Bird flu not a top concern of Americans: survey

By Megan Rauscher

NEW YORK (Reuters Health) - A new survey shows that Americans fear car accidents, terror attacks, hurricanes and other natural disasters more than they fear bird flu.

The national survey of 1,000 Americans was conducted between January 24 and January 25 by marketing and communications research company HCD Research, based in Flemington, New Jersey, in response to recent reports that bird flu may enter the U.S.

"What was really clear from the survey was that with all the talk about bird flu, the more mundane things like hurricanes and car accidents seem to be more on people's minds than the less likely things like bird flu," Glenn R. Kessler, managing partner of HCD Research, told Reuters Health.

While more than half of respondents (59 percent) think that it is likely that bird flu will reach American soil, less than half (44 percent) are concerned that bird flu will affect them personally or their families.

Americans appear to be "really rational" when it comes to bird flu, Kessler said. "If you look at the top two fears -- car accidents (#1) and natural disasters (#2) -- these are events that actually happen; the rest are speculative," he added.

Number three on the list of fears is terrorist attacks employing a dirty or nuclear bomb, followed by bioterrorism, such as the release of smallpox or anthrax, bird flu and airline accidents.

According to the survey, Americans are split regarding their confidence in the federal government's ability to handle a bird flu outbreak in the U.S., with 36 percent indicating that they are confident, 37 percent indicating they are not confident, and the rest being undecided.

"I think now people have a lot of reticence about government response to disasters," Kessler said, perhaps owing to the Hurricane Katrina debacle.

Dr. Arthur Kover, a sociologist and consulting director at HCD Research added in a statement: "Clearly, the federal government must make its case that it is prepared to effectively handle any bird flu epidemic."

© Reuters 2006. All Rights Reserved.

After Training Program Men Easier To Please With Regard To Body Image Than Women

It doesn't take much to make a man feel satisfied with his body: a look in the mirror and a sense of well-being seem sufficient. For women, however, changes in body image need to be supported by hard, physical evidence.

The findings surprised the study's author, Kathleen Martin Ginis, associate professor of kinesiology at McMaster University.

"We thought - obviously incorrectly - that women's body image would improve more than men's as they progressed through the strength training study," Martin Ginis said. "We were surprised by the responsiveness of men's body image to strength training. Men's body image improved as much as women's. Yet interestingly, men didn't care about numbers--how much weight they actually lost or how much muscle they actually gained had no bearing on their body image; if they simply felt more muscular and stronger, or if their pants were looser, that was good enough to improve their body image. But when it came to the women, feeling thinner and stronger was only part of the story. The women who had the greatest improvements in body image were those who saw actual increases in the amount of weight they could lift at the gym."

The study followed men and women, between the ages of 18 and 29, during a 12-week full-body progressive resistance-training program. Significant body image improvements were found for both sexes but it seems that men's and women's body image improved for different reasons. For the men, body image improvements were related to perceived changes in their bodies. For the women, body image improvements were related to perceived and real changes in their bodies.

An illuminating side bar to the study is that all the participants led sedentary lifestyles up until the beginning of the study. In all cases, visible changes in strength were apparent in a short period of time, proving that with a moderate amount of exercise (in this case, about an hour a day), significant changes to physical health and body shape can emerge in a relatively brief period of time.

McMaster University, a world-renowned, research-intensive university, fosters a culture of innovation, and a commitment to discovery and learning in teaching, research and scholarship. Based in Hamilton, the University, one of only four Canadian universities to be listed on the Top 100 universities in the world, has a student population of more than 23,000, and an alumni population of more than 115,000 in 128 countries.

Martin Ginis, K. A., Eng, J. J., Arbour, K. P., Phillips, S. M., & Hartman, J. W. (2005). Mind over muscle? Sex differences in the relationship between body image change and subjective and objective physical changes following a 12-week strength-training program. Body Image: An International Journal, 363-372.

Jane Christmas
chrisja@mcmaster.ca
McMaster University
http://www.mcmaster.ca

Heart Attacks and Winter: Examining the Seasonal Trend

According to results gathered by the Second National Registry of Myocardial Infarction (heart attacks), winter was the top season for heart attacks, followed by fall, then spring, then summer. The December issue of the Harvard Men's Health Watch looks at potential causes for this seasonal trend.

There were 53% more heart attacks in winter than summer. January was the leader with twice as many heart attacks per day than July, the safest month. And winter heart attacks tended to be more serious with a 9% fatality rate. Research suggests that winter heart attacks produce more damage to cardiac muscle than those in any other season.

The Harvard Men's Health Watch suggests a number of factors that contribute to the increased seasonal risk, among them:

-- Cold weather blues

In the cold, blood vessels constrict to help conserve body heat. Narrowed vessels also mean higher blood pressure, which puts additional strain on the heart.

In colder climates, people tend to exercise less when temperatures dip and snow and ice are common. Another weather related problem: snow shoveling. Snow shoveling is heavy exercise that can tax the heart of those who aren't normally active.

Studies show that cholesterol levels peak in the winter months.

-- Holiday happenings

A high-fat holiday meal can interfere with relaxation of the arteries and may also activate the clotting system, which can spell trouble for people with coronary artery disease. Also, excess alcohol intake can increase blood pressure and contribute to heart rhythm abnormalities.

Despite its reputation as joyous time, many people feel depressed or overly stressed during the holiday season. Depression and stress are associated with a higher risk of heart attack.

The Harvard Men's Health Watch reminds men to keep warm and shovel snow with extreme care, or pay someone to do it. Avoid overindulging during the holidays, and reduce stress by seeking comforting social connections during this busy time of year.

The Harvard Men's Health Watch is available from Harvard Health Publications, the publishing division of the Harvard Medical School, for $24 per year. Subscribe at http://www.health.harvard.edu/men or by calling 1-877-649-9457 toll-free.

Harvard Men's Health Watch
Harvard Health Publications
Cambridge, MA 02138
United States
Phone 617-432-4717

Massage For Childbirth Prep May Reduce Episiotomy Rate

Low-tech, at-home preparation in the last month before childbirth could help pregnant mothers avoid one of the more common surgeries performed on women in the United States, a new review suggests.

The review looked at studies in which women used a massage technique in the last four or five weeks of pregnancy to train the lower genital tract for childbirth. During perineal massage a women kneads the tissue below the vagina to prepare the tissue to expand more easily during birth.

There was a 15 percent reduction in episiotomies among the women who practiced perineal massage the review found, based on results from three trials, including data from 2,434 women.

The findings appear in the most recent issue of The Cochrane Library, publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Lead reviewer Dr. Michael Beckmann and his colleagues also discovered an added benefit: Three months after birth, women who had practiced massage were less likely to report perineal pain -- whether or not they had an episiotomy.

Those positive results were most clear for mothers having their first vaginal birth. But Beckmann said the statistical trend of the research suggests that the benefits would also hold true for the other, smaller sub-groups of women in the study -- given larger sample sizes, more time and research.

An episiotomy is performed in up to 35 percent of vaginal births in the United States each year, affecting as many as 1 million women. But Beckmann said the number of episiotomies performed around the world is dropping following a general shift toward reserving the surgical procedure for emergencies.

A May 2005 article in the Journal of the American Medical Association cast doubt on many of the rationales offered for routine episiotomy. That evidence review found episiotomy does not reduce pain or improve healing in the short term, or prevent incontinence or impaired sexual function in the long term - when compared with natural tears.

Many expectant mothers have heard about Kegel exercises to strengthen the pelvic-floor muscles before birth, but perineal massage isn't as well-known or recommended as often.

"It's not standard in obstetrics, but there is interest in this area," said Beckmann, an obstetrician with the QE2 Jubilee Hospital in Queensland, Australia.

"It's amazing the number of women who are fearful about cuts and tears and afraid of an episiotomy," said Sally Avenson, a certified nurse midwife in western Washington state.

As more women demand greater control and involvement in their childbirth plan, Avenson said, preventing an episiotomy -- or the spontaneous tears that can occur at childbirth -- has gained mainstream attention, and become a goal for all providers who care for pregnant women.

Perineal massage is now common in some corners of maternal health care, Beckmann said, so "it's nice to see there's some evidence behind it." He now says expecting women should be provided information on perineal massage and its likely benefits.

In the three reviewed studies, women practiced perineal massage for as little a four minutes three to four times a week, and as much as 10 minutes daily, beginning in week 34 of their pregnancy.

Pregnant women may not hear about perineal massage from their obstetrician, but midwives have recommended the practice for years. Avenson, a lecturer with the University of Washington's department of Family and Child Nursing, said it is difficult to separate the effect of perineal massage alone. But she includes the technique in her discussions about "perineal management."

"It goes along with a plan for exercise and nutrition. You can't isolate the perineum from health," she said.

"It's not anything where I guarantee you won't tear, but it is something you have power to do," said Avenson, who's led her own midwifery practice for 25 years.

Beckmann MM, et al. Antenatal perineal massage for reducing perineal trauma (Review). The Cochrane Database of Systematic Reviews 2006, Issue 1.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit www.cochrane.org for more information.

Michael Beckmann
drmikeb@hotmail.com
Center for the Advancement of Health
http://www.cfah.org

Smokers more likely to quit if decision is spontaneous

LONDON (Reuters) - If you really want to give up smoking then do it.

Research by British scientists shows that smokers who decide to quit immediately, without making plans about how or when, are more likely to succeed.

"Contrary to what experts had previously believed the idea that you have to plan your quit attempts ahead of time isn't necessarily true," said Robert West, a professor of psychology at University College London.

West and his colleague Taj Sohal questioned 1,900 current and ex-smokers in England about their efforts to kick the habit. They discovered that nearly half of all attempts to quit were spontaneous.

Smokers who decided and stopped immediately were also 50 to 60 percent more likely to succeed.

West, who reported the research in the British Medical Journal on Friday, said the findings do not imply that planned attempts to quit are counterproductive.

But the results suggest the state of mind and motivation of the smoker is important for how successful the attempt to quit will be.

West urged smokers who have not managed to quit to keep trying.

"The number of times you have tried to quit in the past isn't related to how likely you are to succeed in the future. It's another roll of the dice," he added.

© Reuters 2006. All Rights Reserved.

Pregnancy and Major Depression a Dangerous Mix

By Amanda Gardner
HealthDay Reporter

TUESDAY, Jan. 31 (HealthDay News) -- Pregnancy does not appear to confer a protective effect on women with major depression , as many experts had thought.

Quite the contrary, pregnant women who discontinue their antidepressant medication are at a five times higher risk of relapse than women who don't, new research shows.

The study, appearing in the Feb. 1 issue of the Journal of the American Medical Association, argues strongly for women and their doctors to discuss medication options.

"Hopefully, we'll be less likely to see arbitrary discontinuation of antidepressants in patients with histories of major depression, which has been frequently standard fare," said study author Dr. Lee Cohen, director of the Perinatal and Reproductive Psychiatry Clinical Research Program at Massachusetts General Hospital in Boston. "This manuscript will round out part of the risk-benefit equation by offering clinicians and their patients a sense of what happens if they either chose to stay on or stop the medicine."

"This challenges a certain myth and hope that people had that a pregnant woman is going to have a quieter time with respect to her mood symptoms than when she's not pregnant," added Dr. Susan Kemker, an assistant attending psychiatrist at Westchester Medical Center and clinical assistant professor of psychiatry at New York Medical College, both in Valhalla, N.Y.

"That is just not the case," she said. "This study shows a risk for relapse which makes the decision-making process for a woman who's pregnant more complicated. It makes it more important for her to really partner with her doctor."

There have been reports that the newer antidepressants known as selective serotonin reuptake inhibitors (SSRIs), which include Prozac, Paxil, and Zoloft, may cause newborns to have withdrawal symptoms. In September 2005, the U.S. Food and Drug Administration issued a warning about possible birth defects in infants born to women taking Paxil during their first trimester. Overall, however, most studies have confirmed the safety of antidepressants taken during pregnancy.

"Our data on psychiatric drugs have been around for a while, and we're not finding increased malformation," said Dr. Jennifer Wu, an obstetrician/gynecologist with Lenox Hill Hospital in New York City. "For the patient who says she's tried coming off and had very bad depressive episodes, physicians in general recently have been starting to keep them on their medication."

Prior to that, many physicians recommended that pregnant women discontinue the medications.

This study compared pregnant women with major depression who stopped or tried to stop taking their medication near the time of conception with women who stayed on their medication. In all, 201 pregnant women at three centers participated. All were less than 16 weeks pregnant at the beginning of the study, and all had a history of major depression before becoming pregnant.

Out of the total sample, 43 percent relapsed during pregnancy, half of them during the first trimester. Sixty-eight percent of women who discontinued their medication experienced a relapse, compared with only 26 percent of women who stayed on their medication. Women who came off their medication also relapses more frequently.

There are also risks if a woman is depressed during her pregnancy.

"Untreated depression actually puts mom at risk, and puts baby at risk," Cohen said. "It is associated with compromised fetal well-being and the well-being of the newborn."

One of the authors' main messages is that women, in conjunction with their doctors, have to make an important decision, one that can't be presented in terms of black and white.

"It is a complicated picture," Wu said. "You really have to individualize care."

SOURCES: Lee S. Cohen, M.D., director, Perinatal and Reproductive Psychiatry Clinical Research Program, Massachusetts General Hospital, Boston; Jennifer Wu, M.D., obstetrician/gynecologist, Lenox Hill Hospital, New York City; Susan Kemker, M.D., assistant attending psychiatrist, Westchester Medical Center, and clinical assistant professor, psychiatry, New York Medical College, both in Valhalla, N.Y.; Feb. 1, 2006, Journal of the American Medical Association

Men overcompensate when masculinity is threatened

Threaten a man's masculinity, and he will assume more macho attitudes, according to a study by a Cornell University researcher.

"I found that if you made men more insecure about their masculinity, they displayed more homophobic attitudes, tended to support the Iraq war more and would be more willing to purchase an SUV over another type of vehicle," said Robb Willer, a sociology doctoral candidate at Cornell. Willer is presenting his findings Aug. 15 at the American Sociological Association's 100th annual meeting in Philadelphia.

"Masculine overcompensation is the idea that men who are insecure about their masculinity will behave in an extremely masculine way as compensation. I wanted to test this idea and also explore whether overcompensation could help explain some attitudes like support for war and animosity to homosexuals," Willer said.

Willer administered a gender identity survey to a sample of male and female Cornell undergraduates in the fall of 2004. Participants were randomly assigned to receive feedback that their responses indicated either a masculine or a feminine identity. While women's responses were unchanged regardless of the feedback they received, men's reactions "were strongly affected by this feedback," Willer said.

"Masculinity-threatened men also reported feeling more ashamed, guilty, upset and hostile than did masculinity-confirmed men," states Willer's report, "Overdoing Gender: Testing the Masculine Overcompensation Thesis."

"The masculine overcompensation thesis has its roots in Freudian psychology, but it has become a popularly accepted idea that I felt should be empirically tested and evaluated," Willer said.

He questioned subjects about their political attitudes, including how they felt about a same-sex marriage ban and their support for President Bush's handling of the Iraq war.

"I created composites from subjects' answers to these and other questions," he said. "I also gave subjects a car-buying vignette, presented as part of a study of purchasing a new car."

Masculinity-threatened participants also showed more interest in buying an SUV. "There were no increases for other types of cars," Willer said.

The study produced "the predicted results," he said. "The intention of the study was to explore whether masculine overcompensation exists and where. But the point isn't to suggest these are the only factors that can explain these behaviors. Likewise, there may be a wide variety of other behaviors that could increase when men are concerned about their levels of masculinity."

In a separate study, Willer verified that support for the Iraq War, homophobia and interest in purchasing an SUV were all considered masculine by study participants.

Willer said he and a colleague are planning additional research on subjects' attitudes regarding violence toward women, using the same method for manipulating masculine insecurity.

"I'm planning another follow-up to the study that involves taking testosterone samples from participants to see if testosterone levels are a mediating factor in this process," he added.

The research involved 111 Cornell undergraduates and was funded by the Department of Sociology at Cornell.

Nicola Pytell
nwp2@cornell.edu
607-254-6236
Cornell University News Service
http://www.news.cornell.edu

Scientists, Linking Gene With Serotonin And Depression, Offer Insights To New Treatments

For the more than 18 million Americans who suffer from depressive illnesses, the best pharmacological treatments are those that increase levels of serotonin, the brain chemical that regulates mood, sleep and memory. New research by an international team of scientists, led by Rockefeller University researchers in Paul Greengard's laboratory of Molecular and Cellular Neuroscience, shows that a gene called p11 is closely related to serotonin transmission in the brain -- and may play a key role in determining a person's susceptibility to depression.

The newly discovered link between depression and the serotonin system, reported in the January 6 issue of the journal Science, could lead to new treatments for these mental disorders.

"We have shown that a gene called p11 is involved in the multiple complex changes that underlie depression," says Per Svenningsson, a research assistant professor and first-author on the paper. "Our findings demonstrate that patients with depression, and mice that model this disease, have decreased levels of p11 protein, and they suggest that drugs that increase p11 are likely to have anti-depressant properties."

Serotonin binds to 14 different receptors on a cell's surface. One receptor in particular, known as 1B, plays a crucial role in regulating serotonin transmission in the brain. Recent studies have suggested a role for the serotonin 1B receptor in depression, as well as in obsessive-compulsive disorder, drug addiction, anxiety, aggression and sleep.

Intrigued by these studies, Svenningsson and colleagues at Rockefeller, the Karolinska Institute, the University of Rouen in France and Eli Lilly and Company, used a blind screen called a yeast two-hybrid screen to identify proteins that associate with the serotonin 1B receptor. They found an association with a protein called p11, a protein previously identified as a regulator of the localization of several proteins on the cell's surface.

The researchers analyzed tissue from a mouse model of depression as well as post-mortem tissue from depressed human patients, and found decreased levels of p11 protein in both cases. On the other hand, p11 levels increased in rats and mice that were treated with anti-depressant medications or electroconvulsive therapy.

To further test the connection, Svenningsson and his colleagues genetically engineered two strains of mice: one that produced more p11 than normal and another that produced no p11 at all. They found that mice that overexpress p11 were hyperactive and, in a test designed to identify depression in rodents, acted just like mice that were on anti-depressant medication. Mice that lacked p11, meanwhile, acted depressed and showed less responsivity to anti-depressant medications.

Taken together, the findings point to p11 as a new target for developing depression treatments.

"In addition to exploring ways to increase p11 in depressed patients, it may also be possible to develop peptide-based compounds that can mimic the action of p11 to achieve a new class of anti-depressant compounds," Svenningsson says.

In addition to Svenningsson and Greengard, the study's other authors are Ilan Rachleff and Marc Flajolet at Rockefeller; Karima Chergui and Xiaoqun Zhang at Karolinska; Malika El Yacoubi and Jean-Marie Vaugeois at the University of Rouen; and George G. Nomikos at Eli Lilly.

This study was supported by the U.S. Public Health Service and the Swedish Research Council.

Joseph Bonner
bonnerj@rockefeller.edu
Rockefeller University
http://www.rockefeller.edu

New No-Needle, No-Scalpel Vasectomy Technique Safe and Effective, Study Shows

A new anesthetic technique for vasectomy that does not involve the use of needles has been shown to be safe and effective, according to a recent study presented by Dr. Marc Goldstein of NewYork-Presbyterian Hospital/Weill Cornell Medical Center's Department of Urology. NewYork-Presbyterian/Weill Cornell is the first and only site in the Northeast to offer the new technique.

Among the 1,391 patients anesthetized using the no-needle technique, the average visual analogue scale (VAS) pain score for the injection was 1.65 of a maximum 10. The average VAS score during the surgical procedure was 0.67. No adverse effects were associated with the technique, reported the study, which was authored by Dr. Ronald Weiss of the University of Ottawa School of Medicine, along with NewYork-Presbyterian/Weill Cornell's Dr. Goldstein and Dr. Philip Shihua Li.

"One straight-forward benefit of eliminating needles is that people don't like needles," says Dr. Goldstein, who performed the first no-needle case in the Northeast in October 2004. "In conjunction with no-scalpel vasectomy, developed in China and introduced by me in the U.S. in 1985, no-needle vasectomy helps reduce men's fear of the procedure and represents the next step in the evolution of minimally invasive vasectomy techniques."

Dr. Goldstein is Surgeon-in-Chief of Male Reproductive Medicine and Surgery at NewYork-Presbyterian/Weill Cornell, and Professor of Urology and Reproductive Medicine at Weill Medical College of Cornell University. Dr. Li is Assistant Research Professor of Urology and Reproductive Medicine, and Director of Microsurgical Training and Research at Weill Cornell. No-scalpel vasectomy -- unlike conventional vasectomy, which involves two scrotal incisions -- involves one tiny puncture, resulting in fewer complications and quicker recovery time.

The MadaJet non-needle anesthetic, manufactured by MADA Medical Products, Inc., of Carlstadt, NJ, has been widely used in many surgical fields such as dermatology, cosmetic surgery, dentistry and podiatry, as well as for immunization. The FDA-approved device employs a high-pressure spray of anesthetic solution that is delivered through the scrotal skin and the tissue around the vas.

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Old Test Offers New Hope For Back Pain Sufferers

A test that has been around since World War II is now providing that era's baby boomer generation with a more definitive diagnosis for the back aches and pains that commonly come with age.

Results from a new University of Michigan Health System study show that the electromyogram (EMG) test can accurately diagnosis spinal stenosis, reducing misdiagnosis of low back pain and other common neuromuscular conditions that have similar symptoms, and even helping to avoid unnecessary back surgery.

The findings from this study are published in this month's issue of Spine.

An estimated 400,000 Americans have spinal stenosis, a narrowing of spaces in the spine that results in pressure on the spinal cord and nerves and can lead to debilitating back pain or even paralysis if left untreated. And the number of people affected by spinal stenosis is only expected to grow as more baby boomers reach their 50s and 60s.

The problem, however, is that the symptoms of spinal stenosis are shared by many other diseases, including peripheral nerve disease and even arthritis in the joints, which can lead to costly misdiagnoses and unnecessary back surgery, says study lead author Andrew Haig, M.D., associate professor in the Department of Physical Medicine and Rehabilitation at the U-M Medical School.

“EMG plays an important role in the diagnosis of back pain because, unlike MRI (magnetic resonance imaging), EMG is more than a picture of a nerve - it can test nerve function and show if there is actual nerve damage,” says Haig. “The EMG is really going to help doctors to avoid unnecessary procedures because it proves that there is nerve damage in the people who clearly have it and can accurately diagnosis spinal stenosis.”

Although EMG has been around for about 60 years, there have been no controlled studies of EMG for spinal stenosis. Further, many past studies of spinal stenosis had only looked at asymptomatic patients, while others failed to include comparison groups for patients with back pain or symptoms of spinal stenosis.

For their study, Haig and his colleagues used 150 participants, ages 55 to 80, to determine how well EMG could find the source of back pain. Participants included those with low back pain but no MRI evidence of spinal stenosis, those with varying severity of spinal stenosis, and individuals who had no symptoms of either condition.

To test the accuracy of EMG, each patient first underwent a physical history, a physical examination and MRI. The data was then reviewed by a physiatrist, neurosurgeon and neuroradiologist, all of whom were masked to any outside information about the patients' conditions, and a unanimous diagnosis was made about each patient's condition.

Following the diagnosis, study participants underwent EMG testing. The EMG results were then compared against the initial diagnosis of the physiatrist, neurosurgeon and neuroradiologist.

The study found that EMG identified nerve or muscle disease in five participants whom medical experts all believed to have spinal stenosis.

In all, the results from the EMG show a substantial difference between the spinal stenosis patients and the two control groups, allowing experts to clearly distinguish spinal stenosis from low back pain. Additionally, EMG successfully detected common neuromuscular disease that can mimic spinal stenosis.

“Most doctors think of EMG as a simple test and incorrectly believe that it is sensitive for nerve damage, but cannot differentiate spinal stenosis form neuromuscular disease,” explains Haig. “But as this study shows, that's not the case. In fact, EMG is an excellent test for spinal stenosis and other neuromuscular disorders using strict evidence-based criteria.”

As a result, MRI shouldn't be used as the only proof that a patient has spinal stenosis, Haig says. Many patients, as this study shows, are misdiagnosed. Some of those patients instead were found to have some form of nerve illness.

Currently Haig and his colleagues are working to further the findings from this study. The team's next study directly compares EMG and MRI to determine which test is best for detecting spinal stenosis. The research also looks to find if either test can predict what happens to people with back pain over time. Results from this study are expected to be published soon.

Along with Haig, co-authors from the U-M Health System were Henry C. Tong, M.D., MS; Karen S. J. Yamakawa, MS; Douglas J. Quint, M.D.; Julian T. Hoff, M.D.; Anthony Chiodo, M.D.; Jennifer A Miner, MBA; Vaishali R. Choksi, M.D.; and Michael E. Geisser, Ph.D.

This study was funded by National Institutes of Health grant 5ROI NF4 1855 02.
Reference: Spine, Vol. 30, No. 23.

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Tamiflu Approved to Prevent Flu in Kids Under 12

But it's not a substitute for a flu shot, FDA says

FRIDAY, Dec. 23 (HealthDay News) -- The Roche Pharmaceuticals drug Tamiflu (oseltamivir phosphate) has been approved by the U.S. Food and Drug Administration to prevent flu in children 1 to 12 years of age. While it's the first drug approved to prevent both the A and B types of flu in children, Tamiflu is not a substitute for the annual flu vaccine, the FDA warned.

In a study of 222 children, the drug reduced the incidence of flu from 17 percent among those who received no preventive treatment to 3 percent in the group that received Tamiflu. The benefit in children mirrored results from previous trials involving adults, the FDA said.

Common side effects included nausea, vomiting, headache, and fatigue. Vomiting was reported more often among children who received a twice-daily dose of the drug than among those given Tamiflu once a day.

The FDA warned that people should stop taking Tamiflu if they develop a severe skin rash or allergic symptoms. The agency said it asked Roche to conduct additional studies of the drug's long-term safety.

The oral anti-viral drug was first approved in 1999 to treat and prevent influenza in adults. It was subsequently sanctioned to treat the illness in children older than 1 year.

More information

Check this FDA site (www.fda.gov ) to learn more about Tamifl

In healthy volunteers, the equivalent of two cups of coffee reduced the body's ability to boost blood flow to the heart muscle in response to exercise

The body's ability to heal even small skin wounds normally slows down as we age. But a new study in older adults finds that regular exercise may speed up the wound-healing process by as much as 25 percent.

"This is the first time we've been able to document this kind of enhancement associated with exercise," said Charles Emery, a professor of psychology and the lead author of the Ohio State University study.

The faster that a wound heals, the less chance it will become infected.

The results appear in a recent issue of the Journal of Gerontology: Medical Sciences.

The study included 28 healthy older adults ranging in age from 55 to 77 (average age was 61). The participants hadn't exercised regularly for at least six months prior to the study. For the research, about half (13) of them exercised three times a week for three months. The other 15 participants served as controls and were asked not to change their physical activity habits during the study period.

Each subject received a small puncture wound on the back of the upper arm. Adults in the exercise group started working out about a month before the wound procedure; this gave their bodies enough time to adapt to a regular exercise program.

The wounds were about 1/8-inch across and deep. The researchers photographed the wounds three times a week until the wounds were no longer visible (about six to seven weeks).

The exercise sessions began with 10 minutes of warm-up floor exercises and stretching followed by 30 minutes of pedaling on a stationary bike. After that, participants either jogged or walked briskly on a treadmill for 15 minutes, followed by about 15 minutes of strength training. All sessions ended with five minutes of cool-down exercises.

Each participant completed assessments of exercise endurance and stress at the beginning and end of the study. The exercise endurance test, completed on a treadmill, measured each subject's aerobic fitness level by measuring how much oxygen he or she consumed while working out.

The researchers also collected saliva samples from each participant in order to measure levels of cortisol, a primary stress hormone. High cortisol levels indicate that the body is under stress; prior studies have suggested that exercise is associated with lower levels cortisol.

Lastly, each subject completed a questionnaire called the Perceived Stress Scale. This scale let the researchers determine how stressful the respondents perceived their lives to be.

At the end of the study, the researchers found that skin wounds healed an average of 10 days faster in the people who exercised (29 days in the exercise group vs. 39 days in the non-exercise group.)

Not surprisingly, exercise endurance increased in the group that worked out, but remained the same in the non-exercise group.

The researchers were somewhat surprised to find a sharp increase in cortisol levels in the exercise group. The hormone is typically boosted by stress, and other studies have suggested that exercise may lower levels of stress.

"The stress of exercise may enhance the regulation of cortisol," Emery said. "This increase in cortisol levels may represent a biological pathway by which exercise helps wounds heal."

There were no changes in perceived stress in either group but none of the adults in this study reported any significant distress in their lives at the beginning of the study.

The current study supports the results of a related study on wound healing conducted at Ohio State a few years ago. That work compared wound-healing rates between older adults caring for a loved one with Alzheimer's disease to rates of older adults who weren't caregivers.

The healing rates of those who weren't caregivers was similar to the healing rates of the non-exercisers in the current studying - wounds in both groups healed in about 40 days. Wounds among older caregivers took about 20 percent longer to completely heal.

"The findings from both studies indicate that the effect of exercise we found in the current study truly represents an enhanced rate of wound healing in older adults," Emery said.

The next step is to determine if older adults who report a fair amount of stress in their lives - such as dealing with the death of a spouse or financial troubles - get the same kind of benefit from exercise.

Emery conducted this study with Ohio State colleagues Janice Kiecolt-Glaser, professor of psychiatry and psychology; Ronald Glaser, director of both the Center for Stress and Wound Healing and the Institute for Behavioral Medicine Research; William Malarkey, associate director of the Center for Stress and Wound Healing; and David Frid, who is currently with Pfizer, Inc.

Support for this work came from several organizations within the National Institutes of Health: the National Heart, Lung and Blood Institute; the National Institute on Aging; the National Institute of Dental and Craniofacial Research; the National Cancer Institute; and the National Center for Research Resources.

Written by Holly Wagner

Charles Emery
emery@psy.ohio-state.edu
Ohio State University
http://researchnews.osu.edu

Coffee Limits Blood Flow To Heart Muscle During Exercise

In healthy volunteers, the equivalent of two cups of coffee reduced the body's ability to boost blood flow to the heart muscle in response to exercise, and the effect was stronger when the participants were in a chamber simulating high altitude, according to a new study in the Jan. 17, 2006, issue of the Journal of the American College of Cardiology.

"Whenever we do a physical exercise, myocardial blood flow has to increase in order to match the increased need of oxygen. We found that caffeine may adversely affect this mechanism. It partly blunts the needed increase in flow," said Philipp A. Kaufmann, M.D., F.A.C.C., from the University Hospital Zurich and Center for Integrative Human Physiology CIHP in Zurich,.

The researchers, including lead author Mehdi Namdar, M.D., F.A.C.C., studied 18 young, healthy people who were regular coffee drinkers. The participants did not drink any coffee for 36 hours prior to the study testing. In one part of the study, PET scans that showed blood flow in the hearts of 10 participants were performed before and immediately after they rode a stationary exercise bicycle. In the second part of the study, the same type of myocardial blood-flow measurements were done in 8 participants who were in a chamber simulating the thin air at about 15,000 feet (4,500 meters) altitude. The high-altitude test was designed to mimic the way coronary artery disease deprives the heart muscle of sufficient oxygen. In both groups, the testing procedure was repeated 50 minutes after each participant swallowed a tablet containing 200 milligrams of caffeine, the equivalent of two cups of coffee.

The caffeine dose did not affect blood flow within the heart muscle while the participants were at rest. However, the blood flow measurements taken immediately after exercise were significantly lower after the participants had taken caffeine tablets. The effect was pronounced in the group in the high-altitude chamber.

Blood flow normally increases in response to exercise, and the results indicate that caffeine reduces the body's ability to boost blood flow to the muscle of the heart on demand. The ratio of exercise blood flow to resting blood flow, called the myocardial flow reserve, was 22 percent lower in the group at normal air pressure after ingesting caffeine and 39 percent lower in the group in the high-altitude chamber. Dr. Kaufmann said that caffeine may block certain receptors in the walls of blood vessels, interfering with the normal process by which adenosine signals blood vessels to dilate in response to the demands of physical activity.

"Although these findings seem not to have a clinical importance in healthy volunteers, they may raise safety questions in patients with reduced coronary flow reserve, as seen in coronary artery disease, particularly before physical exercise and at high-altitude exposure," the researchers wrote.

Although caffeine is a stimulant, these results also indicate that coffee may not necessarily boost athletic performance.

"We now have good evidence that, at the level of myocardial blood flow, caffeine is not a useful stimulant. It may be a stimulant at the cerebral level in terms of being more awake and alert, which may subjectively give the feeling of having better physical performance. But I now would not recommend that any athlete drink caffeine before sports. It may not be a physical stimulant, and may even adversely affect physical performance," Dr. Kaufmann said. "It may not be as harmless as we thought before, particularly if you suffer from coronary artery disease or if you are in the mountains."

Dr. Kaufmann noted that this study was not designed to measure athletic performance.

Although the participants were all healthy, Dr. Kaufmann said that the results raise concerns about possible effects of caffeine in people with heart disease.

"Any advice would be based on results of healthy volunteers and would be a bit speculative; nevertheless, my advice would be: do not drink coffee before doing physical activities. We hope to be able to provide data soon on the situation of patients with coronary artery disease," he said.

The researchers noted that other studies of coffee and heart disease have produced mixed results.

Although this study included only 18 participants, the researchers said that the differences they saw were large enough for them to be confident that the effect of caffeine on heart muscle blood flow is real. They pointed out that longer studies of people with heart disease will be needed in order to understand whether the blood flow effects have important health consequences.

Thomas H. Schindler, M.D. from the David Geffen School of Medicine at UCLA in Los Angeles, California, who was not connected with this study, said that if the results are confirmed, they could have important implications.

"In particular, this may play an important role in patients with obstructive coronary artery disease in the intermediate range between 50 percent and 85 percent narrowing of the epicardial luminal diameter. In this range of coronary artery disease-induced epicardial narrowing, the myocardial flow reserve (MFR) has been widely assumed to compensate for the epicardial narrowing and, thereby, to preserve the myocardial blood flow to the heart. A further reduction of the MFR, for example owing to caffeine intake, therefore could precipitate stress-induced myocardial ischemia, angina pectoris (reflecting an imbalance between myocardial oxygen supply and demand) or could also contribute to the manifestation of acute coronary syndromes. Consequently, as stated by Namdar et al., the current findings indeed raise safety questions in patients with already reduced MFR as seen in coronary artery disease, particularly before physical exercise and at high-altitude exposure," Dr. Schindler said.

Dr. Schindler said that further studies will be needed to answer the important questions raised by this study.

Disclosure Box
Dr. Kaufmann was supported by a grant from the Swiss National Science Foundation.

Amy Murphy
amurphy@acc.org
American College of Cardiology
www.acc.org

Vitamin D Supplementation During Pregnancy Could Reduce Osteoporosis In Children

Vitamin D supplementation of pregnant women could lead to longlasting reduction in osteoporotic fractures in their children, according to a study published in this week's issue of The Lancet. The study shows that children whose mothers were lacking in vitamin D during pregnancy grow up to have weaker bones.

Vitamin D insufficiency is common in women of childbearing age. Professor Cyrus Cooper (MRC Epidemiology Resource Centre, Southampton General Hospital, UK) and colleagues studied 198 children born in 1991-92. The body build, nutrition, and vitamin D supplementation of their mothers were measured during pregnancy. The children were then followed up at age 9 years to relate these maternal characteristics to their body size and bone mass.

Women who took vitamin D supplements and women who were exposed to higher levels of sunshine in pregnancy were less likely to be deficient in vitamin D. Sunlight helps the body to make its own vitamin D. Giving women supplements of vitamin D, particularly if they are pregnant during the winter months when sunlight levels are low, should help their children's bones grow stronger.

Professor Cooper states: "These findings provide evidence that maternal vitamin D status during pregnancy influences the bone growth of the offspring, and their risk of osteoporosis in later life. The results add to a large body of evidence that intrauterine and early postnatal development contributes to bone mineral accrual and thereby osteoporosis risk; they also point to preventive strategies which now require evaluation in randomised controlled trials." (quote by e-mail, does not appear in published paper)

Joe Santangelo
j.santangelo@elsevier.com
Lancet
www.thelancet.com