Johns Hopkins Medicine engineers announce plastic, air- and light-driven device more precise than human hand
Engineers at the Johns Hopkins Urology Robotics Lab report the invention of a motor without metal or electricity that can safely power remote-controlled robotic medical devices used for cancer biopsies and therapies guided by magnetic resonance imaging. The motor that drives the devices can be so precisely controlled by computer that movements are steadier and more precise than a human hand.
"Lots of biopsies on organs such as the prostate are currently performed blind because the tumors are typically invisible to the imaging tools commonly used," says Dan Stoianovici, Ph.D., an associate professor of urology at Johns Hopkins and director of the robotics lab. "Our new MRI-safe motor and robot can target the tumors. This should increase accuracy in locating and collecting tissue samples, reduce diagnostic errors and also improve therapy."
A description of the new motor, made entirely out of plastics, ceramics and rubber, and driven by light and air, was published in the February issue of the IEEE/ASME Transactions on Mechanotronics.
The challenge for his engineering team was to overcome MRI’s dependence on strong magnetic interference. Metals are unsafe in MRIs because the machine relies on a strong magnet, and electric currents distort MR images, says Stoianovici. The team used six of the motors to power the first-ever MRI-compatible robot to access the prostate gland. The robot currently is undergoing preclinical testing.
"Prostate cancer is tricky because it only can be seen under MRI, and in early stages it can be quite small and easy to miss," says Stoianovici.
Friday, April 06, 2007
Tai Chi boosts immunity to shingles virus in older adults, NIH-sponsored study reports
Tai Chi, a traditional Chinese form of exercise, may help older adults avoid getting shingles by increasing immunity to varicella-zoster virus (VZV) and boosting the immune response to varicella vaccine in older adults, according to a new study publishsed in print this week in the Journal of the American Geriatrics Society. This National Institutes of Health (NIH)-funded study is the first rigorous clinical trial to suggest that a behavioral intervention, alone or in combination with a vaccine, can help protect older adults from VZV, which causes both chickenpox and shingles.
The research was supported by the National Institute on Aging (NIA) and the National Center for Complementary and Alternative Medicine (NCCAM), both components of NIH. The study's print publication follows its online release in March. The research was conducted by Michael R. Irwin, M.D., and Richard Olmstead, Ph.D., of the University of California at Los Angeles, and Michael N. Oxman, M.D., of the University of California at San Diego and San Diego Veterans Affairs Healthcare System.
"One in five people who have had chickenpox will get shingles later in life, usually after age 50, and the risk increases as people get older," says NIA Director Richard J. Hodes, M.D. "More research is needed, but this study suggests that the Tai Chi intervention tested, in combination with immunization, may enhance protection of older adults from this painful condition."
"Dr. Irwin's research team has demonstrated that a centuries-old behavioral intervention, Tai Chi, resulted in a level of immune response similar to that of a modern biological intervention, the varicella vaccine, and that Tai Chi boosted the positive effects of the vaccine," says Andrew Monjan, Ph.D., chief of the NIA's Neurobiology of Aging Branch.
The randomized, controlled clinical trial included 112 healthy adults ages 59 to 86 (average age of 70). Each person took part in a 16-week program of either Tai Chi or a health education program that provided 120 minutes of instruction weekly. Tai Chi combines aerobic activity, relaxation and meditation, which the researchers note have been reported to boost immune responses. The health education intervention involved classes about a variety of health-related topics.
After the 16-week Tai Chi and health education programs, with periodic blood tests to determine levels of VZV immunity, people in both groups received a single injection of VARIVAX, the chickenpox vaccine that was approved for use in the United States in 1995. Nine weeks later, the investigators did blood tests to assess each participant's level of VZV immunity, comparing it to immunity at the start of the study. All of the participants had had chickenpox earlier in life and so were already immune to that disease.
The research was supported by the National Institute on Aging (NIA) and the National Center for Complementary and Alternative Medicine (NCCAM), both components of NIH. The study's print publication follows its online release in March. The research was conducted by Michael R. Irwin, M.D., and Richard Olmstead, Ph.D., of the University of California at Los Angeles, and Michael N. Oxman, M.D., of the University of California at San Diego and San Diego Veterans Affairs Healthcare System.
"One in five people who have had chickenpox will get shingles later in life, usually after age 50, and the risk increases as people get older," says NIA Director Richard J. Hodes, M.D. "More research is needed, but this study suggests that the Tai Chi intervention tested, in combination with immunization, may enhance protection of older adults from this painful condition."
"Dr. Irwin's research team has demonstrated that a centuries-old behavioral intervention, Tai Chi, resulted in a level of immune response similar to that of a modern biological intervention, the varicella vaccine, and that Tai Chi boosted the positive effects of the vaccine," says Andrew Monjan, Ph.D., chief of the NIA's Neurobiology of Aging Branch.
The randomized, controlled clinical trial included 112 healthy adults ages 59 to 86 (average age of 70). Each person took part in a 16-week program of either Tai Chi or a health education program that provided 120 minutes of instruction weekly. Tai Chi combines aerobic activity, relaxation and meditation, which the researchers note have been reported to boost immune responses. The health education intervention involved classes about a variety of health-related topics.
After the 16-week Tai Chi and health education programs, with periodic blood tests to determine levels of VZV immunity, people in both groups received a single injection of VARIVAX, the chickenpox vaccine that was approved for use in the United States in 1995. Nine weeks later, the investigators did blood tests to assess each participant's level of VZV immunity, comparing it to immunity at the start of the study. All of the participants had had chickenpox earlier in life and so were already immune to that disease.
New Study May Help Doctors Select Prostate Cancer Treatments
Allison Gandey
April 6, 2007 — The work comparing interstitial brachytherapy and radical prostatectomy for low-risk localized prostate cancer shows that the 2 treatments share a similar cost profile, but have varying adverse effects and a different impact on quality of life. "Our study represents the first multi-institutional, prospective, and comparative study of health-related quality-of-life treatment-related symptoms, and costs in men treated by 1 of the 2 most commonly employed strategies for localized low-risk prostate cancer treatment," report lead author Catherine Buron, PhD, from the Institut Curie in Paris, France, and her team. The work appears in a recent issue of the International Journal of Radiation Oncology, Biology, Physics.
There are currently no published trials directly comparing long-term survival after treatment, leaving the question of survival benefit unanswered. However, studies have reported biochemical relapse-free survival rates that are similar up to 10 years after treatment for localized low-risk patients. Therapy with high-intensity focused ultrasound and active monitoring is being explored in other studies but, the researchers note, no long-term follow-up data are available so far.
In the current analysis, investigators studied 435 men with low-risk prostate cancer from 11 French hospitals. Patients treated with interstitial brachytherapy or radical prostatectomy were invited to complete the European Organization for Research and Treatment of Cancer core quality-of-life questionnaire and a similar prostate-cancer-specific workup. Patients completed the forms before and at the end of therapy and at 2, 6, 12, 18, and 24 months after treatment.
A major finding of the study was that mean societal costs did not differ significantly between the 2 treatments — either in the short- or long-term. "Although these costs appear to be similar, their structure differed between radical prostatectomy and interstitial brachytherapy," the researchers point out. "Mean initial treatment cost was higher in the interstitial brachytherapy than in the radical prostatectomy group, the main drivers being radioactive seed costs in the interstitial brachytherapy group and hospitalization costs in the radical prostatectomy group."
April 6, 2007 — The work comparing interstitial brachytherapy and radical prostatectomy for low-risk localized prostate cancer shows that the 2 treatments share a similar cost profile, but have varying adverse effects and a different impact on quality of life. "Our study represents the first multi-institutional, prospective, and comparative study of health-related quality-of-life treatment-related symptoms, and costs in men treated by 1 of the 2 most commonly employed strategies for localized low-risk prostate cancer treatment," report lead author Catherine Buron, PhD, from the Institut Curie in Paris, France, and her team. The work appears in a recent issue of the International Journal of Radiation Oncology, Biology, Physics.
There are currently no published trials directly comparing long-term survival after treatment, leaving the question of survival benefit unanswered. However, studies have reported biochemical relapse-free survival rates that are similar up to 10 years after treatment for localized low-risk patients. Therapy with high-intensity focused ultrasound and active monitoring is being explored in other studies but, the researchers note, no long-term follow-up data are available so far.
In the current analysis, investigators studied 435 men with low-risk prostate cancer from 11 French hospitals. Patients treated with interstitial brachytherapy or radical prostatectomy were invited to complete the European Organization for Research and Treatment of Cancer core quality-of-life questionnaire and a similar prostate-cancer-specific workup. Patients completed the forms before and at the end of therapy and at 2, 6, 12, 18, and 24 months after treatment.
A major finding of the study was that mean societal costs did not differ significantly between the 2 treatments — either in the short- or long-term. "Although these costs appear to be similar, their structure differed between radical prostatectomy and interstitial brachytherapy," the researchers point out. "Mean initial treatment cost was higher in the interstitial brachytherapy than in the radical prostatectomy group, the main drivers being radioactive seed costs in the interstitial brachytherapy group and hospitalization costs in the radical prostatectomy group."
Fitness gains last in breast cancer survivors
NEW YORK (Reuters Health) - In a recent study, women getting over breast cancer treatment who participated in an 8-week supervised aerobic and strength training program improved their physical fitness and quality of life. Now, a follow up study of the women indicates that some of the physical fitness gains last well beyond the training period.
This is an important finding, the researchers say, given that it is unrealistic to assume that women will continue with an exercise regimen similar to a supervised training program when they're on their own.
In the original 8-week study, Dr. Alejandro Lucia, of the Universidad Europea de Madrid, Spain and colleagues randomly assigned 16 breast cancer survivors to an aerobic and resistance training group or a 'control' group. The training group participated in three 90-minute sessions per week.
By the end of the study period, women in the exercise group, compared to the control group, showed improvements in quality of life, cardiorespiratory fitness, strength and muscle function, according to a report in the International Journal of Sports Medicine.
This is an important finding, the researchers say, given that it is unrealistic to assume that women will continue with an exercise regimen similar to a supervised training program when they're on their own.
In the original 8-week study, Dr. Alejandro Lucia, of the Universidad Europea de Madrid, Spain and colleagues randomly assigned 16 breast cancer survivors to an aerobic and resistance training group or a 'control' group. The training group participated in three 90-minute sessions per week.
By the end of the study period, women in the exercise group, compared to the control group, showed improvements in quality of life, cardiorespiratory fitness, strength and muscle function, according to a report in the International Journal of Sports Medicine.
Survival rate with melanoma has improved
NEW YORK (Reuters Health) - The overall survival of people diagnosed with melanoma, the most serious type of skin cancer, has improved over the past 25 years or so, German researchers report.
They note in their report in the medical journal Cancer that melanoma is quite curable if it's caught early; however, the improvement in survival they have observed may not be entirely due to early diagnosis.
Dr. Claus Garbe and colleagues from Eberhard-Karis-University in Tuebingen analyzed the survival of 4791 patients diagnosed with invasive melanoma in southern Germany between 1976 and 2001, in order to assess factors associated with better survival rates.
The proportion of patients who survived for 10 years, overall, was 88.6% among patients diagnosed in 1990-2001, significantly better than the 80.0% of those diagnosed in 1976-1989.
They note in their report in the medical journal Cancer that melanoma is quite curable if it's caught early; however, the improvement in survival they have observed may not be entirely due to early diagnosis.
Dr. Claus Garbe and colleagues from Eberhard-Karis-University in Tuebingen analyzed the survival of 4791 patients diagnosed with invasive melanoma in southern Germany between 1976 and 2001, in order to assess factors associated with better survival rates.
The proportion of patients who survived for 10 years, overall, was 88.6% among patients diagnosed in 1990-2001, significantly better than the 80.0% of those diagnosed in 1976-1989.
WEB 2.0
Web 2.0, a phrase coined by O'Reilly Media in 2004,[1] refers to a perceived second-generation of Web-based services—such as social networking sites, wikis, communication tools, and folksonomies—that emphasize online collaboration and sharing among users. O'Reilly Media used the phrase as a title for a series of conferences, and it has since become widely adopted.
Though the term suggests a new version of the Web, it does not refer to an update to Internet or World Wide Web technical standards, but to changes in the ways those standards are used. According to Tim O'Reilly, "Web 2.0 is the business revolution in the computer industry caused by the move to the internet as platform, and an attempt to understand the rules for success on that new platform."[2].
Some technology experts, notably Tim Berners-Lee, have questioned whether the term is meaningful, since many of the technology components of "Web 2.0" have been present since the creation of the World Wide Web.[3]
http://www.youtube.com/watch?v=6gmP4nk0EOE
Though the term suggests a new version of the Web, it does not refer to an update to Internet or World Wide Web technical standards, but to changes in the ways those standards are used. According to Tim O'Reilly, "Web 2.0 is the business revolution in the computer industry caused by the move to the internet as platform, and an attempt to understand the rules for success on that new platform."[2].
Some technology experts, notably Tim Berners-Lee, have questioned whether the term is meaningful, since many of the technology components of "Web 2.0" have been present since the creation of the World Wide Web.[3]
http://www.youtube.com/watch?v=6gmP4nk0EOE
COURAGE TRIAL
In this exclusive podcast interview with two Medpage Today reporters, cardiologists Steven Nissen, M.D., of the Cleveland Clinic and Gregory J. Dehmer, M.D., of the Scott and White Clinic in Temple, Tex., and Texas A&M College of Medicine discuss the clinical fallout of the results of the COURAGE trial.
http://www.medpagetoday.com/audio/5385/index.cfm
http://www.medpagetoday.com/audio/5385/index.cfm
Loneliness Increases Risk for AD-Like Dementia
Lonely elderly patients are more than twice as likely to develop Alzheimer's disease (AD)-like dementia than those who are not lonely, according to the results of a 4-year cohort study reported in the February issue of the Archives of General Psychiatry. However, pathology did not reveal Alzheimer's disease or cerebral infarction, suggesting that novel mechanisms may be involved.
"Social isolation in old age has been associated with risk of developing dementia, but the risk associated with perceived isolation, or loneliness, is not well understood," write Robert S. Wilson, PhD, of the Rush University Medical Center in Chicago, Illinois, and colleagues. "We examined these issues using data from the Rush Memory and Aging Project, a longitudinal clinicopathologic study of risk factors for chronic conditions of old age."
At baseline and annually thereafter for up to 4 years, 823 participants recruited from senior citizen facilities in and around Chicago, underwent uniform in-home evaluations including detailed cognitive function testing, clinical classification of dementia and AD, and assessment of loneliness with a modified version of the de Jong-Gierveld Loneliness Scale. For participants who died, uniform postmortem evaluation of the brain quantified AD pathologic abnormalities and cerebral infarction.
On the 5-item loneliness scale, mean baseline score was 2.3 ± 0.6. During follow-up, 76 subjects developed clinical AD, based on previously established composite measures of global cognition and specific cognitive functions.
"Social isolation in old age has been associated with risk of developing dementia, but the risk associated with perceived isolation, or loneliness, is not well understood," write Robert S. Wilson, PhD, of the Rush University Medical Center in Chicago, Illinois, and colleagues. "We examined these issues using data from the Rush Memory and Aging Project, a longitudinal clinicopathologic study of risk factors for chronic conditions of old age."
At baseline and annually thereafter for up to 4 years, 823 participants recruited from senior citizen facilities in and around Chicago, underwent uniform in-home evaluations including detailed cognitive function testing, clinical classification of dementia and AD, and assessment of loneliness with a modified version of the de Jong-Gierveld Loneliness Scale. For participants who died, uniform postmortem evaluation of the brain quantified AD pathologic abnormalities and cerebral infarction.
On the 5-item loneliness scale, mean baseline score was 2.3 ± 0.6. During follow-up, 76 subjects developed clinical AD, based on previously established composite measures of global cognition and specific cognitive functions.
Metabolic syndrome tied to cancer in black men
NEW YORK (Reuters Health) - Certain features of the metabolic syndrome are associated with an increased risk of developing prostate cancer in African-American men, according to a report in the journal Cancer.
Metabolic syndrome is a cluster of conditions that raise the risk of heart disease, including obesity, high blood sugar levels or overt diabetes, and high blood pressure, among others.
Dr. Jennifer L. Beebe-Dimmer and associates from the University of Michigan, Ann Arbor, used data from the Flint Men's Health Study to explore potential correlations between metabolic syndrome conditions and prostate cancer in African-American men.
Abdominal obesity, defined as having a waist greater than 40 inches, was 80 percent more common among African-American men with prostate cancer than among those without prostate cancer, the investigators report, and African-American men with high blood pressure or taking blood pressure medications were 2.4-times as likely to have prostate cancer as those who weren't.
Metabolic syndrome is a cluster of conditions that raise the risk of heart disease, including obesity, high blood sugar levels or overt diabetes, and high blood pressure, among others.
Dr. Jennifer L. Beebe-Dimmer and associates from the University of Michigan, Ann Arbor, used data from the Flint Men's Health Study to explore potential correlations between metabolic syndrome conditions and prostate cancer in African-American men.
Abdominal obesity, defined as having a waist greater than 40 inches, was 80 percent more common among African-American men with prostate cancer than among those without prostate cancer, the investigators report, and African-American men with high blood pressure or taking blood pressure medications were 2.4-times as likely to have prostate cancer as those who weren't.
Hot flashes linked to high blood pressure
NEW YORK (Reuters Health) - While past research has shown a link between menopause and high blood pressure, a new study suggests there is a relationship between hot flashes and high blood pressure, independent of menopausal status.
In the study, reported in the journal Menopause, ambulatory blood pressure monitors worn for 24 hours recorded awake and sleep blood pressure of 154 women, ranging in age from 18 to 65 years (with an average age of 46), no previous cardiovascular disease and either mildly elevated or normal blood pressure.
One third of the women reported having hot flashes within the past 2 weeks, note Dr. Linda Gerber of Weill Medical College of Cornell University, New York, and colleagues.
The average values for systolic blood pressure (the top number of the blood pressure reading), while awake and asleep were significantly higher in the women who had experienced hot flashes compared with women who did not.
In women with hot flashes, average systolic awake and sleep blood pressure was 141 and 129 mm Hg, respectively - this compared with 132 and 119 mm Hg, respectively, for women not reporting hot flashes.
Hot flashes continued to predict higher systolic awake and sleep systolic blood pressure after controlling for race, ethnicity, body mass index and "even after adjusting for whether they were premenopausal, menopausal, or postmenopausal," Gerber said in a statement.
In the study, reported in the journal Menopause, ambulatory blood pressure monitors worn for 24 hours recorded awake and sleep blood pressure of 154 women, ranging in age from 18 to 65 years (with an average age of 46), no previous cardiovascular disease and either mildly elevated or normal blood pressure.
One third of the women reported having hot flashes within the past 2 weeks, note Dr. Linda Gerber of Weill Medical College of Cornell University, New York, and colleagues.
The average values for systolic blood pressure (the top number of the blood pressure reading), while awake and asleep were significantly higher in the women who had experienced hot flashes compared with women who did not.
In women with hot flashes, average systolic awake and sleep blood pressure was 141 and 129 mm Hg, respectively - this compared with 132 and 119 mm Hg, respectively, for women not reporting hot flashes.
Hot flashes continued to predict higher systolic awake and sleep systolic blood pressure after controlling for race, ethnicity, body mass index and "even after adjusting for whether they were premenopausal, menopausal, or postmenopausal," Gerber said in a statement.
Treatment may fuel cancer's spread, study finds
Thu Apr 5, 2007 10:15PM EDT
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - Treating cancer with surgery, chemotherapy or radiation may sometimes cause tumors to spread and U.S. researchers said on Thursday they may have nailed down one of the causes -- a compound called TGF-beta.
Tests in mice show that using the chemotherapy drug doxorubicin or radiation both raised levels of TGF-beta, which in turn helped breast cancer tumors spread to the lung.
But using an antibody to block TGF-beta stopped the process, Dr. Carlos Arteaga and colleagues at Vanderbilt University in Tennessee reported.
Developing drugs that block TGF-beta might help prevent cancer from recurring, Arteaga's team reports in the May issue of the Journal of Clinical Investigation.
"The repopulation and progression of tumors after anti-cancer therapy is a well-recognized phenomenon," the researchers wrote. "It has been shown to occur following radiotherapy, chemotherapy, and surgery."
Cancer experts have wondered if the so-called primary tumor -- the first and biggest tumor -- might somehow suppress the growth of other tumors, and that removing or destroying the first tumor might allow other, undetectable, tumors to then grow.
TGF-beta, which is involved in both the growth and suppression of tumors, may hold part of the answer, Arteaga's team said.
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - Treating cancer with surgery, chemotherapy or radiation may sometimes cause tumors to spread and U.S. researchers said on Thursday they may have nailed down one of the causes -- a compound called TGF-beta.
Tests in mice show that using the chemotherapy drug doxorubicin or radiation both raised levels of TGF-beta, which in turn helped breast cancer tumors spread to the lung.
But using an antibody to block TGF-beta stopped the process, Dr. Carlos Arteaga and colleagues at Vanderbilt University in Tennessee reported.
Developing drugs that block TGF-beta might help prevent cancer from recurring, Arteaga's team reports in the May issue of the Journal of Clinical Investigation.
"The repopulation and progression of tumors after anti-cancer therapy is a well-recognized phenomenon," the researchers wrote. "It has been shown to occur following radiotherapy, chemotherapy, and surgery."
Cancer experts have wondered if the so-called primary tumor -- the first and biggest tumor -- might somehow suppress the growth of other tumors, and that removing or destroying the first tumor might allow other, undetectable, tumors to then grow.
TGF-beta, which is involved in both the growth and suppression of tumors, may hold part of the answer, Arteaga's team said.
Weight-Lifting During Maintenance Dialysis Counteracts Muscle Wasting
Weight-lifting during dialysis counteracts muscle wasting in end-stage renal disease (ESRD), according to the results of a randomized controlled trial reported in the April issue of the Journal of the American Society of Nephrology. "Skeletal muscle wasting is common and insidious in patients who receive maintenance hemodialysis treatment for the management of ESRD," write Bobby Cheema, from the School of Exercise and Sport Science, University of New South Wales in Sydney, Australia, and colleagues. "The objective of this study was to determine whether 12 [weeks] of high-intensity, progressive resistance training (PRT) administered during routine hemodialysis treatment could improve skeletal muscle quantity and quality versus usual care."At the outpatient hemodialysis unit of the St. George Public Hospital in Sydney, 49 dialysis patients were recruited and randomized to PRT + usual care (n = 24) or usual care only (n = 25). Mean age was 62.6 ± 14.2 years; mean duration of dialyis treatment was 0.3 to 16.7 years. During routine hemodialysis treatment, the PRT group performed 2 sets of 10 exercises at a high intensity (15 to 17 out of 20 on the Borg Scale) using free weights, 3 times per week for 12 weeks
Noninvasive Scoring System for Liver Fibrosis May Reduce Need for Liver Biopsy
A noninvasive scoring system may help distinguish patients with nonalcoholic fatty liver disease with advanced fibrosis from those without advanced fibrosis, thereby reducing the need for liver biopsy, according to the results of a study reported in the April 2 issue of Hepatology.
"Patients with nonalcoholic fatty liver disease (NAFLD) and advanced liver fibrosis are at the highest risk for progressing to end-stage liver disease," write Paul Angulo, MD, from the Mayo Clinic College of Medicine in Rochester, Minnesota, and colleagues. "In the absence of decompensated cirrhosis, liver biopsy remains the only reliable means to determine prognosis based on the severity of fibrosis. However, liver biopsy is an expensive and invasive procedure associated with a number of complications and prone to sampling error."
The investigators constructed and validated a scoring system using routinely measured and readily available clinical and laboratory data to separate NAFLD patients with and without advanced fibrosis.
"Patients with nonalcoholic fatty liver disease (NAFLD) and advanced liver fibrosis are at the highest risk for progressing to end-stage liver disease," write Paul Angulo, MD, from the Mayo Clinic College of Medicine in Rochester, Minnesota, and colleagues. "In the absence of decompensated cirrhosis, liver biopsy remains the only reliable means to determine prognosis based on the severity of fibrosis. However, liver biopsy is an expensive and invasive procedure associated with a number of complications and prone to sampling error."
The investigators constructed and validated a scoring system using routinely measured and readily available clinical and laboratory data to separate NAFLD patients with and without advanced fibrosis.
US Dietary Guidelines Effectively Limit Insulin Resistance in Women
A study found that a diet following the 2005 Dietary Guidelines for Americans (DGA) may be effective to limit insulin resistance in women, but the benefits did not occur in men, according to the results of a study from the Framingham Offspring Cohort reported in the April issue of Diabetes Care.
"No study to date has examined the relation between adherence to the 2005 DGA and CVD [cardiovascular disease] risk or intermediate markers of risk," write Jeanene J. Fogli-Cawley, MS, RD, from the Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University in Boston, Massachusetts, and colleagues. "We developed the 2005 Dietary Guidelines for Americans Adherence Index (DGAI) to determine whether a diet consistent with the 2005 DGA was associated with a lower risk of chronic disease. This study assessed the relationship between adherence to the 2005 DGA and insulin resistance, as measured by HOMA-IR [homeostasis model assessment of insulin resistance], and fasting insulin in the Framingham Offspring Cohort."
"No study to date has examined the relation between adherence to the 2005 DGA and CVD [cardiovascular disease] risk or intermediate markers of risk," write Jeanene J. Fogli-Cawley, MS, RD, from the Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University in Boston, Massachusetts, and colleagues. "We developed the 2005 Dietary Guidelines for Americans Adherence Index (DGAI) to determine whether a diet consistent with the 2005 DGA was associated with a lower risk of chronic disease. This study assessed the relationship between adherence to the 2005 DGA and insulin resistance, as measured by HOMA-IR [homeostasis model assessment of insulin resistance], and fasting insulin in the Framingham Offspring Cohort."
Thursday, April 05, 2007
Low testosterone common in type 2 diabetic men
NEW YORK (Reuters Health) - Men with type 2 diabetes, particularly those who are obese, often have low levels of testosterone, making them susceptible to sexual dysfunction, research indicates.
The study, which screened 355 type 2 diabetic men over the age of 30, found that 17 percent had obvious low testosterone or "hypogonadism." A further 25 percent of men had borderline low testosterone levels.
Obesity was a "significant predictor" of low testosterone levels.
"This study has demonstrated that there is a high prevalence of symptomatic hypogonadism in men with type 2 diabetes," write Dr. Dheeraj Kapoor from Barnsley Hospital NHS Foundation Trust and UK-based colleagues in the journal Diabetes Care.
The study, which screened 355 type 2 diabetic men over the age of 30, found that 17 percent had obvious low testosterone or "hypogonadism." A further 25 percent of men had borderline low testosterone levels.
Obesity was a "significant predictor" of low testosterone levels.
"This study has demonstrated that there is a high prevalence of symptomatic hypogonadism in men with type 2 diabetes," write Dr. Dheeraj Kapoor from Barnsley Hospital NHS Foundation Trust and UK-based colleagues in the journal Diabetes Care.
Drug Cuts 'Off' Time for Parkinson's Patients
1 hour, 55 minutes ago
THURSDAY, April 5 (HealthDay News) -- Taking 24-hour prolonged release ropinirole significantly reduced daily "off" time that Parkinson's disease patients experience due to the return of symptoms such as tremors, slowness, stiffness and difficulty walking as drugs wear off, a U.S. study says.
The study, published in the April 3 issue of the journal Neurology, included 393 Parkinson's patients who weren't fully responding to the widely-used Parkinson's drug levodopa. Half the patients took 24-hour prolonged release ropinirole and levodopa for six months, while the other half took a placebo and levodopa. None of the patients' other Parkinson medications were changed during the study.
The average daily "off" time in the ropinirole group was reduced 2.1 hours, compared to 0.3 hours in the placebo group. The study also found that more than half the patients in the ropinirole group were "much improved" or "very much improved," compared to 14 percent of patients in the placebo group. In addition, patients taking ropinirole were able to reduce their dosage of levodopa.
The study was supported by GlaxoSmithKline and Skye Pharma, makers of prolonged release ropinirole.
Involuntary movements, nausea, dizziness, drowsiness, hallucinations, and sudden drops in blood pressure were common side effects among patients taking prolonged release ropinirole.
"Ropinirole 24-hour prolonged release, when taken with levodopa, is effective in reducing daily 'off' time for Parkinson patients who aren't getting the best results from levodopa. We also found the drug helped improve quality of life and motor function," study author Dr. Rajesh Pahwa, of the University of Kansas Medical Center, said in a prepared statement.
THURSDAY, April 5 (HealthDay News) -- Taking 24-hour prolonged release ropinirole significantly reduced daily "off" time that Parkinson's disease patients experience due to the return of symptoms such as tremors, slowness, stiffness and difficulty walking as drugs wear off, a U.S. study says.
The study, published in the April 3 issue of the journal Neurology, included 393 Parkinson's patients who weren't fully responding to the widely-used Parkinson's drug levodopa. Half the patients took 24-hour prolonged release ropinirole and levodopa for six months, while the other half took a placebo and levodopa. None of the patients' other Parkinson medications were changed during the study.
The average daily "off" time in the ropinirole group was reduced 2.1 hours, compared to 0.3 hours in the placebo group. The study also found that more than half the patients in the ropinirole group were "much improved" or "very much improved," compared to 14 percent of patients in the placebo group. In addition, patients taking ropinirole were able to reduce their dosage of levodopa.
The study was supported by GlaxoSmithKline and Skye Pharma, makers of prolonged release ropinirole.
Involuntary movements, nausea, dizziness, drowsiness, hallucinations, and sudden drops in blood pressure were common side effects among patients taking prolonged release ropinirole.
"Ropinirole 24-hour prolonged release, when taken with levodopa, is effective in reducing daily 'off' time for Parkinson patients who aren't getting the best results from levodopa. We also found the drug helped improve quality of life and motor function," study author Dr. Rajesh Pahwa, of the University of Kansas Medical Center, said in a prepared statement.
New studies link the environment to Parkinson's disease
Research will open new possibilities for intervention and prevention
Sunnyvale, CA – April 5, 2007 – The Parkinson's Institute today announced that new findings concerning the role of environmental factors in the development of Parkinson's disease will be reported at Asilomar (Pacific Grove, CA) as part of the final meeting of the Collaborative Centers for Parkinson's Disease Environmental Research (CCPDER). This collaborative research effort, sponsored by the National Institute of Environmental Health Sciences (NIEHS), brings together investigators from Emory University, the University of California Los Angeles and The Parkinson's Institute, which has served as the coordinating center for the study.
Highlights of the research include:
The role of pesticides (eg. Paraquat and Dieldrin) as potential risk factors for Parkinson's disease, a role suggested by both epidemiological statistics and laboratory evidence.
The threat of toxic agents to damage neurons by causing the accumulation of harmful proteins.
Intraneuronal protein aggregates as markers of Parkinson's pathology, based on work carried out at The Parkinson's Institute indicating that these aggregates could be formed as a consequence of toxic exposure.
The importance of targeting a specific protein, alpha-synuclein, in order to achieve neuroprotection in Parkinson's
The role of inflammation in the development of Parkinson's disease and the possibility that anti-inflammatory drugs could be beneficial to patients.
The possibility that nicotine may act as a neuroprotective agent.
Sunnyvale, CA – April 5, 2007 – The Parkinson's Institute today announced that new findings concerning the role of environmental factors in the development of Parkinson's disease will be reported at Asilomar (Pacific Grove, CA) as part of the final meeting of the Collaborative Centers for Parkinson's Disease Environmental Research (CCPDER). This collaborative research effort, sponsored by the National Institute of Environmental Health Sciences (NIEHS), brings together investigators from Emory University, the University of California Los Angeles and The Parkinson's Institute, which has served as the coordinating center for the study.
Highlights of the research include:
The role of pesticides (eg. Paraquat and Dieldrin) as potential risk factors for Parkinson's disease, a role suggested by both epidemiological statistics and laboratory evidence.
The threat of toxic agents to damage neurons by causing the accumulation of harmful proteins.
Intraneuronal protein aggregates as markers of Parkinson's pathology, based on work carried out at The Parkinson's Institute indicating that these aggregates could be formed as a consequence of toxic exposure.
The importance of targeting a specific protein, alpha-synuclein, in order to achieve neuroprotection in Parkinson's
The role of inflammation in the development of Parkinson's disease and the possibility that anti-inflammatory drugs could be beneficial to patients.
The possibility that nicotine may act as a neuroprotective agent.
Plays promote prevention of drug abuse
A new study finds that theatrical drama is an educational tool in the fight against drug addiction and abuse. Research published today in Substance Abuse Treatment, Prevention and Policy, shows that after watching the play Tunnels – a series of six vignettes depicting the effects of alcohol and drug abuse – over half of the audience left the theatre wanting to get involved directly in drug and alcohol prevention in their homes and communities.
Tunnels was inspired by 'life stories' developed by counsellors and researchers working in the substance abuse field and by Howard Craft, the local playwright who authored the play. The production was performed six times under the direction of Karen Dacons-Brock at North Carolina Central University (NCCU). The NCCU research team, led by Allyn Howlett and graduate student Aileen Stephens-Hernandez, asked the Durham, NC audience to fill out a 22-question survey as they entered the theatre lobby, together with a further post-performance survey. A follow-up telephone survey was then carried out three months after the play was shown, to assess people's participation in preventing drug abuse.
Tunnels was inspired by 'life stories' developed by counsellors and researchers working in the substance abuse field and by Howard Craft, the local playwright who authored the play. The production was performed six times under the direction of Karen Dacons-Brock at North Carolina Central University (NCCU). The NCCU research team, led by Allyn Howlett and graduate student Aileen Stephens-Hernandez, asked the Durham, NC audience to fill out a 22-question survey as they entered the theatre lobby, together with a further post-performance survey. A follow-up telephone survey was then carried out three months after the play was shown, to assess people's participation in preventing drug abuse.
Study Questions Exam to Detect Breast Cancer
By GINA KOLATA
Published: April 5, 2007
A highly promoted and widely used computerized system for examining mammograms is leading to less accuracy, not more, a new study finds.
The system, known as computer-aided detection, or CAD, did not find more breast cancer, researchers are reporting today. But it did lead to many more false alarms that resulted in additional testing and biopsies for spots on mammograms that turned out to be harmless.
Such detection systems, approved by the Food and Drug Administration in 1998, are sold by several companies, including Hologic of Bedford, Mass.; iCAD of Nashua, N.H.; and Kodak. According to the National Cancer Institute, the systems are now being used in about 30 percent of mammography centers.
The equipment is expensive, costing $50,000 to $175,000, but Medicare, assuming it would improve the outcome, pays an extra $20 for each mammogram read with it. That made it profitable for large centers to use it. Doctors also worried about lawsuits if they were not using it and missed a cancer.
But all along, as more and more mammography centers bought the software, the assumption was that the computer would find cancers that radiologists would miss, saving women’s lives.
Published: April 5, 2007
A highly promoted and widely used computerized system for examining mammograms is leading to less accuracy, not more, a new study finds.
The system, known as computer-aided detection, or CAD, did not find more breast cancer, researchers are reporting today. But it did lead to many more false alarms that resulted in additional testing and biopsies for spots on mammograms that turned out to be harmless.
Such detection systems, approved by the Food and Drug Administration in 1998, are sold by several companies, including Hologic of Bedford, Mass.; iCAD of Nashua, N.H.; and Kodak. According to the National Cancer Institute, the systems are now being used in about 30 percent of mammography centers.
The equipment is expensive, costing $50,000 to $175,000, but Medicare, assuming it would improve the outcome, pays an extra $20 for each mammogram read with it. That made it profitable for large centers to use it. Doctors also worried about lawsuits if they were not using it and missed a cancer.
But all along, as more and more mammography centers bought the software, the assumption was that the computer would find cancers that radiologists would miss, saving women’s lives.
NEJM Reviews Prophylaxis for Thromboembolism in Hospitalized Medical Patients
A review in the current New England Journal of Medicine reminds clinicians that venous thromboembolism in hospitalized patients is common, but preventable.
Roughly a quarter of all cases of venous thromboembolism are associated with hospitalization and half to three-quarters of those cases occur on medical services. Thrombosis was asymptomatic in over 70%, "probably because most patients spent much of the day in bed."
The review lists risk factors and discusses both drug- and nondrug-based approaches to prophylaxis, and makes recommendations consistent with American College of Chest Physician guidelines.
Link: NEJM article (Subscription required)
Link: ACCP guidelines (Free)
Roughly a quarter of all cases of venous thromboembolism are associated with hospitalization and half to three-quarters of those cases occur on medical services. Thrombosis was asymptomatic in over 70%, "probably because most patients spent much of the day in bed."
The review lists risk factors and discusses both drug- and nondrug-based approaches to prophylaxis, and makes recommendations consistent with American College of Chest Physician guidelines.
Link: NEJM article (Subscription required)
Link: ACCP guidelines (Free)
Relation Between Timing of Starting Hormone Therapy and CVD Risk Unclear
A secondary subgroup analysis from the Women's Health Initiative offers no clear answer on the question of whether starting hormone therapy closer to menopause carries less cardiovascular risk than initiating therapy later.
The study, reported in JAMA, included data on some 27,000 WHI participants. It found that hormone use was associated with a nonsignificant reduction in risk for coronary heart disease among women who started therapy within 10 years of menopause, but with increases in CHD risk among women who started therapy 10 to 19 years, or 20 or more years after menopause. Hormone therapy was associated with elevated stroke risk in all three groups.
The data "suggest that the effect of hormones on CHD may be modified by years since menopause" the authors write, but this trend was not statistically significant. Still, they write, the findings "are consistent with current recommendations that hormone therapy be used in the short-term for relief of moderate or severe vasomotor symptoms, but not in the longer term for prevention of cardiovascular disease."
Link: JAMA article (Free abstract; full text requires subscription)
The study, reported in JAMA, included data on some 27,000 WHI participants. It found that hormone use was associated with a nonsignificant reduction in risk for coronary heart disease among women who started therapy within 10 years of menopause, but with increases in CHD risk among women who started therapy 10 to 19 years, or 20 or more years after menopause. Hormone therapy was associated with elevated stroke risk in all three groups.
The data "suggest that the effect of hormones on CHD may be modified by years since menopause" the authors write, but this trend was not statistically significant. Still, they write, the findings "are consistent with current recommendations that hormone therapy be used in the short-term for relief of moderate or severe vasomotor symptoms, but not in the longer term for prevention of cardiovascular disease."
Link: JAMA article (Free abstract; full text requires subscription)
Long-Term Estrogen Therapy Linked to Increased Breast Cancer Risk
May 9, 2006 — Long-term use of unopposed estrogen is associated with an increased risk for invasive breast cancer, especially for the development of estrogen receptor positive (ER+) and progesterone receptor positive (PR+) tumors, according to an analysis of data from the Nurses' Health Study.
Wendy Y. Chen, MD, MPH, with the Brigham and Women's Hospital and Harvard Medical School, in Boston, Mass, reported their findings in the May 8, 2006, issue of Archives of Internal Medicine.
A total of 28 835 women were included in the final follow-up period, including 11 508 postmenopausal women who had a hysterectomy and reported information on estrogen use at baseline in 1980. Data on estrogen use were collected through a questionnaire given every 2 years.
A total of 934 invasive breast cancers were diagnosed in the study population. Breast cancer risk increased with duration of unopposed estrogen use among longer-term users; the highest risk was seen for the development of ER+ and PR+ tumors.
Overall, the risk for invasive breast cancer increased with increasing duration of use (P for trend < .001). The respective risks for unopposed estrogen use of less than 5 years, 5 to 9.9 years, 10 to 14.9 years, 15 to 19.9 years, and 20 years or longer were 0.96 (95% confidence interval [CI], 0.75 - 1.22), 0.90 (95% CI, 0.73 - 1.12), 1.06 (95% CI, 0.87 - 1.30), 1.18 (95% CI, 0.95 - 1.48), and 1.42 (95% CI, 1.13 - 1.77).
For the development of ER+/PR+ breast cancers, the risk was noted to be significant after 15 years of use (relative risk, 1.48; 95% CI, 1.05 - 2.07).
"Among women who used unopposed estrogen therapy for less than 20 years, we did not observe a statistically significant increased risk of breast cancer overall. However, breast cancer risk was significantly elevated with longer durations of use, primarily for ER+/PR+ cancers," which is consistent with other study findings, the researchers conclude
Wendy Y. Chen, MD, MPH, with the Brigham and Women's Hospital and Harvard Medical School, in Boston, Mass, reported their findings in the May 8, 2006, issue of Archives of Internal Medicine.
A total of 28 835 women were included in the final follow-up period, including 11 508 postmenopausal women who had a hysterectomy and reported information on estrogen use at baseline in 1980. Data on estrogen use were collected through a questionnaire given every 2 years.
A total of 934 invasive breast cancers were diagnosed in the study population. Breast cancer risk increased with duration of unopposed estrogen use among longer-term users; the highest risk was seen for the development of ER+ and PR+ tumors.
Overall, the risk for invasive breast cancer increased with increasing duration of use (P for trend < .001). The respective risks for unopposed estrogen use of less than 5 years, 5 to 9.9 years, 10 to 14.9 years, 15 to 19.9 years, and 20 years or longer were 0.96 (95% confidence interval [CI], 0.75 - 1.22), 0.90 (95% CI, 0.73 - 1.12), 1.06 (95% CI, 0.87 - 1.30), 1.18 (95% CI, 0.95 - 1.48), and 1.42 (95% CI, 1.13 - 1.77).
For the development of ER+/PR+ breast cancers, the risk was noted to be significant after 15 years of use (relative risk, 1.48; 95% CI, 1.05 - 2.07).
"Among women who used unopposed estrogen therapy for less than 20 years, we did not observe a statistically significant increased risk of breast cancer overall. However, breast cancer risk was significantly elevated with longer durations of use, primarily for ER+/PR+ cancers," which is consistent with other study findings, the researchers conclude
100-Year-Olds' Secret: Stay Aware
The secret to a long life is to stay busy, get plenty of exercise and don’t drink too much. Then again, don’t drink too little.-- Hermann Smith-Johannson, 103-year-old cross-country skier, quoted in The New York Times, March 20, 1979.
April 3, 2007 -- The key to long life is a vivid interest in the world around you, a survey of 100-year-olds suggests.
That means people born when Teddy Roosevelt was president are watching music videos, ordering at Starbucks, and even listening to iPods, according to the poll from Evercare, a division of UnitedHealth Group focused on the health care needs of Americans aged 50 and older.
"We are finding older Americans are staying engaged and staying on top of what is going on in the world," Sherri Snelling, director of caregiving services at Evercare, tells WebMD.
Evercare's second annual telephone poll of 100 people aged 99 and older isn't a scientific study -- it's a snapshot of the attitudes of American 100-year-olds. Eighty-seven percent of survey respondents were white; 70% still lived at home; 95% were 100 or older; and 70% were women.
April 3, 2007 -- The key to long life is a vivid interest in the world around you, a survey of 100-year-olds suggests.
That means people born when Teddy Roosevelt was president are watching music videos, ordering at Starbucks, and even listening to iPods, according to the poll from Evercare, a division of UnitedHealth Group focused on the health care needs of Americans aged 50 and older.
"We are finding older Americans are staying engaged and staying on top of what is going on in the world," Sherri Snelling, director of caregiving services at Evercare, tells WebMD.
Evercare's second annual telephone poll of 100 people aged 99 and older isn't a scientific study -- it's a snapshot of the attitudes of American 100-year-olds. Eighty-seven percent of survey respondents were white; 70% still lived at home; 95% were 100 or older; and 70% were women.
Depressive Symptoms in Women Linked to Risk for Metabolic Syndrome
April 4, 2007 — Women with high levels of depressive symptoms have an increased risk of developing metabolic syndrome, according to the results of a prospective cohort study reported in the April issue of Diabetes Care.
"A large body of literature suggests that psychosocial attributes and stressful events predict incidence of CVD [cardiovascular disease] and type 2 diabetes," write Katri Räikkönen, PhD, from the University of Helsinki in Finland, and colleagues. "Despite the plausible roles of psychosocial factors, research devoted to testing whether they also predict the metabolic syndrome is scanty.... We evaluated whether psychosocial factors that are related to cardiovascular disease and type 2 diabetes predict prospectively the risk for the metabolic syndrome using the different clinical criteria available for defining the syndrome."
"A large body of literature suggests that psychosocial attributes and stressful events predict incidence of CVD [cardiovascular disease] and type 2 diabetes," write Katri Räikkönen, PhD, from the University of Helsinki in Finland, and colleagues. "Despite the plausible roles of psychosocial factors, research devoted to testing whether they also predict the metabolic syndrome is scanty.... We evaluated whether psychosocial factors that are related to cardiovascular disease and type 2 diabetes predict prospectively the risk for the metabolic syndrome using the different clinical criteria available for defining the syndrome."
Hormone Therapy Given Closer to Menopause Onset Is Safest
April 7, 2007 — There is new evidence that timing of initiation of hormone therapy (HT) may determine the extent of its cardiovascular effects, this time from a new analysis of the Women's Health Initiative (WHI) randomized controlled trials. The study suggests that coronary heart disease (CHD) risk associated with hormone therapy is not significantly increased in women who take hormone therapy within 10 years of the onset of menopause, and even showed a trend toward reduced CHD risk, but that this risk increases if women start taking hormone therapy after a longer gap. Risk for stroke, however was increased at any time point postmenopause.
Lead author Jacques E. Rossouw, MD, from the National Heart, Lung, and Blood Institute in Bethesda, Maryland, emphasized to heartwire that the findings should be viewed as "reassuring" for younger women with moderate to severe menopause symptoms who have worried about the risks of starting hormone therapy. The study should not, however, be viewed as supporting any role for hormone therapy to reduce cardiovascular events.
"This analysis should be appreciated mainly for the somewhat positive message for the short-term use of hormone therapy for menopausal symptoms," he said. "For those women who were afraid to use it before, there's some encouragement here that it might be a reasonable thing to do in the short term. But it doesn't change anything about our overall recommendations, that is, you don't use hormone therapy for the prevention of heart disease at any age."
Lead author Jacques E. Rossouw, MD, from the National Heart, Lung, and Blood Institute in Bethesda, Maryland, emphasized to heartwire that the findings should be viewed as "reassuring" for younger women with moderate to severe menopause symptoms who have worried about the risks of starting hormone therapy. The study should not, however, be viewed as supporting any role for hormone therapy to reduce cardiovascular events.
"This analysis should be appreciated mainly for the somewhat positive message for the short-term use of hormone therapy for menopausal symptoms," he said. "For those women who were afraid to use it before, there's some encouragement here that it might be a reasonable thing to do in the short term. But it doesn't change anything about our overall recommendations, that is, you don't use hormone therapy for the prevention of heart disease at any age."
Mixing Adjuvant Therapies Prolongs Early Breast Cancer Survival
SUTTON, England, April 4 -- Halting ovarian function by suppression or ablation offers little further benefit for most women already getting adjuvant tamoxifen with or without chemotherapy for early breast cancer, researchers here found.
The three adjuvant treatments had previously been shown to improve early breast cancer survival as monotherapies, but little long-term data had been available for combinations, said Judith Bliss, M.Sc., of the Institute of Cancer Research here, and colleagues.
So they conducted two large studies of combination adjuvant therapy for early breast cancer among women receiving five years of tamoxifen therapy. Both trials were started in the early 1990s before estrogen receptor status was routinely tested, Dr. Bliss and colleagues wrote in the April 4 Journal of the National Cancer Institute.
The three adjuvant treatments had previously been shown to improve early breast cancer survival as monotherapies, but little long-term data had been available for combinations, said Judith Bliss, M.Sc., of the Institute of Cancer Research here, and colleagues.
So they conducted two large studies of combination adjuvant therapy for early breast cancer among women receiving five years of tamoxifen therapy. Both trials were started in the early 1990s before estrogen receptor status was routinely tested, Dr. Bliss and colleagues wrote in the April 4 Journal of the National Cancer Institute.
Mild Brain Injury May Cause Chronic Sleep Trouble
And that could make rehab even tougher, researchers say
WEDNESDAY, April 4 (HealthDay News) -- People who suffer mild brain injuries may be at increased risk for sleep disorders, researchers say.
Reporting in the April 3 issue of Neurology, researchers at the University of California, San Diego, assessed 42 people who complained of insomnia after they'd had a mild traumatic brain injury. Of those 42 patients, 15 (36 percent) had a circadian rhythm sleep disorder (CRSD) -- a problem with the timing of sleep.
Of the 15 patients with CRSD, eight had a "delayed sleep phase syndrome," including problems falling asleep and waking up; and seven had irregular sleep patterns.
"The frequency of sleep disorders in this study is considerably higher than the rate of these disorders among people attending sleep clinics for insomnia, which is seven to 10 percent," study author Liat Ayalon said in a prepared statement.
The findings highlight the need for improved diagnosis and treatment of circadian rhythm sleep disorders in patients who've had a mild brain injury and complain of insomnia.
"Misdiagnosis of these patients as insomniac may lead to prescription of medications, which help people fall asleep but don't help normalize the sleep-wake cycle," Ayalon said.
WEDNESDAY, April 4 (HealthDay News) -- People who suffer mild brain injuries may be at increased risk for sleep disorders, researchers say.
Reporting in the April 3 issue of Neurology, researchers at the University of California, San Diego, assessed 42 people who complained of insomnia after they'd had a mild traumatic brain injury. Of those 42 patients, 15 (36 percent) had a circadian rhythm sleep disorder (CRSD) -- a problem with the timing of sleep.
Of the 15 patients with CRSD, eight had a "delayed sleep phase syndrome," including problems falling asleep and waking up; and seven had irregular sleep patterns.
"The frequency of sleep disorders in this study is considerably higher than the rate of these disorders among people attending sleep clinics for insomnia, which is seven to 10 percent," study author Liat Ayalon said in a prepared statement.
The findings highlight the need for improved diagnosis and treatment of circadian rhythm sleep disorders in patients who've had a mild brain injury and complain of insomnia.
"Misdiagnosis of these patients as insomniac may lead to prescription of medications, which help people fall asleep but don't help normalize the sleep-wake cycle," Ayalon said.
Ibuprofen may boost chance of heart problems in high risk patients with osteoarthritis
Cardiovascular outcomes in high risk patients with osteoarthritis treated with ibuprofen, naproxen or lumiracoxib
The common painkiller, ibuprofen, may boost the likelihood of heart problems in high risk patients who have osteoarthritis, suggests research published ahead of print in the Annals of the Rheumatic Diseases.
Previous studies have suggested that ibuprofen interferes with the effects of aspirin.
The research team compared the cardiovascular health over one year of more than 18,000 patients aged over 50 with osteoarthritis.
The patients were taking part in the Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET).
They were taking either high dose (400 mg a day) lumiracoxib, a type of drug known as a cyclo-oxygenase (COX-2) inhibitor, or ibuprofen (800 mg three times a day), or naproxen (500 mg twice daily), both of which are traditional non-steroidal anti-inflammatory drugs (NSAIDs).
The common painkiller, ibuprofen, may boost the likelihood of heart problems in high risk patients who have osteoarthritis, suggests research published ahead of print in the Annals of the Rheumatic Diseases.
Previous studies have suggested that ibuprofen interferes with the effects of aspirin.
The research team compared the cardiovascular health over one year of more than 18,000 patients aged over 50 with osteoarthritis.
The patients were taking part in the Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET).
They were taking either high dose (400 mg a day) lumiracoxib, a type of drug known as a cyclo-oxygenase (COX-2) inhibitor, or ibuprofen (800 mg three times a day), or naproxen (500 mg twice daily), both of which are traditional non-steroidal anti-inflammatory drugs (NSAIDs).
Wednesday, April 04, 2007
Dairy, fruits and veggies may help smokers quit
DURHAM, N.C. -- Milk does the body good -- and may help smokers break the habit, say researchers at Duke University Medical Center.
Smokers reported that consuming milk, water, fruits and vegetables worsened the taste of cigarettes, while consuming alcohol, coffee and meat enhanced their taste, according to the scientists.
The findings could lead to a "Quit Smoking Diet" or to development of a gum or lozenge that makes cigarettes less palatable, said lead study investigator Joseph McClernon, Ph.D., an assistant research professor of medical psychiatry at the Duke Center for Nicotine and Smoking Cessation Research.
"With a few modifications to their diet -- consuming items that make cigarettes taste bad, such as a cold glass of milk, and avoiding items that make cigarettes taste good, like a pint of beer -- smokers can make quitting a bit easier," McClernon said.
The findings appear in the April 2007 issue of the journal Nicotine and Tobacco Research. The research was funded by the National Institute on Drug Abuse.
Smokers reported that consuming milk, water, fruits and vegetables worsened the taste of cigarettes, while consuming alcohol, coffee and meat enhanced their taste, according to the scientists.
The findings could lead to a "Quit Smoking Diet" or to development of a gum or lozenge that makes cigarettes less palatable, said lead study investigator Joseph McClernon, Ph.D., an assistant research professor of medical psychiatry at the Duke Center for Nicotine and Smoking Cessation Research.
"With a few modifications to their diet -- consuming items that make cigarettes taste bad, such as a cold glass of milk, and avoiding items that make cigarettes taste good, like a pint of beer -- smokers can make quitting a bit easier," McClernon said.
The findings appear in the April 2007 issue of the journal Nicotine and Tobacco Research. The research was funded by the National Institute on Drug Abuse.
UC research shows rapid decline in geriatric medicine studies
CINCINNATI -- The older population may soon be facing a medical care crisis as numbers of students studying geriatric medicine continue to decrease rapidly, say researchers at the University of Cincinnati (UC).
It is estimated that by the year 2030, there will be more than 70 million people over the age of 65 in the United States.
According to the data collected over the last decade, the number of certified geriatricians in the United States has declined from 8,800 to 7,100.
"The population of doctors who are trained to deal with problems of aging people is dropping dramatically," said Elizabeth Bragg, PhD, of UC’s Institute for the Study of Health and co-investigator for the study, adding that trends in the data revealed that numbers will continue to decrease.
Results showed that from 1999 to 2006, the percentage of people entering family medicine or one of its subspecialties, including geriatrics, has dropped 6.3 percent.
Only 67 percent of positions in fellowship programs, needed for geriatric students to graduate, were filled during 2005–06.
The National Institute of Medicine is now using this data as it begins studying the health care workforce for older Americans and targeting the needs of the older population. The study is set to be completed in March 2008.
It is estimated that by the year 2030, there will be more than 70 million people over the age of 65 in the United States.
According to the data collected over the last decade, the number of certified geriatricians in the United States has declined from 8,800 to 7,100.
"The population of doctors who are trained to deal with problems of aging people is dropping dramatically," said Elizabeth Bragg, PhD, of UC’s Institute for the Study of Health and co-investigator for the study, adding that trends in the data revealed that numbers will continue to decrease.
Results showed that from 1999 to 2006, the percentage of people entering family medicine or one of its subspecialties, including geriatrics, has dropped 6.3 percent.
Only 67 percent of positions in fellowship programs, needed for geriatric students to graduate, were filled during 2005–06.
The National Institute of Medicine is now using this data as it begins studying the health care workforce for older Americans and targeting the needs of the older population. The study is set to be completed in March 2008.
One In Five People Will Face A 'shameful' Death - Could It Be You?
Most people are unprepared for the shameful reality of how they could die, warns the author of a new book charting the social history of dying. Although the majority of people imagine they will grow old and die in their sleep, surrounded by friends and family, one in five people will die what previous generations would consider a 'shameful' death - alone, ravaged by dementia and without dignity. The deaths of more than half of the population will be 'managed' by medical professionals following serious injury or ill-health, with a small proportion dying suddenly, and often unexpectedly. The rapid increase of the shameful death is being fuelled by an ageing population and a lack of foresight over how to deal with the ultimate consequences of the medical advances which keep people alive for longer. "Most people think only fleetingly about how they will die, and usually it surrounds some romantic notion of dying in our sleep at home," said Allan Kellehear, Professor of Sociology at the University of Bath and author of the new book A social history of dying (please note - this is NOT an academic text). "This notion couldn't be further from the truth; we are significantly more likely to die a lonely prolonged death in a nursing home or hospital, preceded by multiple organ failure, pneumonia or dementia.
Adding new diabetes drug may aid glycemic control
Wed Apr 4, 2007 7:28AM EDT
NEW YORK (Reuters Health) - The addition of exenatide (Byetta), the first in a new class of drugs called incretin mimetics, to a thiazolidinedione (TZD) in type 2 diabetes patients may improve control of blood sugar (glucose).
The addition of exenatide to thiazolidinediones (TZDs), drugs such as rosiglitazone or pioglitazone, that increase cell response to insulin, appears to results in better glucose control, researchers report in the Annals of Internal Medicine.
NEW YORK (Reuters Health) - The addition of exenatide (Byetta), the first in a new class of drugs called incretin mimetics, to a thiazolidinedione (TZD) in type 2 diabetes patients may improve control of blood sugar (glucose).
The addition of exenatide to thiazolidinediones (TZDs), drugs such as rosiglitazone or pioglitazone, that increase cell response to insulin, appears to results in better glucose control, researchers report in the Annals of Internal Medicine.
Secondhand Smoke Linked To Risk Of Tooth Loss
A study published in this month's issue of the Journal of Periodontology found that subjects with periodontitis who were exposed to secondhand smoke were more likely to develop bone loss, the number one cause of tooth loss.
Researchers studied rats that were induced with periodontal disease. One group was not exposed to cigarette smoke while the other two groups were exposed to either 30 days of smoke inhalation produced by non-light cigarettes (cigarettes containing higher tar, nicotine and carbon monoxide levels) or light cigarettes (cigarettes containing lower tar, nicotine and carbon monoxide levels).
Results showed that bone loss was greater in the subjects exposed to secondhand smoke regardless of if it was smoke from light or non-light cigarettes than those who were exposed to no smoke at all.
"Previous clinical research has proven a strong positive correlation between smoking and gum disease. However, this study is unique in that it evaluated the impact of secondhand smoke on periodontitis," explained study author Getulio da R. Nogueira-Filho, DDS.
Researchers studied rats that were induced with periodontal disease. One group was not exposed to cigarette smoke while the other two groups were exposed to either 30 days of smoke inhalation produced by non-light cigarettes (cigarettes containing higher tar, nicotine and carbon monoxide levels) or light cigarettes (cigarettes containing lower tar, nicotine and carbon monoxide levels).
Results showed that bone loss was greater in the subjects exposed to secondhand smoke regardless of if it was smoke from light or non-light cigarettes than those who were exposed to no smoke at all.
"Previous clinical research has proven a strong positive correlation between smoking and gum disease. However, this study is unique in that it evaluated the impact of secondhand smoke on periodontitis," explained study author Getulio da R. Nogueira-Filho, DDS.
Mental exercise improves stroke outcomes
Wed Apr 4, 2007 9:27AM EDT
NEW YORK (Reuters Health) - A traditional rehabilitation program that incorporates mental practice of tasks during therapy significantly improves outcomes in patients with chronic stroke, according to a report in the journal Stroke.
"Mental practice, sometimes called 'motor imagery,' is a technique by which physical skills can be cognitively rehearsed in a safe, repetitive manner," Dr. Stephen J. Page and colleagues from the University of Cincinnati Academic Medical Center, Ohio, write. "Mental practice increases motor-skill learning and performance in rehabilitative settings, and the same neural and muscular structures are activated when movements are mentally practiced as during physical practice of the same skills."
NEW YORK (Reuters Health) - A traditional rehabilitation program that incorporates mental practice of tasks during therapy significantly improves outcomes in patients with chronic stroke, according to a report in the journal Stroke.
"Mental practice, sometimes called 'motor imagery,' is a technique by which physical skills can be cognitively rehearsed in a safe, repetitive manner," Dr. Stephen J. Page and colleagues from the University of Cincinnati Academic Medical Center, Ohio, write. "Mental practice increases motor-skill learning and performance in rehabilitative settings, and the same neural and muscular structures are activated when movements are mentally practiced as during physical practice of the same skills."
Morphine eases pain, doesn't shorten life
Wed Apr 4, 2007 7:30AM EDT
By Anne Harding
NEW YORK (Reuters Health) - When given in the appropriate doses to treat cancer pain, morphine will not hasten a patient's death by interfering with his or her breathing, a new study shows.
The findings contradict the conventional wisdom-held by many medical professionals as well as lay people--that giving dying patients opioids for pain can shorten their lives by depressing their respiration. "It's in all the textbooks as something to be aware of, but probably the risk has been exaggerated," Dr. Declan Walsh of The Cleveland Clinic Foundation in Ohio, one of the study's authors, told Reuters Health. "It's not that there isn't a risk, but that we've been perhaps been overly concerned about it."
By Anne Harding
NEW YORK (Reuters Health) - When given in the appropriate doses to treat cancer pain, morphine will not hasten a patient's death by interfering with his or her breathing, a new study shows.
The findings contradict the conventional wisdom-held by many medical professionals as well as lay people--that giving dying patients opioids for pain can shorten their lives by depressing their respiration. "It's in all the textbooks as something to be aware of, but probably the risk has been exaggerated," Dr. Declan Walsh of The Cleveland Clinic Foundation in Ohio, one of the study's authors, told Reuters Health. "It's not that there isn't a risk, but that we've been perhaps been overly concerned about it."
Fame hurts Ecuador's "valley of eternal youth"
VILCABAMBA, Ecuador (Reuters) - Nestor Carpio, frail at 89, says he doesn't expect to live as long as his father Miguel, who reached 124 and made this tiny valley famous around the world for the longevity of its inhabitants.
These days, the famous elders of Vilcabamba are dying at a younger age, the result of the stresses of modern life brought by the scores of tourists and health buffs who flock here in search of eternal youth.
"Before life was tranquil, now the town has turned too big," said the bespectacled Carpio, sitting outside his adobe home as cars blasting techno-cumbia cruised nearby. "The really old ones are dying off quickly."
These days, the famous elders of Vilcabamba are dying at a younger age, the result of the stresses of modern life brought by the scores of tourists and health buffs who flock here in search of eternal youth.
"Before life was tranquil, now the town has turned too big," said the bespectacled Carpio, sitting outside his adobe home as cars blasting techno-cumbia cruised nearby. "The really old ones are dying off quickly."
Health Risk to Older Women Is Seen in Hormone Therapy
A new analysis of combined data from two parts of a large federal study of hormone therapy has found that women in their 50s do not appear to have an increased heart attack risk if they take the drugs. But it also found that women in their 60s and 70s who still had hot flashes and night sweats were at increased risk for heart attacks, even if they were not taking hormones. And if these women took hormone therapy, their risk was higher still.
“The main indication now for hormone therapy is hot flashes and night sweats,” said Dr. Jacques Rossouw, a researcher for the National Heart, Lung and Blood Institute who directed the federal study, the Women’s Health Initiative. “This says that if you are older than 60, you should not take it.”
“The main indication now for hormone therapy is hot flashes and night sweats,” said Dr. Jacques Rossouw, a researcher for the National Heart, Lung and Blood Institute who directed the federal study, the Women’s Health Initiative. “This says that if you are older than 60, you should not take it.”
UN, WHO must lead to lower cancer deaths: expert
By Daniel TrottaTue Apr 3, 5:59 PM ET
World bodies like the United Nations and World Health Organization need to develop a coordinated strategy to confront the rising cancer risk in poor countries, an international expert said on Tuesday.
The incidence of cancer, once considered a disease of the developed world, has increased in poorer countries and global policymakers are not keeping pace with the challenge, said Peter Boyle, director of the International Agency for Research on Cancer.
When the agency was founded in 1965, cancer was considered a disease that afflicted wealthy nations. That changed with the growth and aging of the population in poorer countries, which also imported more risk factors such as tobacco and alcohol abuse, obesity and the lack of physical activity, Boyle said.
Boyle's agency, part of the World Health Organization, estimates cancer cases will double from 2000 to 2030, with a majority of cases occurring in low- to medium-resource countries.
"The cancer control community worldwide has suffered from being very diverse, loose and uncoordinated, and it certainly could do with a lot of leadership and an overall coordinated strategy," Boyle told a news conference at United Nations.
World bodies like the United Nations and World Health Organization need to develop a coordinated strategy to confront the rising cancer risk in poor countries, an international expert said on Tuesday.
The incidence of cancer, once considered a disease of the developed world, has increased in poorer countries and global policymakers are not keeping pace with the challenge, said Peter Boyle, director of the International Agency for Research on Cancer.
When the agency was founded in 1965, cancer was considered a disease that afflicted wealthy nations. That changed with the growth and aging of the population in poorer countries, which also imported more risk factors such as tobacco and alcohol abuse, obesity and the lack of physical activity, Boyle said.
Boyle's agency, part of the World Health Organization, estimates cancer cases will double from 2000 to 2030, with a majority of cases occurring in low- to medium-resource countries.
"The cancer control community worldwide has suffered from being very diverse, loose and uncoordinated, and it certainly could do with a lot of leadership and an overall coordinated strategy," Boyle told a news conference at United Nations.
100-Year Olds' Secret: Stay Aware
Keeping Up With the Times Is Key to Long Life, Centenarians Say
By Daniel J. DeNoon WebMD Medical News
Reviewed by Louise Chang, MD
The secret to a long life is to stay busy, get plenty of exercise and don’t drink too much. Then again, don’t drink too little.-- Hermann Smith-Johannson, 103-year-old cross-country skier, quoted in The New York Times, March 20, 1979.
April 3, 2007 -- The key to long life is a vivid interest in the world around you, a survey of 100-year-olds suggests.
That means people born when Teddy Roosevelt was president are watching music videos, ordering at Starbucks, and even listening to iPods, according to the poll from Evercare, a division of UnitedHealth Group focused on the health care needs of Americans aged 50 and older.
"We are finding older Americans are staying engaged and staying on top of what is going on in the world," Sherri Snelling, director of caregiving services at Evercare, tells WebMD.
Evercare's second annual telephone poll of 100 people aged 99 and older isn't a scientific study -- it's a snapshot of the attitudes of American 100-year-olds. Eighty-seven percent of survey respondents were white; 70% still lived at home; 95% were 100 or older; and 70% were women.
The point of the poll, Snelling says, is simply to look at what successful aging looks like.
"When we think about the different aspects of staying involved in the world around us, these nuggets of information are helpful to us," she says.
Some of those nuggets:
31% of centenarians have watched reality TV shows.
27% of centenarians have watched MTV or music videos.
1 in 7 centenarians has played video games.
68% of centenarians get their news from television, although 40% read newspapers.
11% of centenarians have ordered from Starbucks.
When asked whom they most trust to tell the truth, 34% of centenarians chose their minister, rabbi, or priest -- just ahead of their doctor or nurse at 28%.
By Daniel J. DeNoon WebMD Medical News
Reviewed by Louise Chang, MD
The secret to a long life is to stay busy, get plenty of exercise and don’t drink too much. Then again, don’t drink too little.-- Hermann Smith-Johannson, 103-year-old cross-country skier, quoted in The New York Times, March 20, 1979.
April 3, 2007 -- The key to long life is a vivid interest in the world around you, a survey of 100-year-olds suggests.
That means people born when Teddy Roosevelt was president are watching music videos, ordering at Starbucks, and even listening to iPods, according to the poll from Evercare, a division of UnitedHealth Group focused on the health care needs of Americans aged 50 and older.
"We are finding older Americans are staying engaged and staying on top of what is going on in the world," Sherri Snelling, director of caregiving services at Evercare, tells WebMD.
Evercare's second annual telephone poll of 100 people aged 99 and older isn't a scientific study -- it's a snapshot of the attitudes of American 100-year-olds. Eighty-seven percent of survey respondents were white; 70% still lived at home; 95% were 100 or older; and 70% were women.
The point of the poll, Snelling says, is simply to look at what successful aging looks like.
"When we think about the different aspects of staying involved in the world around us, these nuggets of information are helpful to us," she says.
Some of those nuggets:
31% of centenarians have watched reality TV shows.
27% of centenarians have watched MTV or music videos.
1 in 7 centenarians has played video games.
68% of centenarians get their news from television, although 40% read newspapers.
11% of centenarians have ordered from Starbucks.
When asked whom they most trust to tell the truth, 34% of centenarians chose their minister, rabbi, or priest -- just ahead of their doctor or nurse at 28%.
Tuesday, April 03, 2007
Hormone heart risks overstated for some
By LINDSEY TANNER, AP Medical Writer 24 minutes ago
CHICAGO - Maybe hormones aren't so bad for women's hearts after all — if the women are still in their 50s. In a postscript to a landmark study five years ago that led millions of women to abandon hormones during menopause, a new review suggests the heart risks for this group of women were overstated.
In fact, hormones probably are a reasonable short-term option for women in their 50s who need relief from hot flashes, night sweats and other symptoms, said Dr. Jacques Rossouw, the government researcher who led the original research and the new review of the high-profile Women's Health Initiative
The pills — either estrogen alone or a combination of estrogen-progestin — don't get a complete stamp of approval because of stroke risks for both and breast cancer risks for the combination pill.
But many critics of the original study feel vindicated. They had argued that the results were skewed because more than half the women in the study were well past the usual age when hormone users start treatment.
"If you go back to the original WHI results, women were too old, they had too much disease, there was no breakdown by years or time since menopause," said Dr. Debra Judelson, a Beverly Hills cardiologist. The new analysis attempts to clarify those points, she said, and "has got tremendous benefit."
"Hormone therapy is an individualized choice. This actually should help women and doctors to make that kind of decision," said Dr. Joseph Camardo of Wyeth Pharmaceuticals Inc., maker of the hormone pills studied.
The new analysis indicates the pills don't raise the risk of heart attack for women in the 50-to-59 age group. However, that age group did see a higher risk of breast cancer from the combination hormone and a higher risk for stroke from that pill and estrogen alone. The risk was even greater for older women. That's because women in their 70s or who are 20 years past menopause already face increased heart, stroke and cancer risks by virtue of age alone.
Rossouw of the National Heart, Lung and Blood Institute called the new results "somewhat reassuring."
Dr. Deborah Grady, a researcher at the University of California at San Francisco, said many women and doctors overreacted to the initial study data and the re-analysis may help temper some of the aversion to hormones that followed.
"Hormone therapy in women who are near menopause is probably not very dangerous," Grady said, noting that previous analyses of the study data also hinted at that.
However, concerns remain about the higher risk for breast cancer, which turned up in the original study of estrogen-progestin pills. So the general advice for hormones remains the same: Use them only to relieve symptoms, at the lowest effective dose for the shortest possible time, Rossouw said.
The report appears in Wednesday's
Journal of the American Medical Association
CHICAGO - Maybe hormones aren't so bad for women's hearts after all — if the women are still in their 50s. In a postscript to a landmark study five years ago that led millions of women to abandon hormones during menopause, a new review suggests the heart risks for this group of women were overstated.
In fact, hormones probably are a reasonable short-term option for women in their 50s who need relief from hot flashes, night sweats and other symptoms, said Dr. Jacques Rossouw, the government researcher who led the original research and the new review of the high-profile Women's Health Initiative
The pills — either estrogen alone or a combination of estrogen-progestin — don't get a complete stamp of approval because of stroke risks for both and breast cancer risks for the combination pill.
But many critics of the original study feel vindicated. They had argued that the results were skewed because more than half the women in the study were well past the usual age when hormone users start treatment.
"If you go back to the original WHI results, women were too old, they had too much disease, there was no breakdown by years or time since menopause," said Dr. Debra Judelson, a Beverly Hills cardiologist. The new analysis attempts to clarify those points, she said, and "has got tremendous benefit."
"Hormone therapy is an individualized choice. This actually should help women and doctors to make that kind of decision," said Dr. Joseph Camardo of Wyeth Pharmaceuticals Inc., maker of the hormone pills studied.
The new analysis indicates the pills don't raise the risk of heart attack for women in the 50-to-59 age group. However, that age group did see a higher risk of breast cancer from the combination hormone and a higher risk for stroke from that pill and estrogen alone. The risk was even greater for older women. That's because women in their 70s or who are 20 years past menopause already face increased heart, stroke and cancer risks by virtue of age alone.
Rossouw of the National Heart, Lung and Blood Institute called the new results "somewhat reassuring."
Dr. Deborah Grady, a researcher at the University of California at San Francisco, said many women and doctors overreacted to the initial study data and the re-analysis may help temper some of the aversion to hormones that followed.
"Hormone therapy in women who are near menopause is probably not very dangerous," Grady said, noting that previous analyses of the study data also hinted at that.
However, concerns remain about the higher risk for breast cancer, which turned up in the original study of estrogen-progestin pills. So the general advice for hormones remains the same: Use them only to relieve symptoms, at the lowest effective dose for the shortest possible time, Rossouw said.
The report appears in Wednesday's
Journal of the American Medical Association
Hormone therapy safe for younger women: study
Tue Apr 3, 2007 4:17 PM ET
By Julie Steenhuysen
CHICAGO (Reuters) - Younger women may be able to safely take hormone replacement therapy to treat menopause symptoms based on a new analysis of a big U.S. study that had raised alarms about health risks and driven down sales of treatment drugs, according to a report released on Tuesday.
A second look at the highly publicized 2002 study called the Women's Health Initiative, or WHI, suggests that women who begin hormone replacement therapy within 10 years of menopause may have less risk of heart attack than women who start hormone therapy later.
The results are "somewhat reassuring," said Dr. Jacques Rossouw, lead author of the study, which appears in this week's Journal of the American Medical Association.
Rossouw, in a telephone interview, said hormone replacement therapy, known as HRT, still increases the risk of breast cancer and stroke in younger women but the absolute risk for that age group is low.
"Check your blood pressure and have regular mammograms. If you do those things, HRT is a reasonable option in women with severe menopause symptoms," said Rossouw, who is chief of the Women's Health Initiative branch of the National Heart, Lung and Blood Institute.
By Julie Steenhuysen
CHICAGO (Reuters) - Younger women may be able to safely take hormone replacement therapy to treat menopause symptoms based on a new analysis of a big U.S. study that had raised alarms about health risks and driven down sales of treatment drugs, according to a report released on Tuesday.
A second look at the highly publicized 2002 study called the Women's Health Initiative, or WHI, suggests that women who begin hormone replacement therapy within 10 years of menopause may have less risk of heart attack than women who start hormone therapy later.
The results are "somewhat reassuring," said Dr. Jacques Rossouw, lead author of the study, which appears in this week's Journal of the American Medical Association.
Rossouw, in a telephone interview, said hormone replacement therapy, known as HRT, still increases the risk of breast cancer and stroke in younger women but the absolute risk for that age group is low.
"Check your blood pressure and have regular mammograms. If you do those things, HRT is a reasonable option in women with severe menopause symptoms," said Rossouw, who is chief of the Women's Health Initiative branch of the National Heart, Lung and Blood Institute.
Some Flu Viruses Resist Drugs
Japanese Scientists Find Flu Virus That Resists Tamiflu, Relenza
By Miranda Hitti WebMD Medical News
Reviewed by Louise Chang, MD
April 3, 2007 -- Some flu viruses appear to resist the antiviral flu drugs Tamiflu and Relenza, report Japanese researchers.
They included Shuji Hatakeyama, MD, PhD, a virus expert at the University of Tokyo.
Hatakeyama and colleagues had previously noted cases of influenza type A that resisted Tamiflu. Now, they note cases of influenza type B that show reduced sensitivity to Tamiflu and Relenza.
Hatakeyama's team studied flu viruses from a Japanese epidemic of influenza type B from 2004 to 2005.
The flu specimens came from patients including 74 children who took Tamiflu for five days, 282 untreated children, and 66 untreated adults.
One of the children who took Tamiflu had influenza type B that resisted Tamiflu and Relenza, according to the researchers' lab tests.
Seven untreated patients had influenza type B that resisted Tamiflu and Relenza, the study shows.
By Miranda Hitti WebMD Medical News
Reviewed by Louise Chang, MD
April 3, 2007 -- Some flu viruses appear to resist the antiviral flu drugs Tamiflu and Relenza, report Japanese researchers.
They included Shuji Hatakeyama, MD, PhD, a virus expert at the University of Tokyo.
Hatakeyama and colleagues had previously noted cases of influenza type A that resisted Tamiflu. Now, they note cases of influenza type B that show reduced sensitivity to Tamiflu and Relenza.
Hatakeyama's team studied flu viruses from a Japanese epidemic of influenza type B from 2004 to 2005.
The flu specimens came from patients including 74 children who took Tamiflu for five days, 282 untreated children, and 66 untreated adults.
One of the children who took Tamiflu had influenza type B that resisted Tamiflu and Relenza, according to the researchers' lab tests.
Seven untreated patients had influenza type B that resisted Tamiflu and Relenza, the study shows.
Exercise may fend off arthritis in women
Get moving, Grandma! Exercise isn't just about improving your heart and fighting flab that comes with aging. It may also be the answer to preventing stiff, achy joints that can lead to debilitating arthritis.
An Australian study suggests the more time older women spend exercising, the better their chances are of staying pain-free from one of the biggest chronic conditions plaguing developed countries.
Even exercising as little as one hour and 15 minutes a week now can make a difference over the next three years, according to findings recently published in the journal Arthritis Research & Therapy.
"I don't think the results are suggesting that you should just become this maniac exerciser," said lead author Kristiann Heesch from the University of Queensland, Australia. "What it does suggest is that just adding some walking and moderate activity to your life can make a big benefit."
Doctors have long encouraged exercise among aging patients to keep joints flexible, muscles strong and to keep off weight, which is a leading risk factor for arthritis. This is the first study that focuses specifically on middle-aged and older women who did not have a history of stiff and painful joints. It looked solely at pain and symptoms reported by more than 8,700 Australian women over a three-year period, and could offer a vital clue about prevention.
Women in their 70s who exercised 75 minutes a week reported fewer symptoms of arthritis than those who did less, while more spry women who were active at least 2 1/2 hours weekly had even less pain in the three years that followed. Although there appeared to be a direct correlation between exercise and lower joint pain, the reasons why were less clear.
An Australian study suggests the more time older women spend exercising, the better their chances are of staying pain-free from one of the biggest chronic conditions plaguing developed countries.
Even exercising as little as one hour and 15 minutes a week now can make a difference over the next three years, according to findings recently published in the journal Arthritis Research & Therapy.
"I don't think the results are suggesting that you should just become this maniac exerciser," said lead author Kristiann Heesch from the University of Queensland, Australia. "What it does suggest is that just adding some walking and moderate activity to your life can make a big benefit."
Doctors have long encouraged exercise among aging patients to keep joints flexible, muscles strong and to keep off weight, which is a leading risk factor for arthritis. This is the first study that focuses specifically on middle-aged and older women who did not have a history of stiff and painful joints. It looked solely at pain and symptoms reported by more than 8,700 Australian women over a three-year period, and could offer a vital clue about prevention.
Women in their 70s who exercised 75 minutes a week reported fewer symptoms of arthritis than those who did less, while more spry women who were active at least 2 1/2 hours weekly had even less pain in the three years that followed. Although there appeared to be a direct correlation between exercise and lower joint pain, the reasons why were less clear.
Hormone Therapy for Advanced Prostate Cancer Not for Everyone
MONDAY, April 2 (HealthDay News) -- For men with advanced prostate cancer, starting hormone therapy quickly comes with benefits and risks that may -- in some cases -- cancel each other out, according to new guidelines issued by the American Society of Clinical Oncology.
"The message is that immediate use of hormones does reduce the risk of dying of prostate cancer by about 17 percent," explained the guidelines' lead author, Dr. Andrew Loblaw, a radiation oncologist at Toronto-Sunnybrook Regional Cancer Center in Canada. "But also, early use of hormone therapy increased the risk of dying of something else by about 15 percent, so there is no survival advantage. This is something that men and their physicians need to discuss," he said.
The guidelines, published in the Journal of Clinical Oncology, are aimed at about 100,000 of the roughly 250,000 men with prostate cancer in the United States and Canada, Loblaw said. Specifically, they apply to men whose cancer comes back after treatment, those whose cancer progresses after a period of "watchful waiting," and those whose cancer has spread beyond the prostate when they are first diagnosed.
"The message is that immediate use of hormones does reduce the risk of dying of prostate cancer by about 17 percent," explained the guidelines' lead author, Dr. Andrew Loblaw, a radiation oncologist at Toronto-Sunnybrook Regional Cancer Center in Canada. "But also, early use of hormone therapy increased the risk of dying of something else by about 15 percent, so there is no survival advantage. This is something that men and their physicians need to discuss," he said.
The guidelines, published in the Journal of Clinical Oncology, are aimed at about 100,000 of the roughly 250,000 men with prostate cancer in the United States and Canada, Loblaw said. Specifically, they apply to men whose cancer comes back after treatment, those whose cancer progresses after a period of "watchful waiting," and those whose cancer has spread beyond the prostate when they are first diagnosed.
Can An Omega-3 Fatty Acid Slow The Progression Of Alzheimer's Disease?
Nutritionists have long endorsed fish as part of a heart-healthy diet, and now some studies suggest that omega-3 fatty acids found in the oil of certain fish may also benefit the brain by lowering the risk of Alzheimer's disease. In order to test whether docosahexaenoic acid (DHA), an omega-3 fatty acid, can impact the progression of Alzheimer's disease, researchers at Washington University School of Medicine and Saint Louis University School of Medicine will evaluate DHA in a clinical trial sponsored by the National Institute on Aging (NIA).
The local effort is part of a nationwide consortium of leading Alzheimer's disease researchers supported by the NIA and coordinated by the University of California, San Diego. The trial will take place at 52 sites across the United States. It seeks 400 participants age 50 and older with mild to moderate Alzheimer's disease. Joseph Quinn, M.D., associate professor of neurology at Oregon Health and Science University, is directing the national study. James Galvin, M.D., M.P.H., at Washington University School of Medicine, and George Grossberg, M.D., at Saint Louis University School of Medicine, will conduct the study locally.
The local effort is part of a nationwide consortium of leading Alzheimer's disease researchers supported by the NIA and coordinated by the University of California, San Diego. The trial will take place at 52 sites across the United States. It seeks 400 participants age 50 and older with mild to moderate Alzheimer's disease. Joseph Quinn, M.D., associate professor of neurology at Oregon Health and Science University, is directing the national study. James Galvin, M.D., M.P.H., at Washington University School of Medicine, and George Grossberg, M.D., at Saint Louis University School of Medicine, will conduct the study locally.
Exenatide Added to Thiazolidinediones May Be Helpful in Type 2 Diabetes
April 2, 2007 — Exenatide added to thiazolidinediones improved glycemic control and reduced body weight in some patients with type 2 diabetes, according to the results of a randomized, double-blind, placebo-controlled trial reported in the April 3 issue of the Annals of Internal Medicine.
"Exenatide therapy is effective in combination with metformin or sulfonylureas for treating type 2 diabetes," write Bernard Zinman, MD, from the University of Toronto in Ontario, Canada, and colleagues. "Thiazolidinediones (TZDs) also are commonly used, but the efficacy of exenatide with a TZD has not been reported."
From May 2004 to August 2005 at 490 sites in Canada, Spain, and the United States, 233 patients with type 2 diabetes suboptimally controlled with thiazolidinedione treatment (with or without metformin) were randomized to receive additional exenatide (n = 121) or placebo (n = 112). At baseline, mean glycated hemoglobin A1c (HbA1c) level was 7.9% ± 0.1%.
Patients received subcutaneous abdominal injections of 10 μg of exenatide or placebo twice daily, added to thiazolidinedione (with or without metformin), for 16 weeks. The main endpoint was change from baseline in HbA1c level, and other outcomes were fasting serum glucose level, body weight, self-monitored blood glucose level, and adverse events.
"Exenatide therapy is effective in combination with metformin or sulfonylureas for treating type 2 diabetes," write Bernard Zinman, MD, from the University of Toronto in Ontario, Canada, and colleagues. "Thiazolidinediones (TZDs) also are commonly used, but the efficacy of exenatide with a TZD has not been reported."
From May 2004 to August 2005 at 490 sites in Canada, Spain, and the United States, 233 patients with type 2 diabetes suboptimally controlled with thiazolidinedione treatment (with or without metformin) were randomized to receive additional exenatide (n = 121) or placebo (n = 112). At baseline, mean glycated hemoglobin A1c (HbA1c) level was 7.9% ± 0.1%.
Patients received subcutaneous abdominal injections of 10 μg of exenatide or placebo twice daily, added to thiazolidinedione (with or without metformin), for 16 weeks. The main endpoint was change from baseline in HbA1c level, and other outcomes were fasting serum glucose level, body weight, self-monitored blood glucose level, and adverse events.
Ropinirole Prolonged-Release Reduces Parkinson's 'Off' Time
KANSAS CITY, Kan., April 2 -- For patients with Parkinson's disease poorly controlled by levodopa alone, the addition of ropinirole (Requip) both reduced "off" time and allowed for lower doses of levodopa, found a multicenter international study.
Among 393 patients in the randomized study, prolonged-release ropinirole as an adjunct to levodopa led to a mean reduction in daily "off" time of 2.1 hours, compared with 0.3 hours for patients on placebo, reported Rajesh Pahwa, M.D., of University of Kansas here, and colleagues, in the April 3 issue of Neurology.
"We also found the drug helped improve quality of life and motor function," said Dr. Pahwa and colleagues.
Ropinirole is a non-ergot dopamine agonist used as both monotherapy and adjunctively for early and advanced Parkinson's disease. The drug is also approved for restless legs syndrome.
Among 393 patients in the randomized study, prolonged-release ropinirole as an adjunct to levodopa led to a mean reduction in daily "off" time of 2.1 hours, compared with 0.3 hours for patients on placebo, reported Rajesh Pahwa, M.D., of University of Kansas here, and colleagues, in the April 3 issue of Neurology.
"We also found the drug helped improve quality of life and motor function," said Dr. Pahwa and colleagues.
Ropinirole is a non-ergot dopamine agonist used as both monotherapy and adjunctively for early and advanced Parkinson's disease. The drug is also approved for restless legs syndrome.
Breast Cancer Guidelines Add Raloxifene and Urge Caution With Lab Testing and MRI Screening
Allison Gandey
April 2, 2007 — New breast cancer recommendations take recent data into account and include raloxifene for postmenopausal women with lobular carcinoma. The latest guidelines, presented at the National Comprehensive Cancer Network (NCCN) 12th Annual Conference in Hollywood, Florida, also flag the potential dangers of using laboratory testing as the sole determinant for therapy and relying too heavily on magnetic resonance imaging (MRI). Presenting at the meeting, John Ward, MD, from the Huntsman Cancer Institute at the University of Utah, in Salt Lake City, told attendees that significant variability and lack of standardization on how assays are performed and reported raise significant concerns about accuracy. "Laboratory tests that are the sole determinant for therapy selection pose a significant challenge to pathologists performing them and to oncologists who must interpret the results for clinical decisions," he said. One of Dr. Ward's slides quipped that the pathologist now wears a stethoscope, too.
April 2, 2007 — New breast cancer recommendations take recent data into account and include raloxifene for postmenopausal women with lobular carcinoma. The latest guidelines, presented at the National Comprehensive Cancer Network (NCCN) 12th Annual Conference in Hollywood, Florida, also flag the potential dangers of using laboratory testing as the sole determinant for therapy and relying too heavily on magnetic resonance imaging (MRI). Presenting at the meeting, John Ward, MD, from the Huntsman Cancer Institute at the University of Utah, in Salt Lake City, told attendees that significant variability and lack of standardization on how assays are performed and reported raise significant concerns about accuracy. "Laboratory tests that are the sole determinant for therapy selection pose a significant challenge to pathologists performing them and to oncologists who must interpret the results for clinical decisions," he said. One of Dr. Ward's slides quipped that the pathologist now wears a stethoscope, too.
Updated Statement on Hormone Therapy
February 1, 2007 — A scientific advisory panel to the North American Menopause Society has issued a position statement on the use of hormone therapy (HT), which softens its previous stance on the issue. The statement was published in the February 25 Ahead of Print issue of Menopause.
"For women with severe menopausal symptoms, within a few years of their last period, hormone therapy shouldn't be as scary as it has been made out to be," director of the North American Menopause Society and panel chair Wulf Utian, MD, PhD, of Case Western Reserve University in Cleveland, Ohio, told heartwire.
For older women, the decision is more difficult, he says. Although there are fewer women of this age who will require HT, some have menopausal symptoms for many years or have experienced symptoms after stopping HT in the past few years, and this group wants to know whether they can restart therapy. But older women are at higher absolute risk for cancer and heart disease, so "it has to be a personal decision, our panel is stating that very clearly. An older woman must consider all the risks and benefits."
"For women with severe menopausal symptoms, within a few years of their last period, hormone therapy shouldn't be as scary as it has been made out to be," director of the North American Menopause Society and panel chair Wulf Utian, MD, PhD, of Case Western Reserve University in Cleveland, Ohio, told heartwire.
For older women, the decision is more difficult, he says. Although there are fewer women of this age who will require HT, some have menopausal symptoms for many years or have experienced symptoms after stopping HT in the past few years, and this group wants to know whether they can restart therapy. But older women are at higher absolute risk for cancer and heart disease, so "it has to be a personal decision, our panel is stating that very clearly. An older woman must consider all the risks and benefits."
No Benefit of PCI Over Optimal Drugs for Preventing Events in Stable CAD
March 30, 2007 (New Orleans, Louisiana) — Percutaneous coronary intervention (PCI) plus stenting and optimal medical therapy is no better at preventing future events than optimal medical therapy alone in patients with stable coronary artery disease (CAD), according to the results of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial. The much-anticipated results, presented here during a late-breaking clinical-trials session by lead investigator William E. Boden, MD, from the Buffalo General Hospital in Buffalo, NY, add fuel to the mounting fire about whether stents, including drug-eluting stents, are being overused for the treatment of stable CAD or for the prevention of future cardiac events.
Full results of the study were published simultaneously online in the March 27 Early Release issue of The New England Journal of Medicine.
Full results of the study were published simultaneously online in the March 27 Early Release issue of The New England Journal of Medicine.
Early Antibiotic Therapy Reduces Surgical Site Infections After Hip Arthroplasty
March 30, 2007 — Administration of antibiotics before surgery can reduce the risk of surgical site infections, according to the results of a study of patients undergoing total hip arthroplasty.
Antibiotic prophylaxis is standard practice for total hip arthroplasty, the authors explain, but the optimal timing and duration of prophylaxis remain controversial.
Dr. Marjo E.E. van Kasteren from Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands and colleagues explored the contribution of antibiotic prophylaxis parameters, with an emphasis on the timing of administration, to the incidence of surgical site infections among more than 1900 patients undergoing total hip arthroplasty.
Waiting until after the incision to administer the first dose of prophylactic antibiotics resulted in an increased incidence of surgical site infections, the authors report, although the difference was not statistically significant.
Postoperative antibiotic doses and the use of antibiotic-impregnated bone cement did not significantly influence the risk of surgical site infections, Dr. van Kasteren's team reports in the April 1st issue of Clinical Infectious Diseases.
Antibiotic prophylaxis is standard practice for total hip arthroplasty, the authors explain, but the optimal timing and duration of prophylaxis remain controversial.
Dr. Marjo E.E. van Kasteren from Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands and colleagues explored the contribution of antibiotic prophylaxis parameters, with an emphasis on the timing of administration, to the incidence of surgical site infections among more than 1900 patients undergoing total hip arthroplasty.
Waiting until after the incision to administer the first dose of prophylactic antibiotics resulted in an increased incidence of surgical site infections, the authors report, although the difference was not statistically significant.
Postoperative antibiotic doses and the use of antibiotic-impregnated bone cement did not significantly influence the risk of surgical site infections, Dr. van Kasteren's team reports in the April 1st issue of Clinical Infectious Diseases.
Monday, April 02, 2007
New Mammography Guidelines for Women
Women in Their 40s Should Discuss Risks, Benefits With Doctors, Says Physicians Group
By Miranda Hitti WebMD Medical News
Reviewed by Louise Chang, MD
April 2, 2007 -- The American College of Physicians today issued new mammography guidelines for breast cancer screening for women in their 40s.
The guidelines boil down to this: Women in their 40s should work with their doctors to gauge their personal breast cancer risk and to decide whether to get mammography to screen for breast cancer.
If a woman in her 40s decides not to get a screening mammogram, she and her doctor should revisit that decision every one to two years, states the American College of Physicians (ACP).
In short, the ACP isn't making a one-size-fits-all recommendation. Instead, the ACP says the decision should be tailored to each individual woman in her 40s.
"No simple recommendation applies to all women in their 40s," states an editorial published with the guidelines in the Annals of Internal Medicine.
The guidelines only apply to routine screening mammograms, not diagnostic mammograms taken of specific breast lumps or other breast findings.
Mammogram Studies
A team of experts reviewed 125 mammography studies for the ACP. They included Katrina Armstrong, MD, MSCE, of the University of Pennsylvania.
"Screening mammography probably reduces breast cancer mortality in women aged 40 to 49 years modestly," write Armstrong and colleagues.
They note that many women in their 40s will choose mammography for that potential reduction in breast cancer death.
However, Armstrong's team notes that screening mammograms likely save more lives in women aged 50 and older, since breast cancer becomes more common with age.
In addition, mammograms aren't perfect. They may miss a tumor or flag a benign breast lump, leading to more tests and anxiety.
Mammograms also deliver a low dose of radiation, and it's not clear what the long-term consequences of that may be over a lifetime, note Armstrong and colleagues.
Many women find the mammography procedure uncomfortable. But in the reviewed studies, few women said mammography pain would stop them from getting a mammogram.
By Miranda Hitti WebMD Medical News
Reviewed by Louise Chang, MD
April 2, 2007 -- The American College of Physicians today issued new mammography guidelines for breast cancer screening for women in their 40s.
The guidelines boil down to this: Women in their 40s should work with their doctors to gauge their personal breast cancer risk and to decide whether to get mammography to screen for breast cancer.
If a woman in her 40s decides not to get a screening mammogram, she and her doctor should revisit that decision every one to two years, states the American College of Physicians (ACP).
In short, the ACP isn't making a one-size-fits-all recommendation. Instead, the ACP says the decision should be tailored to each individual woman in her 40s.
"No simple recommendation applies to all women in their 40s," states an editorial published with the guidelines in the Annals of Internal Medicine.
The guidelines only apply to routine screening mammograms, not diagnostic mammograms taken of specific breast lumps or other breast findings.
Mammogram Studies
A team of experts reviewed 125 mammography studies for the ACP. They included Katrina Armstrong, MD, MSCE, of the University of Pennsylvania.
"Screening mammography probably reduces breast cancer mortality in women aged 40 to 49 years modestly," write Armstrong and colleagues.
They note that many women in their 40s will choose mammography for that potential reduction in breast cancer death.
However, Armstrong's team notes that screening mammograms likely save more lives in women aged 50 and older, since breast cancer becomes more common with age.
In addition, mammograms aren't perfect. They may miss a tumor or flag a benign breast lump, leading to more tests and anxiety.
Mammograms also deliver a low dose of radiation, and it's not clear what the long-term consequences of that may be over a lifetime, note Armstrong and colleagues.
Many women find the mammography procedure uncomfortable. But in the reviewed studies, few women said mammography pain would stop them from getting a mammogram.
Intensive Therapy Helps Bipolar
Intensive Psychotherapy, in Addition to Medication, May Be Better Than Brief Therapy
By Miranda Hitti WebMD Medical News
Reviewed by Louise Chang, MD
April 2, 2007 -- Treating bipolar depression with intensive psychotherapy plus medication may be more effective than brief psychotherapy plus medication.
That news comes from a study of nearly 300 U.S. adults with bipolar disorder, which is marked by extreme mood shifts from depression to mania.
All of the patients were experiencing bipolar depression (the depressive phase of bipolar disorder) when the study started.
The patients who got intensive psychotherapy plus medication had their depression lift sooner and were more likely to maintain stable moods than those who got brief psychotherapy plus medication.
Intensive psychotherapy "should be considered a vital part of the effort to treat bipolar illness," says researcher David Miklowitz, PhD, in a news release.
Miklowitz and colleagues report their findings in the Archives of General Psychiatry.
Bipolar Depression Study
All patients took mood-stabilizing drugs such as lithium during the study. About 30% of patients were also taking antidepressants.
The researchers split the patients into two main groups:
One group got intensive psychotherapy (up to 30 psychotherapy sessions over nine months) in addition to medication. Those patients got one of the following three types of therapy:
Family-focused therapy, which includes the patient and their relatives
Cognitive behavior therapy, which teaches new coping strategies
Interpersonal and social rhythm therapy, which includes solving relationship problems and setting healthy daily routines for sleep, exercise, and eating
Patients in the second group got brief psychotherapy (three sessions in six weeks) plus medication. The brief therapy sessions included a videotape and a workbook for patients to use.
Study's Results
The researchers followed the patients for one year.
On average, patients in the intensive-therapy group took nearly four months to have their depression ease, compared with nearly five months for those in the brief-therapy group.
By the end of the study, nearly two-thirds of the patients in the intensive-psychotherapy group (64%) had had at least two months of stable moods, compared with about half (51%) of those in the brief-therapy group.
Patients in the intensive-psychotherapy group were about 1.5 times more likely to have stable moods during any given month of the study than those who got brief psychotherapy.
Antidepressants were not responsible for the difference between the two groups' outcomes, according to Miklowitz and colleagues.
The study doesn't show whether one type of intensive psychotherapy was more effective than the others. Future studies should look into that, note the researchers
By Miranda Hitti WebMD Medical News
Reviewed by Louise Chang, MD
April 2, 2007 -- Treating bipolar depression with intensive psychotherapy plus medication may be more effective than brief psychotherapy plus medication.
That news comes from a study of nearly 300 U.S. adults with bipolar disorder, which is marked by extreme mood shifts from depression to mania.
All of the patients were experiencing bipolar depression (the depressive phase of bipolar disorder) when the study started.
The patients who got intensive psychotherapy plus medication had their depression lift sooner and were more likely to maintain stable moods than those who got brief psychotherapy plus medication.
Intensive psychotherapy "should be considered a vital part of the effort to treat bipolar illness," says researcher David Miklowitz, PhD, in a news release.
Miklowitz and colleagues report their findings in the Archives of General Psychiatry.
Bipolar Depression Study
All patients took mood-stabilizing drugs such as lithium during the study. About 30% of patients were also taking antidepressants.
The researchers split the patients into two main groups:
One group got intensive psychotherapy (up to 30 psychotherapy sessions over nine months) in addition to medication. Those patients got one of the following three types of therapy:
Family-focused therapy, which includes the patient and their relatives
Cognitive behavior therapy, which teaches new coping strategies
Interpersonal and social rhythm therapy, which includes solving relationship problems and setting healthy daily routines for sleep, exercise, and eating
Patients in the second group got brief psychotherapy (three sessions in six weeks) plus medication. The brief therapy sessions included a videotape and a workbook for patients to use.
Study's Results
The researchers followed the patients for one year.
On average, patients in the intensive-therapy group took nearly four months to have their depression ease, compared with nearly five months for those in the brief-therapy group.
By the end of the study, nearly two-thirds of the patients in the intensive-psychotherapy group (64%) had had at least two months of stable moods, compared with about half (51%) of those in the brief-therapy group.
Patients in the intensive-psychotherapy group were about 1.5 times more likely to have stable moods during any given month of the study than those who got brief psychotherapy.
Antidepressants were not responsible for the difference between the two groups' outcomes, according to Miklowitz and colleagues.
The study doesn't show whether one type of intensive psychotherapy was more effective than the others. Future studies should look into that, note the researchers
Men's Skin More Sun-Sensitive
Sun Causes Faster-Growing, Worse Skin Cancer in Males, Mouse Study Shows
By Daniel J. DeNoon WebMD Medical News
Reviewed by Louise Chang, MD
April 2, 2007 -- Skin cancer due to sun exposure appears faster -- and is more severe -- in males than in females, mouse studies show.
It's well known that men are more likely to get skin cancer than women are. Men get twice the overall number of skin cancers and three times more squamous cell carcinomas than women do, notes Tatiana M. Oberyszyn, PhD, assistant professor of pathology at Ohio State University in Columbus.
Why? Researchers usually say this is because men are more likely than women to have outdoor jobs -- and that they are less likely to protect their skin with sunscreen, shirts, and hats. Oberyszyn wondered whether this is true.
To test the theory, Oberyszyn's team exposed a breed of hairless mice to ultraviolet rays from a sun lamp. The mice underwent eight- to 10-minute tanning sessions three times a week for six months. That was enough to give both male and female mice skin cancer.
"We found males got skin tumors earlier, got more of them, and more of the tumors were severe," Oberyszyn tells WebMD.
Men’s Skin More Sensitive?
What was going on? Tests of male and female mouse skin turned up a surprising finding. The male skin cells carried fewer antioxidants than the female skin cells.
"Our skin is exposed to both physical and environmental stimuli all the time," Oberyszyn says. "Our immune system keeps us healthy. But the immune system can overreact sometimes. You get overproduction of reactive oxygen species -- and antioxidants protect against this."
The researchers are now looking at human skin to see if men really are like mice.
"We think male skin is just more sensitive," Oberyszyn says. "Perhaps men need something that would provide with them more antioxidants -- maybe diet, maybe a skin cream. In addition to sunscreen, maybe men need to pay more attention to their skin than women do. It is not a cosmetic thing; it really is a health issue."
Marianne Berwick, PhD, is the head of cancer epidemiology and prevention at the University of New Mexico in Albuquerque. Berwick agrees with Oberyszyn that there's a huge difference between men's skin and women's skin
By Daniel J. DeNoon WebMD Medical News
Reviewed by Louise Chang, MD
April 2, 2007 -- Skin cancer due to sun exposure appears faster -- and is more severe -- in males than in females, mouse studies show.
It's well known that men are more likely to get skin cancer than women are. Men get twice the overall number of skin cancers and three times more squamous cell carcinomas than women do, notes Tatiana M. Oberyszyn, PhD, assistant professor of pathology at Ohio State University in Columbus.
Why? Researchers usually say this is because men are more likely than women to have outdoor jobs -- and that they are less likely to protect their skin with sunscreen, shirts, and hats. Oberyszyn wondered whether this is true.
To test the theory, Oberyszyn's team exposed a breed of hairless mice to ultraviolet rays from a sun lamp. The mice underwent eight- to 10-minute tanning sessions three times a week for six months. That was enough to give both male and female mice skin cancer.
"We found males got skin tumors earlier, got more of them, and more of the tumors were severe," Oberyszyn tells WebMD.
Men’s Skin More Sensitive?
What was going on? Tests of male and female mouse skin turned up a surprising finding. The male skin cells carried fewer antioxidants than the female skin cells.
"Our skin is exposed to both physical and environmental stimuli all the time," Oberyszyn says. "Our immune system keeps us healthy. But the immune system can overreact sometimes. You get overproduction of reactive oxygen species -- and antioxidants protect against this."
The researchers are now looking at human skin to see if men really are like mice.
"We think male skin is just more sensitive," Oberyszyn says. "Perhaps men need something that would provide with them more antioxidants -- maybe diet, maybe a skin cream. In addition to sunscreen, maybe men need to pay more attention to their skin than women do. It is not a cosmetic thing; it really is a health issue."
Marianne Berwick, PhD, is the head of cancer epidemiology and prevention at the University of New Mexico in Albuquerque. Berwick agrees with Oberyszyn that there's a huge difference between men's skin and women's skin
Moderate alcohol intake may boost aneurysm risk
Mon Apr 2, 2007 12:31PM EDT
By David Douglas
NEW YORK (Reuters Health) - Drinking alcohol at moderate levels -- two or more drinks per day -- appears to be a risk factor for abdominal aortic aneurysm in men, researchers found.
An abdominal aortic aneurysm, or AAA, occurs when the wall of the aorta -- the body's largest artery that carries blood from the heart -- is stretched or weakened as it passes through the abdomen. Blood pumping through the artery can cause the weakened wall to balloon out and possibly rupture, leading to death in many patients.
Dr. Daniel R. Wong of the Harvard School of Public Health, Boston and colleagues analyzed data for a cohort of more than 39,000 men covering 1986 to 2002 including 376 newly diagnosed cases of AAA.
By David Douglas
NEW YORK (Reuters Health) - Drinking alcohol at moderate levels -- two or more drinks per day -- appears to be a risk factor for abdominal aortic aneurysm in men, researchers found.
An abdominal aortic aneurysm, or AAA, occurs when the wall of the aorta -- the body's largest artery that carries blood from the heart -- is stretched or weakened as it passes through the abdomen. Blood pumping through the artery can cause the weakened wall to balloon out and possibly rupture, leading to death in many patients.
Dr. Daniel R. Wong of the Harvard School of Public Health, Boston and colleagues analyzed data for a cohort of more than 39,000 men covering 1986 to 2002 including 376 newly diagnosed cases of AAA.
Study finds lack of health insurance may be associated with increased rates of stroke
BOSTON – The lack of health insurance prompts people to forego routine physical exams and have a reduced awareness of cardiovascular risk factors and is associated with increased rates of stroke and death, researchers have concluded.
A study in the April issue of the Journal of the Society of General Internal Medicine found people without health insurance are more likely to forego routine physical exams and had a higher risk of being unaware of a personal diagnosis of high blood pressure, diabetes or high cholesterol levels – all risk factors for cardiovascular disease. Surprisingly, researchers say, the lack of health insurance did not translate into a higher risk for myocardial infarction, of heart attack.
“We speculate that this may relate to the relative importance of hypertension as a risk factor for stroke, says Angela Fowler-Brown, MD, MPH, the lead author, a physician in the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center and an Instructor of Medicine at Harvard Medical School.
“Hypertension is the most powerful risk factor for stroke, and in our study we found that hypertension was significantly less likely to be well controlled in those lacking insurance,” she says. “While hypertension is also an important risk factor for myocardial infarction, other factors such as inflammation, cholesterol and inherited traits may of greater relative importance in the development of myocardial infarction than in stroke.
A study in the April issue of the Journal of the Society of General Internal Medicine found people without health insurance are more likely to forego routine physical exams and had a higher risk of being unaware of a personal diagnosis of high blood pressure, diabetes or high cholesterol levels – all risk factors for cardiovascular disease. Surprisingly, researchers say, the lack of health insurance did not translate into a higher risk for myocardial infarction, of heart attack.
“We speculate that this may relate to the relative importance of hypertension as a risk factor for stroke, says Angela Fowler-Brown, MD, MPH, the lead author, a physician in the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center and an Instructor of Medicine at Harvard Medical School.
“Hypertension is the most powerful risk factor for stroke, and in our study we found that hypertension was significantly less likely to be well controlled in those lacking insurance,” she says. “While hypertension is also an important risk factor for myocardial infarction, other factors such as inflammation, cholesterol and inherited traits may of greater relative importance in the development of myocardial infarction than in stroke.
Cost-effectiveness of ligation vs. beta-blockers in the prevention of variceal bleeding
Ligation is cost-effective if quality of life-years are considered
Endoscopic variceal ligation is cost-effective relative to beta-blockers for the prevention of variceal bleeding in cirrhotic patients if quality of life-years are considered. If only life-years are considered, then endoscopic variceal ligation is not cost-effective. These findings are published in the April issue of Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD). Published by John Wiley & Sons, Inc., Hepatology is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/hepatology.
Thirty to forty percent of patients with cirrhosis have esophageal varices. Bleeding from varices occurs in almost one in three of these patients and can be fatal. Non-selective beta-adrenergic blockade has been the most widely investigated therapy to reduce the risk of variceal bleeding. Another effective alternative is endoscopic variceal ligation. The effects of both treatment options on mortality are uncertain.
Since both approaches reduce the risk of variceal bleeding, researchers led by Thomas Imperiale, MD, of Indiana University School of Medicine, sought to compare their cost-effectiveness and quality of life outcomes.
They developed a Markov decision model for patients with cirrhosis, portal hypertension, and medium-to-large esophageal varices who would be candidates for primary prophylaxis with either beta-blockade or ligation. Using a 5-year time horizon, they examined direct costs, life-years, and quality-adjusted life years.
Endoscopic variceal ligation is cost-effective relative to beta-blockers for the prevention of variceal bleeding in cirrhotic patients if quality of life-years are considered. If only life-years are considered, then endoscopic variceal ligation is not cost-effective. These findings are published in the April issue of Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD). Published by John Wiley & Sons, Inc., Hepatology is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/hepatology.
Thirty to forty percent of patients with cirrhosis have esophageal varices. Bleeding from varices occurs in almost one in three of these patients and can be fatal. Non-selective beta-adrenergic blockade has been the most widely investigated therapy to reduce the risk of variceal bleeding. Another effective alternative is endoscopic variceal ligation. The effects of both treatment options on mortality are uncertain.
Since both approaches reduce the risk of variceal bleeding, researchers led by Thomas Imperiale, MD, of Indiana University School of Medicine, sought to compare their cost-effectiveness and quality of life outcomes.
They developed a Markov decision model for patients with cirrhosis, portal hypertension, and medium-to-large esophageal varices who would be candidates for primary prophylaxis with either beta-blockade or ligation. Using a 5-year time horizon, they examined direct costs, life-years, and quality-adjusted life years.
FDA approves accelerated dosing schedule for Glaxosmithkline's Twinrix
New vaccine schedule offers protection against hepatitis A and hepatitis B
Philadelphia, PA – April 2, 2007 – GlaxoSmithKline [NYSE:GSK] announced today that the U.S. Food and Drug Administration (FDA) has approved Twinrix® [Hepatitis A Vaccine (Inactivated) and Hepatitis B (Recombinant) Vaccine], for an accelerated dosing schedule that consists of three doses given within three weeks followed by a booster dose at 12 months. The approval means Twinrix, the only hepatitis A and hepatitis B combination vaccine available in the United States, is now available on a dosing schedule at 0, 7, 21-30 days, followed by a booster dose at 12 months. The vaccine was first approved for adults over age 18 years by the FDA in May 2001 on a 0, 1, 6-month dosing schedule.
“Hepatitis A and hepatitis B are serious liver diseases which can be prevented through vaccination,” stated travel medicine specialist Bradley A. Connor, M.D., Past President, International Society of Travel Medicine and a principal study investigator. “Twinrix’s new accelerated dosing schedule offers an option that could benefit individuals such as those preparing to travel internationally to high-risk areas. It may also benefit emergency first care responders, especially those deploying to disaster areas overseas, as well as others at risk for hepatitis, such as people with sexually transmitted diseases and those who are HIV positive.”
Many regions throughout the world are endemic for hepatitis A and hepatitis B, such as Africa, Asia, South America and parts of the Caribbean. Worldwide, approximately 1.5 million cases of hepatitis A are reported annually. In addition, hepatitis B has infected 2 billion people – one-third of the world’s population. Millions of Americans travel each year to countries where hepatitis A and hepatitis B are endemic. An overwhelming majority of these international travelers are not vaccinated before the trip. Therefore, international travelers may be at risk for contracting both hepatitis A and hepatitis B. They should consult their health care provider prior to traveling abroad.
Philadelphia, PA – April 2, 2007 – GlaxoSmithKline [NYSE:GSK] announced today that the U.S. Food and Drug Administration (FDA) has approved Twinrix® [Hepatitis A Vaccine (Inactivated) and Hepatitis B (Recombinant) Vaccine], for an accelerated dosing schedule that consists of three doses given within three weeks followed by a booster dose at 12 months. The approval means Twinrix, the only hepatitis A and hepatitis B combination vaccine available in the United States, is now available on a dosing schedule at 0, 7, 21-30 days, followed by a booster dose at 12 months. The vaccine was first approved for adults over age 18 years by the FDA in May 2001 on a 0, 1, 6-month dosing schedule.
“Hepatitis A and hepatitis B are serious liver diseases which can be prevented through vaccination,” stated travel medicine specialist Bradley A. Connor, M.D., Past President, International Society of Travel Medicine and a principal study investigator. “Twinrix’s new accelerated dosing schedule offers an option that could benefit individuals such as those preparing to travel internationally to high-risk areas. It may also benefit emergency first care responders, especially those deploying to disaster areas overseas, as well as others at risk for hepatitis, such as people with sexually transmitted diseases and those who are HIV positive.”
Many regions throughout the world are endemic for hepatitis A and hepatitis B, such as Africa, Asia, South America and parts of the Caribbean. Worldwide, approximately 1.5 million cases of hepatitis A are reported annually. In addition, hepatitis B has infected 2 billion people – one-third of the world’s population. Millions of Americans travel each year to countries where hepatitis A and hepatitis B are endemic. An overwhelming majority of these international travelers are not vaccinated before the trip. Therefore, international travelers may be at risk for contracting both hepatitis A and hepatitis B. They should consult their health care provider prior to traveling abroad.
NIDA study identifies genes that might help some people abstain from smoking
Findings move science closer to targeted, improved therapies
Scientists supported by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, have for the first time identified genes that might increase a person’s ability to abstain from smoking. The breakthrough research was conducted by Dr. George Uhl at NIDA’s Intramural Research Program and a team led by Dr. Jed Rose at the Center for Nicotine and Smoking Cessation Research at Duke University Medical Center.
The study, published in the journal BMC Genetics, available on line April 2, brings researchers a step closer toward tailoring individualized drug therapy for addiction based on an individual’s unique genetic makeup.
“This research marks the first time we’ve been able to identify genes involved in the ability to quit smoking,” says NIDA Director Dr. Nora D. Volkow. “It marks a movement from identifying the genetics of addiction vulnerability to identifying the genetic basis of successful abstinence. This knowledge could impact the success rate of cessation programs by helping health care providers choose the most appropriate treatment based on individual differences.”
Dr. Uhl and his colleagues performed a genome-wide analysis on the DNA of two types of nicotine-dependent individuals, one that was able to successfully quit the cigarette- smoking behavior and one that was not.
“We identified 221 genes that distinguished successful quitters from those who were unsuccessful,” says Dr. Uhl. “We know the functions of about 187 of these genes, but 34 have functions that are unknown at present. We also found that at least 62 of the genes that we had previously identified as playing roles in dependence to other drugs also contribute to nicotine dependence.”
Scientists supported by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, have for the first time identified genes that might increase a person’s ability to abstain from smoking. The breakthrough research was conducted by Dr. George Uhl at NIDA’s Intramural Research Program and a team led by Dr. Jed Rose at the Center for Nicotine and Smoking Cessation Research at Duke University Medical Center.
The study, published in the journal BMC Genetics, available on line April 2, brings researchers a step closer toward tailoring individualized drug therapy for addiction based on an individual’s unique genetic makeup.
“This research marks the first time we’ve been able to identify genes involved in the ability to quit smoking,” says NIDA Director Dr. Nora D. Volkow. “It marks a movement from identifying the genetics of addiction vulnerability to identifying the genetic basis of successful abstinence. This knowledge could impact the success rate of cessation programs by helping health care providers choose the most appropriate treatment based on individual differences.”
Dr. Uhl and his colleagues performed a genome-wide analysis on the DNA of two types of nicotine-dependent individuals, one that was able to successfully quit the cigarette- smoking behavior and one that was not.
“We identified 221 genes that distinguished successful quitters from those who were unsuccessful,” says Dr. Uhl. “We know the functions of about 187 of these genes, but 34 have functions that are unknown at present. We also found that at least 62 of the genes that we had previously identified as playing roles in dependence to other drugs also contribute to nicotine dependence.”
Roche's Avastin Approved in Europe for Breast Cancer
Swiss drugmaker Roche said on Thursday that Avastin had been approved in Europe for the treatment of women with metastatic breast cancer.
The European Commission had approved Avastin for the first line treatment of women with metastatic breast cancer in combination with paclitaxel, Roche said in a statement.
The European Commission had approved Avastin for the first line treatment of women with metastatic breast cancer in combination with paclitaxel, Roche said in a statement.
New Test for Prostate Cancer May Reduce Biopsies
A new test for prostate cancer, which measures levels of the prostate cancer gene 3 (PCA3) in urine, may be useful in diagnosing prostate cancer in men who have elevated serum levels of prostate-specific antigen (PSA) but a negative biopsy and save these men from having unnecessary repeat biopsies. The conclusion comes from a study in 226 subjects reported in the March issue of Urology. This population of men with elevated serum PSA levels and a negative biopsy represent an "especially problematic group," say the researchers. An elevated serum PSA may be a sign of prostate cancer, but it may also be a false positive result due to benign prostatic hyperplasia (BPN), so these men undergo repeat biopsies. This incurs costs and carries a risk for morbidity as well as emotional turmoil, but at the moment, it is the only way to check whether there is cancer present or not. PSA is not very good at predicting whether the biopsy will find cancer — in fact, it offers "little better than a coin-toss probability," the researchers comment. This is because PSA is specific for the prostate, but it is not specific for prostate cancer.In contrast, the new PCA3 test measures levels of a gene that is overexpressed by prostate cancer cells but is not produced (or is produced only in very small amounts) by normal cells, even in BPN. The current study concludes that test was 72% specific for prostate cancer.The PCA3 urine test, known as the Progensa PCA3 Assay, was developed by Gen-Probe and was launched in Europe in November 2006. It is currently available in the United States as an analyte-specific reagent from several laboratories and is covered by several insurers. The company is planning to apply for Food and Drug Administration approval for the test.
Biopsy May Underestimate Prostate Cancer in Larger Men
Biopsies for prostate cancer in men who are overweight or obese may be misleading and may underestimate how aggressive the tumor really is, which in turn could result in treatment that is inadequate or inappropriate. This is one of the clinical implications of a new finding reported in the March issue of Urology. "We must keep in mind that even if a well-done biopsy shows a low-grade cancer in an obese patient, there is still a reasonable likelihood that the patients may have high-grade disease," says the lead author, Stephen Freeland, MD, from the Duke University Prostate Center, in Durham, North Carolina. "If we can determine through additional biopsies that an obese or overweight man has more aggressive prostate cancer, we can discuss whether the cancer should be treated with more than 1 approach, such as combining hormonal therapy with radiation," he commented in a press release. In the past, biopsy for prostate cancer was based on a standard of 6 samples, and some people still do that, but this is inadequate, Dr. Freeland told Medscape. The normal procedure today is to take 10 to 12 samples, but for obese men or those with large prostates, he recommends 14. Study Identified Discrepancies The finding comes from a study of 1100 men with prostate cancer who were identified in the Shared Equal Access Regional Cancer Hospital (SEARCH) database, which covers several hospitals in the California area as well as Durham.All the men had undergone a radical prostatectomy (RP). Dr. Freeland and colleagues compared the results obtained on examining the removed prostate tissue with the results obtained from biopsies performed before the operation and found discrepancies. The Gleason grading for the tumor matched in only 62% of cases. Most of the mismatched cases were upgraded (27%), as the grading of the tumor on RP was higher than that from the biopsy. Relatively few cases (11%) were downgraded. After adjustment for clinical covariates, upgrading was associated with an increased risk for biochemical progression, and downgrading was associated with a decreased risk for progression
Buprenorphine-Naloxone May Effectively Treat Opioid Addiction
In a nonresearch primary care setting, opioid-addicted patients can be effectively treated with buprenorphine-naloxone, according to the results of a study reported in the March/April issue of the Annals of Family Medicine.
"Office-based treatment of opioid addiction with a combination of buprenorphine and naloxone was approved in 2002," write Ira L. Mintzer, MD, from the Harvard Medical School/Cambridge Health Alliance in Cambridge, Massachusetts, and colleagues. "Efficacy of this treatment in nonresearch clinical settings has not been studied.... Opiate-agonist pharmacotherapy has been shown to decrease illicit opiate use."
The investigators studied a cohort of 99 consecutive patients enrolled in buprenorphine-naloxone treatment of opioid dependence at 2 urban primary care practices: a hospital-based primary care clinic and a primary care practice in a free-standing neighborhood health center. The main endpoint was sobriety at 6 months as determined by the treating clinician based on periodic urine drug tests, frequent physical examinations, and questioning the patients about substance use.
At 6 months, 54% of patients were sober. These success rates, which range from 50% to 60%, were similar to those reported from more specialized treatment centers using methadone or L-alpha-acetylmethadol.
Site of care, drug of choice, neighborhood poverty level, and dose of buprenorphine-naloxone were not significant predictors of sobriety. However, sobriety was correlated with private insurance status, older age, length of treatment, and attending self-help meetings.
There was 1 adverse patient event: an unexpected cardiac death. Because of the small sample size and the lack of a control group, it could not be determined whether buprenorphine treatment caused this death.
"Opioid-addicted patients can be safely and effectively treated in nonresearch primary care settings with limited on-site resources," the authors write. "Our findings suggest that greater numbers of patients should have access to buprenorphine-naloxone treatment in nonspecialized settings."
"Office-based treatment of opioid addiction with a combination of buprenorphine and naloxone was approved in 2002," write Ira L. Mintzer, MD, from the Harvard Medical School/Cambridge Health Alliance in Cambridge, Massachusetts, and colleagues. "Efficacy of this treatment in nonresearch clinical settings has not been studied.... Opiate-agonist pharmacotherapy has been shown to decrease illicit opiate use."
The investigators studied a cohort of 99 consecutive patients enrolled in buprenorphine-naloxone treatment of opioid dependence at 2 urban primary care practices: a hospital-based primary care clinic and a primary care practice in a free-standing neighborhood health center. The main endpoint was sobriety at 6 months as determined by the treating clinician based on periodic urine drug tests, frequent physical examinations, and questioning the patients about substance use.
At 6 months, 54% of patients were sober. These success rates, which range from 50% to 60%, were similar to those reported from more specialized treatment centers using methadone or L-alpha-acetylmethadol.
Site of care, drug of choice, neighborhood poverty level, and dose of buprenorphine-naloxone were not significant predictors of sobriety. However, sobriety was correlated with private insurance status, older age, length of treatment, and attending self-help meetings.
There was 1 adverse patient event: an unexpected cardiac death. Because of the small sample size and the lack of a control group, it could not be determined whether buprenorphine treatment caused this death.
"Opioid-addicted patients can be safely and effectively treated in nonresearch primary care settings with limited on-site resources," the authors write. "Our findings suggest that greater numbers of patients should have access to buprenorphine-naloxone treatment in nonspecialized settings."
MRI Detects Breast Cancer Missed by Mammography
At the time when cancer is diagnosed in one breast, magnetic resonance imaging (MRI) can detect cancer in the other breast that has been missed by mammography and clinical examination, which is the current practice standard.
These findings come from a study involving 969 women, and MRI detected cancer in 30 of the women, giving an additional diagnostic yield of 3.1%. The results are reported in the March 29 issue of The New England Journal of Medicine.
"Our study shows that MRI can improve the detection of cancer in the contralateral breast when added to a thorough breast examination and mammographic evaluation at the time of the initial diagnosis of cancer," write the authors. Led by Constance D. Lehman, MD, PhD, from the University of Washington in Seattle, the researchers represent the American College of Radiology Imaging Network (ACRIN) Trial 6667 Investigators Group, a co-operative group sponsored by the National Cancer Institute (NCI).
"The current cost of MRI precludes its widespread use in general population, but this imaging tool appears to increase the detection of cancer in women at increased risk, such as women with a recent diagnosis of breast cancer," the authors comment.
"One in ten women diagnosed with cancer in one breast will develop the disease in the opposite breast. Having a better technique to find these cancers as early as possible will increase the chances of successful treatment," the National Institutes of Health director Elias Zerhouni, MD, stated in a press release.
These findings come from a study involving 969 women, and MRI detected cancer in 30 of the women, giving an additional diagnostic yield of 3.1%. The results are reported in the March 29 issue of The New England Journal of Medicine.
"Our study shows that MRI can improve the detection of cancer in the contralateral breast when added to a thorough breast examination and mammographic evaluation at the time of the initial diagnosis of cancer," write the authors. Led by Constance D. Lehman, MD, PhD, from the University of Washington in Seattle, the researchers represent the American College of Radiology Imaging Network (ACRIN) Trial 6667 Investigators Group, a co-operative group sponsored by the National Cancer Institute (NCI).
"The current cost of MRI precludes its widespread use in general population, but this imaging tool appears to increase the detection of cancer in women at increased risk, such as women with a recent diagnosis of breast cancer," the authors comment.
"One in ten women diagnosed with cancer in one breast will develop the disease in the opposite breast. Having a better technique to find these cancers as early as possible will increase the chances of successful treatment," the National Institutes of Health director Elias Zerhouni, MD, stated in a press release.
Fish Oil Sinks Coronary Event Rates When Added to Statins
KOBE, Japan, March 30 -- Fish-oil supplements added to statin therapy can further reduce the risk of major coronary events, even among patients who already eat a diet heavy in fish, investigators here reported.
Among more than 18,000 patients with hypercholesterolemia and a history of coronary artery disease, the addition to statins of eicosapentaenoic acid, a long-chain-n-3 fatty acid in fish oil, reduced the occurrence of major coronary events by 19% over statins alone, reported Mitsuhiro Yokoyama, M.D., from Kobe University here, and colleagues.
Eicosapentaenoic acid, (EPA) was associated with significant reductions in unstable angina and non-fatal coronary events, but there were no differences in either sudden cardiac death or coronary death, the investigators in the Japan EPA Lipid Intervention Study (JELIS).wrote in the March 31 issue of The Lancet.
In an accompanying editorial, Dariush Mozaffarian, M.D., Dr.P.H., of the Harvard School of Public Health commented that the findings lack the flash of clinical trial results on blockbuster drugs, but they show that a low-risk and inexpensive intervention could have a major effect on health
"We must curb our infatuation with downstream risk factors and treatments, and focus on the fundamental risk factors for cardiovascular disease: dietary habits, smoking, and physical activity," he wrote. "If the millions of heart attacks occurring each year were not a clarion call, the obesity epidemic certainly should be. The JELIS investigators should be commended, and their efforts should inspire additional clinical trials of the effects of fish oil and other dietary factors and habits on cardiovascular health."
The JELIS investigators recruited 18,645 patients from 1996 to 1999, with a total cholesterol of 6.5 mmol/L (253 mg/dL) or greater. The patients were randomly assigned to 1,800 mg of EPA daily with a statin (9,326 patients) or statin therapy alone (9,319).
Among more than 18,000 patients with hypercholesterolemia and a history of coronary artery disease, the addition to statins of eicosapentaenoic acid, a long-chain-n-3 fatty acid in fish oil, reduced the occurrence of major coronary events by 19% over statins alone, reported Mitsuhiro Yokoyama, M.D., from Kobe University here, and colleagues.
Eicosapentaenoic acid, (EPA) was associated with significant reductions in unstable angina and non-fatal coronary events, but there were no differences in either sudden cardiac death or coronary death, the investigators in the Japan EPA Lipid Intervention Study (JELIS).wrote in the March 31 issue of The Lancet.
In an accompanying editorial, Dariush Mozaffarian, M.D., Dr.P.H., of the Harvard School of Public Health commented that the findings lack the flash of clinical trial results on blockbuster drugs, but they show that a low-risk and inexpensive intervention could have a major effect on health
"We must curb our infatuation with downstream risk factors and treatments, and focus on the fundamental risk factors for cardiovascular disease: dietary habits, smoking, and physical activity," he wrote. "If the millions of heart attacks occurring each year were not a clarion call, the obesity epidemic certainly should be. The JELIS investigators should be commended, and their efforts should inspire additional clinical trials of the effects of fish oil and other dietary factors and habits on cardiovascular health."
The JELIS investigators recruited 18,645 patients from 1996 to 1999, with a total cholesterol of 6.5 mmol/L (253 mg/dL) or greater. The patients were randomly assigned to 1,800 mg of EPA daily with a statin (9,326 patients) or statin therapy alone (9,319).
Heart Risk Prompts FDA to Pull IBS Agent Tegaserod (Zelnorm)
ROCKVILLE, Md., March 30 -- The FDA said today that Novartis has halted sales of tegaserod (Zelnorm), its agent for irritable bowel syndrome and constipation, following suggestions of a small increase in ischemic events, including angina and stroke, in those taking the drug.
A pooled analysis of data from 29 placebo-controlled trials identified 13 ischemic events among 11,614 patients treated with tegaserod compared with a single case among 7,013 placebo-treated patients. The rate of ischemic events was 0.11% in the tegaserod patients versus 0.01% in the placebo group, a difference that Novartis said was not statistically significant.
One of the 13 events was fatal versus no ischemic deaths in the placebo patients.
The withdrawal came at the request of the FDA. Novartis disagreed that there was any causal link between the drug and the events. Novartis continues to believe that the drug "provides important benefits for appropriate patients suffering from irritable bowel syndrome with constipation."
The ischemic events came to light after Swiss health authorities asked Novartis to analyze trial results to identify all ischemic events. An earlier analysis found an increased rate of ischemic colitis and the FDA requested that those data be added to the tegaserod label in 2004.
In 2002 the FDA approved tegaserod for treatment of IBS-c in women and in 2004 expanded the indications to include treatment of idiopathic chronic constipation in men and women younger than 65.
A pooled analysis of data from 29 placebo-controlled trials identified 13 ischemic events among 11,614 patients treated with tegaserod compared with a single case among 7,013 placebo-treated patients. The rate of ischemic events was 0.11% in the tegaserod patients versus 0.01% in the placebo group, a difference that Novartis said was not statistically significant.
One of the 13 events was fatal versus no ischemic deaths in the placebo patients.
The withdrawal came at the request of the FDA. Novartis disagreed that there was any causal link between the drug and the events. Novartis continues to believe that the drug "provides important benefits for appropriate patients suffering from irritable bowel syndrome with constipation."
The ischemic events came to light after Swiss health authorities asked Novartis to analyze trial results to identify all ischemic events. An earlier analysis found an increased rate of ischemic colitis and the FDA requested that those data be added to the tegaserod label in 2004.
In 2002 the FDA approved tegaserod for treatment of IBS-c in women and in 2004 expanded the indications to include treatment of idiopathic chronic constipation in men and women younger than 65.
Sunday, April 01, 2007
'Functional Foods': Healthy or Hype?
Experts weigh in on gastro-friendly yogurts, vitamin-rich water
By E.J. MundellHealthDay Reporter
SUNDAY, April 1 (HealthDay News) -- The line between the supermarket and drug store keeps getting fuzzier.
Television commercials for Danone's "Activia" line of yogurts claim it's just the thing for folks struggling with what gastroenterologists call "slow transit time."
Switch the channel, and ads for sterol-enriched Becel margarine trumpet its cholesterol-lowering goodness.
Then there are the new "fitness waters," loaded with antioxidant vitamins.
Each of these products cost more than "regular" yogurts, margarines and bottled waters. But are they worth it?
"It's a personal choice," said Patricia Vasconcellos, a Boston dietitian, diabetes expert and spokeswoman for the American Dietetic Association. She said that most of these "functional food" products do deliver on their promises -- but that doesn't mean everyone needs them, or stands to benefit equally.
Take the example of the margarines, cooking oils, milk drinks and other members of the Becel line of cholesterol-lowering foods. Fortified with plant sterols and stenols, they hit supermarket shelves in the late 1990s and can cost twice as much as regular butter or margarine.
"In studies, sterols and stenols have been proven to lower your total cholesterol and your LDL 'bad' cholesterol,'" Vasconcellos said. In fact, according to information on the Becel Web site, clinical-trial participants who took in 2 grams of sterols per day from these products saw a 10 percent to 15 percent drop in LDL within "a few weeks."
Vasconcellos said the spreads "can be expensive. But if you just use it for toast or a potato, instead of cooking with it, that's much cheaper. For cooking, I'd recommend other healthy fats, such as olive or canola oil."
She said that even people who take a cholesterol-lowering statin drug such as Lipitor, Pravachol or Zocor may still benefit from sterol-containing products. "It will only enhance the effect, and work with the statin," Vasconcellos said.
By E.J. MundellHealthDay Reporter
SUNDAY, April 1 (HealthDay News) -- The line between the supermarket and drug store keeps getting fuzzier.
Television commercials for Danone's "Activia" line of yogurts claim it's just the thing for folks struggling with what gastroenterologists call "slow transit time."
Switch the channel, and ads for sterol-enriched Becel margarine trumpet its cholesterol-lowering goodness.
Then there are the new "fitness waters," loaded with antioxidant vitamins.
Each of these products cost more than "regular" yogurts, margarines and bottled waters. But are they worth it?
"It's a personal choice," said Patricia Vasconcellos, a Boston dietitian, diabetes expert and spokeswoman for the American Dietetic Association. She said that most of these "functional food" products do deliver on their promises -- but that doesn't mean everyone needs them, or stands to benefit equally.
Take the example of the margarines, cooking oils, milk drinks and other members of the Becel line of cholesterol-lowering foods. Fortified with plant sterols and stenols, they hit supermarket shelves in the late 1990s and can cost twice as much as regular butter or margarine.
"In studies, sterols and stenols have been proven to lower your total cholesterol and your LDL 'bad' cholesterol,'" Vasconcellos said. In fact, according to information on the Becel Web site, clinical-trial participants who took in 2 grams of sterols per day from these products saw a 10 percent to 15 percent drop in LDL within "a few weeks."
Vasconcellos said the spreads "can be expensive. But if you just use it for toast or a potato, instead of cooking with it, that's much cheaper. For cooking, I'd recommend other healthy fats, such as olive or canola oil."
She said that even people who take a cholesterol-lowering statin drug such as Lipitor, Pravachol or Zocor may still benefit from sterol-containing products. "It will only enhance the effect, and work with the statin," Vasconcellos said.
Study identifies multiple genetic risk factors for prostate cancer
A study led by researchers at the Keck School of Medicine of the University of Southern California (USC) and Harvard Medical School has identified seven genetic risk factors—DNA sequences carried by some people but not others—that predict risk for prostate cancer. According to the study's findings, these risk factors are clustered in a single region of the human genome on chromosome 8 and powerfully predict a man's probability of developing prostate cancer. The paper will be published in the online edition of Nature Genetics on April 1.
"The study has identified combinations of genetic variants that predict more than a fivefold range of risk for prostate cancer," says senior author David Reich, assistant professor of genetics at Harvard Medical School and associate member of the Broad Institute of Harvard and MIT. "Both high- and low-risk combinations of variants are common in human populations."
"The identification of these genetic variants is an important step in helping us understand the higher risk for prostate cancer in African Americans compared with other U.S. populations and, more importantly, why some men develop prostate cancer and others do not," says lead author Christopher Haiman, assistant professor of preventive medicine at the Keck School of Medicine of USC
"The study has identified combinations of genetic variants that predict more than a fivefold range of risk for prostate cancer," says senior author David Reich, assistant professor of genetics at Harvard Medical School and associate member of the Broad Institute of Harvard and MIT. "Both high- and low-risk combinations of variants are common in human populations."
"The identification of these genetic variants is an important step in helping us understand the higher risk for prostate cancer in African Americans compared with other U.S. populations and, more importantly, why some men develop prostate cancer and others do not," says lead author Christopher Haiman, assistant professor of preventive medicine at the Keck School of Medicine of USC
How Web 2.0 is changing medicine
Is a medical wikipedia the next step?
Few concepts in information technology create more confusion than Web 2.0. The truth is that Web 2.0 is a difficult term to define, even for web experts.1 Nebulous phrases like "the web as platform" and "architecture of participation" are often used to describe Web 2.0. Medical librarians suggest that rather than intrinsic benefits of the platform itself, it's the spirit of open sharing and collaboration that is paramount.2 The more we use, share, and exchange information on the web in a continual loop of analysis and refinement, the more open and creative the platform becomes; hence, the more useful it is in our work.
What seems clear is that Web 2.0 brings people together in a more dynamic, interactive space. This new generation of internet services and devices—often referred to as social software—can be leveraged to enrich our web experience, as information is continually requested, consumed, and reinterpreted. The new environment features a highly connected digital network of practitioners (medical or otherwise), where knowledge exchange is not limited or controlled by private interests. For me, the promise of open access in Web 2.0—freed of publishing barriers and multinational interests—is especially compelling.
Web 2.0 is primarily about the benefits of easy to use and free internet software. For example, blogs and wikis facilitate participation and conversations across a vast geographical expanse. Information pushing devices, like RSS feeds, permit continuous instant alerting to the latest ideas in medicine.3 Helpful but lesser known website tagging and organising tools, such as Connotea and Del.icio.us, are proving useful (table). Multimedia tools like podcasts and videocasts are increasingly popular in medical schools and medical journals.4 (This bird's eye view of social software can be fully explored with your favourite medical librarian, after the holidays.)
Few concepts in information technology create more confusion than Web 2.0. The truth is that Web 2.0 is a difficult term to define, even for web experts.1 Nebulous phrases like "the web as platform" and "architecture of participation" are often used to describe Web 2.0. Medical librarians suggest that rather than intrinsic benefits of the platform itself, it's the spirit of open sharing and collaboration that is paramount.2 The more we use, share, and exchange information on the web in a continual loop of analysis and refinement, the more open and creative the platform becomes; hence, the more useful it is in our work.
What seems clear is that Web 2.0 brings people together in a more dynamic, interactive space. This new generation of internet services and devices—often referred to as social software—can be leveraged to enrich our web experience, as information is continually requested, consumed, and reinterpreted. The new environment features a highly connected digital network of practitioners (medical or otherwise), where knowledge exchange is not limited or controlled by private interests. For me, the promise of open access in Web 2.0—freed of publishing barriers and multinational interests—is especially compelling.
Web 2.0 is primarily about the benefits of easy to use and free internet software. For example, blogs and wikis facilitate participation and conversations across a vast geographical expanse. Information pushing devices, like RSS feeds, permit continuous instant alerting to the latest ideas in medicine.3 Helpful but lesser known website tagging and organising tools, such as Connotea and Del.icio.us, are proving useful (table). Multimedia tools like podcasts and videocasts are increasingly popular in medical schools and medical journals.4 (This bird's eye view of social software can be fully explored with your favourite medical librarian, after the holidays.)
Gender linked to development of skin cancer
COLUMBUS, Ohio -- Inherent gender differences – instead of more sun exposure – may be one reason why men are three times more likely than women to develop certain kinds of skin cancer, say researchers at Ohio State University Medical Center.
Squamous cell carcinoma is the second most common form of skin cancer, accounting for nearly 200,000 new cases in the United States each year. While occurring more often than melanoma, squamous cell carcinoma is not nearly as worrisome. Still, it can be lethal in some patients, especially those with suppressed immune systems, including transplant recipients or people who are HIV-positive.
Many studies have shown that the risk of squamous cell carcinoma increases with greater exposure to the sun. For years, investigators assumed that lifestyle had a lot to do with the disparity in the incidence of SCC – believing that men spend more time outside and are less likely to use sun protection than women.
While that may be true, scientists at Ohio State have shown that there may be another, even more critical factor involved – gender-linked differences in the amount of naturally occurring antioxidants in the skin.
The study appears in the April 1 issue of Cancer Research.
Squamous cell carcinoma is the second most common form of skin cancer, accounting for nearly 200,000 new cases in the United States each year. While occurring more often than melanoma, squamous cell carcinoma is not nearly as worrisome. Still, it can be lethal in some patients, especially those with suppressed immune systems, including transplant recipients or people who are HIV-positive.
Many studies have shown that the risk of squamous cell carcinoma increases with greater exposure to the sun. For years, investigators assumed that lifestyle had a lot to do with the disparity in the incidence of SCC – believing that men spend more time outside and are less likely to use sun protection than women.
While that may be true, scientists at Ohio State have shown that there may be another, even more critical factor involved – gender-linked differences in the amount of naturally occurring antioxidants in the skin.
The study appears in the April 1 issue of Cancer Research.
Women Who Exercise Into Their 70's Can Delay The Onset Of Arthritis Symptoms
Women in their 70s who keep active could be dodging painful arthritis symptoms, according to research published recently in Arthritis Research & Therapy. The study is the first to show that the more you exercise, the better your chances of preventing the onset of stiff and painful joints. Kristiann Heesch and colleagues at the University of Queensland, Australia examined data on middle-aged (48-55) and older (72-79) women collected using surveys over three years as part of the Australian Longitudinal Study on Women's Health. Excluding women who reported arthritis symptoms at the beginning of the study, the authors looked at those who began reporting stiff or painful joints 'often' and how much exercise they undertook. The results suggest that for women in the older age bracket, doing a little over an hour of moderate physical activity each week will lessen your chances of developing frequent arthritis symptoms in the next three years. Pushing that up to 2 ½ hours per week is even more likely to prevent arthritis symptoms appearing. These results were not seen for the middle-aged group.
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