Wednesday, October 29, 2008

Workout for brain just a few clicks away

CHICAGO, Oct 14 (Reuters) - Searching the Internet may help middle-aged and older adults keep their memories sharp, U.S. researchers said on Tuesday.

Researchers at the University of California Los Angeles studied people doing Web searches while their brain activity was recorded with functional magnetic resonance imaging scans.

"What we saw was people who had Internet experience used more of their brain during the search," Dr. Gary Small, a UCLA expert on aging, said in a telephone interview.

"This suggests that just searching on the Internet may train the brain -- that it may keep it active and healthy," said Small, whose research appears in the American Journal of Geriatric Psychiatry.

Many studies have found that challenging mental activities such as puzzles can help preserve brain function, but few have looked at what role the Internet might play.

"This is the first time anyone has simulated an Internet search task while scanning the brain," Small said.

His team studied 24 normal volunteers between the ages of 55 and 76. Half were experienced at searching the Internet and the other half had no Web experience. Otherwise, the groups were similar in age, gender and education.

Both groups were asked to do Internet searches and book reading tasks while their brain activity was monitored.

"We found that in reading the book task, the visual cortex -- the part of the brain that controls reading and language -- was activated," Small said.

"In doing the Internet search task, there was much greater activity, but only in the Internet-savvy group."

He said it appears that people who are familiar with the Internet can engage in a much deeper level of brain activity.

"There is something about Internet searching where we can gauge it to a level that we find challenging," Small said.

In the aging brain, atrophy and reduced cell activity can take a toll on cognitive function. Activities that keep the brain engaged can preserve brain health and thinking ability.

Small thinks learning to do Internet searches may be one of those activities.

Old and new viruses spread by air travel, crowding

WASHINGTON, Oct 27 (Reuters) - Tourists traveling by plane and the growth of cities are combining to help new and old infections spread around the world, experts said on Monday.

Viruses such as Chikungunya and dengue fever are finding new homes or returning to places where they were eradicated, the researchers told an infectious diseases meeting.

And new methods of diagnosing infections have led to the discovery of dozens of viruses causing often-serious disease.

"As urbanization spread, so did the mosquito," Duane Gubler of the University of Hawaii told a news conference at a joint meeting of the American Society of Microbiology and the Infectious Diseases Society of America.

Researchers at the Pan American Health Organization told the meeting that dengue fever, which can cause mild illness or deadly hemorrhagic disease, has come back after decades of eradication successes in Latin America.

They said 1.03 million cases of dengue were reported in the 1980s and 2.7 million in the 1990s, but 4.6 million were reported from 2000 to 2007.

The "re-emergence of epidemic dengue is closely associated with global urbanization and global transportation," Gubler said. "Pathogens of all kinds -- many of them actually move in infected people but they also move in infected animals and mosquitoes."

New infections are a threat, as well.

Dr. Ian Lipkin of Columbia University in New York said his lab, using new genetic sequencing techniques, has identified 75 new pathogens -- including a new rhinovirus that has caused serious disease in "scores of children" around the world.


Rhinoviruses are spread person-to-person only and usually cause common colds but this version appears more like severe influenza, Lipkin told the news conference.

"It was literally under our noses and in our noses for a long time," Lipkin said. "It has been found in Asia, Africa, Oceania, North America and Europe," he added. "It clearly is an important pathogen."

Chikungunya virus, which causes painful and sometimes crippling or deadly symptoms, has spread to several new countries in the past two years. One traveler brought it to Italy last year, Gubler noted.

"The same virus was introduced into India and into Sri Lanka, most likely via infected travelers," Gubler said.

Outbreaks of Chikungunya, which originated in Tanzania in 1952 but did not spread much outside of Africa until 2005, have been helped by mutations that let it travel via the Asian tiger mosquito, Aedes albopictus.

In 2005 on tiny Reunion Island in the Indian Ocean, it infected more than a third of the population -- 266,000 people -- and killed 260 of them.

The virus has spread to Singapore and people who go to neighboring Malaysia to buy durian fruit may be helping to carry it, said Dr. Harold Townson of the Liverpool School of Tropical Medicine in Britain.

"Aedes albopictus is very common in the United States and Caribbean," Townson said. "There are risks it could be introduced here."

And Gubler noted that another species of mosquito, the dengue-carrying Aedes aegypti, is re-emerging in Latin America.

Aedes aegypti is the original carrier of Chikungunya -- whose name comes from a word in the Makonde language of Tanzania describing the stooped stance of victims.

Tuesday, October 28, 2008

Cash to boost cervical screening

The NHS is launching a £250,000 scheme to tackle falling numbers of young women in England being screened for cervical cancer.

The announcement comes as a report shows screening rates have declined across the country in the last decade, particularly among women under 35.

The sharpest drop, by 12.6%, was in the number of women aged 25-29 being screened, which now stands at 66.2%.

Apathy is believed to be one of the reasons for the decline.


The number of women aged 30-34 who had been screened in the past five years has also fallen - from 83.5% to 76.8% since 1998, according to the NHS Information Centre.

The number of deaths from cervical cancer has risen to 413 among women aged 25-64 in 2007, up from 388 in 2006.

This means the death rate from cervical cancer among these women is at its highest since 2001.

This was despite the number of women invited (aged 25-64) rising from 4.01m to 4.18m in the last year, an increase of 4.3%.

Improving uptake

A spokesman for the Department of Health said: "We are aware that coverage rates are declining across the country, particularly in young women.

"To tackle this, NHS Cancer Screening Programmes have commissioned the Improvement Foundation to undertake a project to look into ways in which cervical screening uptake can be improved in women aged under 35."

The NHSCSP and Improvement Foundation have identified 10 primary care trusts to work with.

Lessons learned from this project will be shared across the whole programme by the end of 2009.

If overall coverage of 80% can be achieved, the NHS predicts that a 95% reduction in death rates is possible in the long term.

Liberal Democrat health spokesperson Sandra Gidley said: "There are early warning signs in these new figures that suggest the number of deaths is rising.

"Trusts must make strenuous efforts to ensure their screening programmes reach as many women as possible.

"The government must pay more attention to screening or, quite simply, even more women will die unnecessarily."

Dr Anne Szarewski of Cancer Research UK said: "Cervical screening saves lives so it's a big worry if young women start to miss their smear tests. The peak age for cervical cancer to strike is while women are in their late-30s, but it can occur earlier.

"We're not sure exactly why there's been a drop in the numbers of women attending screening but these figures highlight just how important it is that all women - including those who will receive the HPV vaccine - are aware of cervical screening and attend when they receive their invitations."

Shadow Health Secretary Andrew Lansley said: "We already have one of the worst survival rates in Europe for cervical cancer. The decline in screening rates is unacceptable and needs to be reversed."

A Rise in Kidney Stones Is Seen in U.S. Children

To the great surprise of parents, kidney stones, once considered a disorder of middle age, are now showing up in children as young as 5 or 6.

While there are no reliable data on the number of cases, pediatric urologists and nephrologists across the country say they are seeing a steep rise in young patients. Some hospitals have opened pediatric kidney stone clinics.

“The older doctors would say in the ’70s and ’80s, they’d see a kid with a stone once every few months,” said Dr. Caleb P. Nelson, a urology instructor at Harvard Medical School who is co-director of the new kidney stone center at Children’s Hospital Boston. “Now we see kids once a week or less.”

Dr. John C. Pope IV, an associate professor of urologic surgery and pediatrics at the Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, said, “When we tell parents, most say they’ve never heard of a kid with a kidney stone and think something is terribly wrong with their child.”

In China recently, many children who drank milk tainted with melamine — a toxic chemical illegally added to watered-down milk to inflate the protein count — developed kidney stones.

The increase in the United States is attributed to a host of factors, including a food additive that is both legal and ubiquitous: salt.

Though most of the research on kidney stones comes from adult studies, experts believe it can be applied to children. Those studies have found that dietary factors are the leading cause of kidney stones, which are crystallizations of several substances in the urine. Stones form when these substances become too concentrated.

Forty to 65 percent of kidney stones are formed when oxalate, a byproduct of certain foods, binds to calcium in the urine. (Other common types include calcium phosphate stones and uric acid stones.) And the two biggest risk factors for this binding process are not drinking enough fluids and eating too much salt; both increase the amount of calcium and oxalate in the urine.

Excess salt has to be excreted through the kidneys, but salt binds to calcium on its way out, creating a greater concentration of calcium in the urine and the kidneys.

“What we’ve really seen is an increase in the salt load in children’s diet,” said Dr. Bruce L. Slaughenhoupt, co-director of pediatric urology and of the pediatric kidney stone clinic at the University of Wisconsin. He and other experts mentioned not just salty chips and French fries, but also processed foods like sandwich meats; canned soups; packaged meals; and even sports drinks like Gatorade, which are so popular among schoolchildren they are now sold in child-friendly juice boxes.

Children also tend not to drink enough water. “They don’t want to go to the bathroom at school; they don’t have time, so they drink less,” said Dr. Alicia Neu, medical director of pediatric nephrology and the pediatric stone clinic at Johns Hopkins Children’s Center in Baltimore. Instead, they are likely to drink only once they’re thirsty — but that may be too little, too late, especially for children who play sports or are just active.

“Drinking more water is the most important step in the prevention of kidney stones,” Dr. Neu said.

The incidence of kidney stones in adults has also been rising, especially in women, and experts say they see more adults in their 20s and 30s with stones; in the past, it was more common in adults in their 40s and 50s.

“It’s no longer a middle-aged disease,” Dr. Nelson said. “Most of us suspect what we’re seeing in children is the spillover of the overall increase in the whole population.”

The median age of children with stones is about 10.

Many experts say the rise in obesity is contributing to kidney stones in children as well as adults. But not all stone centers are seeing overweight children, and having a healthy weight does not preclude kidney stones. “Of the school-age and adolescent kids we’ve seen, most of them appear to be reasonably fit, active kids,” Dr. Nelson said. “We’re not seeing a parade of overweight Nintendo players.”

Dr. Slaughenhoupt has seen more overweight children at his clinic. “We haven’t compared our data yet,” he said, “but my sense is that children with stones are bigger, and some of them are morbidly obese.”

Dr. Pope, in Nashville, agreed. His hospital lies in the so-called stone belt, a swath of Southern states with a higher incidence of kidney stones, and he said doctors there saw two to three new pediatric cases a week.

“There’s no question in my mind that it is largely dietary and directly related to the childhood obesity epidemic,” he said.

Fifty to 60 percent of children with kidney stones have a family history of the disease. “If you have a family history, it’s important to recognize your kids are at risk at some point in their life,” Dr. Nelson said. “That means instilling lifelong habits of good hydration, balanced diet, and avoiding processed high-salt, high-fat foods.”

There is also evidence that sucrose, found in sodas, can also increase risk of stones, as can high-protein weight-loss diets, which are growing in popularity among teenagers.

A common misconception is that people with kidney stones should avoid calcium. In fact, dairy products have been shown to reduce the risk of stones, because the dietary calcium binds with oxalate before it is absorbed by the body, preventing it from getting into the kidneys.

Children with kidney stones can experience severe pain in their side or stomach when a stone is passing through the narrow ureter through which urine travels from the kidneys to the bladder. Younger children may have a more vague pain or stomachache, making the condition harder to diagnose. Children may feel sick to their stomach, and often there is blood in the urine.

One Saturday last February, 11-year-old Tessa Cesario of Frederick, Md., began having back pains. An aspiring ballerina who dances en pointe five nights a week, she was used to occasional aches and strains. But this one was so intense that her parents took her to the doctor.

The pediatrician ordered an X-ray, and when he phoned with the results, her parents were astonished.

“I was afraid he was calling to say she pulled something and wouldn’t be able to dance,” said her mother, Theresa Cesario. Instead, they were told that Tessa had a kidney stone.

“I thought older men get kidney stones, not kids,” Ms. Cesario said.

The treatment for kidney stones is similar in children and adults. Doctors try to let the stone pass, but if it is too large, if it blocks the flow of urine or if there is a sign of infection, it is removed through one of two types of minimally invasive surgery.

Shock-wave lithotripsy is a noninvasive procedure that uses high-energy sound waves to blast the stones into fragments that are then more easily passed. In ureteroscopy, an endoscope is inserted through the ureter to retrieve or obliterate the stone.

Simple Test To Predict Pre-Eclampsia In Sight

A team of UK researchers has found that women who develop pre-eclampsia in pregnancy have lower than normal levels of a marker protein in their blood at the three-month stage and this could open the door to developing a simple blood test for this potentially life-threatening condition.

The research, which was funded by the British Heart Foundation (BHF), was led by Professor Dave Bates from the Department of Physiology and Pharmacology at the University of Bristol and is published in the journal Clinical Science.

Pre-eclampsia is a common pregnancy-related condition characterized by high blood pressure, protein in the urine, fluid retention, and dysfunction in the lining of blood vessels of the pregnant woman. Up to 1,000 babies and 10 women die every year in the UK as a result of the condition.

Bates and colleagues found that women in their 12th week of pregnancy who went on to develop pre-eclampsia had lower than expected levels of the protein VEGF165b compared to counterparts who did not develop the condition.

They suggested VEGF165b could be used as a biomarker to assess a woman's risk of developing pre-eclampsia and a test based on it could be used to monitor and care for vulnerable pregnancies.

The researchers built on previous studies that suggested links between pre-eclampsia and the VEGF group of proteins. They decided to track the level of VEGF165b in particular.

For the study, Bates and colleagues measured levels of VEGF165b in non-pregnant women, women who did not develop pre-eclampsia and women who did. In the pregnant women they measured levels of VEGF165b at 12 weeks of gestation and intervals through the rest of the pregnancy.

The results showed there was a 10-fold increase in VEGF165b in normal pregnancies at 12 weeks compared to non-pregnancy, while women who went on to develop pre-eclampsia hardly showed any increase at week 12.

Yet at full term, there was no statistically significant difference in the levels of VEGF165b between the women with pre-eclampsia and the women with normal pregnancies. The researchers suggested that VEGF165b increase is delayed in women who go on to develop pre-eclampsia.

43-year-old Karen Partridge from Bristol had severe pre-eclampsia in her first two pregnancies. She said she had to spend 21 days in hospital in her first pregnancy and that it was "a scary time".

She had the classic symptoms, she said:

"Protein in my urine, and high blood pressure and I swelled up like the Michelin man putting on four stone."

Partridge said she had no choice but to have her first baby delivered as quickly as possible and this meant her daughter had a low birthweight of only 5lb 2 oz (2.3 kg) and had to be fed through a tube for her first 10 days of life.

Again, Partridge found herself with pre-eclampsia and very similar symptoms during her second pregnancy, and again it was a very anxious time for her and her family.

"Early detection would have prepared me for the symptoms of this condition and my pregnancy would have been more closely monitored," she said in a statement from Bristol University.

Dr Victoria Bills, the obstetrician who conducted the study and who is also a Clinical Research Fellow at the University said:

"Although there is currently no medicine to cure pre-eclampsia, a VEGF test could guide the prescription of aspirin -- which decreases the incidence of pre-eclampsia by 15 per cent -- and identify women that should be particular mindful of the symptoms, and who should be monitored closely by their doctor and midwife with regular fetal growth scans and blood pressure measurement."

"As this change occurs so early we still need to know whether the VEGF165b contributes to development of the condition, or is a consequence of early changes," she added.

Professor Jeremy Pearson, Associate Medical Director at the BHF likened the medical research quest to develop a test to predict pre-eclampsia to a "holy grail".

"These researchers have made a vital finding that, if confirmed by other studies, has the potential to translate into a simple test that could potentially save many lives," said Pearson.

Prostate Cancer Risk Did Not Reduce With Vitamin E And Selenium

An initial independent review of data from a study looking at whether selenium and vitamin E supplements prevented prostate cancer found they had no benefit, taken either together or alone.

The review of data from the Selenium and Vitamin E Cancer Prevention Trial (SELECT) was funded by the National Cancer Institute (NCI) in the US and other institutes from the National Institutes of Health in the US.

SELECT was started to corroborate findings from studies on other primary cancer outcomes that found significantly fewer prostate cancers in men who took either Vitamin E or selenium supplements.

SELECT started in 2001 and eventually recruited more than 35,000 male volunteers over 50 years The men were randomly assigned to one of four groups: (1) real selenium and real vitamin E, (2) real selenium and vitamin E placebo , (3) selenium placebo and real vitamin E, and (4) placebo selenium and placebo vitamin E.

The study was set up as a double blind trial; that is neither the participants nor the doctors administering the treatment knew which group they were in.

The initial analysis also found two small but disturbing trends, neither of which is statistically significant, but all the men are being told to come off the supplements and continue to be monitored.

There was a small and statistically insignificant rise in the number of prostate cancer cases among the men taking only vitamin E, and a small and statistically insignificant rise in number of type 2 diabetes cases among men taking only selenium.

The researchers said in a statement that:

"Because this is an early analysis of the data from the study, neither of these findings proves an increased risk from the supplements and both may be due to chance."

Letters are being sent to the participants explaining these initial findings and telling them to stop taking their supplements. Study staff will continue to monitor the participants' health for three years of follow up and this may include regular digital rectal exams and tests for PSA (prostate-specific antigen).

The men continue to be blinded to prevent potential bias, but if a participant wishes to know which group he was in and which supplements he received he will be told.

An international network of research institutions called the Southwest Oncology Group (SWOG) coordinates SELECT at more than 400 clinical sites in the United States, Puerto Rico, and Canada.

During the follow up the researchers will also collect blood samples to put in a biorepository. This is another important objective of the study and will provide a bank of samples that researchers can analyse to better understand prostate and other cancers and other diseases of older men.

While the SELECT study was recruiting participants in 2003, another SWOG-sponsored study found that the drug finasteride reduced the incidence of prostate cancer by 25 per cent. The men on the SELECT study were told about this and offered the option to take finasteride, which has not been approved in the US as a prostate cancer prevention drug.

Dr Eric Klein, a study co-chair for SELECT, and a physician at the Cleveland Clinic, said:

"SELECT was always designed as a study that would answer more than a single question about prostate cancer."

"As we continue to monitor the health of these 35,000 men, this information may help us understand why two nutrients that showed strong initial evidence to be able to prevent prostate cancer did not do so," he added.

Prostate cancer is second only to skin cancer as the most common form of cancer among men in the US where in 2008 estimates suggest over 186,000 new cases will be diagnosed and over 28,600 men will die of the disease.

NCI director Dr John E Niederhuber said:

"Finding methods to prevent and treat prostate cancer remains a priority for the NCI, and with the aid of new molecular diagnostic tools and applications, we hope to continue to make headway in reducing deaths and new cases of this disease."

"The science of cancer prevention is also leading toward individualized, molecular prevention, in which we will calculate risk and design preventive steps based on an individual's genome," he added.

The SELECT investigators are continuing with the data analysis and intend to publish the final results in a peer-reviewed medical journal.

Dr Laurence H Baker, chairman of the Southwest Oncology Group, said:

"The SELECT trial owes a tremendous debt to our volunteers, the thousands of men who offered their time and enthusiastic participation, all in the interest of a future when prostate cancer can be prevented."

Statins May Prevent Some Miscarriages

Pregnancy loss associated with antiphospholipid antibodies might be prevented with statin drugs, said researchers here. In a mouse model of antiphospholipid syndrome, treatment with simvastatin (Zocor) and pravastatin (Pravachol) reduced miscarriage by approximately 70%, reported Guillermina Girardi, Ph.D., of the Hospital for Special Surgery, and colleagues in the October issue of the Journal of Clinical Investigation. "We postulate that statins may be a good treatment for women with antiphospholipid-induced pregnancy complications," they wrote. In an interview, Dr. Girardi said her institution is planning to begin clinical trials of statins in women with antiphospholipid antibodies. But she urged clinicians to await the outcome of clinical studies before prescribing them for this purpose.
Antiphospholipid antibodies are seen in 3% to 7% of women of child-bearing age. They have traditionally been associated with excessive blood coagulation and thrombosis, and treatment has typically involved anti-coagulants such as warfarin.
Excessive clotting has been thought to trigger miscarriages by creating placental infarctions, killing the fetus.
But recent studies have suggested that the coagulation dysfunction may be secondary to an inflammatory process and is not the true cause of fetal loss.
In particular, antiphospholipid antibodies appear to activate the C5a complement pathway, inducing expression of tissue factor, which has both pro-coagulant and pro-inflammatory properties.

Cost of diabetes care doubled over last 6 years

CHICAGO, Illinois (AP) -- Americans with diabetes nearly doubled their spending on drugs for the disease in just six years, with the bill last year climbing to an eye-popping $12.5 billion.

Newer, more costly drugs are driving the increase, said researchers, despite a lack of strong evidence for the new drugs' greater benefits and safety. And there are more people being treated for diabetes.
The new study follows updated treatment advice for Type 2 diabetes, issued last week. In those recommendations, an expert panel told doctors to use older, cheaper drugs first.
And a second study, also out Monday, adds to evidence that metformin -- an inexpensive generic used reliably for decades -- may prevent deaths from heart disease while the newer, more expensive Avandia didn't show that benefit.
"We need to pay attention to this," said Dr. David Nathan, diabetes chief at Boston's Massachusetts General Hospital, who wrote an editorial but wasn't involved in the new studies. "If you can achieve the same glucose control at lower cost and lower side effects, that's what you want to do."
The studies, appearing in Monday's Archives of Internal Medicine, were both funded by federal grants.
In one, researchers from University of Chicago and Stanford University looked at which pills and insulin doctors prescribed and total medication costs. Diabetes drug spending rose from $6.7 billion in 2001 to $12.5 billion in 2007, a period when costs dropped for metformin.
More patients got multiple prescriptions as new classes of drugs came on the market. And more patients with diabetes were seeing doctors, increasing from 14 million patients in 2000 to 19 million in 2007.
"There's been a remarkable change in diabetes treatments and remarkable increases in the cost of treatments over the past several years," said study co-author Dr. Caleb Alexander, assistant professor of medicine at the University of Chicago. "We were surprised by the magnitude of the changes and the rapid increase in the cost of diabetes care."
Nearly 24 million Americans, 8 percent of the population, have Type 2 diabetes, which can lead to kidney failure, blindness and heart disease.
Current guidelines say doctors should prescribe metformin (about $30 a month) to lower blood sugar in newly diagnosed patients and urge them to eat healthy food and get more exercise. Other drugs can be added later, on top of metformin, to help patients who don't meet blood sugar goals. The updated guidelines don't include Avandia, which costs about $225 a month.
Dr. Susan Spratt, an endocrinologist at Duke University Medical Center, said she prescribes whatever it takes to lower her patients' future risk of blindness and amputations. That can mean coupling more costly drugs with metformin to hit blood sugar goals.
"I think cost-analysis is important from a public health standpoint," Spratt said. "But when you're sitting across from a patient, you want to use whatever is going to help them get control of their diabetes."

For every 1.1-pound decrease in birth weight, the risk of the birthmark increased nine-fold, Beth Drolet, M.D., of the Medical College of Wisconsin, a

MONROE, Georgia -- It's just after dawn on a chilly Monday morning. The leaves crunch under Van Lewis' feet as he treks through the woods in rural Monroe, Georgia, clutching a hunting rifle.
Lewis is breathing heavily as he makes his way to a ladder leaning next to an old pine tree. He then climbs 20 feet to a custom-built enclosed hunting stand and waits for a deer.
"Ninety percent of the time, it is relaxation therapy," said Lewis, 52, a university police officer in Atlanta, Georgia. "The other 10 percent of the time, it is a workout."
That workout, according to some medical experts, may be too much for some hunters to handle.
"I think it's a very significant problem," said Dr. Eric Good, a cardiologist at the University of Michigan Health System in Ann Arbor.
The biggest danger that some hunters face isn't getting hit by a stray bullet or falling out of a tree stand, Good said. It's heart disease.
"Heart attacks are three times more likely to take a life than a gunshot injury," Good said.

Increase in Hemangiomas Linked to Increasing Rate of Low Birth Weight

For every 1.1-pound decrease in birth weight, the risk of the birthmark increased nine-fold, Beth Drolet, M.D., of the Medical College of Wisconsin, and colleagues reported in the November issue of the Journal of Pediatrics.
"Based on low birth weight statistics, we estimate that the incidence of infantile hemangiomas has increased by 40% in the last 20 years," Dr. Drolet said.
According to the researchers, there's been an increase in the number of U.S. infants who are born at less than 5.5 pounds. The 8.2% below that weight in 2005 was the highest percentage since 1968, and a rate higher than in most industrialized countries, the researchers said.
Dr. Drolet said her institution has also seen a "dramatic increase" in the number of babies with hemangiomas, a common birthmark caused by a conglomeration of blood vessels.
Previous studies have found that other risk factors for hemangiomas include premature birth, female sex, white race, increased maternal age, maternal history of infertility, using assisted reproductive technologies, and having a prior miscarriage.
But the results of this study, Dr. Drolet said, might explain why more infants are developing hemangiomas.
"This study reaffirms several known risk factors for infantile hemangiomas, … but for the first time demonstrates that low birth weight rather than prematurity per se is the most significant risk factor for developing hemangiomas," the authors said.
Their case-control study compared 420 children who had been diagnosed with a hemangioma at the Children's Hospital of Wisconsin and the University of California San Francisco Medical Center with 353 children under age two who had been diagnosed with skin anomalies other than the birthmark.
Infants with hemangiomas were more likely to be female (P<0.0001), non-Hispanic white (P<0.0001), premature (P<0.0001), and of low birth weight (P<0.0001).
Compared with the control group, the odds ratio for hemangiomas in preterm infants was 1.53 (95% CI 0.86 to 2.7) for birth weight below 2,500 g, and the odds ratio was 2.8 (95% CI 1.46 to 5.6).
In the control group, 4.8% of infants were the product of multiple gestation, compared with 10% of infants with hemangiomas (P=0.0064). Of controls, 2.8% were the product of in vitro fertilization compared with 4.2% of the hemangioma patients (P=0.336).
The multivariate analysis also showed that 33% of infants with hemangiomas had a positive family history of the birthmark compared with 15% of the control group (P<0.001).
"The finding that a significantly higher percentage of children with infantile hemangiomas had a positive family history suggests at least some genetic predisposition," Dr. Drolet said.
Even in the regression model, low birth weight was still the most statistically significant risk factor for hemangiomas, the researchers said.
They called for further research into medications used to treat hemangiomas, because there are no FDA-approved medications to treat the condition.

Can Cholesterol-Lowering Drugs Fight Pneumonia Too?

People who take statins and end up in the hospital with pneumonia are more likely to survive than those who are not taking a cholesterol-lowering drug, according to a study in Archives of Internal Medicine.
It’s possible that statins, some of the most commonly prescribed medications in the world, may help fight lung infections. On the other hand, people who take them may be in better health to begin with, which could explain their ability to survive a serious infection.
If statins are shown to fight infection, they could prove to be “a cheap and effective way of treating pneumonia, which would be wonderful,” says Reimar W. Thomsen, MD, PhD, of Aarhus University and Aalborg Hospital in Aalborg, Denmark, who led the study. “We really need new treatment options for pneumonia because it’s a great burden on health-care systems.”
Animal research has shown that statins reduce inflammation and fight blood clotting, so it’s scientifically plausible that they could help treat infections too. There have been studies showing benefits of statins in patients with sepsis, a life-threatening blood infection, as well as pneumonia.
However, the study could also be picking up on a so-called healthy-user effect. Healthy users tend to see their doctors regularly, take their medications as prescribed, exercise, eat their fruits and veggies, and avoid smoking.
Such people also tend to be prescribed medications like statins—or, if they were menopausal women a few years ago, estrogen. In that case, the healthy-user effect made it look like these women were getting benefits like stronger bones and healthier hearts from the hormone—until the Women’s Health Initiative study demonstrated that estrogen was actually harmful.

Pregnancy Normalizes Immunity in Women with Rheumatoid Arthritis

BERLIN, When women with rheumatoid arthritis become pregnant, their immune systems appear to normalize, possibly explaining why they go into remission, researchers But after delivery a suite of genes involved in the innate and adaptive immune systems is over-expressed, compared with healthy women post-partum, according to Thomas Haupl, M.D., of Charité-University Medicine, and colleagues.
The changes appear to correspond to the remission in rheumatoid arthritis commonly seen during pregnancy, Dr. Haupl and colleagues reported in the October issue of Arthritis & Rheumatism.
In six pregnant women with rheumatoid arthritis and eight healthy pregnant controls, the researchers tested gene expression in peripheral blood mononuclear cells during the third trimester of pregnancy and 24 weeks after delivery.
All of the women had uncomplicated pregnancies and delivered healthy children after 36 weeks of gestation, the researchers said, and for all but one patient, disease activity was low during pregnancy. Accordingly, four of the six received no drugs during pregnancy.
Using microarray technology, the researchers looked for genes whose expression differed by at least 1.5 times in at least half of all pairwise comparisons among the participants.
Analysis found the fewest differences were among the healthy women, with 10 genes increased and 50 decreased in activity after delivery, compared with during pregnancy.
But notably, the researchers said, there were also few differences between pregnant rheumatoid arthritis patients and the pregnant healthy volunteers -- with 39 genes increased and 48 decreased in activity.
In contrast to what Dr. Haupl and colleagues called "subtle differences" during pregnancy, many more genes whose activity changed were found when comparing either patients and controls after delivery, or patients before and after delivery.
In the first case, the researchers found, the patients had 155 genes whose activity increased compared with the controls and 30 whose activity decreased.
In the second case, after delivery the patients had 997 genes whose activity increased, compared with levels during pregnancy, and 48 whose activity fell.
The researchers said analysis of 32 "immunologically relevant cellular pathways" showed additional activation of genes related to adhesion, migration, defense against pathogens, and cell activation, including Notch, phosphatidylinositol, mTOR, Wnt, and MAPK signaling.
Dr. Haupl and colleagues found that -- in both patients and controls -- monocyte gene activity increased during pregnancy, while lymphocyte activity was lower.
Monocyte activity fell after delivery in the controls, they found, but persisted in the patients, implying that "innate immune functions play an important role" in reactivation of disease after delivery.
But among the patients, lymphocyte gene activity was also increased after delivery, the researchers said, suggesting that adaptive immune system functions serve as "cofactors in the relapse."

Parents in Greater Numbers Reporting Childhood Food Allergies

HYATTSVILLE, Md., Oct. 23 -- Reports by parents that their children have food allergies have increased sharply in the past decade, CDC researchers reported.
Whether the surging reports represent a true rise in food allergies or an increase in awareness of the condition is not clear, said Amy Branum, M.S.P.H., of the CDC's National Center for Health Statistics, who reported with Susan L. Lukacs, D.O., M.S.P.H., that in the years 1997 to 2007 there has been an 18% increase.
Yet in an NCHS Data Brief they said that more than three million children -- or four of every 100 younger than 18 -- had reported a food or digestive allergy in the previous 12 months.
These data came from a National Health Interview Survey of parents of 9,500 children in 2007 and the National Hospital Discharge Survey. The latter is a sample of 270,000 inpatient records from about 500 hospitals, and it gave an estimate the number of hospital discharges among children attributable to food allergies.
Both the survey results and hospital discharge data showed the same trend -- a growing number of children with food allergies.
"Food allergy has certainly received quite a bit of attention in the news and other outlets in past few years," said Branum. "There's always the possibility that kids are getting in to see doctors more, and parents are taking some of the signs and symptoms more seriously."
She added that she thinks diagnostic tools used to assess allergies have improved over the past decade leading to more frequent diagnosis.
But Ann Munoz-Furlong, founder and CEO of the nonprofit Food Allergy and Anaphylaxis Network, disagreed and said that all allergies, including food allergies, are on the rise.
"We are becoming more allergic as a population," Munoz-Furlong said. "And we need to find out why, so we can stop it."
The study also found that children with food allergies were two to four times more likely than those with no food allergies to have asthma and other allergies.
"I think that it's important for physicians and parents to realize this because these food allergies obviously do not occur in isolation from other problems," Branum said.

Staph germs harder than ever to treat, studies say

WASHINGTON – Drug-resistant staph bacteria picked up in ordinary community settings are increasingly acquiring "superbug" powers and causing far more serious illnesses than they have in the past, doctors reported Monday. These widespread germs used to be easier to treat than the dangerous forms of staph found in hospitals and nursing homes.
"Until recently we rarely thought of it as a problem among healthy people in the community," said Dr. Rachel Gorwitz of the federal Centers for Disease Control and Prevention.
Now, the germs causing outbreaks in schools, on sports teams and in other social situations are posing a growing threat. A CDC study found that at least 10 percent of cases involving the most common community strain were able to evade the antibiotics typically used to treat them.
"They're becoming more resistant and they're coming into the hospitals," where they swap gene components with other bacteria and grow even more dangerous, said Dr. Keith Klugman, an infectious disease expert at Emory University. "It's really a major epidemic."
The germ is methicillin-resistant Staphylococcus aureus, or MRSA. People can carry it on their skin or in their noses with no symptoms and still infect others — the reason many hospitals isolate and test new patients to see if they harbor the bug.
MRSA mostly causes skin infections. Cleveland Browns tight end Kellen Winslow was just hospitalized for a staph infection, his second in recent years, and the team reportedly has had at least six cases in the past three years.
But the germ can be life-threatening if it gets into the bloodstream, lungs or organs. Pneumonia, sinus infections and even "flesh-eating" wounds due to MRSA are on the rise, doctors reported Monday at an infectious diseases conference in Washington.
About 95,000 serious infections and 20,000 deaths due to drug-resistant staph bacteria occur in the United States each year.
To treat them, "we've had to dust off antibiotics so old that they've lost their patent," said Dr. Robert Daum, a pediatrician at the University of Chicago.
The CDC used a network of hospitals in nine cities and states to test samples of the most common community MRSA strain, USA300, over the last few years.
MRSA usually is resistant only to penicillin-type drugs. But 10 percent of the 824 samples checked also could evade clindamycin, tetracycline, Bactrim or other antibiotics.
"The drugs that doctors have typically used to treat staph infections are not effective against MRSA," and family doctors increasingly are seeing a problem only hospital infection specialists once did, Gorwitz said.
Even more worrisome: many of these community strains had features allowing them to easily swap genes and become even hardier.

Family Flu Shots Protect Babies Before Leaving Hospital

New mothers and their immediate family should receive flu shots before their newborns leave the hospital. This will create a "cocooning effect" that will help protect the infants from life-threatening influenza, a new study says.
Researchers at Duke Children's Hospital said they found boosting immunization rates in parents -- especially new fathers -- and siblings is especially effective. They were to present their findings Sunday at the annual ICAAC/IDSA meeting, in Washington, D.C.
"The Centers for Disease Control and Prevention does not recommend vaccinating newborns for flu because they're too young; however, they're a part of the population that is at highest risk," Dr. Emmanuel "Chip" Walter, a pediatric infectious disease specialist at Duke Children's Hospital, said in a university news release.
"Newborns have the highest rate of hospitalizations due to influenza when compared to any other age group of children. Their rates of influenza-related hospitalization are similar to people age 80 and older. And, in some seasons, the influenza-associated mortality rate is highest among infants. We want to protect the newborn by vaccinating the entire family, and send parents home with one less thing to worry about," Walter said.
The study, done at Durham Regional Hospital during the last flu season, included distributing flu education materials to new mothers and setting up a flu vaccine clinic to facilitate getting the shots to other family members around the time of a newborn's birth.
Vaccination of new mothers and other family members increased 16 percent when compared to another hospital in the area, Walter said. The campaign resulted in an additional 45 percent of new mothers -- who had not received a flu shot during pregnancy -- choosing to be vaccinated. There was an equally notable number of new fathers and siblings also getting the flu vaccine when compared to the comparison hospital site, the release said.
"Our study shows that offering the flu vaccine to new mothers during their baby's stay in the hospital is an effective way to assure that all women have the opportunity to get vaccinated and thereby protect their own health and the health of their baby," Walter said. "It also proved to be a convenient, and possibly the most effective, way for fathers to be vaccinated. Protection of the newborn from the dangers of influenza is maximized when those who have the closest contact are vaccinated."

Drug Improves Outcomes for Gout Patients

The drug pegloticase (Puricase) may help gout patients who've had no luck with other treatments, according to researchers who studied 212 patients who'd run out of treatment options.
They were randomly assigned to receive six months of intravenous treatment with either pegloticase or a placebo. One group of patients received 8 milligrams of pegloticase every two weeks, another group received 8 milligrams of pegloticase every four weeks, and a third group received the placebo.
The patients -- mostly men with an average age of 55 years -- had a significantly better response to pegloticase than to the placebo. While there wasn't a significant difference in number of gout flares, more of the patients who took the drug had more complete resolution of tophi, which are chalky deposits or uric acid. The patients who took pegloticase also noticed improved physical function.
Overall, pegloticase was successful in treating 40 percent of patients. Successful treatment was defined as having uric acid readings within the normal range at least 80 percent of the time in months three and six.
Patients who took pegloticase had more serious adverse side effects than those who took the placebo.
"Patients with treatment failure gout suffer from severe pain, increased disability, and reduced quality of life," lead investigator Dr. John S. Sundy, an associate professor of medicine at Duke University Medical Center, said in an American College of Rheumatology news release. "Therefore, these findings are exciting, because they show that pegloticase was able to reduce urate levels and improve clinical outcomes in subjects with gout who had exhausted all available treatment options."
The findings were expected to be presented Sunday at the American College of Rheumatology annual meeting, in San Francisco

Healing Process Found to Backfire in Lung Patients

A mechanism in the body which typically helps a person heal from an injury, may actually be causing patients with idiopathic pulmonary fibrosis (IPF) to get worse, researchers at the National Institute of Environmental Health Sciences (NIEHS), a part of the National Institutes of Health (NIH), and their collaborators have found.
"We identified a new mechanism that explains why some patients with IPF get more short of breath than others, in spite of similar levels of lung scarring," said Stavros Garantziotis, M.D., an NIEHS staff clinician and lead author on the new paper highlighted on the cover of the Nov. 1 issue of the American Journal of Respiratory and Critical Care Medicine.
Idiopathic pulmonary fibrosis is an incurable lung disease that affects approximately 50,000 people in the United States. In IPF, the lung tissue becomes scarred and patients have difficulty breathing, often resulting in death. The cause is unknown, though genes as well as environmental factors such as smoking and exposure to metal dust particles, are thought to raise the risk.
In healthy individuals, the body has a way of forming new blood vessels that can help heal an injury. For example, if you cut your finger, the body knows to deliver nutrients and cells to the injury site to promote wound healing. However, in patients with IPF, although there is a healing process that occurs, researchers say the process backfires or is disrupted and may be doing the patients more harm than good. Garantziotis explains that this involves a blood protein called inter-alpha-trypsin inhibitor (IaI), which binds with a connective tissue molecule called hyaluronan to make new blood vessels.
In people without IPF, this produces a healing process in the lungs. But Garantziotis says something different happens in people with IPF.
"Instead of building healthy new tissue to heal the scarring in the lungs, patients with higher IaI levels develop vessels that are far away from where they should be, pushing the blood away from the lung and bypassing the area where the body gets its oxygen, thus causing more shortness of breath," Garantziotis explains. Patients with IPF may suffer from low oxygen levels and shortness of breath beyond the actual effects of lung scarring itself.
The researchers applied a true bench-to-bedside approach for this study. Starting with basic research findings from in vitro cell and experimental animal studies, they were then able to demonstrate, in patients with IPF, that higher IaI serum levels were associated with less ability to take up oxygen, thus worsening the patients’ condition.
The researchers say there are at least two reasons why this study is important. First, it demonstrates for the first time the important role that a blood circulating protein plays in lung function. Secondly, it identifies a potential new therapeutic target for IPF.

Scientists try to stop hunger with retooled foods

LONDON - Want to lose weight? Try eating. That's one of the strategies being developed by scientists experimenting with foods that trick the body into feeling full.
At the Institute of Food Research in Norwich, England, food expert Peter Wilde and colleagues are developing foods that slow down the digestive system, which then triggers a signal to the brain that suppresses appetite.
"That fools you into thinking you've eaten far too much when you really haven't," said Wilde. From his studies on fat digestion, he said it should be possible to make foods, from bread to yogurts, that make it easier to diet.
While the research is preliminary, Wilde's approach to curbing appetite is one that some doctors say could be key in combating the obesity epidemic.
"Being able to switch off appetite would be a big help for people having trouble losing weight," said Steve Bloom, a professor of investigative medicine at London's Imperial College, who is not connected to Wilde's research.
Scientists in North America and elsewhere in Europe are also trying to control appetite, including through chemical injections or implantable devices that interfere with the digestive system.
Bloom said that regulating appetite through modified foods is theoretically possible. Other mechanisms in the body, like cholesterol production, are already routinely tweaked with medicines.
But Bloom warned that controlling appetite may be more challenging. "The body has lots of things to prevent its regulatory mechanisms from being tricked," he said.
For instance, while certain hormones regulate appetite, the brain also relies on nerve receptors in the stomach to detect the presence of food and tell it when the stomach is full.
Wilde's research hinges on the body's mechanisms for digesting fat.
Fat normally gets broken down in the first part of the small intestines. When you eat a high-fat meal, however, the body can only digest the fat entirely further down in the intestines. That sparks a release of hormones that suppress appetite.
Wilde's approach copies what happens with a high-fat meal: He coats fat droplets in foods with modified proteins from plants, so it takes longer for the enzymes that break down fat to reach it.
That means that the fat isn't digested until it hits the far reaches of the intestines. At that point, intestinal cells send a signal telling the brain it's full.
Even though the body hasn't had a high-fat meal, it suppresses the appetite as if it has. If the fat had been digested earlier in the intestines, no such signal would be sent.
Wilde said the technique should work with any foods that contain fat, like dairy products, precooked sauces, mayonnaise, breads and pastries, and that taste would probably not be affected.
If all goes well, products could be on shelves within a few years, he said.
In another technique, scientists at the University of Newcastle have been testing a seaweed extract called alginate that reduces fat absorption by cutting the level of glucose digested by the body before it gets broken down in the large intestine.

Red-Cell Transfusion After Heart Attack Called Potentially Lethal

PHILADELPHIA, Oct. 27 -- Packed red cell transfusions in patients after myocardial infarction may increase the risk of serious arrhythmic events, often leading to death, said a researcher here.

Lethal cardiac events including ventricular tachycardia and cardiac arrest were more than twice as common in patients given the infusions, reported M. Kamran Athar, M.D., of Cooper University Hospital in Camden, N.J. The data emerged in a retrospective analysis, after adjusting for several risk factors known to affect MI outcomes.
Non-lethal events were increased nearly five-fold in transfused versus non-transfused patients. In-hospital mortality and duration of stay were also substantially greater in the transfused patients, he said.
Speaking at the American College of Chest Physicians meeting here, Dr. Athar said the findings supported "a more restrictive transfusion strategy in the setting of acute MI."
The practice of giving transfusions to patients following a heart attack is long-standing but has become controversial in recent years. Several studies have suggested that it increases mortality.
Dr. Athar said that atrial fibrillation related to packed red cell transfusions has been documented in cardiac surgical patients, but whether it also occurs in the context of acute MI had not been studied.
He and his colleagues reviewed records of 1,496 patients treated at Cooper University Hospital from 2003 to 2007, 148 of them given packed red cell transfusions.

US Doctors Use Placebo Treatments But Don't Always Inform Patients

"Placebo treatments" are regularly prescribed by rheumatologists and internal medicine physicians, often without admitting the intention to the patients, according to a study released on October 24, 2008 on BMJ Online. Placebo treatments are highly criticized because they require some deception on the part of the doctor, which ethically violates patients' rights to autonomy. However, many placebo treatment advocates have pointed out that the effect can still be harnessed, offering effective treatment for many chronic conditions, without deceiving patients. Presently, only limited research has been performed to elucidate the attitudes of doctors towards placebos and magnitude of placebos' use. To investigate these issues, Dr Jon Tilburt of the National Institutes of Health and his colleagues conducted a confidential survey to 1,200 randomly selected, practicing physicians. All of the physicians had specialized in general internal medicine or rheumatology, which are both practices that often come into contact with patients with serious chronic, difficult to manage conditions. Of the 679 responding physicians, half indicated that they prescribed "placebo treatments" on a regular basis. Most of them (62%) believed that this practice was acceptable from an ethical standpoint, and were happy to recommend or prescribe placebos. Most commonly, these placebo treatments were over the counter painkillers (41%) or vitamins (38%). Some physicians also had used antibiotics (13%) and sedatives (13%) for this purpose, while a few had used sugar pills (3%.)Among those respondents who did prescribe placebos, most also reported that they described placebo treatments as "a potentially beneficial medicine or treatment not typically used for their condition,” but very rarely referred to them as “placebos.”The authors note that the study was limited by its relatively low survey response rate (57%), but that even with the most conservative analysis, this is still a remarkably common practice. While placebo use is controversial, they say, the doctors who responded to the survey did not indicate that they felt unethical about either the behavior or the lack of disclosure. The authors note the ethical complexity of placebos in contemporary medicine. In conclusion they determine that harmless treatments like vitamins or over the counter painkillers to promote positive expectations may not create panic. However, the prescription of antibiotics or sedatives without clear medical justification could be harmful for individual patients and for the health of the public. "Whether, or under what circumstances, recommending or prescribing placebo treatments is appropriate remains a topic for ethical and policy debate,." they say.

Flu Vaccination Investigated In PLoS Medicine

With the new flu season beginning, the open-access journal PLoS Medicine has released two studies related to influenza vaccination, each showing that the population burden of the flu can be decreased overall by increasing the number of people vaccinated. The flu vaccine is often recommended for specific groups of people who are at a higher risk of spreading or suffering from influenza in targeted vaccination programs. However, in 2000, the province of Ontario, Canada began a universal immunization program, promoting vaccination in and providing vaccination free of charge to all people over 6 months old. Jeff Kwong from the Institute for Clinical Evaluative Sciences in Toronto and colleagues examined this program's effects on influenza-related health outcomes. To do this, they examined data from both national and provincial records between 1997 and 2004 in order to compare Ontario's flu outcomes before and after the introduction of the universal vaccination program, as well as to compare Ontario's outcomes to those of other provinces which continued their targeted vaccination programs. In the analysis the group found that the universal vaccination program was associated with reductions in influenza outcomes, such as flu-related deaths, hospitalizations, and emergency room and doctor visits. The results also indicated that increasing immunization rates was not as clearly associated with a reduction in mortality and health care need in older people, especially older than 75 years, in comparison with younger people. Additionally, even with the better access to free flu vaccines in Ontario, a modest average of 38% of the overall household population reported that they had received the vaccinations. This suggests that immunizing younger people who come in contact with older people may still be useful in prevention of influenza-related outcomes. .The second study investigated this idea mathematically, capitalizing on a concept known as heard immunity, in which immunization of a few individuals in the population contributes to reduce overall exposure to people who are not immunized. Carline van den Dool and colleagues at the University Medical Center, Utrecht, the Netherlands created a mathematical model simulating the spread of influenza in nursing homes. Specifically, they found that by increasing the proportion of vaccinated health care workers from zero to 100% in a 30 bed nursing home department could reduce infections in patients approximately 60%. On average, vaccinating seven health care workers prevented one patient from influenza. Unfortunately, they found that even full health care worker vaccination does not guarantee complete herd immunity. This suggests that even when immunization rates are high, health care workers should be vaccinated each year to reduce risk to patients. The authors point out that one of the major drawbacks of the study was random variation which limits the abilities of small vaccine trials to assess the real relationship between vaccination and influenza. As a result, further studies should be performed to confirm these results. CĂ©cile Viboud and Mark Miller of the Fogarty International Center, US National Institutes of Health, contributed an accompanying comment in which they discuss the merits and drawbacks of the observational study design for evaluation of influenza vaccination.

Covert Promotion Of Off-Label Drug Use

Several techniques are often employed by drug companies to secretly promote off-label use, according to a piece released on October 27, 2008 in the open-access journal PLoS Medicine. For most drugs, it is legal to prescribe them for off-label uses, which are not specified in the original approval of the drug. These uses are sometimes unavoidable -- for instance, most approvals do not include pregnant women, who may need medication. However, it is illegal for a drug manufacturer to promote these off-label uses, because they have not necessarily been proven effective and may have serious side effects. Adriane Fugh-Berman, of Georgetown University Medical Center, and Douglas Melnick, a preventive medicine physician in North Hollywood, California emphasize that these off-label drug use, though “sometimes unavoidable” and sometimes “demonstrably beneficial," they add that this "should be undertaken with care and caution due to the uncontrolled experiment to which a patient is being subjected.” Even so, drug companies have a potential benefit from promoting off-label use thanks to “larger revenues from larger user populations, especially for products with narrow indications.”They subsequently describe the techniques that are employed by these drug companies to covertly promote the off-label use of their drugs. One such technique is "decoy indication." Int his process, drugs may be initially promising for many different uses, but companies choose a limited number of conditions on which they focus research for efficient approval of the drug. By pursuing a narrower indication, the drug may be sent to market more quickly, but this "decoy indication" simply masks the other uses from drug regulators. Drug representatives may also pass on the information. In the United States, drug representatives are not permitted to inform doctors of off-label uses. The authors quote a pharmaceutical industry attorney in a second paper from Medical Marketing and Media: “Before engaging in off-label promotion, companies should ascertain the risk profile, safety, efficacy, and potential commercial benefits of the use--without committing that last bit to print.” That is, if the potential profits of the action overcome the potential fines, it may be worth a company's consideration. Thus, doctors and patients are often encouraged to engage in off-label use, as pharmaceutical marketing has “distorted the discourse on off-label uses and encouraged the unmonitored, potentially dangerous use of drugs by patients for whom risks and benefits are unknown.”

Monday, October 27, 2008

On Emergency Plan Communication, Nearly Half Of US States Fail

Seven years after Sept. 11, and in the wake of many major natural disasters such as forest fires, hurricanes and flooding, nearly half of U.S. states either have no state-level emergency plan or do not provide it readily to the public, reveals a new study by George Mason University Communication Professor Carl Botan. Despite federal laws that require a state emergency operations plan (EOP) as a prerequisite to some federal funding, 22 states were unable to provide Botan with an EOP, withheld the plan on security grounds or made it difficult for even trained researchers to gain access. Residents of these states, Botan says, may question their state's preparedness because they are unable to find out how the highest authorities in their state coordinate responses to major disasters or how to have a say in those plans. "While most Americans will have access to some important state-level information during emergencies, many may not. When minutes may make the difference between life and death in an emergency situation, the population should not have to waste precious time looking for answers or who to turn to," says Botan. The study, "Using Sense-Making and Co-orientation to Rank Strategic Public Communication in State Emergency Operations Plans," graded and ranked the state emergency operations plans of the 50 U.S. states and the District of Columbia on their communication components. Botan analyzed the accessible state EOPs for three criteria: if the plans had a two-way communication component, if they addressed the communication needs of vulnerable populations and if they treated public communication as important enough to specifically address it in the plan. He found that the 29 jurisdictions that do have plans available make provisions for public communication - including news releases and public broadcasts, but only 16 of them make explicit or implicit provisions for two-way public communication such as community forums and focus groups. Botan feels that two-way public communication is essential in the plans, for that will allow the state to understand what its residents feel they need in emergency situations. Of the 29 plans obtained, only two - Washington, D.C. [which is treated as a state-level entity for this purpose] and New Mexico - received a perfect score of eight for communication. In addition, while 16 states mentioned vulnerable publics, only 13 of these discussed specific communication strategies for these vulnerable publics in their plans. For example, California mentions specific strategies such as dispatching special teams targeting vulnerable populations like the aged and the disabled, while Arizona simply mentions that emergency managers must pay attention to "special needs" people like residents of nursing homes and the hearing impaired, but does not outline specific strategies to communicate with them.

Steroid-loaded erythrocytes show promise for refractory ulcerative colitis

NEW YORK (Reuters Health) - An infusion of dexamethasone-loaded autologous erythrocytes appears to be an effective treatment for mild-to-moderate ulcerative colitis that is refractory to mesalamine, new research suggests. Moreover, this treatment may offer a better safety profile than conventional steroid therapy.
Roughly one quarter of ulcerative colitis patients receiving oral steroids, the current first-line treatment for this condition, become steroid-dependent within 1 year, and nearly all experience steroid-related side effects, Dr. Vito Annese, Ospedale "Casa Sollievo della Sofferenza" in San Giovanni Rotondo, Italy, and colleagues note. Using a patient's own red blood cells to encapsulate the steroids may help localize the drugs to disease regions and reduce adverse events.
To investigate, Dr. Annese's team assessed the outcomes of 40 patients who were randomized to receive two dexamethasone encapsulated erythrocyte (DEE) infusions 14 days apart, oral prednisolone, or sham infusions.
The researchers report their findings in the October issue of the American Journal of Gastroenterology.
At 8-week follow-up, 75% of DEE-treated patients and 80% given oral prednisolone were in clinical and endoscopic remission compared with just 10% of patients who received sham infusions (p < 0.001).
Relative to baseline values, C-reactive protein levels dropped significantly in both the DEE and prednisolone groups, but remained unchanged in the sham infusion group.
Eight of 10 patients treated with oral prednisolone experienced steroid-related adverse events compared with none of the 20 patients who received DEE, the report shows (p < 0.01).
"This study was small and follow-up was limited, but the findings are intriguing," Dr. Michael F. Picco, from the Mayo Clinic in Jacksonville, Florida, comments in a related editorial. "These results should prompt further study of this method of drug delivery to confirm efficacy, assess short-term and possibly long-term side effects, and determine whether this translates into better overall safety."

Sunday, October 26, 2008

Breast Cancer - Catching it Early

National Cancer Institute estimates that there were about 2.4 million women breast cancer survivors in 2004, with a 3.5% increase annually in the incidence of breast cancer. Unfortunately, this means more deaths in 2008 and 2009, unless women respond to the pleas for regular screening so that the disease may be detected early.

The easiest method of screening is, of course, self-examination. This is easy and can be performed in the privacy of one’s home. Many reliable medical websites provide information on the step-by-step process of the breast self-examination. A new tool called Cue is being released this month — this is a small device that may be placed in the shower. It is a small disc like instrument that reminds women of the best time in the month for breast exams, and also provides reminders when it is time for a mammogram.

The CDC recommends that women above 40 years of age schedule a mammogram every two years in addition to regular self-exams. A newer method of screening is the breast ultrasound, using the reflective properties of sonic waves to detect lumps and areas of calcification. When used as an adjunct to mammograms, more diagnoses of Cancer can be made. MRI is the most sensitive at detecting such potentially cancerous masses at much earlier stages of the disease. However, a MRI is recommended for women who are at a high risk (due to genetic, familial and environmental factors) of developing cancer. If lumps or masses are detected, a biopsy usually follows to check if the lump is malignant or benign.
Apart from these specific screening tools, a healthy daily lifestyle may also help decrease the risk of cancer. Foods high in beta-carotene and fiber such as carrots, legumes, squash, and whole grains may have anti-oxidant properties, lowering cancer risk. Foods high in saturated fats such as red meats, margarine, whole fat creams and cheeses may increase risk of all forms of cancer. Getting regular exercise and avoiding smoking and excessive alcohol consumption also contributes towards decreasing the risk of cancer.

Working beyond retirement could be good for you.

As Americans watch years of retirement savings disappear in the stock market collapse, many are having the same thought: Maybe we'll just have to work forever.
While most of us really won't end up working until we die, the trend toward delayed retirement — in full swing even before this financial disaster — raises an interesting question: Will working longer be good or bad for our physical and mental health?
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The answer is unknown, but it's likely some people will thrive as they work into their late 60s or beyond, while many others will suffer, researchers say.
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"We have an interesting experiment going on," says Arie Kapteyn, a researcher with the Rand Corp. "It's a little early to know what the effects are."
The number of American men still working or returning to work after 65 has been rising since the early 1990s, breaking a decades-long pattern of earlier retirements. As more women have entered the workforce, more also have stayed on past 55, 60 and 65, says the National Institute on Aging.
The end of mandatory retirement laws and changes in Social Security helped spur the changes. But so did improvements in health. People who are in good health tend to work longer. So sorting out the health risks and benefits of extra years on the job is complex, says Richard Suzman, director of behavioral and social research at the institute: "There's an interactive effect. Health can affect whether you keep on working, and working can affect your health."
An aging warehouse worker might benefit from the exercise he gets walking and lifting — or might get injured. An executive who retires early might improve her well-being by taking long walks, cooking better meals and visiting friends — or might end up sitting in front of a TV, eating junk food and feeling lonely.
Study results so far are not encouraging for those who keep working. In one preliminary report, researchers looked at older workers and retirees in European countries where typical retirement ages varied. Male workers over age 65 were more likely to report poor physical health than their retired peers, says Rand researcher Gema Zamarro.
But she and her colleagues have not yet analyzed data for women or sorted out the health effects of different kinds of jobs. They also found no harm in working up to age 65 and no evidence that working longer was bad for cognitive or mental health.
Jody Sindelar, a researcher at the Yale School of Public Health, does believe there will be mental fallout, though, for people who end up working years longer than expected.
She is studying such people and, while her data have not yet been published, she predicts these folks "will not be happy." People who expected to travel or spend time with grandkids may instead find themselves struggling to keep up with the physical and mental demands of their jobs. Spouses who expected to retire together may realize that one person must keep working to support another who can't — and that dreams of shared hobbies and travel may never be realized.
"There are some things you can't put off for five years," Sindelar says.
But not everyone wants to retire at 65 or even 70. Some keep working because they like their jobs and are good at them. They should fare well, says Sharon Brangman, chief of geriatrics at SUNY Upstate Medical University in Syracuse, and a board member of the American Society of Geriatrics.
She says she recently lost a patient who worked all her life and loved it: "She was well into her 80s and was teaching a Spanish class every night of the week. She really enjoyed engaging with people."

AIDS treatment should begin earlier

WASHINGTON — A new analysis of the best time to begin HIV treatment found that starting early sharply improves survival, doctors said Sunday.
Doctors say the new evidence is certain to prompt many doctors to change the way they treat patients, and to prompt health officials to begin examining the evidence underlying guidelines for treating the AIDS virus. The study of 8,374 patients in the USA and Canada showed that those treated later in the course of HIV infection are 70% more likely to die than patients treated sooner, says lead researcher Mari Kitahata of the University of Washington-Seattle.
What makes the finding so striking, Kitahata says, is the "magnitude" of the survival difference between the two study groups.
"Seventy percent is a significant and substantial increase in the risk of death," she says.
The finding surfaced from the biggest comparison of the two treatment strategies ever carried out. The data were drawn from 22 studies conducted from 1996 to 2006 in an attempt to answer a decade-old question about when to begin HIV treatment.
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"The guidelines committees are certainly going to look hard at these data next time they meet," says Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which sponsored the research.
Current guidelines say that patients should begin treatment only when their levels of a type of white blood cell called CD4 T-cells fall below 350 per cubic millimeter. The AIDS virus targets these cells, which in healthy people throttle up the immune response. But the guidelines have never adequately been tested, Kitahata says.
The new research found that patients fare better when they begin treatment when their CD4 counts are much higher, between 350 and 500 cells per cubic millimeter.
"There's reason to believe you would have even better survival using drugs available now," she says.
Early treatment, however, depends on awareness. Studies show that fewer than four in 10 U.S. adults have been tested for HIV.

Purple Tomatoes, Rich In Health-Protecting Anthocyanins, Developed With Help Of Snapdragons

Anthocyanins are naturally occurring pigments found at particularly high levels in berries such as blackberry, cranberry and chokeberry. Scientists are investigating ways to increase the levels of health-promoting compounds in more commonly eaten fruits and vegetables.
"Most people do not eat 5 portions of fruits and vegetables a day, but they can get more benefit from those they do eat if common fruit and veg can be developed that are higher in bioactive compounds," says Prof Cathie Martin from the John Innes Centre.
Anthocyanins offer protection against certain cancers, cardiovascular disease and age-related degenerative diseases. There is evidence that anthocyanins also have anti-inflammatory activity, promote visual acuity and hinder obesity and diabetes.
Tomatoes already contain high levels of the antioxidant lycopene. Highly processed tomatoes are the best source, or tomatoes cooked in a little oil, which helps to release the lycopene from cells. Flavonoids meanwhile are soluble in water, and foods containing both water soluble and fat-dissolved antioxidants are considered to offer the best protection against disease.
In this study the scientists expressed two genes from snapdragon that induce the production of anthocyanins in snapdragon flowers. The genes were turned on in tomato fruit. Anthocyanins accumulated in tomatoes at higher levels than anything previously reported for metabolic engineering in both the peel and flesh of the fruit. The fruit are an intense purple colour.
The scientists tested whether these elevated levels actually had an effect on health. In a pilot test, the lifespan of cancer-susceptible mice was significantly extended when their diet was supplemented with the purple tomatoes compared to supplementation with normal red tomatoes.
"This is one of the first examples of metabolic engineering that offers the potential to promote health through diet by reducing the impact of chronic disease," says Professor Cathie Martin.
"And certainly the first example of a GMO with a trait that really offers a potential benefit for all consumers. The next step will be to take the preclinical data forward to human studies with volunteers to see if we can promote health through dietary preventive medicine strategies."

Quicker Pace Of Eating Associated With Higher Body Mass Index

A new study published on finds that people who eat quickly and eat until full are three times as likely to be overweight than people who do not share those eating behaviors.The obesity epidemic gripping the industrialized world is partially the result of eating behaviors that have drastically changed in the last few decades. With the wide availability of inexpensive food in larger portions and fast food, and the increased frequency of eating while distracted (by TV, for example), adults are now able to consume enough energy that their bodies are storing significant amounts of fat.Professor Hiroyasu Iso (Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Japan) and colleagues studied 1,122 Japanese men and 2,165 Japanese women who were between the ages of 30 and 69 in 2003 and 2006. The researchers studied the association among the pace of eating, eating until full, and being overweight by analyzing data collected from diet history questionnaires filled out by the participants.The survey results showed that 50.9% of men and 58.4% of women ate until they were full; 45.6% and 35%, respectively, indicated that they ate quickly. Those participants who claimed to both eat until full and eat quickly had a higher total energy intake and higher body mass index (BMI) than those participants who did not share those behaviors. In fact, both men and women in the "eat until full and quickly" group were about three times as likely to be considered overweight that the same comparison group."The combination of the two eating behaviours had a supra-additive effect (additive interaction) on being overweight," conclude the authors. "As it is difficult to estimate these causal effects in a cross sectional study, prospective cohort and intervention studies will be needed to validate these associations between eating behaviour patterns and being overweight."Elizabeth Denney-Wilson (University of New South Wales, Australia) and Karen Campbell (Deakin University, Australia) write in an accompanying editorial that the findings of Iso and colleagues emphasize the impact of current eating patterns on the current obesity epidemic."Clinicians should recognise that behavioural counselling, using cognitive therapy, can help in the management of this aggressively 'eat more' food environment. Evidence suggests that adults can successfully modify their speed of eating and in turn their energy intake. Furthermore, adults are likely to be responsive to monitoring feedback regarding feelings of fullness. Helping patients to increase their daily physical activity will further reduce energy imbalance," conclude Denney-Wilson and Campbell.

Friday, October 24, 2008

Scientists Find 26 Genes Promoting Lung Cancer

NEW YORK (AP) -- In the largest effort of its kind, scientists have identified 26 genes that, when damaged, appear to promote lung cancer.

It's a step toward developing new treatments that can be tailored to specific patients.

The federally funded project was the largest ever to screen genes for mutations in the most common form of lung cancer, called adenocarcinoma. The results more than double the catalog of genes implicated in that condition. The findings, from scientists at a dozen institutions in the United States and Germany, appear in Thursday's issue of the journal Nature.

Lung cancer is the leading cancer killer in the United States and worldwide.

The study focused on tumors that originated in the lung and were surgically removed. But researchers also hope to study whether the same mutations appear in lung tumors that spread elsewhere.

The scientists sampled 188 tumors. They examined the makeup of 623 genes to look for those that were the most often mutated. The idea is that if a gene is mutated in so many tumors, it probably plays a role in the disease. The mutations clearly arose in the cancers because they did not appear in healthy tissue from the cancer patients.

The results suggest that some drugs already in use or being studied for other purposes may work in people whose tumors show certain mutations. More generally, by knowing what genes promote the development of lung cancer, scientists get targets for developing new therapies.

The work also lays the foundation for future tailoring of therapy to the particular mutations found in a patient's tumor.

Scientists Try to Stop Hunger With Retooled Foods

LONDON (AP) -- Want to lose weight? Try eating. That's one of the strategies being developed by scientists experimenting with foods that trick the body into feeling full.

At the Institute of Food Research in Norwich, England, food expert Peter Wilde and colleagues are developing foods that slow down the digestive system, which then triggers a signal to the brain that suppresses appetite.

"That fools you into thinking you've eaten far too much when you really haven't," said Wilde. From his studies on fat digestion, he said it should be possible to make foods, from bread to yogurts, that make it easier to diet.

While the research is preliminary, Wilde's approach to curbing appetite is one that some doctors say could be key in combating the obesity epidemic.

"Being able to switch off appetite would be a big help for people having trouble losing weight," said Steve Bloom, a professor of investigative medicine at London's Imperial College, who is not connected to Wilde's research.

Scientists in North America and elsewhere in Europe are also trying to control appetite, including through chemical injections or implantable devices that interfere with the digestive system.

Bloom said that regulating appetite through modified foods is theoretically possible. Other mechanisms in the body, like cholesterol production, are already routinely tweaked with medicines.

But Bloom warned that controlling appetite may be more challenging. "The body has lots of things to prevent its regulatory mechanisms from being tricked," he said.

For instance, while certain hormones regulate appetite, the brain also relies on nerve receptors in the stomach to detect the presence of food and tell it when the stomach is full.

Wilde's research hinges on the body's mechanisms for digesting fat.

Fat normally gets broken down in the first part of the small intestines. When you eat a high-fat meal, however, the body can only digest the fat entirely further down in the intestines. That sparks a release of hormones that suppress appetite.

Wilde's approach copies what happens with a high-fat meal: He coats fat droplets in foods with modified proteins from plants, so it takes longer for the enzymes that break down fat to reach it.

That means that the fat isn't digested until it hits the far reaches of the intestines. At that point, intestinal cells send a signal telling the brain it's full.

Even though the body hasn't had a high-fat meal, it suppresses the appetite as if it has. If the fat had been digested earlier in the intestines, no such signal would be sent.

Wilde said the technique should work with any foods that contain fat, like dairy products, precooked sauces, mayonnaise, breads and pastries, and that taste would probably not be affected.

If all goes well, products could be on shelves within a few years, he said.

In another technique, scientists at the University of Newcastle have been testing a seaweed extract called alginate that reduces fat absorption by cutting the level of glucose digested by the body before it gets broken down in the large intestine.

Sick Economy Has Patients Skimping on Medicine

CHICAGO (AP) -- The ailing economy is leading many Americans to skip doctor visits, skimp on their medicine, and put off mammograms, Pap smears and other tests. And physicians worry the result will be sicker patients who need more expensive treatment later.

"I have to pretty much be very ill to go to the doctor," said Julie Shelley, a 49-year-old office manager and mother of three from West Milton, Ohio. "I'm probably at the age where I should have a checkup or physical. I'm not going to do it. I am last on the list."

In Lombard, Ill., Donald Hendricks lost his job over the summer at an event-planning company. When two of his six children came down with a fever and sore throat several weeks ago, he could not afford the gas money to drive them to the doctor. He gave them soup and soda instead, and they got better.

"I never felt the crunch like this before," Hendricks said.

In Indianapolis, Raechelle Miles lost her job at an auto parts plant in July, and lost nearly everything else in a tornado. Now her dental fillings are falling out, and she is putting off a visit to the dentist, even though she realizes that may lead to more expensive treatment later on.

"The health care system was not in a good state really any time in the last five to 10 years. This has simply stressed it to a very severe degree," said Dr. Eric Schackow, a family physician in Chicago. "It does become very disheartening and discouraging because we find ourselves with our fingers in the dike."

Thursday, October 23, 2008

Hepatitis B vaccine urged for all newborns

CHICAGO (AP) — All U.S. newborns should be vaccinated against hepatitis B before leaving the hospital to protect against possible disease from infected mothers, doctors recommend.

Previously, giving the shots in the hospital was recommended only for newborns whose mothers were known to be infected or whose disease status was unknown.

The new recommendation is listed in the childhood immunization schedule for 2002, prepared by the American Academy of Pediatrics, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, and the American Academy of Family Physicians.

It is a minor change from the group's list last year. For one of the first times in recent years, no new shots are recommended; both lists recommend a series of seven vaccine shots starting in infancy for all U.S. children.

The list is published in January's Pediatrics.

The recommendation for hepatitis B shots was made out of concern that some infants of mothers mistakenly thought to be disease-free might be falling through the cracks, said Dr. Julia McMillan, a member of the AAP committee that helped create this year's list.

Doctors also worried that some infants were not being vaccinated early because of concerns that some shots had a mercury-containing preservative called thimerosal, which has since been removed from most vaccines, said Dr. Louis Cooper, AAP president.

While there's been no known increase in infants infected with hepatitis B, vaccinating them before they leave the hospital "just makes good sense," Cooper said.

Newborns can contract the virus from infected mothers' blood during childbirth, but vaccinating them soon afterward can prevent the disease from taking hold, said McMillan, a pediatrics professor at Johns Hopkins University.

The seven recommended vaccines are: hepatitis B; diphtheria, tetanus and pertussis combined; haemophilus influenza type b; inactivated polio; measles, mumps, rubella combined; chickenpox; and pneumococcal vaccine. Hepatitis A and flu vaccines are recommended for certain at-risk children.

McMillan noted that because of a current shortage of pneumococcal vaccine — which protects against childhood pneumonia, meningitis and ear infections — doctors are urged to reserve the full four-shot series for at-risk children with weakened immune systems until supplies rebound.

Vaccine maker Wyeth-Ayerst Laboratories has said it expects the shortage, blamed on unforeseen demand, to ease by the end of March.

Low-salt, low-protein diet can prevent kidney stones

A diet low in salt and meat can dramatically reduce the risk of kidney stones, according to an Italian study that could spell the end for the low-calcium diet that doctors have been recommending for years.

About 10% of the U.S. population — and a much larger percentage of men, who make up 80% of sufferers — will have at least one kidney stone sometime in their lives, and it can be excruciatingly painful. Most stones can be excreted, but in about 15% of cases, surgery or shockwave treatment to pulverize the stones is needed.

Many doctors have told such patients to cut down on calcium because most kidney stones are made of a calcium compound. But recent studies have suggested that such a diet might not prevent kidney stones after all and may even promote them — along with osteoporosis.

The new study "dispelled a myth that a low-calcium diet is important in preventing kidney stones," said Dr. David A. Bushinsky, a kidney specialist at the University of Rochester.

William Keane, president of the National Kidney Foundation, said he is sure the new diet "will become the gold standard."

The University of Parma study randomly assigned either a low-calcium diet or a diet low in salt and extremely low in protein to men who had had at least one kidney stone. Sixty men were assigned to each diet.

Twenty-three men on the low-calcium diet had another kidney stone within five years, compared with 12 on the low-salt, low-protein diet, Dr. Loris Borghi wrote in Thursday's New England Journal of Medicine.

A co-author, Dr. Umberto Maggiore, explained that people on a low-calcium diet excrete less calcium in their urine but more of the other substance that combines with calcium to form most kidney stones.

In addition, salt and one protein common in meat lead to more calcium in the urine, which in turn contributes to the formation of kidney stones, Bushinsky said.

He said he has not prescribed a low-calcium diet in a decade because of evidence that it leaches calcium from the bones, making them weaker. Women were not included in the Italian study because of the danger of osteoporosis.

The low-salt, low-protein diet allowed 2,900 milligrams of salt per day; 2,400 is the maximum recommended by the American Heart Association. But people were allowed only about three-quarters of an ounce of meat per day, with just over an ounce of cheese or other dairy protein.

The American Foundation for Urologic Disease does not mention a low-calcium diet on its Web page about kidney stones, but does say a doctor may suggest a low-meat, low-salt diet. The National Kidney Foundation's Web page says a doctor may suggest either diet, depending on test results.

Borghi's study is the first direct comparison of the two diets, said Dr. Julie R. Ingelfinger, the journal's deputy editor. She wrote that the diet has been proved effective only for men in Italy's Parma region, but is worth trying "for anyone who has had a stone or who has witnessed the suffering of a friend or family member with a stone."

Maggiore said the diet would be equally effective in any country, but he noted that it might be harder to get Americans to stick to it because meat makes up such a great part of the U.S. diet.

Health care for kidney stones added up to $1.8 billion in 1993, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Drinking 10 to 12 big glasses of water during the day can keep stones from forming and push out those smaller than a pea.

Dirty tap water puts pregnant women at risk

Millions of Americans have been drinking tap water contaminated with chemical byproducts from chlorine that are far more than what studies suggest may be safe for pregnant women, two environmental groups say in a new study.

Chlorine is commonly used to disinfect drinking water. When it is added to water that contains organic matter such as runoff from farms or lawns, however, it can form compounds such as chloroform that can cause illness.

The study released Tuesday by the Environmental Working Group and Public Interest Research Groups identified areas that may have increased health risks including miscarriage, neural tube defects and reduced fetal growth from women drinking chlorination byproducts.

"By failing to clean up rivers and reservoirs that provide drinking water for hundreds of millions of Americans, EPA and the Congress have forced water utilities to chlorinate water that is contaminated with animal waste, sewage, fertilizer, algae and sediment," the report says.

Jane Houlihan, EWG's research director, said the report also shows how that cleanup failure has "a direct impact on human health." Pregnant women need to drink plenty of water, she said, but they can reduce their exposure to potential risks through simple measures such as home filters and purchasing bottled water.

One expert on environmental health cautioned that the link between the byproducts and pregnancy risks is suggestive, not conclusive.

Still, if the pregnancy studies are proved, millions could be at risk, said Dr. Robert Morris, an environmental epidemiologist at Tufts University School of Medicine in Boston.

"That body of literature isn't necessarily conclusive but people ought to be aware of it," Morris said. "It's pretty clear that some of these compounds can be pretty bad actors. The fact that these levels are as high as they are is certainly something to be concerned about."

The environmental groups combed water quality records in 29 states and the District of Columbia and matched them with various research into birth defects and miscarriages conducted by state and federal agencies and universities.

The groups said the places statistically most at risk due to chlorination byproducts were those that are populous, lacked buffers from urban sprawl and were downstream from agricultural sites. But women in small towns generally face twice the risk from drinking high levels of the byproducts, Houlihan said.

Matching high rates doesn't prove the environmental risk caused the health problems, however. Also, the results are limited because, among other reasons, such health records do not exist in some states.

The Environmental Protection Agency already has decided that some chlorination byproducts pose health risks and instituted stricter standards on Jan. 1 for seven of them: five haloacetic acids, bromate and chlorite. The agency also began requiring a reduction by one-fifth of the allowable level for trihalomethanes, another chemical produced by adding chlorine to dirty water.