The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
April 26, 2004




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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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

Personal Health for the Week of March 1-5





Friday, March 5, 2004

  1. Americans Eating More Fat, Risking Health – Experts
  2. Blocked Sinuses
  3. Texas Schools Told to Cut Fatty Foods
  4. The Genetics of Rheumatoid Arthritis
  5. Study: Plant Extracts May Ease Dementia Symptoms
  6. Measuring the Damage of Cancer
  7. Sweet White Potato Extract May Help Curb Diabetes
  8. Teen Weight Gain Surpasses Previous Generation
  9. Fitter Men Carry Less Weight Around Belly: Study
  10. Education Fails to Cut Older Drivers' Crash Rates
  11. Pain Relievers Work Against Blood Pressure Drugs
  12. Are You Paying Too Much for Hypertension Drugs?
  13. Earlier Is Better for Anti-Stroke Drug
  14. Arthritis Raises Risk of Back Problems in Women
  15. Skipping Meals: A Bad Idea
  16. High Blood Pressure Risk Climbs with Kids' Weight

    Thursday, March 4, 2004

  17. Arm Exercises After Stroke Improve Function
  18. Dairy, Moderate Fat Intake May Help Kids Stay Lean
  19. Vitamins Don't Prevent Pneumonia in Male Smokers
  20. Education Doesn't Prevent Obesity in Black Women

    Wednesday, March 3, 2004

  21. McDonald's to Eliminate Supersizes by Year-End
  22. Working Poor Face Higher Obesity Rates
  23. California County Bans Planting of Biotech Crops
  24. Study: Obese Women Earn 30 Percent Less
  25. MMR Doctors Reject Own Autism Link Report
  26. Report: FDA Needs Seafood Safety Fixes
  27. Benign Virus May Guard Against AIDS Progression
  28. Safe Stairs For Seniors
  29. Drugs Cut Kidney Failure Risk in Lupus – Study
  30. Vision Loss
  31. Hormone Use May Cut Colon Cancer Risk in Women
  32. For Workplace Safety, the Eyes Have It
  33. Nerve Block Best for Pancreatic Cancer Pain
  34. New Way to Stitch Up Arteries
  35. Stomach Size Alone Affects Food Intake
  36. Health-Care Spending Evens Out in the End
  37. Many Fathers Uninvolved in Children's Health Care
  38. New Exam May Improve Treatment of Lung Disease
  39. Dietary Folate May Lower Ovarian Cancer Risk
  40. Short Daily Walks Not Enough to Fight Fat
  41. School Program Curbs Teen Suicide Attempts: Study
  42. Inactivated Flu Vaccine Works in Kids Too

    Tuesday, March 2, 2004

  43. Shortage in U.S. Forces Cutback in Prevnar Vaccine
  44. Groups Urging No Antibiotics for Earaches
  45. Birth Control Pills Lower Risk of Arthritis
  46. When Breast-Feeding Moms Return to Work
  47. Estrogen Trial Shows Stroke Risk Raised
  48. Iron Deficiency Anemia
  49. New Meat Testing Cuts Food-Borne Diseases – US
  50. When It's Hard to Swallow
  51. Teens Buy Nicotine Patches as Easily as Cigarettes
  52. Taking the No-Smoking Message to Schools
  53. Radiosurgery Helps with Painful Nerve Condition
  54. Battling Bladder Cancer's Return
  55. Symptoms Common After Breast Cancer Treatment
  56. Breast Cancer Vaccine Promising in Mice
  57. Test May Be Safer Way to Detect Fetal Problems
  58. Scans May Aid Blood Clot Treatment
  59. Suicide Thoughts Treatable in Depressed Elderly
  60. Test Boosts Fetal DNA in Mom's Blood

    Monday, March 1, 2004

  61. Scientists Trick Skin Cells Into Fending Off UV Damage
  62. Video Games Make Kids Fat, Violent, Swedish Experts Say
  63. New Tumor Marker Found
  64. Gene-Testing Families Risk Overheating
  65. Temper Tantrum Can Lead to Heart Woes, Study Shows
  66. IRS Allows Weight-Loss Tax Deduction
  67. Breast-Fed Babies Have Lower Blood Pressure –Study
  68. Survey: Americans Have Super-Sized Bodies
  69. Analyst Expects Premarin Trial to Be Halted
  70. Blue Cross Won't Cover Stomach Stapling
  71. Greek Scientists Find Way to Weaken Cancer Cells
  72. Consumers Question What Food Safe to Eat
  73. Antibacterial Soap Doesn't Prevent Viral Infection
  74. CDC Runs Ads to Get Kids to Play Outside
  75. Report: Standard Tests Not Enough for Baby Formula
  76. Doctors Urge Eye Wear for Kids in Sports
  77. Grapefruit to Blame for Side Effect with Zocor
  78. Shin Splints
  79. Experts: Research Needed Into Rising Teen Cancers
  80. Nearsightedness Treatment May Harm Kids' Vision

    Sunday, February 29, 2004

  81. Too Much Weight Tugs at Kids' Hearts
  82. Experts Urge Tools for Women's Health
  83. Study: Cough and Cold Kits Could Stem Antibiotic Use

    Saturday, February 28, 2004

  84. Be Smart When It Comes to Your Heart
  85. Panel Urges Stricter Limits on Acne Drug
  86. A Migraine in the Forecast

Friday, March 5, 2004

Americans Eating More Fat, Risking Health – Experts

By Maggie Fox, Health and Science Correspondent
Friday, March 5, 2004

WASHINGTON (Reuters) - Americans are eating more fat and cholesterol as "low-carb" diets grow in popularity, but people do not seem to be losing weight and they are putting their health at risk, U.S. researchers said on Friday.

If the trend continues toward more fat and fewer vegetables and grains, Americans could suffer more heart disease, already the No. 1 killer in the country, they warned.

"It is pretty clear from marketing data ... that over the past two years there have been specific trends toward more fat intake in the diet. If that is true, that would then suggest that there are tough times ahead with regard to disease risk," said Dr. Randal Thomas of the Mayo Clinic in Rochester, Minnesota.

Several studies being presented at an American Heart Association (news - web sites) meeting on nutrition and heart disease showed the same thing -- Americans eat too much overall, they eat too much fat, and they do not eat enough fruits, vegetables and high-fiber foods. Reporters were briefed on the San Francisco meeting in a telephone news conference.

Thomas and colleagues at the Mayo Clinic in Rochester, Minnesota, found that fat and especially cholesterol intake has gone up over the past five years among 1,200 area residents surveyed for the study.

In 1999, 70 percent of those surveyed were trying to eat less fat in their diets. The share fell to 65 percent in 2003. Daily cholesterol intake rose from 294 milligrams a day in 1999 to 331 in 2003.

Only 29 percent of the residents -- whom Thomas says are representative of the U.S. public -- met government recommendations of getting no more than 30 percent of calories from fat.

"Reasons for this trend are unclear but may include the aggressive marketing of dietary plans that recommend the liberal use of saturated fat and cholesterol in the diet," Thomas said in a report to the meeting.

Fat-Rich Diets

Such fat-rich plans are led by the Atkins diet, which recommends overloading on protein and fat to cause a metabolic condition called ketosis, in which the body sheds water.

While some of these diets have been shown over the short term to help some people lose weight and to lower cholesterol, the Heart Association says there are no long-term studies and it does not recommend the diets.

On the other hand, greater intake of fat and cholesterol is known to worsen heart disease, Thomas said.

"What this (study) shows is some troubling trends," he told reporters in a telephone briefing.

"I think any diet that recommends increasing the amount of saturated fat poses a risk. There may be good things about the diet ... but any diet that recommends increases in saturated fat could be increasing the risk in the population."

And they may not help people lose weight, suggested a study by Linda van Horn of Northwestern University in Chicago and colleagues.

The study assessed more than 4,000 people in the United States, Britain, Japan and China, asking them to write down everything they had eaten over two 24-hour periods.

"Lo and behold, what we did find is that without exception, a high complex-carbohydrate, high-fiber, high vegetable-protein diet was associated with low body-mass index (the standard measure of healthy weight)," Van Horn said.

The more animal protein a person ate, the higher his or her weight, she said.

Dr. Robert Eckel of the University of Colorado, the Heart Association's spokesman on nutrition, said people should aim to eat plenty of fruits, vegetables and high-fiber grain foods, reduce fat consumption, and exercise.

"There are no good foods and bad foods. It is the overall diet that we are interested in," he said.

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Blocked Sinuses

Friday, March 5, 2004

(HealthDayNews) -- Blocked sinuses, which rarely occur in kids under age five, are usually caused by a cold or hay fever, according to St. Louis Children's Hospital.

By treating your child's sinus congestion, you can prevent it from developing into a true sinus infection.

Here are some tips:

  • Use warm water or saline nose drops followed by suction or nose blowing to wash dried mucus out of the nose.
  • Run a humidifier in the home.
  • Ice applied over the sinus for 20 minutes may give some pain relief.
  • With treatment, sinus congestion often resolves in five to seven days.
  • A fever and increased pain could indicate a bacterial sinusitis that may need an antibiotic.
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Texas Schools Told to Cut Fatty Foods

By Kelley Shannon
Associated Press Writer
The Associated Press
Friday, March 5, 2004

AUSTIN, Texas - Deep-fried fritters and whole milk are on the way out, and baked chips are in at Texas public schools.

In an effort to fight childhood obesity, the Texas Agriculture Department is revamping the rules on what foods public schools can serve to their 4.2 million students. Schools have until August to adapt.

The changes range from requiring that canned fruits be packed only in natural juices or light syrups to limiting chips to the reduced-fat or baked varieties.

Deep fat frying is banned altogether, and so are pizza fund-raisers that compete with the cafeteria. There are also limits on how often french fries can be served, how much fat and sugar a meal can have, and what kinds of milk can be offered (2 percent, 1 percent or skim).

The policy expanded on a move last August by Agriculture Commissioner Susan Combs that banned "foods of minimal nutritional value," including sodas, hard candy and gum, during the elementary-school day and at middle-school lunches.

Combs noted Wednesday that 38 percent of Texas fourth-graders are overweight.

"This is a real problem," Combs said. "Schools ought to have a healthy food environment."

About 20 states already restrict students' access to junk food until after lunch, and about two dozen states are considering total bans or limits on vending machine products.

The Texas policy issued this week and takes effect Aug. 1 for schools participating in the national school lunch, breakfast and after-school snack programs.

Some school officials said the deadline is too soon and the cost of implementing the plan remains unclear.

"At a time when school districts face cuts in essential programs and staff, we remain concerned about possible additional unfunded mandates," said Kathy Golson, a lobbyist for the Texas Association of School Boards.

The ban on deep frying, for example, could require some schools to get rid of fryers and force them to buy more ovens, she said.

On the Net:


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The Genetics of Rheumatoid Arthritis

Friday, March 5, 2004

FRIDAY, March 5 (HealthDayNews) -- Researchers have identified several disease features that are common among people with rheumatoid arthritis (RA) who are related.

A report on their findings appears in the March issue of Arthritis and Rheumatism.

The results point to certain genetic factors that influence susceptibility to the disease and its progression. The findings could help scientists identify new markers for prognosis in people with RA.

Researchers studied 1,097 siblings from 512 families with multiple cases of RA. The volunteers provided clinical and demographic information, including whether their parents had RA.

The researchers obtained radiographs of the hands and feet of each study subject, tested all of them for rheumatoid factor, and analyzed the subjects against a list of disease symptoms and possible manifestations.

The study found that the presence of serum rheumatoid factors of nodules was strongly correlated among siblings. There was also a significant sibling correlation for age at RA diagnosis and disease severity.

Interestingly, the study found that, regardless of the total number of brothers or sisters in these families, the number of siblings stricken with RA was remarkably consistent -- between two and three.

This finding challenges previous findings that the number of people with RA is higher in larger families.

"We did not observe an increase in the number of affected siblings as total sibship [the amount of children born to a couple] size increased. The striking difference in our results compared with those reported by investigators in The Netherlands indicates the need for further study of this issue," study author Dr. Damini Jawaheer writes.

More information

The U.S. National Institute on Aging has more about arthritis.

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Study: Plant Extracts May Ease Dementia Symptoms

Friday, March 5, 2004

LIVERPOOL, England (Reuters) - Extracts of sage and lemon balm may help to improve memory and behavioral problems in people with Alzheimer's disease (news - web sites) and other types of dementia, scientists said Friday.

Professor Elaine Perry, of the University of Newcastle upon Tyne in northern England, told a medical conference that the plant extracts produced promising results in studies.

"In controlled trials in normal volunteers, both extracts improved memory, and lemon balm improved mood. Lemon balm reduced agitation and improved quality of life in people with Alzheimer's disease," Perry said in a statement.

Preliminary data showed that sage also had a significant effect on attention and behavior. The impact of sage on Alzheimer's are still being investigated but preliminary data indicate significant effects on attention and behavior, she added.

Perry, who presented the results to a two-day meeting on the psychiatry of old age, selected and prepared the extracts after studying different plant species used in traditional and herbal remedies and identifying the main chemical components.

The extracts produced minimal or no side effects in the patients and volunteers.

"Extracts of both sage and lemon balm are clearly worth pursuing as potential treatments..," Perry added.

Millions of people worldwide suffer from dementia, which is characterized by memory loss and a progressive decline in thinking, comprehension and judgment. Alzheimer's disease is the leading type of the disorder in the elderly.

Alzheimer's is caused by the build-up of protein deposits called amyloid plaque and the accumulation of tangles in the brain. Drugs can alleviate symptoms but there is no cure.

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Measuring the Damage of Cancer

Friday, March 5, 2004

FRIDAY, March 5 (HealthDayNews) -- The difference between DNA damage caused by cancer-fighting drugs and damage caused by natural cell death is outlined in a study in the March 5 online issue of Cytometry, Part A.

Researchers used cytometry measurement of a phosphorylated histone to detect and quantify DNA damage in individual cells.

DNA damage in the form of double-strand breaks can be caused by naturally occurring cell death, radiation, or anti-tumor drugs.

The ability to use multiparameter cytometry to determine what caused DNA damage could prove important in the future study and understanding of DNA damage and repair. That may be especially true in the context of cellular responses to environmental stress or therapy.

More information

The American Medical Association has more about genetics.

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Sweet White Potato Extract May Help Curb Diabetes

Friday, March 5, 2004

NEW YORK (Reuters Health) - The results of a clinical trial confirm the beneficial effects of Caiapo, an extract of white sweet potatoes, on blood sugar and cholesterol levels in type 2 diabetic subjects.

The authors of a report published in the journal Diabetes Care explain that Caiapo is commercialized in Japan as a dietary supplement used to help prevent and control type 2 diabetes. It is derived from a variety of sweet white potato that grows in mountainous regions.

Dr. Bernhard Ludvik, of the University of Vienna Medical School, in Austria, and colleagues examined the tolerability, effectiveness and mode of action of Caiapo on metabolic control in 61 patients with type 2 diabetes. The subjects were randomly assigned to receive 4 grams of Caiapo or a placebo, each given once daily for 12 weeks.

The researchers report that levels of hemoglobin A-1c (HbA1c), used to measure excess blood sugar, decreased significantly from 7.21 percent to 6.68 percent after treatment with Caiapo. In the placebo-treated patients, HbA1c remained unchanged.

Decreases in fasting blood sugar levels (from 143.7 to 128.5 milligram per deciliter) were observed in Caiapo-treated patients, while no significant change was observed in those who received placebo.

On glucose tolerance testing, patients in the Caiapo group also had significantly decreased 2-hour glucose levels compared with the placebo patients.

"At the end of the treatment period, cholesterol levels in the Caiapo group were lower than those in the placebo group," Ludvik and colleagues report.

No significant adverse events were observed with Caiapo.

"Thus," they conclude, "the nutriceutical Caiapo seems to be a useful agent in the management of type 2 diabetes."

Source: Diabetes Care, February 2004.

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Teen Weight Gain Surpasses Previous Generation

By Kathleen Doheny
HealthDay Reporter
Friday, March 5, 2004

FRIDAY, March 5 (HealthDayNews) -- Teens are gaining weight at twice the rate their parents did when they were in adolescence.

And the fatter teens get, the quicker they are to tire when exercising.

Those are the findings of two studies presented March 5 at the American Heart Association (news - web sites)'s Annual Conference on Cardiovascular Disease, Epidemiology and Prevention in San Francisco.

Both studies, the authors say, point to the need for children to maintain a healthy weight so they can stay physically active and reduce their risk of early cardiovascular problems.

About 15 percent of U.S. teens and children are now overweight, according to the U.S. Centers for Disease Control and Prevention (news - web sites), and that number has more than doubled since the early 1970s.

For the first study, University of Iowa researchers compared two generations in a long-running research project called the Muscatine study that began in Iowa in 1971. The researchers compared the body mass indexes (BMIs) of 518 parents when they were aged 15 to 18 with the BMIs of 228 of their children during the same teenage years.

While the parents' BMIs increased by 0.44 per year from the ages of 15 to 18, their children's BMIs rose by 1.1 per year -- more than twice as much.

"I think it's concerning that there is such an increase," says study leader Dr. Patricia H. Davis, an associate professor of neurology at the University of Iowa. The team also found risk factors for heart disease such as high blood pressure were strongly related to weight, with problems more common as weight increased.

Among males, the average BMIs of the parents when they were teens was 22.97; for their sons it was 24.24, Davis says. Among females, the average BMIs of the parents as teens was 21.9; for their daughters it was 24.4.

A BMI of 18.5 to 24.9 is considered normal weight. While the average BMIs of the current teens aren't classified as overweight, they're very close to being considered heavy.

In the second study, researchers found excess weight hampers a child's ability to be physically active, and that can set him or her up for a vicious cycle of inactivity and even more weight gain.

In the study of 525 boys and girls, aged 4 to 18, Dr. Maria Serratto of the University of Illinois at Chicago Medical Center and JHS Hospital of Cook County, tested the children's endurance on a treadmill as they walked at various speeds and inclines.

They could leave the treadmill when they got too tired to continue. "There was a significant difference in endurance time between the obese and non-obese," says Serratto. "For [overweight] boys, it was 2 minutes or less [total treadmill time]; for the girls, 1.5 minutes."

The heavy children, she says, became physically exhausted much sooner than the normal-weight children did.

Another expert says both studies confirm what's been known about childhood weight problems and inactivity, and should serve as a call to action for parents, teachers and others concerned about the health of America's youth.

"This trend of doubling the rate of weight gain within just a 20-year time frame is really quite scary for the future health and productivity of the nation," says Lona Sandon. She is a registered dietitian and researcher at the University of Texas Southwestern Medical Center in Dallas and a spokeswoman for the American Dietetic Association.

While parents, teachers, school administrators and others all need to promote healthy eating and activity habits, Sandon says parents may be the best place to start.

Sandon urges them to serve as good role models for their children when it comes to a healthful diet and proper exercise.

More information

To learn how to help children get more exercise, visit the U.S. Centers for Disease Control and Prevention. For information on weight problems in children, check with the American Academy of Pediatrics.

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Fitter Men Carry Less Weight Around Belly: Study

Reuters Health
Friday, March 5, 2004

NEW YORK (Reuters Health) - Fitter men are less likely to carry extra pounds around the belly, regardless of how much they weigh, a new study has found.

The findings may help explain some of the benefits of aerobic fitness, since abdominal fat has been linked to an increased risk of diabetes and other health problems.

To better evaluate health risks, researchers say it may be a good idea for physicians to measure waist circumference and aerobic fitness in addition to body mass index (BMI), a measure of obesity that takes into account weight and height.

Aerobic, or cardiorespiratory, fitness refers to how efficient the heart and lungs process oxygen. Compared with people with a high level of cardiorespiratory fitness, less fit people have a hard time processing oxygen when they exercise, causing them to "get winded" or have trouble breathing.

Obesity increases the risk of a long list of health problems, but improved cardiorespiratory fitness seems to reduce some obesity-related health risks. A team led by Dr. Robert Ross of Queen's University in Kingston, Ontario, speculated differences in abdominal obesity may be involved in some of the fitness-related differences.

The researchers measured cardiorespiratory fitness and BMI in nearly 400 white men. They also used CT scans to determine two types of abdominal fat: subcutaneous fat, which is found between the skin and muscle, and visceral fat, which is located deeper within the abdomen.

Men with high levels of cardiorespiratory fitness had significantly less of both types of abdominal fat than less fit men, the study found. However, compared with men with the same BMI, men with moderate-to-high aerobic fitness levels had lower waist circumferences than did men with low fitness levels.

The results of the study were reported in the February issue of the journal Medicine and Science in Sports and Exercise.

Since the health risks of abdominal fat are well established, some of the benefits of aerobic fitness may stem from its effect on fat in the belly, the researchers suggest.

Whether the results would hold true for women and for men of other races needs to be confirmed in future studies, according to the researchers.

Based on the study findings, the researchers say it may be "misleading" to rely on BMI alone to determine a person's health risk. Measuring waist circumference and cardiorespiratory fitness as well may "substantially improve" the ability to identify people who are at high health risk, according to the report.

But Ross and his colleagues add that the results do not mean that people must lose weight around the waist to benefit from exercise. They point out that regular physical activity is known to provide a variety of health benefits regardless of whether a person loses weight in the tummy.

Source: Medicine and Science in Sports and Exercise, February 2004.

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Education Fails to Cut Older Drivers' Crash Rates

Friday, March 5, 2004

THURSDAY, March 4 (HealthDayNews) -- The risk of future collisions for high-risk, visually impaired older drivers was reduced by enrolling them in one-on-one educational safety program, says a University of Alabama at Birmingham study.

However, the program had no impact on the actual rate of collisions over the study period.

"This one-on-one program was the Cadillac version of an education program. It was tailored to each individual's needs. We don't know how we could improve the program, because it was so comprehensive -- nonetheless, it showed no effect on collision rates for this population," researcher Cynthia Owsley, a professor of ophthalmology and director of the clinical research unit, department of ophthalmology, says in a prepared statement.

She was to present the study March 4 at an American Medical Association briefing.

In one-on-one sessions, each person discussed how their visual impairment interfered with safe driving and increased their risk of collision. They later worked on strategies to avoid situations where their visual impairment affected their ability to drive.

These strategies included driving during day instead of night, driving on less busy routes, avoiding rush hour, not driving in bad weather, and using driving routes in which right turns could be used in place of left turns.

"Results of our study suggest that, on average, older drivers do embrace these new behaviors," Owsley says.

"If we are going to offer these programs, we need participants to know that there is a high probability that the program will have limited or no effect on crash risk. There's no evidence that these programs make participants safer drivers," she says.

More information

The U.S. National Institute on Aging has more about older drivers.

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Pain Relievers Work Against Blood Pressure Drugs

By Megan Rauscher
Reuters Health

Friday, March 5, 2004

NEW YORK (Reuters Health) - Pain relief drugs called COX inhibitors seem to reduce the blood pressure-lowering effects of ACE inhibitors, a group that includes drugs like Zestril and Monopril, new research suggests.

This drug interaction seems to occur even when newer COX inhibitors, such as Celebrex (celecoxib) and Vioxx (rofecoxib), are used. However, these newer agents don't seem to cause kidney problems that can occur with older pain relievers, such as Voltaren, Motrin and Relafen.

"Physicians need to be alerted to these effects on blood pressure and kidney function and to monitor blood pressure accordingly in all patients receiving" COX inhibitors, Dr. George L. Bakris and colleagues, from Rush Medical Center in Chicago, note.

The report is published in Hypertension: Journal of the American Heart Association (news - web sites).

The researchers examined the effects of Celebrex and Voltaren on blood pressure and kidney function in 25 patients with arthritis and high blood pressure being treated with an ACE inhibitor. Among other conditions, COX inhibitors are used to treat the pain and inflammation that occurs with arthritis.

At four weeks, Voltaren worsened overall blood pressure control more than Celebrex in patients who were also taking an ACE inhibitor, the team reports. However, at peak drug levels, Voltaren and Celebrex had similar effects on blood pressure.

"We showed that in the presence of ACE inhibitors, kidney function was worsened more with" Voltaren than with Celebrex, Bakris told Reuters Health. In fact, even though a diuretic, or "water pill," was given, the kidney impairment triggered by Voltaren led to ankle swelling. In contrast, no ankle swelling was seen with Celebrex.

High blood pressure and arthritis commonly co-exist in the elderly, leading to frequent co-administration of COX inhibitors and ACE inhibitors, the authors point out in their report. They believe their study provides "new information" regarding the blood pressure and kidney effects of using these two drug classes at the same type.

Source: Hypertension, March 2004.

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Are You Paying Too Much for Hypertension Drugs?

By Ed Edelson
HealthDay Reporter
Friday, March 5, 2004

FRIDAY, March 5 (HealthDayNews) -- Many Americans pay too much for the drugs they take to control high blood pressure, in part because doctors prescribe higher-priced brand name products rather than generics that could do the job just as well, a new study finds.

"We looked at the total cost of drugs for treatment of hypertension," the formal medical name for high blood pressure, says Dr. Randall Scott Stafford, who reported the results of his study March 4 at the American Heart Association (news - web sites)'s Annual Conference on Cardiovascular Disease, Epidemiology and Prevention in San Francisco. "We were interested in what played into the increase in cost of this form of therapy."

In 2002, Americans spent $12 billion on prescription drugs for high blood pressure, says Stafford, who is an assistant professor of medicine at the Stanford University Prevention Research Center. While precise cost comparisons are difficult to make, that appears to be slightly more than double what was spent in 1990, he says.

His study includes information on 17,318 visits to doctors' offices for treatment of high blood pressure in 1990, 21,885 visits in 2002, and cost information from 20,000 pharmacies.

Four factors contributed to the increase in total cost, Stafford says. Many more people are taking drugs (although the heart association estimates that only a third of people with high blood pressure are getting adequate treatment), many patients are taking more than one drug, drug prices in general have gone up, and doctors are selecting more expensive drugs.

"When we analyzed the data, we found that the degree to which selection impacted on cost was the biggest factor," Stafford says.

Use of more than one drug for blood pressure -- a tactic recommended by hypertension experts -- accounts for 8 percent of the cost increase, he says. Growth in the number of people taking the drugs -- a welcome phenomenon -- accounts for 17 percent. Overall drug price increases accounts for 29 percent of the increase.

But more than a third of the increase was due to physicians prescribing higher-price drugs over cheaper alternatives, he says.

Specifically, Stafford pinpoints three classes of drugs. Two are angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), newer and higher-cost medications. The third is diuretics, older drugs that are available in cheaper generic versions.

A month's supply of a diuretic costs about $9, compared to $44 for an ACE inhibitor and $56 for an ARB, Stafford says. And while current guidelines call for use of a diuretic as first-line treatment, prescriptions for these drugs decreased by 50 percent between 1990 and 2002, while use of both ARBs and ACE inhibitors increased.

It's entirely possible that the increased usd of the more expensive dugs is justified because of the needs of individual patients, Stafford says. "The data we looked at do not enable us to say if the right ones or wrong ones are being prescribed based on clinical characteristics of patients," he says.

But there are nonmedical reasons for the choices being made, Stafford says. One is that the newer, more expensive drugs get more publicity because they are used in trials whose results are heralded in medical journals.

Marketing tactics of drug companies also are a factor, he says: "Pharmaceutical promotion clearly has an impact on medical practice."

Anyone taking medication for high blood pressure should be aware of the guidelines, which support use of drugs such as diuretics that are available in inexpensive versions, Stafford says.

"If a diuretic is not being prescribed, there should be a good reason for it," he says.

To which Dr. Daniel Jones, vice chancellor for health affairs at the University of Mississippi and a spokesman for the American Heart Association, adds a footnote: "For most patients, the type of drug selected is not as important as getting the blood pressure lowered to the right level."

More information

Guidelines for treating high blood pressure can be found at the American Heart Association or the National Heart, Lung, and Blood Institute.

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Earlier Is Better for Anti-Stroke Drug

By Anthony J. Brown, MD
Reuters Health
Friday, March 5, 2004

NEW YORK (Reuters Health) - Tissue plasminogen activator (tPA), a clot-busting drug, is known to be an effective treatment for stroke when given within three hours of stroke onset. New research now shows that the treatment window may actually extend beyond three hours, although patients do best when tPA is given as soon as possible.

Doctors "often think of the three-hour period as magic--as long as tPA is given within this time, you've done your job," study co-author Dr. Gregory Albers, from Stanford University in California, told Reuters Health. "However, the main point from our study is that every minute counts; the sooner tPA can be given, the better."

At the same time, "the findings suggest that the therapeutic window is longer than three hours," Albers noted. "During later time periods, we believe there are patients for whom tPA will be beneficial, harmful, or have no effect." His group is currently focusing on ways to identify stroke patients who are seen later but still might benefit from tPA.

The new findings, which are reported in The Lancet, are based on an analysis of data from six trials investigating tPA as a treatment for early stroke. The analysis focused on 2775 patients who received tPA or inactive "placebo" within six hours of stroke onset.

When treatment began within 90 minutes or less, tPA-treated patients were about three times more likely than placebo patients to have a favorable neurologic outcome at three months. As the time to treatment rose, the benefit of tPA over placebo decreased, but may have persisted up to six hours. The most dramatic drop in benefit was seen at the 90-minute threshold.

Bleeding in the brain was more common with tPA than with placebo, but was still relatively rare, the authors note. The risk of bleeding seemed to increase with patient age.

For patients seen within three hours after stroke occurs, "it's clear that they should receive tPA," Albers said. "Beyond three hours, the benefits really flatten out and the decision to use tPA will really depend on what other tests like MRI show." For example, if MRI shows a lot of brain tissue that is at risk, and little severely injured brain tissue, "we believe tPA may work quite well."

Source: The Lancet, March 6, 2004.

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Arthritis Raises Risk of Back Problems in Women

By Megan Rauscher
Reuters Health
Friday, March 5, 2004

NEW YORK (Reuters Health) - The risk of spinal deformities, especially multiple or severe deformities, is markedly increased in women with rheumatoid arthritis, new research from Norway indicates.

"These findings have important implications for prevention of established osteoporosis (bone thinning) in rheumatoid arthritis," Dr. Ragnhild Orstavik, from Diakonhjemmet Hospital in Oslo, and colleagues note in the Archives of Internal Medicine (news - web sites).

Using the Oslo rheumatoid arthritis registry, they detected a total of 147 spinal deformities in 249 rheumatoid arthritis patients compared with 51 in 249 similar subjects without rheumatoid arthritis. The majority of deformities in both groups were found in the mid- and lower-back regions of the spine.

Additionally, Orstavik told Reuters Health, rheumatoid arthritis patients more often had multiple or severe deformities, "which are known to be associated with" back pain and a reduced quality of life. Moreover, such deformities raise the risk of spine fractures.

Specifically, 11 percent of rheumatoid arthritis patients had two or more deformities compared with 5 percent of healthy subjects. Moderate or severe deformities were evident in 17 percent of rheumatoid arthritis and 10 percent of healthy subjects.

Importantly, the team notes a diagnosis of rheumatoid arthritis was associated with vertebral deformities, regardless of the patient's bone thickness or whether they used steroids.

"This strongly indicates that disease factors in themselves contribute to an increased risk of the clinically important end point of osteoporosis, eg, fractures," they write. "The association between a diagnosis of rheumatoid arthritis and vertebral deformities," Orstavik added, "supports previous findings on a possible independent effect of inflammation on osteoporosis in rheumatoid arthritis."

Source: Archives of Internal Medicine, February 23, 2004.

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Skipping Meals: A Bad Idea

Friday, March 5, 2004

(HealthDayNews) -- If you're trying to cut your calorie intake by skipping meals, you could end up gaining weight instead.

According to George Washington University, people who skip meals, especially breakfast, are more likely to overeat later in the day. That's because when you skip meals, you upset your body's natural cycle of sleep, wakefulness and hunger.

So in trying to right itself, your system overcompensates and you may end up eating from mid-afternoon until bedtime.

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High Blood Pressure Risk Climbs with Kids' Weight

By Amy Norton
Reuters Health

Friday, March 5, 2004

NEW YORK (Reuters Health) - Overweight children face a far greater risk of high blood pressure than their leaner peers do, a study of Houston public schools shows.

The findings, say researchers, "confirm an evolving epidemic" among U.S. children of weight-related ills once seen almost exclusively in adults.

The study of 5,102 students ages 10 to 19 found that 4.5 percent had high blood pressure, and blood pressure rose in tandem with children's body mass index, or BMI. Among overweight children, 11 percent had high blood pressure, according to results published in the March issue of the journal Pediatrics.

High blood pressure is one of a number of cardiovascular conditions, including type 2 diabetes and high cholesterol, which are increasingly being seen in children as their rates of overweight and obesity climb. In the U.S., childhood obesity has doubled in the past 20 years, and more than 15 percent of kids between the ages of 6 and 19 are considered obese.

In the past, the rate of high blood pressure among children has been estimated at about one percent.

The new findings underscore the importance of preventing children from becoming overweight in the first place, according to study author Dr. Ronald J. Portman of the University of Texas Health Science Center in Houston.

In an interview, he noted that the burden is on adults, as children are largely "powerless" over the problems of obesity and high blood pressure. What's needed, Portman said, are widespread efforts such as healthier, junk-food-free school lunch programs and the revival of physical education in the schools.

"Society has to get together and say 'enough of this,"' he said.

Among adults, high blood pressure is a major risk factor for heart attack and stroke over the long term. But the condition may have a more immediate impact as well.

There's some data suggesting high blood pressure can have subtle neurological effects, Portman noted. He said parents sometimes report improvements in their children's concentration and behavior once their blood pressure is under control.

Portman and his colleagues assessed blood pressure among students at eight public schools; high blood pressure had to be confirmed on three separate occasions for a child to be diagnosed with the condition.

Overall, 20 percent of the students had a BMI at or above the 95th percentile-the definition of "overweight" for children. The prevalence was highest among Hispanic students, 31 percent of whom were overweight. Twenty percent of African-American kids were overweight, as were 15 percent of white and 11 percent of Asian children.

Hispanic children also more frequently had high blood pressure, a finding the researchers tied back to their disproportionately high BMIs.

Unless measures are taken to curb childhood obesity and its related health problems, the researchers conclude, the gains made in fighting cardiovascular disease over the last 50 years could eventually be lost.

Source: Pediatrics, March 2004.

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Thursday, March 4, 2004

Arm Exercises After Stroke Improve Function

Reuters Health
Thursday, March 4, 2004

NEW YORK (Reuters Health) - Early and repetitive stimulation of the affected arm after a stroke can dramatically improve function that persists for many years, new research indicates.

"Although studies have investigated targeted interventions with one-year of follow-up, to the best of our knowledge, this is the first to evaluate such interventions on such a long-term basis," lead author Dr. Hilde Feys, from the University of Leuven in Belgium, said in a statement.

The findings, which are reported in the medical journal Stroke, are based on a study of 100 patients who participated in the exercise program or received a sham therapy within two to five weeks of stroke onset. Sixty-two patients were available for functional evaluation five years later.

With the exercise program, patients were placed in a rocking chair for 30 minutes each day and asked to use the affected arm to generate motion. Patients in the comparison group were also placed in a rocking chair, but instead of being instructed to use the arm, they received fake therapy to the shoulder. Both rehab programs lasted 6 weeks.

At five-year follow-up, patients in the exercise group performed significantly better than the others on two standardized tests of arm function, the researchers note. In contrast, the groups scored similarly on the Barthel index, a more general assessment of stroke recovery.

Patients with severe movement problems seemed to benefit most from the exercise program, the investigators point out.

"We believe this therapy is causing a rewiring of the brain...during the acute phase of stroke recovery, a time in which currently there aren't many treatment alternatives for the arm available," Feys noted. "We need to develop strategies whereby patients can take responsibility for their own therapy and this appears to be a promising one."

Source: Stroke, March 4, 2004.

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Dairy, Moderate Fat Intake May Help Kids Stay Lean

By Amy Norton
Reuters Health
Thursday, March 4, 2004

NEW YORK (Reuters Health) - Diets that are moderate in fat and rich in dairy, fruits and vegetables may guard against obesity in children, a study released on Thursday suggests.

The study of 106 families showed that children whose diets were either high or low in fat gained more body fat as they grew older than did children whose fat intakes fell somewhere in between.

"We found that the children who were the leanest had moderate intakes of fat," the study's lead author, Dr. Lynn L. Moore of Boston University School of Medicine, told Reuters Health.

While adults' weight-watching fads have shifted from fat-free to low-carb, high-fat, these findings point toward the benefits of moderation for children, according to Moore.

Among the children her team followed from preschool age on, those with the highest fat intake--35 percent or more of daily calories coming from fat--had put on the most body fat by early adolescence. Those who got less than 30 percent of their calories from fat gained less body fat, but it was the children whose fat intake fell somewhere in between who turned out to be the leanest.

These children consumed between 30 and 35 percent of their calories as fat, somewhat more than the 30-percent ceiling government guidelines currently recommend.

In addition, children who ate moderate levels of dairy foods like milk, yogurt and cheese put on less fat than kids with the lowest intake. Fruits and vegetables also appeared to cut fat gain, but dairy products had a stronger influence, according to Moore.

She presented the findings on Thursday in San Francisco at the American Heart Association (news - web sites)'s annual Conference on Cardiovascular Disease Epidemiology and Prevention. The study received funding from the National Heart, Lung and Blood Institute and the National Dairy Council.

According to Moore's team, the findings suggest that a diet moderate in fat and heavy in fruits, vegetables and dairy might lower the risk of adolescent obesity.

In the study, the one third of girls with the lowest dairy intakes consumed fewer than one and one quarter servings per day, while boys in the lowest-intake group got fewer than one and three quarter servings. Kids who consumed more than that put on much less fat as they grew older, according to the researchers.

National guidelines recommend two to three daily servings of dairy for adults and children older than 2 years of age.

Exactly why dairy products might help prevent excessive fat gain is not fully clear. Animal research suggests that calcium, by acting on hormones that help store calories as fat, could be the reason.

Moore said that calcium "might be one of the factors involved," but added that other compounds in dairy products could also be at work.

There was no evidence in the study that the fat content of dairy products mattered in body-fat gain. But if a child's overall dietary fat intake is high, according to Moore, low-fat dairy foods are a good option.

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Vitamins Don't Prevent Pneumonia in Male Smokers

Reuters Health
Thursday, March 4, 2004

NEW YORK (Reuters Health) - Overall, the findings from a Finnish study suggest that vitamin E and beta-carotene supplementation have no effect on the incidence of pneumonia in men who smoke. However, it appears that vitamin E may benefit men who start smoking at a relatively late age.

"Vitamin E and beta-carotene affect various measures of immune function and accordingly might influence the predisposition of humans to infections," Dr. Harri Hemila, of the University of Helsinki, and colleagues write the medical journal Chest. "However, only few controlled trials have tested this hypothesis."

To investigate whether vitamin E or beta-carotene supplementation affects the risk of pneumonia, the researchers used data from the Alpha-Tocopherol Beta-Carotene Cancer Prevention study. This study examined the effects of vitamin E and beta-carotene on the rate of lung cancer in 29,133 men who smoked at least five cigarettes per day at the start of the study.

The subjects were randomly assigned to receive the supplements or placebo, an inactive substance. Neither the subjects nor the researchers were aware of which type of pill was given. The men, who ranged between 50 and 69 years of age, were followed for about six years.

In the current analysis, the main outcome measure was the first occurrence of hospital-treated pneumonia. The researchers identified 898 such cases in the national hospital discharge register.

Neither vitamin E nor beta-carotene supplementation had any overall effect on the incidence of pneumonia.

"Only the age of smoking initiation was a significant modifying factor for both vitamin E and beta-carotene supplementation," Hemila and colleagues report.

Vitamin E supplementation decreased the risk of pneumonia by 35% among subjects who had started smoking at age 21 years or older. In contrast, beta-carotene supplementation increased the risk by 58% in this population.

This finding "warrants further investigation," the researchers conclude.

Source: Chest, February 2004.

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Education Doesn't Prevent Obesity in Black Women

By Alison McCook
Reuters Health
Thursday, March 4, 2004

NEW YORK (Reuters Health) - Compared with Caucasian women, a college education appears to be less likely to protect African American women from obesity, according to new research.

U.S. investigators found that the weight gap between African Americans and Caucasians widened with increasing schooling. For instance, although women of both races appeared to have the same average weight if they got no more than a high school education, African American women with a college degree significantly outweighed Caucasian women with a college degree.

"You actually saw (the weight difference) getting bigger, the more education women had," study author Dr. Ten Lewis told Reuters Health.

Weight was measured in terms of body mass index (BMI), a value that factors a person's height into her weight. Individuals with a BMI of 30 or more are considered obese.

The researchers found that among women with no more than a high school degree, both African Americans and Caucasians had an average BMI of 31. Among women with a college degree, however, average BMI in African Americans was around 31, but fell to 27 in Caucasians.

The weight difference between African Americans and Caucasians persisted even after removing the influence of factors such as diet, exercise and age, making its cause somewhat of a mystery, Lewis noted.

She said one potential explanation for the body differences among educated women of different races may rest, in part, with cultural differences in the stigma of being overweight.

Caucasians tend to associate being overweight with a number of negative qualities, she said, such as laziness, lack of intelligence and being unattractive. Those stereotypes are less prominent among African Americans, Lewis noted.

Additionally, she noted that being overweight is not the only health disparity that separates educated African American and Caucasians women, suggesting that even when African Americans achieve a higher education and go on to pursue successful careers, "race still matters."

Lewis explained that, among the college-educated women included in the study, African Americans reported more stress than Caucasians, perhaps resulting from discrimination or other factors linked to their race. Since research has associated stress with weight gain, these added race-related stressors could be responsible for the weight disparity between the two groups, Lewis noted.

If this is the case, it would suggest that "a college education isn't giving (African American women) the same benefits as it's giving white women," Lewis, based at Rush University Medical Center in Chicago, said in an interview.

During the study, Lewis and her team reviewed data collected from 2,017 women, half of whom were African American, and the other half Caucasian. Approximately one third had a college degree. All of the women were participants in a government study investigating differences among women of different races and ethnicity.

According to Lewis, future research is needed to understand the causes behind the weight disparity among educated women of different races and ethnicities, and to design interventions that target those causes.

Lewis and her team presented their findings Wednesday during the American Psychosomatic Society Conference in Orlando, Florida.

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Wednesday, March 3, 2004

McDonald's to Eliminate Supersizes by Year-End

By Deborah Cohen
Wednesday, March 3, 2004

CHICAGO (Reuters) - McDonald's Corp., battered by criticism of its fatty foods, said it would eliminate Supersize french fries and soft drinks by the end of the year, part of a swing toward pleasing health-minded customers and simplifying its menu.

McDonald's Supersize option, which includes a 7-ounce carton of fries and 42-ounce fountain soda, has been targeted by critics as contributing to a growing obesity crisis in the United States where more than half the population is considered overweight or obese.

The world's largest fast-food company, which began offering Supersize portions widely in 1994, said on Wednesday it is making the menu changes to "support a balanced lifestyle" approach that is in keeping with other recent moves to promote healthier behavior.

These include a planned national launch of a Happy Meal for adults called Go Active! which comes with advice from a fitness expert. In the past year, it has introduced several health-oriented foods, such as entree-sized salads and healthy alternatives in children's Happy Meals, including milk and fruit.

McDonald's shares rose 56 cents, or 2 percent, to a 52-week high of $28.99.

"I think it's somewhat of a PR move," said Harris Nesbitt Gerard analyst Matthew DiFrisco of the company's decision to eliminate oversized portions. "But by simplifying the menu, you gain efficiencies and cost reductions, the back-of-the-box type stuff."

A new documentary film, called "Super Size Me" illustrates the negative effects of over-consumption of McDonald's food. The film has not yet been released.

A McDonald's spokeswoman said that the menu changes are not related to any impact of the film on public awareness.

"They had no connection whatsoever," said the spokeswoman, Lisa Howard.

The company has been reducing complexity of its menu, part of a broader push to improve operations and service in its more than 13,000 U.S. restaurants.

"You assist in reducing the labor overhead, demands of the kitchen, and also speed of service, which is very important," DiFrisco said.

Analysts said the change reflects McDonald's move away from discounting toward an emphasis on foods with higher-quality ingredients and better profit margins, such as the new salads and the all-white-meat Chicken McNuggets.

Marketing Move?

In recent months, Oak Brook, Illinois-based McDonald's has been attempting to align its brand with an active lifestyle, highlighted by a new global advertising campaign called "I'm Lovin' It." Launched late last year, the ads feature hip-hop music and a range of lifestyle scenarios shot outside of its restaurants.

Its rivals, including Wendy's Corp. and Burger King Corp., have also been progressively offering more foods that give consumers choices beyond the traditional fast-food fare of burgers, fries and sodas.

Those changes come as concern over corporations' responsibility for public health has been growing. Last year, McDonald's was the target of a high-profile lawsuit filed on behalf of teenagers who alleged its food was the cause of their obesity. The suit was twice dismissed from federal court.

A public health advocate gave McDonald's plans conditional support.

"McDonald's made a move in the right direction by stopping sales of supersized french fries and soft drinks," said Michael Jacobson, director of the consumer-advocacy group Center for Science in the Public Interest in a statement.

"I hope it is an indication that the company is paying more attention to obesity, heart disease, and other diet-related diseases," he said, adding that he hoped other fast-food companies would quickly follow suit.

The Supersize fries contain 610 calories, 29 grams of fat, 390 milligrams of sodium and 77 grams of carbohydrates, according to analysts. (With reporting by Maggie Fox in Washington)

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Working Poor Face Higher Obesity Rates

By Juliana Barbassa
Associated Press Writer
The Associated Press
Wednesday, March 3, 2004

CUTLER, Calif. - Farm worker Iris Caballero often has a hard time keeping the refrigerator and cupboard stocked with food. Yet, she's overweight and diabetic. She is a classic example of a modern-day paradox: as reliable access to healthy food declines, the likelihood of being overweight goes up.

The working poor like Caballero often have no time for cooking, little money to buy fresh vegetables, and a long walk to the closest supermarket with a good produce section.

"We have been pretending that it is easy to replace a diet of soft drinks and fast food with home-cooked meals, fresh fruits and vegetables," said Adam Drewnowski, a University of Washington epidemiology professor who has studied the problem.

The problem is pronounced in what seems an unlikely place — California's Central Valley, where much of the nation's produce is grown. The valley also has some of the highest poverty rates.

Although being overweight is usually associated with eating too much rather than with hunger, a growing body of research is showing that they people who have gained the most weight in the last decade tend to have the lowest incomes, and often go without the kind of food or the amount they need.

Caballero's neighborhood mini-market in the isolated farming town of Cutler offers a full array of processed foods in colorful packages — and battered apples selling for 50 cents.

"Many people can't afford to eat the produce they pick," said Drewnowski, who also heads a center for public nutrition. "These people are obese, frankly, because they have no money, and some diets are cheaper than others.

"The message has been to blame people — 'you're not choosing well, you're not educated enough.' We forget there are people whose choices are severely limited by finances and time allocation."

Caballero understands those limits and their consequences. During harvest season, she picks the grapes and oranges in the groves that surround this small town of Cutler. Fruit is available, and money is too. The family eats relatively well.

During winter, jobs are scarce, so Caballero feeds her husband and three children the cheapest food she can get: potatoes, bread, tortillas.

For Caballero, who has been diabetic since she was 19, the sugar- and fat-laden offerings of her local market are more than unhealthy: they're dangerous. Obesity is a leading risk factor for diabetes, an incurable condition in which the body can't break down sugars in the blood.

Cutler Elementary, which Caballero's children attend, has so many diabetic kids that teachers recently had an emergency workshop on how to handle blood sugar highs and lows. This in a school where 100 percent of the kids qualify for free school lunches.

After a 15-year-old diabetic student became blind — one of the consequences of untreated diabetes — the school sought help. Now, Caballero and other farmworker mothers attend a free nutrition class that considers their culinary traditions, low budgets and lack of time.

The women come because they know that the cheapest, fastest, most filling meal — the burger and soda that look so good at the end of a long day in the fields — is not the healthiest for their families.

In the class, one of at least 10 groups Dolores Vallejo teaches each week, the Spanish-speaking mothers learn to read English-language labels. Vallejo points out that "high fructose corn syrup," "sucrose" and "dextrose" all mean azucar — sugar. She shows them several quick, inexpensive, low-fat recipes their families might enjoy, like vegetable chili.

Unfortunately, most public health programs don't address such issues. As processed foods rich in sugar and fat have become cheaper than fruits and vegetables, the poor in particular are paying a high price with obesity rates shooting up, followed by diabetes.

This is happening even as conditions associated with malnutrition — like anemia, caused by an iron deficiency in diets lacking leafy greens_ continue to plague poor children, said Jay Battacharya, a health economics expert at Stanford University's medical school.

Walking out of the nutrition class, Caballero and the other mothers said they appreciate the tips on healthy eating. But they still have to scrape to pay extra for real fruit juice instead of the punch they now know is mostly sugar and water. And they still have to walk four miles, often with their children, to and from the nearest supermarket, where fresh produce is plentiful and less expensive.

Along the state highway linking Cutler to the supermarket in Orosi, a new sidewalk has just been laid — a testament to the women's efforts to feed their families better.

"I want to feed my family better food," said Irene Flores, a farmworker with three children who stores large sacks of beans to eat during the winter. "My husband was asking me to buy lettuce, because he likes salads. How can I buy it at almost $2 a head?"

On the Net:

California Agriculture Magazine:

American Journal of Clinical Nutrition (news - web sites):

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California County Bans Planting of Biotech Crops

By Carey Gillam
Wednesday, March 3, 2004

KANSAS CITY, Mo. (Reuters) - Opponents of genetically modified foods celebrated a historic victory on Wednesday after voters approved a measure Tuesday night to make Mendocino County, California, the first in the United States to ban genetically modified crops and animals.

The ban was approved despite strong opposition from biotech companies including Monsanto Co. and DuPont Co., which have successfully defeated similar measures elsewhere around the United States.

"We won! We beat the biotech bullies," Laura Hamburg, spokesperson for the "Yes on Measure H" campaign, said on Wednesday. "The people emerged as victorious. We're sending Monsanto and the rest of the biotech corporate club packing in Mendocino County."

The measure bans the planting of biotech crops and the raising of livestock that have been genetically altered. Supporters said the designation as a biotech-free county should make products grown there more marketable, particularly to Europe where anti-biotech sentiment is strong.

Biotech proponents, who spent more than $600,000 to try to defeat the measure compared with about $80,000 raised by its supporters, said they were evaluating how to respond, possibly including legal action.

"We are concerned about the precedent-setting nature of this vote and the message it sends," said Allan Noe, a spokesman for Croplife America, which represents the interests of an array of agricultural and biotech companies.

Noe said passage of the measure was a "short-sighted move," as technology in the pipeline could be beneficial to the county's grape-growers.

But Hamburg said the 80,000 residents in the northern California county, including about 50,000 voters, are dedicated to preserving the purity of the vineyards and other agricultural resources there.

"We're part of a growing grass-roots movement of people all over the world standing up to the biotech industry," said Hamburg.

Indeed, drives similar to Mendocino's effort are being planned in other California counties, and a bill is pending in Vermont that would place a two-year moratorium on planting and growing genetically modified crops.

In North Dakota, where Monsanto is planning to roll out the world's first genetically altered wheat, opponents are renewing efforts to at least temporarily prohibit the biotech crop.

Two years ago, consumer groups in Oregon tried to pass a measure requiring labeling of genetically modified foods, but lost after a coalition of biotech companies, including Monsanto, spent some $5.5 million to kill the initiative.

The vote in California comes amid widespread concerns globally about the genetic modification of crops.

Last week, countries across Asia, Africa, Europe and most of Latin America agreed to tighter rules governing trade in gene-modified seeds, over the opposition of the United States.

The United States has steadfastly defended the spread of biotech crops and has pushed a WTO complaint against the European Union (news - web sites) for keeping its borders closed to the altered foods. Last month, the U.S. Department of State's Bureau of Economic and Business Affairs launched a Web site dedicated to biotech crop development information.

Biotech crop critics say the government is putting corporate interests ahead of the public interest.

They say the technology has not been fully tested to determine if it will cause health problems or irreversible harm to the environment. They also say it does little to address world hunger and health problems and offers only minimal benefits to some farmers, while contaminating conventional and organic crops.

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Study: Obese Women Earn 30 Percent Less

The Associated Press
Wednesday, March 3, 2004

WASHINGTON - Being fat may hurt your income — if you're a highly educated woman. So says research from Finland that suggests weight is a pay barrier for certain women, but not for men.

Obese women who are highly educated earn about 30 percent less — a difference of at least $5,000 a year — than normal-weight or even plump women, the study found. When analyzed by occupation, women with white-collar jobs earned less if they were obese.

Obesity had little or no effect on pay if women were poorly educated, manual workers or self-employed — and no statistically significant effect on men's pay, the study found.

"This suggests that, socio-economically, obesity is not as stigmatizing for men as it is for women," concluded the University of Helsinki researchers.

They couldn't explain why, or why there was a bigger effect on some women, except to say the pressure on women to be thin may be strongest among higher socio-economic classes.

The researchers combed national registries that track Finns' education, occupation and income to choose 2,314 men and 2,068 women for the study. Participants had to be employed in 1993, with no leaves for illness, thus attempting to rule out obesity-caused disease as a reason for lower income.

One limitation: Participants reported their own weight.

The study was published Wednesday in the American Journal of Public Health.

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MMR Doctors Reject Own Autism Link Report

Wednesday, March 3, 2004

LONDON (Reuters) - Ten doctors who co-authored a controversial study in Britain that suggested a link between childhood vaccinations and autism said on Wednesday there was not enough evidence to draw that conclusion.

The release of the report in 1998 led parents to reject a combined vaccine for mumps, measles and rubella because of possible links to autism and bowel disease, even though the study never proved a definite link.

Fears over the single inoculation commonly known as MMR led to a steep drop in the number of British children being vaccinated and has been blamed for outbreaks of measles.

The doctors said in a statement to be carried in the medical journal The Lancet: "Consequent events have had major implications for public health. We consider now is the appropriate time that we should together formally retract the interpretation placed upon these findings in the paper."

"We wish to make it clear that in this paper no causal link was established between MMR vaccine and autism as the data was insufficient," they added.

Two of the co-authors of the study did not sign the retraction.

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Report: FDA Needs Seafood Safety Fixes

The Associated Press
Wednesday, March 3, 2004

WASHINGTON - The safety of imported seafood is improving but the Food and Drug Administration (news - web sites) must act more quickly to stop shipments of potentially bad fish, says a congressional report released Wednesday.

More than 80 percent of the seafood Americans eat is imported.

The General Accounting Office (news - web sites) criticized the FDA in 2001 for its seafood oversight, saying then that far too few seafood suppliers were following safety standards. FDA pledged immediate changes in response to the GAO, Congress' investigative arm, including more frequent inspections of high-risk firms.

In Wednesday's report, the GAO cited some improvements, most notably an increase in documented compliance with a crucial anti-contamination program, from 27 percent of U.S. importers in 1999 to 48 percent in 2002.

But investigators had lingering concerns. They said huge delays persist in alerting border inspectors to check for contamination in shipments from foreign firms that FDA discovers have serious safety problems.

Of six firms FDA cited for safety problems in 2002, the average delay in alerting ports of entry was 348 days. Even when inspectors had recommended immediate detention of shipments, such action wasn't taken because the recommendations were delayed at FDA headquarters.

"This lack of management oversight fails to give priority to taking enforcement action for serious violations, and it increases the likelihood that unsafe products will enter the U.S. market," GAO concluded.

FDA didn't immediately comment Wednesday, but told GAO it was working to fix the delays.

Congressional auditors also noted that while many other imported foods come from countries certified to have equivalent food-safety systems, the FDA still has no such equivalence agreements for seafood. The auditors contend such agreements would add a layer of safety to seafood imports from some of the nation's biggest trading partners, letting FDA focus more attention on imports from riskier areas.

FDA told the GAO that while it did have agreements with some countries on handling high-risk raw shellfish, it didn't think broader seafood agreements would improve safety — and that protecting the food supply from terrorist threats was a bigger priority.

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Benign Virus May Guard Against AIDS Progression

By Gene Emery
Wednesday, March 3, 2004

BOSTON (Reuters) - A harmless virus common in the general population delays the development of AIDS (news - web sites), according to a study released on Wednesday that could help researchers find new treatments for the epidemic.

The benign virus can persist in the body for years and appears to interfere with HIV (news - web sites), the AIDS virus which affects 40 million people worldwide and has killed another 30 million.

Both HIV and the benign virus, known as GBV-C, infect the same types of cells.

Jack Stapleton of the University of Iowa and his colleagues found that HIV-infected men who were no longer infected with GBV-C after five to six years died nearly three times faster than men who continued to show signs of the infection.

And once the GBV-C virus was gone, the AIDS virus seemed to attack with renewed vigor.

"So not only was having a persistent infection better survival-wise than not having an infection, but the subset of men who lost their virus did the worst. It's very unusual that there would be a good virus," Stapleton told Reuters.

The 10-year survival rate was 75 percent for men who showed evidence of the virus at both the one- and five-year marks, 39 percent among people who had never had a GBV-C infection and 16 percent for those whose bodies had cleared the GBV-C virus.

GBV-C does not appear to block people from getting HIV, so it would not be a vaccine. But in a commentary in this week's New England Journal of Medicine (news - web sites), where the study appears, Roger Pomerantz and Giuseppe Nunnari of Thomas Jefferson University in Philadelphia said it could help doctors find new treatments.

Meanwhile, Stapleton and his colleagues are planning experiments to treat HIV cases with blood from people who are carrying the GBV-C virus. Volunteers for that study have already been lined up.

Research into GBV-C has been controversial because some studies have suggested it does not slow the progression from HIV infection to AIDS.

The Stapleton team found the harmless virus, once thought to be a cause of the liver disease hepatitis, does not improve survival during the first 18 months after an HIV infection takes hold.

Only in later months does the benefit of a GBV-C infection become significant.

The benign virus is found in nearly 2 percent of seemingly healthy blood donors, according to a study done in Iowa. In all, 13 percent of the donors in that study had evidence of a past or present GBV-C infection.

Stapleton said the GBV-C virus probably spreads like the AIDS virus, through blood products and sexual contact. It is more common after puberty.

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Safe Stairs For Seniors

Wednesday, March 3, 2004

(HealthDayNews) -- Stairs, inside and outside a home, can be a hazard for elderly people.

The City of Ottawa recommends you ensure that:

  • Stair edges are marked with contrasting colors.
  • They have a non-slip surface.
  • Handrails are present on both sides of stairs.
  • Handrail height feels comfortable when used for support.
  • Handrails extend 12 inches beyond the top and bottom steps, and are round in shape.
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Drugs Cut Kidney Failure Risk in Lupus – Study

By Gene Emery
Wednesday, March 3, 2004

BOSTON (Reuters) - Patients with lupus have a better chance of preventing kidney failure if they start taking one of two drugs which suppress the immune system, researchers reported on Wednesday.

About 1.4 million Americans have lupus, a chronic disease in which the immune system can confuse healthy and foreign tissues and sometimes attacks both. Roughly 780,000 lupus sufferers have kidney disease.

Sandra Raymond, president of the Lupus Foundation of America, said patients have been desperate for better therapies with fewer side effects. "Patients are thrilled," she told Reuters.

A study of 59 volunteers, published in this week's New England Journal of Medicine (news - web sites), found that the conventional treatment -- injections of the drug cyclophosphamide -- prevented a relapse in 43 percent of the cases.

By comparison, one of the drugs found to be effective, azathioprine, worked about 57 percent of the time. The other drug, mycophenolate mofetil, was effective in about 77 percent of the volunteers.

The research team, led by Gabriel Contreras of the University of Miami, said there were not enough people in the study to determine whether mycophenolate mofetil, marketed as CellCept by Roche, was actually better than azathioprine, sold by several companies. Salix Pharmaceuticals Ltd. sells azathioprine under the name Azasan.

An editorial in the Journal said both drugs "are good options for maintenance therapy" in patients whose lupus was damaging their kidneys.

The two drugs tend to have fewer side effects than cyclophosphamide and can be given by mouth.

The Contreras team cautioned the study did not look at children or patients with mild forms of lupus-related kidney problems.

Raymond said she was particularly encouraged by the data for mycophenolate mofetil, which she said seemed to be the best for long-term treatment. But she said a larger study was needed to confirm the findings.

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Vision Loss

Wednesday, March 3, 2004

(HealthDayNews) -- By the time you're 65 years old, your chances of suffering some kind of significant, uncorrectable vision loss are one in nine, according to The Canadian National Institute for the Blind.

Here's how you can reduce your risk:

  • Have regular eye examinations, especially after age 40. Early diagnosis is paramount for preventing further vision loss.
  • Follow your eye care specialist's directions for taking prescribed medications.
  • Report any sudden or unusual changes in your vision to your eye doctor immediately.
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Hormone Use May Cut Colon Cancer Risk in Women

By Anthony J. Brown, MD
Reuters Health
Wednesday, March 3, 2004

NEW YORK (Reuters Health) - Hormone replacement therapy (HRT) with estrogen and progestin seems to reduce the risk of colon cancer in women who are past menopause, new research shows. However, the cancers that do occur seem to be more advanced than those seen in non-HRT users.

Most of the news regarding HRT in recent years has been bad. Just this week, the National Institutes of Health (news - web sites) announced that the estrogen-only arm of the Women's Health Initiative (WHI) trial was being stopped early after the therapy was tied to an increased risk of stroke. This follows the termination of the estrogen/progestin arm in 2002 due to an observed increase in breast cancer, thrombosis, stroke, and heart disease events among HRT users.

However, when the estrogen/progestin arm was stopped, the WHI researchers did notice one potentially beneficial effect for HRT--a decreased risk of colon cancer, according to a report in The New England Journal of Medicine (news - web sites).

To better understand the link between HRT use and colon cancer, Dr. Rowan T. Chlebowski, from Harbor-UCLA Medical Center in Torrance, California, and colleagues analyzed data from 16,608 women who participated in the estrogen/progestin arm of WHI.

Overall, HRT users were 44 percent less likely to develop colon cancer than non-users, the researchers found.

"We were quite surprised to find that colon cancers in HRT users were of higher stage than those seen in controls," Chlebowski told Reuters Health. The cancers that occurred in HRT users usually affected more lymph nodes and were more likely to have spread to other organs, the results indicate.

"Our findings are somewhat similar to what was seen (last year) in the trial with Proscar (finasteride) and prostate cancer--overall risk is decreased but severe disease is more likely," Chlebowski noted.

"Interestingly, among HRT users with colon cancer, those with antecedent vaginal bleeding were the ones most likely to have advanced...disease," Chlebowski pointed out. This bleeding may have slowed the clinical work-up so that the cancer wasn't diagnosed until a more advanced state, he added.

Despite all the unfavorable reports, Chlebowski believes that HRT could still be a viable therapy. "One strategy would be to see if the risks of HRT could be modulated with other agents."

Source: The New England Journal of Medicine, March 3, 2004.

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For Workplace Safety, the Eyes Have It

By E.J. Mundell
HealthDay Reporter
Wednesday, March 3, 2004

WEDNESDAY, March 3 (HealthDayNews) -- It can happen in the blink of an eye.

Laura Lee Carter was using an industrial air-pressured staple gun to box up products at the factory where she worked when something went terribly wrong.

"My gun was pointed up towards me," she remembers. "You know, you're just doing your routine -- staple, staple, staple -- and it just caught and pointed up towards me, and before I even thought not to pull the trigger, I pulled it, and shot that staple right up at me."

The force of impact shattered the safety glasses Carter routinely wore on the factory floor. "You know when a rock hits a windshield? Just like that," she says.

Carter, a 23-year-old from Rocky Mountain, Va., credits those safety glasses with saving her sight. "Something that takes five seconds to do -- putting your glasses on -- if you don't do that, it could change your life forever."

Unfortunately, every year hundreds of thousands of Americans are not so lucky. According to Prevent Blindness America (PBA), nearly 97,000 workplace-related eye injuries were treated in U.S. emergency rooms in 2002 alone. Injuries can range from minor burns, cuts and bruises to total blindness. Besides causing vision impairment, workplace injuries cost the American public nearly $4 billion a year in worker's compensation claims and lost worker productivity, PBA says.

According to PBA statistics, welding equipment remains the biggest source of eye danger at work, causing nearly 14,000 injuries in 2002. Another 9,000 workers reported injuries from use of a wide variety of tools. Chemicals such as acids and adhesives can splash into the eyes, causing serious damage, as well.

"Hammering and grinding are especially likely to produce little metal particles that can fly off in high velocities and actually penetrate the eyeball," adds Dr. Ronald Danis, a professor of ophthalmology at the University of Wisconsin and a member of the board of directors at the American Society of Ocular Trauma. "Other common mechanisms are poking-type injuries -- for example, when someone is pulling on a wire and suddenly it comes free," hitting them in the eye, he explains.

PBA each year tries to bring attention to workplace eye safety by declaring March "Workplace Eye Health and Safety Month." According to Danis, some of their efforts may finally be paying off.

"The large industrial plant environment and commercial construction sites are a lot safer today than they were 10 or 15 years ago," he says. "Because I think corporate America has realized, both from an economic standpoint as well as from an ethical standpoint, that it makes a lot of sense to keep your employees safe and keep them productive."

But small business may not be getting the message, he says. "The auto-body shop, the farm, and the small construction site remain places where safety eyewear isn't mandated and it's generally up to the individual, and that's where injury is occurring."

Even when protective eye gear is available, many workers -- especially men -- don't use it. "Maybe it's something about the Y chromosome," Danis says. "Men can know the risks, but it's just sort of a 'guy thing' to ignore it. I've seen many examples of people who've had eye injuries while their safety glasses were in their pockets."

Too many workers also neglect to wear safety glasses because they find them uncomfortable. But Danis says there's a lot more available than cheap, off-the rack models found at many hardware stores. "With a little more careful attention, [workers] can find products that have very good ventilation and fit well," he says. "There are plenty of options to choose from, and I would encourage individuals to persist in trying to find something that works for them."

As part of their workplace-based "Wise Owl" eye safety program, Prevent Blindness America recommends individuals wear only safety glasses that meet industry safety standards. Consumers can recognize these products by looking for the number "Z87" marked on the frames or lenses.

Richard Jenkins, manager of health, safety and environment at a chemicals plant in Louisville, Ky., has seen firsthand the value of a good pair of safety glasses. In 2001, one of his mechanics was busy taking apart a pipe used to carry highly corrosive sulfuric acid under high pressure.

"It was supposed to be depressured, but for some reason it hadn't been, and he took a shot straight in the face," Jenkins, 63, recalls. But because the mechanic was wearing goggles and a protective suit, he received only minor burns to the face, with no eye injury.

That incident convinced Jenkins. "Always wear your safety gear and use your safety training," he says, since, for those who neglect eye safety, "the consequences can be terrible."

More information

Learn about the new program at Prevent Blindness America. Get more on eye safety at work from the Occupational Safety and Health Administration.

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Nerve Block Best for Pancreatic Cancer Pain

By Megan Rauscher
Reuters Health
Wednesday, March 3, 2004

NEW YORK (Reuters Health) - Blocking certain sensory nerves is more effective than standard drug therapy at relieving the severe pain seen with pancreatic cancer, according to research conducted at the Mayo Clinic in Rochester, Minnesota.

"Pancreatic cancer is notorious for being associated with terrible pain" and patients usually only survive a few months, Dr. Gilbert Y. Wong, a Mayo Clinic anesthesiologist specializing in pain medicine, told Reuters Health. "In this study, we confirmed our clinic experience that (the nerve) block may allow these patients to live more comfortably, often for the remainder of their lives."

With the nerve block, a needle is inserted into the back until it reaches a nerve structure called the celiac ganglion. A concentrated alcohol solution is then injected, which destroys nerves in the ganglion, effectively stopping pancreatic pain signals from reaching the patient's spinal cord and brain.

In the new study, reported in the Journal of the American Medical Association (news - web sites), Wong and colleagues randomly assigned 100 patients with pancreatic cancer pain to receive either the nerve block or standard analgesic therapy. All of the patients were followed until death or for at least one year after enrolling in the study.

During the first week, patients in both groups reported less intense pain but patients receiving the block had a significantly larger decrease from baseline in pain intensity than patients receiving standard therapy. Moreover, follow-up through the first six months showed that nerve block patients continued to have significantly lower levels of pain than other patients.

"With (nerve block), the injected substances destroy the nerve centers responsible for pain transmission for the majority of upper abdominal...pain so the effect can be potentially long lasting and that is in fact what we found," Wong noted.

Quality of life also improved during the first week in both arms, but gradually declined with time. Survival was not markedly different between the two study arms.

The findings of this study indicate that the nerve block technique "should be considered a treatment option" for pancreatic cancer pain, Wong said. "Other types of upper abdominal cancer-related pain may potentially be amenable to this type of nerve block technique as well," he added.

Source: Journal of the American Medical Association, March 3, 2004.

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New Way to Stitch Up Arteries

Wednesday, March 3, 2004

WEDNESDAY, March 3 (HealthDayNews) -- A new device called X-Press gives cardiologists a simpler, safer method of stitching up arterial punctures after such catheter-based coronary procedures as angioplasty and stenting, says an American study.

Eight U.S. medical centers evaluated this new stitching device, which is not yet commercially available in the United States. The study appears in the March issue of Catheterization and Cardiovascular Interventions: Journal of the Society for Cardiovascular Angiography and Interventions.

"We're actually seeing a reduction in complications. This is the first suture device to demonstrate that," study leader Dr. Timothy A. Sanborn, cardiology head at Evanston Northwestern Healthcare in Illinois, says in a prepared statement.

During catheter-based coronary procedures, doctors need to puncture a large artery, usually in the groin, to insert the catheter and thread it through the body and into the heart arteries. Once the procedure is completed, the puncture must be closed to prevent excessive bleeding.

The conventional method is to apply firm pressure to the puncture wound for 20 to 30 minutes after the catheter is removed. This lets a blood clot form and seal the artery. The patient must then lie in bed for six to eight hours so that the blood clot isn't dislodged.

The X-Press device is inserted into the artery puncture wound. It guides the cardiologist as he or she passes stitching needles through the skin and into the artery, above and below the catheter puncture site. As it's pulled from the body, the X-Press pulls the leading end of each stitching thread out with it, creating a loop. The cardiologist ties these threads into a knot, cinching the threads together and closing the puncture in the artery.

The study included 400 patients. It found those who had diagnostic cardiac catheterization to diagnose heart disease and were treated with the X-Press device were able to get out of bed and walk around after an average of 2.2 hours, compared to an average of 6.2 hours for patients treated with manual wound pressure.

The difference was greater among patients who had percutaneous coronary intervention (PCI) to treat clogged heart arteries. Among these patients, those treated with X-Press were able to get out of bed and walk around within an average of four hours, compared to nearly 15 hours for patients treated with manual wound pressure.

More information

The U.S. National Library of Medicine has more about cardiac catheterization.

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Stomach Size Alone Affects Food Intake

By Amy Norton
Reuters Health
Wednesday, March 3, 2004

NEW YORK (Reuters Health) - Although bigger people tend to have bigger appetites, the size of the stomach--and not just the size of the body--appears to affect the feeling of fullness, or satiation, during and after a meal, new research shows.

The findings suggest that factors that control stomach volume, independent of body size, are potential targets in fighting obesity, according to researchers.

The investigators found that compared with normal-weight adults, those who were overweight or obese took longer to feel satiated at mealtime. Similarly, those whose empty stomachs were larger needed more calories to feel completely full.

It was not, however, merely a matter of bigger people having bigger stomachs, according to findings published in the journal Gastroenterology.

Instead, fasting gastric volume--the size of a person's empty stomach--was related to a feeling of fullness independent of body size, researchers at the Mayo Clinic College of Medicine in Rochester, Minnesota, found.

Their study included 134 healthy volunteers who, after an overnight fast, drank a liquid meal until they reached maximum satiation. Their stomach volume before and after eating was measured through non-invasive imaging.

The researchers found that both body mass index (BMI) and fasting gastric volume were independently linked to the time it took participants to become full.

The fact that BMI and stomach size did not go hand-in-hand is "somewhat surprising," study author Dr. Michael Camilleri told Reuters Health, and illustrates that stomach volume is determined by more than mere body size.

Moreover, according to Camilleri, the study suggests that factors governing stomach volume might help predispose people to obesity and could serve as targets for weight-control tactics.

These control mechanisms could range from eating patterns--such as whether a person eats small meals throughout the day or tends to binge--to hormones, to the nerves that control stomach contraction and relaxation, Camilleri noted.

Addressing these factors might then alter how long it takes a person to feel full. For example, Camilleri explained, changes in diet or patterns of food intake might do the job, as could medications that act on the nerves or hormones that control stomach volume, or other procedures or devices that change gastric volume.

Before any of this becomes reality, he noted, further research is needed to pinpoint the critical controls involved in determining stomach volume.

Source: Gastroenterology, February 2004.

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Health-Care Spending Evens Out in the End

Wednesday, March 3, 2004

WEDNESDAY, March 3 (HealthDayNews) -- A new study offers some small consolation for people on the unfavorable side of health-care spending differences related to race and gender.

RAND Corp. found that while it's often true that less money is spent on health care for minorities, the poor and men than on whites, women and higher-income people, that disparity narrows or vanishes in the last year of life for Medicare patients.

This is one of the first studies to identify an area of the U.S. health-care system that's free of gender or race-based spending differences. The RAND researchers examined the medical claims of 241,047 Medicare patients, aged 68 to 90, from across the nation.

"We were very surprised to find that, while differences in medical expenditures vary greatly by gender, race and income among patients two and three years before they die, those differences narrow or disappear during the last year of life. This is the only area of health care where we do not see spending differences," study author Lisa Shugarman says in a prepared statement.

While the study found a reduction in the health spending gap in the last year of life for Medicare patients, it adds there may still be considerable disparities in available services or in quality of end-of-life care.

The study appears in the February issue of the Journal of General Internal Medicine. RAND Corp. is a nonprofit research organization.

More information

The U.S. Centers for Medicare & Medicaid Services has more about Medicare and Medicaid.

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Many Fathers Uninvolved in Children's Health Care

By Alison McCook
Reuters Health
Wednesday, March 3, 2004

NEW YORK (Reuters Health) - In a new study conducted by U.S. researchers, only one half of fathers attended their children's routine health check-ups on a regular basis.

Work obligations were the most common reason fathers gave for why they could not always participate in their children's doctor visits.

Fathers play a crucial role in their children's health, and a father who is very involved in his child's well-being can save that child's life, a study author told Reuters Health.

For instance, if the child has an emergency and the father is the only caregiver present, the hospital will need to know some critical information about the child's health, such as medications and allergies, Dr. Trevena Moore explained.

"If not known, this could potentially compromise the child's care," she said.

More subtly, previous research has shown that fathers' involvement in children's care can have long-lasting influences on their mental and behavioral development. For instance, Moore described a study that showed that children whose fathers are involved in school-related activities tend to do better in math.

Moore added that, for the most part, fathers do not choose to shirk their parenting opportunities.

"Virtually, 100 percent of the fathers wanted to be involved in attending well-child visits," said Moore, who is based at the St. Louis University School of Medicine in Missouri.

In the study, Moore and her co-author interviewed 104 fathers of children younger than 7 years living in a low-income, urban environment, asking them how often they attended a child's regular check-up.

The researchers found that nearly 90 percent of fathers had attended at least one of their children's health check-ups. However, only fifty-three percent had been present during at least 40 percent of these routine visits.

Fathers who had only one child, were older, and whose children were covered by health insurance were more likely to often attend routine check-ups, according to the report, published in the journal Pediatrics.

Moreover, fathers who were present during their children's birth were more than seven times more likely to be present during at least 40 percent of their children's routine health visits, suggesting that it is important to make sure fathers are involved in their children's lives from the very beginning, Moore noted.

She added that pediatricians should try to encourage fathers to take active roles in their children's health care, and talk to mothers about the importance of making sure dads are involved. Given that work poses a significant barrier to men's participation in health visits, providing men with an opportunity to take time off for preventive health visits could also make an important difference, Moore noted.

"Ultimately, I think it should become the expectation that fathers will be involved in their children's health care, just as we expect mothers to be involved. Why should the expectation be any different?" Moore noted.

Source: Pediatrics, March 2004.

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New Exam May Improve Treatment of Lung Disease

By Ed Edelson
HealthDay Reporter
Wednesday, March 3, 2004

WEDNESDAY, March 3 (HealthDayNews) -- An exam that looks at the whole patient, not just the lungs, can refine treatment and may prolong the lives of those with the potentially fatal condition called chronic obstructive pulmonary disease (COPD), a study finds.

COPD is actually a group of conditions in which airflow through the lungs is partially blocked, so a person finds it progressively harder to breathe. COPD now is the fourth-leading cause of death in the United States and Canada, and its toll is predicted to rise.

Yet a new study of 625 patients shows that an exam scale called the BODE index can pick out patients at highest risk of deterioration and death.

The study also shows focused treatment based on the BODE index can help save lives, says Dr. Claudia G. Cote, a pulmonary and critical care physician at the Bay Pines Veterans Administration Medical Center in Florida and a participant in the study.

"We have been taught that COPD is an irreversible, chronic condition that leads to death," she says. "But we have shown that we can improve both survival and quality of life for COPD patients."

The study appears in the March 4 issue of the New England Journal of Medicine (news - web sites).

The BODE index is named for the four physical characteristics it measures -- "B" for body mass index; "O" for the degree of airway obstruction; "D" for dyspnea (difficulty breathing); and "E" for exercise capacity. It was developed by study author Dr. Bartolome R. Celli, chief of pulmonary care at St. Elizabeth's Medical Center in Boston.

"It didn't come out of the blue," Celli says. "I've been seeing patients for 30 years. The medical literature suggests very simple measurements can be used to evaluate patients beyond lung function."

That overall evaluation can be critical, Cote says. "You have one patient with 30 percent lung function in a wheelchair and getting oxygen, and another with the same degree of function is hopping around and functioning fully," she says.

Determining a score on the 1-to-10 BODE index can take only a few minutes, she says. The patient fills out a questionnaire about physical characteristics, takes a test to see how far he or she can walk in six minutes, and has lung function measured by a well-known -- although not commonly used -- technique called spirometry. The doctor also obtains a body mass index reading, a ratio of height to weight that is a standard test of obesity.

Every one-point increase in the BODE index was associated with a 33 percent increased risk of death during the study, the researchers found.

"We hope this paper will allow clinicians to look at patients differently," Celli says. "We can show that walking distance can be improved, and it is conceivable that we can reduce mortality."

The American Thoracic Society is starting a campaign to have specialists use spirometry more often for all patients with COPD, Cote says.

"We're looking forward to doing it," says Dr. Stephen I. Rennard, a professor of medicine at the University of Nebraska Medical Center, and author of an accompanying editorial in the journal. "We think the BODE index is likely to be used in clinical practice. COPD may not be cured, but patients can be made better."

More information

To learn more about COPD, visit the American Lung Association and the National Library of Medicine.

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Dietary Folate May Lower Ovarian Cancer Risk

Reuters Health
Wednesday, March 3, 2004

NEW YORK (Reuters Health) - The results of a study conducted in Sweden indicate that high levels of folate obtained from food sources may protect against ovarian cancer. The benefits were found to be primarily among women who consumed at least two drinks of alcohol per week.

Previous reports have shown that dietary levels of folate, a B vitamin also known as folic acid, are inversely related to the risk of breast and colorectal cancer. In contrast, few studies have looked at the association between folate intake and ovarian cancer risk.

To investigate, Dr. Alicja Wolk, from the Karolinska Institute in Stockholm, and colleagues analyzed data from a population-based group of more than 60,000 women living in Sweden. The subjects ranged in age from 38 to 76 years and all were cancer-free at study enrollment, between 1987 and 1990.

By follow-up in mid-2003, a total of 266 women had developed ovarian cancer, the researchers report in the current issue of the Journal of the National Cancer Institute (news - web sites).

Overall, women with the highest level of folate in their diet (at least 204 micrograms/day) were 33 percent less likely to develop ovarian cancer than those with the lowest levels (less than 155 micrograms/day).

Among women who consumed more than about two drinks per day, the risk reduction seen with high folate intake was much higher -74 percent. In contrast, high folate intake provided no protection against ovarian cancer in women who consumed lesser amounts of alcohol, the investigators point out.

"Additional studies are needed to determine the generalizability of our results to other populations that have higher folate intakes and to evaluate the efficacy and safety of high doses of folate from supplements with respect to cancer," the authors conclude.

Source: Journal of the National Cancer Institute, March 3, 2004.

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Short Daily Walks Not Enough to Fight Fat


Wednesday, March 3, 2004

WEDNESDAY, March 3 (HealthDayNews) -- A daily 15-minute walk or other small increases in daily exercise may not be enough to prevent obesity, Swiss researchers say.

Their study, in the March issue of the American Journal of Public Health, found such short walks don't burn off enough daily calories to compensate for the yearly weight gain seen in the increasingly overweight populations of a number of countries.

Some experts suggest people can prevent obesity by cutting 100 calories our of their daily diets or by doing enough exercise each day to burn off that amount of calories.

But the Swiss researchers say burning off those 100 calories takes more exercise than people may think.

"If the specific goal is to approach expending 100 calories a day through walking, the duration should be closer to 60 minutes for slow walking and 30 minutes for moderate or brisk walking," study co-author Dr. Alfredo Morabia, from Geneva University Hospital, says in a prepared statement.

He and a colleague reached this conclusion after examining data on the normal physical activity of adult residents of Geneva.

More information

The American Academy of Family Physicians (news - web sites) has more about exercise.

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School Program Curbs Teen Suicide Attempts: Study

By Amy Norton
Reuters Health
Wednesday, March 3, 2004

NEW YORK (Reuters Health) - A high school program that teaches teens about the link between suicide and depression cut suicide attempts by 40 percent at five U.S. schools, according to a study out Wednesday.

Among 2,100 students in the study, those who took part in the program were less likely than their peers to report a suicide attempt three months later.

When surveyed, 3.6 percent of these students admitted to attempting suicide in the past three months. That compares with 5.4 percent of their peers, according to findings published in the March 4th issue of the American Journal of Public Health.

Students at the schools, in Hartford, Connecticut, and Columbus, Georgia, were racially diverse and came from low- to middle-income families.

Researchers say such success has not been found in similar studies of other school-based suicide-prevention programs. In general, results from past research have been "disappointing," said the study's lead author, Dr. Robert Aseltine of the University of Connecticut Health Center in Farmington.

He told Reuters Health it appears that the greater understanding that students gained of mental illness, and its connection with suicide, explain the success.

The program, called Signs of Suicide, or SOS, is run by the non-profit organization Screening for Mental Health, and has been used in more than 1,000 U.S. schools. Students see a video featuring dramatizations of depressive and suicidal behavior, as well as interviews with real people whose lives have been affected by suicide.

They also fill out a short survey that allows them to screen themselves for depression, and are told how to seek help if they need it.

The materials focus on teaching kids that suicide is directly related to treatable mental illnesses, usually depression, according to Aseltine. The goal is to get them to recognize and respond to depression and suicidal behavior in themselves and in their friends.

Aseltine said the program tells them "it's OK to go to an adult," and that it's not a "betrayal of trust" to tell someone when they think a friend is suicidal.

He and his colleagues evaluated the SOS program in three high schools in Hartford and two in Columbus. The Hartford schools had large low-income and Hispanic populations, while the Columbus schools had mainly white and black students from working- and middle-class families.

The fact that the program appeared to reduce suicide attempts among such "high-risk" teens in urban schools is important, the researchers note in their report.

Aseltine said they plan to look at whether the lower risk of attempted suicide is lasting, or whether "booster" programs might be needed.

According to the government statistics, the rate of suicide among Americans ages 15 to 24 has tripled since 1950, and suicide now stands as the third leading cause of death in that age group.

Source: American Journal of Public Health, March 4, 2004.

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Inactivated Flu Vaccine Works in Kids Too

By Will Boggs, MD
Reuters Health
Wednesday, March 3, 2004

NEW YORK (Reuters Health) - Injecting young children with a flu vaccine containing an "inactivated" or killed virus is safe, effective, and potentially cost-saving, new research suggests.

In October 2003, the Centers for Disease Control and Prevention (news - web sites) recommended routine annual use of flu vaccine for children aged 6 to 23 months, explains Dr. Frederick L. Ruben from Aventis Pasteur in Swiftwater, Pennsylvania. However, inactivated virus vaccines have largely been unused for that purpose in young children.

Ruben reviewed the literature on the use of killed-virus flu vaccines in children using the MEDLINE/PubMed database. The findings are reported in the medical journal Clinical Infectious Diseases.

"Giving killed-virus influenza vaccines to school-aged children was shown to reduce the impact of influenza in older, unvaccinated adults in two very large studies," the report notes.

Despite the effectiveness of the vaccines, immunization rates in recent years have ranged from 25 percent to as low as 9 percent, Ruben writes. This is much lower than the 78-percent coverage for other recommended childhood immunizations.

One study included in the review concluded that vaccination of preschool children during flexible hours could result in a net cost savings of more than $20 per child.

"Inactivated (killed) influenza vaccines have undergone extensive study in children and have been demonstrated to be both safe and effective," Ruben told Reuters Health. "Of course, as they are used more widely, more experience will be gained."

Influenza is an important disease for children, Ruben concluded, "and it is well worth the efforts required to prevent influenza in children."

In a related editorial, Dr. Kathleen M. Neuzil from University of Washington School of Medicine, Seattle, agrees.

"Every child is susceptible to influenza virus infection," she writes, "and the message to the public needs to be clear: influenza vaccination is safe and effective and should be offered to anyone aged 6 months or older who wishes to reduce his or her chances of becoming ill from influenza."

Source: Clinical Infectious Diseases, March 1, 2004.

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March 2, 2004

Shortage in U.S. Forces Cutback in Prevnar Vaccine

By Maggie Fox, Health and Science Correspondent
Tuesday, March 2, 2004

WASHINGTON (Reuters) - U.S. health officials on Tuesday asked doctors to further reduce the number of vaccine doses given to protect infants against meningitis and deadly blood infections, in order to stretch out a short supply.

The Centers for Disease Control and Prevention (news - web sites) reluctantly recommended that doctors cut back their doses to two per child until supplies of the vaccine, Prevnar, are sufficient to return to the full schedule of four.

"CDC estimates this action will help conserve more than 1 million doses by July 2004, making widespread or prolonged disruptions less likely," the CDC said in a statement.

Wyeth is the sole manufacturer of Prevnar, a vaccine that protects against several different strains of pneumococcal bacteria. The company has had problems with supplies of the vaccine for two years and last month the CDC reduced the recommended number of doses to three.

"It's worsened just in the last three weeks," Dr. Steve Cochi, acting director for the CDC's National Immunization Program, said in a telephone interview.

"Our levels of concern have increased. If we can manage with a limited supply ... we might be able to see our way through this temporary shortage with a two-dose schedule and still protect most, if not all, children."

Normally children should get their first shot of Prevnar at 2 months, another at 4 months, the third at 6 months, and the last between 12 and 15 months.

"This recommendation suspends the third and fourth doses usually administered at 6 months and between 12 and 15 months for healthy children," the CDC said.

"Children with certain health conditions, such as sickle cell anemia or immune system disorders, are at increased risk of severe disease and should continue to receive the full, routine, four-dose series."

Cochi said even with the dose schedule halved, 90 percent of children should be protected against the worst infections. Four doses boosts the protective level to 97 percent.

The CDC lacks a national surveillance program to see what effects the shortage might be having, but it monitors six sites around the country for an indication. Health experts say a better nationwide monitoring system is urgently needed.

The shortage was caused by production problems, Cochi said. "The major problem that they have is their filling line. "The vaccine is made (but they) can't get it into vials."

Before a vaccine was available, pneumococcal infections caused more than 700 cases of meningitis, 13,000 blood infections and about 5 million ear infections in U.S. children, and killed around 200 a year, the CDC said.

Federal health officials said the infections have become less common among adults and children in the United States since the Food and Drug Administration (news - web sites) approved use of the Prevnar vaccine in 2000 for infants.

Health officials had expected the prevalence of pneumococcal disease to drop in young children, but it also fell in adults, especially seniors.

The findings, presented by CDC researchers at conference in Atlanta, indicate young children may have been a reservoir for pneumococcal bacteria.

"We're vaccinating children, and the children in turn are not passing the bacteria on to adults and other children," said the CDC's Cynthia Whitney, who helped conduct two separate studies on the prevalence of invasive pneumococcal disease.

The number of cases of the disease in adults aged 50 and older fell 25 percent to 29 per 100,000 in 2002 from 41 cases per 100,000 reported in 1998-1999, according to a CDC analysis of data from one state and seven cities. (Additional reporting by Paul Simao in Atlanta)

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Groups Urging No Antibiotics for Earaches

By Daniel Yee
Associated Press Writer
The Associated PresS
Tuesday, March 2, 2004

ATLANTA - Parents of cranky children with ear infections be warned: Antibiotics may no longer be what the doctor orders. Two leading medical groups are expected to recommend this spring that doctors stop treating most ear infections in children with antibiotics, federal health officials said Tuesday.

The move contradicts years of pediatric practice and is expected to disappoint weary parents of whimpering, infected toddlers.

About half of all antibiotics prescribed to preschool children are for treating ear infections. Health officials believe if they can reduce child antibiotic use for such infections, they can stop the rise of antibiotic-resistant germs created by overuse of the drugs.

"It will mark a dramatic change in appropriate antibiotic use," said Dr. Richard Besser, acting chief of the meningitis and special pathogens branch of the Centers for Disease Control and Prevention (news - web sites).

The guidelines from the American Academy of Pediatrics and the American Academy of Family Practice must be formally approved by the medical bodies before they are published for doctors.

For years, health officials have been battling improper antibiotic use by emphasizing that the drugs should not be used for viruses, such as colds, because they do no good.

This time, health officials are going even further, urging that antibiotics also be withheld for bacterial ear infections if they appear to be minor.

Most children with ear infections — about 80 percent — typically recover in two to seven days, Besser and other experts say.

"We are making a societal trade-off — at the individual level, some kids may have a little bit longer course of their infection, but for society as a whole, we will be better served if we don't give them," said Dr. Richard Rosenfeld, a member of the committee reviewing the guidelines.

"We should save the power of antibiotics for people with real significant illnesses where 80 percent don't get better in a day or two and can actually die," he said.

As the guidelines are currently proposed, doctors would only prescribe antibiotics for children with serious middle ear infections, known as acute otitis media. Symptoms include a minimum fever of 102.6 degrees or severe ear pain. Milder cases would simply be observed.

Between 5 million and 6 million children under age 5 suffer ear infections each year. Antibiotics are prescribed in many of those visits, said Rosenfeld, also director of pediatric otolaryngology at Long Island College Hospital in Brooklyn, N.Y.

About 10 million prescriptions each year are written for ear infections in children of all ages.

Health officials believe the new guidelines won't cause any extra office visits for parents, although they may be asked to update pediatricians with their child's condition by phone, said Dr. Allan Lieberthal, co-chairman of the medical groups' committee reviewing the guidelines change.

A specific definition for doctors of what constitutes a serious ear infection also is expected to reduce antibiotic overuse.

"Antibiotics only will be considered if it's truly acute otitis media and not every abnormal-appearing ear," Lieberthal said.

Medical studies have found the antibiotics do very little for a child's ear infection pain. Common painkillers such as acetaminophen or ibuprofren are effective for that, said Lieberthal, also a pediatrician for Kaiser Permanente in Panorama City, Calif.

"Since the discovery of penicillin, when there is a bacterial infection, antibiotics are given," Lieberthal said. "Because of the increasing resistance of common bacteria to antibiotics, the importance of limiting their use is essential."

On the Net:

CDC antimicrobial resistance info:

American Academy of Pediatrics info:

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Birth Control Pills Lower Risk of Arthritis

Reuters Health
Tuesday, March 2, 2004

NEW YORK (Reuters Health) - The use of birth control pills, but not estrogen therapy, lowers the risk of developing rheumatoid arthritis, according to a new report. The findings suggest a dose-related effect, as estrogen drugs are typically one-sixth as potent as birth control pills.

Although previous reports suggest a role for sex hormones in the development and progression of rheumatoid arthritis (RA), the authors explain in the February issue of The Journal of Rheumatology, studies investigating the influence of estrogen drugs on the development of RA have yielded conflicting results.

Dr. Sherine E. Gabriel from the Mayo Clinic in Rochester, Minnesota, and colleagues investigated whether exposure to either birth control pills or estrogen therapy influenced the development of rheumatoid arthritis in women. The researchers used data from The Rochester Epidemiology Project.

Women who ever used birth control pills had a 43 percent lower risk of having RA, the authors report, though there was no association between the current use of such pills and RA.

In contrast, exposure to estrogen therapy did not influence the development of RA, the researchers found.

The investigators calculate that the number of women who develop RA could drop by about 38.6 percent if the entire female population of Rochester were exposed to birth control pills.

"Further research...may help to explain the complex relationship between estrogen, progestins, and RA," the authors conclude.

Source: Journal of Rheumatology, February 2004.

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When Breast-Feeding Moms Return to Work

Tuesday, March 2, 2004

(HealthDayNews) -- When breast-feeding moms return to work, they should do so gradually, says the Baylor College of Medicine.

By initially taking one day off a week, your body will get used to being back at work. Too much too soon and you're likely to see your milk supply decrease because of the stress of working full time and caring for your child when you get home.

To help keep your milk flowing, nurse more often in the evenings and on weekends. It's also a good idea to have a supply of frozen breast milk on hand.

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Estrogen Trial Shows Stroke Risk Raised

By Maggie Fox, Health and Science Correspondent
Tuesday, March 2, 2004

WASHINGTON (Reuters) - The National Institutes of Health (news - web sites) said on Tuesday it had stopped a trial of women taking estrogen replacement therapy after finding the pills not only failed to reduce the risk of heart disease but raised the possibility of a stroke.

It was the second large trial of hormone replacement therapy to have been halted in two years. In July 2002, women taking estrogen and progestin were told to stop because of the risk of heart attack, stroke and some forms of cancer.

But officials stressed that women taking HRT should not panic, because the risk of stroke had already been noted years before. "This is not an emergency," Dr. Barbara Alving, director of the trial, called the Women's Health Initiative, told reporters.

"Currently the (Food and Drug Administration (news - web sites)) advises women using hormone therapy to use the lowest doses for the shortest period of time."

The FDA said many women who take HRT to reduce the worse symptoms of menopause such as hot flashes and sexual effects could still consider HRT, with a doctor's advice.

The estrogen-only trial was a separate arm of the WHI that looked at women over 50 who had hysterectomies and were taking Wyeth Co's (NYSE:WYE - news) Premarin, made from the urine of pregnant mares. Already about half the 11,000 women in the trial had dropped out, the researchers said.

The women had received letters in 2000 and 2002 warning them of the stroke risk. The NIH decided to stop the trial about a year early after getting enough information to decide that the benefits of estrogen did not outweigh the stroke risk.

More Details To Come

Some advisers disagreed, but the decision was finally made "at the top level" of the NIH to stop the trial and analyze the data. Details on the effects of estrogen-only therapy will be published in a major medical journal in April, Alving said.

She said the findings would not apply to young women who take estrogen after having hysterectomies. "The mean age of these women is about 70 years of age. We are talking about women of a certain age, a certain population," Alving said.

Dr. Jacques Rossouw, WHI project officer, said the finding would be presumed to apply to all HRT, no matter what the formulation or dose.

Alving said both trials clearly showed that HRT can help prevent osteoporosis. Unlike the estrogen plus progestin trial, estrogen alone did not increase the risk of breast cancer.

Menopausal women and their doctors were shocked when the Women's Health Initiative showed in 2002 that hormone replacement therapy did not, as had widely been believed, prevent heart disease or memory loss.

Wyeth, which makes both drugs used in the WHI, said 6.4 million women were taking Premarin before the 2002 announcement and 3.4 million were taking the estrogen-progestin combination called Prempro.

Now the company estimates 4 million women are taking Premarin and 300,000 are taking Prempro.

Deutsche Banc stock analyst Barbara Ryan said combined global sales of the drugs will likely fall to $1 billion in 2004 from $1.3 billion last year not because of the news but because of the older concerns.

Wyeth said it now has lower-dose formulations of estrogen, although there is no data to show these are any safer.

Dr. Victoria Kusiak, vice president of global medical affairs at Wyeth, said the company had no plans to do any trials of the lower doses, saying they would be difficult to do. Kusiak and Alving agreed that older women need to find other ways to reduce their risk of heart disease, such as exercising, losing weight and eating a healthy diet.

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Iron Deficiency Anemia

Tuesday, March 2, 2004

(HealthDayNews) -- If your child's been diagnosed with iron deficiency anemia, The Children's Hospital of Philadelphia offers these tips:

  • To make your child's medicine more palatable, mix it with one ounce of apple or orange juice.
  • Wipe the teeth after each dose to prevent discoloration of the enamel.
  • Give your child foods high in iron, including meats, fish, chicken, raisins, dried fruits, sweet potatoes, greens, lima beans, chili beans, green peas, and peanut butter.
  • Infant formulas have iron, but regular milk does not. Don't give children under the age of one year regular milk without first talking to your child's doctor.
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New Meat Testing Cuts Food-Borne Diseases – US

By Paul Simao
Tuesday, March 2, 2004

ATLANTA (Reuters) - The number of Americans who become sick from three common food borne bacteria appears to be declining, due in part to improved testing of meat and poultry, federal health officials reported on Tuesday.

An estimated 76 million people in the United States become sick each year after eating undercooked meat, eggs and shellfish, unpasteurized dairy products and other foods containing bacteria.

Symptoms typically include diarrhea, cramping and nausea, and most people recover without hospitalization.

The good news is that a U.S. government survey of nine states found that the incidence of laboratory-confirmed cases of Campylobacter, Listeria monocytogenes and Yersinia enterocolitica fell between 1996 and 2002.

The declines ranged from 24 percent in the case of Campylobacter to 43 percent for Yersinia, according to the Centers for Disease Control and Prevention (news - web sites), which did the study.

Jennifer Nelson, one of the study's researchers, said improved meat testing and other control measures introduced by the U.S. Department of Agriculture (news - web sites) had contributed to the reduced number of confirmed infections caused by these bacteria.

"We now have regular microbiological testing of meat and poultry and there are steps the USDA can take to keep tainted meat from entering the food supply," Nelson said.

While the CDC found little change in the overall incidence of infections caused by the Salmonella, Shigella or E. coli O157:H7 bacteria, it did note that the number of confirmed Vibrio cases jumped 125 percent in the same period.

Consumption of shellfish is the primary cause of Vibrio infections, which typically are marked by chills and fever. Nelson recommended that consumers wash their hands and clean surfaces when handling shellfish and avoid eating raw oysters.

Nelson and her fellow researchers tracked the incidence and trends of seven food borne diseases through the FoodNet surveillance system, which was introduced by the Atlanta-based CDC in 1996.

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When It's Hard to Swallow

Tuesday, March 2, 2004

TUESDAY, March 2 (HealthDayNews) -- If you have trouble swallowing food, beverages or even saliva, you may have dysphagia.

It's a common medical condition, affecting about one in 10 people over age 50, that occurs when something goes wrong at any stage of the swallowing process, says an article in the February issue of the Mayo Clinic Health Letter.

Some people with dysphagia have difficulty starting to swallow while others can start swallowing but get the feeling that food gets stuck as it's going down.

Dysphagia can be caused by medical conditions -- including Parkinson's disease (news - web sites), tumors and acid reflus -- that damage or weaken the nerves and muscles that control swallowing.

If you experience slight or occasional dysphagia, it doesn't mean you have a serious medical problem. But the Mayo Clinic Health Letter says it's a good idea to see your doctor if you have difficulties swallowing.

Treatment to correct the problem depends on the cause. Treatment options include diet changes, surgery, medication and exercises to strengthen swallowing muscles.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more about swallowing disorders.

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Teens Buy Nicotine Patches as Easily as Cigarettes

By Alison McCook
Reuters Health
Tuesday, March 2, 2004

NEW YORK (Reuters Health) - Teenagers can purchase nicotine replacement therapy with relative ease, despite the fact that these products carry warnings saying they are meant for adults, according to new research.

U.S. investigators found that a 15-year-old girl was able to purchase nicotine replacement products like nicotine patches in 8 out of 10 attempts, without showing any proof of age.

Unfortunately, research has shown that some teens "misuse" nicotine replacement products, either trying them when they don't need to quit smoking, or using them while they are still smoking, study author Dr. Karen C. Johnson told Reuters Health.

However, studies have shown that nicotine replacement therapy (NRT) is usually safe and unlikely to become addictive, and some teens may benefit from being able to purchase an NRT product if it can help them quit smoking, Johnson said.

"If a smoking youth wanted to quit smoking by using NRT, with parental permission and supervision, I believe this would be appropriate use of the product," Johnson said.

According to the Archives of Pediatrics & Adolescent Medicine report, one quarter of U.S. high school students smoke, and more than half of these students say they want to quit.

Currently, NRT carries U.S. Food and Drug Administration (news - web sites) warnings that the products should not be sold to anybody under the age of 18. However, experts now agree that the products may be a safe option for some teen smokers who want to stop.

To determine whether young smokers have access to NRT, Johnson colleagues at the University of Tennessee Health Science Center in Memphis observed a teen girl as she tried to purchase NRT at 165 different stores.

During 8 out of 10 attempts, she was not asked a single question about her age, and walked away with the NRT product. Stores that contained cash registers that prompt workers to ask a buyer's age and those that also sold alcohol were more likely to ask her about her age, and less likely to let her buy an NRT product.

Johnson explained that store employees may be often unaware that NRT has warning labels saying the products should not be sold to minors.

"I recommend that retail establishments consider training their staff to inquire about age for all age-regulated products, including NRT and cigarettes," she said.

Dr. William P. Adelman of the National Naval Medical Center in Bethesda, Maryland, who wrote an accompanying editorial, told Reuters Health that although the few studies of NRT use in teens suggest it is not harmful, that does not mean it is safe.

Moreover, no studies have shown that NRT helps teens quit smoking, likely because many teens light up due to behavioral and social pressures, and not an addiction to nicotine, Adelman said.

He added that experts should wait for evidence that suggests NRT actually works in teens before recommending it to this age group as a whole.

"Making NRT widely available, and assuming it is safe and effective for teenagers before it is known to be the case, is not a wise course of action," Adelman said.

Source: Archives of Pediatrics & Adolescent Medicine, March 2004.

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Taking the No-Smoking Message to Schools

Tuesday, March 2, 2004

TUESDAY, March 2 (HealthDayNews) -- Engaging teenager smokers as anti-smoking activists may persuade them to quit the habit more effectively than lectures and scare tactics do.

That's the conclusion of a Stanford University School of Medicine study in the March issue of the Archives of Pediatrics and Adolescent Medicine.

The study included students at 10 alternative high schools in the San Francisco/San Jose area of California. It found that regular smokers who took part in an anti-tobacco advocacy curriculum reduced their own cigarette use by 3.8 percent by the end of the semester, while the rate of cigarette use among regular smokers in a traditional drug abuse prevention classes increased by 1.5 percent.

This decrease in smoking among the teens in the anti-smoking sessions continued six months later, showing a further decline of 1 percent. Such a sustained decline is rare in efforts to reduce teen smoking, the study authors note.

"The real, sustained change we saw is different from most other studies on teenage smoking. In past studies where smoking behaviors changed, the effect was very transitory," study author Marilyn Winkleby, an associate professor of medicine at the Stanford Prevention Research Center, says in a prepared statement.

The anti-tobacco advocacy program was designed to increase the students' awareness of factors that promote cigarette use.

"It's not the traditional approach of providing individuals with information to get them to change their own behavior. It's an indirect way to bring about behavior change by making students aware of the social context of smoking behavior," Winkleby says.

The students learned about tobacco advertising strategies and tobacco availability. They also assessed tobacco promotion in their communities.

"Most of them were surprised and then angry when they realized how extensive it was. Teenagers don't like it when other people try to influence them," Winkelby says.

More information

The American Medical Association has more about kids and smoking.

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Radiosurgery Helps with Painful Nerve Condition

Reuters Health
Tuesday, March 2, 2004

NEW YORK (Reuters Health) - Radiosurgery, a non-invasive radiation technique, is a safe and effective treatment for selected patients with trigeminal neuralgia, a condition involving episodes of intense stabbing pain in the face and neck, new research suggests.

Despite the name, radiosurgery doesn't involve cutting with a scalpel. Instead, X-rays are taken that pinpoint where the "cutting" is to occur and then highly focused beams of radiation perform the "surgery." Although not completely understood, radiosurgery seems to improve trigeminal neuralgia by selectively destroying nerves that carry pain signals.

As a treatment for trigeminal neuralgia, radiosurgery has typically been limited to patients who have failed conventional surgical therapy, Dr. A. A. De Salles and colleagues, from the University of California at Los Angeles, note. Recently, however, radiosurgery has started to be offered as the main therapy for the condition.

In the current study, radiosurgery was performed on 22 patients with trigeminal neuralgia. All of the patients had failed to respond to drug therapy.

The average follow-up period was 21.2 months, and pain relief was assessed by an independent observer. No sedation or hospital admission was required for the radiosurgery treatments, the authors note in the medical journal Neurology.

Pain relief was rated as excellent for 15 patients, good for 6, and poor for 1, yielding a total success rate of 95.4 percent, the authors note. On average, pain relief occurred 2.7 months after radiosurgery. Five patients experienced pain recurrence, but in all cases the pain was less severe than before treatment.

The procedure was well tolerated and complications were limited to mild sensory problems, the researchers point out.

"The results of the present series support the use of the available radiosurgery techniques as a first surgical option," the authors state. Because it takes about three months for pain relief to occur, radiosurgery is not a suitable choice for patients with acute severe pain episodes, they add.

Source: Neurology, February 24, 2004.

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Battling Bladder Cancer's Return

Tuesday, March 2, 2004

TUESDAY, March 2 (HealthDayNews) -- A procedure sometimes used to monitor male bladder cancer patients after they've had radical surgery may help doctors pinpoint which ones are most likely to suffer a recurrence, says a University of Florida study.

The procedure is called urethral wash cytopathology. Patients who are monitored with this procedure after they've had bladder and prostate removal often have a second operation to remove the urethra if urethral wash cytopathology indicates there are still some remaining cancer cells. It's believed this reduces the risk of cancer recurrence.

But this study found no difference in long-term outcomes for patients who had their urethra -- the tube through which urine flows out of the body -- removed after remaining cancer cells were detected using urethral wash cytopathology and patients who did not have the procedure but had their urethras removed.

"What the study says . . . is that the risk for the patient has been determined pretty much by the time the (bladder and prostate removal) is done," study author Dr. William Murphy, a professor of pathology, says in a prepared statement.

He says a positive result from a urethral wash may be viewed as a warning sign that cancer may develop elsewhere in the body, rather than as an indicator that the patient's urethra should be removed.

The study appeared in a recent issue of Cancer/Cancer Cytopathology.

More information

The U.S. National Cancer Institute (news - web sites) has more about bladder cancer.

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Symptoms Common After Breast Cancer Treatment

Reuters Health
Tuesday, March 2, 2004

NEW YORK (Reuters Health) - Women who have completed treatment for breast cancer may seem to be out of the woods, but new research suggests that a broad range of physical symptoms persists in women making the transition from cancer patient to cancer survivor.

In a new study, women who had just completed treatment seemed to be in good emotional shape, but they reported a wide variety of physical symptoms, including hot flashes and aches and pains.

Steps to address common post-treatment symptoms should be considered, according to the study's authors.

Plenty of research has examined the psychological and social impact of breast cancer, but it has mostly focused on newly diagnosed women or on survivors, who completed treatment in the past. There is much less information on the experience of women who have just completed treatment.

Now, a team led by Dr. Patricia A. Ganz at the University of California at Los Angeles Jonsson Comprehensive Cancer Center has taken a closer look at this group of women.

The study involved 558 women who had just completed treatment for breast cancer. The women had undergone mastectomy or lumpectomy either with or without chemotherapy.

Despite having a serious illness and undergoing sometimes prolonged treatment, the women in the study reported a normal level of mental health, Ganz's team found. In terms of mental health, there were no significant differences among the four treatment groups.

But women who had just completed cancer treatment did report a wide range of physical symptoms, including hot flashes, night sweats, aches and pains and vaginal dryness. Women who had had a mastectomy tended to report more physical problems than women who had had a lumpectomy.

After treatment for cancer, women also reported sexual problems, such as painful intercourse and insufficient lubrication. Women who had undergone chemotherapy were more likely than women who had surgery alone to report sexual problems.

The findings appear in Wednesday's issue of the Journal of the National Cancer Institute (news - web sites).

Ganz and her colleagues point out that physicians prepare women for the side effects that they may experience during treatment, such as nausea, vomiting, hair loss and fatigue. But doctors have had little information with which to guide patients through the post-treatment period, the authors note.

"From this study, we now have an accurate description of how women are functioning at the end of primary treatment," the authors write.

The authors plan to continue following these women, who are enrolled in a study that compares two behavioral interventions designed to help women in the transition from treatment to recovery.

Source: Journal of the National Cancer Institute, March 3, 2004.

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Breast Cancer Vaccine Promising in Mice

By Kathleen Doheny
HealthDay Reporter
Tuesday, March 2, 2004

TUESDAY, March 2 (HealthDayNews) -- Using a vaccine that targets an altered gene known to increase breast cancer risk, followed by a booster vaccine a week later, helped halt cancer and reversed cancerous lesions to an earlier stage in animals, Italian scientists report.

Experts caution the research is in its early stages and may not work in humans. The study appears in the March 1 issue of the Journal of Clinical Investigation.

A team led by Dr. Federica Cavallo of the University of Turin, Italy, worked with mice who over-expressed the HER-2/neu oncogene. An oncogene is an altered gene that develops into a cancerous one, and the over-expression of Her-2/neu is found in up to 30 percent of breast cancers as well as other types of cancers. This makes it a popular target for immunologic research.

The combined vaccine approach included a primary vaccination with self-replicating DNA molecules, or plasmids, which encoded portions of the oncogene's protein, rp185neu, to inhibit the growth of precancerous lesions. Then a booster vaccine was given a week later with cells expressing this protein and also engineered to release a kind of interferon, which boosts immune function.

The combination approach kept 48 percent of the mice tumor-free. At 22 weeks, the tumor-free mice were not distinguishable from those of 10-week-old mice who were untreated.

Vaccines for breast cancer is still considered an experimental idea. While traditional vaccines aim to prevent disease, some breast cancer vaccines are designed to treat or cure cancer that's already present. The goal is to stimulate an antibody response by injecting weakened or dead elements of breast cancer cells. Once the antibodies attack and destroy cancer cells, it is hoped they will continue to circulate and attack any new cancer cells that appear.

Several breast cancer vaccines are in development in the United States and overseas. If they bear out, researchers say it might be possible someday to give women at high risk for breast cancer a vaccine to eliminate or reduce the chances they will get the disease.

"The concept is wonderful," says Dr. Herman Kattlove, a spokesman for the American Cancer Society (news - web sites). "But it's an early study."

In the war on cancer, "some kind of immunologic method will probably be necessary," he says. "Vaccines are a way to achieve this." But the research is much too preliminary to be considered promising yet for humans, he cautions. Any application of the new research, he says, is no doubt several years away.

More information

Learn about breast cancer prevention at the National Cancer Institute, while a page on using the immune system to fight the disease is at breast

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Test May Be Safer Way to Detect Fetal Problems

Tuesday, March 2, 2004

CHICAGO (Reuters) - A new technique could make it possible to detect fetal abnormalities with a sample of the mother's blood, instead of invasive procedures that can put the pregnancy at risk, researchers reported on Tuesday.

The new laboratory test uses formaldehyde to stabilize membranes in the blood cells of samples collected from the mother, thus increasing the amount of fetal DNA that can be examined.

Without such stabilization, the DNA samples are often destroyed during collection, handling and processing, a problem that has limited the use of maternal blood samples to identify abnormalities such as Down's syndrome or spina bifida.

The test was developed by Ravgen Inc., a private biotechnology company based in Maryland, which reported the results in an article published in this week's Journal of the American Medical Association (news - web sites).

Invasive prenatal tests with such techniques as amniocentesis or umbilical blood sampling are highly reliable, but carry a risk for loss of the pregnancy, the study said. As a result women who would otherwise be candidates for a diagnosis, such as those over age 35, decline them, the authors said.

In one part of its test, free fetal DNA in untreated blood samples averaged 7.7 percent compared to more than 20 percent in the treated samples, the company said.

A high percentage of free fetal DNA makes it easier to diagnose chromosomal abnormalities, the report said, and suggests that the technique could provide "a solid foundation for the development of a noninvasive prenatal diagnostic test."

In an editorial in the same journal commenting on the study researchers at Baylor College of Medicine in Houston said the findings have major clinical implications.

"Developing a reliable, transportable technology for cell-free DNA analysis impacts two crucial areas--prenatal genetic diagnosis and cancer detection and surveillance," the editorial said.

"With prospective studies focusing on clinical applications of these findings, profound clinical implications could emerge for prenatal diagnosis and cancer surveillance," it added. It could mean that leukemia, for example, could be monitored with a blood test instead of having to take a bone marrow sample, it said.

Source: Journal of the American Medical Association, March 3, 2004.

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Scans May Aid Blood Clot Treatment

By Randy Dotinga
HealthDay Reporter
Tuesday, March 2, 2004

TUESDAY, March 2 (HealthDayNews) -- In a possible bit of good news for people prone to blood clots, researchers report that a new kind of scan can predict which patients need the most drastic treatments for clots in the lungs.

The findings are preliminary and need to be confirmed. But if they hold up, they'll help doctors do a better job of diagnosing and treating the potentially deadly clots, says study co-author Dr. John A. Pezzullo, an assistant professor of diagnostic imaging at Brown University. "It may allow us to stratify these patients and say this patient needs more aggressive treatment to survive," he explains.

Lung blood clots -- also known as pulmonary embolisms, or emboli among linguistic perfectionists -- strike an estimated 600,000 Americans a year and kill 50,000 of them. Lung blood clots have been in the news as doctors have urged airline passengers to beware of the risk of developing them during long flights.

The clots typically break off from vessels in the legs and make their way to the lungs. Once there, they act like traffic jams, preventing the lungs from accepting blood from the heart and oxygenating it.

The symptoms of the clots include shortness of breath and chest pain, and it often takes doctors a while to figure out what is really going on. In recent years, however, scanning technology has given doctors more effective ways to figure out if the clots actually exist.

Pezzullo and his colleagues examined the medical records of 59 patients who had lung blood clots and underwent CT scans. The researchers report their findings in the March issue of Radiology.

Doctors currently use the scans to determine whether the clots exist; the researchers took them a step further and used the results to measure the size of the clots. Five of the six patients with the largest clots died, while all but one of the 53 other patients survived.

"The amount of clot burden [the size of the clot] correlated pretty significantly with patient outcome, whether they survived or died," Pezzullo says.

In cases where patients seem to be at high risk, the scan results could point doctors to more powerful treatments. Among other things, doctors can try to destroy clots by giving drugs to patients or actually injecting drugs into the clots themselves. However, surgery itself can be risky.

Researchers will have to confirm the findings in studies of larger groups, Pezzullo cautions.

Another radiologist agrees. The study is based on "very small numbers" and doesn't take into account other relevant factors such as blood pressure, says Dr. Paul Molina, a professor of radiology at the University of North Carolina at Chapel Hill.

Nonetheless, Molina says, " it's worth looking at this particular variable."

More information

Learn more about pulmonary embolism from Thomas Jefferson University Hospital. If you're concerned about suffering blood clots while flying, check

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Suicide Thoughts Treatable in Depressed Elderly

Reuters Health
Tuesday, March 2, 2004

NEW YORK (Reuters Health) - Recognizing and treating depression in the primary care setting can reduce thoughts of suicide in older patients, according to a report published in this week's issue of the Journal of the American Medical Association (news - web sites).

Dr. Charles F. Reynolds, from the University of Pittsburgh, and colleagues evaluated levels of suicidal thinking, also called "suicidal ideation," in 598 older patients with depression who visited primary care practices. The patients were randomly assigned to receive usual care or a special intervention. Suicidal ideation and depression severity were assessed at the start of the trial and at 4, 8 and 12 months.

The intervention centered on two key aspects of care. Physician knowledge, the first component, was addressed using a systematic treatment plan for managing geriatric depression in the primary care setting. The second component was treatment management, which was implemented by depression care managers.

Suicidal ideation rates fell much faster in the intervention group than in the usual care group, the authors note. At four months, rates of ideation had dropped by about 13 percentage points in the intervention group compared with 3 percentage points in the usual care group.

Participation in the intervention also had a beneficial effect on the severity of depressive symptoms and the speed of symptom reduction, the researchers state. However, among patients with minor depression, the intervention's effects on depression were not significant unless suicidal ideation was also present.

"Together these findings indicate that efforts to improve the quality of depression treatment for geriatric primary care patients can focus on patients with suicidal ideation or major depression with the expectation that appropriate management will reduce depressive symptoms, suicidal ideation, and the risk of suicide in late life," the investigators conclude.

Source: Journal of the American Medical Association, March 3, 2004.

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Test Boosts Fetal DNA in Mom's Blood

By Serena Gordon
HealthDay Reporter
Tuesday, March 2, 2004

TUESDAY, March 2 (HealthDayNews) -- A simple change in the way maternal blood is treated increases the amount of fetal DNA in the blood, which could eventually lead to less invasive prenatal testing for genetic defects.

By adding the preservative chemical formaldehyde to blood samples from expectant mothers, researchers were able to raise the average amount of available fetal DNA from about 8 percent to more than 20 percent.

Results of the study appear in the March 3 issue of the Journal of the American Medical Association (news - web sites).

Currently, the most reliable ways to test for prenatal genetic defects are tests called amniocentesis and chorionic villus sampling. While these tests are very accurate, they are invasive and carry a small risk of miscarriage.

"The main purpose of doing this study was to try to develop a means of noninvasive maternal testing. One of the steps is to find ways to get fetal DNA out of the mother's blood," says study author Dr. Ravinder Dhallan, chief executive officer and founder of Ravgen Inc. in Columbia, Md.

Normally, the percentage of fetal DNA found in a mother's blood sample is very low, "about 3 percent in maternal blood samples," Dhallan explains.

Dhallan and his colleagues thought the actual percentage was higher, and theorized that if they added formaldehyde to mothers' blood samples it would "harden" or preserve the fetal DNA.

In the first phase of the study, the researchers tested two blood samples each from 10 pregnant women recruited from a single U.S. site. One of the samples from each woman was treated with formaldehyde; the other was not.

The percentage of DNA found in the untreated blood samples was 7.7 percent, while the formaldehyde treated samples averaged 20.2 percent fetal DNA.

During the second phase of the study, the researchers gathered 69 maternal blood samples from 27 different sites in 16 U.S. states. All were treated with formaldehyde.

About 59 percent of these samples had more than 25 percent fetal DNA. Just over 27 percent had more than 50 percent fetal DNA.

Dhallan says he believes formaldehyde stops the mother's blood cells from destroying themselves and overwhelming the fetal DNA. He says normally when blood is collected and transported, some of the blood cells burst and release their DNA into the mother's plasma. This reduces the percentage of fetal DNA.

He says this technique is something that could be easily duplicated in other labs, and says these findings have made it "more likely that in the future there will be a test from blood that can give you the same information from amniocentesis and other invasive tests."

In an editorial in the same issue of the journal, Dr. Joe Leigh Simpson, chairman of obstetrics and gynecology at Baylor College of Medicine in Houston, says the implications of this test are far-reaching.

"The real excitement is how we can use this in other ways," he says.

Not only could testing of fetal DNA look for genetic abnormalities, but it can detect earlier in pregnancy if a mother with Rh negative blood is carrying an Rh positive baby, which means all Rh negative women wouldn't need to receive preventive shots at 27 weeks' gestation to avoid developing potentially harmful antibodies.

Simpson also believes that in the future it may be possible to use fetal DNA to predict whether a pregnancy will have complications.

He also says the methods used to capture cell-free fetal DNA could be used to test for cell-free cancer DNA, which could be a better surveillance method than imaging technology for people diagnosed with cancer.

"This could be used as an early warning," says Simpson. "Molecular testing is far more sensitive than imaging."

More information

To learn more about amniocentesis and chorionic villus sampling, go to the March of Dimes or the American Academy of Family Physicians.

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Monday, March 1, 2004

Scientists Trick Skin Cells Into Fending Off UV Damage

Monday, March 1, 2004

MONDAY, March 1 (HealthDayNews) -- Boston University School of Medicine scientists say they've discovered a way to "trick" skin cells into protecting themselves from DNA damage caused by ultraviolet (UV) light.

In research with mice, the researchers showed skin cells can be made to believe they've suffered DNA damage. That triggers natural defense mechanism against further DNA damage, thereby reducing cancer caused by subsequent UV light exposure.

The findings appear in the March 1 issue of the Proceedings of the National Academy of Sciences (news - web sites).

The scientists topically applied a DNA fragment called thymidine dinucleotide (pTT) to hairless mice over several months and exposed the mice to UV light. The proportion of mice treated with pTT that developed tumors was reduced more than sixfold compared to other mice that were also exposed to UV but did not receive pTT.

The study also found tumor development was greatly delayed in the mice that received pTT.

The findings suggest it may be possible to use such DNA fragments to develop a skin product that will help people reduce their risk of skin cancer.

More information

The American Cancer Society (news - web sites) has more about skin cancer.

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Video Games Make Kids Fat, Violent, Swedish Experts Say

Monday, March 1, 2004

STOCKHOLM (Reuters) - Video games can make children fat and, in the case of violent games popular among teenage and younger boys, aggressive and even criminal, Swedish experts said on Monday.

The games industry, estimated at $200 million a year in Sweden and $10 billion in the United States, is dominated on the hardware side by Microsoft Corp.'s Xbox (news - web sites), Sony Corp (NYSE:SNE - news) (news - web sites)'s PlayStation and Nintendo (news - web sites) Co. Ltd's Game Boy and GameCube consoles.

Electronic Arts Inc., Nintendo, Activision Inc., and Take-Two Interactive Software Inc. are among leading games title publishers.

Take-Two's Rockstar unit's Grand Theft Auto -- a game condemned as "horrendous" by former U.S. Democratic presidential hopeful Joseph Lieberman -- is among titles mentioned by a Swedish television documentary in connection with violent youth crimes.

"It's concerning because they (video game players) are rehearsing scripts of behavior that will possibly play themselves out in real life," Michael Rich, a member of the American Academy of Pediatrics who has studied the effects of entertainment media on the physical and mental health of children, was quoted as saying in the 45-minute "Deadly Game" documentary.

Monday's preview of the film, due for prime time broadcasting on Swedish TV4 television on Wednesday, was followed by a panel debate, which concluded that scientific findings of the effects, if any, of violent video games were scant.

"But it has been proved beyond dispute that people who watch a lot of violence on television develop aggressive behavior," said Frank Lindblad, a child psychiatrist at Sweden's Karolinska Institute university hospital.

Diffuse Border

"They run a very high risk of criminal behavior ... there's a lot suggesting that video games are worse," he said, noting that many players tended to identify themselves with game heroes.

"The border between the virtual reality and the real world becomes diffuse and that is dangerous," Lindblad said.

Gustav Niel-Berggren, a 16-year-old student who said he tended to spend many hours a day several days a week playing an interactive online action game called Counter-Strike, which focuses on killing opponent soldiers, disagreed.

"Shooting somebody in a game is just like scoring a goal in a football match," he said, dismissing the documentary's suggestion and Lindblad's fear that youths could not distinguish between the game world and real life.

Elisabeth Junttila, a mother of six and head of a nationwide association promoting closer ties between homes and schools, said some children became addicted to video games, spending all their waking hours in front of a computer screen gorging potato chips, pizza and soft drinks.

Anne Folke, co-founder of a lobby seeking to counteract through public awareness campaigns what it sees as the ill effects of video games, said games were consuming ever more of children's time.

"They are in poor physical shape, they eat unhealthily, grow fat and suffer insomnia," she said.

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New Tumor Marker Found

Monday, March 1, 2004

MONDAY, March 1 (HealthDayNews) -- A new tumor marker that's associated with many kinds of cancers, including one-third of breast and colon cancers, has been identified by Boston University School of Medicine researchers.

They identified this new tumor marker (absence of SMAD8) using a new university-developed procedure called Targeted Expressed Gene Display (TEGD), which can identify related members of a large family of genes, their variants and their patterns of expression.

The research appears in the March 1 issue of Cancer Research.

TEGD could prove an important component in the accurate diagnosis of diseases caused by the absence or loss of critical components of the body, the researchers say. Information provided by TEGD could help assess disease prognosis and design customized treatment for patients.

"We think that TEGD has the potential to advance the ability to probe gene families for genetic and epigenetic defects to a new level of sophistication and could be adopted for routine use in the near future," study author Sam Thiagalingam, an assistant professor of medicine, genetics & genomics and pathology, says in a prepared statement.

More information

The U.S. National Cancer Institute (news - web sites) has more about cancer.

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Gene-Testing Families Risk Overheating

By Lauran Neergaard
AP Medical Writer
The Associated Press
Monday, March 1, 2004

WASHINGTON - "Uncle Joe woke up from minor surgery packed in ice." That's more than interesting family gossip. It's an ominous clue that Joe's relatives are at risk for a rare, inherited condition that can make their bodies overheat enough to kill them if they receive certain types of anesthesia — a clue that every family member should tell their doctors.

Now scientists are preparing to offer the first genetic testing for this condition, called malignant hyperthermia, that may help affected families begin to tell which relatives really are at risk.

The test also may help shed light on whether people at risk of malignant hyperthermia in the operating room may be at higher-than-normal risk of exercise-induced heat stroke.

That problem has been gaining attention since the 2001 death of a 12-year-old North Carolina boy. He survived malignant hyperthermia while having a broken arm set, and collapsed months later after a football game.

The first gene test won't be perfect, cautions Dr. Sheila Muldoon of the Uniformed Services University of the Health Sciences, who helped develop it. Scientists don't yet know if they've found all the genetic mutations involved.

But until now, relatives of someone thought to have suffered malignant hyperthermia have had to assume they were at risk, or undergo a very painful muscle biopsy to prove it.

The gene test, to be offered through the University of Pittsburgh by fall, will require a spot of blood or a swab from inside the cheek. If a malignant hyperthermia survivor has one of 16 mutations the test detects — and roughly a third are expected to — then scientists should be able to tell if his or her relatives inherited the condition.

"I have a son who's almost a year old, and what happens if no one knows" he's susceptible, asks Alex Gross of Bethesda, Md., who spent a week in a coma after suffering malignant hyperthermia during surgery for a noncancerous inner-ear tumor in 2002. "I want to know."

Malignant hyperthermia occurs when certain anesthesia drugs — including a family of inhaled gases, such as isoflurane and sevoflurane, that are top choices for children — trigger a life-threatening attack in a genetically susceptible patient. The drugs set off a state of super-metabolism that breaks down muscles and raises body temperature as high as 110 degrees.

Malignant hyperthermia once killed most victims, but today death is very rare because anesthesiologists watch for early signs and usually reverse symptoms with quick use of a drug called dantrolene.

But more surgery now is performed in physicians' offices, which often don't stock dantrolene, cautions Dr. Henry Rosenberg of the Malignant Hyperthermia Association. He points to patients who have died during cosmetic surgery as a result.

Recovery can be arduous, so knowing if a relative has the condition is important.

"We don't want to get the average person all anxious," Rosenberg cautions; malignant hyperthermia is pretty rare. It's thought to occur anywhere from one in 5,000 to one in 50,000 surgeries that use the triggering anesthetics. Still, no one knows how many people are at risk.

Interestingly, there are geographic clusters. Malignant hyperthermia is so common in Wisconsin and parts of Michigan that many anesthesiologists keep lists of at-risk family names to check new patients against, Rosenberg says. Studies in Grenoble, France, suggest as many as one in 3,000 people there are susceptible.

The key message for anyone about to undergo surgery is simple: Ask if any relative ever had an unusual or bad anesthesia reaction — Rosenberg often hears the "waking up in ice" story — and tell your anesthesiologist. He or she can pick an anesthetic that won't trigger malignant hyperthermia.

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

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Temper Tantrum Can Lead to Heart Woes, Study Shows

Monday, March 1, 2004

WASHINGTON (Reuters) - Men prone to angry tantrums or sulky hostility are more likely to develop an irregular heart rhythm called atrial fibrillation, U.S. researchers reported on Monday.

Having a type-A personality alone was not enough to predispose a man to heart disease, the researchers report in this week's issue of the journal Circulation.

But men who described themselves as fiery- or quick-tempered, hot-headed, furious when criticized, or wanting to hit someone when frustrated were 30 percent more likely to suffer from atrial fibrillation, an irregular heart rhythm that can lead to sudden death.

In fact, such men were 20 percent more likely to have died of anything during the study period than less-angry men, the researchers found.

Men who said they shake with anger, get headaches or muscle tension also were more likely to develop atrial fibrillation, which affects an estimate 2 million Americans a year.

The study suggests that expressing emotions may not always be healthy, said Elaine Eaker of Eaker Epidemiology Enterprises in Chili, Wisconsin, who led the study.

"There has been a perception that you can dissipate the negative health effects of anger by letting anger out instead of bottling it up," Eaker said in a statement.

"But that is definitely not the case in the men in this study -- they were at higher risk not only of atrial fibrillation but of death from all causes."

Massachusetts Study Sample

Eaker worked with colleagues at Boston University and the Framingham Heart Study -- an ongoing study of residents of Framingham, Massachusetts.

They analyzed surveys of 1,769 men and 1,913 women in the study, who had an average age of 48 when this particular analysis started. They filled out standard personality tests as part of the examination.

They were followed for 10 years.

"We failed to find an association in women, but that may be because women develop heart disease later than men and our population was fairly young, with few instances of atrial fibrillation in women during the follow-up period," Eaker said.

She said more study is needed.

Hostility, as defined by the Minnesota Multiphasic Personality Inventory test, is a generally contemptuous attitude toward other people.

Hostile people will agree with statements such as: "I have often met people who were supposed to be experts who were no better than me" or "I frequently have worked under people who arrange things so they get all the credit."

The researchers also looked at the classic "Type-A" personality, which includes feeling rushed and thinking about work a lot, but found no association with atrial fibrillation or other forms of heart disease.

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IRS Allows Weight-Loss Tax Deduction

By Connie Farrow
Associated Press Writer
The Associated Press
Monday, March 1, 2004

Obese Americans who take drastic, expensive action to lose weight under a doctor's orders will at least be able to lighten their tax load.

The Internal Revenue Service (news - web sites) allows taxpayers who are forced to spend thousands of dollars because of obesity to deduct expenses for stomach-stapling surgery, approved weight-loss drugs and nutritional counseling.

"At least one arm of the government recognizes the need to reward people for getting in shape," said Linda Webb Carilli, a spokeswoman for Weight Watchers International Inc.

To claim the deduction, a person must itemize. Deductions are allowed for uncompensated expenses for the treatment of an individual, spouse and dependents if the cost is more than 7.5 percent of adjusted gross income, IRS spokeswoman Kris Moore said.

For example, a person with an adjusted gross income of $50,000 would only be able to deduct medical expenses exceeding $3,750.

The average cost of a gastric-bypass operation is about $25,000. Some, but not all, insurance plans cover them.

The IRS designated obesity as a disease in April 2002 and established deduction guidelines in its Publication 502. Previously, taxpayers only were allowed to claim the cost of weight loss programs recommended by a physician to treat a specific disease associated with obesity, such as hypertension.

"The IRS ruling took a lot of people by surprise," said Morgan Downey, executive director of American Obesity Association. "This takes a different approach from the normal kind of urging everyone to diet and exercise as a lifestyle recommendation because it recognizes obesity as a major medical problem."

The IRS ruling does not define obesity — generally described as excess body fat of 30 pounds or more over ideal body weight, or a body mass index of 30 or more. A doctor's diagnosis is required before the surgery or nutrition counseling costs can be deducted.

There is growing evidence that obesity is taking a toll on the nation's health. The number of obese adults has doubled in 20 years, and is now up to nearly 59 million people, or almost a third of all American adults. Childhood obesity has tripled, with one child in six considered obese.

As the pounds mount, so do health care costs. Obesity increases the risk of high blood pressure, diabetes, gallbladder disease and cancer.

The IRS ruling cited the growing body of research for why it believes "obesity is medically accepted to be a disease in its own right."

Joining a weight control program simply to improve appearance, general health and sense of well-being and not under a physician's guidance does not qualify, Moore said.

And while the IRS allows taxpayers to deduct fees associated with programs such as Weight Watchers and Jenny Craig Inc., it does not allow participants to deduct the expense of diet food. There also is no deduction for joining a gym.

"An expense that is merely beneficial to the general health of an individual is not an expense for medical care," Moore said. "If obesity is the disease, the individual must be enrolled in a weight loss program."

The IRS does not break down medical deductions to determine the number of taxpayers using the obesity rule. Experts acknowledge the 7.5 percent threshold may prevent many from benefiting.

"There's no question that's a pretty high threshold and people who would be exercising and trying to preserve their health probably are not going to have enough expenses to reach that level," Downey said.

However, workers who set aside pretax medical dollars in Medical Savings Accounts and Flexible Spending Accounts through their employers may also benefit because both programs use the IRS definition of medical expenses, Moore said. This also would require a doctor's order to lose weight.

The greatest beneficiaries are those who have obesity-related operations, Downey said. The American Society of Bariatric Surgery estimated 103,200 people had operations to lose weight last year.

Joan Gunter, a group leader and ambassador for Weight Watchers in Kansas City, knows firsthand the pain and frustration those on a tight budget face when dealing with weight loss.

"I was working the hot line, and a woman was on the phone crying, saying that she didn't have any extra money but her doctor had told her that she needed to change her lifestyle or she was going to die," Gunter said.

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Breast-Fed Babies Have Lower Blood Pressure –Study

By Maggie Fox, Health and Science Correspondent
Monday, March 1, 2004

WASHINGTON (Reuters) - Breast-fed babies grow up to have lower blood pressure than bottle-fed children, British researchers reported on Monday.

This could mean they will have lower blood pressure as adults, and thus a lower risk of heart disease, the No. 1 killer in the industrialized world, the researchers said.

For every three months a child was breast fed, his or her systolic blood pressure reading -- the top number -- went down 0.2 points, on average. Breast-feeding time did not significantly affect diastolic blood pressure -- the lower number.

"Even this small reduction may have important population-health implications," said Richard Martin, a senior lecturer in epidemiology and public health at the University of Bristol in Britain, who led the study.

"A one percent reduction in population systolic blood pressure levels is associated with about a 1.5 percent reduction in all-cause mortality," Martin added, equivalent to a reduction in premature death of about 8,000 deaths per year in the United States and 2,000 deaths per year in the United Kingdom.

Lower blood pressure is directly linked to lower risk of heart attack, stroke, kidney disease and other related illnesses.

Breast-fed babies are also less likely to be overweight, have fewer behavioral problems and may show differences in intelligence, other studies have shown. Therefore, groups such as the American Academy of Pediatrics recommend that all mothers breast-feed their babies for the first year, and two years if possible.

Writing in the journal Circulation, the researchers said the nutritional content of breast milk may be responsible.

Breast-fed children tend to consume less sodium, which is one factor that can influence blood pressure. Breast milk also contains long-chain polyunsaturated fatty acids, which are compounds that can affect the development of blood vessels.

Infant formula supplemented with these fatty acids has been associated with lower blood pressure.

Formula feeding can also cause babies to eat more than they need and can, in some babies, cause too-rapid weight gain.

"Excess weight is also associated with higher blood pressures and promotes insulin resistance, which often precedes development of diabetes in adulthood," the American Heart Association (news - web sites), which publishes Circulation, said in a statement.

"There is some weak evidence that there is a small lowering of blood pressure in adulthood (among children who were breast fed), but the evidence is inconsistent," Martin said.

"No one has investigated in a prospective study whether the association changes with age."

Martin and his colleagues examined 4,763 7-year-old children in a long-term health study.

The children who were breast fed for any length of time had lower blood pressure than did formula-fed children.

After adjusting for factors such as mother's education, socioeconomic status and birth weight, the researchers still found lower blood pressure in the breast-fed children.

It was 0.8 mm Hg lower for systolic pressure and 0.6 mm Hg lower on average on the diastolic pressure reading.

The findings held regardless of the child's sex, body mass, or pulse. Family social status, income, number of siblings, whether the mother drank alcohol, the child's health, and the child's ethnicity did not change the association between breast feeding and blood pressure.

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Survey: Americans Have Super-Sized Bodies

By Paul Nowell
AP Business Writer
The Associated Press
Monday, March 1, 2004

CHARLOTTE, N.C. - Well into what paleontologists of the future might call the Fast Food Drive-Thru Epoch, the most complete body survey conducted in 50 years shows Americans have super-sized, particularly in the waist and hips.

TC2, a company based in the Raleigh suburb of Cary, used light-pulsing, 3-D scanner technology to measure some 10,000 Americans of all ages and ethnicities. The SizeUSA survey confirmed that all those extra french fries have come with a price.

The study was funded by clothing manufacturers, the military and colleges and universities, all of whom have a keen interest in body sizes.

Size 8 has long been thought to represent the measurements of the average American woman. In the clothing industry, a size 8 officially is supposed to be a 35-inch bust, a 27-inch waist, and 37 1/2-inch hip.

But in the survey, white women ages 18 to 25 came in, on average, at 38-32-41, with white women ages 36 to 45 coming in at 41-34-43.

In truth, some manufacturers made the adjustment years ago. Some sell a size 10 as a size 8 to flatter women's vanity, TC2's Jim Lovejoy, who conducted the survey, said in a telephone interview Monday.

The last such survey of Americans' bodies was in 1941, and it was a low-tech undertaking, involving measuring tapes.

TC2's technology involves a 3-D measurement system in which four strategically placed cameras register more than 200,000 data points on the body. The data are then fed into measurement software that spits out 200 accurate body measurements in less than a minute.

"By using the body scanner we know it is consistently accurate," said Lovejoy. In contrast, the accuracy of a measuring tape "depends on where it is placed and how tight you pull it."

The 10,000 subjects were grouped into gender, age and ethnicity. The survey also collected information such as ZIP code, annual household income, marital status, lifestyle, education, employment status and clothing preferences.

"From looking at the interim survey data, we can see the U.S. population has grown taller and heavier, but we are growing heavier faster than we are taller," Lovejoy said. "If you look at the grade rules for most manufacturers today, they do not reflect what we are finding in our size survey."

Because of its size and breadth, the survey also will allow a closer look at the typical body size of different minority groups, including blacks, Hispanics and Asians.

"Minority populations were not well represented in previous studies, which included no Hispanics or Asians," Lovejoy said.

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Analyst Expects Premarin Trial to Be Halted

Monday, March 1, 2004

NEW YORK (Reuters) - An industry analyst said he is expecting researchers to soon announce they have halted a large federally-financed study into whether Wyeth's estrogen replacement drug Premarin increases serious health risks.

A similar federally-financed trial called the Women's Health Initiative was halted in July 2002 after it showed women that had been taking Prempro, another Wyeth female hormone replacement drug, had slightly higher risks of heart attack, stroke and breast cancer after five years of use.

Tim Anderson, an analyst for Prudential Equity Group, said he expected the Premarin trial to be halted as soon as this week. Anderson said he did not know why the trial will be halted, but said "significant new safety findings did NOT appear to be the primary driver of the decision to stop the trial."

Anderson, in a research report on Friday, said in his report that many patients may have dropped out of the Premarin trial after the Prempro risks were identified in 2002, making it difficult for researchers to come up with reliable data on the drug's safety.

Wyeth officials declined to comment on Anderson's report, or whether they expect the trial to be halted.

The findings in the Prempro trial spurred a reduction in the number of prescriptions for Prempro, which combines Premarin with a synthetic female hormone called progestin meant to prevent uterine cancer in women taking estrogen products. The findings also hurt sales of Premarin, but to a lesser extent.

The separate Women's Health Initiative trial testing the safety of Premarin by itself was allowed to continue after the Prempro study was halted, with results expected in 2005.

Sales of Premarin and Prempro fell 32 percent in 2003 to $1.3 billion, contributing to a 54 percent decline in company earnings.

SG Cowen on Monday said it was girding for a possible announcement about the Premarin trial. "A negative announcement from the study could result in further sales deterioration" of Premarin, the brokerage said in a research report.

The U.S. Food and Drug Administration (news - web sites) has said estrogen and progestin are worthwhile treatments for post-menopausal symptoms but they should be used in the lowest dose and for the least duration required to provide relief."

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Blue Cross Won't Cover Stomach Stapling

The Associated Press
Monday, March 1, 2004

PANAMA CITY, Fla. - Blue Cross Blue Shield of Florida has announced it will stop covering gastric bypass surgery by the end of the year.

The Jacksonville-based company says safety is the main reason it will drop the $30,000- surgery, also known as stomach stapling, which is considered a last resort for morbidly obese people trying to lose weight.

Dr. Robert Forster, the company's chief medical officer and vice president for health care services, said about three in every 1,000 patients die and up to 20 percent of patients return to the hospital for a second procedure.

There has also been a spike in demand for the surgery, which would have cost the insurer about $200 million over the next few years and could have lead to higher premiums, Forster said.

The surgery's popularity has grown because of the success that celebrities, such as television weatherman Al Roker and singer Carnie Wilson, have had with it.

That has prompted commercialization and the spread of information — on the Internet, radio and elsewhere — on how to get around strict guidelines as to who can safely undergo the surgery, Forster said.

Doctors with limited experience also are jumping on the bandwagon to take advantage of the high demand, he said.

Forster acknowledged successful surgery reduces other health problems such as diabetes, but he said some patients encounter new problems. About 30 percent of patients develop nutritional deficiencies such as anemia, osteoporosis and metabolic bone disease, according to the National Institutes of Health (news - web sites).

Dr. Anthony Terracina, who specializes in the surgery, said he is no longer accepting patients at Surgical Associates of Northwest Florida and will leave the state in June because the surgery is cost-prohibitive without insurance coverage for most people. He plans to relocate to Hampton Roads, Va., because Virginia law requires insurers to cover the surgery.

"It just doesn't make any sense that the insurance companies would do this," Terracina said. "Obesity is the No. 1 health problem in the United States. Why wouldn't you help those patients and keep them out of the hospital?"

Information from: The News Herald,

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Greek Scientists Find Way to Weaken Cancer Cells

By Ellie Tzortzi
Monday, March 1, 2004

ATHENS (Reuters) - Greek scientists said they have found a way to lower cancer cell resistance to medical treatment in what could be a major step in treating a disease that kills more than six million people every year.

The procedure, which only recently started testing on animals, could make chemotherapy more effective at significantly reduced dosages and eliminate many of its side effects.

The key lies in 'switching off' Apolipoprotein J, also known as clusterin or Apo J for short, a protein used by healthy and diseased cells alike as a shield against attacks, Stathis Gonos, leader of the research team, told Reuters on Monday.

"Our research was looking at genetic and environmental factors related to aging, and that is how we found the function of Apo J in healthy cells is to act as a shield, or 'survival factor', against toxic factors in the environment," Gonos said.

"Our next step was to investigate whether Apo J has a similar function in cancer cells, and indeed saw that it retains the same function of defending cells, shielding them from e.g. chemotherapy prescribed by a doctor to treat cancer," he added.

Cells react to what they perceive as an assault with all the weapons they have, producing vast quantities of Apo J as a shield against the attack, be that an infection or an anti-cancer drug.

"We used a new technology called RNA Interference to silence the expression of Apo J and saw that in the case of cancer cells they became a lot more fragile and this made it a lot easier to kill them with normal chemo," Gonos said.

"We had spectacular results even when using a tenth of the usual dosage," he added, "and this means that many of the side-effects of chemotherapy will likely disappear as we are able to reduce dosages."

Many patients undergoing chemotherapy experience anemia, nausea, hair loss or infection due to low blood cell counts.

The Greek team, who are financed by the European Union (news - web sites), have submitted a global patent application in partnership with Canadian biotech firm OncoGeneX and scientists from the University of British Columbia.

They have recently started animal trials at Vancouver General Hospital, with Gonos forecasting human trials to start in between three and five years.

According to data from the World Health Organization (news - web sites)'s World Cancer Report, in the year 2000 alone around ten million people worldwide developed a malignant tumor and more than six million died of the disease.

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Consumers Question What Food Safe to Eat

By Matt Slagle
Associated Press Writer
The Associated Press
Monday, March 1, 2004

DALLAS - Mad cow disease. Fish tainted with mercury and PCBs. Contaminated green onions from Mexico. Bird flu in ducks and chickens. Is anything safe to eat these days?

Across the nation, many consumers have made adjustments to their grocery lists, opting for organically grown meats and vegetables following recent food-borne illness scares.

Most, however, expressed confidence in the safety of the country's food supply.

"Mad cow doesn't bother me," Ohio State University chemistry professor Barbara Pappas said while stocking up on ground round, steaks and chops at Carfagna's Specialty Foods in Columbus. "The probability is so remote. A person smoking next to me is more dangerous."

The most recent food-related problem to hit the United States came last week, when bird flu was found in chickens on a South Texas farm. The U.S. Department of Agriculture (news - web sites) said it poses little threat to people and is a different virus than the one that has killed at least 22 people in Asia.

The bird flu scare comes on the heels of the United States' first reported case of mad cow disease, which was found in a Holstein from Washington state that was slaughtered Dec. 9. People who eat processed beef products tainted by mad cow can develop a deadly brain-wasting illness, variant Creutzfeldt-Jakob disease (news - web sites).

Then, last month, a scientific study found that farm-raised salmon contain far more potentially cancer-causing pollutants than wild salmon because their feed is contaminated with it.

In November, three people died and more than 600 were sickened after eating tainted green onions at a Pittsburgh area Chi-Chi's restaurant in the largest single-source hepatitis outbreak in the nation's history.

The coincidental timing of all these food scares has made some consumers think twice about what they eat.

"I feel like eating fruits and vegetables is definitely safer," said Cindy Hader of North Richland Hills, Texas. "But it's a sad situation in our country when people are buying special foods to avoid poisons and toxins."

Hader, a vegetarian for the past 16 years, said she buys organically grown food whenever possible because of fears over pesticides, fertilizers and genetically modified plants.

Reggie James, director of the Consumers Union's southwest region, said fears over mad cow and avian flu have encouraged more consumers to scrutinize how their food is manufactured.

"This is a good thing," he said. "Consumer preference for more wholesomely produced foods could impact food production practices that lead to higher risks and inhumane conditions for animals."

At the New City Market health food store in Des Moines, Iowa, shoppers who said they've always sought organic alternatives were even more confident in their choices now.

"I prefer to know where my food is coming from whenever I can," shopper Stephanie Weisenbach said. "What's happened the last few months — it's just kind of reaffirmed my decisions."

In Los Angeles, Jasmin Suljic, 27, said he and his girlfriend have been eating less meat and buying more organic produce.

The native of Bosnia said he missed the ease with which he brought fresh milk and produce back home.

"In my country, almost everything was natural. You'd buy milk fresh in the street or at your door," he said.

Some, like Susan Primm of Nashville, Tenn., think the government could do more, especially in the handling of mass-produced chicken and beef.

"I believe it is important for us to raise animals in a healthy way," she said after shopping for groceries. "When animals are not respected and not raised in a healthy way, they get sick."

Surveys since the mad cow case indicate U.S. beef consumption has not fallen.

Speed was key in containing the spread of bird flu at the chicken farm in Gonzales County, Texas. All 6,600 birds in the infected flock were killed, and two live-bird markets in Houston were shut down.

The goal of the public health system is to prevent what can be prevented and to quickly contain what can't, Texas Department of Health spokesman Doug McBride said. "There's no 100 percent guaranteed risk-free situation," he said.

After the mad cow case, the USDA doubled its testing for the brain-wasting disease. Researchers who studied the issue also recommended that farmers change fish feed and urged consumers to buy wild salmon after it was found that farm-raised salmon had more toxins.

Lester Crawford, acting Food and Drug Administration (news - web sites) commissioner, said consumers should feel confident that most of their food is safe to eat.

"The American food supply continues to be among the safest in the world," he said. Better prevention and education practices, fast response to outbreaks and better research "have all contributed to a safe, wholesome, and nutritious food supply."

Eds: Associated Press writers Chris Stadelman in Columbus, Ohio, Patrick Condon in Des Moines, Iowa, Laura Wides in Los Angeles and Matt Gouras in Nashville, Tenn., contributed to this report.

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Antibacterial Soap Doesn't Prevent Viral Infection

By Merritt McKinney
Reuters Health
Monday, March 1, 2004

NEW YORK (Reuters Health) - Using antibacterial soaps and cleansers at home may not necessarily reduce your risk of getting sick, researchers report.

In a new study, people who used antibacterial soaps and cleansers developed cough, runny nose, sore throat, fever, vomiting, diarrhea and other symptoms just as often as people who used products that did not contain antibacterial ingredients.

Since most common infections, including colds and flu, are caused by viruses, the lack of an effect on symptoms "is not surprising," according to study author Dr. Elaine L. Larson at the Columbia University School of Nursing in New York.

"Consumers need to know that it is more important to keep clean than it is to use a specific antibacterial product," Larson told Reuters Health.

"Perhaps the frequent admonitions we heard as children are more valid now than ever--cover your mouth when you cough or sneeze and wash your hands!" Drs. J. Todd Weber and James M. Hughes of the National Center for Infectious Diseases at the Centers for Disease Control and Prevention (news - web sites) in Atlanta note in a related editorial.

In response to the study, the Soap and Detergent Association and the Cosmetic, Toiletry, and Fragrance Association said in a joint statement: "Antibacterial cleaning and personal care products do what they say they do: they kill harmful bacteria."

The results of the study are not surprising, according to the groups, since antibacterial products are not intended to be effective against viruses.

The trade organizations' statement notes that antibacterial products, depending on their active ingredients, may be effective against bacteria that cause odor, skin infections, food poisoning and intestinal illnesses.

According to one study, Larson's group reports, approximately 75 percent of liquid soaps and 29 percent of bar soaps in the U.S. contain antibacterial ingredients. But the benefits of antibacterial products in preventing infectious diseases in households are still unproven, they note.

Larson and her colleagues studied 238 Manhattan families who were given almost a year's supply of free soap and household cleaners. Half of the families were given antibacterial products, while the other half received products that did not contain antibacterial ingredients. Families, most of whom were Hispanic, did not know what type of products they were using.

For nearly a year, the families were closely followed to see how often they experienced a wide variety of symptoms.

Runny nose, cough and sore throat were the most common symptoms, followed by fever, vomiting, diarrhea and skin symptoms. These symptoms occurred just as frequently in people who used antibacterial products at home as they did in people who did not.

Throughout the study, use of antibacterial products did not have a significant effect on any of the symptoms.

The "bottom line" of the study, according to Larson, is that all households improved. During the study, participants had fewer infections and lower bacterial counts on their hands than at the start of the study, she said.

The current report, which appears in this week's issue of the journal Archives of Internal Medicine (news - web sites), does not include information about bacterial counts. But in a previous analysis of the results, Larson and her colleagues found that families experienced a drop in bacterial counts whether they used antibacterial or normal soaps and cleansers.

Despite the lack of an effect on symptoms, Larson and her colleagues note that antibacterial products may be appropriate for preventing bacterial symptoms, or in other specific situations, such as when a family member has a weakened immune system or has skin or gastrointestinal infections.

The authors note that any potential benefits of antibacterial products need to be weighed against the possibility that bacteria may develop resistance to antibacterial products. Although there is no evidence that this has happened, laboratory tests suggest that it may be possible.

Source: Annals of Internal Medicine, March 2, 2004.

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CDC Runs Ads to Get Kids to Play Outside

By Ira Dreyfuss
Associated Press Writer
The Associated Press
Monday, March 1, 2004

WASHINGTON - The Centers for Disease Control and Prevention (news - web sites) is having some success in getting kids to play outdoors by selling physical activity like companies sell toys.

Its national ad campaign, called VERB, encourages 9- to 13-year-olds to find the action-word activities they like to do: skateboarding or bike riding, for instance. The goal is to keep children from picking up the dangerously slothful habits of their moms and dads by steering them outside.

The 9- and 10-year-olds were active 4.3 times a week, according to the CDC's telephone survey last year of 6,000 young people and parents. That's one more time a week than the children had a year earlier, in 2002, when the CDC took a baseline survey before launching the program.

Pollsters asked what these "tweens" had done in the past week that was physically active. Playing video games didn't count, but riding a bike did.

The survey found 75 percent of tweens had heard of VERB, and the children who knew more about the program were more active, said Janet Collins, acting director of the CDC's Division of Adolescent and School Health. Children most familiar with VERB were active 5.6 times a week, she said.

"I'm highly encouraged, but we still have a way to go," Collins said.

Between ages 9 and 13, the range in which the slide into inactivity begins, team sports start to become more competitive, so less-gifted children begin to be winnowed out. And after elementary school, fewer children are required to have daily physical education classes.

To maintain good health and reduce the chance of getting fat, the CDC recommends children be moderately active for at least an hour a day.

The survey did not try to find out exactly how active the children were by asking how much time they spent in their activities or assessing how much energy they were using. Kids are not good judges of that, Collins said, so their answers would not have been accurate.

Because the survey didn't ask, it can't tell if the kids played hard enough to make them fitter or improve their health. But to a Denver pediatrician, that's hardly a big failing. "If you take someone who is sedentary and they move one more time a week, that's a good thing," said Dr. Reginald Washington, who chairs the sports medicine and fitness committee of the American Academy of Pediatricians.

The CDC wants young people to be at least moderately active for an hour a day. But Washington would give the kids a pass on watching the clock. "They should move more than they used to, and not get hung up on, 'I haven't done an hour so I haven't done enough,'" he said.

The ad campaign did not seem to work for 11- to 13-year-olds, and they didn't add to their play time. Collins said officials will have to figure out what to do to change that.

However, the results for the younger tweens indicate the strategy of marketing physical activity as a company markets products is working, Collins said. "Our approach was to hire some of the best kid marketers in the business and really draw on them for guidance," she said. "It's positioning physical activity as fun, cool and social."

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Report: Standard Tests Not Enough for Baby Formula

Monday, March 1, 2004

WASHINGTON (Reuters) - Standard tests of food safety are not good enough when it comes to infant formula ingredients, a panel of experts said on Monday.

Because formula is so important to the growth and development of babies, more care must be taken in testing ingredients for safety and nutrition value, the Institute of Medicine (news - web sites) panel said.

"The current regulatory processes do not fully address the unique role of formula as a food source," Dr. Richard Deckelbaum of the Institute of Human Nutrition at Columbia University, who chaired the panel, said in a statement.

"Formula is infants' only food if they are not being breast-fed. The processes used to regulate the safety of any new additions to formula should be tailored to these products' distinct role and the special needs and susceptibilities of infants. Our report offers a set of guidelines and steps to accomplish this goal."

The institute, an independent group that advises the federal government on health and medical matters, said the Food and Drug Administration (news - web sites)'s "Generally Recognized As Safe" ruling process is not specific enough to use for infant formula.

The Infant Formula Act, which mandates the basic nutrients that formula must contain, also does not specify needed safety tests, the panel said.

The institute panel published its own recommendations for evaluating potential new infant formula ingredients.

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Doctors Urge Eye Wear for Kids in Sports

By Lindsey Tanner
AP Medical Writer
The Associated Press
Monday, March 1, 2004

CHICAGO - With youth basketball season winding down and baseball looming, two influential physician groups are strongly recommending protective eye gear for young athletes in many organized sports.

Balls, bats, rackets and even elbows can cause serious and sometimes permanent eye injury, and children are particularly susceptible because of their aggressive playing style and lack of athletic maturity, the American Academy of Pediatrics and the American Academy of Ophthalmology say in a joint policy statement.

In 2000 alone, more than 42,000 sports and recreation-related eye injuries were reported nationwide, more than 70 percent of them in people under age 25, the groups said.

Eye protectors could reduce the risk of significant eye injury in sports by at least 90 percent, they said.

The policy lists tennis as a moderate-risk sport for eye injury, while baseball and basketball are high-risk and are associated with the most eye injuries in athletes aged 5 to 24.

Recommended eye gear includes helmets with face guards for baseball batters and base runners; and safety goggles for basketball, racket sports and soccer. Fashion eyeglasses are not acceptable, the policy says.

While the number of eye injuries in youth sports is relatively small given the number of participants, "the long-term complications and disability can be great and should not be taken lightly," said Dr. David Bernhardt of the pediatrics academy's committee on sports medicine and fitness.'

"Similar to bicycle helmets, ski helmets, mouth guards and other interventions, this is one more way parents and medical providers can decrease the risk of injury in sport," Bernhardt said.

The authors acknowledge that it might take seeing a teammate get injured to convince kids that protective eye gear is important.

"There's a lot of professional athletes who wear them, so they're not really 'nerdy' glasses," said Dr. Joel Brenner, also on the pediatrics group's committee.

The policy appears in the March issue of Pediatrics, being released Monday. It updates one the groups issued in 1996 and includes new information on currently available protective eyewear that conforms with American Society for Testing and Materials standards.

The recommendations focus on sports deemed high-risk and moderate-risk for eye injury.

Besides baseball and basketball, high-risk sports listed include air rifling, paintball, lacrosse, ice and field hockey, racquetball, fencing, boxing and full-contact martial arts. Moderate-risk sports include football, badminton, soccer, volleyball, water polo, golf and fishing.

Many schools and organized youth sports teams do not require protective eye gear.

Little League baseball requires helmets but not face guards for offensive players, and has no eye-wear rules for fielders.

"Our statistics don't show a reason for mandating their use," said Little League spokesman Lance Van Auken. "Less than two-tenths of 1 percent of Little Leaguers are injured in any given year," and injuries have been decreasing in recent years because of an emphasis on safety, he said.

On the Net:

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Grapefruit to Blame for Side Effect with Zocor

Reuters Health
Monday, March 1, 2004

NEW YORK (Reuters Health) - Eating a grapefruit each morning may have triggered a serious side effect in a woman taking the popular anticholesterol drug Zocor (simvastatin), new research suggests. Although the case involved Zocor, the authors note that similar drugs could also be influenced by grapefruit consumption.

Rhabdomyolysis, a disorder involving muscle breakdown and kidney problems, is a rare but serious side effect of drugs like Zocor, known as statins. In August 2001, drug maker Bayer AG was forced to recall its statin Baycol (cerivastatin), after the drug was linked to an excessive number of rhabdomyolysis cases, including more than 100 fatalities.

The present case involved a 40-year-old woman who was admitted to the hospital with lower extremity weakness, study authors Dr. Jens P. Dreier and Dr. Matthias Endres, from Charite Hospital in Berlin, Germany, note. The report is published in the medical journal Neurology.

The woman reported exercising regularly at the gym and had apparently been healthy until 10 days prior when slight muscle weakness and pain were first noted. The patient had been taking Zocor for high cholesterol levels.

The laboratory findings suggested rhabdomyolysis and, given the patient's medication history, the researcher believed it was related to the Zocor. After discontinuation of the drug and vigorous fluid replacement, the patient's condition improved steadily and she was discharged from the hospital on day six.

Although Zocor was thought to be responsible for the rhabdomyolysis, the researchers were puzzled about the onset, since the patient had been taking the drug for more than two years. So, they questioned her about any recent triggers and that is when she revealed eating one grapefruit every day for the two weeks before admission.

Grapefruit contains a chemical that inactivates an enzyme in the liver that breaks down Zocor and many other statins. Therefore, regular consumption of the fruit can lead to body levels of Zocor that are too high.

Patients taking Zocor and most other statins should be advised not to eat grapefruit, the investigators conclude.

Source: Neurology, February 24, 2004.

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Shin Splints

Monday, March 1, 2004

(HealthDayNews) -- Shin splints are usually caused by inflammation or injury to the shin muscles. The predominant symptom is a sharp, searing type of pain along the bone of your lower leg.

The Calgary Health Region of Canada offers these self-care tips:

  • Rest the affected leg as much as possible.
  • Substitute non-weight bearing exercises, such as swimming, for your usual workout until the pain has gone.
  • Do daily calf muscle and Achilles tendon stretches but avoid stretching the shin muscles.
  • Apply ice to the inflamed area.
  • Wrap your lower leg with a tensor bandage to provide support.
  • Elevate the lower leg above the level of your heart as often as possible.

The pain from shin splints can last from several days to a week, but may become chronic if you don't allow enough time for your leg to heal.

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Experts: Research Needed Into Rising Teen Cancers

By Patricia Reaney
Monday, March 1, 2004

LONDON (Reuters) - Cancer in teenagers and young adults has risen to become the most common cause of natural death for their age, but not enough research is being done into its causes or treatment, health experts said Monday.

Cancer among 13-24 year olds is still rare, with about 1,500 new cases diagnosed each year in Britain.

But while survival rates for children and adults with the disease have improved in recent decades, they have remained unchanged for adolescents and young adults.

"We've orphaned this particular age group," Professor Archie Bleyer, of the University of Texas MD Anderson Cancer Center in Houston, told the Third International Conference on Adolescent Cancer.

"Young people and older adolescents have been left behind."

Bleyer and other cancer experts said teenagers have fallen into a medical gap. Although they develop specific types of cancer and have different medical and psychological needs, they are either treated as children or adults.

Little is known about the causes or risk factors of teenage cancers, yet few young people are involved in clinical trials to discover underlying reasons why they develop the disease or the best ways to treat it.

"There is a great need for high-quality research," said Charles Stiller, of the University of Oxford.

In one of the largest studies done into teenage and young adult cancer involving 21 years of data, Professor Jill Birch of the University of Manchester in England, said cases in Britain have risen from 15.4 to 19.8 per 100,000 between 1979 and 2000 -- an average increase of 1.2 percent per year.

Leukemia was most common in 13 and 14-year-olds, followed by lymphoma and brain tumors. But by 15 and above, lymphoma accounted for the great number of cases.

"The early age of onset and lack of opportunity for chronic exposure to environmental factors suggests that genetic susceptibility may be important," said Birch.

But she added that genetic mutations probably only account for a small number of cases.

"What is more likely is that a cancer develops as a result of exposure to a risk factor in a genetically susceptible individual," she said.

Early exposure to viruses, passive smoking and lifestyle changes, particularly increased sun exposure, may also play a part. Rates of melanoma, the most serious type of skin cancer, have almost doubled over 21 years in the 20-24 age group in Britain and it now accounts for one in 10 of all cancers.

"Worldwide, we need a new discipline in adolescent and young adult oncology," said Bleyer.

"Until we devote resources specially to this age group, there will be little progress," he added.

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Nearsightedness Treatment May Harm Kids' Vision

By Kathleen Doheny
HealthDay Reporter
Monday, March 1, 2004

MONDAY, March 1 (HealthDayNews) -- Children who wore contact lenses overnight as part of a nearsightedness treatment called orthokeratology developed corneal ulcers and suffered some vision loss.

So says a Hong Kong researcher reporting in the March issue of Ophthalmology.

The case review is sure to ignite debate about the orthokeratology regimen, in which nearsighted patients are fitted with a series of rigid gas-permeable lenses to modify the shape of the cornea, in the process reducing or eliminating the nearsightedness.

While orthokeratology has been around since the 1960s, it is currently not as popular in the United States as it is in China, especially in Hong Kong, where up to 71 percent of the adult population is nearsighted. About 25 percent of the U.S. population aged 12 to 54 is believed to be nearsighted.

"More and more cases of corneal ulcer and infection in patients with overnight wearing of orthokeratology lenses are being reported," says study author Dr. Dennis S.C. Lam, chairman and professor of the Department of Ophthalmology and Visual Sciences at the Chinese University of Hong Kong.

"One has to weigh carefully the potential benefits and risks of orthokeratology lenses before choosing," he says.

He reports on six cases of corneal ulcers in children aged 9 to 14 years old, seen at his clinic from March 1999 to June 2001. All wore the lenses at night for eight to 12 hours. And the infections occurred three to 36 months after starting the regimen.

All had some vision loss after the ulcers healed, he adds.

Lam suspects the overnight wearing deprived the cornea of oxygen, boosting the risk of ulcer and infection. But it's not known if the lenses were made of material meant to be used for the orthokeratology regimen.

Other experts point out limitations of the study, but they also call for caution in using orthokeratology.

"We don't really know what the incidence of complications are," says Dr. Thomas L. Steinemann, an ophthalmologist at MetroHealth Medical Center Eye Clinic in Cleveland and a spokesman for the American Academy of Ophthalmology. He notes the study authors just reported on the cases of corneal ulcers they treated.

But corneal ulcers are potentially serious, he adds. "Any infection is significant, particularly when it involves the central cornea, which these did."

While the approach may have a role in a small group of patients, Steinemann says, "the effects [of the treatment] are not permanent."

Some eye experts point out the study has several variables that could affect the results.

"By the authors' own admission, we don't know the lens material," says Carmen Castellano, a St. Louis optometrist who is chairman of the American Optometric Association's Contact Lens and Cornea Section. They might have been lenses not meant for orthokeratology treatment, he says, adding, "We don't know totally the whole story."

Castellano fits children with the orthokeratology lenses if they are good candidates. The ideal candidate, he says, is faithful to cleaning and wearing regimens and has low to moderate nearsightedness. The lenses are worn on a continuous basis at night, he explains, "And then you can leave them out more and more" as the cornea is reshaped to correct the nearsightedness.

To keep the corrective effect, however, you must continue to wear the lenses at night, at least part time, depending on the degree of nearsightedness, Castellano says.

More information

For more information on contact lenses, visit the American Optometric Association and the American Academy of Ophthalmology.

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Sunday, February 29, 2004

Too Much Weight Tugs at Kids' Hearts

By Dennis Thompson Jr.
HealthDay Reporter
Sunday, February 29, 2004

SUNDAY, Feb. 29 (HealthDayNews) -- Need more proof the U.S. childhood obesity crisis may be a ticking time bomb?

Researchers have found that many schoolchildren are exhibiting early risk factors of diabetes and heart disease, often displaying troubling symptoms that usually show up in adults.

In fact, a recent study found one in eight children have three or more risk factors for what doctors call metabolic syndrome, a cluster of symptoms that serve as an early warning signal for heart disease and diabetes. And more than half of the children have at least one of the risk factors.

These risk factors include high blood pressure, inefficient processing of glucose, elevated insulin levels, low levels of "good" HDL cholesterol and elevated triglycerides -- a fatty substance found in the blood.

But the real culprit is obesity, says study leader Joanne S. Harrell, director of the Center for Research on Chronic Illness at the University of North Carolina at Chapel Hill.

"Almost half of our children are overweight or at risk for overweight," Harrell says. "These findings document what has been evident to most people who deal with a large number of children, that obesity is an epidemic in our youngsters."

If parents and educators don't take action, American kids could face an unhealthy and shortened life, says Dr. Henry McGill, a senior scientist emeritus at the Southwestern Foundation for Biomedical Research in Texas. McGill has researched the subject of children and heart disease for decades.

"We know enough about the risk factors related to lifestyle that if we could control them from adolescence or childhood, we could probably prevent 80 to 90 percent of coronary heart disease that happens prior to age 65 or 70," McGill says.

McGill and Harrell recommend a number of ways parents can protect their children:

  • Encourage kids to exercise and engage in active play;
  • Place them -- and the entire family -- on healthier diets, including more fruits and vegetables and less fat;
  • Quit smoking to offer children a healthy role model, and encourage them never to start;
  • Petition your schools to include more physical education, with an emphasis on active games that involve even non-athletic children;
  • Ask educators to remove soft drink and vending machines from schools, and provide healthy meals and snacks.

"There's no magic here," McGill says. "People have to eat less and move around more, although everything in our culture is against that."

Harrell's team followed more than 3,200 students, about half boys and half girls between the ages of 8 and 17, in a rural North Carolina county. The researchers evaluated each student's body mass index, a ratio of weight to height, along with other risk factors.

More than half of the children had at least one of the risk factors for metabolic syndrome. About one-quarter of the children had two or more factors, and one in eight had three or more.

Most troubling, about 8 percent of children aged 8 or 9 already displayed three or more risk factors, Harrell says.

Girls suffered more often from the risk factors, she says. About 16 percent of girls had three or more, compared with 10 percent of boys with three or more.

The most common risk factor was a lack of "good" HDL cholesterol. That was found in more than 40 percent of the children.

One in four children was classified as overweight. "We found that 26 percent were at or above the 95th percentile for expected weight given their age and gender," she says. "You would expect only 5 percent to be at that."

About an equal number were considered at risk for becoming overweight.

High levels of insulin were found in 16 percent of the children, high blood pressure in 10 percent, high triglycerides in 8 percent and glucose intolerance in about 5 percent.

Harrell, who presented her findings at a recent meeting of the American Heart Association (news - web sites), is reluctant to say the presence of the risk factors in children automatically means an unhealthy adulthood, citing a lack of research in that area.

But a recent study by Finnish researchers seems to point to that link. The scientists followed more than 2,000 children and teens and measured them for risk factors. They found if the children displayed several risk factors, they had a greater chance of suffering from hardening of the arteries as adults.

McGill says it's particularly frustrating to get the word out about this potential link because you're talking about symptoms that could take decades to result in a disease.

"It's a tough sell," he says. "Young people think they're immortal. Physicians don't get paid to prevent something that's going to occur 20 or 30 or 40 years later."

More information

To learn more about America's childhood obesity epidemic and what can be done about it, visit the National Institutes of Health and the Food and Nutrition Information Center.

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Experts Urge Tools for Women's Health

By Daniel Yee
Associated Press Writer
The Associated Press
Sunday, February 29, 2004

ATLANTA - More needs to be done to protect women against infectious diseases and other health dangers, international health experts said Saturday.

Better research efforts, educational programs and diagnostic tools are needed to combat infectious disease threats against women, Centers for Disease Control and Prevention (news - web sites) officials said at the first International Conference on Women and Infectious Diseases in Atlanta.

Women in much of the world are more vulnerable than men to diseases including HIV (news - web sites) and AIDS (news - web sites), tuberculosis and malaria, Dr. Julie Gerberding, CDC director, said at the opening of the two-day conference that concluded Saturday.

For example, 55 percent of adult HIV and AIDS infections in sub-Saharan Africa are in women, more than double the rate of female infections in Europe and in the United States. Malaria affects more pregnant women and children under age 5 than other groups.

"We have a lot of theories but really we don't know why women and girls are disproportionately affected by these diseases," Gerberding said.

Some health experts say a lack of access to health education and services combined with other social and economic factors prevent women, particularly in impoverished areas, from avoiding infectious diseases.

Health officials are pushing countries to start collecting separate health data on women instead of combined data on men and women.

"We need to do much more," said Dr. Mirta Roses Periago, director of the Pan American Health Organization on Saturday. "The communities and groups affected still don't know they are still so far behind."

Health officials also are being trained to help broaden female access to health information and to empower women in health matters. The United States and other countries are providing more funding to improve women's health around the world.

"There are hopeful signs that finally the world is beginning to embrace the issue," Gerberding said. "I'm very optimistic a collective effort will begin to make a difference."

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Study: Cough and Cold Kits Could Stem Antibiotic Use

Sunday, February 29, 2004

ATLANTA (Reuters) - Offering patients in health clinics kits with over-the-counter cough and cold medicines appears to significantly reduce unnecessary antibiotic use, according to a new U.S. study released on Sunday.

Researchers from the Minnesota Antibiotics Resistance Collaborative found patients with upper respiratory illnesses or acute bronchitis who visited clinics that distributed the kits were significantly less likely to fill a prescription for antibiotics within three days.

Upper respiratory illnesses and acute bronchitis are generally caused by viral rather than bacterial infections. The overuse of antibiotics, which only work on bacteria, have been cited as one of the major causes of the emergence of drug resistant strains of disease.

"Providing cough and cold care kits does appear to be a useful tool if used with patients who have upper respiratory illness or acute bronchitis to decrease unnecessary antibiotic use," said Pamala Gahr of the Minnesota Department of Health who helped research the study.

The kits, first distributed by three local health plans during the winter of 2000-2001, contained pain relievers, decongestant, cough syrup, lozenges, a packet of powdered chicken soup and a tea bag.

The following year, six local health plans distributed about 31,000 kits.

Gahr said researchers had received a lot of anecdotal feedback from doctors who said that it was "a great idea" to have something to give patients who didn't need antibiotics but were anxious for something to relieve their discomfort.

Researchers, however, said follow-up studies were required because of the study's limited scope.

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Saturday, February 28, 2004

Be Smart When It Comes to Your Heart

By Kathleen Doheny
HealthDay Reporter
Saturday, February 28, 2004

SATURDAY, Feb. 28 (HealthDayNews) -- The story of heart disease in the United States can seem staggering.

For starters, it's America's No. 1 killer.

Cardiovascular disease claimed 931,108 American lives in 2001. That compares with 553,768 deaths due to cancer; 101,537 deaths due to accidents; and 14,175 due to AIDS (news - web sites).

Yet simple lifestyle changes can reduce your risk of heart disease, doctors emphasize. And it's never too early to start. Many young adults and even children are showing warning signs of heart disease that could lead to major health problems later in life.

And what better time to start than February, American Heart Month?

While genetics play some role in the development of cardiovascular disease, there are many risk factors that are what doctors call "modifiable." With a little effort, you can eliminate or control them.

Here are six important strategies to minimize your risk:

  • Stop smoking. On this score, most Americans are doing pretty well. Since 1965, smoking in the United States has declined by more than 40 percent among people aged 18 and older, according to the American Heart Association (news - web sites) (AHA).
  • Exercise. "The minimum amount should be the equivalent of brisk walking for 30 minutes three to four times a week," says Dr. Zi-Jian Xu, a cardiologist at Santa Monica-UCLA Medical Center in California. Dr. Kris Vijay, a cardiologist and director of clinical research and heart failure at the Arizona Heart Institute, urges people to do even a bit more -- 30 minutes five times a week, or two and a half hours total weekly. He tells people to jog, play tennis, walk -- do anything to keep moving.
  • Maintain a healthy weight. "A major risk factor for heart disease is obesity," says Vijay. "We know that one third of America is now obese. That obesity is perpetuating the chain" of risk factors, he says. Obesity can lead to diabetes, high blood pressure and high cholesterol, each of which boosts the risk of heart disease. Keep your body mass index (BMI) below 25 -- the recommended cutoff for optimal health.
  • Eat healthy. That means a balanced diet with plenty of fruits and vegetables, few fried foods, and go easy on the sugar. "Don't add sugar," Vijay warns. "It's not a good thing. The natural sugars in bananas and oranges are better than plain refined sugar." The AHA recommends a nutrition plan that includes five or more servings of fruits and vegetables a day; six or more servings of grain products; fat-free and low-fat milk products; fish; beans; skinless poultry; and lean meats. Fats and oils such as tub margarines or olive oils should have 2 grams or less of saturated fat per tablespoon, the AHA says.
  • Control high blood pressure. One in four adults has high blood pressure, the AHA estimates. Exercise and eating healthfully, paying particular attention to lowering salt intake, can help lower blood pressure. If those strategies don't work, blood-pressure lowering medications can be used.
  • Manage diabetes. Adults with diabetes are two to four times more likely to have heart disease, the heart association warns. Type 1 diabetes can be controlled with insulin. Type 2 diabetes and pre-diabetes can be controlled through proper nutrition and exercise.

If your family doctor or internist doesn't bring up the need to pursue a heart-healthy lifestyle, you should broach the subject. "A lot of primary-care doctors have not paid enough attention to risk factor modification," Xu says.

Then there are the doctors who pay attention but the patients who don't. "Patients have high blood pressure, diabetes, high cholesterol, and they tend to ignore it and don't take medication or don't take enough," Xu says.

More information

For information on a heart-healthy lifestyle, see the American Heart Association. The association also offers a guide to healthy nutrition. To calculate your body mass index, click here.

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Panel Urges Stricter Limits on Acne Drug

By Lisa Richwine
Saturday, February 28, 2004

GAITHERSBURG, Md. (Reuters) - A powerful acne drug that can cause serious birth defects needs even tighter restrictions to make sure pregnant women do not take it, a U.S. advisory panel ruled on Friday.

The panel recommended a mandatory, centralized registry of all patients taking the prescription drug, sold by Roche under the name Accutane, and its generic rivals. Prescribers and pharmacists also should register with the system, which if adopted would make Accutane one of the most restricted medicines.

The program, backed by Roche and generic companies, would require proof of a negative pregnancy test before pharmacists could refill monthly prescriptions.

The Food and Drug Administration (news - web sites) is considering new limits because women have continued to get pregnant while taking Accutane, despite various safeguards that were periodically strengthened and mostly voluntary.

The FDA will weigh the panel's recommendations and try to work out a tougher plan with Roche and generic producers of the widely used medicine.

"Doing nothing and making no change is not an acceptable course of action," said Dr. Sandra Kweder, deputy director of the FDA's Office of New Drugs.

In a one-year period after the safety measures were strengthened in 2002, 120 pregnancies were reported, compared with 127 during a similar period with looser restrictions. Fetuses exposed to Accutane can die or develop defects such as heart and nervous system anomalies.

Under the current pregnancy prevention plan for Accutane, women are supposed to have two negative pregnancy tests before starting therapy, and another each month of therapy, which typically lasts four to six months.

Roche's research showed those recommendations, as well as advice for women to use two forms of contraception during therapy, were not always followed.

The panel voted 16-8 to back a plan from Roche and generic firms for a mandatory registry, and added a few other requirements.

"We are not at odds in any way" with the panel's advice, Roche spokeswoman Carolyn Glynn said. Details for implementing the new program need to be worked out, but "we're all looking at the same goals," she said.

Some panel members said the mandatory system would be too burdensome, and there was no evidence it would reduce pregnancies. Even the stricter system cannot fully regulate patients' behavior regarding contraception, some cautioned.

"We don't go home with them, and we can't control what they do," said panel member Dr. Roselyn Epps, head of pediatric dermatology at Children's National Medical Center in Washington.

Few drugs have tight restrictions on prescribing, but the FDA increasingly has searched for ways to manage safety risks of important medicines, rather than keeping them from patients entirely. Dermatologists hail Accutane as a wonder drug for treating severe acne. Critics charge it is overprescribed for more mild cases.

One tightly controlled drug is thalidomide, a medicine notorious for causing birth defects and now used to treat cancer and leprosy.

Accutane is known generically as isotretinoin. The three generic makers are Barr Pharmaceuticals, Ranbaxy Laboratories Ltd. and Mylan Laboratories Inc. .

Roche said its Accutane sales fell to $144 million in 2003 from $380 million in 2002 after generic competition debuted.

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A Migraine in the Forecast

Saturday, February 28, 2004

SATURDAY, Feb. 28 (HealthDayNews) -- Doctors have long brushed aside patients who think the weather can trigger their migraine headaches.

However, recent research has found weather conditions can unleash the withering headaches in as many as half of all sufferers -- and cold, dry conditions are the most common culprits.

The study was conducted by Dr. Patricia Birgeneau Prince, as part of a project at The New England Center for Headache in Connecticut.

Some people prone to migraines tend to blame high temperatures and humidity for their headaches. And that can be the case.

However, the study found that a combination of low humidity and cold weather is more likely to blame.

Other weather triggers for some patients include shifting weather patterns, and changes in barometric pressure or extreme barometric pressure.

Between 28 million and 30 million Americans -- or about 12 percent of the population -- suffer from migraines. Worldwide, the number is about 6 percent.

About half the patients in Prince's study were truly affected by the weather. Before the study started, 85 percent were convinced weather was their nemesis.

Experts recommend that people who believe they suffer weather-induced migraines keep a calendar for several months. They should note the pattern of their headaches and the weather conditions when each headache hits.

Once weather has been confirmed as a factor in their attacks, and they know what kind of weather they're sensitive to, sufferers can monitor weather reports more closely and take preventive medication when threatening weather patterns develop.

Another workable strategy: Have acute care medicine on hand when a weather trigger is imminent, and take it at the first sign of a headache.

More information

Find out more about migraines and their causes from the National Migraine Awareness Organization.

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