Therapy Shocks Shoulder Pain (May 30, 2003) 

KAOHSIUNG, Taiwan (Ivanhoe Newswire)

Researchers in Taiwan say shock wave therapy is a safe and effective noninvasive treatment for patients with calcific tendonitis of the shoulder.

Researchers from Chang Gung Memorial Hospital treated 37 patients with shock wave therapy, 1,000 impulses at 14 kilovolts, and observed them for up to 30 months. The control group, which consisted of six patients, received a sham treatment with a dummy electrode.

Overall results of the study show nearly 61 percent of patients in the treatment group had excellent shoulder condition after therapy, around 30 percent had good condition, 3 percent had fair condition, and 6 percent had poor condition. Of the participants in the control group around 17 percent had fair condition and 83.3 percent had poor condition after the treatment.

Results also show the symptom recurrence rate in the treatment group was 6.4 percent. Calcium deposits were completely dissolved in 57.6 percent of the treatment group patients, partially dissolved in 15.1 percent of patients and unchanged in 27.3 percent of patients.

No recurrence of calcium deposits was observed in the treatment group during the study. Calcific tendonitis is when calcium crystals develop in the tendon. These crystal deposits can become quite painful and may become a chronic problem.

SOURCE: The American Journal of Sports Medicine, 2003;31:425-430

Pain Killers Help Back Function (May 30, 2003) 

SAN FRANCISCO (Ivanhoe Newswire)

Relief may not be far away for the many people who miss work due to back pain. A new study shows painkillers can help solve the number one cause for missed work by Americans.

Researchers from the University of Alberta studied a group of patients who experienced low back pain. They injected the patients with a strong narcotic painkiller and then asked them to complete an exercise test to measure their function.

Results of the study show painkillers can help relieve pain as well as improve back functionality. When the patients were given the injection, they reported their pain went down and their productivity, while performing certain exercises, increased. Researchers say this is the first study to link pain killers to improved physical performance.

Back pain is the most common disability for adults between ages 19 and 45, and more than $80 billion a year is spent on treating the problem. Chronic back pain can interfere with sleeping, walking, standing, sitting and driving.

Researchers say their results suggest painkillers should help unemployed patients with back pain get back to work. Dr. Saifee Rashiq, Director of Pain Medicine at the University of Alberta, says, “Our study shows that drugs should get them working, so we’re really not sure why they’re not.”

Dr. Rashiq says the reason some patients miss work and other activities may be psychological. “What happens is that people say ‘My back hurts and I can’t do certain things,’” says Dr. Rashiq. “Why not? ... We’ve shown that drugs ought to get these people to be functioning again,” he adds.

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

At Risk for Diabetes Before Work (May 30, 2003) 

PARIS (Ivanhoe Newswire)

Offspring of women with type 1 diabetes could be at an increased risk for type 2 diabetes in adult life, even in the absence of inherited type 1 or type 2 diabetic diseases.

Type 2 diabetes usually occurs in adults and is caused by genetic and environmental factors, such as obesity. Jean-Francois Gautier, and colleagues, from Hospital Saint-Louis in Paris, studied whether prenatal exposure to a diabetic environment is associated with metabolic disorders later in life that can lead to type 2 diabetes.

Study researchers assessed glucose tolerance and metabolic abnormalities in offspring of men and women with type 1 diabetes, but no history of type 2 diabetes. Researchers measured insulin production in response to oral and intravenous glucose in 15 non-diabetic adult offspring of mothers with type 1 diabetes and a control group of 16 offspring of fathers with type 1 diabetes.

One third of the participants exposed prenatally to a diabetic environment from their type 1 diabetic mother showed glucose intolerance compared with none of the control group. Insulin secretion was slowed and insulin concentrations in the blood were lower than in control group patients.

“Exposure to a diabetic environment in utero is associated with increased occurrence of impaired glucose tolerance and a defective insulin secretory response in adult offspring, independent of genetic predisposition to type 2 diabetes. Epidemiological studies are needed to confirm our observations before therapeutic strategies can be devised,” comments Jean-Francois Gautier.

SOURCE: The Lancet, 2003;361:1861-1865

Surgery Better for Opening Blocked Arteries (May 29, 2003) 

LOS ANGELES (Ivanhoe Newswire)

Patients who undergo surgical procedures such as coronary artery bypass surgery or angioplasty to open clogged arteries have fewer reported deaths in a set amount of time compared with those given drug therapy alone.

These are the findings of a new study by researchers from Cedars-Sinai Medical Center in Los Angeles. Narrowed arteries can reduce blood flow and oxygen, a condition known as ischemia, to the heart during stress. Patients with this form of stable coronary artery disease have the option of revascularization or medical therapy to prevent a heart attack.

Lead author, Rory Hachamovitch, M.D., M.Sc., and colleagues, compared the survival benefits of both medical and revascularization approaches in the treatment of blocked coronary arteries. They reviewed data on 10,627 patients who underwent a test to determine the body’s ability to deliver blood and oxygen to the heart both at rest and under stress.

Statistical analysis showed that when patients had more than 10 percent of their heart affected by ischemia they had a lower mortality rate with revascularization than with medical therapy.

“The greater the degree of ischemia, the greater the risk of cardiac death and also the greater the benefit of revascularization. On the other hand, patients with no ischemia had lower mortality rates with medical therapy than with revascularization,” says Dr. Hachamovitch.

“The result of this study may allow physicians to more accurately weigh the benefit of revascularization compared to medications alone in the management of their patients with the common condition of chronic coronary artery disease, potentially resulting in improved long term outcomes in their patients,” says senior author Daniel S. Berman, M.D.

SOURCE: Reported in the rapid access issue of Circulation

Women with Diabetes at Risk for Stillbirth (May 27, 2003) 

COPENHAGEN, Denmark (Ivanhoe Newswire)

Women who have type 1 diabetes before they are pregnant have a five-times higher risk of a stillbirth compared to women without diabetes. A new study shows women with diabetes who have poor glycemic control, have a kidney disorder, who smoke or are poor are most likely to have a stillbirth.

Researchers say the aim of the study was to determine characteristics of a woman with type 1 diabetes who is at risk for a stillbirth. Researchers hope knowing the characteristics will improve care and treatment. Doctors from the National University Hospital in Copenhagen, Denmark, identified women with diabetes who had a stillbirth between 1990 and 2000. Some stillbirths were explainable, and others had no obvious cause.

Researchers found 22 women with 25 stillbirths among the 1,361 births by women with type 1 diabetes. About half of the stillbirths were categorized as explainable or likely explainable. In 12 cases, there was no obvious cause found for the stillbirth. Researchers say nine of these women had poor glycemic control. They also say 14 of the women reported daily smoking, and 10 were unemployed with little education.

Researchers say their study identifies specific characteristics of women with type 1 diabetes who had a stillbirth. They say more attention should be focused on these women during pregnancy, especially when it comes to optimizing glycemic control for their diabetes.

SOURCE: Diabetes Care, 2003;26:1385-1389

Cost-Effective Arthritis Treatment (May 27, 2003) 

LOS ANGELES (Ivanhoe Newswire)

Two common drugs are typically prescribed to treat arthritis pain. One can irritate the stomach and cause ulcers in some patients. While the other does not irritate the stomach, it is much more expensive. A new study examines the cost-effectiveness of these two treatments.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen are often prescribed for arthritis pain. While the drugs are less expensive, they can cause stomach ulcers in some patients. Cyclooxygenase-2 (COX-2) inhibitors, such as celecoxib and rofecoxib, are much more expensive drugs used to treat arthritis pain. However, most people who take these drugs never develop ulcers. The question is whether the increased cost of the latter drug is worth the potential benefits. Researchers from the Veterans Administration Greater Los Angeles Healthcare System conducted a computer-based study to determine the answer.

Instead of actual patients, researchers used computers to simulate what would happen in a group of patients with arthritis who took either NSAIDs or a COX-2 inhibitor. They estimated the cost of the drugs and how much the COX-2 inhibitor would cost for each year of life saved by avoiding a bleeding ulcer. They looked at both quality and length of life.

Researchers say COX-2 inhibitors would cost $275,809 more per year of life saved compared to treatment with NSAIDs. Authors of the study comment that this amount of money is much more than Americans are typically willing to pay for a health care treatment. However, the cost dropped to an acceptable level when the COX-2 inhibitors were only given to patients with a history of a bleeding ulcer.

Researchers conclude that unless the price of COX-2 inhibitors drops by one-tenth of their current price, the benefits of these drugs are not cost-effective for all patients with arthritis. However, researchers note the extra costs are cost- effective for arthritis patients who have had a previous bleeding ulcer.

SOURCE: Annals of Internal Medicine, 2003;138:795-806

Heart Protection (May 26, 2003) 

CHAPEL HILL, N.C. (Ivanhoe Newswire)

Every year, nearly 1 million Americans undergo medical procedures with a catheter to open clogged coronary arteries. Even after the procedure, they remain at high risk for a heart attack, stroke or even death. Now a new treatment dramatically cuts that risk.

Fred Clark says, “Walking two or three blocks, I’d be exhausted. Coming up a flight of stairs, I’d be exhausted.” Clark’s exhaustion followed a stint of sharp pains in his arm, chest and back. “The diagnosis was a fairly complete blockage in one of the arteries,” he says.

Clark had experienced a moderate heart attack. After doctors cleared the blockage, they added the drug clopidogrel to his daily dose of aspirin. Both drugs help thin the blood.

“The thought is that by this combination of blood thinners that you’re much less likely to form a blood clot in your blood vessels, which is normally what causes heart attacks, strokes and death,” says interventional cardiologist Steven Steinhubl, M.D., of the University of North Carolina, Chapel Hill.

A study of patients who had their arteries unblocked showed one year of the combination therapy cut the risk of heart attack, stroke and death by 27 percent. Doctors say it could keep as many as 50,000 patients a year from suffering from these conditions.

Dr. Steinhubl says, “We think that the longer you take the medicine, what this study will show is, the better the results. You get less and less events with longer time compared to just aspirin alone."

Clark says, “It makes me hopeful that I’ll never have another heart attack, because I’m willing to stay on the medication as long as I need to.”

Researchers say the key with the combination therapy is the length of time it is used. This study showed these results after one year of use. Researchers are now testing the therapy in a larger group of patients over four years.

If you would like more information, please contact:

Tom Hughes
University of North Carolina Hospitals
101 Manning Drive
6002 East Wing
Chapel Hill, NC 27514
(919) 966-6047
tahughes@unch.unc.edu
http://www.unchealthcare.org

Deadly Stroke is Preventable (May 26, 2003) 

CINCINNATI (Ivanhoe Newswire)

A deadly stroke that occurs in young people can be prevented, according to new research. Researchers say high blood pressure medication and lifestyle changes could help prevent the stroke from happening.

Subarachnoid hemorrhage (SAH) occurs when a blood vessel on the surface of the brain ruptures and bleeds into the space around the brain. Unlike other strokes, SAH usually happens in younger populations and is deadly about 50 percent of the time. Researchers from the University of Cincinnati conducted a study to determine what causes these strokes in young and middle-aged adults.

The study included patients with SAH from 44 hospitals between 1994 and 1999. The 312 patients included in the study were men and women between 18 and 49 years old who had not suffered a previous stroke. Patients answered questions about their lifestyle and other factors that could be related to the development of SAH. Researchers also included data from 618 healthy individuals who had not had a stroke.

Researchers say they identified several risk factors that put patients at risk for a stroke. For example, stroke patients were more than twice as likely to have high blood pressure than healthy participants. Lead study author Joseph Broderick, M.D., from the University of Cincinnati, says: “One of the study’s key findings is that two-thirds of the people who had a subarachnoid hemorrhage in this age group were current cigarette smokers. That is a huge number. If you’re a smoker in this age group, you are 3.7-times more likely to have this type of stroke than if you’re not a smoker.”

Another factor that plays a role in this type of stroke is familial tendency. People in the study who had SAH were about 3.8-times more likely to have a family member who had a bleeding stroke. Researchers say this finding should give those with a family history of this type of stroke more reason to take care of themselves.

Authors of the study conclude SAH may be a largely preventable disease among young and middle-aged men and women. They say several of the risk factors can be modified by medications or behavioral changes.

SOURCE: To be published in an upcoming journal of Stroke

The Diuretic Diet (May 26, 2003) 

A new study in the current issue of Hypertension reveals how a diet that has been shown to help reduce high blood pressure does the trick.

According to Japanese scientists working with researchers from the United States, the Dietary Approaches to Stop Hypertension (DASH) diet works much like old-fashioned diuretics -- by promoting the elimination of salt from the body.

DASH is a diet high in fruits, vegetables, and low-fat dairy products. Results from an initial study six years ago found people who followed the diet had lower blood pressures, but researchers were not sure how the diet achieved these goals. A subsequent study looked at the diet in people who consumed varying levels of salt. The study showed it had the most impact on people who ate the most salt. The current study aimed to confirm and clarify the relationship between salt excretion and blood pressure.

The research involved 375 adults with normal to mildly elevated blood pressure. Study participants were assigned to eat either the DASH diet or a control diet for three 30-day periods. Salt levels were varied during each period so researchers could compare each diet’s impact on salt excretion. Results showed the DASH diet did, indeed, have a greater impact when people were fed more salt. Not only did they excrete more salt, as measured by urine tests, they lowered their blood pressure. When they were fed less salt, the impact of the diet on blood pressure declined.

Genjiro Kimura, M.D., says, “The DASH diet provides healthy food for people of all ages. I think the diet should be recommended for everyone.”

SOURCE: To be published in an upcoming issue of Hypertension

New Avenue for Hair Growth? (May 26, 2003) 

ANN ARBOR, Mich. (Ivanhoe Newswire)

Researchers from the University of Michigan Medical School found the short activation of a certain protein may induce new hair growth.

That protein, called â-catenin, induced new hair growth in mice. Researchers studied mice with an inactive version of the protein. Then, researchers shaved the backs of those mice along with the backs of mice that had an active version of the protein. A topical treatment called 4-OHT was applied once.

The treatment activated â-catenin. Within 15 days, the mice with the active protein did not grow any hair but the mice that had an inactive version of the protein grew new hair. Furthermore, the new hair was indistinguishable from normal hair and continued to grow as usual.

Researchers caution the activity of â-catenin needs to be precisely controlled. Authors of the study write, "In contrast to the effects of transient and regulated beta-catenin activation, prolonged activation of â-catenin leads to uncontrolled growth and gross distortion of the hair follicle structure."

Approximately two out of every three men lose excessive hair. In the United States, 40 million men and 20 million women are affected by hair loss. Excessive hair loss can be caused by factors such as genetics, disease, injury, or old age, all of which affect the normal growth cycle of hair. Current treatments include medication to reduce hair loss, hairpieces, or hair transplant surgery to cover bald areas.

SOURCE: Genes & Development, 2003;17:1219-1224

Exercise for HIV (May 26, 2003) 

BIRMINGHAM, Ala. (Ivanhoe Newswire)

When someone is diagnosed with HIV, new medications can help him or her live for many years. These medications can also cause the person to gain a lot of weight. Patients with HIV have been told for years not to exercise because it may be harmful. New research proves that theory wrong.

Exercise is good for most people, but for Ken, it’s changed his life. “Oh, I was wretched, I mean just wretched,” he tells Ivanhoe.

Ken is HIV-positive. His medications made him balloon up to the point where he wouldn't even allow himself to be in any pictures. Then he started exercising three days a week and lost 55 pounds in three months. His waist dropped from a 42 to a 30.

“I was actually thinking about, you know, possibly even going to the beach this year,” he says.

University of Alabama at Birmingham exercise physiologist Barbara Smith, Ph.D., R.N. says for years exercise was thought to be bad for HIV patients. “Early in the epidemic, exercise was really not encouraged because of the fear of the wasting,” she tells Ivanhoe.

Wasting -- or massive weight loss -- is risky with HIV, but new drug cocktails cause many patients to gain weight. Smith’s research shows, contrary to popular belief, exercise is good for people with HIV. She says, “They’ll be less fatigued, they’ll be able to tolerate some of the medications even better.”

Ken has found one negative. “The down side is that my wallet is still reeling because you know I’ve had to go out and get a whole new wardrobe,” he says.

Smith says the key is to exercise in moderation. For example, she recommends 30 minutes of aerobic exercise on most days and weight training three days a week.

If you would like more information, please contact:

Barbara Smith, Ph.D., R.N.
University of Alabama at Birmingham
Exercise Physiologist
(205) 934-0582
Smithb@son.uab.edu
http://www.uab.edu

Smoking and Pregnancy (May 26, 2003) 

HYATTSVILLE, Md. (Ivanhoe Newswire)

A new study that used data collected from birth certificates shows smoking during pregnancy is on the decline.

According to researchers from the Federal Division of Vital Statistics, prenatal smoking dropped by 37 percent between 1989 and 2000. About 12 percent of women smoked while pregnant in 2000, compared with about 19 percent in 1989, the first year questions on smoking during pregnancy were included on birth certificates. The study involved all birth certificates filed in 49 states and the District of Columbia. California was excluded from the study because birth certificate questions there differed from the standard format used elsewhere.

Despite the good news about maternal smoking rates, researchers found smoking continues to harm the health of infants born in the United States. Results show babies born to smokers were twice as likely to be born with low birth weight than those born to nonsmokers. The association between smoking and low birth weight held true across all racial, age, and economic groups.

Even light smoking, defined as smoking less than five cigarettes per day, increased the risk of having a baby born too small. Women most likely to smoke during pregnancy were older teenagers and those in their early 20s. The highest rates were noted among non-Hispanic white women who did not complete high school.

Authors conclude smoking during pregnancy continues to be a significant health problem in the United States. They say collecting information on maternal smoking on the birth certificate can help public health officials target smoking cessation and prevention programs to the appropriate groups.

SOURCE: Pediatrics, 2003;111:1176-1180

Unhappy Mom, Smaller Baby? (May 23, 2003) 

ATLANTA (Ivanhoe Newswire)

Does happiness in pregnancy mean protection against having a low birth weight baby?

Not according to a new study from researchers at the Centers for Disease Control and Prevention. Their look at a group of California mothers found no significant link between a mother’s intent to become pregnant, her happiness about having a baby, or her sense of maternal control and the birth weight of her child.

Babies who are born too small are divided into two categories. There are preterm infants who are born early and have not had enough time to grow to normal size, and there are babies who are born full term but small who are said to have intrauterine growth restriction, or IUGR. Regardless of the category they fall into, these infants have many of the same problems, including increased incidence of respiratory problems, seizures, and learning disabilities. Studies have identified numerous risk factors for having a low birth weight baby, including younger age, less education, smoking, and poor nutrition, but these factors have not been able to explain all of the increased risk. Therefore, some researchers have suggested maternal outlook could play a role.

In this study, investigators analyzed data from a survey aimed at finding out how mothers felt about their pregnancies to determine if maternal outlook played a role in the birth weight of their infants. While results initially suggested mothers with low or average sense of control were more likely than those with high sense of control to have babies with IUGR, further analysis revealed no significant association between the two. The mothers’ intent to become pregnant and her happiness about having a child played no role in the subsequent development of IUGR in their infants.

SOURCE: Pediatrics, 2003;111:1171-1175

Atkins Diet vs. Conventional Diet (May 22, 2003) 

PHILADELPHIA (Ivanhoe Newswire)

A new study compares two popular diets and shows the dieters in the two groups lost about the same amount of weight after one year, but there were health differences between the two diets.

About 45 percent of women and 30 percent of men in the United States are trying to lose weight at any given moment. The conventional diet approach is a high-carbohydrate, low-fat, energy-deficit diet, but the popularity of the Atkins diet has challenged this approach. The Atkins diet consists of a low-carbohydrate, high-protein and high-fat diet. Despite the popularity of the Atkins program, there has never been a randomized, controlled trial to evaluate it. Researchers from the University of Pennsylvania School of Medicine conducted a study comparing the Atkins diet to the conventional diet in obese participants.

The 63 obese men and women were randomly assigned to follow one of the two diets. Contact with these individuals during the study was kept to a minimum to replicate the approach used by most dieters.

Researchers found the participants on the Atkins diet lost 4-percent more weight during the first six months. However, at the one-year mark, there was no difference in weight loss between the two groups. Researchers also studied cholesterol levels in the participants. Results show the increase in high-density lipoprotein or the “good” cholesterol and the decrease in triglycerides was greater among those on the Atkins diet. Both diets decreased blood pressure and improved insulin response in the body.

Researchers conclude the low-carbohydrate diet produced greater weight loss during the first six months, but weight loss difference was not seen at the end of 12 months. However, the low-carbohydrate diet was associated with greater improvements in some risk factors for heart disease. Researchers note adherence to both diets was poor in both groups. They say longer and larger studies are needed to determine the long-term safety and efficacy of diets like the Atkins diet.

SOURCE: The New England Journal of Medicine, 2003;348:2082-2090

Therapy for Weak Bones (May 22, 2003) 

PITTSBURGH (Ivanhoe Newswire)

A combination therapy may be a better option for women with severe osteoporosis. A new study published in this week’s issue of the Journal of the American Medical Association shows hormone replacement and alendronate, a drug prescribed for increasing bone mass, yielded greater improvements in bone mineral density at the spine and hip than either therapy alone.

Researchers from the University of Pittsburgh Medical Center analyzed data from 373 women, ages 65 to 90. Participants randomly received hormone therapy and 10 milligrams daily of alendronate, one of those agents alone, or neither. All participants received calcium and vitamin D supplements.

Results of the study show bone mineral density after three years was significantly greater in women treated with the combination therapy than with monotherapy. The average increases of bone mass were 5.9 percent at the hip, 10.4 percent at the postero-anterior lumbar spine, and 11.8 percent at the lateral lumbar spine.

In addition, average increases in bone mass at the hip in women treated with alendronate alone were greater than in those treated with hormone therapy alone (4.2 percent vs. 3 percent), and alendronate resulted in more responders to therapy.

Researchers conclude the combination therapy is safe and effective. However, they caution the study was too small to detect differences in rare but serious adverse events such as myocardial infarction or venous thrombosis.

SOURCE: Journal of the American Medical Association, 2003;289:2525-2533

Exercise Helps Neck Problems (May 21, 2003) 

JYVASKYLA, Finland (Ivanhoe Newswire)

Neck pain is the most common complaint among working women who visit their doctors. Experts now say exercise can help.

Researchers from Jyvaskyla Central Hospital studied 180 women, ages 25 to 53, who had full-time jobs, sought rehabilitation, and suffered from neck pain for at least six months. The participants were placed into three groups. The first followed an endurance-training program, the second group adopted a strength-training regimen, and the third was a control group.

Endurance training involved performing dynamic neck exercises, such as lifting the head up from a lying-down position. The strength-training program required participants to perform high-intensity exercises with an elastic band. All groups were advised to participate in aerobic and stretching exercises at least three times a week.

Results of the study show strength and resistance training can significantly reduce the pain associated with chronic neck problems. Participants in the resistance-training group saw the most improvement. They improved flexion by 110 percent, rotation by 76 percent, and extension by 69 percent. The endurance-training group saw neck flexion improve by 28 percent, rotation by 29 percent, and extension by 16 percent. Those in the control group saw only minimal improvements.

Authors of the study add, “An important practical observation was the long-term benefits could be obtained by training as infrequently as twice a week.”

SOURCE: Journal of the American Medical Association, 2003;289:2509-2516

Intervention Reduces Alcohol-Exposed Pregnancy (May 20, 2003) 

ATLANTA (Ivanhoe Newswire)

Five counseling sessions are effective at reducing the risk of an alcohol-exposed pregnancy in high-risk women, according to new research.

Exposure to alcohol in the womb is one of the leading preventable causes of birth defects, mental retardation and neurodevelopmental disorders. While many women reduce their alcohol consumption once they find out they are pregnant, a large proportion do not realize they are pregnant until well into the first trimester. This is a critical time for the development of the fetus.

Colleagues from the Project CHOICES Intervention Research Group conducted a study to determine if motivational intervention reduces drinking or increases contraception in high-risk women. The study was done in six community settings in three large cities. More than 2,300 women were screened for the study. Researchers say 230 were eligible to be part of the program, 190 enrolled in the program and 143 completed the six-month follow up. The program consisted of four motivational counseling sessions done by mental health clinicians and one contraceptive counseling session done by a family planning clinician. Researchers noted alcohol use, contraceptive use and effectiveness, and risk of alcohol-exposed pregnancy.

The study shows, of the women who completed the six-month program, about 69 percent were no longer at risk of having an alcohol-exposed pregnancy. In particular, about 13 percent of the women reduced their drinking, 23 percent used effective contraception, and 33 percent reported making both changes. The results were consistent in the six different settings.

Researchers conclude that four motivational sessions and one contraceptive counseling session is feasible and effective at decreasing the risk of an alcohol-exposed pregnancy. A stage II clinical trial is now under way to test the efficacy of this intervention in a randomized controlled setting. Meanwhile, researchers say the current study reinforces earlier reports that this intervention program can be helpful for high-risk women.

SOURCE: Pediatrics, 2003;111:1131-1135

Alcohol Causes Weight Gain (May 19, 2003) 

LONDON (Ivanhoe Broadcast News)

Researchers now know heavy alcohol intake contributes directly to weight gain regardless of the type of alcohol consumed.

Moderate alcohol drinkers typically add alcohol to their daily caloric intake rather than substituting it for calories from food. Although it would be surprising if this did not contribute directly to weight gain, this question has been a topic of controversy. The study authors explain the relationship between alcohol intake and body weight “remains an enigma to nutritionists.”

In this study researchers from London measured the body mass index of more than 7,600 men between 40 and 59 years old at year one and then at the end of five years. Five years after the screening the men completed a questionnaire on changes in alcohol intake and body weight.

The authors found the prevalence of men with a high body mass index increased significantly from the light-moderate drinker to the heavy drinker regardless of the type of alcohol they drank. Although there was no evidence that moderate drinking leads to weight gain, heavy drinkers, people who consumed more than 30 grams of alcohol per day, showed the greatest weight gain and had the highest body mass index.

Although the type of alcohol consumed did not change the study results, hard liquor drinkers tended to be heavier than beer and wine drinkers. However, this may be associated with differences in lifestyle and eating habits between men who tended to consume hard liquor compared with beer drinkers.

SOURCE: American Journal of Clinical Nutrition, 2003;77:1313-1317

Another Look at Secondhand Smoke (May 19, 2003) 

LOS ANGELES (Ivanhoe Newswire)

A new study offers conflicting information about the dangers of inhaling secondhand smoke.

Researchers from the University of California in Los Angeles studied more than 115,000 adults enrolled in the American Cancer Society prevention program. They particularly focused on a group of about 36,000 nonsmokers who lived with smokers. The study began in 1959 and ended in 1998.

Results of the study show no link between secondhand smoke and death from coronary heart disease or lung cancer. These findings remained constant at all times throughout the study and at all levels of secondhand smoke exposure.

Previous studies have shown second-hand smoke can significantly increase the risk of coronary heart disease and lung cancer among nonsmokers. The current study clearly challenges that data. Authors say the risk factors for developing disease are a lot lower for nonsmokers than originally thought.

They write, “These findings suggest that environmental tobacco smoke could not plausibly cause a 30-percent increased risk of coronary heart disease as is generally believed, although a small effect cannot be ruled out.”

However, researchers did confirm that active cigarette smoking is a strong risk factor for coronary heart disease, lung cancer, and chronic obstructive pulmonary disease.

SOURCE: British Medical Journal, 2003;326:1057-1061

Top Athletes win Later in Life (May 19, 2003) 

HELSINKI, Finland (Ivanhoe Newswire)

We all know exercise is good for you, but new research shows it may be even more beneficial than previously thought. A new study shows top athletes are healthier even later in life.

While past studies have suggested a long-term benefit of exercise, it has been difficult to study because many people do not keep up vigorous exercise for a long period. In order to look at this population, researchers from Unit for Sports and Exercise Medicine in Helsinki, Finland, conducted a study comparing former top athletes to healthy individuals who were not top athletes.

The study included more than 2,000 men who represented Finland in international events between 1920 and 1965. Researchers also looked at more than 1,400 men who were considered healthy but who were not top athletes. For the study, researchers looked at which medications the men were taking from 1970 to 1998. Specifically, they looked at medications for hypertension, cardiac problems, heart disease, diabetes and asthma. They also looked at the use of anti-inflammatory drugs, antacids and vitamin and mineral supplementation.

Researchers report the top athletes used less medication than the healthy participants. The athletes required less medication for cardiac problems, coronary heart disease and asthma. Furthermore, the use of medication for hypertension and diabetes was reduced among endurance athletes but not power athletes. The study also found the top athletes used fewer anti-inflammatory drugs and antacids. On the other hand, the former top athletes took more vitamins and minerals than the other study participants.

According to the study results, former top athletes appear to live a healthier life than other men who are not top athletes.

SOURCE: Archives of Internal Medicine, 2003;163:1064-1068

Reducing Birth Defect Risk (May 19, 2003) 

ATLANTA (Ivanhoe Newswire)

Doctors recommend all women take a multivitamin in the months before becoming pregnant. Now, a new study finds this recommendation could be especially beneficial to diabetic moms. The research finds women with diabetes who take a multivitamin before and during pregnancy reduce their risk of having children with birth defects.

Diabetic moms are at an increased risk for birth defects including heart and central nervous system defects. Recent studies have suggested taking antioxidants and vitamins during the preconception period could reduce the risk of birth defects. Researchers from the Centers for Disease Control and Prevention in Atlanta conducted a study to evaluate whether diabetic women who take a multivitamin before they become pregnant can reduce their risk of having a child with a birth defect.

For the study, investigators identified more than 3,200 women with diabetes who had a child born with a birth defect. They also included more than 3,000 women who had children without birth defects. Researchers looked at who took multivitamins from three months before pregnancy through the first three months of pregnancy.

The study showed children who were born to diabetic mothers had an increased risk for selected birth defects. However, the increased risk was limited to children of mothers who had diabetes and who had not taken multivitamins before and during pregnancy. The babies born to diabetic mothers who had taken multivitamins had no increased risk for birth defects.

Authors of the study conclude the recommendation that all women who are capable of becoming pregnant should take vitamins daily may be particularly important for women with diabetes. They note two thirds of pregnancies are unplanned. They add that their study points to potentially important prevention implications for women with diabetes during pregnancy.

SOURCE: Pediatrics, 2003;111:1146-1151

Vacuum out Blood Clots (May 16, 2003) 

FAIRFAX, Va. (Ivanhoe Newswire)

NBC reporter David Bloom recently died from deep vein thrombosis. It’s a serious condition where blood clots develop in the deep veins of the legs. One in every 100 people who develop DVT dies. The cause of death is usually a blood clot, traveling from the legs to the lungs. A new tool can now dissolve these life-threatening blood clots. 

Theresa Subalusky’s reunion with interventional radiologist Ted Chambers, M.D., today is a happy one -- but their initial meeting in the ER was much more subdued.

“There was lot of pain, and I couldn't stand it," Subalusky tells Ivanhoe. These X-rays show the tumor that was pushing on a vein and causing blood clots in her legs. She says: “He took a picture of my leg because he never saw one the size of mine with a clot in it. It was just, they tell me, filled with a lot of clots.”

“Her legs were massively swollen and painful, very uncomfortable,” says Dr. Chambers, of Inova Fairfax Hospital in Virginia. If the clots weren’t removed quickly, Subalusky could have long-term complications. Dr. Chambers used a new device called AngioJet. It works like a small, controlled tornado inside the blood vessels.

“We actually put a tiny catheter about the size of this cable into the vein back behind the knee on both sides and ran them all the way up here into the abdomen to dissolve the clot. We use AngioJet to remove clots as well,” says Dr. Chambers.

AngioJet creates a powerful suction, turning the catheter into a mini vacuum cleaner -- sucking out the blood clots.

Subalusky said she noticed an improvement immediately after the procedure. “I can walk on it. I can stand on it. I can jump. I can do anything,” she says.

Another big advantage of this procedure is it helps reduce the amount of time the catheter is in the blood vessel. That means patients spend less time in the intensive care unit and are able to go home much sooner.

If you would like more information, please contact:
Society of Interventional Radiology
http://www.sirweb.org/ 
To find a doctor using AngioJet, please contact:
Eapen Chacko
(763) 717-1157

eapen.chacko@possis.com 

Fish OK During Pregnancy (May 16, 2003) 

ROCHESTER, N.Y. (Ivanhoe Newswire)

A new study shows eating fish during pregnancy will not harm the fetus. Typically, pregnant women are warned not to eat certain fish that have high mercury levels or to limit consumption because of a possible risk to the fetus. Now, new research shows there is no reason to reduce fish consumption.

Exposure to methylmercury before birth can adversely affect a child’s neurodevelopment. The most common exposure to this mercury is through the consumption of fish, but whether this amount harms the fetus is unclear. Researchers from the University of Rochester Medical Center investigated whether fetuses were affected by fish consumption in a region where women consume a large amount of fish.

Researchers included 779 mother-infant pairs who lived in the Republic of Seychelles. The mothers in this area report eating fish an average of 12 times a week. In the United States, the average fish consumption is once a week. Researchers say the fish in the region contained the same concentrations of methylmercury as commercial ocean fish elsewhere. The prenatal exposure to this mercury was determined from tests done on the mother’s hair during pregnancy. The children in the study were also evaluated nine years later. Specifically, the children’s neurocognitive, language, memory, motor, and behavioral functions were tested.

Of the 21 tests the children underwent, only two tests were associated with methylmercury exposure. The tests included decreased performance in a hand motor test and improved scores in a hyperactivity test. Investigators say that these two differences probably happened by chance and there is no evidence of neurodevelopmental risk from prenatal exposure to methylmercury resulting from eating fish.

In an accompanying commentary, Constantine Lyketsos, M.D., from Johns Hopkins Hospital, agrees that this study suggests methylmercury exposure from fish consumption during pregnancy does not affect the child later in life. Furthermore he adds, “For now, there is no reason for pregnant women to reduce their fish consumption below current levels, which are probably safe.”

SOURCE: The Lancet, 2003;361:1686-1692,1667-1668

Binge Drinking and Unintended Pregnancies (May 15, 2003) 

ATLANTA (Ivanhoe Newswire)

Nearly half of all pregnancies in the United States are unintended. A new study shows binge drinking is associated with the risk of a woman getting pregnant when it’s not desired. The study also shows binge drinkers are more likely to put their baby at risk by drinking during pregnancy.

Binge drinking is defined as consuming five or more alcoholic beverages on one occasion. Researchers from the Centers for Disease Control and Prevention conducted a study to determine the relationship between binge drinking in the three months before pregnancy and to characterize binge drinking women who are of childbearing age.

The study included more than 72,900 women who gave birth from 1996 to 1999. The women were asked if their pregnancy was unintended or intended. An unintended pregnancy is defined as one that was mistimed so it was sooner than desired, or unwanted meaning it was not wanted at all. Researchers also asked the women about their age, race and drinking behavior.

Researchers say 45 percent of the women reported an unintended pregnancy. Compared with women who had an intended pregnancy, the women with an unintended pregnancy were more likely to be black, young and binge drink during the three months before they conceived. However, after adjusting for other factors, researchers say binge drinking before getting pregnant was associated with an unintended pregnancy in white women, but not black women. The study found women who were binge drinkers before pregnancy were more likely to be white, unmarried, smoke and be exposed to violence. They were also more likely to drink alcohol and smoke during pregnancy.

While researchers say the risk factors for unintended pregnancy are complex, binge drinking may be an area to focus on. They say many of these same maternal risk factors such as binge drinking put children at an increased risk for subsequent physical and emotional harm. Therefore, the authors of the study recommend addressing binge drinking and other risk factors to reduce the rates of unintended pregnancies and help improve the overall health and well-being of mothers and their children.

SOURCE: Pediatrics, 2003;111:1136-1141

Drug Helps Brittle Bone Disease (May 15, 2003) 

QUEBEC (Ivanhoe Newswire)

A new study shows a drug given intravenously helps patients with brittle bones build muscle.

Osteogenesis imperfecta is also known as brittle bone disease. In severe cases, the disease is seen at birth and can cause newborn babies to have many broken bones. They may also be deformed. Most infants diagnosed with this condition die shortly after birth. The disease can show up later in life in less severe cases. While there is no cure for the disease, recent studies show the drug pamidronate is beneficial to children and adolescents with severe osteogenesis imperfecta. The drug can increase bone mineral density, decrease fracture rates and improve the ability of the patient to get around.

Muscle function and this disease have not received much attention until recently. One study shows muscle strength is low in some patients with osteogenesis imperfecta. Researchers from Shriners Hospital in Quebec conducted a study to determine if the drug pamidronate plays a role in the muscle strength of patients with osteogenesis imperfecta.

The study included 42 patients with severe forms of osteogenesis imperfecta. Patients were treated with intravenous pamidronate infusions given in four monthly cycles. Each cycle consisted of three infusions on three straight days. Researchers measured the grip force of each patient at the beginning of the study, four months after treatment, and two years later.

Researchers found grip force of the patients was low compared to healthy individuals at the beginning of the study. Four months after their first treatment with pamidronate, researchers found grip force of the patients increased significantly. At the two-year mark, grip force scores were not significantly different from the four-month result.

Authors of the study conclude a single cycle of pamidronate increases grip force in patients with osteogenesis imperfecta. They say this grip force is maintained for at least two years after treatment. However, they note the mechanism whereby pamidronate influences muscle force remains to be understood.

SOURCE: Pediatrics, 2003;111:e601-e603

Exercise Helps Women Live Longer (May 14, 2003) 

ATLANTA (Ivanhoe Newswire)

A new study shows older women who are physically active may significantly increase their lifespan.

Researchers studied more than 9,000 women, ages 65 and older. They then assessed 7,553 of those women four years later during a follow-up visit.

Results of the study show women who increased their physical activity levels between the two visits had a 48-percent lower mortality risk, a 36-percent lower cardiovascular risk, and a 51-percent lower cancer risk. Women who were active at both visits had a 32-percent lower all-cause mortality risk. Their cardiovascular mortality risk was 38-percent lower than their sedentary counterparts.

The women who increased their physical activity added about one mile a day of walking to their routine. Authors of the study say more physical activity could also improve cardiorespiratory fitness and reduce the risk of falls, fractures, and physical disabilities.

Previous studies have examined how exercise affects illness, cardiovascular disease, and certain cancers, but the current study is the first of its kind to investigate the relationship between exercise and longevity.

Researchers say studies like this are important because the population of older women in the United States continues to rise and is expected to double in the next 30 years. Currently, more than one-third of older women are sedentary.

The authors conclude, “Modest increases in physical activity could have wide-ranging benefits ranging from improved risk factors to reduced disability.”

SOURCE: Journal of the American Medical Association, 2003;289:2379-2386

Neck and Spine Adjustments Linked to Strokes (May 13, 2003) 

SAN FRANCISCO (Ivanhoe Newswire)

Patients who have their necks and spines adjusted by a chiropractor have an increased risk of stroke, according to a new study.

Researchers studied a group of 51 patients who had a stroke caused by arterial dissection, which tears an artery and causes a blood clot or aneurysm to form. They compared this group to 100 people who had strokes due to other causes. All participants were under age 60.

Results of the study show people under 60 who have strokes or mini-strokes caused by tears in the neck arteries were six-times more likely to have had their neck manipulated by a practitioner within the past 20 days, compared to those who had strokes from other causes.

Seven patients with dissection had cervical spine manipulation before the stroke. Only three patients without dissection had this procedure performed on them. Those with dissection had a stroke less than two days after the manipulation, and those without dissection had their strokes more than eight days after the procedure.

Researchers found 57 percent of the patients with dissections said their head or neck pain increased after the chiropractic adjustment. Doctors say if pain increases after a manipulation, patients should seek medical attention.

Wade S. Smith, M.D., from the University of California, San Francisco, says, “It’s possible that they could have a dissection and be at risk for stroke.”

Dr. Smith says the cause of dissection is unknown in most cases. However, some rare medical conditions increase the likelihood of developing dissection. Also, trauma from motor vehicle accidents and sports injuries could be to blame. Spontaneous dissections cause approximately 16 percent of all strokes in young people.

SOURCE: Neurology, 2003;60:1424-1428

New Scan may Predict Heart Disease (May 13, 2003) 

DALLAS (Ivanhoe Newswire)

A test called electron beam computed tomography (EBCT) may help doctors predict when healthy people with high blood pressure or high cholesterol will develop heart disease, report researchers in the journal Circulation.

Large studies show half of heart attack deaths occur in people with no symptoms. Moreover, one third of people with heart disease do not have any of the traditional risk factors such as hypertension, diabetes, high cholesterol or family history of heart problems. The 10-minute EBCT detects calcium deposits on artery walls. These signal plaque is present, increasing a person’s risk for heart attack or stroke.

George Kondos, M.D., and colleagues from the University of Illinois College of Medicine in Chicago, studied 8,855 men and women ages 30 to 76 with no symptoms of heart disease. The EBCT was administered and the patients were monitored over a three-year period for death, heart attack or cardiac revascularization procedures.

Researchers demonstrated that arterial wall calcium was detected in 74 percent of men and 51 percent of women and that this was associated with cardiac events such as death or heart attack.

The authors conclude that EBCT provides incremental prognostic information when used along with other coronary artery disease risk assessments. Additional population-based studies are necessary to determine the usefulness of EBCT scanning as an adjunct to office-based assessments.

SOURCE: To be published in an upcoming issue of Circulation

Effects After Bypass Temporary (May 12, 2003) 

BALTIMORE (Ivanhoe Newswire)

The mental effects after bypass surgery are reversible and do not last longer than three months, say researchers at the Johns Hopkins Medical Institution.

More than two thirds of patients who have coronary artery bypass surgery have trouble thinking, remembering, and learning after the procedure. They also have a harder time performing tasks such as writing and drawing.

A recent study compared 140 patients who underwent bypass surgery to a group of 92 patients with coronary artery disease who did not have the surgery. The two groups were given several tests to measure their memory and other cognitive abilities. These tests included measures of attention, learning and memory, spatial abilities, and speed of processing.

Researchers found no difference in cognitive abilities when both groups were retested at three and 12 months. Authors say what sets this study apart from other similar studies is the use of the non-surgical group of patients.

“There have been a number of studies showing that bypass surgery causes cognitive decline, but without an appropriate control group we have no way of knowing how serious the defects were nor how long they lasted,” says Ola Selnes, Ph.D., from Johns Hopkins Medical Institution.

Researchers plan to continue to follow both groups of participants for three to five years to further analyze the long-term cognitive effects of bypass surgery.

SOURCE: Annals of Thoracic Surgery, 2003;75:1377-1386

Vitamin Deficiency Screening for the Elderly (May 12, 2003) 

OXFORD, England (Ivanhoe Broadcast News)

A new screening test may identify people at high risk for vitamin B-12 or folate deficiency, a problem common in older people. The prevalence increases with age.

Deficiencies of vitamin B-12 and folate can cause anemia, neurological abnormalities, fatigue, malaise and cognitive impairment. “Accurate identification of vitamin B-12 deficiency is important because inappropriate treatment with folic acid will correct the anemia associate but not the neurological condition,” writes John M. Scott, author of a new study. Tests that measure B-12 concentrations have proven inadequate because a patient’s severity of symptoms has not correlated well with this measurement in the past.

Researchers measured blood levels of two metabolites that are elevated in people with vitamin deficiencies. Methylmalonic acid (MMA) is elevated when there is a vitamin B-12 deficiency. Total homocysteine (they) is elevated in both B-12 and folate deficiency. Researchers hypothesized that these blood tests would identify people at high risk for developing clinical symptoms of vitamin deficiency who were not readily identified by measuring blood concentrations of the vitamins.

Study results indicate 10 percent of people age 65 to 74 and 20 percent of people older than 74 were at high risk of clinical vitamin B-12 and folate deficiency. Researchers also found 10 percent of people with a vitamin B-12 deficiency also had a folate deficiency.

The authors conclude use of they and MMA among older persons with borderline vitamin concentrations may identify those at high risk of vitamin B-12 deficiency who should be considered for treatment.

SOURCE: American Journal of Clinical Nutrition, 2003:77;1241-1247.

FTC and FDA Crackdown on Internet Marketers of Bogus SARS Prevention Products (May 9, 2003) 

Deceptive and Misleading Claims Must be Removed Immediately

The Federal Trade Commission and the Food and Drug Administration (FDA) are warning Web site operators, manufacturers and distributors who suggest that their products will protect against, treat, or even cure Severe Acute Respiratory Syndrome (SARS), that they are aware of no scientific proof for such claims and that the Web site operators must remove any misleading or deceptive claims from the Internet. A coordinated Internet "surf" found 48 sites touting a wide variety of SARS treatment or prevention products. The FTC also retrieved seven promotions for SARS products from its spam database. The two agencies sent warnings to Web site operators, and e mail solicitors, cautioning that it is against the law to make claims about SARS protection or treatment, or any other health benefit, without rigorous scientific support. FDA has sent 8 warning letters to manufacturers and distributors who are making misleading claims. The FTC and FDA staff will follow up by revisiting the targeted sites to determine whether the Web site operators have deleted or revised unproven claims.

The warning campaign is based on information gathered through an Internet surf that the FTC coordinated with the help of the FDA and the Ontario Ministry of Consumer and Business Services. Included in the review were Web sites that promised consumers would be protected from SARS if they purchased such items as personal air purifiers, disinfectant sprays and wipes, respirator masks, latex gloves, dietary supplements like colloidal silver and oregano oil, and SARS "prevention kits" that package various items together, such as gloves, masks and wipes. Web sites may be subject to state or federal investigation or prosecution for making deceptive or misleading marketing claims that their products can treat, prevent, or cure SARS. Firms or individuals who violate the FTC Act could be subject to a federal district court injunction, enforceable through civil or criminal contempt proceedings, or an administrative cease and desist order, enforceable through civil penalties of up to $11,000 per violation. Sellers also could be ordered to make consumer refunds. Operators who violate the Federal Food, Drug and Cosmetic Act by marketing unapproved drugs are liable to injunction and seizure of the illegal products.

"Scam artists follow the headlines, trying to make a fast buck with products that play off the news," said Howard Beales, Director of the FTC’s Bureau of Consumer Protection. "Our message to e marketers making deceptive claims is ‘change your site to comply with the law.’ At the same time, our message to consumers is ‘hold on to your money.’ No products have been found effective in preventing, treating or curing SARS."

"Doctors and health care experts around the world are working hard to find treatments for SARS. Until they succeed, there are common sense actions people can take to protect themselves from SARS and other respiratory infections," said Mark B. McClellan, M.D., Ph.D., Commissioner of Food and Drugs. "Bogus products from questionable Web sites do no good, and can actually make matters worse by providing a false sense of protection. FDA will continue to work with the FTC and other consumer protection agencies to protect the public from SARS related scams."

"It is truly unfortunate that at a time when people were feeling vulnerable, due to a major public health issue, that scam artists would prey on people’s fears," said Tim Hudak, Minister of Consumer and Business Services in Ontario, Canada. "Seven members of our investigations and services staff worked on a surf-and-sweep, and within 48 hours 44 misleading sites were identified worldwide."

The Minister added that this effort was yet another demonstration of the success of the Strategic Partnership on Cross-Border Telemarketing and Fraud in reducing scams and fraud in Canada and the United States. 

In addition to the efforts of the FTC, FDA and other authorities to crack down on SARS related fraud, a broad coalition of trade associations representing the dietary supplement industry has issued a joint advisory recommending that marketers and retailers refrain from promoting dietary supplements as a preventive, cure, or treatment for SARS. According to that advisory, there are no dietary supplements that have been shown to prevent or treat SARS. The joint statement of the American Herbal Products Association, Consumer Healthcare Products Association, Council for Responsible Nutrition, National Nutritional Foods Association, and Utah Natural Products Alliance is available through those organizations web sites. "Consumers, government and responsible marketers and retailers share common ground. They all know there’s no room for misleading claims about preventing, treating or curing SARS," Beales said. 

For consumers who visit Web sites or receive e mails claiming to sell products to prevent or treat SARS, the FTC recommends:

Be skeptical of claims that pills can treat or cure SARS or that air purifiers or other products will kill or eliminate the virus. If and when consumers see ads touting prevention, treatment, or cure claims for SARS, they should ask themselves: if a medical breakthrough involving SARS has occurred, would they be hearing about it for the first time through an ad or sales pitch? 
Be a savvy Internet shopper. For additional information, visit: 
http://www.ftc.gov/bcp/conline/pubs/health/frdheal.htm and 
http://www.ftc.gov/bcp/conline/edcams/cybrspce/index.html 
The FTC issued a Consumer Alert entitled "Rx For Products That Claim To Prevent SARS? A Healthy Dose of Skepticism," produced in consultation with the Centers for Disease Control and Prevention (CDC) and the FDA. The Alert advises consumers to:

Know the facts: SARS appears to spread most readily by cough or sneeze allowing droplets containing infectious virus to reach the respiratory tract of persons in close proximity. SARS also may be spread by touching contaminated objects and then touching your eye, nose or mouth. 
Keep your hands clean: Public health authorities advise that basic personal hygiene is the best protection against the infection. Thorough hand washing with soap and water, or alcohol based hand sanitizers are recommended. 
Check travel advisories for affected areas: To lower your risk of infection, the CDC suggests avoiding travel to affected regions. 
Seek medical attention: If you think you may have SARS symptoms, or you have been in direct contact with someone with SARS, consult a health care professional immediately. 
Stay informed: For more information from the federal government about SARS, visit the CDC at www.cdc.gov/ncidod/sars or the FDA at www.fda.gov/oc/opacom/hottopics/sars/. 
The FTC’s efforts to combat unproven SARS remedies represents the most recent phase of the agency’s ongoing effort to curb Internet health fraud. The agency has conducted several "surfs" to identify fraudulent health marketing in partnership with FDA and other law enforcement and public health authorities in the U.S. and elsewhere around the world. The FTC has focused its most recent crackdown on the marketers of products claiming to protect against biological, chemical, and nuclear terrorism attacks. As follow up to its enforcement efforts against bogus terrorism defense products in 2001 and 2002, the FTC recently conducted another "surf" that resulted in the dissemination of 39 e mail advisories to Web sites promoting dietary supplements and devices to prevent, treat or cure ailments associated with biological, chemical, or nuclear agents. The FTC sent the warnings during the week of April 29, 2003, and the agency will be revisiting sites to evaluate the response. In addition, in March, the FTC sent 35 e mail advisories to Web sites marketing potassium iodide products, urging them not to exaggerate the protective benefits of potassium iodide for use in nuclear emergencies, such as following a nuclear "dirty bomb" explosion. To date, the FTC has received positive responses from about 20 of these sites, indicating that they have modified or will modify certain claims made for their products.

The FDA is taking vigorous enforcement actions against firms marketing dietary supplements that claim to treat or prevent serious, chronic and life threatening diseases, as well as smoking and alcohol abuse. Since the beginning of 2003, for example, the FDA has taken steps to ban the marketing of ephedra, and ordered two large scale seizures of illegal dietary supplements, including $500,000 worth of products misrepresented by Young Again Nutrients in Spring, Texas, as enhancing "the body's natural production of Human Growth Factors and Insulin like Growth Factor 1." In one of its warning letters issued today, the FDA informed the same firm that claiming that its product Better Immunity BETA 1,3/1,6 GLUCAN "strengthens the immune systems defenses against all infectious viral diseases, and possible SARS," violates the law and must be promptly corrected.

For more information from the federal government about treatments for SARS or protection from terrorism threats and public health preparedness, visit www.consumer.gov. or www.fda.gov. For more information from the FDA, call toll free 1-800-INFO-FDA or visit www.fda.gov. Information on SARS and public health preparedness from the CDC is available at www.cdc.gov and also by telephone at 1-800-311-3435. To file a complaint or to get free information on consumer issues, call the FTC, toll free, at 1-877-FTC-HELP or use the complaint form at www.ftc.gov.

Copies of the press releases and consumer alerts are available from the FTC’s and FDA's Web sites at http://www.ftc.gov and http://www.fda.gov and also from the FTC’s Consumer Response Center, Room 130, 600 Pennsylvania Avenue, N. W., Washington, D.C. 20580. The FTC works for the consumer to prevent fraudulent, deceptive, and unfair business practices in the marketplace and to provide information to help consumers spot, stop, and avoid them. To file a complaint, or to get free information on any of 150 consumer topics, call toll free, 1-877-FTC-HELP (1-877-382-4357), or use the complaint form at http://www.ftc.gov/ftc/complaint.htm. The FTC enters Internet, telemarketing, identity theft, and other fraud related complaints into Consumer Sentinel, a secure, online database available to hundreds of civil and criminal law enforcement agencies in the U.S. and abroad.

MEDIA CONTACT:
Brenda Mack, Office of Public Affairs, FTC
202-326-2182

Kim Rawlings, Office of Public Affairs, FDA
301-436-2288 

Chris Eby, Minister’s Office Ministry of Consumer & Business Services
416-326-3050


STAFF CONTACT:

Michelle Rusk or Heather Hippsley, FTC’s Bureau of Consumer Protection
202-326-3148 or 202-326-3285 

Stroke Prevention Surgery (May 9, 2003) 

DALLAS (Ivanhoe Newswire)

One in 10 surgeries to clear blocked arteries to the brain for stroke prevention may be unnecessary, finds a new study reported in the journal Stroke.

A procedure called carotid endarterectomy removes plaque in the arteries of the neck that supply blood to the brain, thereby decreasing a chance of stroke. Studies in the 1990s found these artery clearing surgeries were overused. After that the number of inappropriate surgeries dropped from 32 percent in the 1980s to 10.6 percent between 1997 and 1998.

Ethan A. Halm, M.D., M.P.H., from Mt. Sinai School of Medicine in New York, developed a list of 1,557 indications for the surgery and asked a panel of national experts to rate the appropriateness of each. The ratings were used to assess the appropriateness of surgery in 2,124 patients who underwent the procedure between 1997 and 1998.

“The bad news is that one in 10 operations are still done in situations where the risks may outweigh the benefits. If our results are typical of practice in the United States, then about 14,000 operations are performed annually for inappropriate reasons,” says Dr. Halm.

Researchers also found the type of patient receiving the surgery has shifted. The procedure was originally developed to prevent strokes in patients with neurologic symptoms, but three quarters were done in asymptomatic patients. This is a concern because even though asymptomatic patients have vessel narrowing, they have less to gain than a patient with neurologic symptoms.

In conclusion, researchers say surgery is considered appropriate when the benefits exceed the risks of the procedure.

SOURCE: To be published in an upcoming issue of Stroke.

Zinc Helps Preemies (May 9, 2003) 

LA LEGUNA, Spain (Ivanhoe Newswire)

Giving extra zinc to premature infants helps them grow, report researchers from Spain in the journal Pediatrics.

Premature birth is often associated with inadequate nutritional intake and impaired growth. Malnutrition, and specifically zinc deficiency, can disrupt the various hormones and growth factors that are responsible for normal growth. Therefore, researchers hypothesized that zinc supplementation may increase the growth of preemies.

The study evaluated 36 preterm infants. The infants were randomly assigned to a group fed standard formula supplemented with zinc and a small quantity of copper or a group fed standard formula alone. Researchers examined body length, weight, head size, and total body water.

Alejandro Jimenez, Ph.D., senior study author, reports babies in the zinc supplementation group had significantly greater linear growth up until 6 months of age. These babies also had greater weight and head size, although these data were not statistically significant. The authors conclude that zinc supplementation has a positive effect on growth in premature babies.

Other researchers maintain that the zinc concentration in standard formulas currently used to feed preterm infants after discharge may be insufficient. “This could be related, in part, to the poor growth and development described for many premature infants,” writes Jimenez.

The absorption of zinc contained in human milk is 30-percent higher than the absorption in formula, thereby placing formula fed infants at a higher risk for zinc deficiency.

SOURCE: Pediatrics, 2003;111:1002-1009

Diet Associated with Hypertension (May 9, 2003) 

AMSTERDAM (Ivanhoe Newswire)

A diet with higher intakes of red meat and potatoes and less low-fat dairy and fruit is associated with higher blood pressure, higher total cholesterol and glucose.

These findings were reported in the May issue of the American Journal of Clinical Nutrition.

Other studies have shown that interventions to change dietary patterns can be highly effective in reducing cardiovascular disease. However, the intervention diets used in those studies were very different from common dietary patterns in Western populations.

Rob van Dam, a researcher from the Netherlands and lead author on the study, performed a cross-sectional study of 19,750 men and women ages 20 to 65. Food consumption patterns were identified using a questionnaire. Three food patterns were identified during the study. Cosmopolitan diets had greater amounts of fried vegetables, as well as more salad, rice, chicken, fish and wine. Traditional diets had more meat and potatoes and less fruit. Refined-food diets had more French fries, high-sugar beverages, and white bread.

Results of the study identified that cosmopolitan diets were more likely to be associated with lower blood pressure and higher good cholesterol concentrations, while the traditional diet was associated with higher blood pressure, higher total cholesterol and glucose. The refined foods diet was associated with higher total cholesterol and decreased intakes of micronutrients.

These data suggest that public health efforts targeted at specific population subgroups may be warranted to address diet patterns and improve cardiovascular health.

SOURCE: American Journal of Clinical Nutrition, 2003;77:1156-1163

Diet May Affect Lupus (May 7, 2003) 

GIFU, Japan (Ivanhoe Newswire)

Diet -- and especially, vitamin C -- may play a role in minimizing the effects of lupus.

Japanese researchers publishing in the Journal of Rheumatology report women who had higher intakes of vitamin C were less likely to develop a more serious form of the disease. The U.S. RDA of vitamin C is 60 milligrams per day.

Lupus is an autoimmune disease characterized by fatigue and joint pain. In severe cases, it can cause multiple organ problems, including heart, lung and kidney disease. Animal studies have suggested diet may impact the prognosis of the condition. Mice who were fed a low-fat diet and fish oil, for example, had improved survival and delayed onset of kidney problems. Clinical studies in humans have also shown fish oil supplementation has beneficial effects. Little research exists, however, on other nutrients.

Researchers collected dietary and clinical information from female patients with lupus. Using data on around 200 patients with inactive lupus and no signs of vascular problems at the beginning of the study, they analyzed the results to see how diet impacted the transition to active disease and the development of vascular problems over the four-year follow up.

At the end of the study, 43 patients had developed active disease and seven developed vascular problems. The investigators found women with increased intake of vitamin C were significantly less likely to transition to active disease. Those who ate more crude fiber were similarly protected. The finding on vitamin C remained significant even after results were adjusted to take other factors that could have impacted disease transition into account. Women who developed vascular problems were more likely to consume higher amounts of vegetable fat at the beginning of the study than those who did not suffer these events.

The investigators believe their study is the first to observe a significant association between vitamin C intake and the risk of active disease in people with lupus.

SOURCE: The Journal of Rheumatology, 2003;30:747-754

Arthritis Drugs and Blood Pressure Risks (May 7, 2003) 

STANFORD, Calif. (Ivanhoe Newswire)

A new study shows even small increases in blood pressure caused by common drugs used to treat arthritis can lead to significant increases in the number of heart attacks and strokes.

A large government study on health and nutrition suggests about 30 million Americans age 35 and over suffer from either osteoarthritis or rheumatoid arthritis. Of this number, about 12 million also take medications to control high blood pressure. Doctors have long known drugs used to treat arthritis, such as corticosteroids and NSAIDs, can interfere with drugs used to treat high blood pressure, such as ACE inhibitors and beta-blockers. These researchers used data from the government study to assess the risk of heart attacks and strokes among arthritis patients with high blood pressure to arthritis drugs might be impacting the risk.

Results linked increases in systolic blood pressure of only one millimeter of mercury (mm Hg) to five mm Hg with between 7,100 and 35,700 additional cardiovascular events over one year. Among the estimated 15 percent of arthritis sufferers who had a 20-mm Hg increase in systolic pressure, about 21,700 additional cardiovascular events were noted.

The authors write, “The use of certain classes of drugs with anti-inflammatory properties, namely corticosteroids and NSAIDs, in patients treated with antihypertensive medication can lead to a significant loss of antihypertensive control … Our findings suggest that the clinical and economic consequences of what may appear to be modest increases in blood pressure are considerable.”

SOURCE: The Journal of Rheumatology, 2003;30:714-719

Lifestyle Medicine (May 5, 2003) 

BRANFORD, Conn. (Ivanhoe Newswire)

With obesity and diabetes rising at alarming rates, doctors are turning to more than medication to help patients control these conditions. One Connecticut doctor is part of a movement blending standard medicine with lifestyle therapies.

Noelle has a family history of diabetes and hypothyroidism. She works out every day but gained 15 pounds in the last year. Today, she’s getting her metabolism checked. Cary Taylor is also worried about her weight. She has metabolic syndrome, and is at risk for diabetes.

Both women are patients of endocrinologist Reza Yavari, M.D. He practices therapeutic lifestyle medicine.

“What we typically do is we do a very thorough nutritional profile, psychological profile. We measure their body composition on our X-ray machine. We measure their burn rate. We do a blood test," Dr. Yavari, of Beyond Care in Branford, Conn.

Lifestyle medicine treats the symptoms and the underlying behaviors. The goal is to prevent chronic diseases that often result from bad habits, like unhealthy eating and lack of exercise. Treatments typically include medication and a long-term program of exercise and nutrition. Some may include yoga, stress management and meditation.

Cary lost 40 pounds in six months. She says, “I don’t want to live my life with diabetes. I’m hoping to get rid of it and make an overall health change for my life.”

For her, lifestyle medicine looks like the right prescription.

Dr. Yavari says a good way to know if you have metabolic syndrome is if you’re putting on weight, your blood pressure is going up, and, in particular, if you have been told you have early signs of diabetes. About 23 percent of people in the United States have metabolic syndrome.

If you would like more information, please contact:
Dana Seroud
Administrator
Beyond Care, LLC
1008 Main Street
Branford, CT 06405
(203) 315-2936
info@beyondcare.net 
http://www.beyondcare.net 

Vitamin B-6 Fights Cancer (May 5, 2003) 

By Julie Monheim, Ivanhoe Health Correspondent 

PULLMAN, Wash. (Ivanhoe Newswire)

A new study shows consuming more vitamin B-6 can ward off cancer, especially for smokers.

Vitamin B-6 converts folate to a form the body can use to produce thymine, a component of DNA. If the body does not have enough B-6, it produces components other than thymine, which can stress the normal DNA repair process and potentially cause cancerous cells to form.

Researchers at Washington State University tested patients to determine if adding vitamin B-6 to their diet would decrease the number of stressed DNA cells and increase levels of vitamin B-6 in the body.

For the first month of the study, patients (smokers and non-smokers) were put on a diet that provided very small amounts of vitamin B-6. At the end of this period, all participants had lower vitamin B-6 levels and higher numbers of stressed DNA strands. Smokers had even lower levels of vitamin B-6 than they did before the study began.

Researchers increased the patients’ vitamin B-6 intake for the remaining three months of the study. By the fourth and final month, patients were consuming 10.3 milligrams per day, which is more than seven times the recommended value.

As the amount of vitamin B-6 increased, the patients’ levels went up and the number of DNA strand breaks went down. After three months, the smokers’ B-6 levels reached normal status.

Terry Shultz, Ph.D., and a registered dietician from Washington State University, told Ivanhoe his findings suggest dietary allowances of vitamin B-6 should be higher.

Shultz says eating a diet high in vitamin B-6 is enough to help prevent DNA strands from breaking, and thus, possibly preventing cancer from forming. He says taking a B-6 supplement is not necessary.

Foods high in vitamin B-6 include cereals, beef, chicken, fish, legumes, soy products, and bananas.

SOURCE: Experimental Biology 2003 Meeting in San Diego, April 11-15, 2003

Fatty Acids Help Babies in the Future (May 5, 2003) 

(Ivanhoe Newswire)

Adding fatty acids to formula milk may lower heart disease later in life, shows new research.

In the multicenter European study, 111 newborn infants were fed with a formula containing long chain polyunsaturated fatty acids and 126 were given a formula without the fatty acids, but otherwise nutritionally similar. A reference group of breastfed children also took part in the study.

After six years, researchers measured the children's blood pressure and found it was significantly lower in the group who received fatty acids than in the group who did not receive them. The diastolic pressure of the breastfed children and children who received fatty acids was similar and significantly lower than children who were not given fatty acids. There was also a slight reduction in systolic pressure for the children who were breastfed and who received fatty acids.

Breast milk contains long chain polyunsaturated fatty acids, and previous studies show breastfed children have lower blood pressure than children fed with formula milk.

Researchers say early exposure to dietary long chain polyunsaturated fatty acids, preferably in breast milk, may reduce cardiovascular risk later in life. Blood pressure differences in childhood are known to carry though into adulthood.

Investigators are not sure what the link is between fatty acids and blood pressure. However, previous studies with hypertensive adults show increased dietary intake of omega-3 fatty acids is associated with lower blood pressure.

SOURCE: British Medical Journal, 2003;326:953-955

Narcotics and Antidepressants Linked to Fractures (May 2, 2003) 

SAN FRANCISCO (Ivanhoe Newswire)

Elderly women who take antidepressants or other drugs that affect their central nervous system are more likely to suffer hip and other fractures, find researchers from the University of California, San Francisco.

Studies show drugs that affect the central nervous system, such as antidepressants and narcotics, can cause side effects like sleepiness and dizziness. Those side effects increase the risk of falling and breaking a bone. Little research exists, however, on the link between bone fractures and the various types of medications falling into these two classes of drugs.

Investigators studied the use of four different categories of central nervous system medications in around 8,100 women age 65 and older. The four categories of drugs studied included benzodiazepines, antidepressants, anticonvulsants and narcotics. Women were assessed for use of the drugs between 1992 and 1996, and evaluated for non-spinal fractures until 1999. The average follow-up of the women in the study was about five years.

Researchers noted a significantly higher rate of fractures among women taking any of the medications when compared with those not using the medications. Women taking one of the narcotics were nearly 40-percent more likely to suffer a fracture, while those on one of the antidepressants were 25-percent more likely. When compared to women not taking antidepressants, women on these drugs were 70-percent more likely to fracture a hip, one of the most serious forms of fracture for older people.

The study showed no significant difference between women taking different types of antidepressants. Women on serotonin reuptake inhibitors, or SSRIs, had similar rates of fracture as those on tricyclic drugs. Finally, the research suggests the higher incidence of bone fractures seen in women on benzodiazepines may be explained by lower bone mineral density among those on these drugs.

SOURCE: Archives of Internal Medicine, 2003;163:949-957

Potential Tests for Pre-Eclampsia (May 2, 2003) 

LONDON (Ivanhoe Newswire)

British researchers may be on the track to new tests that could predict which women are most at risk for a potentially life-threatening complication of pregnancy.

As many as 8 percent of women develop a form of high blood pressure during pregnancy known as pre-eclampsia. In severe cases, pre-eclampsia can lead to eclampsia, a condition characterized by convulsions that sometimes lead to the death of both the mother and the child. The problem is most common in under-developed countries. About 50,000 women die from the condition every year.

Women with pre-eclampsia suffer from endothelial dysfunction, which causes high blood pressure due to the inability of the blood vessels to properly dilate. Doctors have been unsure, however, whether endothelial dysfunction actually causes pre-eclampsia, or whether it is simply a symptom of the condition.

Investigators evaluated the link in a study of 43 women with normal pregnancies and 43 others with evidence of impaired pregnancies. Among the women with impaired pregnancies, pre-eclampsia was present in about 25 percent of them.

All the women were assessed for various factors, including the presence of impaired endothelial function and blood levels of asymmetric dimethylarginine, or ADMA, an agent known to promote endothelial dysfunction through the inhibition of nitric oxide. Results showed women who eventually developed pre-eclampsia had both signs of endothelial dysfunction and raised concentrations of ADMA in their blood.

Investigators believe these results could lead to better tests for the prediction of pre-eclampsia, and therefore, earlier treatment of the condition among women considered high risk.

SOURCE: The Lancet, 2003;361:1511-1517

Concussions Linked to Depression (May 1, 2003) 

SAN DIEGO (Ivanhoe Newswire)

A new study shows sports-related concussions can affect a person psychologically.

Researchers from the University of West Virginia reviewed health questionnaires that were distributed to retired National Football League players in 2001. More than 2,000 players completed the survey. On average, participants played professional football for about seven years and played organized football for about 15 years.

Sixty percent of the former players who completed the questionnaire suffered from at least one concussion during their career, and more than 20 percent suffered from three or more concussions.

Results of the study show 11 percent of the retired players had been diagnosed with clinical depression, confirming a link between concussion history and depression. Eighty-seven percent of these players still suffer from depression.

The study also showed that retired players with more than five concussions were three-times more likely to develop depression, and those with three to four concussions were two-times more likely.

Julian Bales, M.D., author of the study, says, “Not only do concussions and other head injuries in early adulthood significantly raise the risk of depression decades later, but they are reported to have a permanent effect on thinking and memory skills later in life.”

Although previous studies have linked concussions to Alzheimer’s, the current study did not find an association between the two.

A concussion is an impact to the head that may result in the brain colliding with the skull. This collision can cause the brain to swell up and bruise. The Centers for Disease Control and Prevention reports that concussions in sports have reached epidemic proportion in the United States.

SOURCE: The 71st Annual Meeting of the American Association of Neurological Surgeons, April 26-May 1, 2003

FDA Clears New Breath Test for Monitoring Asthma (May 1, 2003) 

The Food and Drug Administration (FDA) today cleared for marketing a first-of-a-kind, non-invasive test system to measure the concentration of nitric oxide in exhaled human breath. The test system should help make it easier for doctors to monitor a patient's asthma.

Doctors can use the device in their office to evaluate their patient's response to anti-inflammatory treatment. A decrease in exhaled nitric oxide concentration suggests that the anti-inflammatory treatment may be decreasing the lung inflammation associated with asthma. Recent evidence has shown that nitric oxide levels are increased in the breath of people with asthma and that changes in nitric oxide levels may indicate whether or not treatment for asthma is working.

The test system, called the NIOX Nitric Oxide Test System, is made by Aerocrine AB, of Sweden. It combines equipment that detects nitric oxide and equipment that analyzes exhaled breath with a special computer system.

To use this new device, the patient places a mouthpiece, connected by a breathing tube to the computer, over his mouth. S/he inhales nitric oxide-free air to total lung capacity, then slowly exhales into the mouthpiece. The nitric oxide concentration is displayed immediately on the computer screen. 

FDA cleared the NIOX system based on clinical studies conducted by the manufacturer of 65 patients, both adults and children aged four years and older, with confirmed diagnoses of asthma. The patients were tested with the NIOX system before they began drug treatment and again two weeks later. The studies were conducted at nine medical centers in the United States. The results showed that most patients had a 30%-70% decrease of nitric oxide levels after two weeks of treatment with inhaled steroids. In this study, elevated nitric oxide levels above 30 parts per billion correlated with moderate to severe asthma. 

Asthma is a highly variable disease affecting millions of people worldwide. With asthma, the lungs become inflamed and constrict, limiting airflow and making breathing difficult. The incidence of asthma in the United States has increased in recent years and it now affects about 15 million Americans, including almost five million children. Every year, asthma causes roughly 2 million emergency room visits, approximately 500,000 hospitalizations, and 4,500 deaths.

High Blood Pressure and Diabetes (May 1, 2003) 

BALTIMORE (Ivanhoe Newswire)

Higher blood pressure in young adulthood may help predict whether someone will develop type 2 diabetes later in life.

That’s the finding from a new study out of Johns Hopkins that followed around 1,150 doctors over 38 years. Researchers found those who had signs of high blood pressure at age 30 were significantly more likely to have developed diabetes by their late 50s.

Doctors have long known diabetics are more likely to have high blood pressure. They also know people with diabetes have a much greater risk of cardiovascular disease and other complications linked to high blood pressure. Studies have shown even people who are newly diagnosed with type 2 diabetes are more likely to have these complications.

This study used data from a long-term study being conducted among former medical students at Johns Hopkins University School of Medicine. All participants had their blood pressure readings taken at various times from young adulthood through middle age. The incidence of diabetes was measured based on mailed questionnaires.

Seventy-seven cases of diabetes were identified during the study. The mean age at diagnosis was 58. An analysis showed men who developed diabetes had elevated blood pressure readings as early as age 30, and these readings were significantly higher than those for men who did not develop diabetes. The rate of increase in blood pressure readings was also significantly greater in the diabetic men when compared to the non-diabetic men. After adjusting the findings to take into consideration other factors that could have influenced diabetes development, such as body mass index and smoking, the link between higher blood pressure at age 30 and later development of diabetes remained.

The authors conclude more research is needed to determine whether better treatment of elevated blood pressure in young adulthood could help prevent diabetic complications and even diabetes itself.

SOURCE: Diabetes Care, 2003;26:1110-1115

Anemia Linked to Diabetes (April 30, 2003) 

VICTORIA, Australia (Ivanhoe Newswire)

A new study shows anemia is a common problem in people with diabetes. The study also pinpoints additional factors that may contribute to the development of anemia in these patients.

Diabetes is the single most common cause of end-stage kidney failure. Anemia is the decrease in red cells in the blood. In past studies, it has not been clear if anemia is directly related to the progression of kidney failure or other diabetic complications. To help understand this association, researchers from Austin and Repatriation Medical Center in Australia conducted a study to determine the prevalence and predictors of anemia in diabetics.

Researchers used data from a long-term study on 820 patients. A full blood count and blood and urine tests were done on all patients over two years. Researchers focused on who was anemic and what factors were related to their diagnosis.

Researchers found 190 of the patients had unrecognized anemia. Researchers say this is two-to three-times higher than for patients with comparable kidney impairment and iron stores in the general population. Researchers also found patients with microalbuminuria were more than two times as likely to have anemia than other patients. Microalbuminuria is the presence of albumin in the urine and increases the morbidity and mortality associated with kidney failure in diabetics.

Researchers conclude anemia is a common problem in diabetics, particularly those with microalbuminuria and reduced kidney function. Authors of the study write, “This survey should encourage heightened awareness of the potential impact of anemia in the diabetic population.”

SOURCE: Diabetes Care, 2003;26:1164-1169