Blood pressure rising around the globe
Tue, 15 May 2007 04:29:47 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - The numbers are a shock: Almost 1 billion people worldwide have high blood pressure, and over half a billion more will harbor this silent killer by 2025. It's not just a problem for the ever-fattening Western world. Even in parts of Africa, high blood pressure is becoming common.
That translates into millions of deaths from heart disease alone. Yet hypertension doesn't command the attention of, say, bird flu, which so far has killed fewer than 200 people.
"Hypertension has gone a bit out of fashion," says Dr. Jan Ostergren of Sweden's Karolinska University Hospital, who co-authored a first-of-its-kind analysis of the global impact of high blood pressure.
The idea: to rev up world governments to fight bad blood pressure just as countries have banded together in the past to fight infectious diseases.
International heart specialists welcome the push.
"Even in the U.S., the majority of people with high blood pressure are not treated adequately," says Dr. Sidney Smith of the University of North Carolina at Chapel Hill, who advises the World Heart Federation. "Look at China, look at Africa, go around the world. It is a major risk factor."
And the dangers go well beyond the heart. High blood pressure is a leading cause of strokes and kidney failure. It also plays a role in blindness and even dementia.
Patients seldom notice symptoms until organs already have been damaged.
Yet treating high blood pressure before that happens is a medical best-buy. Improving diet and exercise can help. When that's not enough, blood pressure drugs are among the oldest and thus cheapest on the market — 21 cents a day for a leading diuretic.
Ostergren joined experts from the London School of Economics and the State University of New York to assemble two teams of specialists and map what they call the coming crisis of hypertension: 1.56 billion people are expected to have it by 2025.
With funding from drug maker Novartis Pharma AG, they're providing copies to governments and health officials around the globe; a briefing in Washington is set for Thursday.
The report essentially calls for a cultural change. Consider: In the U.S., commiserating over blood pressure readings is an accepted dinner-table topic. Because black Americans are at especially high risk — roughly 40 percent are affected — hypertension has become a sermon topic at majority-black churches, and post-service screenings aren't uncommon. The government even advertises about the condition.
That adds up to an openness about blood pressure not seen in much of the world, says report co-author Dr. Michael Weber of SUNY's Downstate College of Medicine.
In some regions, "it's sort of an insult to your manhood if you have to take a blood-pressure medicine," Weber says, citing estimates that hypertension affects about one in three adults in Mexico, Paraguay and Venezuela.
"We need to break those barriers as well and make it perfectly fashionable. We need to get role models in those countries to say, 'You know what? I've got high blood pressure.'"
The U.S. still needs to improve, too, Weber hastens to add. High blood pressure affects nearly one in three adult Americans as well, or 72 million people. About a third have their condition well-controlled, not nearly enough but better than other countries that track treatment, the report found.
Normal blood pressure is measured at less than 120 over 80. Anyone can get high blood pressure, a level of 140 over 90 or more. But being overweight and inactive, and eating too much salt, all increase the risk. So does getting older.
The world's population is aging and fattening, fueling a continued increase in blood pressure problems. Remarkably, the report cites worse hypertension rates in much of Western Europe than in the U.S., despite cultural similarities: 38 percent in England, Sweden and Italy; 45 percent in Spain; 55 percent in Germany.
But the biggest jump is expected in developing countries and nations rapidly moving to more Western-style economies, the report warns. In parts of India, studies suggest one in three urban adults has high blood pressure, while it's still rare in rural areas with more traditional lifestyles. More than a quarter of adults in China have hypertension. So do one in four in Ghana and South Africa.
Treatment is difficult, because patients often quit their medicine, not understanding it's necessary even when they feel good. Also, doctors may be reluctant to prescribe the two- or three-drug combinations that half of patients wind up needing.
For poorer countries, the tab for even low-cost diuretics is an issue — not to mention public education about sticking to treatment, notes Smith, the World Heart Federation adviser, who was not involved in the new report.
But fighting bad blood pressure could mean that developing countries avoid epidemics of full-blown heart disease, which they definitely can't afford, Smith stresses. World health and economic groups already are brainstorming strategies to help, such as whether industries that move into poor countries should be required to screen their workers for high blood pressure.
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EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Boy receives new heart at Ark. hospital
Tue, 15 May 2007 02:54:22 GMTBy JON GAMBRELL, Associated Press Writer
LITTLE ROCK - An 8-year-old boy from Mexico received a new heart Monday to replace his diseased one, after spending weeks in a Texas intensive care unit and getting a rare implanted heart pump in Arkansas.
Adrian Saucedo went into surgery just after 3 a.m. for a procedure that lasted about seven hours, said Dr. Elizabeth Frazier, head of the cardiac transplantation program at Arkansas Children's Hospital.
His new heart, flown into Little Rock by an accompanying physician, began beating after warming inside the boy's chest, requiring no electrical shock to come back to life, Frazier said.
"It's always a miracle," Frazier told reporters at a news conference Monday afternoon. "Every time it happens, it's a miracle."
Frazier said Adrian would remain on a ventilator for about a day, then would have the tube removed from his throat so he could speak. Within four to five days, the doctor said Adrian would be up and moving around, a vast improvement for a boy who only weeks earlier needed an experimental heart pump implanted in his chest for him to continue living.
Adrian lives with his mother and father in Piedras Negras, Mexico, just across the border from Eagle Pass, Texas. He spent more than 60 days at Methodist Children's Hospital of South Texas, after doctors determined he suffered from cardiomyopathy — a condition caused in his case by a viral infection eating away at his heart tissue.
While several hospitals rejected him as a transplant patient, residents of San Antonio, Texas, raised half a million dollars for the boy's treatment. Arkansas Children's Hospital in Little Rock admitted Adrian on April 19.
But within days of his arrival, Adrian's condition worsened. Doctors implanted a Berlin heart, the only blood pump available for children at risk of heart failure — a rarity as the U.S. Food and Drug Administration only allows it in the most extreme circumstances.
Frazier said the hospital received word Sunday a heart matching Adrian's blood type and weight was available. Frazier said privacy rules prohibited her from saying where the heart came from. However, she said Dr. Robert D.B. "Jake" Jaquiss, the hospital's chief of pediatric cardiothoracic surgery, flew on a jet to retrieve the heart and bring it back to Little Rock.
The boy went into surgery with Dr. Michiaki Imamura and the hospital's heart team, even before the jet carrying the heart landed, she said.
"Fortunately, the donor heart in this situation promptly started once it warmed up," Frazier said. "It seems to be functioning well within the parameters we look at, but the first 24 to 48 hours is critical. Once things stabilize and his medications are stabilized, then we would hope that he would make progress as far as getting off of the breathing machine."
Currently, the boy and his family are in the United States on a humanitarian visa, and they plan to return home. Frazier said doctors at the hospital spoke with Mexican physicians about the care Adrian would need.
While Adrian's hospital care likely will exceed the half a million dollars raised for him, Frazier said the hospital would handle the rest of the finances without offering specifics. An official from Little Rock's Mexican consulate also attended the news conference.
Frazier said Adrian's chances at a full recovery were good — 75 percent of all children who have heart transplants survive with chances even better for those who suffer the disease Adrian had. But the boy could face infection from the operation or kidney damage from being on the bypass machine.
"We're not out of the woods 'til we're out of the woods," Frazier said. "There's always that question in that once you transport a heart is it going to restart and how good is it going to feel about it. We've passed that hurdle."
FDA FluMist effective for kids under 5
Mon, 14 May 2007 22:17:59 GMTBy MATTHEW PERRONE, AP Business Writer
WASHINGTON - Federal regulators say MedImmune's nasal spray flu vaccine is effective for children under age 5, even though it may increase the risk of respiratory problems.
The vaccine, Flumist, was once thought to be a possible blockbuster drug, but has had modest sales because approved use is limited to healthy people between the age of 5 and 49 years old.
MedImmune wants Food and Drug Administration approval to market the nasal spray vaccine to young children, which could provide a major revenue boost for the company since the U.S. Centers for Disease Control and Prevention recommends children between 6 months and six years old get an annual influenza virus vaccine.
Flumist sales totaled $36.4 million last year, well behind MedImmune's top-selling respiratory virus drug Synagis, which posted sales of $1.1 billion.
The FDA said in documents posted to its Web site Monday that the vaccine appears to prevent influenza in children as young as six months. However, reviewers also noted that children taking MedImmune's nasal spray vaccine were more likely to develop wheezing problems when compared to children treated with an injectable vaccine.
According to one FDA-reviewed study, about 3 percent of children 6 months to 1 year old who took Flumist were hospitalized for respiratory problems compared to 1 percent of children that age who took the injected vaccine.
Although the respiratory problems did not cause any deaths, FDA will ask a panel of outside experts Wednesday whether the side effects warrant limiting the vaccine's use in young children. FDA is not obligated to follow the panel's recommendation though it usually does.
Earlier this year MedImmune won the FDA's OK to market a new version of Flumist, which was first approved in 2003, that can be stored in refrigerators instead of freezers. The company said the new formulation should expand the vaccine's use and will be available for the 2007-2008 flu season.
Last month, Gaithersburg, Md.-based MedImmune agreed to be bought out by British drug maker AstraZeneca for $15.6 billion. The deal is expected to close in June.
Shares of MedImmune Inc. rose 2 cents to close at $57.02 on the Nasdaq Stock Market.
Okla. professors develop cancer protein
Mon, 14 May 2007 21:04:46 GMTNORMAN, Okla. - Two professors at the University of Oklahoma say they've developed a protein that can stop the spread of certain cancer cells without damaging normal cells.
Thomas Pento and Roger Harrison helped develop a fusion protein that keeps some types of cancer cells from ingesting a vital protein called methionine. The fusion protein doesn't affect normal cells because, unlike cancer cells, they can be healthy without that protein.
Chemotherapy and radiation therapies kill normal cells along with cancer cells, which often cause sickness and hair loss.
"Roger has created a mechanism that delivers these compounds specifically to the surface of cancer cells so normal cells won't be affected but only the cancer cells will be damaged," Pento said.
"So you can see it would cause a lot less toxicity and it should really be a lot more effective."
Pento is a Noble Foundation presidential professor of pharmacy at the OU Health Sciences Center; Harrison is an associate professor of chemical, biological and materials engineering on the Norman campus. They worked with other OU scientists, including Xiao-Ping Zang, Naveen Palwai, Megan Lerner and Dan Brackett, research director at the Health Sciences Center's surgery department.
Pento said the research started with breast cancer and expanded to include other types of solid tumors.
They found the fusion protein to be just as helpful in fighting lung, prostate and pancreatic cancers.
"It could be applicable to many types of cancer," Pento said, "but we've found that it's effective for those four types of cancer for sure."
Despite successful testing to this point, Harrison said the fusion protein will need another round of animal tests before moving on to years of human clinical testing.
Three phases of clinical tests could take two years each.
"So it could be in the order of 10 years," he said.
"It sounds so far away, but realistically, given the FDA and all the phases of testing, it could be done rapidly."
The two professors have applied for patents on their technology and plan to conduct animal testing themselves before launching their own company or licensing with a large pharmaceutical company to do it.
"If you don't patent it and get that protection, then no pharmaceutical company is going to spend the half to three-quarter billion dollars that it takes to do the clinical testing and to get this drug on the market," Pento said.
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Information from: The Oklahoman, http://www.newsok.com
PHIT program helps overweight kids and parents
Tue, 15 May 2007 18:41:03 GMTBy Megan Rauscher
NEW YORK - A comprehensive weight management program that educates underserved, ethnically diverse overweight kids and their parents about healthy eating, exercise and everyday issues like how to set goals, solve problems, deal with bullying and boost self esteem has shown promise in pilot testing.
&;Overall, we've seen high satisfaction with kids and parents,&; lead investigator Dr. Sarah Hampl of Children's Mercy Hospital, Kansas City, Missouri, told Reuters Health. &;Initial findings show kids are losing a modest amount of weight and their velocity of weight gain is dropping. Parents are benefiting as well.&;
In the program, called &;Promoting Health in Teens and Kids&; , conducted at the Children's Mercy Hospital, children between the ages of 9 and 18 years are first evaluated by a pediatrician, social worker, dietitian, and physical therapist. The children and their parents then participate in once-weekly group education sessions for 24 weeks, followed by monthly maintenance sessions for 24 months.
&;Clinic visits are paid for by insurance,&; Hampl explained, and the hospital and a local foundation pay for the educational visits. The initial results are based on data for 31 children and their parents.
Six months before the children and parents began the program, &;their weight and growth velocity were all on the rise, and by 24 weeks their weight has stabilized or they have lost a modest amount of weight -- on average about 5 pounds,&; Hampl said.
The children are also showing healthy changes in their insulin levels, reducing their risk of developing type 2 diabetes. PHIT program participants report drinking less sugar-laden drinks, eating more meals as a family and exercising more. Parents, for the most part, indicate their child's quality of life has improved with the program.
Hampl is also encouraged that the vast majority of participants are very satisfied with the program. &;We know that for any sort of lifestyle change to be successful, families must want it and like it. This seems to work,&; she said.
Hampl unveiled the initial PHIT program findings at the Pediatric Academic Societies meeting in Toronto.
Sex education creates storm in AIDSstricken India
Mon, 14 May 2007 13:03:26 GMTBy Krittivas Mukherjee
MUMBAI - Moves to bring sex out of the closet in largely conservative India have kicked up a morality debate between educators who say sex education will reduce HIV rates, and critics who fear it will corrupt young minds.
It's an emotive issue pitting modernists against conservatives in a country with the world's highest number of HIV cases at about 5.7 million, a figure that experts say may balloon to over 20 million by 2010.
Biology teacher Thelma Seqeira infuriates conservatives in India every time she tells her students about masturbation, condoms and homosexuality.
Seqeira is doing exactly what India's federal government wants the country's 29 states and seven federally-administered regions to do -- fight the exponential spread of HIV/ AIDS with information on safe sex.
&;Sex education is the best way to prepare my students for adolescence and protect them from HIV/AIDS,&; said Seqeira, who teaches at a private school in Maharashtra state, western India.
But the governments of Maharashtra, Gujarat and Madhya Pradesh don't agree. They have banned sex education at public schools because they say the learning modules are too explicit, and some pictures are too graphic.
Private schools are able to continue the lessons, but many have watered them down to avoid controversy.
The southern states of Kerala and Karnataka -- considered among India's progressive states with high literacy rates -- are also considering bans.
The Indian government has been unable to stop these bans even as it seeks to curb the spread of HIV. In India, about 86 percent of HIV infections occur through sexual intercourse, one key reason being that migrant workers in cities visit prostitutes and infect their wives when they return home.
KAMA SUTRA
Ignorance about sex is widespread in the land of the Kama Sutra, where explicit sex acts are celebrated in ancient temple architecture.
But at home, mothers hesitate to talk to daughters about something as simple as menstruation, and even the basics of the human reproductive system are taught with much embarrassment in schools.
Experts are calling for a change in prudish attitudes to help counter the spread of HIV/AIDS. They say the winds of change must first blow through the country's schools.
&;Sex education does not mean you are encouraging sex which is how it's interpreted,&; Renuka Chowdhury, India's minister for women and child development, told Reuters last month.
&;Sex education is an insurance for your child. It will protect your child.&;
Among the course elements that have generated much heat are discussions on homosexuality and descriptions of sex acts, including masturbation.
Proponents of the ban say the sex education course -- modeled on those taught in many Western countries, will make students imbibe &;decadent western morality.&;
They point to polls showing that an increasing number of young people -- mostly India's moneyed youngsters that live in cities -- have postponed marriage, but not sex.
An India Today poll revealed one in four Indian women between 18 and 30 in 11 cities had sex before marriage. One in three said she was open to having a sexual relationship even if she was not in love.
&;AIDS is spreading because of cultural decadence and sexual anarchy,&; said Shajar Khan, a prominent student leader who opposes sex education at schools.
Analysts say conservative political parties, such as the Hindu nationalist Bharatiya Janata Party, India's main opposition group, are panning sex education courses at least partly to make political capital out of opposing the West.
But for parents bringing up children in rapidly modernizing India, sex education may be a matter of life and death.
&;The argument that if you teach about sex the children are going to run out and have sex is very unfounded,&; said Roshni Behuria, a mother of two girls.
&;Killing the education bit won't reduce the propensity towards sex. But it just might end up killing safe-sex ignorant young people.&;
New test tells fetus sex after 6 weeks
Tue, 15 May 2007 18:36:38 GMTBy MARIA CHENG, AP Medical Writer
LONDON - A new test dubbed "Pink or Blue" promises to tell parents the sex of their fetus just six weeks into pregnancy, but critics question its reliability and say it could pose an array of ethical issues.
The British company DNA Worldwide launched the test last month for sale over the Internet targeting a broad world audience. A U.S. company has been selling the test online, mainly to Americans, since last year.
The company does not ship to countries including China and India, where there is sometimes a marked preference for boys over girls. Some experts suggested the test could lead some parents to abort if they were unhappy with the result.
The test works by analyzing fetal DNA that leaks into the mother's bloodstream. Some experts expressed doubts about the technique.
"The earlier in pregnancy that you do these tests, the less fetal DNA there will be around, and possibly, the less accurate the test will be," said Dr. Patrick O'Brien, a consultant obstetrician and spokesperson for the Royal College of Obstetricians and Gynecologists.
"At six weeks of pregnancy, it's questionable whether the technology is that good."
Parents willing to wait longer can get a head-to-toe ultrasound at 20 weeks that is almost 100 percent accurate. Invasive procedures like an amniocentesis — which carry a small risk of miscarriage — can be done at about 11 weeks.
Parents who order the Pink or Blue test receive a packet where the mother provides a spot of blood on a special card. That is sent back to the company's laboratories, and within four to six days, the gender of the fetus is revealed with up to 98 percent accuracy if instructions are properly followed, according to DNA Worldwide.
Because the test is marketed as "informational" rather than medical, it is not regulated by health authorities in Britain or abroad.
"We're trying to bridge the gap between science and the consumer," said David Nicholson, director of DNA Worldwide. "Many parents are very keen to know if it's a boy or a girl, and we are about providing that information."
The test works by detecting fetal DNA that can naturally be found in the mother's blood. It looks for the male-specific Y chromosome. If the Y chromosome is detected, the fetus is a boy. If not, it's a girl.
The Pink or Blue test is based on a method developed by Italian researchers, who published their research in the journal Human Genetics in 2005. They claimed the Y-chromosome could be reliably identified in the mother's bloodstream as early as six weeks into pregnancy.
DNA Worldwide offers customers a money-back guarantee if their results prove to be wrong. Of the hundreds of tests sold since the test went on sale in April, Nicholson says they have only had to refund one customer.
Even if DNA Worldwide's test is accurate, experts recommend that parents get professional advice.
"Someone who takes this test should talk to their physician if they're going to do anything with that information besides buying baby clothes or painting the nursery," said Dr. Rachel Masch, an obstetrician/gynecologist at New York University School of Medicine.
"And even in that case, they might have to make a lot of returns."
Other experts worried about ethical implications if parents use the information to select the gender of their babies, by getting an abortion if the test indicates the "wrong" sex.
"Sex-selection might encourage parents to view their kids as commodities," said Marcy Darnovsky, associate executive director of the Center for Genetics and Society, a U.S.-based public interest group. "Tests like this could normalize genetic selection and lead to a scenario where parents are one day picking out their child's characteristics from a catalogue," Darnovsky said.
Still, doctors said the technology behind the test could one day allow advanced genetic screening, like testing for chromosomal disorders such as Down Syndrome.
"If we had a safe and accurate genetic test to look at fetal DNA, that would be the holy grail," said O'Brien.
Too much of a good thing Vitamin link with cancer
Tue, 15 May 2007 18:42:50 GMTBy Julie Steenhuysen
CHICAGO - Men who pop too many vitamins in the hope of improving their health may in fact be raising their risk of the deadliest forms of prostate cancer, especially men with a family history of the disease, researchers said on Tuesday.
Researchers at the National Cancer Institute found that men who exceeded the recommended dose -- taking more than seven multivitamins a week -- increased the risk of advanced cancer by about 30 percent.
The researchers followed 295,344 men over five years to see if there was a link between multivitamin use and prostate cancer.
&;We didn't see any relationship with overall prostate cancer,&; said Dr. Michael Leitzmann, a National Cancer Institute investigator who worked on the study.
He said the increased risk from overuse of multivitamins was linked to more aggressive cancer that has spread beyond the prostate gland or cancer that proved fatal.
In men who took too many multivitamins, the risk of aggressive cancer increased by one third, and the risk of fatal prostate cancer doubled compared to those who took no multivitamins, according to the study, published in the Journal of the National Cancer Institute.
&;We only saw the increase among the subgroup of men who used multivitamins in excessive amounts,&; Leitzmann said in a telephone interview.
The researchers said the association was strongest in men with a family history of prostate cancer and men who also took selenium, beta-carotene or zinc supplements.
Just over a quarter of a million men will be diagnosed with prostate cancer in the United States this year, but fewer than 30,000 will die of it because the tumors grow slowly.
No studies have yet found that people benefit from taking multivitamin and mineral supplements, and some studies have found that vitamins like A and iron are toxic at high levels. Beta-carotene has been found to increase the risk of lung cancer in smokers.
Leitzmann said the researchers were not able to pinpoint which vitamin or supplement ingredient could be driving the cancer. What it does suggest is the need for more study,
&;It's certainly a red flag,&; he said.
The important thing, Leitzmann said, was that men should heed the dosage on their vitamin bottle and use as directed.
