Walking Aids Diabetics (June 30, 2003) 

(Ivanhoe Newswire)

Diabetics can cut their risk of dying prematurely by just getting up and walking, report researchers in this month�s Archives of Internal Medicine.

Their study finds those who walked at least two hours a week had nearly a 40 percent reduction in death from all causes.

Many studies have shown the health benefits of regular physical exercise, including a reduction in the risk of developing diabetes in the first place, but little research has been done on the effect of exercise on people who already have the disease. In this study, investigators from the Centers for Disease Control and Prevention looked at nearly 3,000 adults with diabetes. All were questioned about their exercise habits through surveys administered in the community. Participants were followed for eight years.

When compared with individuals who did not exercise, those who reported at least two hours a week of walking had a 39-percent lower death rate overall and a 34-percent lower death rate from cardiovascular causes. Even better results were seen for those who walked three to four hours a week (up to a 54-percent reduction in overall death rates) and those who reported moderate increases in heart and breathing rates during their walks. These findings held true even after researchers adjusted the results to account for other factors that could increase the likelihood of dying, such as age, body mass index, and having other medical conditions.

The authors conclude, �Overall, these findings support current recommendations that brisk walking on a regular basis is a key health behavior for persons with type 2 diabetes.�

SOURCE: Archives of Internal Medicine, 2003;163:1440-1447

The Magic Pill for Cardiovascular Disease? (June 30, 2003) 

(Ivanhoe Newswire)

Two British researchers say a single pill could reduce heart attack and strokes by more than 80 percent.

The researchers propose a single pill containing aspirin, a cholesterol-lowering drug, three blood pressure-lowering drugs at half the standard dose, and folic acid could be the answer they�ve been searching for to help heart patients. They say if everyone takes the pill every day from age 55, it would have a huge impact on disease prevention in the Western world.

Professors Nicholas Wald and Malcolm Law based their conclusions on more than 750 trials involving 400,000 participants. Each component of the �Polypill� reduced one of four cardiovascular risk factors -- high blood cholesterol, blood pressure, blood cholesterol levels and platelet function.

Wald and Law suggest the pill would be taken without a medical exam or a measurement of risk factors, because the treatment would be effective regardless of the initial levels of risk factors. They add the risk factors are high in everyone in Western society so everyone is at risk. Clinical trials to test if the �Polypill� is safe and effective are planned.

In an accompanying editorial, Dr. Anthony Rodgers, from the University of Auckland in New Zealand, says, �Realizing this enormous potential should be a major goal especially for developing countries.� He notes the medications in the �Polypill� are safe and well tolerated, and new problems seem unlikely since they have been studied extensively and used together often.

SOURCE: British Medical Journal, 2003;326:1419-1423, 1407-1408

Silent Killer: High Blood Pressure (June 30, 2003) 

TAMPA, Fla. (Ivanhoe Newswire)

You could have it and not even know it. High blood pressure can be tested and prevented; but 25 million Americans have it and are unaware of it. The condition can lead to a heart attack, stroke or kidney failure. Here is what you need to know about this silent killer.

Edwin Mendez gets wired up to work out.

Twelve years ago, Mendez found out he has high blood pressure. He was 35. �It took me by surprise when the doctor told me about, it looks like you�re heading in the wrong direction as far as your high blood pressure,� he tells Ivanhoe.

Fifty million Americans have high blood pressure. Half don�t know it. Cardiologist John Dormois, M.D., says high blood pressure has no symptoms, but it does have many myths surrounding it.

According to Dr. Dormois, of St. Joseph�s Hospital in Tampa, many people believe high blood pressure happens later in life. �We�ve revised some of our recommendations, the American Heart Association and others, about when do you start looking for high blood pressure, and really it needs to be started when kids are in grade school.�

Many people also falsely believe that salt causes high blood pressure.

�If someone has high blood pressure, then a high-salt diet will certainly aggravate it. But, you can�t induce high blood pressure in a person who wouldn�t otherwise have it by just eating a lot of salt,� says Dr. Dormois.

Race also affects your risk for high blood pressure. Blacks have the highest risk.Mendez admits he didn�t take his high blood pressure seriously, but a heart attack two years ago changed that. Now he has his blood pressure checked often and he exercises regularly. He�s also improved his diet, and he�s keeping this silent killer in check.

Experts say blood pressure should not be higher than 130/80. They also say you don�t even have to go to a doctor to have it checked. It could benefit many people to check their blood pressure at least once a year at one of the machines often found in drug or grocery stores.

If you would like more information, please contact:
St. Joseph�s Hospital
3001 W. Dr. Martin Luther King Jr. Blvd.
Tampa, FL 33607
http://www.stjosephstampa.com

DDT Exposure and Pregnancy (June 27, 2003) 

(Ivanhoe Newswire)

Could a mother�s exposure to the now-banned pesticide DDT be impacting her daughter�s ability to get pregnant?

Yes, say researchers publishing in this week�s issue of The Lancet. Surprisingly, the problem may be mitigated if the DDT converts to a byproduct known as DDE.

DDT was banned in the United States more than 30 years ago after studies linked the chemical to toxic effects on the environment and health problems in people. It is still used in some countries, particularly those with high rates of malaria because of the pesticide�s effectiveness against mosquitoes.

Since DDT is known as a weak estrogen contaminant, investigators decided to study the pregnancy rate in women born between 1960 and 1963 to mothers who were exposed to DDT. Their aim was to determine if the exposure had any long-term impact on the daughters. The investigation measured DDT concentrations in blood samples taken from the women�s mothers at the time of their birth, along with concentrations of the DDT byproduct DDE.

All the women were questioned about their attempts to get pregnant, birth control use, and other factors impacting pregnancy. Those whose mothers had higher levels of DDT were less likely to become pregnant during times when pregnancy was not being actively avoided. The chance of pregnancy declined by about a third for every 10 micrograms of DDT per liter of blood in their mothers� blood samples. However, the chance of pregnancy during these times actually increased by about a sixth for every 10 micrograms of DDE per liter in their mothers� blood.

The researchers believe these results may foster new understanding about the role of DDT in fertility.

SOURCE: The Lancet, 2003;361:2205-2206

Chemotherapy Booster (June 27, 2003) 

NEW YORK (Ivanhoe Newswire)

Thousands of women with breast cancer have an improved chance of survival thanks to a new way of giving chemotherapy. Experts say this therapy could revolutionize not only breast cancer treatment, but many other cancer treatments as well.

It�s been a year and a half since Sari Sunshine was diagnosed with breast cancer. She says, �I felt some pain in my right breast, and I knew it wasn�t a normal pain, that it needed to be looked out.�

Doctors found a six-centimeter tumor that was quickly removed. Chemotherapy followed, but not in its usual form. Typically, chemotherapy is given every three weeks. Sunshine was treated every two weeks. It�s called dose-dense chemotherapy. It not only cuts treatment from six months to four months, it boosts survival rates by 31 percent.

Medical Oncologist Marc L. Citron, M.D., of Albert Einstein College of Medicine in Long Island, says, �By shortening the interval between chemotherapy, you may be able to increase tumor cell kill and hence increase the chance of cure.�

Until now, killing tumor cells has meant killing healthy white cells, too. A drug called neupogen, taken with chemotherapy, solves the problem, giving white cells a boost.

�Not only can you shorten the whole period of chemotherapy treatment, which may save the patient approximately two months of chemotherapy, but also you�re lowering the risk of infection and hospitalization,� says Dr. Citron.

The infection risk is actually lower with dose-dense therapy.

Sunshine says, �I have my life back, and hopefully it�s just a thing of the past. My prognosis is good.�

Researchers emphasize that dose-dense chemotherapy is not a treatment for advanced breast cancer. The therapy has only proven effective in patients whose cancer had not spread to any organs. The treatment is being tested in other cancers as well as other stages of breast cancer.

If you would like more information, please contact:

Mark L. Citron, M.D.
Albert Einstein College of Medicine
2800 Marcus Avenue
Lake Success, NY 11042
[email protected]

Eat Like a Greek (June 26, 2003) 

(Ivanhoe Newswire)

If you want to live longer, you might consider eating more like the average person from Greece, report investigators publishing in this week�s New England Journal of Medicine.

Their study of more than 22,000 adults in Greece shows those who adhered most closely to the traditional Mediterranean diet were significantly less likely to die from all causes.

Many studies have been conducted on diet and health, and researchers have identified specific foods and nutrients that appear to confer protective health effects. However, most have used data collected for other purposes. This study looked specifically at diet and longevity in a sample of the general population in Greece, where the traditional diet -- high in vegetables, legumes, fruits, nuts, cereals, fish, and olive oil, and low in saturated fats, dairy products, meat, and poultry, with a moderate intake of wine -- could lead to health benefits.

Participants were divided into groups according to how strictly they adhered to the traditional diet, and then followed for 44 months. During that time, 275 individuals died. Analysis showed those who stuck with the traditional diet had about a 25-percent reduction in overall mortality when compared with those who followed it less closely. The reduction in mortality was also seen specifically for both heart disease and cancer.

The investigators conclude, �The magnitude of the reduction in mortality associated with greater adherence to a Mediterranean diet is compatible with the reported survival advantage of adult Mediterranean populations over North American and northern European populations.�

SOURCE: New England Journal of Medicine, 2003;348:2599-2608

New Way to Detect Delivery Time (June 26, 2003) 

(Ivanhoe Newswire)

Researchers have found a new, more accurate way to predict labor and delivery times in expectant mothers.

There are currently several devices and methods used to predict labor and delivery. However, previous research has shown these methods have limited capabilities. In a new study, researchers from the University of Texas Medical Branch in Galveston set out to determine whether delivery could be better predicted by using transabdominal uterine electromyography.

According to the authors, contractions are generated by electrical activity within the uterus. This electrical activity is minimal at first but continues to build intensity throughout the pregnancy until it peaks in successive bursts just before delivery. Researchers say, �It is generally thought that the uterus undergoes a critical transition to become electrically prepared for labor and delivery.� It is the accurate detection of that �transition� time that researchers feel will be most effective in predicting delivery.

In this study, 99 women of varying gestational age were divided into two groups: term (37 weeks or more) and preterm (less than 37 weeks). Uterine electrical activity was measured by transabdominal electromyography and bursts of activity were recorded for 30 minutes. These recordings were later evaluated after the time of delivery was determined.

Study results show that, in general, as women get closer to delivery, the frequency for electrical activity within bursts increases. Researchers say a larger percentage of electrical bursts are found at higher frequencies in term patients that are within 24 hours of delivery at the time of measurement than those who deliver more than 24 hours after recording. Similarly, preterm patients transition into more frequent electrical bursts approximately four days before delivery.

Based on these findings, researchers say noninvasive, transabdominal recording of uterine activity can effectively predict labor and delivery in expectant mothers. They add, �The ability to make a successful negative prediction for labor when no spectral shift is seen is of great use to obstetricians, patients, and hospitals, where subjective analysis might often fail.�

Researchers conclude that it may be useful to monitor the uterine electromyography of patients more frequently as they approach their due date. They say a similar procedure could be established much earlier in pregnancy as a precautionary measure for patients at risk of preterm labor.

SOURCE: Obstetrics and Gynecology, 2003;101:1254-1260

FDA Approves First Co-Packaged Treatments to Reduce Occurrence of Serious Cardiovascular and Cerebrovascular Events (June 25, 2003) 

The Food and Drug Administration (FDA) is announcing the approval of Pravigard PAC (co-packaged pravastatin sodium and buffered aspirin tablets) for use when treatment with both Pravachol (pravastatin) and buffered aspirin is appropriate. This co-packaged product may be more convenient for some patients.

Pravachol and buffered aspirin are both indicated to reduce the occurrence of cardiovascular events, including death, myocardial infarction or stroke, in patients who have clinical evidence of cardiovascular and/or cerebrovascular disease. Patients receiving treatment with Pravigard should also be placed on a standard cholesterol-lowering diet.

Pravachol is a prescription medication that both lowers the amount of �bad� (or LDL) cholesterol and raises the amount of �good� (or HDL) cholesterol. High cholesterol levels can lead to plugs or clots in blood vessels.

Buffered aspirin stops the normal blood clotting process and keeps clots from forming in blood vessels that can lead to myocardial infarctions or strokes. Buffered aspirin has aspirin in it along with other ingredients that may lower patients� chances of getting an upset stomach.

Pravigard PAC should not be taken by patients who have certain liver or kidney problems, women who are pregnant or planning to become pregnant, individuals less than 18 years of age or by individuals who are allergic to non-steroidal anti-inflammatory (NSAID) medicines or any of the ingredients in Pravigard PAC.

Possible serious side effects associated with the use of Pravigard PAC include muscle damage, liver damage, bleeding and stomach problems. It is therefore important for patients taking Pravigard PAC to tell their doctors if they experience any of the following: unexplained muscle pain or weakness, unusual bleeding, heartburn, nausea or vomiting, stomach pain or bowel movements or stools that look like black tar. Liver function tests may be performed prior to the initiation of Pravigard PAC.

The usual dose of Pravigard PAC is 1 aspirin tablet with 1 Pravachol tablet once a day. Pravigard PAC is available in cartons containing either 30 buffered aspirin 81mg or 325mg tablets packed with either 30 Pravachol 20mg, 40mg or 80mg tablets.

The Bristol-Myers Squibb Company of Princeton, N.J., is the sponsor of the approved New Drug Application (NDA) for Pravigard PAC.

Let Anger go, Save the Headache (June 25, 2003) 

(Ivanhoe Newswire)

If you're angry about something, let it out and it might save you a headache. A new study out of St. Louis University shows people with headaches internalize their anger more than those without headaches.

Of the 422 adults who participated in the study, 171 suffered from headaches. Investigators measured trait anger (how much anger experienced in daily life), internalized anger, hostility, anxiety and depression. Participants also provided information about their headache characteristics.

Researchers found holding anger in was the strongest predictor of a headache and is more common among headache sufferers, even when depression and anxiety is taken into account. Trait anger and hostility did not differ between the groups after researchers controlled for depression and anxiety.

Previous research shows people with headaches may experience more problems with anger and how they express it when compared to people without headaches. Recent studies show anger may also be bad for the heart. Researchers from the University of North Carolina at Chapel Hill found people who are prone to anger may be more likely to have a heart attack than others who calmly deal with frustrating situations.

SOURCE: Headache: The Journal of Head and Face Pain, 2003;43:651-663

Screening Test for Gestational Diabetes (June 23, 2003) 

(Ivanhoe Newswire)

In a new study, researchers have determined a fasting plasma glucose test used at the first prenatal visit is not an effective method of screening for gestational diabetes.

The standard method of screening for gestational diabetes mellitus (GDM) in expectant mothers is the one-hour glucose challenge test. However, there are some concerns that have surfaced regarding this test�s clinical efficacy. For example, test results may vary depending on the amount of time since a woman�s last meal. Also, the timing of the test has to be very precise with blood for the glucose test being drawn exactly one hour after ingesting the glucose. Also of concern are unpleasant side effects that the concentrated glucose can cause, often decreasing compliance with the test.

In a new study, researchers from California predicted that using the fasting plasma glucose as a screening test for diabetes early in gestation would offer advantages over the currently used postglucose challenge. The study involved more than 4,500 patients recruited from the Kaiser Permanente Bellflower Medical Center who were not known to have diabetes. All of the women were asked at their first prenatal visit to return for routine laboratory work and a venous plasma glucose test the next morning after a fast beginning no later than midnight.

Upon testing, women whose blood sugar levels were 100 mg/dL to 125mg/dL were advised to have a glucose tolerance test immediately. Those women with a fasting plasma glucose concentration greater than or equal to 126mg/dL were asked to return for a second test. If the second test revealed similar numbers, those women were referred to care for diabetes. All women not identified as having diabetes were advised to have a two-hour GTT at their first visit after their 23rd gestational week.

Study results show that 302 women were identified as having gestational diabetes. However, researchers say there was a false-positive rate of 57 percent to achieve a sensitivity of 80 percent. In other words, over half of all the patients who did not have gestational diabetes underwent a GTT to be able to identify 80 percent of those who did. These false-positive rates were significantly greater than those of other screening methods used to detect gestational diabetes.

Researchers therefore conclude that, while detection of gestational diabetes early in pregnancy is a desirable goal, the implications of the current study show the fasting plasma glucose screening test given at the first prenatal visit is not an efficient screening test for gestational diabetes.

SOURCE: Obstetrics & Gynecology, 2003;101:1197-1203

A Drink a Day may Keep Diabetes Away (June 23, 2003) 

(Ivanhoe Newswire)

The latest results from the ongoing Nurses Health Study II suggest women who consume a light to moderate amount of alcohol each day may decrease their risk of developing type 2 diabetes.

Research on diabetes and alcohol intake has produced conflicting results, with most studies showing a higher risk among heavy drinkers and a lower risk among light to moderate drinkers. Scientists speculate lighter drinking may have a positive effect because alcohol increases insulin sensitivity and slows blood sugar intake from a meal. Most of these studies, however, have been conducted among men.

In this study, researchers used data from the nurses� study to assess diabetes risk in women who never drank or who consumed light, moderate, or heavy amounts of alcohol. Participants were between ages 25 and 42 when the study began in 1989. All completed detailed questionnaires related to diet and health every two years through 1999. For this study, women who already had diabetes or other medical conditions at the start of the study were excluded.

About 930 of the nearly 110,000 women in the study developed diabetes during the follow up. Compared with women who never drank, women who consumed light to moderate amounts of alcohol were significantly less likely to have developed diabetes, even after researchers adjusted the findings to take other factors that could have led to diabetes into account. The effect was most prominent among women who mainly drank beer and wine. Heavier drinkers, however, were found to have an increased risk of developing the disease when compared with the light to moderate drinkers.

The researchers conclude these findings are similar to those seen in other studies conducted mainly among middle-aged men.

SOURCE: Archives of Internal Medicine, 2003;163:1329-1336

Vitamin D Wipes out Cancer Cells (June 23, 2003) 

(Ivanhoe Newswire)

Researchers have found another benefit of vitamin D. A new study shows one form of the vitamin may enhance the effect of radiation treatment for breast cancer.

Investigators compared tumor growth in mice treated with radiation alone to mice exposed to both radiation and EB 1089, a derivative of vitamin D. After treatment, the tumor volume in those women treated with EB 1089 was 50-percent lower than in the group that received radiation alone.

Radiotherapy is commonly used to treat breast cancer, both before surgery to reduce tumor size and after surgery to reduce tumor recurrence. However, some remaining cells are often resistant to radiation. In addition to wiping out radio-resistant cells, researchers have modified EB 1089 so it has fewer side effects.

Lead researcher Sujatha Sundaram, Ph.D., from Dartmouth Medical School in Hanover, N.H., says these results are very encouraging. She adds, "We are eager to push ahead to clinical trials with breast cancer treatments in humans." EB 1089 is now in clinical trials in Europe for the treatment of cancer, but it is not being studied with radiation therapy.

Each year, 200,000 women in the United States are diagnosed with breast cancer.

SOURCE: Journal of Clinical Cancer Research, 2003;9:2350-2356

Breaking up Dangerous Clots (June 20, 2003) 

(Ivanhoe Newswire)

Dangerous blood clots that often develop after hip surgery can be reduced by 96 percent when patients receive about a month�s worth of treatment with a new type of blood thinner.

That�s the major finding from a new study published in this month�s Archives of Internal Medicine. Researchers from Sweden studied about 650 patients who were undergoing surgery for a hip fracture. About half received daily injections of the drug fondaparinux for between 19 and 23 days, while the other half received injections of a placebo. All of the study participants had received six to eight days of treatment with the drug prior to beginning the study.

Researchers were able to measure outcomes in 428 of the patients. The incidence of postoperative venous thromboembolism, a form of deep vein clotting occurring after surgery, was 35 percent in the patients who received placebo vs. 1.4 percent in those who received fondaparinux. There were no significant differences between the two groups in clinically significant bleeding, although those in the fondaparinux group did trend towards more major bleeding than those in the placebo group.

Finding ways to prevent dangerous blood clots in hip surgery patients is a major concern among doctors, because these patients are at highest risk of any surgical patients for the development of deep vein thrombosis. The authors write, �We believe that our study population is representative of patients undergoing surgery for hip fracture in clinical practice and that these beneficial results can be reproduced in a routine setting.�

SOURCE: Archives of Internal Medicine, 2003;163:1337-1342

Stroke Risk in the Unborn? (June 20, 2003) 

(Ivanhoe Newswire)

New research shows pregnant mothers who do not provide proper nutrition for their unborn children may put the children at risk for stroke later in life.

Researchers examined data from four studies that looked at the geographical distribution of stroke patients in England and Wales between 1968 and 1978. They compared this data to the number of newborn and maternal deaths that occurred more than 50 years earlier, which was about the time when the stroke patients were born.

Results of the study show areas with high incidents of stroke in the 1960s and 1970s also had high maternal and newborn death rates around the turn of the century. Mothers living in these areas more than 50 years ago tended to be poor, malnourished, and generally unhealthy overall. Many of these women also had infants with low birth weights.

Researchers say there are geographical variations in stroke death that cannot be explained by lifestyle behaviors. For example, in the United States more strokes occur in the southeastern portion of the country. In England and Wales, more strokes occur in northern towns.

The malnourished pregnant women who lived in certain areas years ago may account for many of the strokes that occur in that region today. Thus, researchers involved in the study believe stroke risks in certain people originate from their responses to malnutrition during fetal life and infancy. They think these responses permanently change the body�s structure and function in ways that lead to disease later in life.

David J.P. Barker, F.R.S., from the University of Southampton, England, says protecting the growth and nutrition of pregnant women may reduce future stroke deaths. �Stroke risk is not just in the genes,� Barker says. �It is about the environment in the womb.�

SOURCE: To be published in an upcoming issue of Stroke

FDA Approves First Biologic for Allergy-Related Asthma (June 20, 2003) 

The Food and Drug Administration (FDA) today approved the first biotechnology product to treat patients with a type of asthma that is related to allergies.

The product, omalizumab, is a monoclonal antibody that has been shown to be safe and effective to treat people 12 years of age and older with moderate to severe allergy-related asthma inadequately controlled with inhaled steroid treatments. In these patients, omalizumab, marketed as Xolair, has been shown to decrease the number of asthma exacerbations or episodes of airway narrowing that result in wheezing, breathlessness, and cough. The product is given as an injection under the skin.
Asthma is an airway disease affecting approximately 17 million Americans. It is estimated that a relatively small percentage of these people would be appropriate candidates for this new drug. It is a second-line treatment, recommended only after first-line treatments have failed; it is not approved for children under the age of 12; and it is known to work and approved only for patients with moderate to severe, allergy-related asthma. 

While the cause for most forms of asthma is unclear, asthma caused by allergies is better understood and results from the immune system�s over-reaction to inhaled allergens such as dust mites or animal dander. The body forms antibodies in response to the allergen and this immune system reaction prompts inflammation causing airway narrowing and other symptoms. Xolair is a genetically engineered protein that blocks this immune response.

Only patients who have asthma caused by allergies can benefit from this new treatment. Therefore, the product�s labeling states that this type of asthma should be established by skin or blood test before treatment.

The effectiveness of Xolair was mainly assessed in two placebo-controlled studies lasting six months that included over 1,000 adolescents and adults. These patients all had persistent symptoms despite the use of inhaled corticosteroids. About 80-85% of patients treated with Xolair had no exacerbations of their asthma symptoms compared to about 70-75% of placebo treated patients. During the clinical trials, more patients treated with Xolair developed a new or recurrent cancer (0.5%) compared to control patients (0.2%). The sponsor is planning long-term studies in an attempt to determine whether there is a relationship between Xolair treatment and cancer. 

The other major safety concern with Xolair identified in the clinical trials was severe allergic reactions or anaphylaxis. Anaphylaxis occurred in three patients; all responded to and recovered following medical treatment. 

Xolair is manufactured by Genentech, San Francisco, Calif. Genentech will jointly market the product in conjunction with Novartis Pharmaceutical Corp., East Hanover, NJ. 

Diabetes Linked to Low Bone Density (June 18, 2003) 

By Stacie Overton, Ivanhoe Health Correspondent
NEW ORLEANS (Ivanhoe Newswire)

Presenting at this year�s 63rd Annual Meeting of the American Diabetes Association in New Orleans, Elsa Strotmeyer, Ph.D., MPH, from the University of Pittsburgh, presented results of a study that shows women with type 1 diabetes have lower bone mineral density than women without diabetes.

Strotmeyer explained case-controlled studies have shown decreased bone mineral density in men and women with type 1 diabetes, but the relationship of BMD and type 1 diabetes before and after menopause is not well established. In a study of more than 200 women, researchers assessed hip, spine and whole body BMD as well as total fat and lean muscle mass in pre-menopausal women with type 1 diabetes and without diabetes.

Though results show no differences in markers of bone formation between the two groups, researchers did find significant differences in BMD between the two groups. Type 1 diabetes was significantly associated with low BMD at the hip and whole body measurements. There was not a significant difference in BMD at the spine. Women with type 1 diabetes also reported more fractures after age 20 (32 percent) than women without diabetes (20 percent).

Strotmeyer explains women with type 1 diabetes may have a higher risk of fracture than nondiabetic women, saying, �A one standard deviation decrease in BMD relates to a two-fold increase in hip fracture, so women with type 1 diabetes may have markedly increased risk of fracture before and after menopause.� She also reports that menopause occurs about eight years earlier in women with type 1 diabetes.

SOURCE: Reported at the 63rd Annual Meeting of the American Diabetes Association, New Orleans, June 13-17, 2003

Stroke and the Pill (June 18, 2003) 

(Ivanhoe Newswire)

Healthy women who take the newer, lower-dose birth control pills are not increasing their risk of stroke, finds a new study.

Ever since birth control pills debuted in the 1960s, doctors have worried the pills could increase a woman�s risk of stroke. Most studies looking at the link, however, have looked at women who took early forms of the pill, which contained higher levels of estrogen compared to those in use today. Whether lower dose pills confer the same risk has been unclear, but most doctors have continued to recommend the pill only for healthy, younger women just to be safe.

In this study, researchers from Australia conducted detailed interviews with 234 women ages 15 to 55 who had experienced a stroke and 234 others who had not experienced a stroke. All were asked to provide a history of birth control pill use, along with information on other health conditions and health-related lifestyle factors.

Results showed no statistically significant stroke risk related to the use of lower-dose birth control pills nor was there a link seen between years of pill use and the risk of stroke. Women who smoked, however, had about four-times greater risk of stroke as nonsmokers, although the risk dropped considerably among former smokers. Women with known stroke risk factors, such as high blood pressure, had about twice the risk.

The researchers conclude otherwise healthy women who do not smoke run few stroke risks from taking oral contraceptives. However, women with conditions known to increase stroke risk, such as high blood pressure, a family history of stroke, and diabetes, should be prescribed the pill with caution.

SOURCE: To be published in an upcoming issue of Stroke

Breastfeeding may Counter Harm of Smoking in Pregnancy (June 16, 2003) 

(Ivanhoe Newswire)

Breastfeeding may compensate for the harmful effects of smoking during pregnancy on a child�s brain, suggests research in the Journal of Epidemiology and Community Health.

Other studies have demonstrated the harmful effects of smoking during pregnancy on the cognitive development of children. Dr. Laura Batstra, and colleagues, from University Hospital Groningen, Groningen, the Netherlands, analyzed 570 only children born from 1975 to 1978. They analyzed details of the mother�s smoking habits during pregnancy and the children�s test scores in math, reading, and spelling at age 9.

Researchers recorded the mother�s choice of feeding preferences for her child when their children were ages 9 and 25 to ensure that their recall was reliable. Children excluded from the study included those who were only breastfed for a couple of weeks and those who were fed both breast milk and formula.

Study results demonstrate only those children whose mothers had smoked during pregnancy and who had been bottle-fed performed poorly on the tests.

The authors explain, �Mothers who breastfeed their children might differ from woman who don�t in some way that has not been accounted for. Or there may be some psychological aspects of breastfeeding that might influence a child�s cognitive development.�

The long chain polyunsaturated fatty acids contained in breast milk may promote brain development counteracting the harmful effects of smoking on fetal development.

The authors conclude, �Mothers who smoke should be encouraged to breastfeed.�

SOURCE: Journal of Epidemiology and community Health, 2003;57:403-404

Obese Patients can Have Surgery (June 16, 2003) 

(Ivanhoe Newswire)

New research suggests there is no justified reason for obese people to be excluded from surgery because of fears about postoperative complications.

Researchers from Zurich's University Hospital in Switzerland investigated about 6,300 patients undergoing general elective surgery. Out of those participants, 13 percent were obese, 9 percent were mildly obese, and 4 percent had severe obesity. Results of the study show no difference in postoperative complications between obese and non-obese patients. The exception was a small increase in the proportion of obese people who developed wound infection after open surgery. Investigators say wound infection in obese patients may be related to the presence of excessive fat tissue.

Study results also show morbidity rates and hospital stay in obese patients compared to non-obese patients were about the same. Minor and major surgeries were more frequently done in patients who were not obese than in those who were obese.

Researchers say prejudice obese patients face may be related to the surgeon's perception that operating on obese patients is confounded by technical difficulties. Investigators suggest surgery should be done laparoscopically whenever possible to reduce infections. During laparoscopy, a small incision and a lighted tube called a laparoscope is inserted into the abdomen. Instruments, such as surgical scissors, can be inserted through additional incisions.

The prevalence of obesity is increasing in all industrialized countries. In the United States, about 300,000 adults die every year of causes directly related to obesity.

SOURCE: The Lancet, 2003;361:2032-2035

Sleep Eating (June 16, 2003) 

FORT WORTH, Texas (Ivanhoe Newswire)

It�s one thing to be shoving fistfuls of food in your mouth and eating uncontrollably. It�s another thing to be doing it in your sleep. Millions of Americans do it. It�s called sleep eating. Many are ashamed to tell anyone or get treatment, but there is help for those with the disorder.

Susan Smith can enjoy this snack because she�s awake. �Then I�d get up and see all the food in the kitchen that was gone, you know, that I had eaten," she tells Ivanhoe.

As a teenager, Smith started eating in her sleep. �Ice cream, bread, you know, cake. You know, you don�t get up and eat apples.� At times, she had eight episodes in one night -- episodes she never remembers. For 30 years, she�s lived with the stigma of her condition.

�I know there are children out there that suffer from this. They shouldn�t have to go through it alone. It�s terrible,� she says.

Lea Montgomery, R.N., M.S., recently wrote an article on sleep eating. The response she received from people with the disorder was overwhelming.

�I�m not talking about making a plate, sitting at the table, having a nice meal in your sleep. I�m talking about frenzied, chaotic, disorganized and primitive eating,� says Montgomery, of Texas Christian University in Fort Worth, Texas.

As many as 4 million Americans are sleep eaters. Exercise, avoiding caffeine and having a bedtime routine can help. Medication may be needed.

Smith tried several drugs but the side effects were too severe. She finally found relief with Wellbutrin, an anti-depressant. �For the first time since I was a teenager, I slept through the night.�

At 43, she�s now in college catching up on the years she�s missed.

Other drugs that have proven effective in the treatment of sleep eating include anti-seizure medications and more recently, drugs that affect dopamine in the brain. The medications do have side effects and experts say there is no guaranteed cure for sleep eating. Experts also say sedatives and alcohol can make sleep eating worse for a patient.

If you would like more information, please contact:

Lea Montgomery, R.N., M.S.
Harris School of Nursing
Texas Christian University
P.O. Box 298620
Forth Worth, TX 76129
(817) 257-6732
[email protected] 

Helping Kids Attain a Healthy Weight (June 16, 2003) 

(Ivanhoe Newswire)

Research shows being overweight in childhood leads to numerous health concerns. But a new study finds kids between ages 8 and 12 are more likely to link weight to athletic performance and appearance than health.

Even more significantly, their parents also fail to see the importance of a healthy weight, instead viewing overweight problems in children more in terms of appearance and self-esteem.

These results come from an extensive set of surveys conducted by investigators from the International Food Information Council Foundation and published in this month�s Journal of the American Dietetic Association.

The prevalence of overweight children has grown by leaps and bounds over the past decade, rising by 50 percent since 1991. Doctors generally believe the problem lies in an imbalance between energy consumed and energy expended -- in other words, kids are eating too much and exercising too little. Combating the problem has been a challenge, and these researchers decided to undertake this extensive consumer survey as a first step in the development of a research-based communications and education campaign.

Given the overwhelming disconnect between the health implications of being overweight and the perceptions of childhood obesity seen in the study, the authors identified the following strategies for addressing the problem:

Parents and children need to work together to address overweight prevention by communicating more effectively about eating and exercise habits. 
Attainable eating and exercise goals should be set and celebrated when achieved 
Self-esteem issues regarding appearance and other issues should be addressed by parents in a sensitive and positive fashion to avoid emotional outbursts that can derail positive changes 
Tools are needed to help parents and children reach their goals concerning weight
To assist with these goals, the researchers have developed a Web site -- http://kidnetic.com -- specifically geared to treating and preventing weight problems in children. Says American Dietetic Association spokesperson Keith Ayoob, �Overall weight management comes from a balance of healthy eating and active living, and Kidnetic.com was designed to get kids moving and make nutrition fun.�

SOURCE: Journal of the American Dietetic Association, 2003;103

Cholesterol Drugs Benefit Diabetics (June 16, 2003) 

(Ivanhoe Newswire)

A new study out of England finds people with diabetes can significantly lower their risk of cardiovascular disease if they take a cholesterol-lowering drug.

The research noted a 25-percent reduction in risk among diabetics who already showed signs of heart disease, and a 33-percent reduction in risk among those who did not show signs of the condition.

Doctors know people with diabetes are at higher risk for heart disease and stroke, and they also know drugs called statins are effective in preventing these conditions in people without diabetes, even if they have normal cholesterol levels. People with diabetes often have lower than normal HDL cholesterol levels (the �good� cholesterol) and elevated triglyceride concentrations. But since most people with the disease tend to have total cholesterol and LDL cholesterol (the �bad� cholesterol) values similar to those in the general population, they are not normally prescribed a statin drug unless these values are elevated. Doctors instead concentrate on achieving good blood sugar control and lowering blood pressure to reduce heart disease risk in diabetic patients.

In this study, researchers compared results for about 6,000 adults with diabetes, about half of whom also showed signs of occlusive arterial disease, and around 14,500 others without diabetes but with occlusive arterial disease. Subjects were randomly assigned to receive either the statin simvastatin or a placebo and then followed for five years.

The 25-percent reduction in cardiovascular risk seen in diabetic subjects taking the statin was similar to the reduction seen in the occlusive arterial disease subjects receiving the drug. It occurred in patients with both type 1 and type 2 diabetes, in older and younger patients, in patients with better and worse blood sugar control, in patients with below average cholesterol levels, and in patients with high blood pressure.

Author Rory Collins notes, �The present study provides direct evidence that cholesterol-lowering therapy is beneficial for people with diabetes even if they do not already have manifest coronary disease or high cholesterol concentrations. Statin therapy should now be considered routinely for all diabetic patients at sufficiently high risk of major vascular events, irrespective of their initial cholesterol concentrations.�

SOURCE: The Lancet, 2003;361:2005-2016,200,2001

Breastfeeding may Counter Harm of Smoking in Pregnancy (June 16, 2003) 

(Ivanhoe Newswire)

Breastfeeding may compensate for the harmful effects of smoking during pregnancy on a child�s brain, suggests research in the Journal of Epidemiology and Community Health.

Other studies have demonstrated the harmful effects of smoking during pregnancy on the cognitive development of children. Dr. Laura Batstra, and colleagues, from University Hospital Groningen, Groningen, the Netherlands, analyzed 570 only children born from 1975 to 1978. They analyzed details of the mother�s smoking habits during pregnancy and the children�s test scores in math, reading, and spelling at age 9.

Researchers recorded the mother�s choice of feeding preferences for her child when their children were ages 9 and 25 to ensure that their recall was reliable. Children excluded from the study included those who were only breastfed for a couple of weeks and those who were fed both breast milk and formula.

Study results demonstrate only those children whose mothers had smoked during pregnancy and who had been bottle-fed performed poorly on the tests.

The authors explain, �Mothers who breastfeed their children might differ from woman who don�t in some way that has not been accounted for. Or there may be some psychological aspects of breastfeeding that might influence a child�s cognitive development.�

The long chain polyunsaturated fatty acids contained in breast milk may promote brain development counteracting the harmful effects of smoking on fetal development.

The authors conclude, �Mothers who smoke should be encouraged to breastfeed.�

SOURCE: Journal of Epidemiology and community Health, 2003;57:403-404

Vitamins Harming, not Helping, the Heart (June 13, 2003) 

(Ivanhoe Newswire)

Antioxidant vitamin supplements aren�t beneficial in the prevention of heart disease or stroke, shows a new study published in this week�s issue of The Lancet.

Researchers have long speculated antioxidant vitamins, such as beta carotene (a form of vitamin A) and vitamin E, might play a role in helping people avoid cardiovascular disease. The vitamins were thought to work by keeping the arteries free of dangerous plaque. Several preclinical studies show supplementing the diet with these vitamins could inhibit plaque build-up in people who have yet to develop any vascular problems. Numerous large studies ensued hoping to confirm that finding.

Investigators from the Cleveland Clinic decided to review the results of eight large-scale studies involving beta carotene treatment and seven involving vitamin E. All trials included at least 1,000 patients. Patients in the studies were followed between 1.4 years and 12 years. Researchers evaluated whether people who received the active treatments had a lower mortality rate, decreased risk of cardiovascular death, and decreased risk of stroke.

Researchers found vitamin E supplements had no effect on overall mortality or cardiovascular mortality, and they failed to reduce the incidence of stroke. Beta carotene supplements were actually associated with a small but statistically significant increase in overall mortality and cardiovascular mortality.

The authors write, �Our findings are especially concerning given that the relevant beta carotene doses are commonly used in preparations of over-the-counter vitamin supplements and are included in smaller doses in readily available multivitamin supplements that have been advocated for widespread use.�

They recommend people stop taking these supplements and discourage any further heart disease-related research involving these vitamins.

SOURCE: The Lancet, 2003;361:2017-1023

Treatment Cuts Preterm Births (June 12, 2003) 

(Ivanhoe Newswire)

A new study shows women at risk of delivering their babies too soon may significantly reduce that risk if they receive regular injections of a form of progesterone while pregnant.

Preterm birth is a common complication of pregnancy in the United States, and the biggest cause of infant mortality throughout the developed world. Women who have one preterm birth are at significantly higher risk for additional preterm births. Small studies have suggested treatment with hydroxyprogesterone caproate, or 17P, might reduce the risk, presumably because of the hormone�s ability to relax the smooth muscle wall of the uterus and block other actions in the uterus that make it contract. Researchers across the country set out to determine if the treatment would work in a larger study conducted at 13 medical centers.

The study involved 463 women who had experienced a previous preterm birth. About two-thirds of the group were treated with weekly injections of 17P, while the rest received placebo injections. Results showed the active treatment cut the number of preterm births by about one-third. Only 36 percent of the women on the treatment delivered their babies before 37 weeks of gestation, compared to nearly 55 percent of women who received placebo injections. Similar benefits for 17P were seen when researchers looked at women delivering even earlier in their pregnancies.

Babies born to mothers who received the injections also suffered significantly fewer complications of birth, including breathing difficulties and inflammation of the colon.

SOURCE: New England Journal of Medicine, 2003;348:2379-2385

Simple Stroke Prevention is Best (June 11, 2003) 

(Ivanhoe Newswire)

Aspirin appears to be a better treatment than the antiplatelet drug ticlopidine for preventing recurrent strokes in black patients, according to new research in this week�s issue of the Journal of the American Medical Association.

The study included 1,809 black men and women who recently had strokes that were not due to bleeding in the brain or to blockage of a blood vessel in the brain. Participants received either a daily 500-milligram dose of ticlopidine or a daily 650-milligram dose of aspirin.

Researchers hypothesized ticlopidine would be more effective in black ischemic stroke patients than aspirin. The study was halted after 6.5 years when researchers found the exact opposite. In fact, study results suggest a 40-percent to 50-percent likelihood of aspirin being significantly better in reducing stroke risk if the study were to continue to completion.

Investigators conclude, "Aspirin is much less expensive than other major antiplatelet agents, is readily available, easy to use, and relatively safe."

Blacks are about twice as likely as most other individuals in the United States to die from or experience stroke. In an accompanying editorial, Ralph Sacco, M.S., M.D., from New York Presbyterian Hospital, says, "[The study] provides new data on an alternate antiplatelet agent (ticlopidine) that should no longer be recommended for prevention of recurrent stroke -- certainly not in black patients."

SOURCE: Journal of the American Medical Association, 2003;289:2947-2957

Gauging SIDS Risk (June 9, 2003) 

(Ivanhoe Newswire)

Mothers who go into spontaneous labor earlier in their full term pregnancies may be more likely to have a baby who succumbs to sudden infant death syndrome, according to a new study out of Scotland.

Many studies have linked premature birth with SIDS, but little is known about the impact of earlier labor in full term births on SIDS. In this study, researchers analyzed the birth records of all infants born between 37 and 42 weeks gestation over three years. This information was compared to death records for infants who died from SIDS in the first year of life during the same time period. The births were divided into two categories: elective births and nonelective births. Elective births were those where labor was intentionally induced. Nonelective births were characterized by spontaneous labor.

The comparison showed no significant association between risk of SIDS and the developmental age of the baby among the elective births in the group. On the other hand, among the spontaneous labor group the risk of SIDS declined with each additional week the baby spent in the womb. Adjustment for other factors that could have impacted SIDS risk, such as maternal smoking, maternal age, and socioeconomic considerations, only slightly altered the risk.

The researchers conclude earlier spontaneous labor at term and SIDS may somehow be linked, most likely through an association with a suboptimal intrauterine environment.

SOURCE: Pediatrics, 2003;111:1367-1371

Response to Exercise Training in CHF Lower in Women Than Men (June 6, 2003) 

NEW YORK (Reuters Health)

Improvements in peak exercise capacity in response to exercise training are more pronounced in men than in women with chronic heart failure, according to a report in the May issue of the American Heart Journal. These differences match the variation between the sexes in changes in myosin heavy chain (MHC) I isoforms.

"Abnormalities of MHC isoforms, enzyme activity, and capillarity contribute to the exercise intolerance that is characteristic of patients with heart failure," Dr. Steven K. Keteyian, of the Henry Ford Heart and Vascular Institute, in Detroit, Michigan, and colleagues note. "To what extent these changes can be reversed with exercise training and whether differences exist in the responses of men and women remains uncertain."

The researchers compared the effects of exercise training on exercise capacity and skeletal muscle histochemistry in 10 men and 5 women with chronic heart failure. The patients completed a 14- to 24-week exercise training program.

Peak oxygen consumption improved significantly (p < 0.05), according to the investigators. However, the increase was mostly attributable to the improvement in men versus women (+20% versus +2%, respectively; p < 0.01).

Men had significantly lower MHC I content at baseline than women (33% versus 49.6%, respectively; p < 0.05). While the MHC I content improved with training in both sexes, the increase was mainly due to the 38% increase found in men (p < 0.05).

"Capillary density at baseline was significantly greater (p < 0.01) in men...than in women...and neither group showed a significant change with training," Dr. Keteyian and colleagues observed. Also, they found no significant differences between men and women for muscle enzyme activity at baseline or after training.

They conclude that, given these findings, "trials involving larger groups of patients, with particular attention to sex-specific responses to mechanistic biochemical and physiological parameters, are warranted."

Source : Am Heart J 2003;145:912-918.

Intensive Therapy Helps Diabetics� Hearts (June 6, 2003) 

(Ivanhoe Newswire)

Type 1 diabetics who opt for intensive therapy may also be increasing their chances of avoiding heart disease.

That�s the take-home message from a new study that looked at carotid artery thickness in about 600 patients who were on intensive diabetes therapy and 600 similar patients who received usual treatment for the disease.

Studies have shown people with type 2 diabetes are significantly more likely to develop cardiovascular disease than those without the condition. The link between heart disease and type 1, or insulin-dependent diabetes, however, has been less clear. Researchers decided to gauge cardiovascular risks in type 1 patients by looking at carotid artery thickness. Thickness of the artery, which is located in the neck, is considered a good predictor of cardiovascular problems.

Patients in the study were taking part in a larger study aimed at comparing intensive therapy, which is geared towards maintaining a lower average blood sugar level, with standard therapy, which generally results in a higher level. After the first year of the study, results showed carotid thickness among the entire group was about the same as that seen in control patients without diabetes. After six years, the diabetic patients, on average, exhibited greater thickening of the artery than nondiabetic patients. However, those who remained on the intensive therapy had significantly less thickening than those who received standard care.

The researchers believe these findings deserve more study, noting �Longer follow-up of this cohort will reveal whether the decrease ... translates into a clinically meaningful reduction in cardiovascular disease events.�

SOURCE: New England Journal of Medicine, 2003;348:2294-2303

Maternal Energy Intake Higher When Carrying a Male Fetus (June 5, 2003) 

NEW YORK (Reuters Health)

Average energy intake is about 10% higher when a pregnant woman is carry a male rather than a female fetus, according to a report published in the June 7th issue of the British Medical Journal.

The reason for the higher intake with male fetuses is unclear, but it may relate to the anabolic effects of testosterone, which is secreted by the fetal testes, Dr. Dimitrios Trichopoulos, from Harvard School of Public Health in Boston, and colleagues note.

Several reports have shown that male birth weights are usually slightly higher than those of females. However, "no study has examined whether the difference is because the pregnant woman has a higher energy intake or more efficient energy utilization if she is carrying a male embryo than if she is carrying a female embryo," the authors point out.

To answer this, the researchers analyzed dietary data from 244 women with singleton pregnancies who were seen at Beth Israel Hospital in Boston between March 1994 and October 1995.

On average, the daily energy intake of women carrying a male fetus exceeded that of female-carrying mothers by 796.2 kJ--an increase of 9.6%.

"Although marginally significant, the difference in energy intake between pregnant women carrying boys rather than girls is not trivial--modelling the data through logistic regression indicates that the odds of having a boy rather than a girl is higher by about 35% when maternal energy intake is higher by about one standard deviation," the authors note.

Source : BMJ 2003;326:1245-1246.

Good News for Diabetics (June 5, 2003) 

(Ivanhoe Newswire)

The early stages of kidney disease often seen in people with type 1 diabetes can be reversed, shows a new study from the Joslin Diabetes Center in Boston.

That�s good news for the roughly 1 million Americans living with type 1 diabetes who are at significantly increased risk of developing end-stage kidney disease requiring either a kidney transplant or dialysis. Statistics show about one out of every three patients with type 1 diabetes develops this condition.

People with type 1 diabetes often suffer from a condition known as microalbuminuria, which is characterized by the leakage of small amounts of proteins from the blood into the urine. Over time, this can lead to kidney disease, with some studies suggesting between a 60-percent and 85-percent risk of progression within six to 14 years. Doctors have traditionally believed the progression could be slowed with treatment, but that it could not be stopped.

In this study, researchers examined nearly 400 patients who had been showing signs of microalbuminuria for two years. All were followed for an additional six years to gauge the progression of the condition and to determine how it was impacted by different treatments. The investigators were surprised to find 58 percent of the group experienced a decline in the leakage of protein over this period, and that it occurred even in those not taking ACE-inhibitors, a drug thought to help treat the condition.

Factors that were associated with a steady improvement included an early diagnosis of microalbuminuria and good control of blood sugar, blood pressure, and, most significantly, cholesterol, a factor known to impact advanced kidney disease, but not previously noted as important in the control of microalbuminuria.

The investigators believe these findings will point the way to more effective treatments for the early stages of kidney disease in type 1 patients. Researchers write, �In the meantime, the study highlights the need for frequent screening and early intervention for microalbuminuria. Once it is identified, the treatment plan should be directed toward improving multiple factors -- blood sugar control, blood pressure control, and cholesterol lowering -- rather than relying on ACE-inhibitor treatment alone.�

SOURCE: New England Journal of Medicine, 2003;348:2285-2293

Relief for Hot Flashes (June 4, 2003) 

(Ivanhoe Newswire)

Recent studies have shown hormonal therapy may increase the risk of heart attack, stroke and breast cancer, causing many menopausal women to stop treatment. Now, doctors say a well-known drug may be a good alternative for women who seek relief from symptoms like hot flashes.

Researchers from the Johns Hopkins� Sidney Kimmel Cancer Center are studying whether antidepressants can help menopausal women control their hot flashes. One particular drug, sold under the brand name Paxil, showed significant improvement for 165 menopausal women who experienced at least two hot flashes a day.

The participants in the study took either 12.5 milligrams or 25 milligrams of the antidepressant or a placebo everyday for six weeks. Throughout the study, patients kept diaries of their hot flashes, completed questionnaires, and were examined by doctors.

The 25-milligram dose of the drug reduced hot flashes by nearly 65 percent, or by about three flashes per day. The 12.5-milligram pills reduced symptoms by about 62 percent, while the placebo reduced hot flashes by less than 40 percent. In addition, nearly 30 percent of the women taking the antidepressant said they experienced no hot flashes by the sixth week of the study.

The side effects reported by the women were mild to moderate and included headaches, nausea and insomnia. Doctors say the new treatment is a good alternative to hormonal therapy, which has even more serious side effects. �This is the best nonhormonal drug we know about right now,� says Vered Stearns, M.D., of Johns Hopkins� Sidney Kimmel Comprehensive Cancer Center.

Dr. Stearns says researchers do not know exactly what causes hot flashes, but scientists think low estrogen levels that throw off the nervous system�s temperature control are to blame.

SOURCE: Journal of the American Medical Association, 2003;289:2827-2834

Periodontal Disease Dangerous for the Heart (June 4, 2003) 

(Ivanhoe Newswire)

A new study shows periodontal disease may increase levels of a protein in the blood that acts as a marker of inflammation and indicates an increased risk for cardiovascular disease in otherwise healthy persons.

C-reactive protein is produced by the liver and serves as a marker of inflammation in the body. Levels of CRP can be used to monitor patients with infections. Elevated levels are often found in people with ischemia and heart attack patients.

Researchers from the University of North Carolina at Chapel Hill evaluated the association between periodontal disease and CRP levels. They examined the mouths of more than 5,500 participants in the Atherosclerosis Risk in Communities study.

The study authors found elevated concentrations of CRP in individuals with extensive periodontal disease. The presence of periodontal disease seemed to result in mild increases in CRP consistent with the modest increases that are seen with increased risk of heart problems among healthy individuals.

Based on these findings researchers say medical and dental diagnoses may be necessary when evaluating the cause of elevated CRP in some patients.

SOURCE: Archives of Internal Medicine, 2003;163:1172-1179

Swimming Pool Chlorine Linked to Asthma (June 3, 2003) 

BRUSSELS, Belgium (Ivanhoe Newswire)

A new study demonstrates an association between chlorine used to disinfect indoor swimming pools and the surge of childhood asthma in developed countries.

Researchers say trichloramine -- or nitrogen trichloride, a highly concentrated volatile by-product of chlorination -- seems to be the culprit. It is readily generated and inhaled during contact between chlorine and organic matter such as urine and sweat.

Researchers from the Catholic University of Louvain in Brussels, Belgium, measured levels of lung proteins, associated with cellular damage, in the blood of 226 healthy primary school children. The children had all been regular swimmers at indoor pools since early childhood.

Researchers assessed the prevalence of childhood asthma, using data from a survey of almost 2,000 children between ages 7 and 14.

Study results indicate that regular attendance at indoor swimming pools was consistently associated with the destruction of the cellular barriers protecting the deep lung, making them more vulnerable to the passage of allergens. Moreover, asthma was linked to the cumulative amount of time spent at indoor pools. 

Levels of trichloramine can vary greatly, depending on how crowded a pool is, how clean the swimmers are, and how well the area is ventilated.

The authors conclude, �The question needs to be raised as to whether it would not be prudent in the future to move toward non-chlorine based disinfectants, or at least to reinforce water and air quality control in indoor pools, in order to minimize exposure to these reactive chemicals.�

SOURCE: Occupational Environmental Medicine, 2003;60:385-394

Eating Fish Helps the Heart (June 2, 2003) 

SEATTLE (Ivanhoe Newswire)

Researchers say eating oily fish like salmon, tuna or bluefish twice a week can prevent sudden cardiac death from irregular heart rhythms.

It has long been known that eating fish is associated with reduced risk of heart disease, but only recently have researchers had scientific evidence to explain the effect. Researchers from the University of Washington in Seattle present a detailed explanation of how omega-3 fish oils benefit the heart.

Animal experiments demonstrate that fatty acids from omega-3 oils are stored in the cell membranes of heart cells and can prevent sudden cardiac death or fatal irregular heart rhythms. Specifically, the oils block excessive sodium and calcium currents in the heart, which can cause electrical discharges that result in erratic changes in heart rhythm.

The first study that showed the benefits of omega-3 oils came from a 1989 study of 2,033 men with heart disease who were given dietary advice on fat, fiber or fish. After two years, the men who ate fish at least twice a week had a 29-percent reduction in death. There was no benefit in either the fiber or fat group.

This study was followed by a series of studies and controlled clinical trials that all showed the same thing: A diet rich in fatty fish reduces fatal heart attacks.

The American Heart Association states that a dietary approach to increasing omega-fatty acid intake is preferable. However, patients with coronary artery disease should consult with their physician regarding fish oil supplements.

SOURCE: To be published in an upcoming issue of Circulation

Spinal Correction (June 26, 2003) 

BALTIMORE (Ivanhoe Newswire)

Spondyloptosis is a severe spine deformity that often causes significant back and leg pain. It has been difficult to treat with surgery, and patients are often left with only a partial correction. Now there is a detailed surgery demanding a lot of patience from surgeons that eliminates the pain.

Darlene Holloway had a tougher time in high school than many of her peers, but it wasn�t because of her grades. �It was just extremely painful to walk,� she tells Ivanhoe.

Holloway had a spinal condition called spondyloptosis. She says, �The only way I could describe it was that my rib cage was sitting on top of my pelvis.�

Spondyloptosis a severe deformity this father-son team of surgeons our of Baltimore says is difficult to correct with standard surgeries.

Mercy Medical Center Spinal Surgeon Charles Edwards II, M.D., says, �Those leave the patient with a residual deformity, which may result in not only a limited cosmetic result, but also a higher risk that they�re going to have continued problems with their back.�

His father, Charles Edwards, M.D., who is also a spinal surgeon at Mercy Medical Center, pioneered a detailed surgery to fix the deformity. �It takes a great deal of patience to do this procedure,� says Dr. Charles Edwards.

In a surgery that takes about 10 hours, Dr. Edwards uses these tools to stretch the ligaments and pull the spine upright. He also stretches the nerves. �I found that to a remarkable extent, they can accommodate several inches of lengthening,� he tells Ivanhoe.

Dr. Edwards compares the surgery to the Eastern philosophy of gardening. �I see the same ropes and stakes pushing trees to create the shapes the gardener wants,� he says.

On the left is Holloway's spine before surgery. On the right is what it looks like today. �It added some inches, of course, to me and it also relieved the pain,� she says. And at 29, this college student says she doesn�t even notice the hardware in her back.

Dr. Edwards says the technique can be applied in spinal deformities like scoliosis as well and is less time-consuming for those conditions. He has operated on about 80 patients with spondyloptosis. He says he only knows of four or five spinal surgeons using this exact technique to correct the deformity.

If you would like more information, please contact:

Charles Edwards, II, M.D.
The Maryland Spine Center
Mercy Medical Center
301 St. Paul Place, Box 225
Baltimore, MD 21202
(410) 539-3434

Coping with Weight Loss (June 2, 2003) 

One effective long-term treatment for morbid obesity is surgery. Gastric bypass surgery reduces stomach size and creates a stomach pouch about the size of a thumb. While the surgery is effective for drastic weight loss, it can also be very hard on a person psychologically. Here are two doctors who help patients deal with the physical and mental changes after surgery.

Jim Cazola used to weigh 400 pounds. �I was willing to do whatever I needed to do to try to lose the weight,� he tells Ivanhoe. It was gastric bypass surgery and a reduction of his stomach that helped him lose 170 pounds in eight months.

For the first time, Cazola can keep up with his three boys. The surgery was easy for him. What came next caught him off guard.

�For me, it was just as much a mental change as it was a physical change because I had to, you know, learn not to eat,� he says.

University of Alabama at Birmingham surgeon Ronald Clements, M.D., and psychologist Paul D. Blanton, Ph.D., have teamed up to help patients better mentally prepare for the changes.

Dr. Clements says, �It�s going to take away your best friend and your best coping mechanism, and those two things put together is sometimes more than some people can deal with.�

�Patients don�t really appreciate the extent of the lifestyle modifications that they�ll have to make,� says Dr. Blanton.

After surgery, a patient can only eat three small meals a day. They are not allowed to eat sugar and they must exercise. They also have to adjust to their new look.

Dr. Blanton says, �Although you think of it as being very positive, a change in body appearance and attractiveness, often times folks are not prepared for that.�

�It would be great to have somebody to talk to, to kind of help you get prepared maybe for that part of it,� says Cazola. Food is no longer a top priority for him, that is unless he�s in his boys� play kitchen.

Many patients do experience depression after the surgery. Before the surgery, some patients would eat when they were depressed, but after the surgery is over, they don�t have the freedom to eat as much as they may have before. This can lead to further depression.


If you would like more information, please contact:

Ronald Clements, M.D.
University of Alabama at Birmingham
KB405, 1530 3rd Avenue South
Birmingham, AL 35294-0016
(205) 934-7877
http://www.uab.edu/obesitysurgery

Ailing Homes (June 2, 2003) 

BIRMINGHAM, Ala. (Ivanhoe Newswire)

About one in 11 children have lead poisoning. There are usually no symptoms, but it can lead to permanent learning and other disabilities. Asthma is another problem for kids that causes more missed days of school than any other illness. Both of these ailments can be triggered by your home. Now a program helping families with sick kids make their homes healthy again. 

Bridgette Antonello knew it would take some work to fix up this house. Even with four kids, she was up to the challenge. Then, one by one, her children got sick. Elise has high levels of lead in her blood. Dominick has asthma. They wondered if her house was the culprit.

A team of healthy home inspectors from the Healthy Home Initiative came to help Bridgette find out.

Many asthma triggers can be found in the carpet. Inspectors also check windowsills and carpet for lead. Even if it�s in the walls, according to HHI, the lead dust still circulates around the room.

In the bathroom, mold and mildew can be problems. Even a little bit of mold and mildew on a shower curtain is a major asthma trigger.

Check the basement for crumbly insulation, then use a pleated air conditioning filter for more efficiency.

E. Kenneth Dillon, Ph.D., of the Department of Environmental Health Sciences at University of Alabama at Birmingham says, �The whole concept of the Healthy Homes Initiative is to not only look for lead, but to look for asthma triggers, look for pesticides in the home.�

Bridgette learned the paint in her house does contain lead. She was also given a new vacuum with a special filter to better fight the allergens living in her carpet. She says, �Whatever is necessary to make it a safe home for us.�

There are programs like this across the country. If you think your home could be making your children sick, contact your local HUD office. Also, if your home was built before 1978, you could have lead paint in your house and should have your children�s blood tested. Remember there are usually no symptoms for lead poisoning, but it can cause severe developmental problems especially for children under age 6. 

If you would like more information, please contact:

Lynn Battle
CLEPP
420 Tenth St. SW
Birmingham, AL 35211
(205) 780-8077
http://www.clepp.org

Healthy Homes Initiative -- HUD
http://www.hud.gov

Golfers and Their Injuries (June 2, 2003) 

MUENSTER, Germany (Ivanhoe Newswire)

It may seem like a relatively safe sport, but a new study shows injuries related to golf are more common than many might think.

Researchers in Muenster, Germany, studied more than 700 golfers. The participants were followed for two full golfing seasons. After the seasons ended, researchers gave the players a six-page questionnaire to gather data.

Results of the study show more than 82 percent of golfing injuries occur because of overuse. More than 17 percent of the injuries happened as single-events. Researchers found carrying a golf bag can aggravate the back, shoulders, and ankles of golfers. More than half of the golfers said their injuries were minor, while nearly 22 percent said their injuries were serious.

Professional golfers endured more injuries than amateurs. More problems occurred in the wrists of the professional group, while elbow injuries were the main complaint from the amateur group. However, both groups said they experienced back and shoulder pain as a result of participating in the sport.

Experts say some simple exercises can help golfers avoid certain injuries. For example, squeezing a tennis ball can help strengthen a player�s forearm muscles, and thus help prevent elbow injuries. Rowing can help prevent back injuries.

Warm-up routines had a positive effect on the golfers� physical condition, as long as the routines were at least 10 minutes. Researchers say golfing can be a safe sport as long as golfers rest their muscles and joints between matches. If overuse is not avoided, injuries related to golf can result in serious and chronic problems.

SOURCE: The American Journal of Sports Medicine, 2003;31:438-443

Moderation Keeps You Moving (June 2, 2003) 

SAN FRANCISCO (Ivanhoe Newswire)

Lower amounts of high-intensity exercise may be the key to sustaining an exercise program, says Duke University Medical Center researchers. They presented their findings this week at the Annual Meeting of the American College of Sports Medicine in San Francisco.

Researchers randomized 87 "couch potatoes" to one of three supervised exercise programs differing in amount and intensity over nine months. Participants in the low-intensity group exercised on average 187 minutes per week at an intensity of about 11 miles per week of walking. The moderate-intensity group exercised 123 minutes per week at an intensity of brisk walking or jogging 11 miles per week. The high-intensity group exercised 180 minutes per week at an intensity of brisk walking/jogging 18 miles per week.

After the supervised portion of the study, most people tended to move toward an exercise regimen closely resembling the moderate-intensity group. Though the high-intensity exercise group gained the most health benefits during the supervised part of the program, they significantly cut back on the minutes per week and intensity of their exercise during the follow-up. Participants in the low-intensity exercise group decreased the number of minutes per week, but increased their intensity of exercise.

Researchers found lack of time was the most common reason given for not continuing to exercise after completing the initial program. Other reasons reported were lack of motivation, family obligations, lack of exercise facilities, illness or injury, and lack of support or travel.

SOURCE: Annual Meeting of the American College of Sports Medicine, San Francisco, May 28-31, 2003