The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
September 9 , 2002




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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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

Personal Health for the Week of August 24-30

  1. Non-Prescription Drugs a Mixed Bag
  2. Drug May Improve Survival in Fatal Lung Disease
  3. Another Statins Benefit Found
  4. Studies to Look at Chemicals, Parkinson's
  5. Predicting Alzheimer's
  6. Hand Transplants More Likely in Future
  7. Protein Emerges as Major Heart Culprit
  8. Sitcoms, Videos Make Even Fifth-Graders Feel Fat
  9. Exercise May Cut Risk of Pre-Diabetic Syndrome

    SUNDAY, AUGUST 25, 2002

  10. Beach Pollution Tests May Be All Wet

    SATURDAY, AUGUST 24, 2002

  11. Experts Urge Weight Loss for Youths


FRIDAY, AUGUST 30, 2002 

Adult 'Bad' Behavior May Encourage Teen Sex - Study 

By Maggie Fox


Friday, August 30, 2002

WASHINGTON (Reuters) - Parents who smoke and drink and otherwise fail to take care of their health are influencing their children to do likewise--but they may also be somehow giving them the nod to have sex, researchers said on Friday.

Teen-agers whose parents smoked were about 50 percent more likely to have had sex by the time they were 15, the researchers reported.

"Adolescents whose parents engage in risky behavior, especially smoking, are especially likely to be sexually active," Esther Wilder of Lehman College in New York and Toni Terling Watt of Southwest Texas State University wrote in their report.

"They are also more likely to smoke, drink, associate with substance-using peers and participate in delinquent activity," the report, published in the health affairs journal Milbank Quarterly, concluded.

"This is not to say that parents who smoke are causing their children to become sexually active," Wilder said in a telephone interview.

"You'd want to go in and see what is going on in these households. It may have to do with things such as parents who are smoking are not eating as healthy and it might be they might not be doing other things. Who knows what all the mechanisms are? I suspect they are very complex."

The two sociologists looked at data from a large national survey called the National Longitudinal Study of Adolescent Health, which includes information on sexual behavior for 19,000 13- to 18-year-olds. Parents and teens were interviewed at length in person for the survey.

About 31 percent of parents were smokers and that was the strongest predictor of risky behavior among their teen-age children, Wilder said.

Obvious associations have been well known. For instance, teens whose parents drank heavily tended to drink as well, and when teens drink they tend also to have sex.

Important Role Models

"Because parents serve as important role models for their children, it stands to reason that parents who exhibit unsafe behaviors are especially likely to have children with similar tendencies," Wilder and Watt wrote.

Experts have long told parents that children will act on what they see parents do, not what they are told, but the survey found some surprising associations.

Wilder and Watt found that boys were more likely to have sex if their parents failed to use seatbelts--but not girls.

Wilder said parents may be teaching by example that risk-taking is desirable. "If parents engage in risky behavior, it sets up a chain of events that encourages other kinds of risky behavior as well," Wilder said.

The survey echoes standard recommendations from child-rearing experts that close supervision makes teens behave more safely. This means being at home when children come home from school, being at home with them in the evening and asking them about their activities.

But if parents smoked or drank heavily, the influence of that behavior outweighed the benefits of supervision, Wilder said. "It persists independent of parental supervision, race, religiosity and income," Wilder said.

She said the findings were especially important because the United States has "exceptionally high rates of adolescent pregnancy and abortion. ... In 1999, nearly half of high-school students reported having had sexual intercourse and 6 percent said they had been pregnant or had gotten someone pregnant," they write.


Study: Transplants Help HIV Patients  

By Laura Meckler

Associated Press Writer

The Associated Press

Friday, August 30, 2002

WASHINGTON (AP) - Larry Kramer was given six months to live. His liver was failing, but because he was HIV ( news - web sites) positive, he was told he wouldn't qualify for a liver transplant.

Then the longtime AIDS ( news - web sites) activist found one of the few hospitals willing to transplant people with HIV. After surgery in December at the University of Pittsburgh, he says his health took a nearly miraculous turn for the better.

"I haven't felt like this since I was a kid," said Kramer, 67, who hopes more centers will open to people with HIV. "It's very hard to convince the old guard that the next guard has come. I'm glad to be a poster boy."

There's now data to back up his case. Researchers Thursday reported that patients with HIV are successfully receiving liver and kidney transplants, challenging widespread reluctance by transplant centers to give scarce organs to people with the incurable disease.

The research, presented at a transplant conference in Miami, offers the latest medical ripple traced to the powerful drugs that revolutionized AIDS care in the mid-1990s. Because thousands of HIV patients are living longer with the drugs, some develop organ failure for other reasons, making them candidates for transplants.

The competition for organs is fierce. More than 80,000 people are now waiting for transplants, and more than 6,000 die each year waiting. While livers and kidneys are typically given to the sickest patients waiting, doctors will not give organs to anyone who is too sick to benefit. In many places, that means anyone with HIV.

Just four or five hospitals offer organs to HIV-positive patients, with most others arguing that limited organs should be saved for patients who do not have another disease complicating their chances for survival. There have also been concerns that drugs taken after transplant surgery may exacerbate patients' HIV, the virus that causes AIDS.

Still, an editorial last month in the New England Journal of Medicine ( news - web sites) argued that these patients should be considered eligible for transplants just like other patients who have chronic diseases such as hepatitis C and diabetes or older patients, all of whom face lower long-term survival chances. HIV, they said, is just another medical factor to consider.

"On ethical grounds alone, there is no justification for providing organs to these groups of patients but not to patients infected with HIV," a trio of researchers argued.

Others say there isn't enough data on the long-term survival of patients with HIV to justify taking an organ that would have gone to an otherwise healthy patient.

"It's true agony for patients on waiting lists, who wonder if they'll live to get transplanted," said Dr. Marlon Levy, surgical director for liver and kidney transplantation at Baylor All Saints Medical Center in Ft. Worth, Texas, one of the nation's busiest transplant centers. "It just becomes an almost overwhelming burden to consider transplantation for someone who has another illness when there are so many people who don't have those barriers."

So far, the HIV transplants have proved successful, according to data presented Thursday at the International Congress of the Transplantation Society, taken from several U.S. centers and one in France that offer kidneys and livers to HIV-positive patients. A year or so after their transplants, these patients are just as likely to survive as other transplant recipients, they said.


        In San Francisco, 13 of 14 liver and kidney recipients are alive, reported doctors from the University of California, San Francisco. And there is no evidence that the HIV has advanced in any of these patients.

        In Philadelphia, 17 of 20 kidney recipients are alive a year after their transplants. None of the three deaths was related to HIV.

        In Pittsburgh, two of seven liver recipients died and all four kidney recipients are alive, several months to five years after the transplants.

        In Miami, all six liver recipients are alive, one to three years after transplants.

Pittsburgh researchers also reported the drug issues are tricky but can be overcome. They warned that these patients require special attention after transplant because drugs given to prevent the body from rejecting the new organ can worsen their HIV. They said it's important to achieve the right balance between HIV and anti-rejection medicines.

Some of the HIV-positive patients were given lower-quality organs or organs from donors at risk of HIV, which is one way to bypass others on the waiting list who may be pickier. Other patients received kidneys or partial livers from living family or friends. Still others came to the top of the waiting list and got organs from people who had died the same way other transplant patients do.


Exercise Could Wipe Out Effect of Stress on Heart 

By Melissa Schorr

Reuters Health

Friday, August 30, 2002

NEW YORK (Reuters Health) - Women who are physically fit may be able to ward off the effect of stress on their body, possibly giving them protection against developing high blood pressure down the line, researchers report.

"One of the potential benefits of being physically fit for women is a lessened blood pressure response to stress, which may help explain why fit women have lower risk for developing hypertension and coronary heart disease," study author Dr. Rod. K. Dishman, a professor of exercise science at the University of Georgia in Athens, told Reuters Health.

Some studies have found a connection between the body's reaction to a physical or mental stress test, such as placing one's hand in cold water, and the likelihood the person will suffer high blood pressure in the future, but others have not.

The researchers suspected that a person's physical fitness level might influence their stress response, with those who are physically fit better able to resist the effects of stress. Research has shown that people in good cardiovascular shape are less likely to develop high blood pressure. "It's possible part of lower risk is because of lower reactivity to stressors," Dishman said.

In addition, he said, previous studies looking at this issue failed to define physical fitness, take into account gender, or control for factors such as anger and discomfort. "It's possible one of the reasons past studies have yielded mixed results is because they haven't considered fitness level," Dishman noted.

In the study, the researchers first placed 13 men and 13 women aged 19 to 38 with above-average physical activity levels on stationary bikes and measured their cardio-respiratory fitness.

The investigators then put the study participants under mental stress by asking them to answer a math question. They also put them under physical stress by placing a cold compress to their forehead or immersing their right hand in cold water for 2 minutes.

The researchers measured the participants' blood pressure, heart rate, blood flow and breathing rate. They also took into account each individual's anger, discomfort and perceived difficulty while taking the tests, according to the report in the September issue of the journal Psychophysiology.

The investigators found that while the participants' hands were immersed in ice water, the women's systolic blood pressure--the upper number in a blood-pressure reading--rose. But women with the highest fitness levels were less likely to have this reaction than less-fit women. However, this link between fitness and blood pressure was not seen among the men.

Dishman and colleagues conjecture that the body's adaptations to the stress of physical exercise may be generalized to other forms of non-exertional stress.

The hand-immersion test is sometimes used to predict women's risk of developing high blood pressure in the future, the authors note, and these results show that a woman's fitness level should be taken into account when using this test.

Source: Psychophysiology 2002;39:568-576.


Be Well-Seated 


Friday, August 30, 2002

(HealthScoutNews) -- If you work in an office, choosing the right chair could be vital to your health.

A bad chair can lead to muscle and nerve problems and could also affect your circulatory system, according to a report in the Ergonomics journal.

If you sit in one place too long, your muscles don't pump enough blood back to your heart, which will cause your ankles to swell.

You can prevent that by taking frequent breaks and walking around, or by having a foot rest that tilts and lets you move your feet.

Or, says a Norwegian study, you can get a chair with a seat that has a backwards tilt.

As long as the seat leans back, even a little, it will help your blood flow to the heart and keep your ankles from swelling. It doesn't matter if the seat is in a permanent tilt, or if it rocks back and forth.

In one study done at Aker University Hospital in Oslo, when workers were moved from non-tilting chairs to chairs that had a backwards angle, the swelling in their calves and ankles went down in less than 30 minutes.


Long Pack-A-Day Habit May Up Breast Cancer Risk 

Reuters Health

Friday, August 30, 2002

NEW YORK (Reuters Health) - While smoking is not traditionally associated with an increased risk of breast cancer ( news - web sites), an international team of scientists say that women who are heavy smokers for many years may be at greater risk of developing the disease.

There is some scientific evidence that tobacco smoke contains potential human breast cancer-causing agents. However, studies have often failed to demonstrate a clear link between breast cancer and smoking.

One possible explanation for this may be that tobacco's potential breast cancer-inducing effects, if they exist, take decades to cause harm, according to the study's lead author Paul D. Terry of the Albert Einstein College of Medicine, Bronx, New York, and colleagues.

To investigate, Terry's team evaluated the smoking habits of nearly 90,000 women between the ages of 40 and 59 years. After nearly 11 years of follow-up, 2,552 were diagnosed with breast cancer.

Relative to women who never smoked, those who smoked a pack of cigarettes a day for 40 years or more had an 83% increase in their risk of developing breast cancer, according to the report published in the August 20th issue of the International Journal of Cancer.

For women smoking a similar number of cigarettes, but who had quit before 40 years, their risk of breast cancer was increased by 22%.

"Our findings suggest that smoking of very long duration and high intensity may be associated with increased risk of breast cancer," Terry and colleagues write.

Because studies of groups of women smokers that have examined breast cancer incidence in relation to smoking duration of 30 to 40 years or more are scarce, more data are needed, the authors conclude.

Source: International Journal of Cancer 2002;100:723-728.


Keeping the Pressure Down 


Friday, August 30, 2002

FRIDAY, Aug. 30 (HealthScoutNews) -- Losing weight and cutting back on salt intake can help seniors reduce their blood pressure after medical intervention for high blood pressure stops.

That's the finding of a study in the August issue of the American Journal of Hypertension.

Researchers at the University of Medicine and Dentistry-Robert Wood Johnson Medical School did a follow-up study on 222 of 244 people who took part in the Trial of Nonpharmacologic Interventions in the Elderly (TONE). It was a four-center controlled clinical trial to see if weight loss, reduced sodium intake or both could maintain normal blood pressure after older men and women stopped taking hypertension medication.

Four years after TONE ended, 23 percent of the people in the weight loss/sodium reduction group didn't need hypertension medication, compared to 17 percent of those in the weight-loss-only group, 15 percent in the sodium reduction group, and 7 percent in the usual care group.

"The probability of remaining normotensive without receiving antihypertensive medication and without sustaining a cardiovascular event remained higher in the intervention groups compared with the usual care group throughout the period of the study," the researchers say.

"This study emphasizes the importance of weight loss and sodium reduction to help keep blood pressure down and the heart working at peak efficiency," says Dr. Michael A. Weber, an editor of the American Journal of Hypertension.

About 50 million Americans -- or 23 percent -- have high blood pressure. Untreated, it causes premature aging of the body's arteries and can lead to strokes, heart attacks and kidney failure.

More information

Seniors can go to the Washington Post for more tips on controlling blood pressure.


Menopause Can Free Lead Lurking in Bone: Report 

By Alison McCook

Reuters Health

Friday, August 30, 2002

NEW YORK (Reuters Health) - Women exposed to lead in the past may end up stockpiling the dangerous compound in bone, which can then release lead into the bloodstream after menopause if women opt out of bone-preserving treatments, according to US researchers.

Bone is constantly disintegrating and rebuilding itself. After menopause, this cycle becomes skewed in favor of disintegration, and without treatments that re-adjust the balance--which include estrogen, calcium and vitamin D supplementation, and drugs called bisphosphonates--women can be at risk of bone loss.

Dr. Susan A. Korrick and her colleagues at Brigham and Women's Hospital and Harvard Medical School ( news - web sites) in Boston, Massachusetts, found that postmenopausal women with high levels of lead in their bones who did not use estrogen therapy, one bone-saving treatment, were also likely to have high levels of the toxin in their blood.

These findings indicate that "even when you're not exposed to lead anymore, it'll still creep out of your bones," study author Dr. Howard Hu told Reuters Health.

The vast majority of lead in the body is stored in bone, and each time a quantity of lead enters the bone, it takes 25 years for half of that original amount to disappear. And although lead pollution in the US has decreased significantly, people continue to be exposed to the toxin through natural sources, such as water, soil and food products.

In the current study, published in a recent issue of the American Journal of Epidemiology, Korrick and her colleagues measured levels of lead in the blood and bones of 264 women aged 46 to 74.

The investigators found that women who did not take estrogen after menopause were more likely than those who did to have higher than average levels of lead in their blood. The amount of lead present in a woman's blood also related to the amount of lead in her bones--but only if she was past menopause, and not using estrogen.

Hu told Reuters Health that while the increase in lead in the blood of postmenopausal women observed in this study was relatively small, this increase could underestimate what happens in the bodies of women with greater past exposures to the toxin.

Although further studies are needed to confirm these findings and determine the implications of increased lead levels in postmenopausal women, Hu said it was "possibly advisable" for doctors to ask women about their previous lead exposures when deciding whether they should opt for bone-preserving treatments after menopause.

Source: American Journal of Epidemiology 2002;156:335-343.


Many Ingredients Make a Happy Kid 


Friday, August 30, 2002

FRIDAY, Aug. 30 (HealthScoutNews) -- The influences of family, school, neighborhood and friends all contribute to producing well-adjusted adolescents.

So says an article in a recent issue of Child Develpment.

Each of these factors plays a different role in shaping the mental, social behavior and school performance of adolescents. There is no such thing as a single "silver bullet," say researchers from Case Western Reserve University, Northwestern University and the University of California at Los Angeles.

They studied 12,398 adolescents in Grades 7 and 8 at 23 schools and 151 neighborhoods in Prince George's County, Md.

"We know that social contexts matter a great deal for kids' development, but the really important questions relate to how . . . different contexts matter in different ways for different kinds of outcomes and different kinds of kids at different points in their lives," says article co-author Richard Settersten, an associate professor of sociology at Case Western Reserve University.

While he and his colleagues say a number of social settings influence adolescents, they did find some specific connections: families impact mental health; schools influence academic performance; peers affect social behavior; neighborhoods shape school attendance and an adolescent's participation in social activities.

The researchers say all these settings are linked and found the strongest coupling was between family and friend quality. The next strongest link was between school and neighborhood quality.

The findings emphasize the need to look at the "whole child" when discussing child development, the researchers say.

"There seems to be no silver bullets that can radically change young lives for the better. Settings that are developmentally sensitive matter and more of them matter more. But improvements in one setting are not likely to dramatically change the functioning of young people in multiple areas," Settersten says.

More information

The National Institute of Mental Health has information on adolescents and violence.


HIV Targets More Active Human Genes 

Reuters Health

Friday, August 30, 2002

NEW YORK (Reuters Health) - As HIV ( news - web sites) replicates within human cells, it latches on to specific DNA within the human genome ( news - web sites). But rather than grabbing genes at random, new research suggests the virus selects those genes that will help it replicate in the quickest--and most lethal--way possible.

The "surprise" finding could someday help scientists design better gene-based therapies to fight HIV, the researchers add.

"Sites of HIV integration in the human genome are not randomly distributed but instead are enriched in active genes and regional hotspots," conclude researchers led by Dr. Frederic Bushman of The Salk Institute for Biological Science in San Diego, California. They report the finding in the current issue of the journal Cell.

HIV, like all retroviruses, reproduces itself by entering a cell, producing a copy of its own DNA, and then inserting that DNA into a chromosome of the host cell. As the host cell uses its genetic material to produce proteins and other gene products, it now also makes copies of the invader virus' genome.

Taking advantage of the recent complete mapping of the human genome, Bushman and his colleagues focused their research on one step in this process: determining which spots on the human genome HIV favors.

They found that, far from alighting willy-nilly onto human DNA, HIV homes in on highly active genetic "hotspots" that seem tailor-made to allow quick replication of the virus. These genes churn out proteins and other materials at relatively high rates compared to non-targeted genes, the researchers explain. Selecting these hotspots "makes a lot of biological sense if the targeting has evolved to promote efficient expression of the (HIV) genome once it integrates into the cell," Bushman said in a statement.

What's more, the researchers theorize that the very act of viral invasion may trigger a rise in activity in these target genes--thus enhancing their ability to replicate HIV. In other words, HIV "wields a double-edged sword, creating a weakness and then taking advantage of it," according to officials at The Salk Institute.

The findings could boost efforts to develop safe, effective gene therapies aimed at fighting HIV, the researchers add. They explain that by identifying specific genes targeted by HIV, scientists may make better choices when it comes to delivering gene therapy in as efficient and non-toxic a manner possible.

Source: Cell 2002;110:521-529.


Kids Too Sweet on Soft Drinks 

By Randy Dotinga
HealthScoutNews Reporter


Friday, August 30, 2002

FRIDAY, Aug. 30 (HealthScoutNews) -- In the same week that the nation's second-largest school district banned soft drinks on campus, a new study reports that typical grade-school kids drink an average of one can of soda a day.

The researchers also found children who drank the most soda were less likely to eat fruits and vegetables.

It's not clear if soft-drink consumption leads to poor diets or the other way around.

"But the bottom line is we need to pay a lot more attention to enabling kids to consider more healthy beverage selections," says study co-author Karen Weber Cullen, a registered dietician and an assistant professor at Baylor College of Medicine.

Americans, predictably, are major consumers of soft drinks. The average person consumed 55.9 gallons of soft drinks and 6.1 gallons of sweetened fruit drinks in 1999, according to Beverage World.

On Wednesday, the Los Angeles school system decided to fight back. The school board voted to ban the sale of soft drinks on all campuses starting in January 2004.

Cullen and her colleagues surveyed 504 Houston schoolchildren about their eating and drinking habits. The kids were in fourth, fifth and sixth grades.

The purpose of the study was to investigate how consumption of soft drinks is related to healthy eating as a whole, Cullen says. Results of the survey appear in the September issue of the American Journal of Public Health.

The children in the study liked sugary drinks. On average, they reported drinking about 20 ounces of beverages other than water per day, and about half were sweetened beverages such as soft drinks and punch.

None of the children reported drinking diet beverages. "That's an easy thing for kids to know," Cullen says. "They may not be able to report how many ounces of meat they had, but they know if they're drinking a Diet Coke."

The kids with the highest consumption levels reported drinking about 20 ounces of soft drinks a day, equal to nearly two regular-sized cans.

Those who drank the most tended to come from the least-educated families, and were more likely to be minorities. They pulled in more calories -- an estimated 330 a day -- from soft drinks. Their diets suffered too, Cullen says.

"Those students were eating twice as much of what we call high-fat vegetables -- french fries, tater tots, items that are far from being a vegetable anymore," she says.

Those students also ate 60 percent less fruit, Cullen says.

"This just highlights the need for everyone to step back and look at what's driving the need for these kids to drink these things instead of water and milk at meals," she says.

Sean McBride, spokesman for the National Soft Drink Association, points out the students surveyed drank an average of only one can a day.

"Our advice to consumers remains as it has been for decades: whether you're a child or an adult, you need to eat a variety of foods in moderation," he says. "Just because you consume soft drinks doesn't necessarily make your diet a poor diet."

What To Do

The American Dietetic Association offers fact sheets on a variety of nutritional issues. Read more on the Surgeon General's new recommendations about obesity.


Bush Administration Unveils Drug Card Program 

By Karen Pallarito

Reuters Health

Friday, August 30, 2002

NEW YORK (Reuters Health) - The Bush administration on Friday announced a new, private prescription discount program that it says will save seniors an average of $170 per person on medications they purchase.

But questions remain about whether the administration has congressional authority to implement such a program.

"Clearly we've had some legal challenges, but we're still committed to doing this," said Tom Scully, administrator of the Centers for Medicare and Medicaid Services (CMS) in Washington, DC.

Under the initiative, sponsors of private drug cards that meet defined criteria will be allowed to market and label their cards using the "Medicare" imprimatur. The program will save roughly 10 million Medicare beneficiaries 10% to 13% off total drug spending, CMS said. It projects total savings of $1.2 billion to $1.6 billion in the first year.

The final regulation will appear in the September 4th issue of the Federal Register, and CMS hopes to begin soliciting proposals from private card sponsors in the fall.

The agency said the final rule differs in many respects from a proposed regulation issued in March, which was blocked by a federal judge in Washington, DC. Pharmacy groups sued, asserting that CMS lacked authority to create the program, but the government secured a stay allowing it to replace that earlier version of the plan.

Under the final rule, card sponsors must secure manufacturer rebates or discounts on brand name and generic drugs to earn Medicare's seal of approval. The rule also "enhances" the information provided seniors on card sponsors' drug prices. Sponsors will have to publish their prices on Medicare's Web site and must maintain those prices for at least 60 days before updating them.

"That kind of true transparency doesn't exist anywhere in the country right now," Scully said in a press briefing this morning. He told Reuters Health that the information would be presented in a way that would help beneficiaries decide which card is best for them. "We think that's going to drive a lot more competitive pricing throughout the market."

Critics, though, said the program differs very little from the earlier version blocked by the federal court.

"Just because they go through a public rulemaking period...doesn't mean that they have the authority to do this card," said Crystal Wright, a spokeswoman for the National Association of Chain Drug Stores, one of the plaintiffs in the lawsuit challenging the card program.

Scully argued that CMS is "not creating a new federal program" and is authorized to grant drug card sponsors the Medicare "seal of approval" as part of its "educational authority." Yet Scully couldn't cite an exact date for the start of the program, conceding that CMS may need to receive clearance from the US District Court or reassurance from Congress. He said CMS would appeal any decision rendered against the agency and would ask Congress for legislative clarification.

"That's like riding a horse in both directions. You can't claim you have authority and then go to the Congress and seek it," said John Rector, general counsel of the National Community Pharmacists Association, another plaintiff in the case against CMS.

"Our view it's even more apparent than it was a year ago that they do not have the authority," he said.

Rector said pharmacies would likely go to court next week to ask for an injunction, unless they unearth something in the test of the rule that validates CMS's position.

Meanwhile, CMS intends to press forward, issuing a request for proposals as early as this fall.

Jeffrey Simek, a spokesman for Medco Health Solutions Inc., one of the nation's largest pharmacy benefit managers, said the company would have to review final terms of the program before deciding whether to submit a proposal to sponsor a Medicare drug card. "We've expressed interest consistently in the past," he added.


Another Deafness Gene Discovered 

By Kathleen Doheny
HealthScoutNews Reporter


Friday, August 30, 2002

FRIDAY, Aug. 30 (HealthScoutNews) -- Scientists have identified yet another deafness gene, and they say their discovery should one day help solve the puzzle of hearing loss and lead to a screening test and treatment.

The newly discovered gene brings to 26 the number of genes known to play a role in deafness. However, how the scientists arrived at the discovery of the latest gene is novel.

First, a team from the University of Michigan identified the gene in mice, naming it the Tmie gene for transmembrane inner ear, which is the location of the protein encoded by the gene.

"Either the protein is not made [in the case of hearing loss], or it's made but is faulty," explains David Kohrman, an assistant professor of otolaryngology and human genetics at the University of Michigan who discovered the Tmie gene.

Next, he shared the information with a team from the University of Iowa and the National Institutes of Health ( news - web sites), which had been studying families with inherited hearing loss. They had located the general area of the gene in these families, but information from the mouse research helped them zero in on the human gene, which they named TMIE.

The findings appear in the September issue of the American Journal of Human Genetics and the August issue of Human Molecular Genetics.

"Defects in lots of different genes cause deafness," says Kohrman, lead author of the Human Molecular Genetics paper. "That's not surprising, based on the fact that the inner ear is a complicated organ with many different cell types."

The new gene is thought to play a role in the normal functioning of the ear's sensory hair cells, which help convert external sounds to electrical impulses that can be transmitted to the brain and interpreted as sounds.

About one in 1,000 infants has a profound hearing impairment, according to the National Institutes of Health. Half of the cases are believed to be genetic in origin.

"Dr. Kohrman and his colleagues did a great job," says Neil Segil, a scientist at the House Ear Institute, a research and treatment facility in Los Angeles. "It's exactly the kind of synergy that can be expected when we invest in animal research, and coordinate it with human research. We can't do this kind of research in humans [that was done in mice to find the gene]."

"The biggest question that is still outstanding is exactly how prevalent this mutation, or defective gene, is," Segil says.

A gene discovered in 1997, called connexin 26, is believed to be responsible for about half the inherited hearing-loss cases.

"There is always some hope that as each new mutation is identified, it will represent a larger portion," Segil says. Eventually, he adds, treatments will be tailored to the genes involved in the particular case of hearing loss.

"There are probably over 100 genes that when mutations occur can cause deafness," Segil says.

The newly discovered gene is not the most common hearing-loss gene, says Ed Wilcox, a staff scientist at the National Institute on Deafness and Other Communication Disorders, part of the National Institutes of Health. He's also co-author of the paper in the American Journal of Human Genetics.

"But it is certainly not a rare gene either," he says. "It is going to contribute to the genetics of hearing loss."

Next, Kohrman plans to look more closely at the faulty gene, to see what goes wrong on the cellular level. Eventually, gene therapy may help correct the defect, he says.

What To Do

For more information on hearing loss, see the Deafness Research Foundation. For information on communication options for children who are deaf or hard of hearing, visit the National Institute on Deafness and Other Communication Disorders.


Experts Offer Advice on Correct Tick Removal 

Reuters Health

Friday, August 30, 2002

NEW YORK (Reuters Health) - To properly get rid of a nasty tick, you should use a match to apply heat to the creature's derriere, right?

Wrong! According to experts at the American Academy of Family Physicians ( news - web sites), the hot-match method is just one of many tick-removal myths circulating among campers and hikers.

"There are several things you should NOT do to remove a tick," AAFP experts say, "including using sharp forceps; crushing, puncturing or squeezing the tick's body; applying hot petroleum jelly, gasoline or lidocaine to the tick"--as well as the hot-match trick.

Instead, those who spot a tick dining on their epidermis should first lightly clean the area around the tick with an antiseptic or soap and water--taking care to not dislodge the tick in the process. Next, using a pair of "blunt, medium-tipped, angled" forceps or pliers, simply pull the tick "straight out," away from the body.

"If the tick's head breaks off in the skin, use tweezers to remove it like you would a splinter," the AAFP advises. After the tick has been completely removed from the skin, wash the area with an antibacterial soap.

Those living in areas endemic for serious tick-borne illnesses such as Lyme disease might want to save the tick in a small bottle of rubbing alcohol. They can then bring it to their doctor, who can send it on to determine whether it could be a source of infection.

According to the AAFP, quick detection and removal of the tick is important, since research suggests that "the risk of Lyme disease transmission increases significantly after 24 hours of attachment and is even higher after 48 hours."

Lyme disease is a bacterial infection spread by ticks that usually live on mice or deer. It

is most common in the Northeast, parts of Wisconsin and Minnesota and northern

California, although cases have been reported in other areas. Besides developing a rash, a person bitten by an infected tick may develop flu-like symptoms. The illness is highly treatable with antibiotics, but if left untreated a small percentage of people with the disease will develop serious complications, including arthritis and heart problems.

Other diseases spread by ticks include Rocky Mountain spotted fever and ehrlichiosis.

The AAFP stresses that a few simple steps can keep you tick--and worry--free. Wear light, long-sleeved shirts and pants when outside near tick-infested areas, and tuck pants into socks. Insect repellents containing DEET are also highly recommended to ward off ticks.


Warts Aren't So Tricky When it Comes to Treatment 

By Ross Grant
HealthScoutNews Reporter


Friday, August 30, 2002

FRIDAY, Aug. 30 (HealthScoutNews)-- Most warts are harmless, but many people are so put off by their ugliness that they'll do anything to get rid of them. They have used banana peels, potatoes, garlic, charms, and even the milky juice in the stem of a dandelion. Huckleberry Finn once tried to remove them by carrying a dead cat into a graveyard at midnight.

A more common therapy used nowadays is to freeze them off, but a British team has found that works no better than topical treatments sold over the counter.

After examining 50 clinical studies on wart treatments, the researchers found that an inexpensive tube of salicylic acid -- Compound W and the like -- is just as effective as any other treatment.

Their review, which appears in tomorrow's issue of the British Medical Journal, also says past studies on warts have warts of their own.

"The research seems to show that the cheapest and humblest treatment probably works best. That's probably hard to bear for patients because they want high-tech treatments," says study author Dr. Sam Gibbs, a dermatology consultant at the Ipswich Hospital in England.

Gibbs examined the issue because he was concerned that the more expensive treatments don't appear to be much better than cheap ones.

"It's a common problem. Just about everybody gets a wart at some point in their life. So, on a national level, probably a lot of money is spent on it," he says.

In the studies, salicylic acid, the active ingredient in over-the-counter treatments such as Compound W and Wart-Off, appears to work as well as other methods. However, Gibbs also found that almost all of the wart studies were less rigorous than most medical trials. For example, the results for cryotherapy -- where the wart is frozen off -- and laser treatment were lacking, he says.

"It is difficult to do a good trial on warts. We're not saying it's easy, but more work has to be done," Gibbs says, adding that he intends to lead more extensive research.

Part of the problem is that most of the trials counted warts instead of people when evaluating a treatment, which slants results since many responsive patients were treated for multiple warts. Also, studies often didn't compare results against other methods or placebos. Also, because warts can go away by themselves, the pool of patients often wasn't stable throughout the trials.

Perhaps the biggest difficulty is that in treating warts doctors focus more on a person's immune system than the wart itself, says Dr. Philip Shenefelt, an associate professor of dermatology at the University of South Florida. Instead of eliminating the wart virus, most treatments merely stimulate the body's immune system to fight the wart on its own.

"It's a viral infection, and basically the body has to build up enough of an immune response so the wart won't come back," Shenefelt says. "It's not that strong a virus, but because it's on the upper layer of the skin it's not adjacent to the blood flow, so it's hard for the immune cells to notice the virus without treatment."

For that reason, different patients need different treatments, which is why most dermatologists have multiple therapies at their disposal. Doctors call upon the quicker but more expensive cryotherapy if patients are unwilling to apply salicylic acid daily for weeks or months, or if they have done so and failed to remove the wart, Shenefelt says.

The British research begged to differ.

"Although it is widely believed that cryotherapy may succeed when topical salicylic acid has failed, there was no clear evidence to support this. Indeed some evidence shows that at best cryotherapy is only equal in efficacy to topical salicylic acid," the study says.

However, Shenefelt counters that having multiple treatments gives patients options. In fact, of all the therapies, he favors hypnotherapy. He says if you concentrate, you can stimulate your immune system.

"It's not clear that one method is better than others," he says. "There are some dermatologists who have preferences, but there are others who say, 'I have five or six therapies for treating warts, let me tell you the pluses and minuses of each one.'"

What To Do

To find out more about warts, visit the American Academy of Dermatology. Not all warts are harmless, especially those on the feet, which can make walking painful. For information about treating plantar warts, visit the American Academy of Orthopaedic Surgeons.


Most American Families Happy, Strong, Report Finds 

Reuters Health

Friday, August 30, 2002

NEW YORK (Reuters Health) - Media portrayals of family dysfunction and strife may make for great drama, but in reality most US families get along just fine, a new report suggests.

"When it comes to the American family, public attention tends to focus far more on what's wrong than what's right," according to Dr. Kristin Anderson Moore and colleagues at the nonprofit, nonpartisan child advocacy group Child Trends.

They found "compelling evidence that many families--including those living in difficult circumstances--have inner strengths that enable them to do a good job of raising their children and supporting one another."

Films, TV talk shows, and other media thrive on tales of battling siblings, marital discord, rotten childhoods and other dysfunctions. But how representative is this of the average American home?

In their study, Moore and her co-researchers examined data from two government studies: the 1997 National Longitudinal Survey of Youth and 1999 data from the National Survey of America's Families. The surveys were based on interviews with more than 45,000 children under age 18.

Among the findings:

        Most families have a strong sense of togetherness. A full 72% of adolescents said they sat down for dinner with their families "at least 5 days a week," and four out of five kids said they shared in household chores on a regular basis. Family togetherness and task-sharing is important, the researchers say, because it fosters responsibility and self-control.

        The majority of children like and respect their parents. Eighty-five percent of those surveyed said they "think highly" of their mom and dad, while about 59% said they "want to be like" their parents. And the "generation gap" between parents and offspring may be narrower than we think, with four out of five kids saying they "enjoy spending time" with their parents. Moms got slightly higher marks than dads, however--79% of adolescents say their mother "usually or always helps with what is important to them," while 67% could say the same about their fathers.

        Forget "Mommy Dearest." According to the report, most children are blessed with happy, loving and supportive parents. A full 71% of US parents consider themselves "happy" with 58% reporting that they felt generally "calm or peaceful" during the previous month. Well-adjusted, emotionally stable parents are a strong source of support for children, with 54% of US adolescents reporting that "they turn to one of their parents, rather than to a friend, another relative, or to no one, when they have problems." About three-quarters of kids surveyed also said they routinely received praise and encouragement from their mothers or fathers for doing well.

        Most parents, especially moms, are deeply involved in their children's lives. According to the report, 73% of mothers and 55% of fathers say they "know whom their adolescent is with when he or she is not at home." Fifty-seven percent of moms and 34% of dads believe they are well-informed when it comes to their teen's closest friends, while 70% of moms and 49% of dads keep close tabs on their children's progress in school. This kind of involvement is important, the researchers say, because it promotes "better grades, socially acceptable behaviors and socially positive actions" in offspring.

Overall, the research suggests that "many families are prospering and strong, and that many families facing challenges are doing an excellent job of raising their children and supporting each other," according to Child Trends. "Given the frequent reporting of negative news about the American family, this is an important research result to share with the American public," they add.


West Nile Case Suspected in Canada  

By Tom Cohen

Associated Press Writer

The Associated Press

Friday, August 30, 2002

TORONTO (AP) - Ontario health officials said Friday they believe three people sick in the province have the West Nile virus ( news - web sites), which would be Canada's first human cases of the mosquito-born illness that has killed 24 people in the United States this year.

Colin D'Cunha, the Ontario chief medical officer, said final confirmation would take another two weeks.

Ontario is Canada's most populous province, and is across the border from U.S. states where the virus has been reported.

If the three have the virus, it would document the continuing spread of West Nile throughout North America. Several U.S. states including North Dakota, Iowa, Arkansas and South Carolina have reported their first human cases this week of a virus that can cause fever, body aches, brain swelling, coma, paralysis or death.

Canadian officials have warned in recent years that the virus, which has been detected in birds and animals in Canada, eventually would spread to the human population. It is transmitted to humans by mosquito bites.

Dr. David McKeown, the medical health officer for the Peel region west of Toronto, said two of the probable cases involved people over 65 from the Mississauga area.

One remains hospitalized in serious condition and another was hospitalized and then released to recover at home, McKeown said.

There was little information immediately available about the third case, but D'Cunha said authorities believe the person became sick in the United States.

According to the U.S. Centers for Disease Control and Prevention ( news - web sites), 24 people have died across the country so far this year from the virus, with almost 500 cases reported in more than 20 states.

The virus is most dangerous for children, the elderly and people with weak immune systems. It can cause flu-like symptoms and encephalitis, a potentially fatal brain infection. Most people bitten by an infected bug never get sick.

West Nile is common in Africa and the Middle East. The disease was first detected in the United States in 1999, when seven people died from it in New York.


Heart Attack Risk Very Low with Latest Pill Version 

By Richard Woodman

Reuters Health

Friday, August 30, 2002

LONDON (Reuters Health) - Third-generation oral contraceptives (OCs) do not increase the risk of heart attack, according to a new study by researchers who were involved in the controversy over the heart and blood vessel side effects of third-generation pills.

Professor Walter Spitzer of McGill University in Montreal, Canada, said the controversy had dwelt on blood clots in the veins but less attention had been paid to the safety of the newer pills in respect to the arteries. All but one recent study also lacked statistical power.

"So, we aggregated the findings of seven studies involving nearly 6,500 women since 1996," he said.

The findings, published in the journal Human Reproduction, show that women who took the third-generation pills showed a 38% to 56% lower risk of heart and blood vessel problems than those on second-generation oral contraceptives.

Compared with women who did not take birth control pills, women who took the third-generation version had a 13% higher risk of such problems, while the risk for second-generation oral contraceptive users was more than doubled.

"Our conclusions should not be interpreted as recommendations against second-generation pills or as a strong recommendation in favor of third-generation pills," Spitzer said in a news release.

"With informed consent by the counseled woman, the choice of an approved OC should always be that of the counseling physician, based primarily on clinical judgement, one patient at a time," Spitzer added.

The authors state in the paper that older women with a family history of heart attack or risk factors for cardiovascular problems should be candidates for third-generation pills. The data also favored third-generation pills if women could not stop smoking and insisted on oral contraception.

"Women with elevated blood pressure should be prescribed OC only with great caution and after it has been brought down. That is true for both second- and third-generation OC products," they added.

Early reports that the risk of venous thromboembolism was higher with third-generation oral contraceptives caused a major scare in Britain in 1995, with many women coming off the Pill and an increase in unwanted pregnancies.

An investigation by the European Medicines Evaluation Agency later concluded that although there was an increased risk, it was low and that there was no reason for women to stop using any oral contraceptives products.

Source: Human Reproduction 2002;17:2307-2314.


Lab Recalls 1.5M Gonorrhea Tests  

By Elizabeth Wolfe

Associated Press Writer

The Associated Press

Friday, August 30, 2002

WASHINGTON (AP) - Abbott Laboratories is recalling 1.5 million gonorrhea tests sold worldwide because they might give false negative results, the government said Friday.

The Food and Drug Administration ( news - web sites) recommended that people who have tested negative for gonorrhea from Jan. 11 to June 24 ask their doctor if another test is necessary.

The FDA gave the recall its highest risk category because of the dangers associated with false negatives for gonorrhea, a sexually transmitted disease that can worsen if left untreated.

"First, the person may not be getting the appropriate treatment," said Larry Spears, acting deputy director the FDA's Office of Compliance. "Second, they (may be) continuing to spread the disease to others."

Abbott Laboratories, based in Abbott Park, Ill., distributed the kits to hundreds of hospitals and laboratories, 80 percent of them in the United States, from Jan. 11 to June 24.

Company spokesman Don Braakman said Abbott voluntarily recalled the tests July 18 and that all customers had been contacted and offered a refund. The company has since produced new test kits now available for sale.

Braakman said only a small percentage of people with gonorrhea would be affected by the defective tests since only those with low levels of the disease could be misdiagnosed.

In men, gonorrhea causes a burning sensation when urinating and irregular discharge from the penis. Undetected, it can lead to sterility. Women initially often show no or only mild symptoms, which can be mistaken for bladder or vaginal infections. If untreated, women can develop pelvic inflammatory disease, which can lead to infertility or complications in pregnancy.

Of the 32 sets of test kits recalled, the company later found that 16 contained tests that could give false readings. Each set contains about 47,000 tests.

The recalled sets are: 84073M400, 84075M400, 84142M300, 84146M300, 85487M200,87007M400, 87103M400, 87243M100, 87377M200, 87899M200, 87905M200, 88097M300, 88105M300, 88107M300, 88439M200 and 88439M201.

For more information, consumers or labs can contact Abbott Laboratories at 1-800-527-1869. Physicians should call 1-866-233-0471. The FDA hot line is 1-888-INFO-FDA.

On the Net:

Food and Drug Administration:

Abbott Laboratories Inc.:


Study: No Link Between Cell Phones, Tumors in Mice 


Friday, August 30, 2002

SYDNEY (Reuters) - A three-year study has found that radio emissions from mobile phones do not trigger the growth of tumors in mice, Australian researchers said Friday.

The research on 1,600 mice, by the Adelaide-based Institute of Medical and Veterinary Science, follows another Australian study on mice five years ago that concluded cellular phones could foster tumor growth.

The 1997 study fueled consumer concern about the safety of mobile phones but the Adelaide scientists said they could not replicate the findings in their mice, half of which were genetically engineered to be extremely susceptible to tumors.

"That then gives you confidence that if you don't find an effect in these animals you are probably not going to find an effect in normal animals, humans being a normal animal," said Tim Kuchel, a spokesman for the Adelaide research team.

Previous studies have often produced conflicting conclusions.

Swedish research published last week concluded that long-term users of first generation mobile phones faced an up to 80% greater risk of developing brain tumors than non-users and the World Health Organization ( news - web sites) said last year more research was needed.

But a Danish study last year of 400,000 mobile phone users showed no increased cancer risk.

Kuchel told Reuters the previous Australian study had a few problems, including variable dosages of radio frequencies on mice. It also allowed mice to huddle, an activity that potentially produces "hot spots" of focused radiation.

He said the new study, the results of which are due to be published this week in the International Journal of Radiation Research, had all the possible safeguards needed to ensure the results were reliable.

This included monitoring mice for external virus contamination and strictly measuring radiation dosages.

Separate batches of 120 mice each were subjected to four levels of radio frequency (RF) energy ranging from 0.25 watts per kg, the equivalent absorbed by a very infrequent mobile phone user, to four watts per kg, which reflects extraordinarily heavy usage.

"(There was) no effect on frequency of tumors, types of tumor or time to tumor," Kuchel said.

The research will be replicated again by a European Union ( news - web sites)-funded study in Italy in order for it to contribute to a debate in the World Health Organization about any likely health hazards that may be associated with mobile phone use.

"An experiment like this, that is potentially going to have a serious influence over people's attitudes toward whether RF can alter tumor biology, this experiment needs to be repeated too," Kuchel said.


Asthmatics Also Likely to Have Panic Attacks 

By Charnicia E. Huggins

Reuters Health

Friday, August 30, 2002

NEW YORK (Reuters Health) - Asthmatics and people with chronic bronchitis or other breathing or lung diseases may be more likely to also suffer from panic attacks, recent study findings suggest.

"Improving our understanding of the possible relation between these two phenomena, and ultimately determining whether the treatment of one can prevent or at least improve outcomes associated with the other, may have important implications for public health," they add.

Drs. Renee D. Goodwin of Columbia University in New York and Daniel S. Pine of the National Institute of Mental Health in Bethesda, Maryland investigated the association between breathing disorders and panic attacks by analyzing data from 3,032 adults in the US aged 25 to 74 years.

The investigators found that adults who reported having asthma, chronic bronchitis or emphysema were almost twice as likely as their peers to also suffer from panic attacks. Adults who said they had other types of lung diseases were slightly more than twice as likely to also have panic attacks, they report in the August issue of Chest.

Furthermore, those who reported having both some type of respiratory disease and another lung disorder were four times more likely to have panic attacks than their peers.

These findings remained true even after the investigators took into account the study participants' other mental disorders, physical problems and demographic characteristics, study findings indicate.

Goodwin told Reuters Health that anxiety or fear about having a lung disease may lead to the development of panic attacks, or the panic attacks may be a "reaction to distress about limitations in physical functioning." Individuals prone to panic attacks may be more vulnerable to developing lung disease, she said.

Finally, she speculated that there may be a third environmental, behavioral or genetic factor associated with both the development of panic attacks and lung disorders.

Source: Chest 2002;122;645-650.



Women Taking Another Look At Ways to Treat Menopause
Problems With Hormone Therapy May Boost Other Remedies

By David Brown
Washington Post Staff Writer

The Washington Post

Thursday, August 29, 2002

The news about hormone replacement therapy's hazards hit the newspapers on a Tuesday. Before another Tuesday rolled around, sales were up for black cohosh, a botanical remedy used by Algonquian natives for centuries to ease the symptoms of menopause.

"We could see the effect on our business within the first four days," said Michele Klingensmith, the head of marketing for Remifemin, a black cohosh preparation sold by GlaxoSmithKline.

The pharmaceutical giant took the cue. Its sales force, which normally pitched the botanical only to 9,000 obstetrician-gynecologists, began passing out Remifemin information to 28,000 internists and family practitioners. Six weeks of free drug samples were snapped up in two. A promotional campaign to be shown on 13 cable channels was quickly mounted.

GlaxoSmithKline's campaign is the start of what many experts believe will be a major boost for botanical medicines after the unexpected closing of the Women's Health Initiative study of estrogen-and-progestin replacement. Anxious about the possible risks of taking estrogen, many women are more open to pitches by companies marketing alternatives.

But the possible turn to alternative medicine therapies for menopause may raise as many questions as it answers. The central irony of the pharmaceuticals-vs.-botanicals debate is that women who opt for botanicals are putting their faith in substances studied far less rigorously and thoroughly than the prescription hormones that are losing their appeal.

The Women's Health Initiative study found that menopausal women taking hormones for an average of five years had higher rates of heart attack, stroke, breast cancer and blood clots (and lower rates of colon cancer and broken bones). On balance, hormone replacement therapy (HRT) tipped slightly toward harm, with 1 in 100 women suffering an "event" she wouldn't have otherwise.

Numerous "dietary supplements" -- the legal name for herbal, botanical, vitamin and mineral products used to prevent or treat symptoms -- are sold for relief of the hot flashes and mood changes that often accompany menopause. They come from diverse fields of alternative medicine and have varying amounts of evidence supporting their claims.

The best studied and most popular are black cohosh (made from the root nodules of a North American plant in the buttercup family), soy extracts and red clover. The latter two contain "phytoestrogens" -- chemical compounds that function in some ways like estrogen, the main hormone of femaleness.

Although sales of some menopause botanicals have risen by 15 percent to 20 percent in the last month, most experts expect a brisk walk, not a stampede, to the alternatives.

Herbal medicine has gone through a boom-and-bust cycle in the last decade, with preparations such as St. Johns wort, ginkgo biloba and echinacea (marketed for depression, early dementia and infection prevention, respectively) experiencing spikes in popularity followed by steep declines. Consumers are warier about claims of benefit and safety of all products, and more demanding of evidence, experts say. Furthermore, many women may decide the small risks of hormone replacement therapy are worth the virtually certain relief of symptoms it provides.

"The message is not 'You should trade your silver bullet for my silver bullet,' " said Michael McGuffin, president of the American Herbal Products Association, a trade group. "We aren't saying that instead of HRT, a woman should use botanicals. We're advising a holistic approach that involves diet and exercise, and yes, there are botanicals that have a significant historical record and have undergone significant historical scrutiny."

The current period of uncertainty "is a wonderful opportunity for the dietary supplement industry to put a good face forward," said Elliott Balbert, president of the Dietary Supplement Education Alliance, which provides synopses of dozens of alternative remedies on a Web site. Instead of making overblown claims, he said, the strategy should be "here is the evidence, reach your own conclusions."

Clearing up the muddled picture of HRT's risks and benefits required a multimillion-dollar clinical trial involving nearly 17,000 women and lasting five years. (The study of estrogen supplements alone in women who have had hysterectomies is continuing, and several more years may be needed to reach a definitive answer.) There are no studies of botanical therapies remotely that large or long.

As with most alternative medicine treatments, the main claim to safety and effectiveness is the long history of traditional use. Studies that have been done in recent decades tend to be small, or lacking in features such as randomization of patients for treatment or the use of placebos -- all of which make their results less certain. Nevertheless, some botanicals used for menopause have been evaluated scientifically.

In one study, 80 women were chosen at random to take estrogen, black cohosh or a placebo for 12 weeks. The women taking the black cohosh showed the greatest reduction in menopausal symptoms, with no difference seen between estrogen and the placebo -- the latter an unusual finding that has led some people to question the study.

A randomized, controlled trial of black cohosh in 85 women who had survived breast cancer and were being treated with tamoxifen, a drug that often causes hot flashes, found that both the botanical and the placebo substantially reduced their symptoms. Many less rigorous studies have shown that black cohosh may decrease hot flashes and improve mood.

A study published this summer of a red clover preparation known as Promensil used an unusual design to try to winnow out the large placebo effect seen in trials of herbal products. Thirty women were randomized to either red clover or placebo, but all were given the placebo during the first month. Half then continued with placebos, and the other half (unknown to either themselves or the researchers) were switched to the herbal remedy. In both groups, symptoms fell 16 percent in the first month, and there was a subsequent further drop of about 40 percent in the red clover group.

Red clover contains "isoflavones," compounds that appear to bind to estrogen receptors on cells in various tissues. Soy also contains isoflavones, and many studies have shown that it can relieve some symptoms of menopause, too.

The lower prevalence of hot flashes in menopausal Japanese women, who consume large amounts of soy as food, and the lower rate of breast cancer in that country are frequently cited as indirect evidence of soy's effectiveness and safety.

The office of complementary and alternative medicine at the National Institutes of Health is funding a head-to-head study of HRT, black cohosh, red clover and a placebo at the University of Illinois at Chicago. In the next few months, 112 women will take part in the randomized trial and be followed for a year. That trial may help answer questions about the botanicals' effectiveness, but it is not likely to answer questions about long-term safety.

Although phytoestrogens are much weaker than the mammalian hormones, it is theoretically possible that women taking them for years might face some of the risks seen in the HRT study. Whether black cohosh has estrogenic effects is a matter of debate, with some studies showing it does and others that it doesn't.

"The hypothesis is reasonable" that botanicals could have long-term adverse effects, said John Cardellina, a scientist and vice president of the Council for Responsible Nutrition, which represents supplement makers. "What we have to find out is whether the phytoestrogen is an absolute mimic of the female hormone. . . . Does it do exactly the same thing or does it bind in some different site and behave differently?"

Although such studies are planned or underway, there are no plans for a clinical trial the size and length of the Women's Health Initiative.

Uncertainty, though, isn't likely to keep women away from botanicals -- or shield physicians from having to learn something about them -- at this time of major upheaval.

"My feeling is that women are particularly open to alternatives because they are so concerned about the potential risk of taking estrogen," said Machelle Seibel, a reproductive endocrinologist in Norwood, Mass. "It's forcing the medical community to look a little harder at alternatives to help their patients, whereas they've shunned them in the past."

A former academic now in private practice, Seibel has looked at and been convinced of soy's benefits, and she has a book on the subject coming out this fall.


Non-Prescription Drugs a Mixed Bag  

By Randolph E. Schmid

Associated Press Writer

The Associated Press

Thursday, August 29, 2002

WASHINGTON (AP) - Dropping the prescription requirement for a drug usually means the price comes down and people can treat themselves for common ailments without seeing the doctor. But it can also mean paying more for the drug and facing the danger of misdiagnosing themselves.

The question of moving drugs from prescription to over-the-counter sales is "a complicated issue that needs to be dealt with on a case-by-case basis," said Dr. Sidney Wolfe of Public Citizen Health Research Group.

It's a balancing act pitting potential health benefits against possible dangers. And it's a decision that involves millions of dollars changing hands among the sometimes conflicting interests of consumers, drug makers and insurance companies.

Studies find many consumers want to treat themselves with nonprescription drugs when possible and an increasing number of drugs once available only with a doctor's approval now are jostling for shelf space in drug stores and supermarkets.

When a drug is switched to over-the-counter sales, the price usually decreases. But whether that's a good thing for users can depend on whether they have insurance.

Insurers generally don't cover nonprescription drugs, so selling more of them that way is good for the industry, said Linda Simoni-Wastila, a pharmacy professor at the University of Maryland in Baltimore. "It can be bad policy for consumers, who absorb the entire cost of the drug."

And the use of such drugs without a doctor's oversight can mask medical complications, she added.

Linda Golodner, president of the National Consumers League, said consumers are taking a more active role in their health care, even self-diagnosing and medicating.

A survey commissioned by her group found that consumers generally like over-the-counter drugs and use them regularly to treat minor health conditions. But one-third of consumers don't regularly read the labels before purchasing or using them, Golodner added.

According to a paper published by the American Academy of Family Physicians ( news - web sites), nonprescription drugs account for about 60 percent of all drugs sold in the United States and are used to treat about 400 ailments.

Former prescription drugs now sold over the counter include painkillers Aleve, Motrin and Advil; heartburn drugs Zantac, Tagamet, Axid and Pepcid; and cold and allergy drugs Tavist-1 and Nasalcrom. Also on the list are the anti-fungal drugs Gyne-Lotrimin, Femstat and Monistat, baldness treatment Rogaine and smoking deterrents Nicotrol, NicoDerm and Nicorette.

Many more drugs could be considered for over-the-counter sale, such as the "morning after" pill that women need in a hurry to prevent pregnancy and vaginal "microbicides" that companies are developing to protect against the AIDS ( news - web sites) virus.

Lori R. Donnelly, author of the academy's paper and an Ohio pharmacist, said the transfer to over-the-counter from prescription generally lowers health care costs because patients are not going to doctors for simple remedies.

"Thus far I have viewed it as a good change," she said, but added that it might be a problem if drugs requiring more involved dosage and monitoring were taken off prescription.

The switch can have positive results. Take, for example, the nicotine patch and gum to help people quit smoking.

In 1996, the products became available over the counter and about 6 million people used them, double the sales of the year before. Within two years it was 9 million.

When the Food and Drug Administration ( news - web sites) considers approving a switch from prescription to over-the-counter, there are two primary concerns: that the drug is used for a condition that the consumer can easily diagnose and monitor and it has low toxicity and little potential for abuse.

Wolfe stressed that with many drugs it is important to see a doctor to make sure that the illness is what the patient thinks it is, and that the right drug is being chosen. And, in many cases, the progress of the condition needs to be monitored.

Consider the heartburn drug Prilosec. The FDA is considering whether to take the hugely popular pill off prescription at the request of manufacturer AstraZeneca, which hopes to make it an over-the-counter success.

"Heartburn is one of those conditions that when you have it, you know you have it," said Golodner of the Consumers League. "Therefore, we feel that consumers can adequately self-diagnose this condition."

An FDA advisory committee agreed, but had reservations, insisting on strong warnings and explanations pointing out that it isn't just another pill to pop after eating too many spicy meatballs.

Two years ago, an FDA advisory committee recommended against allowing nonprescription sales of powerful cholesterol-lowering drugs known as statins out of concern that consumers don't understand cholesterol well enough to self-medicate.


Babbling Is Baby 'Talk', Not Just Baby 'Noise' 

Reuters Health

Thursday, August 29, 2002  

NEW YORK (Reuters Health) - Before there are words, there is babbling. Now, new study findings indicate that babies' early vocalizations are a result of their attempts to speak, and are not only exercises in moving and using their mouths.

Most people rely on one half, or hemisphere, of their brains to speak and understand language. This specialization becomes more obvious when they speak: many adults open the right side of their mouths more than their left when talking, an indication that speech is linked primarily with the left hemisphere.

Now researchers based at Dartmouth College in Hanover, New Hampshire, and McGill University in Montreal, Canada, have discovered that babbling babies opened the right side of their mouth more than their left, indicating that this activity may be babies' early attempts at language.

"We thus conclude that babbling represents the onset of the productive language capacity in humans, rather than an exclusively oral-motor development," they report in the August 30th issue of Science.

Study authors Dr. Laura Ann Petitto and Siobhan Holowka defined babbling as when babies repeat a sound heard in language over and over again, with no indication that the word means anything in particular.

In order to examine the purpose behind babbling, the researchers filmed 10 babies between 5 and 12 months old who were learning French or English. Independent reviewers then watched the videos and determined whether the babies were opening one side of their mouths more than the other.

The researchers found that babies opened the right sides of their mouths more than the left during babbling. In contrast, the babies tended to open the left sides of their mouths more when smiling, and opened both sides equally while using their mouths to make noises other than babbles.

According to the authors, this suggests that language is "lateralized" in the brain at a very early point in development. And, in light of the smiling findings, it appears that babies, like adults, might have their emotional expression controlled by the right side of the brain.

Source: Science 2002;297:1515.


Study: Chimps May Have Survived AIDS 

By Toby Sterling

Associated Press Writer

The Associated Press

Thursday, August 29, 2002

AMSTERDAM, Netherlands (AP)- Dutch researchers theorize that an AIDS ( news - web sites)-like epidemic wiped out huge numbers of chimpanzees 2 million years ago, leaving modern chimps with resistance to the AIDS virus and its variants.

If true, the hypothesis would explain why chimps, which share more than 98 percent of their DNA with humans, don't develop AIDS.

The theory stems from a study of DNA in 35 chimps conducted by the Biomedical Primate Research Center in the Netherlands. The chimps in the study were found to share a cluster of genes in the area that controls their immune systems' defenses against disease.

"Chimps show more genetic variation than humans in all areas with this one exception, which is seriously condensed," said Dr. Ronald Bontrop, who led a Dutch team that worked with statisticians from the University of California.

The findings will be published in the coming issue of the Proceedings of the National Academy of the Sciences of the United States. An online version was already available on the academy's Web site.

Bontrop told The Associated Press that the chimp's lack of genetic diversity, which was found in genes related to the immune system's defense against disease, suggests that a lethal sickness attacked chimps in the distant past.

This unknown disease would have wiped out all or almost all chimps that didn't have the right immune system genes to fend it off, leaving the survivors with a uniform set.

This, combined with the knowledge that modern chimps are largely immune to the AIDS virus and its simian variants, pointed toward an AIDS-like disease as the culprit.

Scientists believe that HIV ( news - web sites), the virus that causes AIDS, originated in apes or monkeys and was transferred or mutated its way into the human population about 50 years ago.

Dr. Luis Montaner, an associate professor at the Wistar Institute in Philadelphia who studies HIV and wasn't involved in the Dutch study, said the findings were intriguing.

"They justify looking at wild populations of chimpanzees to see if they show the same reductions (in genetic variability) as the chimps in the study," he said.

If the findings hold true for all chimpanzees populations, he said, an AIDS-like epidemic in the past would be a plausible explanation but not the only one. It could have been caused by a sickness unrelated to AIDS, or an epidemic which occurred more recently.

The theory put forward by the Dutch researchers notes that chimps split into four subspecies around 1.5 million years ago. Since all subspecies represented in the study share the same genetic reduction, the researchers estimated the epidemic happened before that split.

Additional evidence from other studies suggested that bonobo apes also have a genetic reduction similar to that of the chimps, pushing the time of the epidemic back to 2 million years ago, when bonobos and chimpanzees shared a common ancestor.

But Montaner, the independent researcher, said a more modern disease could have spread among the various subspecies, even though they are separated by wide distances.

He also said there is no definitive proof linking specific genes with resistance to AIDS in either chimpanzees or humans, although researchers have found some evidence and are looking for more.

Bontrop said that chimpanzee immune systems appear to defeat HIV by targeting part of the virus's proteins that don't mutate. A similar defense mechanism may be at work in humans who have been exposed to HIV repeatedly but don't get sick, he said, suggesting an area for further study.

"It's important to understand mechanisms of disease and resistance in order to help develop vaccines," Bontrop said.

Both Bontrop and Montaner said it was impossible to estimate what percentage of chimps would have had to be killed off in order to leave survivors with such a depleted gene pool, but it would have to be high possibly as much as 90 percent or more.

If the theory of an ancient chimp epidemic would hold true for humans, he said, "the implications are pretty scary."


Allergic Reaction to Laser Tattoo Removal Reported 

By Charnicia E. Huggins

Reuters Health

Thursday, August 29, 2002

NEW YORK (Reuters Health) - Texas researchers are reporting what they believe is the first case of an immediate allergic reaction to laser tattoo removal.

The 26-year-old woman developed hives and swelling shortly after laser treatment for a tattoo on her thigh.

"The majority of people tolerate their laser treatment without any sort of reaction," Dr. Ronald W. England, of Wilford Hall Medical Center, Lackland AFB, Texas, told Reuters Health. In light of the present case, however, he said that people should be aware "that they may develop some type of allergic-type reaction" after laser tattoo removal.

England and his colleagues describe the patient's case in the August issue of the Annals of Allergy, Asthma & Immunology.

The patient had two 6-year-old tattoos--a Mardi Gras mask on her thigh and a Tasmanian devil on her chest--that were of different colors and had not been previously associated with any allergic reactions or symptoms, according to England's team.

She did not experience any side effects after undergoing laser treatment for her Tasmanian devil tattoo, but developed hive-like spots and swelling on her thigh a half-hour after undergoing treatment for her Mardi Gras mask tattoo. Laser treatment for the mask tattoo occurred roughly one month after treatment for the Tasmanian devil tattoo.

Preventive treatment with steroids and antihistamines kept the patient from having any similar reaction to her subsequent laser treatments, the report indicates.

There are a few possible explanations for the woman's allergic reaction, the authors suggest. One is that the laser therapy caused the tattoo pigments, which are normally hidden from the immune system inside cells, to explode into the area outside the cells, thereby causing the immune system to react.

In general, however, an allergic reaction to laser tattoo removal is rare, England said. Still, people should "be aware that this is a possibility," he added.

And, he and his colleagues point out, such reactions "may increase as popularity of skin art increases with the need for subsequent removal."

Short-term treatment with steroids and antihistamines can suppress allergic reactions, but such treatment should be done only under the direction of a physician, England noted.

Source: Annals of Allergy, Asthma & Immunology 2002;89:215-217.


Listen To Your Heart 


Thursday, August 29, 2002

(HealthScoutNews) -- All being well, your heart will never sound anything like most of the sound files on the "Normal and Abnormal Heart Sounds" Web page, maintained by the organization Frontiers in Bioscience. It's found at this URL:

Of the heart sounds represented, all but one are abnormal. The names of some of the conditions represented sound somewhat unnerving -- like "opening snap," "mid systolic click," or "early systolic ejection."

The sounds range from about 2 seconds to 5 seconds duration.


Plant Compound Seen as Possible Brain Tumor Therapy 

By Merritt McKinney

Reuters Health

Thursday, August 29, 2002

NEW YORK (Reuters Health) - Blocking a molecular pathway that goes awry in the most common form of childhood brain cancer may hold promise as a therapy for the disease, new research suggests.

The approach, aimed at tumors called medullablastomas, has not been tested in children yet. But the new study shows that a plant-derived compound that interferes with abnormal growth signals can slow tumor growth in mice and kill medulloblastoma cells taken from human patients.

Depending on the stage of the cancer at diagnosis, 50% to 70% of children survive medulloblastoma, according to the study's lead author, Dr. Philip A. Beachy of Johns Hopkins University and the Howard Hughes Medical Institute in Baltimore, Maryland. But the radiation used to destroy cancer cells that might linger afterward "can cause fairly significant brain damage," he told Reuters Health in an interview.

"An agent that would specifically target the tumor would be great to have," he said.

In previous research, Beachy and his colleagues discovered that the molecular pathway involving a protein called Hedgehog behaves abnormally in children with medulloblastoma. As an embryo forms, the Hedgehog pathway is activated to send signals that guide the appropriate development of other cells. But if the pathway is activated inappropriately later in life, certain cancers may develop, Beachy explained.

Both medulloblastoma and basal cell carcinoma, a common form of skin cancer, have been linked to abnormal activation of the Hedgehog pathway, according to the Johns Hopkins researcher.

In the mid-1990s, Beachy and his colleagues found that cyclopamine, a chemical derived from corn lilies that grow in mountain meadows in the western US, blocks the Hedgehog pathway. So they decided to test it as a treatment for medulloblastoma.

In experiments with a mouse model of medulloblastoma, cyclopamine reduced the growth of cancer cells in the laboratory and shrank tumors implanted in mice. What's more, treatment with the plant chemical killed up to 99.9% of cancer cells in medulloblastoma tumors that had been surgically removed from human patients.

A report on the findings is published in the August 30th issue of Science.

The study "shows the potential for cyclopamine and other drugs that could block the pathway," according to Beachy. The chemical did not cause any side effects in the mice, but it has never been tested in humans, he said.

Still, Beachy said that there is enough evidence of the beneficial effects of cyclopamine to justify developing the chemical so that its safety and effectiveness can be tested in human trials.

It is still uncertain, though, he noted, how much of the chemical can be collected by harvesting corn lilies. Due to the complexity of the chemical, it would be very difficult to make synthetically, according to Beachy.

Financial support for the research was provided by several sources, including Immunex and Curis, Inc. Johns Hopkins holds a financial interest in Curis and is entitled to a share of the royalties that might arise from products related to the research.

Source: Science 2002;297:1559-1561.


Blacks Have More Kidney Disease 


Thursday, August 29, 2002

(HealthScoutNews) -- African Americans are disproportionately afflicted with end-stage kidney failure, also known as end-stage renal disease (ESRD). Although they constitute approximately 12 percent of the U.S. population, African Americans comprise 32 percent of ESRD cases.

In black people especially, hypertension is a major cause of ESRD. The racial disparity is most striking in younger African Americans, ages 25 to 44, who are 20 times more likely than whites of that age group to develop kidney failure caused by high blood pressure.

Although better management of high blood pressure has led to a decline in the number of people who develop strokes and heart disease, the number of people developing kidney failure has increased.

Since 1990, the National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) has been investigating the underlying causes of ESRD. It is hoped that, eventually, a specific class of antihypertensive drugs will help slow progression of hypertensive kidney disease in African Americans.


Risk Rises in Pregnancy for Women Prone to Clotting 

By Keith Mulvihill

Reuters Health

Thursday, August 29, 2002

NEW YORK (Reuters Health) - Women with a history of deep vein thrombosis (DVT) are 3.5 times more likely to have a recurrent bout of the potentially life threatening condition when they are pregnant than when they are not carrying a child, new study findings show.

DVT occurs when blood clots form deep in the legs or arms. Pulmonary embolism, or a blood clot in the lungs, can result, and may be fatal.

While pregnancy in general is known to boost a woman's risk for DVT, few studies have aimed to identify the risk of the disorder among pregnant women who have had DVT in the past.

To investigate, Ingrid Pabinger and colleagues at the Vienna University Hospital in Austria evaluated the medical records of 109 women who had been pregnant at least once and had a prior history of DVT. None of the women took anti-blood clot medications while they were pregnant, the researchers note in the August issue of the journal Blood.

The researchers found that 43 of the women had another episode of DVT, while eight of these cases occurred during pregnancy. Analysis of these figures revealed that women with past DVT episodes had more than triple the risk of developing the blood clots again while pregnant, compared to when they were not pregnant.

Commenting on the study, Dr. Hytham Imseis of the Mountain Area Education Center in Asheville, North Carolina, said: "This is a very thorough study that quantifies what we already know--that women with a history of blood clots are at increased risk for having them while they are pregnant."

In general, Imseis, who is a maternal-fetal medical specialist, noted that such high-risk women usually undergo a battery of blood tests to determine whether they are missing specific blood factors that affect clotting or if they have a genetic condition that could increase their clotting risk.

Depending on the outcome of the tests, women are offered various doses of the anti-blood drug heparin, to minimize their chances of developing blood clots while pregnant, Imseis told Reuters Health.

Source: Blood 2002;100:1060-1061.


Teen Computer Program Is No Game 


Thursday, August 29, 2002

THURSDAY, Aug. 29 (HealthScoutNews) -- Vermont is the first state to implement a multimedia driver education program designed to caution teenagers about the dangers of impaired driving.

Crash Site is an interactive ( news - external web site) CD-ROM program designed to inform teens about the consequences of driving while under the influence of alcohol or drugs.

During the coming school year, the program will be introduced to the state's driver education curriculum, which already includes mock crashes and presentations by Mothers Against Drunk Driving (MADD), police, emergency medical workers, car insurers and people convicted of impaired driving.

"Crash Site is interactive, so it catches and keeps a teen's attention. Our goal is to use the program to reach as many teens as possible throughout Vermont to help them truly comprehend the perils of impaired driving," says Barry Ford, director of Vermont Driver Education.

When they use the Crash Site program, teens confidentially input their own personal risk factors to determine what may happen to them in real-life circumstances.

During the two 45-minute sessions of Crash Site, a student gathers clues from a lawyer, police detective, counselor, peer and doctor to find the cause of a crash in which the student was involved as a driver, passenger or witness.

Crash Site also has video interviews with teenagers and parents who talk about their personal experiences after a crash caused by impaired driving. A classroom discussion guide and parent-teen exercises are also part of the program.

More Information

The creator of Crash Site has more information about the program.


Pot Smoking in Youth Tied to More Drug Use Later 


Thursday, August 29, 2002

WASHINGTON (Reuters) - People who first try marijuana early in life may be more likely than others to abuse or become dependent on illegal drugs later on, US government researchers said on Wednesday.

They found that 62% of adults ages 26 or older who first started using marijuana before they were 15 had also tried cocaine at some point.

More than 9% reported they had used heroin, and more than half had used prescription drugs for recreational purposes.

In contrast, less than 1% of those who said they had never tried marijuana reported having tried cocaine or heroin, and just 5% had abused prescription drugs, according to the study by the Substance Abuse and Mental Health Services Administration (SAMHSA).

"These findings are of grave concern because studies show smoking marijuana leads to changes in the brain similar to those caused by cocaine, heroin and alcohol," SAMHSA administrator Charles Curie said in a statement.

"Heavy marijuana abuse impairs the ability of young people to retain information during their peak learning years when their brains are still developing," Curie added.

"Every day in this country, more than 3,000 people--most of them under the age of 18--use marijuana for the first time. Their early marijuana use exposes them to risks of drug dependencies, long-term physical and cognitive consequences, and social problems," John Walters, director of the White House Office of National Drug Control Policy, said in a statement.

The report, based on National Household Survey data, found that 18% of adults who said they first tried pot before the age of 15 met the criteria for either dependence or abuse of alcohol or illicit drugs, compared with 2.1% of adults who said they had never used marijuana.

However, the survey also found that an estimated 2 million Americans age 12 or older said they had used marijuana for the first time in 1999, down from 2.5 million in 1998.

Other researchers have found that teenagers who start smoking are more likely to become addicted to nicotine than people who wait to try cigarettes when they are adults.


Anti-Clotting Drug Works Better with Time 


Thursday, August 29, 2002

THURSDAY, Aug. 29 (HealthScoutNews) -- The use of a new anti-clotting drug for four weeks, compared to just one week, greatly reduced the number of potentially fatal blood clots in people who had hip fracture surgery.

A new study found the drug fondaparinux (brand name Arixtra) virtually eliminated blood clots in the people who took it for four weeks. The research is being presented today at the annual meeting of the International Society of Orthopedic Surgery and Traumatology.

The people who took fondaparinux for four weeks had a 96 percent reduction in deep venous thrombosis (DVT) and pulmonary embolism (PE) compared to people who took the drug for one week, the study says. It found that 1.4 percent of those on the extended treatment had either DVT or PE, while 35 percent of the people on the weeklong treatment had some form of DVT or PE.

The study included 656 people at 57 sites in 16 countries. This is the first study to evaluate the effectiveness of the four-week treatment.

About 800,000 Americans suffer DVT each year. It can lead to PE when a clot in a lower limb moves to the lungs, a condition that kills about 60,000 Americans a year.

DVT is a threat following hip fracture or hip and knee orthopedic surgery. That's because blood vessels can be damaged during surgery, tissue debris can increase blood's tendency to clot, and extended periods of immobility can slow blood flow.

More information

Learn about blood clots from the American Heart Association.


Anti-Dust Mite Bed Covers May Not Help Asthmatics 

Reuters Health

Thursday, August 29, 2002

NEW YORK (Reuters Health) - Encasing mattresses and pillows in special covers to reduce the number of dust mites in beds appears to have little impact on the health of people with severe to moderate asthma, study findings from Switzerland show.

But another investigation of pregnant women and, later, their babies, found that the covers seemed to cut infants' nighttime coughing.

Dust mites, ubiquitous microscopic creatures that live in and on many household surfaces, are believed to worsen asthma and allergy symptoms.

Although the use of mite-proof cases on mattresses and pillows is known to reduce bed-time exposure to dust mites, there is little evidence on whether these measures have any effect on asthma patients' symptoms, note lead author Dr. L. H. M. Rijssenbeek-Nouwens of the Nederlands Asthmacenter in Davos and colleagues.

To investigate, the researchers gave 16 people with severe to moderate asthma anti-dust mite bed covers. Fourteen similarly diagnosed asthma patients received mattress covers that offered no dust mite protection.

Levels of dust mites were tested at the start of the study and one year later. All study participants had lung function tests and answered questionnaires about asthma-related symptoms and quality of life.

While the anti-dust mite cover group saw a significant reduction in the numbers of dust mites sharing their beds, there were no differences in key asthma symptoms between the two groups, the authors report in the September issue of the journal Thorax.

"This lack of effect may be due to the chronic stage of the asthma and/or limiting the avoidance measures (solely) to the bedroom," the authors write. "Future studies should explore whether nighttime and daytime avoidance measures in the early stages of the disease are more effective."

But another study by researchers from Erasmus University Medical Center in Rotterdam, the Netherlands, found that newborn infants experienced "reduced night cough" as a result of anti-dust mite covers.

In this study, mothers used anti-dust mite covers on mattresses and pillows during the last trimester of pregnancy. Special covers were also used on the babies' beds during the infants' first year of life. The findings are published in the September issue of the American Journal of Respiratory and Critical Care Medicine.

When the "test" group of 394 infants was compared to 472 newborns and moms that did not use anti-dust mite covers, researchers found that they were much less likely to cough at night, but that other respiratory symptoms were not affected.

A follow-up investigation of these infants "will determine whether this intervention can reduce the prevalence of asthma...later in childhood," Laurens P. Koopman and colleagues conclude.

Source: Thorax 2002;57:784-790; American Journal of Respiratory and Critical Care Medicine 2002;166:307-313.


Stretching Before Exercise Doesn't Do Squat 

By Adam Marcus
HealthScoutNews Reporter


Thursday, August 29, 2002

THURSDAY, Aug. 29 (HealthScoutNews) -- People who make stretching part of their workout rituals may be pulling their legs if they think it helps reduce muscle pain and injury from exercise.

That's according to Australian researchers who reviewed a roster of studies looking at the benefits -- or lack thereof -- of stretching.

When taken together, five studies showed only a trivial reduction in muscle soreness from limbering up before or after working out -- about 1 millimeter on a 100 millimeter scale.

"Most athletes will consider effects of this magnitude too small to make stretching to prevent later muscle soreness worthwhile," according to the researchers, who report their findings in this week's British Medical Journal.

The researchers, from the University of Sydney, also could find no statistically significant protection from stretching before exercise against injuries like ankle sprains and muscle tears in two studies of army recruits.

The effect for the recruits was so small, they say, that a person would have to stretch for 23 years to avoid a single injury. Since the typical athlete faces a smaller risk of injury than a solider in training, the benefit from stretching for them, if it exists at all, is probably even slighter.

Still, the scientists add, "It would be particularly interesting to determine if more prolonged stretching carried out by recreational athletes over many months or years can produce meaningful reductions in risk of injury."

Dr. Thomas Best, a sports medicine expert at the University of Wisconsin, says the Australian study is in synch with other research -- including his own experiments with animals showing that stretching doesn't strengthen muscles or tendons or make them more resilient.

"Why is it that a professional football player strains his hamstring, or an elite sprinter does, when they're flexible, strong and well-conditioned?" says Best, who co-wrote an editorial accompanying the journal article.

Dr. Ian Shrier, a McGill University sports medicine specialist, says stretching before a workout may, in fact, make muscles more vulnerable to injury by tearing their fibers. What's more, despite popular perceptions, nearly all workout strains and pulls occur not when a muscle hits its limit of extension but when it is contracting -- so widening its range of motion has no theoretical reason for reducing the chances of harm.

"I would like to see people move from stretching to a much better warm-up," says Shrier, of the Center for Clinical Epidemiology and Community Studies at McGill's Sir Mortimer B. Davis Jewish General Hospital in Montreal.

Although Best and Shrier agree that stretching isn't the insurance policy against injury that people believe it to be, neither doctor is ready to discard it completely. Shrier says improving flexibility may potentially boost athletic performance. And Best says people who are inflexible to begin with may reduce their risk of exercise injury by limbering up before working out.

If you insist on stretching, Best adds, it probably won't hurt and it can feel good if done properly.

What To Do

For more on stretching, visit the American Academy of Orthopaedic Surgeons. You can also check the Nicholas Institute of Sports Medicine and Athletic Trauma.


Blood Flow Test May Improve Down Syndrome Detection 

By Richard Woodman

Reuters Health

Thursday, August 29, 2002

LONDON (Reuters Health) - Non-invasive screening for Down syndrome could become more accurate if an assessment of the blood flow between the umbilical cord and the fetus' heart is carried out in combination with an ultrasound measurement called nuchal translucency, scientists said on Thursday.

The team, from St. George's Hospital Medical School in London, examined 256 pregnancies between 11 and 14 weeks' gestation. The women had been referred to the hospital's fetal medicine unit over an 18-month period.

Nuchal translucency, which involves checking the back of a fetus' neck on ultrasound, was measured. The researchers also used a test called color Doppler imaging to determine whether blood flow from the fetus' heart to the umbilical cord was normal when the upper chambers of the heart contracted. The channel between heart and umbilical cord is called the ductus venosus.

The study, published in the British Journal of Obstetrics and Gynaecology, confirmed a clear association between abnormal blood flow in the ductus venosus and fetal chromosomal abnormalities, as shown by earlier studies. Abnormal ductus venosus flow increased the risk of such chromosome abnormalities by 10-fold.

The researchers found that the sensitivity in the detection of Down syndrome increased to 93.5% when the ductus venosus check was carried out in combination with nuchal translucency. This compared with 80.4% for nuchal translucency alone and 58.7% for ductus venosus testing alone.

But Dr. Basky Thilaganathan and colleagues warned: "The specialized nature of Doppler velocimetry of the ductus venosus performed in the first trimester may hinder the widespread acceptance of this test in screening."

Source: British Journal of Obstetrics and Gynaecology 2002;109:1015-1019.


Low Birth-Weight, High Blood Pressure Link Disputed 

By Kathleen Doheny
HealthScoutNews Reporter


Thursday, August 29, 2002

THURSDAY, Aug. 29 (HealthScoutNews) -- The widely held belief that low birth-weight babies may be prone to high blood pressure as adults is wrong, a new analysis of previous studies contends.

After reviewing 55 studies that had reported such a link, Australian researchers found that the larger studies revealed weaker cause-and-effect associations.

"Strong claims for an inverse association between birth weight and blood pressure have been made, and the relationship has been considered to provide some of the strongest support for the 'fetal-origins hypothesis,' " says Rachel Huxley, a researcher at the Institute for International Health in Sydney.

The hypothesis contends that many adult diseases have their start in the womb.

But it doesn't hold up for birth weight and blood pressure, says Huxley, whose findings appear in the Aug. 31 issue of The Lancet.

"After carefully reviewing all of the published studies, there is no good evidence to suggest that there is a causal association between birth weight and blood pressure," she says. "It would therefore be prudent to treat with caution any other claims of associations between size at birth with later health outcomes."

Experts had estimated that every 2.2 pound increase in birth weight reduces systolic blood pressure (the higher number of the two blood-pressure readings) by two to four millimeters of mercury later in life.

Low birth weight is defined as less than 5.5 pounds, or 2,500 grams, at birth. The condition affects about one in 14 babies born in the United States each year, according to a report earlier this year in the Journal of the American Medical Association ( news - web sites).

Why were the earlier studies that found an association between low birth-weight and later blood pressure problems off the mark?

"No allowance was made for the size of the contributing studies," Huxley says. "Previous reviews had combined the results from all studies, making no allowance for whether the study population consisted of only a few hundred individuals or tens of thousands of people."

And twin studies were excluded from the earlier reviews, Huxley adds. They're valuable, she says, because studies of twins are less prone to "confounding factors," differences that can affect outcomes or results.

Health experts offer praise for the Australian study, but say it doesn't mean mothers-to-be shouldn't pay close attention to habits that help reduce the risk of a low birth-weight baby.

"I think this review is pretty interesting and well done," says Dr. F. Ralph Dauterive, chief of obstetrics at the Ochsner Clinic Foundation in Baton Rouge, La. "You have to be careful drawing conclusions from small studies and this [new review of 55 studies] is a good example of why.

"Parents need to be concerned with low birth-weight for many other reasons," he adds. A low birth-weight baby is more likely to have health problems, such as an abnormal body temperature, feeding problems, infection, and, if also premature, underdeveloped lungs and breathing problems.

To help prevent low birth-weight babies, experts recommend that pregnant women have regular checkups, eat a balanced diet containing sufficient calories and vitamins and minerals, gain a healthy amount of weight (usually 25 to 35 pounds) and avoid tobacco and alcohol.

"I worry more about the development of low birth-weight babies, more so than about their blood pressure later on," Dauterive says.

Another expert, Kevin Blake of the University of Western Australia, Subiaco, says an adult's current weight has a more substantial effect on raising systolic pressure than low birth weight. He suggests that study of birth weight is "a very crude marker of growth in the womb."

In a recent study, he measured fetal growth by using ultrasound to measure the thigh bones and found that the longer the thigh bone, the lower the systolic blood pressure later in life. Tracking fetal growth provides more opportunity for medical intervention, he adds.

"My study is saying that a shortened thigh bone in the fetus relatively early in pregnancy may be an indicator that something is not right with the environment in the womb and that the mother's behavior and known risk factors [smoking, lack of exercise, poor diet] need close scrutiny to help the fetus later in its development. In other words, to do something when something can actually be done," he says.

Parents of low birth-weight babies shouldn't worry their children will grow up to have high blood pressure, Huxley concludes.

"Factors such as current body weight [when they are older], diet and exercise remain among the most important, most easily modified determinants of blood pressure," she says.

What To Do

For information on how parents' behavior affects the development of low birth-weight babies, visit the Center for the Advancement of Health. For information on having a healthy pregnancy, go to the National Women's Health Information Center.


Study Links Second-Hand Smoke to Heart Disease 


Thursday, August 29, 2002

LONDON (Reuters) - Being exposed to other people's cigarette smoke dramatically increases the risk of heart disease, researchers in Greece show in a study published Thursday.

The study in the British Medical Association's quarterly specialist journal Tobacco Control suggested banning smoking in the workplace was the best way to protect smokers from giving their non-smoking colleagues heart attacks.

The study found people who never smoked had a 47% higher chance of developing acute heart disease if they were occasionally or regularly exposed to the second-hand smoke puffed out by others.

The risk rose exponentially with the number of years that non-smokers were exposed to other people's smoke.

The scientists looked at 847 Greek men and women with heart disease and 1,078 who did not suffer from it.

Among the heart disease patients, 86% had been exposed to second-hand smoke for more than 30 minutes a day. Among those without heart disease, only 56% had been exposed to smoke.

"The only safe way to protect non-smokers from exposure to cigarette smoke is to eliminate this health hazard from public places and workplaces, as well as from the home," the authors of the study concluded.


First Lupus Test in 4 Decades Gets Go-Ahead 


Thursday, August 29, 2002

THURSDAY, Aug. 29 (HealthScoutNews) -- The first significant new screening test for lupus in 40 years has been approved by the U.S. Food and Drug Administration ( news - web sites).

The test was devised by scientists at the Fred Hutchinson Cancer Research Center in Seattle and is expected to spot up to 20 percent of cases that, using today's testing methods, would have gone undetected.

Lupus is a chronic disorder in which a person's immune system attacks the body. The new test is meant to combat the severest and potentially fatal form of the disease -- systematic lupus erythematosis (SLE). The disease causes inflammation of connective tissue throughout a person's body, from the joints to the kidneys.

Symptoms range from skin rash and mild fatigue to organ failure, often making diagnosis difficult.

Most lupus patients produce an antibody that is detectable via a blood test devised in the 1960s. The new test should detect the disease among those patients who don't produce this antibody, according to the the test's creators.

This information sheet from the National Institute of Arthritis and Musculoskeletal and Skin Diseases defines lupus and may help in directing you to the proper treatment.

It may take some time before the screening test is available nationwide. The Fred Hutchinson Cancer center has filed for patent protection and is looking for a commercial partner to help market and distribute the test.


Study Links Second-Hand Smoke to Heart Disease 


Thursday, August 29, 2002

LONDON (Reuters) - Being exposed to other people's cigarette smoke dramatically increases the risk of heart disease, researchers in Greece show in a study published Thursday.

The study in the British Medical Association's quarterly specialist journal Tobacco Control suggested banning smoking in the workplace was the best way to protect smokers from giving their non-smoking colleagues heart attacks.

The study found people who never smoked had a 47% higher chance of developing acute heart disease if they were occasionally or regularly exposed to the second-hand smoke puffed out by others.

The risk rose exponentially with the number of years that non-smokers were exposed to other people's smoke.

The scientists looked at 847 Greek men and women with heart disease and 1,078 who did not suffer from it.

Among the heart disease patients, 86% had been exposed to second-hand smoke for more than 30 minutes a day. Among those without heart disease, only 56% had been exposed to smoke.

"The only safe way to protect non-smokers from exposure to cigarette smoke is to eliminate this health hazard from public places and workplaces, as well as from the home," the authors of the study concluded.


After Long Decline, Smoking Is Up Among U.S. Women 


Thursday, August 29, 2002

NEW YORK (Reuters Health) - Hard-fought gains in reducing the number of American women who smoke were nearly wiped out in the 1990s, as more and more teen girls picked up the habit, according to a new US Surgeon General report.

In fact, "current smoking among high school senior girls was the same in 2000 as in 1988," according to the report released Thursday. Experts say more needs to be done to "de-glamorize" smoking among impressionable teens.

"Women and Smoking: A Report of the Surgeon General-2001" follows up on a similar study published more than 20 years ago. Surveying smoking trends among thousands of US women since 1980, researchers found that--despite pervasive anti-smoking campaigns and restrictions on smoking in an array of public spaces--22% of all women still smoked as of 1998.

Even more disturbing was the rise during the 1990s of smoking among young girls. Indeed, "much of the progress in reducing smoking prevalence among girls in the 1970s and 1980s was lost with the increase in prevalence in the 1990s," according to the report.

In 2000, nearly a third (29.7%) of high school senior girls surveyed said they had smoked at least once during the previous month. And while smoking "declined substantially" among African-American teen girls during the 1990s, reductions among white girls were marginal.

These trends are especially disheartening considering that far more US women die from lung cancer than any other form of cancer. While about 41,000 American women lose their lives to breast cancer ( news - web sites) every year, nearly 68,000 die from lung cancer--with 90% of those deaths linked to smoking.

Smoking has also been linked to higher risks of other cancers such as those of the mouth, throat, bladder, liver and pancreas, as well as a higher risk for the No. 1 killer of US women, cardiovascular disease.

So what's driving recent increases in women picking up the habit? According to the report, women may be influenced by glamorous images of carcinogen-inhaling models and actresses they see everyday.

Tobacco company advertising expenditures soared from $4.9 billion in 1995 to $6.73 billion in 1998, the researchers say, with ads targeted at women "featuring slim, attractive, athletic models." Indeed, experts point out that many teenage girls start smoking with the hope that the habit will help them control their weight.

Other studies in media trends show that Hollywood's love affair with cigarettes continues. As millions of teen girls watch Julia Roberts or Sarah Jessica Parker light up on screen, health experts say more must be done to hammer home the message that most smart, successful women today do not smoke.

"The fact that almost all women have either rejected smoking for themselves or, if they do smoke now, wish to quit, should be promoted," the report notes.

And the researchers urge Hollywood's leading ladies to join in the effort. "If, for example, smoking in movies by female celebrities promotes smoking, then discouraging such practices as well as engaging well-known actresses to be spokespersons on the issue...should be a high priority," they conclude.

A full copy of the report can accessed online at


Too Much 'Macho' Not Good for a Marriage: Study 

By Alison McCook

Reuters Health

Thursday, August 29, 2002

NEW YORK (Reuters Health) - Married men who are overly and stereotypically "masculine"--too driven, emotionally closed off, and focused on work rather than family--tend to have wives who are relatively unhappy and dissatisfied with the marriage, new study findings show.

Men who possess traits that are considered to be stereotypically male--consumed by success and power, uncomfortable showing affection toward other men, attuned to work over family--are in a state of gender role conflict, according to study author Matthew J. Breiding of the University of Notre Dame in Indiana.

While possessing some of these traits is normal, when men have too many, or express them in an over-the-top way, their relationships with others--including their wives--will be affected, Breiding explained in an interview with Reuters Health.

Adopting a gender role to a rather extreme degree is what "gets a man into trouble," Breiding said.

Previous studies have shown that men who have gender role conflict also tend to show certain behaviors that can be difficult for others, such as hostility, dominance and anger. In addition, these men may hesitate to open up emotionally to their wives--all of which can affect the health and happiness of a marriage, according to Breiding.

In the new study, Breiding and Dr. David A. Smith asked 59 married couples to complete a scale designed to measure the husband's level of gender role conflict. The husband filled out one scale for himself, while his wife completed one on him. Spouses then indicated how content they were in their marriages and whether they felt depressed or unhappy.

The investigators found that the higher the state of gender role conflict in the husband--according to him or his wife--the less happy the wife was in the marriage. Such couples also tended to have more disagreement over marital issues, and the wives were more likely to be depressed.

Husbands were also negatively affected by gender role conflict, but not to the degree that their wives were, the authors note.

Breiding and Smith presented their findings this month during the 110th annual meeting of the American Psychological Association in Chicago, Illinois.

In the interview, Breiding explained that men likely develop their gender role conflict from influences such as role models and messages from media and others that stress the importance of success in work, rather than in relationships.

He noted that a woman may also influence how her husband perceives his gender role and, therefore, may in part be responsible for the husband's potentially destructive self-image. "Certainly, I think the wives can have a reciprocal influence," he said.

Breiding added that his results can also be interpreted in a positive light, since there are apparently many men out there who are not in a state of gender role conflict and have happy, mutually satisfying marriages.

More and more men are "receiving different messages of what it means to be a man," Breiding explained. "That can have a transformative effect on how they interact with their wives and other male friends."


Kids Can Be Hooked After a Few Cigarettes: Report 

By Melissa Schorr


Thursday, August 29, 2002

NEW YORK (Reuters Health) - Even dabbling with smoking can be enough to get youngsters "hooked" on cigarettes, researchers report.

"This contradicts everything previously found about how long you need to smoke to get hooked," study author Dr. Joseph R. DiFranza, of the University of Massachusetts Medical School in Worcester, told Reuters Health. "Addiction to nicotine can begin very rapidly, at very small doses of nicotine."

In a study of nearly 700 12- and 13-year-olds, DiFranza's team found that teens who had started smoking were likely to report symptoms of being "hooked," even after only smoking sporadically. For example, of the youths who had ever used tobacco, even if they had only take a puff, 40% reported symptoms of dependence--which include cravings and withdrawal symptoms such as irritability and mood swings .

The findings are published in the September issue of the journal Tobacco Control.

"Before the study, it was assumed that it took two years for kids to get hooked on tobacco--that they would have to smoke it every day, at least a half a pack per day," DiFranza said. "Nobody suspected that people would have trouble quitting if they didn't smoke every day, but actually, it was quite common."

Overall, nearly half the youths reported using some form of tobacco over the course of the 30-month study. On average, they were just under 12 years old when they took their first puff.

Of all the adolescents who reported some symptoms of addiction, one third were only smoking once a month, and half were smoking once a week.

In addition, the researchers found it did not take long for the youths to develop an addiction. "Half the kids were hooked before they had been smoking two months," DiFranza noted.

Girls also seemed to get hooked quicker than boys, and reported more symptoms of dependence.

"Half the girls who became hooked had symptoms within three weeks. For boys it was six months," DiFranza said. "Girls appear to be especially vulnerable to rapidly developing a dependence on nicotine."

The teens who reported one or more symptoms of addiction were also more likely to have difficulty quitting, with those teens being 30 times more likely to fail at quitting smoking and 44 times more likely to still be smoking at the end of the study than kids with no symptoms of addiction.

Overall, a teenager may be more vulnerable to nicotine dependence than an adult because the teen's brain is still developing, according to DiFranza.

"I'd like to see the message get out to kids that you can't experiment with tobacco. There's no way of smoking safely," DiFranza said. "We need to convince kids that trying even one cigarette can lead to a lifelong addiction."

Source: Tobacco Control 2002;11:228-235.


14 Percent of World Youth Smoke, Survey Finds 


Thursday, August 29, 2002

WASHINGTON (Reuters) - Fourteen percent of teens aged 13 to 15 smoke worldwide, but two-thirds of them want to quit, a survey released on Wednesday finds.

A quarter of all kids who smoke started by the age of 10, the report, by the US Centers for Disease Control and Prevention ( news - web sites), the National Cancer Institute ( news - web sites), the World Health Organization ( news - web sites) and the Canadian Public Health Association found.

The Global Youth Tobacco Survey of 13- to 15-year-olds at 75 sites in 43 different countries, the West Bank and Gaza Strip ( news - web sites) found that developing countries have the highest rates of teen smokers.

More than one-third of the students surveyed in Chile, Russia, Ukraine and Northern Mariana Islands said they were current smokers.

The survey, published on the Internet at, found 17.7 percent of the US teens questioned smoke, but 55.8 percent of them said they wanted to quit.

"Overall, 68.4 percent of students indicated that they wanted to quit smoking immediately," the CDC, whose report is published in the September issue of the journal Tobacco Control, said in a statement.

"Of major concern is the fact that so many young people around the world are exposed to cigarette smoking in their homes and in public places. Nearly half the students reported that they were exposed to second-hand smoke from others in their home," the statement added.

"Overall, 60 percent of students were exposed to second-hand smoke in public areas."

The World Health Organization says 10 million people are expected to die each year from smoking-related illnesses by the year 2030, with 70 percent of these deaths in developing countries.



Study Links Insurance to in Vitro  

By Linda Johnson

Associated Press Writer

The Associated Press

Wednesday, August 28, 2002

Infertile couples in states where health insurers must cover in vitro fertilization were nearly three times more likely to try the costly, complex procedure than those in states with no such law, researchers found.

States where IVF coverage is required also had slightly lower rates of risky multiple births, a common result of fertility treatments that can endanger the mother and babies and cost hundreds of thousands of dollars just for initial medical care.

Doctors at Brigham and Women's Hospital and Harvard Medical School ( news - web sites), both in Boston, scoured data that fertility clinics report to the federal Centers for Disease Control and Prevention ( news - web sites).

In 1998, they found, the rate of in vitro fertilization was 180 percent higher in the three states that required complete insurance coverage for IVF treatment, and 20 percent higher in the five states that required partial coverage, compared to states that didn't mandate it. New Jersey last year became the fourth state to require complete coverage.

Pregnancy and multiple birth rates were slightly higher in states where coverage was not required, probably because couples were using more embryos each time because of the cost, experts said.

"There's an association, but we can't necessarily prove cause and effect," said the lead researcher, Dr. Mark Hornstein.

The study, examining 61,650 treatments resulting in 15,367 births, was reported in Thursday's New England Journal of Medicine ( news - web sites).

In vitro fertilization involves removing eggs from the woman's ovaries with a needle, mixing them with sperm, then transferring some or all of the resulting embryos into the woman's uterus. Extra embryos often are frozen for later attempts.

Beforehand, the woman must take drugs to "ripen" multiple eggs, then be checked every couple days with ultrasound and blood tests to be sure conditions are right. One attempt costs $10,000 to $15,000.

"The economics are clearly an issue" shutting out many couples, said Dr. David Adamson, a board member of the American Society for Reproductive Medicine.

A few for-profit companies, including one run by Adamson, Advanced Reproductive Care, have started offering financing plans through clinics that give them discounts.

Adamson said the study's results are "probably pretty accurate," even though they are based on results by clinic, not individual patients, so they don't show how many couples tried IVF repeatedly. The researchers also couldn't tell how many patients paid for it themselves; only about 20 percent of health plans offered by large employers cover IVF, according to Mercer Human Resources Consulting.

The coverage requirements vary as well. In states with full coverage at the time of the study (Illinois, Massachusetts and Rhode Island) the number of IVF attempts covered varies from six to unlimited. In those requiring partial coverage (Arkansas, Hawaii, Maryland, Ohio and West Virginia) only three apply them to HMOs.

The mandates don't cover small businesses, self-insured companies, unions or the federal government, leaving out roughly half the population.

Erin Kramer of the patient advocacy group RESOLVE said she plans to use the data to lobby for national legislation to require coverage for all workers and end the incentive for couples to risk having sextuplets because they can only afford one shot at IVF.

"We don't think couples should have to go bankrupt in order to have a family," she said.

In an editorial, Dr. David Guzick, dean of the University of Rochester School of Medicine, wrote that more detailed research is needed to determine whether more widespread insurance coverage is wise.

He suggested the number of embryos used in each attempt might be limited to reduce multiple births, as some European countries have done. U.S. medical groups recommend using only three or four embryos for women under 40.

On the Net:


For Older Men, Beefy Physique Doesn't Require Beef 

Reuters Health

Wednesday, August 28, 2002

NEW YORK (Reuters Health) - Older men who are looking to beef up don't necessarily need to eat beef, as long as they are getting enough protein, new study findings suggest.

A vegetarian diet with soy and dairy products as its main protein sources appears to be just as effective in increasing muscle mass for men aged 60 to 70, according to a small study published in the September issue of the American Journal of Clinical Nutrition ( news - web sites).

As a person ages, it becomes more difficult to maintain muscle mass and strength, both of which can keep bones strong, guard against falls, and help sustain a high quality of life.

While previous research has shown that adequate protein intake coupled with resistive training, such as lifting weights, can help men over age 65 build muscle mass and strength, at least one study has questioned the usefulness of non-beef protein sources.

In the current study, lead Dr. Mark D. Haub of Kansas State University in Manhattan, Kansas, and colleagues sought to determine whether beef might be a better booster of muscle growth in older men than soy or dairy.

One group of 10 men got most of their protein from beef, while the another group of 11 men ate the same amount of protein, but derived from soy. The 3-month study required all of the men to pump iron 3 days a week.

During the study period all of the men underwent a battery of tests that measured body composition, resting energy expenditure and muscle metabolites

Men in both groups had improvements ranging from 14% to 38% in maximal dynamic strength of all muscle groups trained, "with no significant difference between the groups," the authors report.

"These data suggest that increases in muscle strength and size were not influenced by the predominant source of protein consumed by older men with adequate total protein intake," Haub and colleagues conclude.

Two possible disadvantages of the study were its small size and relatively short duration, the authors note. They recommend that future studies include more people and use a longer resistive-training period.

Source: American Journal of Clinical Nutrition 2002;76:511-517.


L.A. School Board Bans Soda Sales  

By Louinn Lota

Associated Press Writer

The Associated Press

Wednesday, August 28, 2002

LOS ANGELES (AP) - The board of the nation's second-largest school district voted unanimously to extend the ban on carbonated soft drinks to all its schools in an effort to combat childhood obesity.

An audience of about 100 people burst into applause as the ban was adopted after 2 hours of debate Tuesday night. It will take effect in January 2004.

Board member Julie Korenstein, who co-sponsored the measure, said it was needed to fight obesity among students. But a soda industry official complained that banning drinks isn't the solution.

"Physical education and physical activity are by far, more important in combating obesity than banning soft drinks from students' diets," said Sean McBride, a spokesman for the National Soft Drink Association.

He added: "In the end, this is really about the couch and not the can."

Los Angeles Unified District, which has 748,000 students on its 677 campuses, already prohibited carbonated drink sales at elementary schools. The new measure extends the ban to the district's approximately 200 middle and high schools. It only takes effect during school hours.

Still permitted during school hours are water, milk, beverages with at least 50 percent fruit juice and sports drinks with less than 42 grams of sugar per 20-ounce serving.

Many Los Angeles Unified schools rely on soda sales to fund student activities such as sports and field trips. Sodas sold in vending machines and student stores generate an annual average profit of $39,000 per high school and $14,000 per middle school.

In California, an estimated 30 percent of children are overweight or at risk of being overweight, according to the California Center for Public Health Advocacy.

A study last year by Massachusetts researchers concluded that drinking sugar-sweetened soft drinks increased the chance of childhood obesity. Some other studies have failed to find any link.


A Little Help from Friends May Slow Cancer Progress 

By David Douglas

Reuters Health

Wednesday, August 28, 2002

NEW YORK (Reuters Health) - People who have more support from friends and neighbors may produce less of a growth factor that can foster cancer spread, according to a study of ovarian cancer patients.

While there is strong evidence that stress, social support and other behavioral factors can affect a person's immune system, there has been no research on whether such factors can affect a person's production of vascular endothelial growth factor (VEGF). VEGF helps new blood vessels to form around tumors, which allows tumors to grow and spread more easily. And higher levels of VEGF have been linked to worse survival among ovarian cancer patients.

To investigate whether there might be a link between VEGF levels, social support and depression, Dr. Susan K. Lutgendorf of the University of Iowa in Iowa City and colleagues studied 24 women with ovarian cancer and 5 women with non-cancerous pelvic masses. The cancer patients had not yet had surgery for the condition.

The higher a patient's level of social well-being, the researchers found, the lower her VEGF level. More support from friends and neighbors, as well as less distance from friends, were both linked to lower levels of the growth factor, according to the report in the August 15th issue of Cancer.

While women who reported more feelings of helplessness or worthlessness had higher VEGF levels, depression in general was not related to VEGF levels, the investigators found.

"The exciting thing about these findings is that they open up the possibility of a new mechanism by which psychological factors may be related to cancer progression--that is, through effects on factors related to angiogenesis," Lutgendorf told Reuters Health.

While the study had a number of limitations, the authors concede, the results "point to the possibility of novel pathways between biobehavioral factors and tumor angiogenesis." And, said Lutgendorf, "these findings open up a new area of research into mechanisms underlying these relationships."

Source: Cancer 2002;95:808-815.


Vitamins Help Heart Patient Arteries  

By Maura Kelly

Associated Press Writer

The Associated Press

Wednesday, August 28, 2002

CHICAGO (AP) - A six-month regimen of folic acid, vitamin B12 and vitamin B6 can help prevent recurrence of blocked arteries in patients who have undergone coronary angioplasty, a study found.

The findings, reported in Wednesday's Journal of the American Medical Association ( news - web sites), are an extension of a clinical trial that examined effects of the vitamin combination on treating heart disease.

The treatment apparently works by lowering levels of homocysteine, an amino acid long implicated in heart attacks.

Dr. Guido Schnyder, an assistant professor in the cardiology division at the University of California at San Diego, and his colleagues conducted both studies.

The earlier study, reported in the New England Journal of Medicine ( news - web sites) in November 2001, involved 205 patients who were given either the vitamin combination of folic acid, vitamin B12 and vitamin B6 or a placebo for six months.

During that period, the patients who took the vitamin combination showed a 48 percent reduction in the development of restenosis, or renarrowing of the vessel, compared to patients who received the placebo.

In the new study, Schnyder added 348 patients and extended the follow-up observation period from six months to one year.

"It was important to follow these patients for another six months because that's the time frame in which restenosis typically occurs," he said. "We've now shown that the vitamin combination didn't just delay the development of restenosis, it prevented it."

Schnyder also expanded the study's focus to look at the patient's need for repeat angioplasties or heart bypass operations. He said the vitamin regime decreased by 38 percent the need for repeat angioplasties or heart bypass operations.

Dr. Robert Bonow, chief of cardiology at Northwestern Memorial Hospital in Chicago and president of the American Heart Association ( news - web sites), said the study offers more evidence that B vitamins are important in maintaining healthy blood vessels. More research is needed, though, he said.

"When you have a small trial like this, it's always nice to have confirmation by another group," Bonow said. "I think it's very interesting and it needs to be followed very carefully."

The study was funded by the Swiss National Science Foundation ( news - web sites) and Swiss Cardiovascular Center and the University Hospital in Bern, Switzerland.

On the Net:



Dangerous Strep Bug Can Be Spread by Oral Sex 

By Keith Mulvihill

Reuters Health

Wednesday, August 28, 2002

NEW YORK (Reuters Health) - A bacterial infection dangerous to infants can be spread by sexual activity between men and women, particularly oral sex, new study findings show.

While group B streptococcal infection (GBS) rarely makes healthy young adults sick, the bug can cause health problems for pregnant women and babies, the study's lead investigator, Dr. Betsy Foxman, explained in an interview with Reuters Health. GBS can also sicken elderly people or those with existing medical problems.

"Pregnant women who are colonized with GBS have a one in two chance of passing GBS to their newborn if they are not treated with antibiotics during labor and delivery," said Foxman, who is with the University of Michigan School of Public Health in Ann Arbor.

Infection in newborns can cause neonatal sepsis--a massive immune response that can be fatal--and meningitis, an infection of the membranes surrounding the brain that can be fatal or lead to brain damage, Foxman explained.

"Although GBS is treatable with antibiotics, increasingly, GBS is becoming resistant to antibiotics," she added, "Of every 100 newborn babies infected with GBS, 4 to 6 will die."

Based on these facts, health experts have been increasingly interested in learning more about how GBS is spread.

To investigate, the team of researchers evaluated 120 heterosexual couples for the presence of GBS. Each partner also completed a questionnaire that assessed their sexual habits and risk factors for becoming a GBS carrier. The findings are published in the September issue of the journal Epidemiology.

"We demonstrated...that among heterosexual couples co-colonized with GBS, 86% carried the identical strain. Further, we identified engaging in oral sex as a risk factor for co-colonization with the identical strain," Foxman said.

"While sexual activity between men and women has been suspected to be important in transmitting GBS, this is the first study to give tangible evidence that sexual transmission occurs," added Foxman.

Since male-to-female oral sex resulted in increased co-colonization with group B strep, Foxman advocates safe sex practices, such as using dental dams and condoms when engaging in oral sex.

These practices "would minimize transmission via this route and prevent transmission of other sexually transmitted diseases as well," she said.

Source: Epidemiology 2002;13:533-539.


Child Safety Seats Are Redesigned  

By Nedra Pickler

Associated Press Writer

The Associated Press

Wednesday, August 28, 2002

Parents who have struggled to strap in their children's car seats with safety belts are getting some reprieve starting Sunday, all new vehicles and child safety seats must have attachments designed to make them fit together like a key in a lock.

The new law can't prevent all child seat mistakes. Parents still need to research which seat is best for their child, make sure the seat fits tightly in the vehicle and buckle the child in properly. But the National Highway Traffic Safety Administration ( news - web sites) estimates the new system could prevent 36 to 50 deaths and almost 3,000 injuries annually.

"It represents a huge betterment for parents who have struggled with car seats in the past in getting them properly installed," Jeff Runge, head of the NHTSA, said Wednesday.

"This is a convenience feature, and we are relatively certain that it will make installation rather easy," he said on CBS's "The Early Show."

"We do recommend that parents as always do go to a child seat fitting station to make sure the seats fit properly," Runge said. "It's an amazingly simple idea. It's wonderful that everybody's gotten together to make sure it works. I hope it will be a revolution in properly-fitting child safety seats."

The agency says 80 percent of car seats are incorrectly installed, leading to 68 child deaths and another 874 injuries each year. The new system, called LATCH, which stands for Lower Anchors and Tethers for Children, is designed to make it easier to fit the child seat tightly in the vehicle.

As of Sunday, every vehicle must be made with 6-milimeter bars, or anchors, in the back seat where the cushions meet, and every child seat must be built with clips that connect to the anchors for a secure fit.

The second feature of LATCH is a tether behind the back seat that connects to a strap on top of the child seat. The tethers, which have been required for 2 years, are designed to keep the child from whipping forward during an accident.

The LATCH system works only with forward- and rear-facing child seats. It's not used with booster seats that are recommended for children aged 4 to 8.

Reaction to the system has been largely positive among manufacturers, safety advocates and parents.

Still, some safety advocates complain that LATCH anchors can be hard to find in the seat upholstery and may not be sufficient for toddlers heavier than 50 pounds. Also, automakers are required to put the anchors only at the two outboard seats; many parents prefer to put their children in the middle of the back seat to avoid injuries in side impact accidents.

Lisa Stormont of Baltimore is due to give birth to her second child in October, and she said getting a LATCH-equipped seat in her PT Cruiser was much simpler than installing the older seat for her 17-month-old son.

"It only took a few minutes just to pop it in," she said. "If a 7-month pregnant woman can do it, anyone can do it."

NHTSA kicks off a public education campaign about LATCH on Wednesday, but the agency still is stressing that old seats securely installed with seat belts work just as well as those equipped with LATCH.

Although many vehicles already have the LATCH system, it has not been available in many car seats until recently partly because they are more expensive. Car seats with a rigid metal attachment can add $34 to $44 to the cost, while those with the more common flexible strap connectors cost $10 to $21 more, according to NHTSA.

Some car seat manufacturers sell retrofit kits averaging around $25 that allow the seat to work with the vehicle's LATCH system, but they are not necessary if a seat is tightly secured with a seat belt. Retrofits will not be available for the lower anchors for most vehicles, although Volkswagen and Audi are offering to install the hardware for free in 1993 and newer models.

On the Net: National Highway Traffic Safety Administration:

DaimlerChrysler's site on inspection stations:

General Motors' video on LATCH installation:


Exercise Cuts Depression Risk for Older People 

By Michelle Chard

Reuters Health

Wednesday, August 28, 2002

NEW YORK (Reuters Health) - Older people who exercise are less likely to be depressed, and also face a lower risk of becoming depressed, according to a report in the August 15th issue of the American Journal of Epidemiology.

Dr. William J. Strawbridge of the Public Health Institute, Berkeley, California, and colleagues studied 1,947 people participating in the Alameda County Study. All were between 50 and 94 years old at the beginning of the study, and were followed for 5 years. The investigators examined the effects of physical activity on depression, with and without excluding disabled patients. They used an 8-point scale to rate study participants' physical activity level.

Every 1-point increase in physical activity protected against both prevalent depression and incident depression over 5 years after adjusting for age, sex, ethnicity, financial strain, chronic conditions, disability, body mass index, alcohol consumption, smoking and social relations. Each point cut the risk of being depressed by 10%, and of becoming depressed by 17%. "Regular physical activity, such as walking, exercising, swimming or playing active sports for older adults will reduce the risk of subsequent depression," Strawbridge told Reuters Health in an interview. "This benefit is similar for those with and without physical disabilities."

And, Strawbridge added, "The most common form of physical activity for members of the Alameda County Study is taking long walks, which shows that physical activity does not have to involve elaborate equipment."

The investigators note that "it is plausible that persons with high levels of physical activity are also more likely to engage in other beneficial health behaviors such as not smoking, avoiding obesity, and not drinking to excess."

Source: American Journal of Epidemiology 2002;156:328-334.


Health 101 


Wednesday, August 28, 2002

(HealthScoutNews) -- With all the challenges new college students face, their health sometimes takes a back seat. The University of Connecticut's Student Health Services department advises incoming freshmen to:

  • Provide their campus health service with a complete health history, including immunization records required by law;
  • Advise the campus health service of any chronic illnesses or conditions and allergies to food or medicine that could affect treatment in case of an emergency;
  • Bring any health problems during the term to the attention of the campus health service;
  • Inquire about special services. Many campus health centers offer programs for students with disabilities and support groups for students with such conditions as eating disorders or diabetes;
  • Learn what kinds of services the campus health center offers and what kind of medical services are available in the local community, and;
  • Check with their own health insurers to see what medical services will be covered for a student at school. For example, some insurance programs cover emergencies but not diagnostic or primary care services.

UConn cautions parents that a student's on-campus health records are confidential, so the records cannot be released to the parents without the student's written consent.


The Science of Forgetfulness--Clues from a Protein 

By Alison McCook

Reuters Health

Wednesday, August 28, 2002

NEW YORK (Reuters Health) - You've heard of research designed to uncover nuances of memory. Now, a new study sheds light on the processes mouse brains use to forget, findings that may one day help investigators understand why people experience memory loss as they age.

In experiments with mice, David Genoux of the Swiss Federal Institute of Technology in Zurich and his colleagues found that suppressing the activity of an enzyme known as protein phosphatase 1 (PP1) appeared to improve the mice's memory. This suggests that PP1 is actively involved in forgetting.

The brain's capacity for memory storage is likely limited, study author Dr. Isabelle M. Mansuy of the Swiss Federal Institute of Technology told Reuters Health, so it is perhaps to the advantage of mice to eliminate memories or prevent their formation to avoid brain "saturation." Figuring out how animals forget is an important aspect of determining how they remember, she added. "I think if we want to understand learning and memory deeply, we have to understand all of it," Mansuy said.

Mansuy and her team report their findings in the August 29th issue of the journal Nature.

The investigators discovered the importance of PP1 through a series of experiments using mice. Researchers have long known that animals remember best when learning sessions are punctuated with long rest intervals, rather than short ones.

During the experiments, the researchers presented mice with new objects for an extended period of time or in shorter blocks, then tested the mice to see if the objects had become familiar to them.

The authors confirmed that the mice remembered the objects better when they were presented to them during learning periods separated by longer, rather than shorter, intervals. They also found the mice learned better when the familiarization period was given as five 5-minute sessions, rather than a single 25-minute block.

The researchers then used a technique that enabled them to temporarily block the activity of PP1 in the mice, and repeated the memory tests. They found that without PP1 activity, the mice could remember just as well after the single, longer learning session as they could when taught in five shorter sessions. Therefore, according to Mansuy and her colleagues, when PP1 is active it somehow interferes with the formation of memories during uninterrupted learning periods.

In an accompanying article, Drs. Alcino J. Silva and Sheena A. Josselyn of the University of California in Los Angeles explain that PP1 inactivates a substance known as CREB, which, under normal circumstances, helps designate which genes should be used to form new proteins. Blocking the activity of CREB interferes with the formation of new proteins, which can cause memory problems, they note.

In an interview with Reuters Health, Mansuy said that age-related memory loss may consequently result from increases in PP1 over time. Although the reasons behind these increases remain unclear, the current findings may one day be used to help researchers understand memory loss that is not linked to a physical problem such as damage of the brain tissue.

However, she stressed that since the current findings were conducted in mice, they are not immediately applicable to humans, nor is the technique the investigators employed to temporarily reduce PP1 levels in the mice's brains. She added that the study was also not intended to provide otherwise healthy adults with a means for improving their memory.

"That's not our goal at all," she said.

Source: Nature 2002;418:970-975, 929-930.


Doing the Write Thing 


Wednesday, August 28, 2002

WEDNESDAY, Aug. 28 (HealthScoutNews) -- Your own words have the power to heal you.

If you've had a traumatic experience, writing your thoughts about it in a journal may help you work through that event, says a study in the August issue of the Annals of Behavioral Medicine.

However, writing only about your emotions won't have the same benefits, and may actually make things worse.

"Engagement of both thoughts and emotions while journaling about a stressful or traumatic experience can raise awareness of the benefits of the event," say study authors Philip M. Ullrich and Susan K. Lutgendorf of the University of Iowa.

"In contrast, focusing solely on the emotional aspects of traumas may not produce a greater understanding of traumatic events," they say.

The study included 122 college students. They wrote in their journals at least twice a week for four weeks, and were divided into three groups.

The emotions-only group recorded their deepest feelings about a traumatic or stressful event. The emotions and cognition group wrote about their feelings and their efforts to understand and make sense of a traumatic event. A control group wrote down details of traumatic events reported in the news.

The study found the emotions-cognition group became more aware of the benefits of their traumatic events. These benefits included improved relationships, greater personal strength, spiritual growth and a greater appreciation of life.

The two other groups didn't become aware of such benefits.

More Information

Wofford College has some tips on Keeping a Journal.


Baby's Seizures Rarely Due to Oxygen Lack at Birth 

By Melissa Schorr

Reuters Health

Wednesday, August 28, 2002

NEW YORK (Reuters Health) - Seizures in newborns are only rarely caused by lack of oxygen during delivery, according to the results of a new study.

Seizures are a common early warning that a baby may have some type of neurological problem, such as cerebral palsy. However, experts have disagreed on whether seizures result primarily from a lack of oxygen during birth or other causes, such as the mother's health or genetic factors.

Many malpractice suits are based on the idea that neurological problems in babies can usually be linked to problems during delivery, notes lead author Dr. Ernest M. Graham, an assistant professor of gynecology and obstetrics at Johns Hopkins University School of Medicine in Baltimore, Maryland.

To investigate, Graham and his colleagues compared 12 infants who had seizures with a group of babies matched by birth weight, gestational age and delivery method, who did not have seizures.

The findings were published in the August issue of the Journal of Maternal-Fetal and Neonatal Medicine.

"We found that 70% of the babies with seizures had normal umbilical cord gases, indicating it wasn't due to low oxygen during delivery," Graham said.

Of the remaining babies with some indication of oxygen deficiency, only one, or 8%, had both high acidity and a low Apgar score. These are among the American College of Obstetricians and Gynecologists' criteria for establishing a link between oxygen deficiency during birth and neurological problems.

The investigators conclude that researchers should examine other possible seizure causes. "It tells us if we want to prevent these cases, looking at labor is not going to be successful," Graham said. "We'll have to look at other possible reasons."

Source: Journal of Maternal-Fetal and Neonatal Medicine 2002;12:123-127.


Islet Cell Transplants Offer Hope to Diabetics 

By Amanda Gardner
HealthScoutNews Reporter


Wednesday, August 28, 2002

WEDNESDAY, Aug. 28 (HealthScoutNews) -- More and more people with diabetes are able to live without insulin after receiving pancreatic islet-cell transplants, say studies being presented this week at the International Congress of the Transplantation Society in Miami.

"Four to five years ago, there was a 10 percent success rate at one year, and now it's over 80 percent," says Dr. Camillo Ricordi, scientific director of the Diabetes Research Institute at the University of Miami School of Medicine.

"There's tremendous progress being made right now with islet-cell transplants that has resulted in several centers in the U.S. beginning programs to duplicate that work," adds Dr. George Loss, director of the Pancreas Transplant Program at the Ochsner Clinic Foundation in New Orleans. "There's a tremendous amount of excitement in the community about the ability to at least control diabetes in many patients."

Some 120 million to 140 million people around the world suffer from diabetes, a condition in which the body's ability to produce the hormone insulin is compromised. Insulin controls blood sugar levels.

If blood sugar levels aren't kept in check, complications can include blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage.

Currently, diabetics ( news - web sites) can only manage their disease. There is no cure. Type I diabetics produce no insulin at all, and must give themselves daily insulin shots. Type II diabetics can often manage their disease, at least in the beginning, with exercise and healthy eating. Restoring the body's ability to make insulin has long been a goal of researchers.

Transplantation of an entire pancreas has had some success, but there are several problems, not the least of which is the severe shortage of donors.

Because islet cells, consisting of less than 10 percent of the pancreas, are involved in insulin production, they have become a major focus of research with innovations now taking place on several fronts.

Ricordi's team in Miami, for instance, is using perflurocarbon (PFC), the standard organ preservative, to enable the shipment of islet cells to distant health centers. Nine patients who received islet-cell transplantations at remote sites were able to come off insulin for varying periods of time.

"It's exciting because it shows that we can have regional centers to process and distribute the islets," Ricordi explains. "This proves the concept that you could process islets in centralized facilities, and distribute them regionally and even across the ocean."

Various other routes to expand the available yield of islet cells are also under study.

Stem cells, "generic" cells which can grow into specialized cells, are a huge focus of research. Scientists hope they will one day be able to coax stem cells into becoming insulin-producing cells, and they have already had some success in animal studies. "It's getting closer, but it's still experimental," Loss says.

Researchers from the Children's Hospital of Mexico and the University of Western Ontario reported at the transplantation meeting that one child who received a mixture of pig islet and testicular cells has been insulin-free for one year without any anti-rejection drugs. Other experts are cautious about hailing the results until they've been duplicated.

There have also been advances in countering rejection of transplanted cells. "A major innovation has been the development of much more effective immune-suppressive drugs," Ricordi says.

Recipients generally have to take immunosuppression drugs for the rest of their lives, to prevent their bodies from rejecting the transplants.

"You cannot really talk about a cure until you perform cellular therapies eliminating the need for anti-rejection drugs for life," Ricordi says. Studies at Ricordi's Diabetes Research Institute found that injections of the cancer drug Samarium-Lexidronam helped the body tolerate the transplanted islet cells.

Research is thus proceeding on all fronts.

"We don't know at this point where the cure will come from," Ricordi says. "It may be adult cells, embryonic stem cells or animal cells. As soon as we find which one is the most effective, we can move forward in that direction and maybe then we will have a preferred source."

What To Do

To learn more about islet cell transplantation, visit the National Library of Medicine. For more information on diabetes, visit the American Diabetes Association.


Troubling Rise in Induced Labor During 1990s: Study 

By Melissa Schorr

Reuters Health

Wednesday, August 28, 2002

NEW YORK (Reuters Health) - The rate of induced labor among pregnant women in the US has doubled in the past decade, government researchers report.

"We found a large increase in the percentage of births that had induced labor," study author Dr. Marian MacDorman, of the National Center for Health Statistics in Hyattsville, Maryland, told Reuters Health.

Traditionally, labor induction has been advised for only certain reasons, such as when a medical condition endangers the mother or fetus, or in some instances where pregnancy runs longer than 42 weeks. But recent research has indicated that elective labor induction, for medical reasons or just convenience, is on the rise.

To further examine US trends, MacDorman and colleagues used vital statistics to track all births nationally from 1989 to 1998. They found that the percentage of births among US women that were initiated using some form of medical intervention rose from 9% in 1989 to just over 19% by 1998.

The findings are published in the August issue of the journal Pediatric and Perinatal Epidemiology. They mirror another analysis by researchers from the National Institutes of Health ( news - web sites), which found rates of induction for medical reasons grew more slowly than for induced labor overall.

Looking at the stages of pregnancy in which labor was induced, the researchers found that the rate among women whose pregnancies were longer than normal--or "post-term"--rose from 14.5% in 1989 to 23.8% by 1998.

And among all post-term births, the risk of infant death was 23% lower when labor was induced, according to the researchers.

But there was also a sharp increase in the rate of induced pre-term labor, which rose from 6.7% to 13.4% during the study period.

This may help explain the concerning rise of pre-term births among non-Hispanic white women in the US, MacDorman said. This increase in premature delivery has been partly attributed to various causes, such as the rise in multiple births aided by assisted reproductive technologies.

MacDorman estimated that a significant amount of the increase in pre-term births among white US women is due to induced labors.

"Pre-term babies are more likely to be born at low birth weight and have medical complications, so that's something we should be concerned about," she noted.

Moreover, whether these inductions are always advisable is unclear. MacDorman's team found that only around half of the pre-term inductions had an identifiable medical reason listed on the birth certificate.

In addition, the investigators found that social, economic and ethnic factors influence whether women receive an induction. Women who were white or Native American, highly educated, or having their first pregnancy were found to be more likely to receive an induction.

Because of these variations in the use of induction and the possible health risks to the child from earlier delivery, MacDorman suggested that some women may need to question advice to receive an induction.

"If I had a doctor that wanted to induce pre-term, below 40 weeks, I'd get a second opinion," she said. "It's a medical intervention, and there's certain risks. We should be asking, 'Is it really necessary to do it that often?"'

Source: Pediatric and Perinatal Epidemiology 2002;16:263-273.


Tackling Childhood Depression 

By Amanda Gardner
HealthScoutNews Reporter


Wednesday, August 28, 2002

WEDNESDAY, Aug. 28 (HealthScoutNews) -- Depression shouldn't be part of anyone's childhood, but too often it is.

Some 5 percent of teens and 1 percent of children suffer from depression, according to an article in tomorrow's issue of The New England Journal of Medicine ( news - web sites).

Before puberty, boys and girls are at equal risk for falling victim to the disease. After the onset of puberty, however, girls face a rate twice that of boys. The annual rate of suicide attempts requiring medical attention among adolescents is 2.6 percent.

How do you recognize and treat this insidious condition?

Adolescent depression isn't that different from adult depression. An estimated 40 percent of adults probably had their first depressive episode when they were in their teens, says study author Dr. David Brent.

Brent is professor of psychiatry and academic chief of child and adolescent psychiatry at Western Psychiatric Institute and Clinic, which is part of the University of Pittsburgh Medical Center.

Depression in adults or teens doesn't always manifest itself as sadness. "Not everybody is sad," Brent says. "The things you look for are either a depressed mood, sad mood, boredom, inability to have fun or irritability." Talk of suicide should always be taken seriously, he adds.

Parents -- and physicians -- should also look for changes in how children are functioning. Are they able to function well in school and with their peers and family? Changes in sleep patterns, weight gain or weight loss, difficulty making decisions, difficulty concentrating and low motivation can also be danger signs, Brent says.

Depression often doesn't show up as a sudden change.

"Kids have a gradual descent into depression, in which case often the change isn't something you notice," Brent says. "Often depression starts as a dysthymic disorder [a mild or moderate depression, which is longer-lasting]. It's hard to notice. It's there one day, and not another. We often see patterns of three or four years of this, and then a more full-blown depression."

Diagnosis needs to first rule out other health problems, such as anemia, hypothyroidism or hyperthyroidism, and inflammatory bowel disease.

Unfortunately, there's no simple test for depression, but a number of factors need to be taken into account, including the patient's personal and family histories. If a parent has a history of depression, the child's risk of a depressive episode increases by a factor of two to four, Brent says.

Two basic treatment approaches have been shown to be effective, either separately or in combination, for teens, Brent says. One approach consists of specific psychotherapies (cognitive behavioral and interpersonal). The other consists of administering the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

"The standard in primary care is to treat with SSRIs, and there the most important thing is an adequate dose," Brent says. "Adolescents may need more, and sometimes people aren't aggressive enough in raising the dose."

Eight to 16 sessions of cognitive behavioral therapy over a period of three to four months have been shown to be effective in treating depression. This type of psychotherapy emphasizes acquiring interpersonal skills and modifying self-defeating thought patterns that can lead to depression, among other things.

Interpersonal therapy has also had some success. Here the focus is on coping mechanisms for such things as the loss of relationships.

"[Psychotherapy and medication] have never been directly compared, although if you look at studies they look about equally efficacious. So either approach is a reasonable one to begin with," Brent says.

According to Brent, about 60 percent of teens treated with cognitive behavioral therapy and about 60 percent who are treated with SSRIs will show signs of improvement in fairly short order. Some will be able to stop the treatment after six months or a year, but this is highly variable.

Experienced family physicians can often treat simple depression. However, chronic depression or depression compounded by other conditions such as attention-deficit hyperactivity disorder should be managed by a specialist, such as an adolescent psychiatrist.

Dr. Eugenio M. Rothe, associate professor of psychiatry at the University of Miami School of Medicine, says, "Adolescent depression is different from adult depression in that it is more characterized by irritability and boredom. Of course, that's part of the difficulty in diagnosing, because irritability and mood swings are part of the adolescent process."

What To Do

For more information about child and adolescent psychiatric health, visit the American Academy of Child and Adolescent Psychiatry.

The Western Psychiatric Institute and Clinic has an online assessment to measure symptoms of depression.


Gene Tied to 'Normal' Age-Related Mental Decline 

By Linda Carroll

Reuters Health

Wednesday, August 28, 2002

NEW YORK (Reuters Health) - The so-called normal memory loss and mental decline that comes with age may be linked to a gene variant already associated with Alzheimer's disease ( news - web sites), a new report suggests.

Scottish researchers found that mental decline among elderly people who did not show signs of dementia was more likely if they carried a particular variant of the gene that encodes the protein apolipoprotein E (APOE).

The variant, called APOE-e4, is found in 25% of the population and has been tied to higher levels of Alzheimer's, as well as cardiovascular disease, the authors note in the August 29th issue of the journal Nature.

However, the new study "took great care" to check that the association between APOE-e4 and relative mental decline over a lifetime was not due to the inclusion of people with unrecognized Alzheimer's, co-author Dr. John M. Starr said in an interview with Reuters Health.

Starr, of Royal Victoria Hospital in Edinburgh, and his colleagues tested the mental abilities of a group of 80-year-old men and women. All 466 study participants had taken the same test at age 11, and none had been diagnosed with dementia.

The test is known as the Moray House Test, Starr said.

"It is a general intelligence test, the forerunner of the '11-plus' test which was used to select children for grammar and secondary modern schools in the UK over many years," Starr explained. "It comprises 71 questions to be answered in 45 minutes including items on mental arithmetic, verbal reasoning--for example, if a is to b, then c is to ?--and some spatial reasoning items."

The researchers then tested participants to see which of them carried the APOE-e4 variant. Overall, those who carried the gene scored worse on the test than those who did not.

APOE-e4 is one of several variants of the APOE gene, which helps transport and metabolize cholesterol and other blood fats.

However, Starr said, its role in the brain "appears to be distinct" from this.

"Current thinking is that it is involved in brain cell repair and that the e4 form is less effective at this than the e2 or e3 forms," the researcher explained.

Starr and his colleagues also concluded that the effects of e4 were not due to heart disease or drugs used to treat heart disease.

The new study is "a very nice demonstration of the fact that genes can influence cognition," said Dr. Scott A. Small, an assistant professor of neurology at Columbia University in New York City. "It fits in with some very interesting and provocative twin studies that have appeared in the last 5 or so years."

Still, Small said, despite the efforts made by Starr and his colleagues to prove that none of the study subjects had early Alzheimer's, this possibility cannot be ruled out.

"Currently," he noted, "there is no good diagnostic test for early Alzheimer's."

Source: Nature 2002;418:932.


Early Breast Cancer Linked to Increased Ovarian Cancer Risk 

By Kathleen Doheny
HealthScoutNews Reporter


Wednesday, August 28, 2002

WEDNESDAY, Aug. 28 (HealthScoutNews) -- Women diagnosed with breast cancer ( news - web sites) before age 40 who also have a family history of either breast or ovarian cancer are at a much greater risk of getting ovarian cancer than are young breast cancer patients without such a family history.

That's the finding of a new Swedish study that also suggests these high-risk women should be followed closely, offered counseling and perhaps consider removal of their ovaries as a preventive measure. A report on the research appears today on the Web site of The Lancet.

Dr. Kjell Bergfeldt and his colleagues from the Karolinska Institute in Stockholm followed more than 30,00 women, all under age 70, when they were diagnosed with breast cancer. Then they obtained information about the medical histories of 146,000 of the women's first-degree relatives, including parents, children and siblings.

While it is known that women with breast cancer who have mutations in the so-called breast cancer genes, BRCA1 and BRCA2, are at increased risk for ovarian cancer, these mutations are rare, the authors note. So, the researchers decided to evaluate family history to see whether that might help them account for risk beyond having the breast cancer genes.

After six years of follow up, they found that women diagnosed with breast cancer were twice as likely to get ovarian cancer as women in the general population.

Family history boosted the risk even more.

Those women with breast cancer diagnosed before age 40 and a family history of breast cancer had a five- or six-fold increased risk for ovarian cancer. Women with breast cancer and a family history of ovarian cancer had a 17-fold increased risk for ovarian cancer, compared with the general population.

Put another way, women with breast cancer and a family history of ovarian cancer have an almost 10 percent risk of getting ovarian cancer before age 70. In contrast, about 1 percent of American and northern European women are at risk for getting the disease before their 70th birthday.

Women at high risk for ovarian cancer should be closely followed by their doctors and offered counseling, Bergfeldt says.

"Since the purpose of the counseling is to achieve early detection of a severe disease, the counseling should be performed by a physician, preferably a gynecologist familiar with ultrasound imaging," he says.

Ultrasound is one method used to detect ovarian cancer, which will be diagnosed in about 23,000 women this year in the United States, according to the American Cancer Society ( news - web sites). Identifying women at risk for ovarian cancer is particularly crucial because the disease is difficult to detect early, even with ultrasound and pelvic exams and a blood test that detects antigens that fight off ovarian tumors.

Preventive removal of the ovaries, called a prophylactic oophorectomy, should also be discussed, Bergfeldt says. "If there will be discussion concerning removal of the ovaries, I think that additional experts should be included, that is, oncologists and specialists in genetics. Even psychologists might be included, since removal of healthy organs for prophylactic reasons is a difficult decision."

How willing are women in this high-risk group to undergo ovary removal?

"It is difficult to answer such a question," Bergfeldt says. "Every individual handles risk estimates concerning their health in different ways. Some are willing to be very radical and take every opportunity to reduce the risk, while others are not."

The study supports what experts in the field have suspected and provides a practical way for doctors to assess their patient's risk, says Dr. Robin Farias-Eisner, a gynecologic oncologist and associate professor of obstetrics and gynecology at the David Geffen School of Medicine at University of California, Los Angeles.

"This study supports the concept that there is a connection between unknown genes and cancer susceptibility for ovarian cancer, and that in the absence of these [as yet] unknown genetic risk factors, we can use family history of breast or ovarian cancer as a predictor of those individuals at risk," he says.

"BRCA 1 and BRCA 2 account for less than 5 percent of all breast cancer patients [risk]," he adds.

To account for other risks, Farias-Eisner and others are working to identify the biomarkers that increase risk. "A biomarker is a gene that is turned on in the presence of disease such as ovarian cancer," he explains.

Next, the latest findings should be replicated by other researchers, Farias-Eisner says.

What To Do

For more information on ovarian cancer, see Johns Hopkins University. For information on cancer risk and family history, see FORCE.


Risk Factors for Melanoma 


Wednesday, August 28, 2002

(HealthScoutNews) -- Some people are at greater risk than others for contracting melanomas, the most serious of skin cancers.

About half of melanomas occur in just 1 percent to 5 percent of the population, the Duke University Medical Center says.

People at highest risk are those who:

  • have a family history -- meaning having two or more close relatives who have been diagnosed with melanomas;
  • have displastic (atypical) moles;
  • or have numerous moles -- more than 50 or so.

If you have one or more of these risk factors, regular checkups could help save your life, the medical center says.


Glucowatch Gets OK for Diabetic Children 


Wednesday, August 28, 2002

WEDNESDAY, Aug. 28 (HealthScoutNews) -- A wristwatch-like device already used by adult diabetics ( news - web sites) to monitor glucose levels has been approved for use by children over the age of seven.

The Glucowatch, whose electric currents can replace the constant finger-pricking needed to ensure a proper blood sugar reading, can now be marketed to pediatricians to sell to parents of children who have Type I (insulin dependent) diabetes.

The U.S. Food and Drug Administration ( news - web sites) has given its approval after clinical trials on 66 Type I diabetics between the ages of 7 and 17 showed that its results "were effective for detecting trends and tracking patterns in glucose levels in children and adolescents."

But with the approval comes an FDA warning. The Glucowatch should not be used to replace the finger prick when an accurate glucose reading is needed to confirm a sugar level.

However, it's a big improvement over the way most diabetics -- children and adults alike -- have to check their blood sugar. Often, the only way for Type I diabetics to get an accurate reading is by pricking a finger and placing a drop of blood on reactive strips. And this has to be done many times a day.

The Glucowatch, made by Cygnus, Inc., sounds an alarm when it detects an abnormal reading. It is available only through a doctor.

There are an estimated 17 million diabetics in the United States. The FDA says 150,000 children suffer from Type I diabetes.

Here is the FDA Talk Paper announcing the Glucowatch approval.

And here are the clinical trial test results for the Glucowatch when it was first introduced in 1999.


Drug Cos. Seek Ban on Price Lists  

By Nedra Pickler

Associated Press Writer

The Associated Press

Wednesday, August 28, 2002

WASHINGTON (AP) - Drug companies asked a federal judge on Wednesday to stop states from limiting low-income patients' access to more expensive medicines.

A coalition of drug makers sued Health and Human Services ( news - web sites) Secretary Tommy Thompson for approving Michigan's 6-month-old "preferred drug list" program for Medicaid recipients.

Medications can only get on the list if its manufacturer agrees to offer the drug at a steep discount. If doctors want to prescribe a drug not included on the list, they must get prior approval from the state.

"State programs that restrict access, we feel, violate federal law and can result in harmful consequences to the country's most vulnerable patients," said Jan Faiks, a lawyer for the Pharmaceutical Research and Manufacturers of America or PhRMA.

PhRMA wants U.S. District Court Judge John Bates to stop Michigan's program and similar initiatives in other states. Florida and Louisiana also have the preferred drug list programs, while Connecticut, Missouri, Hawaii, Illinois, Minnesota, Mississippi, New Mexico, North Carolina, Ohio, Vermont and West Virginia are in various stages of implementing such programs, according to PhRMA.

PhRMA attorneys said they are not opposed to preferred drug lists, but decisions about which medicines to include on the list must be based on medical reasons, not price.

In Michigan, a panel of doctors and pharmacists appointed by the governor helped decide which drugs would appear on the preferred drug list. State officials say they included a few drugs that weren't discounted because there were no alternatives.

The states say limiting prescription drug costs is necessary to control skyrocketing Medicaid costs. Michigan spends about $1 billion a year on prescriptions for low-income patients, and the state expects its preferred drug list will save about $42 million this year.

When lawyers opposed to the cost-cutting plans said such plans can harm Medicaid patients by withholding their drug of choice, Bates questioned whether alternative cuts affecting Medicaid would be worse.

And the judge criticized Michigan for not providing a written explanation as to why specific drugs are kept off the preferred list. Michigan's attorney, Charles Cooper, responded that any drug kept off the list "lacks special therapeutic advantage."

Michigan's Court of Appeals is scheduled to hear PHRMA's arguments in a separate case on Sept. 5. Lawsuits also are pending in other states.

Bates did not say when he would make a decision in the case.

Spokesmen for the Department of Health and Human Services ( news - web sites) and the Michigan's Department of Community Health declined to comment on the hearing Wednesday.

On the Net:

Pharmaceutical Research and Manufacturers of America:

Health and Human Services:


Teens Easy Prey for Tobacco 

By Amanda Gardner
HealthScoutNews Reporter


Wednesday, August 28, 2002

WEDNESDAY, Aug. 28 (HealthScoutNews) -- Kids who think they can smoke just a couple of cigarettes a week without getting addicted are fooling themselves.

A study appearing in the new issue of Tobacco Control says that teens can get hooked on nicotine very quickly -- and by extremely low levels of tobacco. Sometimes, even a puff is enough.

Until now, many scientists had thought that addiction happened gradually over time. "They assumed people had to be fairly heavy smokers before they were at risk for addiction," says Dr. Joseph DiFranza, lead author of the study and professor of family medicine and community health at the University of Massachusetts School of Medicine.

The new study seems to turn that theory on its head.

The researchers interviewed 679 seventh-grade students (aged 12 to 13 years) at seven public schools in central Massachusetts over a 30-month period.

Addiction was assessed using several different measures, including signs of withdrawal (irritability, anxiety) and psychological yardsticks, including whether the students felt they needed to smoke or had ever tried to quit.

Forty percent of the 332 students who said they'd tried tobacco -- even a puff -- reported symptoms of addiction. Teenage girls took an average of three weeks to get hooked. Half of the boys sampled were hooked within six months. Sometimes, though, kids were hooked in just a few days.

Adolescents who showed signs of being hooked were smoking an average of two cigarettes a week. Many appeared to be addicted before they were smoking on a daily basis, indicating that addiction actually precedes tolerance to nicotine.

The findings strongly suggest that teens are more vulnerable to nicotine dependence than adults, possibly because the brain is still developing through adolescence. Ninety percent of smokers start by the time they are 18, DiFranza says.

The study authors actually invented a new term -- "juvenile onset nicotine dependence" -- to highlight the differences between adults and youths when it comes to tobacco.

The findings also suggest that teens are a key population to target for prevention and cessation campaigns.

"All of the cessation trials that had been conducted up to this point required kids to be smoking like adults in order to get in," DiFranza says. "Now we know those smoking only a few cigarettes a month may need a great deal of help in order to be able to quit."

Robert Baker, a clinical psychologist in the department of psychiatry at the Ochsner Clinic Foundation in New Orleans, says the new study is "actually not news to me. I have maintained since 1976 or 1977 that one cigarette will pretty much do it for a number of people, although they may not know it at that point."

"The value of this study is that it suggests it may take even less than that. It brings into consciousness again just how addictive [tobacco] is," adds Baker, who started Ochsner's Center for the Elimination of Smoking more than 25 years ago.

DiFranza is calling for new research into cessation methods, including finding out how to help kids who don't consider themselves smokers. "A lot of kids who are addicted think of themselves as social smokers," he says.

"It's good to emphasize with kids that probably one cigarette will do it. You're really playing Russian roulette," Baker says.

Peer pressure may be a more effective strategy than some of the health "scare" tactics that are directed toward adults, Baker says. "With adolescents, you get this sense of immortality," he says.

Ultimately, the most effective message is not to start smoking. "It's kind of like playing war games," Baker notes. "The best way to win is not to play."

What To Do

For more information on children and smoking, check the Campaign for Tobacco-Free Kids or the Centers for Disease Control and Prevention.


An Ounce of Prevention . . . 


Wednesday, August 28, 2002

WEDNESDAY, Aug. 28 (HealthScoutNews) -- Preventive occupational therapy is a cost-effective way to improve quality of life for senior citizens.

So says a University of Southern California (USC) study in the August issue of the Journal of the American Geriatrics Society.

The benefits include improved physical and emotional health, and a decrease in medical costs.

"Occupational therapy is highly cost-effective and a much better use of scarce health-care resources than many other interventions routinely prescribed for senior citizens, which may have a marginal benefit to the overall health of the patient," says lead author Joel Hay, an associate professor of pharmaceutical economics and policy at the USC's School of Pharmacy.

"We held the treatment up against the industry standard for measuring cost-effectiveness, comparing it to therapies such as heart bypass surgery and breast cancer ( news - web sites) chemotherapy. We demonstrated that occupational therapy is an enormous value for the money," Hay says.

The 15-month study included three groups of independent adults over age 60 living in federally subsidized housing in Los Angeles. One group took part in an occupational therapy lifestyle redesign program, another group took part in organized activities but didn't receive occupational therapy, and the third group received no intervention.

"What is particularly important is the significant quality-of-life improvements that the occupational therapy group reported were achieved without increasing health-care costs compared with the control groups," Hay says.

"Through lifestyle redesign by an occupational therapist, each senior citizen enacted a health-promoting routine that was customized for their life situation," says principal investigator Florence Clark, chairwoman of the USC department of occupational science and occupational therapy.

"The key is to build healthy habits into daily routine that is sustainable, and will allow elders to improve their quality of life over time," Clark says.

More Information

The American Occupational Therapy Association has more on this issue.


Anti-Allergy Covers Don't Aid Asthmatics 


Wednesday, August 28, 2002

WEDNESDAY, Aug. 28 (HealthScoutNews) -- If you believe anti-allergic mattress covers help you control your asthma, you may want to sleep on that.

A new study in the journal Thorax found the covers offered no clinical improvement in people with moderate to severe asthma who already use regular treatment to control their asthma.

But the mattress covers do reduce exposure to house dust mites during the night.

The study included 30 non-smokers with asthma who were allergic to dust mites. Sixteen of them used anti-allergic mattress covers for a year and 14 used matching placebo mattress covers. All the people in the study stayed on their normal asthma medication and there was no carpeting in any of their bedrooms.

The researchers measured the subjects' bronchial hyper-responsiveness and quality of life before and after the study period. The patients were asked to score their lung and nose symptoms, morning and evening peak flow values, and their medication use over the course of the study.

Dust samples to determine dust mite allergen (Der p 1) concentrations were taken from the mattress covers before and after the study.

Der p 1 concentrations were much lower after one year on the anti-allergic mattress covers compared to the placebo covers. Both groups of people showed no significant improvements in histamine levels or quality of life, the study found.

Neither group showed much change in lower airway symptoms, morning and evening peak flow values, or use of medication.

The group using the anti-allergic mattress covers did show a decrease in nasal symptoms, but that change wasn't much different than the one in the placebo group.

The authors conclude that anti-allergic mattress covers do reduce house dust mite exposure, but that reduction didn't benefit people with moderate to severe asthma. They say that may be due to the chronic stage of the asthma and/or limiting allergen avoidance measures to the bedroom.

The researchers suggest future studies should examine whether avoidance measures during the day and night in the early stages of asthma are more effective.

More information

For additional insight into home controls for those with asthma, the American Lung Association offers these tips.


Don't Let Back Pain Paralyze You 

By Randy Dotinga
HealthScoutNews Reporter


Wednesday, August 28, 2002

WEDNESDAY, Aug. 28 (HealthScoutNews) -- Anyone who has ever had back pain knows the idea of moving around can be terrifying, but experts say facing your fears is critical to recovery.

No one knows how many Americans with lower back pain become afraid of making any sort of movement that might make their pain worse. However, psychologists have given the condition a name: kinesiophobia.

Slowly reintroducing someone with back pain to normal movement seems to work the best, just as gradual exposure to spiders can cure someone of arachnophobia, says Johan W.S. Vlaeyen, an associate professor of behavioral medicine at Maastricht University in the Netherlands. He spoke on the topic last week at the 10th World Congress on Pain in San Diego.

Humans have a built-in "fear network," he says, and it sometimes requires reprogramming. "Fear reduction only occurs when the fear network is activated, and new information is provided. The most convincing information is personal experience," he explains.

"There is a tendency to stay as still as possible to avoid any more pain," Vlaeyen explains, and those who are afraid of moving become "hypervigilant," watching their bodies carefully for any sign of problems.

"They continuously scan their body for pain and dangerous sensations," he says. "The fearful are better body scanners than their low-fear counterparts."

However, inactivity can actually make a person's pain worse as muscles atrophy and fail to tolerate simple tasks, says Dr. Bill McCarberg, director of the chronic pain management program for the Kaiser Permanente health plan in San Diego. "Muscles can have trouble reactivating to handle normal kinds of events like getting out of bed or standing in the grocery store, bending over and putting shoes and socks on."

McCarberg says the wide majority of patients don't have phobias but simply want to avoid activity that makes them hurt. "You need to keep the person as active as you can, despite pain," he says.

In cases where there is a phobia, the best approach to change a person's attitudes is exposure to movement, Vlaeyen says. Reassurance is least likely to make any sort of difference, and education isn't always effective.

Instead, patients must actually make the movements they're afraid of, he says.

During treatment, patients look at pictures and describe which activities frighten them the most. "Then they go through experiments to see if these certain activities lead to injury," he explains.

The therapy seems to work, he says. "Their fear levels drop drastically."

What To Do

For more information about back pain, go to the National Library of Medicine or the American Academy of Orthopaedic Surgeons.



Poor Air Ups Diabetics' Risk of Heart Ills: Study 

Reuters Health

Tuesday, August 27, 2002

NEW YORK (Reuters Health) - While a number of studies have concluded that air pollution can exacerbate heart disease, new findings suggest that diabetics ( news - web sites) may be particularly vulnerable.

The investigators found that on days with high levels of particulates in the air, diabetics were twice as likely as non-diabetics to be hospitalized for cardiovascular problems. Particulates include dust, soot and other tiny bits of solid materials that are released into and move around in the air.

In the study, Drs. Antonella Zanobetti and Joel Schwartz of the Harvard School of Public Health in Boston, Massachusetts, evaluated hospital records from four US cities: Chicago, Illinois; Detroit, Michigan; Pittsburgh, Pennsylvania; and Seattle, Washington. They compared daily hospital admissions for patients older than 65 with the levels of particulates in the air. All of the cities monitored air particulates on a daily basis during the study period, 1988 to 1994.

The researchers found that, overall, hospital admissions for cardiovascular reasons increased slightly along with elevations in air particulates. But the percentage increase among diabetics was roughly double that of non-diabetics, they report in the September issue of the journal Epidemiology.

Particulate matter--tiny particles that are largely the byproduct of combustion at power plants and in car engines--is a health concern because it can penetrate the sensitive regions of the respiratory tract. Fine particles are of greatest concern because they are linked to the most serious effects, including persistent cough, phlegm production, wheezing and physical discomfort, according to the US Environmental Protection Agency ( news - web sites) (EPA).

Previous research has suggested heavy-pollution days take a toll on the heart, increasing not only heart attack risk, but also sending up blood pressure, accelerating heart rate and causing problems with implanted heart defibrillators.

Experts speculate that when fine particles are deposited in the lungs, this sets off an inflammatory response that may make blood flow more sluggish and prone to clotting. In people with artery-clogging plaques, such cardiovascular stress may trigger a heart attack.

"We conclude," Zanobetti and Schwartz write, "that diabetics are a population that is particularly susceptible to cardiovascular damage by airborne particles."

Source: Epidemiology 2002;13:588-592.


Caffeine Said to Lower Cancer Risk  

By Paul Recer

AP Science Writer

The Associated Press

Tuesday, August 27, 2002

WASHINGTON (AP) - Laboratory mice slathered with caffeine developed fewer skin tumors than untreated animals, suggesting the chemical that adds zip to coffee and tea also may protect against skin cancer, researchers say.

Dr. Allan Conney, a professor of cancer and leukemia research at Rutgers University, said a skin lotion spiked with caffeine or with another compound found in green tea reduced by more than half the number of skin tumors on hairless mice that had been exposed to high levels of ultraviolet radiation.

"We had between 50 to 70 percent tumor formation inhibition in the mice that were treated with caffeine or with EGCG (the other chemical compound)," said Conney, senior author of a study appearing this week in the online site of the Proceedings of the National Academy of Sciences ( news - web sites).

Skin cancer is the most common of all cancers in the United States. The American Academy of Dermatology estimates about a million cases will be diagnosed in the country this year. Among them will be more than 88,000 new cases of melanoma, the disease's deadliest form. Skin cancer generally is curable by cutting, burning or freezing the tumor cells, but left untreated it can be deadly.

To test the effects of caffeine on skin cancer, Conney and his colleagues exposed 90 mice to high levels of ultraviolet radiation twice a day for 20 days. They used a strain of animals called hairless mice, commonly used for skin cancer studies.

After the mice got their UVB doses, the animals were divided into three groups. One group was anointed daily with a solution of acetone and caffeine. Another group received acetone and EGCG. The third group got skin applications of acetone only. Acetone is an organic solution often used on the skin.

At the end of 18 weeks, the three groups of mice were killed, and the level of skin tumor formation was analyzed.

Conney said mice in all three groups developed malignant skin tumors, called squamous cell carcinomas, but the number of tumors per mouse was reduced by 72 percent in those treated with caffeine and by 66 percent among those treated with EGCG, compared to the controls treated only with acetone.

The treated mice also had fewer nonmalignant, sunlight-related tumors, said Conney. Compared to the control group of mice, the mice treated with caffeine had 44 percent fewer nonmalignant tumors and the EGCG group 55 percent fewer, he said.

Conney said that although both compounds were effective in lowering tumor risk, caffeine has an advantage because it is chemically more stable than EGCG.

Unlike sun screen lotions, which protect against skin cancer by preventing the skin from absorbing ultraviolet rays from the sun, the caffeine's cancer protection works in the cells after exposure to the ultraviolet rays. Rays from the sun can cause genetic changes in the skin that can lead to skin cancer. Conney said caffeine apparently blocks this action by causing abnormal cells to kill themselves, a type of programed cell suicide that prevents the development of abnormal growths.

"This is not a sunscreening effect," said Conney. "It is a biological effect."

He said the caffeine acts selectively, causing the abnormal cells to die but not affecting the normal cells.

Caffeine, heavily consumed in coffee, tea and some cola drinks, has been shown in other studies to prompt mental alertness in many people. Some studies have suggested caffeine aggravates symptoms of menopause or intensifies the side effects of some antibiotics. Heavy caffeine use has been linked to miscarriage. Some studies also have suggested that some people can become addicted to caffeine and can experience headaches and other symptoms when deprived of their morning coffee or cola.

Dr. Darrell Rigel, a professor of dermatology at New York University and an expert spokesman for the American Academy of Dermatology, said research like Conney's is needed badly because skin cancer is a major problem.

"I hope this treatment can prove itself, because there are more skin cancers than all other cancers combined in the U.S.," he said.

He said there is a need for a "morning-after" treatment for skin cancer, a therapy that would reduce cancer risk after excessive sun exposure.

Rigel said that although hairless mice are commonly used for such research, "there is really no good animal model for skin cancer. The hairless mouse is the best of a bunch of bad choices" for testing skin cancer compounds in the laboratory.

As a result, he said, "a lot of things that work in mice cannot be extrapolated to humans."

He said other treatments that showed promise in mice have often failed when tried on humans.

Conney said the next step in studying the topical effects of caffeine will be to use the solution on people who are highly susceptible to skin cancer people who have a precancerous condition or who already have had skin cancer.

In another study in Proceedings, researchers studying the effects of alpha and gamma radiation on cells found caffeine prevented some genes from being repaired after they were damaged by radiation. The study, by researchers at Eleanor Roosevelt Institute and Los Alamos National Laboratories, used Chinese hamster ovary cells in a laboratory dish for their study.

On the Net: American Academy of Dermatology:

Rutgers University:


The Secret Garden Wars 

HealthScout News

Tuesday, August 27, 2002

If you think that wonderful smell of freshness that shows up after a summer rain is just nature's way of pleasing you, think again. It really is a jungle out there -- and there's warfare going on.

That pleasant smell of your lawn after a rain shower, for instance, emanates from some pretty unpleasant chemicals produced in a microscopic world by soil-dwelling bacteria fighting for territory.

More noticeable to humans in the increased humidity after a rain, the microbes send out poisonous blasts of gas to keep away competitors, says author David Bodanis in his book, The Secret Family.

Another sweet smell of a humid summer day comes from shrubs that "send an odoriferous alcohol upward to spotlight the point where they're being attacked by caterpillars or other gnawing insects," writes Bodanis. The chemical message is aimed at wasps, to attract them to the munching crawlers that are their prey.

More of the aroma of summer comes from flowers planted too closely together. Bodanis says their roots send hydrogen cyanide into the soil to annihilate competing neighbors. Still another gas is sent out by rose bushes trying to counter attacking fungi.


Exercise May Lower Blood Vessel Inflammation 

Reuters Health

Tuesday, August 27, 2002

NEW YORK (Reuters Health) - Exercise has long been known to cut the risk of heart disease, and now the results of a new study show it may do so, in part, by reducing inflammation inside blood vessels.

Levels of C-reactive protein (CRP), a compound that is used to gauge inflammation in the body, were lower among study participants who reported the most physical activity.

The body releases CRP as part of its response to infection and injury. During infection, blood CRP levels temporarily soar as the immune system jumps into action. More subtly, chronic CRP elevations have been linked to an increased risk of heart disease and type 2 diabetes, and inflammation is believed to play a key role in the hardening and narrowing of arteries that can lead to heart attack and stroke.

"The results of this study showed that physical activity is inversely associated with C-reactive protein concentrations, suggesting that physical activity may mitigate inflammation," Earl S. Ford, from the Centers for Disease Control and Prevention ( news - web sites) in Atlanta, Georgia, reports in the September issue of Epidemiology.

More research into the mechanism by which exercise affects CRP, as well as studies investigating the intensity, duration and type of activities that influence inflammation, are needed, he adds.

Ford analyzed data on nearly 14,000 adults participating in an ongoing US medical study. He looked at concentrations of CRP in relation to each individual's self-reported exercise habits, and took into account other factors that can influence levels of the protein, including smoking, blood pressure, body mass index (BMI), aspirin use, age and gender.

Ford found that participants' blood concentrations of CRP declined as levels of activity rose. For instance, just 8% of vigorous exercisers had elevated CRP, compared with 13% of moderately active and 21% of sedentary adults.

What's more, exercise was associated with a lower white blood cell count, another marker of inflammation and disease, and with lower levels of the protein fibrinogen. Elevated blood fibrinogen can increase the risk of clotting and stroke.

Levels of physical activity were, on average, lower among older people, smokers and those with high blood pressure and cholesterol. Overweight individuals and those with lower levels of education also reported less activity, while men, white adults and those who consumed the most alcohol, fruit and vegetables tended to exercise more than their peers.

"Research to delineate the exact mechanisms through which physical activity influences the inflammatory process will help improve our understanding of some of the benefits of physical activity," Ford concludes.

Source: Epidemiology 2002;13:561-568.


Artificial Heart Recipient Dies  

By Joan Loviglio

Associated Press Writer

The Associated Press

Tuesday, August 27, 2002

PHILADELPHIA (AP) - A retired baker and Vietnam veteran who was the world's fifth recipient of a self-contained artificial heart has died, almost 10 months after being implanted with the device.

Doctors at Hahnemann University Hospital said they were unsuccessful in improving James Quinn's condition after he suffered a stroke last week. He was withdrawn from life support Monday.

"In every aspect, James Quinn was a hero," said Dr. Louis Samuels, director of the surgical team that installed the heart. "He fulfilled his wish to be a pioneer, to live a little longer to see his grandchildren, and to contribute something to mankind."

Of the seven people implanted with the device beginning more than a year ago, only one is still alive.

Quinn, 52, was implanted with the AbioCor heart on Nov. 5. One month later, he walked without assistance into a news conference, a small battery pack on a belt around his waist the only evidence of his transplant.

The West Philadelphia man suffered a stroke in December but was strong enough to be moved the following month from the hospital to a nearby hotel suite, allowing his wife to stay with him and caregivers in an adjoining room to monitor his condition.

He was taken back to the hospital Feb. 3 after developing breathing difficulties, which turned into pneumonia.

In the months before he died, Quinn was able to take several excursions from the hospital to attend church, go home for his wedding anniversary, visit family and friends and even go to a comedy club.

"To me, it was either do or die. There really wasn't much to think about," Quinn said about the operation. "I understood that I would be a pioneer ... if this thing worked or if it didn't work I would be giving something to mankind."

The AbioCor heart was implanted in seven patients, all of whom were dying of heart failure and were too sick to qualify for human heart transplants.

Tom Christerson, 71, the sole living recipient of the device, is back home in Central City, Ky., after being implanted with the device Sept. 13.


Taking America's Pulse 


Tuesday, August 27, 2002

TUESDAY, Aug. 27 (HealthScoutNews) -- A new national survey shows that 23 percent of Americans aged 18 and older report they have high blood pressure, 10.3 percent report they have heart disease, 9.1 percent have asthma and 6.2 percent have diabetes.

The information is from the Agency for Healthcare Research and Quality's Medical Expenditure Panel Survey in 2000.

The annual survey gathers information on health-care use, quality access and the population's health status.

Here are some other findings from the 2000 survey:

         About 43 percent of Americans aged 18 and older who have public health insurance reported they have high blood pressure. That figure was 21.5 percent of people with private insurance and 13.2 percent of people with no health insurance.

  • Hispanics aged 18 and older were less likely than blacks, whites or any other groups of people to report they have heart disease, high blood pressure or asthma.
  • Blacks and Hispanics were more likely than other people to report having diabetes.
  • People aged 18-64 who have diabetes and no health insurance were less likely than people with private health insurance to report having a Hemoglobin A1C test, or to have their feet checked for sores or irritations.
  • People with heart disease aged 65 and older were more likely (98.6 percent) than people with heart disease aged 18-64 (92.9 percent) to report they had their blood pressure checked in the last year. Those over 65 with heart disease were also more likely (89.2 percent) than people aged 18-64 with heart disease (75.3 percent) to have had a routine checkup in the past year.
  • Among people aged 18 and older who had a stroke, 58.7 percent said they'd been advised by a health-care provider to exercise more, and 59.1 percent said they'd been told to change their diet.

More Information

Here's an overview on the Medical Expenditure Panel Survey.


Bulk of Kids' Liquid Intake Is Hi-Cal Sodas, Juices 

Reuters Health

Tuesday, August 27, 2002

NEW YORK (Reuters Health) - More than half of the average American child's daily liquid intake now comes in the form of sugary sodas, juices and high-calorie drinks, researchers report.

Kids who drink more sweetened beverages also have a higher overall calorie intake, are less likely to eat fruit, and are at higher risk for obesity, note Dr. Karen Weber Cullen of the Children's Nutritional Research Center at Baylor College of Medicine in Houston, Texas and colleagues. The researchers believe their study is the first to look at the relationship between consumption of sweetened drinks and food intake.

Cullen conducted the research while at the University of Texas M.D. Anderson Cancer Center, also in Houston.

She and her colleagues analyzed food records from 505 students in grades four through six. Students completed the records over a 3- to 7-day period.

Overall, sweetened beverages made up 51% of the children's daily liquid intake. Kids with the highest consumption of sweetened drinks took in 330 calories more each day than those with the lowest intake. And students with the highest sweetened drink consumption consumed 62% less fruit than those with the lowest.

"Perhaps sweetened beverage consumption is a marker for poor dietary habits or reflects meal sources with few fruit selections and many high-fat food selections," the Texas researchers speculate in their report, published in the September issue of the American Journal of Public Health, journal of the American Public Health Association ( news - web sites).

They recommend that caretakers encourage children to drink healthier beverages such as low-fat milk and water.

Source: American Journal of Public Health 2002;92.


Got a Frog in Your Throat? 


Tuesday, August 27, 2002

(HealthScoutNews) -- If someone tells you they think something is stuck in their throat, take them seriously. Even relatively smooth or rounded objects that remain impacted in the esophagus have the potential for serious problems. And something sharp, such as a fish bone, can perforate the esophagus in only a few days, says a report published by the National Center for Emergency Medical Informatics.

According to Buttaravoli & Stair's Common Simple Emergencies:

  • A pill composed of irritating medicine (e.g., tetracycline) swallowed without adequate liquid may stick to mucous in the pharynx or esophagus and cause an irritating ulcer.
  • Bay leaves, invisible on x-rays and laryngoscopy, can lodge in the esophagus and produce severe symptoms until removed via rigid endoscope.
  • On the other hand, the sensation of a lump in the throat, unrelated to swallowing food or drink, may be globus hystericus, which could be related to anxiety.


1/3 of Americans Have Pre-Diabetes Syndrome: Report

By Maggie Fox


Tuesday, August 27, 2002

WASHINGTON (Reuters) - As many as one in three Americans has a condition called insulin resistance syndrome, putting them at high risk of diabetes and heart disease, a panel of doctors said on Tuesday.

But diet and exercise can take care of the condition in many, if not most, cases, and a few simple tests can tell doctors and patients who is at most risk, the experts said.

In insulin resistance syndrome, also known as metabolic syndrome or syndrome X, a person loses his or her ability to manage insulin effectively. More and more people--children as well as adults--are developing the condition as the population eats more and exercises less.

Left untreated, the syndrome can develop into diabetes as well as heart disease, nonalcoholic fatty liver and perhaps some cancers, including colon and ovarian cancer.

On Tuesday a committee of experts from four top medical organizations--the American College of Endocrinology, American Association of Clinical Endocrinologists ( news - web sites), American Medical Association and the American College of Physicians-American Society of Internal Medicine--issued official guidance on how to diagnose the condition.

"As the prevalence of insulin resistance syndrome has skyrocketed 61% in the last decade, it is crucial that medical professionals have consistent and definitive criteria to assess this serious condition," Dr. Daniel Einhorn of the Scripps Whittier Institute for Diabetes in La Jolla, California, and co-chair of the panel, told a news conference.

"We feel that as many as one in three Americans have this," Einhorn added in an interview.

Einhorn said pediatricians report that 7- to 10-year-old children are developing metabolic syndrome, obesity and type 2 diabetes--once seen only in adults.

"We never saw this before," Einhorn said. "Pediatricians are having to learn about adult medications."

No single test can identify insulin resistance syndrome, but measurements of weight, blood pressure, cholesterol and glucose tolerance can. One quick check that people can do at home is waist circumference, the experts said--men with 40-inch waists and women with 35-inch waists are at higher risk.

Details are available on the Internet at

Other indications a person may have insulin resistance syndrome are polycystic ovary syndrome, which Einhorn believes may affect up to one in 10 women. The condition is marked by infertility, excess facial hair and obesity.

In addition, there is a skin condition, acanthosis nigricans, linked with the syndrome.

What can patients do if diagnosed with insulin resistance?

"It doesn't require draconian measures," Einhorn said. Losing 5% to 10% of total body weight will help a good deal--and studies show that as little as 20 minutes of extra exercise such as brisk walking, 5 days a week, can help most people lose that much weight.

It is not necessary to cut out all sweets, he added. And like many doctors, Einhorn does not believe claims that carbohydrates are to blame for obesity.

"It is not any one thing that's the culprit," Einhorn said. "It's not just the fast food. It's not just the pastries. It's a combination of genetics and the diseases of modern living--obesity and sedentary living."


Fish and Nuts Are Brain Foods 

By Ross Grant
HealthScoutNews Reporter


Tuesday, August 27, 2002

TUESDAY, Aug. 27 (HealthScoutNews) -- The essential fats found in fish and nuts help more than your heart.

They can also reduce memory loss and strokes, claims a new study.

"When we don't have enough omega-3 and omega-6 fatty acids in our system, it can lead to a heart attack or a stroke. You're not getting enough oxygen to your brain, and you are overloading your heart," explains study author Vallie Holloway, a researcher at Loyola University Medical Center in Maywood, Ill.

Those two fatty acids, which are found in fish, nuts, seeds and some oils, are needed for a long list of body functions. However, while the human body manufactures most of the fats it needs, it does not make these two elements, requiring people to get them from their diets.

A string of recent studies have linked these essential fats to healthy hearts and blood vessels, but Holloway's study also targeted the effects of one of them, omega-6, on brain function.

"I would like to either stop or retard Alzheimer's disease ( news - web sites)," says the researcher, who was to present her findings today at the American Physiological Society's convention in San Diego.

Holloway studied 180 rats for a year to examine how their diets influenced their blood pressure and memory. Half of the rats were bred to have high blood pressure, and the other half were bred for low blood pressure. While all of the rats were given a normal diet and a regular regimen of maze-running, half of each group also got a supplement of omega-6 fatty acids.

The results were striking. The hypertensive rats that didn't get the omega-6 supplement saw their blood pressure increase as their brain function decreased. At four months, the rats had already forgotten part of the maze, and at six months their memory functions were badly deteriorated.

"It was like they were aging before your eyes," Holloway says.

By contrast, the hypertensive rats that got the supplement realized a drop in blood pressure and held onto their memory functions much longer. Rather than four months, these rats started forgetting parts of the maze at six months.

Holloway explained her results by focusing on the fats that clog blood vessels. In the feeder blood vessels in the brain, plaque buildup can cause clotting, which leads to strokes and Alzheimer's. At the same time, clogging of the arteries forces the heart to work harder in pumping blood, leading to possible heart failure.

Ironically, the body has a mechanism to limit this buildup, but poor nutrition often stands in the way, she says. When the brain senses an increase in the blood pressure, it sends a signal through the blood vessels to dilate the vessel walls, thereby allowing more blood to pass through. However, the process requires omega-6 and omega-3 fatty acids, which are often in short supply in the body, especially in old age.

"Basically your body doesn't produce enough of the chemical to dilate the blood vessels," Holloway says. "When we get older we need lots of things, and this is one of them."

Ann Yelmokas McDermott, a researcher at Tufts University's Friedman School of Nutrition Science and Policy in Boston, argues the broader issue is finding the proper balance between these two fats. People can't just take supplements of both because they compete for the same enzymes within the body, she says.

"The omega-6 takes care of one set of problems, and the omega-3 takes care of another set of problems. We need them both. But the ratio has to be correct," McDermott says. "The American diet is very high in omega-6 rather than omega-3 fats. It's thought that it should be the inverse for optimal health."

She argues that we should take in one part omega-3 fats to four parts omega-6 fats. Yet the ratio for most American eaters is 9-1. In Japan, where more people eat fish and live longer, the ratio is 1-1. In some European diets, the ratio is 12-1, McDermott says.

To find a better ratio, people can make a few simple substitutions in their diets. For example, instead of safflower oil, which has 77 parts omega-6 to one part omega-3, try canola oil, which is 2-1. Instead of margarine, 13-1, try butter, 1.5-1.

"What does this research mean to human beings? It shows that food can affect health and have medicinal properties," McDermott says. "Our bodies can't create these fatty acids themselves. So they're a big deal to our health."

What To Do

To compare the ratios of the two fatty acids in various foods, visit the University of Montana. Or learn about the benefits of fish from the American Heart Association.


Young Widowers at High Risk of Suicide: Report 

By Alison McCook

Reuters Health

Tuesday, August 27, 2002

NEW YORK (Reuters Health) - Young white men widowed between the ages of 20 and 34 are 17 times more likely to kill themselves than their married peers, new study findings show.

This trend is not limited to whites: among African-American men who are widowed when relatively young, the risk of suicide increases ninefold relative to their married counterparts, according to Dr. Jane L. Pearson of the National Institute of Mental Health and her colleague Jason B. Luoma.

Pearson and Luoma obtained their results from surveys of death certificates completed between 1991 and 1996, which included information about marital status.

The investigators found that suicide rates were highest among young widows and widowers, although men showed a higher risk than women.

In young adults, being widowed was linked to a higher risk of suicide than being divorced, but that pattern appears to reverse as men and women age, Pearson and Luoma add. Among older adults, men and women who divorce were more likely to kill themselves than those whose spouses pass away. This reversal occurs much earlier in women than in men.

Overall, in both sexes and races, as well as in all age groups, married people appear to be less likely to commit suicide than people with another marital status, the authors write in the September issue of the American Journal of Public Health, the journal of the American Public Health Association ( news - web sites).

In an interview with Reuters Health, Pearson said that little research has focused on the reasons why a spouse's death might cause people to take their own lives. The risk of committing suicide will likely relate to history of mental health and characteristics of the relationship, but may also be linked to difficult periods related to the loss of a loved one, she noted.

"One type of a high-risk period could be early after the loss--initial trauma and shock--or a type of high-risk period could be after the loss--grief that doesn't resolve, or additional losses that happen later," she speculated.

Researchers remain equally unclear as to why men appear to have a higher risk of killing themselves after a spouse's death than women do, Pearson added. In general, men are more likely to kill themselves than women, a finding that some attribute to the fact that women are more likely to use less lethal methods to attempt suicide than men. Furthermore, women also tend to rely on social support, which may protect them from suicide, she added.

"We need to test interventions to understand who benefits from what type of treatments," Pearson said. Some widows and widowers say support groups made up of people in similar situations have helped them. "But for others, it may be that repeated 'exposure' to the trauma through repeated telling and questioning may not be so helpful," she noted.

Pearson pointed out that some researchers have also suggested that treating widowed spouses' depression may help decrease their risk of suicide, as well.

"But we need to understand this better so we don't make people worse, despite our good intentions," she concluded.

Source: American Journal of Public Health 2002;92.


A New Liver Can Affect Your Mind 


Tuesday, August 27, 2002

TUESDAY, Aug. 27 (HealthScoutNews) -- A lifetime of booze can leave some liver transplant patients dazed and confused, says a new Mayo Clinic study.

The researchers report in tomorrow's issue of Neurology that they found almost half of people who had liver transplants necessitated by alcoholism suffered acute confusion after their transplant operations.

That short, but severe, confusion, affected 19 of 40 people with alcoholic-liver disease, compared to three of 47 of people with hepatitis C who had liver transplants.

All the people received liver transplants between 1990 and 2000, and were 50 to 70 years old.

The alcoholic patients who suffered acute confusion did so within three to 31 days after their transplant. This mental confusion included interrupted sleep patterns and disorientation -- such as uncertainty about whereabouts and time. The people who suffered the acute confusion also had longer recovery times and hospital stays, the study says.

The phenomenon may have two major causes, says study author Dr. E.F.M. Wijdicks, a Mayo clinic neurologist.

The first may be high levels of ammonia. It's a toxin that an unhealthy liver may no longer be able to convert into urea. The second cause may be alcohol-related brain damage, Wijdicks says.

More Information

Here's more information on cirrhosis of the liver.


Jury Still Out on Antibiotics for E. Coli Infection 

Reuters Health

Tuesday, August 27, 2002

NEW YORK (Reuters Health) - Treating E. coli food poisoning with antibiotics does not seem to increase the risk of a potentially fatal complication that occurs in a small number of children infected with the bug, according to a new report.

But investigators caution that more research is needed to be certain that antibiotics are safe for treating infections with this type of E. coli.

About 6% of patients who develop diarrhea from infection with the O157:H7 type of E. coli bacteria ( news - web sites) suffer a complication called hemolytic uremic syndrome (HUS), which destroys red blood cells, drastically reduces blood platelets and can lead to kidney failure. Children younger than 5 are among those at highest risk of HUS.

The use of antibiotics to treat E. coli O157:H7 is controversial, in part because studies have not shown the drugs to shorten the duration of diarrhea. And some research has suggested that antibiotics may even boost the risk of HUS.

However, studies that have examined this connection have been small, have included a variety of antibiotic regimens, and the results have been conflicting, according to the authors of the new study.

To determine whether antibiotics do influence the risk of HUS in patients infected with E. coli O157:H7, a team led by Dr. Dennis G. Maki, of the University of Wisconsin in Madison, used a technique called meta-analysis, which involves pooling data from a number of studies to reach an overall conclusion.

The researchers looked at nine studies that included more than 1,000 people. They turned up no link between antibiotic use and HUS in patients with E. coli O157:H7, according to findings published in the August 28th issue of The Journal of the American Medical Association ( news - web sites).

Individuals who were treated with antibiotics were more likely to develop the complication, but the increased risk was statistically insignificant, meaning that it could have been a result of chance.

Still, Maki and his colleagues conclude that there is not enough evidence to rule out the possibility that antibiotics may be harmful for some patients infected with E. coli O157:H7. They say a large, randomized trial that includes several different strains of E. coli O157:H7 is needed to determine whether it is harmful to use antibiotics to treat critically ill children and adults who are believed to be infected with the bug.

According to the report, the timing and duration of antibiotics, which the researchers were not able to make adjustments for, could also affect the risk of HUS.

"The authors appropriately conclude that the currently available data, including their meta-analysis, are insufficient to resolve the issue," according to an accompanying editorial.

In the meantime, there is no easy answer for doctors and patients, note the editorial's authors, Dr. Kare Molbak of Statens Serum Institut in Copenhagen, Denmark, and Drs. Paul S. Mead and Patricia M. Griffin, both from the Centers for Disease Control and Prevention ( news - web sites) in Atlanta, Georgia.

For most patients with diarrhea--caused by E. coli or not--antibiotics are not recommended, the editorialists point out. But they add that such treatment may be appropriate for some patients, such as those who have a high risk of developing invasive infections.

Source: The Journal of the American Medical Association 2002;288:996-1001, 1014-1016.


Hair of the Dog May Prevent Allergies 

By Adam Marcus
HealthScoutNews Reporter


Tuesday, August 27, 2002

TUESDAY, Aug. 27 (HealthScoutNews) -- Pets have long been blamed as a major source of allergens in the home, but a new study may give them at least a partial furlough from the doghouse.

Researchers say some children exposed as infants to two or more pets in the house are less -- not more -- likely to develop allergies to dogs, cats, and other irritants later.

The findings, appearing in tomorrow's issue of the Journal of the American Medical Association ( news - web sites), confirm earlier, counterintuitive studies from the United States and abroad showing that pet dander seems to protect children from allergies and asthma.

"For years, I've been telling people concerned about their kids and allergies that they ought to get pets out of the house," said Dr. Dennis Ownby, an allergist at the Medical College of Georgia and leader of the research team. "Now I have to retract that and tell them, 'If you're happy with pets in the home, you can continue to have them without feeling guilty.'"

Ownby took the matter a step further. "If you're going to have a pet," he said, "it's probably better to have two rather than one."

Ownby said there's a debate about why early exposure to pets is protective. His group's feeling is that animals may track in irritants from the dirty world outside the home that beef up a child's immune system. The generally increasing cleanliness in developed countries has been blamed for a recent surge in allergies and asthma.

"This suggests that there is something we can do that will, in fact, reduce risk, and if we could define what it is, maybe we could refine that and give it to kids" as a way to shield them from allergies, Ownby said.

Scientists long believed that pets posed a major source of household allergens -- and for some people that's certainly true, said Dr. Thomas Platts-Mills, an allergy expert at the University of Virginia in Charlottesville.

But, he said, there are children "who would be allergic otherwise, but because there's a cat in the house, they don't become allergic to the cat. That's very, very important, because it implies that high-dose natural exposure can give rise to a form of tolerance."

Platts-Mills, author of an editorial accompanying the journal article, estimated that as many as 20 percent of people may develop tolerance to pet allergens by living with animals.

"That's a big phenomenon," he said.

Platts-Mills, who published a study last year showing that exposure to cats can be protective against allergies, added that researchers have come to realize that not all irritants are created equal -- a commonly held view until only lately. "Twenty years ago we were really thinking it's all the same thing," he said.

In the latest study, Ownby and his colleagues followed 474 Detroit-area children from birth to age 6 or 7. By then, 33.6 percent of those with no cat or dog at home during their first year of life had developed skin sensitivity to six common irritants, including dust mites and pollen. That figure was slightly higher for those with one cat or dog, but it plunged to 15 percent among the 78 children with at least two pets.

The protective effect of having at least two animals at home during infancy was equally impressive on the number of children with blood markers for sensitivity to any of seven allergens.

After adjusting for factors that exacerbate allergies, including exposure to cigarette smoke, dust mites and a parental history of asthma, having two or more cats or dogs in the house while the child was an infant reduced the kid's risk of allergies by between 67 and 77 percent, compared with having one pet or no pets.

"This apparent protective effect includes all allergens, at least the ones we tested, and not just the one [the children] were exposed to," Ownby said.

Intriguingly, and for reasons the researchers don't understand, boys appeared to gain more lung protection from pets than girls did.

Yet even if pets may provide protection against allergies, some allergists aren't advising parents to try a little fur therapy for their children.

"Ten percent of children are allergic to cats and they're at risk of asthma, so telling people to get a cat might help some and harm others," Platts-Mills said.

Dr. Clifford Bassett, an allergy expert at the New York University School of Medicine in Manhattan, agreed.

What's more, he said, the findings don't apply for those who already react badly to animals.

"People who have pet allergies that have been diagnosed should continue to avoid pet exposure," Bassett said.

What To Do

For more on allergies, try the American Academy of Allergy, Asthma and Immunology. And for a look at how allergens trigger an immune reaction, check out HowStuffWorks.


Personal Reminders Up Rate of Repeat Mammography 

Reuters Health

Tuesday, August 27, 2002

NEW YORK (Reuters Health) - Women who are urged to schedule a follow-up mammography via the telephone or mail are more likely to get the screening test, researchers report.

The finding is based on a study of nearly 1,000 women at least 51 years old who had not had a screen for at least 15 months. Current recommendations are that all women over 40 get annual breast cancer ( news - web sites) screening, which includes a mammogram and clinical breast exam.

But while a large percentage of women undergo a first exam, many do not continue to have the exams regularly over the years, Victoria L. Champion from Indiana University in Indianapolis and colleagues explain.

To determine whether women could be persuaded to get follow-up exams, the researchers interviewed women attending two university health clinics about their beliefs regarding the benefits of mammograms, obstacles to obtaining the screening test and their perceived risk of developing breast cancer.

The researchers used this information to develop custom-designed material, including graphics on the mailed brochure and counseling that addressed a woman's perceived risks, benefits and barriers via the telephone.

Women who received information by both telephone and mail were more than twice as likely to go on to get the test, compared with women who did not receive any information. Those who received information via telephone only or via mail only were also more likely to get the test than those who were not contacted, according to the report in the August issue of the Annals of Behavioral Medicine.

"It is clear that as early as 2 months post-intervention, the tailored interventions worked significantly better than usual care for promoting mammography adherence among women who were previously not adherent," Champion and colleagues conclude.

The findings confirm the results of other studies showing that reminders, particularly phone calls, were an effective way to encourage women to schedule a mammogram.

Source: Annals of Behavioral Medicine 2002;24:211-218.


Another Case Of Wine's Health Benefits 

By Jennifer Thomas
HealthScoutNews Reporter


Tuesday, August 27, 2002

TUESDAY, Aug. 27 (HealthScoutNews) -- Studies have shown drinking wine can protect against heart disease by raising levels of so-called "good" cholesterol, but new research has now pinned down exactly how wine lovers get that extra protection.

French scientists looked at the specific components of the good cholesterol in the blood of red wine drinkers, and found men who drank red wine regularly had cholesterol that was richer in polyunsaturated phospholids and omega-3 fatty acids. Previous research has shown omega-3 fatty acids in the diet are associated with lower rates of heart disease.

"This study provides, for the first time, a detailed characterization of HDL ['good' cholesterol] composition in regular drinkers," wrote lead author Bertrand Perret, of the French medical research institute INSERM.

In the study, which appears in the August issue of Alcoholism: Clinical and Experimental Research, researchers surveyed 46 men, aged 35 to 65, about their food consumption during the previous three days. The men also completed an extensive questionnaire about their drinking habits.

More than 90 percent of the men reported drinking only red wine, not surprising since all the men in the study were from Toulouse in the south of France.

The men were put into one of three groups: teetotalers, regular drinkers (who drank less than 35 grams of alcohol daily) and heavy drinkers (who drank 35 to 60 grams a day). Wine contains about 13 percent to 15 percent alcohol. That means a regular drinker, according to this study, drinks about two glasses of wine a day.

The men were asked to fast overnight. The next morning, researchers did a chemical analysis of blood samples from the men.

Researchers found the men who were regular drinkers had higher levels of HDL cholesterol, findings that confirm an already well-documented phenomenon.

"The background is quite clear that a moderate amount of drinking -- one to two drinks a day -- has a benefit to the cardiovascular system," says Dr. David Crabb, a professor of medicine at Indiana University in Indianapolis. "This is trying to get at the basis for that finding."

Their study also found regular red wine drinkers had higher levels of omega-3 fatty acids in their cholesterol, "an effect that might be, in itself, beneficial against cardiovascular disease," Perret wrote.

Crabb says the study is interesting, but far more research needs to be done to determine if those omega-3 fatty acids in the cholesterol really protect against cardiovascular disease. The men in the study would have to be followed over time to see if they had lower rates of heart disease.

"There is a vast gulf between studies that look at dietary intake of omega-3 fatty acids and studies that look at the composition of HDL in the blood," Crabb says.

All the studies on drinking red wine come with a caveat: drinking red wine only helps if you're already at high risk of heart disease.

"This is not going to help a college student, because they're not at risk for heart disease," Crabb says. "They're more at risk of getting in a car accident because of drinking or becoming an alcoholic."

"Nobody is recommending that someone start drinking for any reason," he adds.

The American Heart Association ( news - web sites), for example, acknowledges that research shows drinking alcohol can reduce heart disease by increasing HDL cholesterol levels. However, it cautions that regular physical activity and weight loss are other ways of raising HDL, and they don't have the downside that alcohol has.

Consuming too much alcohol can also raise the level of some fats in the blood, and lead to high blood pressure and obesity.

What To Do

The American Heart Association has information on wine and heart disease. Or read this overview of current research from the Hong Kong Academy of Medicine.


Where There Are Guns, There Are Suicides: Study 

By Alison McCook

Reuters Health

Tuesday, August 27, 2002

NEW YORK (Reuters Health) - Suicide rates tend to be higher in US regions where a higher percentage of households have guns, researchers report.

More people kill themselves using guns than by all other suicide methods combined, according to Dr. Matthew Miller and his colleagues at Harvard School of Public Health in Boston, Massachusetts.

While this study does not show that owning a gun increases the likelihood that household members will try to kill themselves, the authors note, the findings do suggest that a relationship between the two factors exists.

"Although our study is unable to determine causation, our results are consistent with the notion that instrumentality as well as intent affects the rate of suicide," they write.

Each year, an estimated 30,000 people commit suicide in the US--nearly twice the annual number of murders. More than half of suicides involve firearms, according to Miller's team.

The results of their study are based on data gathered between 1988 and 1997 from all 50 states in the US. The data included how many homes have guns, and the rate of suicides using guns or other methods among men and women of different age groups.

Reporting in the September issue of the journal Epidemiology, Miller and his colleagues found that in all 50 states and nine US regions, suicide rates were highest where a higher percentage of households owned guns. Specifically, residents of the six states with the highest rate of gun ownership were almost four times as likely to kill themselves using a gun as residents of the four states with the lowest rate of household gun ownership.

This relationship existed regardless of the gender and age of the people who committed suicide.

In an interview with Reuters Health, Miller summarized the findings in one point: "Where there are more guns, more people are taking their own lives."

Miller added that owning a gun may, in fact, increase the rate of successful suicide attempts because guns are far more lethal than most other suicide methods. He explained that many attempts at suicide are impulsive, in which people consider the act for only minutes before trying to carry it out. While members of households without guns may attempt suicide as often as gun owners, the latter may be more successful in carrying it out.

"The accumulating weight of evidence indicates that some people are likely put at greater risk of suicide because a gun is around," Miller said.

He noted that one of the highest rates of suicide using firearms occurred among children between 5 and 14 years old. In order to protect children and others at risk, the researcher said that general suicide-prevention strategies should be coupled with specific interventions related to firearms.

For example, Miller suggested that guns be designed to permit only the authorized owner to fire them. Health professionals can also step in, he added, educating patients about the risk of suicide associated with keeping a gun around the house, especially one that is loaded or unlocked.

Source: Epidemiology 2002;13:517-524.


Catalytic Converters Tied to Sharp Drop in Poisoning Deaths 

By Serena Gordon
HealthScoutNews Reporter


Tuesday, August 27, 2002

TUESDAY, Aug. 27 (HealthScoutNews) -- Catalytic converters, designed to reduce automobile emissions, may be doing more than help keep the air clean -- they may also be saving lives.

A new study, appearing in tomorrow's issue of the Journal of the American Medical Association ( news - web sites), found that the death rate from unintentional carbon monoxide (CO) poisoning in vehicles has fallen 81.3 percent since the advent of the catalytic converter. And because most CO poisoning deaths are vehicle-related, the converters are also responsible for a 57.8 overall drop in the CO poisoning mortality rate, the study says.

Since the introduction of the catalytic converter, an addition to a vehicle's exhaust system that reduces CO emissions and other pollutants, there also has been a 43 percent cut in suicides committed by intentional CO poisoning, the study says.

"The data clearly show the catalytic converter was associated with reduced deaths," says one of the study's authors, Joshua Mott, an epidemiologist in the air pollution and respiratory health branch of the Centers for Disease Control and Prevention ( news - web sites). In fact, he adds, "11,700 deaths may have been prevented by the introduction of the catalytic converter."

Catalytic converters were introduced in the mid-1970s, enabling car manufacturers to comply with the Clean Air Act of 1970.

Approximately 2,000 people die from carbon monoxide poisoning every year, according to the study. One common source of carbon monoxide is automobiles, particularly when they're operating in enclosed or semi-enclosed areas, like a garage. Seven out of 10 carbon monoxide poisoning deaths are vehicle-related. A high enough concentration of CO can cause unconsciousness and death in just a few minutes.

Mott and his colleagues gathered death certificate information from 1968 through 1998 to see how many deaths were attributable to CO poisoning. From 1968 through 1978, the death rate remained fairly steady. But, after car manufacturers started installing catalytic converters, the death rate from unintentional CO poisonings dropped dramatically.

Carbon monoxide detectors were introduced around 1992, but Mott says there was no dramatic decline in unintentional deaths from CO around this time.

"Only following the introduction of the catalytic converter did we see declines in the death rate," Mott says.

"The authors make a pretty good argument [that the drop is related to catalytic converters]," confirms Dr. Harvey Himel, director of wound care and hyperbaric medicine at Weill Cornell Medical Center of New York-Presbyterian Hospital in New York City.

Interestingly, the number of motor vehicle-related carbon monoxide suicides also went down during that same period. Mott says the researchers can't speculate why this is so.

Despite the decline in carbon monoxide deaths, Mott points out that "CO poisoning still remains a leading cause of unintentional death."

Symptoms of CO poisoning include headache, weakness, dizziness, and nausea or vomiting, says Himel. Eventually, continued exposure to carbon monoxide causes loss of consciousness and ultimately death.

Mott says an important way to prevent CO poisoning is to make sure home heating appliances are operating properly, and to not use kerosene heaters, charcoal grills, or power generators in enclosed areas.

Himel adds that carbon monoxide detectors are important as well. "You need a way to detect it. Carbon monoxide is odorless, colorless, tasteless, and non-irritating," he explains.

What To Do

For more information on this silent killer, go to the Consumer Product Safety Commission. And, here's a checklist from the Centers for Disease Control and Prevention on preventing carbon monoxide poisoning.


Low Vitamin E Linked to Early Artery Disease 

Reuters Health

Tuesday, August 27, 2002

NEW YORK (Reuters Health) - Women who don't get enough vitamin E in their diets appear to be more likely than others to show early signs of the artery disease atherosclerosis, even before they experience any symptoms of the condition, study findings show.

A group of Italian researchers found that the more vitamin E women consumed in their diets, the less likely they were to have the beginning traces of thickening in the neck's carotid arteries, a marker of artery disease throughout the body.

"This association was independent of other cardiovascular risk factors, was not related to vitamin supplements, and supports the hypothesis that low vitamin E intake is a risk factor for early atherosclerosis," Arcangelo Iannuzzi of A Cardarelli Hospital in Naples and colleagues write.

However, they add, women at highest risk of early atherosclerosis were those who took in the lowest amount of vitamin E in their diets. Consequently, increasing vitamin E intake will likely only benefit those whose intake is now relatively low, and may have no effect on women who already get enough of the vitamin in their diets.

"Thus, before advising subjects to change their diet or take antioxidant vitamin supplements, it would be helpful to evaluate their intakes and (blood) concentrations," the authors write. This extra step "would help us identify those who could benefit the most from this type of intervention."

Atherosclerosis is defined as the build-up of fatty plaques in arteries that inhibit blood flow, raising the risk of heart attack or stroke. The condition is linked to a process called oxidation--damage to body tissues caused by byproducts of the body's normal processes called free radicals.

The oxidation of LDL ("bad") cholesterol in the arteries is a major factor in the development of heart and blood vessel disease such as atherosclerosis. Previous research has suggested that because antioxidants such as vitamin E can neutralize oxidative damage in the body, they may help ward off heart disease and certain cancers.

In the current study, Iannuzzi and colleagues performed ultrasounds on 310 women to determine whether they showed early signs of atherosclerosis in their carotid arteries. The study participants completed dietary questionnaires and submitted blood samples that were tested for levels of vitamin E, other antioxidants and cholesterol. All of the women were between 30 and 69 years old, and none were taking vitamin supplements.

The researchers found that the more vitamin E the women consumed in their diets, the less likely they were to show early signs of atherosclerosis. Moreover, the ratio of blood levels of vitamin E to cholesterol was also linked to early artery disease. The less vitamin E in relation to cholesterol in the blood, the more likely patients were to have plaques in the carotid arteries.

The investigators did not see any relationship between blood levels of other antioxidants--such as vitamins A and C--and early atherosclerosis.

Reporting in the latest issue of the American Journal of Clinical Nutrition ( news - web sites), Iannuzzi and colleagues note that women who consumed more vitamin E may have a healthier diet overall, and other aspects of their well-balanced food intake besides vitamin E may have influenced their atherosclerosis risk.

The study participants, who hailed from Southern Italy, got most of their vitamin E from legumes, vegetables and olive oil.

Source: American Journal of Clinical Nutrition 2002;76:582-587.


Diabetes Precursor Rife Among Americans 

By Adam Marcus
HealthScoutNews Reporter


Tuesday, August 27, 2002

TUESDAY, Aug. 27 (HealthScoutNews) -- You might live in blissful ignorance of insulin resistance syndrome, but there's a decent chance you have it.

The condition, which doctors are also calling "dysmetabolic syndrome," involves not only impaired sensitivity to insulin but blood fat anomalies, high blood pressure, and obesity. The syndrome is linked to a constellation of severe health problems, including diabetes, heart ailments, and strokes. Experts suspect that between one in five and one in three Americans have it.

But the good news, they said, is that staying fit and shedding excess pounds can greatly reduce the chances that insulin resistance will lead to illness.

"We have the capacity to make an enormous, enormous impact," said Dr. Gerald Reaven, a Stanford University diabetes expert acknowledged as the father of insulin resistance syndrome, which he initially dubbed Syndrome X. Even modest reductions in body weight, say 5 to 10 percent, and regular physical activity can sharply improve the outlook for people with abnormal insulin sensitivity.

New guidelines for the condition were offered today by a panel that included members of the American Medical Association, the Endocrine Society, the American Association of Diabetes Educators, and the American College of Physicians-American Society of Internal Medicine. The prevalence of the syndrome in this country has soared by 61 percent over the last decade, thanks to an equally stunning rise in obesity.

However, roughly 20 percent of people with insulin resistance syndrome aren't overweight at all, Reaven said. So doctors who only look for the problem in their heavier patients may be missing a large chunk of cases. That's especially important for the detection of risk factors for heart disease, which is a major complication of insulin trouble and its most severe form, diabetes.

Dr. Daniel Einhorn, medical director of the Scripps/Whittier Diabetes Institute in La Jolla, Calif., and co-chairman of the panel, said the guidelines should help doctors identify patients with the syndrome.

A family history of diabetes and heart disease, a high body mass index -- a measure of obesity -- and elevated blood pressure are potential signs of the syndrome. So, too, are high levels of blood fats called triglycerides, and low concentrations of high-density lipoprotein (HDL), the so-called "good" cholesterol. Many people with insulin resistance syndrome may have normal levels of LDL, the "bad" form of cholesterol.

"If you are a person at risk, you should know your values. If you have one or more of these abnormalities, you most likely have the insulin resistance syndrome," Einhorn said.

Doctors should also be alert to the condition in their patients over age 40, as well as those whose body fat is distributed chiefly around their abdomen. And women with a history of diabetes during pregnancy or a disorder called polycystic ovary syndrome have a high risk of insulin insensitivity, too.

Insulin resistance syndrome can't currently be identified directly. But doctors see its shadow in the blood by testing people for how well they process a large dose of blood sugar.

Dr. Omega Silva, past president of the American Medical Women's Association, called insulin resistance a "public health epidemic" that "needs to be prevented rather than treated."

Einhorn noted that while diet and exercise can keep insulin problems from flowering into disease, doctors don't yet have medications approved specifically to enhance sensitivity to the hormone in non-diabetic patients.

Reaven said weight and physical activity each contribute about 25 percent to the variability in insulin sensitivity between people. The rest appears to be genetic, though researchers haven't made much progress identifying the genes involved.

What To Do

For more on insulin resistance syndrome, try the American Association of Clinical Endocrinologists. For more on diabetes, which affects an estimated 17 million people in this country, try the American Diabetes Association.


Early Test for Diabetes in Pregnancy Found Reliable 

Reuters Health

Tuesday, August 27, 2002

NEW YORK (Reuters Health) - Screening women for gestational diabetes in the second trimester of pregnancy can accurately spot the condition, a new report suggests.

Researchers say such early screening could lead to earlier treatment and, potentially, a lower risk of medical complications for both mother and baby.

Currently, women are screened for the condition in the third trimester because physicians believe a later test is more accurate. However, a blood test taken in the 16th week of pregnancy identified 24 of the 25 women in the new study who had gestational diabetes, researchers report in the August issue of the Journal of Reproductive Medicine.

Gestational diabetes is a temporary condition in which a pregnant woman fails to produce enough insulin to keep her blood glucose (sugar) in check. Elevated blood sugar, known as hyperglycemia, increases the risk of an extremely heavy baby that can cause newborn fractures and breathing problems in the infant, as well as a difficult delivery for the mother.

The condition affects 2% to 7% of all pregnant women and can raise the risk of developing type 2 diabetes and possibly heart disease later in life, explain Dr. Gerard Nahum from Duke University in Durham, North Carolina, and colleagues. An early screening test could therefore identify women at risk and allow doctors to initiate treatment.

"By employing such an approach, diabetic women can be identified and their blood glucose levels controlled before the third trimester of pregnancy, when disproportionate fetal growth occurs for women with uncontrolled diabetes," Nahum and his co-authors write.

In the study, 255 women drank a beverage containing 50 grams (g) of glucose in their 16th week of pregnancy. One hour later, doctors drew blood and measured the levels of glucose that remained in the blood. Those with blood sugar levels high enough to indicate possible gestational diabetes underwent further testing to confirm it. The rest of the women later had standard third-trimester screening.

Under normal circumstances, insulin is secreted to shepherd blood glucose into cells throughout the body for use as energy. But in gestational diabetes, insulin secretion is insufficient and blood glucose remains high.

In this study, women whose 16th-week glucose levels exceeded 135 milligrams (mg) for each deciliter (dL) of blood, a widely recognized cutoff level, were found to have a 55% risk of developing gestational diabetes. Women with glucose levels of 110 mg/dL or lower had a less than 1% risk, while the risk for those whose levels fell between these two extremes was about 5%, the investigators found.

"Glucose screening at 16 weeks of pregnancy is a useful alternative to third-trimester screening for gestational diabetes," the researchers conclude. They call for further research investigating the merits of early treatment for gestational diabetes on the mother and baby.

Source: Journal of Reproductive Medicine 2002;47.


MONDAY, AUGUST 26, 2002 

Media Images of 'Hunks' Spur Body Anxieties in Men 

By E. J. Mundell

Reuters Health

Monday, August 26, 2002

CHICAGO (Reuters Health) - Research has for years linked women's exposure to photos of skinny supermodels with feelings of inadequacy about their own bodies. Now, a new study suggests that men are driven to the same insecurities when faced with magazine portrayals of buff, muscled hunks.

"We always think about these sorts of things with women, but we see the exact same things with men," said study co-author Dr. Regan Gurung of the University of Wisconsin, Green Bay. He and co-researcher Jennifer Otto presented the findings here Saturday at the annual meeting of the American Psychological Association.

Magazine, television, and other media depictions of extremely fit, muscled men have increased in number over the past few decades. "There is data that, in the media and advertising literature, exposure of men in advertisements is coming very close to that of women," Gurung said. He said one watershed moment occurred when rap star-turned-actor Mark Wahlberg posed for designer Calvin Klein "in his little white briefs." From then on, images of buff, semi-nude men have become as ubiquitous in advertising as those of the curvaceous supermodel.

What effect are all these images having on the average male viewer? In their study, Gurung, Otto and their colleagues had 45 male and female college students fill out standard questionnaires assessing levels of mood, personal self-esteem, and body-image anxiety.

They then asked each man to view a number of photos of semi-clad male models, asking them to also rate the attractiveness and masculinity of each model depicted. Women were asked to perform a similar task with photos of female models.

"We found that women and men are equal as far as how much physique anxiety they experience after they see these types of pictures," Otto said in an interview with Reuters Health. "We also found that a man who has more physique anxiety is more likely to rate the models as lower (in masculinity and attractiveness), whereas a man who feels good about his own physique would 'call it as he sees it'--he would rate the model high."

The researchers then pushed the experiment a little further. To compare men's and women's feelings of body insecurity in particularly stressful situations, they had participants change into skimpy outfits--a tight vest and shorts for the men--and then have their picture taken by an attractive member of the opposite sex. The participants were then asked to complete some more questionnaires while wearing the outfit.

As expected, levels of physique anxiety rose even higher, but the change in physique anxiety for men "was parallel to the physique anxiety of women doing the same thing," according to Otto.

The take-home message, Gurung said, is that media images of the "perfect body" work to undermine men's body-confidence, too.

For most guys, this may only lead to fleeting resolutions to work out more at the gym. But for a minority of men, an obsession with physical perfection can lead to a psychological disorder where life revolves around muscle building, dieting and the use of dangerous muscle-enhancing drugs.

"Whether it's men or women, there's always that group who are in the danger zone," Gurung said. "What we are trying to do here is get a better handle on what are those identifying flags of people in the danger zone. And social physique anxiety seems to be a very good one."


Exercise May Reduce Risk of Colds  

By Ira Dreyfuss

Associated Press Writer

The Associated Press

Reuters Health

Monday, August 26, 2002

WASHINGTON (AP) - A more active day apparently helps to keep a cold at bay.

Researchers who report this also say people don't have to put in an athletic performance to get the benefit.

"A regularly active person has a lower risk of getting a cold," said Charles E. Matthews of the University of South Carolina.

Matthews and his colleagues looked at 12 months of data on 547 healthy men and women who had taken part in a broader study of health behaviors. The men and women, whose average age was 48, reported regularly on their physical activities and the number of colds they got.

At the higher end, the activities were enough to fit into the U.S. Surgeon General's recommended minimums, Matthews said. Those federal guidelines call for 30 minutes of brisk walks, lawn mowing or other moderate activity on most days of the week. At the lower end, the participants were doing nothing more intense than light dusting, which is below the recommended level.

Over the year, the more active people averaged one cold, which was 23 percent lower than the average for the least active group, said the report in the August issue of the journal Medicine and Science in Sports and Exercise.

The benefit was especially striking in the fall, when about 40 percent of colds occurred, Matthews said. The risk reduction among the more active people was 32 percent, he said.

Studies have found that exercise seems effective in reducing the chance that a person will even get a cold. If the evidence continues to mount, federal health officials might decide to promote the benefit as another reason to exercise, said David C. Nieman of Appalachian State University, who was not part of the Matthews team.

"This is getting so scientifically sound that it is going to demand attention at the National Institutes of Health ( news - web sites) level," Nieman said. "Overall, I feel the evidence is so compelling that I think people can use it as a reason to be active."

In one of Nieman's studies, women who walked regularly and still got colds had symptoms that lasted less than five days, while similar women who did not walk had colds that lasted seven days.

Being physically active seems to stimulate immune cells that target cold infections, Nieman said. The heightened stimulation seems to last only one to three hours and then subsides. But day after day of making the immune system spike may lower the overall risk of catching cold, he said.

However, Nieman also has found that very hard exercise seems to draw down immune defenses. In his research, people who ran a marathon had a higher risk of a cold for several days after the event.

And exercise apparently can't cure the common cold, Nieman said. Other researchers have deliberately given people colds, then had them exercise, and found exercise neither improved nor worsened the course of the cold, he said.

On the Net:

Medicine and Science in Sports and Exercise:


Post-Extraction 'Phantom' Tooth Can Haunt Patients 

By Kathleen Doheny

Reuters Health

Monday, August 26, 2002

SAN DIEGO (Reuters Health) - Phantom limb pain after an amputation isn't the only type of mysterious pain that puzzles doctors and worries patients.

Dental patients who have a tooth extracted can have pain at the site of the extraction for months afterwards. "It's the toothache that won't go away, but there's no tooth there," said Dr. Glenn T. Clark, a professor of oral biology and medicine and orofacial pain at the University of California, Los Angeles (UCLA).

It's not common, Clark added, affecting perhaps less than 1% of dental patients. But phantom tooth pain can last for months, and can also spread beyond the extraction site to other areas of the mouth.

Such phantom tooth pain may be related to changes in a person's pain threshold, according to the new research by Clark and others presented here at the recent 10th World Congress on Pain.

Eamonn Murphy, a dentist at University College Cork, Ireland, conducted his research at UCLA with Clark as his advisor. He evaluated 10 patients with phantom tooth pain and compared them with 16 patients who had a tooth extracted but did not complain of pain at the site. The men and women ranged in age from 21 to 55 years. Those in the pain group had all experienced the pain for 6 months or longer.

Using a thermal probe, Murphy conducted sensory tests to evaluate each patient's reaction to mechanical pressure, warm and hot temperature, cool and cold temperatures.

"The major difference was in mechanical pressure," Murphy noted. "If you put pressure on the area, those who complained of phantom pain had pain at lower thresholds." Between-group differences in reactions to cold and other tests were not as dramatic, he added.

Phantom tooth pain is caused by changes in surrounding nerves that can occur after some extractions, Murphy and Clark conclude.

Until this study, Murphy stated, "no one had shown objectively actual changes in the threshold of pain" in those with the problem. No one knows what causes these changes, he added.

Patients who suspect they may have phantom tooth pain should consult a specialist in orofacial pain to obtain a diagnosis, Clark suggested. Often, when the pain spreads, dentists who don't think about the possibility of phantom tooth pain will suggest more procedures, such as extracting another tooth. "Don't keep having procedures done," he advised, until a diagnosis of phantom tooth pain is ruled out.


Internet Addiction May Be Form of Stress Management 

By E. J. Mundell

Reuters Health

Monday, August 26, 2002

CHICAGO (Reuters Health) - When the going gets tough, many stressed-out Web surfers go "cyberslacking," according to the results of a new study.

Researchers say that a small minority of Internet users may spend hours online in a compulsive effort to avoid life's anxieties.

"Procrastination, low productivity, social withdrawal and relationship difficulties" were common among those spending an unhealthy amount of time on the Web, report researchers led by graduate student Richard Davis of York University in Toronto, Ontario.

He presented the findings here Saturday at the annual meeting of the American Psychological Association.

Experts estimate that only about 2% to 3% of all Web users fall into the category of "Internet addicts"--individuals who typically neglect family and friends, lie about how much time they spend online, and mold their daily lives to fit their Internet use.

In their study, Davis and his colleagues sought to determine the psychological role of Web use among individuals at high risk for addiction. He had 60 undergraduate students complete standard questionnaires measuring their amount of daily Web use, perceived stress, and personal coping styles.

The Canadian researchers found that individuals with online habits suggestive of "problematic Internet use" were more apt to rely on "avoidant coping"--reacting to life's stressors by simply turning to a distractor.

Furthermore, individuals in danger of Internet addiction also tended to be nonassertive when faced with problems. For example, "if their boss has reprimanded them, instead of dealing with it head-on they will do it in non-assertive ways" such as complaining to others or simply avoiding thinking about the incident, Davis explained. Excessive, unhealthy Internet use appeared to combine nonassertive coping with avoidance--something Davis described as "withdrawal coping."

Excessive Internet use was also strongly linked to procrastination, suggesting that the Web is fast becoming a more interactive ( news - external web site) alternative to video games or bad TV. In the workplace, especially, this type of online procrastination is commonly known as "cyberslacking," resulting in "significant losses in productivity," according to the researchers. In fact, one 2001 study found 50% of Web surfers admitting that they spent about half of their online time avoiding more productive activities.

And just what are hardcore Web users doing during all those hours online? "We know that the number-one thing people are looking at is online pornography," Davis said. "That's a big distractor. Also engaging in online gaming (gambling), and chat rooms." While some addicts may be focusing on just one "distractor"--pornography or online casinos, for example--others may split their time between these activities, chatting and more generalized surfing, Davis noted.

The researchers found no differences between men and women when it came to the percentage of individuals showing signs of problematic Internet use, or their underlying psychology. Women are increasingly making up a larger percentage of Web users, Davis pointed out. "For young females, it used to be that young teenage girls used to come home and go to their telephone and talk all night to their friends. Now they are coming home and instant-messaging in a big way."

But the Internet can also offer constructive, positive resources for stress relief, he said. For example, teens worried about approaching a member of the opposite sex may find the Web a more congenial space for tension-free conversation. And online support groups have for years been key in helping otherwise isolated individuals cope with sometimes overwhelming issues. According to Davis, "this highlights what the Internet does best--provides information and a medium for like-minded individuals to interact."


Shy Kids May Be Hiding Something More Serious 


Monday, August 26, 2002

MONDAY, Aug. 26 (HealthScoutNews) -- For hundreds of thousands of American kids, the start of a new school year means coping with more than just the disappointment that summer vacation is over.

About 1 percent (400,000) of children and teens between the ages of 10 and 18 suffer from social anxiety disorder, a psychiatric condition caused by an intense fear of being judged or scrutinized by other people. The disorder, also called social phobia, can lead to severe social withdrawal and problems with daily functioning.

They may invent reasons why they can't go to school, refuse to ride on the school bus, and refuse to take part in after-school activities.

"In my clinical work, I've encountered children who would hide in the restroom instead of entering the school cafeteria for lunch hour," says Patricia DiBartolo, an associate professor of psychology at Smith College.

"In the classroom, these kids would desperately avoid speaking out or reading aloud in class. Some would lug all their books with them throughout the day, rather than stop at their lockers, where they might have to chat with a classmate," DiBartolo says.

If the symptoms of social phobia aren't treated, they can increase over time and hinder a child's natural progress and growth. Preemptive treatment can make a huge difference for these children.

Treatment includes cognitive-behavioral therapy, where children are gradually exposed to anxiety-causing situations.

DiBartolo says parents and teachers should take note of adolescents' social behavior by watching them over a month or two to see how they deal with the normal challenges of the school day. That includes observing how they interact and develop relationships with other children, whether they speak in class, and whether they approach exams with undue anxiety.

More Information

The Center for Mental Health Services has more information on adolescent mental health issues.


Mouse Study Reveals Clues to Lou Gehrig's Disease 

By Keith Mulvihill

Reuters Health

Monday, August 26, 2002

NEW YORK (Reuters Health) - Researchers from the National Institutes of Health ( news - web sites) believe that a study in mice that identified abnormalities in lipid, or fat, metabolism may shed light on how the motor neuron disease amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease ( news - web sites), develops.

The findings may one day lead to new therapies that could delay the progression of the fatal disease, explained lead researcher Dr. Mark K. Mattson of the National Institute on Aging in Baltimore, Maryland, in an interview with Reuters Health.

The report is published in the August 21st issue of the journal Annals of Neurology.

Motor neuron diseases are characterized by destruction of the nerve cells in the brain and spine that control muscle movement. ALS causes progressive muscle weakness. Gradually, as muscles weaken and waste, patients develop difficulty speaking, swallowing and breathing. About half of patients die within 5 years of their first symptoms.

Previously, Mattson and colleagues discovered that tissue samples from the spinal cords of ALS patients--collected during autopsies--had higher levels of several different types of lipids compared with samples from people without the disease. The lipids included ceramides and a form of cholesterol.

Intrigued, the researchers decided to examine the spinal tissue of mice bred to develop ALS-like illness, explained Mattson. To their surprise, they identified a similar pattern of elevated lipids, suggesting that some sort of abnormal lipid metabolism was at work in ALS.

"What we found in the mice is that changes in lipid levels do occur before there are any symptoms of damage to the nerves," he told Reuters Health.

Next, the researchers grew motor neuron cell cultures in the lab to determine whether they could mimic a similar alteration in lipid metabolism.

Since oxidative stress can cause similar changes in cholesterol and lipid metabolism, explained Mattson, the team exposed the motor neuron cells to damaging free radicals and measured lipid levels. Oxidative stress is caused by exposure to free radicals, which are produced by normal metabolic processes and have been implicated in a number of different diseases.

"We saw similar changes in the lipid metabolism compared to what we saw in the spinal tissue samples in the people who died from ALS," said Mattson. "This suggests that an increase in free radicals is sufficient to account for the changes in the lipid regulation in the motor neurons, and promotes their death."

In the last step of the study, Mattson and colleagues used a drug called ISP-1, which prevents the build-up of lipids, in the cells.

"When we treated the motor neurons in culture with this drug, they were resistant to being killed by free radicals," he said.

"The bottom line is that this drug prevents the formation of the damaging lipid ceramide," which in turn keeps the nerve cells alive, Mattson noted.

"The next step is see if the drug works in mice and slows the progression of the ALS-like illness," he concluded.

Source: Annals of Neurology 2002;52.


Why Kids Smoke 


Monday, August 26, 2002

(HealthScoutNews) -- It is widely known -- except to an extraordinarily high number of adolescents -- that smoking enhances your chances of dying young. A recent study has found some reasons why, despite extensive efforts to encourage kids to not smoke, that message isn't being heard or is being ignored.

Researchers at the Georgetown University School of Medicine and the University of Pennsylvania School of Medicine report that adolescent depression, combined with high receptivity to tobacco advertising, plays a powerful role in whether a teen smokes. The National Institute on Drug Abuse, which sponsored the study, says the results "demonstrate the complex interplay of factors that influence the initiation of smoking by youth."

"Adolescents with elevated levels of depression may find the messages delivered by tobacco advertisements more appealing than adolescents without elevated levels of depression," says the senior author of the study, Dr. Janet Audrain of the University of Pennsylvania.

Dr. Audrain's research team surveyed 1,123 high school freshmen, 60 percent of whom reported that they had never smoked, and 40 percent reported having smoked at least a partial or whole cigarette. Across both groups, 34 percent had high receptivity to cigarette advertising -- defined as the ability to name an often-advertised cigarette brand, to name a favorite tobacco ad, and willingness to use a tobacco industry product.

Researchers found that, overall, more adolescents with high receptivity to tobacco advertising had smoked, as compared to those with low receptivity, and these results were further affected by depression.


Study Suggests Cholera Will Worsen as Globe Warms 

By Merritt McKinney

Reuters Health

Monday, August 26, 2002

NEW YORK (Reuters Health) - A new study provides the first direct evidence that global warming ( news - web sites) may be worsening epidemics of infectious disease.

Researchers have found that the cyclic global weather phenomenon El Nino has begun to affect the course of cholera epidemics in Bangladesh, an effect that is likely driven by warming of the land and water in the area due to climate change.

El Nino is an unusual warming of the Pacific Ocean close to the equator. The phenomenon occurs every 2 to 7 years, and can cause weather changes, such as increased temperatures and decreases in rainfall and relative humidity. It has been linked to outbreaks of infectious diseases including dengue fever, malaria and cholera.

Cholera spreads through contaminated food and water, and is common in many less-developed countries. A cholera pandemic is currently under way, affecting more than 75 countries.

To investigate whether there might be a connection between El Nino and cholera, and to determine if global warming could play a role, Dr. Mercedes Pascual of the University of Michigan in Ann Arbor and colleagues reviewed climate records and information on cholera cases in Bangladesh. Their findings are reported in the Early Edition of the Proceedings of the National Academy of Sciences ( news - web sites).

The investigators found little association between cholera cases and El Nino during the first half of the 20th century. But the climate phenomenon was related to changes in the number of cholera cases during the 1980s and 1990s. In fact, the researchers estimate that El Nino accounted for 70% of the variation in the number of cholera cases during the last two decades of the 20th century.

The fact that the link between climate variability and cholera has become stronger in recent decades "provides the first evidence for an effect of climate change on an infectious disease," Pascual told Reuters Health.

"The idea is that with climate change, the variability of climate also changes, leading to a stronger effect on the disease," she said.

Pascual and colleagues note that El Nino, along with global warming, are heating up the land and water of the Indian subcontinent, which could lead to increased proliferation of the bacterium that causes cholera. Also, the authors note, this warming could itself increase the likelihood that people will come into contact with contaminated water.

Most experts expect that the climate changes caused by future El Ninos will be more dramatic, either as a result of global warming or because of naturally occurring variations in climate.

"The implications," according to Pascual, "are sustained or increased levels for future cholera outbreaks in Bangladesh."

Source: Proceedings of the National Academy of Sciences Early Edition 2002;10.1073/pnas.182203999.


Viagra May Protect Your Heart 

By Ed Edelson
HealthScoutNews Reporter


Monday, August 26, 2002

MONDAY, Aug. 26 (HealthScoutNews) -- Animal studies show Viagra could shield your heart against damage.

The drug, renowned for its ability to correct erectile dysfunction, causes the release of substances that precondition and protect cardiac muscle, says a report from Dr. Rakesh C. Kukreja, a professor of internal medicine at Virginia Commonwealth University.

"Our studies show that Viagra given to rabbits prior to experimental heart block causes a significant reduction in damage to heart tissue," Kukreja says.

Kukreja and his colleagues have been working on this preconditioning for more than a decade. The idea is that depriving the heart of blood flow for very brief periods can prepare the heart for something more serious. Kukreja cites studies showing that people who experience angina ( news - web sites) -- heart pain -- before a heart attack have a lower risk of death and fewer complications than those who do not.

While Viagra produces a preconditioning effect by reducing blood flow, its possible use as a way of protecting the heart is a daring concept. Because the drug has been linked to drastic drops in blood pressure and heart attacks in men who were also taking nitroglycerin for a cardiovascular condition, the U.S. Food and Drug Administration ( news - web sites) requires prescription labels to warn against its use by men with heart conditions.

"We are not challenging that existing warning," Kukreja says, adding that much more animal work is needed before human trials can even be contemplated.

A report in the September issue of the American Journal of Physiology -- Heart and Circulatory Physiology describes how rabbits were given Viagra, either orally or by injection, and then were subjected to heart damage. A reduction in damage was observed within 30 minutes, and the effect lasted for almost 24 hours, the report says.

"Definitely more animal work should be done," Kukreja says, not only to study the effect in more detail but also to determine the most effective dose of Viagra. "Some of our studies seem to suggest that the drug provides protection at a much lower dose than needed to treat impotence," he says.

Kukreja says he has begun those studies, estimating it may take two to three years to produce the kind of evidence needed to warrant human trials.

The idea of preconditioning "has been around for a while," says Dr. George Vetrovec, chairman of cardiology at the Virginia Commonwealth University School of Medicine. Some animal studies indicate the effect could last as long as several weeks, he adds.

Viagra is just one of a number of agents that have been tested for their preconditioning effect, Vetrovec says, and although it has "a potent preconditioning effect" it might not be the drug that would eventually be used if and when the idea enters clinical practice.

"In animal research, one thing you keep looking for is the mechanism of action," he says. "If you can figure out the mechanism, you could come up with a drug you could use in the setting of an acute heart attack."

Viagra or another preconditioning drug could eventually be given to someone at high risk of a heart attack, such as a person suffering unstable angina, Vetrovec says.

"Or it could be used before bypass surgery, to induce a transient decrease in blood flow," he says. "Patients who are at risk of a small heart attack during bypass surgery would most probably benefit from it."

What to Do

You can get more information about the established use of Viagra from the U.S. Food and Drug Administration.

Or, here are some frequently asked questions about the drug.


Bone Marrow Cells Help Mend Stroke Damage in Rats 

By Maggie Fox


Monday, August 26, 2002

WASHINGTON (Reuters) - Versatile human bone marrow cells injected into rats traveled to the animals' brains on their own and helped fix some of the damage caused by strokes, researchers said on Monday.

They said their experiment suggested that donated bone marrow cells might be used as a treatment not only for stroke but for Parkinson's disease ( news - web sites) and spinal cord injuries.

"We could have cells sitting on the shelf. When someone comes in, you give them a shot of cells," Michael Chopp of Henry Ford Hospital in Detroit, Michigan, who led the study, said in a telephone interview.

Bone marrow cells are used now to treat cancer, but donors and recipients must be carefully matched so the recipients' immune systems do not destroy the donated cells.

But Chopp and colleagues found that their bone marrow cells seemed to be able to slip by the rats' immune systems and take up residence where needed, pumping out chemicals that help brain and nerve tissue repair itself. Chopp said the cells used by his team lacked some of the surface proteins that usually activate the immune system to attack foreign cells.

"These are smart cells that selectively migrate to the site of injury and become little factories producing an array of helpful molecules to repair the tissue," said Chopp, whose team's findings are published in the journal Neurology.

"We believe this therapy shows promise in treating stroke, Parkinson's disease, spinal cord injury and traumatic brain injury."

There are drugs on the market to treat stroke, but to have any effect they must be given within hours of the stroke. Many patients do not get to the hospital in time, said Dr. Thomas Kent of the University of Texas Medical Branch in Galveston.

Timing Is Critical

"Many people still don't recognize the symptoms of stroke and get to an emergency room quickly enough for treatment. If this new treatment is effective, it could expand the treatment window by several hours or even longer," Kent, who wrote a commentary on the study, said.

Chopp stressed that the cells his team used are not the highly publicized stem cells--progenitor or master cells that can grow a variety of new tissues.

The cells his team used are called stromal cells, and rather than growing into replacement neurons, they seemed to secrete various chemical "factors" that stimulated repair of the cells damaged by stroke.

For their experiment, the team artificially caused a stroke in rats and then waited a week before infusing the human bone marrow cells intravenously.

A week after that, the rats were tested for various abilities that can be affected by a stroke, such as walking and balancing, and for reflexes.

The treated rats completed the tests 60% faster than the non-treated rats, and saw 30% improvement overall. Chopp thinks this means people could be treated effectively for days or weeks after suffering a stroke.

"In (the) rat we actually see better benefit when we infuse the cells a week after injury," Chopp said. "That is probably equivalent to a few months in a human.

Many more tests are needed before such an approach could be tried in human patients, however.

"It's not clear how long the window of opportunity might be," Kent cautioned. "We also don't know the long-term benefits and consequences."

Stroke is the third leading cause of death in the United States, killing nearly 160,000 Americans every year. Every year, an estimated 750,000 Americans have a stroke -- caused either by a clot in the brain or by a burst blood vessel.

Strokes kill brain tissue and can lead to partial paralysis, loss of speech and other disabilities.


Transplant Advance Limits Rejection 

By Adam Marcus
HealthScoutNews Reporter


Monday, August 26, 2002

MONDAY, Aug. 26 (HealthScoutNews) -- A transplant approach pioneered 40 years ago has been resurrected as a way to preserve organ grafts with fewer or potentially no immunity-blocking drugs.

The technique involves wiping out key immune cells before transplant surgery, followed by doses of a single immune-suppressing medication. Many patients can slowly be weaned off the drug, and a few have even been able to drop the therapy completely without suffering rejections of the graft, the researchers say.

"It's exciting, in that many centers are seeing similar results with similar strategies," says Dr. Allan Kirk, a transplant expert at the National Institute of Diabetes and Digestive and Kidney Diseases. "That suggests what people are seeing is real."

Kirk is among a handful of researchers presenting their results with this new-old approach today at the International Congress of The Transplantation Society in Miami. Eventually, he says, as many as 80 percent of transplant patients might be able to avoid rejection on a single immune-suppressing agent. And many could get by on greatly reduced doses of the compounds.

Because these drugs are highly toxic and highly expensive -- it's common for patients to spend $20,000 a year on the therapy -- anything that would reduce the burden of immune-suppressing treatment would be a boon, Kirk says.

"I think there is a need to do it, and it might work," says Dr. Stuart Kanechtle, a University of Wisconsin surgeon. "But we need to figure out how to do it long-term."

The method involves muzzling the activity of the T-cells that marshal the response to an invasion of foreign tissue. Because trauma, including surgery, is frequently a way germs and viruses enter the body, it's not surprising T-cells are on high alert after an operation. While this is good for fighting infection, it's bad for helping the body make peace with a donor organ.

In the early 1960s, scientists reasoned they could clamp down on the T-cell surge after transplant surgery by blocking them before the procedure. They had the right idea, Kirk says, but primitive tools.

Recently, however, some surgeons have revived interest in the practice of T-cell depletion.

In one of the studies to be presented, researchers at the University of Pittsburgh showed that 12 of 22 small-bowel recipients who underwent T-cell depletion are being weaned off the immune-quashing drug tacrolimus.

Although 10 haven't fared as well, and three of the 12 suffered rejections after weaning began, Dr. John Fung, director of transplantation surgery at Pitt, says even that success rate among small-intestine patients is a major victory, because these people are particularly prone to rejections.

Fung is presenting an overview of the Pittsburgh protocol, which is nearing its one-year anniversary. Roughly 80 of 250 patients, including 20 liver recipients, 40 kidney recipients and the 22 bowel recipients, have begun weaning off their immune-suppressing drugs.

The protocol involves killing T-cells with a substance called rabbit anti-thymocyte globulin. If after 90 days the patients show no signs of rejection, the doses of immune-suppressing drugs they take are gradually scaled back.

None is completely off medication, Fung adds. However, some of the most advanced patients are now taking a weekly dose of immune-blocking therapy, compared with the routine of two or three drugs twice a day or more required by conventional treatment.

"The weaning process is critical. You can't just stop the drugs entirely without increasing your risk of rejection," he says.

Kanechtle and his colleagues are reporting the results of 29 kidney transplant recipients who had their T-cells wiped out with a drug called Campath-1H. They are now receiving "maintenance" doses of the immune-blocking compound rapamycin, or sirolimus, and are "doing very well," he says. The Wisconsin group plans to start weaning several of these patients off rapamycin to see if they'll continue to keep their new kidneys.

Complete freedom from immune suppression is the promised land for transplant patients and surgeons alike. A small number of people appear to have reached this happy state, says Kanechtle, who has been following "a couple" of these patients at his hospital in Wisconsin.

However, why these patients do so well, while others who are weaned off the graft-preserving drugs ultimately suffer rejections, remains a mystery, he says.

"They're very interesting and important patients, but these are rare exceptions in the big picture," he says. "I think we need to learn as much as we can from them, and try to learn why they're tolerant."

What To Do

For more on organ transplants, visit the United Network for Organ Sharing or the American Liver Foundation.


Drug May Improve Survival in Fatal Lung Disease 

By Linda Carroll

Reuters Health

Monday, August 26, 2002

NEW YORK (Reuters Health) - For patients with primary pulmonary hypertension (PPH), treatment with a drug that dilates blood vessels can improve survival and quality of life, researchers report.

Continuous intravenous therapy with epoprostenol increased 3-year survival rates by up to 80% and nearly doubled exercise tolerance, according to study findings published this week in a rapid access publication of Circulation: Journal of the American Heart Association ( news - web sites).

PPH is a rare, but fatal, condition that most often strikes young women, the study's lead author Dr. Vallerie McLaughlin of Rush-Presbyterian-St. Luke's Medical Center in Chicago told Reuters Health.

The National Institutes of Health ( news - web sites) determined in 1980 that the average length of survival for patients with PPH was 2.8 years after diagnosis, she noted.

PPH strikes approximately two in 1 million Americans, McLaughlin said. "Most of them are young women in their 30s and 40s," she added. "It's caused by abnormalities in the blood vessels in the lungs that cause blood pressure to go up, making it difficult for the heart to pump blood to the lungs."

The condition can sometimes be a side effect of the weight-loss drug combination known as fen-phen, McLaughlin said. Fen-phen is no longer marketed in the US.

One of the first symptoms of PPH is shortness of breath, McLaughlin explained. "Patients find they can't climb stairs anymore," she added. "Sometimes they feel chest pain. Sometimes they show symptoms of heart failure. Sometimes there is swelling in the legs. Sometimes patients feel lightheaded and pass out."

Because the symptoms of PPH are similar to those of more common conditions, such as asthma, it often takes years for a patient to get a correct diagnosis, McLaughlin said.

For the new study, McLaughlin and her colleagues followed 162 PPH patients treated with epoprostenol for more than 3 years. Patients in the study were among the sickest, McLaughlin said.

Among very sick patients, without-treatment survival at 1, 2 and 3 years is 59%, 46% and 35%, respectively, McLaughlin said. "It's horrific," she added. "It's worse than many cancers, especially when you're looking at a 38-year-old woman."

Survival among patients treated with epoprostenol at 1, 2 and 3 years was 88%, 76% and 63%, respectively, McLaughlin found.

A downside to the therapy is that it must be infused constantly, so patients need to have a catheter and a pump that squirts a small amount of the drug into the veins each minute. Long-term catheter use can lead to infections, McLaughlin said. "And infections can sometimes be serious, especially in patients who are sick to begin with," she added.

But new formulations are being developed, and eventually there may be a drug patients can take orally, McLaughlin said.

The therapy may also be effective in treating another lung disorder, pulmonary arterial hypertension, McLaughlin said. This condition has similar symptoms to PPH, she added. Approximately 100,000 Americans suffer from this condition.

Source: Circulation 2002;10.1161/01.CIR.0000029100.82385.58.


Another Statins Benefit Found 

By Serena Gordon
HealthScoutNews Reporter


Monday, August 26, 2002

MONDAY, Aug. 26 (HealthScoutNews) -- Statins are well known for their ability to lower cholesterol levels, but they also seem to be effective at quickly reducing another risk for a heart attack: inflammation.

A new study finds that the drug simvastatin significantly lowered LDL -- the "bad" cholesterol -- as well as levels of highly sensitive C-reactive protein (hsCRP) in as little as two weeks. Elevated levels of hsCRP indicate inflammation and a higher-than-normal risk for heart attack.

The research is scheduled to appear in the Sept. 17 issue of Circulation: Journal of the American Heart Association ( news - web sites).

"This study was really meant to answer one question: How quickly does hsCRP change after statins are introduced?" says the study's lead author, Dr. Robert H. Eckel, a professor of medicine, physiology, and biophysics at the University of Colorado Health Sciences Center. "And the answer is by day 14."

"So, maybe quickly giving a statin could reduce hsCRP and improve the outcome for heart disease patients," says Eckel, adding that more study needs to be done to address that possibility.

Heart disease remains the leading cause of death in the United States, claiming nearly 1 million lives a year, according to the American Heart Association. More than 61 million Americans have some form of cardiovascular disease.

Forty people between the ages of 25 and 75 volunteered for Eckel's study. All had high cholesterol, but no known heart disease. The researchers randomly assigned each participant to one of two groups. One group took the statin drug for 14 days and then a placebo for 14 days, while the other group started with the placebo and finished with the statin medication.

By the seventh day of treatment with the statin, both groups experienced a 56 milligrams-per-deciliter (mg/dl) drop in LDL cholesterol. At the end of two weeks on the statin, LDL cholesterol dropped another 8 mg/dl in both groups.

HsCRP fell to 1.6 milligrams per liter (mg/L) after two weeks on the statin medication from a high of 2.55 mg/L.

Eckel points out that though only one type of statin was tested, other statins would likely have similar effects.

"This study shows a very early effect on hsCRP from statins," says Dr. Carl Lavie, a cardiologist with the Ochsner Clinic Foundation in New Orleans. "It may add to the urgency of starting statin therapy in high-risk patients."

Until further study is completed, Eckel says experts are not recommending any changes in clinical care.

There are other ways to reduce levels of C-reactive protein, including losing weight and quitting smoking, according to Eckel and Lavie. Eckel says some diabetes medications and triglyceride-lowering drugs can also help reduce hsCRP. Lavie recommends cardiac rehabilitation and exercise for heart disease patients, along with a diet high in omega-3 fatty acids (including many types of seafood) to lower hsCRP levels.

What To Do

This is the latest in a series of studies highlighting the benefits of statins. They've also been found to keep the arteries clear and even reduce the risk of Alzheimer's disease ( news - web sites).

For more information on statin medications, go to the National Heart, Lung and Blood Institute.

Are you at risk for a heart attack? Find out by visiting the American Heart Association.


Studies to Look at Chemicals, Parkinson's 


Monday, August 26, 2002

WASHINGTON (Reuters) - The federal government said on Monday it was giving $20 million to three research centers to try to find out if chemicals or other environmental factors cause Parkinson's disease ( news - web sites).

Farmers and other people exposed to pesticides seem to have a higher risk of developing the incurable brain disease, which slowly robs patients of their ability to move properly, but no one has been able to show a clear and irrefutable link.

"Our best chance for finding successful treatments for persons suffering with Parkinson's disease is to understand more about what triggers the disease," Dr. Kenneth Olden, director of the National Institute for Environmental Health Sciences, said in announcing the grants.

"Even better, this research may lead to ways to prevent Parkinson's disease in the first place."

The NIEHS, one of the National Institutes of Health ( news - web sites), said it was funding the Parkinson's Institute in Sunnyvale, California, to examine risks associated with pesticides and heavy metals, the possibility that tobacco and caffeine may protect against Parkinson's, and genetic susceptibility to the disease.

Emory University researchers in Atlanta will look at the effects of pesticides in Parkinson's and develop new animal and laboratory models of the disease, while a team at the University of California Los Angeles will look at genes and pesticides.

"Evidence of an environmental link to Parkinson's is substantial," Joan Samuelson, president of the Parkinson's Action Network, which lobbies for funding to study the disease, said in a statement.


Predicting Alzheimer's 

By Amanda Gardner
HealthScoutNews Reporter


Monday, August 26, 2002

MONDAY, Aug. 26 (HealthScoutNews) -- The best predictor of Alzheimer's disease ( news - web sites) is a verbal memory test called the California Verbal Learning Test.

That's the conclusion of a group of researchers who presented their findings yesterday at the annual meeting of the American Psychological Association in Chicago.

The California Verbal Learning Test (the "long delay recall" portion) basically measures what information has been lost from that originally stored in the brain. Other similar neuropsychological tests were, in general, better at predicting the onset of the disease than brain imaging tests, the researchers report.

Alzheimer's disease is a devastating dementia that can affect people as they grow older. Approximately 4 million Americans are afflicted with the condition. Abnormal clumps, called amyloid plaques, and tangled bundles of fibers, called neurofibrillary tangles, are considered hallmarks of the disease, according to the Alzheimer's Disease Education and Referral Center. The incidence of the disease is expected to rise dramatically as the population ages.

Currently, there's no cure, no surefire treatments and no reliable way to diagnose Alzheimer's, especially in the early stages.

There are, however, some medications that address symptoms or delay symptoms when given at a very early stage. This makes early detection that much more vital.

"For a disease such as Alzheimer's, to try to identify people in the pre-clinical stages is very important," says Dr. Toby Gropen, director of the division of cerebrovascular diseases at Long Island College Hospital in Brooklyn, N.Y.

"In general, the search for pre-clinical markers, before any symptoms appear, is a critical thing. If we can intervene earlier, we can make a difference," Gropen says.

Experts believe some of the physiological processes of Alzheimer's may begin years or even decades before symptoms are evident. The question is: How do we detect them?

The researchers' findings were based on a survey of 31 existing studies that had examined neuro-imaging and neuropsychological tests, and compared their ability to detect Alzheimer's disease before symptoms were present.

The results were more relative than absolute, says Mark Boulos, co-author of the paper and a researcher at the University of Toronto.

While the California test was the best predictor of Alzheimer's, other neuropsychological tests that measured memory and decision-making showed promising results.

In general, imaging tests were less sensitive than neuropsychological tests, although changes in the hippocampus section of the brain seemed to be the best physical measure of future Alzheimer's cases.

The researchers also looked to see which tests would identify persons with the ApoE gene, which indicates a genetic susceptibility to Alzheimer's. Again, the most effective tests were memory assessments, or neuropsychological tests, rather than neuro-imaging tests. The most reliable test for detecting the gene was, interestingly, an odor identification test.

Even armed with this knowledge, diagnosing Alzheimer's is still going to be a challenge, experts warn.

"None of these are easy in clinical practice at this stage," Gropen cautions. "They're labor-intensive and they're not done on a routine clinical basis."

Boulos adds that although his team's findings confirmed earlier studies, more research needs to be done.

"Nothing is definitive in research," Boulos says. "We want to continually reassess."

What To Do

For more information on diagnosing Alzheimer's, visit the Alzheimer's Association or the Alzheimer's Disease Education and Referral Center.


Hand Transplants More Likely in Future 


Monday, August 26, 2002

MIAMI (Reuters) - Hand transplants are likely to be performed more frequently in the future as studies show that rejection of the new appendage can be controlled by drugs, experts said on Monday.

Patients should be able to live relatively normal lives, they said.

The world's first hand transplant was performed in 1998 and since then only 11 cases have been reported.

However, studies show that drugs used in organ transplantation can effectively control rejection without serious complications, delegates at the Transplantation Society's international congress heard.

The first patient to undergo a transplant had his new hand amputated 28 months after transplantation. He had refused doctors' orders to take the drugs necessary to control rejection, according to reports on the case.

Critics have said such drugs can make patients susceptible to infections and tumor growth, calling into question whether the risks outweigh the benefits.

But studies by Italian, French and US teams said none of these complications have yet affected hand transplant recipients. Some had transient problems such as high blood sugar, but these were corrected.

The drugs were effective in preventing rejection, the experts said.

Dr. Darla Granger of the University of Louisville said one of her patients continued to work full time hanging gutters two months after the operation.

According to the transplant team in Lyon, France, the world's first double-hand transplant patient is able to shave and take care of other personal hygiene tasks that he was unable to do before his transplant.

There have been eight reported single-hand transplants, the first performed in Lyon, France, in 1998, and four double-hand transplants.


Protein Emerges as Major Heart Culprit 

By Ed Edelson
HealthScoutNews Reporter


Monday, August 26, 2002

MONDAY, Aug. 26 (HealthScoutNews) -- If you're heart-conscious and are not yet familiar with c-reactive protein, you should get to know about it, because a new study solidifies its emerging role as a risk factor ranking with cholesterol.

The study, done by researchers at the University of California at Davis, outlines the molecular pathway by which c-reactive protein (CRP, as it's often abbreviated) causes arterial damage that can end in a heart attack or stroke.

The damage is done through inflammation of the endothelium, the delicate outer layer of arterial cells. Those damaged cells are vulnerable to the formation of plaque, the fatty deposit that can rupture and block the artery.

"What we have teased out is that c-reactive protein interferes with a very critical enzyme that produces nitric oxide," says Dr. Ishwarlal Jialal, director of the UC Davis Laboratory for Atherosclerosis and Metabolic Research and lead author of a paper reporting the finding in the journal Circulation: Journal of the American Heart Association ( news - web sites). Nitric oxide plays a key role in keeping endothelial cells healthy, he says.

"More important, c-reactive protein causes more white blood cells to adhere to the endothelium, which is the first step in plaque formation," Jialal says. "When you piece all of the evidence together, including the results of previous clinical studies, you can show that if you have a high CRP level, irrespective of cholesterol, you are vulnerable to a heart attack."

There are several ways to lower CRP levels, he says. One is to lose weight, if you are obese. Another is to take aspirin. And statins, the widely used cholesterol-lowering drugs, have also been shown to reduce CRP levels.

CRP levels are increased by most of the commonly accepted cardiovascular risk factors, such as smoking, obesity, and high blood sugar levels, Jialal says. "I believe there is a place in therapy for CRP reduction."

Treatment can be started if someone is found to have elevated CRP levels in two consecutive tests, two weeks apart -- if they don't have an infection, Jialal says; any infection increases CRP levels. The doctor can then choose the best treatment for a given patient, he says. Weight loss is often effective in obese women but does not work as well in men, he adds.

Dr. Richard A. Stein, professor of clinical medicine at Weill Cornell Medical Center in New York and a spokesman for the American Heart Association, says he now tests many patients for CRP because of a long sequence of studies linking the molecule to inflammation and artery damage.

"Five years ago, we began to appreciate that CRP is a marker of inflammation," Stein says. "We've been fascinated over the past decade by the relationship of inflammation to atherosclerosis. If you open a plaque, you see a lot of what you see in infection, such as white blood cells, lacking the bacteria. About two years ago, studies began to show that CRP might not just be a marker of arterial disease but might atherogenic [plaque-causing].

"I used to do just a cholesterol test on these patients. Now in my practice I also do c- reactive protein and homocysteine, another risk factor. Most cardiologists now are doing that, and hopefully primary care physicians will, too," he adds.

Statin therapy is "the most powerful way" to treat high CRP, Stein says, adding that "most of these patients are probably on a statin already."

What To Do

You can learn about the role of inflammation in cardiovascular disease from the American Heart Association, which also has a page on risk factors you can change.


Sitcoms, Videos Make Even Fifth-Graders Feel Fat 

By E. J. Mundell

Reuters Health

Monday, August 26, 2002

CHICAGO (Reuters Health) - Children just 10 years of age told researchers they were dissatisfied with their own thighs, tummies and bottoms after watching a music video by Britney Spears or a clip from the TV show "Friends."

The finding adds support to the theory that media-fueled obsessions with thinness and the "perfect" body begin early in childhood.

"These were fifth-graders and they are already thinking that parts of their body are too big--and some of them haven't even gotten to the point where they are maturing. So for them it can only get worse," said researcher Leslie Williamson of the University of Wisconsin, Green Bay.

She presented the findings here Saturday at the annual meeting of the American Psychological Society.

Researchers have long understood that adults and adolescents feel pressure from the media to be thin, fit and beautiful. But does this drive start even earlier?

In their study, Williamson and her colleagues used standard tests to evaluate the emotional state and body-image concerns of 23 boys and girls, all fifth-graders from a local elementary school.

Telling the kids they were simply interested in finding out "the amount of TV they watch," the researchers had the children watch either 10-minute videos--by Britney Spears, Destiny's Child or Dream--or a 10-minute clip from the popular TV comedy "Friends."

Williamson told Reuters Health that before viewing the media clips, the children "didn't have exaggerated concerns about their body or different parts of their body," according to their answers on the questionnaires. And boys and girls seemed about equal in terms of body concerns.

However, after viewing either the music videos or the "Friends" clip, "girls were significantly more likely to feel their thighs, hips and bottoms were too large after the videos," according to the researchers. "Girls also reported being significantly more preoccupied with a desire to be thinner."

Williamson said the effect on girls seemed somewhat larger after they viewed the sitcom rather than the music videos. "I think maybe because with 'Friends,' the focus is more on the women. I think in the music videos the women are just seen as part of it, a piece of something bigger," she said.

Boys voiced more concerns about their bodies--especially their abdomens--after viewing the music videos, Williamson said. "Maybe because they showed a lot of really fit men in those videos, they started to become a little preoccupied with their appearance," she speculated.

The bottom line, according to the researchers, is that even elementary school-age boys and girls have "worries about their bodies" and that media images may help create or exacerbate these anxieties.

What can a parent do to help kids struggling with body concerns? Williamson believes it may be impractical to simply try to keep kids away from media images. Instead, she urges parents "to be supportive of their kids, and just let them know that they are beautiful for who they are."

And as for Britney and those rake-thin girls on "Friends": "I think it would be better for parents to talk with their kids and let them know that not everyone looks like the models on TV," Williamson said.


Exercise May Cut Risk of Pre-Diabetic Syndrome

Reuters Health

Monday, August 26, 2002

NEW YORK (Reuters Health) - Researchers have found that middle-aged men who get more than 3 hours of exercise each week are less likely to develop metabolic syndrome, an illness largely characterized by insulin resistance that often precedes development of so-called "adult-onset" type 2 diabetes and heart disease.

Insulin is an essential hormone that clears the blood of glucose (a form of sugar) after a meal and deposits it into cells to use for energy. High blood sugar can increase the risk of complications from diabetes such as heart disease, kidney failure and blindness.

While previous studies have touted exercise's potential to reduce the severity of illness in people already diagnosed with type 2 diabetes or heart disease, little evidence exists on whether or not physical activity prevents the metabolic syndrome that precedes these illnesses, according to lead author Dr. David E. Laaksonen of the University of Kuopio in Finland.

To investigate, Laaksonen's team followed a group of 612 healthy men between the ages of 42 and 60 over a 4-year period. All of the men provided information about various lifestyle habits, including how often they exercised on a weekly basis.

At the end of the study period, 107 men were diagnosed with metabolic syndrome. According to the report, these men had at least three of the following: abdominal obesity (a thick waist), elevated blood fats known as triglycerides, low levels of HDL ("good") cholesterol, high blood pressure and high blood sugar.

On average, these men exercised about 60 minutes or less per week, the authors report in the September issue of the journal Diabetes Care.

Men who exercised more than 3 hours per week, on the other hand, were much less likely to develop metabolic syndrome. This group of men decreased their risk of developing the metabolic syndrome by about 50% compared with the men who exercised no more than 60 minutes per week.

"These findings...suggest that intervention at an early phase in even relatively low-risk men may dramatically reduce the risk for development or progression of metabolic disturbances that eventually culminate in chronic and progressive diseases such as diabetes and (hardening of the arteries)," Laaksonen and colleagues conclude.

Source: Diabetes Care 2002;25:1612-1618.


SUNDAY, AUGUST 25, 2002 

Beach Pollution Tests May Be All Wet 


Sunday, August 25, 2002

SUNDAY, Aug. 25 (HealthScoutNews)-- A raft of recent beach closings may be more a case of bad samplings than bad water.

A study reported in a recent online edition of Environmental Science and Technology says flawed water sampling, not just pollution, may be behind a recent wave of beach closings in California and across the country.

Scientists at the University of California, Irvine, looked at 43 years of data and several high-frequency sampling surveys to study surf water quality at Huntington Beach, Calif.

They found coastal water quality is subject to an intricate relationship of various physical and biological factors. These include tidal cycles, seasonal rainfall and El Nino effects. They say this complex mix of influences makes it a challenge to monitor beach water quality, and raises questions about water monitoring across the country.

There were 19 percent more beach closures and advisories in 2001 in the United States than in the previous year, says a July report by the National Resources Defense Council. Increased monitoring and better testing standards for bacteria were responsible, the report says.

Most of those closings were the result of what's called a single "grab" sample, says Stanley Grant, study author and a professor of environmental engineering at the University of California, Irvine.

He says water quality at beaches changes so rapidly that this type of sampling approach would only be effective if you could provide minute-to-minute updates of beach water quality.

"You'd have to have a stop light up on the beach flashing green and red. It flashes red, and everybody would have to run out of the surf; it flashes green and everybody could run back in," he says.

An averaging method for testing beach water, similar to testing used to determine air quality in urban areas, would be better, Grant says.

More Information

The Environmental Protection Agency answers some questions on the extent of beach pollution.



Experts Urge Weight Loss for Youths 

By Martha Irvine

AP National Writer

The Associated Press

Saturday, August 24, 2002

OAK PARK, Ill. (AP) - By now, it's a well-known fact: the nation's younger generation is fatter than any before it, with 14 percent classified as obese or overweight.

Dana Jenkins was part of that statistic. An athletic but chubby kid much of his life, he weighed 212 pounds 150 percent his ideal body weight by the time he was 15.

Then he decided to do something about it. "I had to," says Dana, now 17 and a senior in high school. "It was time."

With the help of a nutritionist and his family, he changed his eating habits, started exercising more and has dropped 30 pounds over the last two years.

The method may sound tried, true and boring. But experts hope more young people will turn to healthier weight-loss methods, and ignore all the mixed messages about weight around them, from stick-thin models to "super-sized" fast food.

They say a multidisciplinary approach that gives young people and their parents access to teams of exercise therapists, child psychologists, doctors and nutritionists is proving most successful.

For some young people, it's a matter of avoiding serious health problems.

Researchers at the federal Centers for Disease Control say obesity-related child hospitalizations have increased at a "disturbing" rate in the past 20 years. Diabetes diagnoses have nearly doubled and sleep apnea related to childhood obesity is up fivefold.

Dr. Rebecca Unger, a Chicago pediatrician, has noted the trend in her private practice and at the Nutrition Evaluation Clinic at Chicago's Children's Memorial Hospital, where Dana got help.

"A lot of times when kids are referred they're much worse off," Unger says. "They come in weighing 200 percent of what they should weigh."

Experts say the 14 percent obesity figure, which applies to children ages 6 through 19, represents a near-tripling of the number of severely overweight youth since the 1960s. They blame everything from young people's penchant for high-calorie snack foods and soft drinks to a more sedentary lifestyle encouraged by TV and computer games.

Busy parents who play a key role in helping their children lose weight also opt for quicker, high-calorie meals.

"It's 7 o'clock and everyone's hungry. It's a lot easier to order a pizza than to prepare a balanced meal," says Kelly Schloredt, a staff psychologist and research associate at Children's Hospital and Regional Medical Center in Seattle.

Schloredt, a member of the hospital's Child Obesity Action Team, helps "emotional eaters" those who turn to food when stressed or upset find other outlets for their problems.

For Dana, who lives in the Chicago suburb of Oak Park, spending too much time alone was part of the trouble.

"It was more of a habit," he says of snacking on chips and cookies, sometimes entire packages of them. "If I was bored, I'd find myself in the kitchen."

Another problem: He's allergic to most fresh fruits and vegetables. The hospital nutritionist helped him find alternatives crackers, cheese, canned peaches or fruit cocktail.

He started riding his bike more, drank more water and ate breakfast. He also worked out at the YMCA with his mother, Norma, who joined Weight Watchers and added more salads, rice and other low-calorie foods to family meals.

YMCAs across the country are noting the trend and adding fitness programs for teens part of a national movement to encourage young people to be more active.

President Bush ( news - web sites) has launched fitness initiatives for children, while former Surgeon General David Satcher has a national summit on child obesity planned for October in Washington.

Universities and corporate America are also getting involved

The University of North Texas is providing materials and leading discussion groups to give young people and their parents everyday tactics for eating healthier and exercising. It is working with 800 ninth-graders in Dallas schools, and researchers will track the results.

Sporting goods retailer The Sports Authority developed a free "Fitness Authority" exercise program for Boys & Girls Clubs nationwide.

Nicole Dearing, an 18-year-old from Valparaiso, Ind., was one of 250,000 who participated in program competitions in the last year. Earlier this month, she became a two-time national champion in her age category and lost 20 to 25 pounds along the way.

"I've been feeling better. I've got more energy. I haven't been getting headaches," she says. "Overall, I've just been a happier person."

She says she's also cut back on fast food and eats a double-cheeseburger and large fries once a week instead of every other day.

Dana says losing weight has been an important boost to his self-image. He no longer hides beneath baggy clothes, and he's stopped avoiding the swimming pool.

And there's one other benefit his mother has noted.

"More girls are calling," she says, looking at Dana, who just smiles and blushes.

On the Net:

American Academy of Child & Adolescent Psychiatry obesity page: