The American Voice Institute of Public Policy presents

Personal Health

Joel P. Rutkowski, Ph. D., editor
May 19, 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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 20-26

 

  1. FDA Approves Rapid Saliva Test for AIDS Virus
  2. FDA Warns Against Nonmedical Sonograms

  3. 'Safe' Ultraviolet Rays May Cause Cancer

  4. New Treatment Direction for Heart Failure
  5. FDA Says Wyeth Made False Claims About Effexor

  6. Chronic Fatigue Syndrome Still Puzzles

  7. Tests May Show if Vitamins Can Help Diabetic Women

  8. The Dangers of Steroid Use

  9. Doctors Question Evidence for Shaken-Baby Syndrome

  10. Dry Eye Common in Older People

  11. Tiniest Babies Grow Up to Be Mostly Healthy Adults

  12. Talk With Your Teens

  13. No Health Risks Found Near Intel Plant –Study

  14. Tricky Tumors

  15. Changing Your Drinking Habits Changes Your Health

  16. Not All Fruits, Vegetables Created Equal

  17. Fetal Monitoring Fails to Detect Brain Injury

  18. Fetal Alcohol Syndrome Costs Soar

  19. Antibiotics Effective Against Uterus Inflammation

  20. Embolization Bests Surgery for Fibroid Treatment

  21. Molding Baby's Nose Can Cause Respiratory Distress

  22. Walnuts a Smart Choice for Heart

  23. New Virus Tied to Respiratory Infections

  24. St. John's Wort Weakens Leukemia Drug

  25. Traffic Reduction May Lead to Fewer Stuffy Noses

  26. US Panel Urges Vigilance in Medical Tests for Kids

  27. Broader Rules Urged for Child Research

  28. Circumcision Seen as Method to Block HIV Infection

  29. High Schools Struggling With Steroid Use

  30. FDA Finds Cancer-Risk Acrylamides in More Food

  31. Fructose Sweetener Linked to Obesity Rise

  32. Drug Overdoses Fuel Jump in U.S. Poisoning Deaths
  33. Eight Glasses of Water a Day

  34. Study: Food-Poisoning Parasite Can Evade Drugs

  35. Tai Chi Tames Chronic Health Conditions

  36. Common Cervical Cancer on the Decline in U.S. Women

  37. Do Solid Foods Induce Allergies in Infants?

  38. Anti-Clotting Effect of Aspirin Wanes Over Time

  39. Liver Regrowth Slower in Organ Donors

  40. Kids Who Avoid Milk Risk Broken Bones

  41. Public Confused on Cholesterol, Cancer Screening

  42. Longer Diabetes Means Higher Heart Risk

  43. Stents Show Their Mettle in High-Risk Heart Patients

  44. Throat Microbe Can Cause Bone Infections in Kids

  45. Keep Poisons Away From Kids

  46. Obesity Experts Offer a Padful of Prescriptions

  47. U.N.: Lack of Vitamins Eroding Brainpower

  48. Lawmakers Want Stronger Law on Diet Supplements

  49. Bunless Burgers Old News to Calif. Chain

  50. Vegetarian Diet Affects Birth Defect Tests

  51. House OKs Funding to Spur Organ Donations

  52. Thin Bones Predict Heart Disease in Women

  53. What Your Favorite Snack Says About You

  54. Exercising to Music May Make You Smarter

  55. Stopping the Damage of Lead Poisoning

  56. Flu Vaccine May Be Linked with Asthma in Infants

  57. Elderly With Pneumonia Need Antibiotics Quickly

  58. Report: American Children Under Threat from Fat

  59. Chronic Sinusitis is Immune Response to Fungus
  60. Steroids Given to Newborns Cause Problems Later
  61. Alcohol Behind Many ER Visits

  62. Food Additives May Trigger Stuffy Noses in Some

  63. Getting the Hives

  64. ER Visits Identify Undiagnosed High Blood Pressure

  65. Genetic Testing

  66. Walking 15 Minutes a Day Won't Prevent Obesity

  67. Alcohol Use May Help After Heart Procedure

  68. Herbal Supplements/Meds Not That Dangerous a Mix

  69. Snack Food Makers on the Defensive

  70. More Clues to Autism's Origin

  71. Studies Uncertain on Drugs Versus Hysterectomies

  72. New Guidelines for Detecting Cerebral Palsy Early

  73. Study: Low-Calorie Diet May Extend Life

  74. Statins May Speed Stroke Recovery

  75. Asthma Inhaler Ingredient May Counteract Benefits

  76. Gum Disease

  77. Stopping Estrogen Therapy Raises Hip Fracture Risk

  78. The Hazards of Ear Candling

  79. Vitamin D Helps Fight Breast Cancer

  80. DHEA Use by Athletes May Boost Harmful Hormone

  81. UVA Rays May Play Bigger Role in Skin Cancer

  82. People Don't Eat the Right Fruits, Veggies: Experts

  83. Studies Find Hysterectomy Viable Yet Avoidable

  84. Many Factors Impede Colorectal Cancer Screening

  85. Some Asthma Inhalers May Trigger Breathing Problems

  86. Parents' Smoking Raises Kids' Allergy Risk

  87. FDA Says Antidepressant Patients Need Watching

  88. Early Breast Cancer Growth Tough to Treat

  89. Daily Drink Eases Hypertensives' Heart Risk – Study

  90. Study: Insecticides May Affect Infant Size

  91. Stress Can Cause Heart to Misfire, Study Shows

  92. Diabetes Looms Large
  93. Drug to Prevent Breast Cancer Not Fully Used-Study

  94. Feasting After Fishing

  95. Bloated Costs, Risk Cast Doubt on Stomach Stapling

  96. Contact Sports and Skin Infections

  97. Smoking Speeds Up Memory Loss in Old Age
  98. Simple Ways to Improve Colorectal Cancer Screening Rates

  99. Poor Care Plus Dementia Equals Violence, Experts Say

  100. Parental Support Has Lifelong Benefits

  101. Study Yields Clues on Expanded Defibrillator Use

  102. Molecules Further Cystic Fibrosis Inflammation

  103. Self-Reported Food Intake May Thwart Research

  104. Allergic Asthma: What You Don't Know Can Hurt You

  105. Internet Is a Popular Portal for Dieters

  106. Allergies? Sinusitis? How to Tell the Difference

  107. Spring Signals Sneezing Season

  108. Student Drinking Worries Most College Officials

  109. A Doctor's Painstaking Search for MS Clues

 

 

 

Friday, March 26, 2004

 

FDA Approves Rapid Saliva Test for AIDS Virus

 

By Lisa Richwine

Reuters

Friday, March 26, 2004

WASHINGTON (Reuters) - The United States approved the first rapid saliva test for the HIV virus (news - web sites) that causes AIDS (news - web sites), health officials said on Friday.

The test, made by OraSure Technologies Inc., provides results within 20 minutes with 99 percent accuracy. Other approved rapid HIV (news - web sites) tests require blood samples.

Shares of Bethlehem, Pennsylvania-based OraSure gained $1.55, or 19.02 percent, to close at $9.70 on Nasdaq.

"This oral test provides another important option for people who might be afraid of a blood test," Health and Human Services (news - web sites) Secretary Tommy Thompson said.

Officials also said the test, called the OraQuick Rapid HIV-1/2, could help on two fronts, encouraging more people to get tested as well as actually getting them the results.

One-fourth of the roughly 900,000 HIV-infected people in the United States are not aware they have the virus, according to estimates by the Centers for Disease Control and Prevention (news - web sites).

People given standard tests that take a week or two often do not return to get the results. With a rapid test, a patient can get an answer in just one clinic visit. Those who test positive can start treatment quickly and take steps to keep from spreading the virus.

The new saliva test also helps protect health-care workers from becoming infected with HIV because they do not have to handle blood, officials said.

The device could be a valuable tool in fighting the AIDS epidemic in Africa because it is so quick and accurate, Thompson said.

U.S. aid agencies at some point might buy the tests for distribution in Africa, but no plans are yet in place, Thompson said.

The OraSure saliva test is cleared for detecting antibodies to HIV-1, but not for HIV-2, the strain prevalent in parts of Africa. OraSure's 20-minute blood test for HIV is approved for both types.

Only a minority of African patients who test positive for HIV have access to medicines that can suppress the virus.

The Bush administration came under criticism this week from AIDS activists, who accused the government of pushing expensive, brand-name drugs in poor countries over cheaper generics. The administration has said it is concerned that the generics, which often mix several drugs in one pill, may not be safe or completely effective in the long term.

The new test involves wiping a swab along the gums and placing it into a liquid in the testing device. When antibodies to the HIV virus are detected, two reddish-purple lines appear on the device.

Results should be confirmed by a second, more specific test, the Food and Drug Administration (news - web sites) said.

At first, the new saliva test will be available only at hospitals and major clinics which are approved to use that type of test. OraSure could apply for a federal waiver to allow more widespread use at health-care facilities.

The saliva tests could eventually be sold without prescription in drug stores, as pregnancy tests are, Thompson said. The test would have to clear several regulatory hurdles first.

Officials would have to consider how patients might react to the results at home, without health-care workers on hand, said Jesse Goodman, director of the FDA's Center for Biologics Evaluation and Research. False positives could be troublesome, he said.

Separately, OraSure said the FDA was requiring additional data before it would clear the company's Uplink Oral Fluid Drug Detection System, a test for cocaine, marijuana and other abused drugs. (Additional reporting by Susan Heavey)

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FDA Warns Against Nonmedical Sonograms

 

By Martha Mendoza

AP National Writer

The Associated Press

Friday, March 26, 2004

PASADENA, Calif. - Shelly Bunker's due date is months away, but in an upscale shopping mall office last week, tucked among the hair salons and art galleries, she watched her baby boy appear to smile, yawn and wave from inside her womb.

"You can kind of see his personality too," said the beaming father, Ben Bunker, watching the image of his unborn son captured by a bath of ultrasound waves. "He's pretty active."

Despite safety warnings about so-called entertainment ultrasounds from the Food and Drug Administration (news - web sites), the Bunkers — she's a dance teacher, he's finishing law school — are among thousands of parents eager to take advantage of this latest trend in baby pictures.

Ultrasounds have been an important part of routine prenatal care for millions of women since the 1960s and have proven to be a safe diagnostic tool when done by licensed medical professionals within strict scientific guidelines.

In the past two years, something quite different has emerged — dozens of unregulated ultrasound centers have opened for business around the United States with cute names like Fetal Fotos, Prenatal Peek and Womb With A View.

Operating without medical guidelines or standards, they charge about $200 a session, using $100,000 high-density ultrasound machines that provide a much clearer picture — chubby cheeks, hair, even muscular definition — than the two-dimensional scans most doctors use.

The FDA shut down several ultrasound studios about 10 years ago. Due to the resurgence of the business, Deputy Director Dr. Kimber C. Richter said the agency is now considering regulatory action, which typically can mean warning letters, injunctions, fines or seizures.

The agency says it's illegal to administer ultrasound without a prescription or to promote the device for nonmedical use.

Some state laws also say that operating an ultrasound machine without the proper credentials is "practicing medicine without a license." To date, no state medical boards have taken action.

Some franchise owners say they are operating legally because doctors own and run their businesses. Others, like Fetal Fotos, do initial "limited medical" scans before the entertainment portion begins. Some also have gotten doctors to issue a blanket prescription for their machine, hoping this gets around the requirement that each patient have a prescription.

Most companies also issue disclaimers, saying they don't provide prenatal care and are an optional service.

GE Medical Systems, a leading seller of ultrasound equipment, said in a statement to The Associated Press that it "does not support the use of the 4D equipment for nonmedical purposes."

But in its advertisements, GE seems to be selling only the great pictures it produces.

One ad plays the song, "The first time ever I saw your face, I thought the sun rose in your eyes" as a pair of tearful, excited parents watch their baby's image on a monitor. The announcer then says: "When you see your baby for the first time on the new GE 4D ultrasound system, it really is a miracle."

While many doctors and midwives refer patients to the 4-D centers for additional, fun peeks at their babies, some warn against it. The Bunkers said their doctor told them to "go for it."

"If doctors do it, it can't be that bad," said Ben Bunker.

Several medical groups disagree.

Doctors with the Society of Medical Diagnostic Sonography, the Society of Maternal-Fetal Medicine and the American College of Obstetrics and Gynecology stress that ultrasound is a medical procedure, not a photo opportunity. What if an untrained, unregulated scanner finds a malformation? What if uninsured women depend on ultrasound centers rather than doctors?

Even worse, the American Institute of Ultrasound in Medicine warns that although there are no confirmed biological effects from prenatal ultrasounds, possible problems could be identified in the future, especially because these unregulated scans are longer, use more energy and can be more frequent.

Ultrasound uses high-frequency sound waves to produce diagnostic images of developing babies.

Two-dimensional ultrasound has been around since the 1960s, helping doctors diagnose birth defects, fetal growth and position, and more. Millions of fetal ultrasounds are done each year, and more than 30 years of research and practice have found them to be safe.

In recent years, medical technologists have developed 3D ultrasound systems that determine the volume of the fetus and then reconstruct the image in three dimensions. The 4D ultrasounds take those 3D pictures and turn them into moving images.

Outside of obstetrics, ultrasound is widely used for an array of diagnostic and therapeutic reasons, from heating and healing tissue to locating gallstones.

"Ultrasound is a form of energy, and even at low levels, laboratory studies have shown it can produce physical effects in tissue, such as jarring vibrations and a rise in temperature," the FDA said. Because of this, "prenatal ultrasounds can't be considered completely innocuous."

Some small, anecdotal studies in the United States and Europe have shown that it may affect human development, such as delayed speech in children.

In response to a request from the AP, the FDA said it has received a total of 93 reports of problems from all ultrasound machines, not just prenatal. Of those, 63 involved serious injury, 20 involved machine malfunctions and 10 could not be categorized. The agency said it couldn't immediately provide further details.

Dr. Lawrence Platt, an obstetrician in Los Angeles, is both a leading proponent of the 4D ultrasound machines and an outspoken critic of their nonmedical use.

"From diagnostic point of view, it's the most major advance we've had in last 10 years, so how can I help but be enthusiastic about this?" he said.

The higher definition ultrasounds help him diagnose everything from cleft palates to heart problems, he says, and can give babies a better chance of survival by making sure the necessary medical care is standing by.

But he's quick to add that "while it can be helpful, it also can be harmful."

"Used inappropriately, this can be very dangerous," he said. Platt also said several patients have come to him after prenatal portrait sessions turned tragic when problems were discovered.

"These people are not trained to diagnose, nor counsel patients in these situations," he said.

Valerie Christensen, who owns four Fetal Foto studios in Southern California, said her operators have, at times, found fetuses that were malformed or dead.

"At that point we stop the session, switch off the machine, and advise them that they need to see their doctor immediately," she said.

Christensen, and many proponents, said the benefits — a richer bonding experience for parents with their unborn baby — outweigh any possible risks.

Many parents say they leave the sessions more excited about the impending birth.

Carmina Bravo of Lakeview Terrace, Calif., teared up when she viewed her baby boy last week with her 4-year-old daughter, Gissel.

"I kind of made a new connection with this baby," said Bravo. "It was so touching."

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'Safe' Ultraviolet Rays May Cause Cancer

 

Reuters Health

Friday, March 26, 2004

NEW YORK (Reuters Health) - Ultraviolet-B (UVB) rays are the component of sunlight that cause sunburn, while ultraviolet-A (UVA) rays, which produce a tan, are thought to be relatively safe. Now, however, Australian and US researchers report that UVA induces a greater number of mutations in the deep layer of skin, where skin cancers arise, than

Far more UVA light than UVB light penetrates to the basal layers of skin, the scientists point out in an article in the Proceedings of the National Academy of Sciences (news - web sites). However, UVA appears to cause less direct damage to DNA than UVB and has been "considered far less carcinogenic."

Dr. Nita S. Agar from University of Sydney and colleagues used the distinctive "fingerprints" of UVA and UVB damage to DNA to examine which types of rays were causing mutations in deep and shallow skin layers in skin cancers and in pre-malignant solar keratoses.

All UVB mutations in solar keratoses and 82 percent of UVB mutations in squamous cell carcinomas were located in the upper skin layers, the authors report, whereas most UVA mutations (57 percent and 86 percent, respectively) were found in the basal layers.

Further analysis also showed unrepaired DNA damage induced by recent UVB exposure in the upper layers. In the basal layers, unrepaired damage induced by UVA exposure was predominant.

"The identification of UVA mutations in both (skin cancers) and premalignant solar keratoses in almost identical proportions implicates an early role for this band of radiation in tumor progression," the investigators comment.

"Given the traditional emphasis on UVB," they conclude that protection "also from UVA irradiation has profound implications on public health worldwide."

Source: Proceedings of the National Academy of Sciences, online early edition, March 22, 2004.

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New Treatment Direction for Heart Failure

 

By Renee C. Lee

Associated Press Writer

The Associated Press

Friday, March 26, 2004

DALLAS - A new device is helping reshape the hearts of people with congestive heart failure — a different approach to a procedure that's been around for more than 20 years.

Although Italian doctors have been physically reshaping weakened hearts for years, few American doctors are trained to perform surgical ventricular restoration.

A few months ago, doctors used a plastic shaper to help reshape Charles Neal's sickly left ventricle, the lower heart chamber.

After five heart attacks and a stroke, Neal's heart was so worn out that he couldn't walk across a room without feeling exhausted and short of breath.

Constant fatigue caused by congestive heart failure eventually forced the 72-year-old business owner into early retirement.

"I used to go to work every day, go on trips, but that quit two years ago, I couldn't stand up to it," said Neal, who owns an underground fuel tank storage company.

That all changed after the operation, which allowed his heart to pump more efficiently. The surgical ventricular restoration was done along with six bypass procedures, which also contributed to his improved health.

"This is the only device to do this operation," said Dr. John Conte, the director of heart and lung transplants at Johns Hopkins University in Baltimore. "It allows a doctor anywhere in the world to do it in the same fashion."

More than 5 million Americans suffer from congestive heart failure, and about 1,000 people die each day from the condition, typically seen in older people.

The disease develops when the heart is not pumping the way it should, causing the organ to work harder. This happens when the heart has been damaged or weakened by a prior heart attack, clogged arteries or high blood pressure, which can cause the left ventricle to become enlarged.

Patients usually are short of breath, exhausted and suffer from persistent coughing or wheezing and increased or irregular heartbeat.

Doctors usually treat the problem with medicine, but that doesn't always relieve the symptoms. Heart transplants also are an option but many heart patients are too old or too sick to withstand the surgery — even if they are among the 20 percent who succeed at getting a donor heart.

Ventricular restoration can be a better option because it treats the cause of the symptoms and can improve quality of life, doctors said.

"It's a far safer and economical treatment than a heart transplant or putting in a mechanical device," said Conte. But he cautioned that it is not for all heart patients, who should be carefully screened to see if they would benefit from the surgery.

During a two-hour operation, the shaper is inserted into the ventricle and the heart wall is stretched around the device. Once the heart is molded to the right shape and inflated to the right volume, a patch is sewn onto the heart to maintain the shape and the device is deflated and removed.

So far, more than 700 patients in the United States have had the procedure since the FDA (news - web sites) approved the new device two years ago.

The procedure costs about $22,000 to $35,000 and is covered by Medicaid, Medicare and private insurance, said Bert Davis, president and chief executive of Chase Medical, the suburban Dallas company that manufactures the Mannequin shaping device.

Johns Hopkins is the only training institution in the United States for surgical ventricular restoration, but some American doctors are also getting training in Italy.

"Before the Mannequin, doctors had to do it by eyeball," Davis said. That meant some ventricles were made too small, too large or too spherical. He said the device was designed with the help of the Italian doctors who perform restoration surgery.

Dr. Paul Grayburn, Neal's cardiologist at Baylor University Medical Center, said his hospital has done the procedure more than 25 times with good results.

Grayburn said it's uncertain whether Neal will live longer because of the procedure. But Neal is one of the patients in a national study to determine if ventricular restoration is more beneficial than medicine and heart bypasses.

Dr. Eric Eichhorn, a cardiologist at Medical City Dallas and one of the study investigators, said it's the first effort to evaluate the outcomes of the procedure.

"Right now, we don't know what to do with patients — whether to send them to surgery or not," Eichhorn said. "This may help to identify what patients benefit and why, and whether they live longer."

Neal, who had severely depressed heart function, is now walking 25 minutes on a treadmill without feeling exhausted and looks great, Grayburn said.

"I think it also holds out promise for other patients," he said.

Even though the surgery was risky for Neal because of his age and severe heart condition, he said it has allowed him to return to his once active lifestyle.

"The worst thing was I could die on the operating table, but I had reached a point in my life that I was so miserable, I would take any chance for quality of life," said Neal, who has three grown children.

He had the surgery on his birthday, Nov. 6. It was the best present ever, he said.

"I can't tell you how great I feel."

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FDA Says Wyeth Made False Claims About Effexor

 

By Susan Heavey

Reuters

Friday, March 26, 2004

WASHINGTON (Reuters) - The U.S. Food and Drug Administration (news - web sites) on Friday warned U.S. drugmaker Wyeth over circulating misleading claims that its antidepressant Effexor outperforms other popular competitors.

Several print materials, including a journal advertisement, misuse data to say more patients suffered fewer symptoms of depression with Effexor than with selective serotonin reuptake inhibitors, or SSRIs, the FDA said.

Wyeth's claim that Effexor is better "has not been demonstrated by substantial evidence or substantial clinical experience," the FDA said in a letter to the company. The letter was released to the public on Friday.

Some SSRIs include Pfizer's Zoloft, Eli Lilly and Co.'s Prozac and GlaxoSmithKline Plc's Paxil.

Effexor falls under a different class of drugs called serotonin and norepinephrine reuptake inhibitors, or SNRIs. Both groups of drugs block serotonin, a powerful neurotransmitter that affects mood.

The FDA letter also cited Effexor radio ads for not stating side effects or specific signs of depression -- including lack of interest, appetite loss and suicidal thoughts.

"The advertisement fails to communicate important characteristics necessary to distinguish between major depressive disorder and variations of normal daily functioning," the FDA said.

The agency gave Wyeth until April 1 to respond to the warning. If the company fails to act, the FDA can eventually impose fines and other enforcement actions.

Wyeth spokesperson Douglas Petkus said the company received the FDA letter and would work with the agency.

Shares of Wyeth were down 25 cents, or 0.68 percent, to $36.78 in late afternoon trade the New York Stock Exchange (news - web sites).

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Chronic Fatigue Syndrome Still Puzzles

 

By Adam Marcus
HealthDay Reporter

HealthDayNews

Friday, March 26, 2004

FRIDAY, March 26 (HealthDayNews) -- People get run down, tired, even exhausted at times. For most of them, a good night's sleep or a short vacation is enough to recharge their batteries.

But what if you could never shake that weariness? And no matter how much you slept or tried to exercise, the soul-dragging exhaustion never left?

That's what it's like for the estimated half million Americans or more with chronic fatigue syndrome (CFS). No amount of sleep helps them feel more awake, while activity -- both mental and physical -- may make them more tired. Many also endure muscle pains and weakness, memory problems and other symptoms with no detectable source.

The scope and causes of chronic fatigue, and even its existence -- it has been derided as the "yuppie flu"-- are hotly debated.

To shed more light on the condition, March has been declared National Chronic Fatigue Syndrome Awareness Month.

A 1994 panel of experts defined chronic fatigue syndrome as the following: at least six months of severe, lingering exhaustion without any other medical explanation; and the presence of four or more additional symptoms, including memory or concentration problems, sore throat, tender lymph nodes, muscle or joint pain (without swelling or redness), headaches, "unrefreshing" sleep and post-exercise malaise that persists more than a day.

Complicating matters, the symptoms must have recurred across six or more consecutive months, and they must not have predated the onset of chronic fatigue.

Scientists once suspected a link between CFS and infection with the Epstein-Barr virus (EBV), which causes mononucleosis. They have since backed away from that connection, and now no single infection is thought to bring on the disorder.

"Fatigue as a state is something that's very common, and it's something that everyone has experienced," says Leonard Jason, an epidemiologist and psychologist at DePaul University in Chicago. At any given time, for example, one in four Americans reports being fatigued.

Only about 4 percent to 5 percent of people say they're exhausted for six months straight. Many of them have non-medical reasons for their fatigue -- job stress or a new baby, for example. Those who meet the definition of chronic fatigue syndrome make up perhaps 0.4 percent of the population, Jason says. Women with the condition outnumber male patients three-to-one.

Still that works out to "an incredible public health challenge" by numbers alone, Jason says. Despite the sheer volume of patients -- most of whom go undiagnosed, he adds -- the condition is the Rodney Dangerfield of diseases: It gets no respect.

"There's a lack of appreciation for the seriousness of the condition," Jason says, "because everyone has experienced tiredness and fatigue. They say, 'I'm tired and I go to work. Why don't these people?' "

In his own research, Jason has found that the popular stereotypes about chronic fatigue syndrome don't hold true. Contrary to being a "yuppie" ailment, most of the people reporting symptoms consistent with the condition in the Chicago area are poor and members of ethnic minorities. "It wasn't middle-class white women," he says.

If the public is confused about CFS, they're in good company. Dr. Timothy Craig, a CFS expert at the Pennsylvania State University College of Medicine, says scientists have made relatively little progress against CFS. "I think a lot of physicians still don't understand what it is, how to diagnose it," he says.

A smattering of medications work in some patients, though no one drug helps everyone, Craig says. These include antidepressants, nasal steroids to treat sinus infections and new-generation sleeping tablets. But so far, there's no such thing as an "energy pill" that can help all CFS sufferers, he says.

Kim McCleary, who heads the CFIDS Association of America, says treating chronic fatigue is "purely symptomatic at this point. A provider who understands the basics of this syndrome should start by trying to tackle the most severe symptom" first. That's usually -- but not always -- fatigue.

"Sleep can compound pain and cognitive problems. It just generally makes everything worse," McCleary says.

While it's not clear what does help people with chronic fatigue, here are a few things that almost certainly do not work, according to the U.S. Centers for Disease Control and Prevention (news - web sites).

Ultimately, McCleary says, treating CFS requires a great deal of patience on the part of both doctors and patients. "It can be very frustrating," she adds.

 

More information

 

For more on chronic fatigue syndrome, go to the CFIDS Association of America or the National Library of Medicine.

Back to the Top

 

Tests May Show if Vitamins Can Help Diabetic Women

 

By Maggie Fox, Health and Science Correspondent

Reuters

Friday, March 26, 2004

 

WASHINGTON (Reuters) - Taking extra vitamins may help some women with diabetes avoid heart disease, but may worsen clogged arteries in others, Israeli and U.S. researchers reported on Friday.

They said a simple blood test, to detect genetic variations in a blood protein called haptoglobin, may predict which patients would benefit from supplements and who should avoid them.

Diabetes greatly increases the risk of heart disease, so the test may offer useful alternatives to the millions of patients worldwide with type-2 diabetes, the team from the Technion-Israel Institute of Technology in Haifa, George Washington University in Washington and elsewhere said.

Post-menopausal women with diabetes who carry two copies of the variation known as haptoglobin-2 increase their risk of atherosclerosis, or narrowed arteries, if they take doses of the antioxidant vitamins C and E, Dr. Andrew Levy found.

But vitamins seem to slow clogging in diabetic women who have two copies of haptoglobin-1, Levy's team reports in the April issue of the journal Diabetes Care.

"This study says that you can find subgroups of people who actually might benefit and subgroups which will actually be harmed by antioxidant vitamins, so it is important to know which haptoglobin type you are," Levy said in a statement.

Levy's team has done considerable research on haptoglobin, a blood protein that interacts with hemoglobin -- the iron-rich component that makes blood red.

Researchers have found that different versions of haptoglobin can predict a diabetic's risk of heart attack or having an artery clog again after being cleared.

His team looked at vitamins E and C because studies show they can either help or hinder heart disease. Some research has suggested the vitamins can worsen heart disease by interfering with blood cholesterol levels and cholesterol-lowering drugs.

The researchers studied 299 post-menopausal women with at least partial blockage in one coronary artery who either took vitamin E and vitamin C twice a day or placebo pills.

After three years, heart disease was slowed only in women who had two haptoglobin-1 genes and took vitamins. The effect was especially clear in women with diabetes.

But the arteries seemed to narrow faster than usual in diabetic women with two haptoglobin-2 genes who took vitamins, although those without diabetes were not badly affected.

Levy believes haptoglobin affects oxidative stress, or damage to cells in everyday life or from exposure to chemicals or radiation.

Taking vitamins called antioxidants should theoretically slow or reverse this damage but studies have shown mixed results in both heart disease and cancer.

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The Dangers of Steroid Use

 

HealthDayNews

Friday, March 26, 2004

(HealthDayNews) -- Many teenage body builders and athletes mistakenly believe that taking steroids involves all gain and little risk.

Steroids -- usually synthetically made male hormones -- may pump up your body, but they can also damage it.

According to the U.S. Center for Substance Abuse Prevention, recognized side effects of steroid use may include liver tumors, fluid retention, high blood pressure, severe acne, and weakening of the tendons -- which may result in tearing or rupture.

Steroids have been illegal in the United States without a prescription since 1990.

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Doctors Question Evidence for Shaken-Baby Syndrome

 

Reuters

Friday, March 26, 2004

LONDON (Reuters) - Doctors called on Friday for a rethink of shaken-baby syndrome after researchers cast doubt on one of the symptoms used to identify it.

The syndrome results from violently shaking an infant and is recognized by bleeding around the brain and from the eye, along with brain damage. It made international headlines in 1997 when British nanny Louise Woodward was convicted of killing a baby boy in Massachusetts by shaking him violently.

Now British and American scientists said there are serious questions about the syndrome and how it is diagnosed.

"We need to reconsider the diagnostic criteria, if not the existence, of shaken-baby syndrome," said John Plunkett, of the Regina Medical Center in Hasting, Minnesota, and JF Geddes a retired pediatric pathologist.

"If the concept of shaken-baby syndrome is scientifically uncertain, we have a duty to re-examine the validity of other beliefs in the field of infant injury," they added in a British Medical Journal editorial.

Concerns about the validity of the syndrome arose after Patrick Lantz of Wake Forest University School of Medicine in Winston-Salem, North Carolina found little medical evidence to show that bleeding from the eye results only from physical abuse.

They searched for medical evidence after a 14-month-old baby suffered head and eye injuries after a television fell on him at his home.

Despite the father explaining it was an accident, the three-year old brother of the baby was taken into custody because the injuries suffered by the baby were thought to have been caused by severe shaking.

The three-year old was returned home after investigators proved that the father was telling the truth.

"Until good evidence is available, we urge caution in interpreting eye findings out of context," Lantz said in a letter to the journal.

In a separate editorial, doctors from Great Ormond Street Hospital for Children in London said bleeding from the eye can also be caused by accidental injuries.

They added that a diagnosis of shaken baby syndrome should not be based on just one symptom but if all are present it indicates that excessive force had been used.

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Dry Eye Common in Older People

 

HealthDayNews

Friday, March 26, 2004

FRIDAY, March 26 (HealthDayNews) -- There are few risk factors for dry eye, but the condition develops fairly often in older people, says a study in the March issue of the Archives of Ophthalmology.

Dry eye, a common source of discomfort for older people, can affect quality of life and has been associated with rheumatoid arthritis and other autoimmune diseases.

University of Wisconsin-Madison researchers studied 2,414 people over the age of 43 who did not report any dry eye symptoms when they were examined between 1993 and 1995. During these examinations, information was collected about the study subjects' dry eye disease risk factors, medications, cardiovascular disease risk factors, medical history and lifestyle.

The study subjects were re-examined between 1998 and 2000, and it was found that 322 (13.3 percent) of the 2,414 had developed dry eye. The incidence of dry eye was significantly associated with age.

Incidence of dry eye was greater in people with a history of allergy or diabetes who used antihistamines or diuretics and in people with poorer self-rated health. Incidence of dry eye was lower in people taking angiotensin-converting enzyme (ACE) inhibitors (used to treat high blood pressure) and in those who drank alcohol.

The study also identified several factors that were not associated with dry eye. These included: gender, blood pressure, cholesterol levels, body mass index, arthritis, gout, osteoporosis, cardiovascular disease, thyroid disease, smoking, caffeine use, vitamins, antidepressants and anti-anxiety medications.

More information

The American Academy of Ophthalmology has more about dry eye.

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Tiniest Babies Grow Up to Be Mostly Healthy Adults

 

Reuters Health

Friday, March 26, 2004

NEW YORK (Reuters Health) - While children born very premature often develop behavioral and social problems in their teen years, these children report a normal quality of life in early adulthood, according to findings from an ongoing study.

Dr. Richard W.I. Cooke at Liverpool Women's Hospital in the UK has followed a group of very low birth weight children since the early 1980s. The study excluded children with disabilities that prevented them from going to mainstream schools.

Cooke previously reported that the preterm children tended to do more poorly in school than normal weight children. And by early adolescence, they were more likely to have behavioral problems and were having a harder time making friends, Cooke recounted to Reuters Health

"As a result, we supposed that they would have increasing difficulties in early adulthood," he said.

For the most part, that does not seem to be the case, Cooke reports in the March issue of the journal Archives of Disease in Childhood. Based on questionnaires filled out at ages 19 to 22, very low birth weight children and normal weight children reported similar quality of life.

"Despite some differences in achievement and health, the perceived quality of life was similar in the two groups, which is an optimistic outlook for parents and health professionals," Cooke said.

As young adults, the low birth weight group did lag a little behind the normal weight group. The low birth weight group was more likely to be taking prescription medications, mostly for asthma.

They tended to be shorter and weigh less. Perhaps because of their smaller stature, they were less likely to think of themselves as attractive.

But in contrast to their experience during their early teen years, individuals who had been tiny at birth seemed to have normal social relationships. They were just as likely to have had a boyfriend or girlfriend as other young adults and to be sexually active.

There were a few differences in behavior, however. Although smoking was equally common in both groups, the low birth weight group was less likely to report going to pubs. This group was also less likely to use drugs, according to the report.

Socially, low birth weight individuals seemed to have closed the gap, but they tended to be behind their peers in terms of school, the study found.

"Only half as many were in higher education," Cooke said. He noted, however, that the disparity "was made up in vocational training," with the low birth weight group more likely to be enrolled.

One limitation of the study, Cooke noted, was that the results were based on questionnaires, not in-person interviews. He added that preterm children with major disabilities were not included.

To see how well very low birth weight children make the transition from school to the "real world," Cooke said that he plans to contact the participants again when they are in their late 20s.

Source: Archives of Disease in Childhood, March 2004.

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Talk With Your Teens  

 

HealthDayNews

Friday, March 26, 2004

FRIDAY, March 26 (HealthDayNews) -- Listening is a two-way street when it comes to parent-teenager discussions about drug use and other issues.

Parents need to listen to their teens before their teens will listen to them, University of Illinois at Urbana-Champaign researcher John Caughlin says. He believes public service ads that advise parents to "just talk" to their teens about drugs because they'll listen are misleading.

Caughlin, a professor of speech communication, says his research shows that if parents haven't already established a pattern of listening to their teenagers, "there is a decent chance that the teen will not listen to the parent when the topic turns to drugs and alcohol."

He studied 57 parent-adolescent pairs to find out if parents and teens who frequently engaged in a communication pattern known as "demand/withdraw" tended to have negative health outcomes such as poor self-esteem and drug use among the teens.

Demand refers to nagging or criticizing and withdraw means avoiding discussing issues that related to the other person's criticisms.

The study found teen drug use could be predicted by examining teen-parent discussions that weren't directly related to drugs.

Caughlin says this "suggests that communication patterns that are established for dealing with everyday conflicts may influence the way parents and adolescents deal with discussions of more serious issues like adolescents' health-risk behaviors."

While anti-drug campaigns focus on talking to children about drugs, discussions about other topics may also be crucial.

"In addition to such anti-drug conversations, it may be just as important to help parents and adolescents learn constructive strategies for dealing with conflicts regarding mundane issues," Caughlin says.

The study appears in the current issue of the Journal of Social and Personal Relationships.

More information

The U.S. National Institute on Drug Abuse has more about teens and drugs.

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No Health Risks Found Near Intel Plant –Study

 

Reuters

Friday, March 26, 2004

SAN FRANCISCO (Reuters) - An air quality assessment around an Intel Corp. factory in New Mexico found no evidence that chemicals in the air had caused health problems, though it did not rule out the possibility, New Mexico's Environment Department said on Friday.

The health risk assessment is the final piece of a 15-month study into complaints that fumes from an Intel factory were causing rashes, asthma and other ailments in residents of nearby Corrales.

Corrales, which has about 7,300 residents, is just north of Albuquerque, the state's largest city.

"This risk assessment did not find evidence that any of the measured or modeled chemicals are associated with increased acute or chronic health risks," the report stated. "It still remains possible that the health complaints of Corrales citizens are related to local pollutant emission sources."

The electronics industry has long attracted criticism from environmental activists, who have tied chemicals from electronics and computer chip plants to air and water pollution as well as workplace illnesses.

The Corrales study was funded by grants from the U.S. Environmental Protection Agency (news - web sites) and carried out by Gradient Corp., which relied on EPA risk assessment guidelines, the New Mexico Environment Department said in a statement.

The assessment will be combined with other data and included in a draft final report to be issued in April, the department said.

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Tricky Tumors

 

HealthDayNews

Friday, March 26, 2004

FRIDAY, March 26 (HealthDayNews) -- New insight into how cancer cells evade the body's tumor-fighting immune cells is reported in a study in the March issue of Cancer Cell.  

Researchers at the University of Buenos Aires in Argentina found that mouse and human melanoma cells secrete a molecule called galectin-1 (Gal-1), which has a negative impact on the survival of immune system T-cells.

The study also found that inhibition of Gal-1 dramatically reduces tumor formation in mice. Gal-1 is present in many different types of tumors, especially aggressive cancers such as prostate, colon and ovarian cancers and melanoma.

The study findings may help scientists develop more effective anticancer therapies.

"Our results show that Gal-1 contributes to immune privilege of tumors by modulating survival and/or polarization of effector T-cells, providing the first concrete evidence of a link between the immunoregulatory properties of this protein and its contribution to tumor progression," researcher Dr. Gabriel A. Rabinovich says in a prepared statement.

"More importantly, our data highlight a novel molecular target for manipulation of T-cell tolerance and cell death with profound implications for cancer immunotherapy," Rabinovich says.

More information

The National Cancer Institute (news - web sites) has more about the immune system.

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Changing Your Drinking Habits Changes Your Health

 

By Alison McCook

Reuters Health

Friday, March 26, 2004

NEW YORK (Reuters Health) - If you have kept up a healthy habit of having a glass of wine a day, stick with it: either stopping or upping your daily alcohol intake has adverse health effects, new research indicates.

There's plenty of evidence that drinking small amounts of alcohol may protect your heart, while drinking too much is linked to higher risk of health problems, including cancer.

Now, Danish investigators have found that people who switched their drinking habits experienced a corresponding change in their health.

For instance, former teetotalers who switched to a daily habit of light drinking experienced a decrease in their risk of dying of heart disease, while light drinkers who decided to abandon the practice experienced a slight increase in the risk of heart troubles.

Moreover, people who upped their regular intake of alcohol tended to show a higher risk of dying from cancer than people whose former habits remained unchanged.

"Our study tells us that increasing one's intake from nondrinking to light drinking decreases risk of coronary heart disease," while the reverse is also true, study author Dr. Morten Gronbaek told Reuters Health.

He added that just how long it takes for the health effects of a switch in alcohol intake to kick in remains unclear. However, he noted that the changes could take place in the body within "the area of weeks or months."

For their study, Gronbaek and his colleagues followed 14,654 adult residents of Denmark for an average of 10-1/2 years, noting how much alcohol they drank.

Nondrinkers were considered people who downed less than one drink per week, while between 1 and 6 weekly drinks was treated as light drinking. Anything up to 13 drinks were week was labeled moderate drinking, while more than 13 weekly drinks was considered to be a heavy habit.

The researchers found that people who went from being light drinkers to nondrinkers experienced an increased risk of dying from any cause, including a more than 40 percent increase in the risk of death from heart disease.

Light to moderate drinkers who developed a heavy drinking habit tended to show an increase in the risk of dying from cancer, while nondrinkers who decided to start having a couple of drinks per week showed a corresponding decrease in their chances of dying from heart disease.

Source: Epidemiology, March 2004.

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Not All Fruits, Vegetables Created Equal

 

HealthDayNews

Friday, March 26, 2004

FRIDAY, March 26 (HealthDayNews) -- Sure, you may be eating the recommended amount of fruits and vegetables each day.

But are you eating the ones that offer the best health benefits?

Most people aren't, says Susie Nanney, acting director of the Obesity Prevention Center at Saint Louis University.

"People aren't eating the fruits and vegetables that contain the most nutrients. People are quite frankly confused about nutrition. I feel their pain," Nanney says in a prepared statement.

Her research, published in the March issue of the Journal of the American Dietetic Association, shows that most Americans recognize a healthy diet should include at least five daily servings of fruits and vegetables.

But Nanney also found people aren't selecting the most nutritious fruits and vegetables because they're given conflicting information about which ones provide the greatest health benefits.

Nanny advises that the most popular fruits and vegetables -- corn, potatoes, iceberg lettuce, apples and bananas -- are not as rich in nutrients as other choices.

She offers the following color-coded suggestions for improving nutritional intake from fruits and vegetables:

 

More information

 

The American Dietetic Association offers food and nutrition information.

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Fetal Monitoring Fails to Detect Brain Injury

 

By Anthony J. Brown, MD

Reuters Health

Friday, March 26, 2004

NEW YORK (Reuters Health) - Monitoring the heart rate of a baby, which is typically performed during labor, is not useful in detecting brain injuries that lead to cerebral palsy, according to research presented Friday at a meeting in Houston.

This may explain why the rate of occurrence of cerebral palsy has not changed in nearly 50 years.

"Electronic fetal monitoring was introduced in the late 1960s and it was hoped that we could detect which babies were experiencing (low oxygen levels) during labor and then intervene," lead author Dr. Janyne Althaus, from Johns Hopkins University in Baltimore, told Reuters Health.

"Such monitoring gradually became standard of care," she explained, without ever being tested to see if it actually did help prevent cerebral palsy.

"In our study, we found no significant difference in any monitoring characteristics between infants diagnosed with brain injury...and healthy infants," Althaus noted. This suggests that "electronic fetal monitoring really can't tell us the status of the baby's brain."

The findings stem from a study of 40 brain-injured infants and 40 healthy infants born at one hospital between July 1999 and September 2001. Althaus presented her team's research at the annual meeting of the Society for Gynecologic Investigation.

As noted, no differences were seen between the groups in any monitoring parameter, including, among others, fetal heart rate, time spent with a fast or slow heart rate, and variation in the heart rate.

"Although these findings are somewhat discouraging, it's good for us to know the limitations of our technology," Althaus said. "The assumption has always been that fetal brain injury is something that should be easy to pick up. Apparently, it's not."

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Fetal Alcohol Syndrome Costs Soar

 

By Steven Reinberg
HealthDay Reporter

HealthDayNews

Friday, March 26, 2004

FRIDAY, March 26 (HealthDayNews) -- A new study puts a hefty price tag on caring for the victims of fetal alcohol syndrome (FAS), and that price is about 100 times higher than the cost of preventing the condition.

According to researchers, FAS accounts for more birth defects than Down syndrome, spina bifida and muscular dystrophy combined. About 40,000 children born in the United States each year are identified with FAS.

But since 95 percent of those with FAS go undiagnosed, there are many more affected each year, says lead researcher Dr. Larry Burd, director of the North Dakota Fetal Alcohol Center at the University of North Dakota School of Medicine and Health Sciences.

FAS can cause poor growth of the fetus and infant, decreased mental function, heart defects, abnormal facial appearance and deformity of the arms and legs. Other signs include delayed development, low IQ, and, in infants, tremors, agitation and crying.

Since there is no safe level of alcohol consumption, any drinking poses a risk for FAS. However, heavy drinking significantly increases the odds.

In their study, Burd's team reviewed studies that looked at the annual cost and the lifetime cost of caring for FAS victims.

They estimated the annual cost for all those with FAS at about $4 billion, and the lifetime cost for someone with FAS at about $3 million.

"If a state wanted to deposit in a bank enough money to take care of one of these people, they would need to deposit about $932,000, and the interest would pay for lifetime care," Burd says.

These costs include medical treatment, foster care, residential care due to mental retardation, special education services, incarceration and lost productivity.

By preventing just one case of FAS you could save almost $360,000 in the first 10 years and over $1 million over 30 years, they note.

Their findings appear in the March 22 issue of the American Journal of Medical Genetics.

"FAS is a preventable disorder," Burd says. "We are spending massive amounts of money on this problem, but we are spending very little money on prevention."

Right now, Burd says, there are too many women who are not screened for alcohol problems and too many who cannot get into alcohol treatment programs. "These women drink during pregnancy. Many of them have more than one affected child, because there is no money for prevention."

Burd believes that all pregnant women should be screened for alcohol use, and should be told to stop drinking. Women who can't stop need to be referred to an alcohol treatment program.

"The cost for treatment is less than 1 percent of what it is going to cost to take care of one affected child," he adds. "And that's just simply the money -- not the misery, the loss of a person and all the suffering."

Burd says women should not drink during pregnancy: "No amount of alcohol is safe."

"If we don't address this problem we are going to have at least 40,000 babies a year in the U.S. with preventable problems that we are going to take care of for the rest of their lives," Burd says.

"Nothing in this finding surprises me," says Dr. Susan Astley, an associate professor of epidemiology at the Center on Human Development and Disability and director of the Fetal Alcohol Syndrome Diagnostic and Prevention Network at the University of Washington.

"It's far more cost-effective to prevent FAS -- not only physically, but emotionally -- than to continue to intervene with the children after the damage has been done," Astley says.

The most effective prevention is treatment for women who are having problems with alcohol and birth control. "There's two ways to prevent FAS: one is the woman stops drinking; and the other is to avoid unplanned pregnancies," she adds.

Astley adds that FAS is not confined to low-income or certain racial groups. "Alcohol is an equal-opportunity teratogen [able to cause harm to the fetus]; it doesn't matter what race you are, what socioeconomic status you have, if you have a problem with alcohol, your child will be at risk for FAS."

More information

Learn about the disorder from the National Organization on Fetal Alcohol Syndrome, while the National Institute on Alcohol Abuse and Alcoholism can tell you about preventing FAS.

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Antibiotics Effective Against Uterus Inflammation

 

Reuters Health

Friday, March 26, 2004

NEW YORK (Reuters Health) - Antibiotics appear to be an effective treatment for endometritis, an inflammation of the lining of the uterus, new research suggests.

As well as supporting the antimicrobial treatment of subacute endometritis, results of the study indicate that prior pelvic inflammatory disease (PID) as well as current cervical infection are risk factors for endometritis.

Dr. David A. Eschenbach from the University of Washington in Seattle and colleagues analyzed uterus samples from 207 women at risk for endometritis. Thirty-seven (18 percent) patients had evidence of the condition, the researchers report in the American Journal of Obstetrics and Gynecology (news - web sites).

In this study, as in others, two common sexually transmitted infections--chlamydia and gonorrhea--were more common in women with than without endometritis.

However, a "new finding," according to the team, is that tissue evidence of endometritis was more common among women with prior pelvic inflammatory disease, a painful condition often associated with STDs.

In the treatment trial, women with endometritis received a variety of antibiotics for seven days.

After treatment, "significant reductions" occurred in abnormal bleeding, discharge, and tenderness. Moreover, tissue analysis showed an improvement in the endometritis.

Although the treatment results are "encouraging," the authors note that all subjects received antibiotics. Therefore, it's possible that the endometritis may simply have resolved on its own without antibiotics, they conclude.

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

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Embolization Bests Surgery for Fibroid Treatment

 

By Serena Gordon
HealthDay Reporter

HealthDayNews

Friday, March 26, 2004

FRIDAY, March 26 (HealthDayNews) -- A minimally invasive procedure called uterine fibroid embolization to treat fibroids provides faster recovery times and shorter hospital stays than surgery, a new study concludes.

"Women want options. They want to try to find a non-surgical answer that can provide relief from their horrible symptoms," says study co-author Dr. John Lipman, an interventional radiologist at Radiology Associates of Atlanta. "Uterine fibroid embolization is a non-surgical alternative that is safe and effective. It's a wonderful procedure for those who want to avoid surgery."

The study findings were presented March 26 at the Society of Interventional Radiology's annual meeting in Phoenix.

Fibroids are benign tumors that can grow in the lining, or in between the muscles, of the uterus or on the outside of the uterus. They can vary in size from very small -- about the size of an apple seed -- to as large as a grapefruit. Fibroids can cause pain, pressure, heavy menstrual bleeding or bleeding between periods, as well as infertility, frequent urination and pain during intercourse.

Almost 80 percent of women have fibroids, although many have no symptoms. About one in four women with fibroids will eventually seek treatment, according to the National Uterine Fibroids Foundation.

Treatment options include observation, hysterectomy (the surgical removal of the uterus), myomectomy and uterine fibroid embolization (UFE). In myomectomy, surgeons remove large fibroids individually. Uterine fibroid embolization is performed using a catheter threaded into the femoral artery. Tiny particles are then released into the blood vessels that feed the fibroids, cutting off their blood supply, which causes them to shrink.

In the current study, Lipman and his colleagues compared uterine fibroid embolization to myomectomy in 209 women from 16 medical centers across the United States.

Women who had UFE averaged only one day in the hospital, versus 2.5 days for women who had myomectomy. It took an average of 10 days for women who had UFE to return to work, while those who had myomectomy averaged 37 days before they returned to work. And women who had UFE were able to resume all of their normal activities an average of 29 days sooner than those who had myomectomy.

The researchers also found fibroid symptoms were reduced an additional 6 percent for women who had UFE.

Dr. Mark Werner, an obstetrician and gynecologist at William Beaumont Hospital in Royal Oak, Mich., says uterine fibroid embolization is "another tool that we can use to treat fibroids."

But, he says, it's not right for every woman. And women need to have realistic expectations going into the procedure because it doesn't destroy the fibroids, only shrinks them, he adds.

Werner says he wouldn't recommend UFE to women who want to get pregnant sometime in the future because the procedure can block blood flow to an ovary, and the procedure can cause early menopause.

Lipman says this is a small risk, and points out it's also a risk for women undergoing myomectomy.

Uterine fibroid embolization isn't available in every hospital yet, and Lipman suggests women go to a medical center where the physicians have already performed many procedures. He says anyone who is considered a good candidate for surgery can also be considered for UFE, and he says the procedure is covered by insurance companies.

Werner notes UFE can also be an option for women who aren't good surgical candidates, including those who have heart disease, diabetes or are obese.

More information

To learn more about fibroids and treatment options, visit the National Women's Health Information Center or the Society for Interventional Radiology.

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Molding Baby's Nose Can Cause Respiratory Distress

 

Reuters Health

Friday, March 26, 2004

NEW YORK (Reuters Health) - The cultural practice of applying pressure to the noses of newborns in order to alter their appearance, may lead to breathing difficulties, researchers report.

For more than a decade, a particular form of nasal obstruction "has been recognized as a cause of respiratory distress in infants," Drs. Hallam Hurt and Hema Murau, from the University of Pennsylvania, Philadelphia, explain in the Journal of Pediatrics. The reason for the obstruction has not been clear.

The researchers report on a case of respiratory distress that resulted from nasal molding in a boy born to an Egyptian woman. The baby did not undergo facial trauma or vigorous suctioning during delivery, but developed severe respiratory distress three hours after birth.

Mild swelling and a bluish discoloration were seen over the left side of the baby's nose.

When the parents were asked about the infant's condition, the father, with the help of a hospital-based interpreter, reported "molding" the infant's nose shortly after birth. Apparently pressure was applied to the bridge of the nose, to enhance the sharpness of the infant's profile.

The doctors examined the baby's nasal passages with an endoscope and saw significant inflammation and swelling, with nasal congestion on the left side. The abnormalities were similar to those typically seen in the recognized, but unexplained, obstructive syndrome.

Treatment with phenylephrine and antibiotics was begun. Respiratory distress decreased over the next 48 hours, although swelling increased. However, symptoms resolved over the next five days and the baby was discharged in good condition.

Hurt and Murau suggest that "care givers in culturally diverse populations should have heightened awareness" that some parents may be practicing nasal molding on their newborns.

Source: Journal of Pediatrics, March 2004.

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Walnuts a Smart Choice for Heart

 

By Amanda Gardner
HealthDay Reporter

HealthDayNews

Friday, March 26, 2004

FRIDAY, March 26 (HealthDayNews) -- Walnuts protect against heart disease, a small Spanish study contends.

"This is the first time a whole food, an intact food, has shown this effect," says Dr. Emilio Ros, lead author of research appearing in the March 23 online edition of Circulation. "This adds another piece of scientific evidence."

But others note the study, which was partially funded by the California Walnut Commission, was a small one and leaves several questions unanswered.

"This is promising preliminary evidence that walnuts as a foodstuff may have some interesting properties that help coronary disease, but it's too short-term and too limited in the number of patients," says Dr. Marc Siegel, a clinical associate professor of medicine at New York University School of Medicine in New York City.

Nuts have been shown to have heart-beneficial effects and, last summer, the U.S. Food and Drug Administration (news - web sites) allowed the California Walnut Commission to use a qualified claim on the nut's health properties. It reads, "Supportive but not conclusive research shows that eating 1.5 ounces per day of walnuts as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease." The FDA had previously decided that "there is not significant scientific agreement that walnuts may reduce the risk of CHD [coronary heart disease]."

Coronary heart disease affects an estimated 12.6 million Americans, making it the most common form of heart disease. CHD usually results from a condition known as atherosclerosis, which occurs when plaques or fatty substances form inside the arteries that supply blood to the heart.

Epidemiological studies, in particular, have shown that eating nuts on a frequent basis reduces the risk of coronary artery disease.

"These studies have shown that when you eat nuts more than five times a week, which means almost daily, you get a relative risk reduction of coronary heart disease close to 50 percent," says Ros, head of the Lipid Clinic at Hospital Clinic of Barcelona. "That's really an important reaction and not explained by cholesterol lowering."

To find out what other processes might be at play, Ros and his colleagues randomly assigned 21 men and women with high cholesterol levels to follow a Mediterranean diet or a similar diet in which walnuts replaced about one-third of the calories from olive oil, olives, avocadoes and other monounsaturated fats. No nuts other than walnuts were allowed in the Mediterranean diet.

Measurements revealed that the walnuts actually had a dual effect on heart health.

First, the walnut-laced diet increased the elasticity of arteries by 64 percent. Second, it reduced the level of molecules that can gum up blood vessels by 20 percent. It also decreased total and LDL ("bad") cholesterol levels.

It's not entirely clear why walnuts may have this beneficial effect. But, unlike other nuts, they do have high levels of omega-3 fatty acids that have healthful properties. Walnuts also contain the amino acid L-arginine and a form of vitamin E that may prevent vessel blockage, Ros says.

Is all this cause to up your walnut intake? While Ros sees no reason not to, Siegel is more cautious and cites some methodological limitations to the new study.

For one thing, Siegel says, the researchers looked specifically at the brachial artery (in the arm), which is not the same as the coronary artery (supplying blood to the heart). "Blood flow through one artery is not the same," Siegel says. "It might be predictive, but it's not identical."

Also, the researchers removed other monounsaturated fats from the diet. "What is the significance of removing that from the diet?" Siegel asks.

Finally, the duration of the trial could be a problem. "They're only looking at results over a four-week period of time, which is way too short to be drawing conclusions," Siegel says. "Walnuts are not well enough studied to say they're not bad for you."

More information

The American Heart Association (news - web sites) has more on eating for a healthy heart and more on different types of fats.

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New Virus Tied to Respiratory Infections

 

By David Douglas

Reuters Health

Friday, March 26, 2004

NEW YORK (Reuters Health) - Dutch researchers have identified a new virus in a 7-month old child hospitalized because of acute nasal discharge, conjunctivitis and fever.

Since it was discovered, the virus has also been found in other patients with respiratory ailments.

The virus belongs to the family of so-called coronaviruses. The researchers point out in their report in the science journal Nature Medicine that, previously, three coronaviruses were known to affect human, including the variety responsible for severe acute respiratory syndrome (SARS (news - web sites)).

Infection with the new coronavirus "is certainly not as serious as SARS," Dr. Ben Berkhout told Reuters Health, "and it does not kill people. But it seems to account for a significant number of respiratory tract infections that require hospitalization, and for which no viral cause can be identified."

Berkhout of the University of Amsterdam and colleagues identified the virus in nasal secretions from their young patient.

The complete genetic sequence of the virus indicated that it was not a mutation of an existing type, but rather a new group 1 coronavirus.

Screening of patients with respiratory illness over less than a year uncovered seven further cases. The patients ranged in age from 4 months to 72 years.

Such infection seems to be relatively common, the researchers conclude. However, further work "should yield a more accurate picture of the prevalence of this virus and its association with respiratory disease."

Source: Nature Medicine, advance online issue, April 2004.

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St. John's Wort Weakens Leukemia Drug

 

By Kathleen Doheny
HealthDay Reporter

HealthDayNews

Friday, March 26, 2004

 

FRIDAY, March 26 (HealthDayNews) -- St. John's wort, an herb often taken for mild depression, may interfere with the cancer-fighting ability of Gleevec, a drug prescribed for leukemia patients.

That's what University of Florida researcher Reginald Frye will tell his colleagues on March 27 at the American Society for Clinical Pharmacology and Therapeutics' annual meeting in Miami Beach.

Previously, St. John's wort has been found to disrupt the metabolism of other drugs, including a protease inhibitor used to treat HIV (news - web sites), and cyclosporine, a drug used to reduce the risk of rejection in organ transplant patients.

Frye and his research colleagues from the University of Pittsburgh, where he was previously on faculty, gave 12 healthy subjects, aged 20 to 51, a 400-milligram tablet of Gleevec on the first day, then gave them 900 milligrams of St. John's wort in three daily doses on days three to 17. On day 15, they again got 400 milligrams of Gleevec.

On the first day, they measured how fast Gleevec was eliminated from the body, to get a picture of normal metabolism. Those blood tests were repeated after taking St. John's wort.

"You need a particular concentration [of Gleevec] to prevent recurrence of the leukemia," Frye explains.

However, it turned out the herb interfered with the blood levels of the anti-cancer drug. "The blood concentration of Gleevec the second time they took it was 30 percent lower than the first time," Frye says. "By taking the St. John's wort, the concentration was below the ideal threshold for at least one third of the day."

With Gleevec at such low blood levels, cancer growth could recur, he adds.

Gleevec was granted approval in 2001 by the U.S. Food and Drug Administration (news - web sites) for the treatment of chronic myeloid leukemia (CML), gastrointestinal stromal cancer and pediatric leukemia. About 40,000 people in the United States have CML, according to the FDA.

According to Novartis Pharmaceuticals Corp., which makes Gleevec and funded the study, the anti-cancer drug disrupts the molecular process of CML. In patients with the disease, there is a constant signal that tells the body to keep making abnormal white blood cells. The signal comes about after a change in the person's DNA forms a chromosome called the Philadelphia chromosome. In turn, the chromosome creates an abnormal protein that tells the body to transmit the signal to keep making abnormal white blood cells. Gleevec is thought to work by preventing the abnormal protein from transmitting the message.

The finding isn't a surprise to Eric Yarnell, a naturopathic physician in Seattle and an adjunct faculty member at Bastyr University in Seattle. "It's certainly fitting in with the pattern we are seeing with St. John's wort," says Yarnell, referring to other reports of adverse effects when the herb is taken with other drugs.

"This is the 10th study I am aware of that concludes there are adverse effects of St. John's wort on the metabolism of other drugs," Yarnell says. Regarding the latest study, he says the small sample size is one potential drawback. "We really need to see more studies," he adds.

Yarnell prescribes St. John's wort and is involved with a botanical company that distributes it, along with hundreds of other botanicals. It's crucial, he says, to first find out which drugs a patient is taking to avoid adverse interactions with the herb and to avoid the herb if a problem is likely.

Frye agrees. "Either do not take St. John's wort or talk with your doctor or pharmacist and be sure they are aware of everything you are taking," he says.

More information

For more on leukemia, visit the American Cancer Society. To read a public alert on St. John's wort, visit the National Institute of Mental Health.

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Traffic Reduction May Lead to Fewer Stuffy Noses

 

By Amy Norton

Reuters Health

Friday, March 26, 2004

NEW YORK (Reuters Health) - A road bypass built to ease traffic congestion in one neighborhood appears to have relieved some residents' nasal congestion as well, a UK study has found.

A year after the bypass opened in an industrial town in North Wales, "heavy goods" traffic was down by nearly half in neighborhood streets that had previously been highly congested. And the people who lived there were reporting fewer episodes of runny nose, sneezing, and itchy, watery eyes, according to researchers.

Dr. Michael L. Burr of the University of Wales College of Medicine in Cardiff led the study. The findings appear in the March issue of the journal Occupational and Environmental Medicine.

Although significant air pollution is known to cause respiratory symptoms, the extent to which everyday traffic fumes contribute to asthma and allergies has been less clear, according to Burr's team.

Some studies have suggested that people who live near high-traffic roads are more prone to asthma and other respiratory illnesses, while other studies have failed to make such a connection.

The new research suggests that traffic reduction may offer more relief from nasal and eye symptoms than from the chest symptoms that mark asthma, according to Burr. "It suggests that nasal and eye symptoms are more sensitive responses to these pollutants than are lower respiratory symptoms," he told Reuters Health.

That's because although residents of the high-traffic area did report less wheezing and coughing a year after the bypass opened, so did a comparison group of people from nearby low-traffic streets. In fact, the improvement was greater in the latter group.

This suggests the bypass and the subsequent drop in traffic fumes are "unlikely" to be the reason for the fall in chest symptoms, according to Burr and his colleagues. They speculate that other factors, such as a change in weather patterns or rates of respiratory infections, were at work.

Still, Burr said he would expect that had the traffic reduction been greater, the benefit for residents' respiratory health might have been as well.

For the study, his team surveyed 165 residents of congested streets and 283 residents of low-traffic streets about one year before and one year after the bypass opened. The researchers also measured traffic congestion and air pollution at each time point.

They found that after the bypass opened, fewer cars, vans and commercial vehicles clogged the streets of the congested area, and there was less particulate matter polluting the air. The non-congested streets also saw a drop in traffic and air pollution, though a smaller one.

Residents in both areas reported fewer allergy-like symptoms such as runny nose, sneezing and itchy, watery eyes, but those on the once heavily traveled streets had a more significant improvement.

Given these findings, Burr's team concludes, future projects to ease traffic congestion should also include plans to monitor the health effects.

Source: Occupational and Environmental Medicine, March 2004.

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Thursday, March 25, 2004

 

US Panel Urges Vigilance in Medical Tests for Kids

 

Reuters

Thursday, March 25, 2004

WASHINGTON (Reuters) - U.S. government advisers on Thursday encouraged increased medical studies on children but said federal rules protecting the young from risky or unethical medical experiments needed to be extended.

An Institute of Medicine (news - web sites) panel said the government should provide better guidance on the rules to medical researchers and those who oversee them.

"Involving more children in clinical research today will benefit the health and well-being of countless children in the future, but unlike most adults, children usually lack the legal right and the intellectual and emotional maturity to consent to research participation on their own behalf," committee chair Richard Behrman said in a statement.

"Their vulnerability demands additional protections beyond those provided to mentally competent adults," added Behrman, a professor of pediatrics at both the University of California, San Francisco and George Washington University in Washington.

Because it is such a delicate issue, most drugs that are prescribed to children are not tested on them. The effects can often be different to what they are in adults.

Doctors must either assume that a child gets a proportionately smaller dose or simply not prescribe drugs to children that have only been tested in adults.

Current federal rules on testing drugs in children apply mainly to studies that are paid for by the U.S. Department of Health and Human Services (news - web sites) or regulated by the FDA (news - web sites).

The Institute, an arm of the private, non-profit National Academy of Sciences (news - web sites) which advises the federal government on medical and health matters, said the safety rules needed to be extended to cover private sector research and research not funded by the government.

"It is not acceptable for research to expose children to higher levels of risk simply because they are already imperiled by illness, unsafe neighborhoods, or other aspects of their daily lives," the Institute said.

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Broader Rules Urged for Child Research

 

By Randolph E. Schmid

Associated Press Writer

The Associated Press

Thursday, March 25, 2004

WASHINGTON - With increasing emphasis put on medical research involving children, the government is being urged to broaden and clarify its rules designed to protect youngsters from risky or unethical studies.

While current regulations cover research that receives federal funding, the prestigious Institute of Medicine (news - web sites) said Thursday those rules should be extended to cover all pediatric studies.

Physicians are allowed to prescribe medicines approved for adults to children, but a lack of studies in children has meant they were often forced to estimate an appropriate dose for youngsters of various sizes and ages.

That resulted in the deaths of some newborns whose livers were unable to process an adult antibiotic. In another case it was discovered that children needed a larger dose than adults of another medicine because it passed through their bodies faster than it did adults.

Children are not just small adults, said Dr. Charles Prober of the Elizabeth Glaser Pediatric AIDS (news - web sites) Foundation.

"Children are physiologically different than adults, they are developing day by day and year by year and you cannot extrapolate" the dose needed, Prober said.

Prober said many research centers follow federal ethics guidelines voluntarily, and welcomed the IOM report because it stresses the need for more research involving children.

Richard E. Behrman, chairman of the Institute committee that prepared the report, said "involving more children in clinical research today will benefit the health and well-being of countless children in the future.

"But unlike most adults, children usually lack the legal right and the intellectual and emotional maturity to consent to research participation on their own behalf," said Behrman, executive chair of the Pediatric Education Steering Committee of the Federation of Pediatric Organizations.

The Institute report urges the government to provide better guidance to help review boards interpret the federal rules, which are more restrictive for children than adults. In turn, review boards studying whether to allow research should be more thorough and explicit in judging whether research involving children meets the highest ethical and scientific standards, the report said.

In general, rules aimed at protecting people in research trials require that the risks to participants be minimized, that risks be outweighed or balanced by anticipated benefits, that research participants be equitably recruited and that investigators obtain informed consent from them.

The rules call for parents or guardians to grant permission before children can participate in research and they say that, when appropriate, researchers should seek from children themselves their agreement to participate in clinical studies.

When considering the risks from an experiment, the report said, the review board should compare it with the risks that are normally encountered by healthy, average children. That doesn't mean, the report said, that it is acceptable to expose a child to a higher risk merely because the youngster is already threatened by illness or by living in an unsafe neighborhood.

The report also said that it is permissible to reimburse families for expenses related to research, such as parking fees at research facilities, and to give token gifts of appreciation. But it is never acceptable to offer higher payments for enrolling children in more risky research, the report said.

In an effort to increase participation by children in research studies some institutions have offered youngsters gift certificates at toy stores and others provide payments to families ranging from $200 to $1,000.

On the Net:  

Institute of Medicine: http://www.iom.edu

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Circumcision Seen as Method to Block HIV Infection

 

Reuters

Thursday, March 25, 2004

LONDON (Reuters) - Circumcised men are less likely to be infected with the virus that causes AIDS (news - web sites) because of biological reasons and not less risky behavior, scientists said on Friday.

Studies have shown that men whose foreskin has been removed are six to eight times less likely to become HIV (news - web sites) positive but there has been some debate about the reason for the lower infection rate.

Researchers at Johns Hopkins University Medical School in Baltimore, Maryland found that circumcision had a protective effect against HIV, but not against other sexually transmitted infections (STIs) such as syphilis or gonorrhoea.

"The specificity of this relation suggests a biological rather than behavioral explanation for the protective effect of male circumcision against HIV," Dr Robert Bollinger said in a report in The Lancet medical journal. Although male circumcision is common in the United States, the practice varies throughout the world and is influenced by cultural and religious attitudes.

Bollinger and his team studied men in India, where circumcision is not common, between 1993 and 2000. All of the 2,298 men were attending one of three sexually transmitted disease clinics and were HIV negative at the start of the study. Their HIV status and risk behavior were assessed regularly.

"These data confirm previous findings that male circumcision reduces the risk of HIV acquisition," said Bollinger.

Because circumcision did not prevent the men from infection with other STIs, Bollinger believes the study supports the hypothesis that protection is due to the removal of the foreskin, which contains cells that have HIV receptors which scientists suspect are the primary entry point for the virus into the penis.

"Our results suggest that the foreskin has an important role in the biology of sexual transmission of HIV," he said.

Some researchers have recommended male circumcision as a means to prevent the spread of HIV. Bollinger and his team called for clinical trials, where culturally acceptable, to assess the safety and effectiveness of male circumcision as a toll against AIDS.

They also stressed the need for new compounds to block the entry of the virus into the cell.

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High Schools Struggling With Steroid Use

 

By Rob Gloster

AP Sports Writer

The Associated Press

Thursday, March 25, 2004

SACRAMENTO, Calif. - High schools nationwide are struggling with rising steroid use, not just among football linemen battling for college scholarships but also among non-athletes who think bigger biceps will make them more popular.

Most schools cannot afford the costly tests for detecting illegal bodybuilding drugs. Even those that test for marijuana and cocaine do not check for steroids, which are potentially more destructive.

"For a small district to do this kind of testing would be cost-prohibitive," said Joseph Wilimek, school superintendent for Angels Camp.

At Bret Harte High School in Angels Camp, all student-athletes and cheerleaders take urine tests for marijuana, cocaine and other illegal drugs each season, costing the district about $9,000. Checking for steroids would cost an additional $44,000.

That would be enough money to pay for another teacher, Wilimek said. "Right now our priority is keeping staff — we've had to lay off three teachers and reduce our administrative staff already," he said.

Steroids soared in popularity among high school students — girls and boys — after Mark McGwire hit a major league-record 70 home runs in 1998 while using the supplement androstenedione, a steroid precursor.

In a recent national survey of steroid use, 3.5 percent of high school seniors responding reported they have used steroids at least once, up from 2.1 percent in 1991.

Those figures do not include users of over-the-counter supplements such as andro or the more popular creatine, which are much cheaper than steroids.

"There was a big increase when Mark McGwire broke the home run record. Of course he was using andro, but that may have been a distinction lost on a lot of the kids," said Lloyd Johnston, who led the University of Michigan survey of 50,000 teenagers. "If you're looking at a classroom of 30 boys, one of them is using steroids."

Johnston said steroid use is more prevalent among boys than girls, among whites than blacks and among non-college-bound students than those who plan to attend college. Many of the high school kids who use them are apparently non-athletes simply hoping to appear more buff.

Steroid use appears to be much higher in some parts of the country, particularly the South. In a 2001 survey by the Centers for Disease Control and Prevention (news - web sites), 11.2 percent of Louisiana high school boys surveyed reported using steroids, and 5.7 percent of Tennessee high school girls did.

Steroids' side effects can include heart disease, liver damage and rage. They can also stunt growth, shrink testicles and cause girls to grow facial hair.

Many high schools use an NCAA (news - web sites)-approved test for marijuana, cocaine, amphetamines and methamphetamine that costs about $22, plus collecting and handling expenses. But a steroid test costs $50 to $100, not counting collecting and handling.

Few school districts are willing to spend that kind of money.

In Florida, state Rep. Marcelo Llorente wants high school athletes to undergo mandatory testing for steroids. His bill, which would require each county to randomly test at least 5 percent of its athletes, was approved unanimously this week by a legislative subcommittee.

To reduce the cost, Llorente wants the tests to be done for about $33 each by the University of Florida veterinary laboratory that now tests samples from horses and greyhounds.

"I played three sports in high school and had the opportunity to play Division I baseball," said Llorente, who attended Tulane University. "I knew people who used performance-enhancing drugs. Young people don't understand the drastic consequences of using steroids."

In California, state Sen. Jackie Speier has introduced legislation to ban the sale of supplements such as andro to teens. She convened a Senate hearing Thursday to focus on the possibility of state-mandated testing and other ways to fight high school use of steroids and supplements.

"We teach kids not to take candy from strangers, but how many know not to take performance-enhancers from their friends and mentors?" she asked.

Among those testifying at the hearing was Kevin Will, 16, a junior quarterback at Del Oro High in Sacramento. He said coaches have warned the team not to use cocaine or marijuana, but he was never told not to use steroids.

And while he was never pressured by coaches to use steroids, he said, "I was told by friends and coaches I can play on the college level, but I have to get bigger." Will, who is 6 feet tall and weighs 168 pounds, said he has never taken steroids.

One of the few school systems checking for steroids is the relatively wealthy Paradise Valley district in Phoenix, where random tests have been conducted since 1992. The $50 tests are administered to students involved in everything from football to cheerleading and badminton.

Students participating in sports must sign a drug-testing consent form. Positive tests result in a suspension of 18 weeks from the sport for a first offense and a permanent suspension for a second offense. Results are not shared with law enforcement officials.

"The additional cost of testing for steroids is well worth it if we can protect our kids," district spokeswoman Judi Willis said. "We also believe the fact that we do this testing has been a deterrent."

John Walters, director of the White House Office of National Drug Control Policy, said federal officials are monitoring developments in states such as Florida and California — and stressed that pro athletes need to set good examples for kids.

"High school athletes are in some cases being sent the message that if you want to be at the peak of performance that you are going to have to consider using these substances, and maybe using them early," Walters said Thursday by telephone from St. Louis.

"When professional athletes set a bad example by using chemicals to cheat, by using steroids to enhance their performance while harming their health, they encourage young people to copy this."

On the Net:

Youth Risk Behavior survey: http://www.cdc.gov/mmwr/PDF/SS/SS5104.pdf

Monitoring the Future survey: http://www.monitoringthefuture.org

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FDA Finds Cancer-Risk Acrylamides in More Food

 

By Maggie Fox, Health and Science Correspondent

Reuters

Thursday, March 25, 2004

WASHINGTON (Reuters) - Acrylamide, a cancer-causing substance that caused scares when it was found in fried potatoes and other popular foods, is also found in olives, prune juice and teething biscuits, U.S. regulators said on Thursday.

The U.S. Food and Drug Administration (news - web sites) released figures on a new batch of food it tested and confirmed earlier findings that suggest cooked and especially fried snacks contain the highest levels -- potato chips, pretzels and popcorn.

To their relief, officials found no acrylamides in infant formula but said they would continue looking as it is a sole source of food for so many babies.

Scientists stress that they have no idea what any of this means, yet, for human health.

Acrylamide is naturally formed in some starchy foods when they are fried, baked, or roasted at high temperatures. No one suspected it was so pervasive in food until Swedish scientists announced they had found it in 2002.

"To date, acrylamide is known to cause cancer and reproductive problems in animals at high doses and is a neurotoxin in humans at high doses," the FDA said in a statement.

"Although initial reports of acrylamide's presence in some foods raised concerns because of possible links with increased risk of cancer in some laboratory animals, it was largely unknown how pervasive it was in the food supply, and its true public health significance for humans," the FDA added.

"Based on the current understanding of the science, FDA continues to advise consumers to eat a balanced diet, choosing a variety of foods that are low in trans- and saturated fat and rich in high fiber grains, fruits and vegetables."

Trans-fats are created when fat is processed and clog the arteries like cholesterol does.

Testing Popular Foods

To find out how much acrylamide people might be eating, the FDA has been testing popular food products. For its latest sample the FDA bought 750 different foods from bread to pancake syrup.

It found no acrylamide in the processed cheeses, milk and ice cream tested. Relatively high levels were found in arrowroot cookies -- commonly given to small children -- teething biscuits, sweet potatoes and lower levels in some prepared meals such as turkey and vegetable dinners.

Other childhood favorites such as peanut butter and chocolate chip cookies were also sources.

Home-cooked meats seemed acrylamide-free but fried chicken and fast-food chicken nuggets contained the compounds.

Fresh fruits and vegetables seemed clear but bottled prune juice and black olives had relatively high levels of acrylamides.

The FDA says it plans more studies on just how toxic acrylamides may be.

In June a team at the City of Hope National Medical Center in Duarte, California, found that acrylamides can mutate DNA.

Experts say the best way to find out if acrylamide causes cancer in people is to do epidemiological studies -- studies of populations to see if people who eat more foods containing acrylamides have higher rates of cancer.

One such study, published by U.S. and Swedish researchers in January 2003, found no link between acrylamide consumption and the risk of bladder or kidney cancer.

But a consumer group, the Center for Science in the Public Interest, is lobbying for limits on acrylamide in food.

Rhona Applebaum, Executive Vice President of the National Food Processors Association, argued this would not be necessary.

"FDA's research on acrylamide levels in various foods is neither a warning to consumers nor a finding of risk associated with any particular foods or individual brands," she said in a statement.

More FDA data can be found on the Internet at

http://www.cfsan.fda.gov/~lrd/pestadd.html#acrylamide.

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Fructose Sweetener Linked to Obesity Rise

 

By Steve Hartsoe

Associated Press Writer

The Associated Press

Thursday, March 25, 2004

RALEIGH, N.C. - Researchers say they've found more evidence of a link between a rapid rise in obesity and a corn product used to sweeten soft drinks and food since the 1970s.

The researchers examined consumption records from the U.S. Department of Agriculture (news - web sites) for 1967-2000 and combined it with previous research and their own analyses.

The data showed an increase in the use of high-fructose corn sweeteners in the late 1970s and 1980s "coincidental with the epidemic of obesity," said one of the researchers, Dr. George A. Bray, a longtime obesity scientist with Louisiana State University System's Pennington Biomedical Research Center. He noted the research didn't prove a definitive link.

"Body weights rose slowly for most of the 20th century until the late 1980s," Bray said. "At that time, many countries showed a sudden increase in the rate at which obesity has been galloping forward."

The study is being published in the April issue of the American Journal of Clinical Nutrition (news - web sites).

But spokesmen with the food and beverage industry and a leading critic of fast food both said weight gain would be a problem even if the sweetener didn't exist.

"It's not about the high-fructose corn syrup being a part of foods, it's about how many calories we're eating against how many calories we're burning," said Alison Kretser, a registered dietitian and director of scientific and nutrition policy for the Grocery Manufacturers of America. Its members include The Coca-Cola Co., Kellogg Co. and Sara Lee Corp.

Obesity among American adults climbed from 23 percent in the early 1990s to 30 percent today, according to the U.S. Department of Health and Human Services (news - web sites). And two-thirds of Americans are overweight. That means increased risks for heart disease, diabetes and certain cancers.

The debate over high-fructose sweeteners centers on how the body processes sugar. Unlike glucose, a major component in table sugar, fructose doesn't trigger responses in hormones that regulate energy use and appetite. That means fructose is more likely to be converted into fat, the researchers said.

The sweeteners are also cheaper to produce and use in food manufacturing than cane and beet sugars, the study noted.

The report, which says more study is needed, also lays blame on people for eating more and exercising less.

Kretser said studies on how the body digests the fructose corn sweetener are inconclusive because they were done on animals.

Companies are responding to the rise in obesity by adding more nutritious sweeteners to products, such as diet sodas, and returning to smaller containers, she said.

Barry M. Popkin, a professor of nutrition at the University of North Carolina at Chapel Hill who worked on the study, said he believes a third to half of the increase in calorie intake since the 1970s comes from soft drinks and fruit drinks.

Their report says more than 132 calories a day consumed by Americans age 2 and older come from corn sweeteners.

"We cannot increase our physical activity enough to offset the extra 200 calories a day Americans are consuming," he said.

Michael Jacobson, executive director of the Center for Science in the Public Interest, a consumer advocacy group, said there's no nutritional difference in the soft drinks sweetened with table sugar, or sucrose, decades ago and those sold today with high-fructose corn sweeteners.

He said either blend would contribute to a fat problem because of the increase in container sizes and the mass distribution of soft drinks.

Jacobson, a microbiologist and leading critic of the food industry, also called the study erroneous.

"The authors of this paper misunderstand chemistry, draw erroneous conclusions and have done a disservice to the public in generating this controversy," he said.

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Drug Overdoses Fuel Jump in U.S. Poisoning Deaths

 

By Paul Simao

Reuters

Thursday, March 25, 2004

ATLANTA (Reuters) - Illicit use of heroin, cocaine and other drugs helped fuel a dramatic rise in the number of accidental and unexplained poisoning deaths in the United States, health researchers said on Thursday.

The fatality rate from poisoning, excluding suicides and murders, rose an average 145 percent between 1990 and 2001, according to data collected by 11 states and published by the Centers for Disease Control and Prevention (news - web sites).

Narcotics and hallucinogens accounted for 51 percent of these deaths.

Catherine Sanford, an official with the North Carolina Department of Health and Human Services (news - web sites) and one of the authors of the study, said the troubling data highlighted a clear and common message.

"If you use drugs for recreation, there is a good chance you will die," said Sanford, who added that misuse of sedatives, pain killers and other legitimately prescribed drugs also contributed to the poisoning fatality trends.

She stressed that this finding did not indicate a need to restrict legally prescribed drugs, especially if they were used to control chronic pain or treat patients in substance abuse clinics.

There were 22,242 poisoning deaths in 2001 in the United States, 63 percent of which were unintentional. The overall death rate from poisonings -- either intentional or unintentional -- rose 56 percent between 1990 and 2001.

Poisonings cost the nation untold billions every year in medical costs and lost productivity. A 1997 study put the cost at about $925 per incident.

Researchers could not explain why Americans between the ages of 45 and 54 posted the biggest increase -- a 359 percent rise -- in unintentional poisoning fatalities during the 1990-2001 period.

Equally puzzling was the discovery that the rate of increase among women was almost double that of men in Colorado, Delaware, Florida, Kentucky, Massachusetts, New Mexico, North Carolina, Oregon, Utah, Washington and Wisconsin.

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Eight Glasses of Water a Day

 

HealthDayNews

Thursday, March 25, 2004

(HealthDayNews) -- While you know that drinking lots of water is good for you, getting the

The key is to develop a daily routine, according to the State of Kansas:

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Study: Food-Poisoning Parasite Can Evade Drugs

 

Reuters

Thursday, March 25, 2004

WASHINGTON (Reuters) - A genetic analysis of a potentially deadly parasite that is a major cause of food poisoning has shed light on why the bug is so hard to treat, U.S. researchers reported on Thursday.

A team at the University of Minnesota has mapped the DNA of the Cryptosporidium parvum parasite, which can cause veterinary as well as human-health problems, and found it has a few tricks that help it evade drugs.

"Despite intensive efforts over the past 20 years, there is currently no effective therapy for treating or preventing C. parvum infection in humans," the researchers write in an online advance version of their report in the journal Science.

"This is a horrible, hard-to-treat condition, largely because we lack a basic understanding of the genetic makeup of the organism," Mitchell Abrahamsen, who led the study, added in a statement.

Their study shows the parasite is missing many of the structures that current drug therapy targets. Without a target, the drugs are worthless.

"We now realize that many of the conventional anti-parasitic drugs that have been used in an attempt to treat infected individuals have failed because the biochemical targets of the drugs are absent in C. parvum," Abrahamsen added.

But they found some genetic weaknesses that could be exploited by drug developers. The weak points look like they were originally plant or bacteria genes, and they might be so different from any human genes that they could safely be targeted by new drugs, they said.

Cryptosporidum is spread through feces of infected hosts and causes sometimes severe diarrhea in humans and animals.

Most people with healthy immune systems recover after several days of misery. But the very young, very old and those with suppressed immune systems such as AIDS (news - web sites) patients can become severely ill and even die.

It is also a veterinary problem. Cryptosporidium infection can cause newborn calves to die of diarrhea.

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Tai Chi Tames Chronic Health Conditions

 

HealthDayNews

Thursday, March 25, 2004

THURSDAY, March 25 (HealthDayNews) -- The ancient Chinese practice of Tai Chi appears to improve balance, flexibility and cardiovascular health in people with such chronic health problems as heart failure, hypertension, arthritis and multiple sclerosis.

So says a review article by researchers at Tufts-New England Medical Center in Boston.

They analyzed 47 studies that examined the health effects of Tai Chi in patients with various chronic health conditions.

"Overall, these studies reported that long-term Tai Chi practice had favorable effects on the promotion of balance control, flexibility and cardiovascular fitness and reduced the risk of falls in elders," the authors write.

Cardiovascular and respiratory function improvements were noted in healthy people and those who had undergone coronary artery bypass surgery as well as people with heart failure, hypertension, acute myocardial infarction, arthritis and multiple sclerosis.

"Benefit was also found for balance, strength, and flexibility in older subjects; falls in frail elderly subjects; and pain, stress and anxiety in healthy subjects," the authors write.

They add the actual ways that Tai Chi provides these benefits are not well known.

The article appears in a recent issue of the Archives of Internal Medicine (news - web sites).

More information

The Arthritis Foundation has more about Tai Chi.

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Common Cervical Cancer on the Decline in U.S. Women

 

Reuters Health

Thursday, March 25, 2004

NEW YORK (Reuters Health) - The rate of a common type of cervical cancer called invasive squamous cell carcinoma (SCC), continues to fall among US women, but the same cannot be said for another type, known as invasive adenocarcinoma, new research indicates.

Dr. Sophia S. Wang and colleagues, from the National Cancer Institute (news - web sites) in Bethesda, Maryland, used a national database to calculate rates for cervical cancer diagnosed between 1976 and 2000 by subtype and disease stage, as well as by race and age.

More than 27,000 cancers were diagnosed during that period, with 19,703 cases of SCC and 3,895 cases of adenocarcinoma.

The investigators report in the journal Cancer that the "overall incidence of invasive SCC declined over time," and the majority of tumors that are detected are relatively early cancers in young women.

The sharp increase in early SCC cases noted in the early 1990s likely reflects a culmination of events including changes in disease classification, improvements in treatment, and screening, the team reports.

Rates of early adenocarcinoma also increased during the study period, especially in young women, again due to better screening; however, this has not yet translated into a decrease in more advanced cases, according to Wang and colleagues.

Source: Cancer, March 1, 2004.

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Do Solid Foods Induce Allergies in Infants?

 

HealthDayNews

Thursday, March 25, 2004

THURSDAY, March 25 (HealthDayNews) -- There's conflicting evidence about the concept that delaying solid foods for infants reduces the risk of childhood allergies, says research in the current issue of Archives of Disease in Childhood.

One study included 257 infants who were born prematurely. It found that early introduction of at least four solid foods, by or before 17 weeks of age, was associated with a threefold greater risk of eczema by the time the infants were 1 year old.

The study found boys were at greater risk than girls for this association.

A second study, which included 642 children who were monitored until they were 5.5 years old, found that late introduction of solid foods did not protect the children against wheezing, allergic reactions or eczema.

The study also found little evidence of an association between feeding practices and the development of asthma.

More information

The American Medical Association has more about allergies.

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Anti-Clotting Effect of Aspirin Wanes Over Time

 

Reuters Health

Thursday, March 25, 2004

NEW YORK (Reuters Health) - Aspirin is widely used to prevent platelets in the blood clumping together and forming clots, but physicians in Rome report that aspirin's anti-platelet action declines with prolonged treatment.

However, this is not seen with another anti-clotting drug called ticlopidine, also known as Ticlid.

Previous research has suggested a progressive decrease in aspirin's clinical efficacy after two years of treatment, Dr. Fabio M. Pulcinelli and his associates explain in the Journal of the American College of Cardiology. To investigate further, the research team at the University "La Sapienza" monitored blood samples from 150 patients for two years after they started anti-platelet treatment.

In the lab, the maximal percentage of platelets that could be made to clump together decreased from 88 percent at the start of the study to 38 percent after two months. Thereafter, clumping increased progressively to 46 percent at 6 months, 48 percent at 12 months and 62 percent at 24 months.

In contrast, in a group of 80 similar patients, the anti-platelet effects of ticlopidine did not change significantly during two years of treatment.

The authors point out that other researchers have observed a reduction in cardiovascular events when treatment with aspirin was combined with clopidogrel, another anti-platelet agent.

"Future studies should therefore address the question of whether the superiority of such a combination is dependent on a more complete and efficient inhibition of platelet aggregation or on a protective effect provided by clopidogrel in patients with a progressively reduced sensitivity to aspirin," Pulcinelli's team concludes.

Source: Journal of the American College of Cardiology, March 17, 2004.

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Liver Regrowth Slower in Organ Donors

 

HealthDayNews

Thursday, March 25, 2004

THURSDAY, March 25 (HealthDayNews) -- People who receive partial liver transplants have quicker liver growth than donors do after the procedure, says a University of Minnesota study in the March issue of Liver Transplantation.

While both donors and recipients of partial liver transplants have rapid liver regeneration in the months following their surgeries, recipients do it more quickly, the study says.

Researchers studied 70 patients involved in liver transplants -- 24 were living donors (right hepatic lobe), 24 were correlated recipients and 22 were recipients of partial livers from deceased donors.

Three months after their transplants, the 65 surviving participants had computed tomography (CT) scans to determine the extent of their liver regeneration.

"What was interesting in our study was that recipients tended to have a greater increase in liver volume as compared with living donors. The liver of living donors seemed to regenerate at a less vigorous pace, as compared with recipients, and may not be as complete," the study authors write.

Compared to post-transplant measurements, recipients had a 2.2-fold increase in liver volume three months after transplant, while living donors had a 1.8-fold increase. Recipients' livers regenerated to 100 percent of their ideal liver volume, compared with 78 percent among donors.

The study authors note that living donors' liver function was usually completely normal within a week of the operation. So their lesser liver volume relative to the calculated ideal may not be clinically significant, the researchers say.

More information

The American Liver Foundation has more about liver transplant.

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Kids Who Avoid Milk Risk Broken Bones

 

By Amy Norton

Reuters Health

Thursday, March 25, 2004

NEW YORK (Reuters Health) - Children who shun milk and don't get enough calcium-rich substitutes may face an increased risk of breaking a bone, according to a new report.

In a study of 50 children considered "milk avoiders," researchers found that 16 suffered at least one bone fracture by the age of nine. And regardless of whether they broke a bone, these children tended to have inadequate calcium intakes and low bone density, according to the report in the Journal of the American Dietetic Association.

Calcium, along with vitamin D and other nutrients, is essential for building and maintaining strong bones. In the U.S., health officials recommend dairy products as the primary source of calcium, but other sources include fortified soy milk and orange juice, leafy green vegetables and supplements.

The children in this study, however, were not getting calcium-containing milk substitutes, lead author Dr. Ailsa Goulding of the University of Otago in Dunedin, New Zealand, told Reuters Health.

Overall, half of the children did not drink milk because of symptoms such as stomach upset or skin irritation. In other cases, though, the children disliked the taste of milk, or their families simply didn't buy it.

Goulding pointed out that many milk avoiders might "happily" drink soy milk, or be willing and able to consume flavored cow's milk, cheese or yogurt. She advised that parents of children who can't or won't drink milk get help from a health professional to figure out how to best meet their children's needs for calcium, protein and other nutrients.

"The important point," Goulding explained, "is that milk and dairy products do supply very important nutrients to children, and if no substitutions ... are offered, the children who avoid milk may be missing out."

In their report, she and her colleagues also point to the importance of regular exercise, which helps build bone, and getting enough time outdoors to boost the body's synthesis of vitamin D from exposure to sunlight.

Of the 50 children in the study, 16 suffered a total of 22 bone fractures, mostly due to "minor trips or falls incurred during play," according to Goulding's team. The forearm was the most common fracture site, and most of the kids who broke their forearms were overweight.

In fact, nearly half of the milk avoiders -- 22 -- were overweight, and the combination of low bone density and high body mass probably contributed to the children's fracture risk, the researchers note. Some past studies have suggested that low-dairy, low-calcium diets are related to heavier body weight.

The current study received funding from New Zealand Milk, as well as government funds from the Health Research Council of New Zealand.

Source: Journal of the American Dietetic Association, February 2004.

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Public Confused on Cholesterol, Cancer Screening

 

By E.J. Mundell
HealthDay Reporter

HealthDayNews

Thursday, March 25, 2004

THURSDAY, March 25 (HealthDayNews) -- Is cholesterol screening only for folks over 40? What does the Pap smear test for, anyway? Don't feel odd if you don't know the answers: neither does a large percentage of Americans surveyed in a recent Gallup poll.

Most people aren't getting tested, either. While 98 percent of those polled believe screening for cancer or cholesterol does save lives, a much smaller percentage actually go out and get the tests, according to the survey, which further found that doctors aren't urging people to get tested.

"We've got some work to do," says Dr. Paula Szypko, a spokeswoman for the College of American Pathologists, which sponsored the poll. "We need to not only educate our public about what needs to be done, but push them to try and go ahead and get screenings."

The findings were released March 24.

Telephone interviews with nearly 1,500 U.S. adults in late 2003 uncovered serious misconceptions about several common tests aimed at the early detection of disease, pollsters report.

First of all, there seems to be a serious "age gap" in cholesterol screening awareness. While most adults over 40 now get their blood cholesterol checked regularly, most under 40 do not -- even though experts advise that all individuals over 20 get tested every five years.

Moreover, 42 percent of men and 29 percent of women under 40 think they need never get the test, the survey found.

As early as adolescence, blood cholesterol levels are linked "to the development of vascular disease in young and middle-aged adults," warns Dr. Michael S. Lauer, a heart expert with the Cleveland Clinic Foundation. "So the argument is made that by knowing cholesterol levels at a young age, one can potentially change lifestyle habits that might be of benefit later on down the line."

But are doctors prompting younger patients to get tested? When asked by pollsters whether their doctor had suggested getting a cholesterol test, 71 percent of men under 40 and 67 percent of women under 40 replied "no."

Lauer isn't surprised by the finding. "From the point of view of many doctors, as well as patients, they'd say, 'At this point in my life the risk is very low, so is it really critical that we have to check this right now?'"

But while high cholesterol in youth may not pose an immediate threat, Lauer believes for some high-risk individuals -- the obese, diabetics and those with a family history of early heart disease -- it's important to get checked regularly.

The American public seems confused when it comes to tests for colon cancer as well. Even though 91 percent of men over 50 said they knew they should undergo some form of colon cancer screening, just 54 percent had ever done so, according to the poll.

Current guidelines recommend that all men and women aged 50 and over get stool-based screening annually and undergo full colonoscopy once every 10 years, to check for precancerous polyps in the colon.

"A lot of people said they just did not have time" for screening, Szypko says. "They just hadn't gotten round to it." Many others may have an exaggerated idea of the trauma involved in colonoscopy. "It's done under sedation," Szypko points out, "and people that have it done really don't think it's a big deal -- and it can save your life."

Advocates for mammography got better news from the poll. Seventy percent of women over 40 -- the recommended age at which to begin screening -- said they did, in fact, get a mammogram every year. Many were confused, however, regarding the age at which such screening should begin, with 53 percent guessing the threshold was set at 30 years of age or younger.

Women also expressed confusion about one of the oldest and most reliable early-detection tests of all: the Pap smear, used to spot cervical cancer or precancerous lesions of the cervix.

"What was bothersome in our survey was that a lot of women didn't quite know what the Pap test was for," Szypko notes. "They're having it, but a lot of them think they are being screened for STDs."

In fact, just 48 percent of women surveyed understood the Pap test is specific to cervical cancer, while 13 percent believed it was used to detect STDs or ovarian or uterine cancer.

"That's kind of dangerous," Szypko says, "because if women think they have an STD they need to talk to their doctor -- there are [other] tests that can look for those problems." There are currently no effective early-detection tests for either ovarian or uterine cancer.

The survey suggests more needs to be done to get patients into doctor's offices for tests that can help save their lives. Computer technology and the Internet may be key, Lauer said, citing a new initiative that uses e-mails to jog physician memories. "We have a system here at the Cleveland Clinic that will give [doctors] a reminder that a person is due for a cholesterol check, so you don't have to remember."

More information

Try the American Heart Association to learn about cholesterol screening, while the American Cancer Society can teach about early detection. You can set up your own screening reminders by visiting this link set up by the College of American Pathologists.

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Longer Diabetes Means Higher Heart Risk

 

Reuters Health

Thursday, March 25, 2004

NEW YORK (Reuters Health) - The longer people with diabetes have the disease, the greater their risk of developing heart disease, new research shows.

Investigators found that for every 10 years a person has diabetes, his or her chance of developing heart disease increases by 38 percent. Furthermore, after 10 years of diabetes, the risk of dying from heart disease increases by nearly 90 percent.

More studies are needed to determine why having diabetes for longer increases the risk of heart disease, Dr. Caroline Fox of the National Institutes of Health (news - web sites) and her colleagues write in the journal Diabetes Care.

The findings come from a study of people with type 2, or non-insulin dependent, diabetes, which is closely linked to obesity.

In people with type 2 diabetes, blood sugar levels rise as the body becomes resistant to insulin, the hormone that processes sugar in the body. While type 2 diabetes used to be primarily a problem of middle and old age, new cases of the illness among people 30 to 39 have risen 70 percent in the last decade.

Previous research has shown that people with type 2 diabetes are up to 3 times more likely to develop heart disease than non-diabetics. However, results of studies into whether having diabetes for longer puts people at higher risk of heart disease have been contradictory.

During the current study, Fox and her colleagues reviewed information collected from 483 people participating in the Framingham Heart Study. Begun in 1948, the study has followed the heart health of thousands of residents of Framingham, Massachusetts, and their children.

All participants were initially free of cardiovascular disease. Fox and her colleagues followed them for 12 years, noting who developed heart disease and how long they had had diabetes.

Over the course of the study, 86 cardiovascular events occurred, including 36 deaths. Longer duration of diabetes appeared to increase the risk of both heart disease and dying from heart disease, Fox and her team report.

Possible reasons for why more years with diabetes translates to a higher risk of heart disease include the fact that longer duration of diabetes may raise the risk of artery clogging, heart rate problems and cell damage, the authors write.

Source: Diabetes Care, March 2004.

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Stents Show Their Mettle in High-Risk Heart Patients

 

By Amanda Gardner
HealthDay Reporter

HealthDayNews

Thursday, March 25, 2004

THURSDAY, March 25 (HealthDayNews) -- Two trials have found that stenting of the carotid arteries, the main arteries in the neck that supply blood to the brain, are effective for high-risk patients.

Results of the ARCHeR trial, which looked at extremely high-risk patients, and the SAPPHIRE trial were presented Thursday at the 29th annual meeting of the Society of Interventional Radiology in Phoenix.

In both groups of patients, stenting was found to be superior to a conventional procedure called carotid endarterectomy surgery. Stenting is the use of a tube-like device in the coronary artery to keep the vessel open.

Narrowing of the carotid arteries is a major risk factor for ischemic stroke. Up till now, the standard procedure for blocked carotid arteries has been endarterectomy surgery, which removes plaque from the vessels.

The so-called ARCHeR trial assessed the effectiveness of carotid artery stenting with and without embolic protection. Embolic protection is a tiny umbrella-like device to capture debris that might break off during the procedure.

Almost 600 patients were placed in three different arms of the trial: ARCHeR 1, which used the stent on its own; ARCHeR 2, which used the stent plus embolic protection; and ARCHeR 3, which used a newer version of catheters for placing the stent.

At the end of 30 days, ARCHeR 1, 2, and 3 patients had rates of major adverse events of 7.6, 8.6, and 8.3 percent, respectively. The incidence of major stroke or death was 3.8, 2.5, and 2.8 percent, respectively.

At the end of one year, the rate of major adverse events was 8.3 and 10.2 percent for ARCHeR 1 and 2, respectively (data for ARCHeR 3 is not yet available). This was compared to 14.5 percent for surgery patients.

"There were no additional major strokes in ARCHeR 1 and only one in ARCHeR 2," says Dr. Mark Wholey, co-principal investigator of this trial and a member of the executive committee for the SAPPHIRE trial. "There were four minor strokes and all had come back to normal baseline. That was in itself quite impressive."

Yet this is not the final word for some experts.

"The ARCHeR study did not randomize patients," says Dr. Enrico Ascher, chairman of the Vascular Institute at Maimonides Medical Center in New York City. "One would feel that it's logical to believe that a minimally invasive procedure carries less risk than an open procedure. However, it is also known for five decades that carotid endarterectomy is not a dangerous procedure. It is a very safe procedure."

The second trial, called SAPPHIRE, looked at carotid stenting vs. surgery in high-risk diabetic patients.

At 30 days, the incidence of stroke, heart attack or death was 4.8 percent in the stenting group and 22.7 percent in the surgery group.

At one year, the major adverse event rate was 4.8 percent for stenting and 25 percent for surgery. The heart attack rate at this point in time was 2.4 percent in the stenting group and 18.2 percent in the surgery group. Only 2.4 percent in the stenting group had a stroke compared with 11.4 percent in the surgery arm. The differences, Wholey says, were "mind blowing."

"In the high-risk diabetic population, if one can believe the data from SAPPHIRE, stenting is clearly a more favorable option than surgery," Wholey adds. "Now it's true that this is not the most heavily powered study, but nonetheless the incidence of myocardial infarction [heart attack] and stroke were statistically significant."

The U.S. Food and Drug Administration (news - web sites) had originally mandated that stents could only be investigated in high-risk patients. "What is clearly needed now is to proceed with low-risk trials," Wholey says.

More information

The American Heart Association (news - web sites) has more on carotid endarterectomy and on carotid artery stenosis, or narrowing of the carotid arteries.

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Throat Microbe Can Cause Bone Infections in Kids

 

Reuters Health

Thursday, March 25, 2004

NEW YORK (Reuters Health) - Kingella kingae, a usually harmless microbe that can grow in the throat, is increasingly being recognized as a cause of bone infections in children.

In a new report, the US Centers for Disease Control and Prevention (news - web sites) describe three cases of bone infection that occurred at a day care center last year.

Prior to the discovery of the current cases, "only sporadic...cases have been reported," the Atlanta-based agency notes in its Morbidity and Mortality Weekly Report. According to a related report, such infections may be more common than thought because special test bottles are not regularly used to grow the microbe for testing.

In mid-October 2003, the Minnesota Department of Health investigated two confirmed cases and one probable case of K. kingae bone infection that involved children in the same toddler classroom at a daycare center.

The features common to the three cases included fever, throat or ear infection, and refusal to bear weight on the affected leg. Two of the children ultimately required surgery to clear up the bone infection.

Investigation of daycare children and staff members uncovered 16 children who had K. kingae in their throats, including almost half of the kids in the toddler room. The microbe found in these children was identical to the ones found in the patients with bone infections.

All of the children and staff in the toddler room were given a 2-day course of antibiotics to destroy the microbe.

In a 2001-2002 survey of pediatric infectious disease doctors in the US, 23 cases of K. kingae skeletal infection were identified. The report emphasizes that more than a third of doctors surveyed did not use special culture bottles, which might improve detection of the microbe.

Source: Morbidity and Mortality Weekly Report, March 26, 2004.

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Keep Poisons Away From Kids

 

HealthDayNews

Thursday, March 25, 2004

THURSDAY, March 25 (HealthDayNews) -- This week is National Poison Prevention Week, and it's a good time to take a look around your home to make sure your children won't fall victim to accidental poisonings.

Each year, about 1 million children in the United States are exposed to poisonous substances and about 30 die from accidental poisonings.

About 90 percent of those poisonings are caused by children ingesting ordinary household products or medicines, says Rachel Robinson, director of drug information services at the University of Mississippi School of Pharmacy.

"When most people hear the word poison, they think of arsenic, strychnine, cyanide, malathion and so on. However, vitamins, cleaning products and even cosmetics can be poisonous," Robinson says in a prepared statement.

She offers the following advice on how to prevent accidental poisonings:

Even though your first instinct may be to induce vomiting in the poisoning victim, that may actually do more harm than good. For example, strong acids can burn the throat and vomiting may worsen the damage.

"Do not induce vomiting unless the poison control representative tells you do so. Ingestion of anything volatile, like petroleum-based products, can cause aspiration into the lungs," Robinson says.

 

More information

 

The U.S. Consumer Product Safety Commission (news - web sites) has a poison lookout checklist.

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Wednesday, March 24, 2004

 

Obesity Experts Offer a Padful of Prescriptions

 

By David Gregorio

Reuters Health

Wednesday, March 24, 2004

NEW YORK (Reuters) - A doctor, an activist for fat people and a McDonald's dietitian were among experts who offered a wide menu of ideas on Wednesday for shrinking the bulging waistlines that have made obesity the No. 2 cause of death in America.

Americans gain two pounds a year between the ages of 20 and 60, putting them at risk for diabetes, heart disease and other serious ailments, Dr. Xavier Pi-Sunyer told a conference at the State University of New York's Downstate Medical Center in Brooklyn.

"We shouldn't be gaining anything," Pi-Sunyer, director of an obesity research center, said in an interview. "We have to focus on preventing that weight gain because it's so hard to take it off later."

He called for a nationwide education effort, "to make people restrained eaters in an environment where unhealthy food is so cheap and tastes so good."

Claude Coliman, a regional minority health consultant for the U.S. government, said changing eating habits was difficult in low-income neighborhoods like the one outside the auditorium, where multifamily homes packed streets dotted with fried chicken and pizza restaurants.

"You have a lack of supermarkets offering healthier food in some neighborhoods," she noted. "You have a lack of fitness centers."

"If everything that's around you is unhealthy and high-calorie food, it's hard to stick to a good diet," agreed Deja Butts, a high school student studying health sciences.

"In every store you see the 25-cent juice and chips that are four bags for a dollar. It's available, it's inexpensive and you're going to go for it."

Unhealthy Advertising

Several of the 250 health professionals and students at the conference complained about the prevalence of advertising for unhealthy food. But Patricia Baird, a dietitian who discussed items recently unveiled by the McDonald's Corp. hamburger chain as healthier menu choices, said Americans were too quick to pin the blame for obesity on corporations.

"I believe in free choices," said Baird. "As a former fat person, my choice was to eat four helpings of lasagna, three helpings of potatoes and two helpings of roast beef. Did I eat the salads my mother put on the table? No. Did my sister? Yes. Was I fat while she was thin? You bet."

Another expert said concerns about obesity were overblown.

"When you talk about obesity being an epidemic, I don't know about that," said Sandy Schaffer, president of the New York chapter of the National Association to Advance Fat Acceptance.

"Not everybody that's fat is unhealthy," said Schaffer, an aerobics instructor who wears a stout size 24. "I'm big but I'm healthy. At this size I can move and I'm physically fit. You have to separate out diet from exercise."

Harold W. Kohl II, an epidemiologist at the Centers for Disease Control, said obesity had reached epidemic proportions. But he agreed that many experts did not focus enough on exercise.

"Anything people can do to engineer physical activity back into their daily life is absolutely critical," he said. "It's important to work 30 minutes of physical activity into your day."

Dr. Clinton D. Brown, the conference chairman, said many such gatherings will be needed nationwide to get Americans to change their habits.  

"People are finally realizing that obesity is a big problem," he said. "We need to focus our resources and make a community effort."

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U.N.: Lack of Vitamins Eroding Brainpower

 

By Chris Hawley

Associated Press Writer

The Associated Press

Wednesday, March 24, 2004

UNITED NATIONS - The brainpower of entire nations has diminished because of a shortage of the right vitamins, and slipping nutrients into people's food seems to be the only solution, a new U.N. survey says.

To fight the problem, the United Nations (news - web sites) is prescribing a whole pantry of artificially fortified foods: soy sauce laced with zinc, "super salt" spiked with iron, cooking oil fortified with vitamin A.

Deficiencies in these vitamins are having alarming effects in developing countries, even ones where people generally have enough to eat, said the study, released Wednesday.

A lack of iron lowers children's IQs by an average five to seven points, the report said. A deficiency in iodine cuts it 13 more points, said Venkatesh Mannar, president of the Micronutrient Initiative, which produced the report along with the United Nations Children's Fund. Birth defects increase when mothers don't get enough folic acid, and a shortage of vitamin A makes children 25-30 percent more likely to die of disease.

"So ubiquitous is vitamin and mineral deficiency that it debilitates in some significant degree the energies, intellects, and economic prospects of nations," the study said.

It looked at 80 developing countries representing some 80 percent of the world's population. It found:

·        Iodine deficiency has lowered the intellectual capacity of almost all of the nations by as much as 10 to 15 percentage points. It causes 18 million children a year to be born mentally impaired.

·        Iron deficiency in adults is so widespread that it lowers the productivity of work forces — cutting the Gross Domestic Product in the worst-affected countries by 2 percent.

·        Deficiencies in folic acid — a nutrient needed for tissue growth, especially in pregnant women — causes approximately 200,000 severe birth defects every year in the 80 countries.

·        About 40 percent of the developing world's people suffer from iron deficiency, 15 percent lack adequate iodine and as many as 40 percent do not get enough vitamin A.

In most Western countries, governments have fought the problem with additives: iodine is sprayed onto salt before packaging, vitamin A is added to milk and margarine, and flour is enriched with niacin, iron and folic acid.

But that doesn't work in countries where governments are weak, food is not processed in big mills and diets are based on a single starchy staple like rice or corn.

Other health experts said the U.N. findings echoed other studies showing the link between intelligence and nutrition.

"This is absolutely happening," said Ronald Waldman, a professor of clinical health at Columbia University. "Vitamin deficiency is a disease, and when people have this disease they don't reach their ideal mental potential."

While some deficiencies, like lack of vitamin A, can be corrected, "If you grow up and your IQ has suffered from iodine deficiency, it's not going to be reversible," Waldman said.

Furthermore, things are getting worse in some countries, the report said. The percentage of salt that is iodized has slipped to 25 percent in some Central Asian countries and to 50 percent in India, the country with the largest number of iodine deficient people, the report said.

Getting vitamins to people other ways just doesn't work, researchers said. In the United States, most people ignored government pleas to take more folic acid, a nutrient found in nuts — until the government started putting it in flour in 1998. The result: cases of spina bifida and anencephaly, two serious birth defects, dropped by at least 20 percent.

"It becomes an issue of compliance. If people have to eat a vitamin pill every day, a lot of them won't do it," Mannar said.

The report urges countries to step up enrichment in foods that people don't make themselves — things like soy sauce, cooking oil or margarine. It also endorses a new kind of salt fortified with iron in "microcapsules."

Putting more nutrients into the food has a measurable economic effect, Mannar said. He cited an Indian study that showed a 20 percent increase in production among tea leaf pickers after iron was added to their diets.

But the most disturbing gap between countries with good and poor nutrition is in intelligence, said Cutberto Garza, a Cornell University professor who also leads the nutrition program at United Nations University.

"A difference of five to seven IQ points doesn't sound like a lot, but you have to look at the tail ends of the (statistical) curve," Garza said. "You are significantly reducing the number of gifted people and increasing the number of people with mental incapacities."

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Lawmakers Want Stronger Law on Diet Supplements

 

By Lisa Richwine

Reuters

Wednesday, March 24, 2004

WASHINGTON (Reuters) - The U.S. law enacted 10 years ago to regulate vitamins, herbs and other dietary supplements needs strengthening to better protect Americans from dangerous products, lawmakers said on Wednesday.

Critics cited the example of ephedra, a stimulant linked to heart attacks, strokes and deaths, on which Food and Drug Administration (news - web sites) spent years compiling evidence to ban the product, while reports of serious side effects mounted.

Several lawmakers told a House Government Reform subcommittee the FDA needs new tools to act quickly against dangerous dietary supplements, while acknowledging the health benefits of many others.

"Without changes, we could see more and more dietary supplements follow in (ephedra's) wake," Rep. Susan Davis, a California Democrat, told the panel.

Dietary supplements do not have to undergo the same strict safety and effectiveness testing needed for prescription drugs before they can be sold. Supplements are widely available at grocery and drug stores and are used by millions.

The FDA currently can stop misleading or unsupported claims about supplements, ban a product if officials prove an unreasonable risk. But the ephedra ban, set to take effect April 12, is the first time the agency has moved to outlaw a supplement.

Davis and other lawmakers said manufacturers should be required to turn over to the FDA any reports of serious side effects that may be linked to their products. Under current law, such reporting is voluntary, which can hamper investigations of risky supplements.

Industry groups contend that the 1994 law, the Dietary Supplement Health and Education Act, gives the FDA adequate power to force risky supplements off the market, but the law has not been fully implemented and enforced.

FDA officials "have the authority, clearly, to take action on products if they so choose," argued David Seckman, executive director of the National Nutritional Foods Association.

Robert Brackett, director of the FDA's Center for Food Safety and Applied Nutrition, said the agency is revamping its system for reports on side effects, which should improve detection of potential problems.

He said the FDA believes it has adequate power to act against dangerous supplements and is not advocating strengthening the 1994 law. "I think we should use the existing law to its fullest extent," said Brackett.

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Bunless Burgers Old News to Calif. Chain

 

By Daisy Nguyen

Associated Press Writer

The Associated Press

Wednesday, March 24, 2004

LOS ANGELES - As one fast-food behemoth after another jumps on the bunless burger bandwagon, devotees of a small Southern California-based chain of drive-through eateries are taking some pride in saying, "We told you so."

Patrons of In-N-Out Burger have been ordering high-protein, low-carbohydrate hamburgers wrapped in lettuce for more than 30 years.

"In fact, it was customers who gave it the name 'protein style,'" said Carl Van Fleet, the company's vice president of planning.

They also created it, in a sense, when they began requesting it in the early 1970s, Van Fleet said. And although you won't find the protein-style burger listed on any of the white, billboard-like menu signs at In-N-Out's 181 restaurants in California, Nevada and Arizona, all you have to do is ask.

Arnold Schwarzenegger (news - web sites) did last year during a campaign stop at a central California In-N-Out Burger, and got it done his way.

The protein-style burger is part of the "secret menu" that has developed over the years as the privately held chain of restaurants has strived to accommodate its customers' fondness for customized food.

(Another entry on the secret menu is the "animal-style" burger, a beef patty cooked in mustard with grilled onions, pickles and an extra helping of a secret "special sauce.")

It is the protein-style that's getting attention these days, however, as the big chains rush to roll out lettuce-wrapped burgers for an increasingly health-conscious generation of fast-food consumers. Late last year, Burger King, Hardee's, Carl's Jr. and T.G.I. Friday's all began selling them.

At In-N-Out, Van Fleet says, sales of the burger have increased steadily in recent years, without a lick of advertising.

The fat content doesn't seem to deter Deane Wong and her husband, Lorrin, who recently stopped at an In-N-Out near Los Angeles International Airport to indulge in hamburgers and fries.

"It's not healthy, but we like the taste," she said. "We rarely eat fast food, but you need your burger fix now and then. You get your grilled burger, your fresh fries and then you're in and out of here."

The small company retains a cult-like following arguably no less devoted than fans of the rock band Phish. Web sites are devoted to its grilled hamburgers, fries, sodas and milkshakes made with real ice cream. Long lines of cars snaking toward its drive-up, takeout windows are a common sight at most restaurants during all hours of the day.

The chain's popular "double double" burger (two beef patties and two slices of cheese with lettuce, tomato and sauce between two slices of bread) has even inspired Todd Wilbur, author of the "Top Secret Recipes" books, to create his own at-home version.

"The recipe should taste the same as it does in the restaurant. So even at home you can totally get your In-N-Out fix that way," said Wilbur, who has also tried to copy the "animal style" recipe.

(For serious eaters, the secret menu also includes the "four-by-four." As its name implies, it includes four hamburger patties and four slices of cheese.)

Restaurant consultant Edward Engoron attributes In-N-Out's success to sticking to a simple approach for more than 50 years: fast food made from scratch and made-to-order. The restaurants' butchers select and grind the beef and the buns are baked daily. All produce is delivered fresh, and none of the restaurants has freezers or microwaves.

Since the first restaurant opened in 1948 in a Los Angeles suburb, the menu has hardly changed.  

"The fresh-off-the-grill standard and menu selections work well and fuel its popularity," Engoron said.

The company, which says it "has no plans" to offer stock or franchise its operations, does not release financial data, but Engoron estimates that each restaurant earns an average of $2 million annually — about 20 percent of which is profit.

Those are numbers "considerably higher" than McDonald's and Burger King in per store volume and net earnings, he said.

"It seems the biggest complaint about In-N-Out is that there aren't enough of them," Engoron added.

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Vegetarian Diet Affects Birth Defect Tests

 

Reuters Health

Wednesday, March 24, 2004

NEW YORK (Reuters Health) - Pregnant women who are vegetarians have increased levels of a hormone called free beta-hCG, which may lead to an incorrect diagnosis of Down's syndrome in their developing baby, Taiwanese researchers report. This suggests that higher beta-hCG test values need to be established for such women.

The test differences between non-vegetarian and vegetarian mothers largely disappeared when the latter had normal serum levels of vitamin B12, according to the report published in the American Journal of Obstetrics and Gynecology (news - web sites).

The findings are based on a study of 98 vegetarian and 122 non-vegetarian women who were pregnant. Reference values for beta-hCG and a related blood test, alpha-fetoprotein, were derived from a previously surveyed group of 6,312 pregnant women who had healthy babies.

The beta-HCG levels for the vegetarian group were higher than that of a reference group, lead author Dr. Po-Jen Cheng, from the Chang Gung Memorial Hospital in Taipei, and colleagues note. In contrast, the levels in the non-vegetarian group were comparable to that of the reference group.

These beta-HCG differences resulted in an incorrect Down's syndrome screening rate in the vegetarian group of 17 percent, significantly higher than the 5 to 6 percent rates seen in the other groups. Alpha-fetoprotein levels were slightly higher in the vegetarian group compared with the reference group.

Elevated beta-hCG levels were mostly confined to women with low vitamin B12 levels, Cheng and colleagues found. The alpha-fetoprotein level was not associated with the vitamin B12 level.

Until new reference values can be established, Down's syndrome screening in for pregnant vegetarians is more efficient if the screening is performed using ultrasound instead of measuring hCG levels, the investigators conclude.

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

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House OKs Funding to Spur Organ Donations

 

By Aparna H. Kumar

Associated Press Writer

The Associated Press

Wednesday, March 24, 2004

WASHINGTON - The House, hoping to spur more lifesaving organ donations, voted Wednesday to reimburse organ donors for travel and other nonmedical expenses involved in transplant surgery.

The legislation is an "important move to ensure that those who want to give the gift of life are not swayed by financial constraints," said Rep. Edolphus Towns, D-N.Y. It would authorize the Department of Health and Human Services (news - web sites) to spend $5 million a year, beginning Oct. 1, to reimburse qualified donors.

The bill passed 414-2, with only Reps. Ron Paul, R-Texas, and Jeff Flake, R-Ariz., voting in opposition. Next it will go to the Senate, which passed a similar bill in November.

Living donors now outnumber the traditional source of organs — cadavers. Of the 6,808 living donors in 2003, the vast majority gave a kidney, according to the Organ Procurement and Transplant Network. Segments of the liver, lungs, pancreas and, rarely, the intestine, also can be taken from a live donor.

The bill authorizes an additional $15 million in 2005 for grants to states, public awareness efforts and studies on how to increase recovery and donation rates. It also would finance new programs at hospitals and organ procurement organizations to coordinate organ donations.

More than 84,000 people nationwide are currently awaiting donations, the organ procurement group said. Every day, 68 people receive organ transplants, but another 18 die while waiting for a donor match, according to HHS.

"This is a life-or-death legislation for thousands of people on waiting lists," said Rep. Jay Inslee, D-Wash., a sponsor of the legislation.

A key to closing the gap is getting family members to discuss organ donation.

"Sadly, while most Americans indicate that they support organ donation, only about 50 percent of families who are asked to donate a loved one's organs agree to do so," Towns said, citing a study by the National Academy of Sciences (news - web sites)' Institute of Medicine (news - web sites).

On the Net:

Health and Human Services (news - web sites) Department: http://www.organdonor.gov/

Organ Procurement and Transplant Network: http://www.optn.org

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Thin Bones Predict Heart Disease in Women

 

Reuters Health

Wednesday, March 24, 2004

NEW YORK (Reuters Health) - Thin bones, as determined by X-rays of the hand, predict heart disease in women, according to a new report. This raises the possibility that treatments to prevent bone thinning, or osteoporosis, may also reduce the risk of heart disease.

Although thin bones have been linked to stroke in women, no studies have looked at the ability of bone thickness to predict heart disease, lead author Dr. Elizabeth J. Samelson, from Harvard Medical School (news - web sites) in Boston, and colleagues state in the American Journal of Epidemiology.

To investigate, the researchers analyzed data from 1,236 women and 823 men who participated in The Framingham Study. The subjects were free from heart disease at the beginning of the study (1967-1970) when hand X-rays were taken. The participants were followed through the end of 1997 to assess the rate of heart disease.

The rate of heart disease ranged from 11.76 to 15.65 cases per 1000 persons per year for groups with the thickest to thinnest bones in the hand, respectively. In contrast, no association between heart disease risk and bone mass was seen in men.

The presence of this relationship in women only may reflect gender differences in how bone is mineralized, how heart disease evolves, or both, the authors note.

The results suggest that boosting bone density may also prevent heart disease, the researchers note. To draw definitive conclusions regarding the implications of these findings on the treatment or prevention of osteoporosis, further studies are needed that use current tests of bone thickness.

Source: American Journal of Epidemiology, March 15, 2004.

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What Your Favorite Snack Says About You

 

HealthDayNews

Wednesday, March 24, 2004

(HealthDayNews) -- The foods you choose to snack on may reveal more about you than you realize, researchers say.

The Smell & Taste Treatment Research Foundation in Chicago found the following links between snack foods and your personality:

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Exercising to Music May Make You Smarter

 

Reuters

Wednesday, March 24, 2004

WASHINGTON (Reuters) - If music makes you smarter, and exercise helps brain function, can exercising to music really boost brainpower? U.S. researchers said on Wednesday it can.

Volunteers who listened to Vivaldi's "Four Seasons" while working out on a treadmill did much better on a test of verbal ability than when they exercised without music, a team at Ohio State University found.

"Evidence suggests that exercise improves the cognitive performance of people with coronary artery disease," said psychologist Charles Emery, who led the study.

"And listening to music is thought to enhance brainpower. We wanted to put the two results together," Emery added in a statement.

Writing in the latest issue of the journal Heart & Lung, Emery and colleagues said they studied 33 men and women taking part in a cardiac rehabilitation program after having bypass surgery, angioplasty or other procedures to treat clogged arteries.

The volunteers said they felt better emotionally and mentally after working out with or without the music. But their improvement on the verbal fluency test doubled after listening to music on the treadmills.

"Exercise seems to cause positive changes in the nervous system, and these changes may have a direct effect on cognitive ability," Emery said.

"Listening to music may influence cognitive function through different pathways in the brain. The combination of music and exercise may stimulate and increase cognitive arousal while helping to organize cognitive output."

Emery said he now wanted to test people using music of their own choice.

"We used 'The Four Seasons' because of its moderate tempo and positive effects on medical patients in previous research," Emery said. "But given the range of music preferences among patients, it's especially important to evaluate the influence of other types of music on cognitive outcomes."

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Stopping the Damage of Lead Poisoning

 

HealthDayNews

Wednesday, March 24, 2004

WEDNESDAY, March 24 (HealthDayNews) -- American scientists have identified a molecule that appears to play a critical role in the potentially fatal brain swelling caused by high doses of lead.

They report their discovery in this week's online edition of the Annals of Neurology.

The researchers also identified a drug that prevents the swelling in an animal model of lead poisoning.

"Our findings are in rodents and need to be confirmed in humans," senior author Dr. John Laterra, a professor in the departments of neurology, neuroscience and oncology at Johns Hopkins University School of Medicine and the Kennedy Krieger Research Institute, says in a prepared statement.

If these findings are confirmed in humans, that would warrant further research to determine whether the same molecule, called vascular endothelial growth factor (VEGF), plays a role in cognitive problems seen in children who experience smaller, more gradual exposures to lead.

In this study, young rats who ingested high concentrations of lead accumulated the metal in their brains. This accumulation was accompanied by significant edema, as well as increases in VEGF.

Laterra and his colleagues also found a drug that blocked the ability of VEGF to effect molecular changes inside cells prevented edema in the rats with the high doses of lead.

"It is possible that VEGF pathway inhibitors. . . could be used to prevent the development of brain swelling in children acutely intoxicated with lead. It is also possible that other, more subtle, cognitive aspects of low-level lead toxicity are caused by changes in VEGF levels," Laterra says.

Flakes of, and dust containing, old lead-based paints pose a threat to small children.

More information

The U.S. National Institute of Environmental Health Sciences has more about the dangers of lead.

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Flu Vaccine May Be Linked with Asthma in Infants

 

By David Douglas

Reuters Health

Wednesday, March 24, 2004

NEW YORK (Reuters Health) - A study of more than 9,000 children and adolescents indicates that the use of the nasal influenza vaccine (FluMist) is generally safe. However, questions still remain about the risk of reactive airway disease in certain children under the age of 3 years.

As researcher Dr. Steve Black told Reuters Health, "there was a suggestion that (such) children vaccinated with (FluMist) were at increased risk for medical visits for asthma within 6 weeks following vaccine as compared to controls. However, children with asthma prior to vaccination, overall, had a lower risk of asthma visits as compared to controls."

In the Pediatric Infectious Disease Journal, Black of the Kaiser Permanente Vaccine Study Center in Oakland, California, and colleagues note that they came to these conclusions after a trial of the nasal flu vaccine in children between 1 and 17 years old.

All received at least one dose of vaccine or placebo. Those 8 years or younger received a second dose 28 to 42 days later. All children were followed for 42 days after each vaccination.

Following evaluation of 9,689 children, there appeared to be no association between vaccination and acute respiratory tract infections, systemic bacterial infection, acute GI complaints, and those potentially associated with influenza.

However, in children aged 18 to 35 months there was a four-fold increased risk of reactive airway disease.

Thus, continued Dr. Black, "our conclusion was that the risk of asthma following (nasal flu vaccination) in children less than three years old needed further evaluation prior to the use of the vaccine in that age group."

They theorize that if this increased risk is confirmed in another study, it may be that these children have never been exposed to an influenza virus "and might respond to this vaccine differently because of this."

Source: Pediatric Infectious Disease Journal, February 2004.

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Elderly With Pneumonia Need Antibiotics Quickly

 

HealthDayNews

Wednesday, March 24, 2004

WEDNESDAY, March 24 (HealthDayNews) -- Elderly patients with pneumonia who receive antibiotics within four hours of their arrival at the hospital have shorter stays and are less likely to die, says a study in the March 22 issue of the Archives of Internal Medicine (news - web sites).

Researchers form the Centers for Medicare & Medicaid Services in Seattle analyzed medical records of 18,209 Medicare patients older than 65 who were hospitalized with pneumonia from July 1998 through March 1999.

The study found that among the 13,771 patients (75.6 percent) who didn't receive any treatment for their pneumonia before they arrived at a hospital, antibiotic administration within four hours of arrival was associated with: reduced risk of death in the hospital (6.8 percent vs. 7.4 percent); reduced risk of dying within 30 days of admission to the hospital (11.6 percent vs. 12.7 percent); and reduced likelihood that their length of hospital stay was greater than five days (42.1 percent vs. 45.1 percent).

The average length of a hospital stay was a half day less for patients who received antibiotics within four hours of their arrival. Overall, 60.9 percent of the patients received antibiotics within that time period.

"While most Medicare inpatients with pneumonia already receive antibiotics within that time, a substantial proportion do not. Given the growing size of the Medicare population, any additional improvement in administration timing could prevent a substantial number of deaths each year and preserve health-care resources," the study authors write.

Pneumonia is the second leading cause of hospitalization among Medicare beneficiaries, accounting for more than 600,000 Medicare hospitalizations each year. Pneumonia is the fifth leading cause of death among Americans aged 65 and older.

More information

The American Lung Association has more about pneumonia.

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Report: American Children Under Threat from Fat

 

By Maggie Fox, Health and Science Correspondent

Reuters

Wednesday, March 24, 2004

WASHINGTON (Reuters) - American children are under threat from their own fat, with obesity so common that its effects have wiped out many other health gains, according to a report released on Wednesday.

The report, called the Child Wellbeing Index, found that obesity is the single most widespread health problem facing children. When being overweight is included in a statistical profile of how children are faring, health well-being falls nearly 15 percent below 1975 levels.

The report, released by the non-profit philanthropic Foundation for Child Development, finds that U.S. children are better off than they were in 1975, less likely to fall victim to an accident and more connected to their communities.

But it finds that more children are overweight, poor and more attempt suicide than 30 years ago.

"Kids are doing better, but they are not doing nearly as well as they should be given this country's advances in education, health, and social programs," said Kenneth Land, a Duke University sociologist and demographer who developed the index.

At least 15 percent of U.S. children are overweight, according to the U.S. Centers for Disease Control and Prevention (news - web sites), and the numbers steeply increase each year.

"Without the obesity indication in the health domain index, we show about a 15 percent improvement compared to 1975," Land said in a telephone interview. "Whereas with the obesity trend in, we show a deterioration of about 15 percent."

Land said the study does not break down specific problems caused by obesity, but assumes that obesity is a bad thing. Many studies have shown that overweight children grow up to be overweight adults and much more at risk of heart disease, diabetes and some forms of cancer.

Studies are also starting to show that type-2 or adult onset diabetes is affecting younger and younger children.

An estimated 60 percent of U.S. adults are overweight or obese, and obesity is close to overtaking tobacco use as the No. 1 cause of death, according to the CDC.

"The overall conclusion from the study is that child well-being in the United States showed substantial improvement, especially for the seven years from 1994 to 2000," Land said.

But the improvements are slowing, he added.

For the report, Land's group looked at hundreds of studies on children and youth aged 1 to 19. It took into account health; wealth; safety; educational achievement; community connections including school and work; family and friends and emotional and spiritual well-being.

"We're pleased to see that children's lives have improved since 1975, but given America's resources and knowledge, children can and should be doing much better," said Ruby Takanishi, president of the Foundation for Child Development.

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Chronic Sinusitis is Immune Response to Fungus

 

By Serena Gordon
HealthDay Reporter

HealthDayNews

Wednesday, March 24, 2004

WEDNESDAY, March 24 (HealthDayNews) -- In much the same way that allergies cause some people's bodies to overreact to usually harmless substances such as pet dander, people with chronic sinusitis have an immune system that overreacts to a common fungus.

That's the conclusion of a Mayo Clinic study presented March 23 at the American Academy of Allergy, Asthma and Immunology's annual meeting in San Francisco.

As the body attempts to destroy the fungus, the immune system damages the sinus membranes, which causes the symptoms of sinusitis, the researchers say. To combat the fungus and prevent the immune system reaction, the researchers tested the fungicide Amphotericin-B in a double-blind, placebo-controlled study.

"This is the first drug to pass a placebo-controlled trial to treat this common disease," says study co-author Dr. David Sherris, an associate professor and interim chairman of the department of otolaryngology at the University of Buffalo.

As many as 37 million Americans suffer from sinusitis every year, according to the National Institute of Allergy and Infectious Diseases (news - web sites). It is characterized by inflammation of the sinuses that can be caused by a number of factors, including a cold and allergies. The inflammation shrinks the nasal passages so mucus can't drain properly, leading to pain, discomfort and, potentially, infection.

"Sinusitis causes an enormous impact on people's quality of life," Sherris says. "It doesn't kill you, but it sure negatively impacts your life."

For this study, the researchers recruited 24 people with chronic sinusitis. Ten were given the antifungal medication and 14 were given a placebo. Both the medication and the placebo were applied using a nasal spray twice a day for six months.

After six months, the researchers compared computerized tomography (CT) scans from before and after treatment. They also did an examination at the start and end of the study using an endoscope, a special instrument with a light on the end that lets doctors see inside the nose. The researchers also asked the study volunteers to assess their symptoms at the beginning of the study, and then again after six months of treatment.

The percentage of mucosal thickening in the sinuses as seen on CT scans was reduced by nearly 9 percent for the group using the antifungal medication. In comparison, the placebo group experienced an average increase in mucosal thickening of 2.5 percent.

Sherris says that 70 percent of the fungicide group had an improved endoscopic exam versus none of the placebo group. He says 90 percent of those on the medication reported an improvement in symptoms while only 64 percent of the placebo group did. However, Sherris notes there was a flaw in the scoring system used to assess symptoms, and the symptom-relief differences aren't statistically significant.

"This drug decreases inflammation on both objective and subjective measures," Sherris says. People with chronic sinusitis would have to stay on this medication to keep symptoms from coming back, he adds.

"It's a chronic disease, like asthma in your nose. If you don't continue treatment, symptoms will come back," Sherris says.

He says eventual the goal would be to develop a medication that would blunt the immune system response to the fungus. In the meantime, he says, the next step is to test the antifungal medication in a large multi-center trial.

Dr. Richard Lebowitz, an otolaryngologist at New York University Medical Center, says the role of fungus in sinusitis is a controversial topic in medicine right now.

He says some physicians feel that all chronic sinusitis is due to an immune response to fungus, while others believe this only affects a subgroup of people with chronic sinusitis.

"In my mind, not all sinusitis patients are the same. Not all have a reaction to fungus," he says. But, he adds, the antifungal medication "may be useful in the right group of patients."

Sherris says because the medication is applied nasally, it doesn't get absorbed into the bloodstream. As a result, there were very few side effects, he says.

More information

To learn more about sinusitis, visit the American Academy of Otolaryngology - Head and Neck Surgery or the American Academy of Family Physicians.

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Steroids Given to Newborns Cause Problems Later

By Gene Emery

Reuters

Wednesday, March 24, 2004

BOSTON (Reuters) - Giving steroids to premature babies to treat breathing problems can substantially impair their growth, intelligence and development of motor abilities, Taiwanese researchers said on Wednesday.

Doctors have been giving steroids to babies before and after birth since the 1970s, when research suggested that the drugs helped prevent breathing problems and increased survival.

But in 2002, the American Academy of Pediatrics and the Canadian Pediatric Society recommended they no longer be used because of potentially serious side effects.

Now a team led by Tsu Yeh of China Medical University in Taichung found in a long-term study that children who had been given the steroid dexamethasone were easier to distract, performed mental tasks more slowly, and scored lower in tests of arithmetic, perception and grammar than children in a control group who received a salt water placebo.

In addition, 39 percent of the drug recipients had significant disabilities, compared with 22 percent who did not receive the steroid, according to the study published in this week's New England Journal of Medicine (news - web sites).

Motor coordination was also impaired in more children who got dexamethasone for their severe respiratory distress syndrome.

The researchers also concluded that the drug stunted growth.

Although the dexamethasone treatment did not seem to lower the death rate for the premature babies with breathing problems, it did reduce the risk of chronic lung disease 28 days after birth, according to the Yeh group.

Still, they said the benefit seemed to be outweighed by the drawbacks.

In an editorial in the Journal, Alan Jobe of the Cincinnati Children's Hospital Medical Center noted that clinicians continued to give steroids to babies, but he added that the Taiwanese doctors' findings "should end any remaining enthusiasm for early treatment with high-dose dexamethasone."

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Alcohol Behind Many ER Visits

 

HealthDayNews

Wednesday, March 24, 2004

WEDNESDAY, March 24 (HealthDayNews) -- The number of people in the United States who go to hospital emergency rooms for treatment of alcohol-related illnesses or injuries is about three times greater than previously estimated, says a Massachusetts General Hospital study.

Researchers examined data from the National Hospital Ambulatory Medical Care Survey for 1992 through 2000 and identified an estimated 68.6 million alcohol-related emergency department (ED) visits. That's an average of 7.6 million alcohol-related ED visits per year.

From 1992 to 2000, alcohol-related visits accounted for 7.6 percent of the total 866.5 million ED visits.

People aged 30 to 49 had twice the rate of ED visits with diagnoses considered to be completely attributable to alcohol than people 50 or older or those aged 15 to 29. The visit rate for men with diagnoses completely attributable to alcohol was three times higher than for women. The visit rate for blacks with such diagnoses was twice that of whites.

"Although U.S. public health officials recognize that EDs throughout the United States face an enormous burden from alcohol-related diseases and injuries, this study shows that the current literature significantly underestimates the magnitude of this burden," the study authors write.

"Our nine-year study also reveals a rising trend in the number and rate of a widening gap between sexes and a shrinking gap between races among those seen in the ED with certain alcohol-related diagnoses," they write.

The authors suggest that "improving the frequency of ED screening may lead to more appropriate referrals and interventions during alcohol-related ED visits, with a reduction in subsequent illness and additional visits to the ED."

The study appeared in a recent issue of the Archives of Internal Medicine (news - web sites).

More information

The U.S. National Institute on Alcohol Abuse and Alcoholism has more about alcoholism.

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Food Additives May Trigger Stuffy Noses in Some

 

Reuters Health

Wednesday, March 24, 2004

NEW YORK (Reuters Health) - For some people plagued by a chronically stuffy nose, intolerance to food additives might be to blame, a new study suggests.

Italian researchers found that of 226 people with persistent nasal congestion not caused by allergies, 20 had reactions to monosodium benzoate, a preservative widely used in processed foods. When these men and women followed an additive-free diet, their nasal woes waned, according to findings published in the journal Allergy.

Patients in the study had what is known as non-allergic rhinitis. The symptoms, including chronic nasal congestion, runny nose and sneezing, are similar to those of hay fever, but the condition does not involve the abnormal immune response that triggers allergy symptoms. People with non-allergic rhinitis may develop symptoms in reaction to things like temperature changes, cigarette smoke or strong odors.

None of study patients tested positive for allergies to food or to common allergic rhinitis triggers such as pollen, mold and pet dander. But a small percentage appeared to have intolerance to monosodium benzoate--a reaction that differs from immune system-driven allergies.

The findings, say the study authors, suggest that in at least some cases in which the cause of patients' rhinitis is unknown, intolerance to food additives might be at work.

Dr. Maria Luisa Pacor of the University of Verona and her colleagues came to this conclusion after having 226 teenagers and adults with non-allergic rhinitis follow "additive-free" and "additive-rich" diets.

After one month on the additive-free diet, 20 patients, or about nine percent, showed an improvement in their rhinitis, and in six of these patients the symptoms disappeared. But after a few days on a diet heavy in processed foods containing preservatives, dyes and other additives, their symptoms resurfaced.

To pinpoint the culprit, Pacor's team conducted a double-blind placebo-controlled challenge. In this procedure, patients are given capsules containing either a specific food additive or an inactive substance in random order; neither the doctors nor the patients know what is inside each capsule.

The researchers found that all 20 of the patients who improved on the additive-free diet developed runny, stuffy noses and sneezing within a few hours of being given monosodium benzoate.

"This is the first controlled clinical trial that demonstrates the possible role of food additives in persistent rhinitis," Pacor and her colleagues write.

Still, the researchers point out that only six of the 20 patients with intolerance to monosodium benzoate saw a complete remission of their symptoms on the additive-free diet. This, they note, suggests that for some people, food additives may aggravate chronic rhinitis, but not be the underlying cause.

Source: Allergy, February 2004.

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Getting the Hives

 

HealthDayNews

Wednesday, March 24, 2004

WEDNESDAY, March 24 (HealthDayNews) -- To hive or to hive not.

That's the subject of an article in the March issue of the Mayo Clinic Health Letter that outlines some of the causes and treatments for hives.

Many foods -- including milk, eggs, fresh berries, nuts, or fish -- can cause hives. They're red, raised and itchy welts that can be as small as a pencil eraser and as large as a dinner plate. They usually last less than 24 hours. But hives can also last for days, weeks, months, or even years.

Insect bites, medications, infections, and scratching your skin can also cause hives.

It's often difficult to identify the cause of chronic hives, those that last more than six weeks. The cause of chronic hives is identified in only about 10 percent of cases.

People with mild hives may get relief by taking cool showers, using over-the-counter antihistamines, or by applying cool compresses to the affected area.

A severe attack of hives may require emergency care.

More information

The American Academy of Dermatology has more about hives.

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ER Visits Identify Undiagnosed High Blood Pressure

 

By Merritt McKinney

Reuters Health

Wednesday, March 24, 2004

NEW YORK (Reuters Health) - Most people go to the emergency room for treatment of urgent health problems, but new research suggests that many ER patients also have untreated high blood pressure, a major cause of chronic health problems.

High blood pressure in the emergency room should be taken seriously and may not necessarily be caused by ER-related stress, the study's lead author told Reuters Health.

The emergency room is "the only point of contact that many otherwise healthy people have with the healthcare system," Dr. David J. Karras of Temple University School of Medicine in Philadelphia said in an interview. For people who do not see a doctor on a regular basis, the ER may be the only time that they have their blood pressure and other vital signs measured.

The problem with blood pressure readings in the ER is that doctors have not quite known what to do with them, according to Karras. Because going to the emergency room is a stressful experience, doctors have wondered whether high blood pressure may be just a temporary, stress-related increase, and not really high blood pressure (hypertension).

"The temptation is to say that it does not represent true hypertension," Karras explained. "We're in this quandary of not knowing whether to take this blood pressure reading seriously."

Karras and his colleagues have found that, for some seemingly healthy people, high blood pressure in the ER is not a temporary condition.

So far, the study has included about 1,400 people with blood pressure readings of at least 140/90. This represents about 20 percent of all patients seen at four urban emergency departments that served mostly African American and Latino patients.

Karras and his colleagues contacted half of these patients with high blood pressure a few weeks after they were treated in the ER.

High blood pressure "wasn't just a phenomenon of the ER," Karras said. Since being treated in the ER, about one third of patients had been told by a primary care physician that they had high blood pressure.

And of the patients with the most severe high blood pressure--a reading of at least 180/110--about half of them still had high blood pressure several weeks after being treated in the ER.

The bottom line for people who have been told that they have high blood pressure is that "it's extremely important to have that followed up," Karras said. A high blood pressure reading in the ER "really does suggest that you're likely to have hypertension."

While it is important for the public not to ignore high blood pressure readings, Karras pointed out that medical professionals still need to determine the best way to deal with high blood pressure in the ER. As the study continues, he said, "Our goal is to develop some guidelines for managing high blood pressure in the ER."

Karras plans to present the findings of the study in May at a meeting of the Society for Academic Emergency Medicine in Orlando.

The study was funded by Pfizer Inc.

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Genetic Testing

 

HealthDayNews

Wednesday, March 24, 2004

(HealthDayNews) -- Genetic testing can benefit people at risk of developing a genetic disease or passing a genetic defect to an unborn child.

According to the March of Dimes Birth Defects Foundation, people at risk may include:

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Walking 15 Minutes a Day Won't Prevent Obesity

 

Reuters Health

Wednesday, March 24, 2004

NEW YORK (Reuters Health) - Walking briskly for 15 minutes each day is not sufficient to burn off the extra calories in the diet, new research reports.

Rather, to prevent the added pounds from piling up, people need walk briskly for an average of 30 minutes, or 60 minutes if they prefer a slower pace, the authors note.

According to Drs. Alfredo Morabia and Michael C. Costanza of Geneva University Hospital in Switzerland, in most countries, the amount of weight people are gaining is equivalent to taking in an average of 100 extra calories each day.

To determine what level of exercise is needed to burn off those added calories, the authors reviewed information about physical activity collected from 3,014 male and 2,996 female residents of Geneva between 1997 and 2001. The researchers noted how much people exercised, and estimated how many extra calories they would lose if they all walked briskly for 15 minutes each day.

As part of the experiment, Morabia and Costanza assumed that people who already walked 15 minutes each day would continue to do so, and people who typically walked less would increase their activity to no more than 15 minutes of walking per day.

Reporting in the American Journal of Public Health, the researchers found that if every single adult walked briskly for 15 minutes each day, the total amount of extra energy expended each day would average out to significantly less than the extra amount each average person eats.

However, if every adult extended their physical activity to 30 minutes of brisk walking, each person would burn off more than enough to compensate for the extra 100 calories they are eating.

If people prefer a slower pace when exercising, they would need to walk for 60 minutes each day in order to burn off more than 100 calories, the authors note.

"Fifteen minutes per day of moderate or brisk walking, or 30 minutes per day of slow walking, could increase physical activity at the population level," Morabia and Costanza write.

The authors note that they are currently using these results to encourage long, brisk walks in their community, and plan to follow the results to test their predictions about the exercise needed to prevent obesity.

Source: American Journal of Public Health, March 2004.

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Tuesday, March 23, 2004  

 

Alcohol Use May Help After Heart Procedure

 

Reuters Health

Tuesday, March 23, 2004

NEW YORK (Reuters Health) - Moderate alcohol use may benefit patients who have undergone coronary stenting, a procedure designed to open blocked heart arteries with a tiny tube, new research suggests. Alcohol seems to produce this effect by inhibiting inflammation.

Investigators, writing in the medical journal Heart, note that several studies have shown that moderate alcohol intake (up to 2 drinks per day) reduces the risk of death due to heart disease. But data on alcohol's effect on long-term prognosis after successful coronary stenting are lacking.

To investigate, Dr. Michael N. Zairis from Tzanio Hospital in Piraeus, Greece and colleagues analyzed data on alcohol intake, an inflammatory protein called CRP, and mortality in 483 subjects who underwent coronary stenting.

By the end of the 4-year study, 23 percent of subjects were readmitted for chest pain, had a heart attack, or died from heart-related causes. Moderate alcohol use decreased the risk of all these outcomes--provided that the patient's CRP level was above a certain level.

Although the heart benefits of alcohol have been largely attributed to its effects on blood fats and platelets, the current results suggest the benefits may be mediated, at least in part, through an anti-inflammatory mechanism, Zairis and colleagues note.

In an accompanying editorial, two researchers from France recap published studies both for and against the "intriguing and appealing" theory that moderate alcohol intake protects the heart through anti-CRP effects.

Dr. Michel de Lorgeril and Dr. P. Salen from Universit Joseph Fouriar in Grenoble, France, note that "at present, there is no evidence that CRP is a causal (or even a major) factor in" the blood vessel inflammation that leads to coronary plaques.

Further studies are obviously required, they write.

Source: Heart, April 2004.

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Herbal Supplements/Meds Not That Dangerous a Mix

 

HealthDayNews

Tuesday, March 23, 2004

TUESDAY, March 23 (HealthDayNews) -- Most potential interactions between drugs and dietary supplements are not serious, says a University of Pittsburgh study in the March 22 issue of the Archives of Internal Medicine (news - web sites).

In recent years, more and more people have started using dietary supplements to treat health and physical problems. The use of dietary supplements, also called herbal supplements, is common among people taking prescription drugs. Concerns have been raised about possible dangerous interactions.

This study of 458 outpatients visiting general medicine clinics at two Veterans Affairs medical centers in Pittsburgh and Los Angeles found that drug-dietary supplement interactions were not serious in 94 percent of the patient population studied.

During the study, the patients were asked about their dietary supplement use. Researchers cross-referenced that with information about the patients' prescription drug use. Potential interactions were identified from medical searches and other sources.

"This is encouraging news for the millions of patients currently taking prescription medications along with dietary supplements. However, limited information and drug-dietary interactions exists and health-care providers should continue to inquire about dietary supplement use and consider the potential for interactions," Lauren E. Trilli, an assistant professor in the department of pharmacy and therapeutics at the University of Pittsburgh School of Pharmacy, says in a prepared statement.

More information

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

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Snack Food Makers on the Defensive

 

By Patrick Walters

Associated Press Writer

The Associated Press

Tuesday, March 23, 2004

PHILADELPHIA - First it was those evil fats and salts in snack foods. Then, the carbohydrates they contained were vilified. Now snacks are being targeted because obesity has been pegged as one of the country's top killers.

Wondering what might become the next perceived evil of their industry, snack makers are reacting warily to the latest health crazes.

No matter what, many expect the taste bud will win out in the end.

The $22 billion salty snack industry, seemingly always on the defensive against the latest nutritional fad, is adjusting to the latest demand with some new products and advertising. But many companies are still banking on the natural craving for a salty, crunchy snack that flat out tastes good.

"How often do you sit down and say 'I want a cold beer and baked potato chips?'" said David Ray, general manager of Snyder of Berlin, one of many snack makers gathered this week for a Snack Food Association convention in Philadelphia.

The latest blow for snacks came this month when the Centers for Disease Control and Prevention (news - web sites) released a study saying more Americans soon will be dying of obesity than from smoking. A poor diet and physical inactivity caused 400,000 deaths in 2000, a 33 percent jump over 1990, the study said.

Robert Shearer, president of Shearer's Foods Inc., hears that message, but refuses to sacrifice taste by changing the recipe of popular chips like the salt-and-vinegar, kettle-cooked variety.

His Brewster, Ohio-based company has started printing a message on the back of its bags, advising snackers to eat less and to get lots of exercise.

"We're promoting healthy lifestyles," Shearer said, adding that customers complained when the company tried to change to a healthier oil in one variety of chips.

Many people in snack sales say they aren't too quick to respond to health crazes because they often die out.

"We're selling impulse items," said Joseph Papiri, vice president of sales and marketing for Snak King, of City of Industry, Calif., whose company is exploring low-carb products but isn't sure it's worth diving into that market yet.

Many snack makers point to the low-fat craze in the 1990s, which skyrocketed and then faded.

"It went up and everybody got into it and then it dropped like a rock," Ray said.

Dieticians, however, say healthy eating isn't just a fad, and that the obesity epidemic is a perfect example of why snack makers need to help people change what they eat.

"It's not a fad that we're getting fatter in this country, because we've been getting fatter for 30 to 40 years," said Samantha Heller, a senior clinical nutritionist at New York University Medical Center. "That's a problem, a serious problem. ... They're not making their snack foods any healthier."

In general, snack companies tend to ride the wave of health-food fads and not overreact to the latest craze, said Thomas A. Schmidt Sr. president of Quality Ingredients Inc., which supplies ingredients to snack makers. "People get worn out with this stuff," he said.

The folks who make pork rinds aren't complaining, because sales of the no-carb snacks have been surging. Bags of pork rinds made by Dallas-based Rudolph Foods loudly declare "zero carbs" and the company says sales are up 22 percent.

That's the biggest jump since the first President Bush (news - web sites) declared pork rinds his favorite snack in the late 1980s.

"It's putting us into new places in the stores," said Mark Singleton, Rudolph Foods' vice president of sales. "We're now showing up in the better-for-you section."

On the Net:

Snack Food Association: http://www.sfa.org/index.html

NYU Medical Center: http://www.nyumedicalcenter.org/nyuth/nyumc.jsp

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More Clues to Autism's Origin

 

By Kathleen Doheny
HealthDay Reporter

HealthDayNews

Tuesday, March 23, 2004

TUESDAY, March 23 (HealthDayNews) -- Researchers have pinned down more specifically the portions of the brain associated with autism, the developmental disorder that affects up to 1.5 million Americans.

Using imaging technology, the team narrowed down the link to specific areas of white matter, which is essentially the brain's wiring system.

In the process, the researchers also have obtained more clues about the timeline of the disorder, says study leader Dr. Martha R. Herbert, a pediatric neurologist at Massachusetts General Hospital and Harvard Medical School (news - web sites) in Boston. Her report appears in the April issue of the Annals of Neurology.

The findings also strengthen experts' suspicions of a relationship between autism and developmental language disorder, she says, adding the two disorders may be on a spectrum rather than two clearly distinct conditions.

Herbert's findings build on research by her team and other experts. "It's already been established by a growing number [of researchers] that children with autism have a larger brain volume," she says. Herbert's team and one other have also reported previously that what makes the brain bigger in autistic children is more white matter.

Autism, a complex developmental disability, usually appears during the first three years of a child's life, according to the Autism Society of America. It is marked by a lack of normal social interaction, language abnormalities and repetitive, ritualistic behavior.

Developmental language disorder (DLD), as the name suggests, involves language impairments.

Using advanced techniques to analyze magnetic resonance imaging (MRI) studies, Herbert's team studied 63 children, including 13 with autism, 21 with DLD and 29 normal healthy controls. All were aged 8 to 9, had IQs above 80, and were considered high functioning.

In both the autistic and DLD children, the outer area of white matter was larger than that of the controls, they found, but the inner zones of white matter were no different.

The outer zone, called the radiate zone, "is the only part that showed a significant volume increase," Herbert says.

The children with DLD and autism showed the greatest white matter enlargement in the prefrontal area, the very front of the brain.

The areas showing the greatest volume increases are areas in which the white matter myelinates later, Herbert says. Myelination is the process in which portion of nerve cells called axons are covered with a material called myelin.

"Myelin travels up from deep to superficial [parts of the brain]," Herbert says, and also back to front of the brain. "Most of the fibers in the womb are nonmyelinated; they don't have the white sheath around them."

"This gives us a time interval to look for underlying disease mechanisms," she says.

Paul Thompson, an associate professor of neurology at the UCLA David Geffen School of Medicine in Los Angeles, says the research is significant because it pins down more specifically where in the brain autistic children are different and when things may go awry.

"This is a little bit like shining a flashlight on the area of the brain that will encourage researchers to look at this a little more," he says.

This research, he adds, points to the outer layer of white matter as the possible origin of the problem. "Her research also points to when it occurred," he adds, which could be valuable information. Eventually, the finding might help in the diagnosis of autism, he says.

More information

For more information about autism, visit the Autism Society of America and the Cure Autism Now Foundation. Learn about dealing with language development problems from the American Speech-Language-Hearing Association.

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Studies Uncertain on Drugs Versus Hysterectomies

 

Reuters

Tuesday, March 23, 2004

CHICAGO (Reuters) - Women who opt for drug treatment rather than hysterectomy because of abnormal uterine bleeding have about an even chance of having the surgery anyway later on, according to studies published on Tuesday.

If the findings can be applied to the general population, then even if women who suffer from uterine bleeding stay on conservative therapy with drugs, half of them end up getting a hysterectomy, said two experts who reviewed the studies.

"Does it mean that surgery will likely be necessary eventually anyway, so perhaps better sooner than later, sparing the woman continued symptoms? Or does it mean that there is a 50 percent chance of avoiding the hysterectomy and these odds are worth taking to avoid a major operation?" asked physicians Roy Pitkin of the University of California, Los Angeles, and James Scott of the University of Utah in Salt Lake City.

Their comments, in an editorial in the Journal of the American Medical Association (news - web sites), where the studies were published, concluded with a suggestion that more clinical trials are needed "to determine whether these (or other) more conservative treatments are more efficacious and cost-effective in the long run than hysterectomy."

One study published in the journal, from the University of California, San Francisco, involved 63 premenopausal women with abnormal uterine bleeding that either underwent hysterectomies or were treated with hormone therapy.

The study found that hysterectomy "results in substantial improvement in health-related quality of life within six months for women who have not responded to (drug therapy)."

But it said persisting with drug treatment "can also produce benefits for many of these women throughout the ensuing two years (they were studied) although others who prolong (drug) treatment at this stage will decide within a year to have a hysterectomy."

The second study from Finland's Helsinki University Hospital looked at 236 women being treated for heavy bleeding over a period of five years, to compare hysterectomy with a treatment that involves an intrauterine system releasing small doses of the drug levonorgesterel.

After five years, the two groups did not differ substantially in terms of quality of life or psychosocial well-being, the authors said. Forty-two percent of the women in the drug treatment group, however, eventually underwent hysterectomy.

Hysterectomy, in which the uterus is removed, is the most common major surgical procedure performed in the United States for reasons other than childbirth, according to the study from California. U.S. women run about a 25 percent risk of having their uterus removed, it added.

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New Guidelines for Detecting Cerebral Palsy Early

 

HealthDayNews

Tuesday, March 23, 2004  

TUESDAY, March 23 (HealthDayNews) -- Early brain scans for children with suspected cerebral palsy are recommended in new guidelines from the American Academy of Neurology (news - web sites) and the Child Neurology Society.

The guidelines, published in the March 23 issue of Neurology, say evidence supports the use of magnetic resonance imaging (MRI), which is preferred over computerized tomography (CT), when it's suspected a child may have cerebral palsy.

Metabolic and genetic studies don't need to be done routinely unless the cause of a child's brain abnormality is not evident from the MRI or clinical history and examination, the guidelines state.

Early diagnosis of cerebral palsy can help the child's parents and doctor understand the cause of the disorder and assist them in making informed treatment decisions.

Children diagnosed with cerebral palsy should also be routinely examined for related disorders.

"Because children with cerebral palsy often have other conditions such as mental retardation, vision and hearing impairments, speech and language disorders, and chewing and swallowing disorders, the initial assessment should include screening for these associated conditions," the guidelines recommend.

About 10,000 babies with cerebral palsy are born each year in the United States; most are diagnosed with the disorder by the time they're 2 years old. Cerebral palsy, which affects posture and movement, is caused by a lesion in the developing brain. It's a non-progressive disease and most children with cerebral palsy improve as they age.

More information

The March of Dimes has more about cerebral palsy.

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Study: Low-Calorie Diet May Extend Life

 

By Paul Recer

AP Science Writer

The Associated Press

Tuesday, March 23, 2004

WASHINGTON - A study in mice suggests that a low-calorie diet could help extend life even if the dietary change doesn't start until old age.  

The study, appearing this week in the Proceedings of the National Academy of Sciences (news - web sites), showed that mice at the relatively advanced age of 19 months that were placed on a restricted calorie diet lived 42 percent longer than litter mates who continued to eat a standard diet.

Other studies have shown that young mice put on a low-calorie diet live much longer than mice fed the standard fare. But the new research suggests that it is never too late to enjoy a life-extension benefit by reducing calories.

Stephen R. Spindler of the University of California, Riverside, leader of a team conducting the research, said there is little evidence yet that dietary restrictions will extend human life, but in mice, at least, sensible eating even at older ages clearly has a longevity benefit. He said a 19-month-old mouse is the age equivalent of 60 to 65 years in humans.

Spindler said old mice placed on a restricted calorie diet responded quickly with better health and that eventually the animals lived up to six months longer than litter mates fed the standard diet.

If such findings translate to humans, he said, "this could mean a lot more years and a lot of good years. The mice on caloric restriction lived longer and they are healthier."

Spindler said that while older mice that go on a diet do live longer than those that don't, they still don't live as long as mice that have been on restricted diets for a lifetime. He said mice put on low-calorie diets just after birth have been known to live up to four years, almost twice as long as normal mice and months longer than the aged mice in the new study.

The message, he said, is that sensible eating for a lifetime is best, but there are life span benefits even if the diet is not started until old age.

"This is a very important finding," said Dr. George S. Roth of the National Institute on Aging, one of the National Institutes of Health (news - web sites).

"The dogma has always been that the earlier in life you start a restricted diet, the better it works for extending life," said Roth, a researcher studying the aging process who was not involved in Spindler's research. "This finding suggests that you may get some of the same benefits starting late in life."

Spindler said the study also found that the restricted-calorie diets also slowed the development and advancement of cancer. Death from tumors is very common among aged mice, he said, but the researchers found that tumor growth either started later or was slowed among mice fed limited calories.

The researchers also analyzed how the action of genes changed in mice placed on restricted calorie diets. Spindler said there were changes and that these might be biomarkers of how the restricted diet works to extend life.

"People have been searching for 30 years for biomarkers of the changes that take place during the aging process," said Spindler. He said the new study in mice suggests that by measuring the amount and type of proteins made by the genes scientists could pinpoint the biomarkers of aging.

Once those are known, he said, it would be possible to find drugs that have the same effect on life extension as calorie-restricted diets.

Does this mean that eventually aging could be slowed by taking a pill?

"I am confident that that day will come," said Spindler.

On the Net:

Proceedings of the National Academy of Sciences: http://www.pnas.org

National Institute on Aging: http://www.nia.nih.gov

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Statins May Speed Stroke Recovery

 

HealthDayNews

Tuesday, March 23, 2004

TUESDAY, March 23 (HealthDayNews) -- Cholesterol-lowering drugs called statins may improve recovery in stroke patients, says a U.S. study published this week in BMC Medicine.

Researchers observed 433 ischemic stroke patients admitted to the U.S. National Institute of Neurological Disorders and Stroke (NINDS) Stroke Program at Suburban Hospital in Bethesda, Md.

The study found that 51 percent of the patients who were taking statins when they were admitted to the hospital were discharged with no significant disability, compared with 38 percent of the patients who weren't taking statins when they arrived at the hospital.

While the study found an association between prior statin use and improved outcome after stroke, it found no significant differences in the severity of strokes suffered by patients taking statins and those who weren't taking statins.

More information

The American Heart Association (news - web sites) has information about stroke risk factors.

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Asthma Inhaler Ingredient May Counteract Benefits

 

Reuters

Tuesday, March 23, 2004

WASHINGTON (Reuters) - One of the drugs used in inhalers to treat asthma can counteract the benefits of the others, U.S. researchers reported on Tuesday.

The finding may explain why some patients who use the inhalers actually get worse over time, the researchers at the University of Pittsburgh School of Medicine said.

The ingredient is albuterol, in a class of medications called beta-agonists. In inhalers it is combined with steroids to open airways and ease the gasping of patients with asthma and other lung diseases.

But in a report presented to the annual meeting of the American Academy of Allergy, Asthma and Immunology in San Francisco, the researchers said a bad form of albuterol can accumulate in the body and worsen symptoms instead of helping.

Sometimes these patients end up in emergency rooms, said Williams Ameredes, an assistant professor of cell biology and physiology who led the study.

The trouble, said Ameredes, is that albuterol has two forms or isomers -- a so-called left-handed version and a right-handed one. These isomers refer to the molecular structure.

The "right" version relaxed the airways when used with the steroid dexamethasone but the "left" version in fact increased the inflammatory signals that caused the airways to tighten, he said.

"One potential explanation is that long-term repeated usage of albuterol may result in accumulation of the (left) isomer of albuterol, which we know persists in the body three to four times longer than the beneficial (right) isomer, which is normally metabolized in about three hours," Ameredes said in a statement.

It is now possible to make a version of albuterol that contains only the beneficial, right-handed isomer, Ameredes said, and drug companies should examine this possibility.

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Gum Disease

 

HealthDayNews

Tuesday, March 23, 2004  

(HealthDayNews) -- Your risk of developing gum (periodontal) disease increases as you age. Over time, your gums may begin to detach from your teeth.

Left untreated, the supporting bone may dissolve, and when this happens, your teeth may become loose and fall out, says the Maryland Department of Health & Mental Hygiene.

So if you notice that your gums are swollen, red, tender or bleed easily, or that your teeth feel loose, see your dentist as soon as possible. Meanwhile, don't forget to floss and brush your teeth after every meal using a fluoride toothpaste.

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Stopping Estrogen Therapy Raises Hip Fracture Risk

 

By David Douglas

Reuters Health

Tuesday, March 23, 2004

NEW YORK (Reuters Health) - The results of a study of more than 140,000 postmenopausal women indicate that stopping estrogen therapy rapidly increases the risk of breaking a hip. In fact, within years, the risk may be even higher than that seen in women who've never received hormone therapy.

Lead investigator Dr. John Yates told Reuters Health "at this time when so many women are making the decision to discontinue estrogen treatment, it is critical to know whether one of the clear benefits of estrogen, namely reducing the incidence of hip fractures, is maintained after treatment cessation."

To investigate, Yates, of Takeda Global Research and Development Center in Lincolnshire, Illinois, and colleagues analyzed data on 140,584 postmenopausal women who had had no prior history of osteoporosis. The results appear in the medical journal Obstetrics and Gynecology.

Follow-up showed that women who were currently on hormone therapy had a 40-percent lower rate of hip fracture than those who had never used hormone therapy. Furthermore, as expected, women who had ceased hormone therapy for more than 5 years had similar rate to "never users."

However, "surprisingly," according to the authors, women who had stopped hormone therapy within the previous 5 years had an increased risk of such fracture compared to never users.

"This study, at a minimum," continued Yates, "shows that the protection from hip fractures is lost rapidly after discontinuing estrogen, and provocatively raises the question of whether there could even be a rebound, so that post-discontinuation hip fracture risk exceeds that in women who never received estrogen."

Because more women are likely to abandon hormone therapy in the future, he and his colleagues conclude that "postestrogen evaluation should include consideration of the need for intervention to prevent bone loss and fracture."

Source: Obstetrics and Gynecology, March 2004.

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The Hazards of Ear Candling

 

HealthDayNews

Tuesday, March 23, 2004

(HealthDayNews) -- While ear candling is touted as a cure-all for a number of medical problems like sinusitis, this alternative therapy is dangerous and has no proven benefit, says Health Canada.

An ear candle is a narrow, hollow cone that has been soaked in beeswax or paraffin and allowed to harden. During ear candling, the point of the cone is inserted in the patient's ear and then the top of the cone is lit and left to burn for a few minutes.

Practitioners claim that the flame creates warmth and suction, thereby drawing ear wax out of the ear canal.

The risks of the procedure include skin or hair catching fire, serious burns, blockages of the ear canal from hot wax, and loss of hearing.

Health Canada says people should not practice ear candling. If you're concerned about ear wax, consult your doctor.

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Vitamin D Helps Fight Breast Cancer

 

HealthDayNews

Tuesday, March 23, 2004

TUESDAY, March 23 (HealthDayNews) -- Women who increase their intake of vitamin D may help boost their body's ability to fight breast cancer, a new British study says.

Researchers at the University of Birmingham and St. George's Hospital, London, add that their report is the first to show how improved levels of vitamin D may help prevent breast cancer.

It was previously believed that calcitriol, the active form of vitamin D and a potent anti-cancer agent, was made only in the kidney. But this study found breast tissue also contains the enzyme that activates vitamin D and increased levels of the enzyme were found in breast tumors.

The researchers believe this ability to activate vitamin D is part of the breast's natural immune response to a tumor.

"Our work shows that the breast has its own local 'factory' for generating the anti-cancer form of vitamin D. Unfortunately, women who live in cloudy countries like the U.K. may not have enough of the raw material, vitamin D, to fuel this factory," research leader Dr. Martin Hewison says in a prepared statement.

"Exposure to sunlight is the most efficient way of generating vitamin D in our bodies, but we all know the dangers of sunbathing. Perhaps now it's time to look at improving our dietary intake through fortification of more foods with vitamin D," Hewison says.

The study was presented March 23 at the 23rd Joint Meeting of the British Endocrine Societies with the European Federation of Endocrine Societies in Brighton, England.

More information

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

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DHEA Use by Athletes May Boost Harmful Hormone

 

By Merritt McKinney

Reuters Health

Tuesday, March 23, 2004

NEW YORK (Reuters Health) - Many athletes take the steroid-like supplement DHEA to boost testosterone and build muscle, but new research raises the possibility that this supplement also enlarges the prostate.

In a 6-month study, testosterone levels did not rise in young men who took DHEA, but levels of hormones linked with an enlarged prostate did. Although the study was not long enough to show whether DHEA increases young men's risk of developing an enlarged prostate, the study's lead author cautioned against using the supplement.

"DHEA does not increase testosterone levels in reproductive-aged men, but it does increase levels of a hormone that is a growth factor for the prostate," Dr. Rebecca Z. Sokol of the University of Southern California in Los Angeles told Reuters Health.

In the study, none of the men experienced any prostate abnormalities, but Sokol said that young men who use DHEA for an extended period of time theoretically could be at risk of developing an enlarged prostate. The condition, known as benign prostatic hypertrophy, is common in older men and often requires surgery, she said.

"If you are considering taking DHEA, you should understand that you are not likely to reap any benefits, but may be causing yourself harm," Sokol warned.

Until 1994, DHEA was available only by prescription. But the supplement was reclassified as a dietary supplement after the passage of the Dietary Supplement Health and Education Act of 1994.

DHEA supplements are available over the counter, although their use is banned by the International Olympic Committee (news - web sites) and the National Collegiate Athletic Association.

Natural levels of DHEA, or dehydroepiandrosterone decline with age, so supplements of the hormone have been studied in older men. But many young men, who have plenty of natural DHEA, take the supplement to boost athletic performance. The hormone breaks down into various other hormones, including testosterone, that help build muscle.

Concerned about the effect of extra DHEA in young men, Sokol's team studied 14 healthy men aged 18 to 42. The men were randomly assigned to take a daily dose of DHEA-- either 50 milligrams (mg) or 200 mg--or a placebo.

During the 6-month study, the men did not experience any unusual symptoms, such as enlarged breasts, changes in testicle size or growth of the prostate gland.

Use of DHEA also did not have an effect on testosterone levels, which were similar in all three groups of men, Sokol's team reports in the March issue of the journal Fertility and Sterility.

But men who took DHEA did experience a rise in other hormones, including ADG, a hormone associated with prostate growth.

Although none of the men developed an enlarged prostate during the study, more study is needed, according to Sokol and her colleagues. Future studies may determine whether higher doses or long-term use of DHEA has a harmful effect on the prostate, according to the report.

In Sokol's opinion, DHEA and other hormone-based supplements should be regulated by the Food and Drug Administration (news - web sites).

Source: Fertility and Sterility, March 2004.

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UVA Rays May Play Bigger Role in Skin Cancer

 

By Kathleen Doheny
HealthDay Reporter

HealthDayNews

Tuesday, March 23, 2004

TUESDAY, March 23 (HealthDayNews) -- Ultraviolet-A (UVA) rays have long been known to cause aging of the skin, but they may play a bigger role in promoting skin cancer than previously thought, researchers report.

"Studies have shown that sunlight causes skin cancer, but have not determined which part of sunlight," says study author Gary Halliday, a professor of dermatology at the University of Sydney in Australia. "There is good evidence that UVB [ultraviolet-B] is important [in causing skin cancer], but our studies show that UVA is also very important."

The research appears in this week's online issue of the Proceedings of the National Academy of Sciences (news - web sites).

UVB rays have shorter wavelengths and are primarily responsible for sunburn and are known to contribute to skin cancer, including the deadliest form -- melanoma. UVA rays are longer wavelength rays that can damage the skin's connective tissue and lead to premature aging. UVA rays have been considered less carcinogenic than UVB rays.

For the new study, Halliday's team evaluated cells from biopsies taken from 16 patients with squamous cell skin cancer and solar keratosis, precancerous skin growths caused by sun damage. The researchers used a technique called laser capture microdissection and searched for "signature" DNA mutations that are characteristically caused by either UVA or UVB wavelengths.

Damage from UVA causes a different mutation in the cell than does damage from UVB, skin cancer experts say.

The researchers looked at cells called keratinocytes in the epidermis, the outermost layer of skin. They found the majority of UVA signature mutations were found in cancer cells residing in the basal keratinocyte layer of cells, the area that houses stem cells that give rise to keratinocyte cells that migrate upward. Most UVB signature mutations were found in the more superficial, upper layer of keratinocytes.

The finding in human skin cancers mirrors that of several animal studies, Halliday says. "A number of experiments in animal models show that UVA is involved in skin cancer," he says. "However, this is the first report to show UVA causes gene mutations in human skin cancer."

Another skin cancer expert, Dr. Vincent DeLeo, chairman of dermatology at St. Luke's-Roosevelt and Beth Israel medical centers in New York City, calls the new study exciting but says more research is needed to verify the results.

"What [the study] is saying essentially is that in squamous cell and solar keratosis there are changes in the DNA of the basal cells that look like the changes were made to some extent by UVA rather than UVB," he says.

"We've known UVA is a carcinogen, but most experts thought those [skin cancer] tumors were caused by UVB primarily," DeLeo adds.

Researchers talk about a UVA or UVB "footprint" or "fingerprint," and that is a special mutation that has been found in the cancer cells, suggesting which type of wavelength caused it, he says.

"They [the Australian researchers] are showing these [UVA mutations] at the base of the tumor, but then at the top show UVB mutations." That finding, he says, "warrants more study."

In future research, Halliday says he hopes to study how damage to DNA caused by UVA and UVB rays is repaired differently and how the body protects itself against the two different wavelengths.

Meanwhile, Halliday says, "Our studies indicate that it is important to protect from both UVB and UVA. Therefore the best advice is to avoid sunlight exposure as much as possible, and if this is not possible to use a sunscreen which protects for both UVB and UVA," he says.

DeLeo agrees, adding that "protecting yourself from UVB alone is not enough. Use a broad-spectrum sunscreen [that protects against both A and B]. Sunscreens in the U.S. today are not as effective in the A range as the B."

More information

For more information about skin cancer, visit the American Cancer Society and the Skin Cancer Foundation.

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People Don't Eat the Right Fruits, Veggies: Experts

 

Reuters Health

Tuesday, March 23, 2004  

NEW YORK (Reuters Health) - An apple a day may not keep the doctor away: experts.

Not all fruits and vegetables are created equal in terms of preventing disease, they note, and people consistently opt for relatively nutrient-poor choices, such as corn, potatoes, iceberg lettuce, apples and bananas.

Research suggests that people get the most disease-fighting benefits if they opt for so-called "powerhouse" choices that are rich in vitamins, beta carotene and fiber, such as dark green and leafy vegetables, carrots and cauliflower.

"When we look at how to get the most bang for your buck, the most power, it's by eating these other fruits and vegetables instead of the traditional choices," study author Dr. Marilyn S. Nanney said in a statement.

She added that the best way to keep track of which fruits and vegetables are better than others at preventing cancer, heart disease and other ailments is to separate them by color.

For instance:

White: Opt for cauliflower more often than potatoes, onions or mushrooms.

Green: Select dark lettuces, spinach, broccoli and Brussels sprouts, which are healthier than iceberg lettuce and green beans.

Yellow and Orange: Choose carrots, winter squashes, sweet potatoes, cantaloupe, oranges and grapefruit more often than corn or bananas.

Red: Eat tomatoes, red peppers and strawberries instead of apples.

So why the confusion? In the Journal of the American Dietetic Association, Nanney and her colleagues write that people often choose the wrong fruits and vegetables because they get the wrong information about what they should eat.

For instance, the U.S. Department of Agriculture (news - web sites)'s Food Guide Pyramid provides only "general guidance" about diet, Nanney and her team write. The pyramid recommends at least 5 servings of fruits and vegetables per day, and says little about which provide the most disease-fighting benefits.

The "5 A Day The Color Way" program, a revised form of a national program designed to help prevent cancer, includes recommendations for specific vegetables in the dark and leafy category, and which yellow or orange fruits and vegetables people should choose, but includes no guidelines on which cruciferous foods are better than others.

And while the American Cancer Society (news - web sites), the American Heart Association (news - web sites) and the American Institute of Cancer Research all recommend a variety of fruits and vegetables, none say which fruits and vegetables work best at warding off disease.

"People are quite frankly confused about nutrition," said Nanney, who is based at St. Louis University in Missouri. "I feel their pain," she added.

Source: Journal of the American Dietetic Association, March 2004.

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Studies Find Hysterectomy Viable Yet Avoidable

 

By Amanda Gardner
HealthDay Reporter

HealthDayNews

Tuesday, March 23, 2004

TUESDAY, March 23 (HealthDayNews) -- Two new studies on hysterectomy and quality of life conclude that, while there may be a place for surgery in easing abnormal bleeding, it often depends on the individual woman.

"It's kind of a judgment call," says Dr. James R. Scott, co-author of an editorial accompanying the two studies in the March 24/31 issue of the Journal of the American Medical Association (news - web sites). "It depends a lot on the woman. A lot of women don't want surgery. Others say they're just tired and want to get it done."

According to the first study, hysterectomy, which is the surgical removal of the uterus, is the most common major surgical procedure performed in the United States for non-obstetric reasons.

There has been a great deal of debate about whether the operation is performed too often. It is, after all, major surgery and involves significant recovery time, discomfort, and, like all surgery, a small risk of death.

It has also developed a negative reputation that these studies may help ease. "Hysterectomy has had a bad name, and it probably isn't as bad as has been implied -- by some, anyway," says Scott, who is also editor of Obstetrics & Gynecology.

The first study randomly assigned 63 premenopausal women with abnormal uterine bleeding to receive either a hysterectomy or "expanded medical treatment," including hormone therapy. The women, all of whom had tried and stopped the hormone therapy medroxyprogesterone, were followed for about two years to assess their mental health and quality of life.

After six months, women in the hysterectomy group showed greater improvements in overall mental health than women in the other group. They also had greater improvement in symptom resolution, symptom satisfaction, interference with sex, sexual desire, health desire, sleep problems, overall health and satisfaction with health.

Interestingly, at the end of two years, more than half (53 percent) of the women in the medicine group had requested and received a hysterectomy and reported improvements.

Women who continued with the medical treatment also reported improvements, indicating this course of action may eventually lead to improved quality of life.

In sum, though, hysterectomy seemed to come out ahead. "Women who have abnormal bleeding that have tried medicine and hasn't worked well, that hysterectomy is a very good option for them -- not that every woman should have a hysterectomy," says study author Miriam Kuppermann, an associate professor of obstetrics, gynecology and reproductive science at the University of California San Francisco. "For women who have not been adequately treated by medicine, hysterectomy is a worthwhile option to consider."

On the other hand, if a woman really does not want the operation, she can expect to get some benefit from medicine, Kuppermann adds.

The second study, taking place in Finland, compared levonorgestrel-releasing intrauterine system (LNG-IUS) with hysterectomy in women with menorrhagia, the medical term for unusually heavy menstrual bleeding. Levonorgestrel is a hormone. In Finland, the LNG-IUS is approved for contraception and treatment of menorrhagia while, in the United States, it is approved only for contraception. Leiras Co. (now Schering) provided the LNG-IUS free of charge.

Here, the researchers randomly assigned 236 women at five university hospitals in Finland to be treated with the LNG-IUS or hysterectomy. All women were monitored for five years.

The two groups were similar in terms of health-related quality of life and psychosocial well-being. As with the first study, however, a sizable proportion (42 percent) of the women in the nonsurgical group eventually opted for a hysterectomy.

Still, the LNG-IUS was clearly the less expensive route, at $2,817 per woman vs. $4,660 in the surgery group.

As the editorial writers point out, it comes down to deciding if the glass is half-empty or half-full. "You can interpret this two different ways," Scott says. "Does that mean that it's not worth it to try these other things or does it mean, well, look, it's worth it because half the time you can avoid surgery."

The findings are unlikely to change much in clinical practice, Scott adds.

But this might vary by region. "I can speak more to the [San Francisco] Bay Area. Here there really has been an emphasis on trying every last thing before resorting to hysterectomy," Kuppermann says. "This may have an impact. It may introduce hysterectomy as an option earlier on."

The sheer number of choices may indicate that this is a glass-half-full scenario. "There are a lot of choices," Kuppermann goes on to say. "Hysterectomy is a viable option. There has been so much press about overuse, but realize that for that situation, it is a very effective option."

More information

The National Women's Health Information Center and the U.S. Centers for Disease Control and Prevention have more on hysterectomies.

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Many Factors Impede Colorectal Cancer Screening

 

By David Douglas

Reuters Health

Tuesday, March 23, 2004

NEW YORK (Reuters Health) - The results of a survey of almost 900 primary care physicians in a large managed care organization indicate that multiple reasons, including reimbursement problems, keep patients from undergoing colorectal cancer screening tests. The study found that 79 percent of patients at average risk of this cancer were screened.

In an online edition of Cancer, Dr. Gareth S. Dulai of the Greater Los Angeles Veterans Administration Healthcare Systems and colleagues note that although HMOs may have higher rates of such screening than fee-for-service plans, only a limited number of studies have assessed screening practices in managed care.

To investigate further, the researchers analyzed survey responses received from 891 primary health care providers in a Californian HMO.

This study, Dulai told Reuters Health, "provides a 'snapshot' of HMO primary care providers and their colorectal cancer screening practices. Such screening appears to be a priority, but is still underused."

The average rate of recommendation of fecal occult blood testing, which looks for hidden blood in stool, was 90 percent. For flexible sigmoidoscopy, in which a lighted probe is used to examine the rectum and the left colon, the rate was 70 percent.

Among perceived barriers to testing were provider-related shortcomings, such as failure to recall that patients were due for screening. Among patient-related difficulties were poor compliance and lack of knowledge of the risks and benefits.

Reimbursement was also seen by some physicians as a problem, as were perceptions of the effectiveness of the tests. This was true, in particular, of fecal occult blood screening but not of sigmoidoscopy.

Dulai suggested that interventions that may increase the rate of colorectal cancer screening are "improved reimbursement, patient education, reminder systems and annual health exams."

Source: Cancer, May 1, 2004.

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Some Asthma Inhalers May Trigger Breathing Problems

 

By Amanda Gardner
HealthDay Reporter

HealthDayNews

Tuesday, March 23, 2004

TUESDAY, March 23 (HealthDayNews) -- An inactive ingredient found in some asthma inhalers may be counteracting the beneficial effect of steroids, which are often given to people with the breathing disorder.

If validated by future studies, this finding, which was done with cell cultures in a laboratory, may explain why some people have the paradoxical effect of getting worse, instead of better, when they use inhalers.

"Some patients can have wheezing or bronchodilation, which is what it [an inhaler] is designed to prevent or relieve," says Dr. Clifford W. Bassett, an allergist and asthma specialist at New York University Medical Center in New York City.

The research is to be presented March 23 at the annual meeting of the American Academy of Allergy, Asthma and Immunology in San Francisco.

Albuterol, one of a class of drugs called beta-agonists, is often given in combination with steroids to treat asthma and other lung diseases. It works by relaxing and opening the muscle surrounding air passages in the lungs.

"The key is that albuterol is really the sum of multiple parts," explains Dr. Michael Marcus, director of pediatric pulmonology, allergy and immunology at Infants and Children's Hospital of Brooklyn at Maimonides in New York City.

"Biochemically, the end result isn't usually a single chemical but a racemic mixture," he adds. In other words, albuterol has two components, an S-isomer and an R-isomer. The R-isomer is the active component, and it was originally thought that the S-isomer, which is inactive, had no effect on people using inhalers.

In fact, this may not be the case, according to the new study. "As they're able to separate the molecules and test the effects independently, what we've learned now is that the S molecule has significant activity and actually mimics the disease of asthma," Marcus says.

The new research, led by Bill T. Ameredes, co-director of the Asthma, Allergy and Airway Research Center at the University of Pittsburgh Medical Center, looked at the effect of the different isomers on the smooth muscle cells of the human airway. Specifically, the researchers wanted to see if the isomers enhanced or counteracted the anti-inflammatory effects of a steroid given simultaneously.

As it turned out, the R-albuterol in combination with the steroid dexamethasone reduced the production of a key inflammation-producing chemical signal in the airway muscle. This accentuated the anti-inflammatory effects of the steroid. That's the good news.

The unfortunate news is that the S-albuterol increased production of the same signal, effectively nullifying the other effects. "The suppression that we normally would get from steroids, that effect was nullified to a large degree," Ameredes explains.

Still, the study is a preliminary one. "We have to keep in mind that this is an initial study and that it was performed in a cell culture model so it wasn't a study that was actually performed in humans," Ameredes says. "But it gives us an indication that perhaps we need to give some further consideration to the fact that these S-isomers may not be in fact inert but may be producing responses, many of which are unknown but some of which may be counterproductive."

A version of the therapy with only the active ingredient is already available but, Ameredes says, is only available in a nebulized form. "My understanding is that it's used with quite good effect in emergency rooms, in terms of having it in an inhaler form," he says. "It is not available on market yet but I've heard that it is on the way."

More information

The American Academy of Allergy, Asthma and Immunology has more information on asthma medications and on asthma management.

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Monday, March 22, 2004

 

Parents' Smoking Raises Kids' Allergy Risk

 

By E.J. Mundell
HealthDay Reporter

HealthDayNews

Monday, March 22, 2004

MONDAY, March 22 (HealthDayNews) -- Family pets appear to protect infants from developing allergies, but only in homes that are free of cigarette smoke, researchers report.

While children of non-smoking parents were half as likely to develop allergies if exposed to pets in the home, researchers found the presence of pets "did not significantly alter the risk" if one or both parents smoked at home.

Although exact causes remain unclear, "inflammation in the airways caused by the particles and chemicals in cigarette smoke may be just as bad and block the effects, whatever they are, of being exposed to the dog or the cat," says study author Dr. Dennis Ownby, of the Medical College of Georgia in Augusta.

He presented his findings March 22 at the annual meeting of the American Academy of Asthma, Allergy & Immunology (AAAAI), in San Francisco.

Sensitivity to cat or dog dander remains one of the most common forms of allergy, and parents of newborns have long been concerned that the presence of animals in the home might encourage allergies in newborns. However, a string of studies released over the past few years seems to support the opposite view -- that early exposure to cats or dogs actually helps babies avoid a wide range of allergies.

"During that early, early time there seems to be some protection," says AAAAI spokeswoman Dr. Linda Ford. "I don't worry if women are pregnant and they are bringing a child into the house and they have an animal, cat or dog."

However, a quarter of adult Americans still smoke, and Ownby says he wanted to "take into account whether kids are getting exposed to cigarette smoke" at home, along with their exposure to pets.

In their study, the researchers examined the home environment and allergy histories of 474 Detroit-area children from birth to 7 years of age.

As expected, they found the presence of dogs and cats in non-smoking homes during infancy cut children's risk for allergy to dander, ragweed, dust mites and other agents by about 50 percent, compared to homes without pets.

However, no significant reduction in allergies was observed in homes contaminated by secondhand smoke -- even in the presence of pets.

The findings should give parents yet another reason to 'butt out' for good, Ownby says, for their own health as well as the health of their children.

Besides increasing allergy risk, "being exposed to smoke greatly increases the amount of trouble a child will have with their asthma," Ownby points out. "And being exposed to cigarette smoke also increases the risk that a child will have recurrent ear infections, and pneumonia severe enough to require admission to a hospital. There are a whole host of bad effects of secondhand cigarette smoke."

On the other hand, new parents should rest easy when it comes to keeping Fido or Fluffy around. "I don't think they have to feel guilty about having a pet in terms of increasing risks to their children of having allergies," Ownby says.

The findings do not apply to older children with pre-existing allergies, however. "If you have a young child who's already having symptoms and they have a skin test and test positive for cat and dog, then that's a different story," Ford says. In such cases, "the cat or dog has got to go."

More information

For information on allergies and allergy control, visit the American Academy of Allergy, Asthma & Immunology. For help with quitting smoking, check with the American Lung Association.

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FDA Says Antidepressant Patients Need Watching

 

By Susan Heavey

Reuters

Monday, March 22, 2004

WASHINGTON (Reuters) - Patients taking anti-depressants, including children and teenagers, should be closely monitored for signs of worsening depression and suicidal thoughts, U.S. health authorities said on Monday.

The warning comes after a panel of experts last month called on the U.S. Food and Drug Administration (news - web sites) to issue stronger warnings about the possible risks of suicidal behavior among children and teenagers taking antidepressant drugs.

U.S. health officials are studying whether antidepressants can make children and teenagers suicide-prone, but have not yet reached a conclusion.

"We do not know whether or not the treatment ... causes these changes. It may just be the natural course of the disease," said Dr. Russell Katz, head of neuropharmacological drugs at the FDA's Center for Drug Evaluation and Research.

Until it concludes its studies, the agency called on doctors to closely monitor for signs of hostility, anxiety, insomnia, and other behaviors that could signal worsening depression and suicidal thoughts.

Regulators first alerted physicians to carefully watch children or teenagers taking antidepressants last fall. Today's stronger warning calls for closer monitoring and urges patients, families and caregivers to spot behavioral changes.

Patients should alert their doctors, who may consider lowering the dose or ending use of the drug, the FDA said.

The agency also asked manufacturers to change the labels of 10 drugs to include larger and more prominent warnings about patient monitoring.

Those 10 drugs include Eli Lilly and Co.'s Prozac, Pfizer's Zoloft, and three GlaxoSmithKline Plc drugs -- Wellbutrin, Zyban and Paxil.

The FDA is also evaluating Forest Laboratories Inc.'s Celexa, Wyeth's Effexor, Bristol-Myers Squibb's Serzone, Solvay's Luvox, and Akzo Nobel's Remeron.

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

Only Prozac, sold generically as fluoxetine, is approved for treating pediatric depression. Eli Lilly said it welcomed monitoring but emphasized the FDA has not yet found a clear link between antidepressants and suicide.

"Since suicidal thinking is an inherent part of depression, we believe careful monitoring of patients is very important and worthwhile," Eli Lilly spokesperson Jennifer Yoder.

The impact of the FDA warning on drug stocks was unclear. The American Stock Exchange pharmaceutical index closed down 0.89 percent on Monday, a day when major indexes fell more than 1 percent on global security fears.

In Britain, health authorities have advised doctors not to prescribe most SSRI drugs, or selective serotonin reuptake inhibitors, to anyone under 18.

Dr. Richard Gorman, of the American Academy of Pediatrics, said it was too soon to tell whether British officials were being overly cautious or whether U.S. regulators "dragged their feet."

Either way, antidepressant use in youth "should have been studied prior to being released," said Gorman, a pediatrician in Baltimore.

Experts on last month's panel were especially concerned with suicide risk in youth, but the FDA said it was also reevaluating the risk for adults, who should also be monitored.

FDA officials said they plan to make their final decision in September. (Additional reporting by Lisa Richwine)

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Early Breast Cancer Growth Tough to Treat

 

By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, March 22, 2004

WASHINGTON - Women often are told it's the earliest form of breast cancer, but it acts more like pre-cancer — a growth in the milk ducts called DCIS. Diagnosed in over 55,000 women a year, it's vexing to treat.

A major new study shows just how vexing, uncovering vast differences around the country in how these growths are removed — suggesting some women are overtreated and others undertreated — and giving new urgency to efforts to educate patients about their choices.

This growth, named ductal carcinoma in situ, causes intense confusion.

"You hear that carcinoma word, and everybody thinks, 'Oh my God, this is exactly like the big breast cancer that the lady down the road had chemo for eight months for,'" says Dr. Monica Morrow, director of breast surgery at Chicago's Northwestern Memorial Hospital.

In fact, it's very different. Removing DCIS prevents invasive breast cancer, the kind of cancer that can spread through the body and kill. Only about 2 percent of patients originally diagnosed with DCIS die of breast cancer in the next 10 years.

"Understand that your risk of dying of cancer is incredibly low, and there is no rush to be in the operating room in a couple of days," Morrow tells the newly diagnosed.

Some call DCIS pre-cancer, a cluster of abnormal, cancer-like cells in the milk ducts. Others call it "stage zero" breast cancer, the very earliest form. Whatever the name, true DCIS is noninvasive, meaning it hasn't penetrated into the breast tissue and can't itself spread to other parts of the body, explains Morrow.

But it's important to make sure the woman has pure DCIS and not a mix of that and invasive breast cancer.

Also crucial is trying to tell who has a more aggressive form of DCIS, because those women are more likely to suffer a later bout of invasive breast cancer, the life-threatening kind.

The problem: Doctors don't yet have a good way to make that prediction, which makes selecting a treatment difficult. Do women need a mastectomy or lumpectomy? Radiation or not? Lymph node removal or not?

Such questions have arisen only relatively recently. Before 1980, doctors hardly ever diagnosed DCIS. Since then as mammogram use grew, diagnosis of DCIS skyrocketed, to 55,700 new cases last year alone.

Now University of Minnesota scientists have discovered that which treatment is selected may depend more on where the patient lives and which surgeon she chooses than on the actual characteristics of the DCIS.

The study tracked 25,000 women diagnosed with DCIS throughout the 1990s. Among the findings:

·        The proportion who had a mastectomy dropped from 43 percent to 28 percent during that time. Mastectomies sometimes are required for DCIS if there is more than one growth or it's so large that a lumpectomy makes no sense. No one knows what an optimal mastectomy rate is, although specialists believe it should be low.

·        Overall about half of patients who had a lumpectomy for DCIS received radiation afterward. While radiation isn't recommended for everyone, there was wide geographic variability: Only 39 percent of women in parts of California got radiation, compared with 74 percent in Hawaii.

·        Worse, a third whose DCIS was found to be aggressive — the medical term is comedo histology — didn't get radiation.

Removal of lymph nodes from the armpit isn't recommended for DCIS, yet in some regions more than 40 percent of patients underwent that extra step.

"We have to acknowledge the fact that there's this variation and figure out why and what we should do," says Dr. Nancy Baxter, who led the study published in last week's Journal of the National Cancer Institute (news - web sites). "The lion's share is not patient preference."

The good news: Baxter found that while overall DCIS skyrocketed, the proportion that shows signs of being most aggressive stayed about the same.

So what's the best treatment advice?

A consumer group, the National Center for Policy Research for Women and Families, recently held a government-funded meeting of DCIS specialists to reach a consensus on best practices, and plans to issue patient advice later this year.

There's a lot of scientific disagreement, but specialists did stress a thorough pathologic exam to determine DCIS aggressiveness, trying to save the breast, and post-surgery therapy for the right candidates, said center director Diana Zuckerman. That might mean, for example, that a 75-year-old or a woman with some other life-threatening disease could skip radiation while an otherwise healthy 40- or 50-year-old should get it.

"You need to take the time to understand your options," Northwestern's Morrow stresses. "If there's ever a disease that's worthwhile seeking a second opinion on, it's DCIS."

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

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Daily Drink Eases Hypertensives' Heart Risk – Study

 

Reuters

Monday, March 22, 2004

CHICAGO (Reuters) - The protection against heart disease from moderate drinking extends to men with high blood pressure, suggesting current advice for such patients to avoid alcohol is wrong, researchers said on Monday.

Long recognized as a stress reducer that cuts the risk of heart disease and strokes, wine and other forms of alcohol may have anti-clotting properties and boost blood levels of high-density lipoprotein, the so-called good cholesterol.

The study found that hypertensive men who drank moderately -- one or two drinks per day -- had a 44 percent lower risk of dying from a heart attack than nondrinkers with high blood pressure.

Based on an ongoing survey of 14,126 male doctors, the Physicians' Health Study, the five-year study concluded the overall risk of death was 28 percent lower among moderate drinkers with hypertension compared to hypertensive nondrinkers.

The benefit was also seen among light drinkers of one to six drinks a week, but the more alcohol consumed -- as long as it remained moderate -- the lower the risk of dying.

As with other studies that have concluded drinking can be good for one's health, the researchers from Brigham and Women's Hospital in Boston warned about health problems such as liver damage, high blood pressure and obesity that can accompany heavy drinking.

"However, patients with hypertension who are able to maintain light to moderate alcohol intake have no compelling reason to change their lifestyle and eliminate a possibly beneficial habit," lead author Michael Gaziano wrote in the study published in The Archives of Internal Medicine (news - web sites).

There are a variety of risk factors for cardiovascular disease, which is the leading cause of death in the United States, but the findings call into question current American Heart Association (news - web sites) guidelines that recommend hypertensive patients avoid alcohol completely, the report said.

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Study: Insecticides May Affect Infant Size

 

The Associated Press

Monday, March 22, 2004

NEW YORK - Insecticides may adversely affect the size of babies born in upper Manhattan, but new restrictions on the substances have coincided with a rebound in baby sizes in the area, according to a study to be released Monday.

Mothers with the highest amounts of chlorpyrifos and diazinon in their umbilical-cord blood gave birth to babies an average half pound lighter and one-third of an inch shorter than those born to mothers with no discernible level of the substances, the study by researchers from Columbia University found.

But sizes of newborns appeared to rebound as the U.S. Environmental Protection Agency (news - web sites) gradually imposed a ban on indoor use of the two pesticides — once widely used by exterminators — between 2000 and 2002, the study found. (The substances are still allowed on farms.)

The study found one-third of babies were born to high-exposure women between 1998 and 2000, but only one in 77 were in that group between 2001 and 2002. The decrease in exposure coincided with a rise in babies' sizes, said Dr. Robin Whyatt, lead author of the study and a professor at Columbia.

Birth weight may affect children's later physical and mental health, researchers said.

The study included 314 babies born in Harlem and Washington Heights, in upper Manhattan. It was to be published in the journal Environmental Health Perspectives.

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Stress Can Cause Heart to Misfire, Study Shows

 

Reuters

Monday, March 22, 2004

WASHINGTON (Reuters) - Anger and frustration are more likely to kick a susceptible heart into potentially fatal irregular rhythm than exercise is, U.S.-based researchers reported on Monday.

Tests on patients with an implanted defibrillator -- a pacemaker-like device which kicks in to shock the heart back to a normal rhythm -- suggest that mental stress affects the heart through a different pathway that does strenuous exercise, the researchers said.

"There is folklore and epidemiological evidence that aggravation can trigger heart attacks," said Willem Kop of the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

But he said his was the first study to actually show that being angry or mentally stressed can cause arrhythmia, or an irregular heartbeat, among high-risk patients.

These disruptions from mental stress are seen at significantly lower heart rates than those related to exercise, said Kop, who led the study.

Writing in the journal Circulation, Kop and colleagues said they used electrocardiograms to measure fluctuations in heart rate called T-wave alternans, which can precede arrhythmias, in 23 patients with an average age of 62. All the patients had implantable cardioverter defibrillators, or ICDs.

To stress the volunteers, the researchers asked them to recall a recent incident that angered them and also made them subtract multiples of the number seven from a four-digit sum, while interrupting them and telling them to do better.

They also tested 17 healthy volunteers without heart trouble who were matched for age and gender.

Heart medications were withheld from most of the patients before testing, including ACE inhibitors, long-acting nitrates, beta-blockers and calcium channel blockers, they said.

After adjusting for heart rate, mental stress and exercise provoked higher T-wave alternans responses in defibrillator patients than in the volunteers without the devices.

Kop said this suggests that different nervous system mechanisms are involved when mental stress affects the heart that when exercise does.

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Diabetes Looms Large

 

By Adam Marcus
HealthDay Reporter

HealthDayNews

Monday, March 22, 2004

MONDAY, March 22 (HealthDayNews) -- Emerging outbreaks such as SARS (news - web sites), Ebola (news - web sites) and avian flu make the most dramatic headlines, but there's a more destructive epidemic that threatens far more lives in the United States and the rest of the world: Diabetes.

Diabetes is the sixth leading cause of death in the United States. It was directly or indirectly implicated in more than 213,000 deaths in 2000, according to the U.S. Centers for Disease Control and Prevention (news - web sites).

To focus attention on this growing epidemic, the American Diabetes Association has declared March 23 American Diabetes Alert Day.

Experts believe that 18.2 million Americans, or about 6 percent of the adult population, have diabetes, although only 13 million know it. Between 90 percent and 95 percent of diabetics have the type 2 form of the blood sugar disease, the version closely linked to excessive weight.

Unlike type 1 diabetes, in which insulin producing cells in the pancreas die off early in life, patients with type 2 diabetes gradually lose sensitivity to the hormone but continue to make it. Many of these patients require daily injections of insulin to make up for the reduced ability of their cells to respond to insulin.

In addition to people with full-blown diabetes, at least 20 million other Americans have a precursor condition called pre-diabetes. These people show signs of insulin trouble and abnormally high blood sugar that's alarming but not high enough to be called diabetes.

This simmering situation carries its own risks. Scientists have mounting evidence that even moderate blood sugar problems can seriously harm the heart, blood vessels, kidneys and other organs.

As bad as the picture appears, the future only looks worse.

"The worst case scenario is that we'll just get fatter and fatter and more sedentary until we look like Jabba the Hutt [the galactically obese crime kingpin from Star Wars] and everybody will have diabetes in their 40s and 50s," says Dr. John Buse, director of diabetes care at the University of North Carolina School of Medicine.

People who do develop diabetes in their 40s can expect 15 to 20 years fewer, on average, of quality life, Buse, president of the American Diabetes Association, says. "It's a pretty dismal picture." Unless trends change dramatically for the better, one in two Americans born today will be a middle-aged diabetic, he says.

The good news, however, is that pre-diabetes doesn't have to make the jump to the real thing. Taking steps to improve blood sugar, such as losing weight, quitting smoking and exercising regularly, can prevent pre-diabetes from evolving into diabetes.

"It looks like moderately vigorous physical activity, 30 to 60 minutes most days of the week is enough" to control blood sugar, Buse says.

Another tip: Watch the intake of junk foods, swapping them for fresh fruits and vegetables. Also, avoid high-calorie snacks. And be sure to get regular checkups. "Most of these things we can see coming for years, if not decades," Buse says. "Don't neglect yourself."

Dr. Christopher Saudek, a Johns Hopkins University diabetes expert and a past president of the American Diabetes Association, says keeping a close eye on blood sugar is especially important for people at high risk of diabetes and those with a family history of the disorder.

"People at risk are really well-defined," Saudek says. "They're overweight, they have a strong family history of diabetes, a history of diabetes during pregnancy, or they're members of certain minority groups" including blacks, Hispanics and American Indians.

People in these categories should have their blood sugar tested often, probably once a year, he says. Those who aren't at high risk can be tested every three years, starting at age 45, Saudek says.

If a test indicates pre-diabetes, Saudek says, it's time to take action. "Work on some healthy habits like losing weight and being active," he says. "Even by losing five to 10 pounds the blood sugar can improve and may go back to a perfectly normal level."

More information

To learn more about diabetes, visit the American Diabetes Association and the National Institute of Diabetes and Digestive and Kidney Diseases.

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Drug to Prevent Breast Cancer Not Fully Used-Study

 

Reuters

Monday, March 22, 2004

WASHINGTON (Reuters) - A drug that cuts the rate of breast cancer by 50 percent in women most at risk is not being used as much as it could be, because doctors are failing to offer it and some patients are confused about taking it, U.S. researchers said on Monday.

Women may be afraid to take the drug tamoxifen because it raises the risk of cancer of the uterus, as well as the risk of blood clots that can cause heart attacks, embolisms or strokes, the team at Northwestern Memorial Hospital in Chicago found.

They looked at the records of 219 women with higher-than-average breast cancer risk. Only 63 percent of the women were offered tamoxifen and only 26 percent accepted, they found.

"Our findings indicate that both physician practice and the attitudes of at-risk women are responsible for low rates of tamoxifen usage," the researchers wrote in their report, published in the American Cancer Society (news - web sites) journal Cancer.

Tamoxifen, a pill used to treat breast cancer, has been shown to reduce cancer rates by 49 percent in women who have a high risk of the disease either because they have had precancerous lesions, a strong family history, or for other reasons.

Women with lesions called atypical hyperplasia or lobular carcinoma in situ benefited the most. They had an 86 percent reduction in cancer when they took tamoxifen.

And the study in Cancer showed these were the women most likely to be offered tamoxifen.

"That makes sense," said Dr. Monica Morrow, a breast surgeon who led the study.

"What doesn't make sense is that women significantly less likely to have side effects, such as premenopausal women and those without a uterus, did not accept tamoxifen more frequently than other groups," Morrow added in a statement.

She said better education is clearly needed. While tamoxifen increases the risk of uterine cancers, the risk is so low to start with that it still remains more unlikely than breast cancer.

"There clearly is a lot of confusion among women about the risks and benefits of tamoxifen chemoprevention," Morrow said.

"Our findings indicate a great deal of misunderstanding about tamoxifen's risks and benefits among women, probably due to all the negative press it has gotten over the years."

Breast cancer is the biggest cancer killer of women after lung cancer, affecting more than 200,000 U.S. women in 2003 and killing 40,000.

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Feasting After Fishing

 

HealthDayNews

Monday, March 22, 2004

(HealthDayNews) -- For many people, fishing is more than just a sport -- it's a way of putting food on the table.

But before you make your catch tonight's dinner, heed this advice from the Virginia Department of Health:

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Bloated Costs, Risk Cast Doubt on Stomach Stapling

 

By Debra Sherman and Kim Dixon

Reuters

Monday, March 22, 2004  

CHICAGO (Reuters) - Just when the U.S. government has declared obesity a public health crisis, insurers are growing more skeptical of drastic -- and expensive -- remedies like "stomach stapling" surgery.

Demand is skyrocketing for these bariatric surgeries, which shrink the stomach to help the obese lose weight. The number of procedures performed in the United States jumped to 103,000 last year from about 16,000 in the early 1990s, according to Dr. Robert Steinbrook, a national correspondent for The New England Journal of Medicine (news - web sites).

"The epidemic of obesity in the United States has spawned a second epidemic -- of bariatric surgery," he wrote in the March 11 edition.

Analysts say many factors are driving the frenzy, including a rise in obesity, the advent of less-invasive surgical techniques and publicity from celebrities like NBC television personality Al Roker and singer Carnie Wilson, whose surgery was broadcast over the Internet.

But as health insurers grapple with mounting medical costs, the $30,000 procedure is coming under close scrutiny. HMOs say the complication rate is high, and some are refusing to cover it at all.

"While everyone initially covered it, I think everyone is getting more diligent" about qualifying patients who really need it, said Mohit Ghose, spokesman for the trade group that represents most U.S. managed health plans.

The surgery is recommended for people who are "morbidly obese" -- generally defined as overweight by more than 100 pounds for men and 80 pounds for women. According to U.S. government data, 4.7 percent of Americans fall into that category.

But experts agree the risks of the surgery are grave -- including excessive bleeding, blood clots, infection, ulcers, gastrointestinal leaks, respiratory failure and spleen injury.

"Questionable Benefit"

Inamed Corp., maker of the banding device that squeezes the stomach so that a smaller portion is available to digest food, has factored more insurance coverage into its financial projections.

But Blue Cross and Blue Shield of Florida, with 6 million members, will end coverage of bariatric surgeries next year, saying they are "risky" and "of questionable benefit."

These procedures include gastric banding, which uses Inamed's device to reduce the size of the stomach, as well as gastric bypass surgery, which shrinks the stomach and routes food past much of the digestive system.

Barry Schwartz, vice president of care at Florida's Blue Cross, said the risks drove the decision not to cover the surgery, but to a lesser extent, cost also was a factor.

Many physicians consider the procedures a "cash cow," he said, and the number of unqualified doctors performing the surgery has spiked dramatically.

Schwartz contends obesity is not a disease, but rather a condition that people can modify with diet and exercise.

But Morgan Downey, executive director of the American Obesity Association patient advocacy group, said advice to diet and exercise is a "simplistic remedy," although he acknowledged the dilemma for insurers.

"The irony is that they're still paying for all the conditions that obesity causes," Downey said. They include costly ailments like diabetes, hypertension, arthritis and heart disease.

Employers Struggle

Corporate America is putting pressure on health plans to limit big-ticket procedures like bariatric surgeries, according to a recent survey by the nonpartisan Center for Studying Health System Change.

Nebraska's Blue Cross decided most of its plans should stop covering the surgery beginning this year so they can keep costs down and compete more effectively, according to spokeswoman Celann LaGreca.

"It's driven by what employers are willing to pay for," she said.

UnitedHealth Group Inc, the No. 1 health insurer, and Coventry Health Care Inc. are rivals in Nebraska Blue Cross' market, she said.

Coventry spokesman Dale Wolf would only say the company will cover the procedure if it is "medically necessary," but would not elaborate. A UnitedHealth spokesperson did not comment.

William Popik, chief medical officer at Aetna Inc., said the surgery is often performed on patients who have not met criteria like the ability to stay on a diet for several months.

Employers are asking more questions about the legitimacy of paying for coverage for so many people, he said.

"I'm aware of people who have actually gained weight to get up to the morbid criteria to get the surgery," Popik said, "and I'm concerned that people see it as a quick fix."

While achieving weight loss may save the health care system money over the long term, individuals do not stay with one plan long enough for the insurer that pays for the surgery to benefit, said Dr. Alan Wittgrove, president of the American Society of Bariatric Surgery.

"An insurance company isn't interested in saving another insurance company money several years down the road," Wittgrove said. "They have to answer to their shareholders next quarter."

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Contact Sports and Skin Infections

 

HealthDayNews

Monday, March 22, 2004

(HealthDayNews) -- Because of the close body contact involved in sports like football, rugby or hockey, participants face an increased risk of skin infection, according to the Utah Department of Health.

If you play contact sports, use these skin-safety guidelines:

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Smoking Speeds Up Memory Loss in Old Age

 

By Alison McCook

Reuters Health

Monday, March 22, 2004

NEW YORK (Reuters Health) - Elderly people who smoke show a five-fold faster rate of age-related mental decline than people who never smoked, according to new study findings released Monday.

Among former smokers, mental decline occurred around twice as fast as in those who said they never smoked.

And the more people smoked during their lifetimes, the quicker they appear to lose their mental faculties with age, the authors note.

These findings represent another reason why smokers should quit, and one that "may appeal to the people who didn't stop for other reasons," study author Dr. Lenore Launer of the National Institute on Aging in Maryland told Reuters Health.

This is not the first study to link smoking with mental decline. Previous research has shown that middle-aged smokers tend to show a faster rate of decline in old age, and may experience more cognitive changes than non-smokers even before they reach age 60.

During the study, Launer and her colleagues tested mental function in 9,209 people over the age of 65; they then retested them an average of 2 years later. All participants were free of dementia during the study period.

The researchers measured participants' cognitive function using the Mini-Mental State Examination (MMSE), a short assessment tool used worldwide.

The authors found that never-smokers showed a decline in MMSE score of .03 points per year. Among current smokers, MMSE score dropped .16 points each year, while former smokers' scores fell by .06 points annually.

And the more packs of cigarettes people smoked, the faster they tended to lose their mental functioning as they aged, the authors report in the journal Neurology.

In an interview, Launer explained that the small change in MMSE score means that each individual smoker will likely not notice a difference in their mental functioning from year to year. But over time, she added, smokers will likely be quicker than non-smokers to notice that their brains are not working the way they used to.

Moreover, the fact that smokers as a whole experience a faster rate of cognitive decline with age shows that smoking's influence on the brain has a significant impact on public health, Launer added.

Launer explained that smoking likely affects mental functioning by causing problems in the blood vessels feeding the brain, leading to a loss of nutrients and the destruction of brain tissue.

She added that these findings suggest that repeated exposure to secondhand cigarette smoke may also cause changes to young, developing brains, and may also affect cognitive function in elderly non-smokers.

Neurology, March 23, 2004.

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Simple Ways to Improve Colorectal Cancer Screening Rates

 

HealthDayNews

Monday, March 22, 2004

MONDAY, March 22 (HealthDayNews) -- Some simple changes may improve colorectal cancer screening rates in the United States.

That claim comes from a study that's the first to evaluate barriers to screening and factors that might make it easier for people to get screened in a managed-care setting.

Colorectal screening rates in the United States are less than 50 percent, even though colorectal cancer is the second leading cause of cancer death in the nation. In part, that's because the cancer is often detected at advanced stages.

Widely available screening tests include fecal occult blood test (FOBT) and flexible sigmoidoscopy (FS). Both can detect colorectal cancer earlier and reduce the risk of death.

This University of California, Los Angeles, survey of 1,340 HMO primary-care doctors found they screen only 79 percent of eligible patients. Half of the doctors said they recommended FOBT to less than 90 percent of eligible patients, FS to less than 70 percent of patients, and colonoscopy to less than 8 percent of patients.

The survey identified a number of barriers to the use of colorectal cancer screening. These include: poor payment for and lack of time to perform FS; concerns about false positives and negative test results with FOBT; poorly compliant and educated patients; and doctor forgetfulness about when to screen patients.

Suggested ways to improve screening rates include: increased payments to doctors; educating patients and doctors about current screening guidelines and screening effectiveness; developing methods to remind doctors and patients about screening; and regularly scheduled physical examinations.

The study appears in the March 22 online edition and in the May 1 print issue of Cancer.

More information

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

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Poor Care Plus Dementia Equals Violence, Experts Say

 

By Maggie Fox, Health and Science Correspondent

Reuters

Monday, March 22, 2004

WASHINGTON (Reuters) - Demented Americans are going undiagnosed because health care workers who deal with them are untrained and often underpaid -- and the result,

Dr. Constantine Lyketsos, a geriatric psychiatrist at Johns Hopkins University and Hospital in Baltimore, said only about 30 percent of patients with dementia are diagnosed by their primary care doctors.

"Part of the problem is that the costs associated with treating these symptoms are high, and Medicare fee and reimbursement structures are not conducive to clinicians getting paid for managing these symptoms," Lyketsos said in remarks prepared for delivery.

Lyketsos was one of several experts slated to testify before the Senate Special Committee on Aging who warned the problem could worsen as the U.S. population ages unless something is done to better train health care providers and to improve the organization and funding of health care, including Medicare.

Donna Cohen, a professor of aging and mental health at the University of South Florida and a co-founder of the Alzheimer's Association, cited several examples of recent violence by confused or upset dementia patients who killed others, including a man who beat his wife to death and another who shot his wife, a fellow nursing home resident and finally himself.

"Although lethal violence is relatively uncommon at the moment, it is possible that homicide and severe violence may increase as the population ages, accompanied by increasing numbers of individuals with Alzheimer's disease (news - web sites) and related dementias," Cohen said in prepared testimony.

She said in 2000 there were at least 4 million people with Alzheimer's disease and related dementias in the United States, and the number was estimated to increase to between 11.3 million to 16 million Americans by 2050.

Last month's shooting death of sheriff's deputy Brian Litz in Ocala, Florida, was also cited; Litz was killed by an undiagnosed Alzheimer's sufferer, Ivan Gotham, 74.

"Cases of severe violence by seniors with dementia continue to grow," said U.S. Sen. John Breaux of Louisiana, a ranking Democrat on the committee.

"By training family members, health care providers, law enforcement officials and the court system to better understand and treat those with dementia, we can prevent many of these incidents," Breaux said in a statement.

Lyketsos said up to 90 percent of Alzheimer's patients may develop symptoms other than memory loss.

"Among the most troubling to patients and caregivers are depression, delusions, hallucinations and otherwise unexplained agitation," Lyketsos said. "Physical violence is not uncommon, being exhibited by about 15 percent to 18 percent of patients per year."

Doctors, nurses and other health care workers are not trained to detect these symptoms early on, he added.

"This is a major missed opportunity on the part of our health care system to intervene early to prevent severe behavior problems among Alzheimer sufferers," Lyketsos said.

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Parental Support Has Lifelong Benefits

 

By Kathleen Doheny
HealthDay Reporter

HealthDayNews

Monday, March 22, 2004

MONDAY, March 22 (HealthDayNews) -- Abundant parental support during childhood leads to better mental and physical health throughout adulthood, a new study finds.

Conversely, a lack of love is associated with depression and chronic health problems, says Benjamin A. Shaw, an assistant professor of social behavior and community health at the University at Albany School of Public Health in Rensselaer, N.Y.. He is lead author of the study, published in the March issue of Psychology and Aging.

"What I found is a large portion of the association can be explained by what we call psychosocial resources -- the idea is that adults who receive a lot of support from their parents early in life tend to have higher self-esteem, better social relationships, and a better sense of personal control."

Those qualities, in turn, "help people cope with stressful situations, help them problem solve without turning to problem behaviors such as smoking and drinking," Shaw says.

For the study, Shaw and his colleagues analyzed responses from 2,905 adults, aged 25 to 74, who participated in the National Survey of Midlife Development in the United States. The respondents were asked about how available emotional support was from their mothers and fathers during their growing years.

They were asked such questions as how much they could confide in parents and how much love and affection they remembered getting.

If there was a lack of parental support, the adults were more likely to report depressive symptoms and chronic health conditions such as high blood pressure, arthritis, and urinary problems. The connection persisted into early old age.

The association seems to be more strongly linked to mental health than physical health problems, but Shaw says more physical problems may show up as the adults age.

Shaw says his study is not the first to show the association, but the sample size is larger and less specialized.

While many other studies have looked at only mental health outcome, his data adds to the smaller amount of research on physical health outcomes, he adds.

The data didn't quantify the association, Shaw says. There is no way to say, for instance, that a lack of support during childhood was tied to a threefold or fourfold increase in a mental or physical problem in adulthood.

"I think the biggest surprise is that the relationship [between early support and health] persists at these older ages," Shaw says. "The idea that the level of parental support [during childhood] still sort of matters, even up to age 75, is kind of surprising, I think. You'd think these effects would diminish, but they really didn't."

Another expert praises the study. "I think it was a terrific idea to make this connection," says Barry Ginsberg, a child and family psychologist in Doylestown, Penn. He believes the association has to do with security. "If you grow up in an environment in which you feel low anxiety, a sense of safety and the emotional connection you get out of that, the attachment component is probably the most significant aspect of this."

"These early relationships define how you understand yourself and relate to others," Ginsberg adds. "Good skills in those areas can help protect you from physical and mental problems."

More information

To find out more about good parenting, visit the American Psychological Association or Planned Parenthood.

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Study Yields Clues on Expanded Defibrillator Use

 

By Bill Berkrot

Reuters

Monday, March 22, 2004

NEW YORK (Reuters) - Following a landmark study this month that showed far more patients could be saved by simple shocks from implantable defibrillators, officials must now determine who would best benefit from the cardiac devices.

The so-called SCD-HeFT study demonstrated that implantable cardioverter defibrillators, or ICDs, lowered the risk of sudden cardiac death by 23 percent in patients with moderate heart failure. The results could double ICD sales for Medtronic Inc., which sponsored the trial, and other makers of the devices that shock a dangerously irregular heartbeat back into normal rhythm.

"There's no doubt we are going to have to expand ICD usage after SCD-HeFt. I don't think we have any other option but to do it," Dr. Mandeep Mehra, a heart failure specialist at the Ochsner Clinic in New Orleans, told Reuters in an interview.

The trial's lead investigators cautioned against trying to cull meaningful data from subgroups within the study. But doctors and Medicare officials must do just that as they seek to identify those who should be covered for the $25,000 devices, since there is no way government insurance programs can afford to pay for everyone who might benefit.

While it may seem counterintuitive, Mehra said, it appears less severely ill patients may make the best ICD candidates.

Severity of heart failure is ranked on a scale of 1 to 4, with class 4 being the most gravely ill patients. SCD-HeFT looked at class 2 and 3 heart failure patients and included those whose disease was caused by clogged arteries, as well as from other conditions, known as non-ischemic patients.

"Now we are learning that clearly in class 2 patients with heart failure, whether they have coronary disease or not, we ought to consider the placement of an ICD," Mehra said.

"There is not even a hint of benefit in class 3 patients from ICD," he added.

Medicare currently spends about $1 billion a year for a total of some 40,000 ICDs, according to a Medicare agency spokesman. The U.S. Centers for Medicare and Medicaid Services, known as CMS, will almost surely expand coverage based on SCD-HeFT, but by how much and for whom remain the big questions.

The NASPE-Heart Rhythm Society estimates that only a quarter of those who would benefit from an ICD actually receive the devices. Medtronic has suggested an additional 600,000 patients should receive ICDs.

Mehra, who has lectured the CMS on cardiac devices and has been nominated to sit on the Medicare coverage and analysis committee, said CMS will have to come up with more inclusive criteria "to expand use of ICDs to the non-ischemic population and to expand it to class 2 patients."

"The whole thought process is going to have to be based on what is the expectation of a patient's survival," he said. "These devices are not designed to make you feel better. They are designed for crisis intervention."

Dr. Anne Curtis, first vice president of the Heart Rhythm Society and a professor of medicine at the University of Florida, believes SCD-HeFT data requires more detailed analysis. But she said that CMS "may feel some pressure" to open its wallet for ICDs for non-ischemic patients.

"The biggest thing to come out of SCD-HeFT is that patients with heart failure not from coronary artery disease should be eligible to receive defibrillators," Curtis said.

Mehra is currently helping develop comprehensive new guidelines for the Heart Failure Society of America.

"We are rewriting the book on heart failure," he said.

The new guidelines will address SCD-HeFT results, including the part of the study that looked at the widely used anti-arrhythmia drug amiodarone, which is sold as Cordarone by Wyeth .

"The routine use of amiodarone is an ill-conceived notion in heart failure," Mehra said.

"We now know clearly that at least in the more severe heart failure patients, that great caution has to be exercised in amiodarone use, and in fact we believe we should try to avoid amiodarone if at all possible," Mehra said.

"SCD-HeFT has clarified many things for us."

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Molecules Further Cystic Fibrosis Inflammation

 

HealthDayNews

Monday, March 22, 2004

MONDAY, March 22 (HealthDayNews) -- Molecules that influence cystic fibrosis (CF) lung inflammation have been identified by researchers at Cincinnati Children's Hospital Medical Center.

The finding, published in the current issue of Nature Immunology, may help in the development of new treatments to decrease inflammation in children with CF, a life-threatening, genetic disease that causes chronic lung infections and impairs digestion.

The Cincinnati Children's researchers identified a deficiency in the airways of children with CF of a class of molecules called lipoxins. These are key regulators of inflammation.

"When we give analogs of this molecule (lipoxin-like molecules) in mouse models of CF, the molecules do what we'd like them to do -- suppress acute inflammation, switch on the chronic inflammatory process and ameliorate disease -- suggesting that this class of molecules might have therapeutic potential in CF," study author Dr. Christopher Karp, director of molecular immunology at Cincinnati Children's, says in a prepared statement.

Studies in recent years suggest that frequent and prolonged inflammation in the lungs of people with CF eventually destroys the lungs and results in the cardio-respiratory failure that's the primary cause of death in people with CF.

"It's traditionally been thought that the basic problem in the CF lung is an inability to clear bacteria, with infection leading secondarily to lung-damaging inflammation," Karp says.

"Recent studies suggest it may well be the other way around: abnormally vigorous and prolonged airway inflammatory may be a primary problem. Such responses are inefficient at clearing bacteria, and over time lead to airway destruction," he says.

More information

The American Medical Association has more about cystic fibrosis.

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Self-Reported Food Intake May Thwart Research

 

By Amy Norton

Reuters Health

Monday, March 22, 2004

NEW YORK (Reuters Health) - A new study of overweight, diabetic women casts doubt on the reliability of the self-reported dietary habits often used in medical research.

Researchers found that most of the 200 women they studied, as many as 81 percent, reported eating fewer calories than they actually had, based on objective measures.

Many also claimed to have eating habits that closely matched the recommended diet for diabetics, which suggests the women were really reporting what they thought they should be eating, according to the researchers.

The problem with fibbing about or underestimating calories is that it makes it hard to measure the true effectiveness of dietary interventions--a key component of diabetes treatment. The new findings point to the importance of using some objective measure to back up research participants' dietary claims, the study authors report in the March issue of the journal Diabetes Care.

Their study included middle-aged and older African-American women with type 2 diabetes, most of whom were overweight or obese. Past research has shown calorie underreporting to be common among women, people who are overweight, and those who want to lose weight, lead study author Dr. Carmen D. Samuel-Hodge told Reuters Health.

She said people may, for instance, have a hard time remembering what or how much they ate, or may feel pressured to report eating habits that are "socially acceptable."

For the current study, Samuel-Hodge and her colleagues at the University of North Carolina at Chapel Hill compared diabetic women's reported food intake with objective estimates of their calorie expenditure. To get these estimates, they had the women wear small electronic devices called accelerometers, which gauge the number of calories burned during physical activity, for one week. The researchers also measured the women's base metabolic rates. These measures were compared with participants' self-reported dietary intake on three days.

The idea is that in the absence of weight loss or gain, a person's calorie intake should roughly equal calorie expenditure. If someone takes in fewer calories than she burns, she should lose weight.

Samuel-Hodge and her colleagues found that most of the women in their study reported calorie intakes that were lower than their estimated calorie expenditure.

Based on the accelerometer data, the researchers estimate that 81 percent underreported their calorie intake. This estimate dipped, but remained high at 58 percent, when the researchers compared calorie intake with base metabolic rates.

The researchers also found that the heavier a woman was, the more likely she was to underreport calories.

It's possible, the investigators acknowledge, that many of these women, who were part of a larger study on managing diabetes with diet and exercise, truly were cutting calories. But, they note, six months after the current results were compiled, the women were showing no significant weight loss.

The "major implication," the researchers conclude, is that such self-reports need to be independently validated.

Samuel-Hodge said the findings are particularly relevant to studies of people with type 2 diabetes because of their high prevalence of obesity.

Source: Diabetes Care, March 2004.

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Allergic Asthma: What You Don't Know Can Hurt You

 

HealthDayNews

Monday, March 22, 2004

MONDAY, March 22 (HealthDayNews) -- Asthma is a chronic disease that affects more than 20 million Americans, yet many people are unaware of its causes and severity.

That's the finding of a new national telephone survey released by the Allergy and Asthma Foundation of America. It was conducted in February, and included 1,011 men and 1,023 women, aged 18 and older.

The survey found that:

 

More information

 

The American Academy of Allergy, Asthma and Immunology offers a simple allergic asthma self-screening tool.

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Sunday, March 21, 2004

 

Internet Is a Popular Portal for Dieters

 

By Alicia Chang

Associated Press Writer

The Associated Press

Sunday, March 21, 2004

Like most yo-yo dieters, Jacqueline Foss struggled with different fad diets only to watch the pounds creep back. Left with little choice, she turned to an unlikely source to help her slim down — the Internet.

Foss enrolled in an online diet program where she recorded her weight, noted every meal in her food diary and chatted with support groups. She reached her goal of a sleek 125 pounds after six months — losing 28 pounds from her 5-foot-5-inch frame — and even managed to keep the weight off nearly a year later.

"It was convenient for me because I just log on from my house," said Foss, a 41-year-old software saleswoman from Syracuse, N.Y. "It was also private and if I failed, nobody would know but me."

Internet dieting has exploded in the last few years, attracting people who lack the time to attend face-to-face meetings or those too embarrassed to get on a scale in front of strangers. But the popularity of cyberdieting has left some experts wondering whether it is as effective as traditional counseling.

About two-thirds of American adults are overweight or obese. Obesity, which is linked to diabetes, heart disease and other ailments, is on pace to beat smoking as the nation's leading cause of preventable death.

Foss felt she needed to lose some weight and joined eDiets.com, one of the largest online diet programs with over 200,000 active members. For $5 a week, dieters receive personalized meal plans and shopping lists and around-the-clock access to nutritionists and peer-support chat rooms. Dieters are encouraged to keep a daily log of their food and a weekly tally of their weight. If they forget, a message will pop up on their computer the next time they sign on.

"It's not all about food and diet. A lot of it is getting the tools you need to make behavioral changes," said Susan Burke, a registered dietitian and vice president of nutrition services for eDiets.

While cyberdieting generally reaches a wider audience and is significantly cheaper than weigh-in meetings with a counselor, skeptics argue the biggest drawback is lack of accountability.

Unlike traditional dieters whose progress is monitored by a dietitian, online dieters are trusted with keeping track of their own weight, which critics say may cause some to inflate their results.

"When people are trying to make major lifestyle changes, information typed on a page may only go so far for certain people," said Cynthia Sass, a Tampa, Fla.-based registered dietitian and spokeswoman for the American Dietetic Association.

Experts agree more research is needed to determine how effective the Internet is in helping people shed pounds and maintain their goal weight.

A 2001 study by researchers at Brown University found that people who enrolled in a structured online dieting program lost three times more weight in six months than those who casually surfed the Internet for diet information.

But the study published in the Journal of the American Medical Association (news - web sites) did not compare virtual weight-loss programs with traditional counseling.

Last month, researchers at the University of Vermont suggested that the Internet appears to work as well as offline programs in maintaining long-term weight loss. The research published in the journal Obesity Research did not examine whether the Internet actually helped people lose weight.

Instead, Vermont researchers tracked 255 overweight and obese adults who first lost weight with the help of a counselor. The adults were then randomly assigned an 18-month maintenance program via the Internet, in-person counseling or limited face-to-face contact. Researchers found that people in the Internet group lost as much weight in the maintenance phase as those who met regularly with a dietitian.

"From a public health perspective, you can treat so many more thousands of people on the Internet than you can in person," said Jean Harvey-Berino, the study's lead author and an associate professor of nutrition and food science. "There is some value to it."

Joan Rainwater, a paralegal turned yoga teacher from Waterville, Ohio, used to be a "grazer," constantly snacking at night without keeping track of what she ate. But after Rainwater signed on to CaloriesCount.com two years ago, she discovered that being anonymous helped her keep faithful records of her weight without the pressure of weigh-in meetings.

"I was more honest with myself," said Rainwater, who shaved off 32 pounds and slimmed from a size 14 to a size 6. "There were times when I'd skip a meeting because I knew I didn't want to get on the scale."

Many traditional diet centers like Weight Watchers International Inc., best known for their weekly meetings and group support, have extended their presence to the Internet, offering a virtual counterpart to dieters who cannot make in-person meetings.

"We offer the best of both worlds," said Grace Ann Arnold, spokeswoman for WeightWatchers.com.

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Allergies? Sinusitis? How to Tell the Difference

 

By Dennis Thompson Jr.
HealthDay Reporter

HealthDayNews

Sunday, March 21, 2004

SUNDAY, March 21 (HealthDayNews) -- You've got a scratchy throat and a runny nose, and a truly horrible headache.

Are you in the throes of seasonal allergies, which are already bedeviling people in many parts of the country? Or are you struggling with a bout of sinusitis, a condition in which the sinuses become inflamed or infected?

The answer may lie in a handful of telltale clues, doctors say.

On the surface, allergies and sinusitis are very similar, even though they are very different, says Dr. Alpen Patel, an assistant professor of otolaryngology at George Washington University Medical Center in Washington, D.C.

"In fact, it's very difficult for patients and health-care providers to differentiate the two, even with diagnostic studies and imagery," Patel says.

Both diseases affect millions of people.

Doctors estimate that about 37 million Americans are affected by sinusitis every year, according to the National Institutes of Health (news - web sites). And about 32 million people suffer from seasonal allergies.

Allergies are caused by the immune system's overreaction to a misidentified threat, such as pollen. The body's cells defend themselves by releasing histamine, a chemical that causes an "allergic cascade" of familiar symptoms such as coughing, sneezing and a runny nose, says Mike Tringale, a spokesman for the Asthma and Allergy Foundation of America.

Sinusitis, on the other hand, can be triggered by a number of factors, including a cold, allergies or a virus, leading to irritation and inflammation of the sinuses. If left untreated, problems can last from weeks to months, even years, requiring antibiotics and bed rest, Patel says.

Both conditions share a number of symptoms, Patel says. They include:

Making it even more difficult to distinguish between the two, allergy patients are more likely to have sinus infections than people who don't suffer from allergies, Patel says.

 

"They often can't tell whether they have just allergies or an accompanying sinus condition," Patel says.

 

But there are critical differences than can help you figure out just what you've got.

 

The color and consistency of the mucus from your nose is one hint, Patel says. Allergy sufferers have thin mucus that's either clear or white in color. People with sinusitis have thick, discolored and foul-smelling mucus.

Because the histamines released during an allergic reaction can affect other parts of the body, people with allergies also will suffer symptoms outside of the sinuses. These could include watery, itchy eyes, and itchy skin.

 

Sinusitis, on the other hand, can sometimes be accompanied by a toothache or pain between the eyes, suggesting an infection is taking place, rather than an allergic reaction, Patel says.

 

When it comes to treatments, people with allergies can often control their symptoms with antihistamines, Tringale says. They also can get an allergy test that will give them a better idea what is causing the reaction, so they can avoid it.

 

With sinusitis, once a diagnosis has been made, some people can get by with rest, plenty of fluids and over-the-counter medications to treat their symptoms, Patel says.

 

He recommends using a saltwater nasal spray to clean out the nose, to help wash away any viruses, and moisturize the inflamed sinus tissues. Pain relievers and decongestants also are helpful.

 

But if symptoms persist, more aggressive treatments are needed. A person diagnosed with acute sinusitis, for instance, might require a prescription for an antibiotic to eliminate the infection, and a decongestant to reduce congestion. Chronic sinusitis can be more difficult to treat and may require stronger oral antibiotics or intranasal nebulized treatments. If none of these approaches works, or patients have underlying physiological problems such as a narrow sinus passage, surgery may be necessary.

 

People with recurring and chronic sinusitis might also need a CT scan to determine the extent of their problem, Patel says.

 

And while these tips may help you tell the difference between seasonal allergies and sinusitis, experts recommend that you seek medical help for a correct diagnosis and the right course of action.

 

"Because they are so close company, it really requires the intervention of a doctor or allergist," Tringale says.

 

More information

 

To learn more about sinusitis, visit the National Institute of Allergy and Infectious Diseases. For more on seasonal allergies, check with the American Osteopathic Association.

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Saturday, March 20, 2004

 

Spring Signals Sneezing Season

 

HealthDayNews

Saturday, March 20, 2004

SATURDAY, March 20 (HealthDayNews) -- The start of spring signals the start of sneezing season for 25 million Americans who are allergic to the pollen in grasses, flowers and trees.

This allergy is known as hay fever, and while it can be present in the summer and fall, many people suffer most severely in the spring as everything starts to bloom.

Repeated and prolonged fits of sneezing are the hallmark of hay fever. Sufferers may also have a stuffy, runny or itchy nose, along with itchy, red eyes, according to the American Lung Association. People with hay fever may also have trouble breathing at night because the air passageways in their noses are blocked. Complications from hay fever can include chronic sinus infections, nasal polyps or asthma.

Hay fever ranges from mild to severe, but the overall affects of allergies are not inconsequential. In missed work days alone, allergies cost the U.S. economy more than $250 million annually, reports the American Academy of Allergy, Asthma and Immunology.

The best way to control hay fever is to avoid pollen whenever possible. Use air conditioning and air purifiers to keep the levels of pollen down in your home, especially in your bedroom, recommends the lung association. On days when the pollen count is high, an antihistamine can help control some of your symptoms. Over-the-counter nasal sprays should be used with caution, however, because overuse may make symptoms worse.

More information

The U.S. Food and Drug Administration (news - web sites) offers this information on treating allergies.

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Student Drinking Worries Most College Officials

 

HealthDayNews

Saturday, March 20, 2004

SATURDAY, March 20 (HealthDayNews) -- While the majority of American college administrators are concerned about heavy student drinking, they're divided on how to tackle the issue, says a study in the March issue of the Journal of American College Health.

The survey, completed in 2002, found that 81 percent of 747 college administrators of four-year colleges said student alcohol use was a problem or major problem on campus. That's much higher than the 68 percent of college administrators who expressed the same concerns in a 1999 survey.

Administrators of large schools (more than 10,000 full-time undergraduates) and highly competitive schools were most likely to consider student alcohol use to be a major problem, this new survey revealed.

"It is clear that the nation's colleges are collectively concerned about student drinking on their campuses, but are quite divided about what programs to put in place to alleviate the problem of heavy and destructive drinking," study author Henry Wechsler, director of the College Alcohol Studies program at Harvard School of Public Health, says in a prepared statement.

The various prevention measures include:

More information

 

The U.S. National Institute on Alcohol Abuse and Alcoholism has more about college drinking.

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A Doctor's Painstaking Search for MS Clues

 

By Amanda Gardner
HealthDay Reporter

HealthDayNews

Saturday, March 20, 2004

FRIDAY, March 19 (HealthDayNews) -- When Dr. Moses Rodriguez started researching multiple sclerosis two decades ago, the prevailing wisdom was that repairing the nervous system was impossible.

Now he knows that's not true.

Rodriguez, a professor of neurology and immunology at the Mayo Clinic in Rochester, Minn., was intrigued by MS patients who had devastating attacks and then, one year later, seemed to be dramatically better.

"We hadn't done anything," he says. "The body had been able to do something to induce repair."

In the intervening years, Rodriguez has been able to identify a whole series of antibodies that were able to perform dramatic repairs in animal tests of MS. "We have been able to show definitely that we can get very significant repair of the nervous system," he says.

These antibodies are part of the body's natural defense system. "They are present in all of us and are playing a role in repairing our bodies," Rodriguez explains. In people with MS, however, they are present at only low levels.

"It's very exciting, because theoretically it should be very nontoxic," Rodriguez says. "You're giving back. It's a normal, very natural, reparative kind of approach. Most approaches in MS have been destructive. People are trying to get rid of T cells or immunosuppress people or take away things."

Now Rodriguez and his colleagues have identified antibodies in humans and have unraveled the complete molecular sequence, meaning they can manufacture them. In fact, Rodriguez is planning clinical trials in collaboration with Acorda Therapeutics. "The company is committed to taking this forward; I think it's going to happen relatively soon," Rodriguez says.

Rodriguez has departed from conventional MS research in another way as well. Traditionally, experts have focused on the myelin sheath, which insulates the axon or nerve cell. "What we're finding is the real problem is in the neuron or axon, not the myelin," Rodriguez says. "We may be concentrating on the wrong thing. Once we get over that big step, we may be able to find more effective therapies."

Without myelin, the axon is like "a tree without bark," Rodriguez explains. "All of a sudden, anything can get into it and the axon is going to die. One of the things you've got to do is protect those axons from dying."

Killer T-cells, which are part of the body's immune system and the most common T cells in the brains of MS patients, appear to be killing the axons. When Rodriguez and his colleagues deleted killer T-cells in animal models, the animals showed no neurological problems.

"That shows that killer T cells are the bad guys," he says. "If we can get rid of killer T-cells, we can do a lot."

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