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Archive for May, 2003

94984318

28 May

More Smallpox Vaccine Concerns
WASHINGTON, D.C., May 27, 2003
There is new concern about the government’s already troubled smallpox vaccination program. Few of the half-million healthcare workers eligible for innoculation under phase one of the program chose to get vaccinated. And some healh experts are warning — not so fast.
Some states, including Florida and Virginia, are already moving ahead with phase two of the government’s smallpox vaccination program, to include as many as three million firefighters, police and paramedics.
But a new report issued by an Institute of Medicine panel says all civilian vaccinations should temporarily stop, and that the federal government should actively get out the word to states, CBS News Correspondent Sharyl Attkisson reports.
The Committee on Smallpox Vaccine Implementation earlier recommended a “pause” in civilian smallpox vaccination, in part due to unexpected adverse events emerging in what was already known to be the most toxic vaccine on the market.
The head of the committee, Dr. Brian Strom, says the Centers for Disease Control, which advises states on their vaccine programs, recently accepted the idea of a pause. Yet, Strom says, the CDC didn’t explicitly notify states of this change of heart. Tuesday’s report encourages the CDC to take more action.
“What we’re asking is one step further � that they go out of their way to make it easy for those states who want to pause to make it easy for them to be able do that,” says Strom.
“We think that it’s better for public health, we think it’s better for the campaign, that all information be learned about to the degree possible before launching into phase two in a large-scale way. We thought that it was very important that people stop, they take stock of where they are, look to learn from the experience gained today before proceeding onward with the rest of the campaign.”
The report says several issues should be resolved “before deciding whether and how to proceed with vaccination.”
On the issue of safety, the report says a “pause” is needed to collect and evaluate adverse event reports. Although every civilian who receives the smallpox vaccine is supposed to be individually tracked, only 34 percent of vaccinees have made it into the surveillance system so far; two-thirds have not.
“Some adverse events might not arouse concern on a state level, but aggregated nationally, new patterns could emerge,” says the report. “Cardiac complications were unexpected adverse events, and there may be others.”
Says Strom: “At this point only about one-third of the civilian patients who’ve gotten the vaccination are in the surveillance system. And one of the things we’d like know about is the outcomes in the other two-thirds of the patients.”
The report also says the consent forms and educational materials should be revised with updated material and information that can be understood clearly by firefighters, police and paramedics instead of the health care workers who were targeted in phase one.
“In many ways, the most important message we have is that maximum preparedness doesn’t require huge numbers; it requires it be done very safely and very carefully. That’s what’s been done so far. The CDC has done a terrific job. And the CDC should use (a pause in the state’s vaccination programs) as an opportunity to learn maximally from the experience to date, in order to be sure that as we launch into phase two it’s given to the right people, it’s the right size and it’s done as safely as possible,” says Strom.
The panel that issued the new report was created by the Institute of Medicine to advise the federal government on implementing the smallpox vaccine program.
But it’s unclear whether the federal government will take the committee’s advice to publicly encourage states to “pause.” Doing so would highlight touchy subjects in some political circles: unexpected adverse events, and what some view as the lackluster response to President Bush’s smallpox vaccine program. Out of roughly 500,000 eligible health care workers, only a small fraction, 30,000, volunteered to receive the vaccine in phase one.
Many who refused the vaccine were concerned about the vaccine’s risks. Some states have already stopped their smallpox vaccination programs on their own, others are “skipping” phase two altogether.
The inherent conflict involved in this issue is apparent. Strom, chair of the committee that wrote the new report, told CBS News it was issued quickly because of its importance and urgency. Yet a spokesman for the Institute of Medicine told reporters, in advance, there would be nothing particularly newsworthy in the committee’s report.
Source: cbsnews.com

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94492321

17 May

Food cravings: What do they mean?
May 16th, 2003
Many people struggling to lose weight or eat more healthfully feel discouraged by food cravings that seem to undermine their good intentions. Food cravings are quite common, especially among women, according to a new review of the topic in the Journal of Nutrition. Many different factors may create food cravings, although which are the most important and how cravings should be dealt with are far from clear.
FOOD CRAVINGS are at least partly related to sensory appeal. Foods high in both sugar and fat are the most commonly craved foods, especially chocolate. An earlier report in the Journal of the American Dietetic Association notes that, although chocolate cravings are linked with sweet cravings, people who crave chocolate generally report that these cravings are not satisfied by other sweets.

A PHYSIOLOGICAL CAUSE?
Some research has found a physiological basis for cravings, according to the new Journal of Nutrition review. According to some studies, carbohydrates initiate a chain reaction that theoretically can change levels of neurotransmitters influencing mood.
Research with carbohydrate-cravers suggests that cravings for sweets may come with negative or depressed feelings that could be relieved as those levels change, but this idea is not universally accepted. Some studies, like one in the International Journal of Obesity and Related Metabolic Disorders, suggest that carbohydrate snacks may not necessarily improve mood.
Uncomfortably low blood sugar may be another physiological cause for a craving for sweets as the body tries to normalize blood sugar levels.
Others propose that cravings may stem from nutritional deficiencies. For example, lack of adequate magnesium in the diet could be behind a chocolate craving. Chocolate is a good source of magnesium. But avocados and spinach are far more concentrated sources, and we rarely hear of people craving those foods.
Some cravings, especially for chocolate, also seem to fluctuate with hormonal changes before and during women�s menstrual periods.

THOUGHTS AND EMOTIONS
A large body of research shows that thoughts and feelings about food are also strongly influenced by non-physical factors. People who go on diets that forbid certain foods almost always end up craving those foods.
According to a report in the International Journal of Eating Disorders, cravers are often more concerned about their weight than non-cravers. But is this because out-of-control cravings cause undesired weight gain, or because excess concern with weight and dieting leads to more cravings?
Not everyone experiences food cravings. But scientists say we should understand that for those who do, their cravings are real and should be respected.

TIPS FOR CONTROLLING CRAVINGS
For people whose cravings seem to be physiological, eating regular meals and not allowing hunger to become overwhelming can help prevent dropping blood sugar from acting as a trigger. Choosing whole grains, fruits, vegetables and legumes for most of the day�s carbohydrate will supply important nutrients and reduces roller-coaster effects on blood sugars.
For those who seem to crave foods in order to cope with their feelings, eating only small amounts of less-nutritious craved foods, along with a nutritionally balanced snack or meal, may be appropriate.
Some experts observe that the more we use certain foods to ease emotionally laden times, the more we condition ourselves to crave them in the future. For this reason, efforts to find other ways to ease emotional pain are likely worthwhile. Exercise, for example, has proven to have positive, mood-elevating effects.
Finally, don�t create cravings by making overly strict rules as you aim for healthy eating habits. No food needs to be eliminated in order to create a healthy diet – it�s how often and in what portion it is eaten that counts.
Source: msnbc.com

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93707634

03 May

Pregnancy Safety Precautions
NEW YORK, May 3, 2003
(CBS) Alisa Kotler-Berkowitz and her son Matan are the picture of health today, but two-thirds of the way through her pregnancy, Kotler-Berkowitz got an unexpected diagnosis. She learned she had gestational diabetes. “I was concerned because I wasn’t sure what it meant, I didn’t know a lot about diabetes,” says Kotler-Berkowitz.
A woman with gestational diabetes produces the right amount of insulin, but the insulin’s effects are blocked by hormones made in her placenta. It’s a condition that affects between 3 and 6 percent of non-diabetic women. Risk factors include a family history of diabetes, high blood pressure, obesity and being over the age of 30.
“It is very important that we screen pregnant women because there are no symptoms,” says Mt. Sinai Hospital’s Dr. Michelle Morgan.
Women are tested for gestational diabetes between the 24th and 28th week of pregnancy. They begin by drinking a sugary solution. After one hour, their blood is drawn to check the glucose level. If it’s too high, the expecting mom will have to undergo further testing. If it is determined a pregnant woman does have gestational diabetes, she must get it under control immediately. Failure to treat the condition can lead to serious problems for the baby, including excessive birth weight, low blood sugar, jaundice, respiratory problems and sometimes death.
In most cases, gestational diabetes is fairly easy to deal with.
“The main stays of treatment generally consist of a program of diet and exercise, and in some cases if the diabetes is not controlled, an addition insulin would be used,” says Morgan.
Kotler-Berkowitz keeps her diabetes in check by following a healthy diet she hopes to maintain. “Lately I’ve rediscovered my love for chocolate so I’m sort of thinking about it, remembering my diabetic diet.”
Dr. Mallika Marshall from WBZ-TV explained on The Saturday Early Show that regular exercise and a healthy diet have been shown to lower the chances of diabetes in people who are at risk. There’s also a medication, called Metformin, that can help prevent diabetes in people who have mildly elevated blood sugar levels high enough for a diagnosis of diabetes.
Another problem some pregnant women may be concerned about is preeclampsia, says Marshall. It is commonly known as toxemia, or pregnancy-induced hypertension. It only occurs during pregnancy and affects about 5 percent of pregnant women in the United States. It usually develops in the second or third trimester.
Women with preeclampsia develop high blood pressure, protein in the urine and swelling of the legs, hands and sometimes the entire body. In rare cases, women can develop seizures and can even die from the condition.
The cause of preeclampsia is unknown, but it results in constriction of the blood vessels in the mother, which can decrease blood flow to placenta and to the fetus. This can slow the baby’s growth.
Marshall says some women may develop swelling, headaches, blurry vision or abdominal pain if they have preeclampsia. But many women don’t develop symptoms at all. That’s why it’s so important that pregnant women get regular prenatal care and have their blood pressure checked throughout their pregnancy.
The only cure for preeclampsia is to deliver the baby, because it resolves itself as soon as the pregnancy is over. If the symptoms are mild and it’s too soon to deliver the baby safely, the woman will usually be put on bed rest and will be monitored closely by doctors and nurses. Sometimes women are hospitalized and treated with intravenous medications. But if symptoms are severe or the woman develops seizures, the baby has to be delivered.
Another problem to be on the lookout for in the later stages on pregnancy is bleeding. Some women may suffer from placenta previa, which happens when the placenta is located in an abnormally low position in the uterus, partially or completely blocking the cervix. In some cases, as the pregnancy progresses, the placenta changes locations and no longer obstructs the cervix. In some cases, a C-section is required for delivery.
In placental abruption another pregnancy-related problem, a part of the placenta detaches from the wall of the uterus, and can cause pain and bleeding. If minor, bed rest may be all that’s required. If severe, the baby may have to be delivered by C-section.
Marshall says pregnant women with asthma are also at high risk of endangering their unborn child. About a third of women with asthma will notice their asthma symptoms worsen during pregnancy. However about a third of women get better during their pregnancy. Severe uncontrolled asthma can reduce the supply of oxygen to the baby and can increase the risk of premature birth.
Source: CBSNews.com

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93707241

03 May

SARS: Relapses, mutations puzzling
Saturday, May 3, 2003 Posted: 4:41 AM EDT (0841 GMT)
HONG KONG, China (CNN) — Mutations of the SARS virus and relapses among patients are puzzling scientists trying to understand the disease, amid a five-fold increase in the number of deaths in the past month.
Doctors at the Chinese University of Hong Kong said there were two forms of SARS present in the hard-hit Chinese territory, which could complicate efforts to develop a diagnosis and vaccine.
“This rapid evolution is like that of a murderer who is trying to change his fingertips or even his appearance to try and escape detection,” Dr Dennis Lo said. Lo added that more research needed to be done to determine if the virus had become more infectious or deadly.
There were ten new cases and nine deaths reported in Hong Kong on Saturday, bringing to 1621 the total number of infections recorded in the former British colony. A total of 179 people have died from SARS there, while almost 900 have been discharged.
Also worrying scientists is at least a dozen cases of SARS relapses among discharged patients. The World Health Organization is set to discuss the issue with Hong Kong authorities on Monday. The territory’s health chief has also admitted Hong Kong did not respond quickly enough to the SARS outbreak. This was because little was known about the disease, Health Secretary Dr. Yeoh Eng-kiong said in a radio interview on Saturday. Hong Kong authorities have been criticized for being tardy in imposing quarantines on people who might have been exposed to the virus.
However, recent figures in Hong Kong have backed a declaration from the WHO the SARS outbreak had peaked there. Across the border in mainland China, SARS cases continued to mount.
There were another 181 new cases and 9 more deaths in China on Saturday. Most cases and deaths have been reported in the capital, Beijing. So far around 1,600 people have been infected with SARS and 96 have died from it in China’s hardest-hit mainland city to date. The deputy director of Beijing Health Bureau, Liang Wannian, said on Friday he believed the SARS epidemic “was in a stable period with the upward trend contained [in the capital],” China’s official Xinhua news agency reported. Beijing authorities are hoping isolation may help. They have opened a new 1,000-bed hospital to handle patients with the virus and barricaded some roads as patients were being transferred.
The Xiaotangshan Hospital threw open its doors after more than 7,000 builders worked feverishly to erect the structure in just eight days.
China’s central government has also reversed its stance and agreed to allow WHO send experts to Taiwan to assess the SARS outbreak there. China, which regards Taiwan as a renegade province, has blocked efforts by the island to join the United Nations body as an independent country. Taiwan has complained that its non-membership to the U.N. is behind a lack of response from the WHO to its requests for help against SARS. Taiwan authorities have reported nearly 100 SARS cases. There were five new fatalities Friday.
Globally more than 400 have died, and more than 6,000 have been infected with SARS.

In other developments:
� Toronto officials insist the disease is under control in the city after no new SARS cases were reported on Friday. The Canadian city has had the largest outbreak of the virus outside of Asia with 140 probable cases and 23 SARS deaths.
� Singaporean authorities have arrested a man who repeatedly flouted home quarantine. The man, who skipped quarantine and went out drinking on two occasions, was jailed in isolation on Friday. Singapore has put in place strict control measures and has recorded 25 deaths out of 203 cases.
� The World Health Organization says laboratory tests for SARS being used in India are inaccurate. So far, India has reported 19 cases of the disease and has quarantined 200 people.
Source: CNN.com

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93592252

01 May

Double Duty: Study Finds Viagra Works for Women
April 28 � A new study has found that the impotence drug Viagra could ramp up the sex lives of women who take it, just as it has done for men.
The 12-week study focused on 202 post-menopausal or post-hysterectomy women who complained of female sexual arousal disorder. The women in the group who took Sildenafil � the little blue pill commonly known as Viagra � took notes after each sexual experience, and reported better overall sexual satisfaction compared with those who took a placebo.
Their enhanced sex lives included better arousal, lubrication and orgasm.
The study was conducted by Laura Berman, director of the Berman Center and a professor of OB-GYN and psychiatry at Northwestern University in Chicago, and Dr. Jennifer Berman, director of the Female Sexual Medicine Center at UCLA Medical Center in Los Angeles. The researchers say that the results are preliminary.
“In terms of ability to achieve orgasm, there was a statistically significant movement,” Laura Berman said on ABCNEWS’ Good Morning America.
“It increases blood flow to the genital area, increases the sensation of warmth, tingling and fullness,” she said.
More than 50 million women experience some type of sexual dysfunction. Jennifer Berman said it’s important for women to remember that this pill can’t overcome mental and emotional barriers to a satisfying sex life.
“At this point, we can say that women with significant emotional or relationship problems and women that have desire problems related to their interest in being sexual might not be the best candidates,” Jennifer Berman said. “It’s for women who were satisfied with their sexual response at one point and now, for whatever medical reason, are no longer able to respond,” she said.

Increased Blood Flow Theory
Women who suffer from female sexual arousal disorder can experience a variety of symptoms, including lack of “excitement,” vaginal dryness, loss of sensation and sensitivity in the genitals and nipples and low blood flow to the genitals. Women in the study were screened to make sure that psychological or relationship issues were not the cause of the problem.
Since Viagra enhances sexual arousal in men by increasing the blood flow to the penis, the Bermans theorized that the drug could have a similar effect on women, increasing the blood flow to the female genitals and thereby producing better arousal, sensation and lubrication in the genital area.
Women in the study were given doses of 50 milligrams, which was increased to 100 milligrams only once during the study based on how well the lower dose was working, and the women’s tolerance to it. The pill was to be taken prior to sexual activity but no more than once daily.
Each patient had to engage in sexual activity at least once a week and keep a personal log about it. During the course of the study, neither the patients nor the doctors knew which patients were receiving the Viagra. Women taking Viagra reported mild to moderate side effects, including headache, flushing, nausea, and vision symptoms � the same side effects reported by men who take the drug.
Source: abcNews.com

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