WASHINGTON - When Shakespeare called sleep the "chief nourisher of life's feast," he may have been well ahead of his time, medically at least. Researchers at the University of Chicago Medical Center report that disrupting sleep damages the body's ability to regulate blood sugar levels, potentially raising the risk of developing type 2 diabetes.
More than 18 million Americans have diabetes and the most common form is type 2, in which the body either becomes resistant to insulin or doesn't produce enough of it to regulate sugar in the bloodstream.
In a small experiment, researchers led by Dr. Esra Tasali, an assistant professor of medicine, found that disrupting the deepest sleep periods of volunteers rapidly resulted in reduction in their ability to regulate blood-sugar levels.
The findings are reported in Monday's online edition of Proceedings of the National Academy of Sciences.
The researchers studied the sleep patterns of nine volunteers, five men and four women, all of normal weight, in good health and aged 20 to 31.
Normal sleep is divided into several stages, with the so-called slow-wave sleep considered the deepest.
Whenever the volunteers went into slow-wave sleep the researchers made noise — enough to disturb the sleep though not to fully awaken them.
After just three days the ability of the volunteers to regulate blood sugar was reduced by 25 percent, the researchers reported.
Earlier studies have indicated that lack of sleep can reduce the ability to regulate sugar, and this report adds evidence that poor sleep quality is also a diabetes risk.
"This decrease in slow-wave sleep resembles the changes in sleep patterns caused by 40 years of aging," Tasali said in a statement. Young adults spend 80 to 100 minutes per night in slow-wave sleep, while people over age 60 generally have less than 20 minutes. "In this experiment," she said, "we gave people in their 20s the sleep of those in their 60s."
"Since reduced amounts of deep sleep are typical of aging and of common obesity-related sleep disorders, such as obstructive sleep apnea, these results suggest that strategies to improve sleep quality, as well as quantity, may help to prevent or delay the onset of type 2 diabetes in populations at risk," said co-author Dr. Eve Van Cauter, a professor of medicine.
___
On the Net:
Proceedings of the National Academy of Sciences: http://www.pnas.org
Monday, December 31, 2007
Wednesday, December 26, 2007
Experts update "food pyramid" for older adults
NEW YORK (Reuters Health) - A nearly decade-old food guide pyramid for older adults has gotten a makeover to make it more user-friendly and to emphasize the special dietary needs of people older than 70.
Published in the January issue of the Journal of Nutrition, the Modified MyPyramid for Older Adults stresses that older people should be careful to get enough fiber, calcium and vitamins D and B-12. It also emphasizes the importance of regular exercise and adequate fluid intake.
Researchers at Tufts University in Boston originally developed the food pyramid for older adults in 1999. They revamped it in response to changes made to the federal government's general Food Guide Pyramid -- which, along with a new look for the pyramid itself, includes an online component where people can calculate their personal dietary needs based on factors like age, weight and exercise levels.
Since older Americans are typically not as Web-savvy as younger generations, the Tufts researchers created a new version of their food pyramid that contains more graphics and underscores the importance of certain nutrients for older adults.
For example, a flag at the top of the pyramid reminds older people that they may need to take supplements of calcium, vitamin D and vitamin B-12 in addition to what they get from food.
"Adults over the age of 70 have unique dietary needs," Dr. Alice H. Lichtenstein, the lead author of the report, said in a statement.
Older adults' calorie needs usually decline because they are less physically active than they once were, Lichtenstein explained. As they eat less food, it becomes even more important to choose nutrient-rich fare, like fruits, vegetables, low-fat dairy and high-fiber whole grains.
The new pyramid points out that packaged versions of fruits and vegetables -- frozen vegetables and canned or dried fruit, for instance -- might be good alternatives to fresh varieties for some older adults.
"These choices are easier to prepare and have a longer shelf life, minimizing waste," Lichtenstein explained. "Such factors are important to consider when arthritis kicks in or dark, cold days mean it is less likely someone will go out to replenish their refrigerator stores."
At the base of the pyramid are graphics showing physical activities that many older adults can perform -- such as walking, swimming and yard work.
"Regular physical activity is linked to reduced risk of chronic disease and lower body weights," Lichtenstein said. "Government statistics indicate that obesity in adults 70 years and older has been increasing, physical activity is one way to avoid weight gain in later years and its adverse consequences."
SOURCE: Journal of Nutrition, January 2008.
Published in the January issue of the Journal of Nutrition, the Modified MyPyramid for Older Adults stresses that older people should be careful to get enough fiber, calcium and vitamins D and B-12. It also emphasizes the importance of regular exercise and adequate fluid intake.
Researchers at Tufts University in Boston originally developed the food pyramid for older adults in 1999. They revamped it in response to changes made to the federal government's general Food Guide Pyramid -- which, along with a new look for the pyramid itself, includes an online component where people can calculate their personal dietary needs based on factors like age, weight and exercise levels.
Since older Americans are typically not as Web-savvy as younger generations, the Tufts researchers created a new version of their food pyramid that contains more graphics and underscores the importance of certain nutrients for older adults.
For example, a flag at the top of the pyramid reminds older people that they may need to take supplements of calcium, vitamin D and vitamin B-12 in addition to what they get from food.
"Adults over the age of 70 have unique dietary needs," Dr. Alice H. Lichtenstein, the lead author of the report, said in a statement.
Older adults' calorie needs usually decline because they are less physically active than they once were, Lichtenstein explained. As they eat less food, it becomes even more important to choose nutrient-rich fare, like fruits, vegetables, low-fat dairy and high-fiber whole grains.
The new pyramid points out that packaged versions of fruits and vegetables -- frozen vegetables and canned or dried fruit, for instance -- might be good alternatives to fresh varieties for some older adults.
"These choices are easier to prepare and have a longer shelf life, minimizing waste," Lichtenstein explained. "Such factors are important to consider when arthritis kicks in or dark, cold days mean it is less likely someone will go out to replenish their refrigerator stores."
At the base of the pyramid are graphics showing physical activities that many older adults can perform -- such as walking, swimming and yard work.
"Regular physical activity is linked to reduced risk of chronic disease and lower body weights," Lichtenstein said. "Government statistics indicate that obesity in adults 70 years and older has been increasing, physical activity is one way to avoid weight gain in later years and its adverse consequences."
SOURCE: Journal of Nutrition, January 2008.
Tuesday, December 25, 2007
Post-Holiday Letdown Can Be Avoided
TUESDAY, Dec. 25 (HealthDay News) -- Eating a balanced diet and staying active are key to beating the blues this holiday season, say mental health experts.
According to Malone, there are a few things people can do to avoid post-holiday letdown:
Eat a balanced diet, which results in more energy and an improved sense of wellbeing. Cut back on caffeine if you are having trouble sleeping and cut back on the festive cocktails.
Go for a walk. Physical activity helps you lose weight and improves your mood. If the winter weather looks foreboding, work out inside. Take advantage of New Year's specials to join a gym or your fellow post-holiday shoppers walking the outer edge of the mall.
Talk about it. According to Malone, sharing your troubles with someone else can be a relief, and they may be able to offer another perspective that could help you.
If these steps don't help ease the blues away, consider talking to a physician.
The symptoms of depression include a persistent sad or "empty" mood; sleeping too little or too much; weight loss or weight gain; loss of interest in once-enjoyed activities; restlessness; difficulty concentrating; tiredness; and thoughts of death or suicide.
More information
To learn more about coping with the holiday blues, visit the American Psychological Association.
According to Malone, there are a few things people can do to avoid post-holiday letdown:
Eat a balanced diet, which results in more energy and an improved sense of wellbeing. Cut back on caffeine if you are having trouble sleeping and cut back on the festive cocktails.
Go for a walk. Physical activity helps you lose weight and improves your mood. If the winter weather looks foreboding, work out inside. Take advantage of New Year's specials to join a gym or your fellow post-holiday shoppers walking the outer edge of the mall.
Talk about it. According to Malone, sharing your troubles with someone else can be a relief, and they may be able to offer another perspective that could help you.
If these steps don't help ease the blues away, consider talking to a physician.
The symptoms of depression include a persistent sad or "empty" mood; sleeping too little or too much; weight loss or weight gain; loss of interest in once-enjoyed activities; restlessness; difficulty concentrating; tiredness; and thoughts of death or suicide.
More information
To learn more about coping with the holiday blues, visit the American Psychological Association.
Thursday, December 13, 2007
Fewer breast patients may need chemo
SAN ANTONIO - Thousands of breast cancer patients each year could be spared chemotherapy or get gentler versions of it without harming their odds of beating the disease, new research suggests.
One study found that certain women did better — were less likely to die or have a relapse — if given a less harsh drug than Adriamycin, a mainstay of treatment for decades.
Another study found that a gene test can help predict whether some women need chemo at all — even among those whose cancer has spread to their lymph nodes, which typically brings full treatment now.
The findings are sure to speed the growing trend away from chemo for many breast cancer patients and targeting it to a smaller group of women who truly need it, doctors said Thursday at the San Antonio Breast Cancer Symposium, where the studies were reported.
"We are backing off on chemotherapy and using chemotherapy more selectively" in certain women, said Dr. Eric Winer of the Dana-Farber Cancer Institute in Boston.
The gene test in particular "will start changing practice nearly immediately," said Dr. Peter Ravdin of the University of Texas M.D. Anderson Cancer Center in Houston. "The results are compelling that this test ... helps select patients who will most benefit from chemotherapy."
Breast cancer is the most common major cancer in American women. More than 178,000 new cases are expected this year. Most are helped to grow by estrogen, and hormone-blocking medicines like tamoxifen are used to treat those.
Chemo usually is added if the disease has spread to lymph nodes — a situation faced by about 45,000 U.S. women each year. Doctors know that chemo won't help most of these women, but they have had no good way to tell who can safely skip its cost and misery.
Here's where Oncotype DX, a test that measures the activity of 21 genes and gives a score to predict a woman's risk of recurrence, comes in. Doctors have used it for several years to guide treatment for certain women with early breast cancers, especially those that not spread.
The new study, led by Dr. Kathy Albain of Loyola University in Chicago, looked at whether it accurately predicted chemo's benefit in 367 women whose hormone-driven cancer had spread to lymph nodes.
A decade after these women were treated, those who had low scores on the gene test were found to have had no benefit from chemo. Conversely, chemo did a lot of good for those with high scores.
Because 40 percent of the women scored low, it means that as many as 18,000 women each year might safely skip chemo.
The National Cancer Institute and the test's maker, Genomic Health of Redwood City, Calif., sponsored the study. Albain, Winer and Ravdin have consulted or been paid speakers for the company in the past.
Dr. Kelly Marcom, a Duke University cancer expert with no ties to the company, said the test would give valuable information to guide treatment for more patients in the future. He has used it on about 50 women in the last year.
"I've had it cut both ways" — ruling chemo in and out, Marcom said.
The test is expensive — $3,400 — though many insurers are paying for it because it can avoid even more costly chemo.
Albain plans to discuss using it with Andrea DeRosier, a 49-year-old health care administrator from suburban Chicago whose cancer has spread to a single lymph node.
When a surgeon said she likely would need chemo, "I remember thinking, 'Oh, that's terrible,'" DeRosier said. "I want whatever protocol is going to keep me alive," but not futile treatment, she said.
Chemo's side effects are getting greater attention. One drug commonly used for early breast cancer — doxorubicin, sold as Adriamycin and generic brands — is known to cut the risk of having a recurrence or dying, but raises the risk of heart problems and even leukemia.
Dr. Stephen Jones of Baylor-Sammons Cancer Center tested using Taxotere, a drug not linked to heart problems, in its place in more than 1,000 women with early breast cancer. After seven years, 87 percent of those given Taxotere survived, compared with 82 percent of those given Adriamycin. In addition, those given Taxotere were less likely to have had a recurrence.
The study was sponsored by Taxotere's maker, Sanofi-Aventis SA, a French company with U.S. offices in Bridgewater, N.J. Jones consults for the company.
A study in the New England Journal of Medicine in October showed that another drug, Taxol, does not work for the most common form of breast cancer.
These new studies should lead to less use of chemo, but there has been "intense" pushback from doctors, who fear giving up on a treatment that might help some patients, said Barbara Brenner, head of the advocacy group Breast Cancer Action.
"It's very hard to turn a ship like this," she said. "Adding things never takes much, but removing things takes a mountain of data from the medical community."
___
On the Net:
Breast cancer meeting: http://www.sabcs.org
National Cancer Institute: http://www.cancer.gov
One study found that certain women did better — were less likely to die or have a relapse — if given a less harsh drug than Adriamycin, a mainstay of treatment for decades.
Another study found that a gene test can help predict whether some women need chemo at all — even among those whose cancer has spread to their lymph nodes, which typically brings full treatment now.
The findings are sure to speed the growing trend away from chemo for many breast cancer patients and targeting it to a smaller group of women who truly need it, doctors said Thursday at the San Antonio Breast Cancer Symposium, where the studies were reported.
"We are backing off on chemotherapy and using chemotherapy more selectively" in certain women, said Dr. Eric Winer of the Dana-Farber Cancer Institute in Boston.
The gene test in particular "will start changing practice nearly immediately," said Dr. Peter Ravdin of the University of Texas M.D. Anderson Cancer Center in Houston. "The results are compelling that this test ... helps select patients who will most benefit from chemotherapy."
Breast cancer is the most common major cancer in American women. More than 178,000 new cases are expected this year. Most are helped to grow by estrogen, and hormone-blocking medicines like tamoxifen are used to treat those.
Chemo usually is added if the disease has spread to lymph nodes — a situation faced by about 45,000 U.S. women each year. Doctors know that chemo won't help most of these women, but they have had no good way to tell who can safely skip its cost and misery.
Here's where Oncotype DX, a test that measures the activity of 21 genes and gives a score to predict a woman's risk of recurrence, comes in. Doctors have used it for several years to guide treatment for certain women with early breast cancers, especially those that not spread.
The new study, led by Dr. Kathy Albain of Loyola University in Chicago, looked at whether it accurately predicted chemo's benefit in 367 women whose hormone-driven cancer had spread to lymph nodes.
A decade after these women were treated, those who had low scores on the gene test were found to have had no benefit from chemo. Conversely, chemo did a lot of good for those with high scores.
Because 40 percent of the women scored low, it means that as many as 18,000 women each year might safely skip chemo.
The National Cancer Institute and the test's maker, Genomic Health of Redwood City, Calif., sponsored the study. Albain, Winer and Ravdin have consulted or been paid speakers for the company in the past.
Dr. Kelly Marcom, a Duke University cancer expert with no ties to the company, said the test would give valuable information to guide treatment for more patients in the future. He has used it on about 50 women in the last year.
"I've had it cut both ways" — ruling chemo in and out, Marcom said.
The test is expensive — $3,400 — though many insurers are paying for it because it can avoid even more costly chemo.
Albain plans to discuss using it with Andrea DeRosier, a 49-year-old health care administrator from suburban Chicago whose cancer has spread to a single lymph node.
When a surgeon said she likely would need chemo, "I remember thinking, 'Oh, that's terrible,'" DeRosier said. "I want whatever protocol is going to keep me alive," but not futile treatment, she said.
Chemo's side effects are getting greater attention. One drug commonly used for early breast cancer — doxorubicin, sold as Adriamycin and generic brands — is known to cut the risk of having a recurrence or dying, but raises the risk of heart problems and even leukemia.
Dr. Stephen Jones of Baylor-Sammons Cancer Center tested using Taxotere, a drug not linked to heart problems, in its place in more than 1,000 women with early breast cancer. After seven years, 87 percent of those given Taxotere survived, compared with 82 percent of those given Adriamycin. In addition, those given Taxotere were less likely to have had a recurrence.
The study was sponsored by Taxotere's maker, Sanofi-Aventis SA, a French company with U.S. offices in Bridgewater, N.J. Jones consults for the company.
A study in the New England Journal of Medicine in October showed that another drug, Taxol, does not work for the most common form of breast cancer.
These new studies should lead to less use of chemo, but there has been "intense" pushback from doctors, who fear giving up on a treatment that might help some patients, said Barbara Brenner, head of the advocacy group Breast Cancer Action.
"It's very hard to turn a ship like this," she said. "Adding things never takes much, but removing things takes a mountain of data from the medical community."
___
On the Net:
Breast cancer meeting: http://www.sabcs.org
National Cancer Institute: http://www.cancer.gov
Monday, December 10, 2007
Mediterranean diet lengthens Americans' lives
NEW YORK (Reuters Health) - Eating the Mediterranean way could help you live longer, according to the first study to look at how the dietary pattern relates to mortality in a US population.
Men whose diets were closest to the Mediterranean ideal were 21 percent less likely to die over five years than men whose diets were least Mediterranean-like. Similar results were seen in women.
"These results provide strong evidence for a beneficial effect of higher conformity with the Mediterranean dietary pattern on risk of death from all causes, including deaths due to cardiovascular disease and cancer, in a US population," Dr. Panagiota N. Mitrou of the University of Cambridge in the UK and colleagues conclude.
A number of studies have linked the Mediterranean diet, which is rich in fish, fruits and vegetables and nuts and low in dairy foods and red meat, to health benefits, the researchers note in the Archives of Internal Medicine.
They looked at diet and mortality in 380,296 men and women, 50 to 71 years old, who were participating in the National Institutes of Health-AARP Diet and Health Study.
For both men and women, the researchers found, the risk of death from any cause over the five-year follow-up period was lower for those with the most Mediterranean-like diets. Deaths from cancer or cardiovascular disease were also significantly lower in this group.
The benefit was especially strong in smokers who were not overweight, who nearly halved their risk of death if they closely followed the Mediterranean diet pattern. Smokers may have had the most to gain from the antioxidant and blood fat-lowering effects of Mediterranean-style eating, Mitrou and colleagues suggest.
SOURCE: Archives of Internal Medicine, December 10/24, 2007.
Men whose diets were closest to the Mediterranean ideal were 21 percent less likely to die over five years than men whose diets were least Mediterranean-like. Similar results were seen in women.
"These results provide strong evidence for a beneficial effect of higher conformity with the Mediterranean dietary pattern on risk of death from all causes, including deaths due to cardiovascular disease and cancer, in a US population," Dr. Panagiota N. Mitrou of the University of Cambridge in the UK and colleagues conclude.
A number of studies have linked the Mediterranean diet, which is rich in fish, fruits and vegetables and nuts and low in dairy foods and red meat, to health benefits, the researchers note in the Archives of Internal Medicine.
They looked at diet and mortality in 380,296 men and women, 50 to 71 years old, who were participating in the National Institutes of Health-AARP Diet and Health Study.
For both men and women, the researchers found, the risk of death from any cause over the five-year follow-up period was lower for those with the most Mediterranean-like diets. Deaths from cancer or cardiovascular disease were also significantly lower in this group.
The benefit was especially strong in smokers who were not overweight, who nearly halved their risk of death if they closely followed the Mediterranean diet pattern. Smokers may have had the most to gain from the antioxidant and blood fat-lowering effects of Mediterranean-style eating, Mitrou and colleagues suggest.
SOURCE: Archives of Internal Medicine, December 10/24, 2007.
Sunday, December 2, 2007
Avandia may raise osteoporosis risk
WASHINGTON - The popular diabetes drug marketed as Avandia may increase bone thinning, a discovery that could help explain why diabetics can have an increased risk of fractures.
New research raises the possibility that long-term treatment with rosiglitazone, as Avandia is also called, could lead to osteoporosis. The diabetes drug is used to improved response to insulin.
While bones seem solid, they constantly are being broken down and rebuilt by the body. Researchers found that in mice, the drug increased the activity of the cells that degrade bones, according to a report in this week's online issue of Nature Medicine.
Avandia recently was labeled with warnings about the risk of heart failure in some patients. GlaxoSmithKline, which markets the drug, already has acknowledged that a study found a higher risk of fractures among women who take the drug. But this report is the first to attempt to explain the link between the drug and fractures.
The finding "has led to a better understanding of the challenges associated with long-term treatment of patients with Type II diabetes," said Ronald M. Evans of the Salk Institute for Biological Studies in La Jolla, Calif., lead author of the report.
"It also provides a basis for the development of a 'next generation' of drug that can specifically dial out this side effect and a new insight into a previously unrecognized aspect of bone physiology that has important medical consequences," he said in an interview via e-mail.
Nearly 21 million people in the United States have diabetes. Rosiglitazone is widely used in people with Type II, or adult onset diabetes, the most common form of the disease.
Evans said the discovery was fortuitous. Researchers were looking at different aspects of the diabetic mice and did not realize they would be able to change the bone-removing activity.
The assumption had been that more brittle bones in diabetics were the result of a reduced bone-building activity, not increased bone removal.
"Considering the widespread use of these drugs and the known action in people it is surprising that such a key observation had been missed," he said.
"The long-term use of rosiglitazone should be cautious in patients with higher risk of fractures such as older women," he added. Using it in combination with anti-osteoporosis drugs could be beneficial, he said.
The research was funded by the Howard Hughes Medical Institute and the National Institutes of Health.
___
On the Net:
Nature Medicine: http://www.nature.com/naturemedicine
Avandia: http://www.avandia.com/
Food and Drug Administration background on rosiglitazone: http://tinyurl.com/33kkbs
New research raises the possibility that long-term treatment with rosiglitazone, as Avandia is also called, could lead to osteoporosis. The diabetes drug is used to improved response to insulin.
While bones seem solid, they constantly are being broken down and rebuilt by the body. Researchers found that in mice, the drug increased the activity of the cells that degrade bones, according to a report in this week's online issue of Nature Medicine.
Avandia recently was labeled with warnings about the risk of heart failure in some patients. GlaxoSmithKline, which markets the drug, already has acknowledged that a study found a higher risk of fractures among women who take the drug. But this report is the first to attempt to explain the link between the drug and fractures.
The finding "has led to a better understanding of the challenges associated with long-term treatment of patients with Type II diabetes," said Ronald M. Evans of the Salk Institute for Biological Studies in La Jolla, Calif., lead author of the report.
"It also provides a basis for the development of a 'next generation' of drug that can specifically dial out this side effect and a new insight into a previously unrecognized aspect of bone physiology that has important medical consequences," he said in an interview via e-mail.
Nearly 21 million people in the United States have diabetes. Rosiglitazone is widely used in people with Type II, or adult onset diabetes, the most common form of the disease.
Evans said the discovery was fortuitous. Researchers were looking at different aspects of the diabetic mice and did not realize they would be able to change the bone-removing activity.
The assumption had been that more brittle bones in diabetics were the result of a reduced bone-building activity, not increased bone removal.
"Considering the widespread use of these drugs and the known action in people it is surprising that such a key observation had been missed," he said.
"The long-term use of rosiglitazone should be cautious in patients with higher risk of fractures such as older women," he added. Using it in combination with anti-osteoporosis drugs could be beneficial, he said.
The research was funded by the Howard Hughes Medical Institute and the National Institutes of Health.
___
On the Net:
Nature Medicine: http://www.nature.com/naturemedicine
Avandia: http://www.avandia.com/
Food and Drug Administration background on rosiglitazone: http://tinyurl.com/33kkbs
Thursday, November 29, 2007
Graveyard shift work linked to cancer
LONDON - Like UV rays and diesel exhaust fumes, working the graveyard shift will soon be listed as a "probable" cause of cancer. It is a surprising step validating a concept once considered wacky. And it is based on research that finds higher rates of breast and prostate cancer among women and men whose work day starts after dark.
Next month, the International Agency for Research on Cancer, the cancer arm of the World Health Organization, will add overnight shift work as a probable carcinogen. The American Cancer Society says it will likely follow. Up to now, the U.S. organization has considered the work-cancer link to be "uncertain, controversial or unproven."
The higher cancer rates don't prove working overnight can cause cancer. There may be other factors common among graveyard shift workers that raise their risk for cancer.
However, scientists suspect that overnight work is dangerous because it disrupts the circadian rhythm, the body's biological clock. The hormone melatonin, which can suppress tumor development, is normally produced at night.
If the graveyard shift theory eventually proves correct, millions of people worldwide could be affected. Experts estimate that nearly 20 percent of the working population in developed countries work night shifts.
Among the first to spot the night shift-cancer connection was Richard Stevens, a cancer epidemiologist and professor at the University of Connecticut Health Center. In 1987, Stevens published a paper suggesting a link between light at night and breast cancer.
Back then, he was trying to figure out why breast cancer incidence suddenly shot up starting in the 1930s in industrialized societies, where nighttime work was considered a hallmark of progress. Most scientists were bewildered by his proposal.
But in recent years, several studies have found that women working at night over many years were indeed more prone to breast cancer. Also, animals that have their light-dark schedules switched develop more cancerous tumors and die earlier.
Some research also suggests that men working at night may have a higher rate of prostate cancer.
Because these studies mostly focused on nurses and airline crews, bigger studies in different populations are needed to confirm or disprove the findings.
There are still plenty of skeptics. And to put the risk in perspective, the "probable carcinogen" tag means that the link between overnight work and cancer is merely plausible.
Among the long list of agents that are listed as "known" carcinogens are alcoholic beverages and birth control pills. Such lists say nothing about exposure amount or length of time or how likely they are to cause cancer. The American Cancer Society Web site notes that carcinogens do not cause cancer at all times.
Still, many doubters of the night shift link may be won over by the IARC's analysis to be published in the December issue of the journal Lancet Oncology.
"The indications are positive," said Vincent Cogliano, who heads up the agency's carcinogen classifications unit. "There was enough of a pattern in people who do shift work to recognize that there's an increase in cancer, but we can't rule out the possibility of other factors."
Scientists believe having lower melatonin levels can raise the risk of developing cancer. Light shuts down melatonin production, so people working in artificial light at night may have lower melatonin levels.
Melatonin can be taken as a supplement, but experts don't recommend it long-term, since that could ruin the body's ability to produce it naturally.
Sleep deprivation may be another factor in cancer risk. People who work at night are not usually able to completely reverse their day and night cycles.
"Night shift people tend to be day shift people who are trying to stay awake at night," said Mark Rea, director of the Light Research Center at Rensselaer Polytechnic Institute in New York, who is not connected with the IARC analysis.
Not getting enough sleep makes your immune system vulnerable to attack, and less able to fight off potentially cancerous cells.
Confusing your body's natural rhythm can also lead to a breakdown of other essential tasks. "Timing is very important," Rea said. Certain processes like cell division and DNA repair happen at regular times.
Even worse than working an overnight shift is flipping between daytime and overnight work.
"The problem is re-setting your body's clock," said Aaron Blair, of the United States' National Cancer Institute, who chaired IARC's recent meeting on shift work. "If you worked at night and stayed on it, that would be less disruptive than constantly changing shifts."
Anyone whose light and dark schedule is often disrupted — including frequent long-haul travelers or insomniacs — could theoretically face the same increased cancer risk, Stevens said.
He advises workers to sleep in a darkened room once they get off work. "The balance between light and dark is very important for your body. Just get a dark night's sleep."
Meanwhile, scientists are trying to come up with ways to reduce night workers' cancer risk. And some companies are experimenting with different lighting, seeking a type that doesn't affect melatonin production.
So far, the color that seems to have the least effect on melatonin is one that few people would enjoy working under: red.
___
American Cancer Society's list of known and probable carcinogens from IARC and National Toxicology Program: http://tinyurl.com/2kl5ab
International Agency for Research on Cancer: http://www.iarc.fr/
Next month, the International Agency for Research on Cancer, the cancer arm of the World Health Organization, will add overnight shift work as a probable carcinogen. The American Cancer Society says it will likely follow. Up to now, the U.S. organization has considered the work-cancer link to be "uncertain, controversial or unproven."
The higher cancer rates don't prove working overnight can cause cancer. There may be other factors common among graveyard shift workers that raise their risk for cancer.
However, scientists suspect that overnight work is dangerous because it disrupts the circadian rhythm, the body's biological clock. The hormone melatonin, which can suppress tumor development, is normally produced at night.
If the graveyard shift theory eventually proves correct, millions of people worldwide could be affected. Experts estimate that nearly 20 percent of the working population in developed countries work night shifts.
Among the first to spot the night shift-cancer connection was Richard Stevens, a cancer epidemiologist and professor at the University of Connecticut Health Center. In 1987, Stevens published a paper suggesting a link between light at night and breast cancer.
Back then, he was trying to figure out why breast cancer incidence suddenly shot up starting in the 1930s in industrialized societies, where nighttime work was considered a hallmark of progress. Most scientists were bewildered by his proposal.
But in recent years, several studies have found that women working at night over many years were indeed more prone to breast cancer. Also, animals that have their light-dark schedules switched develop more cancerous tumors and die earlier.
Some research also suggests that men working at night may have a higher rate of prostate cancer.
Because these studies mostly focused on nurses and airline crews, bigger studies in different populations are needed to confirm or disprove the findings.
There are still plenty of skeptics. And to put the risk in perspective, the "probable carcinogen" tag means that the link between overnight work and cancer is merely plausible.
Among the long list of agents that are listed as "known" carcinogens are alcoholic beverages and birth control pills. Such lists say nothing about exposure amount or length of time or how likely they are to cause cancer. The American Cancer Society Web site notes that carcinogens do not cause cancer at all times.
Still, many doubters of the night shift link may be won over by the IARC's analysis to be published in the December issue of the journal Lancet Oncology.
"The indications are positive," said Vincent Cogliano, who heads up the agency's carcinogen classifications unit. "There was enough of a pattern in people who do shift work to recognize that there's an increase in cancer, but we can't rule out the possibility of other factors."
Scientists believe having lower melatonin levels can raise the risk of developing cancer. Light shuts down melatonin production, so people working in artificial light at night may have lower melatonin levels.
Melatonin can be taken as a supplement, but experts don't recommend it long-term, since that could ruin the body's ability to produce it naturally.
Sleep deprivation may be another factor in cancer risk. People who work at night are not usually able to completely reverse their day and night cycles.
"Night shift people tend to be day shift people who are trying to stay awake at night," said Mark Rea, director of the Light Research Center at Rensselaer Polytechnic Institute in New York, who is not connected with the IARC analysis.
Not getting enough sleep makes your immune system vulnerable to attack, and less able to fight off potentially cancerous cells.
Confusing your body's natural rhythm can also lead to a breakdown of other essential tasks. "Timing is very important," Rea said. Certain processes like cell division and DNA repair happen at regular times.
Even worse than working an overnight shift is flipping between daytime and overnight work.
"The problem is re-setting your body's clock," said Aaron Blair, of the United States' National Cancer Institute, who chaired IARC's recent meeting on shift work. "If you worked at night and stayed on it, that would be less disruptive than constantly changing shifts."
Anyone whose light and dark schedule is often disrupted — including frequent long-haul travelers or insomniacs — could theoretically face the same increased cancer risk, Stevens said.
He advises workers to sleep in a darkened room once they get off work. "The balance between light and dark is very important for your body. Just get a dark night's sleep."
Meanwhile, scientists are trying to come up with ways to reduce night workers' cancer risk. And some companies are experimenting with different lighting, seeking a type that doesn't affect melatonin production.
So far, the color that seems to have the least effect on melatonin is one that few people would enjoy working under: red.
___
American Cancer Society's list of known and probable carcinogens from IARC and National Toxicology Program: http://tinyurl.com/2kl5ab
International Agency for Research on Cancer: http://www.iarc.fr/
Monday, November 26, 2007
Alzheimer drugs don't delay dementia onset: study
LONDON (Reuters) - Giving Alzheimer's drugs to people with early memory problems does not seem to delay the onset of the disease, researchers said on Tuesday.
Three main drugs -- Aricept, or donepezil; Exelon, or rivastigmine; and Reminyl, or galantamine -- are currently approved for use in mild-to-moderate Alzheimer's disease.
They are also often prescribed on a so-called "off-label" basis to people with pre-dementia.
But doctors are divided over their effectiveness, leading to differing rates of use and bitter arguments over patient access to treatment, notably in Britain where a dispute over their cost-effectiveness has led to legal clashes.
Some experts and patient groups have called for such anti-cholinesterase drugs to be given to people with mild cognitive impairment (MCI) -- a condition where people have memory problems that are more severe than those normally seen in others of their age.
People with MCI are thought to be at high risk of developing Alzheimer's or dementia.
Italian researchers, however, found that in none of six clinical trials they examined did using the drugs significantly reduce the rate of progression from MCI to dementia.
Accurate assessment of the effect of anti-cholinesterase medicines was muddied by the lack of a precise definition for MCI, Roberto Raschetti and colleagues at the National Centre for Epidemiology, Surveillance and Health Promotion in Rome reported in the online journal PLoS Medicine.
Their findings may prompt a rethink among doctors who are currently using anti-cholinesterase drugs off-label in MCI. Off-label use refers to the common practice of prescribing drugs for uses for which they are not officially approved.
In Italy, an estimated 27 percent of patients diagnosed with MCI are given Alzheimer's drugs off-label and Raschetti said it was likely the situation was similar in other countries.
He argued more clinical trials were needed, using a single agreed definition of MCI, before there could be any justification for doctors to use the drugs in pre-dementia cases, especially as the drugs can have harmful side effects.
Aricept is marketed by Japan's Eisai Co Ltd and Pfizer Inc, while Novartis AG sells Exelon. Reminyl is sold by Shire Plc and also by Johnson & Johnson under the brand name Razadyne.
A row over who should get these drugs ended up in court in London earlier this year after Britain's National Institute for Health and Clinical Excellence said they should not be given to newly diagnosed patients with mild Alzheimer's disease.
Drugmakers claimed the agency's cost-effectiveness calculations were flawed but the court backed the restrictions in a ruling handed down in August.
Three main drugs -- Aricept, or donepezil; Exelon, or rivastigmine; and Reminyl, or galantamine -- are currently approved for use in mild-to-moderate Alzheimer's disease.
They are also often prescribed on a so-called "off-label" basis to people with pre-dementia.
But doctors are divided over their effectiveness, leading to differing rates of use and bitter arguments over patient access to treatment, notably in Britain where a dispute over their cost-effectiveness has led to legal clashes.
Some experts and patient groups have called for such anti-cholinesterase drugs to be given to people with mild cognitive impairment (MCI) -- a condition where people have memory problems that are more severe than those normally seen in others of their age.
People with MCI are thought to be at high risk of developing Alzheimer's or dementia.
Italian researchers, however, found that in none of six clinical trials they examined did using the drugs significantly reduce the rate of progression from MCI to dementia.
Accurate assessment of the effect of anti-cholinesterase medicines was muddied by the lack of a precise definition for MCI, Roberto Raschetti and colleagues at the National Centre for Epidemiology, Surveillance and Health Promotion in Rome reported in the online journal PLoS Medicine.
Their findings may prompt a rethink among doctors who are currently using anti-cholinesterase drugs off-label in MCI. Off-label use refers to the common practice of prescribing drugs for uses for which they are not officially approved.
In Italy, an estimated 27 percent of patients diagnosed with MCI are given Alzheimer's drugs off-label and Raschetti said it was likely the situation was similar in other countries.
He argued more clinical trials were needed, using a single agreed definition of MCI, before there could be any justification for doctors to use the drugs in pre-dementia cases, especially as the drugs can have harmful side effects.
Aricept is marketed by Japan's Eisai Co Ltd and Pfizer Inc, while Novartis AG sells Exelon. Reminyl is sold by Shire Plc and also by Johnson & Johnson under the brand name Razadyne.
A row over who should get these drugs ended up in court in London earlier this year after Britain's National Institute for Health and Clinical Excellence said they should not be given to newly diagnosed patients with mild Alzheimer's disease.
Drugmakers claimed the agency's cost-effectiveness calculations were flawed but the court backed the restrictions in a ruling handed down in August.
MRI scans show second-hand smoke damage to lungs
WASHINGTON (Reuters) - One third of people who breath in high levels of secondhand smoke have damage to their lungs similar to that seen in smokers, doctors reported on Monday.
They used a special kind of magnetic resonance imaging, or MRI, scan to look at the lungs of non-smokers who had high exposure to other people's cigarette smoke and found evidence of the kind of damage that causes emphysema.
"We interpreted those changes as early signs of lung damage, representing very mild forms of emphysema," said Chengbo Wang, a magnetic resonance physicist at The Children's Hospital of Philadelphia, who led the study.
"Almost one third of nonsmokers who had been exposed to secondhand cigarette smoke for a long time developed these structural changes," Wang added in a statement.
"To our knowledge, this is the first imaging study to find lung damage in non-smokers heavily exposed to secondhand smoke. We hope our work strengthens the efforts of legislators and policymakers to limit public exposure to secondhand smoke."
Wang, who presented his team's findings to a meeting of the Radiological Society of North American in Chicago, said 35 percent of U.S. children live in homes where someone smokes regularly.
The team studied 60 adults between ages 41 and 79, 45 of whom had never smoked. The non-smokers were considered to have high exposure if they had lived with a smoker for at least 10 years, often during childhood.
"It's long been hypothesized that prolonged exposure to secondhand smoke may cause physical damage to the lungs, but previous methods of analyzing lung changes were not sensitive enough to detect it," said Wang.
His team used a technique called long-time-scale, global helium-3 diffusion magnetic resonance imaging.
"With this technique, we are able to assess lung structure on a microscopic level," Wang said.
They found that 57 percent of the smokers and 33 percent of the nonsmokers with high exposure to secondhand smoke had signs of early lung damage as measured by the scan.
In February, U.S. researchers reported that up to 20 percent of women who develop lung cancer have never smoked.
They used a special kind of magnetic resonance imaging, or MRI, scan to look at the lungs of non-smokers who had high exposure to other people's cigarette smoke and found evidence of the kind of damage that causes emphysema.
"We interpreted those changes as early signs of lung damage, representing very mild forms of emphysema," said Chengbo Wang, a magnetic resonance physicist at The Children's Hospital of Philadelphia, who led the study.
"Almost one third of nonsmokers who had been exposed to secondhand cigarette smoke for a long time developed these structural changes," Wang added in a statement.
"To our knowledge, this is the first imaging study to find lung damage in non-smokers heavily exposed to secondhand smoke. We hope our work strengthens the efforts of legislators and policymakers to limit public exposure to secondhand smoke."
Wang, who presented his team's findings to a meeting of the Radiological Society of North American in Chicago, said 35 percent of U.S. children live in homes where someone smokes regularly.
The team studied 60 adults between ages 41 and 79, 45 of whom had never smoked. The non-smokers were considered to have high exposure if they had lived with a smoker for at least 10 years, often during childhood.
"It's long been hypothesized that prolonged exposure to secondhand smoke may cause physical damage to the lungs, but previous methods of analyzing lung changes were not sensitive enough to detect it," said Wang.
His team used a technique called long-time-scale, global helium-3 diffusion magnetic resonance imaging.
"With this technique, we are able to assess lung structure on a microscopic level," Wang said.
They found that 57 percent of the smokers and 33 percent of the nonsmokers with high exposure to secondhand smoke had signs of early lung damage as measured by the scan.
In February, U.S. researchers reported that up to 20 percent of women who develop lung cancer have never smoked.
Monday, November 19, 2007
High Blood Pressure Linked to Disability, Dementia
MONDAY, Nov. 19 (HealthDay News) -- People with high blood pressure are at increased risk for disability and dementia as they age, two new studies suggest.
In the first report, researchers found that high blood pressure increased the risk of developing disabilities, such as not being able to lift objects, walk up or down stairs, or bathe oneself.
"High blood pressure affects many aspects of a person's life," said lead researcher Dr. Ihab Hajjar, an instructor in medicine at Harvard Medical School. "Not only does it affect the vascular system and the heart and the brain and kidney, but it also affects well-being -- the ability to be independent, ability to perform daily activities, and be physically active."
Individuals who have lower blood pressure tend to develop less disability later in life and show less decline in their physical abilities compared with people who have higher blood pressure, Hajjar said. "This is a new aspect of the risk of high blood pressure," he noted.
The report was published in the December issue of Hypertension.
Hajjar's team collected data on 999 people who took part in the Charleston Heart Study, which started in 1960. Among these people, 70 percent had high blood pressure, but only 21 percent had their blood pressure controlled to optimal levels.
The researchers found that people with high blood pressure were more likely to have difficulty lifting objects, walking up or down stairs, or bathing themselves compared with people who had normal blood pressure.
In addition, people with high blood pressure who didn't have disability in their 80s did have a 15 percent to 36 percent increased risk of developing one of the three types of disabilities by the time they were checked in their early 90s, compared with those with normal blood pressure.
According to Hajjar, people who had their blood pressure controlled by medications fared as well as those who had normal blood pressure. "Controlling blood pressure may lower the risk of disability," he said.
In the second study, in the same issue of Hypertension, Shari R. Waldstein, a professor of psychology at the University of Maryland, Baltimore County, and her colleagues reported that stiff arteries may be associated with the decline in mental function that often accompanies aging.
"People with stiffening of their arteries show a decline in memory and concentration as they grow older," Waldstein said.
The Maryland researchers collected data on 1,749 people in the Baltimore Longitudinal Study of Aging, which was started by the U.S. National Institute on Aging in 1958.
During the study, participants were screened for increased pulse pressure, which is the difference between the maximum and minimum blood pressures produced during one heartbeat. In addition, their brain function was tested. This was done through tests of verbal and non-verbal memory, working memory, and attention.
In addition, Waldstein's team looked at additional data on 582 people who had their pulse wave velocity measured. Measuring pulse wave velocity is a new method for analyzing pulse pressure. Rising pulse pressure is an indicator of arterial stiffness.
The researchers found that increases in pulse pressure and pulse wave velocity affected memory. However, arterial stiffness wasn't linked to attention, hand-eye coordination, the ability to name objects, and speech fluency.
"Arterial stiffening negatively impacts cognitive performance before people have a stroke or develop dementia," Waldstein noted.
The findings suggest that arterial stiffness may be a potential target for drugs to help preserve mental function, Waldstein said. "Early treatment of cardiovascular risk factors that lead to arterial stiffening may help to preserve brain functioning as people age," she suggested.
One expert isn't sure whether high blood pressure is a cause of disability and dementia, or whether it's a marker associated with these conditions.
"Whether reducing blood pressure reduces disability and dementia isn't really known," said Dr. Harlan M. Krumholz, a professor of medicine at Yale University School of Medicine.
"It's part of a complex syndrome," he said. "Having high blood pressure is associated with having small sub-clinical strokes and heart disease, and there can be other complications from medications that don't interact well with each other."
Krumholz thinks that for any given patient, the reasons for dementia and disability are complex. "But, even as we are trying to sort out what these studies mean, the clear and unequivocal recommendation for people is to get high blood pressure under control," he said.
More information
For more on high blood pressure, visit the American Heart Association.
In the first report, researchers found that high blood pressure increased the risk of developing disabilities, such as not being able to lift objects, walk up or down stairs, or bathe oneself.
"High blood pressure affects many aspects of a person's life," said lead researcher Dr. Ihab Hajjar, an instructor in medicine at Harvard Medical School. "Not only does it affect the vascular system and the heart and the brain and kidney, but it also affects well-being -- the ability to be independent, ability to perform daily activities, and be physically active."
Individuals who have lower blood pressure tend to develop less disability later in life and show less decline in their physical abilities compared with people who have higher blood pressure, Hajjar said. "This is a new aspect of the risk of high blood pressure," he noted.
The report was published in the December issue of Hypertension.
Hajjar's team collected data on 999 people who took part in the Charleston Heart Study, which started in 1960. Among these people, 70 percent had high blood pressure, but only 21 percent had their blood pressure controlled to optimal levels.
The researchers found that people with high blood pressure were more likely to have difficulty lifting objects, walking up or down stairs, or bathing themselves compared with people who had normal blood pressure.
In addition, people with high blood pressure who didn't have disability in their 80s did have a 15 percent to 36 percent increased risk of developing one of the three types of disabilities by the time they were checked in their early 90s, compared with those with normal blood pressure.
According to Hajjar, people who had their blood pressure controlled by medications fared as well as those who had normal blood pressure. "Controlling blood pressure may lower the risk of disability," he said.
In the second study, in the same issue of Hypertension, Shari R. Waldstein, a professor of psychology at the University of Maryland, Baltimore County, and her colleagues reported that stiff arteries may be associated with the decline in mental function that often accompanies aging.
"People with stiffening of their arteries show a decline in memory and concentration as they grow older," Waldstein said.
The Maryland researchers collected data on 1,749 people in the Baltimore Longitudinal Study of Aging, which was started by the U.S. National Institute on Aging in 1958.
During the study, participants were screened for increased pulse pressure, which is the difference between the maximum and minimum blood pressures produced during one heartbeat. In addition, their brain function was tested. This was done through tests of verbal and non-verbal memory, working memory, and attention.
In addition, Waldstein's team looked at additional data on 582 people who had their pulse wave velocity measured. Measuring pulse wave velocity is a new method for analyzing pulse pressure. Rising pulse pressure is an indicator of arterial stiffness.
The researchers found that increases in pulse pressure and pulse wave velocity affected memory. However, arterial stiffness wasn't linked to attention, hand-eye coordination, the ability to name objects, and speech fluency.
"Arterial stiffening negatively impacts cognitive performance before people have a stroke or develop dementia," Waldstein noted.
The findings suggest that arterial stiffness may be a potential target for drugs to help preserve mental function, Waldstein said. "Early treatment of cardiovascular risk factors that lead to arterial stiffening may help to preserve brain functioning as people age," she suggested.
One expert isn't sure whether high blood pressure is a cause of disability and dementia, or whether it's a marker associated with these conditions.
"Whether reducing blood pressure reduces disability and dementia isn't really known," said Dr. Harlan M. Krumholz, a professor of medicine at Yale University School of Medicine.
"It's part of a complex syndrome," he said. "Having high blood pressure is associated with having small sub-clinical strokes and heart disease, and there can be other complications from medications that don't interact well with each other."
Krumholz thinks that for any given patient, the reasons for dementia and disability are complex. "But, even as we are trying to sort out what these studies mean, the clear and unequivocal recommendation for people is to get high blood pressure under control," he said.
More information
For more on high blood pressure, visit the American Heart Association.
Friday, November 16, 2007
Transplant patient with HIV not informed donor was high-risk
CHICAGO - A woman in her 30s who is one of the four organ transplant patients infected with HIV and hepatitis was not told that the infected donor was high risk, and had previously rejected another donor "because of his lifestyle," her attorney said.
Attorney Thomas Demetrio filed a petition Thursday in Cook County Circuit Court on behalf of the woman, asking officials to keep a hospital and an organ procurement center from destroying or altering any records involving the donation.
"She's really a mess right now," Demetrio said of the Chicago-area woman. "She's still in shock."
The patient, identified in court documents as Jane Doe, received a kidney transplant at the University of Chicago Medical Center on Jan. 9, Demetrio said.
Gift of Hope Organ & Tissue Donor Network in Elmhurst and the University of Chicago both knew the kidney donor was high-risk and did not inform the patient, Demetrio said.
University of Chicago spokesman John Easton responded in an e-mail: "We believe we follow guidelines, and of course with the patient's consent we will provide necessary records and documents, as is consistent with our open process."
Gift of Hope did not immediately respond to requests for comment.
The woman had been told the donor was a healthy young man, her attorney said. But on Tuesday, hospital officials disclosed to the woman that he was actually high-risk, a 38-year-old gay man, Demetrio said. CDC guidelines say that gay men who are sexually active should not be used as organ donors unless the patient is in imminent danger of death.
The woman was told she had HIV and hepatitis on Nov. 1, he said.
"The (organ) procurement group knew, the hospital knew, but the most important person did not know," he said. "The people that dedicate their lives to these transplant surgeries, they're just great people, but they need to bring the patient into the mix and let them make an informed decision."
U.S. Centers for Disease Control and Prevention guidelines were violated twice, the attorney said. One violation was not informing the woman about the donor's status and then not testing her afterward for HIV until just recently, after HIV and hepatitis were found during tests on another patient who was being evaluated for a second transplant.
The woman had been "doing great" on dialysis and had been on the donor waiting list for over six years, Demetrio said. In fact, she had rejected a potential donor two years ago "because of his lifestyle," the attorney said.
The woman developed renal failure seven years ago but he did not know what caused it.
"The fact is the transplant took very well. She'd been bumping along" doing fine, "then she gets this phone call on Nov. 1."
She's been started on an HIV drug regimen "and unfortunately one of the side effects is it's not good for the kidneys," Demetrio said. She's not hospitalized.
Four patients got organs in January at three Chicago hospitals from a donor who died after a traumatic injury. The donor had engaged in high-risk behaviors, according to a screening questionnaire, but standard testing showed the donor did not have AIDS or hepatitis C.
Gift of Hope tested the organs and approved them for donation, telling the three hospitals that they came from a high-risk donor.
Several months later, when one of the patients was being evaluated, blood tests showed the patient had HIV and hepatitis C. The other three patients were notified and tested, showing they had both viruses.
The CDC says it's the first time ever that both viruses were transmitted simultaneously through an organ transplant. It's also the first known time since 1986 that HIV was transmitted through organ donation.
Attorney Thomas Demetrio filed a petition Thursday in Cook County Circuit Court on behalf of the woman, asking officials to keep a hospital and an organ procurement center from destroying or altering any records involving the donation.
"She's really a mess right now," Demetrio said of the Chicago-area woman. "She's still in shock."
The patient, identified in court documents as Jane Doe, received a kidney transplant at the University of Chicago Medical Center on Jan. 9, Demetrio said.
Gift of Hope Organ & Tissue Donor Network in Elmhurst and the University of Chicago both knew the kidney donor was high-risk and did not inform the patient, Demetrio said.
University of Chicago spokesman John Easton responded in an e-mail: "We believe we follow guidelines, and of course with the patient's consent we will provide necessary records and documents, as is consistent with our open process."
Gift of Hope did not immediately respond to requests for comment.
The woman had been told the donor was a healthy young man, her attorney said. But on Tuesday, hospital officials disclosed to the woman that he was actually high-risk, a 38-year-old gay man, Demetrio said. CDC guidelines say that gay men who are sexually active should not be used as organ donors unless the patient is in imminent danger of death.
The woman was told she had HIV and hepatitis on Nov. 1, he said.
"The (organ) procurement group knew, the hospital knew, but the most important person did not know," he said. "The people that dedicate their lives to these transplant surgeries, they're just great people, but they need to bring the patient into the mix and let them make an informed decision."
U.S. Centers for Disease Control and Prevention guidelines were violated twice, the attorney said. One violation was not informing the woman about the donor's status and then not testing her afterward for HIV until just recently, after HIV and hepatitis were found during tests on another patient who was being evaluated for a second transplant.
The woman had been "doing great" on dialysis and had been on the donor waiting list for over six years, Demetrio said. In fact, she had rejected a potential donor two years ago "because of his lifestyle," the attorney said.
The woman developed renal failure seven years ago but he did not know what caused it.
"The fact is the transplant took very well. She'd been bumping along" doing fine, "then she gets this phone call on Nov. 1."
She's been started on an HIV drug regimen "and unfortunately one of the side effects is it's not good for the kidneys," Demetrio said. She's not hospitalized.
Four patients got organs in January at three Chicago hospitals from a donor who died after a traumatic injury. The donor had engaged in high-risk behaviors, according to a screening questionnaire, but standard testing showed the donor did not have AIDS or hepatitis C.
Gift of Hope tested the organs and approved them for donation, telling the three hospitals that they came from a high-risk donor.
Several months later, when one of the patients was being evaluated, blood tests showed the patient had HIV and hepatitis C. The other three patients were notified and tested, showing they had both viruses.
The CDC says it's the first time ever that both viruses were transmitted simultaneously through an organ transplant. It's also the first known time since 1986 that HIV was transmitted through organ donation.
Wednesday, November 14, 2007
Diabetes drug gets heart risk warning
WASHINGTON - The widely used diabetes drug Avandia got a new warning label Wednesday telling patients that it may, or may not, increase the risk of heart attacks.
Why the confusion? The Food and Drug Administration said studies of the risk are too contradictory to tell if Avandia really is riskier than other medications for Type 2 diabetes.
Still, the FDA put the controversy in a black box on the drug's label — the most severe warning the agency can require — at the behest of its scientific advisers, while it awaits further research to settle the issue.
Further complicating the new warning label: Patients may need a medical dictionary to interpret it. The warning says that Avandia may be associated with "myocardial ischemic events such as angina or myocardial infarction." In layman's terms, that's chest pain or a heart attack.
Type 2 diabetics who also have heart disease or are at high risk for it should talk with their doctor about Avandia's potential risk as they decide among treatment options, the FDA advised.
Avandia manufacturer GlaxoSmithKline PLC has agreed to begin a major new study comparing that drug to another active blood sugar-lowering medication to better understand if there is a risk.
About 1 million Americans with Type 2 diabetes use Avandia. It helps control blood sugar by increasing the body's sensitivity to insulin.
Why the confusion? The Food and Drug Administration said studies of the risk are too contradictory to tell if Avandia really is riskier than other medications for Type 2 diabetes.
Still, the FDA put the controversy in a black box on the drug's label — the most severe warning the agency can require — at the behest of its scientific advisers, while it awaits further research to settle the issue.
Further complicating the new warning label: Patients may need a medical dictionary to interpret it. The warning says that Avandia may be associated with "myocardial ischemic events such as angina or myocardial infarction." In layman's terms, that's chest pain or a heart attack.
Type 2 diabetics who also have heart disease or are at high risk for it should talk with their doctor about Avandia's potential risk as they decide among treatment options, the FDA advised.
Avandia manufacturer GlaxoSmithKline PLC has agreed to begin a major new study comparing that drug to another active blood sugar-lowering medication to better understand if there is a risk.
About 1 million Americans with Type 2 diabetes use Avandia. It helps control blood sugar by increasing the body's sensitivity to insulin.
Tuesday, November 6, 2007
Energy drinks jolt blood pressure, study finds
ORLANDO, Florida (Reuters) - The increasingly popular high-caffeine beverages called energy drinks may do more than give people a jolt of energy -- they may also boost heart rates and blood pressure levels, researchers said on Tuesday.
The results of a small study prompted the researchers to advise people who have high blood pressure or heart disease to avoid energy drinks because they could impact their blood pressure or change the effectiveness of their medications.
The drinks generally have high levels of caffeine and taurine, an amino acid found in protein-rich foods like meat and fish that can affect heart function and blood pressure, the researchers said.
"We saw increases in both blood pressure and heart rate in healthy volunteers who were just sitting in a chair watching movies. They weren't exercising. They were in a resting state," James Kalus of Henry Ford Hospital in Detroit, who led the study, said in an interview.
The increases did not rise to dangerous levels in the group of 15 healthy volunteers, whose average age was 26, the researchers said.
But the increases potentially could be significant in people with cardiovascular disease or those taking drugs to lower heart rate or blood pressure, they told a meeting of the American Heart Association in Orlando, Florida.
"While the amount of caffeine in energy drinks or coffee may cause a slight and temporary increase in blood pressure, it would have no greater effect than walking up a flight of steps," the American Beverage Association industry trade group said in a statement responding to the findings.
"So singling out energy drinks in a unique manner, particularly when compared to a more commonly consumed caffeinated beverage like coffee, does not provide a full and proper context for consumers."
BOOSTING ENERGY
The products have names like Full Throttle, Amp and Rush. Red Bull, made by Austrian company Red Bull GmbH, is a market leader. Beverage companies market various energy drinks as soft drinks that can boost a person's energy.
Kalus declined to say which brand of energy drink was used in the study. He said the drinks generally contain similar ingredients, adding, "By giving the brand, it would dilute the message that all of these drinks need to be looked at."
Coca-Cola Co. makes Full Throttle.
The study participants were asked not to consume other forms of caffeine for two days before starting the study and then throughout a study in which they consumed two cans of energy drinks daily over seven days. Each can contained 80 milligrams of caffeine and 1,000 milligrams of taurine.
The volunteers' heart rates rose by about 8 percent on the first day and 11 percent on the seventh day.
Maximum systolic blood pressure -- the top number in blood pressure readings that represents pressure while the heart contracts -- rose by 8 percent on the first day and 10 percent on the seventh day, the study showed.
Diastolic blood pressure -- the bottom number that gives the pressure when the heart relaxes between beats -- rose by 7 percent on the first day and 8 percent on the seventh day.
The study did not identify ingredients responsible for the changes, but Kalus said it probably was caffeine and taurine.
Kalus said the study did not address possible health effects from the way some people consume these drinks, such as mixing them with alcohol.
The results of a small study prompted the researchers to advise people who have high blood pressure or heart disease to avoid energy drinks because they could impact their blood pressure or change the effectiveness of their medications.
The drinks generally have high levels of caffeine and taurine, an amino acid found in protein-rich foods like meat and fish that can affect heart function and blood pressure, the researchers said.
"We saw increases in both blood pressure and heart rate in healthy volunteers who were just sitting in a chair watching movies. They weren't exercising. They were in a resting state," James Kalus of Henry Ford Hospital in Detroit, who led the study, said in an interview.
The increases did not rise to dangerous levels in the group of 15 healthy volunteers, whose average age was 26, the researchers said.
But the increases potentially could be significant in people with cardiovascular disease or those taking drugs to lower heart rate or blood pressure, they told a meeting of the American Heart Association in Orlando, Florida.
"While the amount of caffeine in energy drinks or coffee may cause a slight and temporary increase in blood pressure, it would have no greater effect than walking up a flight of steps," the American Beverage Association industry trade group said in a statement responding to the findings.
"So singling out energy drinks in a unique manner, particularly when compared to a more commonly consumed caffeinated beverage like coffee, does not provide a full and proper context for consumers."
BOOSTING ENERGY
The products have names like Full Throttle, Amp and Rush. Red Bull, made by Austrian company Red Bull GmbH, is a market leader. Beverage companies market various energy drinks as soft drinks that can boost a person's energy.
Kalus declined to say which brand of energy drink was used in the study. He said the drinks generally contain similar ingredients, adding, "By giving the brand, it would dilute the message that all of these drinks need to be looked at."
Coca-Cola Co. makes Full Throttle.
The study participants were asked not to consume other forms of caffeine for two days before starting the study and then throughout a study in which they consumed two cans of energy drinks daily over seven days. Each can contained 80 milligrams of caffeine and 1,000 milligrams of taurine.
The volunteers' heart rates rose by about 8 percent on the first day and 11 percent on the seventh day.
Maximum systolic blood pressure -- the top number in blood pressure readings that represents pressure while the heart contracts -- rose by 8 percent on the first day and 10 percent on the seventh day, the study showed.
Diastolic blood pressure -- the bottom number that gives the pressure when the heart relaxes between beats -- rose by 7 percent on the first day and 8 percent on the seventh day.
The study did not identify ingredients responsible for the changes, but Kalus said it probably was caffeine and taurine.
Kalus said the study did not address possible health effects from the way some people consume these drinks, such as mixing them with alcohol.
Tuesday, October 30, 2007
Vitamin D may not reduce cancer deaths
WASHINGTON - A large new study found no sign that vitamin D lowers the overall risk of dying from cancer, injecting a note of caution to the latest vitamin craze. The exception: People with more vitamin D in their blood did have a significantly lower risk of death from colorectal cancer, supporting earlier findings.
Getting enough of the so-called sunshine vitamin — the skin makes it from ultraviolet rays — is vital for strong bones. But vitamin D has made headlines in recent years because of research saying it may be a powerful cancer fighter, sparking a push for people to get more than currently recommended amounts, either through diet or sun exposure.
The first-of-a-kind government study released Tuesday shows the issue is far from settled.
National Cancer Institute researchers analyzed vitamin D levels measured in almost 17,000 people as part of a national study that tracked their health. About a decade after enrolling, 536 of those people had died of cancer. Whether people had low or high vitamin D levels played no role in their risk of dying from cancer in general, they reported Tuesday in the Journal of the National Cancer Institute.
Then the researchers examined different types of cancer. There were just 66 deaths from colorectal cancer. Still, people with high levels of vitamin D appeared 72 percent less likely to die of colorectal cancer than people with the lowest vitamin D levels.
"While vitamin D may well have multiple benefits beyond bone, health professionals and the public should not, in a rush to judgment, assume that vitamin D is a magic bullet and consume high amounts," Johanna Dwyer, a dietary supplement specialist at the National Institutes of Health, cautioned in an accompanying editorial.
Indeed, there are numerous risk factors for colorectal cancer, including obesity and low physical activity, and it's unclear if low vitamin D levels play an independent role or are just a marker for those other risks, she said.
Scientists have been interested in vitamin D's effects for decades, since noticing that cancer rates between similar groups of people were lower in sunny southern latitudes than in northern ones. A handful of studies since then have found people given vitamin D supplements have less risk of developing certain cancers, but much of the evidence is circumstantial.
Experts are cautious because other vitamins and nutrient supplements once widely thought to prevent cancer didn't pan out when put to rigorous testing.
The NCI's study is the first to compare blood levels of vitamin D to cancer mortality, and "it's the best research we have on this topic," said Dr. Len Lichtenfeld of the American Cancer Society.
But a big weakness: It measured vitamin D at just one point in participants' lives, when levels can vary widely with dietary changes and especially the seasons.
Overall, most research "seems to be pointing in the direction that there is a role of vitamin D," Lichtenfeld said. Tuesday's study "puts a note of caution in there that says with all the explosion of information and advocacy on behalf of vitamin D, we need to be cautious. ... We really need some further studies that are well done to answer the question."
Getting enough of the so-called sunshine vitamin — the skin makes it from ultraviolet rays — is vital for strong bones. But vitamin D has made headlines in recent years because of research saying it may be a powerful cancer fighter, sparking a push for people to get more than currently recommended amounts, either through diet or sun exposure.
The first-of-a-kind government study released Tuesday shows the issue is far from settled.
National Cancer Institute researchers analyzed vitamin D levels measured in almost 17,000 people as part of a national study that tracked their health. About a decade after enrolling, 536 of those people had died of cancer. Whether people had low or high vitamin D levels played no role in their risk of dying from cancer in general, they reported Tuesday in the Journal of the National Cancer Institute.
Then the researchers examined different types of cancer. There were just 66 deaths from colorectal cancer. Still, people with high levels of vitamin D appeared 72 percent less likely to die of colorectal cancer than people with the lowest vitamin D levels.
"While vitamin D may well have multiple benefits beyond bone, health professionals and the public should not, in a rush to judgment, assume that vitamin D is a magic bullet and consume high amounts," Johanna Dwyer, a dietary supplement specialist at the National Institutes of Health, cautioned in an accompanying editorial.
Indeed, there are numerous risk factors for colorectal cancer, including obesity and low physical activity, and it's unclear if low vitamin D levels play an independent role or are just a marker for those other risks, she said.
Scientists have been interested in vitamin D's effects for decades, since noticing that cancer rates between similar groups of people were lower in sunny southern latitudes than in northern ones. A handful of studies since then have found people given vitamin D supplements have less risk of developing certain cancers, but much of the evidence is circumstantial.
Experts are cautious because other vitamins and nutrient supplements once widely thought to prevent cancer didn't pan out when put to rigorous testing.
The NCI's study is the first to compare blood levels of vitamin D to cancer mortality, and "it's the best research we have on this topic," said Dr. Len Lichtenfeld of the American Cancer Society.
But a big weakness: It measured vitamin D at just one point in participants' lives, when levels can vary widely with dietary changes and especially the seasons.
Overall, most research "seems to be pointing in the direction that there is a role of vitamin D," Lichtenfeld said. Tuesday's study "puts a note of caution in there that says with all the explosion of information and advocacy on behalf of vitamin D, we need to be cautious. ... We really need some further studies that are well done to answer the question."
Wednesday, October 24, 2007
FDA wants big warning on Glaxo diabetes drug: report
NEW YORK (Reuters) - Food and Drug Administration officials are pushing for a "black box" warning on GlaxoSmithKline Plc's hard-hit diabetes drug Avandia, the Wall Street Journal reported, citing sources.
The warning would be a further blow to the top-selling diabetes drug, which came under pressure last May when a U.S. analysis linked Avandia to a 43 percent higher risk of heart attack in patients.
Avandia already has strong warning advising of the risk of a different side effect, heart failure, the paper said. But a similar warning for the risks of heart attack would be more serious, it said.
The European Medicines Agency last week recommended a tighter label for Avandia, but said the benefits outweighed the risks of the drug and a similar one called Actos, made by Takeda Pharmaceutical Co..
Last July, an advisory panel to the FDA recommended that Avandia should stay on the market, but said it should have increased warnings.
Avandia posted global sales of $3.24 billion last year making it the company's second-biggest seller. But sales have plummeted since the May study linking it to increased risk.
The warning would be a further blow to the top-selling diabetes drug, which came under pressure last May when a U.S. analysis linked Avandia to a 43 percent higher risk of heart attack in patients.
Avandia already has strong warning advising of the risk of a different side effect, heart failure, the paper said. But a similar warning for the risks of heart attack would be more serious, it said.
The European Medicines Agency last week recommended a tighter label for Avandia, but said the benefits outweighed the risks of the drug and a similar one called Actos, made by Takeda Pharmaceutical Co..
Last July, an advisory panel to the FDA recommended that Avandia should stay on the market, but said it should have increased warnings.
Avandia posted global sales of $3.24 billion last year making it the company's second-biggest seller. But sales have plummeted since the May study linking it to increased risk.
Tuesday, October 23, 2007
Low testosterone in men linked to earlier death
NEW YORK (Reuters Health) - Older men with low levels of the hormone testosterone may die sooner than other men their age with normal testosterone levels, a study suggests.
Researchers found that among 794 generally healthy older men, those with the lowest testosterone levels were 40 percent more likely to die within the 1985-2004 study period.
The findings do not mean, however, that older men should start taking testosterone supplements to achieve a longer life, the study authors are quick to point out.
The study shows only an association between low testosterone and earlier death -- not a cause-and-effect relationship, lead author Dr. Gail A. Laughlin told Reuters Health. What's more, there was no evidence that having above-average testosterone levels gave men any longevity advantage.
"We cannot recommend that any man take testosterone based on these results," Laughlin stressed.
She and her colleagues at the University of California, San Diego, report their findings in the Journal of Clinical Endocrinology & Metabolism.
In theory, low testosterone could affect older men's longevity through metabolic effects. Some past studies have found that low testosterone can precede the development of abdominal obesity and the metabolic syndrome -- a collection of risk factors for diabetes and heart disease that includes obesity, high blood pressure and unhealthy cholesterol levels.
In their study, Laughlin and her colleagues found that low testosterone was associated with abdominal obesity and aspects of the metabolic syndrome, but when these factors were excluded, low testosterone remained independently linked to earlier death.
The study included 794 men between 50 and 91 year old (average age 73.6 years) who were followed for an average of 11.6 years. Overall, the one quarter with the lowest testosterone levels at study entry were 40 percent more likely to die over the course of the study than men with higher levels of the hormone.
There is some disagreement among experts on how to define overt testosterone deficiency, with some saying it should be diagnosed when levels fall below 300 nanograms per deciliter (ng/dL) and others advocating lower cutoffs.
There was no evidence in this study that raising older men's testosterone above 300 ng/dL might boost survival, according to Laughlin's team.
This finding offers "no support for widespread testosterone therapy for aging men," the researchers write.
Indeed, it's unclear whether raising testosterone in men with a clear deficiency can safely prolong life. Only clinical trials that test hormonal supplementation against a placebo can answer this question, Laughlin said.
SOURCE: Journal of Clinical Endocrinology & Metabolism, October 2007.
Researchers found that among 794 generally healthy older men, those with the lowest testosterone levels were 40 percent more likely to die within the 1985-2004 study period.
The findings do not mean, however, that older men should start taking testosterone supplements to achieve a longer life, the study authors are quick to point out.
The study shows only an association between low testosterone and earlier death -- not a cause-and-effect relationship, lead author Dr. Gail A. Laughlin told Reuters Health. What's more, there was no evidence that having above-average testosterone levels gave men any longevity advantage.
"We cannot recommend that any man take testosterone based on these results," Laughlin stressed.
She and her colleagues at the University of California, San Diego, report their findings in the Journal of Clinical Endocrinology & Metabolism.
In theory, low testosterone could affect older men's longevity through metabolic effects. Some past studies have found that low testosterone can precede the development of abdominal obesity and the metabolic syndrome -- a collection of risk factors for diabetes and heart disease that includes obesity, high blood pressure and unhealthy cholesterol levels.
In their study, Laughlin and her colleagues found that low testosterone was associated with abdominal obesity and aspects of the metabolic syndrome, but when these factors were excluded, low testosterone remained independently linked to earlier death.
The study included 794 men between 50 and 91 year old (average age 73.6 years) who were followed for an average of 11.6 years. Overall, the one quarter with the lowest testosterone levels at study entry were 40 percent more likely to die over the course of the study than men with higher levels of the hormone.
There is some disagreement among experts on how to define overt testosterone deficiency, with some saying it should be diagnosed when levels fall below 300 nanograms per deciliter (ng/dL) and others advocating lower cutoffs.
There was no evidence in this study that raising older men's testosterone above 300 ng/dL might boost survival, according to Laughlin's team.
This finding offers "no support for widespread testosterone therapy for aging men," the researchers write.
Indeed, it's unclear whether raising testosterone in men with a clear deficiency can safely prolong life. Only clinical trials that test hormonal supplementation against a placebo can answer this question, Laughlin said.
SOURCE: Journal of Clinical Endocrinology & Metabolism, October 2007.
Thursday, October 18, 2007
DNA test betters Pap in detecting cervical cancer: study
WASHINGTON (AFP) - The human papillomavirus (HPV) screening test for cervical cancer is far more accurate than the traditional Pap test, according to a Canadian study published Wednesday in the United States.
The first round of the Canadian Cervical Cancer Screening Trial, led by Eduardo Franco, Director of the Division of Cancer Epidemiology at McGill's Faculty of Medicine, put the HPV test's accuracy in detecting pre-cancerous lesions at 94.6 percent, compared to 55.4 for the Pap test.
The study is published in the October 18 edition of The New England Journal of Medicine.
The trial, funded by a grant from the Canadian Institutes of Health Research, followed 10,154 women aged 30-69 in Montreal, Quebec and St. John's, Newfoundland from 2002-2005.
"We already knew before conducting this study that the sensitivity of Pap left a lot to be desired," said Franco.
The Papanicolaou (or Pap) test was invented by Georgios Papanicolaou in the 1940s and requires technicians to look under a microscope for abnormalities in cell samples collected from the patient's cervix. It has been the standard screening procedure for cervical cancer for almost 50 years.
The HPV test also requires the collection of cervical samples, but the analysis process is automated and detects the DNA of high-risk HPV strains known to cause cervical cancer.
"Women currently vaccinated against cervical cancer will still need to be screened, because the vaccines that are available now only prevent about 70% of all cervical cancers, and they're primarily for young women," said Franco.
"The HPV test may be ideal for vaccinated women once they reach screening age, because it gives us an opportunity to monitor the protection that the vaccine is supposed to give them," he added.
Cervical cancer kills more than one quarter of a million women worldwide each year.
The first round of the Canadian Cervical Cancer Screening Trial, led by Eduardo Franco, Director of the Division of Cancer Epidemiology at McGill's Faculty of Medicine, put the HPV test's accuracy in detecting pre-cancerous lesions at 94.6 percent, compared to 55.4 for the Pap test.
The study is published in the October 18 edition of The New England Journal of Medicine.
The trial, funded by a grant from the Canadian Institutes of Health Research, followed 10,154 women aged 30-69 in Montreal, Quebec and St. John's, Newfoundland from 2002-2005.
"We already knew before conducting this study that the sensitivity of Pap left a lot to be desired," said Franco.
The Papanicolaou (or Pap) test was invented by Georgios Papanicolaou in the 1940s and requires technicians to look under a microscope for abnormalities in cell samples collected from the patient's cervix. It has been the standard screening procedure for cervical cancer for almost 50 years.
The HPV test also requires the collection of cervical samples, but the analysis process is automated and detects the DNA of high-risk HPV strains known to cause cervical cancer.
"Women currently vaccinated against cervical cancer will still need to be screened, because the vaccines that are available now only prevent about 70% of all cervical cancers, and they're primarily for young women," said Franco.
"The HPV test may be ideal for vaccinated women once they reach screening age, because it gives us an opportunity to monitor the protection that the vaccine is supposed to give them," he added.
Cervical cancer kills more than one quarter of a million women worldwide each year.
Monday, October 15, 2007
Blood Test Might Spot Alzheimer's Early
MONDAY, Oct. 15 (HealthDay News) -- An international team of scientists has developed a blood test that could reveal which patients with mild cognitive impairment will go on to develop Alzheimer's disease.
If replicated and validated -- and assuming the development of effective treatments against Alzheimer's in the future -- such a test could open the door to medicating at-risk patients earlier and slowing or limiting neurological damage, explained Dr. Allan Levey, chair of neurology at Emory University, Atlanta.
"If it can be replicated, then we will find out how important [the study] really is," said Levey, who was not involved in the research.
The findings were published in the Oct. 14 online issue of Nature Medicine.
According to the Alzheimer's Association, Alzheimer's is a progressive, fatal brain disease that affects almost one in eight individuals over the age of 65.
Yet there currently exists no early diagnostic screen for Alzheimer's disease. Diagnosis today is based not on blood chemistry, but on a combination of psychological and imaging tests. Many of those who present with mild cognitive impairment (MCI), will ultimately develop Alzheimer's disease, but others never do.
"Currently, it's very difficult to know who will progress to Alzheimer's and who will progress to other diseases, or which won't progress at all," said Levey. "Ideally, one wants to be able to know at the stage of mild cognitive impairment, or even earlier, if someone is destined to get Alzheimer's disease."
In the new study, a group led by Tony Wyss-Coray, an associate professor of neurology at the Stanford University School of Medicine, analyzed 259 blood samples obtained from individuals with and without Alzheimer's disease. They focused on 120 proteins involved in cellular signaling and communication.
The team identified 18 proteins in particular whose abundance could distinguish those with Alzheimer's disease from those without it, for an overall accuracy of about 90 percent -- that is, it correctly classified individuals who had been clinically diagnosed with Alzheimer's disease 95 percent of the time and classified as negative those without the disease 83 percent of the time.
This panel of proteins was equally effective when applied to another, completely separate set of patient samples, the researchers noted.
But "the home run of the paper," said Levey, was the finding that, when applied to blood samples collected from patients who were diagnosed with mild cognitive impairment -- a condition that often, but not always, precedes Alzheimer's -- the panel could predict who would ultimately develop Alzheimer's with 81 percent accuracy, 30 months before clinical diagnosis, on average.
Calling the study "very interesting," Levey nevertheless noted two caveats. The first was its relatively small sample size. The other was its use of proteins that have no obvious relationship to Alzheimer's.
"The blood has thousands of proteins, and they started with 120 proteins that they could measure," he said. "I don't think if one were to try to make a biomarker for Alzheimer's that you would necessarily choose these 120 proteins."
Wyss-Coray agreed that the team's decision to focus specifically on signaling proteins might seem like "a bit of a crazy idea." But given the disease's target organ, it makes sense, he said.
"Cells receive input through hundreds of different receptors, and it responds with some output, usually a signaling protein," Wyss-Coray explained. "So, by thinking in terms of this output, we decided to look specifically at signaling proteins and see if there are changes between patients who are healthy versus those with Alzheimer's disease or other dementias."
Others have also made progress in the development of early diagnostic tests for Alzheimer's. At the Alzheimer's Association's International Conference on Prevention of Dementia, in June, for instance, one group described a candidate test based on gene expression levels in blood.
"It's exciting to see this sort of work progress," said Dr. Sam Gandy, chair of the Alzheimer's Association's Medical and Scientific Advisory Council. "The important next step is to be sure that the report can be independently replicated."
Should that happen, Gandy said, patients would not be the only beneficiaries; the drug-development industry could use this assay to help select patient populations for trials of drugs to prevent -- as opposed to treat -- Alzheimer's disease.
"Because we don't have a marker that predicts [Alzheimer's] right now, such a trial is almost prohibitively expensive," he said -- "easily 10 times" the estimated $50 million required for standard clinical trials.
More information
For more on Alzheimer's Disease, visit the Alzheimer's Association
If replicated and validated -- and assuming the development of effective treatments against Alzheimer's in the future -- such a test could open the door to medicating at-risk patients earlier and slowing or limiting neurological damage, explained Dr. Allan Levey, chair of neurology at Emory University, Atlanta.
"If it can be replicated, then we will find out how important [the study] really is," said Levey, who was not involved in the research.
The findings were published in the Oct. 14 online issue of Nature Medicine.
According to the Alzheimer's Association, Alzheimer's is a progressive, fatal brain disease that affects almost one in eight individuals over the age of 65.
Yet there currently exists no early diagnostic screen for Alzheimer's disease. Diagnosis today is based not on blood chemistry, but on a combination of psychological and imaging tests. Many of those who present with mild cognitive impairment (MCI), will ultimately develop Alzheimer's disease, but others never do.
"Currently, it's very difficult to know who will progress to Alzheimer's and who will progress to other diseases, or which won't progress at all," said Levey. "Ideally, one wants to be able to know at the stage of mild cognitive impairment, or even earlier, if someone is destined to get Alzheimer's disease."
In the new study, a group led by Tony Wyss-Coray, an associate professor of neurology at the Stanford University School of Medicine, analyzed 259 blood samples obtained from individuals with and without Alzheimer's disease. They focused on 120 proteins involved in cellular signaling and communication.
The team identified 18 proteins in particular whose abundance could distinguish those with Alzheimer's disease from those without it, for an overall accuracy of about 90 percent -- that is, it correctly classified individuals who had been clinically diagnosed with Alzheimer's disease 95 percent of the time and classified as negative those without the disease 83 percent of the time.
This panel of proteins was equally effective when applied to another, completely separate set of patient samples, the researchers noted.
But "the home run of the paper," said Levey, was the finding that, when applied to blood samples collected from patients who were diagnosed with mild cognitive impairment -- a condition that often, but not always, precedes Alzheimer's -- the panel could predict who would ultimately develop Alzheimer's with 81 percent accuracy, 30 months before clinical diagnosis, on average.
Calling the study "very interesting," Levey nevertheless noted two caveats. The first was its relatively small sample size. The other was its use of proteins that have no obvious relationship to Alzheimer's.
"The blood has thousands of proteins, and they started with 120 proteins that they could measure," he said. "I don't think if one were to try to make a biomarker for Alzheimer's that you would necessarily choose these 120 proteins."
Wyss-Coray agreed that the team's decision to focus specifically on signaling proteins might seem like "a bit of a crazy idea." But given the disease's target organ, it makes sense, he said.
"Cells receive input through hundreds of different receptors, and it responds with some output, usually a signaling protein," Wyss-Coray explained. "So, by thinking in terms of this output, we decided to look specifically at signaling proteins and see if there are changes between patients who are healthy versus those with Alzheimer's disease or other dementias."
Others have also made progress in the development of early diagnostic tests for Alzheimer's. At the Alzheimer's Association's International Conference on Prevention of Dementia, in June, for instance, one group described a candidate test based on gene expression levels in blood.
"It's exciting to see this sort of work progress," said Dr. Sam Gandy, chair of the Alzheimer's Association's Medical and Scientific Advisory Council. "The important next step is to be sure that the report can be independently replicated."
Should that happen, Gandy said, patients would not be the only beneficiaries; the drug-development industry could use this assay to help select patient populations for trials of drugs to prevent -- as opposed to treat -- Alzheimer's disease.
"Because we don't have a marker that predicts [Alzheimer's] right now, such a trial is almost prohibitively expensive," he said -- "easily 10 times" the estimated $50 million required for standard clinical trials.
More information
For more on Alzheimer's Disease, visit the Alzheimer's Association
Sunday, October 14, 2007
What Open Enrollment means to you
For most insurance carriers, the months of October and November are “Open Enrollment”.
Open Enrollment is a time for you to make any changes to your current insurance policy. If you are happy with the coverage you currently have – GREAT! There is probably nothing for you to consider. However, if you are not happy, it is time to make a careful assessment of current coverage and the new coverage that is being offered.
Some things to take into consideration:
· Deductibles versus Premiums. Calculate how much you are spending each year on premiums. This can be calculated by multiplying your weekly deduction by 52, your bi-weekly deduction by 26, your bi-monthly deduction by 24 and your monthly deduction by 12. If your deductible far outweighs your premium, consider changing plans.
· What is covered under your plan? If your teenage son is going to need braces soon, make sure they are covered if your employer offers different options for dental coverage. Also see how much is covered as a yearly maximum.
· Were there any treatments you received over the last 12 months that weren’t covered or had limitations? For example, a routine woman exam is generally allowed once per year. Some plans have a capitation on what they will pay. If the capitation is low, consider choosing a plan with no dollar maximum. It could save you money in the long run. .
· Do you have coverage for dental or vision? If you do not currently have them, and they are available for 2008, you may want to consider paying the premiums. These are important coverages for you and your family.
· LIFE INSURANCE and Accidental Death and Dismemberment coverage. This coverage is most often overlooked. Are your current life insurance amounts acceptable for the size of your family, your standard of living, etc. While this is a topic no one wants to think about, it is something you must include in your analysis.
· Tiered Pharmacy Benefits. If your plan offers different copay amounts based on your pharmaceutical needs, and you or your family purchases more than one or two medications on a regular basis; this is definitely an area you will want to focus on.
Don’t let another year go by if you aren’t happy with the insurance coverage you currently have. Spend a couple of hours analyzing your needs and researching the coverage that is being offered.
Open Enrollment is a time for you to make any changes to your current insurance policy. If you are happy with the coverage you currently have – GREAT! There is probably nothing for you to consider. However, if you are not happy, it is time to make a careful assessment of current coverage and the new coverage that is being offered.
Some things to take into consideration:
· Deductibles versus Premiums. Calculate how much you are spending each year on premiums. This can be calculated by multiplying your weekly deduction by 52, your bi-weekly deduction by 26, your bi-monthly deduction by 24 and your monthly deduction by 12. If your deductible far outweighs your premium, consider changing plans.
· What is covered under your plan? If your teenage son is going to need braces soon, make sure they are covered if your employer offers different options for dental coverage. Also see how much is covered as a yearly maximum.
· Were there any treatments you received over the last 12 months that weren’t covered or had limitations? For example, a routine woman exam is generally allowed once per year. Some plans have a capitation on what they will pay. If the capitation is low, consider choosing a plan with no dollar maximum. It could save you money in the long run. .
· Do you have coverage for dental or vision? If you do not currently have them, and they are available for 2008, you may want to consider paying the premiums. These are important coverages for you and your family.
· LIFE INSURANCE and Accidental Death and Dismemberment coverage. This coverage is most often overlooked. Are your current life insurance amounts acceptable for the size of your family, your standard of living, etc. While this is a topic no one wants to think about, it is something you must include in your analysis.
· Tiered Pharmacy Benefits. If your plan offers different copay amounts based on your pharmaceutical needs, and you or your family purchases more than one or two medications on a regular basis; this is definitely an area you will want to focus on.
Don’t let another year go by if you aren’t happy with the insurance coverage you currently have. Spend a couple of hours analyzing your needs and researching the coverage that is being offered.
Friday, October 5, 2007
Mechanism Of Addiction Of SMOKING
There is little doubt that many habitual smokers find it difficult to quit the habit because they have become addicted to the nicotine present in the smoke. This paper addresses some of the pharmacological mechanisms underlying this addiction and discusses how an understanding of these mechanisms may contribute to the more effective use of nicotine replacement therapy during smoking cessation. It considers critically the evidence that the "rewarding" properties of nicotine, which serve to reinforce drug-seeking behaviour, are related to stimulation of the mesolimbic dopamine system of the brain. The critique focuses specifically on the evidence that many central nicotinic receptors, including those which mediate the effects of the drug on dopamine secretion, are readily desensitized by chronic exposure to agonist and that hypotheses which assume that nicotine inhaled from tobacco smoke invariably results in stimulation of the receptors must be treated with caution. Nicotinic receptors in the brain are, however, heterogeneous in nature with different molecular structures and pharmacologies. It is concluded that the reinforcing properties of nicotine sought by smokers may reflect both stimulation and desensitization of the different nicotinic receptor populations, and that smokers may adjust their smoking habits to achieve the balance of receptor stimulation and desensitization which they find most reinforcing. It seems likely that the efficacy of the different nicotine formulations during the treatment of smoking cessation may also reflect their ability to stimulate or desensitize brain nicotinic receptors.
Wednesday, October 3, 2007
Parkinson's and Alzheimer's dementia very different
NEW YORK (Reuters Health) - Dementia associated with Parkinson's disease is distinctively different from that seen in Alzheimer's disease, Norwegian researchers report in the Journal of Neurology, Neurosurgery and Psychiatry.
Dr. Kolbjorn Bronnick at Stavanger University Hospital, Norway, and colleagues conducted a neurological assessment of 488 patients with Parkinson's disease dementia and another 488 patients with Alzheimer's disease, using the Mini-Mental State Examination and the Alzheimer's Disease Assessment Scale-Cognitive Subscale.
The objective of the study by was to assess whether or not a diagnosis could be made based on the results of the cognitive profiles.
"Both groups showed memory impairment, Alzheimer's disease patients performing worse than Parkinson's disease dementia patients," the investigators report. "On the verbal memory tasks in the Alzheimer's Disease Assessment Scale-Cognitive Subscale, however, both groups were clearly impaired relative to a normal control group, with very large effect sizes."
"Poor performance of the Alzheimer's disease patients on the orientation test in Alzheimer's Disease Assessment Scale-Cognitive Subscale best discriminated between the groups, followed by poor performance of the Parkinson's disease dementia patients on the attentional task in Mini-Mental State Examination," Bronnick's team found.
"Diagnosis was predicted from the cognitive profile, with an overall accuracy of 74.7 percent," they report.
"In conclusion," the researchers write, "we found differential cognitive profiles in patients with Parkinson's disease dementia and Alzheimer's disease."
This strongly supports the hypothesis that Parkinson's disease dementia occurs through a mechanism that is quite different than the one associated with Alzheimer's disease, and that there exist pathological and physiological mechanisms specifically related to Parkinson's disease dementia.
SOURCE: Journal of Neurology, Neurosurgery and Psychiatry, October 2007.
Dr. Kolbjorn Bronnick at Stavanger University Hospital, Norway, and colleagues conducted a neurological assessment of 488 patients with Parkinson's disease dementia and another 488 patients with Alzheimer's disease, using the Mini-Mental State Examination and the Alzheimer's Disease Assessment Scale-Cognitive Subscale.
The objective of the study by was to assess whether or not a diagnosis could be made based on the results of the cognitive profiles.
"Both groups showed memory impairment, Alzheimer's disease patients performing worse than Parkinson's disease dementia patients," the investigators report. "On the verbal memory tasks in the Alzheimer's Disease Assessment Scale-Cognitive Subscale, however, both groups were clearly impaired relative to a normal control group, with very large effect sizes."
"Poor performance of the Alzheimer's disease patients on the orientation test in Alzheimer's Disease Assessment Scale-Cognitive Subscale best discriminated between the groups, followed by poor performance of the Parkinson's disease dementia patients on the attentional task in Mini-Mental State Examination," Bronnick's team found.
"Diagnosis was predicted from the cognitive profile, with an overall accuracy of 74.7 percent," they report.
"In conclusion," the researchers write, "we found differential cognitive profiles in patients with Parkinson's disease dementia and Alzheimer's disease."
This strongly supports the hypothesis that Parkinson's disease dementia occurs through a mechanism that is quite different than the one associated with Alzheimer's disease, and that there exist pathological and physiological mechanisms specifically related to Parkinson's disease dementia.
SOURCE: Journal of Neurology, Neurosurgery and Psychiatry, October 2007.
Tuesday, October 2, 2007
Special teams fight diabetic amputations
WASHINGTON - A stubbed toe can lead to having your foot amputated? It can if you're a longtime diabetic. And it can happen fast.
"Tuesday in the office, they're fine. Friday, they're in the emergency room with gangrene in a toe," says Dr. Peter Sheehan, diabetes chief at New York's Cabrini Medical Center.
It's a little-known statistic: Foot problems — wounds that won't heal, infections, warping bones — are the most common reason diabetics are hospitalized.
And many of the 80,000-plus amputations of toes, feet and lower legs that Americans diabetics undergo each year are preventable, say specialists who brought more than 900 health providers to a meeting last week to figure out how to do just that.
One recommendation: For hospitals to create diabetes limb-salvage teams.
It sounds simple. But it involves pairing specialists who seldom work side-by-side — like podiatrists and vascular surgeons — to shave weeks off the time it can take to get proper care for a festering foot.
"It gets them everything they need right away, without months of waiting (between doctor appointments) while the wound is going downhill," says Dr. John Steinberg, a podiatrist with Georgetown University Hospital's limb-salvage team.
Some 21 million Americans have diabetes, meaning their bodies cannot properly regulate blood sugar, or glucose. Over years, high glucose levels seriously damage blood vessels and nerves, eventually leading to kidney failure, heart disease and other complications.
Among them is a vicious trio: Foot ulcers that strike about 600,000 diabetics annually; loss of sensation in the feet called neuropathy that makes sufferers slow to notice they have a wound; and poor blood flow in the lower legs that makes the ulcers slow to heal.
Amputation may end the grueling cycle of unhealing wounds and infection on one limb. But those patients still face grim odds. About half will develop ulcers and infections in the remaining foot, and undergo more amputations. And within five years, more than 40 percent are dead.
Infection is the chief reason for amputating. But there are no firm guidelines on when a limb is beyond salvaging — and a 2001 study of Medicare-covered diabetics found large differences in amputation rates in different parts of the country.
Until recently, most research into diabetic wounds has focused on methods to clean them out and spur new skin growth.
The newer message: Check blood pressure in a diabetic's ankle before rushing to foot surgery. One in three diabetics over age 50 has a condition called peripheral arterial disease or PAD, where leg arteries become too clogged to get enough blood to the feet.
That's one reason that last week's meeting urged a team approach to saving diabetics' limbs: Whatever foot surgeons apply to heal a nasty ulcer won't work unless a vascular surgeon has first cleared clogged leg arteries.
"We are hostage to the blood flow," is how Dr. David G. Armstrong, a podiatrist at Chicago's Rosalind Franklin University of Medicine and Science, puts it.
Minimally invasive leg-clearing therapy — propping open clogged arteries with balloons and stents, or rooting out the sludge with tiny razors and lasers — is on the rise. But Dr. Richard Neville, Georgetown's vascular surgery chief, says many diabetics have such severe blockages that they need blood rerouted, using one of their own clog-free veins or artificial blood vessels.
Then can come what Armstrong calls the variety of "goops and gadgets" to apply straight to the ulcer.
What works best? Studies are under way to try to determine that, but Armstrong and Steinberg recommend old-fashioned debridement — scraping away dead tissue every few days — and a vacuum-sealing device that helps keep the wound moist. Certain dressings can provide a scaffolding for healthy cell growth from the inside-out.
Between those vascular and ulcer-patching surgeries, patients see a lot of other doctors. Endocrinologists get blood sugar controlled enough to allow surgery. Infectious disease specialists find the right antibiotic cocktail. Orthotists design casts and special shoes to keep pressure off the foot's weak spots.
Treating a simple diabetic foot ulcer can cost $8,000; an infected one, $17,000.
The main message for the average diabetic: Take off your socks and shoes at every visit to the doctor and ask that he or she examine your feet. Many doctors follow this government guideline, but almost half of diabetics don't get a simple foot check that could spot brewing problems in time to avoid a limb-threatening ulcer.
And ask about the ankle blood pressure test, called an ankle brachial index. New York's Sheehan says the simple test is a leading predictor of which diabetics will be hospitalized for foot ulcers, and the American Diabetes Association recommends that every diabetic over 50 get checked.
"Tuesday in the office, they're fine. Friday, they're in the emergency room with gangrene in a toe," says Dr. Peter Sheehan, diabetes chief at New York's Cabrini Medical Center.
It's a little-known statistic: Foot problems — wounds that won't heal, infections, warping bones — are the most common reason diabetics are hospitalized.
And many of the 80,000-plus amputations of toes, feet and lower legs that Americans diabetics undergo each year are preventable, say specialists who brought more than 900 health providers to a meeting last week to figure out how to do just that.
One recommendation: For hospitals to create diabetes limb-salvage teams.
It sounds simple. But it involves pairing specialists who seldom work side-by-side — like podiatrists and vascular surgeons — to shave weeks off the time it can take to get proper care for a festering foot.
"It gets them everything they need right away, without months of waiting (between doctor appointments) while the wound is going downhill," says Dr. John Steinberg, a podiatrist with Georgetown University Hospital's limb-salvage team.
Some 21 million Americans have diabetes, meaning their bodies cannot properly regulate blood sugar, or glucose. Over years, high glucose levels seriously damage blood vessels and nerves, eventually leading to kidney failure, heart disease and other complications.
Among them is a vicious trio: Foot ulcers that strike about 600,000 diabetics annually; loss of sensation in the feet called neuropathy that makes sufferers slow to notice they have a wound; and poor blood flow in the lower legs that makes the ulcers slow to heal.
Amputation may end the grueling cycle of unhealing wounds and infection on one limb. But those patients still face grim odds. About half will develop ulcers and infections in the remaining foot, and undergo more amputations. And within five years, more than 40 percent are dead.
Infection is the chief reason for amputating. But there are no firm guidelines on when a limb is beyond salvaging — and a 2001 study of Medicare-covered diabetics found large differences in amputation rates in different parts of the country.
Until recently, most research into diabetic wounds has focused on methods to clean them out and spur new skin growth.
The newer message: Check blood pressure in a diabetic's ankle before rushing to foot surgery. One in three diabetics over age 50 has a condition called peripheral arterial disease or PAD, where leg arteries become too clogged to get enough blood to the feet.
That's one reason that last week's meeting urged a team approach to saving diabetics' limbs: Whatever foot surgeons apply to heal a nasty ulcer won't work unless a vascular surgeon has first cleared clogged leg arteries.
"We are hostage to the blood flow," is how Dr. David G. Armstrong, a podiatrist at Chicago's Rosalind Franklin University of Medicine and Science, puts it.
Minimally invasive leg-clearing therapy — propping open clogged arteries with balloons and stents, or rooting out the sludge with tiny razors and lasers — is on the rise. But Dr. Richard Neville, Georgetown's vascular surgery chief, says many diabetics have such severe blockages that they need blood rerouted, using one of their own clog-free veins or artificial blood vessels.
Then can come what Armstrong calls the variety of "goops and gadgets" to apply straight to the ulcer.
What works best? Studies are under way to try to determine that, but Armstrong and Steinberg recommend old-fashioned debridement — scraping away dead tissue every few days — and a vacuum-sealing device that helps keep the wound moist. Certain dressings can provide a scaffolding for healthy cell growth from the inside-out.
Between those vascular and ulcer-patching surgeries, patients see a lot of other doctors. Endocrinologists get blood sugar controlled enough to allow surgery. Infectious disease specialists find the right antibiotic cocktail. Orthotists design casts and special shoes to keep pressure off the foot's weak spots.
Treating a simple diabetic foot ulcer can cost $8,000; an infected one, $17,000.
The main message for the average diabetic: Take off your socks and shoes at every visit to the doctor and ask that he or she examine your feet. Many doctors follow this government guideline, but almost half of diabetics don't get a simple foot check that could spot brewing problems in time to avoid a limb-threatening ulcer.
And ask about the ankle blood pressure test, called an ankle brachial index. New York's Sheehan says the simple test is a leading predictor of which diabetics will be hospitalized for foot ulcers, and the American Diabetes Association recommends that every diabetic over 50 get checked.
Monday, September 24, 2007
Lack of sleep may be deadly, research shows
LONDON (Reuters) - People who do not get enough sleep are more than twice as likely to die of heart disease, according to a large British study released on Monday.
Although the reasons are unclear, researchers said lack of sleep appeared to be linked to increased blood pressure, which is known to raise the risk of heart attacks and stroke.
A 17-year analysis of 10,000 government workers showed those who cut their sleeping from seven hours a night to five or less faced a 1.7-fold increased risk in mortality from all causes and more than double the risk of cardiovascular death.
The findings highlight a danger in busy modern lifestyles, Francesco Cappuccio, professor of cardiovascular medicine at the University of Warwick's medical school, told the annual conference of the British Sleep Society in Cambridge.
"A third of the population of the UK and over 40 percent in the U.S. regularly sleep less than five hours a night, so it is not a trivial problem," he said in a telephone interview.
"The current pressures in society to cut out sleep, in order to squeeze in more, may not be a good idea -- particularly if you go below five hours."
Previous research has highlighted the potential health risks of shift work and disrupted sleep. But the study by Cappuccio and colleagues, which was supported by British government and U.S. funding, is the first to link duration of sleep and mortality rates.
The study looked at sleep patterns of participants aged 35-55 years at two points in their lives -- 1985-88 and 1992-93 -- and then tracked their mortality rates until 2004.
The results were adjusted to take account of other possible risk factors such as initial age, sex, smoking and alcohol consumption, body mass index, blood pressure and cholesterol.
The correlation with cardiovascular risk in those who slept less in the 1990s than in the 1980s was clear but, curiously, there was also a higher mortality rate in people who increased their sleeping to more than nine hours.
In this case, however, there was no cardiovascular link and Cappuccio said it was possible that longer sleeping could be related to other health problems such as depression or cancer-related fatigue.
"In terms of prevention, our findings indicate that consistently sleeping around seven hours per night is optimal for health," he said.
Although the reasons are unclear, researchers said lack of sleep appeared to be linked to increased blood pressure, which is known to raise the risk of heart attacks and stroke.
A 17-year analysis of 10,000 government workers showed those who cut their sleeping from seven hours a night to five or less faced a 1.7-fold increased risk in mortality from all causes and more than double the risk of cardiovascular death.
The findings highlight a danger in busy modern lifestyles, Francesco Cappuccio, professor of cardiovascular medicine at the University of Warwick's medical school, told the annual conference of the British Sleep Society in Cambridge.
"A third of the population of the UK and over 40 percent in the U.S. regularly sleep less than five hours a night, so it is not a trivial problem," he said in a telephone interview.
"The current pressures in society to cut out sleep, in order to squeeze in more, may not be a good idea -- particularly if you go below five hours."
Previous research has highlighted the potential health risks of shift work and disrupted sleep. But the study by Cappuccio and colleagues, which was supported by British government and U.S. funding, is the first to link duration of sleep and mortality rates.
The study looked at sleep patterns of participants aged 35-55 years at two points in their lives -- 1985-88 and 1992-93 -- and then tracked their mortality rates until 2004.
The results were adjusted to take account of other possible risk factors such as initial age, sex, smoking and alcohol consumption, body mass index, blood pressure and cholesterol.
The correlation with cardiovascular risk in those who slept less in the 1990s than in the 1980s was clear but, curiously, there was also a higher mortality rate in people who increased their sleeping to more than nine hours.
In this case, however, there was no cardiovascular link and Cappuccio said it was possible that longer sleeping could be related to other health problems such as depression or cancer-related fatigue.
"In terms of prevention, our findings indicate that consistently sleeping around seven hours per night is optimal for health," he said.
Saturday, September 22, 2007
Pelvic Exams Can Help Spot Ovarian Cancer
SATURDAY, Sept. 22 (HealthDay News) -- Ovarian cancer, the "silent killer," may not always be so silent, experts say.
That's why women need to get regular pelvic exams and pay attention to possible symptoms of ovarian cancer, according to a team of University of Michigan Comprehensive Cancer Center experts who are trying to increase awareness about the disease.
September is Ovarian Cancer Awareness Month in the United States.
Until recently, it was believed that ovarian cancer did not produce any symptoms in its earliest, most curable stages. But researchers recently reported a group of symptoms that may indicate ovarian cancer.
The symptoms are: bloating; pelvic or abdominal pain; difficulty eating or feeling full quickly; and problems with urgency or frequency of urination. These symptoms are persistent and represent a change from a woman's normal health.
Women who experience these symptoms almost daily for more than a few weeks should see their gynecologist, the cancer center experts said.
"You can explain away these symptoms to yourself. But the only way to be sure it's nothing is to go get a pelvic exam," Dr. Rebecca Liu, assistant professor of obstetrics and gynecology at the U-M Medical School and a gynecologic oncologist at the U-M Comprehensive Cancer Center, said in a prepared statement.
An annual pelvic exam in a must, especially among older women, who are at increased risk for ovarian cancer.
Survival rates are much higher when ovarian cancer is diagnosed at an earlier stage. Five years after diagnosis, 95 percent of women with stage I ovarian cancer (the earliest stage) are still alive, compared with 30 percent of women with stage III or IV cancer. Currently, about 70 percent of women diagnosed with ovarian cancer are at an advanced stage of the disease.
More than 22,000 women in the United States will be diagnosed with ovarian cancer this year, and more than 15,000 will die from the disease.
More information
The American Cancer Society has more about ovarian cancer.
That's why women need to get regular pelvic exams and pay attention to possible symptoms of ovarian cancer, according to a team of University of Michigan Comprehensive Cancer Center experts who are trying to increase awareness about the disease.
September is Ovarian Cancer Awareness Month in the United States.
Until recently, it was believed that ovarian cancer did not produce any symptoms in its earliest, most curable stages. But researchers recently reported a group of symptoms that may indicate ovarian cancer.
The symptoms are: bloating; pelvic or abdominal pain; difficulty eating or feeling full quickly; and problems with urgency or frequency of urination. These symptoms are persistent and represent a change from a woman's normal health.
Women who experience these symptoms almost daily for more than a few weeks should see their gynecologist, the cancer center experts said.
"You can explain away these symptoms to yourself. But the only way to be sure it's nothing is to go get a pelvic exam," Dr. Rebecca Liu, assistant professor of obstetrics and gynecology at the U-M Medical School and a gynecologic oncologist at the U-M Comprehensive Cancer Center, said in a prepared statement.
An annual pelvic exam in a must, especially among older women, who are at increased risk for ovarian cancer.
Survival rates are much higher when ovarian cancer is diagnosed at an earlier stage. Five years after diagnosis, 95 percent of women with stage I ovarian cancer (the earliest stage) are still alive, compared with 30 percent of women with stage III or IV cancer. Currently, about 70 percent of women diagnosed with ovarian cancer are at an advanced stage of the disease.
More than 22,000 women in the United States will be diagnosed with ovarian cancer this year, and more than 15,000 will die from the disease.
More information
The American Cancer Society has more about ovarian cancer.
Monday, September 17, 2007
Diabetics try new round-the-clock sensor
WASHINGTON - Diabetes care is undergoing a transformation: Thousands of patients are switching from a few finger-pricks a day to track their disease to new sensors that keep guard around the clock.
The last six months brought boosts to the technology, as federal health officials approved children's use of a sensor that works for three days in a row — and cleared the longest-lasting version yet, a seven-day model, for adults.
The ultimate goal is to create an "artificial pancreas," pairing such sensors with implanted pumps that would automatically dispense insulin to make a diabetic's blood sugar better resemble a healthy person's.
That's still years away. For now, the hope is that these under-the-skin sensors will empower the most vulnerable patients — those who require insulin injections — to make changes that better control their disease. Perhaps more important, they come with alarms that can sound in time to avoid dangerously high or low blood-sugar levels.
"It really catches problems before they're problems," says Katie Clark of Grandville, Mich. She bought a sensor for her 7-year-old daughter, and no longer has to wake up in the middle of the night to spot-check whether Ellie's OK.
But these "continuous glucose monitors" cost up to $1,000, plus at least $350 a month for supplies. Insurance coverage is hit-or-miss: Some do pay but many refuse pending proof that the sensors live up to their promise of better health.
Some short-term studies show users greatly improve control of their blood sugar, while other studies have found little impact.
Why the discrepancy? Diabetics who do the worst job fighting their disease aren't going to put in extra effort to improve just because of a sensor, says Dr. Irl Hirsch of the University of Washington.
"We learned that lesson the hard way," says Hirsch, who presented research at a recent diabetes meeting suggesting the sensors instead will most benefit patients who can't lower their blood sugar to optimal levels — a score below 7 on a test called the A1C — despite following best-care guidelines.
Hirsch finds the sensors help lower A1Cs between 7 and 8.5, but not those who start out higher.
By November, scientists should complete enrollment of 450 diabetics into a study funded by the Juvenile Diabetes Research Foundation to address insurers' questions on best use of the sensors. Preliminary results are due next year.
"People thought it would just be the silver bullet, if you got this in somebody's hand they're going to do better," says Aaron Kowalski, a JDRF research director who has used the sensors himself since 2006. "That won't just magically happen. ... They need to utilize that information."
Some 21 million Americans have diabetes, meaning their bodies cannot properly regulate blood sugar, or glucose. About 5 million inject insulin, a hormone that converts glucose into energy, to treat their diabetes — including the roughly 2 million with Type 1 diabetes who require those shots to live.
High glucose levels damage blood vessels and nerves, leading to blindness, kidney failure, amputations and heart disease. Frequent glucose testing — pricking a finger for a blood test four to eight times a day — helps patients maintain tighter glucose control, thus lowering risk of those complications.
But few diabetics test that often, and even frequent testers cannot know if glucose soars or plummets between tests or during sleep.
With the new technology, diabetics use a needle to insert a sensor just under the skin of the side or abdomen every three or seven days. The sensors wirelessly beam glucose readings to a pager-like device every 5 minutes.
Available now are Medtronic Inc.'s three-day Real-Time monitor — sold by itself, for adults or children, or together with a manually adjustable insulin pump — and DexCom Inc.'s STS-7 seven-day monitor for adults. A five-day competitor from Abbott Laboratories is in development.
Users require training. For example, it takes up to 15 minutes for a glucose change in blood to be reflected in the cell fluid that these sensors measure. Doctors warn to always double-check with a blood test when a sensor signals trouble.
But many learn to tell at a glance if they need a snack to head off a coming low, or an insulin dose to block a coming spike.
When Ellie Clark's sensor showed her morning oatmeal made her glucose soar to a level of 300, her mother started giving her entire morning insulin booster before breakfast. Now the 7-year-old's morning jump is to a moderate 200.
Ellie's average glucose dropped so much after six months of sensor use that Katie Clark, also a Type 1 diabetic, bought one for herself, even though insurance wouldn't pay for mother or daughter.
To save on monthly supply fees, Clark uses her own sensor selectively, such as to watch for dropping glucose while driving long distances. "Then, it could be a lifesaver."
_____
EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
On the Net:
Diabetes and glucose sensor information: http://www.jdrf.org
The last six months brought boosts to the technology, as federal health officials approved children's use of a sensor that works for three days in a row — and cleared the longest-lasting version yet, a seven-day model, for adults.
The ultimate goal is to create an "artificial pancreas," pairing such sensors with implanted pumps that would automatically dispense insulin to make a diabetic's blood sugar better resemble a healthy person's.
That's still years away. For now, the hope is that these under-the-skin sensors will empower the most vulnerable patients — those who require insulin injections — to make changes that better control their disease. Perhaps more important, they come with alarms that can sound in time to avoid dangerously high or low blood-sugar levels.
"It really catches problems before they're problems," says Katie Clark of Grandville, Mich. She bought a sensor for her 7-year-old daughter, and no longer has to wake up in the middle of the night to spot-check whether Ellie's OK.
But these "continuous glucose monitors" cost up to $1,000, plus at least $350 a month for supplies. Insurance coverage is hit-or-miss: Some do pay but many refuse pending proof that the sensors live up to their promise of better health.
Some short-term studies show users greatly improve control of their blood sugar, while other studies have found little impact.
Why the discrepancy? Diabetics who do the worst job fighting their disease aren't going to put in extra effort to improve just because of a sensor, says Dr. Irl Hirsch of the University of Washington.
"We learned that lesson the hard way," says Hirsch, who presented research at a recent diabetes meeting suggesting the sensors instead will most benefit patients who can't lower their blood sugar to optimal levels — a score below 7 on a test called the A1C — despite following best-care guidelines.
Hirsch finds the sensors help lower A1Cs between 7 and 8.5, but not those who start out higher.
By November, scientists should complete enrollment of 450 diabetics into a study funded by the Juvenile Diabetes Research Foundation to address insurers' questions on best use of the sensors. Preliminary results are due next year.
"People thought it would just be the silver bullet, if you got this in somebody's hand they're going to do better," says Aaron Kowalski, a JDRF research director who has used the sensors himself since 2006. "That won't just magically happen. ... They need to utilize that information."
Some 21 million Americans have diabetes, meaning their bodies cannot properly regulate blood sugar, or glucose. About 5 million inject insulin, a hormone that converts glucose into energy, to treat their diabetes — including the roughly 2 million with Type 1 diabetes who require those shots to live.
High glucose levels damage blood vessels and nerves, leading to blindness, kidney failure, amputations and heart disease. Frequent glucose testing — pricking a finger for a blood test four to eight times a day — helps patients maintain tighter glucose control, thus lowering risk of those complications.
But few diabetics test that often, and even frequent testers cannot know if glucose soars or plummets between tests or during sleep.
With the new technology, diabetics use a needle to insert a sensor just under the skin of the side or abdomen every three or seven days. The sensors wirelessly beam glucose readings to a pager-like device every 5 minutes.
Available now are Medtronic Inc.'s three-day Real-Time monitor — sold by itself, for adults or children, or together with a manually adjustable insulin pump — and DexCom Inc.'s STS-7 seven-day monitor for adults. A five-day competitor from Abbott Laboratories is in development.
Users require training. For example, it takes up to 15 minutes for a glucose change in blood to be reflected in the cell fluid that these sensors measure. Doctors warn to always double-check with a blood test when a sensor signals trouble.
But many learn to tell at a glance if they need a snack to head off a coming low, or an insulin dose to block a coming spike.
When Ellie Clark's sensor showed her morning oatmeal made her glucose soar to a level of 300, her mother started giving her entire morning insulin booster before breakfast. Now the 7-year-old's morning jump is to a moderate 200.
Ellie's average glucose dropped so much after six months of sensor use that Katie Clark, also a Type 1 diabetic, bought one for herself, even though insurance wouldn't pay for mother or daughter.
To save on monthly supply fees, Clark uses her own sensor selectively, such as to watch for dropping glucose while driving long distances. "Then, it could be a lifesaver."
_____
EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
On the Net:
Diabetes and glucose sensor information: http://www.jdrf.org
Sunday, September 16, 2007
Doctor details 9/11 workers' illnesses
WASHINGTON - Doctors treating sickened ground zero workers offered Congress a detailed diagnosis Wednesday of the ailments still affecting thousands after the Sept. 11 attacks, but warned that there's no way to determine how many more may become afflicted with life-threatening illnesses.
Dr. Philip Landrigan of the Mount Sinai School of Medicine described three months of recent medical treatment to a House panel examining how many of those who toiled on the toxic debris pile are still sick — or may get sick.
Thousands of people "are still suffering," Landrigan said a day after the sixth anniversary of the Sept. 11, 2001 attacks. Their ailments range from runny noses to laryngitis to lung disease, he said.
"Respiratory illness, psychological distress and financial devastation have become a new way of life for many," he told the House Education and Labor Committee. He advocated leaving Sept. 11-related medical programs in place to try to determine how many workers might develop long-term diseases.
Patricia Clark, a regional official with the Occupational Safety and Health Administration, said workers who were exposed to ground zero toxins in the first 48 hours after the attacks were hit with an "incredible assault" on their health. Still, she defended her agency's air sampling, which found little evidence of dangerously high levels of asbestos and other contaminants.
The figures offered Wednesday further define the medical problems found by a 2006 Mount Sinai study, which said 70 percent of ground zero workers suffered new or worsened respiratory problems after their exposure to the debris of the World Trade Center.
Landrigan offered new specifics of the most prevalent symptoms among the police officers, firefighters, construction workers and volunteers examined.
Between April and June of this year, doctors in the 9/11 workers health program overseen by Mount Sinai saw 2,323 patients.
They found:
_Lower respiratory problems in 40 percent of patients. Asthma and asthma-like reactive airways disease were found in 30 percent. Smaller portions of patients had chronic cough — 7 percent — or chronic obstructive pulmonary disease — 5 percent.
_Upper respiratory conditions in 59 percent. The most common condition was runny nose, in 51 percent of the workers, and chronic sinusitis, in about a fifth of them.
_Mental health problems, the most common being post-traumatic stress disorder and depression, in 36 percent of patients.
Landrigan said it is still unclear how many of those patients will continue to experience such symptoms, or how many may develop new diseases like cancer many years after their exposure.
Lingering 9/11-related illnesses — and deaths of some first responders years after the attacks — have led to calls in Congress for a federal program to fund long-term health programs for those workers.
So far, the government has paid for piecemeal screening and treatment of emergency personnel, construction workers and volunteers, but advocates want such programs expanded to include lower Manhattan residents, students and tourists.
(This version CORRECTS TOPS with 5 grafs to UPDATE with testimony, OSHA official; corrects that hearing is before full committee, sted subcommittee.)
Dr. Philip Landrigan of the Mount Sinai School of Medicine described three months of recent medical treatment to a House panel examining how many of those who toiled on the toxic debris pile are still sick — or may get sick.
Thousands of people "are still suffering," Landrigan said a day after the sixth anniversary of the Sept. 11, 2001 attacks. Their ailments range from runny noses to laryngitis to lung disease, he said.
"Respiratory illness, psychological distress and financial devastation have become a new way of life for many," he told the House Education and Labor Committee. He advocated leaving Sept. 11-related medical programs in place to try to determine how many workers might develop long-term diseases.
Patricia Clark, a regional official with the Occupational Safety and Health Administration, said workers who were exposed to ground zero toxins in the first 48 hours after the attacks were hit with an "incredible assault" on their health. Still, she defended her agency's air sampling, which found little evidence of dangerously high levels of asbestos and other contaminants.
The figures offered Wednesday further define the medical problems found by a 2006 Mount Sinai study, which said 70 percent of ground zero workers suffered new or worsened respiratory problems after their exposure to the debris of the World Trade Center.
Landrigan offered new specifics of the most prevalent symptoms among the police officers, firefighters, construction workers and volunteers examined.
Between April and June of this year, doctors in the 9/11 workers health program overseen by Mount Sinai saw 2,323 patients.
They found:
_Lower respiratory problems in 40 percent of patients. Asthma and asthma-like reactive airways disease were found in 30 percent. Smaller portions of patients had chronic cough — 7 percent — or chronic obstructive pulmonary disease — 5 percent.
_Upper respiratory conditions in 59 percent. The most common condition was runny nose, in 51 percent of the workers, and chronic sinusitis, in about a fifth of them.
_Mental health problems, the most common being post-traumatic stress disorder and depression, in 36 percent of patients.
Landrigan said it is still unclear how many of those patients will continue to experience such symptoms, or how many may develop new diseases like cancer many years after their exposure.
Lingering 9/11-related illnesses — and deaths of some first responders years after the attacks — have led to calls in Congress for a federal program to fund long-term health programs for those workers.
So far, the government has paid for piecemeal screening and treatment of emergency personnel, construction workers and volunteers, but advocates want such programs expanded to include lower Manhattan residents, students and tourists.
(This version CORRECTS TOPS with 5 grafs to UPDATE with testimony, OSHA official; corrects that hearing is before full committee, sted subcommittee.)
Doctors: Protocol key to helping players
Winston Moss was still wearing his pads when he went in for the CT scan. The Seattle Seahawks linebacker suffered a neck fracture during a road game in Baltimore in 1997, and the Ravens medical staff's emergency protocol ensured that that he quickly received the proper treatment.
In the aftermath of Buffalo Bills tight end Kevin Everett's severe spinal cord injury, several neurological specialists who work with NFL teams said that the key to giving a player the best chance at recovery from a catastrophic injury is to have a well-rehearsed emergency protocol in place.
Dr. Ralph Dacey, a St. Louis Rams neurosurgeon, said that each year team physicians simulate with trainers how they would respond to a serious spinal injury.
Not all NFL teams require a neurological specialist to attend every game.
"I don't consider it an essential element," said Dr. Joseph Maroon, a neurological surgeon for one of the clubs that does insist on it, the Pittsburgh Steelers. "But I think it is essential that trainers and medical personnel be very well-versed in acute management of concussions and spinal injuries."
The Carolina Panthers' team neurosurgeon, Dr. Tim Adamson, said his presence is less important than the existence of a predetermined plan that immediately gets an injured player to the right hospital and into the necessary diagnostic tests.
"The difference I make is knowing how to quickly get them through the process of treatment and evaluation," Adamson said. "There's nothing magical to do with my presence at the stadium other than to be available to get started quickly with them."
Having a neurological specialist on call near the stadium would serve equally well, he said.
On that day 10 years ago, Moss' CT scan showed no neurological damage. Dr. Kevin Auld, the Seahawks' former team physician who recalled the treatment the player received, said he wasn't completely confident that Moss would've have gotten that needed test as promptly and efficiently in every NFL city.
Before Seattle's road games, the home team's medical staff would often share information about the emergency protocol with Seahawks doctors, but not always. Auld hoped every club had the proper procedures in place but wasn't sure.
The NFL requires that the home team have on hand a physician trained in rapid sequence intubation (for players who need help breathing) as part of the on-field emergency crew. There must also be a medevac helicopter, ambulance, stretchers and carts, X-ray service, oxygen and emergency medical information for that city.
Dr. Andrew Cappuccino, a Bills team physician who oversaw Everett's initial treatment, specializes in spinal surgery. He's a "real star" in his field, Auld said, but what most helped Everett was Buffalo's excellent emergency protocol system. Auld observed the Bills doctors' care in formulating the plan during conversations between the Buffalo and Seattle staffs at the annual NFL pre-draft combines.
While the Everett saga has focused attention on spinal injuries, the doctors agreed that the greatest need for the input of neurological specialists is with concussions, which are far more common in football.
In the aftermath of Buffalo Bills tight end Kevin Everett's severe spinal cord injury, several neurological specialists who work with NFL teams said that the key to giving a player the best chance at recovery from a catastrophic injury is to have a well-rehearsed emergency protocol in place.
Dr. Ralph Dacey, a St. Louis Rams neurosurgeon, said that each year team physicians simulate with trainers how they would respond to a serious spinal injury.
Not all NFL teams require a neurological specialist to attend every game.
"I don't consider it an essential element," said Dr. Joseph Maroon, a neurological surgeon for one of the clubs that does insist on it, the Pittsburgh Steelers. "But I think it is essential that trainers and medical personnel be very well-versed in acute management of concussions and spinal injuries."
The Carolina Panthers' team neurosurgeon, Dr. Tim Adamson, said his presence is less important than the existence of a predetermined plan that immediately gets an injured player to the right hospital and into the necessary diagnostic tests.
"The difference I make is knowing how to quickly get them through the process of treatment and evaluation," Adamson said. "There's nothing magical to do with my presence at the stadium other than to be available to get started quickly with them."
Having a neurological specialist on call near the stadium would serve equally well, he said.
On that day 10 years ago, Moss' CT scan showed no neurological damage. Dr. Kevin Auld, the Seahawks' former team physician who recalled the treatment the player received, said he wasn't completely confident that Moss would've have gotten that needed test as promptly and efficiently in every NFL city.
Before Seattle's road games, the home team's medical staff would often share information about the emergency protocol with Seahawks doctors, but not always. Auld hoped every club had the proper procedures in place but wasn't sure.
The NFL requires that the home team have on hand a physician trained in rapid sequence intubation (for players who need help breathing) as part of the on-field emergency crew. There must also be a medevac helicopter, ambulance, stretchers and carts, X-ray service, oxygen and emergency medical information for that city.
Dr. Andrew Cappuccino, a Bills team physician who oversaw Everett's initial treatment, specializes in spinal surgery. He's a "real star" in his field, Auld said, but what most helped Everett was Buffalo's excellent emergency protocol system. Auld observed the Bills doctors' care in formulating the plan during conversations between the Buffalo and Seattle staffs at the annual NFL pre-draft combines.
While the Everett saga has focused attention on spinal injuries, the doctors agreed that the greatest need for the input of neurological specialists is with concussions, which are far more common in football.
Thursday, September 13, 2007
ER kiosks let patients avoid long lines
DALLAS - An emergency room might be the last place you'd think would have do-it-yourself check-in. But Parkland Memorial Hospital has three self-service computer kiosks, similar to those used by airport passengers and hotel guests. And so do a handful of other hospital ERs, where the long wait in line to register and explain symptoms can be grueling.
True emergency cases — gunshot or car crash victims with serious injuries — are still rushed in for treatment. But patients like Rickey Washington, a diabetic concerned about numbness in his hands and feet, find it fairly simple to sign in by computer.
"Once you look and see, it's kind of easy," said Washington, 44.
Besides offering patients more privacy, the kiosks should help nurses identify the most urgent cases. Newark Beth Israel Medical Center in New Jersey plans to install check-in kiosks in its ER within the next couple months.
"Patients don't always know if their symptom is potentially bad or serious," said Dr. Marc Borenstein, chairman and residency program director for the department of emergency medicine at Beth Israel.
Parkland's administrators say patients have been spared the long check-in lines since the kiosks arrived. The hospital's ER handles about 300 cases a day.
"It's helping us find the people that we need to see right now," said Jennifer Hay, unit manager for the ER department.
Patients spend about eight minutes at the kiosks, using touchscreens to enter their name, age, and other personal information. The computer shows the patient a list of ailments to choose from, like "pain" or "fever and/or chills" and a list of body parts to indicate where it hurts.
Previously, a nurse checked in patients and took their vital signs as lines at the ER got longer and frustration mounted.
"If it's getting people to be able to sit down and not be in a long line, then it's good," said Dr. Brian Keaton, president of the American College of Emergency Physicians.
Once the patient's problem is entered into the system, it pops up on a screen accessible to the nurses. Those with chest pains, stroke symptoms or other worrisome complaints take priority. But for patients with lesser complaints, even computer kiosks can't eliminate the "wait" from ER waiting rooms. It still often takes a couple of hours for a nurse to check their vital signs, and several more to see a doctor.
John Lovelock, research director for industry research firm Gartner Inc., said patients may initially hesitate to use the kiosks, but repeat customers realize they're saving time.
"I think the public is absolutely ready for this," he said.
One family practice and urgent care center in Cookeville, Tenn., has used computer kiosks and hand-held electronic devices to get patient information since opening just over a year ago, said Kara Hufstedler, a systems manager for Satellite Med.
"We had some people who loved it. We had some people who didn't. The staff helps anyone who needs it," she said.
Brandie Glover, 27, of Dallas, said she first thought the kiosks at Parkland were "weird."
"I thought it was kind of impersonal, but at the same time, it's a quicker process," said Glover, who came to the ER with neck and ear pain. But after waiting for more than three hours without seeing a doctor, Glover decided to leave without getting treated.
Hays said that shortening the check-in time only addresses part of the problem. Like other hospitals, she said, Parkland is also trying to find ways to improve the overall wait time in its emergency room.
True emergency cases — gunshot or car crash victims with serious injuries — are still rushed in for treatment. But patients like Rickey Washington, a diabetic concerned about numbness in his hands and feet, find it fairly simple to sign in by computer.
"Once you look and see, it's kind of easy," said Washington, 44.
Besides offering patients more privacy, the kiosks should help nurses identify the most urgent cases. Newark Beth Israel Medical Center in New Jersey plans to install check-in kiosks in its ER within the next couple months.
"Patients don't always know if their symptom is potentially bad or serious," said Dr. Marc Borenstein, chairman and residency program director for the department of emergency medicine at Beth Israel.
Parkland's administrators say patients have been spared the long check-in lines since the kiosks arrived. The hospital's ER handles about 300 cases a day.
"It's helping us find the people that we need to see right now," said Jennifer Hay, unit manager for the ER department.
Patients spend about eight minutes at the kiosks, using touchscreens to enter their name, age, and other personal information. The computer shows the patient a list of ailments to choose from, like "pain" or "fever and/or chills" and a list of body parts to indicate where it hurts.
Previously, a nurse checked in patients and took their vital signs as lines at the ER got longer and frustration mounted.
"If it's getting people to be able to sit down and not be in a long line, then it's good," said Dr. Brian Keaton, president of the American College of Emergency Physicians.
Once the patient's problem is entered into the system, it pops up on a screen accessible to the nurses. Those with chest pains, stroke symptoms or other worrisome complaints take priority. But for patients with lesser complaints, even computer kiosks can't eliminate the "wait" from ER waiting rooms. It still often takes a couple of hours for a nurse to check their vital signs, and several more to see a doctor.
John Lovelock, research director for industry research firm Gartner Inc., said patients may initially hesitate to use the kiosks, but repeat customers realize they're saving time.
"I think the public is absolutely ready for this," he said.
One family practice and urgent care center in Cookeville, Tenn., has used computer kiosks and hand-held electronic devices to get patient information since opening just over a year ago, said Kara Hufstedler, a systems manager for Satellite Med.
"We had some people who loved it. We had some people who didn't. The staff helps anyone who needs it," she said.
Brandie Glover, 27, of Dallas, said she first thought the kiosks at Parkland were "weird."
"I thought it was kind of impersonal, but at the same time, it's a quicker process," said Glover, who came to the ER with neck and ear pain. But after waiting for more than three hours without seeing a doctor, Glover decided to leave without getting treated.
Hays said that shortening the check-in time only addresses part of the problem. Like other hospitals, she said, Parkland is also trying to find ways to improve the overall wait time in its emergency room.
Wednesday, September 12, 2007
Life expectancy in U.S. rises to all-time high of 78
WASHINGTON (Reuters) - Life expectancy in the United States has increased to almost 78 years, the country's highest on record, amid a downturn in deaths from heart disease, cancer and stroke, according to new federal estimates published on Wednesday.
The U.S. Centers for Disease Control and Prevention also said preliminary figures for 2005 showed an increase in the U.S. infant mortality rate from the previous year, although it called the rise statistically insignificant. Black babies under age 1 remained far more likely to die than white babies.
The CDC's National Center for Health Statistics said in a report that a child born in the United States in 2005 can expect to live 77.9 years, up from 77.8 in 2004 and continuing a rise dating back decades. U.S. life expectancy was 75.8 years in 1995 and 69.6 years in 1955.
The United States, a country of 300 million people, ranks 42nd in the world in life expectancy, according to previously released data.
U.S. whites will live longer than blacks, and women longer than men, the CDC said, reflecting enduring disparities.
The 2005 report estimated that white women will live 80.8 years, compared to 76.5 years for black women. However, black women will outlive white men (75.7 years) and black men (69.6 years), the CDC said. The CDC said the figures for both black men and women were the highest ever recorded.
"If death rates from certain leading causes of death continue to decline, we should continue to see improvements in life expectancy," CDC statistician Hsiang-Ching Kung, who worked on the report, said in a statement.
The death rates from heart disease, cancer and stroke, the three leading causes of death in the United States, fell in 2005 compared to 2004. The report showed rises in 2005 in death rates from Alzheimer's disease, the seventh-leading killer, and Parkinson's disease, the 14th-leading cause of death.
The U.S. infant mortality rate is higher than many other rich nations. The CDC said 2005 figures showed an infant mortality rate of 6.89 per 1,000 live births up to age 1, a rise from 6.79 in 2004. Infant mortality for black babies in 2005 was 13.69 per 1,000 live births, compared to 5.76 for white babies, the CDC said.
The agency said birth defects were the leading cause of infant mortality in 2005, followed by problems related to premature birth and low birth weight.
The U.S. Centers for Disease Control and Prevention also said preliminary figures for 2005 showed an increase in the U.S. infant mortality rate from the previous year, although it called the rise statistically insignificant. Black babies under age 1 remained far more likely to die than white babies.
The CDC's National Center for Health Statistics said in a report that a child born in the United States in 2005 can expect to live 77.9 years, up from 77.8 in 2004 and continuing a rise dating back decades. U.S. life expectancy was 75.8 years in 1995 and 69.6 years in 1955.
The United States, a country of 300 million people, ranks 42nd in the world in life expectancy, according to previously released data.
U.S. whites will live longer than blacks, and women longer than men, the CDC said, reflecting enduring disparities.
The 2005 report estimated that white women will live 80.8 years, compared to 76.5 years for black women. However, black women will outlive white men (75.7 years) and black men (69.6 years), the CDC said. The CDC said the figures for both black men and women were the highest ever recorded.
"If death rates from certain leading causes of death continue to decline, we should continue to see improvements in life expectancy," CDC statistician Hsiang-Ching Kung, who worked on the report, said in a statement.
The death rates from heart disease, cancer and stroke, the three leading causes of death in the United States, fell in 2005 compared to 2004. The report showed rises in 2005 in death rates from Alzheimer's disease, the seventh-leading killer, and Parkinson's disease, the 14th-leading cause of death.
The U.S. infant mortality rate is higher than many other rich nations. The CDC said 2005 figures showed an infant mortality rate of 6.89 per 1,000 live births up to age 1, a rise from 6.79 in 2004. Infant mortality for black babies in 2005 was 13.69 per 1,000 live births, compared to 5.76 for white babies, the CDC said.
The agency said birth defects were the leading cause of infant mortality in 2005, followed by problems related to premature birth and low birth weight.
Thursday, September 6, 2007
Breast cancer more deadly in black women
A new study gives a possible explanation for why breast cancer is more deadly in black women: they are more likely to have tumors that do not respond to the hormone-based treatments that help many others with the disease.
The study is the largest yet to link a biological factor to the racial disparity, which also has been blamed on black women getting fewer mammograms and less aggressive treatment.
"This puts biology more to the forefront," said Dr. Julie Gralow, a cancer specialist at the University of Washington School of Medicine familiar with the work. "It's not just access to care, access to treatment and other factors that have been implicated in the past."
The study was led by Dr. M. Catherine Lee of the University of Michigan Comprehensive Cancer Center and is to be presented at a conference starting Friday in San Francisco, organized by the American Society of Clinical Oncology and other cancer groups.
Breast cancer is the most common cancer in American women. An estimated 178,480 new cases and 40,460 deaths from it are expected in the United States this year.
Blacks are less likely than whites to develop breast cancer but are more likely to die from it, doctors have long known. Blacks also are diagnosed at younger ages and at later stages of disease.
Researchers for the first time used the National Cancer Data Base, a tumor registry maintained by the American College of Surgeons, to explore these issues, using more than 170,000 cases diagnosed in 1998. Ten percent were in black women.
The study focused on the 95,500 women whose cancers were invasive rather than still confined to a milk duct. About 39 percent of such tumors in black women were estrogen receptor-negative, or ER-negative, compared with 22 percent of those in white women.
Estrogen helps tumors grow. Drugs that block this hormone, like tamoxifen and a newer class of medications called aromatase inhibitors, work against these cancers.
ER-negative tumors are resistant to such therapies and harder to treat. Other tools like chemotherapy, radiation and targeted biological drugs then become more important for such women, and doctors should consider this when they evaluate black women with the disease, Lee said.
In the study, ER-negative tumors were more common in black women at every stage of disease and at all ages.
For example, only 17 percent of early stage tumors in white women were ER-negative, but 31 percent in black women were. Of the most advanced cancers, 31 percent in whites and 46 percent in blacks were ER-negative.
Echoing previous research, the new study found that black women were diagnosed at younger ages — an average of 57 years old versus 62 for white women — and with more advanced disease: only 29 percent had early stage tumors versus 42 percent of white women. They also had larger tumors and more cell traits that are signs of a poor prognosis.
Smaller studies have suggested biological differences between breast cancer in blacks and whites. Earlier this year, the Carolina Breast Cancer Study found that young black women were more likely to have an aggressive form called the basal-like subtype.
Last fall, two studies by researchers from the University of Texas M. D. Anderson Cancer Center found that black women were more likely to have larger, later-stage tumors and lower survival rates than Hispanic and white women given similar treatments.
But these findings do not mean that differences in screening and health care are not contributing to the trend, especially in certain parts of the country, said Dr. Wendy Woodward, a breast cancer specialist at M.D. Anderson.
"You really have to kind of go at the problem from all angles. If you solve the access problem and women come in and you don't have an adequate therapy for them, you haven't taken a step forward," she said.
Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, agreed. Racial disparity in breast cancer survival did not appear until the mid-1980s, suggesting that much of it is due to lack of screening mammograms and access to care, he said.
___
On the Net:
Cancer treatment information: http://www.plwc.org
American Cancer Society: http://www.cancer.org
National Cancer Institute: http://www.cancer.gov
The study is the largest yet to link a biological factor to the racial disparity, which also has been blamed on black women getting fewer mammograms and less aggressive treatment.
"This puts biology more to the forefront," said Dr. Julie Gralow, a cancer specialist at the University of Washington School of Medicine familiar with the work. "It's not just access to care, access to treatment and other factors that have been implicated in the past."
The study was led by Dr. M. Catherine Lee of the University of Michigan Comprehensive Cancer Center and is to be presented at a conference starting Friday in San Francisco, organized by the American Society of Clinical Oncology and other cancer groups.
Breast cancer is the most common cancer in American women. An estimated 178,480 new cases and 40,460 deaths from it are expected in the United States this year.
Blacks are less likely than whites to develop breast cancer but are more likely to die from it, doctors have long known. Blacks also are diagnosed at younger ages and at later stages of disease.
Researchers for the first time used the National Cancer Data Base, a tumor registry maintained by the American College of Surgeons, to explore these issues, using more than 170,000 cases diagnosed in 1998. Ten percent were in black women.
The study focused on the 95,500 women whose cancers were invasive rather than still confined to a milk duct. About 39 percent of such tumors in black women were estrogen receptor-negative, or ER-negative, compared with 22 percent of those in white women.
Estrogen helps tumors grow. Drugs that block this hormone, like tamoxifen and a newer class of medications called aromatase inhibitors, work against these cancers.
ER-negative tumors are resistant to such therapies and harder to treat. Other tools like chemotherapy, radiation and targeted biological drugs then become more important for such women, and doctors should consider this when they evaluate black women with the disease, Lee said.
In the study, ER-negative tumors were more common in black women at every stage of disease and at all ages.
For example, only 17 percent of early stage tumors in white women were ER-negative, but 31 percent in black women were. Of the most advanced cancers, 31 percent in whites and 46 percent in blacks were ER-negative.
Echoing previous research, the new study found that black women were diagnosed at younger ages — an average of 57 years old versus 62 for white women — and with more advanced disease: only 29 percent had early stage tumors versus 42 percent of white women. They also had larger tumors and more cell traits that are signs of a poor prognosis.
Smaller studies have suggested biological differences between breast cancer in blacks and whites. Earlier this year, the Carolina Breast Cancer Study found that young black women were more likely to have an aggressive form called the basal-like subtype.
Last fall, two studies by researchers from the University of Texas M. D. Anderson Cancer Center found that black women were more likely to have larger, later-stage tumors and lower survival rates than Hispanic and white women given similar treatments.
But these findings do not mean that differences in screening and health care are not contributing to the trend, especially in certain parts of the country, said Dr. Wendy Woodward, a breast cancer specialist at M.D. Anderson.
"You really have to kind of go at the problem from all angles. If you solve the access problem and women come in and you don't have an adequate therapy for them, you haven't taken a step forward," she said.
Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, agreed. Racial disparity in breast cancer survival did not appear until the mid-1980s, suggesting that much of it is due to lack of screening mammograms and access to care, he said.
___
On the Net:
Cancer treatment information: http://www.plwc.org
American Cancer Society: http://www.cancer.org
National Cancer Institute: http://www.cancer.gov
Monday, August 27, 2007
Statins may help prevent Alzheimer's: study
WASHINGTON (Reuters) - Statin drugs may help prevent the brain damage that leads to Alzheimer's disease, U.S. researchers reported on Monday.
Their study, published in the journal Neurology, bolsters a growing body of research that suggests the popular cholesterol-lowering drugs may reduce the risk of Alzheimer's.
Most studies have simply compared people who take statin drugs to those who do not, and track the rate of Alzheimer's.
"But our study is the first to compare the brains of people who had received statins with those who had not," said Dr. Gail Ge Li of the University of Washington School of Medicine in Seattle, who worked on the study.
Li and colleagues examined the brains of 110 people aged 65 to 79 who had donated their brains for research after they died as part of a study when they were still living.
The researchers looked at the brains for evidence of the plaques and tangles that characterize Alzheimer's, an incurable and progressive brain disease that is the leading cause of dementia.
They found significantly fewer tangles in the brains of people who had taken statins than in those who had not.
"These results are exciting, novel, and have important implications for prevention strategies," said Dr. Eric Larson, who helped direct the study.
"But they need to be confirmed, because (ours) is not a randomized controlled trial."
Such a trial would be difficult to conduct. It would require randomly assigning people to either take statins or not, watching to see who developed Alzheimer's, and looking at their brains after they died.
Statin drugs lower cholesterol and may also reduce inflammation in the body. The causes of Alzheimer's are not fully understood, but they are closely linked with cholesterol and also inflammation.
"Statins are probably more likely to help prevent the disease in certain kinds of people than others," Li said.
"Someday we may be able to know more precisely which individuals will benefit from which types of statins for preventing the changes of Alzheimer's disease," Larson added in a statement.
Statins -- which include Pfizer Inc's $10 billion-a-year Lipitor, Bristol-Myers Squibb Co's Pravachol and Merck and Co Inc's Zocor -- are the world's best-selling drugs, taken by millions to reduce the risk of heart attack.
Their study, published in the journal Neurology, bolsters a growing body of research that suggests the popular cholesterol-lowering drugs may reduce the risk of Alzheimer's.
Most studies have simply compared people who take statin drugs to those who do not, and track the rate of Alzheimer's.
"But our study is the first to compare the brains of people who had received statins with those who had not," said Dr. Gail Ge Li of the University of Washington School of Medicine in Seattle, who worked on the study.
Li and colleagues examined the brains of 110 people aged 65 to 79 who had donated their brains for research after they died as part of a study when they were still living.
The researchers looked at the brains for evidence of the plaques and tangles that characterize Alzheimer's, an incurable and progressive brain disease that is the leading cause of dementia.
They found significantly fewer tangles in the brains of people who had taken statins than in those who had not.
"These results are exciting, novel, and have important implications for prevention strategies," said Dr. Eric Larson, who helped direct the study.
"But they need to be confirmed, because (ours) is not a randomized controlled trial."
Such a trial would be difficult to conduct. It would require randomly assigning people to either take statins or not, watching to see who developed Alzheimer's, and looking at their brains after they died.
Statin drugs lower cholesterol and may also reduce inflammation in the body. The causes of Alzheimer's are not fully understood, but they are closely linked with cholesterol and also inflammation.
"Statins are probably more likely to help prevent the disease in certain kinds of people than others," Li said.
"Someday we may be able to know more precisely which individuals will benefit from which types of statins for preventing the changes of Alzheimer's disease," Larson added in a statement.
Statins -- which include Pfizer Inc's $10 billion-a-year Lipitor, Bristol-Myers Squibb Co's Pravachol and Merck and Co Inc's Zocor -- are the world's best-selling drugs, taken by millions to reduce the risk of heart attack.
Wednesday, August 22, 2007
Behind Atherosclerosis
Diesel: The Engine Behind Atherosclerosis?
The combination of cholesterol and particles from diesel exhaust can harden arteries and lead to heart attacks and strokes, according to a new study. The two factors together appear to be much more harmful than the effects of soot containing diesel particles or cholesterol alone, the researchers found.
The relation between diesel fumes--which contain particles less than 2.5 micrometers in diameter--and cardiovascular disease is still unclear. Epidemiological evidence has shown a link, but researchers are unsure about the mechanism. Studies have suggested, however, that like the "bad" form of cholesterol known as low density lipoprotein (LDL), diesel particles cause the release into blood vessels of free radicals, a type of oxygen molecule that is damaging to human tissue.
In the new study, immunologist Andre Nel of the University of California, Los Angeles, and his colleagues exposed samples of human vascular tissue to soot, LDL cholesterol, or both at the same time. The researchers found that the combination was especially adept at setting off genes known to cause inflammation of the blood vessels and at promoting artery hardening, or atherosclerosis.
To test whether the same was true in live animals, researchers took mice genetically engineered to have high cholesterol levels and placed them in one of three environments. The first group was exposed to filtered air for 2 months, the second to the finest particles in diesel fumes, and the third group to both fine and intermediate-sized particles. Examination of the animals' lungs showed that the two diesel groups had the same amount of damage as did the human tissue samples and similar gene activation patterns. The mice exposed to only the finest particles had the most severe damage. The study is published in the 25 July issue of Genome Biology.
"This the first study to go so far into the biology behind the effect air pollutants have on the cardiovascular system," says Stanton Glantz, a toxicologist at the University of California, San Francisco. "Most people figured there was something going on, but this gives us substantial evidence."
In future studies, Nel says he hopes to discover whether antioxidants--compounds that are found in some fruits and vegetables and that can prevent harm from free radicals--can prevent damage from diesel fumes. His team also plans on identifying genes that make people more susceptible to the effects of air pollutants, so that high-risk people may be identified with a DNA test.
So be aware of pollution.
and be healthy..
mitul patel
The combination of cholesterol and particles from diesel exhaust can harden arteries and lead to heart attacks and strokes, according to a new study. The two factors together appear to be much more harmful than the effects of soot containing diesel particles or cholesterol alone, the researchers found.
The relation between diesel fumes--which contain particles less than 2.5 micrometers in diameter--and cardiovascular disease is still unclear. Epidemiological evidence has shown a link, but researchers are unsure about the mechanism. Studies have suggested, however, that like the "bad" form of cholesterol known as low density lipoprotein (LDL), diesel particles cause the release into blood vessels of free radicals, a type of oxygen molecule that is damaging to human tissue.
In the new study, immunologist Andre Nel of the University of California, Los Angeles, and his colleagues exposed samples of human vascular tissue to soot, LDL cholesterol, or both at the same time. The researchers found that the combination was especially adept at setting off genes known to cause inflammation of the blood vessels and at promoting artery hardening, or atherosclerosis.
To test whether the same was true in live animals, researchers took mice genetically engineered to have high cholesterol levels and placed them in one of three environments. The first group was exposed to filtered air for 2 months, the second to the finest particles in diesel fumes, and the third group to both fine and intermediate-sized particles. Examination of the animals' lungs showed that the two diesel groups had the same amount of damage as did the human tissue samples and similar gene activation patterns. The mice exposed to only the finest particles had the most severe damage. The study is published in the 25 July issue of Genome Biology.
"This the first study to go so far into the biology behind the effect air pollutants have on the cardiovascular system," says Stanton Glantz, a toxicologist at the University of California, San Francisco. "Most people figured there was something going on, but this gives us substantial evidence."
In future studies, Nel says he hopes to discover whether antioxidants--compounds that are found in some fruits and vegetables and that can prevent harm from free radicals--can prevent damage from diesel fumes. His team also plans on identifying genes that make people more susceptible to the effects of air pollutants, so that high-risk people may be identified with a DNA test.
So be aware of pollution.
and be healthy..
mitul patel
Friday, August 17, 2007
Whole grains may lower odds of high blood pressure
NEW YORK (Reuters Health) - Women who get plenty of whole grains in their diet may lower their risk of developing high blood pressure, a large study suggests.
Researchers found that middle-aged and older women who ate the most whole grains were less likely than those with the lowest intakes to develop high blood pressure over the next 10 years.
The benefit was modest. Women who consumed the most whole grains had an 11-percent lower risk of high blood pressure than those with the lowest intakes.
But the findings add to evidence of the cardiovascular benefits of whole grains such as oatmeal, bran and brown rice. Past studies have tied diets rich in these foods to lower risks of heart disease and stroke.
The fiber and other nutrients in whole grains may help lower cholesterol, blood sugar and insulin levels, as well as improve blood vessel functioning and reduce inflammation in the circulatory system. Whether whole grains benefit blood pressure has been unclear, however.
For the current study, researchers at Harvard University in Boston used data from the Women's Health Study, which has followed nearly 40,000 U.S. female health professionals since 1992. Upon entering the study, the women completed detailed questionnaires on their diet habits, including their usual intake of whole-grain foods like dark bread, popcorn, oatmeal and whole-grain breakfast cereals.
Of the nearly 30,000 women who were free of high blood pressure at the outset, those who ate the most whole grains had a lower risk of developing the condition. The apparent protective effect held when the researchers considered other factors, like weight, smoking and exercise habits.
In contrast, refined grains -- like pasta, white bread and other foods made from white flour -- were unrelated to high blood pressure risk, according to the researchers, led by Dr. Lu Wang.
Unlike whole grains, refined grains are largely stripped of the fiber- and nutrient-rich bran and germ components of the plant. This difference may explain why only whole grains were related to lower blood pressure, according to Wang's team.
The findings, the researchers conclude, suggest that people may do their blood pressure and heart health some good by replacing refined-grain foods with whole grains.
SOURCE: American Journal of Clinical Nutrition, August 2007.
Researchers found that middle-aged and older women who ate the most whole grains were less likely than those with the lowest intakes to develop high blood pressure over the next 10 years.
The benefit was modest. Women who consumed the most whole grains had an 11-percent lower risk of high blood pressure than those with the lowest intakes.
But the findings add to evidence of the cardiovascular benefits of whole grains such as oatmeal, bran and brown rice. Past studies have tied diets rich in these foods to lower risks of heart disease and stroke.
The fiber and other nutrients in whole grains may help lower cholesterol, blood sugar and insulin levels, as well as improve blood vessel functioning and reduce inflammation in the circulatory system. Whether whole grains benefit blood pressure has been unclear, however.
For the current study, researchers at Harvard University in Boston used data from the Women's Health Study, which has followed nearly 40,000 U.S. female health professionals since 1992. Upon entering the study, the women completed detailed questionnaires on their diet habits, including their usual intake of whole-grain foods like dark bread, popcorn, oatmeal and whole-grain breakfast cereals.
Of the nearly 30,000 women who were free of high blood pressure at the outset, those who ate the most whole grains had a lower risk of developing the condition. The apparent protective effect held when the researchers considered other factors, like weight, smoking and exercise habits.
In contrast, refined grains -- like pasta, white bread and other foods made from white flour -- were unrelated to high blood pressure risk, according to the researchers, led by Dr. Lu Wang.
Unlike whole grains, refined grains are largely stripped of the fiber- and nutrient-rich bran and germ components of the plant. This difference may explain why only whole grains were related to lower blood pressure, according to Wang's team.
The findings, the researchers conclude, suggest that people may do their blood pressure and heart health some good by replacing refined-grain foods with whole grains.
SOURCE: American Journal of Clinical Nutrition, August 2007.
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