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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Methadone a new possible treatment for leukemia

Methadone, a drug used to treat people addicted to heroin and other opioid drugs, holds promise as a new treatment for leukemia, especially treatment-resistant leukemia, according to results of a study.

Laboratory tests show that methadone kills leukemia cells without harming healthy blood cells, researchers at the University of Ulm in Germany report in a paper published today in the journal Cancer Research. Methadone was even effective in killing leukemia cells resistant to killing by chemotherapy and radiation.

"Leukemia cells express opioid receptors, to which methadone binds," study chief Dr. Claudia Friesen told Reuters Health. "Surprisingly, we found that methadone kills leukemia cells efficiently. We never expected that."

These results "provide the foundation for new strategies using methadone as an additional anticancer drug in leukemia therapy, especially when conventional therapies are less effective," the investigators conclude.

"We find this very exciting, because once conventional treatments fail, which occurs in old and also in young patients, they have no other options," Friesen said.

She predicts that methadone will have similar effects in other cancers that express opioid receptors. "In our lab we found that we also can kill solid tumors," she added.

Friesen and her team are studying methadone alone and in combination with other chemotherapy drugs in animal models of cancer.

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Rise in hip replacements

Both hip and knee arthritis are common among older adults, but the need for hip replacements seems to far exceed that for knee replacements, new research suggests.

In a study of nearly 7,600 Spanish adults age 60 and older, researchers found that 7 percent had hip osteoarthritis, while 12 percent had osteoarthritis of the knee. Osteoarthritis refers to the common "wear-and-tear" form of arthritis, in which cartilage in the joints gradually breaks down, leading to symptoms like pain and stiffness.

Both hip and knee arthritis were more common in women than men, with the difference being particularly apparent when it came to the knees: 15 percent of women had knee arthritis versus fewer than 9 percent of men.

But while knee arthritis was generally more common than hip arthritis, the latter condition was much more likely to need surgery, the researchers report in the Archives of Internal Medicine.

Of study participants with hip arthritis, 53 percent of women and 38 percent of men were candidates for a total hip replacement, according to the investigators. In contrast, only 18 percent of women and 12 percent of men with knee arthritis were deemed to be candidates for a total knee replacement.

Dr. Jose M. Quintana, of the Hospital de Galdakao in Spain, led the study.

Quintana's team reached their conclusions after surveying 7,577 adults between the ages of 60 and 90. Those who reported potential symptoms of knee or hip arthritis were then examined by an orthopedic surgeon to confirm a diagnosis and to judge whether a total hip or total knee replacement might be appropriate.

In judging whether surgery was a good option, the researchers considered factors like how much pain and how many physical limitations a patient had, as well as his or her overall health.

In the end, Quintana's team found, joint replacement was far more often an appropriate treatment for hip arthritis than it was for knee arthritis.

The choice of whether to have joint replacement surgery is, of course, an individual one, depending on a person's own symptoms and general health, the researchers note.

The current findings, Quintana and his colleagues write, serve more as a way to help health systems plan for the "growing health problem" of hip and knee arthritis, and their "costly medical interventions."

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Newborns not immune to Hep B

The results of a survey conducted by the US Centers for Disease Control and Prevention indicate that only about 50 percent of newborns receive a dose of hepatitis B vaccine before hospital discharge.

In 1991, the Advisory Committee on Immunization Practices recommended that all newborns receive the first dose of the vaccine before leaving the hospital or at age 1 to 2 months. In 2002, however, this recommendation was changed to indicate a preference for vaccination prior to hospital discharge. Finally, in 2005, the guidelines were again revised to recommend pre-hospital discharge hepatitis B vaccination for all medically stable infants weighing at least 2000 grams (4 pounds 6.5 ounces).

The present findings are based on an analysis of survey data obtained after the 2002 guidelines were implemented but before the 2005 ones were in place.

Overall, 43 percent of newborns received the first dose of the hepatitis B vaccine by age 1 day and 50 percent had received it by age 3 days, CDC researchers report in Friday's Morbidity and Mortality Weekly Report, publication of the CDC.

Wide variations in vaccine coverage were seen between cities and states. Detroit, Michigan had the highest coverage at 77.5 percent, while Fresno County, California had the lowest at about 8 percent.

Infants infected with the hepatitis B virus have a 90 percent chance of becoming chronically infected, which can lead to cirrhosis and liver cancer, CDC researchers note.

Delivery hospitals play a key role in the national strategy to prevent hepatitis B transmission and should have policies and procedures in place to ensure that hepatitis B vaccination is administered to all newborns before they leave the hospital, they emphasize.

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Two arm transplant

German doctors have succeeded in transplanting two complete arms onto a 54-year old man in what their hospital said was the world's first operation of this kind.

During 15 hours of surgery, a team of 40 medics attached the arms to a farmer who lost both his arms in an accident six years ago.

The patient was well, the hospital said on Friday.

"Before the operation, we had to describe to him that he would have to deal with the fact he'd have somebody else's hands," said Edgar Biemer from the hospital in the southern city of Munich, where the operation took place last week.

"When he woke up he looked at his hands and (went): 'Very good'," Biemer, one of the doctors in charge of the operation, told Reuters television.

Biemer said that so far, only transplants of lower arms had taken place. One of the main difficulties for full-arm transplants was finding donors.

"Already, the number of donors willing to donate their internal organs is declining," he said.

"(On top of that), it is more acceptable for people to have a relative's kidneys taken out, than for them to have an entire leg, hand or their face cut off."

In 2005, French doctors performed the world's first partial face transplant on a 38-year old woman, who had her nose, cheeks, mouth, lips and chin replaced by donor tissue after they were torn off by her dog.

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Inadequate TB treatment

In certain "hot zones" where multidrug-resistant tuberculosis is prevalent, patients treated with standard TB drugs have high rates of failure and relapse, new research indicates.

In countries where "drug sensitivity testing" is not performed routinely, the current standard anti-TB drug regimens "may be contributing to worsening drug resistance levels," a multinational research team warns in a report published Friday.

Dr. Dick Menzies, from McGill University in Montreal, and colleagues analyzed the association between drug resistance and treatment outcome in 103 countries, which were selected because their multidrug-resistant TB prevalences were known and because they had each reported on outcomes for more than 250 cases treated with standard treatment regimens in 2003 and/or 2004.

The researchers calculated that every 1 percent increase in the initial prevalence of multidrug-resistant TB was associated with a 0.3 percent increase in treatment failure among new cases, a 1.1 percent increase in failure among retreatment cases, and a 1 percent increase in relapse. The results are statistically significant, the researchers note.

Menzies and his team believe that in countries where initial multidrug-resistant TB prevalence is at least 3 percent, "it is urgent to strengthen capacity to perform drug sensitivity testing, or to reexamine standardized (initial treatment and retreatment) regimens."

In these countries, more than 20 percent of treated patients required retreatment, their report indicates. Moreover, in all countries, retreatment outcomes were generally poor, with high rates of default, failure, and death.

The investigators warn, "Failure to act now will mean far more resources will be needed in the long run to address global drug resistance."

Drs. Marcos Espinal and Mario C. Raviglione, with the World Health Organization in Geneva, Switzerland, agree, noting in an editorial that current tools for managing multidrug-resistant TB "are decades old, complex to use, time consuming, and more importantly, not designed for case management of multidrug-resistant TB."

"Unless those with the responsibility to boost control and research efforts increase their commitments and their financial investments by several fold, we may never see elimination of this major scourge in the decades to come," the editorial concludes.

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Menopause increases risk of metabolic syndrome

As women begin to enter menopause, their risk of developing a collection of heart disease risk factors appears to climb, a study has found.

Researchers found that among 949 U.S. women followed for nearly a decade, the risk of developing metabolic syndrome increased during perimenopause -- the years during which a woman's body begins to transition into menopause, usually starting somewhere in her 40s.

Metabolic syndrome refers to this cluster of risk factors for heart disease, stroke and diabetes -- including high blood pressure, abdominal obesity, high blood sugar, low levels of "good" HDL cholesterol and high triglycerides (another type of blood fat). The syndrome is usually diagnosed when a person has three or more of these traits.

The new findings, published in the Archives of Internal Medicine, appear to be the first showing that the incidence of metabolic syndrome begins to rise during perimenopause.

More specifically, the study found, the risk is related to increases in testosterone activity.

The "main message" here for women is that maintaining a healthy lifestyle may be especially critical during perimenopause, lead researcher Dr. Imke Janssen, of Rush University Medical Center in Chicago, told Reuters Health.

Not smoking, eating a healthy diet and getting regular exercise can all help reduce a woman's risk of the various components of metabolic syndrome, Janssen said.

She and her colleagues based their findings on an ethnically diverse sample of U.S. women who were between the ages of 42 and 52 and free of metabolic syndrome at the outset. The women were followed for nine years.

Overall, Janssen's team found, nearly 14 percent developed metabolic syndrome by the time they had their final menstrual period. The risk of developing the syndrome increased progressively starting six years before the final menstrual period.

But while the odds of developing metabolic syndrome were elevated after menopause, the risk was greater during perimenopause, Janssen noted.

It has long been known that women generally have a lower risk of cardiovascular disease than men do before the age of 45. But after age 55, the trend reverses, with women actually being at greater risk than men their age.

"Obviously, something happens there, between 45 and 55," Janssen said, noting that it was once assumed that diminishing levels of estrogen told the whole story.

But in this study, women's estrogen levels were unrelated to the odds of developing the metabolic syndrome. Instead, the syndrome correlated with an increase in testosterone activity -- suggesting that the direct negative effects of testosterone are more important than the loss of estrogen's positive effects in women's cardiovascular risks.

This idea, Janssen and her colleagues note, is consistent with clinical trials that have found no cardiovascular benefits from estrogen replacement therapy.

The bottom line for women, according to Janssen, is that during these years of hormonal change, healthy habits become more important than ever.

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