The American Voice Institute of Public Policy presents

Personal Health

Joel P. Rutkowski, Ph. D., editor
June 5, 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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 April 3-9

 

  1. New Prostate Test May Improve Cancer Detection
  2. Protection From Pet Diseases
  3. Company Growth May Be Bad for Employees' Health
  4. MRIs Can Detect Blocked Arteries
  5. 'Key-Hole' Surgery Appears Safe for Colorectal Cancer
  6. Prostate Cancer's Effect on Siblings: Higher Risk, Earlier Age
  7. Breathing and Heart Problem Often Seen Together
  8. Study Renews Debate Over Antidepressants for Kids
  9. FDA Expands Warning on Cytotec Products
  10. Irritable Bowel Syndrome: A Painful Yet Mysterious Affliction
  11. Combo Provides Potent High Blood Pressure Therapy
  12. Health Info Too Complex for Many in U.S. –Report
  13. More Doctors Specializing in Weight Mgt.
  14. Avoid Logs to Avoid Ticks, Experts Say
  15. Obesity Prevention Implemented in N.C.
  16. New Drug Approach May Fight Deadly Heart Rhythm
  17. Green Tea Component Kills Leukemia Cells
  18. Flu Season Severest in Four Years
  19. Nursing a Slipped Disc
  20. Daughters Learn Eating Habits from Moms
  21. Aggressive Care Boosts Diabetics' Overall Health
  22. Rat Study: Labor Drug Might Affect Offspring Brain
  23. Lack of Brain Protein Causes Learning Woes in Mice
  24. Laser Light Not Much Good for Diabetic Nerve Pain
  25. Eye Medication May Reduce Stroke Risk
  26. Fewer Blacks, Latinos Treated for Prostate Cancer
  27. Genes Strongly Tied to Asthma Identified
  28. Statin Treatment Before Stroke May Improve Outcome
  29. Second Penicillin Allergies Less Common Than Thought
  30. Secondhand Smoke May Slow Healing in Kids
  31. Pfizer Drug Boosts 'Good' Cholesterol – Study
  32. New Guidelines to Help Cancer Patients
  33. Experts Offer Tips to Keep Toddlers Fit
  34. Blueberry Bonanza

  35. Beta-Blocker Plus Statin Curbs Heart Attack Deaths
  36. How Does Alcohol Affect Your Health?
  37. Patient Dies of 'Flesh-Eating Bacteria'
  38. Iron Therapy Calms Restless Legs Syndrome
  39. Group: 25 Million to Lose Parents to AIDS
  40. Seniors with Gum Disease Lose Weight
  41. Tenn. Aims to Improve Students' Health
  42. Viagra Finds Another Use, for Lung Disease
  43. Elderly Get Tips to Beat Back Depression
  44. U.S. Health Officials Launch Food Poison Campaign
  45. Florida Lawmakers Tackle Youth Obesity
  46. Many Parents Flunk Car Safety When It Comes to Kids
  47. Arkansans Urged to Change Lifestyle
  48. The Young Vegetarian
  49. Chocolate During Pregnancy Has Good Impact on Baby
  50. Squatting Can Cripple Knees
  51. Survey of Mo. Gays a Mixed Bag of Health
  52. Asthma and Exercise Can Go Hand-in-Hand
  53. Surgeons Who Play Video Games Err Less
  54. Hardening of Arteries Takes Emotional Toll
  55. New Tests Predict Prostate, Colon Cancer Better
  56. Alzheimer's Reduces Life Span
  57. Study Disputes Sex-Prostate Cancer Link
  58. L.A. Lawmakers Seek to Ban Beach Smoking
  59. Surgeon General Discusses Importing Drugs
  60. Americans Fail to Protect Against STDs, Study Finds
  61. Study Links Breast Cancer Risk to Famine
  62. Groups Posts Web Site for Free Drug Access
  63. Doctor: Fetus Feels Pain After 20 Weeks
  64. Pig Worm Concoction to Treat Bowel Disease
  65. U.S. Considers Food Guide Pyramid Changes
  66. Tiny Newborns Become Average-Size Adults: Study
  67. Hawaii Schools Cut Back on Selling Soda
  68. U.S. Plans Study on Environment and Kids
  69. Well-Meaning Paramedics May Kill with CPR –Study
  70. Study Links ADHD Drugs to Growth Delays
  71. Exercise Key to Teen Weight Problem - U.S. Study
  72. Unpasteurized Milk Has Fans Despite Risk
  73. Alzheimer's Cuts Life Expectancy in Half – Study
  74. First-Time Moms Over 40 on the Rise
  75. Kids at Risk Even if Parents Go Out to Smoke-Study
  76. Study: Arch Support May Ward Off Injury
  77. Diet, Exercise Improve Blood Vessels in Obese Kids
  78. Some Doctors Choosing Cash Over Insurance
  79. Testosterone Helps Men with Heart Failure
  80. Nebraska Has Plan to Counter Obesity
  81. Chlorination May Increase Stillbirth Risk
  82. Brain Freeze
  83. Toddler TV Habits Tied to Attention Deficit
  84. When Your Memory Is Likely to Fail You
  85. Most Low-Carb Dieters Eat Too Many Carbs-Study
  86. Nailing Down the Cause of Nerve Disorder
  87. Should Preteens Pump Iron?
  88. Smoking Bans May Cut Down on Heart Attacks
  89. Scientists Strive for Breast Cancer Vaccine
 
 
Friday, April 9, 2004

 

New Prostate Test May Improve Cancer Detection

 

By Megan Rauscher

Reuters Health

Friday, April 9, 2004

NEW YORK (Reuters Health) - In men with high PSA levels and negative biopsy results, a test for a protein may reveal undetected cancer, or confirm that the patient does not have the disease, according to report in The Journal of Urology.

A negative biopsy in an individual with increased serum PSA "raises an important clinical dilemma, namely what to do with the patient at this time," investigators explain. Typically, these patients undergo repeat biopsies depending on subsequent PSA readings.

Using antibodies they developed against a protein, called EPCA, Dr. Robert Getzenberg from the University of Pittsburgh Cancer Institute and others stained 29 prostate tissue samples from patients with prostate cancer who had initial negative biopsies and 27 prostate tissue samples from healthy men.

The intensity of the EPCA staining in the samples analyzed from the patients with prostate cancer were significantly different compared to samples from the healthy subjects, "with almost no overlap in staining results," the team reports.

Positive staining for EPCA was significantly associated with the presence of prostate cancer.

Increased EPCA expression was observed in nearly all of the negative biopsies from patients subsequently found to have prostate cancer.

Moreover, EPCA staining "identified prostate cancer 5 or more years prior to its being diagnosed pathologically in these cases," Getzenberg told Reuters Health.

By comparison, non-diseased prostate tissue showed "few instances" with increased EPCA expression.

"The EPCA marker can be used to stain prostate biopsies that do not have pathological evidence of prostate cancer and determine if the patient does or does not have the disease," Getzenberg said. "This will save repeated biopsies in men that might have elevated PSA levels but do not have positive biopsies."

A multicenter trial assessing the value of EPCA in prostate cancer is planned. A test for EPCA "could serve as an adjunct to the current diagnostic approach to a patient who undergoes prostate needle biopsy," the investigators conclude.

Source: The Journal of Urology, April 2004.

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Protection From Pet Diseases

HealthDayNews

Friday, April 9, 2004

FRIDAY, April 9 (HealthDayNews) -- Regardless of how much you love your dog or cat, these and other animals can still transmit certain diseases to you and your family.

Diseases like E. coli, salmonellosis, toxoplasmosis, tuberculosis and rabies can be passed from animals to humans. And they can be deadly if left untreated, according to the Canadian Food Inspection Agency.

Here's how to protect yourself:

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Company Growth May Be Bad for Employees' Health

 

By Alison McCook

Reuters Health

Friday, April 9, 2004

NEW YORK (Reuters Health) - Everyone worries about downsizing, but new study findings suggest that too much hiring can also cause problems for employees.

Swedish investigators found that employees of workplaces undergoing a prolonged period of rapid expansion, increasing staff by at least 18 percent per year, were slightly more likely to be admitted to the hospital or to take a sick leave of at least 90 days.

The effect of a rapidly expanding workforce on health was most pronounced among women working in the public sector, Swedish investigators report in The Lancet.

"Repeated exposure to very large expansion is related to negative health outcomes," said study author Dr. Hugo Westerlund. "And that's somewhat surprising."

In an interview with Reuters Health, Westerlund suggested that expanding workplaces may hurt workers if work load increases faster than bosses can hire new people, leaving existing employees to take on more than their normal share of work.

Additionally, he noted that expanding workplaces may display an "organizational instability," in which much is in flux and people don't know how the now-bigger workplace works. This could also increase stress among workers, affecting their health, said the researcher, who is based at the National Institute for Psychosocial Medicine in Falkoping.

As part of the study, Westerlund and his colleagues reviewed the employment records of 24,036 Swedish workers from 1991 to 1996, noting who worked at sites that experienced a rapid expansion, and how many people took long sick leaves or were hospitalized.

The investigators found that employees who experienced repeated bouts of large expansions were 7 percent more likely to take a long sick leave and 9 percent more likely to be hospitalized than people who didn't experience a big round of hiring.

Women working in the public sector whose workforces were rapidly expanding over the entire study period were almost 3 times as likely as those with no exposure to these workforce changes to be hospitalized or develop a long illness.

Interestingly, moderate expansion--increasing workforce by between 8 and 18 percent per year--was associated with a decreased risk of being hospitalized. Moderate expansion may help employees by making them feel they are part of a "positive climate of a healthy, growing organization," according to Westerlund.

Westerlund noted that organizations can protect their workforce during rapid expansions by involving people in the changes, to prevent them from feeling out of control.

Additionally, companies might consider taking a break in between big bouts of reorganization to let employees settle into the new structure, or link up with doctors or psychologists who treat many people at the same office and can therefore predict which employees might be most at risk during expansion, he added.

Source: The Lancet, April 10, 2004.

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MRIs Can Detect Blocked Arteries

 

By Steven Reinberg
HealthDay Reporter

HealthDayNews

Friday, April 9, 2004

FRIDAY, April 9 (HealthDayNews) -- A new way of using magnetic resonance imaging (MRI) allows doctors to see blood flowing in arteries and might one day replace invasive techniques to check for blockages, a new study suggests.

Now, if your doctor wants to see whether you have a blocked artery, he has to do a procedure called an X-ray angiogram. This involves using a "contrast agent," which is injected into the bloodstream to highlight the artery for the X-ray.

Then a series of X-rays are taken and the images are assembled by computer into a short movie that shows the doctor where the blockage is located.

While an angiogram is safe and effective, it's an invasive procedure and does involve radiation. In addition, contrast agents can sometimes have unpleasant or unwanted side effects, including kidney damage, according to the study authors from Duke University.

In contrast, MRI use harmless magnetic fields and radio frequency signals to image body tissues, the researchers said.

Using this new technique, "you can get images that look like those from an X-ray angiogram, but you can do it with noninvasive MRI," said lead study author Robert M. Judd, an associate professor of radiology and co-director of the Duke Cardiovascular Magnetic Resonance Center at Duke University.

Judd's team reports its findings in the April issue of Nature Medicine.

In their new approach, Judd and his colleagues have created a way to use MRI scanning to "excite" protons in blood cells as they flow in blood vessels. The scanner then detects that signal, which shows blood flowing through blood vessels.

"The technique is still new and there are technical issues that need to be sorted out," Judd said. "But the principle appears to be correct."

Using this technique, doctors should be able to locate a blockage in a blood vessel, and also any partial blockage by measuring the amount of blood flow above and below the blocked portion of the vessel, Judd said.

Judd said that hospitals would not need new MRIs to use this new technique. All that would be needed is an upgrade in software, he said.

Right now, however, the technique works only in large vessels, such as the aorta in the heart and the renal arteries that carry blood to the kidneys.

"Ultimately, you would like to be able to look at vessels in the heart and head, and that's one of the things we will work on over the next few years," Judd said.

Dr. Tony Fuisz, director of cardiac MRI at Washington Hospital Center in Washington, D.C., called the new research interesting. However, he said, "a new way to image segments of the aorta, renal arteries, and other large vessels is like an answer to a question no one is asking. The real Holy Grail is coronary [heart arteries] imaging."

According to Fuisz, there are a number of potential obstacles to using the new technique for coronary arteries. "Some of these obstacles involve fundamental physical limitations and as such may not be able to be overcome," he added.

"Most likely this technique will become a complementary method used in concert with other established techniques. I wouldn't scrap the X-ray angiogram suite just yet," Fuisz said.

Dr. Christopher Kramer, director of cardiac MRI at the University of Virginia Health System, agreed. "This is a very exciting new technique, but its ultimate clinical application needs further evaluation," he said.

Right now, one limitation to the technique is that you can only see a small part of any vessel at one time. Another is that it can only be used in large arteries, Kramer added.

The technique needs to be used in real clinical situations before its value can be determined, he said.

More information

The Rochester Institute of Technology can tell you more about MRIs, and the National Library of Medicine has information about angiograms.

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'Key-Hole' Surgery Appears Safe for Colorectal Cancer

 

Reuters Health

Friday, April 9, 2004

NEW YORK (Reuters Health) - Several reports have shown that recovery after surgery is more rapid when patients with colorectal cancer undergo a less-invasive laparoscopic, or "key-hole" procedure, rather than conventional surgery. Now, new research indicates that the laparoscopic approach does not adversely affect disease control or jeopardize survival.

There has been concern about the adequacy of surgery with the laparoscopic approach after reports linked the procedure with early recurrence at the site of incision. Until the long-term effects were clear, it was recommended that laparoscopic surgery be limited to the clinical trial setting.

During laparoscopic surgery for colorectal cancer, a tiny scope and instruments are inserted through small incisions. A surgeon then draws the cancerous tissue through a small incision, removes it, and then reconnects the colon.

In a study reported in the medical journal The Lancet, Dr. Ka Lau Leung, from the Chinese University of Hong Kong, and colleagues describe the outcomes of 403 patients with colorectal cancer who were assigned to undergo laparoscopic or conventional open surgery between 1993 and 2002.

After the procedures, the probability of survival after 5 years in the laparoscopic group was 76.1-percent higher, but not significantly different from the 72.9-percent rate in the conventional group, the researchers note. The probability of being disease-free after 5-years for the laparoscopic and conventional groups were 75.3 and 78.3 percent, respectively.

Consistent with previous reports, the laparoscopic surgery took longer to perform than open surgery. The average operating time for laparoscopic surgery was 189.9 minutes-about 45 minutes longer than the time needed for open surgery.

Postoperative recovery, as determined by factors such as time to first bowel movement and hospital stay, was significantly accelerated in the laparoscopic group.

However, this benefit came at the expense of a higher direct cost--$9297 per patient for laparoscopic procedure versus $7148 per patient for open surgery.

No differences were seen between the groups in overall illness or operative mortality, the investigators point out.

Laparoscopic surgery did not worsen survival or disease control for patients with colorectal cancer compared with open resection, and "its benefits in reducing pain and allowing earlier postoperative recovery were confirmed," the authors conclude.

Source: The Lancet, April 10, 2004.

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Prostate Cancer's Effect on Siblings: Higher Risk, Earlier Age

 

HealthDayNews

Friday, April 9, 2004

FRIDAY, April 9 (HealthDayNews) -- Not only are brothers of men with prostate cancer twice as likely to develop the disease, but they will often get it at an earlier age.

These men are often aware that they have an increased risk of prostate cancer and many of them taken vitamins or supplements in an attempt to improve their health and ward off cancer, according to two University of Michigan Health System studies.

In the first study, 111 brothers of men diagnosed with prostate cancer said they felt they had a 50 percent chance of developing prostate cancer. More than half of the 111 men said they were at least somewhat concerned about developing prostate cancer.

The lifetime prostate cancer risk for men with one first-degree relative with prostate cancer is about 56 percent. The study was published in the April 1 issue of the journal Cancer.

In the second study, published in the February issue of the journal Urology, the same group of 111 men were asked about their use of complementary and alternative medicine. More than half the men said they were currently taking at least one vitamin or supplement.

Thirty percent of those were taking a form of complementary medicine linked to prostate health or prostate cancer prevention.

"These findings suggest our educational programs are working. The information is out there and these people understand they're at risk," study author Dr. David Wood, professor of urology at U-M Medical School, said in a prepared statement.

More information

The American Cancer Society (news - web sites) has more on prostate cancer prevention.

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Breathing and Heart Problem Often Seen Together

 

Reuters Health

Friday, April 9, 2004

NEW YORK (Reuters Health) - A breathing problem called sleep apnea syndrome (SAS) seems to be common in patients with a heart condition called atrial fibrillation. Still, it is unclear whether the rate of SAS is any higher than that seen in healthy people.

SAS is a potentially serious problem that involves brief periods of absent breathing during sleep. Atrial fibrillation is a rhythm problem of the heart in which the upper chambers, or atria, beat fast and irregularly.

According to several studies, SAS predisposes patients to heart rhythm problems, but the rate of SAS in specific conditions has not been determined, Dr. Kimmo Markus Porthan, of Helsinki University Central Hospital, in Finland, and colleagues write in the medical journal Chest.

In the new study, the researchers examined the rate of SAS in 59 patients with atrial fibrillation and in 56 similar subjects without heart problems. The average age of all subjects was 59 years.

Thirty-two percent of atrial fibrillation patients had SAS, a high rate but not that much different from the percentage in the healthy group--29 percent.

Compared with men in the healthy group, those in the atrial fibrillation group had larger necks, a well-known risk factor for SAS. Also, patients in the atrial fibrillation group had more severe SAS symptoms, such as daytime tiredness and nightly breathing pauses.

"The higher prevalence of well-known risk factors for (SAS) in patients with atrial fibrillation does suggest that this relationship needs further study," the authors conclude.

Source: Chest, April 2004.

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Study Renews Debate Over Antidepressants for Kids

 

By Amanda Gardner
HealthDay Reporter

HealthDayNews

Friday, April 9, 2004

FRIDAY, April 9 (HealthDayNews) -- A review of existing scientific studies on the use of antidepressants by children adds fuel to the fire currently raging over the safety and efficacy of these drugs.

Specifically, Australian researchers publishing in the April 10 issue of the British Medical Journal conclude that trials of such newer antidepressants as selective serotonin reuptake inhibitors (SSRIs) for children and teens contain such "disturbing shortcomings" that they "cannot confidently be recommended as a treatment option for childhood depression."

The latest research follows a move last month by the U.S. Food and Drug Administration (news - web sites) instructing the makers of 10 antidepressants to add a visible warning on the drug label indicating the potential for suicidal thinking and behavior.

The authors of the new review, three of whom are involved in the management of Healthy Skepticism, a nonprofit group, examined six randomized controlled trials of newer antidepressants -- Effexor and the SSRIs Prozac, Paxil and Zoloft -- that had been published in refereed journals. They concluded that the benefits were exaggerated and that the side effects -- including suicidal thoughts -- were not well-documented. The researchers added also that the studies were sometimes funded by the drugmakers, or that the researchers had been compensated by pharmaceutical companies.

"No study presented data on rates of attempted self-harm," the study said, citing what it called "the failure of drug companies to disclose increased suicidal activity."

Practicing psychiatrists, however, are dismissing the newest allegations.

"One has to keep in mind that 4,000 children and teenagers have participated in clinical trials, and there hasn't been one suicide among those 4,000 kids," said Dr. Harold Koplewicz, director of the New York University Child Study Center and author of More Than Moody: Recognizing and Treating Adolescent Depression.

"In general, [antidepressants are] an effective treatment; they have minimal side effects -- most of the time, they're nuisance side effects -- so that they're not life-threatening. They work in the majority of kids," added Koplewicz, who was an investigator on the one of the trials criticized in the article.

One of the main side effects that has concerned researchers and regulators is the potential for suicidal actions or thought. But practitioners feel there is little or no justification for this concern. "There is absolutely no evidence that suicidality is increased with these medications compared to placebo," Koplewicz said.

Furthermore, critics claimed that the authors of the review never adequately delineated what the serious adverse effects are.

"When these investigators talk about adverse effects, more often than not it's a little bit of a headache," Koplewicz contended. "They never really delineate what they mean by 'serious adverse' effects, but what they imply is suicidality, and I think that's a little disingenuous."

Dr. Jon Jureidini, lead author of the article and head of psychological medicine at Women's and Children's Hospital in North Adelaide, said that in one study he reviewed on Paxil, the serious adverse events included headache, worsening depression, suicidal thoughts, hostility and euphoria, and the hospitalization of 8 percent of the study participants.

And, he added, all the studies, including the one on Paxil, failed to follow the patients over the long term.

"Since suicide is relatively rare, you might have significantly increased risk and still would not expect to see suicides during this short period," he said.

In one trial of Zoloft, Jureidini pointed out that the difference in withdrawal rates in the placebo and drug arms were significantly different, yet the authors concluded that the antidepressant was safe and effective.

"We have no idea what they mean by serious adverse effects and, in reality, most of the adverse effects are really quite minimal -- and there's no evidence of suicidality whatsoever," said Dr. Jon Shaw, director of child and adolescent psychiatry at the University of Miami School of Medicine.

Funding by pharmaceutical companies does not necessarily compromise the results of a study, Koplewicz added.

"They state repeatedly that the fact that some of these studies were funded by pharmaceutical companies somehow taints them," Koplewicz said. "All of the studies that were published clearly stated who funded them. And since I actually participated in one of these studies, I can tell you that the rigor of the science was just as hard as when we get federal funding."

"There definitely seems to be an ax to grind," Koplewicz said of the article. "To add resistance to parents questioning treating their teenagers with depression is irresponsible. This kind of article only blows smoke and clouds and breeds fear among parents, and it does a disservice to the 2 million children and teenagers who truly have a diagnosis of depression."

More information

The American Academy of Child and Adolescent Psychiatry and the National Institute of Mental Health have information on depression in young people.

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FDA Expands Warning on Cytotec Products

 

Reuters

Friday, April 9, 2004

WASHINGTON (Reuters) - The U.S. Food and Drug Administration (news - web sites) on Friday expanded its warning against products that were sold as safe and legal alternatives to street drugs by Cytotec Solutions Inc. of Tampa, Florida.

The FDA in February warned consumers against Cytotec's Green Hornet liquid, or herbal ecstasy, saying it contained potentially dangerous drugs that had sent four Colorado teenagers to the hospital with seizures and high heart rates.

Now the FDA says its investigation has revealed additional products which consumers should not use: Trip2Night, Invigorate II, Snuffadelic, Liquid Speed, Solar Water, Orange Butterfly and Schoomz.

Green Hornet was found to contain high levels of over-the-counter cough and cold drugs, diphenhydramine and dextromethorphan.

The FDA said its analysis of the additional products, manufactured or distributed by Cytotec, had also found ephedrine and the controlled substances GBL and GHB.

Cytotec is no longer producing or distributing the products but the FDA remains concerned.

"There is no doubt that these products pose a potential public health concern, and FDA is concerned that these products may be misused or abused by individuals, especially minors and young adults," acting FDA Commissioner Lester Crawford said in a statement.

The FDA said any product containing undeclared active drug ingredients violates the law. The FDA director of enforcement for regulatory affairs, David Elder, told Reuters the investigation of Cytotec is continuing.

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Irritable Bowel Syndrome: A Painful Yet Mysterious Affliction

 

By Dennis Thompson Jr.
HealthDay Reporter

HealthDayNews

Friday, April 9, 2004  

FRIDAY, April 9 (HealthDayNews) -- Irritable bowel syndrome is a horribly uncomfortable disease, made worse by its embarrassing symptoms -- chronic constipation or diarrhea with gas, bloating and debilitating stomach cramps.

Just ask Janet Krause. The 54-year-old Torrance, Calif., woman wonders every workday if she'll make the hour-long commute to her job as a billing manager for a doctor's office before the pain and the need for relief begin.

"If I ate breakfast before I left for work, I would be cramping before I got there," said Krause, who estimates she has suffered from IBS for about 15 to 20 years, although it has gotten steadily worse during the past decade.

Irritable bowel syndrome remains something of a quiet mystery, despite the fact that doctors believe it affects an estimated 30 million people in the United States, 60 percent to 65 percent of whom are female.

Less than one half of sufferers ever seek advice from a doctor. On average, it takes more than three years to have irritable bowel syndrome properly diagnosed, and patients will see up to three doctors before the correct diagnosis takes place, according to the International Foundation for Functional Gastrointestinal Disorders.

Among health professionals, there's still no clear consensus on what causes the disorder, although a couple of successful medications have aided in its treatment.

That's why the foundation has designated April as Irritable Bowel Syndrome Awareness Month, to promote discussion of the disease's diagnosis and treatment as well as the way it affects people's lives.

"The disorder has been around for a long time, but it's been one that people haven't been willing to talk much about," said Dr. G. Richard Locke III, a gastroenterologist with the Mayo Clinic. "People don't like talking about their bowels."

People afflicted with IBS suffer from spasms in the colon, a 6-foot-long tube that connects the lower intestines to the rectum. That's the place where the waste matter from digestion forms into stool, and movements of the colon push the waste along until it's ready to exit the body.

The spasms are caused by a disturbance in the interaction between the gut, the brain and the autonomic nervous system that regulates movement of the colon and bowels. The nerve endings in the lining of the bowel become unusually sensitive, while the nerves that control the muscles of the gut become unusually active, Locke said.

"The bowels can be too slow," Locke said. "The bowels can be too fast. In addition, there's often bloating, mucus and the feeling you aren't finished even after you go."

The condition doesn't cause permanent harm to the intestines, and will not result in intestinal bleeding or a life-threatening disease such as cancer.

Still, it's a very tough cross to bear, doctors say.

No one is sure what causes the syndrome. Doctors initially thought it was triggered by emotional upset, an extreme form of "nervous stomach." They no longer believe that to be the case, although stress has been found to exacerbate or unleash certain IBS symptoms.

Other researchers have focused on diet, genetics or infection as the reason behind IBS.

"We've known for a long time that some people will develop IBS after an infection, and we're slowly understanding why," Locke said. That line of research is focusing on whether the inflammation that accompanies infection affects the way the nerves that work the gut do their job, or whether a low-grade inflammation remains in the gut following the infection.

"The infection itself is gone, but it turns something on or in some way changes the body and that persists," Locke said.

Because so little is known about IBS, and because its symptoms are varied and unpredictable, doctors and patients struggle to find successful treatments.

"In general, IBS can be challenging to treat," said Dr. Lin Chang of the University of California, Los Angeles's Division of Digestive Diseases. "There are medications that can treat a specific symptom, but not many medications that can treat IBS overall."

Some people alter their diet to help relieve symptoms, while others use over-the-counter medications to combat constipation, diarrhea and gas, Chang said. Psychological counseling, relaxation training and hypnosis also have proven effective as non-medicinal treatments.

Over the last few years, a couple of broad-spectrum medications have been approved for use in treating irritable bowel syndrome as a whole. Tegaserod, also known by the trade name Zelnorm, is approved for use by women with irritable bowel syndrome accompanied by constipation. Alosetron, on the market under the name Lotronex, is used to treat women with IBS with diarrhea.

"They both work by changing the way serotonin works in the gut and brain," Locke said. "By activating one type of receptor, you make the bowels move better. By blocking another type of receptor, you slow down the GI tract."

Lotronex has had a checkered history. It was taken off the market in November 2000, 10 months after the U.S. Food and Drug Administration (news - web sites) approved its use, because it was found to cause severe constipation that required surgery. Several deaths were reported.

However, the drug had proven so successful in treating severe cases that thousands of patients petitioned the FDA to place it back on the market. The agency relented in June 2002, but it is only available through doctors and only for people with severe diarrhea who haven't responded to other treatments.

Krause currently takes Lotronex, which has helped her more than any other medication. But because of the potential side effects, she has to check in with her doctor often.

The worst part about IBS is that Krause can no longer eat the foods she really enjoys, like vegetables or fruits.

"I do better when I go and eat at McDonald's," she said. "I can maybe have a salad once or twice a week."

But she feels best when she hasn't eaten anything at all, and sometimes goes long periods during the day without taking any food.

"If my stomach's empty, I feel great," Krause said. "But when I eat, I get gas and feel terrible."

More information

To learn more about irritable bowel syndrome, visit the National Digestive Diseases Information Clearinghouse or the Irritable Bowel Syndrome Association.

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Combo Provides Potent High Blood Pressure Therapy

 

Reuters Health

Friday, April 9, 2004

NEW YORK (Reuters Health) - In a study of patients with high blood pressure, treatment with olmesartan medoxomil in combination with the diuretic hydrochlorothiazide (HCTZ) was well-tolerated and led to significantly greater reductions in blood pressure than treatment with either drug alone.

It is now widely recognized that most patients with high blood pressure require more than one drug to achieve adequate blood pressure control, Dr. Steven G. Chrysant from the University of Oklahoma in Oklahoma City and colleagues note in the American Journal of Hypertension.

They assessed the safety and effectiveness of the olmesartan/HCTZ combination compared with olmesartan or HCTZ alone in 502 patients with high blood pressure. The subjects were randomly assigned to 8 weeks of placebo, olmesartan alone (10, 20, or 40 milligrams per day), HCTZ alone (12.5 or 25 milligrams per day), or one of six groups of the olmesartan/HCTZ combination.

The two-drug combination led to greater reductions in both systolic and diastolic blood pressure (the top and bottom reading, respectively) than did therapy with either drug alone.

In an editorial, Dr. C. Venkata S. Ram, from The Texas Blood Pressure Institute in Dallas notes that the combination of a long-acting angiotensin receptor blocker (such as olmesartan) and a diuretic is increasingly being used with much success to treat patients with high blood pressure.

Combining an angiotensin receptor blocker with a diuretic improves control of high blood pressure and can also provide "freedom of side effects, which historically limited the widespread acceptance of previously available combination therapies," Ram adds.

Source: American Journal of Hypertension, March 2004.

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Thursday, April 8, 2004

 

Health Info Too Complex for Many in U.S. –Report

 

By Susan Heavey

Reuters

Thursday, April 8, 2004

WASHINGTON (Reuters) - Drug labels, consent forms and other health information often include too much jargon for most Americans to understand -- a problem that can lead to poorer health and higher costs, a panel of experts said on Thursday.

As managed care continues to squeeze doctors and lump more responsibility on patients, the ability to grasp medical data is even more critical, according to an Institute of Medicine (news - web sites) report.

"Many people who deal effectively with other aspects of their lives may find health information difficult to obtain, understand or use," the independent group, which advises the federal government on health matters, said in its report.

Medical experts reviewed more than 300 studies and found language used by doctors, insurance companies and researchers is often above a high-school level. Information meant only for the public also includes highly technical terms, they said.

About half of all American adults, or about 90 million, read below a high school level, and half of those have trouble finding information on charts, forms and labels, according to the report.

Older adults, non-English speakers and those with less education have the most trouble, but the experts found native-born English speakers and those with more education also struggled.

Less-literate patients with chronic conditions requiring constant management are particularly vulnerable and can have trouble making decisions about their care, the Institute said.

Navigating The System

Difficulties navigating the health care system are made worse by the flood of information from the government, food and drug companies and the media, especially Web sites.

"People are frequently and repeatedly exposed to quick, often contradictory bits of information," the report reads.

The report also found such confusion can inflate costs.

Less literate adults are less likely to follow healthy lifestyles or take preventive steps, and they are more likely to be hospitalized and use emergency services, it found.

One study showed poor reading skills increased costs by $29 billion in 1996. The Institute said that figure could grow to $69 billion a year.

The experts reported their findings in a 331-page report that included seven chapters, four appendixes and nearly 30 charts.

Some recommendations to make health information less complex included:

"... a national consensus conference to initiate the development of operational measures of health literacy which would include contextual measures."

"... the development of conceptual frameworks on the intersection of culture and health literacy to direct in-depth theoretical explorations and formulate the conceptual underpinnings that guide intervention."

While acknowledging their report may not be the best example of simple information, the experts said it was clear medical professionals -- including researchers -- could improve.

"We all need to communicate better," John Nelson, the American Medical Association's incoming president, said.

The report also said health care companies, federal agencies and others should make documents more readable. Schools should also use real-world health examples in math, reading and other standard classes, it said.

The report was paid for by Pfizer Inc., MetLife Foundation, the National Cancer Institute (news - web sites), and the American Academy of Family Physicians (news - web sites) Foundation, among others.

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More Doctors Specializing in Weight Mgt.

 

By J.M. Hirsch

Associated Press Writer

The Associated Press

Thursday, April 8, 2004

HAMPTON, N.H. - A growing number of physicians are specializing in weight management after their family practices were overwhelmed by patients with weight-related health problems.

When Milton Martin Jr. decided he was past due to lose 30 pounds, the former body builder and college football player couldn't bring himself to join a diet center.

"I don't function well in group therapy," he said, adding that he'd tried Weight Watchers and hated the meetings.

The 64-year-old accountant wanted more science and less socializing. He also wanted a plan that addressed all of his concerns — including his escalating cholesterol — not just his belly.

Now he sees Dr. Jennifer Warren, a weight management specialist.

"Primary care is preventive medicine. This really is the ultimate preventive medicine," said Warren, who left her general practice in February to open Physicians Healthy Weight Center, a Hampton obesity clinic.

"That's what got me started in this direction," the 39-year-old said in a recent interview. "So many of the medical problems I was treating in family care were weight-related."

Three weeks into his treatment, Martin's cholesterol was down and he'd lost 12 pounds, thanks to low-dose appetite suppressants and calorie-cutting. And he doesn't miss the meetings.

"If I'm going to lose weight, I'm not going to lose it for the group," the Durham man said. "I'm going to lose it for me."

With two-thirds of Americans now overweight and at greater risk for heart disease, diabetes and certain cancers, many in the medical community want to redefine the role doctors have in helping people slim down.

Doctors say the pressures of general practice — which can limit time with patients to mere minutes — and a lack of specialized training make it difficult to treat obesity in a primary care environment.

They say treatment involves not only creating individualized diet and fitness plans, but also assessing serious health concerns and addressing the underlying emotional and psychological issues that contributed to the weight gain.

"In eight minutes you can't undue all that stuff," said Peter Vash, a Los Angeles doctor who has treated obesity for 25 years.

Though often associated with gastric surgery, a procedure that reduces the size of the stomach, so-called bariatric medicine includes a gamut of treatments, from special diets to counseling to prescription drugs.

The impetus for change comes mostly from medical schools, according to Dr. George Blackburn, associate director of Harvard Medical School (news - web sites)'s nutrition division.

Medical students and young doctors are demanding to know more about nutrition and weight management, which previously was absent from most curricula, he said.

"We always ask physicians whether they see obese patients in the practice. They just laugh at us and say at least half," said Beth Little, executive director of the American Society of Bariatric Physicians.

"They used to say there was nothing they could do," she said. "Now they are just taking it a lot more seriously."

Head counts of bariatric physicians are imprecise; the field isn't tracked by the American Medical Association.

Little's group has 1,104 members, an increase of 165 from two years ago. The American Board of Bariatric Medicine has 236 certified physicians, and expects to add another 50 this year. Most years the increase has been around 30.

There have been spikes before, fueled mostly by popular drugs and procedures, such as the now banned diet drug fen-phen and more recently a surge of interest in bariatric surgery. But Little said this time the interest is more sustained.

Academia has noticed. The theme of Harvard Medical School's annual conference on obesity in June is "Obesity Medicine: Emergence of a New Discipline."

Earlier this month, Duke University Medical Center announced it now will offer fourth-year medical students a course in the causes and treatment of obesity.

But change is slow. Though medical schools are improving at teaching nutrition, doctors complain that instruction still is limited mostly to postgraduate courses.

"When I came out of medical school in 1992, all we were told is tell your patients don't eat fat," Warren said.

Until recently, the specialty struggled for respect. Vash, executive medical director at Lindora Medical Clinic in Los Angeles, said his decision to enter the field more than two decades ago mostly was derided by fellow doctors.

"Many of my colleagues looked at me and laughed," he said. "Why would you go into treating obesity? That's like the bottom of the barrel."

It wasn't until obesity was declared an epidemic some 20 years later that others took the field seriously, he said.

Money also is an issue. Though most insurers offer discounts for fitness and diet programs and cover nutrition services and even gastric surgery, coverage for services such as Warren's is spotty, making it hard for doctors to get into the field.

Warren charges $95 for the first visit, which includes an exam, creating fitness and diet programs, and monitoring and treating any related health problems.

Monthly appointments thereafter are $75. Warren points out that her fees still are probably less than diet programs that require special food purchases.

Susan Pisano, spokeswoman for America's Health Insurance Plans, a trade group, said this is an emerging field being studied by the industry. She noted that in 2002 a quarter of insurance plans included some kind of disease management plan for obesity.

Bariatrics also can be frustrating and not very glamorous. Treatment can take months or years, and its success depends as much on the patient's motivation as the doctor's intervention.

"It may not be as glamorous as a heart transplant or as rewarding as treating pneumonia and having the patient get better in a week, but it is very glamorous in the sense that you are giving this person a whole new orientation on life," Vash said.

He also said the delay in recognizing the importance of bariatrics will prove troublesome for years to come.

"There are going to be so many patients coming to physicians for the treatment of their heart disease, and their diabetes, and their lipid problems and their back and knee pain that it has the potential to overwhelm our health care system," he said.

Doctors in the field don't consider themselves in competition with over-the-counter approaches, including popular diet centers such as Weight Watchers, saying people should use whatever method works for them.

But they say health concerns make them a better choice for many patients. Doctors also can enhance accountability.

"You're really committing yourself when you're going to a physician," Little said. "If you don't show up (at a diet center) nobody's going to say, 'Oh, where are you?' There's a difference between that and missing a doctor's appointment."

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Avoid Logs to Avoid Ticks, Experts Say

 

Reuters

Thursday, April 8, 2004

WASHINGTON (Reuters) - Want to avoid ticks? Avoid sitting on logs, experts advised on Thursday.

Researchers at the University of California, Berkeley, used themselves as bait to see where the greatest risk of picking up a tick was, and found logs were the worst places to sit.

"We sat on logs for only five minutes at a time, and in 30 percent of the cases, it resulted in exposure to ticks," said Robert Lane, a professor of insect biology who led the study.

"It didn't matter if we sat on moss or the bare surface; the ticks were all over the log surface. The next riskiest behavior was gathering wood, followed by sitting against trees, which resulted in tick exposure 23 percent and 17 percent of the time, respectively," Lane said in a statement.

Writing in the Journal of Medical Entomology, Lane and colleagues said they were looking for ticks carrying Borrelia burgdorferi, the bacteria that cause Lyme disease.

"If we're going to develop effective strategies and educational programs for the prevention of Lyme disease, it is critical that we understand how people are exposed to the ticks that transmit the bacteria in the first place," Lane said in a statement.

"We intentionally looked at behaviors that people would typically engage in while spending time in the woods."

Sitting in leaves was not especially risky, they found.

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Obesity Prevention Implemented in N.C.

 

The Associated Press

Thursday, April 8, 2004

RALEIGH, N.C. - A state panel and North Carolina's largest health insurer said Wednesday they will work together to fight obesity in the state, where more than half of adults are overweight or obese.

The N.C. Health & Wellness Trust Fund Commission and Blue Cross and Blue Shield of North Carolina announced a program called Fit Together, a three-year, $4.5 million initiative.

One of Fit Together's goal is to let people know that being "fit" doesn't necessarily mean going to the gym everyday. It means being active through activities such as walking the dog, gardening, pushing a child in a baby stroller, mowing the lawn or playing outside.

The program will include a public education campaign, consisting of advertising and other communications to the public and a Web site. It will also highlight successful community programs through a clearinghouse and awards program.

The media campaign and other program initiatives will begin this year.

The Centers for Disease Control recently reported that 27 percent of North Carolina's high school students are overweight or at risk of becoming overweight and more than half of North Carolina adults are overweight or obese.

Blue Cross and Blue Shield of North Carolina, the state's largest health insurer, has about 3 million customers.

The Health & Wellness Trust Fund Commission funds programs that promote preventive health. It was created by the General Assembly in 2000 to allocate a portion of North Carolina's share of the national tobacco settlement.

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New Drug Approach May Fight Deadly Heart Rhythm

 

By Maggie Fox, Health and Science Correspondent

Reuters

Thursday, April 8, 2004  

WASHINGTON (Reuters) - A new approach to treating heart failure could prevent the irregular heart rhythms that kill hundreds of thousands of people every year, U.S. researchers reported on Thursday.

They found a leaky cellular channel causes the deadly heartbeat patterns, or arrhythmias, and found a drug that seems to plug the leak without causing serious side-effects.

The drug has only been tested in mice. But the researchers at Columbia University in New York say some people with a genetic predisposition to develop fatal arrhythmias while exercising have the same defective channel.

It suggests that what works in mice might work in people, said Dr. Andrew Marks, a cardiologist and molecular biologist who led the study.

"About four years ago we found a calcium channel that was defective in patients with heart failure," Marks, head of the physiology department at Columbia, said in a telephone interview.

While some heart drugs are called calcium channel blockers, this channel, involved in muscular contractions, was actually a different molecular doorway, Marks said.

"It is not able to close tightly, so it becomes leaky," Marks said. "Patients with mutations in the channel that cause sudden cardiac death also have this leak. We decided if we could come up with a drug that could plug up the leak we'd have a treatment for heart failure."

An estimated 5 million Americans have heart failure, a chronic condition caused by the heart's inability to pump blood properly. It can be caused by a virus, by a heart attack, or by chronic high blood pressure, and kills half of its victims within five years.

The irregular heart rhythm caused by heart failure kills 340,000 Americans each year, according to the American Heart Association (news - web sites).

No Cure

There is no cure for heart failure and patients must take cocktails of drugs. Many can only survive with a heart transplant or with an implanted device that keeps the heart beating properly.

But a drug that targets the molecular cause could be taken as a pill.

"We know exactly what is causing the leak," Marks said.

A protein called calstabin2 attaches to calcium channels and closes them. They found a drug called JTV519 helps calstabin2 stop the leak.

"It does that without blocking the channel, so we are not inhibiting the natural function of the channel, which opens to make muscles contract," Marks said.

Other channel blockers totally shut off the channels they target, sometimes causing toxic side-effects. Many have been pulled out of development because they caused worse problems than they solved, Marks said.

Writing in the journal Science, Marks and colleagues said the drug completely prevents sudden death from arrhythmia in mice that have the same heart defect as people with heart failure.

"The drug will be an incredible advance if it works in patients," Marks said in a statement.

"It represents the beginning of an era when drugs will directly fix the molecular defects in heart failure. While our drug is one of the first molecular-based therapies for heart failure and arrhythmias, it won't be the last."

He said his team was now looking for a drug company to help them make the drug and test it.

"We are moving ahead very quickly to develop it for clinical (human) use," Marks said.

"Our idea is to take a pill instead of spending hundreds of thousands of dollars on implants and heart transplants."

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Green Tea Component Kills Leukemia Cells

 

HealthDayNews

Thursday, April 8, 2004

THURSDAY, April 8 (HealthDayNews) -- A component of green tea helps kill cells of B-cell chronic lymphocytic leukemia (CLL), the second most common leukemia in American adults, according to new research.

Mayo Clinic researchers found that the component, called epigallocatechin-3-gallate (EGCG), destroys leukemia cells by interrupting the communication signals they need to survive. The research appears online in the journal Blood.

CLL is most often diagnosed in people in their mid-to-late 60s. Chemotherapy is used to treat the most severe cases, but there is no cure for CLL.

In this study, the Mayo scientists found that EGCG prompted leukemia cells to die in eight of 10 patient samples tested in a laboratory.

"We're continuing to look for therapeutic agents that are nontoxic to the patient but kill cancer cells, and this finding with EGCG is an excellent start," study leader Dr. Neil E. Kay said in a prepared statement. "Understanding this mechanism and getting these positive early results gives us a lot to work with in terms of offering patients with this disease more effective, easily tolerated therapies earlier."

More information

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

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Flu Season Severest in Four Years

 

By Paul Simao

Reuters

Thursday, April 8, 2004

ATLANTA (Reuters) - This season's influenza epidemic in the United States was the severest in four years, largely because of the predominance of a more virulent strain, the Centers for Disease Control and Prevention (news - web sites) said on Thursday.

U.S. flu cases appeared earlier than usual last October, peaked in November and December and declined rapidly in the first two months of this year, according to an article published in the CDC's weekly morbidity and mortality report.

But based on preliminary data from labs, doctors and city and state health officials, "it was comparable to several seasons in the 1990s in which similar influenza virus strains circulated," the CDC said.

The Atlanta-based agency said it had received reports of 142 flu-related deaths in U.S. residents under the age of 18 as of March 27.

The CDC had not previously tracked these deaths, so it could not say whether they had increased.

Exact figures for flu fatalities among adults are unavailable because doctors are not required to report them.

Influenza, which is marked by respiratory inflammation, fever, muscle pain and intestinal tract irritation, kills about 36,000 people and hospitalizes 114,000 in the United States every year.

The flu, which typically circulates in the nation from October through March, hit the nation hard late last year before many Americans had been vaccinated. A subsequent rush for shots led to a temporary vaccine shortage in some areas.

Drug makers produced 83 million doses of vaccine for the 2003-2004 flu season, fewer than in the previous year when a large number went unused and were thrown away.

Efforts to combat the flu were further complicated by the fact that the vaccine was not very good at protecting people against the A (H3N2) flu strain that was most common this season.

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Nursing a Slipped Disc

 

HealthDayNews

Thursday, April 8, 2004

(HealthDayNews) -- A slipped disc occurs when part of the spongy core of a disc (a pad between two spinal vertebrae) bulges out or pops through the outer coating of the disc. This then puts pressure on the nerves that run up and down the spinal column, according to the Calgary Health Region.

Symptoms of a slipped disc may include: pain or a feeling of numbness in your back, arm, buttock, thigh, lower leg or foot; a feeling of stiffness in your lower back; and loss of the lower back's normal inward curve.

In most cases, symptoms improve with self care:

If the pain doesn't subside within a few days, see your doctor.

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Daughters Learn Eating Habits from Moms

 

By Alison McCook

Reuters Health

Thursday, April 8, 2004

NEW YORK (Reuters Health) - Like the old adage "like mother, like daughter" says, women can pick up many eating habits by watching their mothers in the kitchen.

Investigators found that low-income African-American women often learn from their mothers to be "grateful" for the food they are given, but may get few lessons on which foods are healthier than others.

Specifically, discussions with 21 women between the ages of 25 and 65 revealed that women were often taught that food was scarce, and they should eat everything they are served - a practice that could lead to overeating.

And while some mothers told their daughters that they should eat more vegetables because they are "good for you," other daughters received no such information.

Girls watch their mothers closely, and these findings demonstrate that women have a great opportunity to provide their daughters with life-long healthy eating habits, "by their own positive example," study author Dr. Diane Baer Wilson told Reuters Health.

"Habits become behaviors when they begin early, when they are routinely observed in parents, and seem to be valued by an authority figure," she said.

"Parents can use their influence to model positive health habits for children, including healthy eating and exercise," added Wilson, who is based at the VCU School of Medicine in Virginia.

During the study, Wilson and her team reviewed information gathered from four discussion groups with the women. Two of the groups included women between the ages of 25 and 45, and the other two groups were made up of women between the ages of 46 and 65.

All study participants were members of the African Methodist Episcopalian church, and lived in low-income communities in South Carolina.

Although there were many similarities between the older and the younger women, the researchers discovered important differences, as well.

For instance, younger women were more likely to say that they eat differently now than their mothers did, noting that their busier lifestyle and added conveniences like microwaves often discourage them from cooking large meals three times per day, as their mothers did.

Younger women also indicated that they learned about the importance of healthy eating and its relationship to diseases like diabetes and high blood pressure at an earlier age than older women.

In many cases, women also picked up their attitudes about their bodies from their mothers. For instance, older women said they were often taught by their mothers to be happy with their bodies, and their mothers only rarely spoke about wanting to lose or gain weight. However, some younger women reported that their mothers dieted, or were concerned that their daughters looked too thin.

Source: Journal of Cultural Diversity, April 2004.

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Aggressive Care Boosts Diabetics' Overall Health

By Serena Gordon
HealthDay Reporter

HealthDayNews

Thursday, April 8, 2004

THURSDAY, April 8 (HealthDayNews) -- When it comes to managing diabetes, more care results in better overall health.

That's the conclusion of a new study appearing in the April issue of Clinical Diabetes, which found that when diabetics were more intensively supervised by their physicians, their blood sugar, blood pressure and cholesterol levels were lower.

"This was a concerted effort to get physicians to follow the American Diabetes Association [ADA] guidelines for diabetes care," said the lead author of the study, Dr. Francis Solano, Jr., the chief medical officer of the University of Pittsburgh Medical Center's Community Medicine, Inc.

More than 18 million Americans have diabetes, according to the ADA. If the disease isn't properly treated, diabetes can have serious complications, such as heart disease, kidney failure and blindness.

In 2000, the University of Pittsburgh Medical System, which includes the practices of 220 primary care physicians, began implementing the ADA Standards of Care. Initially, approximately 125 physicians voluntarily began the project; eventually, participation was mandatory. At the end of the two-year study period, 95 percent of the physicians' offices were participating.

Physicians were educated on the ADA guidelines, given supporting literature, and taught strategies for teaching self-management to people with diabetes. Education was done during meetings or lectures, or through telecommuting for doctors in outlying, rural areas. All of the physicians were asked to keep track of any interventions, such as prescribing medication, and were given quarterly lab reports detailed their patients blood tests.

At the end of two years, blood tests on almost 16,000 people with diabetes showed an average HBA1C of 6.97 percent. HBA1C is a test that measures how well blood sugar has been controlled during the previous two to three months; according to Solano, the national average is nearly 8 percent. He said a 1 percent drop results in a 35 percent decreased risk of complications, such as eye, kidney or nerve problems.

For the study, the researchers tracked blood pressure and cholesterol management in 4,598 people. Almost 80 percent had lowered their blood pressure below 140/90 -- the figure deemed to be hypertension -- and 51 percent managed to get below 130/80. Just over three-quarters were able to get their LDL (the "bad") cholesterol levels under 130 milligrams per deciliter of blood -- a figure of under 130 is considered desirable -- and almost 43 percent managed to get this level under 100 mg, according to the study.

"They really hit the nail right on the head with their model," said Dr. Michael Fleming, president of the American Academy of Family Physicians (news - web sites). "Their data backs up what we all probably intuitively knew. You need to have a medical home, a physician that you see on a regular basis who knows you. But the big issue is time. Time is limited, and most physicians aren't in an integrated system [like the one in the study]."

Dr. Daniel Nadeau, medical director of HealthReach Diabetes of Exeter Hospital in Exeter, N.H., said the study's results were encouraging. "In a fairly short time, they were able to make a real difference in their patients' outcome," he noted.

In a perfect world, diabetics would have an endocrinologist help them manage their disease, but Nadeau said that there simply aren't enough of these specialists.

Another important issue in diabetes management is cost. Dr. Stuart Weiss, an endocrinologist at New York University Medical Center, said, "Diabetes is a time-consuming, poorly compensated disorder."

Weiss noted that in the study, the researchers were able to make a difference in blood sugar, blood pressure and cholesterol control without large additional expenditures.

Using nurse practitioners for education and monitoring can be a good way to keep costs down without sacrificing care,he added, noting also that newer glucose monitors store blood sugar readings and can be downloaded onto a doctor's computer before the patient's visit.

"This disease is treatable," said Weiss, and "with good monitoring and good control, some of the complications can be delayed or hopefully avoided."

Solano says the five most important factors in diabetes management are controlling blood sugar, cholesterol, and blood pressure, and getting your eyes and feet checked on a regular basis.

More information

To learn more about diabetes, go to the American Diabetes Association (ADA). The ADA also offers advice on who should be on your health care team.

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Rat Study: Labor Drug Might Affect Offspring Brain

 

By Merritt McKinney

Reuters Health

Thursday, April 8, 2004

NEW YORK (Reuters Health) - Research in rats suggests that a drug frequently used to stop premature labor could make the brain of the offspring more susceptible to chemicals that are widespread in our environment, particularly pesticides.

Newborn rats given the drug terbutaline experienced more extensive brain damage when they were later exposed to a chemical often used in pesticides, researchers report.

Although the study was conducted in animals not people, the findings may help explain the reported increased risk of psychiatric and learning disorders in children who were exposed to terbutaline in the womb, according to a report in the March issue of the journal Toxicology and Applied Pharmacology.

Using drugs for preterm labor "comes at a cost: potential increase in the incidence of brain damage and associated cognitive and psychiatric problems later in life," said Dr. Theodore A. Slotkin, a pharmacologist at Duke University Medical Center in Durham, North Carolina.

Slotkin told Reuters Health the animal study suggests that children exposed to terbutaline in the womb may become especially sensitive to pesticides and other chemicals.

These children could be vulnerable to levels of chemicals that are otherwise "safe" for everyone else, he added.

Terbutaline helps stop premature labor by relaxing smooth muscles, which interferes with the contractions of the uterus.

According to Slotkin, for several years the American College of Obstetricians and Gynecologists has not endorsed the prolonged use of terbutaline to control preterm labor, and the drug's maker also advises against this practice.

"Nevertheless, many obstetricians continue to prescribe terbutaline or related drugs for long-term administration in pregnancy," he said.

"Our studies show that there are significant liabilities in doing so, and that the risk-benefit comparisons need to be reevaluated," he said.

In the rat study, Slotkin and his colleagues examined the effects of terbutaline and an insecticide called chlorpyrifos, which is known to have harmful neurological effects.

The Food and Drug Administration (news - web sites) began gradually restricting the home use of chlorpyrifos in 2000, but it is still widely used in agriculture. People can be exposed to chlorpyrifos residues on produce. <

Baby rats were exposed to terbutaline alone, chlorpyrifos alone or terbutaline followed by chlorpyrifos. A group of "control" rats were not exposed to either chemical.

When given alone, each chemical caused long-lasting changes in the development of brain cells, the researchers report.

What's more, terbutaline seemed to make the brain more sensitive to the effect of chlorpyrifos. As shown in rats that received both chemicals, the effect of the combined exposure was greater than the sum of the individual exposures.

More research is needed to determine the human impact of long-term terbutaline during pregnancy, according to Slotkin.

Children whose mothers were given terbutaline should be carefully evaluated for possible effects on intellectual and psychological development, he said. Future studies should also monitor the long-term effects of the drug on children's exposure to chemicals in the environment, according to the Duke researcher.

Source: Toxicology and Applied Pharmacology, March 2004.

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Lack of Brain Protein Causes Learning Woes in Mice

 

HealthDayNews

Thursday, April 8, 2004  

THURSDAY, April 8 (HealthDayNews) -- Lack of a brain protein called RIM1 alpha causes serious learning and memory problems in mice, says a study by researchers at University of Texas Southwestern Medical Center in Dallas.

The study, published this week in the journal Neuron, provides the first evidence that the absence of this protein causes serious deficits in the learning process. The research adds to scientists' understanding of the molecular processes associated with memory and learning.

These complex processes can be impaired in people with Alzheimer's disease (news - web sites), mental retardation, schizophrenia, and other human neuropsychiatric disorders.

"This is the first indication that these proteins could be good targets for treatment of specific brain disorders," study lead author Dr. Craig Powell, assistant professor of psychiatry and neurology, said in a prepared statement.

He and his colleagues compared behaviors of normal mice to three kinds of genetically altered mice. Each group of genetically altered mice was lacking a specific protein involved in releasing neurotransmitters.

The mice lacking the RIM1 protein were the only group of mice unable to learn the location of an escape platform in a pool, despite repeated attempts over several days.

More information

The U.S. National Institute on Aging has information about Alzheimer's disease.

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Laser Light Not Much Good for Diabetic Nerve Pain

 

Reuters Health

Thursday, April 8, 2004

NEW YORK (Reuters Health) - Nerve damage in the legs and feet caused by diabetes can give rise to severe pain, which is often difficult to treat. There has been some evidence that the condition can be eased by shining low-intensity laser light on the affected area, but the results of a new clinical study are discouraging.

Canadian investigators report "a trend to improvement" with low-intensity laser therapy (abbreviated to LILT), but after four weeks of treatment there were no clinical differences compared to treatment with a sham laser.

Because painful diabetic neuropathy is often not improved with medication, Dr. Vera Bril and colleagues explain in the medical journal Diabetes Care, they evaluated the application of LILT as an additional or alternative therapy.

The researchers at Toronto General Hospital recruited 50 people with diabetes who reported pain intensities in both feet of 4 or higher on an 11-point scale. The participants' medications remained unchanged for at least 4 weeks before and throughout the study.

Twice-weekly treatment was administered to two painful areas on each foot for five minutes. First, all participants were given sham treatment for two weeks, then laser treatment was randomly assigned to 25 patients while the other 25 continued on the sham treatment.

Both groups reported a decrease in average weekly pain scores after the two weeks of sham therapy. After six weeks, there was no further change in pain scores in the sham group and only a small drop in the active treatment group. The difference in pain scores between groups was not significant, statistically.

Also, there were no significant changes in measurable factors such as nerve conduction, skin responses to stimulus, and sensory tests.

However, the change in pain scores from before the study started to the end of laser treatment were "clinically meaningful," the authors write, so "the observed trend warrants further investigation."

And because longer duration or more frequent laser treatment could perhaps produce greater benefit, they advocate the development of home laser equipment as a more convenient option for patients.

Diabetes Care 2004;27:921-924.

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Eye Medication May Reduce Stroke Risk

 

HealthDayNews

Thursday, April 8, 2004

THURSDAY, April 8 (HealthDayNews) -- A drug used to improve the function of retinal blood vessels may help reduce stroke risk, according to a study in the April 8 rapid access issue of Stroke: Journal of the American Heart Association (news - web sites).

The study of 38 young adults found that endothelial function is abnormal in the eye blood vessels of people with early stage hypertension, or high blood pressure. The endothelium -- the lining of vessel walls -- plays a major role in the ability of vessels to constrict and relax.

The study also found that treatment with an angiotensin-receptor blocker (ARB) drug improved endothelial function in these people.

Retinal and brain blood vessels are similar. So this study's findings suggest that an ARB can improve the function of brain blood vessels as well as the function of eye blood vessels, said the study's lead author Dr. Christian Delles. Delles is a research fellow at the British Heart Foundation Glasgow Cardiovascular Research Center in Scotland, but he did the study at the Clinical Research Center at the University of Erlangen-Nurnberg in Germany.

"Studying the reaction of blood vessels in the eyes may offer insight into stroke prevention by revealing how blood vessels in the brain react to high blood pressure, a major risk factor for stroke," Delles said in a prepared statement.

More information

The American Medical Association has more about the effects of stroke.

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Fewer Blacks, Latinos Treated for Prostate Cancer

 

By Alison McCook

Reuters Health

Thursday, April 8, 2004

NEW YORK (Reuters Health) - Black men in the United States are more likely to die of prostate cancer than are white men, and new research suggests this disparity may stem from differences in how the groups are treated for the disease.

After reviewing the records of more than 140,000 men diagnosed with prostate cancer, researchers found that black and Latino men were less likely to undergo surgery or radiation than were whites.

As prostate tumors became more aggressive--more likely to spread to other parts of the body--black and Latino men became less and less likely to receive surgery or radiation compared with whites.

"As you increase the aggressiveness of the cancer, the disparity widens. Which doesn't make sense," lead study author Dr. Willie Underwood told Reuters Health.

Although some researchers believe that black men may have genetic differences that make their cancers more deadly, this report suggests that access to treatment may also be responsible for the survival gap between blacks and whites diagnosed with prostate cancer, co-author Dr. John Wei explained.

Any number of factors may affect whether black men receive surgery or radiation for prostate cancer, Wei told Reuters Health. For instance, blacks may carry cultural beliefs that cause them to forgo treatment, they may have less information about its benefits, or may be treated differently by health staff, he said.

Underwood added that while there may be biological differences in the prostate cancers of men in different racial groups, previous research has shown that when blacks receive the same treatment as whites, they are just as likely to survive prostate cancer.

How can we say that biology is the reason blacks and whites fare differently with prostate cancer? he asked. "They've never had the same treatment."

Underwood and Wei, both based at the University of Michigan in Ann Arbor, reviewed data collected from 142,340 white, black and Latino men diagnosed between 1992 and 1999 with prostate cancer that had not yet spread.

The authors noted who received surgery or radiation for their cancer.

Although black and Latino men were less likely to be treated for prostate cancer than were whites, that gap appeared to decrease during the 1990s, particularly among Latino men, according to the Journal of Urology report.

Underwood suggests that this trend may stem from increased awareness of the benefits of treatment for prostate cancer, which may have had more of an effect on Latino men.

Source: Journal of Urology, April 2004.

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Genes Strongly Tied to Asthma Identified

 

By Steven Reinberg
HealthDay Reporter

HealthDayNews

Thursday, April 8, 2004

THURSDAY, April 8 (HealthDayNews) -- Swedish scientists have found two genes directly linked with increasing the risk of asthma and other breathing problems, a discovery that may open new avenues to drug therapy.

chromosome 7. Mutations in chromosome 7 have been linked to asthma, and parts of the GPRA gene have been associated with asthma and certain inherited allergies.

"These genes on chromosome 7 are genetic risk genes for developing asthma," said lead researcher Dr. Juha Kere, a professor of molecular genetics at the Karolinska Institute in Stockholm.

Kere and his colleagues studied these genes in biopsy samples from three different populations, two in Finland and one in French Canada. In addition, they tested the function of the genes in mice, according to their report in the April 9 issue of the journal Science.

These genes make a protein that is found on the cells of the airway and also on smooth muscle cells, Kere said. Both are important cell types in asthma, he added.

Since asthma is an inflammation coupled with a muscle constriction of the airway, these genes appear to play a direct role in the disease, Kere said.

Kere added that not only are these proteins involved in asthma, but they also are drug targets for treating asthma.

"More than half of the asthma medications sold today are targeted at these proteins," Kere said. "That makes these new genes promising targets for developing new drugs for asthma."

Unlike other genes that have been identified as playing a part in asthma, these new genes appear to be more common risk genes than many of the others, Kere said.

In fact, the altered form of the gene linked to asthma is found in almost half of the asthma patients the researchers studied, he said. How these genes affect other asthma sufferers is not clear, Kere added.

However, Kere believes that this same genetic pathway might be altered in other ways in most asthmatics, although this still needs to be investigated.

In addition, how alterations in these genes work to cause asthma is not known. The researchers' next task is to uncover how these genes work and how they are related to other genes involved in asthma, Kere said.

Dr. Lanny J. Rosenwasser, an immunology and asthma expert at the National Jewish Medical and Research Center in Denver, said that this is a solid and important finding.

"But asthma is such a complex genetic disease that there are probably dozens of these kinds of findings that have been made and will continue to be made as we try to piece together how the pathogenesis of asthma works," he said.

"This study highlights a potential contributor to asthma that we didn't know much about before," he added.

There is clearly an important genetic component to asthma, but -- like other diseases -- one set of genes is not the major cause. There may be as many as 50 genes, with many mutations of each that contribute to asthma, Rosenwasser said.

The problem is working out how these genes interact to cause the inflammation and changes in the lungs that results in asthma, he added.

However, if the genes highlighted in this study identify pathways that are important in lung function or in inflammation, then it could lead to developing new drugs to treat asthma, Rosenwasser said.

More information

The American Academy of Allergy, Asthma and Immunology and the National Institute of Allergy and Infectious Diseases can tell you more about asthma.

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Statin Treatment Before Stroke May Improve Outcome

 

Reuters Health

Thursday, April 8, 2004

NEW YORK (Reuters Health) - Cholesterol-lowering "statin" drugs (such as Zocor or Lipitor (news - web sites)) are prescribed to protect the heart, but they may also protect the brain.

According to doctors in Barcelona, Spain, people who were taking a statin before they suffered a stroke were functioning better three months later than other stroke patients who had not been on a statin.

In the medical journal Stroke, Dr. Joan Marti-Fabregas, at Hospital de la Santa Creu i Sant Pau, and colleagues followed 167 consecutive patients who suffered a first-time stroke. Thirty of these subjects were taking a statin drug at the time of their stroke.

Even though more of these 30 pre-treated patients had diabetes, a prior "mini-stroke," and high cholesterol, they were more likely to be living without significant disability three months later than were patients not taking a statin.

Mortality was also lower in the statin group compared with the non-statin group (3.4 percent versus 6.6 percent died), although the difference could have been due to chance.

"This article is important in strengthening previous observations," Dr. Jonathan Y. Streifler notes in an editorial commentary. However, he notes that the study did not describe other treatments the patients might have been taking, which could have conferred additional benefits.

Source: Stroke, April 8th rapid access issue, 2004.

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Second Penicillin Allergies Less Common Than Thought

By Kathleen Doheny
HealthDay Reporter

HealthDayNews

Thursday, April 8, 2004

THURSDAY, April 8 (HealthDayNews) -- People who have had one allergic reaction to penicillin may not always have a second reaction to the drug, experts now contend.

New research finds that the number of reactions the second time around isn't as high as thought.

Still, the findings shouldn't be interpreted as carte blanche to prescribe the antibiotic to those who have had a previous reaction, says the study's author, Dr. Andrea Apter, an allergy-immunology specialist at the University of Pennsylvania. Her research appears in the April issue of the Journal of Allergy & Clinical Immunology.

"The overall rate is lower than quoted in the literature," she said. "Doctors say that 60 percent of those with an initial reaction will have problems the next time. In actuality, it rounds to about two percent."

Those numbers are based on the evaluation of more than three million electronic medical records of patients in Great Britain who received a prescription for penicillin from 1987 to September 2001, Apter said. Of that total, more than 2 million patients received at least two prescriptions for penicillin 60 days apart, and almost all of them had no adverse reaction to either dose.

There were, however, 3,014 patients among those who got two doses who had an adverse reaction to the first dose. But only 57 patients had an adverse reaction to the second course. Those 57, Apter said, represent 1.89 percent of the total number of patients.

"Having a problem the second time is much less common," she said.

Exactly why doctors give patients penicillin again when they've had problems remains unclear, Apter said. But sometimes people don't really know if they have had a penicillin allergy, she said.

Sometimes penicillin reactions are fairly immediate, she said. "If within an hour or two [of taking penicillin], they get rash, hives, shortness of breath, and there are no other reasons [for the symptoms], they know [they have an allergy]."

But sometimes the first allergic reaction occurred when people were very young and their memories of it aren't clear. Or a rash might appear days after the penicillin regimen is started, so the link isn't clear.

Penicillin skin testing is currently imperfect and remains commercially unavailable, Apter said.

The study shouldn't be interpreted to mean that those with a penicillin problem after the initial course can take it again without worry, Apter reiterated. "I wouldn't say someone who has had a problem with penicillin could safely have it again," she said.

More research is needed, she added.

Dr. Eric Macy, chairman of the Adverse Reactions to Drug and Biologicals Committee for the American Academy of Allergy Asthma and Immunology, said the new study points to the need to get accurate penicillin skin testing on the market as soon as possible.

"The materials to perform accurate penicillin skin testing are not commercially available anywhere in the world," Macy added. "There has been an orphan drug application on file with the FDA (news - web sites) since 1987 for the penicillin skin test materials, but no pharmaceutical company has produced the materials for commercial sale."

"The AAAAI has started an initiative to bring pharmaceutical manufacturers, the Food and Drug Administration, the Centers for Disease Control and Prevention (news - web sites) and large health-care providers together to get these important skin test materials produced and made available in the U.S.A. and the rest of the world," he said.

More information

The American Academy of Allergy Asthma and Immunology has more information on allergies to penicillin and skin testing for allergies.

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Wednesday, April 7, 2004

 

Secondhand Smoke May Slow Healing in Kids

 

The Associated Press

Wednesday, April 7, 2004

LOS ANGELES - A child's ability to heal from cuts, burns or infections could be slowed by exposure to secondhand tobacco smoke, a new study shows.

The study by researchers at the University of California, Riverside suggests that parents who smoke around their children could cause a range of health-related issues for youngsters.

"The idea is to make people aware of the fact that secondhand smoke is just as bad, or maybe I could say worse, than firsthand smoke for certain kinds of problems," said Manuela Martins-Green, an associate professor of cell biology who led the research team.

The study was published Monday in the online journal BMC Cell Biology.

Cells typically rush to all areas of a wound. But when exposed to smoke, the cells cluster in one area on the edge of the wound, limiting healing and causing scars, Martins-Green said.

The research could have implications for larger problems, including the effect of secondhand smoke on the liver, kidney, heart and arteries, the professor said.

The research team focused on cells that were extracted from animals and humans, and studied how smoke affected healing cells called fibroblasts in culture dishes.

Public health officials have warned against the perils of secondhand smoke. The American Lung Association identifies it as a cause of lung cancer.

A representative of Philip Morris USA said the cigarette producer has not researched the impact of secondhand smoke on wounds.

"The people should be guided by the findings or conclusions of public health officials," said Jamie Drogin, spokeswoman for Philip Morris in Richmond, Va.

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Pfizer Drug Boosts 'Good' Cholesterol – Study

 

By Gene Emery

Reuters

Wednesday, April 7, 2004

BOSTON (Reuters) - A small study has found an experimental Pfizer drug can more than double the level of "good" cholesterol in the body and may herald a new way of fighting heart disease.

The study of six volunteers, funded by Pfizer, found that the drug torcetrapib, given twice a day for eight weeks, boosted the amount of high-density lipoprotein (HDL) by 106 percent. HDL clears "bad" cholesterol from the body.

Many scientists believe that raising HDL levels is as important in fighting heart disease as cutting levels of "bad cholesterol," or LDL, although further studies are needed to conclusively show this and some researchers say the benefits of HDL may be overstated.

The findings were part of a larger four-week trial of 19 volunteers who were given the experimental drug alone, or in combination with another Pfizer Inc. drug, Lipitor (news - web sites), which lowers "bad" cholesterol levels.

The people who got one 120 milligram torcetrapib tablet a day had a 46 percent increase in HDL. The effect was higher when Lipitor was added to the mix: "good" cholesterol increased by 61 percent.

Ronald Clark, a Pfizer scientist who helped summarize the study and helped discover torcetrapib, said those who took the drug with Lipitor saw their levels of "bad" LDL cholesterol fall about 60 percent -- 17 percentage points lower than those taking Lipitor alone.

He said that contrasts with a statistically insignificant 7.5 percent reduction in LDL cholesterol among those taking torcetrapib alone, suggesting that use of it with Lipitor magnifies the respective LDL-lowering abilities of the two drugs.

Pfizer in December acquired Esperion Therapeutics Inc. for $1.3 billion so it could add the promising torcetrapib to its pipeline of experimental drugs. It hopes a combined Lipitor/torcetrapib pill -- once approved -- can become an even bigger seller than the $10 billion-a-year Lipitor, the world's best selling medicine.

The latest study, led by Margaret Brousseau of Tufts University School of Medicine in Boston, did not gauge whether the higher levels of "good" cholesterol actually reduced the risk of heart disease. All of the volunteers had unusually low levels of HDL cholesterol to begin with.

Pfizer, which has budgeted a record $800 million on a separate late stage trial of the combination pill, paid for the research, which was published in this week's edition of The New England Journal of Medicine (news - web sites).

Although doctors have a choice of several drugs for lowering "bad" cholesterol, they have fewer options when it comes to pumping up levels of the good variety, and the increases are usually modest. Exercise is also known to raise HDL, but not dramatically.

Every point a person's "good" cholesterol level is increased translates into a 2 to 4 percent decrease in the risk of heart disease, according to researchers.

Researchers hope that higher levels of "good" cholesterol may be able to eat away at the plaques that narrow blood vessels and can lead to a heart attack or stroke.

Torcetrapib-type medicines "hold great promise as a new class of drugs that will be of major benefit in the treatment of cardiovascular disease," said Bryan Brewer Jr., of the National Heart, Lung, and Blood Institute in Bethesda, Maryland, in a Journal editorial.

He said doctors are already experimenting with direct infusions of HDL in the hope that it will open up narrowed arteries.

Industry analysts say the Lipitor/torcetrapib pill could hit drug stores within three years and compete with a combination pill made by Merck & Co Inc and Schering-Plough Corp that is now awaiting U.S. approval.

That pill combines Merck's $5 billion-year cholesterol fighter Zocor, which is in the same "statin" class as Lipitor, with Zetia, which was recently launched by Schering-Plough and Merck. Zetia has been shown to lower LDL by over 50 percent, but increases HDL by less than 10 percent.

A raft of recent studies have shown the greater the reduction in bad cholesterol, the less chance that people have of developing heart disease and stroke. (Additional reporting by Ransdell Pierson in New York)

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New Guidelines to Help Cancer Patients

 

The Associated Press

Wednesday, April 7, 2004

OMAHA, Neb. - Teaching cancer patients and doctors how to prevent and treat nausea and vomiting is the goal of recently updated guidelines, formulated with the help of the University of Nebraska Medical Center.

UNMC's Eppley Cancer Center and 18 other institutions in the National Comprehensive Cancer Network have collaborated with the American Cancer Society (news - web sites) to create guidelines for treating those common side effects to cancer treatments.

A reader-friendly version of the guidelines for patients, which include suggestions for medicines that might help, is being made available in paper form from the American Cancer Society, Cancer Network spokeswoman Kim Schwalje said. The Cancer Network also plans to post the guidelines on its Web site, she said.

Guidelines for doctors were released earlier this year, she said. Both include information on different cancer medications and ways to combat the side effects of nausea.

Dr. Ralph B. Nance, the national volunteer president of the American Cancer Society, said the guidelines are important because nausea and vomiting are two of the many feared side effects of cancer treatment.

"Cancer patients and their families now have the reliable, specific, and easy-to-understand information they need to make timely and well-informed decisions about this critical health care issue," he said.

On the Net:

National Comprehensive Cancer Network, http://www.nccn.org/

American Cancer Society, http://www.cancer.org

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Experts Offer Tips to Keep Toddlers Fit

 

By Janet McConnaughey

Associated Press Writer

The Associated Press

Wednesday, April 7, 2004

NEW ORLEANS - It doesn't take a personal trainer to get a preschooler to exercise. All it takes is some imagination. How would you reach for a star? How would you pick a flower? Let's see you tiptoe. Now, let's gallop.

These are tips offered by a physical education and sports group to help parents make sure their kids don't soon join the 123 million American adults who are overweight.

"We tend to think that we need specialized knowledge or fancy equipment or to enroll them in programs that cost a lot of money to get our kids to exercise," said Rae Pica, who wrote a booklet of suggestions for parents.

She and officials from the National Association for Sport and Physical Education and other sponsors promoted it recently at a daycare center.

An estimated 64 percent all adults in this country are overweight or obese. Ten percent of all children age 2-5 and 15 percent of older children are overweight, according to the National Center for Health Statistics.

"We've found, through research, that if you're active when you're young, you'll be active when you're older," said Dr. Dorothy G. Richardson, vice chair of the President's Council on Physical Fitness and Sports.

Most of the exercises in the "Kids in Action" brochure don't need any equipment at all. The most complicated equipment is a plastic sheet or old tablecloth to sit on, two big plastic cups, and sand or water to pour from one cup to the other. Outside, in the summer.

Many can be done just about anywhere, any time, one mother noted after watching her son and his classmates stretch, jump, and mirror Pica's movements.

"Just today I was with Ely at the doctor's office. These are things you can do with them when they just have to occupy themselves," Katherine Johnston said.

The government, physical fitness organizations and Kellogg Co. sponsored the booklet, which is available on NASPE's Web site.

The booklet recommends several hours of active play every day for small children, with at least 30 minutes of exercises — in 10- or 15-minute chunks — for toddlers and an hour for preschoolers.

Dr. Dennis M. Styne, a pediatrics professor, likes the parental involvement illustrated in the pamphlet and called its activities "absolutely safe."

But the problem of excess weight has many causes, says Styne, of the University of California at Davis. "Calories — and availability of parents — are another part," he said.

So is television. "Small children ... should never be inactive for more than 60 minutes," the booklet notes.

One translation: Turn off the TV.

"We watch 28 hours of television a week," Styne said. "The average child has wasted three years of their life by the end of high school."

However, he said, making sure small children eat a healthy diet is often a bigger problem than getting them to move.

Most toddlers love to move, he said, but they also tend not to like new food — especially vegetables. "Children are born with a taste for sweet and a taste for salt and an aversion for bitter. Many vegetables are bitter. If you don't train a child to taste vegetables regularly, it becomes more difficult later."

On the Net:

Brochure: http://www.aahperd.org/naspe/template.cfm?templatekids_brochure.html

http://www.naspeinfo.org

http://www.aahperd.org

Government information about childhood obesity:

http://www.cdc.gov/nccdphp/dnpa/obesity/trend/index.htm child

http://childstats.gov/ac2003/indicators.asp?IID122&id4

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Blueberry Bonanza

 

HealthDayNews

Wednesday, April 7, 2004

(HealthDayNews) -- Blueberries are more than a tasty, decorative addition to a fruit plate.

One serving of blueberries contains a cup full of goodness, says Moses Taylor Hospital in Pennsylvania.

Here are the facts:

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Beta-Blocker Plus Statin Curbs Heart Attack Deaths

 

Reuters Health

Wednesday, April 7, 2004

NEW YORK (Reuters Health) - People who survive a heart attack but develop heart failure as a result fare better when treated with a beta-blocker or a statin drug. Moreover, combination treatment with both types of drug increases the benefits, according to a new study.

Dr. Aina Hognestad, of the University of Oslo, Norway, and colleagues looked at data on 5301 heart attack survivors who were enrolled in a clinical trial of various drug treatments.

A total of 1971 participants (37 percent) were treated with both statins and beta-blockers, 496 (9 percent) were given statins alone, 2004 (38 percent) received beta-blockers alone, and 830 (16 percent) were given neither treatment.

A total of 770 patients died during the following three years, and 726 had another heart attack, the team reports in the American Journal of Cardiology.

Compared with no treatment, statin treatment alone reduced the risk of dying by 26.1 percent, beta-blockers alone yielded a decrease of 30.6 percent, and the combination of statins and beta-blockers cut mortality by 48.3 percent, Hognestad and colleagues found.

Based on these findings, the researchers conclude that early initiation of statin and beta-blocker therapy for patients with a heart attack complicated by heart failure can decrease mortality.

Source: American Journal of Cardiology, March 1, 2004.

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How Does Alcohol Affect Your Health?

 

HealthDayNews

Wednesday, April 7, 2004  

WEDNESDAY, April 7 (HealthDayNews) -- American adults who drink are being encouraged to take part in free nationwide screenings April 8 to find out how alcohol affects their health.

The "Alcohol and Your Health -- Where Do You Draw the Line?" screenings will be offered at more than 5,000 sites across the United States as part of National Alcohol Screening Day.

"National Alcohol Screening Day can help save lives by maximizing the power of prevention," U.S. Surgeon General Dr. Richard H. Carmona said in a prepared statement. "No one wants to hurt themselves or others through drinking, and a free screening provides the opportunity to learn how alcohol affects you -- so that you can prevent risks from becoming tragedies."

"Drinking can have unintended and even tragic consequences," Carmona added, noting that alcohol consumption in the United States leads to more than 100,000 deaths each year from related injuries and illnesses.

People who attend a screening will complete a brief written assessment of their alcohol use. They will also have the opportunity to talk privately with a health professional to discuss their results and ask questions.

More information

Here's where you can find a local screening site.

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Patient Dies of 'Flesh-Eating Bacteria'

 

The Associated Press

Wednesday, April 7, 2004

GAINESVILLE, Ga. - A nursing home patient has died of an ailment commonly known as "flesh-eating bacteria," state health officials said Wednesday.

The condition, called necrotizing fasciitis, is a skin infection caused by Group A streptococus. Another nursing home resident is hospitalized with strep A infection, said Richard Quartarone of the Georgia Division of Public Health.

Two other residents of Bell Minor Nursing Home died with the bacteria. But their deaths are not believed to have been caused by it, Quartarone said.

Bell Minor Nursing Home officials contacted the health department on March 19 to request a review of their infection control procedures after a resident was suspected to have the infection.

"These kinds of things are very difficult to contain unless you get on top of it like this nursing home did," Quartarone said.

Officials cleaned the private 104-bed nursing home and provided antibiotics to any staff members or patients who had the bacteria.

About 10 percent of staff and patients tested positive for the bacteria, much lower than the 15 percent of the U.S. population who typically carries the bacteria, Quartarone said.

Good handwashing, covering the mouth and nose during coughing and infection control practices can prevent passing the bacteria to others, he added.

About 600 cases of necrotizing fasciitis — resulting in about 150 deaths — are reported annually in the United States, according to the Centers for Disease Control and Prevention (news - web sites).

The skin infection enters through an existing wound, quickly destroying muscle, fat and skin tissue as it outwits antibiotics and other treatment.

Pneumonia, blood and skin infections, and meningitis are among the more serious forms of Strep A, according to state epidemiologist Dr. Gary Hlady. In contrast, millions of Americans get strep throat every year.

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Iron Therapy Calms Restless Legs Syndrome

 

By David Douglas

Reuters Health

Wednesday, April 7, 2004

NEW YORK (Reuters Health) - Restless leg syndrome -- marked by uncomfortable sensations and an urge to move the legs, most often at night -- frequently afflicts people with end stage kidney disease. Now, doctors have shown that the condition can be eased by intravenous infusions of iron dextran.

However, relief is transient, the researchers report in the American Journal of Kidney Diseases.

In such patients, "our findings, coupled with those of other investigators, suggest abnormal iron transport in the movement centers of the central nervous system," lead author Dr. James A. Sloand, told Reuters Health.

Sloand of the University of Rochester, New York and colleagues note that restless legs syndrome may be linked to iron deficiency.

To investigate whether iron replenishment might be helpful, the researchers conducted a study in which 11 patients at random were given daily treatment with iron dextran while 14 others receive an inactive placebo.

Although the patients "did not have iron deficiency by the usual noninvasive biochemical standards," say the investigators, at the end of one week, there was a significant improvement in restless legs syndrome severity scores in the iron dextran group.

The infusion had its greatest effect after two weeks, but by 4 weeks the scores were no longer significantly different from those in the placebo group.

This information, Dr. Sloand concluded, "will ultimately enhance our understanding of the cause of restless legs syndrome and help target future therapeutic endeavors to provide long-term relief of symptoms for those suffering from this syndrome."

Source: American Journal of Kidney Diseases, April 2004.

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Group: 25 Million to Lose Parents to AIDS

 

By Malia Rulon

Associated Press Writer

The Associated Press

Wednesday, April 7, 2004

WASHINGTON - The number of children worldwide who have lost one or both parents to AIDS (news - web sites) is expected to reach 25 million by the end of the decade, activist groups said Wednesday.

Sens. Mike DeWine, R-Ohio, and Hillary Rodham Clinton (news - web sites), D-N.Y., released the report along with the two groups to raise awareness of the millions of children worldwide who are affected by the disease — being orphaned at a young age or contracting the illness.

Of the estimated 40 million people worldwide who are living with the HIV virus (news - web sites) that causes AIDS, more than 2.5 million are under 15 and about 11.8 million are between 15 and 24, the report said.

The groups said 13.4 million children — roughly the population of Los Angeles County — have lost one or more parents to AIDS. That number is expected to nearly double by the end of the decade, the report said.

These numbers are personalized in the report through stories of individual children: Olivia Nantongo of Kampala, Uganda, was left an orphan at 12 when her mother, following her father, died of AIDS. Shunned by her family and neighbors, she sought refuge at a support group.

In 1999, Nantongo was part of a delegation that came to Washington to speak to then-President Clinton (news - web sites) and Congress about AIDS. Soon after her return home, she was diagnosed with AIDS; she died a year later.

"We talk a lot now about getting treatment to people living with AIDS, but we also have to look at the social impact that this epidemic is having on families and communities, particularly in the hardest-hit regions," said Sandy Thurman, president and CEO of the Washington-based International AIDS Trust, which provided half of the $100,000 funding for the report.

The Children Affected by AIDS Foundation provided the rest of the funding.

Children who are orphaned by AIDS are an emerging problem, especially in sub-Saharan Africa. Like Nantongo, they "experience high levels of psychological distress, ... social isolation, stigma and discrimination." They also are more at risk for "physical and sexual abuse, as well as child labor exploitation," the report said.

President Bush (news - web sites) announced in February a five-year, $15 billion plan aimed at stopping the spread of HIV (news - web sites)/AIDS worldwide. The plan would send $9 billion in new funding to help with prevention, treatment and care services at 14 of the most affected countries. So far, only $350 million of the total funding has been released.

DeWine said Wednesday's report underscores the need for Congress to approve the funds to improve public health systems in developing countries.

"This isn't just about AIDS. Most of the childhood deaths are avoidable and preventable. We can do simple things to save millions of children's lives," DeWine said.

On the Net:

International AIDS Trust: http://www.aidstrust.org/

Children Affected by AIDS Foundation: http://www.caaf4kids.org/

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Seniors with Gum Disease Lose Weight

 

Reuters Health

Wednesday, April 7, 2004  

NEW YORK (Reuters Health) - Having periodontal disease is linked to an increased likelihood of weight loss in older adults, according to a new study, and the more extensive the disease the greater the weight loss. This may lead to an increased risk of illness and death.

In a study published in the Journal of the American Geriatrics Society, Dr. Robert J. Weyant, of the University of Pittsburgh, and colleagues examined the association between periodontal disease and weight loss over a 2-year period in 1053 randomly selected participants who were at least 65 years of age.

The researchers defined the severity of periodontal disease in terms of pocket depth and attachment loss, the extent of bleeding on probing, and gingival inflammation.

Overall, "weight loss of at least 5 percent occurred in 140 (13.4 percent) members of the study population," the researchers report.

"Oral health variables showed a significant association with weight loss, with the weight losers having worse oral health status than weight-stable participants," they write.

After adjusting for other factor, the researchers found that seniors with periodontal disease were 53 percent more like to have experienced weight loss than those with healthy gums and teeth.

"Weight loss of at least 5 percent body weight in older adults is associated with increased risk of morbidity and mortality," Weyant told Reuters Health. "Hence, if periodontal disease is ultimately found to be a cause of weight loss, having periodontal disease may place older adults at higher risk for a variety of systemic morbid conditions (e.g., cardiovascular disease, stroke, etc.), and even lead to increased mortality."

"Fortunately, periodontal disease is also treatable," he added, and can be addressed by primary care physicians or dentists.

Source: Journal of the American Geriatrics Society, April 2004.

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Tenn. Aims to Improve Students' Health

 

By Karin Miller

Associated Press Writer

The Associated Press

Wednesday, April 7, 2004

NASHVILLE, Tenn. - A House subcommittee approved bills Tuesday to limit the weight of textbooks public school students carry and the types of food they can buy from school vending machines.

The goal: healthier students.

"These textbooks are throwing these kids' backs out of whack," said Rep. Joe Towns, who chairs the K-12 Education Subcommittee and sponsors the bill requiring the state to create weight standards.

Bruce Opie, legislative liaison for the state Department of Education (news - web sites), noted that the bill could cost state and local governments a lot of money if many large textbooks must be divided into two or three volumes to lighten the load for students.

About $60 million a year is spent on textbooks and the bill would increase that by an estimated $1.2 million to $6 million.

But Towns said the state will have a bigger financial burden if children covered by publicly funded TennCare have to seek medical care because of their overloaded backpacks.

"When children are calling out for physical help, we need to listen," said Towns, D-Memphis.

He also suggested state officials aren't "flexing our muscles enough" with publishers, who could be required to lower prices or provide paperback texts or books printed on lighter paper.

Rep. Richard Montgomery, R-Seymour, suggested forming a coalition with other states to try to get publishers' attention. Opie said that was an excellent idea that he would discuss with members of the state textbook commission.

The subcommittee approved Towns' bill unanimously, then took up Rep. Joe Fowlkes' legislation requiring schools with K-8 students to replace sodas, candy bars and potato chips sold from vending machines with more nutritious choices.

He said he's trying to address obesity and the health problems it causes.

Tennessee has the nation's third-highest rate of obesity and one of the highest rates of Type 2 diabetes among schoolchildren, according to a coalition of bill supporters that includes the Tennessee Medical Association, Tennessee Nurses Association and Tennessee School Health Coalition. Type 2 diabetes is strongly linked to poor diet and being overweight.

Currently, Fowlkes said, students attend classes teaching them to eat healthy but can walk down the school hallway to find vending machines selling soft drinks, chips and candy bars.

The bill requires that vending machines limit food sold to students before and during class time to grain products, fruit and fruit juices, vegetables and vegetable juices, water, dairy products, nuts and seeds, and sports drinks.

"This is just a small step. It's not going to cure the problem. ... You've got to start somewhere," Fowlkes said.

He said studies have found that children will purchase just as many of the healthier items as they would the junk food. And he said the bill won't cost local governments the proceeds from vending sales because the companies that sell sodas and chips already make nutritious alternatives.

Rep. Diane Black, R-Hendersonville, said that as a nurse she supports both bills.

"We need to say to our children, 'We're thinking about your health. We want you to think about your health,'" she said.

On the Net:

Read the vending machine bill, SB2743/HB2783; and the textbook bill, HB2759/SB2496 at: http://www.legislature.state.tn.us

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Viagra Finds Another Use, for Lung Disease

 

By Megan Rauscher

Reuters Health

Wednesday, April 7, 2004

NEW YORK (Reuters Health) - Viagra can do more than help with erections. The drug is basically a blood-vessel dilator, and this has proven beneficial to people with pulmonary hypertension -- a condition in which pressure buildup in the lungs' circulation can ultimately cause the heart to fail.

Viagra significantly improved exercise capacity, the pumping strength of the heart, and quality of life for patients with pulmonary hypertension, according to the results of the first strictly scientific study to examine the drug's effect on the condition.

Previous reports of Viagra's benefits for such patients came from clinical observations and small uncontrolled studies.

Viagra is a "very effective medication" for people with pulmonary hypertension, Dr. B. K. S. Sastry who led the study told Reuters Health. "It relieves their symptoms ... and, compared to previously available medications, it is a simple medication without many side effects."

Dr. Sastry and colleagues from the CARE Hospital in Hyderabad, India, randomly assigned 22 patients with pulmonary hypertension to either Viagra at various doses three times daily depending on body weight, or to treatment with an inactive placebo. After six weeks, patients crossed over to the other treatment for the next six weeks.

During Viagra treatment, treadmill exercise time increased by 44 percent over the level achieved on placebo, the team reports in the Journal of the American College of Cardiology. With Viagra, output from the heart also improved significantly.

These benefits were accompanied by significant improvements in the breathless and fatigue components of a quality-of-life questionnaire.

In a statement, Dr. Lewis J. Rubin, who was not connected with the study, said, "it's an encouraging, but still preliminary study." While the crossover design "adds to the strength" of the observations, it was a small study of short duration, he points out.

Dr. Rubin, from the University of California, San Diego School of Medicine, said results of an international, placebo-controlled trial involving several hundred patients due out in a few months should be more definitive.

The study was supported by the CARE Foundation, a not-for-profit organization that promotes clinical research.

Source: Journal of the American College of Cardiology, April 7, 2004.

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Elderly Get Tips to Beat Back Depression

The Associated Press

Wednesday, April 7, 2004

SEATTLE - Older adults can learn to beat back depression through problem solving, exercise and social activity, according to a Seattle study published in Wednesday's Journal of the American Medical Association (news - web sites).

After one year, study participants were much more likely than others to halve their symptoms of depression, such as feelings of hopelessness, poor appetite and difficulty falling asleep.

Their health status and emotional well-being improved and they tended to be hospitalized less, the study said. Many participants managed to shed their depression completely.

"It was a lifesaver for me," says Chuck Lazenby, 72, of Seattle, who slipped into despair after his partner of 50 years died of a heart attack.

Late-life depression affects 15 percent to 20 percent of older Americans, said Dr. Paul Ciechanowski, a co-investigator and psychiatrist on the study, called Program to Encourage Active Rewarding Lives for Seniors, or PEARLS.

Only about half of depressed older adults receive treatment, though many don't receive adequate treatment, Ciechanowski said.

The study was conducted by the University of Washington's Health Promotion Research Center, which is leading a national research effort on healthy aging for the Atlanta-based federal Centers for Disease Control and Prevention (news - web sites), which paid for the study.

Driving a national search for solutions are the prevalence of the disorder, the health care costs and the large numbers of aging baby boomers.

The goal is to create programs that can be demonstrated to improve the health of older adults at low cost in communities nationwide.

The study cost $630 a year for each participant, which included eight in-home sessions with a social worker and monthly follow-up phone calls.

"This is an attempt to reach the most vulnerable population in our society," said Dr. Jim LoGerfo, the UW center's director.

Efforts are underway to make the program available to more seniors throughout the state, in senior centers as well as in homes.

The UW study extends the 2002 findings of a large national study. Seattle was one of seven cities in that study, which found that depressed patients at clinics improved through problem-solving therapy, increased social activity and medication management.

The UW study extended that approach into the community and people's homes. It also relied on partner agencies in the community: Aging and Disability Services — a city of Seattle division — and Senior Services.

An editorial in the journal said depression studies such as the UW's "provide evidence-based hope for millions of elderly persons living in the dark tunnel of major depression or the only slightly less dim tunnels of 'lesser' depressions."

Triggers often are life's losses, such as careers ending, family and friends dying, the body weakening, and independence ebbing. Seniors with chronic conditions or physical limitations often stay inside and can feel isolated and unneeded.

During the 2 1/2-year study, social workers from Aging and Disability Services visited the homes of 138 low-income seniors, age 60 and older, most of whom were single and had serious disabilities.

The social workers focused on a therapy that emphasized exercise and more socializing. The participants learned to identify what was bothering them and to write down step-by-step solutions.

"It's like breaking the bundle one stick at a time," Ciechanowski says.

Social workers followed up with visits and phone calls to keep patients on track. But patients were expected to solve their own problems, which helped them regain a sense of control over their lives.

Information from: The Seattle Times, http://www.seattletimes.com

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U.S. Health Officials Launch Food Poison Campaign

By Maggie Fox, Health and Science Correspondent

Reuters

Wednesday, April 7, 2004

WASHINGTON (Reuters) - The patient has classic symptoms of food poisoning -- nausea, diarrhea, some stomach cramps. It will probably clear up in a few days. Nothing to be excited about, the doctor decides.

But U.S. health officials and the American Medical Association says maybe doctors should start getting interested in such cases.

The AMA, Centers for Disease Control and Prevention (news - web sites), Food and Drug Administration (news - web sites) and U.S. Department of Agriculture (news - web sites) launched an education campaign on Wednesday aimed at encouraging doctors, nurses and patients to look more carefully at cases of possible food poisoning.

With 5,000 people a year dying of foodborne illness in the United States alone and 76 million getting sick from it, it is a growing problem, they say. And now that the threat of bioterrorism is considered to be greater than ever before, health officials need to know quickly about outbreaks.

"Last year's outbreak of hepatitis A in Tennessee, Georgia, North Carolina and Pennsylvania was eventually traced to contaminated green onions imported from Mexico and served at a chain restaurant," said Dr. Cecil Wilson, an AMA trustee from Winter Park, Florida.

"In Pennsylvania alone, there were 555 cases of foodborne illness linked to the green onions and, sadly, three people died."

Each case on its own may have looked unremarkable to a doctor or a nurse. The health officials say they want these health workers to notify state health departments who may be able to connect the dots.

And after the Sept. 11, 2001, attacks on New York and Washington and the anthrax letter attacks that followed, intentional poisoning is a risk that worries officials.

"In addition, imported foods and increased travel abroad have increased the risk of exposure to foreign pathogens dramatically," Wilson said at a news conference.

Educating Doctors And Nurses

The AMA, CDC, FDA and USDA are distributing a "primer" aimed at educating health workers about food poisoning, but say they would like to see a general change in attitude.

"We certainly hope this will encourage and empower physicians on the front line," said Dr. Art Liang, director of the CDC's food safety initiative.

Lab tests that would not normally be ordered could be useful in identifying patterns of food-related illness, he said.

"We can use that information in ways that we couldn't before," Liang said. Genetic fingerprinting can now help track an organism to its source, and perhaps get tainted food from the same source recalled before it can make anyone else sick.

Dr. David Acheson, the FDA's food safety and security director, said it was also important to recognize that foodborne illness can have more than the "classic" symptoms.

"It could be something much more subtle," he said, including meningitis caused by Listeria or paralysis caused by botulinum poisoning.

"This whole country is re-introducing itself to the concept of public health. It is important not only to identify that disease based on symptoms the patient has and to treat them, but to consider the broader population as well," said Wilson.

Plus, while cholera and typhoid are diseases of the past in the United States, new pathogens such as E. coli 0157 -- a mutant killer form of a normally harmless bacterium -- have emerged. Liang said there are now more than 200 known possible causes of food poisoning.

Liang said 50 percent to 80 percent of all cases of possible food poisoning are never identified, which suggests unknown causes.

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Florida Lawmakers Tackle Youth Obesity

By Brent Kallestad

Associated Press Writer

The Associated Press

Wednesday, April 7, 2004

TALLAHASSEE, Fla. - Finding ways to battle an obesity epidemic among the state's youth was touted as one of the most important issues Florida lawmakers planned to tackle in this year's legislative session.

But with three weeks remaining, little — if any — progress has been made.

The Senate Education Committee still hasn't heard bills that would require that students be subjected to more physical education classes and nutrition instruction. No movement's been made on the notion of removing candy-filled and soda-laden vending machines from schools, either.

More than half of Florida's adults are overweight or obese, officials said. And many feel that unless drastic measures are taken in schools, that number will keep rising.

"We don't want them to be fat," said Sen. Walter "Skip" Campbell, D-Fort Lauderdale. "If they're going to be fat, you're going to have a problem with kids dying before they should."

A panel chartered to study obesity among Floridians reported earlier this year that schools should consider finding ways to offset revenues generated by vending machines placed on their campuses, although it didn't mandate removing the machines from all schools.

The biggest reason? Money.

Duval County, for example, generates $2.7 million annually for its schools because of its vending-machine deal with Pepsi. Without that money, parents may have to pay for sports and other extracurricular programs. That's why the panel appointed by Gov. Jeb Bush recommended local districts decide for themselves.

"We would encourage local control, absolutely," said Kelly McAndrew, spokeswoman for Somers, N.Y.-based Pepsi Bottling Group. "We think it is best to keep the decision as close as possible to the people who are being affected."

Miami-Dade schools are already providing more options for the more than 360,000 children attending its schools.

"We have some vending machines that have only 100 percent juice, milk, water and baked snack items," said Carol Chong, the district coordinator for nutrition education. "We feel we need to provide some better options to maintain nutrition integrity."

However, health advocates would like Florida to have statewide standards — an idea that seems to be catching on nationwide.

Elementary schools in California, Arkansas and Texas have limited student exposure to vending machines, or removed them completely. Philadelphia's schools no longer allow soda sales, and New York City schools have done away with sodas and all sugary snacks.

And some lawmakers are pushing schools to be both diet-conscious and exercise-conscious.

More than half of Florida's students attend no more than one physical education class each week — a figure Sen. Gwen Margolis is seeking to dramatically increase. Her bill (SB 308) would require students have either a physical education class or recess daily is moving, but even if passed won't become law for at least another year so schools can closely examine cost implications and scheduling concerns.

Another Margolis bill (SB 306) would establish state standards on what types of foods could be sold in vending machines is languishing and unlikely to pass this year. It hasn't been heard by any of the five committees it was referred to after it was filed last fall.

"This legislation is not a physical education mandate," Margolis said. "It's a health mandate to improve the outlook for the next generation."

Sen. Lee Constantine, R-Altamonte Springs and chair of his chamber's education committee, vowed that the bills will begin moving after lawmakers return from the weeklong break to observe Easter and Passover. Margolis, though, is clearly worried that the pressures of time will leave the bills unresolved.

Bush said he believes lawmakers will have a bill for him.

"I think the Legislature will make some good recommendations," Bush said.

There are some parents who fear mandatory physical education classes would cut into both the time and money allocated for art, music and other culture-based classes. Margolis is a staunch arts advocate, but says there must be a balance and decried what she terms a "disinformation" campaign.

"If a child is sick, he can't do music," she said. "If a child is sick, she can't do art."

On the Net:

Florida Legislature: http://www.leg.state.fl.us/

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Tuesday, April 6, 2004

 

Many Parents Flunk Car Safety When It Comes to Kids

 

By Adam Marcus
HealthDay Reporter

HealthDayNews

Tuesday, April 6, 2004

TUESDAY, April 6 (HealthDayNews) -- People take pains to learn how to use their computers, their DVD players and the rest of their high-tech gadgetry.

So why are they so apparently indifferent when it comes to simple devices that can protect their children from injury and death in cars?

Child safety restraints are proven to save lives and reduce the risk of harm in crashes. But parents continue to install and use them improperly. Earlier this year, U.S. transportation officials reported that nearly three in four child safety restraints are used incorrectly, greatly raising young passengers' risk of serious or deadly harm in a wreck.

"Child safety seats are very effective when used properly," Dr. Jeffrey W. Runge, administrator of the National Highway Traffic Safety Administration (news - web sites) (NHTSA), says in a statement about the findings. "Parents and caregivers should take time to understand how to better protect children of all ages."

That's a message safety experts hope to spread on April 7, World Health Day 2004. The day's theme: Road safety.

The good news, officials say, is that overall child safety restraint use is rising, up 50 percent since the mid-1990s among children who weigh 60 pounds or less. However, nearly 12 percent of children remain unrestrained while riding in a motor vehicle.

Rae Tyson, a NHTSA spokesman, says parents of newborns seem to be clear on the proper way to install safety seats and how their infants should ride in them. But something happens as the children grow larger.

"When the confusion and the parental diligence drops off is when the child starts to get a little older, when they move from rear-facing to front-facing seats, and when they should move to a booster seat," Tyson says. Many parents apparently skip the booster seat stage and start buckling their children into belts designed for adults.

"That's not a good thing," Tyson says. "Children at that age are not ready to use an adult restraint."

To review:

The American Academy of Pediatrics calls for children under 1 year of age and/or 20 pounds to ride in rear-facing seats designed specifically for infants or that can be converted for infant use. Older children can ride facing forward, as long as their seats are anchored by the vehicle's three-point safety straps.

The NHTSA recommends that children between the ages of 4 and 8 years use a booster seat, unless they are at least 57 inches (4 feet, 9 inches). These seats face forward and should be held in place by both lap and shoulder belts. The lap belt should sit low and tight across the lap and upper thighs, while the shoulder belt should be snug across the chest and shoulder to avoid abdominal injuries.

Children age 12 and under should never ride in the front seat, the agency advises.

Psychologist David Eby, a University of Michigan researcher who studies safety restraint use, says belting a child who should be in a booster seat raises the risk of serious injury in a crash threefold, and quadruples the risk of a serious head injury.

"The whole idea of a booster seat is that the child isn't big enough to fit into an adult belt. It helps the belt fit properly, and when it doesn't, the belt causes injuries."

Lap belts are designed to lie over the hip bones. But on small children not in a booster seat, the belts fit over the soft tissue and organs of the abdomen. "During the crash you have no bony structure but the spine" to absorb the forces of impact, he says.

Adding to the confusion, not all booster seats are equal. For a time, manufacturers produced seats with a "shield" bar intended to provide an extra measure of safety. But Ebel says these devices are less safe than conventional booster seats for two reasons: They're harder to install and children can hit the shield or their knees with their head.

"To me [installing a shield booster] is considered a misuse" of the devices. "It's important for parents to understand that," says Eby, who is launching a study of booster seat use, and misuse, in Michigan that he hopes will identify the reasons parents have so much trouble with child safety restraints.

If you don't trust yourself to properly install a child safety seat, or you want to make sure you've done it right, take your car to an expert. Try car dealers, police and fire stations, or insurance agencies. "There are clinics going on all the time," Tyson says.

More information

The National Highway Traffic Safety Administration's guidelines for proper child restraints can be found on the agency's Web site. You can also try the National Safety Belt Coalition.

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Arkansans Urged to Change Lifestyle

 

By Cristina Rodriguez

Associated Press Writer

The Associated Press

Tuesday, April 6, 2004

LITTLE ROCK, Ark. - Arkansans need to change their lifestyle if they want to improve their health, according to the state's top doctor.

Dr. Fay Boozman, director of the state Health Department, said health problems in Arkansas are related to tobacco use, physical inactivity and obesity. These factors are hard for government to regulate since they have to do with individual behavior.

"We're not going to solve these problems through regulation," Boozman said. "We're not going to add a regulation: You can only Supersize two times per week."

The way to promote health, he said, is to encourage it through schools, workplaces and community coalitions.

Boozman and other health professionals honored organizers of health programs across the state on the Capitol steps in kicking off Arkansas Public Health week, the state's first. The campaign includes lectures and a dedication Wednesday of the University of Arkansas for Medical Sciences College of Public Health building.

Dr. James Raczynski, dean of the UAMS College of Public Health, said Arkansas was among the states leading the country in tobacco use, physical inactivity and obesity. He said the college will study why that is.

According to 2002 data from the Centers for Disease Control and Prevention (news - web sites) in Atlanta, Arkansas ranks No. 12 for people at risk from smoking, No. 13 for people at risk from inactivity and No. 15 for people at risk from obesity.

Raczynski said the problems could be from a combination of environmental and cultural factors. For example, many Arkansans can't afford health insurance, which means they don't get the medical care they need, he said. Also, some groups traditionally eat fatty foods and would be reluctant to change their habits.

"From our perspective, if the state were uniform you can really adopt a uniform approach," Raczynski said. "But you really have to tailor what you do and the way you talk about issues in a cultural context."

Boozman said the health department was asking people to create hometown health coalitions, such as a Polk County group that was among the honorees Monday.

The group had a "Walk Across Polk County" initiative made of eight-member teams that encouraged one another to walk. Team members said they lost weight and lowered their cholesterol counts.

So far 53 counties have health coalitions, he said.

"The real challenge centers around how we get people to change their behaviors," Boozman said.

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The Young Vegetarian

 

HealthDayNews

Tuesday, April 6, 2004

(HealthDayNews) -- Some children go through a vegetarian phase -- declaring that they'll never eat meat again.

Whether this is a lasting dietary change or a fleeting fancy, you need to make sure your child's eating regimen is sufficiently varied.

Akron Children's Hospital suggests you include the following nutrients in your child's diet:

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Chocolate During Pregnancy Has Good Impact on Baby

 

Reuters

Tuesday, April 6, 2004

LONDON (Reuters) - Pregnant women rejoice. Eating chocolate is good for the baby, say Finnish researchers.

Scientists at the University of Helsinki, who asked 300 pregnant women to record their chocolate consumption and stress levels, found that daily treats had a positive impact on the baby's behavior.

Six months after the infants were born the mothers who had eaten chocolate reported more reactions such as smiling and laughter in their offspring.

"And the babies of stressed women who had regularly consumed chocolate showed less fear of new situations than babies of stressed women who had abstained," New Scientist magazine said on Tuesday.

Katri Raikkanen and her colleagues who conducted the research admitted they can't be certain that chocolate consumption and the babies' behavior are not linked with other factors.

"But they speculate that the effects they observed could result from chemicals in chocolate associated with positive mood being passed on to the baby in the womb," the magazine added.

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Squatting Can Cripple Knees

HealthDayNews

Tuesday, April 6, 2004

TUESDAY, April 6 (HealthDayNews) -- Prolonged squatting increases the risk of osteoarthritis (OA) of the knee, says a study in the April issue of Arthritis & Rheumatism.

Knee OA, which erodes the cartilage of the knee joint, is a leading cause of chronic disability among older Americans. It's also common among elderly Asians, especially women.

In this study, an international team of researchers examined the link between knee OA among Chinese people and squatting, a common daily posture for them.

Of the 2,269 people (all older than 60) studied, 40 percent of the men and 68 percent of the women reported they routinely squatted for more than an hour a day at age 25. Among these people, the prevalence and severity of knee OA was much greater than among people who reported they squatted for 30 minutes or less each day when they were younger.

The researchers compared their findings with data on white Americans and found that, on average, Chinese women were 9.5 percent more likely to be afflicted with tibiofemoral OA (a form of knee OA) than their white American counterparts. Chinese men were 5.4 percent more likely than white American men to have tibiofemoral OA.

The study authors concluded that prolonged squatting in youth is a strong, independent risk factor for knee OA in old age.

More information

The American Medical Association has more about knee OA.

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Survey of Mo. Gays a Mixed Bag of Health

The Associated Press

Tuesday, April 6, 2004

KANSAS CITY, Mo. - A survey of more than 1,000 gays, lesbians and bisexuals found a population that is generally healthy practicing unhealthy habits such as smoking, unprotected sex and missed medical tests.

The survey was conducted the Kansas City Health Department and the Lesbian and Gay Community Center of Greater Kansas City.

It found that more than 95 percent of those polled considered themselves in good to excellent health. More than 40 percent got at least 30 minutes of exercise several days a week. While 24 percent were obese, that was well below the overall adult obesity level of 34 percent in Kansas City.

Most gays and lesbians were "out" to friends and family and many were in faithful, long-term relationships.

But the survey also found 38.4 percent were smokers, which is significantly higher than the national adult smoking rate of 23.1 percent. About 34 percent of gays and 24 percent of lesbians drank to get drunk at least once a month. Stress and depression were common.

Many lesbians did not get regular mammograms, although research suggests they may be at increased risk of breast cancer.

And some sexually active men were not using condoms consistently, raising their risk of AIDS (news - web sites) and other sexually transmitted diseases. Nine percent of gay men said they had the AIDS virus.

The survey was distributed from May through July of 2003 at events, such as the Heartland Pride Festival and AIDS Walk, that attract members of the gay community.

Altogether, 1,143 questionnaires were completed and counted for people living in Jackson, Clay, Platte and Cass counties in Missouri and Johnson, Wyandotte and Leavenworth counties in Kansas.

"We didn't try to be statistically representative," said Gerald Hoff, a Health Department epidemiologist who helped analyze the data and write the report. "But the survey accomplished its main objective: to create some baseline data."

Health information directed at gays typically has focused on AIDS prevention, ignoring health problems like cancer and heart disease that affect everybody, said Jamie Rich, director of the Lesbian and Gay Community Center.

"A public health message has to be delivered to the gay community beyond, `Don't get AIDS,'" he said.

Little national data about gay and lesbian health is available, said Randall Sell, a public health researcher at Columbia University.

"You want to find something to help people, to intervene and save lives. Because of the lack of data, it's often left to speculation," he said. "That's the good thing about this survey. It's phenomenal (the Health Department) would support that."

The emotional problems many reported in the survey — about a fifth said they felt stressed or depressed almost always or very often — is another recognized concern.

"It's the stress of being stigmatized," said Anthony Silvestre, a University of Pittsburgh researcher on gay health issues. "It's not so much that sexual orientation itself carries health problems, but society's reaction to it."

The survey found that 65 percent of lesbians, 51 percent of gays and 41 percent of bisexuals were in relationships.

Those numbers run counter, Hoff said, to the "prevailing assumption these are people who run around and have sex. A lot of these people are in stable relationships for a long period of time."

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Asthma and Exercise Can Go Hand-in-Hand

HealthDayNews

Tuesday, April 6, 2004

TUESDAY, April 6 (HealthDayNews) -- Parents' misconceptions that exercise can be risky for their asthmatic children may be partly to blame for low levels of physical activity among children with the disease, according to a study by researchers at Johns Hopkins Children's Center.

The study, in the April issue of the journal Pediatrics, found that 20 percent of children with asthma do not get enough exercise, even though research has shown that running, swimming and other kinds of physical activity decrease the severity of asthma symptoms.

Researchers conducted a telephone survey of 137 parents of children with asthma and 106 parents of healthy children. About 20 percent of all the parents indicated they believed that exercise is dangerous for children with asthma.

About 25 percent of the parents of asthmatic children said they were afraid that exercise would make their child sick, and that their child gets upset with strenuous activity. The children of parents who expressed such views were more likely than other children to be inactive.

"These results are troubling," study lead author Dr. David Lang said in a prepared statement.

"Despite medical advances and a better understanding of asthma, we found that beliefs still exist that exercise is dangerous for asthmatic children and that children with asthma should not exercise. In reality, physical activity has important benefits for all children, including those with asthma," Lang said.

It's essential that pediatricians educate asthmatic children and their parents about the benefits of exercise, he said.

More information

The American Lung Association has more about asthma in children.

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Surgeons Who Play Video Games Err Less

By Verena Dobnik

Associated Press Writer

The Associated Press

Tuesday, April 6, 2004

NEW YORK - All those years on the couch playing Nintendo (news - web sites) and PlayStation appear to be paying off for surgeons. Researchers found that doctors who spent at least three hours a week playing video games made about 37 percent fewer mistakes in laparoscopic surgery and performed the task 27 percent faster than their counterparts who did not play video games.

"I use the same hand-eye coordination to play video games as I use for surgery," said Dr. James "Butch" Rosser, 49, who demonstrated the results of his study Tuesday at Beth Israel Medical Center.

Laparoscopic surgery — using a tiny camera and instruments controlled by joysticks outside the body — is performed on just about any part of the body, from an appendix to the colon and gall bladder.

The minimally intrusive surgery involves making tiny keyhole incisions, inserting a mini-video camera that sends images to an external video screen, with the surgical tools remote-controlled by the surgeon watching the screen. Surgeons can now practice their techniques through video simulations.

Rosser said the skill needed for laparoscopic surgery is "like tying your shoelaces with 3-foot-long chopsticks."

"Yes, here we go!" said Rosser, sitting in front of a Super Monkey Ball game, which shoots a ball into a confined goal. "This is a nice, wholesome game. No blood and guts. But I need the same kind of skill to go into a body and sew two pieces of intestine together."

The study on whether good video game skills translate into surgical prowess was done by researchers with Beth Israel and the National Institute on Media and the Family at Iowa State University. It was based on testing 33 fellow doctors — 12 attending physicians and 21 medical school residents who participated from May to August 2003.

Each doctor completed three video game tasks that tested such factors as motor skills, reaction time and hand-eye coordination.

The study "landmarks the arrival of Generation X into medicine," said the study's co-author, Dr. Paul J. Lynch, a Beth Israel anesthesiologist who has studied the effects of video games for years.

Kurt Squire, a University of Wisconsin researcher of video game effects on learning, said that "with a video game, you can definitely develop timing and a sense of touch, as well as a very intuitive feel for manipulating devices."

Squire, who was not involved in Rosser's project, said applying such games to surgery training "could play a key role in preparing medical health professionals."

Beth Israel is now experimenting with applying the findings.

Rosser has developed a course called Top Gun, in which surgical trainees warm up their coordination, agility and accuracy with a video game before entering the operating room.

"It's like a good football player," Rosser said, "you have to warm up first."

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Hardening of Arteries Takes Emotional Toll

HealthDayNews

Tuesday, April 6, 2004

TUESDAY, April 6 (HealthDayNews) -- Older people with hardening of the arteries are more likely to be depressed, according to a Dutch study in the April issue of Archives of General Psychiatry.

The study examined the link between atherosclerosis at different locations in the body and depression in 4,019 men and women aged 60 and older. It found that severe atherosclerosis was associated with a higher prevalence of depressive disorders.

The study also found that people with severe coronary calcifications (calcium deposits in the heart) were nearly four times more likely to have depressive symptoms. People with calcifications in the aorta were twice as likely to have depressive symptoms.

"In this population-based study, we found that subjects with atherosclerosis were more likely to be depressed. A combined measure of extracoronary (not in the heart itself) atherosclerosis was related to depressive disorders, although at some of the different locations the association was only moderate and non-significant. A strong relationship was observed only between severe coronary and aortic calcifications and depressive disorders," the study authors wrote.

More information

The American Heart Association (news - web sites) has more about atherosclerosis.

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New Tests Predict Prostate, Colon Cancer Better

Reuters

Tuesday, April 6, 2004

WASHINGTON (Reuters) - Two new tests may predict who is most at risk of two top cancer killers, colon and prostate cancer, U.S researchers said on Tuesday.

One test can show which men might be most at risk of colon cancer while the other points to who is most likely to die from prostate cancer if surgery or radiation fails.

Both studies, done at Brigham and Women's Hospital and Harvard Medical School (news - web sites) in Boston, are published in the Journal of the National Cancer Institute (news - web sites).

Dr. Jiang Ma and colleagues found that men with longtime high levels of C-peptide -- an indicator of insulin production -- had triple the risk of developing colorectal cancer.

A high C-peptide reading usually suggests a patient has hyperinsulinemia, in which insulin in the body can rise to damaging levels. Plasma C-peptide levels are higher among people who are overweight, inactive and eat lots of red meat, high-fat dairy products and refined grains.

"This study supports our hypothesis that men with long-term elevated insulin production, as a result of long-term exposure to Western dietary and lifestyle risk factors, are at a much higher risk of developing colorectal cancer in their lifetimes," Ma said in a statement.

Patients with high levels may be able to eat better and exercise more to prevent cancer, although no study has shown this will work.

Ma and her colleagues looked at the medical records of nearly 500 men followed for 13 years as part of a larger, long-term study called the Physicians' Health Study.

They compared C-peptide levels among 176 men who were diagnosed with colorectal cancer to 294 men who were cancer-free.

Colon cancer will kill 57,000 people in the United States alone this year and is the second leading cause of cancer death and lung cancer.

In the prostate cancer study Dr. Anthony D'Amico and colleagues found that the patterns of prostate specific antigen after treatment for prostate cancer could predict who was more likely to die.

They found men whose PSA levels rose quickly and fell slowly after getting hormone-based therapy were 13 times more likely to die than men whose PSA levels rose slowly at first and then fell sharply.

D'Amico's team followed 1,454 men whose prostate cancer came back after surgery or radiation therapy, and thus had hormone therapy.

D'Amico said the patients with a pessimistic PSA reading could go on for experimental treatment. "Once identified these men can enter expedited clinical trials aimed at finding a way to curtail and eventually eliminate the inevitable end these men currently face today," he said.

Prostate cancer (news - web sites) will kill more than 30,000 U.S. men this year, according to the American Cancer Society (news - web sites).

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Alzheimer's Reduces Life Span

 

By Serena Gordon
HealthDay Reporter

HealthDayNews

Tuesday, April 6, 2004

TUESDAY, April 6 (HealthDayNews) -- While it's long been known that Alzheimer's greatly reduces quality of life, a new study confirms that the disease also decreases the duration of life.

The researchers found the average survival after a diagnosis of Alzheimer's disease (news - web sites) was 5.7 years for women and 4.2 years for men.

The study, which appears in the April 6 issue of Annals of Internal Medicine, also found that certain symptoms of the disease, such as problems walking and urinary incontinence, indicated a shorter life expectancy.

"People often wonder what the future will portend and make their plans based on how long they think they'll live," said study author Dr. Eric Larson, director of the Center for Health Studies at Group Health Cooperative in Seattle.

The study's finding that people with Alzheimer's disease have a shorter life expectancy is "something people can intuitively understand," he added.

This information, he said, may help people make plans for the long-term care of a loved one with Alzheimer's. The data may also be useful for refining public health policies and allocating limited health-care resources.

Approximately 4.5 million people in the United States have Alzheimer's disease, according to the Alzheimer's Association.

Larson and his colleagues gathered data on 521 people diagnosed with Alzheimer's disease between 1987 and 1996. All were from the Seattle area, and their ages ranged from mid-60's to late 80s.

The researchers collected information on other existing diseases (heart disease, high blood pressure, diabetes, stroke and depression); education; age; and Alzheimer's symptoms, including falls, wandering, paranoia and urinary incontinence. They also performed a "Mini-Mental State Examination" on each person.

They found that people with Alzheimer's have only about half the average life expectancy at the time they're diagnosed with the disease than people in the general population.

For instance, an American woman who lives to be 70 years old can normally expect to live another 15.7 years. But the study found a 70-year-old woman with Alzheimer's will only live another eight years.

And a 70-year-old American man typically lives another 9.3 more years, but a 70-year-old male with Alzheimer's will only live another 4.4 years, according to the study.

Not surprisingly, the older someone was at the time of the Alzheimer's diagnosis, the shorter the life expectancy was.

The presence of other medical conditions and more severe Alzheimer's symptoms indicated the likelihood of a shorter life expectancy.

"Certain people with Alzheimer's disease have a worse prognosis than others," said Larson. In particular, he said, people with heart disease, diabetes, poor cognitive function, wandering and walking problems don't do well.

He said the shorter life expectancy may not be directly related to Alzheimer's, but the disease may cause indirect consequences that decrease longevity. For example, people with Alzheimer's are less active, which may predispose them to heart disease or pneumonia. And they're less adaptable, which may make them more prone to falls and injuries, Larson said.

Katie Maslow, associate director for Quality Care Advocacy for the Alzheimer's Association, added, "For a family, while it's difficult to hear, it's good to understand what the likelihood of survival is when planning for the care of a person. And this information is particularly valuable for letting physicians know what factors influence how long a person might live."

Maslow noted that it was discouraging to see that about half the people in this study already had significant cognitive loss when they were diagnosed.

She pointed out that there are medications that may help if the disease is diagnosed earlier. And existing diseases, such as heart disease and diabetes, can be managed more effectively if family members know that dementia is present, she said.

Dr. Barry Reisberg, clinical director of the Silberstein Aging and Dementia Research Center in New York City, said this study "provides newer and additional information" on the Alzheimer's disease process.

It's important for people to realize that "patients with proper care need not suffer, and that caregivers with proper support can better cope with this condition," he added.

Knowing how long a person might live, he noted, could help families plan so they can be sure proper support is available.

More information

To learn more about Alzheimer's disease, visit the Alzheimer's Association or the Alzheimer's Disease Education and Referral Center.

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Study Disputes Sex-Prostate Cancer Link

 

By Lindsey Tanner

AP Medical Writer

The Associated Press

Tuesday, April 6, 2004

CHICAGO - Contrary to some research, frequent sexual activity does not increase the risk of developing prostate cancer and might even reduce the danger, a study of nearly 30,000 men found.

Some previous studies have suggested that men who have frequent ejaculations — whether through sex or masturbation — might be more prone to prostate cancer. One theory is that lots of sex exposes men to various germs and viruses that somehow lead to prostate cancer.

The latest study should be "reassuring to those men who may be more active than others," said Dr. Durado Brooks, prostate cancer director for the American Cancer Society (news - web sites).

The study involved 29,342 health professionals ages 46 to 81 who were asked about their ejaculations in their 20s, 40s and during the previous year, 1991. During about eight years of follow-up, 1,449 men developed prostate cancer.

On average, the men overall had four to seven ejaculations a month. No increased risk of prostate cancer was seen in men who reported more frequent ejaculations, and there appeared to be a decreased risk in men with the highest reported levels.

The two highest activity levels — 13 to 20 ejaculations a month, and at least 21 a month — were linked with decreased cancer risks of 14 percent and 33 percent respectively.

One theory is that frequent ejaculations help flush out cancer-causing chemicals or reduce the development of calcifications that have been linked with prostate cancer.

But relatively few men in the study reported heavy sexual activity, so more research is needed to establish whether there is, in fact, a link, said Dr. Michael Leitzmann, a researcher at the National Cancer Institute (news - web sites) who led the study.

"It's too early to suggest that men should change their sexual habits to alter their prostate cancer risk," he said.

The study appears in Wednesday's Journal of the American Medical Association (news - web sites).

The theorized connection between frequent sexual activity and prostate cancer is not entirely far-fetched: High levels of the male hormone testosterone can cause a strong sex drive and can also fuel the growth of cancer cells.

The study involved mostly white men. Leitzmann said it is unclear whether similar results would be found in blacks, who have much higher prostate cancer risks than whites. But he said the biological mechanisms that might explain the results probably do not differ by race.

Prostate cancer (news - web sites) is the second most common cancer in men, after skin cancer. One in every six men will develop it. The American Cancer Society estimates that this year, 230,900 new cases will be diagnosed and that about 29,900 men will die from prostate cancer.

The walnut-sized prostate gland produces fluids that are contained in semen.

On the Net:

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

American Cancer Society: http://www.cancer.txorg

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L.A. Lawmakers Seek to Ban Beach Smoking

 

By Sarah Tippit

Reuters

Tuesday, April 6, 2004

LOS ANGELES (Reuters) - Attention all visitors to sunny Los Angeles area beaches: Watch your

Smoking has already been banned in workplaces here, in public parks, bars and restaurants. And if a panel of city lawmakers has its way, smokers won't be permitted to light up on one of the most popular stretches of sunny California coastline.

The 15-member Los Angeles city council is expected to approve a ban on smoking on public beaches later this month.

"Our beaches are our most precious natural resource and it's good news for L.A. if the world knows our beaches are cleaner and more smoke-free than ever before," said Los Angeles Councilman Jack Weiss, who sponsored the bill and said he is "confident" his colleagues on the council would back it.

Cigarettes are the most common litter on California beaches. During the state's Coastal Commission's cleanup day in 2002 more than 300,000 butts were removed from the state's coastal areas, he said.

Weiss said he drafted the bill after "spending hours on my hands and knees with my children" during a beach cleanup, picking up other peoples' butts.

"It's disgusting, inexcusable and hopefully soon it will be illegal," he said. Since then he has received support from The American Heart Association (news - web sites), The American Cancer Society (news - web sites) and others.

But some smokers are convinced that a ban would deter potential international travelers who would look forward to sitting on the beach enjoying coffee or beer and a smoke.

"If they stop the smoking on the beach the people would not go, believe me," said Mike Vasko, who works at the LA Tobacco smoke shop. "Lots of people from Europe and Asia -- everybody -- they smoke. What I hear from them is they cannot go there anymore. There's no way to smoke. That's the point. (Los Angeles) will lose business. Lots of business."

There are also at least a few locals who see a beach smoking ban as discriminatory. "It stinks," said Ray Domkus, a spokesman for the California branch of FORCES, an international smokers rights group. "Let's think about who is paying the taxes for these beaches. As a smoker, I've paid my share of taxes. Why can't I smoke in the open air? The argument is usually the trash which smokers can be pretty poor about. But what about all the dirty diapers, cans and papers that accumulate? If you're going to ban smoking why not ban everything else?"

There are other California cities are on the same wavelength as Los Angeles. The city of Solana Beach in San Diego County banned smoking on its shoreline last year. Last month officials in the Orange County city of San Clemente voted 3-2 to draft a smoking ban. Lawmakers in Santa Monica, which is adjacent to Los Angeles, said they are also expecting to approve a smoking ban in the near future.

Weiss said people will be relegated to parking lots and sidewalks. "The message is very simple. This is all about a pristine environment and smoking has no place there."

Isn't life a beach?

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Surgeon General Discusses Importing Drugs

 

By Lolita C. Baldor

Associated Press Writer

The Associated Press

Tuesday, April 6, 2004

WASHINGTON - Counterfeiting operations would complicate development of a safe and cost-effective program for importing lower-cost prescription drugs from Canada and other countries, Surgeon General Richard H. Carmona said Tuesday.

In an Associated Press interview, Carmona said drug makers made compelling arguments during a forum Monday that legalizing importation would make it easier for drug counterfeiters to market unsafe products.

"We were not aware of the extremely robust counterfeiting system," said Carmona, chairman of a government task force investigating whether drugs can be imported safely and efficiently.

"Certainly this would pose significant challenges to any importation plan that we may be considering in the future."

Carmona said consumers who are crying out for cheaper drugs must understand that "this is not simply, `pick a pharmacy across the border and just walk across and get your medication.' It's an extraordinarily complex problem that challenges the best minds in the field."

But city officials in Springfield, Mass., who have allowed city workers to order drugs from Canada since last July, repeatedly have proclaimed their program a success.

"No one has gotten any improper medications, no one's had any problems," the program's administrator, Chris Collins, said Tuesday.

The task force held a three-hour session Monday with pharmaceutical company executives and drug distributors as part of a study mandated by Congress in the new Medicare prescription drug law. Members of Congress have been pushing importation proposals as a way to lower drug costs for millions of Americans, and the task force must submit a report to lawmakers by Dec. 1.

Carmona said he has not closed the door to finding a way to legalize importation, but he said the panel needs to make sure any program would guarantee patient safety. And he said the companies' dire warnings about counterfeit drugs were surprising.

"I understand that corporate America is going to want to keep their stake in the market. But some of the evidence they presented, irrespective of their stake in the market, was compelling," said Carmona.

While he agreed that counterfeiting problems suggest that the drug delivery network isn't entirely safe now, he said allowing importation would require an even higher standard of safety.

Prescription drug makers and distributors told the task force Monday that importation would be unsafe, would lower incentives to market cheaper generic drugs and would increase prices in other countries.

At the panel's initial meeting, however, consumer groups said Americans are already safely importing drugs to cope with skyrocketing medical bills.

In the interview, Carmona noted that Health and Human Services (news - web sites) Secretary Tommy Thompson and his Clinton administration predecessor, Donna Shalala, each reviewed importation plans and decided it could not be done safely and cost-effectively.

"It may be that we find it is cost-prohibitive; we may find importation is not the way to go. Or we may find other options," said Carmona.

The task force has scheduled additional hearings, including one early next month with city and state officials who are allowing employees to buy prescription drugs from Canada.

Carmona said he has asked Minnesota and North Dakota officials for details of importation plans they're considering so the task force can see every option available.

On the Net:

Surgeon general: http://www.surgeongeneral.gov/sgoffice.htm

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Americans Fail to Protect Against STDs, Study Finds

 

By Maggie Fox, Health and Science Correspondent

Reuters

Tuesday, April 6, 2004

WASHINGTON (Reuters) - Americans may say they know a lot about sexually transmitted diseases but they do not practice what they preach when it comes to defending against them, according to a survey published on Tuesday.

While one in four Americans will be infected with an STD -- and up to half of younger adults will be -- most of those surveyed believed they were not personally at risk.

This is precisely why STDs spread so easily and so pervasively in society, said the American Social Health Association, which published the survey.

"The findings in our survey are quite disturbing. Despite the fact that STDs are extremely widespread and have severe consequences, it is troubling that there is such a large portion of people who still feel invincible," said Dr. James Allen, president and chief executive officer of the ASHA.

"In addition, people's lack of awareness about the various STDs only underscores the need for continued education to prevent the spread of these serious diseases," Allen added in a statement.

STDs cause a range of long-term problems. Human wart virus or HPV is the main cause of cervical cancer, while bacterial infections such as gonorrhea or chlamydia can cause infertility in women.

They often have no symptoms and people are often unaware they are infected.

The non-profit group, which promotes awareness about sexually transmitted diseases, published a poll of 1,155 adults aged 18 to 35 interviewed by Harris Interactive. It had a margin of error of plus or minus three points.

Despite not knowing whether their partner had been tested, 93 percent said they were sure their partner did not have an STD, the survey found.

Just over one-third of those surveyed felt "very knowledgeable" about STDs, compared to 22 percent who felt they knew a lot about diabetes, asthma or migraines.

Feeling Invincible

Sixty-three percent said they were well-informed about the risks associated with sex and 84 percent said they felt they took the right precautions.

But 82 percent of those who said they were sexually active said they never used protection against STDs for oral sex, 64 percent never used protection for anal sex and 47 percent never used protection for vaginal sex.

Even among single adults, 71 percent used no protection when having oral sex, 42 percent never protected against an STD when having anal sex and 23 percent always had unprotected vaginal sex.

STDs including the AIDS (news - web sites) virus, gonorrhea, syphilis and chlamydia are transmitted orally, anally and vaginally. In the United States, heterosexual contact is the primary means by which HIV (news - web sites) is transmitted now.

The survey also found Americans ignorant of the risks of hepatitis A, B and C, all of which can be transmitted sexually. he group said hepatitis A and B cause more than 170,000 infections each year in the United States alone, killing 5,000 people a year.

"One in every four Americans will contract an STD sometime in their lifetime," the group said.

In February, Advocates for Youth -- a nonprofit group advocating sex education -- and the sexual health-oriented Alan Guttmacher Institute published a report that said 27 million young Americans under the age of 25 were sexually active.

The Centers for Disease Control and Prevention (news - web sites) says there were 18.9 million new cases of STDs in 2000, of which 9.1 million or 48 percent were among teens and adults aged 15 to 24. That means one-third of all sexually active young adults and teens contracted an STD in 2000 alone.

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Study Links Breast Cancer Risk to Famine

 

The Associated Press

Tuesday, April 6, 2004

WASHINGTON - Women who as children were severely affected by a World War II-caused Dutch famine have an increased risk of breast cancer, a new study says.

The finding, if confirmed, suggests the calories-and-cancer link may be even more complex than anticipated.

Animal studies show cutting calories by a third to a half, long-term, can prevent various cancers. Evidence in people is scant, but studies in Norway suggest women who experienced modest World War II rationing there were less likely to develop breast cancer.

Conversely, obesity increases the risk of certain cancers, including breast cancer.

The newest research, in Wednesday's Journal of the National Cancer Institute (news - web sites), raises the possibility that a short period of severe malnourishment can spur breast cancer.

Parts of the Netherlands experienced famine for six months starting in fall 1944 because of a German-imposed food embargo. Official adult daily rations dropped to 700 calories, leaving residents foraging for more, wrote researchers at the University Medical Center Utrecht.

A Dutch cancer registry in the 1980s surveyed almost 20,000 women about their experiences during the famine, including their recall of hunger and weight loss. The registry tracked the women's later development of breast cancer.

The Utrecht scientists randomly chose 2,355 of those women, 585 of whom had developed breast cancer by January 2000.

Those who recalled being severely affected by the famine were 48 percent more likely to have developed breast cancer than unaffected women, they found. The risk was largest, a doubling, among those who were ages 2 to 9 during the famine.

The researchers hypothesized that the children's developing hormone systems may have adapted to famine and couldn't readapt to later food abundance, ultimately increasing cancer risk.

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Groups Posts Web Site for Free Drug Access

 

Reuters

Tuesday, April 6, 2004

WASHINGTON (Reuters) - The drug industry lobbying group PhRMA published a new Web site on Tuesday aimed at helping poor people get discounted or free drugs offered by the drug companies.

The drug companies have been under fire in the U.S. Congress and the media for fighting efforts to import low-cost prescription drugs from other countries, notably Canada.

The Internet site, at http://www.helpingpatients.org, promises "one-stop-shopping" for various patient assistance programs, the Pharmaceutical Research and Manufacturers of America said.

It connects to a database paid for by the pharmaceutical companies but also carries information about government and private patient assistance programs, PhRMA said.

The group, which advocates on behalf of commercial drug companies, said patient assistance programs helped more than 6.2 million underinsured or uninsured patients fill nearly 18 million prescriptions in 2003.

"The estimated wholesale value of medicines distributed though company patient assistance programs last year totaled almost $3.4 billion," PhRMA said.

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Doctor: Fetus Feels Pain After 20 Weeks

 

By Kevin O'Hanlon

Associated Press Writer

The Associated Press

Tuesday, April 6, 2004

LINCOLN, Neb. - A type of abortion banned under a new federal law would cause "severe and excruciating" pain to 20-week-old fetuses, a medical expert testified Tuesday in one of three trials across the country testing the law's constitutionality.

"I believe the fetus is conscious," said Dr. Kanwaljeet "Sonny" Anand, a pediatrician at the University of Arkansas for Medical Sciences. He took the stand as a witness for the government, which is defending the Partial-Birth Abortion Ban Act.

Anand later acknowledged that he believes a less controversial abortion procedure, known as "dilation and evacuation," would cause the same amount of pain to a fetus. An estimated 140,000 D&Es, the most common method of second-trimester abortion, take place in the United States annually.

He also said there is no medical definition of "consciousness."

The law, signed by President Bush (news - web sites) in November, has not been enforced because judges in Lincoln, Neb., New York and San Francisco agreed to hear evidence in three simultaneous, non-jury trials on whether the ban violates the Constitution.

Anand said Tuesday that fetuses show increased heart rate, blood flow and hormone levels in response to pain.

"The physiological responses have been very clearly studied," he said. "The fetus cannot talk ... so this is the best evidence we can get."

The Bush administration has argued that the procedure, referred to by opponents as "partial-birth abortion," is "inhumane and gruesome" and causes the fetus to suffer.

During the procedure, which doctors call "intact dilation and extraction" or D&X, a fetus is partly removed from the womb and its skull is punctured. It is generally performed in the second trimester.

Abortion rights advocates argue that it is sometimes the safest procedure for women, and that the law will endanger almost all second-trimester abortions, or 10 percent of the nation's 1.3 million annual abortions.

Another government witness, Dr. Leroy Sprange, who practices obstetrics and gynecology in Illinois, said he has never performed a D&X but he believes it increases the risk of infection and causes undue trauma to the cervix.

"I've never seen a situation where intact D&X is the safest or best procedure to preserve the health of the mother," Sprange said Tuesday.

The law would be the first substantial limitation on abortion since the Supreme Court legalized it 31 years ago in the landmark Roe v. Wade (news - web sites) case.

Challenges to the ban were filed by several doctors being represented by the Center for Reproductive Rights, the National Abortion Federation (news - web sites) and the Planned Parenthood (news - web sites) Federation of America. The issue is expected to reach the Supreme Court.

On the Net:

U.S. District Court of Nebraska: http://www.ned.uscourts.gov

Center for Reproductive Rights: http://www.crlp.org

National Right to Life Committee (news - web sites): http://www.nrlc.org

Justice Department (news - web sites): http://www.usdoj.gov

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Pig Worm Concoction to Treat Bowel Disease

 

Reuters

Tuesday, April 6, 2004

LONDON (Reuters) - It may sound revolting but scientists say drinking a concoction containing thousands of pig worm eggs could protect people against bowel disease.

Early trials of the beverage called TSO, which was developed by the German company BioCure, were so successful in patients suffering from inflammatory bowel disease (IBD) that the firm hopes to begin selling the product in Europe in May.

"A lot of researchers couldn't believe this treatment was effective, but people are always skeptical when confronted with new ideas," Joel Weinstock, of the University of Iowa in the United States, told New Scientist magazine Tuesday.

He came up with the idea after noticing that a rise in cases of IBD coincided with a drop in infections caused by roundworms and human whipworms.

Weinstock also noted that IBD is rare in developing countries where parasitic infections are more common.

When he tested it twice a month on 100 patients in the United States with IBD, which includes ulcerative colitis and Crohn's disease, symptoms such as abdominal pain, bleeding and diarrhoea, disappeared.

Fifty percent of patients with ulcerative colitis and 70 percent of Crohn's disease sufferers went into remission.

"With these new impressive results, we can come out of the closet," said Weinstock, who plans to present the findings at a medical conference next month.

The scientists decided to use pig whipworms because they do not survive long in the body. About half a billion people are infected with human whipworm, according to the magazine.

"Weinstock's theory is that our immune systems have evolved to cope with the presence of such parasites and can become overactive without them," New Scientist explained.

BioCure's sister company, Biomonde, sells leeches and maggots for treating wounds.

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U.S. Considers Food Guide Pyramid Changes

 

By J.M. Hirsch

Associated Press Writer

The Associated Press

Tuesday, April 6, 2004

The suggestions range from wacky to reasonable, but plenty of people have ideas about how to revamp the federal Food Guide Pyramid, that iconic graphic that supposedly guides how people eat.

An artist wants the pyramid redrawn as a heart pumping iron. A North Carolina man wants it to warn of the "poisons" in vegetables. A Virginia man seems to suggest dumping leafy greens — his nephew doesn't like them. And just about everyone thinks it should be more specific.

Over 600 pages of letters, e-mails and drawings provide a snapshot of what a nation obsessed with diet really thinks. The revised pyramid is expected to be released in early 2005.

For a month and half last fall, 254 responses from citizens and special interest groups poured in to the U.S. Department of Agriculture (news - web sites).

"The science has evolved and yet most Americans are health illiterate," wrote Caile Spear of Boise, Idaho. "They do not understand how to make good choices based on the best science."

The pyramid, first released in 1992 and now under one of its periodic reviews, was envisioned to help people do just that. Replacing the four food groups that so many Americans grew up with, the pyramid aimed to simplify the flood of increasingly complex dietary advice.

The pyramid principle — even the shape itself is up for debate — is simple: a triangle sliced horizontally into segments, with each segment representing different foods.

But more is at stake than the nation's waistlines. Industries and lobbyists also seized the opportunity to weigh in with changes, hoping to prove people can't live well without their products.

Walnut growers were the most prolific, with more than 20 letters touting the nut's alpha-linolenic acid, an essential fatty acid that cannot be manufactured by the body.

The national debate on carbohydrates was reflected, with carb-friendly industries cautioning against sticking them with the dreaded top of the pyramid — the smallest slot, reserved for foods deemed less healthy.

"Americans need to stop blaming carbohydrates for weight problems," wrote the Washington-based Independent Bakers Association. "Simply put, Americans need to cut down on caloric intake and increase their physical activity."

In fact, the folks at the American Association of Cereal Chemists in St. Paul bolstered their pro-carb stance by pointing out biblical references to manna from heaven and the bread of life.

Meanwhile, promoters of the low-carb Atkins Diet began a media blitz this week with full-page ads of their food pyramid in major newspapers and magazines. Breads and cereals are relegated to the pyramid's peak.

Across the board, Americans want more information. The current pyramid groups all grains at the bottom, followed by fruits and vegetables, then meat and dairy products and finally fats and sugars.

Virtually everyone asked for more distinctions, separating simple and complex carbs, healthy and unhealthy oils, breaking nuts and beans out of the meat and fish category, and even separating starchy vegetables from leafy greens.

"I have a real beef with equating a serving of french fries or scalloped potatoes to other vegetables, as well as equating 1 1/2 cups of ice cream to a glass of lowfat milk," wrote Joanne Milkereit, a nutrition consultant.

Many also disagreed with the one-size-fits-all approach, saying separate pyramids are needed for the elderly and obese.

Most saw a need to feature fitness and give fruits and vegetables more prominence, especially the nearly 40 vegetarians and vegans who wrote in. They were the largest of any single group of advocates.

Eric Jaffa wants the "Meat and Beans" group renamed "Beans and Meat" to encourage people to eat more of the former and less of the latter. But the United Fishermen of Alaska want it renamed "Meat, Fish and Beans."

Sunkist, a citrus supplier, warns against changing the pyramid's unit of measurement from servings to cups. This will increase confusion, the group wrote. "Families do not think of a cup of oranges or a cup of bread."

Some groups were surprisingly restrained, leaving agendas behind. The Snack Food Association of Alexandria, Va., offered several reasonable ideas for improving the pyramid, and not one involved Twinkies or pork rinds.

Others were less subtle.

"In fact, every comprehensive review of the scientific literature continues to exonerate sugar's intake involvement in any lifestyle disease, including obesity," wrote The Sugar Association of Washington.

And the old pyramid wasn't without its defenders, especially those who use it to teach nutrition. The Oregon Dairy Council said it isn't the pyramid that needs changing:

"We argue instead that it has become the unfortunate scapegoat for a society that has lost all focus when it comes to balance, variety and proportionality."

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Tiny Newborns Become Average-Size Adults: Study

 

By Amy Norton

Reuters Health

Tuesday, April 6, 2004

NEW YORK (Reuters Health) - Even the tiniest of newborns are likely to grow up to be average-weight, average-height adults, a new study suggests.

Australian researchers found that among forty-two 20-year-olds who weighed less than 2.2 pounds at birth, the average adult weight was similar to the norm. And although they tended to be slightly shorter than average, their stature was generally in line with their parents', according to findings published in the April issue of the Archives of Disease in Childhood.

Advances in neonatal care in recent decades have dramatically raised survival rates among extremely low birth weight newborns. But even when infants survive with no major health problems, parents may still worry about their growth -- particularly since many tiny newborns remain small for their age into early childhood.

"Most parents wonder if their child will ever grow," the study's lead author, Dr. Lex W. Doyle of the University of Melbourne, told Reuters Health.

"We can tell them that they will end up with expected heights consistent with the mix of their parents' heights, and their weight is also within the normal range."

The study followed a group of premature, very low birth weight babies born at one Australian hospital in the late 1970s. Of 159 consecutive infants born weighing less than 2.2 pounds, 60 survived, and 42 had their height and weight measured periodically until the age of 20. Five of the original group were excluded because they were diagnosed with cerebral palsy, a group of movement disorders for which low birth weight infants are at greater risk.

During the earlier assessments, Doyle and his colleagues had found that the children typically made their biggest gains in growth between the ages of 8 and 14. These latest findings on adulthood height and weight should help "reassure" parents of very low birth weight children, according to the researchers.

At age 20, men in the study group were an average of 3.5 centimeters shorter than the norm for their age, while women were 3 centimeters below. However, as mentioned, the researchers found that these slight deficits were consistent with that expected based on their parents' heights.

As for weight, the young men and women were actually relatively heavy for their heights-but, the study authors note, that's not unusual. Overall, one-third were overweight, and nearly 10 percent were obese, but the group's average body mass index was similar to the norm.

"I think our findings are consistent with the general tendency for all of us to increase our weight over the expectation for our height," Doyle said. "Whether we are extremely low birth weight or not."

Source: Archives of Disease in Childhood, April 2004.

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Hawaii Schools Cut Back on Selling Soda

The Associated Press

Tuesday, April 6, 2004

HONOLULU - The state Board of Education has decided to restrict the amount of soda available in vending machines at public schools.

The board voted this past week to have the machines stocked with primarily healthy drinks, such as water, fruit juices and milk. The move is aimed at reducing obesity.

The specific regulations, which will be drawn up by state Schools Superintendent Patricia Hamamoto and her staff, may require as much as 80 percent of drink selections be healthy.

The board had considered a proposal to restrict the vending machines to only healthy drinks. Some health care professions had supported a total ban on soda in school vending machines.

State Health Director Chiyome Fukino had told the board vending machines could contribute to childhood obesity and poor nutrition.

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Monday, April 5, 2004

 

U.S. Plans Study on Environment and Kids

 

By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, April 5, 2004

WASHINGTON - Does a pregnant woman's exposure to certain chemicals put her child at risk of learning disabilities? Do genetics and pollution interact to cause asthma? What's the real impact of TV on toddlers?

The government is preparing the largest study of U.S. children ever performed — it will track 100,000 from mothers' wombs to age 21 — to increase understanding of how the environment affects youngsters' health.

It's called the National Children's Study, and pediatric specialists say it is coming at a crucial time. Rates of autism, asthma, certain birth defects and other disorders are on the rise, as is concern about which environmental factors play a role. And technology has finally advanced enough to allow study of multichemical and gene-environment interactions that might explain why some children seem at greater risk.

The study "really represents our generation's best hope of coming to learn the environmental causes of these conditions," says Dr. Philip Landrigan, an expert on children and the environment at New York's Mount Sinai School of Medicine.

It's a quest to prove both what's harmful, and what's not.

"There are things we probably should be worrying about that we're not worrying about enough, and there are things we're worrying about too much," adds Landrigan, who is advising the National Institutes of Health (news - web sites) on the study's design.

The study, ordered by Congress in 2000, is in its late planning stages. Enrollment of pregnant women is set for 2006, although proponents hope three pilot sites could begin work late next year. Already, families alerted by interested patient-advocacy groups are asking how to participate.

The question is money. Scientists say they need $27 million to $50 million next year to ramp up, including hiring a laboratory big enough to store more than 2 billion anticipated biological and environmental samples — from participants' blood and DNA to dust from their houses, soil from their yards and air from their neighborhoods.

Congress has provided roughly $12 million annually for three years of study preparation. President Bush (news - web sites) requested the same amount for next year, and budget constraints have lawmakers indicating they're unlikely to provide more.

A partnership of strange bedfellows is lobbying for more. The industry's American Chemistry Council, which expects the study to vindicate some of its products, is pairing with environmentalists and patient and doctor groups, who argue that the study will help fight diseases that cost billions every year.

Its ultimate cost over two decades: $2.7 billion.

The last major child-health study, in the 1960s, tracked the children of 55,000 pregnant women until age 7 to learn the causes of cerebral palsy. It also yielded other important discoveries, such as that doctors at the time weren't properly treating infants' fever-caused seizures.

The National Children's Study is to be far more encompassing. Among its overall aims, says director Dr. Peter Scheidt of NIH's National Institute of Child Health and Human Development:

_To measure environmental exposures of concern and hunt differences by degree of exposure.

Chemicals and pollutants top the list. Scheidt cites a Minnesota study that found signs of pesticide exposure in the urine of 85 percent of children tested, but does exposure equal harm? Another example: chemicals such as phthalates, which soften plastic, may affect hormones to cause male birth defects or encourage early puberty.

Other environmental influences studied may include day care, diet, early-life infections and television.

_To study health problems specifically suspected of environmental links, in hopes of pinpointing risk factors.

For example, studies of genetically identical twins show when one twin gets Type 1, or juvenile, diabetes, the other has just a 50 percent of getting it. Genes put these children at risk, but something else, perhaps a virus, pushes them over the edge.

Brain development is another huge concern, and some substances can harm a developing brain in subtle ways and tiny amounts. Only recently have scientists learned to measure low-level contaminant exposure and to show not only that a person was around something toxic, but it actually absorbed into their DNA. And then there are windows of vulnerability: An exposure may harm during one month of pregnancy but not another.

_Storing genetic and other health and exposure data long-term to test future questions without starting from scratch.

"The kinds of information we'll be collecting ... will provide an enormously valuable resource for doing this kind of research for decades to come," Scheidt says.

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

On the Net:

NIH study information: http://www.nationalchildrensstudy.gov

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Well-Meaning Paramedics May Kill with CPR –Study

 

Reuters

Monday, April 5, 2004

WASHINGTON (Reuters) - Well-meaning paramedics may be losing heart patients by trying to resuscitate them too vigorously, researchers reported on Monday.

They found that some ambulance crews giving cardiopulmonary resuscitation, or CPR, were giving more than the American Heart Association (news - web sites)'s recommendation of 12 to 15 breaths per minute.

This may well mean they are doing little good, the researchers report in Tuesday's issue of the journal Circulation.

"The overall survival rate in the United States from cardiac arrest is about 5 percent," said Dr. Tom Aufderheide, a professor of emergency medicine at the Medical College of Wisconsin in Milwaukee, who led the study.

"Excessive ventilation may be contributing to that poor outcome."

His team studied 13 cardiac arrest victims. For the first seven patients, the average maximum ventilation rate was 37 breaths a minute -- much, much more than recommended.

Even after retraining, the paramedics still gave 22 breaths a minute to the next six patients.

One solution might be to use a system that flashes a light every five seconds to let a rescuer know when to deliver another breath of oxygen, Aufderheide said.

During CPR, the chest is compressed, raising pressure and forcing blood out of the heart and into the rest of the body. When the pressure is released the chest expands, which creates a slight vacuum inside.

The body needs this vacuum for blood in the veins to return to the heart most efficiently, said the American Heart Association, which publishes Circulation. Without it, not as much blood returns to the heart.

"The decreased return of blood to the heart reduces the blood going out of the heart, and that may decrease the effectiveness of CPR," Aufderheide said.

"Medical directors of all systems -- all professional rescuers, including EMTs (emergency medical technicians), nurses, doctors, respiratory therapists and anyone else who would do CPR as part of their profession -- need to get this message: Do not hyperventilate," he said.

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Study Links ADHD Drugs to Growth Delays

 

The Associated Press

Monday, April 5, 2004

CHICAGO - New research bolsters evidence that stimulants like Ritalin (news - web sites) used for attention deficit problems may stunt children's growth, but it does not address whether the affect is permanent.

Children who took stimulants during the two-year study grew more than half an inch less and gained over eight pounds less than those who weren't medicated.

The study involved 540 youngsters with attention deficit hyperactivity disorder, who were aged 7 to 9 at the outset of the study and were randomly assigned to receive common treatments including medication, behavior management and a combination of the two.

Girls generally reach their final height around age 16 and boys around age 18, so it's too soon to tell if the growth delays continued or were permanent, the researchers said.

American Academy of Pediatrics' guidelines that recommend treating ADHD with stimulants and behavior therapy say evidence collected by following youngsters into adulthood indicates the drugs don't cause any significant height reduction.

Weight loss, however, is a known potential side effect from long-term stimulant use.

The study, led by University of California at Berkeley researcher Stephen Hinshaw, was funded by the National Institute of Mental Health and appears in the April issue of Pediatrics.

Initial results after 14 months of follow-up, published in 1999, showed that drugs alone or used with behavior therapy were the most effective treatment.

The 24-month follow-up found that drug treatment with or without behavior therapy remained superior, though the effect diminished somewhat over time. The researchers attributed this in part to patients stopping or starting medication.

ADHD, the most common neurobehavioral disorder in childhood, affects 4 percent to 12 percent of U.S. school-age children. Symptoms may include short attention span, impulsive behavior, and difficulty focusing and sitting still.

On the Net:

Pediatrics: http://www.pediatrics.org

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Exercise Key to Teen Weight Problem - U.S. Study

 

By Maggie Fox, Health and Science Correspondent

Reuters

Monday, April 5, 2004

WASHINGTON (Reuters) - Exercise may be the key to keeping the pounds off adolescents and may help overweight children reverse some of the harm caused by being fat, two teams of researchers reported on Monday.

The studies bolster the argument that children in rich countries need to get more exercise. In the United States, some 15 percent of children under age 19 are overweight, and many are starting to develop weight-related diseases such as type-II diabetes and heart disease.

A study of more than 850 southern California teenagers and younger children showed that just a bit of vigorous exercise made the difference between being of normal weight and being overweight.

On average, the children with normal weight had four minutes more of vigorous exercise over a single day than the overweight children, the team at the University of California San Diego found.

"This might be an indicator of a more active lifestyle generally," Dr. Kevin Patrick, a professor of family and preventive medicine who led the study, said in a telephone interview.

Children who ate more fruits and vegetables also were less likely to be overweight, Patrick's team found, and fiber intake better predicted who would be overweight than fat intake did.

"Insufficient physical activity and too much time spent on sedentary behaviors like computer games and watching TV may equal, and even exceed, diet quality as important contributors to overweight in adolescence," Patrick said.

In fact, the normal-weight children consumed slightly more calories than the overweight children, but apparently burned them off, Patrick's team said in the April issue of the American Medical Association's Archives of Pediatric and Adolescent Medicine.

Patrick's team chose 878 children age 11 to 15 registered at six San Diego County clinics. They found that nearly half of the children were at risk for becoming overweight or were already overweight by standard measures.

They questioned the children carefully, asked them to write down everything they ate in food diaries, and attached devices to measure how much exercise they got over a day.

They analyzed the group by age, sex, ethnic group, sedentary behavior, vigorous exercise, household income and diet. Of all these measures, only exercise clearly predicted which children would be overweight, Patrick said.

Vascular Abnornmalities

In the second study, a team at The Chinese University of Hong Kong studied 54 boys and 28 girls with an average age of just under 10. All were either overweight or obese.

At age 9, tests of their blood vessel function "matched those of a 45-year-old adult who had been smoking for more than 10 years," said Dr. Kam Woo, who led the study.

"We were surprised that the children had developed vascular abnormalities at such a young age -- and by how readily these could be reversed with simple lifestyle measures," said Woo, whose study is published in this week's issue of the American Heart Association (news - web sites) journal Circulation.

All the children met with a dietitian twice a week and followed a 900- to 1,200-calorie diet that was low in fat and high in fruits, vegetables and whole grains.

Some children were led by a trainer through a 75-minute program twice a week that included aerobics and other exercises.

After six weeks, all the children narrowed their waists, lowered their cholesterol and had healthier arteries. But the blood vessel improvement was more marked in those who exercised.

After a year, the children who stuck with the exercise program had a major improvement in one measure of heart disease risk -- the thickness of the carotid artery, the researchers said. They also had less body fat and lower cholesterol levels.

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Unpasteurized Milk Has Fans Despite Risk

 

By Ira Dreyfuss

Associated Press Writer

The Associated Press

Monday, April 5, 2004

HERNDON, Va. - Like most moms, Cathy Fairbairn makes sure her kids get lots of milk. Nine-year-old Corinne and 7-year-old Ryan love the stuff. It also is unpasteurized.

Drinking this kind of milk appalls health officials. They credit pasteurization with preventing countless cases of sickness and death from diseases spread through bacteria in milk.

But Fairbairn, who lives in Herndon, and other advocates of raw milk say pasteurization's scalding heat destroys nutrients, ruins the taste and just is not natural. They have formed their own supply networks to get what they want.

"If you're open to it, you cross this line and then you're part of the other culture," Fairbairn said.

In their books and Web sites, raw milk advocates say that health officials and doctors are narrow-minded bacteria-phobes. One site — www.rawmilk.org — calls nonpasteurized milk "the only healthy milk."

Fairbairn, who came to raw milk in 2000 by attending seminars and reading articles about it, said ordinary milk drinkers "have been fed a line."

The practice also fits a back-to-the-roots lifestyle. Fairbairn, for example, grinds her own grain for the bread she bakes. Natural foods are healthier because they follow the "traditional diets of our ancestors," she said.

Doctors and health officials do not accept the raw milk argument.

"We continue to see outbreaks of foodborne illnesses associated with the consumption of raw milk every year," said John Sheehan, director of the Food and Drug Administration (news - web sites)'s division of dairy and egg safety.

Unpasteurized milk can be breeding grounds for food poisoning bacteria such as campylobacter, E. coli and salmonella, as well as forms of tuberculosis that can be transmitted from cattle to people.

Fairbairn said her family has not gotten sick. Also, some experts say raw milk is not uniformly dangerous. Sanitary handling from farm to delivery can keep the risk of bacteria down, said Rusty Bishop, director of the Center for Dairy Research at the University of Wisconsin-Madison.

"It's amazing how clean milk is when you look at where it comes from," Bishop said. "If God had done it right, he would have put the teats at the other end of the cow."

Bishop does not drink raw milk. Pasteurization is good health insurance, and the odds of disease can catch up with people who regularly drink raw milk, he said. Countries where more raw milk is consumed have higher rates of food poisoning traced to it, he said.

In the United States, the FDA forbids interstate transportation of raw milk packaged for retail sale, but 28 states allow sales within the state's borders, Sheehan said.

Virginia is not one of the 28, but Fairbairn said she and about 40 other families in northern Virginia have found a way to get their milk anyway. To avoid having to buy milk, they banded together in a loose co-op that owns shares in Jersey cows at Hedgebrook Farm, a small dairy operation near Winchester, Va., in the Shenandoah Valley.

Each $60 share in the "cow boarding" system entitles the owner to one gallon of milk a week. Shareholders pay for the upkeep of the cows and home delivery of the milk at $15 per month per share. The farm's owner, Kitty Hockman-Nicholas, said the milk winds up costing them around $4 per gallon.

It is more trouble than driving to the supermarket for milk. But raw milk advocates say the health benefits are worth it.

They say pasteurization reduces heat-sensitive vitamins such as vitamin C and thiamin and changes some of milk's calcium into a form that is more difficult for the body to use.

Health officials disagree.

"You'll see people claim pasteurized milk is not nutritionally equal to raw milk and that is not so in any appreciable sense," said Sheehan. "It's pretty much FDA's position that the health risks far outweigh the benefits that might accrue."

Health and dairy experts acknowledge that raw milk advocates have a point in their claim that pasteurization changes the taste of milk. Pasteurization's heat cooks a slightly sweeter taste into milk, but it is hard to notice, Bishop said.

In this reporter's taste test in Fairbairn's kitchen, pasteurized milk bought at a local supermarket was a little sweeter, although the milk from the farm's jerseys tasted just a little creamier.

Another taste tester, however, had a stronger opinion. Holding a glass of the product he has been drinking for most of his life, young Ryan Fairbairn declared, "This is the real milk."

On the Net:

FDA background: http://www.cfsan.fda.gov/dms/a2z-p.html pasteurize

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Alzheimer's Cuts Life Expectancy in Half – Study

 

Reuters

Monday, April 5, 2004  

WASHINGTON (Reuters) - An Alzheimer's diagnosis cuts a person's remaining life expectancy in half, according to a report on Monday that gives a new estimate of how long patients have to live with the disease.

The study of 521 people with newly diagnosed Alzheimer disease found that the median survival period was 4.2 years for men and 5.7 years for women, about half what a person of the same age who did not have the disease would be expected to live.

Alzheimer's is always fatal and there is no cure, although drugs can reduce the symptoms in some patients for a while. It is the most common cause of dementia and affects 4.5 million Americans.

But there has been no firm estimate of just how long an Alzheimer's patient has to live.

Dr. Eric Larson and colleagues at the University of Washington followed 521 men and women over 60 who had been recently diagnosed with Alzheimer's disease (news - web sites).

Those diagnosed in their 70s lived longer than those diagnosed at age 85 or older, said Larson, director of the Center for Health Studies at the Group Health Cooperative in Seattle and a former medical director of the University of Washington Medical Center.

"This finding moves us toward a more precise vision of the course that Alzheimer's may take in people with certain clinical characteristics," Larson said in a statement.

"For doctors, this provides very useful data for gauging the prognosis of an (Alzheimer's) patient. For patients and their caregivers, as difficult as this may be to hear, it can help in making appropriate plans for the future."

The study, funded by the National Institute on Aging, is published in Tuesday's issue of the Annals of Internal Medicine.

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First-Time Moms Over 40 on the Rise

 

By Pauline M. Millard

Associated Press Writer

The Associated Press

Monday, April 5, 2004

NEW YORK - Judith Newman was almost 40 and getting a little nervous. She knew her clock was ticking.  

After marrying at 33, she spent seven years and $70,000 trying to get pregnant. The ups and downs of the fertility treatments were frustrating, even maddening at times, she says, and seeing doctors and taking tests was becoming a full-time job.

All she wanted was a baby.

How about "babies"?

Turns out all her efforts paid off — Newman is now the mother of twins.

"I thought of the technology that got them here. Unnatural? Maybe. But so's the Sistine Chapel and no one complaining about that," she writes in "You Make Me Feel Like an Unnatural Woman" (Miramax).

In the book, Newman approaches fertility treatments, birth and learning the ropes of motherhood at what doctors like to call an "advanced age" with humor.

"I think that there's a part of you that when you go through all these treatments that are so funny and sad and ridiculous and a roller coaster of emotions that you need to go back and revisit that," she says in an interview.

Newman, 43, is not alone in her struggle. Births to women over the age of 40 have doubled in the in the past 30 years, according to Doreen Nagle in her book "But I Don't Feel Too Old to be a Mommy" (Health Communications).

This is good news for Newman, who says she likes looking around the playgroup and seeing other faces her age.

She also is reassured by women's willingness to discuss fertility treatments — often a part of later-in-life motherhood. Newman says that she often gets into very graphic and very personal conversations with women about what doctor they used and how often it took before they conceived.

"It's becoming so common. There was a time when people didn't want to talk about it, when it was covered in secrecy the way plastic surgery was," Newman says. "Women also didn't want to admit to other women that they were going in for these treatments, but I think that is changing."

Nancy Hemenway of Arlington, Va., creator of an infertility-resources Web site, had her first daughter at 45 after several trials with a fertility doctor.

The stigma of being an over-40 mom is being erased by all the over-40 moms out there, says Hemenway. She didn't have to look too far to find another one: Her next-door neighbor.

There are some advantages to waiting to have children, she says, including using life experiences and applying them to raising children. She also feels more financially stable.

"Kids keep you young," she says. "Even when they're complaining about wanting to stay up longer to watch 'Full House.' It's a good problem to have."

However, adding an extra person to the family can affect your marriage, especially one with very established routines, says Lianna Miller of Aliso Viejo, Calif.

Miller and her husband had been married for 20 years before they adopted their daughter Emilie. Having an infant around the house changed just about everything — and it made Miller realize the importance of spending time alone with her spouse.

"When you have your first child after 40, you've had a lot of time to go on dates and travel or just sit around the house," she says. "But even after the baby arrives you still need to have dinner together alone or get away to just have a conversation."

Newman agrees: "On the one hand everything changes. There are just bombs dropped into the nice life you created for yourself and your husband," she says. "Then again, you've had a lot of time to go to parties. I had many, many years to make witty conversation with strangers about the latest thing in the New York Times Book Review. And I'm not saying it gets old. I'm saying the pleasure now is keener. You savor it."

But as much as Susan Kostas of Rumford, R.I., loves doting on her infant twins Peter and Allison, she misses the working life. One of the biggest adjustments she's had to make is accepting the fact that she's not going into work every day and doesn't have the camaraderie she once knew with her co-workers, says Kostas, who had worked up until two weeks before she delivered her children.

Kostas, 42, does participate in some playgroups but she hasn't really connected with the other — mostly younger — mothers.

Having a support network is key to raising children no matter what the mother's age, says parenting author Nagle, but over-40 moms seem to think it's even more important.

Mary Resnick of Dix Hills, N.Y., says that both she and her husband were well established in their careers when they had a baby two years ago. And neither was willing to give up those jobs when they decided to have a child, so they knew that "parenting" would also include a grandmother who would watch their son during the workday.

"I'm happy that I waited," Resnick says. "I don't know if I would have had the mature outlook that I have now. Now I know how to forecast things and how to ask for things that I need. It's almost like having a business plan."

On the Net:

Judith Newman's Unnatural Woman: http://www.unnaturalwoman.com

The InterNational Council on Infertility Information Dissemination: http://www.inciid.org

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Kids at Risk Even if Parents Go Out to Smoke-Study

 

Reuters

Monday, April 5, 2004

STOCKHOLM (Reuters) - Children of parents who smoke face double the risk of passive-smoking-related diseases than children of non-smokers even if the smoking mom or dad lights up only outdoors, a Swedish study showed on Monday.

The World Health Organization (news - web sites) regards environmental tobacco smoke (ETS) exposure as a health hazard which affects almost half of the world's children.

"The results of this study indicates that smoking behavior in the home is of significance for children's ETS exposure," said a Linkoping University doctoral dissertation published in the April issue of the medical journal Pediatrics.

Researchers at the university in central Sweden said they had detected double as high levels of cotinine -- a chemical created when the body processes nicotine -- in the urine of children whose parents smoked only outdoors with the door closed than for a control group of children with non-smoking parents.

Since nicotine is highly specific for tobacco smoke, cotinine levels track exposure to tobacco smoke and its toxic constituents.

"One can speculate that it's from the smoker's breath but we have not studied this and we can't be sure," AnnaKarin Johansson, one of the researchers at Linkoping University's Faculty of Health Sciences, told Reuters by telephone.

For children of parents who varied their smoking between outdoors and by an open window the exposure was 2.4 times higher, and for children in homes where parents smoked by the kitchen fan or outdoors it was more than three times higher.

In homes where parents regularly smoked indoors the exposure was 15 times higher than for children in the control group.

The study carried out from April 2001 to January 2003 analyzed urine samples from 366 children with at least one smoking parent and from 433 children of non-smoking parents. All children were between 2.5 and three years old.

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Study: Arch Support May Ward Off Injury

 

By Ira Dreyfuss

Associated Press Writer

The Associated Press

Monday, April 5, 2004

WASHINGTON - A little extra cushioning in the shoe may prevent a small crack in a tiny foot bone that can end a basketball player's season, a study suggests.

And arch supports likely could also help protect weekend athletes, particularly those with flat feet, researchers say.

The little bones in the foot take a lot of punishment.

"The forces proven to occur just from landing following a jump are greater than five times body weight," said Dr. Joseph Guettler, a researcher and orthopedic surgeon at William Beaumont Hospital in Royal Oak, Mich.

The study focused on the fifth metatarsal, a bone about a half inch wide and 3 to 4 inches long, which runs along the top outside edge of the foot.

The foot bones are held together by a web of muscles, tendons and ligaments. They absorb the shocks, twists and stretches that come as an athlete runs and jumps.

The accumulated stress can create tiny breaks that develop into bigger ones, said Guettler, who studied bone stress while an orthopedic fellow at Duke University. He presented his findings at a recent meeting of the American Academy of Orthopaedic Surgeons.

Guettler and his colleagues studied 11 players from North Carolina Central University in Durham. The players wore very thin electronic insoles that transmitted data on foot pressure as they made one-foot landings after jumps, and did two reverse-direction moves — a shuffle and a forward sprint.

Using the insoles, the researchers measured the players with and without extra arch support in their shoes.

Forces on the fifth metatarsal were consistently greater without the arch support, the study found, suggesting that cushioning the arch could reduce stress.

If that's the case, the finding could have important implications for basketball players, since injuries can take six weeks or more to heal, Guettler said.

Although the study looked at collegiate players, he noted the same principles would apply to recreational basketball players and others whose sports require pivoting and jumping.

In addition, all the players in the study had some degree of flat-footedness, a common condition in basketball, Guettler said. Since people with flat feet are more likely to get stress fractures, he said, they ought to use arch supports.

The supports also likely would help people with high arches, because other studies have found they, too, have higher risks of injury to the fifth metatarsal, he said.

Guettler says the most effective supports are probably custom-fitted. But those can cost several hundred dollars, and even cheaper, store-bought supports provide some benefit.

The arch support seemed to shift stresses away from the fifth metatarsal, said Dr. Jonathan Chang, an assistant professor of orthopedics at the University of Southern California. Chang was not part of the Guettler study but saw the presentation.

If an arch support does prevent injury, even a custom support could be worth the money by heading off a fracture that "could make or break an entire season," Chang said.

Still, it will take more tests to know whether what was true of Guettler's 11 players is true of players in general, Chang said. "Some would jump on it immediately, others would say, 'I want to see more proof first,'" he said.

Chang is among those reserving judgment.

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Diet, Exercise Improve Blood Vessels in Obese Kids

 

Reuters Health

Monday, April 5, 2004

NEW YORK (Reuters Health) - The blood vessels of children who are obese show changes that can lead to heart disease later in life. Now, new research shows that these changes can largely be reversed with diet and exercise.

"We were surprised that the children had developed (blood vessel) abnormalities at such a young age--and by how readily these could be reversed with simple lifestyle measures," researcher Dr. Kam S. Woo, from The Chinese University of Hong Kong, said in a statement.

The findings are based on a study of 82 overweight children who were put on a low-fat diet alone or in combination with a structured exercise program for six weeks. After this period, all 41 kids in the diet-only group and 22 of 41 in the diet-plus-exercise group continued their assigned regimens for 1 year.

During the initial 6 weeks, both interventions were associated with a drop in cholesterol levels and with improved blood vessel function. The effect on function was more pronounced with diet plus exercise than with diet alone, according to a report in the American Heart Association (news - web sites)'s journal Circulation.

At 1-year follow-up, further improvements in blood vessel function were seen in kids who continued the exercise program. Moreover, continued exercise had beneficial effects on blood vessel wall thickening and body fat content. Less dramatic benefits were seen in children who remained on the diet only.

"This highlights the importance of regular exercise in preventing obesity-related (blood vessel) dysfunction in children," Woo emphasized.

In a related editorial, Dr. Stephan Gielen and Dr. Rainer Hambrecht, from the University of Leipzig in Germany, comment that this report "provides conclusive evidence that aggressive lifestyle modification by diet and physical exercise training are needed in overweight children" to correct blood vessel dysfunction, a risk factor for heart disease.

Source: Circulation, April 6th online issue, 2004.

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Some Doctors Choosing Cash Over Insurance

By Rebecca Cook

Associated Press Writer

The Associated Press

Monday, April 5, 2004

RENTON, Wash. - When Chuck O'Brien visits his doctor, they talk about his aches and pains, his heart problems and his diet, but never about his health insurance. That's because Dr. Vern Cherewatenko is one of a small but growing number of physicians across the country who are dumping complicated insurance contracts in favor of cash.

Is this the health care wave of the future? Probably not, experts say. Most people are content with monthly premiums and $10 copays; nine out of 10 doctors contract with managed-care companies. But cash-only medicine is becoming an increasingly attractive option for doctors frustrated by red tape and for the 43 million Americans who lack health insurance.

"It's a terrible indictment of the collapsing health care system," said Arthur Caplan, chairman of the medical ethics department at the University of Pennsylvania Medical School. "Insurance and managed care were supposed to streamline — instead what they've done is add so much paperwork and bureaucracy they're driving some doctors out."

When O'Brien leaves the exam room, he writes a check for $50 and he's done — no forms, no ID numbers, no copayments.

"This is traditional medicine. This is what America was like 30 years ago," said O'Brien, 55 and self-employed, who believes he has saved thousands of dollars by dropping his expensive insurance policy and paying cash. "It's a whole world of difference."

Health insurers downplay the trend, while emphasizing recent efforts to mend tattered relationships between doctors and managed care companies.

"I don't look at it as a threat," said Mohit Ghose, spokesman for the industry group America's Health Insurance Plans. "It's just a different way of practicing."

Medical establishment leaders don't object to doctors working for simple cash.

"This is America. One size does not fit all," said Dr. John C. Nelson, president-elect of the American Medical Association. "We certainly support the physicians' right to do that."

An obstetrician-gynecologist in Salt Lake City, Nelson easily recalled times when he believed managed care rules prevented his patients from getting the best treatment. He said cash-only doctors are driven by the desire to practice medicine without interference.

"There is a great intrusion by third parties into the patient-physician relationship," Nelson said. "We can understand their frustration."

Cherewatenko, a broad-shouldered 45-year-old who wears black jackets and red stethoscopes at work, switched to cash out of desperation six years ago. His suburban Seattle practice was hemorrhaging money, and he and his partners realized they were spending hundreds of thousands of dollars just to process insurance paperwork.

"We said, 'Let's cut out this administrative waste,'" Cherewatenko said. Before, he charged $79 for an office visit and got $43 from an insurance company months later, minus the $20 in staff time it took to collect the payment. Now he charges $50 — and he never worries about collection costs, because patients pay in full after every visit.

Cherewatenko sees fewer patients now. His whole office would probably fit inside his old waiting room. But he says the freedom is worth it.

"Accounts receivable is zero. It's a great feeling," Cherewatenko said. "I feel like I'm a real doctor again."

He started a group called SimpleCare to spread the gospel of cash-only medicine. The organization steers patients to doctors who offer cash discounts, and gives technical and moral support to doctors who want to start cutting their ties to insurance. Membership has grown to 22,000 patient members and 1,500 doctors. Some reject all insurance and take only cash, while others continue to accept insurance while offering discounts of 15 percent to 50 percent for cash-paying patients.

Independent of SimpleCare, doctors in California, Colorado, Minnesota, Texas, Mississippi and other states have also quit the insurance game. Some tired of the paperwork and administrative expenses. Some wanted to spend more time with patients without managed care bean-counters peering over their shoulders. The patients who pay cash range from poor to wealthy, with most in the blue-collar middle.

"When I first started, I thought it would be the elite. That's not the case," said Dr. Shelley Giebel, an obstetrician-gynecologist in Temple, Texas, who washed her hands of insurance eight years ago.

Her standard, hour-long annual checkup costs $140. Everyone pays cash.

If a patient needs extra tests or treatment, Giebel tells them upfront what it will cost.

"If it is an urgent test, we'll go ahead and do it. We're not going to delay medical care because they don't have the money in hand," she said. Often, patients return later with the money.

"It has usually not been a problem that people forgo medical care," she said.

The cash-only movement isn't just changing the way people pay, it's changing the way these doctors work. Because of managed care's low reimbursement rates, doctors on insurance contracts must limit their time with each patient.

Giebel, a typical example, said she would have to double her patient load to make ends meet if she relied on insurance — something she can't imagine. "How can you possibly talk about prevention of cancer and heart disease when you're seeing patients every 12 minutes?" she asked.

Cash-only patients rave about the quality of care.

"They take time here with you," said Jesse Rainwater, a 59-year-old church pastor from Bellevue, Wash., who credits Cherewatenko with teaching him to manage his diabetes. "They don't just bring you in and run you out like a bunch of cattle. You feel like you're loved."

The cash-only approach evokes Norman Rockwell-tinged visions of country doctors being paid with chickens. The simplicity is tempting, but the truth is many people went without preventive health care in those "good old days." A $50 charge can be powerful incentive to delay seeing a doctor until you're in pain — which can lead to more expensive health problems later.

"Medicine used to be a cash-only business, and there were certainly many people who didn't have the cash," said Caplan, the medical ethicist. Doctors who insist on cash also have an ethical obligation to help people who can't afford the fee, he said — even if it means accepting chickens.

Cash crusaders acknowledge the need for some type of insurance. Without it, expensive surgery or hospitalization would force most people into bankruptcy. But they think health insurance should work more like car insurance: you pay for the routine maintenance and little dings yourself, and insurance pays for more expensive repairs.

O'Brien, a freelance marketing specialist, switched from a comprehensive health plan with $300 monthly premiums to a catastrophic plan that costs $75 a month, with a $2,000 deductible. He pays out-of-pocket for routine checkups, and his insurance will kick in if he ever needs expensive care.

The promise of a simple cash payment lured him to Cherewatenko's office, but the doctor's personal attention keeps him coming back. The $50 exams are just part of the bargain for O'Brien. Cherewatenko recently met him for coffee to talk about improving his diet — including an admonition to cut back on caffeine.

"How often does your doctor go out and have a cup of coffee with you?" O'Brien asked.

On the Net:

http://www.simplecare.com

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Testosterone Helps Men with Heart Failure

Reuters Health

Monday, April 5, 2004

NEW YORK (Reuters Health) - Treatment with the male hormone testosterone appears to improve exercise tolerance and reduce symptoms in men with heart failure, findings from a small study suggest.

Larger studies are needed to verify these benefits and to clarify how the hormone works.

The findings, which are reported in the medical journal Heart, are based on a study of 20 men with heart failure who were given testosterone or inactive "placebo" injections every 2 weeks for 12 weeks.

Treatment with testosterone produced a significant improvement in the distance they could walk, Dr. K. S. Channer, from Royal Hallamshire Hospital in Sheffield, UK, and colleagues note.

Testosterone therapy also led to dramatic improvements in heart failure symptoms and may have had a beneficial effect on depression. None of these effects was seen with placebo.

Treatment with the hormone had no major effect on muscle bulk and strength.

Treatment with testosterone appeared to be safe and well tolerated, the authors note. However, one patient in the testosterone group did experience breathlessness after 8 weeks of therapy.

Source: Heart, April 2004.

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Nebraska Has Plan to Counter Obesity

The Associated Press

Monday, April 5, 2004

KEARNEY, Neb. - A statewide program being implemented through the University of Nebraska at Kearney is working to help Nebraskans shed extra pounds.

Nebraska On the Move, an affiliate of America on the Move, is a new initiative designed to stop yearly weight gain.

Kate Heelan, director of the state program, said it encourages people to eat 100 fewer calories a day and walk 2,000 more steps a day.

"By doing this, we can maintain the weight we are at right now as a first step in tackling the obesity trends," Heelan said.

Heelan said 54 percent of Nebraskans are considered overweight or obese and that people on average gain two to three pounds every year.

Because of poor eating habits and lack of physical activity, there is an increase in obese-related illnesses — especially in children, she said. Those include type-two diabetes, high blood pressure and cardiovascular disease.

"Those aren't diseases you relate to children," she said.

Obesity related medical expenditures in Nebraska are estimated at $454 million every year, Heelan said. If that trend continues, everyone in the United States will be obese by 2030, she said.

"It's a touchy subject. However, people need to account for their own health behaviors," she said.

Choices that could help include drinking diet soda rather than regular soda.

"Twenty-five percent of our calories come from pop consumption," Heelan said. "There are kids at 7-months-old drinking pop."

A survey conducted in Buffalo County indicated that 34 percent of 4- to 12- year-olds were overweight or obese, she said, and overweight and obese fourth- and fifth-grade children gained 36 percent more body weight in eight months compared to their normal-weight peers.

Obesity was 38 percent higher in children who watched more than three hours of television a day, she said, and poor diet and lack of physical activity contribute to those trends.

Kearney's Wellness Works will sponsor "Walk Out On Your Job" on May 19 at UNK, and could include 1,500 participants, Heelan said. Participants will walk 1.5 miles, and a healthy lunch will be included in the program.

Ongoing programs include N-Lighten Nebraska, a five-month team wellness program encouraging weight loss and increased physical activity.

Outreach to children through a Kids Fitness and Nutrition Day in October and to employees through increased work-site wellness programs also are planned.

On the Net:

America On the Move: http://www.Americaonthemove.org

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Chlorination May Increase Stillbirth Risk

Reuters Health

Monday, April 5, 2004

NEW YORK (Reuters Health) - Exposure to tap water containing high levels of chlorination byproducts, particularly compounds called trihalomethanes (THMs), is associated with an increased risk of stillbirth, Canadian researchers report.

Still, whether THMs cause stillbirth is unclear, because the risk did not increase in step with increasing levels of the chemicals.

On the other hand, the new findings support several reports that have linked THM exposure with stillbirth, including a study by the same research group published in 1999.

Dr. Linda Dodds, from Dalhousie University in Halifax, Nova Scotia, and colleagues interviewed 112 women who had a stillbirth and 398 "controls" who had a live birth, and analyzed water samples obtained from the women's homes.

The investigators' findings are published in the March issue of Epidemiology.

Women with tap water containing THM levels of at least 80 micrograms per liter were 2.2-times more likely to have a stillbirth than women not exposed to THM. The increased risk with THM exposure held true for both asphyxia-related stillbirths and, to a less extent, unexplained stillbirths.

However, women in the middle range of THM exposure had the second highest risk of stillbirth - a "non-linear" relationship, which brings causality into question.

If the link between THM exposure and stillbirth is causal, "consuming filtered or bottled water will not completely eliminate risk because showering and bathing contributed to the overall exposure," the authors point out.

They also suggest that "a decrease in population exposure will be most effectively achieved at treatment plants rather than the household level."

Epidemiology 2004;15:179-186.

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Brain Freeze

HealthDayNews

Monday, April 5, 2004

(HealthDayNews) -- Have you ever wondered what triggers an ice cream headache?

Sometimes when you eat something cold, especially ice cream, it touches the top of your mouth and initiates a nerve reaction that swells blood vessels in your head. This causes a headache that usually resolves within a minute.

To avoid "brain freeze," the University of Dalhousie in Canada suggests you try eating frozen goodies slowly, giving the roof of your mouth time to warm up between bites.

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Toddler TV Habits Tied to Attention Deficit

By Michael Conlon

Reuters

Monday, April 5, 2004

CHICAGO (Reuters) - The more television children watch between the ages of 1 and 3, the greater their risk of having attention problems at age 7, U.S. researchers reported on Monday.

They found that each hour of television that preschoolers watched per day increased the risk of attention problems such as attention deficit-hyperactivity disorder, by almost 10 percent later on.

The study, published in the April issue of Pediatrics, the journal of the American Academy of Pediatrics, adds inattention to the list of harmful effects of excessive television viewing that also includes obesity and violent behavior.

Frederick Zimmerman of the University of Washington in Seattle, one of the authors, said it was impossible to say what a "safe" level of TV viewing would be for children between the ages of 1 and 3.

"Each hour has an additional risk," he said in an interview. "You might say there's no safe level since there's a small but increased risk" with each hour.

"Things are a trade-off. Some parents might want to take that risk. We didn't find a safe level in that sense."

The data from 2,500 children covered by the study found that they watched an average of 2.2 hours per day at age 1 and 3.6 hours per day at age 3. But some watched 12 hours or more.

The ages are significant because brain development continues through those years, the study said.

"This study suggests that there is a significant and important association between early exposure to television and subsequent attentional problems," said Dimitri Christakis, a physician at Children's Hospital and Regional Medical Center in Seattle who headed the study.

"We know from national estimates that children watch an average of two to three hours of television a day in the 1- to 3-year-old age group, and that as many as 30 percent of all children have a television in their bedroom," he said.

"There is a tremendous and growing reliance on television for a variety of reasons. However parents should be advised to limit their young child's television viewing," Christakis said.

In the United States between 3 percent and 5 percent of children are diagnosed with attention deficit disorder, which is marked by reduced ability to concentrate, difficulty in organizing and impulsive behavior. The symptoms do not typically show up until children are older, around age 7.

Study Limited

The authors said the study had some limitations.

The television viewing data came from the parents and may not be completely accurate. Also, there is no way to know whether the children already had attention problems early on that attracted them to TV viewing, though symptoms don't appear that early, it said.

It was also possible the parents who allowed excessive TV viewing were themselves distracted and neglectful, creating a household that fostered attention problems in the children. Attention deficit-hyperactivity disorder has a high heritability level, the study said.

And the study did not look at what kinds of programs the children watched.

"Despite these limitations our results have some important implications if replicated in future studies," it said. "First we (have) added inattention to the previously studied deleterious consequences of excessive television viewing ... (and) our findings suggested that preventive action can be taken."

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When Your Memory Is Likely to Fail You

 

HealthDayNews

Monday, April 5, 2004

MONDAY, April 5 (HealthDayNews) -- Low levels of vitamin B12 are associated with much worse scores on memory tests by older people with a genotype that puts them at high risk for Alzheimer's disease (news - web sites).

That's according to a study in the April issue of Neuropsychology.

The genotype, apolipoprotein E Type 4 allele, is carried by about 15 percent of people and is a risk factor for dementia. Research indicates that nearly one out of four carriers with one copy of the 4 allele and nearly half of people carrying two copies of the 4 allele will develop Alzheimer's disease.

Scientists also know that low levels of two B vitamins -- B12 and folate -- are linked to diminished memory and increased risk for Alzheimer's disease.

But few studies have examined the 4 allele genotype and nutrition together to see how they affect cognition.

This Swedish-British study included 167 healthy people, average age 83. Each of the participants had their blood checked for vitamin levels and genotype. They then completed a series of memory tests.

The study found the combination of low B12 levels and the 4 allele genotype was significantly associated with poorer memory. The study authors suggest people with the 4 allele genotype may get greater cognitive benefits from B12 and folate supplements.

"Supplement treatment is relatively inexpensive and may be required as part of preventive health regimes for older persons," the authors write.

More information

The U.S. National Institutes of Health (news - web sites) has more about Alzheimer's disease.

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Most Low-Carb Dieters Eat Too Many Carbs-Study

 

Reuters

Monday, April 5, 2004

NEW YORK (Reuters) - Most U.S. consumers who say they are following low-carb diets are actually eating more carbohydrates than such diets recommend, a new survey found.

According to a study of 11,000 people released by market research firm NPD Group Monday, only one out of every four low-carb dieters "are actually significantly cutting carbs."

At any given time, about 10 million Americans are following low-carb diets such as the Atkins and South Beach, the report said.

But adults who are reducing their carb intakes are still eating about 128 grams of refined carbohydrates a day, the study found. That compares with the estimated 20 to 50 grams of carbs per day recommended by some low-carb diets. Refined carbohydrates are total carbs minus dietary fiber.

"Low-carb diets are a fad," Harry Balzer, vice president of NPD, said in a statement. "People still want to lose weight by eating, but getting people to change their behavior is very difficult to do."

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Nailing Down the Cause of Nerve Disorder

HealthDayNews

Monday, April 5, 2004

MONDAY, April 5 (HealthDayNews) -- An abnormality in the mitochondria, which produce energy for cells and fuels the nerves required for muscle control, is responsible for Charcot-Marie-Tooth disease (CMT), one of the most common inherited disorders in humans.

The discovery by neurogeneticists at Duke University's Center for Human Genetics and their international colleagues could help in the development of treatments for CMT and provide scientists with a better understanding of various diseases that affect the peripheral nervous system.

The study, published in the April 4 issue of Nature Genetics, included seven families with a form of the degenerative nerve disorder CMT type 2A. The scientists found the families had defects in a gene called mitofusin 2, which is critical to mitochondrial movement.

Using gene therapy to restore lost gene function in people with CMT might serve as an effective treatment, the researchers suggest.

There is no cure for CMT, which affects about 150,000 Americans. Symptoms include weakening of the feet and hands that gradually spreads to the arms and legs. Physical therapy and moderate activity to maintain muscle strength are the only treatments for CMT. People with the disorder often have to use leg braces, and some become wheelchair-dependent.

More information

The Muscular Dystrophy Association has more about CMT.

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Should Preteens Pump Iron?

HealthDayNews

Monday, April 5, 2004

(HealthDayNews) -- Your preteen has told you he wants to start pumping iron, but you think he's too young and could hurt himself.

Well, if your son is 12 years old or older, weight training is generally safe, provided the program is supervised and properly designed, according to St. Louis Children's Hospital. Young girls usually can lift weights from age 10.

But tell your child not to expect too much buildup of muscle mass, since this requires certain hormones that pre-adolescent kids lack. Weight training at this age will increase muscle fibers to develop strength, but not muscle mass.

It's also a good idea for your child to have a medical checkup before starting a weightlifting program.

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Smoking Bans May Cut Down on Heart Attacks

HealthDayNews

Monday, April 5, 2004

MONDAY, April 5 (HealthDayNews) -- A public smoking ban may reduce the number of heart attacks in a community, says a study in the April 5 online issue of the British Medical Journal.

The study was conducted in the small American community of Helena, Montana, which enacted a ban on smoking in public and in workplaces. The ban, in effect from June to November 2002, was overturned by opponents in December 2002.

During the six months of the smoking ban, the number of heart attack patients from Helena admitted each month to the local hospital fell by about 40 percent. There was no significant decline in heart attack admissions for people living outside Helena during that period.

This is the first study to report an association between a public smoking ban and a decline in heart attacks. Further research is needed to confirm the findings, the study authors noted.

However, they added the findings suggest that smoking bans not only protect people from the dangers of secondhand smoke, they may also be associated with a rapid decrease in heart attacks.

More information

The U.S. National Cancer Institute (news - web sites) has more about the dangers of secondhand smoke.

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Sunday, April 4, 2004
 
Scientists Strive for Breast Cancer Vaccine

 

By Kathleen Doheny
HealthDay Reporter

HealthDayNews

Sunday, April 4, 2004

SUNDAY, April 4 (HealthDayNews) -- The prospect of breast cancer vaccines -- from ones that would attack the cancer to others that would prevent it -- generates tremendous hope among cancer patients and their doctors.

But the reality, researchers say, is at least a decade away.

"Probably dozens of breast cancer vaccines are under study," says Dr. Robert Vonderheide, an assistant professor at the Leonard and Madlyn Abramson Family Cancer Research Institute at the University of Pennsylvania.

"It has been a huge area of research for a long time," he adds. "It's a goal over the next decade to have a vaccine against breast cancer. But it's important to recognize how long this will take."

To understand the urgency for a cancer vaccine, consider that the immune system doesn't see tumors as dangerous, so it fails to mount an aggressive attack against them, cancer experts say.

Vaccines that are being designed to treat existing cancers are called therapeutic vaccines, while those intended to prevent cancers are known as prophylactic vaccines, the National Cancer Institute (news - web sites) (NCI) says.

Most therapeutic vaccines under development -- including those not just for breast cancer but for other cancers such as melanoma, lung, ovarian and prostate tumors -- focus on "kick-starting" the immune system. The goal: to prevent the further growth of existing cancers, block the recurrence of treated cancers or kill cancer cells not destroyed by previous treatment.

Currently, the only cancer-related vaccine approved by the U.S. Food and Drug Administration (news - web sites) is a prophylactic vaccine for the hepatitis B virus, which is associated with liver cancer.

Yet, several breast cancer vaccines show preliminary promise. If the research bears fruit, it may be possible some day to administer such a vaccine to women at high risk for breast cancer.

"The majority [of breast cancer vaccines under study] are in the early stages," says Dr. Teresa Gilewski, a medical oncologist on the breast cancer service at Memorial Sloan-Kettering Cancer Center in New York City.

The first step is to perfect a therapeutic vaccine or vaccines that would treat women with breast cancer by preventing a recurrence of their disease or shrinking their tumors, Gilewski says.

Once that goal has been reached, researchers can focus on preventive vaccines, she says.

Using vaccines to treat breast cancer is still considered experimental, so there are several different approaches under review.

Vonderheide and his team, for instance, are studying the effectiveness of a telomerase peptide as a vaccine. "Telomerase is an enzyme," explains Vonderheide. "Tumor cells have more telomerase than found in normal cells. Our vaccine is designed to generate a particular kind of white blood cell." These blood cells should, in theory, attack the telomerase in the cancer cells, killing off the tumor, he says.

Vonderheide has started a Phase I clinical trial to evaluate the effectiveness of a telomerase peptide as a vaccine. The study will measure potential tumor cell shrinkage in women after an immune response has been triggered to the telomerase peptide, which is found in more than 90 percent of breast cancer tumors, the researchers say.

The type of therapeutic vaccine under review by Vonderheide falls under the category of antigen/adjuvant vaccines, the NCI says. These antigen vaccines use specific protein fragments or peptides to mobilize the immune system. Sometimes the antigens are combined with another substance -- known as an adjuvant -- that triggers an immune response.

Sometimes vaccines are made by taking cells from a patient's own tumor or from the tumor of other patients, and then these vaccines are used to bring about an immune response.

There are still other approaches, such as taking specialized white blood cells, known as dendritic cells, from a patient's blood through a process called leukapheresis. In a laboratory, these cells are stimulated with the patient's own cancer antigens, grown and then re-injected into the patient. The vaccine then activates cancer-fighting T-cells in the immune system, causing them to multiply and attack tumor cells that produce the antigen.

Gilewski's team is testing breast-cancer vaccines using a variety of synthetic antigens.

"Antigens can come from the patient's own tumor or from others' tumors," Gilewski says. Antigens can be peptides, proteins, carbohydrates, DNA or other substances, she says. "There may be numerous antigens in the same vaccine," she adds.

Whatever the antigen or antigens, she says, "you are giving the immune system something to react to."

Dr. Herman Kattlove, a spokesman for the American Cancer Society (news - web sites), calls the concept of breast cancer vaccines "wonderful." If cancer is to be cured when surgery doesn't work, he adds, "some kind of immunologic method will be necessary."

But he, too, cautions that vaccines are at early stages.

Vonderheide agrees. "There are many roadblocks and many questions to be answered," he says.

More information

For more information on breast cancer vaccines, visit the University of Pennsylvania and the University of Minnesota.

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