The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
March 29, 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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 February 14-20



Friday, February 20, 2004

  1. Kidney Cancer Vaccine Shows Promise
  2. Science Inches Closer to Regenerating Sight
  3. Cod Liver Oil May Delay Osteoarthritis
  4. Simple Math Might Prolong Your Life

    Thursday, February 19, 2004

  5. Why Obesity Aggravates Blood-Sugar Control

    Wednesday, February 18, 2004

  6. HPV Test May Help Predict Cervical Cancer
  7. New Test Could Fine-Tune Antibiotic Use
  8. Testing for Hereditary Colorectal Cancer
  9. Exercise Need Not Be Painful: Study
  10. Playing, Working Outside Bring UV Risk
  11. Small Babies Augur Later Stillborn Risk
  12. Skin Cancer Surgery Prompts Better Sun Habits
  13. Hospice Care Can Increase Medicare Expenditures
  14. From Eyeglasses to Contact Lenses
  15. Pasta Fights Back Amid Low-Carb Trend
  16. Grieving Children
  17. Special Insoles Prevent Foot Ulcers in Diabetics
  18. Heart Tests Not for Everyone
  19. Wiping Out Stomach Bug Improves Cholesterol Level
  20. Cancer Tumors Clamp Blood Vessels Shut

    Tuesday, February 17, 2004

  21. Cord Blood Cells Transform Into Heart Muscle
  22. Aspirin May Lower Risk of Hodgkin's
  23. Statins Cut Deaths From Heart Failure
  24. Bone Density Declines in Teens with Cystic Fibrosis
  25. What Hurts the Heart Also Hurts the Kidney
  26. More People Creating Gyms at Home
  27. Baby Shows if Insulin Needed for Diabetes in Pregnancy
  28. Tests Suggest Link Between Anger, Smoking
  29. Video Game Content Ratings Not Always to Be Trusted
  30. New Lens Expands Horizons for Cataract Patients
  31. Campaign Helps Kids Get Active: Survey
  32. Marathon Training
  33. Men with Eating Disorders Have Healthy Body 'Ideal'
  34. Testicular Cancer
  35. Brain Scans Used to Monitor Effect of Cancer Drug
  36. Human Mouth Harbors Clues to Fighting Infection
  37. Cholesterol Drugs May Fight Heart Failure Study
  38. Exercise Sharpens Judgment

    Monday, February 16, 2004

  39. Antioxidants Appear to Protect Against Diabetes
  40. Teaching Hospitals Safe Place for Tricky Surgeries
  41. Study Finds Familial Link in Many Cancers
  42. Tests Suggest Some Predisposed to Smoke
  43. Diaper Rash
  44. Antibiotic Use Linked with Breast Cancer Risk
  45. If Parents Smoke
  46. Fitness Can Improve Thinking Among Aging
  47. Alcohol Sensitivity Runs in the Family
  48. More Evidence Vegetarian Diet May Cut Cancer Risk
  49. Your Heart's Health Is in Your Hands
  50. Campbell to Launch Goldfish Minus Transfatty Acids
  51. Heart Trouble Can Start in the Young

    Sunday, February 15, 2004

  52. The Fight Against Osteoporosis Should Start in Childhood

    Saturday, February 14, 2004

  53. Government Computerizes Calorie Plan

Friday, February 20, 2004

Kidney Cancer Vaccine Shows Promise

By Amanda Gardner
HealthDay Reporter
Friday, February 20, 2004

FRIDAY, Feb. 20 (HealthDayNews) -- An experimental vaccine for kidney cancer appears to reduce the risk of recurrence and increase survival odds for people with the disease.

The findings, appearing in the Feb. 21 issue of The Lancet, have led the study authors to conclude the vaccine can be considered for patients who have tumors larger than 2.5 centimeters, the group that benefited the most from the vaccine in the study.

Outside experts, however, state that while researchers may be closer to a vaccine for kidney cancer, they still are not there.

"The findings are suggestive, but not conclusive," says Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society (news - web sites) in Atlanta.

While surgery to remove all or part of the kidney is standard practice for this type of cancer, additional treatments such as chemotherapy or radiation have not met with much success. As a result, half of patients will have a recurrence within five years.

On the other hand, there has been a great interest in developing a vaccine for this particular type of cancer because some people have had unexplained response in their tumors even without treatment.

"Kidney cancer has been recognized as a possible target for a vaccine therapy because of the way the cancer itself behaves," Lichtenfeld says. "Some people have had unexplained changes in their tumor, suggesting that the body may in fact be able to recognize kidney cancer." This unexplained behavior has long represented a hopeful window of opportunity for researchers in this field.

Although many studies are ongoing, no cancer vaccines have yet been approved for use. The idea is to take cancer cells (often from the actual patients) and process them in such a way that they can be given back to the patients to help foster an immune response.

The current trial, which used cells from the patients' own tumors, is one of the largest and furthest along of its kind. "As far as I can tell, this is the largest vaccine phase III [final stage] trial for kidney cancer that's been finished and come out," says Dr. Mayer Fishman, an assistant professor of interdisciplinary oncology at the Moffitt Cancer Center of the University of South Florida in Tampa and author of an accompanying commentary.

The study authors analyzed information on 379 patients from 55 medical centers in Germany who had had surgery for cancer of the kidney. Before surgery was performed, all of the participants were randomized to receive a vaccine (six injections in all) or no additional treatment.

More than three-quarters (77 percent) of the vaccine group and 68 percent of the control group survived without a recurrence for five years.

Patients who were at a high risk for recurrence (that is, they had a large tumor size and high tumor grade) had an even greater therapy, although this data was not outlined in the report.

The trial was sponsored by a company, LipoNova of Hannover, Germany, a factor Fishman says may have affected how the data was presented.

The paper did not include overall survival comparisons between the two groups, Fishman points out. "The primary endpoint of the study was not about survival, and the purpose of the paper was not to be the final word about data," he says. "This is an industry-sponsored trial, and every page of that they consider to be proprietary information."

At this point, the findings are specific and limited, experts say.

"We're dealing with a study that has been published that suggests tumor vaccines may work in this situation, but we still have a long way to go in knowing how really effective these vaccines may be in this type of cancer," Lichtenfeld says. "It's similar to other studies that suggest a possible effect, but more research is needed before we can incorporate it into therapy for all kidney cancer."

According to Fishman, the company has already started approval proceedings in Germany, but it's unclear if that will succeed and, even if it does, how the U.S. Food and Drug Administration (news - web sites) will respond.

"I don't think they have enough from this study to get this product approved for this indication," Fishman adds. On the other hand, the company may be using the study to find out what additional specific information the regulatory authorities need before approving the product. "In that sense, that's a reasonable commercial endeavor."

More information

For more on kidney cancer, visit the National Cancer Institute. The American Cancer Society has more on cancer vaccines.

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Science Inches Closer to Regenerating Sight

Friday, February 20, 2004

FRIDAY, Feb. 20 (HealthDayNews) -- Using a two-pronged approach to encouraging growth, American scientists say they've made an important advance in regenerating damaged nerve fibers.

A combination of activating nerve cells' natural growth state and using gene therapy to mute the effects of growth-inhibiting factors let them achieve about three times more nerve fiber regeneration than previous attempts, say researchers at Children's Hospital Boston and Harvard Medical School (news - web sites). Results appear in the Feb. 18 Journal of Neuroscience.

The experiments were conducted on the damaged optic nerves of rats.

"When we combined these two therapies -- activating the growth program in nerve cells and overcoming the inhibitory signaling -- we got very dramatic regeneration," Dr. Larry Benowitz, director of neuroscience research at Children's Hospital, says in a prepared statement.

The amount of regeneration wasn't enough to restore the rats' vision. But it was about triple the amount of regeneration achieved by stimulating growth factors alone.

Benowitz says his lab will continue trying to repair damaged optic nerves to restore vision.

"We have to fine-tune the system, and we have some ideas of how to do it," Benowitz says. "But then we come to another big hurdle."

That hurdle is getting the optic nerve fibers to link up to the correct areas in the brain in a way that visual images don't get scrambled.

"It's a mapping problem," Benowitz says. "We have to retain the proper organization of fiber projections to the brain."

More information

To learn more about eye diseases, go to the National Eye Institute .

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Cod Liver Oil May Delay Osteoarthritis

Friday, February 20, 2004

FRIDAY, Feb. 20 (HealthDayNews) -- Cod liver oil helps slow the destruction of joint cartilage in people with osteoarthritis, says a British study.

Experts say that could reduce the number of knee and hip replacements done each year and shorten waiting lists for joint replacement surgery.

The study reports that 86 percent of the arthritis patients who took 1,000-milligram capsules of extra-high-strength cod liver oil a day had no levels, or significantly reduced levels, of the enzymes that cause cartilage damage. That compares with 26 percent of the arthritis patients who took a placebo oil capsule for the study.

Those who took the cod liver oil also had a marked reduction in some of the enzymes that cause joint pain, according to the study, by researchers at Cardiff University in Wales.

"This breakthrough is hugely significant because it demonstrates the efficacy of cod liver oil in patients with osteoarthritis taken prior to their joint replacement surgery," researcher Bruce Caterson says in a prepared statement. "The data suggests that cod liver oil had a dual mode of action, potentially slowing down the cartilage degeneration inherent in osteoarthritis and also reducing factors that cause pain and inflammation."

"What these findings suggest is that by taking cod liver oil, people are more likely to delay the onset of osteoarthritis and less likely to require multiple joint replacements later in life," he says.

The study included 31 people in the United Kingdom who were on a national waiting listing for total knee joint replacement surgery. Half of the participants took cod liver oil and half took a placebo for 10 to 12 weeks before their surgery.

During surgery, samples of the patients' cartilage and joint tissue were taken from the knee joint for analysis by the researchers.

More information

To learn more about osteoarthritis, go to the Arthritis Foundation.

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Simple Math Might Prolong Your Life

Friday, February 20, 2004

FRIDAY, Feb. 20 (HealthDayNews) -- Warnings about the health dangers of trans fats seem to be everywhere -- and with good reason.

The unhealthiest of all fats, trans fats pose a double threat to your arteries. They raise the level of the bad cholesterol -- low-density lipoprotein (LDL) -- and lower the good cholesterol -- high-density lipoprotein (HDL). They're found in vegetable shortening, some margarines, crackers, candies, baked goods, cookies, snack foods, fried foods, salad dressings and many processed foods, according to the U.S. Food and Drug Administration (news - web sites).

Trans-fat consumption results in at least 30,000 deaths from heart disease each year in the United States, say Harvard School of Public Health researchers.

To help lower your intake of trans fat, the Harvard Women's Health Watch offers the following advice:

  • Read food labels. If a food product lists shortening or hydrogenated or partially hydrogenated oil as one of its first ingredients, that means it contains a lot of trans fat.
  • Do the simple math to figure out trans fat content of foods. Add the polyunsaturated and monounsaturated fats to the saturated fats. Subtract that sum from the "Total Fat" listed on the label. The result equals the amount of trans fat in the product.
  • Pay attention to margarine. The softer margarine is at room temperature, the lower its trans fat content. The best choices are margarines labeled "trans fat-free."
  • Use canola oil or olive oil when frying food. Be careful when eating in restaurants. Foods that are fried in trans fat-laden partially hydrogenated vegetable oil often are labeled as being "cholesterol free" or "cooked in vegetable oil."
  • Make your own food when possible. Commercial breads, soups, cereals, dips, salad dressings and packaged entrees usually have hidden trans fats.

More information

To learn more about food fats, go to the American Heart Association.

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Thursday, February 19, 2004

Why Obesity Aggravates Blood-Sugar Control

By Karen Pallarito
HealthDay Reporter
Thursday, February 19, 2004

THURSDAY, Feb. 19 (HealthDayNews) -- You're overweight and have type 2 diabetes. Your doctor urges you to drop those excess pounds, knowing a leaner you will have a better chance of managing your blood sugar.

Today, scientists may be a bit closer to knowing just why that's so.

A new study on mice, published in the Feb. 20 issue of Science, suggests a fat-derived hormone called resistin may promote insulin resistance, a condition in which the body fails to use insulin properly.

Insulin is the substance that controls blood sugar in the body. When there isn't enough of it or it isn't used effectively, sugar builds up in the blood, starving the cells of the fuel they need for energy.

Mice that don't have resistin are largely protected from insulin resistance, says Dr. Mitchell Lazar, director of the Penn Diabetes Center at the University of Pennsylvania and one of the study's authors.

If resistin plays a similar role in humans, the authors say, this finding could lead to new ways to diagnose and treat people with type 2 diabetes.

"We might be able to really make an impact on insulin resistance and, therefore, on diabetes," Lazar says.

About 17 million Americans have type 2 diabetes, according to the American Diabetes Association. The disease frequently goes undiagnosed yet poses serious and life-threatening complications such as blindness, kidney disease, heart disease and stroke.

Carrying extra body fat puts people at increased risk. About 80 percent of adults with type 2 diabetes are overweight, according to the National Diabetes Information Clearinghouse.

Perhaps not surprisingly, the nation's diabetes epidemic tracks a dramatic rise in obesity among adults and children in the United States. Almost two-thirds of adults are overweight or obese and about 15 percent of children and adolescents ages 6 to 19 are overweight, according to the U.S. Centers for Disease Control and Prevention (news - web sites), based on the 1999-2000 National Health and Nutrition Examination Survey.

In 2001, Penn scientists first reported the existence of a hormone produced by fat cells that seemed to promote insulin resistance. They christened it "resistin," suggesting resistance to insulin.

In the current study, the Penn team bred mice without resistin and compared their blood sugar regulation with mice possessing the hormone. Both groups of rodents gained weight on a high-fat diet, but glucose tolerance was significantly better in the resistin-free mice. Those lacking resistin also had lower fasting blood glucose levels than normal mice.

Lazar believes resistin may have played an important role in evolution, helping to keep blood sugar normal during periods of fasting. With obesity, he says, resistin may get out of whack and contribute to difficulties handling blood glucose.

Dr. Richard Hellman, medical director of the Heart of America Diabetes Research Foundation, says the study is interesting, particularly in light of a growing body of research examining the function of fat cells and fat metabolism.

"What it doesn't say is how this extrapolates to humans," Hellman observes. Nor does it say how important resistin is within the hierarchy of factors that could be contributing to insulin resistance, he adds.

Translating the results to people becomes tricky, Lazar explains, because resistin in humans is expressed mainly by white blood cells, not fat cells as in mice.

"It may not be coming from fat cells but still may be an important link between obesity and insulin resistance in people," he says.

More information

To learn more about insulin resistance, visit the National Diabetes Information Clearinghouse. For more on type 2 diabetes, go to the American Diabetes Association.

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Wednesday, February 18, 2004

HPV Test May Help Predict Cervical Cancer

Wednesday, February 18, 2004

WEDNESDAY, Feb. 18 (HealthDayNews) -- Testing for human papillomavirus (HPV) can help identify potential cases of cervical cancer, according to a report in the Feb. 18 issue of the Journal of the National Cancer Institute (news - web sites).

Belgian researchers reviewed data from 15 studies and concluded that, compared with a repeat Pap smear, a test for HPV infection enables a more accurate prediction of whether a woman with an equivocal cervical abnormality found on a Pap smear is likely to develop invasive cancer.

The studies were done on women with atypical squamous cells of undetermined significance (ASCUS), one of the most common cervical abnormalities.

This new study found that HPV testing accurately identified 84.4 percent of women with ASCUS who had high-grade cervical intraepithelial neoplasia (CIN2) or worse. With CIN2, abnormal cell growth on the surface of the cervix has the potential to become cancerous.

HPV testing accurately ruled out CIN2 or worse in 72.9 percent of women with ASCUS, according to the report.

When the Belgian researchers looked only at studies that used a recently developed test for HPV, called the Hybrid Capture II assay, they found that HPV testing was 94.8 percent accurate in identifying women with CIN2 or worse and 67.3 percent accurate in ruling out CIN2 or worse.

A repeat Pap smear accurately identified 81.8 percent of women with CIN2 or worse and was 57.6 percent accurate in ruling out CIN2 or worse.

More information

To learn more about cervical cancer, visit the American Cancer Society online.

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New Test Could Fine-Tune Antibiotic Use

By Emma Ross
AP Medical Writer
Reuters Health
The Associated Press
Wednesday, February 18, 2004

LONDON - A blood test could help doctors determine whether antibiotics are needed for common respiratory infections and may reduce the over-prescribing that creates drug-resistant germs, new research suggests.

About 75 percent of all antibiotics are given for lower respiratory tract infections such as bronchitis and pneumonia. Most of these infections are caused by a virus, not bacteria. Experts say antibiotics are not only useless against viral infections, but also help bacteria evolve defenses against drugs.

The new test, described this week in The Lancet medical journal, measures blood levels of a chemical marker that is elevated in bacterial infections but not so high when the cause is a virus. It yields results within an hour.

"This looks very promising," said Roy Anderson, an expert on antibiotic resistance at Imperial College in London. "Cutting the overuse of antibiotics is crucial to combatting antibiotic resistance."

Anderson, who was not connected with the study, said current tests are too expensive and cumbersome to be practical for use by family doctors.

"What you want eventually is a kind of quick and easy dipstick test that can tell you right away. It needs refining, but something like this could evolve into a dipstick where it turns one color for a positive and another color for a negative," he said.

The study involved 243 patients treated at the University Hospital in Basel, Switzerland, for suspected lower respiratory tract infections.

Half the patients got the standard care, which usually included a physical examination, temperature check and chest X-ray, while the others got standard care plus the blood test.

In both groups, the decision on prescribing antibiotics was left to doctors. However, in the blood test group, the doctors had to decide on prescribing antibiotics before learning the blood test results.

After the blood test results were revealed, the researchers then advised the doctors to prescribe antibiotics only if the blood level of the chemical marker, called procalcitonin, was above a certain level.

The rate of antibiotic prescriptions foreseen by the doctor was similar in both groups before the blood test results were disclosed.

But once test results were known, antibiotic prescriptions dropped almost in half. A total of 99 patients in the comparison group got antibiotics, compared with 55 in the blood test group.

Antibiotics were given to 22 patients with a blood test showing low levels of the chemical marker. Doctors often prescribe antibiotics to people with severe viral infections because viruses can damage the airways enough to encourage a subsequent life-threatening bacterial infection.

"Importantly, withholding antibiotic treatment was safe and did not compromise clinical and laboratory outcome," said the study, led by Dr. Beat Muller at the University of Basel.

Dr. Marc Siegel, a professor of medicine at New York University School of Medicine, said the study convinced him the procalcitonin marker may help doctors, but larger studies are needed to determine if it is safe to withhold antibiotics from high-risk patients.

The danger of missing a severe or progressing bacterial infection is too great to rely solely on the blood test, Siegel said. "You worry about antibiotic resistance, but you also worry about patients dying," he said.

On the Net:

U.S. FDA (news - web sites) on antibiotic resistance:

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Testing for Hereditary Colorectal Cancer

Wednesday, February 18, 2004

WEDNESDAY, Feb. 18 (HealthDayNews) -- Revised criteria for testing for a hereditary type of colorectal cancer have been issued by a group of international experts.

The revised Bethesda Guidelines, which appear in the Feb. 18 issue of the Journal of the National Cancer Institute (news - web sites), should help doctors determine if a patient's colorectal cancer is a specific form that is inherited, which may mean the person's family members have an increased risk of the disease.

Hereditary nonpolyposis colorectal cancer (HNPCC) usually occurs in people younger than age 45. It can lead to development of cancers in a variety of tissues, including the colon, rectum, endometrium, stomach, ovaries, brain and skin.

HNPCC results from inherited genetic mutations. That means that family members of people with HNPCC also may have the genetic characteristics that put them at increased risk for cancers.

A major genetic characteristic of HNPCC tumors is the instability of short repeated sequences of DNA known as microsatellites. This instability occurs when mutations in genes responsible for repairing damaged DNA cause microsatellites to become longer or shorter.

The revised criteria suggest that tumors from colorectal cancer patients should be tested for this instability. Subsequent genetic testing, to confirm a mutation in one of the genes responsible for colorectal cancer, is recommended if:

  • The patient is younger than age 50;
  • The patient has multiple tumors in the colon or in other areas known to be caused by the same mutations, either at the same time or occurring over a period of time;
  • A patient younger than age 60 has colorectal cancer that has microscopic characteristics indicative of the DNA instability;
  • The patient has at least one first-degree relative who had colorectal cancer at age 50 or younger;
  • The patient has at least two first- or second-degree relatives who had HNPCC-related tumors at any age.

More information

To learn more about colorectal cancer, visit the National Cancer Institute online.

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Exercise Need Not Be Painful: Study

By Merritt McKinney
Reuters Health
Wednesday, February 18, 2004

NEW YORK (Reuters Health) - "No pain, no gain" may be the mantra of coaches everywhere, but it's bad advice for most exercisers, research suggests.

In a new study, pain or displeasure was the most accurate indicator that a person had crossed a threshold believed to be the optimum level of exercise.

"As astonishingly simple as it sounds, perhaps the most appropriate level of exercise intensity for health-oriented exercise is the intensity that does not feel unpleasant," lead author Dr. Panteleimon Ekkekakis of Iowa State University, Ames, told Reuters Health.

Ekkekakis noted that it is natural for people not to want to continue doing things that are consistently unpleasant or uncomfortable.

"People will go to the gym after New Year's resolutions, but, if exercise hurts the first few times, after a while they will opt to stay home and watch TV," he said.

Most Americans could benefit from more physical activity, but Ekkekakis said that most people are not very good about estimating how hard they are exercising. People often do more or less than what is recommended, he said.

People who do too little miss out on the full benefits of exercise, but those who do too much may become exhausted and give up.

Ekkekakis explained that there is a specific level of exercise intensity that seems to be appropriate for a wide variety of people. This intensity corresponds to the level of the transition from aerobic to anaerobic metabolism--when the body switches over from burning fuel from aerobic (with oxygen) to anaerobic (without oxygen) sources.

This level of intensity is desirable for several reasons, including the fact that previously sedentary middle-aged and older people seem to get the same benefits at or just below this level than when they exercise at a higher intensity, Ekkekakis said. In addition, people who exercise significantly above this threshold quickly run out of steam.

People are often told to gauge their exercise intensity by measuring their heart rates, but this can be inconvenient, according to Ekkekakis. Another method of measuring exercise intensity involves rating a person's perceived exertion level, but doing this can be tricky, the Iowa researcher noted.

Ekkekakis' team set out to determine the best way to know when a person has reached this exercise threshold. The researchers believed that if a person exceeded the level of the aerobic-anaerobic transition, "that's precisely the point where they will start feeling gradually worse," Ekkekakis said.

"This is exactly what we found in the two samples of college students we tested," he said.

In two groups of 30 students who underwent exercise testing, feelings of pleasure and displeasure were more accurate than heart rate and other measures at determining the aerobic-anaerobic transition, the researchers report in the February issue of the journal Preventive Medicine.

For people who are just starting an exercise program, particularly those who are overweight, the intensity that corresponds to their individual aerobic-anaerobic transition may be very low, "perhaps not faster than a stroll," Ekkekakis said.

He added, "It is important that they stick to the intensity that feels comfortable rather than trying to match cultural expectations of what exercise should look like or feel like to be effective."

Preventive Medicine, February 2004.

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Playing, Working Outside Bring UV Risk

Wednesday, February 18, 2004

WEDNESDAY, Feb. 18 (HealthDayNews) -- A person's sun exposure correlates with the dose of ultraviolet radiation (UVR) they receive, says a Danish study in the February issue of the Archives of Dermatology (news - web sites).

UVR exposure is a risk factor for skin cancer.

The study included 285 Danish volunteers, aged 4 to 68, who wore a special device called a dosimeter that measured their UVR exposure while they were outdoors. The dosimeter readings were collected in segments over a three-year span.

The results showed indoor workers received the least UVR exposure and gardeners had the most exposure. Girls received more estimated UVR than boys. Sunbathing and going to the beach increased UVR exposure, and teenagers and children received more than half their total UVR exposure while they were at the beach.

Half of the UVR exposure received by people in the study was measured between noon and 7 p.m.

More information

The American Cancer Society (news - web sites) has more about ultraviolet radiation.

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Small Babies Augur Later Stillborn Risk

By Jeff Donn
Associated Press Writer
The Associated Press
Wednesday, February 18, 2004

BOSTON - Women who give birth to small babies whether prematurely or not are more likely to have stillborns during their next pregnancy, a study found.

The Swedish study, published in Thursday's New England Journal of Medicine (news - web sites), suggests that the same causes may underlie both stillbirths and stunted growth in fetuses.

However, since so little can be done about many growth problems, the study is not expected to bring about any big changes in obstetrics.

The researchers used a national registry with 410,021 women who had two consecutive pregnancies resulting in live or stillbirths.

Women who had small but full-term babies ran double the risk of a stillbirth in their next pregnancy.

Preterm newborns raised the later risk of a stillbirth only if they were also small for their fetal age. The risk of a later stillbirth was five times higher if the newborn was both very small for its fetal age and very early in its delivery before 32 weeks.

Newborns who were in the bottom 2.5 percent in size at a given stage of development were considered small for their fetal age.

Though small newborns heightened the risk of later stillbirths, the overall rate of stillbirths for the second pregnancy was low at 2.6 per 1,000 births. Even in the highest risk group, there were only 19 stillbirths per 1,000 births.

Infections, respiratory problems, congenital defects and other factors can cause stillbirths. This study did not consider the causes of the stillbirths, so it is not clear exactly which ones stillbirths and small-for-fetal-age births may share.

A probe called Doppler ultrasound can show blood flow in a fetus and point to possible nutritional problems and stunted growth at an early stage of development.

However, the study leaves doctors in a bind over whether to induce delivery of very preterm babies with serious growth problems. An early delivery could save the child from stillbirth but put it at risk by such an early birth.

"If you have a baby that may be suffering 14 weeks prior to delivery, how to you deal with this one? I don't think anybody knows," said one of the researchers, Dr. Sven Cnattingius of the Karolinska Institute in Stockholm.

However, pediatrician Dr. Mark Klebanoff, a researcher at the National Institutes of Health (news - web sites) who co-wrote an accompanying commentary, said the study should at least help doctors and women judge the magnitude of risk for stillbirths.

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Skin Cancer Surgery Prompts Better Sun Habits

Wednesday, February 18, 2004

WEDNESDAY, Feb. 18 (HealthDayNews) -- People who've had surgery to remove skin cancer are more likely to protect themselves from the sun than they were before their surgery.

That newfound common sense is detailed in a study in the February issue of the Archives of Otolaryngology.

Medical College of Wisconsin researchers studied whether there was a change in quality of life for 121 people after they had surgery to remove nonmelanoma skin cancer and whether those individuals changed their sun-protection habits and other risky behaviors, such as smoking, after their surgery.

The people were surveyed a month after surgery and again at four months.

The study found that, overall, there was little change in the people's general quality of life after surgery, but there was a significant improvement in their mental and emotional health. Many people started taking steps to protect themselves from the sun, such as using sunscreen and wearing hats. But there wasn't much change in their smoking habits.

Forty-nine percent of those surveyed had used sunscreen before surgery, and 72 percent used sunscreen one month after surgery. The number of people wearing hats outside increased from 67 percent before surgery to 74 percent after surgery, and those avoiding the sun increased from 20 percent to 44 percent.

More information

The American Academy of Family Physicians (