Health News, Wellness, and Medical Information

Researchers report that people with chest pain who are given an electrocardiogram by paramedics before reaching the hospital don’t wait as long to receive treatment to open their arteries.

They often were able to bypass the emergency room and go directly to the cardiac catheterization laboratory for treatment with what’s commonly known as an angioplasty, the study found.

They were treated 60 minutes, on average, after reaching the hospital, compared with 91 minutes for people who did not have an EKG before arriving at the hospital. The findings were published in the January issue of Catheterization and Cardiovascular Interventions.

Research has shown that rapid angioplasty treatment reduces the chances of dying within the next year.

For the study, the researchers examined medical records for cardiac patients taken to three hospitals in Southeast Michigan from 2003 to 2008. When EKGs were done outside of a hospital, data were transmitted to the hospital before patients arrived so doctors could prepare.

Of those who did not have an EKG done before arrival, 2 percent (seven of 241 patients) died in the hospital. None of the 108 patients who were given pre-arrival EKGs died in the hospital, the study reported.

SOURCE: Wiley-Blackwell

Researchers have identified four regions of the human genome that predict a heightened risk of pancreatic cancer as a result of what they describe as the biggest-ever sweep of the genome for genes related to the disease.

Though some of the locations had been linked to other cancers, the discovery of others apparently surprised the researchers.

“This lets us go places we had never thought of before,” said senior study author Dr. Stephen Chanock, chief of the laboratory of translational genomics at the U.S. National Cancer Institute.

However, he cautioned that though the regions “are conclusively associated with the risk of developing pancreatic cancer, it doesn’t mean if you have a variation in that region you’re going to get pancreatic cancer.”

It simply means risk is increased, and, more than likely, environmental factors would have to come into play to complete the picture, he explained.

The findings were reported online Jan. 24 in Nature Genetics.

Pancreatic cancer has an extremely grim prognosis, with only 5 percent of people still alive five years after detection.

“Pancreatic cancer is often diagnosed at a very late stage, and that’s partly due to anatomical location,” Chanock said. “The disease can fester and grow for extended periods of time before it impinges on a vital structure that produces symptoms, and we have not developed sufficiently good ways to identify people at risk with tests.”

Smoking, a history of diabetes and weight problems all can contribute to risk, as can a family history of the disease, although family clusters account for less than 5 percent to 10 percent of all pancreatic cancers, he added.

But only recently have scientists begun to unravel the myriad genetic factors that might trigger the disease.

After analyzing genes in close to 4,000 people with pancreatic cancer and an equivalent number of people without the disease, the investigators identified three genetic regions associated with a greater risk for the cancer.

Combined with previous work, the discovery gives scientists four particular areas of interest in understanding the disease.

The first genetic location plays an important role in ABO blood types, something scientists had suspected even before the genetic connection was made.

The second location is in a region of chromosome 5 that harbors a gene important for telomeres, structures at the end of chromosomes that get shorter each time a cell divides.

“The telomerase gene has already been identified in lung cancer, brain cancer, skin cancer and leukemia, and it’s associated with a rare lung disease and blood disorders,” Chanock said. “This seems to be pointing toward a ’soft spot’ in the human genome — that there’s something about genetic variation in that region that can predispose toward a number of different diseases.”

The question now is why someone with this predisposition would develop lung cancer rather than skin cancer, and that’s where environmental cues probably come into play, Chanock said.

The other two regions — on chromosomes 1 and 13 — are “enigmatic,” Chanock said. “They are new places we’d never thought of in pancreatic or any type of cancer.”

Dr. Michael Hall, director of the gastrointestinal cancer risk assessment program at Fox Chase Cancer Center in Philadelphia, described the study as “a monumental effort to gather this many samples.”

“The findings were very consistent and, I think, very believable,” Hall said. “The next question becomes what do you do with that information. Once this starts to get meshed together with what other people have found, the impact is going to be greater.”

And as Chanock explained, researchers now are faced with the laborious task of making sense of the findings and figuring out how to use them to reduce risk.

“It’s more complicated than just using markers to predict risk,” Chanock said. “Some work together, some work against each other. It will take more studies to move toward risk profiles that will help us to figure who’s at greater or lesser risk for pancreatic cancer and who might need certain types of tests or to visit their doctor more frequently, or who would be candidates for a trial of chemoprevention.”

SOURCES: Stephen Chanock, M.D., chief, laboratory of translational genomics, U.S. National Cancer Institute, Bethesda, Md.; Michael Hall, M.D., director, gastrointestinal cancer risk assessment program, Fox Chase Cancer Center, Philadelphia

- Children who are around smokers face a higher risk of early emphysema when they become nonsmoking adults, perhaps because their lungs never totally recovered from secondhand smoke exposure, new research suggests.

Researchers reached their conclusions after conducting CT scans on 1,781 non-smokers from six communities in the United States. About half of them grew up in homes with at least one smoker.

“We were able to detect a difference on CT scans between the lungs of participants who lived with a smoker as a child and those who did not,” Gina Lovasi, an assistant professor of epidemiology at Columbia University’s Mailman School of Public Health, said in a university news release. “Some known harmful effects of tobacco smoke are short-term, and this new research suggests that effects of tobacco smoke on the lungs may also persist for decades.”

The researchers didn’t find a link between childhood exposure to tobacco smoke and lung function. “However, emphysema may be a more sensitive measure of damage compared with lung function in this relatively healthy cohort,” Lovasi noted.

The findings are published in the December issue of the American Journal of Epidemiology.

Restaurant menus that include calorie information do seem to encourage diners to exercise some restraint, a new study suggests.

What’s more, researchers found, menus that give added information — namely, the number of calories the average adult should get in a day — could prove even more effective at curbing appetites.

The findings, reported in the American Journal of Public Health, give some weight to the growing movement to require restaurant chains to place calorie information on their menus and menu boards.

In 2008, New York City became the first U.S. city to mandate such changes at fast-food and coffee chains. That law became a model for California and other U.S. states and cities that have since implemented or are considering similar measures.

And soon the federal government may be stepping in; provisions for menu labeling are part of the healthcare reform legislation currently before Congress.

The intention is to help combat the nation’s obesity problem by raising consumer awareness of just how many calories lurk in their burgers, sandwiches, fries and desserts.

But questions have been raised about the effectiveness of menu labeling.

In October, an independent study of New York’s law concluded that menu labeling had done nothing to change consumer habits in the city’s low-income neighborhoods. Shortly thereafter, the city’s health department released preliminary data from a larger study suggesting that New Yorkers had, in fact, started buying fewer calories at 9 of 13 fast- food and coffee chains included in the research.

For the current study, Yale University researchers tested the effects of menus that provide not only calorie content, but also a line stating that the average adult should get about 2,000 calories a day.

The researchers randomly assigned 303 adults to order from one of three menus: one with no calorie labeling; one with calorie information; and one with calorie content, plus a label with the 2,000- calorie recommendation.

Overall, the study found, diners in the two calorie-label groups ate 14 percent fewer calories at the meal than those who had ordered from the label-free menus.

And when study participants later reported on their food intake for the remainder of the day, the researchers found that those who had seen the 2,000-calorie recommendation downed fewer calories — an average of 250 fewer than those in the other two groups.

The setting was experimental, and not “real world,” but that allowed the researchers to show cause-and-effect, noted Christina Roberto, a doctoral candidate at Yale who led the study. “We can say that is the menu labeling having the effects” on calorie intake, she told Reuters Health.

Moreover, Roberto said, the findings highlight the potential impact of a simple line stating the number of calories a person should get each day. “That turned out to be really important,” said Roberto, noting that the information helps people put their single meal in the context of a whole day.

“By putting that ‘anchor’ in,” she said, “you can maximize the effectiveness of menu labeling.”

Roberto noted that the current healthcare reform bills would have restaurants include the daily-calorie recommendation on menus.

Older women who suffer from major depression are at greater risk of developing urinary incontinence than women of the same age who are not depressed, new research shows.

Since urinary incontinence and depression often occur together in women, Dr. Jennifer Melville from the University of Washington in Seattle and colleagues set out to determine if a causal relationship exists between the two conditions.

Previous studies demonstrated a high rate of depression among women being treated for urinary incontinence but none had examined whether one condition led to the other.

Melville’s team hypothesized that because the brain chemical serotonin plays a role in both depression and bladder function, the physiological changes brought on by one illness may set the stage for the other.

“We thought maybe we’d see it both ways. In some people because of chemical changes in the body, depression could lead to incontinence but in others, the cause would run the other way because of the psychologic reaction to incontinence,” Melville told Reuters Health in a telephone interview.

They scoured data gathered over six years in the ongoing Health and Retirement Study of the financial and physical health of recent retirees in 70,000 households.

The investigators conducted two analyses. In the first, women who entered study with depression were examined to see if urinary incontinence developed. The second analysis looked at women who entered the study with urinary incontinence to see if depression was reported at follow-up.

In this sample of nearly 6,000 women with an average age of 59 years, “we just saw the one pathway, very strong, leading from depression to incontinence and in fact incontinence not leading to depression,” Melville said.

The unambiguous results of the study were not expected, she admitted. “We were surprised at was how one-sided the effect looked.”

Doctors can use the findings in the current study “to counsel women with depression about a potentially increased risk for development of urinary incontinence or what to do if incontinence symptoms begin to emerge,” Melville and her colleagues write in the American Journal of Obstetrics and Gynecology.

The loss of bladder control may take a large toll emotionally because of the impact it can have on daily life, they note in their report. Many people feel humiliated and helpless about their condition and restrict social and work activities as a result.

The findings, Melville and colleagues add, also highlight “the importance of addressing depression urgently as a public health priority,” because of the effect it may have on other biological functions.

Among people aged 75 and older, the herbal supplement Ginkgo biloba does not prevent heart attacks, stroke or death, a new study finds.

There is some evidence that the popular herbal remedy might help prevent the leg-circulation problem known as peripheral artery disease, however.

Ginkgo contains nutrients called flavonoids, which are also found in fruits, vegetables, dark chocolate and red wine, and are believed to offer some protection against cardiovascular events, the researchers say. The supplement, which is popular in the United States and Europe, has been touted to improve memory, and to prevent dementia, heart disease and stroke.

However, “ginkgo had no benefit in preventing heart attack or stroke,” said study lead researcher Dr. Lewis H. Kuller, distinguished university professor of public health and professor of epidemiology at the University of Pittsburgh.

“But, surprising to us, was that the results were consistent with the observations in Europe that ginkgo appeared to have some benefit in preventing peripheral vascular disease,” he said.

This could be due to flavonoids acting as both antioxidants and also causing blood vessels to expand, Kuller said.

The report was released online Nov. 24 in advance of publication in an upcoming print issue of the journal Circulation. Last year the same University of Pittsburgh team reported that ginkgo biloba had no effect on preventing dementia.

For their latest study, Kuller’s group randomly assigned 3,069 patients to 120 milligrams of highly purified ginkgo biloba or placebo, twice a day as part of the Ginkgo Evaluation of Memory Study.

Over the six years of the trial, 385 participants died, 164 had heart attacks, 151 had strokes, 73 had mini-strokes (”transient ischemic attacks”) and 207 had chest pain, the researchers found.

There was no significant difference between those taking ginkgo or placebo for any of these outcomes, Kuller said.

However, among the 35 people who were treated for peripheral artery disease, 23 received placebo and 12 were taking ginkgo — a statistically significance difference, the researchers noted.

About 8 million Americans have peripheral artery disease, which typically affects the arteries in the pelvis and legs. Symptoms include cramping and pain or tiredness in the hip muscles and legs when walking or climbing stairs, although not everyone who has PAD is symptomatic. The pain usually subsides during rest.

“This study demonstrated that there were absolutely no benefits of ginkgo biloba in reducing cardiovascular events such as heart attack or stroke or in reducing death due to cardiovascular disease,” said Dr. Gregg A. Fonarow, a professor of cardiovascular medicine at the University of California, Los Angeles.

“Individuals interested in maintaining cardiovascular health should stick to interventions that have been proven to be beneficial, including not smoking, engaging in regular exercise, and maintaining healthy weight, blood pressure and cholesterol levels rather than taking herbal supplements,” Fonarow said.

Mark Blumenthal, founder and executive director of the American Botanical Council, an independent non-profit educational organization, pointed to the study’s more positive outcome.

“I believe it is important to emphasize that the results of this current exploratory trial do not in any manner reduce or negate the existing positive results of ginkgo biloba as an effective treatment in peripheral artery disease patients, which has been evaluated, confirmed, and approved by government regulatory drug authorities in leading Western European countries like Germany and France,” he said.

In addition, Blumenthal said, the trial showed that ginkgo biloba was safe and well-tolerated.

Three-stage graduated licensing for teens and other new drivers prevents injuries and saves lives, say U.S. researchers who analyzed five years of crash data from six states — Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin.

More than 300 lives could have been saved if all of these states had added new, evidence-based modifications to their graduated driver’s licensing (GDL) programs, study leader Dr. Timothy Corden, an associate professor of pediatrics at the Medical College of Wisconsin, and colleagues reported in a university news release.

The study authors also concluded that more than 21,400 traffic injuries could have been prevented if all these states had instituted at least five of seven components recommended by the Insurance Institute for Highway Safety:
Minimum age of 16 years for obtaining a learner’s permit.
A waiting period of at least six months after obtaining a learner’s permit before applying for an intermediate-phase license.
At least 30 hours of supervised driving.
Minimum age of 16.5 years for entering the intermediate phase.
No unsupervised driving at night after 10 p.m. during the intermediate phase.
No unsupervised driving during the intermediate phase with more than one passenger younger than 20.
Minimum age of 17 for a full license.

“Our study lends support for states moving to include more of the best-practice components included within the Insurance Institute for Highway Safety recommendations for state GDL regulations,” the researchers said. “This could be viewed as a ‘policy treatment prescription’ capable of keeping teenagers alive and families intact.”

While some politicians may be reluctant to revise GDL laws, parents are generally supportive of GDL programs and play an important role in the development of successful GDL policies, the researchers said.

Some herbal supplements may boost the levels of lead in the blood of women, new research shows.

Among 12,807 men and women age 20 and older, Dr. Catherine Buettner, at Beth Israel Deaconess Medical Center in Boston, Massachusetts, and colleagues found blood lead levels about 10 percent higher in women, but not men, who used specific herbal supplements.

When they examined herbal supplement use among women of reproductive age (age 16 to 45 years old), “the relationship with lead levels was even stronger, with lead levels 20 percent higher overall, and up to 40 percent higher among users of select herbal supplements compared to non-users,” they report in the Journal of General Internal Medicine.

Lead accumulates in the body over time and may pass from a woman’s placenta and breast milk to developing fetuses and infants. The U.S. Food and Drug Administration does not specify safe lead limits, or even routinely test for this toxin in herbal supplements.

Buettner’s team found that women using Ayurvedic or traditional Chinese medicine herbs had lead levels 24 percent higher than non-users, while those using St. John’s wort and “other” herbs had lead levels 23 percent and 21 percent higher, respectively, than non-users.

When combined with prior studies hinting at excess lead in specific supplements, the evidence strongly suggests use of specific herbal supplements may result in higher lead levels among women, Buettner said.

In the current study, Buettner was reassured to find “no evidence of lead toxicity,” she told Reuters Health in an email.

The researchers point out that the use of some herbal supplements among study participants was low, which limited the power to detect associations among specific herbal supplements.

They also emphasize that the current study does not prove that herbal supplements cause higher lead levels. They urge further studies to analyze how other lead exposures, calcium intake, or use of other dietary supplements alter lead levels.

Dr. Adriane Fugh-Berman, at Georgetown University Medical Center in Washington, D.C. concurs in an editorial on the study, and also cautions, “let us not use too broad a brush to tar all herbal products.”

Specific analyses of specific herbal products or the blood of users, Fugh-Berman writes, should be used to establish products containing problematic amounts of lead.

A shorter, more intense course of whole-breast radiation works as well as the traditional six-week course, at least for some early-stage breast cancers, a new study shows.

“This concept of a shorter length of treatment is gaining acceptance,” said Dr. Manjeet Chadha, associate chair of radiation oncology at Beth Israel Medical Center and associate professor of radiation oncology at Albert Einstein College of Medicine, both in New York City. Chadha led the study and is scheduled to present the results Wednesday at the American Society for Radiation Oncology annual meeting, in Chicago.

Researchers previously have tried to investigate whether they can alter the duration of radiation therapy or the volume, Chadha said. “My study focuses on the duration of it,” she said.

In her three-week treatment — called accelerated hypofractionated whole breast irradiation — a woman gets the entire affected breast irradiated and receives a ”boost,” or extra dose, at the site where the tumor was removed. Other approaches include giving a boost dose after the entire radiation treatment to the whole breast is completed.

Chadha’s study is ongoing, but she planned to report on 122 patients with early-stage breast cancers who underwent lumpectomies followed by the accelerated treatment. They were then tracked for a median of two and a half years (half followed longer, half less). The patients’ median age was 66.

No relapses were noted, and the three-year survival rate was nearly 95 percent, Chadha said.

”It sounds encouraging,” she said of her results. To further evaluate the accelerated treatment, she compared the first 50 patients on the briefer approach to a matched group of 70 patients who got the more traditional six-week radiation treatment.

Side effects, such as skin irritation and redness, were similar, she found. ”There was no difference in fatigue or breast edema [swelling],” she said. The cosmetic results were satisfactory, too.

The new study adds some valuable information for doctors trying to decide for individual women which radiation treatment approach might be best, said Dr. Nayana Vora, a professor of radiation oncology and associate member of the developmental cancer therapeutics program at the City of Hope Comprehensive Cancer Center in Duarte, Calif.

”It’s a short follow-up,” she said, noting that some side effects may surface later. But, she noted that a study outside the United States that looked at the briefer treatments has followed patients for up to 12 years with results similar to Chadha’s study.

”Very few studies have been documented in the U.S. with external whole beam [to the whole breast] and a concomitant boost,” Vora said. ”It tell us that, yes, patients can be treated with a short course of radiation treatment. Will it become the standard of care? I don’t know.”

While Vora typically offers her patients the six-week treatment unless they can’t commit to that time period because of transportation problem or other obstacles, she said she now may consider the shorter treatment.

In another study to be presented at the oncology meeting, researchers reported that breast cancer patients who have a mastectomy and then receive radiation to the lymph nodes behind the breast bone (the internal mammary lymph nodes) do not live longer than those who don’t get those nodes treated.

The study evaluated 1,334 women with stage 1 or 2 breast cancers that had spread to the axillary lymph nodes under the arms or whose original tumor was in a central, internal location. All got radiation to the chest wall and nodes above the collar bone. But half got the internal mammary radiation and half did not.

After a decade, survival differences between the groups were small, with 60 percent of those who didn’t get the extra radiation still alive, and 63 percent of those who got it surviving.

Most radiation oncologists are reluctant to radiate the internal mammary nodes, Vora explained, because of their proximity to the heart.

Many patients don’t like how long it takes to receive the results of radiology tests and aren’t happy with the lack of information when they do get the results, a U.S. study has found.

Radiology imaging tests include MRI, CT, ultrasound, mammography and X-ray.

“Most of the patients in our study were decidedly dissatisfied with how they find out about their radiology test results. Specifically, they were unhappy with the delay before getting results and the lack of detail when they do find out what the tests showed,” lead investigator Dr. Annette J. Johnson, an associate professor of radiology at Wake Forest University School of Medicine, said in a university news release.

“The classic, most common story we heard was that the patient went to her doctor for a symptom such as pain, was sent for an MRI and then heard nothing until their next regular doctor’s appointment,” Johnson said. “Then, when the patient asked what the MRI showed, her doctor gave a generic answer — ‘Everything was fine.’ The patients in our study said that they don’t want to hear ‘fine’ weeks after the test. They want to know details and they want to know them as soon as the results are in.”

The patients in the study were asked about their experiences with radiology imaging tests, what they want to know from the tests, and how they would like to learn about the results.

Johnson and colleagues found that patients “want their results quickly, in writing, and they want detailed information about the test results in language they can understand.”

Many patients said they’d like a secure way to see their results online as soon as they’re available. That would give them time before the next doctor’s appointment to prepare questions, learn more about their condition or disease, and get a jump on setting up referrals if needed. Being able to see their test results would help them play an active role in their care.