B vitamins fail to curb risks in heart patients

Reducing levels of the amino acid homocysteine with folic acid and B vitamins failed to prevent serious complications in patients with heart disease, Norwegian researchers said on Tuesday.

The study was the latest of several large trials to show that lowering homocysteine through vitamin therapy offered no benefit to people with heart disease.

Other research had found a link between high concentrations of homocysteine in the blood and heart attacks and strokes.

But the researchers said the failure of their study and others like it suggests that homocysteine may be a marker for heart risks, and not a cause.

"Our findings do not support the use of B vitamins as secondary prevention in patients with coronary artery disease," Dr. Marta Ebbing of Haukeland University Hospital in Bergen, Norway, and colleagues wrote in the Journal of the American Medical Association.

Ebbing's team studied 3,096 patients with coronary artery disease in two Norwegian hospitals between 1999 and 2006 who were having procedures to remove blood clots that were blocking the flow of blood to the heart.

They divided patients into four groups, testing different combinations of B6 and B12 vitamins with or without folic acid. The vitamins were given in addition to other treatments.

Patients were scheduled for follow-up visits with an interview, clinical examination and blood sampling at one month, one year, and at a final study visit.

The study was stopped early because preliminary results from a similar study in Norway found no benefits from the therapy and an increased risk of cancer associated with B vitamins.

Based on the data they collected, Ebbing and colleagues found no sign that a combination of folic acid plus vitamin B12 or B6 helped reduce the risk of death or major heart events, such as heart attacks or strokes.

They did find a trend toward fewer strokes and a higher risk of cancer in groups receiving folic acid, but they said the numbers were not statistically significant.

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Prostate enlargement treated by Impotence Drug

Impotence drugs may be able to help reduce the symptoms caused by enlarged prostates, such as trouble urinating, U.S. researchers reported on Tuesday.

Men who took Eli Lilly and Co's Cialis every day had fewer symptoms, such as urinary frequency, urgency, intermittence, straining, incomplete emptying or a weak urinary stream, they reported in the journal Urology.

With about 50 percent of men over 50 suffering from some version of this problem, the study suggests a large potential market for erectile dysfunction drugs.

Researchers at the University of Texas Southwestern Medical Center at Dallas, Northwestern University in Chicago and Lilly Research Laboratories tested more than 1,000 men with enlarged prostates -- a condition known as benign prostatic hyperplasia or BPH.

Some got various doses of Cialis, known generically as tadalafil, while some got a placebo. Those who got Cialis were more likely to report their symptoms had improved, and a relatively low dose of 5 mg a day did the trick, reported the researchers, led by UTSW's Dr. Claus Roehrborn.

Cialis caused relatively few side effects, they added, in contrast to the drugs now used to treat BPH.

"Although they are effective, each of these drug classes can produce unwanted side effects, including dizziness, hypotension (low blood pressure) and sexual dysfunction," they wrote.

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Bacterial pneumonia a deadly killer in 1918

Bacterial pneumonia may have killed most people during the 1918 flu pandemic, and antibiotics may be as crucial as flu drugs to fight any new pandemic, U.S. researchers reported on Tuesday.

Samples of lung tissue taken from soldiers who died in the pandemic, the worst of the 20th century, showed evidence of damage both by the flu virus and by pneumonia-causing bacteria.

Such so-called co-infections also cause many influenza-related deaths today.

"In essence, the virus landed the first blow while bacteria delivered the knockout punch," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which conducted the study, said in a statement.

Writing in The Journal of Infectious Diseases, Fauci, Dr. Jeffery Taubenberger and colleagues said preparations for future pandemics should include stockpiling antibiotics as well as antiviral drugs and vaccines.

The researchers also reviewed scientific and medical journals for studies on autopsies conducted on influenza victims from the 1918 pandemic, in which between 50 million and 100 million people died around the world over 18 months.

They consistently found evidence of bacterial pneumonia along with flu in the victims, the researchers said.

Most experts agree that another influenza pandemic will come at some time, although no one can predict when and what strain of flu might cause it. Influenza constantly mutates and pandemics usually occur when a completely new strain gains the ability to easily infect humans and then pass from person to person.

The current chief suspect is the H5N1 avian influenza affecting mostly birds in Asia, Europe the Middle East and Africa. It rarely infects people but has killed 243 out of 385 humans infected since 2003.
Many countries are preparing for a pandemic by stockpiling drugs, developing vaccines and making plans to help society function when many people are sick or staying home to avoid infection.



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Stem cells to help treat bowel cancer

Stem cell scientists have developed a new and more accurate way of spotting aggressive forms of bowel cancer, allowing for tailored treatment that should improve patients' chances of survival.

British researchers said on Wednesday those with the most aggressive kind of cancer could be identified early by testing for a stem cell marker protein called Lamin A.

The team concluded that patients testing positive for Lamin A should be given chemotherapy, in addition to surgery, to increase their chances of survival.

The discovery is the latest example of new tests being developed that can help doctors decide how and when to treat different manifestations of cancer.

In the two earliest of the four key stages of bowel cancer, patients normally have an operation to remove their tumor but are rarely given chemotherapy, since the toxic treatment can cause more harm than good.

The new research, however, suggests that around one third of these early-stage patients will have the Lamin A stem cell marker, indicating a more serious form of disease, and they are likely to benefit from chemotherapy.

"Chemotherapy can be very useful but can have a number of side effects, so we only want to use it where we think there's a good chance it will help. This test will help us determine that," said Robert Wilson, a bowel cancer specialist at The James Cook University Hospital, Middlesbrough.

The team from Durham University and the North East England Stem Cell Institute now aims to develop a robust prognostic tool that eventually can be used widely in hospitals.

Their research was published in the Public Library of Science journal PLOS One and is available online here

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Alexander technique benefits back pain

Chronic back pain can be eased by teaching the Alexander technique, an alternative therapy involving learning better posture, British researchers said on Wednesday.

Until now, there has been no real evidence of the long-term benefits of the Alexander technique, although previous research has suggested it may offer short-term relief.

To find out more, a team of researchers from the University of Southampton and the University of Bristol compared the effectiveness of different therapies in more than 500 patients.

After a year of treatment, patients receiving 24 Alexander technique lessons reported experiencing just three days of back pain, compared to 21 days for those given normal care by their doctor, they wrote in the online edition of the British Medical Journal.

Back pain causes more disability than almost any other condition in Western societies but very few effective long-term treatments are available.

The technique was originally developed at the end of the 19th century by the Shakespearean actor Frederick Alexander.

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Joint surgery and cardio risk factors

In addition to confirming previously identified risk factors for cardiovascular complications after total joint replacement surgery, researchers have now found that bilateral (involving both sides of the body, such as two hip or knee replacements), as well as revision operations, are associated with increased risk.

"Revision joint replacement and bilateral surgery are much more prolonged operations than primary unilateral joint replacement," Dr. Jeffrey N. Katz, from Brigham and Women's Hospital in Boston, said in a statement. "These findings suggest an increased risk with more prolonged surgery."

The results, reported in the journal entitled Arthritis and Rheumatism, come from a study of 209 patients with a history of heart attack, heart failure, unstable angina (chest pain), arrhythmia (irregular heart beat), symptoms of low blood pressure, or a blot clot in the lung at admission for total joint replacement, and 209 patients matched to characteristics of the others, but did not have cardiovascular complications.

In line with prior findings, an increased risk of heart disease was 0.7-times greater in older patients, 2.6-greater in those with history of arrhythmia and 1.6-times greater in patients with a history of coronary artery disease, heart attack, heart failure, or valvular heart disease.

The strongest risk factor, however, was one of the newly identified ones, bilateral surgery, which increased the risk by 3.5-fold. Revision surgery also increased the risk by 2.2-fold.

"Clinicians can use this information to better estimate the risk of cardiovascular complications following total joint replacement surgery," Katz said, "and, ultimately, to prevent and better manage these complications."

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Pneumonia vaccination and diabetes

Researchers from Denmark say they have "strong evidence" that diabetes is associated with a 25 percent to 75 percent increase in the relative risk of hospitalization due to pneumonia.

Writing in the journal Diabetes Care, the researchers say these results "emphasize the value of influenza and pneumococcal immunization, particularly for patients with longer diabetes duration, and the importance of improved glycemic control to prevent pneumonia-related hospitalization among diabetic patients."

Using health care databases for northern Denmark, Dr. Jette B. Kornum from Aarhus University Hospital, Aalborg and colleagues identified 34,239 individuals with a pneumonia-related hospital admission and 342,390 individuals from the general population who served as a control group.

The analysis of these data revealed that individuals with diabetes had a 26 percent higher risk of pneumonia-related hospitalization compared with those without diabetes.

The risk of pneumonia-related hospitalization was increased by 4.4-fold in subjects with type 1 diabetes and by 1.2-fold in those with type 2 diabetes.

The longer duration of diabetes with poor glycemic control, the higher the risk of hospitalization for pneumonia became, Kornum and colleagues observed. Compared with the subjects without diabetes, having diabetes for 10 years or more was associated with a 37-percent greater risk.

Diabetes combined with an A1C level of 9 percent or greater, a standard measure of blood glucose, which should be 7 percent or lower, was associated with a 60 percent increased relative risk of pneumonia-related hospital admission, while diabetics who had an A1C of less than 7 percent had a 22 percent risk, compared with nondiabetic subjects.

"Our data extend previous studies suggesting that diabetes is a risk factor for pneumonia," Kornum and colleagues conclude.

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Mental illness may up risk of postpartum suicide

New mothers with a history of depression or other psychiatric disorders appear more likely than other women to attempt suicide soon after giving birth, a new study suggests.

Researchers found that among nearly 1,800 women who recently gave birth, those with a history of a psychiatric disorder were 27 times more likely to attempt suicide in the year after having their baby.

Similarly, women with a history of substance abuse had a six-fold increase in their risk of attempted suicide.

Postpartum suicide is rare, but the new findings point to a group of women who may be at greatest risk, the researchers note in the American Journal of Obstetrics & Gynecology.

Women, their families and their doctors should be aware that past psychiatric disorders and substance abuse are risk factors for postpartum suicide, lead researcher Dr. Katherine A. Comtois, of the University of Washington School of Medicine in Seattle, told Reuters Health.

The findings are based on hospital records from women who gave birth in Washington State between 1992 and 2001. The researchers identified 355 women who were hospitalized for a suicide attempt in the year after giving birth; they matched each of these women with another four who had given birth in the same year but did not attempt suicide.

Overall, Comtois and her colleagues found, the risk of postpartum suicide was markedly higher among women who'd been hospitalized with a psychiatric disorder, substance abuse problem or both 5 years before giving birth.

Such diagnoses are "clearly important risk factors" of which families and medical providers should be aware, Comtois said.

The American College of Obstetricians and Gynecologists recently recommended that women be screened for depression and other "psychosocial risk factors" during prenatal care, Comtois and her colleagues note in the report.

"Future studies," they write, "should evaluate the effectiveness of screening for psychiatric and substance use disorders on decreasing adverse outcomes such as suicide attempts during the postpartum period."

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West Nile patients recover

Patients infected with West Nile virus can develop long-term symptoms such as fatigue, fuzzy thinking and movement difficulties but these symptoms go away after about a year, doctors reported on Monday.

The mosquito-borne virus arrived in the Americas in 1999 and quickly began to sicken patients in New York. It has now spread across the United States, Canada and Mexico and continues to infect people in Africa, Australia, western Asia, Europe and the Middle East.

West Nile causes no symptoms in about 80 percent of cases. About one in 150 people infected with the virus develop severe illness with high fever, headache, neck stiffness, stupor, disorientation, vision loss, numbness, coma, paralysis and other symptoms.

Sometimes the neurological effects last for weeks or months and many doctors had feared this nerve damage was permanent.

Dr. Mark Loeb of McMaster University in Ontario, Canada, and colleagues wanted to see what the long-term effects were.

"This is the first study to comprehensively look at a large population of infected persons to study the long-term effects of West Nile virus," Loeb said in a statement.

"We found that both physical and mental functions, as well as mood and fatigue, seemed to return to normal in about one year."

Writing in the Annals of Internal Medicine, Loeb said his team studied 156 West Nile patients between 2003 and 2007.

They found symptoms and recovery times were similar among patients who had neurological effects and those who did not.
There is no human vaccine for West Nile virus, although one is sold to protect horses. The U.S. Centers for Disease Control and Prevention advises people to use repellents containing DEET and clothing to cover up as the best way to prevent mosquito bites and infection.


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Teens who lack sleep have high blood pressure risks

Poor sleep habits can do more than annoy parents and make teenagers drowsy in school -- they can lead to high blood pressure, U.S. researchers reported on Monday.

Teens who slept fewer than 6 1/2 hours a night had more than twice the risk of high blood pressure and those with troubled sleep had more than triple the risk, the team at Case Western Reserve University in Cleveland, Ohio found.

Writing in the American Heart Association journal Circulation, the researchers found the pattern held even when adjusted for sex, weight and socioeconomic status.

"Our study underscores the high rate of poor quality and inadequate sleep in adolescence coupled with the risk of developing high blood pressure and other health problems," said Dr. Susan Redline, the pediatrician who led the study.

"We also found that a low sleep efficiency may be more consistently associated with pre-hypertension than a shorter sleep period."

High blood pressure can damage arteries and kidneys, causing stroke, kidney disease and other illnesses.

Redline's team studied 238 13-to-16-year-olds and found 14 percent of the adolescents had high blood pressure or readings at the borderline, called pre-hypertension.

For adults, high blood pressure is defined as a reading of 140/90 or above, but for children it is defined as being in the 90th percentile for their age.

They had the volunteers fill out sleep diaries but also measured their movements while in bed to gauge whether they were really asleep. On average, the teens got just 7.7 hours of sleep a night, while they need nine hours at that age.

And 16 percent of the teens had low sleep efficiency, meaning they had trouble falling asleep much of the time or woke up too early. Another 11 percent slept less than 6 1/2 hours a night.

"These associations may have a large public health impact," Redline said in a statement.

"Part of the problem is the technological invasion of the bedroom with computers, cell phones and music," Redline said.

"There are teens who text message or listen to music all night, compounded by early school hours. Adolescents need nine hours of sleep. Parents should optimize sleep quality for their family with regular sleep and wake times and bedrooms should be kept quiet, dark and conducive to sleep."

The National Heart, Lung and Blood Institute said caffeine and too-warm temperatures also keep people awake.

"Signs of not getting enough sleep or sleeping poorly include consistently taking more than 30 minutes to fall asleep, awakening more than a few times or for long periods each night, feeling sleepy during the day, or having trouble concentrating at school or at work," the NHLBI, part of the National Institutes of Health, said in a statement.

Redline said the study may underestimate the problem because it excluded children with known sleep disorders and other illnesses.

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Armchair olympics causes obesity fear in China

Armchair athletics may not be an Olympic sport but it's the most popular activity in China this month, fuelling concerns about rising obesity rates.

Chinese media has even given its army of TV Olympic spectators a name -- otaku -- a Japanese word that means "venerable house" and usually refers to someone nerdy who is totally devoted to a hobby to the point of not leaving home.

Figures have shown about 840 million of China's 1.3 billion population tuned in to watch the August 8 opening ceremony of the Beijing Games and interest is expected to stay high to August 24.

Increased TV viewing, less physical jobs and a shift away from a traditional Chinese diet rich in vegetables and carbohydrates with little animal-sourced food to a more Western diet heavier in meat, eggs and dairy has piled on the pounds.

"Lots of mothers don't know what to feed their children anymore," said Zhao Hua, who was having lunch with her 6-year-old son Tanning at a massive McDonald's in the Olympics site.

"In the past it was good to be a bit fat because it was a sign of strength but now children are getting too fat."

Figures show about a quarter of Chinese adults are obese or overweight, which is lower than many other countries but has jumped from 13 percent in 1991 with forecasts it could double by 2028.

By comparison World Health Organization figures show 65 percent of adult Americans in 2005 were overweight or obese.

A University of North Carolina study, published in the July/August issue of the journal Health Affairs, showed of all developing countries, only Mexico's rate of obesity was growing faster than that of China.

The World Food Program says a 6-year-old boy in China is now 13 pounds (6 kgs) heavier and almost two-and-a-half inches (6.4 cms) taller than a 6-year-old was 30 years ago.

"We need to find the right investments and regulations to encourage people to adopt a healthy lifestyle, or we risk facing higher rates of death, disease, and disability and the related costs," warned researcher Barry Popkin.

The Chinese diet has changed, with hundreds of McDonald's and KFC outlets in China, but experts also blame a drop off in physical activity, with more cars and less bikes on the roads.

Chinese newspaper the People's Daily said China has fewer than seven training fields for every 10,000 Chinese, compared with 200 sports fields for every 10,000 people in United States, and Japan.

"Now all the teenagers just like to play video games and watch television and our children like McDonald's. It is not healthy," said Yu Yanbing who was tucking into some fries at McDonald's with his 3-year-old son Zixi.

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Obesity and diabetes increase heart disease risk

People who are both obese and have diabetes are highly likely to develop heart disease during their lifetime, a new study shows.

Researchers found that of more than 3,400 adults in a long-running U.S. heart study, women who were obese and diabetic had a nearly 80 percent chance of developing heart disease at some point. For their male counterparts, that figure was nearly 90 percent.

Lifetime risk was based on the likelihood that a 50-year-old would develop heart disease in the next 30 years.

Obesity and diabetes commonly go hand-in-hand. The new findings, published in the journal Diabetes Care, show that diabetes on its own significantly raises the lifetime risk of heart disease, and that obesity worsens the situation.

Dr. Caroline S. Fox of the National Heart, Lung and Blood Institute in Bethesda, Maryland, and her colleagues the lifetime heart disease risk of normal-weight women who did not have diabetes was 34 percent. The risk for normal-weight women with diabetes was 55 percent.

Among obese women, those who did not have diabetes had a 47 percent chance of developing heart disease, while the risk for those with diabetes was 79 percent.

The pattern was similar for men, with a lifetime heart disease risk of 49 percent among normal-weight, non-diabetic men, and a 77 percent risk for normal-weight men with diabetes. Obese men without diabetes had a 67 percent lifetime heart disease risk, while the risk for obese diabetic men was 87 percent.

The number of Americans with diabetes is expected to rise to 48.3 million by 2050, the researchers note, and heart disease due to diabetes appears to already be on the rise.

"This trend may continue to worsen if current trajectories do not change," they warn.

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Diabetes caused by exposure to PCB

People who have been exposed to high levels of toxic polychlorinated biphenyls (PCBs) may face an elevated risk of type 2 diabetes, a new study shows.

The findings, reported in the journal Diabetes Care, come from a long-term study of Taiwanese adults who, in the 1970s, had been poisoned by cooking oil contaminated with PCB pollutants.

Once used in products ranging from fluorescent lights and appliances to insulation and insecticide, PCBs were banned in the late 1970s as carcinogens and general health hazards. They linger in the environment, however.

In the new study, Dr. Yueliang Leon Guo, from the National Taiwan University in Taipei, and colleagues examined the incidence of type 2 diabetes among 378 Taiwanese "oil disease" victims and 370 of their neighbors who had not been poisoned.

They found that women who had been exposed to the PCB-laced oil were twice as likely as other women to develop type 2 diabetes over 24 years. And women who had been most severely affected by the PCB exposure had a more than five-times higher diabetes risk.

There were no similar risks seen in men, however.

Other studies have found that people with diabetes tend to have relatively higher levels of organic pollutants, such as PCBs, in their blood. In comments to Reuters Health, Guo said that since "everyone" has detectable PCB levels in his or her body, it's possible that exposure to such pollutants has helped feed the widespread rise in diabetes in recent decades.

"The public health implication of these findings can be huge," Guo added, "considering the burden of diabetes and its multiple long-term complications."

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Stroke treatment often delayed

Stroke victims frequently fail to seek emergency treatment promptly enough, and even when they do get to the ER quickly, their treatment is often delayed, a new study shows.

"Our study shows that most people with stroke symptoms still do not get to the hospital in a timely manner," lead researcher Dr. Kathryn R. Rose, of the University of North Carolina, Chapel Hill, told Reuters Health.

"This precludes them from being considered for time-dependent treatments that can reduce disability and death following a stroke."

In most cases, strokes are caused by a blood clot hindering blood flow to the brain. A drug called tissue plasminogen activator, or tPA, can be used to dissolve the clot and limit stroke damage, but it must be given within three hours of a person's first symptoms.

In their study, Rose and her colleagues found that of 15,177 patients in a North Carolina stroke registry, less than one-quarter arrived at the hospital within two hours of symptom onset. Of these patients, just 24 percent received a CT scan within the recommended time frame.

The researchers report the findings in the journal Stroke.

A CT scan is considered crucial to stroke diagnosis, and one must be done before tPA can be given. National guidelines call for running a CT scan within 25 minutes of a patient's arrival at the hospital, regardless of when their symptoms began.

Yet, Rose and her colleagues found, among stroke patients who arrived at the hospital more than two hours after their symptoms started, only 9 percent received a CT scan within 25 minutes.

"While patients that arrive to the hospital within 2 hours of symptom onset are more likely to receive a timely CT scan than those who do not," Rose said, "most do not. This points to areas where stroke systems of care within hospitals can be improved."
ne way stroke sufferers might improve their odds of prompt treatment is to call an ambulance, the study suggests.

Patients who arrived via emergency medical services were twice as likely to receive a timely scan as those who arrived on their own, the researchers found.

Given the implications of timely arrival, Rose said, "it is important for people to recognize the symptoms of stroke and promptly call emergency services when they occur."

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Birth control pills affect sexiness of man

Birth control pills may affect how appealing a woman finds a man's scent -- potentially steering her toward a mate who is genetically similar to her, according to British researchers.

The sense of smell is thought to be important to mate-seeking animals and humans. Genes of the major histocompatability complex (MHC) play a role in a person's odor, and people tend to be attracted to those with an MHC makeup that is dissimilar to their own.

This could have evolutionary significance, since genetic diversity in a couple increases the chances of having healthy children.

But in the new study, researchers found that after women began using birth control pills, their smell preferences tended to shift -- making them more likely to find the scent of a genetically similar man "sexy."

The findings appear in the journal Proceedings of the Royal Society B: Biological Sciences.

For the study, researchers led by Dr. S. Craig Roberts, of the University of Liverpool, recruited 110 women between the ages of 18 and 35. They had each volunteer rate the odors of six men, using t-shirts that the men had worn overnight.

The women were asked to rate odor "pleasantness" -- considered a correlate of "sexiness" -- and odor intensity. Odor "desirability" was tested with the question, "Based on this smell, how much would you like this man as a long-term partner?"

For each woman, the investigators pre-selected three MHC-similar and three MHC-dissimilar men.

At the time of the first sniffing session, none of the women was using oral contraception. A second session took place three months later, after 40 women had started using birth control pills.

The researchers found that, in general, the more pleasant a woman found a man's odor, the more desirable he was to her. But among women who began using birth control pills, the definition of a sexy odor changed over time.

"The results showed that the preferences of women who began using the contraceptive pill shifted towards men with genetically similar odors," Roberts said in a written statement.

If the sense of smell is in fact a strong player in humans' mate choices, the researchers write, birth control pills just might nudge a woman toward a less-than-ideal man.

"Not only could MHC-similarity in couples lead to fertility problems," Roberts said, "but it could ultimately lead to the breakdown of relationships when women stop using the contraceptive pill, as odor perception plays a significant role in maintaining attraction to partners."

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Asthma risk increased with childhood eczema

Children with the allergic skin condition eczema are at increased risk of developing asthma well into adulthood, according to a decades-long study.

Australian researchers found that among nearly 8,600 study participants followed from the age of 7, those who'd had childhood eczema were roughly twice as likely to develop asthma by middle-age.

It's not clear whether the eczema directly contributed to asthma development in these cases. However, the findings do suggest a cause-and-effect relationship between the two conditions, according to the researchers, led by Dr. John A. Burgess of the University of Melbourne.

They report the results in the Journal of Allergy and Clinical Immunology.

The findings come from a study that began in 1968, when parents of 8,583 7-year-old children in Tasmania were surveyed about their children's health. The children also had a medical exam. At that time, 769 were found to have eczema.

The researchers found that children with eczema were twice as likely as their peers to develop asthma as teenagers, and 63 percent more likely to develop the lung condition as adults.

Other researchers have noted a phenomenon dubbed the "atopic march," which refers to the sequential development of eczema, followed by nasal allergies and finally asthma. The current findings, Burgess and his colleagues write, suggest that this march continues on well past childhood.

It's also possible that eczema directly contributes to asthma development, the researchers say. One theory is that certain immune system cells, primed for an allergic response, might migrate from an eczema patient's skin to tissue of the airways. That could make their airways more likely to inflame in response to an inhaled allergen, leading to asthma symptoms.

"Our data suggest that a causal link is possible," Burgess told Reuters Health.
"If in fact the link was causal," he added, "then aggressive treatment of childhood eczema aimed at really tight control of that disease might have an impact on the development of asthma in adolescence and in adult life."


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Sextuplets birth in Iraq

A woman has given birth to rare sextuplets in southern Iraq, but two of them died because the hospital lacked the proper equipment to keep them alive, her doctor said on Saturday.

Some Iraqi media described it as the first birth of sextuplets -- six children born at once -- in the country, although this could not be verified.

Sextuplet births are extremely rare although fertility treatments have increased the frequency of multiple births.

"Two of the children died because of problems breathing," said Dr Ali al-Jabiri, in charge of premature infants at Al-Habboubi Hospital in the southern Iraqi city of Nassiriya.

"If we had suitable medical equipment then we could have saved them," he added.

The babies all weighed between 700 and 1,200 grams (24-44 ounces). Two boys and two girls survived. Their mother had used fertility drugs.

"The problem is, how can I take care of them? How to feed them?" said their mother, Ibtisam Najim Abid, at the hospital.

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Eye cells may improve sleeping pills

Sleepiness can be controlled by a set of nerve cells in the eye, tests on mice suggest, offering a new target for drug developers that may lead to better sleeping pills, British scientists said on Sunday.

Light levels have long been known to affect alertness, which is why dimly lit rooms lead people to feel drowsy. But the biological mechanism for this has been unclear.

Now University of Oxford researchers have discovered that so-called retinal ganglion cells play a key role. In mice where these cells are turned off genetically, the effects of light on sleep and alertness is completely abolished.

"We have discovered a new pathway that modulates sleep and arousal," lead researcher Russell Foster, of the Nuffield Laboratory of Ophthalmology, said.

"If we can mimic the effect of light pharmacologically, we could turn sleep on and off."

Many drugs have been developed to modify sleep-wake cycles, creating a multibillion-a-year sleeping pill market. But the action of current medicines is relatively crude and the drugs have side-effects.

By targeting the specific mechanism controlling the action of retinal ganglion cells, it may be possible in the future to develop much more sophisticated treatments.

The researchers were able to track the sleep pathway to the brain, showing that two sleep-inducing centers there were directly activated by the cells.

The research, however, is still at an early stage and scientists have yet to establish if the same processes affecting the back-to-front world of the mouse will work in humans.

Because mice are nocturnal, the affects seen in the animal tests were opposite to those that would be expected in humans.

Mice normally sleep when it is light and wake up in the dark -- but those mice in which the light-sensitive cells were turned off stayed wide awake when the lights were on.

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Bipolar disorder linked to genetic traits

Two genes that influence the activity of nerve cells in the brain may play a key role in a person's risk for bipolar disorder, marked by dramatic swings from depression to manic behavior, researchers said on Sunday.

The findings are not expected to lead to a genetic test for the risk of the condition but could help unravel the mystery of how it arises and lead to better treatments, they reported in the journal Nature Genetics.

An international team of scientists examined the genomes of 10,596 people mainly from Britain and the United States, including 4,387 with bipolar disorder, also sometimes known as manic-depression.

The researchers found those with bipolar disorder more likely to have certain variants of the ANK3 and CACNA1C genes. Proteins made by the two genes help govern the flow of sodium and calcium ions into and out of neurons in the brain, influencing the activity of these nerve cells.

"The key importance of this is that it gives us a clear idea of the sorts of chemicals and mechanisms in the brain that are involved in bipolar disorder," Nick Craddock of Britain's Cardiff University, who helped lead the study, said in a telephone interview.

"Over a number of years, that will help researchers to develop better approaches to diagnosis and treatment."

Because it tends to run in families, scientists have been trying to pinpoint genes involved in bipolar disorder. This was the largest genetic analysis of its kind on the disease, which affects an estimated 1 percent to 3 percent of adults worldwide, Craddock said.

The brain disorder causes extreme shifts in mood, energy and ability to function. It is marked by high periods of elation or irritability and low periods of sadness and hopelessness that can last months.

EQUILIBRIUM

The proper function of brain neurons depends on a delicate equilibrium between sodium and calcium, the researchers said.

"The brain operates according to how quickly calcium and sodium are going in and out of cells and how much of it goes in and out," Craddock said.

The findings suggest that bipolar disorder may stem at least in part from malfunctions in the flow of these ions, which are electrically charged versions of the chemicals.

There is a need for better treatment, Craddock said. Lithium, the most common, helps only about two-thirds of those with the disorder and can cause drowsiness, weight gain and mild shakiness.

The U.S. government's National Institutes of Health helped fund the research. Dr. Thomas Insel, director of the NIH's National Institute of Mental Health, said the findings may help solve the puzzle that is bipolar disorder.

"It's not going to tell us the whole story -- it doesn't give you the whole puzzle -- but it's something to build on," Insel said in a telephone interview.

Craddock said identifying the two gene variants probably will not be helpful in determining an individual's risk for the disorder because many who do not have the disease will have the genes.

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1918 flu survivors protected by antibodies

Antibodies from survivors of the 1918 flu pandemic, the worst in human memory, still protect against the highly deadly virus, researchers reported on Sunday.

The findings by a team of influenza and immune system experts suggest new and better ways to fight viruses -- especially new pandemic strains that emerge and spread before a vaccine can be formulated.

These survivors, now aged 91 to 101, all lived through the pandemic as children.

Their immune systems still carry a memory of that virus and can produce proteins called antibodies that kill the 1918 flu strain with surprising efficiency, the researchers report in the journal Nature.

"It was very surprising that these subjects would still have cells floating in their blood so long afterward," said Dr. James Crowe of Vanderbilt University in Tennessee, who helped lead the study.

The antibodies also protected mice from the 1918 virus, which swept around the world at the end of World War One killing between 50 million and 100 million people, Crowe's team reports in the journal Nature.

"The antibodies that we isolated are remarkable antibodies. They grab onto the virus very tightly and they virtually never fall off," Crowe said in a telephone interview.

"That allows them to kill the 1918 virus with extreme potency, meaning it takes a very small amount of antibody."

The human body has two systems for fighting off bacterial and viral invaders. One system uses so-called T-cells while the other employs B-cells, made in the bone marrow, which in turn make antibodies to both flag and directly attack the targets.

RESURRECTED VIRUS

Dr. Christopher Basler and colleagues at the Mount Sinai School of Medicine in New York tested the 1918 survivors and found that in most of them, the B-cells made antibodies highly attuned to the 1918 flu strain.

Dr. Terrence Tumpey at the U.S. Centers for Disease Control and Prevention had worked on a team that resurrected the 1918 virus taken from buried victims of the epidemic and tested this virus in mice. Mice given the antibodies from the elderly survivors lived, while those given placebos died.

Crowe said it will now be important to test other people who have had influenza to see if their immune responses are as strong. "The thought is the first influenza that you see during life is the one that you have the best immunity to," he said.

"If we can learn the rules about how these antibodies work we may be able to design antibodies to lots of other viruses."

The 1918 flu was an H1N1 strain that apparently came straight from birds. "This study tells us that human beings can make long lasting immune responses to bird influenza," Crowe said.

Crowe said his team is working to get antibodies from people vaccinated with experimental shots for the H5N1 avian influenza now circulating in Asia, Europe, the Middle East and Africa. H5N1 mostly affects birds but it has infected 385 people since 2003, killing 243.

Experts fear that, like the H1N1 virus did in 1918, H5N1 will mutate into a form that passes easily among people and spark another pandemic. No one knows if the vaccines being made now would protect against whatever form of H5N1 might emerge.
Crowe said antibodies from survivors might make a good interim treatment while a vaccine is formulated, manufactured and distributed -- a process that would take months.


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Obese men with prostate cancer have poor prognosis

Prostate cancer diagnosis tends to be delayed and surgical treatment more difficult in obese men than in lean men, according to two studies published Friday.

The primary reason for the later diagnosis, and consequently poorer prognosis, seems to be that the PSA test used to screen for prostate cancer is "biased" against obese men, according to researchers.

The problem, they explain, may stem from obese men's larger blood volume, which dilutes their PSA levels. High blood levels of PSA -- or prostate specific antigen - can signal the presence of a prostate tumor.

"We know that obese men tend to have lower PSA values than their normal-weight counterparts, possibly caused by larger blood volumes which dilute their readings," Dr. Stephen J. Freedland, who led the studies, said in a written statement.

"Now we know some of the real implications of this -- that these men are at a disadvantage in terms of prognosis compared to normal-weight men."

Freedland, of Duke University Medical Center in Durham, North Carolina, and his colleagues report their findings online in the journal BJU International.

In one study, the researchers looked at the outcomes of nearly 3,400 prostate cancer patients who had undergone surgical removal of the prostate between 1988 and 2007. Some had had their cancer detected by PSA, while the rest had had it discovered during a digital rectal exam.

Overall, Freedland's team found, obese men were more likely to have more-aggressive tumors and to suffer a cancer recurrence after surgery.

However, the link between weight and disease progression was limited to men treated since 2000, when PSA screening had become the norm.

By contrast, obesity had no effect on the risk of progression for cancers detected by digital rectal exam. The findings support the notion that PSA testing, in particular, confers a bias against obese men, according to Freedland.

In the second study, the researchers found that obese prostate cancer patients tend to have a higher rate of "positive surgical margins" after prostate removal -- which means the odds are higher that some tumor cells were left behind.

"The aggressiveness of obese men's tumors, coupled with the fact that they may be more difficult to remove, is like a double whammy for being obese," Dr. Jayakrishnan Jayachandran, another researcher on the studies, said in a statement.

The findings of both studies, according to Freedland, build up the case for developing alternative prostate cancer screening methods for obese men -- or for lowering the PSA threshold for these patients.

"The least we can do is find a way to level the playing field when it comes to diagnostic tools," Freedland said.

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Physical barriers affect India's fight against HIV

Vast distances are a major hurdle to India's efforts to curb its soaring HIV rate.

India, which has the world's third largest HIV-positive caseload, gives drugs for free to HIV/AIDS patients. But doctors say this is not enough to stop the spread of HIV which is making inroads in rural India, especially among women infected by itinerant husbands, and also children.

For three days a month, Sambit squeezes into a crowded and often filthy train for a three hour journey to Delhi to receive HIV treatment.

"There's no seat and I am very weak," said the 30-year-old former tailor, who asked that his full name not be revealed. He can't afford lodging in Delhi and can barely afford the train tickets.

"I need to borrow money from my family for all these trips," he said.

Many patients in the same position simply give up treatment, an anathema in HIV therapy as it gives rise to drug resistance. These patients may then need more powerful second line treatment, which is not freely available in India.

"Travel can affect drug compliance. Patients who don't get family support, women who may not like to travel alone will just give up," said a doctor at a New Delhi hospital, who spoke on condition of anonymity because he did not have permission to speak to reporters.

There are 147 "antiretroviral therapy" or ART centers in the country, part of a government drive that has been encouraged by the World Health Organization in a bid to prevent HIV from becoming a major health problem.

Delhi has nine such centers and is far better served than many other states. Up to 6,000 patients receive treatment in Delhi, nearly half of these live outside the capital.

The government now plans to build "link centers", small facilities that are closer to where patients live so people like Sambit can obtain their medications more easily.

"They just come to pick up the drugs if they have no side effects and they go home ... that saves transport and other costs," Rao said, adding that the plan was to have as many as 500 such centers all over India.

INFECTION FIGURES AREN'T GOING DOWN

India has 2.47 million HIV cases, according to the latest figures, but health workers say the number is rising rapidly and spreading to new population groups.

"Our numbers are going up," said Loon Gangte, South Asia coordinator of the Collaborative Fund for HIV Treatment Preparedness.

"It's not confined to high risk groups, it's going into the general population. It's not a problem of sex workers, drug users or truck drivers. These people have wives and children at home and the disease is making its way into the general population."

Sujatha Rao, director-general of the government's National AIDS Control Organization, says doctors are increasingly seeing women infected by their husbands.

In some clinics, 1 out of 100 women who come for ante-natal care checkups are HIV positive, she said.

"It is a generalized epidemic," she said. "We have pockets where the prevalence is more than 1 percent among ante-natal care mothers, so we need to intensify our work."

Out of India's 611 districts, HIV prevalence is more than 1 percent of the population in 156 districts.

"The epidemic is getting deeper into (certain) rural, general areas of the country ... it is migrant-related. They go to work and then they take back the infection to their homes," she said.

Even though HIV drugs are free, only about 155,000 people have access to retroviral drugs, up from 20,000 just two years ago.

Health expert say there are many people who do not know they are infected or who do not know that treatment is available.

Some health professionals believe India's HIV problem is closely intertwined with poverty and that the government must tackle poverty if it seeks to curb the spread of HIV.

"Many of these people are very poor, they worry about food, shelter. So they may not think their HIV status is a problem because they don't even know where their next meal is coming from," said Errol Arnette of the help group Sahara.

"A lot of AIDS patients die of TB because it's hard for hospitals to keep them (in hospital). HIV patients are just thrown in a corner because of heavy stigma."

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Doctors fall short on heart disease prevention

Some doctors are not making the grade when it comes to helping their patients ward off heart disease, a new survey suggests.

The survey, of nearly 900 U.S. primary care doctors, found that many do not follow practice guidelines on managing patients who are at elevated risk of heart and blood vessel disease.

"Despite the benefits demonstrated for managing cardiovascular risks, gaps remain in primary care practitioners' management of risks according to guideline recommendations," conclude researchers in a report in the journal BMC Family Practice.

"Patients should talk to their physicians about setting goals together for reducing blood pressure and cholesterol and making a plan to achieve the goals," lead researcher Dr. Hamidreza Doroodchi, from Birmingham, Alabama-based Outcomes, Inc., noted in comments to Reuters Health.

Doroodchi and colleagues sent a survey on cardiovascular disease management to a random sample of 12,000 U.S. family physicians and general internists. A total of 888 completed the survey, which contained "case vignettes" for managing adults deemed to be at low or high risk of heart disease.

The study found that in the hypothetical case of a low-risk 45-year-old woman, only 28 percent of family doctors and 37 percent of internists made the "guideline-based preventive choice" of prescribing no aspirin or other antiplatelet therapy -- drugs that help prevent blood clots by keeping platelet blood cells from clumping together. The majority indicated that they would prescribe a daily aspirin for such a patient to reduce the risk of heart attack.

When asked whether they would start drug therapy to combat abnormal cholesterol levels, 51 percent of doctors said they would not do so in this low-risk patient -- which is in accordance with guidelines. On the other hand, 41 percent said they would prescribe a statin.

When it came to basic lifestyle advice, which is appropriate for low- and high-risk patients alike, doctors often fell short.

For example, while experts recommend that all adults limit their intake of artery-clogging trans fats, over one-third of doctors in the survey failed to recommend this measure for the low-risk 45-year-old woman.

For a 50-year-old man at high risk for heart disease, only 59 percent of family doctors and 56 percent of internists correctly identified the guideline-based goal of keeping "bad" LDL cholesterol below 100 milligrams per deciliter.

Similarly, for a 78-year-old woman at high risk for heart disease but no obvious symptoms, only about half of family doctors and internists were in accordance with guidelines to order a stress test should she develop chest pain or shortness of breath.

Doctors in practice for 10 years or less were much more likely than doctors in practice for more than 10 years to make appropriate guideline-based choices for the prevention of heart disease. Younger doctors were also more apt to adhere to guidelines than were more experienced doctors.

Doroodchi and colleagues found it "especially concerning" that doctors who see a greater percentage of patients with high blood pressure and cholesterol abnormalities were significantly less likely to offer guideline-based care.

"Innovative educational approaches," they conclude, "are needed to address barriers, and target specific groups of physicians to facilitate implementation of guideline-based recommendations for cardiovascular management."

The findings should not, however, be taken as a sign that doctors lack concern for their patients, according to Doroodchi.

"Most primary care physicians are concerned about cardiovascular risk in their patients and set goals for their patients to reduce this risk," the researcher said. "Physicians are concerned that their patients do not follow their advice about changes in exercise and diet, and (that) they do not always take the medicine that is prescribed."

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Study shows few HIV patients tested for tuberculosis

A new report suggests that only 1 percent of HIV-positive patients worldwide have been screened for tuberculosis, a curable infection that frequently kills those living with the AIDS virus.

The low TB screening rate is "unacceptable," researchers from the Advocacy to Control TB Internationally (ACTION) coalition said during a press conference at the International AIDS Conference underway here.

"A mere one percent of people living with HIV/AIDS are reported to have been screened for TB," said Dr. Jim Yong Kim, chief of the division of social medicine and health inequalities at Harvard Medical School. "One of the great tragedies of this epidemic is that people who are living with HIV, after hard-fought battles for access to antiretroviral treatment, go on to die needlessly from TB."

Quoting WHO statistics, the report says that of the 33 million HIV-positive people worldwide, only 314,394 individuals had been tested for tuberculosis. Of those who had been screened, over one in four were found to have active tuberculosis, according to a press release issued by ACTION.

"Persons living with HIV/AIDS are 50 times more likely to develop tuberculosis, than those who are HIV negative," the release cautions. "Without treatment, approximately 90% of persons living with HIV/AIDS die within a few months of developing TB."

"We are facing a preventable plague inside a devastating epidemic," said Michel Sidibe, assistant secretary general and deputy executive director of UNAIDS.

Screening for tuberculosis is not mandatory in the programs being funded by the three major international donors -- Global Fund, PREPFAR and the World Bank, the release states.

The ACTION group recommends universal TB screening of all people living with HIV/AIDS and access to the 3 "I"s -- Intensified case finding, Infection control, and Isoniazid preventive therapy.

Screening tests for tuberculosis are inexpensive compared to the cost of the drug cocktails used to treat HIV/AIDS, Kim said in response to a question at the press conference.

An integrated HIV/TB approach is needed, Kim told Reuters Health.

"TB is a curable disease," he said. "It is a crime not to test for tuberculosis."

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Family planning groups against abortion proposal

Family planning groups said on Friday they were still planning to lobby against a proposed new regulation aimed at countering state laws that require certain health care workers to provide contraception to women.

A widely circulated version of the draft regulation would have cut off federal funds to hospitals and states that attempt to compel medical providers to offer legal abortion and contraception services to women.

Health and Human Services Secretary Mike Leavitt said a version of the regulation is still under consideration.

"Not only are there clear provisions in three separate laws protecting federally funded health care providers' right of conscience, but doing otherwise undermines the most fundamental moral underpinning of freedom of expression and action," Leavitt wrote in his blog.

Leavitt said the part that many groups objected to most strongly, which defined abortion to include most birth control pills and intrauterine devices, would not be included.

But Nancy Northup of the Center for Reproductive Rights said her group objected to other parts of the proposal.

"It broadly defines everyone who works at a healthcare establishment as being involved in doing procedures," Northup said in a telephone interview.

"It allows everybody, whether you are a receptionist or a maintenance person ... to object to doing their jobs because they object to abortion or sterilization," she added. "It puts women in the position of not knowing when they go to get healthcare if someone is going to say, 'I am not going to help you here.'"

The National Family Planning & Reproductive Health Association said it was concerned the proposed regulation would target 37 state laws.

"These laws mandate the availability of EC (emergency contraception) in emergency rooms, bar pharmacies from flatly refusing to fill prescriptions and mandate coverage of contraception when other prescriptions are covered," the group said in a statement.

"Given that at least 17.5 million women in America are in need of publicly funded contraceptive services ... we believe the department should be working to increase access to these crucial health care services, rather than working to limit them."

New York Sen. Hillary Clinton also expressed doubts after reading Levitt's comments.

"It is crucial that science, not ideology, be the basis of any rules released by the Department of Health and Human Services," she said in a statement. "It is unconscionable that this administration would even consider putting women's health and prevention in jeopardy."

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Heart drugs combination can cause muscle damage

U.S. health officials warned the public on Friday about the risk of a rare type of muscle injury seen when the cholesterol drug simvastatin is combined with the anti-arrhythmia medicine amiodarone.

The Food and Drug Administration said it continued to receive reports of rhabdomyolysis, a type of muscle injury that can lead to kidney failure or death, despite a 2002 warning about combining the drugs.

Simvastatin is an ingredient in Merck & Co's Zocor and Abbott Laboratories Inc's Simcor, and is sold generically. It also is one of two components in Merck and Schering-Plough Corp's Vytorin.

Amiodarone is an ingredient in Wyeth's Cordarone and is also sold generically. Upsher-Smith sells a version under the name Pacerone. The drug is used to control a life-threatening type of abnormal heart beat.

All drugs in the statin class of medicines, which include simvastatin, Pfizer Inc's Lipitor and others, carry a potential risk of rhabdomyolysis.

But compared with other statins, the risk is "more pronounced" when simvastatin is given with amiodarone, the FDA said. The risk increased with simvastatin doses greater than 20 milligrams per day.

"Prescribers should be aware of the increased risk of rhabdomyolysis when simvastatin is prescribed with amiodarone, and they should avoid doses of simvastatin greater than 20 mg per day in patients taking amiodarone," the FDA said in a notice on its website.

The FDA has confirmed 52 U.S. reports of rhabdomyolysis associated with use of amiodarone and simvastatin since the 2002 warning, agency spokeswoman Susan Cruzan said. During the same period, there were six cases linked with use of other statins and amiodarone, she said.

Patients should contact a doctor immediately if they develop unexplained muscle cramps, pain, tenderness, stiffness or spasms, the FDA said.

The muscle injury risk has been "very clearly stated" on Zocor's label since 2002, Merck spokesman Ron Rogers said.

Schering-Plough spokesman Lee Davies also said the risk was noted in Vytorin's prescribing instructions for years, and Abbott spokeswoman Elizabeth Hoff said the "prescribing information for Simcor already contains this information."

Wyeth noted a possible interaction specifically with simvastatin on Cordarone's label about six months ago, company spokesman Doug Petkus said. Earlier information mentioned a risk when combining Cordarone with Lipitor and implied it would apply to other statins, he said.

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Longterm smoking linked to gene

For most people, the first experimental drags on a cigarette bring on nausea, coughing and other signals from the brain that say, "Turn back. This is a bad idea." But for some, they bring a wave of pleasure.

Those in the second group likely bear a gene type that not only increases their addiction risk, but has been implicated in the development of lung cancer, researchers said on Friday.

"If you have this variant, you are going to like your earliest experiences with smoking," said Ovide Pomerleau of the University of Michigan Medical School, whose research appears in the journal Addiction.

Pomerleau said the finding suggests that for some, smoking even one cigarette is a bad idea. "It's a trap," he said in a telephone interview.

"What they don't realize is if they have this kind of genetic make-up, they are on their way to dependency," he said, and that raises their risk for lung cancer.

The research is part of a growing understanding of genetic factors involved in nicotine addiction and lung cancer.

Teams of scientists reported earlier this year that smokers who had certain changes in three nicotine receptor genes -- which control entry of nicotine into brain cells -- were more likely to develop lung cancer than other smokers.

This week, Canadian researchers said that, by manipulating receptors for the chemical dopamine, they were able to control which rats in a study enjoyed their first exposure to nicotine and which were repelled by it.

Pomerleau said the field may soon lead to new treatments for nicotine addiction and tests to assess addiction risks.

Smoking causes nine out of 10 cases of lung cancer, the leading cause of cancer death in men worldwide and the second-leading cause of cancer death among women.

Pomerleau and colleagues studied data from 435 people. Some had tried a cigarette but never developed a habit; others smoked at least five cigarettes a day for the past five years.

Regular smokers in the study were far more likely than those who had never smoked to have a change in the CHRNA5 nicotine receptor gene. Smokers were eight times more likely to report liking cigarettes from the start.

Pomerleau said work has begun to develop a genetic screen for the CHRNA5 variant. Two other researchers on the team, Laura Bierut and John Rice at Washington University, hold a patent on the gene variant, which has been licensed by privately held Perlegen Sciences Inc.

Pfizer Inc, maker of the smoking cessation drug Chantix owns a $50 million stake in Perlegen.

Pomerleau, who has served on Pfizer's scientific advisory board, said he favors development of diagnostic tests, as long as people understand it is not the only risk factor for nicotine addiction.

"What we don't know is far greater than what we do know," he said.

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Weight loss can affect bones longterm

When people lose weight, they often lose some bone mass as well. Now a new study suggests that changes in bone metabolism may persist even after the weight loss stops.

In a study of obese adults who followed a very low-calorie diet, researchers found that even after the dieters stopped shedding pounds and entered the "weight maintenance" phase, changes in their bone turnover remained.

Bone turnover, or "remodeling," refers to the normal process by which the body constantly breaks down old bone and builds up new tissue to replace it. It's known that even moderate weight loss can cause an imbalance in this process, leading to a dip in bone mass, but it has been unclear whether changes in bone turnover persist after a person's weight stabilizes.

Among dieters in the current study, researchers found that the balance between bone breakdown and bone formation was restored after they stopped losing weight. However, the overall rate of bone turnover increased during weight loss, and it stayed higher once their weight stabilized.

This is a potential concern, says lead researcher Dr. Pamela Hinton, because increased bone turnover can make bones more fragile, even when bone breakdown and formation are balanced.

"Accelerated bone remodeling is thought to be an independent risk factor for bone fracture," explained Hinton, an associate professor of nutritional sciences at the University of Missouri in Columbia.

However, she told Reuters Health, long-term studies are still needed to see how weight loss ultimately affects people's actual bone density and fracture risk.

Bone mass changes slowly, Hinton noted, and it takes six months to a year to see a shift. Moreover, bone fractures may not occur for many years after the weight loss, she said.

Her team's findings, which are to be published in the Journal of the American College of Nutrition, come from a weight-loss study of 37 obese adults age 50 and older.

For three months, the men and women followed a liquid-based diet that provided just 500 calories per day; in the end, they lost an average of 20 percent of their initial weight.

Hinton and her colleagues then followed the dieters through a nine- month maintenance phase where they increased their calorie intake to a level designed to maintain their weight or to continue a slower, gradual weight loss.

Periodically, the researchers measured the study participants' blood levels of certain proteins that serve as markers of bone breakdown and formation. Based on those markers, the average rate of bone remodeling sped up during weight loss and remained higher during the weight-maintenance phase.

It's not clear what people can do to alter their bone turnover rate after weight loss. Hinton said there is some evidence that a high calcium intake -- 1,500 to 1,800 milligrams per day -- lessens bone loss and adverse effects on bone turnover as people are losing weight.

Weight-bearing exercise -- such as jogging, stair-climbing and weightlifting -- helps build bone in people who are not shedding pounds, Hinton noted. However, she said, research has been inconclusive as to whether it can prevent bone loss in people who are losing weight.

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Diabetes risk can be prevented by high vitamin C intake

An abundance of vitamin C in the diet may help lower a person's risk of developing type 2 diabetes, new research suggests.

In a study of middle-aged and older men and women, those with the highest blood levels of vitamin C were significantly less likely to develop diabetes over 12 years than those with the lowest levels, researchers found.

Fruits and vegetables are the main source of vitamin C in Western diets, and blood levels of vitamin C are good markers of fruit and vegetable intake, Dr. Nita G. Forouhi, at the Institute of Metabolic Science at Addenbrooke's Hospital, Cambridge, England, and colleagues note.

The current findings "re-endorse the public health message of the beneficial effect of increasing total fruit and vegetable intake," the investigators wrote in Archives of Internal Medicine.

Forouhi's team followed 21,831 healthy men and women who were 40 to 75 years old for the development of type 2 diabetes. At study entry, all participants provided detailed health and lifestyle information, as well as blood samples, which investigators used to determine vitamin C levels.

Over the course of the study, 423 men and 312 women developed type 2 diabetes, an overall rate of 3.2 percent.

According to the investigators, the likelihood of developing diabetes was 62 percent lower in men and women with the highest circulating vitamin C levels, relative to men and women with the lowest vitamin C levels.

Factoring out other characteristics associated with diabetes risk, such as older age, gender, family history, alcohol intake, physical activity, smoking status and body weight did not significantly alter these associations.

These data offer "persuasive evidence of a beneficial effect of vitamin C and fruit and vegetable intake on diabetes risk," Forouhi and colleagues conclude.

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Diabetes worries parents

Parents of children with type 1 diabetes are particularly concerned about the complications of the disease, new research shows.

Initially, most of the concern is centered on daily management tasks, but over time it shifts to concerns about long-term complications, such as kidney disease, blindness, and amputation, according to the report in the journal Diabetes Care.

Dr. Lisa M. Buckloh, from Nemours Children's Clinic in Jacksonville, Florida, and colleagues studied 30 mothers, 14 fathers, and 3 other relatives of 33 children with type 1 diabetes who participated in focus-group discussions of diabetes complications.

In general, the parents said they preferred a flexible, collaborative approach with their child's healthcare provider in discussing complications. Moreover, they wanted the information to be tailored to the child's age and duration of diabetes.

A number of participants desired more sensitive communications and improved emotional support from their healthcare professional.

Motivating children to care for their disease was cited as being particularly challenging, the report indicates. Family burnout with diabetes care over time was also observed.

Misinformation about diabetes complications was uncommon.

"Amount, depth, and timing of presentation of information about complications to youth should be tailored to the child's developmental maturity, the family's prior exposure to diabetes, and parental preferences," Buckloh and colleagues conclude.

"Parents should receive emotional support and guidance in talking with their children about complications in a positive, constructive, and motivating manner rather than using negative methods such as scare tactics."

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Cognitive problems cause heart disease

Results of a study in the European Heart Journal indicate an association between heart disease and lower thinking or "cognitive" performance in middle-aged adults.

Using data from the Whitehall II study, Dr. Archana Singh-Manoux, of INSERM, Cedex, France, and colleagues examined the association between heart disease and cognition in 10,308 subjects who were 35 to 55 years of age when the study began in the late 1980s. Heart attacks and other related heart problems were recorded up to 2004, at which point 5837 subjects had completed six cognitive tests.

Men and women who developed heart disease scored lower on a number of cognitive tests, particularly those involving reasoning and vocabulary, than did their peers without heart disease. Moreover, there was evidence, at least in men, that the longer the heart disease was present, the greater the impairment in thinking.

"Our results suggest that even among middle-aged individuals, heart disease is associated with poor cognitive performance with some evidence to suggest a stronger effect among those with longest standing (disease)," Singh-Manoux and colleagues conclude.

However, these findings are unable to answer the question of whether heart disease leads to impaired cognition or vice versa, the authors note.

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Early Screening Not Related To Family Breast Cancer

New research suggests that just because a woman has family members with breast cancer, it does not mean that she should undergo early screening for the cancer. According to the report, there are certain factors doctors can look for to determine whether early screening is advisable.

"Breast cancer is very common. Familial clustering is also rather common," Dr. Geertruida H. de Bock, the study's first author, told Reuters Health. "About 25 to 30 percent of breast cancer is family clustered, but the (rate) of breast cancer in the family is not very useful in predicting if you will get breast cancer yourself."

At present, having a first-degree relative (mother, sister, or daughter) diagnosed with breast cancer before age 40 is considered to be an indication for starting breast cancer screening before age 50, de Bock and her team note in the journal BMC Cancer. However, this practice is based on estimates from families with risky gene mutations or who are otherwise cancer-prone.

To better understand the risk in the general population, the researchers looked at 1,987 women, all of whom had sisters who had been diagnosed with breast cancer. Some of the study participants had breast cancer while others didn't.

The researchers identified four familial factors that were related to developing breast cancer at a younger age:

--at least two cases of breast cancer in a first-degree relative;

--at least two cases of breast cancer in first or second-degree (grandparent, grandchild, uncle, aunt, nephew, niece, half-sibling) relatives younger than 50;

--at least one case of breast cancer in a first or second-degree relative younger than 40;

--or any case of cancer affecting both breasts

Women who had at least two of these risk factors were roughly eleven times more likely than those with no risk factors to develop breast cancer by age 30. For cancers occurring before ages 40 and 50, the presence of two or more factors raised the risks by five-fold and two-fold, respectively.

However, because breast cancer is so uncommon in younger women, even with two or more of the above factors, the odds of breast cancer by age 30 is just 1 percent. By ages 50 and 70, the risks of breast cancer increased to 13 and 11 percent, respectively. Given that these risks are already pretty low, women with just one factor are likely to have a very low risk and may not require early screening at all.

The authors believe that by looking for the factors they identified, doctors can better inform patients of their true risk of breast cancer and whether early screening is warranted.

"There is a tendency to screen everyone and I think screening has disadvantages as well as advantages," de Bock said. Doctors "should be critical about it and really think about it if there isn't really an increased risk."

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Chemotherapy information not given to terminally ill cancer patients

Patients with incurable cancer are often not clearly informed of what they stand to gain from palliative chemotherapy, according to the study results published in BMJ Online First. As a result, British investigators say, patients may lack sufficient knowledge make a decision based on informed consent.

Palliative chemotherapy is not intended to cure patients of cancer, only to make their lives more tolerable. Nonetheless, this treatment may slightly improve survival.

Dr. Suzanne Audrey, at the University of Bristol, and colleagues observed and recorded 9 oncologists and 37 patients during consultations in which palliative chemotherapy for advanced lung, pancreas, or colon cancer was first discussed.

In all cases, patients were informed that their cancer could not be cured, and the purpose of palliative chemotherapy was explained. They were also informed about treatment options, common side effects and associated risks.

In 8 cases, survival was not discussed at all. In 18 cases, information was "vague," involving comments such as "about 4 weeks, a few months extra, and buy you some time." Only 6 patients were given numerical data about how much longer they would probably live if palliative chemotherapy were used.

"If the oncologist focuses on the benefits of palliative chemotherapy in terms of control of symptoms and quality of life, but omits information about survival benefit, the patient might assume much greater potential to prolong life than is likely to be the case," Audrey and colleagues suggest.

"Perhaps most difficult of all is when a patient, or their partner or carer, makes it clear that they do not want to receive any more bad news. Talking about life expectancy can seem cruel at this point," they continue. "But... supplying basic information about the survival benefit of treatment need not entail giving 'intrusive' data about prognosis."

Instead of evading the subject, the authors recommend that oncologists receive coaching on how to inform patients without taking away hope.

In a related editorial, Dr. Daniel F. Munday at Myton Hamlet Hospice in Warwick and Dr. E. Jane Maher at Mount Vernon Hospital in Middlesex urge researchers to investigate the dynamics of end-of-life consultations and to develop "decision aids" to help patients fully understand and interpret the information they are given.

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Bowel Disease and Hygiene Hypothesis

Children who grow up in a spick-and-span home may have a higher risk of developing inflammatory bowel disease, a study suggests.

Inflammatory bowel disease, or IBD, refers to a group of conditions marked by chronic inflammation in the intestines, leading to symptoms like abdominal pain and diarrhea. It's thought that the conditions arise from an immune system overreaction that injures the body's own intestinal tissue.

In the new study, published in the American Journal of Gastroenterology, researchers looked at whether the so-called "hygiene hypothesis" might be involved in young people's risk of developing IBD.

The hygiene hypothesis was first advanced in the late 1980s as one explanation for the rise in allergic diseases in developed nations.

The theory is that when children are exposed to few viruses, bacteria and other microorganisms early in life, their immune system development is affected in a way that raises the risk of abnormal immune reactions.

For example, studies have found that young children who spend time in daycare, where they are likely to be exposed to viruses and other microorganisms, are less likely to develop allergies than their peers who spend little time around other children early in life.

For the current study, Dr. Eran Israeli and colleagues looked at the relationship between IBD risk and certain markers of how "hygienic" a child's upbringing was -- including how many siblings a child had, his or her spot in the family birth order, and whether the family lived in an urban or rural area. A rural environment is considered generally less hygienic than an urban one.

The researchers found that among the nearly 400,000 Israeli teenagers included in the study, 768 -- or 0.2 percent -- had been diagnosed with IBD. Those with one sibling were between two and three times more likely to have IBD than teens with five or more siblings.

Similarly, teenagers who lived in an urban setting were 38 percent more likely to suffer from IBD than their rural counterparts.

The findings do not prove that the hygiene hypothesis is at work in IBD, according to Israeli, of Hadassah Medical Center-Hebrew University in Jerusalem.

The study, he told Reuters Health, looked only at "surrogate markers" of childhood hygiene and showed an association between those markers and IBD.

But if the extra-clean surroundings of modern life do indeed contribute to IBD development in certain susceptible individuals, what are the implications?

"It would of course be impractical to suggest living in a less 'hygienic' environment or changing living conditions in order to afford possible protection (from) future development of IBD," Israeli said.

However, he added, it might be possible to lower IBD risk in people who are at higher-than-normal risk -- such as those with family members with the disease -- by exposing them to harmless microbes to help regulate their immune responses.

Researchers have already begun studying whether exposure to harmless parasitic worms might help treat Crohn's or colitis. Studies have not yet investigated such tactics for preventing IBD in healthy, high-risk people, Israeli noted.

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