The American Voice Institute of Public Policy presents

Personal Health

Joel P. Rutkowski, Ph. D., editor
December 1, 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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 June 26 - July 2


  1. U.S. Warns of Reactions to Permanent Makeup Ink
  2. Report Says Johns Hopkins Is Top Hospital
  3. Diabetes Ups Cancer Death Risk
  4. Hospital Uses Pill With Camera Inside
  5. SARS May Raise Risk of Tuberculosis
  6. Long-Held Cystic Fibrosis Theory Challenged
  7. Kids Do Much of Their Munching in Front of TV
  8. Stents As Good As Radiation for Blocked Arteries
  9. Study: Insulin Pumps Help Children Control Diabetes
  10. Caution Urged on Mosquito Repellent for Kids
  11. Lidocaine Patch Helps with Diabetes Pain
  12. Alzheimer's Patients Can Still Learn
  13. Coffee Doesn't Seem to Affect Heart Attack Deaths
  14. Health Tip: Pacifier Safety
  15. 'Western' Diet Raises Stroke Risk - U.S. Study
  16. Chemo More Dangerous Than Thought for Kids
  17. Smokers, Drinkers Show Gene Changes in Mouth Cells
  18. Immune System Linked to Miscarriage
  19. Flu Vaccination Benefits Elderly
  20. Alcohol May Boost Bone Density
  21. Blood Pressure Drop Warns of Dementia – Study
  22. New Kidney Cancer Therapy Shows Promise
  23. Vitamins May Slow Progress of AIDS Virus –Study
  24. Hormone Warns of Hypertension
  25. Protein Warns Lupus Patients of Kidney Woes
  26. Cutting Down on Stroke Damage
  27. Obesity Can Cause Heart Attacks in Kids – Study
  28. Virtual Reality Fights the Reality of Pain
  29. Artificial Sweeteners Make Calorie Counting Hard
  30. Casual Strolls May Be Risky for Older Women
  31. Relapse Common After Anorexia Treatment
  32. Skipped Heartbeats Probably No Concern
  33. St. John's Wort May Cut Levels of Heart Drug
  34. Sweat the Stress Out
  35. HRT Speeds Progression of Heart Disease in Diabetics
  36. Passive Smoking Heart Risk Double Earlier Estimates
  37. Starbucks' Summer Drinks Can Be Fattening
  38. Dieting Makes Little Girls Fatter, Study Finds
  39. Bird Flu Strain May Threaten Humans
  40. Pictures of Puffing Stars Encourages Teen Smoking
  41. Chronic Stress Tied to Heart, Stroke Risks in Men
  42. Cancer Treatments Often Sideline Job
  43. Mental Problems May Follow Strep Infection in Kids
  44. Germs Hide in Unexpected Places
  45. Irritable Bowel Linked to High Surgery Rates
  46. Gene Mutation Tied to Higher Parkinson's Risk
  47. Low Triglycerides Tied to More Severe Stroke
  48. Fetuses Vulnerable to Air Pollution
  49. Low Vitamin D Linked to Insulin Resistance
  50. Elderly Play It Safe in Treating Osteoarthritis
  51. High Blood Pressure Often Means High Cholesterol
  52. Drug Cuts Side Effects in Prostate Cancer
  53. Hunger Hormone Acts Differently in Fat Men
  54. Gene Measurement Could Help Breast Cancer Treatment
  55. More Women Seemingly Choosing C-Sections
  56. Anorexia Relapse Risk Lingers
  57. Studies Try to Determine Who Can Use HRT Safely
  58. Second Heart Surgery Costly to Medicare
  59. Medical World Debates Risk of Being Pudgy
  60. Hypertension, Cholesterol Often Twin Threats
  61. High Protein Diet May Affect Female Fertility
  62. Hazard of Weight Gain for Blacks Unclear
  63. Blood-Sucking Leeches Approved for Therapy
  64. Idaho Farmers Pass on Lower-Carb Potato
  65. Mobile Phones May Damage Sperm?
  66. Poor Nutrition Leading Cause of Child Death
  67. Nighttime Hunger Hormone Surge Missing in Obese
  68. Berries, Beans Top 'Best Antioxidants List'
  69. Clotting Factor Treats Bleeding Strokes
  70. PTSD May Raise Physical Woes in Women
  71. Hip Fractures Need Special Care
  72. Don't Be Lulled by the Sun
  73. Hospitals Seek to Spare Children's Pain



  Friday, July 2, 2004


U.S. Warns of Reactions to Permanent Makeup Ink



Friday July 2, 2004

WASHINGTON (Reuters) - A type of ink used to apply permanent makeup has been linked to cases of serious disfigurement from swelling, scarring and other reactions, U.S. regulators said on Friday.

The Food and Drug Administration (news - web sites) said it had received more than 50 reports of reactions to certain ink shades made by the American Institute of Intradermal Cosmetics. The company in Arlington, Texas, also does business under the name Premier Products, and the inks were sold under the Premier Pigments brand.

Permanent makeup is a form of tattooing used to apply lip liner, eyeliner or eyebrow color.

Reactions reported to the FDA (news - web sites) include swelling, cracking, peeling, blistering and scarring around the eyes and lips, as well as granulomas, which are lumps of inflamed tissue, the agency said in a statement.

In some cases, the reactions caused serious disfigurement that resulted in difficulty eating and talking, the FDA said.

Premier Pigments said allergic reactions were a risk with all permanent cosmetic and tattoo procedures.

The company recalled some pigment products in 2003 because of the reactions, and had asked the FDA to investigate, a statement said.

"Premier Pigments will continue to work in unison with the FDA to do everything necessary to inform and maintain the safety of the public," Sandi Hammons, president of Premier Pigments, said in a statement.

The company recalled five ink shades in July 2003, the FDA said. The agency continued to receive reports of reactions involving shades not subject to the recall, the FDA said.

The agency urged consumers and health-care providers to report reactions from tattoos and permanent makeup to the FDA as well as state and local health authorities.

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Report Says Johns Hopkins Is Top Hospital


The Associated Press

Friday July 2, 2004

BALTIMORE - The Johns Hopkins Hospital leads U.S. News & World Report's ranking of American hospitals for the 14th straight year.

The rankings to be released Friday are based on a survey of doctors nationwide on hospital reputations in 17 medical specialties and an analysis of indicators such as death rates, technology and nurse staffing. Hopkins ranked in the top 10 in 16 of the 17 categories, the magazine said.

The hospital ranked first in gynecology, otolaryngology and urology, and second in geriatrics, kidney disease, neurology/neurosurgery, ophthalmology and rheumatology. Hopkins ranked third in cancer, digestive disorders, hormonal disorders, pediatrics, psychiatry and respiratory disorders.

The second-ranked hospital on the list was the Mayo Clinic and third was Massachusetts General.

They were followed by The Cleveland Clinic; UCLA Medical Center; Duke University Medical Center in North Carolina and University of California San Francisco (a tie); Barnes-Jewish Hospital, St. Louis; New York-Presbyterian Hospital and University of Washington Medical Center (tie); University of Michigan Medical Center; Brigham and Women's Hospital, Boston; Hospital of the University of Pennsylvania, and Stanford Hospital and Clinics in California.

On the Net:

Johns Hopkins:

U.S. News and World Report Web site at

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Diabetes Ups Cancer Death Risk


Reuters Health

Friday July 2, 2004

NEW YORK (Reuters Health) - Diabetes appears to increase the risk of death from a number of types of cancer, new research suggests. Moreover, this holds true even after accounting for obesity, which is common among diabetics and is a well-known risk factor for cancer.

"Several studies have suggested that diabetes mellitus may alter the risk of developing a variety of cancers, and the associations are biologically plausible," Dr. Steven S. Coughlin, from the Centers for Disease Control and Prevention (news - web sites) in Atlanta, and colleagues point out

To investigate further, the researchers examined the relationship between diabetes and death from cancer in a group of 467,922 men and 588,321 women who were cancer-free when the study began in 1982. The findings are published in the American Journal of Epidemiology.

After 16 years of follow-up, the authors uncovered a link between diabetes and death from colon and pancreatic cancers.

In addition, in men, diabetes seemed to increase the death risk from liver and bladder cancers, whereas in women an association with death from breast cancer was seen.

The researchers note that study had a number of limitations, but conclude that the findings "may help to clarify cancer risks for men and women with a history of diabetes mellitus."

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

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Hospital Uses Pill With Camera Inside

By Ava Thomas Benson

Associated Press Writer

The Associated Press

Friday July 2, 2004

LITTLE ROCK, Ark. - A camera encased in a pill is giving doctors at Arkansas Children's Hospital a look at their young patients' entire digestive tracts — about 90 percent of which had gone unseen before.

The Given Imaging M2A Capsule, developed in the United States by an Israeli missile specialist in the mid-1990s, was given to the first two Children's Hospital patients Thursday. It is equipped with flash bulbs and takes 50,000 pictures over the course of eight hours, or the amount of time it takes the pill to work its way through the gastrointestinal tract.

Children's is one of about 1,700 hospitals worldwide using the pills, according to a representative for Given Imaging, the company that manufactures and distributes the pills. The hospital is also one of nine pediatric hospitals to begin using the pills since the Food and Drug Administration (news - web sites) approved them for pediatric use last fall.

Gary Gramling, 17, of Paragould, and Caleb Strange, 11, of Log Cabin, La., were the first to take the pill at Children's. Doctors suspect both may have Crohn's Disease, an ailment that can cause intestinal blockage and sores or ulcers that can tunnel through the intestinal wall, become infected and require surgery.

The pill is about the size of a multivitamin — a little less than an inch long and about as big around as the tip of an average woman's pinky finger. Patients swallow the pill with a glass of water and spend eight hours wearing a belt fitted with a wireless digital image recorder to record images sent by the camera. At the end of the day, they return the recorder to the hospital and the images are downloaded onto a computer for viewing.

Hospitals began using the pill in 2001 for diagnosis as an alternative to a traditional endoscopy. An endoscope is a long, flexible tube with a camera at the end that is inserted through the patient's mouth. Dr. Emmanuel Siaw, a gastroenterologist at Children's, said an endoscopy only allows doctors to see the first six to eight inches of the small intestine. The M2A pill provides photographs of the full 20- to 27-foot-long organ.

Siaw said Gramling and Strange had each had endoscopies and that doctors had been unable to confirm the Crohn's diagnosis.

Carlo de la Mata, a spokesman for Given, said even though the pill does not have some of the advantages of an endoscopy, "its value is in the diagnosis."

The pill photographs the intestine in its natural state, de la Mata said, because it is being pushed through like food would without the interference created by an endoscope.

"An endoscopy is not seeing the natural state," he said. "It works very well, but now we're seeing things we never saw before ... and it's very patient-friendly; a little less invasive than an endoscopy."

Siaw said he does not believe the M2A capsule will replace the endoscopy because the capsules can't take tissue samples during their trips. However, he said about 40 percent to 50 percent of patients with intestinal problems are affected in areas doctors are only able to see with the capsule.

To help doctors sift through the 50,000 photographs, they use software that identifies abnormalities, Siaw said. It takes about two or three hours to read the results from the test, he said.

The better look at patients' small intestines will allow doctors to better diagnose various diseases, including cancer, but Siaw said the pill would mostly be used for detecting diseases other than cancer at Children's because gastrointestinal cancer is uncommon in children.

Siaw said the one-time-use pill usually leaves the body on its own within 1 to 3 days.

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SARS May Raise Risk of Tuberculosis

Reuters Health

Friday July 2, 2004

NEW YORK (Reuters Health) - The discovery of tuberculosis (TB) in two patients with SARS (news - web sites) raises concern that the latter disease may somehow increase susceptibility to the former, according to researchers from Singapore.

SARS or severe acute respiratory syndrome wreaked havoc on China, Hong Kong, and other countries across the world last year. The disease was found to be caused by a microbe called a coronavirus.

In the journal Clinical Infectious Diseases, Dr. J. G. H. Low and colleagues, from Tan Tock Seng Hospital, describe two men who developed TB in association with SARS, "a phenomenon not previously reported."

The occurrence of two cases of TB among 236 patients with probable SARS, far exceeds the TB rates typically seen in the general population of Singapore, the authors note.

In both cases, TB only came to light after full recovery from SARS, when the patients developed persistent lung symptoms and worsening chest X-ray findings. It is "highly likely," the team notes, that both patients developed TB after acquiring SARS.

The investigators suggest that the SARS coronavirus temporarily suppresses the immune system making it harder for people to fight off the TB microbe if exposure occurs.

Source: Clinical Infectious Diseases, June 15, 2004.

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Long-Held Cystic Fibrosis Theory Challenged

By Kathleen Doheny
HealthDay Reporter


Friday July 2, 2004

FRIDAY, July 2 (HealthDayNews) -- Could a new finding turn a longstanding theory about the nature of cystic fibrosis (CF) on its head?

For years, doctors have blamed the life-threatening lung infections suffered by those with CF on the excess production of airway mucus. That notion has never been proven conclusively. Now, researchers at Wake Forest Baptist Medical Center say the problem may actually be the opposite: too little airway mucus.

If the research bears out -- the study was small -- it could lead the way to more effective treatments for the disorder, which affects about 30,000 children and adults in the United States. The study appears in the July 1 online issue of the American Journal of Respiratory Cell and Molecular Biology.

The median survival for a person with cystic fibrosis is 33.4 years, according to the Cystic Fibrosis Foundation.

Traditional thinking goes this way, explained Dr. Bruce Rubin, a professor of pediatrics at Wake Forest and a corresponding author on the study: "You make too much mucus, it gets plugged up [in the airway], the bacteria that are there don't get cleared out, and you get infections." While mucus normally lubricates and protects the respiratory system, those with CF have chronic coughs and infections, and it has been assumed the airways were too full of mucus.

But the new thinking, said Rubin, goes thusly: "Mucus is good for you, it's your friend. The problem in cystic fibrosis is it doesn't get into the airway. It may be made in the cell, but not getting out of the cells into the airway. If it goes out into the airway, it would prevent the infection in the first place."

Rubin and his team, led by Dr. Markus Henke, at the time of research a fellowship student in Rubin's lab but now at Philipps-University in Germany, collected sputum from 12 patients with cystic fibrosis and 11 without the lung disease, then analyzed the contents.

"The results really surprised us," Rubin said.

Those with CF had substantially less of the two major proteins that form mucus, called MUC5AC and MUC5B, than those with healthy lungs.

The substance clogging the lungs of the CF patients isn't mucus at all, they suggest. "What's in the cystic fibrosis lung is basically pus," Rubin says. "It's a lot of inflammatory cells, broken down."

The mucus may actually protect the airway from infection, Rubin speculates. If that bears out, he said, that may lead to a treatment for cystic fibrosis -- increasing the mucus in the airway early on to help prevent the infection.

Another expert lauds the study, but cautions it might not be met with total agreement.

"I thought it was an interesting study, I thought it was carefully done," said Dr. Judy Voynow, a pediatric pulmonologist and associate professor of pediatrics at Duke University Medical Center. "I think it is going to be controversial."

"Other scientists have also found in cystic fibrosis mucus there is a high concentration of DNA, other proteins called proteoglycans," Voynow added. "So we already know that cystic fibrosis mucus is complicated, and we may need multiple approaches to get rid of it."

If the new research eventually points to a new therapy, it would be welcome, Voynow said.

More information

Learn about the disease from the Cystic Fibrosis Foundation.

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Kids Do Much of Their Munching in Front of TV

By Amy Norton

Reuters Health

Friday July 2, 2004

NEW YORK (Reuters Health) - Elementary school children appear to down many of their daily calories while planted in front of the television, a new study shows.

TV viewing has caught a good part of the blame for the growing problem of excess weight and obesity among U.S. children. Some research has linked TV time to the risk of obesity, and experts have speculated that one reason is that children tend to eat a lot while watching television.

The new study of third- and fifth-graders at California public schools found that, on average, children ate roughly 20 percent of their daily calories while watching TV. The weekend was a particularly popular time for munching in front the tube, as kids consumed more than one-quarter of their calories for the day during TV time.

The findings, published in the American Journal of Clinical Nutrition (news - web sites), are the first to give an idea of how much TV-time munching is actually going on, according to lead study author Dr. Donna M. Matheson, a research associate at Stanford University School of Medicine.

"Children are eating a lot of food in front of the TV," she told Reuters Health, "and parents should be aware of it."

However, Matheson said, there are still a lot of unknowns -- including whether the children would have been eating less if the TV were off, and whether those who most often combined TV and food face a greater risk of becoming overweight.

For the study, Matheson and her colleagues surveyed an ethnically diverse sample of third- and fifth-graders on three separate occasions, asking them what they'd eaten over the past day and what they were doing while they ate.

Overall, the children ate 17 to 18 percent of their weekday calories, and about one-fourth of their calories on a weekend day, while watching TV. In general, they ate fewer fruits and vegetables, and less soda and fast food, when the TV was on.

The amount of food the children ate during TV time was not associated with their body mass index, or BMI, a measure of their weight in relation to their height. However, among third-graders, those who ate higher-fat foods in front of the TV had a higher BMI than those who ate lower-fat fare.

If a parent is worried about a child's weight, Matheson said, turning off the television may be a good first step. And when it's on, she added, parents can try giving kids healthy snacks such as fruits and vegetables.

Source: American Journal of Clinical Nutrition, June 2004.

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Stents As Good As Radiation for Blocked Arteries


Friday July 2, 2004

FRIDAY, July 2 (HealthDayNews) -- New stents that release a drug into the bloodstream may be as effective as localized radiation to treat arteries that have become re-blocked after surgery to implant a conventional stent, a new study says.

Stents are small, scaffold-like devices that attempt to keep open a blocked artery. But about 20 percent of people treated with bare metal stents experience a re-narrowing of the same arteries because of the buildup of scar tissue, a condition called in-stent restenosis.

Drug-eluting stents, which are implanted at the site of restenosis, slowly release antibiotics that prevent the formation of scar tissue.

Localized radiation therapy has been considered the best treatment for in-stent restenosis. With this approach, a catheter is used to treat the inner wall of the artery with radiation. This prevents the arterial cells from rapidly multiplying or from forming large amounts of scar tissue.

Dutch researchers compared both methods and found them to be equally effective. After nine months, the heart attack rate was 2.3 percent in both groups, and the survival rate was also equal.

The results appear in the July issue of Catheterization and Cardiovascular Interventions: Journal of the Society for Cardiovascular Angiography and Interventions.

More information

The U.S. Food and Drug Administration (news - web sites) has information about a drug-eluting stent.

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Study: Insulin Pumps Help Children Control Diabetes


Friday July 2, 2004

CHICAGO (Reuters) - Insulin pumps appear to work better than the newest long-acting insulin therapy in helping children with juvenile type-1 diabetes to maintain healthy blood sugar levels, a study said on Friday.

In a study involving just 32 patients and funded by insulin pump-maker Medtronic Inc., the pump compared favorably to Lantus, a long-acting injectable form of insulin.

The 16-week trial found the pump significantly reduced glucose levels as compared with patients who got multiple daily insulin injections of Lantus.

The pager-sized pump is a programmable device that infuses insulin through a catheter. Insulin has to be taken several times a day.

Lantus is made by Aventis and is a longer-acting insulin designed to keep blood sugar at a consistent level for extended periods. Patients also needed additional injections with short-acting insulin after meals.

"In this population, it (pump therapy) was better than what is thought to be the state-of-the-art injection therapy," said lead investigator William Tamborlane of Yale University.

The study appeared in the July issue of the journal Diabetes Care.

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Caution Urged on Mosquito Repellent for Kids


Friday July 2, 2004

FRIDAY, July 2 (HealthDayNews) -- Mosquito repellents with DEET may cause short- and long-term health effects, says a Duke University Medical Center researcher.

Pharmacologist Mohamed B. Abou-Donia found frequent and prolonged use of DEET, the most often recommended, most effective and most common mosquito repellent ingredient, caused brain cell death and behavioral changes in rats.

The health threat posed by DEET (N,N-diethyl-3-methylbenzamide) to humans is still being studied, but Abou-Donia said his 30 years of research on pesticides' effects on the brain clearly indicate that people need to be cautious about their use of DEET.

He added that children are especially vulnerable to subtle brain changes caused by chemicals in the environment. That's because their skin more readily absorbs such chemicals, which have more of an impact on a child's developing nervous system.

Parents should not use mosquito repellents that contain more than 10 percent DEET on children under age 6, the American Academy of Pediatrics advises. Many heavy-duty repellents have much higher concentrations.

In another study, University of Manitoba scientists found that the rate of DEET absorption into the skin skyrockets when DEET-based repellents are mixed with oxybenzone, a common ingredient in sunscreens. When DEET and oxybenzone are mixed, DEET absorption into the skin increases to 30.2 percent from the normal 9.6 percent. Moreover, people tend to re-apply sunscreen because it washes off, while DEET doesn't; it wears off.

Evidence suggests that when DEET and oxybenzone are used together, there may be an increased risk for stroke, headache and high blood pressure, according to the study, released last summer.

More information

The American Academy of Pediatrics outlines safety precautions you need to take when using DEET on children.

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Lidocaine Patch Helps with Diabetes Pain

By Megan Rauscher

Reuters Health

Friday July 2, 2004

NEW YORK (Reuters Health) - A skin patch containing the anesthetic lidocaine appears to be a useful treatment for the hand and foot pain often experienced by people with diabetes, new research suggests.

As reported in the Archives of Neurology, Dr. Richard L. Barbano, from the University of Rochester in New York, and colleagues tested the patch on 56 diabetic patients who had had nerve pain for longer than 3 months. A maximum of four patches could be given each day for a total of 18 hours. Many of the patients had allodynia, a condition in which pain is triggered by stimuli that normally aren't painful.

During a 3-week treatment period, most of the patients experienced a dramatic reduction in pain, the authors note.

Patients also reported an improved quality of life with treatment, according to the team. Significant improvements were noted in sleep quality as well as in various psychologic measures, such as depression and anger.

Also, "these benefits were maintained in a subgroup of patients treated for an additional 5 weeks," during which time the dose of other pain medications could be slowly decreased, the authors report. Moreover, pain relief and quality of life improvements with the patch were comparable in patients with and without allodynia.

Even when used four times a day, the patches were well tolerated without any significant side effects.

Although promising, the findings need to be confirmed in a study in which some patients are treated with the lidocaine patch, while others receive an inactive "placebo" patch, the researchers emphasize.

The study was funded by the patch's manufacturer, Endo Pharmaceuticals, Inc., Chadds Ford, Pennsylvania.

Source: Archives of Neurology, June 2004.

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Alzheimer's Patients Can Still Learn

By Amanda Gardner
HealthDay Reporter


Friday July 2, 2004

FRIDAY, July 2 (HealthDayNews) -- People in the early stages of Alzheimer's disease (news - web sites) might have more capacity to learn new things than previously thought.

The findings may eventually make life easier for patient and caretaker alike. They are the result of two new studies supported by the National Institute on Aging (NIA).

"This is the first time we've shown that a non-pharmacological intervention can actually augment a pharmacological intervention," said David Loewenstein, lead author of the first study and director of research at the Wien Center for Alzheimer's Disease and Memory Disorders at Mt. Sinai Medical Center in Miami Beach. "As we develop more effective medications and hopefully maybe even start stopping the disease in its tracks, we are still going to have millions of individuals who are going to have cognitive and functional deficits because of brain impairment that has already occurred. This type of intervention may be able to help."

Alzheimer's disease is a progressive deterioration of brain processes whose early trademark symptom is the erosion of a person's memory. Currently, the disease affects about 4.5 million Americans; that number is expected to rise as the population ages.

The first study, appearing in the July-August issue of the American Journal of Geriatric Psychiatry, involved 44 people all taking cholinesterase inhibitor drugs such as Aricept who were randomized into one of two groups. The first group attended 45-minute "cognitive rehabilitation" sessions twice a week for 12 weeks.

The lessons included learning to associate names with facial features (for example, Smiling Sam), ways to make change for a purchase, and how to use a calculator to balance a checkbook after paying three bills. There were also exercises designed to improve attention span and cognitive processing speed.

The second group played computer games requiring memory, concentration and problem-solving skills. They also did crossword puzzles and word scrambles.

People in the cognitive rehabilitation group showed, on average, a 170 percent improvement in their ability to recall faces and names and a 71 percent improvement in their ability to provide the right change for a purchase. The study shows the improvements remained three months later and more recent data shows they are still intact six months on, Loewenstein said.

"The patients and the caregivers got very excited because it's something they're doing that is constructive that is actually dealing with activities that are relevant to everyday life," Loewenstein said. "The alternative is to take medicine and hope for the best. These people are taking charge."

"This study is really the first to combine various techniques and look for outcomes that are more practical, and the effect seems to last at least three months," said Neil Buckholtz, chief of the NIA's Dementias of Aging Branch.

The findings are preliminary, however. "It would be premature to say how what they're doing would be quickly translated into some application, although certainly what they've found gives us an indication of promise for intervention," added Molly Wagster, the NIA's program director for Neuropsychology of Aging Research.

The second study, which appeared in the June 10 issue of Neuron, involved 34 young adults, 33 older adults without any symptoms of Alzheimer's, and 24 older adults with early symptoms of Alzheimer's. They were looking at a type of "implicit" or subconscious memory, which helps people act faster on items they are familiar with than on new items.

All of the groups were faster when asked to categorize repeated words rather than new ones, indicating that this ability remains intact in people with early Alzheimer's. Functional magnetic resonance imaging (fMRI) indicated the brain did not have to work as hard when a word was repeated.

"This kind of memory is automatic, unconscious," said study author Cindy Lustig, who did the research while she was a postdoctoral fellow in psychology at Washington University in St. Louis. "The brain areas involved in high-level, complex thought are affected by aging and Alzheimer's disease, but they can still benefit and show changes related to learning. Our question now is how to best target those preserved abilities so that they can be translated into training and rehabilitation programs to help older adults, especially those with Alzheimer's disease."

More information

To learn about treating Alzheimer's, visit the National Institute on Aging's Alzheimer's Disease Education and Referral Center.

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Thursday, July 1, 2004


Coffee Doesn't Seem to Affect Heart Attack Deaths


Reuters Health

Thursday, July 1, 2004

NEW YORK (Reuters Health) - Coffee drinkers probably don't have to worry that they might not fare well if they have a heart attack. Self-reported coffee consumption does not appear to affect the risk of dying after a heart attack, researchers have found.

Previous studies have generally suggested no ill-effect of coffee on the risk of having a heart attack, Dr. Kenneth J. Mukamal, of Beth Israel Deaconess Medical Center, in Boston, and colleagues explain in the American Heart Journal. "The effect of coffee consumption on prognosis after (a heart attack) is uncertain."

The investigators examined the effects of both caffeinated coffee and cola consumption on death rates in 1935 patients hospitalized with a heart attack between 1989 and 1994. Interviewers assessed how much of these beverages they drank before their attack.

Data on coffee and cola intake were available for 1902 patients. Of these, 315 died during an average follow-up of 3.8 years. Of the 315 deaths, 235 were due to cardiovascular disease.

Coffee drinkers tended to be younger, male, and free of non-cardiac illnesses, which worked in their favor. However, coffee drinkers were also more likely to be smokers.

Overall, no association was observed between coffee consumption and any overall change in long-term mortality rates after the heart attack.

Mukamal's team did, however, observe an "unexpected and unexplained" relationship between coffee consumption and mortality. Specifically, in the first 3 months coffee drinkers actually had a lower death rate, but thereafter the pattern reversed so that the two trends canceled out over time.

The researchers say this needs further exploration.

Meanwhile, they say, "Our findings are consistent with current American Heart Association (news - web sites) dietary guideline, which do not specifically advise for or against consumption of coffee and other caffeinated beverages."

Source: American Heart Journal, June 2004.

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Health Tip: Pacifier Safety



Thursday, July 1, 2004

(HealthDayNews) -- If your baby is hooked on his pacifier, you should follow these safety precautions, according to Boys Town Pediatrics in Omaha.

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'Western' Diet Raises Stroke Risk - U.S. Study



Thursday, July 1, 2004

WASHINGTON (Reuters) - Add stroke to the list of health problems caused by a Western diet rich in red meat, white flour and sugar, researchers said on Thursday.

A study of more than 71,000 nurses found those who ate a "prudent" diet rich in fruits, vegetables, fish, legumes and whole grains were less likely to have strokes than nurses eating a more typical American diet.

Writing in the journal Stroke, the team at the Harvard School of Public Health said its study was the first to examine overall dietary habits and stroke risk.

Health experts already say a diet high in animal fat, especially red meat, and low in fiber, fruits and vegetables raises the risk of heart disease, diabetes, some cancers and obesity.

Stroke is the third-leading cause of death in the United States, killing nearly 170,000 people in 2003.

"Several foods and nutrients have been linked to the risk of stroke; therefore, dietary modification may be an important way to reduce the risk of stroke," said Teresa Fung, an assistant professor of nutrition at Simmons College School for Health Studies in Boston, who led the study.

"Because nutrients and food are consumed in combination, their cumulative effect on disease risk may be best investigated by considering the entire eating pattern."

The researchers began studying 71,768 female nurses aged 38 to 63 in 1984 who had no history of heart disease or diabetes. They followed them until 1998, dividing them into two groups -- "prudent" and "Western" eaters.

Each group was further divided into fifths, depending on a woman's reported eating pattern.

There were 791 strokes during the 14-year study period.

The women who ate the "worst" Western diet had a 58 percent higher risk of stroke than women who ate the healthiest diets.

The nurses with Western eating habits were also more likely to smoke, less likely to take vitamins and to be less active, the researchers found.

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Chemo More Dangerous Than Thought for Kids



Thursday, July 1, 2004

THURSDAY, July 1 (HealthDayNews) -- Children with acute lymphocytic leukemia (ALL) who suffer genetic damage caused by chemotherapy may face an increased risk of further cancers and other diseases later in life.

That bad news comes from a University of Vermont Medical School study published in the July 1 issue of Cancer Research.

The study found 45 children who received chemotherapy and survived their disease had a 200-fold increase in the frequency of somatic mutations in their DNA. These genetic changes remain embedded in the children's DNA.

"The therapies used to assist these children overcome ALL have the potential to cause genetic damage to many different cell populations in their rapidly growing bodies," Dr. Barry A. Finette, an associate professor of pediatrics, said in a prepared statement.

"Because they have larger numbers of replicating cell populations during their growth and development stages than adults have, they are more susceptible than adults to the effects of the chemotherapies' genotoxicity," Finette said.

ALL is the most common malignant cancer in children. Since the 1960s, the five-year survival rate in the United States for children with ALL has increased to nearly 80 percent, thanks to development of national standardized chemotherapy treatment guidelines.

"Because of the effectiveness of the treatment employed today, we are able to give many more children a chance for a long life without cancer," Finette said.

"Our studies are aimed at enabling us to better understand further challenges that we may face in keeping these patients health as they get 10, 15, or more years out from overcoming ALL," he said.

More information

The Nemours Foundation has more about childhood leukemia.

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Smokers, Drinkers Show Gene Changes in Mouth Cells


By Amy Norton

Reuters Health

Thursday, July 1, 2004

NEW YORK (Reuters Health) - Many healthy people who smoke or drink may have a genetic alteration in the cells of the mouth and throat that could signal an increased risk of developing cancer, according to researchers at the University of Hong Kong.

The genetic alteration affects the p15 gene, which is involved in the process that normally kills off cells when they go haywire. In many cancers, the p15 gene is methylated, meaning that it is turned off and is unable to perform its "tumor suppressor" function.

The researchers' study of healthy adults and patients with head and neck cancers found that 68 percent of healthy smokers and drinkers showed methylated p15 in some of their oral cells. The same was true of 48 percent of the cancer patients, but only 8 percent of healthy adults who were non-smokers and drank only occasionally or not at all.

The investigators say it is unclear whether the healthy men and women who showed signs of p15 methylation are in fact at increased risk of developing head and neck cancer, a group of diseases that includes cancers of the mouth, nasal cavity and throat.

However, the findings do support the idea that "these p15 methylation changes are present in the very early stages of head and neck cancer development," study co-author Dr. Anthony Po-Wing Yuen told Reuters Health.

He and his colleagues report on the study in the July 1st issue of the journal Cancer.

That smokers and drinkers face a risk of head and neck cancers is nothing new. Tobacco use is behind the majority of these cancers, and people who smoke and drink are at greater risk than those who do one or the other.

Identifying the "early genetic aberrations" that spur the cancer process may help doctors predict which smokers and drinkers are at particular risk of head and neck cancers, according to Yuen. What's more, he said, if scientists know which early genetic changes are at the root of cancer, they may be able to develop drugs that reverse these alterations.

However, the researcher stressed, cancer development is a complex process, and a range of factors -- including any number of genetic aberrations -- conspire to determine who develops cancers of the head and neck.

The study included 37 healthy adults who did not smoke and drank rarely or not at all, and 22 healthy adults who smoked and regularly drank or did one or the other. Thirty-one patients with head and neck cancers also participated.

Yuen's team found that while only three people who abstained from smoking and drinking showed p15 methylation in some of their oral cells, 15 of the 22 smokers and/or drinkers did.

Among the cancer patients, nearly half had p15 methylation in their mouth and throat cells, and even more -- 65 percent -- showed the genetic alteration in their tumor cells.

The fact that some participants who neither smoked nor drank showed some p15 methylation suggests that other factors, such as pollution or exposure to secondhand smoke or certain chemicals, may also help trigger the process, the researchers note.

Source: Cancer, July 1, 2004.

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Immune System Linked to Miscarriage


Thursday, July 1, 2004

THURSDAY, July 1 (HealthDayNews) -- New information about how a woman's immune system can cause early pregnancy loss is outlined in a Harvard School of Public Health study in the latest issue of the Journal of Clinical Investigation.

In research with mice, the Harvard scientists found that activation of an immune cell receptor called CD40 in early pregnancy results in an inflammatory process that causes loss of the embryo.

This inflammatory process caused a decrease in progesterone, the hormone that's responsible for preparing the body for pregnancy and maintaining it until birth.

The study authors concluded that immune system interference with reproductive hormones may contribute to human infertility, especially in cases of recurrent pregnancy loss.

The finding that there's a link between the immune system and reproductive hormone secretion may offer scientists a new target for treating women who suffer repeated and early pregnancy loss.

More information

The American College of Obstetricians and Gynecologists has more about repeated miscarriage.

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Flu Vaccination Benefits Elderly

Reuters Health

Thursday, July 1, 2004

NEW YORK (Reuters Health) - Influenza vaccination reduces hospitalizations and deaths due to respiratory disease in older individuals, according to a new report.

Results from clinical trials suggest that flu vaccination is only 58 percent effective in preventing influenza, the authors explain in The Journal of Infectious Diseases, so it would seem unlikely that vaccination would have a large effect on mortality rates.

To look into this further, Dr. Punam Mangtani from the London School of Hygiene and Tropical Medicine, and colleagues compared rates of admissions for respiratory diseases and rates of death due to respiratory disease among several thousand people over age 64 years, over a 10-year period. About a third had been given flu shots.

Hospitalizations for respiratory disease were 21 percent lower among vaccinated individuals over 9 seasons of varying influenza activity, the authors report.

Similarly, the influenza vaccine reduced the risk of death due to respiratory disease during the influenza season by 12 percent, the report indicates.

Influenza vaccination provided better protection to individuals under age 84 years and to low-risk individuals, the researchers note.

These findings "should reinforce the fact that the population aged over 64 years, both at low and high risk from flu, does benefit from yearly flu vaccination over years that include both epidemic and non-epidemic years for influenza," Mangtani told Reuters Health.

"Expansion of the UK influenza vaccination program to all adults over 64 years old is confirmed to be of benefit," the investigator concluded.

Source: Journal of Infectious Diseases, July 1, 2004.

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Alcohol May Boost Bone Density


Thursday, July 1, 2004

THURSDAY, July 1 (HealthDayNews) -- Drinking moderate amounts of alcohol may help protect women against osteoporosis, claims a study in the current issue of the Annals of the Rheumatic Diseases.

The study findings are based on 46 pairs of identical female twins. Within each pair of twins, one drank moderate amounts of alcohol while the other drank very little. Researchers measured the twins' bone mineral density at the hip and also measured chemical markers of bone turnover in the twins' urine.

The study found moderate drinking (an average of eight units of alcohol a week) was associated with significantly denser bones at the hip and spine. The researchers suggest alcohol may improve the micro-architecture of the bones.

The findings confirm that alcohol doesn't increase the risk of brittle bones in women and may even be beneficial.

The study also found that smoking was associated with reduced bone density.

More information

The University of Alabama has advice about how to tone your bones.

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Blood Pressure Drop Warns of Dementia – Study


Thursday, July 1, 2004

WASHINGTON (Reuters) - Elderly people whose blood pressure drops suddenly may be about to develop Alzheimer's or other forms of dementia, researchers in Sweden reported on Thursday.

Patients whose systolic blood pressure -- the top number -- dropped 15 points or more in six years or less had triple the risk of Alzheimer's disease (news - web sites) or other dementia, the team at the Karolinska Institutet in Stockholm found.

"Our findings imply that poor blood flow in the brain, resulting from an extensive decline in blood pressure, may promote the dementia process," Dr. Chengxuan Qiu, who led the study, said in a statement.

"These findings indicate a possible threshold level in systolic pressure, especially for people with vascular disease in whom further reduction of blood pressure under this level may precipitate dementia onset," Qiu added.

"Using antihypertensive medications is important for high blood pressure and related disorders, but our findings suggest that it is necessary to monitor these drugs in the very old to avoid a probable dangerous drop of blood pressure under a certain threshold."

Writing in the journal Stroke, the researchers said they studied 947 people aged 75 or more who had no evidence of dementia. They were examined initially and three and six years later.

At three years, 147 were diagnosed with Alzheimer's disease and 39 with other dementia. After six years an additional 91 had Alzheimer's and 27 more were diagnosed with other types of dementia.

"Our data show no substantial differences in blood pressure levels at enrollment between non-demented persons and those that were demented three to six years later," said Dr. Bengt Winblad, a professor of geriatric medicine at Karolinska Institutet.

"However, some elderly people who experience a significant decline in systolic blood pressure three to six years before diagnosis do have an increased risk of dementia and Alzheimer's disease."

The researchers said it is possible that degeneration of cells in the parts of the brain that regulate blood pressure may cause the pressure to fall. That could mean the low blood pressure was a symptom of dementia that could accelerate an already ongoing process.

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New Kidney Cancer Therapy Shows Promise


Thursday, July 1, 2004

THURSDAY, July 1 (HealthDayNews) -- A minimally invasive technique called radiofrequency ablation is a promising treatment for people with kidney cancer that hasn't spread.

Wake Forest Baptist Medical Center researchers report the good news in the July issue of the American Journal of Roentgenology.

The three-year study of 22 kidney cancer patients found that complete tumor elimination was achieved after a single treatment in 83 percent of the patients. Another 8 percent of the patients had complete tumor elimination after at least two treatments with radiofrequency ablation.

None of the patients experienced serious or long-term complications, the study found.

In this procedure, computed tomography is used to guide a needle-shaped electrode into the tumor. A radiofrequency current is then passed through the electrode to heat the tumor and destroy it.

"These results are significant and encouraging because the incidence of kidney cancer in the United States has increased 126 percent over the past 50 years," principal investigator Ronald J. Zagoria, a professor of radiologic sciences at Wake Forest, said in a prepared statement.

For decades, the standard of care for kidney cancer has been kidney removal. More recently, removal of affected areas of the kidney have shown to be effective in treating small low-stage kidney cancer. But that kind of surgery is not suitable for many patients, such as those who can't have surgery due to other health-related conditions.

"Radiofrequency ablation offers us another potentially curative option for appropriate patients," Zagoria said.

More studies are needed to determine the long-term success of radiofrequency ablation.

More information

The American Cancer Society (news - web sites) has more about kidney cancer.

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Wednesday, June 30, 2004


Vitamins May Slow Progress of AIDS Virus –Study


By Gene Emery


Wednesday, June 30, 2004

BOSTON (Reuters) - A daily multivitamin tablet may slow the progress of the AIDS (news - web sites) virus and allow doctors to delay treatment of the deadly disease, according to a study released on Wednesday that may prove especially helpful in developing

B Vitamins, along with vitamins C and E, may also reduce the symptoms of the disease, including fatigue, nausea, vomiting, difficulty swallowing, and mouth and stomach problems, the study found.

But the test of 1,078 pregnant women in Tanzania also found that vitamin A seems to counteract the benefits of giving the supplements.

About 40 million people are infected with HIV (news - web sites), the AIDS virus, and less than 8 percent of the people who should be getting treatments actually are.

"Multivitamin supplements delay the progression of HIV disease and provide an effective, low-cost means of delaying the initiation of antiretroviral therapy in HIV-infected women," said the research team, led by Wafaie Fawzi of the Harvard School of Public Health.

The effect of the multivitamin was strongest during the first two years, according to the Fawzi team.

Although the benefits of multivitamin therapy, which cost about $15 per year, were statistically significant, they were not dramatic.

The chance of dying or developing an advanced case of HIV was 24.7 percent among the vitamin recipients, compared to 31.3 percent among women who received placebo tablets instead.

The researchers said the recipients of the vitamin supplements tended to have higher levels of disease-fighting cells and lower levels of HIV virus (news - web sites) particles in the blood.

But in cases where vitamin A had been added to the treatment, the benefit faded and those women fared about as well as the volunteers getting placebos.

Those findings, reported in this week's edition of The New England Journal of Medicine (news - web sites), should be viewed in light of previous research showing that vitamin A supplements increase the likelihood that a mother will spread HIV to her child, the researchers said.

"Adding vitamin A to the multivitamin supplement apparently reduced the benefit of the latter regimen, raising questions about the safety of including vitamin A in supplements recommended for HIV-infected adults," they said.

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Hormone Warns of Hypertension


By Ed Edelson
HealthDay Reporter


Wednesday, June 30, 2004

WEDNESDAY, June 30 (HealthDayNews) -- Contradicting conventional medical wisdom, a new study finds that people with apparently normal blood levels of a hormone called aldosterone can be at increased risk of high blood pressure.

"It is a very exciting finding that has tremendous public health implications," said one expert, Dr. Bertram Pitt, a professor of medicine at the University of Michigan.

Traditionally, doctors treating high blood pressure have been concerned only about unusually high levels of aldosterone, Pitt explained. The new finding indicates that some people whose blood pressure can't be controlled with standard medications such as diuretics might benefit from an aldosterone-blocking drug, he said.

The new research is published in the July 1 issue of the New England Journal of Medicine (news - web sites). It comes from the long-running Framingham Heart Study, in which researchers from the National Heart, Lung, and Blood Institute have monitored thousands of New Englanders since 1948.

This part of the study linked blood levels of aldosterone to the later development of high blood pressure, which is a major risk factor for heart attack, stroke, and other cardiovascular diseases. Following 1,688 participants who started with normal blood pressure, the researchers found that the 25 percent of people with aldosterone levels at the high end of normal were 60 percent more likely to develop high blood pressure over the next four years than those with the lowest aldosterone levels.

Aldosterone is produced by the body to retain salt when it is lacking in the diet, said Dr. Daniel Levy, director of the Framingham Heart Study. Normally, aldosterone production is reduced when people eat the kind of high-salt diet common in the United States, but "some of us may not be able to regulate it in that way," Levy said.

About 90 percent of cases of hypertension -- the medical name for high blood pressure -- are classified as "essential," which simply means that there's no evident cause. Abnormally high aldosterone levels are known to cause some of the other 10 percent of cases.

"What they [study researchers] found is new, that people in the normal physiological range of aldosterone have an increased risk of hypertension," Pitt said. "There are lots of implications for the therapy of hypertension."

High blood pressure usually can be controlled with combination drug therapy using such medications as diuretics and beta blockers, but treatment does not work in some cases, Pitt said. Adding an aldosterone blocker might be appropriate for those people, he said.

Until recently, only one aldosterone-blocking drug was available, spironolactone. Doctors have been reluctant to use it because it can cause serious side effects, including nausea, vomiting, diarrhea, and breast enlargement in men.

But a newer aldosterone blocker, eplerenone, doesn't produce such side effects. Doctors can consider using it when conventional therapy fails to keep blood pressure under control, Pitt said.

Dr. William W. Frishman, chairman of the department of medicine at New York Medical College, said the finding raises the possibility of preventing high blood pressure by giving an aldosterone blocker.

"This can be a biological marker of individuals who will develop hypertension," he said. "We are always looking to know who is susceptible, and this identifies a susceptible group."

Levy added, "Clearly, more research is needed to understand the relationship of aldosterone and blood pressure," he said.

More information

The National Library of Medicine outlines the causes, consequences, and treatment of high blood pressure.

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Protein Warns Lupus Patients of Kidney Woes



Wednesday, June 30, 2004

WEDNESDAY, June 30 (HealthDayNews) -- A protein that provides early warning of kidney disease in people with the autoimmune disorder lupus has been identified by University of Florida scientists.

Lupus patients with kidney disease have markedly increased levels of this protein, called MCP1, in their urine. This means a simple urine test can be developed to let doctors check for the presence of the protein as an early indicator of kidney disease and take appropriate treatment measures.

"All we can do now is quote newly diagnosed lupus patients the statistics for the chance of kidney disease," study co-author Dr. Hanno B. Richards, co-director of the university's Lupus Clinic, said in a prepared statement.

"We can offer detailed genetic testing and assess what the likelihood of the disease might be. But with MCP1, we can screen for the levels in the urine and base our need for treatment on that," Richards said.

He and his colleagues found that kidney disease was about two to three times more likely to develop in lupus patients with particular genetic variants that produce MCP1, which directs immune system cells toward areas of inflammation.

Kidney disease affects about half of the 1.5 million Americans who have lupus.

The study appears in the current issue of Arthritis and Rheumatism.

More information

Learn more at the Lupus Foundation of America.

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Cutting Down on Stroke Damage



Wednesday, June 30, 2004

WEDNESDAY, June 30 (HealthDayNews) -- The athletic performance supplement creatine reduced the risk of stroke-related brain injury in mice.

Researchers from Brigham and Women's Hospital in Boston report their finding in the June 30 issue of the Journal of Neuroscience.

The results suggest creatine may help prevent stroke-related brain damage in humans.

The researchers found mice that were given creatine for a month before a stroke experienced less brain cell death than mice that didn't receive creatine. Brain cell death caused by stroke contributes to the impaired brain function suffered by many people who survive strokes.

Previous studies found creatine provides brain protection in test tube models of Parkinson's disease (news - web sites), Huntington's disease, ALS and traumatic brain injury. But this is the first study outside of a test tube to demonstrate the protective effects of creatine.

"The effects of stroke are often debilitating and can lead to paralysis and other forms of disability that significantly impact a positive quality of life," study author Dr. Robert M. Friedlander, an associate professor of neurosurgery at Harvard Medical School (news - web sites) in Boston, said in a prepared statement.

"The results of this study provide evidence that creatine may be used in a prophylactic fashion for patients at risk for stroke, in a similar manner as aspirin is used in the same target population," Friedlander said.

More information

The American Heart Association (news - web sites) has more about the effects of stroke.

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Obesity Can Cause Heart Attacks in Kids – Study



Wednesday, June 30, 2004

WASHINGTON (Reuters) - Extremely obese youngsters can have heart abnormalities that put them at serious risk of heart attacks and chest pains, U.S. researchers said on Wednesday.

The researchers at Cincinnati Children's Hospital Medical Center studied 343 patients at the hospital who ranged in age from 5 to 23 but had an average age of 12.

The children already had changes in the heart's left ventricle, the pumping chamber of the heart, the researchers found.

"Increased thickness of the heart is a risk factor for ischemic heart disease -- heart attack," cardiologist Dr. Tom Kimball said in a statement.

"The thicker a patient's heart, the more likely the patient is to potentially have issues with reduced blood flow, leading to a heart attack," he said.

The heavier the children, the higher their risk, the researchers told a meeting in San Diego of the American Society of Echocardiography.

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Virtual Reality Fights the Reality of Pain


By E.J. Mundell
HealthDay Reporter


Wednesday, June 30, 2004

WEDNESDAY, June 30 (HealthDayNews) -- Outpatient chemotherapy rooms at most cancer centers look the same: rows of beds with a dozen or more patients in various stages of disease, hooked up to IV drug feeds.

"You look around the room and you see very sick patients, and you worry -- 'Will this be me in two months?' or 'Will that patient be here next week, will they be alive?'" said Susan M. Schneider, director of the graduate oncology nursing program at Duke University Medical School.

"All these anxious feelings and concerns during the infusion can make you more anxious, and you know that symptoms -- things like nausea, lack of concentration fatigue --- are all related to being worried," she said.

But for patient volunteers in three recent Duke studies led by Schneider, regular chemo sessions suddenly became a lot less grim.

Looking for ways to ease their chemo symptoms, Schneider's team of researchers had breast cancer patients undergo chemotherapy as usual, but allowed them to wear special virtual reality headsets that sent them into a computerized world of play. In these richly detailed virtual worlds, patients could solve mysteries, visit an art gallery, or even go deep-sea diving -- all while receiving their chemo infusion.

And in each study, "we've found that using virtual reality during chemotherapy helps relieve some of the symptoms that patients experience" in the hours and days after therapy, Schneider said.

In fact, "I had one patient say after she was finished, 'That was fun! I was kind of frustrated when the chemotherapy ended because I didn't get to finish the game.'"

Cancer patients aren't the only ones benefiting from virtual reality.

"Some burn patients responded amazingly strongly to virtual reality, even with really severe burns," said Hunter Hoffmann, director of the Virtual Reality Analgesia Research Center at the University of Washington in Seattle.

The pain felt by burn victims is so intense that even the most gentle of hospital procedures -- actions such as delicately cleaning wounds or replacing bandages -- can be excruciating. But according to Hoffman, many burn patients in his study reported a 40 percent to 50 percent drop in perceived pain if given virtual reality headsets.

Trying to get a better understanding of the mind-body connections underlying this phenomenon, Hoffmann's team clipped a heat-emitting device to the feet of eight healthy volunteers, enough to cause them mild discomfort. Half of the volunteers wore headsets that let them enter "SnowWorld" -- a realistic, fantasy game environment where the goal was to lob snowballs at Arctic characters such as snowmen, igloos and penguins. The other study participants had no such distraction.

Watching their brain activity on high-tech magnetic resonance imaging (MRI), Hoffmann said he saw "dramatic reductions in pain-related brain activity when the people were in virtual reality." While pain centers in the brains of individuals without the virtual reality lit up whenever foot pain was induced, volunteers diverted by "SnowWorld" showed much less activity.

"They also gave us strong [positive] ratings of going inside the computer-generated environment," Hoffmann said. The study, published in the June issue of NeuroReport, was funded by grants from the National Institutes of Health (news - web sites) and Paul Allen, co-founder of Microsoft Inc.

While the exact mechanisms by which virtual reality reduces pain remain unclear, "it's very likely to involve attentional distraction," Hoffmann said.

"People have a limited amount of information that can be processed, and the perceptual system seems to be able to focus the spotlight of attention only at specific things," he said. "We draw the spotlight of attention into this virtual world, instead, leaving less attention available to process incoming pain signals."

Schneider, who is familiar with Hoffmann's work, agreed with his theory, adding that virtual reality may also help cancer patients by removing some of the dread from chemotherapy.

"If you're really anxious and worried about something, you can feel stressed out for a couple of days. But if you get through the chemotherapy experience and it's actually more pleasant, then we break that cycle of anxiety and your symptoms are less likely to be magnified," she said. "It's like giving people a mental vacation from the stress."

It wouldn't cost much to provide patients with these mini-vacations, either, she added. Schneider's team estimates the cost to hospitals of adding virtual reality to chemotherapy would total only about $5 per session.

Computerized worlds are helping in other fields of medicine, as well. Virtual reality is already standard therapy for helping individuals conquer phobias such as fear of flying or of spiders, allowing them to confront their fears in a safe, controlled manner.

"There's huge room for improving the virtual world," Hoffmann said. "We're just getting started."

More information

There's more on Hoffmann's virtual reality research at the University of Washington.

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Artificial Sweeteners Make Calorie Counting Hard


By Merritt McKinney

Reuters Health

Wednesday, June 30, 2004

NEW YORK (Reuters Health) - Using artificial sweeteners may throw off our ability to monitor how many calories we consume, new animal research suggests.

Rats that had been fed an artificially sweetened diet tended to overeat when given naturally sweetened high-calorie food compared with rats that had never consumed artificial sweeteners.

Researchers also found that the thickness of a sweetened drink seems to interfere with rats' abilities to keep their calorie consumption under control.

The results are preliminary, but they raise the possibility that artificially sweetened foods and high-calorie beverages may interfere with the ability to keep calorie consumption under control, one of the study's authors told Reuters Health.

"We propose that humans and other animals use sweetness and viscosity to help estimate the caloric content of the foods they eat, with sweeter and thicker foods signaling more calories and less sweet and thinner foods signaling fewer calories," said Dr. Terry L. Davidson of Purdue University in West Lafayette, Indiana.

Along with Purdue co-author Dr. Susan E. Swithers, Davidson hypothesized that consuming foods and beverages that are either low-calorie but very sweet or high-calorie but very thin may interfere with the ability to rely on taste and thickness to regulate caloric intake.

"The data presented in our paper suggest that such interference increases the tendency to overeat and gain weight in rats," Davidson said.

Davidson explained that one way that people and other animals are thought to control their weight is by reducing the amount of food they eat on some occasions to compensate for pigging out at other times.

"I think many people who now struggle to keep off extra pounds remember a time when they could perform this type of compensation almost effortlessly, without consciously trying to watch and control their caloric intake," Davidson said.

The Purdue researcher said he doubts that there is a single explanation for the diminished ability to control calories without much conscious reckoning. But it is possible that certain foods that have become popular in recent years may play at least some part, he said.

For instance, the number of Americans who consume sugar-free products has risen from less than 70 million in 1987 to more than 160 million in 2000, Davidson and Swithers note in a report in the International Journal of Obesity. Consumption of high-calorie soft drinks has also surged during the past few decades.

The researchers conducted two rat studies to evaluate the impact of artificial sweeteners and high-calorie drinks on calorie consumption.

In the first, one group of rats was fed a naturally sweetened liquid while another group was given an artificially sweetened liquid. After consuming the sweet drink for more than a week, the rats were offered a high-calorie, sweet chocolate treat before having a meal of normal rat chow.

Rats that were used to drinking the naturally sweetened liquid compensated for the pre-meal snack by eating less rat chow. But the rats accustomed to the artificially sweetened liquid ate more rat chow, suggesting that they were less adept at figuring out how many calories they should eat.

In the second study, rats were given a high-calorie dietary supplement that had the consistency of either chocolate milk or chocolate pudding. Even though the thick and thin supplements had the same amount of calories, rats given the thin one consumed more and gained more weight during the study.

"Our preliminary research indicates that the effects of consuming certain types of processed foods on longer-term caloric intake and body weight deserve additional study," Davidson said. Future studies should try to determine to what extent people normally use taste and viscosity to gauge calories, he said.

Source: International Journal of Obesity, July 2004.

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Casual Strolls May Be Risky for Older Women


Wednesday, June 30, 2004

WEDNESDAY, June 30 (HealthDayNews) -- Walking is a popular and healthy activity, but it also causes more injuries among older women than any other exercise using no equipment, says a University of Arkansas study.

Researchers examined data from hundreds of U.S. emergency room visits by women aged 65 and older who were injured while doing exercise that required no equipment. This included walking, aerobics, hiking, swimming, stretching, yoga, and tai chi.

Walking was the activity most frequently linked to injury. Falls were the major cause of injuries while walking.

"Environmental hazards were a big issue -- like when you're walking or hiking, and you encounter obstacles such as street curbs, rocks, holes, and even animals," researcher Ches Jones, an associate health science professor, said in a prepared statement.

Falls are a particular concern for older women, due to their increased risk for fractures.

"It brings up the question, 'Is walking the best activity for this age group?' It is obviously popular and healthy, but is the best?" Jones said.

The study was presented recently at the World Conference on Injury Prevention and Safety Promotion in Vienna. It will be published in the summer 2005 issue of the Journal of Women and Aging.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about walking.

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Relapse Common After Anorexia Treatment

By Amy Norton

Reuters Health

Wednesday, June 30, 2004

NEW YORK (Reuters Health) - Many women who are successfully treated for anorexia are in danger of relapsing for at least two years afterward, new research suggests.

In a study of 51 women who'd regained their normal weight after being hospitalized for anorexia nervosa, researchers found that more than one-third had a setback within two years of being discharged.

The most dangerous period appeared to be the 6 to 17 months after hospital discharge -- showing, the study authors say, that even women who seem to be doing well a full year after treatment remain at risk of relapse.

Anorexia, which affects an estimated one to two percent of women at some point in their lives, is particularly challenging to treat; people with the disorder see themselves as heavy even when they become dangerously underweight, and harbor an intense fear of gaining weight.

Women in the current study had suffered from the disorder for an average of six years before entering the intensive group therapy program at Toronto General Hospital (news - web sites). More than half had already tried treatment at other institutions.

The findings from the study, published in the journal Psychological Medicine, highlight the need for therapy to prevent the problem resurfacing, according to Dr. Jacqueline Carter, an assistant professor of psychiatry at the University of Toronto and the study's lead author.

Right now, Carter told Reuters Health, long-term therapy to guard against relapse is not the norm. Such treatment, she noted, is expensive and is only beginning to be studied.

"I think the field still has a lot to learn about the effective treatment of anorexia," Carter said.

In their research, she and her colleagues discovered some characteristics that separated the 35 percent of women who relapsed from those who did not, and that could prove useful in designing relapse prevention therapy.

Women who relapsed were more likely to have previously had specialized treatment for an eating disorder or to have attempted suicide. In addition, excessive exercise in the first few months after leaving the hospital was a significant predictor of relapse. For some women, the study authors note, exercise may serve as a way to exert self-control, one of the overriding concerns that marks anorexia.

Another factor linked to relapse was whether a woman remained highly preoccupied with her body weight and shape. While distorted body image is a well-known feature of anorexia, Carter said that not all forms of treatment for anorexia directly address these harmful perceptions.

The new findings, she and her colleagues conclude, "suggest it is essential that treatments for anorexia target cognitive distortions concerning the significance of shape and weight."

Source: Psychological Medicine, May 2004.

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Skipped Heartbeats Probably No Concern



Wednesday, June 30, 2004

WEDNESDAY, June 30 (HealthDayNews) -- If you feel your heart skip a beat, it's probably nothing serious, says an article in the July issue of Mayo Clinic Women's HealthSource.

It's likely that your heart didn't actually skip a beat, and what you felt was an early extra heartbeat. When your heart has an early heartbeat, it delays a little longer than normal before it beats again. To you, that may feel like your heart actually skipped a beat.

These so-called skipped beats and many other kinds of heart palpitations are common even among people with healthy hearts. In most cases, they don't require any treatment.

Skipped beats, fluttering, pounding, or other palpitations are caused when the coordinated electrical timing of millions of heart cells is disrupted. These palpitations can also be triggered by caffeine, fear, anxiety, stress, alcohol, smoking, vigorous exercise and certain medical conditions.

Even though most heart palpitations are harmless, they can pose a threat to some people, including those with coronary artery disease, heart failure or other heart structure abnormalities.

The Mayo article recommends you see a doctor if symptoms wake you or interfere with daily activities, the palpitations increase in frequency or severity, or if you have heart disease risk factors such as diabetes, hypertension, high cholesterol or a family history of heart disease.

More information

The Texas Heart Institute can explain your heartbeat.

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St. John's Wort May Cut Levels of Heart Drug


Reuters Health

Wednesday, June 30, 2004

NEW YORK (Reuters Health) - Certain formulations of St. John's wort, an herbal remedy for depression, seem to reduce levels of digoxin, a drug that helps the heart to pump in people who have heart failure, new research suggests.

If the digoxin level falls too low, the drug may not provide a beneficial effect.

In the journal Clinical Pharmacology and Therapeutics, a German research team headed by Dr. Silke C. Mueller of the University of Rostock reports on a study in which 93 healthy volunteers took digoxin for 21 days.

After a 7-day period during which they took only digoxin, the subjects then added a 14-day course of either inactive "placebo" or one of ten over-the-counter St. John's wort preparations.

Medications were administered under supervision, and participants were fed standardized meals three times a day throughout the study.

St. John's formulations rich in chemicals called hypericin and hyperforin seemed to reduce blood-stream levels of digoxin. There were no interactions, however, when volunteers took "traditionally used" St. John's wort preparations.

The authors believe that the hypericin- and hyperforin-rich formulations produce their effect by turning on enzymes that break down digoxin.

Source: Clinical Pharmacology and Therapeutics, June 2004.

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Sweat the Stress Out


Wednesday, June 30, 2004

WEDNESDAY, June 30 (HealthDayNews) -- A good dose of exercise may help ease your depression or anxiety.

Even just 10 minutes of moderate exercise can improve your mood, says an article in the July issue of Mayo Clinic HealthSource.

Benefits of exercise include:

More information


The American Academy of Family Physicians (news - web sites) has more about how you can control your anxiety.

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Tuesday, June 29, 2004


HRT Speeds Progression of Heart Disease in Diabetics


By Amanda Gardner
HealthDay Reporter


Tuesday, June 29, 2004

TUESDAY, June 29 (HealthDayNews) -- Hormone therapy can contribute to the development of cardiovascular disease in postmenopausal women with diabetes or pre-diabetes.

This finding, appearing in the June 28 online issue of Circulation, bolsters previous research that has suggested hormone replacement therapy (HRT) should not be used to reduce the risk of cardiovascular disease among postmenopausal women in general.

Both diabetes and pre-diabetes are already risk factors for cardiovascular disease, especially among women. And the national Women's Health Initiative (WHI) found that estrogen combined with progestin increased the risk of heart disease, stroke and blood clots. However, Yale University researchers reported Monday that the results of that landmark study cannot be applied to all menopausal women because the average age of the participants was 63. Menopause typically occurs between the ages of 50 and 55.

The Circulation study used data from the Women's Angiographic Vitamin and Estrogen (WAVE) study, which randomly gave 423 postmenopausal women either estrogen, estrogen plus progestin or a placebo for three years. Many of the participants had diabetes or glucose intolerance when the study started and all had evidence of atherosclerosis, or hardening of the arteries. The trial is the first to use angiography (X-rays of coronary vessels) to record the progression of atherosclerosis in postmenopausal women with diabetes or impaired glucose tolerance.

At the end of the study period, cholesterol profiles were better among women who had taken HRT, as were their fasting glucose and insulin resistance levels. These are all risk factors for heart disease.

On the other hand, the women in the hormone groups exhibited narrower arteries and worse levels of inflammatory markers such as C-reactive protein and fibrinogen, both of which are associated with cardiovascular disease. C-reactive protein and fibrinogen levels decreased slightly in women taking hormones who had normal glucose tolerance. When the math was done, HRT appeared to speed the progression of atherosclerosis.

"The study showed that in women with diabetes [who were also taking hormone therapy], the artery blockage moves faster than in women without diabetes," said study author Barbara Howard, president of MedStar Research Institute in Hyattsville, Md.

Dr. Alan J. Garber is a professor of medicine and biochemistry and cell biology at Baylor College of Medicine in Houston. He said, "Patients with diabetes have so many concomitant cardiovascular risk factors that they're virtually a seething cauldron of heart disease risk problems, and so what you do is you're just throwing another spice into the brew" with hormone therapy. "This becomes important when you consider that patients with diabetes have a well-known previously described tendency to translate small negatives into large negatives. That is what has happened here."

Using hormones to ease menopausal symptoms -- such as hot flashes or vaginal dryness -- in women with diabetes or prediabetes should be an individualized decision made in close consultation with a woman's physician, the study authors stressed.

"It's always a risk-benefit calculation," Howard said. "For women without diabetes if they're under 50 years old, where their absolute risk for some of these events is not high, we can say use estrogen for a year or so to get them through the [menopausal] symptoms. The problem is that women are at increased risk for cardiovascular disease if they have diabetes, so it might be something you might not want to be eager to do in these women."

Garber added: "Patients with diabetes need to be very careful about each individual risk factor that they have. When present in diabetic patients, it becomes a big deal. You have to balance the severity of the [menopausal] symptoms against the risk posed by trying to treat symptoms with these hormones. There are other ways to treat symptoms. Each menopausal woman should consult their physician."

More information

For more on diabetes and heart disease, visit the American Diabetes Association.

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Passive Smoking Heart Risk Double Earlier Estimates


By Patricia Reaney


Tuesday, June 29, 2004

LONDON (Reuters) - Passive smoking may be much more dangerous than scientists had thought, researchers said on Wednesday in new study that is likely to boost demand for a ban on smoking in public places.

Earlier research into the effects of second-hand smoke had focused on non-smokers living with smokers. Scientists in Britain studied exposure to passive smoke by measuring a breakdown product of tobacco smoke called cotinine in the blood of non-smokers.

They found high concentrations of blood cotinine levels were associated with a 50-60 percent higher risk of coronary heart disease (CHD).

Previous studies had estimated the raised risk of heart disease from passive smoking in non-smokers at 25 to 30 percent.

"We've studied only people who are non-smokers and seen how their levels of cotinine, which reflect the amount of passive smoking they have been exposed to, and then related it to their subsequent heart disease risk," Professor Peter Whincup, of St George's Hospital Medical School in London, said in an interview.

"People who were non-smokers but had relatively high levels of cotinine had a heart disease risk of about 50 percent higher than those people who were exposed to low levels," he added in an interview.

Whincup, who reported the findings on BMJ Online First, said the research provides further evidence that passive smoking has adverse effects which may have been underestimated in the past.

Supporters of a ban on smoking in the workplace, bars and restaurants described the findings are further evidence for new smoking legislation.

"The need for a ban on smoking in public places in the UK has never been better illustrated than by this potentially pivotal study. We have known for some time that passive smoking was strongly associated with increased risk of coronary heart disease (CHD), but this study strengthens the evidence considerably," Dr Tim Bowker, of the British Heart Foundation which partly funded the research, said in a statement.

"The evidence is now compelling. The government should not delay any further in introducing legislation to protect non-smokers from this unnecessary risk," he added.

Ireland recently became the first country to introduce a national ban on smoking in public places. New York and parts of Australia have taken similar measures.

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Starbucks' Summer Drinks Can Be Fattening


By Allison Linn

AP Business Writer

The Associated Press

Tuesday, June 29, 2004

SEATTLE - Gary Lass didn't think twice before ordering his usual Starbucks grande mocha Frappuccino one sunny afternoon.

"I drink too many of these, and they're not good for me," the 63-year-old admitted a bit sheepishly as he sipped the 420-calorie chocolate, coffee and whipped cream concoction. "I always wish I hadn't afterward, but my craving overcomes common sense."

It may seem counterintuitive to say that coffee is fattening — and, indeed, a regular cup of joe at Starbucks has just 10 calories. But add a little milk, a splash of chocolate or a squirt of whipped cream and things can get considerably more caloric.

A 16-ounce nonfat latte weighs in at a meager 160 calories, but the same size mocha — with whole milk and whipped cream — jumps up to 400 calories.

The sweet, summery frozen drinks can be even more tempting — and sinful. The largest Java Chip Frappuccino tips the scales at 650 calories — 50 calories more than a Big Mac — and contains 25 grams of fat, compared with 33 grams for the Big Mac.

Surprised that your afternoon coffee break can be so caloric? Diane Javelli, a clinical dietitian with the University of Washington in Seattle, said many people do not count the calories they slurp, whether it's coffee, juice or soda.

"I think often we have the perception if we're drinking it, it doesn't have to have calories," she said.

When compiling a diet history, Javelli often walks through her patient's coffee drink choice, breaking down everything from flavoring to milk fat.

She doesn't necessarily recommend cutting out lattes altogether — after all, there is protein, calcium and vitamin D in that milk — but she does often counsel patients to try a smaller size or limit themselves to just a few drinks a week.

For kids, however, Javelli is more cautious. The fat and calories in drinks like Frappuccinos might be enough to give a parent pause, she said, and the caffeine is just an added stimulant that youngsters probably don't need.

Hoping to appeal to more calorie-conscious coffee drinkers, Starbucks on Wednesday will launch "light" versions of its Frappuccino drinks, made with lower-fat milk and artificial sweeteners. A 12-ounce serving of the new light drink will have 110 calories and 1 gram of fat, compared with 190 calories and 2.5 grams of fat for the regular version.

The Seattle-based chain of coffee shops also plans to stock stores with brochures detailing nutritional information about all their drinks. The same data has been available on Starbucks' Web site for about a year.

Despite the increased attention to obesity in America, Starbucks Senior Vice President Michelle Gass said the company has not seen a backlash from customers suddenly worried about how fattening their coffee is. The new light drinks and brochures, she said, "are just part of, in general, us trying to answer consumer needs."

Carl Sibilski, an analyst with Morningstar in Chicago, said he has not seen any evidence that sales of the higher-calorie Frappuccinos are down. The move to offer light drinks follows an industry trend toward more healthy foods, which could expand Starbucks' customer base, he said.

Still, he doubts the light Frappuccinos will be a blockbuster item. "I don't think that people are thinking about calories or the health of the products they buy when they go into a Starbucks," he said.

Instead, he said, people seem to see their Starbucks drinks as an affordable indulgence they deserve.

Gass said Starbucks spent two years perfecting a light Frappuccino that still tastes good. But she does not expect it to lure away those who are loyal to the originals — people like Lass.

"When does nonfat taste good?" he asked skeptically.

Even nonfat drinks add up.

Diana Kawamoto, 31, of Aptos, Calif., usually orders her 20-ounce venti Chai lattes two at a time, a treat that can add up to 600 calories even though she always asks for nonfat milk.

Javelli notes that reducing your caloric intake by 250 calories a day can lead to a weight loss of half a pound per week.

"Some of those coffee drinks might be the difference between losing half a pound a week or not, even though they're the light ones," she said.

On the Net:

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Dieting Makes Little Girls Fatter, Study Finds



Tuesday, June 29, 2004

WASHINGTON (Reuters) - Girls who are starting to get too fat at 5 are often experienced dieters by the age of 9 -- but put on extra fat instead of taking it off, U.S. researchers said on Tuesday.

They said their study shows that children and their parents are well aware when they weigh too much, but they do not know the best ways to slim down.

Jennifer Shunk and Leann Birch of Pennsylvania State University studied 153 girls living in central Pennsylvania. Those who weighed too much tried to diet, but ended up putting on more weight, they wrote in their report, published in the Journal of the American Dietetic Association.

The unhappier the girls were with their weight, the more they tried to diet, but they failed. This supports other research that shows "youths' attempts at weight control may promote weight gain," Shunk and Birch wrote.

At age 5, 32 of the girls were considered at risk of being overweight by Centers for Disease Control and Prevention (news - web sites) standards.

They were checked again at ages 7 and 9. At 7, girls at risk for overweight were eating significantly more than those not at risk, the researchers wrote.

For the study they were asked about foods they ate and answered questions such as, "Do you try to only eat a little bit on purpose so that you won't get fat?"

The girls were left in a room with toys and snacks and told to play or eat while the researchers left the room. The researchers watched to see what the children ate.

The heavier girls tended to munch snacks even if they were not hungry.

The researchers said their study supports other research that shows when people try to diet by simply eating too little, they eventually set themselves up for binges.

Mothers may also help this along by forbidding the girls to eat snacks, they said.

"Even during the preschool period, before any evidence for the emergence of dietary restraint, maternal feeding practices that restrict children's access to palatable foods can promote children's overeating," they wrote.

Middle-class families, especially, try to restrict snacks because they do not want overweight children, they added.

"However, rather than promoting moderation, these feeding practices can promote disregulated overeating in children."

Instead, parents should themselves demonstrate healthy patterns of eating and exercise, the researchers advised.

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Bird Flu Strain May Threaten Humans


By Randolph E. Schmid

Associated Press Writer

The Associated Press

Tuesday, June 29, 2004

WASHINGTON - A type of bird flu that has killed millions of chickens is becoming more infectious to mammals. Scientists fear it could cause the next worldwide pandemic in humans.

The avian flu has forced authorities to slaughter millions of chickens and other fowl in Asia to stem outbreaks in recent years. Thousands more have been killed in the United States and elsewhere.

Already the flu has passed from birds to humans in Hong Kong, killing six of 18 people infected in 1997, and human cases have been reported since then in Vietnam and Thailand.

Now China-based researchers studying the H5N1 strain of the flu report that it has been changing over the years to become more dangerous to mammals. Their research, based on tests in mice, is reported in Monday's issue of Proceedings of the National Academy of Sciences (news - web sites).

"Our results demonstrate that while circulating in domestic ducks, H5N1 viruses gradually acquired the characteristics that make them lethal in mice," reported the team led by Hualan Chen of the Animal Influenza Laboratory of the Chinese Ministry of Agriculture.

Human infections from bird flu remain rare, but the World Health Organization (news - web sites) considers it a potential major threat.

Two possibilities exist for the bird virus becoming a serious danger to people.

Viruses constantly mutate, and this one could accumulate enough genetic changes to become good at passing between humans. So far human cases have derived from birds, and no evidence has arisen of the bird flu being passed from person to person.

Even more worrisome, the experts say, would be sudden change that could be caused should the flu combine with a human flu in someone's body. The two viruses could swap genes and create a potent hybrid as deadly as the bird strain and as contagious as a regular human strain.

Klaus Stohr, head of the WHO's global influenza program, noted the new study confirms that the virus is evolving fairly rapidly, and viruses that are pathogenic for chickens are more apt to be transmitted to humans because humans are in contact with chickens.

The tests in mice act as a magnifying glass to help understand how dangerous the virus might be for humans, Stohr said in a telephone interview.

While seeing no cause for panic, Stohr observed that the virus' ability to infect humans raises the possibility of a new worldwide epidemic, or pandemic, of dangerous flu.

Dr. Linda Lambert, an influenza program officer at the U.S. National Institute of Allergy and Infectious Diseases (news - web sites), said the flu virus has an error-prone replication system.

It plays Russian roulette with its genome, she said, and could get a change that would allow it to spread among people.

The new Chinese analysis looked at samples of the H5N1 virus collected from ducks in China in 1991-2002. Ducks can carry the flu without appearing ill.

The researchers tested the effect of the viruses in mice and found that the samples collected in 1999-2000 were less dangerous than those from 2001-2002.

They rated the viruses as low, middle or high pathogens for mice.

Those rated low infected the lungs in modest amounts. In the middle group the viruses infected the lungs and in some cases the spleen and brain. The group rated high invaded the lungs, spleen, kidney and brains of the mice.

"While circulating in ducks, the natural host, H5N1 viruses gradually acquired the ability to infect and kill mammals," said researcher Chen.

How the viruses evolved with increasing lethality is not clear, but the researchers say it may have occurred in farms where pigs and ducks live in close proximity, which would have allowed the virus to move back and forth between mammals and fowl.

They said they have no reports of the H5N1 virus being isolated from pigs, but pigs have been infected with the virus in experiments.

Another possibility is that the virus was passed from ducks to humans and back again. But, they added, "The transmission of the virus from humans back to ducks is difficult to envision."

On the Net:


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Pictures of Puffing Stars Encourages Teen Smoking


By Alison McCook

Reuters Health

Tuesday, June 29, 2004

NEW YORK (Reuters Health) - Watching a favorite movie star smoke appears to encourage teen girls to adopt the habit themselves, according to new findings released Tuesday.

Investigators found that girls who said their favorite celebrity was someone who had smoked in at least two recent movies were almost twice as likely to start smoking within the next three years as girls whose favorite stars did not smoke in films.

"Really, smoking in movies is just an effective form of marketing," study author Dr. John Pierce told Reuters Health.

Pierce, based at the University of California in San Diego, added that it is also common for teens to copy their favorite stars' clothing, hair and jewelry. Those habits are easy to alter as styles evolve, he said, but once teens become hooked on smoking, "that is something that's very hard to change."

Pierce noted that the tobacco industry has argued that it does not pay for actors to smoke on screen, and actors do it simply because it makes them feel more comfortable.

If that is the case, then one could argue that the stars themselves are responsible for encouraging teens to smoke, and should be held accountable for that, Pierce noted.

"If it's the stars, and they're liable, then they'd better watch out," he said.

To investigate whether watching stars smoke on-screen influences teens to do the same, Pierce and his colleagues asked 3104 never-smokers between the ages of 12 and 15 to name their two favorite female stars and two favorite male movie stars.

The researchers reviewed the stars' movies during the past 3 years, and counted them as smokers if they puffed during at least two films. They then re-interviewed teens three years later, to see how many had started smoking.

When Pierce and his team first contacted teens in 1996, the most popular stars among teen girls were Brad Pitt (news - web sites), Sandra Bullock and Leonardo DiCaprio. Favorite actors for boys were Pamela Anderson (news - web sites), Sandra Bullock and Demi Moore. More than 40 percent of girls and 30 percent of boys had favorite stars who smoked.

Favorite stars who did not smoke on-screen included Jim Carrey, Tom Hanks and Tom Cruise (news - web sites).

Although girls appeared to be influenced by the smoking habits of favorite stars, boys were not, the authors report in the American Journal of Public Health.

They note that research has shown that boys tend to prefer action movies, which tend to include less smoking by stars, while girls prefer more smoke-filled romances and dramas.

Pierce explained that his team also measured each child's susceptibility to smoking -- defined as being unwilling to rule out the option of future smoking. This removed the possibility that only those who were susceptible to smoking would have a favorite star who smoked on-screen, he said.

Dr. Stanton Glantz of the University of California in San Francisco, who was not an author of the paper, noted that research shows that the more teens see people smoke, the more likely they are to pick up the habit. The latest findings suggest that policymakers should strictly limit teens' exposure to on-screen smoking, he said.

Restricting smoking to R-rated movies would apply "the same rules that Hollywood applies to saying the F-word," Glantz said.

Source: American Journal of Public Health, July 2004.

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Chronic Stress Tied to Heart, Stroke Risks in Men


By Amy Norton

Reuters Health

Tuesday, June 29, 2004

NEW YORK (Reuters Health) - A stress-filled life really does seem to raise the odds of heart disease and stroke down the road, according to a large study from Sweden.

The researchers found that among more than 13,600 men and women followed since middle-age, those who reported chronic stress at the study's outset faced a somewhat higher risk of fatal or non-fatal heart disease or stroke over the years.

The link was strong only among men, although a weak relationship between stress and cardiovascular ills was found in women, the study authors report in the European Heart Journal.

Researchers have long studied the possible role of chronic stress in heart problems and stroke, with many studies -- though not all -- supporting a relationship. It's thought that constant stress may take a toll on the arteries in a number of direct or indirect ways, from causing chronically high levels of stress hormones to pushing people to maintain unhealthy habits like smoking.

The new study included middle-aged men and women who between 1974 and 1980 were questioned about their stress levels over the previous one to five years. They were then followed through 1999 to see who developed cardiovascular disease.

The researchers found that participants who reported chronic stress at the study's start were 14 percent more likely to develop heart problems or suffer a stroke, regardless of other factors such as family history, body weight, smoking and high blood pressure.

But it was men's risk of fatal stroke that showed the clearest relationship to stress; stressed-out men were twice as likely as their peers to die of a stroke.

The reason for this particularly strong link is unknown, the study's lead author, Dr. Bertil Ohlin of University Hospital in Malmo, told Reuters Health.

He noted that other investigators have made similar findings, although he also said he knows of "no good biological hypothesis" to explain why stress might raise the risk of fatal stroke in particular.

It's been suggested, Ohlin noted, that stress is related to lower income, which could mean that highly stressed people tend to seek hospital care later than others do. However, he and his colleagues factored in participants' occupations, making lower income an unlikely explanation for the higher rate of fatal stroke.

As for the weaker findings among women, Ohlin said this is likely due to the fairly low number of heart disease and stroke cases among women, rather than a resistance to the health effects of chronic stress.

Source: European Heart Journal, May 2004.

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Cancer Treatments Often Sideline Job



Tuesday, June 29, 2004

TUESDAY, June 29 (HealthDayNews) -- Treatment for head and neck cancer can leave many patients so disabled they're unable to return to work, according to a study led by University of Michigan Health System researchers.

The study of 384 people with head and neck cancer found that 52 percent of them couldn't go back to work after they received chemotherapy or neck surgery.

Patients who had chemotherapy were 3.5 times more likely to report work-related disability. Those who had neck dissection -- surgery to remove lymph nodes in the neck -- were twice as likely to report disability.

Higher pain scores were also associated with work-related disability.

"Although chemotherapy and neck dissection appear to be associated with disability, patients should not opt out of these important treatments because of that. Decisions about treatment should be primarily concerned with ensuring survival and preventing recurrence. Still, disability and quality-of-life issues are secondary concerns and need to be addressed," study author Dr. Jeffrey Terrell, an associate professor of otolaryngology, said in a prepared statement.

"As we develop new therapies, doctors need to consider ways to minimize patients' discomfort. Pain needs to be prevented or treated appropriately, and the negative effects of chemotherapy and neck dissection should be addressed in an effort to reduce patient disability," added study co-author and otolaryngology resident Dr. Joseph Taylor.

The study appears in the June issue of the Archives of Otolaryngology -- Head and Neck Surgery.

More information

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

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Mental Problems May Follow Strep Infection in Kids


Reuters Health

Tuesday, June 29, 2004

NEW YORK (Reuters Health) - Infection with strep bacteria may give rise to psychiatric and neurologic disorders in some children, UK researchers report.

Various movement problems may occur as complications of strep infection, the authors explain, and the spectrum of such disorders may be broader than previously described.

Dr. R. C. Dale from the Institute of Child Health, London, and colleagues report their experience of post-strep psychiatric and neurologic disorders in 40 children seen at their center between 1999 and 2002. The findings are published in the Archives of Disease in Childhood.

Thirty-three children (83 percent) experienced emotional or behavioral changes, the researchers note, including emotional instability, obsessions or compulsions, and depression.

Other behavioral changes included aggressive, oppositional, or disruptive behaviors and attentional deficits.

Spastic movement problems were also common among the kids.

Sixteen of the children had a close family member with psychiatric or movement disorders. "The prevalence of movement and emotional disorders in first degree family relatives suggests that a genetic predisposition is important in disease development," the investigators write.

Source: Archives of Disease in Childhood, July 2004.

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Germs Hide in Unexpected Places


Tuesday, June 29, 2004

TUESDAY, June 29 (HealthDayNews) -- Many American don't know that germs are lurking on many common objects in their homes, offices, and public areas such as playgrounds, according to a University of Arizona survey.

Kitchen sinks, computer keyboards, escalator handrails, ATMs, picnic tables, playground equipment, and office desks are places that harbor more germs than many people may think, said professor Charles Gerba, a leading expert on environmental biology who's also known as "Dr. Germ."

"This lack of knowledge about where germs lurk is a real health problem, because people touch these objects and 80 percent of infections are spread through hand contact. The solution is to practice proper hand hygiene by washing with soap and water or by using an alcohol-based hand sanitizer," Gerba said in a prepared statement.

The survey found 64 percent of the 1,000 respondents mistakenly believed that a public washroom had more germs than an ATM. Most of the respondents were unaware the kitchen sink is more contaminated with bacteria than the toilet bowl or garbage can.

The majority of people didn't know the toilet seat at work actually has less germs than their office desks, computer keyboards, and elevator buttons. Outdoor portable potties are cleaner than picnic tables, shopping cart handles, escalator handles and playground equipment.

The survey found that 51 percent of the respondents said they cleaned their hands after sneezing or coughing, but only 17 percent cleaned their hands always or most of the time after shaking hands.

More information

The American Society for Microbiology has more about the importance of hand washing.

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Irritable Bowel Linked to High Surgery Rates

Reuters Health

Tuesday, June 29, 2004

NEW YORK (Reuters Health) - People with irritable bowel syndrome (IBS) -- a disease of unknown origin involving abdominal pain and diarrhea -- are more likely than other people to undergo several types of surgery, including gallbladder removal and appendectomy, a new study shows.

Many of these operations are probably unnecessary, according to a related editorial.

The findings, which appear in the medical journal Gastroenterology, are based on a study of nearly 90,000 subjects who completed medical and lifestyle questionnaires.

Of the six surgeries studied, gallbladder removal, appendectomy, hysterectomy, and back surgery were all significantly more common among IBS patients than among other subjects, note Dr. George F. Longstreth, from Kaiser Medical Center in San Diego, California, and Dr. Janis F. Yao, from the Permanente Medical Group in Pasadena, California.

The strongest link was with gallbladder removal, which was twice as common among patients with IBS as those without the condition.

By contrast, rates for coronary artery surgery and peptic ulcer surgery were similar for subjects with and without IBS, the report indicates.

"Although it is impossible to know how much of the surgical predisposition we identified resulted from misdiagnosis, consideration of our findings with those of other studies suggests that diagnostic error is an important factor," the researchers note.

In a related editorial, Dr. Nicholas J. Talley, from the Mayo Clinic in Rochester, Minnesota, comments that follow-up "data on the indications and outcomes of surgery in IBS is now needed."

He adds that "whether the excess surgery in IBS is cause or effect, unnecessary surgery must be avoided and gastroenterology (doctors) should take responsibility for actions to protect the public."

Source: Gastroenterology, June 2004.

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Gene Mutation Tied to Higher Parkinson's Risk


Tuesday, June 29, 2004

TUESDAY, June 29 (HealthDayNews) -- A specific form of a gene called APOE is associated with a slight increase in the risk of Parkinson's disease (news - web sites).

University of North Carolina (UNC) researchers report on the link in the June issue of Neurology.

"We found that APOE-2 conveyed a slight but statistically significant risk for Parkinson's disease, with an odds ratio of 1.2," lead author Dr. Xuemei Huang, an assistant professor of neurology at the UNC School of Medicine, said in a prepared statement.

"This means that people with this gene have about a 20 percent higher chance of developing Parkinson's disease than people without it. Given that the overall prevalence of Parkinson's in the general population is about 1 percent, this means the prevalence of the disease in people with APOE-2 is about 1.2 percent," Huang said.

He and his colleagues reviewed the results of 22 studies involving thousands of people.

They also found another version of the gene called APOE-4, which has been linked to an increased risk of Alzheimer's disease (news - web sites), is not a risk factor in Parkinson's disease.

"It basically shows that neurodegenerative diseases may differ in significant risk factors, contrary to prevailing views," Huang said.

More information

You can learn more about the disorder at the Parkinson's Disease Foundation.

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Low Triglycerides Tied to More Severe Stroke

Reuters Health

Tuesday, June 29, 2004

NEW YORK (Reuters Health) - You should reduce levels of cholesterol and triglycerides as much as possible, right? Well, in terms of stroke, that advice may go too far.

Low triglyceride levels are associated with increased stroke severity, according to results of a study published in the American Heart Association (news - web sites)'s journal Stroke.

A previous study had linked low triglycerides with higher mortality after stroke. In the current study, Dr. Tomasz Dziedzic and colleagues from Jagiellonian University, in Krakow, Poland, studied 863 consecutive patients with acute stroke caused by blockage of blood supply to the brain.

The team measured triglyceride levels within 36 hours after stroke onset, and used the Scandinavian Stroke Scale (SSS) to assess stroke severity when patients were admitted to the hospital. The patients were put into one of two groups: those with severe stroke (SSS score of 25 or less) and those with mild-to-moderate stroke (SSS higher than 25).

Compared to patients with mild/moderate stroke, those with severe stroke had significantly lower levels of serum triglyceride, the investigators report.

After making adjustments for various other factors that affect stroke risk, the team found that the risk of severe stroke was 42% lower for patients with triglyceride levels higher than 2.3 millimoles per liter than for those with levels below this.

The researchers note that the biological mechanisms responsible for this association remain unknown. While low triglyceride levels can reflect poor nutritional status, they note, malnutrition did not explain stroke severity.

"Therefore, we believe that alternative explanations focusing on potentially neuroprotective properties of cholesterol should be considered," Dziedzic and colleagues conclude.

Source: Stroke, June 2004.

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Fetuses Vulnerable to Air Pollution


By Holly VanScoy
HealthDay Reporter


Tuesday, June 29, 2004

TUESDAY, June 29 (HealthDayNews) -- Babies in the womb are more sensitive than their mothers to health risks from air pollution, a new study finds.

The study is part of a broader, multi-year research project that's examining the health effects on pregnant women and babies of a range of air pollutants, including vehicle exhaust, commercial fuels, tobacco smoke, residential pesticides and allergens.

The research, by scientists at the Columbia Center for Children's Environmental Health in New York City, appears in the June issue of Environmental Health Perspectives.

For the new study, the scientists examined the effects of prenatal exposure to carcinogenic air pollutants on 265 pairs of New York City pregnant women and their unborn children. The pollutants were ones that result from fuel burning in vehicle engines, residential heating, power generation or tobacco smoking. This kind of combustion produces carcinogenic pollutants called polycyclic aromatic hydrocarbons (PAHs) that have proven harmful to humans and laboratory animals in previous studies.

Blood samples were collected from the mothers and the umbilical cords of their newborns and examined for signs of DNA damage and secondhand cigarette smoke exposure. Because all mothers in the study were nonsmokers, any tobacco exposure was assumed to be from secondhand smoke.

The researchers found that fetuses received PAHs in amounts that were 10 times lower than their mothers because of the protection provided by the placenta. But the levels of DNA damage were comparable in newborns and their mothers. Also, the newborns' levels of cotinine -- a measure of tobacco smoke exposure -- were actually higher than their mothers'.

"These results raise serious concerns about the long-term risks of cancer, as well as developmental problems," said study leader Frederica P. Perera, a professor of environmental health sciences. "The evidence it provides about fetal susceptibility to DNA damage from air pollution underscores the importance of reducing pollution levels in our city."

An earlier study by the center that was released in January reported that high levels of PAH-DNA damage and secondhand smoke, at levels present in New York City, were associated with lower birth weights and smaller head circumferences in newborns.

But it's not just New York City infants that are at risk from the air their mothers breathe, according to Perera and other experts.

Bonnie Holmes-Gen, a spokeswoman for the California Lung Association, said the Columbia study results are consistent with other studies linking air pollution to genetic damage, birth defects -- even infant death.

"These studies very definitely should drive a strong public response demanding a reduction in vehicle pollution and other forms of damaging combustion," Holmes-Gen said. "To protect our unborn children, we need cleaner vehicles and fuels, we need to reduce our dependence on motorized vehicles as transportation, and we need to promote smoking-cessation programs and eliminate all smoking around pregnant women and young children."

Perera said she couldn't agree more.

"The current study's results can be generalized to all urban centers around the world," she said. "New York City pollution levels are comparable to those of many other communities, where there is undoubtedly the same kind of relationship between the quality of the air and the risks to unborn children. This is, first and foremost, a public-policy problem that requires public-policy solutions."

More information

The University of Georgia has more on the hazards posed by air pollution to pregnant women.

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Low Vitamin D Linked to Insulin Resistance

By David Douglas

Reuters Health

Tuesday, June 29, 2004

NEW YORK (Reuters Health) - People with a low level of vitamin D in the blood have poorly functioning insulin-producing cells and show a poor response to insulin, even when their blood sugar levels are normal, according to California-based researchers.

"Low vitamin D is extremely common," lead investigator Dr. Ken C. Chiu told Reuters Health. Moreover, "our observations indicate that low vitamin D has a small but significant impact" on blood glucose metabolism and diabetes, he said.

Chiu and colleagues at the University of California, Los Angeles came to this conclusion after a study involving 126 healthy, glucose-tolerant subjects.

As reported in the American Journal of Clinical Nutrition (news - web sites), the team found that the lower the vitamin D concentration, the longer it took for blood glucose levels to decline during oral glucose testing.

Overall, subjects with low levels of vitamin D were more likely than did those with higher concentrations to exhibit components of the so-called metabolic syndrome, such as obesity, high blood pressure and insulin resistance.

In particular, 14 of 49 participants classified as having vitamin D were deemed at risk of the syndrome versus 9 of 79 without such deficiency.

"Now, we have one more reason to keep up vitamin D," Chiu added. However, he also emphasized that "correction of low vitamin D itself is not sufficient in the treatment of these conditions and too much vitamin D could also be harmful."

Source: American Journal of Clinical Nutrition, May 2004.

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Elderly Play It Safe in Treating Osteoarthritis

By Steven Reinberg
HealthDay Reporter


Tuesday, June 29, 2004

TUESDAY, June 29 (HealthDayNews) -- Older people would rather be safe than sorry when it comes to treating their arthritic knees, even when safe may also mean ineffective.

A variety of medications are available to relieve pain caused by osteoarthritis, but each varies in its helpfulness and potential side effects.

Results of a new study find older patients with knee osteoarthritis often choose treatments that have fewer side effects rather than ones that may work better.

According to the report, knee osteoarthritis is a major cause of disability in older people. Treatment to improve knee function includes surgery, weight loss, muscle-strengthening exercises and joint protection techniques.

There are also drugs that can decrease pain. These vary greatly in cost and risk of side effects. In their report, Yale University researchers looked at these medication options.

"We were interested in what patients' treatment preferences were for knee osteoarthritis," said lead researcher Dr. Liana Fraenkel, an assistant professor of internal medicine and rheumatology.

Fraenkel and her colleagues wanted to know if patients were informed of all the available alternatives, and if they were, what they would choose given the tradeoffs between the risks and benefits of each of the treatments.

"We looked at a range of things from very safe creams to pills, all having various toxicity profiles," Fraenkel said. "You could have a cream that was very safe but didn't work as well, and you could have pills that were somewhere in the middle and pills that worked better but had more side effects."

The research team interviewed 100 patients with knee osteoarthritis. The patients were an average of 70 years of age, according to the report in the June 28 issue of the Archives of Internal Medicine (news - web sites).

"Surprisingly, patients strongly preferred safer alternatives even when they were less effective," Fraenkel said. "That's really against what many doctors prescribe for the treatment of pain, and even what guidelines say."

Fraenkel noted other studies in cancer patients have found older patients tend to prefer treatments with fewer side effects, even if they are less effective.

Fraenkel said the reasons for this finding included patients being used to their pain after having had it for a long time, and also fear of additional side effects. Many patients, she added, are willing to receive less pain relief rather than contend with side effects that can diminish their quality of life.

"Many times patients may not agree with what physicians would assume," Fraenkel said. "This reinforces the importance of informing patients of everything that is a rational treatment option and figuring out what is best for them," she added.

"It is the physician's responsibility to present all available options, not only what physicians consider the best," Fraenkel said. "We need to discuss with patients what they consider to be important in order to decide what might be the best choice for them."

"These results do not surprise me, and are consistent with what we see as specialists in physical medicine and rehabilitation," said Dr. D. Casey Kerrigan, a professor and chairman of the Department of Physical Medicine and Rehabilitation at the University of Virginia.

"Patients come to us keenly interested in treatments with minimal adverse effect and seek our advice in particular about different types of exercise, and what types of activities they should do or avoid," he added.

More information

The National Institute of Arthritis and Musculoskeletal and Skin (news - web sites) Diseases can tell you about osteoarthritis.

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High Blood Pressure Often Means High Cholesterol

Reuters Health

Tuesday, June 29, 2004

NEW YORK (Reuters Health) - High cholesterol is common among people with high blood pressure, but the cholesterol problem often gets scant attention, according to a new study.

"Nearly 50 million US adults have (high blood pressure). Our study suggests that more than two-thirds of them also have high cholesterol that likely is not being treated aggressively enough," senior author Dr. Stephen Turner, from the Mayo Clinic in Rochester, Minnesota, said in a statement. "This double whammy has enormous implications for disease prevention."

The findings, published in the Archives of Internal Medicine (news - web sites), are based on analysis of data from 1286 black and 1070 white subjects with high blood pressure.

At least 50 percent of subjects had cholesterol problems, typically high levels of "bad" LDL cholesterol or low levels of "good" HDL cholesterol. Such problems were more common in whites than in blacks and among men than women.

Overall, about 9 out of 10 people with cholesterol problems received inadequate or no treatment for their condition, the authors state.

Blacks were less likely than whites to be using medication to improve their cholesterol levels. However, blacks using such drugs were more likely than their white peers to achieve target cholesterol levels. Among white subjects, women were less likely than men to use such drugs.

"Additional studies are imperative to better understand reasons for underuse of (cholesterol-lowering drugs) and to develop more effective methods of evaluation, treatment, and control of" cholesterol problems among people with high blood pressure, Turner's team adds.

Source: Archives of Internal Medicine, June 28, 2004.

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Drug Cuts Side Effects in Prostate Cancer


Tuesday, June 29, 2004

TUESDAY, June 29 (HealthDayNews) -- An alternative hormone blocker called bicalutamide causes fewer side effects in prostate cancer patients, claims a new study.

Bicalutamide blocks androgen activity by binding to the hormone's receptors. The study of 51 men with nonmetastatic prostate cancer found those taking bicalutamide had improved bone density and fewer side effects than those taking leuprolide, a traditional therapy that lowers androgen levels.

"The differences between the two groups were dramatic. Bone mineral density increased among men taking bicalutamide, while men in the leuprolide group lost bone," lead researcher Dr. Matthew Smith, of the Massachusetts General Hospital (news - web sites) Cancer Center, said in a prepared statement.

The study was partially funded by AstraZeneca, which markets bicalutamide under the brand name Casodex. It appears in the July issue of the Journal of Clinical Oncology.

More information

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

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Monday, June 28, 2004


Hunger Hormone Acts Differently in Fat Men



Monday, June 28, 2004

WASHINGTON (Reuters) - A hormone that affects hunger acts in surprising and different ways in lean and fat men -- a finding that may offer new ways to treat obesity, U.S. researchers reported on Monday.

Tests on 10 men showed the thin men had an overnight spike in the hormone, called ghrelin, while the five fat men did not.

Ghrelin is the latest in a line of hormones discovered in recent years that act on appetite and eating behaviors. Another hormone, called leptin, makes fat rats lose weight when injected but in humans has little effect -- showing that these compounds interact in complex ways in people.

Dr. Julio Licinio, a professor of psychiatry and medicine at the University of California Los Angeles and colleagues tested 10 volunteers, keeping them overnight in their lab and carefully feeding them a controlled diet. They took regular blood samples and tested ghrelin levels, among other things.

They were surprised to discover a giant burst of ghrelin in the lean men's blood between midnight and dawn. It was a bigger spike even than that seen just before a meal, they wrote in this week's issue of the Proceedings of the National Academy of Sciences (news - web sites).

In the fat men, ghrelin levels stayed level all night long.

"The most powerful ghrelin surge was missing in the obese men, suggesting that their regulatory system has gone awry or can no longer listen to its own cues," Licinio said in a statement.

"At first glance, our findings appear contradictory. You'd expect the blood levels of the heavier men to contain more hunger hormone. Something must be overriding obese persons' ghrelin," he added.

The finding also shows that the hormone peaks in people of normal weight while they are asleep -- when they are unlikely to eat. None of the lean men woke up hungry, they said.

"This defies the stereotype of overweight people waking up in the middle of the night to raid the refrigerator," Licinio said. "The men in our study slept through the night, and both groups ate meals designed to maintain their current weight."

They also noted that the obese men in general responded less to ghrelin cues -- when they ate, ghrelin levels did not fall, as they do in thinner people.

Other studies have linked ghrelin to diabetes and high blood pressure, and the researchers said their findings may help shed light on this.

Obesity may be caused by a complex disruption of hormones that all act on one another, said the researchers. They included a team at Louisiana State University's Pennington Biomedical Research Center, which does extensive work on obesity.

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Gene Measurement Could Help Breast Cancer Treatment



Monday, June 28, 2004

MONDAY, June 28 (HealthDayNews) -- The activity of a gene called ALCAM may help doctors make early decisions about the best treatment for women with breast cancer.

A study in the June 27 issue of Breast Cancer (news - web sites) Research found the ALCAM gene, which is involved in the adhesion of cells, is less active in breast tumors with a poor prognosis.

By measuring the activity of the ALCAM gene in primary breast tumors, doctors may be able to better predict the potential outcome of the disease. That could help them decide whether to use more aggressive treatment, such as chemotherapy, at an earlier stage.

Researchers from the University of South Alabama and University of Wales College of Medicine compared ALCAM (Activated Leukocyte Cell Adhesion Molecule)in normal breast tissue and in tissue samples taken from primary breast tumors.

"Tumors from patients who died of breast cancer had significantly lower levels of ALCAM transcripts than those with primary tumors but no metastatic disease or local recurrence," the study authors wrote.

"The data clearly suggest that decreased ALCAM expression in the primary tumor is of clinical significance in breast cancer, and that reduced expression indicates a more aggressive phenotype and poor prognosis," the authors wrote.

More information

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

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More Women Seemingly Choosing C-Sections


By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, June 28, 2004

WASHINGTON - Doctors reassured Randi Rosenberg there was no reason to fear natural childbirth — she was in fine shape. But she so wanted to skip labor with her first baby that she switched doctors to get an elective Caesarean section. It's still very rare — and intensely controversial — but more expectant mothers seem to be choosing C-sections even when there's no clear medical need.

So says a new study that, by counting insurance claims data, estimates some 80,000 women had preplanned, elective C-sections in 2002, up from an estimate of just under 63,000 the year before.

That's a tiny fraction of the nation's 4 million births. But the numbers are stirring a major debate among obstetricians who for years have been urged, by the government and consumer groups, to lower the overall number of Caesareans they perform. In 2002, C-sections accounted for 26.1 percent of all births, a record high.

Make no mistake: Caesareans can be life- or health-saving for many mothers and babies. Fetal distress, breech babies, twins or more, or diseases that make labor risky for the mother can all be important reasons to have one.

Still, it's major abdominal surgery that, although safer today than ever before, still carries some serious, occasionally life-threatening, side effects: hemorrhage, infection, blood clots. Possibly more important, one C-section brings even more risks to future pregnancies.

So critics insist C-sections require a compelling medical reason.

But proponents of elective C-sections say the worst risks are extremely rare, especially in a healthy, rested woman — and that vaginal birth has its own problems, including a possible but unproven higher risk of incontinence from vaginal tears or use of forceps. They say fully informed women should be able to choose.

"Most doctors, when they are being honest ... recognize there are cases to be made for both sides — and also recognize that the question hasn't been studied in a way that permits anyone to know for certain what the best course is," says Dr. Jeffrey Ecker, a Massachusetts General Hospital (news - web sites) high-risk obstetrician.

He co-wrote recent ethics guidelines for the American College of Obstetricians and Gynecologists to help doctors determine how to weigh the pros and cons with interested patients, and when to refer them to another physician.

"This is surgery, this is not getting your nails done," adds Dr. Jacques Moritz of St. Luke's-Roosevelt Hospital in New York.

He performs some elective C-sections, including Rosenberg's, but makes women debate the options — plus his hospital wants such patients to get a second opinion.

"It felt like the right thing to do," said Rosenberg, 38, whose daughter Alexandra Marais was born June 8.

Years ago, Rosenberg had surgery to remove a fibroid. Now she feared that pushing during natural childbirth could rupture her uterus. Moritz and another doctor said the old scar wasn't a threat, but she wasn't convinced. And the convenience of knowing when to temporarily close her business added to the allure of a planned C-section.

"There are lifestyle considerations on top of the health considerations," she says. "In the end, you have to make the decision that fits your life."

Rosenberg seems typical of the fledgling trend: Women getting elective C-sections are usually over 35, more affluent, and planning only one child, says Dr. Samantha Collier of HealthGrades, a Denver-based company that studies health care quality.

HealthGrades culled insurance claims from 16 states, covering half the nation's deliveries, in estimating first-time, preplanned C-sections without a clear medical indication. They accounted for 2.2 percent of deliveries in 2002, a 25 percent increase in three years, the study says.

Isn't increased cost a barrier? Not necessarily, Moritz says. C-sections usually cost more because of an extra day or two in the hospital. But many women spend so long laboring in the hospital before a vaginal delivery that they can cost as much in extra nursing care and pain relief, he says.

So what should women consider?

·        Discuss your delivery concerns, Ecker says, because they might be addressed without surgery. Labor pain can be controlled. As for incontinence, some research suggests simply being pregnant raises that risk.

·        Think seriously about future children. One C-section "may doom you for life to have repetitive C-sections," each one riskier, Moritz cautions.

·        Seek information on delivery methods. Moritz recommends a new consumer brochure from the nonprofit Maternity Center Association, available at

Editor's Note: Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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Anorexia Relapse Risk Lingers



Monday, June 28, 2004

MONDAY, June 28 (HealthDayNews) -- Anorexia nervosa is often chronic and women can suffer a relapse long after they've been treated for the eating disorder, a new study finds.

Researchers at the University of Toronto and Toronto General Hospital (news - web sites) found women who've been treated for anorexia nervosa face a significant risk of relapse for up to two years after they've returned to their normal weight and been discharged from the hospital.

The study of 51 patients found 35 percent of them relapsed within two years of leaving Toronto General Hospital's eating disorders program. The mean time for relapse was 18 months.

"Our most important finding is that in a significant proportion of cases, the illness is chronic and debilitating," study leader and psychiatry professor Dr. Jacqueline Carter said in a prepared statement.

"We're pretty good at helping people to become weight-restored in the hospital, but really the challenge now is to figure out how to improve relapse prevention treatments and improve long-term outcomes for people with anorexia nervosa," Carter said.

The study found the strongest predictor for relapse was intensive exercise immediately after a patient was discharged from the hospital. Other strong predictors were: previous suicide attempts, obsessive-compulsive symptoms, and too much concern about weight and shape.

This information about predictors can be used to develop ways to prevent relapses, Carter said.

The study appeared in a recent issue of Psychological Medicine.

More information

The American Academy of Family Physicians (news - web sites) has more about anorexia nervosa.

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Studies Try to Determine Who Can Use HRT Safely



Monday, June 28, 2004

WASHINGTON (Reuters) - Hormone replacement therapy may be especially dangerous for older women with diabetes, researchers said on Monday, but a separate group said HRT may not be so harmful for younger, healthy women.

The two studies are among several that will break down just who is most at risk by studying the details from the giant Women's Health Initiative, which found that hormone replacement therapy actually raises the risk of heart disease, stroke and some forms of cancer.

Doctors and patients alike have complained that the findings are confusing, and many experts say that HRT can be safe and useful for short-term relief of some of the debilitating symptoms of menopause.

The big study that determined the risk of HRT looked at women well past menopause, with an average age of 63, and looked at a very large population of women with various characteristics.

To narrow it down, Barbara Howard, president of MedStar Research Institute in Washington, and colleagues studied 423 women past menopause who had atherosclerosis, a hardening of the arteries.

"People once thought that hormone therapy could prevent heart disease in women, especially in women with diabetes, who have an increased risk," Howard said in a statement.

"But this study provides evidence that hormone therapy should not be used to reduce cardiovascular disease risk in women with diabetes or pre-diabetes."

The women took either estrogen, estrogen plus progestin or a dummy pill for an average of nearly three years.

The women who had abnormal glucose tolerance -- meaning they either had diabetes or pre-diabetes -- and who took hormones had changes in their blood suggesting they had a higher risk of heart disease, Howard's team reported in the American Heart Association (news - web sites) journal Circulation.

But another report published in the June issue of Fertility and Sterility said younger women just entering menopause may not risk heart disease as much when they take HRT.

Dr. Frederick Naftolin of Yale University in Connecticut and colleagues noted that few women in their 40s and early 50s took part in the Women's Health Initiative.

"The effects of hormone therapy on the health of a woman in her 40s just beginning the menopausal transition will be different from its effects on a woman 15 years older," said Dr. Marian Damewood, president of the American Society for Reproductive Medicine, which publishes the journal.

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Second Heart Surgery Costly to Medicare


By Steven Reinberg
HealthDay Reporter


Monday, June 28, 2004

MONDAY, June 28 (HealthDayNews) -- If you've had angioplasty to open a clogged heart artery, chances are you also had a stent implanted during the procedure to help ward off new blockages.

This procedure is usually successful, but because the artery can become blocked again through a process called restenosis, many patients will have to have the procedure redone within a year. These second procedures add a substantial amount to Medicare (news - web sites) costs and may not be for everyone, a new study says.

"Among Medicare patients, about 17 percent needed another angioplasty or bypass operation during the year following their first procedure," said lead author Dr. David J. Cohen, an associate professor of medicine at Harvard Medical School (news - web sites).

Of these patients, 14 percent develop a blockage at the site where the stent was placed, he added. "The cost of doing the second procedure is about $19,000," Cohen said.

A stent is a wire mesh tube used to prop open an artery that has been cleared using angioplasty. During the procedure, the stent is put over a balloon catheter and moved to the blocked part of the artery. Then the balloon is inflated, expanding the stent. The stent then locks in place and forms a scaffold that keeps the artery open.

Cohen's team collected data from the Medicare Standard Analytic File on 9,868 patients who had angioplasty in 1998, according to the report in the June 29 online issue of Circulation.

"If we had treatments that could substantially reduce restenosis, we could offset a lot of cost for the health-care system," Cohen said.

Cohen believes the advent of drug-eluting stents, which release medication that can prevent restenosis, might go a long way to reducing the problem.

"These drug-eluting stents look like they are very promising for reducing the rates of restenosis by 10 to 20 percent," he said.

However, drug-releasing stents cost about $3,000, compared to the $1,000 price tag of a bare metal stent. Cohen said the price of drug-eluting stents has been dropping. "In a couple of years," he predicted, "the price will be low enough to fully offset the additional cost."

"Restenosis, while less common than many people would have guessed, is very expensive, and therefore it is worth spending money to prevent it," Cohen said.

Boston Scientific Corp., a maker of drug-eluting stents, paid for part of the study, and three of the authors are employees of the company.

Cynthia A. Yock, a research associate at Stanford University and an expert in cost-effectiveness of heart treatments, said the newer stents will go only so far to cut costs. "The opportunity for drug-eluting stents to improve outcomes and costs is only among the 14 percent who have restenosis, and then only among that small portion of patients that a fancy stent can fix, " she said.

"Drug-eluting stents may reduce restenosis to 9 or 10 percent, but given that they are so expensive, it is not clear that they are worth the investment," she added.

Yock noted that part of the problem is how to identify those patients that are likely to have restenosis. There are no clear clinical guidelines as to which patients should get a drug-eluting stent, she said. "So you have to use drug-eluting stents in 100 patients to get a 2 to 3 percent improvement in restenosis," she said. "If you could identify these patients, then it might be worth it."

Yock also said that both Medicare and private insurance cover the use of drug-eluting stents, but physicians complain the reimbursement is too low.

Dr. Jonathan Abrams, a professor of medicine at the University of New Mexico Health Sciences Center, said stents do reduce restenosis.

Abrams believes Medicare is doing the right thing by covering the newer stents. He assumes the use of drug-eluting stents will become standard care, but he believes these stents are not for everyone.

There is probably no choice, he said. "The horse is out of the barn on drug-eluting stents," Abrams added. "But Medicare could limit the number of drug-eluting stents used on a single patient."

Abrams believes that patients who have had restenosis should receive drug-eluting stents, but until a way is found to identify patients likely to have restenosis, drug-eluting stents should not be used on every patient.

"The selection of a drug-eluting stent should be tempered by the assessment of what is the likelihood of the artery in question to be a high or low risk for restenosis," Abrams said.

More information

The U.S. Food and Drug Administration (news - web sites) can tell you about stents.

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Medical World Debates Risk of Being Pudgy


By Daniel Q. Haney

AP Medical Editor

The Associated Press

Monday, June 28, 2004  

There is little doubt among mainstream health professionals that being truly obese is a health hazard. But what about the borderline plump? The mildly pudgy? All those people with BMIs between 25 and 29, who according to the charts are overweight?

Government health agencies often lump all degrees of overweight together, noting for instance that over 60 percent of Americans are too heavy. But more than half of these people — roughly one-third of all Americans and 800 million people worldwide — are overweight but not obese.

Riding to the mall one Saturday, Joanne Ikeda's younger sister turned to her and asked, out of nowhere, "Do you know that I am now overweight?"

From heart-sinking personal experience, millions upon millions of people can imagine exactly what led up to that admission. She had stepped on the scales and noticed a number a little north of usual. So she looked it up on a body mass index chart. And — No! — she was officially too heavy.

Not obese, not even close. But her BMI was 26, a full, leaden point above the carved-in-stone cutoff for being overweight.

Many who are overweight but not obese are like Ikeda's sister, Irene Pakel: 55 years old, 5-foot-3, weight in the mid-140s, maybe 10 pounds or so into the overweight category. Does she have a weight problem, one that might even shorten her life?

To many in the field, the answer is clear.

"Over 99 percent of experts throughout the world are convinced by overwhelming data that being overweight is a huge problem indeed for the majority of the world," says Dr. Philip James, chairman of the International Obesity Task Force in London.

But as co-director of the Center for Weight and Health at the University of California at Berkeley, Ikeda has a professional, though somewhat contrarian, opinion: Not likely.

"She's very physically fit," says Ikeda. "She goes to Curves everyday after work. To look at her, you would say, 'Here is someone who is not even slightly chubby.'"

Ikeda has a weight problem of her own. Her BMI is 33, which makes her officially obese. Does that bother her? "Not really," she said. "What matters is my metabolic fitness."

Some in the world of diet and health — and as James says, they are a minority — feel too much is made of the lower end of the BMI scale, that perhaps even the entire category called overweight causes much anxiety for nothing.

"This is so ludicrous," says Ikeda. "Why are we doing this to ourselves? I think it has a lot to do with the dieting and pharmaceutical industry and the pressure to medicate every condition."

"A completely phony category" is what University of Colorado attorney Paul Campos calls overweight. He is author of "The Obesity Myth" and argues that the real health problem is too little exercise, not too much weight.

"There is no basis in the medical literature to draw the conclusion that having a BMI between 25 and 29 an is an independent health risk," he says. "It is quite preposterous to make that claim."

Such out-of-step pronouncements are fighting words in the field of nutrition and health, where many consider the evils of fat to be beyond question.

Former New England Journal of Medicine (news - web sites) Editor Jerome Kassirer remembers the indignation six years ago when he wrote a skeptical editorial calling the data linking weight and ill health "limited, fragmentary and often ambiguous."

"We got flack from just about everybody except the fatties," he remembers, although he hasn't seen anything since to change his mind.

One of the most persistent doubters is Steven Blair of the Cooper Aerobics Center in Dallas. His research buttresses the idea that fitness is more important than fatness.

Following 25,000 Cooper patients for eight years, he found that it is better to be fit and fat than skinny and sedentary. In fact, overweight people who have good stamina on a treadmill test live just as long as equally fit people who are not overweight.

"If you look at people in the overweight category, many have none of the conventional risk factors, like elevated blood pressure and cholesterol," says Blair. "Should they be stigmatized and treated? For what?"

Many obesity experts concede Blair has a point: People who are overweight but fit probably do escape many of the consequences of their size. But they often add: So what?

"It may be true, but the fact is, overweight people are not fit," says Dr. Xavier Pi-Sunyer, head of obesity research at St. Luke's-Roosevelt Hospital Center in New York City. "The average American is incredibly sedentary."

Not always, says Blair. About half of the oversize people who get physical exams at Cooper in fact are physically fit, based on their treadmill tests. While hardly a random sample — these people are overwhelmingly white, educated and well off — Blair contends plenty of overweight Americans are just like him.

"I'm a short fat guy," says Blair, whose BMI is about 32. "Would I rather be a short thin guy? Sure. But I'm not. I run everyday and eat a healthy diet and do what I can."

Until a few years ago, government agencies generally agreed that concern about weight begins when a man's BMI hits 28 and a woman's 27. That's 152 pounds for a 5-foot-3 female. But in 1997, the World Health Organization (news - web sites) adopted a new standard. BMIs between 25 and 29.9 were now "preobese."

The next year, an expert committee of the U.S. National Institutes of Health (news - web sites) came to the same conclusion and called the new category "overweight." Suddenly an extra 35 million Americans were judged to have weight problems.

"We felt it makes sense that if someone's BMI is between 25 and 30, they should not gain more weight," says Pi-Sunyer, who headed the U.S. committee. "We don't feel those millions of people should be trying desperately to lose weight. At a BMI of 30, the risk for both disease and early mortality is so great that people should begin to lose weight."

The 25 cutoff was chosen, he said, because of evidence that the risk of diabetes, high blood pressure and high cholesterol all seem to increase around that point.

The studies backing this up are mostly reviews of large population groups that look for ties between increasing weight and the risk of various diseases and death. The individual studies may have flaws, but taken together, many contend they draw a convincing picture of weight being on a continuum from good health to ill.

"Some say it's all made up, that there's no risk to being moderately overweight," says Dr. Lawrence J. Cheskin, director of the Johns Hopkins Weight Management Center. "But there is more and more data to show a very definite dose effect. The heavier you are, the greater your risk."

Some believe the ideal body weight is actually around a BMI of 20 or 21, or a willowy 115 pounds for that 5-foot-3 woman. Others put it closer to 24 or 25. "Everybody agrees that if your BMI is 28, you are at increased risk," says Dr. Steven Heymsfield of St. Luke's-Roosevelt.

This view is backed by studies showing mortality inching up gradually when BMIs reach the high 20s, then climbing more sharply through the 30s and beyond.

One of the most recent, published last year in the Journal of the American Medical Association (news - web sites), concludes that white men and women lose about an average year of life if their BMIs top 26 or 27 by the time they reach middle age. However, for reasons that are not easy to explain, this may not be true for blacks. They actually seem to live a year or so longer if overweight but not obese.

While some question the scientific rigor of the mortality estimates, there is less disagreement that common health problems increase among people who are overweight but still below the obesity threshold of a BMI of 30.

For instance, a woman with a BMI of 26 is twice as likely as one who is 21 to develop coronary heart disease. She is twice as likely to get high blood pressure. And she is eight times as likely to get diabetes. Of course, a very thin woman has only a tiny risk of these diseases, so a risk that is double or triple may still be small.

Nevertheless, national health surveys show that about a quarter of people who are overweight but not obese have metabolic syndrome, a particularly worrisome combination of high blood sugar, high blood pressure, low HDL and high triglycerides.

Diabetes is an especially important concern, even for those nowhere near rotund. In fact, the ideal size for avoiding this disease appears to be around a BMI of 22. The risk goes up 25 percent with each unit of BMI after that, and it appears to be especially great for those with pot bellies, even small ones.

Of course, just because surveys of thousands of people show a clear link between rising BMIs and bad health doesn't mean that any particular individual is in trouble with a BMI that hits 25. Many lucky people carry their extra pounds with no ill effect, especially if they have normal blood sugar, healthy blood pressure and no worrisome cholesterol signs.

Many experts contend the biggest hazard of being overweight is what almost inevitably comes next.

"Fat people get fatter," says Dr. Peter McCullough, head of the weight control center at Beaumont Hospital in suburban Detroit. "It is very clear that those who are overweight will become obese over time. People need to understand they have to get this under control."

Editor's Noter: Medical Editor Daniel Q. Haney is a special correspondent for The Associated Press.

On the Net:

Overweight statistics:

BMI chart:

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Hypertension, Cholesterol Often Twin Threats


By Ed Edelson
HealthDay Reporter


Monday, June 28, 2004

MONDAY, June 28 (HealthDayNews) -- Many people with high blood pressure are likely to have high blood cholesterol levels that aren't being treated properly, a new study reports.

Both high blood pressure (hypertension) and high cholesterol are significant risk factors for cardiovascular problems such as heart attack or stroke. The study, by researchers at the Mayo Clinic, found that "this double whammy has enormous implications for disease prevention," said Dr. Stephen Turner, a Mayo nephrologist and hypertension specialist who was the lead author of the report. It appears in the June 28 issue of the Archives of Internal Medicine (news - web sites).

The study participants consisted of approximately 1,000 white residents from the Mayo Clinic's hometown of Rochester, Minn., and nearly 1,300 black residents of Jackson, Miss. All had high blood pressure.

Roughly half of the black participants -- 49.5 of the women and 56.7 percent of the men -- also had hyperlipidemia, the medical name for unhealthy levels of cholesterol. The same was true for an even larger percentage of the white participants -- 78.4 percent of the men and 64.7 percent of the women.

Yet fewer than one-third of those with high cholesterol levels were taking cholesterol-lowering drugs such as statins. And fewer than half of those taking the drugs had reached recommended levels of cholesterol, the study found.

"The concordance of hypertension and high lipids (cholesterol levels) is not new," said Cashell Jaquist, a genetic epidemiologist at the National Heart, Lung, and Blood Institute. "We have seen it in some other studies. What is surprising is the lack of treatment for the lipid problems."

The finding has implications for medical genetics, Jaquist added. "We haven't looked for some forms of hypertension as a common genetic disorder that might also affect lipids. This is a hypothesis that this study has raised, something to look at in the future."

Turner said the finding surprised him because participants in the study were chosen because they had high blood pressure and thus were expected to be aware of other cardiovascular risk factors, such as cholesterol levels. They were well aware of the risks of high blood pressure, Turner said.

"But the rates of people being treated and controlled for high lipid levels were comparable to those seen in other groups," he said.

The study was not designed to determine the reasons for undertreatment of cholesterol levels, but Turner said he could speculate "on the basis of my own clinical practice."

"High blood cholesterol is one of a number of asymptomatic (symptomless) problems that people can have," he said. "It is generally recognized that many people, both physicians and patients, are reluctant to use medications for problems that are asymptomatic."

But the need for people with high blood pressure to keep their cholesterol levels down is urgent, Turner said. "There is a synergistic risk," he said. "The whole is greater than the sum of the parts."

More information

The National Heart, Lung, and Blood Institute has details on the DASH diet, which is designed to combat high blood pressure but is also effective against high cholesterol.

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High Protein Diet May Affect Female Fertility



Monday, June 28, 2004

BERLIN (Reuters) - Eating a high protein diet may make it more difficult for women to conceive, American researchers said on Monday.

Dr David Gardner, of the Colorado Center for Reproductive Medicine in Englewood, said diets containing 25 percent protein disrupt the development of early mice embryos and may have a similar impact in humans.

"Although our investigations were conducted in mice, our data may have implications for diet and reproduction in humans," Gardner told a fertility meeting.

In mice the high protein diet seems to interfere with a genetic process known as imprinting, which controls the activity of genes inherited from the father and mother.

The researchers fed mice a diet of either 25 percent or 14 percent protein for four weeks before mating them. Afterwards they examined 42 of the resulting early embryos, which are known as blastocysts, to see if imprinting for an important growth gene was altered.

They also transferred 174 early embryos into the wombs of mice which were eating a normal diet to study the impact of maternal diet before implantation on fetal development.

"We found only 36 percent of blastocysts developed in mothers on the 25 percent diet showed a normal imprinting pattern, compared to 70 percent in the control group," Gardner explained.

Fewer embryos in the high protein group developed into fetuses -- 65 percent compared to 81 percent in the lower protein group.

"These findings, together with similar work carried out in cows means that it would be prudent to advise couples who are trying to ensure that the woman's protein intake is less than 20 percent of their total energy consumption," Gardner told the European Society of Human Reproduction and Embryology.

"The available data certainly indicate that a high protein diet is not advisable while trying to conceive," he added.

But Dr Stuart Trager, the medical director of Atkins Nutritionals Inc which developed the low-carbohydrate Atkins Diet, said some studies have shown a positive correlation between controlling carbohydrates and female fertility.

"The differences between mice and human embryos have recently been demonstrated by the ability to produce mice embryos from a single parent, a process that cannot be replicated in humans," Trager said in a statement.

"This casts a large discrepancy on the ability to derive conclusions about the clinical implications of this study with regard to humans," he added.

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Hazard of Weight Gain for Blacks Unclear


By Daniel Q. Haney

AP Medical Editor

The Associated Press

Monday, June 28, 2004

While much research suggests even a little extra weight can be bad for people's health, the hazard is much less clear for black people than for whites.

Several studies show little or no association between rising weight and the risk of death for U.S. blacks, especially women. In fact, being overweight but not obese could even be a benefit rather than a hazard.

The question is why. Are blacks truly less susceptible than whites to the ill effects of fat? Or are the studies somehow so flawed that they fail to measure this effect?

"People don't know what to make of it," says Dr. Steven Heymsfield of Columbia University. "Blacks still have a lot of strokes and heart attacks, but maybe it's for reasons other than BMI."

Also unclear is whether the same is true for people of African descent in other parts of the world, experts say, since large studies like those in the United States have not been done.

One of the largest reports to look at this, an analysis of American Cancer Society (news - web sites) data on more than 1 million U.S. adults, found strong ties between weight and longevity for whites but much less solid evidence for blacks.

For instance, the study found only about a 20 percent increased risk of death among overweight black women, and even then only when their body-mass index exceeded 35, which is well into the obese range. The risk for black men began to rise when they reached the overweight category, but the increase was small.

The rising risk was not considered statistically meaningful for either men or women, but that might have been because only about 12,000 study participants were black, too few to show a clear trend.

Another review that combined data from several large population follow-ups suggests a little extra weight might actually be a good thing for American blacks. Both men and women appeared to live a bit longer than usual if their BMIs were in the overweight but not obese category.

Some question the significance of the racial comparison. They say that since blacks die younger than whites, the studies might underestimate the health effects of weight or fail to account for weight loss that results from underlying diseases.

"I don't think a direct comparison of the relative mortality risk in blacks and whites is helpful," said Shiriki Kumanyika, an epidemiologist at the University of Pennsylvania. "You would have to know the circumstances that influence death across the BMI distribution in the black population."

Still, if blacks truly suffer fewer consequences of modest weight gain, she and others speculate that differences in body fat distribution might partly explain why.

Fat is thought to be most dangerous if it is packed around the internal organs. This kind of fat is most biologically active, throwing off cholesterol levels and forcing up insulin levels.

Overweight blacks tend to have lower levels of harmful triglycerides and higher amounts of protective HDL than do similar-size whites, and this might be due to where their fat is deposited. Blacks tend to carry a larger proportion of their fat in a layer under the skin rather than deep in the belly.

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Blood-Sucking Leeches Approved for Therapy



Monday, June 28, 2004

WASHINGTON (Reuters) - Blood-sucking leeches -- used for thousands of years in medicine -- now have the U.S. government's approval as a tool for healing skin grafts or restoring circulation, regulators said on Monday.

The Food and Drug Administration (news - web sites) approved an application from French firm Ricarimpex SAS to market leeches for medicinal purposes. The company has been breeding leeches for 150 years, the FDA (news - web sites) said.

Doctors have used the small aquatic worms for several thousand years in the belief that bloodletting helps to cure a wide range of complaints from headaches to gout. They reached their height of medicinal use in the mid-1800s.

Today, doctors around the world use leeches to remove blood pooled under skin grafts for burn patients, or to restore circulation in blocked veins by removing pooled blood, the FDA said in a statement.

Leeches are particularly useful in surgeries to reattach body parts such as fingers or ears, Ricarimpex said on its Web site. The leeches can help restore blood flow to reconnected veins.

The FDA said it considered the leeches a medical device. The agency approved their sale after reviewing medical literature and safety data provided by Ricarimpex.

The FDA also examined information about how the leeches are fed, their environment, and the employees who handle them.

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Idaho Farmers Pass on Lower-Carb Potato


The Associated Press

Monday, June 28, 2004

TWIN FALLS, Idaho - The leading promoter of the state's signature commodity sees little interest in shifting any production to a new lower-carbohydrate potato targeted at the dieting crowd.

Idaho Potato Commission President Frank Muir believes producers throughout the state will stick with the varieties they have already been successful with and continue stressing the nutritional value of traditional potatoes.

Muir was confident that the new strain with 30 percent fewer carbohydrates than the Russet Burbanks Idaho is "going to be a niche product."

Five years of testing in Florida has produced the new variety that scientists at the University of Florida say tastes good, has a shorter growing cycle, is disease-resistant and handles extreme weather conditions.

Independent research shows about 3 1/2 ounces of the new potato contain about 13 grams of carbohydrate compared to around 19 grams in the same size serving of a Russet Burbank. The new baseball-size potato will be available in supermarkets and restaurants in January.

But Muir questioned whether the lower-carb potato will catch on with the general public.

"Anytime you reduce the starch in a potato, you end up with a gummy potato," he said. "If it doesn't taste like a regular potato, consumers won't eat it."

Beside that, he said a regular potato has much more going for it than its carbohydrate content. An average potato contains 100 calories, has no fat, is low in sodium, high in potassium, has dietary fiber in the skin and contains vitamins C and B-6.

The National Potato Promotion Board has launched a $4.5 million campaign marketing the nutritional value of traditional spuds.

Colette Heimowitz of Atkins Health & Medical Information Services said dieters can eat potatoes once they reach their goal weights, and if they remain carbohydrate-conscious at that point, she said they can get the benefit of the lower-carb potato by just eating a third less regular potatoes.

On the Net:

Idaho Potato Commission:

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Mobile Phones May Damage Sperm?


By Patricia Reaney


Monday, June 28, 2004

LONDON (Reuters) - Mobile phones may damage men's sperm, Hungarian scientists say, in a study that fertility experts dismissed Monday as inconclusive.

Carrying a mobile in hip pockets or a holster on the waist could cut sperm count by nearly 30 percent, according to the research.

"The prolonged use of cell phones may have a negative effect on (sperm production) and male fertility," Dr. Imre Fejes, of the department of obstetrics and gynecology at the University of Szeged said in a summary of the study.

Fejes and his team analyzed sperm from 221 men and questioned them about their use of mobile phones. They found correlations between the use of the phones, even in a standby setting, and reduced sperm concentration and quality.

Fejes said more research is needed to support the findings, which will be reported to this week's conference in Berlin of the European Society of Human Reproduction and Embryology.

Professor Hans Evers, a past president of the society, said the results are interesting but far from conclusive.

"It ... appears not to take into account the many potential confounding factors that could have skewed the results," Evers, who works at the Academic Hospital in Maastricht in the Netherlands, said in a statement.

He added that the study did not seem to analyze stress levels, the type of jobs the men have and whether they smoked, which could all influence sperm count.

"These factors would have a considerable effect on the outcome of the research," he said.

Britain's National Radiological Protection Board, which has reviewed research into the health effects of exposure to radiofrequency waves including mobile phones, said, so far, the waves appear to be safe.

But mobiles phones have been in widespread use for only a short time so more research is needed.

"This is an unexpected result and we will look at it very carefully but the decline in male fertility has been going on for decades now, before the widespread use of mobile phones, and there can be many reasons for it," Dr. Michael Clark, scientific spokesman for the British board, told Reuters.

The World Health Organization (news - web sites) has said none of the recent reviews has concluded that exposure to radiofrequency waves from mobile phones or their base stations damages health, but stresses that more studies are needed.

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Poor Nutrition Leading Cause of Child Death



Monday, June 28, 2004

MONDAY, June 28 (HealthDayNews) -- Improved nutrition could save the lives of more than half the children who die around the world each year, says a study in the current issue of the American Journal of Clinical Nutrition (news - web sites).

"Rates of undernutrition are not declining quickly enough. If we invest more resources in child nutrition interventions, we can potentially save millions of young lives," study author Laura E. Caulfield, an associate professor at Johns Hopkins University Bloomberg School of Public Health, said in a prepared statement.

Undernutrition, defined as underweight or low-weight-for-age, is responsible for more than 53 percent of all the world's child deaths each year, more than infectious diseases, pnuemonia, diarrhea, measles and malaria.

"Malnutrition does not have to be severe to have a significant impact on child health and survival. Our analysis shows that even children who were small, but whose weight would not classify them as malnourished, were twice as likely to die as children in our reference group," Caulfield said.

She and her colleagues examined data from sub-Saharan Africa and Southeast Asia. They believe efforts to prevent undernutrition should be among the top priorities in worldwide efforts to reduce child death rates.

More information

The American Academy of Family Physicians (news - web sites) has information about nutrition.

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Nighttime Hunger Hormone Surge Missing in Obese


By Merritt McKinney

Reuters Health

Monday, June 28, 2004

NEW YORK (Reuters Health) - A hormone that triggers hunger may be released on a different schedule in obese people than in thin people, researchers report.

In a small study, levels of the "hunger hormone" ghrelin peaked when lean men were asleep. But obese men did not experience a surge of the hormone during the night.

"That may help explain why obese people are eating more," lead author Dr. Julio Licinio at the University of California at Los Angeles told Reuters Health in an interview. Licinio explained that ghrelin is the only circulating hormone that encourages people to eat. When levels of the hormone rise, people get hungry.

The California researcher noted that for normal-weight men in the study, "the highest amounts of ghrelin are in the middle of the night when they are sleeping "when they cannot eat."

In contrast, in the obese, "at night the levels don't go up," Licinio. This means that ghrelin levels are at their highest during the day, when people can satisfy their hunger by eating, he said.

Licinio said he would like to see what happens to the pattern of ghrelin levels when people lose or gain weight.

"I'd like to see if these patterns are different," Licinio said. He noted that even after people lose weight, it is not easy to keep the extra pounds from coming back. Licinio said it will be interesting to see if people who were obese begin experiencing nighttime surges in ghrelin as other lean people do.

Ghrelin is one of several hormones being studied by obesity researchers. Ghrelin is known as the hunger hormone because people given the hormone in previous experiments became so hungry that they ate up to one third more food than usual.

Another hormone called adiponectin, which is secreted by fat tissue, seems to affect how well the body responds to the sugar-processing hormone insulin.

Leptin, another hormone released by fat cells, tells the brain to curb appetite. However, most obese people have elevated levels of the hormone, suggesting that they may be resistant to its appetite-suppressing effect.

The release of hormones varies throughout the day, so Licinio and his colleagues set out to look for obesity-related differences in how ghrelin, adiponectin and leptin circulate.

The study included five obese men and five lean men whose hormone levels were measured every 7 minutes over a 24-hour-period.

Levels of adiponectin and leptin varied between obese and lean men, Licinio explained. But he noted that the general patterns of how these hormones were released were similar in both groups of men.

That was not the case with ghrelin, Licinio and his colleagues report in the advance online edition of the journal Proceedings of the National Academy of Sciences (news - web sites).

As mentioned, obese participants did not experience a surge of the hunger hormone while sleeping as lean men did.

While the findings do not mean that differences in ghrelin patterns make people gain weight, Licinio said that they could play some role in obesity.

Licinio cautioned that the patterns need to be studied in larger groups of men, as well as in women. Licinio and his colleagues have already started a similar study in women.

Source: Proceedings of the National Academy of Sciences Early Edition (news - web sites), June 28, 2004.

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Berries, Beans Top 'Best Antioxidants List'

By E.J. Mundell
HealthDay Reporter


Monday, June 28, 2004

MONDAY, June 28 (HealthDayNews) -- A variety of veggies, fruits and nuts battled it out this month for the top spot on a new list of the 20 most antioxidant-rich foods, ranked by nutrition scientists at the U.S. Department of Agriculture (news - web sites) (USDA).

In the end, small red beans won the day, narrowly beating out wild blueberries as the food with the highest concentration of disease-fighting compounds per serving.

Antioxidants fight damage to cells from rogue molecules called "free radicals." Experts believe this assault on cells may fuel killer diseases such as heart disease and cancer, and even aging itself.

The new Top 20 list, published in the June issue of the Journal of Agricultural and Food Chemistry, "is a relative ranking of the capacity of foods to interfere with or prevent oxidative processes and to scavenge free radicals," explained list co-creator Ronald L. Prior, a USDA nutritionist and research chemist based in Little Rock, Ark.

Prior and his colleagues used the most advanced technologies available to tabulate antioxidant levels in more than 100 different types of fruits, vegetables, berries, nuts and spices.

Their Top 20:

  1. Small red beans (dried).
  2. Wild blueberries.
  3. Red Kidney beans.
  4. Pinto beans.
  5. Blueberries (cultivated).
  6. Cranberries.
  7. Artichokes (cooked).
  8. Blackberries.
  9. Prunes.
  10. Raspberries.
  11. Strawberries.
  12. Red Delicious apples.
  13. Granny Smith apples.
  14. Pecans.
  15. Sweet cherries.
  16. Black plums.
  17. Russet potatoes (cooked).
  18. Black beans (dried).
  19. Plums.
  20. Gala apples.

There's "still a lot we haven't learned" about why some foods are richer in antioxidants than others, Prior said. Even though the small red bean came out on top, "we don't have a lot of information on beans," he added.

Berries are better understood. "The components that contribute a lot of the antioxidant activity are what are called anthocyanins, the compounds that give many berries their dark blue color," he said.

In fact, color may be key to spotting foods that fight free radicals, said Roberta Anding, an American Dietetic Association spokeswoman and a nutritionist at Texas Children's Hospital in Houston.

"If you're looking for the best places to get antioxidants, I will usually tell folks to look at the colors of the rainbow," she added.

For example, "you'll find lutein with some of the yellow pigments found in corn; orange can be the pigments from the carotenoid family that are found in cantaloupe, butternut squash and mango; red could come from things like lycopene, found in tomatoes and watermelon. And then the darker colors -- the purples, blues, in berries," she said.

But Prior cautioned that just because a food has proven to be antioxidant-rich in the USDA's lab, that doesn't mean all those nutrients will be successfully absorbed by the human digestive tract.

"As we learn more and more, we're finding that, depending on the chemical makeup of antioxidants in different foods, some of them aren't apparently absorbed as well, or else they are metabolized in a form where they are no longer antioxidants," he said.

Whether a food is eaten fresh, frozen, processed or cooked can also affect its antioxidant potency -- for good or ill, he said. Blueberries are best when eaten fresh rather than cooked in a pie, for example. On the other hand, research has shown that gentle cooking raises the antioxidant power of tomatoes, he noted.

Although experts are working hard on the project, ongoing efforts to come up with daily dietary guidelines for antioxidant consumption will be "a long process," Prior said.

"How antioxidants behave, how they act within the body, the dose-response -- we just don't know enough about it," he said.

For her part, Anding said people shouldn't get too hung up on gorging on one particular food, but "cast your net widely," eating generous daily servings of a variety of fruits, vegetables and other wholesome foods.

Looking over the USDA's list, Anding suggested creating what she called an antioxidant "power salad."

First, she said, "put together a salad with a variety of mixed greens. Then I'd throw in some dried cranberries or blueberries from the health food store, toss in a few nuts, with a low-fat salad. Again -- choosing from the colors of the rainbow."

More information

Check out the U.S. Centers for Disease Control and Prevention (news - web sites) for its Color Your Way to 5 A Day antioxidant-rich diet plan.

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Clotting Factor Treats Bleeding Strokes

By M. Mary Conroy

Reuters Health

Monday, June 28, 2004

VANCOUVER (Reuters Health) - The normal use of coagulation Factor VII is to treat bleeding episodes in people with hemophilia, who lack the factor in their blood. Now researchers have shown that it can also be used to treat people suffering a type of stroke caused by bleeding in the brain, or intracerebral hemorrhage.

The international team found that when patients with intracerebral hemorrhage were treated with Factor VII (NovoSeven, made by Danish pharmaceutical company Novo Nordisk) within 4 hours of stroke onset, the volume of the bleed and the mortality rate was reduced.

The study, which was conducted at 73 centers worldwide, randomly assigned 400 patients to one of three doses of NovoSeven or placebo. Bleeding strokes were confirmed by a CT scan within 3 hours of onset and treatment was administered within 1 hour of the scan.

The study's lead investigator, Dr. Stephan A. Mayer of Columbia University College of Physicians and Surgeons in New York, presented the results at the World Stroke Congress here.

"We attained a 50 percent relative reduction in bleeding after baseline," he said. "The relative risk reduction in mortality was 35 percent, with a 10 percent absolute reduction in mortality, but this was not significant."

In an interview following the presentation, Dr. Mayer told Reuters Health that the study is the "first to show that a medical treatment can reduce bleeding as measured by CT scan."

He noted, too, that the benefit is achieved with a relatively small change in bleed volume. "I learned a difference a few drops of blood can make," he said. "We learned you can cut bleeding a little and get a huge difference in outcome. One teaspoon of blood meant we avoided death or severe disability in one of out five patients."

He likened the finding to the results of clot-buster therapy used to treat so-called ischemic strokes, which are caused by blockages in arteries supplying blood to the brain.

Dr. Daniel Hanley of Johns Hopkins Medical Institutions, Baltimore, told Reuters Health that perhaps the most important take-home message from the study is "that we should be treating intracerebral hemorrhage as an emergency in much the same way that we are now treating is chemic stroke."

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PTSD May Raise Physical Woes in Women


Monday, June 28, 2004

MONDAY, June 28 (HealthDayNews) -- For many women with posttraumatic stress disorder (PTSD), declines in mental and physical health too often go hand-in-hand, researchers report.

"Posttraumatic stress disorder is associated with a greater burden of medical illness than is seen in depression alone," write the authors of a study in the June 28 issue of the Archives of Internal Medicine (news - web sites).

First associated with returning Vietnam veterans, PTSD can affect survivors of traumatic events such as natural disasters, violent crimes or serious accidents. Symptoms include intrusive flashbacks to the trauma, nightmares, insomnia, emotional withdrawal and depression.

In a study involving 30,000 women, researchers at Veterans Affairs Palo Alto Health System in California compared the number of medical symptoms and overall health status of women with PTSD, women diagnosed with depression alone, and women without depression or PTSD.

They found women with PTSD reported poorer health and more physical illnesses than women who have only depression.

In fact, across all age groups, women with PTSD had more medical conditions and worse physical health status -- things such as low daily energy, chronic pain and poor physical functioning -- than women with depression alone or women with neither PTSD or depression.

PTSD may turn out to be "an important component" of the excess rate of illness and death seen in depressed women, the study authors conclude.

The California team also found that, among women younger than 45, 17 percent had a reported history of PTSD, while 25 percent had a reported history of depression. Those rates were roughly similar for middle-aged women between 45 and 64, and fell to 4 percent and 20 percent, respectively, for women aged 65 or older.

More information

The American Psychiatric Association has more about posttraumatic stress disorder.

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Sunday, June 27, 2004


Hip Fractures Need Special Care



Sunday, June 27, 2004

SUNDAY, June 27 (HealthDayNews) -- Hip fractures are a very common, yet serious problem that can afflict the elderly. Recovery can be especially uncomfortable in the heat of the summer.

About 320,000 hospitalizations result each year from hip fractures, according to the American Academy of Orthopaedic Surgeons, yet only one in four patients recover completely.

Patients often wind up on crutches or using a walker and needing to do physical therapy exercises. And because the body's ability to respond to summer heat decreases with age, such exertions can make surviving the heat even more of a challenge.

If medications are being taken or if there is other illness causing poor blood circulation or fever, the risk for heat stress or other heat-related illness can further increase.

Signs that a person may be experiencing heat-related illness include headache, nausea, muscle spasms and fatigue after exposure to heat, according to the National Institute on Aging (NIA).

If an elderly person reports such symptoms, it's important to get them to a cool place, preferably one that is air-conditioned. They should be offered fluids (not containing alcohol or caffeine), and encouraged to shower, bath or cool off with water, says the NIA.

It's always important to make sure elderly people recovering from hip fractures have access to transportation, but it's especially important in weather conditions of extreme heat or cold, in case air conditioning or heat sources are not available or fail to function.

Transportation services are available in many communities through agencies, religious groups and senior citizen centers. People without fans or air conditioners can sometimes find relief in shopping malls, movie theaters or libraries.

More information

You can read more about hip fractures through the American Academy of Orthopaedic Surgeons.

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Saturday, June 26, 2004


Don't Be Lulled by the Sun



Saturday, June 26, 2004

SATURDAY, June 26 (HealthDayNews) -- Warnings about the risks of exposure to the sun are perhaps so prevalent that they're apparently going unheeded.

Despite widespread knowledge that suntans and burns can increase the risk for skin cancer, a recent U.S. Centers for Disease Control and Prevention (news - web sites) survey found that about 43 percent of white children under age 12 had been sunburned at least once in the past year.

With skin cancers accounting for more than half of all cancers diagnosed in the United States each year, the warnings are not likely to let up.

The most preventable risk factor for skin cancer is exposure to the sun's ultraviolet (UV) rays, and you don't need to become a hermit to protect yourself. Activities such as going to the beach or taking that bike ride can be enjoyed safely if you take a few easy precautions, says the American Academy of Dermatology.

First and foremost, make sure to wear a waterproof sunscreen with a Sun Protection Factor (SPF) of at least 15, or preferably higher if you're going to be in stronger sun.

A good time to use that higher SPF sunscreen would be if you're going to be out between 10 a.m. and 4 p.m. -- the hours when the sun is strongest. If possible, try planning activities earlier or later in the day -- cooler temperatures may make the activities more enjoyable anyway.

Wear a wide-brimmed hat to keep the sun off your face and head, and try to stay in the shade.

Don't be fooled into believing artificial sources of sunlight are any safer than the real thing -- the American Cancer Society (news - web sites) says indoor tanning is just as bad for your skin as sunlight.

The good news about skin cancer is that the most common forms can be treated and even cured if detected early enough. Examine your body regularly for any unusual moles or discoloring, and make sure to see your dermatologist if you see anything suspicious.

More information

Find out your risk of developing skin cancer in the American Academy of Dermatology Skin Cancer Risk Test.

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Hospitals Seek to Spare Children's Pain

By Holly Ramer

Associated Press Writer

The Associated Press

Saturday, June 26, 2004

LEBANON, N.H. - The medical community appears to have heeded the American Academy of Pediatrics' policy statement on childhood pain. Issued in 2001, the policy urges doctors to relieve needless suffering by better anticipating and assessing pain, creating soothing environments in their offices and getting parents more involved.

The Pain Center at Akron Children's Hospital in Ohio uses everything from acupuncture to aromatherapy to soothe children undergoing medical procedures or recovering from surgery. The Children's Hospital and Research Center in Oakland, Calif., has a "Child Life" team dedicated to making hospital stays as comfortable as possible. And at Texas Children's Hospital, relaxation and distraction techniques used by pediatric anesthesiologists include blowing bubbles and letting children ride tricycles to the operating room.

When her 6-month-old son had surgery, lawyer Kathryn Babin argued her way into being allowed to hold him beforehand, but was denied permission to wait for him in the recovery room.

Baby Roger shrieked as an intravenous tube was inserted in his arm and was crying again when she finally was allowed to pick him up later.

"This is crazy," Babin thought. "Isn't there some other way?"

Now nearly 3, Roger has undergone several more medical procedures, but thanks to an innovative program at the Children's Hospital at Dartmouth, both he and his parents are much more relaxed. Instead of being held down and poked with a needle, he played in the hospital's "Comfort Corner," surrounded by ocean-themed murals and colorful kites, then snuggled with his mother while a mask delivered anesthesia.

"This last time, he told me, 'I'm ready to go to sleep now,'" Babin said.

The staff at Dartmouth's Pain-Free Program still sees plenty of tears, but the reason is different: Patients don't want to leave because they're having so much fun. Whether they're performing scary diagnostic tests or repeated treatments, the program's team of specialists uses technology and creativity to reduce the pain and stress of medical procedures.

"The hardest thing to do is relinquish your child to someone else," Babin said. "When they're doing something to them and you can't be there, it's very hard and nerve-racking. ... the way the Pain-Free clinic approaches it is so much more of a relaxed environment."

A generation ago, many health care providers bought into the misconception that children don't feel pain as adults do. But youngsters deserve — and parents now expect — better, said Dr. Joe Cravero, an anesthesiologist and medical director of the program.

"There's no reason a kid needs to be crying and screaming in the hospital," he said. "If you or I come in for an appendectomy, we get the anesthesia we need. It comes down to how interested you are in doing this right."

Though many hospitals offer clinics for helping children deal with chronic pain, the Dartmouth program works with all children, even those undergoing routine — but still sometimes frightening — procedures.

The Pain-Free team consults with parents and offers tips to prepare children for their appointments. By the time the children arrive, staff members know how to put them at ease, by asking about their pets by name or having their favorite movies cued on individual DVD players.

One of the first patients when the program started two years ago was a teenage girl with severe developmental disabilities who hadn't received needed medical care — just being approached by a doctor traumatized her. But when the Pain-Free team discovered she loved to dance, it arranged to have music playing when she walked through the door.

"We were all dancing, and she jumped right in," said team member Kristin (news - web sites) King, a child life specialist. Moments later, the girl was calm enough to be sedated.

"She has not fallen asleep in my arms since she was a baby," the girl's tearful father told King.

At the Pain-Free Program, stocking up on the latest animated movies is just as important as keeping up with the latest medical advances. Some techniques are complicated, such as figuring the correct dose of fast-acting, short-term anesthesia. Others are as simple as letting children wear their own clothes and sit on their parents' laps during sedation.

Older children who can stay still long enough for 45-minute MRI brain scans are helped by visualizing a trip into outer space — hospital workers count down to blastoff and explain the thumps and bumps they hear as passing planets.

To practice at home, some parents are told to have their child lay underneath a blanket-draped coffee table to get a feel for the machine's enclosed space.

On a recent Tuesday, 3-year-old Izabella Gyurcsan was one of half a dozen children scheduled for MRIs. Around 9:30 a.m., she was led to a cupboard of toys and then offered her choice of sedation mask — pink, purple or red. A few minutes later, she was wheeled down to the MRI room, her tiny socks peeking out from under the sheet. By 10:45, she was awake, nestled against a stack of pillows, clutching a stuffed animal and watching "Finding Nemo."

Her parents drove two hours from Milton for the test, which they hoped would rule out any serious problem connected to their daughter's hand tremors. They worried about whether Izabella could handle the test — she had woken up scared in the middle of the night and then threw up on the way to the hospital.

Paula Gyurcsan said she couldn't bear to watch Izabella get loaded into the imposing MRI machine, but the toddler seemed unfazed by the experience.

"It was fun for her," she said.

Dr. Joseph Hagan, a Vermont pediatrician who co-wrote the policy on childhood pain, said things have improved so much that pain has become "the fifth vital sign."

"When I was in medical school you always presented the patient's temperature, blood pressure, pulse and respiration rate — you didn't say they were in distress or no distress," he said. "That was something we knew but we didn't approach it as directly, and we should."

In the past, too many doctors assumed parents would treat their children's pain at home.

"We probably thought that kind of nurturing was the role of moms or dads," Hagan said. "But we're now taking responsibility for the fact we need to help them do that properly."

The Pain-Free Program isn't curing any children, but it is taking away their suffering, Cravero said.

"Parents eventually come to terms with what the diagnosis is. What they can never come to terms with is watching their child suffer repeatedly in a hospital," he said. "We can stop that part of it."

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