Moms prechewing food gave HIV to kids
Wed, 06 Feb 2008 23:23:52 GMTBy MIKE STOBBE, AP Medical Writer
ATLANTA - For the first time, health officials report that the AIDS virus can be spread by a mother pre-chewing her infant's food, a practice mainly seen in poor, developing countries.
Three such cases were reported in the United States from 1993-2004, government scientists said Wednesday in a presentation in Boston at a scientific conference.
It's blood, not saliva, that carried the virus because in at least two of the cases the infected mothers had bleeding gums or mouth sores, according to investigators at the U.S. Centers for Disease Control and Prevention.
CDC officials say more study is needed. But they are asking parents and caregivers with HIV not to pre-chew infants' food, and are trying to educate doctors about this kind of transmission.
Health officials believe chewed-food transmission is rare in the United States, where such behavior is considered unusual. In some countries, mothers do it because they have no access to baby food or a means of pulverizing food for toothless infants.
"But even one case is too many," said the CDC's Dr. Ken Dominguez, who helped investigate the U.S. cases.
The first involved a 15-month-old African-American boy in Miami, diagnosed in 1993. His great-aunt was infected with HIV and pre-chewed food for the boy when he was between the ages of 9 months and 14 months.
Then a 3-year-old Caribbean-American boy was diagnosed in 1995, also in Miami. His HIV-infected mother pre-chewed food for her son.
Still uncertain they had definitively connected the practice to the spread of HIV, the doctors wanted more evidence. It was years later before they could confirm a third case, which occurred in 2004. A 9-month-old African-American girl was diagnosed with HIV in Memphis. The mother began pre-chewing the girl's food when she was about four months old.
All three children were infected with HIV at a time they would have been teething and had inflamed gums. It may be that both a caregiver and a child must have wounds in their mouths for the virus to have a good chance of passing from one bloodstream to another, the investigators said.
Previous studies have linked pre-chewing to the spread of other infections including Helicobacter pylori, a bacteria that causes stomach ailments, and streptococcal pharyngitis, which triggers sore throat. That research, too, is preliminary and needs to be confirmed, CDC officials said.
In developing nations without other feeding options, any campaign against pre-chewing could be nutritionally harmful, said Kimberly Hagen at the Emory Center for AIDS Research in Atlanta.
"This would really take a lot of thinking before you could say, 'We've had three cases in 11 years, so you have to stop pre-chewing your child's food,'" Hagen said.
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On the Net:
Conference on Retroviruses and Opportunistic Infections:
http://www.retroconference.org/2008/
Deaths partially halt diabetes study
Wed, 06 Feb 2008 23:24:58 GMTBy LAURAN NEERGAARD and RANDOLPH E. SCHMID, Associated Press Writers
WASHINGTON - The government abruptly halted aggressive treatment in a major study of diabetes and heart disease after a surprising number of deaths among patients who pushed their blood sugar to super-lows — findings that call into question a growing movement in diabetes care.
Wednesday's move doesn't affect health guidelines for most Type 2 diabetics, but it raises concern about a particularly vulnerable group: Patients at especially high risk of heart attack or stroke.
The 10,000-patient study, dubbed ACCORD, was supposed to answer a big question: Could pushing blood sugar to near-normal levels, below today's recommended target, help protect these high-risk patients' hearts?
Instead, the National Institutes of Health took the rare step of halting part of the study 18 months early — citing 257 deaths among aggressively treated patients compared to 203 among diabetics given more standard care.
That translates into an extra three deaths for every 1,000 participants per year, and researchers were at a loss to explain why. Diabetics' blood sugar wasn't too low, a condition known as hypoglycemia. And a close look at the multiple medications patients used, including the drug Avandia that is suspected of being heart-risky, showed no sign that any were to blame.
Ironically, the study's death rate was well below what doctors usually see in Type 2 diabetics, probably due to the extra care and monitoring they received as part of the research.
Moreover, the aggressively treated patients suffered about 10 percent fewer heart attacks overall than their counterparts, said Dr. William Friedewald of Columbia University, who helped monitor the study.
"However, it appeared that if a heart attack did occur, it was more likely to be fatal" in that group, Friedewald said. "In addition, the intensive treatment group had more unexpected sudden deaths, even without a clear heart attack."
So for now, the NIH's message: Diabetics with heart disease shouldn't strive for near-normal glucose, but to a level long described as optimal for all diabetics — around 7 on a measurement scale known as the A1C.
"We obviously were surprised. We were hoping for a positive outcome, but the reason we do this research is we don't know that," said study researcher Dr. Hertzel Gerstein of Canada's McMaster University.
The findings contradict previous research suggesting that the lower diabetics can make their blood sugar, the better. That had specialists cautioning Wednesday that it's too soon to know if the finding among heart patients was a fluke, or a real sign of how exquisitely tailored to each patient's risk factors diabetes care must be.
"Everything else has suggested, for 50 years or more, that tight control was good," said Dr. James Dove, president of the American College of Cardiology. "We've got half a century of literature that is put on the back burner right now by one study. ... It may not be the final decision."
Some 21 million Americans have diabetes, meaning their bodies can't properly regulate blood sugar, or glucose. Diabetics already are at increased risk of heart disease. Type 2 diabetes, the most common form, is linked to obesity, which in turn harms the heart. Plus, high blood sugar over time damages blood vessels.
The A1C test tracks average glucose levels over two or three months. People without diabetes have A1C levels as low as 5.
The American Diabetes Association has long recommended that diabetics aim to get their A1C level below 7, far below the long-common 8 or 9. Every point-drop lowers the risk of serious complications, such as blindness or kidney failure, by 25 percent to 40 percent.
Recent research shows that about half of U.S. patients have succeeded, and that "this overall level of glucose control appears to be of great benefit rather than harm," the ADA said Wednesday.
Getting too far below an A1C of 7 is very difficult, and very few patients outside of research studies succeed. The NIH study aimed to have aggressively treated patients dip below a level of 6, into near-normal range. Only half got below 6.4, compared to an A1C of 7.5 among study volunteers getting standard treatment.
Wednesday's announcement does not change that guideline. Rather, the NIH's National Heart, Lung and Blood Institute added the nuance that diabetics with heart disease stop at a level of 7 rather than dip below, while researchers try to figure out what happened. They have switched all the study participants to standard therapy, and will track their health until June 2009.
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On the Net:
NHLBI: http://www.nhlbi.nih.gov
FDA fines Red Cross another 364.6 million
Thu, 07 Feb 2008 02:05:10 GMTBy KEVIN FREKING, Associated Press Writer
WASHINGTON - The Food and Drug Administration has fined the Red Cross an additional $4.6 million for the distribution of "unsuitable blood products," bringing penalties against the organization to more than $19 million in recent years.
The FDA issued a letter Wednesday stating that it reviewed 113 recalls of blood products by the Red Cross from April 2003 to April 2006. The recalls involved the release of an estimated 4,094 unsuitable blood components.
Agency officials noted that having to conduct a recall shows that safety protocols were breached. For example, a donor may not have been appropriately asked about international travel or intravenous drug use.
FDA spokeswoman Peper Long said the agency didn't find any evidence of serious health consequences as a result of the safety breaches.
Red Cross officials said it was taking several steps to find problems in the collection and distribution of blood supplies. It's increasing supervision at blood drives and consolidating processing facilities. Its goal is to meet the FDA's standards for quality and safety, officials said.
"It takes time and it takes resources, but we're committed to doing whatever's necessary to meet that goal," said Red Cross spokeswoman Stephanie Millian.
Millian stressed that the fine would not be paid through donations but through the operating fees that it charges those who get blood units, such as hospitals.
The latest fine is being added to a tally of nearly $15 million in previous FDA penalties for violation of blood-safety laws, regulations and the terms of a 2003 consent decree.
That settlement resolved charges that the Red Cross had committed "persistent and serious violations" of federal blood safety rules dating back 17 years.
In 2004, the Red Cross implemented a plan, with the FDA's blessing, to detect, investigate, monitor and correct the sorts of problems repeatedly cited by government investigators.
Fat people cheaper to treat study says
Wed, 06 Feb 2008 23:25:39 GMTBy MARIA CHENG, AP Medical Writer
LONDON - Preventing obesity and smoking can save lives, but it doesn't save money, researchers reported Monday. It costs more to care for healthy people who live years longer, according to a Dutch study that counters the common perception that preventing obesity would save governments millions of dollars.
"It was a small surprise," said Pieter van Baal, an economist at the Netherlands' National Institute for Public Health and the Environment, who led the study. "But it also makes sense. If you live longer, then you cost the health system more."
In a paper published online Monday in the Public Library of Science Medicine journal, Dutch researchers found that the health costs of thin and healthy people in adulthood are more expensive than those of either fat people or smokers.
Van Baal and colleagues created a model to simulate lifetime health costs for three groups of 1,000 people: the "healthy-living" group , obese people, and smokers. The model relied on "cost of illness" data and disease prevalence in the Netherlands in 2003.
The researchers found that from age 20 to 56, obese people racked up the most expensive health costs. But because both the smokers and the obese people died sooner than the healthy group, it cost less to treat them in the long run.
On average, healthy people lived 84 years. Smokers lived about 77 years, and obese people lived about 80 years. Smokers and obese people tended to have more heart disease than the healthy people.
Cancer incidence, except for lung cancer, was the same in all three groups. Obese people had the most diabetes, and healthy people had the most strokes. Ultimately, the thin and healthy group cost the most, about $417,000, from age 20 on.
The cost of care for obese people was $371,000, and for smokers, about $326,000.
The results counter the common perception that preventing obesity will save health systems worldwide millions of dollars.
"This throws a bucket of cold water onto the idea that obesity is going to cost trillions of dollars," said Patrick Basham, a professor of health politics at Johns Hopkins University who was unconnected to the study. He said that government projections about obesity costs are frequently based on guesswork, political agendas, and changing science.
"If we're going to worry about the future of obesity, we should stop worrying about its financial impact," he said.
Obesity experts said that fighting the epidemic is about more than just saving money.
"The benefits of obesity prevention may not be seen immediately in terms of cost savings in tomorrow's budget, but there are long-term gains," said Neville Rigby, spokesman for the International Association for the Study of Obesity. "These are often immeasurable when it comes to people living longer and healthier lives."
Van Baal described the paper as "a book-keeping exercise," and said that governments should recognize that successful smoking and obesity prevention programs mean that people will have a higher chance of dying of something more expensive later in life.
"Lung cancer is a cheap disease to treat because people don't survive very long," van Baal said. "But if they are old enough to get Alzheimer's one day, they may survive longer and cost more."
The study, paid for by the Dutch Ministry of Health, Welfare and Sports, did not take into account other potential costs of obesity and smoking, such as lost economic productivity or social costs.
"We are not recommending that governments stop trying to prevent obesity," van Baal said. "But they should do it for the right reasons."
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On the Net:
PLoS: http://medicine.plosjournals.org
Born to Be Obese
Wed, 06 Feb 2008 04:47:02 GMTBy Jeffrey Perkel
HealthDay Reporter
TUESDAY, Feb. 5 -- The brain circuitry that controls appetite might be wired differently in some people, and that could predispose them to obesity, California researchers suggest.
The study was conducted in rats, not humans, and yet it could ultimately lead to novel obesity treatments, said Philip Smith, director of the Office of Obesity Research at the National Institute of Diabetes and Digestive and Kidney Diseases.
"It is not just about drugs that modify short-term appetite," he said, "there may be drugs that stimulate development of the appropriate neural pathways. So, it is an exciting, but very early, time in this field."
The study was published in the February issue of Cell Metabolism.
Sebastien Bouret, an assistant professor of neuroscience at the University of Southern California, and his colleagues examined neural circuits emanating from the appetite, hunger and body-weight control center of the brain -- the so-called arcuate nucleus of the hypothalamus -- in a series of rats bred to be either prone to, or resistant to, obesity.
The team found fewer neural connections projecting from the ARH in obesity-prone animals than in their leaner counterparts. Surprisingly, Bouret said, this deficiency developed very early in life, before the animals became obese, and appeared to extend into adulthood.
"Somehow, these animals are programmed to become obese," Bouret said. "The obesity is hard-wired into the brain."
When the researchers then looked at why the brains of obese rats differed from their normal-weight counterparts, they found that the neurons from obesity-prone animals were less responsive to leptin, a hormone that controls the development of these circuits, and which also signals the body's energy status and controls metabolic rate.
"This paper presumes to say, these animals must be leptin-resistant, and that is why the pathways are not developing," said Smith.
But that doesn't mean they are doomed to a life of severe obesity, said Dr. Barbara Kahn, chief of the Division of Endocrinology, Diabetes and Metabolism at Beth Israel Deaconess Medical Center, in Boston. How they live their lives also matters.
"It is important not to 'blame' the obese person or imply that he/she is responsible for being obese," Kahn noted. "Having said that, reasonable, healthy caloric restriction and a safe and sustainable program of physical activity can help limit weight gain and often bring about some degree of weight loss. In addition, healthy eating and regular exercise can reduce the complications of obesity such as type 2 diabetes and cardiovascular disease."
At the same time, she added, not everyone can wear a size 4.
"There is a certain aspect of genetics that sets somebody in a certain range of possible body weights, and then how that person lives his or her life will determine whether they are at the bottom or top of the range," she explained.
Human obesity has both genetic and environmental roots. The rats used in this study, like most humans, developed obesity when fed a high-energy diet. On a normal diet, they were heavier than normal rats, but not yet obese.
"This is quite an exciting paper," said Smith, "because it links more closely to human behavior than most rodent models we have seen."
The findings also suggest a possible therapeutic approach to combating human obesity. If drugs could be designed to influence the formation of neural circuits during development and targeted to at-risk pregnancies, Smith said, "there is a good likelihood we could have successful interventions that improve the health of the mother, and which have a major impact on disease risk for the infant, during pregnancy."
A related study from Boston University researchers in the same journal found that bulking up muscle mass can lead to a general metabolic improvement in obese individuals. "Interventions designed to increase skeletal muscle mass in at-risk human populations may prove to be critical weapons in the fight against obesity and obesity-related comorbidities, including diabetes, heart disease, stroke, hypertension and cancer," an accompanying editorial stated.
More information
For more on obesity, visit the National Institute of Diabetes and Digestive and Kidney Diseases.
Many sex ed teachers may lack training
Tue, 05 Feb 2008 17:38:43 GMTNEW YORK - A sizable minority of sex education teachers does not cover all of the basics, and many lack training to teach sex ed at all, a survey of teachers in one state suggests.
In a study of sex ed teachers at 201 Illinois schools, researchers found that one-third of teachers did not give comprehensive instruction -- defined as covering the four basic topics of abstinence, birth control, HIV/AIDS and other sexually transmitted diseases.
In addition, 30 percent said they had no special training in teaching sex education, and these teachers were less likely to teach a comprehensive course.
"For this study, we set the bar for comprehensiveness fairly low relative to what most medical and public health organizations recommend," lead researcher Dr. Stacy Tessler Lindau said in a statement, "and one out of three programs failed to clear it."
The findings suggest that doctors caring for teenagers may need to "fill gaps" in their knowledge of sexual health, according to Lindau and her colleagues at the University of Chicago.
They report the study results in the journal Obstetrics & Gynecology.
The study involved 335 sex ed teachers at Illinois middle schools and high schools. Lindau and her colleagues defined "comprehensive sex education" as courses teaching both abstinence and contraception, as well as information on HIV and other STDs.
They left out a fifth, more controversial topic often recommended by public health experts: giving students information on where to go for sexual health services, condoms and birth control.
Overall, two-thirds of teachers met this more relaxed definition of comprehensive education. In general, the most frequently covered topics were HIV and STDs, which about 96 percent of teachers said they addressed. Eighty-nine percent of teachers covered the topic of abstinence-until-marriage.
Among the least frequently taught subjects were homosexuality, abortion and information on how to use condoms or birth control properly.
"Most parents support school-based sex education and teens regard it as an important source of information," Lindau said, "yet we found that several important health topics and skills are omitted, more often than not, from most Illinois public school sex-education
criteria."
When it came to discussing condoms and birth control, teachers who omitted the topic generally did so because it was not in the official curriculum or because of "school or district policy." About half of teachers also lacked confidence in their ability to teach the topic -- rating their ability as anywhere from "average" to "very poor."
"Our study provides important new data from the teachers' perspective," Dr. Melissa Gilliam, another researcher on the study, said in a statement. "It supports other recent studies showing that large numbers of teens, especially low-income and youth of color, received no instruction about birth control methods before they first had sex."
SOURCE: Obstetrics & Gynecology, February 2008.
Health Tip Don39t Use a Hot Tub During Pregnancy
Thu, 07 Feb 2008 04:47:02 GMT- While a hot bath may sound like a great way to soothe aching muscles during pregnancy, becoming overheated in a hot bath or a hot tub poses risks for a developing fetus, the American Pregnancy Association says.
So using a hot tub is generally not recommended for pregnant women.
If you decide to take a bath, the association offers this advice on how to do it safely:
- Don't let the water get too hot, whether it's in a bath or hot tub.
- If you do choose to use a hot tub, don't stay for more than 10 minutes.
- Body temperatures of 102.2 degrees Fahrenheit or higher can be dangerous for a fetus, so take your temperature regularly to be sure it is not too high.
- If you start to feel uncomfortable, sick, or notice that you've stopped sweating, get out of the water as quickly as possible.
Health Tip Am I Getting Too Old to Drive
Thu, 07 Feb 2008 04:47:03 GMT-- Driving can become dangerous for some seniors as they decline both physically and mentally.
Here are warning signs that a senior may no longer be safe behind the wheel, courtesy of the U.S. National Library of Medicine:
- Memory problems, such as forgetting the destination or route.
- Difficulty concentrating.
- Difficulty seeing in general, or under certain conditions.
- Hearing problems.
- Arthritis, especially when it affects the hands and fingers.
Less Invasive Way to Stage Lung Cancer Shows Promise
Thu, 07 Feb 2008 04:47:04 GMTBy Amanda Gardner
HealthDay Reporter
TUESDAY, Feb. 5 -- Less invasive approaches for determining how far lung cancer has spread may be better than traditional, invasive procedures.
Although the finding, published in the Feb. 6 issue of the Journal of the American Medical Association, needs to be confirmed, it may point to a new era for people with lung cancer or suspected lung cancer.
"Currently, most patients in the U.S. who have lung cancers get a surgical procedure to determine if the cancer has spread to the lymph nodes," explained study author Dr. Michael Wallace, a professor of medicine at the Mayo Clinic College of Medicine in Jacksonville, Fla. "This study suggests that a less invasive set of procedures are highly accurate and less invasive than surgical procedures, and therefore might be an alternative."
Lung cancer is the number one cancer killer in the United States. While early detection is key, proper staging, which primarily involves determining if the malignancy has spread to the lymph nodes, is important for therapy and prognosis.
For people whose cancer is still confined to the lungs and certain lymph nodes, surgery is the recommended treatment. But the benefit of surgery is less clear for patients whose cancer has spread further.
"If the cancer has already spread to the lymph nodes in the middle of chest, you can't cure it [with surgery], so it's very important to know if it has spread to those lymph nodes," explained Norman Edelman, chief medical officer for the American Lung Association. "This so-called mediastinoscopy [which requires general anesthesia] is considered the gold standard although . . . there are some nodes that are hard to get this way."
"Could this replace mediastinoscopy? Yes, it could, but right now the doctors would have to make a judgment," added Edelman. "We don't have the absolute final answer, but it's promising."
Edelman pointed out, however, that the minimally invasive techniques described in this paper may not be available in many local hospitals.
Current noninvasive techniques such as computed tomography or positron emission tomography have high false-positive and false-negative results, respectively.
This study compared the accuracy of three different minimally invasive methods of staging and combinations thereof: traditional transbronchial needle aspiration , endobronchial ultrasound-guided fine-needle aspiration , and transesophageal endoscopic ultrasound-guided fine-needle aspiration .
"These procedures are endoscopic, meaning there's no cutting involved through the skin, and they're done as outpatients under twilight sedation," Wallace explained. "Individuals come in and go home on the same day. Essentially, there is no recovery other than just letting the sedation wear off."
A total of 138 patients with suspected lung cancer were involved; 30 percent had malignant lymph nodes.
EBUS-FNA was more sensitive than TBNA, detecting 69 percent of malignant lymph nodes versus 36 percent.
The combination of EBUS-FNA and EUS-FNA had 93 percent estimated sensitivity and a 97 percent negative predictive value (proportion of patients with negative results who are actually negative), compared with either method used alone.
The combination, which had both higher sensitivity and higher negative predictive value, may be a substitute for current, invasive techniques, the authors stated.
If mediastinoscopy had been done only when the combination results were negative, the more invasive surgical procedure would have been avoided in 28 percent of patients, the study showed.
If the combination had completely replaced mediastinoscopy, 97 percent would have been correctly labeled as negative.
"It is really focused on less invasive ways to stage the cancers as opposed to earlier detection methods, but it allows us to better select patients who will benefit from surgery to do it in a less invasive way and, importantly, to avoid surgical procedures in patients where the tumor has already spread who wouldn't benefit from the surgery," Wallace said.
Wallace reported that he had received research grants from different makers of equipment relevant to endoscopic ultrasound.
More information
The American Lung Association has more on lung cancer.
