Weightloss surgery boosts survival rate
Wed, 22 Aug 2007 21:04:15 GMTBy ALICIA CHANG, AP Science Writer
LOS ANGELES - The first long-term studies of stomach stapling and other radical obesity treatments show that they not only lead to lasting weight loss but also dramatically improve survival. The results are expected to lead to more such operations, possibly for less severely obese people, too.
Researchers in Sweden and the United States separately found that obese people who underwent drastic surgery had a 30 percent to 40 percent lower risk of dying seven to 10 years later compared with those who did not have such operations.
The research, published in Thursday's New England Journal of Medicine, should put to rest uncertainties about the benefits and risks of weight-loss surgery and may cause governments and insurers to rethink who should qualify for the procedure, some doctors said.
"It's going to dispel the notion that bariatric surgery is cosmetic surgery and support the notion that it saves lives," said Dr. Philip Schauer, director of bariatric surgery at the Cleveland Clinic in Ohio, who had no role in the research.
Obesity surgeries have surged in recent years along with global waistlines. In the United States alone, 177,600 operations were performed last year, according to the American Society for Metabolic & Bariatric Surgery. The most common method was gastric bypass, or stomach-stapling surgery, which reduces the stomach to a small walnut-sized pouch and bypasses part of the small intestine where digestion occurs.
The Swedish study is the longest look yet at how obesity surgery affects mortality.
Researchers led by Dr. Lars Sjostrom of Goteborg University compared 4,047 people with a body-mass index over 34 who had one of three types of surgery or received standard diet advice. BMI is a standard measure of height and weight and a BMI over 30 is considered obese.
After a decade, those in the surgery group lost 14 percent to 25 percent of their original weight compared to 2 percent in the other group. Of the 2,010 surgery patients, 101 died. There were 129 deaths in the comparison group of 2,037 people.
In the U.S. study, Ted Adams of the University of Utah led a team that looked at 7,925 severely obese people in the state who had gastric bypass. They were matched with similar people who did not have the operation and who were selected through their driver's license records listing height and weight.
After an average of seven years' follow-up, 213 people who had surgery died compared to 321 who did not have the procedure. The study did not look at weight loss.
Deaths from diabetes in the surgery group were dramatically cut by 92 percent; from cancer by 60 percent and from heart disease by 56 percent. Surprisingly, the surgery group had a higher risk of death from accidents, suicides and other causes not related to disease. The researchers were puzzled by this.
Both studies were done before surgery advances that have led to smaller incisions and faster recovery time. Experts say future long-term survival rates from obesity surgery should be even better.
While neither study was the gold standard test, where patients are randomly given one treatment or another, surgery's dramatic benefits make it ethically hard to deny patients the operation, said Dr. George Bray of the Pennington Biomedical Research Center at Louisiana State University.
Herb Olitsky, a 53-year-old business owner from New York City, credits his improved lifestyle to gastric bypass.
A diabetic, Olitsky was given months to live after developing a life-threatening bacterial infection near his heart muscles.
Olitsky, who stands 5 feet 8 inches, underwent stomach-stapling surgery in 1999 and went from 520 pounds to his current weight of 160. He no longer struggles to walk a quarter block and has managed to control his blood pressure and heart rate.
"I knew I had to get it and that's what's kept me alive," Olitsky said. "I'm healthier now than I've ever been."
More than 400 million people worldwide are obese and surgery is the only proven method to shed significant pounds in a short time. In the United States, it costs $17,000 to $35,000 and insurance coverage varies.
Weight-loss surgery is considered relatively safe with the risk of death from the surgery at less than 1 percent. Common complications include nutritional deficiency, gallstones and hernia.
U.S. guidelines recommend that surgery be considered only after traditional ways to slim down have failed. Candidates must be at least 100 pounds overweight and have a BMI over 40, or a BMI over 35 plus an obesity-related medical condition such as diabetes or high blood pressure.
This fall, a panel of experts from the National Institutes of Health will revisit the obesity surgery guidelines. It's not yet known whether a BMI change would be considered, said spokeswoman Susan Dambrauskas.
Susan Pisano, a spokeswoman for America's Health Insurance Plans, which represents 1,300 insurers, said the group will rely on any new recommendations from the federal government.
The Sweden study was paid for by the government-funded Swedish Medical Research Council, drug makers Hoffmann-La Roche Inc. and AstraZeneca PLC and Cederroth, which makes health care products. The U.S. study was supported by an NIH branch; one of the researchers has received a lecture fee from a company that makes equipment for obesity surgery.
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On the Net:
New England Journal: http://www.nejm.org
Body Mass Index calculator: http://www.nhlbisupport.com/bmi/bminojs.htm
Ruptured eardrum may signal brain injury
Wed, 22 Aug 2007 21:04:02 GMTBy MARILYNN MARCHIONE, AP Medical Writer
An unusual study by doctors treating blast victims at a field hospital in Iraq has found that ruptured eardrums may help reveal which troops are at risk of hidden brain injury.
The finding is important because many such brain injuries have been missed in the past, especially when more severe or obvious wounds demanded attention.
Researchers report their observation in a letter in Thursday's issue of the New England Journal of Medicine.
Diagnosing brain injury, especially mild damage, is based largely on subjective symptoms like irritability and forgetfulness. Imaging tests like CAT scans do not help, and neurological function tests are not very useful without baseline information.
"It's very early in the game of understanding how to evaluate this carefully," and better ways are badly needed, said Jordan Grafman, a brain injury expert at the National Institute of Neurological Disorders and Stroke. Grafman had no role in the study.
Researchers led by Air Force Lt. Col. Dr. Michael Xydakis checked all troops brought for treatment from roadside bombs and other explosions to the Air Force Theater Hospital in Balad, Iraq, during the last three months of 2005.
The study focused on the 210 surviving U.S. troops who were evaluated for eardrum rupture and loss of consciousness. Of those, 35 percent had ruptures and 36 percent had lost consciousness; the two were closely linked.
Those with ruptured eardrums had a nearly threefold greater risk of concussive brain injury.
The eardrum is only half a millimeter thick — thinner than a contact lens — and ruptures easily, Xydakis said. It is only half an inch from the brain, so "whatever hits the eardrum is going to hit the brain," such as the pressurized shock wave that follows an explosion, he explained.
Eardrum ruptures usually heal by themselves but occasionally need to be reattached. Concussive brain injuries have a variety of treatments, depending on severity and symptoms. Early detection is thought to improve the chances of avoiding permanent damage.
More research is needed to prove that eardrum rupture is a good marker for possible brain injury; Xydakis hopes that it will lead to more of these injuries being detected.
"We are the first to show this link," with a study done amid bombs and bullets flying in Iraq, he said. "It's a very challenging place to do this type of research."
Study challenges claim on AIDS remedies
Wed, 22 Aug 2007 20:11:21 GMTBy CLARE NULLIS, Associated Press Writer
CAPE TOWN, South Africa - A study by South African scientists said Wednesday there was no evidence that foods such as garlic and beetroot were a substitute for AIDS medicine, disputing claims by the country's health minister.
The report — confirming what experts worldwide have said — was likely to increase pressure on the minister, who has been ridiculed for promoting olive oil, garlic, lemon and the African potato for people with AIDS and for questioning the effectiveness of anti-retroviral drugs.
Health Minister Manto Tshabalala-Msimang is also under fire because of the dismissal of her deputy and over newspaper allegations her liver transplant may have been needed because of alcohol abuse. Recent news reports also said she was banned from Botswana for 10 years in the 1970s after being accused of theft at a hospital.
"The panel has concluded that no food, no component made from food, and no food supplement has been identified in any credible study as an effective alternative to appropriate medication," said professor Barry Mendelow, one of the authors of the 300-page study by the Academy of Science of South Africa.
The 15-member panel said healthy eating does appear to help slow the progression of AIDS and tuberculosis. But it cautioned that there was little reliable evidence about the influence of nutrition on the diseases.
"This contrasts dramatically with the huge cloud of often acrimonious controversy that hangs over the subject and has become a source of widespread concern in, and about, the government, both within and outside the country," the panel said.
Tshabalala-Msimang's spokesman could not be reached for comment on the report.
Controversy about the country's AIDS policy has raged for years, with critics accusing the government of doing too little to slow the epidemic, which affects an estimated 5.4 million South Africans. An estimated 900 people die each day of the disease in South Africa, and some 1,400 are newly infected. A report last year warned that only half the 15-year-olds now alive would live to celebrate their 60th birthdays.
In April, the government finalized a plan to halve the number of new infections by 2011 and extend treatment and care to 80 percent of those in need. But AIDS activists voiced concern about the commitment to those targets after the dismissal this month of Deputy Health Minister Nozizwe Madlala-Routledge, who was widely credited with revitalizing the AIDS campaign.
President Thabo Mbeki said he axed the deputy for not working as part of a team. But Madlala-Routledge and other critics say it was because she had differences with her 66-year-old boss, a close friend of Mbeki's from the anti-apartheid struggle.
Tshabalala-Msimang has attracted titles such as "Dr. Garlic" and "Dr. Beetroot" for her ideas on AIDS treatment.
"Raw garlic and a skin of the lemon — not only do they give you a beautiful face and skin, but they also protect you from disease," she told a news conference in 2005. "All I am bombarded about is anti-retrovirals, anti-retrovirals. There are other things we can be assisted in doing to respond to HIV/AIDS in this country."
The Academy of Science disagreed.
"One of our most important findings has been that nutrition is important for general health, but is not sufficient to contain either the HIV/AIDS or the tuberculosis epidemic," said panel member Dr. Dan Ncayiyana, editor of the South African Medical Journal. "We need a well-nourished nation. But a well-fed population on its own is not going to resist HIV/AIDS without anti-retroviral drugs."
The report said there might be unknown and unrecognized substances in edible and medicinal plants with beneficial effects. "However, until these suggested remedies have been proven to do more good than harm the panel cannot support their use," it said.
The opposition Democratic Alliance renewed calls for Mbeki to dismiss the health minister. It said the report was "yet another piece of evidence to contradict the minister's highly public and extremely damaging opinion that good nutrition is of equivalent value to anti-retrovirals in treating AIDS."
Survey Teens face stress at higher rate
Wed, 22 Aug 2007 20:07:11 GMTBy JOCELYN NOVECK and TREVOR TOMPSON, Associated Press Writers
NEW YORK - Stressed out by your high-pressured job? Don't assume your kid is any less stressed out by school, especially if she's a she. Young people experience stress at a high rate, and females more than males, an extensive Associated Press/MTV survey shows.
A similar divide exists in terms of fears and safety: Girls and young women are less likely to feel safe in their neighborhoods, in schools, or from terror attacks.
The source of stress changes as we get older, the survey shows. Among 13-17 year olds, school is by far the most commonly mentioned source. Among 18-24 year olds, it's jobs and financial matters. In all, fully 85 percent of young people said they felt stress at least sometimes.
"I'm a pretty high-stressed person," says Katie Duda, 21, who's finishing up a degree in culinary arts and awaiting the birth of her first child in a few weeks. "But if I'm not stressed out, I'm bored." Right now, it's the responsibility of parenthood that is stressful to Duda, who lives in Bakersfield, Calif.
"It's the unknown of it all," she says. "Not the birth itself, but the next 18 years."
Tenth-grader Madelyn Dancy of Memphis has a whole other set of concerns. She wants badly to excel in school so she can fulfill her dream — and the hopes of her family — of becoming a doctor. "That's why I work so hard," says the 15-year-old. "They're looking at me to do something in my life that they couldn't do." For her, stress comes from schoolwork, and "having to do so much in so little time." She also plays lacrosse and tries to have a life outside school.
"It's going pretty well," says Dancy. "I've hit all my goals, but I'm setting more."
Kelly O'Brien has goals, too — the 20-year-old from Santa Rosa, Calif. plans to finish her business administration degree within a year, get married two years from now, and later have a family and own a home. Stress comes from balancing her schoolwork with two part-time jobs, as a bookkeeper and as a candy store clerk.
"It's always in the back of my mind," says O'Brien of the financial pressures of young adulthood. "Right now I'm comfortable, but I've had friends my age who've actually bought a home. I'm like, 'How can they do that?'"
In the survey, 45 percent of girls and young women reported experiencing stress frequently, to 32 percent of boys and young men. Those from urban areas experienced it more frequently than those in rural areas, and surprisingly, those from middle-income households had it more frequently than those from both lower and higher-income households.
Psychologist Jean Twenge, a professor at San Diego State University, is not surprised by the high stress rate in the AP-MTV survey — a rate 10 points higher than the 75-percent rate among adults in an AP-Ipsos poll last year.
"Anxiety is higher among adolescents," says Twenge, the author of "Generation Me." "Thankfully, it tends to wane in their 20s and 30s." Another explanation, she says, is the difference in generations; anxiety and depression are rising from generation to generation. Twenge is also not surprised by the male-female divide, which has been documented in other ways.
What is surprising is the higher rate for those from middle-income households, she says: "You'd expect those from a disadvantaged background to have more anxiety."
Though most feel safe in their neighborhoods and schools, only 25 percent feel "very safe" from terror attacks. Yet when asked about the general threat of terrorism, most say they don't think about it very often, and haven't changed how they lead their lives.
"It does cross my mind, but it's not a big worry," says Cory Walseth, 19, a construction worker in Thief River Falls, Minn.
For Dancy, the high school student from Memphis, it's simply counterproductive to think too much about things like the threat of terrorism.
"The thought is always there," she says. "I just don't want to let it run my life."
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The AP-MTV poll was conducted by Knowledge Networks Inc. from April 16 to 23, and involved online interviews with 1,280 people aged 13 to 24. It had a margin of sampling error of plus or minus 3 percentage points.
AP News Survey Specialist Dennis Junius contributed to this report.
Seniors want sex and they get it study finds
Wed, 22 Aug 2007 21:11:38 GMTBy Gene Emery
BOSTON - Sex is important to many seniors into their 80s and 90s, and they work to enjoy it even if illness or other problems get in the way, according to a study published on Wednesday.
Many older people have sex regularly, usually as often as younger people do, said Stacy Tessler Lindau of the University of Chicago, who led the study.
&;The frequency of sexual activity does not change a whole lot across age groups,&; she said.
Lindau's team found that 73 percent of people aged 57 to 64 reported having sex at least once in the past year, which put them into the &;sexually active&; category of the study.
The number fell to 53 percent for men 65 to 74 and to 26 percent for those 75 to 85. Women were less likely to be active because they were less likely to have a partner.
&;We found that about 50 percent of men and a quarter of the women reported that they masturbate, and this was irrespective of whether or not they had a sexual partner,&; Lindau told reporters in a telephone briefing.
&;This suggests that, among older adults, there is an internal drive or need for sexual fulfillment.&;
The study, based on surveys of more than 3,000 U.S. adults, was designed to give some insight in what is normal and what is possible for senior citizens.
&;The prevalence of sexual activity declines with age, yet a substantial number of men and women engage in vaginal intercourse, oral sex, and masturbation even in the eighth and ninth decades of life,&; the researchers wrote in their report, published in the New England Journal of Medicine.
TABOO SUBJECT
&;Discussion of sexuality later in life has long been a taboo subject, and physicians, like the rest of the public, have been susceptible to perpetuating these stereotypes,&; Lindau said.
&;The study provides information that allows people to see where their experiences align against the experience of others of similar age and similar health status.&;
She said it also might encourage doctors to ask more questions about a patient's sex life and arrange for treatment if necessary.
Among the findings:
* More than half of the sexually active people in the study said they had sex with a partner two or three times a month, even at age 75 to 85.
* 14 percent of men and 1 percent of women said they took some type of drug to improve sexual function.
* 35 percent of women rated sex as being &;not at all important,&; compared to just 13 percent of men. Older women were more likely to feel that way.
* About half of men and women said they had at least one bothersome sexual problem. For men, it was often erection difficulties, lack of interest or climaxing too quickly. For women, the problems included pain, inability to climax or lack of lubrication.
When the researchers asked men aged 75 to 85 who had a spouse or intimate relationship why they had not had sex in the last three months, 19 percent cited lack of interest, 17 percent said their partner was not interested, 9 percent said religious beliefs prohibited sex outside marriage and 2 percent said they lacked the opportunity.
At the same time, 61 percent cited health problems or limitations, and 23 percent said the limitations of their partner was the reason.
