The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
September 20 , 2002

 

 

 

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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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

Personal Health for the Week of SEPTEMBER 1-6

FRIDAY, SEPTEMBER 6, 2002

  1. Immune Factors May Influence Post-Cancer Fatigue
  2. US: Race Gap for Prostate Cancer Survival Closing
  3. Women Could Need Antioxidants More Than Men
  4. Genes, Virus Implicated in Multiple Sclerosis
  5. Fish Oil Plus Statins May Improve Cholesterol
  6. Little Mixing of Black, White Seen in Elderly Care
  7. Sex of Fetus May Influence Pregnancy Complications
  8. Glucose May Help in Cardiac Arrest

    SUNDAY, SEPTEMBER 1, 2002

  9. Sleep Apnea Steals More Than Sound Slumber From Kids
  10. Medications Are Not Kids' Play
  11. Sex Discrimination in the Medicine Cabinet
  12. A Dose of Technology With Your Medicine


FRIDAY, SEPTEMBER 6, 2002

Link Suggested Between Water Acidity, Diabetes

By Keith Mulvihill

Reuters Health

Friday, September 6, 2002

NEW YORK (Reuters Health) - A preliminary investigation from Norway suggests a possible link between acidic drinking water and type 1 diabetes.

Children who consumed water with a pH between 6.2 and 6.9 were 3.7 times more likely to be diagnosed with type 1 diabetes, compared to children drinking less acidic water, lead author Dr. Lars C. Stene and colleagues report in the September issue of the journal Diabetes Care.

The pH scale is used to measure the acidity or alkalinity of a solution. A pH of 7, which is normal for water, is considered neutral. Values below 7 denote acidity. The lower the number, the stronger the acid.

However, the authors write, "Acid water in itself is unlikely to be causally related to type 1 diabetes, but may be a marker of some other factor."

Perhaps, they speculate, the association could have something to do with minerals in the water that are leached out of soil or plumbing fixtures due to the water's acidity. On the other hand, more acidic water may provide an environment for bacteria or viruses to grow, which could in turn trigger diabetes.

But further analysis found no association between drinking water's mineral content and diabetes. The researchers did not analyze the water for the presence of microorganisms.

Stene, who is with Aker and Ulleval University Hospitals in Oslo, and his team evaluated tap water samples from the homes of 64 children with type 1 diabetes and 250 healthy children.

"Although there are many possible sources of error, these results suggest the possibility that quality of drinking water influences the risk of type 1 diabetes," the authors write.

"I think (the researchers) have identified an interesting association, but it is clearly not the acidity of the water that's causing diabetes," said Dr. Gene Barrett, president-elect of the American Diabetes Association, who commented on the study in an interview with Reuters Health.

Barrett pointed out the amount of acidity that people get from drinking water is trivial compared to acidity in other foods and beverages.

"It appears that even the authors of the study would have a hard time saying that there is a relationship between how acidic the water is and something causing diabetes," said Barrett, who is with the University of Virginia in Charlottesville.

"When you encounter a study like this, the next step is to see whether you find the same association in another independent sample of people. If you do, then maybe there is something real to it, and if you don't, then maybe the initial findings were an anomaly."

While he finds the link interesting, Barrett said, it is "by no means a major step toward identifying" what causes diabetes.

In type 1 diabetes, the immune system launches a misguided attack against pancreatic cells called beta cells, which produce insulin. This leads to low or nonexistent levels of the sugar-regulating hormone. People with this type of diabetes must take daily insulin injections to survive.

Source: Diabetes Care 2002;25:1534-1538.

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Male Nurses Leaving Profession

By Joann Loviglio

Associated Press Writer

The Associated Press

Friday, September 6, 2002

PHILADELPHIA (AP) - Recent graduates of the nation's nursing schools are leaving the profession more quickly than their predecessors, with male nurses bolting at almost twice the rate of their female counterparts, according to a new study.

About 7.5 percent of new male nurses left the profession within four years of graduating from nursing school, compared to 4.1 percent of new female nurses, according to the study by a University of Pennsylvania researcher. It was reported Thursday in the journal Health Affairs.

"In general, nurses are looked down upon, especially by physicians," said Jerome Koss, a nurse since 1978 and an administrator for Fox Chase Cancer Center in Philadelphia. "It's changing but it's still an issue — and I think men are much less tolerant than women of that kind of treatment."

The research, which looked at data in a national survey of registered nurses conducted by the U.S. Department of Health and Human Services ( news - web sites) in 1992, 1996 and 2000, is the latest to highlight the nationwide nursing shortage.

Tom Foster, a nurse for eight years, said low pay is a big issue for men and women alike, and he questioned whether some men may discover after graduation that they have problems working in a female-dominated field.

"Many men are interested in the technical aspect of nursing and they use nursing as a stepping stone" to more advanced and better-paying jobs in critical care or as nurse anesthetists, said Foster, who also works at Fox Chase.

Though men only make up about 5 percent of the nursing work force nationwide, their departure rates are still a cause for concern, said Bill Cruice, director of the Pennsylvania Association of Staff Nurses and Allied Professionals.

"For men or women, the problem will not be solved until you deal with staffing levels, mandatory overtime, lack of respect and recognition and lack of a decent pension," he said.

Government and medical groups have said that if current trends continue, the nation will face a shortage of half a million nurses by 2020. The nation's nursing corps is aging, nursing school enrollments have been dropping and nearly 2.7 million nurses in the United States aren't actively practicing, according to a government report released earlier this year.

"If new RNs are leaving the profession after only a few years, the shortage is likely to reach crisis proportions sooner rather than later," said Julie Sochalski, associate professor at Penn's School of Nursing and author of the study.

The study also found that the dropout rate for new graduates of both genders is accelerating — rising from 2 percent of men in 1992 to 7.5 percent in 2000; and 2.7 percent of women in 1992 to 4.1 percent in 2000.

Job satisfaction also differed by gender, with 75 percent of new female nurses reporting they were satisfied with their jobs compared to 67 percent of male nurses. Among nurses established in their careers, 69 percent of women and 60 percent of men reported being satisfied with their jobs.

"Men, I think, want more autonomy in their careers ... they want to be making decisions about their own practice," Koss said. "The profession is changing and there's more room for that than there used to be. Maybe the problem is that the word's not getting out."

The report did not attempt to address why more new nurses, and specifically new male nurses, are leaving. But Sochalski said it shows the importance of looking for the reasons.

On the Net:

http://www.nursing.upenn.edu

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Total Diet, Not Just Fat Intake, Determines Weight

By Charnicia E. Huggins

Reuters Health

Friday, September 6, 2002

NEW YORK (Reuters Health) - Women who eat a high-fat, high-sugar "empty calorie" diet are likely to become overweight in later years, according to a team of researchers, whose new study results provide more evidence that you are--or will be--what you eat.

On the other hand, yo-yo dieters who cut fat out of their diet or drastically reduce their fat intake may not necessarily be protecting themselves from becoming overweight either, the study findings suggest.

"The truth is that people are still confused about how their dietary behavior contributes to health risk," lead study author Dr. Paula A. Quatromoni of Boston University School of Public Health in Massachusetts told Reuters Health.

"And people are frustrated with the controversy that exists, with arguments even among nutrition experts as to whether it's the amount of fat or the type of fat that matters most; whether high-carbohydrate diets are good for you; whether low-fat diets are appropriate either."

Quatromoni and her colleagues investigated the controversy about whether dietary patterns predict the development of overweight in a long-term study of 737 non-overweight women.

Overall, 214 (29%) of the women became overweight by the end of the 12-year study period, the investigators report in the September issue of the Journal of the American Dietetic Association.

Women categorized as "empty calorie" eaters--i.e. "junk food junkies," according to Quatromoni--were 40% more likely to be overweight than those who ate a "heart healthy" diet, consisting of more fruits and vegetables, low-fat milk, and other low-fat and high-fiber foods.

Empty calorie eaters were also more likely to be smokers--who were 20% more likely to be overweight at follow-up--and to be younger than women with other dietary habits, study findings indicate.

Yet, the "light eaters," or chronic dieters, tended to have fluctuating weights, as might be expected, and had a slightly higher risk of being overweight, the authors note.

These women "tend to cut back on their calories, but not necessarily in the most wise way," Quatromoni said. They did not replace the foods and nutrients they cut out of their diet and so lacked dietary balance and variety, she explained.

Altogether, the findings show that consumers should indeed heed the advice of nutritionists--to eat a balanced diet rich in fruits and vegetables, and to exercise, an activity all of the women studied could have used more of, Quatromoni said.

"People are looking for a quick fix (and are) willing to do one without the other," but exercise goes hand in hand with dietary changes, she added.

"I believe that consumers need to hear that message as often and as consistently as possible in light of the obesity epidemic worldwide," Quatromoni said.

Previous study findings have shown that nearly one quarter of all US adults are obese and more than half are overweight.

To maintain health and reduce the risk of heart disease and cancer, however, Americans should try to eliminate saturated fats and added sugars from their diets, and exercise for at least one hour each day, according to a new report released Thursday by the Institute of Medicine ( news - web sites)'s Food and Nutrition Board.

Source: Journal of the American Dietetic Association 2002;102:1240-1246.

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Radiation Alone Can Treat Rectal Cancer

HealthScoutNews

Friday, September 6, 2002

FRIDAY, Sept. 6 (HealthScoutNews) -- Radiation therapy alone is adequate treatment for people with rectal cancer who don't want surgery or can't have it because they're in poor physical shape.

So says a new study that appears in the September issue of the International Journal of Radiation Oncology, Biology and Physics.

It included 63 people, median age 72, who were enrolled in the study between 1986 and 1998. They had to have T2-T3, N0-N1, M0 adenocarcinoma of the middle or lower rectum involving less than two-thirds of the circumference.

Their radiation therapy began with contact X-rays, followed by external beam radiation therapy with a concomitant boost. After four to six weeks, the people received an iridium implant that delivered a completion dose to the tumor. The people in the study didn't receive any chemotherapy.

After 54 months, the primary tumor control was 63 percent. The overall survival rate after 5 years was 64.4 percent. For the 42 patients younger than 80, the 5-year survival rate was 79 percent, with 10 of those people still alive after 10 years.

Surgery is the most common treatment for rectal cancer. It's sometimes combined with radiation therapy to improve the outcome. However, some people can't have surgery because they're in poor physical condition. Others won't consent to surgery and its possible side effects.

"Surgery remains, without a doubt, the main treatment of rectal adenocarcinoma. Nevertheless, in inoperable patients, combined radiation therapy should be considered," says study author Dr. Jean-Pierre Gerard, of the Centre Antoine-Lacassagne in France.

"Research aimed at improving the quality of life of patients with rectal cancer is ongoing, and this study contributes to that body of knowledge," he says.

More information

The National Cancer Institute ( news - web sites) has more on rectal cancer.

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Older Fathers' Kids Face Higher Schizophrenia Risk

Reuters

Friday, September 6, 2002

STOCKHOLM (Reuters) - Swedish scientists have found that older men face a much greater risk of fathering schizophrenic children than younger men.

Schizophrenia is a debilitating form of mental illness with symptoms ranging from delusions and an altered sense of self to apathy and social withdrawal.

Scientists at Sweden's Karolinska Institute found that children fathered by men aged 45 or older were three times as likely to develop schizophrenia as offspring of men aged 20-24.

"We already knew there was an increased risk when older women have children," Christina Dahlman, the physician who led the study, told Reuters Friday.

"When I looked closer at the men I noticed that many children with schizophrenia had old fathers."

The findings, released this week, support earlier studies by Israeli and American scientists.

As in many Western countries, couples in Sweden are delaying having their first child. In the past three decades, the average age of a first-time mother has risen five years to 28.5 years.

Dahlman and colleague Peter Allebeck studied 524 schizophrenics for more than seven years and found that being fathered by an older man doubled the risk of developing the disease.

As most older men tended to have older wives, the cumulative risk was three times greater.

The reasons for the link were unclear, but Dahlman said sperm cell mutations, which increase as a man ages, have been known to cause various other diseases.

Children of older men may also lose their fathers at an early age, he noted, and stress caused by the loss of a parent could exacerbate any underlying schizophrenia.

Around 24 million people worldwide suffer from schizophrenia, according to the World Health Organization ( news - web sites). Symptoms can be treated but there is no cure.

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Panel: DOD Vaccine Program Limited  

By Suzanne Gamboa

Associated Press Writer

The Associated Press

Friday, September 6, 2002

WASHINGTON (AP) - The Department of Defense ( news - web sites)'s vaccine acquisition program is underfunded and poorly organized, limitations that put military operations, the health of personnel and national security in jeopardy, an Institute of Medicine ( news - web sites) panel said Friday.

The panel, convened in April 2000, urged the Pentagon ( news - web sites) in a 133-page report to make vaccine acquisition a higher priority and create a single authority responsible for acquiring vaccines for the military.

"Limitations in the acquisition process make the path from basic research to the procurement and use of vaccines both inefficient financially and cumbersome," the report said. "This approach risks the success of military operations and the health of personnel and potentially places national security at risk."

Infectious diseases have historically been a concern in military campaigns, and recent threats of bioterrorism, last year's anthrax mailings and the possibility of a U.S. attack on Iraq, which is believed to be stockpiling biological weapons, have raised concerns about U.S. vaccine supplies.

The panel said the biggest problems in the Department of Defense vaccine programs are that too many agencies have overlapping responsibilities. One part of the department purchases and maintains licensed medical products including vaccines, while a number of different Department of Defense agencies oversee research and development.

In addition, the department has divided its programs in a way the committee says "makes no sense." The U.S. Army Medical Research and Materiel Command acquires vaccines for infectious diseases, while the department's Joint Vaccine Acquisition Program, acquires vaccines for biological agents used as weapons.

The panel recommends combining all the programs because naturally occurring infectious diseases and infectious agents used as biological weapons can be the same, in the case of small pox for instance.

With a single program, budgets also could be consolidated, making more money available. The current process "does not take sufficient account of the fact that vaccines are complex systems and not simply commodities that can be specified, procured and placed on the shelf for future use," the panel said.

Spokesmen for the Pentagon and Army could not be reached by phone. In an e-mail, Department of Defense spokesman Jim Turner said: "We appreciate the thoughtful work of the IOM on this important matter and will be studying their recommendations carefully. In the meantime, no decisions about the report have been made."

To illustrate the failure of the military's modern vaccine programs, the committee cited the example of widespread acute respiratory illnesses, caused by adenovirus infections, at military basic training facilities over the decades.

The military developed vaccines in the 1980s, but the sole vaccine manufacturer stopped producing them in 1996 after failing to reach agreement with Department of Defense on improvements required at the manufacturing facility by the Food and Drug Administration ( news - web sites).

The illnesses re-emerged causing hospitalizations among trainees and at least two deaths. The committee said many recruits today repeat their training because the sickness causes them to lose training time.

"After many years, what was not a problem, became a problem," said Dr. Stanley Lemon, committee chairman and dean of medicine at the University of Texas Medical Branch, Galveston.

The U.S. Army Medical Research and Materiel Command receives about $60 million a year for its vaccine acquisition program. A total for the Department of Defense's biological weapons vaccines program was not available.

Lemon said development of a single vaccine usually costs hundreds of millions of dollars.

"In 1950 and 1960, we as a nation were better prepared to use the knowledge we had available to us for protection against infectious disease than is the case today in 2000," he said.

On the Net: Institute of Medicine of National Academies: http://www.iom.edu/

U.S. Army Research Medical Research and Materiel Command: http://mrmc-www.army.mil/

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Sept. 11 Attacks Caused Anger, Unhealthy Behavior

By Karen Jacobs

Reuters

Friday, September 6, 2002

ATLANTA (Reuters) - The September 11 attacks caused emotional problems and an increase in unhealthy behavior among New York-area residents, pointing to a need for programs to help people cope with traumatic events, according to a study released on Thursday by US health officials.

A survey of 3,512 people in New York, Connecticut and New Jersey revealed 75% had problems such as increased anger stemming from the attacks, the Atlanta-based Centers for Disease Control and Prevention ( news - web sites) said.

The findings were based on a telephone survey that took place between October and December of last year.

The federal health agency said people across all races and educational levels were deeply affected by the hijacked plane attacks on the United States that killed about 3,000 people, including more than 2,800 in the destruction of New York's World Trade Center.

Yet only 12% of the survey participants got help to cope with their problems, mainly from family and friends, the CDC added.

Respondents said 21% of smokers smoked more, while 1.4% of nonsmokers began smoking, the CDC said. About 3% of alcohol drinkers drank more after the attacks.

"The findings in this report underscore the need to consider the emotional and psychological well-being of Americans after traumatic events," said Wayne Giles, a physician at the CDC's National Center for Chronic Disease Prevention and Health Promotion.

"We don't want people adopting adverse health behaviors" after disasters, Giles added. He said programs that included moderate levels of physical activity could help people cope with stress.

Among survey respondents, about half participated in religious or community memorial services after the attacks, with 13% attending a funeral or service for a relative or acquaintance killed in the attacks. About 27% of respondents missed work after the attacks, mainly because of transportation problems, the study found.

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Orange Packers Are Dying To Please You

HealthScoutNews

Friday, September 6, 2002

(HealthScoutNews) -- Color additives -- any dye, pigment or substance that can impart color when added or applied to a food, drug, or cosmetic -- either meet or set our expectations for foods and other products. Many add nothing but color; others dyes also affect a food's taste.

The Food & Drug Administration ensures the safety of all color additives used in the United States. The ones used in food all are classified as "certifiable" or "exempt from certification". The former are manmade, while the latter include pigments derived from natural sources such as vegetables, minerals or animals, and man-made counterparts of natural derivatives.

For example, caramel color is produced by heating sugar and other carbohydrates under strictly controlled conditions for use in sauces, gravies, soft drinks, baked goods and other foods.

Certifiable additives are used widely because their coloring ability is more intense than most colors derived from natural products. In addition, certifiable color additives are more stable, provide better color uniformity and blend together easily to provide a wide range of hues.

Certifiable color additives generally do not impart undesirable flavors to foods, while color derived from foods such as beets and cranberries can change another food's taste.

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Psychotic Illness Behind Few Violent Acts: Report

Reuters Health

Friday, September 6, 2002

NEW YORK (Reuters Health) - Despite a few well-publicized cases of people with serious mental illness committing violent crimes, patients with psychosis are responsible for little of the violence in society, according to UK researchers.

They say that, overall, recent studies show that people with psychotic illness have a "modest" increase in the odds of violent behavior. But other factors, including drug abuse and poverty, are much stronger contributors to violence.

"Fear and stigma of mentally ill people have been exaggerated by high profile and occasionally sensationalist reporting of rare, albeit tragic, violent acts," Elizabeth Walsh and Thomas Fahy write in the September 7th issue of the British Medical Journal.

Psychosis, like that seen in schizophrenia, involves a break with reality. Patients show disturbed thinking and perception, including hallucinations and delusions. But violence, according to Walsh and Fahy, is not a common feature of psychotic illness.

In their look at studies in the field, the researchers from Guy's, King's and St. Thomas's School of Medicine in London found that less than 10% of serious violence, including homicide, is attributable to psychotic illness.

Instead, they report, far more violence can be linked to substance abuse--alone or in combination with serious psychiatric illness--as well as mental conditions known as personality disorders. These conditions, which include antisocial personality disorder, involve ingrained, inflexible traits and behaviors that interfere with a person's ability to function in day-to-day life.

In addition, Walsh and Fahy found that being male, young and of low social and economic status are far more important factors than psychotic illness in the odds of violent behavior. They note that a recent US study showed that 16% of low-income men between the ages of 18 and 24 had committed violent acts, "which presents a far greater risk than all people with schizophrenia in the sample."

The researchers conclude that "the scientific literature...refutes the stereotyping of all patients with severe mental illness as dangerous."

It is "inappropriate," they argue, for mental health policy or laws to be driven by a "preoccupation with the risk of violence" among people with psychosis.

Source: British Medical Journal 2002;325:507-508.

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Some Seek Attention by Making Pets Sick

Reuters Health

Friday, September 6, 2002

NEW YORK (Reuters Health) - Some people have a rare disorder in which they deliberately cause illness in others, and then use the illness to get sympathy and medical attention. Most cases involve mothers who hurt their own children, but a new report shows that people with this illness may also hurt their pets.

In a recent report, a group of UK researchers suggest that up to 9 of every 448 cases of non-accidental injury in a pet--or 2%--may result from an owner's deliberate actions.

The mental illness that may be causing owners to hurt their animals is known as Munchausen syndrome by proxy. People with Munchausen syndrome repeatedly play the patient role to gain sympathy and medical attention by feigning illness or by hurting themselves, while those who use a proxy seek attention by making others ill.

The recent study suggests that, in some cases, the proxy is a pet. In one instance described in the report, a man visited a veterinarian and said a neighbor had poisoned his dog. However, the owner was later convicted of trying to poison his child, and during the court proceedings, officials discovered that he had tried to poison two previous pets--suggesting that the owner himself had made his pet sick.

During the study, the investigators sent questionnaires to 1,000 veterinary surgeons, asking them about their experiences with non-accidental injuries in animals. The veterinarians submitted information about 448 cases, 6 of which they said they believed were instances of Munchausen syndrome by proxy.

After reviewing the information, the researchers, led by H.S. Tucker of the Royal United Hospital in Bath, UK, noted that 3 other cases may have also resulted from owners deliberately hurting their pets.

In the report, published as a letter in the Archives of Disease in Childhood, Tucker and colleagues also note that many suspicious cases had certain features in common--notably, owners would often change veterinarians, or request frequent appointments. In one case, an owner reportedly asked for four appointments in one day.

To help identify cases of Munchausen syndrome by proxy, Tucker and colleagues recommend communication between the agencies that deal with child and animal abuse.

"Communication between child protection agencies, veterinary surgeons, and the RSPCA (Royal Society for the Prevention of Cruelty to Animals) is beginning to occur in different parts of the country," the authors write. "Such liaison should be welcomed by pediatricians."

Source: Archives of Disease in Childhood 2002;87:263.


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Teenage Girls Shun Milk as They Get Older--Study 

By Randy Fabi

Reuters

Friday, September 6, 2002

WASHINGTON (Reuters) - Despite popular ads featuring milk-mustached athletes and rock stars, American teenage girls drink less milk as they grow older and instead quench their thirst with sugar-filled soda, a new study said on Thursday.

A US Agriculture Department ( news - web sites) study of girls aged 12 through 19 found the youngest drink the most milk and the least soda.

In a survey of 732 girls, 78% of 12-year-old girls drank milk, while consuming only nine ounces of soda per day. The oldest teenagers, the 19-year-olds, gulped down 14 ounces of soda per day and only 36% continued to drink milk.

"I was surprised with the trend," said Shanthy Bowman, the author of the study. "This could have been due to peer pressure...as milk could be seen as only for children."

When comparing with previous studies, the study found a 36% decrease in overall milk consumption among US teenage girls from the 1970s to the mid-1990s.

Bowman said many 19-year-olds had inadequate amounts of vitamin A, calcium, phosphorus and magnesium, which are important for strengthening bones. The lack of these essential nutrients could later make them vulnerable to obesity, high blood pressure and osteoporosis.

The study found most of the soda was consumed at home, not purchased from vending machines at school. That means parents have the ultimate control of what their children eat and drink, Bowman said.

The American School Food Service Association said research has proven children are more likely to drink more milk if their parents are.

"Children are strongly impacted when they see what their parents are doing," said Jan Stanton, director of public awareness for the nonprofit organization.

The study comes as school districts reevaluate whether to continue offering soda during lunch periods. Last month, Los Angeles County school officials voted to ban the sale of soft drinks to its 735,000 students amid worries about increasingly overweight children.

The American School Food Service Association, which supported the ban, said it was working with the US Dairy Council to develop new milk flavors and trendy products that would attract older teenagers.

For more than five years, US dairy groups have used a "Got Milk?" advertising campaign featuring such celebrities as tennis star Serena Williams ( news - web sites), football running back Terrell Davis, Brazilian ( news - web sites) model Gisele Bundchen, and members of Cirque du Soleil circus wearing milk mustaches.

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New Nutritional Guidelines Tie Exercise, Calories
Report Urges Americans to Consume More Fiber and Less Sugar, and Sets Carbohydrate Goals

By Sally Squires
Washington Post Staff Writer

The Washington Post

Friday, September 6, 2002

New nutritional recommendations issued yesterday urge Americans to exercise an hour a day, boost their fiber intake and significantly cut back on consuming foods with added sugar, including such popular fare as soft drinks and candy.

Instead of setting a single average target for the maximum number of calories people should consume every day -- the previous guidelines advised about 2,900 calories a day for men and 2,200 calories for most women -- the new guidelines also conclude that how much people eat should be tied directly to how much physical activity they get. For example, a sedentary woman might only need 1,800 calories a day, the report notes, but a very active woman the same age and size could eat up to another 1,000 calories a day to maintain a healthy body weight.

For the first time, the guidelines set a recommended daily intake for carbohydrates -- a move that many nutritionists said is likely to influence the debate about a low-carbohydrate vs. a high-carbohydrate approach to dieting. Children and adults need a minimum of 130 grams a day of carbohydrates to provide enough glucose to the brain, the guidelines state, noting that most people more than achieve that goal. That's about six times as much as what low-carbohydrate regimens like the Atkins diet advise during the weight-loss phase.

Carbohydrates can come from bread, crackers, pasta, fruit, vegetables, potatoes, beans and a host of other foods. But only 25 percent of total calories each day should come from foods with added sugar, such as full-strength soft drinks, candy, cookies and even fruit drinks with added sugar, according to the guidelines.

Issued by the National Academy of Sciences after more than two years of study, the report is called the Dietary Reference Intakes and takes the place of what were formerly called the Recommended Dietary Allowances -- better known as RDAs. The new report is the latest in a series from the academy revising all its dietary recommendations for the first time since 1989.

The new guidelines also ease up a little on fat. Instead of urging a blanket approach that about 30 percent of total daily calories can come from fat, they say that a healthy diet can include from 20 percent calories from fat to as much as 35 percent. That upper limit echoes the latest guidelines issued by the National Heart, Lung and Blood Institute, but goes farther than current recommendations set by the American Heart Association.

Healthful fats are emphasized in the new guidelines, which set a daily intake for two types of polyunsaturated fat that appear to help reduce sudden death from heart disease. These beneficial fats cannot be manufactured by the body and so need to be eaten every day, the report notes. While dietary supplements can supply them, Joann Lupton, chair of the committee that drafted the report, said that it is important to "meet these requirements with food." Good sources include milk, nuts, avocados, olives, flaxseed, soybeans as well as safflower, canola and corn oils.

At the same time, the report underscores the dangers of saturated fat -- such as that found in fatty cuts of meat or whole fat dairy products -- and of trans fatty acids, which often appear in baked goods and fried foods. Dietary cholesterol, the report notes, should also be eaten sparingly because the body naturally makes all that it needs. All three of these fats help contribute to the risk of heart disease, the report notes.

"It's definitely a step in the right direction,'" said Dean Ornish, director of the Preventive Medicine Research Institute in Sausalito, Calif., and an advocate of the low-fat approach.

Fiber, on the other hand, is a food that the report found is often lacking in most people's diets. For this reason, the guidelines establish the first recommended dietary allowance for fiber, setting 38 grams for men ages 50 and younger and 25 grams a day for women the same ages. This requirement can be met by eating more fruit and vegetables, beans and whole grains, such as whole wheat bread, oatmeal and other whole grain cereals and brown rice, the report notes.

Most importantly, experts said that the new report underscores the need for Americans to reach a healthy weight and maintain it. Government figures show that more than half of Americans 18 and older are overweight or obese. This growing epidemic results in an estimated 300,000 deaths per year and billions of dollars in health care expenses. Childhood obesity is also increasing, and with it the incidence of health problems once seen only in adults, including Type 2 diabetes.

With its emphasis on an hour a day of activity, the new report goes farther than some groups, including the American Heart Association, in advocating exercise. "We need to assess that," said Heart Association President Robert Bonow. "The last thing we want to do is to have messages that appear to be conflicting." The new guidelines stress that people can fulfill the need for 60 minutes of exercise a day in smaller increments throughout the day and do not necessarily have to spend a full hour exercising all at once.

Some experts applauded the inclusion of physical activity, but worried that consumers might find it confusing to calculate calories based on exercise. "It's a hard concept to get across," said Judith Stern, professor of nutrition and internal medicine at the University of California at Davis. "But it is really important for people to recognize that energy balance -- energy in and energy out -- is what contributes to obesity."

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Smoking + Chronic Infection = Artery Trouble 

Reuters Health

Friday, September 6, 2002

NEW YORK (Reuters Health) - While it's well known that smoking increases a person's risk of heart disease, new findings from Italy suggest that the risk may be due to a combination of smoking and chronic infection.

In the study, smokers or ex-smokers with chronic infections had more rapid atherosclerosis, the build-up of fatty deposits in arteries characteristic of heart disease, than smokers without such infections.

"This study provides the first epidemiological evidence that the atherosclerotic effects of smoking are mediated in part by chronic infection," said lead investigator Dr. Stefan Kiechl of Innsbruck University Hospital in Austria.

In the 5-year study, the researchers assessed the artery health of 4,793 men and women between the ages of 40 and 79 years living in northern Italy. All of the participants answered questions that assessed smoking behaviors and were screened for various chronic infections such as bronchitis, urinary tract infections, ulcers, skin infections, gastrointestinal infections or gum disease. For example, the participants were considered to have a chronic urinary tract infection if they had three or more documented episodes of infection in a 2-year period.

After 5 years, 332 men and women developed new plaques in the carotid artery of the neck, the authors report in the September issue of Stroke: Journal of the American Heart Association ( news - web sites).

Kiechl's team found that current and ex-smokers who had chronic infections were 3.3 times more likely to develop early atherosclerosis compared to current, past and non-smokers without chronic infection.

What's more, the investigation revealed that people with chronic infections who were only exposed to passive, or secondhand, smoke also experienced a high risk of atherosclerosis. And ex-smokers with chronic infection saw their risk of early atherosclerosis remain elevated even 10 years after kicking the habit.

"Active and passive smoking represents one of the most severe risks for atherosclerosis," Kiechl said. "Smokers are at significantly higher risk of developing severe early atherosclerosis, but we found the risk falls to that of non-smokers after they quit, unless there is a history of chronic infection."

The researchers recommend that smokers seek treatment for their chronic infections.

Source: Stroke 2002;33.


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Even Light Weights Can Help Elderly Get Stronger

Reuters Health

Friday, September 6, 2002

NEW YORK (Reuters Health) - Resistance training with even light loads can boost strength and endurance in healthy elderly adults, study findings show.

The results are good news for older people who want to get stronger while minimizing the chance of injury, according to researchers.

A number of studies have shown that strength training benefits young and old alike. For the elderly, the decline in muscle mass and strength that typically comes with age can hinder mobility and increase the risk of falls and injury.

But the ideal way for older adults to strength train--how long, how often and at what intensity--is unclear. Low-intensity training involves lighter weights and more repetitions, while high-intensity training uses fewer repetitions with heavier weights.

Now the new study, reported in a recent issue of the Journal of the American Geriatrics Society, suggests that low- and high-intensity training offer the same benefits to healthy older adults.

Researchers had healthy men and women between the ages of 60 and 83 go through 6 months of supervised resistance training, either low- or high-intensity. A third group that did not train served as the "control" group. The exercisers trained on resistance machines three times a week, working on major muscles in the legs, arms and trunk.

Of the 62 participants who completed the study, those in both training groups saw similar improvements in their muscle strength and endurance. They also cut the time it took them to climb a flight of stairs, according to the study authors, led by Dr. Kevin R. Vincent of the University of Florida in Gainesville.

These comparable benefits are important when it comes to exercise recommendations for the elderly, Vincent and his colleagues note.

"Lighter loads may allow the exerciser to obtain adequate benefits while reducing the possibility for injury," they write.

And, they point out, all participants did only one set of repetitions per exercise, with the whole circuit taking 15 to 30 minutes. Similar regimens have been linked to good compliance and lower risk of injury.

Source: Journal of the American Geriatrics Society 2002;50:1100-1107.


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Obesity, 'Spare Tire' Up Stroke Risk in Older Men

Reuters Health

Friday, September 6, 2002

NEW YORK (Reuters Health) - Men older than 70 who are obese and carry much of their extra weight in the form of a "spare tire" around the waist have a higher risk of suffering a stroke than their more svelte peers, new study findings suggest.

In contrast, neither extra weight nor abdominal fat appeared to increase the risk of stroke for women, the researchers found.

Obesity is linked to a host of health problems, and previous studies have suggested that excess belly fat, compared to fat elsewhere on the body, can increase the risk of heart disease and type 2 diabetes.

Researchers have also shown that a large pot belly increases the risk of stroke in middle-aged men and women, but investigations into the relationship between obesity and stroke in this population have produced mixed results. Body fat tends to increasingly relocate to the abdomen with age, but little research has been conducted on the risk of stroke in relation to abdominal fat and overall obesity in older adults.

Dr. Debashish K. Dey of Goteborg University in Sweden and colleagues examined 1,242 women and 1,045 men at least 70 years old, then followed them for 15 years to determine how many had a stroke. The investigators measured abdominal fat according to the patients' waist circumferences, and obesity in terms of body mass index (BMI), which takes into account a person's weight in relation to their height.

During the study, 453 strokes occurred--207 in men and 246 in women. Dey and colleagues found that men with the most abdominal fat were 65% more likely to have strokes than those with the smallest tummy bulges, and stroke risk increased by 68% in the most obese men relative to those with the lowest BMIs.

The risk of stroke in relation to obesity and the size of an older man's "spare tire" did not change when Dey and colleagues factored in other cardiovascular risk factors, such as smoking, coronary heart disease and diabetes.

However, in women, neither obesity nor increased abdominal fat seemed to up the risk of stroke, the authors report in the latest issue of the Journal of the American Geriatrics Society.

"Thus, it appears that overweight and increased abdominal (fat) are risks for stroke in older men but not women," Dey and colleagues conclude.

Source: Journal of the American Geriatrics Society 2002;50.


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Indoor Air Quality Fails In Schools

HealthScoutNews

Friday, September 6, 2002

(HealthScoutNews) -- Twenty percent of the U.S. population, nearly 55 million people, spend their days in elementary and secondary schools. Studies show that one-half of the nation's 115,000 schools have problems linked to indoor air quality, the Environmental Protection Agency ( news - web sites) reports.

Students are at greater risk because of the hours spent in school facilities and because children are especially susceptible to pollutants, the EPA says.

The three major sources of indoor air problems in schools are building maintenance, waste management and food service.

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Higher Dose of Head-Trauma Drug May Save Lives

Reuters Health

Friday, September 6, 2002

NEW YORK (Reuters Health) - Upping the dose of a drug that helps alleviate fluid build-up in the brains of patients with severe, life-threatening head trauma may double their chances of survival, according to the results of a study from Brazil.

In the investigation, the researchers compared the effects of conventional doses of the drug mannitol in 69 patients versus a higher dose of the drug in 72 patients. All of the men and women in the study were in a coma and had abnormally widened pupils, indicating a high risk of death, the authors report in the September issue of the journal Neurosurgery.

Mannitol is commonly given to head injury patients to reduce brain swelling and pressure within the skull, which helps keep brain damage to a minimum.

Among patients given the higher dose of mannitol--double the conventional dose--pressure within the skull returned to normal 3 days earlier, on average, than among those who received the smaller dose. The abnormally widened pupils also returned to normal more quickly in patients given more mannitol.

But pupil response to mannitol was worse in patients whose pupils already showed abnormal widening at the scene of the accident, versus those whose pupils did not expand until they reached the hospital.

The findings suggest that giving brain-injured patients mannitol before they reach the hospital "should be considered," according to Dr. Julio Cruz of the Federal University of Sao Paolo in Brazil and colleagues.

Six months after the injury, 19% of the patients given the higher dose of mannitol had died, versus 36% of those who received the conventional dose, the report indicates.

"It will be interesting to see whether other investigators can replicate these findings," Alex B. Valadka of Houston, Texas, writes in an accompanying editorial. "If so, one important lesson to take from this article is that it may be wise to optimize the use of conventional, old-fashioned, tried-and-true therapies before abandoning them for new, unproved, or experimental treatments."

Source: Neurosurgery 2002;51:628-638.


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Medium-Rare Please, And Deliver It to My Cave

 

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Friday, September 6, 2002

FRIDAY, Sept. 6 (HealthScoutNews) -- The recent discovery of a 7,700-year-old female thighbone has given scientists new insight into the eating habits of our ancient ancestors.

 It appears they didn't even come close to following a balanced diet.

Using stable isotope analysis, researchers from the University of Sheffield and Bradford University in England found the woman ate nearly as much meat as a wolf.

Dubbed the Lady of Trent, the woman's thighbone was found during excavation of a gravel pit in a dried up channel of the River Trent in Staythorpe. Scientists believe the woman lived during the Mesolithic era.

Analysis of nitrogen isotopes in bone measure how much meat was present in a person's diet over a period of several years, and carbon isotopes can be used to measure the amount of marine or land-based food sources in the diet, according to the University of Sheffield archaeologist who found the bone, Glyn Davies.

"For the meat, her nitrogen figure was 9.3. For comparison, a cow would have a figure of about six and a carnivore like a wolf around 10 or more," says Davies. "This suggests that her diet included a lot of meat, but would have included some plants."

Davies says the Lady of Trent ate no marine life, which wasn't surprising because she lived 35 miles from the coast.

The archaeologists also found bones from deer and wild cattle near the woman's thighbone. These animal bones had cut marks on them, suggesting they had been butchered, Davies says.

Of course, just because our ancestors might have eaten this way, it doesn't necessarily mean it's a healthier way to live.

"Our ancestors made due with what they had to eat," says New York University nutritionist Samantha Heller, explaining that other research has found people who lived near the coast ate mostly fish.

Humans live much longer lives now, Heller points out. Our ancestors probably died long before heart disease, diabetes or cancer would have set in, she says. Plus, they were much more physically active than people are today.

Most important, she says, this is only the bone of one woman, and you can't judge the diet of an entire people by one person.

If you want to stay healthy, avoid the Lady of Trent's diet, Heller advises. Eat a mostly plant-based diet with lots of vegetables, legumes and whole grains.

"Don't eat a lot of full-fat animal products. We know that a high consumption of saturated fat and cholesterol greatly increases our risk of heart disease," she adds.

What To Do

To learn more about the Mesolithic period and what people might have eaten back then, visit the University of Leicester or the Chichester District Museum.

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More Behavior Problems for Low Birth Weight Kids

By Charnicia E. Huggins

Reuters Health

Friday, September 6, 2002

NEW YORK (Reuters Health) - Eleven-year-olds who were born weighing less than normal are more likely to have psychiatric and behavioral disorders--attention problems in particular--than their normal birth weight peers, according to a team of Norwegian researchers.

They hypothesize that the children's inattention may lead to their behavior problems and resulting lack of social skills, or difficulty relating with their peers, both of which have been previously reported.

To investigate, Dr. I. Elgen from the University of Bergen in Norway and her colleagues studied 130 11-year-olds who, at birth, weighed less than 2,000 grams (4.4 pounds). Their study also included 131 normal birth weight children for comparison.

Nearly 30% of the low birth weight children had psychiatric disorders, most commonly attention-deficit/hyperactivity disorder (ADHD). These types of problems were reported three times more often among low birth weight children than among their normal birth weight peers, the researchers report in the September issue of the journal Archives of Disease in Childhood: Fetal and Neonatal Edition. Other psychiatric disorders included depression, separation anxiety and some type of phobia.

Furthermore, 4 in 10 low birth weight children had behavioral problems, in comparison to less than 10% of their normal birth weight peers, study findings indicate. In fact, the low birth weight children were eight times more likely to have behavioral problems than their peers.

"The amount of behavioral problems are much higher than psychiatric disorders, meaning that even though a low birth weight child does not have a disorder, they might suffer from behavioral problems that have to be taken care of," Elgen told Reuters Health in an interview.

Behavior problems included inattention and social problems--which were strongly linked and were reported by both mothers and teachers--as well as anxiety problems and delinquency problems, the report indicates. Low birth weight children were also more likely to have low self-esteem.

The link between the children's social problems and their attention problems--in terms of them being easily distracted, impulsive and unable to adapt easily--suggests that inattention may be the root of the problem among low birth weight children, the researchers speculate.

"Possibly having difficulties with adaptability, impulsivity, and sustaining attention is the cause of difficulties in relating to peers and the cause of lower self-esteem and lower social activity level in the present study," Elgen and colleagues write.

Commenting on the study, Dr. Joan Kinlan, a Washington, DC-based private practice child and adolescent psychiatrist, said, "There appears to be a slightly higher incidence of behavioral and psychiatric disorders, but the majority of these is ADHD, which may be coincidental and is highly treatable."

The ADHD-related finding may be coincidental because the condition may be genetic and Elgen's study provided little background information about the mothers of the low birth weight children, Kinlan explained.

Since there was a "slight association," however, parents with concerns about their child's behavioral or psychiatric state should have them evaluated by a trained professional, she said.

Most of all, "enjoy your child," Kinlan advises parents. "Most of them catch up (to their peers) by age 5, and for those that do have problems, they are highly treatable."

The Norwegian Foundation for Health and Rehabilitation and the Norwegian Research Council funded the study.

Source: Archives of Disease in Childhood: Fetal and Neonatal Edition 2002;87:F128-F132.


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Moms May Play Role in Risk of Asthma from Cats

By Alison McCook

Reuters Health

Friday, September 6, 2002

NEW YORK (Reuters Health) - Some studies have suggested that exposure to cats in early childhood can actually protect children from asthma and allergies. However, a new report suggests that for children born to asthmatic mothers, the opposite may be true.

Dr. Juan C. Celedon of Brigham and Women's Hospital and Harvard Medical School ( news - web sites) in Boston, Massachusetts, and his colleagues found that children whose mothers have asthma appear to be more likely to develop wheezing--a labored breathing that can be a precursor to asthma--when exposed to a cat.

However, children whose mothers were asthma-free had a lower risk of wheezing if they spent time around a cat during the first few months of life, compared to those without early feline company. All 448 children in the study were from families with a history of allergies, some who were exposed to cats at ages 2 to 3 months while others were not.

"Our findings, along with those of other studies, suggest that exposure to a cat in early childhood reduces the risk of asthma and allergies for most children," Celedon told Reuters Health.

"Based on the findings of the study, however, I would not recommend that children born to mothers with asthma have a cat during the child's early life until this issue is clarified," he said.

Celedon's team interviewed a child's caretakers once every 2 months during the first 2 years of a child's life, and then once every 6 months for the rest of the study period, until the youngster was 5 years old.

During the surveys, the researchers asked if there was a cat in the house, and whether the child was wheezing or experiencing whistling in the chest. In addition, Celedon and his colleagues measured the level of substances produced by cats that trigger allergic reactions--known as allergens--in house dust when children were between 2 and 3 months old.

In an interview with Reuters Health, Celedon explained that a child's exposure to cats during the first few months of life is important because previous studies have indicated that those early moments have a strong influence on the development of the immune system. However, most children who had household cats during their first months of life still lived with cats when they were 5 years old, which suggests that the risk of asthma presented in the current findings relates to both early and ongoing exposures to cats in childhood, he noted.

Just why Mom's history of asthma affects a child's reaction to cats more than Dad's history of the condition remains unclear, Celedon said. He suggested that genetic influences or early life exposures shared by mother and child may play a role.

Celedon cautioned that not all children who experience wheezing develop asthma, but that those with a parental history of the condition have a relatively higher chance of eventually exhibiting the condition.

"Because our children were born to parents with a history of asthma, hay fever, or allergies, however, wheezing--particularly at the age of 5 years--is more likely to represent asthma than in children not born to parents with allergic diseases," he said.

Source: The Lancet 2002;360:781-782.


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THURSDAY, SEPTEMBER 5, 2002

Mom's the Key to Cats Curbing Asthma in Kids

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Thursday, September 5, 2002

THURSDAY, Sept. 5 (HealthScoutNews) -- Babies exposed to a cat at home gain protection from later allergies -- unless their mother has a history of asthma.

That's the conclusion of a new study that adds to the growing body of evidence suggesting that pets often prevent rather than aggravate childhood allergies.

"Even in this high-risk group, exposure to a cat in early childhood was protective against wheezing in the first five years of life," said Dr. Juan Celedón, a researcher at Brigham and Women's Hospital in Boston and lead author of the study. "It could be that exposure to these pet allergens influences the immune system of newborns so that it goes into a non-allergic mode."

However, Celedón said the new study does sound a note of caution for some children: Those whose mothers had a history of asthma were more prone to wheezing at age 3 or later if exposed to a cat as infants. The reason could be genetic or perhaps some shared environmental influence either during pregnancy or shortly after birth, Celedón said. The study couldn't say. Nor, Celedón added, did the researchers look at whether the children of women allergic to cats were more likely to be allergic to felines themselves.

Whatever the case, dogs appear to be off the hook: Celedón's group found no link between exposures to dogs and their allergens and childhood airway troubles. A report on the findings appears in the Sept. 7 issue of The Lancet.

The study followed 448 children from birth to age 5. All had at least one parent with a history of allergies or asthma -- known collectively as atopy -- putting them at increased risk of the conditions. The researchers periodically interviewed parents about their child's lung health. They also collected household samples to determine levels of pet allergens.

Celedón's group found no connection between early exposure to a cat and future chronic wheezing in kids whose fathers had atopy. But those whose mothers were asthma-free had a 40 percent lower risk of wheezing if a cat was around during their first two months of life than those not exposed to the animals. That was true even if the mothers had allergies.

These children also had lower blood levels of an immune protein called IgE, which is an indirect marker of sensitivity to irritants. This molecule predicts risk of allergies, though not their severity.

Those whose mothers had asthma, on the other hand, were three times as likely to develop airway distress by the time they were 5 if exposed to a cat during infancy. They seemed to "become sensitized to cat allergen in early life and wheeze afterwards when re-exposed," the study said.

"It's a very interesting story that's emerging here," said Dr. Gerald Gleich, a dermatologist at the University of Utah, referring to the string of studies, including the latest one, showing a protective benefit from household pets.

Gleich counts himself in the camp of experts who believe in the "hygiene hypothesis" -- which states that as the developed world becomes cleaner, children are exposed to fewer irritants as their immune system matures.

"Our environment is actually quite clean now, so clean that the filth and feces that had been our lot in the past has been significantly cleaned up. The immune system doesn't see all of the signals that it had seen in years gone by," he says.

The result is an epidemic of allergies and asthma -- except, perhaps, in the children who are primed early on by irritants like those shed by household pets.

But while Gleich believes the latest findings bolster the hygiene hypothesis, they do so with a twist. "There's a maternal influence that overrides the [cat allergen] exposure effect," he said. "What that is is obscure."

What To Do

For more on allergies, try the American Academy of Allergy, Asthma and Immunology. And for a look at how allergens trigger an immune reaction, check out HowStuffWorks.

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Study Finds Reciting Poetry Calms the Heart

By Charnicia E. Huggins

Reuters Health

Thursday, September 5, 2002

NEW YORK (Reuters Health) - While the rhythmic sounds of poetry may woo a lover's heart, it might also be healthy for the heart of the speaker, according to recent study findings.

"Our findings suggest that the stress-releasing effect of guided recitation of old poetry can lead to a deep relaxation afterwards," Dietrich von Bonin of the University of Berne in Switzerland and Dr. Henrik Bettermann of the University of Witten/Herdecke in Germany told Reuters Health in an e-mail interview.

"This effect could be beneficial not only in stress management but also for the prevention of heart disease and other illnesses related to irregular breathing," they added.

The researchers investigated the effects of poetry on heart rate in a study of seven individuals. After having their heart rates measured for a 15-minute period, the study participants recited poetry for 30 minutes, or spent the same amount of time engaged in conversation. Then their heart rates were measured again, also for 15 minutes.

After reciting poetry, the study participants' heart rates slowed to match their breathing rates in "harmonic interaction," according to the authors. Further, this effect persisted for up to 15 minutes after the recitation exercises, the investigators report in the International Journal of Cardiology.

No similar effects were observed when the individuals engaged in everyday conversation, the researchers noted.

In light of the findings, "we recommend to foster old skills like recitation of rhythmic poetry not only in therapy but also in education, in order to optimize early prevention of heart disease and other stress-related problems," von Bonin and Bettermann said.

These findings may also help explain the calming effect of chanting, the researchers note, "since chanting of calming songs also generates a slow and deeper breathing."

Source: International Journal of Cardiology 2002;84:77-88.

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Asthma Got Worse in NYC After Terrorist Attack

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Thursday, September 5, 2002

THURSDAY, Sept. 5 (HealthScoutNews) --The Sept. 11 World Trade Center attack had a direct, bad effect on New York area people with asthma, in both the lungs and the brain.

At its weekly Morbidity and Mortality Report meeting today, the U.S. Centers for Disease Control and Prevention ( news - web sites) gave statistics on some of the environmental after-effects of the terrorist attack that occurred almost a year ago.  

Some of it was physical, the result of breathing air polluted with the dust cloud created by the collapse of the two 103-story buildings. But a lot of it was psychological, with the incidence of worsened symptoms greatest in those who already had stresses in their lives, such as the recent death of a close relative, says the report. 

A telephone survey of 1,008 people living south of 110th Street in Manhattan found that 27 percent of those with asthma reported worsening symptoms in the weeks after Sept. 11, says Dr. Thomas Matte, an environmental diseases specialist at the CDC who helped compile the report.

"Asthma attacks usually increase in the fall, so some increase was not unexpected," Matte says. "But the results suggest that both the environmental and psychological consequences of the attack were related to the reported effect."

The findings offers guidelines for people with asthma and their physicians in other disaster-like situations, such as the major forest fires that have occurred this year, Matte says.

"Following a disaster, it is particularly important to know that people with asthma are doing things helpful to control their asthma," Matte says. "Clinicians should be aware of the possibility that there will be an increase in people presenting with asthma symptoms."

There is strong evidence that other stresses had a major effect, says Joanne Fagan, a consultant to the New York Academy of Medicine, which participated in the survey.

"Of the people with zero life stressors in the 12 months before the attack, 21 percent reported increased symptoms," Fagan says. "Of those with two or more life stressors, more than 46 percent reported increased symptoms. And 47 percent of those who reported a panic attack at the time of the event or who had depression during the preceding month had more severe symptoms."

The expected seasonal effect does confuse the issue somewhat, Matte acknowledges. But the study asked about the severity of symptoms, not the number of attacks, he adds.

Another survey found that the health effects of Sept. 11 extended beyond Manhattan, says Dr. Wayne Giles, a CDC chronic diseases specialist. A study covering New York, New Jersey and Connecticut found that 21 percent of smokers increased their smoking, 1 percent of nonsmokers started smoking and 3 percent of drinkers increased their alcohol intake, Giles says.

Studies of the longer-term effects of the World Trade Center attack are continuing, Fagan says. "We have conducted two other surveys in the suburbs and other parts of New York," she says, referring to the New York Academy of Medicine. "The Department of Health and other agencies in New York are also working on this."

What To Do

Basic information about asthma is available from the Asthma and Allergy Foundation of America.

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Label on Hormone Products To Reflect Concern on Risks

By Marc Kaufman
Washington Post Staff Writer

The Washington Post

Thursday, September 5, 2002

The maker of the most popular hormone therapies for post-menopausal women has told doctors that there are possibly increased risks from all its estrogen-based products, and that their labels will now reflect that concern.

The new company information will state that estrogen products should not be taken to prevent heart disease and should be taken for as short a time as possible. In addition, doctors were told to carefully consider alternatives to estrogen when trying to prevent osteoporosis in patients.

The new labeling follows the conclusions from a large government study this summer that found potentially serious side effects from hormone replacement therapy.

That study involved Prempro, a combination of the hormones estrogen and progestin, but the new labeling will apply to estrogen-only Premarin too. While the Women's Health Initiative (WHI) study of Prempro was halted due to increased incidence of heart disease and breast cancer, the arm of the study using Premarin was allowed to continue.

"When we considered the implications of the study, we decided we wanted to apply the information to all the post-menopausal hormone therapies," said Victoria Kusiak, North American medical director for Wyeth Pharmaceuticals, the maker of the drugs. "The absence of data does not imply safety, and there's no way of telling from the study whether the risks were from the estrogen or the estrogen in combination with progestin."

The new labeling was written by Wyeth in consultation with the Food and Drug Administration. The issue of how estrogen therapy should be used remains in flux, however, and FDA officials said the label may well change again after meetings this fall.

The Office of Research on Women's Health at the National Institutes of Health will sponsor a forum on menopausal hormone therapy Oct. 23-24, and the FDA is expected to hold an advisory committee meeting on the subject soon after.

Reflecting the increased complexity of the subject, the new Wyeth labeling will tell doctors to carefully consider alternatives to estrogen when using it solely to prevent the bone-thinning disease osteoporosis. One of the accepted indications for the estrogen products is prevention of post-menopausal osteoporosis, and the WHI study found that women taking Prempro did experience fewer osteoporosis-related hip fractures.

The study also found, however, an increased incidence of heart disease, breast cancer and stroke among women taking Prempro for five years. The study was especially surprising, because researchers had believed estrogen could protect the heart.

The results from the WHI study have had a dramatic effect on the sales of Wyeth's estrogen drugs. A Wyeth official said that Prempro sales dropped by about 30 percent in the month following the study and that Premarin sales declined by about 15 percent. Before the study, about 14 million American women took the hormone treatments.

The new label, and the fact that it will be used for all estrogen products, was something of a surprise, according to Wulf H. Utian, executive director of the North American Menopause Society. He said the recommendations on osteoporosis prevention in particular would be confusing to some doctors.

"They seem to be opening the door to further reassessments of the risk and benefits of the estrogen drugs," Utian said. "Prevention of osteoporosis is an approved indication for them, but now there's going to be greater concern about that use."

He said physicians have become increasingly wary of prescribing estrogen for long-term uses unless there is a specific medical reason, and that the new labels will speed that move to short-term use.

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Older Adults at Risk of Chlamydia, Too: Study

By Alison McCook

Reuters Health

Thursday, September 5, 2002

NEW YORK (Reuters Health) - Around 1% of all diagnosed cases of chlamydia in Los Angeles County occur in adults at least 50 years old, with the highest rates seen among women and African Americans, US researchers report.

These findings demonstrate that "there are no age barriers for sexually transmitted infections," according to Dr. Lisa V. Smith of the University of California, Los Angeles and her colleagues.

Chlamydia is the most common sexually transmitted infection in the US, with 3 million new cases each year. About two thirds of patients never develop symptoms, but if left untreated the infection can have serious health consequences, including chronic pelvic pain and sterility.

Since reproductive concerns do not affect older adults, the authors note in the September issue of the Journal of the American Geriatrics Society, many people who track the prevalence of chlamydia have ignored members of this age group. But older adults may not only contract the infection themselves; they can also pass it along to others.

And previous research has found that people with chlamydia may face a higher than average risk of contracting HIV ( news - web sites), while people over age 50 account for 11% of US AIDS ( news - web sites) cases.

In order to investigate the prevalence of chlamydia among one group of older adults, the researchers reviewed reports of chlamydia cases among people over age 50 submitted to Los Angeles County.

The investigators found that 1,421 cases of the disease were reported between 1991 and 1998 for people in this age group, or around 9 new cases for every 100,000 people each year.

Smith and colleagues also found that women were up to three times more likely to have chlamydia than men, a ratio also seen among people 20 to 35 years old. Comparing ethnic groups, African Americans showed two to nine times the rate of infection as other groups.

In an interview with Reuters Health, Smith said that media campaigns launched in magazines popular among older adults will help communicate the message that they are also at risk of contracting sexually transmitted diseases (STDs). "In addition, clinicians should be providing health education materials that would help them obtain sexual histories from older patients," she noted.

"Lastly, more research is needed to identify ways to increase the awareness of STDs in older groups," Smith recommended.

Just how many people are already aware of the risk of STDs in older adults is not clear, Smith added, "but we hope to enlighten as many as we can."

Source: Journal of the American Geriatrics Society 2002;50.


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Chronic Infections Raise Heart Risk in Smokers

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Thursday, September 5, 2002

THURSDAY, Sept. 5 (HealthScoutNews) -- If you have a chronic infection -- such as bronchitis, an ulcer, a urinary tract infection or even gum disease -- smoking raises your risk of developing cardiovascular disease.

 A new study has found that smokers with chronic infections were three times as likely to develop early atherosclerosis -- hardening of the arteries caused by plaque deposits -- than smokers without such an infection. The researchers also found the risk remained high in former smokers. Even passive or secondhand smoke increased the risk for early atherosclerosis in people with chronic infections.

"Part of the effects of smoking are irreversible when chronic infections have emerged, and smoking risk starts with a few cigarettes per day," says Dr. Stefan Kiechl, a professor of neurology at Innsbruck University Hospital in Austria and lead author of the study. The research appears in the September issue of Stroke.

Some 47 million Americans still smoke cigarettes, and more than 400,000 die every year from smoking-related diseases, according to the Centers for Disease Control and Prevention ( news - web sites) (CDC). Direct medical costs from smoking top $75 billion annually in this country, the CDC reports.

Kiechl and his colleagues examined ultrasound scans of 826 men and women from northern Italy who were between the ages of 40 and 79. Four hundred and fifty three had never smoked; 212 were former smokers and 161 were current smokers.

Two ultrasound scans were taken -- one in 1990 and the other in 1995. The scans detailed the carotid arteries, the main arteries that send blood to the brain. During the five years, 332 people had new plaque deposits in their carotid arteries.

The more a person smoked -- number of years and number of cigarettes per day -- the more likely they were to develop atherosclerosis, the study found. Interestingly, the increased risk was only for those who also had a chronic infection.

Smokers with a chronic infection had 2.9 times the risk for early atherosclerosis, while past smokers with a chronic infection had a 1.9 times increased risk. Even nonsmokers who had chronic infections had a 1.8 times higher risk.

Kiechl says a chronic infection is one that lasts for three or more months in at least two consecutive years. So, someone who has five bouts of acute bronchitis that last a week or two each during a year wouldn't be considered to have chronic bronchitis.

Smokers who didn't have a chronic infection didn't appear to be at any greater risk of developing early atherosclerosis, according to the study.

Does that mean it's OK to continue smoking?

Absolutely not, says Kiechl. Smoking is detrimental to the health in many ways. Smokers are at an increased risk of cancer and many other diseases. "In addition, the risk of acquiring chronic infections continuously increased with increasing duration of smoking and age, reaching near 100 percent in subjects over age 60 with more than 35 years [of smoking a pack a day]. They should not miss the opportunity to stop smoking before chronic infections have emerged," Kiechl says.

Smokers are more susceptible to chronic infection because the habit impairs the body's ability to fight infection, explains Dr. Dan Fisher, a cardiologist at New York University Medical Center.

Fisher says smokers who already have chronic infections shouldn't be discouraged by this study's findings. While it appears that the risk for early atherosclerosis stays high even after quitting, it does go down. And, he says, the sooner you quit, the sooner you start reducing your risk.

"Smoking increases your risk of coronary disease dramatically," Fisher says. "I can't say it enough: Don't smoke."

What To Do

To learn more about the health effects of smoking, go to the University of Michigan Health System. For information on quitting, visit the Centers for Disease Control and Prevention.

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Study Finds Walks Cut Health Risk In Women

By David Brown
Washington Post Staff Writer

The Washington Post

Thursday, September 5, 2002

Walking is as good as running when it comes to reducing the risk of heart attack or stroke for women middle-aged and older, according to the results of a large study sponsored by the federal government. Brisk walking for about 21/2 hours a week or an equivalent amount of more strenuous exercise cut the risk of heart disease and stroke by about one-third, the researchers found after tracking about 74,000 women for six years.

The results suggest that the benefits of exercise are within reach of virtually every American woman and don't require equipment, organized sports or painful exertion.

" 'No pain, no gain' is an outdated notion," said JoAnn E. Manson, chief of preventive medicine at Brigham and Women's Hospital in Boston and the lead author of the study, which appears in today's New England Journal of Medicine. "Exercise doesn't need to be strenuous or uncomfortable -- moderate exercise will provide the lion's share of the health benefit."

Gerald F. Fletcher of the American Heart Association said the findings are important because in effect they lower the bar on a major public health hurdle -- the effort to reverse the epidemic of inactivity in the United States.

"Everybody needs to do something," said Fletcher, director of preventive cardiology at the Mayo Clinic branch in Jacksonville, Fla. "But a lot of people don't want to because they believe they have to exercise hard, have to mess up their hair. But they can do moderate exercise, and enjoy it to some degree, and still get benefit."

The study doesn't discount the possibility that women who engage in very high levels of exercise -- training for marathons or triathlons, for example -- may experience even bigger gains in cardiovascular health.

"That is highly plausible," Manson said. She said the study, despite its size, had too few endurance athletes to address the question.

What it does suggest, however, is that there is a threshold of benefit that is fairly easy to reach. The biggest health gain, Manson said, comes when a person moves from a sedentary lifestyle to one that includes moderate, regular exercise.

The research is part of the federal government's massive Women's Health Initiative, which is studying numerous health questions important to women after menopause.

Earlier this summer, the initiative announced that women randomly assigned to take pills containing estrogen and progesterone had higher rates of cancer and heart disease than women assigned to take placebo pills -- a finding expected to have profound effects on the popularity of hormone replacement therapy.

The exercise part of the study was purely observational; it did not involve assigning women to do one thing or another. The participants, between ages 50 and 79 when the study began in the mid-1990s, filled out detailed questionnaires about their activity. Researchers then quantified the amount of exercise (in terms of time spent and energy expended) and divided the women into five categories, from least to most active.

The number of heart attacks, strokes and new cases of angina was small -- 1,551 in about 74,000 women observed for just under six years. Women who walked about briskly for at least 21/2 hours a week had 30 percent fewer "events" than women who did not exercise.

The benefit was almost the same as the 31 percent reduction seen in women who exercised "vigorously" for a similar amount of time. Vigorous exercise was defined as exercise in which "you work up a sweat and your heart beats fast," and included aerobics, jogging, tennis and swimming laps.

The study also discovered that sitting in a chair for at least 16 hours each day was itself a risk factor for heart disease and stroke, regardless whether a person exercised or not.

A second, unrelated study in the same journal gave a detailed picture of the lack of exercise at the other end of a woman's life -- the adolescent and teenage years.

The fraction of American girls who exercise regularly during that period drops precipitously, so that by age 18, one-third of white girls and more than half of black girls are living essentially sedentary lives.

The decline in exercise is associated with the education level of the parents in whites but not in blacks, with daughters of college-educated parents continuing to exercise in greater numbers than those whose parents went only through high school. Pregnancy also caused a decrease of exercise in black girls (about 20 percent of whom had become pregnant by age 18), and smoking caused a decrease in white girls' activity (about 25 percent had the habit by the end of the teenage years).

Many studies -- including several surveys done by the Centers for Disease Control and Prevention and other federal agencies -- have documented the decline in exercise among youth over the last two decades. This study, however, was different in that it followed the same group of girls -- about 1,200 blacks and 1,200 whites -- from ages 9 to 19. The girls were recruited from public, private and parochial schools in Cincinnati and a suburb of San Francisco and from a health maintenance organization in the Washington area.

The findings were based on what the girls reported and on what was recorded on a activity-measuring device periodically worn around the waist. By eight years into the study, 56 percent of black girls and 31 percent of white ones reported no regular leisure-time exercise.

"It is a crisis. It is the new challenge in public health in the United States," said Sue Y.S. Kimm, a physician and epidemiologist at the University of Pittsburgh School of Medicine who headed the Growth and Health Study run by the National Heart, Lung and Blood Institute.

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Kids Born Too Early May Be More Fearful as Teens

By Alison McCook

Reuters Health

Thursday, September 5, 2002

NEW YORK (Reuters Health) - Adolescents who were born prematurely appear to have a higher than average fear of dying and may be less able than their peers to cope with distress effectively, new study findings show.

Dr. Ofra Lubetzky of the Tel-Aviv University School of Medicine in Israel told Reuters Health that these findings suggest that the effects of prematurity can linger for many years.

"If (health professionals) now have an extremely low birth weight infant, (they) have to follow many of them until adolescence," Lubetzky said.

The researchers base their findings on a group of 50 teens between 14 and 16 years old who were born prematurely at very low birth weights. The group was compared with similarly aged peers born at full-term. During the study, the investigators asked the teens to indicate how much they feared their own death, and to agree or disagree with a number of statements focused on their attachment style, a marker of how well they deal with distress.

Reporting in the August issue of the journal Death Studies, the authors found that teens born prematurely had a relatively high fear of death. Furthermore, they note that these teens were more likely than their peers to have adopted a so-called insecure attachment style, using "avoidant" or "anxious-ambivalent" coping strategies to deal with problems.

Lubetzky told Reuters Health in an interview that teenagers who were preterm infants may have a higher than average fear of death because their lives began in relative danger. For while many premature babies survive, their risk of dying during the first days of life is much higher than that of full-term babies.

Low birth weight babies "know what it is to be in danger from the beginning," Lubetzky said.

In terms of their coping mechanisms as teens, Lubetzky explained that insecure attachment styles sometimes appear in people who did not experience early responsiveness and sensitivity from their parents. Indeed, when a baby is born prematurely, she is often forced to spend prolonged periods of time away from her mother, and these early bumps in the road to establishing a good parent-child relationship may affect the child for many years, the report indicates.

In order to help adolescents born prematurely to avoid having unhealthy fears of death and using ineffective coping mechanisms, Lubetzky suggested that doctors and other health professionals check in with mothers and preterm children over time, and provide them with help if they need it.

Source: Death Studies 2002;26:523-543.


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Vaccine prevents stroke in rats

By Katrina Woznicki
UPI Science News
From the Science & Technology Desk

United Press International

Thursday, September 5, 2002


WASHINGTON, Sept. 5 (UPI) -- Researchers have developed a new vaccine that interferes with the inflammation of blood vessels and has reduced the risk of stroke significantly in animal studies, a finding that could lead to drugs that prevent thousands of strokes in humans.

 

The researchers, led by John Hallenbeck, chief of the stroke branch at the National Institute of Neurological Disorders and Stroke, administered a nasal spray carrying an important protein called E-selectin. Under normal circumstances, E-selection contributes to inflammation in the cells of the interior walls of blood vessels, a natural response by the body when the immune system is repelling an invading organism.

When Hallenback and colleagues exposed rats to E-selectin, however, they found the animal's bodies tended to trigger cells called lymphocytes that monitor the blood vessels for signs of this particular protein. When the lymphocytes found it, they attacked and suppressed the inflammation that potentially could lead to a stroke.

In other words, E-selectin acted like a vaccine against stroke.

The researchers administered the protein, as well as two other substances, randomly to 113 rats genetically altered to have high blood pressure and be susceptible to stroke. Some rats received E-selectin through the nasal spray every other day for 10 days while the remaining animals received the 10-day course of treatment every three weeks until they died or the study, which lasted more than a year, concluded.

Results showed rats receiving E-selectin suffered only one-sixteenth as many ischemic strokes, in which a blood vessel becomes blocked, compared to the other animals who had received different substances. None of the rats suffered a hemorrhagic stroke, where a clot bursts and causes internal bleeding.

Strokes that did occur among the rats taking E-selectin produced significantly less brain damage than strokes in the rats not receiving this critical protein, the researchers reported. Testing revealed E-selectin among the treated rats produced a type of chemical called a cytokine that prevented inflammation in the blood vessels.

"Normally with a vaccine, what you want to do is activate the immune system," Hallenbeck told United Press International. "Here, the reason it was called a vaccine was that we were giving a protein ... but instead of developing an immune response, the lymphocytes (became) immosuppressive." They suppressed part of an immune system reaction.

Although a single shot will not protect against stroke, the researchers said the findings suggest repeated doses of the E-selectin vaccine could assist in preventing stroke for the long-term.

Hallenbeck said the findings are so encouraging an E-selectin vaccine should be tested in human studies. A Phase I clinical trial is planned to test the effects of human and bovine E-selectin vaccines in patients at high risk for stroke. That study will assess whether the vaccines are safe to use and what the side effects may be.

Bovine E-selectin will be tested in addition to the human protein because there is a chance it may produce a stronger response. The two vaccines are being produced by Novavax Inc. of Columbia, Md., under a cooperative agreement with NINDS.

"The important thing about this work is that the majority of effort that's gone into preventing stroke and prevent heart attacks has gone into preventing platelets and in preventing clotting," Hallenbeck said. "This is a new dimension that hasn't been explored perhaps as much as it deserves."

Hal Unwin, director of the stroke program at the University of Texas Southwestern Medical Center in Dallas and a neurologist, called the research exciting.

"To basically have 16 times fewer strokes, I mean, is just incredible," Unwin told UPI. "That's a big response. Now, whether that can be translated into humans isn't known."

Stroke prevention requires high-risk patients to exercise, eat healthy, and in some cases, adhere to their medication treatments. One of the big advantages of a vaccine, Unwin said, is it would help people who might have difficulty complying with traditional stroke therapies and prevention strategies.

"Clearly the best chance we have in stroke is prevention," he said. "And stroke is pretty much a preventable disease. And with a vaccination, basically it doesn't require the patient to do much of anything."

Stroke is the third-leading cause of death among Americans with more than 500,000 new cases every year and about 150,000 deaths annually from stroke-related causes.

The study is published in the September issue of Stroke.

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Can Pesticides Trigger Depression? Study Continues

Reuters Health

Thursday, September 5, 2002

NEW YORK (Reuters Health) - Farm workers poisoned by industrial strength agricultural pesticides containing organophosphates face a nearly sixfold increased risk of suffering depression in the months following their exposure, new study findings show.

Organophosphates are extremely toxic and easily absorbed into the bloodstream through the skin, nose, eyes, gut and lungs. Immediately after being poisoned, a person may experience vomiting, abdominal pain, fatigue, headaches and blurred vision, among other symptoms.

There have also been reports of organophosphate poisoning leading to neurological problems such as anxiety, depression, irritability and restlessness, according to study authors Dr. Lorann Stallones and Cheryl Beseler of Colorado State University in Fort Collins.

"In some states, farmers have been reported to have higher rates of depression than other population groups," the authors write in the August issue of the Annals of Epidemiology. However, "little work has been done to describe the effects of exposure to organophosphate compounds and depressive symptoms among the farming population."

To investigate the relationship, the two researchers interviewed 761 farm residents, operators and their spouses living in Colorado between 1992 and 1997. All participants completed interviews assessing various aspects of their physical and mental health, as well as their organophosphate exposure.

Sixty-nine study participants reported having been sickened by pesticide poisoning, the report indicates.

After accounting for other known depression risk factors such as age, marital status, education level and alcohol use, farmers who reported organophosphate poisoning were 5.8 times more likely to score high on tests measuring level of depression than farmers who did not report having been poisoned, the authors found.

"The findings reported here provide further support for evidence of an association between mental health and pesticide poisoning," Stallones and Beseler write.

But further research is needed to establish a causal link, they conclude.

Source:  Annals of Epidemiology 2002;12:389-394.

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Diet Report Calls for More Exercise

By Randolph E. Schmid

Associated Press Writer

The Associated Press

Thursday, September 5, 2002

People who want to stay healthy need to exercise for at least an hour a day — double the previous workout recommendation — according to new dietary guidelines on fat, protein and carbohydrate intake.

Independent advisers to the government, in a report Thursday, avoided setting strict amounts for each of the three major components, proposing ranges so people can balance their diet.

"The ranges are new and were developed to assure a nutritionally adequate diet," said Joanne R. Lupton of Texas A&M University, head of the Institute of Medicine ( news - web sites) committee that prepared the study.

The institute, for the first time, added an exercise recommendation to its dietary advice.

"To reduce some of the main killers of America we will have to increase the level of physical activity," said Dr. Benjamin Caballero, director of the Center for Human Nutrition at Johns Hopkins University in Baltimore.

The committee recommended at least one hour of moderate physical activity daily, such as walking, slow swimming, leisurely bicycle riding or golfing without a cart. That's twice the latest government guidance, recommended by the surgeon general in 1996.

Lupton said the committee recognizes that the lifestyles of many people might make this goal seem difficult to achieve. But Caballero noted that the exercise can be broken up and spread throughout the day.

In addition to recommending an hour of exercise daily for adults, the same amount was suggested for youngsters, and comes at a time when worry is increasing over the number of obese children.

Former Surgeon General David Satcher has organized a national summit of health and education experts next month to discuss ways to trim the fat from young people.

"We based our conclusions on the most scientifically compelling evidence," said Lupton, who teaches nutrition. "We hope this report will guide policy-makers, health professionals and others."

The report was prepared for government agencies that deal with health and nutrition in the United States and Canada. It could eventually lead to changes in food labels and government dietary recommendations.

The institute edged away from previous guidelines that called for getting 50 percent or more of calories from carbohydrates and 30 percent or less from fat.

"We established ranges for fat, carbohydrates and protein because they must be considered together," Lupton said.

The institute, part of the National Academy of Sciences ( news - web sites), said that because fats, carbohydrates and protein can all serve as sources of energy they can, to some extent, substitute for one another in providing calories.

The guidelines suggest getting 45 percent to 65 percent of calories from carbohydrates (sugars and starches found in such foods as fruit and bread); 20 percent to 35 percent from fat (meat, dairy products and oils); and 10 percent to 35 percent from protein (available from meat, eggs, dairy products and some vegetables). The protein recommendation is the same as in the past.

Panel members declined to discuss specific diets recommending such things as high fats or low carbohydrates. But they noted the report urges eating at least 130 grams of carbohydrates daily to ensure that the brain has enough glucose to function properly.

"We must distinguish between diets to lose weight and diets to maintain health," Caballero said. He said weight loss diets are temporary and provide less energy intake than needed.

"Our report focuses on diet for the long term to maintain health," he said. For obese people, dieting is not enough, they must also increase their activity level, he said.

Lupton noted that studies have shown that when people eat very low levels of fat and very high levels of carbohydrates their good cholesterol declines. Good cholesterol, or high-density lipoprotein, can reduce the likelihood of heart attack.

On the other hand, she added, high-fat diets can lead to obesity and its health dangers.

The study noted that fat is a major source of energy in the diet, but urged avoiding saturated fats and trans fatty acid as much as possible because they can increase the risk of heart disease.

The main sources of saturated fats are baked goods, meat and full-fat dairy products. Trans-fatty acids are often found in cookies, crackers and meats. The institute recommended this year that trans-fatty acids be listed on food product labels so people can reduce their intake.

For adults under age 50 the report recommends a daily intake of 38 grams of fiber for men and 25 grams for women. Over age 50 the recommendations are 30 grams for men and 21 grams for women. It also urges avoiding added sugars, such as in soft drinks.

The academy is an independent organization chartered by Congress to provide guidance to the government in scientific issues.

On the Net:

National Academies: http://www.national-academies.org

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People Born in Autumn Live Longer, Study Says

Reuters

Thursday, September 5, 2002

BERLIN (Reuters) - People born in the autumn live longer than those born in the spring and are less likely to fall chronically ill when they are older, an Austrian scientist said Thursday.

Using census data for more than 1 million people in Austria, Denmark and Australia, scientists at the Max Planck Institute for Demographic Research in the northern German town of Rostock found the month of birth was related to life expectancy over the age of 50.

Seasonal differences in what mothers ate during pregnancy and infections occurring at different times of the year could both have an impact on the health of a newborn baby and could influence its life expectancy.

"A mother giving birth in spring spends the last phase of her pregnancy in winter, when she will eat less vitamins than in summer," said Gabriele Doblhammer, one of a team of scientists who carried out the research.

"When she stops breast-feeding and starts giving her baby normal food, it's in the hot weeks of summer when babies are prone to infections of the digestive system."

Babies born in the autumn weighed more than those born at springtime, she said. In later life, low birth weight was associated with increased blood pressure, cholesterol levels, some forms of obesity and a decrease in lung function.

In Austria, adults born in autumn (October-December) lived about seven months longer than those born in spring (April-June), and in Denmark adults with birthdays in autumn outlived those born in spring by about four months.

In the southern hemisphere, the picture was similar. Adults born in the Australian autumn-- the European spring--lived about four months longer than those born in the Australian spring.

The study focused on people born at the beginning of the 20th century, using death certificates and census data. Although nutrition at all times of the year has improved since then, the seasonal pattern persists, Doblhammer said.

In a separate study, Doblhammer analyzed the birth weight of about 3,000 twins born in the United States in the 1970s and 1980s and found that those born in spring and summer weighed less than those born in autumn.

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Researchers Study Healthy Sperm

 

By Emma Ross

AP Medical Writer

The Associated Press

Thursday, September 5, 2002

Researchers have determined the genetic fingerprint of healthy human sperm — an advance that could be a major step forward in understanding male infertility. The discovery could also lead to new types of male contraceptives.

Experts say a test that compares the genetic pattern of the sperm of infertile men with the "benchmark" profile of fertile sperm would show mismatches that explain the problem. Infertility in men now remains inexplicable in two-thirds of cases.

The research, outlined this week in the Lancet medical journal, was conducted by scientists at the U.S. Environmental Protection Agency ( news - web sites), Wayne State University in Detroit and Leeds University in England.

"At the moment, at infertility clinics, we are completely blind when it comes to trying to find out why men are infertile," said researcher David Miller, a lecturer in reproductive biology at Leeds University. "We rely on things like standard semen analysis (looking at the shape, size and movement of sperm) to give us some idea of what the problem is, but essentially we really are in the dark."

The scientists analyzed thousands of millions of sperm cells from healthy, fertile men in three different samples.

The first sample contained sperm from the testicles of 19 men. In the second sample, the scientists pooled together the genetic material from the semen of nine fathers and the third sample contained the sperm from the semen of one man.

The scientists were looking for a key genetic substance called messenger RNAs in the samples. Messenger RNA is the molecule that delivers instructions from the gene to the cell's protein-making machinery

Combining the semen of nine men showed the range of messenger RNAs.

They compared the messenger RNAs among the three samples.

"There was remarkably little variation between the individual and the pooled sample. We can say that because there was a high level of correspondence between the pooled and the individual ejaculates, that we have identified a set of RNAs that are like a fingerprint for fertility," Miller said.

The scientists found that less than 3,000 messenger RNAs define fertile sperm.

"The argument is once you've got that, then you can look at abnormal men and look at the differences," said sperm expert Christopher Barratt, a professor of reproductive medicine at Birmingham University in England. "It's a significant advance that he's come up with a fingerprint, albeit a first draft, but it's a good first draft," he said of Miller.

Barratt, who was not connected with the research, predicted the test could be available in clinics in about two years.

Miller said the strategy might also one day improve the safety and quality of in vitro fertilization when the problem lies with the man.

"It will help us identify men who clearly shouldn't be using their own sperm for IVF, or at least be able to tell them more accurately what the risks of using their sperm are to the offspring," Miller said.

The fingerprint could also be used to design contraceptives for men.

"If you found what goes wrong that makes men infertile, then you just generate the problem in a healthy man and you've got contraception. There's always a mirror image of infertility and contraception," Barratt said.

An example of this is the female contraceptive pill, which suppresses ovulation. Lack of ovulation is one of the causes of female infertility.

On the Net:

http://www.thelancet.com

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Seniors Having Tougher Time Seeing Docs

By Karen Pallarito

Reuters Health

Thursday, September 5, 2002

NEW YORK (Reuters Health) - Senior citizens in America, whether they have Medicare or are privately insured, are having a more difficult time getting to see a physician, a new study finds.

Medicare beneficiaries and privately insured seniors alike report delays in getting needed care and longer waits for appointments, the Center for Studying Health System Change (HSC), a nonpartisan policy think tank, reported in a study released on Thursday. At the same time, the percentage of doctors accepting new patients has slipped for both people on Medicare and the privately insured, it said.

The findings suggest that "system-wide" issues appear to be at play, which may have nothing to do with Medicare. That revelation could create a dilemma for Congress as it considers whether to raise physicians' Medicare rates: Cut too deeply and beneficiaries' access problems may worsen, but raising rates may not solve the problem either.

"The question for Congress is, What's the tipping point for compromising physicians' willingness to care for Medicare patients?" says HSC President Paul Ginsburg. "Additional Medicare cuts of the magnitude expected over the next few years are likely to increase beneficiaries' access problems, especially in markets where private insurers pay significantly more than Medicare for physician services."

Physicians balked at a 5.4% cut in Medicare fees that took effect in January and are pressing for "giveback" legislation to boost their payments. If the Medicare payment formula is left unchanged, they'll face further reduction over the next several years.

The HCS study shows that access problems are increasing both for Medicare patients and privately insured Americans ages 50 to 64, the so-called "near-elderly." More than 40% of people on Medicare in 2001 had to wait a week or more for an appointment when they were sick, up from 34.6% in 1997, for example. The percentage of near-elderly reporting long wait times also rose during that period to 36.3% from 29.9%.

National access measures tell only part of the story. The study also finds that access problems vary depending on where people live. Alwyn Cassil, a spokeswoman for HSC, said local market conditions might be among the many non-Medicare factors affecting people's access to care. Demand for physician services and how well private payers reimburse for doctor services are other possible factors in the equation.

"The message for policymakers is these access problems are larger than just Medicare and thinking that Medicare can fix it in isolation is probably not realistic," she told Reuters Health. "But at the same time additional cuts of the magnitude being proposed could very well contribute to further deterioration of access."

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Doctors Not Sure Why Elders Halt Cholesterol Drugs

By Alicia Ault

Reuters Health

Thursday, September 5, 2002

NEW YORK (Reuters Health) - Several recent studies have shown that senior citizens often stop taking cholesterol-lowering drugs called statins, and researchers don't know exactly why.

Statins are among the best-selling drugs in the world, largely because they work so well at reducing "bad" cholesterol levels. They are usually the first therapy given to people who can't lower cholesterol through diet and exercise, especially if they've had a heart attack, said Richard Pasternak, director of preventive cardiology at Massachusetts General Hospital, and a spokesman for the American College of Cardiology.

And, several statins have been proven to reduce chances of a second heart attack and death.

Even so, many elderly patients aren't sticking with the statins they are prescribed, according to two studies published in July in The Journal of the American Medical Association ( news - web sites).

In one study, Dr. Joshua S. Benner, a research fellow at Brigham and Women's Hospital, and several colleagues found that only 53% of patients 65 or older prescribed statins were still taking them 6 months later, and only 35% were taking them 5 years later.

In the second study, Cynthia Jackevicius of Toronto General Hospital and colleagues looked at patients aged 66 and older. They found that only 40% of patients who had a heart attack or chest pain were still taking their medicine two years later, compared with 36% of those with chronic heart disease and 25% prescribed the drugs to prevent heart disease.

Dr. William Applegate, dean of the Wake Forest University School of Medicine in Winston-Salem, North Carolina, in an editorial, called the findings alarming, noting the drugs' life-saving potential.

"If people were more adherent, we could pretty much guarantee them they'd have fewer heart attacks and fewer strokes," Applegate told Reuters Health.

So why do seniors stop taking statins? Benner said steep drop-offs in the first few months aren't surprising. When people are asked to try something new--no matter what medication--they usually quickly make up their minds as to whether it makes them feel "funny," and if they are committed to taking it, he said.

In his trial, cost did not seem to influence compliance, Benner told Reuters Health, noting that most people only paid $5 or less for their statins. In the Canadian study, medications were also free. In reality, elderly people do stop taking statins because of price--$50 to $100 a month, Pasternak said. "For most of our elderly patients, cost is a factor," he told Reuters Health.

The physicians also said side effects were not likely a major reason for discontinuation. "We know that side effects for statins are relatively low," said Applegate.

With statins, "there is definitely a higher incidence of muscle soreness," said Pasternak, but he added that it's more of a perceived problem than a real one. Side effects are highlighted in direct-to-consumer ads, and, he said, "almost everybody knows somebody who's been on a statin and got sore." But Pasternak said that soreness and fatigue are more often due to lifestyle, not the statin.

Side effect worries were fueled by last August's recall of Baycol (cerivastatin), a statin that was associated with severe muscle weakness, and several deaths from rhabdomyolysis, in which the muscle breaks down.

Just after that, the consumer advocacy group Public Citizen petitioned the US Food and Drug Administration ( news - web sites) to add a large warning to all statins about the potential for severe muscle weakness and wasting. Nothing has come of the request.

The American College of Cardiology, the American Heart Association ( news - web sites), and the National Heart, Lung and Blood Institute recently issued clinical guidelines that say that despite the problems with Baycol, statins are safe, and one of the best weapons against high cholesterol and reducing stroke and heart attack risk.

Physicians say the main reason people don't take statins--not just the elderly--is because they can't "feel" that they have high cholesterol.

"When patients are asymptomatic, it's harder to get them to focus their attention on continued consistent compliance," said Applegate.

When they've had a heart attack or other coronary event, people are much more likely to stick to their regimens, he said. Benner found in his study that patients who began statin therapy after a heart attack, or who had active heart-related chest pain, were more likely to stay on the medications.

"The more they somehow have it in their mind that there is something wrong with them, the more likely they are to be persistent in taking (a medication)," agreed Pasternak.

Source:The Journal of the American Medical Association 2002;288:455-461, 462-467, 495-497.

New Technique Tested Against Cervical Cancer

Reuters

Thursday, September 5, 2002

LONDON (Reuters) - British scientists have devised a new technique that kills cervical cancer cells without harming healthy ones, which could improve treatment for the deadly disease.

The technique, called RNA interference, wipes out the deadly cells by silencing genes in a virus that contributes to the illness.

"Our work has identified a novel agent with major therapeutic potential for the treatment, and possibly also the prevention, of human cervical cancer," Professor Jo Milner, of the University of York, said Thursday.

Unlike chemotherapy, which has serious side effects because it destroys healthy as well as cancerous cells, RNA interference restores the immune system and only targets the cancerous cells.

Cancer develops when something goes wrong during normal cell division and instead of destroying itself, the mutated cell divides uncontrollably and forms a tumor.

Cervical cancer, the second most common cancer in women worldwide, is linked to the human papilloma virus, which attacks two important proteins in the body called p53 and RB.

RB controls cell division and p53 kills damaged cells that could become cancerous. Without them mutated cells can multiply uncontrollably.

But in laboratory studies using cancer cells from human tumors, Milner and Dr. Ming Jiang found that when they silenced two genes in the virus all the cancer cells died, while healthy cells were not harmed.

Their research is reported in the journal Oncogene.

"As soon as we silenced the viral genes, the infected cancer cells committed suicide," said Milner, adding that the results were "absolutely remarkable."

Cervical cancer affects about 465,000 women worldwide each year and causes 300,000 deaths. If the illness is diagnosed and treated early there is a high survival rate.

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Baby Vaccines An Anxious Mystery to Most Parents

By Ross Grant
HealthScoutNews Reporter

HealthScoutNews

Thursday, September 5, 2002

THURSDAY, Sept. 5 (HealthScoutNews) -- While almost all parents say they understand the need for immunizations, a new survey shows childhood vaccines are an anxious mystery to many of them.

For instance, 80 percent of the 1,000 new parents surveyed didn't know which shots their children needed or what the vaccines protected against.

Moreover, most parents said they become anxious when their children received vaccine shots, and 55 percent said the shots hurt them more than their kids.

"I don't think we as health professionals realize how much anxiety parents have about seeing their kids poked," says Carolyn Montoya, coordinator of the Family Nurse Practitioner Concentration at the University of New Mexico.

"No one wants to hear a baby cry, and definitely no one wants to hear their own baby cry," she says.

With children getting 20 shots before their second birthday, the anxiety seems warranted. However, it doesn't have to be so nerve-racking.

The three nursing groups that conducted the summer survey -- the American Nurses Association, the American College of Nurse Practitioners and the National Association of Pediatric Nurse Practitioners -- have since prepared tips to help parents cope. The program was also funded by GlaxoSmithKline, a major vaccine producer.

One way to make the immunization process more comfortable is for parents to hold their toddlers during the shots. This may sound natural, but most parents don't do it, according to the survey. While 91 percent of parents gave their children pain relievers for the shots, only 13 percent reported they physically comforted their children.

Parents may also want to breast-feed their children after the shot or give them a bottle. If the children are frightened before the shot, parents can try to distract them by making silly faces, showing them a toy or blowing bubbles.

Perhaps most importantly, though, parents should try to stay calm themselves when they catch sight of a needle aimed at their baby.

"Babies pick up on parents' cues. If parents can stay calm, their babies will pick up on this," says Montoya, former president of the American College of Nurse Practitioners.

The other important finding in the survey showed that parents were often confused or ignorant about the immunizations their kids need. Of those surveyed, 83 percent said they didn't know how many shots are given in the first two years, and more than half couldn't identify vaccine-preventable diseases.

Although doctors and nurses generally inform patients about the purpose of each shot, parents can take an active role by asking for combination vaccines or to have more shots given each visit. The 11 diseases targeted by the vaccines such as diphtheria, polio ( news - web sites), rubella and whooping cough are becoming less well-known because vaccines are so effective, but parents shouldn't forget the diseases still exist.

"They're big long names, so they're intimidating. But I still believe that we shouldn't give our child medicines unless we know what we're giving them," Montoya says. "Another reason is that sometimes there is an outbreak in your community, and you'll know if your baby has been immunized."

Dr. Deborah Wexler, executive director of the Immunization Action Coalition, adds this: "Every parent should have a little chart showing the vaccines and schedule of shots."

Since most of the shots are given in the first six months, before a child has a chance to start worrying about needles, parents should take care to stay on schedule.

"The older they are, the more children will worry about getting a shot," Wexler says.

What To Do

For the immunization tip sheet, visit the American Nurses Association. For a schedule of which shots a children and teens need and when they should have them, visit the Immunization Action Coalition.

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Healthy Diet May Not Prevent Prostate Cancer

By Alison McCook

Reuters Health

Thursday, September 5, 2002

NEW YORK (Reuters Health) - A diet that is low in fat and full of fiber, fruits and vegetables is a good idea in general, but it may not protect men against developing prostate cancer ( news - web sites), US researchers report.

These findings appear on the tail of previous research that demonstrated that a high-fat diet is linked to an increased risk of advanced prostate cancer.

So what's a man to eat? Lead author Dr. Moshe Shike of the Memorial Sloan-Kettering Cancer Center in New York told Reuters Health that although these results suggest that eating well may not protect against prostate cancer, it nonetheless can have a powerful effect on the eater's general health.

"In spite of this study, the low-fat, high-fruit, high-vegetable diet is a healthy diet," Shike said.

This study "is by no means an indication not to follow this diet," he added.

In terms of the seemingly contradictory results between the current and previous findings, Shike noted that the two studies used different techniques to obtain their results. Specifically, in the first study, researchers asked men to remember their diets over the past 3 to 5 years, and not many people can recall their long-term eating habits with great detail, the researcher noted. In contrast, the current study followed the men over time, a technique considered to be more accurate by the research community, Shike said.

Shike's team measured the risk of prostate cancer in terms of rising levels of PSA, a protein produced by the prostate gland. Many cases of prostate cancer are only diagnosed when the disease is at an advanced stage, so doctors try to catch the cancer in its early stages by measuring PSA levels in the blood, with PSA spikes signaling a man may have the beginnings of prostate cancer.

The investigators obtained their findings by following a total of 1,350 men, half of whom received intense counseling to opt for a low-fat diet that was rich in fiber, fruit and vegetables. Shike and his colleagues then measured the men's PSA levels every year for 4 years, and noted when any study participant was diagnosed with prostate cancer.

Reporting in the September issue of the Journal of Clinical Oncology, Shike and his team note that most men who were asked to change their diets did so in the first year, and maintained their healthy habits throughout the study.

However, the authors also write that the healthy diet appeared to have no effect on how fast PSA levels increased in men, and just as many men from both dietary groups had elevated PSA blood levels throughout the study.

Furthermore, a similar number of men developed prostate cancer in the two groups--19 of those whose diet was unchanged, and 22 men who had adopted the healthy eating habits.

Based on these findings, if a middle-aged man decides to switch his diet to the one described in this paper, "that man cannot expect that this diet, if consumed for 4 years, will reduce his risk of developing prostate cancer," Shike said.

However, he noted that 4 years is not a very long period of time to study the life cycle of cancer. Consequently, it is possible that if a young boy were to adopt these healthy eating habits, the diet could reduce his risk of developing prostate cancer once he reaches middle age, Shike said.

In an accompanying editorial, Dr. Alan R. Kristal of Fred Hutchinson Cancer Research Center in Seattle, Washington, notes that the study findings appear sound, but may not present the whole picture of the influence diet has on the risk of developing prostate cancer.

"We should remember that this study does not address whether a low-fat and high-fiber dietary pattern affects very early processes in carcinogenesis, before a detectable increase in PSA would occur, nor does it address whether dietary change affects the development of invasive disease," he writes.

Source:Journal of Clinical Oncology 2002;20:3570-3571, 3592-3598.

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Finding a Way to Reverse a Drug's Effect

HealthScoutNews

Thursday, September 5, 2002

THURSDAY, Sept. 5 (HealthScoutNews) -- What is a veritable feast one day may turn into poison the next.

 With this theory in mind, researchers at Duke University Medical Center believe they've found a way to reverse the effects of long-lasting drugs when it's no longer necessary for them to perform.

The example they used, as published in today's issue of Nature, is reversing the effects of the blood thinner heparin.

The basic element in creating the reversal is to develop a class of antidotes to a specific class of drugs, similar to the way antidotes are created for types of poisons, researchers say. It's especially important for those drugs whose effects must be nullified immediately.

According to a Duke news release, the antidote system came as a result of some inquiries about blood thinners.

Dr. Bruce A. Sullenger, vice chair of surgery at Duke University Medical Center and senior author of the study, says, "While heparin's blood thinning activity can usually be controlled with an existing antidote called protamine, it doesn't always work. It is difficult to administer and is associated with its own set of toxicities."

Heparin is a powerful blood thinner, often given during open heart surgery or after a heart attack.

Drugs called aptamers were used as the antidotes. They are compounds made of nucleic acid that bind directly to a target protein and inhibit the protein's activity.

While the research has only begun, scientists say they believe that aptamers have the potential to cause reversal in the whole class of blood thinning drugs.

More information

The Texas Heart Institute has a good explanation of how blood thinners work.

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Black Women at Lower Risk of Bulimia Than Whites

By Alison McCook

Reuters Health

Thursday, September 5, 2002

NEW YORK (Reuters Health) - Young African-American women appear to have fewer risk factors for developing bulimia than their white peers, and show fewer symptoms of the condition, new study findings show.

People with bulimia will binge on food, and then purge themselves by vomiting or taking laxatives. They may also exercise excessively.

Study author Dr. Gregory T. Smith of the University of Kentucky in Lexington told Reuters Health that previous researchers have also hinted that black women may be less likely to develop eating disorders than whites, although the reasons for that disparity remain somewhat unclear.

"It may be that the pursuit of thinness, leading to extreme dieting and the resulting failure of the dieting, leads to eating disorders," Smith noted. "So, African-American women may be at less risk because, culturally, they are less likely to feel that it is in their interests to pursue thinness as aggressively as do many white women."

Smith and his team compared the rate of risk factors and symptoms of bulimia in 200 black and 300 white female undergraduate students. During the study, the women completed forms designed to determine their eating behaviors and attitudes toward food and being thin. The students were an average of 25 years old.

The investigators found that black and white women tend to develop bulimia in the same manner. Specifically, they found that the same group of risk factors--trying and failing to restrain eating, or expecting rewards from dieting and slimming down--tended to lead to the same symptoms of bulimia in all women.

However, Smith and his team note in the latest issue of the International Journal of Eating Disorders, despite the fact that white women and black women follow the same path to bulimia, black women, on average, had fewer risk factors for and symptoms of the condition.

The study did not assess the women's attitudes toward anorexia, Smith noted, although he said he expects the results would be similar. "On average, extreme thinness is not seen, by African-American women, as bringing significant life rewards," he said. "That's probably good news for their risk for anorexia."

Smith added that he is now investigating whether African-American women who come to "accept and espouse" white culture also face an increased risk of bulimia and anorexia.

"We don't yet know, but we are studying whether a bad side effect of African-American women's total integration into white culture is increased risk for eating disorders," Smith noted.

Source:International Journal of Eating Disorders 2002;32:326-334.

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Liver Dialysis on the Horizon

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Thursday, September 5, 2002

THURSDAY, Sept. 5 (HealthScoutNews) -- A new liver dialysis procedure may help critically ill patients survive long enough to get a liver transplant.

 Known as albumin dialysis, University of Michigan researchers say the system works in a manner similar to kidney dialysis: blood is removed from the body, toxic substances are filtered out, and healthy blood is returned to the body.

"For the first time, there is a mechanical device that can help people with liver failure," says researcher Dr. Robert Bartlett, a professor of surgery at the University of Michigan. "[Albumin dialysis] is a bridge to liver transplantation. It stabilizes the patient so they can wait for a donor."

Bartlett and other researchers will be discussing their latest findings today at the Fourth International Symposium on Albumin Dialysis in Liver Disease in Rostock, Germany.

Every year, liver disease kills 25,000 Americans, according to the U.S. Centers for Disease Control and Prevention ( news - web sites). Livers fail for a variety of reasons. Cirrhosis, hepatitis and chemical toxins are the most common causes of liver failure, according to Bartlett. More than 17,000 Americans are on the liver transplant list, he adds.

The liver performs many important functions, including aiding in digestion, storing vitamins and other nutrients, breaking down and removing toxic substances, and regulating blood clotting. Currently, when the liver fails, there is no treatment other than to try to control the symptoms, such as jaundice or fluid retention, or to perform a liver transplant.

"It's been quite frustrating," explains Dr. Stuart Gordon, chairman of gastroenterology and hepatology at William Beaumont Hospital in Royal Oak, Mich. "We can assist with almost every other end-stage form of disease. When kidneys fail, we have dialysis. We have drugs and machines to help when the heart fails and when the lungs fail. But we don't have medications or devices to do the functions of the liver," he says.

That's why this device appears to be the "beginning of a dream," he says, although he cautions that the latest work is just a first step. He says the next step is a randomized controlled trial, which is exactly what Bartlett and his colleagues are undertaking, beginning in early 2003.

Albumin is a substance that grabs toxic substances and transports them through the blood to the liver. In people with diseased or damaged liver, these toxins stay in the blood and cause damage.

In albumin dialysis, blood is pumped out of the body and filtered through a thin membrane containing albumin. The albumin on the membrane grabs the toxins from the blood and filters them out. The filtered blood is then pumped back into the body.

The University of Michigan researchers have already used the device on 20 desperately ill liver-failure patients in a preliminary clinical trial with promising results. Two patients recovered complete liver function. Almost all of the remaining patients showed some improvement in liver function tests, and six patients lived long enough to receive a liver transplant. Results from the first nine patients were published in the August 2001 issue of Surgery.

The device is currently approved for use in Europe, but Bartlett says if the next trials go well, it will probably be about three years before the dialysis system is widely available in this country.

"All of this is very exciting," Gordon says of Bartlett's research. "Livers can fail quite abruptly, and often people die on the waiting list. We don't have anything to offer them right now. If liver dialysis can tide people over till transplant -- even for days or weeks -- it could save lives."

What To Do

To learn more about how the human liver functions, go to the American Liver Foundation or to the University of Utah Health Sciences Center.

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Young Baseball, Football Players at Risk of Injury

By Charnicia E. Huggins

Reuters Health

Thursday, September 5, 2002

NEW YORK (Reuters Health) - Children who participate in little league baseball or other youth sports may not be engaging in harmless fun, new study findings show. Young athletes, particularly football players, do sometimes face serious injury risks, researchers report.

The death this week of 10-year-old Taylor Davison, the only girl on her Chicago-area school football league, may serve to highlight the risks inherent in little league sports. According to a report in the New York Times, Davison collapsed during football practice on Friday and died Monday. Medical examiners believe her death may have been linked to a blood clot to the head incurred during a full-body tackle three days prior to her collapse.

"Children are getting injured in youth sport participation, especially youth football, (and) the injuries and severity are often unrecognized and thus may be mis-managed," study author Dr. Scott M. Lephart of the University of Pittsburgh Medical Center's (UPMC) Center for Sports Medicine told Reuters Health.

"There is need for uniform medical coverage and healthcare professionals to be tending to youth sport athletes similar to high school, college and professional athletes," he added.

Lephart and his colleagues investigated the injury rate among young sports players in an observational study of 1,659 children aged 7 to 13. The children participated in community baseball, softball, soccer and football.

The overall injury rate for each sport ranged from 1 to 2.1 injuries per every 100 games or practices, the investigators report in the September online issue of the journal Pediatrics. The researchers grouped games and practices together as "athlete exposures." In 37 cases, a child's injury required a visit to the emergency department or to their doctor's office.

Bruises were the most common injury, reported in 54% of the cases, but some players also suffered sprains, fractures and even concussions, study findings indicate.

The highest injury rate--2 injuries per every 100 athlete exposures--was in soccer. Yet this may be due to underreporting of injuries in other sports, the researchers speculate.

Although slightly higher in baseball, injury rates were similar in baseball and football, the authors note. When researchers evaluated the frequency of injury per team per season, they found the rate of injury in football was 4 to 7 times higher than the risk seen in other sports.

Softball had the lowest injury rate.

"Our observation showed that softball practices and games were less intense than baseball or soccer events, with a focus on skills acquisition, not competitiveness," Lephart and colleagues write.

In other findings, many coaches failed to follow prescribed return-to-play guidelines after players were injured and instead used their own judgement on when players should be able to return to the game.

"Because proper management of musculoskeletal injuries for this age group is vital to normal growth and development, premature return to sport not only can increase the risk of reinjury but also can result in life-long consequences," the authors write.

In light of the findings, "youth sport organizations and federations should reevaluate their policies for medical coverage and likely institute stronger regulations related to the medical coverage for children participating in such sports," Lephart said.

Also, he advised that parents "insist that organizers institute healthcare coverage policy for youth sports and insist that the policy be enforced."

Source:Pediatrics 2002;110:e28.


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Stroke Vaccine Passes Early Test

By Randy Dotinga
HealthScoutNews Reporter

HealthScoutNews

Thursday, September 5, 2002

THURSDAY, Sept. 5 (HealthScoutNews) -- Federal researchers say they're on the road to creating a vaccine that could tweak the linings of blood vessels so they can't begin the process that leads to a stroke.

 While the new study suggests the vaccine works in rats, no one knows whether it will have similar effects in humans. However, if it works, the vaccine could offer a "new dimension" in stroke prevention, says Dr. John M. Hallenbeck, the study's senior author and chief of the Stroke Branch at the National Institute of Neurological Disorders and Stroke.

Strokes happen in one of two ways: either a blood clot forms and cuts off circulation to part of the brain or a blood vessel ruptures and leaks blood into the brain. In both cases, a stroke can lead to permanent disability or death.

Half a million Americans have strokes each year, and about 150,000 die from stroke-related causes. Only heart disease and cancer claim more lives.

In his study, Hallenbeck and colleagues sprayed a protein known as E-selectin into the noses of rats that were genetically designed to suffer from high blood pressure and be susceptible to strokes. Other rats received two other treatments for the sake of comparison.

The results appear in the September issue of Stroke.

During the year-long study, rats that received repeated treatment with the protein had 16 times fewer strokes caused by blood clots than those that received other treatments. And the strokes that did occur were less severe.

None of the rats that had repeated treatment suffered from a hemorrhagic stroke, in which blood vessels rupture.

Unlike most vaccines, the treatment appears to dampen down the immune system instead of gearing it up, Hallenbeck says. The protein primes blood vessels so they're ready to attack inflammation when it occurs, Hallenbeck says.

Strokes begin when inflammation occurs on a molecular level in blood vessels as part of a response by the immune system. "It's not a big, red, swollen and hot joint. It's more subtle," he says. "That process can be interrupted by this approach."

The key appears to be giving the treatment often enough to make it work properly, he says. Rats that received the protein less frequently were more likely to suffer strokes.

Hallenbeck says the next step is to study whether the vaccine will work in humans. Researchers will first have to study side effects, and figure out how to safely give the vaccine to people. Protein derived from people may not work, so researchers may turn to cow-derived protein, he says.

The vaccine would most likely be targeted to people who are susceptible to strokes because they've already had them, he says. "You would take it once every other day for five days about once a month."

Dr. James Grisolia, a neurologist at Scripps Mercy Hospital in San Diego, cautions that tinkering with the immune system could create problems in elderly people.

"Are you going to increase their risk of pneumonia, of urinary tract infections, of septic shock with this vaccine?" Grisolia asks. "How long will the immunity (to strokes) last in humans? Maybe the risks will be acceptable for high-risk patients, but would not make the treatment desirable for the general population, at least not until they've had one or more strokes already."

However, he adds there's reason for hope: "These worries aside, the vaccine concept offers a lot of promise for stroke, the nation's number one crippling disease. More research will answer the practical questions."

What To Do

For a range of information on strokes, visit the National Stroke Association or the American Heart Association.

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Adult Bed Potential Hazard to Sleeping Infant

By Todd Zwillich

Reuters Health

Thursday, September 5, 2002

WASHINGTON (Reuters Health) - Infants who sleep in adult beds are vulnerable to several "hidden hazards" including suffocation and falls, a federal safety agency warned Thursday.

Officials from the US Consumer Product Safety Commission ( news - web sites) (CPSC) said that more than 100 infants under 2 years of age died between 1999 and 2001 while sleeping in a bed made for adults. The majority were under 3 months of age.

Many adults believe that pushing a bed against a wall or surrounding a napping baby with pillows makes it a safe place for infants to sleep, said Elaine Tyrrell, CPSC's director of outreach. But such moves still place babies at risk of suffocation, she said.

"Babies move and they have been found suspended between the mattress and the wall," Tyrrell said.

Experts recommend that infants only be placed to sleep on a firm surface with no pillows, thick quilts or other forms of soft bedding surrounding them, even if an adult bed is used. Soft or pliable objects can trap breathed air and raise suffocation risk, and parents should be aware that bed frames and headboards also can pose a risk.

Babies have also died by falling from a bed and suffocating on piles of clothing or plastic bags.

"We believe that parents and caregivers are not aware of these risks," Tyrrell said. If using a crib, parents should be sure to only use the mattress that came with the crib and be sure the set-up has a tight-fitting sheet, experts said.

The agency and several infant product manufacturers will spend September promoting baby safety tips in retail stores throughout the nation.

Experts also stressed the importance of placing infants to sleep on their backs, not their stomachs. Sleeping on the belly is the leading risk factor for sudden infant death syndrome (SIDS).

About 2,500 infants died from SIDS in 1999, though numbers have dropped by half since 1994 due to widespread efforts to promote the safer sleeping position, said Laura Reno, marketing director for the SIDS Alliance.

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Many Cancer Patients Turn to Alternative Medicine

HealthScoutNews

Thursday, September 5, 2002

THURSDAY, Sept. 5 (HealthScoutNews)-- More than 70 percent of adult cancer patients in western Washington use alternative therapies, and almost all report improvements in well-being as a result, a new study shows.

The research, the first population-based study of its kind to look at predictors, motivators and costs of different types of alternative medicine use in adults with cancer, was conducted by the Fred Hutchinson Cancer Research Center. The findings were published in yesterday's issue of The Journal of Alternative and Complementary Medicine.

Researcher Ruth E. Patterson and her colleagues at Fred Hutchinson's Public Health Sciences Division led the study, which was supported by grants from the National Cancer Institute ( news - web sites) and funds from Fred Hutchinson.

"This is the first study to specifically inquire about patients' attitudes regarding the effectiveness of alternative treatments," Patterson says.

Patients were considered users of alternative medicine if they received care from an alternative provider within the past year or had used at least one alternative supplement or therapy.

Depending on the type of therapy, 83 percent to 97 percent of patients surveyed said they used alternative medicine for general health, and nearly all reported that use of these therapies improved their well-being.

A smaller number of those surveyed, between 8 percent and 56 percent, turned to alternative interventions to actually treat their cancer.

The most common form of alternative treatment was the use of dietary supplements, which were taken by 65 percent of the patients, many of whom used several such products simultaneously.

Cancer type also appeared to influence alternative therapy use: for example, those with breast cancer ( news - web sites) were significantly more likely to see alternative providers or take dietary supplements than were colon cancer patients.

"Since most therapies were used to enhance overall health and well-being, it seems unlikely that patients would substitute these therapies for conventional medicine," Patterson says.

But, she adds, "doctors should be wary of discounting alternative medicine, given that the majority of patients overwhelmingly feel it improves their quality of life."

The survey was based on telephone interviews with 356 adults who had been diagnosed with breast, prostate or colon cancer between February 1997 and December 1998. The group was divided equally among men and women, with equal representation among the three types of cancer.

One limitation to the study, Patterson notes, is that use of alternative medicine could be high in western Washington for a variety of reasons.

First, vitamin use is highest in the western United States compared to other areas of the nation. Also, health insurers in Washington are required by state law to provide coverage for licensed alternative providers.

"Regardless of incidence of alternative medicine use in Washington, other studies also indicate that alternative medicine use is common in patients with cancer," Patterson adds.

More information

The National Center for Complementary and Alternative Medicine has more information.

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Australia Tan Implants May Help Prevent Skin Cancer

By Sophie Hares

Reuters

Thursday, September 5, 2002

SYDNEY (Reuters) - Sun-worshippers may be able to get that bronze tan without baking for hours in potentially lethal rays, and fight skin cancer at the same time, if a new drug implant hits the market in few years time.

Designed to allow sun-free tanning and help prevent skin cancer, implants using the drug melanotan are being developed by a biotech firm in sunny Australia, which has the world's highest rate of skin cancer.

Dubbed the "Barbie Drug," melanotan stimulates the production of the melanin pigment in the skin that causes a tan and helps prevent damage from potentially cancer-causing rays.

"The melanin in the skin is your internal sunscreen, it has a protective rating," said Wayne Millen, chief executive of Melbourne-based EpiTan Ltd, which is developing the drug.

"This is another bullet to fire in the war against skin cancer," Millen told Reuters on Thursday.

Developing the drug for medical use, EpiTan expects melanotan to be ready for sale by 2005.

But melanotan is likely to be eagerly sought by people more interested in its ability to produce a much coveted sunkissed look rather than any cancer-preventing properties.

A new phase of human clinical trials is due to begin within the next few weeks after earlier tests saw white-haired dogs and green frogs turn jet black when they were injected with the drug.

Users will eventually be able to have a matchstick-sized capsule implanted under the skin by a dermatologist to promote a summer-long glow and help prevent the dangerous side effects of suntanning, Millen said.

EpiTan is collaborating with the Southern Research Institute in Alabama and is considering a tie-up with a big pharmaceutical firm to distribute melanotan when it is ready for commercial use.

Around 1,000 Australians die each year from melanoma, the most dangerous form of skin cancer.

WEDNESDAY, SEPTEMBER 4, 2002

Govt urged to halt Alzheimer's study

By Steve Mitchell
UPI Medical Correspondent
From the Science & Technology Desk
United Press International

Wednesday, September 4, 2002

 WASHINGTON, Sept. 4 (UPI) -- A consumer group Wednesday called for the federal government to halt a study examining whether common pain-killing drugs can prevent Alzheimer's disease because the group says the drugs used in the study have been shown to be ineffective.

Public Citizen also charged, in a letter to Health and Human Services Secretary Tommy Thompson, that people enrolled in the study are being exposed to potentially serious side effects from the drugs, which include Naprosyn and Celebrex, painkillers commonly used to treat arthritis.

"The study should be immediately stopped," Sid Wolfe, director of Public Citizen's Health Research Group, told United Press International.

Wolfe noted people in the study would be taking Celebrex for 7 years, and over this amount of time the risks due to the drug "start mounting" and include kidney toxicity and liver toxicity, which could lead to gastrointestinal damage, infringement of bone healing and even death.

Patients in the study, funded by the National Institutes of Health, are not being informed fully of the potential for these side effects or the alleged ineffectiveness of the drugs to prevent Alzheimer's, the degenerative brain illness that affects as many as four million Americans, Wolfe said.

The NIH began the 7-year study last year to look at whether a class of painkillers known as non-steroidal anti-inflammatory drugs, or NSAIDs -- including Naprosyn, ibuprofen and Celebrex -- could prevent Alzheimer's. The study was slated to enroll more than 2,600 people over age 70. So far, 1,000 people have enrolled at six centers across the United States.

The study was based on observational evidence suggesting that people who took these drugs regularly had a lowered risk of developing Alzheimer's.

However, Public Citizen claims in the letter recent studies that became available after the study began have shown only certain NSAIDs -- not Naprosyn and Celebrex -- have the potential to prevent Alzheimer's.

Alzheimer's experts, however, discounted Public Citizen's claims. Paul Aisen, director of the memory disorders program at Georgetown University in Washington, was involved in a study Public Citizen cited in its letter supporting its argument that the drugs will not prevent Alzheimer's.

Aisen's study, which was presented in July at an Alzheimer's disease conference in Stockholm, found Naprosyn and Vioxx -- a drug similar to Celebrex -- to be ineffective for halting the progression of Alzheimer's in patients who already had symptoms of the disease.

"Our study does not mean that the NIH prevention trial will not be successful," Aisen told UPI, noting his study involved people who already had Alzheimer's.

"The NIH study should not be stopped based on the results of our trial," he said. Naproxen and Celebrex "certainly may have a preventative effect, and if the trial is stopped prematurely, we may never know," Aisen added.

Vicky Cahan, spokeswoman for the National Institute of Aging -- the NIH agency overseeing the study -- told UPI, "NIA is reviewing the letter." She added the study is still ongoing at this point.

Bill Pierce, spokesman for the HHS, which oversees the NIH and to which Public Citizen addressed the letter, told UPI, "The most important thing is this is just one organization's opinion."

In response to claims that people enrolled in the trial were not informed of the risks, John Breitner, a psychiatrist at the University of Washington School of Medicine in Seattle who is the principal investigator of the study, said in a written statement, "Patients who receive the test medications ... were adequately informed in the consent form they signed upon entering the trial regarding the potential risks of the study medicines."

Public Citizen's letter claimed recent research has shown only NSAIDs that block an enzyme called secretase have the potential to prevent Alzheimer's. The group noted Naprosyn and Celebrex do not block this enzyme.

Aisen pointed out, however, the secretase research was done in animals and thus might not hold true in humans. "I do not view that as a reason that the NIH trial should be stopped," he said.

Breitner agreed with Aisen and noted, "The effort to prevent Alzheimer's disease requires investigation into all the avenues that show promise, and NSAIDs may well play a strong preventive role."

Aisen added that he "remains interested in the idea that NSAIDs may be useful for preventing Alzheimer's." His group is "still considering testing other anti-inflammatory drugs" to determine if they have a beneficial effect on the disease.

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Case of 2nd HIV Infection Documented

By Stephanie Nano

Associated Press Writer

The Associated Press

Wednesday, September 4, 2002

Swiss researchers have documented a rare case of a patient contracting a second HIV ( news - web sites) infection years later with a different strain of the virus.

Doctors once assumed that patients' natural immunity would keep them from getting the virus more than once. However, in Thursday's New England Journal of Medicine ( news - web sites), researchers describe the case of a 38-year-old man who acquired a second strain through unprotected sex more than two years after he was first infected in 1998.

"It just shows how little we understand what's happening with HIV-related immunity," said one of the researchers, Dr. Bernard Hirschel of the University of Geneva.

The researchers said the case could have implications for the development of an AIDS ( news - web sites) vaccine and supports the practice of safe sex even among HIV-infected partners.

Hirschel said researchers were able to document the case because the patient was enrolled in an AIDS drug study to test early treatment of the virus. The man was successfully treated for more than two years and was taken off the drugs after getting an experimental vaccine intended to boost his immune system. A few months later in April 2001, and weeks after he had unprotected sex with men, his virus level jumped. He was found to be infected with a different strain.

"What would have really have helped to clinch this case is if we had the found the source," Hirschel said. "But he had a number of anonymous sex partners in Brazil and it was hopeless."

The patient resumed taking the AIDS drugs and has responded well, Hirschel said. The study was funded by the Swiss government and drug maker GlaxoSmithKline.

A similar Boston case was reported by Dr. Bruce D. Walker at a recent AIDS conference.

In an editorial, Walker and Dr. Philip J.R. Goulder of Massachusetts General Hospital said the Swiss report provides "convincing evidence that HIV-1 superinfection can occur long after an initial infection is established."

"With sexual activity seemingly increasing among persons with HIV-1 infection, this is a public health message that needs to be broadcast loud and clear," they wrote.

On the Net:

New England Journal: http://www.nejm.org

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Teen Girls and Exercise? Not!

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Wednesday, September 4, 2002

WEDNESDAY, Sept. 4 (HealthScoutNews) -- By the time they finish high school, many American girls have lost whatever semblance of being physically active they had when they were younger.

 A new study finds that the amount of regular exercise girls get in their spare time drops by more than 80 percent between elementary school and late adolescence. Black teens reported a 100 percent falloff in regular physical activity each week. Their white peers fared a little better, but even their exercise scores dropped by nearly two-thirds over the 10-year period.

The findings help explain why obesity, Type II diabetes and inactivity are higher among black women than among white women, which raises their risk of heart disease, stroke, colon cancer, osteoporosis and other health problems tied to exercise. Some 15 percent of American youth are overweight, triple the number since 1970s.

Dr. Sue Kimm of the University of Pittsburgh led the study, which appears in tomorrow's New England Journal of Medicine ( news - web sites).

Kimm and her colleagues followed 1,213 black girls and 1,166 white girls from the age of 9 and 10 to 18 and 19. The girls were queried regularly about their exercise habits during out-of-school hours, as well as about other health habits and their family's social and economic status.

At the start of the study period, the two groups reported roughly the same amount of weekly exercise, as estimated in units called metabolic equivalents, or METs, in the form of swimming, biking, dance, gymnastics, and other sports. Black girls had 27.3 and white girls had 30.8 METs, respectively.

But 10 years later, black girls reported getting 0 METs in their free time each week, on average, a decline of 100 percent from the earlier figure. Whites got 11 MET-times a week, 64 percent fewer than before.

The number of girls in each group who reported getting no regular leisure exercise by age 16 or 17 was 56 percent for blacks and 31 percent for whites. For the entire study, the average activity score plunged 83 percent.

Black girls had higher average body mass -- a marker of overweight and obesity -- than the white girls in all age brackets. High body mass index (BMI) was associated with steeper declines in physical activity for both groups.

The rate of smoking was more than four times greater among white girls, 27 percent vs. 5.7 percent, and smoking predicted who exercised less.

Black girls were three times as likely to get pregnant by the eighth year of the study -- 22.3 percent vs. 7.5 percent. Pregnancy was cited as a reason for lack of exercise for blacks, but not for whites.

White girls whose parents were poorly educated had greater drops in exercise between childhood and adolescence. But that effect held only for black girls in their teens. Other work has found a similar link between years of education and amount of physical activity among women in this country.

Richard Troiano, an epidemiologist at the National Cancer Institute ( news - web sites) and author of an editorial accompanying the journal article, said the study underscores how exercise-unfriendly American culture has become.

People take elevators rather than climb stairs, they drive to work and school instead of walk. Neighborhood playgrounds are no longer seen as safe havens for local kids, meaning those who want to participate in sports have to be taken to gyms, fields, or parks -- trips that require sacrifices of time and often money from parents.

"We need to re-emphasize the need for physical activity," Troiano said. "We have to put it back in because we've essentially taken it out."

Bernard Gutin, an exercise expert at the Medical College of Georgia in Augusta, called the latest findings "pretty scary. The implication is that after school [teen girls] just don't do a blessed thing."

Gutin and his colleagues have studied fitness interventions in both boys and girls, with encouraging results. A half-hour or more daily of moderate-to-vigorous exercise can help them shed pounds and take off fat even without changing their diet, he said. His group is now looking at the impact of regular 80-minute workouts on body and abdominal fat.

Sumru Ekrut, a Wellesley College researcher who studies the exercise habits of girls, said the trends in the latest analysis aren't surprising, though the magnitude of the reduction in physical activity is larger than she has found.

"With increasing age, fewer kids are physically active; this is true for both boys and girls," Ekrut said.

The phenomenon of the athletic girl is relatively recent. So researchers know little about the negative effects of stopping exercise in this group, Ekrut said.

"No one has looked at what happens to girls who stop being physically active -- whether their developmental trajectory changes. It might, but one could also argue that the protective effects linger."

While participation in sports is generally perceived as a good thing for girls, Ekrut said it's not always an unmitigated plus. Team sports can expose younger girls to the more adult, and potentially dangerous, behaviors of older students, like drinking alcohol. These in turn can make them vulnerable to risky sexual practices and other hazardous activities.

What To Do

For more on the importance to the skeleton of exercise in childhood, visit the National Institute of Child Health and Human Development.

For more on how to involve your daughter in sports, try Girls in Sports or the YWCA.

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Dutch Boy Exits Bubble After Care

By Anthony Deutsch

Associated Press Writer

The Associated Press

Wednesday, September 4, 2002

AMSTERDAM, Netherlands (AP) - The remnants of lunch were on Wilco Conradi's rosy cheeks when the 2-year-old grabbed a large ice cream and ran back to the table.

"Let's see if this tastes OK," he said, climbing onto his mother's lap and drawing a giggle.

This summertime outing at the zoo once was unthinkable for the Dutch boy, who lived his first months in a germ-proof plastic enclosure after being born with severe combined immunodeficiency, or SCID. The plastic enclosure protected Wilco from infections that would have killed him.

But the blond, blue-eyed boy underwent a new gene therapy technique that apparently cured his disease and allowed him to leave his plastic bubble. He needs no medication or special treatment and eats a regular diet.

"He can go to school, go on vacation, and live like any other child," said his father, Theo Conradi. "Just look at him!"

Wilco was peering disapprovingly at a boy sleeping in a stroller, apparently worn out by the heat.

Wilco is among the first four boys to undergo the new treatment — all with successful results — for the inherited disease that occurs in about one of every 75,000 births. The disorder, which is carried by women but afflicts only boys, has plagued Wilco's family for generations, killing one of his uncles and two cousins.

The illness renders the immune system ineffective against microbes ordinarily harmless to people with normal resistance. The best-known victim was David, Houston's famous "bubble boy," who lived in a germ-proof plastic enclosure until his death at age 12 in 1984.

Many afflicted babies are saved by bone marrow transplants, but for the rest of their lives take monthly intravenous infusions of immune globulin, antibodies culled from donated blood.

Wilco was a baby when he received the experimental treatment at the Hopital Necker-Enfants Malades in Paris. After receiving a single injection of genetically modified stem cells, Wilco now has a normal immune system.

In April, the experimental procedure passed its first major test when Wilco got sick.

"He had chicken pox and recovered on his own," said Dr. Nico Wulffraat, an immunologist at the Wilhelmina Children's Hospital in Utrecht. "Normally, that would have been lethal."

The boy has no signs of complications — such as fever or infection — that could indicate problems, Wulffraat said.

"Everything looks right, but we are closely following his case," Wulffraat said. "Several other children have now received the same treatment."

Similar gene therapy might be used to fight other inherited disorders, Wulffraat said, "but these children will have to be followed for a long time" to know the long-term results.

The day Wilco was born, his father took a blood sample to Wulffraat, fearing the boy had inherited the disease first discovered in his family 45 years earlier. The diagnosis was confirmed hours later and the next day Wilco was admitted to the hospital.

Wulffraat then introduced the family to Paris immunologist Dr. Alain Fischer.

The four boys treated in France lacked an essential protein due to a genetic mutation. As a result, they could not produce two types of infection-fighting immune cells and a third type did not work, leaving their bodies vulnerable to infection.

To reverse that gene defect, doctors drew bone marrow from the boys. They culled stem cells from the marrow and mixed them with a harmless virus that contained a gene that makes the missing protein.

After the virus infected the bone marrow cells, millions of each boy's cells were injected into his bloodstream to give them healthy immune systems.

Wilco visits the hospital four times a year, twice in Paris and twice in the Netherlands. He does not remember anything about his groundbreaking treatment or about his infancy in isolation.

At the Artis zoo in downtown Amsterdam, Wilco scampered off with his 12-year-old sister, Petra, to play on the slide as his parents explained how the treatment lifted what seemed like a family curse. Their second child, Wilma, died of a brain tumor a year before Wilco was born.

"It feels like we have been given a second chance," said Wilco's mother, Roelien. "But it is still difficult to treat him like a normal child."

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Fats, sugars may affect brain chemistry

By Katrina Woznicki
UPI Science News
From the Science & Technology Desk
United Press International

Wednesday, September 4, 2002

 Cheeseburgers, sodas and other fatty and sugary foods long have been known to contribute to obesity but science is beginning to discover how these tasty treats can disturb the action of key hormones in the body and consequentially alter brain chemistry.

Growing evidence suggests consumption of fats and fructose -- a type of sugar found in fruits and in processed beverages such as sodas and juice drinks -- affect the natural action of three important hormones: ghrelin, which is produced by the stomach to stimulate food intake but also recedes when appetite is sated; insulin, produced by the pancreas to regulate the fat cells; and leptin, produced by the fat cells to signal the brain the body is full.

Several studies have suggested that too much fat results in insulin resistance, creating a situation where hormone signaling becomes so gummed up the brain cannot tell the body when to put down the fork. The same appears to hold true for fructose.

"The more fat and fructose you have on your diet, the less effect you have on these hormones that keep your body stable," Peter Havel, an endocrinologist at the University of California at Davis, told United Press International.

"These hormones help keep your body weight stable," he said.

Sugar, like glucose, ignites insulin production, which then helps set off a biochemical chain reaction throughout the body that indicates fullness. Fructose, however, does not stimulate insulin production and this, researchers said, is a crucial link to understanding why some people develop obesity.

"When you drink beverages with lots of fructose ... you're not triggering insulin secretion or leptin" because leptin is dependent on insulin production, Havel explained. Ghrelin levels are not dropping in the stomach, therefore the body is confused. By consuming fructose-heavy products, the body continues to take in calories, but the hormones are not able to tell the body it is full and to stop eating.

"Many fast food meals are washed down with a large beverage," Havel said. "When you eat such a meal, you're not going to produce as much insulin and leptin and you're not going to lower your ghrelin as well."

If the brain and body do not receive signals that appetite needs have been met, then eating will continue and, in turn, the chances of obesity increase. This cycle raises one's risk for a slew of dangerous ailments such as heart disease, hypertension and diabetes.

Havel's research, conducted with the University of Pennsylvania in Philadelphia, looked at 12 women of normal weight, ages 20 to 40 and compared their blood samples on days they consumed fructose to days they consumed glucose. Although Havel would not go into to many details because the research has yet to be published, he did say the days of fructose consumption showed higher triglyercide levels, a risk for potential heart disease.

Havel said a 12-ounce soda contains about 25 grams of fructose. A 64-ounce soda -- the kind of "super-size" serving widely available at convenience stores, contains 130 grams. In contrast, an apple contains 13 grams of fructose, a banana has 7 and a peach contains 4. Plus, fruit provides several other needed nutrients such as fiber and vitamins that are not provided by fructose-heavy drinks.

"What is it about composition of diet that allows you consume more than you otherwise would?" asked endocrinologist Michael Schwarz of the University of Washington in Seattle, who also is investigating this issue. "If the phenomenon exists that you become (hormone) resistant under these conditions of obesity, then there must be reason for that," Schwarz told UPI.

Stephen Woods, a psychiatry professor and director of the obesity research center at the University of Cincinnati, said the natural processes of our bodies and brains might have become too overwhelmed by the hyper-stimulating environment of ubiquitous high-caloric fast food.

"The food industry, particularly the fast food industry, is very good at making foods so appealing that people are willing to consume (them) and that will in turn override other types of (biological) controls," Woods told UPI.

One of these controls is called cholecystokinin, or CCK, a signal that comes from the lower stomach to indicate fullness.

"There's lot evidence when you eat these calorically-dense, high-sugar, high-fat foods, that your body and your brain is less sensitive to CCK," Woods explained. "What that means is that you have to eat bigger meals in order to secrete enough CCK to turn off your appetite."

According to the U.S. Surgeon General's Office and the Centers for Disease Control and Prevention, the nation's girth continues to bulge. At present, 61 percent of the American population is either overweight or obese. As a result, health experts have been warning the public to minimize its intake of fatty and sweet foods.

One mystery scientists are pursuing is the link between genes and how fats and sugars affect the body and brain. Some people might be more genetically susceptible to developing hormone insensitivities as a result of their fat and sugar intake, while in others, environment might be the source of over-eating.

"When we live in a world with these stimuli that look good and smell good and taste good and are calorically dense," Woods said, "then we're going be heavier."

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Breastfeeding Can Cut Cholesterol Later in Life

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Wednesday, September 4, 2002

WEDNESDAY, Sept. 4 (HealthScoutNews) -- A new study offers yet another good reason to breastfeed babies: It seems to help lower cholesterol levels later in life.

That's the conclusion of researchers from St. George's Hospital Medical School in London, writing in the September issue of the journal Pediatrics.

The research team studied more than 1,500 adolescents, measuring their current cholesterol levels and then asking parents how the teens were fed as infants. The team also reviewed 37 other studies evaluating infant feeding styles and blood cholesterol levels at various stages of life.

The cholesterol levels of breastfed infants were higher than bottle-fed babies, probably due to the high cholesterol content of breast milk compared to formula. The researchers also found no differences in total cholesterol levels in later childhood or teen years between breastfed and bottle-fed subjects.

But by adulthood, those who had been breastfeed had lower cholesterol levels, the researchers found. The differences were modest, averaging just under 10 milligrams per deciliter.

"A reduction in mean [total cholesterol] of this magnitude in adult life would be associated with a reduction in coronary heart disease of approximately 10 percent, based on observational data," the researchers say.

So how long should a baby be breastfed to help cholesterol levels later?

"The duration of breastfeeding required for reduction of adult cholesterol is uncertain," says Christopher G. Owen, an epidemiologist at St. George's and lead author of the study. "Other studies have suggested that breastfeeding for longer than three months may lower cholesterol, while breast feeding for longer than a year may elevate cholesterol in adult life."

Exactly how breastfeeding leads to lower cholesterol in adulthood also isn't certain. But the researchers suspect that early breastfeeding somehow improves fat metabolism later in life by triggering some sort of nutritional programming.

If this is the case, Owen says, "there is a strong argument for the content of formula feeds to match that of human milk."

High cholesterol levels are powerful but reversible risk factors for heart disease. Adults age 20 and older are advised to have their cholesterol levels measured at least once every five years, according to the National Cholesterol Education Program.

Total cholesterol levels should be less than 200 milligrams per deciliter. Low-density lipoproteins, the so-called bad cholesterol, are considered at optimal levels if less than 100 milligrams per deciliter. High-density lipoproteins, the so-called good cholesterol, should be above 60 milligrams per deciliter to help lower heart disease risk.

While heredity plays a role in how much cholesterol a person produces, paying attention to diet by limiting saturated fat and cholesterol in foods can improve the cholesterol profile. So can losing weight, if necessary, and becoming more physically active.

The new study highlighting the cholesterol-lowering benefit of breastfeeding will probably be news to most people, says Carol Huotari, a lactation consultant and manager for the Center for Breastfeeding Information at the La Leche League International, an organization that promotes breastfeeding.

She plans to post the news of the study on the organization's Web site, she says, to further impress on new parents all the benefits of breastfeeding.

Previous studies have found that breastfeeding a baby provides not only good nutrition, but a host of health benefits, including reduced risk of ear infections, allergies and other ailments.

The study by the St. George's researchers makes sense, Huotari adds.

It found that cholesterol levels of breastfed babies were higher than bottle-fed babies, but that's a good thing, she points out. "Infants need fatty acids" from the cholesterol to ensure the development of the brain, for instance, she says.

What To Do

For more information on breastfeeding, see the American Academy of Pediatrics. For cholesterol information, visit the National Heart, Lung, and Blood Institute.

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Eating Disorders May Affect Bone Health for Years

Reuters Health

Wednesday, September 4, 2002

NEW YORK (Reuters Health) - Even years after a person is diagnosed with anorexia nervosa ( news - web sites), they have twice the risk of bone fractures as their peers without the eating disorder, new study findings from Denmark show.

The findings suggest that damage caused to bones by eating disorders may be permanent, according to a report in the International Journal of Eating Disorders.

However, it is possible that patients in the study were still struggling with the eating disorder, which may have kept bones from regaining strength, the report indicates.

Previous studies have found that people with eating disorders such as anorexia or bulimia can suffer from weakened bones because of poor nutrition. Experts say that this can increase the risk of osteoporosis and fracture.

In the current investigation, Peter Vestergaard of the Aarhus University Hospital in Denmark and colleagues looked at 2,149 people diagnosed with anorexia nervosa, 1,294 people with bulimia nervosa and 942 people with another type of eating disorder. All of the patients--more than 90% female--were compared to a group of over 4,000 healthy people.

Compared to those without an eating disorder, patients were about twice as likely to break a bone after their diagnosis and the risk remained elevated for up to 10 years after diagnosis. The fracture risk was also elevated in those with other eating disorders, but not as dramatically as in patients with anorexia.

The researchers believe anorexia may cause permanent damage to the skeleton, which is later compounded by the loss of bone that can occur with aging. On the other hand, the researchers point out that even after diagnosis and treatment, the eating disorder may not have been completely reversed, resulting in continued nutritional deficits and further decreases in bone mass.

"In conclusion," the authors write, "an increased risk of fractures is present many years after diagnosis of anorexia nervosa, and the group of other eating disorders. These findings call for more awareness of potential skeletal complications linked to eating disorders in general."

Source: International Journal of Eating Disorders 2002;32:301-308.

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Just Standing Up Can Cut Heart Risk

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Wednesday, September 4, 2002

WEDNESDAY, Sept. 4 (HealthScoutNews) -- Don't just sit there. Do something, for your heart's sake.

Even the act of standing up will help lower the risk of heart disease, and taking a brisk walk will do even more.

That's the message of a five-year study of almost 74,000 post-menopausal women between the ages of 50 and 79 who are participating in the Women's Health Initiative.

One expected finding, says a report in tomorrow's New England Journal of Medicine ( news - web sites), is that women who walk or exercise vigorously for 30 minutes a day, five days a week, reduce their risk of heart attack and stroke by at least 30 percent. But the study also found that just standing up reduces cardiovascular risk as well.

"We looked at what the risk is of being totally sedentary," says Dr. JoAnn E. Manson, chief of preventive medicine at Harvard's Brigham and Women's Hospital and lead author of the report. "Women who spent fewer than four hours a day sitting had a lower risk than those with more prolonged sitting."

The basic message of the study, that exercise is good for the arteries, is not new, Manson acknowledges; that has been shown for both men and women. What this report adds, she says, is proof that the benefit applies to all ethnic groups.

"Most previous studies were done in white populations," she says. "We extend the findings to an ethnically diverse population."

To be precise, African Americans (5,661 women), Hispanics (2,880), Asian/Pacific Islanders (2,288) and American Indian or others (1,340). The results were consistent.

"Walking and vigorous exercise were associated with similar risk reductions, and the results did not vary substantially according to race, age or body-mass index," says the journal report. "A brisker walking pace and fewer hours spent sitting also predicted lower risk."

But that last sentence shouldn't deter a woman from doing something physical, Manson says. The report should help kill a long-standing belief by some experts that only vigorous physical exercise is good you, she says. "It's the 'no pain, no gain' dogma," Manson says. "This study suggests it is an outdated notion."

Encouraging women -- and men -- to do something physical is an urgent need, she says, because we are in "a public health crisis," with 75 percent of Americans getting less than the 30 minutes of exercise five days a week recommended by the American Heart Association ( news - web sites) and the American College of Cardiology.

There actually is a good case for upping that quota, says Dr. Paul D. Thompson, chief of preventive cardiology at Hartford Hospital in Connecticut, who wrote an accompanying editorial. "The present recommendations are good, but they were never intended to be the ideal amount or maximum amount, just something you could achieve easily," he says.

For optimum health, Thompson says, "You're better off doing an hour a day." Indeed, he says, "If you look at the bulk of information on exercise, more is always better. I don't think we have reached a point where we can say that someone can do too much exercise."

But this is a world of television viewers and couch potatoes, Thompson quickly acknowledges, and "the real question is how we get more people to do more exercise."

One thing that could help is knowledge of the mechanism by which exercise helps the arteries, which we don't have now, he says. "We'll have a better handle on how much exercise is best when we have a better understanding of what the mechanisms are," Thompson says.

What To Do

For basic information on the benefits of basic physical activity, turn to the American Heart Association or the National Heart, Lung and Blood Institute.

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Drug Maker Amends Hormone Therapy Prescribing Info

Reuters

Wednesday, September 4, 2002

ST. DAVIDS (Reuters) - Drug maker Wyeth on Wednesday said it changed the prescribing recommendations for women taking its hormone replacement therapy products to reflect recent studies that raised safety questions about the medicines and sparked a nationwide debate.

The labels for Premarin, Prempro and Premphase will now recommend that women remain on the therapies for the shortest time possible given the individual patient's treatment goals. The drugs should also not be taken to prevent heart disease, and other treatments should be considered for osteoporosis prevention, a common use of hormone replacement therapy, the labels now state.

The prescription information will include results of a study spearheaded by The Women's Health Initiative that suggested Prempro carried a slightly increased risk of breast cancer ( news - web sites), stroke and heart disease after five years of use. A second study prompted safety questions about Premarin.

Premarin contains the hormone estrogen for the treatment of menopause symptoms while Prempro combines estrogen with a synthetic female hormone called progestin.

Wyeth, which saw US prescriptions drop more than 20% in the weeks immediately after the Prempro study came out in July, has been criticized for not adequately warning patients of the potential risks of the medicines.

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Prostate Cancer Supplement Contaminated

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Wednesday, September 4, 2002

WEDNESDAY, Sept. 4 (HealthScoutNews) -- An herbal mixture that was widely used for the treatment of prostate cancer ( news - web sites), but is no longer on the market, was contaminated with synthetic drugs.

That's the conclusion of a new study in today's Journal of the National Cancer Institute ( news - web sites).

The mixture, called PC-SPES, began to be used in late 1996 and early 1997, says study author Dr. Robert Nagourney. It was sold as a dietary supplement "for prostate health," but was widely used to treat prostate cancer.

In the beginning, the mixture looked good, Nagourney says, who heads Rational Therapeutics Inc., a research and therapy institute focusing on alternative treatments.

"We were seeing genuine responses," he says. Patients with advanced prostate cancer were seeing a decline in their levels of PSA (prostate-specific antigen), a marker for the disease.

"But patients, meantime, were complaining of breast tenderness," Nagourney says.

To investigate, Nagourney and his co-workers got eight lots of PC-SPES, manufactured at different times between 1996 and last year, and analyzed them. They found all lots contaminated with indomethacin, a pain reliever, and most with diethylstilbestrol, a potent synthetic estrogen that accounted for the breast tenderness. Later, warfarin, a blood thinner, began appearing in the herbal mix.

Nagourney and his colleagues originally presented the information in April at a meeting of the American Association for Cancer Research. The paper in today's journal provides more detailed analysis.

Was the contamination by the manufacturer, BotanicLab, which has since gone out of business, accidental or deliberate?

Nagourney says he can't tell for sure. However, he adds that it seems "highly improbable" the drugs would get there accidentally, especially since one is a potent pain reliever and prostate cancer patients are often in pain, and another a potent estrogen, a treatment that had been used in prostate cancer treatment in previous years. Warfarin is a blood thinner that counteracts the effects of estrogen, such as an increased likelihood of blood clots.

While Nagourney's team has no plans to put together another PC-SPES formula, "we have redoubled our efforts to identify compounds for the treatment of prostate cancer," he says. "We anticipate we will have some such product available in the future."

About 189,000 new prostate cancer cases will be diagnosed in the United States this year, according to American Cancer Society ( news - web sites) estimates, and 30,200 men will die of the disease.

Meanwhile, Dr. Jeffrey D. White, director of the Office of Cancer Complementary & Alternative Medicine at the National Cancer Institute, calls the contamination a "lesson" for future dietary supplement research.

"Herbal research is complicated enough without having to deal with the added problem of potential product adulteration," he writes in an accompanying editorial in the journal.

Consumers should be aware that such problems can exist, White says. "Don't just expect these products should have undergone the same testing as [prescription] drugs." Since they are regulated as dietary supplements, they do not undergo the same rigorous review.

White praises the Nagourney study as "a very complete, careful analysis of several lots of the product, rather than looking at just a couple of recent lots."

Before deciding to use a dietary supplement for cancer treatment -- or other health problems -- patients should talk to their doctor and get as much information as possible, White and Nagourney agree.

What To Do

For more information on complementary and alternative medicine treatments, see the National Cancer Institute's Office of Cancer Complementary and Alternative Treatment. For information on prostate cancer, see the American Cancer Society.

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New Radiotherapy Regimen Ups Lung Cancer Survival

By Richard Woodman

Reuters Health

Wednesday, September 4, 2002

LONDON (Reuters Health) - Treating lung cancer patients with a higher dose of radiotherapy but giving them weekends off to recover can improve tumor control and increase survival rates, according to the results of a new study.

Cancer Research UK scientists said computer models predicted that the new regimen could eradicate 33% of non-small-cell lung tumors compared with 19% under the current "gold standard" treatment system.

Continuous hyperfractionated accelerated radiotherapy (CHART)--the present gold standard--gives patients three doses of radiation a day for 12 consecutive days. The new regimen, dubbed CHARTWEL, builds on CHART by giving a higher dose of radiation but one that is still tolerable and that incorporates a break at weekends.

Professor Michele Saunders, who led the research at Mount Vernon Hospital, West London, said CHARTWEL was also more practical as radiographers are only allowed to work around 36 hours a week and there is a shortage of staff, especially at weekends.

"Although CHART has been shown to be more effective than conventional radiotherapy, it is used in fewer than 10 hospitals (in Britain) because we don't have radiographers to staff the machines at weekends."

A small clinical study, also published in Clinical Oncology by Saunders' team, shows that combining CHARTWEL and chemotherapy can greatly improve tumor control in non-small-cell lung cancer patients.

When patients had a combination of treatments, tumor remission increased from 55% in those who had CHARTWEL alone to 72% who received both CHARTWEL and chemotherapy.

Saunders said that while the CHARTWEL radiotherapy and chemotherapy combination might not dramatically improve survival rates, the small improvements seen could translate into substantial gain with thousands of patients surviving 5 years or more per year.

"It is clear that there is now a need for randomized clinical trials to take the work forward and, if successful, make the treatment available throughout the country," she added in a statement.

Source: Clinical Oncology 2002;14:353-360, 372-381.

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Condom Slipups Common Among College-Age Men

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

WEDNESDAY, Sept. 4 (HealthScoutNews) -- Many men on college campuses fail Condom Use 101, and their poor performance could lead to sexually transmitted diseases, pregnancy or both, a new study has found.

 The study, reported in the September issue of Sexually Transmitted Diseases, found that roughly four in 10 college students wanted to use a condom during sex, but didn't have them around when the time arose. Of the ones that did have the prophylactics available, many routinely made "technical" errors wearing the devices that increased their risk of tearing or slippage during sex.

Dr. Richard A. Crosby, of Emory University in Atlanta, and his colleagues in Indiana surveyed 158 male Indiana University students about their experience with condoms over the preceding three months. All of the men said they'd worn a condom at least once during sex in that period, but their consistency was spotty.

Six in 10 said they didn't talk about condoms with their partners before starting to have sex, and 42 percent said they wanted to use the devices but didn't have any on hand.

Forty-three percent said they wore condoms during sex but didn't don them until after intercourse commenced -- a no-no for both pregnancy and disease prevention. Meanwhile, 15 percent made the equally risky move of taking them off before finishing.

Almost a third of men reporting losing their erections after they put on a condom. Four in 10 didn't allow ample space at the tip of the condoms, leaving them prone to rupture or spillage, and 30 percent initially put them on upside down, potentially exposing their partner to pathogens or semen released before ejaculation when they flipped the latex jacket over.

Nearly one in three of the men said they'd had a condom tear or slip off during sex, and the likelihood of either of these problems was higher among those who reported technical troubles, the researchers say. "If we count these errors up and take an average, errors are associated with breakage and slippage," Crosby says.

That's "really good news" for the image of condoms, Crosby adds, since it means that user error, not product failure, may account for most cases of faulty rubbers.

Crosby's group didn't query the men about whether they'd contracted a sexual infection or gotten a partner pregnant during the study, so they don't know the consequences of these blunders. To be sure, he adds, not all of the errors are created equal. "Not putting it on early is obviously going to have a severe impact, while others are far less severe," he says.

Experts says the study gives sex educators and public health workers a clear goal: improving the way men use condoms may be just as important as raising rates of condom use.

Jon Knowles, director of public information for Planned Parenthood ( news - web sites) Federation of America in New York City, says the new study confirms what his group has long known. "The condom is a really good thing, very effective, but you have to use it correctly," Knowles says. "Boys don't ask for directions."

Knowles said that in addition to improving education for sexually active men, women should also learn proper condom use to protect themselves from disease and pregnancy.

What To Do

For more on condoms and other contraceptive methods, try Planned Parenthood. You can also learn about STD prevention from the Centers for Disease Control and Prevention.

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Patients Halt Aspirin, Despite Ability to Cut Risk

Reuters Health
Wednesday, September 4, 2002

BERLIN (Reuters Health) - Although taking low-dose aspirin daily is known to reduce further heart risk in people who have survived a heart attack, many of those who are prescribed the drug stop taking it soon after leaving the hospital, researchers reported here Wednesday at the European Society of Cardiology Congress.

In large clinical trials, more than 70% of people prescribed aspirin after a heart attack keep taking the medicine, but research presented here shows the real-life situation is different.

Dr. Gad Cotter from the Assaf-Harofeh Hospital in Tel Aviv and colleagues measured aspirin-related blood functions 6 months after a heart attack in 65 patients prescribed aspirin. The researchers didn't tell the participants they were monitoring their aspirin use.

Overall, about half the patients were found to be taking their aspirin as directed. A further 22% were taking some doses, while 27% were found not to be taking the medication at all.

"These findings highlight the difference between results obtained in large clinical studies, which consistently report high adherence levels to aspirin, compared to real clinical settings," Cotter's colleague, Irit Dinur, told Reuters Health.

The researchers found that people who kept taking the aspirin were significantly more likely to survive without further cardiovascular problems, Dinur said.

"Survival free of cardiac events was 75% after one year for non-adherent patients, compared to 95% in patients who took the aspirin," she said.

She said the findings suggest that doctors should consider using a blood test to see whether their heart attack patients are still taking aspirin.

"Maybe when patients come for a check up, ideally 6 months following (their heart attack), maybe doctors should test their adherence to aspirin," she said.

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Kids Follow in Parents' Risky Footsteps

By Lisa Girard
HealthScoutNews Reporter

HealthScoutNews

Wednesday, September 4, 2002

WEDNESDAY, Sept. 4 (HealthScoutNews) -- New research strengthens the old saw that the apple doesn't fall far from the tree -- at least among people who smoke, drink and do other things to put their health at risk.

The National Longitudinal Study of Adolescent Health, a school-based study of the health-related behaviors of adolescents, shows that parents who do not take care of their health are much more likely to have children who engage in unhealthy behaviors as well.

Specifically, the study showed that children of parents who smoke were around 50 percent more likely to have had sex -- and also more likely to have had sex by age 15. Teenagers whose parents engage in risky health behaviors -- defined in the report as "those behaviors that endanger one's physical being or health" -- were also more likely to smoke, drink, associate with peers who use drugs, and engage in delinquent behavior such as stealing and damaging property.

"Unsafe parental behaviors are not only associated with an increased likelihood that adolescents often practice these same behaviors, but also that they engage in analogous risky behaviors," says Esther I. Wilder, a professor of sociology at Lehman College who co-authored the study with Toni Terling Watt of Southwest Texas State University. "For example, adolescents whose parents smoke are not only more likely to smoke themselves, they are also more likely to drink, associate with friends who use substances, be sexually active, and/or have sex at early ages."

Of those who participated in the study -- which involved about 19,000 children in grades 7 through 12 -- 37 percent of girls and 39 percent of boys reported having had sex. However, Wilder and Watt found no correlation between unsafe parental behavior and whether the sexually active teen used contraceptives. Contraceptive use was more connected to the year in which the adolescent first had sex, with use being more likely after 1990 and the onset of the AIDS ( news - web sites) awareness movement.

The researchers also found that teenagers whose parents drink heavily tend to drink as well, and teen alcohol use is also closely linked to earlier sexual activity. For boys only, a parent's failure to wear a seat belt was also linked with a modest increase in the likelihood of adolescent sex.

The study showed different effects of parental supervision. Boys whose fathers are present at bedtime and when they leave for and return from school, for instance, were less likely to have had sex. The same was true for girls whose mothers were present at those times. However, the mother's presence had no impact on whether a boy was sexually active, and the father's presence had no bearing on a girl's likelihood to engage in sex.

Jennifer Lansford, a research scholar at Duke University's Center for Child and Family Policy, says the study's findings raise the question of through what mechanisms parents' own risky behaviors influence their adolescents' risky behaviors.

"Modeling particular behaviors is certainly one possibility," she says. "That explanation is clearest for the finding that parents who smoked and drank were more likely to have adolescents who also smoked and drank. Modeling is less likely to be the explanation for the finding that parents' smoking and drinking also increase adolescents' likelihood of engaging in sexual activity and decrease adolescents' likelihood of wearing a seat belt."

The National Longitudinal Study of Adolescent Health assesses a wide variety of health behaviors such as substance use, diet, physical disability and sexual behavior. According to Wilder, it also seeks to identify the social context of these behaviors and examine individual, family, peer, school and community characteristics as well.

The report will appear in the September issue of the Milbank Quarterly, a journal of public health and health care policy.

What To Do

Learn more about the health of the nation's teenagers from the Society for Adolescent Medicine or the American Medical Association.

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Impotence from Beta-Blockers Partly Psychological

By Stephen Pincock

Reuters Health

Wednesday, September 4, 2002

BERLIN (Reuters Health) - Problems with erectile dysfunction among men given beta-blocker drugs may in part be psychological and related to a general knowledge that the drugs are associated with such difficulties, Italian researchers reported on Wednesday.

Dr. Giuseppe Rosano from San Raffaele hospital in Rome told Reuters Health that men prescribed beta-blockers commonly report ED. He and colleagues wanted to assess to what extent these erectile problems might be psychological.

They evaluated 96 men around 52 years old with cardiovascular disease who had been prescribed atenolol, a newer beta-blocker. Thirty-two were told they were being given a beta-blocker, 32 were informed the drug was a beta-blocker and were told about possible ED side effects, and 32 were not told what type of drug they were being given.

Nine patients told about the potential for ED reported erectile problems, compared with four patients who knew the type of drug but were not told about the side effects, and just one patient who did not know what type of drug he was taking, Rosano told Reuters Health.

All those who reported erectile problems were then prescribed Viagra and an inactive placebo on consecutive days, in random order.

"Almost all men improved with both sildenafil and placebo, suggesting that in most of the cases, the ED was psychological," Rosano said.

Only one patient had erectile dysfunction that did not respond to either the drug or placebo, he said.

The researcher said doctors should reassure their patents that the risk of ED with current beta-blockers is relatively low.

"Whenever you give a beta-blocker to a young patient, they ask, 'What about my sexual activity?' You have to tell them that most reports of erectile dysfunction are based on really old drugs," Rosano added.

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Dopamine Extinguishes Smoking

HealthScoutNews
Wednesday, September 4, 2002

WEDNESDAY, Sept 4 (HealthScoutNews) -- Medicine that mimics increased levels of the brain chemical dopamine could help extinguish a smoker's desire for cigarettes.

That's the finding of a study, appearing in the September issue of Nicotine and Tobacco Research, that focused on 20 heavy smokers. They were given drugs that either increased or decreased their brain's dopamine levels. Dopamine is a neurotransmitter that affects motor function and is believed to affect emotion.

Animal studies show nicotine causes dopamine release in brain areas linked to feelings of pleasure.

This new study found that when the smokers were given the dopamine-mimicking drug bromocriptine, they smoked less than when given a drug that impedes the effects of dopamine.

Bromocriptine is used to treat Parkinson's disease ( news - web sites), some tumors and menstrual problems.

"Overall, these results imply that smoking behavior can be manipulated within the same subjects in opposite directions by alternately stimulating and blocking dopamine, which strongly suggests the importance of dopamine in reinforcement from cigarette smoking," says lead researcher Nicholas H. Caskey, of the Veterans Affairs Greater Los Angeles Healthcare System and the Neuropsychiatric Institute at UCLA's David Geffen School of Medicine.

More information

Read how genetics may play a role in nicotine addiction.

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Exercise Can Ease Knee Pain from Arthritis

Reuters Health

Wednesday, September 4, 2002

NEW YORK (Reuters Health) - Therapeutic exercise programs can help reduce knee pain from osteoarthritis, and can also help the joint to function better, an analysis of 14 studies shows.

Osteoarthritis occurs when the cartilage that cushions joints breaks down, leading to pain and swelling. In the US, osteoarthritis is a leading cause of disability among the elderly. There is currently no cure for osteoarthritis, and treatment focuses on reducing symptoms.

Dr. Marlene Fransen of the University of Sydney in Australia and colleagues from the University of Toronto, Canada, reviewed 14 studies including a total of 1,633 patients with osteoarthritis of the knee.

The selected trials evaluated individual, group and home-based therapeutic exercise programs that included muscle strengthening, aerobic walking and balance coordination.

Most study participants, 936, participated in therapeutic exercise, while the rest had been assigned to a non-exercise "control" group. Each exercise session lasted 30 to 90 minutes and exercise program duration ranged from 1 month to 3 months. The findings are published in the August issue of the Journal of Rheumatology.

The investigators found that for patients with symptomatic osteoarthritis of the knee, these types of exercises had "at least immediate moderate" benefits in terms of reducing lower limb pain, and "immediate small" benefits in terms of self-reported improvement in physical function.

The researchers were unable to determine the effects of similar exercises on pain associated with osteoarthritis of the hip because only two studies including 100 patients were identified that could potentially provide sufficient information.

While there is currently no cure for osteoarthritis, Fransen and colleagues conclude that "disease-related factors, such as impaired muscle function and fitness, are potentially amenable to exercise intervention."

Source: Journal of Rheumatology 2002;29:1737-1745.

Insulin Resistance Behind Kidney Disease in Diabetics

HealthScoutNews
Wednesday, September 4, 2002

WEDNESDAY, Sept. 4 (HealthScoutNews) -- Insulin resistance is probably a significant cause of kidney disease in people with Type I diabetes, says a study in the September issue of Kidney International.

"Kidney disease is a major lethal complication for people with diabetes, particularly those with Type I diabetes, and until now there has been no clear explanation for its cause beyond blood sugar itself," says principal investigator Dr. Trevor Orchard, acting chairman of the department of epidemiology at the University of Pittsburgh Graduate School of Public Health.

"We now suspect that reducing or preventing insulin resistance, possibly through exercise, weight loss and drugs, may help people with Type I diabetes avoid nephropathy (kidney disease)," Orchard says.

In this study, he and his colleagues analyzed data from the Pittsburgh Epidemiology of Diabetes Complication Study (PEDCS) -- a 10-year project involving 658 adults with Type I diabetes.

The researchers focused on 485 people who didn't have nephropathy at the start of the study. They tracked them and found 56 of them developed nephropathy sometime during the 10-year span of PEDCS.

In all those people, there was a strong relationship between insulin resistance and nephropathy, the study found. The researchers measured insulin resistance by using a calculation based on waist-to-hip ratio, hypertension status and long-term blood sugar levels.

Up to 40 percent of people with Type I diabetes develop kidney disease, in which the kidneys become unable to filter wastes and excess water from the blood.

More information

For more on kidney disease, go to the National Institute of Diabetes & Digestive & Kidney Diseases.

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Corn's an Amazing Wavy Grain

HealthScoutNews
Wednesday, September 4, 2002

(HealthScoutNews) -- Corn, which seems strong, sturdy and healthy as you drive by fields of it, doesn't come by its good looks naturally. At least the modern high-tech versions don't.

Every modern specie is specially bred to stand up well against the army of enemies corn plants face -- both the natural ones (animal, bacterial and viral) and those produced by man to attack the environment's own troublemakers.

Man's arsenal of pest controllers come in the form of herbicides, insecticides and other chemical killers. Though all these chemicals must be certified as safe by the U.S. government, some people remain concerned for those who will eventually consume traces of field chemicals.

According to the Ohio State University Agricultural Extension, corn is treated with well over 20 different chemicals before it ends up on our kitchen tables.

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Money Can't Buy Happiness for the Materialistic

NEW YORK (Reuters Health) - Even millionaires can be unhappy in life if their material desires are bigger than their bank accounts, new research suggests.

In a series of studies of college students, researchers found that participants' satisfaction with various hypothetical incomes depended upon whether they would be able to buy the things they desired. Even "very comfortable" six-figure incomes often weren't enough if participants felt they would be missing out on the toys wealthier people enjoyed.

In one of the studies, which asked the students to envision themselves in the year 2050, participants were less likely to be happy with an annual salary of $150,000 if they found out they wouldn't be able to afford the "teletransporters" that futuristic folks would be using to whisk themselves around the globe--among other "desirable" possessions.

In another study, participants described the type of home and other possessions they hoped to one day have, and their future incomes were estimated based on the careers they wanted to pursue. Overall, income satisfaction was similar among the students--until some found out they would have a tough time reaching their material aspirations, sending financial satisfaction downhill.

And if people aren't happy with their buying power, they may be unhappy in general, according to study author Dr. Ed Diener, a professor of psychology at the University of Illinois at Urbana-Champaign.

"Materialistic people have been found in many studies to be less happy," he told Reuters Health. "For one thing, materialism can distract people from things such as social relationships, which are more important to happiness."

Of course, there is no simple path to overall happiness in life, and having money "is not bad," according to Diener. Past research, he noted, shows that well-off people are, on average, slightly happier than poorer folks.

"It is just that the strong desire for money can be self-defeating because one can never get enough," Diener said.

The current findings, reported in the September issue of the Journal of Personality and Social Psychology ( news - web sites), suggest that having desires in line with one's income--and not just making more money--is important to happiness, according to Diener.

"People 50 years ago made less than half of what we make today," he said, "but they were about as happy as we are."

Source: Journal of Personality and Social Psychology 2002;83:725-734.


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Five-A-Day Is Only Halfway There Now

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Wednesday, September 4, 2002

WEDNESDAY, Sept. 4 (HealthScoutNews) -- Those of you who have been struggling to eat the recommended five servings of fruits and vegetables a day, brace yourself.

There's a new message coming from the National Cancer Institute ( news - web sites): Nine a day is what's needed.

"The recommendation is not five-a-day anymore. It's five to nine servings a day," says Lorelei DiSogra, director of the 5 A Day Program at the cancer institute.

Since 1991, both the food pyramid and dietary guidelines have recommended that people eat at least five servings of fruits and veggies a day. While five is good, nine is apparently a whole lot better when it comes to health benefits.

"It's not a new number. It's a range. The range has always been there," DiSogra says.

Dietary guidelines recently released by the U.S. Department of Agriculture ( news - web sites) and the U.S. Department of Health and Human Services ( news - web sites) recommend that children aged 2 to 6 eat five servings of fruits and vegetables a day for good health. Children over the age of 6 should eat six servings; active women and teens should eat seven, and active teen boys and men should eat nine.

The new numbers are the theme of "5 A Day" week, which runs Sept. 22-28. "Eating 5 to 9 and Feeling Fine: Fruits and Vegetables Anytime!" is the new theme song of the "5 A Day" Program, which will be retaining its name.

"After all these years, we decided we needed to start clearly communicating," DiSogra says. "We didn't just make this up. It's just that adults really need to eat nine servings. That's what the science says."

The vitamins, minerals, fiber and, especially, the phytochemicals in fruits and vegetables appear to reduce the risk for heart disease, hypertension, certain types of cancer, diabetes and other diseases.

Adding fruits and vegetables to your diet can lower blood pressure quickly and dramatically in just a few weeks.

Americans are actually doing pretty well, eating an average of 4.9 servings a day, according to the cancer institute. However, with more than 60 percent of adults in the United States overweight or obese, more fruits and vegetables are definitely going to be better.

The cancer institute is launching a special campaign to reach black men between the ages of 35 and 50. Blacks have the lowest intake of fruits and vegetables and the highest rates of many diet-related diseases such as diabetes. Blacks also have the lowest awareness -- less than 14 percent -- of the importance of this component of the diet, the cancer group says.

Other groups who lag in their consumption of fruits and vegetables are school-aged children, teenagers, men aged 20 to 59, and lower-income and less educated populations.

The final message from the "5 A Day" folks is that nine a day is not going to be as tough as you think because servings are smaller than you think: A cup of cooked fruits or vegetables constitutes one serving, as does a cup of dried fruit, a cup of 100 percent fruit juice, one cup of salad or a cup of tomato sauce over pasta.

Although both fruits and veggies are naturally low in calories and high in fiber and water, try to tilt the balance in favor of the veggies, says Dawn Jackson, a spokeswoman for the American Dietetic Association and a dietician with Northwestern Memorial Wellness Institute in Chicago.

"One serving of fruit is about 60 calories, and veggies have about 25. It's about one-third less," she says. "Try to have two to three servings of fruit, but then really try to bulk up on the vegetables."

What To Do

For more information on getting all your fruits and veggies, visit the National Cancer Institute's 5 A Day site. Everything you ever wanted to know about produce, including recipes, can be found at aboutproduce.com. And the American Dietetic Association has a wealth of information, including daily nutrition tips.

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Drowning Risks Go With Pool Ownership

HealthScoutNews
Wednesday, September 4, 2002

(HealthScoutNews) -- Drownings account for a significant share of death for children across the U.S.

If you have a pool, suggests the University Medical Center in Tucson, limit access to it by installing a wall at least four (preferably six) feet high. Gates should be child-proof and self-closing with a latch no young child can reach. A lock with a key is best.

Be particularly cautious if you have a pool cover: children can climb or fall under a cover. Teenagers and adults in the family should be trained in cardiopulmonary resuscitation (CPR). And complete emergency instructions, including CPR instructions and emergency telephone numbers, should be clearly posted.

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TUESDAY, SEPTEMBER 3, 2002

Kids' TV Viewing Habits Tied to Smoking Habits Later

By John Dillon
HealthScoutNews Reporter

HealthScoutNews

Tuesday, September 3, 2002

TUESDAY, Sept. 3 (HealthScoutNews) -- A new study that combines two hallmarks of a dangerously sedentary lifestyle for people of any age finds that adolescent couch potatoes are far likelier to start smoking than kids with more restricted viewing hours.

Researchers say children who spend at least five hours a day parked in front of the tube are six times more likely to begin puffing than their peers who watch two hours or less.

The cigarette habit begins in just two years, according to the study, which appears in the September issue of Pediatrics. The figures held up even after other risk factors for smoking -- lower income, intelligence and how many years of education the mother had -- were taken into account.

"The more exposure, the more likely they were to initiate smoking," says Dr. Pradeep P. Gidwani, a pediatrician at the Center for Child Outcomes in San Diego and the study's lead author. "Television watching may have an influence on risk behaviors in adolescents."

Gidwani says his study didn't aim to finger television as a smoking gun for smoking among adolescents.

"It's a little hard for us to say this is a cause of it," he says. But the link, he cautions, is inescapable, because children are still exposed to smoking on TV, even though cigarette ads were banished from the airwaves more than 30 years ago.

His team followed 558 kids between the ages of 10 and 15 -- with a median age of 11.5 years -- from 1990 until 1992. By the end of the study, none had yet reached their 18th birthday.

The study found what it called "a clear trend" in the initiation of smoking and the number of daily hours of TV viewing.

Those who watched between two and four hours a day were between two and three times at risk of starting the habit, a figure Gidwani says isn't statistically significant but nonetheless telling.

The real danger zone started at the four-hour level, when the risk rose to five times that of kids who watched two hours or less.

White children who watched excessive amounts of TV were more at risk of starting smoking than were blacks or Hispanics, the study says. Also, it found that children of married mothers were at half the risk of starting as were children of unmarried mothers.

The researchers chose the two-hour level as the baseline because the American Academy of Pediatrics has recommended that children watch no more than that amount every day.

"You're looking at TV as indirect advertising," Gidwani says. Smoking is "everywhere," including music videos, billboards at televised sporting events, and prime-time programs.

"Rarely is smoking portrayed in an unattractive manner or associated with negative consequences," the study says, adding it often linked with "sexually suggestive" viewing.

"You have to remember, too, that there's old movies -- and people are watching old movies," Gidwani says. Smoking is prevalent even in family films, he adds, noting a study finding that characters smoked in 43 percent of a sample of G-rated films.

The weakness in the study, Gidwani acknowledges, is that it didn't ask the children or the parents what they were watching: Is a child less likely to take up smoking, for instance, if he spends those five hours watching C-Span? Still, he maintains, the amount of viewing is more important than the content.

Moreover, Gidwani says, time spent watching TV is time not spent doing something else that may guard against risky behavior -- sports, for instance.

"They're not interacting with their parents," he adds. "They're not interacting with adult role models." He adds he realizes many of these parents may be watching TV along with the children.

"Being a parent is a very tough job," he says. "Limiting the amount of hours of television is another battle with your kids."

What To Do

Gidwani suggests following the American Academy of Pediatrics recommendations of no more than two hours of "quality" programming a day. The group also has a page on how to develop positive viewing habits.

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McDonald's Looks to Cut Some Fat

By Liz Austin

Associated Press Writer

The Associated Press

Tuesday, September 3, 2002

CHICAGO - McDonald's plans to use a new cooking oil for french fries and other fried foods that it says will do less damage to your diet.

Nutritionists call the fast food giant's effort to reduce trans fatty acids a good first step but say the change doesn't make french fries a health food.

"They're still french fries, and they're still high in fat," said Kathleen Zelman, a registered dietitian and spokeswoman for the American Dietetic Association. "But if people are going to eat them anyway, we can at least reduce the saturates which are artery-clogging."

The Oak Brook-based company says the new oil will halve the trans fatty acid levels in its french fries while increasing the amount of the more beneficial polyunsaturated fat.

Trans fatty acids increase the body's levels of bad cholesterol while simultaneously reducing its levels of good cholesterol, said Dr. Meir Stampfer, professor of epidemiology and nutrition at Harvard School of Public Health.

Reducing the amounts of artery-clogging trans fatty acid levels in fast food allows people to painlessly lower their risk of heart disease, Stampfer said.

"People don't have to change their habits, they don't have to exert willpower; without doing anything they would be eating a healthier diet," he said.

McDonald's worked with its longtime supplier Cargill to develop the new oil, which a few restaurants will begin using in October. All 13,000 domestic restaurants will use the oil by February.

Company executives say McDonald's is the first national fast-food chain to set a goal of eliminating trans fatty acids in oil.

Stampfer said he hopes McDonald's — and other fast food chains — eventually reach that goal.

"If we can get rid of trans fat in the diet, we could prevent thousands of heart attacks every year," he said.

Phil Sokolof, president of the National Heart Savers Association, said McDonald's announcement would give consumers a false sense of security when eating fast food.

"French fries are still one of the worst foods for raising cholesterol level," Sokolof said.

The move comes about a month after a man sued McDonald's and three other fast food chains in July, claiming their food made him obese.

The 56-year old man weighs 272 pounds, had heart attacks in 1996 and 1999 and has diabetes, high blood pressure and high cholesterol. He said he ate fast food for decades, believing it was good for him until his doctor cautioned him otherwise.

McDonald's spokesman Walt Riker said the oil switch had been in the works for years and was unrelated to legal actions.

Riker said the french fries will still contain beef flavoring, as they have for many years.

Vegetarian groups sued the company last year for using the flavoring while claiming its fries were vegetarian. The company in May agreed to pay $10 million to organizations that support vegetarianism and $2.4 million in legal fees.

Shares of McDonald's fell 73 cents to close at $23.03 on the New York Stock Exchange ( news - web sites).

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Depo-Provera May Raise Heart Disease Risk in Some Women

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Tuesday, September 3, 2002

TUESDAY, Sept. 3 (HealthScoutNews) -- A new British study sounds an alarm for some women who use the injectable contraceptive Depo-Provera.

The alert applies only to women at increased risk of cardiovascular disease because of a risk factor such as diabetes, high cholesterol or a family history of heart disease, says Dr. Dudley J. Pennell, leader of the study. Even those women could still go on using the contraceptive, with some adjustments, he says.

However, a warning is needed because the study shows that Depo-Provera can reduce the ability of arteries to widen, so that they might not respond to a need for increased blood flow, says Pennell, a professor of cardiology at the Imperial College School of Medicine in London. That failure could result in a blockage that would cause a heart attack, he adds.

His study contradicts the conventional wisdom that Depo-Provera is safer than other contraceptives for women at increased risk of heart disease.

Pharmacia, the company that markets Depo-Provera, says the study does not contradict existing evidence that the drug is safe.

It has "a well-proven safety profile," says Dr. Joel Krasnow, medical director of the Pharmacia Women's Healthcare division. In both a World Health Organization ( news - web sites) study of 15,000 users and a U.S. trial including 775 users, "no cases of thrombolytic disease, heart attack, or stroke were reported," Krasnow says.

Pennell says he investigated the effect of Depo-Provera on the arteries because it acts by blocking the hormonal signals that cause ovulation, which means that it lowers blood levels of the estrogen hormone estriadol. That hormone acts on the endothelium, the sensitive layer of cells that line the inner artery walls.

"Endothelial cells operate to make arteries bigger and smaller, particularly to make them get bigger, or dilate," Pennell says. "When arteries can dilate, they are healthy. When they cannot dilate, they are not."

Pennell's study, reported in today's issue of Circulation, included a small group of women -- 12 who were taking Depo-Provera and nine who were not. He used a technique called magnetic resonance imaging (MRI) to measure the flexibility of the brachial artery, the artery in the arm where blood pressure usually is measured.

The nine non-users were tested during menstruation, when circulating levels of estriadol are low, and during ovulation, when levels are high. The 12 users were measured 48 hours after they had an injection of Depo-Provera, which is done every three months for contraception, and three months after their last injection.

Tests showed the ability of the arteries to dilate was reduced substantially in the Depo-Provera users. Their arteries dilated an average of 1.1 percent after a temporary blockage with a blood pressure cuff, compared to 8 percent dilation in the non-users.

"Two recent studies suggest that persons with reduced endothelial function are at greater risk of cardiovascular disease," Pennell says. "At this stage of our understanding, it is a very reasonable conclusion that if you have a drug that causes endothelial dysfunction, it doesn't make sense to give it to women with risk factors for cardiovascular disease."

That conclusion applies only to women with known risk factors, Pennell emphasizes. "If you are a young person taking Depo-Provera and have no risk factors, there is no reason to worry," he says. "Continue as you are. But if you are on it because your doctor feels it is safer for you because you have cardiovascular risk factors, it might not be good for you."

He suggests that "if you are a long-term user of this drug -- the women in our study averaged four years of use -- and you have risk factors for heart disease, it is sensible to discuss your options with your physician."

One option is to switch temporarily to a barrier contraceptive device, such as an IUD, Pennell says. "Or you could use a barrier method completely," he says. "Or you could from time to time switch from Depo-Provera to a combined pill. It has estrogen that will help return the endothelium to normal function."

He has one final word: "There is absolutely no reason to panic. But a woman who is a long-term user of Depo-Provera and has cardiovascular risk factors should make an appointment to see her physician, with no rush, to discuss her options."

Pharmacia's Krasnow notes that Pennell and his colleagues "studied a small, non-randomized sample of users" and that "the authors clearly state that they cannot determine the clinical impact on cardiovascular events from this study." He adds that "health-care providers must carefully consider any medication, including Depo-Provera, before prescribing, particularly for women with pre-existing cardiac risk factors."

What To Do

You can get detailed information about Depo-Provera from Planned Parenthood or Ohio State University.

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New Mammogram Studies Divided on Benefits

By Gina Kolata
The New York Times

Tuesday, September 3, 2002

Two papers published today on the benefits and risks of mammography come to different conclusions about the breast cancer screening, continuing a debate that has erupted over the past year.

One paper, by the United States Preventive Services Task Force, makes recommendations that are generally followed by the nation's primary care doctors and concludes that the pooled data from randomized trials support mammography every one to two years for women ages 40 to 74.

The group announced its conclusions at a news conference last winter, but its paper, being published today in The Annals of Internal Medicine, is the first formal publication of its methods, results and conclusions.

A second paper in the same issue determines that women in their 40's reap no benefit from mammography and have real risks of harm from unnecessary treatment. It presents the latest results from a study of more than 90,000 Canadian women.

Earlier findings from the same study after seven years also found no benefit, but some medical experts predicted that benefits would emerge with time. The new findings show that even 11 to 16 years after the women were enrolled, mammography had not saved any lives and had led to excess treatment.

The papers are accompanied by two editorials that call into question the widespread public assumption that the mammography debate has been settled.

It is a debate mostly taking place among researchers and some advocacy groups. Guidelines from major medical organizations are in accord that women should have regular mammograms starting in their 40's.

Dr. Steven Goodman, a biostatistician at the Johns Hopkins Kimmel Cancer Center who wrote one of the editorials, said in an interview last week that the arguments among researchers continued because the data were so inconclusive.

"If we are still unsure after looking at something like half a million women, that points to how small the risks are and how much smaller the benefit is in absolute numbers," Dr. Goodman said.

"There is statistical uncertainty around the estimates of benefits and harm, but perhaps the biggest unknown is how much harm women will find acceptable for an uncertain benefit," he added.

The current dispute on the value of routine mammograms began last year when two researchers published a paper examining the major clinical trials and concluding that nearly all were so flawed as to be invalid. Of those found acceptable, said the two scientists, Dr. Peter C. Gotzsche and Ole Olsen of the Nordic Cochrane Center in Copenhagen, the pooled data indicated that no lives were saved by mammography.

Women who had the test were just as likely to die from breast cancer as those not screened, they said in a paper in The Lancet. Moreover, the screened women had more mastectomies, more radiation therapy and more surgery. That extra treatment, in the absence of an overall benefit, made the researchers question the widespread use of mammography.

Some medical experts applauded the analysis, saying that the two investigators had pointed out serious flaws in the mammography studies and that they had appropriately emphasized that there were real risks of having the diagnostic test.

Others said that the analysis itself was flawed and that Dr. Gotzsche and Mr. Olsen had arbitrarily discarded data from major studies whose conclusions did not fit with their notion that mammography was not working.

In the meantime, the National Cancer Institute and the American Cancer Society reiterated their positions that women should start having regular mammograms at age 40 because, they said, the test saves lives. In February, Tommy G. Thompson, the secretary of health and human services, held a news conference to announce the Preventive Services Task Force's conclusion that mammography was beneficial starting at 40.

Yet the questioning continued in medical circles, with researchers publishing dueling articles, analyses and editorials in medical journals and holding debates at meetings. As the papers in the current issue of The Annals indicate, there are no signs that the dispute will soon be settled.

Dr. Steven H. Woolf, a task force member, said the message he wanted to convey in his group's analysis was that "there is clearly a mortality benefit with mammography," and he said the benefit increased as women grew older. In its paper, the group took note of what that benefit might be, and what the risks might be. It wrote that with mammography, the breast cancer death rate was reduced by about 16 percent. That meant that if 1,224 women were screened, one death might be prevented after 14 years.

Dr. Woolf said his group was also aware of the test's risks, including unnecessary biopsies and anxiety about false positive results. He added that the group also had another concern, for which, he said, the evidence was suggestive but not solid. That is the possibility that a woman will have a treatment like a mastectomy for a small and self-contained tumor that would not have been noticed in her lifetime if she had not been screened.

The group added that the clinical trials evaluating mammography had imperfections, leading it to regard the evidence as "fair" rather than "good." That complicated its determination of benefits.

"In absolute terms, the mortality benefit of mammography screening is small enough that biases in the trials could erase or create it," the group wrote in its paper. "However, we find that although these trials were flawed in design or execution, there is insufficient evidence to conclude that most were seriously flawed and biased and consequently invalid."

Dr. Woolf said the group was aware of the data from the Canadian study that failed to find benefits from screening women in their 40's, but that did not change its conclusion that mammography's benefits start at 40. The group, he explained, considered the totality of the evidence.

But Dr. Cornelia Baines of the University of Toronto, a principal investigator for the Canadian study, said she thought that the question of mammography for women in their 40's should be settled by her group's extensive data.

"After 13 years, the number of deaths was the same in the group that had mammograms and the group that had normal medical care," she said. In addition, she said, mammography was finding some cancers that would never have been detected and never have caused any problem if the women had not been screened. But once found, as would be expected and is appropriate, they were treated.

While cancer researchers recognize that not every cancer will grow and become deadly, they cannot predict which ones are dangerous and which are not, so they treat them all.

"Some women were getting mastectomies that they didn't need," Dr. Baines said, adding that the test did not help younger women. "I think the message should be accepted by all rational people."

In an accompanying editorial, Dr. Harold Sox, editor of The Annals, wrote that his interpretation of an analysis of several large randomized clinical trials in Sweden was that they also failed to find a benefit from mammography in women under 50.

"The big picture message is that the effect of screening in any age group is limited at best," Dr. Sox said in a telephone interview. He said there appeared to be a small benefit in women starting at 50, and so he agreed with the task force for that age group. But, he said, for women in their 40's, "it is not clear that there is any benefit at all." With such questions, he added, "I think we should be worried about harms."

In interviews, medical experts with different views on the test's value maintained opinions that they had previously expressed.

Dr. Harmon Eyre, chief medical officer of the American Cancer Society, applauded the task force's report. "It confirms the value of mammography both in women over age 50 and under age 50," he said. "That in my mind is the message."

Dr. Larry Norton, past president of the American Society of Clinical Oncology, said he, too, advocated screening, starting at 40. "On the basis of the total amount of information available," he said, his conclusion is to "continue to screen."

But Dr. Donald Berry, chairman of the department of biostatistics at M. D. Anderson Cancer Center in Houston, said, "If there is a benefit, it is not very great." Dr. Berry is a member of an expert group, the P.D.Q. screening and prevention editorial board, which writes information for the National Cancer Institute's online database. It concluded in January that evidence was insufficient to show that mammograms prevented breast cancer deaths.

Dr. Goodman said that despite the figures disseminated, like the task force's finding that there was a 16 percent mortality benefit with mammography, uncertainty reigned, and most scientists who studied the data were well aware of it. "That's the shadow element. There is a level of scientific uncertainty that is not reflected in the numbers but exists in the minds of all the analysts," he said.

In the end, he said, the mammogram debate reflected a conundrum of modern medicine. The answers that are needed — what are the benefits and what are the risks — are right at the fuzzy boundary of what science can deliver. He said it was like looking through a microscope at something just at the limits of resolution. "Reasonable people can differ on what the evidence is," he said.

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Lowering Cholesterol Prevents Stroke in Heart Attack Patients

HealthScoutNews
Tuesday, September 3, 2002

TUESDAY, Sept. 3 (HealthScoutNews) -- Aggressive drug therapy to lower cholesterol levels after a heart attack can guard against stroke.

So says a study in today's online issue of Circulation.

The study found that heart attack patients who underwent intensive drug therapy to lower their cholesterol in the four months after their heart attack or other "coronary event" had about half the risk of stroke than heart attack patients who didn't receive the drugs.

Researchers analyzed data from 3,086 people who had suffered a heart attack or chest pain between May 1997 and September 1999. The patients were randomly assigned to take the drug atorvastatin or a placebo within four days of being hospitalized.

During the four months following hospitalization, 36 of the people had 38 strokes. They included 12 taking atorvastatin and 24 taking the placebo. Three people in the drug group and two in the placebo group had fatal strokes.

"An estimated 1 million to 2 million people a year suffer from acute coronary syndrome in the United States alone. So if these results are confirmed in future studies, an absolute reduction of stroke of this order means that many strokes would be prevented," says study author Dr. David D. Waters.

Waters is chief of the division of cardiology at San Francisco General Hospital and a professor of medicine at the University of California, San Francisco School of Medicine.

More information

To learn more about atorvastatin, visit the National Library of Medicine.

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Chaotic Heartbeats Seen in Winter

By Emma Ross

AP Medical Writer

The Associated Press

Tuesday, September 3, 2002

BERLIN (AP) - The likelihood of being admitted to hospital or dying with atrial fibrillation, a life-threatening chaotic heartbeat common among the elderly, increases dramatically during winter months, new research indicates.

A study found that among people aged 75-84, hospital admissions for atrial fibrillation were 25 percent higher than average in the winter, and nearly 40 percent higher than normal for those 85 and older.

The study, presented this week at a meeting of the European Society of Cardiology, also found that deaths from the condition were higher in winter.

The doctors' advice: stay warm, get a flu shot and stay sober.

The disorder affects people of all ages, but is particularly common among the elderly. It afflicts about 10 percent of people older than 75, including 2 million in the United States.

With an aging population and a greater proportion of people surviving heart attacks, experts predict that the number of cases of atrial fibrillation is likely to increase in the next decade.

"Given the almost universal problem of peak winter demands on hospitals in almost all countries with variable climatic conditions and the likelihood of an epidemic of atrial fibrillation in the near future, these represent significant findings," said Dr. Simon Stewart, the study's lead investigator.

"It is possible, for example, that greater efforts can be made to warn high risk patients of the dangers of inadequate heating and clothing, the need for flu vaccinations and the need to limit alcohol intake," said Stewart, a professor of cardiology at the Queen Elizabeth Hospital in Adelaide, Australia.

"As atrial fibrillation is often a precursor to stroke and heart failure — two of the most costly, deadly and disabling of diseases — the potential to save lives, and money, is enormous," he said.

Researchers have already determined that heart attacks, heart failure and heart-related sudden deaths are more common in winter.

Although experts were not surprised at the findings, they said the study is the first to document a seasonal influence on chaotic heart rhythm.

"That is the time for flu and pneumonia and we know .... that may be a cause of atrial fibrillation," said Dr. Jean-Yves Le Heuzey, an atrial fibrillation specialist at the Pierre and Marie Curie University in Paris.

Atrial fibrillation occurs when the two small upper chambers of the heart (the atria) quiver instead of beating effectively. Blood isn't pumped completely out of them, so it may pool and clot. Clots that travel to the brain can cause strokes.

The disturbances can last anywhere from a few seconds to a lifetime.

About 15 percent of strokes occur in people with atrial fibrillation, according to the American Heart Association ( news - web sites).

In the study, the researchers used a nationwide registry of disease and death in Scotland to identify all hospital admissions related to chaotic heart beat in Scotland between 1990 and 1996 and all deaths occurring in those patients between 1990 and 1997.

There were 58,320 hospital admissions related to chaotic heart beat — about 93 admissions a day.

Significantly more people were checked into the hospital in the winter than in the summer.

In both men and women, the peak rate was in December. Hospital admissions were 9 percent higher than normal among men and 12 percent higher than normal among women.

June was the quietest month for women, while the men were least likely to be checked into a hospital in August.

Deaths from chaotic heart beat were 23 percent higher than normal in December and about 15 percent lower than normal in August.

Besides the cold temperatures and greater levels of chest infections during winter, Stewart said it was possible that higher alcohol consumption — particularly around the holiday season — contributed to the winter peak.

According to the American Heart Association, drinking too much alcohol can lead to high blood pressure, heart failure, and possibly even stroke as well as atrial fibrillation.

In both sexes, the biggest variation occurred in people over the age of 75.

Many of the hospital admissions and deaths in the patients with chaotic heart beats involved heart attacks and strokes, the study found.

"It would be interesting to see whether there is a difference in places like southern Europe, where you don't have this range of weather conditions," said Dr. Gunter Breithardt, an atrial fibrillation expert from the University of Munster in Germany who was not connected with the study.

On the Net:

Congress of the European Society of Cardiology: http://www.escardio.org

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Wine Prevents Second Heart Attack

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Tuesday, September 3, 2002

TUESDAY, Sept. 3 (HealthScoutNews) -- Scientists in France have found that middle-aged men who drink modest amounts of wine regularly after a heart attack are less likely to suffer a second heart attack or other cardiovascular complications.

The findings, which appear in today's online issue of Circulation, corroborate previous research, with a couple of new twists.

"It's really more of the same," says Dr. Terrence Sacchi, chief of the division of cardiology at Long Island College Hospital in Brooklyn, N.Y. "It's interesting, but it doesn't really add anything. I don't think any cardiologist is going to say this is what you need to do."

Certainly previous studies have had similar findings, but few have looked at the role of wine in secondary prevention, claims lead author Dr. Michel de Lorgeril, of the Cardiovascular Stress and Associated Pathology Laboratory at Joseph Fourier University in Grenoble, France.

Also in contrast with most previous research, the men in the study were drinking almost exclusively wine and the population was very homogenous, meaning the researchers could control for a good many other complicating factors.

De Lorgeril and his team looked at data on 353 French men between the ages of 40 and 60 who were participating in the Lyon Diet Heart Study. All of the men involved had similar lifestyles and backgrounds, so the effect of the wine was easier to discern.

"We were able to control for the main confounding factors," de Lorgeril says. "In the U.S., people who drink wine are different from people who drink other alcoholic beverages. For instance, wine drinkers have higher education levels, they smoke less, they have different dietary habits and, in consequence, it is difficult to make the difference between effect of lifestyle in general and the effect of the drink."

During a mean follow-up of four years, the study participants experienced a total of 104 cardiovascular complications (including another heart attack, stroke and heart failure). The majority of these complications occurred in men who drank no alcohol (36) or who drank fewer than two four-ounce glasses of wine a day (34). Those who drank more wine had significantly fewer problems. There were 18 complications among those who drank about two glasses a day, and 16 among men who drank an average of four to five glasses of wine a day.

Men who consumed two or more glasses of wine a day reduced their risk for a recurrent heart attack by more than 50 percent, compared with non-drinkers.

Herein lies a huge paradox. The inverse relationship between wine and cardiovascular complications was independent of the major risk factors for cardiovascular disease, including smoking, cholesterol and blood pressure, among others.

In other words, drinking alcohol raises blood pressure and other predictors of heart disease, but doesn't lead to a heart attack. "Drinkers are protected," de Lorgeril says. "There is something very, very strange in the relationship between coronary heart disease and alcohol."

Why this might be the case is still the subject of much research. "We can say there is a secret of wine, but what is the secret? We are working to discover the biological mechanisms by which wine and alcohol in general are protective," de Lorgeril says. Although he and his colleagues have "some important data," the doctor is not willing to reveal his secrets just yet.

Meanwhile, de Lorgeril and others are quick to caution that the message here is not to start drinking or to increase your alcohol intake, especially if your profile does not match that of the study participants.

For healthy people, the American Heart Association ( news - web sites) recommends that if you do drink, do so in moderation -- that means two drinks a day for men and one drink for women. If you don't drink, this is not a reason to start.

"You have to be very careful of this because of the physiological and psychological effects of alcohol," Sacchi warns. "The study is limited. In no way is it definitive."

What To Do

For more information on alcohol, wine and cardiovascular disease, check out the American Heart Association.

BBC News has more on how red wine works its magic.

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Link found between smoking and SIDS

By Ed Susman
UPI Science News
From the Science & Technology Desk
United Press International

Tuesday, September 3, 2002

 BERLIN, Sept. 3 (UPI) -- Researchers said Tuesday they may have discovered why cigarette smoking increases the risk of newborns suffering sudden infant death syndrome.

Working with baby rats exposed to carbon monoxide -- one component of cigarette smoke -- through their mothers, researchers determined that shortly after birth, the heart rhythm of the animals showed dangerous changes that could lead to sudden death.

Among human babies such rhythm disturbances could result in crib deaths, the doctors suggested.

"Prenatal carbon monoxide exposure affects heart rhythms in the rats," said Alessando Fugelli, professor of medicine at the University of Florence, Italy. He demonstrated to attendees at the annual meeting of the European Cardiology Society that the baby animals have normal rhythms at birth, but in the first few weeks of life, electro-cardiographic evidence finds a critical fraction of the heartbeat -- the QT interval -- is lengthened. This prolonged QT interval in human babies is associated with SIDS.

Fugelli noted the baby rats' rhythms returned to normal after a couple of months. He said among children, most babies pass from the danger of SIDS by about 2 years of age and the return to normal in the experimental animals' hearts would occur roughly a at similar time in the rat's life cycle.

"These studies could explain why cigarette smoking is linked to SIDS," said Lars Ryden, professor of cardiology at the Karolinska Hospital in Stockholm, Sweden. "It is another reason why someone should not smoke in the neighborhood of a child."

Claes Held, professor of cardiology at the Karolinska Institute in Stockholm, said, "Why smoking is dangerous to babies is probably due to several factors. It is possible that some type of arrhythmias may be linked to SIDS. Dr. Fugelli's work in Italy is a possible explanation of what happens in SIDS."

Identification of risk factors for SIDS -- such as placing newborns on their stomachs -- has resulted in a "success" story in dramatically reducing the numbers of those crib death tragedies, said Ulrich Keil, professor and director of the Institute of Epidemiology and Social Medicine at the University of Münster, Germany.

Keil said changes in sleeping positions probably have resulted in a 50 percent reduction in SIDS. In the United States, SIDS deaths have fallen from 1.4 per 1000 births to about 0.6 per 1,000 births over the past two decades. He suggested incorporating advice on prenatal smoking, and smoking in homes where newborns live, might halve those mortality figures again.

The problem of smoking is not occurring only among babies, however, Keil said, adding despite numerous warnings about the dangers of smoking, the numbers of smokers in Europe increased by 2-3 percent from 1995 to 2000.

"I blame it on a lack of political will," Keil told United Press International. He said countries such as Sweden have been able to use government programs to mobilize against smoking, resulting in falling rates in that country. He decried the lack of similar efforts in other countries in Europe. "In Germany," he said, "108,000 people will die from tobacco this year."

Keil said programs aimed at keeping children from starting to smoke ignore the fact that millions of smoking adults require help in quitting the habit. He said such help could include reimbursement for nicotine gum and other services.

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Doctors Blunder When Lacking Slumber

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Tuesday, September 3, 2002

TUESDAY, Sept. 3 (HealthScoutNews) -- The long hours of doctors-in-training take their toll in the form of duller minds and fumbling fingers and may be harming patients, a new study has found.

Residents, who typically work more than 24 hours without sleep, are cheap labor for hospitals. This heavy workload, which has long been controversial, recently has taken on new urgency.

Congress is now debating two bills that would shorten residents' work weeks to 80 hours. And earlier this summer, the Accreditation Council for Graduate Medical Education, which sets standards for the nation's 1,100-odd residency programs, issued mandatory guidelines, effective July 2003, that establish an 80-hour work week.

The guidelines, which until next summer are voluntary, also limit continuous shifts to 24 hours (plus up to six hours for extras like education and transfer of patients), and impose a minimum 10-hour rest period between shifts. Failure to comply with the rules could result in a program's loss of accreditation -- and millions of dollars in Medicare payments.

"You would never think of letting a pilot fly for 24 hours straight," said Dr. Sigrid Veasey, a sleep researcher at the University of Pennsylvania School of Medicine and leader of the new study. But young doctors, who are equally entrusted with the lives of others, do so as a matter of course.

Veasey and her colleagues reviewed 50 previous studies of fatigue and residents, and their findings appear in tomorrow's Journal of the American Medical Association ( news - web sites).

They found that sleep deprivation affects both a doctor's cognitive ability -- the skill needed to read a heart monitor correctly, for example -- and surgical precision.

One study found that complication rates were 45 percent higher for surgical residents who'd been "on call" the night before. Two others of simulated laparoscopy found that residents performed worse and needed more time to operate on post-call mornings.

"One of the consistent findings in the careful studies is that subjectively, there's a gross under-appreciation of how impaired you are when you're sleep-deprived," Veasey said. "That goes for both chronic loss of sleep and staying up all night. When you give [a tired resident] the task, they can't do it."

How much, if at all, sleep deprivation among residents contributes to the estimated 44,000 to 98,000 deadly hospital errors each year in this country isn't known, the researchers said. However, the U.S. government's Agency for Healthcare Research and Quality is now funding $300 million worth of studies to address the issue of medical errors, including the role of residents' restfulness and scheduling.

The effects of little rest on the doctors themselves are clearer. Residents face a sharply higher rate of deadly car accidents during their training, especially in the hours when they are no longer on call. "We lose a medical student every two to three years at Penn," Veasey said.

Makeba Williams, legal affairs director for the American Medical Student Association, which supports the 80-hour work week, said some evidence suggests that going more than 24 hours without sleep has the same effect on cognitive function as a blood alcohol content of 0.1, which is above the legal limit in most states.

Williams, who is between her third and fourth years of medical school, said residents also have about three times the rate of depression as the general population, which may be due to their lack of sleep.

Ingrid Philibert, who oversaw the accreditation group's guideline debate, said the 80-hour requirement was drawn from standards for internal medicine residents and New York State's maximum work week, and it's also the figure used in several studies of fatigue.

But Philibert said 80 hours isn't a magic number above which all residents will perform badly. "There are huge interpersonal differences in how people respond to sleep deprivation," she said.

What's more, unpublished data from Europe suggest that the number of patient handoffs from doctor to doctor, not the length of shifts, may generate physician errors. "A tired physician familiar with the case will perform better than a rested physician who doesn't know the details," Philibert said.

Still, the latest study suggests that simply shortening the work week -- to a level twice that of the typical employee -- isn't necessarily a solution to the problem of exhausted residents.

A better approach, Veasey said, would be to shape schedules using scientifically sound principles based on circadian rhythms. That would include two-hour naps timed for the periods of the day when the body most needs rest, and patient rounds at 10 a.m. rather than 8 a.m., when residents are most groggy.

These steps and related measures would help ease the strain on residents while sparing hospitals crushing costs from having to boost staffing levels, she said.

What To Do

For more on patient safety, try the Agency for Healthcare Research and Quality or the Medical College of Wisconsin.

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Drugs prevent heart from enlarging

By Ed Susman
UPI Science News
From the Science & Technology Desk
United Press International

Tuesday, September 3, 2002

 BERLIN, Sept. 3 (UPI) -- Heart remodeling -- a dangerous structural change that occurs in patients with a condition known as heart failure -- can be slowed significantly in patients who receive the beta-blocker drug carvedilol, researchers reported Tuesday.

"The trial results clearly demonstrate that early addition of carvedilol to other therapies in mild heart failure can reverse the effects of remodeling, which will significantly improve the prognosis for patients," said Dr. Willem Remme, director of the Sticares Cardiovascular Research Foundation in Utrecht, the Netherlands, at the annual congress of the European Society of Cardiology.

About 4 million people in the United States suffer from heart failure, a diagnosis that is devastating, said Remme, because mortality from the disease is greater than that for most cancers. In heart failure, the normally oval-shaped left ventricle of the heart -- the major blood pumping chamber -- becomes rounder and larger, usually because of injury caused by a heart attack.

As the remodeling process continues, the heart cannot pump blood efficiently and patients often tire easily and frequently have difficulty breathing. The misshapen heart also can beat abnormally, creating rhythmic distubances which can be rapidly fatal.

In the Carvedilol ACE Inhibitor Remodeling Mild CHF Evaluation, or CARMEN, trial, patients who were diagnosed with mild heart failure were assigned to receive one of three drug regimens: carvedilol plus a placebo medication; the angiotensin-converting enzyme, or ACE, inhibitor, enalapril and a placebo; or both enalapril and carvedilol.

Remme noted that people with mild heart failure still may be able to lead a normal daily life, but if their condition is left untreated they can sustain further heart damage, leading to a rapid progression of the disease to a severe and debilitating condition.

Imaging studies determined that remodeling was slowed significantly by carvedilol alone, but not by enalapril. Nevertheless, Remme said, the combination of the two drugs worked best of all in protecting patients' hearts.

Standard therapy in treating mild heart failure is to start patients on ACE-inhibitors, said Dr. Abraham Caspi, professor of cardiology at the Hebrew University in Jerusalem, who applauded Remme "for his courage to challenge historical therapy."

Caspi told United Press International he would expect clinicians would not abandon starting patients on ACE-inhibitors, despite the findings by Remme and numerous other researchers showing the benefits of beta blockers in treating heart failure.

"However," he said, "I think doctors may begin treating patients with the combination."

The CARMEN study, supported by F. Hoffman-La Roche, of Basel, Switzerland, the manufacturer of carvedilol, enrolled 572 patients into the multicenter trial in 13 European countries.

Patients took their drugs for 18 months. Ultrasound devices were employed to measure left ventricular functioning of the heart non-invasively. All three of the treatment alternatives resulted in similar ability of patients to tolerate the medication. Side effects in each group also were similar.

"CARMEN is the first large-scale direct comparison of a beta-blocking agent versus an ACE-inhibitor on the effects of ongoing damage of the heart," Remme said. "It indicated that carvedilol can be safely administered before starting ACE-inhibitor treatment, but it is clear from these results that patients presenting with mild heart failure should receive a combination of carvedilol and an ACE-inhibitor at the initiation of therapy to help slow disease progression."

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Pediatricians Urge Schools to Nix 'No Nit' Policies

By Nancy A. Melville
HealthScoutNews Reporter

HealthScoutNews

Tuesday, September 3, 2002

TUESDAY, Sept. 3 (HealthScoutNews) -- It's that time of year again, when children come skipping home from their first days of school with their little heads full of new friends' names, homework assignments, and -- all too often -- lice.

The dreaded little bugs may mean a trip to the drugstore, a few extra shampoos and sessions with a fine-toothed comb. In many school districts, though, it also means time off: So-called "no nit" policies prevent children from returning to school before all of the lice -- and the lice eggs, or nits -- are gone.

The nation's leading group of child doctors now says that's doing children a great disservice.

The American Academy of Pediatrics (AAP) strongly discourages such policies, saying "no healthy child should be excluded from or allowed to miss school because of head lice."

The recommendation appears in the September issue of Pediatrics.

The pediatricians estimate that between 6 million and 12 million will come down with a case of head lice this year. While there are no hard statistics on precisely how many schools have no-nit policies, the AAP describes numerous reports of children missing weeks of school due to head lice, and even in some cases being forced to repeat a grade because they were not allowed back into school with the problem.

There's no reason why head lice should cause children to miss even more than one day, argues Dr. Howard Taras, a professor of pediatrics at the University of California, San Diego, and chairman of the AAP's Committee on School Health.

"If you use the [lice treatment] in the morning, I frankly don't see why a child can't return to school that very afternoon," he asserts.

The lice treatment recommended by the AAP is a cream rinse called permethrin, which is sold as an over-the-counter product called Nix.

While the product should kill most head lice, many of the nits typically remain, clinging to the hair with a gluey substance scientists have yet to figure out how to dissolve.

That's where the controversy comes in: Although the nits are not infectious and may not even contain live eggs, some schools see them as harbingers of another infestation waiting to happen.

"The argument some give is that any nit can hatch at any moment," explains Dr. Barbara Frankowski, a professor of pediatrics at the Vermont Children's Hospital in Burlington. "But many of the nits that are seen are just the remaining casing and don't even contain eggs at all, or they contain dead eggs that were killed by the treatment."

"And even if they hatch, it's still two weeks before they matured to lay eggs and cause any kind of infestation," Frankowski adds.

In the meantime, if the treatment is used and followed by a fine-toothed comb through the hair, the problem can usually be resolved within a week or two.

The AAP says it's not necessary to try to manually remove nits after medication for lice to prevent their spread, but advises that parents may want to try to make an effort to pull out nits to further decrease the chance of a misdiagnosis.

But don't expect to remove all of those nits by hand in one sitting.

"It's simply unreasonable to expect that a 7-year-old is going to sit still for three hours while you try to pull out all of the nits," says Frankowski. "What we suggest is that you do short sessions every night for seven to 10 days, because by that time, any nits that are left would have hatched."

Another problem about lice that many parents dread is the laborious process of having to disinfect everything from couches and carpets to bedding and clothing with various lice-removal products.

But the effectiveness of such efforts has yet to be determined, experts say.

In most cases, transmission in fact occurs by direct contact with the head of another infested individual. That's why children's play, and their close contact with one another, makes them the group most susceptible to lice.

Lice cannot hop or fly -- they crawl, says the AAP. While indirect transmission through such means as the sharing of hats or hairbrushes is possible, it is much less likely than is commonly believed.

Many experts say don't bother turning your home inside out with those lice removal products.

"It makes sense to look around the house, take note of places in which your child's head is frequently in contact, and perhaps vacuum that area, if it's a couch," advises Frankowski. "But regarding use of the various products, your time is probably better spent just using the [permethrin] directly on your child's head and making sure you really use it correctly."

The many misconceptions about head lice transmission and control, combined with the sheer creepiness of having live bugs living in one's hair, gives head lice an understandably unique stigma. But that stigma shouldn't keep children from learning, says the AAP.

"People are both fascinated and horrified by lice, and since they don't want to get it themselves or want others to get it, they can do drastic things," says Taras. "But it's important to take a step back and ask why a child should miss any days of school when they're not really infectious."

What To Do

You can read more about head lice in this news release from the American Academy of Pediatrics. The Centers for Disease Control and Prevention also has a page devoted to the critters.

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Control Your Life, Help Your Heart

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Tuesday, September 3, 2002

TUESDAY, Sept. 3 (HealthScoutNews) -- Feeling out of control isn't just bad for your mental health, it may also be bad for your heart.

That's the conclusion of a new study that appears in the September issue of Pyschophysiology.

Researchers from Pennsylvania State University found that when study volunteers believed they had no control over one aspect of a test they were given, their blood pressure was higher than when they felt they had some control.

"Having control over stressful situations might make a difference in the way the cardiovascular system responds," says study author Suzanne Weinstein, program manager of assessment and measurement at Penn State.

Weinstein and her colleagues recruited 32 college students for the study. Twenty-one were women, and 70 percent of the students were white.

The researchers asked the volunteers to play a video game of "catch," in which a square came down a computer screen and the student had to manipulate the paddle at the bottom of the screen to catch the square. The game program was set to keep the students constantly playing at the same level -- if they got better, the game got harder; conversely, if they weren't performing well, the test got easier.

Randomly, the researchers would play a burst of annoying white noise after an error. The noise blasts didn't occur after every error though, so the students didn't know when they were coming.

In one test, the researchers told the students they could control the noise by improving their performance. In another, they were told the blasts were random and they couldn't be controlled. In both instances, the researchers played the noise seven times, regardless of performance.

As the tests were being performed, the researchers measured blood pressure, heart rate and total peripheral resistance to blood flow -- a measure of cardiac output, according to Weinstein.

The students who believed they were in control had slightly lower systolic blood pressure and total peripheral resistance compared to those who thought they couldn't affect the noise.

So, the students who believed they were in control experienced less cardiac stress, and Weinstein points out that only the illusion of control was needed to reduce that stress. However, Weinstein also says the effect was modest -- only several blood pressure points.

"Studies like this are very difficult because humans are very complex," says Dr. Stephen Siegel, a cardiologist at New York University Medical Center in New York City. He adds that personality could affect the results because some people crave control more than others.

However, he also notes, this is interesting data and supports other research that has shown a lack of control and the anger associated with losing control can be a risk factor for cardiovascular disease.

Siegel says he will continue to advise his patients to deal with their anger and stress and look for ways to control what is going on in their lives.

What To Do

For more information on stress and heart disease, go to the American Heart Association. Read about how stress plays a role in heart disease.

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Some Problem Drinkers More Prone to Heart Trouble

HealthScoutNews

Tuesday, September 3, 2002

TUESDAY, Sept. 3 (HealthScoutNews) -- A certain form of a particular enzyme may make some alcoholics more likely to develop a form of heart failure called cardiomyopathy.

That's the conclusion of a study in today's issue of the Annals of Internal Medicine.

Alcoholics with that genetic trait are more likely than other alcoholics to develop heart failure, even when they drink the same amount of alcohol over a lifetime.

Researchers from Thomas Jefferson Medical College in Philadelphia and the University of Barcelona studied 30 Spanish male alcoholics with congestive heart failure. Using a questionnaire, the researchers found out how much alcohol the men drank and gathered information about their lifestyle and background.

These men were compared to 27 alcoholic men who drank the same amount but had normal hearts.

The researchers found the two groups had a difference in the angiotensin-converting enzyme (ACE) gene, which plays a role in hypertension and other cardiovascular conditions. A particular form of the gene is believed to be a factor in heart problems.

Some copies of the ACE gene may contain an extra piece of inserted (I) DNA sequence, while others have a deleted (D) portion of DNA. Genes come in pairs, and each part of the pair is called an allele. The allele with deleted DNA has been linked with cardiomyopathy, the researchers say.

The researchers found that nearly 60 percent of the alcoholics with heart failure had two copies of the D allele, while only 10 percent of them had two copies of the I allele.

"We showed that the alcoholics who have two copies of the D allele have a 16 times greater risk of developing cardiomyopathy compared to the same individuals who drank just as much but had one copy of the I gene," says study co-author Dr. Emanuel Rubin, a professor and chair of pathology at Jefferson Medical College.

More information

The American Heart Association ( news - web sites) has more on drinking and heart disease.

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Deserts Hold Hazards

 

HealthScoutNews
Tuesday, September 3, 2002

(HealthScoutNews) -- Living in or visiting a desert environment such as Arizona's can be a fascinating experience but a dangerous one, if you're not careful.

Deserts have numerous, special hazards, particularly in the hot summer months. Among them, notes the University Medical Center, at the University of Arizona's Tucson campus, are cacti and other plants.

Cacti

While most people try to keep their distance from cacti, playing children sometimes don't -- and end up with a cactus spine imbedded in a foot, hand or another area of the body.

The best way to pull a spine out is with a tweezers, cellophane tape or a fine-toothed comb, being careful not to break off the spine. To get out smaller spines that may not even be visible to the eye, apply a thick layer of household glue (such as Elmer's) and let it dry. As the glue is peeled off, the spines come out. Apply antiseptic to the puncture wound. Watch carefully for redness or swelling, which may indicate an infection from fungus on the spines.

Plants

Many poisonous plants found in Southern Arizona are frequently used in landscaping. Oleanders are among the most popular and beautiful landscaping shrubs, but their long narrow leaves and brightly colored flowers (red, pink or white) are extremely poisonous.

Don't let young children spend time near this plant. A toddler might chew the leaves or suck the flower nectar. And never use the branches for barbeque kindling or skewers. These forms of contact all cause the same series of symptoms, including nausea, vomiting, irregular heartbeat, drowsiness and convulsions. Contact can be fatal within 24 hours.

The Arizona Poison and Drug Information Center recommends that anyone who ingests or suspects that they may have been exposed to oleander, seek help immediately. Don't wait for symptoms to occur.

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Too Much Caffeine? Go Figure

HealthScoutNews

Tuesday, September 3, 2002

(HealthScoutNews) -- Without realizing it, you could easily be consuming enough caffeine to be affecting your sleep or other aspects of your health. Why? Because consumption of a little of this, a little of that and a bit of something else containing this stimulant will put far more in your system, far faster, than you may realize.

In addition to coffee, tea and many soft drinks, caffeine also is contained in chocolate and many prescription and non-prescription drugs. Scientists say that a combined consumption of more than 250 mg of caffeine a day can increase your metabolism, raise your blood pressure and heart rate, and accelerate breathing. It also can offset the effects of sleep deprivation, according to the National Sleep Foundation.

Because caffeine content levels vary greatly from one food or beverage to another, you might do well to check out the NSF's Caffeine Calculator ( http://www.sleepfoundation.org/caffeine.htm), which reflects differences based on such things as the type of coffee bean, brands of coffee, the way coffee is brewed and the way caffeine is presented. This can be a highly valuable tool for those who want to avoid caffeine for health or dietary reasons.

MONDAY, SEPTEMBER 2, 2002

Pump Used to Reverse Heart Failure

By Emma Ross

AP Medical Writer

The Associated Press

Monday, September 2, 2002

BERLIN (AP) - Ten patients with end-stage heart failure were successfully treated with implants of mechanical pumps to rest their hearts while drugs helped repair the damaged organs, a renowned heart surgeon said Monday.

It took an average of six months on the pump for the hearts to recover, and the patients — once near death — since have returned to work, Sir Magdi Yacoub said at the annual meeting of the European Society of Cardiology.

Their hearts have been functioning normally for an average of a year, with one patient reaching four years, Yacoub said.

"I've been around for 35 years and this is the most exciting thing I've seen in my whole career," said Yacoub, a pioneering heart transplant surgeon. "You have someone who's so sick he is emaciated, then you have him running in the park, playing football, or whatever."

Colleagues, while impressed, said it was too early to tell whether the patients have been cured.

"It's going to take more than 10 patients to really see where this fits," said Dr. Sidney Smith, medical director of the American Heart Association ( news - web sites). "But it is a potential solution to a major problem — in the United States alone more than 40,000 patients need transplantation and there are only 2,500 donor organs."

Yacoub reported results on a study of 19 patients with end-stage heart failure, which means their hearts had almost stopped working. Most of them were in their 50s or 60s and had suffered from progressive heart failure for many years.

All the patients had enlarged hearts from their disease — their hearts bulked up to try to compensate for the damage but only became less efficient. Other organs also deteriorated.

The patients' only hope was a heart transplant, but they were taken off the waiting list because they were too ill.

Three patients were too sick and died early on in the study from multi-organ failure. Another one died from an infection.

Yacoub implanted the heart pumps in the chests of the remaining 15 patients and left them there for as long as it took to reverse the heart damage.

The pump, called the HeartMate, takes over the heart's job of pumping blood around the body, giving the heart a chance to shrink back to its proper size and repair itself. The heart continues beating, it just stops pumping blood.

"Unloading alone, we believe, is not enough," Yacoub said, adding that he gave the patients regular drugs to treat heart failure, but at very high doses — doses the diseased heart would not normally be able to handle if it also had to pump blood around the body.

As the heart recovers, it shrinks too much because its workload has been taken over by a pump. To prepare the heart to assume circulation duties again, Yacoub used another drug to build the heart muscle up to the right level.

"With that strategy, we have been able to explant two-thirds (remove two-thirds of the pumps) already ... and they are absolutely normal now for a period of up to two-and-a-half years," said Yacoub, a professor of cardiothoracic surgery at the National Heart and Lung Institute at Imperial College in London.

He weaned 10 of the 15 patients off the pumps. Although the average recovery time for the hearts was six months, one case took 1 years.

Those patients still take regular heart drugs.

The other five patients remain on pumps.

Yacoub said the strategy could be widely used but Dr. Mark Entman, scientific director of the DeBakey Heart Center at Baylor College of Medicine in Houston, said he believed the technique likely will pan out differently.

"It's unlikely that you will have large groups of these people where you will say, 'Go. Be well. You are cured,'" he said. "That's probably not going to happen."

He envisages the technique as an opportunity to regress heart damage a few years.

"While they may still have some problems, it's possible that this second time around you can treat them more intelligently," he said.

When mechanical heart pumps were introduced in the late 1980s, they were designed to take over the heart's work for a brief period until a suitable transplant organ could be found.

Studies have shown that the newer pumps can be left permanently in terminally ill patients. Some patients have survived with the HeartMate device for about two years.

On the Net:

Congress of the European Society of Cardiology — http://www.escardio.org

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What You Don't Hear May Hurt You

HealthScoutNews
Monday, September 2, 2002

MONDAY, Sep. 2. (HealthScoutNews) -- Listen up!

Here's some advice about protecting your hearing at work.

The American College of Occupational and Environmental Medicine (ACOEM) is focusing on hearing protection for its annual Labor Day checklist.

The list includes advice and suggestions on ways that workers and employers can reduce or eliminate noise in the workplace. There are also tips about controlling lifestyle or recreational noise-related problems.

The ACOEM says hearing loss is the most common occupational disease in the United States and the second-most reported occupational illness or injury. Impaired communication, tinnitus (ringing in the ears) and lost worker productivity can all result from workplace-related hearing loss.

More than 30 million American workers are exposed to hazardous noise. Hearing damage can be caused when someone is exposed to noise higher than 85 decibels (dBA) averaged over 8 working hours.

For example, a bulldozer operator is exposed to noise levels of about 105 dBA.

The danger includes office workers, not just people who work in factories or other obviously noisy work environments. Even a ringing phone can register up to 80 dBA.

"Occupational hearing loss can be prevented. But, we can't wait until employees' hearing deficiency begins to affect their quality of life - it is too late then to correct the problem," says ACOEM president Dr. Edward J. Bernacki.

More information

You can find information about the ACEOM hearing program as well as other Labor day health projects at this location.

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MDs Cut Back on Anti-Rejection Drugs

By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, September 2, 2002

WASHINGTON (AP) - Lynette Fralick in January received an intestine transplant, the organ most prone to being rejected when it's put into a new body. Yet in a daring experiment, the New York woman has been weaned down to a mere three anti-rejection pills a week, not the usual handfuls that transplant recipients swallow.

Powerful medications keep transplant patients' immune systems from attacking and destroying their new organs, but they also can cause debilitating, even deadly, side effects.

Now, in a series of experiments spanning the globe, scientists are trying different methods to wean several hundred transplant recipients off anti-rejection drugs.

They're nerve-racking studies: The patients could lose their new organs, even their lives, in the still elusive quest to go drug-free. Indeed, some patients undergoing weaning have had to quickly resume the pills when rejection started to occur. Transplant surgeons insist that organ recipients should not try quitting on their own.

Yet a small but growing number of successes has scientists edging closer to understanding what makes some bodies able to tolerate a stranger's cells — an understanding indispensable to determining one day which patients might be able to safely dump the pills.

"The question is how low can you go" with anti-rejection pills, explains Dr. Samuel Strober of Stanford University. "Can you go to zero, and if you go to zero, how long?"

Even if patients can't quit completely, "everybody is of the same mind that the price that one pays of lifelong immunosuppression is higher than we'd like right now, and you'd like to reduce it," he says.

"We are on the right track," agrees Dr. Kareem Abu-Elmagd of the University of Pittsburgh, which is attempting to wean Fralick and more than 100 other recipients of new livers, kidneys or intestines.

The drug-free quest was spurred by Pittsburgh transplant pioneer Dr. Thomas Starzl's discovery in 1990 of seven people given kidney transplants 40 years earlier, who had stopped their anti-rejection medicine later in life, yet miraculously survived. They had a trait called chimerism — some of the donor's immune cells rode in during the transplant and spread until donor and recipient cells peacefully coexisted in their bodies.

But there's no way, yet, to know in advance who would be so lucky. So doctors are hunting ways to force chimerism. Among the attempts reported at a major transplant meeting last week:

·        In the Pittsburgh experiment, scientists administer one pre-transplant dose of a medicine that kills certain immune cells. Then, after 90 days of lower-than-usual doses of one anti-rejection drug, tacrolimus, patients with no signs of rejection are slowly weaned off. Of 120 now being weaned, several dozen are down to one, two or three pills a week; the goal is eventual stoppage.

That directly contradicts today's standard practice of major immunosuppression immediately following surgery. The Pittsburgh theory is that allowing an early but mild immune reaction permits attack cells that initially targeted the new organ to lose interest and die off.

"I'm feeling great," says Fralick, 40, of Medina, N.Y. But she wants to stay at just three pills a week for a while before the scarier step of further weaning. "I don't want to get to the point where I may go into rejection," she said.

·        Other researchers suspect infusions of tissue or stem cells from donors before transplanting the actual organ may help mediate rejection. Scientists at the Institute of Kidney Diseases in Ahmedabad ( news - web sites), India, infused donor kidney tissue into the recipient's thymus — where developing immune cells are directed to their target — 15 days before kidney transplant. Some 26 kidney recipients have been off all anti-rejection drugs for three months.

·        Stanford researchers implanted kidneys into four people, then gave them radiation to kill certain immune cells and then infused immune-spurring stem cells taken from their kidney donor. For a few months, all showed signs of chimerism as the donor and recipient immune cells mixed — and two were able to stop anti-rejection pills for five months before an early warning sign of rejection sent them back on low doses. A third is weaning now; one had early rejection that prohibited weaning.

·        Stem cell infusions alone aren't the answer, say University of Miami doctors, who have 19 liver recipients off all anti-rejection drugs, 10 for more than a year. Some of these patients received no pretreatment.

Modena Bailey, 77, of Davie, Fla., doesn't know why she's one of the lucky ones: "I just say, 'thank God I'm off all those pills'," she said.

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

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Keep Your Food Clean and Properly Prepared

HealthScoutNews

Monday, September 2, 2002

MONDAY, Sep. 2 (HealthScoutNews) -- Even though Labor Day signals the winding down of summer, you still need to think about food safety. Whether you're having end-of-season picnics and cookouts or doing your daily cooking and food handling at home, how you handle and store your perishable food makes a big difference.

Shopping, storage, handling, preparation and food transportation are all important areas when it comes to food safety, says Lorie Ann Phillips, registered dietitian with the Duke University Health System.

Here are some suggestions she put together:

  • When you go to the grocery store, buy your frozen food last, just before you get the checkout counter. Always check food expiration dates.
  • As soon as you get home, refrigerate or freeze perishable foods. Keep all foods well away from household cleaning products.
  • Keep everything in your kitchen clean. That includes food containers, cutting boards, and utensils.
  • Wash your knives and other utensils after cutting raw meat, and don't use the same platters for raw and cooked meat and poultry.
  • In warm weather, be especially careful with foods made with raw or partially cooked eggs or mayonnaise. "That includes potato salad, chicken or tuna salads and macaroni salads," Phillips says. "You want to pay special attention to these kinds of dishes. Keep them in the cooler as much as possible because of the risk of salmonella."
  • Cook all meat and poultry thoroughly and keep them hot until you serve them.

More information

The U.S. government has recently placed greater emphasis on getting information out about food safety. This page from the Food and Drug Administration ( news - web sites) highlights a number of programs to help ensure a clean kitchen.

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Fitness May Predict Hypertension Risk in Women

HealthScoutNews

Monday, September 2, 2002

MONDAY, Sept. 2 (HealthScoutNews) -- A woman's fitness level may help predict her future risk of hypertension, says a study in the September issue of Psychophysiology.

"We think these initial findings are sufficiently positive to encourage a randomized controlled trial that will provide a better test of the independent effects of cardiorespiratory fitness on responses during stress," says study author Rod K. Dishman.

The study included 13 men and 13 women, average age mid-20s, with normal blood pressure. They all exercised moderately or vigorously at least three times a week over the previous year.

They were given three tests. They did mental math by subtracting a two-digit number from a four-digit number without the aid of a calculator or paper and pencil. In another test, they place an ice bag on their forehead for two minutes. In the third test, they immersed their right hand in ice water for two minutes.

During all these tests, the researchers measured the subjects' blood pressure, heart rate, breathing frequency and calf muscle blood flow.

The mental math test increased both systolic and diastolic blood pressures and blood flow to the calf muscle. The hand/ice water test increased blood pressure readings, but had no effect on calf muscle blood flow. The forehead/icebag test resulted in only slight blood pressure increases and no changes in calf muscle blood flow.

The researchers found something particularly interesting during the hand/ice water test. Women who were more fit had less of an increase in systolic blood pressure.

"The blunted systolic blood pressure response among the fitter women has implications for clarifying the usefulness of the [hand in ice test] as a predictor of future risk of hypertension among women," the researchers write.

More information

Learn how to keep your blood pressure under control from the National Heart, Lung, and Blood Institute.

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Neurological Disease Tied to Eating Type of Bat

By Alison McCook

Reuters Health

Monday, September 2, 2002

NEW YORK (Reuters Health) - A new study provides further evidence to support the link between a neurological disease among the indigenous population on the island of Guam and a cultural tradition of eating a type of bat.

In the 1940s, a neurological disease dubbed ALS-PDC mysteriously plagued the Chamorro population of Guam, producing symptoms that resemble amyotrophic lateral sclerosis (ALS), Alzheimer's disease ( news - web sites) and Parkinson's. People with ALS-PDC often exhibit signs of weakness, paralysis and wasting, inevitably resulting in death.

The condition was once a leading cause of death among Chamorro adults, occurring at rates 100 times the rate of ALS in the US. However, over time, the incidence of ALS-PDC decreased among the Chamorro just as mysteriously as it first appeared.

Recently, US researchers suggested that the changing prevalence of ALS-PDC may be linked to a rise and fall in the population of the flying fox, a type of bat considered a delicacy among the Chamorro people.

According to Drs. Paul Alan Cox of the National Tropical Botanical Gardens in Kauai, Hawaii, and Oliver Sacks of the Albert Einstein College of Medicine in New York, the flying fox consumes a lot of cycad seeds, which contain toxins known to cause neurological disorders.

Although the Chamorro knew the cycad seeds to be toxic and may not have snacked on them, Cox and Sacks proposed that the toxins could accumulate in the tissues of the flying fox, exposing the humans who consume them to damaging amounts of the toxins.

This theory jibes with the changes in the concentration of flying foxes on the island, which began to drop steadily in the 1940s due to their popularity as a delicacy, until they became classified as endangered.

Recently, Dr. Sandra Banack of California State University in Fullerton presented additional results linking the occurrence of ALS-PDC to the consumption of flying foxes at a joint meeting of the Ecological Society of America and the Society for Ecological Restoration in Tucson, Arizona.

Banack and her colleagues interviewed residents of two villages, asking them how often they consumed flying foxes. According to their report, men said they were more likely to eat the entire bat, while women often stuck with only the breast meat. This finding may help explain the marked gender differences in the incidence of ALS-PDC, which strikes men three times as often as women.

The researchers also learned that because the Chamorro people believe that eating the flying fox is so important, they are willing to risk fines or imprisonment to obtain the animals--imposed because the species is now considered rare.

In an interview with Reuters Health, Banack said that even though eating the bats is a deep-rooted tradition within Chamorro culture, traditions can change.

"ALS-PDC is a devastating disease," she said. "Some people are bound to hear the message and be willing to change their habits to protect their health."

Banack added that people should always use caution when eating bush meat. "Free-ranging animals--those that feed on wild plants in the environment--are eating a whole host of plant phytotoxins. Plants produce these toxins as a defense mechanism to stop animals from eating them," she said.

"We control the diet of domesticated animals and do not feed them foods high in toxins. When people eat bush meat they are eating the toxins consumed by that animal," Banack noted.

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Study: Mammograms Don't Cut Deaths in Women in Their 40s

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Monday, September 2, 2002

MONDAY, Sept. 2 (HealthScoutNews) -- In findings that will no doubt revive the heated debate over mammography, Canadian researchers have found women in their 40s who had annual mammograms over five years did not have a lower mortality rate than women who were not screened.

This eagerly anticipated third report from the Canadian National Breast Cancer ( news - web sites) Screening Study tracked the women for 13 years. Two earlier reports, at seven and 10 years, had similar results. The latest research appears in tomorrow's issue of the Annals of Internal Medicine.

"Mammography did not reduce mortality in the 40-to-49 age group," says Dr. Cornelia Baines, co-principal investigator of the study and professor emeritus in the department of public health ( news - web sites) sciences at the University of Toronto. "It's important to realize that much of what we believed until recently has been fueled by wishful thinking. The evidence has never been there to warrant the enthusiasm with which screening is taken up. There isn't evidence supporting effectiveness of screening in this age group."

This unwelcome news comes on the heels of several other studies with similar results.

Ironically, Baines says, "mammography did achieve early detection. It found more cancers. It found smaller cancers with less nodal follow-up." Nevertheless, after 13 years of follow-up, the number of deaths were the same for both groups of women.

The Canadian study followed 50,430 women who were between 40 and 49 years of age when they were first enrolled in the study. Participants were randomized into one of two groups: one that received annual mammograms along with physical breast exams and one that received a single physical breast exam followed by "usual care" from their personal doctor.

Both groups received instruction in how to conduct a breast self-exam. By the end of 1996, 16 years after the first woman was enrolled, 105 women in the mammography group and 108 in the other group had died from breast cancer. A total of 592 cases of invasive breast cancer and 71 cases of in situ breast cancer (in the breast only) were diagnosed in the mammography group, compared with 552 and 29 cases, respectively, in the "usual-care" group.

In the same issue of the journal, the U.S. Preventive Services Task Force (USPSTF) recommends that all women aged 40 and over have mammographies with or without clinical breast exams by a doctor every one to two years. The recommendation was issued after conducting a meta-analysis of eight randomized, controlled trials that provided "fair" evidence, the task force says. The USPSTF also admits the evidence for mammography is strongest in the 50-to-69 age group.

It's not entirely clear why the discrepancy exists, but it does and that will undoubtedly fuel the controversy.

"The whole debate will continue to be in the spotlight," says Dr. Dana Smetherman, co-section head of breast imaging at the Lieselotte Tansey Breast Center at the Ochsner Clinic Foundation in New Orleans. "Mortality has been steadily decreasing in this country, and we have to be doing something right. I think at this point no one wants to completely abandon mammography. It's always going to be a more difficult issue to prove in the younger age group where the incidence is smaller."

Baines disagrees. A number of factors may explain why overall breast cancer mortality is down, including better treatment and the fact that tumors that are brought to medical attention today are much smaller than in the past. "There's a huge difference in size of presentation, and that in itself will demonstrate that even the early detection that we now achieve is enormously better than the very late detection in the first half of the 20th century," Baines says.

For those who say mammography can't hurt, Baines has these sobering remarks: A woman has a one in three chance of getting a false negative response from a mammogram. She has a 50 percent chance of having a false positive if she is between the ages of 40 and 49 and gets screened every year. Seven of every 100 women who are screened will not actually have cancer but will receive treatment anyway. Sixty percent of women would have been cured without the mammogram.

Moreover, Baines says, repeated studies have shown that, since the early 1980s, during the first few years after a screening program is started anywhere, more women die of breast cancer in the mammography group than in the control group. "It's a phenomenon that has been censored both by public and health professionals defending screening," Baines says.

Why do these women die? No one knows, but a "reasonable hypothesis" is that some women may have primary tumors that put out a negative growth factor, suppressing early micrometastases. If this is the case, removing the primary tumors means the tiny metastases are free to flourish.

Mammography does seem to lower mortality in the 50-and-over age group.

So what's a woman -- especially a woman under the age of 50 -- to do? "Breast awareness," Baines says. "Women see their breasts when they have showers, when they're getting dressed and as far as I'm concerned they should do what I did when I was in my 40s: Be aware of changes and be aware of symmetry." Don't worry if one breast is bigger than the other, but do worry if one part of your breast becomes thicker, or looks more full than it did two or three months before, and particularly when the changes are only on one side.

"The tragic story is when a woman finds a lump in her 30s, gets a mammogram and the doctor tells her not to worry about it," Baines says. "If it's an asymmetric lump, you get it biopsied."

What To Do

The Susan G. Komen Breast Cancer Foundation has a wealth of information on all aspects of the disease, as does the National Cancer Institute.

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Study: Airport Noise May Be Bad for Kids' Memory

By Charnicia E. Huggins

Reuters Health

Monday, September 2, 2002

NEW YORK (Reuters Health) - The loud noise that accompanies the take-off and landing of airplanes may be more than an inconvenience for people living near airports. New study findings suggest regular exposure may also dampen children's memory.

"Aircraft noise impairs learning and memory, in particular, of difficult texts," lead study author Dr. Staffan Hygge, of the University of Gavle in Sweden, told Reuters Health. "Language-based cognitive skills are more vulnerable to noise than other cognitive skills," he added.

The study, begun in Germany before the opening of the new Munich International Airport and the closing of the old airport, involved 326 children who lived near either the old or new airport sites. The findings appear in the September issue of Psychological Science.

Children who lived within close range of the old airport experienced improvements in both their long- and short-term memory and their reading after the airport closed, the investigators report. Those newly exposed to aircraft noise when the new airport opened, however, showed a deterioration in their long-term memory and reading abilities.

This finding "provides strong causal evidence for the vulnerability of central language processing to noise exposure, and the reversible nature of the impact," the authors write.

Children who lived near the new airport also showed deterioration in their speech perception--the ability to hear spoken words when there's background noise. And a similar dip among children who lived near the old airport did not improve after the airport closed, the researchers note.

The findings may be applicable to children in the United States, according to Hygge. "Maybe even more so since, in contrast to the children studied in Germany, who were all perfectly fluent in German, the US has a substantial number of immigrants and children that are not fluent in English, which will add to the negative effects of aircraft noise," he said.

To minimize such harmful effects, Hygge advises parents to "choose schools in quiet areas and schools that meet the best building specifications according to interior noise and insulation between and within classrooms."

He suggested that "it would be interesting" to see schools rated for noise levels, in much the same way equipment like lawnmowers and dishwashers are.

According to the researcher, the findings also imply that airports should be located in areas where "few persons, and in particular, children in schools, are exposed to the noise."

The study was funded by a number of national agencies and organizations including the National Institute of Child Health and Human Development, the Swedish Environmental Protection Agency ( news - web sites) and the National Swedish Institute for Building Research.

Source: Psychological Science 2002;13.


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Crossing the Legs Can Prevent Fainting Spells

By Natalie Engler

Reuters Health

Monday, September 2, 2002

NEW YORK (Reuters Health) - Simply crossing your legs and squeezing them together may keep you from passing out, new research shows.

The study, published in the September 3rd rapid access issue of Circulation: Journal of the American Heart Association ( news - web sites), revealed that striking a pose normally used to stave off another type of urge may prove an inexpensive alternative to drugs or a pacemaker for people prone to fainting.

"Muscle tensing can prevent or abort an impending vasovagal faint, by far the most frequent cause of transient loss of consciousness," noted lead author Dr. Wouter Wieling of the University of Amsterdam in the Netherlands in an interview with Reuters Health.

A vasovagal faint is brought on when the pull of gravity causes blood to pool in the leg veins, lowering blood pressure and causing a person to become lightheaded or faint after standing for a long time. Emotional stress can also be a trigger.

Wieling and his colleagues in Amsterdam and the US taught 20 adults with a history of vasovagal fainting to cross their legs and tense their leg, abdominal and buttock muscles while standing. The researchers then induced fainting conditions by placing the patients on a table that can be rotated to an upright position, and tilting it 60 degrees for 20 minutes. Patients who failed to become dizzy were then given nitroglycerine, which induces fainting by dilating blood vessels, thereby lowering blood pressure. They were then tilted for another 15 minutes.

As soon as the patients showed signs of fainting, they were told to cross their legs and squeeze their muscles until their symptoms had subsided for 30 seconds. If the dizziness returned, they were instructed to resume the maneuver until it disappeared.

The maneuver prevented loss of consciousness for 5 of the 20 patients. The remaining 15 were able to postpone a faint by an average of 2.5 minutes.

Offering a possible explanation, Wieling stated that "leg muscle tensing squeezes the swollen veins and thereby brings blood back to the chest." This enables the heart to pump more blood, which increases blood pressure and the flow of oxygen to the brain.

The effects of such muscle tensing are comparable to those of putting your head between your knees, he added.

In follow-up telephone interviews with the study participants about 1 year later, the researchers found that 13 of the patients used the leg-crossing maneuver in their daily lives to prevent or control dizziness and fainting. Only two had fainted since the test.

Therefore, leg crossing and muscle tensing may be a preferable alternative to a pacemaker for people prone to vasovagal fainting because it is easy to perform and effective, without any side effects, the authors conclude.

They add that by enabling people to prevent or delay loss of consciousness, the maneuver "can increase patients' sense of control over their symptoms and thereby improve their quality of life."

Source:Circulation 2002;106.

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Strawberries, Raspberries Halt Cancer in Rats

By Anne Harding

Reuters Health

Monday, September 2, 2002

BOSTON (Reuters Health) - If animal studies are correct, black raspberries and strawberries may be "very, very powerful" inhibitors of cancer growth, an Ohio researcher reported here this month at the American Chemical Society's annual meeting.

People should make berries one of their daily fruit servings, or at least try to eat berries two or three times a week, Dr. Gary D. Stoner of Ohio State University told Reuters Health.

Animal studies by Stoner and his colleagues found the berries were potent inhibitors of cancer development in rodents given cancer-promoting chemicals. The team is now planning studies in people to investigate the effect of berries on both esophageal and colon cancer.

Stoner and his team are studying squamous cell carcinoma (SCC) of the esophagus, which makes up 95% of cases of esophageal cancer worldwide. Overall, survival is very poor, with 10% of patients living 5 years after diagnosis.

Esophageal SCC is particularly common in China, Japan, the Transkei region of South Africa, Iran, France and Puerto Rico. Men are more likely than women to develop the disease, and African Americans also face an increased risk compared with whites.

Smoking, alcohol, salt, and hot and spicy foods are known to promote the development of esophageal SCC. Fungal toxins and chemicals called nitrosamines--both found in the Chinese diet--and vitamin and mineral deficiencies have also been implicated.

To investigate strategies for blocking esophageal SCC growth, Stoner and his team fed rats two types of cancer-promoting nitrosamine chemicals. While chemicals called isothiocyanates proved to be the best way to stop tumors from forming in the first place, strawberries and black raspberries from an Ohio farm worked best for preventing tumors from growing.

Isothiocyanates are found in many foods, including cruciferous vegetables like broccoli and wasabi, a pungent Japanese condiment.

Rats that consumed 5% to 10% of their diet as freeze-dried black raspberries and strawberries showed dramatic reductions in the growth of precancerous cells and tumor progression, the researchers found. And in other animal tests, Stoner told Reuters Health, the berries reduced colon cancer growth by 80%.

The Ohio Department of Agriculture supported the research Stoner presented at the meeting.

Eating berries could be a way to help people at risk of esophageal SCC protect themselves from the disease, Stoner said.

But there are obstacles. For one, he pointed out, berries are a seasonal food in most of the world, which has also made it difficult to conduct epidemiological studies of their effects on cancer. And in some countries where esophageal SCC is a major problem--like China--people rarely eat berries. Finally, berries are expensive.

One way to get around these problems, Stoner said, might be to use extracts of the freeze-dried berries. He and his colleagues have been able to develop some potent berry extracts, he added.

Stoner and his team have completed Phase I trials to investigate the toxicity of the berries and whether berry components reach the bloodstream. People who ate two large bowls of berries a day showed no toxic effects, and many fruit components were absorbed into the blood, according to Stoner.

The researchers, in partnership with a food company, are now launching Phase II clinical trials to investigate whether berries have a cancer-protecting effect on esophageal cancer among people in China and the US. They also plan to investigate the effect of berries on colon cancer.

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Combo Therapy Reduces Severity of Cold Symptoms

By Merritt McKinney

Reuters Health

Monday, September 2, 2002

NEW YORK (Reuters Health) - It's not a cure for the common cold, but an experimental combination of three medications provides some relief to cold sufferers, the results of a study suggest.

The treatment works by keeping the cold virus from replicating, as well as by targeting the inflammation caused by colds.

But don't expect to see the combination therapy at your local pharmacy any time soon, according to one expert.

"I suspect that the combination therapy used in this study would be too complicated and expensive for widespread treatment of the common cold," Dr. Bert L. Semler, a professor of microbiology and molecular genetics at the University of California at Irvine, told Reuters Health.

But Semler, who was not involved in the study, said that the researchers probably never intended for this particular combination to be used clinically, but instead aimed to prove that an approach combining antiviral and anti-inflammatory drugs could reduce cold symptoms.

"This work could now be the basis of future studies aimed at testing different combinations of therapeutic drugs and at developing new inhibitors," Semler said.

People often talk about finding a "cure" for the common cold, and this search implies that a single drug will be able to tackle the cold, according to the authors of the new study, led by Dr. Jack M. Gwaltney, Jr., of the University of Virginia in Charlottesville.

"Because of this belief, people have been ready to embrace simplistic approaches to cold treatment, such as vitamin C and zinc," the researchers noted in a recent issue of The Journal of Infectious Diseases.

An alternative to looking for that elusive single drug that can cure the cold, according to the researchers, is to use a combination of medications to attack the cold on all fronts. That is exactly the type of therapy that Gwaltney's team tested in a group of 150 healthy men and women.

To attack the cold virus head-on, the researchers included in the combination therapy nose drops that contained an antiviral protein called interferon-alpha2b. An over-the-counter antihistamine, chlorpheniramine, was included to treat sneezing and runny nose, while ibuprofen, the active ingredient in certain over-the-counter pain relievers such as Advil, was meant to treat headache and other aches and pains.

Twenty-four hours after being exposed to the cold virus, one group was given all three drugs, while another group received ibuprofen and chlorpheniramine, but got only placebo nose drops, which did not contain any medication. A third group received placebo versions of all three drugs.

Over the course of 4 to 5 days of treatment, participants who received all three drugs had the greatest reduction in symptoms, according to the report. Among patients with cold symptoms when they started taking the combination therapy, the severity of the symptoms was reduced 33% to 73% in people taking all three drugs. And in a sign that the combination therapy helps relieve runny noses, people taking all three drugs used less than half as many tissues.

In comments to Reuters Health, Gwaltney said: "Development of the new (combined) cold treatment was the result of our earlier work on what causes symptoms of colds. We discovered that the symptoms of a cold are due to the body's release of inflammatory mediators in response to the cold virus infection."

According to the authors, the study shows that a three-pronged approach is more effective at treating colds than a single drug.

The investigators, as well as the University of Virginia, have a financial interest in the combination cold therapy.

According to Semler, the University of California researcher, it is true that developing a "one-shot" drug to treat the common cold has been difficult. By the time symptoms appear, he explained, drugs that target only the replication of the cold virus will not have a strong effect on symptoms.

But single-drug therapy "might certainly reduce the length of time that the symptoms persist," he said. Semler noted that reducing the length of a cold may be particularly helpful for people with lung disorders such as asthma.

Source:The Journal of Infectious Diseases 2002;186:147-154.

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High-Fat Diet May Foster Prostate Cancer Spread

Reuters Health

Monday, September 2, 2002

NEW YORK (Reuters Health) - New research has linked a high-fat, high-calcium diet to an increased risk of advanced prostate cancer ( news - web sites). And higher total calorie intake, the researchers found, appeared to boost the risk of both localized and more advanced prostate cancer.

This suggests that modifying diet after prostate cancer treatment could help reduce the risk that cancer will return, according to Dr. Alan Kristal from the Fred Hutchinson Cancer Research Center in Seattle, Washington, and colleagues.

"Our findings clearly show decreased risk for late-stage disease in men with diets that are low in fat and moderate in calcium, perhaps because these diets slow progression of prostate cancer into more aggressive disease," Kristal said in a statement.

"For men diagnosed with early-stage prostate cancer, this finding could be important because it suggests that moderating fat and calcium consumption may reduce the risk of cancer recurrence following treatment," he added.

Kristal and colleagues collected data on 605 men with prostate cancer and on 592 healthy men. All were 40 to 64 years old. The researchers investigated whether prostate cancer risk might be linked to total dietary energy, fat, calcium and vitamin D.

Study participants filled out questionnaires about their diet during the past 3 to 5 years, either before their prostate cancer diagnosis or before they entered the study, according to the report in the August issue of Cancer Epidemiology, Biomarkers and Prevention.

Higher calorie intake was linked to an increased prostate cancer risk, the investigators found. Compared with the lowest level of energy intake of fewer than 1,322 calories per day, men with the highest calorie intake--2,439 calories daily or more--were about twice as likely to develop local or more advanced prostate cancer.

Fat intake was associated only with regional/distant, or more advanced, cancer. Men with the highest fat intake had about double the risk of developing advanced prostate cancer compared to men with the lowest intake.

While higher calcium intake was associated with a 7% increased risk of localized prostate cancer, the risk of advanced cancer was more than doubled in these men compared to men with the lowest calcium intake.

There was no association between prostate cancer and vitamin D or with omega-3 fatty acid intake, the authors add.

"Our interpretation of these results is that high-energy intake increases prostate cancer risk overall, while high dietary fat and calcium intakes increase the risk of more clinically significant, advanced stages of the disease," Kristal and colleagues conclude.

Source:Cancer Epidemiology, Biomarkers and Prevention 2002 August.

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High Calcium Intake May Lower Ovarian Cancer Risk

By Suzanne Rostler

Reuters Health

Monday, September 2, 2002

NEW YORK (Reuters Health) - Women whose diet includes plenty of calcium-rich dairy foods may have a lower risk of ovarian cancer, preliminary study findings suggest.

The investigators found that women with the highest intake of dairy products were 54% less likely to be diagnosed with ovarian cancer than their peers who consumed the least dairy food.

While more research is needed to identify the specific components in dairy foods that might benefit women, "these results suggest that intake of low-fat milk, calcium, or lactose may reduce the risk of ovarian cancer," according to Dr. Marc T. Goodman from the University of Hawaii in Honolulu and colleagues.

Goodman added that the daily recommendation that women include 1,000 milligrams (mg) to 1,200 mg of calcium in their daily diet might be enough to lower their ovarian cancer risk.

"As part of their general health, women should be advised to monitor dietary calcium intake levels to reduce osteoporosis and other diseases related to this nutrient. If women maintain recommended levels of calcium intake, a concomitant benefit might be to reduce their risk of ovarian cancer," he said in an interview with Reuters Health.

Previous research on the relationship between ovarian cancer and dairy food consumption has had mixed results. To investigate, Goodman and colleagues interviewed 558 women with ovarian cancer and 607 healthy women about their eating and lifestyle habits, use of hormones, and reproductive and medical history.

Women who consumed the most dairy products overall, including low-fat and skim milk, were the least likely to be diagnosed with ovarian cancer regardless of their ethnic group. Consumption of whole milk was not associated with a lower risk, however, according to the report in the American Journal of Epidemiology. And the researchers found no relationship between a woman's intake of yogurt, cheese or ice cream and her ovarian cancer risk.

Higher intake of both calcium and lactose--the primary type of sugar in dairy foods--also appeared to lower ovarian cancer risk. Lactose, Goodman's team explained, may increase calcium absorption and promote the growth of bacteria that keep cancer-causing compounds at bay.

The findings, if confirmed by other studies, may provide women with a tool to lower their risk of an often-deadly cancer. While ovarian cancer is highly treatable in its early stages, it is rarely diagnosed early, in part because symptoms such as bloating and abdominal pain can signal any number of problems. Once ovarian cancer spreads to other sites, the 5-year-survival rate is only 29%.

"Although these results are intriguing, we cannot rule out the possibility that both calcium and lactose are surrogates for another, unidentified component of dairy foods," the researchers conclude.

In other findings, there was no relationship between total calorie, fat, carbohydrate or protein intake and ovarian cancer risk.

Source: American Journal of Epidemiology 2002;156:148-157.


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Duration of Type 2 Diabetes Tied to Impotence Risk

Reuters Health

Monday, September 2, 2002

NEW YORK (Reuters Health) - Impotence is known to be a common problem among diabetic men, and new research suggests that the longer a man has had type 2 diabetes, the greater his chances of erectile dysfunction.

The study of men aged 53 to 90 found that those with type 1 or type 2 diabetes were more likely to have erectile dysfunction (ED) than non-diabetic men. Among those with type 2 diabetes, ED risk grew in tandem with the duration of the diabetes.

Men who had been diagnosed with type 2 diabetes within the past 10 years showed no particular risk of ED. But for men who had been diagnosed more than 20 years before, the risk of ED was 70% greater than that of non-diabetic men their age.

The researchers, led by Dr. Constance G. Bacon of Harvard School of Public Health in Boston, Massachusetts, based their findings on data from more than 30,000 men in a long-running US study. The results are published in the August issue of the journal Diabetes Care.

ED was nearly twice as common among men with diabetes (45.8%) as among men without diabetes (24.1%), the authors report, and ED was more prevalent with type 1 diabetes (61.8%) than with type 2 diabetes (45.2%).

In addition, men with both diabetes and heart disease or high blood pressure were most likely to have ED: it affected half of all these men, across age groups. In contrast, men who were free of diabetes and heart disease had the lowest rate of ED, at 17%.

Although more research is needed to confirm these findings, the authors write, they suggest that ED prevention efforts "may be most effective" if started soon after diabetes is diagnosed.

"Healthcare providers who address sexual function issues with diabetic patients early," they note, "may be able to reduce (the) severity or delay onset of ED."

Pfizer, Inc., maker of the anti-impotence drug Viagra, provided partial funding for the study.

Source:Diabetes Care 2002;25:1458-1463.

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Birth Defect Risk Unknown for Most New Drugs

By Alison McCook

Reuters Health

Monday, September 2, 2002

NEW YORK (Reuters Health) - More than nine-tenths of drugs approved since 1980 have not been properly tested to ensure they do not cause birth defects if taken by pregnant women, study findings show.

According to researchers based at the University of British Columbia in Vancouver, Canada, new drugs must be tested to determine if they cause birth defects in pregnant animals before they are approved by the US Food and Drug Administration ( news - web sites) (FDA).

However, what a drug does in animals is not always what it does in humans, they note--so once a drug is approved, researchers need to track what happens in human patients, and use that information to determine whether pregnant women who take the drug are putting their fetuses at risk.

However, as W.Y. Lo and Dr. J.M. Friedman show, these follow-up studies have not been performed for the vast majority of new drugs. As such, more than 90% of new drugs are still considered to have an "undetermined" risk of producing birth defects, according to the report in the September issue of the journal Obstetrics & Gynecology.

Many women need to take drugs for a variety of reasons during pregnancy, and not knowing the risks of these drugs can be frustrating, Friedman told Reuters Health.

"My experience is that many members of the general public, both pregnant women and their partners, are surprised and frustrated about how little we really know about the safety of medications in pregnancy," Friedman said.

The solution, Friedman offered, is simply to keep track of what effects the drugs cause in pregnant women who take them, either because not doing so would risk their or their babies' health, or because they do not yet know they are pregnant.

"I would like to see an ongoing effort to obtain information about the effects on the baby of maternal use of prescription medications in human pregnancy," the researcher said.

Lo and Friedman base their findings on a review of information on birth defect risk of 468 drugs approved between 1980 and 2000. They found that 91% of these new drugs were designated as carrying an "undetermined" risk of birth defects if taken by pregnant women.

In an interview, Friedman said that the companies that manufacture the drugs often have no financial incentive to conduct further studies on birth defects once the drug is FDA-approved. Proper studies cost money, the researcher noted, and there is usually no regulatory requirement that the companies perform these tests.

Friedman added that it would be "unethical" to conduct a study in which researchers gave pregnant women a drug to see if it produced birth defects. "However, almost all drugs are taken by some pregnant women," the study author said.

Studies could follow a group of pregnant women and record what medications they take and the subsequent health of their babies, or interview parents of babies with birth defects and determine which medications their mothers took, Friedman suggested.

"The point is that such studies are possible, and I believe that they need to be done on a sufficient scale to learn about the safety of all medications in human pregnancy," Friedman said.

Source: Obstetrics & Gynecology 2002;100:465-473.

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Heart Attack Does Not Always Cause Chest Pain

By Merritt McKinney

Reuters Health

Monday, September 2, 2002

NEW YORK (Reuters Health) - Chest pain is a tell-tale sign of a heart attack, but it is not the only one. In a new study of more than 700 patients treated for a heart attack, nearly half came to the emergency department because of symptoms other than chest pain.

"We found that heart attacks frequently present with symptoms other than chest pain," the study's lead author, Dr. Jeffrey A. Tabas of the University of California, San Francisco, told Reuters Health.

Forty-seven percent of all patients in the study had primary symptoms other than chest pain: shortness of breath (17%), cardiac arrest (7%), dizziness, weakness or fainting (4%), abdominal pain (2%) and other symptoms (17%).

According to Tabas, the rate of so-called atypical presentations for heart attack in this study was much higher than the 33% figure found in studies of the general population. Noting that the study was conducted at an urban public hospital, Tabas said that the higher rate could reflect the fact that patients at a public hospital are more likely to have a language barrier, to have mental health problems and to have drug and alcohol problems.

"While the public has received extensive education to recognize chest pain as the hallmark of a heart attack, the medical field needs to realize and then educate the public that other symptoms may be just as concerning, such as new onset of shortness of breath or weakness and dizziness," Tabas said.

A report on the findings is published in the August issue of the journal Annals of Emergency Medicine.

The San Francisco researcher said that he and his colleagues did not track all patients with shortness of breath, so they cannot say how often this is the major symptom of a heart attack.

But based on the study, he said, "If you have these symptoms, you should consider being seen in an emergency department."

The investigators studied all patients who were admitted to a public hospital for a heart attack during a 5-year period ending in 1998. The researchers reviewed patients' medical records to identify what had been their primary symptom upon arrival at the emergency department.

The research team found that the odds that a person's chief complaint was a symptom other than chest pain increased with age. Patients older than 84 were least likely to have chest pain. In addition, women were more likely than men to have a heart attack without having chest pain.

Source: Annals of Emergency Medicine 2002;40:180-186.


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Immune Factors May Influence Post-Cancer Fatigue

 

By Merritt McKinney

Reuters Health

Monday, September 2, 2002

NEW YORK (Reuters Health) - New research suggests that immune system molecules that promote inflammation may play a role in the fatigue that plagues many women years after being treated for breast cancer ( news - web sites).

"Enduring fatigue seen in some breast cancer survivors may be related, at least in part, to chronic, low-level changes in the immune system," the study's lead author, Dr. Julienne E. Bower of the University of California, Los Angeles (UCLA), told Reuters Health.

As many as one third of breast cancer survivors continue to have moderate to severe fatigue 2 or more years after treatment.

In the study of 40 breast cancer survivors, the 20 women who continued to suffer fatigue an average of 5 years after treatment tended to have higher blood levels of several markers linked to immune molecules called proinflammatory cytokines. These molecules are released by the immune system after an injury, trauma or infection to help orchestrate the immune response.

Despite the apparent link between cancer-related fatigue and proinflammatory cytokines, Bower cautioned that the results come from a small sample and must be confirmed in a larger study. She added that many other factors may affect fatigue, including depression, pain, menopausal symptoms and socioeconomic factors.

For example, the study found that women with fatigue were more likely to be depressed than non-fatigued women. It is a bit like the old question about the chicken and the egg--researchers do not know which came first, depression or fatigue. Though depression can bring on fatigue, feeling tired all the time can make a person feel depressed.

The researchers also are not sure what caused the spike in cytokine activity in fatigued women. One cause that is "plausible," according to a report in the journal Psychosomatic Medicine, is that immune disturbance and the accompanying fatigue may be long-lasting effects of cancer treatment.

But Bower's team did not find any link between particular therapies and fatigue or cytokine levels, although they note that the small size of the study meant that only a few women received each type of treatment.

Despite the several unanswered questions about the relationship between fatigue and the immune system, the results do suggest a new approach for treating fatigue in cancer survivors, Bower noted.

"If fatigue is related to proinflammatory cytokine activity, as we found here, there are medications designed to block these cytokines that could be tested as potential treatments for this symptom," she said.

The UCLA researcher and her colleagues are now studying whether elevated levels of these proinflammatory cytokines may be associated with other symptoms experienced by cancer patients, including sleep disturbances and problems with mental function and mood.

Source:Psychosomatic Medicine 2002;64:604-611.

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US: Race Gap for Prostate Cancer Survival Closing

Reuters Health

Monday, September 2, 2002

NEW YORK (Reuters Health) - Black American men have been less likely than white Americans to survive prostate cancer ( news - web sites), but the results of a new study suggest that this racial survival gap may be narrowing.

In a study of more than 1,000 men with prostate cancer who had their prostates removed during the 1990s, men treated during the second half of the decade were more likely to survive and be cancer-free than those treated before 1996. Survival improved in both races but more so in blacks than in whites.

"These early data suggest that the survival gap in black and white American men is narrowing and may become statistically insignificant," researchers report in the August issue of The Journal of Urology.

According to a team led by Dr. Fernando J. Bianco, Jr. of Wayne State University in Detroit, Michigan, greater awareness and widespread use of a screen that measures prostate specific antigen (PSA)--a protein linked to prostate cancer--have led to diagnosis of prostate cancer in an earlier stage, when it is easier to treat. In the study, men treated after 1996 were more likely to be diagnosed at an earlier stage of cancer.

The study included men with prostate cancer who underwent prostate surgery either from 1990 through 1995 or from 1996 through 1999.

Prostate cancer has a better prognosis when it is detected before the cancer has spread beyond the prostate. But among men treated during the first half of the 1990s, only 37% of black Americans and 48% of whites had cancer that was confined to the prostate. In the second group of men, however, the rates of organ-confined disease climbed to 58% in blacks and 62% in whites.

Survival also improved in both races, but particularly among black Americans. Forty-two months after treatment, 81% of whites and 68% of blacks in the first group were still alive and cancer-free. In the second group of men, these rates rose to 90% in whites and 88% in blacks.

This survival gap between the races was so small in the second group of men that the researchers could not be sure that it did not occur by chance, the report indicates.

Source:The Journal of Urology 2002;168:479-482.

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Women Could Need Antioxidants More Than Men

Reuters Health

Monday, September 2, 2002

NEW YORK (Reuters Health) - Might that morning glass of orange juice or vitamin tablet be more important for women than men? It is too soon to say, but for reasons that remain unclear, new study findings suggest that women experience more oxidation--a process suspected of increasing the risk of heart disease, stroke and several other diseases--than men. Vitamin C and other antioxidant vitamins can counteract this process.

Oxidative stress is the accumulation of cell-damaging substances called free radicals. This stress can be caused by outside factors, such as cigarette smoking, or by factors on the cellular level. Damage caused by oxidative stress is thought to contribute to the aging process and to many diseases. To confirm the role of oxidation in the development of disease, many large studies have measured the dietary intake of antioxidants, such as vitamin C. But few studies have gauged the extent ofoxidative damage in people.

That is exactly what a team led by Dr. Gladys Block of the University of California at Berkeley has done. They measured oxidative damage in 298 healthy adults who ranged in age from 19 to 78. The study included 138 cigarette smokers, 92 nonsmokers and 68 people who reported exposure to secondhand smoke.

The researchers measured levels of two substances--malondialdehyde and F2-isoprostanes--that are markers of oxidative damage. These byproducts are produced after fatty substances called lipids are oxidized.

Based on levels of these markers, oxidative damage was significantly more extensive in women than in men, according to a report in the American Journal of Epidemiology. In fact, female sex was a more powerful predictor of oxidative damage than smoking.

The higher level of oxidative damage in women was unexpected, and the researchers do not have a good explanation for it. At first, Block and her colleagues thought that the higher percentage of body fat in women might be to blame, but when they accounted for body mass index (BMI)--a measurement that considers both weight and height--women still had higher levels of oxidation.

The finding of higher levels of oxidative stress in women is particularly interesting, according to the authors, "in view of the fact that women have been found to be at greater risk of lung cancer than men exposed to similar levels of cigarette smoke."

People with higher levels of a substance called C-reactive protein--a marker of inflammation that has been linked to heart disease--also tended to have more oxidative stress, the researchers report.

In contrast, oxidative stress was lower in people who ate the most fruit as well as in those who had higher blood levels of vitamin C and carotenoids--pigments in fruits and vegetables that the body uses to make vitamin A, Block's team found.

However, neither smoking, age, alcohol use nor other dietary factors affected levels of oxidative stress. Likewise, a form of vitamin E called alpha-tocopherol did not seem to influence oxidative stress, the report indicates.

Source:American Journal of Epidemiology 2002;156:274-285.

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Genes, Virus Implicated in Multiple Sclerosis

By Linda Carroll

Reuters Health

Monday, September 2, 2002

NEW YORK (Reuters Health) - Certain genetic variations may make some people more prone to developing multiple sclerosis (MS), researchers have found.

According to European scientists, these genetic variations could make it difficult for the immune system to distinguish between the Epstein Barr virus (EBV) and myelin--the fatty material that insulates the nerves and allows them to transmit electrical signals, according to a report in the advance online publication of Nature Immunology.

When the immune system mistakes myelin for EBV, it attacks it. Electrical signals in the body then slow down or become garbled, which leads to the symptoms experienced by MS patients. But exactly what triggers this misguided immune system assault is unclear.

The study by Lars Fugger of the Aarhus University Hospital in Skejby Sygehus, Denmark, and colleagues found that a genetic variation in an MS patient made the patient's immune system more likely to confuse myelin for EBV.

The study gives more credence to the notion that the body might be mistaking proteins of the central nervous system for proteins in the virus, said Dr. Clyde Markowitz, co-director of the MS Center at the University of Pennsylvania in Philadelphia.

"The new study fulfills a lot of expectations," agreed Dr. James R. Miller, director of the MS Center at Columbia-Presbyterian Medical Center in New York. "For some time we've known there was some relation between viral and MS attacks. This doesn't mean the virus is the cause of MS, but it shows how viruses might trigger it."

Ultimately, Miller noted, researchers may find that more than one type of gene variation leads to susceptibility to MS.

Source: Nature Immunology online 2002.

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Fish Oil Plus Statins May Improve Cholesterol

By Merritt McKinney

Reuters Health

Monday, September 2, 2002

NEW YORK (Reuters Health) - For obese people who are at risk of developing diabetes, cholesterol-lowering drugs and fish oil both improve the balance of fatty substances in the blood, study findings show.

Since the drugs, known as statins, and fish oil work in different ways, combining the two treatments could be a promising approach for obese individuals with so-called pre-diabetes, according to one of the study's authors.

"Statins and fish oil improve lipids in obesity and pre-diabetes by different mechanisms," Dr. Gerald F. Watts, of the University of Western Australia in Perth, told Reuters Health.

"Combination therapy is likely to be very effective," according to Watts, but he cautioned that this idea must be put to the test in a large clinical trial.

Watts and his colleagues studied 48 obese men who were vulnerable to developing type 2 diabetes, the most common form of diabetes. It occurs when the body can no longer properly use the blood sugar-regulating hormone insulin. All men in the study had insulin resistance, a precursor to full-fledged type 2 diabetes in which the body becomes less responsive to insulin. They also had a condition called dyslipidemia, which is characterized by high levels of triglycerides and "bad" LDLcholesterol, and low levels of "good" HDL cholesterol.

The men were randomly assigned to one of four daily regimens for 6 weeks. One group took both the cholesterol-lowering drug atorvastatin and fish oil tablets; a second group took atorvastatin with a placebo, which did not contain fish oils; and a third group took fish oil tablets plus a placebo. The fourth group took neither fish oil nor the statin, receiving two inactive placebos instead.

Though none of the regimens improved insulin resistance, both statins and fish oil improved the men's balance of blood fats. And the two treatments worked in different ways, according to a report in the August issue of the journal Diabetes.

Statin therapy blocked the formation of cholesterol, which improved the clearance of molecules called ApoB that carry the harmful form of cholesterol in the blood. In contrast, fish oils interrupted the making of triglycerides, which interfered with the liver's production of a certain type of ApoB molecules.

Given that two previous studies have found that a combination of statins and fish oil may reduce the risk of cardiovascular disease, the results of this study "provide a rationale for a clinical trial to assess the efficacy of statin plus fish oils in the prevention of cardiovascular disease in subjects with insulin resistance and type 2 diabetes," the report concludes.

Pfizer Australia provided some of the study's funding, and the Norwegian company Provona Biocare provided the fish oil tablets used in the study.

Source: Diabetes 2002;51:2377-2386.


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Little Mixing of Black, White Seen in Elderly Care

By Merritt McKinney

Reuters Health

Monday, September 2, 2002

NEW YORK (Reuters Health) - When it comes to nursing homes and other types of long-term care for the elderly, blacks and whites lead largely separate lives, new research suggests.

In a study of 220 US nursing homes, retirement centers and assisted-living facilities in four states, nearly all whites lived in centers that were mainly white, while the majority of African Americans lived in facilities that were mostly black.

In fact, in two types of facilities, assisted-living or retirement centers with fewer than 16 residents and traditional nursing homes, most facilities did not have a single African-American resident, according to a report on the findings in the August issue of the American Journal of Public Health, journal of the American Public Health Association ( news - web sites).

But more studies are needed, researchers say, to understand the causes of the racial differences and determine whether they have a negative impact on the care that African Americans receive.

"Through our research we are beginning to document the racial disparity in healthcare that exists for the African-American elderly and how this disparity may be lessened by effectual policy change," the lead author of the report, Dr. Daniel L. Howard of Shaw University in Raleigh, North Carolina, told Reuters Health.

"Future research," Howard said, "must examine if facilities are reacting to racial, social or economic factors with regard to the admission of African Americans into long-term care settings."

According to Howard, changes are needed in the admission criteria of facilities and, perhaps, in the reimbursement levels received by homes and centers.

While research is needed to make sure that African Americans receive adequate care, "We need to avoid a gut reaction that racial separation is necessarily bad, because older people value being with others whose cultural background they share," according to Dr. Philip D. Sloane of the University of North Carolina at Chapel Hill, one of the study's co-authors.

"The challenge," according to Sloane, "is to assure that quality is equal across a variety of facility types."

Another co-author of the study, Dr. Sheryl Zimmerman of the University of North Carolina at Chapel Hill, agreed that it is too soon to say that African Americans receive lower quality long-term care than whites.

"While access to different kinds of settings definitely differs for people with less money," she told Reuters Health, "there is no real evidence to cause alarm about the quality provided to minorities. The real issue is whether the care they receive is culturally sensitive (and) consistent with what they and their families want."

Zimmerman added, "The fact that racial separation occurs may actually be a good thing in that regard."

The study included long-term care facilities in Florida, Maryland, New Jersey and North Carolina. There were no African-American residents at 58% of facilities, and African Americans made up no more than a quarter of the residents at 27% of long-term care centers.

The percentage of African-American residents varied among different types of facilities, ranging from 24% at traditional nursing homes to just 4% to 5% in assisted-living or retirement centers. The newest type of assisted-living facilities, which are growing more rapidly than any other type of long-term care facility, had the lowest percentage of African-American residents, raising concerns that racial disparities may be increasing, according to the report.

Not surprisingly, perhaps, the proportion of African-American residents in a facility was related to the size of the black community in the surrounding area. Facilities with a higher proportion of African Americans were also more likely to admit mentally retarded residents or individuals with problems walking. These facilities also tended to have poorer cleanliness, maintenance and lighting scores.

Source: American Journal of Public Health 2002;92:1272-1277.

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Sex of Fetus May Influence Pregnancy Complications

Reuters Health

Monday, September 2, 2002

NEW YORK (Reuters Health) - Pregnant women who are carrying a male fetus and who develop high blood pressure tend to have higher levels of certain hormones than those with normal blood pressure, study findings indicate.

These results suggest that the sex of the fetus may influence how a woman responds to this complication of pregnancy, known as preeclampsia.

Preeclampsia is marked by high blood pressure, swelling in the legs and other symptoms. The complication affects as many as 1 in 10 first pregnancies. If left untreated, preeclampsia can develop into eclampsia, a life-threatening condition in which a woman has convulsive seizures in late pregnancy or during the first week after delivery.

During the study, Dr. Johan Arnt Steier and colleagues at Haukeland University Hospital and the University of Bergen in Norway measured levels of the hormones testosterone and human chorionic gonadotropin (hCG) in pregnant women with or without preeclampsia.

While testosterone is commonly known as the "male" hormone, women also produce small amounts of the hormone, and testosterone levels increase during pregnancy. HCG is a hormone naturally produced during pregnancy, as well.

Levels of both of these hormones tend to increase in women who develop preeclampsia, relative to those without the complication.

During the study, Steier and colleagues examined blood samples from 137 pregnant women, around half of whom had mild to moderate preeclampsia. The fetuses had been growing in the wombs of their mothers for between 30 to 38 weeks.

The investigators found that women with preeclampsia who were carrying boys had higher levels of hCG in their blood than male fetus-bearing women without the complication, while this difference was not seen in women who later gave birth to a girl.

Furthermore, all women with preeclampsia had higher levels of testosterone in their blood than women without the complication, and testosterone was highest in women who later delivered a boy, according to the report in the recent issue of Obstetrics & Gynecology.

Preeclampsia largely resolves when the placenta is removed, indicating that this structure plays an important role in the condition, Steier and colleagues write. They suggest that changes in women with preeclampsia may partly result from changes within the placenta that are linked to the sex of the fetus.

Genes from the father are the only genes expressed inside the placenta, they add, so increases in testosterone and hCG blood levels may also result from a gene donated by the father.

Source:Obstetrics & Gynecology 2002;100:552-556.

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SUNDAY, SEPTEMBER 1, 2002

Glucose May Help in Cardiac Arrest

By Emma Ross

AP Medical Writer

The Associated Press

Sunday, September 1, 2002

BERLIN (AP) - Giving most heart attack patients an infusion of glucose soon after they come to the hospital could dramatically improve their chances of survival, preliminary new research suggests.

The Dutch study found that supplementing regular treatment of heart attacks with the extra fuel reduced the risk of dying within a month from 4.2 percent to 1.2 percent — but only for patients whose hearts had not suffered substantial damage in the attack.

Experts said the study — presented Sunday at the annual meeting of the European Society of Cardiology — was promising but stressed the findings were preliminary.

"The time of follow-up is probably too short to draw firm conclusions," said Dr. Lars Ryden, a professor of cardiology at the Karolinska Institute in Stockholm, who was not involved with the research. "We are eager to know the long-term results."

When heart muscle is damaged, the metabolism in the heart increases and the cells need a lot more glucose, their main fuel, to stay alive.

The infusion includes insulin, which is needed to transport the glucose into the cell. However, insulin also causes a flux of potassium into cells, which depletes the levels in the blood. Potassium is therefore added to the infusion to compensate for that effect.

In the 1950s and 1960s, several studies investigated the prospect of boosting fuel to the heart with infusions of glucose, insulin and potassium.

However, the evidence was inconclusive and doctors were left confused. Also, it has never been tested in combination with today's standard therapies.

Those involve trying to get rid of the clot that caused the heart attack either by widening the arteries with instruments or dissolving the clot with drugs.

The latest study involved 940 patients treated at the De Weezenlanden Hospital in Zwolle in the Netherlands.

Half the patients also got an infusion of the high-dose glucose mixture. They got about 4.3 pints of the fluid intravenously over 10 hours.

Overall, the death rate over the next 30 days was about the same in the two groups — about 5 percent.

However, the results significantly improved when restricted to the 90 percent of patients who had not suffered severe damage or heart failure.

Only 5 people who got the infusion were dead 30 days later, compared with 18 in the group who didn't get the tonic.

"These data show that at least we should take it seriously," said Dr. Felix Zijlstra, a cardiology professor who led the research. "Metabolic intervention seems to have a future — on top of other therapy and provided they don't have heart failure."

About three quarters of people who have a heart attack have no signs of heart failure.

While experts were encouraged by the glucose findings, they appeared to give up on another infusion for heart patients that had once shown promise — magnesium.

A number of small studies conducted on humans in the 1980s suggested magnesium reduced deaths. But a large study in 1993 failed to find a benefit.

However the larger study left open the possibility magnesium could be helpful if given sooner after an attack and to people with a worse prognosis — such as the elderly or people who couldn't have their arteries widened or receive clot-busting drugs.

The U.S. National Heart, Lung and Blood Institute funded a Harvard Medical School ( news - web sites) study of more than 6,000 patients in 14 countries to answer that question.

The findings, presented at the Berlin meeting, showed that magnesium infusions were useless for such patients.

Fifteen percent of the patients died in the month after their heart attacks, regardless of whether they had had the magnesium infusion.

"I think magnesium is now dead in the water," said Rory Collins, an Oxford University epidemiologist who was not connected with the study.

On the Net:

Congress of the European Society of Cardiology:

http://www.escardio.org

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Sleep Apnea Steals More Than Sound Slumber From Kids

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Sunday, September 1, 2002

SUNDAY, Sept. 1 (HealthScoutNews) -- The troubles of children with sleep apnea may stretch far beyond not getting a good night's sleep.

Researchers at the Baylor College of Medicine in Houston have found the more severe the condition, the more impaired the child's performance on tests of intelligence, memory, academic performance, social skills and attention.

These findings and others raise the possibility that attention-deficit hyperactivity disorder, or ADHD, and other behavioral and learning problems may sometimes be a symptom of obstructive sleep apnea syndrome (OSAS).

"I think it's a possibility," says Dr. Daniel G. Glaze, lead author of the study and an associate professor in the departments of pediatrics and neurology at Baylor. "If they don't sleep well at night, they can't function in an appropriate way during the day. One hypothesis is that the hyperactivity is a mechanism of trying to keep yourself awake."

Fortunately, many of the kids in this study experienced dramatic improvements in quality of life when they had their tonsils and adenoids surgically removed.

"The data is incomplete because the study is still ongoing, but we have enough data at the six-month follow-up period to see dramatic improvements in several aspects of quality of life," says Dr. Michael Stewart, a co-author of the study, which was presented at the recent annual meeting of the American Society of Pediatric Otolaryngology in Boca Raton, Fla.

Children with OSAS experience an obstruction of their upper airway -- often but not always because of enlarged tonsils and/or adenoids -- that disrupts their breathing while they sleep.

One telltale symptom is snoring. Although the condition is well-recognized in adults, it is just beginning to gain attention in the pediatric world. At least 2 percent of children are estimated to suffer from the condition.

In children, the condition tends to peak in elementary school-age children, which is when tonsils and adenoids tend to be larger, says Dr. Michael Light, a professor of clinical pediatrics at the University of Miami School of Medicine and author of the Clinician's Guide to Pediatric Chronic Illness. This is also the time when children are making huge strides in their cognitive development.

"The main job of kids is to go to school. If they're not sleeping well at night, they'll have problems concentrating. That has become very clear," Glaze says. "Our preliminary findings indicate that breathing problems during sleep impact on a number of parameters including intelligence, memory, academic performance, behavior. And it impacts on families as well as on the child."

The researchers looked at 23 boys and girls between the ages of 5 and 13 who had difficulty breathing while they slept. Intelligence, memory, academic performance, attention and adaptive behavior were measured both before and after they had tonsillectomies and adenoidectomies.

Six months after surgery, the children exhibited dramatic improvements in their quality of life. One question that remains is whether these improvements will be sustained at a year or longer.

"It was our finding that, following [the surgeries] at six months, there were significant improvements on quality-of-life questionnaires," Glaze says. "As to improvements in behavior and cognition, we have not shown this. The subjects will be retested at one year to see if there is improvement and, if so, in what areas."

The quality-of-life improvements also extended to the families of children diagnosed with OSAS.

"Often when I see kids come in, the biggest problem is with their parents," Glaze says. "Several mothers had to quit their jobs because they were up and down with the kids at night, they were driving when they were drowsy, and they were falling asleep on the job."

Heartening as these results are, not all cases of OSAS can be explained by the presence of enlarged tonsils and adenoids.

Obesity, for instance, is another major risk factor for the condition, says Light, who is about to start studying the relationship between sleep and obesity.

"We haven't even scratched the surface of it," he says.

What To Do

For more information on OSAS, visit Stanford University or ABC7Chicago.com.

Medications Are Not Kids' Play

HealthScoutNews

Sunday, September 1, 2002

SUNDAY, Sept. 1 (HealthScoutNews) -- The kids are going back to school, but it's the parents who should bone up on the 3 Rs -- risk, respect and responsibility -- when it comes to giving their children over-the-counter medicines.

So says the National Council on Patient Information and Education.

The council released a survey of 1,011 adults earlier this year that found many of them are unclear about the relationship between a child's weight and age in determining dosages of such medicines.

The survey also found parents are having trouble understanding about different concentrations of medicines. That can be significant because infant formulations are often more concentrated than medicines for older children.

The NCPIE offers the following advice to parents:

·         If in doubt about which medicine to give your child or how to give it, ask your doctor or pharmacist.

  • Make sure your child's doctor knows about all the medicines your child is taking before the doctor writes a prescription for your child. If your child takes prescription medicines, discuss it with your doctor or pharmacist before you give your child any over-the-counter medicine.
  • Know your child's weight so you can give them the proper dose of medicine.
  • Follow label directions carefully.
  • Use the specific dropper, dosing cup or other device that comes with your child's medicine. Household utensils such as spoons vary in size and aren't accurate enough to measure medicine doses.
  • If your child is taking multiple over-the-counter medicines, check them for duplicate ingredients and usage. Make sure you're not giving your child more than one product with the same active ingredient without first checking with your doctor or pharmacist.
  • Babies and children should take only medicines specifically formulated for their weight and age. A child can overdose on adult strength tablets that are cut in half or receive what you estimate to be a half dose of an adult-strength liquid medicine.
  • Remember that most voer-the-counter medicines are for temporary relief of minor symptoms. If your child's symptoms persist or get worse, see a doctor.
  • Don't give medicines in the dark. You can make a mistake reading the dosage information.
  • Teach children that medicines are not candy and they shouldn't touch, taste or sniff them on their own. Only a responsible adult should give medicine to children. Keep all medicines out of children's reach.

More Information

Here's more information on medications for children.

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SATURDAY, AUGUST  31, 2002

Sex Discrimination in the Medicine Cabinet

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews

Saturday, August  31, 2002

SATURDAY, Aug. 31 (HealthScoutNews) -- Do drugs discriminate by gender?

Absolutely, say doctors and scientists -- certain drugs can trigger side effects that trouble women more than men. Conversely, other drugs can shortchange men, not giving them, for instance, the pain relief that women get from the same medications.

But that doesn't mean these drugs can't benefit both.

"It's certainly a cause for concern -- men and women do respond differently to certain drugs. And it's really crucial to look for these differences in clinical trials and post-trial use," says Sherry Marts, scientific director for the Society for Women's Health Research, which compiles information on drugs and their effects on the different genders.

"But," she adds, "it hasn't resulted in a lot of serious health problems. And if they [drug makers] figure out what's going on, they can reverse the effects."

One of the more significant problems facing women: There are approximately 50 drugs that have been shown to increase the risk for an irregular and rapid heartbeat, a condition called Torsades de Pointes.

When women take one of these drugs -- including a number that, ironically, are designed to treat irregular heartbeats -- they're automatically at higher risk for Torsades de Pointes than men, health experts say.

"This is serious in the sense that every drug class has a drug within it that has this problem. And more importantly, even though women are now being included in study data for drugs, the data isn't being analyzed by gender," says Dr. Raymond Woosley, vice-president of health sciences at the University of Arizona and the author of studies on drugs' effects by gender.

Drugs prescribed to treat irregular heartbeats that can lead to Torsades de Pointes include brand names like Cardioquin, Quinaglute, Corvert and Norpace. In addition, some anti-depressants, like Zoloft and Prozac, and even common antiobiotics like erythromycin -- when given intravenously -- carry warnings of an increased risk of Torsades de Pointes, Woosley says.

More drug manufacturers are noting the risk to women on the drugs' packaging.

Sotalol, for instance, which goes by the brand name Betapace AF, is another drug used to treat irregular heart beats.

Clinical trials before its approval by federal regulators showed that approximately six percent of the 3,135 men and women who took the drug suffered irregular heartbeats as a side effect. Of the six percent, however, two-thirds were women, a "statistically significant number," says Dr. John Williams, director of clinical research in the cardiovascular division of Berlex Laboratories, which manufactures the drug.

"This is a common side effect of all this class of drugs," Williams says, and women have an increased susceptibility to it. For that reason, the potential side effect for women is mentioned in the consumer information packet that accompanies the drug.

But the risk of side effects like Torsades de Pointes shouldn't preclude women from the benefits of an effective drug, says cardiologist Neica Goldberg, chief of the women's heart program at New York City's Lenox Hill Hospital.

Most of these drugs are first prescribed in a hospital where the physician can monitor their effects, she says. "And any physician prescribing them knows it is a known side effect that many anti-arrhythmic drugs actually increase the risk of Torsades de Pointes."

"There may be some predisposition for women for this, but that should not mean women should not have the drug. Doctors should be more cautious in the dosages, and to know that the dosage has to be adjusted downward," she adds.

Men aren't impervious to the drug-gender pitfall. For example, it's been found that men are far less likely to experience pain relief than women when given a prescription for the standard painkiller nalbuphine (brand name Nubain) after surgery.

"We were amazed and then perplexed, because this drug has been around for a long time," says Dr. Jon Levine, a professor of medicine at the University of California, San Francisco, who conducted a study of the effectiveness of nalbuphine on the pain resulting from removal of impacted wisdom teeth.

"The women could get a very powerful, long-lasting analgesic effect that was better than morphine. But for men, the response was weak, and in some doses, it made the pain significantly worse," he says.

It's still not known why these gender differences exist, Levine adds. "We have to begin to tease out how the nervous system in men and women is different," he says.

There's a growing body of literature on the topic, and physicians, other health-care professionals and the public should be alert to the new information, he says.

"For individuals as well as health-care providers, if you don't get the response you expect from a drug, you have to be open-minded to the fact that gender may actually be important," Levine says.

Marts advises everyone to ask their doctors about possible gender effects of drugs they're prescribing. "It doesn't hurt to ask the question," she says.

Also, people should be sure to tell their doctor what other medications they're taking, not just prescribed drugs but over-the-counter drugs and herbal remedies, she adds.

"This applies particularly to women, because women take more drugs in combination because of birth control pills," Marts says.

What To Do

For a list of drugs that have been shown to lead to Torsades de Pointes, visit the University of Arizona. For advice on how to safely use medications, see the Public Citizen's Health Research Group.

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A Dose of Technology With Your Medicine

HealthScoutNews

Saturday, August  31, 2002

SATURDAY, Aug. 31 (HealthScoutNews) -- Most Americans prefer an electronic prescribing system that lets doctors send prescriptions directly to pharmacies instead of first sending prescriptions to insurance companies or health maintenance organizations, says a new survey.

The survey was conducted by Harris Interactive ( news - external web site) and released at the recent National Association of Chain Drug Stores' annual pharmacy and technology conference.

It found that 82 percent of Americans prefer this kind of e-prescribing because it offers a number of benefits, including less waiting time at the pharmacy, faster prescription renewals, and more time for people to discuss the medicines with pharmacists.

Another advantage cited by survey respondents was that e-prescribing minimizes the chance of prescription errors due to a pharmacist being unable to read a doctor's handwritten prescription.

The survey also looked at the amount of time Americans spend getting prescriptions filled, and found that 60 percent of Americans visit their pharmacies one to five times a year to fill or renew prescriptions. Eleven percent said they go to their pharmacies six to 10 times a year and another 11 percent said they go 11 to 30 times a year to fill or renew prescriptions.

The number of prescriptions filled in the United States each year has increased 50 percent since 1990. It was 3 billion in 2001, and is expected to be 4 billion by 2005.

More Information

The U.S. Food and Drug Administration has more on prescriptions.