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Low weight at birth may impair later ovulation (8/4/03)
(Reuters Health)
NEW YORK (Reuters Health) - Low birth weight may affect ovulation--and perhaps fertility--later in life, results of a new European study suggest.
The researchers found that teenage girls who were small at birth were less likely to release eggs regularly than girls who were normal-sized at birth.
Whether the ovulation rate increases as teens get older is uncertain, but if the rate remains low, it could explain some cases of infertility, according to a report in the July issue of the Journal of Clinical Endocrinology and Metabolism.
The most important phases of ovary development occur before birth, so the ovaries may not develop normally if growth during pregnancy is insufficient. Girls who are born small for their gestational age-those that are smaller than average without being born prematurely--tend to have smaller ovaries and to be less sensitive to an ovary-stimulating substance called follicle-stimulating hormone.
In the new study, Dr. Lourdes Ibanez of the University of Barcelona in Spain studied 24 teenaged girls with an average birth weight (about 7.3 pounds) and 25 who were small for gestational age (about 5.1 pounds). None of the girls had been born prematurely. Samples of the girls' blood were analyzed for signs of ovulation.
Teenaged girls who had been small at birth were much less likely to be ovulating, the researchers report. Forty percent of the girls who had been born small were not ovulating compared with just 4% of the girls who had been normal-weight babies. And among girls who were ovulating, ovulation was less frequent in those who had been small babies.
Ibanez and her colleagues called the ovulation rate among girls who had been small at birth "strikingly low." The reduced ovulation rate was seen in girls regardless of their size as teenagers. This suggests that ovarian development does not "catch up" during childhood, according to the report.
Noting that the study also confirmed previous links between small size at birth and high levels of several hormones, including insulin, the researchers raise the question of whether treatment to correct these hormone imbalances might boost ovulation rates.
Despite the findings of reduced ovulation in teenaged girls, the researchers note that whether or not it continues into adulthood "remains to be verified."
"If it does, then fetal growth restraint may prove to be one of the enigmatic components underpinning hitherto unexplained female subfertility," they conclude.
SOURCE: Journal of Clinical Endocrinology and Metabolism 2002;87:3391-3393.
Correction: Women and Men Benefit Equally From Angioplasty (8/4/03)
[Corrects story posted Dec 17, 2002. The original version (paragraph 6) erroneously stated that the emergency CABG rates in 1999 were 0.06% for women, 0.05% for men.]
NEW YORK (Reuters Health) Jan 06 - Women who undergo angioplasty fare as well as their male counterparts when it comes to survival, according to a report published in the December 18th issue of the Journal of the American College of Cardiology.
These findings may help put to rest concerns that women fare worse after undergoing percutaneous coronary interventions (PCI). Findings from the new study, which included nearly 34,000 PCI cases, showed that the rate of emergency open-coronary artery bypass grafting (CABG), myocardial infarction, and death were roughly equal between the sexes.
In addition, the rate of emergency CABG and myocardial infarction after PCI declined during the study period.
"Regardless of sex, and despite intervening on a sicker patient population, outcomes for PCIs are improving," lead author Dr. David Malenka, from Dartmouth Medical School in Lebanon, New Hampshire, told Reuters Health.
In the current study, the investigators reviewed data from 33,666 consecutive hospital admissions for PCI between 1994 and 1999.
Overall, the need for emergency CABG and the rate of myocardial infarction declined during the study period. The adjusted emergency CABG rates for women declined from 2.20% in 1995 to 0.60% in 1999; for men the rates declined from 2.15% to 0.55%. Similarly, the rate of myocardial infarction was roughly equal among women and men.
The rate of death did not decline during the study and remained slightly higher for women, possibly because they tend to be sicker by the time they are referred for these procedures, the researchers write.
While it is not clear why outcomes improved during the 6-year period, the researchers suggest that the increased use of stents may have played a role.
"It seems logical to assume that the use of stents allowed cardiologists to better cope with suboptimal results and thus, avoid acute closures which would necessitate open heart surgery," Dr. Malenka noted.
However, improvements in other devices such as catheters and balloons, the availability of new devices, better drugs, and the cumulative experience of the physicians participating in the study, may also have contributed, he added.
J Am Coll Cardiol 2002;40:2092-2101.
Hyperinsulinemia Seen as Central in Pathogenesis of Polycystic Ovary Syndrome (8/4/03) NEW YORK (Reuters Health) Jan 03 - In women with polycystic ovary syndrome (PCOS), treatment with the insulin-lowering drug metformin appears to reduce FSH-stimulated aromatase activity, according to a recent report. This finding lends support to the hypothesis that hyperinsulinemia plays a key role in the pathogenesis of PCOS. Dr. Vincenzo De Leo, from the University of Siena in Italy, and colleagues assessed the effect of metformin therapy on FSH-stimulated aromatase activity in 20 women with PCOS. Their findings are published in the December issue of Fertility and Sterility. The researchers found that metformin therapy was linked to a significant drop in free testosterone levels, insulin plasma levels, and in the insulin response to glucose tolerance testing. Furthermore, the FSH-stimulated estradiol response was significantly lower after metformin was given than before. Analysis of estradiol, androstenedione, and testosterone areas-under-the-curve suggested that metformin therapy was associated with a reduction in FSH-stimulated aromatase activity, the investigators note. "Our results demonstrate that metformin therapy in women with PCOS is associated with a reduction in aromatase activity in response to FSH and that insulin affects not only androgen production but also estrogen production," Dr. De Leo's team states. The current findings support "the hypothesis that insulin plays a role in the endocrine and paracrine control of the ovaries," they add. Fertil Steril 2002;78:1234-1239
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Red wine can protect against common cold, study finds (6/16/02)
By Amanda Gardner HealthScoutNews Reporter
WEDNESDAY, May 1 (HealthScoutNews) -- Wine can apparently go to your head in more ways than one.
According to new research out of Spain, wine -- especially red wine -- may actually prevent you from coming down with the common cold.
All it takes, it seems, is one to seven glasses of wine per week. However, the protective effects are stronger with even more: eight to 14 glasses a week.
"The strength of the association increases with the amount of wine, but people who drink one glass a day also had a lower incidence of colds," says Dr. Miguel A. Hernan, a co-author of the study and an instructor in the department of epidemiology at the Harvard School of Public Health in Boston.
"We were amazed at how strong these protective effects were," says Dr. Bahi Takkouche, lead author of the study and a professor of preventive medicine at the University of Santiago de Compostela in Spain.
The results are preliminary and there are several limitations, which both the study authors and outside experts point out.
"There could be a lot of explanations for this," cautions Dr. Arnold S. Monto, a professor of epidemiology at the University of Michigan School of Public Health. "We don't have a clear mechanism or a believable mechanism, but there might be one. This is a first and very interesting, but we need to work into it more carefully."
Though the common cold causes the loss of at least 30 million work days each year in the United States, very little is known about risk factors for the illness.
This study, reported in today's issue of the American Journal of Epidemiology, is actually part of a larger group of studies seeking to understand what might predispose people to the sneezing, sniffling and aches and pains of colds.
The researchers have already found stress is a strong risk factor for cold, and that vitamin C and zinc have no preventive effect. They next hope to see if there's a relationship with tobacco.
The current study was originally designed to see whether consumption of wine, beer, spirits and total alcohol intake were associated with the common cold.
The researchers had 4,287 faculty members and administrative staff at five Spanish universities answer questionnaires about their drinking habits, medical history and other lifestyle variables. Participants were then asked to record daily whether or not they had any of eight symptoms of the common cold. Every 10 weeks, the individuals transcribed their notes and sent them to the researchers.
When the results were tallied, there didn't appear to be any association between total alcohol intake or beer and spirits consumption and occurrence of the common cold, but there was an inverse association with wine, especially red wine.
No one knows why this might be, though the effect does not seem to be attributable to the alcohol.
"Apparently total alcohol intake did not have any effect, but wine consumption and red wine consumption had strong effects, so the logical conclusion is that apparently the effect is not due to alcohol but to other components," Takkouche says.
Just what those other components might be remains a mystery.
One explanation is that resveratrol, a component of wine with a strong anti-inflammatory effect, is responsible. Another explanation attributes the effect to the antiviral properties of the flavonoids found in red wine. Wine may also have an effect on immune response.
"These are just speculations; we really don't know," Hernan emphasizes.
What To Do
For more information on the dreaded common cold, check out this fact sheet from the National Institute of Allergy and Infectious Diseases.
For some caveats on red wine and other alcohol and the heart, visit the American Heart Association.
SOURCES: Bahi Takkouche, M.D., Ph.D., professor, preventive medicine, University of Santiago de Compostela, Santiago de Compostela, Spain; Miguel A. Hernan, instructor, department of epidemiology, Harvard School of Public Health, Boston; Arnold S. Monto, M.D., professor, epidemiology, University of Michigan School of Public Health, Ann Arbor; May 1, 2002, American Journal of Epidemiology
Copyright © 2002 ScoutNews, LLC. All rights reserved.
Same health benefits from less chocolate: report (6/16/02)
By Alison McCook
NEW YORK (Reuters Health) - For those of us who took the recent good news that chocolate can be good for the heart as an excuse to eat loads of the sweet stuff, hold on: there's now another encouraging report showing that smaller quantities of chocolate may produce the same beneficial effects, but with fewer calories.
Dark chocolate contains compounds called flavonoids. Previous studies have shown that flavonoids decrease the "stickiness" of platelets, a type of cell that plays a key role in blood clotting.
The researchers, based at the University of California, Davis, and candy manufacturer Mars, Inc. determined the effect of chocolate on platelet function by measuring the amount of certain chemical compounds in the blood that influence platelet functioning. Their findings are published in the May 1st issue of The Journal of the American Medical Association.
In the study, the researchers asked 18 healthy adults to consume 25 grams--about a handful--of semi-sweet chocolate chips. At points 2 and 6 hours after subjects ate the chocolate, the researchers noted that the concentration of flavonoids increased in the blood, and platelets in subjects' blood took longer to clot after eating chocolate than before.
In a previous report, the investigators found similar results after subjects consumed approximately four times the amount of flavonoids and flavonoid-derived substances as they did in the current study.
Given the problem of obesity in the US, lead author Roberta Holt of the University of California, Davis, told Reuters Health that she does not recommend people eat a lot of chocolate.
Americans prefer milk chocolate, she said, which contains fewer flavonoids than dark chocolate. Furthermore, other foods besides chocolate contain flavonoids, but without the high calories and fat.
"We do not recommend that individuals eat chocolate in place of other flavonoid-rich foods in their diet, such as fruits and vegetables, but instead consume flavonoid-rich chocolate or cocoa in moderation," Holt said.
And for those with diabetes, Holt said that studies have found people achieved similar health benefits from sugarless, fat-free cocoa beverages.
Although the study only measured the benefits of chocolate up to 6 hours after consumption, Holt said that the long-term benefits of eating flavonoid-rich chocolate in moderation are currently under investigation, as well.
SOURCE: The Journal of the American Medical Association 2002;287:2212-2213.
BARCELONA, Spain (Reuters) Mar 20 - Scientists have developed a new high-speed technique to determine if breast cancer has spread by looking at how light is scattered by cancerous tissue, a cancer researcher said on Wednesday.
Instead of patients waiting for histologic analysis following surgery, an "optical biopsy" would determine almost immediately if it contained cancerous cells, Andrew Lee of University College London (UCL) said in an interview.
"The potential application for our system is that it will detect cancer at the time of the initial surgery, so that it saves the patient the necessity of coming back for a second operation and the anxiety of waiting a few days for the analysis," Lee explained.
The optical biopsy would detect the spread of cancer to the lymph nodes as well as any residual cancer in the breast that had not been removed during surgery, said Lee, one of the developers of the new technique. He was speaking at the 3rd European Breast Cancer Conference, a 5-day event attended by 4000 scientists, physicians, and patient advocates.
The optical biopsy produces an almost instant result by analysing how light is scattered by the tissue sample. Light is fed down an optical fibre on the lymph node sample, and as it is scattered it is picked up by a second fibre and fed into a portable computer. It then compares the optical signatures to samples of healthy and cancerous tissues.
"The whole process including the analysis takes about a second. Hopefully the end product will be a system that will tell the surgeon whether there is cancer or not," Lee said.
So far, tests on 200 patients have provided promising results. "The number of patients is still relatively low, but the preliminary results indicate that the same diagnostic information could be obtained 93% of the time for breast tissues and in 85% of lymph glands examined, but in a fraction of a second," Lee said.
The new technique, which has won US army funding, has also been tested on skin cancer. More research and patient trials are needed but Lee said a clinically useful device could be available within a few years. Although it may not replace traditional biopsies it could be used with existing techniques to improve the treatment of breast cancer.
LONDON (Reuters) Mar 19 - Cancer researchers tried to dispel doubts over the benefits of breast cancer screening on Tuesday, saying an analysis of published studies showed that regular mammography does save lives.
"A woman who is screened regularly aged 50-69 years old with mammography can expect about a 35% reduction in her risk of death from breast cancer," Professor Bruce Armstrong, of the International Agency for Research on Cancer (IARC) said.
Professor Armstrong headed a team of 24 experts from 11 countries who analysed studies investigating the benefits of breast cancer screening. IARC, part of the World Health Organisation, conducts and analyses research into the causes and prevention of cancer.
Criticisms have been made in recent months that screening often gives inaccurate results and might not be cost effective. Confusion has grown over how often women should be tested and at what age.
The results of the independent analysis, released ahead of the start of the 3rd European Breast Cancer Conference in Barcelona on Tuesday, confirmed the benefits of regular screening and showed the criticisms were unsubstantiated, IARC said.
Dr. Robin Wilson, the secretary of the European Group for Breast Cancer Screening, and other experts at the Barcelona meeting said they supported the IARC findings.
"Current evidence based on actual screening outcomes strongly support its effectiveness," Dr. Wilson said in a statement.
The IARC experts admitted false positive results could cause anxiety and some cancers could be missed. But they said screening was an effective means of detecting a disease that kills half a million women a year world wide.
FEWER BREAST CANCER DEATHS
The IARC analysis showed the benefits were most significant for women 50-69 years old. They found inadequate evidence of the efficacy of screening for women under 40 years old or over 69.
Britain, the Netherlands, Sweden, Finland and Luxembourg, Ireland, Belgium and Norway have full national screening programmes. France, Germany, Spain, Greece and Portugal are conducting pilot programmes.
Women in the United States are advised to have annual mammograms from the age of 40. In Britain and other countries women begin screening later and do not have mammograms as often.
Professor Valerie Beral, of the University of Oxford and a member of the IARC panel of experts, said the findings were a consensus of independent experts.
Over a 10-year period an estimated 10-20 of every 1,000 healthy women aged 50-69 years old will develop cancer and four to six women will die of the disease. Screening could reduce the number of deaths by two in every 1,000, according to Professor Beral.
"It's a true reduction in deaths," she said.
Screening, the latest surgical techniques and new biological agents will be among the main topics when 4,000 scientists, doctors and patient advocates meet for the Barcelona breast cancer conference from March 19-23.
Ovarian Drilling Again Shown to Ameliorate Polycystic Ovary Disease, Improve Fertility (4/2/02)
BUENOS AIRES (Reuters Health) Mar 20 - The latest reports of success with ovarian drilling for polycystic ovary disease, showing that the technique can improve the chances of a woman with the disease becoming pregnant, were presented here Tuesday at the 12th World Congress on In Vitro Fertilization. The procedure involves laparoscopic visualization of the ovaries and the creation of 6 to 12 openings approximately 3 mm in diameter on the surface of each ovary, using a bipolar electrical probe.
Dr. Victor Gomel of the University of Vancouver, British Columbia, Canada, told attendees that in a recent small study of 22 patients who had undergone ovarian drilling, nine went on to give birth. Prior to treatment, only one of the patients had given birth, Dr. Gomel reported.In second study involving 23 patients, 11 became pregnant with one spontaneous abortion. Seven of the patients became pregnant spontaneously, another two became pregnant by donor insemination following FSH therapy, and the remaining two underwent in vitro fertilization (IVF).
"Ovarian drilling is an appropriate therapy for the minority of patients with polycystic ovary disease who do not respond to medical therapy," said Dr. Gomel. "Typically, 80% resume normal ovulation and 50% succeed in becoming pregnant."
Patients who require fertility treatment with ovulation-stimulating medications have less risk of hyperovulation syndrome and multiple pregnancies, because patients have lower levels of luteinizing hormone (LH) after ovarian drilling, he said.
Ductal Lavage Can Guide Breast Cancer Prophylaxis Choices (11/29/01)
WESTPORT, CT (Reuters Health) Nov 06 - Breast ductal lavage can detect atypical or malignant cells in women with normal breast examination and mammography findings, investigators report in the November 7th issue of the Journal of the National Cancer Institute. Such findings can guide the choice of prophylactic treatment in women deemed to be at high risk of breast cancer.The finding of atypia on a biologic specimen is associated with a markedly increased breast cancer risk for about the next 10 years, Dr. William C. Dooley, of the University of Oklahoma Health Sciences Center in Oklahoma City, told Reuters Health.
When initial findings of this research were presented at the 18th annual Miami Breast Cancer Conference, the investigators reported that ductal lavage was safe and feasible. In the new report, they show that ductal lavage can provide samples adequate for diagnosis in 78% of women. In contrast, 27% of samples obtained through nipple aspiration fluid (NAF) are adequate for diagnosis.
The investigators successfully cannulated the breasts of 426 women who had NAF-yielding ducts. The success rate was 95% for parous women compared with 84% for nulliparous women. All the subjects had undergone mammography and a clinical breast examination "interpreted as not suspicious for breast cancer within 12 months before entry in the study," the investigators note.
Ductal lavage was 3.5 times more likely than nipple aspiration to result in a cytologic diagnosis. When either technique resulted in a diagnosis of at least mildly atypical cells, ductal lavage was almost five times more likely than nipple aspiration to result in a higher grade abnormal diagnosis.
Dr. Dooley lauded the abilities of the technique, saying, "we have detected [atypical cells] at the periphery of the breast, more than 6 to 8 inches away from the nipple. It seems to give information about the majority of the system that is producing fluid." He added that over 95% of tumors are associated with a fluid-producing duct.
On a 100-mm visual analog scale, subjects gave a median rating of 8 mm for nipple aspiration and 24 mm for ductal lavage. About half of subjects reported that ductal lavage was no more uncomfortable than mammography.
Dr. Dooley maintained that ductal lavage "is best geared toward women who were recently diagnosed with cancer in one breast and in whom we believe the opposite breast is normal. If we lavage that breast and find atypia, we can factor that into our treatment, because we might want to use tamoxifen."
Results of ductal lavage can also provide more information to women at high risk of breast cancer who are considering chemoprophylaxis or prophylactic mastectomy, he said.
"Right now, the only proven drug treatment is tamoxifen, which reduces risk by about half. If you find out you have high risk because of family history and add on the finding of atypia, you may decide that a 50% reduction of an 80% risk may not be good enough, and that you want a prophylactic mastectomy," Dr. Dooley pointed out.
J Natl Cancer Inst 2001;93:1624-1632.
Dry-Eye Syndrome: An Overlooked Side Effect of HRT (11/29/01)
WESTPORT, CT (Reuters Health) Nov 07 - Women on hormone replacement therapy (HRT), particularly estrogen-only regimens, are at increased risk of keratoconjunctivitis sicca, also known as dry-eye syndrome, researchers report in the November 7th issue of The Journal of the American Medical Association."Dry-eye syndrome is a very common condition affecting millions of middle-aged and older women, and physicians should recognize the possibility that HRT may have ocular side effects," Dr. Debra A. Schaumberg, of Brigham and Women's Hospital in Boston, told Reuters Health.
Dr. Schaumberg and colleagues used the Women's Health Study cohort, which included 25,665 postmenopausal women, to study the relationship between HRT and dry-eye syndrome. Participants provided information on the use of HRT at baseline, 12 and 36 months, along with data on dry-eye syndrome at 4 years.
The prevalence of dry-eye syndrome was significantly related to HRT use. Women who used estrogen alone had the highest prevalence at 9.1%, while women who never used HRT had the lowest prevalence at 5.9%. The prevalence of dry-eye syndrome in women who used estrogen plus progesterone/progestin regimens was 6.7%.
In multivariate analyses, the adjusted odds ratio for dry-eye syndrome was 1.69 and 1.29 for estrogen use alone and estrogen plus progesterone/progestin use, respectively, compared with no HRT use.
The risk of dry-eye syndrome appears to increase with longer duration of HRT, according to the data. "Each 3-year increase in the duration of HRT use was associated with a significant 15% elevation in risk of clinically diagnosed dry-eye syndrome or severe symptoms," the investigators report in JAMA.
Dry-eye syndrome is an under-recognized side effect of HRT, Dr. Schaumberg said, "with the caveat that, until our study, there were no epidemiological data available to link the two." Dry-eye syndrome can have "a significant impact on quality of life and can increase risk of ocular infection," the researcher added.
JAMA 2001;286:2114-2119.
OC Users Who Skip Spacer Pills Reduce Bleeding Days, Menstrual Headache (11/29/01)
WESTPORT, CT (Reuters Health) Nov 02 - In a recent study, women who extended their traditional 28-day oral contraceptive (OC) cycle to a 49-day cycle had a reduction in cyclic bleeding and hormonal withdrawal symptoms, without an increase in breakthrough bleeding.
Dr. Leslie Miller and Katherine M. Notter from the University of Washington in Seattle describe their study in the November issue of the journal Obstetrics and Gynecology.
"This study demonstrates that women can skip their spacer pills to reduce their bleeding days while using the birth control pill," Dr. Miller told Reuters Health. And while this is still not FDA-approved or included in the labeling for the birth control pill, Dr. Miller said many women in Europe and Australia already manipulate their OC use to reduce monthly bleeding. "Hopefully the next generation of OCs will include an option for manipulating the withdrawal bleeding," she said.
Briefly, Dr. Miller and her colleague randomized 90 women to a 28-day or extended 49-day cycle of a monophasic regimen of 30 µg ethinyl estradiol plus 300 µg norgestrel for 1 year. Roughly 54% of women on the 28-day cycle and 63% on the 49-day cycle completed all 12 cycles.
Throughout the year, women on the 49-day cycle experienced a marked reduction in bleeding days and bleeding episodes compared with women on the 28-day cycle, and they were no more likely to have spotting or breakthrough bleeding. Headache and genital itch scores were significantly lower by the end of the study in extended OC users as well.
In a subanalysis of women who planned to continue hormonal contraception, 52.4% of extended cycle users said they wanted to continue the 49-day regimen and 16.7% of 28-day users wanted to switch to the extended regimen.
Annually, women on the 28-day cycle spent $41.45 on feminine products compared with an annual expenditure of $17.54 for women on the 49-day cycle. Having to purchase more OCs would likely offset this cost, however.
"This option of extended use could be offered to women experiencing cyclic symptoms during the hormone-free week like headaches or dysmenorrhea," Dr. Miller said. The best formulation and regimen for extended pill use is not yet known.
Dr. Miller is a spokesperson for Wyeth-Ayerst Laboratories, which supplied the OCs used in the study.
The idea that monthly menstruation is "normal and healthy for women using contraception is being challenged," Dr. Miller and her colleague note in their report. "Historically, women without access to contraception could have as few as 50 menstrual cycles in a lifetime" due to multiple pregnancies and a shorter lifespan. Today, women with reduced fecundity may have up to 450 menstrual cycles.
Obstet Gynecol 2001;98:771-778.
Use of OCs May Negate Benefit of Exercise in Building Bone
(7/19/01)NEW YORK (Reuters Health) Jun 21 - Young women who exercise regularly and use oral contraceptives may not get the boost in bone strength seen in women who exercise and do not use oral contraceptives, results of a study suggest.
According to a report in the current issue of Medicine & Science in Sports & Exercise, regular resistance training and aerobic exercise strengthened bones in women aged 18 to 31 over a 2-year period. However, oral contraceptives appeared to prevent the build-up of bone in the spine that was seen in women who exercised.
The findings suggest that women who exercise and take oral contraceptives may be compromising their chances of attaining peak bone mass at key sites of the body, according to Dr. Connie M. Weaver of Purdue University in West Lafayette, Indiana, and colleagues.
"We think oral contraceptives may control blood estrogen levels and prevent the exercise-induced increase (in bone)," Dr. Weaver told Reuters Health.
The researchers measured the density of several bones every 6 months for 2 years in two groups of women. One group did three sessions of resistance exercise and jumped rope for 60 minutes each week, and the other did not exercise. The women were further divided into those who took oral contraceptives and those who did not.
The investigators found that exercisers increased bone mineral content by about 1% to 2% at skeletal sites throughout the body at 6 months and 2 years, while women who did not exercise had about a 1% to 2% loss in bone mineral content. Women who did not use oral contraceptives had higher bone mineral content at skeletal sites throughout their body at 2 years compared with women who used oral contraceptives.
Among women who exercised and used oral contraceptives, bone mineral density at the spine decreased after 6 months, and 2 years later levels remained lower than those of non-exercisers who used oral contraceptives.
Med Sci Sports Exercise 2001;33:873-880.
Donate a Mammogram (7/19/01)
Breast cancer is becoming a big killer of Black women and other women of color. Please allow someone of modest means the way to get a free mammogram.
The Breast Cancer site is having trouble getting enough people to click on it daily to meet their quota of donating at least one free mammogram a day to a woman coming from an historically-underserved community (i.e.women of color, poor women). It takes less than a minute to go to their site & click on "donating a mammogram" for free (pink window in the middle) their corporate sponsors/advertisers use the number of daily visits to donate a mammogram in exchange for advertising. Here's the website! Pass it along to all your friends!!
http://www.thebreastcancersite.com
Please take a minute and help us spread the word about The Breast Cancer Site. By telling 10 friends about this fast, free way to provide mammograms to historically-underserved groups of women, you make a real impact on the number of women we help. In the first month of this year, we generated funds to provide 200 women with mammograms. With your help, we can impact lives of more than 2,000 women in 2001. 43,000 women will die from breast cancer this year. Please click daily and tell others about The Breast Cancer Site. This is genuine! Please take a moment to pass it along.
Thanks so much. Thank you for your participation and support.
Women Outlast Men (6/19/01)
Men may grow bigger muscles, but women have more stamina. A recent study compared the length of time men and women could hold a muscle contraction. The researchers found that the women lasted 75% longer. The explanation may be in the hormones: estrogen seems to promote blood flow, and the more blood you can deliver to the muscles, the longer they can work.
From Health Magazine, Jan/Feb 2001
Soy lowers 'bad' cholesterol in postmenopausal women (5/7/01)
NEW YORK, Feb 05 (Reuters Health) - Consuming soy may result in at least a small drop in "bad" cholesterol in older women with normal or only slightly elevated cholesterol, results of a new study suggest.
The drop was seen in a small study in which women aged 45 to 70 consumed powdered isoflavones, a component of soy, for roughly 3 months.
"Soy protein containing isoflavones will not replace lipid-lowering drugs for those that need them. But soy exerts a small benefit, and in combination with other dietary changes such as lowering dietary fat, soy may help lower cholesterol levels," co-author Dr. Mindy S. Kurzer of the University of Minnesota in St. Paul, told Reuters Health.
In the study, the researchers tested the blood of 18 postmenopausal women during three 93-day test periods in which they consumed 7, 65 or 132 milligrams of isoflavones per day.
During the high-isoflavone diet, the level of LDL ("bad") cholesterol was 6.5% lower compared to the levels when the women had the lowest amount of soy protein, according to the report published in the February issue of the American Journal of Clinical Nutrition.
"Although the effects were small, it is possible that isoflavones may contribute to a lower risk of coronary heart disease if consumed over many years in conjunction with other lipid-lowering strategies," Kurzer said.
The decrease in LDL cholesterol observed in the study "could be associated with a 16% reduction in coronary artery disease risk," the authors conclude.
"Postmenopausal women have a very high rate of heart disease, and many women are looking for non-drug ways to reduce risk. Of course, lowering dietary fat is the main dietary way that many women can lower their cholesterol levels," Kurzer explained.
"We've shown that soy-containing isoflavones may enhance the cholesterol lowering benefit of a low-fat diet. Over many years, this might reduce risk of heart disease," she added.
SOURCE: American Journal of Clinical Nutrition 2001;73:225-231.
Copyright © 2001 Reuters Limited.
Feb. 5, 2001 (Ivanhoe Newswire) -- A new study offers reassuring evidence for women prone to breast cancer who are considering breast reduction or mastectomy surgeries.
Previous research has shown that breast reduction surgeries substantially lower women's risk of developing breast cancers. Reduction in risk is typically significant, from 30 percent to 50 percent, particularly in women ages 40 years or older at the time of surgery. Still, relatively little is known about the mechanisms behind the success of these surgeries. A study published in Cancer tested the theory that reduction in risk is related to the amount of breast tissue removed.
Investigators from the National Cancer Institute sought medical records for 161 women with breast cancer and 483 women without breast cancer drawn from a population of 31,910 Swedish women who had breast reduction surgery. Findings confirmed that the incidence of breast cancers decreased as the amount of breast tissue removed increased. Subjects who had 800 grams or more of breast tissue surgically removed from each breast (a total of 1600 grams) had a 76 percent decreased risk of breast cancer compared to those having less than 400 grams of tissue removed from each breast (at total of 800 grams). In the Swedish sample, the protective effects of breast reduction persisted across all age groups.
Investigators suggest that tissue reduction procedures may remove cells in the breast that contribute to the start of cancer-promoting activity.
Though breast reduction is not favored for all patients prone to breast cancers, the procedure does offer protective benefits for those seeking relief from breast-related pain and discomfort.
Copyright © 2001 Ivanhoe Broadcast News, Inc.
Smell of female (5/7/01)Men can smell when women are at their most fertile, according to a T-shirt test in Texas Men can tell by smell alone when women are at their most fertile, say researchers from Texas. They reached this conclusion after getting men to sniff T-shirts worn by women during fertile and infertile stages of their menstrual cycles. Overwhelmingly, men rated the smells from the T-shirts to be most "pleasant" and "sexy" when they had been worn by women during their fertile phase. "It may be a cue that men pick up subtly," says Devendra Singh, the psychologist at the University of Texas in Austin who made the discovery. But Singh doesn't think the smell would play as important a role as visual cues in determining sexual attractiveness. The findings shed light on how our ancestors selected mates and may even open new avenues for treating infertility. Fresh shirt Singh and his colleague, Matthew Bronstad, gave a pair of previously unworn T-shirts to women volunteers. Women slept in the first T-shirt during the fertile phase of their cycle - 13 to 15 days after their previous period. They slept in the other T-shirt during the infertile phase on days 21 to 22 of the cycle. The women avoided contact with strong odours to avoid masking subtle scent changes. They washed with unscented toiletries, avoided sex and gave up spicy or aromatic foods, such as garlic. Two women had to drop out after indulging in pizzas and cigarettes. When men sniffed the 21 pairs of T-shirts, 17 gave a resoundingly higher rating to the smells from the fertile phase. They had been told that one set of T-shirts came from women who were more attractive. The findings were the same when a second set of men sniffed the T-shirts after they'd been stored for seven days. "We wanted to see how stable the smell was," says Singh. Advertising strategy He says that the odours probably enable women to advertise their readiness for fertilisation. But in the modern world they are probably overwhelmed by more obvious cues such as dress, make-up and behaviour. Singh says it is not known if the odour has a subconscious effect or if it can be detected if a woman wears perfume. The findings contradict those of a 1999 study by Randy Thornhill and Steven Gangestad of the University of New Mexico. They found men could not smell any difference. But Singh claims his findings carry more weight because each pair of T-shirts came from the same woman. In Thornhill's study, T-shirts from fertile and infertile phases came from different women. Men may therefore have picked up differences between women, rather than between menstrual phases. Thornhill acknowledges this. "It's a nice and important study," he says. "Singh and his colleague deal with the problem in our studies of inter-individual differences in body scent," he says. Thornhill says that his most recent, unpublished study agrees with Singh's, even though shirts again came from different women. More at: Proceedings of the Royal Society, London B (vol 268, p 797) Correspondence about this story should be directed to |
New Scientist Online News
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Hormone Device May Help Women Avoid Hysterectomy (3/11/01)
NEW YORK (Reuters Health) - A hormone-releasing device may halt heavy menstrual bleeding and help at least some women avoid a hysterectomy, a study conducted in Finland suggests. The device is approved in the US as a contraceptive but not to treat menstrual bleeding.
Women who had the device implanted had a similar quality of life one year later as women who underwent hysterectomy, or surgical removal of the uterus. Because hysterectomy is major surgery, and can lead to complications, many women want to avoid the operation if possible.
In a new study, carried out simultaneously at five university hospitals in Finland, 119 women were selected to receive the hormone-releasing device and 117 were assigned to receive hysterectomies. One year later, 24 women in the hormone device group (20%) had opted for hysterectomy instead, while 81 (68%) continued to use the device.
Although women who were still using the device reported more pain than women who had undergone hysterectomy, the quality of life reported by the two groups of women was similar, including reductions in depression and anxiety, according to the report published in the January 27th issue of The Lancet.
The device, known as the levonorgestrel-releasing intrauterine system (IUS), is inserted through the cervix. Levonorgestrel is a progestin, similar to the progesterone made in the ovaries.
The women in the study were in their late 30s or 40s and all had menorrhagia, an excessive menstrual-like bleeding that is a common problem in women in that age group. It may be caused by a number of problems including fibroid tumors in the uterus.
In the study, the researchers used Mirena, a device made by the Finnish company Leiras Pharmaceuticals. The IUS can be left in the uterus for at least 5 years.
Insertion of the IUS was reported as being easy for most women, but required local anesthetic in 10%. Reasons women gave for having the device removed included bleeding and hormonal symptoms.
``Bleeding problems with the levonorgestrel-releasing IUS during the first few months are common, and in most cases they resolve by 3 to 6 months of use,'' write the researchers, led by Dr. Ritva Hurskainen of the University Hospital Helsinki.
Treatment costs for IUS, at an average cost of $1,530 per patient, were a fraction of the expense for hysterectomy, which costs an average of $4,222.
The researchers note that more lengthy follow-up is needed to fully evaluate the difference between hysterectomy and IUS, both in terms of patients' quality of life and costs.
In the United States, there are other procedures available to some women with menorrhagia who want to avoid a hysterectomy. Such techniques usually involve ablation, or destruction, of the uterine lining using heat or microwave energy.
SOURCE: The Lancet 2001;357:273-277.
Pregnancy Weight Gain Linked to Obesity Rise (3/11/01)
By Heather Lea-Brown
NEW YORK (Reuters Health) - If a woman gains a lot of weight during pregnancy, she runs the risk of being significantly overweight even a year after delivering her baby, researchers report.
Dr. Christine Olson, of Cornell University in Ithaca, New York and colleagues charted the weights of nearly 600 rural, white women in upstate New York from early pregnancy to one year after giving birth.
Each woman was initially classified by body mass index (BMI) in early pregnancy. BMI is a ratio of weight to height and a value between 19.8 and 26 is considered normal and healthy, Olson noted in a Cornell statement.
Weight measurements were taken throughout the pregnancy and at 6 months and 1 year after giving birth. These measurements were compared with the recommended weight gains for each woman's particular BMI.
Olson found that 42% of women in the study gained more weight during the pregnancy than is recommended by the Institute of Medicine (IOM) of the National Academy of Sciences. According to the IOM guidelines, a woman with a normal BMI can gain up to 35 pounds during pregnancy. On average, the Institute of Medicine reports that a woman will gain about 2.2 pounds within a year after having a baby.
Olson determined that there was a significant retention of weight after a year in women from the normal, high or obese BMI groups who gained more than the recommended weight during pregnancy. One fourth of the women studied were at least 10 pounds heavier one year after giving birth.
The researchers presented their findings at a meeting of the Federation of American Societies for Experimental Biology held in San Diego, California.
``I didn't think that they would be as heavy as they were at one year postpartum. That was a surprise,'' said Olson in an interview with Reuters Health.
The most startling result was that 28 of the women who had not been obese in early pregnancy and had excessive weight gain were considered to be obese at one year postpartum. This clearly suggests that gaining too much weight during pregnancy can lead to obesity after giving birth, Olson explained. Moreover, she added, staying within the recommended weight gain guidelines easily prevents the risk of obesity.
``The most important result of this study is that women should be aware that there is a bottom level that they must stay above but also a top level that they must stay below'' for weight gain during pregnancy, Olson said.
Since the 1960s, the incidence of obesity in women of childbearing age has nearly doubled. Obesity is linked to an increased risk of many chronic health conditions, such as cardiovascular disease and diabetes.
High calcium intake can lead to weight loss in women (2/28/01)
NEW YORK, Jan 25 (Reuters Health) - Young women who are trying to lose weight often eschew dairy products because they tend to be high in fat. But a recent study reports that women with the highest intake of calcium from dairy foods--relative to the number of calories they consumed each day--lost the most weight and body fat over 2 years, regardless of exercise.
"These results have important implications for preventing weight and fat mass increases in young women aged 18 to 31 years, a time when overall weight begins to increase with advancing age," according to Dr. Dorothy Teegarden and colleagues from Purdue University in West Lafayette, Indiana.
Based on their findings, the researchers suggest that public health recommendations for calcium targeting young women should emphasize weight maintenance in addition to bone health.
The findings, published in the December issue of the Journal of the American College of Nutrition, support previous research showing that individuals who consume the most calcium have lower body fat.
But exactly how calcium affects body weight and fat is not clear. The report indicates that a component of dairy products not analyzed in the study, such as conjugated linoleic acid, may be responsible. Calcium from dairy and non-dairy sources may also replace another nutrient.
In other findings, average daily intake of calcium was 781 milligrams (mg) per day--below the recommended level of 1,000 mg daily for young women. Dairy calcium accounted for 69% of total calcium intake.
And women who consumed the highest level of vitamin A gained the most weight and body fat over 2 years, a finding that warrants further study, the researchers note.
The authors conclude that both calcium and vitamin A have a major impact on body weight and body fat. They recommend that young women who want to lose weight consume about 1,950 calories a day, 5,000 international units (IU) of vitamin A, and 1,000 mg of calcium.
SOURCE: Journal of the American College of Nutrition 2000;19:754-760.
Getting Pregnant Too Soon After C-Section Risky (2/28/01)
NEW YORK (Reuters Health) - Women who become pregnant shortly after having a cesarean section increase the risk of having their uterus rupture if they try to give birth vaginally the second time around, results of a study suggest.
After having a C-section, women are often encouraged to attempt a ``trial of labor'' to see whether they can give birth vaginally, avoiding the pain and recovery time associated with C-sections. But in rare cases--about 1% of the time--a trial of labor causes a woman's uterus to rupture. Some women, including those who have had several previous C-sections, are known to be at increased risk of rupture.
Now, researchers report in the February issue of the journal Obstetrics & Gynecology that women who become pregnant 9 months or less after having their first C-section are much more likely to have their uterine rupture than women who wait longer.
In the study, Dr. Thomas D. Shipp of Harvard Medical School in Boston, Massachusetts, and colleagues analyzed the records of 2,409 women who underwent a trial of labor after having a previous cesarean delivery.
When the researchers took into account factors that could have influenced the results, including the mother's age and length of labor, they found that women who gave birth within 18 months of having a C-section were three times more likely to experience uterine rupture than women with a longer time between deliveries.
``One possible explanation for our findings is incomplete healing of the uterine scar from the previous cesarean,'' Shipp and his colleagues write. Complete healing of the scar on a woman's uterus is believed to take at least 6 months and perhaps as long as 9 months, the report indicates.
SOURCE: Obstetrics & Gynecology February 2001.
Asthma Hits Women Harder Than Men (2/28/01)
By Adam Marcus
HealthScout Reporter
TUESDAY, Jan. 23 (HealthScout) -- Women are more than twice as likely as men to be hospitalized with asthma attacks, but scientists say they don't know why.
But a new study from Yale researchers, which appears in this month's issue of Chest, suggests women may simply suffer more severe asthma symptoms.
Researchers have long known that hospitalization rates for asthma patients vary by gender. In early childhood, boys are twice as likely as girls to be admitted for the condition. But after the age of 20, the pattern shifts and women are hospitalized at 2.5 times the rate of men. However, the prevalence of asthma, which affects some 17 million Americans, appears to be spread evenly between men and women.
In this latest study, Dr. David Trawick, now of the University of Rochester, and his colleagues at Yale University wanted to learn whether women had more severe asthma than men. They looked at 188 asthma patients, ages 18 to 50, admitted to Yale-New Haven Hospital at least twice over a 10-year period. All had potentially fatal forms of the disorder.
Of those, the researchers selected 103, accounting for 382 hospital admissions. In this group, 72 percent were women, who made up nearly 69 percent of the admissions.
Female patients were about as likely as men to require intensive care and tube-assisted breathing, and they appeared to stay about a day longer in the hospital for their condition, the researchers found.
However, tests of the patients' blood gas levels revealed the women typically had lower concentrations of carbon dioxide than did the men. Excess carbon dioxide indicates obstructed airways in the lungs.
"Perhaps, and I underline perhaps, part of the difference in admission rates may be attributable to differences in the response to respiratory load, or in the sensitivity to CO2 levels in the blood," Trawick says. But why women would be more sensitive to impaired airways "is the $64,000 question," he adds.
Hormones, particularly estrogen and progesterone, might play a role, and some evidence suggests that the severity of a woman's asthma varies with her menstrual cycles. That may help explain why asthma is more common among boys than girls early in life but the opposite is true after adolescence, Trawick says.
Dr. Carlos Camargo Jr., a Harvard University researcher who has studied gender differences in asthma, says men might be less attuned to their lung problems or more likely to deny they're having trouble breathing than women with the disease.
On the other hand, Camargo says, "there are no answers at this point."
What To Do
To learn more about asthma and ways to help prevent attacks, visit the American Academy of Allergy, Asthma & Immunology or the Asthma and Allergy Foundation of America.
Fish May Endanger Pregnant Women (2/14/01)
W A S H I N G T O N, Jan. 13 — Pregnant women should not eat shark, swordfish, king mackerel or tilefish because they may contain enough mercury to damage the fetus' nervous system, the U.S. Food and Drug Administration said.
Young children, nursing mothers and women who may become pregnant should avoid those fish as well, the FDA said in a consumer advisory.
Consumer groups wanted tuna, one of the most commonly consumed fish, added to the list as well. "They've got a long way to go," said Michael Bender of the Mercury Policy Project.
Seafood, a naturally low-fat source of protein, can be an important part of a balanced diet for pregnant women and women who may become pregnant, the FDA said. It said those women could eat up to 12 ounces (340 grams) a week from a variety of shellfish, canned fish, smaller ocean fish or farm-raised fish.
Mercury enters the environment naturally and through industrial pollution. Nearly all fish contain trace amounts of methyl mercury but longer-lived, larger fish that feed on other fish accumulate the highest amounts of methyl mercury and pose the largest threat to people who eat them regularly.
"Smart probe" for breast cancer detects malignant tumors instantly (2/14/01)
Livermore, CA — The pain and anxiety women experience undergoing breast cancer tests and awaiting the results may soon be lessened thanks to a new, minimally invasive diagnostic tool that can instantly detect cancerous tissue.
Lawrence Livermore National Laboratory has partnered with San Jose-based BioLuminate, Inc. to develop "Smart Probe," a tool for earlier, more accurate breast cancer detection that removes no tissue and is expected to achieve accuracy levels comparable to surgical biopsies in detecting cancerous cells. The BioLuminate "Smart Probe," smaller than the needle used in routine blood tests, is inserted into breast tissue after an initial screening indicates an area of concern. The probe looks for multiple known indicators of breast cancer, instantaneously providing physicians with information they can use to determine whether more invasive and costly tests are necessary. The results of the "Smart Probe" procedure are immediately available to patients, helping relieve anxiety.
First human studies using the device are expected to begin this spring at sites to be selected in Northern California.
"Physicians have been seeking a way to acquire more specific information about a suspected cancer site before performing a biopsy or surgery," said Neil Gorrin, MD, Assistant Chief of Surgery at Kaiser Permanente Medical Center in South San Francisco.
"The "Smart Probe" not only is less invasive, but it provides several specific measurements of known cancer indicators in real time, which will improve our chances of making the right diagnosis and treatment plan for the patient."
Fewer Unnecessary Biopsies Breast cancer is the second leading cause of death among women in the United States. Last year in the U.S., 182,800 women were diagnosed with breast cancer and more than 40,800 died of the disease. In the U.S. each week, approximately 16,000 women undergo unnecessary, surgical breast biopsies on suspicious tissue that turns out benign. In addition, physicians miss about 4,600 cases of breast cancer each week during physical examinations and mammogram reviews.
"By using the BioLuminate ‘Smart Probe’ before biopsies are performed on suspicious lesions, many unnecessary surgeries can be eliminated," said Richard Hular, President and CEO of BioLuminate. "Not only is this a great benefit for the patient, it also has the potential to save the U.S. healthcare system over $2 billion annually."
Cancer Indicators Measured in Real Time Once a mammogram or physical exam has detected a possible malignant lump, "Smart Probe" is inserted into the tissue and guided to the suspicious region. Sensors on the tip of the probe measure optical, electrical and chemical properties that are known to differ between healthy and cancerous tissues. The "Smart Probe" can detect multiple (5 to 7) known indicators of breast cancer. Tissue measurements are made in real time in both normal and suspect tissue.
"Smart Probe's" sensors begin gathering information the moment the probe is inserted into tissue. Computer software compares the real-time measurements to a set of known, archived parameters that indicate the presence or absence of cancer. The results are displayed instantly on a computer screen. "The key technology and experience that Lawrence Livermore Lab has to offer will allow the ‘Smart Probe’ to be much smaller than first conceived, and acquire data more accurately," said Luiz Da Silva, Ph.D, Livermore’s Associate Medical Technology Program Leader and primary investigator for the "Smart Probe." "In addition, we will have the capacity to add additional measurements if necessary."
Human Trials to Begin This Spring Lawrence Livermore has signed a research and development agreement with BioLuminate to use the Laboratory’s propriety optical imaging and probing technology to develop "Smart Probe" for all cancer detection applications.
BioLuminate and Livermore researchers are designing and fabricating the first "Smart Probe" prototype. The first human studies are expected to begin this spring at sites to be selected in Northern California. The device is expected to be commercially available by 2003. Eventually, the "Smart Probe" also is expected to be used on prostate, lung, colon, cervical and brain cancer patients to detect malignancies and deliver and monitor treatment.
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Founded in 1952, Lawrence Livermore National Laboratory is a national security laboratory, with a mission to ensure national security and apply science and technology to the important issues of our time. Lawrence Livermore National Laboratory is managed by the University of California for the U.S. Department of Energy.
BioLuminate, Inc. is a private San Jose, Calif. start-up firm that is developing the "Smart Probe" in collaboration with LLNL and NASA Ames. The company has an exclusive license to NASA’s "Smart Surgical Probe" technology for all cancer applications and has the exclusive rights to develop LLNL’s optical imaging and probing technology for all cancer detection applications. For more information: www.bioluminate.com and www.LLNL.gov
New Drug Information Proposed for Pregnant Women
(2/14/01)By Dulce Zamora
Jan. 11 (CBSHealthWatch)--Women who must take medications during pregnancy may soon have more guidance on the safety of those drugs. In the next couple of weeks, the Food and Drug Administration (FDA) plans to propose a rule that would, every 6 months, require drug makers to disclose the risks and benefits their products may have for expecting women.
Currently, drug companies collect reports on their own about side effects related to pregnancy. The FDA's proposal would open cases of adverse events up for federal scrutiny.
"If there's enough information there to warrant putting some information into the labeling [of drugs] to serve as a warning to physicians prescribing a product for a pregnant woman, then that's what the agency will do," says Crystal Rice, a spokesperson for the FDA's Center for Drug Evaluation and Research.
Diane Kennedy, project manager of the FDA's Pregnancy Labeling Task Force, says the reporting rule is a part of a larger postmarketing surveillance proposal that attempts to standardize manufacturers' reports for different countries. Kennedy says the proposal identifies pregnant women as one of the special populations needing extra consideration.
Separate from the reporting rule, sometime this year the FDA also plans to make the pregnancy section of drug labeling more useful to expectant women and their doctors.
"Our current labeling is really not helpful in that regard," says Kennedy. "Usually the labels would just say, 'Use only in pregnancy if the benefits outweigh the risks.' But we have no idea what the benefits are because they never study drugs in pregnancy, and we don't know what the risks are, because there's no requirement that they monitor for that."
Kennedy says the lack of information has made it difficult for doctors to prescribe certain drugs to expectant women. Physicians are cautious about recommending certain medicines, she notes, because a woman's physiology changes dramatically during pregnancy.
It's rare to find women to who are not exposed to drugs during pregnancy, says Beth Conover, a genetics counselor at the Nebraska Teratogen Information Service at the University of Nebraska Medical Center in Omaha. She advises women who are concerned about exposure to certain drugs, either inadvertently or because they have to take them for a chronic conditions such as depression, asthma, or epilepsy.
Conover says it's best for a woman who is thinking about having a baby to discuss her
medications before becoming pregnant. But, if a woman is expecting and need to
discuss the effects of medicines, Conover suggests calling the Organization of Teratology
Information Services (OTIS) at 888-285-3410, or tapping into the OTIS Web site.
Wine, Women, and Stroke (2/5/01)
A Little of the Grape May Lower Stroke Risk in Young Women
By Neil Osterweil
WebMD Medical News
Reviewed by Dr. Jacqueline Brooks
Jan. 4, 2001 -- "Wine is as good as life to a man, if it be drunk moderately," says the Bible, and the same apparently goes for women. Drinking up to two glasses of wine per day may protect young women against the most common form of stroke, say researchers from the CDC in Atlanta.
Stroke is the third-leading cause of death in the U.S., after heart disease and cancer. It kills approximately 150,000 Americans annually, according to figures from the National Institute of Neurological Disorders and Stroke in Bethesda, Md. The most common type is the ischemic stroke, in which blood flow in the brain is interrupted by a blood clot. The resulting damage to brain tissue can lead to paralysis, loss of speech, or mental incapacitation.
Although the risk for stroke increases with age, young people suffer them, too. The CDC estimates that 100,000 American women under the age of 44 have had a stroke. In 1997, the most recent year government statistics are available, around 1,200 women under age 44 were killed by an ischemic stroke.
The CDC research ran in the January issue of Stroke, a journal published by the American Heart Association. It found that of more than 600 women studied, all between 15 and 44 years of age, the ones who were light to moderate wine drinkers -- that is, who drank just one or two glasses of wine per day -- had a 40%-60% lower risk of ischemic stroke than those who didn't drink wine at all.
Beer and liquor drinkers had slightly lower risks for stroke, but the effect was not as dramatic as that seen with wine, the researchers say.
"It looks like moderate intake [of alcohol] is beneficial in the young as ... has been found in the old," says study author and CDC scientist Ann M. Malarcher, PhD, MSPH, in an interview with WebMD. "We also had this finding that wine consumption was particularly protective, although that needs to be confirmed in other studies, because some studies have found that and others haven't."
Although wine -- and perhaps other alcoholic beverages -- may help protect against this type of stroke, Malarcher cautions that women who don't drink now would nevertheless be wise to stay off the bottle.
"I don't think that any responsible practitioner is going to suggest that someone drink, because of the myriad of potentially damaging medical and behavioral effects it can have," agrees Adam K. Myers, PhD, professor of physiology and biophysics at Georgetown University in Washington, D.C., who commented on the relationship between alcohol and stroke in an interview with WebMD.
But there is also a growing body of evidence to suggest that alcohol in moderation may protect against heart disease and stroke through its ability to boost levels of HDL, the "good cholesterol," and through its effects on blood-clotting systems in the body, Myers tells WebMD. There is evidence from scientific studies that alcohol may be protective, he says, although the evidence for protection against stroke is just not as strong.
Breast Implant Websites May Be Biased (2/5/01)
NEW YORK (Reuters Health) - Women seeking information about breast implants may want to think twice before relying on the Internet as an accurate source of information.
Researchers at the Cooper Hospital University Medical Center in Camden, New Jersey used three search engines to find 41 websites focused on breast augmentation.
On average, 15% of the sites could be recommended to patients, 28% were considered neutral, leaving the majority of the sites, 57%, as not recommended.
While 28 of the 41 sites gave details of the surgery, ''most of these were considered to be limited in quantity,'' according to Dr. Julian B. Gordon and colleagues. The researchers point out that slightly more than half the sites did not discuss complications of the procedures.
And while a picture can be worth a thousand words, Gordon and colleagues note that of sites that include photographs, two-thirds only posted good results while 11% showed bad results and 16% showed good and bad results. More than 80% of sites were ``biased toward a particular surgical technique,'' they note.
In addition to sites found through search engines, the team also went directly to 17 health websites and evaluated content pertaining to breast implant surgery.
``No site met the criteria of accurate, complete information on the surgical procedure of breast augmentation,'' Gordon and colleagues write.
``This study demonstrates that it is difficult for the average layperson to get authoritative information quickly and easily on at least one aspect of cosmetic surgery,'' conclude the authors.
Their findings can be found in the January issue of the journal Plastic and Reconstructive Surgery.SOURCE: Plastic and Reconstructive Surgery
For women, night work may up breast cancer risk (2/5/01)
NEW YORK, Dec 28 (Reuters Health) - Women who work at night, such as nurses or flight attendants, may be slightly more likely to develop breast cancer than women who work in the daytime, a Danish researcher reports.
The finding is from a study of 7,035 women between the ages of 30 and 54 who had been diagnosed with breast cancer. Dr. Johnni Hansen of the Institute of Cancer Epidemiology in Copenhagen, Denmark looked at cancer registry records that also contained information regarding each women's employment history.
Women who worked in occupations requiring nighttime work were 1.5 times as likely as daytime workers to be diagnosed with breast cancer, Hansen reports in the January issue of Epidemiology. The risk seemed to increase the longer a woman worked in such an occupation, according to the report.
The reason for the link is unclear. Some studies have shown that nighttime workers are more likely to consume alcohol, a risk factor for breast cancer.
However, Hansen points to another theory--that exposure to artificial light suppresses the hormone melatonin, which is normally produced in the body at night. Some studies have suggested that low levels of melatonin may either promote breast cancer cell growth or encourage increased production of estrogen, which may increase cancer risk.
Women who are completely blind, Hanson points out, cannot sense light visually. Their secretion of melatonin is, therefore, not inhibited. Among blind women the risk for breast cancer is about 50% that of other women, making this theory "biologically plausible," the researcher writes.
Some 26% of men and 18% of women in the United States worked in jobs that include variable shift schedules, according to 1980 figures cited in the report. About 20% of women in Denmark work at night.
SOURCE: Epidemiology 2001;12:74-77.
Veggies Good for Women's Bones
By Fran Berger
HealthScout Reporter
Women whose diets are heavy on meat and light on vegetables may be headed for bone loss and fractures in their later years.
"Our study found that women who ate most of their protein from animal sources had three times the rate of bone loss and 3.7 times the rate of hip fractures as women who ate most of their protein from vegetable sources," says Dr. Deborah Sellmeyer, an assistant professor of medicine and director of the Bone Density Clinic at the University of California, San Francisco, Medical Center at Mount Zion.
"Animal protein may be related to the increased bone loss and fracture for a couple of reasons," says Sellmeyer, lead author of the new study. "Protein from both animal and vegetable sources provides amino acids. When … metabolized by the liver, they produce sulfuric acid as a byproduct. This acid is released into the blood and must be dealt with by the body."
Normally, the kidneys excrete the acid in the urine, Sellmeyer says. But, as we age, the kidneys are less able to take care of the acid, and she says the body finds a different way to handle things.
In basic chemistry, she says a base neutralizes an acid. "Base in foods comes pretty much exclusively from fruit and vegetables" that, when metabolized by the liver, work to neutralize the acids from animal foods, she says.
"When we eat more animal than vegetable foods, which unfortunately most Americans do, we are giving our bodies more acid than base, and the body must use something to neutralize that acid," Sellmeyer says.
Bones, which are made up of base and minerals, step in to combat the acid, and, as a result, they dissolve over time, losing mass and calcium, she says.
However, just piling on the veggies is not the answer, says Marc O'Meara, a registered dietitian at the Cardiac Wellness Center at the Mind/Body Medical Institute in Boston.
Instead, he says choose seeds, beans, nuts and legumes as the best protein sources.
"You don't have to become a vegetarian," O'Meara says. Consider "cutting down on meat, poultry and fish [and] having more vegetables at meals. Try a natural peanut butter sandwich rather than turkey some days of the week," he says.
And because fruits contain no protein, adding lots of them -- although healthy for other reasons -- will not solve the problem if you eat high levels of animal protein, O'Meara says.
In the latest study, considered one of the largest of its kind, the researchers analyzed data from a study of osteoporotic fractures in which 1,035 women, aged 65 to 80, recorded how much they ate of 64 different types of foods. The researchers grouped the women into three categories: those with a high ratio of animal-to-vegetable protein, a middle range or a low ratio. They then compared that ratio to bone mineral density, bone loss and fractures during a seven-year follow-up. Results appear in the January 2001 issue of the American Journal of Clinical Nutrition.
Although the research team could not link bone loss directly to the need to neutralize the acids, Sellmeyer says the findings are exciting because they "did adjust for everything we could think of that might otherwise explain the relationship … and it didn't change the results."
What To Do
There's no need to cut out all animal protein from your diet, Sellmeyer says. "Protein is very important for strong bones and muscles, and we don't want women cutting back on protein," she says.
Besides adding vegetables to your diet, you can take other steps to ensure healthy bones, experts say. Sellmeyer urges lifestyle changes, like "maintaining a good calcium intake, exercising regularly, stopping smoking and limiting alcohol to moderate use."
And O'Meara says soy is a good addition to the diet. From soy milk to soy cheese to tofu, he says soy adds vegetable protein to the diet. And, he suggests meat eaters try a veggie burger. "Switching to a veggie burger may be a lot easier than switching to tofu," he says.
Older women get less home care than men
CHICAGO (Reuters) -- Caring for the elderly most often falls to women, some of them older women acting as caregivers for their disabled husbands despite needing help themselves, researchers said Tuesday.
A survey of 7,443 Americans aged 70 and older found women received fewer hours of informal home care than men, and the disparity was even greater among married disabled women who were often called upon to help their frail husbands with dressing, eating or other tasks.
Even healthy men in the study were less prepared to fulfill the social role of caregiver, the report published in this week's Journal of the American Medical Association said.
Only 11 percent of disabled women reported any informal care from a spouse, compared with 44 percent of the disabled men, the report said.
Disabled women were better off than men when it came to receiving care from children or grandchildren. Four out of five of the younger caregivers were women.
"Because disabled elderly women rely heavily on children for support, especially female children, the family burden and stress associated with caring for a disabled woman should be the subject of further study," study author Steven Katz of the University of Michigan in Ann Arbor wrote.
Because women live longer than men and generally have less net worth, they are more likely to need unpaid care to cope with disabilities associated with aging and chronic disease, the report said.
| — Common sense says a bad marriage can lead to heartbreak. Swedish researchers
said today that women with heart disease who are in a stressful relationship triple their
risk of recurrent heart trouble. |
A new warning for pregnant women: Avoid herbal supplements pending further study, experts caution
By Charlene Laino MSNBC
NEW YORK — Most herbal supplements and other “natural” products should be avoided during pregnancy as they have not been adequately studied to ensure safety and effectiveness, experts caution.
WHILE the Food and Drug Administration requires that drugs be proven safe and effective before they can be marketed, supplements are exempt from such regulations, said Dr. Donald Mattison, medical director of the March of Dimes, which sponsored a news conference on supplements in pregnancy here Tuesday. “It’s as if we should assume [supplements] are safe until proven harmful,” he said. “As a result, pregnant women who think they are doing everything right to ensure the health of their baby may unknowingly be causing harm.” Despite the lack of data, the use of herbal products during pregnancy is widespread. As many as four in 10 women use natural products ranging from gingko to peppermint tea at some time during pregnancy, and one in five opt to take them throughout the nine months’ gestation period, said Dr. Michael Greene, director of maternal-fetal medicine at Massachusetts General Hospital, Boston, and chairman of the FDA’s Reproductive Drugs Advisory Committee and Pregnancy Labeling Subcommittee. “There seems to be an assumption that because they are ‘natural,’ such products are safe,” Greene said. “Even many doctors assume that at worst, they won’t do anything to help, that they’re harmless.” Such assumptions are grossly false, according to the Boston physician. While some supplements such as folic acid have been proven to cut the risk of birth defects, many more have been shown to be potent teratogenics — substances that when taken during pregnancy can have an adverse effect on the developing fetus, Greene said. Among them: Blue cohish. An herb that can help to induce labor in the third trimester, blue cohish can cause cardiac defects in the unborn if taken during the first three months. Hellebore. Said to relieve painful cramping as well as to curb vomiting, hellebore has been linked to miscarriages and defects such as cleft palate in the newborn. Hemlock. Taken by some women to relieve tingling or painful nerve endings and joints, hemlock is known to cause cleft palate and clubfeet. Tragacanth. Often available in gum or lozenge form as a natural laxative, tragacanth can induce miscarriages and cause birth defects such as clubfeet.
Further conflicting the problem is that many health Web sites carry conflicting advice on herbal supplements, Greene said. Take seemingly benign peppermint tea as an example. The Herb Doc recommends the tea as a digestive aid that is safe after the first trimester, while The Total Health Network says the herbal preparation should be avoided during pregnancy altogether as it contains volatile oils that can be hazardous to fetal development, Greene said. Similarly, The Herb Doc endorses the use of ginger root for morning sickness, while The Physicians’ Desk Reference for Herbal Medicine says the supplement should be avoided during pregnancy altogether, he said. “I don’t know how doctors can sort it all out, never mind their patients,” Greene said. “It’s hard for women to even know what they are getting when they take one of these products.”
TIP OF ICEBERG Conflicting advice is just the tip of the iceberg when it comes to problems with using supplements during pregnancy, the experts said. Compounding the situation, for example, is that many people don’t tell their physicians when they take herbal products as they sense, rightly or wrongly, that their doctors will disapprove, Mattison said. Then, there are issues of purity and dose. FDA regulations require that drugs contain an exact dose of any pharmacologically active compound and that the medication be tested for purity.
“But with supplements, there are no such rules so it’s hard to know exactly how much of an active medication you are taking,” Greene said. “For example, the heart medication digitalis is found in the foxglove plant. But our ancestors who self-medicated with the plant in the early part of the century often took too much — which proved to be fatal,” according to Greene. “The advantage of the pharmaceutical formulation that is used now is that it provides consistent amounts of the active drug,” he said. As for purity, Greene pointed to the “fashionable practice some years ago of getting calcium from natural sources such as limestone. “Unfortunately, it had toxic substances such as lead in it as well,” he said. “Likewise, you can’t know for sure if natural products on the market now are pure as they are not regulated by the FDA.”
NO REAL ANSWERS Until the government chooses to oversee herbal products, is there anywhere a pregnant woman who’d rather “be natural” turn for authoritative information? Advertisement
Not really, the experts said. Even the Physicians’ Desk Reference — considered by U.S. physicians to be their bible for drug information — can’t be relied on, Greene said. The PDR is in fact a legal document, a compilation of labeling information on drugs that has been approved by the FDA, he explained. But the PDR for Herbal Medicine, while published by the same people, doesn’t carry such authority. Similarly, the German Schedule E, considered by many to be the original scrolls of herbal medicine, does not cite studies showing safety and effectiveness, he said. “Until better information is available, it’s hard to recommend any single agent for use in pregnancy,” said Dee Quinn, president of the Organization of Teratology Information Services, a nationwide information network regarding exposures during pregnancy. Mattison went a step further. Pointing out that about half of all pregnancies in the United States are unplanned, the March of Dimes believes that all women of childbearing age, whether they plan to conceive or not, should consult with a doctor before taking vitamins, minerals or other herbal products. “Not only can dietary supplements produce a false sense of security, delaying needed treatment, but they also can potentially harm, even kill, an embryo or fetus,” he said.
Ugly Urges: Why women flock to mediocre men
By Adam Pasick
Meredith Heuer/ FOXNews.com
The Billy Joel Syndrome is one of the great social science mysteries: Why do beautiful women sometimes fall for not-so-good-looking guys?
For the answer, says Dr. Lee Alan Dugatkin, look to guppies.
Guppies are the first species in which scientists have observed the phenomenon of "mate copying": A female guppy is much more likely to have the hots for a male guppy if other female guppies like him, too. And it seems humans behave in much the same way.
Dugatkin conducted a study of 60 men and 74 women who were shown pictures of strangers and asked if they'd like to date them. They were also given information about whether other men and women, respectively, found the strangers attractive.
"Unsurprisingly, the male and female subjects both liked attractive people," says Dugatkin, a professor at the University of Louisville. "But females weighed the opinions of other females much more highly than the men did."
Women also described the guys they preferred in the pictures as more wealthy, funny and personable — even though they had never met them.
"When humans see their peers flock around someone, they may wonder what the fuss is all about," the study says.
In other words, Dugatkin says, mate copying "could lead a female to go out with a physically unattractive male because other females said they'd go out with him." After all, he must have something going for him. Right?
Crudely put, Dugatkin's research suggests if you go out even once with an exceptionally attractive babe — say, Christie Brinkley, Joel's ex-wife — you may be set for life in the romance department.
It's not that women are lemmings when it comes to getting a date. Rather, their behavior is strongly rooted in evolutionary decision-making.
"Using other females' information is an statement of women being choosy," Dugatkin says. "From an evolutionary perspective, females should be the choosier sex; they have more to lose. If a female makes a mistake and chooses the wrong mate, she'll be out of commission for nine months. And if one parent leaves, it's almost always the male."
So if a woman doesn't have much information to go on when sizing up potential mates, she'll probably prefer the guys that other women want to get busy with.
Back to Billy for a minute. Since he and the Uptown Girl divorced, how has he done in the romance department?
Pretty well. His current relationship is with local television news anchor Trish Bergin, who would rate pretty high on most men's attractiveness scales. Oh, and by the way: Joel was introduced to Bergin by Bergin's very good friend, Christie Brinkley.
Side Effect of Women's Most Common Form of Birth Control Just a Myth
Study Finds No Link Between Having 'Tubes Tied' and Problem Periods
By Denise Mann WebMD Medical News
Reviewed by Dr. Pamela R. Yoder
Dec. 6, 2000 -- Women dread 'that time of the month' and would avoid anything that aggravates their monthly cycle. Now a new study shows that -- contrary to popular belief -- women who have their tubes tied as a form of birth control are at no greater risk for abnormal periods.
The study shows that there is no such thing as problem periods after the procedure called tubal sterilization or tubal ligation, which is the most common method of birth control for women in the U.S. The supposed problems include periods that are longer, heavier, and more painful. It was also thought bleeding between periods would result.
The findings are important because the researchers had previously reported that women undergoing tubal sterilization were four to five times more likely to end up having a hysterectomy due to such problems. Moreover, some doctors will recommend a hysterectomy instead of tubal sterilization as a way to bypass the potential for menstrual problems.
In the largest study of its kind to date, the researchers compared menstrual abnormalities among more than 9,500 women who underwent sterilization and about 570 women who had not been sterilized. They underwent phone interviews every year during a five-year period.
In fact, women who had their tubes tied were no more likely to have problem periods than were women who did not undergo the procedure, according to the study, which appears in the Dec. 7, 2000 issue of The New England Journal of Medicine.
On the other hand, this is not to say that sterilization reduces risk of menstrual problems, the study authors are quick to point out.
"The findings are strongly reassuring about the long-term safety of tubal sterilization," says lead author Herbert Peterson, MD, who was the chief of the women's health and fertility branch at the CDC when the study was conducted. He is now a medical officer at the World Health Organization in Geneva.
"These are the best available data that we have on the subject," adds Steven C. Kaufman, MD, medical officer at the National Institute of Child Health and Human Development in Bethesda, Md. "I have heard from providers that these are major concerns," he tells WebMD.
Over 10 million American women have opted to undergo tubal sterilization, according to Carolyn Westhoff, MD, of Columbia University in New York, who wrote an editorial on the study. And Westhoff points out the need to provide accurate and relevant information to the more than 500,000 women considering the procedure each year. She is also attending physician and professor of ob-gyn and public health at Columbia Presbyterian Medical Center in New York City.
Tubal ligation can be done several ways. But basically, the operation closes off the fallopian tubes, where the woman's eggs are fertilized by sperm. When the tubes are closed, sperm cannot reach the egg, and pregnancy is most likely avoided. This procedure is more than 99% effective at preventing pregnancy in the first year after it's done.
Men Do Hear -- But Differently Than Women, Brain Images Show (12/3/00)
INDIANAPOLIS -- Research conducted at the Indiana University School of Medicine may help resolve an age-old dilemma between the sexes. Men listen with only one side of their brains, while women use both, according to information on brain imaging presented Tuesday, Nov. 28, at the 86th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA). The study may add fuel to the females' argument, but researchers say the findings don't address whether women are better listeners than men.
"Our research suggests language processing is different between men and women, but it doesn't necessarily mean performance is going to be different," said Joseph T. Lurito, M.D., Ph.D., assistant professor of radiology at IU School of Medicine. "We don't know if the difference is because of the way we're raised, or if it's hard-wired in the brain."
In the study, 20 men and 20 women underwent functional magnetic resonance imaging (fMRI) while listening to a passage from "The Partner," a John Grisham novel. A majority of the men showed exclusive activity on the left side of the brain, in the temporal lobe, which is classically associated with listening and speech. The majority of women showed activity in the temporal lobe on both sides of the brain, although predominantly on the left. The right temporal lobe traditionally is associated with non-language auditory functions. "As scientists, we're figuring out what normal is, and more and more often it seems we're finding that normal for men may be different than normal for women," said Micheal Phillips, M.D., assistant professor of radiology and co-author of the study. "That doesn't mean one is better or more capable than the other."
The finding may help with research regarding how men and women recover from stroke and brain tumors, said Dr. Lurito. It also may help guide brain surgeons in avoiding certain areas of the brain, depending on whether they're operating on men or women, he said. "Also, scientists working on improving imaging technologies, such as fMRI and PET (positron emission tomography), need to be aware of potential gender differences," said Dr. Phillips.
Co-authors of a paper on the topic being presented at RSNA by Drs. Lurito and Phillips are Mario Dzemidzic, Ph.D., assistant professor of radiology; Mark J. Lowe, Ph.D., assistant professor of radiology; Yang Wang, M.D., assistant scientist of radiology, and Vincent P. Mathews, M.D., associate professor of radiology. The research was funded by the IU School of Medicine Department of Radiology.
The RSNA is an association of 31,000 radiologists and physicists in medicine dedicated to education and research in the science of radiology. The society's headquarters is located in Oak Brook, Ill.
The Indiana University School of Medicine, the state's only medical school, has nine regional campuses with more than 1,000 full-time faculty teaching nearly 2,000 medical students and residents annually.
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Note: This story has been adapted from a news release issued by Indiana University for journalists and other members of the public. If you wish to quote from any part of this story, please credit Indiana University as the original source. You may also wish to include the following link in any citation:
http://www.sciencedaily.com/releases/2000/11/001129075326.htm
One in 48 Women in Developing Countries Dies in Childbirth (11/18/00)
FIGO Save the Mothers Fund Offers New Hope and Promise of Self-Sufficiency
WASHINGTON, Sept. 5 /PRNewswire/ -- Antonia Chapeta Querma, of Xeujupup, Guatemala, almost died. After delivering a healthy baby, the 32-year-old mother of six experienced severe postpartum bleeding. Just a few months ago, none of the physicians at the Solola health center knew how to recognize and treat postpartum hemorrhaging. But because of recent training provided by Save the Mothers Fund, Dr. Juan Gonzalez controlled the bleeding. And saved her life. Antonia is one of thousands of women in eight developing countries who received emergency obstetric care provided through Save the Mothers Fund. The International Federation of Gynecology and Obstetrics (FIGO) initiated the fund to save mothers' lives and improve obstetric care through partnerships between professional obstetric and gynecology societies in developed and developing countries. Program funding came from the Pharmacia Corporation, the United Nations Population Fund (UNFPA) and the World Bank. "Around the world, one woman dies each minute from complications of pregnancy and childbirth. The majority of these deaths are preventable with access to emergency obstetric care," said Giuseppe Benagiano, M.D., chair of FIGO's Save the Mothers Fund Committee and director, Italian National Institute of Health. "While it is still early in the program, we have been very pleased that the health care providers have found ways to improve emergency obstetric care in ways that will benefit women for years to come. We hope to expand upon these results going forward." Today, FIGO provided the initial results of Save the Mothers Fund at the XVI World Congress of Gynecology and Obstetrics meeting in Washington, DC. Researchers have found emergency obstetric care is severely inadequate: more often than not, services fall far below the UNICEF/WHO established standards of minimum care. For example, the international minimum standard is one hospital for every 500,000 (0.5 million) residents. In the region targeted by Save the Mothers in Ethiopia, there is one hospital for 2.5 million residents. Managing maternal health continues to be a major challenge in developing countries, where the risk of dying from childbirth is one in 48, as compared to one in 1,800 in developed countries. More than seven million women suffer serious health problems as a result of childbirth. As many as 50 million women suffer adverse health consequences after childbirth. The death of a woman of reproductive age significantly lowers the chances that her children will survive. In addition to creating orphans, her death causes family distress and negatively impacts the economic well-being of rural communities. Medical professionals from the obstetric/gynecology societies in the developed and developing countries worked with FIGO to identify and improve quality emergency obstetric care in areas with the greatest needs. The Fund's initiatives focused on training, improving facilities, establishing procedural standards, and donating basic equipment. The goal: to reduce the number of deaths of childbirth and other pregnancy-related causes in a sustainable manner.
Helping People Help Themselves Toward Self-Sufficiency FIGO efforts focused on regions within eight developing countries with high mortality rates and little resources. To provide local support, they partnered the professional obstetric and gynecology societies in five developed countries with eight developing countries: Canada and Uganda; Italy and Mozambique; Sweden and Ethiopia; United Kingdom and Pakistan; U.S. and Central America (Guatemala, Honduras, Nicaragua, El Salvador). Physicians from the developed countries traveled to their target regions to meet their counterparts. There, with the local obstetric/gynecology societies, they assessed the needs of the region for potential solutions. In most cases, the improvements may be considered insignificant by industrial standards; however, FIGO noted that they make a tremendous difference in these developing countries where emergency obstetric care falls below even the lowest standards. "We are talking about providing the most basic health services," said Dr. Benagiano. "For example, a key problem is access to care. Forty percent of the maternal deaths in the region covered by Save the Mothers in Uganda are due to a delay in getting to the hospital."
Women in each country targeted by FIGO's Save the Mothers Fund suffer from gravely substandard emergency obstetric services that may result in unnecessary deaths: -- In 1998, more than 1,000 women died due to complications of childbirth in El Salvador, Guatemala, Honduras and Nicaragua. -- In Ethiopia, nearly 2.7 of the 2.9 million births occurred at home with the assistance of family members or traditional birth attendants in 1998. -- In Mozambique, only 17 percent of births are delivered in the hospital setting and only two percent are delivered by cesarean section. -- In her lifetime, an average Pakistani woman faces a one in 38 chance of dying during childbirth because the health care system does not have the capacity to provide proper emergency obstetric care. -- In Uganda, 54 women die annually out of an estimated 8,272 live births.
The success of Save the Mothers Fund initiatives is measured in small victories. "Each initiative implemented special steps to improve maternal health based on the individual needs of a participating region," said Dr. Mahmoud Fathalla, professor of obstetrics and gynecology, Assuit University, Egypt; past FIGO president; and founder of the Save the Mothers Fund. "All regions received emergency obstetric training, improvements to facilities or staffing and tools. We have seen an increase in the number of women who are delivering their babies in medical facilities. The measure of true success: the mothers who are alive today because they received emergency care when most needed."
International Federation of Gynecology and Obstetrics (FIGO) FIGO is the only world organization representing the obstetricians and gynecologists in more than one hundred countries. The mission of FIGO is to promote the well being of women and to raise the standard of practice in obstetrics and gynecology. FIGO is a benevolent, non-profit organization funded through subscriptions received from member societies, through grants and from the proceeds of its triennial World Congress. Save the Mothers Fund is FIGO's first foray into implementing a project with the unique design of partnering developed and developing countries' obstetric and gynecologic societies. It differs from other initiatives as it is being carried out at a grassroots level, targeting the specific needs of each identified region and employing tactics of teaching as well as providing a structure to create positive changes.
Pharmacia Corporation Pharmacia Corporation (NYSE: PHA) has a long history of developing and marketing products for women's health. Currently the company offers a diverse portfolio of products for conditions that affect women, including contraception, menopause, breast cancer, overactive bladder and rheumatoid arthritis. Looking forward, the company remains committed to developing and investing in products that advance the health and enhance the lives of women.
United Nations Populations Fund United Nations Population Fund (UNFPA) is the largest internationally funded source of population assistance to developing countries. The Fund assists countries to improve reproductive health, including safe motherhood, STDs/AIDS prevention and family planning services on the basis of individual choice, and to formulate policies in support of sustainable development.
World Bank The Population and Reproductive Health Capacity Building Program, a program of the World Bank's Development Grant Facility, supports innovative ways to stimulate and sustain local responses to population and reproductive health needs. It provides funding for organizations working to: increase access to, and choice in, family planning, reduce maternal mortality and morbidity, promote the health of adolescents and women, and reduce harmful practices such as Female Genital Mutilation.
SOURCE Pharmacia Corporation Web Site: http://www.pnu.com
Moderate Alcohol Consumption May Reduce Women's Risk of Heart Disease, New Study Shows (11/18/00)
By Jacob Gaffney
As recent studies increasingly point to the health benefits associated with drinking wine in moderation, three London researchers have studied nearly 14,000 women to determine how many drinks per week it takes for the benefits of alcohol consumption to shift to increased risks instead.
The study, published in the International Journal of Epidemiology, concluded that moderate drinkers have lower risk of heart attack and are less prone to hypertension, a condition that can lead to certain kinds of strokes.
"Women consuming 1-14 units [defined as a glass of wine or half a pint of beer] per week had a reduction in cardiovascular heart disease risk," wrote the authors, led by Kiran Nanchahal of the Department of Epidemiology and Population Health at the London School of Hygiene and Tropical Medicine. "But there was an increased prreviewence of hypertension among those consuming more than 15 units per week," the study also points out.
The three researchers selected 13,986 women over the age of 30 who worked at Marks & Spencer, a department-store chain in the United Kingdom, and asked them to answer questions about their lifestyles. The scientists also tested the women's blood for factors related to cardiovascular health and hypertension, such as blood sugar, cholesterol and blood pressure.
The researchers divided the women into five groups, based on their amount of alcohol consumption: nondrinkers, one to seven drinks per week, eight to 14 drinks per week, 15 to 21 drinks per week and more than 22 drinks per week.
From the results of the questionnaires and blood tests, the researchers then determined each group's risk of cardiovascular disease based on the women's levels of high- and low-density cholesterol, triglycerides, apolipoprotein, glucose levels and other factors.
"There was a steady decrease in the predicted cardiovascular heart disease risk with increasing alcohol consumption, except for women consuming more than 22 units per week," the study states. "The greatest reduction occurred between nondrinkers and women drinking one to seven units per week."
The researchers wrote that the women who consumed from eight to 14 drinks a week had the lowest rate of hypertension and the second-lowest rate of heart attacks. The group at lowest risk for heart attack consumed 15 to 21 drinks per week, but they also had the highest level of hypertension.
The researchers pointed out that their study relied on risk factors instead of actual incidences of cardiovascular disease and strokes. They also suggest that employed women tend to be in better shape than those without jobs, and unemployed women were not represented in the study.
Society for Women's Health Research Testifies on Health Disparities (10/10/00)
PRNewswire/ -- Society for Women's Health Research Executive Director Phyllis Greenberger, M.S.W., testified today s submitted for publication. A letter was sent to editors at 32 journals urging revision of publication guidelines " ... to reflect the requirement to include women in clinical trials, and to analyze the results by sex, as has been legislated to NIH."
The hearing will also examine rural and minority health disparities. Greenberger will testify along with Representative J.C. Watts (R-OK); Representative John Lewis (D-GA); Representative Jesse Jackson, Jr. (D-IL); Ruth Kirschstein, M.D., acting director of the NIH; the Honorable Louis Sullivan, M.D., president of the Morehouse School of Medicine in Atlanta, GA; John Maupin, D.D.S., president of Meharry Medical College in Nashville, TN; Elena Rios, M.D., president of the National Hispanic Medical Association; and Gilbert Friedell, M.D., director emeritus of the Markey Cancer Center at the University of Kentucky in Lexington.
The Society for Women's Health Research is the nation's only not-for- profit organization whose sole mission is to improve the health of women through research. Founded in 1990, the Society brought to national attention the problem of the exclusion of women from major medical research studies and the resulting need for more information about conditions affecting women. The Society advocates increased funding for research on women's health, encourages the study of sex differences that may affect the prevention, diagnosis and treatment of disease, and promotes the inclusion of women in medical research studies. Visit the Society's Web site at www.womens-health.org for more information.
If you would like to receive the study on women in clinical research published in the Journal of Women's Health and Gender-Based Medicine, please contact Sarah Gevers at 202-496-5015. SOURCE Society for Women's Health Research
Is women’s health care overrated? (9/22/00)
Healthy Eve: Ob-gyns get less training than other surgeons
By Linda Carroll SPECIAL TO MSNBC
I don’t know about you, but I value my uterus at least as much as my breasts. The loss of my ovaries would be no less consequential than the loss a finger. But if you look at how surgeons are trained in this country, it’s clear that women’s reproductive organs aren’t considered to be as important — or complicated — as other parts of the body.
‘It’s one thing to know how to take out a uterus, it’s another to know
when to do it.’ — DR. LUIGI MASTROIANNI, JR. University of Pennsylvania Medical
Center.
OBSTETRICIAN-GYNECOLOGISTS, the doctors who operate on our reproductive system, spend far
less time practicing procedures in their residencies than do other surgeons. The ob-gyn
residencies include so many other areas of instruction, such as primary care, obstetrics
and preventive medicine, that little time is left to devote to actually learning to
operate on patients. Some ob-gyns see less than two years of surgical training during
their four-year residencies, says Dr. Barbara Levy, a clinical assistant professor of
obstetrics and gynecology at the University of Washington in Seattle and at Yale
University in New Haven, Conn., and a former president of the American Association of
Gynecologic Laparoscopists.
LESS EXPERIENCE
In general, ob-gyn residents spend between 18 and 24 months in surgical training, says Dr.
Norman Gant, the executive director of the American Board of Obstetrics and Gynecology and
a professor of obstetrics and gynecology at the University of Texas Southwestern Medical
School in Dallas. The general surgeon, the operative Jack-of-all-trades, spends five years
in residency, with three years that intensely focus on surgery. In their residencies,
urologists spend two years with the general surgery department and then focus on urology.
The thoracic surgeon’s residency includes five years in general surgery training and
then specialized training for another two years. The hand surgeon gets at least five years
of surgical training in a residency in either orthopedic surgery, general surgery or
plastic surgery and then another year of specialized training in hand surgery. Why so much
time? Medical schools have experimented with shorter residencies, says Dr. Wallace P.
Ritchie, Jr., the executive director of the American Board of Surgery. “They dropped
it right away,” Ritchie adds. “It was clear that the surgeons from these
programs were not as good as the ones who had gone through five year programs.” The
disparity in training time isn’t lost on some gynecologic surgeons who think the
system could be made better.
“On a scale of A to F, we’re not failing,” says Dr. Morris Wortman, a clinical associate professor of gynecology and obstetrics at the University of Rochester and director of the Center for Menstrual Disorders and Reproductive Choice, both in Rochester, N.Y. “But we’re somewhere in the C to D range.” Wortman points out that the problem is compounded by the fact that medical advances have reduced the numbers of women needing reproductive surgery. For example, Wortman says, at Rochester, where a surgeon-in-training might once have 100 hysterectomies under her belt by the end of a residency, now she might only have the opportunity to perform 25. And this means that in residency training, surgeons aren’t seeing as wide a range of complicating factors and differences in anatomies these days, Wortman says. “And this leaves the door open for more complications on fairly easy cases and also for doctors to feel less confident than a well-trained surgeon should be,” he adds. Are women being harmed by this? Not if they are proactive in asking about their surgeon’s training and experience, Levy says. “If your surgeon is just a couple of years out of training, then one or two surgeries per month is not enough,” she explains. “If she is doing one or two a month, but has over a thousand under her belt over the course of 20 years, then that’s probably enough. “It’s like learning how to drive. If you don’t drive much when you first are learning, you won’t do well. If you’ve been driving for years and then go on vacation for a month and don’t drive at all, you still will be OK to drive when you come back.”
ASK THE RIGHT QUESTIONS
Still, Levy allows, women who aren’t asking the right questions may not be getting
the best care. “The bottom line is, yes, they may be harmed by their surgeons’
lack of experience,” she says. “The surgery may not be optimally done. The wrong
type of surgery may be done. Surgery may be done when it’s not the right choice for
the patient.” One way to improve things would be to allow some ob-gyns to concentrate
on surgery during their residencies.
“There’s a move afoot to divide us into three tracks,” Levy says. “One track would be holistic women’s health. This would be primary care model that looks at women in the context of our lives. Another track would be obstetrics. The third would be gynecologic surgical track, which would include surgery for infertility, oncology [cancer], and pelvic floor reconstruction.” Currently some ob-gyns do go on, after their residencies, to do a two- to three-year fellowship that specializes in areas such as cancer surgery or infertility, Levy allows. But these fellowships aren’t required for a surgeon to operate on patients with reproductive cancers or fertility problems. Gant agrees that training programs could be better and is pushing for more flexibility in residencies to allow doctors who want to concentrate on surgery to spend more time practicing procedures and those who aren’t interested in surgery to focus more on primary care or obstetrics. Still, he argues, “ob-gyns coming out of residency programs today are excellently trained.” Not everyone agrees that women will be best served if residencies split women’s care between those who deal with primary care and those who operate. “This is an ongoing debate,” says Dr. Luigi Mastroianni, Jr., the William Goodell professor of obstetrics and gynecology at the University of Pennsylvania Medical Center in Philadelphia. “This will result in a splintering of care. “It is my opinion that the total care of the patient is much more important than some technical expertise. You can teach a monkey to do some of the procedures in the O.R.. But you can’t give the monkey the breadth of exposure to the overall area that will allow appropriate decisions to be made. It’s one thing to know how to take out a uterus, it’s another to know when to do it.”
By this logic, all doctors would be surgeons. They would perform the initial examination of the patient, diagnose the illness and then operate. But for some reason, health experts concluded that patients would be better served if one doctor figured out what was wrong and then referred the patient on to a surgeon — unless that patient happens to be a woman with a damaged reproductive organ. For myself, I’d feel a bit more comfortable if I knew my gynecologic surgeon spent as much time training to operate as a hand surgeon or breast surgeon.
Linda Carroll is a health and medical writer based in New Jersey whose work has appeared in Newsday, the Chicago Sun Times, the Detroit Free Press and the Los Angeles Times.
The truth about caffeine. How much do you really know about it? (9/8/00)
NBC News
June 12 — It makes getting out of bed in the morning almost worthwhile. Caffeine is part of so many things we love from coffee to chocolate to soda. But is caffeine friend or foe? We’ve heard so much conflicting information, it’s hard to know. How much do you really know about caffeine? Chief Medical Correspondent Dr. Bob Arnot reports.
|
IT SEEMS THAT almost everyday that we hear something new about
caffeine. Even the experts don’t seem to agree so it’s no wonder we’re
confused about caffeine. Should we have a little or a “latte”? Even if you’ve made up your mind to cut down on espresso, caffeinated products are hard to avoid. There’s caffeine in chocolate, in most sodas and even in some painkillers. “Almost everyone in the United States takes in caffeine in some form or another,” says Dr. Stephen Scheidt, director of the cardiology training program at New York Hospital. For several years he has studied and lectured on the effects of caffeine on the entire body. We asked him to give us the scoop on caffeine. COFFEE OR TEA? For starters, which has more caffeine: tea or coffee? Dr. Scheidt says the answer is clear. “Coffee has more caffeine than tea,” he says. “Coffee as brewed in the united states has about 100 to 130 milligrams of caffeine per cup. Tea usually has about 40 or 50 milligrams of caffeine.” If you are a tea drinker, Dr. Scheidt says you should know the darker the tea, the more caffeine it will likely have. EFFECT ON BLOOD PRESSURE So what kind of effect will caffeine have on your body? Can it give you high blood pressure? Dr. Scheidt says that caffeine can temporarily increase your blood pressure — perhaps for minutes or even hours. But “the key question is: Is caffeine associated with a development or the worsening of high blood pressure that 60 million Americans have?” asks Dr. Scheidt. “And that’s myth.” CAFFEINE AND YOUR HEART So if caffeine won’t give you high blood pressure, could it give you a heart condition? Dr. Scheidt says there’s no question. “Mainly myth,” he says. “Caffeine certainly cannot give you a heart condition. Inconceiveable, has never even been suggested.” But if you do have a heart problem, Dr. Scheidt says caffeine might make your heart race. But it’s highly unlikely to worsen your heart condition. RELATIONSHIP TO CANCER Another concern people have about caffeine and cancer? Is there a link between caffeine and cancer? Dr. Scheidt says this has been studied exhaustively. “It’s been looked at very, very seriously,” he says. “There is no association with cancer.” WHO SHOULD AVOID CAFFEINE? But should certain people avoid caffeine? Should pregnant women avoid caffeine? And the doctor’s orders? “I think that to be prudent, someone who’s pregnant should reduce caffeine consumption and should probably drink fewer than three cups of coffee a day,” says Dr. Scheidt. |
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| So expectant moms shouldn’t have to give up
caffeine altogether. But what if a woman is trying to get pregnant. Will caffeine affect
her fertility? Scheidt says, “There are some studies that show that large doses of caffeine — that would be three to five to seven cups of coffee a day — can delay fertility. That means you get preganant a couple of months later than you otherwise would have gotten pregnant.”
Here are some other things to remember about caffeine: It’s a performance
enhancer. It can make you more alert. And it’s also a pain killer, which is why you
often find it in medications. |
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9/8/00
Non-Invasive Procedures for Detection and Treatment of Breast Cancer Touted
By Sharon Cramer Bell
ATLANTA -- Two emerging innovative technologies promise a kinder, less invasive approach to breast cancer detection and treatment. One may enable doctors to pick up abnormalities before breast cancer actually develops and another could do away with the need for surgery for small tumors.
Susan Love, M.D., adjunct professor of surgery at the University of California at Los Angeles, and her team have developed a virtually painless way to access the lining in the milk ducts and potentially find "cells that are just thinking about becoming cancer." She explained the technique at the Department of Defense Breast Cancer Research Program's Era of Hope meeting here Saturday.
"We already knew that all breast cancers arise in cells in the lining of milk ducts," she said. "But scientists believe that even the tiniest tumors visible on mammograms have already been growing for several years." What was needed for truly early detection was a way to access cells en route to becoming cancer.
Before there could be routine sampling of ductal cells, the researchers first had to map the system of milk ducts and then find a way to remove the cells. Love's team constructed a diagram of the anatomy of the breast and its milk ducts by examining nipples of lactating women (using volunteers from La Leche League), X-ray images and breast tissue from surgeries. They were surprised to learn that each nipple has five to nine openings connected to independent milk ducts that extend back to the chest wall. "Contrary to prevailing views, the breast is actually a collection of ductal systems, not one organ," Love explained.
The next step was to design a device to retrieve cells from the ducts. Love and her colleagues came up with a so-called double-lumen catheter, a tube containing two tiny threads, that can be inserted about half an inch into natural openings in the nipple with little discomfort. She explained that a saltwater solution is injected into the ducts through one thread and cells are flushed out through the other in a process called "ductal lavage."
Dr. Susan Love Image courtesy of www.susanlovemd.com An independent study at 19 major breast cancer centers in the U.S. and Europe compared this new technique with another procedure in which a suction cup draws fluid out of the ducts. Preliminary findings on a subset of 502 women at high risk for breast cancer, ranging in age from 26 to 81 years, showed that ductal lavage found abnormal cells in 15 percent of the subjects, while the suction technique uncovered such cells in about 4 percent of the comparison group.
Love is a cofounder of a company that has developed a commercial version of the new catheter, which has been approved for marketing by the Food and Drug Administration. She said that the technique is not yet widely available. "More doctors need to be trained, but it should be available at local breast cancer centers soon," she added.
Exhibit depicts long path to women's health
(9/8/00)PORTLAND - Rita Pinkowski was interested in the displays on heart disease and osteoporosis, but she was fascinated by the section on the stages of childbirth.
"When I had my children, you didn't get to know those things. Mothers were pretty much knocked out," the 64-year-old mother of seven said.
The exhibit, called "The Changing Face of Women's Health," is showing through Sept. 4 at the Oregon Museum of Science and Industry before moving on to other science museums across the United States.
The exhibit describes a time when women's health meant reproductive health, when females were basically considered smaller versions of males and when health studies were often done without any women subjects.
Now issues such as breast cancer, osteoporosis and estrogen replacement are front-page news and are addressed in the exhibit.
"It's interesting they're finally starting to put all the pieces together that I've heard over time," said Pinkowski, who went to a gym for the first time this month to lift weights in order to improve her flexibility and strength.
"Most of the studies seem to have been done on men, and then they assumed they applied or didn't apply," Pinkowski said. "Women are not just smaller versions of men. There are fundamental differences."
The exhibit runs the gamut of medical subjects - childbirth, stress, cancer, heart disease, osteoporosis, eating disorders, depression - and addresses issues such as advertising and body image.
"After dinner, doing the dishes, watching TV . . . all great times to light up a Lucky," a smiling, apron-wearing homemaker says in one cigarette magazine advertisement from the 1950s as her suited husband looks on.
Some of the exhibit focuses on how to look for, prevent and treat disease and works to dispel misconceptions about what ranks as the No. 1 killer of women - not breast cancer but heart disease.
The exhibit spotlights landmark studies of women's health - and low points, such as the Physician's Health Study, which didn't include any women among its 22,000 subjects.
The exhibit doesn't shy away from debates, such as arguments for and against genetic testing for breast cancer. And random blurbs spout statistics - like the fact that Miss America contestants and playboy Playmates have become taller and thinner over the years, while the average American woman has become heavier.
Many of the features are hands-on.
One is an actual scale where museumgoers can place weights representing the pros and cons of hormone replacement therapy. Sacks simulate what a tumor feels like in a breast and computer quizzes focus on risk factors for heart disease.
But there is also a more emotional side to the exhibit - represented by televisions broadcasting women telling their stories.
Lu Damianos of Pittsburgh relates how a change in insurance and extensive traveling distracted her from getting mammograms for five years.
When she finally had one, a cancerous tumor was discovered. Almost two years ago, she had a lumpectomy and radiation.
"Fortunately after some time, breast cancer recedes a little bit in your mind so you can live a life again without thinking about it every minute," she says on the tape. "But there was quite a time when it was on my mind as I awakened every day and it was the last thing I thought about at night."
Alice Pittrell talks about the relief she felt after she passed 50 - the age at which her mother died of a heart attack. But at age 51, Pittrell suffered her first of four - prompting a triple bypass, followed by angioplasty procedures for the other attacks.
"I'm a survivor. My mother only had one. Every time I think about that, it tells me how fortunate I am to be living in this day and age," she said.
The exhibit was developed collaboratively by the nine museums that belong to the National Health Sciences Consortium, according to Nancy Stueber, president of OMSI. Part of its funding comes from the Centers for Disease Control and Prevention and the National Institutes of Health.
"I hope all women feel empowered by the exhibit and get information that will help them feel more confident about making choices or asking for information when talking to their physician," Stueber said.
After leaving Portland, the exhibit is scheduled to travel to the Exploratorium in San Francisco, the National Museum of Health & Medicine in Washington, D.C., the Franklin Institute Science Museum in Philadelphia, the Museum of Science in Boston, the Museum of Science and Industry in Chicago and the California Science Center in Los Angeles.
Soy Breast Implants Recalled (9/5/00)
| By Adam Pasick |
NEW YORK — In the search for the perfect breast implant, cross soybeans off the list. Implants filled with soya oil were pulled from the market in the United Kingdom last week, with manufacturer AEI Inc. offering to pay for some 5,000 women to have them removed.
If AEI's Trilucent implants rupture, experts say, there is a chance the oil inside could oxidize into chemicals that cause birth defects and other mutations. Women with the implants have been advised by British health officials not to breastfeed or become pregnant.
Three-quarters of the women had the implants for cosmetic reasons; the rest were part of reconstructive surgery.
Soya implants have not been approved in the United States; it is now unlikely they ever will be, barring new research that shows they are safe. Still, according to the Food and Drug Administration, approximately 200 American women received the implants as part of a clinical trial. They are being advised to see a physician.
"They're asking us to get all of our patients back in and discuss this with them," said Dr. Leroy Young of Washington University, who worked on the study. He called the decision to pull the implants "purely a precautionary measure."
At least one company offered package deals for American women to fly to London to receive the soya implants. Officials for the FDA say they have no knowledge or jurisdiction over such cases.
Another Crisis
The latest recall is only the latest in a long string of breast implant crises and controversies.
Silicone breast implant manufacturers are entangled in a decade-long legal battle with women who said their implants caused arthritis, lupus and a host of other maladies. And the Food and Drug Administration recently decided to keep saline implants on the market even though as many as 75 percent of patients experience complications.
The saline implants are the only type available, but that didn't play a role in the FDA decision, according to an FDA official who asked not to be named. Saline implants "were reviewed on their own merits," she said.
Caroline Bromm has been beset with health troubles for more than 20 years, which she blames on the silicone breast implants she received. The news that soya implants may be dangerous comes as no surprise, she says, since she has learned to distrust implants, the companies that make them and the doctors who perform the surgeries.
"The medical profession has sided with the rich companies, and turned a blind eye to the women and the illnesses they have," she wrote in an e-mail. "So we are left with no life, no health, no money and no insurance."
The Perfect Implant
With silicone implants banned by the FDA except for special cases, almost all breast implants currently performed in the U.S. are saline-based. But like every implant on the market thus far — others include polyvinyl pyrrolidone and polyethylene glycol — saline is far from perfect.
"No matter what [implant] you pick, there's some aspect of it that's less than perfect," Young said. For example, silicone implants are the most aesthetically pleasing, but if they rupture they may cause health problems. Saline is thought to be virtually harmless if absorbed by the body, but saline implants often don't "look and feel as natural," Young said.
Of particular concern is whether an implant is radiolucent, which means they won't block mammograms to detect breast cancer. Saline, thus far, is the only type of implant that qualifies.
Despite the problems that have dogged breast implant users, Young argued they were still mostly safe, and that most women report a high degree of satisfaction. Citing figures that showed the number of implants increased more than 50 percent since the early 1990s, he said, "It seems like people have decided implants are reasonably safe.
"The psychological gain people experience makes it worth it to them."
Female Obesity: Premenstrual Chocolate Cravings Yield Unsavory Results (6/27/00)
Robert Miskimon, Medical Writer
The answer may lie in the female monthly hormone cycle. Just before their menstrual period, most women crave sweet, fatty foods. And for women prone to premenstrual overeating, particularly strong cravings for chocolate are associated with greater tendencies to overeat, according to a recent study at the Pennington Biomedical Research Center of Louisiana State University, Baton Rouge.
Researchers asked 63 women to taste and rate four dishes of chocolate pudding with varied sugar and fat content. Then the subjects were given a large bowl of pasta and told to eat as much as they liked. Women who had problems with overeating liked the high- sugar/high-fat pudding more--especially during the premenstrual phase--than did women without overeating problems.
Women with less control over their eating behavior ate more chocolate pudding and more pasta during their premenstrual phase than did women with no overeating tendencies. But just after menstruation, women who ate too much preferred the low-sugar/low-fat pudding more than did women who did not tend to overeat.
"After eating a high-sugar/high-fat chocolate food in the premenstrual phase, women with overeating problems subsequently ate more than three times as much pasta for lunch than did women who do not have overeating problems," says Paula Geiselman, PhD, lead investigator of the study.
"The fact that women with overeating problems liked the high-sugar/high-fat chocolate food better in the premenstrual phase appears to be an important factor in provoking their overeating. Across all women tested, we found that how well the women liked the taste of the chocolate food was positively and significantly associated with their eating behavior."
Before menstruation, women produce increasing amounts of progesterone. Their cravings for sweet, fatty foods increase. This makes sense in terms of evolution: After ovulation, a woman's body automatically prepares for pregnancy, so a bigger appetite is the body's way of adapting to this condition, Geiselman says. These survival instincts in women who tend to overeat are easily aroused during the premenstrual cycle by certain foods--like chocolate.
"We aren't sure why, but chocolate is a much greater stimulus for women than for men," says Geiselman. "Women crave chocolate twice as much as men. It contains substances that can affect areas of the brain. Women also have been found to have a lower threshold for detecting sweet stimuli than men, which is an important factor in overeating and obesity."
Nature seems to have programmed women to crave high-sugar/high-fat foods like chocolate, but those foods may be less satisfying than other "macronutrient" combinations. For example, studies have shown that women report significantly greater hunger and eat more calories after eating high-sugar/high-fat chocolate than they do after eating a high-protein (chicken) or high-starch (pasta) food.
To help women manage cravings produced by their monthly hormone cycles, Dr. Geiselman has several suggestions:
Another element to consider where weight gain in women is concerned is smoking. "Many young women smoke to control their weight," says Geiselman. "Unfortunately, women do get weight control benefits from smoking, and one of the primary nicotine withdrawal symptoms that differs between men and women is increased appetite in women. But since 1987, lung cancer is the predominant cause of cancer death in women. And women smokers are more at risk for lung cancer than men who smoke."
She suggests that smokers use the nicotine patch in an effort to control appetite after quitting smoking.
Marital strife may hike diabetes risk
(6/27/00)By Jacqueline
Stenson
MSNBC
SAN ANTONIO, June 10 — Married people who squabble more than they smooch may be at risk for something other than divorce court. A study presented here Saturday found that those with high marital stress were twice as likely to develop diabetes as contented couples.
STUDY AUTHOR Sharon Gaskill Fowler, a public health
researcher at the University of Texas Health Science Center in San Antonio, said the new
findings are in line with recent studies in both animals and humans suggesting that stress
can raise levels of glucose, or blood sugar.
Elevated glucose levels are a hallmark of type 2 diabetes, the
form of the disease that accounts for 90 percent of the 16 million diabetes cases in the
United States and is a leading contributor to kidney failure, blindness and heart disease.
Type 2 diabetes is on the rise in America, mostly because of increasing obesity and
sedentary behavior, experts say.
Our data
suggest that it’s not enough, in the prevention and treatment of diabetes, to look
only at such factors as glucose levels and weight,” Fowler said at the annual meeting
of the American Diabetes Association. “The stress people are under may affect whether
they will go on to develop diabetes and, if they do develop it, how well they will keep it
under control.”
She noted that previous studies have found that in people who
already have diabetes, blood glucose levels can escalate during periods of stress.
Dr. Gerald Bernstein, an endocrinologist at Beth Israel Medical
Center in New York and a past president of the American Diabetes Association, said it
would be inaccurate to conclude from this study that stress directly causes diabetes.
Rather, he said, stress is one factor that may accelerate
development of the disease in high-risk individuals, such as those who are overweight or
have a family history of the disease. He said stress may spur production of adrenaline and
cortisol, hormones that can impair the action of insulin, the hormone that allows cells to
convert glucose to energy. If insulin can’t do its job, blood glucose levels rise.
STUDY DETAILS
From 1984 to 1988, Fowler and colleagues involved with the San
Antonio Heart Study examined 1,733 married, non-diabetic Mexican Americans and
non-Hispanic whites ages 25 to 64.Tests at the beginning of the study included blood
sampling for diabetes and standardized questionnaires for various types of stress,
including that of marriage. Participants were asked to think about their lives with their
marriage partners and to score how often they felt various ways, such as annoyed, tense,
bored, angry, worried, neglected, contented, relaxed and unhappy. At the follow-up period eight years later,
blood tests revealed that 18 percent of those in the group with high marital stress (15
percent of the total population) had developed type 2 diabetes, compared with 9 percent in
the low-stress group.
“There was a doubling in the incidence of diabetes among
those in the high-stress group,” Fowler said.
Overall, 11 percent of the population developed diabetes during
the study period.
Even when the researchers accounted for the effects of a family
history of diabetes, obesity, high blood pressure and other factors known to be associated
with the development of diabetes, marital stress remained an independent risk factor.
And while the study also looked
at the impact of overall daily stress and job stress, only marital stress was a predictor
of the disease. “All three types showed some increase in diabetes, but only marital
stress was clinically significant,” Fowler said.
She said other types of stress probably also contribute to
diabetes but that perhaps the questionnaires used to assess these types of stress were not
sufficient.
On the other hand, she said, marital stress may have a larger
impact because it is essentially ever-present. “When you go home, you can leave your
work stress behind,” she said. “But marital stress hits closer to the
bone.”
DOWNSIDE OF DIVORCE
Fowler stressed that divorce is not necessarily the answer to
better health.
“One of the messages we don’t want people to take
away from this study is that if they are in a high-stress marriage they should jettison
the marriage to save their blood glucose,” she said. “Our data suggest that
working to improve and heal the marriage and working to improve on other risk factors
would be a good strategy.” Fowler, who was married just six days ago, said the study findings
didn’t deter her plans to wed. In fact, she said marriage generally seems to keep
people healthy. In her study, people who became separated, divorced or widowed during the
study period were 30 percent more likely to develop diabetes than the others.
Prescription Drug Plans Discriminate Against Women (6/27/00)
| Jun 06, 2000 Knight Ridder/Tribune News Service (KRT) June 7 marks the 35th anniversary of the landmark U.S. Supreme Court decision, Griswold vs. Connecticut, that legalized the use and distribution of contraceptives. While this decision paved the way for access to contraceptives, today the denial of insurance coverage sets up a roadblock to that access. Although almost all traditional fee-for-service plans now offer general prescription drug coverage, fewer than half fully cover prescription pregnancy prevention. The leading reversible prescription methods_IUD, diaphragm, hormonal implants like Norplant or injectables such as Depo Provera_receive no coverage from such insurers, and only about a third of such plans fund oral contraceptives, according to a study by the Alan Guttmacher Institute. Even though HMOs tend to provide better contraceptive coverage, only 39 percent of such plans cover all the major reversible methods. Some policies exclude coverage even if a contraceptive is prescribed for a medical condition other than birth control. Such policies also deny coverage for the so-called morning after pill, when emergency contraception is used to prevent pregnancy up to 72 hours after unprotected sex. This failure of coverage is irrational and inconsistent. If you have high blood pressure or depression, you can seek treatment, take medication and be covered. If you are infertile, you can be prescribed multiple and expensive drugs and insurers often don't balk at reimbursing you. You can take Viagra, and chances are your plan will cover it. But if you're a woman who needs contraception, chances are you're out of luck. Why this glaring omission? At the heart of such lopsided coverage is the bottom line. While it clearly costs far more to provide pre-natal and delivery costs than the estimated annual $20 per employee to provide contraceptive coverage, there is more to the equation. What insurers know, and women have proven, is that when denied coverage, women will choose to absorb the cost of contraception themselves rather than risk an unplanned pregnancy. No wonder women's out-of-pocket costs average 68 percent more than men's and amount to $300 per year for oral contraceptives. Women are giving insurance companies a free ride. Ironically, women in poverty who rely on Medicaid have contraceptive coverage superior to many women with employer-sponsored prescription drug plans. Medicaid-eligible women receive full coverage for all five reversible contraceptive methods. In some cases, Medicaid recipients receive even further coverage for contraceptives than they do for other prescriptive drugs and devices. Twelve states currently mandate that insurance companies offer contraceptive coverage when providing prescriptive drug plans. These states have gotten it right. The time has come for the federal government to mandate that private insurers follow suit. More than two decades ago, Congress took similar steps to erode employment discrimination on the basis of pregnancy. In 1978, the Pregnancy Discrimination Act established that women could not be discriminated against on the basis of "pregnancy, childbirth or related medical conditions." Today, there is a strong argument that employers who likewise refuse to provide contraceptive coverage are illegally discriminating against women on the basis of sex and "pregnancy related" conditions. We have remained acquiescent for too long to this blatant form of discrimination by prescription. The best way to celebrate the anniversary of the legalization of contraceptives is to insist that insurance companies provide equal coverage for women. (The writer Julie F. Kay is a staff attorney with the Center for Reproductive Law and Policy (Web site: www.crlp.org), a legal advocacy organization with domestic and international programs dedicated to promoting women's reproductive rights through litigation, research, policy analysis and public education. She can be reached at pmproj@progressive.org.
|
Source: Cornell University (http://www.cornell.edu)
ITHACA, N.Y. -- As unpleasant as it is, the nausea and vomiting of "morning sickness" experienced by two-thirds of pregnant women is Mother Nature's way of protecting mothers and fetuses from food-borne illness and also shielding the fetus from chemicals that can deform fetal organs at the most critical time in development. That is the conclusion of two Cornell University evolutionary biologists who examined the outcomes of thousands of successful and unsuccessful pregnancies. In the latest issue of The Quarterly Review of Biology (Vol. 75, No. 2, pp. 113-148, June 2000), Samuel M. Flaxman and Paul W. Sherman report that NVP (for nausea and vomiting in pregnancy, as morning sickness is known in medical terms) serves a beneficial function. The finding helps explain why many pregnant women develop an aversion to meats, as well as to certain vegetables and caffeinated beverages, in early pregnancy and prefer bland-tasting foods instead.
Sherman and Flaxman believe their exhaustive analysis and synthesis of dozens of studies is the first to gather compelling evidence that morning sickness protects both the unborn and the mother-to-be.
"'Morning sickness' is a complete misnomer," says Sherman, professor of neurobiology and behavior at Cornell and co-author of the report, "Morning Sickness: A Mechanism for Protecting Mother and Embryo." "NVP doesn't occur just in the morning but at any time during the waking hours, and it's not a sickness in the pathological sense. We should change the name to wellness insurance."
Flaxman, a Cornell biology graduate student, says the analysis of hundreds of studies covering tens of thousands of pregnancies suggests that morning sickness and the aversion to potentially harmful foods is the body's way of preserving wellness of the mother at a time when her immune system is naturally suppressed (to prevent rejection of the child that is developing in her uterus) and has reduced defenses against food-borne pathogens.
By creating food aversion, NVP also protects against toxins from microorganisms and other teratogenic (fetal organ-deforming) chemicals, Sherman says. "At that same time, in the first trimester of pregnancy, the cells of the tiny embryo are differentiating and starting to form structures. Those developing structures and organ systems -- such as arms and legs, eyes and the central nervous system -- at this critical stage of a new life could be adversely affected by the teratogenic phytochemicals in some food plants," Sherman says. These chemicals are secondary compounds that plants make to defend themselves against disease and insects.
Although phytochemicals have no known nutritive function for humans, most people tolerate their presence in food. (Small amounts of these chemicals might even be beneficial because of their antioxidant properties and trace elements.) But during pregnancy, according to the Cornell biologists, women with morning sickness are shielding the developing unborn from the harsh chemicals by vomiting and by learning to avoid certain foods altogether until the fetus develops beyond the most susceptible stage.
Their other findings:
-- Among women who experience morning sickness, symptoms peak precisely when embryonic organogenesis (organ development) is most susceptible to chemical disruption -- between week 6 and week 18 of pregnancy.
-- Women who experience morning sickness are significantly less likely to miscarry than women who do not. Women who vomit are significantly less likely to miscarry than those who experience nausea alone.
-- Aversion to and avoidance of certain foods also peaks during the first trimester for many pregnant women. The most-observed aversion was to meats, fish, poultry and eggs -- the foods that were more likely to carry harmful microorganisms and parasites before the advent of modern refrigeration and food-handling processes. Strong-tasting vegetables, as well as alcoholic and caffeinated beverages, also are disliked by many women.
-- In seven traditional societies with virtually no morning sickness, animal products are not a dietary staple. Plant-based foods -- and corn, in particular -- were found to be the dietary staple in six of seven societies with little or no morning sickness. The edible parts of the corn plant, the kernels, have very low levels of phytochemicals.
The Cornell biologists acknowledge that previous researchers have proposed parts of the embryo-protection hypothesis and that alternative explanations for morning sickness have been advanced. These include hormones, mother-offspring genetic conflict, or communicating to nearby males and kin that women are pregnant (resulting in decreased sexual activity and increased help from family members). However, Sherman says, intercourse during the peak period of morning sickness, the first trimester, generally is not harmful for pregnant woman.
The genetic-conflict hypothesis predicts more morning sickness later in pregnancy (when the embryo is able to take resources), but, the biologists observe, morning sickness actually peaks early in pregnancy. Regarding the hormone hypothesis, Flaxman and Sherman say they are not disputing the role of these influential chemical signals from the mother's endocrine glands; rather, they are interested in why maternal hormones have the effect they do -- prompting nausea and food aversions -- instead of some other symptom, such as headaches.
Moreover, the Cornell biologists emphasize that their findings on the usefulness of morning sickness should not alarm women without NVP.
"Our analysis of thousands of pregnancies shows that most women in Western societies bear healthy babies whether or not they experience morning sickness," Sherman says. "The lack of NVP symptoms does not portend pregnancy failure any more than experiencing NVP guarantees that the pregnancy will have a positive outcome."
Instead, the Cornell biologists say, pregnant women and their physicians should derive a two-part message from the large-scale study of pregnancy outcomes:
-- Attempting to alleviate the symptoms of "normal" (not severe) NVP probably will not improve the outcome of a pregnancy and could have the opposite effect if treatment interferes with the expulsion or avoidance of potentially dangerous foods.
-- Encouraging women to eat foods they dislike during pregnancy will not improve the pregnancy outcome and could increase the embryo's exposure to pathogens and harmful chemicals.
"We are not suggesting that pregnant women cut meat and vegetables out of their diets. In other words, listen to your body," Sherman says.
Editor's Note: The original news release can be found at http://www.news.cornell.edu/releases/May00/morning.sickness.hrs.html
Preconception care (6/14/00)
May 31 —
By Francesca
Lyman
SPECIAL TO MSNBC
ARE GOVERNMENT public health programs
doing enough to track exposure risks and forewarn people of reproductive age? Many experts
believe much more needs to be done.
Forewarned is forearmed. But without warning, even the
smartest, hippest moms and dads can be caught by some nasty surprises.
Consider the young mother who moved out of her inner-city
apartment before her twin daughters were born to avoid exposing them to the old, hazardous
lead-paint-covered walls. She was shocked when routine tests at their 12-month checkup
revealed both infants suffered from high blood levels of lead.
“Our pediatrician was not very helpful,” recalls
Stephanie, who asked that her real name not be used. “She said, ‘Those levels
are not so high,’ and ‘Don’t worry — they’re sure to come
down.’”
LEAD LEVELS
As a mother, Stephanie’s response was just the opposite.
She immediately got herself tested, since she had done work in the past with building
renovations, and “got out the wipes and kits” to test her new apartment.
After these sources were ruled out, a call to the city water
department proved that lead pipes fed her water supply. Another call got the pipe promptly
removed.
Today, her darlings are healthy, and their lead levels
“have come down.” A home water purifier helps screen out lead and other
impurities in city water. But the experience of worrying over the source of those toxic
exposures is still painful. Stephanie wishes they’d tested her water long before they
did.
ARE GOVERNMENT public health programs doing
enough to track exposure risks and forewarn people of reproductive age? Many experts
believe much more needs to be done.
Forewarned is forearmed. But without warning, even the
smartest, hippest moms and dads can be caught by some nasty surprises.
Consider the young mother who moved out of her inner-city
apartment before her twin daughters were born to avoid exposing them to the old, hazardous
lead-paint-covered walls. She was shocked when routine tests at their 12-month checkup
revealed both infants suffered from high blood levels of lead.
“Our pediatrician was not very helpful,” recalls
Stephanie, who asked that her real name not be used. “She said, ‘Those levels
are not so high,’ and ‘Don’t worry — they’re sure to come
down.’”
LEAD LEVELS
As a mother, Stephanie’s response was just the opposite.
She immediately got herself tested, since she had done work in the past with building
renovations, and “got out the wipes and kits” to test her new apartment.
After these sources were ruled out, a call to the city water
department proved that lead pipes fed her water supply. Another call got the pipe promptly
removed.
Today, her darlings are healthy, and their lead levels
“have come down.” A home water purifier helps screen out lead and other
impurities in city water. But the experience of worrying over the source of those toxic
exposures is still painful. Stephanie wishes they’d tested her water long before they
did.
According to a Government
Accounting Office study released in May, hundreds of millions of dollars are spent each
year looking at the extent to which toxic chemicals pollute air, land and water, but the
nation’s public health researchers “have a long way to go” in assessing the
impact of these chemicals on human health. Of 1,400 chemicals potentially threatening to
human health, only 6 percent are being tracked.
OTHER ENVIRONMENTAL TOXINS
“Environmental toxins begin affecting the lives of our
children long before other health risks,” said Rep. Nancy Pelosi (D-Calif.). The
report pointed to a need for more “human exposures” data — such as blood,
hair and urine tests — and disease surveillance.
“For example, consumption of environmentally contaminated
fish by pregnant women has been directly linked to low birth weight, weak reflexes,
reduced motor function and measurable deficits in intelligence, memory and attention in
their children,” said Pelosi.
Every day, the average mom and
dad come in contact with toxins that could affect their reproductive health or their
children’s health, according to the authors of “Generations At Risk:
Reproductive Health and the Environment.”
For doctors, reproductive health and birth defects are
complicated issues, scientifically complex and emotionally charged. “Most ob/gyn
practitioners — doctors, nurses, midwives — are not comfortable practicing in
this area because they’re untrained in it,” says Dr. Don Mattison, an
obstetrician and medical director of The March of Dimes, in White Plains, N.Y. “These
are not easy questions,” he adds, “trying to trace exposures — and whether
they happened at the fetal stage, before or after.”
Preconception care is not covered
by most insurance providers,” adds Mattison, but “if it’s this important,
it should be part of any medical insurance program.”
Some pediatricians have become more informed about
environmental health because they are the ones seeing the children with birth defects and
learning disabilities thought to be environmentally related, says Lynn Goldman, a
pediatrician and professor of public health at Johns Hopkins University.
But ob/gyn professionals and family practice doctors should be
more proactive, she believes, because “prevention can be done at that point, before
mothers and fathers even become pregnant.”
If researchers could pinpoint which chemicals could affect
pregnancy it could go a long way to changing medical practices, says Mattison.
“Doctors could then institute questionnaires and screening tests for couples at
risk,” he says.
J.P.Myers of the Alton Jones Foundation suggests that new
studies “begin by establishing chemical exposures for the fetus created by a
mother’ s accumulation of contaminants prior to pregnancy.”
Could physicians do more to forewarn new mothers than they are
today, even without new research?
Allan Lieberman of the Center of Occupational and Environmental
Medicine has imported the British Foresight system because he’s so persuaded of its
potential for improving fertility and pregnancy outcomes.
“My biggest
disappointment is the lack of interest here in preconception care in the United
States,” says Lieberman, who notes that there are only two environmental-minded,
prevention-based preconception care practices like Belinda Barnes’ Foresight program
in this country.
“I tell doctors every visit that is a non-pregnancy visit
gives them a chance to do preconception care on a woman of reproductive age. This could be
the last time you address issues like environmental health and good overall health,”
says Mattison. “The next time you see her she could be pregnant.”
Francesca Lyman is an environmental and travel journalist
and editor of the American Museum of Natural History book, “Inside the Dzanga-Sangha
Rain Forest” (Workman, 1998).
Women, too, may benefit from Viagra (6/14/00)
ATLANTA (CNN) -- Viagra may not only be for men. Women who suffer from sexual dysfunction can also benefit from the anti-impotence pill, according to a preliminary study.
Joanne Dorman, who described sex as "more of a job or a task" before taking Viagra for the study, said her attitude had since changed drastically.
"It's fabulous, it's an enjoyable moment in my life," she said.
Dorman was one of 35 women with an average age of 50 in the study who had developed sexual difficulties after undergoing a hysterectomy. Those problems decreased significantly with the use of the drug, authors of the study reported Monday at the annual meeting of the American Urological Association in Atlanta.
After taking Viagra for six weeks, the women reported "increased lubrication, increased sensation, and increased ease and facility for reaching orgasm," said Laura Berman, co-director of Boston University's Women's Sexual Health Clinic.
Impact of Viagra on post-hysterectomy sexual complaints of 24 women Before drug After drug Low sensation 100% 22% Inability to reach orgasm 100% 18% Little/no sexual desire 52% 45% Little/no lubrication 67% 40% Pain or discomfort 68% 33% The study's authors think the drug works best in women whose sexual difficulties stem from physical -- not emotional -- problems. Those problems can be age-related such as menopause or post-surgical complaints after hysterectomies.
Viagra appears to work the same way in women as it does for men.
"What Viagra does is it increases the blood flow to the genital area -- and blood flow is a very important part of female sexual arousal," said Berman, who presented the paper at the conference.
Viagra, which generically goes by the name of Sildenafil, has been a highly popular with men since it came out on the market two years ago. Pfizer, the company that makes the drug, is now doing larger-scale studies on women. Independent scientists conducted this recent study.
But Dr. Ira Goldstein, a leading researcher in sexual dysfunction at Boston University, warned that the study was not scientifically controlled.
"In a European study with Viagra where a placebo was used, if you simply look at the placebo response, the responses were up to 70 percent," he told a telephone news briefing.
"It would be a mistake to conclude that Sildenafil, with this trial, is an effective agent in sexual dysfunction," he said.
Researchers like to compare any drug to a placebo, or dummy pill, to guard against this "placebo effect." It is not understood why, but people can have a physical response to the simple action of taking a pill.
The best trials give half the volunteers a dummy pill, and both the researchers and patients are "blinded," meaning they do not know, until the end of the trial, who got what.
"Before women start rushing to this agent, a truly placebo-controlled, double-blind, multi-institutional study has to be done," Goldstein said.
Some scientists are studying apomorphine, a drug used to treat male impotence and used experimentally to treat Parkinson's Disease. Others are looking at drug-herb combinations to solve problems that until recently hardly anyone even mentioned.
Researchers also suggested that women may unduly worry about sexual dysfunction. "There is a school of thought that the standards by which we measure sexuality are skewed, just as standards of beauty in the media are," Berman said.
That is why some of the researchers told of their attempts to create tools to physically measure sexual function in women. In men, sexual function is easy to measure -- an erection can clearly be seen. In women, it is more difficult to tell.
Other researcher noted that while there is still a stigma about discussing female sexual dysfunction, attitudes are beginning to change and they expect to see more and more research on drugs to treat women's sexual problems.
Medical Correspondent Elizabeth Cohen and Reuters contributed to this report.
Eating recommended foods associated with decrease in risk of mortality for women (6/14/00)
Dietary patterns including fruits, vegetables, whole grains, low-fat dairy, and lean meats are key
New data suggest that a dietary pattern characterized by consumption of foods recommended in current dietary guidelines is associated with decreased risk of mortality in women, according to an article appearing in the April 26 issue of The Journal of the American Medical Association (JAMA).
Ashima K. Kant, PhD, from Queens College of the City University of New York, Flushing, N.Y., and colleagues studied data from phase two of the Breast Cancer Detection Demonstration Project. A total of 42,254 women (mean age 61.1 years) in the study completed a food frequency questionnaire to measure overall diet quality. Answers were tabulated to create a recommended food score (RFS). The RFS was calculated by the sum of the number of foods recommended by current national dietary guidelines (fruits, vegetables, whole grains, low-fat dairy, and lean meats and poultry) that were reported on the questionnaire to be consumed at least once a week. There was a median follow-up time of 5.6 years, during which 2,065 deaths occurred.
The study shows the association between RFS and death from cancer, coronary heart disease, stroke, and all other causes combined.
"Our study suggests that women reporting dietary patterns that included fruits, vegetables, whole grains, low-fat dairy, and lean meats, as recommended by current dietary guidelines, have a lower risk of mortality," the authors write. "Women in the highest intake level of recommended foods had 30 percent lower risk of multivariate-adjusted all-cause mortality compared with those in the lowest level."
The authors write that few studies have examined global measures of diet quality as it relates to mortality and that although many studies have examined the role of single nutrients, foods, or food groups in the etiology of disease, relatively little research has addressed the health effects of dietary patterns comprising multiple interdependent dietary factors.
"Our results provide evidence in support of the prevailing food-based dietary guidelines and suggest that diets complying with current dietary recommendations are indeed associated with improved health outcome. The potential public health implications of these findings are considerable."
### To contact Ashima K. Kant, PhD, call Ron Cannava at 718-997-5590. If you would like to request a copy of the article, please call the Science News Department at 312-464-5374 or 5904. For more information, contact the AMA's Scot Roskelley at 312-464-4431, email: Scot_Roskelley@ama-assn.org.
Posted by the Center for the Advancement of Health http://www.cfah.org. For information about the Center, call Petrina Chong, pchong@cfah.org 202-387-2829.
UNIVERSITY OF PITTSBURGH RESEARCHERS DEVELOP NEW MODEL TO STUDY HIV TRANSMISSION IN WOMEN (5/9/00)
PITTSBURGH, March 28, 2000 -- A new understanding about HIV transmission in women-- information that could lead to preventative strategies for this population -- will likely come from an organ culture model recently developed by researchers at the University of Pittsburgh’s Graduate School of Public Health (GSPH). The new model, which is described in the April issue of the journal Nature Medicine, may result in breakthroughs such as barrier medications that prevent HIV from crossing through tissue linings of the female genital tract.
"The main route of HIV transmission has always been sexual, and heterosexuals are quickly becoming the largest HIV-positive population, particularly in third-world countries," said researcher Dr. Phalguni Gupta, Ph.D., professor in the department of infectious diseases and microbiology. "A model such as this is long overdue in understanding the virologic and host factors involved in HIV transmission in women."
According to Dr. Gupta, the new model will help researchers develop and test creams, suppositories or other medications to block the transmission of HIV.
Models used to date have demonstrated HIV transmission across a single layer of human cells grown specifically for that purpose. The new Pittsburgh model uses actual human tissue and thus closely mimics the stratified cell layers that are present at the sites of sexual transmission in women -- the vagina and outer portion of the cervix.
"This model provides the natural tissue architecture of the female genital tract, including epithelial cells, submucosa and immune cells, and it will allow us to effectively track transmission of HIV," said Dr. Gupta. It allows more rapid screening than did previous models, and by reducing the need for animals is more cost effective.
The new organ culture system involves placing a thumbnail-sized piece of squamous cervical tissue, with the epithelium layer on top, in the top chamber of a transwell device. HIV is added to the top of the tissue, and transmission of HIV is measured in the bottom chamber.
Scientists believe that the multilayer mucosal tissue structure of the female genital tract plays an important role in the sexual transmission of HIV. By allowing detailed study of the tissue structure, the model will enable researchers to determine which cells become infected initially, and how these cells interact with one another.
"The beauty of this model is that it allows us to test tissues from different areas of the human female genital organ to determine the role of each in transmission of HIV," said Dr. Gupta. In addition, tissue extracted at different stages of a woman’s menstrual cycle can shed light on any effects hormonal and other changes might have on transmission.
Through further modification of the model scientists will be able to examine different genetic strains of HIV, as well as the effects of other sexually transmitted diseases on HIV transmission.
Using the new model, University of Pittsburgh researchers have already seen indications that cell-free virus is transmitted through the tissue structure much more efficiently than is cell-associated HIV, in which the virus remains inside a cell. Dr. Gupta and his colleagues are continuing research to further test these findings.
According to Dr. Gupta, plans also call for using the model to test rectal tissue in an effort to determine virologic and host factors in transmission between men.
This study was supported by the National Institutes of Health. It is a collaboration between Dr. Gupta’s laboratory, including graduate student Kelly Brown Collins, and the laboratories of Daniel V. Landers, M.D., and Gregory J. Naus, M.D., of the Magee-Womens Hospital of the UPMC Health System.
For additional information about the Graduate School of Public Health at the University of Pittsburgh, access http://www.pitt.edu/~gsphhome/. For information about UPMC Health System, access http://www.upmc.edu.
Contact: Dr. Richard Gandour
gandour@vt.edu
540-231-3731
Virginia Tech(Blacksburg, Va.) -- A research team representing public and private laboratories is developing a gel that will allow women to discreetly control their fertility and reduce the risk of infection from sexually transmitted diseases. The research was presented at the 219th American Chemical Society (ACS) National Meeting March 26-30 in San Francisco.
Virginia Tech chemistry professor Richard Gandour explains that the acylcarnitium analog, which the researchers call Z-15, has demonstrated in vitro that it is an excellent spermicide and that it inhibits HIV, yeast infection, herpes, and other sexually-transmitted diseases (STDs). "This is a product with a lot of potential that we will continue to work with to improve its activity against STDs," says Gandour.
"We want to develop an all-in-one product," says Prashant Savle. As a research scientist at Virginia Tech, he synthesized a series of analogues, including Z-15, from the natural chemical, (R)-carnitine.
"Dr. Salve devised an all synthetic route and executed it quickly and brilliantly, making this effective, affordable product possible," says Gandour. As a gel, the product could be used to coat vaginal contraceptive devices, such as diaphragm, cervical cap, sponge, and condoms, "but the goal is to develop a product for topical application for use by women who are in circumstances or cultures where they can't insist upon or do not have access to other forms of birth control or prevention against STDs," says Gustavo F. Doncel, who has been in charge of the biological characterization of this promising agent. He is head of the Sperm Biology and Contraceptive Research Laboratory of the Contraceptive Research and Development (CONRAD) Program at the Eastern Virginia Medical School. The research has been sponsored by CONRAD (http://www.conrad.org). The program, under a cooperative agreement with the U.S. Agency for International Development (USAID), has as its primary objective the development of new or improved contraceptive methods that are safe, effective, acceptable, and suitable for use in the United States and developing countries.
The gel also recently passed an FDA-recommended test as virtually nonirritating -- not a surprise to the researchers since the chemical structure is a betaine surfactant, similar to that found in baby shampoo, Gandour explains.
"In addition to being effective and nonirritating, it is important that the product be easy to use and affordable," says Savle. He explains that the incidents of HIV infection are declining in the United States while they are on the rise in the third world, particularly in India and sub-Saharan Africa. "The idea is to make a product that would be cheap enough for the USAID to be able to purchase for free distribution, so that the women in those countries would have a choice."
Professor Gandour became aware of carnitine, a muscle chemical, a decade ago when he was doing research to develop medicines for non-insulin dependent diabetes. "We made this analogue and, from its chemical structure, knew it could be a spermicide," but it was expensive and tedious to prepare from the natural product, (R)-carnitine. "Dr. Savle designed and executed the brilliant synthesis from inexpensive, synthetic compounds and asked Dr. Doncel to test this compounds," says Gandour. After initial success in in-vitro studies, "it became apparent that multi-gram quantities of starting material would be required. Savle took on the challenge of making this starting material reliably to allow synthesis of a series of Z-15 analogs. He developed a procedure that allowed us to make all forms of Z-15.
"That is important, since the FDA requires that all forms of a potential therapeutic agent be tested," explains Savle (a rule passed after the 1960¹s incident relating to the use of Thalidomide that resulted in birth defects). The researchers are now working to produce Z-15 in kilogram quantities for final preclinical assessment and phase one clinical trials. A patent is pending on the product.
"Drs. Doncel and Stephen D. Bryant of Buckman Laboratory International of Memphis, Tenn., contributed substantially to the success of this research," says Gandour.
The Buckman Lab specializes in industrial microorganism control. "We don't produce human medicines or products, but we do screen many compounds," explains Bryant. "We screened compounds provided by Dr. Gandour¹s group for microbial activity, specifically against Candida (yeast infections)." The lab is also looking for industrial applications for Z-15 and the other compounds provided by the Virginia Tech researchers, he said.
Co-authors on the ACS paper are Savle, now Chiral Product Specialist at Aldrich in Milwaukee, Gandour, Doncel, and Bryant. The ACS paper (MEDI paper 127) is about multi-gram synthesis of Z-15. It was presented Sunday evening, March 26 as part of the Division of Medicinal Chemistry poster session.
Comprehensive study reveals no systemic breast implant dangers (4/25/00)
Contact: David Williamson
david_williamson@unc.edu
919-962-8596
University of North Carolina at Chapel HillCHAPEL HILL - The largest, most comprehensive study done to date of the possible link between silicone breast implants and connective tissue diseases has found no evidence that the implants impair women's health.
Reported in Thursday's issue (March 16) of the New England Journal of Medicine, the University of North Carolina at Chapel Hill research could uncover no relation between the medical devices and such illnesses as rheumatoid arthritis, lupus erythematosus, scleroderma or other systemic conditions.
"This is an issue that has caused considerable and persistent debate in medical and legal circles," said Dr. Esther C. Janowsky, adjunct assistant professor at the UNC-CH School of Public Health and lead author of the paper. "The goal of our research was to look at the question of possible harm from silicone breast implants using several different approaches while at the same time including as many studies as possible. Our conclusion is consistent with earlier work indicating no relationship."
Other authors of the New England Journal article are Drs. Lawrence L. Kupper, Alumni Distinguished professor of biostatistics, and Barbara S. Hulka, Kenan professor of epidemiology, both also in public health at UNC-CH.
Researchers performed a series of meta-analyses. Meta-analysis involves combining and analyzing information from previous studies and is particularly useful when previous studies have lacked enough subjects to produce a clear result, Janowsky said. Through various computer searches, the UNC-CH team found 757 citations in the world medical literature and reviewed all the potentially relevant work on the effects of silicone breast implants.
The team eventually included information from nine cohort studies, nine case-control studies and two cross-sectional studies that met various standards, including the presence of an internal comparison group and numbers available to create tables for the meta-analyses. Most took place in the United States but also represented investigations in Canada, Australia, the United Kingdom and northern Europe.
Women who had direct injections of any material into their breasts, including silicone, were excluded from the analysis, the physician said. The two studies that included enough information to analyze the effect of how long implants had been in place suggested that the likelihood of any illness did not increase over time. Not enough information was available to assess the effect of implants if they leaked or ruptured while inside women's breasts.
Intensive publicity about suggested adverse health effects of breast implants is likely to have made women with implants more aware of their symptoms and to have resulted in over-reporting of disease among such women as compared with others without implants, the authors wrote.
"On the basis of our meta-analyses, there was no evidence of an association between breast implants in general, or silicone-gel-filled breast implants specifically, and any of the individual connective-tissue diseases, all definite connective tissue diseases combined, or other autoimmune or rheumatic conditions," they said.
"From a public health perspective, breast implants appear to have a minimal effect on the number of women in whom connective tissue diseases develop, and the elimination of implants would not be likely to reduce the incidence of connective tissue diseases," they concluded.
The Administrative Office of the U.S. Courts supported the UNC-CH study, which originally was part of a report by a National Science Panel appointed by Judge Sam C. Pointer Jr. for the federal judiciary. Hulka was a member of the panel. Pointer's goal was to hear from scientists responsible only to the courts and not from paid experts representing either side in suits for damages allegedly caused by silicone implants.
Pain drug reveals what most already know - men's and women's brains are simply different (4/17/00)
Contact: Jennifer O'Brien
jobrien@pubaff.ucsf.edu
415-476-2557
University of California, San FranciscoResearchers led by UCSF scientists are reporting that an experimental pain drug known as a kappa-opioid brings pain relief to female rats but not males, a finding that adds weight to a recent UCSF clinical finding, and highlights, they say, the need to evaluate drugs by gender.
Traditionally, kappa-opioids have been dismissed as ineffective analgesics in humans, though the drugs have shown mixed results in animal studies, depending on how they have been administered.
The finding, published in the March issue of Pain, may help to resolve the controversy about the drug's effectiveness, the researchers say, and underscores a weakness in traditional drug screening: Until the early 1990s, most drugs, including kappa-opioids, were primarily evaluated in men.
"The problem of gender differences, particularly in response to opioid drugs, is extremely important and widely under-appreciated," says the senior author of the study, Howard Fields, MD, PhD, a leading expert on the brain mechanisms of pain and a pain-treatment specialist. Fields is UCSF professor of neurology, a member of the Keck Center for Integrative Neuroscience and director of the UCSF Wheeler Center for the Neurobiology of Addiction.
"There may be classes of drugs that are particularly effective in women that don't have the side effects of currently available potent drugs," says Fields. "Kappas are an example, but it may be true for a lot of drugs and we just don't know it because we haven't looked. Drug companies might be throwing away a perfectly good drug because it doesn't work in males."
The specific finding is important because morphine, a class of opioid and the painkiller most often used for severe pain, has limitations - over time, people can develop tolerance to the drug and/or become dependent on it. As a result, researchers are intent on identifying an alternative class of opioids that lack the drug's limitations.
"A lot of people don't want to go on morphine because it is addictive," says Fields. "What if kappa agonists were non-addicting in females but were potent analgesics?"
The idea that males and females respond differently to opioids is not new, but until recently the difference was believed to be limited to potency, with clinical studies showing that women require less morphine for post-operative pain than men.
Fields' finding -- that specific brain regions in male and female rats have opposite reactions to kappa-opioids - suggests that the difference may be more fundamental, supporting clinical studies at UCSF that indicate kappa-opioids are more effective in women for clinically significant pain.
The original clinical study, led by UCSF professor Jon Levine, MD, PhD, showed that, in women, a drug made up of a diluted concentration of kappa-opioid had no effect, while a drug made up of a higher dose of the drug combination had a strong and lasting analgesic effect. In contrast, in men, the low dose actually increased pain; as the dose was increased, the heightened pain disappeared and a weak, short-lived analgesic effect set in.
The clinical finding was serendipitous. "The drug had been known for more than two decades and had simply been considered a bad analgesic," says Levine.
The discovery, he says, demonstrates a clear biological difference in the way women and men respond to kappa-opioids.
"If it weren't for the people data, I'd say, `who knows, a rat's a rat and our finding may have nothing to do with people,'" says Fields, "but taken together the findings have importance."
Fields' study pushes the investigation into the region of the brain where opioids bring about their analgesic effect, and puts researchers on track for determining the targets or mechanisms accounting for the contrasting responses.
The study also confirms the role of kappa-opioid in the contrasting analgesic responses. While Levine's team was restricted to using clinically available drugs that could have other effects, the Fields lab was able to use a drug that acted only at the kappa-opioid receptor.
The Fields investigators focused their study on a neural circuit in the brain that extends from a collection of pain-sensing neurons known as the ventrolateral periaqueductal gray (v1PAG) downward to another set, known as the rostral ventromedial medulla (RVM), and finally to a set in the spinal cord. This so-called "descending pathway" is the principal circuit through which opioids relieve pain in the body.
The nerve cells within the PAG and RVM structures are made up of pain-sensing cells that either transmit signals of pain or actively shut off pain. These so-called "on" and "off" cells, discovered by Fields, have opioid receptors on them. Opioids bring about pain relief by latching on to these receptors and setting into play a series of descending signals that first shut off, or inhibit, neurons that make pain worse and then, further down the circuit, exciting cells that shut off pain messages.
Morphine is one of a dozen drugs that target the so-called mu opioid receptor in the descending pathway. The kappa drug used in the study is one of several forms of kappa known to work at the kappa-opioid receptor. A major goal of current research efforts is to identify subtypes of opioid receptors that could provide targets for drugs that act like morphine without its side effects. The immediate goal of the current study was to tease out the impact that kappa-opioids have on the descending pathway of opioid pain relief.
Three years ago, the Fields team showed that treating the vlPAG neurons of male rats with a mu opioid brought about pain relief, but that subsequently adding kappa-opioid into the RVM markedly decreased the mu opioid's analgesic effect.
In the current study, the team observed the opposite response. Treating the vlPAG neurons of female rats with a mu opioid brought on the expected pain relief, but subsequently adding kappa-opioid into the RVM increased the mu opioid's analgesic effect.
"In males, kappa-opioid is somehow inhibiting the actions of mu opioid," says Fields.
One possible explanation, says Fields, is that the kappa receptors are acting on opposite types of neurons in males and females. In males, kappas may be inhibiting the so-called "off" nerve cells in the RVM that normally tell the spinal cord to shut off pain signals. In females, kappa-opioids actually excite the off neurons, which would relieve pain.
In their study, the researchers also discovered that female rats received significantly more pain relief when mu opioid was injected into the vlPAG than male rats, a fact that was not attributable to body weight or diffusion of the drug in the body.
This finding suggests, says Fields, that mu receptors in females also respond differently to mu opioids than they do in males. The ultimate explanation for the sexual dimorphism with respect to the mu and kappa-opioid receptors may prove to be hormonal, says Fields.
But regardless of the explanation, he says, "People need to understand that male and female brains are different, period. And this fact has to be taken into consideration when thinking about drug treatments, particularly drugs that act on the central nervous system."
The other co-authors of the Fields study were Sheralee A. Tershner PhD, formerly a post-doctoral fellow in the Fields lab and currently of the Department of Psychology, Western New England College, and Jennifer Mitchell, PhD, formerly a graduate student in the Fields lab.
The study was funded by the National Institute on Drug Abuse.
###
Notes:
Opioids, which include morphine and heroin, originally derived from the juice of the opium poppy plant, and have been used for thousands of years to lessen pain and produce euphoria. They mimic naturally occurring forms of opioids -- the neurotransmitters known as endorphins and enkephalins - which act in the body in response to signals of pain, latching on to receptors on sensory nerve cells that normally receive and transmit pain signals.
Many people develop tolerance to morphine, but at very different rates, some over weeks, some over months.
Cholesterol Drug Plus Hormones Effective in Women
(4/17/00)LOS ANGELES —
Older women may be better off combining cholesterol-lowering drugs with hormone replacement therapy than taking cholesterol drugs alone, researchers said Monday."Cardiovascular disease is the leading cause of death in women," said Dr. Michael Davidson, the study's lead investigator. He added that the combination of therapies is a promising way to significantly lower cholesterol levels, reducing women's risk of developing cardiovascular disease and having a heart attack or a stroke.
The trial at the Chicago Center for Clinical Research compared the separate and combined effects of Prempro, a hormone replacement therapy marketed by American Home Products Corp., and Zocor, a cholesterol-lowering drug made by Merck & Co., in 139 post-menopausal women with high cholesterol.
Specifically, researchers investigated which therapy lowered the women's levels of LDL, the so-called bad cholesterol, to the target set by the National Heart, Lung and Blood Institute's National Cholesterol Education Program.
The results showed that hormone replacement therapy and Zocor taken together produced more favorable changes in cholesterol profiles than either therapy alone, according to the research presented at the American College of Cardiology's annual conference in Anaheim, Calif..
After six weeks of treatment, 79 percent of women on combined therapy achieved the goal, compared with 59 percent of those on the cholesterol drug alone and 32 percent on hormone replacement therapy alone.
Percentage declines in LDL were 37 percent for women on combined therapy compared with 29 percent and 17 percent, respectively, for women who received Zocor alone or hormone replacement therapy alone.
The study also measured changes in total cholesterol and HDL, or "good" cholesterol. Both therapies alone and in combination improved HDL levels by 4-13 percent, and reduced total cholesterol levels by 9-24 percent, the researchers said.
Elevated LDL levels are four times higher among women 55-64 years of age compared to women aged 35-44.
Davidson suggested that women with elevated cholesterol levels should talk with their doctors about the therapy that is best for them.
Estrogen fails to prevent heart disease, study says Copyright © 2000 Nando Media
Copyright © 2000 Associated Press
American College of Cardiology siteBy DANIEL Q. HANEY
ANAHEIM, Calif. (March 13, 2000 3:27 p.m. EST http://www.nandotimes.com) - Challenging a 20-year-old medical doctrine, a study found no evidence that estrogen supplements protect older women from heart disease.
The findings are likely to confuse doctors and patients alike about the already complicated decision of whether to take estrogen for many years after menopause. Estrogen has both benefits and risks, including an increased chance of breast cancer.
The latest research, released Monday, is the second major study to question the doctrine that hormone replacement is a powerful way to ward off heart disease, the leading killer of older women.
That belief has been a centerpiece of women's health care since the 1980s and has helped make the estrogen pill Premarin the most widely prescribed medicine in the United States.
Many doctors think estrogen helps the heart largely because it seems to improve cholesterol levels after women go through menopause. The pills lower total cholesterol and "bad" cholesterol, while raising "good" cholesterol. Doctors assume these changes translate into less heart disease, even though no experiments definitively prove this.
The first to put the idea to the test was the landmark Heart and Estrogen-progestin Replacement Study - HERS - finished two years ago. Its conclusion shocked doctors: Four years of treatment with combination estrogen and progestin pills failed to lower the risk of new heart attacks in women who already had heart disease.
While some physicians immediately stopped putting their elderly heart patients on long-term hormone replacement, many others have simply refused to believe the results.
The latest report backs up HERS' disturbing conclusion. It studied post-menopausal women with heart disease to see if hormone replacement slows the buildup of fatty deposits in their heart arteries, the major underlying cause of heart attacks. It, too, found no benefit from hormones.
"These results are indeed somewhat surprising in view of the large body of evidence indicating that estrogen does have a favorable effect on cholesterol and heart disease," said the study's director, David Herrington of Wake Forest University Baptist Medical Center in Winston-Salem, N.C.
"We can't say for certain there is no benefit, but we can rule out a large effect," he said. Herrington presented the results in Anaheim at the annual scientific meeting of the American College of Cardiology.
The results are unlikely to settle the question.
Sidney Smith of the University of North Carolina, a spokesman for the American Heart Association, noted that neither HERS nor the latest study shows whether hormone replacement helps if begun early in menopause or before women develop heart disease.
The answer to those questions should come from the federally sponsored Women's Health Initiative, which is examining the effects of hormone replacement on more than 27,000 women ages 50 to 79. The first results are expected in about five years.
Weighing the risks and benefits of estrogen is already complex. Many women use it for a few years to relieve hot flashes and other ill effects of menopause. Others stay on the hormone for many years to improve cholesterol levels and to prevent brittle bones and vaginal changes, even though the treatment can also increase the risk of breast cancer.
Now doctors are clearly confused and divided over what to expect from estrogen on the heart. However, many agree that even if the hormone proves to be good, its benefit is unlikely to be as large as that of statin drugs, which clearly lower cholesterol and save lives.
In Herrington's study, sponsored by the National Institutes of Health, 309 older women with heart disease were randomly assigned to Premarin, the estrogen-progestin combination Prempro or dummy pills. After four years, doctors measured their heart arteries and found no difference in the progression of their disease.
Marion Limacher of the University of Florida said until recently, she routinely recommended estrogen supplements for older women with heart disease. Now she takes them off hormone replacement, largely as a result of HERS.
Nevertheless, she said, "some doctors discount HERS as flawed or not to be believed."
However, Michael H. Davidson of the Chicago Center for Clinical Research said estrogen may still turn out to be good for many women's hearts. He presented evidence that estrogen plus a statin lower cholesterol more than does a statin alone.
"We have several years to go before we know which women will benefit from hormone replacement therapy and which ones should avoid it," Davidson said.
Lack of physical fitness causes higher sports injury rates among women (3/21/00)
A new study may help explain why women are more prone to sports injuries than men, as previous research has suggested. Lack of physical fitness, rather than gender differences, may be the cause, according to a study of Army trainees.
"These results suggest that gender per se is not as good an indicator of injury risk as overall physical fitness, and therefore the excess risk women experience may be reduced through modified training programs," said lead author Nicole S. Bell, ScD, MPH, of Social Sectors Development Strategies, Inc., and Boston University School of Public Health, in Boston, MA.
Bell and colleagues followed a group of 861 male and female Army trainees over the course of their eight-week basic combat training course. Muscle endurance and aerobic fitness were measured at the start and end of the course by an Army physical fitness test involving push-ups, sit-ups, stretching, and one- or two-mile runs.
Women experienced approximately twice as many injuries as men, overall. Also, their risk for more serious injuries (that led to at least one day of lost duty) was almost 2.5 times greater than the risk for male trainees, the researchers found.
Considered alone, these results suggest that female gender is linked with higher injury risk. However, when the researchers took into account the fitness levels of the female trainees -- who were less physically fit than the male trainees as measured by the Army fitness test -- they reached another conclusion. "Much of the gender-injury relationship appears to be explained by physical fitness, in particular aerobic fitness, as opposed to gender per se," said Bell.
The slowest runners, whether male or female, experienced more sports injuries than the fastest runners, the researchers found. Both males and females with the fastest run times had the lowest injury risks. "Women and men at same levels of fitness can be expected to have similar injury risks when performing similar activities," said Bell.
The researchers also found that the female trainees improved their levels of fitness faster -- approximately twice as fast -- as the male trainees, during the eight-week training period. This finding is consistent with previous research indicating that those who start training at lower initial fitness levels experience greater fitness improvements relative to those who are relatively fit when they begin training.
Women's sit-up scores improved by 98 percent, versus a 44 percent improvement for men; push-up scores improved by 156 percent compared to 54 percent for men; and aerobic fitness improved by 23 percent compared to 16 percent for men, the researchers found. The study results appear in the April 2000 issue of the American Journal of Preventive Medicine.
"These results suggest that women and men initiating a vigorous physical training or exercise program, who exhibit low levels of physical fitness, are more likely to be injured by training activities, but will also improve their level of fitness more rapidly than their more fit peers," said Bell.
Women can substantially improve their fitness levels with training, according to Bell. "In the early phase of training it may be wise to assign trainees to fitness-appropriate levels of training and progress slowly to more advanced training as their fitness improves," she suggested.
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The American Journal of Preventive Medicine, sponsored by the Association of Teachers of Preventive Medicine and the American College of Preventive Medicine, is published eight times a year by Elsevier Science. The Journal is a forum for the communication of information, knowledge, and wisdom in prevention science, education, practice, and policy. For more information about the journal, contact the editorial office at (619) 594-7344.
Posted by the Center for the Advancement of Health http://www.cfah.org. For information about the Center, call Petrina Chong, pchong@cfah.org (202) 387-2829.
February 8, 2000
Scientists Do the Math to Fight Breast Cancer
By DENISE GRADY: New York Times
For women who are facing difficult decisions because they carry a gene that heightens their risk of breast cancer, doctors have developed a bracingly rational, cut-to-the chase method of helping them weigh the pros and cons of various strategies for reducing risk.
The new method, based on statistics and mathematical modeling, looks at different options for cancer prevention and gives approximate answers to one crucial question: how much time will each option add to a woman's life?
The technique, described last week in The Journal of the American Medical Association, was devised specifically for women who have already had breast cancer and have been found to carry mutations in the genes BRCA1 or BRCA2, which play a role in 5 percent to 10 percent of the 180,000 cases of breast cancer a year in the United States. The mutations predispose women to both breast and ovarian cancer, and a woman with a mutation who has already had cancer in one breast also has a higher than average risk of developing cancer in the other breast.
The degree of risk varies, but for a young woman with breast cancer and one of the mutations, the generally accepted lifetime risk of a second breast cancer can run as high as 65 percent, and the risk of ovarian cancer can be more than 40 percent. By contrast, young women with breast cancer but no BRCA mutation have a 10 percent lifetime risk of cancer in the second breast, and only a 2 percent risk of ovarian cancer.
"These are difficult issues to discuss," said Dr. Deborah Schrag, first author of the journal article and an oncologist in the department of epidemiology and statistics at Memorial Sloan-Kettering Cancer Center in New York. "No one wants to tell someone who's been hit over the head with one cancer diagnosis, 'Oh, gee, you have to worry about a second cancer.' You don't want to scare them. On the other hand, you don't necessarily do people a favor if you don't give them the information they need to take charge of their health."
Part of the difficulty is that the options for women with BRCA mutations are not appealing. Some women choose to watch and wait, scheduling frequent examinations and mammograms to be ever on the lookout for tumors. But that approach cannot prevent breast cancer; the best it can do is catch the disease early.
Women who want a more active approach can consider removing the healthy breast, removing the ovaries or taking a five-year course of the estrogen-blocking drug tamoxifen, which has been proved to reduce the rate of breast cancer in high-risk women. Or, they can combine two or even all three of those strategies.
Feelings about the options vary widely. Women who have had children may be glad to get rid of their ovaries, unlike those still hoping for families. Many women consider mastectomy too drastic. Some are wary of medication. Others find watching and waiting too nerve-wracking.
Regardless of their emotional responses, Dr. Schrag said, women want facts.
"People come in and say, 'I know it's about my personal preferences, but how do I think about just the objective component of this?' " Dr. Schrag said.
She and her colleagues developed a computer model that included data from published studies: probabilities of cancer in the second breast, of ovarian cancer, or of dying from those cancers or from the original breast cancer. The model also included estimates of the reduction in cancer incidence and death rates from removing the breasts or ovaries, or taking tamoxifen, as well as the risks from taking those measures.
From that information, the model estimated how much a woman could expect to gain in life expectancy from the various options. According to the model, those with the lowest risk, logically, gain the least because they live the longest on their own.
On average, for a 30-year-old woman with a BRCA mutation and an early-stage breast cancer, tamoxifen would add 0.4 to 1.3 years, ovary removal 0.2 to 1.8 years and removal of the healthy breast 0.6 to 2.1 years. Having both operations would add 0.8 to 4.2 years, and combining both operations with tamoxifen would add 0.8 to 4.4 years.
Part of the reason for the wide range of the estimates is that different mutations confer different degrees of risk, and so do early stage cancers, depending on the type of tumor and on how many lymph nodes the cancer has invaded. Generally, women with early cancers and the highest-risk mutations stand to gain the most from preventive strategies.
But doctors cannot always tell how dangerous a particular mutation is. The clearest evidence is from families in which one mutation is linked to many cancer cases, but not every patient has enough relatives for doctors to make that assessment.
"None of these estimates can say what will happen to any one woman," Dr. Schrag said. "They're probabilities. My goal is that they should be used as a catalyst for discussion of this difficult issue."
Not every patient finds probabilities useful, she acknowledged. "For some, it's gobbledygook," she said. "But others feel they gain a sense of control by knowing every number and estimate."
Dr. Schrag emphasized that the figures are averages, and that the gains for an individual woman could be far greater or smaller. "Let's consider a hypothetical woman," she said, suggesting a woman of 40 with BRCA1 or BRCA2, who has her ovaries removed. "It's possible she was going to get bad ovarian cancer at 43 and succumb at 45." But, because she had her ovaries removed, she never got the ovarian cancer and lived to be 75.
Therefore her gain in life expectancy could be 35 years. Her sister has the same procedure, but even though she had the mutation, she was never going to get ovarian cancer. She gets zero additional life expectancy."
In the long run, she said, many women choose to watch and wait, take tamoxifen or have their ovaries removed.
Dr. Lynn Hartmann, an oncologist at the Mayo Clinic in Rochester, Minn., who has studied cancer prevention in high risk women, said Dr. Schrag's model had some great strengths, but also serious limitations.
"What I like is that this broadens our approach," Dr. Hartmann said. "When a young woman comes in with breast cancer, sometimes our focus is on that breast, and we forget what else she is at risk for. This incorporates several competing risks that a woman is facing."
But the limitation, Dr. Hartmann said, is that the model is hypothetical, based on assumptions, some of which she questioned.
As an example, she cited one assumption: that with watching and waiting, 80 percent of breast cancers would be caught before they spread to the lymph nodes, when the odds of cure are high.
"We have no evidence that our surveillance strategies are that good in a young, high-risk population," Dr. Hartmann said. If in real life the cancers are detected at a later stage, they have a greater chance of being fatal, which means that a woman would be more likely than the model predicts to benefit from taking preventive measures.
Dr. Robert A. Smith, director of cancer screening for the American Cancer Society, called the model "a snapshot of a work in progress," and said that knowledge in the field was growing so rapidly that the estimates would be updated frequently.
But he said the model would be useful to doctors who were trying to counsel patients. "Any time we're looking at alternatives," he said, "we often said, 'on the one hand, on the other hand,' and women are left to try to reconcile competing alternatives. This gives people an opportunity to quantify recommendations they might otherwise make on the basis of a clinical hunch."
Federal Research In Arkansas Finds Soy Can Prevent Breast Cancer. WASHINGTON, /PRNewswire via COMTEX/ -- New research in Arkansas funded by the U.S. Department of Agriculture has found that soy protein can help prevent breast cancer, with a 20 to 25 percent rate of success. Agriculture Secretary Dan Glickman hailed the research, conducted by scientists at the Arkansas Childrens Nutrition Center in Little Rock, using rats in a laboratory setting.
"This is significant new research," Glickman said. "These findings underscore the importance of research as the critical link between nutrition and health."
Results of the Arkansas study were published this month in the journal Cancer, Epidemiology, Biomarkers and Prevention, the official publication of the American Association for Cancer Research.
Researchers found that both soy protein and whey protein help protect against breast cancer. In laboratory studies, Thomas M. Badger, director of the Arkansas Childrens Nutrition Center, said soy protein prevented approximately 25 percent of breast cancer that had been chemically induced in the test rats.
Glickman said the research may "help protect women and children from developing breast cancer." Badger noted that more than 180,000 new breast cancer cases are diagnosed each year in women living in the United States.
"Our results indicate that diets rich in soy reduce the incidence of chemically-induced mammary tumors by approximately 20 percent," the six-person research team headed by Badger reported in the cancer journal.
SOURCE Foods for the Future (C) 2000 PR Newswire.
From Birth Control to Hormone Replacement:
New 'pill' promises fewer side effects
By Marian Jones, Fox News
NEW YORK —
Femhrt comes in a round, dial-shaped package and it looks like a birth control pill. But it doesn't prevent pregnancy: It's a new hormone replacement therapy for menopausal women. Femhrt is manufactured by Parke-Davis, the manufacturer of the birth control pill Estrastep. It contains smaller doses of the same synthetic female hormones, ethinyl estradiol and norethindrone acetate, that have been used in birth control pills for several decades.Femhrt "basically increases the options for women," said Dr. Wulf Utian, chairman of the Department of Reproductive Biology at Case Western Reserve University School of Medicine.
"Thirty years of clinical experience and research has taught me that no two women are the same — their needs, tolerance and reaction to products differs. So the more options we have, the better it is for women," said Utian, who serves as executive director of the North American Menopause Society.
"Femhrt has unique properties," said Dr. Alan Altman, an assistant clinical professor of obstetrics, gynecology and reproductive biology at Harvard Medical School who has conducted experimental trials of Femhrt.
It leads to less uterine bleeding than other similar medications, Altman said, and "it also tends to increase bone density above and beyond what estrogen alone would do. It may be the only progestagen that does this."
Hormone replacement therapy (HRT) typically includes a substance similar to the female hormone estrogen, often with the addition of the hormone progesterone. It has been shown to prevent the brittle-bone disease osteoporosis, and relieve symptoms of menopause such as hot flashes and night sweats. It also may protect against heart disease and Alzheimer's disease when taken over the long term, although studies in these areas are inconclusive.
For years, menopausal women were given estrogen alone, but this treatment increased the risk of endometrial (uterus) cancer in women who had not had hysterectomies and still had their uterus. Progesterone, the hormone that causes uterine bleeding and protects the uterus from disease, was added in order to help protect the uterus from this risk.
However, several recent studies, including one published this week in the Journal of the American Medical Association, link the combined estrogen-progesterone therapy to an increased risk of breast cancer, raising further questions about HRT.
Femhrt is one of three hormone replacement therapy products that provide a steady combination of estrogen and progesterone-like hormones. The other "continuous combined" HRT medications include a product called Prempro (with a variant called Premphase where the progesterone component is phased in and out), and a skin patch called the Combipatch. Other hormone replacement therapies offer only estrogen (ERT), or include separate medications for estrogen and progesterone.
A Better Period Profile?
A significant potential advantage this product presents is that women may be more willing to take it over the long term, say doctors.
Progesterone-like substances, which are typically added 12 to 14 days per month, often cause the body to mimic the normal menstrual cycle. But this can lead to a problematic side effect: menstrual-like bleeding.
"One of the rewards for menopause is not to menstruate," said Utian. "If you tell an older women that there's a great medicine, but it will bring back her period, she looks at you and says 'you're crazy'."
Femhrt appears less likely to have this unpleasant side effect than other combined estrogen-progestigen therapies, say doctors.
"At three months of use, only 30 percent of women on Prempro were without bleeding, whereas at three months of use Femhrt jumps to 70 percent or higher," said Altman.
"This is very, very important because most of the benefits [of HRT] necessitate staying on [it] for at least 7 to 10 years," and the major annoyance that causes women to stop HRT or to choose not to go on it at all is bleeding," Altman said.
Other doctors say that Femhrt is comparable to Prempro, which includes Premarin, an estrogen derived from the urine of pregnant mares, and the synthetic progesterone-like substance medroxyprogesterone acetate. Clinical use in the general population will determine which product works for which women.
"Both [products] have been tested to receive hot flashes, and to protect against calcium loss from bones," said Dr. James Liu, a professor of obstetrics and gynecology and a director of reproductive endocrinology at the University of Cincinnati. "Both are designed to reduce uterine bleeding."
Breast Cancer Risk Elevated?
The concern raised recently about combined therapy and breast cancer is a serious one, doctors agree.
Women with a previous history of breast cancer should probably avoid forms of combined HRT, Altman said.
But this form of combined therapy may not have any effect on women who do not already have breast cancer, Liu said. "The current thinking is that [HRT's] effect is related to stimulation of very small cancer cells already present in the breast tissue, that it doesn't induce a change from a normal breast cell to a cancerous breast cell."
Marketing Advantages
One much-touted advantage of this new product is that the hormones in it have been safety tested and used over a number of decades, in much higher doses.
But even women who have been unable to handle the side effects of birth control pills during their reproductive years could benefit from Femhrt, Altman asserts. "The level of hormones in the birth control pill is five to eight times higher than in Femhrt."
The similarity to birth control pills may in fact increase compliance, Liu believes. "Baby Boomer women who have been taking birth control pills in the past will find [the product] familiar," he said. "It's in the same packaging, it has the same hormones, but the doses are lowered."
Study Backs Hormone Link to Cancer for Women
By DENISE GRADY New York Times A study of 46,355 women has confirmed earlier findings that long-term use of hormone replacement after menopause can increase the risk of breast cancer.
Researchers said the new study, done at the National Cancer Institute, provided relevant information but still did not resolve the dilemma faced by millions of women who are trying to weigh the pros and cons of hormone replacement. Breast cancer is just one of a panoply of serious conditions affected by the hormones.
"There are always issues of competing risks," said Dr. Larry Norton, head of the division of solid tumor oncology at Memorial Sloan Kettering Cancer Center, who was not involved in the study. "Every individual has to balance benefit and risk. Individualizing care is the key."
Hormone replacement eases menopausal symptoms like hot flashes, insomnia and vaginal dryness. It is known to prevent osteoporosis, a serious weakening of the bones, and it is thought to protect women against cardiovascular disease. Preliminary studies suggest that it may also help prevent Alzheimer's disease, colon cancer and macular degeneration, a leading cause of blindness.
The drawbacks of the treatment include an increased risk of breast cancer and of blood clots, which can be life threatening.
Women with a strong family history of breast cancer should not use hormone replacement, Dr. Norton said. Those with a low risk of breast cancer and a high risk of fractures from osteoporosis would clearly benefit from the hormones, he said. But the decision is rarely so clear cut.
Most women taking hormone replacement take two hormones: estrogen and progestin. The estrogen replaces what the body lacks because the ovaries shut down at menopause and provides the treatment's benefits. But given alone, estrogen also increases the risk of uterine cancer. Progestin counters that risk, which is why the hormones are given in combination. The only women advised to take estrogen alone are those who have had hysterectomies and therefore do not have to worry about uterine cancer.
Earlier studies had found a small increased risk of breast cancer among women taking estrogen and progestin, but the risk was attributed largely to the estrogen. The new study suggests that some of the risk is due to the progestin.
The study included postmenopausal women from 29 breast cancer screening centers who took hormone replacement treatment for some period from 1980 to 1995. The researchers relied on the women's own reports from memory of what hormones they had taken.
The researchers, led by Dr. Catherine Schairer, an epidemiologist at the National Cancer Institute, found that women who took the hormone combination for five years had a 40 percent increase in the risk of breast cancer, compared with those who did not take the treatment. Women who took estrogen alone had a 20 percent increase. The risk increased with the duration of treatment but existed only for women who were current users of the hormones or who had taken them in the past four years. The study provided no information about death rates among the women.
The risks applied only to women of normal weight and not those who were overweight. The researchers were not sure why.
Dr. Schairer said one way to illustrate the increased risk was to consider a group of 100,000 normal-weight women, ages 60 to 64, none of whom take hormone replacement. During a five-year period, 350 cases of breast cancer would be expected. But if all the women took combined hormone replacement for five years, about 560 cases would be expected.
The idea that hormone treatment could bring on breast cancer within just a few years would seem to contradict the widely held idea that cancer takes a long time to develop. But Dr. Schairer said hormones might stimulate the growth of minuscule tumors that already existed but were too small to detect.
"Fear of breast cancer should not deter women from using these hormones for the short term, two or three years, to alleviate menopause symptoms," Dr. Schairer said. "But I think longer term use raises more concerns about breast cancer risk. We still don't have a lot of data about the long term of the estrogen-progestin regimen."
Other scientists said more research was needed and that it would be premature to allow this study to change the advice already given to women considering hormone replacement.
Dr. Michelle Warren, a professor of medicine and obstetrics and gynecology at Columbia University, and medical director of the Center for Menopause, Hormonal Disorders, and Women's Health, said, "It's good to have a balance and tell all the facts, but this overemphasis on breast cancer and its relation to hormones is scaring a lot of women from a very beneficial treatment."
Author: "Beata C. Lewis"
FOR WOMEN (and concerned men) I have to share some things with you that I have learned
in my job. In my job, I review criminal and psychiatric files of imprisoned sex
offenders who are approaching their release date. I decide if they are likely to
re-offend based on certain criteria and then civilly commit them to a sex offender
treatment facility if I decide that they are at significant risk to re-offend. I have read
hundreds and hundreds of files, and have taken note of some of the mistakes women make.
Let me preface this by saying that a woman is NEVER EVER EVER at fault for being raped or
attacked, but there are definitely ways to reduce your risk of being a victim.
Here are the most common mistakes women make that could result in them getting
kidnapped, attacked, and/or raped:
1. Getting into the attacker's car when he pulls a gun and orders you to get into his
vehicle.
Most attackers don't want to shoot you ... they want you to get into the car so that they
can drive you to a deserted place and torture you. Don't comply. Run screaming. It is MUCH
more likely than not that he will just move on to an easier target.
2. Pulling over when a man drives alongside of you pointing at your car pretending
something is wrong.
If this happens, drive to the nearest well-lit and populated gas station and look the car
over yourself (or ask an attendant). Never pull over. Believe it or not, many women
have fallen for this for fear of their car spontaneously exploding in the middle of the
road. Not likely.
3. Not locking your doors while driving.
I have read several cases where the attacker simply walks up to a woman's car while she's
at a traffic light and jumps in with his gun or knife drawn.
4. Opening your front door when you have not positively identified who is there.
If you don't have a peep hole, get one. I've seen countless cases where the attacker gains
access to its victims simply by knocking on their door. Don't let an attacker get into
your home. He then has a private, relatively soundproof place to attack you.
5. Not being alert in parking lots.
If you go to the grocery store at night, don't be shy about asking for an escort to your
car. Too many women are abducted from parking lots or even raped in the parking lot. Look
in your back seat before entering your car. Cars provide endless hiding places for
attackers, both inside them and in between them. Be aware of your surroundings by looking
to the left and right and behind you with your head up all the time. You may appear
paranoid and look funnyto others, but an attacker will think twice about approaching
someone who appears so aware of what's going on.
6. Trusting a clean cut, honest looking stranger.
I see mug shots of every sex offender in the state of Florida. They do not look like
monsters. They often look like they could be your friendly grocer, bank teller, waiter,
neighbor, clergy, doctor, etc. They are every age between 15 and 90, and probably beyond.
Only a small minority actually looks scary. I just read a case yesterday of a man with
onlyone leg who beat up his victim with his crutch before he raped her. Who would have
ever thought that a one-legged man could be a rapist?
7. Trusting people to be alone with your children.
This is a difficult one, because child molesters end up being the LAST person the parents
would believe is the molester. Most of the child molesting cases I see involve the
stepfather, the uncle, the sister's boyfriend, the mother's boyfriend, the
grandfather, the baby-sitter, the neighbor, the family friend, the youth camp director,
day care worker, etc. Although rare, even women can be molesters. In every case, the
perpetrator is a nice guy, trusting, good with children, and the family is baffled or even
in disbelief that the person could be abusing their child. When it comes to your children
and grandchildren, be suspicious of everyone, no matter who they are. And pay attention to
what your child says and how he/she reacts to the mention of different people in their
lives. I didn't mean to make anyone uncomfortable with this, but I am at work rightnow
reviewing files, and realized that this email is a way I can reach many women at one time.
I have the dirty job of reading all these files, and it makes me feel good to know
that I can share some inferences from what I have learned. This is not an exhaustive list
of what not to do, but just some things that I have observed more than just a few times.
Pass this on to the women in your lives.
