The American Voice Institute of Public Policy presents

Personal Health

Joel P. Rutkowski, Ph. D., editor
December 26, 2004

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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PERSONAL HEALTH for the week of July 24-30

 

  1. New Pill May Help Recovering Alcoholics Stay Sober
  2. Breast-Feeding Cuts Genetic Breast Cancer Risk
  3. Survey: Americans Sad About 3 Days a Month
  4. At Last, a Plus for Weight Gain: Healthier Babies
  5. Topical Painkillers Only Offer Temporary Arthritis Relief
  6. Pregnancy After Heart Repair May Be Harmful
  7. Simple Test Predicts Diabetes Amputation Success
  8. Carpal Tunnel Screening Not Good for Bottom Line
  9. Chickenpox Vaccination May Not Prevent Infection
  10. Heart Enlargement Appears Early in Type 1 Diabetes
  11. US FDA Warns of Fake Drugs Bought in Mexico
  12. Seizure Drug Helps Reduce Cancer Pain
  13. Smoking During Pregnancy Linked to Cleft Lip in Newborns
  14. Bone Loss Seen in Adults with Cystic Fibrosis
  15. Too Little Fish Oil Hurts Your Heart
  16. Child Vaccinations Hit Record, But Many Uncovered
  17. Smoking Raises Risk of Kidney Disease
  18. New Drugs Get at Root of Alzheimer's in Mice
  19. Lyme Test Overused; Insistent Patients Cited
  20. Study Finds MRIs Better on Breast Cancer
  21. Related Drugs Vary in Benefit After Heart Attack
  22. Study: Heart Tumors May Be More Common
  23. Exercise-Related Pain Diminishes with Training
  24. Women More Prone to Back Pain
  25. Test Predicts Walking Problems with Artery Disease
  26. Stutterers Process Language Differently
  27. More Americans Are Getting Osteoporosis
  28. More Americans Are Getting Osteoporosis
  29. Report Says 195,000 Deaths Due to Hospital Error
  30. N.D. Schools Promote Healthy Lifestyles
  31. Test Predicts Walking Problems with Artery Disease
  32. An Egg a Day May Be Too Much for Some Women
  33. Statins: The Next Miracle Drugs?
  34. Study May Have Clue to Preventing Premature Births
  35. Helping Breast Cancer Patients Make Tough Choices
  36. Workout Sweat Not Just a Matter of Temperature
  37. Bladder Cancer Patients Need Not Lose Their Bladder
  38. Demographics Influence Cervical Cancer Rates
  39. Drug Cuts Death Risk for Heart Patients
  40. Irritable Bowel Can Follow Dysentery
  41. An Unlikely Ally Against Cancer
  42. Pain Assessment in Nursing Homes Varies Widely
  43. Ankle Readings Foretell Walking Problems
  44. Sleeping Disorder Linked to Risk of Stroke Death
  45. The Body, Not the Mind, Predicts Cancer Survival
  46. Study: Cancer Risk Low From WTC Chemicals
  47. Radical Shift Seen in Osteoporosis Therapy
  48. Study: Caffeine Interferes with Diabetes Control
  49. AP: Americans Fear AIDS Threat to Kids
  50. Long-Term Acetaminophen Use May Harm Kidneys –Study
  51. Staying With Same Doctor Leads to Better Care
  52. Vitamin E No Benefit to Heart, Researchers Say
  53. Health Tip: Natural Help for Arthritis Pain
  54. Drinking Tea Keeps Blood Pressure Down – Study
  55. Many Stroke Patients Get Wrong Therapy in Hospitals
  56. Aloe May Save Lives on Battlefield, Study Finds
  57. Migraine Drug Users Don't Need Cardiac Stress Test
  58. Study: Moderate Exercise Helps Diabetics Avoid Death
  59. Menstrual Migraines Hit Hard
  60. Potential Lung Cancer Gene Narrowed Down – Study
  61. U.S. Sets Sights on Electronic Health Records
  62. AP: U.S. Worries About AIDS Threat to Kids

  63. Vision Loss a Growing Threat for Many Americans
  64. Medical Fitness Centers Grow in Popularity
  65. Record Number of Flu Vaccines to Be Made
  66. Schizophrenia Drug Maker Clarifies Risks
  67. New Hope for Women Struggling With PMS

 

 

Friday, July 30, 2004

 

New Pill May Help Recovering Alcoholics Stay Sober

By Susan Heavey
Reuters          

WASHINGTON (Reuters) - A new pill that aims to keep alcoholics from drinking again after they have quit could hit the shelves by the end of this year after U.S. health officials approved the drug on Thursday.

The drug, called Campral, may not work for people who are actively drinking when they start taking the pill or who are abusing other substances, the U.S. Food and Drug Administration (news - web sites) said in a statement.

It was not clear how the pill worked, health officials said, but studies showed more patients who took the drug stayed away from drinking compared to those who took a placebo.

"While its mechanism of action is not fully understood, Campral is thought to act on the brain pathways related to alcohol abuse," the FDA (news - web sites) wrote.

Lipha Pharmaceuticals, a subsidiary of German drug maker Merck KGaA, makes the drug, generically known as acamprosate.

Forest Laboratories Inc. owns the licensing rights to sell the drug in the United States and plans to start selling it later this year, the company's President and Chief Operating Officer Kenneth Goodman said in an interview.

The FDA had previously rejected the drug in 2002, asking Merck and Forest to conduct additional clinical trials.

Another company, Alkermes Inc., is in late-stage clinical trials to test its drug Vivitrex in alcoholic men. Other approved treatments, including the generics naltrexone and disulfiram, have been on the market for a number of years.

Alcoholism is a widespread problem in the United States. Last month, U.S. government researchers reported 17.6 million adults abused alcohol in 2001-2002. The National Institute on Alcohol Abuse and Alcoholism also found men and younger people aged 18 to 44 were more likely to drink heavily.

"Alcoholism, or alcohol dependence, is a disease ... that places a tremendous burden on society in terms of health care costs, lost wages and personal suffering," the FDA said in its statement.

Common side effects from Campral, which has been widely used in Europe for 15 years, include diarrhea, nausea, vomiting and abdominal pain.

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Breast-Feeding Cuts Genetic Breast Cancer Risk

 

By Megan Rauscher

Reuters Health

NEW YORK (Reuters Health) - The well-known risk of breast cancer for women who harbor mutations in the BRCA1 gene is significantly reduced among those who have breast-fed for a cumulative total of more than 12 months, new research shows.

The protective effects of breast-feeding seem to be much greater for BRCA1 mutation carriers than for women in general population.

"This means that if the woman is identified to have a BRCA1 mutation, it is possible to modify her breast cancer risk without having to resort to surgery," Dr. Steven A. Narod from the Center for Research in Women's Health in Toronto told Reuters Health.

Narod's team evaluated of 965 women with breast cancer and an equal number of control women without breast or ovarian cancer. Among the 685 women with BRCA1 mutations, the average total duration of breast-feeding was significantly shorter for those who developed cancer than for those who did not.

Women carrying BRCA1 mutations who breast-fed for more than 1 year were about 60 percent less likely to have breast cancer than women who never breast-fed, the investigators report in the Journal of the National Cancer Institute (news - web sites).

Nonetheless, "the remaining risk is still high," Narod commented.

"We are making a lot of progress in identifying the means of reducing breast and ovarian cancer risk in BRCA1 mutation carriers," Narod continued. "And this means that it will become more acceptable to undergo genetic testing," he added.

Source: Journal of the National Cancer Institute, July 21, 2004.

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Survey: Americans Sad About 3 Days a Month

 

By DANIEL YEE

Associated Press Writer

ATLANTA - Feeling blue? Americans reported spending an average of three days a month feeling "sad, blue or depressed," according to a government survey released Wednesday.

The survey also found that the more days a month people said they were sad, the more likely they were to take risks including not using seat belts or binge drinking, said Dr. Marc A. Safran, a Centers for Disease Control and Prevention (news - web sites) medical epidemiologist and psychiatrist.

The report stressed the "need for more attention to the relationship between how someone feels and the other elements of their health and riskier behavior," Safran said.

The telephone survey of 166,000 adults in 38 states between 1995 and 2000 is the first of its kind to examine how many Americans say they feel bad during the course of a month.

Women reported an extra day of feeling blue than men. Young adults felt the worst, with 18- to 19-year olds saying they were sad an average of 3.6 days a month. Young adults, between the ages of 20 and 24, said they were feeling down 3.4 days a month.

Those who were not physically active, engaged in binge drinking, infrequently used their seat belts or smoked cigarettes had "substantially higher" rates of being "sad, blue or depressed" than those who did not engage in the CDC's so-called risky behaviors.

The CDC says having a "negative mood" makes it difficult for people to adopt and maintain healthy behaviors.

Because the data was self-reported, health officials do not know if the people who said they were sad or depressed actually were clinically depressed. But saying one feels depressed or sad is one symptom of depression, said Rosemarie Kobau, a CDC public health adviser.

Those who are troubled by other depression symptoms — including unexplained sadness, low energy, a lack of interest in life and other things once previously enjoyed — should seek a doctor for help, Kobau said.

"It's very important we properly diagnose mental disorders, which are very treatable," Safran said.

___

On the Net:

CDC Mental Health info: http://www.cdc.gov/mentalhealth

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At Last, a Plus for Weight Gain: Healthier Babies

NEW YORK (Reuters Health) - Women who put on a small amount of weight between pregnancies and add on enough pounds while pregnant are less likely to give birth to dangerously tiny babies, according to a report released Friday.

The investigators found that women who gained weight between pregnancies were 20 percent less likely to give birth to a baby that was small for his or her gestational age-meaning, the baby fell below the tenth percentile for birth weight.

Women who only gained a little weight during pregnancy -- defined as less than half a pound per week -- were also 90 percent more likely to give birth to an extremely small baby, the authors note in the journal Obstetrics & Gynecology. -

These findings suggest that while gaining weight between pregnancies may help your baby, making sure you gain enough while pregnant may be more important, the authors write.

Furthermore, they caution that exactly how much weight women should gain is not clear, and gaining too much can be unhealthy for both mother and child. "Gaining excessive weight can lead to production of a large birth weight infant, especially among obese women, which has its own risks," they write.

This is not the first study of this subject, with previous research showing that underweight moms-to-be have an up to two-fold higher risk of delivering babies that are small for their gestational age.

To investigate whether weight gain between pregnancies also influenced babies' health, Dr. Christine J. Cheng at Washington University School of Medicine in St. Louis, Missouri and her colleagues reviewed the birth certificates of more than 8,000 babies born small for their gestational age, and compared them to the same number of normal weight babies.

They found that, for a woman of average height and weight -- around 5 feet and 5 inches, about 140 pounds -- gaining 4-1/2 pounds between pregnancies reduces their risk of having a baby that is small for its gestational age by 16 percent.

Mothers were also less likely to deliver small babies if they gained enough weight during pregnancy, were free of heart disease, had never given birth to an overly tiny baby, didn't smoke and did not experience high blood pressure related to pregnancy, known as preeclampsia.

Babies that are small for their gestational age are known to have a higher risk dying during their first days of life and a higher risk of a number of later problems, such as poor physical growth, and trouble in school.

Source: Obstetrics & Gynecology, August 2004.

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Topical Painkillers Only Offer Temporary Arthritis Relief

By Ed Edelson
HealthDay Reporter

FRIDAY, July 30 (HealthDayNews) -- Topical painkillers used to treat osteoarthritis offer only passing relief, a new study finds.

In formal medical language, non-steroidal anti-inflammatory creams (NSAIDs) give only temporary help for the pain of the joint condition, said the report in the July 31 issue of the British Medical Journal.

Doctors often prescribe topical NSAIDs to avoid the intestinal bleeding that can occur when the drugs are taken orally, said Weiya Zhang, a senior lecturer in epidemiology at the University of Nottingham, and lead author of the report.

But there was very little research on the longer-term pain relief provided by the topical NSAIDs, Zhang said. So he and his colleagues examined the medical literature and gathered information from 13 studies that looked at the efficacy of treatment with topical versions of NSAIDs. The drugs ranged from over-the-counter medications such as aspirin and ibuprofen, to prescription drugs such a diclofenac (Cataflam, Voltaren) and piroxicam (Feldene, Nu-Pirox). The trials included nearly 2,000 patients and lasted up to four weeks.

"After two weeks, there was no evidence of efficacy," Zhang said. "We really need some sort of long-term treatment for this disease."

Osteoarthritis generally occurs later in life, as the cartilage that cushions joints is degraded over the years. It's the most common form of arthritis and a major cause of disability in older people. The damaged joints generally are in the fingers, knees, hips and spine, and the pain can be intense.

A newer class of drugs, Cox-2 inhibitors, can be an alternative to NSAIDs, Zhang said. But these drugs, the first of which were Celebrex and Vioxx, are expensive and can cause intestinal problems, he said.

The new study results "coincide with the experience of those who use topical NSAIDs," said Dr. Frank B. Kelly, a member the American Academy of Orthopaedic Surgeons' board of directors, who is in private practice in Macon, Ga. Those drugs are more effective for soft-tissue problems such as tendonitis, he said.

Kelly said his treatment regimen for the pain of osteoarthritis starts with lifestyle changes. "About 90 percent of what we do is nonsurgical," he said.

Weight loss can help someone who is obese, as can an exercise program aimed at strengthening muscles, Kelly said. If drug treatment is needed, he generally starts with an oral anti-inflammatory medication such as buffered aspirin or ibuprofen. Cox-2 inhibitors can be used if those drugs fail to give relief. If all else fails, injections of a steroid such as cortisone might be tried, he said.

More information

For more on osteoarthritis, visit the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

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Pregnancy After Heart Repair May Be Harmful

NEW YORK (Reuters Health) - Women who have had an operation in infancy to correct a congenital heart defect can have a successful pregnancy, but it carries a risk of subsequent heart problems, a Canadian group has found.

A fetal deformity called transposition of the great arteries, in which the aorta is connected to the right ventricle of the heart and the pulmonary artery to the left ventricle -- instead of vice versa -- can be corrected with a surgical procedure called the Mustard operation.

However, dysfunction of the right ventricle "remains a continuing problem" in these cases, Dr. Antoine Guedes from the Montreal Heart Institute in Quebec and colleagues explain in the Journal of the American College of Cardiology. "Concerns exist about the potentially deleterious effects of pregnancy on this ventricle."

The team reviewed the records of 16 women who had undergone the Mustard procedure and had completed 28 pregnancies.

They found that six of the women suffered a reduction in functional level during seven pregnancies, and in two cases it did not return to pre-pregnancy levels after delivery.

The data also showed that five women suffered enlargement of the right ventricle during seven pregnancies, with no return to pre-pregnancy dimensions at their last examination.

Based on their findings, the investigators say it "seems reasonable" not to discourage women who have had a Mustard operation from having children if they have a good exercise capacity, and normal or near normal right ventricle function.

"These women must, however, be made aware of the possibility of right ventricle dysfunction occurring with pregnancy and that this deterioration may occur at their first pregnancy," they emphasize, "and that it might not be reversible after delivery

Source: Journal of the American College of Cardiology, July 21, 2004.

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Simple Test Predicts Diabetes Amputation Success

By E.J. Mundell
HealthDay Reporter

FRIDAY, July 30 (HealthDayNews) -- Each year, more than 10,000 Americans with diabetes face agonizing decisions as the disease leads to foot ulcers that just won't heal, indicating a need for amputation.

In about 75 percent of cases, the partial amputation of a foot may be enough to stop ulcer progression. But for the remaining 25 percent, this type of operation will fail, leaving doctors no choice but to remove the leg from below the knee in yet another costly and painful surgery.

Now, Canadian researchers say a simple blood sugar reading can predict which patients will fare best with partial-foot amputations.

"The findings underscore the importance of controlling blood sugar after the surgical procedure is done," said Dr. Eugene Barrett, past president of the American Diabetes Association. "This points out that if blood sugar is poorly controlled, then the likelihood of success is diminished."

The finding was presented July 29 at the annual meeting of the American Orthopaedic Foot and Ankle Society in Seattle.

Chronic diabetes can restrict blood flow to the lower limbs, especially in older individuals. Poorer blood flow means impaired healing, raising risks for hard-to-treat diabetic ulcers.

Complicating matters, many patients also suffer from diabetic neuropathy -- a deadening of nerves in the feet and legs -- that leaves them without the sensation of pain that might otherwise send them into early treatment.

Neuropathy can leave feet and lower legs so numb patients "could walk around with a nail under their foot for a day and not realize it," Barrett explained. By the time many patients seek treatment, their ulcers are already surrounded by gangrenous tissue and the foot or limb cannot be saved.

In the past, a below-the-knee removal of the affected leg was standard procedure. But over the past decade, a limb-sparing surgery called transmetatarsal amputation (TMA) has become more popular, where just the front part of the foot is removed.

For most, amputation stops there. TMA fails some patients, however, leaving them no choice but below-the-knee amputation.

In their study, researchers Dr. Alastair Younger and Dr. Colin Meakin, of St. Paul's Hospital in Vancouver, looked for markers that could predict those patients in whom TMA would be most successful. They compared factors such as age, smoking status, duration of ulcer, and blood sugar levels in 21 diabetic patients for whom TMA was successful and 21 patients for whom the operation had failed.

The study found that, in patients with blood sugar levels greater than 10 percent of the blood "the TMA is bound to fail," Younger said in a prepared statement. These patients may require full below-the-knee surgery, and should not be put through the prior stress and expense of partial amputation.

On the other hand, in patients with blood sugar levels of 7 percent or lower "the rate of success is high, and a surgeon should perform a TMA," Younger said.

Barrett had one caveat to add, however. In his opinion, too many U.S. doctors still don't realize a surgical alternative to below-the-knee amputation even exists.

"The people who end up doing this procedure [below-the-knee amputation] are usually general surgeons or orthopedic surgeons," many of whom received their training prior to the advent of TMA, he explained. "If when they were trained they were told, 'For diabetic foot ulcer, you do a below-the-knee amputation,' that's what they do." According to Barrett, better education of surgeons may be key to saving more limbs through TMA.

Diabetic foot ulcers can also have a devastating impact on patients' psychological well-being, according to a second study presented at the Seattle meeting by Dr. Michael Pinzur of Loyola University Medical Center in Chicago.

According to Pinzur, patients treated for foot ulcers experience bouts of deep depression just as frequently as patients who have already undergone amputation, probably because these ulcers so often precede amputation.

 

 

"There's something very profound that occurs when you tell someone that they're going to lose a foot or leg," Barrett said. "I've had patients say that they'd just as soon die."

According to Pinzur, that's just one more reason to opt for the less-disabling TMA procedure whenever possible. In a prepared statement, he said experts must "work to come up with methods of treatment that will not impact [patients'] lives as much as it does now."

More information

To learn more about diabetic foot ulcers, visit the American Diabetes Association.

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Carpal Tunnel Screening Not Good for Bottom Line

 

By Amy Norton

Reuters Health

NEW YORK (Reuters Health) - Companies that test potential employees for their risk of developing carpal tunnel syndrome may be wasting their money, a new study suggests.

Researchers say the findings -- based on more than 2,000 employees of an automobile-parts manufacturer -- suggest that most companies that refuse to hire people who "fail" the test will end up hurting their bottom lines.

Carpal tunnel syndrome (CTS) is a disorder of the wrist and hand caused by pressure on the median nerve, which runs through a narrow passageway in the wrist -- the carpal tunnel. Symptoms include pain, numbness and weakness in the hand, fingers and wrist.

Swelling in nearby tendons is often the source of pressure on the median nerve. Because certain jobs that put repetitive stress on the hand and wrist may lead to CTS, some companies screen prospective hires for their risk of the condition. Tests that measure how well nerve impulses travel through the carpal tunnel can spot people who are vulnerable to CTS.

It's unclear how many U.S. companies use nerve testing to screen potential hires, but evidence suggests "it's not rare," Dr. Alfred Franzblau, the new study's lead author, told Reuters Health.

Yet they're apparently doing it without evidence that it actually saves them money, according to Franzblau, a professor at the University of Michigan School of Public Health in Ann Arbor.

In their study, reported in the Journal of Occupational and Environmental Medicine, he and his colleagues followed 2,150 employees at one company that tested for carpal tunnel risk as part of its "post-offer" medical exams. At the time the employees were hired -- between 1996 and 2001 -- the company was using nerve testing, but hiring workers regardless of the test results.

Franzblau's team found that through May 2003, these employees made 35 workers' compensation claims for carpal tunnel syndrome. And while the rate was higher among the 15 percent of workers who'd had abnormal nerve-test results, most CTS claims -- 63 percent -- came from employees who had tested normal.

Had the company refused to hire candidates with abnormal test results, the screening process would have cost it far more than it would have saved in workers' comp and other costs, according to the study.

The researchers estimate that the company would have lost $357,353, once other factors, such as the cost of screening another several hundred applicants, were considered.

The findings further suggest that most companies would lose out financially, Franzblau said, because the study group had a "very high" rate of CTS claims -- much higher than the typical company would see.

He and his colleagues note that the study looked only at the cost-effectiveness of not hiring people who fail nerve testing. It's possible, but unproven, that the results would be different for companies that use the tests to place at-risk people in jobs that put less stress on the hand and wrist.

Source: Journal of Occupational and Environmental Medicine, July 2004.

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Chickenpox Vaccination May Not Prevent Infection

NEW YORK (Reuters Health) - During an outbreak of chickenpox in Minnesota in the fall of 2002, more than half the children who became infected had been immunized with the varicella vaccine, according to a new report.

Evidently, booster shots may be required to provide stronger protection against chickenpox.

Dr. Brian R. Lee, at the Minnesota Department of Health in Minneapolis, and his colleagues investigated the outbreak that involved 55 children among 319 attending an elementary school in northern Minnesota.

According to the team's report in the Journal of infectious Diseases, 29 of the affected children had been vaccinated, and 6 had apparently had chickenpox previously -- which usually prevents another infection.

The primary case in the outbreak was a vaccinated 6-year-old boy.

The investigators found that 25 percent of vaccinated children came down with chickenpox, as did 56 percent of unvaccinated students; among those with a history of varicella, the infection rate was 6 percent.

Lee's group estimates that the effectiveness of the vaccine in warding off infection was 56 percent. However, immunized children did have fewer lesions, less fever, and fewer sick days than their non-immunized kids.

The risk of catching chickenpox was more than two-fold higher for those vaccinated 4 or more years before the outbreak, compared with those vaccinated more recently -- so protection wanes over time.

These findings underscore the importance of keeping any child with chickenpox out of school, regardless of their vaccination status, Lee's team states.

They also highlight the importance of continuing "to maintain and improve the national level of vaccination against varicella zoster and to consider whether a booster dose will offer additional protection," the researchers conclude.

Source: Journal of infectious Diseases, August 1, 2004.

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Heart Enlargement Appears Early in Type 1 Diabetes

NEW YORK (Reuters Health) - Children and adolescents with insulin-dependent (type 1) diabetes, particularly girls, show early signs of changes in the heart, a research team in Belgium has found.

Dr. Bert E. Suys at University Hospital of Antwerp and colleagues used ultrasound to examine the hearts of 80 young people with diabetes and 52 age-matched control subjects. .

As reported in the medical journal Diabetes Care, the wall of the left ventricle, the main pumping chamber of the heart, was thicker in girls with diabetes than in the non-diabetic group. The hearts of diabetic girls also showed delayed relaxation between heartbeats.

For boys, the only difference between those with and without diabetes was in the relaxation time.

Suys and his associates theorize that, in children, "perhaps already a small increase in blood glucose is sufficient to initiate changes in the cardiovascular system," thus underscoring the importance of long-term blood sugar control.

Patients with diabetes may benefit from drugs like ACE inhibitors and beta-blockers that are used to treat heart failure, the researchers add, but only further research will clarify this issue.

Source: Diabetes Care, August 2004.

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US FDA Warns of Fake Drugs Bought in Mexico

WASHINGTON (Reuters) - Some versions of a cholesterol drug and a muscle relaxant bought by Americans in Mexico were fake, U.S. regulators warned on Friday.

Tests found pills purported to be Merck & Co. Inc.'s cholesterol fighter Zocor did not contain any of the active ingredient, the Food and Drug Administration (news - web sites) said.

Other batches of a generic muscle relaxant called carisoprodol were not as potent as the real product, the FDA (news - web sites) said.

The counterfeit medicines were purchased at pharmacies near the Mexican border, the FDA said. The fake Zocor was sold in 40-milligram doses with the lot number K9784 and a November 2004 expiration date.

The carisoprodol tablets were sold in 350-milligram doses with the lot number 68348A.

Anyone who purchased medicines meeting those descriptions should contact a physician as well as local FDA authorities, the agency said.

The FDA repeatedly has warned that buying medicines from other countries may be risky.

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Seizure Drug Helps Reduce Cancer Pain

NEW YORK (Reuters Health) - A drug used to prevent seizures can improve pain relief for some people taking opioids for cancer pain, European researchers report.

There have been anecdotal reports that the new-generation anti-convulsant Neurontin (gabapentin) is effective when used in combination with opioid painkillers, Dr. Augusto Caraceni of the National Cancer Institute (news - web sites) of Milan, Italy and colleagues note in the Journal of Clinical Oncology.

To investigate further, the researchers studied 121 patients with nerve-type cancer pain, which was partially relieved with opioid drugs. While remaining on their opioid medication, the participants were randomly assigned to additional treatment with Neurontin or an inactive placebo. Extra opioid doses were supplied as needed.

Overall, 89 patients completed the ten-day study. Average pain scores on a 10-point scale were significantly different between patients taking Neurontin (4.6) and those given the placebo (5.4).

Moreover, use of supplementary opioid doses was higher and more frequent among placebo patients.

The researchers conclude that the findings "demonstrate a limited role of gabapentin as adjuvant to opioids for neuropathic cancer pain." Nevertheless, they add, "Significant benefit could be seen in some patients."

Source: Journal of Clinical Oncology, June 15, 2004.

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Thursday, July 29, 2004

 

Smoking During Pregnancy Linked to Cleft Lip in Newborns

 

HealthDayNews

Thursday, July 29, 2004

THURSDAY, July 29 (HealthDayNews) -- Women who smoke during pregnancy increase the risk that their babies will be born with cleft lip, new British research contends.

The study, conducted from 1997 to 2000, found a small increased risk of cleft lip -- with or without a cleft palate -- among babies born to mothers who smoked during the first trimester of pregnancy. The findings add to those of previous studies in North America and northern Europe.

In this new study, researchers interviewed women in Scotland and England about six months after childbirth. The mothers provided information about their smoking history before and during pregnancy and the kind (filtered/nonfiltered) of cigarettes they smoked.

The researchers also collected information about secondhand-smoke exposure, but they weren't able to reach any definite conclusions about secondhand smoke and cleft lip in newborns.

The study appears in the July issue of the Cleft Palate-Craniofacial Journal.

More information

The Nemours Foundation has more about cleft lip and palate.

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Bone Loss Seen in Adults with Cystic Fibrosis

 

Reuters Health

Thursday, July 29, 2004

NEW YORK (Reuters Health) - There appears to be a relationship between bone loss and generalized inflammation in adults with cystic fibrosis, according to a new study.

Inflammatory compounds stimulate the activity of osteoclasts -- cells involved in the normal removal of excess bone tissue -- "and this could lead to increased bone resorption in patients with cystic fibrosis," Dr. Charles S. Haworth, of Papworth Hospital in Cambridge, UK, and colleagues write in the medical journal Thorax.

They therefore examined whether markers of systemic inflammation are related to changes in bone mineral content in adults with cystic fibrosis.

The researchers measured total-body bone mineral content in 100 patients at the start of the study and one year later. At the same time points, blood samples were taken to measure markers of systemic inflammation.

Bone mineral content declined by an average of 16 grams after one year. The team found that higher average levels of inflammatory compounds called interleukin 6 and C-reactive protein were found in patients with the greatest loss of bone.

Urinary markers of osteoclast activity also correlated with interleukin 6 levels.

Inflammation in turn was related to infection with Burkholderia cepacia -- common in people with cystic fibrosis -- and with greater need for antibiotic therapy.

"These data provide a pathophysiological mechanism by which chronic pulmonary infection results in bone loss in this patient population," Haworth and colleagues conclude.

Source: Thorax, July 2004.

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Too Little Fish Oil Hurts Your Heart

HealthDayNews

Thursday, July 29, 2004

THURSDAY, July 29 (HealthDayNews) -- Doctors have identified a new risk factor for heart disease, according to an article in the July issue of Preventive Medicine.

The Omega-3 Index measures the levels of the most heart-healthy omega-3 oils, gained mostly by eating fish or taking fish oil supplements.

Research has shown that an Omega-3 Index of 8 percent to 10 percent reduces a person's relative risk of death from coronary heart disease by 40 percent, and from sudden cardiac death by 90 percent.

However, lower levels of omega-3 oils in a person's body can increase the risk of heart disease, said researchers at St. Luke's Mid-America Heart Institute in Kansas City.

"We are designed to thrive on a diet high in omega-3 fatty acids, but most Americans eat far too little fish to reap any benefits from the omega-3 oils," lead researcher Dr. William Harris said in a prepared statement. "Even those who regularly eat fish or take fish oil supplements may not be getting enough for their unique, individual needs."

More information

The American Heart Association (news - web sites) has more about fish oils.

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Child Vaccinations Hit Record, But Many Uncovered

By Maggie Fox, Health and Science Correspondent

Reuters

Thursday, July 29, 2004

WASHINGTON (Reuters) - U.S. immunization rates have hit a record high but one-fifth of American children are not receiving all the vaccinations they need, the Centers for Disease Control and Prevention (news - web sites) said on Thursday.

Because of shortages of one vaccine that protects against a range of diseases from ear infections to meningitis, only just over a third of children have received the full four doses that provide optimal protection, the CDC said.

"Among U.S. children aged 19 to 35 months, estimated coverage with recommended vaccines was greater in 2003 than in 2002 and represented all-time highs," the CDC said in its report.

Holes remain in coverage in some areas, especially some big cities, the CDC said. "A substantial number of children in the United States still aren't adequately protected from vaccine-preventable diseases," CDC Director Dr. Julie Gerberding told a news conference.

"The suffering or death of even one individual from a vaccine-preventable disease is an unnecessary human tragedy."

More than 20 percent of America's 3-year-olds lack the full series of vaccines, the CDC said.

It found that 79.4 percent of children had received the full series of vaccines in 2003, compared to 74.8 percent in 2002 and 73.7 percent in 2001.

Four million children are born in the United States each year, and start their vaccines right away with a dose to protect them against hepatitis B.

Over the next three years they are supposed to be given four doses of the combined diphtheria, tetanus and pertussis or whooping cough vaccine, three doses of polio vaccine, one dose of measles, mumps and rubella or German measles vaccine, three doses of Haemophilus vaccine that protects against meningitis and ear infections, and two more doses of hepatitis B vaccine.

They are also supposed to get up to four doses of Prevnar pneumococcal vaccine, which protects against several strains of bacteria that cause ear infections, meningitis, pneumonia and other serious diseases.

The recommendation was cut back to two essential doses when the vaccine was in short supply but the CDC moved its guidelines back up to three earlier this month.

The CDC found that nearly 85 percent of children have received the chicken pox, or varicella vaccine, up from 80.6 percent in 2002. The vaccine protects against deadly complications from the virus and also against shingles, a painful disease, in adulthood.

"In 2003, as in previous years, urban areas reported lower immunization rates than states, mostly due to large concentrations of lower socio-economically displaced persons," the CDC said. In Boston, nearly 89 percent of children were fully vaccinated while in Houston just 69 percent were.

The CDC has recently added influenza to the list of vaccines advised for babies aged 6 months to two years.

Denver nurse Jodi Wild said flu nearly killed her healthy 2-year-old daughter Katie in a matter of days. Within hours of developing cold-like symptoms her lips became gray and her skin clammy, Wild told the news conference.

She rushed the child to urgent care. "She suddenly became limp in my arms," Wild said.

It took another day for Katie to be diagnosed with influenza. "The virus had attacked her heart," Wild said. The child ended up with hospital bills of more than $100,000 and 18 months of cardiac care. "Influenza needs to be taken seriously," Wild said.

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Smoking Raises Risk of Kidney Disease

HealthDayNews

Thursday, July 29, 2004

THURSDAY, July 29 (HealthDayNews) -- Long-term and heavy smokers have about a 50 percent increased risk of progressive kidney disease, a new Swedish study says.

Researchers assessed tobacco use and other risk factors among 926 people with chronic renal failure (CRF) and 998 people with normal kidney function. Chronic renal failure is a gradual, irreversible loss of kidney function that leads to end-state renal failure. Treatment can slow the rate of kidney deterioration in people with CRF, but can't restore normal kidney function.

The study found that people who smoked more than a pack of cigarettes a day had a 51 percent greater risk of CRF than people who never smoked. People who smoked for more than 40 years had a 45 percent increased risk of CRF.

Based on their findings, the researchers estimated that smoking is responsible for about 9 percent of CRF cases among Swedes. The study confirms that smoking is a significant but preventable risk factor for kidney disease.

The study appears in the August issue of the Journal of the American Society of Nephrology.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has information about how you can prevent kidney disease.

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Wednesday, July 28, 2004

 

New Drugs Get at Root of Alzheimer's in Mice

 

Reuters Health

Wednesday, July 28, 2004

NEW YORK (Reuters Health) - Drugs called protein kinase C (PKC) activators seem to attack the cause of Alzheimer's disease (news - web sites) as well as the symptoms, according to findings from an animal study.

"The medications currently used to treat Alzheimer's disease only treat the symptoms," senior author Dr. Daniel L. Alkon, from Blanchette Rockefeller Neurosciences Institute in Rockville, Maryland, said in a statement. The PKC activators, by contrast, treat the cause and the symptoms, he added.

This occurs because PKC, an enzyme, appears to play a role in both Alzheimer's memory loss and in the protein buildup that causes the disease, according to the report in the Proceedings of the National Academy of Sciences (news - web sites).

In the study, Alkon's team evaluated the effects of two PKC activators -- benzolactam and bryostatin -- in cell cultures and in mouse models of Alzheimer's disease.

In cell cultures, the drugs produced chemical changes that could have beneficial effects in patients with Alzheimer's disease. In mice, the drugs reduced protein build-up in the brain, helped prevent premature death, and improved behavioral outcomes, the report indicates.

Bryostatin is currently being investigated as an anticancer agent in humans, the authors note. "Given its...relatively low toxicity, and current use in humans," the agent may be a candidate for development as an Alzheimer's treatment, they add.

Source: Proceedings of the National Academy of Sciences, July 27, 2004.

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Lyme Test Overused; Insistent Patients Cited

By Steven Reinberg
HealthDay Reporter

HealthDayNews

Wednesday, July 28, 2004

WEDNESDAY, July 28 (HealthDayNews) -- Doctors order too many inappropriate tests for Lyme disease, often giving in to patients' demands, researchers report.

According to the new study, some 2.8 million tests for Lyme disease are given each year in the United States. All this testing costs the health-care system more than $100 million annually.

"We found that a good number of Lyme disease blood tests are ordered inappropriately, primarily for patients who come in without symptoms," said study author Dr. Alan H. Ramsey, an assistant clinical professor of family medicine from the University of Wisconsin.

But an advocate for people with Lyme disease disagreed, saying the test itself needs to be improved and people should take the test to, at the very least, put themselves at ease.

Lyme disease is an infection that results from being bitten by deer ticks that carry the Borrelia burgdorferi bacterium. Among its telltale signs are a bulls-eye rash at the bite site and stiffness in major joint such as knees and shoulders. The disease is treated with antibiotics.

In their study, the researchers looked at 356 blood tests for Lyme disease in Wisconsin. Of these, only 20 percent were classified as appropriate. At least 27 percent were inappropriate, and the rest were discretionary.

In more than 50 percent of the inappropriate tests, the patients didn't have symptoms of Lyme disease, according to the article in the July/August issue of the Annals of Family Medicine.

Moreover, 27 percent of the tests were done because the patients asked for them. Of these, almost 40 percent were inappropriate.

"There are many patients with nonspecific complaints asking for a test, worried that they have Lyme disease," Ramsey said. "It correlates these days with West Nile virus (news - web sites), with people coming in with nonspecific symptoms, worried that they have West Nile. If we can target those 27 percent of tests that are inappropriate and eliminate those, we are not going to miss any cases of Lyme disease."

To lower the number of inappropriate tests and reduce costs, patients and doctors need more education about Lyme disease, Ramsey said.

Testing should not be done to confirm that Lyme disease has been cured, Ramsey said. "That has no utility whatsoever," he added.

"Testing should be done based on symptoms," Ramsey added. Patients who have pain in some joints, inflammation of one of the facial nerves, meningitis, or who show signs of some heart problems such as an atrial ventricular block, should be tested for Lyme disease, he said.

Ramsey believes that people who have the typical bulls-eye rash associated with Lyme disease -- it is seen in almost 80 percent of cases -- do not need to be tested, but should be treated with antibiotics automatically. "If you are going to go ahead and treat the patient anyway, there is no utility in doing the test," he said.

"A tick bite doesn't mean that someone needs to have a Lyme disease test," Ramsey said. "Ordering or asking for a Lyme disease test without knowing what the signs and symptoms are is not a good approach."

"I am not at all surprised that only 20 percent of the serologic tests for Lyme disease that were ordered were considered appropriate," said Dr. Eugene D. Shapiro, a professor of pediatrics, epidemiology and investigative medicine from the Yale University School of Medicine.

Shapiro, who is a scientific advisor to the American Lyme Disease Foundation, believes that most of the tests that were classified as discretionary also were actually inappropriate. "There have been many other studies that have had similar findings," he added.

"Physicians frequently order such tests inappropriately as screening tests for patients with nonspecific, common complaints, such as fatigue or arthralgia [joint pain]," Shapiro said. "Positive tests in this setting are almost always falsely positive. There are bulletins from the FDA (news - web sites) [U.S. Food and Drug Administration (news - web sites)] that emphasize that tests for Lyme disease are not meant to be used as screening tests."

However, Karen Forschner, chairwoman of the board of directors of the Lyme Disease Foundation, worries that Lyme disease tests are not accurate and may miss many cases of the disease. She is also concerned that many people with Lyme disease go undiagnosed, and that limiting testing will add to that problem.

"Government and researchers would do better to develop a very good, sensitive test," she said. "The concern is not whether patients should be tested. The real concern is: What does the test mean, and why isn't the research community spending its time and effort developing an improved test?"

Forschner also said that patients should request tests if they are concerned. "They should have that discussion with their physician. It only makes sense," she said.

More information

The National Library of Medicine has plenty of information about Lyme disease.

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Study Finds MRIs Better on Breast Cancer

By Marilynn Marchione

AP Medical Writer

The Associated Press

Wednesday, July 28, 2004

In women at high risk of breast cancer, new research suggests MRI scans find nearly twice as many tumors as mammograms do, but they cost a lot and trigger more unneeded biopsies.

Ordinary mammograms are still recommended for screening most women, starting at age 50. But the benefit of better detection from MRI, or magnetic resonance imaging, may outweigh its drawbacks for those with a strong family history of breast cancer or faulty genes.

MRI also may make monitoring a less dangerous option for women who choose it instead of having their healthy breasts and ovaries removed as a preventive measure.

"Women who are at high risk should consider getting MRI besides mammography," said Dr. Stephen Feig, a radiology professor at Mount Sinai School of Medicine in New York and past president of the Society of Breast Imaging.

He had no role in the study, which was done by doctors at six cancer centers throughout the Netherlands and was partly funded by the Dutch Health Insurance Council. Results were reported in Thursday's New England Journal of Medicine (news - web sites).

The value of mammograms for women at average risk of breast cancer has been hotly debated, though most doctors agree that the test saves lives in women over 50. The new study involved women with a higher than average risk, such as those with a faulty gene or a mother or sister who had breast cancer. For them, screening is less controversial.

Researchers studied 1,909 Dutch women including 358 with one of the BRCA genes or other mutations that predispose women to breast cancer. Up to half of such women get it by the time they're 50, and they are also prone to ovarian cancer.

They can cut their risk of cancer and death by having their breasts or ovaries removed, or by taking estrogen-blocking drugs. But many don't want such drastic measures, and researchers wanted to see if intensive screening could help such women by finding tumors early, when they're most treatable.

They compared mammograms, which are breast X-rays, to MRI scans, which use magnets to make detailed images without radiation. An MRI scan costs $700 to $1,000 — about 10 times the cost of a mammogram. Many large insurers already cover MRIs for women at high risk.

Women were screened three ways: a breast exam by a doctor every six months, annual mammograms and annual MRI scans. Results were analyzed by different doctors, so none knew what the others had found.

After an average of nearly three years, 51 breast cancers had been identified. Some results were excluded for various reasons. Of the remaining 45 tumors, 32 were identified by MRI, including 22 that hadn't been visible on mammograms. Only 18 of the 45 tumors were caught by mammograms, a lower rate than studies typically show, some experts noted. In the United States, mammography is thought to miss 15 percent to 25 percent of cases.

Still, experts acknowledged that MRI was superior at detection. But the scans also gave more false alarms.

"MRI led to twice as many unneeded additional examinations as did mammography (420 vs. 207) and three times as many unneeded biopsies (24 vs. 7)," the authors reported.

Both kinds of screening did find cancers early. Researchers compared women in the study to two other groups: breast cancer patients participating in a different study on faulty genes, and all women diagnosed with breast cancer in the Netherlands in 1998.

Tumors in the women in the screening study were smaller and less likely to have spread to lymph nodes. Many women in the study also had cancer detected at a young age.

"Our study firmly establishes the value of screening for women with inherited predisposition for breast cancer, provided that MRI is added to mammography," said the lead researcher, Dr. Jan G.M. Klijn of Erasmus Medical Center-Daniel den Hoed Cancer Center in Rotterdam.

But doctors are hesitant to recommend it in place of preventive surgery without proof it saves lives.

"The prognosis is better for small, early cancers, but detecting small cancers at an early stage does not guarantee improved survival rates," Dr. Laura Liberman of Memorial Sloan-Kettering Cancer Center in New York cautioned in an accompanying editorial.

Klijn was optimistic that proof would come.

"Although the follow-up is still very short, we expect a mortality reduction of at least 20 percent to 25 percent after 15 years of follow-up," he said.

The American Cancer Society (news - web sites) recommends that women at high risk consider having an MRI plus mammography but not in place of it, because mammography found some cancers that MRI missed, said Dr. Robert Smith, the society's director of screening. Women must be counseled carefully about whether to try intensive screening instead of having their breasts or ovaries removed.

"It would be ideal to try to avoid the surgery if you could," he said.

If women do get an MRI, they should time it for midway through their menstrual cycles when results are best, and they should go to centers capable of performing MRI-guided biopsies if a scan shows something that needs follow-up, Liberman suggested.

Breast cancer is the most common cancer in American women after skin cancer. About 216,000 new cases will be diagnosed this year, and it will cause about 40,000 deaths.

On the Net: http://www.nejm.com

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Related Drugs Vary in Benefit After Heart Attack

Reuters Health

Wednesday, July 28, 2004

NEW YORK (Reuters Health) - Drugs called ACE inhibitors have been shown to improve survival after a heart attack, but new research suggests that some ACE inhibitors, namely Altace (ramipril) and Aceon (perindopril), work better than others.

ACE inhibitors vary in potency and in how they are metabolized by the body, factors that could influence their effectiveness, Dr. Louise Pilote, from Montreal General Hospital, and associates point out in the Annals of Internal Medicine.

To compare the benefits of various ACE inhibitors, the researchers analyzed data from 7512 patients who took a single ACE inhibitor for at least 1 year after a heart attack.

Patients treated with Altace or Aceon had nearly the same risk of death, which was 28 to 71 percent lower than the risk seen in patients treated with other ACE inhibitors. Moreover, the advantage for Altace and Aceon persisted for up to 5 years after the heart attack.

"Our results suggest that not all drugs within the class of ACE inhibitors should be considered to have the same effect," the researchers conclude. Forward-looking studies with direct comparisons between different ACE inhibitors may be warranted, they add.

However, these findings may be subject to bias, Drs. Sean Hennessy and Stephen E. Kimmel, from the University of Pennsylvania in Philadelphia, maintain in a related editorial. For example, patients prescribed Aceon and Altace were more likely to be using other potentially beneficial drugs, suggesting that they may simply have received better medical care than their peers.

Source: Annals of Internal Medicine, July 20, 2004.

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Study: Heart Tumors May Be More Common

By Marilynn Marchione

AP Medical Writer

The Associated Press

Wednesday, July 28, 2004

Scientists studying a rare genetic disorder have made a surprising discovery that helps explain why certain heart tumors develop and suggests they may be more common than had been believed.

Doctors should look more broadly for signs of such tumors, which aren't cancerous but are dangerous because they can break off and cause strokes, researchers say.

"This may be more widespread than we had ever thought," said Dr. Jil Tardiff, a cardiologist at Albert Einstein College of Medicine in New York who reviewed the research that was reported in Thursday's New England Journal of Medicine (news - web sites).

The work was led by Dr. Craig Basson, a cardiologist at Weill Medical College of Cornell University, and involved four other hospitals in the United States and two in Belgium.

They studied a large Belgian family with 18 members who had a muscle disorder that caused spotty skin pigmentation, tight or clenched hands and feet, and an inability to open their jaws fully. Three also had heart tumors called myxomas, which affect one of every 100,000 people each year.

"Anybody who's a cardiologist has seen one," Basson said of such tumors.

No one had connected them to muscle disorders, but Basson suspected a link. He surprisingly found it in myosin, a group of proteins with an array of important jobs, including making muscles contract.

Defects in myosin genes are known to cause disorders such as Usher syndrome, the leading cause of blindness and deafness in young children. A decade ago, they were linked to sudden cardiac death in young people.

The gene defect Basson identified is very similar to some of the mutations that cause sudden cardiac death — an "unexpected and exciting" discovery, Tardiff wrote.

"It makes us think more broadly" about who may have heart tumors, and to suspect the condition in people with other muscle disorders or unusual orthopedic symptoms like the clenched hands, Tardiff said. "Many people think it's underdiagnosed."

Now that the cause of such tumors is known, scientists can try to design treatments like drugs and gene therapy as alternatives to surgery, the only treatment for them now, Basson said.

The discovery also could have implications for the field of stem cell biology. The myosin defect Basson identified is in a gene that was thought to stop functioning shortly after birth. His work shows it may keep going to some degree in some people, which he views as evidence that there's a type of stem cell in the adult heart, a widely debated theory.

The National Institutes of Health (news - web sites) funded the study.

On the Net: http://www.nejm.com

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Exercise-Related Pain Diminishes with Training

Reuters Health

Wednesday, July 28, 2004

NEW YORK (Reuters Health) - "No pain, no gain," may be the advice of coaches and trainers around the world, but it may not be true when it comes to cycling, research from Australia suggests.

In a series of bicycle time trials, cyclists experienced less pain during the last trial than during the first. What's more, the bikers covered more ground even though they did not pedal any harder.

Intense exercise and pain often go hand in hand, but there is little scientific research on the relationship between exercise and pain and discomfort. Dr. Peter S. Micalos and colleagues at Charles Sturt University in Bathurst set out to measure the intensity of muscle pain during cycling.

Eight men and three women with a range of cycling experience volunteered for the study. Over the course of a couple of weeks, each participant rode his or her bike on a stationary trainer three times.

During each session, participants were told to cycle the greatest distance as possible within an hour, although they did not have to maintain a particular speed. Every 10 minutes, riders were instructed to "sprint" for a minute to simulate intense training.

As would be expected, over the course of cycling for an hour, muscle pain became more intense.

But pain intensity was not the same in each session, the researchers report in the June issue of the Journal of Sports Science and Medicine.

Muscle pain during the last 10 minutes of the third cycling trial was significantly less intense than during the last few minutes of the first trial.

The results are in contrast with a previous study that found that muscle pain was consistent throughout several exercise sessions. But the authors note that the exercise sessions in the current study were three times as long as in the previous study, which could have accounted for the difference.

One thing that is certain is that the drop in pain intensity did not mean that cyclists were slacking off. In fact, cyclists' pedaling power remained steady throughout the three sessions.

But cyclists actually increased the distance covered while on the bike. One possible explanation, according to the report, is that cyclists changed their use of bicycle gears to cover more ground.

Source: Journal of Sports Science and Medicine, June 2004.

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Women More Prone to Back Pain

HealthDayNews

Wednesday, July 28, 2004

WEDNESDAY, July 28 (HealthDayNews) -- Women are at least twice as likely as men to develop some musculoskeletal disorders of the upper body, such as lower back pain and carpal tunnel syndrome.

"Any way you slice the data, women have a significantly higher prevalence -- anywhere from two to 10, even 11 times higher than men -- for many of these disorders," Delia Treaster, a former doctoral student at Ohio State University who worked on the study, said in a statement.

"The question now is, why? Is it biomechanical, physiological, psychological, or what?" Treaster continued. "Most likely, it is due to a combination of factors."

Until now, some researches suspected that women only appear to have a higher incidence of these disorders because they are more likely than men to seek treatment. Others thought the gender difference was due to a greater exposure to certain risk factors for women.

Treaster and Deborah Burr, an assistant professor of epidemiology and biometrics, performed a statistical analysis of previous studies to remove factors that could have skewed the results either way.

Their findings appear in the current issue of the journal Ergonomics.

More information

The National Institute of Neurological Disorders and Stroke has more about carpal tunnel syndrome.

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Test Predicts Walking Problems with Artery Disease

Reuters Health

Wednesday, July 28, 2004

NEW YORK (Reuters Health) - A simple test called the ankle brachial index (ABI) can help predict future walking problems in patients with peripheral arterial disease, a condition that involves hardening of the blood vessels in the legs and elsewhere, new research shows.

The ABI, which can be determined in just a few minutes with standard equipment, is the ratio of the blood pressure in the ankle to the pressure in the arm. Any value below 1 is considered abnormal and values below 0.25 indicate severe blood flow problems that could result in amputation of the leg if left untreated.

Previous reports have shown that the ABI and leg symptoms correlate with a person's current walking status. However, it was unclear whether these parameters could be used to gauge future functional impairment.

To investigate, Dr. Mary McGrae McDermott, from Northwestern University Feinberg School of Medicine in Chicago, and colleagues evaluated the outcomes of 676 subjects who had walking tests performed when the study began and 1 to 2 years later. Of the participants, 417 had peripheral arterial disease and 259 did not.

The ABI, coupled with leg symptoms, predicted how far and how fast patients with artery disease would be able to walk in the coming years. Compared with subjects without artery disease, patients with persistent leg pain experienced greater annual declines in walking distance and speed.

Even in the absence of symptoms, peripheral artery disease was associated with an increased risk for becoming unable to walk continuously for 6 minutes.

"Our findings underscore the importance of using the ABI to identify persons with peripheral arterial disease, since (it) is frequently undiagnosed " or symptomless, the authors note.

Source: Journal of the American Medical Association (news - web sites), July 28, 2004.

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Stutterers Process Language Differently

HealthDayNews

Wednesday, July 28, 2004

WEDNESDAY, July 28 (HealthDayNews) -- Even when people who stutter aren't speaking, their brains process language differently than other people, say Purdue University researchers.

In a series of studies, the scientists measured brain activity of adults who stutter and those who don't as they responded silently, by pressing a button, to questions about sentence meaning, grammar, and rhyming.

"Traditionally, stuttering is thought of as a problem with how someone speaks, and little attention has been given to the complex interactions between neurological systems that underlie speaking," researcher Christine Weber-Fox, an assistant professor of speech sciences, said in a prepared statement.

"We have found differences in adults who stutter, compared to those who don't, in how the brain processes information when people are thinking about language but not speaking. For example, there was a significant delay in response time when subjects were given a complex language task. We also found that in people who stutter, certain areas of the brain are more active when processing some language tasks," Weber-Fox said.

"Adults who stutter often have great language skills, meaning they don't have problems with rules of grammar or with the sounds we use to code the words of our language. When they speak, however, their motor output falters, so they pause or trip over words. We wanted to evaluate the brain activity when they were not stuttering and, in fact, when they were not having to engage their speech motor systems," she said.

The findings were presented July 23 at a meeting of the American Speech-Language Hearing Association in Portland, Ore. The results will also appear in the August issue of the Journal of Speech, Language and Hearing Research.

More information

The Nemours Foundation has information about stuttering in children.

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Tuesday, July 27, 2004

 

More Americans Are Getting Osteoporosis

 

By LINDSEY TANNER

AP Medical Writer

 

CHICAGO - The number of Americans diagnosed with osteoporosis surged sevenfold over the past decade, coinciding with the development and marketing of new drugs to treat the bone-thinning condition, a study found.

As of 2003, there were an estimated 3.6 million people who had been diagnosed with osteoporosis, compared with half a million in 1994, according to the study by Stanford University researchers. Also, the number of doctor visits for the condition jumped to 6.3 million last year from 1.3 million in 1994.

The increases coincided with the introduction of the bone-protecting drugs alendronate, sold as Fosamax, in 1995; raloxifene, or Evista, in 1997; and risedronate, or Actonel, in 1998.

All three are among the non-hormonal alternatives to estrogen supplements, which have long been used to prevent osteoporosis but have lost popularity because of recent studies linking them to heart problems, breast cancer and other risks.

In 1988, estrogen was prescribed at 35 percent of osteoporosis-related doctor visits, but that fell to 3 percent last year, the study found.

The estrogen alternatives have grown into a multibillion-dollar-a year industry with widespread ads and slick promotional campaigns that have helped raise awareness about osteoporosis. The researchers said that probably helped increase diagnosis rates.

Partly because of the newer drugs, "the whole way that we think about osteoporosis has shifted ... to one of prevention," said Dr. Randall Stafford, who led the study. "We hope to catch it early enough to treat it early enough to prevent fractures."

Nevertheless, osteoporosis remains underdiagnosed and undertreated, said Dr. Ethel Siris, head of the National Osteoporosis Foundation's science and research committee.

Osteoporosis affects an estimated 10 million Americans, mostly women, who face a high risk of debilitating bone fractures, according to the foundation. An additional 34 million have less severe bone thinning that also increases the risk.

The study's authors said new guidelines recommending universal screening for women 65 and older may further improve diagnosis and treatment.

The study appears in Monday's Archives of Internal Medicine (news - web sites).

Stafford and colleagues analyzed data from a physician survey conducted by IMS Health, a health care information company. About 3,500 randomly selected doctors participate each quarter in the survey.

Prescriptions for calcium, an older standard treatment for osteoporosis, fell during the study period. The authors had no data on sales of over-the-counter calcium pills. Stafford said the decrease is a concern, because calcium remains an important way of helping to prevent osteoporosis.

Siris agreed. Getting calcium and vitamin D — either through diet or supplements — and exercising "are part of the package" for preventing osteoporosis, she said. "Those things are cheap and easy."

On the Net:

Archives: http://www.archinternmed.com

National Osteoporosis Foundation: http://www.nof.org

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More Americans Are Getting Osteoporosis

By LINDSEY TANNER

AP Medical Writer

CHICAGO - The number of Americans diagnosed with osteoporosis surged sevenfold over the past decade, coinciding with the development and marketing of new drugs to treat the bone-thinning condition, a study found.

As of 2003, there were an estimated 3.6 million people who had been diagnosed with osteoporosis, compared with half a million in 1994, according to the study by Stanford University researchers. Also, the number of doctor visits for the condition jumped to 6.3 million last year from 1.3 million in 1994.

The increases coincided with the introduction of the bone-protecting drugs alendronate, sold as Fosamax, in 1995; raloxifene, or Evista, in 1997; and risedronate, or Actonel, in 1998.

All three are among the non-hormonal alternatives to estrogen supplements, which have long been used to prevent osteoporosis but have lost popularity because of recent studies linking them to heart problems, breast cancer and other risks.

In 1988, estrogen was prescribed at 35 percent of osteoporosis-related doctor visits, but that fell to 3 percent last year, the study found.

The estrogen alternatives have grown into a multibillion-dollar-a year industry with widespread ads and slick promotional campaigns that have helped raise awareness about osteoporosis. The researchers said that probably helped increase diagnosis rates.

Partly because of the newer drugs, "the whole way that we think about osteoporosis has shifted ... to one of prevention," said Dr. Randall Stafford, who led the study. "We hope to catch it early enough to treat it early enough to prevent fractures."

Nevertheless, osteoporosis remains underdiagnosed and undertreated, said Dr. Ethel Siris, head of the National Osteoporosis Foundation's science and research committee.

Osteoporosis affects an estimated 10 million Americans, mostly women, who face a high risk of debilitating bone fractures, according to the foundation. An additional 34 million have less severe bone thinning that also increases the risk.

The study's authors said new guidelines recommending universal screening for women 65 and older may further improve diagnosis and treatment.

The study appears in Monday's Archives of Internal Medicine (news - web sites).

Stafford and colleagues analyzed data from a physician survey conducted by IMS Health, a health care information company. About 3,500 randomly selected doctors participate each quarter in the survey.

Prescriptions for calcium, an older standard treatment for osteoporosis, fell during the study period. The authors had no data on sales of over-the-counter calcium pills. Stafford said the decrease is a concern, because calcium remains an important way of helping to prevent osteoporosis.

Siris agreed. Getting calcium and vitamin D — either through diet or supplements — and exercising "are part of the package" for preventing osteoporosis, she said. "Those things are cheap and easy."

___

On the Net:

Archives: http://www.archinternmed.com

National Osteoporosis Foundation: http://www.nof.org

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Report Says 195,000 Deaths Due to Hospital Error

WASHINGTON (Reuters) - As many as 195,000 people a year could be dying in U.S. hospitals because of easily prevented errors, a company said on Tuesday in an estimate that doubles previous figures.

Lakewood, Colorado-based HealthGrades Inc. said its data covers all 50 states and is more up-to-date than a 1999 study from the Institute of Medicine (news - web sites) that said 98,000 people a year die from medical errors.

"The HealthGrades study shows that the IOM report may have underestimated the number of deaths due to medical errors, and, moreover, that there is little evidence that patient safety has improved in the last five years," said Dr. Samantha Collier, vice president of medical affairs at the company.

The company, which rates hospitals based on a variety of criteria and provides information to insurers and health plans, said its researchers looked at three years of Medicare data in all 50 states and Washington, D.C.

"This Medicare population represented approximately 45 percent of all hospital admissions (excluding obstetric patients) in the U.S. from 2000 to 2002," the company said in a statement.

HealthGrades included as mistakes failure to rescue dying patients and the death of low-risk patients from infections -- neither of which the Institute of Medicine report included.

It said it found about 1.14 million "patient-safety incidents" occurred among the 37 million hospitalizations.

"Of the total 323,993 deaths among Medicare patients in those years who developed one or more patient-safety incidents, 263,864, or 81 percent, of these deaths were directly attributable to the incidents," it added.

"One in every four Medicare patients who were hospitalized from 2000 to 2002 and experienced a patient-safety incident died."

The U.S. government said it is trying to spearhead a move to get hospitals and clinics to use electronic databases and prescribing methods. The Institute of Medicine report said many deaths were due to medication prescribing errors or to errors in delivering medications.

"If the Centers for Disease Control and Prevention (news - web sites)'s annual list of leading causes of death included medical errors, it would show up as number six, ahead of diabetes, pneumonia, Alzheimer's disease (news - web sites) and renal disease," Collier said.

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N.D. Schools Promote Healthy Lifestyles

GRAND FORKS, N.D. - School officials from across the state are learning to take health care education beyond the classroom walls.

The University of North Dakota Center for Health Promotion has been training school officials though a program known as the Coordinated Approach to Child Health, or CATCH. The North Dakota Department of Public Instruction also is participating.

About 80 educators and workers met in Bismarck this week to learn more about the program, which includes health education and new physical activity programs.

"For the most part, it's designed to get kids more active and to help them develop lifelong healthy choices," said Nancy Vogeltanz-Holm, health promotion director at the university.

Vogeltanz-Holm said the program asks classroom and physical education teachers, food service workers, administrators and community members work together to improve children's health. It also stresses parent and community involvement.

"The kids will have healthier food choices, fun physical activities and classroom education that stress lifelong health," she said.

Grafton elementary principal Ron Thompson said more parent involvement was a goal this year for his school. The new program has families walking together and watching children's weight, he said.

"It's good to go out and be active," he said. "Obesity is a major problem in our nation and it's not going to go away unless we help and do something, and we know education is with young kids."

The North Dakota schools taking part in the program have more than 2,000 students.

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Test Predicts Walking Problems with Artery Disease

NEW YORK (Reuters Health) - A simple test called the ankle brachial index (ABI) can help predict future walking problems in patients with peripheral arterial disease, a condition that involves hardening of the blood vessels in the legs and elsewhere, new research shows.

The ABI, which can be determined in just a few minutes with standard equipment, is the ratio of the blood pressure in the ankle to the pressure in the arm. Any value below 1 is considered abnormal and values below 0.25 indicate severe blood flow problems that could result in amputation of the leg if left untreated.

Previous reports have shown that the ABI and leg symptoms correlate with a person's current walking status. However, it was unclear whether these parameters could be used to gauge future functional impairment.

To investigate, Dr. Mary McGrae McDermott, from Northwestern University Feinberg School of Medicine in Chicago, and colleagues evaluated the outcomes of 676 subjects who had walking tests performed when the study began and 1 to 2 years later. Of the participants, 417 had peripheral arterial disease and 259 did not.

The ABI, coupled with leg symptoms, predicted how far and how fast patients with artery disease would be able to walk in the coming years. Compared with subjects without artery disease, patients with persistent leg pain experienced greater annual declines in walking distance and speed.

Even in the absence of symptoms, peripheral artery disease was associated with an increased risk for becoming unable to walk continuously for 6 minutes.

"Our findings underscore the importance of using the ABI to identify persons with peripheral arterial disease, since (it) is frequently undiagnosed " or symptomless, the authors note.

Source: Journal of the American Medical Association (news - web sites), July 28, 2004.

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An Egg a Day May Be Too Much for Some Women

 

By Amy Norton

Reuters Health

NEW YORK (Reuters Health) - Women who eat eggs on a daily basis may have a higher risk of dying than other women their age, study findings suggest.

Researchers in Japan found that women who consumed one or more eggs a day were more likely to die during the 14-year study than women who ate one or two eggs a week. The findings are published in the American Journal of Clinical Nutrition (news - web sites).

After being shunned not so long ago for their cholesterol-rich yolks, eggs have made a comeback in recent years. Research has shown that moderate consumption may not raise a person's cholesterol levels or heart disease risk, and eggs are welcome in low-carb eating plans.

However, health experts still recommend limiting egg yolks, as one yolk contains about two-thirds of a healthy adult's suggested allotment of cholesterol. The American Heart Association (news - web sites) says healthy adults can have up to one egg per day, as long as they watch their intake of other cholesterol sources such as meat and dairy products.

The new results support advice to eat eggs in moderation, Dr. Yasuyuki Nakamura of Kyoto Women's University told Reuters Health.

Still, the finding that one egg per day might raise women's death risk is at odds with some U.S. studies that have uncovered no such link. According to Nakamura's team, it's possible that the health effects of eggs are greater in a population such as the Japanese, who may get a relatively large portion of their dietary cholesterol from eggs.

The researchers studied data on nearly 9,300 men and women who in 1980 completed lifestyle surveys, which included questions on how frequently they ate various foods. Participants' blood pressure, cholesterol levels and other health indicators were measured at the start of the study, and deaths were tracked over the next 14 years.

At the start of the study, the average cholesterol level among women who had a daily egg was three percent higher than that of women who ate eggs more sparingly.

The researchers found that women who ate an egg a day were 22 percent more likely to die of any cause compared with those who ate only a couple eggs per week -- regardless of factors such as age, smoking habits and body weight. Those who ate two or more eggs a day showed a still higher death risk, but only small number of women fell into that category.

Women who ate the most eggs also had higher rates of death from heart disease and stroke, although in statistical terms, the link was not significant -- probably, Nakamura said, because too few women overall died of either cause.

As for men, there was no connection between egg consumption and the risk of death from any cause. The reason is unclear, but Nakamura speculated that women may simply have been more accurate than men in reporting their eating habits.

The researchers did not account for all lifestyle factors, such as exercise, that are known to affect death risk and could help explain the connection between an egg-heavy diet and mortality.

However, Nakamura noted, women who ate fewer eggs actually had a slightly higher rate of smoking than the egg-a-day group, suggesting that the former group was not more health-conscious in general.

Source: American Journal of Clinical Nutrition, July 2004.

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Statins: The Next Miracle Drugs?

By Adam Marcus
HealthDay Reporter

TUESDAY, July 27 (HealthDayNews) -- If you've been paying any attention to medical news in the last few years, you've almost certainly heard the word "statins."

You may even have heard this question: "Could statins be the next miracle drug?"

Statins, the marketing term for a group of drugs called HMG-CoA reductase inhibitors -- named for the enzyme whose activity they block -- are most commonly prescribed for their ability to lower levels of LDL cholesterol, the "bad" kind that clogs arteries.

They are extremely effective at this task. Studies have shown that statin therapy can cut a person's LDL levels in blood by between by 25 percent to 35 percent. That translates into a significantly lower risk of heart attack and stroke.

Statins also appear to raise levels of HDL, the "good" cholesterol, too, which further reduces the risk of cardiovascular trouble. And they help the heart and vessels in other ways -- by preventing the breakaway of clot-forming deposits, or plaques, that line diseased arteries, and by relaxing blood vessels, spurring the formation of new vessels and preventing blood clots.

Evidence also indicates that higher doses of statins continue to bring down LDL, which doctors are increasingly coming to recognize as "the lower the better" marker of heart disease risk.

The strength of their cholesterol-busting properties has propelled statins to blockbuster status. In 2000, they were already the world's number two class of prescription drugs, with sales of $15.9 billion, according to IMS Health, a market research group.

And use of statins is expected to increase. U.S. health officials earlier this month issued new guidelines for heart patients to lower their LDL levels to 70, from the previously recommended level of 100.

Still, statins are still considered to be widely under-prescribed, at least for cholesterol.

Roughly 11 million Americans are getting the drugs, while an estimated 36 million should be on them, experts say. More than 200 million people worldwide meet the criteria for statin treatment, yet only 25 million are using the drugs.

Research is showing that statins have beneficial attributes for other health problems, including breast cancer, stroke, bone strength and rheumatoid arthritis.

As encouraging as the research is, statins aren't ready to be added to drinking water. They can cause potentially serious side effects, including a muscle destroying disease called rhabdomyolysis that can be crippling and even deadly if not caught early. Bayer pulled its entry in the statin stakes, in August 2001, after 31 people died of rhabdomyolysis linked to the medication.

Statins also have been known to cause muscle pain and weakness, fatigue, memory and cognitive problems and sleep disturbances. And the drugs may lead to erectile dysfunction and sweats and other trouble regulating body temperature.

And in April, researchers from the U.S. National Institutes of Health (news - web sites) reported that statin use by women during the first trimester of pregnancy may increase the chances that their babies will be born with severe central nervous system defects and limb deformities.

 

More information

 

To learn more about statins, visit the National Heart, Lung, and Blood Institute.

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Study May Have Clue to Preventing Premature Births

CHICAGO (Reuters) - Researchers said on Tuesday they have identified "biomarkers" created by infections in amniotic fluid that could help lead to earlier diagnosis and treatment of womb infections often to blame for premature births.

In a study of rhesus monkeys, researchers identified so-called biomarkers created by infections of the amniotic fluid. Similar biomarkers were found when examining pregnant women who were giving birth prematurely.

Babies born prematurely are at increased risk of a variety of health problems and early death.

Nearly 12 percent of babies in the United States are born prematurely, and more than half of those premature births are believed to be caused by infections in the amniotic fluid usually discovered too late to be treated with antibiotics, the study said.

"Biomarkers for infection were detected in a very short amount of time, within only 12 hours of infection," said study co-author Srinivasa Nagalla of Oregon Health & Science University in Portland.

"The likely outcome of this finding is that a simple test may be developed to detect the presence of these biomarkers, thereby signaling the pregnant woman has an infection that needs treatment," she said in a statement.

The study said the testing would be noninvasive and not require insertin of a needle to extract amniotic fluid, as in the genetic testing commonly known as amniocentesis.

In a postscript to the study, published in this week's issue of the Journal of the American Medical Association (news - web sites), the authors said they have a significant financial interest in ProteoGenix, a company hoping to develop and market such tests. An independent panel at the university reviewed their research for objectivity.

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Helping Breast Cancer Patients Make Tough Choices

By E.J. Mundell
HealthDay Reporter

TUESDAY, July 27 (HealthDayNews) -- In today's everchanging health-care environment, cancer patients and their doctors are turning to computers and other technologies to help with complicated decisions concerning care.

However, two new studies suggest nothing beats the human touch.

Educational "decision aids" for women worried about breast cancer work just fine but can never replace expert counseling from physicians or other health professionals, such as genetic counselors, the studies found.

"In the ideal world, these things are an educational tool, perhaps for use in a 'pre-counseling' session. But otherwise, trained people absolutely need to be involved," said Dr. Charis Eng, director of clinical cancer genetics at Ohio State University.

The two studies, plus Eng's commentary, appear in the July 28 issue of the Journal of the American Medical Association (news - web sites).

According to Eng, recent advances in diagnostic procedures and treatments, plus a wider understanding of the role of genetics in disease, has made decision-making on the part of patients and their doctors tougher than ever.

Especially in the area of genetics, there simply aren't enough trained genetics counselors like Eng to go around -- only about 400 in the United States.

Nevertheless, "medicine is going to be pervaded by genetics and genomics," Eng said. Relying on one's doctor for up-to-date genetics information is dicey, she said, because medical schools still underemphasize genetics in their curriculum, and "most physicians aren't trained in this field."

Eng said she has seen firsthand the unfortunate results of a lack of good genetics counseling, with some doctors misinterpreting gene test results for women who worry they might have a genetic predisposition to breast cancer. In some cases, these women opt for prophylactic mastectomy -- removal of the breasts to ensure they escape the disease.

In the case of dubious genetic advice from their doctors, Eng said, "some women will call us, just to be sure, and then we pick up the pieces. But many of them have also had their breast removed because their surgeon told them the wrong thing."

Many women with a family history of breast cancer may worry they carry the BRCA1 or BRCA2 gene variants that can raise cancer risk.

In the first study, researcher Dr. Michael J. Green and colleagues at Penn State College of Medicine compared the usefulness of an educational, interactive computer program he created against traditional in-person genetics counseling. The goal: To see how the computer program helped women come to grips with issues surrounding BRCA1/BRCA2.

The computer "decision aid" first outlines the causes of breast cancer, then talks about genetic inheritance of disease in general before focusing on specific genes such as BRCA1 and BRCA2.

"We found that for improving knowledge, the computer program and the genetic counseling were both very effective," Green said. "They both raised knowledge levels considerably."

"On the other hand, knowledge isn't everything," Green added. "For lowering anxiety, counselors did better than the computer. People like talking to a counselor, they like that one-on-one interaction."

The second study, led by Timothy Whelan of Hamilton Health Services in Hamilton, Canada, examined the effectiveness of a "decision board" -- a kind of flip chart -- to help breast cancer patients make informed choices about whether to have a mastectomy or a less-radical lumpectomy.

The decision board guided women through various topics, such as "Treatment Choice," "Side Effects," and "Results of Treatment Choice for the Breast/for Survival."

The researchers found use of the chart "helpful in improving communication and enabling women to make a choice regarding treatment."

But while they may be useful tools, Eng said computer programs or decision boards should not and cannot replace the advice of a well-informed doctor or genetics counselor.

For one thing, she said, "Who's going to keep these things updated?" Genetics research is proceeding at an incredibly fast pace, she pointed out, so what seems like good information today may be obsolete a year from now. The genetics of disease is also becoming increasingly complicated, with malignancies dependent on the interaction of a number of genes, not just a single mutation, Eng said.

Green agreed, stressing that his computer program "isn't designed to give people specific advice."

"It's not a substitute for talking to a health-care professional," he said. "It's designed to provide information -- it doesn't tell them whether or not to get tested, or their specific risks for breast cancer, it's much more general. If they have specific questions they should always talk to a treatment professional."

More information

To learn more about breast cancer, visit the American Cancer Society.

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Workout Sweat Not Just a Matter of Temperature

By Merritt McKinney

Reuters Health

NEW YORK (Reuters Health) - Summer heat and vigorous exercise can both cause you to break a sweat, but new research suggests that another factor unrelated to temperature may also influence the body's sweat rate.

Researchers in Japan and the U.S. suspect that receptors on muscles that sense motion may play some role in regulating sweating.

The research could help point the way to counteracting how the body's ability to regulate its temperature declines with age, according to the study's lead author.

Receptors called mechanoreceptors on muscles respond to mechanical pressure, a team led by Dr. Manabu Shibasaki at Nara Women's University in Japan explains in an article in the Journal of Applied Physiology.

To see if mechanoreceptors modulate sweating, Shibasaki's team studied seven healthy young men who performed two 20-minute bouts on a tandem reclining exercise bike.

After one session, the participant rested without moving his legs. But after the other exercise session, participants' legs were "passively cycled" by the other person on the tandem bike. This meant that the participant's legs were moving -- and mechanoreceptors were being activated -- even though he was not exerting any effort at all.

As expected, active exercise increased internal temperature as well as the sweat rate and skin blood flow.

There was no difference in internal and skin temperatures during the two different rest periods, according to the report. But participants sweated more on the arm and chest when their legs were moved by their biking partner than when their legs were still.

The absence of a difference in temperature "strongly suggests" that the stimulation of muscle mechanoreceptors was the main trigger for the extra sweating, according to the researchers.

The findings add to previous evidence that several exercise-related factors affect the sweat rate, Shibasaki's team concludes.

The regulation of heat in the body by sweating and skin blood flow is "mainly controlled" by internal and skin temperature, Shibasaki told Reuters Health. But during exercise, it appears that several non-temperature related factors also influence sweating.

This is important, Shibasaki said, because "exercise-related factors cause sweating before internal temperature elevates."

This increased sweating "could prevent excessive elevation of internal temperature," Shibasaki noted.

The regulation of heat in the body tends to become less efficient as we age, but exercise may help slow this decline, according to Shibasaki.

Source: Journal of Applied Physiology, June 2004.

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Bladder Cancer Patients Need Not Lose Their Bladder

TUESDAY, July 27 (HealthDayNews) -- Patients with invasive bladder cancer need not lose their bladder to the disease, contends an article in the current issue of the Journal of General Oncology.

Doctors have found minimally invasive surgery combined with chemotherapy and radiation therapy has potential in some patients to cure the cancer and preserve the bladder, a pilot study by the University of Michigan Health System has found.

Typically, treatment for invasive bladder cancer has meant an operation to remove the bladder and nearby organs, leaving patients with a reconstructed bladder or a urostomy bag.

In the study, 24 patients underwent transurethral surgery -- which requires no incision -- to remove the tumor cells. Six weeks of radiation therapy and low doses of a chemotherapy drug called gemcitabine followed the surgery.

About four years later, 65 percent of the patients were cancer-free, results that mirror more aggressive surgery.

More information

The National Institutes of Health (news - web sites) has more about bladder cancer.

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Demographics Influence Cervical Cancer Rates

By Will Boggs, MD

Reuters Health

NEW YORK (Reuters Health) - Cervical cancer occurrence and death rates remain higher among women of lower socioeconomic status than among better-off women, according to a new report.

"The importance of early detection for this cancer cannot be overemphasized in terms of ensuring high survival rates," Dr. Gopal K. Singh from the National Cancer Institute (news - web sites) in Bethesda, Maryland, told Reuters Health. "Yet one sees dramatic ethnic and socioeconomic disparities in the use of Pap tests and early-stage diagnoses of cervical cancer."

As reported in the online issue of the medical journal Cancer, Dr. Gopal and colleagues used data from 11 population-based cancer registries along with census data to examine socioeconomic patterns in cervical cancer for the total population and for major racial/ethnic groups.

Cervical cancer rates trended downward between 1975 and 2000, the authors report, but women in high poverty counties had at least a one-third higher incidence than women in low poverty counties throughout the study period.

Differences were especially marked for non-Hispanic whites, Hispanics, and American Indians.

During the 25-year period, differences in deaths from cervical cancer between high and low poverty counties actually widened slightly.

"Cervical cancer screening is of course critical," Singh said, "and targeting women of lower socioeconomic status and ethnic minority women in deprived neighborhoods in particular should be a priority."

The toll from cervical cancer "can be dramatically reduced through universal cervical cancer screening," Singh added.

He noted that prevention of infection by human papilloma virus, which causes nearly all cases of cervical cancer, is another goal. It's possible that a vaccine against HPV infection could be a reality soon.

Source: Cancer, July 26 online issue, 2004.

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Drug Cuts Death Risk for Heart Patients

TUESDAY, July 27 (HealthDayNews) -- The anti-hypertensive drug clonidine helps cut the risk of complications and death caused by inadequate blood flow to the heart among non-cardiac surgery patients who have heart disease or are at risk for it, a new study says.

This is the second drug identified by this research team that can be taken before non-cardiac surgery in order to protect this group of patients; the other drug is the beta blocker atenolol. The new study, by researchers at the University of California-San Francisco and the San Francisco Veterans Affairs Medical Center, appears in the August issue of the journal Anesthesiology.

"In the earlier study we found an inexpensive way to reduce the incidence of death due to surgery. Now we have found another drug to do the same thing," lead researcher Dr. Arthur Wallace, associate professor of anesthesia and perioperative care, said in a prepared statement.

The study included 190 male patients who had non-cardiac surgery. All of the men had been diagnosed with at least two of five risk factors for cardiac disease: age 60 or older, hypertension, smoking within the previous year, a cholesterol level of 240 or greater, and diabetes.

The two-year, postsurgical death rate for those who received clonidine before surgery was 15 percent, compared to 29 percent for those who didn't receive the drug.

More information

The U.S. National Library of Medicine has more about heart disease.

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Irritable Bowel Can Follow Dysentery

NEW YORK (Reuters Health) - In some cases, irritable bowel syndrome can result from a bout of dysentery caused by acute intestinal infection with Shigella bacteria, according to a report from China.

Irritable bowel syndrome, or IBS, is an often-mysterious ailment, with no obvious explanation for sufferers' bloating, pain, diarrhea and constipation. Previous studies have suggested that a history of dysentery triples the risk of IBS, the researchers explain in the medical journal Gut.

Despite this clue, it's not known how often IBS or the similar condition known as functional bowel disorder (FBD) occurs after Shigella-related dysentery.

Dr. G-Z Pan and colleagues from Peking Union Medical College Hospital, Beijing, looked into this question by studying 295 subjects with so-called bacillary dysentery and 243 matched "controls" without the intestinal infection.

After bacillary dysentery, 22 percent of patients had FBD and 8 percent had IBS, the authors report -- significantly higher than the corresponding rates (7 percent and 1 percent, respectively) among controls.

The duration of infection was an important risk factor for FBD.

Compared with controls, the researchers note, patients with IBS had higher inflammatory factors in the lining and nerves of the intestines.

"Our study provides new evidence in support of bacillary dysentery as a causative factor of post-infectious IBS," the authors conclude.

They say their findings indicate "that the immune system and the nervous system both play important roles in the (cause) of post-infectious IBS."

"There is increasing recognition of the importance of infection" in IBS, Dr. S. M. Collins from McMaster University Medical Center, Hamilton, Ontario, and Dr. G. Barbara from the University of Bologna, Italy, write in a related commentary.

They add, "With emerging evidence supporting a role for inflammation and immune activation in IBS, studies are encouraged to address the influence of the microbial environment on the epidemiology and clinical expression of IBS across the globe."

Source: Gut, August 2004.

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An Unlikely Ally Against Cancer

TUESDAY, July 27 (HealthDayNews) -- Fat can actually be your friend in fighting cancer, an Iowa State University study claims.

Researchers found you need at least a bit of fat in your salad for your body to absorb the cancer-fighting agents found in salad vegetables. The fat helps promote absorption of lycopene and alpha and beta carotenes, which can help protect you from cancer and heart disease, researcher Wendy White said in a statement.

"We're certainly not advocating a high-fat diet or one filled with full-fat salad dressing. If you'd like to stick with fat-free dressing, the addition of small amounts of avocado or cheese in a salad may help along the absorption," said White, an associate professor of food science and nutrition.

"Our findings are actually consistent with U.S. dietary guidelines, which support a diet moderate, rather than very low, in fat. But what we found compelling was that some of our more popular healthful snacks, like baby carrots, really need to be eaten with a source of fat for us to absorb the beta carotene," White said.

The 12-week study, published in the July 22 issue of the American Journal of Clinical Nutrition (news - web sites), included men and women between the ages of 19 and 28. They ate salads of spinach, romaine lettuce, cherry tomatoes and carrots, topped with Italian dressings containing 0, 6 or 28 grams of canola oil.

Hourly blood samples were collected from the study participants for 11 hours after each meal. No beta carotene absorption was detected when they ate salads with fat-free dressings. Much greater absorption of lycopene and alpha and beta carotene was detected when they ate salads with full-fat dressings, compared with low-fat dressings.

More information

Iowa State University has more about the health benefits of fruits and vegetables.

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Pain Assessment in Nursing Homes Varies Widely

NEW YORK (Reuters Health) - Pain is a frequent companion for many nursing home residents, and it often goes unattended because of a breakdown in communications, investigators report.

Their new study findings suggest that adopting standardized steps in pain management would optimize the flow of information about pain suffered by residents to nursing staff and to clinicians -- and ultimately reduce pain in these patients.

Pain often arises from degenerative joint disease, nerve damage, or compression fractures among nursing home residents, Dr. Grace Y. Jeng, at Yale University School of Medicine in New Haven, Connecticut, and her associates note.

To look into the communication processes currently involved in managing these patients' pain, Jeng's group interviewed directors of nursing at 63 nursing homes in New Haven County.

For the survey, the nursing directors were asked how often nurses assess residents' pain, when nurses notify clinicians about the pain, how often the clinicians themselves assess pain and intervene, and when nurses reassess pain after each new intervention.

Responses were highly variable, the researchers report in the Archives of Internal Medicine (news - web sites).

In 76 percent of facilities, nurses assessed pain in residents not complaining of pain at least every three months. However, fewer than half assessed pain in residents with pain at least once per shift.

Physicians were routinely notified of inadequate pain treatment regimens only 42 percent of the time, and only 55 percent of nursing directors reported that clinicians assessed pain at least once every 1 to 2 months.

Guidelines addressing pain management currently exist, Jeng's team points out, but they do not focus on the overall communication process regarding pain experienced by residents.

"Studies are needed to determine optimal timing in the communication process of pain to allow better pain management outcomes and quality of care for nursing home residents," the authors conclude.

Source: Archives of Internal Medicine, July 26, 2004.

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Ankle Readings Foretell Walking Problems

By Ed Edelson
HealthDay Reporter

TUESDAY, July 27 (HealthDayNews) -- A test that checks blood pressure in the ankle as well as the arm can warn of a future loss of mobility caused by blockage of the leg arteries, even if that blockage is causing no obvious problems, a study finds.

The test measures the ankle brachial index (ABI), the ankle blood pressure divided by the blood pressure in the arm. A normal ABI is between 1.0 and 1.1, with lower readings indicating reduced blood flow in the legs caused by narrowing of the arteries.

The study of nearly 700 people aged 55 and older found those with low ABI readings had significant declines in walking endurance over the next two years compared to those with normal readings, even when the artery blockage was causing no apparent symptoms. The report, by researchers at the Northwestern University Feinberg School of Medicine, appears in the July 28 issue of the Journal of the American Medical Association (news - web sites).

Participants with ABIs below 0.5 were nearly 13 times more likely to be unable to walk for six straight minutes than those with normal readings, the study found.

The most significant finding was that the loss of mobility occurred in people who were not experiencing intermittent claudication, the leg pain that is the classic symptom of what is formally called peripheral arterial disease (PAD), said study leader Dr. Mary McGrae McDermott, an associate professor of medicine at Northwestern.

As expected, the people with PAD whose legs hurt them after they walked for a while did have a greater reduction in walking endurance than people without PAD. But the study also found patients whose PAD was causing no symptoms "had significantly greater declines in six-minute walk performance than did participants without PAD."

That finding suggests the need to screen everyone aged 70 and older for PAD, and to do that screening starting at age 59 for smokers and people with diabetes, who are at increased risk of leg artery blockage, McDermott said. The reason is that early detection and treatment can often help people stay on their feet longer.

The basic treatment is simple, McDermott said: walking, preferably in a controlled situation.

"Supervised treadmill walking appears to be the best, with a nurse or physiologist present, for 30 minutes three times a week," she said, acknowledging that "even if you walk at home, you can get some benefit."

It has been thought that people with symptom-free PAD did not suffer any deterioration in walking endurance, McDermott said. It now appears that those people were reporting no trouble simply because their condition caused them to walk less, she said.

"When you walk slower, you don't feel pain, but you decrease your functional capacity," said Dr. Richard A. Stein, associate chairman of medicine at Beth Israel Medical Center in New York City and a spokesman for the American Heart Association (news - web sites).

Treatment for PAD, even if it causes no symptoms, is helpful for more than just walking, McDermott said. The condition is associated with an increased risk of heart attack, stroke and other cardiovascular problems.

It is important to detect those patients because PAD, like any other artery-blocking condition, will progress steadily unless treated, possibly leading to gangrene that requires amputation, Stein said.

An essential treatment is "vigorous, vigorous" control of risk factors such as blood cholesterol level and smoking, Stein said. But doctors are starting to use some of the same techniques employed for blockage of heart arteries, such as implanting stents, flexible tubes that keep blood flowing, Stein added.

More information

Read about peripheral arterial disease at the American Heart Association.

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Monday, July 26, 2004

 

Sleeping Disorder Linked to Risk of Stroke Death

 

Reuters

Monday, July 26, 2004

LONDON (Reuters) - A sleep-related disorder that causes repeated interruptions in breathing is a new risk factor for death from stroke, Spanish researchers said Tuesday.

Sleep apnea affects about 20 percent of people. Sufferers can stop breathing for 10 seconds or more while asleep, sometimes more than 300 times a night.

Dr Olga Parra and researchers at Barcelona University Hospital in Spain monitored 161 stroke patients and found that their risk of dying from a stroke was linked to sleep apnea.

"It's the first time the link between apnea and stroke has been shown to affect mortality," Parra said.

The link was most clear in patients with obstructive sleep apnea, when breathing may be interrupted because the upper airways collapse.

Parra and her colleagues began monitoring the breathing of stroke patients shortly after they were admitted to hospital following strokes and calculated an apnea index for each one.

During the 30-month study, 22 patients died. Half of them had suffered a second stroke. The higher the patient scored on the apnea scale, the greater the risk of dying from stroke, the researchers said in the study reported in the European Respiratory Journal.

Stroke is a leading killer worldwide and occurs when a blood vessel to the brain bursts or is blocked by a clot, cutting off vital oxygen. In 2002, an estimated 5.5 million people worldwide died from strokes, according to the World Health Organization (news - web sites).

"This Spanish study represents a milestone in our understanding of the potential role of sleep apnea in stroke patients," Ludger Grote, of the Sahlgrenska Hospital in Sweden, said in a commentary in the journal.

"Its results could have considerable implications for the future management of stroke," he added.

Parra and her team did not explain why sleep apnea raises the risk of stroke death but they said the disorder can be treated by using a nasal mask that supplies a continuous flow of pressurized air to reduce the breathing interruptions.

They have now launched a study in several centers in Spain to see if treating sleep apnea could cut the death rate from stroke. The results of that study are expected in about five years.

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The Body, Not the Mind, Predicts Cancer Survival

 

By Karen Pallarito
HealthDay Reporter

HealthDayNews

Monday, July 26, 2004

MONDAY, June 26 (HealthDayNews) -- Terminal cancer patients may feel anxious or spiritually distressed, but their physical symptoms -- not their emotions -- are what signal the beginning of the end, an international research team reports.

In the early stages of terminal cancer, patients with intense nausea are 70 percent more likely to die within six months than patients without that symptom, researchers report in the July 26 online edition of Cancer.

In late-stage cancer, shortness of breath was associated with a 50 percent increase in patients' immediate risk of dying, they found.

These physical symptoms appear to reflect the severity of a patient's cancer cachexia, a wasting syndrome that causes people with tumors to become anorexic, weak and fatigued.

"The presence of these symptoms should be like red flags," indicating that a patient's cancer is more advanced than it might otherwise appear, explained study author Dr. Antonio Vigano, an assistant professor in the Palliative Care Division of McGill University Health Center in Montreal.

"I think that patients presented with these symptoms should be referred earlier to palliative care, and treatment to improve the symptoms should be started earlier rather than later," he said.

The study is important because it scientifically supports what health professionals who work with advanced cancer patients already know, said Dr. Robert A. Brescia, director of the Palliative Care Institute at Calvary Hospital in the Bronx, which provides end-of-life care to adults with advanced cancer.

"Cancer patients often suffer increasing physical distress -- including shortness of breath, weakness, nausea and vomiting -- as they get closer to death," he noted.

Nevertheless, Brescia cautions against focusing on risk of death in dealing with patients and their families.

"It is very risky, and often inappropriate, to try and predict how long any particular patient has to live," he asserted. "Even the most experienced clinicians will tell you that this is difficult to do, and attempting to do so can unwittingly add to the suffering of both the patient and family."

Existing research suggests that patients' physical symptoms, not their emotions, are good predictors of how long they will live. But because those studies failed to use precise research methods, the results were questionable.

To clarify the issue, Vigano and colleagues studied two groups of terminal cancer patients at different stages of the disease. One group included 248 patients admitted to Cross Cancer Institute in Edmonton, Alberta, at the onset of terminal cancer. The other group represented 756 new referrals to palliative home-care services in Southern Ireland; these people were cared for in the later stages of their disease.

Investigators examined the relationship between how long the patients lived and various quality-of-life measures, including physical and emotional symptoms. At each stage of the disease, physical factors predicted shorter survival.

For patients in the early stages of terminal cancer, risk of death increased 68 with nausea or vomiting and 28 percent with shortness of breath. But these associations were not as strong as other disease-related factors.

For example, the risk of dying almost tripled for patients with liver metastases -- malignant tumors that originated elsewhere in the body and spread to the liver through the bloodstream.

Death risk doubled for patients with high tumor burden, a measure that approximates the number of tumors they have, including primary tumors and secondary tumors that form as the cancer spreads.

Among later-stage cancer patients, weakness, meaning a general lack of energy, boosted chances of dying by three, four and five times, respectively, for people with late-stage colorectal, genitourinary (including bladder, uterine, kidney, and prostate cancers) and breast cancer.

If health-care providers are able to identify these symptoms, they can intervene in a way that will improve cancer patients' quality of life, Vigano said.

Although anxiety and spiritual distress were not predictors of survival, Brescia nevertheless favors aggressively treating patients' psychological symptoms.

"These symptoms often cause the patient and family even more pain and suffering than physical symptoms and too often are completely ignored by health-care professionals," he explained.

In a separate study in the same edition of Cancer, Dr. Gopal K. Singh and colleagues from the National Cancer Institute (news - web sites) report a link between income and education in cervical cancer patients. The study shows that the incidence and death rates for cervical cancer rose with increasing poverty and decreasing education levels.

More information

Visit the American Cancer Society (news - web sites) for more on coping with cancer's physical and emotional aspects.

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Study: Cancer Risk Low From WTC Chemicals

 

By Randolph E. Schmid

Associated Press Writer

The Associated Press

Monday, July 26, 2004

WASHINGTON - A group of hazardous chemicals released into the air following the collapse of the World Trade Center doesn't appear to be much of a cancer risk to local residents.

Previous studies have indicated the chemicals may have some endangered unborn babies of women in the area. But a new report says the chemicals dissipated rapidly and any increase in the danger of cancer is very small.

A team led by Stephen M. Rappaport of the University of North Carolina studied 243 samples collected near Ground Zero, analyzing the amounts of nine chemicals known as polycyclic aromatic hydrocarbons, which are known to cause cancer.

"The public was exposed to some toxic PAHs at levels that were quite high soon after the collapse. However, due to the rapid decline in PAH levels, with the dissipation of the fires, the long-term risks of cancer were minuscule," Rappaport said.

"Nonetheless, " he added, "sensitive populations, such as the offspring of women who were pregnant at the time, were at particular risk and may well have suffered as a result of their exposure to PAH during that critical time period."

Rappaport said the risk of cancer related to PAHs would be 0.157 cases per million people over 70 years near Ground Zero, and this would increase only to 0.167 cases per million as a result of the chemicals released in the building collapse and resulting cleanup.

The report, appearing in this week's issue of Proceedings of the National Academy of Sciences (news - web sites), concluded that more than 90 percent of the airborne particles released in the building collapse were larger than 10 microns across, a size that tends to settle quickly out of the air. Ten-microns is about one-seventh the width of the average human hair.

A fraction of the particles were 2.5 microns or less, a size that can easily remain in the air and penetrate into the lung, the report noted. These particles were released in the fires accompanying the collapse and from diesel engines used in the cleanup, the report said.

The researchers added that while the cancer risk for area residents was small, workers taking part in the cleanup could have been exposed to much higher levels of PAHs than indicated in their samples. They also said that if chemicals were concentrated inside apartments and offices, there may have been higher exposures, and there may have been other cancer-causing chemicals released in addition to PAHs.

A study published last year in the Journal of the American Medical Association (news - web sites) noted an increase in smaller babies among women who were near the collapsing towers. Those women faced double the normal risk of delivering babies that were up to half-a-pound smaller than babies born to non-exposed women, that report said.

Rappaport's new analysis was done in collaboration with the Environmental Protection Agency (news - web sites) and was funded by the National Instate of Environmental Health Sciences.

On the Net:

PNAS: http://www.pnas.org

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Radical Shift Seen in Osteoporosis Therapy

By Amanda Gardner
HealthDay Reporter

HealthDayNews

Monday, July 26, 2004

MONDAY, July 26 (HealthDayNews) -- A new study unearths a seismic shift in osteoporosis treatment in the last decade: More women are getting the newest drugs from their doctors while fewer women are using tried-and-true therapies such as calcium supplementation.

And despite the dramatic surge in both visits to the doctor and prescriptions for the new medications handed out since the 1990s, experts say osteoporosis remains under-diagnosed and under-treated.

"The good news is that we've improved enormously in the likelihood of someone with osteoporosis getting diagnosed and treated. The bad news is there's still a gap," said Dr. Randall S. Stafford, lead author of the study appearing in the July 26 issue of the Archives of Internal Medicine (news - web sites) and an assistant professor of medicine at the Stanford Prevention Research Center. "By our calculations, it looks like about 40 percent of the population who may have osteoporosis is actually getting diagnosed and treated in doctors' offices."

Osteoporosis is a disease characterized by low bone mass and fragility, which leads to an increased susceptibility to bone fracture. According to the article, in 2000, about 10 percent of Americans suffered from the condition. It is most common among postmenopausal women, who account for at least 90 percent of the cases.

Using a nationally representative database, the study authors tracked the frequency of osteoporosis visits and drug-prescribing patterns in the United States from 1988 to 2003.

Between 1994 and 2003, the number of doctor visits for osteoporosis increased nearly fivefold, from 1.3 million visits to 6.3 million visits. In 2003, 3.5 million patients visited their doctors for osteoporosis treatment, compared with half a million in 1994. (This takes into account multiple visits.) The proportion of doctor visits for osteoporosis where medications were prescribed jumped from 82 percent in 1988 to 97 percent in 2003.

The sharpest increases were seen in the mid-1990s. This coincided with the availability of new, easier-to-take and more effective drugs for the disease, especially bisphosphonates such as alendronate (Fosamax) and the selective estrogen receptor modulator raloxifene (Evista).

Between 1994 and 2003, the percentage of doctors' visits where bisphosphonates or raloxifene were prescribed increased from 14 percent to 73 percent and from 0 percent to 12 percent, respectively. Prescriptions for older medications declined during the same time period.

Although it's hard to pinpoint exactly why these increases happened, Stafford can think of a number of possibilities. Fosamax was shown to be very effective in helping to reduce fractures and was heavily marketed, having come onto the market after direct-to-consumer advertising was allowed.

This also coincided with improvements in, and the wider availability of, technology for bone mineral density testing. Perhaps as a result, primary-care physicians started taking more responsibility for diagnosing and treating the disease. "[In] the mid-1990s, primary-care physicians as well as the public started to become aware that osteoporosis was something worth worrying about," Stafford said.

Prior to 1996, before these drugs became available, the leading treatments were estrogen and calcium. The decline in estrogen treatment long predated the landmark Women's Health Initiative study, which found in 2002 the therapy was linked to a higher risk of cancer and cardiovascular diseases.

One worrisome and unexpected finding from the study was a decline in the number of osteoporosis patients taking calcium supplements, from 43 percent in 1994 to 24 percent in 2003.

"Calcium is a necessary part of treatment for osteoporosis. Clinical trials require that women take calcium so the trial data basically assumes that these new drugs are effective in women who are taking calcium," Stafford said. "I think physicians and patients are so enamored by the new drugs that they forget osteoporosis treatment should be a package -- and that package should include calcium, vitamin D and some sort of weight-bearing exercise."

These elements also form part of osteoporosis prevention, which should be a priority, the study authors said. "Nature didn't expect us to become osteoporotic," confirmed Dr. Steven R. Goldstein, a professor of obstetrics and gynecology at New York University School of Medicine. "Left to nature's devices, we probably had enough bone mass for the little bit of time after menopause we survived."

All that has changed with soaring life expectancies. "We can encourage women from puberty to be sure that they have enough calcium and vitamin D in their life so that their bone mass peaks at age 35 so that when they get to menopause, they have a better place to start off because that does make a difference," Goldstein said.

After that, "screening for osteoporosis [in postmenopausal women] should be as much on the top shelf of doctors' minds as we have now become ingrained with mammograms," Goldstein said.

More information

For more on osteoporosis, visit the National Osteoporosis Foundation.

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Study: Caffeine Interferes with Diabetes Control

 

Reuters

Monday, July 26, 2004

WASHINGTON (Reuters) - Caffeine could interfere with the body's ability to handle blood sugar, thus worsening type 2 diabetes, U.S. researchers said on Monday.

The team at Duke University Medical Center in North Carolina found a strong correlation between caffeine intake at mealtime and increased glucose and insulin levels among people with type 2 diabetes.

The American Diabetes Association says that at least 90 percent of the 17 million Americans diagnosed with diabetes have type 2, in which the body either does not produce enough insulin or cells ignore the insulin, which the body needs to convert food into energy.

The findings are significant enough that the researchers recommend people with diabetes consider reducing or eliminating caffeine from their diets.

"In a healthy person, glucose is metabolized within an hour or so after eating. Diabetics, however, do not metabolize glucose as efficiently," said James Lane, a psychiatry professor who led the study.

"It appears that diabetics who consume caffeine are likely having a harder time regulating their insulin and glucose levels than those who don't take caffeine."

Writing in the journal Diabetes Care, Lane and colleagues said they studied 14 habitual coffee drinkers with type 2 diabetes.

The researchers put the volunteers on a controlled diet.

They took their medications, had their blood tested and then were given caffeine capsules. More blood was taken then and after giving the volunteers a liquid meal supplement.

Caffeine had little effect on glucose and insulin levels when the volunteers fasted, the researchers found.

But after the liquid meal, those who were given caffeine had a 21 percent increase in their glucose level and insulin rose 48 percent.

"The goal of clinical treatment for diabetes is to keep the person's blood glucose down," Lane said in a statement.

"It seems that caffeine, by further impairing the metabolism of meals, is something diabetics ought to consider avoiding. Some people already watch their diet and exercise regularly. Avoiding caffeine might be another way to better manage their disease. In fact, it's possible that staying away from caffeine could provide bigger benefits altogether."

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AP: Americans Fear AIDS Threat to Kids

 

By Will Lester

Associated Press Writer

The Associated Press

Monday, July 26, 2004

WASHINGTON - Fewer people believe the overall threat of AIDS (news - web sites) is very serious these days, but a majority of Americans say they worry about the impact of the sexually transmitted disease on the nation's children, an Associated Press poll found.

That decline in fears about AIDS comes at a time the disease is showing signs of making a comeback in the United States.

About six in 10, 61 percent, said they feel AIDS is a "very serious" problem, according to the poll conducted for the AP by Ipsos-Public Affairs. When people were asked in 1987 how serious AIDS was as a national health problem, almost nine in 10 said it was "very serious."

Revolutionary new drugs allow people to live longer with AIDS, and young gay men have no memories of the devastating early days of the sexually transmitted disease two decades ago. Health officials fear complacency could contribute to a comeback of the disease.

Their fears were confirmed a year ago when AIDS diagnoses increased for the first time in a decade.

Only two in 10 polled said they were concerned they would personally be infected with HIV (news - web sites), but more than half, 51 percent, said they were worried that a son or daughter could be infected.

"The way I look at it, kids are going to be kids," said Mike Savicz, a 45-year-old father from Albuquerque, N.M., "like what we did when we were teenagers."

More than six in 10 of those with children said they were concerned that a child might be affected. Even four in 10 of those with no children acknowledged fears about the possibility of a child being infected, if they had one.

Teaching safe sex should be a high priority to curb AIDS, Savicz said, noting that promoting abstinence is likely to get a cynical reaction from teenagers: "Yeah, yeah, like I'm going to do that."

A majority in the poll, 55 percent, said teaching safe sex should be the focus of efforts to prevent AIDS, rather than promoting abstinence, backed by 40 percent.

The United States provides financial help to developing countries that support President Bush (news - web sites)'s insistence that abstinence — rather than condoms — should be the main way to prevent the disease.

Americans say they support the $15 billion the United States has pledged to help fight AIDS in developing countries overseas. But when asked whether the money should go abroad or be used to fight the epidemic at home, they choose keeping the money here by a 2-1 margin.

The recent increase in diagnosed cases of AIDS is likely a sign of things to come, said Dr. Jim Curran, dean of the Rollins School of Public Health at Emory University and a longtime veteran of AIDS prevention efforts.

"There are a number of factors that would suggest that AIDS and HIV infections will continue to be on the rise in the United States," Curran said. "There are more people infected than ever, there's a lower death rate, a rise in infection rates among young gay men."

Four in 10 in the AP poll said they know someone who had AIDS, died of it or has been infected by HIV.

For 23-year-old Heather Sweeney of Philadelphia, AIDS remains a "very serious" problem. Losing a young friend to the disease reinforced that view.

"People are a lot more careless about protection," she said. "A lot more people are having sex younger and they're not as aware of it."

When asked what health problem should be the federal government's highest priority for spending on medical research, people were most likely to say cancer. AIDS, Alzheimer's and heart disease tied for a distant second.

Efforts to raise private money for research have struggled as AIDS faded from the media spotlight. For example, in May, Pittsburgh held its last annual AIDS walk to raise money to fight the disease because of declining public interest and participation.

"You don't hear as much about AIDS," said Arthur McAteer, a federal government worker in West Melbourne, Fla. "People are more educated now, they take precautions."

The AP-Ipsos poll of 1,002 adults was taken July 19-21 and has a margin of sampling error of plus or minus 3.5 percentage points.

On the Net:

Ipsos News Center: http://www.ipsos.com/ap

(Savicz in 7th  graf is correct)

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Long-Term Acetaminophen Use May Harm Kidneys –Study

 

Reuters

Monday, July 26, 2004

CHICAGO (Reuters) - Long-term, habitual use of the painkiller acetaminophen, sold under the brand name Tylenol, may cause a decline in kidney function in some people, a study of middle-aged women said on Monday.

Overall, one in 10 of the 1,700 women studied over 11 years experienced a 30 percent decline in their kidney's filtration function.

Acetaminophen, which is sold as Tylenol by a subsidiary of Johnson & Johnson and also marketed generically, was alone among commonly used painkillers to show an association with kidney impairment.

"Our findings should not prompt people to discontinue using acetaminophen," said study author Gary Curhan of Brigham and Women's Hospital in Boston.

"Instead, this study suggests a need for the medical community to consider alternative pain therapies that may help patients avoid long-term dependence on these drugs until we clearly understand the potential side effects.

"The good news is that, based on this research, it appears that for the vast majority of women, most pain relievers are safe for the kidney," Curhan said.

A spokesman for the marketer of Tylenol disputed the study's findings, saying it contradicted previous research into the impact of moderate use of pain relievers on renal function.

Acetaminophen is less likely to harm the kidneys than other pain relievers, said Kathy Fallon of McNeil Consumer & Specialty Pharmaceuticals. While aspirin and other analgesics relieve pain by acting on blood cells that pass through the kidneys, acetaminophen does not, she said.

In the study, which was published in The Archives of Internal Medicine (news - web sites), women who had taken between 1,500 and 9,000 tablets over their lifetimes raised their risk of kidney impairment by 64 percent.

For those who took more than 9,000 tablets, the risk more than doubled.

There was no association in this study between kidney impairment and aspirin or other anti-inflammatory drugs known collectively as non-steroidal anti-inflammatory drugs (NSAIDs), but some previous research has shown a connection.

"Pain relievers are used commonly, especially among women," Curhan said. "As a growing number of patients take painkillers on a regular basis to alleviate chronic pain or to prevent heart disease and stroke, it is important for clinicians to fully appreciate that these medications may also have adverse effects on an individual's long-term health."

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Staying With Same Doctor Leads to Better Care

 

HealthDayNews

Monday, July 26, 2004

MONDAY, July 26 (HealthDayNews) -- Adults who regularly visit the same doctor are most likely to receive better preventive treatment, according to a new study published in the Journal of General Internal Medicine.

Influenza vaccinations and mammograms were two types of care offered significantly more to adults who had a regular doctor and visited the same health-care site, said Dr. Mark P. Doescher of Harborview Medical Center in Seattle. He also found an increase in the amount of advice given on smoking cessation.

The study traced data from households in more than 60 communities across the United States.

The findings go hand-in-hand with a second study published in the journal that found hospital readmission or relative risk of death decreases for patients who return to the doctor who actually treated them during hospitalization.

The study concluded that continuity of care can greatly affect the quality of patient recovery.

More information

The Agency for Healthcare Research and Quality has more about medical check-ups.

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Vitamin E No Benefit to Heart, Researchers Say

 

Reuters

Monday, July 26, 2004

CHICAGO (Reuters) - Taking Vitamin E supplements does not ward off heart disease and may even mislead people into thinking they do not need to take drugs of proven value or adopt a healthier lifestyle, a study said on Monday.

Summarizing the findings of seven studies conducted since 1990, the report published in The Archives of Internal Medicine (news - web sites) concluded that people who took Vitamin E supplements did not protect themselves against cardiovascular disease.

Vitamin E in the diet is a so-called antioxidant and is thought to help prevent cholesterol from clogging arteries, said lead author Rachel Eidelman of the Agatston Research Institute in Miami Beach, Florida. But taking Vitamin E in supplement form did not appear to provide the same benefit, she said.

The report warned that some people may take Vitamin E pills in lieu of adopting healthier habits. They may also skip taking drugs of proven benefit in combating heart disease such as aspirin, statins and beta-blockers.

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Health Tip: Natural Help for Arthritis Pain

 

HealthDayNews

Monday, July 26, 2004

(HealthDayNews) -- Some people with mild to moderate osteoarthritis who take glucosamine or chondroitin sulfate get the same pain relief as people taking anti-inflammatory drugs such as aspirin and ibuprofen, according to the Arthritis Foundation.

But because dietary supplements are unregulated, the quality and content can vary. If you decide to take these supplements after making sure osteoarthritis is the cause of your pain and consulting a doctor, choose products sold by well-established companies and read the labels carefully to make sure the ingredient list makes sense to you.

Recommended doses cost about $1 to $3 per day. Such therapies aren't covered by most insurance companies.

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Drinking Tea Keeps Blood Pressure Down – Study

 

Reuters

Monday, July 26, 2004

CHICAGO (Reuters) - Drinkers of green and oolong tea are less likely to develop high blood pressure than nondrinkers, a Taiwanese study said on Monday.

The risk of hypertension, a condition that can lead to heart disease and stroke, declined the more green or oolong tea was consumed regularly, the study by researchers from National Cheng Kung University in Tainan, Taiwan, said.

Some varieties of tea contain 4,000 chemical compounds, including flavonoids that help protect against heart attacks, strokes and kidney failure, study author Yi-Ching Yang wrote in the report published in The Archives of Internal Medicine (news - web sites).

None of the 1,500 participants suffered from hypertension at the start of the study, and those who drank between 120 and 599 milliliters (4 to 20 fluid ounces) of tea per day for at least a year prior had a 46 percent lower risk of developing high blood pressure than nondrinkers.

Drinking 600 milliliters of tea or more a day lowered the risk of hypertension by 65 percent, the study showed.

Few of the participants drank black tea.

About 40 percent of the study subjects were regular tea drinkers, and they were more likely to be younger men who smoked more, drank more alcohol and ate fewer vegetables.

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Many Stroke Patients Get Wrong Therapy in Hospitals

 

HealthDayNews

Monday, July 26, 2004

MONDAY, July 26 (HealthDayNews) --New research suggests that up to 65 percent of stroke patients are likely to be treated for hypertension in their first four days in the hospital, despite current guidelines that say such treatment can extend and worsen stroke symptoms.

The report appears in the July 27 issue of Neurology.

The American Stroke Association recommends against treating all but the most severe cases of hypertension in the first few days following a stroke. Studies have found that lowering elevated blood pressure in stroke victims through medication can cause more damage both short- and long-term.

In the research, doctors reviewed medical records of 154 patients admitted for stroke at a community-based teaching hospital in Minnesota.

They found that only 26 percent of patients who were treated for hypertension actually met the guidelines for treatment.

More information

The National Institutes of Health (news - web sites) has more about stroke.

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Aloe May Save Lives on Battlefield, Study Finds

 

Reuters

Monday, July 26, 2004

WASHINGTON (Reuters) - The aloe vera plant could provide a fluid to help keep alive trauma victims such as battlefield casualties until they can get a blood transfusion, U.S. researchers said on Monday.

Tests on rats show that the sticky fluid found inside the leaves of aloe vera can help preserve organ function after massive blood loss, the team at the University of Pittsburgh said.

Writing in the journal Shock, they said just small injections of the substance helped counteract the more immediate deadly effects of blood loss.

"We hope this fluid will offer a viable solution to a significant problem, both on and off the battlefield," Dr. Mitchell Fink, a professor of critical care medicine who led the study, said in a statement.

"Soldiers wounded in combat often lose significant amounts of blood, and there is no practical way to replace the necessary amount of blood fast enough on the front lines. When this happens, there is inadequate perfusion of the organs which quickly leads to a cascade of life-threatening events," Fink added.

"Medics would need only to carry a small amount of this solution, which could feasibly be administered before the soldier is evacuated to a medical unit or facility," he added.

The researchers, who got funding from the Defense Advanced Research Projects Agency, tested the mucilage from inside aloe leaves. It is rich in sugar compounds called polysaccharides that affect the qualities of fluid.

"It may provide better diffusion of oxygen molecules from red blood cells to tissues because of its ability to better mix in the plasma surrounding red blood cells," said Marina Kameneva, an artificial blood expert who worked on the study.

They tested rats, injecting them either with the aloe derivative or salt solution after draining them of some blood.

Just half the 10 rats injected with saline survived, while eight of 10 rats that got aloe did.

In a second experiment involving more blood loss, five of 15 rats survived for two hours after getting aloe compared to one of 14 treated with saline solution alone. Seven animals receiving no treatment all died within 35 minutes.

Trauma is the leading cause of death for people under the age of 40 in the United States, killing 150,000 people a year. Loss of blood accounts for nearly almost half these deaths.

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Migraine Drug Users Don't Need Cardiac Stress Test

 

HealthDayNews

Monday, July 26, 2004

MONDAY, July 26 (HealthDayNews) -- First-time users of migraine drugs known as triptans should not have to undergo cardiac stress tests, say Duke University Medical Center researchers, who have analyzed data on the drugs' effects.

Concerns have been raised that triptans such as Imitrex and Zomig are possibly related to cardiac disease. Studies have shown the drugs can constrict blood vessels in the heart, which could be hazardous to people with heart disease.

However, patients without known cardiac disease who do not belong to any at-risk groups do not need exercise testing before starting triptans, said Dr. David Matchar, senior author on the paper.

The researchers created a "virtual clinical trial" using population data from previous migraine studies to create a simulated patient pool.

The number of heart attacks and cardiovascular deaths were similar across those who took triptans, took them after receiving a stress test, or didn't receive them.

However, there were 70 percent fewer migraines in the group that received triptans, compared to the group that did not.

The research appears in the July issue of Headache.

More information

The National Institutes of Health (news - web sites) has more about migraines.

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Study: Moderate Exercise Helps Diabetics Avoid Death

 

Reuters

Monday, July 26, 2004

WASHINGTON (Reuters) - Moderate exercise, such as walking or cycling to work every day, can help keep people with diabetes alive, Finnish researchers reported on Monday.

More vigorous exercise helps, too, but the Finnish study shows that people with type-2 or adult onset diabetes can work life-saving exercise into their everyday routines.

"Regular physical activity should be part of standard treatment for diabetic patients," said Dr. Jaakko Tuomilehto, a professor at the National Public Health Institute in Helsinki, Finland.

"People with diabetes need to look for ways to build activity into their work, their commuting to and from work and also their leisure time. Physical activity during commuting is one of the easiest, least-time consuming ways to promote health."

Diabetes is a leading cause of death -- number six in the United States -- and it also greatly increases the risk of heart disease. Exercise can reverse the effects, but Tuomilehto's team wanted to see just how easy it would be to get the right kind of exercise.

"We know that type-2 diabetes can be prevented or at least postponed by physical activity and a healthy diet, but too often people think only of leisure-time physical training or other aerobic activities," Tuomilehto said in a statement.

Writing in the American Heart Association (news - web sites) journal Circulation, the Finnish researchers said they reviewed data on 3,316 people aged 25 to 74 who had type-2 diabetes.

These people had filled out extensive surveys on their health and leisure habits.

They defined light commuting as using motorized transportation; moderate commuting as walking or bicycling up to 29 minutes daily and active commuting was walking or cycling 30 minutes or more a day.

Light leisure activity included reading or watching television while moderate activity included more than four hours each week of walking, cycling or light gardening.

The researchers found that moderately active work was associated with a 9 percent reduction in cardiovascular death and active work was associated with a 40 percent reduction in heart or stroke death.

People who ran, cycled heavily or jogged in their leisure time were 33 percent less likely to die and moderate exercisers had a 17 percent drop in risk.

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Menstrual Migraines Hit Hard

 

By Serena Gordon
HealthDay Reporter

HealthDayNews

Monday, July 26, 2004

MONDAY, July 26 (HealthDayNews) -- Migraines can attack with a vengeance during menstruation, but taking medication before your period begins may help stave off these excruciating headaches.

That's the conclusion of two studies that appear in the July 27 issue of Neurology.

One study sought to confirm the association between migraine and menstruation that many women already report to their doctors. The British researchers found that, indeed, such an association does exist: Women are 2.5 times more likely to have a migraine during the first three days of menstruation, and they're more than three times as likely to report the migraine as severe.

The other study looked for a way to relieve menstrual migraines. Researchers compared the preventative use of the migraine medication frovatriptan to a placebo. They found that by starting frovatriptan therapy two days before menstruation begins and continuing treatment for six days, the occurrence of menstrual migraines could be reduced by as much as 26 percent.

Of her study, Dr. Anne MacGregor, director of clinical research at the City of London Migraine Clinic, said, "This is the first study to compare menstrual vs. non-menstrual attacks within individual women. It confirms what women themselves tell us, that it is the menstrual attacks that give them the most problems."

Dr. Raina Ernstoff, an attending neurologist at William Beaumont Hospital in Royal Oak, Mich., said that menstrual migraines are more common than many women realize. She said many women have menstrual migraines, but attribute them to other triggers. However, she noted that if women are exposed to these triggers when they're not in the premenstrual or menstrual period, they may not get migraines.

MacGregor's study included 155 women who had a history of migraines. None were taking birth control pills or using hormone therapy. All of the women kept diary cards that contained information on each headache and its severity, as well as any medications taken, and where in her menstrual cycle a woman was. Data were gathered for 693 menstrual cycles.

The researchers found that women were 2.1 times more likely to have a migraine in the two days before a period, and that number increased to 2.5 times more likely during the first three days of menstruation. Women were 3.4 times more likely to report that migraines that occurred during menstruation were severe.

In the treatment study, 443 women with migraines were recruited from 36 centers across the United States. They were randomly assigned to one of three groups during each of three menstrual cycles. One group took a placebo; one group took 2.5 milligrams of frovatriptan once daily; and the other took 2.5 milligrams of frovatriptan twice a day. All took the treatments for six days, beginning two days before the expected start of menstruation.

Sixty-seven percent of the women taking the placebo reported having migraines, while only 52 percent of those taking frovatriptan did. The group taking frovatriptan twice a day had the best results, with only 41 percent experiencing a migraine.

"More than half of patients who used frovatriptan 2.5 milligrams twice daily had no menstruation-associated migraine," study author Stephen Silberstein, from Thomas Jefferson University in Philadelphia, said in a statement.

The researchers said the drug was well-tolerated in this study, but Ernstoff pointed out that frovatriptan, as with other triptan medications, can't be used in women with cardiovascular disease or in those with uncontrolled hypertension.

Plus, she added, if your headaches don't interfere with your daily living, it's a good idea to cut back on medications whenever possible.

"Women should talk to their neurologists about other ways of dealing with migraine symptoms, because there may be ways to reduce medications," she said.

MacGregor said knowing when menstruation will occur can help women prevent their migraines.

"We found that for many women in our study, being able to predict menstruation and hence migraine made them more able to prepare for menstrual attacks, avoiding other triggers and treating early," she said.

More information

To learn more about migraines, visit the National Institute of Neurological Disorders and Stroke.

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Potential Lung Cancer Gene Narrowed Down – Study

 

Reuters

Monday, July 26, 2004

WASHINGTON (Reuters) - Some people may be genetically programmed to develop lung cancer even if they do not smoke much, U.S. researchers said on Monday

They said they were closing in on a gene that may predispose people to lung cancer. They have not pinpointed the precise gene, but they have narrowed down its location on the chromosomes that carry the genes, they report in September issue of the American Journal of Human Genetics.

"The discovery of genes for other types of cancer has led to better understanding of those diseases, which in turn can lead to better strategies for treatment and prevention," said Joan Bailey-Wilson of the National Human Genome Research Institute, who helped lead the study.

"We hope that uncovering a gene or genes responsible for lung cancer will do the same for this devastating disease," she added in a statement.

Lung cancer is by far biggest cancer killer in the United States and most of the developed world, causing 157,000 deaths in 2003 in the United States alone.

Only 15 percent of lung cancer patients are still alive after five years. Smoking or exposure to cigarette smoke is by far the leading cause of lung cancer.

But not everyone who smokes gets lung cancer, and it can strike heavy and light smokers alike. Scientists know there must be a genetic predisposition, as there is for other cancers such as breast and colon cancers.

The team at 12 separate research institutions and universities, including the National Cancer Institute (news - web sites) and the NHGRI, examined 52 families who had at least three close relatives with lung, throat, or laryngeal cancer.

They used 392 known genetic markers -- DNA sequences known to vary from one person to another. They then compared DNA of affected and non-affected family members.

The evidence pointed to an area on chromosome 6, they said.

They also found that some family members did not have the suspicious DNA but some developed cancer anyway. This seemed to be linked with how much they smoked, the researchers said.

But in the family members who carried the genetic marker, any amount of smoking increased lung cancer risk.

Now they will closely examine known genes and perhaps find a new one, said Jonathon Wiest of the NCI. "Often you can discover a new function for a gene that normally works in a different cellular pathway, so you never know what you're going to find," he said.

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U.S. Sets Sights on Electronic Health Records

By Amanda Gardner
HealthDay Reporter

HealthDayNews

Monday, July 26, 2004

MONDAY, July 26 (HealthDayNews) -- Scott Wallace's dog, Samantha, has computerized health records. His car does, too. But he does not.

"I have more information on the treatment of my 14-year-old Acura Legend than my own treatment in the last 14 years, and I have more current available information about my dog than I do about myself or any of my kids," Wallace said. "That's crazy."

The U.S. government agrees, so sometime over the next decade Wallace and many other dog and car owners should get their own computerized health records.

U.S. Health and Human Services (news - web sites) Secretary Tommy G. Thompson has just released the first outline of a 10-year plan to computerize health care. The report, cumbersomely named The Decade of Health Information Technology: Delivering Consumer-centric and Information-Rich Health Care, was unveiled in Washington, D.C., at an information technology summit.

"No longer will up to 100,000 people die from medical errors," said Dr. David J. Brailer, the new National Coordinator for Health Information Technology, a position created by President Bush (news - web sites) in April. "No longer will we spend up to $300 billion a year on inappropriate treatment or up to $150 billion on administrative waste. No longer will we have to fill out the same form 50 times."

The issue, says Wallace, owner of Samantha and president and chief executive officer of the National Alliance for Health Information Technology in Chicago, is "how do you make information move with patients, so that patients aren't having to carry it around on their own physically and in their head? How do you make the system more efficient?" The alliance represents an effort to use more technology in the health-care arena.

The report, which was prepared by Brailer, is an outgrowth of President Bush's recent call for electronic health records for most Americans.

According to the report, the U.S. health-care system lags behind banks and grocery stores when it comes to information technology. In 2002, only 13 percent of hospitals and 14 percent to 28 percent of physicians' practices reported using electronic health records.

The new system would let consumers access medication information on the Web or via phone and even teleconference with their physician over the Internet, Brailer explained. "They'll have access to information on how well their doctor or hospital does various procedures," he added. "They can pick the provider that works best for them. It's consumer-centric. It's built around the person and not the different players."

Needless to say, the initiative will take great coordination of an extremely fragmented health-care system. And it will need to ensure that records stay secure. According to Wallace, this is not as much of an issue as it sounds. "I'm not stupid enough to think that all records are forever impenetrable, but most are, and at least we have systems [on computers] to see who was looking," he said.

The technology already exists. "This is not a technology issue and not a health-care issue. It's a leadership issue," Wallace said. In fact, various experiments around the country are under way, including one with Medicare recipients in Indiana.

Wallace's own interest in the subject came out of personal experience. After suffering a stroke, Wallace's father had what's known in medical parlance as an "adverse drug event." A cardiologist prescribed medication that conflicted with what the neurologist had already given him, causing his heart to stop. "The squad picked him up and raced him to the hospital," Wallace recalled. "This was a third set of doctors who had to figure out what the first two had done."

"What we're trying to get to with the whole concept of electronic health records is the idea that patients aren't responsible for their information, and physicians aren't responsible for their information," Wallace continued. "The system provides the information. It puts up big flashing screening, saying, 'Don't do this.' It allows for a coordination. I have yet to meet a dastardly doctor. They want to do well, but systems are bad."

Wallace eventually moved his father to a Veterans Administration facility that had a centralized computer system.

As for the dog, Samantha, the age of computers allowed her to vacation in Canada. "We were going to Canada and we were unaware that we had to have the immunization records with us," Wallace related. But sitting at customs outside the Peace Bridge separating New York State from Ontario, Wallace called up Samantha's records on the Internet and showed them to the agent. After reviewing her medical history on the computer screen, Canadian Customs waved the whole family through.

More information

For more on the report, visit the U.S. Department of Health and Human Services.

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Sunday, July 25, 2004

 

AP: U.S. Worries About AIDS Threat to Kids

 

By Will Lester

Associated Press Writer

The Associated Press

Sunday, July 25, 2004

WASHINGTON - More than half of Americans are worried their children might become infected with the virus that causes AIDS (news - web sites), even though fewer people believe the overall threat is very serious, an Associated Press poll found. That decline in fears about AIDS comes at a time the disease is showing signs of making a comeback in this country.

About six in 10, 61 percent, said they feel AIDS is a "very serious" problem, according to the poll conducted for the AP by Ipsos-Public Affairs. When people were asked in 1987 how serious AIDS was as a national health problem, almost nine in 10 said it was "very serious."

Revolutionary new drugs allow people to live longer with the disease and young gay men have no memories of the devastatingly deadly early days of the sexually transmitted disease two decades ago. Health officials fear complacency could contribute to a comeback of the disease.

Their fears were confirmed a year ago when AIDS diagnoses increased for the first time in a decade.

Only two in 10 polled said they were concerned they would personally be infected with HIV (news - web sites), but more than half, 51 percent, said they were worried that a son or daughter could be infected.

"The way I look at it, kids are going to be kids," said Mike Savicz, a 45-year-old father from Albuquerque, N.M., "like what we did when we were teenagers."

More than six in 10 of those with children said they were concerned that a child might be affected. Even four in 10 of those with no children acknowledged fears about the possibility of a child being infected, if they had one.

Teaching safe sex should be a high priority to curb AIDS, Savicz said, noting that promoting abstinence is likely to get a cynical reaction from teenagers: "Yeah, yeah, like I'm going to do that."

A majority in the poll, 55 percent, said teaching safe sex should be the focus of efforts to prevent AIDS, rather than promoting abstinence, backed by 40 percent.

The United States provides financial help to developing countries that support President Bush (news - web sites)'s insistence that abstinence — rather than condoms — should be the main way to fight AIDS.

Americans say they support the $15 billion the United States has pledged to help fight AIDS in developing countries overseas. But when asked whether the money should go abroad or be used to fight the epidemic at home, they choose keeping the money here by a 2-1 margin.

The recent increase in diagnosed cases of AIDS is likely a sign of things to come, said Dr. Jim Curran, dean of the Rollins School of Public Health at Emory University and a longtime veteran of AIDS prevention efforts.

"There are a number of factors that would suggest that AIDS and HIV infections will continue to be on the rise in the United States," Curran said. "There are more people infected than ever, there's a lower death rate, a rise in infection rates among young gay men."

Four in 10 in the AP poll said they know someone who had AIDS, died of it or has been infected by HIV.

For 23-year-old Heather Sweeney of Philadelphia, AIDS remains a "very serious" problem. Losing a young friend to the disease reinforced that view.

"People are a lot more careless about protection," she said. "A lot more people are having sex younger and they're not as aware of it."

When asked what health problem should be the federal government's highest priority for spending on medical research, people were most likely to say cancer. AIDS, Alzheimer's and heart disease tied for a distant second.

Efforts to raise private money for research have struggled as AIDS faded from the media spotlight. For example, in May, Pittsburgh held its last annual AIDS walk to raise money to fight the disease because of declining public interest and participation.

"You don't hear as much about AIDS," said Arthur McAteer, a federal government worker in West Melbourne, Fla. "People are more educated now, they take precautions."

The AP-Ipsos poll of 1,002 adults was taken July 19-21 and has a margin of sampling error of plus or minus 3.5 percentage points.

On the Net:

Ipsos News Center: http://www.ipsos.com/ap

(Savicz in 7th  graf is correct)

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Vision Loss a Growing Threat for Many Americans

 

By Karen Pallarito
HealthDay Reporter

HealthDayNews

Sunday, July 25, 2004

SUNDAY, July 25 (HealthDayNews) -- Vision loss is one of the health conditions Americans fear most. One survey ranked it third, after cancer and heart disease.

More than ever, there's good reason for concern. Americans are living longer, and as people age their risk of contracting eye diseases such as age-related macular degeneration, cataracts, glaucoma and diabetic retinopathy tends to increase.

And with type 2 diabetes on the rise, more folks -- young and old -- are at risk of developing eye disease. Diabetic retinopathy alone accounts for up to 24,000 new cases of blindness each year, according to Prevent Blindness America (PBA), a national eye health and safety organization.

One in three children born in 2000 will develop diabetes in their lifetime, according to the U.S. Centers for Disease Control and Prevention (news - web sites). The coming wave of diabetic children worries eye health professionals.

"As a society, if we don't get a handle on that, that's going to be the next big surge of vision loss," cautioned Dr. Lylas G. Mogk, an ophthalmologist and spokeswoman for the American Academy of Ophthalmology.

Loss of vision is devastating, no matter what the cause. Some 1.1 million Americans are legally blind, 3 million have low vision, and 200,000 have severe visual impairment, according to Healthy People 2010, the U.S. Department of Health and Human Services (news - web sites)' (HHS) disease prevention initiative.

Yet, every year many people suffer from blindness or impaired vision that could have been prevented or stalled with appropriate diagnosis and treatment.

Federal data suggest an estimated 80 million Americans have a potentially blinding eye disease. By 2030, the number of blind and visually impaired people in the United States will double if nothing is done.

Diabetic retinopathy affects 4.1 million Americans aged 40 and older, but that number is expected to swell to 7.2 million by 2020.

The condition affects the small blood vessels that nourish the retina, the light-sensitive tissue that lines the back of the eye. In its early stages, it can lead to blurred vision, although some people may have no symptoms at all. Left untreated, the disease can cause blindness.

"It's a crisis," warns PBA spokeswoman Betsy van Die. Of the 18.2 million Americans with diabetes, 5.2 million don't even know they have it, she said.

Another 41 million Americans have "pre-diabetes," which means they have elevated blood sugar levels that put them at risk of diabetes, HHS warned earlier this year.

With 40 percent to 45 percent of diabetics at some stage of diabetic retinopathy, the National Eye Institute urges everyone with diabetes to have a complete dilated eye exam at least once a year.

The most prevalent eye problem in America is cataract, affecting 20.5 million people aged 40 and older. It's also one of the most treatable, eye health professionals say.

A cataract is a clouding of the lens of the eye, which can lead to blurred vision, glare, poor night vision and other sight problems. Most often, it is related to the aging of the eye, with more than half of Americans having cataracts by age 80, van Die said.

But surgical replacement of the lens makes it possible for most cataract sufferers to regain their vision. Thanks to advances in technology, cataract surgery is 95 percent successful in the United States, according to PBA.

Glaucoma, another common eye disease known as the silent thief of sight, can't be cured. But it can be controlled if detected and treated before major vision loss occurs.

Some 2.2 million adults aged 40 and older have glaucoma, which is caused by rising fluid pressure in the eyes. People can have the disease without symptoms, but as it progresses it can cause damage to the optic nerve, diminishing the field of vision and ultimately leading to blindness.

Anyone can get glaucoma, but it is five times more common in blacks than whites, according to the National Eye Institute.

"Glaucoma is the reason that everybody starting at 40 should have an eye exam every two to three years," Mogk said. "If you catch it early, you can treat it early."

Perhaps more worrisome is a disease known as age-related macular degeneration, which gradually destroys detailed central vision. The macula is a spot in the center of the retina that allows the eye to see objects clearly and perform tasks that require straight-ahead vision, such as reading, driving and sewing.

"Among adults, what they more and more are thinking about -- and for good reason -- is macular degeneration," said Mogk, noting the disease is exceedingly common and there's no effective treatment.

Prevent Blindness America says it affects 1.8 million people aged 40 and older, but another 7.3 million are at risk of vision loss due to the disease.

There are two types of macular degeneration -- wet and dry -- of which the most common form is dry. Studies suggest the macula becomes diseased, leading to gradual deterioration of that area's light-sensing cells.

Scientists don't know exactly what causes it, but one theory suggests that exposure to environmental toxins can damage the macula, explained Mogk.

Research suggests nutritional supplements may help. One study sponsored by the National Eye Institute found that people at high risk of developing advanced macular degeneration who took supplements that contained Vitamins C and E, beta carotene, zinc and copper reduced the risk of continued progression by 25 percent.

A National Institutes of Health (news - web sites)-sponsored study found people who ate the highest amounts of lutein, a plant-based antioxidant found in dark green, leafy vegetables such as spinach and kale, reduced risk for macular degeneration by 43 percent compared with those who consumed the lowest amounts.

Lutein, a yellow pigment, is also found in high concentrations in the macular. The belief is that it helps neutralize damage caused by the sun's harmful rays and other environmental toxins, experts say.

In general, to prevent eye disease, experts recommend people eat a healthy diet, quit smoking and wear sunglasses that protect against the sun's harmful rays.

Above all, eye health professionals urge everyone, beginning at age 40, to have a dilated eye exam every two years. People with specific risk factors, of course, may need to be examined earlier and more often.

More information

Visit the National Eye Institute to assess your risk for eye disease.

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Medical Fitness Centers Grow in Popularity

 

By Josefina Loza

Associated Press Writer

The Associated Press

Sunday, July 25, 2004

The rising popularity of medical fitness centers is in line with the growth of a wellness culture, said Cary Wing with the Virginia-based Medical Fitness Association.

"The consumer is becoming much more savvy," Wing said. "They're asking questions whether they attend a commercial club or health center."

There were more than 700 medical fitness centers in the United States, Canada and Japan this year, compared with 550 reported in 2000, Wing said. The first medical fitness centers opened in the late 1970s.

After Howard Graff had bypass surgery 11 years ago, he needed a place where he could exercise without having a heart attack.

He wanted to work out under the watchful eye of a doctor or nurse. So the 62-year-old man from Skokie, Ill., joined a Chicago medical fitness center with health professionals — not just aerobics instructors — on staff.

"When someone comes out of surgery, you feel very alone. You were on the brink of going to the other side," Graff said. "I went through an enormous amount of mental stress and the center provided me with moral support."

He pays $60 a month for his membership at Galter LifeCenter, which offers guidance on nutrition and other healthy habits, along with the exercise.

In Lincoln, Neb., Madonna (news - web sites) ProActive Health and Fitness, a nonprofit medical fitness center under construction, will include machine and free weights, a lap pool, therapy pool, whirlpool, exercise rooms, running track, classrooms and day spa services. Doctors, nurses, sports psychologists, dietitians and fitness trainers will be on hand to supervise members.

The center is geared toward people between the ages of 35 and 65 because they are at higher risk of developing health problems, said Lori Warner, a spokeswoman for Madonna Rehabilitation Hospital.

"The goal is to try to help people live more complete lives," Warner said. "We're not just reacting after someone is hurt or sick, but to help prevent that."

The main difference between regular gyms and medical fitness centers is having doctors and nurses on hand to advise and oversee clients with health problems. It is medical professionals who help set exercise goals, Warner said.

Madonna ProActive is also expected to house outpatient rehabilitation therapy and offer services for people who don't have medical problems but simply want to stay fit.

Graff's cardiac problems finally forced him to quit his job as a consultant three years ago. But he remains comforted knowing his continuing workouts are under the domain of doctors and nurses.

"The peace of mind knowing there is skilled personnel to ... advise me and to guide me and protect me is priceless," he said.

Graff said he has become a walking advertisement for Galter LifeCenter, especially after a cardiac episode during his exercise there.

A fitness trainer stopped him from his workout routine because he saw Graff was having chest pain. A doctor at the center immediately examined Graff and performed several cardiac tests.

"I thought it would go away and it didn't," he said. "There are times when I've had chest pain and had there not been trained personnel there to take me into an emergency room, I might not be here today."

On the Net:

http://www.medicalfitness.org/

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Record Number of Flu Vaccines to Be Made

 

By Paul Elias

AP Biotechnology Writer

The Associated Press

Sunday, July 25, 2004

 

SAN FRANCISCO - In the heat of summer, the flu is probably the last thing on most minds. But July is when the nation's two main vaccine makers begin shipping shots to wholesalers, who in turn parcel them out to hospitals, clinics and doctors' offices nationwide. This year, health officials and shot producers vow not to run out as they did during last year's exceptionally early season start.

So this year, the Centers for Disease Control and Prevention (news - web sites) plans for the first time to stockpile 4 million vaccines for children and the two vaccine makers — Chiron Corp. of Emeryville and Aventis Pasteur — plan to make a combined 100 million doses. That's about 17 million more than were available last year.

On Friday, Chiron said it shipped 1 million doses to wholesalers as part of a production run that will ultimately yield 52 million shots this year, the most the company has produced in a single year.

Last year, the company made 38 million shots, accounting for about $230 million in revenue. That supply was quickly exhausted because the flu started in early October and quickly swept across the nation. By December, both makers had exhausted their supplies and many clinics ran out of shots before season's end.

"Last influenza season hit early and hit hard," said Howard Pien, Chiron's president and CEO.

A spokesman for Pennsylvania-based Aventis didn't return a telephone call Friday.

The CDC recommends that about 185 million Americans — including the elderly, children, and people with weakened immune systems — get flu shots each year. However, far fewer are actually vaccinated. Health officials expect a record number of people to request vaccinations this year owing to the publicity generated by last year's season and the subsequent shortage.

Vaccine manufacturing is a risky business — much guesswork goes into which strains to protect against each year and how many doses to make.

Two years ago, three manufacturers made 95 million doses — but only 80 million were used. The companies had to absorb the cost because the government doesn't pay for unused doses, prompting Wyeth to drop out of the business.

Based on the mild 2002-2003 flu season, the two remaining major manufacturers scaled back production last year and were unprepared for the surge in demand.

A third company, MedImmune Inc. of College Park, Md., produced a needle-free vaccine called FluMist last year, the first new vaccine on the market in 50 years. FluMist is squirted in the nose and the company had hoped it would be a popular alternative to the conventional vaccines, which are brewed in chicken eggs and delivered with a needle jab. But FluMist failed miserably, selling only 450,000 of 4 million doses it produced, and reported only $33 million in revenue.

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Schizophrenia Drug Maker Clarifies Risks

 

By Bruce Shipkowski

Associated Press Writer

The Associated Press

Sunday, July 25, 2004

 

TRENTON, N.J. - The maker of a popular medicine for schizophrenia has notified doctors that it minimized potentially fatal safety risks and made misleading claims about the drug in promotional materials.

Janssen Pharmaceutica Products sent a two-page letter to the health care community this past week to clarify the risks of Risperdal, Carol Goodrich, a spokeswoman for the Johnson & Johnson subsidiary, said Saturday.

The letter stems from a directive issued last year by the Food and Drug Administration (news - web sites), which told several makers of anti-psychotic drugs to update their product labels.

Janssen complied in November 2003, but the FDA (news - web sites) determined that the company's promotional materials still minimized the risk of strokes, diabetes and other potentially fatal complications. The agency also said Janssen made misleading claims that the medication was safer in treating mental illness than similar drugs.

The Miami Herald reported Saturday that a handful of boys in Florida developed lactating breasts after taking Risperdal.

The drug, which is prescribed to more than 10 million people worldwide, was cited in a federal lawsuit filed earlier this month by a doctor who claims children have been harmed and even killed by the misuse of drugs he blames on aggressive marketing by drug manufacturers.

"The FDA did not think we had (initially) provided enough information, so that is why further notification was done," Goodrich said.

Risperdal is the leading drug used to combat schizophrenia and other types of psychotic disorders, earning Janssen about $2.1 billion in annual sales. The drug was first marketed about eight years ago.

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Saturday, July 24, 2004

 

New Hope for Women Struggling With PMS

 

By Karen Pallarito
HealthDay Reporter

HealthDayNews

Saturday, July 24, 2004

SATURDAY, July 24 (HealthDayNews) -- Many women find the week or two leading up to their monthly period marred by unpleasant physical and emotional symptoms, which may include bloating, breast tenderness, fatigue and irritability.

While these symptoms usually disappear after the period starts, premenstrual syndrome (PMS) can be a monthly nuisance for many women, interfering with daily activities.

PMS symptoms tend to get trivialized, but they're no laughing matter. The American College of Obstetricians and Gynecologists reports that up to 40 percent of menstruating women experience some symptoms of PMS.

An estimated 5 percent to 10 percent of these women have a severe form of PMS called premenstrual dysphoric disorder (PMDD), characterized by depression, anxiety, tension and persistent anger or irritability.

With better treatments to ease or eliminate symptoms of PMS and PMDD, women needn't suffer in silence. Yet many still do.

Women have a grin-and bear-it mentality instilled by their own mothers who told them to just get through it, explained Ellen W. Freeman, a research professor in the Department of Obstetrics and Gynecology at the University of Pennsylvania School of Medicine in Philadelphia.

In some cases, she continued, women simply fail to take the time they need to seek out appropriate remedies: "They don't take care of themselves; they take care of everybody else."

While the causes of PMS are not clear, it appears some women may be more sensitive than others to fluctuating hormone levels.

Freeman led a recent study that may help confirm the hormone connection. In the May issue of Obstetrics & Gynecology, her research team found that PMS sufferers are at greater risk of experiencing common menopausal symptoms, such as hot flashes, depression, poor sleep and decreased libido.

"One of the theories is that PMS women are sensitive to hormonal changes -- their hormones are not abnormal, but they are sensitive to the changes in hormone," she said.

Similarly, studies suggest PMDD sufferers may be more susceptible to swings in estrogen and progesterone, negatively affecting brain function and triggering symptoms of depression.

But unlike a typical case of PMS, PMDD symptoms are so severe they lead to problems with relationships, work and social activities. According to the American Psychiatric Association, a woman must exhibit at least five symptoms nearly every month to be diagnosed with PMDD.

Experts say the newest class of antidepressants, called selective serotonin reuptake inhibitors (SSRIs), works well to treat the mood symptoms of PMDD. This class includes medications such as Prozac and Zoloft, among others.

"They eliminate symptoms, at least during the period of treatment," said Dr. Kimberly A. Yonkers, an associate professor of psychiatry at Yale University School of Medicine.

But if women stop the medication, their symptoms very often return, Freeman cautioned. "It does appear to be a chronic disorder that doesn't go away if you have it," she said.

At this point, there aren't many non-pharmaceutical treatments for PMDD, Yonkers noted. Diet and exercise are not nearly as effective as the SSRIs, and psychotherapy is very understudied, she said.

To relieve the physical symptoms of PMS, the National Women's Health Information Center says regular exercise, a healthy diet and medications such as over-the-counter PMS formulations or ibuprofen may help. It's also recommended that women avoid salt, sugary foods, caffeine and alcohol when they are having PMS.

For severe symptoms, your doctor may prescribe diuretics to ease bloating or birth control pills to stop ovulation.

There haven't been many studies to evaluate the role of vitamins and minerals in easing PMS symptoms, according to the American Academy of Family Physicians (news - web sites).

The one nutritional supplement that doctors don't hesitate to recommend is calcium, which is critical for bone health and often lacking in women's diets. A 1998 study found taking 1,200-milligram calcium supplements each day significantly reduced PMS symptoms.

If you've tried over-the-counter medications, supplements and lifestyle changes and still aren't getting relief, don't be discouraged. Women respond differently to different remedies, and your doctor may help you find the right combination of treatments.

More information

Visit the National Women's Health Information Center to learn more about the differences between premenstrual syndrome and premenstrual dysphoric disorder.

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