have angioplasty or surgery to open the blood vessels that feed the heart, physicians in Israel have found.

There seems to be a growing proportion of very old patients who can benefit from such procedures, "but careful individual patient selection...will continue to be needed," lead author Dr. David A. Halon, from Bruce Rappaport School of Medicine in Haifa, told Reuters Health.

Halon's group assessed the outcomes in 449 patients age 70 and older hospitalized at their institution for heart disease. Included were 251 patients age 70 to 79 years and 198 older patients. The researchers' findings are published in the Journal of the American College of Cardiology.

Treatment decisions were based on the patients' clinical circumstances. Blood vessel testing and possible treatment was recommended for 110 patients in the younger group and 58 in the older group.

Two-year survival rates after the heart procedures were similar for patients in both groups. However, older patients were less likely than younger patients to survive for 2 years if they received only medications.

"Our study shows that in those selected for (surgery or angioplasty), significant benefits were obtained," Halon pointed out.

However, these procedures are not for everyone, Halon emphasized. For example, they shouldn't be used for patients at risk for complications or for patients whose disability status is unlikely to improve.

Source: Journal of the American College of Cardiology, February 2004.

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Soaring costs add new urgency to debate over US health care reform

Agence France Presse
Tuesday, February 3, 2004

ST LOUIS, United States (AFP) - When Paula Jones filed for bankruptcy in January 2003, she resolved to get her finances in order. A year later, the 36-year-old mother-of-three is back to square one: stressed out, buried under a mountain of debt, and wondering how she and her husband are going to pay off 20,000 dollars in medical bills.

"I feel like I'm back in the hole again," said Jones, an assistant at a nursing home in suburban St Louis. "I know I've got to get some kind of payment plan worked, but I try not to think about it."

Like most working Americans, Jones and her husband Dwayne Rodgers have job-related health insurance, but Rodgers had only token coverage, leaving him to pick up most of the tab for a week's hospital stay following a severe stroke in December.

Rodgers -- a relatively fit 32-year-old -- has bounced back, but the couple's finances could take longer.

"It could be several years before we pay it all off," said Jones, who earned 22,000 dollars last year. "We are stuck from here to eternity in medical bills."

Health care is a signature Democratic issue, and all seven candidates seeking the Democratic presidential nomination this election year have proposed plans to provide health coverage to all or most of the 43 million uninsured Americans.

Mindful of former President Bill Clinton (news - web sites)'s failure to push through a top-to-bottom restructuring of the system during the early 1990s, the Democratic candidates have focused on programs that would build incrementally on existing federal and state programs.

Even so, the costs for the proposed health-care reforms are daunting, particularly at a time of mushrooming US deficits.

They range from a 590 billion-dollar 10-year plan to insure all children by expanding existing government programs, to former Vermont governor Howard Dean (news - web sites)'s top-of-the-line 932 billion-dollar, 10-year program.

Funding those proposals in an era of ballooning deficits could be a stretch, one analyst said.

"It's one thing to bash President Bush (news - web sites) for budget deficits, but then you are under some constraints not to run up the deficit yourself," said Fred Greenstein, a professor of politics at Princeton University.

However, soaring health care costs and growing indignation at the runaway cost of prescription drugs have built popular support for reform.

The prescription drug issue has had the greatest impact on seniors, millions of whom now buy or order their medications from Canada where drug prices are regulated, but working Americans have also felt the pinch as cost-conscious employers seek to eliminate or shrink their benefits.

The number of working Americans covered by job-related health insurance has plummeted in the past 10 years, while those still covered by such plans are paying much more for the privilege, according to a study by the US Bureau of Labor Statistics.

The number of Americans with job-related health insurance fell 18 percent between 1992-3 and 2003, while the average employee contribution to medical insurance premiums soared about 75 percent, according to the study of private-sector businesses published in September.

Corporations argue that rationalising employee benefits is essential if they are to compete with rivals in markets like China, where labour is cheap, or European countries where taxpayers subsidise health care.

"We are under extreme price pressure," explained Albert Adams, a director of human resources for Lincoln Industrial Corp. a St Louis-based manufacturer of lubrication and pumping systems for the automotive and mining industries.

The company recently implemented a new contract for its salaried workforce that requires employees to pay more of the cost of non-emergency medical care out of their own pockets in a bid to rein in runaway health costs.

The company's health care bill more than doubled in the past five years, but revenues remained flat.

"Our intention is to provide enough coverage so that a medical catastrophy doesn't mean financial ruin for our employees or their families," said Adams, "but we can't afford to continue to provide first dollar coverage."

Under the contract introduced January 1, salaried workers will have to pay the first 500 dollars of any medical claim -- a change that managers hope will give employees pause for thought before they run off to the doctor's surgery.

"People need to have a vested interest in their own health and health care," he continued. "To the degree that they stay healthy, their out-of-pocket costs will be less and so will ours."

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British Surgeons Close Wounds with Paperclips

Tuesday, February 3, 2004

LONDON (Reuters) - British surgeons are endangering patients by using paperclips to close wounds and tongue depressors as splints for babies, a government agency said on Tuesday.

The Medicines and Healthcare Products Regulatory Agency said it had uncovered an increasing trend for doctors to use medical devices in ways they were not meant to be used, and also "adapt non-medical products for clinical purposes."

Such misuse can put patients' health at serious risk, it said.

"For example, use of tongue depressors in a neonatal intensive care unit as limb splints led to two deaths and one amputation because of fungal infection," the agency said.

Surgeons were closing wounds with paperclips and urinary catheters. Others were using wooden clothes pegs to clip devices that measure the pulse on to patients' earlobes, or using fake fingernails to fix cuts on the nail bed.

"The use of a device in these circumstances exposes users and patient to unknown and therefore unacceptable risks and may have legal and ethical implications," it said.

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Monday, February 2, 2004

Detecting Changes in Multiple Sclerosis

Monday, February 2, 2004

MONDAY, Feb. 2 (HealthDayNews) -- Genetic information from a simple blood test may help doctors detect changes in people with multiple sclerosis (MS) and improve diagnosis and treatment for these patients.

So says a study published Feb. 2 in the online edition of the Annals of Neurology.

American and Israeli scientists say their preliminary results indicate that gene microarrays, which can measure the expression of thousands of genes at once, can help identify different states of MS without the need to use more invasive procedures such as spinal taps.

"Our study was not designed to study response to treatment and predict course; however, it does provide support to the notion that microarray results could be used to predict course of disease and, potentially, therapeutic response," researcher Dr. Naftali Kaminski, of the University of Pittsburgh Medical Center, says in a prepared statement.

She and her colleagues found significant differences in more than 1,000 genes between control subjects and people with MS. The scientists identified a different subset of more than 200 genes whose expression level changes -- becoming more or less active -- in people with flare-ups of MS.

More research is needed to determine whether gene array results can help predict what type of disease course will be experienced by a person newly diagnosed with MS or whether a person with MS in remission is likely to experience a relapse.

More information

Here's where you can learn more about multiple sclerosis.

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High Aspirin Doses Best at Preventing Colon Cancer

Reuters Health
Monday, February 2, 2004

NEW YORK (Reuters Health) - Previous reports have shown that regular aspirin use can reduce the risk of colon cancer. Now, new research suggests that the strongest benefits occur with aspirin doses higher than those recommended for preventing heart disease.

Still, aspirin does raise a person's risk of bleeding and it's possible that this risk, especially at high doses, outweighs the anti-cancer benefits, according to a related editorial.

The results, which are published in the Annals of Internal Medicine, are based on a study of more than 27,000 women who underwent colonoscopy between 1980 and 1998.

At enrollment, the participants reported no history of colon tumors or other diseases. Aspirin use was assessed with biennial questionnaires.

During the study period, 1368 cases of colon cancer were diagnosed, lead author Dr. Andrew T. Chan, from Massachusetts General Hospital in Boston, and colleagues note.

Overall, women who used at least two standard aspirin tablets per week were 25 percent less likely to develop a tumor than were less frequent users. Moreover, the tumor risk fell as aspirin use increased. Compared with non-use, the use of more than 14 tablets per week decreased the risk by 51 percent. This association held true for both short- (no more than 5 years) and long-term aspirin users.

"Before aspirin can be recommended for chemoprevention in the general adult population, these results suggest the need for a more thorough evaluation of the risks and benefits of routine aspirin use at doses not previously considered," the authors state.

In a related editorial, Dr. Robert S. Sandler, from the University of North Carolina in Chapel Hill, warns that "until we have different or better information from randomized trials, aspirin use should be limited to persons at higher risk for (tumors)" and to persons without diseases for which aspirin use might be hazardous.

Source: Annals of Internal Medicine, January 2004.

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Good Bacteria Never Take a Day Off

Monday, February 2, 2004

MONDAY, Feb. 2 (HealthDayNews) -- So-called "good bacteria" in the intestines, which may help people with inflammatory bowel disease, allergies and some forms of cancer, work even when they're inactive, says a study in the February issue of Gastroenterology.

Called probiotics, they are bacterial organisms that contribute to the health and balance of the intestinal tract. Recent studies have proven the health benefit of these bacteria.

The effectiveness of probiotics has been attributed to their live, metabolic activity. But active probiotics are used in only a small number of food products, such as yogurt. Active probiotics are unsuitable for most food products because they induce fermentation, which changes the taste, texture and freshness of food on an hourly basis.

This new study, by researchers at the University of California, San Diego School of Medicine and the Shaare Zedak Medical Center in Jerusalem, found probiotics contain immune system-stimulating DNA that makes them just as effective when they're inactive.

The finding offers the potential to use inactivated probiotics in a variety of food products.

The study also outlines a method to determine and select which probiotic bacteria provide the most benefit for people with inflammatory bowel disease.

More information

Here's where you can learn more about probiotics.

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Pizza Makers Consider Low-Carb Dough

By Martin Finucane
Associated Press Writer
The Associated Press
Monday, February 2, 2004

BOSTON - Pizza might be hailed as the food of the gods, one of America's best-loved meals, a hearty delectable dish that fills the stomach and seems to soothe the soul. But to low-carb dieters, it's just a gut-busting disk of dough.

And that has caused pizza makers around the nation to wonder if the low-carb craze will force changes in one of America's best-loved foods.

They're saying, "Hey, we've got a problem here. Pizza's built on bread. It's the No. 1 enemy of the Atkinites," said Tom Boyles, senior editor of PMQ Magazine, a publication that follows the pizza industry.

Boyles has a word for those who want to avoid carbohydrates: "carbavoids."

Although industry sales haven't taken a hit yet, some pizza operators are considering offering customers low-carb pizzas.

"Pizza operators are asking themselves, 'Do I want to do this?' and they're bouncing the idea back and forth," Boyles said. "It's at that point where they're going, 'Just how far is this going to go?'"

According to the National Association of Pizzeria Operators, about 3 billion pizzas are sold each year in the United States by about 40,000 shops.

At the same time, low-carb diets like the Atkins, South Beach and Zone have gained wider popularity. A Harris Interactive poll done last summer for Novartis Consumer Health Inc. estimated that 32 million Americans were on some kind of high-protein, low-carb diet.

Doug Ferriman, owner of Crazy Dough's Pizza Co. in Cambridge's Harvard Square, said he didn't think low-carb dieters would put "too much of a dent" in the pizza business, but he had clipped a recipe for low-carb dough from an industry publication and was going to try it in the spring.

"We're going to have to fiddle around with it for a while," he said.

Some local pizza shop owners and some smaller chains have already moved to meet low-carb dieters' demands.

In Columbus, Ohio, Donatos Pizzeria has announced it will roll out a pizza with a low-carb crust in its 182 outlets. Spokesman Tom Santor said the pizza dough, made out of soy protein and other ingredients, "tastes fabulous."

In Louisville, Ky., Bearno's Pizza, a small chain, offers a crustless pizza on the usual circular baking pan.

And in Escondido, Calif., John Pontrelli, owner of Pit Stop Pasta, offers what may be a traditionalist's worst nightmare: "pizza in a bucket." It has all the pizza toppings placed in a crock or, for takeout customers, a metal can.

While it's not a big item, he said, some people have asked for it, and "Our motto here is: you want to say no to people as little as possible."

At Low-Carb Creations in Vancouver, Wash., Craig Adams, vice president and general manager, said sales of low-carb pizza dough had risen 300 percent to 400 percent in the past six months. Adams said the small company, which has 17 employees, had signed agreements to provide the skins to several smaller chains and dozens of other stores.

Tom Lehmann, of the American Institute of Baking in Manhattan, Kansas, a consultant who works with bakeries and pizza operations worldwide, said, "Low-carb is probably the biggest pebble to be dropped in this little pizza pond for a long time. There's just a huge, huge amount of interest."

Lehmann, who writes in industry publications as "The Dough Doctor," said he has received an average of five requests per day for the past three months on how to make low-carb dough.

He said his own experiments so far with making a low-carb dough had turned out a product that tasted, well, different.

"If you consider a pizza crust as being an edible breadlike product that's located beneath the toppings, the cheese and tomato sauce, OK, that's all we can say about it. ... Wipe away any memories of your old traditional pizza crust," he said.

Steve Coomes, editor of, wondered if the low-carb craze would last and whether it was just part of New Year's resolution dieting.

"I still think that the vast majority of American pizza consumers are going to look at pizza and those side items like wings as an indulgence and will continue to enjoy them in their intended form," he said.

"They love it to the tune of $26 billion per year."

In Boston's Italian North End, talk of a low-carb pizza was viewed as sacrilege.

"In my culinary heart, I will never do low-carb," Salvo Goglio, 36, a native of Sicily and chef at Antico Forno, said while chopping zucchini in a cramped kitchen.

Brandishing a container of golden polenta, he asked, "How can you get low-carb and keep the flavor?"

Just then, an order came off the printer above the counter where Goglio was working: roast chicken on a salad, hold the bread. And it turned out that several members of the staff, including Goglio himself, had been "on the Atkins."

Still, Goglio said, "If you want to really eat good food, you can't cut down carbs."

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When a Cut is Deep

Monday, February 2, 2004

(HealthDayNews) -- While you can treat most cuts at home, deeper ones require emergency medical treatment.

If your child cuts himself severely and you can't get to the hospital right away, The Nemours Foundation suggests you:

  • Rinse the wound and apply pressure to the cut with sterile gauze, a bandage or a clean cloth.
  • If blood soaks through, place another bandage over the first, and continue applying pressure.
  • Raise the inured part to slow bleeding, but don't apply a tourniquet.

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Testosterone Drop in Men Can Cause Depression, Study Finds

Monday, February 2, 2004

CHICAGO (Reuters) - A steep decline in levels of the hormone testosterone can trigger depression in some older men, researchers said on Monday.

While most men's testosterone levels decline gradually after age 40, a severe drop called hypogonadism afflicts roughly 30 percent of men over age 55.

The condition can cause decreased muscle mass and strength, less bone mineral density, diminished appetite, decreased libido, fatigue and irritability.

"Hypogonadal men showed an increased incidence of depressive illness" in the study of 278 men older than 44, wrote study author Molly Shores of Veterans Affairs Puget Sound Health Care System, Seattle.

Shores said 22 percent of the men with hypogonadism were diagnosed with depression over a two-year period, against 7 percent of those without the condition.

Testosterone levels normally peak in early adulthood, and then decrease by approximately 1 percent per year after age 40.

The study appeared in the journal Archives of General Psychiatry.

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Detect Vision Problems Early

Monday, February 2, 2004

(HealthDayNews) -- The sooner problems with vision are detected, the quicker a child can get the necessary treatment.

According to The Children's Hospital of Philadelphia, some children are more at risk for vision problems. Your infant may be more prone if:

  • She or he was born prematurely.
  • There is a family history of vision problems.
  • You had an infection during pregnancy.
  • Your baby has heart disease or hearing problems.

If you suspect your baby is having difficulty seeing, consult your doctor.

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Blood Patterns May Help Spot Cancer Early

Lauran Neergaard
AP Medical Writer
The Associated Press
Monday, February 2, 2004

WASHINGTON - Imagine a blood test that could detect the earliest signs of ovarian cancer to help far more women survive. Or one that could prevent thousands of aging men from undergoing unnecessary biopsies for prostate cancer.

Those tests are moving toward reality, thanks to new technology that can spot early signals in drops of blood.

The National Cancer Institute (news - web sites) has begun a major study to prove if the blood test detects early relapse in ovarian cancer patients. Relapse occurs dismally often, and if the test works as well as earlier research suggests, it could win Food and Drug Administration (news - web sites) approval for that use within a few years.

It would take longer to prove to FDA's standards whether the test also can spot ovarian cancer the first time it strikes.

Two national testing laboratories aren't waiting. Later this year, Quest Diagnostics and LabCorp hope to begin offering the blood test, by prescription, for women at high risk of ovarian cancer because of genetic or family history.

Despite caution from the test's own inventors that it's not yet ready for wide use, federal law allows those labs to offer tests that aren't FDA-approved provided they meet other government certification standards, which they're now attempting to do.

How does the testing work? It's called proteomics, the study of all proteins in living cells.

Proteins are molecules that do the body's work by directing cells' actions. Scientists have long used single aberrant proteins as a signal, or biomarker, for different diseases such as PSA, or prostate specific antigen, used to screen men for prostate cancer.

But one protein gone bad seldom is definitive. Indeed, most men with elevated PSA levels don't have cancer but a benign enlarged prostate. Too often, it takes a surgical biopsy to tell.

The new method: Proteins usually work through networks of circuit boardlike interactions that leave behind microscopic patterns. In a unique collaboration, scientists at the cancer institute and FDA discovered how to measure those patterns with special technology that picks out protein fragments floating in blood, patterns that can show when normal cells have turned cancerous.

"There is a wealth of information in the blood that we didn't know about before," says NCI's Dr. Lance Liotta, who co-directs the program. "We're finding an ocean of biomarkers."

First, Liotta and his partner, FDA microbiologist Emanuel Petricoin, pursued patterns that signal ovarian cancer, a disease in desperate need of better diagnosis.

Some 25,580 women will be diagnosed with ovarian cancer this year, and 16,090 will die, the American Cancer Society (news - web sites) estimates. Caught in its earliest stages, five-year survival is around 95 percent. But there is no screening method, so three-quarters of patients are diagnosed in advanced stages, when they have only a 20 percent survival chance.

Liotta and Petricoin tested blood samples from 250 women, some with ovarian cancer and some healthy. So far, the test has spotted all the cancers but sometimes falsely indicated that healthy women had cancer, too.

Nailing down that error rate, with much more study, is crucial, says NCI ovarian cancer specialist Dr. Elise Kohn. Even if the test ultimately were 98 percent accurate, she says, for every cancer caught, 49 healthy women would have unnecessary biopsies because of false results.

So Kohn is enrolling women who just finished initial ovarian cancer treatment into a clinical trial to see if the test detects relapse early. That's easier to prove.

Quest and LabCorp, meanwhile, have licensed the test method. They're working to show how accurately their machinery can detect protein patterns believed indicative of ovarian cancer. Quest plans to analyze 1,000 blood specimens before deciding whether to market the test for high-risk women and pledges to publish results in a medical journal.

"This is not a consumer test," stresses Quest spokesman Gary Samuels. Doctors would have to order it.

Prostate cancer (news - web sites) is next on the government's agenda. Initial research suggests a proteomics blood test might prevent 55 percent of unnecessary biopsies while missing 3 percent of cancers when given to men whose PSA levels are in a diagnostic gray zone. Now scientists are working to prove that and to see if protein patterns also signal which prostate tumors are aggressive and which are unlikely to kill.

Next on the list: patterns that seem to signal lung cancer and the earliest beginnings of deadly pancreatic cancer.

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

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Antidepressant Use by Moms-To-Be May Affect Baby

Reuters Health
Monday, February 2, 2004

NEW YORK (Reuters Health) - Certain antidepressants taken by mothers during pregnancy can lead to disturbed behavior in their offspring, according to the results of a small study.

Antidepressants like Prozac or Paxil, known as selective serotonin reuptake inhibitors (SSRIs), have previously been shown not to cause birth defects, the authors explain in the medical journal Pediatrics. However, only a few studies have looked at the potential neurobehavioral effects of these medications on newborns.

Dr. Philip Sanford Zeskind and Laura E. Stephens from the Carolinas Medical Center in Charlotte, North Carolina, examined the neurobehavior of 34 newborn infants. Seventeen of the mothers used SSRIs during pregnancy, while the other 17 mothers did not.

The team measured the babies' motor activity, heart rate, behavioral state, sleeping state, startle responses, and tremors between 14 and 39 hours of age.

SSRI-exposed infants had significantly more tremors. These infants also had fewer changes in behavioral state and had fewer different behavioral states during the hour-long observation than did nonexposed infants, the authors report.

Infants of mothers who took SSRIs also had more active sleep, which was characterized by fewer contiguous periods of REM sleep that were longer-lasting and by more spontaneous startles or arousals, compared with nonexposed infants.

"The present study provides the first systematic evidence that prenatal SSRI exposure is significantly associated with a wide range of neurobehavioral outcomes among healthy, full-birthweight infants," the authors conclude.

"In all, results of the present study call into question the conclusion that SSRI use during pregnancy has little impact on the developing fetus and infant outcome," Zeskind and Stephens state.

Are these effects long-lasting? "At this point," the investigators say, "it is also unclear whether these outcomes are transient or provide the basis for subsequent neurobehavioral problems that may be detected with sensitive measures of neurobehavioral development at a later age."

Source: Pediatrics, February 2004.

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First Lady Warns Women on Heart Disease

By Deb Riechman
Associated Press Writer

The Associated Press
Monday, February 2, 2004

WASHINGTON - She loves to eat enchiladas and barbecue, but in kicking off the start of "Heart Awareness Month," first lady Laura Bush said Monday that while she used to resolve every year to lose weight, her goal now is to "get and stay healthy."

To raise the awareness of heart disease, especially in women, Mrs. Bush joined several hundred doctors, researchers, heart disease survivors and health advocates as well as her husband in the East Room to discuss how prevention and education can save lives.

Many women think heart disease is a man's disease, yet it kills nearly a half million women a year, she said.

"In fact, 65,000 more women will die from cardiovascular disease this year than men," Mrs. Bush said. "What's most alarming is that most women don't know this. Many believe that cancer is their greatest concern, yet heart disease kills more women in our country than all forms of cancer combined."

She called on Americans, especially women, to: exercise daily, eat healthy foods, avoid tobacco, refrain from drinking too much alcohol and get preventive screenings to detect heart problems early.

"Women often take more time taking care of other people instead of themselves," she said. "Oh, we might soak in the bathtub or get a facial, but these are little perks that make us look good on the outside. I'm talking about taking care of our heart by eating healthy food, exercising and visiting the doctor."

She said she tries to walk at least three times a week.

"If my mother-in-law, Barbara Bush, can swim 88 laps at a time, the rest of us surely can walk for 30 minutes," Mrs. Bush said.

In introducing the president, Mrs. Bush said her husband exercises at least five days a week and has a resting heart rate of 45 beats a minute. His "greatest health risk is eating pretzels," she said referring to an incident in 2002 when the president fainted after swallowing a pretzel.

Bush, who signed a proclamation for "American Heart Month" this month, joked that when he asked Vice President Dick Cheney (news - web sites), who has had four heart attacks, what he was doing today, Cheney quickly replied that "he was headed to the treadmill."

"Whatever our age or physical condition, or however busy we may be, we can all do something to stay healthy," Bush said.

More than 1 million Americans will die of cardiovascular disease this year 2,600 a day, said Dr. Cristina Beato, acting assistant secretary of health at the Department of Health and Human Services (news - web sites).

During the past 40 years, there has been a reduction in the number of deaths for heart disease in men, but no corresponding reduction in deaths in women, said Dr. Susan K. Bennett, who specializes in heart disease, especially in women, at the Washington Hospital Center.

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Tyson Foods Taking Trans Fat Out of Some Products

Monday, February 2, 2004

NEW YORK (Reuters) - Tyson Foods Inc., the No. 1 U.S. meat company, on Monday said it has begun removing trans fat ingredients from fully-cooked retail products and "child nutrition"-labeled school products.

Medical experts now believe that trans fats are more harmful to the heart than other forms of fat that have been linked to heart disease like animal fats.

The company started this week removing trans fat from Tyson-brand breaded chicken products, such as nuggets, patties and tenders, and is expected to be phased in over the next three months.

Packaging announcing the removal of trans fats will be in supermarkets in late spring and early summer, the Springdale, Arkansas-based company said.

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Another Trial Ties HRT to Breast Cancer

By Amanda Gardner
HealthDay Reporter
Monday, February 2, 2004

MONDAY, Feb. 2 (HealthDayNews) -- For the third time in less than two years, researchers have halted a hormone therapy trial because the drugs posed unacceptably high breast cancer risks to women.

The latest trial, based in Sweden, was the first randomized study to look at the effects of hormone replacement therapy (HRT) on women who have had breast cancer. It was halted early because the risks of a recurrence of cancer were judged to be too great.

The finding prompted the head of the American Cancer Society (news - web sites) to say it would be "unwise" to prescribe HRT to women with a history of breast cancer.

The Swedish study was originally scheduled to enroll at least 1,300 women and follow them for five years. The trial was stopped on Dec. 17, 2003, after following 345 women for about two years.

Twenty-six women in the HRT group and seven in the non-HRT group had a recurrence of breast cancer while they were receiving hormones.

"That's a substantial absolute risk," says lead investigator Dr. Lars Holmberg, a professor of clinical cancer epidemiology at the Regional Oncologic Centre of University Hospital in Uppsala, Sweden. "Most of us on the steering committee were prepared that, despite earlier studies, we might see a slightly increased risk but that the risk-benefit ratio still would be reasonable. So this was to us a surprise and also a very worrying result."

The finding will appear in the form of a research letter in the online edition of The Lancet on Feb. 3 and in the Feb. 7 print edition of the journal.

A concurrent study in Stockholm did not find a higher risk of cancer recurrence. But because a pooled analysis of the trials found an increased overall risk, that trial was also terminated. The results are not yet in on a third study, this one being conducted in the United Kingdom.

The latest announcements come on the heels of the early endings of two other high-profile HRT studies. In July 2002, the hormone therapy arm of the U.S.-based Women's Health Initiative (WHI) was halted when women taking hormones were found to have higher risks of coronary heart disease, stroke, blood clots and breast cancer. In October of the same year, the Women's International Study of Long Duration Oestrogen after Menopause (WISDOM), a British trial evaluating hormone therapy, was also stopped after finding elevated risks of breast cancer.

The results of the Swedish study have some doctors reevaluating their views on HRT.

Dr. Harmon J. Eyre, chief medical officer of the American Cancer Society, says in a statement: "Many women experience menopausal symptoms after treatment for breast cancer, some because they stopped using HRT, some as a result of chemotherapy and others as a natural part of aging. In the past, some doctors have offered HRT to selected breast cancer survivors who suffered from severe menopausal symptoms because a handful of small, preliminary studies had failed to show a risk."

"This study will no doubt change that," he adds. "It is large enough and clear enough to show that HRT appears to increase the chance of a new or recurring breast cancer. Because of that, offering HRT to women with a history of breast cancer would be unwise."

Dr. Steven Goldstein, a professor of obstetrics and gynecology at New York University School of Medicine in New York City, says the findings are "very, very significant. It's big news."

Many clinicians had felt HRT was safe for breast cancer survivors because observational studies, which are less stringent than randomized studies, had found no risk or only a slightly elevated risk, Holmberg says.

The halted Swedish study began recruiting in 1997. Women were randomized either to receive HRT or not to receive HRT. Participants in both groups were similar in age and other characteristics, although they might have varied in whether they had estrogen-receptor positive or negative cancers, the study authors write.

When results were compiled after about two years of follow-up, women in the HRT group were found to have a three-and-a-half times greater risk of having a recurrence of breast cancer than women in the non-HRT arm of the trial. The absolute risk of having a recurrence was 7.5 percent in the HRT group and 2 percent in the non-HRT group.

In addition to breast cancer, eight women in the HRT group and four in the non-HRT group experienced other serious health problems such as blood clots.

"I had been telling those patients going through menopausal transition that there is some data suggesting they can safely take HRT. This study suggests that is not true," Goldstein says.

Will he stop recommending hormone therapy to his patients who have had breast cancer?

"We still have to take this one pace at a time," Goldstein said. "If you have a 51-year-old woman nine years after her breast cancer with negative nodes who is absolutely beside herself [with menopausal symptoms], we may still decide on short-term therapy."

Holmberg adds: "I don't think this is the final word because our estimate is imprecise because it's so few women and the long-term results might be different."

Still, he notes, this is what doctors have to guide them for the foreseeable future.

More information

Get more on hormone therapy from the National Women's Health Information Center or the American College of Obstetricians and Gynecologists.

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New Therapy for Cerebral Palsy Helps Kids Move Arms

By Karla Gale
Reuters Health
Monday, February 2, 2004

NEW YORK (Reuters Health) - A new treatment for young children with cerebral palsy, known as constraint-induced (CI) movement therapy, can dramatically improve how well they can use their affected arms, researchers report.

"Pediatric CI therapy offers hope for the first time to patients with motor deficits due to cerebral palsy," lead investigator Dr. Edward Taub told Reuters Health, adding that "conventional physical rehabilitation procedures have not worked well at all."

CI was first developed for treatment of adult patients with partial paralysis due to stroke, explain Taub and his colleagues at the University of Alabama in Birmingham. They adapted CI for young children and conducted a trial comparing CI therapy with conventional treatment, they explain in the medical journal Pediatrics.

Pediatric CI requires a cast on the child's less impaired arm -- which forces the child to use the affected arm -- along with intensive physical therapy for 6 hours daily for 21 days. "Shaping tasks" are used to develop such skills as reaching, holding objects, bearing weight on the arm and making hand gestures.

Taub's team compared CI with conventional therapy for 18 children with cerebral palsy. There were nine children in the CI group and nine in the comparison group, for whom conventional therapy was administered for about 2 hours per week. Ages ranged from 7 months to 8 years.

After CI, patients had acquired an average of 9.3 new motor patterns and classes of functional activity, while the comparison group acquired only 2.2. There were also larger improvements in use and sensory awareness of the more-impaired arm. Repeat testing at 3 and 6 months showed that treatment gains were maintained in the CI group.

According to Taub, many of the children began crawling for the first time. One child even began playing baseball and joined a Little League baseball team. Parents reported that their children's social and communications skills have also improved.

His group plans to use similar therapy to treat children with affected leg movements.

The biggest challenge in providing CI to children with cerebral palsy is the expense, which many insurance companies are not willing to reimburse, Taub noted. In attempts to lower cost, his group is now trying to automate the treatment. He explained that, with "tele-rehab," patients work at computer stations in clinics or at home, with a video hookup so that a therapist monitors the treatment at a central location.

For children, this would involve perhaps 1 week of intensive physical therapy by a professional therapist (instead of 3), during which parents would be trained in the techniques at the same time.

Source: Pediatrics, February 2004.

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'Designer' Estrogen Shows Promise for Menopausal Problems

By Colette Bouchez
HealthDay Reporter
Monday, February 2, 2004

MONDAY, Feb. 2 (HealthDayNews) -- For women looking to stop hormone replacement therapy and switch instead to the bone-enhancing drug Raloxifene, there's good news: You won't experience any increase in hot flashes.

The finding, published in the February issue of Obstetrics and Gynecology, is also the first to document that once discontinuing hormone replacement therapy (HRT), the peak recurrence of hot flashes can be expected at approximately eight weeks, rather than four.

"This study is important because drugs similar to Raloxifene have been shown to increase hot flashes and, in fact, at least one never came to market because of this problem," says Dr. Steven Goldstein, a professor of obstetrics and gynecology at New York University School of Medicine.

The study is one of three in this month's journal to examine treatments for menopause and attendant health problems, such as osteoporosis and hot flashes.

Raloxifene is known as a SERM, a selective estrogen reuptake modulator. These are the so-called "designer" estrogens -- drugs that act like a hormone in certain areas of the body, such as the bones, while acting as an "anti-hormone" in other areas, such as the breasts and uterus. In this way, a SERM can offer some of the same health benefits as estrogen with fewer risks, Goldstein says.

One of the downsides of SERMS has been a tendency to increase hot flashes. This can be a problem for women wanting to get off HRT and take this alternative approach to bone health.

"What this study told us is that you can stop taking HRT on a Sunday and start taking Raloxifene on a Monday and it won't cause you to have any more hot flashes than you might otherwise have when stopping HRT," Goldstein says.

It's important to note, however, that most women who do stop HRT experience a return of at least some hot flash activity. All the new study is saying is the introduction of Raloxifene into the regimen won't exacerbate the problem, Goldstein adds.

Health experts say the second finding -- that hot flashes peak at about eight weeks rather than four after stopping HRT -- is also important. The study authors suggest the commonly used "washout" period at four weeks -- when HRT doses are slowly tapered off -- may not be relevant because symptoms won't peak until eight weeks. Goldstein believes, however, that if the tapering is gradual enough and the dosages of HRT carefully monitored, the incidence of hot flashes can be controlled.

The study involved 266 women who had been taking HRT for at least five months. Each woman was assigned to take one of the following treatments for 12 weeks: HRT; a placebo; HRT for four weeks, followed by Raloxifene for eight weeks; or Raloxifene alone. This initial treatment was followed by 36 weeks of Raloxifene-only therapy for all the women.

The result: Raloxifene did not appear to increase the risk of hot flashes over and above a placebo, when used after discontinuation of HRT.

Eli Lilly and Co., the maker of Raloxifene, supported the study and all of the doctors involved have ties to the company.

In another study of Raloxifene, published in the same journal, a different group of doctors found the drug did not increase the risk of urinary incontinence, even after three years of treatment.

This research involved nearly 1,000 women at 10 sites across the United States. All of them were at least two years past menopause and diagnosed with osteoporosis. Each of the women filled out a questionnaire at the start of the study detailing, among other things, any incidence of incontinence. They were then assigned to take either a placebo or Raloxifene for three years. At the conclusion they were once again questioned on the same topics.

The result: The use of Raloxifene did not worsen any incontinence problems already present. And it did not bring on the condition in those who did not experience it before. Eli Lilly also sponsored this study, and part of this research team has financial ties to the company.

In a third study also published in this month's Obstetrics and Gynecology, a team of doctors led by Dr. Wolf Utian of the Cleveland Clinic tested the ability of a new plant-derived synthetic estrogen compound to quell hot flashes. Experts have suggested the new preparation, made from 10 different plant sources, could be poised to rival the controversial Premarin estrogen preparation, which is made, in part, from horse urine.

The 12-week study compared three different doses of the "new estrogen" to a placebo in 281 women, all of whom were experiencing an average of 50 hot flashes a week.

The study found that all three doses reduced the incidence of hot flashes over and above a placebo, and the estrogen compound was well tolerated. The new estrogen is not expected on the market for at least several more years.

More information

To learn more about SERMs, visit the American Medical Association. Or to discover additional ways to treat osteoporosis and improve bone health, check with the National Osteoporosis Foundation.

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Study: Breast-Feeding May Prevent Weight Problems

Monday, February 2, 2004

CHICAGO (Reuters) - The longer white infants from low-income families are breast-fed, the less likely they will be overweight as young children, researchers said on Monday.

The study of more than 177,000 children from low-income families who visited U.S. public health clinics between 1988 and 1992 found that formula-fed infants and babies breast-fed for less than a month were more likely to develop weight problems by age 4 than infants breast-fed for longer periods.

However, the correlation between breast-feeding duration and healthier weight was limited to whites in the study, and did not apply to Hispanics or blacks, who made up nearly one-third of the participants.

U.S. obesity rates among children and adults have been climbing, with Hispanics and blacks the most likely to be overweight.

The report, which was published in the journal Pediatrics, speculated that different dietary habits among low-income Hispanics and blacks overwhelmed breast-feeding's benefits.

Among the possible reasons behind the correlation are that breast-fed children seem to be better able to self-regulate their eating at mealtimes compared to formula-fed children, the report said. Breast-fed babies likely exert more control over when to stop suckling, while babies fed formula might be urged to finish off a bottle or were left wanting more.

Breast-fed children also have been found to make an easier dietary transition to vegetables than formula-fed children, wrote study author Laurence Grummer-Strawn of the U.S. Centers for Disease Control and Prevention (news - web sites) in Atlanta.

And compared to breast milk, formula provokes a greater insulin response that may lead to early deposits of body fat, he wrote.

Breast-feeding is known to provide valuable nutrients and to strengthen the bond between mother and child. The American Academy of Pediatrics, which publishes Pediatrics, recommends mothers breast-feed for at least a year, and the World Health Organization (news - web sites) recommends two years.

In 2001, only 69.5 percent of new American mothers said they had ever breast-fed their newborns and just 32 percent were still breast-feeding at six months. Low-income mothers were the least likely to breast-feed.

In the study, less than one-third of the children were ever breast-fed, and only 6 percent were breast-fed for more than six months.

Among whites, 14.5 percent of infants who had never breast-fed became overweight, compared to 7 percent of those breast-fed at least a year. The proportion of overweight Hispanic children in the study ranged from 22 percent to 29 percent, and among blacks between 13 percent and 19 percent, with duration of breast-feeding having little impact.

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Program Keeps Kids Away From TV

By Ed Edelson
HealthDay Reporter
Monday, February 2, 2004

MONDAY, Feb. 2 (HealthDayNews) -- A family-based intervention program reduced television viewing for preschool children substantially, and it's something most parents can do on their own, researchers report.

More accurately, it's something parents can do in cooperation with their children, says program leader Dr. Barbara A. Dennison, since the key element is finding things that children prefer to television.

"We weren't just negative," says Dennison, an associate professor of clinical pediatrics at Columbia University in New York City. "We encouraged parents and day schools to promote the things that children would like to do."

Those things include having a parent read to them, having children set the table for TV-free meals, making "No TV" stickers to put on television sets, and having a weekend party to celebrate a TV-free week, says Dennison, who works at Bassett Healthcare in Oneonta, N.Y., an upstate Columbia teaching facility.

Mealtimes are important, she says: "It's better to have a lot of people sitting around a table eating and talking, rather than lined up in front of a television set."

The program included children aged 2.5 to 5.5 years old attending 16 preschool or day-care centers in the Oneonta area. Some of the children were given seven sessions of teaching that emphasized alternatives to television watching, while others were left on their own. Parents, whose permission for the study was obtained in advance, kept logs of their children's viewing hours.

At the start, children who got the lessons were watching television an average of 11.9 hours a week, compared to 14 hours a week for those who got no lessons. Two years later, the children in the intervention program reduced their TV watching by an average of 3.1 hours per week, while those left alone increased their TV time an average of one hour a week, says a report in the February issue of the Archives of Pediatrics and Adolescent Medicine.

It's not always easy for parents to keep children away from the television set, Dennison acknowledges. When a tired parent comes home from work, the temptation is to use television as a babysitter.

"The biggest challenge is to get parents to buy into it," says Theresa J. Russo, an assistant professor of child and family studies at the State University of New York at Oneonta.

Part of the parent recruiting effort is to inform them about the possible ill effects on children of too much television watching, says Russo, who prepared the study materials. Research has shown that kids who spend many hours staring at the screen are more likely to be obese, and that they can pick up violent behavior from many shows, even cartoons.

The American Academy of Pediatrics has long recommended active efforts by parents to limit children's viewing time, Russo notes.

It's not certain the reduction in television viewing will last, she says, because "we didn't follow families long-term."

"But hopefully, if you make that lifestyle change, they won't go back to it," Russo says.

More information

A rundown on why too much TV is bad for kids and what parents can do about it can be found at the University of Oregon or the American Academy of Pediatrics.

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Study: Fat-Fighting Drugs Could Raise Cancer Risk

By Maggie Fox, Health and Science Correspondent
Monday, February 2, 2004

WASHINGTON (Reuters) - Drugs being developed to fight obesity and clogged arteries may raise the risk of colon cancer, U.S. researchers warned on Sunday.

Tests on mice showed the compounds, known as PPAR-delta agonists, can cause mice to grow pre-cancerous polyps.

The tests were done on mice bred to develop colon cancer and so do not necessarily apply to humans, but the team at Vanderbilt University in Nashville said the study suggested that companies testing these drugs might need to do more experiments before proceeding in people.

Dr. Raymond DuBois and colleagues worked with a copy of GlaxoSmithKline's experimental compound, known as GW501516.

It is being studied as a possible drug to improve cholesterol levels and perhaps reverse heart disease caused by metabolic syndrome -- the so called "syndrome x" marked by a tendency to abdominal fat, high blood pressure and poor cholesterol levels.

The drugs affect a protein called peroxisome proliferator-activated receptor-delta -- PPAR-d for short. This chemical doorway into cells is important in a number of biological functions, including metabolizing fats and some of the processes that underlie the clogging of arteries.

"We have shown that in over 80 percent of human colon cancers, this receptor was increased pretty significantly," DuBois, a cancer researcher, said in a telephone interview.

"We wanted to pursue this to see if, in an animal that is susceptible to develop colon cancer, if the drug had any effect there."

Writing in the March issue of the journal Nature Medicine, DuBois and colleagues said they gave the drug to specially bred mice that spontaneously develop the little polyps that can lead to colon cancer.

The mice that got the drugs grew twice the usual number of polyps, and they were larger than usual.

"They had a pretty big effect," DuBois said.

This could mean that patients who already have polyps -- which do not cause any symptoms -- may be at higher risk of colon cancer if they take the drugs, the researchers warned.

DuBois, who had no communication with Glaxo and who actually obtained a synthetic copy of the drug, noted that big drug companies routinely test for cancer-causing effects. "But they usually don't test in these kind of animal models," he said.

"It's only a mouse study and we've seen these mouse studies before that didn't really apply to humans," he added.

"But these mice have the same mutations that humans (prone to colon cancer) get. So I think it is something that we need to be aware of and look out for."

Not only that, but the PPAR-delta receptor may be a target for drugs to battle colon cancer, he said. A drug that worked the other way, inhibiting the receptor rather than stimulating it, might treat the deadly cancer, DuBois said.

"We are definitely looking into that," DuBois said

Colon cancer is the second-leading cause of cancer death in the United States after lung cancer, affecting nearly 150,000 this year and killing 57,000, according to the American Cancer Society (news - web sites).

Heart disease is the no. 1 cause of death and stroke, caused by factors including obesity. Clogged arteries ranks as the No. 3 cause of death after cancer.

A Glaxo spokesman said his company could not comment on the report but was studying it. He said the drug, which is in Phase II safety and efficacy trials in human volunteers, had been thoroughly tested by the company in the lab and no colon cancer effect had been observed.

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Moms' Blues Bad News for Their Kids

By Serena Gordon
HealthDay Reporter
Monday, February 2, 2004

MONDAY, Feb. 2 (HealthDayNews) -- Two new studies suggest maternal depression may affect children more than had previously been realized.

The first study found that even though babies born to mothers taking medications for depression appear to develop normally physically, subtle changes in their nervous systems may occur. The authors suggest further research should be done to determine if the benefits of taking these medications truly outweigh the potential risks.

The second study discovered that mothers who were depressed were more likely to have sicker children, not enough food in the home, and to have reported losing federal benefits such as welfare.

Both papers appear in the February issue of Pediatrics.

Nearly one in 10 Americans suffers from depression every year, according to the National Institutes of Mental Health.

"Depression in and of itself can affect the neurodevelopmental status of newborns. It is certainly something we need to be concerned about," says the lead author of the first study, Philip Sanford Zeskind, director of neurodevelopmental research at Carolinas Medical Center in Charlotte, N.C.

But, he adds, doctors and parents also need to be concerned about potential side effects from selective serotonin reuptake inhibitors (SSRIs), commonly used antidepressants. Zeskind explains that past research has concluded these medications are safe to take during pregnancy because they don't cause physical developmental problems, such as low birth weight or preterm birth.

However, such measures of an infant's health are an "antiquated" way to assess the development of a baby's nervous system, he says.

"When your car isn't working well, your mechanic can open up the hood and see that all the parts are there. But if he doesn't turn it on to see how the engine runs, he's a terrible mechanic," Zeskind explains. What researchers need to do is "turn the engine on in babies" to see how well their neurobehavioral system is working to properly assess the effects of SSRI use in pregnancy.

In his study, Zeskind compared 17 babies whose mothers used SSRIs in pregnancy to 17 babies who weren't exposed to SSRIs in the womb.

Babies born to mothers who used SSRIs were more tremulous, had greater motor activity, startled more often, slept deeply for very long periods of time, had fewer changes in behavioral states, and their heart rhythms were more erratic than babies who were not exposed to SSRIs.

Zeskind says he doesn't know what the long-term effect of these changes might be, and the researchers don't know if these changes are caused by a quick withdrawal from the drug, or from serotonin syndrome, a serious condition caused by too much serotonin.

In the second study, more than 5,000 mothers from across the United States were interviewed after bringing their children either to a general clinic or an emergency department. The researchers conducted a depression screen and asked the mothers about their child's health and conditions at home.

Thirty-five percent of the mothers interviewed tested positive for depression.

"Mothers positive on a depression screening are more likely to have lost federal support [such as welfare or food stamps], be food-insecure, and consider their children in poor health," says study co-author Dr. Patrick Casey, director for the Center on Applied Research and Evaluation at Arkansas Children's Hospital in Little Rock.

Casey points out their findings suggest "that policymakers who want to move families off welfare should consider evaluations for maternal depression if they want to optimize successful outcomes." And, he says, getting treatment for depression should count towards welfare eligibility hours.

More information

To learn more about depression, visit the National Institute of Mental Health or the Depression and Bipolar Support Alliance.

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Colon Cancer Screening Low Among African Americans

By Will Boggs, MD
Reuters Health
Monday, February 2, 2004

NEW YORK (Reuters Health) - African Americans on Medicare -- and therefore with apparently equal access to healthcare -- are less likely than Caucasians to undergo colorectal cancer screening, a study shows.

African Americans are diagnosed more frequently with colorectal cancer at later stages than are Caucasians, the authors explain in the medical journal Cancer. However, previous studies have not investigated whether screening and diagnostic procedures differ between the races.

Dr. Gregory S. Cooper and Dr. Siran M. Koroukian from Case Western Reserve University in Cleveland, Ohio, investigated the use of fecal occult blood testing (FOBT), sigmoidoscopy, colonoscopy, or barium enema exams among approximately 33.8 million Medicare beneficiaries during 1999.

Sigmoidoscopy, colonoscopy, and FOBT were performed significantly more commonly in Caucasians than in African Americans, the authors report, whereas barium enema was performed more commonly in African Americans.

In contrast, studies of the upper gastrointestinal tract were performed more often in African American patients than in Caucasian patients, the investigators write, suggesting "that the observed racial differences with respect to colorectal procedures are not due merely to an inability to access endoscopic or radiologic facilities."

So what might be the reason? "The implication is that for whatever reason, blacks may wait until they're symptomatic to get testing rather than go for routine screening or polyp follow up," Cooper told Reuters Health.

"We know that blacks are more likely to present with advanced stage colon cancer, and this may well be one of the major reasons," he added.

"The next step in addressing racial disparities would be to determine what is driving it," Cooper said. "Is it that blacks are less likely to adhere to physician screening recommendations? Are physicians less likely to recommend certain tests to black patients? These answers can only be obtained from more qualitative studies."

Source: Cancer, January 15, 2004.

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Birth Risks Higher on Weekends

Monday, February 2, 2004

MONDAY, Feb. 2 (HealthDayNews) -- The risk of stillbirth or early neonatal death is greater among infants delivered on weekends in Canada, says a study in the new issue of the Canadian Medical Association Journal.

Dr. Michael Kramer, of the department of pediatrics and epidemiology and biostatistics at McGill University in Montreal, and his colleagues examined data from more than 3 million births recorded in Canada between 1985 and 1998.

They wanted to determine if delivery in a country with universal health care was riskier on weekends.

The study concluded the risk of stillbirth and early neonatal death was about 6 percent greater on weekends compared to weekdays. That difference was less when the researchers factored in the length of gestation, which is a known risk factor for stillbirth and neonatal death.

The researchers write that this reduction in excess risk after adjustment for gestational age can likely be explained by the selective timing of low-risk elective deliveries, most of which are scheduled on weekdays.

More information

Here's where you can learn more about stillbirth.

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FDA Panel to Consider Lung Nodule Screening Tool

By Susan Heavey
Monday, February 2, 2004

WASHINGTON (Reuters) - A computer-aided system that can detect lung nodules and possible early-stage lung cancer -- easily missed by the naked eye -- faces review by a U.S. advisory panel on Tuesday.

Privately-held R2 Technology Inc. is seeking Food and Drug Administration (news - web sites) approval for its ImageChecker CT-LN 1000, which automatically searches for suspicious areas in chest images taken through computer tomography, or CT scans.

The software-like tool uses computer-aided detection, or CAD, to mark areas of the lungs as small as 4 millimeters wide that have the characteristics of lung nodules.

While such small, knobby masses can be benign, they can also indicate lung cancer. Other previous conditions a patient may have had, such as tuberculosis, fungal infections and blood clots, can also form nodules.

"No matter how carefully you look at an image or a set of images and how well you're trained ... just by the way of human perception, abnormalities that are clearly present on the image at times are overlooked," said Dr. Ron Castellino, chief medical officer for the company.

The FDA advisers will consider whether to recommend that the agency allow the company to sell the device in the United States. The FDA usually follows the advice of its advisory panels.

An evaluation prepared for the meeting by FDA medical officer William Sacks said the software showed "statistically significant" improvement in detection, but there was a "large variation" in performance depending on individual doctor's assessment of the suspicious areas.

According to the American Cancer Society (news - web sites), 157,200 American adults died from lung cancer last year, accounting for 28 percent of all cancer deaths.

While the tool can mark false positives -- areas of the lung that are not a concern -- the company said they can be evaluated and dismissed by a radiologist. For the roughly 350 chest images resulting from a patient's CT scan, the system generates an average of about two to three false positives.

"It acts as a second set of eyes for the radiologist," Susan Wood, R2 Technology's vice president of clinical marketing, said.

The technology is designed to run with the Sunnyvale, California-based company's ImageChecker CT LN-500 workstation, which the FDA approved for sale in 2002. Although sales of the workstation have not been huge, the company said, many potential buyers have indicated they are waiting for the CAD upgrade.

Wood said the upgrade would result in "a healthy uptake" in company sales if approved by the FDA.

In Europe, the ImageChecker CT-LN 1000 began commercial use in March 2003.

R2 Technology uses similar technology in its breast cancer screening devices that screen for suspicious areas of the breast.

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Eye Disease May Steal Sound Sleep

Monday, February 2, 2004

MONDAY, Feb. 2 (HealthDayNews) -- Inner retinal and optic nerve disease may be a major risk factor for sleep disorders, says a study in the February issue of Ophthalmology.

The study included 25 visually impaired people, aged 12 to 20, and 12 people with normal sight. Researchers compared the sleep-wake cycles of both groups over 14 days.

Previous research has suggested the retina contains non-visual photoreceptors in the inner ganglion cell layer that communicate directly with areas of the brain involved in circadian rhythms. In light of that, the visually impaired people in this study were divided into two groups -- those with optic nerve disease and those without.

"The study showed the subjects with optic nerve disease were 20 times more likely to have pathologic levels of daytime sleepiness, as indicated by napping, than the subjects with normal sight," researcher Dr. Russell N. Van Gelder, an assistant professor in the department of ophthalmology and visual sciences at Washington University Medical School, says in a prepared statement.

"They were also nine times more likely to have pathologic sleepiness than the visually impaired subjects who were blind from the non-optic nerve diseases. We suspect these patients have difficulty using daylight to synchronize their internal rhythms to the outside world," Van Gelder says.

The study also found the people with the optic nerve disease also had highly variable wake-up times and had greater difficulty falling asleep than the others in the study.

"Taken together, these results lead to the unexpected conclusions that eye disease is a risk factor for sleep disorders and whether the optic nerve is healthy or diseased strongly influences the risk of sleep disorders," Van Gelder says.

Doctors need to be aware of this when treating people with optic nerve diseases, he suggests.

More information

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

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Sunday, February 1, 2004

Study: Fat-Fighting Drugs Could Raise Cancer Risk

By Maggie Fox, Health and Science Correspondent
Sunday, February 1, 2004

WASHINGTON (Reuters) - Drugs being developed to fight obesity and clogged arteries may raise the risk of colon cancer, U.S. researchers warned on Sunday.

Tests on mice showed the compounds, known as PPAR-delta agonists, can cause mice to grow pre-cancerous polyps.

The tests were done on mice bred to develop colon cancer and so do not necessarily apply to humans, but the team at Vanderbilt University in Nashville said the study suggested that companies testing these drugs might need to do more experiments before proceeding in people.

Dr. Raymond DuBois and colleagues worked with a copy of GlaxoSmithKline's experimental compound, known as GW501516.

It is being studied as a possible drug to improve cholesterol levels and perhaps reverse heart disease caused by metabolic syndrome -- the so called "syndrome x" marked by a tendency to abdominal fat, high blood pressure and poor cholesterol levels.

The drugs affect a protein called peroxisome proliferator-activated receptor-delta -- PPAR-d for short. This chemical doorway into cells is important in a number of biological functions, including metabolizing fats and some of the processes that underlie the clogging of arteries.

"We have shown that in over 80 percent of human colon cancers, this receptor was increased pretty significantly," DuBois, a cancer researcher, said in a telephone interview.

"We wanted to pursue this to see if, in an animal that is susceptible to develop colon cancer, if the drug had any effect there."

Writing in the March issue of the journal Nature Medicine, DuBois and colleagues said they gave the drug to specially bred mice that spontaneously develop the little polyps that can lead to colon cancer.

The mice that got the drugs grew twice the usual number of polyps, and they were larger than usual.

"They had a pretty big effect," DuBois said.

This could mean that patients who already have polyps -- which do not cause any symptoms -- may be at higher risk of colon cancer if they take the drugs, the researchers warned.

DuBois, who had no communication with Glaxo and who actually obtained a synthetic copy of the drug, noted that big drug companies routinely test for cancer-causing effects. "But they usually don't test in these kind of animal models," he said.

"It's only a mouse study and we've seen these mouse studies before that didn't really apply to humans," he added.

"But these mice have the same mutations that humans (prone to colon cancer) get. So I think it is something that we need to be aware of and look out for."

Not only that, but the PPAR-delta receptor may be a target for drugs to battle colon cancer, he said. A drug that worked the other way, inhibiting the receptor rather than stimulating it, might treat the deadly cancer, DuBois said.

"We are definitely looking into that," DuBois said.

Colon cancer is the second-leading cause of cancer death in the United States after lung cancer, affecting nearly 150,000 this year and killing 57,000, according to the American Cancer Society (news - web sites).

Heart disease is the no. 1 cause of death and stroke, caused by factors including obesity. Clogged arteries ranks as the No. 3 cause of death after cancer.

A Glaxo spokesman said his company could not comment on the report but was studying it. He said the drug, which is in Phase II safety and efficacy trials in human volunteers, had been thoroughly tested by the company in the lab and no colon cancer effect had been observed.

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Saturday, January 31, 2004

That Cough May Be More Than Just Annoying

Sunday, February 1, 2004

SATURDAY, Jan. 31 (HealthDayNews) -- If you've endured a nagging cough for a few weeks, it may be time to see you doctor.

A cough that's continued for more than three weeks may be a sign of allergies, asthma or chronic bronchitis, according to Dr. Henry Milgrom, an allergist at National Jewish Medical and Research Center in Denver.

"Many people let a persistent cough go untreated for too long. If a cough doesn't go away, you should see a doctor to learn if it is symptomatic of something more serious and treatable," Milgrom says in a prepared statement.

He explains that coughs are defined in three stages: acute, sub-acute and chronic.

An acute cough lasts less than three weeks and, if you feel fine otherwise, usually doesn't require a visit to your doctor.

"However, if fever, discomfort or generalized malaise accompanies your cough or if your cough is keeping you awake at night, by all means see a doctor," Milgrom says.

A cough that persists for more than three weeks may be an indication of something more serious. A sub-acute cough, lasting three to eight weeks, may be a sign of sinusitis, viral or bacterial infection, allergies or mild asthma.

A chronic cough, lasting longer than six weeks, may be a symptom of gastroesophageal reflux, chronic bronchitis, undiagnosed asthma or chronic obstructive pulmonary disease (COPD).

"Chronic bronchitis and COPD are frequently accompanied by mucus, whereas some other illnesses associated with chronic cough are not," Milgrom says.

More information

Here's where you can learn more about chronic cough.

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