Adult
'Bad' Behavior May Encourage Teen Sex - Study
By Maggie Fox
Reuters
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.
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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.
Specifically:
·
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.
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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.
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Be
Well-Seated
HealthScoutNews
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.
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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.
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Keeping
the Pressure Down
HealthScoutNews
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.
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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.
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Many
Ingredients Make a Happy Kid
HealthScoutNews
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.
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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.
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Kids
Too Sweet on Soft Drinks
By Randy Dotinga
HealthScoutNews Reporter
HealthScoutNews
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.
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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.
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Another
Deafness Gene Discovered
By Kathleen Doheny
HealthScoutNews Reporter
HealthScoutNews
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.
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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.
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Warts
Aren't So Tricky When it Comes to Treatment
By Ross Grant
HealthScoutNews Reporter
HealthScoutNews
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.
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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.
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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.
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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.
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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: http://www.fda.gov
Abbott Laboratories Inc.: http://www.abbott.com
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Study:
No Link Between Cell Phones, Tumors in Mice
Reuters
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.
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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.
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THURSDAY,
AUGUST 29, 2002
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.
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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.
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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.
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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."
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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.
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Listen
To Your Heart
HealthScoutNews
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: http://www.bioscience.org/atlases/heart/sound/sound.htm.
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.
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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.
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Blacks
Have More Kidney Disease
HealthScoutNews
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.
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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.
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Teen
Computer Program Is No Game
HealthScoutNews
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.
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Pot
Smoking in Youth Tied to More Drug Use Later
Reuters
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.
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Anti-Clotting
Drug Works Better with Time
HealthScoutNews
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.
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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.
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Stretching
Before Exercise Doesn't Do Squat
By Adam Marcus
HealthScoutNews Reporter
HealthScoutNews
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.
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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.
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Low
Birth-Weight, High Blood Pressure Link Disputed
By Kathleen Doheny
HealthScoutNews Reporter
HealthScoutNews
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.
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Study
Links Second-Hand Smoke to Heart Disease
Reuters
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.
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First
Lupus Test in 4 Decades Gets Go-Ahead
HealthScoutNews
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.
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Study
Links Second-Hand Smoke to Heart Disease
Reuters
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.
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After Long Decline, Smoking
Is Up Among U.S. Women
Reuters
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 www.cdc.gov/tobacco.
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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."
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Kids
Can Be Hooked After a Few Cigarettes: Report
By Melissa Schorr
Reuters
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.
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14
Percent of World Youth Smoke, Survey Finds
Reuters
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 http://www.cdc.gov/tobacco/global/GYTS.htm,
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.
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WEDNESDAY,
AUGUST 28, 2002
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:
http://www.nejm.org
http://www.resolve.org
http://www.asrm.org/
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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.
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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.
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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.
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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:
JAMA: http://jama.ama-assn.org
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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.
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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:
http://www.nhtsa.dot.gov
DaimlerChrysler's site on inspection stations: http://www.seatcheck.org
General Motors' video on LATCH installation: http://www.gmability.com
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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.
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Health
101
HealthScoutNews
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.
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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.
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Doing
the Write Thing
HealthScoutNews
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.
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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.
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Islet
Cell Transplants Offer Hope to Diabetics
By Amanda Gardner
HealthScoutNews Reporter
HealthScoutNews
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.
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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.
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Tackling
Childhood Depression
By Amanda Gardner
HealthScoutNews Reporter
HealthScoutNews
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.
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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.
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Early
Breast Cancer Linked to Increased Ovarian Cancer Risk
By Kathleen Doheny
HealthScoutNews Reporter
HealthScoutNews
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.
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Risk
Factors for Melanoma
HealthScoutNews
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.
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Glucowatch
Gets OK for Diabetic Children
HealthScoutNews
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.
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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: http://www.phrma.org/litigation
Health and Human Services: http://www.hhs.gov
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Teens
Easy Prey for Tobacco
By Amanda Gardner
HealthScoutNews Reporter
HealthScoutNews
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.
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An Ounce of Prevention . . .
HealthScoutNews
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.
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Anti-Allergy
Covers Don't Aid Asthmatics
HealthScoutNews
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 clinica
