Health Tips

Health Food Tips, Weight Loss Tips, Health and Safety Tips, Good Health Tips and more Tips...

Weight Loss Tips

Quick weight loss tips, Easy weight loss tips, Summer health tips, Natural health tips, Health care tips

Tuesday, March 31, 2009

Most Teens Aren't Getting Preventive Health Care

Almost two-thirds lacked this type of service within past year, study found.



Most American teens don't receive the appropriate amount of preventive health services, even though this type of care can establish good health behaviors and discourage damaging behaviors that can affect teens for the rest of their life, a new study finds.

The University of California, San Francisco, researchers analyzed data gathered from almost 8,500 adolescents, ages 10 to 17, who took part in the Medical Expenditure Survey, a national survey of families and medical providers. The UCSF team focused on several aspects of preventive care for adolescents, including the extent to which they'd received care in the past year, whether they received counseling about various health issues, and whether they had any time alone with their health-care provider.

The study found that only 38 percent of these young people had a preventive health visit in the past year.

"The results were pretty shocking to us. With so many adolescents not receiving the recommended preventive care, it is clear we need to develop new strategies that will help increase the delivery of services," study first author Dr. Charles Irwin, director of the Division of Adolescent Medicine at UCSF Children's Hospital, said in a university news release.

Irwin and colleagues also examined the extent to which doctors counseled teens or parents about six specific preventive health issues -- dental care, healthy eating, regular exercise, wearing a seat belt, wearing a bicycle helmet, and being exposed to secondhand smoke. Less than half of the teens who had a preventive health visit were counseled about at least one of these issues, and only 10 percent were counseled about all six.

"We really need to encourage physicians to make this type of counseling routine; otherwise, we might lose an opportunity to make a difference in these kids' lives," study senior author Sally Adams, a specialist in the Division of Adolescent Medicine at UCSF, said in the news release.

Family income and insurance status can affect the amount of preventive care received by teens -- 48 percent of those from high-income families had a preventive visit in the past year, compared with 36 from middle-income families and 32 percent of those from low-income families. Adolescents with private insurance were more likely to have received preventive care in the past year than those who were publicly insured or uninsured.

"Health-care professionals must continue advocating for programs that increase the number of adolescents who are insured, because insurance is key to gaining access to preventive care," Adams said.

The study was published online March 30 in the journal Pediatrics.

Rapid Infant Weight Gain Linked to Childhood Obesity

Harvard study suggests earliest intervention may reduce risk.



Babies who gain weight quickly during the first six months of life may be more prone to obesity as toddlers, Harvard researchers report.

"We need to start our preventive methods when children are much younger," said study author Dr. Elsie M. Taveras. "Even in the first couple of weeks of life, we can start guiding parents about how to prevent rapid weight gain in their infants."

While past research has established a link between birth weight and obesity, the impact of factors such as length of gestation, height and lifestyle of the mother were often not considered.

The researchers tracked 559 children who were part of Project Viva, an ongoing study of pregnant women and their children. The babies were measured for weight and height at birth, at 6 months and again at the age of 3.

After adjusting for factors such as the babies' length, researchers found that those who increased their body-mass index (BMI) during their first six months were more likely to be classified as obese at age 3.

"At present, most guidelines around obesity management recommend that we start assessment and treatment of children after the age of 2," Taveras said.

According to the National Institutes of Health, nearly a third of adults in the United States are obese. Obese people are 10 percent to 50 percent more likely to die of all causes. In 2000, the obesity epidemic cost the U.S. health system $117 billion.

"The key indication for this study is the importance of better education about feeding infants," said Connie Diekman, director of university nutrition at Washington University in St. Louis. "Since the study did not look at what children were fed after weaning, it is hard to know if overfeeding then is a contributor."

Addressing this issue may involve simply making minor changes. In Germany, water fountains were installed in 32 schools located in poor areas of two German cities. Teachers then presented four lesson plans to second- and third-grade students about the benefits of water consumption.

The study found that the students who attended these schools were 31 percent less likely to become overweight than those who attended other schools not involved in the study.

Both studies are to be published in the April issue of Pediatrics.

"The researchers themselves identified that we need to study caregiver and infant relationships, since other studies have shown when there is a lack of a bonding during feeding, infants will change what they eat," says Diekman. "In addition, other potential confounders need to be removed, and then the study repeated, to see if weight gain during pregnancy is a factor."

"Our study raises a lot of questions about the reason rapid infant weight gain results in obesity later on," Taveras said. "We need more research to identify the factors that explain this relationship."

Kidney Nerve Deactivation Could Ease Hypertension

Problem blood pressure fell with no long-term effects, study concludes.



Using a catheter-based technique to deactivate nerves in the kidneys -- a process called renal denervation -- could help people with tough-to-treat high blood pressure, a new study suggests.

About 30 percent to 40 percent of the world's population has hypertension and about 5 percent to 10 percent of those have resistant hypertension. There's a link between hyperactivity of the sympathetic nervous system (serving the kidneys) and the progression of high blood pressure, as well as chronic kidney disease and heart failure, according to background information in a news release on the study.

The research included 45 patients with resistant hypertension, defined as having a systolic blood pressure of 160 mmHg, while taking three or more antihypertensive medications, including a diuretic. Some of the patients underwent what's known as "percutaneous radiofrequency catheter-based treatment" and were then followed for up to one year.

The treatment involves placing a catheter in the femoral artery (in the abdomen/thigh), guiding it to the renal (kidney) artery, and advancing it to where the kidney nerves are located. Radiofrequency energy is then used to disrupt the nerves.

Before treatment, the patients' mean blood pressure was 177/101 mm Hg. After treatment, mean blood pressure was reduced by -14/10, -21/-10, -22/-11, -24/-11, and -27/-17 mm Hg at one, three, six, nine and 12 months. Among the non-treated patients, the mean rise in blood pressure was +3/-2, +2/+3, +14/+9, and +26/+17 mm Hg at one, three, six and nine months.

"We showed an excellent safety profile of this brief, catheter-based therapy," wrote Henry Krum, of the Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia, and colleagues. "No long-term adverse events resulted from the procedure ... Therapeutic renal denervation led to a large and persistent decrease in blood pressure, which was achieved in patients resistant to multiple existing hypertensive drug types. Moreover, reduction of blood pressure was evident as early as one month, was further reduced at three months, and persisted through subsequent assessments."

The findings were presented at the American College of Cardiology meeting in Orlando, Fla., and appear online and in an upcoming print issue of The Lancet.

If further studies prove the value of this treatment, it must be reserved for patients with truly resistant hypertension, only after drug therapy has failed or isn't tolerated by the patient, experts wrote in an accompanying comment.

"We strongly believe that Krum and colleagues provide hope for the management of a difficult clinical condition," wrote Dr. Michael Doumas, of George Washington University in Washington, D.C., and Dr. Stella Douma, of Hippokration Hospital, Aristotle University of Thessaloniki, Greece. The two experts co-authored an accompanying commentary in the journal.

Sunday, March 29, 2009

No Increase in Clots With Drug-Eluting Stents

Risk appears the same for bare metal or drug-eluting devices, study found.



Despite initial concerns that stent thrombosis, a blood clot inside a stent, is more common with the drug-eluting device, there appears to be no difference in the clot risk for either drug-eluting or bare metal stents, a large new study found.

After a heart attack, many patients undergo a treatment called angioplasty, which opens the blocked coronary artery that caused the attack. With many of these procedures, the stent, a metallic mesh tube that props open the narrowed artery, is also inserted and left in place.

"We had a thrombosis rate of 3.3 percent over a year, which sounds high, but these are patients with acute [heart attacks] getting a stent," lead researcher Dr. George Dangas, an associate professor of medicine at Columbia University Medical Center in New York City, said during a Sunday morning teleconference at the American College of Cardiology's annual scientific sessions in Orlando, Fla. "So it's not that high after all."

"With any type of bare metal stent or drug-eluting stent, there was no difference after one year," Dangas added.

Bare metal stents -- as the name implies -- are bare tubes of metal mesh. Drug-eluting stents, in addition to keeping the artery open, slowly release a medication to prevent the build-up of scar tissue inside the stent.

A stent thrombosis can block blood flow through the stent and cause another heart attack or even death. Concerns have been raised that stent thrombosis might be more common in drug-eluting stents than bare-metal ones.

Dangas and his colleagues looked at data on 3,202 patients who participated in the HORIZONS-AMI trial; these patients received either bare metal stents or drug-eluting stents.

During the year after treatment, 107 patients (3 percent) developed stent thrombosis. The rate of stent thrombosis was the same for those treated with bare metal and those with drug-eluting stents, the researchers found.

Also, there was no difference in the rate of patients developing stent thrombosis whether they were taking the blood thinner Angiomax (bivalirudin) or heparin plus glycoprotein IIb/IIIa inhibitors, which also help prevent clots from forming.

Although patients treated with Angiomax had a higher rate of acute stent thrombosis, both groups had equal rates of stent thrombosis after a month, the researchers reported.

Dangas's group also collected information on factors that could lead to stent thrombosis, such as smoking, insulin-treated diabetes, implanting several stents, treatment of ulcerated lesions and complete blockage of the artery responsible for the heart attack.

For these patients, high doses of the anti-clotting drug Plavix (clopidogrel) protected against stent thrombosis.

A related presentation Saturday at the cardiology conference found that patients with coated stents had fewer cases of serious complications. The study -- the largest one ever to evaluate "real-world" stent patients -- included 217,675 patients over age 65 with coated stents and 45,025 patients with bare-metal devices, the Wall Street Journal reported.

The study found that patients with coated stents were significantly less susceptible to non-fatal heart attacks or death. And there were slightly fewer cases of repeat procedures with coated stent patients, while stroke rates were about the same in both groups of patients, the newspaper said.

Hormone Reduces Mortality in Heart Patients With High BP

Relaxin cuts shortness of breath and trimmed hospital stays, phase 2 study concludes.

The hormone relaxin reduces shortness of breath and cardiovascular death in people with heart failure who also have high blood pressure, according to a phase 2 trial conducted in eight countries.

The study included 234 people who, within a few hours of arriving at a hospital, were randomly assigned to receive an intravenous infusion of a placebo or varying doses of relaxin -- 10, 30 100 or 250 micrograms/kilogram (µ/kg) -- a day.

Shortness of breath improved in 40 percent of those who were given 30 µ/kg, compared with 23 percent of those who received the placebo.

After 60 days, fewer people given 30 µ/kg of relaxin had died from a cardiovascular cause or had to be readmitted to the hospital because of heart or kidney failure than in the placebo group: 2.6 percent compared with 17.2 percent. After 180 days, there were no cardiovascular deaths in the relaxin group at this dosage, but 14.3 percent of the placebo group had died from cardiovascular causes, the study found.

The study also found that people in the relaxin 30 µ/kg group spent less time in the hospital than did those in the placebo group (10.2 days vs. 12 days) and lived longer after discharge (47.9 days vs. 44.2 days). No safety concerns were noted in the relaxin 30 µ/kg group.

The study was funded by Corthera, and several of the researchers worked for the biopharmaceutical company, which has the rights to develop and market relaxin. The findings were to be presented at the American College of Cardiology meeting in Orlando, Fla., and appear online and in an upcoming print issue of The Lancet.

Over time, standard therapy can resolve shortness of breath and high blood pressure caused by heart failure, but evidence from this study "suggests that early administration of this drug in addition to standard therapy might be associated with more rapid, sustained and complete resolution of acute heart failure, as well as with more favorable long-term outcomes," wrote Dr. John R. Teerlink, of the San Francisco Veterans Affairs Medical Center and his colleagues.

On the basis of the study's results, the researchers said they plan to conduct a phase 3 clinical trial of relaxin, at 30 µ/kg, in people with heart failure.

New Surgery for Heart Failure Proves Ineffective

Isolating damaged heart tissue does not produce better outcomes, study finds.



A surgical procedure called ventricular reconstruction that doctors hoped would improve symptoms in people with heart failure does not seem to work, a new study has found.

The hope was that by isolating the damaged part of the left ventricle -- the chamber of the heart that pumps blood to the body -- people would see an improvement in symptoms and exercise capacity, and there would be fewer deaths and hospitalizations as well.

"There has been interest among certain proponents in using a surgical approach to treat ventricular remodeling that can occur after heart attacks through left ventricular volume reduction surgery," said Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, who was not involved in the study. "However, evidence of safety and efficacy for this surgical approach was lacking."

But the new study findings "demonstrate that the addition of surgical ventricular reconstruction to standard coronary artery bypass surgery does not result in any clinically meaningful improvement in outcomes," he said. "The use of this type of surgery, which has become common in certain [medical] centers should, with few exceptions, now cease."

The findings were reported online March 29 in the New England Journal of Medicine, to coincide with a presentation of the study at the American College of Cardiology annual meeting in Orlando, Fla.

For the study, Dr. Robert H. Jones, of the Duke Clinical Research Institute, and his colleagues randomly assigned 1,000 people with heart failure, all participants in the Surgical Treatment for Ischemic Heart Failure (STICH) trial, to cardiac bypass surgery alone or bypass surgery plus ventricular reconstruction.

Ventricular reconstruction involves making an incision in the damaged part of the left ventricle. After surgeons identify the damaged part, they basically sew the healthy part together. After tightening the sutures, the surgeons place a patch over the damaged tissue, leaving the damaged tissue outside the ventricle.

During 48 months of follow-up, the researchers found that people who underwent both procedures had 19 percent less "end-systolic volume" -- the amount of blood left in the ventricle after contraction and before it starts filling again. This compared with 6 percent less volume for those who had just bypass surgery.

But, people who had their hearts surgically altered did not show improvement in symptoms, the ability to exercise or a reduction in deaths or hospitalizations for heart problems.

"This is an outstanding example of the essential need to test new cardiovascular therapies and surgical approaches in randomized, controlled clinical trials," Fonarow said.

Another heart expert agreed that the study demonstrates that ventricular reconstruction is not effective.

"Enlarged hearts don't function as well as small ones, so cardiologists thought that a procedure to shrink the main heart chamber would help," said Dr. Byron Lee, an assistant professor of medicine at the University of California, San Francisco.

"However, this study convincingly shows that this type of surgical reconstruction is of no benefit to patients undergoing bypass operations," Lee said.

Dr. Elizabeth G. Nabel, director of the U.S. National Heart, Lung and Blood Institute, which funded the study, described the research as having "tremendous public health importance since it provides much-needed clinical, trial-based evidence to help physicians choose the best treatment for their heart failure patients."

She added, in a prepared statement, that it also was "a superb example of comparative effectiveness research, allowing evaluation of real-world treatments in hopes of improving clinical care."

Thursday, March 26, 2009

Midwest and Northeast May Face Surgeon Shortage

Specialists are concentrating in areas with high doctor/patient ratios, experts say.



THURSDAY, March 26 (HealthDay News) -- Certain rural and urban areas of the United States may soon face shortages of access to surgical care, especially for underserved and aging populations, a new study warns.

Researchers found that surgeons are moving to areas with already established medical communities, a trend that could lead to shortages in some local areas, particularly in the Northeast and Midwest. Though the federal government offers incentives to persuade primary care doctors to practice in underserved areas, no such program exists for general surgeons.

"Our data shows that, over the past decade, surgeons moved more frequently than all other physicians and tended to relocate to areas with higher concentrations of established physicians," Thomas C. Ricketts, co-director of the Health Policy Institute of the American College of Surgeons and a University of North Carolina professor, said in a news release from the surgeons' group. "This is the opposite of that seen for physicians in general, who were more likely to move to areas with less competition. If this trend continues, the need for surgeons in rural and urban underserved areas, especially in the Northeast and Midwest, may increase significantly."

An analysis of data gathered in prior studies revealed that more than 32 percent of the 94,630 physicians who were established surgeons in clinical practice between 1996 and 2006 moved to another county during that time period. Other data showed that about 27 percent of all physicians moved in a 10-year period.

The average distance of surgeons' moves was 593 miles. Interstate moves were largely from the Northeast and parts of the Midwest to the South and West. Surgeons tended to move to counties with a slightly higher ratio of total physicians to population, counties that are slightly less densely populated, counties that are three times more likely to be more rural than the county they left, and counties with lower income levels, a lower proportion of Hispanic residents, a lower unemployment rate and lower poverty than the county they left.

The likelihood of moving varied by surgical subspecialty. More than half of surgical critical care practitioners moved. Thoracic and neurological surgeons were more likely to move (41 percent and 38 percent) than urologists and ophthalmologists (27 percent and 26 percent). The study also found that older surgeons moved farther. For each additional year of age, the distance increased by eight miles.

The findings were shared during a March 24 panel discussion organized by Operation Patient Access, a campaign formed by surgical groups and others involved in health care.

Registry Created for Broken Heart Syndrome

Data collection aims to aid in recognizing, treating rare but real condition.



THURSDAY, March 26 (HealthDay News) -- New details about the symptoms and outcomes of a relatively rare but potentially life-threatening condition called broken heart syndrome have been collected by U.S. researchers into a registry of people treated for the syndrome.

Two-thirds of the 70 people in the new registry -- nearly all postmenopausal women -- had suffered an extremely stressful emotional or physical event just before they arrived at a hospital with heart attack-like symptoms. About 20 percent of them were critically ill and required emergency room treatment to keep them alive, but all had a full recovery, the researchers said.

"It can be difficult for cardiologists and emergency room physicians to diagnose and manage patients with broken heart syndrome," Dr. Richard Regnante, an interventional cardiology fellow at The Miriam Hospital in Providence, R.I., and lead author of the study, said in a news release from the hospital. "However, this data will help us better understand the disease process and could play a major role in developing and tailoring more effective short- and long-term treatment strategies."

A report on the registry and its findings is in the April 1 issue of the American Journal of Cardiology.

Unlike heart attacks, broken heart syndrome -- officially known as Takotsubo cardiomyopathy -- occurs most often in spring and summer months. Symptoms typically mimic a heart attack and usually occur after someone has been through an intense emotional or physical event -- a domestic argument, bad news about a family member, severe physical illness or a car accident.

It's believed that the symptoms of broken heart syndrome are caused by the heart's reaction to a surge of adrenaline and other stress hormones that cause part of the heart to temporarily weaken or become stunned.

But, with quick treatment, it seems that broken heart syndrome is temporary and completely reversible, the researchers said.

"Although there is much we're still learning about broken heart syndrome, we do know that it is rarely fatal as long as patients are fully supported with medications, respirators and other critical devices in the first 48 hours," Regnante said.

Genes May Boost Harm to Kids From Secondhand Smoke

Certain variants weaken lungs' defenses against free radicals, researchers say.



THURSDAY, March 26 (HealthDay News) -- Variations in several genes can influence children's lung growth and function, as well as how vulnerable they are to secondhand smoke, say University of Southern California researchers.

"Many factors can affect lung function and growth, including genetic variation and environmental exposures such as tobacco smoke and air pollutants," study lead author Carrie Breton said in a USC news release.

"We wanted to determine whether specific gene variations would have measurable and predictable effects on lung function growth and susceptibility to environmental insults," she said. "We looked at a class of genes known to be involved in antioxidant defense, the glutathione-s transferase (GST) genes. Overall, we found that variation in several of the GST genes was important. This was particularly true for children of mothers who had smoked during pregnancy."

Breton and colleagues analyzed eight years' worth of lung function and genotyping data from more than 2,100 children. They identified three specific halotypes (patterns of genetic variation within genes) that had a significant effect on lung function. These halotypes were found in the genes GSTM2, GSTM3 and GSTM4.

The gene variants may not alter lung development, the researchers explained, but they may change the ability of the lungs to defend against damage caused by free radicals, such as those found in smoke.

"The GST genes are important to the detoxification of reactive oxygen species, including carcinogens and environmental exposures, such as cigarette smoke. We speculate that the patterns of genetic variation we investigated may alter this process, thereby reducing the lung's ability to detoxify harmful agents and causing a cascade of other events that promote inflammation, bronchial constriction, airway hyper-responsiveness and asthma-like symptoms," Breton said.

The study is in the first April issue of the American Journal of Respiratory and Critical Care Medicine.

"The next step would be to investigate how these genes interact with one another to jointly affect lung development," Breton said. "Future studies should also investigate the timing and quality of tobacco smoke exposure during pregnancy in combination with variation in these genes to further understand how they jointly affect fetal lung development."

Black Women at Higher Risk for Aggressive Breast Tumors

Triple negative growths 3 times more likely regardless of age, weight, study finds.



WEDNESDAY, March 25 (HealthDay News) -- Black women are three times more likely than women of other races to develop aggressive breast cancer, a U.S. study finds.

The United States has the highest rate of cancer in the world. Black women have a lower overall rate of breast cancer than white women, but when black women do get breast cancer, it's often more advanced when it's diagnosed, is more likely to return after treatment, and has a less favorable outcome.

In this study, Boston University School of Medicine researchers analyzed data on 415 breast cancer cases. They looked at clinical features such as patient age, weight and race/ethnicity, and pathological features including the "triple negative" pattern -- tumors that lack expression of the estrogen receptor, the progesterone receptor, and the HER2 gene.

"The odds of having a triple negative tumor were three times higher for black women than for non-black women in the study," research leader Dr. Carol Rosenberg said in a news release. "Previously, it was known that premenopausal black women had more triple negative tumors. What we found that was new was that these tumors were just as common in black women diagnosed before or after age 50, and in those who were or were not obese."

"The higher prevalence of triple negative breast tumors in black women in all age and weight categories likely contributes to black women's unfavorable breast cancer prognosis," Rosenberg said.

The study was published recently in the journal Breast Cancer Research.

Faulty Household Wiring Can Trigger a Heart Defibrillator

Several cases of inappropriate shocks from appliances have been reported.



WEDNESDAY, March 25 (HealthDay News) -- A literally shocking tale of the potential dangers of do-it-yourself home repairs for people with implanted defibrillators comes from cardiologists in Denmark.

"We recently cared for a patient who, after receiving an implantable cardioverter defibrillator, was readmitted shortly after hospital discharge because of two shocks delivered while the patient was showering," said a report in the March 26 issue of the New England Journal of Medicine.

There was no apparent physical reason why the device, which delivers a shock to restore normal heart rhythm if an arrhythmia occurs, should have gone off, but analysis "raised suspicion that electrical noise had caused an inappropriate ICD discharge," the report said. So the physicians sent an electrician to check the wiring of the house.

"It was found that it was due to improper installation of wiring in the patient's home because he installed a washing machine himself," said Dr. Kristian Eskesen, a cardiologist at Gentofte Hospital in Hellerup, one of the physicians reporting the event. "It was not properly grounded."

The shock would not have occurred if the washing machine had been installed by a licensed electrician, since Danish law requires safe grounding, Eskesen said. Cardiac safety was not the reason for the law, he said, "but it is one way of avoiding such problems with ICDs," he added.

There have been scattered reports of similar events with heart defibrillators. In 2002, for example, cardiologists in Hong Kong reported two such cases -- one caused by electrical signals from a power drill, the other by signals from a washing machine. And, German cardiologists described an instance of a defibrillator shock delivered because of electromagnetic signals from a washing machine.

"The reason for writing our report was to make colleagues aware of this possible problem," said report co-author Dr. Soren Hjortshoj, of Aalborg Hospital, in Aalborg, Denmark. "ICD therapy is generally a safe treatment that can help people with heart disease. But physicians should be aware of the possibility of false shocks and the reason for these."

In general, "manufacturers of ICDs do a tremendous job of making ICDs safe," Hjortshoj said. Still, "an ICD has to be sensitive to very small changes in the electrical impulses coming from the heart," which makes it vulnerable to some electrical signals originating outside of the heart, he said.

"It is luckily a rare phenomenon, but even in a very regulated society like Denmark, these occurrences take place," Hjortshoj said. "It is very essential that the ICD works correctly and triggers on the right event, otherwise it may be hostile."

Properly monitored, "the ICD is a safe treatment," he said. "But the authorities need to be aware that the regulations about electrical equipment should be followed."

Brain 'Thinning' May Indicate Susceptibility to Depression

Cognitive problems also might be linked to right hemisphere thickness, study finds.



WEDNESDAY, March 25 (HealthDay News) -- A thinning in the right hemisphere of the brain may be associated with a higher risk for depression, U.S. researchers report.

The study included 131 people, aged 6 to 54, including those who did and did not have a family history of depression. Brain scans revealed that those with depression in their family history had a 28 percent thinning of the right cortex, the brain's outermost surface. No thinning was seen in those with no family history of the disorder.

The degree of thinning was on par to the loss of brain matter typically seen in Alzheimer's disease and schizophrenia patients, the researchers said in a news release from Columbia University Medical Center.

"The difference was so great that at first we almost didn't believe it," study first author Dr. Bradley Peterson, director of child and adolescent psychiatry and director of MRI research at Columbia and the New York State Psychiatric Institute, said in the news release. "But we checked and re-checked all of our data, and we looked for all possible alternative explanations, and still the difference was there."

A thinner cortex might increase depression risk by disrupting the ability to pay attention to, and interpret, social and emotional cues from other people, he said. Tests conduced on study participants showed that the thinner the right cortex, the worse a person did on attention and memory tests.

"Our findings suggest rather strongly that if you have thinning in the right hemisphere of the brain, you may be predisposed to depression and may also have some cognitive and inattention issues," Peterson said. "The more thinning you have, the greater the cognitive problems. If you have additional thinning in the same region of the left hemisphere, that seems to tip you over from having a vulnerability to developing symptoms of an overt illness."

He said that the findings, which appear online in this week's online issue of the Proceedings of the National Academy of Sciences, could help lead to new ways of treating or preventing depression.

Tuesday, March 24, 2009

Anesthesia in Youngest Kids May be Linked to Learning Disabilities

Study found having 'gone under' more than once by age 3 seemed to raise risk for problems.



TUESDAY, March 24 (HealthDay News) -- Children who have had anesthesia two or more times by the age of 3 may be at a higher risk of developing learning disabilities later, new research suggests.

Although this is the first human study to indicate such an association, it's still unclear if the anesthesia is the culprit, or if some other factor is at play.

"We don't want to alarm parents," said Dr. Robert Wilder, lead author of a study appearing in the April issue of Anesthesiology. "We have an association here between kids who received two or more anesthetics in surgery and an increase in learning disabilities, but we don't have clear causality that it was the anesthetics that caused the learning disabilities."

"Even if I knew for a fact that anesthesia might be increasing the risk for learning disabilities, my advice would still be, if your kid needs to have surgery done, they're better off having the anesthetic," added Wilder, who is a consultant in anesthesiology at the Mayo Clinic in Rochester, Minn., and an associate professor of anesthesiology at the Mayo Medical School. "Of course, you don't want to submit your kid to any unnecessary surgical or medical procedure, but that would have been my advice before studying this."

Prior animal studies have suggested that anesthesia drugs might affect the developing brain.

One study last year found that youngsters under the age of 3 who had hernia surgery showed almost twice the risk of behavioral or developmental problems later compared to kids who hadn't had surgery. Researchers suspect that exposure to general anesthesia during these operations might have played a role in the jump in risk.

Other studies have demonstrated a similar link. Still, the authors of this study said it's unclear if anesthesia really affects this risk in children.

One expert noted that the issue is of utmost concern to anesthesiologists.

"This is more information on an area that has been of intense interest to anesthesiologists," said Dr. Randall Clark, chairman of the American Society of Anesthesiologists committee on pediatric anesthesia and chairman of anesthesiology at Children's Hospital Denver. "We're all very concerned about this and working hard to see if has implications for human infants, but we don't have any clear evidence that that's the case yet."

"Research is this area is ramping up dramatically, and we are working with the FDA [U.S. Food and Drug Administration] to get answers to these questions," he added.

And, Clark noted, "very little of total elective surgery is done in the age ranges where we think children might be of risk. These are needed procedures and, to the best of our knowledge, the need for the procedure would outweigh what we now know are potential risks."

The authors of this latest study scoured the educational and medical records of all 5,357 children born in five towns in Olmsted County, Minn., between 1976 and 1982, and who had lived in the same county at least until the age of 5.

Generally, the children who had been under anesthesia had received halothane and nitrous oxide (laughing gas). Halothane is no longer available in the United States, according to the study, but it has been replaced by newer drugs, although these work by similar mechanisms. Nitrous oxide is used widely in this country.

Children's brains are still rapidly developing during these early years of life and are therefore very vulnerable to insults, the researchers noted.

The team said that just one exposure to anesthesia did not up the risk of developing a learning disability before the age of 19. Two exposures, however, increased the risk by 59 percent, while three or more exposures increased the risk by a factor of 2.6. Children who stayed under anesthesia for longer periods of time also faced a greater degree of risk.

But the association could also be due to the stress from the surgery itself or to the fact that children who undergo multiple surgeries at such a young age are sicker and therefore more likely to develop learning disabilities in general, the study suggested.

If future research does point to the anesthesia as the guilty party, new anesthesia agents may mitigate the effect.

But, Wilder pointed out, "even though finding new drugs might be the holy grail, that won't be easy."

HPV Data May Aid Vaccine's Effectiveness

Most cervical cancers arose from strains covered by the shot, study finds.



TUESDAY, March 24 (HealthDay News) -- The majority of invasive cervical cancers in New Mexico in the 1980s and 1990s contained DNA from human papillomavirus type 16 (HPV16) and HPV type 18 (HPV18), says a new study.

It also found that women diagnosed with HPV16- or HPV18-positive cancers were an average of five years younger than those diagnosed with cancers associated with other HPV types.

The HPV vaccine (Gardasil) protects against infections caused by HPV16 and HPV18, so the new findings may have implications for future cancer screening programs, the researchers said.

The researchers analyzed U.S. data in the Surveillance, Epidemiology and End Results registry and identified 1,213 cases of in situ cervical cancer diagnosed between 1980 and 1999, as well as 808 cases of invasive cervical cancer diagnosed between 1980 and 1999 in New Mexico.

HPV16 DNA was found in 53.2 percent of invasive cervical cancers, HPV18 DNA was found in 13.1 percent, and HPV45 DNA in 6.1 percent. HPV16 DNA was found in 56.3 percent of in situ cervical cancers, HPV31 DNA in 12.6 percent, and HPV33 DNA in 8 percent.

Patients' median age at diagnosis of invasive cancer with HPV16 and HPV18 was 48.1 years, and 45.9 years, respectively. Median age at diagnosis of invasive cancer with other HPV genotypes was 52.3 years.

The study is in the March 24 online issue of the Journal of the National Cancer Institute.

"To our knowledge, this is the largest study of its kind conducted in a U.S. population," wrote a team led by Cosette M. Wheeler, of the University of New Mexico Health Sciences Center in Albuquerque.

"This study of HPV genotypes in New Mexico provides important baseline data for evaluating the effectiveness of nearly implemented HPV-based technologies, HPV vaccines, and HPV screening in the prevention of cervical cancer," she said. "Moreover, these data can guide the future application of these technologies to maximize the cost-effective, public health benefits of these interventions."

Omega-3 Fatty Acids Guard Against Advanced Prostate Cancer

Even men genetically predisposed to disease benefit from eating fish, study finds.



TUESDAY, March 24 (HealthDay News) -- Omega-3 fatty acids could help protect men against advanced prostate cancer, researchers report.

Eating fish at least once a week may reduce the risk of developing advanced prostate cancer even if one is genetically predisposed to developing the disease, but more work is needed to see if the association is real, the researchers said.

"Eating a healthy diet that includes dark fish and other sources of long-chain omega-3 fatty acids may decrease risk of more advanced prostate cancer even if one has a cox-2 genetic predisposition to the disease," said lead researcher John S. Witte, a professor in the Institute for Human Genetics, Epidemiology & Biostatistics at the University of California, San Francisco.

The report is published in the April issue of Clinical Cancer Research.

For the study, Witte's team studied 466 men with aggressive prostate cancer and 478 healthy men. The researchers collected data on the men's diet and genetically assessed nine cox-2 single nucleotide polymorphisms.

"We detected strong protective associations between increasing intake of long-chain omega-3 polyunsaturated fatty acids and more advanced prostate cancer," Witte said. "These fatty acids are primarily from dark fish such as salmon."

This association held even if men had a high-risk genetic variant in the cox-2 gene, Witte said. "In contrast, men with low intake of dark fish and the high-risk variant had a substantially increased risk of more advanced prostate cancer," he noted.

The researchers found that men who had the highest intake of omega-3 fatty acids had a 63 percent lower risk of aggressive prostate cancer compared with men with the lowest intake of omega-3 fatty acids.

Then the researchers looked at the effect of omega-3 fatty acid in men with a cox-2 variant called rs4647310, a known inflammatory gene. Among men with low omega-3 fatty acid intake and this variant, the risk of developing advanced prostate cancer increased fivefold. However, men who had a high intake of omega-3 fatty acids had a significantly lower risk, even if they had the cox-2 variant.

These findings suggest that eating fish or other sources of long-chain omega-3 polyunsaturated fatty acids may decrease a man's risk of being diagnosed with more advanced prostate cancer, Witte said. "And the decrease in risk may be even more pronounced if one has a high-risk genetic variant in the cox-2 gene."

Focusing on more advanced tumors is important, since these tumors are most likely to take an aggressive course and thus impact a man's survival, he added. "Moreover, our results further support the hypothesis that long-chain omega-3 polyunsaturated fatty acids may modify prostate inflammation through the cyclooxygenase (cox) pathway," Witte said.

Eric Jacobs, strategic director of pharmacoepidemiology at the American Cancer Society, thinks the jury is still out on connecting omega-3 fatty acids with a reduced risk of advanced prostate cancer.

"In this study, a diet high in long-chain omega-3 fatty acids was associated with lower risk of developing advanced prostate cancer," Jacobs said. "However, some previous studies did not find similar results."

Indeed, other research has proved fruitless when it comes to using supplements to help prevent prostate cancer. Two studies released in January in the Journal of the American Medical Association found no evidence of benefit from supplemental selenium, vitamin E or vitamin C on prostate cancer and other cancers. Other recent studies have suggested that vitamins, B, C, D, E, folic acid and calcium taken alone, or in various combinations, aren't effective for cancer prevention either.

Nevertheless, more research into omega-3s role in prostate cancer prevention is needed, Jacobs said.

"One way men can reduce their risk of developing advanced prostate cancer, as well as risk of many other diseases, is to maintain a healthy weight. Many studies have shown that being obese is associated with increased risk of developing advanced prostate cancer," he said.

Monday, March 23, 2009

Study IDs Gene Variants Tied to Sudden Cardiac Death

Finding could prevent fatal arrhythmias by limiting meds in those with risk factor.



MONDAY, March 23 (HealthDay News) -- Fourteen common genetic variants associated with a risk factor for sudden cardiac death have been identified by researchers who analyzed genetic data from more than 13,000 people.

The gene variants they identified influence the QT interval measured on electrocardiograms (EKGs) routinely used by doctors to assess patients' heart health. The QT interval is the time from the beginning of electrical activation of the heart to the end of electrical relaxation, according to background information in a news release about the study.

The researchers said their findings, published online in Nature Genetics, could help prevent heart arrhythmia and prevent sudden cardiac death by limiting the use of medications that affect QT interval in people with these 14 gene variants, which are located in 10 different gene regions.

"It is well-established that prolongation of the QT interval in the general population is a potent and heritable risk factor for sudden death. In addition, QT prolongation results from medications leading to drug-induced cardiac arrhythmias and sudden death. This is a cardiotoxic side effect of scores of medications in widespread use and has been a major barrier to the development of novel drugs," study author Dr. Christopher Newton-Cheh, of the Massachusetts General Hospital (MGH) Center for Human Genetic Research and Cardiovascular Research Center, said in an MGH news release.

"From studies of families with congenital long-QT syndrome, we know that rare mutations with strong effects on ion channel function lead to QT prolongation and sudden death. But the common genetic basis for QT prolongation has been very difficult to establish," he said.

A companion study in the same issue of Nature Genetics looked at more than 15,000 people and confirmed 12 of the 14 variants identified in the first study. It also identified two additional gene regions.

"We were very reassured to see such strong replication in two independent studies," Newton-Cheh said.

While a combination of risk factors -- such as heart disease, older age, being female and use of other medications -- contributes to drug-induced arrhythmias, "it is certainly possible that common genetic variants will add incrementally to risk prediction, " he said.

But, Newton-Cheh added, it's "premature to advocate screening gene variants for risk assessment, but someday it may be possible to identify individuals who are particularly high risk and should avoid" medications that can cause QT prolongation.

High Blood Fat Levels Common in Americans

And those fats, called triglycerides, may contribute to heart risk, study says.



MONDAY, March 23 (HealthDay News) -- Many Americans have higher-than-recommended levels of the blood fats called triglycerides, and most aren't making the lifestyle changes necessary to bring those levels down, a study finds.

"Clearly, the focus in this country has been on cholesterol levels," said Dr. Earl S. Ford, with the U.S. Centers for Disease Control and Prevention and lead author of a report in the March 23 Archives of Internal Medicine. "But there are a fair number of studies that suggest that triglycerides have a role in cardiovascular disease."

While just about everyone knows about the link between cholesterol and heart disease, few Americans seem concerned about triglycerides, which are the most common kind of fats in the body -- and in food.

Triglyceride levels aren't nearly as big a concern as cholesterol levels. While the journal report states that, "increasing evidence supports triglyceride concentration as a risk factor for cardiovascular disease," the report also hedges that a bit, saying, "if triglycerides are indeed a risk factor."

Nonetheless, the National Cholesterol Education Program offers a list of recommendations about blood triglyceride levels: that they are best kept under 150 milligrams per deciliter; considered borderline high between 150 and 199 milligrams per deciliter; and deemed high at 200 or greater.

Data on 5,610 Americans in National Health and Nutrition Examination Surveys between 1999 and 2004 found that 33.1 percent of them had borderline high triglyceride levels; 17.9 percent had readings of 200 or higher; 1.7 percent came in at 500 or higher; and 0.4 percent were at 1,000 or higher, the study found.

Use of three triglyceride-lowering drugs was limited, with 2.6 percent of those in the borderline high group and 3.6 percent of those in the 200-and-higher group taking them. The drugs -- gembifrozil, niacin and fenofibrate --are also prescribed to raise levels of HDL cholesterol, the "good" kind that helps prevent artery blockage.

That may be just as well, Ford said. "Unlike LDL cholesterol, where we have all kinds of trials showing the benefits of statins against cardiovascular disease, there is not as strong a database for triglycerides," he said. "Until we get stronger evidence of benefit, drug treatment of triglycerides remains a little uncertain. Whether taking these drugs will reduce cardiovascular disease is unclear."

So the recommended treatment for elevated triglyceride levels is the kind of lifestyle recommended for high cholesterol levels, Ford said. Indeed, survey participants with high triglyceride levels tended to be overweight, inactive and smoke.

Losing weight, getting exercise, eating low-fat foods and giving up smoking apply to triglycerides as well, Ford said. An additional recommendation is to reduce consumption of alcohol, which promotes triglyceride production by the liver.

Dr. Stephen Nicholls, a cardiologist at the Cleveland Clinic, believes that triglycerides may deserve more scrutiny by physicians. "Many doctors are not sure about how aggressive they should be in treating elevated triglycerides," he said. "There are always other issues, such as obesity and smoking, involved. But we are understanding more and more that looking after triglycerides is important in providing heart care. If you look at large populations, those with high levels of triglycerides always do worse."

Sunday, March 22, 2009

What to Expect From a Colonoscopy

While many patients are nervous, doctors say it isn't as scary as some believe.



SUNDAY, March 22 (HealthDay News) -- As part of Colorectal Cancer Awareness Month, Americans are being urged to schedule a colonoscopy to check for this common and highly preventable type of cancer.

But many people are too nervous or scared to have the important screening test, which is recommended if you're age 50 or older or have a family history of colorectal cancer.

A colonoscopy isn't as scary as some people believe, says Dr. Dale Burleson, a colorectal surgeon at Baylor Medical Center at Frisco.

The most difficult part of the procedure may be the preparation, when patients take a laxative pill or drink to "flush" the colon. This is necessary to make sure the colon is as clean as possible so that the doctor gets the best possible view of the colon.

The preparation isn't "nearly as bad as it's made out to be. It only takes a few hours. By the time you're ready for bed, you're all set," Burleson said in a Baylor news release.

The colonoscopy exam itself is probably the easiest part. "The patient is awake, but with sedation, there's little or no discomfort. Many patients have told me it wasn't nearly as scary as they expected," Burleson said.

During the procedure, a long, flexible tube with a tiny video camera is inserted into the colon. The camera sends images to a monitor viewed by the doctor. The images can be printed and stored in a computer.

A colonoscopy is used to look for inflammation, bleeding, ulcers, changes in color, and small growths of tissue called polyps. Most polyps are noncancerous, but they are generally removed during a colonoscopy, and a biopsy is taken to determine if they're benign or malignant.

"The normal lining of the colon should look like the inside of a cheek, completely smooth. We're looking for anything that might signal a digestive condition or early signs of cancer," Burleson said.

Protein From Yellow Peas May Lower Blood Pressure

Finding in rats holds promise against kidney disease, too, experts say.



SUNDAY, March 22 (HealthDay News) -- Certain proteins found in the yellow garden pea appear to help lower blood pressure and delay, control or even prevent the onset of chronic kidney disease, at least in rats, a Canadian study has found.

"What we seem to have here is sort of a natural approach to treating this disease, as opposed to the normal pharmacological approach," said the study's lead author, Rotimi E. Aluko, an associate professor in the department of human nutritional sciences at the University of Manitoba in Winnipeg. "We're talking about an edible product, not a drug, which can help to reduce blood pressure and, at the same time, reduce the severely negative impact of kidney disease."

Aluko and his colleagues were to present their findings Sunday at the American Chemical Society's national meeting in Salt Lake City. The study was underwritten by several Canadian government entities.

Kidney disease affects an estimated 13 percent of American adults, the authors noted, and is a notoriously difficult disease to treat, with most people eventually succumbing to cardiovascular complications from high blood pressure linked to kidney malfunction.

Because of this, the researchers focused on the potential effect on blood pressure that might come from peas, long-heralded as a cholesterol-free source of fiber and protein.

After purifying a mix of yellow garden pea proteins, collectively called "pea protein hydrolysate," the researchers spent eight weeks feeding the derivative to rats that had kidney disease.

They found that blood pressure dropped 20 percent in the rats treated with the pea protein mixture, compared with the blood pressure of untreated rats.

They also found that urine production, which can be severely curtailed by kidney function breakdown, improved by upwards of 30 percent among the treated rats.

Despite the positive findings, the researchers do not advocate the ad hoc consumption of yellow green peas. They explained that a complex protein purification process is needed to activate what is otherwise a dormant vegetable benefit.

The pea protein would need to be mixed with certain enzymes into a food additive or nutritional supplement in liquid or pill form. In that form, Aluko said, it might be easier to tolerate than blood pressure drugs, given the pea protein's natural sourcing. A natural treatment, he said, would also eliminate the risk for overdosing.

He said that human trials are underway and that, if successful, a pea-based therapy might be available in two to three years.

Dr. George Bakris, director of the hypertensive diseases unit at the University of Chicago, described the finding as "fascinating."

"This is not the first time that the secret to blood pressure control has been found in Mother Nature," Bakris noted. "Ten years ago, a substance was isolated in celery, for example, that also had a controlling effect. But here what they seem to have shown is that there is a substance in this pea, when cleaved, which works in a similar fashion to the ACE inhibitors that have been out for the last 25 years. So basically, they have a natural substance that works like standard drugs we know a lot about."

"Of course, we have to see what the human studies show, " Bakris cautioned. "But if the results are as compelling as they were in animals, then this would potentially be a very reassuring, exciting and positive development as it is certainly very difficult to control blood pressure in people with kidney disease."

With Spring Here, Use Sun Sense to Enjoy It

Experts offer advice on keeping skin safe from harmful rays.



SATURDAY, March 21 (HealthDay News) -- Spring brings warmer weather and more outdoor time for most Americans, and along with that comes the need to protect the skin from the sun.

Before heading out, suggests the American Society for Dermatologic Surgery, remember to:

* Avoid peak sun hours. The rays are strongest between 10 a.m. and 4 p.m., so staying indoors during these times is the best protection.
* Wear the right sunscreen every day. Use products labeled for broad-spectrum protection -- to help block ultraviolet A (UVA) and ultraviolet B (UVB) rays -- and with a minimum sun protection factor (SPF) of 30. Slather on sunscreen about 20 minutes before going in the sun, using about an ounce (the size of a shot glass) to cover your entire body. Reapply every two to three hours spent outdoors. Also, use lip balm with an SPF rating.
* Wear the right clothing. A typical cotton T-shirt offers protection equivalent to only SPF 6, far below the commonly recommended minimum of SPF 15. Wear clothing with a thicker weave or apply sunscreen under a thin, porous shirt. In addition, a hat with a full, wide brim gives added protection to the face, neck and scalp, and sunglasses help protect the eyes from damage.
* Ignore skin type and base tans. Everyone can burn, regardless of skin pigmentation and even if already tanned. Sunscreen and clothing, not skin color, offer the best protection.

Sunscreen, in fact, should be worn regardless of what you're doing while outside, including swimming, the society suggests. Water doesn't protect against the sun's rays, so sunscreen and, if possible, a sun-protective bathing suit are recommended.

Other tips from the group include reminders that:

* Breaks soothe but don't protect. Swimming and hanging in the shade for a few minutes may make hot skin feel better, but they do not prevent burns.
* Clouds are not a foolproof sunscreen. Clouds filter only about 20 percent of the sun's UV rays, meaning 80 percent still get through to the skin.
* Certain medications and the sun don't mix. Some antibiotics, for instance, increase the skin's sensitivity to the sun, making you more prone to sunburn. Ask a doctor or pharmacist for help and read directions and warnings carefully on all medications you take.

And though springtime prompts thoughts of sun and skin, keeping an eye on your skin should be a year-round task, the society says. Watch for early signs of skin cancer -- discoloration, a mole that changes shape or color or a patch of rough, red skin. And if you notice anything, contact a doctor.

Hospital Practices Influence Which Moms Will Breast-Feed

Offers of water, formula supplementation cut likelihood new mothers will achieve goals.



FRIDAY, March 20 (HealthDay News) -- Hospital practices such as providing formula or water to supplement breast-feeding significantly reduce the number of mothers who breast-feed only, U.S. researchers report.

They analyzed national survey data from 1,573 mothers who gave birth in a hospital to a single infant in 2005. The women were asked retrospectively about their breast-feeding intentions, infant feeding practices at one week, and hospital practices.

The study found a significant difference between the numbers of mothers who said they intended to exclusively breast-feed and those who actually did so one week after giving birth. Among first-time mothers, 70 percent said they intended to exclusively breast-feed, but only 50 percent did so one week after giving birth.

The data suggests that more than 400,000 infants a year are born to mothers in the United States who intend to exclusively breast-feed but don't achieve that goal, the researchers said.

Hospital practices strongly influenced whether mothers followed through on their breast-feeding goals. Those who weren't offered water or formula supplementation were much more likely to achieve their intention to exclusively breast-feed -- 4.4 times more likely among first-time mothers and 8.8 times more likely among mothers who'd previously given birth.

The study found that 49 percent of first-time mothers who intended to exclusively breast-feed said their babies were given water or formula supplementation, and 74 percent reported being given free formula samples or offers.

The researchers also identified other hospital practices that influenced breast-feeding. For example, first-time mothers who gave birth in hospitals that practiced at least six of seven recommended steps to encourage breast-feeding -- such as helping mothers get started and not giving pacifiers to babies -- were six times more likely to achieve their goal of breast-feeding only than mothers at hospitals that followed one or none of the practices meant to encourage breast-feeding.

The study was published online in the American Journal of Public Health.

"Why are those hospital practices that have been repeatedly shown to increase breast-feeding among new mothers not more consistently instituted in United States hospitals? A large proportion of mothers stop exclusive breast-feeding within the first week, and that action was strongly related to hospital practices," wrote study leader Eugene Declercq, a professor of maternal and child health at Boston University School of Public Health, and colleagues.

They noted that the American Academy of Pediatrics and other medical groups recommend that infants consume only mother's milk for at least the first six months of life.

"Very often, research studies yield conclusions that don't translate easily into changes in practice or policy," Declercq said. "In this case, the message is loud and clear -- hospital practices can make a difference in early breast-feeding success and, in particular, every effort should be made to avoid supplementation of healthy babies of mothers who intended to exclusively breast-feed."

Thursday, March 19, 2009

'Good Feelings' From Alcohol Only Come With Fewer Drinks

Rat study suggests pleasurable endorphin release ends as drinking gets heavier.



THURSDAY, March 19 (HealthDay News) -- New research suggests that when it comes to getting pleasure from alcohol, less may be more.

Experiments in rats suggest that a low or moderate amount of drinking releases "feel-good" brain chemicals called beta-endorphins, but this activity tapers off with heavier drinking.

"Drinking the low amounts of alcohol is associated with mild euphoria, decreased anxiety and a general feeling of well-being, while drinking high amounts of alcohol is associated with sedative, hypnotic effects and often with increased anxiety," said study author Christina Gianoulakis, a professor of psychiatry and physiology at McGill University and Douglas Mental Health University Institute, in Montreal.

The bottom line: "If after consumption of about two drinks of alcohol an individual does not experience the pleasant effects of alcohol, he or she should stop drinking," Gianoulakis said.

In the study, researchers injected male laboratory rats with saline or alcohol and tracked levels of opioid brain chemicals such as endorphins, enkephalins and dynorphins.

Rodents given low to moderate levels of alcohol showed increased levels of beta-endorphins, which produce a feeling of well-being in humans, while those given higher levels of alcohol did not. The same doses did not alter levels of the other the two other opioids, enkephalins and dynorphins.

Higher doses of alcohol failed to trigger the same release of beta-endorphins, the team found.

The study results were published online March 19 in the journal Alcoholism: Clinical & Experimental Research and will be available in the journal's June print issue.

Besides helping to explain the "buzz" that comes with light, social drinking, the research may have implications for the treatment of alcoholism, experts said.

"We're always looking for medications that can be used with the alcoholic to cut back on craving and dependency," noted Dr. Marc Galanter, director of the division of alcoholism and drug abuse in the department of psychiatry at New York University School of Medicine in New York City. "That's why this whole neurotransmitter system is one area where we may find useful medications."

While medications that curb alcoholism by acting on brain chemicals are already prescribed today, Gianoulakis speculated that future research may lead to even more targeted therapies.

"Among the current treatments of alcoholism is administration of substances that block the activity of opioid peptides in a non-specific fashion [all opioid peptides in all brain regions]," she explained. "Our findings suggest that a more targeted approach may be developed by blocking the activity of beta-endorphin in the [brain's] ventral tegmental area."

But researchers say additional research is needed to better understand the relationship between alcohol and endorphins and to further develop treatments to treat the disease, beginning with studies involving human beings who actually consume alcohol.

"This is a laboratory study, so it's not easy to extrapolate from this study into specific effects on people in real-life situations," Galanter said. "But it does illustrate how that whole domain is important in research for alcoholism treatment."

Until definitive conclusions are drawn, addiction specialists and physicians continue to advocate that healthy adults consume alcohol in moderation.

"Consumption of high amounts of alcohol not only will fail to increase the release of endorphins and produce a feeling of well-being, but may stimulate other systems in the brain that may lead to the development of anxiety and depression," said Gianoulakis. "My advice to everyone is to drink less alcohol, because more is not necessarily better."

PSA Testing: What Should Men Do?

Fallout from 2 studies, pro and con, has experts in a quandry.



THURSDAY, March 19 (HealthDay News) -- In the wake of yesterday's publication of two major studies on the prostate-specific antigen (PSA) test to detect prostate cancer -- one finding that it didn't save lives and another finding that it did -- American men may be wondering if the test is still worth taking.

The studies, published in the New England Journal of Medicine, probably won't end the long controversy surrounding a blood test that millions of men have routinely been taking for years.

While an elevated PSA reading may indicate a life-threatening cancer, it may also detect much slower moving tumors that would never cause death. Because doctors cannot yet tell the difference, treatments are often ordered that can impair men's quality of life -- causing many experts to worry that the PSA test is overused.

The American Cancer Society, for one, does not currently recommend routine PSA screening for all men.

"We stopped mentioning screening in 1997, and since then have been for 'informed decision-making,'" said Dr. Otis Brawley, chief medical officer of the society. "We recommend that the physician should offer the test and inform men of the potential risk and potential benefit of screening."

One of the NEJM studies, which followed almost 80,000 American men for seven years, found no reduction in prostate cancer deaths among those who had regular PSA tests, compared to men who made no special attempt to have such tests. But the other study, which included 182,000 European men, found a 20 percent lowering of prostate cancer deaths among men who had such screening.

"At least initially, these won't change our recommendations," said the ACS' Brawley. However, "we will get our prostate cancer advisory committee together to consider the issue," he added.

According to Brawley, men at higher risk of prostate cancer, such as those with a family history and African-Americans, should have that conversation with a physician at age 45, while most men can wait until age 50.

African-American men have a higher incidence of prostate cancer and a higher risk of dying of the malignancy.

But Dr. Judd Moul, director of the Duke University Prostate Center, sees flaws in the U.S. study (which argued against a mortality benefit) that he believes invalidate its findings.

"In the American study, the control group was under routine medical care, and in that control group, half the men had PSA screening," Moul said. "So, it was screening versus 'semi'-screening."

In addition, there was no provision in the American study that men with high PSA levels should seek treatment, Moul said. "It's not a screening test if it isn't followed up with treatment," he said.

Moul has an admittedly personal interest in the subject, since his father-in-law died of prostate cancer. And, he said, he has vivid memories of the pre-PSA-test era, when most men with the disease were only diagnosed at an advanced, tough-to-treat stage.

"I don't want to go back to the days when I had patients all over the ward dying of painful metastatic prostate cancer," Moul said.

And so, he prefers the recommendation of the National Comprehensive Cancer Network, formed by major U.S. cancer centers, that all men have an initial PSA test at age 40, which would indicate their risk of developing prostate cancer, with follow-up testing at age 45. "After age 50, I would follow the recommendation of the American Cancer Society," Moul said.

And PSA testing should certainly stop at age 70, said Dr. Derek Raghavan, chairman of the Cleveland Clinic's Taussig Cancer Institute -- but with one caveat. If previous annual tests have shown a rising level of PSA, a protein produced by the prostate, testing should continue, Raghavan said.

"The studies certainly have added fuel to the controversy about PSA testing," Raghavan said. It is a controversy that starts with the knowledge that a PSA test is not cancer-specific. A high reading must be followed by a biopsy to find if cancer is present.

A finding of cancer also opens the door to a second level of controversy, because prostate tumors are notoriously variable. Some can grow aggressively and fatally. Many grow so slowly that they are no danger to life. But no test currently available can tell the difference between a life-threatening and an indolent prostate cancer.

On the other hand, aggressive treatment of prostate cancer carries its own dangers, which include possible incontinence and impotence. Raghavan noted that the overall survival in the European trial was the same for those who had screening and those who did not, while Brawley was uncomfortable with the European finding that 48 men had to be treated to save one life.

"The data that have come out show only a small relative benefit," Raghavan said. "For people who are looking for an argument for screening, it isn't there."

Moul countered that, "we may be detecting many cancers that never threaten lives. But we are saving lives."

Natasha Richardson Died From Head Trauma: Autopsy

'Epidural hematoma' is a blood clot between the brain and the skull.



THURSDAY, March 19 (HealthDay News) -- Actress Natasha Richardson died from a blunt impact to the head after falling Monday on a beginner's ski slope in Canada, the New York City medical examiner said Thursday.

The cause of death, which was ruled an accident, was "epidural hematoma due to blunt impact to the head," said medical examiner spokeswoman Ellen Borakove, the Associated Press reported. An epidural hematoma is a blood clot that pools between the brain and the skull.

The 45-year-old, award-winning Richardson, who died Wednesday at a hospital in New York City, reportedly suffered the head injury after falling during a private lesson at a resort in Quebec.

Richardson seemed fine after she fell, but about an hour later, she complained she didn't feel well. She was hospitalized Tuesday in Montreal and later flown to Lenox Hill Hospital in Manhattan, where she died, the AP reported.

Until the autopsy results were released Thursday, many were wondering how Richardson suffered a devastating brain injury after an apparently minor fall on a beginner's ski slope.

"If you take the name Natasha Richardson out of the picture and ask how a neurosurgeon would think of a case where someone has a fall which seems fairly minor and then deteriorates a few hours later, quite a few things would go through the surgeon's differential thinking," Dr. Arno Fried, chairman of neurosurgery at Hackensack University Medical Center in New Jersey, said Wednesday. "It's not an uncommon scenario."

A worse-case scenario would be bleeding either on the surface or deep inside the brain, Fried said.

According to news reports, Richardson fell during a beginner skiing lesson at the Mont Tremblant ski resort north of Montreal. She was not wearing a helmet.

Richardson suffered no immediately apparent injuries and was able to walk and talk right after the accident. "She was awake and alive and laughing and breathing," Catherine Lacasse, the public relations supervisor for Mont Tremblant Resorts, told Bloomberg News. "She refused to see a doctor. She said she was fine, and everything was OK."

But, Richardson complained of a headache about an hour after the mishap and her condition deteriorated. She was taken by ambulance to a nearby hospital, then transferred to Hopital du Sacre-Coeur de Montreal and then flown Tuesday afternoon to New York City, where she reportedly received care at Lenox Hill Hospital before passing away on Wednesday.

Dr. Steven R. Flanagan, director of the Rusk Institute of Rehabilitation Medicine at New York University's Langone Medical Center in New York City, said Wednesday that a diagnosis of hemorrhage would account for the headache that surfaced after the accident.

"It's not terribly common, but someone can be perfectly lucid [after hitting their head], then go rapidly downhill," Flanagan said. "It's not a major surprise. It's clearly reported in the literature."

Fried said that "slow bleeding [could] take a few hours to make itself known."

"The brain is contained within the skull, and the skull is a rigid box. There is no movement [possible]," he added. "Any pressure that builds up will put pressure on the brain, which is very unforgiving and sensitive to pressure."

Dr. Eugene Flamm, chairman of neurosurgery at Montefiore Medical Center and Albert Einstein College of Medicine in New York City, agreed. He stressed that the low-velocity, low-impact type of accident that Richardson experienced would typically not result in a grave outcome.

Such outcomes are "pretty rare," Flamm said. However, he added that it was certainly a possibility that physicians hold in their mind when seeing patients.

"It's quite unusual, but we see a lot of people in the emergency room, and if they have a head injury, and the scan is OK, we send them home but with instructions to 'look out,' " Flamm said. "I don't think any neurologist would say they had never heard of this scenario."

Richardson, who had appeared in several movies and won a 1998 Tony Award for her performance in Cabaret, was married to the actor Liam Neeson. The couple's two sons were reportedly with Richardson on the ski holiday.

Richardson was born into one of the most lauded acting families in Great Britain. She was the daughter of the actress Vanessa Redgrave and film director Tony Richardson, who died in 1991, the niece of the actress Lynn Redgrave, and the granddaughter of Sir Michael Redgrave.

Wednesday, March 18, 2009

2 Studies Conflict Over Value of Prostate Cancer Screening

Doctors acknowledge that the PSA test is a far from perfect tool.



WEDNESDAY, March 18 (HealthDay News) -- Two new studies offer conflicting views on the value of screening men with a prostate-specific antigen (PSA) test to check for prostate cancer.

But at least one leading oncologist says this much seems to be clear: A younger man with a strong family history of prostate cancer should pay attention to a PSA test, while an older man with known medical problems can probably avoid the exam.

That assessment comes from Dr. Gerald Andriole, chief urologic surgeon at the Washington University Siteman Cancer Center in St. Louis, and lead author of one of the two papers on major PSA screening trials being released Wednesday by the New England Journal of Medicine.

But the reports are far from the final word on the issue of PSA screening, because there's a significant debate on the subject among the experts who know the most about it. Uncertainty is the prevailing mood, as demonstrated by the journal's decision to avoid the customary authoritative "commentary" on the study results, and instead run the transcript of a debate on the issue with two authorities, replete with "ifs" and "buts."

Start with the study results. The American trial, funded by the U.S. National Cancer Institute, followed almost 77,000 men. Half were recommended to have annual PSA tests for six years and digital rectal exams for four years, while the other half was told to have their usual medical care.

While 22 percent more prostate cancers were diagnosed in seven years in the PSA group, there were actually more deaths from prostate cancer in that group than in the usual-care group -- 50 to 44. And there were more deaths overall in the PSA group -- some of them possibly attributable to overtreatment of the prostate cancers, Andriole said.

The European trial, which included 182,000 men, offered either a PSA test every four years or no screening test at all. Over nine years, prostate cancer was diagnosed in 8.2 percent of the PSA group, and 4.8 percent of the no-screening group. The prostate cancer death rate was 20 percent lower in the PSA group.

The two studies can't be compared directly, Andriole said, largely because of differences in their designs. And neither answers the question: Is PSA screening worthwhile?

Dr. Christine Berg, a National Cancer Institute leader of the U.S. trial, said the problem is that while the PSA test can help diagnose prostate cancer, it can't single out the aggressive tumors that will eventually be fatal. The standard statement among doctors is that more men die with their prostate cancer than of it, and no current test can tell a slow-growing, not-dangerous tumor from an aggressive killer.

One recent study found that as many as two of every five men diagnosed with prostate cancer by a PSA screening test had tumors that were too slow-growing to ever be a threat.

"There is no test right now that can be done on blood or urine that will determine how aggressive a tumor is," said Dr. Edward P. Gelmann, professor of oncology at Columbia University Medical Center in New York City. "We're pretty good at identifying very aggressive tumors or very indolent tumors, but there is a large grey area."

"That kind of advance might be just around the corner," Berg said. "I do think we are making strides toward understanding the genetics of prostate cancer. The pace and rapidity with which we will get those answers is improving."

Meanwhile, men who have surgery or other treatments for nonaggressive prostate cancers face such problems as impotence and incontinence.

The death rate from prostate cancer in the United States has been dropping steadily since the early 1990s, when the PSA screening test was first introduced, Gelmann said, but there have been major improvements in treatment since then, so the effect of the PSA test is unclear.

The picture might become clearer as follow-up of the men in the U.S. study continues, Andriole said, because of the relatively limited follow-up time so far. "We just don't know what is going to happen to the youngest cohort of men in the study," he said. "We may see a benefit."

The message is clearest for older men, Andriole said. "If the man sitting in front of me is an elderly man with a limited life span, I can in good conscience tell that man that a PSA test is not necessary," he said.

There is a more complex message for younger men and their physicians, Andriole said. "I'm not confident we can tell younger men what to do," he said. "If they do have a digital rectal exam and a PSA test, then the physician's reaction needs to be less knee-jerk than it has been in the medical community so far -- to have a biopsy and the move directly to treatment if it is positive."

A PSA test measures levels of a protein produced by the prostate and thus is now cancer-specific, Andriole noted, and so, "if the results of this trial hold up, we may say that the PSA test is not a good indicator of prostate cancer."

Mussel-Based Glue May Make Surgery Safer

The natural medical adhesive might be applied using inkjet printer technology, researchers say.

WEDNESDAY, March 18 (HealthDay News) -- Using such unlikely partners as marine mussels and printer inkjet technology, researchers say they've come up with medical adhesives that can be used with greater precision, promote faster recovery and reduce scarring.

Currently, sutures and synthetic adhesives are used to join tissue together after a patient has surgery, a team at North Carolina State University explained. But sutures can cause complications such as discomfort, infection and inflammation. According to background information in the study, there are also concerns about the toxicological and environmental effects of synthetic medical adhesives. Finally, these adhesives don't break down in the body and may cause inflammation, tissue damage and other problems, the researchers said.

However, the NC State team noted that adhesive proteins found in the glue of marine mussels are both non-toxic and biodegradable. These natural proteins can be placed in solution and applied, using inkjet technology, to create customized medical adhesives with a variety of uses.

For example, this method may "significantly improve wound repair in eye surgery, wound closure and fracture fixation," study co-author Dr. Roger Narayan, an associate professor in the joint biomedical engineering department, said in a university news release.

"This is an improved way of joining tissues, because the use of the inkjet technology gives you greater control over the placement of the adhesive. This helps ensure that the tissues are joined together in just the right spot, forming a better bond that leads to improved healing and less scarring," Narayan said.

The study is to be published in the Journal of Biomedical Materials Research B in April.

Researchers Use Gene to End High Blood Sugar in Mice

Whether method might someday help people awaits further study.

WEDNESDAY, March 18 (HealthDay News) -- Delivering a gene called neurogenin3 into the livers of diabetic mice activates adult stem cells that promote steady insulin production, say researchers at the Baylor College of Medicine in Houston.

The mice had type 1 diabetes. Within a week after the gene was delivered using a disarmed virus, the researchers said, the rodents' blood sugar levels returned to normal and remained that way for the rest of their lives.

The gene triggers a two-step response. First, neurogenin3 goes into the mature liver cells and causes them to make small quantities of insulin, enough to reduce blood sugar levels to normal.

"This is a transient effect. Liver cells lose the capacity to make insulin after about six weeks," Dr. Vijay Yechoor, assistant professor of medicine-endocrinology at Baylor and the study's first author, said in a news release from the college.

Other cells that make larger amounts of insulin show up later. These cluster around the portal veins, which carry blood from the intestines and abdominal organs to the liver. These new cells, which look similar to pancreatic islet cells that normally make insulin, come from a small population of adult stem cells usually found near the portal vein, the authors said.

These stem cells normally act as reserves in case of liver injury. When the liver is damaged, the stem cells form mature liver cells or bile duct cells. But neurogenin3 changes their programming so that they become insulin-producing beta cells in the liver, the researchers said.

The study appears in the March issue of Developmental Cell.

Though the finding is important, much more research is needed before similar results might be seen in humans, Yechoor and his colleagues said.

Lymphedema Raises Cost of Breast Cancer Care

Painful swelling can require treatments for infections and depression.



TUESDAY, March 17 (HealthDay News) -- In breast cancer survivors, lymphedema -- an uncomfortable swelling of the arm and wrist -- can be one of the most vexing side effects of treatment.

Now, a new study has found that women who develop lymphedema fare worse than women without the condition and have higher out-of-pocket medical costs after radiation and surgery.

Breast cancer survivors who develop lymphedema report a lower quality of life, higher levels of anxiety and depression, an increased likelihood of chronic pain and fatigue and greater difficulty functioning socially and sexually, according to a study in the March 16 online issue of the Journal of Clinical Oncology.

Lymphedema also boosted two-year, postoperative medical costs by $14,877 to $23,167, the study found. The additional cost came from office visits, treatments for infections and mental health services, including prescriptions for antidepressants.

One reason for higher out-of-pocket costs: Insurance companies don't always fully cover lymphedema treatments, which can include compression garments and specially trained therapists who provide massages and physical therapy to help the area drain, said Ya-Chen Tina Shih, an associate professor of health economics at the University of Texas M.D. Anderson Cancer Center, in Houston, and an author of the study.

Although federal regulations and about 21 states require private insurance to cover lymphedema treatments after mastectomies, the laws are not specific about what constitutes lymphedema treatment and insurance companies have wide latitude in determining benefit levels, Shih said.

"Right now, it's really up to insurance companies' interpretation for what is appropriate lymphedema treatment," Shih said.

Lymphedema is caused by a buildup of lymphatic fluid, usually as a result of damage to the lymphatic system from radiation or surgery. Melanoma and cancers of the head, neck and pelvic area can also leave people susceptible to the condition, said Dr. Brian Lawenda, clinical director of radiation oncology at the Naval Medical Center in San Diego and a lieutenant commander in the U.S. Navy.

To some breast cancer survivors, lymphedema, which can develop years after radiation and surgery, is as distressing as the initial breast cancer diagnosis, the study found.

Using medical claims information on 1,877 women, researchers found that 10 percent sought treatment for lymphedema. However, that was probably an underestimate of the true incidence, Shih said, because there is no standard definition for lymphedema, doctors may not list lymphedema as a reason for the office visit and not all women seek treatment.

Previous research has shown that up to 50 percent of breast cancer survivors develop lymphedema, with 32 percent having persistent swelling three years after surgery, according to the study.

"It's a terribly overlooked problem," said Robert Smith, director of cancer screening for the American Cancer Society. "Many of these women have significant out-of-pocket expenses, and prolonged and chronic health problems, as a result of it. It's not curable, and once women have lymphedema, unless it's properly managed and treated, it can become progressively worse."

While some have mild cases, for others, the swelling can lead to loss of motion in the affected arm, cysts, skin thickening and infections such as lymphangitis, a bacterial infection of the lymphatic vessels, or cellulitis, an inflammation and infection just below the surface of the skin.

About a third of people with lymphedema get infections, which occur because the fluid backup inhibits the immune system's response, Lawenda said.

The study found that women in the western United States were more likely to have filed lymphedema-related insurance claims than those in the Northeast. Women in all regions of the country probably suffer from the condition equally, Shih said, but more states in the West have passed laws requiring insurance companies to cover treatments.

Standard treatments include keeping the skin clean and moisturized, being careful when clipping nails, wearing compression sleeves to prevent swelling, doing therapeutic exercises and having massage to promote manual lymphatic drainage, Lawenda said.

"It is a condition that's not curable," he said. "However, it is manageable, treatable and will improve."