EWIMA Healthcare

Whooping cough outbreak in Lake County

2008-11-20T20:07:00.000-08:00

Lake County health officials are alerting the public to "a dramatic increase" in the number of pertussis cases this year, particularly among school-aged children.

As of Nov. 20, health officials reported 82 confirmed or probable cases of pertussis so far this year, with the majority of cases occurring in children between 5 and 11 years old.
"I'd say it's a dramatic increase," said Victor Plotkin, an epidemiologist for the Lake County Health Department.

Pertussis is often known as "whooping cough" because the symptoms include a cough with a high-pitched whooping sound. Symptoms are similar to those of a common cold accompanied by coughing. Symptoms usually appear within five to 10 days of exposure but can last as long as 21 days.

Plotkin said the health department started to see an increase in pertussis cases in late spring with 11 cases in May. The number of cases reached a high of 18 cases in July, before leveling off and then spiking again this fall.

There were 10 reported pertussis cases in September, 14 in October, and 7 so far in November, he said.

"We had another wave of increase in October, especially at Townline (Elementary) School in Vernon Hills," said Plotkin. "But it's spread out throughout Lake County."
Townline Elementary School has posted a notice to parents about pertussis on the school's Web site.

"Cases of pertussis (also known as whooping cough), are cropping up around the area, including at Townline," the school's Web site states. "Parents are urged to be extra vigilant when students show symptoms, which are often similar to that of a common cold."

In addition to Vernon Hills, Plotkin said there have also been pertussis cases include Grayslake, Round Lake, Highland Park, Mundelein, Libertyville, Antioch, Waukegan, Beach Park and other areas.

"Basically, it's everywhere," he said.

The Illinois Department of Public Health reports that Lake County and Chicago are seeing an increased number of pertussis cases this year, while suburban Cook, McHenry, Stephenson, Whiteside and Winnebago counties are reporting clusters of pertussis cases in school-aged children.

Plotkin said the 82 cases in Lake County so far this year is well above normal. In 2007, there were 20 cases of pertussis and there were 68 in 2006.

Plotkin said the county did see very high numbers of cases during a nationwide outbreak of pertussis in 2004 and 2005. In 2004, there were 152 cases of pertussis and 135 cases in 2005. However, before that, pertussis cases in the county had averaged about 8 to 10 a year for many years.

Plotkin said the 2004 and 2005 pertussis outbreak appears that it may have been attributed to waning immunity among older children and adults who had not received booster shots. He said the most recent outbreak is a bit more puzzling because many of the children who are becoming ill are younger children who were recently vaccinated.

"Unfortunately, during this outbreak, even people that have been recently vaccinated are becoming sick anyway," he said. "Their symptoms are milder, but they still can pass the bacteria along to others and make others sick."

Plotkin said there have been no deaths reported because of pertussis in the county this year. However, three babies were hospitalized over the summer.

Health officials urge anyone who has a cough lasting more than a week to consult their physicians, especially if the cough becomes worse at night and has a different sound than a typical respiratory cough. Pertussis can be treated with antibiotics, which will alleviate the symptoms and help prevent its spread to others.

"People need to be especially aware because of the upcoming holidays," he said. "If they are sick or have suspicious symptoms, they should stay home."

Persons who are interested in pertussis vaccinations should call Healthy Trust Immediate Medical Care at (847) 243-0333.

Healthy Trust Can Diagnose Deep Vein Thrombosis

2008-09-16T11:40:00.000-07:00

Far too many Americans are dying of dangerous blood clots that can masquerade as simple leg pain, says a major new government effort to get both patients and their doctors to recognize the emergency in time.

"It's a silent killer. It's hard to diagnose," said acting Surgeon General Dr. Steven Galson, who announced the new campaign Monday. "I don't think most people understand that this is a serious medical problem or what can be done to prevent it."

At issue are clots with cumbersome names: A deep vein thrombosis, or DVT, forms in large veins, usually a leg or the groin. It can quickly kill if it moves up to the lungs, where it goes by the name pulmonary embolism, or PE.

These clots make headlines every few years when seemingly healthy people collapse after long airplane flights or being in similarly cramped quarters. Vice President Cheney suffered one after a long trip last year. NBC correspondent David Bloom died of one in 2003 after spending days inside a tank while covering the invasion of Iraq.

But that provides a skewed vision of the problem. While there aren't good statistics, the new surgeon general's campaign estimates that every year, between 350,000 and 600,000 Americans get one of these clots - and at least 100,000 of them die.

There are a host of risk factors and triggers: Recent surgery or a broken bone; a fall or car crash; pregnancy or taking birth control pills or menopause hormones; being immobile for long periods. The risk rises with age, especially over 65, and among people who smoke or are obese.

And some people have genetic conditions that cause no other symptoms but increase their risk, making it vital to tell your doctor if a relative has ever suffered a blood clot.

People with those factors should have "a very low threshold" for calling a doctor or even going to the emergency room if they have symptoms of a clot, said Galson, who issued a "call to action" for better education of both consumers and doctors, plus more research.

Symptoms include swelling; pain, especially in the calf; or a warm spot or red or discolored skin on the leg; shortness of breath or pain when breathing deeply.

But here's the rub: Doctors are ill-informed, too. For example, studies suggest a third of patients who need protective blood thinners when they enter the hospital for major surgery don't get them. And patients can even be turned away despite telltale symptoms, like happened to Le Keisha Ruffin just weeks after the birth of her daughter, Caitlyn.

Ruffin made repeated visits to doctors and emergency rooms for growing pain in her leg and groin in December 2003 and January 2004, but was told it must be her healing Caesarean section scar.

Finally one night, Ruffin's husband ran her a really hot bath for pain relief - only to have her climb out minutes later with her leg swollen three to four times its normal size, and then pass out.

"I like to call that my miracle bath," Ruffin said, because the sudden swelling proved the tip-off for doctors.

Pieces of a giant clot in her right leg had broken off and floated to her lung. The ER doctor "said if I hadn't made it in when I did, I may not have lived through the rest of the night," recalled Ruffin, now 32, who spent a month in the hospital and required extensive physical therapy to walk normally again.

These clots "tend to fall through the cracks" because they cross so many areas of medicine, said Dr. Samuel Goldhaber, chairman of the Venous Disease Coalition and a cardiologist at Boston's Brigham & Women's Hospital.

With the surgeon general's campaign, "DVT after all these years will finally get the national spotlight like cigarette smoking did in the mid-60s," he said.

In addition to Galson's report:

-The Agency for Healthcare Research and Quality is issuing a 12-page booklet to help consumers tell if they're at risk for DVTs and what to do - and a 60-page DVT treatment-and-prevention guide for doctors and hospitals.

-As a prevention incentive, starting Oct. 1 Medicare will withhold payment from hospitals when patients develop the clots after knee- or hip-replacement surgery.

Healthy Trust Immediate Medical Care can diagnose DVT right in the office using ultrasound in only a few minutes without an appointment.

Get ready for the 2008-2009 Flu Season

2008-09-15T14:20:00.000-07:00

Healthy Trust Immediate Medical Care is your official Chicago North Shore Flu Clinic. We provide low cost flu vaccinations to help make sure you will stay healthy this winter.

If you do happen to get the flu this year we use the latest techniques to make sure that you will recover and get back to your daily routine quicker.

Influenza is a viral infection that sickens millions of people each year and can cause serious complications, especially in children and older adults. Fortunately, the flu vaccine available in the form of a flu shot or a nasal spray offers protection against the flu.

When is the flu vaccine available?

The flu vaccine is generally offered between September and mid-November, which is typically before the late-fall or early winter start to flu season.

What kind of protection does the flu vaccine offer?

A flu shot is between 70 percent and 90 percent effective in warding off illness, depending on the length and intensity of a given flu season and your overall health. In a few cases, people who get a flu shot may still get the flu, but they'll get a much less virulent form of the illness and, most important, they'll have a decreased risk of flu-related complications especially pneumonia, heart attack, stroke and death to which older adults are especially vulnerable.

A study published in 2006 showed that the nasal spray flu vaccine (FluMist) was only between 30 percent and 57 percent effective in preventing the flu in adults. However, another study in 2006 found that giving nasal spray vaccine to school-age children helped reduce the spread of flu in the community. And in 2007, researchers compared the effectiveness of FluMist with the flu shot in children ages 6 months to 5 years. The children treated with FluMist experienced about half as many cases of flu as did those who received the shot. However, FluMist increases the risk of wheezing in this age group especially in those who already have asthma or recurrent wheezing and in all children under age 2. In 2007, the Food and Drug Administration (FDA) therefore approved FluMist for children older than 2 years who don't have asthma or recurrent wheezing. Consult with your doctor about which form of vaccination may be best for you or your child.

Why do I need to get vaccinated every year?

You need annual flu protection because the vaccine changes from year to year. The flu vaccine you got last year wasn't designed to fight the virus strains in circulation this 2008-2009 flu season.

Influenza viruses mutate so quickly that they can render one season's vaccine ineffective by the next season. A Centers for Disease Control and Prevention (CDC) advisory committee meets early in the year to estimate which strains of influenza virus will be most prevalent during the upcoming flu season, and manufacturers produce vaccine based on those recommendations.

Will this year's vaccine protect me against the flu?

The flu vaccine protects against the three main flu strains that research indicates will cause the most illness during the flu season. This years influenza vaccine contains three new influenza virus strains.

They are:

A/Brisbane/59/2007(H1N1)-like virus
A/Brisbane/10/2007 (H3N2)-like virus
B/Florida/4/2006-like virus.

The 2008-09 influenza vaccine can protect you from getting sick from these three viruses, or it can make your illness milder if you get a related but different strain of flu virus.

What are my options for the flu vaccine?

The flu vaccine comes in two forms:

A shot

A flu shot contains an inactivated vaccine made of killed virus. The shot is usually given in the arm. Because the viruses in the vaccine are killed (inactivated), the shot won't cause you to get the flu, but it will enable your body to develop the antibodies necessary to ward off influenza viruses. You may have a slight reaction to the shot, such as soreness at the injection site, mild muscle ache or fever. Reactions usually last one to two days and are more likely to occur in children who have never been exposed to the flu virus.

A nasal spray

Administered through your nose, the nasal spray vaccine (FluMist) consists of a low dose of live, but weakened, flu viruses. The vaccine doesn't cause the flu, but it does prompt an immune response in your nose and upper airways as well as throughout your body.

Who should get the flu vaccine?

Most people who want to reduce the risk of having influenza can get a flu shot. The CDC recommends the flu vaccine in particular if you:

Are age 6 months to 4 years

Are a child on long-term aspirin therapy

Are pregnant

Are 50 years old or older

Have a chronic medical condition such as asthma, diabetes or heart, kidney or lung disease

Have a weakened immune system such as from medications or HIV infection

Are a resident of a nursing home or other long term care facility

Are a child care worker or health care worker or live with or care for someone at high risk of complications from the flu

Who shouldn't get the flu shot?

Don't get a flu shot if you:

Have had an allergic reaction to the vaccine in the past.

Are allergic to chicken eggs.

Developed Guillain-Barre syndrome, a serious autoimmune disease affecting the nerves outside the brain and spinal cord, within six weeks of receiving the vaccine in the past. People who have experienced Guillain-Barre after the flu vaccine are at higher risk than are others of developing it again.

Have a fever. Wait until your symptoms improve before getting vaccinated.

Why do children need two doses of the flu vaccine?

Children younger than 9 years old require two doses of the flu vaccine if it's the first time they've been vaccinated for influenza. That's because children don't develop an adequate antibody level the first time they get the vaccine. Antibodies help fight the virus if it enters your child's system. If a flu vaccine shortage was to occur and your child couldn't get two doses of vaccine, one dose might still offer some protection.

I heard the flu shot isn't very effective for older adults. Is it worth getting vaccinated if you're over 65?

If you're over age 65, the vaccine doesn't offer as much protection as it would to someone younger because older adults produce fewer antibodies in response to the virus. Still, the vaccine offers more protection than does skipping the shot altogether. More important, the flu vaccine decreases the risk of flu-related complications especially pneumonia, heart attack, stroke and death to which older adults are especially vulnerable.

Will the flu shot protect against bird flu if there's an outbreak among humans?

An annual flu shot won't protect you specifically from bird flu, but it will reduce the risk of simultaneous infection with human and bird flu viruses. This is important because simultaneous infections are the main way that viruses swap genes and create new strains that potentially can cause flu pandemics.

Can I lower my risk of the flu without getting a flu shot?

With or without a flu shot, you can take steps to help protect yourself from the flu and other viruses.

Practice good hygiene Good hygiene remains your primary defense against contagious illnesses.

Wash your hands thoroughly and often with soap and water or an alcohol-based sanitizer containing at least 60 percent alcohol.

Avoid touching your eyes, nose or mouth whenever possible.

Avoid crowds when the flu is most prevalent in your area.

Cover your mouth and nose with a tissue when you cough or sneeze.

If I've already had the flu, can I get it again?

Once you've had the flu, you develop antibodies to the viral strain that caused it. But those antibodies won't protect you from new or mutated strains of influenza or other viruses.

What should I do if I get the flu?

First of all, don't go to work or school you'll risk spreading this contagious disease to others.

To relieve your symptoms:

Drink plenty of fluids.

Avoid alcohol and tobacco.

Consider over-the-counter medicine such as acetaminophen (Tylenol, others) to ease the discomfort associated with muscle aches or fever, but don't give aspirin to children or teenagers because of the risk of the rare but serious disease, Reye's syndrome. And keep in mind that acetaminophen can cause severe liver damage if taken in excess.

Use antiviral medications if prescribed by your doctor, but no longer than recommended. Be sure to monitor yourself. If you start feeling worse, consult your doctor to make sure you're not developing a flu-related complication.

What kind of complications can arise from the flu?

Complications include bacterial infection, pneumonia and dehydration. If you have a chronic medical condition, you may experience a worsening of that condition. Children can develop sinus and ear infections.

Is there any medicine to treat the flu?

Antivirals work both to prevent the flu and to help reduce the severity and duration of the illness by a day or two. Antiviral medications must be taken within 48 hours of the onset of your symptoms and are available only by prescription. Ask your doctor about getting a rapid flu test that can verify within a few hours whether you have the flu.

These two antivirals are recommended for treating the flu virus:

Zanamivir (Relenza)

Oseltamivir (Tamiflu)

Each of these drugs can cause side effects, including lightheadedness, nausea, loss of appetite and difficulty breathing. They can also lead to the development of antiviral-resistant viruses.
People with the flu, particularly children, who take Tamiflu may be at increased risk of self-injury and confusion. The FDA recommends that individuals with the flu who take Tamiflu be closely monitored for signs of unusual behavior. In July 2007, the FDA approved two lower dose versions of Tamiflu for children. Still, discuss possible side effects with your doctor before starting any antiviral medication.

Your best bet for treating flu symptoms remains the tried and true:

Rest.

Get plenty of fluids.

Take acetaminophen or ibuprofen (Advil, Motrin, others) for aches and pains.

Come see the doctors at Healthy Trust Immediate Medical Care.

It's also important to eat healthy and get some daily activity to help keep your immune system in top form.

Healthy Trust Immediate Medical Care is the official flu clinic of the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Popcorn safe for bowel condition

2008-09-07T20:46:00.000-07:00

Men with abnormal pouches in their bowels can safely eat nuts and popcorn, and those foods may even lower the chance of intestinal flare-ups, a study found.

The University of Washington research, published in the Journal of the American Medical Association, contradicts the advice of doctors who have told people with the condition known as diverticulosis to avoid those products. No studies have shown that to be true, the researchers said.

One-third of the U.S. population will develop the condition by age 60, the researchers said. Inflammation, bleeding and obstructions may result, and treatment costs about $2.4 billion a year. While diverticulosis remains little understood, it may be linked to too little fiber in a diet, doctors say. Nuts and popcorn are high in fiber.

"For many doctors, hopefully they will not tell their patients that they can't have some of the foods that they enjoy and may actually be good for them, such as nuts," said Jennifer Christie, an Emory University gastroenterologist in Atlanta who wasn't involved in the study.

Diverticulosis, occurs when a person has many small pouches in the lining of the large intestine, or colon, that bulge out through weak spots, causing discomfort like bloating or abdominal pain, according to the U.S. National Institutes of Health. When those pouches become inflamed, diverticulitis develops, which can lead to rectal bleeding, infection or an intestinal obstruction from scarring.

Between 10 percent and 25 percent of people with diverticulosis develop diverticulitis, according to the U.S. government.

A lack of fiber can lead to constipation, which may make people strain on the toilet, increasing pressure on the colon and causing the colon lining to bulge out through weak spots. These bulges or pouches may then become inflamed when bacteria or stool are caught in them.

Patients with the condition have been told to avoid nuts, popcorn and seeds because doctors thought particles from the foods may become lodged in the pouches, causing inflammation or bleeding, according to the study.

Researchers analyzed data collected from an 18-year study that included 47,228 men ages 40 to 75 who filled out medical questionnaires about their health and diet every few years. The men didn't have diverticulosis at the start of the study.

Twenty-seven percent of men in the study ate nuts at least twice a week, and 15 percent ate corn or popcorn at least twice a week. Over the 18 years, 801 men developed diverticulitis and 383 diverticular bleeding.

The researchers found that men who ate nuts at least twice a week had a 20 percent lower risk of diverticulitis than those who ate nuts once a month. And those who ate popcorn at least twice a week had a 28 percent lower risk of the condition, compared with those who ate popcorn less than once a month.

The high amounts of fiber in nuts and popcorn may be one reason men who ate more of those foods had fewer complications from diverticulosis, said the lead author, Lisa Strate, an assistant professor of medicine at the University of Washington in Seattle. Nuts also may help reduce inflammation, she said yesterday in a telephone interview.

The study was presented last year at Digestive Disease Week, a meeting of gastroenterologists, in Washington.

Strate is studying other reasons, such as obesity and physical inactivity, that people may develop complications from diverticulosis. Future studies should look at whether high-fiber diets help, and whether a diet high in red meat contributes to complications, she said.

Does morning sickness indicate a girl?

2008-09-06T20:44:00.000-07:00

THE BELIEF:

Morning sickness means a baby girl is more likely.

THE FACTS:

Old wives' tales about predicting a baby's sex -- relying on clues like the way the woman carries and the fetal heart rate -- are usually more fantasy than fact.

But the notion that morning sickness can sometimes indicate that a girl is on the way may be an exception. A number of large studies in various countries have examined the claim, and almost all have found it to be true, with caveats. Specifically, studies have found that it applies to women with morning sickness in the first trimester, and with symptoms so severe that it leads to hospitalization, a condition known as hyperemesis gravidarum.

One of the most recent studies was conducted by epidemiologists at the University of Washington. The scientists compared 2,110 pregnant women who were hospitalized with morning sickness in their first trimester and a control group of 9,783 women who did not get severely ill. They found that the women in the first group were more likely to deliver a girl, and that those who were the sickest -- hospitalized for three days or more -- had the greatest odds: an increase of 80 percent compared with the control women.

Other studies in The Lancet and the journal Epidemiology, among others, have repeated the findings. It is thought that certain hormones produced by female fetuses may be the culprit.

THE BOTTOM LINE:

Severe morning sickness may indicate a higher likelihood that the baby will be a girl.

Can manipulating your neck lead to a stroke?

2008-09-05T20:42:00.000-07:00

THE BELIEF:

Manipulating your neck could lead to a stroke.

THE FACTS:

Manipulating your neck is supposed to relieve pain, not cause it. But years ago neurologists noticed a strange pattern of people suffering strokes shortly after seeing chiropractors, specifically for neck adjustments.

Their hypothesis was that a chiropractic technique called cervical spinal manipulation, involving a forceful twisting of the neck, could damage two major arteries that lead through the neck to the back of the brain. Strokes in people under age 45 are relatively rare, but these cervical arterial dissections are a leading cause of them.

Studies that followed suggested a link. One at Stanford that surveyed 177 neurologists found 55 patients who suffered strokes after seeing chiropractors. Another, published in the journal Neurologist, said young stroke patients were five times more likely to have had neck adjustments within a week of their strokes than a control group. It estimated an incidence of 1.3 cases for every 100,000 people under 45 receiving neck adjustments.

But other studies have cast doubt. One published this year examined 818 cases of stroke linked to arterial dissections at the back of the neck. Before their strokes, younger patients who saw chiropractors were more likely to have complained beforehand of head and neck pain -- symptoms often preceding a stroke -- suggesting they had undiagnosed dissections and had sought out chiropractors for relief, not realizing a stroke was imminent.

THE BOTTOM LINE:

Forceful neck manipulation seems to carry a small risk of arterial tears.

High risk from energy drinks

2008-09-04T20:37:00.000-07:00

When researcher Kathleen Miller persuaded the federal government to give her nearly a half-million dollars, the plan was to study "toxic jock identity." That's her term for the "hyper-attraction" some college-level male athletes have to masculinity and high-risk behaviors such as substance abuse and violence.

As an afterthought, her questionnaire asked about consumption of highly caffeinated energy drinks such as Red Bull, Monster and Rockstar.

"I threw in a few questions about energy drinks, mostly because of what I observed in a nephew of mine. He was drinking a lot of energy drinks and suddenly becoming explosive, blowing up at his family when he was never that way before. I wondered if the caffeine was part of it," said Miller, a Ph.D. researcher at the University of Buffalo's Research Institute on Addictions.

That's because the typical energy drink contains three times more caffeine than a soda pop and sometimes up to 10 times as much. A 12-ounce Coke or Pepsi has about 34 to 38 milligrams of caffeine, while the same amount of Red Bull or Monster rings up 116 to 120 milligrams.

In comparison, an espresso shot has about 75 milligrams and 12 ounces of regularly brewed coffee has roughly 250 milligrams. One difference, though, said Miller, is coffee is usually served hot so we sip it but "energy drinks you can slam right back."

The drinks are marketed primarily to 18- to 25-year-olds -- yet increasingly used by younger teens -- and have annual sales of more than $3 billion.

The more days in the past month a college student consumes an energy drink, the higher the probability of high-risk behavior, according to two Miller studies published this year. For example, students whoconsume an energy drink six or more days a month are three times more likely to smoke, abuse prescription drugs or have been in a serious fight during the previous year. Those frequent energy-drink consumers are twice as likely to experience alcohol-related problems or use marijuana, plus the energy-drink crowd will be more likely to practice unsafe sex or neglect to use a seat belt.

"This research doesn't mean the energy drinks cause the behavior," said Miller, but she does propose "frequent energy drink consumption may be a red flag or warning sign for identifying a young person at higher risk for health-compromising behavior."

Should parents be worried? Probably, and certainly more aware of the energy-drink hold on even younger people. There have been media reports of nausea, abnormal heart rhythms, profuse sweating, caffeine highs and emergency room visits at high schools and middle schools during the past academic year.

Maybe France, Turkey, Denmark, Norway, Uruguay and Iceland are onto something. These countries have all banned high-caffeine energy drinks, and Sweden only permits use with a prescription. Canada banned energy drinks until 2004 and now requires warning label cautioning against use by children or pregnant women, use in large quantities by anyone and in combination with alcohol.

What's more, Miller found two-thirds of energy drink consumers have combined energy drinks with alcohol, typically vodka, gin, whiskey or, yikes, Jagermeister.

"College kids have the misconception that you don't get a drunk with the caffeine from energy drinks," said Miller. "Their speech isn't as slurred and they have less fatigue, so they can dance until 3 but still wrap a car around a tree on the way home. And bartenders can't tell as easily who to stop serving."

Dr. Mary Claire O'Brien of Wake Forest University Baptist Medical Center has described the energy-drink cocktail effect as "you're every bit as drunk, you're just an awake drunk."
O'Brien surveyed students at 10 North Carolina universities about energy drink and alcohol trends. She published a 2007 study showing that students who mix energy drinks with liquor got drunk twice as often as those who consumed alcohol only and were far more likely to be injured or require medical attention. Energy drink users were additionally more likely to be perpetrators or victims of aggressive sexual behavior.

Miller said that she has appeared on call-in radio shows in which students have provided a range of responses from "no problem" to "horror stories."

"Some teens, as you might expect, called assuring me they drink lots of energy drink with no problems," said Miller, who has a grant proposal with the National Institutes of Health to find out where energy drinks users will be five years from now. "But other young callers talked about drinking three or four energy drinks in a row, then not being able to drive a car or feeling bad enough to go to an emergency room."

Breast-feeding may cut risk of aggressive cancer

2008-09-03T20:34:00.000-07:00

Science has proved that mothers and babies benefit from breast-feeding in all sorts of ways, and now researchers at the Fred Hutchinson Cancer Research Center have shown that this practice can reduce the risk of a particularly aggressive form of breast cancer.

"It's a form more common among younger women and African-American women," said Amanda Phipps, a scientist in the public health division of the Seattle cancer center and lead author of a report published Monday in the journal Cancer. "We wanted to find out what puts women at risk for this."

The aggressive cancer type is called "triple negative" breast cancer because the tumor doesn't respond to a critical regulatory protein known as "HER2" or two key hormones, estrogen and progestin, which also are fundamental to many hormone-based treatments for breast cancer.
"That's why we can't use hormonal treatments on these tumors," Phipps said.

Triple-negative breast cancer is an aggressive cancer estimated to be involved in anywhere from 15 percent to 30 percent of all breast cancers, she said. Little is known about why some women are at higher risk of developing this form of cancer.

Phipps and her colleagues at Fred Hutchinson examined two groups of women from 55 to 79 years old with and without a diagnosis of breast cancer. They compared 1,476 women without the cancer with 1,140 women with several different forms of breast cancer including the "triple negative," the most common "luminal" form and another subtype associated only with the HER2 protein.

The researchers then examined these women with respect to their reproductive health histories including breast-feeding practices, onset of menstruation and menopause. All of these, Phipps said, provide indicators of the hormone levels over time for these women.

"We've known for a long time that breast-feeding reduces your risk of breast cancer, and that it was probably related to hormones," she said. But there has been little specific research, she said, on which hormones might affect the risk of these more aggressive forms of breast cancer.

By comparing the molecular nature of these breast cancer types with each woman's reproductive history, Phipps and her colleagues found that breast-feeding for at least six months corresponded with a lower risk of both the common luminal form as well as the triple-negative form of breast cancer. They also found that early onset of menstruation (before age 13) was associated with a higher risk of the HER2 breast cancer.

Late onset of menopause and the use of hormone treatments were found to increase the risk of luminal breast cancer. They found no risk differences associated with the number of children or the mother's age at first birth.

While it is common knowledge that female hormone levels change with the onset of menstruation or menopause, and so may be related to hormonally influenced cancer risks, it is not fully understood why breast-feeding would be correlated with this cancer-hormone link.

"One possible explanation is that while women are breast-feeding, they aren't menstruating and so their hormones aren't cycling," Phipps said.

So the more women breast-feed, she said, the less chance their hormones may have to trigger a cancer. Another theory, she said, is that breast-feeding alters breast cell structures in ways that make them less prone to develop into cancer cells.

The findings support the overall view that breast-feeding can reduce a woman's risk of cancer, Phipps said. More importantly for scientists, she said, it shows that different reproductive health behaviors have different effects on various forms of breast cancer.

"It helps explain why some women are at higher risk and also why certain therapies are not effective against these more aggressive forms of breast cancer," she said.

Brisk walking can help memory

2008-09-02T20:32:00.000-07:00

Brisk walking led to slight improvements on mental tests for older people with memory problems in what is billed as the first rigorous test of exercise on the aging brain. The results from the small Australian study were only modest. But they back up observational studies showing potential mental benefits from physical activity.

The effects of exercise were at least as good, if not better, than those seen with drugs approved to aid mental function in Alzheimer's disease, according to experts not involved in the study.

Still, the study authors cautioned that the results don't prove that exercise will produce meaningful improvement in brain function or memory. They also said the results should not be used to imply that exercise reduces the risk of dementia or Alzheimer's - that can't be determined from this type of study.

The authors said it's not clear how exercise might affect brain function; one theory is that it improves blood flow to the brain. Their study did not involve brain imaging that would have shown any changes in blood flow associated with exercise.

Results appear in Wednesday's Journal of the American Medical Association.

Study participants included 85 Australian adults aged 50 and older assigned to do at least 2 1/2 hours of weekly physical activity, mainly brisk walking, for six months. They recorded their exercise in diaries and also got phone calls and newsletters encouraging them to stick with it.
They were urged to remain active even after the initial six months, and were compared with a control group of 85 people who were not asked to exercise.

The exercise group engaged in about 20 minutes more activity a day than the control group.
After six months, the exercise group performed 1.3 points better on a 70-point scale of brain function than the non-exercise group. The effects remained at 18 months, though the difference by then, about 0.7 points, was minimal.

"To our knowledge, this is the first randomized clinical trial being published" on exercise and brain function in older adults with problems, said the lead author Dr. Nicola Lautenschlager of the University of Melbourne.

"It's an important piece in that it's the first intervention in people with memory complaints that's showing some potential benefit," said Dr. Raj Shah, director of the memory clinic at Rush University Medical Center. He was not involved in the study.

Shah said larger studies are needed before physical exercise would be prescribed to treat memory problems in older adults.

Dr. Ron Petersen of the Alzheimer's Association agreed that the study should not be "overhyped," but said he will use the results in discussing potential benefits of exercise with patients.

Study: No link between measles vaccine and autism

2008-09-01T20:30:00.000-07:00

New research further debunks any link between measles vaccine and autism, work that comes as the nation is experiencing a surge in measles cases fueled by children left unvaccinated.

Years of research with the measles, mumps and rubella vaccine, better known as MMR, have concluded that it doesn't cause autism. Still, some parents' fears persist, in part because of one 1998 British study that linked the vaccine with a subgroup of autistic children who also have serious gastrointestinal problems. That study reported that measles virus was lingering in the children's bowels.

Only now have researchers rigorously retested that finding, taking samples of youngsters' intestines to hunt for signs of virus with the most modern genetic technology. There is no evidence that MMR plays any role, the international team - which included researchers who first raised the issue - reported Wednesday.

"Although in fact there was evidence that this vaccine was safe in the bulk of the population, it had not been previously assessed with respect to kids with autism and GI complaints," said Dr. W. Ian Lipkin of Columbia University College of Physicians and Surgeons, who led the work published in PLoS One, the online journal of the Public Library of Science.

"We are confident there is no link between MMR and autism," Lipkin said.

Added co-author Dr. Larry Pickering of the Centers for Disease Control and Prevention: "I feel very certain that it is a safe vaccine."

Measles, a highly infectious virus best known for its red skin rash, once routinely sickened thousands of children a year and killed hundreds, until childhood vaccinations made it a rarity in this country. But so far this year, the U.S. has counted 131 measles cases, the most in a decade. Most patients were unvaccinated. Some were infants too young for their first MMR shot, but nearly half involved children whose parents rejected vaccination, the CDC reported last month.

No one knows just how many autism patients also suffer gastrointestinal disorders, pain that they may not be able to communicate. But Lipkin said that by some estimates, up to a quarter may be affected.

The MMR fear was that the vaccine's weakened measles virus somehow lodged in and inflamed intestines, allowing waste products to escape and reach the central nervous system, Lipkin said. So his team had two questions: Does measles virus really persist in children with both disorders and not other youngsters? And did vaccination precede the GI complaints which in turn preceded autism?

Researchers studied 25 children with both autism and GI disorders, and another 13 children with the same GI disorders but no neurologic problems. The youngsters - the average age was 5 - all were undergoing colonoscopies for their GI conditions anyway, allowing tissue samples to be tested for genetic traces of measles virus. All had been vaccinated at younger ages.

The tests uncovered traces of measles genetic material in the bowels of one boy with autism - and one boy without autism. That doesn't prove virus never temporarily lodged in more children, but it contradicts the earlier study that raised concern.

Nor was there a relationship with vaccine timing: Just five of the 25 autistic children had MMR precede GI complaints that in turn preceded autism symptoms.

Researchers consulted some prominent vaccine critics in designing the study. California advocate Rick Rollens praised the work but said it didn't eliminate other vaccine concerns that deserve similar study. Meanwhile, he said it should draw much-needed attention to the suffering of patients like his son, who has both autism and GI disorders.

"No longer can mainstream medicine ignore the parents' claims of significant GI distress," he said.

Smoking riskier for women's hearts

2008-08-31T20:29:00.000-07:00

Women typically get heart disease much later than men, but not if they smoke, researchers said Tuesday.

In fact, women who smoke have heart attacks more than a dozen years earlier than women who don't smoke, Norwegian doctors reported in a study presented to the European Society of Cardiology. For men, the gap is not so dramatic; male smokers have heart attacks about six years earlier than men who don't smoke.

"This is not a minor difference," said Dr. Silvia Priori, a cardiologist at the Scientific Institute in Pavia, Italy. "Women need to realize they are losing much more than men when they smoke," she said. Priori was not connected to the research.

Dr. Morten Grundtvig and colleagues from the Innlandet Hospital Trust in Lillehammer, Norway, based their study on data from 1,784 patients admitted for a first heart attack at a hospital in Lillehammer.

Their study found that the men on average had their first heart attack at age 72 if they didn't smoke, and at 64 if they did. Women in the study had their first heart attack at age 81 if they didn't smoke, and at age 66 if they did.

That works out to eight and 15 years, respectively, for men and women. After adjusting for other heart risk factors like blood pressure, cholesterol and diabetes, researchers found that the difference for men was about six years for women about 14 years.

Previous studies looking at a possible gender difference have been inconclusive.

Doctors have long suspected that female hormones protect women against heart disease. Estrogen is thought to raise the levels of good cholesterol as well as enabling blood vessel walls to relax more easily, thus lowering the chances of a blockage.

Grundtvig said that smoking might make women go through menopause earlier, leaving them less protected against a heart attack. With rising rates of smoking in women - compared with falling rates in men - Grundtvig said that doctors expect to see increased heart disease in women.

"Smoking might erase the natural advantage that women have," said Dr. Robert Harrington, a professor of medicine at Duke University and spokesman for the American College of Cardiology.
Doctors aren't yet sure if other cardiac risk factors like cholesterol and obesity also affect women differently.

"The difference in how smoking affects women and men is profound," Harrington said. "Unless women don't smoke or quit, they risk ending up with the same terrible diseases as men, only at a much earlier age."

Gene domino effect behind brain, pancreatic tumors

2008-08-30T20:26:00.000-07:00

Scientists have mapped the cascade of genetic changes that turn normal cells in the brain and pancreas into two of the most lethal cancers. The result points to a new approach for fighting tumors and maybe even catching them sooner. Genes blamed for one person's brain tumor were different from the culprits for the next patient, making the puzzle of cancer genetics even more complicated.

But Friday's research also found that clusters of seemingly disparate genes all work along the same pathways. So instead of today's hunt for drugs that target a single gene, the idea is to target entire pathways that most patients share. Think of delivering the mail to a single box at the end of the cul-de-sac instead of at every doorstep.

The three studies, published in the journals Science and Nature, mark a milestone in cancer genetics.

"This is the next wave," said Dr. Phillip Febbo of Duke University's Institute for Genome Sciences and Policy, who was not involved with the new research. "What's really important is that finding those common elements within the landscape suggests there are therapeutic interventions that can help the whole group."

Despite 30 years of laborious work, scientists until now have found only a fraction of the genetic alterations required to cause any of the 200 diseases that collectively are called cancer. Different tumors require a different domino effect of genetic changes to arise, and to determine their severity and even which treatments will work.

The new maps do not include just mutated genes. They cite missing ones, extra ones, and overactive or underactive ones, too, in the most comprehensive look ever at human tumors.
Teams led by Johns Hopkins University examined more than 20,000 genes in tumors taken from 24 pancreatic cancer patients and 22 patients with the most dangerous brain tumor, called glioblastoma multiforme. Separately, The Cancer Genome Atlas project - a government-funded network of 18 medical centers - analyzed 600 genes in glioblastomas from 206 patients.

The Hopkins teams found hundreds of genetic changes, including a particularly intriguing gene named IDH1. Twelve percent of glioblastoma patients, mostly young ones, harbored a mutated version that brought longer survival: a median of 3.8 years compared with the 1.1 years for patients without the mutation.

If additional study proves that effect, doctors soon might use an IDH1 test to help determine prognosis, said Hopkins' Dr. Victor Velculescu, who led the glioblastoma work. If so, the next question is whether certain drugs work better in those patients as well.

The bigger discovery involved cancer's genetic chaos. No tumors were identical. The typical pancreatic cancer contained 63 genetic alterations and the average brain tumor 60, Hopkins researchers reported in Science.

Fortunately, "genes don't work alone," said Hopkin's Dr. Kenneth Kinzler, who led the pancreatic work. Figure out which genes cluster in which pathways and "a simpler picture emerges."
The Hopkins team identified 12 core pathways that were abnormal in most pancreatic tumors.

In Nature, The Cancer Genome Atlas researchers reported three core pathways at work in most glioblastomas.

The pathways do different things. Some allow damaged DNA to escape repair. Some switched off protective factors meant to suppress tumors.

Finding drugs that block those pathways will not be easy, said Dr. Bert Vogelstein of Hopkins and the Howard Hughes Medical Institute, who oversaw the research. They also may cause more side effects than current "targeted therapies" that work against only a specific gene defect.

But companies already are researching drugs to block a particular enzyme pathway implicated in the studies.

Also, pathway blockers should work in larger groups of patients, Vogelstein said. One particular pancreatic cancer pathway contains a variety of genes mutated in only a few people, but regardless of which gene ran amok, the whole pathway was broken in every tumor studied.

"Even though it sounds complex, it's actually allowing us to simplify the complex into pathways that will allow us, I think, to truly understand cancer for the first time and take a much more rational approach to treatment," said Dr. Anna Barker of the National Cancer Institute, who co-directs the cancer atlas project. "I'm more optimistic."

Moreover, the work suggests possible ways to catch cancer earlier, by tracing mutant DNA floating through the bloodstream well before tumors themselves start to spread, Vogelstein added. "I don't think that's any longer science fiction."

Exercise can help memory

2008-08-29T20:24:00.000-07:00

Adding even a small amount of exercise to a person's daily routine can reduce the risk of developing Alzheimer's disease, according to a study published in Wednesday's Journal of the American Medical Association.

The study, by Australian researchers, showed that six months of physical activity -- averaging about 20 minutes a day -- in volunteers 50 and older modestly improved memory and cognition.

"This is the first time anybody has shown that a modest exercise program seemed to slow the rate of Alzheimer's disease," said Dr. Eric Larson, executive director of the Seattle-based Group Health Center for Health Studies, who wrote an editorial accompanying the study.

"In the United States, pharmaceutical direct-to-consumer advertising has sensitized patients and the public to using cholinesterase inhibitors for Alzheimer's disease," Larson wrote. "This illustrates the appeal of 'doing something -- anything' that might help prevent a dreaded disease, even if its value is minimal. Promoting habitual exercise for aging patients seems more worthy."

The researchers randomly engaged 170 volunteers in 24 weeks of physical activity, including walking and swimming, and compared them with a similar group that didn't exercise. The volunteers all reported having memory problems, but none suffered from dementia. They each wore a pedometer and kept a diary of their physical activity.

Participants were asked to perform at least 150 minutes of moderate-intensity physical activity per week, which participants were asked to complete in three 50-minute sessions. They averaged 142 extra minutes of exercise.

Researchers used an 11-test Alzheimer's scale to assess memory, language and skill application over 18 months. Scores range from zero to 70 -- the higher the number the more severe the impairment.

By the end of the study, participants in the exercise group had better scores and less delayed recall. The exercisers also had lower dementia scores.

The study showed an average improvement of 1.3 points on the Alzheimer's scale after six months of enhanced exercise, and 0.69 points after 18 months. That's a tiny boost, researchers admit, but "potentially important when one considers the small amount of physical activity undertaken by participants of the study."

The results are encouraging, said Nancy Dapper, executive director of the Alzheimer's Association's Western and Central Washington chapter.

"With Alzheimer's we don't often have a lot to turn to, and with this study, the amount of exercise is manageable for most people," she said. "The studies are building on each other about the benefits of exercise to the brain.

"The next question might be: Is it worthy to do more studies looking at more vigorous exercise or different types of exercise?"

Researchers don't yet know why exercise makes a difference, but the added benefits can go beyond brain improvements.

Larson said one explanation could be that exercise improves blood flow to the brain. That allows people to better handle the stress that can damage parts of the brain.

"If you ask doctors what disease they fear the most, it's Alzheimer's," said Larson, who writes exercise prescriptions for some of his patients to prod them into getting needed workouts.

"This is a potential motivator to our society to design more walkable and bikeable communities," he said of the study. "It gives people yet another reason to exercise."

Heart defibrillator shock can signal more trouble

2008-08-28T20:22:00.000-07:00

A lifesaving shock from an implanted heart defibrillator provides relief that a crisis was avoided, but new research suggests it can also be a sign that more trouble is ahead.

A study found that heart failure patients were far more likely to die within four years after their defibrillator zapped the heart into beating normally than those who got no shock.

Experts said patients should promptly tell their doctors if their defibrillator triggers. And doctors should check to see if their patients' condition has worsened and whether tests or medication changes are needed.

"We need to think about everything else we possibly could do to make them as healthy as they can be," said the study's lead author, Dr. Jeanne Poole of the University of Washington.

The findings are in Thursday's New England Journal of Medicine, along with another study that concluded that having an implanted defibrillator doesn't appear to diminish one's quality of life.
About 234,800 North Americans have defibrillators, which cost between $25,000 and $35,000. The devices, about the size of a stopwatch, are designed to correct dangerously high or erratic heartbeats in the lower, pumping chambers of the heart.

Previous research found that the devices cut the risk of death by 23 percent. The new reports come from that same study of 2,500 heart failure patients - their weakened hearts didn't pump efficiently - who hadn't yet had a life-threatening irregular heartbeat.

The new government-funded reports show that a defibrillator prolongs "survival in patients with heart failure, with relatively little compromise in the quality of life," wrote Drs. Jeff Healey and Stuart Connolly of McMaster University in Hamilton, Ontario, in a journal editorial. But they added: "It is somewhat disturbing to realize that actually receiving a shock is such an important predictor of death."

In the study, about a third of the 811 patients with defibrillators were shocked during nearly four years of follow-up. Data recorded by the devices shows whether the shock corrected a life-threatening irregularity or was inappropriately fired by another problem, such as an abnormal rhythm in the heart's upper chambers.

The researchers found that those who needed a shock were more than five times more likely to die over the next four years than those who didn't require one. Even people who didn't seem to need a shock but got one had double the risk of dying.

Dr. N.A. Mark Estes, president of the Heart Rhythm Society, noted that the defibrillators used in the study are a generation-old, and that newer devices can often correct a high heartbeat through painless pacing techniques, before a shock would be needed.

"The frequency of shocks would be considerably less with contemporary devices," said Estes, of Tufts Medical Center in Boston. He had no role in the studies but has been involved in others.
For the quality of life study, participants were questioned four times over 2 1/2 years about their activities and well-being to see how the defibrillator was affecting their lives. There was no difference between the groups treated with defibrillators, medication or dummy pills, the researchers said.

"We found no evidence that the patients who got the defibrillator were feeling any worse for having received that therapy," said Dr. Daniel Mark, lead author of the study from Duke University Medical Center.

A patient at Duke, John McKinnon, said he was initially reluctant to get a defibrillator about two years but has had no concerns since. Months ago, the 65-year-old pastor got a shock, which he described as a strong kick. Since then he's had a procedure to treat an abnormal heartbeat.

"I'm getting my energy back, doing some walking, getting some exercise," said McKinnon.
Medtronic Inc. provided the defibrillators used in the research and Wyeth provided the medicine. Many of the researchers and the editorial writers have received lecture fees or grants from makers of defibrillators.

Check your Balance

2008-08-27T21:29:00.000-07:00

There are times in your life when feeling a little off-balance may actually be a good thing. Take it from the experts.

Although there are some changes you can't avoid as you get older, including deterioration of your hearing, vision and coordination, research suggests that it's worth taking steps — even risking a few missteps — to slow the decline in your balance.

Loss of balance makes us vulnerable to falls, which can be dangerous at any age but is the fifth-leading cause of death for people 65 and older, according to the Centers for Disease Control and Prevention.

The CDC makes a number of recommendations to prevent falls, including exercising regularly to maintain muscle and getting enough vitamin D and calcium to preserve bone strength.
But a growing number of physicians, physical therapists and personal trainers go further, advocating exercises designed to challenge the complex system of reflexes that governs our stability and spatial orientation.

And, as Roger Yasin, a personal trainer in Arlington, Va., puts it, it's smart for younger people to start doing these exercises.

Yasin said many of his clients are surprised to find out how their balance declines over time, and they often underestimate how important balance is to navigating the hazards in their daily lives, from escalators to uneven sidewalks and grassy hills.

"Many people don't think of balance when they think of personal training; they think of diet and weight loss, or they want to get ready for a wedding or reunion."

Whether you're preparing for an event or doing your regular workout routine, Yasin and others recommend including exercises that address your balance.

Doing so has the added advantage of helping you lose weight. "Since you are trying to stabilize your body, you're using multiple muscle groups and can burn so many more calories," he said.
Yasin said everyone should start by balancing on the floor with one foot, before progressing to challenging equipment.

The following are a few of the many products aimed at different levels of fitness and expertise. Consult your trainer or doctor before choosing one that's right for you.

Balance pads look like thick gymnastics mats but feel much softer. The feeling of instability created by the pad's foam surface increases as the user puts more weight on it. It can be used for rehabilitation, exercise and coordination training. Performing lunges, push-ups or sit-ups on a balance pad improves overall strength and stability. By stacking two pads on top of one another, the user can create greater instability for a tougher workout.

Bosu ball. The Bosu, whose name stands for "Both Sides Utilized," resembles half a ball, with one flat and one domed side; it can be used for cardio, balance-building workouts or yoga. Users can sit, stand or squat on the curved side and sit or try push-ups on the flat side, all while trying to maintain balance as the body shifts to compensate for the movement of the ball.

Dyna-Disc. Yasin says the squishy surface of this circular, air-filled mat makes his clients feel as if they're stepping on a deflated football. People of all ages can sit, stand or lie on the disks to improve posture and balance in the lower body. The Dyna-Disc is made from the same material as a gym ball but is more stable since it can't roll away. It comes in different sizes suitable for a variety of exercises. Users can perform curls or other moves standing on the disk to strengthen core muscles. They can change the inflation level of the disk or stand with one under each foot to increase exercise difficulty.

Bongo board. This skateboardlike board is the most difficult of these products to use. It's designed to improve coordination by challenging the user to keep the board stable over a rolling wheel. The Bongo board is for more-advanced users and can also be used for push-ups to strengthen core muscles.

Other products are being created for people whose balance has decreased, whether through age or illness, and are geared toward preventing falls.

Insoles inspired by NASA technology that help astronauts keep their balance in space use sensors to record information about a person's ability to balance. Erez Liebermann, a graduate student at the Harvard-MIT Division of Health Sciences and Technology, began working on the iShoe insole as a NASA intern; it could be available in 18 months and cost about $100, according to the division's Web site.

Another product in development is the vibrating insole, or "noise-enhanced sensory function." Its inventor, Jim Collins, says it is intended to help elderly people detect changes in their environment, increase sensitivity to their surroundings and improve their balance. Collins said the insole is beginning the process of winning approval from the Food and Drug Administration.
If you don't frequent the gym but would still like to avoid falls, Scott McCredie, author of "Balance: In Search of the Lost Sense," says you don't need gadgets to improve your stability or core strength.

"All you need to do is stand on one leg in various poses, and you can do that anywhere," McCredie said, whether "waiting for the bus or brushing your teeth in the bathroom."
Physical therapist Kristine Legters takes this low-tech approach by incorporating balance training into her clients' everyday lives.

"Standing on a pillow, walking on grass as opposed to concrete, or looking around and moving your head while walking as opposed to looking straight challenges and improves your balance," said Legters, who works in Pennsylvania.

The takeaway message is clear: To maintain your stability as you get older, you need to throw yourself off-balance once in a while.

Does Cholesterol Drug Increase Chance of Cancer?

2008-08-26T21:23:00.000-07:00

Federal drug-safety regulators said Thursday they are investigating whether the cholesterol-lowering drug Vytorin can increase patients' risk of developing cancer.

However, Food and Drug Administration (FDA) officials said patients should not stop taking Vytorin, because the evidence of a cancer link is unclear. While one recent clinical trial indicated higher rates of cancer for patients taking the medication, two current studies have shown no increased risk, agency officials said.

Meanwhile, senior lawmakers in Congress demanded data on the clinical trial that indicated a cancer risk.

Vytorin, a combination of Merck's Zocor and Schering-Plough's Zetia, has been heavily promoted as a novel way to reduce cholesterol. Zocor, a statin, reduces the amount of cholesterol produced by the liver. Zetia limits the cholesterol absorbed through the digestive system. But the combination became a focus of controversy after a study this year showed it was no better at reducing the buildup of plaque in the arteries than simvastatin, the much cheaper generic form of Zocor.

Separately Thursday, leaders of the House Energy and Commerce Committee asked the companies for extensive data on the clinical trial that indicated a possible cancer risk for Vytorin.
Merck and Schering-Plough said they would cooperate with the panel. The companies defend the drug, saying it is effective at reducing cholesterol, its approved use.

Committee Chairman Rep. John Dingell and Rep. Bart Stupak, both Michigan Democrats, sent a letter to the chief executives of the drug companies, giving them two weeks to supply detailed information. The study showing a link to cancer was originally designed to determine whether Vytorin could help prevent a worsening of heart-valve disease, but found that it did not.

The FDA officials anticipate the agency's investigation and analysis will take about nine months.

Critics question cervical cancer vaccine

2008-08-25T21:24:00.000-07:00

In two years, cervical cancer has gone from obscure killer confined mostly to poor nations to the West's disease of the moment.

Tens of millions of girls and young women have been vaccinated against the disease in the United States and Europe in the two years since two vaccines were given government approval in many countries and, often, recommended for universal use among females ages 11 to 26.

One of the vaccines, Gardasil, from Merck, is made available to the poorest girls in the country, up to age 18, at a potential cost to the U.S. government of more than $1 billion. Even the normally stingy British National Health Service will start giving the other vaccine — Cervarix, from GlaxoSmithKline — to all 12-year-old girls at school in September.

The lightning-fast transition from newly minted vaccine to must-have injection in the United States and Europe represents a triumph of what the manufacturers call education and their critics call marketing.

The vaccines, which offer some protection against infection from sexually transmitted viruses, are more expensive than earlier vaccines against other diseases. Gardasil's list price is $360 for the three-dose series, and the total cost is typically $400 to nearly $1,000 with markup and office visits, and is often only partially covered by health insurance.

"One less statistic"

Advertising has promoted the vaccines. In ads on shows such as "Law & Order," a multiethnic cast urges girls to become "one less statistic" by getting vaccinated.

The vaccine makers also brought attention to cervical cancer by providing money for activities by patients and women's groups, doctors and medical experts, lobbyists and political organizations interested in the disease.

Even critics of the marketing recognize the benefits of the vaccines. Girls who get the shots are less likely to have Pap tests with worrisome results that would lead to further treatment, saving themselves anxiety and discomfort and, in those cases, saving money. When it occurs, cervical cancer is a dreadful disease; genital warts, partly prevented by the Merck vaccine, can be a painful nuisance.
But some experts worry about the consequences of the rapid rollout of the new vaccines without more medical evidence about how best to deploy them.
In the United States, hundreds of doctors have been recruited and trained to give talks about Gardasil — $4,500 for a lecture — and some have made hundreds of thousands of dollars. Politicians have been lobbied and invited to receptions urging them to legislate against a global killer.
"There was incredible pressure from industry and politics," said Dr. Jon Abramson, a professor of pediatrics at Wake Forest University who was chairman of the committee of the Centers for Disease Control and Prevention (CDC) that recommended the vaccine for all girls once they reached 11 or 12.

"This big push is making people crazy, thinking they're bad moms if they don't get their kids vaccinated," said Dr. Abby Lippman, a professor at McGill University in Montreal and policy director of the Canadian Women's Health Network. Canada will spend $300 million on a cervical-cancer-vaccine program.

Merck's vaccine was studied in clinical trials for five years, and Glaxo's for nearly 6 1/2, so it is not clear how long the protection will last. Some data from the clinical trials indicate immune molecules may wane after three to five years. If a 12-year-old is vaccinated, will she be protected in college, when her risk of infection is higher? Or will a booster vaccine be necessary?

Some experts are concerned about possible side effects that become apparent only after a vaccine has been more widely tested over longer periods.

And why the sudden alarm in developed countries about cervical cancer, some experts ask. A major killer in the developing world, particularly Africa, where the vaccines are too expensive to use, cervical cancer is classified as rare in the West because it is almost always preventable through regular Pap smears, which detect precancerous cells early enough for effective treatment.

Because the vaccines prevent only 70 percent of cervical cancers, Pap-smear screening must continue.

"Merck lobbied every opinion leader, women's group, medical society, politicians, and went directly to the people; it created a sense of panic that says you have to have this vaccine now," said Dr. Diane Harper, a professor of medicine at Dartmouth Medical School. Harper was a principal investigator on the clinical trials of Gardasil and Cervarix, and she spent 2006-7 on sabbatical at the World Health Organization developing plans for cervical-cancer-vaccine programs around the world.

"Because Merck was so aggressive, it went too fast," Harper said. "I would have liked to see it go much slower."

In receiving expedited consideration from the Food and Drug Administration (FDA), Gardasil took six months from application to approval and was recommended by the CDC weeks later for universal use among girls. Most vaccines take three years to get that sort of endorsement, Harper said, and then five to 10 more for universal acceptance.

Dr. Richard Haupt, medical director at Merck, said five years in clinical trails was normal before applying for licensing. He said Merck educated people about the new vaccine to "accelerate and facilitate access."

Spokesmen for Merck and Glaxo said all indications are that their vaccines are safe and effective, and there is no evidence a booster shot will be needed.

Need greater elsewhere?

Health economists estimated that depending on how they are used, the two cervical-cancer vaccines will cost society $30,000 to $70,000, or higher, for each year of life they save in developed countries.

Looked at another way, countries that pay for the vaccines will have less money for other health needs. "This kind of money could be better used to solve so many other problems in women's health," said Lippman at McGill. "I'm not against vaccines, but in Canada and the U.S., women are not dying in the streets of cervical cancer."

By contrast, if the vaccine were to become cheap enough to be used in the developing world, it would revolutionize women's health. Charities such as the Global Alliance for Vaccine and Immunizations, backed by the Bill & Melinda Gates Foundation, are trying to devise a solution.

The vaccines offer partial protection against infection from human papillomavirus, or HPV. The Merck vaccine also prevents some genital warts that are caused by other strains of the virus.
Cervical cancer is the second-leading cause of cancer death in women, with 500,000 new cases worldwide each year. More than 90 percent are in developing countries, according to the World Health Organization; 274,000 women died of this cancer in 2006.

New ways to repell Mosquito's

2008-08-24T10:26:00.001-07:00

This has been a particularly bad year for mosquito's in Northern Illinois. We love to do a lot of outdoor entertaining in warm months. This year most of those gatherings have come to rapid end after the sunset when the voracious mosquitos come out to feed.

We have found that bug sprays, and we have tried quite a few of them this year are not really that effective against these blood thirsty little guys. Unless you dip yourself head to toe before coming outside it seems they find an unprotected place to snack.

We did find unexpected relief from a couple of products that seemed at first like the snake oil mosquito fad of the year. The first one is Johnson and Johnsons "OFF" mosquito lantern. It consists of a cheesy looking plastic lantern with a votive candle inside. On the top you slide a repellant pad into the top, light the candle and you are protected in a 15 x 15 area. We have been pretty surprised because everytime we have used it the patio has been protected.

The second device out there is called the ThermaCell. It is a little fan shaped device that would fit in the palm of your hand. It also uses a pad similar to what "OFF" uses. The difference is it is powered by a small butane fuel cell that last 12 hours. The pads still have to be replaced every four hours.

Both of these products work extremely well. If you are having a large dinner party outside just put one of the lanterns or ThermaCell's on each table and you are ready to go.

The only drawback is cost. Both require replacement insect repellant pads which last only four hours. With "Off" you need to replace the votive candle when it burns out.

On the ThermaCell you must replace the tiny butane cylinder every twelve hours which is more expensive but more reliable than a candle. The advantage of the ThermaCell is it is very portable which makes it perfect for camping or going to the beach. It ignites with a click and you don't have to mess with a cheesey looking candle.

ThermaCell devices run between ten to twenty dollars depending on the model you choose. One 12 hour use including butane and three pads is going to run you $6.50.

The "Off" Lanterns are all around ten to fifteen dollars retail. A refill that includes votive candles and three pads goes for $5.50.

With both systems you can save quite a bit of money if you buy your supplies in bulk quantities which is available on line from Amazon.

If you were to use each of these units 90 days during the summer season for four hours per day it would cost you appproximately $130-$150 per season depending on the product you use.

Preparing For a Possible Pandemic

2008-08-22T09:33:00.000-07:00

The 1918 influenza pandemic killed more than 50 million people worldwide including an estimated 675,000 people in the United States, and it is one of the touchstones for today’s public health preparedness initiatives. To put it in perspective, that’s more people than all those who died (both military personnel and civilians) during World War I (1914–1918).

The 1957 Influenza Pandemic caused at least 70,000 U.S. deaths and 1–2 million deaths worldwide. Improvements in scientific technology made it possible to more quickly identify that pandemic when compared with the 1918 event. These first-person and family accounts contained herein provide an intimate, personal view of the 1918 and 1957 pandemics that goes beyond the staggering statistics associated with those events and, therefore, can help planners re-energize their efforts and fight preparedness fatigue and apathy.

The need for the Pandemic Influenza Storybook became evident as the Centers for Disease Control and Prevention (CDC) conducted Crisis and Emergency Risk Communication (CERC) throughout the country for public health professionals involved with a variety of emergency response communications activities. The “Basic” CERC course debuted in 2002 and two additional modules have been added; “Leaders for Leaders” and “Pandemic Influenza”. The storybook is a resource tool for the latter module for certified CERC trainers and trainees. The online storybook contains narratives from survivors, families, and friends who lived through the 1918 and 1957 pandemics. Additionally, stories from the 1968 pandemic will be added to this resource as they become available.

Problems with Byetta

2008-08-21T08:46:00.000-07:00

Federal regulators are working on a stronger label for a widely used diabetes drug marketed by Amylin Pharmaceuticals Inc. and Eli Lilly & Co. after deaths were reported with the medication despite earlier government warnings.

The Food and Drug Administration said Monday it has received six new reports of patients developing a dangerous form of pancreatitis while taking Byetta. Two of the patients died and four were recovering.

Regulators stressed that patients should stop taking Byetta immediately if they develop signs of acute pancreatitis, a swelling of the pancreas that can cause nausea, vomiting and abdominal pain. The FDA warned that it is very difficult to distinguish acute pancreatitis from less dangerous forms of the condition.

The FDA announcement updated an October alert about 30 reports of Byetta patients developing pancreas problems. None of those cases were fatal, but Byetta's makers agreed to add information about the reports to the drug's label.

However, the FDA made clear Monday that it is seeking a stronger, more prominent warning about the risks.

Amylin and Eli Lilly said in a statement that patients taking Byetta have shown "very rare case reports of pancreatitis with complications or with a fatal outcome." The companies added that diabetes patients are already at increased risk of pancreatitis compared with healthy patients.

The pancreas produces several important biological fluids, including insulin - the sugar-regulating hormone that most diabetics lack.

The FDA said doctors should consider prescribing other medications to patients with a history of pancreas problems.

Byetta competes against blockbuster drugs from GlaxoSmithKline PLC and Takeda Pharmaceuticals in the $24 billion global market for diabetes medications, according to health care research firm IMS Health.

More than 700,000 patients with type 2 diabetes have used the injectable drug since it was launched in June 2005. It is jointly developed and manufactured by San Diego-based Amylin and Eli Lilly.

Byetta's $636 million in sales made up about 80 percent of Amylin's total revenue last year. The drug accounted for just 3 percent of Eli Lilly's sales. The companies are developing a long-lasting version of Byetta that could be injected once weekly, instead of twice daily.

Robert Baird & Co. analyst Thomas Russo cautioned investors that concerns about pancreatitis could affect the FDA's review and requirements for the new version. Russo rates Amylin "outperform," but said in a note to investors he could revise that rating as more information becomes available.

Insurance Gap Hurting the Elderly

2008-08-20T08:44:00.000-07:00

Many people in Medicare with diabetes, high blood pressure and other chronic conditions stop taking their medicine when faced with picking up the entire cost of their prescriptions, researchers say.

About 3.4 million older and disabled people hit a gap, known as the doughnut hole, in their Medicare drug coverage in 2007. When that happened, they had to pay the entire costs of their medicine until they spent $3,850 out of pocket. Then, insurance coverage would kick in again.

About 15 percent of those hitting the coverage gap stopped their treatment regimen. That rate varied depending upon illness. For example, about 10 percent of diabetes patients stopped buying the medicine, as did 16 percent of patients with high blood pressure and 18 percent of patients with osteoporosis.

The drug benefit, which began in 2006, has come in under budget. Most participants report they are satisfied with the program. But many lawmakers and health analysts say improvements could be made.

"If a new president and Congress consider changes to the drug benefit, it will be important to keep in mind that the coverage gap has consequences for some patients with serious health conditions," said Drew Altman, the chief executive officer and president of the Kaiser Family Foundation. The foundation conducted the study with researchers at Georgetown University and the University of Chicago.

The Republican-led Congress in 2003 crafted the doughnut hole as a way to make the drug benefit more affordable for the federal government.

The researchers based their findings on pharmacy claims data provided by IMS Health, a company specializing in collecting health care data. They excluded people who get extra help in paying for their drug coverage because of their income; they do not pay the full cost of medicine even when in the doughnut hole.

When looking at spending by people who did not receive the extra help, researchers could determine when they hit the coverage gap, which began at $2,400 in total drug spending. They also could determine when they passed through the gap and catastrophic coverage kicked in.

The researchers focused their analysis on eight categories of drugs. Those least likely to stop taking their medicine were Alzheimer's patients, at 8 percent. Those most likely, at 20 percent, were patients taking medicine for heartburn, ulcers and acid reflux disease, 20 percent.

Jeff Nelligan, a spokesman for the Centers for Medicare and Medicaid Services, said the coverage gap kicks in after participants have saved about $1,600 on their drug costs, on average. He also noted that many plans offer some coverage when beneficiaries hit the doughnut hole. Those plans cost at little as $28.70 a month, and are available in every state for less than $50 a month.

"We urge beneficiaries to choose wisely when selecting their drug coverage," Nelligan said. "Again, we emphasize that any changes to the coverage gap would need to come from Congress."
The share of Medicare recipients who reached the doughnut hole varied widely by region. About one-third in Arkansas and seven states in the Northern Plains hit the coverage gap in 2007, but only 12 percent in Nevada did.

Researchers said such regional differences may occur because of physicians' prescribing patterns as well as overall health of the population. A separate factor may be enrollment in Medicare Advantage plans. Such plans offer comprehensive health coverage on top of the drug benefit. Regions where Medicare Advantage plans were most prevalent had fewer enrollees hit the coverage gap, which could reflect stronger management of drug use.

Democratic lawmakers have led efforts to let the government use its purchasing power to negotiate cheaper drug prices. They say the savings could be used to reduce the coverage gap, though the Congressional Budget Office projected that the legislation would not lead to any significant savings.

About 5 percent of the people who hit the Medicare coverage gap switched to another medication, most often a generic drug, while 1 percent reduced the number of medications they were taking in a particular class of drugs, the report said.

Can Vitamin B Ward off Mosquitoes?

2008-08-19T08:42:00.000-07:00

THE BELIEF: Vitamin B can ward off mosquitoes.

THE FACTS: Mosquitoes are more attracted to some people than to others; that much is known from several studies.

But the Internet is full of advertisements for pills and supplements that are supposed to keep the pests away from walking mosquito magnets. One pervasive claim is that taking vitamin B, or wearing patches and other products that are infused with it, can do the trick. Studies dating to the 1960s suggest that taking small doses of the supplement three times a day during biting season helps to produce a skin odor that mosquitoes find repulsive.

But more recent studies have shown that assertion to be a myth. In a study published in 2005 in the Journal of the American Mosquito Control Association, scientists had a group of subjects take vitamin B supplements every day for eight weeks, while a second group took vitamin C and a third took no supplements. Once every two weeks, the scientists used swarms of mosquitoes to examine whether the supplements were having any effect. Although the subjects' attractiveness to the mosquitoes varied considerably, over all there was no evidence that vitamin B did anything to help.

Another study by scientists in Brazil tested it by administering vitamin B droplets to animals and exposing them to female mosquitoes (the only ones that bite). They found no difference in attractiveness between the vitamin B group and control groups.

THE BOTTOM LINE: Studies suggest that vitamin B is not an effective mosquito repellent.

Facts About Acupuncture

2008-08-18T08:40:00.000-07:00

Acupuncture is among the oldest healing practices in the world. As part of traditional Chinese medicine, acupuncture aims to restore and maintain health by maintaining balanced energy flow through the stimulation of specific points on the body.

Acupuncture has been practiced in China and other Asian countries for thousands of years. Today, scientists continue to study the effectiveness of acupuncture for a wide range of conditions. Here are two common myths and facts about acupuncture:

Myth: Acupuncture is dangerous.

Fact: According to the National Institutes of Health, relatively few complications from acupuncture have been reported to the U.S. Food and Drug Administration since it approved acupuncture for use by licensed practitioners in 1996.

This is particularly significant considering the millions of people treated and the number of acupuncture needles used each year. Nevertheless, it is important to choose a practitioner who graduated from an accredited program and who is certified by the National Commission for the Certification of Acupuncture.

Myth: Because acupuncture involves needles, it is painful.

Fact: Patients may or may not feel a very slight prick when the hair-thin needle is inserted, but it is much less than the sensation felt during an injection, because acupuncture needles are much thinner. Some may feel a heaviness, numbness, achiness, or soreness after the needles have been inserted. However, these sensations quickly subside. Most patients find the treatments pleasant and relaxing.

Be Careful With Similar Drug Names

2008-08-17T14:39:00.000-07:00

Three years ago, Johnson & Johnson changed the name of its Alzheimer's drug Reminyl because doctors and pharmacists were confusing it with the diabetes medication Amaryl. Mix-ups were linked to two deaths.

Changing the name of a drug already on the market is unusual, but the case highlights a growing problem facing the drug industry, doctors, pharmacists and patients—drug names that look or sound so much alike they can lead to medication errors.

"This is a very urgent problem," said Diane Cousins of U.S. Pharmacopeia, the official standard-setting authority for prescription and over-the-counter medicines. "The number of reports of similar-named drugs is increasing, and the number of different products implicated in medication errors is increasing."The Food and Drug Administration is preparing to change the way it reviews and approves drug names in hopes of improving safety and streamlining the process.

The agency rejects 35 percent to 40 percent of the names proposed by drugmakers, but data show the system is badly flawed.

According to U.S. Pharmacopeia, nearly 1,500 brand-name and generic drugs have been implicated in medication errors because their names looked or sounded like another drug. The non-profit organization recently compiled 3,170 pairs of similarly named drugs, nearly double the count from a 2004 survey.

The drug most commonly confused with others, according to U.S. Pharmacopeia: Cefazolin, an antibiotic. It has been confused with 15 other drugs, with such names as Cephalexin, Ceftriaxone, Cefoxitin and Cefotaxime.

Synvisc and Orthovisc Injections for Osteoarthritis

2008-08-16T16:12:00.000-07:00

Arthritis is one of the most common diseases in the world today. The total cost of this condition has been estimated to be as high as 1% of the gross national product in the United States. The knee is among the most commonly involved joints with arthritis, and can be one of the most serious affecting many aspects of an individual's quality of life. Patients with arthritis of the knee are susceptible to complications from other medical conditions, as they are more likely to live a sedentary lifestyle and are more often obese. Effective treatment for knee arthritis is a priority of orthopedic surgeons.

Motor Oil for the Knee Joint

One possible method for treating arthritis of the knee without performing surgery has been with an injectable medication called Synvisc (the generic name is Hylan, and sold under the trade name "Synvisc"). Hyaluronan, the name of the substance in Synvisc, is secreted by cells in the cartilage of joints. Hyaluronan is one of the major molecular components of joint fluid, and it gives the joint fluid, also called synovial fluid, its viscous, slippery quality. The high viscosity of synovial fluid allows for the cartilage surfaces of joints to glide upon each other in a smooth fashion. By injecting Synvisc in a knee, some people consider this a so-called joint lubrication. This is why you may hear of Syvisc as a 'motor oil' for the knee joint.

Thanks to Synvisc, and Orthovisc injections, chronic pain in your knees and other joints caused by osteoarthritis is no longer a fact of life. Arthritic joints can now be 'lubricated' using a technique called viscosupplementation.

Healthy Trust Immediate Medical Care uses ultrasound to give an accurate diagnosis and help guide the needle to the correct target area which helps provide the best results for the patient. Studies show that injections that are not guided by ultrasound have a much lower success rate.

Fast Facts About Synvisc Injections

Viscosupplementation has been studied for osteoarthritis treatment since the 1970s.
Synvisc was FDA approved on 08/08/97.
Synvisc injections are typically given once a week, 7 days apart, over a 15-day period, for a total of three injections.
To get the best results, diseased osteoarthritic synovial fluid is typically removed from the knee before the first injection.
Synvisc is considered a treatment or therapy, not a drug.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Kids can overcome strokes

2008-08-16T14:34:00.000-07:00

Noticing that her daughter, Noelle, didn't reach with her right hand, Judy Bergman assumed the infant was left-handed. But an MRI taken when Noelle was 7 months old confirmed that she had suffered a stroke, most likely before she was born. "I had never heard of a child having a stroke," said the Grayslake mother of two, recalling her shock. She remembers thinking: "What is the future going to hold? What are her challenges going to be?

"The American Heart Association last month issued guidelines to physicians for the first time on the diagnosis and treatment of stroke in infants and children. The group said that strokes are far more common in children than previously thought and that the causes, risks and symptoms differ greatly from those in adults.The guidelines were developed because early diagnosis and therapy are critical to helping children recover the best they can.

'Challenges'

Childhood strokes are not increasing in prevalence, doctors emphasized. Instead, improved knowledge has led to greater recognition of it. For example, doctors now believe that cerebral palsy and intracranial bleeding are different forms of strokes.

And though a stroke can be devastating medically, researchers are finding that children have greater potential to recover and adapt than adults because of the plasticity of their brains, said Susan Levine, a professor of psychology at the University of Chicago.

For example, a stroke that injures the left hemisphere of the adult brain typically causes problems with speech. Children, on the other hand, continue to acquire language skills, although language development is usually delayed, Levine said."Up until age 13, there is the ability to transfer language processing from the left to the right hemisphere of the brain," said Dr. Deborah Gaebler-Spira, director of the cerebral palsy program at the Rehabilitation Institute of Chicago. "So our anticipation of recovery of certain very distinct brain functions is much more optimistic for children.

"Most children suffer strokes on one side of their brains (Noelle's was in the left hemisphere). The most common risk factors are sickle cell disease and birth defects of the heart.At least half of children who have strokes are left with residual impairment or disability, said Dr. Jose Biller, guidelines co-author and chairman of neurology at Loyola University Chicago Stritch School of Medicine.

As part of a research project funded by the National Institutes of Health, for five years Levine has been studying a group of 40 children as young as 14 months who have had a stroke and 60 children who have not. The researchers videotaped interactions between the children and their parents.

So far their research suggests that for children who have had a stroke, "there are slight delays in getting language off the ground, but their progress is pretty similar to the typically developing children," Levine said.

The researchers will continue to follow the children to determine if they have difficulty developing the more complex language skills needed to succeed in school.About 10 in every 100,000 children in the U.S. suffer a stroke in a given year. The risk is greatest in the first year of life, particularly in the first two months.Only people older than 65 have a higher stroke risk than babies younger than a month, said Dr. E. Steve Roach, chairman of the task force that developed the American Heart Association guidelines. Roach is neurologist in chief at Nationwide Children's Hospital in Columbus, Ohio.

SeizuresIn newborns and babies affected in utero, the first symptoms of a stroke often are seizures that involve a single limb. Such seizures are so common that stroke is believed to account for about 10 percent of seizures in full-term newborns, Roach said.

Bergman mentioned Noelle's preference for her left hand to the child's doctor during a routine exam. The MRI diagnosed the stroke. (Children generally do not show a hand preference before age 2.)

Noelle, now 5, has been undergoing physical and occupational therapy, and recently completed speech therapy. Casts, and later braces, were placed on her legs to increase her range of motion and correct her gait. Her biggest challenge now is improving her limited use of her right hand.

Said Bergman: "When we started on this journey I was shocked. I was heartbroken.

... Now I think because I see how well she's doing, I know truly in my heart, she will be able to do anything she wants to do."

Taking a closer look at concussions

2008-08-15T14:31:00.000-07:00

Your brain needs more of a time-out than just missing the next game to recover from a concussion. New research suggests student athletes who are too active - not just on the field, but at home and school - may hinder their recovery.

More puzzling, female athletes may take longer to recover than males.

It's part of growing evidence that healing from this common sports injury is more complicated than once thought, an important message for parents and coaches as school sports programs gear up for fall.

"No two concussions are the same," warns Kevin Guskiewicz, an athletic trainer who chairs the sports science department at the University of North Carolina at Chapel Hill. "We need to be cautious with what we're allowing someone to do, and at what point in their recovery they're allowed to do it."

Concussions are brain injuries and among the most difficult of sports injuries, starting with even identifying who's had one. Many athletes never lose consciousness, the most obvious symptom. Brain scans can't diagnose a concussion. Nor are other symptoms always apparent right away, and players can sometimes hide or minimize them: "Nope, no headaches, coach; put me back in."
Doing so has grave risks. A second concussion before recovering from the first can cause brain swelling that can trigger permanent damage, even death.

And there's mounting concern from studies of retired professional athletes that those who suffered multiple concussions over the years may be at increased risk for depression, memory problems and other neurological problems later in life.

The latest U.S. estimates suggest there are anywhere from 1.6 million to 3.8 million sports- and recreation-related concussions each year.

The good news: Awareness is growing, at least among college and professional athletes.

Guskiewicz says reports of concussions have risen 10 percent in the last three years - not that more athletes are being injured but that more who properly seek care.

But how much time is needed to heal, and how much activity is OK while recovering, remains uncertain.

The worry isn't just another bump. An injured brain undergoes metabolic changes that affect its energy levels, meaning physical and mental exertion might add more strain.

So researchers at the University of Pittsburgh and one of Guskiewicz's UNC colleagues tracked 95 high school athletes evaluated in a university-based program that gave a battery of memory, reaction time and other cognitive tests up to a month after the concussion. The researchers grouped patients by activities recorded in their medical records: No school; some schoolwork but no other activity; moderate activity described as schoolwork and some routine home chores; that plus sports practice; or schoolwork and playing some sports.

Those with moderate activity showed the best recovery, scoring better on brain tests than even the less active patients, researchers reported in the Journal of Athletic Training. The more active patients scored much worse - and although their allowed activity suggested they were thought to have a mild concussion, they ultimately performed as poorly as athletes initially diagnosed with a more serious concussion.

The goal is "to keep the brain stimulated but not enough to push it into overdrive," explains Guskiewicz.

Another Pittsburgh study of 234 soccer players found that two weeks after their concussion, female players scored worse on some brain-function tests than similarly injured males. Dr. Alexis Chiang Colvin found size differences didn't explain the discrepancy. She couldn't find an alternate explanation, and while the gender question is explored, urges coaches and athletes to be aware that female players may need a little extra time to recover.

Increasingly, professional and college athletes are given preseason tests of memory and other cognitive skills. After a concussion, retesting can help athletic trainers determine when athletes are ready to return to play.

That's far less common in high school sports. Are young athletes returning too soon? The only national study of high school injuries, run by Ohio State University, is analyzing that question now.

Meanwhile, what's the advice? A government campaign and concussion specialists urge that:
-Parents, players and coaches know the symptoms - from immediate signs, such as being dazed, amnesia, moving slowly or clumsily, to later symptoms such as dizziness, sleep problems, irritability and concentration problems.

-Athletes don't return to play until cleared by a health professional.

-Appropriate health officials be on site to assess concussion "whether it's Pop Warner football or soccer or high school teams," Guskiewicz says.

Teaching young players the seriousness is the big challenge, says Ohio State injury specialist Dawn Comstock: "It's difficult for them to realize this one game Friday night is not as important as my cognitive ability the rest of my life."

Angioplasty's early advantage gone after 3 years, study says

2008-08-14T14:22:00.000-07:00

People with chronic chest pain who are not in big danger of a heart attack now may have even less reason to rush into an artery-opening angioplasty: There's more evidence drugs should be tried first and often are just as effective.

The slim early advantage for angioplasty at relieving pain in these nonemergency cases starts to fade within six months and vanishes after three years, according to a new report from a landmark heart study.

That is sooner than the five years doctors estimated last year after their first analysis of the study. The new information comes from patients' own reports of how they fared after treatment. Results are in Thursday's New England Journal of Medicine.

"This study should be enlightening and practice-changing for doctors and patients alike," and should lead more to try drugs before resorting to the $40,000 heart procedure, said Duke University's Dr. Eric Peterson, who co-authored an editorial in the medical journal.

The number of angioplasties has been falling since the first results from this big study came out in 2007, according to new figures requested by The Associated Press from an American College of Cardiology database.

Angioplasty remains the top treatment for people having a heart attack or hospitalized with worsening symptoms. It involves using a tiny balloon to flatten a clog and propping the artery open with a mesh tube called a stent.

However, at least a third of angioplasties are done on people not in imminent danger, to relieve chest pain. These patients are no more likely to die or suffer a heart attack if initially treated with drugs alone, the big 2,287-patient study revealed.

Still, angioplasty's fans tout it as a quick fix that improves quality of life. That benefit is fairly small and short-lived, compared with good medication use alone, the new report found.
Researchers did follow-up health surveys of about 70 percent of the study's participants. At the start, 78 percent had chest pain.

Three months after treatment, 53 percent of patients who had angioplasties plus drug treatment and 42 percent of the drugs-alone patients were free of chest pain. Both groups continued to improve, and the gap started to narrow within six months. After three years, their scores on chest pain, quality-of-life and treatment satisfaction did not significantly differ.

"Patients get better," regardless of which initial treatment they have, said study leader Dr. William Weintraub of Christiana Care Health System in Newark, Del.

One exception: Those who started out with more severe chest pain fared better with angioplasty. And not everyone did well on drugs alone - about one-third ultimately needed an angioplasty or heart bypass surgery.

The study was funded by the U.S. Department of Veterans Affairs, the Medical Research Council of Canada and a host of drug companies. Many of the researchers have consulted for drug makers, and many of the study's critics have consulted for stent makers.

People in the study were properly tested to ensure they were medically stable, said Dr. Spencer King, a cardiologist at St. Joseph's Heart and Vascular Institute in Atlanta and past president of the cardiology college. "My greatest fear" is that some patients now may be given medications without adequate testing to show angioplasty can safely be delayed, he said.

The study patients also received an ideal mix of medicines, potentially including aspirin, cholesterol-lowering statins, nitrates, ACE inhibitors, beta-blockers and calcium channel blockers.

Doctors debate when to declare organ donors dead

2008-08-13T14:25:00.000-07:00

A report on three heart transplants involving babies is focusing attention on a touchy issue in the organ donation field: When and how can someone be declared dead?

For decades, organs have typically been removed only after doctors determine that a donor's brain has completely stopped working. In the case of the infants, all three were on life support and showed little brain function, but they didn't meet the criteria for brain death.

With their families' consent, the newborns were taken off ventilators and surgeons in Denver removed their hearts minutes after they stopped beating. The hearts were successfully transplanted, and the babies who got the hearts survived.

"It seemed like there was an unmet need in two situations," said Dr. Mark Boucek, who led the study at Children's Hospital in Denver. "Recipients were dying while awaiting donor organs. And we had children dying whose family wanted to donate, and we weren't able to do it."

The procedure - called donation after cardiac death - is being encouraged by the federal government, organ banks and others as a way to make more organs available and give more families the option to donate.

But the approach raises legal and ethical issues because it involves children and because, according to critics, it violates laws governing when organs may be removed.

As the method has gained acceptance, the number of cardiac-death donations has steadily increased. Last year, there were 793 cardiac-death donors, about 10 percent of all deceased donors, according to United Network for Organ Sharing. Most of those were adults donating kidneys or livers.

"It is a much more common scenario today that it would have been even five years ago," said Joel Newman, a spokesman for the network.

The heart is rarely removed after cardiac death because of worries it could be damaged from lack of oxygen. In brain-death donations, the donor is kept on a ventilator to keep oxygen-rich blood flowing to the organs until they are removed.

The Denver cases are detailed in Thursday's New England Journal of Medicine. The editors, noting the report is likely to be controversial, said they published it to promote discussion of cardiac-death donation, especially for infant heart transplants.

They also included three commentaries and assembled a panel discussion with doctors and ethicists. Many of the remarks related to the widely accepted "dead donor rule" and the waiting time between when the heart stops and when it is removed to make sure that it doesn't start again on its own.

In two of the Denver cases, doctors waited only 75 seconds; the Institute of Medicine has suggested five minutes, and other surgeons use two minutes.

State laws stipulate that donors must be declared dead before donation, based on either total loss of brain function or heart function that is irreversible. Some commentators contended that the Denver cases didn't meet the rule since it was possible to restart the transplanted hearts in the recipients.

"In my opinion, it's an open-and-shut case. They don't have irreversibility, and they don't have death," said Robert Veatch, a professor of medical ethics at Georgetown University.

But others argue the definition of death is flawed, and that more emphasis should be on informed consent and the chances of survival in cases of severe brain damage.

The Denver transplants were done over three years; one in 2004 and two last year. The three donor infants had all suffered brain damage from lack of oxygen when they were born. On average, they were about four days old when life support was ended.

In the first case, doctors waited for three minutes after the heart stopped before death was declared. Then the waiting time was reduced to 75 seconds on the recommendation of the ethics committee to reduce the chances of damage to the heart.

The authors said 75 seconds was chosen because there had been no known cases of hearts restarting after 60 seconds.

The hearts were given to three babies born with heart defects or heart disease. All three survived, and their outcomes were compared to 17 heart transplants done at the hospital during the same time but from pediatric donors declared brain dead.

"We couldn't tell the difference," said Boucek, who's now at Joe DiMaggio Children's Hospital in Hollywood, Fla.

There were nine other potential cardiac-death donors at the hospital during the same period, but there wasn't a suitable recipient in the area for their hearts, the report said.

The parents of one of the infants in the study, David Grooms and Jill Airington-Grooms, faced the devastating news on New Year's Day 2007 that their first child, Addison, had been born with little brain function and wouldn't survive.

After they decided to remove life support, they were asked about organ donation, and quickly agreed.

"The reality was Addison was not going to live," said Jill Airington-Grooms. "As difficult as that was to hear, this opportunity provided us with a ray of hope."

Three days later, Addison was taken off a ventilator and died. Her heart was given to another Denver-area baby, 2-month-old Zachary Apmann, who was born five weeks premature with an underdeveloped heart.

His parents, Rob and Mary Ann Apmann, said they were given several options and decided to wait for a transplant. They agreed they would accept a cardiac-death donation to increase Zachary's chances.

Mary Ann Apmann said she wasn't worried that the first available heart came from a cardiac-death donor.

"At that point, Zachary was so sick. We did have him at home. But we knew it wasn't much longer," she said.

After the transplant on Jan. 4, his condition quickly improved, and his blue lips disappeared.
Now, at 21 months: "He's just a crazy little kid who loves to play and swim and throw rocks," his mother said.

The two families haven't met yet but have been in touch through letters and calls.

Coincidentally, David Grooms said he had an older brother who died three days after he was born in the 1970s with the same heart condition as Zachary's. The Grooms now have an 8-month-old daughter, Harper.

"Addison did only live three days in this world, but because of this, she lives on," her mother said.

Are you overweight and heart healthy?

2008-08-12T14:28:00.000-07:00

You can look great in a swimsuit and still be a heart attack waiting to happen. And you can also be overweight and otherwise healthy. A new study suggests that a surprising number of overweight people - about half - have normal blood pressure and cholesterol levels, while an equally startling number of trim people suffer from some of the ills associated with obesity.
The first national estimate of its kind bolsters the argument that you can be hefty but still healthy, or at least healthier than has been believed.

The results also show that stereotypes about body size can be misleading, and that even "less voluptuous" people can have risk factors commonly associated with obesity, said study author MaryFran Sowers, a University of Michigan obesity researcher.

"We're really talking about taking a look with a very different lens" at weight and health risks, Sowers said.

In the study, about 51 percent of overweight adults, or roughly 36 million people nationwide, had mostly normal levels of blood pressure, cholesterol, blood fats called triglycerides and blood sugar.

Almost one-third of obese adults, or nearly 20 million people, also were in this healthy range, meaning that none or only one of those measures was abnormal.

Yet about a fourth of adults in the recommended-weight range had unhealthy levels of at least two of these measures. That means some 16 million of them are at risk for heart problems.
It's no secret that thin people can develop heart-related problems and that fat people often do not. But that millions defy the stereotypes will come as a surprise to many people, Sowers said.
Even so, there's growing debate about the accuracy of the standard method of calculating whether someone is overweight. Health officials rely on the body mass index, a weight-height ratio that does not distinguish between fat and lean tissue. The limits of that method were highlighted a few years ago when it was reported that the system would put nearly half of NBA players in the overweight category.

A number of experts say waist size is a more accurate way of determining someone's health risks, and the study results support that argument.

Dr. Robert Eckel, a former American Heart Association president and professor of medicine at the University of Colorado, said the new research may help dismiss some of the generalizations that are sometimes made about weight and health.

Study co-author Judith Wylie-Rosett emphasized that the study shouldn't send the message "that we don't need to worry about weight." That's because half of overweight people do face elevated risks for heart disease, explained Wylie-Rosett, a nutrition researcher at Albert Einstein College of Medicine in New York.

But, for those without elevated risks, losing weight "might be important only from a cosmetic perspective," she said.

To arrive at the estimates, scientists analyzed nationally representative government surveys involving 5,440 people age 20 and over, and extrapolated to calculate nationwide figures.

The new study, appearing in Monday's Archives of Internal Medicine, used government surveys from 1999 to 2004 that included lab tests and height and weight measurements. Participants reported on habits including smoking and physical activity.

In all weight categories, risk factors for heart problems were generally more common in older people, smokers and inactive people. Among obese people who were 50 to 64, just 20 percent were considered healthy compared with half of younger obese people.

The results underscore how important exercise is for staying healthy, even for people of healthy weight, Wylie-Rosett said.

The authors noted that fat tissue releases hormones and other substances that affect things like blood vessels, cholesterol and blood sugar. The results suggest this interaction varies among overweight and obese people, the authors said.

The results also add to mounting evidence that thick waists are linked with heart risks.

Among people of healthy weight in the study, elevated blood pressure, cholesterol and other factors were more common for people with larger waists or potbellies. This often signals internal fat deposits surrounding abdominal organs, which previous research has shown can be especially risky.

Similarly, among overweight and obese adults, those in the "healthy" category tended to have smaller waists than those with at least two risk factors.

Dr. Lewis Landsberg, a Northwestern University obesity expert, noted that the research didn't look at heart disease, and that not everyone with high risk factors develops heart problems.

Still, he said, the study shows that waist measurements can help assess health.

Can artificial sweetners speed the absorption of alcohol?

2008-08-11T07:52:00.000-07:00

THE BELIEF:

Beware of drink mixers based on diet soda.

THE FACTS:

Usually it is solely the liquor component of a cocktail -- not the mixer -- that determines its inebriating effects. But some people contend the artificial sweeteners in diet soda speed the absorption of alcohol.

Odd, perhaps, but research suggests it's true. In a 2006 study, a team of scientists recruited healthy subjects and had them consume vodka cocktails. On some occasions, it was a 20-ounce drink mixed with a sugar-sweetened beverage, and on others it was a nearly identical drink mixed instead with a diet beverage.

In the diet-mixer conditions, the alcohol entered the subjects' bloodstream about 15 minutes faster, and their blood-alcohol concentration was higher, peaking at 0.05 percent, compared with 0.03 percent with the regular mixer.

One theory is that the alcohol is absorbed more quickly because there is no sugar to slow it down, which would mean that club soda would have a similar effect. A second study in 2007 also showed that alcohol was absorbed far more quickly when mixed with carbonated beverages than with flat mixers, possibly because of the effervescence. As a result, experts say, it's best to choose flat mixers like orange or cranberry juice over diet sodas or juices.

THE BOTTOM LINE:

Compared with sugar-sweetened drinks, artificial sweeteners can speed inebriation.

Are Cholesterol Drugs Linked to Muscle Pain?

2008-08-11T07:47:00.000-07:00

Q: I was on Lipitor for a number of years and have severe muscle and nerve damage to the extent that I am in a power wheelchair. Do you think Lipitor could be to blame?

A: Statin-type cholesterol-lowering drugs such as Crestor (rosuvastatin), Lipitor (atorvastatin), Mevacor (lovastatin) and Zocor (simvastatin) are linked to muscle pain, weakness and nerve damage. Most physicians have assumed that muscle problems are an extremely rare side effect.

New research (New England Journal of Medicine online, July 23, 2008) suggests that some people are highly susceptible to muscle-related complications from high-dose statins. This genetic vulnerability may affect up to one-fourth of the population.

Time to update your childs vaccinations

2008-08-10T07:50:00.000-07:00

State public-health officials are reminding parents that several immunizations are required before children can attend school or child care. Requirements for new vaccines or boosters change year by year to phase in protection for all students.

This year, students entering sixth and seventh grade must get the tetanus, diphtheria and pertussis (Tdap) vaccine. This is a booster shot for most children and will help protect older ones against whooping cough (pertussis).

Also this year, children starting first, second and sixth grades must get chickenpox (varicella) vaccine or document that they've had the disease; kindergartners need two doses.

Exemptions are allowed for medical, religious or personal reasons, but children who are not fully immunized may be excluded from attending school, preschool or child care if an outbreak occurs, noted Michele Roberts, health promotion and communication manager for the state's immunization program.

Average ER waiting time nears 1 hour, CDC says

2008-08-09T07:35:00.000-07:00

The average time that hospital emergency rooms patients wait to see a doctor has grown from about 38 minutes to almost an hour over the past decade, according to new federal statistics released Wednesday.

The increase is due to supply and demand, said Dr. Stephen Pitts, the lead author of the report by the Centers for Disease Control and Prevention.

"There are more people arriving at the ERs. And there are fewer ERs," said Pitts, an associate professor of emergency medicine at Atlanta's Emory University.

Overall, about 119 million visits were made to U.S. emergency rooms in 2006, up from 90 million in 1996 - a 32 percent increase.

Meanwhile, the number of hospital emergency departments dropped to fewer than 4,600, from nearly 4,900, according to American Hospital Association statistics.

Another reason for crowding is patients who are admitted to the hospital end up waiting in the ER because of the limited number of hospital beds, Pitts added.

A shortage of surgical specialists also contributes. So, too, does the difficulty many patients have in getting appointment to doctor's offices - which causes some to turn to emergency departments, experts said.

"It takes me a month to get an appointment for my own doctor, and I'm a physician, for God's sake," said Dr. Ricardo Martinez, an Atlanta emergency physician. He is executive vice president of Schumacher Group, an organization that manages about 140 hospital emergency departments.

The amount of time a patient waited before seeing a physician in an ER has been rising steadily, from 38 minutes in 1997, to 47 minutes in 2004, to 56 minutes in 2006.

Pitts added that 56 minutes may be the average, but it's not typical: The average was skewed to nearly an hour because of some very long waits.

"Half of people had waiting times of 31 minutes or less," Pitts noted.

Researchers also found that there has not been any recent increases in the number of patients arriving by ambulance, or in the number of cases considered to be true emergencies.

Black patients visited emergency departments at twice the rate as whites in 2006. Among age groups, the highest visitation rates were for infants and elderly people aged 75 and older.

About 40 percent of ER patients had private insurance, about 25 percent were covered by state programs for children and about 17 percent were covered by Medicare, the report found. About 17 percent were uninsured.

Some more findings: Summer and winter were the busiest season in ERs, and the early evening - around 7 p.m. - tended to be the busiest time of day. There were geographic differences as well, with hospitals in the South having the highest ER visitation rates.

Also, half of hospital admissions in 2006 came through emergency departments, up from 36 percent in 1996.

"The ER has become the front door to the hospital," said Pitts, a fellow at the CDC's National Center for Health Statistics.

Some doctors said the report supports a call for increased governmental funding for hospital emergency services.

"Millions more people each year are seeking emergency care, but emergency departments are continuing to close, often because so much care goes uncompensated," Dr. Linda Lawrence, president of the American College of Emergency Physicians, said in a statement.

"This report is very troubling, because it shows that care is being delayed for everyone, including people in pain and with heart attacks," her statement added.

The results are based on a national survey of 362 hospital emergency departments.

States mandate 'culturally competent' health care

2008-08-08T07:33:00.000-07:00

When a doctor doesn't look an Asian-American patient in the eye, that might be seen as a sign of respect. But making eye contact is encouraged with black patients, according to the American Academy of Orthopaedic Surgeons, which has published a guidebook for culturally competent care.

As the country's ethnic profile diversifies, some states are trying to assure that health care providers are trained in "cultural competency."

New Mexico passed a law last year requiring that higher education institutions with health education programs provide such training, though the state still is grappling with how it will be implemented. New Jersey and California are among a handful of states with similar measures already in place.

"We don't expect that a provider is going to know everything about every nationality," said William Flores, chairman of New Mexico's task force charged with developing the curriculum.

"The critical thing here is developing sensitivity and the understanding that not every culture responds to medical providers in the same way, sees medicine in the same way."

Dr. Elizabeth Szalay, an associate professor of pediatric orthopedics and pediatrics at the University of New Mexico's Carrie Tingley Hospital, said that it's important for doctors to understand how patients may be different, but patients also need to be open about themselves, by asking questions and revealing their beliefs, concerns or fears.

Navajos often are reluctant to do so, without the coaxing of a social worker, said Linda Henderson, who interprets for Navajo patients. They view Western health care as foreign and won't question a doctor even if they don't understand what is being recommended, she said. It's a matter of respect.

"From our people's point of view, we're offending the doctors, because they're the experts as far as modern contemporary medicine," said Henderson, from Sanostee in the Navajo Nation.

Cynthia Lin, 55, of Taiwan, says she never has experienced a cultural barrier between herself and doctors, which she attributed to her open attitude.

She felt the need to tell a pediatrician once about something that's common among Asian babies - that they are born with a sort of bruised look near the buttocks.

"Some doctors may think, 'Oh my goodness, what happened to the baby's butt?'" said Lin, who lives in Albuquerque. "(But) the doctor understood that's just how Asians are. If the physician already knows about it, if they are aware that certain races have certain characteristics, then they don't have any doubts."

The New Mexico task force is holding meetings around the state to gather input on what should be included in the training and hopes to have the curriculum in place by 2010, Flores said.

New Jersey's law is similar to New Mexico's, requiring that the state's medical schools provide instruction to their students as a condition of receiving a degree. But the schools also must provide cultural competency training to licensed physicians who did not receive the training while they were in school - something Flores said the New Mexico Legislature might tackle down the road.

Although New Jersey's law was passed in 2005, the regulations weren't finalized until April.
California had a voluntary program in place since 2003 but later made it mandatory for the state's 400 continuing medical education providers.

Under the law, every CME course has to have an element of cultural and linguistic competency, which are accredited by the Institute for Medical Quality.

Alecia Robinson, project administrator for the Cultural and Linguistic Competency Program under IMQ, said how the requirements would be met has largely been left up to the providers.
"Each program is unique," she said.

Medical providers agree there's no one resource that can make a person culturally competent, but they say it's important to be familiar with a culture, drop any stereotypes or bias and treat patients in the appropriate way.

"It's a mind-set," Robinson said. "I've heard people speak of it as a level of humility about understanding different cultures. That's quite appropriate."

Pandemic Flu Not Terrorism Biggest Risk in UK

2008-08-07T07:31:00.000-07:00

Pandemic flu, not terrorism, is the most serious risk to the U.K. public, says Britain's first ever national threat assessment, published on Friday.

The document, part of Prime Minister Gordon Brown's overhaul of homeland security strategy, considers the likely dangers posed by threats including terrorism, climate change, extreme weather and pandemic disease.

Britain's Cabinet Office - which drafted the document - said on Friday that a potential flu pandemic poses the most imminent danger over the next five years.

Previous government assessments have suggested an outbreak could cause as many as 750,000 deaths in Britain and acknowledged it could take several months to develop adequate vaccines against a particular strain of the virus.

Brown ordered a list of threats faced by Britain to be drafted shortly after he replaced Tony Blair in June 2007, arguing that previously classified assessments should be made public.

Though the new register does not rank threats in order of seriousness, it does indicate that flu is considered the most pressing concern, a spokeswoman for the Cabinet Office said on Friday.
"It looks at the whole range of risks and looks at them from a national perspective," said the spokeswoman, on condition of anonymity in line with policy. "It is the first time all of this has been brought together in this way."

Brown said in March that Britain was increasing its defenses against terrorism, but also preparing for potentially more serious risks from climate change and disease.

It followed a warning from Richard Mottram, who retired in November as Brown's chief adviser on intelligence and security, that the risks of a global flu pandemic, the impact of mass global migration and threats from organized crime were receiving too little attention.

Mottram claimed that the U.K.'s security strategy is too tightly focussed on terrorism.
But Britain's domestic spy agency MI5 says it is monitoring a constantly changing network of around 2,000 potential terrorists in the U.K., who are planning around 30 potential attacks at any given time.

Jonathan Evans, head of MI5, has acknowledged that the workload means officers are neglecting key counterespionage duties - despite an active spying threat from China and Russia against the U.K.

Under Brown's new security strategy, the agency will grow from around 3,000 staff to 4,000, and resources and technology at GCHQ, the government's secret eavesdropping center, will be upgraded.

A new advisory panel of security experts has also been created to report to Brown on threats faced by Britain.

Some cholesterol and heart drugs don't mix

2008-08-06T07:29:00.000-07:00

Patients taking some common medications for high cholesterol and irregular heart beats can suffer severe muscle damage because of a problem in the way the drugs interact, the government warned on Friday.

The Food and Drug Administration said doctors should use extra care when prescribing Zocor, generic Zocor, or Vytorin to patients who are also taking amiodarone, a heart rhythm drug marketed as Cordarone or Pacerone. The danger is higher for patients taking more than 20 milligrams a day of the cholesterol drugs, the agency said.

The generic name for the cholesterol medications is simvastatin.

Muscle injury is a risk with any of the cholesterol drugs known as statins, including Lipitor, particularly for the elderly. Although the risk of such injuries is low overall, they can be serious because they can lead to kidney failure and even death.

The FDA urged doctors to consider switching patients who are taking the heart rhythm drug to other statins for controlling cholesterol. The heart medication is mainly used to treat irregular rhythms in the ventricles, the heart chambers that pump blood to the lungs and body.

A previous warning dating back to 2002 about the drug interaction apparently has not put an end to the problem. The FDA said since that time it has received 52 reports of serious muscle injury to patients taking the combination of medications, and almost all the patients had to be hospitalized.

Failures Give Children a Chance to Learn

2008-08-05T07:22:00.000-07:00

In an era of so-called "helicopter parents," we've learned once again the downside of too much of a good thing. Swooping in and rescuing your child before he or she can make a mistake – in the hopes of preserving self-esteem – can bypass many learning opportunities.

Many adults have probably told themselves at some point that we "learn from our mistakes." Overcoming and learning from failure are vital life skills that your child needs your help to learn and develop during childhood.

Building your child's self-esteem is absolutely an important part of good parenting. Living in an environment of safety and love is central to building your child's healthy self-esteem. If your child knows your love is unconditional, he or she can attempt new things without fear of "losing" your love.

But it can be a tough balancing act. You want to encourage your child – help him or her try new things, reach for more and build on accomplishments – yet you may worry about what will happen when he or she inevitably fails at something and may feel the urge to prevent that failure. You want to acknowledge when your child is good at something, but you don't want him or her thinking they are so good that they don't need to try anymore.

What's important is instilling the message that, yes, it is great to be good at something, but ultimately it's about the effort put forth. Failure and setbacks are opportunities to learn and better ourselves.

In addition to praising the effort, it's important that you help your child learn to manage his or her self-criticism and temper when they do have problems. It is our role as parents to help teach children "child appropriate" coping skills. Let your child know that mistakes are a fairly routine part of life.

Often, mistakes happen through experimentation or when conditions are out of our control. Some mistakes happen when we don't have enough knowledge. And that is OK. That's how we learn for next time.

Some children react more to failure – they are much harder on themselves than others. If your child falls into this category, you'll need to spend extra energy helping your child manage his or her behavior in the face of adversity.

In addition to getting upset with him or herself, your child may be afraid of your reaction. It's important that you not be overly critical. Give your child space and the opportunity to think about what went wrong and why it happened. See if he or she can problem-solve the issue with some support from you.

React calmly and try to focus on what your child could do differently next time. Try to find an upside to the situation, and also try to find the humor in it; however, teasing or ridiculing is never acceptable. Your unconditional love will help your child be willing to try again.

You also need to be a great model through accepting your own failures. If you swear and sling the pan in the sink if you burn the dinner, you are not providing a good example of handling adversity!

It's great to involve your child in activities and projects that play to his or her interests and strengths. These successful experiences will help build and improve self-esteem. It's also important that your child doesn't go to great lengths to avoid failure. A child might avoid activities just because they are unfamiliar or uncomfortable and not things the child is sure he or she can do well.

If your child needs an example of someone who had success after years of failure, he probably needs to look no further than the bedroom bookshelf. Harry Potter series author J. K. Rowling gave Harvard's commencement address this year and said:

"Failure taught me things about myself that I could have learned no other way. Such knowledge is a true gift, for all that it is painfully won."

Flu Shots May Not Protect Elderly

2008-08-04T04:14:00.000-07:00

But researchers say seniors should get one anyway. Why?

The flu vaccine might not protect seniors as much as previously thought, according to a study of more than 3,500 patients over age 65 that found no link between flu vaccination and risk of pneumonia during three flu seasons.

One problem with previous studies looking at efficacy is that they failed to account for differences between healthier seniors and those who were 'frail,'" said lead researcher Michael Jackson, a postdoctoral fellow at the Group Health Center for Health Studies.

This study, published in The Lancet, used a rigorous case control method that included a control time period, after a flu vaccine became available but before each flu season actually started.
During those pre-flu season periods, people who had been vaccinated were much less likely to get pneumonia.

Why?

One possibility is the "healthy user" effect.

"Those who got the vaccine happened to be healthier--not because the flu vaccine was protecting them from pneumonia caused by the flu, since it wasn't present yet," Jackson said.
It's not the first study to point out that the use of flu vaccines in seniors might be a waste of time and money. A review by George Washington University researchers published in the Lancet Infectious Diseases found that flu shots may not save as many older patient's lives as generally claimed.

And a study led by Dean Eurich of the University of Alberta found that flu vaccinated people fared better than those without vaccination during the part of the year when influenza wasn't circulating. Once they adjusted for the "healthy user" effect, however, they found the benefit close to disappeared.

"So for several years now, we have had large studies which question the benefit of influenza vaccination. The notion that flu shots are so important thus seems more the result of repeated assertion than the weight of solid scientific evidence," said Peter Doshi, a graduate student at MIT, who was not involved in the Lancet study.

One of Doshi's studies, published in the May issue of the American Journal of Public Health, questioned the impact of influenza itself. Doshi suggests influenza is not as much of a problem as we have thought. Deaths from influenza have been consistently declining over the twentieth century, a trend that began far before the introduction of widespread vaccination, Doshi asserts.

Still, the researchers say the flu vaccine is safe so it seems worth getting, even if it might lower the risk of pneumonia only slightly.

"Despite our findings, and even though immune responses are known to decline with age, I still want my grandmother to keep getting the flu vaccine," said Jackson.

Doshi finds this troubling because it suggests there is an unspoken rule that "responsible scientists" must encourage vaccination, never question, discourage, or remain neutral, no matter what the evidence is.

"Such a taboo is irresponsible and definitely not serving the public's best interest," he said.
It also throws us back to the 1950s, the era of "the drug is safe, therefore let's use it," Doshi said. In 1962 the Food and Drug Administration required that drug manufacturers had to prove the effectiveness of their products before marketing them.

Exercise in a Pill?

2008-08-03T15:50:00.000-07:00

Scientists have discovered what could be the ultimate workout for couch potatoes: exercise in a pill.

In experiments on mice that did no exercise, the chemical compound, known as AICAR, allowed them to run 44 percent farther on a treadmill than those that did not receive the drug.

The drug, according to the researchers, changed the physical composition of muscle, essentially transforming the tissue from sugar-burning fast-twitch fibers to fat-burning slow-twitch ones—the same change that occurs in distance runners and cyclists through training.

According to the study, published Thursday in the journal Cell, the researchers said the drug's fat-burning ability could also help reduce weight, ward off diabetes and prevent heart disease—the benefits of daily aerobic activity without the perspiration.

It is unknown if the drug has any benefit for athletes who actually work out—or any human for that matter, because the research has so far only involved mice.

Lead researcher Ronald Evans, a molecular physiologist at the Salk Institute for Biological Studies in La Jolla, Calif., said he already has been contacted by dozens of athletes and overweight people who have heard about his research from lectures he has given on the subject.

Evans said he has notified world anti-doping officials, who are scrambling to implement a test for it before the Beijing Olympics start next week.

The compound, which is naturally produced in tiny amounts in human muscle cells and has been studied for decades, is readily available through Web sites that cater to researchers. One site was offering it for $120 a gram.

Bee Stings and Anaphylaxis

2008-08-02T09:35:00.000-07:00

Anaphylaxis has been characterized as a serious allergic reaction that is rapid in onset and may cause death. The reaction can range from mild to severe. It could be a bee sting, as in your friend's case, or a food substance that triggers this reaction.

The body's immune system occasionally identifies a substance -- for example, insect venom -- as a foreign invader, almost like bacteria, and sends antibodies to attack the offending substance. This action results in a release of chemicals within the body that can cause an allergic reaction, such as hives.

However, sometimes an individual develops a sensitivity to the allergen and, when exposed to it, the immune system has an over-the-top response. The chemicals are released in a flood, the blood pressure may drop and the bronchial tubes narrow, causing difficulty breathing or even unconsciousness and death. An anaphylactic response can occur within seconds or minutes of exposure to the allergen.

Why some people have this reaction is still a matter of debate and research. Infrequently the condition appears to be inherited or genetic, but for the majority of cases, we don't have an answer.

We do know that certain factors such as eczema and childhood asthma appear to put people at higher risk for an anaphylactic reaction. But often it's completely unpredictable.

People who've had a mild reaction to a food substance or insect sting should be wary. A mild reaction in the first episode, for example a couple of hives, could be associated with a severe or life-threatening reaction the next time.

You also should be aware that the symptoms may recur soon after treatment. Typically, such symptoms (a biphasic reaction) would return within eight hours of treatment, but in rare instances, they may recur 24 hours or even a day or two later.

Prevention is key. Avoid exposure to known allergens. People who are at risk should carry a syringe of adrenaline (epinephrine). These auto-injectors (EpiPen, Twinject) can be self-administered or used by a loved one on your behalf in the event of an anaphylactic reaction. Some research on desensitization to allergens is under way, but so far desensitization has not been entirely successful.

A S.A.F.E. campaign was developed by experts to promote steps you should take when confronted with such a situation:

Seek support -- If you've had an anaphylactic reaction, educate those around you as to its signs and symptoms and when and how to use medication such as the auto-injector. It also means that during an event, contact 911 early. Even after using an auto-injector, you still need to go to an emergency department to be evaluated for care, as the effects of the epinephrine are only temporary.

Assess for allergen -- Right after the event is probably the time when you and your family are best able to remember what you were exposed to. Most of the time it is obvious, for example, an insect sting or a food source such as seafood, a peanut or tree nut, such as a walnut or pecan.

Follow-up -- Anyone who has experienced a systemic allergic reaction should seek timely follow-up care with a primary care physician and referral to an allergist for further treatment and testing.

Epinephrine -- This is really the cornerstone of treatment for severe reactions with hypotension (low blood pressure) or difficulty breathing. The epinephrine should be given right away at home, in the field or in the emergency room. Those who have had an anaphylactic episode should carry an auto-injector of epinephrine.

Some kinds of food reactions are not dangerous, for example mild scratching in the roof of the mouth or a mildly upset stomach. On the other hand, we prefer to err on the side of caution. People who have experienced an allergic reaction to a food substance or an insect sting should talk to their primary care provider about whether they should carry epinephrine.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

The Facts About Natural Medicine

2008-08-01T21:32:00.000-07:00

While the use of natural medicine is on the rise, many misconceptions still exist surrounding the use and benefits of these therapies. Here are two common myths and facts about Complementary and Alternative Medicine (CAM) and its role in the future of health care:
Myth: You must choose either natural medicine or conventional medicine.

Fact: People no longer think they have to choose, realizing that both natural and conventional approaches can play a role in meeting their health care needs. According to a study conducted in 2005 by the Institute of Medicine at the National Academy of Sciences, more than a third of American adults use some form of Complementary and Alternative Medicine, including herbal remedies and acupuncture, with total visits to CAM providers each year now exceeding those to primary care providers. As health care consumers demand more options, the medical establishment is responding. Surveys show that 60 percent of conventional medical schools teach some form of complementary medicine. The number of accredited naturopathic medical schools in the country also is growing -- as are their enrollment numbers.

Myth: Herbal remedies are safe and nontoxic, so I can self-prescribe them.
Fact: It is important to realize that "natural" doesn't necessarily mean "safe." Although the vast majority of herbs are safe when used properly, they also are powerful. They can cause adverse effects and can interact negatively with conventional medicines. Seek advice from someone trained in herbal and natural medicines and buy products from a reputable source to ensure quality and purity.

Always tell your conventional health care provider about any CAM therapies you use, because it will give him or her a better understanding of your whole health care picture. For more information on which CAM therapies may benefit you, consult a licensed naturopathic physician.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Exercise Safely in Summer Heat

2008-07-31T21:29:00.000-07:00

Summer is finally here and it's the perfect time to take your exercise routine outdoors. However, the soaring temperatures can take a toll on even the most dedicated fitness enthusiast, so it is essential to take some precautions while exercising in warm weather.

Here are some helpful safety tips to follow while exercising during the summer:

Take it easy -- If you're used to exercising indoors or in cooler weather, start out slowly. As your body adapts to the heat, gradually increase the length and intensity of your workouts. It generally takes three to seven days for the body to adjust to significantly hotter weather.

Drink plenty of water -- While exercising in hot weather, you easily can lose up to a liter of water an hour. Drink water before, during and after exercising. Beverages containing electrolytes should be consumed during outdoor exercise sessions lasting more than 90 minutes.

Avoid the midday sun -- Exercise in the morning or evening, when it's likely to be cooler outdoors, rather than the middle of the day. If possible, exercise in the shade or in a pool.
Wear sunscreen -- Apply SPF 15 sunscreen at least 30 minutes before exercising outdoors. Protect your eyes with sunglasses that block the sun's UV rays. A sunburn decreases your body's ability to cool itself.

Choose the appropriate clothing -- Wear loose-fitting clothing to allow circulation of air between your skin and the environment. Also, light-colored clothing will reflect sunlight, while darker clothing will absorb the heat. Clothing designed to wick away perspiration also is a great way to keep cool in the hot weather.

If you are concerned about the level of heat outside, stay indoors. A good backup plan, such as walking laps inside a mall or climbing stairs in an air-conditioned building, can help you get exercise without putting yourself at risk of heat exhaustion or heat stroke.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Millions at Risk with Pre Dementia

2008-07-30T21:26:00.000-07:00

A milder type of mental decline that often precedes Alzheimer's disease is alarmingly more common than has been believed, and in men more than women, doctors reported Monday.

Nearly a million older Americans slide from normal memory into mild impairment each year, researchers estimate, based on a Mayo Clinic study of Minnesota residents.

That's on top of the half-million Americans who develop full-blown Alzheimer's or other forms of dementia – a problem sure to grow as baby boomers age. The oldest boomers turn 62 this year.
"We're seeing that in fact there's a much larger burgeoning problem out there" of people at risk of developing dementia, said Dr. Ronald Petersen, the Mayo scientist who led the study.
Dr. Ralph Nixon, a New York University psychiatrist and scientific adviser to the Alzheimer's Association, was blunt.

"We're facing a crisis," he said.

There are no treatments now to prevent this mental slide or reverse it once it starts.
But that may be changing. Researchers on Monday reported early, somewhat encouraging results from an experimental nose spray that seemed to improve certain memory measures in a study of mildly impaired people.

The drug, for now called AL-108, needs testing in a longer, larger study. It is being developed by Allon Therapeutics Inc., based in Vancouver, B.C.

Doctors said it shows the potential for new types of medicines that target the protein tangles that kill nerve cells, instead of targeting the sticky brain deposits that have gotten most of the attention up to now.

The studies were reported at the International Conference on Alzheimer's Disease in Chicago.
Petersen is the scientist who defined mild cognitive impairment, or MCI, as a transition phase between healthy aging and dementia. It is more than "senior moments" like forgetting where you parked the car, but not as severe as having dementia, where you forget what a car is for.
People with it have impaired memory but not other problems like confusion, inattention or trouble putting thoughts into words.

The Alzheimer's Association says more than 5 million Americans have Alzheimer's, but no estimate for this "pre-dementia" has been available until now.

Petersen's federally funded study involved about 1,600 people, ages 70 through 89, living in Olmstead County, Minn., which surrounds the Mayo Clinic. All tested normal when they were enrolled in the study, but more than 5 percent had developed mild impairment when evaluated a year later.

Men were nearly twice as likely as women to develop it. That's a surprise, because some studies have found more women with Alzheimer's than men. But there may be a simple explanation:
Even though more men may be impaired, women outlive them and therefore have more time to develop full-blown dementia.

"This is a very large and important issue for our country and for the world," said Duke University psychologist Brenda Plassman. A smaller study she published earlier this year backs up the Mayo study's findings.

The mild impairment rate is two to three times larger than many researchers had expected, Petersen said.

"It's the iceberg under the tip," agreed Dr. R. Scott Turner, incoming director of the memory disorders program at Georgetown University Medical Center. A prime goal is finding drugs to treat the mild impairment before Alzheimer's develops.

The AL-108 study tried to do that. Scientists gave 144 people with mild impairment either a low or high dose of the drug or a dummy drug for 12 weeks. The study missed its main goal – a composite of various memory scores – and the low dose showed no effect. But those on the higher dose improved on some memory tasks after one month and benefits lasted a month after they stopped treatment, said the study's leader, Dr. Donald Schmechel of Duke University.

The study was sponsored by the drug maker.

In another study presented at the conference on Sunday and published on the Internet by the British medical journal The Lancet, researchers reported that dementia rates in developing countries may be considerably higher than official estimates and closer to rates in wealthy countries.

Scientists used a more liberal definition of dementia more suitable to poorer, less educated populations, where respect for family often means relatives don't regard dementia as a burden and may be less likely to report problems.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Cell Phone Texting Can Lead to Injuries

2008-07-29T21:24:00.000-07:00

The warning came too late for Barack Obama's adviser: Don't walk and text at the same time.
Obama aide Valerie Jarrett fell off a Chicago curb several weeks ago while her thumbs were flying on her Blackberry.

"I didn't see the sidewalk and I twisted my ankle," Jarrett said. "It was a nice wake-up call for me to be a lot more careful in the future, because I clearly wasn't paying attention and I should have."

Jarrett got off easy and didn't need medical attention.

But in an alert issued this week, the American College of Emergency Physicians warns of the danger of more serious accidents involving oblivious texters. The ER doctors cite rising reports from doctors around the country of injuries involving text-messaging pedestrians, bicyclists, Rollerbladers, even motorists.

Most involve scrapes, cuts and sprains from texters who walked into lampposts or walls or tripped over curbs.

Still, ER doctors who responded to a recent informal query from the organization reported two deaths, both in California. A San Francisco woman was killed by a pickup truck earlier this year when she stepped off a curb while texting, and a Bakersfield man was killed last year by a car while crossing the street and texting.

The U.S. Consumer Product Safety Commission has no national estimate on how common texting-related injuries are. But among the reports it has received: A 15-year-old girl fell off her horse while texting, suffering head and back injuries, and a 13-year-old girl suffered belly, leg and arm burns after texting her boyfriend while cooking noodles.

Giancarlo Yerkes texted his way across a busy Chicago street Tuesday and escaped unscathed. But the 30-year-old advertising employee admitted he once walked straight into a stop sign while texting and bumped his head.

Yerkes said that he texts while walking to maximize his time, and that the emergency doctors' warning probably won't stop him.

"There's a lot of things you shouldn't do — this is another one on my list," Yerkes said.
Dr. James Adams, chairman of emergency medicine at Northwestern Memorial Hospital in Chicago, said he has treated minor injuries in several texters.

Common sense isn't always common," Adams said.

Sometimes even among doctors.

"I have to admit that I started a text while I was driving and then I said, 'This is so stupid,' so I stopped," Adams said.

Dr. Patrick Walsh, an emergency physician in Bakersfield, Calif., said he is a texter, too, but tries to remind himself to do it intelligently.

"We think we're multitasking, but we're not," he said. "You're focusing on one task for a split second, then focusing on another one, and with something moving 40 miles an hour like a car, it just takes a couple of seconds to be hit."

Walsh, a native of Ireland, said that on a recent visit there he noticed an effective government TV ad campaign against texting and walking, aimed at teenagers.

The message echoes the new advice from U.S. emergency doctors.

"We don't want to sound like some stern schoolmistress, telling people don't text on your cell phone," Walsh said. "But when you're texting, look around," he said.

The ER group also says people should never text while driving, and should avoid talking on a cell phone or texting while doing other physical activities, including walking, biking, boating and Rollerblading.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Free Vasectomies?

2008-07-28T19:13:00.000-07:00

From 15-cent train rides to excellent $1 meals, Thailand's tropical capital is teeming with budget options for the penny-pinching traveler. Where else in the world can you get a free vasectomy?

It's easy to spend hundreds of dollars a day in Bangkok, home to some of the most luxurious hotels in the world. But following some guidelines, you can enjoy the city at a fraction of the price.

Accommodations: Most budget tourists head straight for Khao San Road, a lively, colorful area where you can pay the equivalent of just $4.50 a night for a bed in a dorm room. Despite the low price, the accommodations are perfectly decent. It's heaven for backpackers, but more recently is attracting more upmarket tourists as well.

In Bangkok's prime residential area of Sukhumvit Road, one budget option is Suk 11, a quirky guesthouse legendary among backpackers, where the halls have been remade with creaking wooden planks and hanging lanterns to look like old Bangkok alleyways. A bed in a clean, air-conditioned dorm room starts at $7.50.

Getting around: Buses in Bangkok charge only 15 cents for non-air-conditioned service, and up to 50 cents for air-conditioned vehicles.

Traveling in Bangkok during rush hour is an exercise in Zen patience, so tourists in a hurry would do best to use the excellent BTS Skytrain and underground Metro, with trips starting at 45 cents.

Trains in Bangkok are cheap. A third-class trip from some suburban areas to the heart of town cost as little as 15 cents.

Or hop aboard one of the public ferries along the Chao Phraya River for some spectacular views from the water for 27 cents.

Food: You can pay as little as $1 per meal at a neighborhood street stand. Follow the crowds. Any place packed with customers is bound to offer tasty, fresh fare. Try the stalls at the Banana Family Park, near the Ari Road Skytrain stop, for tasty vegetarian options. Two meatless dishes cost 75 cents.

Massage: For a cheap and novel Thai massage, head to the Skills Development Center for the Blind, where sightless trainees charge just $3 per hour. The center is located just north of the city in Pak Kret.

Madame Joe's, staffed by graduates of the famous Wat Po Massage School, offers affordable massage in the Khao San area, at about $5.40 for one hour.

Bars: Cheap Charlie's, a ramshackle but atmospheric outdoor bar in the Sukhumvit area, has been popular with frugal expatriates for years. Just $1.80 for a small bottle of local brew.

Some bars have ladies-night specials. Try Coyote on Convent Road, where waiters will keep your margarita glass overflowing for free from 6 to 8 p.m. Wednesdays. The trendy Q Bar, in Sukhumvit, allows women to forgo the $15 cover on Wednesday nights.

Attractions and events: Museums and the more notable Buddhist temples in Bangkok are cheap, generally charging $1 or $2 for entry, while parks, art galleries, less famous temples and outdoor shrines are free.

In the wee hours of the morning, the centrally located Lumpini Park fills up with fitness buffs. Look for groups practicing yoga or tai chi. Instruction is in Thai, but most classes will allow you to join in for free. The fun ends at 8 a.m., when the national anthem is played, but crowds return at sundown for more exercise, including aerobics classes.

The Lingam Shrine, filled with phallic symbols, is a must-see among Bangkok's free oddities.
Traditional dances are performed without charge at the Erawan Shrine, near the Grand Hyatt Erawan hotel.

At Siam Square, a popular hangout for the younger crowd, free break-dancing competitions and concerts take place in the shadows of chichi malls and high-end apartment complexes.

Check out BK Magazine (www.bkmagazine.com/)or the "Real Time" section of Friday's English-language Bangkok Post for up-to-date schedules of free performances and other events in the city.

Inside info: Just saying "hello" ("sawadee kha" if you are a woman; "sawadee krap" if you are a man) and "thank you" ("khopkhun kha/krap") may well get you a lower price, especially when bargaining in markets.

Never throw the grown-up version of temper tantrums. Thais abhor them — and may add a bit on to your bill in revenge.

As for those free vasectomies?

The Population and Community Development Association offers them to any man, any nationality, who has fathered two children already.

How's that for a good deal?

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

High Risk of Injury for Young Athletes

2008-07-25T05:36:00.000-07:00

A 14-year-old gymnast with a stress fracture in her lower back. A 12-year-old who tore his ACL in a soccer game. A 16- year-old runner with a leg stress fracture. A 15-year-old who tore his meniscus playing basketball.

A single morning's patients for Harvard's Dr. Mininder Kocher provides a window into a troubling trend: Injuries once seen mostly in adult athletes are becoming distressingly common in youth athletes -- not just in high school, but in Little League and Pee Wee Football.

These aren't simple injuries. In the past decade, "Tommy John" surgeries to repair elbows blown out playing baseball -- an operation named for a Hall of Famer -- have almost tripled among adolescents at a high-profile Alabama clinic, a meeting of sports medicine specialists were told by researchers last week.

Worse, some injuries don't have good treatments for young patients. The surgery that fixed the torn ACL in Tiger Woods' knee, for instance, can thwart the growth of a young child's leg.
Kocher, an orthopedic surgeon at Children's Hospital Boston, is about to begin a government-funded study to figure out the best treatment for children who tear that anterior cruciate ligament while growth plates around the knee still are active.

But no matter how well certain injuries heal for now, Kocher worries about the long-term consequences for little joints.

"I wonder what these kids are going to be like 20 to 30 years down the road," he says. "Will we have a whole generation of middle-aged adults with early arthritis?"

Why the sudden influx? Orthopedic surgeons say that today's youth sports are more intense, with players often picking just one to specialize in as young as 8. And they can play and train in some sports virtually year-round -- with a school team, recreation league, travel league, summer camp.

"Youth athletes are not the same as small adults," says Dr. Lyle Cain Jr. of the Andrews Sports Medicine & Orthopaedic Center in Birmingham, Ala. Certain types of injuries "can cause permanent damage that affect their future growth."

More than 3.5 million children 14 and under receive medical treatment for sports-related injuries each year. Along with the typical sprains and strains are a lot of overuse injuries -- stress fractures, tendonitis, cartilage damage.

Pitching offers a prime example. The Andrews clinic counts a five- to sixfold increase in serious shoulder and elbow injuries in youth baseball and softball since 2000.

The worst is a torn ulnar collateral ligament on the inside of the elbow. By 2006, nearly a third of Tommy John surgeries to repair it were on patients under 18, Cain told a meeting of the American Orthopaedic Society for Sports Medicine.

Prompted by such research, Little League Baseball last year limited how many pitches youngsters of different ages are allowed to throw before mandatory rest periods.

Then there's the notoriously painful torn ACL -- not an overuse injury but one that can happen to anyone who lands wrong while pivoting on a knee.

It was long thought a rarity in childhood. But among males, 20 percent of torn ACLs occur before age 18; the figure is 30 percent among females, Kocher says.

In 2006, McCall Maddox of Jacksboro, Texas, tore his ACL during Pee Wee Football at age 12. Three doctors refused to do surgery until he was 16 and had quit growing, ordering no running until then. Join the swim team, one advised.

Why? Standard ACL repair involves drilling through the leg's growth plates, risking a stunting of any still-to-come growth.

McCall, a good athlete, was devastated. And in his small town, said his mother, Roxanna Maddox, "We don't have a swim team. We don't have a chess club. We don't have any other options."

She sought out Kocher in Boston, who repairs children's ACLs in a different way: Winding the new ligament around the shinbone instead of drilling. Kocher reports patients doing well five to eight years later but acknowledges a big question: "Will it hold up 20, 30 years down the line" as the adult surgery does?

McCall took a chance with the operation and, after six months of sometimes grueling physical therapy, he was back playing football and basketball and running track in seventh grade.
"Was his mother nervous? Absolutely," Maddox says with a laugh. But her son had "no trouble, none. ... It was a risk worth taking."

Such success stories, however, don't make scientific proof. So Kocher is joining Dr. Allen Anderson of Nashville -- whose own pediatric ACL repair involves drilling near but not through growth plates -- and about 10 hospitals around the country to compare the different surgeries or waiting to operate, to find the best approach.

Until then, Kocher has some easy advice: Try old-fashioned play, such as jumping rope, playing hopscotch, climbing trees. High school teams now are trained to avoid ACL tears with core-body conditioning and tips on bending knees for jumping -- things younger children can learn on their own just by having fun.

"A lot of the stuff kids used to do in free play was ACL prevention," he says. "Now they don't get that, and they jump into high-level soccer."

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Beware of Fragranced Products

2008-07-24T05:31:00.000-07:00

The scented fabric sheet makes your shirts and socks smell flowery fresh and clean. That plug-in air freshener fills your home with inviting fragrances of apple and cinnamon or a country garden.
But those common household items are potentially exposing your family and friends to dangerous chemicals, a University of Washington study has found.

Trouble is, you have no way of knowing it. Manufacturers of detergents, laundry sheets and air fresheners aren't required to list all of their ingredients on their labels -- or anywhere else. Laws protecting people from indoor air pollution from consumer products are limited.

When UW engineering professor Anne Steinemann analyzed of some of these popular items, she found 100 different volatile organic compounds measuring 300 parts per billion or more -- some of which can be cancerous or cause harm to respiratory, reproductive, neurological and other organ systems.

Some of the chemicals are categorized as hazardous or toxic by federal regulatory agencies. But the labels tell a different story, naming only innocuous-sounding "perfume" or "biodegradable" contents.

"Consumers are breathing these chemicals," she said. "No one is doing anything about it."
Industry representatives say that isn't so.

"Dr. Steinemann's statement is misleading and disingenuous," said Chris Cathcart, president of the Washington, D.C.-based Consumer Specialty Products Association, in a statement.
"Air fresheners, laundry products and other consumer specialty products are regulated under the Federal Hazardous Substances Act and subsequently have strict labeling requirements," he said. "Companies producing products that are regulated under FHSA must name on the product label each component that contributes to the hazard."

Millions are spent annually to ensure that fragrances in the products are safe, according to a joint statement from the Fragrance Materials Association, which represents fragrance manufacturers, and the Research Institute for Fragrance Materials, which works closely with the association.
Ingredients are routinely tested, and chemicals that are considered dangerous are present at levels much too low to cause harm, according to the groups.

But there are numerous reports of people -- particularly those with asthma, chemical sensitivities and allergies -- having strong adverse reactions, researchers said.

That's a problem when public restrooms in restaurants or airplanes use air fresheners, or when hotels wash towels and sheets in scented laundry supplies. And even when the concentrations are low in individual products, people are exposed to multiple sources on a daily basis.
Aileen Gagney, Asthma and Environmental Health Program manager with the American Lung Association in Seattle, herself an asthma sufferer, has a rule of thumb to help avoid exposure: "If it smells bad, it's bad; if it smells good, it's bad."

But even that won't always work.

According to Steinemann, even products labeled "unscented" sometimes contain a fragrance and a "masking" fragrance to make them odor-free.

With fears growing over chemicals in consumer products -- lead in toys, bisphenol A in plastic baby bottles, phthalates in shower curtains and cosmetics -- environmentalists and health advocates are calling for stricter regulations of chemicals in everyday goods. They also want shoppers to have more readily accessible information.

Manufacturers and trade groups representing consumer products routinely counter that there's plenty of testing and oversight from within the industries and from government regulations to ensure safety.

In the fragranced-products arena, they point to industry Web sites with information on product ingredients and suggest contacting companies with specific questions.

Critics maintain that's not enough.

"There's obviously a loophole," said Michael Robinson-Dorn, a UW law professor who aided Steinemann's research. "We regulate many of these chemicals in other circumstances, yet when they're in products that we're in contact with daily, in some cases, we don't wind up finding out about them."

He said the items can slip between regulatory cracks by falling into the jurisdiction of multiple government agencies, none taking ownership.

"Any time you have a product that is regulated by many different agencies, it's easy for them not to react," he said.

In the absence of strong laws, the marketplace is starting to regulate itself.

After the Natural Resources Defense Council last fall found troubling levels of phthalates -- plasticizing chemicals that can potentially harm developing babies -- in air fresheners, Walgreens pulled the products from its shelves.

Last month, NRDC and other environmental groups sued the Environmental Protection Agency to force manufacturers to test air freshener safety and label products with a full ingredient list.
Steinemann's study could push the process along.

"Consumer demand for less-toxic products will encourage companies to reformulate their products," she said. "This is a case where a little information could have a great public benefit."

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Foreign TB Cases Need Better Control

2008-07-23T07:26:00.000-07:00

Tuberculosis cases continue to fall in the United States, but some immigrants have disturbingly high rates of the disease, according to a study released Tuesday that called for more aggressive action.

TB rates were highest among residents from lower Africa and parts of Southeast Asia. Most drug-resistant TB cases also were from foreign-born residents, the study noted.

The researchers called for wider testing, including efforts to seek out latent cases of TB from long-term immigrant residents in certain populations.

Rates of at least 250 TB cases per 100,000 were found among people from African countries such as Ethiopia, Kenya and Somalia and from Southeast Asian nations including Vietnam, Cambodia and the Philippines.

By comparison, the overall rate of TB in the U.S. is fewer than 5 per 100,000, according to researchers at the Centers of Disease Control and Prevention, whose study is based on data from 2001-06. Their findings are being published in Wednesday's Journal of the American Medical Association.

Dr. Henry Blumberg of Emory University's medical school, said the research shows "that it's in the interest of the United States to try to enhance global TB efforts."

Of those infected, drug-resistant TB was found in 20 percent of recent immigrants from Vietnam and 10 percent of foreign-born residents overall, compared with a little more than 4 percent of U.S.-born residents.

Public health officials worry that drug-resistant TB could become a worldwide scourge because of global travel and immigration. The issue made headlines last year when an Atlanta attorney with drug-resistant TB flew to several countries. Tests later showed he did not infect anyone on those flights.

U.S. law requires TB screening for people who want to immigrate to the United States, said the CDC's Dr. Kevin Cain, the study's lead author.

Another step that would help curb the rise of tuberculosis, he said, would be to find and treat latent TB infections. He said the study helps identify which foreign-born groups would be most appropriate for such an effort.

While most TB cases come from recent arrivals, a significant number involve people who have lived in the United States for at least 20 years, the study authors said. Most of these likely resulted from latent infections acquired years earlier abroad, they wrote.

Latent, non-contagious infections mean germs are present but the body is able to fight off symptoms. Latent infections can morph into active disease, causing contagious illness, at any time, particularly as people age and their immune systems weaken.

Latent infections are detected with skin tests and treated with nine months of antibiotics. Foreign-born U.S. residents aren't routinely tested for latent TB. And with more than 37 million foreign-born people living in the United States, giving all of them skin tests "would be daunting to say the least," Cain said.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Is it a cold or is it an allergy?

2008-07-22T07:24:00.000-07:00

THE BELIEF:

It's a cold. No, it's an allergy.

A stuffy head, a sore throat and sneezing fits that could leave you with a migraine: According to some surveys, about 20 percent of Americans report experiencing symptoms such as those at the same time every year.

That would suggest they are because of an allergy, not a cold. But how to tell the difference?
Symptoms of seasonal allergies and colds overlap, but studies suggest there are ways to tell them apart.

The first is the onset of symptoms. Colds move more slowly, taking a day or longer to set in and gradually worsening -- with symptoms such as loss of appetite and headache -- before subsiding after about a week and disappearing within 10 days. But allergies begin immediately. The sneezing is sudden and overwhelming, and the congestion, typically centered behind the nose, is immediate. Allergy symptoms also disappear quickly -- almost as soon as the offending allergen, like pollen, is no longer around.

Then there are hallmark symptoms of each. Allergies virtually always cause itchiness, in the eyes, the nose, the throat, whereas a cold generally does not. Telltale signs of a cold are a fever, aches and colored mucus.

If confusion persists, consult your family tree: Studies show that having a parent with allergies greatly increases your risk, particularly if that parent is your mother.

THE BOTTOM LINE:

There are a few slight differences that can help you separate allergies from a cold.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Hydrate The Right Way

2008-07-21T07:20:00.000-07:00

Summertime brings many opportunities for outdoor activity, but exercising in heat and humidity for prolonged periods of time can overtax the body. We all know how important it is to avoid dehydration, especially when exercising in extreme temperatures. So what's the best way to stay hydrated?

Water or sports drink? Water is the best choice when it comes to normal fluid loss, that is, when going about everyday activities such as running errands, housecleaning and other routine tasks. Consuming sports drinks is generally recommended as a suitable fluid replacement in cases in which physical activity is of long duration (generally more than one hour) or where there is excessive sweating. With sweating, the body loses salts and other valuable minerals, which must to be replaced. In this case, a sports drink can be a good idea. Try chocolate milk, many sports nutritionists are beginning to tout it's benefits after a workout and prefer it over sports drinks.
Pre- and post-workout drinks. Whey is a protein-rich liquid component of milk, produced as a byproduct of the cheese-making process. Whey protein has been called the ultimate functional food and is used as a key ingredient in many pre-and post-workout drinks and shakes to help promote adequate muscle recovery and repair. Designer Whey is one of the most popular and recognized brands of this type, with ready-todrink products as well as easy-tomix powders.
Energy drinks. There is much controversy as to whether energy drinks are safe. Energy drinks are typically carbonated beverages with stimulants such as caffeine, certain herbs and other ingredients, and high amounts of sugar, although sugar-free energy drinks are now available. Caffeine is a diuretic, which increases fluid loss and accelerates the rate of urination.

Travel Immunizations

2008-07-20T05:55:00.000-07:00

Passport? Check. Plane tickets? Check. Immunizations? Uh-oh."

Most people are so absorbed in the passport and tickets and reservations at the hotel that they don't think about health," said physician Phyllis Kozarsky, a consultant for the U.S. Centers for Disease Control and Prevention and a professor of medicine at Emory University in Atlanta.

Thinking about immunizations is not something travelers can consider on the way to the airport. Most inoculations should be planned at least four weeks before travel so the vaccines can become active in the body, said physician Kamaljit Singh, an infectious-disease specialist at Rush University Medical Center in Chicago.

Whether a traveler even requires a vaccine depends on the travel location, itinerary, lifestyle and season of travel, said Singh, who heads the Rush Travel Medicine and Immunization Clinic.

He added that an increasing number of people heading for more exotic locations has surprised him, and they are prime candidates for vaccinations.

"Are you staying in a five-star hotel and wearing suits and jackets or will you have on a backpack and climb on a bicycle?" Singh said, explaining that being out in the elements is more likely to require vaccinations.

A recent trip to China was all business for Chet Kondas, who traveled for nine days in May to major cities such as Beijing. Singh said business travelers such as Kondas usually do not require vaccinations.

Kondas wore a business suit all day, stayed in upscale hotels and spent most of his time indoors.
"We were going from one meeting to the next, and the lunches and dinners were really formal," said Kondas of Chicago.

Having considered the clean conditions he would be in, Kondas did not receive any vaccines before traveling but said he might for future trips. "We stayed in a very nice hotel," he said. "The only thing was you had to be careful about the [drinking] water.

"But travelers planning an outdoor adventure or time in rural areas are more likely to require vaccinations. Singh, for example, will be traveling to Uganda this summer to practice medicine in an underserved area.

His itinerary requires vaccinations against rabies, Hepatitis A, Hepatitis B, yellow fever and a polio booster. Additionally, travelers are advised to be sure they are up to date with shots of U.S.-recommended vaccines such as tetanus, Singh said.

Having as many vaccines as Singh is getting may seem excessive, but travel-medicine physicians argue that the shots protect against dangerous diseases. Typhoid, for example, is transmitted by contaminated food and water and is recommended for travelers heading to most foreign destinations, including Eastern Europe. Likewise, Hepatitis A is transmitted by food and water and is recommended for people traveling to those same places.

Hepatitis B is transmitted by blood and bodily secretions and is advised for patients who expect to receive a tattoo, have contact with needles or have sex with locals while traveling, Kozarsky said.

Other vaccines such as yellow fever and Japanese encephalitis are transmitted by mosquitoes, so if a person's travel itinerary won't lead them to infested places, such vaccinations may be unnecessary. But Kozarsky said medical professionals tend to recommend shots for travelers planning time in rural areas, such as a biking trip through Vietnam.

Rabies pre-exposure shots also may be recommended for travelers heading into rural areas or for travelers with children, who are more likely to pet animals and may not report a bite. But the pre-exposure vaccination does not eliminate the need for post-exposure shots.

The pre-exposure vaccination simply makes the post-exposure treatment easier to receive, Kozarsky said, because the pre-exposure vaccination contains a product that is not always available in countries such as China or India and is required for post-exposure treatment."You face the risk of rabies or having to leave the country and going to another country to find the medication," Kozarsky said.

One shot recommendation that may surprise American travelers is the polio booster. Polio has not been eradicated in other countries, Kozarsky said, but fortunately one booster covers a person for adulthood.

While some diseases can be prevented with vaccines, others can be treated only with medicine. Malaria, for example, does not have a vaccine, so travelers are given pills to take before, during and after travel as prevention. Again, Kozarsky said, a person's itinerary determines which drug will be used, because malaria parasites in some areas are resistant to certain drugs.

So travel-medicine specialists can help a traveler determine whether vaccinations are needed. According to Singh, this is what a traveler should explain to a doctor about the itinerary:

Places the person will travel, including whether in cities or farming areas.
The season.
Lodging—for example, a hotel or a tent.
Time to be spent outdoors.

Doctors in travel medicine also know which vaccinations are required for a visa. For example, Singh said, Saudi Arabia requires a meningitis vaccine. Beyond that, he noted, many of these vaccinations, such as a routine tetanus shot, can be helpful whether traveling or not."You don't have to cut yourself in Uganda," Singh said. "You can cut yourself raking your yard."

Local clinics

Need malaria pills or a polio booster? Here are some travel medicine and immunization clinics in the Chicago area:

Healthy Trust Immediate Medical Care
342 S. Milwaukee Avenue
Wheeling, IL 60090
847-243-0333

Secondhand Tobbaco Smoke Drastically Drops

2008-07-19T05:50:00.000-07:00

Nearly half of nonsmoking Americans are still breathing in cigarette fumes, but the percentage has declined dramatically since the early 1990s, according to a government study released Thursday.

A main reason for the decline in secondhand smoke is the growing number of laws and policies that ban smoking in workplaces, bars, restaurants and public places, said researchers with the Centers for Disease Control and Prevention.

Another factor is the drop in the number of adult smokers: It has now inched below 20 percent, according to 2007 CDC data.

The new study found about 46 percent of nonsmokers had signs of nicotine in their blood in tests done from 1999 through 2004. That was a steep drop from 84 percent when similar tests were done in the late 1980s and early 1990s.

But health officials stopped short of celebrating. "It's still high," said Cinzia Marano, one of the study's authors. "There is no safe level of exposure."

Cigarettes cause lung cancer and other deadly illnesses not only in smokers, but also in nonsmokers who breathe in smoke, studies have shown.

For nonsmoking adults, secondhand smoke increases their lung cancer risk by at least 20 percent and their heart disease risk by at least 25 percent. Children exposed to secondhand smoke are at increased risk of asthma attacks, ear problems, acute respiratory infections and sudden infant death syndrome, health officials say.

The new CDC report drew its data from the National Health and Nutrition Examination Survey, a unique government study that sends mobile trailers out to communities.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

When Should You See a Dietician?

2008-07-18T05:52:00.000-07:00

A registered dietitian, or RD, is a food and nutrition expert who translates the science of nutrition into practical solutions for healthful living. Taking a highly personalized approach to diet and health, a dietitian can work within the context of your values and daily life patterns to help you achieve your nutrition goals.

RDs undergo rigorous training and must hold a bachelor's or master's degree in dietetics from an accredited college or university, complete a six- to 12-month dietetic internship, and pass a national examination administered by the Commission on Dietetic Registration. Most often they are up to date on the latest research surrounding the connection between diet and health and can provide guidance to integrate a healthy diet into your lifestyle.

A dietician can provide guidelines for digestive and immune support and offer recommendations for weight-related dietary changes. He or she also can offer customized dietary recommendations to treat chronic illnesses such as heart disease and diabetes and support healthy living.

During the initial meeting with a dietitian, he or she will work with you to paint a complete picture of your overall nutritional status. The dietitian will ask questions about your health history and your eating habits. He or she will then work with you to problem solve and develop a customized plan to help you achieve optimal health through nutrition.

Consult your physician to find out if a registered dietitian may be a good addition to your health care team.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Cipro a Risk for Tendons?

2008-07-17T08:30:00.000-07:00

Drug safety officials Tuesday imposed the government's most urgent safety warning on Cipro and similar antibiotics, citing evidence that they may lead to tendon ruptures, a serious injury that can leave patients incapacitated and needing extensive surgery.

The Food and Drug Administration ordered makers of flouroquinolone drugs - a potent class of antibacterials - to add a prominent "black box" warning to their products and develop new literature for patients emphasizing the risks.

Tendon ruptures are normally thought of as sports injuries, generally occurring among men in their mid-30s. The link to treatment with the antibiotics is highly unusual, and scientists still don't fully understand why it happens. However, FDA officials stressed that many of the serious injuries appear to be preventable if patients stop taking the drug at the first sign of pain or swelling in a tendon, call their doctor, and switch to another antibiotic.

The two leading drugs covered by the warning are Cipro, made by Bayer, and Levaquin, which is made by Ortho-McNeil. Cipro became a household name during the anthrax attacks of 2001. It is effective against that deadly bacteria, and is among the drugs stockpiled by the government in case of a bio-terror attack. In everyday medicine, Cipro is often used to treat urinary tract infections. Levaquin is generally used to treat respiratory infections. The FDA warnings do not apply to fluoroquinolone drops used to treat eye infections.

The FDA's action came after the consumer group Public Citizen petitioned - and later sued - the agency for such warnings. Regulators took too long to act, complained Sidney Wolfe, head of the consumer group's health section. Many injuries "would have been prevented if patients and doctors had known a pain in the tendon is an early sign that leads to rupture," Wolfe said. Public Citizen's original petition was filed nearly two years ago.

FDA officials pointed out that prescribing literature for the drug class already carried clear warnings of the risk of tendon rupture. They said the agency acted to emphasize the warnings because continued reports of injuries indicated that the message may not have gotten through to doctors and patients.

"The continued reports demonstrate additional steps are warranted to better manage the risk of tendon rupture," said Renata Albrecht, director of an FDA office that focuses on unusual microbes.

FDA officials said they had received several hundred reports of tendon ruptures, but would not cite a specific number. Wolfe, of Public Citizen, said the number was 407 at the end of 2007, with another 341 reports of tendinitis. He continued to criticize the agency, saying it should also require drug makers to send individual letters to doctors about the risks. FDA officials said manufacturers could choose to send such letters on their own.

Tendons are cords of tissue that join muscles and bones, and are essential in movement. The most common kind of rupture reported to the FDA involved the Achilles tendon in the heel, but some also involved the rotator cuff in the shoulder, and tendons in the hands, biceps, and even the thumb.

Some of the ruptures reported to the FDA occurred without warning - the patient felt a snap or pop soon after starting treatment. That suggests flouroquinolone antibiotics may be toxic to some people, the FDA said.

But typically, patients felt some kind of pain or inflammation for a week or two before they suffered a tendon rupture. That suggests that many of the most serious problems can be avoided if patients stop the drug, officials said.

The FDA's analysis found that patients with the highest risk of problems include people over 60, those with kidney, heart and lung transplants, and those also taking steroids.

Manufacturers called the tendon ruptures a rare side effect. They said are complying with the FDA order and remain confident that the drugs' benefits outweigh their risks.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Bullying Doctors

2008-07-16T08:27:00.000-07:00

Bullying doctors can make nurses afraid to question their performance, resulting in medical errors, according to a hospital group that announced new requirements for cracking down on intimidating behavior.

Outbursts and condescending language threaten patient safety and increase the cost of care, according to a safety alert issued Wednesday by the Joint Commission, an independent organization that accredits most of the nation's hospitals.

Hospitals will be required by next year to have codes of conduct and processes for dealing with inappropriate behavior by staff, said the group's president, Dr. Mark Chassin. Hospitals without such systems risk losing their accreditation, he said.

Powerful doctors mean money for hospitals because they choose where to admit their patients, but they "should not be left off the hook," said Dr. Peter Angood, vice president of the group, which is based in suburban Chicago.

Grena Porto, a nurse involved in the group's efforts, said nurses need to be "appropriately assertive" and feel safe enough to ask a doctor, "Are you sure we're supposed to operate on the right leg, rather than the left?"

Nurses, pharmacists and hospital administrators also can be culprits, but it's the doctors who bully nurses that are the most significant for patient safety, said Dr. Alan Rosenstein, a researcher on the topic. He applauded the group's action.

Rosenstein, medical director of VHA West Coast, an alliance of nonprofit hospitals, surveyed 1,500 hospital employees for a 2005 study published in the American Journal of Nursing, and received comments like these:

"Most nurses are afraid to call Dr. X when they need to, and frequently won't call. Their patient's medical safety is always in jeopardy because of this.
"I have caught myself in the middle of mislabeling specimens after confrontations that have been upsetting.

Another survey in 2003 by the Institute for Safe Medication Practices found that 40 percent of health providers said they had kept quiet rather than question a known bully. Hospitals have pecking orders and are stressful work environments, but "there's a right way and a wrong way to manage that stress," Chassin said.

Overweight Men Have Bad Sperm?

2008-07-15T08:25:00.000-07:00

Too many fatty foods are dangerous not only to men's waistlines, but to their sperm production.
In research presented Wednesday at a meeting of the European Society of Human Reproduction and Embryology, scientists found that obese men have worse sperm than normal-weight men.

"There is a very long list of health hazards from being overweight," said Ghiyath Shayeb, the study's lead researcher at the University of Aberdeen. "Now we can add poor semen quality to the list."

But experts aren't sure if that necessarily means obese men face major difficulties having children.

"If you have a man who isn't fantastically fertile with a normal partner who is fertile, her fertility will compensate," said Dr. William Ledger, a professor of obstetrics and gynecology at Britain's University of Sheffield, who was unconnected to the study.

But if both partners are heavy, Ledger said that could be a problem, since obesity is known to decrease women's fertility.

Shayeb and colleagues analyzed the sperm samples of more than 5,000 men in Scotland, and divided the men into groups according to their Body Mass Index. Men who had an optimal BMI (20 to 25) had higher levels of normal sperm than those who were overweight or obese.

Fat men had a 60 percent higher chance of having a low volume of semen, according to Shayeb's research. They also had a 40 percent higher chance of having some sperm abnormalities.
Shayeb and colleagues found that underweight men were just as likely to have the same problems as obese men. "But there were not many underweight men in Scotland," he noted.

The researchers adjusted their analysis to account for other factors that could have affected men's sperm count, like smoking, alcohol intake, history of drug abuse, and age.

"Male fitness and health are clearly linked to a man's fertility," said Neil McClure, professor of obstetrics and gynecology at Queen's University in Belfast.

The study supported results of an earlier sperm study done by doctors at hospitals and universities in Denmark.

There are several theories about why obese men might have bad sperm. Because fat tissue influences the metabolism of sex hormones, scientists think it might also disrupt sperm production.

It could also be a temperature problem. Sperm is best produced at a temperature two degrees cooler than normal body temperature. But because obese men have more fat, Shayeb said their bodies might be overheated.

Another study presented at the conference concluded that diabetes in men damages their sperm and is linked to male infertility.

Con Mallidis and colleagues at Queen's University in Belfast examined semen samples from nearly 40 men who were being treated for diabetes, but were not overweight. They found significant DNA damage linked to the excess sugar in the body from diabetes.

They found that diabetic men had twice the rate of DNA damage in their sperm as men without diabetes.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Salmonella in the food supply

2008-07-14T01:23:00.000-07:00

Think of your favorite recipe for salsa. Three common ingredients now are suspects in the salmonella poisonings that have become the nation's largest foodborne outbreak in at least a decade.

And therein lies the frustration. Seven weeks into their investigation, federal health officials aren't shortening the list of potential culprits but adding to it. Now jalapeno pepper producers are being probed alongside tomato distributors, and even fresh cilantro is under suspicion too.

It's quite a departure from the 2006 E. coli outbreak in spinach, a mystery solved in about two weeks. "We really, really got spoiled, if you will, with the spinach outbreak," Dr. Robert Tauxe, food safety chief at the Centers for Disease Control and Prevention, told The Associated Press.

There aren't as many spinach lovers as tomato lovers, and the spinach consumers remembered eating came in bags, often still left in their refrigerators, bearing bar codes that were as good a clue as a fingerprint in helping investigators race to the very field that had been contaminated.

This time around, the suspects seldom are left over in the refrigerator or bear individual bar codes. Also, the victims are having a harder time remembering. They say, "'Well, I'm not sure, I may have had guacamole, or a garnish,'" Tauxe notes.

But this outbreak is lasting an unusually long time, with a record 1,017 cases confirmed by Wednesday - the first of whom fell sick April 10 and the latest so far on June 26.

Tauxe said that makes the toll of the current salmonella outbreak far surpass recent large outbreaks of any foodborne disease: salmonella linked to peanut butter in 2006 and hepatitis A from green onions in 2003. It's not quite as big as when cyclospora-tainted raspberries sickened well over 1,000 people in the mid-1990s.

The scope is bad both for public health and a battered tomato industry that estimates losses at $100 million. Yet it is giving federal investigators some apparently valuable new clues.

Early on, lots of individuals got sick, not clusters of people who all ate at the same restaurant or catered picnic. But by mid-May and continuing well into last month, those clusters of five or more people sickened in the same spot were appearing. That's good news for disease detectives, who find it easier to trace suppliers for a few restaurants than hundreds of stores and market.

Plus, the CDC just finished comparing 144 people who got sick in June with 287 people who live near them but didn't fall ill. That study of the June cases shows the sick are far more likely than the well to have eaten either raw tomatoes, raw jalapeno peppers or fresh cilantro. In one of the largest clusters, those sickened had consumed fresh tomatoes and fresh jalapenos mixed together. In two other large clusters, illnesses were linked only to a dish that contained fresh jalapenos but no tomatoes.

What does that mean?

"We are quite sure that neither tomatoes nor jalapenos explain the entire outbreak at this point. ... We're presuming that both of them have caused illness," Tauxe said.

That has the Food and Drug Administration looking furiously for intersections between peppers and tomatoes. Perhaps there are farms that grew tomatoes earlier in the spring and then switched to pepper harvesting, or distribution centers that handled both types of produce and contaminated incoming produce, said FDA's food safety chief, Dr. David Acheson.

The government's advice for now is to continue avoiding certain raw tomatoes - red round, plum and Roma - unless they were grown in areas cleared of suspicion.

People at highest risk of severe illness from salmonella should not eat raw jalapeno and serrano peppers, the CDC said Wednesday. The most vulnerable are the elderly, people with weak immune systems and infants. Serranos are on the list because they're hard to distinguish from jalapenos.

Did the CDC just miss a pepper connection early on?

"It's very hard for us to say that peppers were absolutely not part of the problem initially. They may have been part of the problem initially but not large enough to catch the attention of the investigations," Tauxe acknowledges.

But there are clusters of illness where jalapenos "simply were not on the menu," he added. "Likewise tomatoes have not disappeared," and more sick people than their healthy neighbors continue to report having eaten them.

The geography offers a potentially good clue too. Patients live in 41 states, Washington, D.C., and even Canada - where three people got sick while traveling to the U.S. and a fourth case is under investigation. Most of the sick are in the Southwest, while parts of the Northwest have no cases and parts of the Southeast few.

"That begs the question is there something about the distribution of the product that contributes to that," Acheson said. "We've been trying to tease that apart."

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Carotid Artery Disease Treatment

2008-07-13T08:21:00.000-07:00

The purpose of treatment for carotid artery disease is to prevent a stroke. But the type of treatment you receive depends on several factors, including the extent of the blockage, the signs and symptoms you're experiencing, and other medical conditions you may have.

The carotid arteries are a pair of blood vessels that deliver blood to your brain and head. When these blood vessels become clogged with fatty deposits (plaque) that restrict blood flow -- a condition known as carotid artery disease -- your risk of stroke increases. Most strokes associated with carotid artery disease are caused by small clots that form in the area of the restricted blood flow and travel to the brain.

With a 50-percent blockage, and if you haven't had any signs or symptoms of a stroke, I would generally recommend that your condition be treated with lifestyle changes and medication.

Eating healthy foods, exercising, losing weight and, in some cases, lowering the amount of sodium in your diet, may help slow the progression of carotid artery blockage (stenosis). Cigarette smoking is a risk factor for carotid artery disease and stroke. If you use tobacco, you should permanently stop.

Effectively managing chronic medical conditions also is important. High blood pressure (hypertension) is a key risk factor for stroke among people with carotid artery disease. Bringing your blood pressure down to approximately 120 over 70 mmHg can reduce your risk of stroke significantly. Controlling your blood sugar levels if you have diabetes and lowering your cholesterol levels with diet, exercise and, if necessary, a statin drug -- if you have high cholesterol -- may reduce your stroke risk, as well.

Taking an aspirin every day is often part of treatment for carotid artery disease, too. Aspirin is an effective blood-thinning medication that can help prevent blood clots from forming in the narrowed carotid arteries. If you can't take aspirin, your doctor can prescribe another drug that will have a similar effect.

You don't mention if you've had signs or symptoms of a stroke, such as sudden weakness, numbness or paralysis on one side of your body affecting the face, arm or leg; slurred speech; or sudden blindness in one eye. If you experience any of these, seek immediate medical attention.

Even if they last for only a short time, tell your doctor. Signs and symptoms of a stroke that last less than 24 hours, and after which you feel normal, may be the result of a temporary shortage of blood to part of your brain (transient ischemic attack or TIA). Having a TIA significantly increases your risk of having a stroke.

For people who have carotid artery disease and experience TIA or other stroke signs and symptoms, or for those who have a higher level of blockage than you do, such as 70 percent or more, lifestyle changes and medication usually aren't enough. Treatment in these situations typically involves a procedure to remove the blockage. A carotid endarterectomy is the most common operation. During this surgery, performed under general anesthesia, a surgeon opens the carotid artery and removes the plaque.

In some cases, a carotid endarterectomy may not be an option. The location of the blockage may be difficult to reach directly. Or, a patient may have a condition that makes surgery too risky, such as previous neck radiation or neck surgery, severe heart or lung disease, or kidney failure.
In these situations, carotid angioplasty and stenting may be appropriate. This procedure involves inflating a tiny balloon at the end of a long hollow tube (catheter) within the blocked artery, then inserting a wire-mesh metal stent into the artery to keep it open.

These are the general treatment guidelines for carotid artery disease but they don't apply in all situations. Factors such as your age, past medical history and underlying medical conditions also need to be taken into consideration. Talk to your doctor about a treatment plan that's best for you.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

The Incredible Edible Egg

2008-07-12T08:19:00.000-07:00

Get thin, get smart. One little oval package helps you make both happen, and you don't even have to get a prescription for it (yes, it's legal).

Eggs were reinstated as a health food a while back, when major studies cleared them of increasing heart attack and stroke risk. Now there's evidence that people who scramble, boil or poach one for breakfast -- versus eating a bagel with the same number of calories -- bypass junk-food cravings and eat fewer calories for at least 24 hours. Without even trying.

While eggs are a good source of nutrients and protein, it turns out that they make your body feel fuller longer, for reasons that aren't completely clear.

Not only are you smart, as far as your waist is concerned, for eating them, but they're good brain food, too. Eggs are packed with selenium, a nutrient that can help keep your memory sharp and your thinking fast. In fact, people who get at least 55 micrograms (mcg) a day of selenium have cognitive test scores that put them in a league with people 10 years younger.

An egg (14 mcg) on whole-grain toast (10 mcg) gets you almost halfway there. Round out your day with some albacore tuna (63 mcg for 3 ounces and no mercury), turkey (27 mcg for 3 ounces) or Brazil nuts (a mother lode at 270 mcg per half-ounce). Repeat the next morning.

You know that line about "the incredible, edible ..."? Looks like the jingle writer had a clue.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Cholesterol Drugs For Children?

2008-07-11T08:17:00.000-07:00

For the first time, an influential doctors group is recommending that some children as young as 8 be given cholesterol-fighting drugs to ward off future heart problems.

It is the strongest guidance ever given on the issue by the American Academy of Pediatrics, which released its new guidelines Monday. The academy also recommends low-fat milk for 1-year-olds and wider cholesterol testing.

Dr. Stephen Daniels, of the academy's nutrition committee, says the new advice is based on mounting evidence showing that damage leading to heart disease, the nation's leading killer, begins early in life.

It also stems from recent research showing that cholesterol-fighting drugs are generally safe for children, Daniels said.

Several of these drugs are approved for use in children and data show that increasing numbers are using them.

"If we are more aggressive about this in childhood, I think we can have an impact on what happens later in life ... and avoid some of these heart attacks and strokes in adulthood," Daniels said. He has worked as a consultant to Abbott Laboratories and Merck & Co., but not on matters involving their cholesterol drugs.

Drug treatment would generally be targeted for kids at least 8 years old who have too much LDL, the "bad" cholesterol, along with other risky conditions, including obesity and high blood pressure.

For overweight children with too little HDL, the "good" cholesterol, the first course of action should be weight loss, more physical activity and nutritional counseling, the academy says.

Pediatricians should routinely check the cholesterol of children with a family history of inherited cholesterol disease or with parents or grandparents who developed heart disease at an early age, the recommendations say. Screening also is advised for kids whose family history isn't known and those who are overweight, obese or have other heart disease risk factors.

Screening is recommended sometime after age 2 but no later than age 10, at routine checkups.
The academy's earlier advice said cholesterol drugs should only be considered in children older than 10 after they fail to lose weight. Its previous cholesterol screening recommendations also were less specific and did not include targeted ages for beginning testing.

Because obesity is a risk factor for heart disease and often is accompanied by cholesterol problems, the academy recommendations say low-fat milk is appropriate for 1-year-olds "for whom overweight or obesity is a concern."

Daniels, a pediatrician in the Denver area, agreed that could include virtually all children. But he said doctors may choose to offer the new milk advice only to 1-year-olds who are already overweight or have a family history of heart problems.

The academy has long recommended against reduced-fat milk for children up to age 2 because saturated fats are needed for brain development.

"But now we have the obesity epidemic and people are thinking maybe this isn't such a good idea," said Dr. Frank Greer of the University of Wisconsin, co-author of the guidelines report, in the July edition of Pediatrics, the group's medical journal.

Very young children are increasingly getting fats from sources other than milk and Greer said the updated advice is based on recent research showing no harm from reduced-fat milk in these youngsters.

With one-third of U.S. children overweight and about 17 percent obese, the new recommendations are important, said Dr. Jennifer Li, a Duke University children's heart specialist.

"We need to do something to stem the tide of childhood obesity," Li said.

Li said that 15 years ago most of her patients with cholesterol problems had an inherited form of cholesterol disease not connected to obesity.

"But now they're really outnumbered" by overweight kids with cholesterol problems and high blood pressure, she said.

Dr. Elena Fuentes-Afflick, a pediatrics professor at the University of California at San Francisco, also praised the new advice but said some parents think their kids will outgrow obesity and cholesterol problems, and might not take it seriously.

"It's hard for people to really understand" that those problems in childhood can lead to serious health consequences in adulthood, Fuentes-Afflick said.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Good Hygeine Can Diminish MRSA Threat

2008-07-10T08:14:00.000-07:00

There are lots of stories in the news about healthy people getting antibioticresistant staph infections. And some parents are wondering how they might protect their children.

It will help, at the start, to gain an understanding of these infections. They actually have been happening for years, though there is evidence that the rate is increasing.

Methicillin-resistant Staphylococcus aureus, or MRSA (pronounced MERsuh), can be spread through skin-to-skin contact or by touching something that has MRSA bacteria on it.

Staph bacteria are everywhere. Some of you reading this likely have it right now, without ever knowing it or showing symptoms. According to a Mayo Clinic study, a variety of staph are normally found on the skin or in the nose of about three in every 10 people at any given time.

However, being "colonized" is not really a concern. Staph bacteria become a problem only when they cause infection, usually by entering the body through a cut or wound. For some people, especially those who are weak or ill, these infections can become serious.

MRSA infections are more difficult to treat than ordinary staph infections because they don't respond to many types of antibiotics.

The chances of resistant bacteria developing have been increased by people in a community who fail to finish a full course of antibiotics.

Symptoms of a MRSA infection depend on its location. If MRSA is causing an infection in a wound, the first sign of infection may look like a spider or insect bite. If you have pneumonia, you may develop a cough.

The best way to protect your child from staph bacteria is to teach him or her good hygiene. Thorough hand washing is very important -- teach your child to wash hands with lots of soap and warm water for the length of time it takes to sing the "Happy Birthday" song twice. Your child should learn to not share personal items such as towels, clothing, deodorants and athletic equipment.

At home, you can help by disinfecting common surfaces such as telephones, light switches, computer keyboards and toilets. Have antibacterial hand sanitizers at the ready in the car, backpack, sports bag and purse. Keep cuts and abrasions clean and covered with a bandage until they are healed.

If you are concerned your child is infected with MRSA, see the doctor right away. He or she may send a sample to a lab to see if there is bacteria and then test to see which kinds of antibiotics kill the bacteria. This test may take several days.

The chances are great that MRSA will never be a problem for your family, but instilling great hygiene habits is always beneficial. Also, be responsible when anyone in the family is prescribed an antibiotic -- complete the prescription, even if the infection is getting better. Don't share antibiotics with others or save unfinished antibiotics for another time. Inappropriate use of antibiotics contributes to resistance.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Radio waves foil medical tools

2008-07-09T07:47:00.000-07:00

Wireless systems used by many hospitals to keep track of medical equipment can cause potentially deadly breakdowns in lifesaving devices such as breathing and dialysis machines, researchers reported Tuesday.

The wireless systems send out radio waves that can interfere with equipment such as respirators, external pacemakers and kidney dialysis machines, the study said. Electromagnetic glitches occurred in almost 30 percent of 123 tests when microchip devices similar to those in many types of wireless medical equipment were placed within about 1 foot of the lifesaving machines. Patients were not using the equipment at the time.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

New Lung Cancer Treatment

2008-07-08T07:46:00.000-07:00

A non-surgical procedure used to treat liver cancer also holds promise for lung cancer patients. Percutaneous image-guided radio frequency ablation, which takes less than an hour, targets large tumors with no harm to surrounding healthy tissue. Seventy percent of lung cancer patients treated with RFA survived at least one year with few side effects, according to a study expected to be published in the July edition of The Lancet Oncology.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Vomiting Linked to Irregular Periods

2008-07-07T07:44:00.000-07:00

Teenage girls who vomit one to three times a month to control weight increase their risk of having irregular menstrual periods by 60 percent, a recent study reports; those who vomit once a week or more triple their risk. When researchers restricted the analysis only to girls of normal weight, the association was stronger.

Self-induced vomiting can cause electrolyte imbalance, dental enamel erosion, tears in the esophagus and other medical problems, according to background information in the study and an accompanying editorial. Irregular periods are an indication of hormonal disruptions that can affect bone health and mental function in ways that may not be reversible.Researchers analyzed self-reported data from 2,791 girls ages 14 to 19 nationwide. Almost 9 percent reported vomiting for weight control one to three times a month.

Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Generous Bartenders

2008-07-06T07:42:00.000-07:00

A new study finds that bartenders pack a lot more booze into common drinks than many people realize. Researchers visited 80 bars and restaurants in Northern California last year and found that glasses of wine and spirits are often 50 percent larger than the "standard" size used in guidelines. That means people who follow recommendations about avoiding more than one drink an hour may be getting more booze than they bargained for, say researchers at the Public Health Institute's Alcohol Research Group.

Big breakfast can lead to significant weight loss

2008-07-05T07:36:00.000-07:00

A large breakfast packed with carbohydrates and lean protein can help lessen cravings and hunger the rest of the day, which can lead to significant weight loss, new research suggests. Obese, sedentary women who followed a "big breakfast" diet, in which the first meal accounted for about half their daily calories, lost nearly 40 pounds on average after eight months. Women on a high-protein, low-carbohydrate diet lost about 9 pounds each. The study was presented at the Endocrine Society's annual meeting in San Francisco.

New Combo Vaccines for Kids

2008-07-04T07:33:00.000-07:00

New combination vaccines for infants and toddlers approved Thursday by the Advisory Committee on Immunization Practices will soon appear in doctors’ offices in Chicago and across the country.

And parents are sure to have a lot of questions.

Moms and dads will want to know if giving babies a single shot containing protection against four or five infections could be dangerous. Might it overwhelm an infant's immune system and are adverse side effects more likely?

Don’t worry, says Dr. Tina Tan, a pediatric infectious disease specialist at Children’s Memorial Hospital in Chicago.

The new vaccines are as safe and effective as individual vaccines already on the market, she adds, and combining existing immunizations into a single shot doesn’t raise the risk of harm.

“It’s not going to overload your infants’ immune system,” the physician says.

“If you think about what you or I or a baby is exposed to every day in the environment, you are being challenged by more antigens [proteins] than you get through these vaccines,” Tan explains.

But others are concerned.

“There are too many unknowns here; I’d like to see more research on the effects of combining so many vaccines at once,” said Anne Dachel, a member of the board of Advocates for Children’s Health Affected by Mercury Poisoning.

She and others suspect a link between thimerosal – a mercury-based preservative once used in vaccines -- and autism. More than 99 percent of vaccines no longer use the preservative.
But medical experts say research doesn’t support that suspicion.

“When you look at the science, there’s no evidence that there is any connection,” says Tan, who tells anxious parents that the illnesses they’re guarding babies against are a much more considerable threat.

The benefit of the new combination vaccines is a reduction in the number of shots babies get. Instead of four or five shots per visit at the age of 2 months, 4 months, 6 months, and 15 to 18 months, infants will now endure one or two needle sticks.

My Tribune colleague and fellow blogger, Julie Deardorff, notes today that many parents are alarmed by the sheer number of immunizations kids are now asked to get.

"In 1982, The Centers for Disease Control recommended 23 doses of 7 vaccines for children up to age 6," she writes. "Today, the CDC recommends that children get 48 doses of 12 vaccines by age 6." With flu shots, the total expands to 69 doses of 16 vaccines by age 18.

Pentacel, manufactured by Sanofi Pasteur, protects again five infections at the same time (diopththeria, tetanus, pertussis, polio and Haemophilus influenza type B) and was tested on more than 5,000 children.

Kinrix, made by GlaxoSmith Kline, protects against four infections (diphtheria, tetanus, pertussis, and polio).

Both vaccines were approved Thursday by the Advisory Committee on Immunization Practices, which advises the U.S. Centers for Disease Control and Prevention on vaccine policy.

Municipal Questions about Fluoride use

2008-07-03T07:27:00.000-07:00

The great American assault on tooth decay began here 63 years ago, earning Grand Rapids a special place in the annals of dental history: the first city in the world to fluoridate its public water system.

So it is more than a little head-scratching that fluoride, the chemical widely credited with dramatically cutting cavities and promoting oral hygiene, is having its scientific credentials questioned in the city that literally swallowed it first.

The belated questioning of fluoride in the most unlikely of places stems partly from unsettled questions—some new, some old—about possible links to cancer and thyroid and kidney problems if too much fluoride is ingested. But the push here mirrors a spreading nationwide awareness and re-examination of the health impact of a wide variety of chemicals added to food, health-care products and water, as well as the use of pesticides.

Unusual findings

Local and state governments around the nation are taking a second — and in some cases a first — look at chemical practices and their potential impact. A county in Utah has stopped encouraging people to flush unused prescription drugs down the toilet because they might contaminate the water system. That action was taken after a report from the U.S. Geological Survey found chemicals from prescription drugs in streams and rivers.

A Tribune examination of Chicago's drinking water this year found traces of pharmaceuticals and personal-care products.

In California, several communities are cracking down on aerial pesticide spraying because of its potential impact on humans and animals. Experts predict that in-depth examinations of chemicals formerly considered benign will become more frequent.

"I think this pattern has been growing because there is better environmental health research that draws connections between low levels of chemical exposure and changes in our bodies," said Dr. Howard Hu, chairman of environmental health sciences at the University of Michigan.

"As the research has become more sophisticated, it shows that environmental toxicants can do other things beyond just kill you—they can stunt your growth, change behavior and increase the risk of cardiovascular disease," Hu said.

'On my radar screen'

Fluoride fights stretch back more than a half-century. Recent studies, though, suggest a possible link to thyroid trouble and problems for people on dialysis. The U.S. Centers for Disease Control and Prevention maintains that water fluoridation is a safe and cost-effective way to prevent tooth decay, but some scientists say questions about the long-term impact cannot be dismissed.

Recent studies, while not conclusive, convinced Corky Overmyer, the director of environmental sustainability for Grand Rapids, that a review was needed to study fluoride's impact on the 11 communities served by the city's water system.

"This has been on my radar screen for a while," said Overmyer, who several years ago led the effort to remove chlorine from the city's water. Overmyer insists he has drawn no conclusions about the safety of fluoride.

Grand Rapids commemorates the 1945 fluoridation with a 30-foot sculpture in the heart of downtown, and the questioning of fluoride has stirred controversy. Dentists have doubted or condemned the effort, and the Grand Rapids Press counseled caution in an editorial.

Grand Rapids, long known as a furniture-making city, is working to reinvent itself as a center of medical research. The timing of the fluoride examination is, at best, awkward because some of the most prominent groups in the medical establishment—the American Dental Association, the American Medical Association and the CDC—have endorsed fluoride.

"They tend to look at little bits of information that are taken out of context," Dr. Howard Pollick, a dentist and chief spokesman for the ADA, said of fluoride opponents.

Overmyer said he is taking heat."I had no idea [fluoride] was that sensitive an issue," he said, noting he has "teeth marks" in his backside from his dentist and the city's mayor, who declined to return phone calls to discuss fluoride.About two-thirds of Americans, including those in Chicago and most major metropolitan areas, are served by fluoridated water. Resistance to fluoride usually is localized, with battles occurring in small towns. In May, voters in two Massachusetts towns overwhelmingly rejected efforts to fluoridate the water.

The Internet has effectively re-energized the former ragtag group of activists by making new information—valid or not—instantly available.And the re-examination by Grand Rapids, the mother of fluoride, has provided an unanticipated boost for opponents.

"If Grand Rapids falls, that could be the beginning of the end of fluoride," said Paul Connett, a retired chemistry professor and director of the Fluoride Action Network, which advocates against fluoridation.

There is strong political and medical resistance to reversing the fluoride policy. Dr. Tim Gietzen, who has practiced dentistry in Grand Rapids for 30 years, said he can tell which of his patients grew up with fluoridated water just by looking in their mouths.

Gietzen said fluoride should remain in the water system "unless someone is causing problems."That's the question to be pursued by Overmyer, who said, "I'm just trying to be honest and open, and I've become a lightning rod."

Rotavirus shot puts cases at new low

2008-07-02T07:20:00.000-07:00

A rotavirus vaccine approved in 2006 is having a significant impact in the United States, delaying the onset of the rotavirus season by three months and reducing its severity by about half, federal officials said Wednesday.

The incidence of rotavirus activity during the first months of 2008 was the lowest it has been since the federal Centers for Disease Control and Prevention began monitoring the disease 15 years ago, researchers reported in the agency's Morbidity and Mortality Weekly Report.

The highly contagious rotavirus is the leading cause of severe vomiting and diarrhea in infants and young children around the world. Each year in the U.S., it causes as many as 272,000 emergency room visits, up to 70,000 hospitalizations and 20 to 60 deaths. Worldwide, an estimated 500,000 children die from the virus each year.

The RotaTeq vaccine has prevented 74 percent of all rotavirus infections, 98 percent of severe infections and about 96 percent of hospitalizations. The CDC recommends that all infants receive their first dose of the vaccine by 12 weeks old and all three required doses by the time they reach 32 weeks.

No good data exist about the number of children who have been vaccinated, but studies at selected sites suggest that about 50 percent of 12-week-olds have received one shot and that about one-third of 13-month-old infants have received all three doses.

The decline in new cases appears "greater than expected based on the protective effects of the vaccine alone," Dr. Anne Schuchat, director of CDC's National Center for Immunization and Respiratory Diseases, said in a statement. She speculated that vaccination was helping reduce the spread of the virus to unvaccinated people.In the past 15 years, the rotavirus season typically began in mid-November. Last winter, according to the report, it began in late February

Promoting Wellness Through Empowerment

2008-07-01T04:20:00.000-07:00

The process of seeking medical treatment sometimes can feel hazardous to your health. From the days it takes to schedule an appointment, the hours spent in waiting rooms, and the all too brief face-to-face contact with doctors, it is easy to forget that we are capable of making important choices about our health. For all individuals, it is important to recognize the steps we can take to become our own health advocates.

First, consider what is most important for practitioners to know about you. Well-being extends beyond lab results and basic health questionnaires. For some, it will be important to share cultural traditions, religious beliefs and spiritual practices relevant to making health care decisions. For others, it may be important to share experiences of prejudice or discrimination adversely affecting their wellness. Since not all practitioners will ask questions about these areas, be prepared to offer this information.

Next, identify the steps you can take to support your well-being. These may include making certain your health care provider is meeting your current needs as well as engaging actively during your office visits. If you are contemplating whether your health care provider is a good fit for you, it is important to consider whether the practitioner respects and supports you, and if she or he understands and addresses your primary concerns.

The following suggestions may be helpful in advocating for your health care needs:
Prepare a list of questions to ask your practitioner.

When possible and appropriate, bring a family member or friend along to your appointment for support.

Bring a pen and paper to write down notes and information discussed during your appointment.
Insist on being fully informed on the proposed treatment, its risks and benefits, and alternative options.

Don't be afraid to seek a second opinion.

Through ensuring your health care providers are interested in and capable of relating to you as a whole person, you can work together to promote your optimal health.

Eliminate Anxiety

2008-06-30T04:18:00.000-07:00

That tummy ache? Must be stomach cancer. That headache? Brain tumor. Forgetting things? Uh-oh, Alzheimer's.

Everyone has overreacted to utterly common problems -- especially once you start Googling them. (Cyberchondria, anyone?) But some people are especially prone to health fears. In fact, up to 20 percent of us suffer from various degrees of health anxiety. One antidote: Exercise, because sweaty workouts shrink medical worries as well as waistlines. So if your left brain (the rational side) knows you're fine, yet your right brain can't let go of nagging fears, go for a walk, jog or swim; or pump a little iron; or try some chi gong -- anything that gets your muscles moving.

Even if it's not enough, it's a good start. Some overreactors need more focused treatment, such as cognitive behavior therapy or medication. But physical activity can still make a real difference, even if you're trying to push back panic attacks.

Of course, not all physical worries should be brushed off. If you have persistent, unexplained health symptoms, if they're sudden or severe enough to twist your body with pain or if your heart's pounding so hard that it feels as if it could jump out of your chest, see your doctor, not your trainer.

That said, physical exertion is a remarkably effective way to calm down when there's nothing to fear but fear itself.

Besides, your mind tends to rest easier when you're doing something that's good for your body.
Ideally, it's something that demands your total focus, so you can't think of anything else while you're doing it. That could be yoga, one-on-one basketball or taking dance lessons -- hip-hop, swing, the samba, whatever. Go for it.

Health care found to be better with online help

2008-06-29T04:15:00.000-07:00

Even though his doctor told him what to do to lower his high blood pressure, John Mason had trouble doing it.

Watching a diet and exercising regularly isn't easy for anyone, he said, so for five years he lived with hypertension.

But as the Burien man approached 50 -- the same age his father, aunt and cousin died of heart disease -- he began taking his blood pressure seriously.

In 2006, he enrolled in a first-of-its-kind clinical trial to check whether monitoring blood pressure at home and having regular contact with a health care provider through the Internet helped patients lower their blood pressure.

The Seattle-based study, which began in 2006, showed patients with online help controlled their high blood pressure more than twice as well as those who didn't have extra resources, and they did it with fewer doctor visits.

The study, published in Wednesday's Journal of the American Medical Association, involved 778 Group Health patients with uncontrolled high blood pressure.

The eligible patients -- who needed Internet access to participate in the nearly three-year study -- were randomly assigned to one of three groups to see which resources better helped them control their blood pressure.

One group got standard care, which included blood pressure pamphlets and access to doctor e-mail and Group Health's Web site.

The second group got blood-pressure monitors and also had access to the Web, but were trained in how to navigate the site and shown how to send blood pressure results to their doctors online.
The third group, which Mason was in, got home blood-pressure monitors and Web training, but also got care from pharmacists online, usually about every two weeks.

Mason tracked his blood pressure and exchanged e-mails with pharmacists about twice a month. They reminded him when to send in his blood-pressure readings and developed lifestyle goals for him to follow. They also adjusted medication doses as needed -- all via e-mail.

Web-based care nearly doubled the percentage of people whose blood pressure was controlled, said Dr. Beverly Green, a Group Health family doctor and lead researcher of the study. It nearly tripled for those with the highest blood pressure, she said.

Nearly 60 percent of patients in the pharmacist group controlled their high blood pressure, which means their average reading was below 140/90. That compared with 31 percent in the standard-care group and 36 percent in the second group.

"Hypertension is one of the most common reasons for a clinic visit, and we don't manage it very well," Green said. "You're dealing with a packed day and even if a patient comes in with high blood pressure, it may not be the main reason for the visit and can get overlooked.

"We don't have a superpill for high blood pressure like we do for cholesterol, which is hard for a patient," she said.

Allowing patients to be anywhere in the world and still have direct access to information and their physician is empowering, Green said, but she fears the nation's current health care system isn't conducive to online visits.

Doctors are reimbursed by how many visits they have -- not how many e-mails they send, she said.

But some Seattle-area physicians see the landmark study as a step in the right direction.
"This answers some of our questions about the safest ways to join the patient in a care team that improves blood pressure control," said Dr. Kim Pittenger, a family doctor at Virginia Mason Kirkland.

"We assume and hope that improved control will prevent heart disease and stroke," she said. "Most of what we know about planning out care with patients tells us they get better results the more confident they are and the more we entrust patients with targeted self-care. It's not all about visiting the doctor all of the time."

Swedish Medical Center is scheduled to launch a "telehealth" service in mid-July to help home-care patients monitor chronic health problems. Though high blood pressure isn't one of the initial five categories available for monitoring, which includes diabetes and congestive heart failure, Swedish said the program helps the hospital intervene before a medical crisis is full-blown.

Mason, now 53, has significantly lowered his blood pressure.

Though he didn't know exactly how many points he's dropped, his doctor is pleased with the results. Since completing the study, Mason is creating his own goals and finding it easier to eat healthy and exercise. And his wife and nine children don't worry about him as much.

"As a man, you don't go to the doctor until you have to," he said. "With the study, the greatest thing in the world was to have the pharmacist available to me online. I had goals I had to reach, and it was helping me develop good habits.

"That human contact helped."

Fighting Cancer Naturally

2008-06-28T04:13:00.000-07:00

Cancer touches everyone's lives. Whether through personal battle or through struggles of a friend or family member, it is likely that you are familiar with the debilitating effects of this disease. Fortunately, the food choices you make can greatly influence your risk of developing cancer and affect the body's ability to fight existing cancer.

A diet that provides vitamins, minerals, antioxidants and phytochemicals helps bolster our immune system and maintain or repair wellness. Here are some steps you can take to make your diet a cancer-fighting tool:

Eat a wide variety of fruits and vegetables, concentrating on strong, vivid colors, such as those found in red peppers, green broccoli and orange yams. The antioxidants and phytochemicals in these foods provide powerful protection against cancer.

Increase fish intakes while limiting red meat. A diet rich in salmon, mackerel and halibut provides the highest concentration of omega-3 fatty acids. Compounds known as prostaglandins derived from omega-3 fatty acids may inhibit cancer growth.

Drink green tea. Aim for three cups a day to help block the formation of cancer-causing compounds.

Swap white flour products for whole grains. Look for breads offering 100 percent whole grains. Whole grains may cut colon cancer risk.

Eat high fiber foods such as legumes and vegetables, and drink plenty of water to help your body eliminate toxins.

Reduce your exposure to pesticides. Buy organic when possible, particularly when buying foods in which pesticides are concentrated, such as meat, eggs, cheese and milk.

What we choose to eat truly does have the power to boost our health and fight off disease. For additional dietary guidelines, schedule an appointment with a registered dietitian (RD).

Scientists Find Alzheimers Gene

2008-06-27T04:12:00.000-07:00

Scientists have identified a gene that may raise the risk of getting the most common kind of Alzheimer's disease by about 45 percent in people who inherit a certain form of it.

That form of the gene appears to hamper a brain cell's ability to take in calcium, researchers said. If drugs can be found that reverse its effect, they may be useful in fighting Alzheimer's, researchers said.

Most cases of Alzheimer's appear after age 65. So far, only one gene has been firmly established as affecting the risk of this late-onset version. The gene proposed in the new study, called CALHM1, appears to have a much smaller impact on the disease risk.

Dozens of other genes are also under study as possibly affecting risk of the disease.

The new work appears Friday's issue of the journal Cell. The work is reported by Philippe Marambaud of the Feinstein Institute for Medical Research in Manhasset, N.Y., and others in the United States and elsewhere.

They studied the gene with data from more than 2,000 people with Alzheimer's and about 1,400 people without the disease.

Can Croup Be Treated with Humidified Air?

2008-06-26T03:56:00.000-07:00

THE CLAIM

Croup can be treated with humidified air.

THE FACTS

Pediatricians have long recommended 20 or 30 minutes of exposure to humidified air as a home remedy for the respiratory infection that causes harsh coughing and is known as croup. The thinking is that the heat and moisture help relax tight or swollen airways.

But now scientists are beginning to think that the treatment may be little more than an exercise in futility. This year, British researchers compiled data from three large studies that have examined the treatment over the years and found that it had no clear benefits.

The researchers reviewed 135 mild to moderate cases of croup in children treated with humidified air in a hospital or not treated at all. After looking at factors like mortality, the progression of symptoms and the number of school days missed, the researchers found that children with croup did "not improve greatly with inhalation of humidified air."

The study appears in the latest issue of The Cochrane Library, which examines research in health care. The authors say the apparent benefits of humidified air may have more to do with secondary factors like the calming effect of a parent's presence or encouragement to take deep breaths.

THE BOTTOM LINE

Despite anecdotal evidence, research suggests that humidified air does not relieve croup.

Eight Percent of Americans have Diabetes

2008-06-25T04:09:00.000-07:00

The number of Americans with diabetes has grown to about 24 million people, or roughly 8 percent of the U.S. population, the government said Tuesday.

A report by the Centers for Disease Control and Prevention, based on data from 2007, said the number represents an increase of about 3 million over two years. The CDC estimates another 57 million people have blood sugar abnormalities called pre-diabetes, which puts people at increased risk for the disease.

The percentage of people unaware that they have diabetes fell from 30 percent to 25 percent, according to the study.

Dr. Ann Albright, director of the CDC Division of Diabetes Translation, said the report has "both good news and bad news."

"It is concerning to know that we have more people developing diabetes, and these data are a reminder of the importance of increasing awareness of this condition, especially among people who are at high risk," Albright said in a statement.

"On the other hand, it is good to see that more people are aware that they have diabetes."
A message left Tuesday night seeking further comment from the CDC wasn't immediately returned.

The disease results from defects in insulin production that cause sugar to build up in the body. It is the seventh leading cause of death in the country and can cause serious health problems including heart disease, blindness, kidney failure and amputations.

Among adults, diabetes increased in both men and women and in all age groups, but still disproportionately affects the elderly. Almost 25 percent of the population 60 years and older had diabetes in 2007.

After adjusting for population age differences between various groups, the rate of diagnosed diabetes was highest among American Indians and Alaska Natives (16.5 percent). This was followed by blacks (11.8 percent) and Hispanics (10.4 percent), which includes rates for Puerto Ricans (12.6 percent), Mexican Americans (11.9 percent), and Cubans (8.2 percent).

By comparison, the rate for Asian Americans was 7.5 percent, with whites at 6.6 percent.

Do some type of Alcohols cause worse Hangovers?

2008-06-24T04:07:00.000-07:00

THE CLAIM

Some types of alcohol cause worse hangovers than others.

THE FACTS

Too much alcohol of any kind can cause sickness and regret the morning after. But it's often said that some kinds of drinks are worse than others.

Experts say that the type of alcohol you drink does make a difference, but for various reasons. Among the most important is the amount of congeners (pronounced CON-juh-nurz) -- complex organic molecules, like methanol -- in a particular drink. Impurities in poorly refined spirits like cheap vodka also can play a role, but congeners, which are common in darker liquors, seem to have the greatest effect.

According to one report in The British Medical Journal, which looked at the effects of different types of alcohol, the drink that produced the most hangover symptoms was brandy, followed by red wine, rum, whiskey, white wine, gin and vodka. Another study showed that bourbon was twice as likely to cause sickness as the same amount of vodka.

There also is wide variation within certain categories, such as wine. Wines that come from countries where a small change in climate can greatly affect their quality, some experts say, can contain significantly more hangover-inducing compounds in a bad season. Inexpensive red wines, in particular, have a reputation for causing sickness. But that may be because some people suffer from a syndrome called red wine headache, whose cause is unknown. What scientists do know is that the wines that cause it vary from person to person, and across brands, grapes and price.

THE BOTTOM LINE

Certain types of alcohol can make a hangover worse.

How Much Weight do you Gain during Holidays?

2008-06-23T04:03:00.000-07:00

It starts with the Halloween candy that stays around for weeks. Then there is the feast on Thanksgiving Day, and eventually the incessant eating and drinking at the end of December, not to mention all that extra time on the couch.

With all the opportunities to gorge and laze around over the holidays, it is little surprise that conventional wisdom suggests that the average person will pack on at least 5 pounds this season.
In reality, though, studies show that most people will gain far less. The only problem is that the holidays probably account for much of a person's annual weight gain over the course of a lifetime.
According to most studies on the subject, the average person gains 1 to 2 pounds from Thanksgiving to New Year's Day. One of the most recent and thorough studies to examine the idea, published in The New England Journal of Medicine in 2000, followed a diverse group of about 200 adults, half men.

The researchers found that from early October to late February the subjects gained an average of 1.05 pounds, 75 percent of that from Thanksgiving to Jan. 1.

Those who were the most active had the least gain, and those who already were overweight gained the most.

But only 10 percent of people gained more than 5 pounds. Another study carried out at Tufts had similar results.

A pound does not sound like much. But because a typical adult gains 1 to 2 pounds a year, the holiday pound has significant long-term effects.

THE BOTTOM LINE

Most people gain about 1 pound over the holidays.

Can Raisins soaked in Gin stop Arthritis pain?

2008-06-22T04:01:00.000-07:00

THE CLAIM

Raisins soaked in gin can ease arthritis pain.

THE FACTS

In 2004, Teresa Heinz Kerry, the Mozambique-born heiress and wife of John Kerry, who was then running for president, advocated an unusual remedy for arthritis while discussing health care at a campaign stop in Nevada.

"You get some gin and get some white raisins -- and only white raisins -- and soak them in the gin for two weeks," she said. "Then eat nine of the raisins a day."

Although some people poked fun at the statement, Heinz Kerry was repeating a popular folk remedy that has been around for decades. Countless Web sites for arthritis sufferers mention it as a cure for pain, and several books on folk remedies promote it. But whether there is any real science behind it is an open question.

To date, no rigorous studies have examined whether gin or raisins -- together or alone -- can ease arthritis symptoms. Grapes contain compounds called proanthocyanidins, which are thought to help fight infection and reduce inflammation. They also contain resveratrol, the powerful antioxidant that scientists say gives red wine many of its disease-fighting properties.
Dr. Steven Abramson, the director of rheumatology at the New York University Hospital for Joint Diseases, said studies are looking at whether resveratrol and other substances in red wine can affect joint disease. But raisins are a poor source of resveratrol, which usually is destroyed when grapes are dried. And the Department of Agriculture says levels of proanthocyanidins in raisins are "undetectable."

As for the gin, Abramson said, some people find it can help dull pain, but only in moderation.

THE BOTTOM LINE

There is no evidence that raisins soaked in gin have any particular effect on arthritis pain.

Does chlorine in drinking water increase the risk of Cancer?

2008-06-21T04:00:00.000-07:00

THE CLAIM

Chlorine in drinking water can increase the risk of cancer

THE FACTS

Companies that sell water filters often claim that the chlorine in most tap water causes cancer. Is it true? Scientists say chlorination can produce at least one group of chemical byproducts, trihalomethanes, that are considered carcinogenic. But studies over the years have differed on whether levels of these compounds in tap water adversely affect health.

Some studies have found a link to cancer, others have not. The most reliable findings may be those of meta-analyses, large studies that pool results of many smaller ones. Three such meta-analyses in 1992, 2003 and 2004 linked long-term consumption of chlorinated water to small increases in the rates of bladder cancer, particularly in men. Several agencies, including the World Health Organization, say the evidence is weak and point out that any risk from chlorine byproducts is tiny compared with risks associated with non-chlorinated water. Many countries that have relaxed chlorination standards have seen outbreaks of cholera and other diseases.

THE BOTTOM LINE

Some studies have found byproducts of chlorination associated with a slight increase in cancer risk, but the findings are disputed by major health organizations.

Are heart Attacks More Frequent on Birthdays?

2008-06-20T03:58:00.000-07:00

THE CLAIM

Heart attacks are more common on birthdays.

THE FACTS

If the stress of a pink slip or the strain of physical exertion can set off a heart attack, why not the emotion associated with birthdays?

One extensive examination of the claim was conducted by Canadian researchers and published in the journal Neurology this year. In the study, the researchers tracked more than 50,000 patients, with an average age about 70, who were treated for heart failure at hospitals in Ontario in a two-year period. They found a strong relationship between birthdays and the onset of so-called vascular events.

Strokes, acute myocardial infarctions and transient ischemic attacks were 27 percent more likely to occur on birthdays than on other days of the year. But there was no corresponding increase for other types of illness, such as appendicitis, head trauma or symptoms of asthma, suggesting that heart attacks were unique. The scientists attributed the phenomenon largely to anxiety and other "psychosocial stressors," but other factors may be involved.

Another large study, in New Jersey in 1993, found a similar birthday spike -- 21 percent for men and 9 percent for women -- suggesting that overindulgence may play a role. Drinking and smoking, for example, are more common on birthdays, especially among men, something that also could explain the gender difference in the New Jersey study.

THE BOTTOM LINE

Heart attacks occur more frequently on birthdays than on other days of the year.

US panel endorses 2nd vaccine for kids' virus

2008-06-19T04:05:00.000-07:00

A federal advisory panel has endorsed a second vaccine to combat a common and potentially fatal virus that causes diarrhea and vomiting in children.

The new two-dose vaccine for infants, made by GlaxoSmithKline, was licensed by the Food and Drug Administration in April. The vaccine advisory committee agreed Wednesday that it should be added to the recommended vaccines for infants, as well as the three-dose vaccine made by Merck & Co. and approved in 2006.

Both vaccines are given orally to prevent rotavirus, which causes 67,000 hospitalizations of children under 5 each year in the U.S., but only about 30 deaths. Worldwide, it kills an estimated 500,000 children a year.

Rotavirus is a leading cause of severe diarrhea in infants and children, but is perhaps better known as the cause of vomiting that often strikes children in the winter.

The vaccine advisory panel's recommendations typically are adopted by the government, which issues vaccination guidelines to doctors and hospitals.

The committee voiced no preference for one vaccine over the other.

The new two-dose version can be completed in four months, compared to six months for the older version. Both are estimated to cost about $200. Government endorsement of a vaccine often means insurance companies will pay for it.

Wide use of the older vaccine is credited with reducing the severity of rotavirus over the past year.

The virus follows a pattern similar to flu season, but the 2007-08 season was the mildest in 15 years, the Centers for Disease Control and Prevention said.

Never Bathe in a Thunderstorm?

2008-06-18T03:54:00.000-07:00

THE CLAIM

Never bathe or shower in a thunderstorm.

THE FACTS

It has the ring of an urban legend and seems too bizarre to be true. But the claim that taking a shower during a lightning storm can electrocute you is no old wives' tale, experts say.

The basis of the claim is that a bolt of lightning that hits a house or building -- even one that is protected against severe weather -- can travel through plumbing, into metal pipes, and shock anyone who comes into contact with a faucet or appliance.

Metal pipes are not only excellent conductors of electricity, but they also carry tap water laden with impurities that help conduct electrical current.

In the real world, the odds of being harmed this way are extremely minute. But it is not unheard of. Ron Holle, a former meteorologist with the National Oceanic and Atmospheric Administration who tracks lightning injuries, estimates that 10 to 20 people in the United States are shocked annually while bathing, using faucets or handling appliances during storms. "There are a ton of myths about lightning," he said, "but this is not one of them."

In a storm, a protected building acts somewhat like a metal cage. Electricity from a lightning strike is conducted around you and eventually dissipates into the ground. There is no real risk unless you touch something connected to plumbing, electrical wiring or another conducting path.
Dr. Mary Ann Cooper, who runs the Lightning Injury Research Program at the University of Illinois at Chicago, said people had been shocked and even killed washing dishes, doing laundry and sitting in bathtubs in storms. A database of these incidents is online at struckbylightning.org.

THE BOTTOM LINE

Lightning can travel through plumbing and shock people

Can Air Fresheners Cause Lung damage?

2008-06-17T03:52:00.000-07:00

THE CLAIM

Air fresheners can cause lung damage.

THE FACTS

For years, scientists have suspected that a chemical in many household deodorizing products may cause short-term lung problems -- and possibly worse.

Now it appears that those concerns are probably valid. In a study published this month, scientists at the National Institutes of Health say they found that people with relatively high blood concentrations of the substance -- 1,4-dichlorobenzene, an organic chemical -- show signs of slightly reduced lung function. The chemical is also in mothballs, tobacco smoke and toilet deodorizers.

The study, published in Environmental Health Perspectives, followed 953 Americans, average age 37, for six years. After controlling for factors like smoking, it found that the 10 percent of people with the highest blood levels of 1,4-DCB did 4 percent worse on lung function tests than the 10 percent of people with the lowest levels.

Four percent may sound inconsequential, but the researchers pointed out that even a small reduction in respiratory function "may indicate some harm to the lungs."

The simple solution, scientists say, is to limit the use of such products.

THE BOTTOM LINE

Studies suggest chronic exposure to a chemical in air fresheners can cause lung problems.

Does Exposing Wounds to Air Help Healing?

2008-06-16T03:50:00.000-07:00

THE CLAIM

Wounds heal better when exposed to air.

THE FACTS

Most parents and school nurses have a time-honored approach to treating a small wound: Clean it up, stop the bleeding and then let it get some air.

The point of this approach is to lower the odds of infection and to speed the healing process. But over the years, researchers have found that what many people know about treating small cuts and scrapes is wrong.

Exposing a wound to the air so it can breathe is a terrible mistake, experts say, because it creates a dry environment that promotes cell death.

A handful of studies have found that when wounds are kept moist and covered, blood vessels regenerate faster and the number of cells that cause inflammation drop more rapidly than they do in wounds allowed to air out. It is best to keep a wound moist and covered for at least five days.

Another common mistake is applying antibiotic ointments, said Dr. Mark Davis, a professor of dermatology at the Mayo Clinic in Rochester, Minn. These ointments may keep the wound moist, he said, but they also can lead to swelling and an allergic reaction called contact dermatitis. Plain and simple Vaseline, applied twice a day, works fine.

And as awful as removing scabs may sound, it may be a good idea, Davis said. A small initial scab will help stop the bleeding, but if left for too long it will do more harm than good.

THE BOTTOM LINE

Exposing a cut so it can breathe slows healing.

Do some foods have negative calories?

2008-06-15T03:48:00.000-07:00

THE CLAIM

Some foods have negative calories.

THE FACTS

For years, diets and weight-loss books have boasted that you can eat a piece of food and burn calories at the same time. The idea is that some foods have so few calories that the act of chewing them requires expending more energy than is absorbed, resulting in a calorie deficit and ultimately weight loss.

Topping the list of "negative calorie" foods are vegetables such as cabbage, lettuce, cucumbers and celery. Celery, for example, contains eight to 10 calories a stalk and is 95 percent water.
Chewing most foods typically only burns about five calories an hour, but the act of digesting may require slightly more. That is particularly the case with celery because it is mostly cellulose, a type of fiber that humans do not have the enzymes necessary to properly break down and use.
Cathy Nonas, director of obesity and diabetes programs at North General Hospital in New York City, said that while no hard studies exist, it is possible that snacking on celery might cause a very slight calorie deficit. But the difference would be so minuscule that at the end of the day it would have no real impact unless the celery was replacing other fattening or high-calorie foods.

The other problem is that celery is not only low in calories but also low in vitamins and minerals.
"If you substitute celery for cookies and pretzels, and those are the things that were putting you over the top in terms of weight then, yes, you will lose weight," she said. "But you're not going to lose weight by chewing celery a couple times a day if you're not exercising and changing what else you eat."

THE BOTTOM LINE

It may be possible to expend a few more calories than you absorb eating something like celery, but in the end the deficit is negligible.

Does a spicy meal before bed disrupt sleep?

2008-06-14T03:44:00.000-07:00

THE BELIEF:

A spicy meal before bed can disrupt sleep.

THE FACTS:

An old wives' tale has it that a little kick to the palate before bed can lead to fitful sleep, if not nightmares.

It's the sort of wisdom that often turns out to be based on no evidence at all -- or, worse, flat wrong. But in this case, it's good advice.

Research has shown over the years that a spicy meal at night can indeed lead to poor sleep. The most direct study to show this was published in The International Journal of Psychophysiology by a team of Australian researchers. The scientists recruited a group of young, healthy men and had them consume meals that contained Tabasco sauce and mustard shortly before they turned in on some evenings and nonspiced control meals on other evenings.

On the nights that included spicy meals, there were marked changes in the subjects' sleep patterns. They spent less time in both the light phase of sleep known as Stage 2 and the deep, slow-wave Stages 3 and 4. All of which meant that they experienced less sleep over all and took longer to drift off.

Several things may account for the effect. An obvious possibility is indigestion. But the scientists also noted that after eating the spicy meals, the subjects had elevated body temperatures during their first sleep cycles, which has been linked in other studies to poorer sleep quality.

THE BOTTOM LINE:

A spicy meal before bed can impair sleep.

Cell Phones and TB

2008-06-13T15:56:00.000-07:00

Researchers at MIT believe they've discovered a new weapon in the battle against tuberculosis: Free cell phone minutes.

For years, doctors have struggled to get some TB patients to take all their medication, which generally involves a six-month regimen of multiple drugs.

Now a student-led group at the Massachusetts Institute of Technology has developed a way to use cell phones to let patients test themselves. And if the tests show patients are following doctor's orders, they get rewarded with free minutes.

"We're piggybacking on one of the bigger rollouts of infrastucture out there, which is wireless technology and telecom technology," said Jose Gomez-Marquez, one of the project's leaders.

The system works like this: Patients test their urine using a strip that reveals a numeric code if it detects TB medicine. They then text message the code to their health care provider and get credit toward incentives such as free minutes.

The in-home tests also eliminate the need for health care workers to make several patient-monitoring visits a week, a routine that is often impractical in remote places, Gomez-Marquez said.

Mobile phones are good tools for the project because they are common in the developing world, where it's often cheaper to erect cell towers than miles of poles and wires, Gomez-Marquez said.
Dr. Mario Raviglione, director of a World Health Organization program to fight TB, called the MIT idea "creative." But he said personal visits must continue because systems that depend heavily on patient self-reporting have often failed.

"I would think it's a dangerous game to rely only on incentives," he said.

In 2006, the most recent year statistics are available, 9.2 million people worldwide were diagnosed with tuberculosis and 1.7 million died.

The disease can be cured with a steady regimen of drugs. But many patients start feeling better and stop taking the medicine too soon. Others abandon the drugs because of side effects such as nausea, fever and rashes.

If the drugs are taken only sporadically, the bacteria build up resistance. The WHO estimates that 5 to 10 percent of TB deaths are patients who stop taking medication properly.
The MIT group - which originally included five students - took on the TB problem in 2007 as part of the university's annual "IDEAS competition," which challenges participants to solve various world problems.

Under the TB treatment system used by the WHO, the relationship between the patient and health care worker can get adversarial, said Elizabeth Leshen, an MIT junior working on the project.

"We wanted to do something that takes the health care worker out of the supervisory role and puts him or her back into the patient care role," she said.

Cell minutes were chosen as an incentive because patients want them and phone companies are willing to give them out, said Gomez-Marquez, who added that other incentives and reporting methods can be tailored to different regions.

A small study of 20 patients in Nicaragua last year indicated the MIT system could work, and a larger study in Pakistan is planned for this summer. The team is trying to raise the $200,000 for a full-scale clinical trial.

The WHO's Raviglione said the MIT group's program could be an asset, particularly in developed countries, where people are more familiar with technology. But he said it must be combined with regular visits from health care workers or community leaders who can ensure patients take their medicine.

Before personal visits became routine in the 1990s, death rates from tuberculosis were estimated at 40 to 50 percent, according to the WHO. After officials began making visits as part of a broad strategy to fight TB, that figure dropped to 15 percent.

"Human contact is essential for people who have to take drugs for a long time," Raviglione said.

Hearts don't gain if blood sugar is leashed

2008-06-12T09:51:00.000-07:00

Two large studies involving more than 21,000 people found that those with Type 2 diabetes experienced no reduction in their risk of heart attacks and strokes and no reduction in their death rates if they rigorously controlled their blood-sugar levels.

The results bolster findings reported in February, when one of the studies, by the National Institutes of Health, ended prematurely. At that time, researchers made the surprising announcement that study participants who were rigorously controlling their blood sugar actually had a higher death rate than those whose blood sugar control was less stringent.

Now the federal researchers are publishing detailed data from that study. Researchers in the second study, from Australia and involving participants from 20 countries, are also publishing their results on blood sugar and cardiovascular disease. That study did not find an increase in deaths, but neither did it find any protection from cardiovascular disease with rigorous blood-sugar control.Thus both studies failed to confirm a dearly held hypothesis that people with Type 2 diabetes could be protected from cardiovascular disease if they strictly controlled their blood sugar.

Changing behavior

It was a hypothesis that seemed almost obvious. Cardiovascular disease accounts for 65 percent of deaths among people with Type 2 diabetes. And because diabetes is characterized by high levels of blood sugar, the hope was that if people with diabetes could just get their blood sugar as close to normal as possible, their cardiovascular disease rate would be nearly normal as well.

Diabetes researchers say the message is that patients should obtain at least moderate control of blood sugar to protect against eye, kidney and nerve disease. But for heart disease, they say, the only proven method of preventing complications is to give statins to control cholesterol, drugs to control blood pressure and aspirin to control blood clotting, and encourage people to lose weight and exercise.

The Australian study did find one advantage to strict blood-sugar control—a slight reduction in new or worsening kidney disease. The rate among those with intense sugar control was 4.1 percent as compared with 5.2 percent among those with less intense control.

That study got its major support from French drug manufacturer Servier. The company had no influence on the conduct of the study or the analysis or publication of its results, said Stephen MacMahon, a principal investigator and professor of cardiovascular medicine and epidemiology at the University of Sydney.

Food Industry Improves Non Allergenic Lines

2008-06-11T09:47:00.000-07:00

Kari Keaton is the sort of customer most businesses used to hate. The Rockville, Md., mother lingers at the grocery store, poring over ingredient labels. She calls food manufacturers and interrogates their customer service representatives about what sorts of foods get processed in the same facility and probes them on the meaning of "natural flavoring." And after all that effort, she still may not buy their product.

Keaton's sons, 10 and 15, have severe food allergies. Keeping them from accidentally eating something that could trigger a fatal reaction has become the former IBM field manager's full-time job.

But Keaton, 52, and consumers like her are increasingly coveted by corporations and entrepreneurs who see an economic opportunity in catering to the needs of people who have food allergies or celiac, a condition treated by avoiding gluten. Marketing to the food-sensitive has become so widespread that the Girl Scouts now sell three kinds of milk-free cookies, Anheuser-Busch has a gluten-free beer and Kellogg's makes Pop-Tarts in nut-free factories.

The market for food-allergy and intolerance products is projected to reach $3.9 billion this year, according to Packaged Facts, a New York research firm. And the market for gluten-free foods and drinks is expected to hit $1.3 billion by 2010, up from $700 million in 2006, according to research firm Mintel.

Who's affected?

14 million affectedAn estimated 12 million people in the United States have food allergies, and an additional 2 million have celiac disease, a disorder in which the body's immune system attacks itself when exposed to gluten, a protein found in wheat, barley and rye. The number of children with peanut allergies alone has doubled in the past decade.

Until scientists learn more about the increase in the number of people with food allergies, the prescription for people with life-threatening food allergies or celiac is to avoid the foods that make them sick, a task that is getting easier.

Whereas a decade ago the "free from" food market consisted of small manufacturers whose products were sold mainly in health-food stores, today it encompasses an ever-growing list of start-up companies, mainstream retailers such as Safeway and Giant Food, and some food industry giants such as General Mills.

Food manufacturers have had to pay more attention to the needs of people with food allergies since the federal government in 2006 began requiring ingredient labels to disclose whether products contain milk, eggs, peanuts, tree nuts—such as almonds and cashews—fish, shellfish, soy and wheat.

Gluten is not on that list, but many manufacturers disclose it. Some companies, such as Stonyfield Farm, use gluten-free in their marketing. In April, General Mills said it had reformulated Rice Chex to be gluten-free."Rice Chex ... was truly our effort to meet the needs of these consumers," said Kevin Farnum, director of sanitation, quality and regulatory operations for General Mills. "We know there is a great demand among consumers to have free-from labeling.

"Other major food manufacturers such as Kellogg's and Campbell Soup also sell products safe for people with food allergies and celiac, but they have been more cautious about embracing the free-from claim. Unlike with organic products, there are no government standards for what "free-from" means.

Complicated processThe steps General Mills took to ensure that Rice Chex was gluten-free also illustrate how hard it can be for a large manufacturer to do so. In addition to tweaking the recipe, the company had to review its production process, from the time the rice is harvested to when the cereal is packaged, to be certain gluten would not get into the product.

New, smaller companies are more nimble. They don't have existing factories to convert. They can build facilities that are peanut- and tree-nut-free from Day One.

The National Association for the Specialty Food Trade estimates that 300 of its 2,800 members offer more than 7,000 non-allergenic products, compared with five years ago, when about 50 members did.Internet start-ups are also seeking to satisfy demand. Heather and Brian Selwa started online store Peanut Free Planet two years ago in Cicero, Ind. Competitors Patrick Felkner and Steve Rubinstein launched Allerneeds.com, another peanut-free retailer, in Anaheim, Calif., four months ago.

Brick-and-mortar stores are clearing space on their shelves too. "We've seen a dramatic increase in the number of customers looking for these type of products really in the last few years," said Safeway spokesman Greg TenEyck. "We've greatly increased the number and types of products we are offering.

"The same thing is happening at Giant and at Whole Foods Market, which has an array of private-label products and a designated gluten-free bakery in North Carolina.

All this is good news for food allergy and celiac sufferers, said Anne Munoz-Furlong, co-founder of the Food Allergy and Anaphylaxis Network in Fairfax, Va. "They want to be able to go to the grocery store and buy food like everyone else," she said.

Protein shakes quell hunger pangs, with differing results

2008-06-10T08:34:00.000-07:00

Ever get so hungry you could gnaw your way through the refrigerator door? Maybe you need more protein in your diet.

Protein is the nutrient that tells the brain you've had enough to eat, said Dr. Michael Tamber, an endocrinologist at The Everett Clinic.

Some protein-rich shakes can even help you lose weight when used as meal replacements, but many are laden with calories and sugar.

The ideal protein shake contains between 100 and 150 calories, at least 10 grams of protein and no more than 2 grams of fat, he said.

Sugar should be low, which he defined as less than a few grams. Artificial sweeteners and sugar alcohols used for flavorings, such as sorbitol, are both fine.

We compared three popular protein shakes. All the nutritional value is based on the mix alone. Not surprisingly, all three taste better blended with cold milk. Eight ounces of skim milk adds 90 calories and 8 grams of protein.

Shaking it up?

Tamber typically recommends a shake for breakfast and lunch, and protein bars for snacks midmorning and midafternoon. Eat a sensible dinner with a lean protein and vegetables. Keep "white" carbohydrates, such as rice and potatoes, to a minimum. Avoid calorie-laden juice, sodas and blended coffee drinks, or nuts and full-fat cheese. Snack on vegetables and lean proteins.

GNC Designer WheySold at GNC stories, Designer Whey is marketed to athletes who want to gain lean mass and lose fat. It comes in a mammoth 2.1-pound container. Because it's 97 percent lactose-free, it's suitable for most people with lactose intolerance. It mixes easily with a spoon; no blender is needed, according to the directions.

Nutrition: The product contains 100 calories, 2 grams of fat, no fiber and 18 grams of protein per serving when mixed as directed. Flavors: The product comes in chocolate and French vanilla. We tested the chocolate.

Cost: $34.99 for a 2.1-pound container; 87 cents a serving.

Taste: Let's face it, none of these are going to taste like malted milk.

Designer Whey tastes like a glass of not-too-sweet chocolate milk.

What the doctor says: It's low in calories, fat and sugar, and almost entirely made up of protein. This product would work as a meal replacement. However, little evidence exists to suggest that this product builds muscles more effectively than similar products, he said.

Kashi GoLean Energy Shake Mix This mix is designed to satisfy hunger. Nutrition: The mix, with 23 grams of protein and 7 grams of fiber, contains only half a gram of fat. It's also loaded with 220 calories and 23 grams of sugar per serving when mixed as directed. Flavors: It comes in vanilla and chocolate; we tested the vanilla.Cost: $7.99 for a 14.8-ounce canister; $1.14 a serving.

Taste: Whirred up in a blender with some milk and ice, this is the yummiest of the bunch, probably because of all that glorious sugar. However, this stuff becomes gloppy and grainy when shaken rather than blended. What the doctor says: Very high in sugar and fairly high in calories. This product contains a lot of protein, but it's not among his first choices for meal replacement.

SlimFast Optima

This product is aimed at dieters, and it claims to control hunger "up to four hours."

Nutrition: The mix contains 110 calories, 3 grams of fat, 5 grams of fiber and 2 grams of protein per serving when mixed as directed.Flavors: It comes in various flavors; we tested the milk chocolate.

Cost: $9.85 for 12.83 ounces; 70 cents a serving.

Taste: True chocoholics won't find anything here to write home about, but this shake offers a pleasant enough chocolate taste, even mixed with water. Shaken or stirred, the mixture comes out smoother than the other two.What the doctor says: This product has been the subject of many studies and research does show people have some success losing weight with it. The protein content, however, is low. People who choose to use this product should make sure they get plenty of lean protein from other sources, such as fish or poultry.

Experts on aging say medical breakthroughs are right around the corner

2008-06-09T06:53:00.000-07:00

Is 90 the new 50?

Not yet, researchers into aging say, but medical breakthroughs to extend life significantly and ease the ailments of getting older are closer than many people think.

"The general public has no idea what's coming," said David Sinclair, a Harvard Medical School professor who has made headlines with research into the health benefits of a substance found in red wine called resveratrol.

Speaking on a panel of aging experts, Sinclair had the boldest predictions. He said scientists can greatly increase longevity and improve health in lab animals like mice, and that drugs to benefit people are on the way.

"It's not an if, but a when," said Sinclair, who co-founded Sirtris Pharmaceuticals to pursue such drugs. The company, which is testing medicine in people with Type 2 diabetes, recently was purchased for $720 million by GlaxoSmithKline, the world's second-largest drug maker.
Sinclair said treatments could be a few years or a decade away, but they're "really close. It's not something (from) science fiction and it's not something for the next generation."

The discussion of aging was a closing event of the first World Science Festival, a five-day celebration of science for the public that brought together researchers ranging from biologists to quantum physicists. Participants included Nobel laureates, business leaders and philosophers.
Robert Butler, a pioneer of aging research who won the Pulitzer Prize in 1976 for the book "Why Survive? Being Old in America," said that while medicine and biology are important for longevity, having friendships and close relationships also have a big impact.

Butler said a revolution in longevity has already arrived, noting that in the last century life spans increased 30 years, more than in the previous 5,000 years of human history.

Given the latest research, he said, more resources must be devoted to understanding the biology of aging, since "with one pill, we might be able to do a lot for many different conditions."
Some of that research comes from Richard Weindruch, a professor at the University of Wisconsin and director of LifeGen Technologies who studies how extremely low-calorie diets affect aging.

Weindruch said his research, which began by showing how consuming little food could greatly increase the life spans of mice, moved on in 1989 to a long-term study on monkeys that can live up to 40 years.

"Just now we're starting to see statistically significant improvements in survival and resistance to disease and favorable effects on brain aging," he said. He said his team hopes to publish these results soon.

Sinclair said that based on Weindruch's work, he set out a decade ago to find the genes involved in caloric restriction and find a pill that can provide the benefits "without you feeling hungry all the time."

He described how his research found that mice given large doses of resveratrol "live longer, they're almost immune to the effects of obesity. They don't get diabetes, cancer, Alzheimer's as frequently. We delay the diseases of aging."

Sinclair showed video of mice on resveratrol running on a treadmill far more vigorously than those who didn't get the substance. He called them "our Lance Armstrong mice."

A large dose meant the equivalent of a human drinking about 1,000 bottles of red wine daily, he said.

While the implications of the 2006 study for humans was uncertain, the news set off a surge in sales of dietary supplements with resveratrol. Some scientists warned of its unproven effects and raised safety concerns.

Sinclair has said that he has taken resveratrol supplements, but at the longevity event he cautioned that right now there is no proven magic pill to extend life.

His suggestion?

Exercise.

Tell teens to diet? Fat chance that works

2008-06-08T18:50:00.000-07:00

If you want your overweight teenagers to slim down, don't tell them to go on a diet. That most likely will make matters worse, according to a new study.

University of Minnesota researchers who study adolescent health found that parents who correctly perceived their kids as overweight tended to use only one strategy: advising them to diet. But five years later, those kids were far more likely to still be too heavy than were overweight kids whose parents had no idea they were fat and did nothing.

In short, it's a technique that seems certain to backfire, said Dianne Neumark-Sztainer, a professor of epidemiology at the university and the lead author of the study published this week in the journal Pediatrics.

"My concern is that if parents know their kids are overweight, they are going to do things that lead to further weight gain over time," she said.

Neumark-Sztainer said she decided to research the issue because of the growing practice of schools evaluating kids' weight and sending the results home to parents. In some places it's called an obesity report card. It began because parents often don't know whether their kids are at a healthy weight, and some experts think telling them is one way to fight skyrocketing rates of childhood obesity.

The practice was recommended for schools by the federal government's health advisory agency, the Institute of Medicine. But it's highly controversial because it can be embarrassing and stigmatizing to adolescents and teenagers.

"When my son became overweight in middle school, they used to measure body fat and send (the result) home with him," said Anne Fletcher, a Mankato, Minn., mother and the author of "Weight Loss Confidential," a book that examines how teenagers, including her own son, successfully lost weight. "It was devastating. He said, 'Don't they know I already know I'm fat?' "
Neumark-Sztainer said she wanted to find out whether parents would use that information wisely.

The researchers looked at survey results for 300 adolescents and some of their parents taken in 1998 as part of an ongoing adolescent health study at the university called Project EAT. The kids, from Minnesota middle and high schools, reported heights and weights that put them in the overweight category.

They found that 46 percent of girls' parents and 60 percent of boys' parents incorrectly thought their kids' weights were about right. Of the parents who knew their kids were too heavy, about 60 percent encouraged them to diet.

In 2003, about 200 of the kids were re-surveyed. Those who had been encouraged to diet were much more likely to still be overweight -- about 74 percent of boys compared with 52 percent of those boys not encouraged to diet. For girls, the difference was 66 and 44 percent, respectively. Both groups reported about the same eating patterns, including the frequency of fast-food meals, and the quantity of fruits and vegetables at home.

Neumark-Sztainer said public health experts have known that adolescents and teenagers who say they diet are the ones who are most likely to have long-lasting weight and eating disorder problems. She said this study shows that just informing parents their kids are overweight is counterproductive.

"If you are going to talk with parents about their children's weight, you need to specifically help them make positive changes at home," said Neumark-Sztainer, who has written a book for parents on the subject called "I'm Like So Fat."

Fletcher said that when she talked to teens for her book, they said the worst thing their parents could do was pressure them.

"Nagging, preaching, coercion does not work," she said. "Let the kid be in charge. It's up to the teen to decide if and how he or she wants to lose weight."

That can be very difficult for parents. "There seems to be a fine line between helpful and harmful parenting," the researchers said in their study.

The best thing parents can do to be role models, said Neumark-Sztainer, is to provide and eat healthful food, have regular family meals, and do physically active things with their kids. "Do more. Talk less," she said.

Healthy eating with diabetes

2008-06-07T18:48:00.000-07:00

Careful meal-planning plays an important role in regulating diabetes, but there is not a single diet that works for everyone. Each individual should have a meal plan based on diabetes treatment goals, eating habits and lifestyle. Here are some general guidelines to help you create a balanced diet:

Choose whole-grain products, such as whole-grain breads, pastas and brown rice, over refined products.
Eat foods high in fiber such as fruits, vegetables, whole grains and beans. Fiber helps regulate blood sugar.
Choose whole fruits over fruit juices.
Avoid "empty calorie" foods, which are foods high in calories but low in nutrients.
Limit saturated fat by avoiding fried foods and limiting animal products.
Limit salt. Season with herbs, garlic or lemon. Canned foods and frozen meals usually are high in salt.
Choose low-sodium options.
Eat cold-water fish, such as salmon, sardines or mackerel, two to three times a week.
Other sources of omega-3 fatty acids are fish oil supplements, flax seeds and walnuts.
Eat magnesium-rich foods. Sources include tofu, beans, nuts, seeds, whole grains and green leafy vegetables.

In addition to the above recommendations, the American Diabetes Association recommends that people with diabetes consult a registered dietician once per year to design an individualized meal plan.

Is blood-sugar control's value limited?

2008-06-06T08:45:00.000-07:00

Two large studies involving more than 21,000 people found that people with type 2 diabetes had no reduction in their risk of heart attacks and strokes and no reduction in their death rate if they rigorously controlled their blood sugar.

The results provide more details and bolster findings reported in February, when one of the studies, by the National Institutes of Health, ended prematurely. At that time, researchers surprised diabetes experts with the announcement that study participants who were rigorously controlling their blood sugar had a higher death rate than those whose blood-sugar control was less stringent.

Now the federal researchers are publishing detailed data from that study. Researchers in the second study, from Australia and involving participants from 20 countries, are also publishing their results on blood sugar and cardiovascular disease.

That study did not find an increase in deaths, but neither did it find any protection from cardiovascular disease with rigorous blood-sugar control.

Thus both studies failed to confirm a dearly held hypothesis that people with type 2 diabetes could be protected from cardiovascular disease if they strictly controlled their blood sugar.
It was a hypothesis that seemed almost obvious. Cardiovascular disease accounts for 65 percent of deaths among people with type 2 diabetes. Since diabetes is characterized by high levels of blood sugar, the hope was that if people with diabetes could get their blood sugar as close to normal as possible, their cardiovascular-disease rate would be nearly normal.

The two studies were presented Friday in San Francisco at the annual meeting of the American Diabetes Association and will be published next week in The New England Journal of Medicine.
A third study, similar but smaller, by the Department of Veterans Affairs, will be presented at the meeting Sunday.

Diabetes researchers said the message is that patients should obtain at least moderate control of blood sugar to protect against eye, kidney and nerve disease. But for heart disease, they said, the only proven method of preventing complications is to give statins to control cholesterol, drugs to control blood pressure and aspirin to control blood clotting, and encourage people to lose weight and exercise.

The Australian study did find one advantage to strict blood-sugar control: a slight reduction in new or worsening kidney disease. But researchers disagreed about whether the kidney-disease effect in the Australian study was enough to advise patients to strive for rigorous blood-sugar control. The Australian investigators said it was.

Others were not so sure. The kidney effect was "a modest benefit," said David Nathan, director of the diabetes center at Massachusetts General Hospital.

And the excess deaths among patients in the intensive-treatment group in the U.S. study gave Nathan and others pause.

Researchers said it was difficult to compare the studies from the United States and Australia. For example, patients in the two studies took different drugs to lower blood sugar and lowered their blood glucose at different rates: quickly in the U.S. study, over a period of years in the Australian one.

Those in the U.S. study used a wide variety of drugs. But all those in the Australian study assigned to rigorous blood-sugar control were required to take the diabetes drug sulfonylurea gliclazide (modified release), which is not used in the United States.

The study got its major support from Servier, the drug's maker. Servier had no influence on the conduct of the study or the analysis or publication of its results, said Stephen MacMahon, a principal investigator and professor of cardiovascular medicine and epidemiology at the University of Sydney.

In both studies, intensive control of blood sugar meant levels of a blood protein, hemoglobin A1C, of 6 percent to 6.5 percent, and less rigorous control meant an A1C goal of 7 percent to 7.9 percent, typical levels achieved by people with type 2 diabetes in the United States.

Hospitalized Children Pick Up Too Many Infections

2008-06-05T08:51:00.000-07:00

Hospitalized children suffer too many infections and other preventable complications that extend their stays and cost millions, according to a study released today.

Researchers found that some complications occurred in up to 4 percent of children treated at 38 children's hospitals nationwide.

Children are three times more susceptible to infections in hospitals compared with adults, the study shows. Better hand washing, sterilization, preventive antibiotic treatments and other safety techniques can help reduce hospital-based infections.

"I disagree with the notion that we should take it as a given that some infections will happen," said the study's co-author, Dr. Matthew Kronman, an infectious-disease specialist at The Children's Hospital of Philadelphia. "I think we can do better."

Researchers studied the medical records of thousands of children hospitalized in 2006, looking for 12 complications known as adverse events by the federal Agency for Healthcare Research and Quality.

The complications include infections from catheters, bedsores, accidental punctures and foreign objects left in children's bodies after surgery.

Children and adults suffer different complications at different rates, and the study is the first to analyze pediatric patients alone.

Children are more likely than adults to have some complications, such as postoperative infections and hemorrhaging, but less likely to suffer others, such as bedsores.
The study found that of 430,000 children hospitalized in 2006, more than 6,600 suffered complications caused by their care. Also, 4,300 of the total number of children studied died, but it is not clear whether the deaths resulted from medical mistakes.

"We need to do a better job of identifying ways to prevent some of these complications," said study leader Dr. Samir Shah, an infectious-disease specialist at the Philadelphia hospital.
"A lot of the ongoing safety efforts have focused on adults, but complications of medical care have a clear impact on children's health as well as the costs of caring for children."
Researchers said that the nearly 3,000 cases of infections caused by medical care were distressingly high.

"If we were to eliminate all infection due to medical care, that would save over $700 million in charges each year," Kronman said.

The complications lengthened hospital stays from a range of three days for accidental lacerations to 24 days for sepsis, an infection of the bloodstream. The resulting additional charges ranged from $35,000 to $337,000, according to the report.

Medicare and some private insurers have recently announced they will stop paying for certain preventable medical errors.

Co-author Shah said the report, published in the June issue of the journal Pediatrics, could lead to changes in nurse-to-patient ratios as well as hospital safety policies.

Donate $10 to Stop Malaria

2008-06-04T08:49:00.000-07:00

Donating $10 to buy a mosquito net to save an African child from malaria has become a hip way to show you care, especially for teenagers. The movement is like a modern version of the March of Dimes, created in 1938 to defeat polio, or like collecting pennies for UNICEF on Halloween.
Unusual allies, such as the Methodist and Lutheran churches, the National Basketball Association and the United Nations Foundation, are stoking the passion for nets that prevent malaria. The annual "American Idol Gives Back" fundraising television special has donated about $6 million a year for two years. The music channel VH1 made a fundraising video featuring a pesky man in a mosquito suit.

Part of what has helped the campaign catch on is its sheer simplicity and affordability — $10 buys one net to save a child. Nothing But Nets, the best-known campaign, has raised $20 million from 70,000 individuals, most of it in donations averaging $60.

That is a small fraction of the overall need, which experts estimate at $2.5 billion. But it gives the effort a populist edge, and participation is psychologically rewarding for anyone whose philanthropic pockets are shallower than those of Bill Gates.

Crucial to the drive against malaria, which kills an estimated 1 million people a year, mostly in Africa, has been the development of an inexpensive, long-lasting insecticidal net. Unlike old nets, which either had no insecticide or had to be dipped twice a year, the new ones keep killing or repelling mosquitoes for three to five years. When more than 60 percent of the inhabitants of a village use them over their beds while they are sleeping, malaria rates usually drop sharply.
Major donors have focused on malaria since the creation in 2001 of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has paid for 106 million nets. President Bush in 2005 started the President's Malaria Initiative, which has bought 6 million so far.

The Gates Foundation has spent almost $1.2 billion on malaria, and although most goes toward research into vaccines and new drugs, part went to match the first $3 million raised by Nothing But Nets.

In recent years a welter of malaria campaigns has sprung up worldwide, but U.S. participation was anemic until two years ago when Rick Reilly, then the back-page columnist for Sports Illustrated, stumbled onto a BBC documentary about malaria in Africa, which said: "Up to 3,000 children die needlessly each day of malaria — and all they need is a net."

Before asking his readers to donate $10 or $20, he searched for an agency to collect the money and buy the nets. He found the U.N. Foundation, started in 1998 by Ted Turner. Already sponsoring a campaign called Malaria No More, it agreed to his request that a new group be started with the name Nothing But Nets. "That's a real title," Reilly said. "It's so simple that even sports fans can get it."

Red Wine Can Increase Your Life Span

2008-06-02T08:47:00.000-07:00

Red wine may be much more potent than was thought in extending human life span, researchers say in a new report.

The study is based on dosing mice with resveratrol, an ingredient in some red wines. Some scientists take resveratrol in capsule form but others think it is far too early to take the drug, especially using wine as its source, until there is better data on its safety and effectiveness.
The report is part of a new wave of interest in drugs that may enhance longevity. On Monday, Sirtris, a startup founded in 2004 to develop drugs with the same effects as resveratrol, completed its sale to GlaxoSmithKline for $720 million.

Sirtris is seeking to develop drugs that activate protein agents known in people as sirtuins. "The upside is so huge that, if we are right, the company that dominates the sirtuin space could dominate the pharmaceutical industry and change medicine," Dr. David Sinclair, of the Harvard Medical School, a co-founder of the company, said Tuesday.

Mainstream scientists have long derided the idea of life-extending elixirs, but the door has been opened to drugs that exploit an ancient biological survival mechanism, that of switching the body's resources from fertility to tissue maintenance. The improved tissue maintenance seems to extend life by cutting down on the degenerative diseases of aging.

The reflex can be prompted by a faminelike diet, known as caloric restriction, which extends the life of laboratory rodents by up to 30 percent, but is far too hard for most people to keep to and has not been proven to work in humans.

Research started nearly 20 years ago by Dr. Leonard Guarente, of the Massachusetts Institute of Technology, showed recently that the famine-induced switch to tissue preservation may be triggered by activating the body's sirtuins. Sinclair, a former student of his, found in 2003 that sirtuins could be activated by a number of natural compounds, including resveratrol.

Sinclair's finding led in several directions. He and others have tested resveratrol's effects in mice, mostly at doses far higher than the minuscule amounts present in red wine.

One of the more spectacular results was obtained last year by Dr. John Auwerx of the Institute of Genetics and Molecular and Cellular Biology in Illkirch, France. He showed that resveratrol could turn couch-potato mice into champion athletes, making them run twice as far on a treadmill before collapsing.

Sirtris, meanwhile, has been testing resveratrol and other drugs that activate sirtuin. These drugs are small molecules, more stable than resveratrol, and can be given in smaller doses.
Separately, a research team led by Tomas Prolla and Richard Weindruch, of the University of Wisconsin, reports in the journal PLoS One today that resveratrol may be effective in mice and people in much lower doses than previously thought necessary.

In earlier studies, like Auwerx's of mice running on treadmills, the animals were fed such large amounts of resveratrol that to gain equivalent dosages people would have to drink more than 100 bottles of red wine a day.

The Wisconsin scientists used a dose on mice equivalent to just 35 bottles a day. But red wine contains many other resveratrol-like compounds that may also be beneficial. Taking these into account and mice's higher metabolic rate, four 5-ounce glasses of wine "starts getting close" to the amount of resveratrol they found effective, Weindruch said.

Resveratrol can also be obtained in the form of capsules marketed by several companies.

Hyperventilation

2008-06-01T07:48:00.000-07:00

THE BELIEF:

If you're hyperventilating, breathe into a paper bag.

THE FACTS:

Like a bandage for a cut or a crutch for a broken leg, the brown paper bag is a symbol for hyperventilation.

Grabbing a bag and breathing into it repeatedly, known in medical literature as "rebreathing," has long been recommended to ease rapid, uncontrolled breathing. Some doctors even keep bags in the office for that reason. But most medical studies and experts suggest that the method, though accepted, is dangerous and should be retired.

The idea behind it is to increase carbon dioxide levels. Hyperventilation causes the body to expel too much carbon dioxide, and "rebreathing" exhaled air helps restore that lost gas.

The problem is that several medical conditions, such as asthma and heart attacks, can be confused with hyperventilation. In such cases reducing oxygen and increasing carbon dioxide can be deadly. One study in The Annals of Emergency Medicine described three cases in which people having heart attacks thought, wrongly, that they were hyperventilating and died after losing oxygen while breathing into bags.

Another study said using a bag was no better at easing hyperventilation than using an open tube. For better results, experts say, stay calm and practice breathing slowly and deliberately.

THE BOTTOM LINE:

Most studies advise against paper bags to treat hyperventilation.