The American Voice Institute of Public Policy presents

Personal Health

Joel P. Rutkowski, Ph. D., editor
September 11, 2004

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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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



















PERSONAL HEALTH for the week of May 29 - June 4


  1. Weight Training Improves Diabetic Nerve Function
  2. Study Examines Teen Summer Marijuana Use
  3. Antibiotics Can Cut Meningitis Risk to Contacts
  4. Parents Think Too Many Teens Get Antidepressants
  5. New Cancer Drugs Aim at Multiple Targets
  6. Losing the Fat May Be Key to Longer Life
  7. Antacid Overuse Sickens Montreal Patients-Study
  8. Poison-Proof Your Home
  9. Many Parents Clueless About Children's Weight
  10. Think About Statins for Every Diabetic –Group
  11. Lung Cancer Inches Down in Women
  12. Too Much Vitamin C May Be Bad for Arthritis
  13. Kids' Obesity May Be Worse Than Thought
  14. Heart Patients Often Don't Receive Drug Therapy
  15. Hormonal Clue to Autoimmune Diseases Found
  16. Food Additives Increase Hyperactivity in Kids
  17. Many HIV-Positive Men Don't Realize It: Study
  18. Inhaled Insulin Controls Diabetes Over Long Term
  19. Cancer Survival Rates Up
  20. Experts See U.S. Health-Care Cost Rises Slowing
  21. Gaily Colored Fruits May Reduce Stroke Risk
  22. Two-Gene Signature Predicts Breast Cancer Relapse
  23. Two Genes Provide Clues to Tamoxifen Success
  24. Halting Cancer's Spread
  25. Vaccine Critics Attack Mercury Report
  26. New Way to Ease Pain of Gallbladder Removal
  27. Study: Dieting Can Weaken Immune System
  28. Experts to Review New Ultrasound Fibroid Therapy
  29. Kraft Backs Off Plan to Reduce Portions
  30. Moderate Alcohol Use Not Bad After Heart Attack
  31. Many Not Doing Enough to Prevent Heart Disease
  32. Obesity Ups Kids' Health Risk More Than Expected
  33. Black Children Lag on Vaccines
  34. Fewer Women Than Men Take Aspirin for Heart Health
  35. Diabetes Increases Death Risk for Elderly
  36. Pipe Smoking Carries High Cancer Risk –Study
  37. New Guidelines on Vision Checks for Kids
  38. Anemia Linked with Heart Disease in Women
  39. Study: Doctors' Neckties May Harbor Germs
  40. Women Smokers Have Same Lung Cancer Risk as Men
  41. Hospitals Go Gourmet, Offer New Cuisine
  42. Study: Smoking Alters Saliva to Raise Cancer Risk
  43. Air Pollution Poses Cardiovascular Risks, Heart Association Says
  44. 'Safer' Tobacco Products Not as Safe as They Seem
  45. Chocolate Can Keep Cardiovascular System in Shape
  46. Kids' Use of Bike Helmets, Seatbelts Less Than Parents Think
  47. Study: Driving Longer Means Larger Waists
  48. Catch Carpal Tunnel Syndrome Early
  49. School Asthma Program Improves Health and Grades
  50. Say So Long to Spit Tobacco
  51. Small Steps Are Urged for Weight Loss
  52. Health Tip: Kids in Hot Parked Cars
  53. Many Don't Get Full Dose of Chemo
  54. New Risk Factor for Teen Smoking Found
  55. Demand for Surgery for Obesity Increases – Expert
  56. Food Variety May Increase Consumption



Friday, June 4, 2004


Weight Training Improves Diabetic Nerve Function


By Megan Rauscher

Reuters Health

Friday, June 4, 2004

NEW YORK (Reuters Health) - Resistance training improves nerve function in elderly diabetic patients with a common condition called peripheral neuropathy, according to findings presented today at the annual meeting of the American Diabetes Association. It also has a favorable impact on risk factors for heart disease.

Peripheral neuropathy typically affects the feet and hands and can cause a variety of problems including numbness, tingling sensations, pain, and weakness.

"We noticed that many of our elderly diabetic patients were not tolerating traditional medicines used for neuropathy pain or they just weren't working," lead researcher Dr. Regina T. Kurian, from the University of Louisville in Kentucky, told Reuters Health.

"Our results show that resistance training is safe for elderly patients with neuropathy and it can improve their symptoms and increase muscle strength and maybe help prevent some falls," she said.

In the study, 11 elderly diabetic patients with peripheral neuropathy engaged in roughly 30 minutes of supervised resistance training of the lower extremities three times per week for 12 weeks. "This was a pilot study to see if this was doable and to see if we could get some good data --and we did," Kurian said.

Resistance training was associated with improved muscle strength in the calf and hamstring, a reduction in waist circumference, a drop in blood pressure, and an increase in "good" HDL cholesterol.

Resistance training also led to improvements in scores on two standard neuropathy tests.

Based on these results, the investigators suggest considering resistance training in the management of diabetics with peripheral neuropathy.

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Study Examines Teen Summer Marijuana Use


By Martha Irvine

AP National Writer

The Associated Press

Friday, June 4, 2004

CHICAGO - Summer's almost here and that means teens will have more time on their hands to pick up bad habits — such as smoking marijuana and drinking alcohol, a new federal survey says.

The National Survey on Drug Use and Health found that June and July were the most popular time for teens to try marijuana, with about 6,300 new users a day during those months. That compares with about 4,700 new users a day during other times of the year.

Additionally, the survey found that first-time use of alcohol and cigarettes also increases during the summer, when many teens are less supervised and, particularly in this economy, having trouble finding jobs.

At a Friday news conference in Chicago, White House drug czar John Walters challenged teens and parents to quell marijuana use this summer, noting that the drug has been developed to become much more potent and addictive over the last 20 years.

"You are going to be on the front line of those influences," said Walters, who heads the Office of National Drug Control Policy, addressing a group of Chicago high school students. "But we need adults to stand with you."

Several teens who were present said they understood the risks of drug use, which they learned in their health classes. Still, they know other teens who use marijuana, which they and surveys say is the most common illegal drug taken by high-schoolers. Some said they even know elementary school students who've been caught using it.

"It's definitely a problem," said Julissa Santoy, a freshman at Whitney Young High School, a public magnet school. "We should say something. We shouldn't just mind our own business."

But Maribel Davila, another freshman, also placed responsibility on parents.

"A lot of kids are pushed because there's a lot of stuff going on at home," she said, referring such things as divorce, adults' own addiction issues and other family discord.

None of the students were surprised by the findings. Nor was at least one researcher not involved with this survey who tracks teen drug use.

While its helpful to know when young people are most likely to start taking drugs "the real question is 'What should they do based on that information?'" said Lloyd Johnston, who heads the University of Michigan's Institute for Social Research and oversees an annual national survey of teens called "Monitoring the Future."

The most recent University of Michigan survey, released late last year, found an 11 percent drop in illegal drug use in the past two years. But it also found that, while marijuana use had dropped, nearly half of 12th-graders surveyed said they had tried it at least once — and about a third said they had used it in the last year.

Walters agreed with Johnston that the best way to deter marijuana use is not just to say "Don't do drugs."

To that end, federal officials have begun running advertisements directed at teens that urge them to take a stand with friends who use marijuana and other drugs.

The government has also begun a campaign titled "School's Out — Don't let your teen's summer go to pot," which maps out basic tactics for parents such as setting rules, monitoring a teen's activity and scheduling family time.

At Friday's news conference, YMCA executive director Ken Gladish called the suggestions "fundamental common sense."

He referred to a recent YMCA survey that found 14.3 million young people are unsupervised outside school — a number that triples in the summertime.

Meanwhile, he said, more than half of those teens surveyed said they wished they had access to more supervised programs in their neighborhoods.

On the Net:

Martha Irvine is a national writer specializing in coverage of people in their 20s and younger. She can be reached at

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Antibiotics Can Cut Meningitis Risk to Contacts


By Stephen Pincock

Reuters Health

Friday, June 4, 2004

LONDON (Reuters Health) - When someone comes down with meningitis, giving household contacts the appropriate antibiotics can reduce their risk of infection by 89 percent, according to a review in this week's British Medical Journal.

Meningitis can be caused by a number of bacteria or viruses, but the meningococcus microbe is the usual culprit in epidemic forms of the disease.

Dr. James M. Stuart and colleagues from the Communicable Disease Surveillance Center in Gloucester, England, and centers in Wales, Austria and Germany, identified studies on meningitis outbreaks that included at least 10 cases in which outcomes were compared between treated and untreated groups.

Their analysis revealed that the odds of a contact catching the infection when they were given preventive antibiotics was only 11% of the risk for untreated contacts.

"We found that if household contacts of a patient with meningococcal disease are given prophylaxis with antibiotics that eradicate meningococcal carriage there are fewer subsequent cases," the team writes.

The 89 percent risk reduction seen in the analysis was substantial, Stuart told Reuters Health. "I think it's a big reduction," he said. "To me, the size and consistency of that reduction are quite supportive of a protective effect (and it) makes us more confident that this is a true benefit."

The authors also point to a shortage of evidence about the value of preventive antibiotics in childcare settings, where variation in government policy is wide. Stuart and others are currently in the middle of a Europe-wide study looking at the incidence of clusters in nursery or day care settings, and correlating that evidence with policy.

"There's probably enough variation in practice there that we might get some differences shown in risk and look at whether it is appropriate to recommend a consistent policy across Europe in day-care setting as well," he said.

Source: British Medical Journal, June 6, 2004.

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Parents Think Too Many Teens Get Antidepressants



Friday, June 4, 2004

FRIDAY, June 4 (HealthDayNews) -- While many parents are concerned about depression among teenagers, a number of them are apprehensive about antidepressants, says a new poll from Columbia University.

The poll of 512 parents with children under 18 found that:

"Parents are worried that many teens with depression aren't getting treated and many teens without depression are," Laurie Flynn, director of the university's Carmel Hill Center for Early Diagnosis and Treatment, said in a prepared statement.

"What's more troubling is parents lack basic information on depression and medication and they don't know where to turn. This poll is a wake-up call to physicians, educators, researchers and even the media to step up efforts to sort out the confusion," Flynn said.

One in five youths will have one or more episodes of major depression by the time they reach adulthood, the researchers added.


More information


The Nemours Foundation has more about teen depression.

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New Cancer Drugs Aim at Multiple Targets


By Toni Clarke


Friday, June 4, 2004

NEW YORK (Reuters) - Last year, the big news in cancer therapy was Avastin, a colorectal cancer drug that extends life by an average of five months. This year, scientists are looking hard at the "children" of Avastin, drugs that are based on the same principle but have additional bells and whistles.

Avastin works by cutting off blood supply to tumors, a process known as anti-angiogenesis. New drugs under development, to be discussed at the year's biggest cancer conference this weekend, do that, but also home in on proteins that help cancer cells grow.

Moreover, they come in the form of pills, whereas most cancer drugs are delivered intravenously.

"These drugs represent the next generation of anti-angiogenesis drugs beyond Avastin," said William Li, president and medical director of the Angiogenesis Foundation, a non-profit institution based in Cambridge, Massachusetts. "If chemotherapy is like a dirty bomb and Avastin like a smart bomb, then the new therapies are more like cluster bombs that have multiple targets."

Data from mid-stage clinical trials of these drugs will be presented this weekend at the annual meeting of the American Society of Clinical Oncology (news - web sites) in New Orleans, and the results are expected to show promise.

Pfizer Inc. will present mid-stage data on a drug with the working title SU11248. It hits four targets, including a protein known as VEGF, which is heavily involved in the process of angiogenesis and is targeted also by Avastin. The drug also targets KiT, which is hit by Novartis's successful drug Gleevec; and FLT-3, which is found on both cancer cells and tumor blood vessels.

Side Effects ‘Manageable'

While more may prove better in some ways, cancer specialists point out that the more targets that are hit the more likely the drug is to cause side effects and toxicity. But George Demetri, director of the Sarcoma Center at the Dana Farber Cancer Institute, said the side effects are not intolerable.

"Compared to chemotherapy they are still very manageable," he said.

Bayer AG and Onyx Pharmaceuticals Inc. are co-developing a drug, BAY 43-9006 that hits a new target known as RaF kinase, an enzyme that acts as a control switch for the RaF gene, which helps control tumor growth. It also targets VEGF, which is considered one of the main proteins involved with blood vessel growth.

It isn't clear to scientists, however, which target is responsible for promising results in early trials, which is one of the disadvantages of all targeted therapies.

Genentech Inc. will present data from a mid-stage trial combining Avastin with Tarceva, a drug it is developing with OSI Pharmaceuticals Inc. . Unlike the others, these are separate drugs that hit two different targets.

All three combinations are being developed for kidney cancer, known to be packed with blood vessels which rely heavily on VEGF to flow. The trials are in renal cell carcinoma, which accounts for about 85 percent of all kidney cancer, a condition that affects about 31,000 patients a year.

Novartis AG and Schering AG are co-developing a drug for colorectal cancer, PTK 787, which turns off all the VEGF receptors, meaning no VEGF signal can bind to them. Avastin blocks just one of the five VEGF signals that bind to the three receptors.

"Our expectation is that we will be able to have a more complete blockade of the angiogenesis process which may result in superior efficacy compared to Avastin," said David Guy, vice president of global strategic marketing, oncology, for Schering.

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Losing the Fat May Be Key to Longer Life


By Steven Reinberg
HealthDay Reporter


Friday, June 4, 2004

FRIDAY, June 4 (HealthDayNews) -- Is there a connection between being lean and living longer? Researchers think there is -- at least, in mice.

It has been known for a long time that mice live longer on diets that severely restrict calories, but until now the reason has not been clear.

In new research, Massachusetts Institute of Technology (news - web sites) (MIT) scientists experimenting with mice and mouse cells think they have found the answer.

Restricting calories causes a gene called SIR2 to become active, and this in turn activates another gene called PPAR-gamma that regulates fat storage.

When PPAR-gamma becomes active, fat is broken down and metabolizes, according to a new report in the June 3 online edition of Nature.

It has been known for about 75 years that, for mice, "a diet with very low calories seems to slow down aging and mitigate diseases of aging," said lead researcher Dr. Leonard Guarente, a professor of biology at MIT. "But what we haven't known is how that works."

The critical gene involved in the process is called Sirt1, which is the mouse form of the SIR2 gene found in humans, Guarente said.

This gene senses the scarcity of calories and causes fat storage cells to shed their fat. "The fat then gets pushed out of these cells into the blood where it gets metabolized," he explained. "This is a process that correlates with good health and longevity."

One of the reasons that mice on a calorie-restricted diet live longer is that they are incredibly lean, Guarente said. "And this is how they get lean."

Understanding the mechanism is the first step to developing drugs that mimic the effects of calorie restriction and deliver the benefits of calorie restriction, Guarente said. This has enormous potential in terms of diseases of aging.

I think that we can have drugs that can deliver some of the benefits of a low-calorie diet, without having to live a Spartan existence to get the benefit," Guarente said.

Dr. Heidi A. Tissenbaum, a gene expert at the University of Massachusetts Medical School, said this finding may be the mechanism that explains why calorie restriction works to extend life.

The finding is suggestive, but not conclusive, she added. "This could be one way SIR2 functions in calorie restriction, to extend lifespan," Tissenbaum said.

The broad implications could be new drug targets for treating human obesity and type 2 diabetes, she noted.

It may also lead to a new diet pill, she said. "The two things that work all the time are diet and exercise. I don't think that we will ever be able to take a pill and eat whatever we want," Tissenbaum said.

In terms of longevity, Tissenbaum said it's unclear how these genes act in later life.

"We don't know when these genes are active in the adult lifespan. We know how they act in the cell, but we don't know, until we have the data in mice and humans, that if you change one thing you can extend lifespan," Tissenbaum said.

Dr, Ronen Marmorstein, a researcher from the Wistar Institute at the University of Pennsylvania, added, "It is pretty clear that Sirt1 activity has an effect on fat metabolism and storage."

"Whether or not there is a longevity connection in mammals is still and open question," he added.

More information

The American Aging Association can tell you about growing older.

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Antacid Overuse Sickens Montreal Patients-Study


By Sue Thomas


Friday, June 4, 2004

TORONTO (Reuters) - Overuse of a popular antacid has increased the risk of severe and potentially fatal diarrhea in patients in Montreal hospitals, a research study published in the Canadian Medical Association Journal warned on Friday.

The study links the increasing prevalence of clostridium, an organism that causes severe diarrhea, in Montreal hospitals to the increased use of proton pump inhibitors, a powerful antacid used to treat peptic ulcers and esophageal reflux disease.

It also found that using antibiotics while taking the antacid added to the risks of getting clostridium.

"Our research found that patients were twice as likely to get the disease if they were on antibiotics and proton pump inhibitors than those who were just on antibiotics," Dr. Sandra Dial, who led the study, told Reuters.

Antibiotics change the normal bowel flora, and the proton pump inhibitors lower the stomach's acidity, allowing the bug to pass into the gut.

Dial's study looked at 1,187 patients in a Montreal teaching hospital, where the incidence of clostridium had increased "significantly" in 2003 from 2002. It did not say by how much the disease had increased.

Around half of the 1,187 patients were prescribed antibiotics and antacids, and the other half were prescribed just antibiotics. Of the total number, 81 developed clostridium, 55 of whom had taken antibiotics and the antacid.

At the same time, the researchers looked at 94 patients who already had clostridium. The study found that within 30 days of being diagnosed with clostridium, 21 patients had died.

The study concluded that patients who developed clostridium diarrhea "had substantial mortality and morbidity. We found that the use of proton pump inhibitors was independently associated with an increased risk of (clostridium) diarrhea."

Dial, a critical care physician at the Montreal Chest Institute, said she believed clostridium was more prevalent in Montreal because proton pump inhibitors are readily available in Quebec hospitals.

"Proton pump inhibitors are restricted in hospitals in most provinces because of their cost," she said. "In Quebec and Alberta they are not."

Hospitals in Calgary, Alberta, quelled a similar outbreak of the infection in 2000-2001, and a less virulent strain has recently resurfaced, the CMAJ said.

Dial said she had presented her findings to a number of Montreal hospitals, and suggested that patients switch to milder antacids if their conditions do not warrant the more powerful proton pump inhibitors.

"The hospitals are very concerned about the disease. They haven't gone as far as introducing restrictions for proton pump inhibitors, but I think I might have convinced them there may be something that should be looked at," she said.

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Poison-Proof Your Home



Friday, June 4, 2004

FRIDAY, June 4 (HealthDayNews) -- Every 15 seconds, someone in the United States is accidentally poisoned.

About 60 percent of those victims are children younger than 6 whose curiosity about medications, plants and such common household products as cleaners and cosmetics can have serious, even deadly, consequences.

Brenda Schroeder, a safety management specialist at the University of Michigan Health System, offers some tips on how to prevent accidental poisonings in the home.

Parents have to be especially vigilant in high-risk areas such as the kitchen, bathroom, laundry room and garage. Philodendrons, ivy, daisies and tulips are among the common plants that pose a potential threat.

Here are some ways you can poison-proof your home:

Adults should never behave in way that might tempt children to want to try medications.

"Always make sure not to refer to medications as candy. And, if possible, do not take your medication in front of your children. Children often like to pretend to be grown up and mimic what adults do," Schroeder said.


More information


The U.S. National Center for Injury Prevention and Control has more about poisonings.

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Many Parents Clueless About Children's Weight


By Merritt McKinney

Reuters Health

Friday, June 4, 2004

NEW YORK (Reuters Health) - As many as half of all children in middle school may be overweight or at risk of being overweight, according to the results of a new U.S. study. However, the results of a study from the UK indicate that many parents do not see a problem.

"Parents are unaware that their children are overweight or obese," study author Alison N. Jeffery of Derriford Hospital and Peninsula Medical School in Plymouth told Reuters Health in an interview.

What's most troubling is that "most were unconcerned" about their children's weight, said Jeffery, who is a senior research nurse on the study.

The results of both the US and UK studies were presented Friday at the annual meeting of the American Diabetes Association in Orlando.

About a third of obese girls and about half of obese boys were considered to weigh "about right" by their parents, Jeffery's team found in a study of 300 children and their families.

Moreover, a third of mothers and half of fathers who were overweight or obese themselves considered their own weight to be "about right."

Children were no better at judging their weight. When asked to rate themselves based on body mass index (BMI), a measure that takes into account weight and height, 51 percent of children underestimated their BMI.

Social class, parental education and family income were not related to actual or perceived BMI, Jeffery said.

Part of the problem, she said, is that "overweight is now seen as the norm." The UK researcher noted that some parents of normal-weight children were concerned that their children were underweight.

"We've got to consider the awareness of parents" when confronting overweight and obesity in children, Jeffery said. "We're losing out."

In the American study, which included 1,700 eighth-grade students, nearly 50 percent were overweight or were at risk of being overweight, lead researcher Dr. Francine Kaufman of Children's Hospital of Los Angeles told Reuters Health in an interview.

Kaufman and her colleagues found that about 40 percent of children had pre-diabetes, which is marked by above-normal levels of blood glucose. In addition, nearly half of the students had low levels of HDL, the "good" form of cholesterol, and many had blood pressure that was above normal for their age.

Although only a few students had diabetes, the widespread presence of pre-diabetes and other risk factors meant that children may be at risk of developing diabetes down the road.

"These findings suggest that school - particularly middle school - is an excellent place to deliver diabetes prevention strategies," Kaufman said.

It is important to promote a healthy lifestyle during childhood because children "get into health behaviors that often track throughout their lives," according to Kaufman.

The study being reported this week is a pilot study that is part of a larger study that will test ways to improve the health and diet of middle-school students. "We were compelled to action" by the initial findings, Kaufman commented.

In the study, researchers will alter and improve the "nutritional environment" in schools, including cafeterias, vending machines and school stores, Kaufman said. Schools that participate will also increase the time students spend in moderate to vigorous physical activity in P.E. class, according to Kaufman.

The study will also include special efforts to "energize" children to take advantage of healthier choices and to promote healthy lifestyles away from school, too, Kaufman said.

About 100 schools in several states will participate in the study, with some receiving the intervention and some not. The results of the study should be available in 2009, Kaufman said.

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Thursday, June 3, 2004


Think About Statins for Every Diabetic –Group


By Maggie Fox, Health and Science Correspondent


Thursday, June 3, 2004


WASHINGTON (Reuters) - Almost everyone with diabetes should consider taking a statin drug to lower cholesterol, even if they already have low cholesterol levels, the American Diabetes Association advised on Thursday.

Diabetes patients are at such high risk of heart disease that the statins almost certainly will do them some good, the group said in its latest treatment guidelines.

People with diabetes should all consider taking a daily aspirin, too, the new guidelines say.

"It may well be that everybody with diabetes should be on a statin," said Dr. Nathaniel Clark, vice-president for clinical affairs for the group.

"We know that statins lower low-density cholesterol but they may also have some other qualities that have not been tested," Clark said in a telephone interview.

An estimated 18 million Americans have diabetes, 90 to 95 percent of them type-2 diabetes. This once was called adult-onset diabetes but it is showing up in children more often now.

Type-1 diabetes is an autoimmune disease caused when the body mistakenly destroys insulin-producing pancreas cells.

Type-2 diabetes is strongly associated with being overweight and sedentary. It greatly raises the risk for heart disease, stroke and heart attack and can also lead to blindness and limb loss.

Clark said the Association decided to add statins to the guidelines after seeing the results of a British study, published earlier this year in the Lancet medical journal, that showed people who took statins had a one-third lower risk of stroke.

Their study included adults over the age of 40 whose total cholesterol levels were as low as 135 -- considered extremely low by most standards. Among normal healthy people, doctors do not usually consider giving drugs to lower cholesterol until total levels hit 200.

But Clark said diabetics are a special case.

"It is now a consensus that having diabetes is the equivalent in terms of cardiovascular risk of already having had a heart attack," Clark said.

"We are talking about what we would consider a high-risk group."

Statins are becoming more and more popular with doctors as study after study finds they can lower the risk of a range of heart conditions and may also help patients with multiple sclerosis and Alzheimer's disease (news - web sites).

Worldwide, 25 million people take statins, but up to 200 million could be eligible.

The drugs are not cheap, however. The United States already spending $12.5 billion on statin drugs, more than any other type of medicine, and the drugs can cause a rare type of side-effect called rhabdomyolysis, which damages muscles.

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Lung Cancer Inches Down in Women


By Lauran Neergaard

AP Medical Writer

The Associated Press

Thursday, June 3, 2004

WASHINGTON - Lung cancer is inching down among women after decades of smoking-fueled increases — and overall survival rates are improving for most types of tumors among both men and women.

Not everyone is reaping the gains: Minorities still are more likely than whites to die from cancer, says the nation's annual report on cancer, to be published Thursday in the journal Cancer.

But largely, the news remains optimistic. Death rates from cancer in general have dropped 1.1 percent a year since 1993, and Thursday's report confirms that decline continued in 2001. Rates of new cases are declining about half a percent a year, too.

Most striking in this latest tally is what's happening with the No. 1 cancer killer: Rates of female lung cancer diagnoses have declined about 2 percent a year since 1998, years after men began a similar improvement. Also, female death rates from lung cancer have leveled off, remaining virtually unchanged since 1995, the report says.

"For the first time, we are turning the corner in the lung cancer epidemic in women," said Ahmedin Jemal of the American Cancer Society (news - web sites), who co-wrote the report with scientists from the National Cancer Institute (news - web sites), Centers for Disease Control and Prevention (news - web sites) and North American Association of Central Cancer Registries.

"We have been anticipating ... this for a long, long time," Jemal added. "It has been overdue."

Smoking became rampant among men long before women, and the resulting lung cancer consequently struck men sooner.

Lung cancer remains the nation's top-killing malignancy for both sexes, and the second most common cancer. But it slowly declined among men starting in the early 1990s as older smokers died and fewer young men took up the habit — a pattern doctors expect to eventually see in women.

The report's other new finding: More people are living at least five years after a diagnosis of most types of cancer.

Five-year survival is a major milestone for cancer patients, and the scientists found significant gains over the past two decades in how often that milestone was met.

For men, survival rates improved the most — more than 10 percent — for cancers of the prostate, colon and kidney, and for melanoma and leukemia.

For women, the biggest survival improvements came in colon, kidney and breast cancers.

What does that mean? Today, 99.3 percent of men diagnosed with prostate cancer will live five years, up from 70 percent in the 1970s. Five-year survival for breast cancer is 88 percent, up from 75 percent in 1970s.

But that survival is strongly connected to how early cancer is caught, stressed co-author Brenda Edwards of the NCI's cancer-control division.

For example, five-year survival for lung cancer is just 15 percent, largely unchanged from the 1970s, because more than half of patients are diagnosed after the disease has spread beyond their lungs. In the few cases where tumors are caught early, five-year survival jumps to 49 percent — but there is no proven early-screening method for lung cancer.

Even with colorectal cancer, where good tests have improved survival, only one of three cases still is caught at the earliest stage, Jemal lamented.

Then there's the racial gap.

When looking at all cancers combined, black men are 26 percent more likely to die of a malignancy than white men, and Hispanic men are 16 percent more likely than non-Hispanic whites, said the cancer society's Jemal. Black women are 52 percent more likely to die of cancer than white women, and Hispanic women 20 percent more likely, he said.

Much of the disparity reflects minorities' poorer access to cancer prevention and early detection services, Jemal said.

But notable differences remain even when scientists examine people diagnosed at the same stage of cancer, said NCI's Edwards. Black women were more likely to die of breast cancer, even though that disease is more common among whites.

Access to the best treatment options probably plays a role, as may additional illnesses patients have that complicate cancer treatment, Edwards said.

"It's not one simple story as to what is our national cancer burden," she cautioned.

Added Jemal: "We know much about cancer. We need to apply everything about cancer control equally to all populations."

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Too Much Vitamin C May Be Bad for Arthritis


By Will Boggs, MD

Reuters Health

Thursday, June 3, 2004

NEW YORK (Reuters Health) - Prolonged exposure to high doses of vitamin C seems to make osteoarthritis worse, according to findings from a study involving guinea pigs. This suggests that people should not exceed the recommended dietary allowance for vitamin C.

Previous short-term studies have indicated that vitamin C might be protective against osteoarthritis, but long-term treatment with vitamin C has not been studied, the researchers note in the medical journal Arthritis & Rheumatism.

Dr. Virginia B. Kraus from Duke University Medical Center in Durham, North Carolina, and colleagues investigated the effects of 8 months' exposure to low, medium, and high doses of vitamin C on the development of knee arthritis in guinea pigs.

The low dose was the equivalent of the amount needed to prevent scurvy, the medium dose represented that obtained by a person consuming five fruits and vegetables daily, and the high dose to match that shown in a previous study to slow the progression of arthritis in guinea pigs.

The guinea pigs exposed to the highest dose in the current study had more severe arthritis than the animals exposed to low or medium doses, the investigators report.

"This study highlights the potential drawbacks of long-term, high-dose vitamin C intake on joint health, suggesting that dietary intake should not be supplemented above the currently recommended dietary allowance (90 mg/day for men and 75 mg/day for women)," the authors note.

Kraus told Reuters Health that in addition to a balanced diet, one multivitamin per day is sufficient to achieve the recommended amount of vitamin C.

Besides the association with arthritis, long-term use of high dose vitamin C has been linked with diarrhea, iron problems, and kidney stones, Kraus added.

Source: Arthritis & Rheumatism, June 2004.

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Kids' Obesity May Be Worse Than Thought


By Cristina Rodriguez

Associated Press Writer

The Associated Press

Thursday, June 3, 2004

LITTLE ROCK, Ark. - Forty percent of public schoolchildren in Arkansas are overweight, and nearly one in four is obese, a sign that obesity among children nationwide is probably far worse than health officials had thought.

The findings are the broadest and most recent comprehensive look at children's weights, the result of a state law in Arkansas, where state officials have made obesity a top issue.

"I think we'll find as we go along that Arkansas is not that much more obese than other parts of the country," said Dr. Carden Johnston, president of the American Academy of Pediatrics. "(The) Arkansas data is the best that we have because it's cross-sectional."

The Arkansas numbers paint a more dire picture than previous national studies. Those have indicated that about 30 percent of American children are overweight or obese. Those falling into the obese category account for about 15 percent.

In Arkansas, about 22 percent of the children are considered obese while 18 percent are merely overweight. Fifty-eight percent are normal weight, and 2 percent underweight.

Those results, released Thursday in Williamsburg, Va., at a Time-ABC News obesity summit, represent 276,000 of Arkansas' 450,000 public school students.

"This is a childhood issue now and it's sobering to see the number of children who have it," Johnston said. "The whole society will take obesity more seriously."

Arkansas already has removed vending machines from elementary school campuses and set up a Child Health Advisory Committee to help parents get their children to normal weights.

"I hope we start seeing results immediately," said Gov. Mike Huckabee, who has lost more than 100 pounds since being diagnosed last year with diabetes. "A year from now we'll know parents are taking this seriously and encouraging healthier habits ... some as simple as saying, 'You're not going to sit in front of the computer screen with a bag of potato chips.'"

Last year Arkansas legislators passed a law requiring schools to find out the body-mass index of all schoolchildren and report to their parents. Health officials say the benefit of spotting at-risk children outweighs the stigma of branding them as too heavy.

"...It is more harmful not to identify the child as overweight," Johnston said. Studies show that childhood obesity can lead to diabetes and heart disease.

Nationwide, two-thirds of American adults are classified as either overweight or obese by the Centers for Disease Control and Prevention (news - web sites).

And while some studies indicate a higher rate of people in the South are overweight than the national average, some researchers believe the Arkansas numbers are reflective of children across the country.

"This is a trend we're seeing nationwide. The lack of physical activity, the nutritional behaviors that we have developed over the years didn't start in Arkansas and it's not going to end in Arkansas," said Joy Rockenbach, program director at the Arkansas Center for Health Improvement, which conducted the study. "If other states were collecting this info, we wouldn't see a difference."

Individual findings are sent to the students' parents with guidelines on a healthy lifestyle. Because the BMI calculation doesn't consider muscle mass, parents are asked to take overweight children to a doctor to see if their child is truly unhealthy.

"A parent may be aware that the child is overweight," Huckabee said, but may not realize the "very serious medical consequences" of obesity.

Johnston said the Arkansas study, because it is so far-reaching, will enable researchers to compare data across socio-economic and racial groups and identify trends.

Experts say children develop most eating habits in their home and changing attitudes there is important in the battle against obesity.

Carrie Roberson of Arkadelphia took her fourth-grade son to the doctor when his weight problem was diagnosed through the new school policy — and he changed his behavior himself.

"We were not concerned about his health, it was just kind of having the heads-up that if we didn't watch the snacks and lack of physical activity he's in jeopardy," she said. "It was very good information. Having any kind of indicator on how we can keep our children healthy as a parent is useful."

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Heart Patients Often Don't Receive Drug Therapy


Reuters Health

Thursday, June 3, 2004

NEW YORK (Reuters Health) - Despite convincing evidence for the benefits of treatment with an angiotensin-converting enzyme inhibitor (ACEI) drug in patients with heart failure, many hospitalized heart failure patients are not prescribed an ACEI at the time of discharge. For those who are, a significant proportion of them, for reasons not completely understood, stop taking ACEI therapy within the first 6 months to one year.

"Assuring therapy with ACEIs at discharge after heart failure hospitalization is a key Medicare quality measure," the researchers note in the Journal of the American College of Cardiology.

Dr. Javed Butler from Vanderbilt University in Nashville, Tennessee and colleagues assessed ACEI use among 960 hospitalized heart failure patients. They discovered that 55 percent of the patients were discharged with an ACEI order.

By postdischarge day thirty, 77 percent had filled their ACEI prescription, but by one year only 63 percent were still taking the medication.

"Although we expected the rate of long-term use to go down over time, we were surprised at the magnitude to which it did," Butler said in a statement.

Moreover, if patients are not prescribed an ACEI at discharge, the chance of initiating one in the outpatient setting is "very unlikely," Butler told Reuters Health. For patients with no discharge order for ACEIs, only about 12 percent had been prescribed one by 30 days. By one year, only 19 percent of were current ACEI users.

"This is a huge healthcare problem, which we need to realize exists and that costs patients their health and society significant financial burden," Butler said. Further studies are needed to understand the "root causes" of these trends, he added.

Quality improvement efforts should focus on discharge planning -- increasing the number of heart failure patients discharged with an ACEI prescription -- and outpatient care -- helping more of them stay on ACEI, the researchers suggest.

Source: Journal of the American College of Cardiology, June 2004.

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Hormonal Clue to Autoimmune Diseases Found



Thursday, June 3, 2004

THURSDAY, June 3 (HealthDayNews) -- New information about the relationship between estrogen and the antibodies that regulate inflammation is reported in a Baylor College of Dentistry study in the June issue of Arthritis and Rheumatism.

The findings suggest the need for further study into the role of estrogen on the incidence and severity of such autoimmune diseases as lupus and rheumatoid arthritis among women.

Researchers used cell cultures to examine several specific pathways where estrogen interacts with immune cells. They found a decrease of estrogen levels results in an increase in levels of CD16, a molecule of the cell surface that regulates inflammation.

This increase in CD16 starts a chain reaction of inflammation that affects joint and organ tissues.

The researchers say this shows that changes in estrogen can make a woman more vulnerable to rheumatoid arthritis and other kinds of inflammatory autoimmune diseases. Changes in estrogen can also increase the severity of symptoms caused by these diseases.

Autoimmune diseases are much more common in women than men. For example, lupus affects women up to 10 times more often than men, and women are two to three times more likely to have rheumatoid arthritis.

More information

The Arthritis Foundation has more about rheumatoid arthritis.

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Food Additives Increase Hyperactivity in Kids


By Will Boggs, MD

Reuters Health

Thursday, June 3, 2004

NEW YORK (Reuters Health) - Artificial food colorings and benzoate preservatives increase hyperactive behavior in preschool children, according to a new report.

Despite claims about the detrimental behavioral effects of artificial food colorings and preservatives, the authors explain in the June Archives of Disease in Childhood, there have been no broad studies of the prevalence of hyperactivity related to intolerance to food additives.

Dr. John O. Warner from Southampton General Hospital, UK, and colleagues studied the impact of artificial food colorings and benzoate preservative on the behavior of 277 preschool children.

At the start, 36 children had hyperactivity and allergies, 75 were only hyperactive, 79 had only allergies, and 87 did not have either condition.

Parents' ratings of their children's hyperactivity fell after withdrawal of food additives from the children's diets, the team reports, and there was an increase in hyperactivity when food additives were re-introduced.

Parental hyperactivity ratings increased significantly when children were exposed to food additives regardless of their hyperactivity status or the presence of allergies at the start of the study.

"Additives do have an effect on overactive behavior independent of baseline allergic and behavioral status," Warner told Reuters Health. "The effect is significant but its magnitude requires further elaboration before making any sweeping recommendations about legislation on permitted food additives."

New research "will be based in schools and pre-schools in Southampton to involve 4- and 9-year-olds," Warner said. "By basing objective observation in schools, we hope to have a more sensitive way of substantiating the parents' observations. It is also important to know whether the effect is seen in older children."

He added, "We do not yet know which artificial additives are important in relation to behavior or whether the list extends to other natural equivalents."

Source: Archives of Disease in Childhood, June 2004.

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Many HIV-Positive Men Don't Realize It: Study


By Randy Dotinga
HealthDay Reporter


Thursday, June 3, 2004

WEDNESDAY, June 2 (HealthDayNews) -- A new British report suggests that one in 10 homosexual men who visit popular gay venues in London are infected with the AIDS (news - web sites) virus, and a third of them don't realize it.

In another disturbing finding, the researchers found the percentage of gay men who admitted engaging in the most dangerous form of unsafe sex increased at a fast clip over the four-year study period.

The numbers won't come as a surprise to American researchers, who have been tracking similar trends in this country.

While it's easy to tell people what they should do to protect themselves from AIDS, encouraging change is a challenge because "there's a complex of factors that lead to people to engage in activities that are harmful," explained Tom Coates, an AIDS specialist and a professor of infectious disease at the University of California at Los Angeles.

British researchers surveyed 8,052 gay men in London five times between 1996 and 2000 at a variety of locales, including bars, nightclubs and bathhouses. The participants completed anonymous questionnaires. At the end of the study, 1,206 men provided samples of their saliva to be tested for HIV (news - web sites), the virus that causes AIDS.

The findings appear in the June issue of Sexually Transmitted Diseases. The long delay in the release of the results is not unusual in the academic world, where it can take years for studies to become published.

Of the men tested in 2000, 11 percent turned out to be HIV-positive. But only a third knew it. The surveys didn't ask why the men hadn't gotten tested recently enough to find out that they were infected.

Researchers also found that the percentage of men surveyed who engaged in unprotected anal sex grew from 30 percent in 1996 to 42 percent in 2000.

However, the men who engage in the riskiest unsafe sex practices don't appear to be developing higher rates of HIV, said study co-author Julie Dodds, a research fellow at the Royal Free & University College Medical School in London.

The reasons for this discrepancy aren't clear, but she speculated that men may be more willing to openly discuss their sexual practices with researchers. Another possibility is that they're turning to strategies other than condom use to reduce their risk of infection, she added.

In the United States, a similar study completed from 1994 to 2000 suggested that one out of every 10 young gay men in the United States is HIV-positive, and 80 percent of them don't realize they're infected. In that study, researchers interviewed 5,719 gay and bisexual men aged 15 to 29 at bars, clubs and other venues in six large American cities.

Experts caution it's impossible to extrapolate survey-based findings to the entire gay male population because researchers only interview men at specific venues.

Other studies have suggested that American gay men are having more unsafe sex, perhaps because they aren't as worried that AIDS will kill them. The disease has largely become treatable over the last decade, and many HIV-infected people are living with few or no symptoms.

One major problem facing public health officials is the failure of HIV-infected men to refrain from unsafe sex. Often, the infected men feel they don't have a responsibility to disclose their illness. "We don't seem to be able to get ahead of that issue," Coates said.

Other factors, such as methamphetamine and alcohol use and depression, contribute to the spread of AIDS, he said. "Those of us who think about public health need to think about not just motivating people (to avoid AIDS), but dealing with substance abuse and mental health issues as well."

Another complication is the lack of access to health care among younger men, especially minorities, Coates added.

Medical researchers are developing new ways to prevent AIDS, such as microbicide creams and drugs that people could take before they have sex. But they "may or may not help," Coates said, depending on whether people bother to use them.

More information

Get details about everything from AIDS treatment to vaccine development from the federal HIV/AIDS Education & Research Center.

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Inhaled Insulin Controls Diabetes Over Long Term


Reuters Health

Thursday, June 3, 2004

NEW YORK (Reuters Health) - People with diabetes might soon be able to throw away their insulin syringes. An inhaled form of insulin provides good long-term control of blood sugar levels, a new study shows, and patients much prefer the treatment to injected insulin.

Previous short-term (12-week) studies demonstrated the efficacy and patient acceptance of inhaled insulin among people with type 1 or type 2 diabetes, Dr. Robert A. Gerber from Pfizer Global Research and Development in Groton, Connecticut, and colleagues explain in the medical journal Diabetes Care. They then followed 121 participants in the original studies who participated in a 1-year extension study.

Improvements in hemoglobin A1c levels -- a measure of long-term control of blood sugar levels -- were similar in subjects who continued taking inhaled insulin, those who switched from injected to inhaled insulin, patients who continued on injected insulin, and people who switched from inhaled to subcutaneous insulin, the authors report.

Episodes of excessively low blood sugar levels were also similar regardless of insulin treatment, the report indicates.

There had been questions about the effect of inhaled insulin on the lungs, but average changes in pulmonary function were the same with inhaled or injected insulin.

During the 1-year extension, participants taking inhaled insulin reported significantly greater improvements in overall satisfaction, ease of use, and social comfort than did patients on injected insulin, the researchers note.

"Results from the current investigation are the first to suggest that the rapid improvement in patient satisfaction with inhaled insulin is sustained," the authors conclude, "and long-term improvements in glycemic control and patient satisfaction are maintained up to the 1-year follow-up."

Source: Diabetes Care, June 2004.

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Cancer Survival Rates Up

By Amanda Gardner
HealthDay Reporter


Thursday, June 3, 2004

THURSDAY, June 3 (HealthDayNews) -- For the first time ever, lung cancer rates have begun to drop among American women.

And survival rates for many other types of cancer are improving for both men and women.

That's the encouraging news from the Annual Report to the Nation on the Status of Cancer. The report, which covers the period from 1975 to 2001, appears in the June 3 issue of Cancer.

Not all the news is positive, however. The decline in death rates was more dramatic in men than in women from 1992 to 2001. And all ethnic and racial groups -- except Asian/Pacific Islander women -- had a higher risk of dying from cancer than whites.

But health experts are encouraged by the increase in survival rates for many cancers and the decline in lung cancer rates among women.

Rates of lung cancer -- the number one cancer killer -- have declined approximately 2 percent a year among women since 1998. Men experienced a similar drop in lung-cancer diagnoses years ago -- reflecting the fact that many American women started smoking decades after men did and many men began kicking the habit years before women tried to do so.

Also, death rates from lung cancer have begun to plateau among women, remaining constant since 1995, according to the report.

"We're seeing the impact of quitting smoking among the early [women] smokers," said Brenda K. Edwards, director of the National Cancer Institute (news - web sites)'s Surveillance Research Program.

Edwards is one of several authors of the annual report, a collaboration between several different health organizations that include the National Cancer Institute (NCI) and the American Cancer Society (news - web sites).

While previous reports only looked at the four most common cancers, this one examines the top 15 and includes a racial/ethnic breakdown.

Overall, cancer incidence rates dropped 0.5 percent between 1991 and 2001 for men and women, while death rates declined 1.1 percent between 1993 and 2001. A higher percentage of patients are also surviving five years after their initial diagnosis, according to the study. The five-year survival rate is a significant milestone for cancer patients.

When it comes to other types of tumors, colorectal cancer rates decreased while prostate cancer rates increased, perhaps reflecting better detection methods.

"It's probably a function of the sensitivity of the PSA [prostate-specific antigen] test and picking up cancers much earlier than we were able to do in the past," said Dr. Louis Harrison, chairman of radiation oncology at Beth Israel Medical Center and St. Luke's Roosevelt Hospital Center in New York City.

Improvements in cancer rates, however, were not equally distributed. The decline in death rates was more dramatic in men (1.5 percent a year between 1993 and 2001) than in women (0.8 percent annually from 1992 to 2001).

And, all ethnic and racial groups (except Asian/Pacific Islander women) had a higher risk of dying from cancer than whites.

"The issue of differences in outcome based upon socioeconomic class is not surprising to anyone in the field," Harrison said. "It just highlights the need to better serve the underprivileged population."

In addition to lung cancer, the incidence of five cancers among women -- colon, cervix, pancreas, ovary and oral cavity -- dropped. But rates for breast, thyroid, bladder, kidney cancer and melanoma rose. Women with colon, kidney and breast cancers, as well as non-Hodgkin's lymphoma, are surviving longer than ever, according to the report.

Breast cancer rates increased 0.4 percent per year from 1987-2001, a slower rate of increase than before 1987. Death rates from breast cancer decreased beginning in the early 1990s, with steeper declines among white women than black women. Rising breast cancer incidence rates during the 1990s have been attributed, in part, to increased mammography screening.

For men, incidence rates decreased for seven of the top 15 cancers -- lung, colon, oral cavity, leukemia, stomach, pancreas and larynx. On the other hand, the rates increased for melanoma as well as prostate, kidney and esophageal cancer. Men with prostate, colon and kidney cancers, as well as non-Hodgkin's lymphoma, melanoma and leukemia, saw their survival rates boosted more than 10 percent.

Survival rates increased dramatically for childhood cancers during the past 20 years: 20 percent in boys and 13 percent in girls. Right now, 75 percent of children with cancer can expect to live five years or longer, a huge advance from 40 years ago, when most childhood cancers were fatal, the researchers said.

The report also uncovered racial disparities.

Black men had the highest incidence of cancer and the highest death rates for all cancers combined. The incidence of prostate cancer for black men was 62 percent higher and the death rate twice as high, compared to white men.

Black women had the highest deaths rates for all cancer sites combined, the report found. Death rates from breast cancer were almost 30 percent higher than for white women, despite a lower incidence of the disease.

Hispanic/Latino women had higher cervical and gallbladder cancer incidence rates and gallbladder cancer death rates than other racial/ethnic populations.

The big-picture improvements are most likely due to a combination of factors, Harrison said.

"Early detection is important," he said. "I also think there is no question that therapies for cancer have improved. Surgery is better. Radiation therapy is better. There are new drugs."

"One of the things that isn't obvious from the report is that in addition to a lower mortality rate and a lower incidence of certain cancers, what has also happened is that cancer treatment has become less toxic," Harrison added. "Treatments are very focused on quality of life and trying to minimize the damage that's done to people in the pursuit of treating cancer. People are not only living longer, they're living better."

More information

The National Cancer Institute has questions and answers about the report.

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Experts See U.S. Health-Care Cost Rises Slowing

By Kim Dixon


Thursday, June 3, 2004  

CHICAGO (Reuters) - Health care cost increases are abating and growth could slow to single-digit percentages for the first time in five years, according to a closely-watched survey of Fortune 500 companies.

After years of double-digit increases in the cost of health care, HMOs are proposing an average premium increase of 13.7 percent for 2005 over this year's levels, according to a report by Hewitt Associates released on Thursday.

But once negotiations between employers and HMOs and cost sharing with employees is taken into account, the actual price jump is likely to be in the single digits, the poll's director and analysts said.

"We're starting to see a moderation in health care premium increases with the possibility of employers seeing increases in the single-digits for the first time in five years," said Ken Sperling, health care expert at Hewitt.

While still roughly three times above the rate of inflation, the rise is several percentage points below the rate of growth of premium hikes in recent years.

Experts expect the rise in medical costs to slow to 9 percent to 10 percent this year, to be roughly matched by premiums.

Margins Tight

Moderation in the rate of increase in health-care premiums could compress HMO profit margins, worrying some investors.

Narrowing between medical costs and premiums leaves less room for profit. Because pricing tends to move in cycles and is now on the downswing, investors fret that HMOs could get caught underestimating costs.

"The financial community is wondering about how hard or soft that landing is going to be," Sperling said.

The tepid pace of job growth in the United States has also dried up enrollment among HMOs, forcing them to become more competitive on pricing to win new members from rivals, according to analysts.

Most plans say they will grow membership this year and next.

"Health plans are starting to price opportunistically," to steal members away from each other, Sperling said.

Several companies, including Humana Inc. and Health Net Inc., warned in first-quarter conference calls that the pricing environment has become more competitive, which could hurt profits.

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Gaily Colored Fruits May Reduce Stroke Risk

By Ed Edelson

HealthDay Reporter


Thursday, June 3, 2004

THURSDAY, June 3 (HealthDayNews) -- Higher blood levels of carotenoids, antioxidants found in fruits and vegetables, might reduce the risk of stroke, a study finds.

The risk of ischemic stroke, the most common kind that happens when a clot blocks a brain artery, was 40 percent lower in men with the highest blood levels of carotenoids than in those with the lowest levels, said a report in the June 4 issue of Stroke.

The report came from the Physicians' Health Study, which has followed more than 22,000 male doctors since 1982. It covers a 13-year period, in which 297 of them had ischemic strokes.

The researchers measured blood levels of a variety of antioxidants in blood samples given by the participants when the study started. They found the higher risk in men with the lowest levels of three carotenoids: alpha-carotene; beta-carotene; and lycopene.

Carotenoids are molecules that the body converts into vitamin A. They help provide the vivid coloring of carrots, peaches, watermelon and other fruits and vegetables. They are also popular ingredients in vitamin supplements.

The study was not designed to determine the source of the carotenoids, said study author Dr. Jing Ma, an assistant professor of medicine at Harvard Medical School (news - web sites).

But they "most likely came from food," Ma added. "At the time the study began, the participants were asked not to take supplements, so we most likely measured what came from fruits and vegetables."

It's not possible to say whether the carotenoids themselves were responsible for any protective effect, since "there are so many other good nutrients from fruits and vegetables other than the ones we measured," she said.

And the evidence that carotenoids in general are good for the arteries is not clear, Ma said. A recent report from the Physicians' Health Study found no relationship between carotenoid levels and risk of heart attack, she noted.

The long-term goal of the study is to help determine the role that antioxidants play in prevention of heart attack, stroke and other cardiovascular diseases, Ma said. "In a few years, we should have more definite conclusions from this study," she added.

Meanwhile, the current results support the American Heart Association (news - web sites) position that "diet should be the source of antioxidants and not supplements," said Dr. Robert H. Eckel, a professor of physiology and biophysics at the University of Colorado Health Sciences Center. "The evidence to support the value of supplements is just not available. It is what we eat rather than what we supplement that is important."

An excellent way to choose antioxidant-rich fruits and vegetables is to go by color, Eckel said. "Colorful vegetables are where we expect a higher content," he explained, "sweet potatoes and spinach, apricots, carrots, things with an orange or yellow color."

More information

A rundown on carotenoids and other antioxidants is offered by the American Heart Association.

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Two-Gene Signature Predicts Breast Cancer Relapse

By Megan Rauscher

Reuters Health

Thursday, June 3, 2004

NEW YORK (Reuters Health) - The level of two genes in breast cancer tissue can accurately identify women who are at high risk for recurrence of the disease after tamoxifen therapy, new research shows.

Tamoxifen, an anti-estrogen, is often given to women whose cancer has been removed and has been shown to be sensitive to estrogen. Knowing which women are most likely to not benefit from tamoxifen would allow earlier use of alternative therapies that might be more effective.

"But until now, we haven't been able to identify which of these women would be at risk for recurrence in the setting of adjuvant tamoxifen," Dr. Dennis C. Sgroi, director of breast pathology at Massachusetts General Hospital in Boston said in a telephone interview with Reuters Health.

Sgroi and his colleagues analyzed gene levels in 60 archived estrogen-receptor-positive breast tumor tissue samples. All 60 patients had been treated exclusively with tamoxifen after surgery. According to the medical records, 32 women remained free of breast cancer for an average of eight years, while 28 had a recurrence or spread of their cancer.

As reported in the medical journal Cancer Cell, the team found that the ratio of two genes -- HOXB13 to IL17BR -- was a strong predictor of treatment outcome.

Women who had a higher level of expression of HOXB13 over IL17BR, and a low level of expression of IL17BR, had seven-fold higher odds of recurrence compared with women without this expression pattern.

Sgroi told Reuters Health that the results from an independent validation sample of 20 more tamoxifen-treated breast cancer cases confirmed the predictions of the two-gene expression ratio.

Also, he explained, the HOXB13 gene may play a role in tumor progression and invasiveness. This suggests that the cellular chemistry controlled by HOXB13 might be a new treatment target for breast cancer, Sgroi added.

Source: Cancer Cell, June 2004.

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Two Genes Provide Clues to Tamoxifen Success

By Serena Gordon
HealthDay Reporter


Thursday, June 3, 2004

THURSDAY, June 3 (HealthDayNews) -- The activity of two genes may tell doctors who will succeed on tamoxifen therapy for breast cancer and, more importantly, who will fail.

That's the conclusion of a new study that found if high levels of a gene called HOXB13 or low levels of a gene known as IL17BR were expressed, tamoxifen therapy wasn't successful.

The simple gene test, researchers report in the June issue of Cancer Cell, was more than 80 percent accurate in predicting a recurrence of the cancer.

Tamoxifen is a breast cancer medication that blocks the effects of estrogen. This is important because, in many cases, breast cancer cells are fueled by estrogen. Estrogen-blocking drugs such as tamoxifen are often prescribed after a woman has surgery for breast cancer that is hormone-sensitive to try to keep the cancer from returning. Hormone-sensitive breast cancers are also known as hormone receptor positive.

"Thirty to 40 percent of women who are hormone receptor positive will recur even if taking tamoxifen," explained study co-author Dr. Dennis Sgroi, director of breast pathology at Massachusetts General Hospital in Boston. "Right now, we have no way of knowing who will do well. What we wanted to do was to find something that could identify the population that won't do well."

Sgroi and his colleagues from Massachusetts General Hospital, Harvard Medical School (news - web sites) and Arcturus Bioscience Inc. examined frozen tumor samples from the initial biopsies of 60 women who had hormone receptor positive breast cancer. All had been treated with tamoxifen.

Thirty-two women from this sample remained disease-free up to 10 years later, while 28 women had a recurrence of cancer or their cancer spread to other areas of the body.

Sgroi said the researchers did detailed gene expression profiling and found two genes that were strongly associated with a recurrence of cancer -- HOXB13 and IL17BR.

Sgroi said the researchers don't know for sure what role these genes play in the development and spread of breast cancer. They suspect that HOXB13 may help cancer cells migrate and invade other cells. The role of IL17BR is less clear. Sgroi said other research has suggested this gene may play a role in inflammation and the immune system.

"Independently, each gene predicted recurrence, but when we looked at them together, we did even better. We were able to predict with 81 percent accuracy [by looking at the ratio of expression between the two genes]," Sgroi said.

To confirm these findings, the researchers validated the initial results on a smaller cohort of women who also had hormone receptor positive cancer and received tamoxifen therapy. The findings were similar.

"We are cautiously optimistic. These findings need to be validated in a population-based study, which we're in the process of doing," Sgroi said.

But, he added, it appears that "we've come up with a simple test that may assist an oncologist in deciding whether tamoxifen therapy alone is adequate."

"Not all breast cancers are alike," said Dr. Duane Superneau, chief of the section of medical genetics at Ochsner Clinic Foundation Hospital in New Orleans. "This could give clinicians a means to see what therapy would be most individually suited. Our strategies for treatment could be more directly applied for the individual and their individual disease."

Superneau said that any lab that currently does gene testing should be able to conduct these tests.

Both Sgroi and Superneau said that in addition to learning who will respond well to tamoxifen, the knowledge that a higher expression of HOXB13 and a lower expression of IL17BR occur in tamoxifen-resistant cancers could also help direct future research into treating those cancers.

More information

To learn more about tamoxifen, visit the National Cancer Institute.

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Wednesday, June 2, 2004


Halting Cancer's Spread



Wednesday, June 2, 2004

WEDNESDAY, June 2 (HealthDayNews) -- The ability to switch off a cellular enzyme involved in the progression of several forms of human cancers has been discovered by researchers at the University of North Carolina School of Medicine.

This enzyme is called focal adhesion kinase (FAK), which normally promotes cellular activity and growth. But overactivity of FAK encourages cancer cell growth and the spread of cancer.

The UNC researchers found a segment of FAK, called the FERM domain, is crucial to the activation of FAK. They also found that subtle changes to the FERM domain suppresses FAK activity.

This finding suggests it may be possible to develop drugs that mimic this modification and turn off FAK in cancer patients.

The study appears in the June 2 issue of Molecular and Cellular Biology.

More information

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

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Vaccine Critics Attack Mercury Report


By Maggie Fox, Health and Science Correspondent


Wednesday, June 2, 2004

WASHINGTON (Reuters) - Several members of Congress who believe that vaccines can cause autism in children criticized an official report meant to lay such fears to rest, saying on Wednesday they do not believe the findings.

The Institute of Medicine (news - web sites) report last month was the final in a series of investigations into vaccine safety. It was meant to answer concerns about whether vaccines or the mercury-based preservatives in them can cause autism.

The panel of experts said there was no evidence to link vaccines with autism and urged researchers to look elsewhere.

But Indiana Republican Rep. Dan Burton, who has led Congressional efforts to find a connection between autism and vaccines, denounced the report.

"Unfortunately, I believe the findings announced in the May 18 IOM report are heavily biased, and unrepresentative of all the available scientific and medical research," Burton, who has a grandchild with autism, said in a statement.

He said the findings were "based on selective scientific studies that are greatly flawed to begin with."

The Institute of Medicine is an independent organization, free of government funding, that advises the federal government on health matters.

The vaccine panel was headed by Dr. Marie McCormick, an expert in child and mother health at the Harvard School of Public Health.

She has denied being biased and noted the panel was not paid and had no ties to vaccine makers or to the government.

Autism can affect a child's ability to learn, speak and socialize. No one is sure precisely how many children have autism, but some researchers say it could be as common as one in every 1,000 children.

Barbara Loe Fisher, who founded the National Vaccine Information Center, said she was not convinced by the report and said she would not trust any government-comissioned panel.

"Just because there is not a preponderance of scientific proof does not mean that we should discontinue investigations," said California Democrat Rep. Diane Watson, Ranking Minority Member of the House Government Reform Subcommittee on Human Rights and Wellness.

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New Way to Ease Pain of Gallbladder Removal



Wednesday, June 2, 2004  

WEDNESDAY, June 2 (HealthDayNews) -- People who received anti-inflammatory drugs called cox-2 inhibitors before and after laparoscopic surgery to remove their gallbladder had less pain and fewer postoperative complications and returned to their normal activities sooner, says a Duke University Medical Center study.

The study in the June issue of Anesthesia and Analgesia found that giving cox-2 inhibitors to these patients reduced the amount of opiates needed to control their pain and also reduced the patients' postoperative nausea and vomiting (PONV).

Researchers followed 276 people who had minimally invasive laparoscopic gallbladder removal. Some received intravenous cox-2 inhibitors before their surgery and then in pill form for seven days after their surgery. Others received a placebo.

Nearly a third of the patients receiving the cox-2 inhibitors resumed normal to light activity a day after surgery, compared to 7 percent of those in the placebo group. More than 50 percent of those taking cox-2 inhibitors were back to their normal activities by the second day after surgery, compared with 36 percent of those on placebo.

"Ten to 15 years ago, this was an open procedure that required three or four days of recuperation in the hospital," study leader and anesthesiologist Dr. Tong Joo Gan said in a prepared statement.

"Now, with laparoscopic surgery, patients can go home the same day as surgery. With the growing popularity of minimally invasive surgery, the onus is on us as anesthesiologists to come up with ways to better control pain and reduce the incidence of PONV so patients can go home comfortably after their surgery," Gan said.

More information

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

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Study: Dieting Can Weaken Immune System


By Kristen Gelineau

Associated Press Writer

The Associated Press

Wednesday, June 2, 2004

SEATTLE - A new study has found that "yo-yo dieting" — repeatedly losing, then regaining weight — may harm a woman's immune system. The study by the Fred Hutchinson Cancer Research Center also found that maintaining the same weight over time appears to have a positive effect on a woman's immune system, according to one of the lead researchers.

Researchers in the study, published Tuesday in the Journal of the American Dietetic Association, interviewed 114 overweight but otherwise healthy sedentary, older women about their weight-loss history during the past 20 years. The women had to have maintained a stable weight for at least three months before joining the study, which was funded by the National Cancer Institute (news - web sites).

The study, which found that long-term immune function decreases in proportion to how many times a woman has intentionally lost weight, measured natural killer cell activity in the women's blood. Natural killer cells are an essential part of the immune system, killing viruses and leukemia cells, said Cornelia Ulrich, senior author and an assistant member of the Hutchinson Center's Public Health Sciences Division.

Low natural killer cell activity has been associated with increased cancer rates and a higher susceptibility to colds and infections, she said.

"While one weight-loss episode of 10 pounds or more in the previous 20 years was not associated with current natural killer cell activity, more frequent weight-loss episodes" were associated with a significant decrease in such activity, Ulrich said.

The study found that women who maintained a fairly stable weight over several years had higher levels of such cells than those whose weight frequently fluctuated.

Those who reported losing weight more than five times had about a third lower natural killer cell function, the study found. Conversely, women who maintained the same weight for at least five years had 40 percent greater natural killer cell activity as compared to those who maintained their weight for fewer than two years.

Though no men participated in the study and further research is needed, Ulrich said the immune systems of male dieters would likely be affected the same way.

The findings, while intriguing, are preliminary, cautioned Ulrich, who is also a research assistant professor in epidemiology at the University of Washington School of Public Health and Community Medicine.

Researchers had to rely on the participants' own reports of their weight loss histories and the analysis was based on blood samples collected at a single point in time, representing a narrow sample.

A long-term study could provide more conclusive results, said Ulrich, who is planning to collaborate with Canadian researchers who have been working on a similar study.

Although the study suggests that yo-yo dieting is harmful, Ulrich stopped short of saying that people should stop attempting to lose weight.

"There's clearly evidence that weight loss is beneficial for your health," she said. "What we're concerned about is this pattern of weight cycling where women go up and down."

Exercise has been shown to boost immunity and temper some of the negative effects of weight loss on the immune system, Ulrich said.

Despite its preliminary nature, the study is significant, said Katherine Tallmadge, a spokeswoman for the American Dietetic Association in Washington, D.C. Although dietitians have known for years the negative psychological effects of yo-yo dieting, this appears to be the first study to examine the long-term impact of such dieting on immunity, she said.

People should avoid popular low-carb and low-fat diets that can produce initial weight loss but rarely work in the long term, Tallmadge said.

"Study after study shows that more moderate restrictions are more likely to last permanently," Tallmadge said. "That's why we registered dietitians are urging people not to do the fad diets, and just try small changes that they're more likely to be able to live with — even if the weight loss is slower." ___

On the Net:

Fred Hutchinson Cancer Research Center

American Dietetic Association:

National Cancer Institute:

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Experts to Review New Ultrasound Fibroid Therapy


By Susan Heavey


Wednesday, June 2, 2004

WASHINGTON (Reuters) - A new treatment using ultrasound to break up fibrous clumps in the uterus could soon become the first U.S.-approved alternative to hysterectomies and other surgical treatments.

InSightec, a subsidiary of Tel-Aviv, Israel-based Elbit Medical Imaging, is seeking U.S. Food and Drug Administration (news - web sites)'s approval for the new treatment, called ExAblate 2000.

On Thursday, an advisory panel to the FDA is due to discuss whether to recommend approval of the procedure. The agency usually follows its panels' advice.

The procedure, already approved in Europe and Israel, uses magnetic resonance imaging (MRI) to pinpoint the non-cancerous tumors. Heat from conventional ultrasound waves is then used to kill the fibroid tissue, which is flushed from the body naturally.

In a clinical trial of ExAblate 2000, patient symptoms improved by about 71 percent over six months, exceeding the main goal of the trial, which was a success rate at six months of at least 50 percent, according to documents posted on the FDA's Web site,, on Wednesday.

The documents, compiled by FDA staff, noted a number of side effects during the trial including nerve injury, leg pain, bowel symptoms, bladder symptoms and skin injury.

About 80 percent of women suffer from uterine fibroids at some point in life, according to the National Institutes of Health (news - web sites). Symptoms include pain, bleeding and uterine swelling, but some women have no symptoms.

Fibroids can also cause miscarriages and other pregnancy problems.

Not all fibroids require treatment, but about one quarter of women who suffer from them require surgery, InSightec said. According to the National Uterine Fibroids Foundation, fibroids are the main cause of all hysterectomies, which involve the surgical removal of the uterus.

Other treatments include pain medication and hormonal therapy.

"So many women don't want to go through any kind of surgical intervention. They live with their symptoms, and their fibroids continue to grow," said Dr. Elizabeth A. Stewart, an associate professor at Harvard Medical School (news - web sites) who led one of the studies for the technique.

National Uterine Fibroids Foundation Executive Director Carla Dionne said women with fibroids are desperate for nonsurgical options.

But the ExAblate 2000 -- which takes a couple of hours and can require follow-up sessions -- may be a time-consuming and costly alternative, especially for women with many fibroids, she said.

"There's temporary relief for now, and six months later they have more fibroids that need to be zapped," Dionne said.

Officials for Israel-based InSightec declined to comment ahead of the FDA meeting.

The company is also studying ExAblate 2000 as a possible treatment for breast cancer and other breast tumors.

Shares of Elbit Medical rose 22 cents, or 2.9 percent, to $7.86 in early trading on Nasdaq.

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Kraft Backs Off Plan to Reduce Portions


The Associated Press

Wednesday, June 2, 2004

NORTHFIELD, Ill. - Kraft Foods Inc. has abandoned its plan to reduce some portion sizes, citing consumer research that shows shoppers prefer to have the choice of whether to go with smaller packages.

The nation's largest food company disclosed the decision in a progress report on the anti-obesity initiatives it announced last July. With the food industry facing growing consumer health concerns and the risk of obesity lawsuits, Kraft had pledged to change some product recipes, reduce portions in some single-serve packages, quit marketing snacks via giveaways at school and encourage healthier lifestyles.

"When we spoke with consumers about what they wanted with single-serve, what they told us was that they didn't want us to reduce the size because they wanted to have more choice," Kraft spokeswoman Kris Charles said Wednesday. "Different people have different body sizes and activity levels, and it made more sense to provide different portion choices."

Kraft said it would offer a broad range of portion-size choices, including snacks in small packages such as its new Nabisco 100 Calorie Packs. It also said it will give nutrition information for entire packages, rather than just for individual portions, "so consumers don't have to do the math themselves."

That move, Kraft said, should support the U.S. Food and Drug Administration (news - web sites)'s recent call for food companies to enhance labeling on packages in a way that helps consumers make informed choices.

The company also said it has reduced the fat content and made other changes to about 200 products it sells in North America. That accounts for about 5 percent of its products, and Kraft called it "just a beginning."

"Our ongoing actions are part of a broader societal response to growing health and wellness concerns, including obesity," CEO Roger Deromedi said. "It's going to take a comprehensive approach that involves many sectors of society to truly accelerate the change that's needed. We're ready, as are many other food companies, to collaborate and cooperate with governments, policy experts, industries and communities around the world."

Kraft shares rose 15 cents to close at $30.05 on the New York Stock Exchange (news - web sites).

On the Net:

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Moderate Alcohol Use Not Bad After Heart Attack


Reuters Health

Wednesday, June 2, 2004

NEW YORK (Reuters Health) - Drinking up to 10 alcoholic beverages a week does not increase the risk of heart failure in patients who've had a heart attack, new research shows. Whether it's safe to consume more than this amount is unclear.

Although research has suggested that alcohol use protects against coronary heart disease, the most common type, there is some evidence that because of its chemical effects, alcohol may raise the risk of heart failure.

To investigate, Dr. David Aguilar, from the University of Texas in Houston, and colleagues assessed the outcomes of 2231 participants in the Survival And Ventricular Enlargement (SAVE) trial, a study of patients who had experienced a heart attack and were at risk for heart failure.

Based on their alcohol use, the subjects were classified as nondrinkers, light-to-moderate drinkers (up to 10 drinks per week), or heavy drinkers (more than 10 drinks per week). The researchers' findings are published in the Journal of the American College of Cardiology.

There was no evidence that light-to-moderate alcohol use increased the risk of heart failure. By contrast, there was a suggestion that heavy alcohol use may have raised the risk, but there were not enough subjects to confirm this association, Aguilar said in a statement.

"We were pretty much in the dark about what to do with these patients when someone in the clinic would ask, 'Should I stop drinking?'," Aguilar noted..."It's probably all right, as long as we stress moderation," he added.

Source: Journal of the American College of Cardiology, June 2, 2004.

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Many Not Doing Enough to Prevent Heart Disease


By Steven Reinberg
HealthDay Reporter


Wednesday, June 2, 2004

WEDNESDAY, June 2 (HealthDayNews) -- From taking aspirin to exercise and diet, many Americans are still not doing nearly enough to prevent heart disease or prevent second heart attacks and stroke, a new study finds.

In a surprise twist, the researchers also found women are not taking aspirin to prevent heart disease as much as men are, despite the fact that it is the leading killer of women.

Data on 97,000 men and women from 20 states reveal that only 26 percent of women and 35 percent of men take aspirin to prevent heart attacks and stroke. Only about two-thirds of men and women reported exercising, and two-thirds to three-quarters reported changing their diet.

The sample was made up of a cross-spectrum of people at various levels of risk for heart disease, who participated in the U.S. Centers for Disease Control and Prevention (news - web sites)'s Behavioral Risk Factor Surveillance System, according to a report in the June issue of the American Journal of Preventive Medicine.

The data are especially worrying among the 14 percent of men and 12 percent of women who are at the greatest risk because they are diabetics or have a history of heart attack, stroke or heart disease.

"Woman and men who are at high risk for heart disease don't take aspirin as much as they should," said study author Dr. Catherine Kim, an assistant professor in the departments of internal medicine and obstetrics and gynecology at the University of Michigan Medical School.

It is generally recommended that people who have had a heart attack or diabetes or a stroke take a daily aspirin to prevent further events, she added.

"Only about half the people who actually had one of these problems actually took aspirin," Kim noted.

There was a significant difference between men and women, she said. For women at high risk, only 46 percent took aspirin compared with 59 percent of men.

Kim said that she is not sure why this difference exists. But women were prescribed aspirin less often than men, she noted.

Kim and her colleague, Dr. Gloria Beckles, from the CDC's Division of Diabetes Translation, also found doctors failed to give advice on diet and exercise often enough.

"The reports of people actually dieting and exercising were not as good as they could have been," Kim said.

The research team found women were slightly more likely than men to diet and exercise, except among high-risk patients, where men were almost equal to women in exercising.

Physicians need to discuss aspirin use with their patients, the researchers urged.

Even though diet and exercise advice from a doctor has never been shown to affect behavior, "it's cheap advice, it's probably not harmful, and should be brought up in the context of a checkup," Kim said.

On the patient's side, Kim believes that people are not hearing the discussion about aspirin. "The way to bring it to the doctor's attention is to bring it up yourself," she advised.

In terms of diet and exercise, people aren't doing it. "It is really something that has been shown to lower your risk of disease. Folks need to make major lifestyle changes," Kim said.

"If you don't feel that you can do that, you need to ask for help from your doctor or nutritionist or a weight loss program," she added.

Dr. David L. Katz, an associate clinical professor and director of the Prevention Research Center at Yale University School of Medicine, said "it is remarkably difficult to convince women that heart disease affects them, too."

Even though 10 times as many women die of heart disease as die of breast cancer, "breast cancer remains a far more feared and provocative topic for women than heart disease," he said.

"Until recently, the only real reason to take aspirin was for heart disease prevention. Thus, it comes as no surprise that women have neglected aspirin use for the most part. Men accept they are at risk for heart disease, and aspirin is an easy way to reduce that risk," Katz said.

That women make a greater effort with lifestyle -- particularly diet -- is not surprising either, Katz said. "Diet offers many potential benefits, including weight control, and thus this effort may be related to concerns quite distinct from heart disease prevention."

"The challenge is getting the right people to apply the right preventive strategies at the right times for the right reasons," Katz said.

More information

The National Heart, Lung, and Blood Institute can tell you more about reducing your risk of heart attack.

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Obesity Ups Kids' Health Risk More Than Expected


By Merritt McKinney

Reuters Health

Wednesday, June 2, 2004

NEW YORK (Reuters Health) - Obese children are more likely than previously thought to develop a cluster of health conditions that put them at increased risk of diabetes and cardiovascular disease, results of a new study suggest.

The more weight children gain, the more likely they are to develop so-called metabolic syndrome, researchers report.

"Obesity in children and adolescents can lead to a number of complications like high blood pressure, type 2 diabetes and so forth," Dr. Sonia Caprio told Reuters Health.

"Obesity is not a cosmetic issue and preventive measures ought to be implemented to stop further weight gain," said Caprio, who is at Yale University School of Medicine in New Haven, Connecticut.

The metabolic syndrome is a cluster of risk factors that often precedes type 2 diabetes and cardiovascular disease. Signs of the metabolic syndrome include abdominal obesity, high levels of blood fats called triglycerides, low levels of HDL ("good") cholesterol, high blood pressure and high blood sugar.

It's no secret that the waistlines of America's children and teens are rapidly expanding, so Caprio and her colleagues set out to measure the relationship between obesity and a variety of health risk factors.

The study included 439 obese children and adolescents as well as 20 of their non-obese brothers and sisters and 31 overweight siblings.

Obese children and adolescents were at high risk of the metabolic syndrome, Caprio and her team report in this week's issue of The New England Journal of Medicine (news - web sites).

Almost 39 percent of moderately obese children and almost 50 percent of the severely obese were classified as having the metabolic syndrome. The higher a child's body mass index (BMI) -- a measure of weight in relation to height - the greater was the risk of the metabolic syndrome.

"Our findings suggest that the metabolic syndrome is far more common among children and adolescents than previously reported and that its prevalence increases with the degree of obesity," the team writes.

Obesity was also associated with an increased risk of impaired glucose tolerance, a condition marked by elevated blood sugar levels that often precedes type 2 diabetes.

"If the weight and degree of obesity increases, the child or the adolescent is at risk for the development of type 2 diabetes and cardiovascular disease at a young age," Caprio said.

In fact, among a group of children and adolescents who were re-examined two years later, eight participants who already had the metabolic syndrome had developed type 2 diabetes.

Future studies should examine the underlying causes of the metabolic syndrome in children and how to reverse it, Caprio said. "More importantly, we need to prevent childhood obesity," she said.

Source: New England Journal of Medicine, June 3, 2004

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Black Children Lag on Vaccines


By Randy Dotinga
HealthDay Reporter


Wednesday, June 2, 2004

WEDNESDAY, June 2 (HealthDayNews) -- Researchers who launched a routine review of immunizations of American preschoolers have uncovered a disturbing trend: While more white kids are completing the full course of recommended vaccines, the rate among black children has stayed the same.

In other words, there's a color gap, and it's growing.

"The trend isn't going in the direction we had been assuming. If we don't start thinking about why this is going on, the gap could widen to the extent that it undermines the success we've built up so far," said study co-author Susan Y. Chu, associate director for science at the National Immunization Program.

Chu and her colleagues studied U.S. vaccination rates among preschool children from 1996 to 2001, comparing the levels among whites, blacks, Latinos and Asians. In the last year of the study, 2001, the researchers studied the vaccination records of more than 20,000 children.

The researchers focused on whether the kids had received the recommended doses of vaccines that protect against diphtheria, pertussis, tetanus, polio, measles, influenza and hepatitis B. Many of the vaccines must be given three times or more to be fully effective.

The findings of the study appear in the June issue of the American Journal of Public Health.

Among whites, the percentage of fully immunized preschoolers rose from 69 percent in 1996 to 75 percent in 2001. Immunization rates grew even more among Latinos, from 64 percent in 1996 to 74 percent five years later, while the rates for Asians stayed steady at about 74 percent.

But among black children, the rate of immunization stood at 67 percent in both 1996 and 1997.

The reasons for the racial gap aren't entirely clear, nor do researchers understand why it widened over five years. In 1996, "disparities for many of the vaccines were pretty much gone," Chu said.

One theory is that changes in the health-care system, including more expensive insurance coverage, may play a role. Also, immunization schedules have become more complicated.

"To get a child fully vaccinated involves a lot of trips to the doctor and support from the provider," Chu said. "It's not like getting four or five shots, it's like getting 16 to 18 by the time they're 2 years old. For a lot of young parents in particular, that's very difficult."

Another factor may be skepticism about the value of immunization, she said.

Dr. Leonard E. Egede, an assistant professor of medicine at the Medical University of South Carolina who studies the effect of race upon health care, said the study researchers pinpointed a problem in federal immunization efforts.

"It suggests that despite what's been going on at the national level, it's not translating into direct benefit for patients," he said.

The findings aren't unusual, Egede added. Many studies have shown that minority patients receive worse care than whites, even when researchers take pains to compare people with similar incomes.

More information

The U.S. Centers for Disease Control and Prevention has more on childhood vaccinations.

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Fewer Women Than Men Take Aspirin for Heart Health


By Amy Norton

Reuters Health

Wednesday, June 2, 2004

NEW YORK (Reuters Health) - Despite evidence that an aspirin a day can ward off heart attacks, many high-risk people -- especially women -- are not taking the drug, a large U.S. survey shows.

The study of more than 97,000 adults found that women were 30 percent less likely than men to take aspirin to prevent cardiovascular diseases like heart attack and stroke, and the difference was present even among adults at high risk.

But aspirin use was fairly low among high-risk men and women alike -- surprisingly so, lead study author Dr. Catherine Kim of the University of Michigan in Ann Arbor told Reuters Health.

Among the 12,000-plus participants at high risk of cardiovascular complications, 58 percent of men said they were taking aspirin daily or every other day. That figure was 45 percent among women.

High-risk women were, however, slightly outdoing men when it came to making diet changes for their heart health, according to findings published in the American Journal of Preventive Medicine.

The study was based on data from a federally funded survey of 97,387 adults in 20 states. Respondents were considered to be at high risk of cardiovascular problems if they had ever suffered a heart attack or stroke or had coronary heart disease or diabetes. Those with two or more risk factors-including smoking, high cholesterol or high blood pressure-were put in the "intermediate-risk" group, and the rest were deemed "low risk."

Kim said the findings on aspirin use suggest that both men and women at high risk of cardiovascular disease should talk to their doctors about using the drug. And, she pointed out, "everybody should be dieting and exercising more."

Overall, high-risk women were the ones most likely to be cutting fat and cholesterol from their diets, with about 80 percent saying they had done so. Rates were lower among men and among women in the other two risk groups, and the percentage of people who said they were trying to exercise more often hovered around 60 percent in all groups.

The reason for the gender difference in aspirin use is unclear, Kim said. The survey asked participants whether they took aspirin, and not whether a doctor had prescribed it, so the researchers don't know what kind of advice doctors were giving.

Aspirin is not for everyone, and it can cause side effects like stomach upset and ulcers. Among participants who did not take aspirin regularly, women were more likely than men to say that stomach problems or other conditions prevented them from taking the drug.

But Kim said that while a higher rate of side effects may be a "contributor" to the sex difference in aspirin use, it probably doesn't fully explain the disparity.

It's possible, she and her colleagues note in the report, that women and their doctors perceive their cardiovascular risk as being lower than men's, and therefore think aspirin use unnecessary.

Past surveys have suggested that fewer than half of all women are aware that cardiovascular disease is the leading killer of women in the U.S.

Source: American Journal of Preventive Medicine, July 2004.

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Diabetes Increases Death Risk for Elderly



Wednesday, June 2, 2004

WEDNESDAY, June 2 (HealthDayNews) -- Diabetes greatly increases premature deaths among people 65 and older, says a Wake Forest University Baptist Medical Center study.

The study of 148,519 people found the death rate among people 65 and older was 10 percent per year among those with diabetes and 6 percent per year among those without diabetes.

Diabetes increased the risk of death by about 60 percent in blacks, by 80 percent in whites, and by more than 100 percent among Hispanics and Native Americans.

"The main implication of our findings is that diabetes-related mortality may be expected to increase in relative importance compared to other causes of death in the elderly, given recent trends of increasing diabetes prevalence," researcher Dr. Alain G. Bertoni said in a prepared statement.

"These new findings suggest that prevention of diabetes among the elderly should be a priority. The Diabetes Prevention Program has shown that diabetes in high-risk individuals can be prevented," Bertoni said.

The program promotes modest weight loss and physical activity and has achieved a 71 percent reduction in diabetes among people age 60 and older, compared to people who the same age who made no changes to their normal lifestyles.

The study appears in the online edition of the Annals of Epidemiology.

More information

The U.S. Centers for Disease Control and Prevention (news - web sites) has more about diabetes.

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Pipe Smoking Carries High Cancer Risk –Study



Wednesday, June 2, 2004

WASHINGTON (Reuters) - Pipe smokers have five times the risk of lung cancer and nearly four times the risk of throat cancer as people who use no tobacco, researchers from the U.S. Cancer Society reported.

Writing in Wednesday's issue of the Journal of the National Cancer Institute (news - web sites), epidemiologist Jane Henley and colleagues said they studied more than 15 thousand male pipe smokers.

They found the pipe smokers also had a higher risk of cancers of the esophagus, larynx, colon and pancreas than people who do not smoke.

In addition, they had a 30 percent higher risk of heart disease, a 27 percent higher risk of stroke and nearly triple the risk of chronic obstructive pulmonary disease compared to non-smokers.

While the health risks for pipe smokers are generally lower than those associated with cigarette smoking, they compare to the risks of smoking cigars, Henley said in a statement.

The harmful pipe smoking includes hookahs and other trendy pipes, the researchers said.

"For example, in the last few years, hookahs have been marketed as a trendy, fun, and less hazardous alternative to cigarette smoking. The significant risks we found should leave no doubt that all tobacco products cause disease and death."

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New Guidelines on Vision Checks for Kids


Wednesday, June 2, 2004

WEDNESDAY, June 2 (HealthDayNews) -- Children younger than 5 years old should be screened by primary-care doctors for vision problems such as lazy eye, crossed eyes and near- and far-sightedness.

So says a new U.S. Preventive Services Task Force recommendation in the May/June issue of the Annals of Family Medicine.

There's fair evidence that screening tests can help detect these kinds of vision problems, according to the task force, an independent panel of experts sponsored by the Agency for Healthcare Research and Quality.

If screening reveals a child to have any of these vision problems, he should be referred to an eye specialist for further testing, the task force recommends.

Between 5 percent and 10 percent of preschoolers in the United States have a visual impairment.

"Early testing for vision problems is key to preventing learning disabilities or, in some cases, significant visual impairment in children," task force chairman Dr. Ned Calonge, chief medical officer and state epidemiologist at the Colorado Department of Public Health (news - web sites) and Environment, said in a prepared statement.

"Screening, including the newer methods available, can help parents and clinicians detect and treat vision problems early," Calonge said.

More information

The Nemours Foundation has more about children's vision.

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Tuesday, June 1, 2004


Anemia Linked with Heart Disease in Women


Reuters Health

Tuesday, June 1, 2004

NEW YORK (Reuters Health) - Anemia, as indicated by low hemoglobin levels, has been associated with adverse cardiovascular outcomes in patients who have had heart attacks or who have congestive heart failure. Now, new research suggests that this risk also extends to women with limited heart disease.

The findings, which appear in the Journal of the American College of Cardiology, are based on a study of 936 women with chest pain who underwent tests to detect ischemia, or reduced blood flow to the heart.

Most of the women had limited coronary artery disease. Complete data were available for 864 of the women and the average follow-up period was 3.3 years.

Twenty-one percent of the women were anemic, lead author Dr. Christopher B. Arant, from the University of Florida College of Medicine in Gainesville, and colleagues note. Compared with their non-anemic counterparts, anemic women were more likely to be nonwhite and to have a history of high blood pressure, congestive heart failure and diabetes.

Anemic and nonanemic women were no different in terms of coronary artery disease severity. Still, anemic women were more likely to have adverse cardiovascular outcomes and to die from any cause. On further analysis, for each 1 g/dL drop in hemoglobin level below normal the risk of adverse outcomes increased by 20 percent.

The prevalence and prognostic importance of anemia in this population needs to be confirmed, the authors note. Also the underlying disease mechanisms, along with the potential benefits of treating anemia in women with suspected ischemia, need further investigation, the authors note.

Source: Journal of the American College of Cardiology, June 2004.

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Study: Doctors' Neckties May Harbor Germs


By Josef Federman

Associated Press Writer

The Associated Press

Tuesday, June 1, 2004

JERUSALEM - Your doctor's necktie may be hazardous to your health.

That's the conclusion of a new study by an American medical student who found that while neckties may look nice, they also provide a convenient nesting ground for germs.

Steven Nurkin, who is completing his medical studies at Israel's Technion University, said he came up with the idea for the study while doing an elective course at New York Hospital Queens.

Nurkin, used to the casual open-collar atmosphere at Israeli hospitals, immediately noticed that his American colleagues wore ties.

"While examining patients, they would lean over, and their neckties would swing onto the bedding or onto the patient. Often it got coughed on or came into contact with a variety of other things," said Nurkin, 27, a native of Brooklyn.

Although the doctors would wash their hands after treating patients, they would also fix their ties after drying off, potentially re-exposing them to well-known hospital bugs, Nurkin said. The fact that neckties are rarely washed adds to the potential risk, he said.

Nurkin examined 42 ties of doctors and clinical workers at the New York hospital and found that 20 of them — or 48 percent — carried at least one infectious microbe.

In comparison, he examined the ties of 10 security guards who don't come into direct contact with patients. Only one of the ties carried a disease-causing microorganism.

"A clinician's necktie provides little benefit to patient care," the study concludes. "This study brings into question whether wearing a necktie is in the best interest of our patients."

Nurkin said the study did not find direct evidence that ties can cause infections, but it showed the potential risk.

"The necktie is almost on the front lines of treating patients with infectious diseases," he said.

Nurkin, the lead author of the study, presented his research last week to a conference of the American Society of Microbiology in New Orleans.

However, Dr. James J. Rahal, director of the infectious disease section at New York Hospital Queens, cautioned against reading too much into the study.

He said there was no evidence that ties present any additional health risk, noting that all the bacteria found in the study were common and easily treated by antibiotics.

"These are not dangerous ties," he said. "These are not organisms we consider dangerous in the hospital. These were the organisms that are normally found in our environment."

Israel Steiner, a professor of neurobiology and expert in infections of the nervous system at Hebrew University, agreed that any additional risk by neckties is probably minimal. He said that doctors' clothes, medical equipment and jewelry are all exposed to germs.

"Basically, I don't think this adds to the risk of infections in hospitals," said Steiner, who conceded that he is one of the few Israeli physicians to wear a tie.

Steiner said a better study might have been a comparison of doctors' ties with other articles of clothing they wear. He said a good follow-up would be to ask a group of well-dressed doctors to work without ties for two weeks and see whether there was a change in the overall risk of infection.

Nurkin said the study was meant to raise awareness of a potential risk and help provide better quality care. Possible solutions for the problem include wearing bow ties or tie clasps, using disinfectant or even a "necktie prophylactic."

"We also can imitate the doctors in Israel, who rarely wear neckties," he said.

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Women Smokers Have Same Lung Cancer Risk as Men


Reuters Health

Tuesday, June 1, 2004

NEW YORK (Reuters Health) - Contrary to what has been suggested by recent studies, women do not seem to have a higher risk than men for developing lung cancer if they have comparable histories of smoking.

The new findings, in the Journal of the National Cancer Institute (news - web sites), are based on data from two large studies: the Health Professionals Follow-up Study of men and the Nurses' Health Study of women. The analysis focused on the period from 1986 through 2000 and included 25,397 men and 60,296 women.

During the study period, 311 men and 955 women were diagnosed with lung cancer, Dr. Diane Feskanich, from Brigham and Women's Hospital in Boston, and colleagues found. The patients ranged in age from 40 to 79 years.

The rates of lung cancer were similar for men and women. Among current smokers, the number of cases among the equivalent of 10,000 people over 10 years were 232 for men and 253 for women. For former smokers, the numbers were much lower, at 73 and 81 cases.

The differences between men and women could have arisen by chance and were not statistically meaningful.

"The combined nurses and health professionals cohort is the third large American cohort in which there has been no measurable excess of lung cancer among female smokers compared with male smokers, once amounts smoked have been controlled," Dr. William J. Blot and Dr. Joseph K. McLaughlin, from Vanderbilt University Medical Center in Nashville, Tennessee, note in a related editorial.

"With large numbers and consistent findings, the clear picture that emerges from the cohort studies is that women do not have higher rates of smoking-induced lung cancer than men," they add.

Source: Journal of the National Cancer Institute, June 2, 2004.

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Hospitals Go Gourmet, Offer New Cuisine


By Jamie Stengle

Associated Press Writer

The Associated Press

Tuesday, June 1, 2004

DALLAS - Welcome to hospital food nouveau, where menus tout salmon with cucumber and melon relish. Or chocolate chip pancakes. Reservations not required. Hospital gowns acceptable.

A growing number of hospitals are moving to hotel-style room service for patients.

"I think people have that perception before they even come into the hospital, 'Oh it's hospital food. I know it's going to be bad,'" said Mary Ann Moser, director of food and nutrition services for Medical City Dallas Hospital, which recently began its new food service.

The hospital serves about 350 meals each breakfast, lunch and dinner. Patients can call from 6:45 a.m. to 7 p.m. to place orders for food that is prepared fresh and delivered to their rooms within 45 minutes.

"Patient satisfaction was really a key for us," Moser said.

Trying to lure patients and keep them happy in a competitive market is what inspired hospitals across the nation to start banishing bland food served at set times.

"It's kind of a trend of placing the patient in the center of what a hospital does," said Alicia Mitchell, a spokeswoman for the American Hospital Association. "This is one example of a hospital offering more choice."

The National Society for Health Care Food Service Management is surveying hospitals to find out how many now offer menu or gourmet service, said Mike Giuffrida, chief executive for the Washington-based trade group.

He said the trend began about seven years ago, but in the last 18 months "it's become an absolute avalanche."

At Medical City, there is no extra charge to the patient for the improved food. Hospital officials say there are savings by having less wasted food and their hope is to entice visitors to eat there, too. They would be paying customers.

Patients may choose from 22 different menus that cater to everyone from diabetics and children to cardiac and gastric bypass patients.

"We had one patient call that said that it was some of the best food they'd ever tasted," Moser said. "And it made their experience much better in the hospital."

That's exactly what chef Kenneth Furtado wants to hear. "I really want them to feel like they are in a five-star hotel," he said.

The selection at Medical City inspired Brian Matlock, 25, to join his wife for lunch in her hospital room the day after she gave birth to their daughter.

"He definitely wasn't interested in what I had yesterday," said Mindy Matlock, 24, whose stay overlapped with Medical City's switch to the new menu service. The first day Matlock had cold sandwiches.

The next day she and her husband enjoyed chicken-fried steak, mashed potatoes, green beans and a rich piece of chocolate cake.

The hospital's old system, know as "cook-chill," meant dishes such as chicken, rice and vegetables were prepared, frozen and then warmed up, limiting the variety and time frame for serving.

Freshly prepared food not only tastes better, but also could help speed recovery because a patient may eat sooner and gain more strength.

Cancer patients often have a loss of appetite or changes to their sense of taste and smell because of radiation or chemotherapy, said Carol Frankmann, director for clinical nutrition at the M.D. Anderson Cancer Center in Houston. When her hospital began offering a menu service in 2000, doctors and nurses noticed an immediate difference.

"One of the things that was observed immediately was that the trays came out of the room empty," Frankmann said. "Because our patients are ordering what they want at the moment, they're generally eating all of it."

At Memorial Sloan-Kettering Cancer Center in New York, patients began getting gourmet service in 2002. Offerings such as crab cakes, New York strip steak and veggie quesadillas have been a hit, said Sharon Cox, director of food and nutrition services.

Dee Maggio, a cancer patient at Medical City, has enjoyed the freedom the menu service offers. On one day, after a big breakfast of cream of wheat and an egg-white omelet, she decided she wouldn't have her next meal until later that afternoon.

"It's kind of like being spoiled," said Maggio, 58, of Plano.

On the Net:

Medical City Hospital:

 National Society for Healthcare Food Service Management:

Memorial Sloan-Kettering Cancer Center:

M.D. Anderson:

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Study: Smoking Alters Saliva to Raise Cancer Risk



Tuesday, June 1, 2004  

LONDON (Reuters) - Smoking destroys protective molecules in saliva and transforms it into a dangerous cocktail of chemicals that increases the risk of mouth cancer, scientists said on Tuesday.

"Cigarette smoke is not only damaging on its own, it can turn the body against itself," said Dr Rafi Nagler, of the Technion-Israel Institute of Technology in Haifa, Israel.

Saliva contains antioxidants, molecules that normally protect the body against cancer, but Nagler and his colleagues have discovered that cigarette smoke destroys the molecules and turns saliva into a dangerous compound.

"Our study shows that once exposed to cigarette smoke, our normally healthy saliva not only loses its beneficial qualities but it turns traitor and actually aids in destroying the cells of the mouth and oral cavity," he added.

In research reported in the British Journal of Cancer, Nagler and his team studied the impact of cigarette smoke on cancerous cells in the laboratory.

Half of the cells were exposed to saliva exposed to cigarette smoke and the other half just to the smoke. Cells exposed to the saliva mixture had more damage and it increased along with the time of exposure.

"Most people will find it very shocking that the mixture of saliva and smoke is actually more lethal to cells in the mouth than cigarette smoke alone," Nagler added in a statement.

Smoking and drinking are the leading causes of head and neck or oral cancers, which includes cancer of the lip, mouth, tongue, gums, larynx and pharynx. Nearly 400,000 new cases of the illness are diagnosed worldwide each year with the majority in developing countries. The five-year survival rates are less than 50 percent.

Nagler and his colleagues believe the research could open up new avenues to develop better treatments to prevent oral cancer.

"This insight into how mouth cancer can develop offers more reasons for smokers to try and quit," said Jean King, of Cancer Research UK, which publishes the journal. "People know the link with lung cancer and this research adds compelling evidence about the damage smoking can do to the mouth."

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Air Pollution Poses Cardiovascular Risks, Heart Association Says


By Ed Edelson
HealthDay Reporter


Tuesday, June 1, 2004

TUESDAY, June 1 (HealthDayNews) -- Taking a stand for the first time, the American Heart Association (news - web sites) now says air pollution increases the risk of heart attack, stroke and other cardiovascular problems.

The scientific evidence has not been strong enough until now to support such a position, said a scientific statement in the June 2 issue of the association journal Circulation. But recent studies clearly establish the risk, especially from the fine particles emitted by sources such as diesel engines, power plants and industrial activity, it said.

No single study was responsible, said Dr. Robert D. Brook, an assistant professor of medicine at the University of Michigan who headed the committee that drew up the statement, just "a sense among those responsible that the level of evidence had risen to "a point where for the first time, the American Heart Association [AHA] should recognize air pollution as a public health problem."

One study cited by the committee, done by the American Cancer Society (news - web sites), reported a numerical relationship between risk and exposure, with the risk of death from a cardiovascular event increasing by 12 percent for every increase of 10 micrograms per cubic meter of air of fine particle pollutants.

Levels of fine particulate pollution can vary by 30 milligrams or 40 milligrams per cubic meter of air day by day, Brook said.

Most of those deaths triggered by air pollution are due to heart attacks and other events that cause blockage of arteries, but deaths from other causes such as heart failure and heart rhythm abnormalities also rise as pollutant levels increase, Brook said.

"Prolonged exposure to elevated levels of particle pollution is a factor reducing overall life expectancy by a few years," the association statement said. "Short-term exposure to elevated levels of particle pollution is associated with the increased risk of death due to a cardiovascular event."

Air pollution does not pose as great a risk as other established factors, such as high blood pressure and high cholesterol, Brook said, but health-care providers and people in general need to pay attention to it.

It's especially important for people at high risk -- those older persons or those with diabetes, for example -- to be aware of day-to-day levels of air pollution, Brook said. When pollution levels go up, they can take simple protective measures such as restricting activity or staying indoors in a less-polluted environment, he said.

"They should be aware of the Environmental Protection Agency (news - web sites) Web site or media sources that make daily air pollution levels available daily," Brook said.

The warning about air pollution laps over to cover secondhand cigarette smoke, the major form of indoor air pollution, said Dr. Sidney C. Smith Jr., a professor of medicine at the University of North Carolina and an AHA spokesman. Cigarette smoke is rich in fine particles, Smith noted.

"Studies show that in people with otherwise normal coronary arteries, exposure to secondhand smoke can change the response of the arteries similar what is seen in smokers," he said.

The AHA will not get into the politically sensitive controversy about controls of power plant emissions, Brook said. But, he added, "we hope that these conclusions will provide further support to the importance of the present-day air quality standards."

More information

Daily pollution readings for more than 150 cities are provided by the U.S. Environmental Protection Agency.

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'Safer' Tobacco Products Not as Safe as They Seem


By Alison McCook

Reuters Health

Tuesday, June 1, 2004

NEW YORK (Reuters Health) - A new type of cigarette that contains less cancer-causing substances than conventional brands may not be doing much to protect smokers, according to new research released Tuesday.

Although testing of the new OMNI cigarettes showed that they contain 50 percent less of a particular carcinogen, or substance that causes cancer, smokers who switched to the OMNI cigarette had only 20 percent less of the carcinogen in their bodies than they did while smoking conventional cigarettes.

This relatively small drop in carcinogen levels may not be enough to reduce a smoker's chance of developing cancer, study author Dr. Dorothy K. Hatsukami told Reuters Health. "Does that (20 percent difference) really translate to reduced cancer risk? We're not sure," she said.

She warned that smokers should not believe that by switching to a less carcinogenic brand, they are sidestepping the dangers of smoking.

If smokers think the new so-called "reduced-exposure" tobacco products are safe, "they'll maintain their smoking rather than make a concerted effort to quit," Hatsukami pointed out. "The best way to reduce your risk of disease is still quitting smoking," she added.

Tobacco naturally contains carcinogens, which are enhanced during the processing of tobacco leaves. In order to design safer tobacco products, companies are beginning to release cigarettes and snuff products that contain fewer carcinogens, created by adding protective chemicals, processing the tobacco differently, or using genetically engineering tobacco.

In the current study, Hatsukami and her colleagues at the University of Minnesota in Minneapolis tested the benefits of reduced exposure products by asking 54 smokeless tobacco users and 51 smokers to switch to either the newer brands or a nicotine patch for four weeks. Snuff users tried Swedish snus, while smokers switched to OMNI cigarettes.

Reporting in the Journal of the National Cancer Institute (news - web sites), the researchers found that smokers who switched to reduced-exposure products experienced a smaller decrease in the carcinogen NNK than was predicted by machine testing. Snuff users showed lower levels of carcinogens after switching to snus, but both snuff users and smokers experienced a smaller decrease in carcinogens than nicotine patch users.

In an interview, Hatsukami explained that people smoke in a different way than machines, and some smokers may have absorbed more carcinogens by taking more puffs per cigarette or inhaling more smoke than the machine predicted.

"Consumers really need to be wary when they see advertisements for reduced exposure products," she said.

Source: Journal of the National Cancer Institute, June 2, 2004.

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Chocolate Can Keep Cardiovascular System in Shape

By Ed Edelson
HealthDay Reporter


Tuesday, June 1, 2004  

TUESDAY, June 1 (HealthDayNews) -- For those who think the world is a bitter place, medical science offers this sweet health tidbit: Chocolate might be good for you.

Not just any chocolate, and always in moderation, said Mary Engler, a professor of physiological nursing at the University of California, San Francisco, School of Nursing. But her new study does find that biting into the right stuff can make arteries expand, increasing blood flow and thus reducing cardiovascular risk.

Milk chocolate won't do, Engler sressed, because it's, well, too milky. Look for darker chocolates, because darkness is an indicator of high levels of flavonoids, the chemicals that loosen up the arteries.

And this is one instance where good taste and good health go hand in hand, Engler said.

You can tell that a chocolate has a high flavonoid content because "the flavor is so intense and rich," she said.

The study that Engler and her colleagues are reporting in the Journal of the American College of Nutrition had 11 willing participants eat 1.6 ounces of flavonoid-rich chocolate every day for two weeks. Another 10 volunteers, sacrificing themselves for science, consumed an equal amount of low-flavonoid chocolate.

Ultrasound measurements showed that expansion of the arteries in response to greater blood flow increased by 10 percent in the flavonoid consumers, while there was a slight decrease in those who got the flavonoid-poor chocolate. Blood levels of a powerful flavonoid, epicatechin, rose more than eightfold for the high-flavonoid group and remained unchanged for the others.

The study was done in collaboration with the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. Jeffrey Blumberg, chief of the center's Antioxidant Research Laboratory, said the work has expanded to look at other flavonoid-containing foods.

"Not only chocolate, but also tea, oat bran, almond skins and blueberries, all are good sources of flavonoids," Blumberg said. "We're trying to get a better understanding of vital chemicals, flavonoids being one of the larger groups."

Chocolate "happens to be a rich source of flavonoids," Blumberg said, but he added that "we are not trying to position chocolate as a health food."

In addition to flavonoids, chocolate also has a lot of calories and a lot of saturated fat, neither of which is good for the arteries, he said.

"But in the context of a reasonable diet, chocolate is not only a pleasurable food but might contain some health-promoting ingredients," Blumberg said.

Recommendations about chocolate can be compared with those about wine, Engler said. An occasional glass or two of wine has been shown to be associated with a reduced risk of cardiovascular disease, she said, "but people should not be overindulgent with wine. The same is true of dark chocolate in moderation as part of a well-balanced diet."

More information

You can explore the frontier of chocolate research by consulting the Chocolate Information Center.

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Monday, May 31, 2004


Kids' Use of Bike Helmets, Seatbelts Less Than Parents Think



Monday, May 31, 2004

MONDAY, May 31 (HealthDayNews) -- Children aren't using their bicycle helmets and seatbelts as often as their parents believe they are, claims a study in the current issue of Injury Control and Safety Promotion.

The study of 731 fourth and fifth graders and 329 of their parents found 70 percent of the parents said their children always wear a bike helmet while riding. But only 51 percent of the children reported that they actually wear a bike helmet.

While 20 percent of the children said they never wear a bicycle helmet, only 4 percent of parents said their children never use a helmet.

The study also found discrepancies between parents and children about the use of seatbelts. Parents said their children use a seatbelt 92 percent of the time while the children said they used a seatbelt 70 percent of the time.

About 80 percent of the parents said their children always sit in the vehicle's back seat. But only 43 percent of the children said they always sit in the back seat.

"There's a real void between the availability of good safety devices and actual use by parents and children," study author Dr. Peter Erlich, a pediatric surgeon with the University of Michigan Health System, said in a prepared statement.

"This study shows the need to target injury prevention programs to parents and children together. We can't rely solely on parental reports of children's safety behaviors. Injury prevention must be treated as a family issue," he added.

Erlich did the study while at the Children's Hospital of West Virginia.

More information

The National Safe Kids Campaign has more about child safety.

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Study: Driving Longer Means Larger Waists


By Daniel Yee

Associated Press Writer

The Associated Press

Monday, May 31, 2004

ATLANTA - Spending more time behind the wheel — and less time on two feet — is adding inches to waistlines and contributing to the nation's obesity epidemic, a new study concludes.

The survey of 10,500 metro Atlanta residents found that for every extra 30 minutes commuters drove each day, they had a 3 percent greater chance of being obese than their peers who drove less.

The survey also found that people who lived within walking distance of shops — less than a half mile — were 7 percent less likely to be obese than their counterparts who had to drive.

"The more driving you do means you're going to weigh more — the more walking means you're going to weigh less," said Lawrence Frank, associate professor at the University of British Columbia who oversaw the study when he worked at Georgia Tech.

That much seems obvious, but researchers were surprised to discover that how much time a person spent driving had a greater impact on whether a person was obese than other factors such as income, education, gender or ethnicity.

About 91 percent of the people surveyed said they didn't walk to destinations. Many spent more than an hour each day in their cars.

The study is one of the first to look at the link between the environment and obesity, said Kelly Brownell, chairman of Yale University's psychology department and director of its Center for Eating and Weight Disorders.

"Studies of this type are very important because they show factors in our environment that can either help or hurt our waistline," said Brownell, who was not involved in the study. "These results show that the environment, affecting our physical activity, is quite influential."

In the study, which is expected to appear in the June issue of the American Journal of Preventive Medicine, researchers tracked participants' travel behavior and measured their height and weight from 2000 to 2002.

The study focused on Atlanta, but Frank said the city is not alone.

"Most regions look very similar to Atlanta — anything that's built after World War II is pretty much auto-oriented," he said. "We need to start to look at the way we're designing our communities ... the collective impact of having to drive everywhere is becoming really large."

Suburban, white men typically weighed about 10 pounds more than men who lived in dense urban areas with shops and services, according to the study, which will be presented Thursday at a national obesity conference in Virginia.

The study was paid for by $4 million in grants from the Georgia Department of Transportation, Georgia Regional Transportation Authority and the federal Centers for Disease Control and Prevention (news - web sites). The Atlanta Regional Commission and the Environmental Protection Agency (news - web sites) also participated.

On The Net:

Georgia Institute of Technology:

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Catch Carpal Tunnel Syndrome Early



Monday, May 31, 2004

MONDAY, May 31 (HealthDayNews) -- If you feel pain and tingling in your hands, it could be a sign of carpal tunnel syndrome.

Early diagnosis and treatment of this problem can help relieve the pain and numbness and prevent permanent damage, says an article in the May issue of Mayo Clinic Women's HealthSource.

Carpal tunnel syndrome occurs when a large nerve in the hand becomes compressed. Women are three times more likely than men to develop the condition. It's not understood why carpal tunnel syndrome is more common among women.

Protecting your hands may help ease the symptoms of carpal tunnel syndrome and prevent further injury. Mayo Clinic Women's HealthSource offers the following precautions:

More information


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

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School Asthma Program Improves Health and Grades


Reuters Health

Monday, May 31, 2004

NEW YORK (Reuters Health) - A comprehensive school-based asthma management program improved health status and school performance of children with asthma, particularly those with persistent disease, according to a new study.

The findings, which appear in the medical journal Chest, are based on a study of 835 asthmatic children in grades 2 through 5 in 14 schools in low-income communities in Detroit, Michigan.

School-based asthma programs, "can help children with asthma experience fewer symptoms and do better at school," Dr. Noreen M. Clark from the University of Michigan School of Public Health told Reuters Health. "Since resources are always scarce, focusing such a program on children with persistent disease can produce the best results," she added.

The aim of the program is education of the asthmatic child to improve their skills in managing the disease. A series of components targets key people in the child's social environment -- parents, classmates, and school personnel -- who can also assist.

Seven schools (416 children) were randomly assigned to the intervention program and another 7 schools (419 children) were wait-listed for the program and served as the "controls." Interviews were conducted with parents and school personnel at the start of the program and two years later.

The results showed that children with persistent asthma who were assigned to the school-based program had significant declines in both daytime and night-time symptoms (14 percent fewer episodes for both).

Among children with both mild intermittent and persistent disease, those in the intervention group had 17 percent fewer daytime asthma symptoms, but 40 percent more night-time symptoms. The authors believe that the intervention program "may have stimulated attention to symptoms at night by parents of children with mild intermittent disease."

Intervention children also posted higher grades in science, but not in reading, math, or physical education. School absenteeism rates did not differ between the groups, however, parents of intervention children reported 34 percent fewer asthma-related absences in the previous 3 months and 8 percent fewer in the preceding 12 months.

In conclusion, Clark emphasized that "implementing such a program is not difficult, especially if a group like the American Lung Association can provide volunteers who can be trained to work in the school."

Source: Chest, May 2004.

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Say So Long to Spit Tobacco

By Adam Marcus
HealthDay Reporter


Monday, May 31, 2004

MONDAY, May 31 (HealthDayNews) -- Smokers have no doubt been barraged with warnings about the dangers of their bad habit, but those who use smokeless tobacco might also want to heed the health cautions.

"Smokeless tobacco is not without health risks," said Dr. John Spangler, a family medicine specialist at Wake Forest University who studies tobacco use. "Although it doesn't seem to cause cardiovascular disease or cancers to the same rate that cigarette smoking does, it definitely does cause them."

It seems a perfect time to stop, since May 31 has been designated World "No Tobacco" Day, when smokers will put away their cigarettes in a gesture to good health.

The American Cancer Society (news - web sites) says people who use chewing tobacco and snuff face 50 times the risk of developing cancers in their cheeks and gums as those who don't chew. Every day, an estimated 24 Americans die of oral cancer -- nearly 8,800 a year -- according to the Oral Cancer Foundation.

The habit is also linked to cancer of the pancreas, kidneys, prostate and possibly the breast, Spangler said.

Chewing tobacco and snuff -- another form of the leaf that's put in the mouth -- should be a particular concern for America's youth. Nearly 10 percent of the nation's high school students (almost 16 percent of boys and 1.5 percent of girls) say they've used smokeless tobacco in the past month, according to the U.S. Centers for Disease Control and Prevention (news - web sites).

One misconception about spit tobacco is that it's chemically more benign than tobacco that's smoked. Untrue, Spangler said. Both products contain the same litany of cancer-causing chemicals, especially tobacco-specific nitrosamines (TSNAs). However, smokeless tobacco users ingest far greater concentrations of these TSNAs than do smokers, 10 times more, on average, according to the Oral Cancer Foundation.

Less serious but by no means pleasant, smokeless tobacco use is associated with cosmetic problems such as chronic bad breath, stained teeth and gum and tissue disease.

One "dip" of spit tobacco is said to contain 10 times the nicotine jolt of a cigarette, and that sends the heart racing, constricts blood vessels, kicks up blood pressure and strains the heart, Spangler said. It also makes spit tobacco more addictive than cigarettes, and therefore potentially more difficult to give up, he added.

Difficult, but not impossible. Herbert Severson is a researcher who studies spit tobacco cessation programs. He and his colleagues at the Oregon Research Institute are launching an online program to help people quit chewing.

Like other chewing tobacco cessation efforts, resembles smoking cessation plans in several respects, but it's not identical.

"There are subtle differences," Severson explained. "The kind of withdrawal symptoms people experience with chewing tobacco are a little different." While smokers may become depressed when they quit, chewers are more likely to become agitated and angry and to see their ability to concentrate suffer.

Oral substitutes, such as nicotine gum, are quite important for chewers, and use patterns are different, Severson said. That last point is key, he added, because chewing tobacco often takes on a more central part of a person's life. Ironically, users -- almost always men -- may work at smoke-free companies that have indirectly encouraged employees to go smokeless, Severson said.

Chewing tobacco also provides background activity for typically male pursuits -- hunting, fishing and baseball -- when smoking isn't necessarily possible. "You can use it in a lot of situations where you can't smoke," Severson said., which has received funding from the National Cancer Institute (news - web sites), offers tips for successful cessation. It also provides information on a "blending program" that reduces nicotine exposure by mixing tobacco with nicotine-free plants such as mint snuff or herbal alternatives.

Perhaps the most effective component, Severson said, is encouraging men to take a look at the damage chewing tobacco is doing to their mouth. "It's really quite motivational" to see the lesions that form where the tobacco sits against the gums, he said. Seven in 10 regular users develop these sores; 3 percent to 4 percent of those sores become tumors. Having mouth damage "is directly related to the length of time a man has chewed and the weekly amount," Severson said.

More information

For more on the harms of chewing tobacco, try the Oral Cancer Foundation.

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Small Steps Are Urged for Weight Loss

By Melissa Trujillo

Associated Press Writer

The Associated Press

Monday, May 31, 2004

MILWAUKEE - There are no complicated diets, pricey workout equipment or strict personal trainers. Participants of Lighten Up programs in 16 states from Maine to Hawaii are learning to make healthy choices by making small lifestyle changes: drinking one more glass of water each day; eating fruits and vegetables; taking the stairs instead of the elevator.

It's making a difference in Wisconsin, a state where almost 58 percent of residents were overweight or obese in 2002, and cheese, beer and sausage are practically their own food groups.

"It's not such a threatening thing anymore," Sandi Tritz said of dieting and exercising since joining Lighten Up Wisconsin. "They weren't so outlandish, like I had to run a marathon."

More than 20,500 people nationwide are involved in some form of Lighten Up, said Nicole Mueller, director of health initiatives for Wisconsin Sports Development Corp., a nonprofit sports management organization that runs the state's version.

In Iowa, nearly 12,000 members lost about 23.5 tons of weight last year, or roughly four pounds per person, said Kim Nanke of Iowa Games, a nonprofit group that created the first Lighten Up program in 2002.

In Wisconsin, more than 1,700 people shed an average of 4.9 pounds midway through the five-month program.

Four to five pounds may not seem like much, but health experts say even the smallest improvements count because they can boost participants' confidence to exercise more or improve their diets.

"Starting and losing five pounds of weight is better than not starting and gaining five pounds," said Mary Kay Sones, a health specialist with the federal Centers for Disease Control and Prevention (news - web sites).

Participants joined the Wisconsin program in teams, which turned in their collective weights in January and March. A final weigh-in next month will determine the three teams — out of 226 — that lost the most weight, earning them statewide recognition and medals.

"We never see their individual weight," Mueller said. "They don't have to feel so pressured as individuals."

Each week the program offers a challenge, such as parking the car farther from the office, switching to 1 percent milk (cutting about 50 calories per cup), or using low-calorie condiments such as mustard or vinegar on sandwiches, instead of butter or mayonnaise.

Each challenge eliminates just a few calories at a time, but that adds up, said registered dietitian Cathy Alessi, a nutrition specialist for the Food and Nutrition Information Center of the U.S. Department of Agriculture (news - web sites).

Switching to a lower-calorie salad dressing cuts almost five pounds a year, she said. "Small changes do take longer, but most of the time, people find them more effective."

Melissa Surek has lost at least 10 pounds since starting the program, partly because she doesn't get discouraged. "It's something easy enough where you can go, 'Oh, I can do that for a week,'" said Surek, who works at a health clinic in Medford.

Other weight loss programs seemed to set her up for failure, such as one requiring 100 sit-ups every day. "Well, I can never stay with those," she said. "The fact that it's happening little by little, I think it's a lot better."

Tritz, a 53-year-old office worker from Marshfield, appreciates the support she gets from her six teammates, all co-workers. Her team lost 22 pounds by March.

"I'm finding that we're able to connect with each other," Tritz said. "Sometimes all you need is a glance."

Some of the weekly challenges during the 2004 Lighten Up Wisconsin program.

·        Drink an extra glass of water each day.

·        Take the stairs rather than the elevator.

·        Eat breakfast every day.

·        Increase exercise by five minutes each day.

·        Replace regular soda with diet soda.

·        Park as far away from your destination as possible.

·        Switch from 2 percent milk to 1 percent milk.

·        Eat six small meals a day, not three large ones.

·        Pick up the pace while walking.

·        Put mustard or vinegar instead of butter and mayonnaise on sandwiches.

·        Use cooking spray rather than oil.

·        Replace unhealthy snacks with healthy ones.

·        Replace regular salad dressing with fat-free version.

·        Replace soda, even diet soda, with water.

·        Stretch every day for three to five minutes.

·        Avoid fried foods.

·        Turn to exercise, not food, when stressed.

·        Downsize rather than super-size.

·        Cut back on sugar.

·        Cut 100 calories from your diet each day.

On the Net:

Lighten Up Wisconsin:

Lighten Up Iowa:

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Health Tip: Kids in Hot Parked Cars



Monday, May 31, 2004

(HealthDayNews) -- Never leave a sleeping child alone in the car while you dash into the grocery store, especially during the hot summer months.

Rising temperatures inside a car can cause a child to suffer from heat stress, dehydration, shock and death.

The temperature inside a parked car can top 122 degrees within 10 to 20 minutes on a typical summer day, according to The Hospital for Sick Children in Toronto. And opening the window slightly does not keep the temperature at a safe level.

Young kids, particularly infants, are 3 to 5 times more sensitive to heat than adults. Due to the small sizes of their bodies, they can't regulate their body temperatures as quickly as adults.

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Many Don't Get Full Dose of Chemo


By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, May 31, 2004

WASHINGTON - It's a worrisome finding: About a third of patients with potentially curable breast cancer aren't getting full-strength doses of chemotherapy because of side effects or other problems.

Now researchers are preparing to find out whether this inadvertent chemo-lite is common with other cancers, too — and how much the dose can dip before patients' chances of survival are harmed.

"This is not just a breast cancer problem," predicts Dr. Gary Lyman of the University of Rochester Medical Center, who is leading some of the research.

"We're very concerned about it," adds Dr. Larry Norton, deputy physician-in-chief for breast cancer at Memorial Sloan-Kettering Cancer Center.

Norton's own research shows that undergoing breast cancer chemotherapy every two weeks instead of every three can improve survival by 30 percent. That means skipping chemo sessions or lowering doses has ominous implications.

What could the toll be?

"The bottom line is nobody knows," says Dr. Howard Ozer, with the Oklahoma University Cancer Center, who is heading an effort by the American Society of Clinical Oncology (news - web sites) to examine some of the issues. "It has not been recognized that this (under-dosing) is a problem."

Strict scientific studies set the "dose intensity" for different chemotherapy cocktails — the proper dose plus how often it must be given.

But community oncologists often don't stick to those recommendations as rigorously as do researchers, and Lyman's breast cancer data provides the best picture of that so far. He reviewed medical records for more than 20,000 breast cancer patients who underwent post-surgery chemotherapy.

Lyman found that more than half received less than 85 percent of the recommended dose intensity that is considered the minimum for optimal treatment. For a quarter of patients, the problem was postponing chemo sessions; for the rest, it was dosage cuts, presumably because of side effects.

Many of those women were treated in the mid-1990s, before a shift to some easier-to-tolerate chemotherapy agents. So Lyman is examining records from 10,000 women treated since 2000 — and is finding some improvement, with about a third of patients now undertreated. He plans to report this at a cancer meeting later this year.

Still, that's worse than the 5 percent to 10 percent of patients that Lyman and some other researchers believe truly cannot tolerate full-strength dosing despite today's improved medications to counter side effects.

No one knows how often patients with other cancers are under-dosed, although a much smaller study suggests half of those with non-Hodgkin's lymphoma are.

To help answer the question, Lyman has begun a registry tracking patients from 100 community-based oncology practices nationwide as they receive chemo for breast, lung, ovarian and colorectal cancers and lymphoma. About 3,000 patients are enrolled so far.

This time, he'll also check why chemo is postponed or cut — gathering details on side effects, and whether some skipping is due to physician disagreement over proper dosing or simply the patient's ill-informed desire for a break.

"I've had patients say to me, 'I'd like to skip a week to take an exam or a trip,'" Sloan-Kettering's Norton says. "I can't force you to get treatment on time, but I sure can encourage you."

Lyman's work is funded by Amgen Inc., which makes one of the treatments for the common chemotherapy side effect neutropenia, a loss of white blood cells that leaves patients vulnerable to infection.

Drugs that spur white blood cell production can prevent neutropenia so chemo won't have to be cut or delayed, but they're too expensive for routine use. In June, Ozer and colleagues at the American Society for Clinical Oncology will finalize guidelines to help determine who is at high enough risk of neutropenia to receive such drugs protectively.

And Ozer is helping to plan a study of five cancers similar to Lyman's registry — but that also will attempt to determine at what level does dips in doses cause real harm.

What side effects must be tackled to prevent under-dosing will be cancer-specific, because different chemotherapies are used for each, cautions Dr. James Doroshow of the National Cancer Institute (news - web sites).

Genetic tests within a few years could decrease concern about under-dosing, by allowing doctors to tailor patients' chemo dose in ways now impossible, Doroshow says.

Until then, Norton and Lyman advise cancer patients to talk candidly with their doctors about ways to ease side effects without cutting chemo doses.

Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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New Risk Factor for Teen Smoking Found



Monday, May 31, 2004

MONDAY, May 31 (HealthDayNews) -- Parent or guardian job loss may play a powerful role in pushing teens to start smoking, says a University of Southern California study in the May issue of Health Psychology.

The study of 2,016 students in Southern California found that adolescents in families where adults lost their jobs were almost 90 percent more likely to start smoking within a year of the job loss than those in families that didn't experience job loss.

"Previous research has shown that stressful life events like divorce and abuse are associated with risky health behaviors. This study extends previous research by identifying a specific life event -- job loss in the family -- as a health risk factor," study author Jennifer B. Unger said in a prepared statement.

The students in the study were first surveyed in the sixth grade. None had ever smoked. They were surveyed again in the seventh grade.

Among students who reported a job loss in the family since the first survey, 87 percent were more likely to have tried smoking or to have smoked within the previous 30 days than students who did not report any job loss in the family.

The study also found a lower risk of smoking among students who did well in school, had good communication with their parents, were monitored by their parents, or were Asian.

"In times of economic and employment instability, many more families could face losing their jobs. It's important that we do more research to understand the impact of job loss and develop interventions to help all family members learn to cope with it without turning to substance use or other behaviors that harm their health," Unger said.

More information

The American Academy of Family Physicians (news - web sites) offers advice to teens about smoking.

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Saturday, May 29, 2004


Demand for Surgery for Obesity Increases – Expert


By Patricia Reaney


Saturday, May 29, 2004

PRAGUE (Reuters) - The fattening of the rich world has sparked a surge in demand for surgery to help people lose weight, a European specialist said on Saturday.

Most people can drop excess pounds or kilos through exercise, eating less or medication, but for the most obese and people suffering a weight-related disease, this may not suffice.

Dr Martin Fried, of the Laparoscopic-Obesity Treatment Hospital in Prague, told a medical conference more patients are opting for surgery to cure their obesity.

"Demand is increasing because people are getting fatter and are better informed," he said.

Weight-loss surgery restricts the food a person can consume or interferes with calorie absorption by shrinking the stomach with bands or staples or bypassing part of the organ.

Up to 50,000 operations have been performed each year in Europe and many more in the United States where the surgery was invented and developed.

Only the most severely overweight -- the technical term is morbidly obese -- or people close to that category but have a serious illness linked to obesity, such as high blood pressure or diabetes, qualify for the surgery.

Morbidly obese people have a body mass index (BMI) of 40 or more -- equal to being about 100 pounds or 50 kg overweight.

BMI measures fat distribution. It is calculated by dividing weight in kg by height in meters squared. A healthy person will have a BMI of 25 or under.

For people above a certain weight, diet and exercise are unlikely to lead of sustained weight loss and surgery may be more effective. "Of the morbid obese about 30-40 percent would qualify for surgery," said Fried.

Gastric bypass surgery is one of the most popular types of weight-loss surgery in the United States.

In Europe, Fried said gastric banding, in which a silicon band is placed over the top of the stomach during keyhole surgery to decrease its capacity, is more common.

"It is a straightforward operation and takes from one hour to do," he said.

Average weight-loss within the first 18 months after surgery is about 40 kg (90 pounds) and the complication rate is about five percent, compared to 12 percent with gastric bypass surgery, and the mortality rate is minimal, according to Fried.

"Non-surgical treatment fails in maybe 70-80 percent of patients. Surgical treatment is successful in around of 70-75 percent of patients," he added.

About 2,500 doctors, researchers and clinicians are attending the four-day European Congress on Obesity in Prague.

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Food Variety May Increase Consumption


By J.M. Hirsch

Associated Press Writer

The Associated Press

Saturday, May 29, 2004

CONCORD, N.H. - Ed Glomb admits he gets a little carried away when faced with the more than 150 all-you-can-eat options on the Red Apple Buffet's Italian-American-Chinese-Japanese menu.

But Glomb's tendency to pile it on at his favorite restaurant — and his rotund size — may have as much to do with the number of choices on the buffet table as the unlimited portions being offered.

Call it the "salad bar effect." Studies suggest that variety increases consumption. With monotonous meals, people eat until they are full. Add variety, even something as subtle as different shapes of pasta, and they eat more.

"Everybody has a tendency to eat with their eyes," he said recently, adding that he'd already eaten soup, shrimp and crab legs — starters to be followed by roast beef, potatoes and dessert. "It's a little bit of this and a little bit of that."

Studies dating back to the 1960s have shown that variety can increase calorie consumption an average of 25 percent, according to Megan McCrory, a nutrition scientist at Tufts University.

That has some researchers grappling with the global obesity epidemic considering what role an often dizzying array of food choices might play in expanding the collective waistline.

"Nutritionists have been wrong. We've been telling you for years variety is important, but it's that variety that really helps to make you fat," said Judith S. Stern, vice president of the American Obesity Association.

The science may not be familiar to most people, but its effects probably are.

It plays out "in restaurants when you're really stuffed to the brim and you just can't have another bite," McCrory said. "Then the waiter brings around the dessert cart. ... There's always room for dessert."

Blame it on so-called sensory specific satiety, a mental process that makes food taste better at first but progressively less interesting as a person continues to eat it. Switch to a new food and, even if the person is full, it will be appealing.

Marketers know this. Coca-Cola sells nearly 400 different drinks, Frito-Lay offers about 150 different chips and pretzels in the United States alone, and Campbell's produces 170 soups.

"If all you have is chicken soup, you probably won't eat soup night after night," said John Faulkner, a spokesman for the Campbell Soup Company. "But the more varieties you have, the more of it you'll eat."

Barbara Rolls, a professor of nutrition at Penn State University, said this dietary trigger dates back to humanity's early days, when survival was best served by a natural inclination to eat a variety of foods.

"It encourages you to switch from food to food," she said. "As omnivores with a variety of nutrient requirements, we need to switch from food to food and take in a lot of different nutrients. This is actually an adaptive response."

Most researchers agree on the science behind sensory specific satiety. Where they differ is on how it affects overall eating patterns and how significantly it contributes to obesity.

Rolls and McCrory, two of the leading researchers in the field, think it does.

"There's so much variety that especially when the variety tastes really good we're more apt to go ahead and eat it, especially when it's everywhere you turn," McCrory said.

The problem isn't just that people seek variety, but also that the foods they are eating are high in calories, Rolls said. People learn as children to prefer high-calorie foods because they satisfy cravings quickly.

Rolls said it's a prescription for obesity — easy access to a growing variety of high-calorie foods paired with a natural inclination to eat more of them.

And though obesity long has been considered an American problem, the rest of the world is catching up. McCrory thinks that might be due to a greater variety of foods becoming available in other nations, especially calorie-dense items.

Availability of such foods overseas has increased dramatically. Since 1989, U.S. exports of snack foods have quadrupled to more than $1.5 billion last year, according to the U.S. Department of Commerce.

An influx of variety has had a dramatic effect on the people of the Solomon Islands in the South Pacific, said Gary Miller, a professor of nutrition and obesity at Wake Forest University.

He said 30 year ago the islanders' diet was limited mostly to what could be produced locally. Trade has since introduced a torrent of variety, especially calorie-dense foods previously absent from this nation of 340,000 people.

The country now has one of the highest obesity rates in the world.

Richard Mattes, a nutrition professor at Purdue University, said it isn't that simple. Though he agrees that variety prompts people to eat more, he said studies have yet to prove the effect of sensory specific satiety lasts beyond a particular meal.

In fact, some studies suggest that after a meal of variety-induced excess, people compensate and eat less later, he said.

But Dr. Terry Maratos-Flier, head of obesity research at the Joslin Diabetes Center in Boston, said that's generally only true with lean people. Overweight people — roughly two-thirds of Americans — often don't compensate.

Mattes also questions whether variety is responsible for the global spread of obesity. He said that more likely is due to sedentary lifestyles and an overall increased consumption of calorie-dense foods.

"Has variety really increased over say the last 20, 25 years? Yes, there have been many new products introduced into the market place. But that's not the measure," he said.

"The measure is what are the number of unique foods Americans ate during the 1970s and what is the number of unique foods Americans are eating today?"

Maratos-Flier thinks people are eating a greater variety, but not because there are more foods. She said low costs and ease of transportation have made it easier for more people to eat more food, and more types of food.

Consumers are surrounded by a staggering array of food: The typical American grocer has 35,000 products, up from 10,000 in 1983, according to Walter Heller, research director for Progressive Grocer magazine. During the 1930s, it was around 800 items.

Researchers don't think food variety alone dooms people to being overweight, but it doesn't hurt.

Sensory specific satiety can help people lose weight. Obesity experts agree that the most successful diets are the most restrictive — the more people eat of one food, the less they want it. As a result, they eat less and lose weight.

"Even if you went on a doughnut diet, if that's all you had you would undoubtedly lose weight because of monotony and lack of variety. Obviously that's not a good idea," Rolls said.

But since human nature is working against it, such diets also are the hardest to stick with.

Giving in to the urge for variety also can be good, as long as the food choices are sound. Filling up on a variety of low-calorie foods leaves less room for calorie dense-foods.

"You can't get rid of variety. People want 100 channels. They wants thousands of CDs and books. There's no policy that's going to get rid of variety in foods," Maratos-Flier said. "What you need is education" about good food choices.

As Glomb's wife has found, human nature is hard to fight. The urge doesn't diminish even in the face of absurd variety.

"This is good but it would be nice to have something different for a change," Marilynn Glomb said after mulling the options at the Red Apple Buffet, where the Merrimack couple eats twice a week. "It's the same thing every time you come."

On the Web:

Tufts University Human Nutrition Research Center on Aging:

Penn State University:

American Obesity Association:

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