Men as well as women need bone tests
Mon, 25 Feb 2008 21:18:40 GMT
By LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Bone tests aren't just for women anymore. New guidelines are calling for older men to get a routine check for bone-thinning osteoporosis.
There's news for women, too: A new computerized tool uses more than bone-density tests to predict who is at highest risk of breaking a bone in coming years — by adding in such important risk factors as whether a parent ever broke a hip.
It's an effort to better target who really needs treatment and who can safely skip it, even before someone's bones become thin enough to be officially labeled an osteoporosis patient.
And it promises a major shift in bone care.
"You treat the people who have high risk, and you would reassure the women at low risk and ask them to come back for a re-check in a few years," explains Dr. Ethel Siris of
Columbia University and president of the
National Osteoporosis Foundation, which issued the new guidelines last week.
Moreover, the new work stresses that a disease long associated with little old white ladies actually can strike anyone as they age. The biggest change: The NOF guidelines recommend a bone-mineral density X-ray test for all men 70 and older, just like women 65 and older have long been urged to get.
"There's a recognition more so now than in the past that men are at risk," says Dr. Jay Magaziner of the
University of Maryland medical school, who has long researched hip fractures — osteoporosis' most-feared break.
Don't misunderstand. Postmenopausal women are still at greatest risk of osteoporosis, when bone-strengthening estrogen plummets. But a quarter of hip fractures occur in men, and as men live longer, the number who break a hip is steadily rising, Magaziner told a recent meeting of the
American Academy of Orthopaedic Surgeons.
Screening men "as we do with women can have some real payoffs in terms of prevention," he says.
Another conundrum: More than half of fractures due to bone loss occur in people whose bones are thinning but aren't quite thin enough to be labeled osteoporosis. They're in a gray zone known as osteopenia.
In the U.S. alone, some 10 million people have osteoporosis but 34 million are estimated to have osteopenia. With the population rapidly aging, the government estimates half of Americans over 50 will be at risk of fractures from too-thin bones by 2020.
The World Health Organization funded a Web-based tool called FRAX, unveiled last week, that helps calculate the odds of a hip, wrist, shoulder or spine fracture within the next 10 years for anyone 40 or older in nine different countries — regardless of whether they have full-fledged osteoporosis or just low bone mass.
Both geography and ancestry matter for bone health. Consider differences such as diet, exercise and exposure to Vitamin D-making sunlight, and odds of a break differ dramatically from
China and
Japan, to
France and
Spain, and on to the highest-risk U.S. and
Sweden. Here, white women have the highest risk and black women the lowest. FRAX lets users take all that into account.
How? Researchers at Britain'
s University of Sheffield used data from 60,000 people in developed countries — where life expectancy is long enough for osteoporosis to be an issue — to determine factors that play the biggest role in an individual's odds of thinning bones as they age.
Breaking a bone during adulthood that's not the result of, say, a bad car crash is one risk factor. A parent who broke a hip suggests a genetic risk. Smoking also thins bones, as does heavy alcohol consumption and long-term use of steroid-containing medicines.
Plug in a patient's score from a
bone-density measurement of the hip for the final calculation.
That number alone doesn't say whether someone needs bone-building treatment. So in the U.S., the
National Osteoporosis Foundation went a step further. It used the FRAX predictions to update guidelines on who needs bone-density testing, and to calculate when fracture risk becomes high enough that bone-building drugs would be cost-effective.
In addition to a routine bone check for older men, the guidelines recommend:
_Treat postmenopausal women and men 50 and older who have thinning bones, but not osteoporosis yet, if they have at least a 20 percent risk of any major fracture in the next decade, or at least a 3 percent risk of a hip fracture.
_Check for
osteoporosis risk factors in postmenopausal women and men 50 and over, to see who needs a bone test before their senior years.
_A bone test for anyone who has any type of fracture after age 50, or who has conditions associated with bone loss, such as rheumatoid arthritis.
_For adults over 50, 1,200 milligrams a day of calcium and 800 to 1,000 international units a day of Vitamin D, more D than the government recommends.
_Do regular weight-bearing and muscle-strengthening exercise.
___
EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
On the Net:
FRAX Web site: http://www.shef.ac.uk/FRAX
Bill proposed after R.I. surgery errors
Tue, 26 Feb 2008 02:02:04 GMT
By MICHELLE R. SMITH, Associated Press Writer
PROVIDENCE, R.I. - Lawmakers have proposed a system to investigate and track medical mistakes and so-called "near misses" after brain surgeons at
Rhode Island Hospital operated on the wrong side of patients' heads last year on three separate occasions.
Bills introduced in the House and Senate would create a
Rhode Island Patient Safety Organization, which is designed to hunt down the potential causes of medical errors and fix them at hospitals and nursing homes statewide before patients are hurt.
The legislation was introduced by Rep. Joseph McNamara, a Democrat, and Sen. David Bates, a Republican, and designed by Health Director David Gifford.
Gifford said Monday he was prompted to act by last year's problems at Rhode Island Hospital.
"It made us ask, 'What else could we do?' Clearly, we do not want to see this happen again," Gifford said. "When we look at our data, Rhode Island Hospital wasn't the only one who's had problems."
The Department of Health already requires hospitals and nursing homes to report medical mistakes, but they don't have to report near misses. So while the department can investigate and take action against doctors or hospitals after a patient has already been hurt by a medical error, there's not a strong system for examining the cases when doctors and nurses narrowly avoiding making a mistake.
"It's a way to learn from our mistakes," Gifford said. "Right now, we're not seeing a change in errors overall."
The Department of Health said it gets about 300 reports of medical errors from hospitals every year as well as 275 reports from nursing homes.
The system would be voluntary, and doctors and nurses could not be punished for reporting mistakes to the Patient Safety Organization. Bill supporters said that was to encourage people to come forward so the organization can keep better track of what's happening.
Lifespan Corp., owner of the not-for-profit Rhode Island Hospital, and the
Rhode Island State Nurses Association also support the legislation. George Vecchione, Lifespan's CEO, said the legislation would make hospitals safer.
"We recognize that more can be done," he said.
Once it gets a report, the Patient Safety Organization would investigate and enter its findings into a database. The database would help the group make recommendations to the state's health providers.
For example, if it found persistent problems with pre-surgery checklists designed to ensure that a doctor doesn't operate on the wrong part of a patient's body, it could recommend all hospitals in the state use a standard checklist, Gifford said.
Rhode Island's legislation is modeled on the federal Patient Safety and
Quality Improvement Act, which passed in 2005. Gifford said the state proposal focuses more than the federal law does on investigating and making recommendations for change.
While the state is in the middle of a budget crisis, with widespread layoffs and cutbacks, the bills' sponsors said they were hopeful. Money for the Patient Safety Organization would not come out of the state budget, but would be funded by surcharges paid by hospitals, nursing homes and insurance providers licensed in the state. Bates pointed out that medical mistakes are expensive, and reducing them will benefit not just patients, but insurers and health providers.
"This is an investment," he said. "They are going to save money in the long run by correcting these problems."
ATT Tenn. create medical info exchange
Mon, 25 Feb 2008 12:39:30 GMT
By ERIK SCHELZIG, AP Business Writer
NASHVILLE, Tenn. -
AT&T Inc. is partnering with
Tennessee to provide the country's first statewide system to electronically exchange patient medical information, the telecommunications company said Monday.
The system is designed to securely transmit detailed patient information between medical professionals. It will allow doctors to access medical histories, prescribe medicines over the Internet and transfer images like X-rays, MRIs and CT scans.
"As patients we really want our information to be available to physicians whenever and wherever they're needed," said Diane Turcan, director of health care marketing for
AT&T in
Atlanta. "And we certainly don't want to be copying paper records."
Tennessee's program is seen as a model for other states and may be a springboard for interstate information sharing networks in the future, she said.
Doctors can use the system to remotely evaluate patients in rural areas who have less access to medical facilities. It will also link to the state Department of Health for access to the immunization and disease registry, death certificate processing and medical license renewals.
Tennessee Gov.
Phil Bredesen, who ran HealthAmerica Corp. before becoming a politician, has championed electronic records because of the inefficiency of the current paper-based system.
"If patients' medical history and record of care are available to their hospital, laboratory, pharmacy or physician, then they will ultimately receive better and more cost-effective medical care," Bredesen said in a written statement.
AT&T is developing a private portal within the secure network it already provides for state agencies in Tennessee. Turcan said AT&T's investment in the portal has been "significant" but declined to elaborate.
Antoine Agassi, director and chairman of the governor's
eHealth Council, said Tennessee's deal with AT&T should keep costs down for individual subscribers. Doctors can apply for state grants to defray the costs of getting set up on the system.
"Having the ability to get this from a pre-negotiated service level at a very, very competitive rate is a huge step forward," he said.
The state and AT&T will spend most of this year fine-tuning the system and hope that consumers will begin to notice a change by the end of 2008, Agassi said.
Cutoff cancer patient to get 369M
Sat, 23 Feb 2008 19:30:44 GMT
By THOMAS WATKINS, Associated Press Writer
LOS ANGELES - A woman who had her medical coverage canceled as she was undergoing treatment for breast cancer has been awarded more than $9 million in a case against one of
California's largest health insurers.
Patsy Bates, 52, a hairdresser from Lakewood, had been left with more than $129,000 in unpaid medical bills when
Health Net Inc. canceled her policy in 2004.
On Friday, arbitration judge Sam Cianchetti ordered
Health Net to repay that amount while providing $8.4 million in punitive damages and $750,000 for emotional distress.
"It's hard to imagine a situation more trying than the one Bates has had to endure," Cianchetti wrote in the decision. "The rug was pulled out from underneath, and that occurred at a time when she is diagnosed with breast cancer, one of the leading causes of death for women."
Bates, a mother of two, said she screamed when she heard about the damage award.
"I am elated," she said.
Bates' attorney William Shernoff said he wanted other insurers to take notice of the award.
"We are going to put a stop to this practice," he said.
Health Net said it was implementing a freeze on policy cancelations that would last until the company sets up a third-party review panel to scrutinize cases.
"Obviously we regret the way that this has turned out, but we are intent on fixing the processes to maintain the public trust," spokesman David Olson said.
The award came a day after the
Los Angeles city attorney sued Health Net, claiming it illegally canceled the coverage of about 1,600 patients. City Attorney Rocky Delgadillo also said the company illegally ran an incentive program in which it paid bonuses to an administrator for meeting targets of policy cancelations.
Health Net acknowledged that such a program existed in 2002 and 2003 but was subsequently scrapped.
"It's hard to imagine a policy more reprehensible than tying bonuses to encourage the recision of health insurance that helps keep the public well and alive," Cianchetti wrote in the Bates decision.
Bates had been insured with another company but was persuaded to switch over to a Health Net policy after an agent suggested she could save money.
She said she had undergone surgery to remove a tumor and had received her first two chemotherapy treatments when doctors stopped treating her because her bills were going unpaid.
"I was devastated. I didn't know what was going to happen," Bates said. "It's boggling that someone can do that to you."
Bates went on to complete her cancer treatment through a state-funded program.
Health Net also said it would review its practices and the way its brokers and agents are trained.
Obesity more dangerous than terrorism experts
Mon, 25 Feb 2008 06:55:36 GMT
by Lawrence Bartlett
SYDNEY -
World governments focus too much on fighting terrorism while obesity and other "lifestyle diseases" are killing millions more people, an international conference heard Monday.
Overcoming deadly factors such as poor diet, smoking and a lack of exercise should take top priority in the fight against a growing epidemic of preventable chronic disease, legal and health experts said.
Global terrorism was a real threat but posed far less risk than obesity, diabetes and smoking-related illnesses, prominent US professor of health law Lawrence Gostin said at the
Oxford Health Alliance Summit here.
"Ever since September 11, we've been lurching from one crisis to the next, which has really frightened the public," Gostin told AFP later.
"While we've been focusing so much attention on that, we've had this silent epidemic of obesity that's killing millions of people around the world, and we're devoting very little attention to it and a negligible amount of money."
The fifth annual conference of the Oxford Health Alliance -- co-founded by
Oxford University -- has brought together world experts from academia, government, business, law, economics and urban planning to promote change.
An estimated 388 million people will die from chronic disease worldwide over the next 10 years, according to World Health Organisation figures quoted by the alliance.
"There's a political paralysis in dealing with the issue," said Gostin, an adviser to the US government and a professor at
Georgetown and
Johns Hopkins universities.
He noted that prevention of obesity and its effects had hardly rated a mention in the current campaign for the US presidency.
"Yet the human costs are frightening when we consider that obesity could shorten the average lifespan of an entire generation, resulting in the first reversal in life expectancy since data collecting began in 1900," he said.
Like terrorism, some passing health threats get major government attention and media coverage, while heart and lung disease, diabetes and cancer account for 60 percent of the world's deaths, the meeting was told.
"It is true that new and re-emerging health threats such as
SARS,
avian flu, HIV/AIDS, terrorism,
bioterrorism and
climate change are dramatic and emotive," said Stig Pramming, the Oxford group's executive director.
"However, it is preventable chronic disease that will send health systems and economies to the wall."
The conference is due to end Wednesday with a "
Sydney Resolution" calling on governments and big business among others to take action to avert millions of premature deaths due to chronic disease.
"The way we live now is making us sick, it's making our planet sick and it's not sustainable," said Asia-Pacific co-director Ruth Colagiuri.
The Sydney resolution focuses on four key areas, including the need to make towns and cities healthier places in which to live by urban design which promotes walking and cycling and reduces carbon emissions from motor vehicles.
Insufficient physical exercise is a risk factor in many chronic diseases and is estimated to cause 1.9 million deaths worldwide each year, said Tony Capon, professor of health studies at
Australia's
Macquarie University.
"We need to build the physical activity back into our lives and it's not simply about bike paths, it's about developing an urban habitat that enables people to live healthy lives: ensuring that people can meet most of their daily needs within walking and cycling distance of where they live," he said.
The resolution also calls for a reduction in sugar, fat and salt content in food, making fresh food affordable and available and increasing global efforts to stop people smoking.
China reports rise in sexually transmitted diseases
Fri, 22 Feb 2008 14:14:41 GMT
BEIJING -
China unveiled on Friday a large
percentage rise in 2007 in diseases transmitted sexually or via
blood, including
AIDS and syphilis, without reporting exact
figures.
The number of new AIDS infections soared 45 percent in
2007, compared with 2006, the Health Ministry said in a
statement on its Web site , adding new syphilis
cases rose 24 percent.
The ministry's statement did not elaborate.
China has been battling an acknowledged rise in
HIV/AIDS
infections, now mainly sexually transmitted, though has said
previously that the rate overall is slowing.
In the past, most infections were caused by
intravenous
drug use.
The government had said late last year it estimated about
700,000 people were
living with HIV/AIDS in China in 2007, up
from an earlier estimate of 650,000.
The government has rolled out a major television campaign
to promote condom use, a major move for a country where talking
about sex is still taboo for many people.
The Health Ministry added scarlet fever and measles cases
also rose in 2007, though other diseases declined.
There was just one death from plague last year, and no
deaths from cholera, even as the number of new infections edged
up a little under three percent, it said.
Study doubts effectiveness of antidepressant drugs
Tue, 26 Feb 2008 07:19:10 GMT
WASHINGTON -
Antidepressant medications appear to
help only very severely depressed people and work no better
than placebos in many patients, British researchers said on
Monday.
Researchers led by Irving Kirsch of the
University of Hull
reviewed a series of studies, both published and unpublished,
on four antidepressants, examining the question of whether a
person's response to these drugs hinged on how depressed they
were before getting treatment.
They were
Eli Lilly and Co's Prozac, also known as
fluoxetine,
Wyeth's Effexor, also called venlafaxine;
GlaxoSmithKline's Paxil, also called Seroxat or paroxetine, and
Bristol-Myers Squibb Co's drug Serzone, also called nefazodone,
which it no longer markets in the United States.
They are all so-called selective serotonin reuptake
inhibitors, or SSRIs.
The researchers found that compared with placebo, these
new-generation antidepressant medications did not yield
clinically significant improvements in depression in patients
who initially had moderate or even very severe depression. The
study found that significant benefits occurred only in the most
severely depressed patients.
"Drug-placebo differences in antidepressant efficacy
increase as a function of baseline severity, but are relatively
small even for severely depressed patients. The relationship
between initial severity and antidepressant efficacy is
attributable to decreased responsiveness to placebo among very
severely depressed patients, rather than to increased
responsiveness to medication," the researchers wrote.
The researchers obtained data on all the clinical trials
submitted to the
U.S. Food and Drug Administration for the
licensing of the four drugs.
"Although patients get better when they take
antidepressants, they also get better when they take a placebo,
and the difference in improvement is not very great. This means
that depressed people can improve without chemical treatments,"
Kirsch said in a statement.
But Mary Ann Rhyne, a spokeswoman for Paxil maker GSK, said
the study only looked at data submitted prior to the drug's
U.S. approval.
"The authors have failed to acknowledge the very positive
benefit these treatments have provided to patients and their
families who are dealing with depression and they are at odds
with what has been seen in actual clinical practice," Rhyne
said.
"This analysis has only examined a small subset of the
total data available, while regulatory bodies around the world
have conducted extensive reviews and evaluations of all of the
data available," she said.
Doug Petkus, a spokesman for
Wyeth, maker of Effexor, said
he had not seen the study and could not comment.
(Reporting by Will Dunham and Julie Steenhuysen; Editing by
Eric Walsh)
Viral Infections Tied to Pregnancy Complications
Tue, 26 Feb 2008 04:47:05 GMT
MONDAY, Feb. 25 -- Exposure to viral infection --
especially herpes viruses -- may be associated with high blood pressure
during pregnancy and preterm birth, Australian researchers report.
The findings -- the first of their kind -- are a major advance in
learning more about the
cause of hypertension in pregnancy, according to
the authors of the study, which was published in the
British Journal of
Obstetrics & Gynaecology.
Over 10 years, researchers from Adelaide's Women & Children's
Hospital and the
University of Adelaide detected the presence of viral
nucleic acid in heel-prick blood samples from 1,326 newborns -- more than
400 of whom were diagnosed with cerebral palsy.
"This is an exciting finding and further studies are now required to
look at the link between viral exposure in pregnancy and genetic
susceptibility to adverse pregnancy outcomes, such as high blood pressure,
premature delivery and cerebral palsy," research group leader Alastair
MacLennan, a professor in the Department of Obstetrics and Gynaecology,
said in a prepared statement.
High blood pressure occurs in up to 10 percent of first pregnancies in
the United States and other developed nations. It's a common cause of
death among pregnant women in developing countries.
Previously, the Adelaide group identified a link between viral
infection in pregnancy, genetic mutations in genes controlling
inflammatory and blood clotting processes, and the development of cerebral
palsy. They also found an association between several hereditary gene
mutations and changes in inflammatory proteins that may cause dysfunction
and constriction of blood vessels in the placenta and brain, resulting in
increased blood pressure during pregnancy.
"We are just beginning to understand the interaction and importance of
exposure to viruses and genetic susceptibility to infection both in
pregnancy and the newborn," Paul Goldwater, an associate professor and the
research team's virologist, said in a prepared statement.
More information
The
American Academy of Family Physicians has more about high blood pressure during
pregnancy.
Antibiotic Use in Dementia Patients Questioned
Tue, 26 Feb 2008 04:47:01 GMT
By Serena Gordon
HealthDay Reporter
MONDAY, Feb. 25 -- Almost half of nursing home
patients with advanced dementia are given antibiotics in the last two
weeks of life, a new study found.
What's not clear is whether or not that therapy has any benefits, such
as prolonging life or improving the quality of life. And, of concern are
the risks associated with antibiotic use, such as pain from intravenous
antibiotics and unpleasant side effects, as well as the fact that frequent
use of antibiotics in people with advanced dementia may help fuel the
growing problem of
antibiotic resistance.
"Antibiotic exposure is extensive in nursing home residents with
advanced dementia, and it increases as patients near death," said study
lead author Dr. Erika D'Agata, an assistant professor of medicine at
Harvard Medical School. "We really need to determine if antibiotics
should be given to patients at the end of life. Do they benefit
from treatment?"
The study findings are published in the Feb. 25 issue of
Archives of
Internal Medicine.
About 70 percent of the 5 million Americans with dementia will end up
in a nursing home at the end of their lives. Repeated infections and
fevers are common at the end of life, according to background information
in the study.
"In general, in the population of severely demented elderly patients,
as the health of the patient deteriorates, infection becomes increasingly
frequent. According to common medical practice, these episodes of
infection are usually treated with antibiotics, but death often results
nevertheless," the authors of an accompanying editorial in the journal,
Dr. Mitchell Schwaber and Dr. Yehuda Carmeli, of the
Tel Aviv Medical
Center's division of epidemiology, said in an
e-mail interview.
To get a more precise idea of how antibiotics are used in nursing home
residents with advanced dementia, D'Agata and her colleague, Dr. Susan
Mitchell, reviewed data from a group of 214 people and followed them for
18 months or until death.
The researchers found that 66 percent of the patients received at least
one course of antibiotics during the study period, and that the average
number of days an advanced dementia patient spent on antibiotics was 53
days per every 1,000 days. Respiratory-tract infections were the most
common reason antibiotics were prescribed, according to the study.
During the study period, 99 people died. Of those, 42 percent were on
antibiotic therapy during the last two weeks of their lives. Many were
given antibiotics through an intravenous line or by intramuscular
injection.
The next step, according to D'Agata, is to figure out whether these
patients benefit from antibiotic therapy, and what are the consequences
from the
overuse of antibiotics to the patient and to society.
Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore
Medical Center in
New York City, agreed that more research is needed.
"Physicians need a bit more data on outcome than we have from this
article. We can't say that we know what the consequences of withholding
antibiotics in this group are. If the data says that most of the time
treatment with antibiotics doesn't prolong life or improve quality of
life, then physicians can go to the families with a recommendation not to
treat someone in the advanced stages of dementia," he said.
Schwaber and Carmeli said: "Not every infection [in someone with
advanced dementia] must be treated with antibiotics. If no enhancement in
the quality of life can be expected by the use of antibiotics, withholding
their use may be the appropriate step to take in the case of
infection."
However, D'Agata, Kennedy, Schwaber and Carmeli all agreed that the
decision to use antibiotics or not needs to be made on a case-by-case
basis with the family. And, Kennedy added, this study points to the
importance of having an advance directive, which allows patients to spell
out their wishes for end-of-life care.
Soon after a diagnosis of dementia or Alzheimer's, patients and their
families and treating physicians should discuss what types of treatment
are wanted, Kennedy suggested. Would the person with dementia want to be
placed on a ventilator or have a feeding tube? Would the person want to
be hospitalized or medicated at the end of life?
"This needs to be done in early dementia, because the more the dementia
progresses, the less they have the capacity to participate," Kennedy
said.
More information
Learn more about end-of-life decisions for people with dementia at the
Alzheimer's Association.
Cancer risk up in Japanese women exposed to smoke
Tue, 26 Feb 2008 00:29:16 GMT
NEW YORK -
The results of a study
published in the International Journal of Cancer confirm that
passive smoking is a risk factor for lung cancer, especially
adenocarcinoma, among non-smoking Japanese women.
"Although smoking is a major cause of lung cancer, the
proportion of lung cancer cases among Japanese women who never
smoked is high," Dr. Norie Kurahashi, of the National Cancer
Center, Tokyo, and colleagues write. "As the prevalence of
smoking in Japan is relatively high in men, but low in women,
the development of lung cancer in non-smoking Japanese women
may be significantly impacted by passive smoking."
In a population-based study, the researchers examined the
association between a husband's smoking and the lung cancer
risk in his non-smoking wife. The authors also assessed the
association between passive smoking from other sources -- at
the workplace or during childhood -- in women with lung cancer
who never smoked.
A total of 109 cases of lung cancer were diagnosed among
28,414 lifelong non-smoking women over an average follow-up of
13.3 years. Of these women, 82 developed adenocarcinoma.
Overall, 49 percent of the women were exposed to passive
smoking from husbands who were current smokers. Compared with
women married to men who never smoked, those married to current
smokers had a 34 percent increased risk of all types of lung
cancer.
Passive smoking from husbands who were current smokers was
associated with a statistically significant two-fold increased
risk of lung adenocarcinoma.
Passive smoking in the workplace also increased the risk of
all lung cancers by 32 percent and the risk of adenocarcinoma
by 16 percent.
No association was observed between passive smoking in
childhood and lung cancer risk.
These findings are supported by the mechanism of sidestream
smoke through the nasal passages, which shows that the volatile
components of sidestream smoke are more likely to reach the
outer portions of the lungs compared with mainstream smoke,
Kurahashi and colleagues point out.
"Particularly in Japan, where room sizes tend to be small
and living conditions congested, sidestream smoke may be
directly transmitted to non-smoking women before dilution by
room air," they add.
SOURCE: International Journal of Cancer, February 2008.
