Top : 2007 : 2007_01_26

Spot in brain may control smoking urge

Fri, 26 Jan 2007 03:36:11 GMT
By LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Damage to a silver dollar-sized spot deep in the brain seems to wipe out the urge to smoke, a surprising discovery that may shed important new light on addiction. The research was inspired by a stroke survivor who claimed he simply forgot his two-pack-a-day addiction _ no cravings, no nicotine patches, not even a conscious desire to quit.
"The quitting is like a light switch that went off," said Dr. Antoine Bechara of the University of Southern California, who scanned the brains of 69 smokers and ex-smokers to pinpoint the region involved. "This is very striking."

Clearly brain damage isn't a treatment option for people struggling to kick the habit.

But the finding, reported in Friday's edition of the journal Science, does point scientists toward new ways to develop anti-smoking aids by targeting this little-known brain region called the insula. And it sparked excitement among addiction specialists who expect the insula to play a key role in other addictions, too.

"It's a fantastic paper, it's a fantastic finding," said Dr. Nora Volkow, director of the National Institute on Drug Abuse and a longtime investigator of the brain's addiction pathways.

"What this study shows unequivocally is the insula is a key structure in the brain for perceiving the urges to take the drug," urges that are "the backbone of the addiction," Volkow added.

Why? The insula appears to be where the brain turns physical reactions into feelings, such as feeling anxious when your heart speeds up. When those reactions are caused by a particular substance, the insula may act like sort of a headquarters for cravings.

Some 44 million Americans smoke, and the government says more than 400,000 a year die of smoking-related illnesses. Declines in smoking have slowed in recent years, making it unlikely that the nation will reach a public health goal of reducing the rate to 12 percent by 2010.

Nicotine is one of the most addictive substances known, and it's common for smokers to suffer repeated relapses when they try to quit.

So imagine Bechara's surprise at hearing a patient he code-named "Nathan" note nonchalantly that "my body forgot the urge to smoke" right after his stroke.

At the time, Bechara was at the University of Iowa studying the effects of certain types of brain damage after strokes or other injury. While Nathan was hospitalized, stroke specialists sent his information to that brain registry. He was 38, had smoked since 14, said he enjoyed it and had had no intention to quit. But his last puff was the night before his stroke. His surprised wife said he never even asked for a smoke while in the hospital.

It's not unusual for a health scare to prompt an attempt at quitting. "That's the quitting that's not as interesting," Bechara said.

Instead, Nathan experienced what Bechara calls a "disruption of smoking addiction," and he wanted to know why.

Bechara and colleagues culled their brain-damage registry for 69 patients who had smoked regularly before their injuries. Nineteen, including Nathan, had damage to the insula. Thirteen of the insula-damaged patients had quit smoking, 12 of them super-easily: They quit within a day of the brain injury, and reported neither smoking nor even feeling the urge since then.

Of the remaining 50 patients with damage in other brain regions, 19 quit smoking but only four met the broken-addiction criteria.

If Bechara's findings are validated, they suggest that developing drugs that target the insula might help smokers quit. There are nicotine receptors in the insula, meaning it should be possible to create a nicotine-specific drug, Bechara said _ albeit years from now.

More immediately, NIDA's Volkow wants to try a different experiment: Scientists can temporarily alter function of certain brain regions with pulses of magnetic energy, called "transcranial magnetic stimulation." She wants to see if it's possible to focus such magnetic pulses on the insula, and thus verify its role.

Other neurologic functions are known to be involved with addiction, too, such as the brain's "reward" or pleasure pathways. The insula discovery doesn't contradict that work, but adds another layer to how addiction grips the brain, Bechara said.

Study Most diabetics dont exercise

Fri, 26 Jan 2007 11:33:34 GMT
By CHASE SQUIRES, Associated Press Writer
DENVER - Bad news when it comes to diabetics and exercise: Most people with Type 2 diabetes or at risk for it apparently ignore their doctors' advice to be active.
Fewer than 40 percent get exercise, a new study found, and the more in danger the patients are, the less likely they are to be active.

That's despite an earlier study that found nearly three-quarters of diabetics said their doctors had advised them to exercise. The patients who got the strongest warnings to get moving were the least likely to listen, according to research being released Friday.

"People should exercise more, that story is out," said Dr. Elaine Morrato, who led both studies. "What we're saying is, 'Here's a high-risk population that can benefit from exercise, and they're even less likely to exercise.'"

Without exercise, Type 2 diabetics face complications ranging from nerve damage to high blood pressure.

Morrato, an assistant professor at the University of Colorado Denver with a doctorate in public health and epidemiology, said researchers surveyed more than 22,000 patients for the new survey. Results of the study appear in the February edition of the American Diabetes Association's journal Diabetes Care.

The federal Centers for Disease Control and Prevention estimates more than 20 million Americans have diabetes, about 90 percent of them Type 2, which is linked with obesity.

Dr. Larry Deeb, president of medicine and science at the American Diabetes Association, said by the time patients have Type 2 diabetes or are at risk of getting it, the deck is stacked against them. They may already have problems with mobility as a result of obesity or foot and circulatory disorders that make exercise difficult.

"We have to be careful not to blame the victims," he said. "There's a difference between being unable and being unwilling."

Even for the most disabled, there's hope, said author and fitness expert Charlotte Hayes, but health professionals must do more.

Hayes, who wrote "The I Hate to Exercise Book For People With Diabetes," said telling patients to exercise is different from telling them how.

Every step of exercise is important, she said. For those who can walk, a few steps a day helps. For those who can't, there are alternatives.

"We take a small-steps approach," she said.

The American Diabetes Association recommends people get at least 30 minutes of aerobic exercise, such as brisk walking, five times a week. But the association says for those who can't, there are benefits from even five minutes a day, along with everyday activities such as gardening or walking to work.

Morrato said she doesn't know the answer, only that the results of her study are disappointing.

"It is difficult to be optimistic about addressing the twin epidemics of obesity and diabetes without success in increasing physical activity in the population," her study concludes. "The results of this study provide very pessimistic data."

Deeb, who specializes in pediatrics, said the next generation is off to a better start. Children, he said, are taught nutrition and the benefits of physical activity. Now, families, local governments and school boards need to take action, while doctors need to follow up and find out if at-risk patients know where to get help.

"When you ask a family what they're doing, the answer is all about time. They know what's good for their families, but both parents are working, and sometimes the only time they have is to pick up fast food," he said. "They have to understand, your health depends on it.
"We will not give up," he said. "We can't give up."
___
On the Net: The American Diabetes Association, http://www.diabetes.org/

Traditional scans often miss strokes

Fri, 26 Jan 2007 03:35:55 GMT
By MARIA CHENG, AP Medical Writer
LONDON - The most common method of diagnosing a stroke in the emergency rooms catches only about one out of every four cases, far fewer than an MRI scan, which also was better at spotting the type of stroke, a U.S. government funded study showed.
The study led some experts, writing in the medical journal The Lancet, to declare that MRI scans should replace CT X-rays as the standard of care. The journal published the stroke study in Friday's issue.

"This mantle should now be passed to magnetic resonance imaging," wrote Dr. Geoffrey A. Donnan and colleagues at the University of Melbourne in Australia in an accompanying commentary.

MRI scans should be adopted as the new standard of care, wrote the doctors, while they also criticized governments and health care systems for their poor track record of assessing new technologies.

However, others argue it's not such a clear-cut choice. MRI results take more time, a delay that can prove deadly to a stroke patient, these doctors contend.

"The time delay between MRI and CT may be around 15 to 20 minutes," said Dr. Joseph Broderick, chairman of neurology at the University of Cincinnati College of Medicine. "And in an emergency, 15 to 20 minutes can make a big difference."

Broderick had no role in the study, which was led by Dr. Julio Chalela, of the Medical University of South Carolina. Chalela was with the U.S. National Institutes of Health when the study was conducted.

Chalela and colleagues examined 356 patients, of whom 217 were ultimately diagnosed with an acute stroke. Patients were scanned both by CT and MRI machines. CT scans are a type of X-ray, whereas magnetic resonance imaging uses powerful magnets instead of radiation to produce an image.

The scans were independently interpreted by four experts, who had no other patient information. Based only on the MRI scans, experts accurately diagnosed acute strokes 83 percent of the time. Using the CT scans, however, they were right just 26 percent of the time.

MRI scans were also more precise in spotting the cause of the stroke _ a blood clot or bleeding in the brain. The vast majority of strokes are caused by clots. In patients scanned within three hours of symptoms, MRIs detected strokes caused by clots in 41 of 90 patients, while CT scans only picked up 6 of the 90 patients.

The first few hours following a stroke are critical, since clot-busting drugs must be given within three hours to have a real impact. If they are given to the wrong patients, however, death or severe disability can result.

Strokes are the second leading cause of death worldwide, and account for approximately 5.5 million deaths each year.

Though CT scans may lose out to MRI scans on accuracy, on issues such as time and money, CT scans are far ahead. Widely available in emergency rooms in all developed countries, CT machines are compact pieces of equipment that produce images in as little as two minutes. In comparison, MRI machines are large, coffin-like structures that require patients to lie still for up to 30 minutes. They are also unsuitable for patients with pacemakers, metal objects, or who may be pregnant.

MRI scans also cost significantly more than CT scans and require specialized technicians to operate them and to read the scans.

"The superiority of MRI in detecting stroke in ideal conditions is unquestioned," said Dr. Lee Schwamm, an associate professor of neurology at Harvard Medical School. Schwamm was not connected to the study. But combined with a consideration of patient symptoms, he says that CT scans are just as effective in diagnosing patients in emergencies.

MRI scans may offer more detailed information, but such information hasn't yet been proven to make a difference in patient outcomes. Experts say studies are needed to determine if MRI scans might save more lives than CT scans in emergencies.

Schwamm likens the comparison between the two techniques to the difference between FM and AM radio. "FM radio is better because it's high-definition, and is great if you're listening to classical music," he said. "But sometimes all you need is the weather and the news, so AM is just fine."

In the same Lancet issue, an all-stroke special, two other studies found that stroke patients treated in a stroke care unit have a better chance of recovery than if they were treated in a conventional hospital ward.

Mammogram rate drops slightly in U.S.

Fri, 26 Jan 2007 03:37:19 GMT
By MIKE STOBBE, AP Medical Writer
ATLANTA - The percentage of American women getting mammograms has dropped slightly over the past few years, in what health officials said Thursday is a troubling sign that the battle against breast cancer may be flagging.
The share of women 40 and older who said they had a mammogram in the previous two years slipped from 76.4 percent to 74.6 percent between 2000 and 2005, according to a study released by the Centers for Disease Control and Prevention.

The rate had risen dramatically over the past two decades, from 29 percent in 1987, according to American Cancer Society statistics.

The CDC and other researchers said possible explanations for the drop include a shortage of mammography screening centers and specialists, and a lack of health insurance among patients.

Dr. Len Lichtenfeld, the cancer society's deputy chief medical officer, said the decline may also reflect complacency among women.

"This is a group of women who have `grown up' with mammography as they've aged, they've perhaps had it done many times over the years and they've decided, `Well, it's been OK, maybe I can put it off for a while,'" he said.

He warned that the recently reported declines in breast cancer incidence rates and cancer deaths are at risk if the decline continues. "If we don't pay attention now, we run the risk of seeing some of the gains we've made reversed," he said.

The decline of less than 2 percentage points may seem small, but it could be terribly significant, Lichtenfeld said. But if you consider that about 80 million U.S. women should be getting a mammogram every year, it means more than 1 million fewer women are getting the screening test, he said.

And that may mean thousands of cases of breast cancer may not be diagnosed. Women whose breast cancer is caught early have more treatment options and a better chance of beating the disease.

The decline may also at least partly explain a recent drop in U.S. breast cancer rates: It may be that if fewer women are getting mammograms, fewer cases of breast cancer are being discovered.

Some researchers instead tied the drop in breast cancer to reduced use of hormones for menopause.

The study is being published this week in a CDC publication, Morbidity and Mortality Weekly Report. It was based on a national telephone survey of more than 14,000 women in each of the survey years.

The study is not the first to spot the decline. The cancer society keeps statistics, derived from a different national survey, that showed a slight decline in mammogram from 2000 to 2003. Another study of HMO patients showed a decline in screening rates from 1999 to 2002.

Mammography rates increased substantially during the 1990s, so there seems to have been some turning point around 2000.


Normalweight obese syndrome may up heart risks

Fri, 26 Jan 2007 19:35:27 GMT

NEW YORK - People who are normal-weight but carry a good deal of body fat may be at increased risk of heart disease and stroke, a small study suggests.
Most people have by now heard of body mass index , a measure used to classify people as normal-weight, overweight or obese based on their weight and height.

However, there are people who are technically normal-weight based on their BMI yet have a substantial amount of excess fat, and some researchers say this is its own type of "syndrome."

In research published last year, a group of Italian researchers described what they call "normal-weight obese" or NWO syndrome -- where BMI is normal but body fat makes up more than 30 percent of weight.

The good news for these individuals is that they don't have the metabolic conditions that often mark obesity -- such as high blood pressure, unhealthy cholesterol levels and high blood sugar.

On the other hand, the bad news, according to this latest study, is that people with NWO syndrome may be prone to high blood levels of certain inflammation-related proteins. That suggests they are at risk of becoming obese or developing cardiovascular disease in the future, the study authors report in the American Journal of Clinical Nutrition.

Dr. Antonino De Lorenzo of the University of Tor Vergata in Rome led the research team, the same one that first described NWO syndrome.

The study included 20 young women who met the definition of NWO syndrome, along with 20 normal-weight women and 20 who were overweight based on their BMI and had a body fat percentage greater than 30 percent.

Overall, the researchers found, the NWO group had higher levels of several inflammatory proteins than normal-weight women did. The excess body fat in the former group may explain the difference, as research suggests that fat tissue secretes inflammatory substances, De Lorenzo and his colleagues note.

Because inflammation has been implicated in the buildup of artery-clogging plaques, women who have a normal weight but high fat mass may be at increased risk of heart disease and stroke down the road, according to the researchers.

What's more, they point out, these women are likely to have a false sense of security about their heart health because their BMI is normal.]

This means that measuring body fat percentage, and not just BMI, could be an important part of preventing obesity-related ills, the researchers conclude.

SOURCE: American Journal of Clinical Nutrition, January 2007.


Moms mono virus ups risk of leukemia in child

Fri, 26 Jan 2007 18:59:48 GMT
By Megan Rauscher
NEW YORK - A new study provides more evidence that reactivation during pregnancy of Epstein-Barr virus, which causes mononucleosis, may be associated with a proportion of childhood leukemia cases. What that proportion may be has yet to be defined, researchers say.
In 2003, Dr. Matti Lehtinen from National Public Health Institute, Oulu, Finland and colleagues identified a link between maternal EBV reactivation and the development of acute lymphoblastic leukemia in offspring.

In that study -- based on data from 550,000 Finnish and Icelandic mothers and their offspring -- the presence of EBV antibodies suggesting reactivation of the virus were associated with a 2.9 adjusted odds ratio for ALL.

To confirm EBV's role in ALL, they analyzed first-trimester serum samples of mothers whose offspring later developed leukemia for different EBV antibodies that are known indicators of EBV reactivation. Altogether, they analyzed sera from mothers of 304 ALL cases and 39 non-ALL leukemia cases and 943 mothers of controls.

"We found some further confirmation to our findings, suggesting an association between maternal EBV infection and risk of leukemia in the offspring, especially infants < 1 year of age," lehtinen told reuters health.>

"We are preparing for a four times larger study, which should verify or falsify our observations," Lehtinen told Reuters Health.

SOURCE: American Journal of Epidemiology January 15, 2007.


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Top : 2007 : 2007_01_26

Spot in brain may control smoking urge

Fri, 26 Jan 2007 03:36:11 GMT
By LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Damage to a silver dollar-sized spot deep in the brain seems to wipe out the urge to smoke, a surprising discovery that may shed important new light on addiction. The research was inspired by a stroke survivor who claimed he simply forgot his two-pack-a-day addiction _ no cravings, no nicotine patches, not even a conscious desire to quit.
"The quitting is like a light switch that went off," said Dr. Antoine Bechara of the University of Southern California, who scanned the brains of 69 smokers and ex-smokers to pinpoint the region involved. "This is very striking."

Clearly brain damage isn't a treatment option for people struggling to kick the habit.

But the finding, reported in Friday's edition of the journal Science, does point scientists toward new ways to develop anti-smoking aids by targeting this little-known brain region called the insula. And it sparked excitement among addiction specialists who expect the insula to play a key role in other addictions, too.

"It's a fantastic paper, it's a fantastic finding," said Dr. Nora Volkow, director of the National Institute on Drug Abuse and a longtime investigator of the brain's addiction pathways.

"What this study shows unequivocally is the insula is a key structure in the brain for perceiving the urges to take the drug," urges that are "the backbone of the addiction," Volkow added.

Why? The insula appears to be where the brain turns physical reactions into feelings, such as feeling anxious when your heart speeds up. When those reactions are caused by a particular substance, the insula may act like sort of a headquarters for cravings.

Some 44 million Americans smoke, and the government says more than 400,000 a year die of smoking-related illnesses. Declines in smoking have slowed in recent years, making it unlikely that the nation will reach a public health goal of reducing the rate to 12 percent by 2010.

Nicotine is one of the most addictive substances known, and it's common for smokers to suffer repeated relapses when they try to quit.

So imagine Bechara's surprise at hearing a patient he code-named "Nathan" note nonchalantly that "my body forgot the urge to smoke" right after his stroke.

At the time, Bechara was at the University of Iowa studying the effects of certain types of brain damage after strokes or other injury. While Nathan was hospitalized, stroke specialists sent his information to that brain registry. He was 38, had smoked since 14, said he enjoyed it and had had no intention to quit. But his last puff was the night before his stroke. His surprised wife said he never even asked for a smoke while in the hospital.

It's not unusual for a health scare to prompt an attempt at quitting. "That's the quitting that's not as interesting," Bechara said.

Instead, Nathan experienced what Bechara calls a "disruption of smoking addiction," and he wanted to know why.

Bechara and colleagues culled their brain-damage registry for 69 patients who had smoked regularly before their injuries. Nineteen, including Nathan, had damage to the insula. Thirteen of the insula-damaged patients had quit smoking, 12 of them super-easily: They quit within a day of the brain injury, and reported neither smoking nor even feeling the urge since then.

Of the remaining 50 patients with damage in other brain regions, 19 quit smoking but only four met the broken-addiction criteria.

If Bechara's findings are validated, they suggest that developing drugs that target the insula might help smokers quit. There are nicotine receptors in the insula, meaning it should be possible to create a nicotine-specific drug, Bechara said _ albeit years from now.

More immediately, NIDA's Volkow wants to try a different experiment: Scientists can temporarily alter function of certain brain regions with pulses of magnetic energy, called "transcranial magnetic stimulation." She wants to see if it's possible to focus such magnetic pulses on the insula, and thus verify its role.

Other neurologic functions are known to be involved with addiction, too, such as the brain's "reward" or pleasure pathways. The insula discovery doesn't contradict that work, but adds another layer to how addiction grips the brain, Bechara said.

Study Most diabetics dont exercise

Fri, 26 Jan 2007 11:33:34 GMT
By CHASE SQUIRES, Associated Press Writer
DENVER - Bad news when it comes to diabetics and exercise: Most people with Type 2 diabetes or at risk for it apparently ignore their doctors' advice to be active.
Fewer than 40 percent get exercise, a new study found, and the more in danger the patients are, the less likely they are to be active.

That's despite an earlier study that found nearly three-quarters of diabetics said their doctors had advised them to exercise. The patients who got the strongest warnings to get moving were the least likely to listen, according to research being released Friday.

"People should exercise more, that story is out," said Dr. Elaine Morrato, who led both studies. "What we're saying is, 'Here's a high-risk population that can benefit from exercise, and they're even less likely to exercise.'"

Without exercise, Type 2 diabetics face complications ranging from nerve damage to high blood pressure.

Morrato, an assistant professor at the University of Colorado Denver with a doctorate in public health and epidemiology, said researchers surveyed more than 22,000 patients for the new survey. Results of the study appear in the February edition of the American Diabetes Association's journal Diabetes Care.

The federal Centers for Disease Control and Prevention estimates more than 20 million Americans have diabetes, about 90 percent of them Type 2, which is linked with obesity.

Dr. Larry Deeb, president of medicine and science at the American Diabetes Association, said by the time patients have Type 2 diabetes or are at risk of getting it, the deck is stacked against them. They may already have problems with mobility as a result of obesity or foot and circulatory disorders that make exercise difficult.

"We have to be careful not to blame the victims," he said. "There's a difference between being unable and being unwilling."

Even for the most disabled, there's hope, said author and fitness expert Charlotte Hayes, but health professionals must do more.

Hayes, who wrote "The I Hate to Exercise Book For People With Diabetes," said telling patients to exercise is different from telling them how.

Every step of exercise is important, she said. For those who can walk, a few steps a day helps. For those who can't, there are alternatives.

"We take a small-steps approach," she said.

The American Diabetes Association recommends people get at least 30 minutes of aerobic exercise, such as brisk walking, five times a week. But the association says for those who can't, there are benefits from even five minutes a day, along with everyday activities such as gardening or walking to work.

Morrato said she doesn't know the answer, only that the results of her study are disappointing.

"It is difficult to be optimistic about addressing the twin epidemics of obesity and diabetes without success in increasing physical activity in the population," her study concludes. "The results of this study provide very pessimistic data."

Deeb, who specializes in pediatrics, said the next generation is off to a better start. Children, he said, are taught nutrition and the benefits of physical activity. Now, families, local governments and school boards need to take action, while doctors need to follow up and find out if at-risk patients know where to get help.

"When you ask a family what they're doing, the answer is all about time. They know what's good for their families, but both parents are working, and sometimes the only time they have is to pick up fast food," he said. "They have to understand, your health depends on it.
"We will not give up," he said. "We can't give up."
___
On the Net: The American Diabetes Association, http://www.diabetes.org/

Traditional scans often miss strokes

Fri, 26 Jan 2007 03:35:55 GMT
By MARIA CHENG, AP Medical Writer
LONDON - The most common method of diagnosing a stroke in the emergency rooms catches only about one out of every four cases, far fewer than an MRI scan, which also was better at spotting the type of stroke, a U.S. government funded study showed.
The study led some experts, writing in the medical journal The Lancet, to declare that MRI scans should replace CT X-rays as the standard of care. The journal published the stroke study in Friday's issue.

"This mantle should now be passed to magnetic resonance imaging," wrote Dr. Geoffrey A. Donnan and colleagues at the University of Melbourne in Australia in an accompanying commentary.

MRI scans should be adopted as the new standard of care, wrote the doctors, while they also criticized governments and health care systems for their poor track record of assessing new technologies.

However, others argue it's not such a clear-cut choice. MRI results take more time, a delay that can prove deadly to a stroke patient, these doctors contend.

"The time delay between MRI and CT may be around 15 to 20 minutes," said Dr. Joseph Broderick, chairman of neurology at the University of Cincinnati College of Medicine. "And in an emergency, 15 to 20 minutes can make a big difference."

Broderick had no role in the study, which was led by Dr. Julio Chalela, of the Medical University of South Carolina. Chalela was with the U.S. National Institutes of Health when the study was conducted.

Chalela and colleagues examined 356 patients, of whom 217 were ultimately diagnosed with an acute stroke. Patients were scanned both by CT and MRI machines. CT scans are a type of X-ray, whereas magnetic resonance imaging uses powerful magnets instead of radiation to produce an image.

The scans were independently interpreted by four experts, who had no other patient information. Based only on the MRI scans, experts accurately diagnosed acute strokes 83 percent of the time. Using the CT scans, however, they were right just 26 percent of the time.

MRI scans were also more precise in spotting the cause of the stroke _ a blood clot or bleeding in the brain. The vast majority of strokes are caused by clots. In patients scanned within three hours of symptoms, MRIs detected strokes caused by clots in 41 of 90 patients, while CT scans only picked up 6 of the 90 patients.

The first few hours following a stroke are critical, since clot-busting drugs must be given within three hours to have a real impact. If they are given to the wrong patients, however, death or severe disability can result.

Strokes are the second leading cause of death worldwide, and account for approximately 5.5 million deaths each year.

Though CT scans may lose out to MRI scans on accuracy, on issues such as time and money, CT scans are far ahead. Widely available in emergency rooms in all developed countries, CT machines are compact pieces of equipment that produce images in as little as two minutes. In comparison, MRI machines are large, coffin-like structures that require patients to lie still for up to 30 minutes. They are also unsuitable for patients with pacemakers, metal objects, or who may be pregnant.

MRI scans also cost significantly more than CT scans and require specialized technicians to operate them and to read the scans.

"The superiority of MRI in detecting stroke in ideal conditions is unquestioned," said Dr. Lee Schwamm, an associate professor of neurology at Harvard Medical School. Schwamm was not connected to the study. But combined with a consideration of patient symptoms, he says that CT scans are just as effective in diagnosing patients in emergencies.

MRI scans may offer more detailed information, but such information hasn't yet been proven to make a difference in patient outcomes. Experts say studies are needed to determine if MRI scans might save more lives than CT scans in emergencies.

Schwamm likens the comparison between the two techniques to the difference between FM and AM radio. "FM radio is better because it's high-definition, and is great if you're listening to classical music," he said. "But sometimes all you need is the weather and the news, so AM is just fine."

In the same Lancet issue, an all-stroke special, two other studies found that stroke patients treated in a stroke care unit have a better chance of recovery than if they were treated in a conventional hospital ward.

Mammogram rate drops slightly in U.S.

Fri, 26 Jan 2007 03:37:19 GMT
By MIKE STOBBE, AP Medical Writer
ATLANTA - The percentage of American women getting mammograms has dropped slightly over the past few years, in what health officials said Thursday is a troubling sign that the battle against breast cancer may be flagging.
The share of women 40 and older who said they had a mammogram in the previous two years slipped from 76.4 percent to 74.6 percent between 2000 and 2005, according to a study released by the Centers for Disease Control and Prevention.

The rate had risen dramatically over the past two decades, from 29 percent in 1987, according to American Cancer Society statistics.

The CDC and other researchers said possible explanations for the drop include a shortage of mammography screening centers and specialists, and a lack of health insurance among patients.

Dr. Len Lichtenfeld, the cancer society's deputy chief medical officer, said the decline may also reflect complacency among women.

"This is a group of women who have `grown up' with mammography as they've aged, they've perhaps had it done many times over the years and they've decided, `Well, it's been OK, maybe I can put it off for a while,'" he said.

He warned that the recently reported declines in breast cancer incidence rates and cancer deaths are at risk if the decline continues. "If we don't pay attention now, we run the risk of seeing some of the gains we've made reversed," he said.

The decline of less than 2 percentage points may seem small, but it could be terribly significant, Lichtenfeld said. But if you consider that about 80 million U.S. women should be getting a mammogram every year, it means more than 1 million fewer women are getting the screening test, he said.

And that may mean thousands of cases of breast cancer may not be diagnosed. Women whose breast cancer is caught early have more treatment options and a better chance of beating the disease.

The decline may also at least partly explain a recent drop in U.S. breast cancer rates: It may be that if fewer women are getting mammograms, fewer cases of breast cancer are being discovered.

Some researchers instead tied the drop in breast cancer to reduced use of hormones for menopause.

The study is being published this week in a CDC publication, Morbidity and Mortality Weekly Report. It was based on a national telephone survey of more than 14,000 women in each of the survey years.

The study is not the first to spot the decline. The cancer society keeps statistics, derived from a different national survey, that showed a slight decline in mammogram from 2000 to 2003. Another study of HMO patients showed a decline in screening rates from 1999 to 2002.

Mammography rates increased substantially during the 1990s, so there seems to have been some turning point around 2000.


Normalweight obese syndrome may up heart risks

Fri, 26 Jan 2007 19:35:27 GMT

NEW YORK - People who are normal-weight but carry a good deal of body fat may be at increased risk of heart disease and stroke, a small study suggests.
Most people have by now heard of body mass index , a measure used to classify people as normal-weight, overweight or obese based on their weight and height.

However, there are people who are technically normal-weight based on their BMI yet have a substantial amount of excess fat, and some researchers say this is its own type of "syndrome."

In research published last year, a group of Italian researchers described what they call "normal-weight obese" or NWO syndrome -- where BMI is normal but body fat makes up more than 30 percent of weight.

The good news for these individuals is that they don't have the metabolic conditions that often mark obesity -- such as high blood pressure, unhealthy cholesterol levels and high blood sugar.

On the other hand, the bad news, according to this latest study, is that people with NWO syndrome may be prone to high blood levels of certain inflammation-related proteins. That suggests they are at risk of becoming obese or developing cardiovascular disease in the future, the study authors report in the American Journal of Clinical Nutrition.

Dr. Antonino De Lorenzo of the University of Tor Vergata in Rome led the research team, the same one that first described NWO syndrome.

The study included 20 young women who met the definition of NWO syndrome, along with 20 normal-weight women and 20 who were overweight based on their BMI and had a body fat percentage greater than 30 percent.

Overall, the researchers found, the NWO group had higher levels of several inflammatory proteins than normal-weight women did. The excess body fat in the former group may explain the difference, as research suggests that fat tissue secretes inflammatory substances, De Lorenzo and his colleagues note.

Because inflammation has been implicated in the buildup of artery-clogging plaques, women who have a normal weight but high fat mass may be at increased risk of heart disease and stroke down the road, according to the researchers.

What's more, they point out, these women are likely to have a false sense of security about their heart health because their BMI is normal.]

This means that measuring body fat percentage, and not just BMI, could be an important part of preventing obesity-related ills, the researchers conclude.

SOURCE: American Journal of Clinical Nutrition, January 2007.


Moms mono virus ups risk of leukemia in child

Fri, 26 Jan 2007 18:59:48 GMT
By Megan Rauscher
NEW YORK - A new study provides more evidence that reactivation during pregnancy of Epstein-Barr virus, which causes mononucleosis, may be associated with a proportion of childhood leukemia cases. What that proportion may be has yet to be defined, researchers say.
In 2003, Dr. Matti Lehtinen from National Public Health Institute, Oulu, Finland and colleagues identified a link between maternal EBV reactivation and the development of acute lymphoblastic leukemia in offspring.

In that study -- based on data from 550,000 Finnish and Icelandic mothers and their offspring -- the presence of EBV antibodies suggesting reactivation of the virus were associated with a 2.9 adjusted odds ratio for ALL.

To confirm EBV's role in ALL, they analyzed first-trimester serum samples of mothers whose offspring later developed leukemia for different EBV antibodies that are known indicators of EBV reactivation. Altogether, they analyzed sera from mothers of 304 ALL cases and 39 non-ALL leukemia cases and 943 mothers of controls.

"We found some further confirmation to our findings, suggesting an association between maternal EBV infection and risk of leukemia in the offspring, especially infants < 1 year of age," lehtinen told reuters health.>

"We are preparing for a four times larger study, which should verify or falsify our observations," Lehtinen told Reuters Health.

SOURCE: American Journal of Epidemiology January 15, 2007.


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