WF- News December 2003

Kids: Turn Off the TV and Eat an Apple! (December 17, 2003)

(Ivanhoe Newswire)

Parents know kids aren’t as healthy when they watch too much television because it keeps them from exercising or keeps them snacking in front of the television, but new research shows TV watching may actually impact fruit and vegetable consumption among adolescents.

Harvard researchers found each hourly increment of TV viewing was associated with a decrease in fruit and vegetable consumption among adolescents. They found the more television the teens watched, the fewer fruits and vegetables they ate. The authors studied the eating and TV viewing habits of teens for nearly two years. They say a young person who watched television three hours a day in the beginning of the study and increased his or her viewing by one hour a day had, on average, 2.25-fewer servings of fruits and vegetables per week. That means these kids are getting about 110 fewer servings of fruits and vegetables per year than those who do not watch television. The researchers say, “In sum, fruit and vegetable consumption was negatively associated with hours of television viewing.”

The researchers have several theories for their findings. First, they point to previous studies that show children ages 2 to 11 are exposed to an average of 150 to 200 hours of commercial messages (or 20,000 commercials) each year, and nearly 56 percent of these ads are for food. Other studies have shown that nearly half of food commercials aimed at kids have implicit messages that the foods are healthy or nutritious, including ads that market sugary breakfast cereals as part of a “balanced diet.” This study reveals children’s nutritional knowledge may be biased by these marketing strategies. Plus, since the people kids see on television are rarely obese or suffering from poor health caused by bad dietary habits, kids may have unrealistic expectations about the consequence of bad eating habits.

The U.S. Department of Agriculture’s Food Guide Pyramid recommends three to five servings of vegetables each day. Most surveys estimate kids eat between 2.2 and 2.4 servings daily -- well below those guidelines. In addition, 25 percent of the reported “vegetables” eaten by children and adolescents are french fries. This study shows only one in five children consumes five or more servings of fruit and vegetables each day.

The Harvard researchers say children should be made aware of the goal of commercials so that they become informed consumers. They also say parents need to try to stick to the American Academy of Pediatrics recommendation of no more than two hours of television per day. They write, “It is essential that parents are informed of the potential impact television viewing may have on their children.”

SOURCE: Pediatrics, 2003;112:1321-1326

Breast Cancer Patients Need Better Treatment (December 16, 2003)

(Ivanhoe Newswire)

Too many breast cancer patients are not receiving optimal therapy for their cancer, report researchers publishing in the most recent issue of the Journal of Clinical Oncology.

The study shows more than half of those with early-stage cancer fail to get the full dose of chemotherapy they need to reduce the risk of recurrence or death.

Studies have shown chemotherapy reduces the risk of recurrence by about 23 percent and death by about 14 percent in women whose breast cancer is diagnosed in the early stages. But chemotherapy also has unwanted side effects. In many women, for example, the treatment kills off white blood cells, putting women at increased risk for infections. Chemotherapy must then be delayed or doses must be reduced to give the white blood cells a chance to recover. New medications do exist, however, to combat the loss of white blood cells, making it possible to continue chemotherapy on schedule.

This study analyzed chemotherapy treatment among nearly 21,000 women being treated in centers across the country. Fifty-six percent of the women failed to receive 85 percent or more of their recommended chemotherapy. The percentage was even lower among older women. About two-thirds of those 65 and older didn’t complete the treatment on schedule. Only about one-fourth of the patients received medications to boost white blood cell counts during treatment, and most received them only after developing low white blood cell counts.

The authors say other researchers have developed a model to predict which women will be most likely to develop low white blood cell counts during treatment. They suggest doctors use this model and other factors to target patients at higher risk of developing low white blood cell counts during treatment so they may receive preventative treatment with the new medications.

Gary Lyman, M.D., M.P.H., from the University of Rochester in New York, says, “Far too many patients are not receiving the chemotherapy doses they need in order to have the best chance of remission or cure. We need to find better ways to identify patients at risk in order to provide optimal supportive care.”

SOURCE: Journal of Clinical Oncology, 2003;21:4524-4531

Diabetes Linked to Depression (December 16, 2003)

(Ivanhoe Newswire)

A new study shows women with diabetes have a higher risk of depression.

British researchers studied more than 4,200 women between ages 60 and 79. The participants were divided into two groups. The first group included women with diabetes, and the second included those without diabetes. Women who did not have diabetes were again divided into four smaller groups, based on their levels of insulin resistance.

Researchers assessed the women’s mental states by evaluating their medications, medical history, and results from a mood questionnaire. Results of the study show women without diabetes, who have increasing levels of insulin resistance, are not likely to be depressed. However, the risk of depression increases in women with diabetes.

Previous studies have shown individuals who are insulin-resistant may have higher serotonin concentrations and may be more prone to depression and even suicide. Authors of the study write, “Insulin resistance is inversely associated with depression. Our results are consistent with a large prospective study in which indicators of insulin sensitivity were associated with suicide risk.” They say women with diabetes may be more likely to suffer depression because of the clinical diagnosis.

Authors of the study conclude, “If our findings are confirmed, there may be an indication for assessing depressive symptoms among individuals receiving treatments that affect insulin resistance, since depressive symptoms are often disabling and could affect compliance with treatment and quality of life.”

SOURCE: British Medical Journal, 2003;327:1383-1384

Pain Blamed on Vitamin D Deficiency (December 12, 2003)

(Ivanhoe Newswire)

A new study conducted by researchers at the University of Minnesota shows a link between musculoskeletal pain and vitamin D deficiency.

Researchers examined 150 children and adults with non-specific musculoskeletal pain for their levels of vitamin D. Among the participants, all African-American, East African, Hispanic and Native American patients had vitamin D deficiencies, as were all patients younger than 30. Five patients actually had no vitamin D at all.

Greg Plotnikoff, M.D., lead author of the study, says it is a misconception to believe vitamin D deficiency is only prevalent in older or housebound people.

"We found the worst vitamin D deficiency in young persons -- especially women of childbearing age," says Dr. Plotnikoff.

The risks involved with vitamin D deficiency include women giving birth to children with adverse fetal effects or neonatal illnesses, young adults not developing optimal bone mass, and older adults experiencing osteoporotic fractures.

Vitamin D deficiency is also associated with significant risks for osteoporosis, hypertension, diabetes, cancer and auto-immune diseases such as multiple sclerosis.

Dr. Plotnikoff recommends further investigation to determine relief and management of musculoskeletal pain with prescriptions of vitamin D. He adds, “... Screening all outpatients with such pain for hypovitaminosis D should be standard practice in clinical care.”

Unsuccessful treatment of pain costs $61.2 billion per year, according to the November 2003 pain management issue of the Journal of the American Medical Association.

SOURCE: Mayo Clinic Proceedings, December 2003;1463-1470

Benefits of Asthma Treatment Outweigh Risks (December 12, 2003)

(Ivanhoe Newswire)

Government guidelines on the treatment of asthma have long recommended inhaled corticosteroid (ICS) therapy as the best treatment for people with persistent forms of the condition.

But reports about side effects of these drugs have led many people -- including parents of asthmatic children -- to question their use. Specifically, ICS has been linked to growth retardation in children, weak bones in children and adults, skin thinning, and eye problems.

Now leading scientists hope to put those fears to rest. Three medical groups -- the American College of Chest Physicians, the American Academy of Allergy, Asthma, and Immunology, and the American College of Allergy, Asthma, and Immunology -- have teamed up to publish a systematic review of the medical evidence on ICS therapy and related side effects. Their conclusion is that the therapy is safe and effective and should remain the gold standard of treatment.

According to the report, published in this month’s CHEST:

ICS therapy is not associated with bone thinning in children.
ICS therapy is linked to skin thinning and bruising in both adults and children, but the effects are mostly related to dose, length of use, and the gender of the patient.
ICS therapy is associated with a decrease in childhood growth rates, but the effect is small and studies suggest it may not persist with long-term therapy. Adult height of asthmatic children treated with ICS therapy is not substantially different from adult height attained by nonasthmatic children.
Conclusions could not be drawn on the effect of ICS therapy on bone thinning in adults or eye problems such as cataracts and glaucoma due to a lack of sufficient medical evidence.

Lead author Frank T. Leone, M.D., M.S., from Thomas Jefferson University in Philadelphia, says, “After a systematic and accurate review of the proven risks, we can say with confidence that the majority of evidence supports the conclusion that the clinical effectiveness of ICS therapy decidedly outweighs the proven risks.”

SOURCE: CHEST, 2003;124:2329-2340

New Indicators for High Blood Pressure (December 11, 2003)

(Ivanhoe Newswire)

High levels of a plasma protein may indicate future high blood pressure, according to new research.

Researchers at Brigham and Women’s Hospital and Harvard Medical School examined whether C-reactive protein levels were associated with hypertension -- high blood pressure -- and they found there was a “positive association” between increasing levels of C-reactive protein and the risk of developing hypertension.

More than 20,000 women over age 45 participated in the study. At the beginning of the study, they had normal blood pressures and blood samples were collected to measure C-reactive protein levels. Half the women were followed for longer than 7.8 years and half were followed less than 7.8 years for development of hypertension. Over the follow-up period, 5,365 women developed high blood pressure. Women who had the highest levels of C-reactive protein levels at the beginning of the study were about twice as likely to develop hypertension.

C-reactive proteins rise in the blood with inflammation from certain conditions, and they are used as a test to reflect the presence and intensity of inflammation. The authors of this study say their data suggests inflammation may have a potentially important role in the development of hypertension.

In an accompanying editorial, Scott M. Grundy, M.D., Ph.D., of the University of Texas Southwestern Medical Center in Dallas, discusses a similar association between low-grade inflammation and metabolic syndrome -- a cluster of conditions including abdominal fat, high blood sugar, insulin resistance, high cholesterol and high blood pressure. Dr. Grundy writes, “The present demonstration of an apparent connection between low-grade inflammation and hypertension supports the concept that elevated blood pressure should be listed as one of the components of the metabolic syndrome.”

SOURCE: Journal of the American Medical Association, 2003;290:2945-2951,

Statement on Use of Type 2 Diabetes Drug (December 10, 2003)

(Ivanhoe Newswire)

A series of studies have linked the use of the diabetic drug known as thiazolidinediones (TZDs) to congestive heart failure. In response to these studies, the American Heart Association and the American Diabetes Association have issued a statement on the use of the drug. The statement explains new recommendations for the use of this drug in patients with diabetes.

Diabetes is a major risk factor for heart disease. The TZD drugs help doctors manage a person’s blood sugar level and may even lower other heart disease risks such as high blood pressure and high cholesterol. TZDs are a popular choice to treat patients with type 2 diabetes. However, new studies show the drugs are associated with fluid retention such as swelling in the feet. This fluid retention is known as edema and is a sign of congestive heart failure. Doctors from the AHA and the ADA examined the existing studies to give physicians and patients new recommendations on the use of TZDs.

The group recommends that people with moderate to severe congestive heart failure should avoid TZDs. They also say patients who have impaired hearts such as impaired pumping ability can still be prescribed TZDs but should be started on a low dose and watched carefully for signs of edema. As for diabetic patients with mild to moderate heart failure, TZDS can be prescribed but should be started with a low dose and carefully watched. This is the same recommendation for patients without heart disease, but have one or more risk factor for heart failure.

Doctors say they don’t know from the studies whether or not the patients who are on TZDs also had underlying heart disease. “We don’t know the real risk because we don’t know either the actual number of patients with diabetes who are taking a TZD and develop congestive heart failure, compared to the total number of patients who are taking a TZD,” says Richard Nesto, M.D., chair of the department of cardiovascular medicine at the Lahey Clinic in Burlington, Mass. and lead author of the joint statement. “This risk is probably quite low, but without solid data that’s just guesswork.”

Doctors say the TZDs are an otherwise excellent class of drugs that can improve glycemic control in diabetics. They feel the new guidelines will help physicians and patients balance potential risks of using TZDs in different types of patients with diabetes.

SOURCE: To be published in an upcoming issue of Circulation

Atkins Diet Linked to Curtailing Epileptic Seizures in Children (December 10, 2003)

(Ivanhoe Newswire)

New research shows the popular high-fat, low-carbohydrate Atkins diet may prevent seizures in children with epilepsy.

Researchers from Johns Hopkins Children's Center presented their findings at the American Epilepsy Society Meeting in Boston. Their study included six patients with epilepsy who were on the Atkins diet for at least four months. Three of the participants were 12 years or younger. At the end of the term, two children and one young adult were seizure-free and were able to reduce their anticonvulsant medication.

Researchers cautioned that because of the limited time spent on the study, it is still too early to recommend the Atkins diet to treat children with epilepsy or to substitute it for the ketogenic diet, the rigorous high-fat, low-carbohydrate diet proven to eliminate difficult-to-control seizures.

Eric Kossoff, M.D., a pediatric neurologist Johns Hopkins, says, "We just don't know yet how effective the Atkins diet is in reducing seizures or if it comes close to the benefits of ketogenic diet, but our report raises new questions about the ideal level of calorie and protein restriction imposed by the ketogenic diet."

Like the ketogenic diet, the less-restrictive Atkins diet also produces ketones, a chemical byproduct of fat that can inhibit seizures. In the study, five out of six patients produced ketones within days of starting on the diet and maintained moderate to high levels of ketosis for six weeks to 24 months.

The researchers plan to continue to examine the role the Atkins diet plays in reducing epileptic seizures in children. For now Dr. Kossoff says it is possible the Atkins diet could be used as a "trial run" in patients considering the ketogenic diet in the future.

"Success on the Atkins diet may be a good indication of patient compliance and efficacy of the ketogenic diet," he adds.

SOURCE: American Epilepsy Society Annual Meeting, Boston, Dec. 5 - Dec. 10, 2003

More Reasons for Regular Mammograms (December 8, 2003)

(Ivanhoe Newswire)

Past evidence has shown that breast cancer patients who use hormone replacement therapy have better survival rates than those who have never taken hormones. A new study finds this is probably due to more frequent mammograms rather than any effects of the hormones on tumor biology.

Janet Daling, Ph.D., the lead author of the study, says benefits that have been ascribed to HRT, like smaller tumor size and earlier diagnosis, are most likely a result of women visiting their doctor’s office once year for prescription renewals -- and mammograms -- and not a benefit of the HRT. Daling and colleagues found that 90 percent of women who used combination estrogen/progestin HRT had undergone a mammogram within two years of breast cancer diagnosis. However, only 65 percent of women with breast cancer who never used HRT underwent one in the same time.

Researchers also discovered a significant difference in tumor size between those who had recently been screened and those who had not. Sixty-seven percent of women who had been screened in the last two years had tumors smaller than two centimeters, or about the size of a pea. Among women who had not been screened that recently, only 34 percent had tumors that small.

“I was floored when I saw this data because tumor size is one of the most important prognostic factors in breast cancer,” says Daling. “If that isn’t a good advertisement for mammography screening, then I don’t know what is.”

After adjusting for screening history and other factors that could influence breast cancer outcome, researchers found other links between HRT use and improved prognosis. They say this suggests HRT does have an impact on tumor biology. For example, researchers found a statistically significant link between the use of estrogen therapy and reduced odds of being diagnosed with more-advanced disease. Women who took estrogen only were 70-percent less likely to be diagnosed with advanced breast cancer than those who had never taken hormones. Researchers also found a higher incidence of hormonally sensitive tumors -- ones that respond well to estrogen-blocking drugs such as tamoxifen -- and lobular breast cancer -- considered to be the more treatable kind of breast cancer -- among women on continuous-combined HRT than women who had never used hormones.

SOURCE: Cancer Epidemiology, Biomarkers and Prevention, 2003;12:1175-1181

Importance of Autopsies (December 8, 2003)

(Ivanhoe Newswire)

Researchers say a growing number of parents who terminate a pregnancy because of suspected abnormalities in their unborn child are declining autopsies. However, a new study shows these parents may be missing out on vital information that could help them plan future pregnancies.

Researchers from Oxford studied more than 57,000 deliveries that were terminated between 1991 and 2000. They then examined autopsy findings and diagnostic information to determine if the information pathologists give parents after the autopsy differed from that given to them prior to the autopsy.

Results of the study show less than 1 percent of deliveries were terminated due to a defect diagnosed before birth. They say the number of terminated births increased during the study, while the number of autopsies performed decreased. Researchers say one quarter of the autopsies done on fetuses that had had a defect determined by ultrasound alone provided important information that changed the parents’ risk of having another child with a defect.

Researchers say by declining an autopsy, parents may be missing out on critical details that could have implications for future pregnancies. Authors of the study say parents need full information about the potential benefits of an autopsy, as well as information about the procedure itself, so they can make an informed decision. They say an appropriately trained professional should initiate this discussion.

SOURCE: British Medical Journal, Dec. 2003

Breast Cancer Survivors Worry About Infertility (December 8, 2003)

(Ivanhoe Newswire)

A new survey conducted by the Dana-Farber Cancer Institute shows more than half of young breast cancer survivors overestimated their risk for developing treatment-related infertility problems.

Nearly 700 members of the advocacy organization Young Survival Coalition Group who were 40 years old or younger were surveyed. More than half of the respondents, or 57 percent, said they were concerned about being infertile as a result of cancer treatments they had undergone.

Past research has revealed that few women in this age group go through menopause because of standard treatment, and some studies even show a zero-percent incidence in patients.

Ann H. Partridge, M.D., says this study should serve as a wakeup call for health care providers.

"We don't have a great system for educating these women and showing them data -- even if incomplete -- about these questions and advising them on what they can consider to attempt to preserve fertility," says Dr. Partridge."[Women's] risk perceptions are likely grossly exaggerated; there is room for education here."

Doctors often assume infertility concerns are more prevalent in younger women with less-advanced stages of cancer. However, research shows that infertility is an issue for women who have a desire to bear children, regardless of age or cancer stage.

Dr. Partridge also says the effects of older treatments are fairly well known, but there is less information on the more modern ways of delivering chemotherapy.

The study was presented at the San Antonio Breast Cancer Symposium. Researchers say it is the largest study to date that addresses infertility and menopausal concerns among young women with breast cancer.

SOURCE: 26th Annual San Antonio Breast Cancer Symposium, San Antonio, Dec. 3 - Dec. 6, 2003

Second Opinion Changes Breast Cancer Treatment (December 8, 2003)

(Ivanhoe Newswire)

A new study shows seeking a second opinion for breast cancer may make a significant difference in how patients are treated and diagnosed.

Researchers from the University of Michigan Comprehensive Cancer Center examined the medical records of nearly 150 women who were diagnosed with breast cancer and who sought a second opinion. Results of the study show 45 percent of patients had a significant difference in the interpretation of their mammograms. More than 25 percent of these patients changed their treatment management.

Researchers say 7 percent of patients found out they had an additional cancer that was not detected during their first consultation. Twenty-eight biopsies were recommended after seeking a second opinion, and 45 percent of the biopsies came back positive for cancer.

Amy Rochester Guest, M.D., from the University of Michigan Comprehensive Cancer Center, says, “Although many patients’ diagnostic and treatment plans stayed the same after a consultation, enough of them changed that we see added value from seeking the opinion of a specialized team with extensive experience.” She says this is especially true in complex cases.

Authors of the study say second opinions are often covered by insurances, but patients usually need to seek them out on their own.

SOURCE: 89th Scientific Assembly and Annual Meeting of the Radiological Society of North America, Chicago, Nov. 30 - Dec. 5, 2003

Kidney Stone Myths (December 8, 2003)

CHAPEL HILL, N.C. (Ivanhoe Newswire)

Many people who have had kidney stones say it’s the worst pain they’ve ever experienced, but who’s at risk? Here’s the truth about kidney stones.

Urologist Culley Carson, M.D., has removed some giant kidney stones in his time -- stones that took major surgery to take them out. But kidney stones aren't always this large. In fact, about 80 percent of stones are less than a quarter-inch wide and will usually pass on their own. Sharon Presnell nearly passed out from a stone she passed. “It was the worst pain I’ve ever experienced,” she tells Ivanhoe.

Presnell shatters a common kidney stone myth, that only men get them. While men have a slight edge, the numbers are almost even. Myth number two is that they’re rare.

“Kidney stones are very common. In fact, one patient in 50 will have a kidney stone each year,” Dr. Carson, of University of North Carolina at Chapel Hill, tells Ivanhoe.

Another myth is that kidney stones cannot kill you. But Dr. Carson says you absolutely can die from a kidney stone. Still, death is extremely rare. Another myth is that calcium is the main culprit. It’s not, but excessive oxalate is a factor. It’s found in dark green leafy vegetables, iced tea and beer. Too much protein can also promote stones, while lemonade can actually prevent them.

Dr. Carson says, “The best way to eliminate or avoid kidney stones is to drink large amounts of water.”

Presnell follows that advice. “Oh yes,” she says, “I’m very fastidious about that. I don’t need to have that experience again.” Since kidney stones run in her family, Presnell watches her diet too. Small steps she’s willing to take to avoid another stone.

More than 1 million people a year get kidney stones, and the numbers are growing. Some doctors say one reason could be due to the high protein diets like Atkins that are popular right now.

If you would like more information, please contact:
Stephanie Crayton-Robinson
Media Relations Manager
UNC Healthcare
(919) 966-2860
scrayton@unch.unc.edu

Female Smokers Beware (December 2, 2003)

(Ivanhoe Newswire)

New research shows women have double the risk of developing lung cancer from smoking than do men. Results of the study were presented this week at the 89th Scientific Assembly and Annual Meeting of the Radiological Society of North America in Chicago.

Researchers from New York Hospital/Cornell Medical Center in New York studied nearly 3,000 men and women ages 40 and older with some history of smoking to determine what factors -- such as age, gender and number of years smoking -- impacted the probability of developing lung cancer. To best determine who is most at risk, these factors were combined with the size and texture of lung nodules found on CT scans.

Seventy-seven lung cancers were diagnosed in the men and women screened. Researchers further studied the probability of cancer based on the size and texture of nodules in more than 1,000 participants who had at least one lung nodule. Claudia I. Henschke, M.D., Ph.D., from New York Hospital/Cornell Medical Center, says: “We found that women had twice the risk of developing lung cancers as men, independent of how much they smoked, their age, or the size and textures of nodules found in their lungs. There is, as of yet, no clear consensus why women are at increased risk.”

Researchers also found the more people smoke and as they age, the greater their risk of developing lung cancer. Currently, lung cancer is the leading cause of cancer death among men and women in the United States. In 2003, the American Cancer Society figures about 171,900 new cases of lung cancer will be diagnosed and that 157,200 people will die from it.

SOURCE: 89th Scientific Assembly and Annual Meeting of the Radiological Society of North America, Chicago, Ill., Nov. 30 - Dec. 5, 2003

Stem Cell Work Breaks New Ground (December 2, 2003)

(Ivanhoe Newswire)

Scientists have, for the first time, taken adult stem cells and turned them into the bone and cartilage found in the human jaw.

They say the groundbreaking work may one day lead to better treatments for the approximately 30 million people who suffer from temporomandibular disorders.

The laboratory study started with adult stem cells taken from rats. Previous research has shown these cells can be coaxed to become any other type of cell in the body -- bone, muscle, ligaments, cartilage, and even teeth. In this case, researchers treated the cells with special growth factors and other chemicals to make them become bone and cartilage. They then took that mass and molded it into the shape of a human ball structure found in the jaw known as the articular condyle.

They watched the structure for a couple of weeks and found it retained the human shape. Tests also showed the structure continued to consist of human-like bone and cartilage.

While the investigators emphasize much more work must be done before tissue-engineered structures such as the ball are ready for use in people, they believe these results bode well for the future.

“This represents the first time a human-shaped articular condyle with both cartilage and bone-like tissues was grown from a single population of adult stem cells,” says author Jeremy Mao. “Our ultimate goal is to create a condyle that is biologically viable -- a live tissue construct that integrates with existing bone and functions like the natural joint.”

SOURCE: Journal of Dental Research, 2003;82:950-955

Aspirin is the Way (December 2, 2003)

(Ivanhoe Newswire)

New research shows aspirin is the most cost-effective way to prevent heart disease.

Researchers from the United Kingdom analyzed the cost effectiveness of aspirin, blood pressure-lowering drugs, cholesterol-lowering drugs, and an anti-clotting medication in preventing heart disease. They then calculated the cost per coronary event for each treatment.

Results of the study show aspirin and blood pressure-lowering drugs are the most cost-effective preventive treatments. Researchers say the cost per cardiac event in patients with a 10 percent risk over five years was less than $6,100 for aspirin, between $21,000 and $32,000 for blood pressure-lowering medications, and more than $103,000 for cholesterol-lowering and anti-clotting drugs. Results also show aspirin costs less than a fifth as much per cardiac event than cholesterol lowering drugs in patients with a 5 percent, five-year coronary risk.

Researchers say aspirin and blood pressure-lowering medicines provide most of the benefits that the more expensive, cholesterol-lowering and anti-clotting drugs do. They say treating a patient with a five-year coronary risk of 7.5 percent with aspirin and low-cost blood pressure-lowering medications is more cost effective than treating a patient who has a 30 percent risk with a cholesterol-lowering drug.

Authors of the study conclude, “A more effective strategy would be to offer most men over 55 and most women over 65 aspirin than to give statins to a few high-risk patients.”

SOURCE: British Medical Journal, 2003;327:1264-1267

CT Scans Detect Small Cancers (December 2, 2003)

(Ivanhoe Newswire)

New research presented at the annual meeting of the Radiological Society of North America shows computed tomography scans may accurately detect small cancers and stones in the kidneys, bladders and urinary tracts of high-risk patients.

Researchers from the University of Michigan studied a version of the CT scan, called multi-detector CT urography (MDCTU), to determine if the technology can accurately detect small kidney, bladder, and urinary masses. Results of the study show the MDCTU scan detected 93 percent of urinary system cancers in the 65 patients studied. Researchers say MDCTU can spot numerous problems in the tiny vessels of the urine collection system and also detect bladder cancer and kidney stones.”

Intravenous pyelogram (IVP) is the traditional method used to detect these problems but it identifies the cause of symptoms less than 50 percent of the time. IVPs also tend to have high false-positive and false-negative rates. Elaine Caoili, M.D., from the University of Michigan, says, “Our experience to date with MDCTU in patients with prior bladder and urinary tract cancer has convinced us that it is as good as IVP -- and probably far better -- for detecting all abnormalities of the urinary system.”

Researchers say MDCTU allows them to spot subtle tumors as small as two millimeters to three millimeters in areas where other exams cannot go. They say MDCTU also saves patients from having to endure repeated diagnostic scans and procedures.

MDCTU scans can be performed using helical CT scanners, which pass X-rays through the body from different angles. Patients are given a contrast dye that allows the scanner to make detailed images of the entire urinary system in slices smaller than a millimeter thick. Computers then combine these slices to create images that can be viewed.

More than 91,000 Americans are diagnosed with urinary system cancers each year. Dr. Caoili concludes, “We hope that MDCTU can become the first and only imaging test used for evaluating high-risk patients with urinary system symptoms, and that it will soon allow patients everywhere to get accurate early diagnoses that might improve their outcomes.”

SOURCE: The Annual Meeting of the Radiological Society of North America, Chicago, Ill., Nov. 30 - Dec. 5, 2003

Relieving Cancer Side Effects (December 2, 2003)

TORRANCE, Calif. (Ivanhoe Newswire)

Each year, more than 1 million people are diagnosed with cancer. Sometimes the tumors can cause additional problems that affect everyday tasks like eating. Now a treatment to relieve the extra medical problems that tumors often bring is just what the doctor ordered.

Gary Mc Ardle couldn’t do much of anything just a few weeks ago. “I’d be very nauseous. Depending on what I ate, I would throw up sometimes," he says. "I lost like 30 pounds over the space of about four months.”

He finally went to a doctor. A huge mass in his colon was crowding his intestines. “They said a mass the size that I had is normally related to cancer.”

Gastroenterologist Viktor Eysselein, M.D., of Harbor-UCLA Research & Education Institute, says obstructions like these are common in people with pancreatic, colon and uterine cancer. “As soon as a tumor grows, you will get obstruction in most cases.”

To open that obstruction, he uses this expandable stent that enlarges over time. “The metal mesh goes from a diameter of maybe two, three millimeters, goes up to 20 to 22 millimeters, and it develops over time,” Dr. Eysselein says.

He says the soft metal is nearly painless and is life-changing. “The first time they could eat solid food again, not only liquids, or if it was in the stomach, they could eat again without vomiting. It’s a tremendous increase in quality of life.”

During the surgery to insert the mesh stent, Mc Ardle's found out his mass wasn’t cancer. It was inflammation from Crohn's disease. He says: “It’s been fantastic. I’m building my strength back up. I’m living a day-to-day basis like a normal person.”

The expandable stents can also help people with esophageal cancer if their tumor is obstructing their esophagus. The stents are permanent once they’re inserted.

If you would like more information, please contact:
Christine Lewis
Communications Consultant
Issues Management Network
(310) 215-0234
clewis@issuesmanagement.com

Exercise Lowers Pre-term Birth Risk (December 1, 2003)

CHAPEL HILL, N.C. (Ivanhoe Newswire)

Many women become less active when they become pregnant, sometimes over fear that exercise could induce premature labor. But a new study shows exercise during pregnancy may do just the opposite.

Kristin Oguntoyinbo loves to exercise, but she slowed down during her first pregnancy. “I gained 50 pounds, and you know, you have the kid, and the kid only weighs seven pounds and you’re like, ‘Oh, okay, there’s all this weight I have to lose,” she tells Ivanhoe.

Now, 26 weeks into her second pregnancy, Oguntoyinbo maintains a regular exercise program, walking two miles at least three days a week. “And it’s just been so much easier," she says. "The whole thing has been easier. I’ve felt bet felt better. I haven’t gained as much weight, so when I have the baby, it won’t be as difficult.”

A new study shows Oguntoyinbo is also more likely to carry her baby to term. Researchers at the University of North Carolina at Chapel Hill studied women who exercised well into their pregnancy. “And in fact women who were able to do this activity in the second trimester of pregnancy, actually had a somewhat lower risk of pre-term birth,” says Kelly Evenson, Ph.D., an epidemiologist at University of North Carolina at Chapel Hill.

The study showed 22 percent of the women exercised regularly before pregnancy, but that dropped to 8 percent in the second trimester. Researchers say there’s no need to cut back. Evenson says, “If she’s been doing it before pregnancy, and she doesn’t have any medical or obstetric complications, then it should be fine for her to continue.”

Oguntoyinbo says, “My general theory is that if you do things that are stress relievers and are healthy for you, if you eat healthy, if you take vitamins and you exercise, you’re going to be able to carry to term more effectively.”

CDC guidelines say adults should get at least 30 minutes of moderate exercise most days of the week, and the American College of Obstetrics and Gynecology has approved that recommendation for pregnant women as well, as long as they check with their doctor first and do not have other medical concerns that would prohibit them from being active.

If you would like more information, please contact:
The Pregnancy, Infection, and Nutrition Study
http://www.cpc.unc.edu/projects/pin/

Identifying Insulin Resistance (December 1, 2003)

(Ivanhoe Newswire)

Researchers publishing in this month’s Annals of Internal Medicine have come up with a simple way to identify overweight or obese people who are likely to be insulin resistant.

Insulin resistance is a major medical problem often leading to diabetes and cardiovascular disease. Being overweight greatly increases the odds someone will be insulin resistant, but not all overweight or obese people are afflicted. Identifying those who are early on is key to decreasing death and disability from these diseases. The insulin suppression test used to identify insulin resistance, however, is too difficult to administer to large numbers of people. Experts say easier methods are needed to screen people across the board.

These researchers looked at three simple tests to see if they could help identify people who were insulin resistant. The study involved about 250 overweight volunteers who had normal blood pressures and were not diabetic. Results showed tests measuring triglyceride levels, the triglyceride-HDL cholesterol ratio, and insulin concentration can be helpful in identifying overweight and obese people most at risk for insulin resistance.

While the tests are not perfect, the researchers believe they should be used by doctors to help determine which individuals would benefit the most from making lifestyle changes that could reduce their risks.

In an accompanying commentary, editors of the journal agree, noting these tests won’t help doctors make a firm diagnosis of insulin resistance, but they are likely to be useful in selecting patients for intense weight reduction efforts.

SOURCE: Annals of Internal Medicine, 2003;139:802-809

Exercise Lowers Pre-term Birth Risk (December 1, 2003)

CHAPEL HILL, N.C. (Ivanhoe Newswire)

Warnings About Some Natural Family Planning Methods (December 1, 2003)

(Ivanhoe Newswire)

Women who use menstrual cycle monitors to detect their fertile times of the month should research their choices carefully because some methods are much more reliable than others.

German researchers studied different systems for accuracy. The researchers estimate 10 percent to 15 percent of women of reproductive age in Europe use variations of natural family planning methods and an estimated 30 percent to 40 percent rely on some type of menstrual cycle monitor to detect their fertile times for either conception or contraceptive purposes. The days predicted as fertile by each of the monitoring systems were compared to the fertile time revealed by ultrasound scans, the detection of the surge of luteinizing hormone -- a hormone that controls the length and sequence of the menstrual cycle -- and basic daily conception probabilities.

Researchers found systems using a mini-microscope, which rely on the user recognizing “ferning” patterns from small samples of saliva or cervical mucus are highly susceptible to producing false negatives. The “ferning” patterns indicate fertility, so if a woman does not see a “ferning” pattern, she may incorrectly surmise she’s not likely to conceive on that day. Even the most accurate of the three systems tested was wrong at least half of the time and the worst one was wrong nearly three-quarters of the time. The researchers say these methods should not be considered for further efficacy testing since they were typically inaccurate.

However, researchers were optimistic about the symptothermal method, which relies on a woman’s own observation of two indicators of fertility -- changes in her basal body temperature and in her cervical mucus patterns -- plus some calculation rules. This method did not give the women involved in the study any false negatives.

Other methods such as a monitor that tests hormone levels in urine and a mini-computer that records and stores changes in basal body temperature also worked reasonably well.

Lead investigator Guenter Freundl, a gynecological endocrinologist from the Department of Reproductive Medicine and Gynecological Endocrinology at Staedtische Kliniken Dusseldorf gGmbH concludes, “This meant that the symptothermal method of [natural family planning] that relies on a woman’s own observations proved to be the most effective of the natural family planning methods. The temperature computers scored the upper range of reliability and the hormonal computer in the medium range. But, the mini-microscopes had a very low estimated efficacy.”

The authors say there is an “urgent need” to test the systems that met their basic quality index standards. They say the mini-microscopes method should not be offered to patients and are not worth further investigations.

SOURCE: Human Reproduction, 2003; 18:2628-2633