The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
August 27, 2002

 

 

 

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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 August 17 -- 23

FRIDAY, AUGUST 23, 2002

1. Painkillers Come With Major Risks
2. Ban on Paxil TV Ads Delayed
3. Cardiac Disease a Bigger Problem for Women
4. After Injury, Brain May Repair Itself -- with Help
5. Lack of Oxygen at Birth Not the Cause of Most Newborns' Seizures
6. Army To Probe Health Issues in Slay
7. Poll Finds Momentum for Radical Healthcare Reform

8. Peanut Butter as Health Food
9. Pregnant Moms' Diet Can Help Newborns Sleep Better
10. Bladder Condition Difficult to Diagnose
11. Study Suggests Early Screen for 'Lazy Eye' Is Best
12. Scientists Fight Head Lice With ... Lice
13. Bedwetting Treatment Eases Kids' Emotional Problems

14. Girls With Attention-Deficit Disorder Need Attention
15. Puzzling Particles Found in Schizophrenia Patients
16. Molds More of a Culprit in Asthma
17. Men: Going for the Grains May Cut Diabetes Risk
18. Ecstasy Is Anything But
19. FDA Warns of Possible Cryolife Heart-Valve Risk
20. Screen Early for Gestational Diabetes
21. Maker Says Malarone Safer Than Other Malaria Drugs
22. No Bones About It -- Milk Helps Kids' Growth

THURSDAY, AUGUST 22, 2002

23. Get The Lead Out!
24. New AIDS Drug Raises Hopes, Fears
25. Heartening News on Vitamin E
26. We Will Be What We Eat
27. Petting Zoos: Steer Clear of Dirty Hands
28. Study: No '90s Health Coverage Boom
29. Fish in Moms' Diets Fuel Growth of Newborn Brains
30. Some Stem Cells May Be Less Versatile Than Thought
31. FDA Reviews Novartis Cancer Drug
32. Some Early Mobiles Reportedly Pose Brain Tumor Risk
33. Lice Aren't Nice
34. Sports Injuries Send 4.3 Million to ERs Each Year
35. FDA: Prilosec Needs Clearer Label
36. NIH Considers Dietary Supplements
37. Gene Variant Linked to Higher Arrhythmia Risk
38. Theory on Rheumatoid Arthritis Found
39. Epilepsy Drug Linked to High Rate of Eye Problems
40. Dental Device Cuts Pain, Lengthens Injection Time
41. Ear Thermometers Not So Hot

WEDNESDAY, AUGUST 21, 2002

42. FDA to Revamp Drug Making Rules
43. Coffee, Chocolate Compounds Potential Cancer Drug
44. Enzyme May Destroy Anthrax
45. Natural Carbohydrates Contribute to Arthritis
46. Inner Ear Fixes Noise Damage in 48-Hour Cycle
47. Bush Admin. to Push Embryo Adoption
48. Cataract Surgery May Cut Older Drivers' Crash Risk
49. Mastectomies: More Is Not Better
50. Panel: Monitor Biotech Animal Food
51. Ouch! Pain Costs Employers $80 Billion Annually
52. Simpler Bypass Surgery Makes a Difference
53. Colon-Cancer Test Supposedly Easier
54. Guard Against Tornadoes
55. Breast Cancer Gene Study Questioned
56. Suicide Choice Said a Control Issue
57. Scientists Probe Nev. Cancer Cluster
58. Vaccinate Against Tetanus
59. Study: Ginkgo Doesn't Aid Memory
60. Groups Angry With Preventable Deaths
61. Risky Business
62. Study Finds Exception to Cell Rules
63. Bedwetting Linked to Delayed Brain Development

TUESDAY, AUGUST 20, 2002

64. Antimicrobials in Soaps, Lotions Don't Help: AMA
65. Teens Say Buying Marijuana Is Easy
66. Groups Seek National ATV Standards 

MONDAY, AUGUST 19, 2002

67. Hormone Patch May Heat Up Women's Desires
68. Deviant Gene May Up West Nile Risk
69. Don't Let Worms Dog You
70. Indiana U. Named Top 'Party School'
71. (Beware Of) Water, Water Everywhere
72. Early heart disease indicator identified

73. New Potential Drugs for AIDS Discovered
74. FDA Approves Light Therapy for Acne
75. Aromatherapy May Do More Than Soothe Your Spirit
76. Backpacks Not Always to Blame for Kids' Back Pain
77. Nutritional Value of Water Studied
78. Moms and dads differ on kid's pain
79. Test of Cancer Drug Disappointing
80. Ibuprofen Better Fever Reducer for Kids: Report
81. Cooling device aims to limit heart damage
82. Left Side of Brain Important for 'Self-Memory'
83. Antibiotics lower heart re-hospitalization
84. Tiny Swap Distinguishes One Blood Type from Another
85. Daily Aspirin Not Recommended for Everyone
86. Blueberries May Help Old Folks Keep Their Smarts
87. Honey Shown to Boost Antioxidants in Blood
88. Broccoli-Derived Pill May Help Ward Off Cancer
89. Almonds, as Part of Healthy Diet, Cut Cholesterol
90. Enzymes Help Predict Death Rate After Angioplasty
91. More Evidence HRT Doesn't Cut Heart Risk: Study
92. Tests Begin on New Type of Vaccine for Malaria
93. Fewer U.S. Teens May Be Smoking, Using Drugs
94. Jab-Free Blood Sugar Test Inching Closer to Reality
95. Flu Vaccine Guards Against Illness and Saves Money 

SUNDAY, AUGUST 18, 2002

96. A New Take on the Prescription Drug Flap
97. Getting Into the Swing of Things
 

SATURDAY, AUGUST 17, 2002

98. Democrat: Medicare Fails Elderly
99. Fitting Fitness Back in Your Life

FRIDAY, AUGUST 23, 2002 

Painkillers Come With Major Risks

By Randy Dotinga
HealthScoutNews Reporter

HealthScoutNews

Friday, August 23, 2002

FRIDAY, Aug. 23 (HealthScoutNews) -- As medicine enters a new era of pain treatment, a researcher reminded thousands of doctors yesterday that popular painkillers are not without their risks.

Even a modern generation of drugs known as COX-2 inhibitors are anything but harmless, said Henry J. McQuay, a professor of pain relief at the University of Oxford, in a speech before the 10th World Congress on Pain in San Diego.

"It's incredible how casual and careless the doctors are, all of us," when it comes to prescribing proper doses of mediations known as non-steroidal anti-inflammatory drugs, he said. "We just forget doses... and it matters."

The International Association for the Study of Pain holds a conference every three years in a different country. The main topics at the 2002 conference, which ended yesterday, included new medications, treatment of pain in the elderly, the psychology of pain and the use of medical marijuana.

After decades of neglect, pain has become one of the hottest topics in medicine over the last five years. Many doctors, nurses and hospitals are responding to criticism that they don't do enough to relieve pain, a notoriously difficult symptom to understand and treat.

Among other things, many hospitals now routinely measure the self-described pain level of patients -- the so-called "fifth vital sign" -- along with pulse, respiration rate, blood pressure and body temperature.

However, painkillers still have side effects. Opium-based drugs, like morphine and OxyContin, are powerful but can cause addiction. And non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen and naproxen can cause gastrointestinal bleeding, a potentially fatal condition in fragile patients.

Some doctors fail to realize the drugs can also hurt the hearts and kidneys of patients, McQuay added. "We have this kind of blinkered approach in our medical teaching and training. You could ask any health-care professional what the non-steroidals do, and they'll say they make your guts bleed. But the cardiac effects may be just as important."

The COX-2 inhibitors appear to be less risky, but they can spell trouble, McQuay said.

In an interview, another pain specialist said some doctors do indeed neglect the risks of non-steroidal painkillers. However, like McQuay, he said doctors shouldn't abandon the drugs but instead use them with care.

"It's generally perceived that the non-steroidals are very safe given the fact that you can even buy them over the counter without a prescription," said Dr. Bill McCarberg, director of the chronic pain management program for the Kaiser Permanente health plan in San Diego. "But in reality, there are risks related to their use."

Patients should be especially vigilant about letting their doctors know when they take over-the-counter painkillers, McCarberg said. Otherwise, doctors may inadvertently cause a potentially serious drug interaction.

Doctors must take special care when prescribing drugs for the elderly, McQuay said at the pain conference.

"As the population ages, we're going to have a lot more older people," he said. "And older people have other medical problems, too. Many of our pain patients are taking eight medications on average. So, if we put in another medicine, we're likely to be causing ripples in the pond."

But McQuay also acknowledged that his advice is only based on current medical knowledge. "I'm acutely aware that everything I say will have to be changed in two or three years' time," he said.

What To Do

Learn more about other topics discussed at the 10th World Congress on Pain.

To learn more about potential painkiller side effects, read this piece about drugs and peptic ulcers from the National Institute of Diabetes and Digestive and Kidney Diseases.

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Ban on Paxil TV Ads Delayed

By Paul Wilborn

Associated Press Writer

The Associated Press

Friday, August 23, 2002

LOS ANGELES (AP) - A court-ordered deadline to pull national TV commercials that claim the anti-depressant Paxil is not habit-forming was delayed from Sept. 1 to Sept. 12, an attorney involved in the case said Friday.

The postponement will give the U.S. Food and Drug Administration ( news - web sites) time to file a brief supporting the ads.

The stay came in response to a "statement of interest" brief from the FDA asking U.S. District Judge Mariana Pfaelzer to rescind a decision that grew out of a civil lawsuit. FDA officials said they were worried the ruling improperly interferes with the way the agency regulates drugs and drug companies.

The judge's decision to delay the ban came during a conference call with the parties involved, said Karen Barth, an attorney's for plaintiffs suing the makers of Paxil.

A new brief from the FDA is due Sept. 5. The plaintiffs then have until Sept. 12 to file a response, Barth said.

Lawrence Bachorik, a spokesman for the FDA, confirmed that the judge had issued a stay but did not elaborate.

The civil lawsuit against Paxil producer GlaxoSmithKline was filed on behalf of 35 patients who claimed they suffered withdrawal symptoms such as nausea, fever, and "electric zaps" to their bodies.

In a filing Tuesday, the FDA said there were often side effects when patients stop taking certain medications "abruptly," but the agency labels drugs as habit-forming only when such drugs "cause drug-seeking behavior, often with the user escalating the dose for psychological or physical gratification."

Pfaelzer found that in other countries, labels on the drug warn of adverse reactions when use of the drug is discontinued.

The commercials were "misleading and created inaccurate expectations about the ease of withdrawal from the drug," Pfaelzer ruled Monday.

The judge's ruling was preliminary and comes at an early stage of the court proceedings. A hearing is set for Oct. 7 to decide whether the lawsuit should be converted to a nationwide class-action, Barth said.

Surging U.S. sales of Paxil and the asthma drug Advair led to a 15 percent increase in second-quarter profits for London-based GlaxoSmithKline PLC. Global sales of Paxil grew 29 percent.

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Cardiac Disease a Bigger Problem for Women

HealthScoutNews

Friday, August 23, 2002

FRIDAY, Aug. 23 (HealthScoutNews) -- No one is happy to learn that he or she has cardiac disease. But the quality of life for women with heart disease is considerably worse than a man's, according to a new study.

Researchers from Ohio State University say they found that women had a significantly worse time than men, regardless of the kind of cardiac disease, age, race, or cardiac risk factors. The quality of life remains lower for women a year after their diagnosis or initial treatment for heart problems.

The study included 536 people (35 percent women) with a mean age of 59.5 years. All the people in the study filled out a survey questionnaire and were interviewed at three-month intervals over the following year.

The survey measured psychological functioning and quality of life, including activity levels, emotional state, sadness and anxiety, and the person's perception of available social support.

Women scored lower on both mental and physical composite indicators of quality of life at every survey point in the study.

The authors say the study supports the theory that social support is an important factor in the reduced quality of life for women with cardiac disease.

The study was presented yesterday at the annual convention of the American Psychological Association.

More information

This information from the National Heart, Lung, and Blood Institute can help women determine how high their risk might be in developing cardiovascular problems.

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After Injury, Brain May Repair Itself -- with Help

By Linda Carroll

Reuters Health

Friday, August 23, 2002

NEW YORK (Reuters Health) - Scientists have discovered that certain immature cells in the brain can be coaxed to mature into functioning nerve cells, replacing damaged ones, new study findings show.

By injecting growth factors into rat brains, Japanese researchers were able to stimulate "progenitor" cells to grow into mature neurons, according to the report published in the August 23rd issue of Cell.

"This is a way to allow the brain to use its own tools to make repairs," Ramesh Raghupathi, a research assistant professor in the department of neurosurgery at the University of Pennsylvania, told Reuters Health in an interview. "What is interesting about this study is that it is one of the first to show that endogenous progenitor cells can actually become fully mature neurons."

Other studies have used transplants of stem cells from the blood or fetal stem cells to try to repair brain damage, Raghupathi added.

For years, researchers have assumed that brain and spinal cells can't repair themselves. But the Japanese researchers suspected that progenitor cells, a kind of cell that can develop into at least three different types of nerve cell, could be coaxed to mature into neurons in a brain-injured animal.

"It has long been believed that the adult mammalian central nervous system (CNS) is incapable of significant self-repair or regeneration," the study's lead author Hirofumi Nakatomi, a researcher in the departments of neurobiology and neurosurgery at the University of Tokyo Graduate School of Medicine, wrote. "Many lines of recent evidence have revealed, however, that progenitors with the ability to produce new neurons...remain in the adult CNS."

Nakatomi and his colleagues studied rats with damage to the hippocampus, the part of the brain responsible for laying down new memories. The scientists damaged the hippocampus by briefly interrupting blood and oxygen flow to this part of the brain.

Other studies have shown that after a brain injury in rats, progenitor cells migrate to the damaged area, Nakatomi noted. So, shortly after the rats' brains were injured, Nakatomi and his colleagues infused growth factors into the some of the rats' brains.

When the researchers examined the rats days later, they found new hippocampal nerve cells in the rats treated with growth factor.

To test whether these cells had grown proper connections with the rest of the hippocampus, Nakatomi and his colleagues tested uninjured rats, injured rats with no treatment, and treated injured rats in a water maze. Normal rats quickly learn--and then remember--that there is a hidden platform they can climb onto to get out of the water.

Rats that had hippocampal damage had trouble finding the platform and remembering where it was shortly after the brain injury. But later, after the regrowth of neurons in rats that received growth factor, treated rats were able to remember where the platform was placed.

These results don't mean that we have an immediate cure for brain and spinal injuries, Raghupathi said. But, he added, "This is a good first step. Now we need to see if it works in higher animals, such a primates."

Source: Cell 2002;110:429-441.

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Lack of Oxygen at Birth Not the Cause of Most Newborns' Seizures

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Friday, August 23, 2002

FRIDAY, Aug. 23 (HealthScoutNews) -- Most newborn seizures aren't the result of oxygen starvation during birth, according to a new study.

Johns Hopkins University researchers found that only one of 12 cases of infant seizures out of 22,000 deliveries at that hospital over an 11-year period had brain damage that likely resulted from the birthing process. And 70 percent of seizure patients showed no signs of oxygen deprivation, a leading cause of birth-related neurological injuries.

"We don't know" what's causing the seizures, says Dr. Ernest Graham, a Johns Hopkins ob/gyn and leader of the research team. "It could be a family history of seizures or malformations" of the brain that lead to most of the attacks. But in the vast majority of cases, an oxygen bottleneck -- like a constricting umbilical cord or too much time in the birth canal -- isn't to blame.

A report on the findings appears in the August issue of the Journal of Maternal-Fetal and Neonatal Medicine.

Seizures are the most common sign of brain trouble in early infancy. They affect up to 6 percent of newborns born weighing 3.3 pounds or less, but only 0.2 percent of infants born between 5.5 and 8.8 pounds, or full-term size.

Seizures raise the odds of brain damage in newborns two-to-five times, compared with infants who haven't had the episodes, according to the study. That damage can include cerebral palsy, a devastating neurological disorder.

Some evidence has suggested that as many as half of all newborn seizures are the result of oxygen starvation during labor, Graham said. But another study by the National Institutes of Health ( news - web sites) found the number to be only 10 percent.

In the latest look at the issue, Graham and his colleagues analyzed roughly 22,000 deliveries at their hospital between 1988 and 1999, of which 13 involved newborns who'd suffered seizures shortly after birth. One was excluded because the child had a chromosome anomaly.

Graham's group compared the 12 infants who'd had seizures with 24 babies of similar gestational age, birth weight and delivery method. They also looked at key measures of newborn health and vigor for both sets of children, including the acid content of the umbilical cord blood and so-called Apgar scores at one minute and five minutes after delivery. The Apgar test is a gauge of how active or lethargic a baby is at birth. A high blood acid content can indicate a lack of oxygen.

Seizure-suffering infants were more likely than the other babies to have poor Apgar scores. Yet, only 30 percent of them had clinically significant blood acid buildup, and only one of the 12 met the American College of Obstetricians and Gynecologists (ACOG) criteria for delivery-related oxygen deprivation and brain injury.

However, Graham noted that the ACOG criteria for labor-related trauma have been criticized as being so strict that they exclude many potential cases.

"They're a little tougher than in the past has been thought" appropriate, agreed Dick Leavitt, director of science information at the March of Dimes, a birth defects group based in White Plains, N.Y. One likely reason, Leavitt said, is professional self-defense.

Still, Leavitt said the new findings agree with the current consensus among neonatologists that most cases of cerebral palsy and related defects have their roots far earlier than delivery.

What To Do

While this study didn't find a cause for most infantile seizures, it did narrow the possibilities by placing oxygen deprivation in perspective.

For more information on birth defects, try the March of Dimes or United Cerebral Palsy.

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Army To Probe Health Issues in Slay

By Robert Burns

AP Military Writer

The Associated Press

Friday, August 23, 2002

WASHINGTON (AP) - Alarmed by a series of domestic killings and suicides at Fort Bragg, N.C., the Army is sending in a team of health specialists to study a range of possible explanations, officials said Friday.

The Army disputed reports that it is focusing mainly on the possibility of a link to use of the anti-malarial drug, Lariam, although officials said this was among the issues to be examined.

Lariam was prescribed to troops who fought in Afghanistan ( news - web sites). Three of the four soldiers involved in the killings had recently returned from duty there, although the Army will not say how many of them took Lariam.

"Contrary to news reports speculating that the team will focus primarily on anti-malaria prophylaxis/medications taken by soldiers, the team will consult with local medical and unit/installation leadership at Fort Bragg on a wide variety of possible contributing factors," an Army statement said.

The team will consider factors related to how the Army prepares soldiers and their families to deal with personal and other problems before an overseas deployment and supports them upon their return.

The Army said it would look into "behavioral health issues" related to overseas deployments that are not unique to Fort Bragg, home of the Army Special Operations Command and the 18th Airborne Corps. Soldiers from those units featured prominently in U.S. ground operations in Afghanistan.

The inquiry at Fort Bragg will last most of next week, the Army said. Consultants in psychology, social work and psychiatry will join Army epidemiologists and chaplains as well as officials from the government's Centers for Disease Control and Prevention ( news - web sites).

"Members will also look at specific data associated with recent cases looking for patterns, organizational dynamics and medical issues that may have contributing significance," the Army statement said.

The Fort Bragg killings began June 11.

That day, Sgt. 1st Class Rigoberto Nieves, 32, a Special Forces soldier, fatally shot his wife and then himself, two days after he had returned from Afghanistan. Later that month, according to police investigators, another Special Forces soldier, Master Sgt. William Wright, 36, killed his wife and weeks later led authorities to her body.

On July 19, Sgt. 1st Class Brandon Floyd, reportedly a member of the secret Delta Force, shot his wife and then killed himself.

Also in July, Marilyn Griffin, who had separated from her husband in May, was stabbed to death and her body set on fire in her home. Sgt. Cedric Griffin, 28, who is with the 18th Airborne Corps and had never been to Afghanistan, was charged.

Local police said all the couples had reportedly had marital problems. Army officials say there is no evidence that Lariam, the anti-malarial medication, played any role. Yet questions about the drug persist.

The manufacturer of Lariam, Roche Laboratories, acknowledges reports of suicide and suicidal thoughts attributed to Lariam, also known as mefloquine. But company spokesman Terence Hurley said they are extremely rare, "only a small percentage of the more than 25 million people that have successfully used Lariam."

Roche says some cases of severe neuropsychiatric disorders have been reported in connection with Lariam use. These include anxiety, depression, panic attacks, hallucinations, aggression and psychotic reactions.

The World Health Organization ( news - web sites) puts the incidence of serious neuropsychiatric effects from the drug at 5 in 100,000. Of the millions of travelers given mefloquine each year, one in 6,000 to one in about 10,000 will experience some kind of serious adverse reaction, the WHO says.

On the Net:

Fort Bragg at http://www.bragg.army.mil/

Centers for Disease Control and Prevention at http://www.cdc.gov/

Lariam at http://www.rocheusa.com/products/lariam/

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Poll Finds Momentum for Radical Healthcare Reform

Reuters Health

Friday, August 23, 2002

NEW YORK (Reuters Health) - With many different groups expressing dissatisfaction with the US healthcare system, sentiment for "radical reform" is growing, a new poll suggests.

In the past, the public has been more dissatisfied with the healthcare system than have physicians, employers and health administrators, according to nationwide surveys by Harris Interactive ( news - external web site). But now a new Harris poll finds significant narrowing in the differences among those groups' points of view.

Doctors soured on healthcare beginning in 1999 and have remained less satisfied than they have been in the past. Harris believes doctors' negative views reflect lingering anger about managed care.

With health plans loosening restrictions on doctors, physician attitudes have perked up a bit in the past two years, the poll found. Still, doctors' sentiments are more negative now than at any time between 1984 and 1997, Harris noted.

Health plan managers also have grown notably more dour than they were three years ago, the poll found. And while employers are more satisfied than the public, they expressed more hostility this year than in any previous survey, Harris said.

Public support for a major overhaul of the healthcare system remains strong. While 17% think the system works pretty well, almost twice as many (31%) think it needs to be rebuilt.

Harris calculated a "radical change" score for each group based on its "overall view" of the country's healthcare system. Respondents were asked to indicate whether they believe that the nation's healthcare system works pretty well and requires only minor changes, that it has "good things" about it but needs fundamental change; or that so much is wrong that it needs to be completely rebuilt.

The public's radical change was highest, at 56, followed by hospital managers (51), employers (48) and health plans (50). Physicians scored lowest, at 46.

The poll was conducted between April and June with separate samples of 1,013 adults, 406 physicians, 301 employers, 101 health plan managers and 301 hospital managers. Data for previous years were derived from similar surveys.

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Peanut Butter as Health Food

HealthScoutNews

Friday, August 23, 2002

(HealthScoutNews) -- Good news about a convenient, tasty kid food: peanut butter. It can help protect against two serious health threats -- heart disease and obesity -- reports Clarian Health Partners, an affiliate of Indiana University.

Recent studies show that diets rich in peanuts and peanut butter appear to protect against heart disease by lowering levels of bad LDL cholesterol and controlling body weight, benefits that older children and teens need more than ever. Just don't let the kids overdo it.

And remember to follow this important caveat: The American Academy of Pediatrics suggests that parents wait until their children are at least 2 years old before introducing them to peanut butter. Hold off until age 3 if either parent has any type of allergy.

Start with just a little bit, spread thin on a cracker. And wait until age 4 before serving chunky peanut butter, to guard against choking.

Discourage eating peanut butter right from the spoon. It can cause choking in both children and adults.

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Pregnant Moms' Diet Can Help Newborns Sleep Better

By Alison McCook

Reuters Health

Friday, August 23, 2002

NEW YORK (Reuters Health) - Newborns whose mothers consumed adequate amounts of a particular fatty acid during the last 3 months of pregnancy exhibit healthier sleep patterns than others, US researchers report.

The amount of time babies spend in different stages of sleep may indicate whether they are experiencing normal brain development. Consequently, mothers who get enough of the fatty acid docosahexaenoic acid (DHA) in their diets may also be helping their babies' mental functioning, according to Dr. Sunita R. Cheruku and her colleagues at the University of Connecticut in Storrs.

"The results of this study are strongly suggestive of the importance of DHA levels during the last trimester," study author Dr. Evelyn Thoman told Reuters Health.

Thoman cautioned that even if newborns appear to show disrupted sleep patterns, they may only have a higher risk of--and are not doomed to--less than optimal development. "Risk factors do not mean certainty of outcome," she noted.

DHA is a long-chain polyunsaturated acid that appears to boost brain development. Infants accumulate fatty acids in their brains during the last 3 months in the womb and the first few months outside it. The fatty acids are found in cold water fish and fish oils.

The current study, published in the American Journal of Clinical Nutrition ( news - web sites), is not the first to suggest a link between babies' DHA intake and their brain development. Previous research demonstrated that babies who receive breast milk, which contains DHA, exhibit more mature brain development than their formula-fed peers.

Other studies have also suggested that infants who get enough DHA early in life may have a reduced risk of later heart disease. When levels of DHA are reduced in animal studies, the animals develop high blood pressure as adults. There is also evidence that when these fatty acids are given to adults with mild to moderate hypertension, their blood pressure returns to normal.

During the study, Thoman and her colleagues measured the levels of DHA in the blood of 17 women when they delivered their babies. The investigators then monitored the sleeping patterns of the babies during their first 2 days of life, using a sensor pad to record how the baby was breathing and moving while asleep.

The researchers found that more babies of mothers with high levels of DHA in their blood showed mature sleeping patterns--defined as a shorter sleep-to-wake transition time, relatively high amounts of wakefulness, and a lower ratio of active to quiet sleep--than those whose mothers consumed less of the fatty acid.

In an interview with Reuters Health, Thoman said that previous research has indicated that less-than-optimal development in babies--as exhibited by their sleeping patterns--may predict brain function later in life. However, she noted, many different factors influence a child's development.

"Many aspects of life during a child's development are significant for mental, motor and physiological maturation," she said.

The study was funded by grants from the National Institutes of Health ( news - web sites), the US Department of Agriculture, the Donaghue Medical Research Foundation and the University of Connecticut Research Foundation.

Source: American Journal of Clinical Nutrition 2002;76:608-613.

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Bladder Condition Difficult to Diagnose

HealthScoutNews

Friday, August 23, 2002

(HealthScoutNews) -- It's always a painful when your doctor can't tie your pain to a specific cause. A common example is interstitial cystitis (IC), a chronic pelvic pain disorder for which diagnosis is difficult and there's no known cure.

IC affects some 700,000 Americans, 90% of whom are women. Their recurring discomfort or pain in the bladder and surrounding pelvic region is accompanied by an urgent or frequent need to urinate. In severe cases, that need recurs up to 60 times daily.

Because IC varies so much in symptoms and severity, most researchers believe that it is not one, but several, diseases. One of the steps in diagnosing IC involves eliminating the possibility the patient could be suffering from another ailment.

Current treatments -- including bladder distension, bladder instillation, oral drugs, exercise and diet -- are aimed at relieving symptoms. And various types of surgery are being tested with unpredictable results.

In 1998, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a part of the National Institutes of Health ( news - web sites) (NIH), initiated the IC Clinical Trials Group, a project designed to develop and test new treatment strategies for patients with IC. The first trial focuses on two oral drugs Elmiron and Atarax.

The second trial will test whether the bacterium Bacillus Calmette-Gurin (BCG) will relieve the pelvic pain and frequent urination that are hallmarks of IC.

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Study Suggests Early Screen for 'Lazy Eye' Is Best

By Keith Mulvihill

Reuters Health

Friday, August 23, 2002

NEW YORK (Reuters Health) - People with amblyopia--commonly known as "lazy eye"--can go on to injure their healthy eye later in life, putting them at risk for severe vision impairment or even blindness, researchers report.

The research findings emphasize the importance of screening and treating children with the condition, according to Dr. Jugnoo S. Rahi of the Institute of Child Health in London, UK. Treatment at an early age can ward off the vision loss that can occur if the condition is untreated.

While many industrialized nations promote screening for lazy eye among school-age children, the value of such programs has recently come under question, Rahi told Reuters Health.

In amblyopia, one eye is weaker than the other, usually due to a misalignment or crossed eyes. Without treatment--which can include wearing a patch over the stronger eye or using eyedrops to blur vision in the eye--the weaker eye gets progressively worse. The degree of visual impairment varies from person to person and the condition is believed to afflict about 1% of the population.

In the current investigation, Rahi and colleagues surveyed the UK population over a 2-year period. They looked for people with one amblyopic eye who had recently suffered vision loss in their good eye severe enough to prevent them from driving.

The team identified 370 people with a broad range of visual impairment, including blindness, according to the report in the August 24th issue of The Lancet.

"Our findings revealed that the risk of ending up visually impaired by losing sight in your better eye is much higher than people previously thought," Rahi told Reuters Health. "One previous report suggested the risk was 1 in 1,000. We are suggesting that it is 1 in a 100."

The most common reason for loss of sight in the good eye was an accident, such as a car accident, sports injury, or on-the-job mishap, the report indicates.

It's not that people with lazy eye are necessarily more prone to accidents, "it's just that when accidents happen you are more likely to get injured in your dominant (or better) eye," Rahi explained.

Aside from the severely diminished quality of life that these people experience, Rahi noted that the consequences of people with lazy eye suffering additional visual loss also "has large economic impacts."

"If you could prevent this, that would be good," she said, "and the findings support screening of children for lazy eye."

According to Rahi, the policy implications of her team's findings are important in the UK where screening is very seriously being questioned. "This study now very strongly supports (the continuation) of screening," she said.

Source: The Lancet 2002;360:597-602.

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Scientists Fight Head Lice With ... Lice

HealthScoutNews

Friday, August 23, 2002

FRIDAY, Aug. 23 (HealthScoutNews) -- An attack of the mutant head lice may sound like a shoddy 1950s horror flick, but it's a serious problem for schoolchildren.

About 6 million to 12 million American youngsters contract head lice each year. The most common way to treat them is with products that contain the insecticide permethrin. However, mutant strains of head lice have appeared that are resistant to the insecticide.

Now, University of Massachusetts scientists say they've taken the first step towards finding a way to defeat that resistance. They've discovered a way to grow colonies of mutated head lice. That will let scientists study the little critters and develop new ways to kill them.

A report about the research was presented at this week's annual meeting of the American Chemical Society in Boston.

The University of Massachusetts scientists are the first to create an artificial feeding system that lets them raise mutant head lice for study.

"We have a membrane and automatic blood feeding system that allows us to rear these things on little hair tufts. We just cut little hair tufts and make teepees out of them, and the head lice kind of sit on this membrane and they think they're on a scalp and they wander down and take a blood meal and go back up," says entomology professor John Clark.

More Information

The Harvard School of Public Health has more information on head lice.

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Bedwetting Treatment Eases Kids' Emotional Problems

Reuters Health

Friday, August 23, 2002

NEW YORK (Reuters Health) - It is not necessary to treat children who wet the bed for any emotional or behavioral problems they may have prior to treating them for bedwetting, new study findings suggest.

In fact, treating kids for bedwetting may reduce such problems, according to lead author R. A. HiraSing of Free University in Amsterdam, the Netherlands, and colleagues. And, they found, children with emotional problems do just as well with bedwetting treatment as those without such problems.

Bedwetting is so common among preschool children it is not considered a concern. By school-age, it becomes much less prevalent, with about 5% of 7-year-olds still wetting the bed.

The causes of bedwetting are unclear, but experts note that a significant physical condition such as kidney infection or diabetes is only rarely involved. Genetics may be important, however, as the problem tends to run in families.

In some cases, emotional difficulties such as anxiety also may play a role. Some children who wet the bed may be treated for emotional problems prior to bedwetting treatment, based on the rationale that these problems could be the cause of bedwetting.

But few studies have looked at whether curing bedwetting could actually help resolve a child's emotional problems. To investigate, HiraSing and colleagues monitored the effects of bedwetting treatments and parent-reported emotional and behavioral problems of 91 bedwetting children between the ages of 6 and 15 years. At the start of the 6-month study period, the children wet their bed an average of 5.4 times each week.

The children were treated with the Dry Bed Training program, which involves a behavior modification approach, for example waking a child frequently during the night and helping him or her to wake up with "mild prompts."

At the end of the study period, bedwetting had decreased among the children to an average of 1 episode per week, according to the report in a recent issue of the journal Acta Paediatrica.

Of the children who scored just below or in the clinical range of having emotional or behavioral problems meriting treatment, 58% decreased their bedwetting frequency down to a level considered normal, the authors report.

What's more, the investigators found that children who wet their bed less often or not at all after treatment also saw a reduction in the overall number of behavioral and emotional problems that had been recorded by their parents.

"The children seemed to have less internal distress, fewer problems with other people, and were less anxious and/or depressed," HiraSing and colleagues write. "The behavioral/emotional problems of children who wet their beds need not be treated first," they add.

"Children who have relatively many behavioral/emotional problems, according to parental reports, become dry just as often as children with problem scores in the normal range," the researchers conclude.

Source: Acta Paediatrica 2002;91:960-964.

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Girls With Attention-Deficit Disorder Need Attention

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews

Friday, August 23, 2002

FRIDAY, Aug. 23 (HealthScoutNews) -- Young girls are often ignored when it comes to a proper diagnosis for attention-deficit/hyperactivity disorder (ADHD), claims a new survey of gender differences in the treatment of ADHD.

That's especially troubling because their suffering, particularly in terms of self-esteem and socializing, is more pronounced than that of boys with ADHD, and the disorder hits girls as often as it does boys, says a doctor who specializes in ADHD.

"This is the first national survey that confirms what we've seen clinically, that we've missed diagnosing about 50 percent of the girls who have ADHD," says Dr. Patricia Quinn, director of the National Center for Gender Issues and ADHD and an independent advisor on the survey. "The diagnosis ratio of male to female with this disorder should be 1:1. We're way behind the curve."

ADHD affects 3 percent to 5 percent of all children, perhaps as many as 2 million American children. However, at least twice as many boys are diagnosed with the disorder, according the National Institute of Mental Health.

More than 3,000 people responded to the survey, which was conducted by Harris Interactive ( news - external web site): 346 adolescents who had been diagnosed with ADHD; 541 parents of children with ADHD; 550 elementary and high school teachers, and 1,797 adults in the general population.

Among the findings with the ADHD children, aged 12 to 17, were that more girls than boys reported it was "very difficult" to make friends (27 percent versus 18 percent), to get along with their parents (39 percent versus 25 percent), to get things done in general (57 percent versus 39 percent), and to focus on schoolwork (77 percent versus 66 percent).

The girls were also more likely to report it was "very or somewhat difficult" to feel good about themselves before treatment compared to the boys -- 68 percent compared to 57 percent.

Further, before diagnoses, the girls were three times as likely as the boys to have been treated for depression, the survey found.

The parents of the ADHD children concurred with the children's assessments: 55 percent of the girls' parents reported their daughter's ADHD affected her self-esteem a great deal, compared to 46 percent of the boys' parents; 78 percent of the girls' parents said, if left untreated, the disorder negatively affected relationships with peers and classmates, compared to 64 percent of the boys' parents.

"Girls tend to internalize their problems and withdraw," which lowers their self-esteem, says Quinn, who is a pediatrician at Georgetown University.

Teachers, too, seem to be aware that girls are under-diagnosed, the survey found.

Eighty five percent of the teachers thought that girls with ADHD are less likely to be diagnosed than boys, with 92 percent reporting it was because girls don't "act out."

Quinn agrees, explaining there are three subsets of ADHD: inattentive; hyperactive/impulsive; and a combination of the two.

While most boys with ADHD fall into the latter two categories, most girls with ADHD exhibit the less noticeable symptoms of inattentive behavior.

"A boy will often manifest ADHD by getting up to go to the pencil sharpener and being disruptive in the classroom, while a girl will be sitting quietly staring at the teacher praying she won't call on her," Quinn says.

Girls will often exhibit forgetfulness, a lack of organization or daydreaming, she says, all things a teacher might not notice.

It's a problem," says Nadine Kaslow, chief psychologist at Emory University School of Medicine. "Girls have more of the attentional difference, and might be considered not as smart or not hard-working, rather than suffering from a disorder."

Quinn says recent research shows the disorder is a neuro-biochemical one, meaning that parts of the brain that help with concentration and organization are not activated in patients with ADHD. Medications can stimulate those areas of the brain and improve performance.

"The drugs stimulate the areas that aren't 'turned on,'" she says.

It is important that other treatments be used as well, Kaslow adds.

"Patients need a thorough evaluation and treatment that can include parent training, remedial help for the child in school, and patients may also need therapy," she says.

The survey was funded by Novartis Pharmaceuticals, which manufactures Ritalin ( news - web sites), a drug used to treat ADHD. It was conducted over the Internet, using Harris' standard polling techniques, and the data was weighted to reflect age, gender, race, region, income and education in the general population.

What To Do

To see if your daughter might be suffering from ADHD, you can look at the self-report questionnaire at Addvance, a Web site focusing on women with ADHD. A fact sheet about ADHD can be found at The Center for Children and Youth with Disabilities.

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Puzzling Particles Found in Schizophrenia Patients

By Stephen Pincock

Reuters Health

Friday, August 23, 2002

STOCKHOLM (Reuters Health) - Swedish scientists have found a tiny particle in the spinal fluid of people with schizophrenia that could be a marker for the disease, or even play some part in causing it.

"The micrometer-sized particles may serve as biological disease markers in schizophrenia," the researchers report in a study published on Friday. "Hyopthetically, they may be involved in the development of the disease or may result from the disease process in brains of schizophrenic patients."

Schizophrenia is a widespread and debilitating form of mental disease with symptoms ranging from delusions and an altered sense of self, to apathy and social withdrawal. It affects around 1% of people, but how it develops is poorly understood.

Dr. Lennart Wetterberg, professor of psychiatry at Stockholm's St. Goran Hospital and one of the co-authors of the study, said the full significance of the finding was not yet clear and more research was needed.

"It could be anything, and we're open to all possibilities. It's not a quiz game and we're not gambling with bookmakers," he told Reuters Health. "We have to do more work."

Wetterberg said he hoped the publication of the study would stimulate other researchers to conduct research.

"If it's hopeful or discouraging only the next step will tell," he said.

The researchers took spinal fluid from 22 schizophrenic patients and 38 healthy "control" patients. In the journal Neuroscience Letters, they report finding spherical particles in the spinal fluid of 20 of the 22 patients with schizophrenia but only 2 of the 38 controls.

One theory could be that it is a new form of life, although it is still uncertain what the micrometer-sized particles, which are bigger than viruses but smaller than bacteria, actually are.

The particles did not include bacterial DNA material and so far have not replicated in culture.

"They are not any of the usual viruses or bacteria that have been found," Wetterberg said. "They are more like something like the prion which is causing mad cow disease--but it took 15 years until it was found out what that really was.

"And of course there are still many open questions there, so we should be quite humble," he said.

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Molds More of a Culprit in Asthma

HealthScoutNews

Friday, August 23, 2002

FRIDAY, Aug. 23 (HealthScoutNews) -- Sensitivity to airborne molds can increase asthma severity.

That's the claim of a European study in this week's British Medical Journal.

The study used data from 1,132 people with asthma from the European Community respiratory health survey. The researchers found a strong connection between a person's sensitization to molds and the severity of their asthma, but found no such connection with pollen or cats.

The researchers suggest the small size of fungal spores of airborne molds let the spores enter a person's lower airways. Also, while pollen is present only at certain times, molds are present throughout the year and their spore counts just increase during autumn.

Mold exposure levels are probably greater than those of pollen because mold exposure occurs indoors, where people spend most of their time.

The study authors say people with asthma who are sensitized to airborne molds must pay close attention to their asthma symptoms and adhere to their treatment programs, especially during the fall when mold spore counts increase.

Improving the ventilation and decreasing the dampness in your house can also help decrease your exposure to molds, the authors say.

More Information

The American Lung Association has more information about asthma.

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Men: Going for the Grains May Cut Diabetes Risk

Reuters Health

Friday, August 23, 2002

NEW YORK (Reuters Health) - In the long run, men who chow down on a diet rich in whole-grains may reduce their risk of type 2 diabetes, researchers report.

According to a study in the August issue of the American Journal of Clinical Nutrition ( news - web sites), whole-grain products--such as brown rice, oats, corn and barley--were protective against diabetes. Men who ate the most whole-grain products were less likely to be diagnosed with type 2 diabetes than men who consumed mostly refined grains--like those found in cookies, doughnuts, pasta or white rice, the study results show.

Because whole grain results in lower levels of blood glucose (sugar), the body does not have to produce as much insulin to process the food. Refined grains, on the other hand, result in more than double the amount of sugar in the blood and cause more insulin to be secreted than whole-grain products.

And experts point out that whole grains contain vitamins and nutrients that may be important in modifying the risk of the disease.

Type 2 diabetes occurs when the body fails to respond to insulin, the hormone that clears the blood of sugar after a meal and deposits it into cells to use for energy. High blood sugar can increase the risk of complications from diabetes such as heart disease, kidney failure and blindness.

"Efforts should be made to replace refined-grain with whole-grain foods," writes Teresa T. Fung of Simmons College in Boston, Massachusetts and colleagues.

The team of researchers looked at the eating and lifestyle habits of nearly 43,000 healthy men and followed them for roughly 12 years.

At the end of the study period, 1,197 men had developed type 2 diabetes. Men who consumed the least amount of whole grains, about 0.4 servings per day, were nearly 60% more likely to develop type 2 diabetes compared with men who consumed the most--about 3.2 servings of whole-grains per day.

In other findings, Fung's team discovered that the benefit of eating whole grains wasn't just limited to lean men. Obese men who were getting exercise and consuming whole grains were 52% less likely to develop type 2 diabetes, the authors report.

"Given the current overall low intake of whole grains, efforts should be made to decrease the cost and increase the availability and consumption of whole-grain products," Fung and colleagues conclude. "This has the potential to reduce substantially the incidence of type 2 diabetes and possibly other chronic diseases when sustained over time."

The National Institutes of Health ( news - web sites) and the American Diabetes Association funded the study.

Source: American Journal of Clinical Nutrition 2002;76:535-540.

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Ecstasy Is Anything But

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Friday, August 23, 2002

FRIDAY, Aug. 23 (HealthScoutNews) -- Ecstasy, the popular dance party drug, is often used by those who feel socially isolated and need help coping with their loneliness.

That's the conclusion of a new study presented yesterday at the American Psychological Association's Annual Convention in Chicago.

"Ecstasy users may choose this drug to help mediate the negative effects of loneliness," says Tricia Orzeck, the co-researcher on the paper from York University in Toronto.

While turning to drugs to cope with psychological problems isn't a new phenomenon, using ecstasy to feel better may be even more troublesome than using other drugs. Ecstasy can cause confusion, depression, sleep problems, drug craving, severe anxiety and paranoia, according to the National Institute for Drug Abuse, and recent studies have indicated it may cause permanent, long-term brain damage.

Orzeck and her colleague, Ami Rokach, recruited 818 people for their study. One hundred and six were regular users of ecstasy, 88 used other drugs, such as marijuana or alcohol, and 624 reported no drug use. The average age of the volunteers was 22. Of the total, 543 were women and 275 were men.

Each participant completed a questionnaire on how they had coped with loneliness in the past. The answers fell into six broad coping strategies: reflection and acceptance, self-development and understanding, social support network, distancing and denial, religion and faith, or increased activity.

The researchers found drug users coped with loneliness differently than non-drug users, and ecstasy users coped differently than other drug users did.

Ecstasy users were at least three times more likely to deny that they were feeling lonely than non-drug users, and almost twice as likely as other drug users. People who used ecstasy were also the most likely to seek out social support and to increase their daily activities.

By contrast, non-drug users most often turned to reflection and acceptance, meaning they spent time alone, reflecting on their fears and accepted the pain of their loneliness. Non-drug users were also much more likely to turn to religion and faith to help them cope with loneliness than either ecstasy or other drug users.

Dr. Kenneth Skodnek, chair of the department of psychiatry and psychology at Nassau University Medical Center in East Meadow, N.Y., says the findings make sense.

"Alcohol has been labeled a social lubricant in the past, because people who didn't feel comfortable at social gatherings would drink to loosen up," says Skodnek. "Perhaps ecstasy is the newest version of the social lubricant."

However, he says ecstasy use should be avoided: "There can be severe physical consequences and lingering effects on brain function. This is not a benign substance."

He says there are effective prescription medications that can help people with social phobias or anxiety, but adds that teens and young adults often don't seek help from their parents or health-care professionals.

The researchers suggest that by understanding the coping strategies used by different groups, counselors can come up with more effective and healthier options when counseling lonely young people.

What to Do

For more information on the detrimental effects of ecstasy, visit the Drug Policy Alliance or the National Institute on Drug Abuse.

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FDA Warns of Possible Cryolife Heart-Valve Risk

Reuters

Friday, August 23, 2002

WASHINGTON (Reuters) - U.S. regulators this week urged doctors to consider alternatives to heart valves from Cryolife Inc., the company subject to a major recall of its human tissue implants.

Cryolife's heart valves were not part of the recall and are still available, but the Food and Drug Administration ( news - web sites) said the valves may carry an infection risk.

The FDA has "serious concerns" regarding Cryolife heart valves "because patients who receive these devices may be at increased risk for infection," the agency said in a notice posted on its Web site on Wednesday. The FDA sent e-mails to alert doctors and others to the notice.

The notice advises surgeons thinking of implanting a Cryolife heart valve to "consider using processed allografts from alternative manufacturers/processors."

On Aug. 14, the FDA told Cryolife to recall soft tissue products processed after Oct. 3 and halt sales because the firm cannot ensure the products are free of bacterial or fungal contaminants. The FDA said Cryolife tissue was linked to the Nov. 7 death of a 23-year-old knee-surgery patient.

The heart valves were not included in the recall because they are essential for correcting certain heart problems in children, the FDA said. "Under these circumstances, the benefit of these devices outweighs the risk," the FDA said.

The agency urged doctors to monitor patients who have had a Cryolife heart valve implanted recently and inform them of the FDA's concerns.

Cryolife officials were not immediately available for comment. The company has said it is appealing the FDA's recall order and has confidence in the safety of its processed tissue.

Shares of Cryolife, based in Kennesaw, Georgia, fell 12.5 percent to close at $3.22 on Friday. The shares have traded as high as $43 in the past year.

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Screen Early for Gestational Diabetes

HealthScoutNews

Friday, August 23, 2002

FRIDAY, Aug. 23 (HealthScoutNews) -- It's more efficient to screen pregnant women for gestational diabetes at 16 weeks rather than the current practice of screening in the third trimester.

That what a new study in the August issue of the Journal of Reproductive Medicine suggests.

The earlier tests mean earlier detection and treatment of gestational diabetes in women at highest risk, possibly reducing complications to both mothers and babies, says study author Dr. Gerard Nahum, an associate clinical professor in the department of obstetrics and gynecology at Duke University Medical Center.

He and researchers from the University of Hawaii and California State University studied 255 pregnant women who came to a private obstetrics practice in Honolulu. The women were given a glucose screening test between 14 and 18 weeks of pregnancy.

In that initial screening, 14 of the women had blood plasma glucose levels higher than 135 milligrams of glucose per deciliter of blood (mg/dL). They were sent for more testing to confirm whether they had gestational diabetes.

The other 241 women were screened again at between 24 and 32 weeks of pregnancy. Any who had a blood plasma glucose level higher than 135 mg/dL were sent for more testing.

"Women who had a 16-week glucose screening test result of less than 110 mg/dL had a 99.4 percent chance of not developing gestational diabetes," Nahum says.

"None of the women who had a result of less than 104 mg/dL developed gestational diabetes. This gives us a cutoff point. Women who test in this range at 16 weeks are almost guaranteed not to develop gestational diabetes," he says.

More studies are needed to confirm that earlier screening for gestational diabetes can benefit mothers and their babies, Nahum says.

Gestational diabetes occurs in 2 percent to 7 percent of all pregnancies in the United States.

More Information

The National Institute of Child Health & Human Development has more information on gestational diabetes.

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Maker Says Malarone Safer Than Other Malaria Drugs

Reuters Health

Friday, August 23, 2002

WASHINGTON (Reuters Health) - The US Food Administration has allowed drugmaker GlaxoSmithKline to boost safety claims for its malaria drug Malarone, Glaxo said Friday.

The company said the FDA ( news - web sites) approved the addition of favorable new safety data that showed it has fewer overall adverse events than two competitors, chloroquine/proguanil and Roche's Lariam (mefloquine).

Several marketed malaria treatments are labeled with possible serious side effects including seizures, psychotic episodes and depression. Glaxo said the comparative safety study showed that patients receiving Malarone (atovaquone and proguanil hydrochloride) suffered fewer adverse events overall, compared to travelers who used Lariam and chloroquine/proguanil.

The announcement followed reports that an Army epidemiological team had been dispatched to Fort Bragg, North Carolina, to investigate the recent killings of four women there, and what role, if any, Lariam may have played.

Specifically, the company said the study showed that 14% of travelers using Malarone had neuropsychiatric side effects such as strange or vivid dreams, insomnia, dizziness or vertigo, anxiety and depression, compared to 29% on Lariam. The studies also showed that those on Malarone experienced fewer gastrointestinal side effects than those who used chloroquine/proguanil (12% vs. 20%), Glaxo said.

"We are hopeful that the addition of this new safety data to Malarone's label will assure physicians they can prescribe an antimalarial that is both effective and well tolerated," said Jo LeCouillard, vice president of GlaxoSmithKline's Vaccine Business Unit, in a statement. "On the strength of these study results, Malarone may well become the preferred option for malaria prevention for both travelers and physicians."

The FDA approved Malarone in July 2000 for the prevention and treatment of acute, uncomplicated malaria in adults and children. The drug is taken orally one to two days before travel, every day during the trip and for seven days after the return.

GlaxoSmithKline said that malaria poses a serious threat to an estimated seven million Americans who travel to malaria-endemic countries each year. Each year, about 1,000 to 1,500 will contract the disease, the company added.

A corporate spokeswoman told Reuters Health that the timing of the Malarone safety data being announced following the news of the Army investigation was coincidental.

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No Bones About It -- Milk Helps Kids' Growth

By Nancy A. Melville
HealthScoutNews Reporter

HealthScoutNews

Friday, August 23, 2002

FRIDAY, Aug. 23 (HealthScoutNews) -- With cartoon-character juices and sodas lining the lower level of store shelves, it has never been harder for parents to sell kids on the virtues of good old-fashioned milk.

However, according to new research, failure to get enough milk in childhood could keep those higher shelves out of reach for kids much longer than expected.

In comparing a group of 50 children who had avoided milk between the ages of 1 to about 6 with 200 habitual milk consumers in the same age group, researchers in New Zealand found the milk-avoiders were not only substantially shorter in stature, but had worse bone health and much higher rates of bone fractures.

Evaluations of calcium intake and bone mineral density showed that only four of the non-milk drinking children had adequate intakes of calcium, and in general, children in that group had a lower total-body bone mineral content than the control group.

In addition, the annual incidence of forearm fractures was 3.5 percent in milk-avoiding children, compared with an expected rate of about 1 percent in regular milk consumers.

Interestingly, while the milk-avoiding children were found to be in generally good health, about 30 percent were overweight or obese, a problem the researchers attribute to the likely substitution of sugary juices or sodas for their liquid intake.

"Milk and dairy products generally provide about 75 percent of the dietary calcium in Western diets," explains co-author Ailsa Goulding, a professorial research fellow at Otago University in New Zealand.

"But milk consumption is falling today in the U.S. and other countries, as many youngsters (are given) excessive fizzy drinks and fruit juices instead of milk because they are cheaper," she adds.

The findings appear in the August issue of the American Journal of Clinical Nutrition ( news - web sites).

While other studies have shown lower calcium levels in children who have low milk consumption, Goulding says this is the first study to measure bone density throughout the skeleton of a group of young children who have chronically avoided cow milk; to ask about bone fractures; and to look at height and levels of obesity accurately.

"We were surprised not just by the severity of the low density in the children we studied, but also by the high number of young children we saw who had already broken bones and by their shortness and (excessive weight)," she says.

Goulding notes that only about half the participants had ever experienced any unpleasant physical symptoms from milk consumption. Many instead avoided milk simply because they disliked the taste or because family members chose not to offer it to them.

"One child refused milk merely because she didn't like cows," Goulding says.

The American Academy of Pediatrics (AAP) recommends 800 milligrams of calcium each day for children, and 1,200 to 1,500 milligrams per day for preteens and adolescents, or three servings of low-fat dairy products per day. Exercise is also important in enhancing bone mass.

Experts stress that fat-reduced dairy products such as skim milk are not less nutritious for older children than whole milk, and they say there are plenty of creative -- and appetizing -- alternatives to regular milk that parents can use to satisfy the calcium requirements.

Yogurts, cheeses and fruit smoothies containing milk, yogurt or ice cream are good choices, says Dr. Marc Jacobson, co-chair of the AAP's committee on nutrition and a professor of pediatrics at Schneider Children's Hospital in New Hyde Park, N.Y.

"Even chocolate milk is fine, " he adds.

Calcium supplements may help, but doctors say the nutritional mix provided in milk is much more valuable.

"Milk is a complex and well-balanced nutrient -- it's also a major source of protein, for example," Goulding says. "And in addition to the calcium, milk offers plenty of the vitamin D that's necessary to absorb the calcium efficiently."

While getting enough calcium is important throughout life, there's no time when it's more critical than in the developing years, when the bones are still growing, Jacobson adds.

"A good way to look at it is like making deposits in your bone bank, realizing that once you get to a certain age, usually in your 20s, that bank is no longer going to accept deposits and you just have to live with what you've got," Jacobson says.

"You can prevent loss in later years with good calcium intake, but you can't add new bone mineral. The skeletal structure is finished developing," he adds.

What To Do

You can read more about the American Academy of Pediatric's recommendations on calcium intake in its policy statement on Calcium Requirements of Infants, Children, and Adolescents.

And the American Dietetic Association offers helpful information on how Calcium Intake Increases When Milk Takes a Flavor and Getting Kids to Drink Milk.

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THURSDAY, AUGUST 22, 2002 

Get The Lead Out!

HealthScoutNews

Thursday, August 22, 2002

(HealthScoutNews) -- More than 80 percent of the U.S. homes built before 1978 still have lead-based paint in them. And the older the house is, the more likely it is to contain a higher concentration of lead in the paint, according to the Centers for Disease Control and Prevention ( news - web sites).

Lead, a highly toxic metal, may cause a range of health woes, from behavioral problems and learning disabilities to seizures and death. Children 6 years old and under are most at risk, because their bodies are growing quickly.

Research suggests that the primary sources of lead exposure for most children are, in addition to deteriorating lead-based paint, lead-contaminated dust and lead-contaminated residential soil.

According to recent CDC estimates, 890,000 U.S. children ages 1-5 have elevated blood lead levels, and more than one-fifth of African-American children living in housing built before 1946 have elevated blood lead levels. Children between 12 months and 36 months old have a lot of hand to mouth activity, so if there is lead in their homes, they are more likely to ingest it than are older children.

Children at risk for lead exposure should have a blood test. If treatment is deemed necessary, it can prevent irreversible damage caused by lead poisoning.

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New AIDS Drug Raises Hopes, Fears

By Theresa Agovino

AP Business Writer

The Associated Press

Thursday, August 22, 2002

NEW YORK (AP) - The federal government has approved tests of an experimental and potentially expensive AIDS ( news - web sites) drug that could prolong the lives of patients with drug-resistant strains of HIV ( news - web sites).

Dubbed Fuzeon by its developers, Roche Group and Trimeris Inc., the drug won a priority, six-month review from the Food and Drug Administration ( news - web sites). The companies hope to put Fuzeon on the market by spring.

"Everyone is so pleased about the drug itself," said Martin Delaney, founding director of Project Inform, an advocacy organization. "It is such a significant development. But we are terribly apprehensive about the cost."

Roche, based in Switzerland, and Trimeris, of Durham, N.C., won't discuss pricing details until the drug is approved, but say Fuzeon is complicated to produce and will be expensive. Experts predict a cost of $10,000 to $15,000 a year per patient.

The most expensive AIDS drugs now available cost about $7,500 a year, although some combination treatments approach $15,000 in annual costs.

Fuzeon's cost should be kept in perspective, said Dr. James Thommes, the drug's medical director at Roche, saying that it keeps people from expensive hospital stays and prolongs their lives.

"No one wants drug companies to stop looking at ways to treat AIDS" because of expense issues, he said.

Cash-strapped AIDS assistance programs are already worried they might not be able to afford Fuzeon. Roche and Trimeris also have said they may not be able to make enough Fuzeon to meet initial demand.

The drug is the first in a class known as fusion inhibitors, which are designed to block HIV from entering blood cells. It acts on the third stage of that entry process, known as fusion.

Fuzeon's journey to the marketplace exemplifies the challenges of transforming innovative science into a drug that fits into a complex web of production, pricing and patient demands.

Roche began outfitting a plant to produce Fuzeon two years ago, when only one 28-patient study on its effectiveness was completed. The companies knew Fuzeon had promise but couldn't know how it would perform in large trials.

The plant was set up to produce enough Fuzeon for 25,000 patients by the end of 2003 and 40,000 patients by 2004.

Now, it looks like demand will be greater.

It is unclear how many of the 850,000 to 950,000 Americans infected with the virus have a drug-resistant form. Resistance often becomes a problem after people start taking AIDS medicines.

A recent study in the New England Journal of Medicine ( news - web sites) found that the number of newly infected people with resistance to one drug increased threefold from 1995 to 2000, to 12.4 percent. A study by the Department of Veterans Affairs ( news - web sites) released last December found that 78 percent of the 1,647 people they tested showed resistance to one or more AIDS drugs.

Clinical tests showed that when Fuzeon was added to the regimen of patients with drug resistance, they were twice as likely to have virus concentrations decrease below detectable levels than those who didn't add the medicine.

Fuzeon was discovered by two researchers at Duke University, Dani Bolognesi and Tom Matthews, who then founded Trimeris.

Fuzeon is a large, complex peptide, or string of amino acids, that is difficult to manufacture and must be taken by injection twice daily. Most drugs are small molecules that are easier to produce and can be taken orally.

"We knew we'd have challenges in cost and production, but what was the alternative?" Bolognesi said. "The important thing is there is a new AIDS drug."

As they struggle with the already high cost of existing drugs, AIDS assistance programs in 11 states have closed enrollment or limited access because of budget constraints. The programs provide care to those who can't afford it using state and federal money, and illustrate how cost is a factor not just in poor countries, where pharmaceutical firms have been pressured to reduce prices.

When Fuzeon becomes available, "no one knows how they are going to afford to pay for this," said Bill Arnold, chairman of the ADAP Working Group, an advocacy organization for the programs.

Activists are seeking an accounting of costs from the manufacturers. They are concerned the makers might try to make as much profit as possible before other drugs arrive. Merck and Schering-Plough are developing another class of AIDS drugs that can be taken orally.

Bolognesi thinks activists' concerns about Fuzeon's price are premature because it is still unclear how the drug will fit into the current treatment mix. It may wind up replacing one or two drugs in a patient's regimen, so the total treatment cost might not jump significantly, he said.

On the Net:

http://www.trimeris.com

http://www.fda.gov

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Heartening News on Vitamin E

HealthScoutNews

Thursday, August 22, 2002

THURSDAY, Aug. 22 (HealthScoutNews) -- If you are a woman who doesn't get enough vitamin E, you could increase your risk of cardiovascular disease.

A study in the September issue of the American Journal of Clinical Nutrition ( news - web sites) found that low vitamin E intake in middle-aged women is a risk factor for early atherosclerosis.

The study included 307 southern Italian women, average age 56, with no clinical history of cardiovascular disease. The women did not take any vitamin supplements containing the antioxidant vitamins A, C or E.

Their average daily intakes and plasma concentrations of antioxidants were assessed, using questionnaires and blood samples. They were also given ultrasound examinations of the carotid arteries and branches.

The researchers found that 66 percent of the women had atherosclerotic plaques at one or more sites in the carotid arteries. Women with the lowest vitamin E intake were more than twice as likely to have plaque in their carotid branches.

There was no connection between such plaque in the women's carotid arteries or branches and their intake of vitamins A and C, the study found.

The women in the study reported their main sources of dietary vitamin E were legumes, vegetables and olive oil.

The study authors say only people with low intakes of vitamin E could benefit from increasing their intake of the vitamin. Before anyone alters their diet or takes antioxidant supplements, they need to assess their daily vitamin E intake with their doctor, the authors say.

More Information

The National Institutes of Health has an extensive overview on vitamin E.

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We Will Be What We Eat

HealthScoutNews

Thursday, August 22, 2002

THURSDAY, Aug. 22 (HealthScoutNews) -- Here's an inner child you might not want to carry into adulthood.

A child with a high body mass index (BMI) is more likely to be obese or overweight as an adult, says a study in the September issue of the American Journal of Clinical Nutrition ( news - web sites).

The researchers used newly revised BMI-for-age charts from the Centers for Disease Control and Prevention ( news - web sites) to estimate the probability that an overweight or obese child will be that way when they grow up.

The new charts that say a BMI of 25 or more (26 for men and 28 for women on the previous chart) is considered overweight for both males and females aged 2 to 20 years.

The study found the higher a child's or adolescent's BMI and the older the child, the more likely they would be an overweight or obese adult.

The study included 166 white males and 31 white females who were enrolled in the study soon after they were born. A comparison was done between their weight and stature when they were 3 to 20 years old and when they were 30 to 39 years old.

Young males with high BMI-for-age were more likely to be overweight adults than young females with high BMI-for-age.

Here's an example of what the researchers found: A 12-year-old girl with a BMI of more than 25 would be in the 95th percentile of BMI for her age, the researchers say, and would have an 80 percent probability of being an overweight adult.

That would increase to a 90 percent probability if she remained in the 95th percentile for BMI when she was 20.2 years old.

The researchers say the findings mean that adolescence is a critical period in terms of lifetime weight management.

They recommend this predictive approach be used to evaluate and monitor children and adolescents who are in the 85th or higher percentile of BMI for their age.

More Information

Calculate and learn more about your BMI at the Centers for Disease Control and Prevention.

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Petting Zoos: Steer Clear of Dirty Hands

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Thursday, August 22, 2002

THURSDAY, Aug. 22 (HealthScoutNews) -- The Escherichia coli 0157:H7 that poisoned 51 people, mostly children, at a Pennsylvania petting zoo two years ago was likely caused by contact with calves and young cattle contaminated with the bacteria.

That's the conclusion of a new post-mortem of the outbreak, which helped spur the Centers for Disease Control and Prevention ( news - web sites) (CDC) to issue new guidelines for proper sanitation at petting farms.

Although no visitor who fell ill during the episode died, the newborn baby of the farm's owners died four days after birth from a mix of infections that included E. coli, officials said at the time. However, the subsequent investigation eliminated the 0157 strain as a culprit in the infant's death.

Petting zoos have long been known, among microbe hunters if not the public, to be infection risks. Children touch animals, pick up germs that live in their feces, and ingest those organisms by bringing their unclean hands to their mouths.

Incidents similar to that in Pennsylvania have been reported in England, Canada and other parts of the United States -- including one in 2000 in Washington that sickened five children, three of whom required hospitalization.

In response to the Pennsylvania and Washington outbreaks, the CDC issued voluntary guidelines for petting zoos. The agency called on farms to locate hand-washing stations close to animal pens, post signs stressing the importance of clean hands in preventing E. coli infection, and take other steps to reduce transmission of the bacteria.

"The single most important thing that people can do to avoid [E. coli] from farm animals is to wash their hands immediately after touching an animal," says Dr. John Crump, a CDC medical epidemiologist and lead author of the latest report.

"We have learned of some farms that have implemented changes," Crump adds, but he notes the agency has no enforcement powers. The analysis of the outbreak appears in tomorrow's issue of The New England Journal of Medicine ( news - web sites).

The outbreak, at Merrymead Farms in Montgomery County, Pa., seems to have occurred between September and November. Of the 51 people sickened, 47, or 92 percent, were 10 years old or younger. Their symptoms included bloody diarrhea, fever, vomiting and other signs of gastric infection. None died, although 16 were hospitalized.

Thirty-three, or 15 percent, of the farm's 216 cows were found to be contaminated with E. coli0157:H7. However, none of the 43 other animals at the petting farm tested positive for the germs.

Of the 33 cows with the 0157 strain, 28, or 85 percent, had the same molecular profile as the bugs isolated from patients.

Not surprisingly, investigators learned, the petting zoo's youngest attractions were the source of the disease. "We know from the animal literature that it's the young animals that are most often colonized with E.coli. What we found with the herd at the farm was consistent with that," Crump says.

E. coli poisons roughly 73,000 Americans a year, killing 60. Most contract the infection through tainted food and water.

"You're more likely to come down with a diarrheal illness from a food product then you are from a petting zoo. But if you die from visiting a zoo, you're just as dead," says Philip Tierno Jr., a pathogen expert at New York University Medical Center in New York City.

"Of all of the things that expose children to pathogens, petting zoos are easiest to control," adds Tierno, author of The Secret Life of Germs.

What To Do

To learn more about E. coli, try the CDC or the U.S. Food and Drug Administration.

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Study: No '90s Health Coverage Boom

By Laura Meckler

Associated Press Writer

The Associated Press

Thursday, August 22, 2002

WASHINGTON (AP) - The booming economy of the late 1990s did not lead to an increase in the percentage of American workers covered by employer-sponsored health insurance, a study finds.

The number of uninsured children in working families dropped, but only because of a new government program.

Overall, about three in four people under age 65 in working families got health insurance from an employer in 2001, statistically unchanged from 1997, according to the report released Wednesday by the Center for Studying Health System Change.

During most of those years, health costs were relatively stable. That, combined with the strong economy and demand for workers, should have helped increase health insurance coverage in the private sector but it didn't, analysts said.

"These findings tell us that relying on economic growth to reduce the number of uninsured won't work," said Paul B. Ginsburg, president of the research center. "Short of a major public investment ... significantly reducing the number of uninsured Americans in working families isn't likely."

In 2001, there were 189 million people under age 65 in working families. Of them, 75.6 percent had insurance through an employer. Another 8.4 percent were offered insurance but didn't take it, typically because their share of the premium was too expensive. Sixteen percent were not offered health insurance at all.

Kate Sullivan, director of health policy for the U.S. Chamber of Commerce ( news - web sites), said the numbers didn't increase more because so many of the new jobs were created by cash-strapped small businesses, who traditionally have trouble affording coverage for their workers. She added that in raw numbers, rather than percentages, the number of people with employer-sponsored coverage rose, as the total number of workers rose.

Still, she agreed with the report's conclusion. "I don't think you can count on employers to solve the problem of the uninsured," she said.

The increase in coverage came thanks to the State Children's Health Insurance Program, CHIP, which was created in 1997 and now covers more than 3 million children. It typically offers insurance on a sliding scale, with parents who earn more money paying a higher portion of the premium.

The portion of uninsured children in working families fell from 20.4 percent in 1997 to 15.5 percent in 2001.

Some of those kids were eligible for coverage from their parents' employers — a problem that lawmakers worried about when creating CHIP. The program was designed to minimize this, to avoid spending taxpayer money to cover kids who have access to insurance in the private sector.

The study found that about a third to half of the children who signed up for CHIP otherwise would have had access to private coverage, though it might have been too expensive for their parents to buy.

The results are based on a telephone survey conducted in 1996-97 and again in 1998-99 and 2000-01. Each survey gathered information concerning about 60,000 people.

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Fish in Moms' Diets Fuel Growth of Newborn Brains

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Thursday, August 22, 2002

THURSDAY, Aug. 22 (HealthScoutNews) -- Pregnant women who eat more of a key fatty acid found in fish have babies who show signs of more mature brain development, a new study has found.

Those newborns whose mothers had more of it in their blood had heartier sleep patterns in the first 48 hours after delivery compared to those whose mothers consumed less of the compound, known as docosahexaenoic acid (DHA).

Infant sleep patterns are thought to reflect the maturity of their nervous system, and have been correlated with more rapid development in their first year of life. A report on the findings appears in the September issue of the American Journal of Clinical Nutrition ( news - web sites).

An omega-3 fatty acid, DHA, along with another substance, arachidonic acid (AA), are key building blocks in breast milk that contribute to healthy brain and eye development. Indeed, acknowledging the advantages of these compounds, two of the nation's largest formula makers, Ross Products and Mead Johnson Nutritionals, announced earlier this year that they would begin adding them to select brands.

The two substances are also passed from mother to fetus across the placenta. Some 70 percent of brain cell development takes place during gestation.

In the new study, Carol Lammi-Keefe and her colleagues at the University of Connecticut compared DHA levels and newborn sleep patterns in 17 women and their babies. Ten of the women had high blood concentrations of DHA -- considered to be more than 3 percent of their total circulating fatty acids -- while seven had less than that amount.

Lammi-Keefe's group didn't ask the women about their diets. None of the subjects in the study had DHA levels that reflect eating three or more fish meals a week, what many experts recommend. Other foods, like eggs and red meat, contain modest amounts of the nutrient, but cold-water fish such as tuna and mackerel are considered the best source.

Women with low DHA were more likely to be minorities and to have received fewer years of education. They were also five years younger, on average, than those in the high DHA category -- 24 versus 29 years.

All the babies were delivered vaginally, and none of the women had been given drugs known to make newborns lethargic, the researchers say.

Using a motion-sensing pad to measure breathing and movement during sleep cycles, the researchers found babies of women in the low-DHA group had less advanced sleeping patterns than the other infants. They had a greater ratio of "active" to "quiet" sleep, spent more time transitioning between sleeping and waking, and spent less time fully awake than those of women with higher blood levels of the fatty acid.

"As an infant matures, normally you would see the infant spending more time in a wakeful state," Lammi-Keefe says. "Infants born to mothers with more DHA have sleep characteristics of a more mature central nervous system compared with the infants of mothers with lower DHA levels."

The researchers are now organizing a study that will look at dietary intake of DHA in pregnant women. It will follow their children over the course of a year to assess the substance's impact on development. Lammi-Keefe says she hopes to enroll between 140 and 160 women in the project.

June Machover Reinisch, director emerita of the Kinsey Institute and a child development expert, says the findings seem to echo the importance of breast feeding for optimal infant growth. However, she notes it's difficult to draw meaningful conclusions from the research.

After all, many factors, from method of delivery and the use of anesthesia during labor to the infant's gender, can influence a newborn's wakefulness.

"We have to be flexible in our definition of development," Machover Reinisch says. "With the child who sleeps not as well at two days, it may be related to the DHA, but it doesn't necessarily mean that there's going to be a problem with that child."

Researchers have correlated newborn sleep states with performance on mental and motor developmental tests at 9 months of age. However, both Lammi-Keefe and Reinisch say there's no way to predict whether a child with less mature sleeping habits in the first week of life will be anything other than healthy.

What To Do

For more on fatty acids and infant development, try Infant Canada. For more on infant sleep states, try Lamaze.com

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Some Stem Cells May Be Less Versatile Than Thought

By Amy Norton

Reuters Health

Thursday, August 22, 2002

NEW YORK (Reuters Health) - Although past animal research has suggested stem cells in adult bone marrow can develop into brain cells, the results of a new study in mice indicate that this is not a universal phenomenon.

The finding may take some air out of the hope that a person's own bone marrow cells could one day be used to replace brain cells damaged by diseases such as stroke--a possibility raised by some previous animal work.

"That was the promise, but our study suggests it's not that simple," lead author Dr. H. David Shine of Baylor College of Medicine in Houston, Texas, told Reuters Health.

However, that's not to say that adult bone marrow cells will not someday turn out to be a useful source of new brain cells, according to the researcher. Instead, the new findings indicate that the transformation of bone marrow cells into brain cells is "probably not a general phenomenon," Shine explained.

He and his colleagues report their findings in the August 23rd issue of Science.

In the study, the researchers transplanted bone marrow stem cells from one type of lab mouse into another. The mice used as "donors" carry a gene called LacZ in most of their cells, which allowed the scientists to weed out which cells in the recipient mice were derived from the bone-marrow-cell transplant.

Some of the mice were given brain injuries to see if the donor bone marrow cells would develop into replacement brain cells. However, Shine's team found no evidence of this--nor did they find any donor-derived neural cells in the uninjured mice.

"Of course, we were disappointed," Shine said.

However, these results are far from the final word on the potential of adult bone marrow cells in treating brain injury, according to the researcher. Instead, he noted, it emphasizes that there is much more work to be done.

Source: Science 2002;297:1299.

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FDA Reviews Novartis Cancer Drug

The Associated Press
Thursday, August 22, 2002

BASEL, Switzerland (AP) - Novartis said Thursday that its anti-cancer drug Gleevec is receiving a priority review from the U.S. Food and Drug Administration ( news - web sites) for use by a wider range of sufferers.

The FDA took only three months to approve the drug for the treatment of adults in the late-stages of chronic myeloid leukemia, or CML, and stomach cancer.

Now the Swiss pharmaceutical company has applied for approval of Gleevec — known as Glivec outside the United States — for the treatment of children and of newly diagnosed CML patients.

The FDA grants priority reviews to products for serious or life-threatening diseases that may offer a significant improvement compared with existing therapies.

"The current labeling represents around 25 to 30 percent of patients suffering from chronic myeloid cancer," said David Epstein, head of Novartis' oncology unit.

He said research and trial data show that the earlier CML patients are treated with Gleevec, the more likely they are to respond positively to the drug.

Currently, a bone marrow transplant is the only known cure for CML. The standard treatment is with interferon, which can extend a leukemia patient's life by up to two years but can have side effects that cause about 20 percent of patients to stop using it.

Initial data showed that the treatment with Gleevec is about three times more effective than today's standard treatment with interferon, Epstein said.

Novartis is developing a number of drugs that work similarly to treat solid tumors found in colon, ovary or breast cancer ( news - web sites), metastatic colorectal cancer and iron overload, he said.

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Some Early Mobiles Reportedly Pose Brain Tumor Risk

By Anna Peltola

Reuters

Thursday, August 22, 2002

STOCKHOLM (Reuters) - Long-term users of some first generation cell phones face up to 80 percent greater risk of developing brain tumors than those who did not use the phones, a new Swedish study shows.

The study, published in the European Journal of Cancer Prevention, looked at 1,617 Swedish patients diagnosed with brain tumors between 1997 and 2000, comparing them with a similar control group without brain tumors.

Researchers found that those who had used Nordic Mobile Telephone handsets had a 30 percent higher risk of developing brain tumors than people who had not used that type of phone, particularly on the side of the brain used during calls. For people using the phones for more than 10 years, the risk was 80 percent greater.

"Our present study showed an increased risk for brain tumors among users of analog cellular telephones. For digital cellular phones and cordless phones the results showed no increased risk overall within a five-year latency period," the study said.

Two major mobile phone manufacturers disputed the findings of an increased risk of cancer.

The world's biggest mobile producer, Finland's Nokia ( news - web sites) Oyj, which still produces two models of phones working in the Nordic Mobile Telephone standard, said scores of other studies conducted on the health effects of cell phones showed no evidence of health hazards for users.

"There have been close to 200 studies done on different areas of mobile phones and in the light of those and the way the scientific evidence is, there is no health risk in using mobile phones," Marianne Holmlund, communications manager at Nokia Phones, told Reuters Thursday.

Mikael Westmark, a spokesman for Sweden's Telefon AB LM Ericsson ( news - web sites), which used to make Nordic Mobile Telephone handsets, said: "The study and the conclusions it reaches differs from at least three other studies in the past in several highly regarded scientific journals. None of these studies found a connection between mobile phones and cancer."

Developed To Serve Nordic Countries

The Nordic Mobile Telephone network was initially developed to serve the Nordic countries, starting operations in the early 1980s, but then became popular in Russia and the Baltic countries.

It is still used in more than 40 countries, but has been overtaken in several countries by the Global System for Mobile Communications, which is due to be gradually replaced by rapid third-generation mobile networks.

Analog Nordic Mobile Telephone phones have been in operation for 20 years, making it possible to study the longer-term impact of microwave exposure to their users, but researcher Kjell Hansson Mild said it was too early to draw conclusions on the currently widely used digital Global System for Mobile Communications phones.

"Nothing can be said about GSM at this stage," said Hansson Mild, professor at the National Institute for Working Life and co-leader of the study.

"These are tumors that develop very slowly, and GSM does not have users who have been using it for 10 years," he told Reuters. (Additional reporting by Jan Strupczewski)

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Lice Aren't Nice

HealthScoutNews

Thursday, August 22, 2002

(HealthScoutNews) -- Lice, small insects that live on humans, survive by feeding on blood. They are spread easily from one host to another through close bodily contact or through shared clothing or personal items (such as hair brushes). They can not jump or fly but they can itch like crazy.

Outbreaks of head lice are common in children in school and day care centers, reports Clarian Health Partners, an affiliate of Indiana University. Girls are slightly more likely to be infested than boys. People from all income and social levels can be affected by head and pubic lice, as can people who bathe, shampoo their hair, and wash their clothing regularly.

By comparison, body lice are more common among people who do not bathe regularly or who do not wash their clothes often.

Both nonprescription and prescription products are available to treat head and pubic lice. An oral prescription medication (ivermectin) may be used to treat them when two or more approved topical medications have not been effective. Itching may persist even after successful treatment.

Medicines generally are not needed to treat body lice, since they live in clothing, not on your body. Washing the clothing in hot (130 degree F/54.4 C) water usually is sufficient to eliminate the problem.

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Sports Injuries Send 4.3 Million to ERs Each Year

By Alison McCook

Reuters Health

Thursday, August 22, 2002

NEW YORK (Reuters Health) - Summer is a great time to run around outdoors, but sporting aficionados may not be taking enough precautions to avoid potentially life-threatening injuries, according to US government researchers.

From the summer of 2000 to the following year, 4.3 million people sought emergency care after being injured while engaged in sports or recreational exercise, representing 16% of all "unintentional injury-related emergency department visits" in the US.

These types of injuries are more common than those involving passengers in motor vehicles, which total only 3.5 million annually, according to Dr. Julie Gilchrist and her colleagues at the Centers for Disease Control and Prevention ( news - web sites) (CDC).

"This happens a lot," Gilchrist told Reuters Health. "People end up in the emergency department as a result of activities that are considered healthy."

In order to prevent such injuries, Gilchrist and colleagues urge people engaged in sports or play to use safety gear, make sure they are fit enough for the activity, and use only safe equipment. It's time to "remind people who are participating to take precautions that are known to work," she said.

Injury rates were obtained from a national surveillance program that monitors injuries treated in emergency departments across the US.

The rate of injuries varied by age and gender, with the highest incidence of these accidents occurring in boys aged 10 to 14, and the lowest in women at least 45 years old.

In young children, injuries were most likely to result from frolicking on playgrounds or riding bicycles, while teens tended to be injured most often during organized sporting activities such as basketball and football. Adults often injured themselves when engaged in exercises including weight lifting, aerobics and jogging.

The most common injuries were sprains or strains--representing almost 30% of all reported sports-related injuries--fractures, and bruises or abrasions, the authors note in the August 23rd issue of the CDC's Morbidity and Mortality Weekly Report.

In an interview with Reuters Health, Gilchrist said that this report does not include injuries that people treat at home, nor those they choose to bring to a primary care physician or sports medicine clinic rather than the emergency department. "There are a lot of sports-related injuries that don't end up in the emergency department," she said.

And although the study does not examine which prevention strategies would best reduce these injuries, Gilchrist noted that knowing which sports pose the most danger to different age groups helps point researchers in the right direction.

"You need to know what's going on before you know what sports to target," she said.

Source: Morbidity and Mortality Weekly Report 2002;51:736-740.

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FDA: Prilosec Needs Clearer Label

The Associated Press

Thursday, August 22, 2002

CINCINNATI (AP) - The Food and Drug Administration ( news - web sites) has told Procter & Gamble Co. to provide a clearer label for Prilosec before the consumer products concern can sell the heartburn drug in stores.

The agency also told P&G in a letter earlier this month that the company would have to conduct a study to prove that patients can understand the label for an over-the-counter version of Prilosec.

The letter is standard procedure and usually indicates the agency expects to approve a drug once any remaining issues are resolved.

Cincinnati-based P&G had hoped to have the over-the-counter Prilosec on the market by early next year, but that was before the company had received the specific FDA requirements, Greg Allgood, associate director of P&G Health Sciences Institute, said Thursday.

"We always expected to do a label study and included that in our timeline projections, but we couldn't proceed until we got the specifics from the FDA," he said. "Now that we have those, we hope to have the drug on the market in the first half of 2003, pending FDA approval."

Allgood said P&G expects to keep the Prilosec name for its over-the-counter heartburn drug. The prescription version of Prilosec, which is used to treat a variety of acid-related diseases, is expected to remain on the market, he said.

Allgood said the requirements stated in the FDA letter were not any different from what an FDA advisory committee told P&G in June.

He said the company has no concerns that generic over-the-counter versions of Prilosec will make it to the market before P&G's over-the-counter drug.

"Once you get FDA approval, which is still pending, you normally have about three years of exclusivity before any generic over-the-counter drugs could get on the market," he said.

In afternoon trading on the New York Stock Exchange ( news - web sites), P&G shares were down 55 cents at $90.34.

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NIH Considers Dietary Supplements

The Associated Press

Thursday, August 22, 2002

WASHINGTON (AP) - The National Institutes of Health ( news - web sites) is bringing together researchers this week to assess whether the dietary supplements garlic, ginkgo, hawthorn and phytoestrogens help the heart, as touted.

Understanding the possible mechanism of the biological action of widely used herbal supplements is important in designing clinical trials to see if they really help, or if they cause side effects or merely are a waste of money.

Herbs can contain numerous natural chemicals. If they do have a medicinal effect, the pills and other supplement products made from them must contain the responsible ingredient or a user won't get the hoped-for benefit, explained Dr. Michael Lin of the NIH's National Heart, Lung and Blood Institute, who organized the meeting.

There is no federal regulation of supplements to ensure that this happens.

Consider garlic. Eating one or two fresh cloves a day has been associated, in some studies, with a lower risk of heart disease. But clinical trials of less smelly garlic pills and powders have produced mixed results, with some finding no effect from garlic at all.

It turns out that some of those dietary supplements studied contained parts of garlic that are inactive, so "no wonder it didn't work," Lin said.

While the effects of garlic's other, presumably active, ingredients on the heart have yet to be proved, the example shows that before designing more clinical trials of supplements, "we want to be sure we know what we're dealing with," Lin said.

In addition to garlic, NIH will hear research about ginkgo, mostly touted as a memory booster, although a major study this week concluded it failed to help healthy people; hawthorn, touted for heart failure; and phytoestrogens, plant-based estrogens, mostly from soy.

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Gene Variant Linked to Higher Arrhythmia Risk

By Merritt McKinney

Reuters Health

Thursday, August 22, 2002

NEW YORK (Reuters Health) - A gene variation found in more than 1 out of 10 African Americans increases the risk of potentially fatal heart rhythm abnormalities called cardiac arrhythmias, new research suggests.

But the risk of experiencing cardiac arrhythmia is still very low in people who carry the genetic variant, according to one of the study's authors, Dr. Mark T. Keating of Harvard Medical School ( news - web sites) in Boston, Massachusetts.

Each year, roughly 450,000 Americans die from cardiac arrhythmia. There are several risk factors for the heart rhythm abnormalities, including heart attacks, reduced blood flow to the heart and certain medications, but not everyone who is at high risk experiences an arrhythmia. One possibility is that genetic factors may influence a person's risk.

In comments to Reuters Health, Keating explained that everyone carries genetic variants, or polymorphisms, that subtly increase the risk of disease. To identify genetic variants that might raise the risk of arrhythmia, Keating and his colleagues screened DNA samples from individuals with cardiac arrhythmia. They identified Y1102, a variant form of a gene called SCN5A. In additional DNA screening, the risk of cardiac arrhythmia turned out to be 8 times higher than normal in individuals who carried the Y1102 variant.

The researchers estimate that this variant occurs in roughly 13% of African Americans. No one in a sample of several hundred whites and Asians carried the variant and it was present in just 1 out of more than 100 Hispanics screened, according to a report on the findings published in the August 23rd issue of the journal Science.

Despite the increased risk associated with having the variant gene, Keating said, "it is important to note...that most people carrying the variant will never have an arrhythmia." The information will be most useful, he noted, for people who are already at higher risk of arrhythmia, such as those with a heart condition called cardiomyopathy or those who take certain medications, such as diuretics used to treat high blood pressure.

"Once this and other genetic tests are generally available, Y1102 will be another tool in a physician's medical bag," Keating said. "Clinicians will be able to use genetic information for predicting risk and preventing disease."

Since the risk of arrhythmia remains very low in people who carry the variant form of the gene, Keating explained, "there is no urgent need to obtain a test. It will be of greatest use for individuals who are already known to be at risk for arrhythmia for other reasons."

If a person is found to be at high risk for arrhythmia, there are several ways to prevent the heart rhythm abnormalities. Avoiding certain medications that increase the risk of arrhythmias, such as diuretics, maintaining adequate levels of potassium in the blood, and treatment with drugs called beta-blockers may minimize the risk of arrhythmias.

Source: Science 2002;297:1333-1336.

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Theory on Rheumatoid Arthritis Found

The Associated Press

Thursday, August 22, 2002

BOSTON (AP) - A study in mice raises the possibility that carbohydrates in human tissue may be a target of the misguided immune system attack that results in rheumatoid arthritis.

The case, however, is still far from proven, and much more research will be necessary to show how these essential components of cells might be involved in this crippling autoimmune disease, which affects about 2.1 million Americans.

The research, conducted by Dr. Julia Wang and colleagues from Boston's Brigham and Women's Hospital, was presented Wednesday at a meeting of the American Chemical Society.

Experts have long known that rheumatoid arthritis results when the body's own disease-fighting cells attack the cartilage and joints. The new work suggests that the specific target of this onslaught is essential carbohydrates in the tissue.

"This is potentially of enormous importance," said Dr. John H. Klippel, medical director of the Arthritis Foundation.

If the theory proves true, it could eventually lead to new medicines for protecting the joints from this destruction.

The researchers believe the target of the disease is carbohydrates called glycosaminoglycans, which are naturally present in joint cartilage and fluid, among other places.

In the experiment, the researchers injected glycosaminoglycans into mice and found that it triggered arthritis symptoms, including swelling, inflammation and joint damage.

"This study shows that rheumatoid arthritis may result from the body's mishandling of its own carbohydrates that, under normal circumstances, would not be interpreted as a threat," Wang said.

On the Net:

http://www.arthritis.org/

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Epilepsy Drug Linked to High Rate of Eye Problems

Reuters Health

Thursday, August 22, 2002

NEW YORK (Reuters Health) - More than 40% of people with epilepsy who take a particular drug to treat their symptoms may develop eye problems as a result, UK researchers report.

The drug is called gamma-vinyl GABA (GVG), also known as vigabatrin or Sabril. The treatment has been used for years to treat epilepsy in Europe, and is also available in Canada. It is currently awaiting approval by the US Food and Drug Administration ( news - web sites) (FDA).

Previous reports have suggested that patients who take vigabatrin may have an increased risk of developing visual problems. In the present study, Dr. Andrew Nicolson of the University of Liverpool in the UK and his colleagues found that 43% of 98 patients tested had visual field defects that could only be attributed to their use of the drug. None of the patients tested had obvious symptoms of visual problems.

"This study confirms the previously reported high incidence of asymptomatic visual field defects associated with vigabatrin. Many patients taking vigabatrin may not have been counseled about the risks," the authors write.

In epilepsy, abnormal electrical activity in the brain leads to seizures. Some patients with the condition have partial seizures, which occur in only one area of the brain, and can range from sudden, unexplained feelings or sensations to total loss of consciousness.

Vigabatrin reduces the number of seizures by altering how brain cells communicate--specifically, by increasing the amount of a messenger chemical in the brain called GABA. This process allows brain cells to transmit messages to each other more smoothly, preventing the uncontrolled releases of chemicals into the brain that can lead to seizures.

In 1997, reports began to emerge that the treatment may cause some patients to experience a narrowing of their field of vision, which appeared to be irreversible, and became worse as the treatment continued.

In the current study, published in the Journal of Neurology Neurosurgery and Psychiatry, Nicolson and his colleagues tested eye functioning in 98 patients with epilepsy who had been given vigabatrin. Of these patients, 42 had problems with their field of vision that could not be explained by other events, such as stroke, trauma or brain damage. Men were more likely to have vision problems than women.

Although there was no clear relationship between dose of vigabatrin and the risk of visual problems, patients who received the largest overall dose did appear to have a slightly higher incidence of eye abnormalities.

During the study, which included 583 patients, a total of 445 patients stopped taking vigabatrin, and the vast majority--93%--did not experience any increase in their symptoms as a result, casting doubt on claims that stopping the drug can cause patients to lose control over their seizures.

"Our study provides information from large numbers of patients that the seizure outcome is generally good on cessation of vigabatrin," Nicolson and his team write.

Despite the high prevalence of side effects, the authors stressed that "there are clearly some circumstances in which patients would elect to continue taking vigabatrin," and that they should balance the drug's benefits against its risks.

Aventis, the manufacturer of the drug, declined to comment on the findings.

Source: Journal of Neurology, Neurosurgery and Psychiatry 2002;73:327-329.

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Dental Device Cuts Pain, Lengthens Injection Time

By Melissa Schorr

Reuters Health

Thursday, August 22, 2002

NEW YORK (Reuters Health) - A computerized injection device can lessen the pain children endure at the dentist's office, but it takes longer to administer than the traditional anesthetic jab, which may mean kids who receive it will spend more time squirming in the dentist's chair.

"We found that it actually helps reduce the discomfort during the initial injection (of anesthesia)," study lead author Dr. Keith D. Allen, a professor of pediatrics and psychology at the University of Nebraska Medical Center in Omaha, told Reuters Health.

The computerized device, called the Wand and made by Milestone Scientific, Inc., injects the numbing solution into the gums at the slowest possible rate. The device is available to dentists, but little research has been conducted on whether it is useful for reducing pain among young children.

To investigate, Allen and his colleagues conducted a study comparing the Wand to a traditional anesthetic injection. Milestone Scientific helped fund the research, which is published in the August issue of the journal Pediatric Dentistry.

Forty children requiring local anesthesia for dental procedures were randomly assigned to receive Wand injections or traditional injections. The children ranged in age from 2 to 5.

The investigators measured signals of pain such as moaning, crying and moving.

Children given the Wand injection cried less and were less disruptive, the researchers found. For example, none of the children using the Wand required some kind of restraint during the first 15 seconds of the shot, while nearly half the children receiving a traditional shot did.

But Allen noted that the Wand injection takes an average of 3 minutes to administer. A traditional shot may hurt more, but takes only around 15 seconds.

"With preschoolers, because the Wand takes so much longer, by the time you're done, those kids are becoming a little fidgety," he said. "It's faster to get a shot--but it hurts more. It takes a little longer to do a Wand injection, but you end up with a kid who is less disruptive and in less pain."

However, this lengthy injection time may outweigh the benefits of reduced pain, noted Dr. Joel Weaver, a spokesperson for the American Dental Association and the director of anesthesiology at Ohio State University's College of Dentistry. "This Wand can be beneficial in some children, but the advantages seemed to go away as the injection continued for a long period of time," he told Reuters Health.

For example, at 45 seconds into the injections, 80% of patients receiving injections from both the Wand and the regular injection became disruptive.

However, Allen contended that reducing the extreme pain of the traditional shot and adding a period of only modest discomfort may help prevent children from developing a fear of the dentist. "You try to avoid experiences that are really discomforting for kids," he said, "because you want them to associate going to the dentist with good things."

Source: Pediatric Dentistry 2002;24:315-320.

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Ear Thermometers Not So Hot

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Thursday, August 22, 2002

THURSDAY, Aug. 22 (HealthScoutNews) -- The popular use of the ear thermometer is being challenged.

Despite what you may have heard, the new-age aural gauges aren't as accurate as the old-fashioned rectal types when it comes to taking a child's temperature.

So say British researchers who reviewed a passel of studies comparing the two gauges. They found the ear thermometers come close, but perhaps not close enough, to rectal readings. The researchers stress that doctors, hospitals and parents don't need to throw out their ear thermometers -- they miss the mark from rectal thermometers by an average of only a fraction of a degree centigrade.

However, says Dr. Rosalind L. Smyth, a pediatrician at the University of Liverpool and leader of the research group, when clinical decisions hinge on an accurate temperature reading, rectal is the way to go. Because while the average variation from rectal temperature with the ear devices was .29° centigrade, some studies found that the range of error might be three times as great, or nearly 2° Fahrenheit.

"There are specific clinical situations where one reading would perhaps change a patient's management," Smyth says. For example, children with compromised immunity may require intravenous antibiotics at the first sign of a fever. So, underestimating body temperature might have disastrous consequences.

An accurate measure of fever is also crucial for very young infants, experts say.

Smyth and her colleagues report their findings this week in The Lancet.

The ear thermometer technology works by reading the infrared radiation -- a reflection of heat -- in the ear canal. A computer then converts that information into body temperature.

Ear thermometers have obvious appeal. They can take readings in seconds and present doctors, nurses and parents with a less embarrassing route of temperature measurement. Not surprisingly, nearly two-thirds of pediatricians and family doctors in the United States report using the technology in children.

Smyth's group reviewed 31 studies, involving 4,441 children, comparing rectal and ear thermometers. The ear devices can be programmed to simulate temperatures at various sites in the body, giving readings for the ear canal and the rectum, arm pit and a core figure. So the researchers included studies that included these simulations.

When taken together, the studies showed that ear thermometers consistently varied from rectal readings. They even did so when simulating rectal temperature, though not by as much as the average discrepancy. While the average difference was only .29° centigrade, the highs and lows swung well above and below the average difference.

"We're not saying that people should stop using [ear thermometers]. We feel that in the majority of situations people should continue with the practice they find most comfortable," Smyth says. However, when the most accurate reading possible is needed, rectal thermometers are best, she stresses.

Richard Harbin, a pediatric nurse practitioner at the Indian River County Health Department in Vero Beach, Fla., says he's not surprised by the latest report. "I would agree with the findings," says Harbin, who called the reading differences "a big problem" for health practitioners.

"The manufacturers say that these things are accurate, but most people in practice" prefer rectal thermometers, Harbin says. "If I saw a sick kid come in here and thought he had a fever, I'd use a rectal thermometer" to make sure.

What To Do

For more on ear thermometers, try HowStuffWorks, or ParentsPlace.com.

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WEDNESDAY, AUGUST 21, 2002 

FDA to Revamp Drug Making Rules

By Lauran Neergaard

AP Medical Writer

The Associated Press

Wednesday, August 21, 2002

WASHINGTON (AP) - The Food and Drug Administration ( news - web sites) is poised to revamp rules for safe drug manufacturing for the first time in 25 years, reacting in part to companies' desire to automate pill production and the government's own inability to inspect factories as rigorously as it once did.

The FDA's planned update comes even as numerous major medical factories have repeatedly failed to meet current standards of quality manufacturing.

Just last week, the FDA ordered a Georgia tissue bank to recall soft tissue grafts because it couldn't guarantee they were free of bacterial contamination. Drug maker Schering Plough recently agreed to a $500 million FDA fine for quality-control violations; Eli Lilly & Co. last month said factory problems could delay as many as five drugs under FDA review; and Abbott Laboratories in 1999 paid a $100 million fine in agreeing to clean up its plants.

The FDA said its changes will modernize the way it inspects medical factories — ultimately focusing most on those that make the riskiest products — and allow pharmaceutical companies to make better use of new technology that could improve quality.

"There's a tremendous scientific and technological opportunity here, and we need to embrace that and help the industry embrace it," FDA drug chief Dr. Janet Woodcock said Wednesday.

For example, she cited fully automated manufacturing systems that some U.S. drug makers use in factories in Europe and other countries — but not here — that contain sensors embedded in different steps. Those sensors could tell if a batch of pills or powders has an ingredient wrong, for example. So can FDA-required laboratory testing of a few pills here and a few pills there, but a sensor may provide continuous, immediate quality control, Woodcock said.

The FDA likes the promise of that technology, but drug makers recently told agency officials that they believed the government's 25-year-old manufacturing rules made it too hard for them to adopt it in their U.S. factories. As a first step in its planned update of "good manufacturing practices," the FDA already has begun streamlining how companies can adopt such technology, Woodcock said.

The Pharmaceutical Research and Manufacturers of America, the industry's trade group, welcomed Wednesday's announcement, saying FDA's development of new manufacturing standards "will help ensure that patients continue to benefit from timely access to high-quality" drugs.

But Larry Sasich of the consumer advocacy group Public Citizen called the plans "very, very troubling."

He questioned whether FDA was loosening some standards simply because it has run out of money to inspect medical factories frequently, and asked how technology could really be transforming the industry when so many factories have recently run into trouble. "It just doesn't add up."

Last year the FDA inspected 1,600 factories for compliance with good manufacturing practices, down from 4,300 in 1980, Woodcock said. The reason: Even as the number of drugs FDA oversees has increased, Congress has not increased funding for regular inspections to ensure those medications aren't contaminated and contain the proper, safe level of ingredients in each batch.

The FDA's update won't loosen standards but strengthen them so "we'll be able to allocate inspections better based on risk," said enforcement chief John Taylor.

The update is expected to take several years to complete; companies must follow the old rules until then.

On the Net:

Food and Drug Administration: http://www.fda.gov/

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Coffee, Chocolate Compounds Potential Cancer Drug

By Stephen Pincock

Reuters Health

Wednesday, August 21, 2002

LONDON (Reuters Health) - Compounds found in coffee and chocolate could form the basis of new drugs for cancer, heart disease and inflammation, British scientists said on Wednesday.

Professor Peter Shepherd and colleagues from University College London and elsewhere found that caffeine and a related molecule called theophylline block an enzyme that is crucial for cell growth.

They warned that the study did not mean people should overdose on caffeine in an effort to avoid cancer, but said modified forms of caffeine might one day be used to stop uncontrolled cell growth in cancer or prevent blood clots that cause heart attack and stroke.

In their study, the researchers used genetically engineered insect cells to produce an enzyme called p110 delta. Caffeine and theophylline both blocked the enzyme's function, according to their report in the Journal of Biological Chemistry.

"Alongside possible advances in cancer treatment, this research suggests that caffeine type drugs could be used to treat heart disease and inflammatory illnesses," Shepherd said in a statement.

P110 delta is found mostly in white blood cells, meaning it could be particularly useful in treating cancers like leukemia and for inhibiting white blood cells that cause inflammation, Shepherd told Reuters Health. In fact, theophylline has been used for years as an asthma drug, but nobody really knew how it worked, he added.

The enzyme is one of a group of molecules known as PI 3-kinases that have become a focus of interest for major pharmaceutical companies.

"Many drug companies around the world are looking for inhibitors of these molecules at the moment," Shepherd told Reuters Health. "This one was sitting there under their noses all the time."

But the researcher stressed that chocolate and coffee were not cures for cancer.

"The message to the general public is not to overdose on chocolate or coffee. Caffeine has well-known side effects that make it inappropriate for drug use," he said.

An Australian company called Kinacia has begun human studies with a molecule that blocks another enzyme in the PI 3-kinase family. It is hoping to develop anti-clotting medicines that lack the side effects of drugs like aspirin.

Dr. Shaun Jackson, the founder and principal scientist of the company, told Reuters Health that the British research would speed the development of PI 3-kinase blockers.

"What it tells us is that we can modify the structure of caffeine and come up with more potent inhibitors that could ultimately become new therapies. It's exciting in that respect," he said.

Source: Journal of Biological Chemistry 2002.

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Enzyme May Destroy Anthrax

By William McCall

Associated Press Writer

The Associated Press

Wednesday, August 21, 2002

A bacteria-killing enzyme can detect and destroy anthrax, and should work even if terrorists create antibiotic-resistant strains, researchers say.

The enzyme was isolated from a virus that attacks bacterial cells.

"Essentially, it cracks them open and releases all the cell contents, so the bacterial cell explodes," said Raymond Schuch of The Rockefeller University in New York, co-author of a study published Thursday in the journal Nature.

Ordinary anthrax responds to antibiotics, but there is concern that terrorists might develop resistant strains. The researchers suggested it would be difficult to create strains that resist the enzyme because it acts on a vital part of the bacterial wall, one that can't easily be modified.

Schuch and colleagues reported that the enzyme, called PlyG lysin, kills anthrax bacteria in the laboratory. What's more, when they infected mice with a related kind of bacteria that can kill the animals within five hours, prompt treatment with PlyG saved 13 of 19 animals.

They also found that spores of this anthrax-related bacteria could be quickly detected using PlyG and a hand-held device.

"I think this is a very clever piece of work," said Stephen Morse, a Columbia University molecular biologist and former program manager of the advanced diagnostics program at the Defense Advanced Research Projects Agency.

The PlyG enzyme possibly could be made into a drug that would hunt down anthrax bacteria as they begin to infect a person or an animal, Morse said.

"As always, it will take some time to fully develop and validate this approach to make sure it has therapeutic value, but it's very promising," Morse said.

Phil Hanna, a University of Michigan microbiologist who specializes in anthrax, said the next step will be further animal tests to see if the enzyme can halt an anthrax infection.

The key, Hanna said, as with conventional antibiotics used against anthrax, is early treatment before the bacteria produce enough toxin to kill healthy cells and tissue.

"If you wait too long, until serious symptoms appear, even if you use antibiotics to kill all the anthrax bacteria, the animal is doomed because of the toxin levels," Hanna said.

Calvin Chue of the John Hopkins Center for Civilian Biodefense Studies in Baltimore, Md., said the enzyme likely will have more value as an alternative treatment for anthrax than for detecting anthrax bacteria.

"There are detection methods coming down the line that are more useful," Chue said, including equipment that can identify bacterial DNA.

On the Net:

Nature magazine: http://www.nature.com

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Natural Carbohydrates Contribute to Arthritis

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Wednesday, August 21, 2002

WEDNESDAY, Aug. 21 (HealthScoutNews) -- Carbohydrates that are naturally present in the human body may help cause rheumatoid arthritis, a debilitating, painful disease that has no cure and no clear cause.

"Basically, we found that altered recognition and handling of glycosaminoglycans (GAGs) in your body by the immune system can cause rheumatoid arthritis," says Julia Ying Wang, lead author of the new study and an assistant professor of medicine at Brigham and Women's Hospital and Harvard Medical School ( news - web sites). "It affects primarily the joints, but also skin and other connective tissues such as tendons."

The findings, which are being presented today at the American Chemical Society's annual meeting in Boston, are in keeping with what is already known about this disease, other experts say.

"Even though it may not be the cause, it may be an important component in the cascade that leads to the damage," says Dr. Mark Jarrett, a rheumatologist and chief medical officer at Staten Island University in New York City. "We certainly feel rheumatoid arthritis is a disease that's immune-mediated. One of the problems is that we've never known what sets off the immune system that promotes the disease. It certainly could be some natural carbohydrates in our body, which, for some reason, are altered or recognized as looking like they're altered by the immune system, and trigger the cascade of inflammation that results in the disease."

GAGs are sugars that are already present in joint cartilage, joint fluid, connective tissue and skin. They do not come from outside the body. "That's why it's called an autoimmune disease. The body attacks itself," Wang explains.

When Wang and her colleagues injected large amounts of GAGs into lab mice, the mice developed symptoms of arthritis, including swelling, inflammation and joint damage.

The same type of GAG-binding cells were also found in tissue taken from people with rheumatoid arthritis. In both mice and humans, the cells which experienced inflammation had receptors that bonded with the GAGs.

Wang suspects rheumatoid arthritis may be initiated by microorganisms either because they present GAGs very similar to our own on their surfaces or because they secrete enzymes that liberate GAGs from the connective tissue.

"This is definitely a very nice target for drugs because we found the same type of cells in humans already," Wang says. "To design inhibitors that block this interaction would be a good drug target."

"It is an important step, even though it may not be the critical step. If you can block that, it certainly might lead to a treatment," Jarrett says.

Drugs developed to attack this mechanism would be classified as biological agents, which target specific parts of the immune system. Biological agents have become more and more important in the treatment of rheumatoid arthritis.

"This complements the work that's ongoing," Jarrett says.

What To Do

For more information on rheumatoid arthritis, visit the Arthritis Foundation or the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

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Inner Ear Fixes Noise Damage in 48-Hour Cycle

By Alison McCook

Reuters Health

Wednesday, August 21, 2002

NEW YORK (Reuters Health) - The short-lived hearing loss that follows a burst of noise such as a gunshot or loud concert may result--and be reversed by--the damage and repair of tiny structures in the inner ear, according to researchers from the National Institutes of Health ( news - web sites).

Tiny hair bundles found inside the inner ear, which enable humans to hear, regenerate themselves every 48 hours--the amount of time needed to recover from a temporary loss of hearing, according to a new study by Dr. Bechara Kachar and colleagues.

The study was published in the August 22 issue of the journal Nature.

In an interview with Reuters Health, Kachar likened the process to renovating a building, in which workers repair the structure without tearing any part down. "You keep the building in place, but you change 1 brick at a time, starting at the top, and going to the bottom," he said.

However, these findings are not a call to concert-lovers to abandon their earplugs, Kachar told Reuters Health. Permanent hearing loss can occur from a single exposure to one very loud noise, Kachar warned. Furthermore, just because researchers have uncovered the means by which the ear may regain hearing after temporary loss, "that doesn't mean we have a way to prevent noise-related hearing loss" in the first place, he added.

The researcher added that when people experience permanent hearing loss, the tiny hair bundles may become "overwhelmed" by the excessive noise and stop functioning, causing the hair cells in the ear to die. As such, there are "limits to what this machinery can stand," Kachar noted.

These findings may also shed light on some inherited hearing abnormalities, Kachar added, which may result from problems in the processes responsible for the formation and maintenance of the tiny hair bundles.

Source: Nature 2002;418:837.

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Bush Admin. to Push Embryo Adoption

By Laura Meckler

Associated Press Writer

The Associated Press

Wednesday, August 21, 2002

WASHINGTON (AP) - Pushed by Congress, the Bush administration is set to promote "embryo adoption," in which one infertile couple donates leftover embryos to another. It's the latest move in the heated debate over the moral and legal status of an embryo.

The administration plans to distribute nearly $1 million for public awareness campaigns promoting donation of embryos, one of several options available to couples who create more than they need for in vitro fertilization. Another option: Donate them for stem cell research that has generated controversy because the embryo must be destroyed to get the stem cells.

The Department of Health and Human Services ( news - web sites) says it has no political agenda and is simply following orders from Congress. The grant program was inserted into an HHS spending bill by Sen. Arlen Specter ( news, bio, voting record), who supports both abortion rights and embryonic stem cell research.

Specter, R-Pa., said the embryos should be available for research, but only if they are going to be thrown away otherwise.

"If any of those embryos could produce life, I think they ought to produce life," he said in a statement.

The public awareness campaign, he said, is "sort of a test program" for embryo adoption. "Let us try to find people who will adopt embryos and take the necessary steps on implanting them in a woman to produce life," he said.

Still, the program is making some people nervous. Officials at the American Society for Reproductive Medicine are considering applying for a grant but fear it will suggest that donating embryos to another couple is preferable to donating them for research or discarding them altogether.

"Our biggest concern is to protect all of the options for the patients, not to make any one thing the designated best option," said Eleanor Nicoll, spokeswoman for the fertility clinic trade group. "Some patients are extremely uncomfortable about the idea of other people bearing and raising their genetic offspring."

Abortion rights advocates worry that the program lays the legal groundwork for considering embryos human beings with full legal rights. Using the term "adoption" rather than "donation" makes it appear that the program views embryos as children, said Kate Michelman, president of the National Abortion and Reproductive Rights Action League ( news - web sites).

If an embryo were a person with equal rights, abortion could be more easily declared illegal, she said. "It can be used to support their effort to roll back Roe vs. Wade."

Fertility clinics that offer clients the option of giving embryos to other couples use the term "embryo donation." The phrase "embryo adoption" comes from a Christian adoption agency, which uses the same procedures to place embryos as it uses to place babies.

That agency, Nightlight Christian Adoptions, plans to apply for one of the grants. Its embryo program, called Snowflakes, has produced 18 babies, with five women pregnant now.

Officials there are thrilled by the opportunity to promote their philosophy with federal dollars.

"I believe every embryo is a child that deserves a chance to be born," said JoAnn Eiman, a spokeswoman for Snowflakes. "This is more than mere tissue. They need an option they haven't had in the past."

She added that it should be up to each family to decide what to do with its leftover embryos and hopes the education campaign will inform more people about the adoption option.

The embryos are a byproduct of in vitro fertilization, in which an egg is fertilized in the lab and then implanted into a woman's uterus a few days later. Typically, couples fertilize about a dozen eggs, in hopes that they will have enough healthy embryos to produce the children they want. Those that are not implanted are frozen for future use or discarded.

But after a couple has all the children it wants, there are often embryos leftover. And tens of thousands of embryos are now frozen in fertility clinics, often because couples don't know what to do with them.

Their options are limited. They can throw them away. They can leave them in the freezer. They can donate them for research — though research using newly destroyed embryos is not eligible for federal funding under a decision made by President Bush ( news - web sites) last year. They can also give them to another woman hoping to get pregnant.

The grants being offered by HHS are intended to boost interest in the latter. A total of about $900,000 will be distributed, and federal officials anticipate awarding three to four grants of $200,000 to $250,000 each.

HHS officials said they don't know what programs will be proposed. Snowflakes plans to suggest a video promoting adoption, particularly at IVF clinics that don't offer it already, a Web site, a public relations campaign and mailings to obstetricians. Applicants must have experience with embryo adoption and be prepared to evaluate their programs.

Applications are due next week.

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Cataract Surgery May Cut Older Drivers' Crash Risk

By Alison McCook

Reuters Health

Wednesday, August 21, 2002

NEW YORK (Reuters Health) - Older adults who have surgery to repair their cataracts may be less likely to have a car accident than cataract patients who opt out of surgery, new study findings suggest.

However, there is only a small reduction in risk--about 5 crashes per million miles of travel--and experts caution against assuming the surgery can make people better drivers.

Although people over 60 are some of the safest drivers on the road, previous research has demonstrated that older adults with cataracts are more likely to be involved in a car crash than their cataract-free peers. The current research suggests that surgery may help decrease that gap. This added benefit of surgery may be something patients and their doctors should consider when deciding whether to undergo an operation, according to the study's lead author, Dr. Cynthia Owsley of the University of Alabama at Birmingham.

"These are benefits that those who have cataract surgery can appreciate, but are also benefits that may not be explicitly discussed at the time one is thinking about surgery," she told Reuters Health.

Cataracts occur when proteins in the eye's lens begin to clump together and cloud vision. All people, if they live long enough, will experience some clouding in the eye lens, which can increase the effects of glare while driving and reduce visual acuity.

During cataract surgery, doctors remove the cloudy lens, which is usually replaced with an intraocular lens, after which vision can be close to normal.

Currently, half of white adults between the ages of 65 and 74 are estimated to have cataracts, while the condition may affect up to 60% of black Americans in that age group.

Owsley and her colleagues obtained their findings from surveys of 277 patients ages 55 to 84 with cataracts, 174 of whom decided to undergo surgery. The researchers followed the patients for 4 to 6 years, and noted how many experienced car crashes.

According to the report in the August 21st issue of the Journal of the American Medical Association ( news - web sites), the authors found that people who underwent surgery were 53% less likely to be involved in a car crash than those who did not have surgery. All-told, patients who had surgery experienced an average of 5 fewer crashes per million miles traveled.

"We have identified a way that crash risk can be reduced, at least for a certain segment of the population," Owsley said in an interview.

People over 60 have the lowest crash rate of licensed drivers, about 40 crashes per 1,000 licensed drivers, compared with 140 per 1,000 for those under 25.

She added, however, that the purpose of the study was not to increase the rate of cataract surgeries among older adults, but rather to help doctors and patients make decisions about whether the procedure is appropriate.

"Medical decision-making between patient and doctor will be a more effective process as patient and doctor have as much information as possible about the impact of the procedure on the patient's quality of life," she said.

In an accompanying editorial, however, Dr. Barbara E. K. Klein of the University of Wisconsin-Madison urges caution in interpreting the study results.

The decrease in crashes between the two groups was relatively small, Klein noted, and patients who opted out of surgery may have had other medical risk factors that influenced both their decision to avoid the procedure and their risk of car crashes.

"The limited potential benefit of cataract surgery reported in the study...should, therefore, be weighed against the risks of cataract surgery, which may include patients' fear of surgery, the inconvenience of surgery, and its cost," Klein writes.

Source: Journal of the American Medical Association 2002;288:841-849,885-886.

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Mastectomies: More Is Not Better

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Wednesday, August 21, 2002

WEDNESDAY, Aug. 21 (HealthScoutNews) -- When it comes to mastectomies, new research shows that more is not better.

A 25-year update of the first randomized clinical trial to ever look at this issue finds that a radical mastectomy is not more effective than a simple mastectomy, in which lymph nodes and muscles are left in place. In this latest follow-up, both procedures produced essentially the same survival rates.

The findings appear in tomorrow's issue of The New England Journal of Medicine ( news - web sites).

The "B-04" trial, as it is called, launched the trend towards less surgery to treat breast cancer ( news - web sites).

"This was one of the most important trials ever in breast cancer," says Dr. Alan J. Stolier, medical director of the Lieselotte Tansey Breast Center at the Ochsner Clinic Foundation in New Orleans. "It told us that what we thought might be true intuitively was not true, that more was not better. The cure was the same whether we did a more simple procedure versus a more radical procedure. This trial was one that was given credit for doing away with most radical breast surgery."

"This opened the door for what we are now doing," says Dr. Bernard Fisher, the study's author and scientific director of the National Surgical Adjuvant Breast and Bowel Project (NSABP), which conducted the trial. "This was the turning point in the story of the surgical management of breast cancer, plus it led to the understanding that you weren't going to cure more people by bigger operations, and that you needed systemic therapy in order to do that. And that opened the door for chemotherapy."

In 1971, when the study first started enrolling women, radical mastectomy -- in which the entire breast, muscles of the chest wall and nearby lymph nodes are all removed -- was the norm.

However, not all doctors agreed and they pushed for less invasive procedures. To resolve the controversy, the NSABP started the B-04 trial.

The study involved 1,765 women who were randomly assigned to one of three groups. The first group received a radical mastectomy. The second got a simple mastectomy, plus radiation. The third received a simple mastectomy without radiation.

"There was no difference in the outcome by any of the three methods," Fisher says.

Twenty-five years later, the survival rate for all three groups was 14 percent if their lymph nodes tested positive for cancer at the time of surgery. The survival rate for all three groups was 23 percent, on average, if the lymph nodes tested negative for cancer at the time of surgery.

At the time the trial started, biopsies and mastectomies were done at the same time, while the woman was under general anesthesia.

Stolier, then a resident, operated on some of the women in the trial and remembers waiting in the operating room with the whole surgical team for the biopsy results to come back. If the diagnosis was cancer, Stolier was handed a white envelope that contained which of the three procedures he was to perform on the woman, still asleep on the operating table.

Part of the significance of the trial is its sheer length.

"I don't know of anything else that long," Fisher says. "It provides the first real solid natural-history information to what happens to these women."

A substantial proportion of women had recurrences of breast cancer after the watershed five-year mark, indicating the need for long-term follow-up, even when the patient has a good prognosis.

Because none of the women in the study received chemotherapy, the trial also serves as a good baseline for what is accomplished with the addition of chemotherapy, Fisher says.

"I don't know of any other studies that really have that information," he adds.

What To Do

For more information on cancer trials, visit the National Surgical Adjuvant Breast and Bowel Project.

Here is a primer on the different types of mastectomies.


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Panel: Monitor Biotech Animal Food

By Emily Gersema

The Associated Press

Wednesday, August 21, 2002

WEDNESDAY, August 21(The Associated Press) - A report by a panel of scientists is feeding consumer groups' claims that federal regulators should work to ensure food safety by tightening oversight of animal cloning and genetic modification.

The National Research Council ( news - web sites) released a report Tuesday that evaluated risks of animal biotechnology, including food safety. The Food and Drug Administration ( news - web sites) commissioned the report in response to questions about whether dairy and other food products from cloned animals might be unsafe to eat or drink.

While foods made from cloned animals probably are safe, the committee said, products from transgenic animals — those altered with genes from other species or from drugs — might not be.

The panel believes the federal government needs to balance addressing people's concerns with allowing the technology to advance, said council chairman John Vandenbergh, zoology professor at North Carolina State University.

"By identifying these concerns, we hope we can help this technology be applied as safely as possible without denying the public its potential benefits," he said in a written statement.

The panel wasn't asked to recommend policy changes, but it said the three agencies monitoring biotechnology — the FDA, the Department of Agriculture and the Environmental Protection Agency ( news - web sites) — need to toughen guidelines and clearly define their responsibilities.

The report also questioned "the legal and technical capacity of the agencies to address potential hazards, particularly in the environmental area."

Genetically engineered animals could become an environmental problem should they escape, squeezing out their relatives in the wild by taking control of the food supply and wiping out weaker animals, the group said.

Rebecca Goldburg, a spokeswoman for Environmental Defense, said the report underscores the need for stronger federal oversight, especially in the case of altered fish.

The population of farmed Atlantic salmon is quickly growing, she said, and it has escaped the fish farms, taking control of territory where wild salmon spawn.

"The few remaining wild Atlantic salmon in the U.S. are on the endangered species list," Goldburg said. "Genetically engineered Atlantic salmon ... could further imperil wild salmon."

The Center for Food Safety said the report demonstrated that the government shouldn't allow modified animals to be used in food production.

"You don't rectify the regulatory inadequacies by letting it come on the market," said Joseph Mendelson, legal director for the Center. "That is potentially going to lead to terrible results for human health and the environment."

The industry, however, believes the benefits of transgenics and cloning outweigh the risks.

Scientists have worked mostly with cows, introducing genes to produce drugs or plasma in large quantities in milk.

People should realize that scientists aren't trying to play with nature, said Lisa Dry, spokeswoman for the Washington-based Biotechnology Industry Organization. Rather, they are trying to develop drug therapies through transgenics and cloning.

Citing Hematech Inc.'s research as an example, Dry noted that the Sioux Falls, S.D., company and its partner, Kirin Brewing Co., are harvesting disease-fighting human antibodies in cow's milk. The proteins will be used to treat illnesses ranging from tetanus to earache-causing viruses.

"These are important treatments that you just can't get any other way," Dry said.

The FDA is considering whether cloned animals will require government approval before they can be sold for food. Farmers and companies owning cloned animals aren't allowed to sell the animals until the debate is resolved.

___

On the Net:

National Research Council: http://www.nas.edu/nrc/

Food and Drug Administration: http://www.fda.gov/

Department of Agriculture: http://www.usda.gov/

Environmental Protection Agency: http://www.epa.gov

Biotechnology Industry Organization: http://www.bio.org

Center for Food Safety: http://www.centerforfoodsafety.org/

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Ouch! Pain Costs Employers $80 Billion Annually

By Kathleen Doheny
Reuters Health

Wednesday, August 21, 2002

WEDNESDAY, August 21 (Reuters Health) - Pain from common conditions such as headaches and back ache costs US employers about $80 billion a year in lost productivity, according to a report presented here at the 10th World Congress on Pain.

But the bulk of the loss, or about $64 billion, is largely invisible to employers because it occurs not when workers take sick days but rather when they are on the job but in too much pain to perform up to par.

The survey is "the first to really measure the cost of pain," lead author Walter Stewart, a researcher at the Center for Work and Health at AdvancePCS in Hunt Valley, Maryland, told Reuters Health. AdvancePCS provides information on health improvement services.

"People are at work but not performing as well as they would were they pain-free," said Judith Ricci, another member of the research team.

To arrive at the estimate, the researchers conducted an ongoing telephone survey, from July 2001 to July 2002, including more than 29,000 employed and more than 1600 unemployed people ranging from 18 to 65 years old. They described pain complaints from headache, arthritis, backache and other musculoskeletal conditions as well as work absences and reduced work performance.

The researchers converted the subjects' lost productive time to dollars per worker per week, using self-reported annual salary.

"I was surprised at how pervasive pain is," Ricci says. "Over half the people we interviewed who were working reporting being in pain at least once in the past two weeks," Ricci says. Even more pain reports were received from the unemployed respondents.

The researchers conclude that pain is the most prevalent health condition in the US work force and the most costly in terms of productive work time. Headache and back pain account for the majority of on-the-job pain complaints. Pain has the most impact on the job for men, those 35 to 40 years, those with less education, African Americans and workers with high demand jobs over which they have little control

"The critical finding here is that pain is common in the workforce," Stewart says. "People bring it to work and they don't function well. And it's invisible to employers."

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Simpler Bypass Surgery Makes a Difference 

By Ed Edelson
HealthScoutNews Reporter
Heatlh Scout News
Wednesday, August 21, 2002

WEDNESDAY, Aug. 21 (HealthScoutNews) -- The increasing availability of a surgical technique that uses a small incision for bypass surgery is making a difference.

The technique, minimally invasive bypass surgery, now is preferable for many patients who otherwise would be treated with the artery-opening procedure called angioplasty, says a report in tomorrow?s issue of The New England Journal of Medicine ( news - web sites). Angioplasty is when thin balloons and other devices are threaded into a coronary artery and inflated to remove plaque that has blocked blood flow.

With the minimally invasive technique, the surgeon can do a bypass procedure through an incision as small as 4 inches, rather than sawing open the breastbone, as is done in conventional bypass surgery. Minimally invasive surgery can be done on the beating heart; conventional surgery requires the heart be stopped and the patient put on a heart-lung machine.

In the latest study, cardiologists at the University of Leipzig Heart Center in Germany compared the outcome of the minimally invasive technique to angioplasty followed by the implantation of a stent, a tube designed to keep the blood vessel open. Included in the study were 220 patients with blockage of a major heart vessel, the left anterior descending coronary artery.

This is "a very important coronary artery, and one that is at high risk for restenosis," says lead author Dr. Gerhard Schuler, a professor of medicine at Leipzig. Restenosis is a potentially life-threatening closing of the artery after its blood flow has been restored by angioplasty or a bypass.

The study was done because balloon angioplasty followed by stenting has become the standard procedure for the condition, but no studies have compared stenting with minimally invasive bypass, Schuler says. In the study, half the patients had stenting, the other half had minimally invasive bypass surgery.

Overall, the results favored bypass surgery, Schuler says. The incidence of complications immediately after the procedure was higher for the surgery patients, but after six months only 21 percent of the bypass patients had angina ( news - web sites) -- chest pain caused by artery blockage -- compared to 38 percent of the angioplasty-stent patients. Restenosis occurred in 29 percent of the stent patients, compared to 5 percent of the bypass patients. And 31 percent of the stent patients had a major cardiac event such as a heart attack, compared to 16 percent of the bypass patients.

Those results indicate that bypass surgery is a preferable treatment, but only if it is done with the minimally invasive method, in which "surgical trauma is much less severe and the hospital stay is shorter," Schuler says.

Other medical conditions influence the decision, he adds: "For patients at high risk of stenosis, such as those with diabetes, we feel that they should undergo bypass surgery, conventional or minimally invasive."

Also, the arrival of a new generation of stents that are coated with drugs designed to prevent the artery from closing might make a difference, says an accompanying editorial by Dr. Thomas E. MacGillivray and Dr. Gus J. Vlahakas, both of Massachusetts General Hospital.

"Recent studies using drug-coated stents suggest that these devices reduce...recurrent stenosis, although long-term data are not yet available," they write.

What To Do

You can learn more about minimally invasive bypass surgery from the American Heart Association.

Find out who is a candidate for angioplasty.

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Colon-Cancer Test Supposedly Easier

By Daniel Rosenberg
The Associated Press

Wednesday, August 21, 2002

WEDNESDAY, August 21 (AP) - Even if President Bush ( news - web sites) and Katie Couric might make it seem that way, getting screened for colorectal cancer isn't easy. But that may be about to change.

The most accurate screening procedure — colonoscopy — is uncomfortable and embarrassing, meaning many people who need it never get it.

Other procedures like flexible sigmoidoscopy and fecal occult blood testing, though not as invasive, are no less embarrassing and require the patient to alter his or her diet. Worse, they frequently yield false positive results or fail to find existing cancers.

Don Hardison, president and chief executive of Exact Sciences Corp., once received a positive result for colon cancer after having such a test, only to find after further testing that he was cancer free.

Now his Maynard, Mass. applied genomics company has developed a test for colorectal cancer that taps into the science of the human genome ( news - web sites), promising ease of use, better detection and less need for a red face.

The PreGen-Plus, which Exact hopes to introduce next year, features proprietary technology that can detect cancer-indicating mutations in human DNA extracted from the stool. The test requires no dietary changes and causes no discomfort. A user just produces a sample and mails it to the laboratory in a sealed container.

"There's no diet modification, no bowel preparation," Hardison said in an interview. "You can do the test in the privacy of your own home and it's shipped back to the lab. You just do something you probably do every day anyway."

Colon cancer kills 57,000 Americans a year and is the deadliest cancer among non-smoking men and women. But if it's caught early, the five-year survival rate is more than 90 percent. The problem is persuading people to get tested. About 80 million Americans over age 50 are at risk, but only 12 million to 14 million actually get screened, said Anthony Shuber, chief technology officer at Exact.

The problem is persuading people to get tested. In an attempt to coax people into getting a colonoscopy, journalist Couric had one performed live on television in March 2000 after her husband died of colon cancer. President Bush also had a colonoscopy performed this summer.

A non-invasive test like PreGen-Plus, which analysts think will cost around $500 to $700 and may be able to detect cancer 65 percent to 70 percent of the time, could have a market worth hundreds of millions of dollars, Hardison said.

Based on early studies, accuracy will be about equal to a Pap smear test and compares well with 50 percent sensitivity for sigmoidoscopy and around 30 percent for a single fecal occult blood test, Shuber said.

If the Exact test indicates cancer, 95 percent of the time cancer is there, so the rate of false positives appears low.

Colonoscopy is better than any other test, including PreGen-Plus, with sensitivity of around 90 percent. But the test, which probes the entire colon and requires advance preparation by the patient, can't detect very early changes in DNA that might lead to colon cancer. Some patients have been injured by the procedure.

"Colonoscopy is an expensive test," Hardison said, noting it can cost up to $2,000. "You have to do a bowel preparation that's not a lot of fun, and you miss a day of work. A huge market of people will never do it."

Exact is conducting two U.S. trials of approximately 10,000 patients for PreGen-Plus. The question is whether Exact can have equal success detecting cancer in the general population, as its data to date is based on smaller studies of patients who were, for the most part, symptomatic. The first results, on a study of 5,000 patients, are due by the second half of next year, and will go a long way toward determining whether the product will be a success.

For many years, scientists thought it would be impossible to isolate human DNA from the stool. Some said it simply didn't exist there. But Shuber found a way to do so. The technology can detect various gene mutations, including one in the APC gene that is evident in almost all cases of colon cancer. Because these mutations can occur before there's any other evidence of disease, the test can lead to an earlier diagnosis, raising the survival rate.

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Guard Against Tornadoes

Health Scout News
Wednesday, August 21, 2002

WEDNESDAY, August 21 (HealthScoutNews) -- While nothing can be done to prevent tornadoes, having a Tornado Emergency Plan can reduce your risk of injury.

Here are some tips from the Centers for Disease Control and Prevention ( news - web sites):

  • Sketch a floor plan of your home, or walk with family members through each room and discuss where and how to seek shelter.
  • Show a second way to exit from each room or area. If you need special equipment, such as a rope ladder, mark where it is located.
  • Make sure everyone understands the siren warning system, if your area has one.
  • Mark where your first-aid kit and fire extinguishers are located.
  • Mark where the utility switches or valves are located so they can be turned off in an emergency.
  • Teach your family how to administer basic first aid, how to use a fire extinguisher, and how and when to turn off water, gas, and electricity.
  • Learn the emergency dismissal policy for your child's school.
  • Be sure to conduct drills and ask questions to make sure your family remembers information on tornado safety, particularly how to recognize hazardous weather conditions and how to take shelter.

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Breast Cancer Gene Study Questioned

By Paul Recer
AP Science Writer

The Associated Press

Wednesday, August 21, 2002

WEDNESDAY, August 21 (AP) - Some women with gene mutations have had their breasts removed after studies showed they were at a high risk of cancer. A new analysis suggests the studies may have exaggerated the breast cancer ( news - web sites) risk.

Precautionary breast removal, called prophylactic mastectomy, has been performed for many women who have a high frequency of breast cancer in their families and who have mutations in the BRCA1 and BRCA2 genes. Such women are thought to have lifetime breast cancer risks of 80 percent or more.

But Colin B. Begg of Memorial Sloan-Kettering Cancer Center in New York said this high risk rate cannot be applied to every woman with mutations of the BRCA genes.

"It is likely that the typical mutation carrier would have risks lower than that," said Begg, who wrote an analysis published this week in the Journal of the National Cancer Institute ( news - web sites). "Relatively few mutation carriers would have risks that high."

Some experts acknowledge there probably have been women who chose to have their breasts removed based on data now known to be exaggerated.

Begg said early studies that evaluated breast cancer risk among gene mutation carriers selected women in families where sisters, mothers and grandmothers had breast cancer. This created a statistical bias that skewed risk estimates for women in the general population, he said.

"The risks that have been quoted are among the highest because they have been based on studies using high-risk families," Begg said in a telephone interview from France, where he was on vacation.

Later studies showed the breast cancer risk among mutation carriers "is highly variable," he said. "The average risks are lower than what has been quoted."

"We don't know at the moment how to predict risks well for the individual," he said.

Dr. Kathy J. Helzlsouer, an epidemiology professor and medical oncologist at Johns Hopkins University in Baltimore, said she and most other doctors and genetic counselors have realized in recent years that a lot of uncertainty remains in computing cancer risks among women with the BRCA gene mutations.

Yet some women probably chose to have their breasts removed based on exaggerated data "because that is all we had."

"We've all been concerned about the numbers," Helzlsouer said. "Big decisions are being made based on the estimates of risk, so we need to keep doing research on it."

Helzlsouer said medical counselors face the challenge of advising patients on what option to follow if they discover they have a BRCA gene mutation. Some may choose a mastectomy, while others may decide to take medicine, such as tamoxifen, to lower the risk. Still others may decide to do nothing.

"If you say to everybody who comes in with the mutation that their breast cancer risk is up to 75 to 80 percent (based on the early studies), we know that is way too high," said Helzlsouer. "So what is the real risk (for the individual woman)? The answer is, we don't know."

But clearly women with BRCA gene mutations have a breast cancer risk much higher than the lifetime risk of 11 percent to 12 percent for the general female population in the United States, said Helzlsouer. She said a study of mutation carriers in Iceland found a 20 percent risk, while a similar study among Ashkenazi Jews found a 56 percent lifetime risk.

"Some women will look at that and say, `Well, since it's about 50-50, I will try other means and not remove parts of my body,'" said Helzlsouer. "But others will say, `That's too high for me' and choose mastectomy."

Both Begg and Helzlsouer see an urgent need to determine precisely the breast cancer risk for women with specific types of BRCA mutations. There is a genetic revolution under way in medicine and many experts believe genetic profiles of patients will eventually become routine.

Begg said when it becomes common to identify women whose only breast cancer risk factor is gene mutation, "We need to know how to advise them."

___

On the Net: Journal of the National Cancer Institute: http://jncicancerspectrum.oupjournals.org/

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Suicide Choice Said a Control Issue

By William McCall
Associated Press Writer
The Associated Press
Wednesday, August 21, 2002

WEDNESDAY, August 21 (AP) - Hospice patients who request physician-assisted suicide under a landmark Oregon law want control over their death and generally don't show signs of depression or worry that they could become a burden to their families, according to a survey of nurses and social workers.

The Oregon Death With Dignity Act was approved by voters in 1994 and went into effect three years later after voters overwhelmingly rejected an effort to repeal it and the U.S. Supreme Court ( news - web sites) ruled that states have the authority to pass laws regulating assisted suicide.

In a study published Thursday in the New England Journal of Medicine ( news - web sites), Oregon researchers surveyed 306 nurses and 91 social workers who have treated hospice patients since 1997.

Nearly half — 45 percent — said they had cared for a terminally ill patient who had requested a lethal prescription, and 30 percent had cared for a patient who received one.

Control over the timing and manner of death was repeatedly the most important reason that dying patients cited for their request, while depression was rated the least important by hospice workers, said Dr. Linda Ganzini, an Oregon Health & Science University psychiatry professor who led the study.

"It's surprising how we found so little variation with regard to this characteristic, almost as if the nurses and social workers were all seeing the same patient," Ganzini said.

The study also suggests that lack of social support or fear of being a financial drain on family members are the least important factors in the decision to request assisted suicide, contrary to the criticism from opponents of the law, Ganzini said.

Supporters of the law say the study is further evidence it is working well and limited only to terminally ill patients who at least want the option.

"It should quiet the fears of people who believe that choice at the end of life is bad for patients or bad for medical care," said Barbara Coombs Lee, who heads Compassion in Dying and helped draft the Oregon law.

The survey was conducted in 2001, when the Oregon Health Division had recorded that 91 people had died by assisted suicide since the law went into effect late in 1997.

A questionnaire was mailed to 545 hospice nurses and social workers at all 50 Medicare-certified hospices in Oregon, and 397 workers responded.

There were 82 terminally ill patients at the hospices who requested lethal prescriptions, evenly divided between men and women with a mean age of 63.6 years. Eighty-three percent had cancer.

Dr. Susan Tolle, director of the Center for Ethics in Health Care at Oregon Health & Science University, said the study may reflect some bias by hospice workers who may be less opposed to assisted suicide.

The survey found 59 percent of the nurses and social workers supported the Oregon law, 26 percent opposed it, and 14 percent said they were neutral.

Ryan Ross, spokesman for the Denver-based Hemlock Society, said the survey shows the law works.

"All of the fears about what could happen if physician-assisted suicide was legalized have not happened," Ross said. "We can approach the end of life without undercutting the social fabric or pressuring people into doing what they don't want to do."

___

On the Net:

New England Journal of Medicine: http://www.nejm.org

Oregon Health & Science University: http://www.ohsu.edu

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Scientists Probe Nev. Cancer Cluster

By Brendan Riley
Associated Press Writer

The Associated Press
Wednesday, August 21, 2002

WEDNESDAY, August 21 (AP) - High levels of arsenic and tungsten were found in residents of this northern Nevada town during an investigation of a mysterious cancer cluster, government scientists reported Tuesday.

There's no known correlation, however, between high levels of the minerals and acute lymphocytic leukemia, the Centers for Disease Control and Prevention ( news - web sites) said. Of the 16 confirmed childhood leukemia victims linked to Fallon since 1997, three have died.

Eight of 10 residents showed high levels of tungsten, compared to the national average of one in 10, according to the CDC's Dr. Carol Rubin. A third of the residents had arsenic levels above 50 parts per billion, high enough to cause a wide range of health problems.

Tungsten was mined for years in Fallon, about 60 miles southeast of Reno, before the mines were shut down, and arsenic occurs naturally in the area.

Rubin said studies have linked arsenic to some adult cancers, but not to acute lymphocytic leukemia. She said there have been no studies on possible links between tungsten and acute lymphocytic leukemia.

State epidemiologist Randall Todd said the latest research opens a new area of inquiry.

"This was on nobody's radar screen as something to consider," he said of the tungsten data. "This opens a door to another room that we didn't know existed."

The CDC study is not expected to be completed until this fall, but health officials had promised worried residents that any unusual findings would be released immediately.

Some officials suspect an environmental cause for the cancer cluster.

Fallon's water supply for decades has contained naturally occurring arsenic at 100 parts per billion, 10 times the federal standard, and the city is building a new water treatment plant.

Another focus of attention has been a jet fuel pipeline that serves Fallon Naval Air Station. In May, two federal agencies investigating the cancer cluster ruled the pipeline out as a public health hazard.

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Vaccinate Against Tetanus

HealthScoutNews
W
ednesday, August 21, 2002

WEDNESDAY, August 21 (HealthScoutNews) -- Tetanus, a potentially fatal disease, is less common now than it ever was in the United States. But it is more common, lately, among those under 40 than it is among their elders.

The percentage of young victims of tetanus -- the result of a tiny organism, clostridium tetani, entering the body through a wound -- rose from 28% in the 1991-95 period to 42% between 1996-2000. This shift coincided with an increase in the intravenous use of drugs and from the increase in puncture wounds related to a rise in self-performed body-piercing and tattoos.

The best way to avoid contracting tetanus: Get vaccinated against the disease, and get booster shots at intervals suggested by your doctor, advises the Centers for Disease Control and Prevention ( news - web sites).

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Study: Ginkgo Doesn't Aid Memory

By Lindsey Tanner
AP Medical Writer

The Associated Press
Wednesday, August 21, 2002

WEDNESDAY, August 21 (AP) - A new study suggests ginkgo supplements do nothing to quickly improve memory in healthy people, a finding that goes against years of well-publicized claims that helped turn the supplements into a multimillion-dollar industry.

The over-the-counter supplements are made using extract from the fan-shaped leaves of the ginkgo biloba tree.

Early studies suggested the supplements could boost mental function in people with and without mild dementia, however, those studies had methodological flaws and were too short to measure a true effect, according to the authors of the new study.

The new study, reported in Wednesday's Journal of the American Medical Association ( news - web sites), involved 230 people over age 60 who had no signs of memory impairment and found that the ginko supplements worked no better to improve memory than dummy pills over a six-week period. Some of the supplements are advertised to have a noticeable benefit in four weeks.

"We don't see any benefit," said lead author Paul Solomon, a psychology professor at Williams College.

Solomon said his study involved the same type of rigorous testing required by the Food and Drug Administration ( news - web sites) for pharmaceutical drugs, though supplements like gingko are not FDA-regulated. The same battery of mental tests was given at the beginning and end of the study.

While both groups' scores improved slightly, that likely was because they'd taken the tests before, and the placebo and ginkgo patients performed equally well the second time around, Solomon said.

Ginkgo has been thought to improve blood flow to small veins and capillaries, ostensibly helping deliver oxygen to the brain. It also contains antioxidants, substances that absorb chemicals called free radicals produced during metabolism that are thought to damage cells.

Dr. Steven DeKosky, chairman of the University of Pittsburgh's neurology department, said the study doesn't address whether larger doses taken for a longer duration or taken by people who already have memory problems would be beneficial.

DeKosky is the lead researcher in a government-funded study examining whether ginkgo in doses equal or double those in the JAMA study can help prevent Alzheimer's disease ( news - web sites). Participants in his study are older than 75, have normal mental function or slight memory problems and are taking ginkgo for five years.

Solomon said it's possible ginkgo pills would show some mental benefits in healthy people if taken longer than six weeks, the study's duration. But he noted that the tablets used in the study, Pharmaton Natural Health Products' Ginkoba, are marketed as producing noticeable benefits after just four weeks at the study's dose, 120 milligrams daily.

Pharmaton's David Morrison said the findings are from a single study that doesn't "negate the vast body of evidence showing that ginkgo biloba is effective."

___

On the Net:

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

Ginkoba: http://www.ginkoba.com

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Groups Angry With Preventable Deaths

By Ravi Nessman
Associated Press Writer
The Associated Press
Wednesday, August 21, 2002

WEDNESDAY, August 21 (AP) - AIDS ( news - web sites) killed 3 million people last year. The year before, tuberculosis killed 1.7 million and malaria more than a million others. Millions more died from diarrhea and other easily preventable diseases.

A decade ago, world leaders at the Earth Summit in Rio promised to tackle diseases of the poor. But with so many of the world's most vulnerable still dying in droves, many health activists are furious that more has not been done to save them.

"We are losing 6 million people every year to AIDS, TB and malaria alone, 14 million to communicable disease. This is not progress," said Rachel Cohen, spokeswoman with Medecins Sans Frontieres, the medical aid group known in English as Doctors Without Borders ( news - web sites).

"You really have to think twice about whether this health revolution that is being talked about in the West is any way benefiting the people that need it the most," she said.

Leaders meeting at the World Summit for Sustainable Development starting Monday in Johannesburg will again discuss ways to fight preventable diseases in the developing world.

In recent years, there have been some stunning successes.

In 1988, when the world launched its drive to eradicate polio ( news - web sites), 350,000 new cases of the deadly disease were reported. Last year, following massive immunization campaigns, the World Health Organization ( news - web sites) said just 480 new cases were reported.

It also said a campaign against leprosy has cut new cases by 85 percent over the past 15 years and eliminated it from 98 countries.

But other diseases have gotten far worse.

Between 1990 and 2000, the number of people infected with tuberculosis in Africa and Eastern Europe, regions highly vulnerable to the disease, jumped from 200 million to 450 million.

HIV ( news - web sites) infections jumped from 8-10 million people to 40 million.

Meanwhile, resistant strains of malaria have spread across the world, forcing many poor African countries to exchange their cheap and increasingly ineffective drugs for more potent medicine that can cost 10 times as much.

The Global Fund to Fight AIDS, Tuberculosis and Malaria was created last year with hopes of distributing $7 billion a year of the estimated $10 billion in aid needed to tackle these diseases. But only $2 billion have been pledged to the fund.

"The amount that is needed is just four days' global military spending. So the 10 billion is not an unreasonable demand," said Jo Nickolls, a policy adviser at Oxfam GB.

In some cases, rich countries have damaged the already weak health care systems in many poor countries, activists said.

Countries including Canada, Great Britain and the United States have tried to solve their nursing shortages by recruiting health workers from countries such as South Africa, which have shortages of their own.

Efforts to enforce patent rights for HIV medicines have also kept available but expensive treatments away from those too impoverished to pay, Nickolls said.

For many other diseases, there are no new drugs and no plans to make any, she said.

According to Oxfam, global drug research and development spending is about $70 billion, but only 10 percent of that money goes to research on diseases that account for 90 percent of the world's infections.

"There's very little interest in creating medicines that can cure people who are poor in a poor country," Nickolls said.

Many of the poor countries themselves have shown a lack of political will to tackle many of these diseases, Cohen said, especially AIDS.

The disease, which disproportionately affects people of working age, has killed the main breadwinners in many families, decimated the ranks of skilled workers and left tens of millions of children orphaned in the most vulnerable countries. Many of Africa's scarce teachers will die and millions of children, forced to help support their families, will no longer attend school.

The economies of the hardest hit countries could fall by 8 percent by 2010, according to UNAIDS ( news - web sites).

"Sustainable development is great. But if we can't bring AIDS under control, forget about development at all, much less sustainable development," said Dr. Peter Piot, director of UNAIDS.

Many health activists cautiously hope the summit might help spark a true war against these diseases.

"All we can do is continue to make the case that it is not acceptable to let millions of people die," Cohen said.

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Risky Business

HealthScoutNews
Wednesday, August 21, 2002

WEDNESDAY, August 21 (HealthScoutNews) -- HIV ( news - web sites)-positive men are more likely to have unprotected sex if they love a good thrill and believe alcohol enhances their sexual enjoyment.

So says a new study in the August issue of the Annals of Behavioral Medicine.

The study found that HIV-positive men described as "sensation seekers" were more likely to have unprotected sex, whether or not they drank alcohol. It also found alcohol use predicted unsafe sex independently.

Alcohol was a factor in HIV-positive men having risky sex if the men believed it would improve their sexual experience, the study found.

The researchers collected information from 197 HIV-positive men in Atlanta. Most of them were black, and 66 percent said they were gay.

Statements such as "I would like to try bungee jumping" or "I get bored seeing the same old faces" were used to assess whether the men were sensation seekers. Statements such as "sex is better after I have been drinking" and "drinking helps me relax about having sex" were used to evaluate the men's attitudes about alcohol and sex.

The study found that 28 percent of the men had unprotected sex during the previous three months, and 11 percent had unprotected sex with multiple partners over that time.

Lead author Seth C. Kalichman did the study while at the Medical College of Wisconsin. He's now a professor of psychology at the University of Connecticut.

He says the finding could offer insight into ways to reduce risky sexual behavior in HIV-positive men.

"Cognitive approaches to challenging beliefs about the effects of alcohol on sexual performance and arousal can be incorporated into existing risk-reduction interventions," the researchers say.

More information

Read more about HIV risks among black men.

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Study Finds Exception to Cell Rules 

By Daniel Q. Haney
AP Medical Editor

The Associated Press

Wednesday, August 21, 2002

WEDNESDAY, August 21 (AP) - Every biologist knows that people inherit their cellular power plants, called mitochondria, only from their mothers, not their dads. Now a surprising new discovery suggests there can be exceptions to this carved-in-stone rule.

Cells employ mitochondria — microscopic creatures captured eons ago — to extract energy from food. Mitochondria have their own genes, separate from the usual human blueprints, and scientists long believed that only mothers passed them on to the next generation.

But now, Danish scientists have documented the first known exception to the rule, a man whose muscle cells contain mitochondria that came mainly from his father.

The discovery was so unexpected that the researchers repeated their experiments several times to make sure they hadn't mixed up samples or made other mistakes.

"The only explanation for our results is that it is a case of paternal inheritance of mitochondria. It was a very big surprise to us," said Marianne Schwartz, a geneticist at Copenhagen University Hospital.

Some rare diseases are caused by mutations in mitochondrial genes. However, it makes no difference whether or not the bad gene came from the mother, so the latest discovery has little practical importance to patients.

However, some wonder whether it might throw off the study of human evolution, since mutations in mitochondrial genes are used to calculate how long ago humanity dispersed from a single individual or small group. The estimates are based on the assumption that only females pass on this DNA through the generations.

Schwartz's study, published in Thursday's issue of the New England Journal of Medicine ( news - web sites), involved a 28-year-old man with a severe, lifelong inability to exercise or run more than a few steps. His problem was traced to a deletion in one of the genes that controls his mitochondria.

However, the researchers found that only his muscle, the tissue that uses the most energy, had mitochondria with the genetic defect. Cells in his blood, skin, hair and elsewhere contained mitochondria with a different genetic pattern. Further genetic testing revealed that mitochondria in his muscle were identical to his father's, while those elsewhere in his body came from his mother.

No one knows how often something like this happens, although Schwartz and others believe it's quite rare. "Maybe we will never see it again, but I think it could happen more than we think," she said.

Both the sperm and the egg that come together to make an embryo carry mitochondria. However, the sperm packs only about 100 copies, while the egg has 100,000.

According to one theory, the male's mitochondria are simply swamped by the far larger number from the female. However, even highly sensitive genetic tests have routinely failed to find any trace of fathers' mitochondria after the early days of development in the womb. Another theory suggests some surveillance system in the embryo weeds out the father's mitochondria.

Evolutionary biologists have assumed that each person's mitochondrial DNA is a copy of their mother's, their grandmother's and so on, back to the dawn of the species. The genes acquire mutations more quickly than ordinary genes, so in theory it is possible to estimate how long two groups of people have been separated by looking at how much their mitochondrial DNA differs.

This led to the theory that all humans descended from an African Eve more than 100,000 years ago. However, Dr. R. Sanders Williams, dean of Duke University's medical school, said the possibility of male DNA oozing in could throw off these calculations.

"This will generate new debate about the validity of the Eve hypothesis," he said. "Are we all derived from a single female or a small group in Africa, or are our origins a bit broader than that?"

But evolutionary biologist Alan Templeton of Washington University doubts the occasional bit of male genetic material will make much difference.

"It is so rare that it won't affect the overall patterns over long periods of time," he said. "It's not something I'm overly concerned about."

___

EDITOR'S NOTE: Medical Editor Daniel Q. Haney is a special correspondent for The Associated Press.

___

On the Net:

Journal: http://content.nejm.org

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Bedwetting Linked to Delayed Brain Development

HealthScoutNews 
Wednesday, August 21, 2002

WEDNESDAY, August 21 (HealthScoutNews) -- Delayed neurological development, which can be predicted by a drawing test, may explain bedwetting in some children.

That's the finding of a new British study that appears in the September issue of the Archives of Disease in Childhood.

The study included 34 children, aged 7 to 13. They all wet the bed at least four times a week and had been treated with a synthetic form of the hormone vasopressin. The natural hormone vasopressin is produced by the pituitary gland and reduces urine production.

None of the children in the study had any known neurological or urinary problems, or special educational needs.

The children were given a neuro-psychological test called the Rey-Osterrieth test. It uses a linear figure that tests the ability to copy and redraw from memory. The test measures planning and organizational skills, problem-solving and perceptual, motor and memory functions.

Scoring of the children was done according to the number of boundary errors they made by spacing incorrectly or leaving out lines and shapes in the linear figure.

The researchers found that significantly more boundary errors were made by the children who didn't respond well to the synthetic vasopressin. In the test, 11 children made three or more mistakes. All of them were children who had no response to synthetic vasopressin.

The Rey-Osterrieth test may let doctors better predict how children will respond to treatment with synthetic vasopressin, the authors say.

To avoid wetting the bed at night, you need appropriate nerve signaling between the visual cortex, the hypothalamus, the pituitary gland in the brain and the bladder, the researchers say. This nerve signaling results in the release of vasopressin from the pituitary gland, and the ability to wake up if your bladder is full.

The researchers say the appropriate growth of nerves that regulate nighttime urine production are affected by unknown factors before and after birth.

More information

Here's more information about bedwetting.

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TUESDAY, AUGUST 20, 2002

Antimicrobials in Soaps, Lotions Don't Help: AMA

Reuters Health

Tuesday, August 20, 2002

NEW YORK (Reuters Health) - Consumer products such as soaps and lotions often contain germ-killing antimicrobials, but there is scant evidence they are helpful in preventing infections, according to an American Medical Association (AMA) committee.

What's more, they may actually be harmful in terms of promoting bacterial resistance to germ-killers, according to a report from the AMA's Council on Scientific Affairs published in the August issue of the journal Archives of Dermatology ( news - web sites).

Indiscriminate, widespread use of antimicrobial products is discouraged by the medical community because it is believed to promote the growth of bacteria resistant to chemicals used as hospital disinfectants.

Still, the use of antimicrobial-laden products, such as disinfecting hand soaps and lotions, have skyrocketed in recent decades. Indeed, 45% of consumer soaps contain an antimicrobial, even though there is no proof the products can prevent infections better than regular soap, the report indicates.

In the study, Dr. Litjen Tan and colleagues reviewed scientific papers published between 1966 and 2001 in an effort to learn if antimicrobial consumer products may be a "significant source of antimicrobial resistance."

The authors report that "a growing number of studies" suggest that bacteria are gaining resistance to the antimicrobials used in these products. It is even possible that bacteria that become resistant to such antimicrobials may also be harder to treat with therapeutic antibiotics, but more study is needed to determine if this is true, Tan and colleagues said.

"Considering the available data and the critical nature of the antibiotic resistance problem, it is prudent to avoid the use of antimicrobial agents in consumer products," they conclude.

While antimicrobial-containing soap and other products can help prevent the spread of infection in hospitals, nursing homes and newborn nurseries, they are used in a "dramatically different" way than the consumer products, the authors point out.

"These same surface chemicals have been used effectively for several decades in hospitals under stringent guidelines that require, among other precautions, minutes--not seconds--of exposure," according to an editorial by Dr. Stuart Levy of Tufts University School of Medicine in Boston, Massachusetts. A high concentration of the chemicals is left on surfaces "long enough to do the antimicrobial job required."

In the home, however, the products leave a residue on the skin, kitchen or bathroom in a less-than-effective dose, setting up the "perfect condition for the selection of microbes resistant to their action," Levy notes.

There is no "evidence that additional cleaning or disinfecting power is needed (in the home) beyond that provided by normal cleansers, soap and water," Levy writes. "Instead the negative consequences stemming from the residues of these compounds present an unacceptable risk to the household."

In 2000, the AMA urged the US Food and Drug Administration ( news - web sites) to closely monitor and possibly regulate the use of such substances in private homes, a decision Levy said is a good one.

However, the manufacturers of such products feel differently. In a statement to Reuters Health, the Cosmetic, Toiletry and Fragrance Association (CTFA) noted that "antimicrobial products kill germs, and that is a benefit to consumers and their families. Removing these products would deprive consumers of effective hygiene products and would not help in eliminating antibiotic resistance."

The CTFA added that "the AMA should focus efforts on preventing misuse and over-prescription of antibiotic medicines by doctors and their patients, factors that are known to contribute to an increase in antibiotic resistance."

The Washington, DC-based CTFA is a trade association for the personal care products industry.

Source:  Archives of Dermatology 2002;138:1082-1086.

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Teens Say Buying Marijuana Is Easy

By Greg Toppo

AP Education Writer

The Associated Press

Tuesday, August 20, 2002

Teenagers say marijuana is easier to buy than cigarettes or beer — one in three say they can find it in a matter of hours — but only 25 percent admit trying it, a national survey finds.

When the National Center on Addiction and Substance Abuse polled 1,000 teens last winter, 27 percent said they could buy marijuana in an hour or less; another 8 percent said it would take a few hours. But for the first time since the study began in 1996, teenagers said it was easier to buy marijuana than cigarettes or beer.

The annual survey didn't specify whether drugs are easy or difficult to buy at school, but 63 percent of students said their schools are "drug-free," nearly double the number who said the same in 1998. It's the highest percentage since 1996.

While many have criticized nationally used anti-drug programs such as D.A.R.E., educators said years of using such programs seem to be paying off.

"I think we're starting to see the fruition of some of those programs," said Gerald Tirozzi, executive director of the National Association of Secondary School Principals.

He said student drug use has been dropping for the past four or five years as communities began financing anti-drug programs. "There has been a sense that the drug problem, while not solved, has been improving," he said.

More than half of students said they don't drink alcohol in a typical week, and about as many said they have never had a drink.

While one in four pupils said at least one parent smokes cigarettes, 69 percent said they have never smoked.

Joel Willen, principal of Pershing Middle School in Houston, said teachers and administrators are seeing less drug activity at school. "I think the kids are not bringing whatever it is they're doing, if they're doing it, to school," he said.

Pershing's drug-prevention programs are paired with a get-tough policy on drugs that includes twice-yearly, random locker and backpack searches by drug-sniffing dogs, Willen said. Students caught using or selling drugs can be sent to an alternative school or even expelled.

"They know we take a real hard line on drugs," he said.

The survey also found that:

8 percent of students believe there's a teacher at their school who uses illegal drugs.

25 percent said they have seen illegal drugs being sold at school.

55 percent said they'd report someone they saw using drugs at school.

56 percent said they'd report someone they saw selling drugs at school, the highest level since 1996.

24 percent said drugs are "the most important problem facing people your age," highest among several problems such as crime, peer pressure, sexuality and the environment.

The National Center on Addiction and Substance Abuse, based at Columbia University, polls teenagers on drug use and the presence of drugs in schools. This year's random telephone survey of students age 12-17 was conducted Dec. 27, 2001-Feb. 6, 2002, by QEV Analytics. It has a margin of error of plus or minus 3.1 percent age points.

An accompanying survey of parents found them equally divided on their children's drug habits: 44 percent said it's "not very likely" their child will ever try illegal drugs, but 43 percent it's "very likely" or "somewhat likely" that their kids will try them.

The federal Centers for Disease Control and Prevention ( news - web sites) estimates that, by the time they complete high school, 47 percent of teenagers have smoked marijuana, 24 percent have used another illicit drug and 81 percent have drunk alcohol. The agency also estimates that 70 percent have smoked cigarettes.

On the Net:

National Center: http://www.casacolumbia.org

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Groups Seek National ATV Standards

By Laurie Kellman

Associated Press Writer

The Associated Press

Tuesday, August 18, 2002

WASHINGTON (AP) - Advocacy groups say the government should ban children from riding all-terrain vehicles and force other riders to obey new safety standards, contending a surge in deaths and injuries show the ATV industry has failed to protect and educate riders.

Representatives from consumer, children's and environmental groups cited statistics showing injuries to ATV riders under 16 have nearly doubled in the last eight years.

"Self-regulation by the ATV industry has led to larger and faster ATVs and more children being killed and injured," said Rachel Weintraub, assistant general counsel to the Consumer Federation of America.

Children, she said, are being disproportionately hurt and killed by ATVs. According to government statistics, those under 16 represent about 14 percent of ATV riders but suffer 37 percent of ATV-related injuries and 38 percent of ATV-related deaths.

Grown-ups, not the government, bear responsibility for keeping their kids safe and riding only on child-sized machines, say ATV proponents.

"Unfortunately, some people ride these things stupidly," said Bill Ford, owner of a West Virginia company that offers ATV tours. He recalls seeing a mother and two kids riding an ATV down a highway without helmets. "There's a lot we should be doing with education."

ATVs are motorized machines that can traverse off-road terrain. While popular for recreation, they are also used extensively by farmers, police and others who find them less expensive than trucks and tractors and easier to maneuver in regions with few roads.

Rules for operating the vehicles vary widely by state. Some have no restrictions, while others require licenses for owners and operators and bar children under 16 from riding them.

The ATV industry has opposed some efforts to restrict the vehicles' use, saying it will hurt those who depend on ATVs for their livelihood and unfairly penalize safe operators.

In West Virginia for example, it's still legal to drive an ATV on a highway without a helmet. Critics have tried and failed for years to inspire the state legislature to pass new rules governing ATV use. The efforts have been blocked in part by farmers and coal industry workers, who say they need to use the vehicles to do their jobs.

"ATVs have been a way of life for certain parts of West Virginia for some time. And from a tourism perspective, it's doing wonders for the economy," said Ford, an attorney and owner of Charles Town-based Mountain Thunder.

In response to a rising fatality rate, particularly among children, the government and the industry entered a court-approved consent decree in 1988 banning the manufacture of three-wheel ATVs. It also ordered ATV distributors to use their "best efforts" to assure that dealers do not sell adult-size ATVs to children under 16.

The advocacy groups said rising death and injury rates indicate the voluntary guidelines are not working.

Annual injuries for four-wheel ATVs have increased more than 200 percent — from about 36,000 in 1993 to about 100,000 in 2001, according to the Consumer Product Safety Commission ( news - web sites).

Annual injuries from all ATVs — some three-wheel vehicles made before the ban took effect still are in use — more than doubled during that period, from about 50,000 to about 111,700, the commission said.

And ATV injuries to children under 16 increased from about 17,000 in 1993 to about 34,800 in 2001.

The Consumer Federation of America, the Bluewater Network, the National Trails and Waters Coalition and various emergency medical professionals say they want Congress and federal agencies to bar children under 16 from riding ATVs. The coalition also wants every state to adopt legislation to license, train and require safety rules for ATV owners and operators.

Separately Tuesday, Arctic Cat Inc. of Thief River Falls, Minn., recalled about 45,000 all-terrain vehicles because a mechanical problem can cause them to overturn, resulting in injuries.

On the Net:

Consumer Products Safety Commission: http://www.cpsc.gov

Consumer Federation of America: http://www.consumerfed.org

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MONDAY, AUGUST 19, 2002 

Hormone Patch May Heat Up Women's Desires

HealthScoutNews

Monday, August 19, 2002

MONDAY, Aug. 19 (HealthScoutNews) -- A skin patch that may help restore sexual desire in post-menopausal women is being tested in clinical trials at more than 150 sites in the United States and Canada.

The thin, nearly transparent hormone patch is worn on the abdomen. It's main ingredient is testosterone, a hormone long-associated with sexual desire and aggresiveness in men.

Millions of women have decreased sexual desire because of lower hormone levels following menopause or hysterectomy. That can lead to frustration, unhappiness and relationship problems.

"More than 40 million women suffer from the lack of sexual desire, which often leads to personal distress or relationship issues," says Sheryl Kingsberg, a clinical psychologist at MacDonald Women's Hospital at University Hospitals of Cleveland, one of the study sites.

"Since no medications currently are approved by the U.S. Food and Drug Administration ( news - web sites) for the treatment of diminished sexual desire, these clinical studies are an important step in the development of new therapeutic options to help many women and their partners regain a satisfactory sex life," Kingsberg says.

It's estimated that about 43 percent of women have experienced some form of difficulty in their sexual function, compared to about 31 percent of men.

This isn't the first trial involving testosterone and women. John Hopkins researchers conducted similar experiments last year, and a trial is also being conducted at New Hyork uniersity Medical center.

The decline in a woman's sexual desire can be accompanied by other problems, such as inability to achieve orgasm.

More Information

Physicians, researchers and post-menopausal women continue to search for ways to deal with some of the problems that come along after menopause. Lately, there's been debate over when and if a woman should have hormone replacement therapy (HRT).

This report from the National Institutes of Health ( news - web sites), called The Women's Health Initiative, sums up all the new information about HRT's risks since a major July 2002 report was issued.

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Deviant Gene May Up West Nile Risk

By Paul Recer

AP Science Writer

The Associated Press

Monday, August 19, 2002

WASHINGTON (AP) - Only about one in five people infected with the West Nile virus ( news - web sites) develop a severe, life-threatening illness. A study in mice suggests a gene variation may be the reason some become very sick from the mosquito-borne virus, while others recover easily.

Experts said the research is an important step toward finding a drug to treat West Nile, a virus that has caused 11 deaths in the United States this year. The Centers for Disease Control and Prevention ( news - web sites) reported Saturday there have been at least 251 human cases of the disease this year.

West Nile is carried by mosquitos whose bite can spread the virus to birds, horses and humans. So far this year, the virus has been found in dead birds, in horses, in humans or in mosquito pools in at least 39 states, New York City and the District of Columbia. Human cases have occurred in 11 states and the District of Columbia.

For most people, West Nile causes only flu-like symptoms. But for some patients, particularly the young and the elderly, West Nile can be a killer, causing a swelling of the brain that can be lethal.

Just why some people are more susceptible to serious illness from the virus has intrigued researchers and prompted scientists at the Pasteur Institute in France to search for a gene variation that might explain the difference.

The French first tested a series of laboratory mouse strains to find a genetic type that was most likely to die after being exposed to the West Nile virus.

They found that animals in the mouse strain called BALB/c all died within 13 days when injected with the West Nile virus. When these animals were mated with other mouse strains, some of the offspring died from the virus, while others were little affected.

By analyzing the genes of both the BALB/c mice and the mixed strains with a high rate of West Nile deaths, the researchers isolated a specific gene variation that increased the susceptibility to the virus, the researchers report. They called the variation the West Nile gene.

Dr. Jean-Louis Guenet of Pasteur, a co-author of the study appearing this week in the Proceedings of the National Academy of Sciences ( news - web sites), said the West Nile gene allows the virus to cause disease by blocking production of a group of proteins that normally prevent viruses from reproducing inside a cell.

"The variation ... stops the action of the gene prematurely, making it nonfunctional," said Guenet. "It is the absence of some proteins made by this gene that leads to susceptibility."

He said the flawed gene contains a "stop codon," an arrangement that prevents the full expression of the gene. Without the full expression, some virus-fighting proteins are not made.

"All of the susceptible mice have the stop codon. All of the other mice do not have this stop codon," said the Pasteur researcher.

Guenet said the missing proteins participate in a network of proteins that normally degrade viral genes inside a cell.

The exact gene variation has not been found yet in humans, Guenet said, but researchers at the National Institutes of Health ( news - web sites) said the finding by the Pasteur scientists is important because it moves research closer to finding a drug for West Nile virus.

"The most promising thing about this study is that it could help lead to a drug" that would restore the missing protein and give patients protection against replication of the virus, said Catherine A. Laughlin of the National Institute of Allergy and Infectious Diseases ( news - web sites) at the NIH.

"The possibility of developing a drug is why we are excited about this finding," said James M. Meegan, a virology research program leader at NIAID.

Meegan said that NIAID is funding research on three West Nile virus vaccines and one may be ready for human trials next year.

On the Net:

Proceedings of the National Academy of Sciences www.pnas.org

West Nile virus: http://www.cdc.gov/ncidod/dvbid/westnile/

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Don't Let Worms Dog You

HealthScoutNews

Monday, August 19, 2002

(HealthScoutNews) -- Roundworms, a parasite (Toxocara) commonly found in the intestines of dogs and cats, can be passed from pets to humans and cause an infectious disease called toxocariasis. It sickens some 10,000 people yearly in the United States. More than 700 of them experience total or partial loss of vision.

Heavy or repeated Toxocara infections, while rare, can initiate a disease that causes swelling of the body's organs or central nervous system.

Though hard to pronounce, toxocariasis can easily be prevented:

  • Have your veterinarian treat your dogs and cats, especially young animals, regularly for worms.
  • Wash your hands well with soap and water after playing with your pets and after outdoor activities, especially before you eat.
  • Teach children to always wash their hands after playing with dogs and cats and after playing outdoors.
  • Do not allow children to play in areas that are soiled with pet or other animal stools.
  • Clean your pets' living area at least once a week. Feces should be either buried or bagged and disposed of in the trash.        
  • Teach children that it is dangerous to eat dirt or soil.

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Indiana U. Named Top 'Party School'

By Shannon Dininny

Associated Press Writer

The Associated Press

Monday, August 19, 2002

BLOOMINGTON, Ind. (AP) - Indiana University was crowned the nation's No. 1 "party school" Monday in an annual Princeton Review survey that school leaders and medical experts derided as irresponsible and unscientific.

Following IU in the rankings were Clemson University, the University of Alabama-Tuscaloosa, Pennsylvania State University and the University of Florida.

IU officials questioned the No. 1 ranking. The school, which didn't appear on the list last year, has toughened its stance on student drinking since the 1998 alcohol-related death of a student.

In the past year, five IU fraternities have been suspended or expelled for violations of alcohol policies, said Bill Stephan, the university's vice president for public affairs.

"I think there are some serious questions about the methodology of the study and it really calls into question the credibility of the ranking," Stephan said.

IU freshman Anya Simonova said her school may be perceived as a party school, but noted that "it's getting quieter because they're cracking down more." Junior Erin Pritchard agreed.

"I'd be surprised to hear we're number one," she said. "Even though most people party three or four times a week, this past year they've been a lot more strict."

The survey, conducted since 1992, ranks schools in 63 categories based on in-person or computer interviews with 100,000 students. The party school designation is based on student reports on alcohol and marijuana use, the amount of time spent studying outside of class and the popularity of fraternities and sororities on campus.

Princeton Review, a test-preparation and college admissions company with no connection to Princeton University, defended its survey.

"We simply are reporting on the conditions that exist on those particular campuses, and if social life continues to be an aspect that students comment on, then I will continue to include that list in the book," said Robert Franek, the company's editorial director.

Franek noted that the survey also lists the top-20 "Stone-Cold Sober Schools," where students say there is little drinking. Brigham Young University topped that list for the third straight year.

The American Medical Association has repeatedly criticized the "party school" rankings, saying they irresponsibly legitimize high-risk drinking and portray alcohol as central to college life.

On Monday, Richard Yoast of the AMA's Office of Alcohol and Other Drug Abuse called the survey "a marketing gimmick" and said it does a disservice to quality universities.

Following Florida, the rest of the top 10 party schools were the State University of New York-Buffalo; the University of New Hampshire; the University of Colorado-Boulder; Florida State University; and the University of Wisconsin-Madison.

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(Beware Of) Water, Water Everywhere

HealthScoutNews

Monday, August 19, 2002

(HealthScoutNews) -- Many a vacation in the U.S. and abroad has been ruined by intestinal illness brought on by the consumption of contaminated food or drink. Water is the most frequent carrier of infectious agents.

In areas with poor sanitation, you may be able to safely drink only boiled water, hot beverages (such as coffee or tea) made with boiled water, canned or bottled carbonated beverages, beer, and wine. Ice may be made from unsafe water and should be avoided.

Boiling is the most reliable method to make water safe to drink. Bring water to a vigorous boil, then allow it to cool; do not add ice. At high altitudes, allow water to boil vigorously for a few minutes. Adding a pinch of salt or pouring water from one container to another will improve the taste.

As a last resort, water that is uncomfortably hot to touch may be safe for drinking and brushing teeth after it is allowed to cool. However, many disease-causing organisms can survive the usual temperature reached by the hot water in overseas hotels.

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Early heart disease indicator identified

From the Science & Technology Desk
United Press International

Monday, August 19, 2002

FRAMINGHAM, Mass., Aug. 19 (UPI) -- The presence of an easily detectable protein in the blood can help predict the onset of heart disease before any symptoms appear, new research from the Framingham Heart Study suggests.

The Framingham study, which was begun in 1948 by the organization that is now the National Heart, Lung, and Blood Institute in Bethesda, Md., has attempted to identify common factors or characteristics that contribute to diseases of the heart and cardiovascular system by tracking a large group of subjects -- all residents of the town -- who had not yet developed symptoms or suffered a heart attack or stroke.

In the latest research, investigators examined 2506 men and women with no apparent symptoms of cardiovascular disease. Using computed tomography or CAT scans, they found increased levels of a protein called C-reactive indicate higher levels of calcium in the coronary arteries of the heart. Higher calcium levels, which cause the buildup of fatty deposits called atherosclerotic plaques, are associated with heart disease and are predictors of heart attack.

"We found that the majority of men and women in the study had calcium in their arteries. But we also found that the more C-reative protein they had, the more calcium they had," Dr. Thomas Wang, lead author of the study and a research fellow at the institute, told United Press International.

"For the first time since the inception of the Framingham study more than 50 years ago, investigators have the ability to study what is happening in the arteries of the heart with CT scans," Wang said. "Using CT scanning, we have found that many (individuals showing no symptoms) with elevated C-reative protein levels appear to have objective evidence of atherosclerosis in their coronary arteries," he added.

Although two previous studies had failed to find a link between increased C-reactive protein and calcium deposits, the groups in those studies consisted of post-menopausal women and male Army personnel aged 40 to 45. The authors of the new research said the use of Framingham subjects, representing a broader segment of the population -- men and women aged 35 to 84 with an average age of 60 -- might be responsible for the difference in the results.

Wang acknowledged the new research does not address certain questions about an individual patient's condition.

"Whether or not a physician would send a person with an elevated C-reactive protein for more advanced testing needs to be studied further," said Wang, who also is a fellow in the cardiology division at Massachusetts General Hospital in Boston.

C-reactive protein, which plays an important role in the body's immune defenses, indicates that there is inflammation somewhere in the body. Earlier work has shown a correlation between elevated C-reactive protein and heart attack and a number of studies have associated inflammation with increased heart disease.

Other diseases also need to be ruled out, however. Increased C-reactive protein levels can indicate rheumatoid arthritis, rheumatic fever, cancer, tuberculosis and pneumococcal pneumonia, as well as cardiovascular disease.

In the current research, investigators drew blood from the subjects between 1991 and 1995 to analyze for C-reactive protein. They then divided the subjects into five groups based on their protein scores.

Four to 8 years after taking the original samples, the researchers gave each subject a type of CAT scan called electron beam computed tomography or EBCT, a procedure that can detect calcification of the arteries. They found calcification scores increased uniformly with increasing levels of C-reative protein among both males and females.

"Once again the investigators from the Framingham Study have provided us with valuable information, which should give us more insight about how to identify even earlier persons at risk for cardiac events, "Dr. Sidney Smith, chief science officer for the American Heart Association, told UPI.

Other experts urged caution in jumping to conclusions, however. Michele Hamilton, associate clinical professor of cardiology at the David Geffen School of Medicine at the University of California at Los Angeles, and co-director of the UCLA heart failure program, told UPI, "Right now, I would not recommend that everyone go out and have their C-reactive protein level checked because our therapy for protection against coronary artery disease is directed by the other known risk factors." Hamilton specified cholesterol levels, blood pressure, diabetes and smoking as the usual targets of therapy.

John P. Cooke, associate professor and director of vascular medicine at Stanford University Medical School in Palo Alto, Calif., told UPI, "It's not terribly surprising that C-reactive protein is correlated with coronary calcium because C-reactive protein is associated with coronary events (and) I think it's really a modest extension of the data we already have."

Smith agreed. "Clearly, we need further research to tell us how to accurately integrate and use these two sources of information to better predict cardiovascular events," he said.

The research is reported in the Aug. 20 in the journal Circulation and on the American Heart Association's rapid access Web site.

(Reported for UPI Science News by Joe Grossman in Santa Cruz, Calif., and Bruce Sylvester in West Palm Beach, Fla.)

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New Potential Drugs for AIDS Discovered

HealthScoutNews

Monday, August 19, 2002

MONDAY, Aug. 19 (HealthScoutNews) -- American and Belgian scientists apparently have discovered several new potential drugs to treat AIDS ( news - web sites), including compounds that block all known drug-resistant strains of the virus.

According to a report being presented today at the American Chemical Society's annual meeting in Boston, two of the new drugs, Dapivirine and R165335, have shown promise in Phase I and Phase II clinical trials.

Because it's easy to manufacture and has a low cost, Dapivirine may prove useful for treating AIDS in developing countries. The drug is also being tested as a microbicide to prevent HIV ( news - web sites) transmission.

A third drug called R278474 is scheduled for Phase I trials. The researchers say it's even more active against common and mutant HIV strains.

The emergence of drug-resistant HIV strains has been a major obstacle to long-term treatment, the researchers say.

More information

The U.S. Food and Drug Administration ( news - web sites) offers a history of the AIDS medical fight.

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FDA Approves Light Therapy for Acne

The Associated Press

Monday, August 19, 2002

WASHINGTON (AP) - Patients with a certain type of acne can soon opt for light therapy to try to clear it up.

The Food and Drug Administration ( news - web sites) approved a device Monday that emits high-intensity light to help clear up moderate inflammatory acne.

The ClearLight system doesn't work on severe acne or mild cases of pimples but works only on inflammatory acne, which is caused by bacteria, said Neil Ogden, FDA's director of general-surgery devices.

The theory is that the light kills the bacteria inside the pimples.

It's blue light, a different wavelength than skin-damaging ultraviolet light, and thus is thought to cause no side effects, he said.

Israel-based Lumenis Inc. studied about 48 patients with moderate inflammatory acne, treating half the face with the ClearLight and comparing the result with the untreated other side of the face, Ogden said.

The treatment consisted of eight twice-a-week, 15-minute light sessions.

Not everyone responded. If the acne does not seem better after two or three sessions, there's only a 10 percent chance it will respond to the treatment at all, Ogden said. About half of the patients who finished all eight treatments saw at least 50 percent decreases in the number of pimples, he said.

Acne patients have a range of options, from topical ointments to antibiotics and, for the most severe cases, drugs like Accutane. That drug can cause severe birth defects, however, so it's used under very strict precautions to treat young women. ClearLight would offer a subset of acne sufferers — Lumenis estimates up to 13 million — a nondrug alternative.

The company estimates patients would pay about $50 a session, or $400 for a full course of treatment. It's not clear how often recurrent acne sufferers could undergo light therapy.

Lumenis said it would begin shipping the light device to dermatologists immediately. The company would not disclose how much the machines will cost doctors.

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Aromatherapy May Do More Than Soothe Your Spirit

By Randy Dotinga
HealthScoutNews Reporter

HealthScoutNews

Monday, August 19, 2002

MONDAY, Aug. 19 (HealthScoutNews) -- Imagine inhaling a certain scent that would help protect your lungs from damage if you found yourself in a smoke-filled room.

A California scientist says his research into the healthy properties of aromas could make that a possiblity one day.

Kwang-Geun Lee, of the University of California at Davis, released findings at the annual meeting of the American Chemical Society yesterday in Boston that suggest some smells could act as antioxidants, the healthful agents found in fruits and vegetables.

"Exposure to these aromas may help to prevent (oxygen) damages, which are a factor in many diseases," Lee says.

Humans have known about the positive effects of smell for thousands of years, and "aromatherapy" has become a household word. Scientists have a good understanding of how smell works, from the sensors in the nose that take in information to the areas of the brain that process the data, says George Preti, a researcher at Monell Chemical Senses Center in Philadelphia.

However, Lee says, scientists still aren't sure why odors seem to have healthy effects on the body.

At his laboratory, Lee distilled and extracted 30 chemicals that produce aroma from 10 plants. Then, he tested them for the presence of antioxidants.

In initial research, Lee found levels of antioxidants -- similar to those in Vitamin E -- in soybeans, mungbeans, kidney beans, eucalyptus leaves and several types of spices, including basil, thyme, rosemary, chamomile and cinnamon.

Experts believe antioxidants block certain types of cell damage caused by molecules called free radicals, which are caused by exposure to tobacco smoke and some chemicals.

Foods rich in antioxidants help destroy free radicals, and scientists think they reduce the risk of diseases such as cancer, heart disease and stroke. However, more research will be needed to figure out if the antioxidants in the aromas actually affect the body, Lee says.

If they do, he says, it's possible they could be released in a room full of smokers to counteract the damaging effects of tobacco.

Preti notes that some body creams have antioxidant properties, and it's not "too far-fetched" to believe that odors could do the same.

However, if researchers do try to put aromas to work to protect a person's health, they'll need to use a lot of them, Preti notes.

"Most of the things you smell are at very low quantities. Your olfactory abilities are fairly sensitive. Most things aren't in high enough quantities to cause any physiological or unhealthy sensations," he says.

What To Do

To learn about research on antioxidant therapy for heart disease and other conditions, visit the Linus Pauling Institute.

For more on Vitamin E, a major source of antioxidants, visit the National Institutes of Health.

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Backpacks Not Always to Blame for Kids' Back Pain

By Kathleen Doheny

Reuters Health

Monday, August 19, 2002

SAN DIEGO (Reuters Health) - Parents often warn their school-age children not to carry heavy backpacks, worried that they'll get backaches. But a new study has found that the load on the back is often not the culprit when youngsters develop low back pain.

Children with emotional or behavioral problems, as well as those who frequently complain of stomachaches or headaches, are more likely to have low back pain than those who tote around a heavy backpack, researchers reported Sunday at the 10th World Congress on Pain.

Like most experts, a research team from the University of Manchester in the UK figured that heavy backpacks would take a toll on children's back health. "Our hypothesis was that the greater the load, the more low back pain," said Gary Macfarlane, an epidemiologist at the University of Manchester and the lead researcher.

"But we found there is very little difference in risk of low back pain no matter how much you carry," he said. The heaviest backpack in the study weighed about 39 pounds, but most were about 13 pounds. And the kids who carried the heaviest packs, walked to school with them on, and carried them around all day did have a slightly increased risk of back pain.

But the real predictor of back pain was whether the children had emotional or behavior problems, or frequently reported stomachaches or headaches, according to Macfarlane.

"Those with conduct problems were at three times the risk of developing low back pain," he said, compared with those who carried heavy backpacks. "We know that psychological factors can predict the onset of low back pain in adults," Macfarlane said, and this might be true in children as well.

The team went to 39 schools, recruiting children ages 11 to 16. The investigators weighed students' backpacks on 5 consecutive days and asked the students questions about how well they got along with others and other psychosocial issues.

In all, 18.6% of the 903 children surveyed had low back pain.

As for backpack weight, Macfarlane stressed that it is not a good idea to load backpacks to any weight. "We're not saying carry whatever you want," he said. But a backpack weighing up to about 25 pounds, depending on the age and size of the child, is probably fine, he noted.

The American Academy of Pediatrics recommends that backpack weights not exceed 10% or 20% of a student's body weight and recommends wheeled backpacks if possible.

When Macfarlane's research team reviewed medical records of the children with low back pain, they often saw notes advising the parents to caution children about not overloading their backpacks.

The message, Macfarlane said, might also be to keep in mind that the pain may be related to emotional and behavioral problems.

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Nutritional Value of Water Studied

By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, August 19, 2002

"Drink at least eight glasses of water a day" is an adage some obsessively follow, judging by the people sucking on water bottles at every street corner — but the need for so much water may be a myth.

Fear that once you're thirsty you're already dehydrated? For many of us, another myth. Caffeinated drinks don't count because they dehydrate? Probably wrong, too.

So says a scientist who undertook an exhaustive hunt for evidence backing all this water advice and came up mostly, well, dry. Now the group that sets the nation's nutrition standards is studying the issue, too, to see if it's time to declare a daily fluid level needed for good health — and how much leaves you waterlogged.

Until then, "obey your thirst" is good advice, says Dr. Heinz Valtin, professor emeritus at Dartmouth Medical School, whose review of the eight-glass theory appears in this month's American Journal of Physiology.

It's about time for all the attention, says Pennsylvania State University nutritionist Barbara Rolls, a well-known expert on thirst. "There's so much confusion out there."

Much of it centers on where you should get your daily water.

"There's this conception it can only come out of a bottle," and that's wrong, notes Paula Trumbo of the Institute of Medicine ( news - web sites)'s Food and Nutrition Board, which hopes to decide by March whether to issue the first official water-intake recommendation.

In fact, people absorb much water from the food they eat. Fruits and vegetables are 80 to 95 percent water; meats contain a fair amount; even dry bread and cheese are about 35 percent water, says Rolls. That's in addition to juices, milk and other beverages.

And many of us drink when we don't really need to, spurred by marketing, salty foods and dry environments, Rolls says.

"For most of us, that's not going to matter — you're just going to need to go to the bathroom more," she says.

But for people with certain medical conditions, chugging too much can be harmful, sometimes fatal, Valtin warns. Even healthy people — such as teenagers taking the party drug Ecstasy, which induces abnormal thirst — can occasionally drink too much. So-called water intoxication dilutes sodium in the blood until the body can't function properly.

Conversely, no one disputes that getting enough water is crucial. Indeed, the elderly often have a diminished sensation of thirst and can become dangerously dehydrated without realizing it. People with kidney stones, for example, require lots of water, as does anyone doing strenuous exercise.

But the question remains: How much water does the typical, mostly sedentary American truly need? And what's the origin of the theory, heavily promoted by water sellers and various nutrition groups, that the magic number is at least 64 ounces?

Valtin, who has spent 40 years researching how the body maintains a healthy fluid balance, determined the advice probably stems from muddled interpretation of a 1945 Food and Nutrition Board report. That report said the body needs about 1 milliliter of water for each calorie consumed — almost 8 cups for a typical 2,000-calorie diet — but that "most of this quantity is contained in prepared foods."

That language somehow has morphed into "at least" 64 ounces daily, Valtin says. (One Web site's "hydration calculator" even recommends a startling 125 ounces for a 250-pound couch potato.) And aside from the American Dietetic Association's advice, few of the "drink more water" campaigns targeted to consumers mention how much comes from food.

Valtin couldn't find any research proving the average person needs to drink a full 64 ounces of water daily.

Also, contrary to popular opinion, he cites a University of Nebraska study that found coffee, tea and sodas are hydrating for people used to caffeine and thus should count toward their daily fluid total.

Other myths:

·        That thirst means you're already dehydrated. That can be true of the elderly, and studies of marathon runners and military recruits in training have found that some focus so intently on strenuous exercise that they block thirst sensations until they're in trouble. But Rolls did hourly hydration tests to prove that drinking when thirsty is good advice for the rest of us.

·        That water blocks dieters' hunger. Studies show water with food can help you feel full faster, but that just drinking water between meals has little effect, Rolls says.

So how much do we need? Until the Institute of Medicine sets a level, "if people obey their thirst and they are producing urine of a normal yellow color, that's a safe sign," Valtin concludes.

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

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Moms and dads differ on kid's pain

By Peggy Peck
UPI Science News
From the Science & Technology Desk
United Press International

Monday, August 19, 2002 

SAN DIEGO, Aug. 19 (UPI) -- A study from Finland suggests mothers and fathers react differently to a child in pain -- dads are more likely to think the child should suffer in silence, while moms tend to reach for the baby aspirin.

Researcher Paivi Kankkunen based her findings on a survey of parents whose children had undergone outpatient surgery. Just over 200 mothers and a little more than 100 fathers filled out the survey forms.

"Generally, fathers were more likely to think that children could be faking pain and they were also more likely to think that children should learn to live with the pain," Kankkunen said in an interview with United Press International. She added that both mothers and fathers also thought "boys should be encouraged to tolerate the pain without pain medication." Parents also said it was more acceptable for boys to engage in risk-taking play that might result in injury, but were less likely to support such activities by girls.

Although her survey detected gender-based differences, Kankkunen said she found mothers and fathers are similar because they generally are very reluctant to give children any pain medication.

Kankkunen, who presented her findings Monday at the 10th World Congress on Pain, said a few days of watching American television have convinced her this reluctance to use pain medicines sets Finnish parents apart from their American counterparts. "Here, you advertise analgesics for children! That would never be done in Finland," she said.

Dr. Sandra Chaplan, a clinical professor of anesthesiology at the University of California at San Diego and a member of the organizing committee for the pain meeting, told UPI physicians often see "this in our offices -- a mother may be more empathetic than the father. Often, for example, a father is less willing to give a Tylenol to the child who is complaining about a headache."

Chaplan said she does not think Kankkunen's findings "can really be applied to North American parents. There have been several hallway conversations about this particular paper and the feeling among the people that I've talked to is that this probably doesn't reflect the attitudes of American parents."

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Test of Cancer Drug Disappointing

The Associated Press

Monday, August 19, 2002

LONDON (AP) - Anglo-Swedish drug company AstraZeneca PLC said Monday a key trial of its new cancer drug Iressa was disappointing.

The setback sent the company's shares tumbling to $32.24 in late morning trading on the New York Stock Exchange ( news - web sites), down $4.76, or 13 percent.

AstraZeneca said the late-stage trials showed Iressa didn't improve survival rates for patients with advanced non-small cell lung cancer when used with existing chemotherapy drugs.

Iressa, a new type of treatment known as Epidermal Growth Factor Receptors, is a tablet taken once daily.

Iressa had shown better results in an earlier trial, where it was used alone, said Brent Vose, AstraZeneca's vice-president for oncology.

AstraZeneca used the earlier trial to make submissions to regulators. Japan has already approved the drug and the U.S. Food & Drug Administration will consider this submission in September.

The latest results cast doubt on the drug's potential sales. Some analysts had expected Iressa to reap as much as $2 billion a year at its peak, but those estimates took account of Iressa used by itself and in combination with chemo drugs for various cancers.

The setback with Iressa comes just weeks after the company said its other promising up-and-coming drug Crestor, for cholesterol, will be delayed.

Iressa and Crestor are key to the company's future earnings growth as AstraZeneca prepares for the possible loss of patent coverage on Losec/Prilosec, once the world's biggest selling drug and cornerstone of the company's profit.

AstraZeneca said Monday its full-year earnings guidance remains unchanged.

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Ibuprofen Better Fever Reducer for Kids: Report

By Kathleen Doheny

Reuters Health

Monday, August 19, 2002

SAN DIEGO (Reuters Health) - The drug ibuprofen, the active ingredient in Motrin, Advil and other over-the-counter drugs, is better at reducing fever in children than acetaminophen, another often-used fever reducer found in Tylenol and other medications, Australian researchers reported Sunday at the 10th World Congress on Pain.

To reach that conclusion, Tiina Piira, a clinical psychologist, and Dr. G. David Champion, director of the pain research unit at Sydney Children's Hospital, Randwick, and their colleagues conducted a comprehensive analysis of both published and unpublished data.

The team performed a meta-analysis of studies in the medical literature and solicited unpublished data. In all, they evaluated 28 studies, with more than 4,000 children, that looked at the use of ibuprofen and acetaminophen for pain and fever, and for their potential for side effects. The children ranged in age from about 18 months to 16 years, Piira said.

The general feeling among many doctors as well as parents, Champion said, is that acetaminophen is the better choice for fever reduction in children.

But the investigators found that a single dose of ibuprofen was more effective at reducing fever than a single dose of acetaminophen at 2 to 6 hours after the treatment.

When it comes to reducing pain, both medicines were fairly equal, the researchers reported. And they are equally safe. However, "you have to conclude that at the doses tested, ibuprofen comes out better for fever," Champion said.

In the studies, fever was defined by each research team, Champion said, but normally is considered a temperature of about 101 degrees Fahrenheit (38.3 Celsius) or above.

The study was partially funded by Boots Healthcare Australia, a pharmaceutical company. The company makes ibuprofen, among other drugs. But Piira said great care was taken when evaluating the studies to ensure that the investigators did not know details such as the researchers' names or the funding for the studies. "We looked at the scientific merits of each paper," she said.

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Cooling device aims to limit heart damage

From the Science & Technology Desk
United Press International

Monday, August 19, 2002 

MINNEAPOLIS, Minn., Aug. 19 (UPI) -- Doctors in Minnesota announced Monday that they have treated the first patient ever with a device designed to cool the body rapidly and thereby reduce irreversible damage that can occur during a heart attack.

The patient, a 50-year-old man who suffered a heart attack, "left the hospital with basically normal heart function," Kenneth Baran, a cardiologist at the St. Paul Heart Clinic, told United Press International.

Baran noted, "it's hard to say" whether the patient would have the same result had he not been treated with the device, called the Celsius Control System. The patient will be examined again in 30 days to look for signs of heart damage.

More than 1 million people will suffer a heart attack in the United States this year and two-thirds will not make a complete recovery.

It is not yet known if the principle of cooling down the body will spare damage to the heart, but it has looked promising in studies in animals, said Robin L. Allgren, vice president of clinical research and medical affairs at Innercool Therapies of San Diego, the company developing the device.

A heart attack deprives the heart of oxygen, which can result in the death of heart tissue. If the damage is large enough, it can impair heart function, Allgren said. The hope is that lowering the body temperature will prevent some of the damage from occurring in the first place, she said.

The Celsius system consists of a cooling catheter inserted in a vein in the thigh. As blood passes over the catheter, it is rapidly cooled. As a result, the body's temperature drops 7 degrees, from 98.6 Fahrenheit to 91.4 F in one hour, and maintains that level for 6 hours.

The advantage of the device is it can cool down the body very rapidly, Baran said. Ice baths can take hours to achieve similar body cooling and often will induce shivering in the patient, which interferes with rapid cooling.

The patient is the first of 400 patients Innercool intends to enroll in the study, which is taking place at more than 25 clinical centers in the United States. The study will be ongoing for the next 2 years.

The company also is developing the device for use in brain surgery or conditions such as stroke, where cooling the body can help prevent brain damage.

Baran noted the device also could prove useful for treating heat stroke. For example, if it had been available last year when Minnesota Vikings football player Corey Stringer died from heat stroke, "it probably could have saved his life," he said.

(Reported by Steve Mitchell, UPI Medical Correspondent, in Washington)

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Left Side of Brain Important for 'Self-Memory'

Reuters Health

Monday, August 19, 2002

NEW YORK (Reuters Health) - Most of the time, the right side of the brain is better at identifying familiar faces, but when it comes to recognizing one's own face, the left side of the brain is tops, new research suggests.

A man who had undergone surgery to treat epilepsy provided Dr. David J. Turk and colleagues at Dartmouth College in Hanover, New Hampshire, with an opportunity to evaluate separately the ability of each side of the brain to recognize familiar faces.

To treat epilepsy that did not respond to other therapies, fibers in the man's brain that connect the left and right brain hemispheres had been cut. Therefore, the two brain hemispheres could no longer communicate with one another, which allowed the researchers to investigate their individual functions.

Using computer technology, the researchers altered a pair of photos, one of the patient himself and the other of "Mike," a doctor the patient knew well. Some of the altered photos looked more like the patient while others resembled the doctor more. When shown the photos, the man had to decide whether the picture looked more like himself or Mike. The same exercise was repeated with photos of other easily recognized faces, including President Bush ( news - web sites) and former President Clinton ( news - web sites).

The right hemisphere of his brain did a better job at recognizing faces, with one exception, according to a report in the advance online edition of the journal Nature Neuroscience for September. The left side of the man's brain was more accurate at recognizing his own face.

"Our results support the view that, although both hemispheres are capable of self-recognition, cortical networks in the left hemisphere have an important role in the execution of this process," Turk and his colleagues write.

According to the researchers, the brain is thought to possess a "self-memory system" made up of each person's conception of himself or herself. The fact that the left hemisphere is better able to recognize photos of the self suggests that this side of the brain plays a dominant role in the self-memory system, the authors report.

Source: Nature Neuroscience 2002;10.1038/nn907.

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Antibiotics lower heart re-hospitalization

From the Science & Technology Desk
United Press International

Monday, August 19, 2002 

LONDON, Aug. 19 (UPI) -- British researchers have found giving certain antibiotics to patients hospitalized for heart attack or severe chest pain reduces re-hospitalization for these problems.

Patients receiving the antibiotics were 39 percent less likely to be hospitalized or to die from heart problems for one year compared with patients who did not receive the medications. Short-term effects were also seen, researchers said. Within the first three months of receiving antibiotics, 27 percent of patients who had taken no medication were re-hospitalized for heart problems or died from a heart attack, compared with only 17 percent in the antibiotic group.

Most acute heart disease episodes probably are associated with inflammation of the fatty deposits in the coronary arteries, the study's co-author, Michael A. Mendall, told United Press International.

"The question's always been, what causes that acute inflamation? ... Is it infection or is it something else?" asked Mendall, a gastroenterologist at Mayday Hospital and senior lecturer at St. Georges Medical School.

The researchers wanted to see if two different classes antibiotics -- called macrolides and non-macrolides -- would affects heart patients differently. This was the first time the two classes have been compared in a heart disease study.

They found although the macrolides and non-macrolides both reduced re-hospitalization, taking the antibiotics had no effect on the 5 percent rate of fatal heart attacks suffered by the patients. Instead, most of the benefit was in the reduction of hospital readmissions for unstable angina, a condition that creates pain or discomfort in the upper body and can occur whether the patient is resting or active. It is caused by blockages in blood vessels that supply the heart.

The researchers randomly created three groups from 325 patients admitted to the hospital for acute myocardial infarction -- heart attack -- or unstable angina. Two of the groups received antibiotics while a third received identical-looking placebos. The patients took antibiotics or placebos for one week.

The groups treated with antibiotics received both metronidazole and omeprazole, but one group also received azithromycin, a macrolide and a known anti-inflammatory agent. The other group received amoxicillin, a non-macrolide with no known anti-inflammatory effect.

The researchers said it might have been the action of the metronidazole or the omeprazole, given to both antibiotic treatment groups, that was responsible for the lower heart incident rates in the treated group.

"Our original hypothesis was that inflammation may be due to infections with either Chlamydia pneumoniae or Helicobacter pylori (bacteria), but the study suggested that the antibiotics weren't working that way -- that they were working in a different way," Mendall said.

Mendall said he believes the antibiotics may work against other infections in the body or against a general infection. "One possibility is that the antibiotics lighten the load on the immune system or have a direct anti-inflammatory action," he said.

John P. Cooke, associate professor and director of vascular medicine at Stanford University Medical School in Palo Alto, Calif., suggested one possibility for what happened: "Maybe those bacteria weren't the factor. Maybe there's another bacteria that's being treated that hasn't been recognized," he told UPI.

"This hypothesis has been tested in two large-scale, well-designed trials involving more than 20 times the number of patients reported in this trial and have shown no benefit of the antibiotic treatment in patients with acute coronary symptoms syndromes," Gregg Fonarow, associate professor of medicine at the University of California at Los Angeles and director of the Ahmanson-UCLA Cardiomyopathy Center, told UPI.

Fonarow acknowledged, however, that previous trials did not use some of the antibiotics included in the current study.

The research appears in the Aug. 20 issue of the journal Circulation and on the rapid-response Web site of the American Heart Association.

(Reported by Joe Grossman, UPI Science News, Santa Cruz, Calif.)

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Tiny Swap Distinguishes One Blood Type from Another

By Alison McCook

Reuters Health

Monday, August 19, 2002

NEW YORK (Reuters Health) - Although getting the wrong type of blood during a transfusion can possibly kill you, researchers have determined that only a tiny change in an enzyme can make the difference between type A and type B blood.

These findings demonstrate that relatively minor tweakings of body chemicals can produce widely varying results, study author Dr. Stephen V. Evans told Reuters Health.

"If you have blood group A, blood group B, it's a difference in one amino acid," Evans said. Amino acids are the building blocks of protein, and the enzyme that constructs blood types contains a total of 354 amino acids.

"Actually, it's quite an amazing story," he noted.

A person's blood type results from the structure of certain sugars present on the surface of red blood cells. Enzymes called transferases assemble the sugars that make up the different blood types.

Researchers have known that the sugar structures present in A and B blood types differ in only one respect--one small chemical group present on one of the sugars.

Similarly, researchers know the sequences of the A and B blood type transferases differ in only four amino acids, out of a chain of 354. In the new study, Evans and his colleagues discovered that of the four amino acids, only one appears to be able to contact both the sugar chain being built and the chemical that needs to be donated to the chain in order to distinguish A and B blood types.

"There's only one amino acid, and that amino acid makes all the difference," Evans said.

The researchers made the discovery by using x-ray crystallography to generate highly detailed, three-dimensional images of the structures of the A and B blood type transferases. They report their findings in the advance online publication of the journal Nature Structural Biology for September.

That single difference becomes "very important," the researcher noted. For example, if a person with type A blood is given type B blood, that one chemical that distinguishes the two types will trigger the immune system to attack the new blood as a foreign substance, perhaps ultimately killing the patient.

Source: Nature Structural Biology 2002;10.1038/nsb832.

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Daily Aspirin Not Recommended for Everyone

By Alison McCook

Reuters Health

Monday, August 19, 2002

NEW YORK (Reuters Health) - Research into the benefits of daily aspirin for preventing heart attacks have not adequately measured the effects of the drug in people at low risk of cardiovascular disease, according to US researchers.

Although current research suggests that those at risk of heart attack can benefit from daily aspirin, this does not mean that the drug is right for everyone, lead author Dr. John M. Boltri of Mercer University School of Medicine in Macon, Georgia, told Reuters Health.

"Right now, there is just insufficient evidence to justify recommending aspirin therapy to low-risk individuals," Boltri said.

In fact, given the risk of aspirin's side effects, such as bleeding, people who have a low risk of heart attack might be better off without a daily dose, Boltri noted. If they would never experience heart attacks anyway, their risk of side effects outweighs the treatment's ability to save their lives, he added.

However, Boltri cautioned that patients should rely on their doctors to help them determine their risk of heart attack, because many adults have so-called "silent" conditions that place them unknowingly in a higher risk category.

"It really should be something they are talking to their physicians about," Boltri noted.

Researchers have suggested that aspirin may help prevent heart attacks by reducing the "stickiness" of platelets, substances in the blood that can form a life-threatening blood clot within the blood vessels.

Reporting in the August issue of The Journal of Family Practice, Boltri and his colleagues reviewed previous research into the benefits of daily aspirin for preventing heart disease and heart attacks in people at low risk of these events.

Low-risk individuals were defined as having no more than one of the common risk factors, including high blood pressure, family history of the disease, or diabetes. In men, a risk factor for cardiovascular disease includes being older than 45, and for women being over 55.

The researchers restricted their search to studies that measured death rates in patients from all causes, because only reporting deaths from cardiovascular disease might miss those who die from side effects of aspirin, which include gastrointestinal bleeding and bleeding in the brain.

The investigators ended up with three studies that met their criteria, which included more than 110,000 patients.

Boltri's team found that two of the studies showed that people who were at low risk of cardiovascular disease had no lower risk of death when they took aspirin regularly than when they didn't. Moreover, the other study included in the analysis suggested that low-risk patients who take aspirin might have an even higher risk of dying than those without a daily dose.

"There is insufficient evidence for or against recommending aspirin to low-risk individuals," the authors conclude.

Source: The Journal of Family Practice 2002;51:700-704.

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Blueberries May Help Old Folks Keep Their Smarts

By Anne Harding

Reuters Health

Monday, August 19, 2002

BOSTON (Reuters Health) - A cup of blueberries a day may keep "senior moments" away, new findings suggest.

A team of Massachusetts and Florida researchers has shown that the fruit reduces aging-related damage in rat brains, and can also prevent mental decline in mice genetically engineered to develop Alzheimer's-like plaques in their brains.

The findings, along with early results from a human study, suggest a healthy diet can go a long way toward preventing the mental decline that often accompanies aging, Dr. James A. Joseph of the Center on Aging at Tufts University in Boston and USDA Human Nutrition Research told Reuters Health.

Joseph presented his findings here Monday at the American Chemical Society's annual meeting.

Cell-damaging products of normal metabolism known as free radicals can injure tissue, an effect known as oxidative damage. Antioxidants -- found in several fruits and vegetables, including blueberries -- help prevent this damage, which has been implicated in a number of conditions including cancer, Alzheimer's and heart disease. Oxidative damage is also a factor in aging.

Aged rodents that consumed the human equivalent of one cup of blueberries a day showed less oxidative damage in tissue from two distinct brain regions, Joseph and his team found.

To evaluate whether this effect might extend to behavior, Joseph and colleagues David Morgan, Gary Arrendash and David Diamond from the University of South Florida, put mice through a three-armed maze.

Half of the mice were genetically engineered to develop Alzheimer's-like plaques in their brains, while the rest were not. In each group, half of the animals were given blueberry-based pellets.

Testing began when the mice were young, before the genetically modified animals had developed plaques. The study lasted a year.

The mice with pseudo-Alzheimer's that didn't eat blueberries performed worse and worse on the maze over time. But the genetically modified animals given blueberries showed no decline; they performed just as well as normal mice, even though they still developed plaques.

Joseph said he believes the berries' brain-protecting power goes beyond its known antioxidant and anti-inflammatory effects. Blueberries seem to "directly influence the way neurons communicate," he told Reuters Health.

Preliminary results from a new study, he added, show that people who ate a cup of blueberries a day appeared to be protected from aging-related mental decline. Joseph expects the study will be published late this fall.

The next steps, the Boston researcher said, will be to do more tests in transgenic animals, evaluate which chemicals in blueberries find their way into the brain, and study how the fruit might be protecting the brain.

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Honey Shown to Boost Antioxidants in Blood

By Anne Harding

Reuters Health

Monday, August 19, 2002

BOSTON (Reuters Health) - If findings from preliminary research pan out, honey could offer a sweet way to get a serving of antioxidants.

Dr. Nicki Engeseth from the University of Illinois at Urbana-Champaign reported on her research, the first to look at blood levels of antioxidants in humans after honey consumption, at the American Chemical Society's annual meeting here Monday.

Engeseth and her colleagues demonstrated in previous studies that the darker the honey, the richer it is in antioxidants. The color and composition of honey depends on the blooms. Buckwheat is the darkest honey the researchers have tested, and it's "higher in just about everything," Engeseth noted, including protein and chemicals called phenolics.

On a per-weight basis, she and her colleagues have shown, the darkest honey contains antioxidant levels similar to those found in spinach and garlic. While it wouldn't be advisable to consume the weight equivalent of a vegetable serving in honey, Engeseth noted that it's easy for people to slip honey into their diets in place of sugar and other sweeteners.

Engeseth's team decided to test the effect of honey on antioxidant blood levels in a group of 25 men aged 18 to 68 years. After they had fasted for 12 hours, the researchers gave the men water, black tea, water and honey, tea and honey or tea with a sugar-like sweetener. The men were given about four tablespoons of honey in a 16-ounce glass of water or tea, and tested once a week for 5 weeks.

Their blood was tested 60 and 90 minutes after they drank the beverage. Surprisingly, the researchers found that water mixed with honey was the only drink that increased levels of antioxidants in the blood, even though tea itself is known to contain antioxidants.

She and her colleagues are now conducting a longer-term experiment in rabbits with high cholesterol, to see if honey has any effect on blood vessel and heart health. Engeseth's research is funded by the National Honey Board, as well as the Functional Foods for Health Program.

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Broccoli-Derived Pill May Help Ward Off Cancer

By Anne Harding

Reuters Health

Monday, August 19, 2002

BOSTON (Reuters Health) - A new molecule based on the cancer-fighting chemical found in broccoli, cabbage and other pungent vegetables (called sulforaphane) is safer than the original and much cheaper, Chicago researchers reported here Monday. And it appears, so far, to be equally effective in building the body's defenses against cancer.

Dr. Jerry Kosmeder of the University of Illinois reported on an animal study of the new chemical, oxomate, at the American Chemical Society's annual meeting.

Sulforaphane, found in broccoli, Brussels sprouts and other cruciferous vegetables, strengthens the body's defenses against cancer by promoting the activity of detoxifying chemicals known as phase II enzymes.

But sulforaphane can be toxic, and is very expensive to produce. The going rate for synthesizing 50 grams of sulforaphane, Kosmeder told Reuters Health, is $50,000. Kosmeder and his colleagues "tweaked" the original molecule to come up with oxomate, which also boosts phase II enzyme activity but is 7 to 10times less toxic than sulforaphane. And for $50,000, he told Reuters Health, it's possible to synthesize hundreds of kilograms of oxomate.

The Chicago researchers tested oxomate in female rats that had been given cancer-promoting chemicals. Oxomate produced a 50% reduction in breast tumors in the animals. The team is now investigating whether oxomate can prevent skin cancer in ultraviolet-irradiated mice. They are planning a similar study of colon cancer in the "near future." All research is being funded by the National Cancer Institute ( news - web sites).

The goal of the research, Kosmeder said, is a pill people could take every day, like a vitamin, to help prevent cancer.

"For people who are at risk, like cigarette smokers, this would be very advantageous," he added.

Kosmeder filed for a provisional patent on oxomate last week, with the intention of drawing interest from pharmaceutical companies. Funding from industry, he explained, could speed the development of a nutritional supplement based on the chemical.

Kosmeder anticipates that human studies could begin in 5 years.

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Almonds, as Part of Healthy Diet, Cut Cholesterol

By Suzanne Rostler

Reuters Health

Monday, August 19, 2002

NEW YORK (Reuters Health) - Including almonds in an overall healthy diet may help to reduce cholesterol levels, the results of a small study suggest.

According to the report funded by The Almond Board of California and the Canadian government, adults who substituted 74 grams of almonds (about 2 ounces) for other foods reduced their LDL ("bad") cholesterol by nearly 10% after 1 month. Adults who consumed fewer nuts also saw their cholesterol levels fall, researchers report in the September 10 rapid access issue of Circulation: Journal of the American Heart Association ( news - web sites).

However, adding nuts to a diet already sufficient in calories and fat could lead to weight gain, a risk factor for heart disease, cautions Julie Walsh, a spokesperson for the American Dietetic Association. While nuts are rich in protein and healthy monounsaturated fat, they are also high in calories.

"People have to remember when they eat nuts they have to take out calories elsewhere," Walsh said in an interview with Reuters Health.

The study included 27 adults with high cholesterol and an average age of 64 years, who agreed to follow three diets with a different snack of about 420 calories per day, for a month each.

The first diet included a snack of 74 grams of almonds, the second diet included about 37 grams of almonds plus one-half of a muffin, and the third diet substituted a whole-wheat muffin, low in saturated fat, for the nuts. The muffin had roughly the same amount of protein and saturated and polyunsaturated fat as the nuts.

But almonds are higher in monounsaturated fat, found also in avocados, olive oil and other types of nuts. When substituted for saturated fat or trans fat, which is found in processed foods and baked goods, monounsaturated fat has been shown to lower cholesterol levels.

Indeed, adults eating the diet with more almonds reduced their LDL cholesterol by 9.4% and lowered their ratio of LDL to HDL ("good") cholesterol -- an important marker of heart disease risk -- by 12%, after one month.

The diet with the half-portion of almonds was associated with a more than 4% average reduction in LDL and a nearly 8% reduction in the LDL to HDL ratio. Average cholesterol levels did not fall in those on the diet that included just the muffin. There was no change in body weight associated with any of the snacks.

"Almonds (and nuts) may be included as part of a healthy diet to reduce the risk of heart disease without weight gain," Dr. Cyril W.C. Kendall, a study author from the University of Toronto in Canada, told Reuters Health.

"The health benefits would be observed in individuals with high cholesterol and in those with normal levels," he added.

Source: Circulation 2002;10.1161.01.CIR.0000028421.91733.20.

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Enzymes Help Predict Death Rate After Angioplasty

By Merritt McKinney

Reuters Health

Monday, August 19, 2002

NEW YORK (Reuters Health) - Checking levels of a heart-related enzyme may identify patients who are at the greatest risk of dying after having balloon angioplasty to unclog blocked blood vessels, according to the results of a new study.

The enzyme, known as creatine kinase-MB (CK-MB), rises after a heart attack to signal that heart muscle has been damaged. Measuring CK-MB levels is a standard test for diagnosing heart attack. But levels of the enzyme also may rise after angioplasty, during which a balloon-tipped catheter is threaded into a blocked artery and inflated, flattening fatty plaques against the artery wall.

Doctors often measure CK-MB levels in angioplasty patients, but what to do with the results has been uncertain, the study's lead author, Dr. Stephen G. Ellis, of the Cleveland Clinic Foundation in Ohio, told Reuters Health in an interview. The results of the study, he said, should help physicians "better understand what to do with the results."

For most angioplasty patients, even those with elevated CK-MB levels, reducing the risk of death does not require extra time in the hospital, although they may benefit from cholesterol-lowering drugs, Ellis and his colleagues suggest in a report on the findings. The report, which is being published online, will appear in the September 3rd issue of Circulation: Journal of the American Heart Association ( news - web sites).

Patients with CK-MB levels that are more than five times higher than normal--who were found to have an increased risk of dying--should probably only be kept in the hospital longer if they have other risk factors, such as congestive heart failure, kidney failure and older age, according to Ellis and his colleagues.

The study included more than 8,000 patients whose CK-MB levels were measured 6 to 8 hours after angioplasty as well as on the morning after the procedure.

Patients with higher-than-normal CK-MB levels, especially those whose enzyme levels were more than five times higher than normal, were more likely to die during the 4 months after angioplasty. During this time,1.2% of patients with normal CK-MB levels died, compared with 1.9% of patients whose levels were one to five times higher than normal, and 8.9%of those with higher levels. The increased risk of dying was most prominent during the first few months after angioplasty.

But among patients with CK-MB levels that were one to five times above normal, the increase in death risk mostly occurred more than 1 week after angioplasty, suggesting that keeping these patients in the hospital for a few extra days would do little to prevent deaths, the researchers report.

But because the study showed that patients who were not taking cholesterol-lowering drugs called statins were more likely to die after angioplasty, the authors conclude that high-risk patients should be" strongly considered for statin therapy." In the interview, Ellis recommended that angioplasty patients ask their physicians whether they should be taking statins. Although the drugs were developed to lower cholesterol, Ellis speculated that the benefits to angioplasty may stem from anti-inflammatory actions of the medications.

Source: Circulation 2002;10.1161/01.CIR.0000028146.714162E.

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More Evidence HRT Doesn't Cut Heart Risk: Study

By Suzanne Rostler

Reuters Health

Monday, August 19, 2002

NEW YORK (Reuters Health) - Hormone replacement therapy (HRT) does not lower the risk of developing heart disease among postmenopausal women, according to a review of more than 30 years of medical data.

The findings support those of a much-publicized trial halted last month, which demonstrated that the risks of HRT outweigh the benefits for the majority of postmenopausal women. In that study, the Women's Health Initiative, women with an intact uterus who took the combined estrogen plus progestin therapy had a higher risk for breast cancer ( news - web sites), heart attack, blood clots and stroke.

The current report found that HRT neither lowered nor increased the risk of heart disease and coronary artery disease (CAD), a type of heart disease that occurs when fatty deposits narrow the arteries that supply blood to the heart. CAD can lead to chest pain and heart attack.

A number of previous studies have linked hormone use with a decreased risk of heart disease. But according to the current analysis, other variables may have been responsible for these results.

For instance, studies reporting a protective effect of HRT did not account for women's socioeconomic status, and studies that showed little or no protective effect took a woman's social and economic class into account, Dr. Linda L. Humphrey and colleagues note in the August 20th issue of the Annals of Internal Medicine.

"Healthy women...tend to have more money, time, obtain preventive healthcare, and have behaviors that may protect them from heart disease," Humphrey explained in an interview with Reuters Health.

"You can get a spurious relationship because healthy women are the ones who decided to take hormones in the first place," added Humphrey, from the Veterans Affairs Medical Center in Portland, Oregon.

The researchers reviewed observational studies on the relationship between HRT, heart disease and coronary artery disease, and included 20 studies in their final analysis. All of the studies included data on potentially confounding factors such as a woman's age, smoking and exercise habits, cholesterol levels, family history of heart disease, socioeconomic status, and other conditions such as high blood pressure or diabetes.

The results "support the findings of the Women's Health Initiative that there is no current evidence to support using hormones to prevent heart disease," Humphrey said. "My personal belief is that you shouldn't take hormones for cardiovascular disease protection."

She recommends that women who have been taking HRT review the reasons why they are taking hormones with their physicians and discuss the potential risks and benefits.

Source: Annals of Internal Medicine 2002;137:273-284.

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Tests Begin on New Type of Vaccine for Malaria

Reuters

Monday, August 19, 2002

LONDON (Reuters) - British scientists have begun tests in Gambia on a new type of vaccine for malaria that could one day save millions of lives.

Some 360 Gambian adults will be given shots. Half will receive the malaria vaccine, with the other half given a rabies shot to compare the effects.

At present there is no effective, widely used vaccine for the tropical disease spread by mosquitoes.

Professor Adrian Hill of Oxford University told Reuters the vaccine being tested was the first of a new kind.

Unlike conventional vaccines, which "teach" the body's immune system to recognize and destroy an organism that causes an infection, the new vaccine would teach the body to recognize its own infected cells.

"Kill the cell and the parasite at the same time. That's the principle," he said. "This would be the first (vaccine) that is explicitly designed to stimulate that arm of the immune system."

Similar principles could one day be used to help prevent or treat other diseases, such as cancer or HIV ( news - web sites), he said.

Hill said his vaccine has already been shown to help curb the spread of malaria in tests done in Britain, where volunteers allowed themselves to be bitten by infected mosquitoes.

The Gambia trials will be the first large-scale test in the field. The research is being funded by Britain's Wellcome Trust, the world's largest medical research charity.

Hill said he hoped proving the vaccine was at least partially effective in the field would attract investment from large drugs companies, who have so far been reluctant to commit resources to preventing a disease found mainly in poor countries.

"Nobody becomes a billionaire by making a malaria vaccine," Hill said. "It is extremely complicated research."

Each year, malaria sickens millions of people in tropical countries and kills between one and two million children, Hill said.

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Fewer U.S. Teens May Be Smoking, Using Drugs

Reuters Health

Monday, August 19, 2002

NEW YORK (Reuters Health) - US high school students have an easier time buying marijuana than cigarettes and beer, according to a national survey of public school students. At the same time, more public schools are drug free than in the past seven years.

The researchers found that the roughly one third of teenagers surveyed who said they had an easier time buying marijuana were 1.5 times more likely than their peers to use drugs.

Similarly, teens who said marijuana is not harmful were nearly three times more likely to abuse pot than their peers who believe the drug is dangerous, according to the report by the National Center on Addiction and Substance Abuse (CASA) at New York City-based Columbia University.

But availability and beliefs about drugs are not the only influences on teens' decisions to use drugs, the survey found. At home, younger siblings who believe that their older brother or sister had tried illegal drugs were 1.5 times more likely to report smoking, drinking or using illegal drugs.

And teens who live with a sibling who pushes drugs are twice as likely to abuse substances, while teens who said their older sibling would be "very angry" to learn they were using marijuana were less likely to abuse substances, the survey reports.

Overall, however, a majority of 12- to 17-year-old public school students reported that their school is drug free for the first time in the survey's 7-year history. About 62% of the 1,000 students surveyed said drugs were not used, kept or sold at their school, up from 42% in 2000.

Parochial school students reported a similar rise to 79% of those surveyed from 65% in 2000.

The results may indicate that a smaller percentage of students are abusing drugs than in the past, because studies have shown that the risk of substance abuse is cut by half when teens attend a drug-free school.

The findings also underscore the role parents can play, Joseph A. Califano, Jr., CASA president, stressed in a prepared statement. Studies have shown that parents who express strong negative opinions about marijuana, for instance, can lower the risk that their teen abuses pot.

"Parents must raise their voices and refuse to tolerate drugs in their teens' schools to maintain this improvement," he said. "It's time all American parents get as angry about drugs in schools as they are about asbestos in schools."

But many parents feel powerless when it comes to protecting their children from drugs, according to the study. More than one-third said they have little influence over whether their teen tries drugs, alcohol or cigarettes. What's more, 43% of parents said their teen was likely to use drugs in the future, compared with just 16% of teens.

To find out about drugs in schools, CASA recommends that parents ask some key questions, including what steps are taken to keep drugs and alcohol off school premises, whether teachers are trained to spot signs of drug abuse, and what education and prevention programs are offered and in what grades.

Indeed, the majority of teens who drink alcohol and smoke cigarettes and marijuana begin between the ages of 12 and 16 years, when the risk of substance abuse increases by 500%, according to the report.

"Drug education efforts must begin as early as elementary school," Califano said in a statement.

The survey was conducted by QEV Analytics, and included telephone interviews with 1,000 teenagers and 541 parents between December 2001 and February 2002.

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Jab-Free Blood Sugar Test Inching Closer to Reality

By Anne Harding

Reuters Health

Monday, August 19, 2002

BOSTON (Reuters Health) - Scientists are hard at work looking for ways people with diabetes can measure their blood sugar without the painful and scarring jabs now necessary for blood collection.

Several researchers discussed the state of the art Sunday at a symposium at the American Chemical Society's annual meeting.

Dr. Yizhong Yu, chief scientist at Animas Corporation in Frazer, Pennsylvania, discussed his company's efforts to develop a tiny, titanium-coated device that would communicate continuous blood glucose readings to a monitor worn on the patient's wrist. Sensors would poke through a blood vessel wall to gauge the blood's absorption of near-infrared light. The device, roughly the size of a pacemaker, would convert these readings to blood glucose levels, and is intended to last for at least 5years in the body.

One major hurdle in developing devices that use light to measure blood glucose has been coming up with a formula to convert light wavelength readings into glucose levels. Yu reported that blood tests from more than 500 patients--far more than other companies developing similar devices--have shown Animas's formula is quite accurate.

Human tests will likely begin in a year or less, Yu said. But, he added, "I do not want to paint a very rosy picture...there is a lot for us to do to really get a sensor to the market." He told Reuters Health he could not estimate the price of the device, but said it would be a cost insurers would be comfortable paying.

Animas's device, Yu and other panelists at the meeting said, is the furthest along among other similar implantable devices under development.

Researchers are also investigating a completely non-invasive method: measuring wavelengths of near-infrared light after it passes through the skin. Dr. Mark A. Arnold of the University of Iowa in Iowa City reported on his efforts using this method.

After about 9 years, Arnold said, he and his colleagues are ready to begin clinical tests of a system in which a beam of light is passed through a roughly 2 millimeter pinch of skin at the back of the hand. The experiments are being funded by NASA ( news - web sites), the National Institute of Diabetes and Digestive and Kidney Diseases, and Inverness Medical Technology.

Dr. Gerard L. Cote of Texas A&M University and his colleague Michael V. Pishko of Pennsylvania State University are developing a sensor that would be implanted just under a patient's skin. The implant would consist of tiny beads or a thin slab of material that would glow under fluorescent light to varying degrees depending on the glucose concentration between skin cells.

In this method, a person would, theoretically, get the implant at a doctor's office. Then he or she could shine fluorescent light from a device about the size of a laser pointer on the skin over the implant. The device could read the resulting level of fluorescence and provide a blood glucose reading.

Tests in rats have shown the implants did not produce inflammation in the animals or irritate them in any apparent way, and that the beads did fluoresce under the skin under fluorescent light. A sheet of the material would probably be most practical for human use, Cote noted, as it would be easier to remove and provide a larger area for readings. He predicts such an implant could probably last a year in the body.

He predicted that human tests of the material could begin in 5 years. "A lot of it depends on funding," he added.

Dr. Vladimir Alexeev of the University of Pittsburgh and colleagues are developing a material that, they hope, could be used as an eye insert or contact lens that would monitor glucose levels in the tear fluid covering the eye. The material, called a hydrogel, changes color as glucose levels increase and decrease.

Alexeev and colleagues are now working on their third generation of the material, which shows a shift from red to blue as glucose levels rise. Alexeev's team has received an NIH grant to begin animal studies of the material.

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Flu Vaccine Guards Against Illness and Saves Money

By Charnicia E. Huggins

Reuters Health

Monday, August 19, 2002

NEW YORK (Reuters Health) - Annual influenza vaccinations seem to protect all adults--not just elderly and other at-risk individuals--during flu season and may also be a money-saving option for employers, new study findings suggest.

Each year, influenza reportedly affects as many as 2 out of every 10 individuals in the United States.

"From this analysis it appears that vaccination of healthy workers is cost saving (in) paying for itself and reducing the frequency of flu," study author Dr. Eric D. Peterson of Duke University Medical Center in Durham, North Carolina, told Reuters Health.

He and his colleagues analyzed previously published data to determine the most cost-effective strategy for preventing and treating the flu in healthy adult workers aged 18 to 50 years. The economic value of the treatment was determined by treatment costs and the number of workdays gained.

Overall, the health benefits of flu vaccination outweighed its associated costs, the investigators report in the August 20th issue of Annals of Internal Medicine.

The best treatment strategy for individuals already infected with the flu bug was vaccination combined with the antiviral drug rimantadine, study findings indicate.

This treatment combination was associated with a cost savings of $30.97 in health benefits, such as workdays gained, compared with nonvaccination and no antiviral treatment, study findings indicate.

Peterson and his team also compared rimantadine with two newer antiviral drugs, to determine if the newer drugs were worth their higher cost.

They found that all of the drugs had health benefits that equaled or exceeded their costs, the report indicates.

Rimantadine was slightly more cost-effective than the newer drugs, yet it was also associated with more frequent nausea and dizziness--side effects known to be more severe in elderly individuals than among healthy workers, the researchers note.

Further, rimantadine is mainly effective against only one type of influenza, according to Peterson.

Taking the newer drugs would require individuals to "trade off a little more cost for newer drugs for their efficacy and fewer side effects," Peterson said. But "if feeling better leads to more days of work, you've more than covered the cost of the drug," he said.

Peterson added that his study did not pit the drugs against each other to determine which drug was the best treatment for influenza.

"Head-to-head trials of various flu treatments need to be done in order to decide which is the best overall," he said.

Source: Annals of Internal Medicine 2002;137:225-231.

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SUNDAY, AUGUST 18, 2002

A New Take on the Prescription Drug Flap

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews

Sunday, August 18, 2002

SUNDAY, Aug. 18 (HealthScoutNews) -- Amid the controversy surrounding the high cost of prescription drugs, some health professionals contend there's already a product in place that ensures the fairest prices for consumers.

It's called the generic drug.

"The development of generics has been one of the best success stories in the health-care field in the last 20 years," says Daniel Albrant, president of a Virginia-based health-care consulting company, and a spokesman for the American Pharmaceutical Association.

"And the present medications are probably one of the most cost-effective parts of the health-care system," he adds.

Others disagree, saying access to prescription drugs needs tweaking -- at a minimum -- so it's more palatable to consumers.

"I'm fairly horrified by the cost of drugs -- they should be available at a much lower cost," says Dr. Jean Barbey, interim director of Georgetown University Hospital's division of clinical pharmacology in Washington, D.C.

Generic drugs are copies of brand name drugs whose patents have expired. A drug company that creates a new drug has a 17-year patent on that drug, after which time it loses the exclusive right to manufacture it. Then other companies are free to produce the same drug, Albrant says.

Because those companies don't have to pay for the expensive research and development that goes into the creation of a drug, they can sell it at a much lower cost. The savings to the consumer, or a third-party provider, are considerable -- often half the price of the brand name drug, Albrant says.

Since 1984, when Congress passed a law to streamline the production of safe generic drugs, the Food and Drug Administration ( news - web sites) has approved the sale of about 250 generic drugs every year. The result has been a huge savings for consumers, either directly or through health-care plans, says Albrant.

"It's difficult for consumers to see, but it's true that all these new drugs have improved people's life spans and the quality of their lives," he says.

But health-care experts like Barbey contend that not enough is being done to keep prescription drugs within the reach of all who need them.

"Money is spent on marketing and direct advertising to potential customers that could constructively be used in other ways," Barbey says. "Right now, no health authority is trying to regulate this free-for-all market, trying to limit it a little bit without stifling research."

Barbey, a Swiss native, says the more socialistic European models are better able to control prices.

In France, for instance, a drug company seeking to develop a drug must consult with the government about its plan. Then the government, weighing the health benefits and cost-effectiveness of the drug, sets the price at which the company can sell it.

In the United States, Barbey says, the free market also allows drug companies to try to extend their patents by manufacturing so-called "new" drugs that are simply variations on the original. This often happens, he says, with drugs that treat common ailments like allergies and depression.

And, Barbey adds, American drug companies seeking to boost profits often manufacture too many of the same kind of drugs, called "me-too" drugs. He points to the approximately one dozen different ACE inhibitor drugs on the market, which are designed to treat high blood pressure.

"This is an excellent class of drugs, and you could argue that you need more than one drug from the class, but do you need 12?" he asks.

But Albrant counters that the very free-market system that Barbey criticizes has actually encouraged the development of more and better drugs. Facing deadlines on their patents, companies are always seeking to develop new products.

"The pharmaceutical industry has become more efficient," he says. "They can't sit back on their laurels. They need to continue to produce more compounds."

This has meant that companies that would have been content to produce drugs for large segments of the population -- such as those with cardiovascular disease or cancer -- have had to target smaller groups of people, developing new drugs for those with conditions like migraines, epilepsy or depression.

Despite their philosophical differences, Albrant and Barbey agree that generic drugs are as effective and as safe as brand name drugs.

"I have no hesitation in prescribing generic drugs," Barbey says.

Adds Albrant: "I recommend them all the time, confident that the products are equivalent in every way to the trade name products, but at a reduced cost."

The testing for generics is quite thorough, Barbey says. In a typical study to compare them to brand name drugs, study participants are divided into two groups. One group takes the brand name drug and the other takes the generic, and both groups have blood samples taken.

Several weeks later, the test is repeated, only this time the participants switch drugs, then give another blood sample.

All the blood samples are then examined to reveal how quickly both drugs were absorbed into the blood, the maximum concentration of the drug in the blood, and how long it stayed in the body.

If the results show that the generic drug comes close to matching the performance of the brand name drug, it is approved as "bio-equivalent" to the original drug.

What To Do

To look up any drug approved by the Food and Drug Administration, check the agency's Orange Book. For more on the difference between generic and brand name drugs, visit this Federal Trade Commission Web site.

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Getting Into the Swing of Things

HealthScoutNews

Sunday, August 18, 2002

SUNDAY, Aug. 18 (HealthScoutNews) -- Don't let tennis elbow serve up a grand slam of trouble.

Overuse of your arm and forearm muscles can cause abrupt or subtle tearing of the muscles and tendons around the outside of the elbow, resulting in pain. That's tennis elbow.

Just because it's called that doesn't mean it's limited to people who play tennis. It can affect other athletes and people who do leisure or work activities that require repetitive arm, elbow and wrist movement, says Dr. Stephen Silver, an orthopedic surgeon at the Insall Scott Kelly Institute for Orthopaedics and Sports Medicine at Beth Israel Medical Center in New York City.

He offers the following tips to prevent tennis elbow:

·         Hit some soft shots with a partner before you start a tennis match.

  • When hitting backhand, begin the motion at the shoulder and avoid placing your thumb behind the racket's grip. This reduces the amount of vibration absorbed by your arm.
  • Dust your racquet handle with sawdust or chalk to reduce slippage.

Silver says the most common symptoms of tennis elbow include:

·         Pain slowly increasing around the outside of the elbow. Sudden development of pain can occur, but is less common.

  • Your pain is worse when you shake hands or squeeze objects.
  • The pain is made worse when you stabilize or move your wrist by force. For example, when lifting, using tools or handling simple utensils such as a knife or fork.

Silver says 95 percent of people with tennis elbow improve and recover with non-surgical treatment. However, such treatment is most effective if it starts as soon as symptoms appear. The longer you've had tennis elbow, the longer your rehabilitation and the greater chance you'll need surgery.

More information

The Canadian Centre for Occupational Health and Safety has all the facts about this condition.

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SATURDAY, AUGUST 17, 2002

Democrat: Medicare Fails Elderly

The Associated Press

Saturday, August 17, 2002

WASHINGTON (AP) - Medicare limits the services available to many elderly patients by failing to adequately reimburse hospitals and health care professionals in dozens of states, Rep. Leonard Boswell ( news, bio, voting record), D-Iowa, said Saturday.

"It must be fixed," Boswell said in the Democrats' weekly radio address. "Despite the fact that everyone pays the same Medicare taxes, the outdated Medicare formulas do not equally reimburse for seniors' health care."

Hospitals, doctors and nurses across the country are "at risk of being unable to provide the most up-to-date treatment and the most effective care," he said.

Iowa ranks last in the nation in Medicare reimbursement, getting $3,053 for each Medicare recipient, Boswell said. Louisiana is the top-ranked state, getting $7,336 for each recipient.

"In states like Iowa, we are losing a billion dollars for every year that we get reimbursed at less than the national average," Boswell said. He added that 34 other states are paid below that level.

Boswell said he has proposed legislation to bring Medicare reimbursements in all states closer to the national average. He called on President Bush ( news - web sites) and members of Congress to pledge to "end Medicare discrimination."

Boswell is one of several Iowa representatives fighting for re-election this fall in redrawn voting districts. A third-term congressman, he left his farm and a new majority-Republican district and moved to Des Moines in hopes of saving his place in the House.

Last month, Boswell accused the Bush administration of paying close political attention to Iowa while ignoring its shabby treatment in the health care system.

"Clearly, the administration views Iowa as a politically important state," Boswell said then. "I am hopeful we can leverage that into support for Medicare equity."

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Fitting Fitness Back in Your Life

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Saturday, August 17, 2002

SATURDAY, Aug. 17 (HealthScoutNews) -- In the good old days before you were married, had kids, got the promotion, bought the house and did the yard work, you really worked out.

Hard, fast, regularly. Back then, you could run a five-minute mile. Or bench press your weight. Or sweat through that 90-minute advanced aerobics class.

These days, are you spending more time feeling guilty about not working out than working out?

If so, you're probably the kind of lapsed boomer President Bush ( news - web sites) was talking to when he recently declared war on being fat and sedentary. No wonder you weren't invited along on that three-mile fun run with him and his staff.

But you have plenty of company. You've joined the 4-in-10 adult Americans of all ages who admit they are not physically active at all, according to the President's Council on Physical Fitness and Sports.

Exercise experts like Richard Cotton and Cedric Bryant have heard it all before -- busy boomers complaining that, between carpools and van pools and making ends meet, they barely have time for a movie, much less a regular exercise routine.

Cotton is an exercise physiologist and also a spokesman for the American Council on Exercise in San Diego, Calif., an organization that certifies instructors and oversees exercise research. Bryant is the chief exercise physiologist for the council.

They both specialize in motivating inactive people to become involved in exercise programs. They inspire woefully out-of-shape, middle age lapsed exercisers or never-exercisers to consider the benefits of incorporating workouts into their however-hectic-or-sedentary routine, convincing them that the stress-reduction and disease-risk reduction benefits are worth the effort.

Here are some of their best tips.

·        Blot out that "hard body image" memory. It's normal to have a mental image of yourself when you last exercised regularly, says Cotton. If your image is from high school, you could be in big trouble. Even if it was from last year, forget it. "Try to have as little memory as possible of what you used to look like and do," Cotton says. "Be in the present."

  • Start slowly. "Do much less than you think you are able to," Cotton suggests. Take a 10-minute stroll if you're newly back to workouts. Clients tell Cotton, "It's not enough." No, he replies, it's not, "but it's a start." Consider walking as a good way to get back to exercise.
  • Know the risks of too much, too fast. "Go too fast and you're likely to get injured," Bryant says. That could set you back to square one.
  • Prepare. Plan your workout wardrobe so you'll be comfortable. Consider the weather you will be walking in and decide: long pants, long sleeves, shorts, hat?
  • Don't skimp on shoes. A good pair of shoes should cost about $70, says Cotton, and they'll help ensure good shock absorption and cushioning. Which type? "If you are walking with the hope of jogging eventually, buy running shoes," says Cotton. If you plan to walk as your main exercise, get walking shoes.
  • Don't overlook good socks. Best for workouts: Socks with some synthetic fibers (rather than all-cotton) because they wick away sweat better. When you try on exercise shoes, wear your exercise socks.
  • Increase your duration of exercise in small increments. "Spend one week minimum at each phase," Cotton says. Exactly how long you will walk in each phase will depend on your stamina and your doctor's advice. But you might begin with as little as a 15- or 20-minute walk, then work up, Cotton says. Add duration before speed. You can increase the length of the walk each phase, by perhaps five minutes a phase. Soon, you'll be at the recommended 30 minutes (or more) a day, five or more days a week. "Accept yourself where you are," Cotton says.
  • Do the talk test. If you can't talk with ease as you walk or jog, you're going too fast and trying to do too much, Bryant says.
  • Remember to stay well-hydrated. "The thirst mechanism is less sensitive by age 50," Bryant says.
  • Add strength training to the cardiovascular routine. But only when you are ready, Cotton suggests.
  • Consider getting an exercise buddy. That could help increase your faithfulness to your new routine. "An exercise buddy is always nice," Cotton says, "especially if you can latch on to someone who already has the habit. That's a free ride."
  • Be realistic about the payoff. You might notice looser waistbands but no difference on the scale. "As you get up into the 35-, 40- or 45-minute walks that are brisk, you can expect weight loss," Cotton says. "But figure it takes six to eight weeks to transform your body. And even if you do not lose a pound, you are healthier if you exercise."

And quite possibly, that might put you higher up on Bush's invite list, should he host another run.

What To Do

For more information on exercise and age-related weight gain, see the American College of Sports Medicine. For information on staying fit, see American Council on Exercise.

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