(HealthDay News) -- The erectile dysfunction drug Viagra may have found a new, potentially life-saving use in hospital pediatric intensive care units, researchers report.
Australian researchers gave the drug to 15 babies with congenital heart disease who were being weaned from inhaled nitric-oxide therapy, a treatment that ICUs use to help these infants survive.
The researchers found that a dose of Viagra prevented a common life-threatening complication called rebound pulmonary hypertension. They also found that it significantly reduced the amount of time the babies spent on mechanical ventilation and in the ICU.
"Rebound pulmonary hypertension is a very common problem," said Dr. Steven Abman of The Children's Hospital in Denver, who was not part of the study. "This is the most rigorous study that's ever been done to demonstrate that Viagra can prevent this complication."
The study results were published in the November issue of the American Journal of Respiratory and Critical Care Medicine.
Viagra is useful for treating both erectile dysfunction and preventing rebound pulmonary hypertension because it affects pathways involved in both conditions.
"Viagra enhances the body's levels of cyclic-GMP, a naturally occurring substance that relaxes arteries and reduces their pressure, which is why its primary indication is for men with erectile dysfunction," explained the study's lead researcher, Dr. Lara Shekerdemian of the Pediatric Intensive Care Unit at the Royal Children's Hospital in Melbourne.
"However, cyclic-GMP is abundant in the lungs and is the molecule via which nitric oxide acts as a dilator of pulmonary arteries," Shekerdemian said. "That's why its use was explored in the setting of pulmonary hypertension in the newborn."
In the study, Shekerdemian and colleagues gave a single dose of Viagra to 15 infants with congenital heart disease who were undergoing withdrawal from nitric oxide, which is used to relax pulmonary blood vessels in mechanically ventilated lungs. Another 14 infants undergoing withdrawal were given placebo.
None of the Viagra-treated infants developed rebound pulmonary hypertension compared to 10 of the placebo-treated infants. After more than 24 hours, all of the infants who developed rebound hypertension were given Viagra during a subsequent and successful attempt to wean them from nitric oxide.
The Viagra-treated infants also spent less total time on a mechanical ventilator than the placebo-treated infants -- a little over 28 hours compared to 98 hours -- and had a considerably shorter stay in the intensive care unit (47.8 hours vs. 189 hours).
"Although we expected to see an avoidance of rebound, we were not expecting to see these additional benefits," Shekerdemian said. "Any intervention that smoothes their course in the intensive-care unit would have at least a short-term positive influence on their recovery from their underlying condition."
Unless there's some reason for not using Viagra, Shekerdemian said that it should be routinely used as infants are weaned from nitric oxide. "We certainly do so now in our pediatric intensive-care unit," she said.
Many hospitals are already doing just that. "I think it already has become standard clinical practice, because the idea of using Viagra for this is not new," Abman said. "What's new is that this is the first study to look at it with a nice protocol in which they randomized patients and controlled in a blinded way.
So it verifies what we've already been doing in clinical practice."
Shekerdemian and her team are now conducting a similar study in the Royal Children's Hospital's Neonatal Intensive-Care Unit to see if Viagra can prevent rebound pulmonary hypertension in premature infants.
More information
There's more on premature newborns at the March of Dimes.
Monday, December 25, 2006
Healthy Hearts Never Take a Holiday
(HealthDay News) -- This holiday season, give yourself the gift of a healthier heart.
Limiting your alcohol consumption is one important step, said Dr. Ajit Raisinghani, director of the non-invasive cardiac lab at the University of California, San Diego.
He said that every year during the holidays, emergency rooms at hospitals across the United States see patients with heart palpitations and light headedness. Many of these patients have an abnormal heart rhythm caused by drinking too much alcohol -- a condition called "Holiday Heart."
"Usually the patient experiences palpitations accompanied by a sensation of light-headedness. When the patients come into the ER, we learn they've usually spent the weekend drinking. Most often, they're college kids who are otherwise healthy," Raisinghani said.
The condition usually resolves itself within 24 hours. However, some patients will be admitted to hospital and given medication to slow down their heart rate until it returns to its normal rhythm.
Raisinghani offered some other tips for keeping your heart healthy during the holidays and the rest of the year:
Get regular exercise -- 30 minutes of aerobic exercise three times a week can significantly reduce the risk of developing heart disease.
Limit your salt intake. Too much salt contributes to high blood pressure, a leading cause of heart failure and stroke. People who have heart disease need to be especially careful about their salt intake.
Make an effort not to gain weight over the holidays.
Avoid saturated fats, which stimulate the production of LDL (bad) cholesterol and increase blood cholesterol levels.
Learn how to effectively cope with stress, which can be caused by trying to do too much during the holidays. Tension, frustration and sadness can trigger or worsen heart irregularities.
Exercise is a good way to relieve stress.
Schedule time for rest and relaxation during the holidays.
Nurture friendly, caring relationships in order to counter loneliness, which can have negative effects on the heart.
Make time to do activities that make you happy and make you laugh.
More information
The U.S. Food and Drug Administration has more about heart health.
Limiting your alcohol consumption is one important step, said Dr. Ajit Raisinghani, director of the non-invasive cardiac lab at the University of California, San Diego.
He said that every year during the holidays, emergency rooms at hospitals across the United States see patients with heart palpitations and light headedness. Many of these patients have an abnormal heart rhythm caused by drinking too much alcohol -- a condition called "Holiday Heart."
"Usually the patient experiences palpitations accompanied by a sensation of light-headedness. When the patients come into the ER, we learn they've usually spent the weekend drinking. Most often, they're college kids who are otherwise healthy," Raisinghani said.
The condition usually resolves itself within 24 hours. However, some patients will be admitted to hospital and given medication to slow down their heart rate until it returns to its normal rhythm.
Raisinghani offered some other tips for keeping your heart healthy during the holidays and the rest of the year:
Get regular exercise -- 30 minutes of aerobic exercise three times a week can significantly reduce the risk of developing heart disease.
Limit your salt intake. Too much salt contributes to high blood pressure, a leading cause of heart failure and stroke. People who have heart disease need to be especially careful about their salt intake.
Make an effort not to gain weight over the holidays.
Avoid saturated fats, which stimulate the production of LDL (bad) cholesterol and increase blood cholesterol levels.
Learn how to effectively cope with stress, which can be caused by trying to do too much during the holidays. Tension, frustration and sadness can trigger or worsen heart irregularities.
Exercise is a good way to relieve stress.
Schedule time for rest and relaxation during the holidays.
Nurture friendly, caring relationships in order to counter loneliness, which can have negative effects on the heart.
Make time to do activities that make you happy and make you laugh.
More information
The U.S. Food and Drug Administration has more about heart health.
Draw Up a Holiday Dining Plan
(HealthDay News) -- With just a bit of planning and effort you can control your eating over the holidays, and you won't have to work so hard in January to shed extra pounds.
"Follow the smart diet," suggested Dr. Santiago Horgan, director of the Center for the Treatment of Obesity at the University of California, San Diego, Medical Center.
"Eat the calories you want but not the ones you don't need. Avoid unhealthy snacking. Think ahead and choose where you are going to consume your calories. For example, if you have a big holiday meal planned, decided ahead of time where you want to consume your calories," Horgan said in a prepared statement.
If you love pumpkin pie, then have some of that, but limit your consumption of other foods such as potatoes, gravy, or dressing.
Horgan offered some other tips on how to control your calorie intake over the holidays:
Dampen you appetite by eating a healthy snack before you go to parties.
Think about and control your portions by using a salad-sized plate for your entree and side dishes. Eat a salad on an entree-sized plate before the main meal.
Recognize when you're full. "It takes a good 20 minutes before your stomach signals you brain that it's full, so eat slowly, and the second you start feeling satisfied, stop eating," Horgan said.
Reduce the amount of fat in holiday meals. For example, use fat-free chicken broth or low-fat milk instead of butter when you prepare mashed potatoes. When sauteing celery and onions for the stuffing, use non-stick spray in the pan. Bake the stuffing in a separate dish instead of inside the turkey. Skim the fat off the turkey drippings before you use it to make gravy.
Try to get exercise or do other kinds of physical activity to offset extra holiday calories.
More information
The American Academy of Family Physicians has more about weight control.
"Follow the smart diet," suggested Dr. Santiago Horgan, director of the Center for the Treatment of Obesity at the University of California, San Diego, Medical Center.
"Eat the calories you want but not the ones you don't need. Avoid unhealthy snacking. Think ahead and choose where you are going to consume your calories. For example, if you have a big holiday meal planned, decided ahead of time where you want to consume your calories," Horgan said in a prepared statement.
If you love pumpkin pie, then have some of that, but limit your consumption of other foods such as potatoes, gravy, or dressing.
Horgan offered some other tips on how to control your calorie intake over the holidays:
Dampen you appetite by eating a healthy snack before you go to parties.
Think about and control your portions by using a salad-sized plate for your entree and side dishes. Eat a salad on an entree-sized plate before the main meal.
Recognize when you're full. "It takes a good 20 minutes before your stomach signals you brain that it's full, so eat slowly, and the second you start feeling satisfied, stop eating," Horgan said.
Reduce the amount of fat in holiday meals. For example, use fat-free chicken broth or low-fat milk instead of butter when you prepare mashed potatoes. When sauteing celery and onions for the stuffing, use non-stick spray in the pan. Bake the stuffing in a separate dish instead of inside the turkey. Skim the fat off the turkey drippings before you use it to make gravy.
Try to get exercise or do other kinds of physical activity to offset extra holiday calories.
More information
The American Academy of Family Physicians has more about weight control.
Unwrapping the Science of Santa's Mystical Journey
(HealthDay News) -- It's a question that has puzzled kids and grown-ups for centuries: How does Santa Claus get all those gifts to millions of homes worldwide in just one night?
In St. Louis, four-year-old Kaelyn this week suggested Santa "wraps presents ahead of time," which certainly must help.
Standing near her at a recent performance of The Nutcracker, six-year-old Liam proposed a high-tech solution. "He has a gadget on his sleigh that makes it go turbo. He can go down the chimney in one second!" he said.
Over in Hillsdale, N.J., however, five-year-old Amelia offered a simpler solution: "Maybe he has a secret shortcut."
Each of these kids may be onto something, according to Santa expert Larry Silverberg, a noted U.S. engineer and self-described "rocket scientist."
Silverberg is a professor of mechanical and aerospace engineering at North Carolina State University in Raleigh. He believes that Santa -- whom experts say moved to his underground complex at the North Pole more than 500 years ago -- has spent the last five centuries researching better ways to deliver presents at light-speed to kids everywhere.
In doing so, he and the elves have made scientific breakthroughs that the rest of humanity can only dream of, Silverberg said.
First up: Santa's uncanny ability to understand children's wishes in the weeks leading up to Christmas.
Letters to Santa are a big help, of course.
"But up at the North Pole, you also have a lot of space to construct an underground antenna that can span miles," Silverberg said. "You collect incoming electromagnetic waves and filter them, finding out which thought-waves are coming from which kids."
Sounds impossible, you say?
"Remember, we have EEG technology now to measure brain waves," Silverberg said. "And when you're talking on your wireless cell phone, there's a very complicated process whereby signals coming from around the world get to you. All that seems like magic, too. Santa's just a bit more advanced."
Of course, further filtering is done to divide children into the required naughty/nice categories, but technologies such as the polygraph lie-detector suggest that that's "probably one of the easier things to do," Silverberg said.
Once wishes are collected in his huge Arctic database, Santa checks them twice and then waits for what people call "Christmas Eve."
To most children, Christmas Eve seems like a few very long hours.
Not so for Santa, though.
"It's tough to explain, but in his 'theory of relativity,' Albert Einstein discovered that space and time are bendable," Silverberg said. While the theory is almost a century old, modern society has yet to harness relativity.
Santa did so long ago, however, and uses it each Christmas.
"What we know about physics is that, in one reference frame, distance and time look different than in another," Silverberg explained. "Time can dilate -- get much longer -- and space can contract. That's exactly what you'd need to deliver millions of gifts around the globe on one night."
Silverberg's hypothesis -- as yet unproven -- is that Santa uses his advanced knowledge to wrap his sleigh and eight reindeer in a "relativity cloud."
"So, inside the cloud a month might go by, but it would only feel like a split-second outside the cloud -- for example, in a child's bedroom," the expert said. "Santa probably also shrinks and expands the cloud, so he can enter houses through tiny openings. A chimney is one such entryway, but he might also enter through keyholes, doggy-doors, etc."
Silverberg's team at NCSU performed detailed calculations using this relativity model. "We found that in six months, a fleet of 750 sleighs could get to all of the homes on Earth, traveling an average of 84 mph in the relativity cloud," he said. "Of course, outside the cloud, all that happens on Christmas Eve."
Highly advanced onboard computers with built in GPS-like systems also plot optimal routes from Santa's central SleighPort at the North Pole out to the seven continents. "Federal Express and UPS already have similar, but more primitive, systems," Silverberg noted.
The lightning speed at which Santa arrives at, and then leaves, houses means that children will be hard-pressed to actually spot him, of course. "Sure, sometimes you hear of kids seeing him on the roof or at the Christmas tree, but that's incredibly rare," Silverberg said.
Of course, those reindeer help, too. "'St. Nick fell in love with reindeer when he first moved North, and he's been using genetic bioengineering to perfect their flying, their roof-walking and their night-vision abilities ever since," Silverberg said.
He also wanted to clear up one misconception. "I believe that Santa does not bring toys from the Pole to each home -- that's just far too bulky and inefficient," the scientist said.
Instead, the jolly gent uses sophisticated nanotechnology to build toys and other presents in a flash, right there on the family living-room floor. "It's a process of bringing atomic physics to engineering, something we're only now exploring ourselves," Silverberg said.
The end result of all this high-tech yuletide wizardry: millions of absolutely thrilled kids -- and grown-ups -- on the morning of Dec. 25.
Other experts agreed, more or less, with Silverberg's theories.
Five-year-old Ellie, of Alexandria, Va., figured that Santa is "very fast, works very hard, and has lots of elves to help him."
Back in St. Louis, three-year-old Elle didn't seem interested in all that complicated science. Her answer to the Christmas Eve riddle: "Because he's Santa."
More information
There's more on the "science of Santa" here.
In St. Louis, four-year-old Kaelyn this week suggested Santa "wraps presents ahead of time," which certainly must help.
Standing near her at a recent performance of The Nutcracker, six-year-old Liam proposed a high-tech solution. "He has a gadget on his sleigh that makes it go turbo. He can go down the chimney in one second!" he said.
Over in Hillsdale, N.J., however, five-year-old Amelia offered a simpler solution: "Maybe he has a secret shortcut."
Each of these kids may be onto something, according to Santa expert Larry Silverberg, a noted U.S. engineer and self-described "rocket scientist."
Silverberg is a professor of mechanical and aerospace engineering at North Carolina State University in Raleigh. He believes that Santa -- whom experts say moved to his underground complex at the North Pole more than 500 years ago -- has spent the last five centuries researching better ways to deliver presents at light-speed to kids everywhere.
In doing so, he and the elves have made scientific breakthroughs that the rest of humanity can only dream of, Silverberg said.
First up: Santa's uncanny ability to understand children's wishes in the weeks leading up to Christmas.
Letters to Santa are a big help, of course.
"But up at the North Pole, you also have a lot of space to construct an underground antenna that can span miles," Silverberg said. "You collect incoming electromagnetic waves and filter them, finding out which thought-waves are coming from which kids."
Sounds impossible, you say?
"Remember, we have EEG technology now to measure brain waves," Silverberg said. "And when you're talking on your wireless cell phone, there's a very complicated process whereby signals coming from around the world get to you. All that seems like magic, too. Santa's just a bit more advanced."
Of course, further filtering is done to divide children into the required naughty/nice categories, but technologies such as the polygraph lie-detector suggest that that's "probably one of the easier things to do," Silverberg said.
Once wishes are collected in his huge Arctic database, Santa checks them twice and then waits for what people call "Christmas Eve."
To most children, Christmas Eve seems like a few very long hours.
Not so for Santa, though.
"It's tough to explain, but in his 'theory of relativity,' Albert Einstein discovered that space and time are bendable," Silverberg said. While the theory is almost a century old, modern society has yet to harness relativity.
Santa did so long ago, however, and uses it each Christmas.
"What we know about physics is that, in one reference frame, distance and time look different than in another," Silverberg explained. "Time can dilate -- get much longer -- and space can contract. That's exactly what you'd need to deliver millions of gifts around the globe on one night."
Silverberg's hypothesis -- as yet unproven -- is that Santa uses his advanced knowledge to wrap his sleigh and eight reindeer in a "relativity cloud."
"So, inside the cloud a month might go by, but it would only feel like a split-second outside the cloud -- for example, in a child's bedroom," the expert said. "Santa probably also shrinks and expands the cloud, so he can enter houses through tiny openings. A chimney is one such entryway, but he might also enter through keyholes, doggy-doors, etc."
Silverberg's team at NCSU performed detailed calculations using this relativity model. "We found that in six months, a fleet of 750 sleighs could get to all of the homes on Earth, traveling an average of 84 mph in the relativity cloud," he said. "Of course, outside the cloud, all that happens on Christmas Eve."
Highly advanced onboard computers with built in GPS-like systems also plot optimal routes from Santa's central SleighPort at the North Pole out to the seven continents. "Federal Express and UPS already have similar, but more primitive, systems," Silverberg noted.
The lightning speed at which Santa arrives at, and then leaves, houses means that children will be hard-pressed to actually spot him, of course. "Sure, sometimes you hear of kids seeing him on the roof or at the Christmas tree, but that's incredibly rare," Silverberg said.
Of course, those reindeer help, too. "'St. Nick fell in love with reindeer when he first moved North, and he's been using genetic bioengineering to perfect their flying, their roof-walking and their night-vision abilities ever since," Silverberg said.
He also wanted to clear up one misconception. "I believe that Santa does not bring toys from the Pole to each home -- that's just far too bulky and inefficient," the scientist said.
Instead, the jolly gent uses sophisticated nanotechnology to build toys and other presents in a flash, right there on the family living-room floor. "It's a process of bringing atomic physics to engineering, something we're only now exploring ourselves," Silverberg said.
The end result of all this high-tech yuletide wizardry: millions of absolutely thrilled kids -- and grown-ups -- on the morning of Dec. 25.
Other experts agreed, more or less, with Silverberg's theories.
Five-year-old Ellie, of Alexandria, Va., figured that Santa is "very fast, works very hard, and has lots of elves to help him."
Back in St. Louis, three-year-old Elle didn't seem interested in all that complicated science. Her answer to the Christmas Eve riddle: "Because he's Santa."
More information
There's more on the "science of Santa" here.
Wednesday, December 13, 2006
Exercise Cuts Breast Cancer Risk
(HealthDay News) -- Postmenopausal women who engage in more vigorous physical activity seem to have a lower risk of breast cancer.
The beneficial effect was most pronounced for estrogen receptor positive/progesterone receptor negative tumors, which are generally more aggressive.
"It seems like another confirmation to the fact that exercise will help reduce the risk of breast carcinoma and may play some other interesting roles in addition to effects on cardiovascular health," said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La.
While overweight and obesity are risk factors for breast cancer, the findings also suggest that additional mechanisms may be involved in promoting the growth of tumors.
The association between exercise and a reduced risk of breast cancer is not a new one. Previous studies have shown that physical activity can reduce the risk for the disease among women of all ages.
But because breast cancer is such a varied disease, there may be different risk factors, depending on different tumor characteristics, including estrogen receptor (ER) and progesterone receptor (PR) status. Receptor status refers to whether these hormones bind to the surface of the tumor.
Only three small studies have looked at the association between physical activity and postmenopausal breast cancer defined by receptor status, the study authors said.
The new study, called the Iowa Women's Health Study, is the largest study to cross-classify estrogen receptor (ER) and progesterone receptor (PR) status, said Dr. James Cerhan, senior author of the study and professor of epidemiology at the Mayo Clinic College of Medicine in Rochester, Minn. The findings are published in the Dec. 11/25 issue of Archives of Internal Medicine.
Cerhan and his colleagues looked at 41,836 postmenopausal women who were between the ages of 55 and 69 in 1986. The participants filled out a 16-page questionnaire at the beginning of the study about their recreational physical activity and then were monitored for 18 years.
Women who engaged in high levels of physical activity had a 14 percent lower risk of breast cancer than those who participated in low levels of activity. After the researchers adjusted for body mass index (BMI, a ratio of weight to height), they found that women with high physical activity levels had a 9 percent lower risk of breast cancer.
"Physical activity protected against breast cancer, but when we adjusted for BMI, it weakened the association," Cerhan explained.
This would imply that something in addition to exercise contributed to the protective effect.
The findings were even more striking when hormone receptor status was taken into account. Women with high physical activity levels had a 33 percent lower risk of developing estrogen receptor-positive tumors.
High levels of physical activity included vigorous exercise such as jogging, swimming or racket sports two or more times a week or moderate activity such as bowling, golf, gardening or walking more than four times a week. Medium physical activity was vigorous activity once a week or moderate activity one to four times a week.
Being overweight is a well-known risk factor for breast cancer, as body fat produces estrogen that signals some tumors to grow.
"This is another reason to be physically active. But I think much of the information is for medical scientists trying to think about the mechanisms of breast cancer," Cerhan said.
More information
To learn more about breast cancer, visit the American Cancer Society.
The beneficial effect was most pronounced for estrogen receptor positive/progesterone receptor negative tumors, which are generally more aggressive.
"It seems like another confirmation to the fact that exercise will help reduce the risk of breast carcinoma and may play some other interesting roles in addition to effects on cardiovascular health," said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La.
While overweight and obesity are risk factors for breast cancer, the findings also suggest that additional mechanisms may be involved in promoting the growth of tumors.
The association between exercise and a reduced risk of breast cancer is not a new one. Previous studies have shown that physical activity can reduce the risk for the disease among women of all ages.
But because breast cancer is such a varied disease, there may be different risk factors, depending on different tumor characteristics, including estrogen receptor (ER) and progesterone receptor (PR) status. Receptor status refers to whether these hormones bind to the surface of the tumor.
Only three small studies have looked at the association between physical activity and postmenopausal breast cancer defined by receptor status, the study authors said.
The new study, called the Iowa Women's Health Study, is the largest study to cross-classify estrogen receptor (ER) and progesterone receptor (PR) status, said Dr. James Cerhan, senior author of the study and professor of epidemiology at the Mayo Clinic College of Medicine in Rochester, Minn. The findings are published in the Dec. 11/25 issue of Archives of Internal Medicine.
Cerhan and his colleagues looked at 41,836 postmenopausal women who were between the ages of 55 and 69 in 1986. The participants filled out a 16-page questionnaire at the beginning of the study about their recreational physical activity and then were monitored for 18 years.
Women who engaged in high levels of physical activity had a 14 percent lower risk of breast cancer than those who participated in low levels of activity. After the researchers adjusted for body mass index (BMI, a ratio of weight to height), they found that women with high physical activity levels had a 9 percent lower risk of breast cancer.
"Physical activity protected against breast cancer, but when we adjusted for BMI, it weakened the association," Cerhan explained.
This would imply that something in addition to exercise contributed to the protective effect.
The findings were even more striking when hormone receptor status was taken into account. Women with high physical activity levels had a 33 percent lower risk of developing estrogen receptor-positive tumors.
High levels of physical activity included vigorous exercise such as jogging, swimming or racket sports two or more times a week or moderate activity such as bowling, golf, gardening or walking more than four times a week. Medium physical activity was vigorous activity once a week or moderate activity one to four times a week.
Being overweight is a well-known risk factor for breast cancer, as body fat produces estrogen that signals some tumors to grow.
"This is another reason to be physically active. But I think much of the information is for medical scientists trying to think about the mechanisms of breast cancer," Cerhan said.
More information
To learn more about breast cancer, visit the American Cancer Society.
Younger Siblings May Boost Brain Tumor Risk
(HealthDay News) -- Can the number of brothers and sisters you have affect your risk of developing a brain tumor?
Possibly, German researchers report. They found that children with three or more younger siblings face two to four times the risk of developing a brain tumor by age 15 compared to children with no siblings.
This risk was not seen in children with three or more older siblings or in adults who grew up in large families, however.
"The association with number of younger siblings, and not with number of older siblings, suggests that infections or re-infections in late childhood may play an important role in the development of pediatric nervous system tumors," said lead researcher Dr. Andrea Altieri, of the German Cancer Research Center in Heidelberg, Germany. The findings are published in the Dec. 12 issue of Neurology.
The population-based study, which Altieri called the largest of its kind, analyzed more than 13,600 Swedish brain tumor cases.
It found that children with three or more younger siblings had twice the risk of nervous system tumors known as neuroblastomas, more than twice the risk of brain cancers such as medulloblastoma or ependymoma, and nearly a quadruple risk of meningioma (cancer of the brain's lining, the meninges) compared to children with no siblings.
"The association between the number of siblings and other measures of child overcrowding and the risk of infections is well-documented," Altieri said. "The strongest evidence comes from several studies showing that children attending day-care centers have a two- to fourfold increased risk of infection compared to children cared for at home."
But how would the age of siblings influence brain tumor risk? Altieri has a theory.
"When you have many younger siblings, you have a higher risk of infection during early adolescence and a higher risk of being re-infected from your younger siblings," the researcher pointed out.
On the other hand, the presence of many older siblings increases the risk of infection in infancy and early childhood. "As has been reported for other childhood malignancies, very early infection could even be protective against nervous system tumors," Altieri said, which could explain why no increased risk was seen in children with three or more older siblings.
"There is growing evidence that specific viral infections are associated with several types of cancer," Altieri said, citing links between the Epstein-Barr virus and Hodgkin's lymphoma, human papillomavirus (HPV) and cervical cancer, hepatitis C virus and liver cancer, and HIV and Kaposi's sarcoma.
Although there may be a link between childhood infections and brain tumors, Altieri points out that there's still no proof that infections actually cause them. "Any attempt to show a causal association should selectively consider child nervous system tumors and take into account not only the type of infection but also the individual frequency of childhood infections, the age of infections and the persistency of infections," the researcher said.
"This is a large, well-done study," said Dr. Paul Graham Fisher, of Stanford University in Palo Alto, Calif. "It puts out the idea that maybe there's an issue with birth order and brain tumors, which is interesting. It also points to the fact that we don't have a good understanding of how the immune system, for good or ill, influences the development of brain tumors."
But Fisher said that the study's suggestion that infections may play a role in brain-tumor development has been contradicted by other recent epidemiological research. "A lot of folks have either abandoned or pooh-poohed the idea that brain tumors in kids are virally mediated," he said. "This study should have been put in the context of prior studies that really haven't panned out."
Fisher also faulted the researchers not considering other possible reasons why children with younger siblings are at increased risk. "Maybe it's because Scandinavian people have more children after the first one is diagnosed with a brain tumor," he said. "So, there could be a selection bias here."
Altieri said that several small studies involving fewer than 100 cases have investigated an association between different types of infections -- such as influenza during pregnancy and polyoma virus infection in childhood -- and the subsequent risk of brain tumors. "The results have been inconsistent," the researcher said. However, "this does not mean that infections are not associated with these malignancies."
Altieri allowed that other factors may account for an increased risk of brain tumors. "So far, the association of nervous system tumors with other socioeconomic factors has been very inconsistent. However, we cannot rule out the possibility that other socioeconomic correlates are associated with the disease."
More information
To learn more about primary brain tumors, visit the National Library of Medicine.
Possibly, German researchers report. They found that children with three or more younger siblings face two to four times the risk of developing a brain tumor by age 15 compared to children with no siblings.
This risk was not seen in children with three or more older siblings or in adults who grew up in large families, however.
"The association with number of younger siblings, and not with number of older siblings, suggests that infections or re-infections in late childhood may play an important role in the development of pediatric nervous system tumors," said lead researcher Dr. Andrea Altieri, of the German Cancer Research Center in Heidelberg, Germany. The findings are published in the Dec. 12 issue of Neurology.
The population-based study, which Altieri called the largest of its kind, analyzed more than 13,600 Swedish brain tumor cases.
It found that children with three or more younger siblings had twice the risk of nervous system tumors known as neuroblastomas, more than twice the risk of brain cancers such as medulloblastoma or ependymoma, and nearly a quadruple risk of meningioma (cancer of the brain's lining, the meninges) compared to children with no siblings.
"The association between the number of siblings and other measures of child overcrowding and the risk of infections is well-documented," Altieri said. "The strongest evidence comes from several studies showing that children attending day-care centers have a two- to fourfold increased risk of infection compared to children cared for at home."
But how would the age of siblings influence brain tumor risk? Altieri has a theory.
"When you have many younger siblings, you have a higher risk of infection during early adolescence and a higher risk of being re-infected from your younger siblings," the researcher pointed out.
On the other hand, the presence of many older siblings increases the risk of infection in infancy and early childhood. "As has been reported for other childhood malignancies, very early infection could even be protective against nervous system tumors," Altieri said, which could explain why no increased risk was seen in children with three or more older siblings.
"There is growing evidence that specific viral infections are associated with several types of cancer," Altieri said, citing links between the Epstein-Barr virus and Hodgkin's lymphoma, human papillomavirus (HPV) and cervical cancer, hepatitis C virus and liver cancer, and HIV and Kaposi's sarcoma.
Although there may be a link between childhood infections and brain tumors, Altieri points out that there's still no proof that infections actually cause them. "Any attempt to show a causal association should selectively consider child nervous system tumors and take into account not only the type of infection but also the individual frequency of childhood infections, the age of infections and the persistency of infections," the researcher said.
"This is a large, well-done study," said Dr. Paul Graham Fisher, of Stanford University in Palo Alto, Calif. "It puts out the idea that maybe there's an issue with birth order and brain tumors, which is interesting. It also points to the fact that we don't have a good understanding of how the immune system, for good or ill, influences the development of brain tumors."
But Fisher said that the study's suggestion that infections may play a role in brain-tumor development has been contradicted by other recent epidemiological research. "A lot of folks have either abandoned or pooh-poohed the idea that brain tumors in kids are virally mediated," he said. "This study should have been put in the context of prior studies that really haven't panned out."
Fisher also faulted the researchers not considering other possible reasons why children with younger siblings are at increased risk. "Maybe it's because Scandinavian people have more children after the first one is diagnosed with a brain tumor," he said. "So, there could be a selection bias here."
Altieri said that several small studies involving fewer than 100 cases have investigated an association between different types of infections -- such as influenza during pregnancy and polyoma virus infection in childhood -- and the subsequent risk of brain tumors. "The results have been inconsistent," the researcher said. However, "this does not mean that infections are not associated with these malignancies."
Altieri allowed that other factors may account for an increased risk of brain tumors. "So far, the association of nervous system tumors with other socioeconomic factors has been very inconsistent. However, we cannot rule out the possibility that other socioeconomic correlates are associated with the disease."
More information
To learn more about primary brain tumors, visit the National Library of Medicine.
Protein 'Fingerprint' Could Spot Alzheimer's in Living Patients
(HealthDay News) -- U.S. scientists say they've identified a panel of 23 protein biomarkers in cerebrospinal fluid that form a neurochemical "fingerprint" that may someday be used to confirm Alzheimer's disease in living patients.Currently, doctors rely on their judgment to determine whether a patient has Alzheimer's instead of another form of dementia. In most cases, a true diagnosis can only be confirmed when brain tissue is examined after a patient dies, noted researchers at Cornell University and Weill Cornell Medical College.
"Our study is the first to use sophisticated proteomic methods to hone in on a group of cerebrospinal fluid biomarkers that are specific to autopsy-proven Alzheimer's disease.
Those postmortem tests confirmed that the panel is over 90 percent sensitive in identifying people with Alzheimer's disease," Kelvin Lee, a professor of molecular and cell biology and an associate professor of chemical and biomolecular engineering at Cornell, said in a prepared statement.
The researchers compared 2,000 cerebrospinal proteins from 34 patients with autopsy-proven Alzheimer's to those from 34 age-matched people without Alzheimer's disease.
"Just as the human genome reflects the array of genes a person possesses, the 'proteome' is the vast collection of proteins expressed by those genes. Essentially, we used high-tech methods to contrast the proteomes of Alzheimer's patients against those of a control cohort that included people with other forms of dementia as well as healthy individuals, looking for key differences between the two groups," Lee said.
The findings are published in the December online issue of the Annals of Neurology.
"Typically, Alzheimer's disease is not diagnosed until the disease has already caused some amount of dementia. Having a chemical test available may allow patients to be diagnosed earlier in the course of the disease," lead author Erin Finehout said in a prepared statement.
A highly accurate biomarker test for Alzheimer's could help guide patient treatment and may prove valuable in research by helping scientists gauge the impact of treatments for the disease.
More information
The U.S. National Institute of Neurological Disorders and Stroke has more about Alzheimer's disease.
Treatment Beats Watchful Waiting for Older Prostate Cancer Patients
(HealthDay News) -- Aggressive treatment of early prostate cancer, and not watchful waiting, improves the survival of older men, a new study suggests.
"There has been a belief that watchful waiting was the safest treatment for older men with moderate prostate cancer," said Dr. Yu-Ning Wong, an oncologist at Fox Chase Cancer Center who is lead author of the report in the Dec. 13 issue of the Journal of the American Medical Association. "Our study suggests there may be a survival benefit," Wong said.
But a more definitive answer will have to wait for the outcome of controlled studies that are under way, Wong added.
"Our study was observational," she said. "We looked at the records of men treated or not treated for prostate cancer. It was not a randomized, controlled trial."
The issue of treatment vs. watchful waiting has grown in importance as more men live longer; many are diagnosed with low- and intermediate-grade cancer that poses no immediate threat to their lives.
The study looked at data on more than 44,000 such men, aged 65 to 80, who survived a year or more past diagnosis. About three quarters of them -- 32,000 -- had surgery or radiation therapy in the six months following diagnosis. Another 12,600 did not, as the physicians opted for watchful waiting.
The death rate for men who received treatment was 31 percent lower over a 12-year follow-up period, the researchers reported. The death rate was 23.8 percent for those who had treatment, compared to 37 percent for those who did not.
The reduced death rate was seen in all subgroups, including men aged 75 to 80 at diagnosis and those with low-risk disease.
"The cautionary note when interpreting this trial is that although it suggests that every man should be treated radically, the decision must be made case by case," said Dr. Mark S. Litwin, a professor of urology and public health at the University of California, Los Angeles, and co-author of an accompanying editorial.
As a general principle, "we know that most men don't die from it [prostate cancer], but die with it," Litwin said. "One has to be careful to be sure not to over-treat. The treatment can be worse than the disease."
When making a decision, the doctor "has to be very astute in assessing a patient's general functional status and overall health," Litwin said. And the patient's voice must be heard, he added.
"The patient should be the driving voice," Litwin said. "The physician must be cautious not to be paternalistic because this generally is not an acute, life-threatening illness."
Some smaller studies have indicated a benefit for watchful waiting, but most have found better survival with treatment, Wong said.
"Ultimately, a randomized, controlled trial will give us the answer we are looking for," Litwin said.
Such a trial is being done by the U.S. Veterans Administration, Wong said. Results are expected in a few years.
Until then, "the decision needs to be based on the patient's overall condition and personal beliefs," she said.
More information
The U.S. National Cancer Institute can tell you more about prostate cancer.
"There has been a belief that watchful waiting was the safest treatment for older men with moderate prostate cancer," said Dr. Yu-Ning Wong, an oncologist at Fox Chase Cancer Center who is lead author of the report in the Dec. 13 issue of the Journal of the American Medical Association. "Our study suggests there may be a survival benefit," Wong said.
But a more definitive answer will have to wait for the outcome of controlled studies that are under way, Wong added.
"Our study was observational," she said. "We looked at the records of men treated or not treated for prostate cancer. It was not a randomized, controlled trial."
The issue of treatment vs. watchful waiting has grown in importance as more men live longer; many are diagnosed with low- and intermediate-grade cancer that poses no immediate threat to their lives.
The study looked at data on more than 44,000 such men, aged 65 to 80, who survived a year or more past diagnosis. About three quarters of them -- 32,000 -- had surgery or radiation therapy in the six months following diagnosis. Another 12,600 did not, as the physicians opted for watchful waiting.
The death rate for men who received treatment was 31 percent lower over a 12-year follow-up period, the researchers reported. The death rate was 23.8 percent for those who had treatment, compared to 37 percent for those who did not.
The reduced death rate was seen in all subgroups, including men aged 75 to 80 at diagnosis and those with low-risk disease.
"The cautionary note when interpreting this trial is that although it suggests that every man should be treated radically, the decision must be made case by case," said Dr. Mark S. Litwin, a professor of urology and public health at the University of California, Los Angeles, and co-author of an accompanying editorial.
As a general principle, "we know that most men don't die from it [prostate cancer], but die with it," Litwin said. "One has to be careful to be sure not to over-treat. The treatment can be worse than the disease."
When making a decision, the doctor "has to be very astute in assessing a patient's general functional status and overall health," Litwin said. And the patient's voice must be heard, he added.
"The patient should be the driving voice," Litwin said. "The physician must be cautious not to be paternalistic because this generally is not an acute, life-threatening illness."
Some smaller studies have indicated a benefit for watchful waiting, but most have found better survival with treatment, Wong said.
"Ultimately, a randomized, controlled trial will give us the answer we are looking for," Litwin said.
Such a trial is being done by the U.S. Veterans Administration, Wong said. Results are expected in a few years.
Until then, "the decision needs to be based on the patient's overall condition and personal beliefs," she said.
More information
The U.S. National Cancer Institute can tell you more about prostate cancer.
Monday, December 04, 2006
'Double Diabetes' a New Threat
(HealthDay News) -- Despite the flurry of public service campaigns and education efforts, the diabetes epidemic in the United States continues to escalate out of control.
An estimated 20.8 million Americans -- or 7 percent of the population -- are now believed to be diabetic. Of those, 6.2 million people have the disease but don't know it. And that doesn't include the 41million people with pre-diabetes, a condition in which blood-glucose levels are higher than normal but not high enough to be diagnosed as type 2 diabetes.
In fact, the epidemic has become so pervasive that doctors are now finding patients who suffer from both type 1 and type 2 diabetes -- a phenomenon known as "double diabetes" or "hybrid diabetes."
"It's mostly people who have a type 1 diabetes who become overweight and show the profile of a type 2, with obesity and hypertension," said Dr. Stewart Weiss, an assistant clinical professor of medicine at New York University School of Medicine in New York City.
Doctors and health-care experts are urging people to take the steps necessary -- basically proper nutrition and plenty of exercise -- to avoid joining the ranks of those already diagnosed with the disease.
Type 1 diabetes is caused by the body's inability to produce insulin, the hormone that ushers blood sugar -- called glucose -- to cells for energy. An estimated 5 percent to 10 percent of Americans with diabetes have type 1 disease. Type 2 diabetes results from insulin resistance -- the body's inability to properly use the hormone. Most Americans diagnosed with diabetes have type 2 diabetes, and excess weight and lack of exercise are big contributors to this form of the disease.
But, doctors are now seeing strong indications that double diabetes is a growing phenomenon. For instance, recent studies suggest that as many as 30 percent of newly diagnosed diabetes cases among children involve youngsters with both type 1 and type 2 diabetes.
Generally, double-diabetes sufferers will often look as though they have the more common type 2 version because they're overweight. But subsequent blood tests reveal they also have type 1 disease.
Double diabetes takes the suffering caused by the disease a step further, and complicates efforts to treat it.
Type 1 diabetics normally have to take daily injections of insulin to remain healthy, while type 2 diabetics require different medication and regular monitoring of their blood sugar. Doctors now are researching how to juggle treating both types of diabetes in the same patient, Weiss said.
"We have all sorts of medications that address different problems for different types of diabetes," Weiss said. "The question with double diabetes becomes, when can we use the different types of medications and what would be appropriate for different patients?"
Weiss suspects that double diabetes might be caused, in part, by type 1 diabetics who are taking insulin but haven't made the other lifestyle changes necessary to deal with the disease.
"One of the consequences of proper insulin use is weight gain," he said. "Often, patients who have not had a good understanding of how to eat are taking the insulin to cover what they normally eat."
The national trend toward unhealthy weight gain has spurred both the diabetes epidemic and this newer, more complex form of the disease, agreed Dr. Francine Kaufman, past president of the American Diabetes Association and head of the Division of Endocrinology and Metabolism at Childrens Hospital Los Angeles.
"It's mirroring the obesity epidemic," Kaufman said.
Diabetes can cause a number of complications that range from life-damaging to life-threatening. They include heart disease and stroke, high blood pressure, blindness, diseases of the nervous system, lower-limb amputations, dental disease and complications during pregnancy.
The best way to avoid these complications is to avoid contracting diabetes. A recent study conclusively showed that people on the verge of contracting type 2 diabetes prevented its onset through changes to their diet and increased exercise, according to the American Diabetes Association.
The federal Diabetes Prevention Program study found that diet and exercise actually worked better than some medications in delaying the development of diabetes, according to the association. Just 30 minutes a day of moderate physical activity, coupled with a five percent to 10 percent reduction in body weight, produced a 58 percent reduction in diabetes.
"People need to maintain a healthy weight and a healthy lifestyle," Kaufman said.
Weiss recommends improving diet by eating more vegetables, fewer starches and more lean meat and fish. "I like to say there's no medication that can overcome a bad diet," he said.
He also said people should not only eat healthier, but they should try to eat less, too.
"The problem really is overeating in general," he said. "The portion size put before us is very large, so portion control is the single most important thing. You've got to know when to say when."
More information
To learn more, visit the American Diabetes Association.
An estimated 20.8 million Americans -- or 7 percent of the population -- are now believed to be diabetic. Of those, 6.2 million people have the disease but don't know it. And that doesn't include the 41million people with pre-diabetes, a condition in which blood-glucose levels are higher than normal but not high enough to be diagnosed as type 2 diabetes.
In fact, the epidemic has become so pervasive that doctors are now finding patients who suffer from both type 1 and type 2 diabetes -- a phenomenon known as "double diabetes" or "hybrid diabetes."
"It's mostly people who have a type 1 diabetes who become overweight and show the profile of a type 2, with obesity and hypertension," said Dr. Stewart Weiss, an assistant clinical professor of medicine at New York University School of Medicine in New York City.
Doctors and health-care experts are urging people to take the steps necessary -- basically proper nutrition and plenty of exercise -- to avoid joining the ranks of those already diagnosed with the disease.
Type 1 diabetes is caused by the body's inability to produce insulin, the hormone that ushers blood sugar -- called glucose -- to cells for energy. An estimated 5 percent to 10 percent of Americans with diabetes have type 1 disease. Type 2 diabetes results from insulin resistance -- the body's inability to properly use the hormone. Most Americans diagnosed with diabetes have type 2 diabetes, and excess weight and lack of exercise are big contributors to this form of the disease.
But, doctors are now seeing strong indications that double diabetes is a growing phenomenon. For instance, recent studies suggest that as many as 30 percent of newly diagnosed diabetes cases among children involve youngsters with both type 1 and type 2 diabetes.
Generally, double-diabetes sufferers will often look as though they have the more common type 2 version because they're overweight. But subsequent blood tests reveal they also have type 1 disease.
Double diabetes takes the suffering caused by the disease a step further, and complicates efforts to treat it.
Type 1 diabetics normally have to take daily injections of insulin to remain healthy, while type 2 diabetics require different medication and regular monitoring of their blood sugar. Doctors now are researching how to juggle treating both types of diabetes in the same patient, Weiss said.
"We have all sorts of medications that address different problems for different types of diabetes," Weiss said. "The question with double diabetes becomes, when can we use the different types of medications and what would be appropriate for different patients?"
Weiss suspects that double diabetes might be caused, in part, by type 1 diabetics who are taking insulin but haven't made the other lifestyle changes necessary to deal with the disease.
"One of the consequences of proper insulin use is weight gain," he said. "Often, patients who have not had a good understanding of how to eat are taking the insulin to cover what they normally eat."
The national trend toward unhealthy weight gain has spurred both the diabetes epidemic and this newer, more complex form of the disease, agreed Dr. Francine Kaufman, past president of the American Diabetes Association and head of the Division of Endocrinology and Metabolism at Childrens Hospital Los Angeles.
"It's mirroring the obesity epidemic," Kaufman said.
Diabetes can cause a number of complications that range from life-damaging to life-threatening. They include heart disease and stroke, high blood pressure, blindness, diseases of the nervous system, lower-limb amputations, dental disease and complications during pregnancy.
The best way to avoid these complications is to avoid contracting diabetes. A recent study conclusively showed that people on the verge of contracting type 2 diabetes prevented its onset through changes to their diet and increased exercise, according to the American Diabetes Association.
The federal Diabetes Prevention Program study found that diet and exercise actually worked better than some medications in delaying the development of diabetes, according to the association. Just 30 minutes a day of moderate physical activity, coupled with a five percent to 10 percent reduction in body weight, produced a 58 percent reduction in diabetes.
"People need to maintain a healthy weight and a healthy lifestyle," Kaufman said.
Weiss recommends improving diet by eating more vegetables, fewer starches and more lean meat and fish. "I like to say there's no medication that can overcome a bad diet," he said.
He also said people should not only eat healthier, but they should try to eat less, too.
"The problem really is overeating in general," he said. "The portion size put before us is very large, so portion control is the single most important thing. You've got to know when to say when."
More information
To learn more, visit the American Diabetes Association.
U.S. Blacks Seek Answers to AIDS Epidemic
(HealthDay News) -- By now, most Americans know the drill: Practice safer sex, and HIV should leave you and your community alone.
Except that it's not really working out that way for America's blacks. Study after study shows that HIV infections continue to escalate among this community -- especially among gay and bisexual black men -- even though they practice safe sex at rates that equal or exceed those of whites.
For example, a study published in time for World AIDS Day on Friday in the American Journal of Public Health found that young black adults who had engaged in no sex over the past year, didn't drink, and didn't abuse drugs were still 25 times more likely to test positive for a sexually transmitted disease or HIV than whites who practiced similar behaviors.
According to the U.S. Centers for Disease Control and Prevention, fully half of the nation's new HIV infections occur among blacks, who make up just 13 percent of the population. That rate continues to soar, despite the fact that condom use among blacks now tops 50 percent, compared to just one-third for young whites.
According to the CDC, black women have 21 times the risk of white women of contracting HIV, while black males are eight times as likely to become infected as white men.
And, according to a recent five-city study conducted by the CDC, a staggering 46 percent of young gay black men in America now carry HIV -- a rate that equals or exceeds that of most nations in sub-Saharan Africa. By comparison, the infection rate among gay American white men hovers around 21 percent.
"However, black men who have sex with men (MSM) do not engage in higher rates of unsafe sexual behaviors compared to other MSM -- we found that in about 30 studies," said CDC HIV/AIDS investigator Gregorio Millet. He spoke at a Foundation for AIDS Research (amfAR) summit on the issue held earlier this week in New York City.
Millet noted that studies also show that gay and bisexual black men use illicit drugs at roughly the same rate as their white peers.
So, if black Americans are doing so much that is right, what is going wrong? Twenty-five years into the AIDS epidemic, no one really knows for sure.
Denise Hallfors, the author of the American Journal of Public Health paper, said that for too long, the CDC and other public health entities have looked upon HIV/AIDS from a solidly white perspective.
Since the beginning of the AIDS epidemic, most infections among whites were largely contained within specific groups, such as gay men and intravenous drug users. "The thinking was, you have to go after those very high-risk populations," said Hallfors, who is senior research scientist at the Pacific Institute for Research and Evaluation in Chapel Hill, N.C.
"So, those are the populations that the CDC focused on and did outreach with.
And if you look at the data from our study, that makes perfect sense -- whites have very low rates of STDs if they are not in those risk categories. As soon as they enter those risk categories, their rates triple."
But the black community appears to work differently, with the borders between low- and high-risk groups much more blurred. "High-risk individuals can and often do cross over into low-risk groups," Hallfors said. "Once they cross over into the low-risk group, then they spread infection to the much larger community."
Because of the higher death and incarceration rate of black men, black women -- who tend to partner with black men -- have a smaller pool of potential mates to pick from compared to whites, Hallfors added.
"So, if you are a young black female adult and you go to church every Sunday, you have a pretty conservative lifestyle, you don't drink, smoke or do drugs, and you have even one or two partners in your lifetime, if one of them happens to be infected, you're sitting there with an STD," Hallfors said. And since this woman's apparently low-risk, church-going partner may have unknowingly contracted his infection from a prior high-risk contact, she believes she is "safe" and thus doesn't get tested for HIV, or gets tested far too late.
The same may hold true among gay black men, Millet said. "Black MSM are also less likely than other MSM to be tested for HIV," at least on a regular basis, he said. That leaves them more open to unknowingly pass the virus on to other partners.
There could be many other reasons for the virulent spread of HIV among gay black men, but the data just isn't out there, he said. Gay black men may be at higher risk because of their genetics, their lower rate of circumcision (circumcision reduces infectivity), reduced access to health care, their pattern of sexual partners, and their higher rates of incarceration -- one in four black men will serve jail time vs. one in 24 whites. "Unfortunately, there are all these hypotheses where we just don't have sufficient data," Millet said.
Until recently, there's also been little outreach to this hard-hit community, Millet added. "This epidemic has been raging among black MSM for well over 20 years and for some reason there have not been enough HIV prevention programs directed at blacks," Millet said.
Damon Dozier, director of government relations and public policy at the National Minority AIDS Council, said it's taken the recent release of shocking statistics to wake policymakers from their focus on whites.
"I think that no one really paid attention to what was going on, but that 46 percent infection rate is a huge number," he said. "Because of that, the wool has been pulled from people's eyes."
But Dozier said that the CDC, especially, is less able to tackle these issues now than it was in the past. "The CDC prevention budget has been slashed over the past few years," he said. "It would take a number of dollars just to get them back to baseline. Our hope is that with this new Congress, with Ms. Pelosi [incoming House Majority Leader Nancy Pelosi, a California Democrat] as leader, that we can devote more money to prevention and direct those prevention dollars to that 46 percent demographic."
There are signs of a real turnaround at the CDC. Late in 2005, the agency's head, Dr. Julie Gerberding, met with black activists who had pasted signs reading 46% is Unacceptable to the front of their desks. As reported by The Advocate at the time, Gerberding told them that, "Whatever we are doing right now, it is not enough."
Since then, the agency has launched a flotilla of HIV/AIDS education and prevention programs aimed at specific black communities -- many with proven track records in turning attitudes and behaviors around.
And, on Thursday, Gerderding issued a statement noting that the CDC has "recently issued new recommendations to make HIV screening a routine part of medical care for all patients between the ages of 13 and 64." Most experts who deal with minority communities say getting individuals acquainted with their HIV status is key to helping them get treated, protect their partners, and slow the epidemic.
CDC investigator Millet said he believes the situation "is getting better, in that we are now asking the right questions -- there are more people from these affected populations who are doing the needed research."
Hallfors agreed. She said that papers like hers, and new data coming out of the CDC and elsewhere, "is really important, because policymakers can start to think differently. Whites and blacks are different, the dynamics are different, and you can't just treat these diseases the same for both groups."
More information
Find out more about HIV/AIDS from the U.S. Department of Health and Human Services.
Except that it's not really working out that way for America's blacks. Study after study shows that HIV infections continue to escalate among this community -- especially among gay and bisexual black men -- even though they practice safe sex at rates that equal or exceed those of whites.
For example, a study published in time for World AIDS Day on Friday in the American Journal of Public Health found that young black adults who had engaged in no sex over the past year, didn't drink, and didn't abuse drugs were still 25 times more likely to test positive for a sexually transmitted disease or HIV than whites who practiced similar behaviors.
According to the U.S. Centers for Disease Control and Prevention, fully half of the nation's new HIV infections occur among blacks, who make up just 13 percent of the population. That rate continues to soar, despite the fact that condom use among blacks now tops 50 percent, compared to just one-third for young whites.
According to the CDC, black women have 21 times the risk of white women of contracting HIV, while black males are eight times as likely to become infected as white men.
And, according to a recent five-city study conducted by the CDC, a staggering 46 percent of young gay black men in America now carry HIV -- a rate that equals or exceeds that of most nations in sub-Saharan Africa. By comparison, the infection rate among gay American white men hovers around 21 percent.
"However, black men who have sex with men (MSM) do not engage in higher rates of unsafe sexual behaviors compared to other MSM -- we found that in about 30 studies," said CDC HIV/AIDS investigator Gregorio Millet. He spoke at a Foundation for AIDS Research (amfAR) summit on the issue held earlier this week in New York City.
Millet noted that studies also show that gay and bisexual black men use illicit drugs at roughly the same rate as their white peers.
So, if black Americans are doing so much that is right, what is going wrong? Twenty-five years into the AIDS epidemic, no one really knows for sure.
Denise Hallfors, the author of the American Journal of Public Health paper, said that for too long, the CDC and other public health entities have looked upon HIV/AIDS from a solidly white perspective.
Since the beginning of the AIDS epidemic, most infections among whites were largely contained within specific groups, such as gay men and intravenous drug users. "The thinking was, you have to go after those very high-risk populations," said Hallfors, who is senior research scientist at the Pacific Institute for Research and Evaluation in Chapel Hill, N.C.
"So, those are the populations that the CDC focused on and did outreach with.
And if you look at the data from our study, that makes perfect sense -- whites have very low rates of STDs if they are not in those risk categories. As soon as they enter those risk categories, their rates triple."
But the black community appears to work differently, with the borders between low- and high-risk groups much more blurred. "High-risk individuals can and often do cross over into low-risk groups," Hallfors said. "Once they cross over into the low-risk group, then they spread infection to the much larger community."
Because of the higher death and incarceration rate of black men, black women -- who tend to partner with black men -- have a smaller pool of potential mates to pick from compared to whites, Hallfors added.
"So, if you are a young black female adult and you go to church every Sunday, you have a pretty conservative lifestyle, you don't drink, smoke or do drugs, and you have even one or two partners in your lifetime, if one of them happens to be infected, you're sitting there with an STD," Hallfors said. And since this woman's apparently low-risk, church-going partner may have unknowingly contracted his infection from a prior high-risk contact, she believes she is "safe" and thus doesn't get tested for HIV, or gets tested far too late.
The same may hold true among gay black men, Millet said. "Black MSM are also less likely than other MSM to be tested for HIV," at least on a regular basis, he said. That leaves them more open to unknowingly pass the virus on to other partners.
There could be many other reasons for the virulent spread of HIV among gay black men, but the data just isn't out there, he said. Gay black men may be at higher risk because of their genetics, their lower rate of circumcision (circumcision reduces infectivity), reduced access to health care, their pattern of sexual partners, and their higher rates of incarceration -- one in four black men will serve jail time vs. one in 24 whites. "Unfortunately, there are all these hypotheses where we just don't have sufficient data," Millet said.
Until recently, there's also been little outreach to this hard-hit community, Millet added. "This epidemic has been raging among black MSM for well over 20 years and for some reason there have not been enough HIV prevention programs directed at blacks," Millet said.
Damon Dozier, director of government relations and public policy at the National Minority AIDS Council, said it's taken the recent release of shocking statistics to wake policymakers from their focus on whites.
"I think that no one really paid attention to what was going on, but that 46 percent infection rate is a huge number," he said. "Because of that, the wool has been pulled from people's eyes."
But Dozier said that the CDC, especially, is less able to tackle these issues now than it was in the past. "The CDC prevention budget has been slashed over the past few years," he said. "It would take a number of dollars just to get them back to baseline. Our hope is that with this new Congress, with Ms. Pelosi [incoming House Majority Leader Nancy Pelosi, a California Democrat] as leader, that we can devote more money to prevention and direct those prevention dollars to that 46 percent demographic."
There are signs of a real turnaround at the CDC. Late in 2005, the agency's head, Dr. Julie Gerberding, met with black activists who had pasted signs reading 46% is Unacceptable to the front of their desks. As reported by The Advocate at the time, Gerberding told them that, "Whatever we are doing right now, it is not enough."
Since then, the agency has launched a flotilla of HIV/AIDS education and prevention programs aimed at specific black communities -- many with proven track records in turning attitudes and behaviors around.
And, on Thursday, Gerderding issued a statement noting that the CDC has "recently issued new recommendations to make HIV screening a routine part of medical care for all patients between the ages of 13 and 64." Most experts who deal with minority communities say getting individuals acquainted with their HIV status is key to helping them get treated, protect their partners, and slow the epidemic.
CDC investigator Millet said he believes the situation "is getting better, in that we are now asking the right questions -- there are more people from these affected populations who are doing the needed research."
Hallfors agreed. She said that papers like hers, and new data coming out of the CDC and elsewhere, "is really important, because policymakers can start to think differently. Whites and blacks are different, the dynamics are different, and you can't just treat these diseases the same for both groups."
More information
Find out more about HIV/AIDS from the U.S. Department of Health and Human Services.
Prescription Labels Often Misunderstood
(HealthDay News) -- Many Americans, including those with college degrees, have trouble interpreting the instructions on prescription drug labels, a new study finds.
Indeed, only 34.7 percent of the people with lower literacy, grade level or below, interviewed for the study could determine the number of pills to take daily when faced with "take two tablets by mouth twice daily," according to the study report in Annals of Internal Medicine.
And 9 percent of all those interviewed had trouble with the instruction, "take one tablet by mouth once each day."
The problem is most common with the "two tablets twice daily," noted researcher Michael S. Wolf, assistant professor of medicine at Northwestern University's Feinberg School of Medicine. That is often misinterpreted to mean "two tablets a day," he said. But the number of misinterpretations rises with the amount of numbers included in the instructions, Wolf said.
So, "take one teaspoon twice a day for seven days" is especially confusing, for example, he noted.
It's an important issue because more and more Americans are taking more and more medications, said lead researcher Terry C. Davis, professor of medicine and pediatrics at Louisiana State University Health Sciences Center in Shreveport.
"The topic resonates because most people are taking some medication and taking them safely is important," she said.
Important enough for the American Academy of Physicians Foundation to appoint a new advisory committee, headed by Wolf, to come up with better ways of making sure that people know how much of a drug they should be taking, and when.
"We're working to push for policy change, and we expect to report this month or early in January," Wolf said.
The problem can start in the doctor's office, Davis said. "Most doctors don't give any instructions on how to take the medicine" that they write prescriptions for, she said. "Doctors can be more precise -- saying when a drug should be taken, how many times a day and for how long," she said.
This type of detailed information can be included if a patient asks for it, either in the physician's office or at the pharmacy, Davis said.
But there's a more basic problem, Wolf said. "We may need more explicit instructions," he said. "The current system is very bad at providing information on prescription drugs. Instructions can vary not only by pharmacy but also by physician."
The committee probably will recommend "some regulatory oversight to standardize dosage, of a kind we've never had before," Wolf said.
The issue of "how we can confuse patients less" about the drugs they take is of growing importance, Wolf said. He estimated that perhaps 500,000 adverse events occur each year in this country because people misread their drug instruction.
More information
There's more on prescription drugs at the U.S. Food and Drug Administration.
Indeed, only 34.7 percent of the people with lower literacy, grade level or below, interviewed for the study could determine the number of pills to take daily when faced with "take two tablets by mouth twice daily," according to the study report in Annals of Internal Medicine.
And 9 percent of all those interviewed had trouble with the instruction, "take one tablet by mouth once each day."
The problem is most common with the "two tablets twice daily," noted researcher Michael S. Wolf, assistant professor of medicine at Northwestern University's Feinberg School of Medicine. That is often misinterpreted to mean "two tablets a day," he said. But the number of misinterpretations rises with the amount of numbers included in the instructions, Wolf said.
So, "take one teaspoon twice a day for seven days" is especially confusing, for example, he noted.
It's an important issue because more and more Americans are taking more and more medications, said lead researcher Terry C. Davis, professor of medicine and pediatrics at Louisiana State University Health Sciences Center in Shreveport.
"The topic resonates because most people are taking some medication and taking them safely is important," she said.
Important enough for the American Academy of Physicians Foundation to appoint a new advisory committee, headed by Wolf, to come up with better ways of making sure that people know how much of a drug they should be taking, and when.
"We're working to push for policy change, and we expect to report this month or early in January," Wolf said.
The problem can start in the doctor's office, Davis said. "Most doctors don't give any instructions on how to take the medicine" that they write prescriptions for, she said. "Doctors can be more precise -- saying when a drug should be taken, how many times a day and for how long," she said.
This type of detailed information can be included if a patient asks for it, either in the physician's office or at the pharmacy, Davis said.
But there's a more basic problem, Wolf said. "We may need more explicit instructions," he said. "The current system is very bad at providing information on prescription drugs. Instructions can vary not only by pharmacy but also by physician."
The committee probably will recommend "some regulatory oversight to standardize dosage, of a kind we've never had before," Wolf said.
The issue of "how we can confuse patients less" about the drugs they take is of growing importance, Wolf said. He estimated that perhaps 500,000 adverse events occur each year in this country because people misread their drug instruction.
More information
There's more on prescription drugs at the U.S. Food and Drug Administration.
Choosing Safe Christmas Toys Isn't Child's Play
(HealthDay News) -- Don't toy with your child's safety this Christmas.
When picking toys, be sure to consider the youngster's age, interests and skill levels, said Dr. Michael Gittelman, an emergency medicine physician at Cincinnati Children's Hospital Medical Center.
Adults also need to read product warnings and labels on toys; avoid items with sharp edges and points; look for sturdy construction; quickly discard plastic wrappings after the toy is opened; and keep older children's toys away from younger siblings.
"Children under five years -- and especially those under three years -- are particularly vulnerable to airway obstruction due to small airways, inexperience with chewing and a natural tendency to put everything in their mouths," Gittelman said in a prepared statement.
Choking was the cause of more than 90 percent of toy-related deaths in the United States in 2003, safety experts note. Toy balls and latex balloons were responsible for most of those deaths. Parents can buy a "choke tube" to test if a toy or toy parts pose a choking hazard.
A choke tube is a small plastic cylinder with a diameter that's about the same as a child's airway. If an object fits entirely in the choke tube, it's small enough to be a choking hazard.
Riding toys are another major hazard.
"Riding toys (including unpowered scooters) are associated with more injuries than any other toy group," Gittleman warned. "Death may occur when a child is hit by a motor vehicle, or when a child rides the toy into a body of water or down the stairs. The majority of riding toy-related injuries occur when children fall from toys."
The U.S. Consumer Product Safety Commission (CPSC) offers the following age-appropriate guidelines for toys:
Newborns to age one: crib gyms, floor activity centers, activity quilts, squeaky toys, soft dolls or stuffed animals.
More information
The CPSC has more about toy safety.
When picking toys, be sure to consider the youngster's age, interests and skill levels, said Dr. Michael Gittelman, an emergency medicine physician at Cincinnati Children's Hospital Medical Center.
Adults also need to read product warnings and labels on toys; avoid items with sharp edges and points; look for sturdy construction; quickly discard plastic wrappings after the toy is opened; and keep older children's toys away from younger siblings.
"Children under five years -- and especially those under three years -- are particularly vulnerable to airway obstruction due to small airways, inexperience with chewing and a natural tendency to put everything in their mouths," Gittelman said in a prepared statement.
Choking was the cause of more than 90 percent of toy-related deaths in the United States in 2003, safety experts note. Toy balls and latex balloons were responsible for most of those deaths. Parents can buy a "choke tube" to test if a toy or toy parts pose a choking hazard.
A choke tube is a small plastic cylinder with a diameter that's about the same as a child's airway. If an object fits entirely in the choke tube, it's small enough to be a choking hazard.
Riding toys are another major hazard.
"Riding toys (including unpowered scooters) are associated with more injuries than any other toy group," Gittleman warned. "Death may occur when a child is hit by a motor vehicle, or when a child rides the toy into a body of water or down the stairs. The majority of riding toy-related injuries occur when children fall from toys."
The U.S. Consumer Product Safety Commission (CPSC) offers the following age-appropriate guidelines for toys:
Newborns to age one: crib gyms, floor activity centers, activity quilts, squeaky toys, soft dolls or stuffed animals.
- Ages one to three: soft blocks, large blocks, push and pull toys, books, pounding and shaping toys.
- Ages three to five: nontoxic art supplies, pretend toys (i.e. play money, telephone), teddy bears or dolls, outdoor toys (i.e. tricycle and helmet).
- Ages five to nine: arts and crafts kits, puppets, jump ropes, action figures, miniature dolls.
Ages nine to 14: handheld electronic games, board games, sports equipment with protective gear, model kits, musical instruments.
More information
The CPSC has more about toy safety.
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