Thursday, May 31, 2007

Parkinson's Linked to Pesticides, Head Trauma

Pesticides and head injury can both bump up risks for Parkinson's disease, European researchers report.

Moreover, odds for the illness increase as exposure to these brain insults rises, the report found.

For example, "Those who were heavily exposed to pesticides had a 41 percent increased risk of developing Parkinson's disease, and those with lower exposure had a 13 percent increased risk," said lead researcher Dr. Finlay Dick, from the Department of Environmental and Occupational Medicine at Aberdeen University Medical School, Aberdeen, U.K.
In addition, people who were knocked unconscious even once had a 35 percent increased risk of developing Parkinson's, Dick said.

That finding has real implications for sports such as boxing, the researchers said. In fact, professional boxing legend Muhammad Ali, 65, now suffers from advanced Parkinson's disease.

The findings are published in the May 30 online edition of Occupational and Environmental Medicine.

According to the National Parkinson Foundation, 1.5 million Americans currently have the degenerative illness, which strikes men and women in roughly equal numbers, usually after the age of 65.

In the study, Dick's team collected data on 959 people with Parkinson's or Parkinson's-like syndromes and almost 2,000 people without the condition. All the people were questioned about their exposure to pesticides as well as iron, copper and manganese. They were also asked if they had ever having been knocked unconscious or had a family history of Parkinson's disease.

The team found that people who had been exposed to low levels of pesticides were 13 percent more likely to have Parkinson's compared to people who had never been exposed. And people exposed to high levels of pesticides were 41 percent more likely to develop the condition.

Dick's group also found that Parkinson's disease occurred 35 percent more often in people who had been knocked unconscious once compared with those who had never been knocked out, and more than two-and-a-half times more frequently in people who had been knocked out more often.

In terms of pesticides, the researchers don't know which compounds are most likely to increase the risk for Parkinson's, Dick said. More research is needed, he added.

One take-home message: avoiding head injury is a good way to cut Parkinson's risk. "This has implications for contact sports, particularly for things like boxing," Dick said.

One expert lauded the research.

"This study adds to a growing body of evidence that points toward an association between exposure to environmental issues being related to neurodegenerative diseases like Parkinson's disease," said Dr. Michael S. Okun, the medical director of the National Parkinson Foundation.

He speculated that environmental exposures may trigger genes that spur the illness. "In some way, environmental exposures are affecting a series of events that unfold in the human brain that result in neurodegenerative diseases," he said.

While the causes of Parkinson's aren't known, Okun believes that it is a combination of factors, such as a genetic predisposition for the disease, coupled with environmental triggers.

"It would be a mistake to assume that this is a disease linked directly to pesticides or linked directly to genes and to close the door on potential interactions between them," he said.

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Pesticides increase risk of Parkinson's

Health News, Seniors/Aging News
Exposure to pesticides, even in small amounts, can lead to an increase in Parkinson's disease, according to a scientific study published Wednesday.

Research on nearly 1000 Parkinson's sufferers in five countries -- one of the largest such studies to date -- showed that high-level exposure upped the risk of contracting the debilitating brain disease by 39 percent.

Lower-level exposure, consistent with hobby-gardening use of pesticides, corresponded with a nine-percent increase, said Finlay Dick, the lead author of the study, published in the British journal Occupational and Environmental Medicine.
Parkinson's is an incurable, degenerative disease of the central nervous system that causes uncontrollable shaking, along with impaired speech and movement. In approximately one third of cases it also results in dementia.

Estimates of its prevalence vary between 0.1 and 0.3 percent of the population, said Dick, meaning that approximately one in 500 people contract the disease.

Previous studies have also established a clear link between Parkinson's and pesticides, with a major survey in the United States among agricultural workers last year reporting an even higher risk, at some 70 percent.

But the research by Dick and his colleagues at Aberdeen University provides far more detailed information about how and when -- and to what extent -- exposure occurred.

Using British occupational safety limits as a standard, the researchers divided the respondents into two groups based on the intensity and duration of exposure.

The 959 respondents were questioned about lifetime exposure to pesticides and a variety of other chemicals, as well as other potential factors that may contribute to the illness, such as incidence within the family and head injuries.

"The biggest risk was family history," Dick told AFP. A parent or sibling with Parkinson's increased the risk by a factor of three.

Not surprisingly, farm workers in the five regions examined -- in Scotland, Sweden, Romania, Italy and Malta -- were the occupational group showing the highest link between pesticide use and Parkinson's.

Dick emphasized that an increased risk factor does not mean that anyone who has used pesticides is now in danger of contracting it.

"The key message here is that just under half of those interviewed" -- including an additional 1989 people in a control group -- "reported some use of pesticides," he said. "The vast majority of people who used them will never have Parkinson's."

Genetic factors and being knocked unconscious also showed a significant link with the onset of the disease, according to the study. The link with pesticide "is another piece in the jigsaw," Dick said.

Interestingly, tobacco use offered a clear measure of protection against the disease.

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Health Tip: Safe Toys For Your Child

All toys, no matter how safe, may not be appropriate for children of all ages. Other toys may have moving parts or sharp edges that make them inappropriate for children of any age.

Here are suggestions on how to choose safe toys for your child, courtesy of the American Academy of Family Physicians:

  • Don't give your child toys with small parts that can be easily removed or broken.
  • Follow safety information and age guidelines listed on toys.
  • Look for toys that say "non-toxic," or "washable/hygienic materials" on stuffed animals that can be washed.
  • Make sure your child only has access to toys that are appropriate for her age.
  • To prevent choking, don't allow young children to play with marbles, or other small toys less than 1 3/4 inches diameter or 2 inches long.

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Children good at approximate math

Children who had never been taught addition or subtraction were able to solve approximate math problems involving large numbers, researchers said on Wednesday in a finding that reveals a new understanding of children's innate math ability.

They said children's early struggles with math may be linked to the need to produce a precise number. Their finding could lead to better ways to teach math to young children.

Writing in the journal Nature, Camilla Gilmore of the University of Nottingham, Elizabeth Spelke of Harvard University and colleagues conducted a series of experiments with 5- and 6-year-old children from a wide variety of socioeconomic backgrounds.

"I was astonished," said Spelke, who expected to find just the opposite.

"Clearly, the number words have to be learned and the Arabic notation has to be learned. These things aren't built into us, but I do think there is a basic nonsymbolic sense of number that is built into us," she said in a telephone interview.
Spelke said researchers have known for some time that adults, children, infants and animals have a sense of number.

What surprised them was that children who had learned their numbers could draw on this ability when presented with problems in symbolic arithmetic.

"We didn't think they would be able to do it," she said.

In one experiment, children were read simple statements and a question: "Sarah has 64 candies. She gives 13 of them away. John has 34 candies. Who has more?" These were accompanied by simple faces and numbers.

Most of the children (65 percent) were able to solve the problems without resorting to guessing or other means of calculation, and the finding could not have been the result of chance, the researchers said.

To see whether the children were drawing on prior knowledge of addition they may have learned at home or elsewhere, the researchers asked them to produce the exact solution, which they were not able to do.

They said teachers in the classroom-based study were skeptical about the experiment and surprised by their students' success and how much they enjoyed participating.

The authors said their study might be useful for teaching math to young kids.

"It may help children who are at a point of getting discouraged," Spelke said.

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Stressed-out moms at risk of poor mental health

Health News, Sexual Health News
Mothers of young children who feel they lack emotional support or help in caring for their children have more than three-times the risk of mental health problems compared to their peers who feel adequately supported, a new study shows.

More than one third of the 1,747 mothers participating in the study reported at least one parenting stressor that boosted their risk of mental health problems, Dr. Ritesh Mistry of the University of California, Los Angeles and colleagues note in the American Journal of Public Health. "If parenting stressors such as those examined here are to be addressed, changes may be required in community support systems, and improvements in relevant social policies may be needed," they conclude.

Mothers of small children are known to face a substantial risk of mental health problems and their mental health has a "strong influence" on their child's health and development, the researchers note.
Mistry and associates conducted the study to determine how certain parenting-related stressors might affect mothers' mental health and whether these stressors were related to financial and social factors.

The mothers of children 4 to 35 months old completed a five-item questionnaire to assess their general mental health.

Women who reported feeling a lack of emotional support (they had no one to rely on for day-to-day emotional help with parenting) represented nearly 14 percent of the total sample and were 3.4 times more likely to report being in poor mental health, the researchers found.

Roughly 12 percent of mothers who said they lacked functional support in caring for their children (they had no one to care for their children when they needed a break) had a 2.2-times greater risk of poor mental health.

When asked about time spent with their child, 37.2 percent of mothers said they spent too little, 11.2 percent said they spent too much, and 51.6 percent said the amount of time they spent with their child was just right. While mothers who said they spent too little time with their children had a slightly increased risk of poor mental health, those who said they spent too much time had a 3.5-times greater risk of mental health problems.

Overall, mothers who reported having one parenting-related stressor had triple the risk of poor mental health, while having two or more stressors increased risk nearly 12-fold.

Improving family leave policies and making high quality child care more "affordable and accessible" could help ease the stresses on parents identified in the current study, they add. They conclude by calling for further research to investigate how such stresses affect fathers' mental health.

SOURCE: American Journal of Public Health, July 2007.

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Finger length may foretell academic potential

The length of children's fingers may hint at their natural abilities in math and language, a new study suggests.

In a study of 75 children between the ages of 6 and 7 years old, researchers found that finger length correlated with how well the children performed on standardized tests of math and verbal skills.

Specifically, boys whose index fingers were short compared with their ring fingers tended to excel at numbers and girls with index and ring fingers of similar length tended to do better on the verbal portion of the test.

The findings are reported in the British Journal of Psychology.
A number of studies have now found that "digit ratio," or the length of the index finger compared with the ring finger, is connected to cognitive performance, some personality traits, athletic prowess and the risk of certain medical conditions.

Researchers believe hormones explain the findings. Finger length is thought to be determined in the womb, with exposures to testosterone and estrogen playing a key role. Greater testosterone exposure appears to result in a shorter index finger relative to the ring finger, while estrogen encourages more equality between the two fingers.

Prenatal hormone exposure is also thought to influence brain development.

"Testosterone has been argued to promote development of the areas of the brain which are often associated with spatial and mathematical skills," study leader, Dr. Mark Brosnan, explained in a statement.

Estrogen, in turn, is thought to affect brain areas involved in language ability, noted Brosnan, who heads the psychology department at the University of Bath in the UK.

Therefore, finger length may serve as a marker of fetal hormone exposures, and possibly our inborn math and language abilities.

No one is saying that finger measurements should replace SAT tests, Brosnan added. But finger length does offer "an interesting insight into our innate abilities in key cognitive areas."

SOURCE: British Journal of Psychology, May 2007.

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Nigerian state files criminal suit against Pfizer

A Nigerian state has filed criminal charges against Pfizer Inc. for its alleged role in the deaths of children who received an unapproved drug during a meningitis epidemic, court papers showed on Wednesday.

Pfizer, the world's biggest drug maker, said in a statement the allegations of negligence are untrue and it acted ethically when it tested the antibiotic Trovan in Kano state in 1996.

The director of public prosecutions of Kano, in northern Nigeria, filed eight criminal charges before a state high court. The accused are Pfizer, its Nigerian subsidiary and eight individuals who worked for the companies at the time.
The case will have its first hearing on June 4.

Separately, the attorney general of the state filed a civil lawsuit seeking $2.075 billion in damages from Pfizer.

"The accused persons ... caused an untested and unregistered drug ... to be administered on about 200 patients without an informed consent from parents," said the criminal charge sheet, adding that they had acted in a "rash and negligent manner."

"The acts of the accused persons endangered human lives by causing side-effects (such) as deafness, muteness, paralysis, brain damage, loss of sight, flawed speech and even death," the document added in a "summary of evidence."

Officials in Kano have alleged for years that Pfizer's actions resulted in the deaths of some of the children and left others with permanent health problems.

The state government alleges Pfizer selected children and infants from crowds at a makeshift epidemic camp and gave about half of the group Trovan, which it says was untested at the time.

The legal dispute has been going on for years. A U.S. federal judge in 2005 dismissed a lawsuit that accused Pfizer of not properly warning Nigerian families about the risk of Trovan, saying it should be heard in a Nigerian court.

Pfizer said the clinical trial was conducted with the full knowledge of the Nigerian government "and in a responsible and ethical way consistent with the company's abiding commitment to patient safety."

The company said that at the time of the meningitis outbreak, Trovan was in late-stage development and had been evaluated in 5,000 patients.

The Washington Post newspaper in the United States said it obtained internal Pfizer records that showed five children died after being treated with Trovan. However, "there is no indication in the documents that the drug was responsible for the deaths. Six children died while taking the comparison drug," the paper said.

The U.S.Food and Drug Administration cleared Trovan for adult use in 1997 but did not approve the drug for use by American children.

(Additional reporting by Debra Sherman in Chicago)

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More than half of EU adults overweight

More than half of adults in European Union nations are obese or overweight and the young are increasingly making Europe a fat continent, the EU's top public health official said Wednesday.

Diets based on fatty and sweet ingredients combined with lack of physical activity account for six of the seven top factors leading to poor health, said EU Health Commissioner Markos Kyprianou.

For years the EU Commission has warned governments to act, but the situation is getting worse. "Everybody has to be blamed — including the authorities, including the industry, including the consumers," Kyprianou said.
His biggest worry is the growing girth of children. "If we don't act, today's overweight children will be tomorrow's heart attack victims," he said.

In the 27-nation bloc, the EU says that over 21 million children are overweight. "Even more worrying is that the rate of increase of that number is more than 400,000 children a year."

To counter the trend, the EU has asked food manufacturers to promote healthier foods and says it has obtained commitments from many popular producers.

But consumers consciously make bad choices, Kyprianou said. Around the Mediterranean, a healthy diet based on olive oil and fresh fish is on the wane.

"Now the biggest problem of obesity is in the southern member states who have abandoned the Mediterranean diet and go for the same kind of nutrition of fast food as elsewhere," Kyprianou said.

Overall, the consumption of fruit and vegetables is lower than medical recommendations. The intake of fat and saturated fats is high throughout the continent, while the consumption of cereals has fallen by a quarter since the 1960s in Europe.

It has contributed to a situation "in which the majority of the member states, more than 50 percent of the adult population, is overweight or obese," Kyprianou said. "The numbers are frightening."

On Wednesday, the Commission proposed to tighten advertising standards on unhealthy processed food. It called on the food industry to cut down on sugar, fat and salt and urged sports organizations to do more to get youngsters to engage in physical exercise.

Even sports are becoming sweat free, Kyprianou noted. "A parent said that his son would go home and play basketball on the computer. They like the game but they won't play it."

"They sit in front of a television, the computer screen or play video games," he said. "It is a reality of life."

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EU mulling tougher food ad, labelling rules to fight obesity

The European Commission said Wednesday it was considering tightening food advertising and nutrition labelling rules if companies failed to improve consumer awareness about unhealthy foods.

In a new drive against obesity, EU Health Commissioner Markos Kyprianou said he wanted to "encourage" food companies to provide consumers with full information about the health risks associated with their products.

But if they failed to improve the information available to consumers, he said "we cannot exclude the possibility" of setting tougher advertising and labelling rules on companies.

"What consumers eat is up to them, but they should be able to make informed choices, and have a range of healthy options to choose from," said Kyprianou.
"That is why the Commission is reviewing the options for nutrition labelling, and calling on industry to advertise responsibly and reduce levels of salt, fats and sugar in food products," he added.

The European Commission's new anti-obesity push is a response to growing evidence that Europeans, including a rising number of children, are too fat with over half estimated to be obese or overweight.

According to the World Health Organisation, obesity rates have more than trebled since the 1980s in many European countries as the average daily intake of calories has risen.

Of particular concern, was the growing prevalence of obesity among children, with over 21 million classified as obese across Europe.

"We have to acknowledge the fact that children don't entertain themselves any more through physical activity," said Kyprianou, adding that they needed to be "reintroduced" to physical games.

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Wednesday, May 30, 2007

Blood Marker Could Point to Alzheimer's Risk

Scientists have zeroed in on blood biomarkers that could someday help doctors predict who's at risk for Alzheimer's disease. They might even help guide treatment, the U.S. researchers added.

These biomarkers, called cytokines, are all hallmarks of heightened inflammatory responses. Cytokines specific to Alzheimer's disease were found in greater numbers on white blood cells called mononuclear cells.

Higher concentrations of inflammatory markers in the blood have been linked to Alzheimer's disease before. But other conditions of old age, such as heart disease and arthritis, can also trigger inflammation, the researchers pointed out.

However, the newly discovered markers point specifically at Alzheimer's disease-linked inflammation in the brain, the scientists said.
That's important, because right now "there's no single blood test or neuroimaging study -- CT scan or MRI -- that can reliably predict whether somebody has Alzheimer's disease, much less whether someone is at risk of developing the illness," explained lead researcher Dr. Zaldy Tan, director of the Memory Disorders Clinic at Beth Israel Deaconess Medical Center, in Boston.

"So, if this finding is validated in other studies and larger samples, it might become a test for future risk of Alzheimer's disease," he said.

There are currently no effective treatments for Alzheimer's disease, which now affects more than 5 million Americans, according to the Alzheimer's Association. Scientists project that unless new ways are found to prevent or treat the disease, that total could climb to 16 million by mid-century.

The exact role of inflammatory processes in Alzheimer's remains a mystery, although numerous studies support the notion that they are at least associated with the mind-robbing illness.

"The data has been conflicting," Tan said. "Most of the studies out there are population-based, looking at the use of anti-inflammatory drugs, for example, on the incidence of Alzheimer's disease." Those studies have found no good evidence that taking steroids or nonsteroidal anti-inflammatories (for example, aspirin or ibuprofen) cuts Alzheimer's risk.

Tougher still has been the search for a blood marker that might precisely indicate the presence of, or risk for, Alzheimer's disease in a particular patient.

A number of studies with elderly patients have correlated a high number of cytokines in red blood cells with Alzheimer's, but "since this population is significantly older, there are other reasons someone might have inflammation -- arthritis, for example," Tan said.

The new study, published in the May 29 issue of Neurology, focused on a particular type of white blood cell, the mononuclear cell. Tan's team focused on these cells because they have the ability -- unlike many other cells -- to cross the blood-brain barrier.

Taking advantage of the ongoing Framingham Heart Study, Tan and his colleagues periodically tested the blood of 691 healthy elderly participants averaging 79 years of age. Then they tracked the volunteers' mental health for the next seven years.

Over that period of time, 44 of the participants developed Alzheimer's disease.

The researchers found that individuals with the highest levels of mononuclear cell-derived inflammatory cytokines were twice as likely to develop the illness as those with the lowest levels of the inflammatory markers.

"So, our hypothesis now is that it is possible to indirectly measure [Alzheimer's-linked] brain inflammation by looking at the amount of inflammatory markers released by these blood cells, cells that may eventually make it to the brain," Tan said.

One expert agreed the finding could someday lead to a real advance in the care and understanding of Alzheimer's disease.

"What this study does is take us to another level in terms of diagnostics," said Paul Sanberg, director of the Center of Excellence for Aging and Brain Repair at the University of South Florida College of Medicine, in Tampa. "They are finding a more consistent result when they look at the inflammatory markers in mononuclear cells."

He said the jury is still out on whether treating inflammation might prevent or treat Alzheimer's, since no one is sure whether inflammation helps cause the disease or is simply a product of the illness.

But if it turns out that dampening inflammation can help, a blood test measuring these cytokines might be of great use to doctors, Sanberg said. "If you can find a consistent marker, then maybe some patients might be treated by anti-inflammatories better than others, depending on the [blood] level of these markers," he said.

Tan agreed that it's too early to talk about treatments, but he believes the new finding brings effective diagnostics and therapy that much closer.

"This is another piece of the puzzle in the mechanism of Alzheimer's disease," he said.

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Turning off gene makes mice smarter

Health News, Weight Loss News
Turning off a gene that has been associated with Alzheimer's disease made mice smarter in the lab, researchers said on Sunday in a finding that lends new insight on learning and may lead to new drugs for memory problems.

They said these mice were far more adept at sensing changes in their environment than their mouse brethren.

"It's pretty rare when you can make an animal smarter," said Dr. James Bibb, assistant professor of psychiatry at the University of Texas Southwestern Medical Center, who led the study published in the journal Nature Neuroscience.
Bibb and colleagues used genetic engineering techniques to breed mice that could be manipulated to switch off Cdk5, a gene that controls production of a brain enzyme linked to diseases marked by the death of neurons in the brain, such as Alzheimer's.

"Any time we're losing neurons, Cdk5 may be contributing to that process. That has made it an area of great interest," Bibb said in a telephone interview.

"We have shown that we can turn off a gene in an adult animal. That has never been done before," he added. When they had tried to breed mice that completely lacked the gene, the pups died at birth.

Bibb said they put the mice though a series of tests and found the altered mice did better than normal mice.

"Everything is more meaningful to these mice," he said. "The increase in sensitivity to their surroundings seems to have made them smarter."

Bibb said the mice were better at tasks based on associated learning, Bibb said.

"It's the most important kind of learning in the animal kingdom. It's how we know where our car is and that is our wife or our husband and that's our kids. It's how we connect things," he added.

The smart mice were better at learning to navigate a water maze and remembering that they got a shock when they were in a certain cage.

"It was very clear right off the bat that the loss of Cdk5 made them have a much stronger associative memory," Bibb said.

"What was really interesting is they not only remembered better, but the next day, if you put them back in those same circumstances, they noticed they were not getting shocked."

Bibb said his work was inspired by the 1999 discovery of "Doogie" mice, a smarter breed of mice developed at Princeton University that were named after the TV program "Doogie Houser," a show that featured a child prodigy.

Those mice were bred by manipulating NR2B, a gene that also plays a role in associative memory.

"It turns out Cdk5 was controlling the regulation of NR2B," Bibb said.

"Maybe by finding these new mechanisms we can find new drugs that improve the cognitive performance of people who have deficits."

He and colleagues are working on developing drugs that could create the same effect without the need for genetic alteration.

"There are other cases -- in post-traumatic stress disorder, addiction and depression -- where we may want to modulate memory not so much to improve it, but to selectively modify it to remove the negative memories that are causing the problems. I think that has a lot of potential," Bibb said.

However, he said the long-term effects are not yet clear.

"If all of your (brain) synapses were magically strengthened all the time, that might be good for the short term, but I'm not sure if it would be good all the time," he said.

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Most Errors in Pediatric Chemo Make It to Patients

The vast majority of potentially harmful errors in chemotherapy for children with cancer do find their way to these young patients, a new study finds. And they are more often caused by dispensing or administration mistakes than by prescribing mix-ups, the researchers found.

In total, 85 percent of these drug errors were not spotted until the child received the medication, according to a study led by Dr. Marlene Miller, associate professor of pediatrics at the Johns Hopkins School of Medicine, Baltimore. These errors do not always cause harm to the child, the authors added, but they are always worrisome.
Their analysis of the United States Pharmacopeia's voluntary medication error-reporting database, MEDMARX, also found that prescribing errors accounted for only 10 percent of cases occurring in patients under 18 years of age from 1999 to 2004. Instead, most of the mistakes arose from dispensing errors by pharmacy staff or administration blunders by nurses and other health care workers.

A total of 310 chemotherapy errors for pediatric patients were logged during the study period, from 69 different institutions. (As of 2004, 616 institutions were participating in the MEDMARX program, up from 56 in 1999.) More than eight out of 10 of these incidents reached the patient, meaning they were not caught prior to administration, and about 16 percent required an escalation of care as a result, Miller said.

Surprisingly, prescribing errors accounted for just one in 10 cases. Most errors (48 percent) involved mistakes in administration, followed by errors in dispensing (30 percent). The most commonly cited types of error were mistakes in dose or quantity (23 percent), or time of administration (23 percent), followed by omission errors (that is, failing to deliver the drug at all, 14 percent) and improper administration technique or route (12 percent). By far the biggest cause of error was "performance deficit" -- human error -- at 41 percent.

The research was published online May 25 in the journal Cancer, and is expected to be published in the July 1 print issue.

Children generally are more susceptible to medication errors than adults, Miller said, because unlike with adults, there is no "usual" dose for children; pediatric dosages generally are based on body size.

The problem is even more pronounced for anticancer medications, however, because these drugs are so potent and their so-called therapeutic window is so narrow.

"I can give four times the normal dose of Motrin, and you will be fine," Miller said as an example. "You cannot do that for chemo; they have a very narrow safety window."

Many hospitals use computer systems to compute proper dosages and reduce such errors, but, Miller said, these systems often do not include chemotherapy agents, as the rules for dosing and the protocols for administering the drugs are constantly being revised as new clinical trial data appear.

"The dosing [for chemotherapeutics] is so different, so the vendors haven't built in the logic of how to do this," Miller said. "So, we have lots of interventions and tools to improve patient safety, but chemo falls off the radar screen."

Even when such safety systems are in place, errors can still occur.

At the University of California, San Francisco, for instance, a computer system is used to calculate dose based on a patient's height and weight for a particular protocol and then produce appropriate electronic orders, as Dr. Katherine Matthay, chief of pediatric hematology-oncology at the UCSF Children's Hospital , explained. These orders are then checked by a nurse practitioner, an oncologist, and a pharmacist, checked again as the medicine is prepared, and yet again by the nurse who actually administers the drug.

"Despite this, occasionally errors are made in timing or due to faulty equipment or human error as noted in the article," Matthay said.

Miller stressed that this study in no way reports the actual rate of chemotherapy errors. To calculate that, she would need to know the total number of chemotherapy doses administered, which she does not have. In addition, MEDMARX is a voluntary database, and some errors undoubtedly go unreported. Indeed, that 85 percent of the reports cited in this study reach the patient could well be due to the fact that hospitals are more likely to report incidents that reach patients than those that are caught in time, she said.

Yet Miller expressed the hope that this study could lead to the development of what she called "targeted interventions" -- specific systems that can lower the likelihood of medication errors.

"It is impossible to be vigilant on everything, to never make an error, never be late. It's impossible. So, our struggle is to introduce something to make it more error-free," she said, citing as examples anything from new computer software, to enhancements in teamwork between the pharmacist, nurse, and physician, to standardizing protocols for administration of a particular drug.

Another expert called chemotherapy error monitoring "a huge issue."

Sarah Scarpace, a pediatric clinical pharmacist at UCSF Children's Hospital, said staff often have to contend with an additional level of confusion in administering chemo -- the fact that protocols sometimes differ in how they number their days. For example, one protocol may begin on "day 0" while another begins on "day 1," and staff can get confused -- the drug a patient gets on day 1; is that really their first day or their second?

Scarpace suggests standardizing the numbering of days in protocols and using barcoding technology to ensure the correct drug goes to the correct patient. "Certainly the barcoding thing may help to ensure you get the right drug to the right person at the right time," she said.

And one more thing: "Everyone should take a 'time out' to verify this is the right thing [drug]," she said. A "time out" is that moment when everyone steps back and makes sure the correct drug is being given at the right time, dose, to the right patient, Scarpace explained.

Parents can be key players in maintaining safety, too, Miller added. She advised parents to be active participants in their children's care. "Question each dose. Be empowered. Know what's going on. Know the drugs, doses, times, and routes, so when the nurse comes in to administer the drug, you know it is right, and you can help troubleshoot," she said.

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Asthma doesn't usually increase pregnancy risks

Adverse obstetric or pediatric complications are not generally increased in women with asthma, according to a report in the May 15th American Journal of Respiratory and Critical Care Medicine.

Previous studies have suggested the possibility of increased risks of pregnancy complications in women with asthma, the authors explain, but these studies have had various statistical shortcomings.

To further investigate, Dr. Laila J. Tata from University of Nottingham in the UK and colleagues used data from more than 280,000 pregnancies to compare the risks of obstetric complications and adverse pregnancy outcomes in women with asthma and those without asthma.
Asthma did not significantly increase the risk of high blood pressure, diabetes, thyroid disorders, the need for assisted delivery, placental separation from the uterine wall (placental abruption), placenta blocks the opening to the birth canal (placental previa), pre-eclampsia (a condition affecting multiple body systems characterized by high blood pressure and kidney failure), or eclampsia (progression of pre-eclampsia to a life-threatening severity).

However, when compared with women without asthma, women with asthma did have a 20-percent increased risk of hemorrhaging during delivery, a 38-percent risk of hemorrhaging after delivery, a 6-percent risk of anemia, and a 57-percent increase risk of depression. They were also 11-percent more likely to deliver by cesarean section.

Women with more severe asthma and a history of asthma exacerbations had an increased risk of miscarriage and depression, the researchers note, but increased risk of hemorrhage after delivery was restricted to women with milder asthma and no exacerbations.

"Our results provide reassuring evidence that the risks of most adverse pregnancy outcomes and obstetric complications are similar to those in women without asthma," the investigators conclude.

"With the possible exception of increased vigilance in monitoring certain complications in pregnant women with asthma, our findings do not indicate a necessity to alter current practice of optimal (asthma drug therapy) in women of child-bearing age in the general population," the authors add.

SOURCE: American Journal of Respiratory and Critical Care Medicine, May 15, 2007.

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Heavy infants run high risk of being obese later on

Babies who are born heavy and grow fast have a 150 percent chance of being overweight or obese by the time they are seven years old, a survey of more than 8,000 children in Hong Kong has shown.

Obesity has long been associated with a person's lifestyle and dietary habits, but the study shows it might just as well be dependent on "epigenetics" -- factors such as genes, and the eating habits and lifestyle of parents and grandparents, said researchers at the University of Hong Kong.

"You tend to assume it's just your lifestyle, but what people are realizing is it's not just what you are doing now, but what people have done in your family in the past," said Mary Schooling, assistant professor at the university's School of Public Health.
New born infants would be considered heavy if they weigh 3.65 kg (8 pounds) and over.

Excess weight and obesity pose major risks for chronic diseases such as diabetes, heart disease, hypertension, stroke and some forms of cancer.

Globally, more than 1 billion adults are overweight, of which 300 million are obese, said the World Health Organisation.

And the problem is not confined to advanced nations in the west. In China, Japan, certain African nations, Thailand, Malaysia, Singapore and Hong Kong, childhood obesity is on the rise. In China, 10 million children aged between 7 and 18 were overweight in 2000, up 28 times from 1985.

Some experts explain this using the "thrifty gene" theory. Assuming a frugal environment from as recent as the 1950s and 1960s, the Asian constitution is programmed to store fat. But faced with sudden affluence, it is less able to cope and the person ends up obese and assailed with health problems.

The west, however, adapted to an environment of plenty over a far longer period, starting with the industrial revolution from the mid 18th century.

TRACKING A GENERATION OF CHILDREN

More than 8,300 children born in April and May 1997 in Hong Kong are involved in the long-term study and researchers plan to monitor them for the rest of their lives.

The scientists tracked their development at birth, 3 months, 9 months, 36 months and 7 years.

About 800 children in the study are now overweight or obese.

Boys at 7 years with a body mass index of more than 17.9 are considered overweight, while a BMI of over 20.6 would be obese. For girls, a BMI of over 17.53 would be overweight and more than 20.5 obese.

"What we have shown here is that babies who are born big and who have grown fast have a higher risk of being overweight or obese at age 7," Schooling said.

"The key point is to make sure that babies grow at a reasonable rate. That can be achieved most effectively by ensuring they are breastfed."

Experts say breastfeeding helps prevent overfeeding. Schooling and colleague Gabriel Leung said a child's body size may well be dependent on a host of other factors. "It has to do with the mother's diet, her lifestyle, even the grandmother's living environment ... it has to do with the life course of your parents, grandparents," Leung said.

"Perhaps our grandparents lived in scarcity, they may have the biological imprint for the baby to prepare for scarcity. But there is excess now, and the human body has no time to prepare for this change ... that's why our diabetes rate is so high."

The researchers plan to interview parents and grandparents of the group children to see if their body sizes are linked to dietary and lifestyle habits of the older generations.

Further ahead, these children would be monitored for health problems that tend to appear later in life, such as high blood pressure and diabetes.

Read More..

Increased smoking may be linked to asthma epidemic

More adults, especially women, are smoking these days and their secondhand smoke may be contributing to the asthma epidemic among children in the United States, results of a study suggest.

"This is the first study to suggest, and provide evidence consistent with the hypothesis that the parallel increase in smoking, especially among women who are primary caregivers, may explain the increase in asthma in children via increased exposure to ETS (environmental tobacco smoke) over time," Dr. Renee D. Goodwin, of Columbia University in New York City, told Reuters Health.

"It is conceivable that greater efforts to protect children from exposure to secondhand smoke, from birth onwards, may be effective in starting to prevent asthma in children and ultimately decrease the direction of this epidemic," she added.
There has been a 3-fold increase in the prevalence of childhood asthma over the past 30 years, for unknown reasons, particularly in industrialized nations, studies show. Currently, more than 15 million children experience daily secondhand tobacco exposure at home and almost 5 million children in the US under the age of 18 are known to have asthma.

Goodwin investigated whether increased cigarette smoking, particularly among women, after World War II may have indirectly contributed to the increasing asthma epidemic among children.

The researcher examined data on 4,500 children who were involved in the National Health Interview Survey and compared it with data from the American Lung Association on cigarette use in the United States from 1900 to 2003.

As suspected, Goodwin found that rates of cigarette use during the past century increased along with rates of childhood asthma.

For example, for each consecutive year from 1980 to 1995, there was an estimated 5 percent annual increase in the overall prevalence of asthma among children, and this increase was particularly evident among 5- to 10-year olds, Goodwin notes in the Annals of Allergy, Asthma & Immunology.

Likewise, in 2003, an estimated 400 billion cigarettes were consumed, a substantial increase from the estimated 2.5 billion cigarettes that were smoked in 1900. Cigarette smoking reached its peak around 1981 with 640 million cigarettes smoked annually.

Although cigarette consumption in the US had declined in the past 10 years, "the consequences and health effects of the drastic increase in cigarette consumption in the mid-1980s are thought to be still affecting adults and children in the United States," Goodwin writes.

And "while new laws are increasingly implemented to protect workers from smoke in the workplace, diners in restaurants and even bar patrons, from the dangers from secondhand smoke, no such measures have been taken that directly aim to protect children, who are most vulnerable," she contends.

In light of this, "educational programs aimed at high risk groups for smoking may be beneficial," Goodwin added, "as it is likely that many are unaware of the impact of ETS on child respiratory health."

SOURCE: Annals of Allergy, Asthma & Immunology, May 2007.

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British school offered treatment after child infected with bird flu

Health News, Parenting/Kids News
A group of school pupils and teachers have been given anti-viral treatment as a precaution after a child became infected with a low-risk strain of bird flu in Wales, health officials said on Monday.

The National Public Health Service for Wales (NPHS) said a dozen schoolchildren aged nine and 10 as well as two teachers were receiving the Tamiflu drug after it learned they had spent time with the youngster.

It said in a statement that the group in Ysgol Henllan school in Denbighshire, which has 58 pupils, were at a "very slight" risk of infection.
NPHS said Sunday that a total of 11 people had symptoms of flu or conjunctivitis, though nobody is seriously ill. They were among 36 people who could have been in contact with the disease.

It said the child, who lives close to the farm in Corwen, north Wales, where the H7N2 strain was first discovered, was responding to treatment at home.

Health officials could not rule out that the disease had spread from person-to-person but said they were still investigating.

"Person to person spread would be very unusual but limited spread of this type has been seen elsewhere in the past in some cases of bird flu," an NPHS spokeswoman said.

Chickens from a second farm in the Llyn Peninsula in northwest Wales were being tested, with restrictions imposed on the movement of people and animals from the property.

A total of 30 chickens from the smallholding in Corwen have now been slaughtered after 15 Island Red chickens died.

Brendan Mason, a consultant epidemiologist with the NPHS for Wales, said offering the Tamiflu to the group "is an unusual step for us to take because the risk of the infection being passed from the child to other pupils is so small.

"However, this particular virus usually only affects birds and is relatively unknown in humans. Its clinical characteristics have not been fully defined," Mason added.

"It is very rare to see this particular flu virus so we are taking every reasonable precaution to eliminate it from the community."

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Nerve damage may occur after weight-loss surgery

Patients can develop potentially disabling neurological complications after gastric bypass surgery performed to treat morbid obesity, most likely due to deficiencies in certain nutrients, a new study shows.

While correcting these deficiencies can help patients, some are left with permanent damage, Dr. Katalin Juhasz-Pocsine and colleagues from the University of Arkansas for Medical Science in Little Rock report. Symptoms can strike many years after the surgery, they note, possibly because stores of certain nutrients may take this long to become depleted.
Some patients begin hallucinating and lose the ability to walk a couple of months after the surgery, Juhasz-Pocsine explained in an interview with Reuters Health. "After resolution of the acute symptoms they are quite weak, and it takes around a year to recover.

Some are permanently disabled," she said. Among patients who develop symptoms years down the road, the spinal cord typically is affected, resulting in falling, extreme coordination and gait problems, and severe spasticity, and some individuals need to use wheelchairs.

Juhasz-Pocsine and her team describe 26 cases of neurological problems that occurred in gastric bypass patients in the medical journal Neurology. Symptoms typically involved more than one portion of the neurological system.

While restoring nutritional deficiencies, which included lack of vitamin B12, thiamine, or copper, helped patients, many continued to have symptoms for months, while symptoms remained permanent in some patients, Juhasz-Pocsine and her team report. The patient who fared best was a woman who underwent surgery to reverse her gastric bypass after developing rapidly progressing symptoms that didn't respond to other treatment.

Gastric bypass patients and their doctors should be aware of the early signs and symptoms of neurological problems, and should know that these symptoms can strike many years after a person has had the surgery, Juhasz-Pocsine advises. Further research is needed, she added, on the risk of neurological problems in gastric bypass patients whose nutritional needs change dramatically, for example during pregnancy or breastfeeding or among individuals undergoing cancer treatment.

The researchers suggest that steps should be taken to help prevent gastric bypass patients from developing these problems in the first place by advising them to take vitamin and mineral supplements and to avoid "severe and rapid weight loss."

"Many of our patients were not instructed to take vitamin supplements, and postoperative follow-up visits with medical nutritionists were not emphasized," they note.

SOURCE: Neurology, May 22, 2007 online.

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High-carb diet linked to higher blood pressure

Carbohydrate-rich diets are associated with slightly higher blood pressure than diets rich in monounsaturated fats, according to the findings published in the American Journal of Clinical Nutrition.

However, the difference is not enough to justify making recommendations to change the carbohydrate and monounsaturated fat content of the diets to control blood pressure, Dr. Meena Shah and colleagues from the University of Texas Southwestern Medical Center at Dallas, report

The researchers conducted a review of 10 published studies, also referred to as a "meta-analysis," that compared high-carbohydrate and high-monounsaturated fat diets to better understand their effects on blood pressure.
The results of the authors' mathematical model revealed that the carbohydrate-rich diets led to a significantly higher blood pressure compared with the diets rich in monounsaturated fat.

When the analysis was restricted to studies in which the subjects were randomly assigned to one diet and then switch over to the other diet, the blood pressure readings were higher for the carbohydrate-rich diets than the monounsaturated fat diets, but the difference was not statistically significant.

The slight increase in blood pressure of subjects in the high-carbohydrate diet may be cause by elevated insulin levels, or "hyperinsulinemia," Shah's team suggests.

It has been suggested that hyperinsulinemia enhances the activity of the sympathetic nervous system, "which increases heart rate, cardiac output, vascular resistance, and sodium retention and thus blood pressure."

SOURCE: American Journal of Clinical Nutrition, May 2007.

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Heavy infants run high risk of being obese later on

Babies who are born heavy and grow fast have a 150 percent chance of being overweight or obese by the time they are seven years old, a survey of more than 8,000 children in Hong Kong has shown.

Obesity has long been associated with a person's lifestyle and dietary habits, but the study shows it might just as well be dependent on "epigenetics" -- factors such as genes, and the eating habits and lifestyle of parents and grandparents, said researchers at the University of Hong Kong.

"You tend to assume it's just your lifestyle, but what people are realizing is it's not just what you are doing now, but what people have done in your family in the past," said Mary Schooling, assistant professor at the university's School of Public Health.
New born infants would be considered heavy if they weigh 3.65 kg (8 pounds) and over.

Excess weight and obesity pose major risks for chronic diseases such as diabetes, heart disease, hypertension, stroke and some forms of cancer.

Globally, more than 1 billion adults are overweight, of which 300 million are obese, said the World Health Organisation.

And the problem is not confined to advanced nations in the west. In China, Japan, certain African nations, Thailand, Malaysia, Singapore and Hong Kong, childhood obesity is on the rise. In China, 10 million children aged between 7 and 18 were overweight in 2000, up 28 times from 1985.

Some experts explain this using the "thrifty gene" theory. Assuming a frugal environment from as recent as the 1950s and 1960s, the Asian constitution is programmed to store fat. But faced with sudden affluence, it is less able to cope and the person ends up obese and assailed with health problems.

The west, however, adapted to an environment of plenty over a far longer period, starting with the industrial revolution from the mid 18th century.

TRACKING A GENERATION OF CHILDREN

More than 8,300 children born in April and May 1997 in Hong Kong are involved in the long-term study and researchers plan to monitor them for the rest of their lives.

The scientists tracked their development at birth, 3 months, 9 months, 36 months and 7 years.

About 800 children in the study are now overweight or obese.

Boys at 7 years with a body mass index of more than 17.9 are considered overweight, while a BMI of over 20.6 would be obese. For girls, a BMI of over 17.53 would be overweight and more than 20.5 obese.

"What we have shown here is that babies who are born big and who have grown fast have a higher risk of being overweight or obese at age 7," Schooling said.

"The key point is to make sure that babies grow at a reasonable rate. That can be achieved most effectively by ensuring they are breastfed."

Experts say breastfeeding helps prevent overfeeding. Schooling and colleague Gabriel Leung said a child's body size may well be dependent on a host of other factors. "It has to do with the mother's diet, her lifestyle, even the grandmother's living environment ... it has to do with the life course of your parents, grandparents," Leung said.

"Perhaps our grandparents lived in scarcity, they may have the biological imprint for the baby to prepare for scarcity. But there is excess now, and the human body has no time to prepare for this change ... that's why our diabetes rate is so high."

The researchers plan to interview parents and grandparents of the group children to see if their body sizes are linked to dietary and lifestyle habits of the older generations.

Further ahead, these children would be monitored for health problems that tend to appear later in life, such as high blood pressure and diabetes.

Read More..

Tuesday, May 29, 2007

NJ starting agency to battle obesity

New Jersey's health department is escalating the battle against the bulge by starting a new Office of Nutrition and Fitness to better coordinate programs aimed at preventing obesity. The agency is particularly needed in New Jersey — possibly the first state to create such a government body.

The Garden State has the highest percentage of overweight and obese children under age 5, at 17.7 percent, according to a 2004 survey by the U.S. Centers for Disease Control and Prevention. New Jersey also has many black and Latino youth, who are more likely to be overweight than white kids.

Dr. Fred M. Jacobs, commissioner of the state Department of Health and Senior Services, said young people are a crucial target for the new agency because it's easier to instill good diet and exercise habits to prevent obesity in young people than it is to reverse weight problems in adults; adults almost always gain back any weight they lose — and then some.
Jacobs says he wants to tackle the obesity problem through education, support groups and encouraging physical activity, rather than by banning particular foods. One goal is to "de-normalize" the massive portions served in restaurants.

"I want to do that without creating a further stigma on individual people," Jacobs said. "It's bad enough when you're fat that people think less of you. I don't want the government piling on."

He is mulling the idea of having schools notify parents, via report cards, about children with weight problems.

Morton Downey, spokesman for The Obesity Society, which represents doctors, researchers and others in the field, said he knows of no other state with a dedicated agency fighting obesity, although federal grants in recent years have helped numerous states develop plans to fight obesity. He called New Jersey's initiative a very encouraging step that could become a national model.

"There's not really been an institutional base for people with ideas to go to gain support for their ideas" and funding for new programs, Downey said.

Obesity has become the country's No. 2 cause of preventable death, after smoking. Excess weight raises risk of heart disease and stroke, type 2 diabetes, high cholesterol, asthma, depression, arthritis and several types of cancer.

In New Jersey, almost 23 percent of residents are considered obese and another 37 percent are overweight, according to the CDC.

Setting up the anti-obesity agency was one of many recommendations in the New Jersey Obesity Prevention Action Plan, written by a large task force established by the state Legislature.

Jacobs said the new agency will begin operations within weeks, and may be able to win more federal and private grant money. He said it will coordinate spending of more than $2 million in nutrition and fitness programs, including promoting physical activity at all ages, providing fresh fruit and vegetables to eligible women, children and senior citizens, and encouraging breast-feeding, which can reduce the baby's chances of a weight problem later.

Other state agencies will be working with the health department. The Agriculture Department, for example, has been boosting the number of farmers market bringing fresh produce to seniors and city residents whose local stores don't stock much produce, said its head, Charles Kuperus.

More than half of all schools have already complied with the department's new rules limiting the amount of high-calorie, high-sugar foods available, a strategy meant to prevent kids from bypassing nutritious lunches and getting french fries or snacks from vending machines, he said. Every school is expected to be in compliance by the September deadline.

Assemblyman Herb Conaway, who's also a physician, calls the new agency "an important step," much needed because the cost of caring for the chronic illnesses linked to obesity will strain both government and private insurance programs.

Sue Shapses, a Rutgers University nutritionist who heads a statewide group of researchers focused on obesity, said setting up the new agency is "very commendable," but said to succeed, it must focus on programs proven to work.

"With the right person in charge, this can lead to great changes in New Jersey and beyond," she said.

Jacobs said the agency has to do far more than just tell people to lose weight, given that genetics and other factors play a role in obesity. He especially understands the battle, having struggled with a weight problem all his life until undergoing surgery in December. He's since lost 85 pounds.

"I'm very close to where I would like to stop," he said. "I'm feeling great."

Read More..

Obesity bad for the bones

Health News, Weight Loss News
New research does not support the general belief that obesity increases bone mass and is therefore good for bone health. A study, in which investigators corrected for the mechanical loading effect of increasing body weight, suggests the opposite.

"Our study found that increasing body fat mass decreases bone mass, for people of similar weight," Dr. Hong-Wen Deng from University of Missouri-Kansas City told Reuters Health. "Therefore, increasing obesity (fat mass) is not good for bone health."

The finding is "important," Deng and colleagues say, because it suggests that interventions or treatments aimed at reducing obesity may increase bone mass and thus protect against osteoporosis.
Past studies on the relationship between obesity and osteoporosis did not control for the "mechanical loading effects" of a person's total body weight on bone mass, the investigators note in a report published this month.

Deng's team reevaluated the relationship between obesity and osteoporosis taking into account mechanical loading effects of total body weight on bone mass in more than 6,400 healthy adults.

According to the investigators, when the mechanical loading effect of body weight on bone mass was adjusted for, fat mass was negatively associated with bone mass; that is, in general, the greater the fat mass, the lower the bone mass.

The results of their study, the researchers say, also "reaffirm the beneficial effects of appropriate weight-bearing and mechanical loading on a healthy skeletal system."

SOURCE: The Journal of Clinical Endocrinology and Metabolism, May 2007.

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Sunday, May 27, 2007

Doctors in Italy perform first lung transplant on HIV-positive patient

An Italian hospital has carried out the first ever transplant of two lungs into a patient with HIV, who is doing well after the operation, a spokeswoman said.

The patient, an adult man whose life was in danger from respiratory illness, "was operated on at the start of the week and his post-operation diagnosis is good," said Serena Pizzo, spokeswoman for the Mediterranean Institute for Transplantation and Advanced Specialised Therapies (ISMETT) in Palermo.

Liver, kidney and pancreas transplants for HIV-positive patients have previously been performed successfully, but the operation in Italy was the first involving lungs, she said.
"The possibility of carrying out transplants on HIV-positive patients has been made possible by a new range of treatments that are very effective against HIV," said Paolo Grossi, a specialist in infectious diseases in charge of monitoring the patient's post-operative condition.

Pizzo said one of the main difficulties in performing transplants on HIV-positive patients is that they must be submitted to treatments that lower their immune systems while they are already immune-deficient.

ISMETT, a public institution, partners with the University of Pittsburgh Medical Centre in the United States.

Alessandro Nanni Costa, director of the national transplantation centre, called the operation "an important event for progress in the transplantation world."

Read More..

Cruciferous veggies may ward off bladder cancer

Substances found in cruciferous vegetables, like broccoli and cauliflower, may help protect people from bladder cancer, a new study shows.

People who consumed the most of these substances, called isothiocyanates (ITCs), had a 29-percent lower risk of the disease than those who consumed the least, Dr. Hua Zhao and colleagues from the University of Texas M.D. Anderson Cancer Center in Houston found.

Studies in animals have found ITCs prevent tumor growth, while epidemiological studies suggest they may lower lung and colon cancer risk, Zhao and his team note in the International Journal of Cancer. They point out that ITCs have detoxifying effects and can enhance the normal development of cells while promoting cell suicide in abnormal cells.
To investigate whether ITCs might protect against bladder cancer, the researchers compared ITC intake for 697 bladder cancer patients and 708 healthy controls. The average age of the subjects in both groups was 63 years old.

On average, the cancer patients consumed fewer ITCs than the healthy individuals. The average number of daily half-cup servings of cruciferous vegetables 1.76 for the healthy individuals and 1.41 for the cancer patients, a statistically significant difference.

High ITC intake reduced cancer risk by 29 percent. The patient factors with the strongest association with reduced risk included past smoking, current heavy smoking, older age and male sex.

The bladder may be particularly susceptible to the anti-cancer effects of ITCs, the researchers note, given that compounds produced by ITC metabolism are excreted through the urine.

"Our data provide strong evidence that consumption of ITCs from cruciferous vegetables protect against bladder cancer," the researchers conclude.

SOURCE: International Journal of Cancer, May 15, 2007.

Read More..

Tips to Keeping the Barbecue Cancer-Free

The Memorial Day holiday is the traditional kick-off of the summer barbecue season in the United States, but research has shown that grilling can create cancer-causing compounds in meat, experts say.

Among the compounds are heterocyclic amines (HCAs), which are created when heat acts on amino acids, and creatinine in animal muscle.

The longer the cooking time and the higher the heat, the more HCAs, say experts at the University of California, Davis, Cancer Center. That means that barbecuing produces the most HCAs, followed by pan-frying and broiling. Baking, poaching, stir-frying and stewing produce the least HCAs.

The UC Davis experts offer the following advice for limiting HCAs:

  • Before you barbecue meat, partially cook it in the microwave and then throw out the juices that collect in the cooking dish. Finish cooking the meat on the grill. Precooking a hamburger for a few minutes in the microwave reduces HCAs by up to 95 percent.
  • Flip hamburgers often. Doing so every minute reduces HCAs by up to 100 percent. This is likely because constant flipping keeps internal meat temperatures lower.
  • Marinate meat before grilling. This can greatly reduce HCAs. For example, one study found that chicken marinated for 40 minutes in a mixture of brown sugar, olive oil, cider vinegar, garlic, mustard, lemon juice and salt cut HCAs by 92 percent to 99 percent.
  • Don't cook meat to "well done." Use a meat thermometer and cook poultry to an internal temperature of 165-180 degrees F, ground beef, pork and lamb to 160-170 degrees F, and beef steaks and roasts to 145-160 degrees F.
  • One or two days before you barbecue, eat cruciferous vegetables such as broccoli, cabbage, cauliflower, kale and brussels sprouts. These vegetables contain compounds that activate enzymes in the body that detoxify HCAs.


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Nursing Homes Need Better Diabetes Care

Treatment of elderly patients with type 1 and type 2 diabetes in U.S. nursing homes often fails to meet American Diabetes Association standards, according to a new study.

Researchers at the Ohio University College of Osteopathic Medicine studied the quality of care received over a year by 108 diabetic residents living in 11 nursing homes in Ohio and West Virginia.

They found that only 38 percent of patients met blood glucose [sugar] goals, only 55 percent had satisfactory blood pressure levels, and only 31 percent had lipids (serum total cholesterol) checks yearly. Of those who had regular lipids checks, only 58 percent had acceptable levels.
The study authors noted that these three areas -- hypertension control, blood sugar and cardiovascular risk factors (such as cholesterol) -- have a major effect on the life expectancy of people with diabetes.

The findings, published Friday in the journal Diabetes Care, revealed that the nursing homes in the study lacked a systematic approach to diabetes care and that treatment guidelines for diabetic nursing home residents must be developed in order to provide optimal care.

The researchers are currently developing treatment protocols for diabetic patients in nursing homes. They plan to offer these protocols to the medical directors of those nursing homes included in the study.

A follow-up study will examine the effectiveness of these treatment protocols.

Read More..

Between-meal snacks OK for elderly

Health News, Seniors/Aging News
Jo Spann used to be a steak-and-potatoes, three-squares-a-day type, but as the years have gone by, the 72-year-old now finds herself snacking "all the time." A full meal now is usually a once-a-day event. Researchers say such snacking is OK — in fact, regular nibbling can be good for older people.

An Auburn University study of the diets of 2,000 people aged 65 and older found that snackers ate more calories at a time in their lives when they are susceptible to weight loss and poor nutrition. Snacking provided significantly more protein, carbohydrates and fat.

So while snacking might fuel obesity for the young, it may ensure that seniors are eating enough calories, said Claire Zizza, an assistant professor of nutrition at Auburn and lead author of the study published in this month's Journal of the American Dietetic Association.
She said several factors, including health problems, medication and changes in taste could lead to poor appetite and weight loss in seniors. Compared to 25-year-olds, 70-year-old men ate 1,000 to 1,200 fewer calories; the decline for women was between 600 to 800 calories a day, according to the study.

Zizza's research, based on a federal nutrition survey from 1999-2002, found that snackers ate about 250 more calories than non-snackers.

Jean Lloyd, national nutritionist for the U.S. Administration on Aging, said the study "does a couple of real important things" by indicating that healthy eating can be reached various ways and by providing guidance to health professionals.

"You're not always sure in clinical practice how to handle a patient with decreased appetite who may have other health problems. You don't know if you should tell them to eat something small after lunch because maybe then they won't be hungry later and won't eat dinner," Lloyd said.

"The answer in this article says, 'No, that's good,'" she said. "...You can suggest with confidence that having a small snack midmorning or midafternoon is a good behavior."

Lloyd and Zizza both caution against chips, cakes, cookies and other "empty snacks." The snacks should be healthy to have the biggest benefit, Zizza said.

Lynelle Bumgardner, who directs the Daleville Senior Center in southeast Alabama, said a hot lunch is served there five days a week. She often sees patrons eating cookies, crackers and fruit before and after the noontime meal, which is provided using federal Meals on Wheels money and contains one-third of the U.S. Agriculture Department's recommended dietary allowances.

Some of the seniors save the bread, cookies or juice from their lunches to eat later and load up on the snacks offered by the center to take home and share with elderly spouses, Bumgardner said.

"I think for some of them, cooking for one is too much trouble and they'd rather just have a TV dinner or go out to eat and sometimes that's not nutritious," she said. "That's why I think the lunch meal is so important. For some of them, this is it for the day."

Spann, a Daleville resident, agrees. She usually finds one square meal a day sufficient — along with the snacks.

"I used to eat three big meals a day and some more in between," she said in a recent phone interview during a lull between bingo games at the senior center. "I'm a Yankee — I still love my potatoes. I used to like meat, but your taste buds change as you get older."

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Diabetes complications frequently afflict elderly

People who develop diabetes late in life often suffer from a range of diabetes-related complications, and their life expectancy is shorter than that of nondiabetic individuals of the same age, a new study shows.

The investigators, Dr. Frank A. Sloan, of Duke University in Durham, North Carolina, and colleagues point out in the Archives of Internal Medicine that "little is known about the impact of diabetes mellitus in elderly populations."

The researchers examined illness and mortality rates in 33,772 Medicare beneficiaries with diabetes and in 25,563 similar people without diabetes ("controls") over a 14 year period.
The death rate was over 9 percentage points higher among the people with diabetes than the control patients. Being newly diagnosed as diabetic translated into a loss of life expectancy of just over 2 years.

Overall, 92 percent of the diabetes group experienced an adverse health event compared with 72 percent of the control group.

Disorders affecting the legs and complications associated with surgery were higher among patients with diabetes. Furthermore, 58 percent of those with diabetes were diagnosed with heart failure, compared with 34 percent of the control group. While kidney disease and retinal eye disorders were less common, both increased markedly in the diabetic group.

"Although the present data provide no insight into the cause of these patterns, the burden of diabetes mellitus complications on the individual and on the health care system is enormous," the researchers conclude.

SOURCE: Archives of Internal Medicine, May 14, 20077.

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Keeping Weight Off in Youth Pays Off in Old Age

Staying trim and healthy in younger years can lead to a healthier, more mobile old age, U.S. researchers say.

Researchers analyzed data on more than 2,800 people, ages 70 to 79, in the Pittsburgh and Memphis metropolitan areas.

Reporting in the International Journal of Obesity, they found that women and men who were obese at ages 25 and 50, as well as at the time of the study, scored significantly lower on physical performance tests than those who were normal weight at those ages.
The physical performance tests measured walking speed, balance, and the ability to rise from a chair. The researchers noted that poor physical performance in older adults is a predictor of future disability, nursing home admission and death.

Women who were overweight but not obese at ages 25, 50 and between 70 to 79 also had lower physical performance test scores than those with normal weights at those ages.

The study also found that men and women who were overweight or obese in early- to mid-adulthood had lower scores than those who became overweight or obese in late-adulthood.

There may be a number of reasons for these findings, said lead author Denise K. Houston, an instructor in internal medicine-gerontology at the Wake Forest University School of Medicine in Winston-Salem, N.C.

"Obesity may lead to joint wear and tear, reduced exercise capacity, and a higher rate of chronic diseases such as cardiovascular disease, diabetes, and arthritis that can result in physical disability," Houston said in a prepared statement.

"Obesity in young and middle adulthood may result in earlier onset of chronic diseases and lower physical activity, contributing to decreased muscle strength and cardiovascular fitness and greater declines in physical performance," she said.

According to Houston, the findings suggest that "interventions to prevent overweight and obesity in young and middle-age adults may be useful in preventing or delaying the onset of physical disability later in life."

Read More..

Elan, Wyeth plan advanced trials of drug

Ireland's Elan Corp. PLC and Wyeth of the United States said Monday they are planning advanced trials of a drug to combat Alzheimer's, the incurable brain disease that afflicts more than 20 million people worldwide.

The pharmaceutical companies are seeking regulatory approval to begin advanced "phase 3" trials of bapineuzumab, which they hope will eventually be used to stop the memory loss and dementia symptomatic of Alzheimer's.

Both companies said they plan to begin advanced studies in the second half of 2007 — several months ahead of their previous target — but do not expect to announce results from their current mid-stage, "phase 2" trials until 2008.
"It is important to remember that Alzheimer's disease is a complex and formidable challenge, and our immunotherapeutic programs still contain inherent risks," the companies cautioned.

Shares of Dublin-based Elan surged 20 percent, to close at a new 52-week high of $18.95 on the Irish Stock Exchange. Wyeth shares were up $1.52, or 2.7 percent, at $57.90 in midday trading.

Analysts said the surprise decision to accelerate the advanced clinical trials for bapineuzumab raised investors' confidence that the drug was on course for U.S. Food and Drug Administration approval in 2008.

"The Alzheimer's market is huge," said Ian Hunter, an analyst at Goodbody Stockbrokers in Dublin. "It has the potential to be the next big indication for pharmaceutical companies, especially as the baby boomers come into the Alzheimer's-prone age group."

Several biotechnology companies are racing to develop the first FDA-approved drug that can effectively stop the development of amyloid plaques in the brain, which is believed to be the root cause of Alzheimer's.

While current drugs for Alzheimer's sufferers are administered to suppress symptoms, the new experimental drugs seek to prevent, or remove, the plaque formations.

Among rivals for the Elan-Wyeth project are Myriad Genetics Inc., whose Flurizan drug is already in phase 3 trials, and Medivation Inc., which expects its Dimebon drug to reach that level in 2008. Memory Pharmaceuticals Corp. expects phase 2 results of its drug, MEM 1003, in late 2007.

The current Elan-Wyeth trials of bapineuzumab involve treating 240 people with mild to moderate cases of Alzheimer's, chiefly in the United States, over an 18-month period, and a separate study of 30 Alzheimer's sufferers in Europe.

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Nearly 100 in hospital in China with encephalitis B

Nearly 100 people, apparently including many children, have been taken to hospital with encephalitis B in southwest China's Yunnan Province, Xinhua news agency reported on Saturday.

More than 30 are being treated at Shidian County Hospital in Baoshan, a city in the west of the province close to the Myanmar border, it quoted a hospital source as saying.

The hospital received more than 40 encephalitis B patients last week, Xinhua said, and more patients were in hospital at a clinic in a village of the province.
The provincial health authority has sent an expert panel consisting of top pediatricians to the county, indicating that many of the patients are children, Xinhua said.

Last summer, an outbreak of mosquito-borne encephalitis B -- which inflames the brain -- killed at least 14 people in the central province of Henan and 26 in the northern provinces of Shanxi and neighboring Shaanxi, according to state media.

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TV linked with poor diabetes control

Diabetic children who spent the most time glued to the TV had a tougher time controlling their blood sugar, according to a Norwegian study that illustrates yet another downside of too much television.

The findings, based on a study of children with Type 1 diabetes, lend support to the American Academy of Pediatrics' advice that children watch no more than two hours of TV daily, said lead author Dr. Hanna Margeirsdottir of the University of Oslo.

Type 1 diabetes is the less common form of the disease and used to be called juvenile diabetes. It is not related to obesity and is caused when the body cannot make insulin, which converts sugar from food into energy. People with Type 1 must take insulin daily and regulate their blood-sugar levels.
Snacking and overeating can increase blood-sugar levels; physical activity can lower them. While TV-viewing is often accompanied by snacking, the researchers didn't examine diet or physical activity.

The study results "suggest that encouraging children with Type 1 diabetes to watch less television may be important for improved blood glucose control and better health outcomes," the study authors wrote.

Other experts said the study also might suggest something else. Diabetic children who already have consistently high blood-sugar levels could feel too sick to do much besides watch TV, said Jill Weissburg-Benchell, a psychologist and diabetes educator at Children's Memorial Hospital in Chicago.

"It's very clear that there is a relationship. Now the question is what underlies that relationship," she said.

Results of the Oslo research will appear in the June edition of the journal Diabetes Care.

The study involved 538 children with an average age of 13. In Norway, about 25,000 people have Type 1 diabetes. In the United States, there are 3 million with the condition and about 30 million worldwide.

The study evaluated results of a routine test that measured average blood-sugar control over three months. There was a continuous increase in the level of blood sugar with every hour of TV watched, rising to the highest level for those who watched at least four hours daily.

The results didn't surprise Chicago diabetes educator Monica Joyce, who founded a basketball camp for diabetic children.

Campers typically are asked how much TV they watch and are taught "they can get much better blood sugars if they're active," Joyce said.

If the researchers' theory is right, then turning off the TV could be added to a list of remedies "that are very low-cost to the health care system," said Dr. Francine Kaufman, head of a diabetes program at Children's Hospital in Los Angeles.

"This has got to be the social norm that it's just not acceptable for kids to be baby-sat by TV," she said.

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Factor XI deficiency increases postpartum bleeding

Some women with factor XI deficiency, a genetic disorder, have an excessive risk of bleeding after childbirth, UK researchers report in the current issue of BJOG.

Factor XI deficiency is an autosomal recessive disorder, also called hemophilia C, in which patients who lack this clotting factor may or may not have a tendency to bleed. Patients generally don't have other symptoms, such as bruising or joint pain, but excessive bleeding can occur following dental work, trauma or surgery. Spontaneous bleeding is rare.
One group of patients with a high risk of having this blood-clotting factor deficiency is Ashkenazic Jews. Patients with this disorder can be identified by obtaining activated partial thromboplastin times.

Dr. Bethan Myers of Queen's Medical Center, Nottingham, and colleagues note that the treatment of pregnant women with factor XI deficiency poses a challenge because of the variability of bleeding and the risks associated with therapeutic replacement of this factor.

To investigate this further, the researchers reviewed the files of 105 pregnancies in 33 women with this disorder. Two hematologists examined the case notes and independently classified the women as "bleeders" or "non-bleeders."

Overall, there were 16 bleeders and 17 non-bleeders. Overall, pregnancy and delivery were uncomplicated in 71 percent of the women. Live births occurred in 76 percent of the non-bleeders and 65 percent of the bleeders.

There was no apparent between-group difference in the incidence of miscarriage, but bleeders had more than 7-times the risk of postpartum hemorrhage.

The researchers point out that a large, collaborative study is required to identify the factors that define the "bleeder" group among these patients.

Women with factor XI deficiency and a tendency to bleed require extra vigilance during delivery and prevention of caesarean sections, they conclude.

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Malnutrition stalks India's children

Health News, Parenting/Kids News
His wizened frame cradled in his mother's arms, 18-month-old Nitish gazes listlessly at his surroundings in an Indian government feeding centre in this parched farming belt.

The baby's skin is so taut that each rib can be counted and his whispy hair is a rusty brown rather than glossy black, characteristic of malnutrition.

"He just got thinner and thinner after getting diarrhea," said his mother Savitri, 24, a farm labourer's wife.

On the other side of the room, seven-month-old Niketa, being fed formula milk with a spoon by her grandmother, waves a stick-like arm. Her mother died two days after she was born following a difficult delivery.
"God is unjust -- He took her mother away and her father doesn't want her," said her grandmother Soni, 55, rocking the tiny doll-like figure at the feeding centre in Kolaras in central Madhya Pradesh state.

These babies, lying in a room hung with pictures of roly-poly infants smiling down, are just two of the 46 percent of all Indian children under three years old that the government says are malnourished.

In the dust-bowl state of Madhya Pradesh, where monsoon rains have been scant for five years, the number is higher -- a staggering 60 percent, the worst in the country.

"It's the silent emergency -- children are just fading away," said Meital Rusdia, spokeswoman for the UN children's agency Unicef.

Malnutrition endures despite India's booming economy, which grew by an average 8.5 percent over the past four years.

"It's shameful to have India become a trillion-dollar economy and to have nearly 50 percent of the children hungry," pediatrician Vandana Prasad, a member of the People's Health Movement.

Government investments in development are "insufficient," Unicef says.

Figures for child mortality, underweight children and other basic health indicators have shown no significant improvement in seven years.

While India has banished the spectre of famine that plagued its history and overshadowed the early years of independence, "household level" food security has still not been achieved.

Millions subsist on the barest of basic foods -- wheat, lentils and rice. Poor sanitation, undernourishment and haphazard immunisation makes them vulnerable to infection. Children suffer most in this cycle.

The "anganwadis" or village child care centres look after children under six and are the government's first line of defence against malnutrition.

The Supreme Court has ordered free noon meals for all children under six. But the Citizens' Initiative for the Rights of Children Under Six has highlighted lack of funds, poor staffing and corruption in providing meals that are often scanty and sometimes non-existent as the money has been pocketed.

At one centre visited by AFP, the children were served two small pieces of flat Indian bread and a tiny portion of potatoes. There was no protein.

"The government only gives two rupees (five cents) per child. What can you do with such small funds. What they get is a disgrace," said an aid worker who asked not to be identified.

To help severely malnourished babies, the government has set up intensive feeding centres but there just are not enough.

"The babies' mothers are often undernourished and they have low weight babies," said Dr Nisar Ahmed, whose job it is at the Kolaras feeding centre to fatten up the children.

Nearly a third of children are born underweight which means their mothers are underweight and undernourished.

"Some mothers just don't produce enough breast milk," he says.

Also, as pediatrician Prasad notes, many mothers do not have time to regularly breastfeed as they must work as farm or manual labourers, domestic servants or in factories.

"Some 97 percent of working women in India work in the unorganised sector" -- a catch-all phrase for casual workers -- "and nobody makes time for them to breast-feed so their children suffer," she says.

Some unlucky babies like Niketa lose their mothers in childbirth or soon after. The maternal mortality ratio is 540 maternal deaths per 100,000 births, mainly due to lack of timely, proper health care.

Malnutrition exacts a high cost.

"Their physical and mental development is stunted," says Ahmed.

With 40 percent of India's population under 18, the malnutrition figures are significant for India's future. Some studies suggest widespread malnutrition lops two to four percentage points off potential economic growth.

Ahmed says for every baby who is saved, many go undetected. We do our best but we can't reach everyone," he said.

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Complications seen burdening type 2 diabetic kids

Children and adolescents with type 2 diabetes, like adults, are at risk for developing complications from the disease. However, these complications are expected to develop earlier in young patients, experts say.

Given the rise in childhood cases of diabetes because of the obesity epidemic, this finding suggests there'll be "serious public-health challenges in the next few decades."

There is also concern that children and teens with type 2 diabetes will be more prone to complications due to poor adherence to treatment, write Dr. Orit Pinhas-Hamiel, from Sheba Medical Center, Ramat-Gan,Israel, and Dr. Philip Zeitler, from the University of Denver, in a review published in The Lancet medical journal.
In the last 15 years, the prevalence of type 2 diabetes in children and adolescents rose dramatically. Previously, type 2 diabetes accounted for just 3 percent of all cases of diabetes diagnosed in adolescents, but now it is responsible for 45 percent of cases.

The authors of the report say that type 2 diabetes complications are already being seen, including high blood pressure, impaired kidney function, and early eye damage.

They found that in most cases the complications were being detected at the time diabetes was diagnosed.

In addition to the well known complications of the disease, children and adolescent with type 2 diabetes were at heightened risk for psychiatric disorders, according to findings from one of the studies reviewed. Roughly one in five children with diabetes experienced depression or another disorder.

Type 2 diabetes in adolescents also takes a toll on pregnancy outcomes. In a Canadian study, girls with the disease had a very high pregnancy loss rate -- 38 percent.

"These findings, although still limited, suggest that we urgently need to develop approaches to awareness and early management of type 2 diabetes and associated abnormalities," the authors emphasize.

SOURCE: The Lancet, May 26, 2007.

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Overweight people get less out of exercise


Overweight and obese people get less out of resistance training than leaner people do, researchers said on Friday in a study that suggests the overweight may have to try harder to get results.

But it does not mean they should give up, said the researchers, who noted the differences were small.

"People who are overweight and obese experience numerous health benefits from exercise training programs even in the absence of significant amounts of weight loss or improvements in cardiopulmonary physical fitness," Linda Pescatello of the University of Connecticut and colleagues wrote in their report, published in the Journal of Strength and Conditioning Research.
They tested 687 adults aged 18 to 39, measuring their body fat and using magnetic resonance imaging to look at their muscles and fat.

The volunteers did 12 weeks of 45- to 60-minute workouts of their upper arms, working the biceps and triceps.

Everyone gained strength and muscle. But the overweight and obese volunteers gained 4 percent to 17 percent less than those of normal weight.

Differences could be genetic, the researchers said.

"People with overweight and obesity have alterations in skeletal muscle structure and function compared to those who are normal weight that could also contribute to variability in the exercise response," they wrote.

In a second study in the same journal, Jacob Baty and colleagues at the University of Texas found that carbohydrate and protein supplements prior to and during exercise did not help people exercise more efficiently.

But their 34 male volunteers who drank a high-protein, high-carbohydrate supplement did show less muscle damage, Baty's team reported.

"By consuming a carbohydrate-protein supplement similar to the one used in our study at a similar schedule during exercise, athletes can significantly reduce the amount of muscle damage produced in a given resistance exercise bout," the researchers said.

That could mean competitive athletes might reduce the time they must rest between workouts, they added.

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Friday, May 25, 2007

More households forbid smoking

More households forbid smoking
Smoking is forbidden in nearly three out of four U.S. households, a dramatic increase from the 43 percent of homes that prohibited smoking a decade ago, the federal government reported Thursday.

The Centers for Disease Control and Prevention, which conducted the survey in 2003, said it was the first study to offer a state-by-state look at the prevalence of smoking in American homes.

Utah led the nation, with people in nearly nine out of 10 homes saying smoking was never allowed. The state's large population of Mormons, who eschew tobacco, probably contributed to that statistic, the agency said.
Kentucky was in last place, with a little more than half of households sending smokers outside (or, at least, to the garage).

But even in Kentucky, smokers found fewer place to light up. Ten years earlier, only a quarter of the state's households barred smoking.

"That really says that people are starting to understand the hazards of secondhand smoke," said Dr. Corinne Husten, co-author of the study and chief of the epidemiology branch of the
CDC's Office on Smoking and Health.

Tobin Hilliard joined the millions of Americans living in smoke-free homes when he moved in with his non-smoking fiancee 10 years ago. He had to abandon the pleasure of smoking a cigarette at the kitchen table, on the living room couch or in the bedroom.

"It was just understood: 'If you're lighting up, you will be stepping out into whatever the weather conditions are,'" said Hilliard, 35, who is still a pack-a-day smoker in Clermont, Fla.

The CDC report was based on a national survey done mostly by telephone every two years. For a household to be included in the results, everyone 15 and older had to respond, and they all had to agree on the smoking rules.

The survey covered 127,000 U.S. households in 2003, the most recent year for which such data was available. The study looked at 900 to 7,000 homes in each state. Similar numbers were surveyed in previous years.

Participants were asked whether smoking was allowed everywhere in the home, only in some places, or not at all.

Among households with at least one smoker, the national prevalence of take-it-outside rules rose from about 10 percent in the early 1990s to 32 percent in 2003. Among households with no smokers, the percentage with such rules rose from 57 percent to almost 84 percent.

The CDC said the increases were driven in part by scientific reports and other information in the last 15 years warning that secondhand smoke causes premature death and disease.

A growing number of state and local smoking bans in restaurants, bars and workplaces may also have been influential at home, Husten said.

Loyd Silberstein, a retired school teacher in California, said he smokes at home — but not when his children or grandchildren come over. On those occasions, he goes out to the backyard or garage.

"My wife says I don't care about her, just the kids," laughed Silberstein, 75, of San Mateo.

The study was published the CDC's Morbidity and Mortality Weekly Report.

In another MMWR article this week, surveys of nearly 750,000 teens in 137 countries and territories showed that students exposed to smoking at home were most likely to take up the habit themselves.

The study found that more than 71 percent of nonsmoking students surveyed in Europe said they were exposed to cigarette smoke at home. The exposure was much lower in other parts of the world — particularly in Africa, where the statistic was just 23 percent.

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