Serious Health Problems for Young Diabetics (October 30, 2003) 

(Ivanhoe Newswire)

A new study focuses on what’s being called a serious public health problem. More and more young adults are being diagnosed with type 2 diabetes and now research shows this diagnosis puts these young people at a greater risk for a heart attack and stroke. Specifically, the research shows younger adults diagnosed with type 2 diabetes are 14-times more likely to suffer a heart attack and 30-times more likely to suffer a stroke than their peers without diabetes.

“This means that huge numbers of people are going to get heart disease, heart attacks and strokes years, sometimes even decades, before they should,” says lead study author Teresa Hillier, M.D., an endocrinologist and investigator at Kaiser Permanente’s Center for Health Research. She says, “Young adults are increasingly likely to be overweight and diabetic. Our study is the first to look at the health outcomes of young adults who get diabetes, and the greatly increased risk of heart attack and stroke are very alarming.”

Researchers compared outcomes of more than 7,800 adults who were diagnosed with type 2 diabetes between 1996 and 1998. More than 6,200 of the participants were 45 years or older and 1,600 were under the age of 45. Researchers then used incidence models to estimate future complications.

The study shows people with early onset type 2 diabetes are 80-percent more likely to need insulin therapy than those who get diabetes later in life. Researchers also report those who are diagnosed with diabetes at a young age are significantly more obese on average than those diagnosed later in life. As for heart attack and stroke risk, researchers say young women account for nearly all the increase in heart attack risk, while young men are twice as likely to suffer a stroke as young women.

Researchers say more research is needed to understand the clinical course of type 2 diabetes and how it differs by the age of onset. However, study authors say it’s clear diabetes at a young age is a very serious health problem. Dr. Hiller says, “The CDC is predicting that at least one out of every three Americans born after 2000 are going to develop diabetes, and the trend we’ve seen of diabetes affecting young adults and even teenagers is going to continue.”

SOURCE: Diabetes Care, 2003;26:2999-3005

Easier Treatment for Blood Clot (October 30, 2003) 

(Ivanhoe Newswire)

A pulmonary embolism is a fairly common condition that can be fatal. It is defined as an obstruction of a blood vessel in the lungs, usually due to a blood clot, which blocks a coronary artery. While treatment is not always successful for a pulmonary embolism, a new study shows a new treatment is just as effective and easier to administer to patients than the current treatment.

According to the American Heart Association, about 600,000 Americans develop a pulmonary embolism annually; 60,000 die from one. The standard treatment for a pulmonary embolism is intravenous heparin requiring the patient to be monitored and hospitalized. Researchers conducted a study to see if a daily injection of the drug fondaparinux would be effective for patients with a pulmonary embolism.

The study included 2,213 patients who had a pulmonary embolism. The patients received either one of three doses of fondaparinux or a continuous intravenous infusion of heparin. Both of the drugs were given for five days. Researchers compared how the patients in each group did after three months and noted if they had a recurrent pulmonary embolism.

Researchers report only 42 of the 1,103 patients on fondaparinux had a recurrent problem compared to 56 of the 1,110 patients on the standard treatment. They also found major bleeding occurred in 1.3 percent of the patients on fondaparinux compared to 1.1 percent of the patients on heparin. The mortality rates after three months were similar in the two groups. About 15 percent of the patients on fondaparinux received the drug on an outpatient basis.

Study authors conclude treatment of pulmonary embolisms with fondaparinux is at least as effective and as safe as the standard treatment. They feel because of the simplicity in giving fondaparinux, it could become the first treatment of choice for many patients with a pulmonary embolism.

SOURCE: New England Journal of Medicine, 2003;349:1695

Extended Therapy for Blood Clots (October 30, 2003) 

(Ivanhoe Newswire)

An oral drug given after a standard six-month treatment could help prevent future blood clots in patients, according to new research.

Venous thromboembolism (VTE) affects approximately 2 million Americans each year. VTE includes deep vein thrombosis (blood clots common in the thigh and back) and pulmonary embolism (blood clots common in the lung). Despite progress in diagnosis and treatment, VTE is still associated with high morbidity and mortality. While previous studies have shown a risk of recurrence after six months, treatment is often stopped after six months because of the risk of bleeding. A new study examines the use of the oral drug ximelagatran or placebo as a treatment after the six-month standard treatment.

The study included 1,233 patients with VTE who had six months of anticoagulant therapy. Half of the patients were then given the drug ximelagatran and the other half was given a placebo for 18 months. Researchers then analyzed how the patients did on the drug compared to those on the placebo.

Researchers report only 12 patients on ximelagatran had a recurrent problem compared with 71 patients on the placebo. They found six patients on the drug died during the 18 months compared with seven patients who died in the placebo group. However, 134 patients on ximelagatran experienced bleeding compared to 111 patients on the placebo. Still, study authors point out that the risk of major hemorrhage was low. Researchers say those patients on ximelagatran had high levels of alanine aminotransferase which is an enzyme present in the liver and heart cells. The levels of this enzyme in patients on the drug were more than three-times the normal level and cause a concern for more research on this treatment, according to study authors.

In conclusion, researchers say the drug ximelagatran is superior to placebo for an extended treatment for VTE. However, they say more research is needed to understand why patients on the treatment had high levels of a certain enzyme.

SOURCE: New England Journal of Medicine, 2003;349:1713

Corticosteroids Safe for Bones (October 29, 2003) 

By Julie Monheim, Ivanhoe Health Correspondent
ORLANDO, Fla. (Ivanhoe Newswire)

Previous studies have shown inhaled corticosteroids can decrease a person’s bone mineral density. However, researchers now say long-term use of ICS therapy is not associated with a significant change in BMD.

Corticosteroids are commonly used to treat asthmatics and people with chronic obstructive pulmonary disorder. Researchers say these medications are good at reducing inflammation and mucus production in the airways of the lungs. They also make other quick-relief medicines more effective.

Jordana Schmier and colleagues examined more than 260 studies and presented their findings at the Annual Scientific Assembly of the American College of CHEST Physicians in Orlando, Fla. They reviewed both published and unpublished literature and selected 14 studies that met their criteria. Researchers say the majority of the studies reviewed included patients who received moderate to high doses of corticosteroid therapy.

Results show long-term use of these medications by patients with asthma or COPD was not associated with significant changes in BMD. Schmier says using ICS therapy is important in controlling symptoms of various lung disorders. She concluded, “ICS treatment at standard doses in patients with asthma or COPD does not have a clinically meaningful effect on BMD.”

SOURCE: The Annual Scientific Assembly of the American College of CHEST Physicians in Orlando, Fla., Oct. 25-30, 2003

Antibiotic for Knee Osteoarthritis (October 27, 2003) 

(Ivanhoe Newswire)

New research shows an antibiotic used to treat a variety of infections may also help patients who suffer from knee osteoarthritis.

Researchers from the Indiana University School of Medicine studied more than 430 obese women between ages 45 and 64 who suffered from osteoarthritis in one knee. Participants received either 100 milligrams of the antibiotic doxycycline twice a day or a placebo. Researchers measured patients’ knee pain at the start of the study and again during a series of exams over 30 months.

Results show patients who received doxycycline reported more than a 33 percent decrease in loss of joint cartilage. Patients taking the antibiotic were also less likely than those in the placebo group to report worsening of pain throughout the course of the study. Researchers say doxycycline also appeared to help the patients’ good knees -- even when X-rays showed that the joints in these knees were normal.

Researchers say the antibiotic works to relieve arthritis pain by inhibiting enzymes that break down joint cartilage. They say their study shows doxycycline can slow the progression of structural damage and help reduce joint pain. Kenneth D. Brandt, M.D., lead author of the study, concludes, “Our findings indicate that osteoarthritis is a disease whose natural history can be modified by pharmacologic therapy.”

SOURCE: The American College of Rheumatology’s Annual Scientific Meeting in Orlando, Fla., Oct. 23-28, 2003

Breast Cancer Prevention through Lifestyle (October 27, 2003) 

(Ivanhoe Newswire)

A new study confirms what doctors and dieticians have long said -- exercise and a healthy weight can significantly improve your life and even reduce the early onset of cancer. In the study, physicians from the University of Washington in Seattle report cancer can be prevented in women with genes that put them at the greatest risk.

Women who carry the genes BRCA1 or BRCA2 have a lifetime risk of breast cancer of more than 80 percent. They also have an increased risk for ovarian cancer. The new study findings indicate even among this group of women, exercise and a healthy weight as an adolescent led to delayed onset of cancer.

According to researchers, women with the BRCA1 or BRCA2 mutation have a 20 percent chance of developing breast cancer by age 40, a 55 percent chance by age 60, and more than 80 percent by the time they reach 80. The authors of this study say women who exercised during their teenage years were more likely to develop cancer later in life than women who did not exercise. The same was true for weight. If women were average weight during their teenage years, they delayed the onset of cancer.

More than 1,000 women with invasive breast cancer were enrolled in the study. It is believed to be the first study to show exercise and weight control can influence the onset of cancer in women who are predisposed to cancer. Only about 100 of the 1,000 women had the mutated BRCA1 and BRCA2 genes.

Interestingly, the authors point out some of those women had no family history of breast or ovarian cancer because the genes were passed through the father. Therefore, they stress that women should get to know their family’s medical history in great detail from both the mother’s and the father’s side of the family.

SOURCE: Science, 2003;302:643-645

Building Strength for Lung Patients (October 24, 2003) 

TORRANCE, Calif. (Ivanhoe Newswire)

Chronic obstructive pulmonary disease -- or COPD -- is a lung disease that affects up to 30 million Americans. Emphysema and chronic bronchitis are the two main diseases that fall under the category of COPD. It is the fourth-leading cause of death in the United States, and it’s the only leading cause of death where the death rate keeps increasing. Now patients are building muscle and building strength.

Walks like these were once hard to imagine for Pat Ternstrom. After 40 years of smoking, she has COPD -- a lung disease that plagues many smokers. “I became pretty much like a couch potato," Ternstrom tells Ivanhoe. "I would do things as long as I didn’t have to walk.”

Pulmonologist Richard Casaburi, M.D., Ph.D., says that’s a common result for many people with the disease. “These people will struggle to breathe," he says. "They will be unable to exercise.”

Dr. Casaburi, of Harbor-UCLA Research and Education Institute in Torrance, says that lack of exercise weakens muscles and leaves patients with little strength. “We found that working on their muscles definitely benefits the patients, so they can sort of overcome their lung limitations.” He is helping women build muscle with weights and weekly injections of testosterone.

“Testosterone is not just a man’s hormone," Dr. Casaburi says. "You can get muscle mass gains -- up to 18 pounds of muscle -- from testosterone administration for fairly high doses.” Even low doses could boost muscle mass in women.

Along with the hormone, women lift weights three times a week for 10 weeks. Dr. Casaburi says, “These people will recondition their muscles, and they can function an awful lot better.”

Ternstrom says her new strength has had a big impact. “I feel I would say 100 percent better. I feel like I was almost reborn again.” At 77, her new muscles are keeping pat full of energy and life.

Results of the study of testosterone and weight lifting among women should be known in the next year. In men, muscle strength increased about 20 percent with a program like this. Ternstrom said two years ago, she wasn’t able to pick up her newborn great-grandson. After participating in this program, she is proud to say she’s able to pick up her most recent great-grandchild -- born just two months ago.

If you would like more information, please contact:

Christine Lewis, Communications Consultant
Issues Management Network
(310) 215-0234
clewis@issuesmanagement.com

The Return of Rickets (October 24, 2003) 

(Ivanhoe Newswire)

For years, doctors thought of rickets as a disease of the past. New research shows it should still be considered a problem and prevention should start before birth. The study, by researchers from the United Kingdom, suggests pregnant women should be given vitamin D supplementation.

Rickets is a childhood disorder involving softening and weakening of the bones, primarily caused by lack of vitamin D, calcium, or phosphate. It is most likely to occur during rapid growth, when the body demands high levels of calcium and phosphate. Rickets may be seen in young children 6 to 24 months old.

In this article, doctors say rickets is increasing for two main reasons. They say more babies are being breastfed longer, with no vitamin D supplementation and children and mothers get less sun exposure because of concerns about skin cancer. Doctors also indicate immigrant groups have a higher prevalence of rickets.

Researchers suggest pregnant women (living outside the tropics) in the second and third trimesters should receive a supplement of 400 IU to1000 IU daily. Additionally they write, “Exclusively breastfed children of Asian and black mothers living outside the tropics should receive 280 to 400 IU.” They recommend vitamin D supplements be given to children until the growth spurt that accompanies puberty is finished. Moderate sun exposure will also help.

SOURCE: The Lancet, 2003;362:1389-1400

Radiation after Breast Reconstruction OK (October 24, 2003) 

(Ivanhoe Newswire)

Previous studies have shown breast cancer patients who receive radiation therapy after undergoing breast reconstruction and a mastectomy may be more likely to develop complications. However, a new study shows this may not be the case.

Researchers from the Fox Chase Cancer Center studied 85 women with breast cancer who underwent a mastectomy, breast reconstruction, and postoperative radiation between 1987 and 2002. Seventy patients received radiation after their mastectomy and reconstruction procedure. The other 15 patients received radiation prior to reconstruction. Fifty patients underwent a reconstructive procedure called tissue expander placement with or without an implant, and 35 patients received a transverse rectus abdominis myocutaneous (TRAM) reconstructive flap.

Results of the study show, after five years, none of the patients who received a TRAM flap had major complications or required corrective surgery. Only 5 percent of patients who were in the tissue expander placement group had a major complication, and two of these patients had to have their implant removed. Nearly 40 percent of patients in the TRAM group had minor complications, and about 15 percent of the women with implants had minor complications.

Penny R. Anderson, M.D., from the Fox Chase Cancer Center, says, “What’s interesting about this reported complication rate for breast implants is that not only is it low compared to other studies involving radiation after reconstruction, it is also low when considering the rate of major complications following reconstruction when radiation is not a factor.”

SOURCE: American Society for Therapeutic Radiology and Oncology’s Annual Meeting in Salt Lake City, Oct. 19-23, 2003

Improving Mammography (October 22, 2003) 

(Ivanhoe Newswire)

When it comes to improving mammography screening, Americans could take a lesson from the Brits.

According to a new study in this week’s Journal of the American Medical Association, half as many British women who undergo a mammography screening are recalled for further testing and half as many undergo surgical biopsies to explore possible cancer. Cancer detection rates between the two countries, however, are virtually the same.

The authors believe these findings point not only to less worry for British women undergoing the screening, but also to lower costs for the health care system.

The study involved data from three large clinical trials involving mammography screening, two in the United States conducted among more than 1.5 million women and one in the United Kingdom conducted among 3.94 million women. About 27,000 women in all three groups were diagnosed with cancer following screening. Detection rates per 1,000 mammograms in the three studies were 5.8, 5.9, and 6.3, respectively. Recall rates among women age 50 to 54 undergoing a first screening were 14.4 percent, 12.5 percent, and 7.6 percent, respectively.

Authors write, “The goal of any cancer screening effort is to obtain high cancer detection rates while avoiding unnecessary diagnostic evaluation following false-positive results, which are costly and associated with ongoing psychological morbidity.”

They suggest the United States might benefit from adopting British practices, which include less frequent screenings for women age 50 to 69 (every two years rather than once a year), a single, organized approach to screening, more experienced radiologists to read the mammograms, and national quality assurance standards governing mammography.


SOURCE: Journal of the American Medical Association, 2003;290:2129-2137

Knee Injuries in Female Athletes (October 20, 2003) 

PITTSBURGH (Ivanhoe Newswire)

With school back in session and sports in full swing, the number of injuries suffered on the field and court are likely to be on the rise in coming months. Sports researchers say female athletes seem to be at especially high risk for knee injuries, and physicians are taking steps to reduce the problem. Here is a look at the cause of the injuries and what’s being done about them.

Jumping, landing, twisting and pounding all take a toll on athletes’ knees -- especially the anterior cruciate ligament. “These injuries are occurring in epidemic proportions," says Scott Lephart, Ph.D., a sports medicine researcher at University of Pittsburgh Medical Center.

The anterior cruciate ligament -- or ACL -- supports the knee. Researchers like Lephart have seen an increasing number of ACL tears in women. Now, he’s trying to understand, first, why they happen. He says, “Our injury prevention model starts with identifying risk factors.”

Some reasons are slower development of quadriceps and a reduced ability to sense where the joint is. “So, when the knee starts getting in this position of vulnerability, there’s a slower ability of the muscle to adapt to help protect it,” Lephart tells Ivanhoe. With this information, he’s developed a program to reduce the risk of injury.

Young athletes performed various exercises including one-legged squats, hops and jumping to help balance, strength and coordination. Lephart says, “We need to encourage coaches and strength trainers to incorporate the activities that we know induce these desirable adaptations and will likely reduce injury rates.”

As a volleyball player, Summer Rippel agrees with the need for more education. She says, “You don’t realize how easy you could actually do that, tear it.” She’s lucky and hasn’t had the injury, and since taking part in the study, she’s one step ahead in protecting herself for the short- and long-term.

Lephart says it’s important to protect the ACL for more reasons than just to keep participating in sports. Following ACL injuries, people often go on to develop early arthritis, which leads to the inability to be physically activity over the course of a person’s life.

If you would like more information, please contact:
UPMC Physician Referral Line
(412) 647-UPMC

Less Oxygen During Exercise Could Mean Heart Problems (October 20, 2003) 

(Ivanhoe Newswire)

During the first few minutes of exercise, the amount of oxygen per heartbeat increases and continues to rise as the heart carries the oxygen to the blood. A new study shows less oxygen to the body after the first few minutes of exercise could signal heart trouble.

Researchers from Johns Hopkins studied nearly 100 patients between ages 55 and 75 who had mild hypertension. Researchers measured the patients’ heart sizes and performance at rest by using an ultrasound and tissue Doppler imaging. They compared these results with heart performance tests that measured oxygen usage during exercise.

Results of the study show patients who delivered less oxygen to the body per beat after the first few minutes of exercise had reduced levels of heart function. Researchers say this finding could help doctors follow the progress of patients with problems in the left ventricle. However, they say more research is needed to determine whether oxygen pulse during exercise is a useful screening tool for identifying heart problems.

Kerry J. Stewart, Ed.D., from Johns Hopkins, says, “Our research shows that patients with mild hypertension have some reductions in heart function. We found signs that their hearts were not operating efficiently during exercise, and this was matched with decreased heart function at rest as revealed by newer imaging methods. We need to get their blood pressure under control, even if it is only mildly elevated.”

SOURCE: The Annual Meeting of the American Association of Cardiovascular and Pulmonary Rehabilitation in Kansas City, Oct. 17, 2003

Not all Type 2 Diabetes Created Equal (October 20, 2003) 

(Ivanhoe Newswire)

The specific version of type 2 diabetes a person has makes a difference in the type of treatment he or she should receive.

That’s the major finding from a study out of Great Britain published in this week’s issue of The Lancet. Researchers analyzed the response to standard diabetic medications among people for whom no known cause of the disease could be established and those with a genetic form of the condition known as HNF-1a.

Results showed patients with the genetic form of the disease did significantly better when they were given sulphonylurea drugs as opposed to when they received metformin drugs. Conversely, patients whose diabetes had no known cause did equally well on both types of medication.

The authors comment, “We have shown that the cause of diabetes determines the response to hypoglycemic drugs; with a genetic subtype of diabetes being very sensitive to the effects of sulphonylureas. This knowledge is crucial in deciding the best treatment for individual patients. The individualization of patients’ treatment is an important goal of the major work to define the genetic and environmental causes of diabetes.”

The authors note current recommendations for diabetes care fail to take the cause of the disease into account, instead assuming all patients will have a similar response to the various therapies available. Since more than 150 million people worldwide have type 2 diabetes, better strategies are needed to ensure more people get optimal care.

SOURCE: The Lancet, 2003;362:1275-1281

Cholesterol Drugs Prevent Breast Cancer (October 17, 2003) 

(Ivanhoe Newswire)

New research shows the same drugs you take to lower cholesterol may help protect against breast cancer.

Researchers from the University of Pittsburgh followed more than 7,500 women ages 65 years and older for more than seven years. Results of the study show more than 3 percent of women who did not use cholesterol-lowering drugs developed breast cancer, while 2.1 percent of women who used statin cholesterol-lowering drugs did, and 1.3 percent of women who used nonstatin drugs did. Overall, women who used a drug to lower cholesterol had a 68-percent reduced risk of breast cancer.

Researchers say this is the first study of its kind to examine the relationship between cholesterol-lowering medications and breast cancer. Jan Cauley, Dr.PH, from the University of Pittsburgh, says, “There is a significant difference in the percentage of breast cancer events between women who used lipid-lowering drugs and those who did not, and these findings have important public health implications given the widespread used of the medications today.”

Authors of the study say more research is needed to confirm their findings. They write, “Our findings need confirmation by other, larger studies involving more women and randomized clinical trials before we can recommend therapeutic interventions to prevent breast cancer with these agents.”

SOURCE: Journal of Women’s Health, October, 2003

Promising Treatment for Diabetes (October 16, 2003) 

(Ivanhoe Newswire)

Researchers appear to be on the road to a new and possibly better treatment for type 2 diabetes.

Doctors typically treat type 2 diabetics with oral medications to control blood sugar. They’ll sometimes also use insulin if the condition worsens. These medications are effective, but they also carry increased risk for low blood sugar, or hypoglycemia, particularly as people age. This study, published in this month’s Diabetes Care, shows older people with type 2 diabetes who received a continuous infusion of a gut hormone called glucagon-like peptide 1, or GLP-1, had significantly fewer of these complications than those who remained on standard oral medications.

The study involved 16 patients. Eight remained on usual care and eight discontinued their usual oral medications and received a continuous infusion of GLP-1 via an infusion pump for 12 weeks. Although blood sugar levels and body weight were maintained equally well in both groups, the investigators noted 87 episodes of hypoglycemia in the usual care group compared to just one in the GLP-1 group.

Researchers believe these results show promise for treatment, but note further study is needed to make the therapy practical on a larger scale. They write, “Our study was designed to test the potential of GLP-1 treatment in elderly individuals using continuous subcutaneous administration. However, long-term administration of GLP-1 by subcutaneous infusion using currently available pumps is impractical for many patients. To allow this therapy to have broader clinical utility, newer delivery systems ... need to be developed.”

SOURCE: Diabetes Care, 2003;26:2835-2842

Cell Infusion for Heart Attack Patients (October 14, 2003) 

(Ivanhoe Newswire)

The key to improving a heart attack patient’s pumping power of their heart could be in the patient’s own cells. A new study shows infusing a patient’s own cells into a heart artery a few days after a heart attack speeds up the healing process.

Progenitor cells are derived from stem cells, which have the potential to develop into any cell in the body. German researchers extracted progenitor cells from a patient’s blood or bone marrow and infused them into an artery. All of the patients had been treated with angioplasty and anti-clotting drugs. The patients received infusion of the cells an average of 4.7 days after their heart attack. The patients underwent an MRI a few days after the infusion and four months later. Researchers assessed the heart damage and heart ability from the two MRIs.

“The infusion of progenitor cells was associated with a reduction in the size of muscle damage, a significant improvement in pumping function, and less enlargement of the heart within four months after a heart attack,” says co-author Andreas Zeiher, M.D., from the University of Frankfurt. Researchers say the finding of this study corroborates previous research that indicates stem and progenitor cells can reduce heart attack damage.

Specifically, researchers report the average amount of blood pumped from the heart increased from 44 percent to 49 percent. The amount of blood normally pumped is about 60 percent. Researchers also report the average volume of the dead tissue decreased by about 20 percent during the four-month follow up. Furthermore, study authors say cells from both the blood and bone marrow proved equally effective in improving the heart’s ability.

While researchers are impressed with these promising findings, study authors say larger studies with randomized, placebo-controlled patients are required to prove that this treatment reduces the occurrence of heart failure.

SOURCE: To be published in an upcoming issue of Circulation

Exercise to Prevent Early Breast Cancer (October 13, 2003) 

(Ivanhoe Newswire)

Previous research proved exercise reduces the risk of breast cancer, and now a new study adds to that finding. Researchers say exercise may lower a woman’s risk of developing breast carcinoma in situ -- a cluster of abnormal cells that can develop into invasive breast cancer if left untreated.

Researchers from the American Cancer Society studied more than 1,500 women between 35 and 64 years old. More than 550 participants had been previously diagnosed with BCIS. Of the more than 1,000 women in the control group, around 600 had been screened within two years of starting the study. Researchers asked the participants questions about their involvement in activities such as walking, jogging, dancing and swimming to calculate a weekly activity log for each woman.

Results of the study show women who exercised had a 35-percent lower risk of developing BCIS than those who were inactive. Women who exercised more than four hours a week had a 47-percent lower risk of BCIS than women who did not exercise. However, researchers say exercise did not reduce the risk of BCIS in women who had a family history of breast cancer.

Some researchers believe exercise reduces the risk of BCIS by lowering levels of female hormones. Leslie Bernstein, Ph.D., co-author of the study, says, “Although we presume that physical activity works through a hormonal means to reduce BCIS risk, this may not be an important mechanism for women who may have a hereditary form of the disease.”

SOURCE: Cancer, published online Oct. 6, 2003

Reduction in Hormone Replacement Use (October 13, 2003) 

(Ivanhoe Newswire)

New research shows a significant drop in the use of hormone replacement therapy following a 2002 report that HRT is not suitable for the prevention of chronic diseases.

In 2002, the Women’s Health Initiative released results that say the effects of combined estrogen plus progestin therapy on healthy postmenopausal women increases breast cancer rate, coronary heart disease, stroke and venous thromboembolism. The conclusion of the study was that combined HRT was not suitable for the prevention of chronic diseases. The results of the study were released in 2002.

Researchers from New Zealand gathered information on about 800 women who were using hormone replacement therapy between January 2000 and November 2002. These women were using HRT but were ineligible or unwilling to join the international study they had been recruited for. Six months after the publication of the results of the Women’s’ Health Initiative, women were sent an information sheet and questionnaire by mail. Researchers wanted to determine how many women were still taking HRT after the release of the study.

When the results were published, 776 women questioned were on HRT. After seeing the study results, 423 reported stopping the treatment. Of those, 132 went back on it when this survey was performed. Many of the women who restarted did so because of the return of symptoms, and 83 percent of women said they had discussed HRT with a health professional.

Researchers report older age, use of combined HRT, and longer duration of HRT were associated with stopping HRT.

SOURCE: British Medical Journal, 2003;327:845-846

Exercise for Parkinson’s (October 13, 2003) 

PITTSBURGH (Ivanhoe Newswire)

Parkinson’s disease is a degenerative disease caused by a loss of the cells in the brain that produce the chemical dopamine. While there are medications that can slow the loss of dopamine, they can bring about negative side effects after long-term use. That’s why many look for other methods to slow disease progression.

As a former engineer, Dick Beyer takes a calculated approach to everything he does -- especially now that he has Parkinson's disease. “I was having trouble reaching for a glass off the second shelf in the kitchen, so I developed an exercise in the total gym, which basically repeats that motion,” he tells Ivanhoe.

According to University of Pittsburgh Medical Center physical therapist Kathi Brandfass, these movements help the many symptoms of Parkinson's. She says, “At the heart of what we’re working on are really the tasks that involve targeting, reaction, their reaction to a target.”

Brandfass started the program to study the effect of targeted exercises on Parkinson's. “All of them have had significant postural changes, and balance, there’s a big balance improvement,” she says.

Since Parkinson's affects one side or the other, the exercises work both. Moving backwards initiates new motor programs.

Beyer says, “I feel like what I’m participating in is the giveback program, so the people with Parkinson’s after me will have more than I had.”

Parkinson's patient Jim Cordy is also looking out for more than himself. He says, “I’m curing Parkinson’s. I don’t have time to take care of Jim Cordy.”

But if the results hold true, Cordy will be helping himself -- just by exercising.

Brandfass also points to the importance of starting exercise programs early -- before the problems become debilitating. Of course, you’ll want to talk to your doctor before starting any exercise program. She says a trained individual can create a program with exercises to help each person’s specific needs.

If you would like more information, please contact:

UPMC
Sports Medicine
3200 S. Water St.
Pittsburgh, PA 15203
(412) 432-3700

Weight and Blood Pressure (October 10, 2003) 

(Ivanhoe Newswire)

A new study highlights the importance of weight control throughout life to control blood pressure. The study also reports low birthweight and low socio-economic status during childhood can also contribute to higher blood pressure in the future.

Researchers have suggested the negative effect of birthweight on systolic blood pressure may be initiated in utero and amplified with age. Researchers from Royal Free and University College of Medicine in London conducted a study to look at birthweight, weight throughout life, and socio-economic status to determine how they affect blood pressure.

More than 3,640 people born in Britain in 1946 were included in the analysis. The participants’ systolic and diastolic blood pressures were measured at ages 36, 43 and 53 years old. Researchers also had data on the participants’ birth weight and childhood social class.

Researchers report a consistent negative association between birthweight and systolic blood pressure from age 36 to 53 years old. Researchers also say those in a lower socio-economic class in childhood had higher blood pressure levels. Study authors say this difference was largely the result of an increased body mass index over the years.

Study authors conclude weight control throughout life is key to prevention of raised blood pressure during middle age. They add that understanding the link between early childhood socio-economic environment and adult obesity could make prevention strategies more effective.

SOURCE: The Lancet, 2003;362:1178-1183

Drugs Reduce HIV Transmission to Baby (October 10, 2003) 

(Ivanhoe Newswire)

Research shows a combination drug therapy given to babies soon after childbirth is effective at preventing HIV transmission from mother to child. The therapy was used because the babies’ mothers did not know they were HIV positive until the time of delivery.

Research has shown the drugs zidovudine and nevirapine reduce the mother-to-child transmission of HIV in breastfeeding women in Africa. The treatment is generally given late in pregnancy and continued until early infancy. Researchers from Johns Hopkins Bloomberg School of Public Health conducted a study to determine if the two drugs given together reduced transmission more than just nevirapine alone when given after the baby is born.

The study included 1,100 babies of African women in which the mother did not know she was HIV-positive until about two hours before delivery. The babies were randomly given nevirapine alone or the combination therapy. Both drugs were given immediately after birth. The infant’s HIV status was determined at birth and six to eight weeks later.

According to the study, 15 percent of the babies given the combination therapy were HIV-positive compared to 21 percent of the babies given nevirapine alone. Of the babies who were HIV-negative at birth, 7.7 percent of the babies given the combination therapy were HIV-positive at the follow up test compared to 12.1 percent of the babies given nevirapine alone.

Researchers conclude the combination therapy could be a way to reach babies of women who are not tested during pregnancy and do not find out they are HIV-positive until they give birth. They say this is especially important in parts of Africa where women arrive to the labor room without knowledge of their HIV status, making it too late for other treatment options.

SOURCE: The Lancet, 2003;362:1171-1177

Air Pollution Tied to Stroke Risk (October 10, 2003) 

(Ivanhoe Newswire)

New research shows high air pollution levels may make people more susceptible to suffering a stroke.

In previous research, air pollution levels have been connected to daily death rates for respiratory problems and heart disease. But research on air pollution and stroke has been conflicting. Investigators from Kaohsiung Medical University in Taiwan conducted a study to compare air pollution levels and stroke hospital admissions.

Researchers collected data on 23,179 hospital stroke admissions from 1997 to 2000 in Kaohsiung, Taiwan. It is the second largest city on the island and is a heavy industrial area. Investigators compared air pollution levels on the dates of hospital admissions with air pollution levels one week before and one week after admissions.

The study shows two common pollutants were associated with an increase in the number of stroke admissions. “Particulate matter (PM10) and nitrogen dioxide (NO2) seem to be the most important pollutants and the effects appear to be stronger on warm days,” says Chun-Yuh Yang, Ph.D., M.P.H., professor, director and dean at the Institute of Public Health, College of Health Sciences at Kaohsiung Medical University. Researchers found an increase of these air pollutants increased the risk of two types of stroke including an intracerebral hemorrhage stroke and an ischemic stroke. An intracerebral hemorrhage is when a defective brain vessel bursts and an ischemic stroke happens when a blood clot blocks blood flow to the brain.

Study authors conclude this research provides new evidence that higher levels of certain pollutants increase the risk of hospital admissions for a stroke.

SOURCE: To be published in an upcoming issue of Stroke

FDA Approves Estrasorb For Treatment of Menopausal Hot Flashes (October 10, 2003) 

FDA approved Estrasorb (estradiol topical emulsion), an estrogen therapy product in a topical form. Current estrogen products available for treatment include oral pills, transdermal patches, and a vaginal ring. Estrasorb has been proven effective for treating moderate to severe symptoms of hot flashes and night sweats associated with menopause.

Estrasorb is a white lotion-like emulsion that women apply only to their legs, thighs or calves on a daily basis. The product is absorbed through the skin into the blood stream to achieve its effect. As a precaution women are advised not to apply sunscreen and Estrasorb at the same time because this may affect the amount of estradiol absorbed.

In January 2003, FDA advised women and their doctors that menopausal hormone therapy – estrogen and estrogen with progestins – may be associated with an increased risk of heart disease, heart attacks, strokes, and breast cancer. This was based on the findings of the Women’s Health Initiative (WHI) conducted by the National Institutes of Health (NIH). Label warnings and cautions for Estrasorb are similar to other menopausal hormonal therapy products.

To help women make decisions about whether to take hormone therapy, FDA and NIH initiated a nationwide information campaign to raise awareness about the recent WHI findings. FDA, NIH and a variety of organizations developed a menopause and hormone-therapy fact sheet, and a purse guide that women can use to discuss their options with a health professional. These materials are available in both English and Spanish from the National Women's Health Information Center (NWHIC) at www.4woman.gov.

Based on the latest evidence, FDA believes that estrogens and estrogen with progestin products, such as this new product, provide valuable therapy for many postmenopausal women, particularly those with “hot flashes.” FDA reminds women that these treatments also have important risks, and should be used in the lowest dose and for the least duration required to provide relief.

Today’s action gives postmenopausal women a new option for getting the benefits of estrogen.

Postmenopausal women who use or are considering the use of these treatments should discuss with their physicians whether the benefits outweigh the risks for them individually. FDA also reminds women that estrogens and estrogen with progestin products should not be used to prevent heart disease, heart attacks, or strokes.

Estrasorb is manufactured and distributed by Novavax, Columbia, Md.

Reducing Recurrence of Breast Cancer (October 10, 2003) 

(Ivanhoe Newswire)

Many postmenopausal women with breast cancer undergo tamoxifen therapy to prolong survival after surgery. Now, new research shows letrozole therapy, which suppresses estrogen production, may help these women after they’re finished with tamoxifen therapy.

Researchers studied more than 5,100 women to determine if five years of letrozole treatment following five years of tamoxifen therapy lowers a woman’s risk of cancer recurrence. About half of the women received letrozole treatment and the other half received a placebo. Previous studies have shown tamoxifen therapy reduces the risk of recurrence by 47 percent and reduces the risk of death by 26 percent when taken over five years.

Results of the study show just 75 women in the letrozole group had a recurrence of breast cancer, while 132 women in the placebo group had a recurrence. Forty-two women in the placebo group and 31 women in the letrozole group died during the study. Overall, letrozole reduced the risk of recurrence by 43 percent. Those in the letrozole group reported more cases of hot flashes, arthritis, arthralgia, and myalgia. However, vaginal bleeding was more common in the placebo group. Nearly 6 percent of women receiving letrozole treatment were diagnosed with osteoporosis compared to 4.5 percent who received placebo.

Researchers say their study shows letrozole therapy improves survival in patients who previously completed standard tamoxifen therapy. Authors of the study conclude, “We found a significant improvement in disease-free survival, including a substantial reduction in the rate of distant metastasis in the letrozole group as compared with the placebo group; the rate of death due to breast cancer was almost halved.”

SOURCE: To be published in an upcoming issue of New England Journal of Medicine

Asthma -- From Childhood to Adulthood (October 09, 2003) 

(Ivanhoe Newswire)

A new study shows asthma that begins in early childhood will continue to be a problem into adulthood. Researchers say interventions to modify asthma may need to target the very young.

The current study included 613 children born in 1972 and 1973 in Dunedin, New Zealand. The children underwent tests every two years from age 9 to 26 years old. The tests included questionnaires, pulmonary-function tests, bronchial-challenge testing and allergy testing. Researchers focused on the risk factors for persistent asthma and relapse.

Researchers report, by age 26, about half of the study participants reported wheezing at more than one test. Eighty-nine of the participants had wheezing that persisted from childhood to 26 years old. Study authors also report sensitization to house dust mites predicted the persistence of wheezing and relapse, as did airway hyperresponsiveness. Smoking at age 21 also predicted a persistence of wheezing. The study shows pulmonary function was consistently lower in those with persistent wheezing than in those without persistent wheezing.

In conclusion, more than one in four children had wheezing that persisted from childhood to adulthood that relapsed after remission. The risk factors for a relapse included house dust mites, airway hyperresponsiveness, female patients, smoking, and early age of the onset of the disease. Researchers suggest that outcomes in adult asthma may be determined in early childhood.

In an accompanying editorial, Fernando Martinez, M.D., from the University of Arizona, says, while 90 percent of patients with asthma can lead a normal life, there is no accepted strategy for the prevention of the disease. Dr. Martinez says there is hope from recent research that asthma could be thwarted before it starts or even stopped before it causes irreversible harm.

SOURCE: The New England Journal of Medicine, 2003;349:1414-1422;1473-1475

Obesity Linked to Type 1 Diabetes (October 09, 2003) 

(Ivanhoe Newswire)

Researchers have long blamed obesity for the increasing number of type 2 diabetes cases among children. Now, a new study shows being obese may also increase a child’s risk of developing type 1 diabetes.

Researchers studied more than 90 children between ages 1 and 16. They found a strong correlation between age, weight, and a diagnosis of type 1 diabetes. Results show younger children diagnosed with type 1 diabetes are more likely to be overweight. Terry Wilkin, M.D., from Peninsula Medical School, says: “Basically, the age (at diagnosis) got younger and younger as the children got heavier and heavier. This doesn’t prove that insulin resistance drives type 1 diabetes, but it is some of the first direct evidence suggesting that it plays a role.”

The study also shows three-times as many children diagnosed with type 1 diabetes in the 1990’s were considered overweight as those diagnosed in the 1980’s. Dr. Wilkin says his findings suggest that children who develop type 1 diabetes are genetically predisposed to the disease, but being overweight may accelerate the process.

A separate study examined the prevalence of obesity and type 1 diabetes in black and white children. Researchers found one in 10 white children and once in four black children were both genetically predisposed to type 1 diabetes and were insulin-resistant -- a condition associated with type 2 diabetes, where the body produces insulin but is unable to use it properly. Researchers refer to this risk as “double diabetes.”

Ingrid Libman, M.D., Ph.D., from the Children’s Hospital in Pittsburgh, says, “It is too simple to look at a child with diabetes and say they are overweight so they have type 2 disease or they have autoimmunity so they have type 1 disease. There seems to be more and more overlap between the two, especially among black children.”

SOURCE: Diabetes Care, 2003;26:2865-2870;2871-2875

Lifetime Risk for Diabetes (October 09, 2003) 

(Ivanhoe Newswire)

New research shows about one in three people born in the year 2000 will develop type 1 or type 2 diabetes.

According to the American Diabetes Association, about 17 million Americans are living with diabetes. Recent studies show the prevalence of diabetes in adults increased by 40 percent from 1990 to 1999. Another study shows the number of people diagnosed with the disease will increase by 165 percent between 2000 and 2050.

Researchers from the Centers for Disease Control and Prevention in Atlanta reviewed data from the National Health Interview Survey to estimate age, sex and race-specific risk of developing diabetes for people born in 2000. Researchers also hypothesized how old people would be when they were diagnosed, how long they would have the disease, and how many years of life would be lost due to the disease. They also estimated how much quality of life would be lost because of diabetes.

Authors of the study report that women have a higher lifetime risk for developing diabetes, but not by much. The risk for developing diabetes in females born in 2000 is 38.5 percent. For men, the risk is 32.8 percent. The highest risk is among Hispanics.

People with diabetes have a large reduction in life expectancy. Researchers write, “We estimate that if an individual is diagnosed at age 40 years, men will lose 11.6 life-years and 18.6 quality-adjusted life-years, and women will lose 14.3 life-years and 22 quality-adjusted life-years.”

Results show the lifetime risk for men is one in three and the risk for women is slightly higher at two in five. Authors of the study conclude: “For individuals born in the United States in 2000, the lifetime probability of being diagnosed with diabetes … is substantial. Primary prevention of diabetes and its complications are important public health priorities.”

SOURCE: Journal of the American Diabetes Association, 2003;290:1884-1890

Ozone’s Effect on Asthma (October 08, 2003) 

(Ivanhoe Newswire)

A new study shows asthmatic children who are exposed to ozone levels below the Environmental Protection Agency’s standards are more likely to develop respiratory problems.

Researchers from Yale University School of Medicine in New Haven, Conn., studied more than 270 children younger than 12. Participants all had physician-diagnosed active asthma and lived in southern New England. Researchers examined the children’s exposure to concentrations of ozone and fine particulate matter (PM2.5) from April 2001 to September 2001.

Results of the study show ozone levels, and not PM2.5, were significantly associated with respiratory symptoms among children. Children who were exposed to a 50-parts per billion increase in ozone exposure over one hour were 35-percent more likely to wheeze and 47-percent more likely to experience chest tightness. The highest levels of ozone were associated with increased shortness of breath and medication use. However, researchers found no correlation between pollutants and respiratory symptoms in children who did not use maintenance medication for their asthma.

Authors of the study conclude, “These results add to others that suggest that, even at low levels of ambient ozone and controlling for ambient fine particle concentration, children with severe asthma are at a significantly increased risk of experiencing respiratory symptoms.”

SOURCE: Journal of the American Medical Association, 2003;290:1859-1867

New Research into Immune Responses (October 07, 2003) 

(Ivanhoe Newswire)

Scientists have more understanding of how to interrupt an immune response. The new research, conducted by Harvard Institutes of Medicine in Boston, attempts to stop the immune response to skin cells.

When an injury occurs to the skin, the T cells rush to the inflamed area. For years, doctors have searched for ways to stop that process by developing new anti-inflammatory treatments for disorders such as psoriasis, skin allergies, and severe rashes. Doctors know two proteins -- E-selectin and P-selectin -- are a key part of the process whereby T cells go to the injured area.

In this new study, scientists found a way to stop production of a compound called selectin ligand, which in turn blocks the E-selectin protein from participating and the skin response does not occur. The agent used by the researchers is a sugar compound called 4-F-GlcNAc and it was more effective than some commonly used drugs called glucocorticoids and calcineum inhibitors. Both of these types of medications are prescribed to treat skin allergies and psoriasis.

The scientists are optimistic this finding could one day lead to the development of new medications to treat skin disorders. However, they caution it is a long way off. Until then, they hope it will shed light on new pathways to attack the disease.

SOURCE: Journal of Clinical Investigation, 2003;112:1008-1018

Key Factors for Insulin Resistance (October 07, 2003) 

(Ivanhoe Newswire)

A new study shows several environmental factors play a key role in insulin resistance. Researchers from Sydney, Australia, led a study of nearly 800 non-diabetic female twins. They looked at several environmental factors and their effects on insulin resistance and secretion.

Insulin resistance is a key component of the metabolic process and researchers say its presence predicts type 2 diabetes and heart disease. Various studies of alcohol consumption, hormone replacement therapy, and exercise have had differing results regarding insulin resistance. This study used twins to examine the relationship between genes and environment.

Thirty-nine percent of the women in the study were postmenopausal and 34 percent used hormone replacement therapy. Sixty women abstained from alcohol altogether while the majority fell into the "light-drinker" category. Researchers found women who used HRT and those who exercised were less insulin resistant.

For the HRT users, estrogen-only users were less insulin resistant than estrogen plus progestin users. The researchers also say, "A major finding in this study was that, even in healthy non-diabetic women, regular moderate alcohol consumption was associated with increased insulin sensitivity and lower abdominal adiposity (obesity) than abstinence."

Authors of the study conclude, "Moderate alcohol consumption, estrogen replacement, and physical activity are associated with increased insulin sensitivity in female twins."

SOURCE: Diabetes Care, 2003;26:2734-2740

CPR from Bystanders Works (October 07, 2003) 

(Ivanhoe Newswire)

If your heart stops, it could mean life or death if you receive CPR. A new study shows survivors of cardiac arrest, who were given CPR by a bystander, have a good quality of life in the year that follows the event.

The American Heart Association reports 250,000 people in the United States die each year of cardiac arrest outside the hospital. Cardiac arrest means the heart stops. Experts say only about 5 percent of victims survive, because there is only a five- to 10-minute window for resuscitation before death. This study, conducted by researchers in Ottawa and Tucson, Ariz., followed more than 8,000 people who had cardiac arrest outside a hospital.

Only 4 percent of the more than 8,000 people in the study had survived at least one year. Only 14.3 percent of those studied received CPR from a bystander before going to the hospital. Survivors who received CPR from a bystander reported a good quality of life. Researchers say 86 percent of patients had high overall cerebral performance. Lead author Ian Stiell, M.D., from the Ottawa Health Research Institute, says: "The earlier you have CPR, the more likely that there will be less damage. You restore circulation to other vital organs earlier as well. We think that bystander CPR is being sadly overlooked."

The researchers say the results of this study support the need for community-based education. They write, "Given the low rate of citizen-initiated CPR in many communities, we believe that local and national initiatives should vigorously promote the practice of bystander CPR. We're concerned at times that there is too much focus on high technology solutions. You don't have to be a doctor or nurse -- anyone can do it. You just need your hands and basic training."

SOURCE: To be published in an upcoming issue of Circulation

Technology can Help Heart Patients (October 07, 2003) 

(Ivanhoe Newswire)

A new study supports the use of high-tech medical imagery to determine who will most benefit from an implantable cardioverter defibrillator (ICD). Researchers from the Netherlands used single photon emission computed tomography (SPECT) imaging and echocardiography (ultrasound images of the heart) to study the hearts of people who survived dangerous arrhythmias. Ventricular arrhythmias are irregular heart rhythms.

The doctors found patients who had extensive scar tissue and the most reduction in a specific measurement of blood flow in the heart are more likely to suffer recurrences. They believe these patients would benefit the most from an implantable defibrillator. Currently, patients with heart disease are often treated by either opening up the arteries or bypassing them. Despite this, many patients still die of cardiac arrest. Researchers say ICDs are proven effective for preventing future arrhythmias and cardiac arrest.

Until now, there's been no clear way to determine who will benefit from an ICD. This research shows scar tissue is very predictive. The researchers are quoted as saying, "More scar tissue reflects more severe damage in the heart, and frequently patients with more scar tissue have suffered more than one heart attack." The researchers recommend doctors follow a specific approach when dealing with patients who survive sudden cardiac arrest and consider using technological screening methods to evaluate the condition of their hearts.

SOURCE: To be published in an upcoming issue of Circulation

New Research into Immune Responses (October 07, 2003) 

(Ivanhoe Newswire)

Scientists have more understanding of how to interrupt an immune response. The new research, conducted by Harvard Institutes of Medicine in Boston, attempts to stop the immune response to skin cells.

When an injury occurs to the skin, the T cells rush to the inflamed area. For years, doctors have searched for ways to stop that process by developing new anti-inflammatory treatments for disorders such as psoriasis, skin allergies, and severe rashes. Doctors know two proteins -- E-selectin and P-selectin -- are a key part of the process whereby T cells go to the injured area.

In this new study, scientists found a way to stop production of a compound called selectin ligand, which in turn blocks the E-selectin protein from participating and the skin response does not occur. The agent used by the researchers is a sugar compound called 4-F-GlcNAc and it was more effective than some commonly used drugs called glucocorticoids and calcineum inhibitors. Both of these types of medications are prescribed to treat skin allergies and psoriasis.

The scientists are optimistic this finding could one day lead to the development of new medications to treat skin disorders. However, they caution it is a long way off. Until then, they hope it will shed light on new pathways to attack the disease.

SOURCE: Journal of Clinical Investigation, 2003;112:1008-1018

Cholesterol Drug Best in Evening (October 06, 2003) 

(Ivanhoe Newswire)

New research confirms at least one common statin may be most effective when taken at night as opposed to the morning. Statins are drugs prescribed to lower cholesterol.

Researchers from England studied 83 patients who were taking either 10 milligrams or 20 milligrams of simvastatin, otherwise known as Zocor. They were taking the drug for primary or secondary prevention of coronary heat disease, stroke, or peripheral vascular disease.

Patients were randomized to take the drug in the mornings or in the evenings. Fifty-seven patients completed the trial. Most manufacturers of statins recommend the drugs be taken at night, but doubt has been cast on whether that is the best time.

Researchers found when patients switched from taking their nighttime pill to the morning, there were significant increases in total cholesterol and LDL, or the bad, cholesterol.

Authors of the study write, “Simvastatin is probably best taken at night because concentrations of total cholesterol and of low density lipoprotein are significantly greater when it is taken in the morning. This finding has implications for compliance in preventing coronary heart disease.”

SOURCE: British Medical Journal, 2003;327:788

Sexual Pleasure Improves after Hysterectomy (October 06, 2003) 

(Ivanhoe Newswire)

Many women fear a hysterectomy will affect their sexual attractiveness, but new research shows sexual pleasure actually improves after the procedure.

Dutch researchers surveyed women before and after their surgeries, and they found no matter which type of hysterectomy was performed -- vaginal, subtotal abdominal or total abdominal -- women reported their sexual pleasure improved significantly.

Both before and after the surgery, women were also asked about “bothersome problems” with lubrication, orgasm, pain or sensation in the genitals and arousal. Researchers found sexual problems that existed before surgery were less common afterwards, no matter which type of hysterectomy was performed.

Hysterectomy is the most common major gynecological operation. A hysterectomy can be performed either through the vagina or the abdomen. In a subtotal hysterectomy, the uterus is removed but the neck (cervix) is left intact. In a total hysterectomy, the entire uterus is removed. Earlier studies have been divided over whether the removal of the cervix helps or hurts sexual well-being. This study, however, finds the removal of the cervix has no adverse effects on sexuality.

Participants in the study completed a questionnaire before their surgery and again six months later. They were asked 36 questions about their general perception of their sexuality, the frequency of sexual activity, and different types of problems they experienced during sex. Results show the frequency of sex was similar both before and after the hysterectomy and the general satisfaction about sexuality improved after all three techniques.

Of the patients who reported one or more bothersome sexual problems before hysterectomy, the problems were still reported by 59 percent after vaginal hysterectomy, by 54 percent after subtotal abdominal hysterectomy, and by 56 percent after total abdominal hysterectomy. New sexual problems developed in 23 percent of patients after vaginal hysterectomy, in 24 percent after subtotal abdominal hysterectomy, and in 19 percent after total abdominal hysterectomy.

Source: British Medical Journal, 2003; 327:774-778

Walk for your Health (October 06, 2003) 

WINSTON-SALEM, N.C. (Ivanhoe Newswire)

Latest data show only 15 percent of adults over 18 exercise at least 30 minutes a day, five days a week. In a national survey, the highest percentage of regular walkers was found among men 65 years and older. Experts are urging more people to take it on. Here's an easy, effective way to stay in shape.

Robin Munden has found a way to improve her health. “I lost 40 pounds,” she tells Ivanhoe. If you’re overwhelmed by odd exercises, why not try her little secret? Munden says, “I just try to walk everyday for 30 minutes.” That’s right. In addition to eating low-fat meals, Munden pounds the pavement.

“All you really need is a good pair of shoes,” says exercise scientist Stephen Messier, Ph.D., of Wake Forest University in Winston-Salem, N.C. He says walking improves balance and strengthens bones and muscles. “So, not only are you living longer, but the quality of those years is better.”

Walking lowers your risk of diabetes, hypertension, high cholesterol, heart attack, osteoarthritis, obesity and stroke. Messier recommends you work up to walking 30 minutes a day, five days a week.

Charles Hunt has been on the move for 24 years. He says, “Get up, get out here. Get some speed going. You wanna live longer, you got to help yourself!”

And Messier says your walk doesn’t have to be all at once. “Get 10 minutes in this morning, 10 minutes in this afternoon and 10 minutes in this evening.”

So, park far away. And use the stairs.

Brisk walking one mile in 15 minutes burns about the same number of calories as jogging an equal distance in eight and a half minutes. Need another reason to walk? A recent study in the Annals of Internal Medicine shows regular exercise among men age 50 to 90 reduced incidence of erectile dysfunction by 30 percent. If you’re over 40, Dr. Messier recommends getting a medical check-up first.

If you would like more information, please contact:

Stephen P. Messier, Ph. D.
Exercise Scientist
Department of Health and Exercise Science
Wake Forest University
(336) 758-5849
messier@wfu.edu

Insoles could Help Balance (October 03, 2003) 

(Ivanhoe Newswire)

Researchers say vibrating insoles can jumpstart the nervous system into action. A new study looked at the use of the insoles to help people maintain better balance. They proved most effective in elderly people -- a group who can benefit most from better balance and reduce the number of falls and bone fractures.

Researchers from Boston University led the study and tested the insoles on 15 young people and 12 older people. The theory is small vibrations should stimulate the sensory system and therefore help to maintain proper balance. Doctors say the nervous system deteriorates with age and affects posture and balance.

In the study, the participants were asked to stand quietly on vibrating gel insoles. Video cameras measured the amount they swayed. The researchers note elderly participants showed greater improvement than their younger counterparts. They write, “Young participants might have almost optimum sensory feedback and balance control compared with elderly patients, who often have lateral postural instability and raised sensory feedback thresholds.”

The authors of the study say noise-based devices such as the randomly vibrating insoles may eventually help elderly people walk with better balance. This would be an important advance if it could reduce the number of falls. A recent study published in the Journal of Epidemiology and Community Health found the over 74 age group were 11-times more likely to be hospitalized after a fall compared to those ages 60 to 64. That study also found falls cost the National Healthcare System in the United Kingdom more than $1.5 billion.

SOURCE: The Lancet, 2003;362:1123-1124

Obesity not Related to Cancer Recurrence (October 03, 2003) 

(Ivanhoe Newswire)

New research proves obese women are not at an increased risk for breast cancer recurrence. Research shows obesity does not increase the chance of breast cancer recurrence and does not appear to decrease the effectiveness of the drug tamoxifen. The study, led by researchers from the University of Chicago, focused on women with early-stage, hormone-responsive cancer.

The study included nearly 3,400 women and tracked obesity and how it related to the risk of cancer recurrence, the effectiveness of the drug tamoxifen, and overall death rate. Previous studies have shown obese women have worse outcomes than lean women in regards to breast cancer. The authors report, “Overall, women who used tamoxifen had a 23-percent reduction in overall mortality relative to women who took placebo, and this effect did not differ by BMI (body mass index) group.”

Researchers say they did find in both obese premenopausal and postmenopausal women, there was a greater risk of breast tumors in the opposite breast and other areas of the body. Additionally, they report, “Obese women did have a modestly increased mortality risk relative to normal-weight women, and the small proportion of women classified as underweight also had increased mortality relative to normal-weight women.”

At this point, the study authors recommend use of tamoxifen in obese and non-obese breast cancer patients. Further studies will be done to continue to understand the role obesity plays in breast cancer.

SOURCE: Journal of the National Cancer Institute, 2003;95:1467-1476

Low Birthweight may Predict Cerebral Palsy (October 03, 2003) 

(Ivanhoe Newswire)

Doctors now know a little more about the origins of the physical disability cerebral palsy. A new European study finds babies born in the lowest 10 percent group for weight are four- to six-times more likely to develop cerebral palsy. Those in the highest 3 percent are also at risk.

Cerebral palsy is a group of disorders characterized by loss of movement or loss of other nerve functions. These disorders are caused by injuries to the brain and doctors do not fully understand how this occurs. Previous theories suggested it was connected to complications during childbirth, but new research suggests it occurs during fetal development.

In this new study, conducted by physicians from around the world, data looking at birthweight, gestational age, and the incidence of cerebral palsy was compared. The doctors write, “Babies of 32 to 42 weeks’ gestation with a birthweight for gestational age below the 10th percentile (using fetal growth standards) were four- to six-times more likely to have cerebral palsy than were children in a reference band between the 25th and 75th percentiles.” Children above the 97th percentile showed a slight risk.

The authors write, “The risk of cerebral palsy, like the risk of prenatal death, is lowest in babies who are of above average weight-for-gestation at birth, but risk rises when weight is well above normal as well as when it is well below normal.” They also suggest this debunks the theory that obstetrical complications cause CP.

An accompanying editorial supports the validity of the study and says the most surprising finding is that children in the highest weight percentiles are at risk. They write, ”The abnormal or injured brain could lead to accelerated growth through neuroendrocrine or other central influences.”

SOURCE: The Lancet, 2003;362:1106-1111

FDA Approves First New Drug Application for Treatment of Radiation Contamination due to Cesium or Thallium (October 02, 2003) 

This is a revised version of FDA Press Release P03-75, originally issued earlier on Oct. 2, 2003. Corrections were made to the original version, which is now obsolete.

The Food and Drug Administration (FDA) today approved a New Drug Application for Radiogardase, also known as Prussian blue, to treat people exposed to radiation contamination, due to harmful levels of cesium-137 or thallium. Radiogardase capsules contain Ferric (III) hexacyanoferrate(II).

The approval of Radiogardase is part of FDA’s continuing efforts to provide the American public with medical countermeasures in the event of a terrorist attack. Approval for Radiogardase was based on analysis of epidemiological studies and literature reporting on patients treated with Prussian blue in emergencies involving exposure to cesium-137 or thallium. Radiogardase works by increasing the rate of elimination of these substances from the body.

“FDA has taken a significant role in helping to speed the development of bioterrorism countermeasures,” said FDA Commissioner, Mark B. McClellan, M.D., Ph.D. “This first NDA approval for Radiogardase is part of the FDA initiatives aimed at bringing these critically important products to fruition.”

For several decades, Prussian blue has been used to enhance the excretion of cesium-137 and thallium from the body into the stool. Contamination with cesium-137 or thallium can occur through a variety of routes including ingestion, inhalation, or wounds and can cause serious illness or death when high radiation doses are absorbed and delivered to critical organs. At lower doses such contamination has been associated with the development of cancer.

Cesium-137 is widely used by industry and in medicine in a variety of devices and to treat certain cancers. Non-radioactive thallium is used in industry and as a rat poison. The radioactive form of thallium (thallium-201) is an approved drug used in small doses for medical imaging procedures. This use of radioactive thallium at low doses is very safe.

Contamination by Cesium-137 is of particular concern because of its potential use as a component of a conventional explosive device containing radioactive material, commonly called a "dirty bomb." Although this radiological dispersal device is not a nuclear bomb, it is detonated as a means to spread radioactive material and contaminate people and property.

Radiogardase is given orally. The main possible side effects are constipation and upset stomach. Treatment should begin as soon as possible after exposure to radioactive cesium or thallium. When the sources of radiation contamination are multiple or unknown, other drugs (such as potassium iodide) can be used together with Radiogardase.

The NDA for Radiogardase was sent to the agency in response to FDA’s announcement in January, 2003, that Prussian blue is safe and effective, when produced under conditions specified in approved marketing applications, for the treatment of exposure to radioactive thallium, non-radioactive thallium, or radioactive cesium. The national stockpile of products for use in the event of an emergency includes stores of Prussian blue.

FDA has also determined that pentetate calcium trisodium (Ca-DTPA) and pentetate zinc trisodium (Zn-DTPA) are safe and effective, when produced under conditions specified in approved marketing applications, for treatment of contamination with radioactive isotopes of the elements plutonium, americium and curium. FDA has encouraged manufacturers to use these findings to submit marketing applications for these drug products to use as medical countermeasures.

More information about FDA’s efforts to counteract bioterrorism is available on FDA’s website at www.fda.gov/oc/opacom/hottopics/bioterrorism.html.

Radiogardase is manufactured by HEYL Chemisch-pharmazeutische Fabrik GmbH & Co. KG. of Berlin, Germany.

Surgery for Spina Bifida Shows Success (October 01, 2003) 

(Ivanhoe Newswire)

New research shows a surgery performed on unborn fetuses may reduce symptoms of the birth defect spina bifida.

Spina bifida is the most common birth defect of the central nervous system and affects about one in 2,000 births. It occurs when the bone and tissue covering of the fetus’ spinal cord opens. Children with the birth defect may suffer leg paralysis, lack of bowel and bladder control, and fluid pressure on the brain.

Researchers from the Children’s Hospital of Philadelphia studied the outcomes of 50 fetal surgeries performed between 1998 and 2002. The average age of the fetuses undergoing surgery was 23 weeks. Three of the fetuses died from complications following a premature delivery.

All of the remaining 47 fetuses had reversal of hindbrain herniation -- a dangerous neurological condition that occurs when a portion of the brain pokes through the skull and into the spinal column. Fifty-seven percent of infants showed better neurologic leg function than researchers predicted. Forty-three percent required shunts compared to 85 percent of infants who required shunts in another study that examined surgery after birth.

Surgery is typically performed on newborns with open spina bifida lesions and requires closing tissue over the defect to protect the spinal tissue. However, some studies have shown neurological damage may occur before or during birth. Thus, researchers say performing the surgery before birth may be a more effective solution.

Authors of the study say more research is needed to confirm their results and further evaluate leg function, bladder and bowel functions, and neurological development in later childhood. They also say the potential benefits of fetal surgery need to be weighed against the risk of pre-term delivery and surgical risks for mothers.

SOURCE: American Journal of Obstetrics and Gynecology, 2003;189:482-487

New Diabetes Drug Next Big Step (October 01, 2003) 

By Stacie Overton, Ivanhoe Health Correspondent
(Ivanhoe Newswire)

A new drug under review by the FDA could be one of the most significant advances in diabetes since the discovery of insulin more than 80 years ago, say doctors involved in the research.

Diabetes is a disease in which the hormone insulin is not made by the body (type 1 diabetes) or the body does not effectively use the insulin it does produce (type 2 diabetes). Researchers from Amylin Pharmaceuticals, Inc., are studying another hormone -- amylin -- to aid in the treatment of diabetes. Amylin is a hormone secreted with insulin by the beta cells in the pancreas. The drug, called SYMLIN, is a man-made version of amylin. Specifically, the drug would be for diabetics -- type 1 or type 2 -- who take insulin injections.

Orville Kolterman, M.D., Senior Vice President of Clinical Affairs at Amylin Pharmaceuticals, Inc., in San Diego, says insulin does not totally suppress the glucagon that the body secretes. Often, diabetics notice that their blood sugar levels tend to be higher after a meal -- even when they take insulin to cover the amount of food eaten. Insulin stimulates the removal of glucose in the blood, but Dr. Kolterman says, “What’s happening is you’re making excess glucagon following a meal.” The hormone amylin works to control the output of that glucagon. Dr. Kolterman tells Ivanhoe taking insulin without also replacing the hormone amylin is like driving a car with only the accelerator and no brakes. He says, “What we’re doing is, by taking [amylin] before a meal, we’re putting brake fuel back in the brake system.”

Studies show, after six months, amylin causes a significant reduction in hbA1c levels. These levels reflect a patient’s average blood sugar level over the last three months. The drug currently cannot be mixed with insulin, so patients would need to take additional injections. Dr. Kolterman has not found that to be a problem among most of the patients in the studies.

Dr. Kolterman says the FDA sent an approvable letter for the drug in October 2001 but thought more studies needed to be done. After five additional studies were conducted, the research was submitted again to the FDA in June 2003. The final decision on this drug, which will be marketed as SYMLIN, is expected no later than December 2003. When asked what he expects to happen, Dr. Kolterman says, “I’m optimistic.”

SOURCE: Ivanhoe interview with Orville Kolterman, M.D., Senior Vice President of Clinical Affairs at Amylin Pharmaceuticals, Inc. in San Diego, 2003

No More Binging! (October 01, 2003) 

GAINESVILLE, Fla. (Ivanhoe Newswire)

Binge-eating is a condition where a person eats uncontrollably. It affects up to 4 percent of all Americans. Binge-eaters binge -- on average -- at least two days per week for at least six months. There are no FDA approved treatments for binge-eating, but now one drug helps binge-eaters limit uncontrolled eating.

Emily Wollman has been dieting most of her life, but avoiding food often did more harm than good. "I would go and get anything that I had been deprived of," Wollman tells Ivanhoe. She would eat up to three pints of ice cream and a half box of cookies during a binge. She says it deflected issues she didn't want to deal with. "Food becomes like the BAND-AID you put on your emotional wounds."

Psychiatrist Nathan Shapira, M.D., Ph.D., of the University of Florida in Gainesville, says binge-eating is a common outlet for emotions. Now, he's trying to stop the binging with the anticonvulsant drug topiramate or topamax. "One of the mechanisms of this compound may have a direct effect on, say, the satiety center or the appetite disregulation," he says.

Earlier studies in epilepsy patients show the drug lessened appetites. "About 80 percent of them had completely stopped binge-eating on topiramate, versus about a quarter on placebo. People would typically go from binge-eating five times a week, down to one or less a week."

For some, that was a surprise.

"They described that they used to be able to eat a Big Mac and fries, and now all they could eat was a Happy Meal, and it was very disturbing to them," Dr. Shapira says.

For Wollman, coming to peace with herself and her body helped defeat her binging. She says, "I've gotten to the point where I can even -- when I'm really connected to myself -- like, cook a bowl full of spaghetti and, to the strand, know how much to put on the plate."

But, for those who need an extra push, help is on the way.

About 20 sites across the country are beginning trials to further test topiramate for binge-eating disorders that are associated with obesity. Researchers are hoping to enroll 360 patients. Topiramate is FDA approved for epilepsy.

If you would like more information, please contact:

Nikki Ricciuti, R.N., LMHC
University of Florida
Gainesville, FL
(352) 265-0162

Researchers Prescribe Exercise for Healthy Knees (October 01, 2003) 

(Ivanhoe Newswire)

Researchers say there’s an easy way to help your kids avoid knee problems as they get older.

Simply put, Australian researchers say turn off the television, shut down the video games, and send them outside to play. Researchers reviewed numerous studies on knee osteoarthritis that link lack of physical activity in children with knee osteoarthritis in adulthood.

According to the studies, exercise is a key component in the building of cartilage in the knee. One report, for example, noted up to 25 percent less cartilage among children who had been physically inactive for just two weeks, when compared with other children who had maintained only mild levels of activity. Investigators in another study found high activity levels increased knee cartilage by as much as 15 percent per year in boys and 10 percent per year in girls. Children who participated in more vigorous activity also appeared to gain more cartilage. Kids taking part in sports requiring higher activity levels gained about twice as much cartilage as those who participated in sports requiring less activity. Studies conducted in animals indicate withholding exercise in early life leads to abnormal cartilage development.

The investigators say more study is needed to pin down exercise’s role in the development of cartilage during childhood, but believe the findings so far point to its benefits. They write, “The current evidence supports a prescription of vigorous physical activity for optimum joint development in children.”
 

SOURCE: British Journal of Sports Medicine, 2003;37:382-383