Indonesia works to stem bird flu cases

Wed, 17 Jan 2007 07:19:09 GMT
By NINIEK KARMINI, Associated Press Writer
JAKARTA, Indonesia - Indonesia plans to slaughter hundreds of thousands of backyard chickens over the next few weeks in a bid to stem a surge in human deaths from the H5N1 virus, the health minister and other officials said Wednesday.
Indonesia has recorded 61 deaths from bird flu, including four in the last week.

Siti Fadilah Supari said local governments would issue regulations banning the rearing of poultry in residential areas, signaling a more forceful approach in the nation worst hit by the virus.

She said owners of chickens, ducks and other fowl would receive compensation of just under $1.50 per bird, with the main focus in the capital, Jakarta, and densely populated areas to the west where most of Indonesia's human infections have occurred.

The country's cash-strapped government has come under fire for failing to take steps to stamp out the virus and has largely failed to follow through on earlier promises to stamp out the virus through mass slaughters.

In an early sign of possible confusion about the campaign, Supari said it would occur within the next week, but Jakarta Governor Sutiyoso said residents would in the capital would have two weeks before officials began forcefully slaughtering birds.

Bird flu remains hard for humans to catch. But international experts fear it may mutate into a form that could spread easily between humans and potentially kill millions around the world, including in wealthy nations that have so far been spared human cases.

Until last week, Indonesia had not recorded any cases for six weeks — a lull that led some Indonesian officials to say they were succeeding in beating the disease. The World Health Organization cautioned that it was too soon to draw that conclusion.

Drug may delay pancreatic cancer return

Wed, 17 Jan 2007 02:43:04 GMT
By CARLA K. JOHNSON, Associated Press Writer
CHICAGO - Offering a glint of hope for treating a notorious killer, researchers found that a common chemotherapy drug can help pancreatic cancer patients who have undergone surgery stave off a return of the disease longer.
In the German study, the group receiving Gemzar, or gemcitabine, lived on average of 13.4 months without their cancer coming back. A comparison group that did not receive the drug lived without disease for 6.9 months.

The 6 1/2-month gain may look modest. And scientists said they have seen no difference so far in the overall survival rates between the two groups. But pancreatic cancer is such a rapid and efficient killer that the findings were still highly encouraging.

Pancreatic cancer has one of the worst chances of recovery of all types of cancer. Most patients are not diagnosed until the cancer has spread, and fewer than one in 10 patients are alive five years after diagnosis.

Only 20 percent of newly diagnosed patients are good candidates for surgery, the best hope for a cure. And even then, the disease returns in the vast majority of cases.

The new findings, when considered along with preliminary results from a large U.S. trial reported last year, suggest that chemotherapy after pancreatic cancer surgery should at least include gemcitabine.

The study appears in Wednesday's http://jama.ama-assn.org

Castro reportedly struggles with disease

Wed, 17 Jan 2007 00:13:09 GMT
By MARIA CHENG, AP Medical Writer
LONDON - The intestinal disease Fidel Castro is reportedly suffering from is usually easy to treat — but if complications develop in an elderly patient like the Cuban leader, it can quickly become a death sentence.
The Spanish newspaper El Pais reported Tuesday that the 80-year-old Castro is suffering from diverticulitis, an inflammation of the colon that can lead to serious infection if contents from the intestine leak into the abdomen.

In the elderly, the prognosis for this kind of infection is generally very poor — with the mortality rate as high as 90 percent. "Castro would definitely qualify as critically ill," said Dr. Roshini Rajapaksa, a gastroenterologist at New York University School of Medicine, referring to the report.

In a younger patient, even the severe complications Castro has reportedly suffered are not necessarily fatal. But Castro's advanced age is a major factor.

"When you're in your 80s, any complication can be fatal," said Dr. Joel Weinstock, director of the gastroenterology department at Tufts Medical School.

Still, it is possible that Castro could recover.

"If they get the infections under control, he should get stronger in the next few weeks," Weinstock said. "But given everything he's supposedly been through, it would be difficult. He's had a tough run."

About 65 percent of people develop weak spots, or bulges called diverticula, on their colons by age 85. In about 10 percent of cases, these pouches become inflamed, causing pain and other problems, a condition called diverticulitis. The illness can become life-threatening if other complications, such as infection, occur, requiring removal of part or all of the large intestine.

Patients with mild diverticulitis are usually treated with antibiotics, as well as being put on a liquid diet. El Pais reported that Castro had his entire large intestine removed, suggesting the infection was extremely severe.

Doctors then reportedly implanted a bile duct device, presumably to help drain the infected area, as Castro may have been too ill to have his gall bladder removed.

Additional problems — such as a clot caused by remaining immobile in bed, a heart attack due to increased stress or kidney failure — are still possible, experts said. In his weakened condition, Castro is also vulnerable to additional infections.

The El Pais report was not made public in Cuba, where the government controls the media and Cubans have become accustomed to very limited details about their ailing leader's health.

A Cuban diplomat called the report a "lie," and the government has not otherwise reacted.

In its report, El Pais cited two unidentified sources from Gregorio Maranon Hospital in Madrid, which employs surgeon Jose Luis Garcia Sabrido, who flew to Cuba in December to treat Castro. It said a grave infection in the large intestine, at least three failed operations and various complications have left Castro with a "very grave prognosis."

One of the journalists who wrote the article told The Associated Press that Sabrido was not one of the two sources. The journalist, Oriol Guell, said the sources were both doctors at the hospital, but declined to identify them.

El Pais said that in December, when Garcia Sabrido visited, Castro had an abdominal wound that was leaking more than half a pint of fluids a day, causing "a severe loss of nutrients." The Cuban leader was being fed intravenously, the report said.

Garcia Sabrido, the Madrid hospital's chief surgeon, could not immediately be reached for comment Tuesday. A secretary who answered the phone at his office said the doctor did not plan to comment on the report.

France touts rising fertility rate

Tue, 16 Jan 2007 17:58:30 GMT
By PIERRE-YVES ROGER, Associated Press Writer
PARIS - It's almost a "bebe" boom: France had more babies in 2006 than in any year in the last quarter-century, capping a decade of rising fertility that has bucked Europe's graying trend, the state statistics agency said Tuesday.
The government trumpeted the figures as a victory for family-friendly policies such as cheap day care and generous parental leave — many of which were launched under Socialists like presidential candidate Segolene Royal, who was family minister in the early 1990s, and have continued to grow under today's conservative government.

France had 830,000 new babies last year, the highest annual total since 1981, the Insee statistics agency said. That brought France's population to 63.4 million people as of Jan. 1, up from 62.9 million a year earlier.

The fertility rate was 2.0 children per woman, up from 1.92 in 2005 — and that might make France the most fertile nation in the European Union, Insee director Jean-Michel Charpin predicted.

In 2005, only Ireland had a higher fertility rate than France: the Irish rate was 1.99, to France's 1.94. Irish figures for 2006 were not yet available.

"The deciding factor comes from the fact that it is easier to reconcile professional activity and a family life here than in most other European countries," Charpin said at a news conference.

Families minister Philippe Bas called 2006 a good year for French births.

"This should encourage us to go even further in our ambitious family policy," Bas told lawmakers in parliament Tuesday.

The growing birth rate was a welcome boost for a government plagued by a stagnant economy, high unemployment and voter disillusionment with those in power.

France's fertility rate has been climbing steadily since 1996, Insee said, but it still has not passed 2.1 — considered what it takes to replace a population in developed countries. The rate in the United States is 2.1.

Charpin noted that the fertility rate among France's immigrant population was slightly higher than among the population at large, but said the difference was minimal.

France is one of the few countries in Europe where most of the population growth comes from births instead of from immigration. Insee predicted the fertility rate would remain high in the coming years.

Most European countries are concerned with how to stem a decades-long decline in fertility rates, fearing it could drag on economic growth and lead to skyrocketing pension bills, as the number of young people contributing to retirement schemes drops while the number of retirees climbs.

Among its pro-family measures, the French government offers euro750 a month to parents who take one year's unpaid leave from work after the birth of a third child. Large families also get shopping discounts and reduced fares on public transport. French fathers are also guaranteed paid paternity leave, a measure championed by Royal — herself a mother of four, who would be France's first woman president.

French life expectancy is also on the rise, at 77.1 years for men and 84 years for women, Insee said.

The number of French marriages is continuing to decline, as more and more French couples are choosing to form civil unions instead, Insee said.

Binge eating does not increase bypass surgery risk

Tue, 16 Jan 2007 18:39:28 GMT
By Will Boggs, MD
NEW YORK - Regular binge eating before surgery does not increase the risk of poor outcomes in the first year after gastric bypass surgery (also referred to as "bariatric" surgery), in extremely obese patients, according to a report in the Journal of Clinical Psychiatry.
"Whether or not individuals with binge eating problems represent a surgical risk or have a poor prognosis following surgery has been a topic of heated debate," Dr. Marney A. White told Reuters Health. "Our study found that bariatric patients -- regardless of whether or not they binge eat before surgery -- show substantial weight losses in the 12-months following surgery."

White from Yale University School of Medicine, New Haven, Connecticut and colleagues compared weight loss, depression, self-esteem, body dissatisfaction, and eating disorder features before surgery and at 12 months after surgery among 139 extremely obese patients.

Nearly 40 percent of the patients reported binge eating at least once during the 28 days before surgery, the authors report. About 10 percent met criteria for binge eating disorder.

Although the binge-eating patients tended to be more distressed before surgery than those who did not binge, the binge eaters experienced greater reductions in depression after surgery, to the extent that there were no significant group differences at follow-up.

Body mass index declined over the 12 months after surgery to a similar extent among regular binge-eaters, infrequent binge-eaters, and non-binge-eaters, the researchers note.

Overall, the average body mass index (the ratio of body weight to height) was 51.7 before surgery and 33.3 one year after surgery.

"Overall, pre-operative binge eating does not appear to be a negative prognostic indicator for surgery in the initial 12-month period following surgery, in that patients -- regardless of binge eating status -- show dramatic improvements in terms of weight loss and psychosocial functioning," White said.

"For the most part, binge eating remitted following surgery," White added. "However, those patients who reported preoperative binge eating did report slightly elevated eating-related disturbances following surgery. This underscores the need for continued follow-up care and the need to identify disturbed eating behaviors and/or psychosocial difficulties that may relate to longer-term outcomes."

The team stresses the results are limited to the first year after surgery. "We have planned follow-up studies to occur at later intervals to determine whether these findings persist," White said. "In particular, we are interested in the influence of binge eating in the context of the weight loss plateau and re-gain that occurs in the 2-10 year interval."

SOURCE: Journal of Clinical Psychiatry, December 2006.

One STD counseling session may not be enough

Tue, 16 Jan 2007 20:24:02 GMT

NEW YORK - Screening young women for sexually transmitted diseases can identify those who need treatment, but it may take more extensive efforts to lower their risk of future infections, new research suggests.
In a study of female military recruits, researchers found that screening, treatment and a brief counseling session did not change the women's sexual behavior or lower their odds of again becoming infected with an STD.

The findings suggest that young women need more than screening and one-time counseling, the study authors report in the journal Obstetrics & Gynecology.

Young women between the ages of 15 and 24 have the highest rate of STDs, including gonorrhea, chlamydia and trichomoniasis. Experts recommend routine STD screening for sexually active young women as a way to curb the problem.

However, it's been unclear whether people's behavior changes after STD screening and treatment, according to Dr. Loris Y. Hwang and colleagues at the University of California, San Francisco.

To investigate, the researchers followed 1,712 women, an average of 18 years old, in the Marine recruit training program. The women were screened for chlamydia, gonorrhea and trichomoniasis when they began the first 13 weeks of their training. Hwang's team also gave them a questionnaire about sexual history.

The women then had an average of 10 days vacation time before becoming another 3 weeks of training. At the end of this second phase, the women were again screened for STDs and were given questionnaires about their sexual activity during vacation.

At the start of the study, 12 percent of the recruits had one of the three STDs, most commonly chlamydia. These women received treatment and underwent a short counseling session about STDs and safer sex.

In the second round of questionnaires, the researchers found that 61 percent of the recruits said they'd had sex during vacation. Women who'd tested positive for an STD at the outset and those who did not were just as likely to report risky sex practices, including inconsistent condom use and casual sex.

Despite similar sexual behaviors, the women who initially tested positive for an STD were again more likely than their fellow recruits to test positive for an STD during the second round of screening.

The findings suggest that the "standard-of-care approach" of STD screening followed by a brief counseling session is not enough to change young women's sexual behavior, Hwang and her colleagues report.

In addition, the results suggest that STD "acquisition cannot be reliably predicted by a woman's history of risky sexual behaviors."

The researchers suggest that more detailed counseling, tailored to individuals rather than a one-size-fits-all approach, might be necessary.

SOURCE: Obstetrics & Gynecology, January 2007.

Doctors offered electronic prescription system

Tue, 16 Jan 2007 21:58:01 GMT
By Will Dunham
WASHINGTON - The National ePrescribing Patient Safety Initiative aims to coax physicians and pharmacies to use a Web-based prescription system designed to prevent medication errors often caused by illegible handwritten paper prescriptions.
At a news conference to unveil the plan, its advocates cited a 2006 Institute of Medicine report that found that more than 7,000 people die and at least 1.5 million are harmed by preventable medication errors in the United States annually.

They said the new system involves no cost to the doctor and requires minimal training.

The initiative involves several leading technology companies and health care providers, as well as politically well-connected figures including Newt Gingrich, former speaker of the U.S. House of Representatives.

"I'm very optimistic that e-prescribing is going to become commonly used," said Glen Tullman, CEO of Allscripts Healthcare Solutions Inc., a provider of medical software that along with computer maker Dell Inc. is leading the coalition of companies behind the plan.

Doctors are being invited to register for the program online at .

"In the 21st century, the legibility of a doctor's handwriting should not determine whether a patient lives or dies," said Gingrich, who founded the advocacy group Center for Health Transformation.

"Yet the paper prescription system has remained essentially unchanged for 200 years. There is simply no excuse for medical errors when they are caused by an antiquated system that can easily be modernized and replaced," Gingrich added.

Dr. Nancy Dickey, former president of the American Medical Association, called electronic prescribing a way to improve patient safety.

"You would think if you were a pharmacist and you couldn't clearly read what I had written, that you would simply pick up the phone and call. But it's astonishing how often they make their best guess," said Dickey, president of the Texas A&M University Health Science Center.

Only about a fifth of U.S. doctors currently prescribe drugs electronically, with the rest clinging to pen and paper.

Growth hormone doesnt slow aging

Tue, 16 Jan 2007 17:43:27 GMT

NEW YORK - The findings from a new study suggest that growth hormone is not a useful therapy for "setting back the clock" in elderly individuals. The beneficial changes in body composition that the hormone produces are small and side effects are common.
Growth hormone is widely used as anti-aging treatment, even though the US Food and Drug Administration has not approved it for this purpose, the researchers report in the Annals of Internal Medicine.

Secreted by the pituitary gland, growth hormone promotes growth during childhood and adolescence. It acts on the liver and other tissues to stimulate insulin-like growth factor, which leads to its effects. However, blood levels of circulating insulin-like growth factor tend to decrease as people age or become obese.

Several studies have shown that growth hormone treatment can improve body composition, bone density, cholesterol levels, and may even stave off death in growth-hormone deficient individuals. The safety and effectiveness in healthy individuals seeking an anti-aging solution, however, is unclear.

Dr. Hau Liu, from Stanford University in California, and colleagues examined the risks and benefits of hormone therapy in elderly individuals by analyzing data from relevant studies identified through a search of MEDLINE and EMBASE. Data from 31 studies with a total of 220 participants were included in the analysis.

The average patient age at the start of the study was 69 years and the most of the subjects were overweight but not obese. The average initial growth hormone dose was 14 micrograms per kilogram per day, and the average treatment duration was 27 weeks.

Although statistically significant, the drop in overall fat mass and the increase in lean body mass were small, -2.1 kg and 2.1 kg, respectively. The net effect of these changes, as expected, was that body weight did not change significantly.

Growth hormone therapy led to a decrease in total cholesterol levels, but the reduction was not statistically significant after accounting for body composition changes. Growth hormone had no apparent effect on bone density or fat levels in the blood plasma.

As noted, the side effects were common with growth hormone therapy and included swelling, joint pain, gynecomastia, , and carpal tunnel syndrome (painful compression of the median nerve that extends from the forearm into the wrist.) In addition, growth hormone therapy may have slightly increased the risk of diabetes.

"Although growth hormone has been widely publicized as an anti-aging therapy and initial studies suggest that it might be clinically beneficial and safe in the healthy elderly, we find little evidence to support these claims," the authors state. "On the basis of available evidence, growth hormone cannot be recommended for use among the healthy elderly."

SOURCE: Annals of Internal Medicine, January 16, 2007.

Gum disease linked to increased pancreatic cancer risk

Tue, 16 Jan 2007 23:14:18 GMT

WASHINGTON - Gum disease may increase the risk of the highly fatal cancer of the pancreas, according to a study published in the United States.
"Our study provides the first strong evidence that peridontal disease may increase the risk of pancreatic cancer," lead author Dominique Michaud, assistant professor of epidemiology at the Harvard School of Public Health, said in a statement.

"This finding is of significance as it may provide some new insights into the mechanism of this highly fatal disease," he said.

The study will appear in the January 17 issue of the Journal of the American Medical Association .

Periodontal disease is caused by bacterial infection or inflammation of the gums that over time causes loss of bone that supports the teeth.

Pancreatic cancer is the fourth leading cause of cancer deaths in the United States, expected to kill some 30,000 Americans in 2007, according to US statistics.

The cancer is very difficult to treat and little was previously known about what causes it, although it has been linked to cigarette smoking, obesity, diabetes type two and insulin resistance.

Two previous studies established a link between tooth loss caused by severe gum disease and pancreatic cancer, but one involved only smokers and the other was not conclusive because it did not control for smoking in the analysis.

The data for this new study was collected between 1986 to 2002 and included 51,529 men working in US health professions.

Researchers found 67 cases of gum disease among 216 cases of pancreatic cancer in the group.

One possible explanation for the results is that inflammation from gum disease may somehow cause the cancer, said Michaud.

Another is that individuals with periodontal disease have higher levels of oral bacteria or nitrosamines, a carcinogen found in beer, fish and pickled foods, in their mouths, that may play a role in the cancer.

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