for Fitness Walking
December 19, 1997
Thought you mastered walking at age one?
Well, think again. Fitness walking isn't an afternoon
stroll. We're going to get all of you exercise newbies
moving with an easy walking program that's guaranteed to
help you get fit, toned, and on track with a fun
Before you get started let's run through some
easy-to-follow walking tips. By following these key
steps, you'll reduce your risk of injury, ensure that
your body works at its peak, and show that you're serious
and ready to get healthy.
Stand up straight. Look directly ahead. Imagine that a
string is attached to the top of your head and is lifting
you from the ground. Keep your shoulders back and
relaxed, chest out, and tailbone slightly tucked under.
Relieve the stress points. Relax your shoulders and shake
out any tension from your arms and wrists. Bend your arms
at the elbow about 83 degrees. Wiggle your fingers and
then hold your hands in loose balls (pretend you're
clasping a jumbo-size magic marker against your palms).
Swing your arms naturally as you walk, but try not to let
your hands extend above your chest.
Keep your steps short and fast. The faster you move, the
better your cardiovascular workout. Try to keep an even
stride and maintain a steady pace.
Heel-to-toe motion. As you walk, your heel should be the
first part of your foot to hit the ground. Roll along the
length of your foot and push off with your toes. This
motion reduces the risk of shin splints and tendon pulls.
Fitness assignment: This week hit the pavement for 10
minutes on three days. Watch your form as you walk!
Tips to Fight Fatigue
December 9, 1997
You know the tell-tale signs: First your
eyelids get droopy, then whatever's on your computer
screen starts to swim around, and you feel glued to your
chair. Yes, it's the afternoon slump. And for those
who've had it everyday for years, it can seem hopeless.
But there is hope. Try these five food tricks and see the
difference it makes in your day.
1. Eat a light breakfast
combining low-sugar cereal and low-fat milk or yogurt.
Not eating breakfast puts you at an energy deficit
when you need the fuel the most. Sugar and
carbohydrates alone will trigger an energy rush that
quickly peters out. Carbohydrates combined with
protein make for long-lasting energy. Fat and lots of
calories will trigger serotonin production in your
brain, making you more calm, almost sleepy.
2. Have one or two cups of
The caffeine in coffee stimulates your whole system.
One or two cups makes you a coffee achiever. Caffeine
is also a serious drug, and consuming more than five
cups a day can trigger withdrawal symptoms when you
are not drinking it. People who drink lots of coffee
often spend their days on an energy roller coaster,
with extreme highs after coffee and deep lows as it
wears off. Not only is this depressing, it's
3. Make lunch light and
protein-rich -- with choices like a low-fat turkey
Any meal over 1,000 calories will slow you down and
make you drowsy. So heavy lunches can be your ruin.
Too many carbohydrates without protein (pasta for
example) will elevate serotonin levels in your brain,
leaving you calm and sleepy for the afternoon. Too
much fat will do the same thing. Lunch should be
satisfying, you should feel lightly full afterwards.
If you only eat salads with non-fat dressing, you're
eating the equivalent of a fruit juice, without the
sugar. Try adding some chick peas, or sunflower seeds
4. Snack on fruits, pretzels,
fresh veggies, or granola between meals. Avoid sugar-rich
candies or sweets.
Snacks are good for you. Eating small meals
throughout the day gives you a steady supply of
energy -- never too much, never too little. Sugar,
which is supposed to be an "energy" food,
actually slows you down. Not only does it raise
serotonin levels in the brain, it also dumps into
your system so fast that your body has to divert
energy from other places just to process it.
5. Drink lots of water, even when
you are not thirsty.
Dehydration, which is a lot more common than you
might think, causes crankiness and fatigue.
Helps Retain Memory
December 23, 1997
Taking estrogen after menopause may
protect against age- related memory decline, a new study
suggests. Women over 40 who took the hormone tended to
score better on visual memory tests, and retain an edge
over time, compared with women who never took estrogen,
according to a report in the current issue of Neurology.
The findings may indicate that taking hormones can ward
off memory decline, or even Alzheimer's disease, as some
other reports have suggested. On the other hand, the
study looked at estrogen-users in the general population,
women who tend to have more money, education and
healthier lifestyles than their peers - factors that may
influence memory decline.
Overall, hormone users had an average of two fewer errors
than women not taking estrogen. Test results from a small
group of 18 women tested before and after starting
estrogen suggested that the hormones protected against
age-related memory decline.
Those who started taking hormones during the study
"maintained stable performance over time, whereas
women who remained off estrogen replacement therapy
showed the predicted age-associated increase in memory
errors," concluded lead study author Dr. Susan
Resnick, of the Laboratory of Personality and Cognition
at the National Institute on Aging in Bethesda, Maryland.
The study included 116 hormone users and 172 non-users
who took the Benton Visual Retention Test (BVRT) in which
a series of 10 different forms are shown for a few
seconds, and then the participant is asked to reproduce
them on a blank sheet of paper. Test scores tend to
decline with age, particularly in the late 60s and early
70s, and may dip several years before Alzheimer's disease
symptoms become apparent. The women took the test every
six years from 1978 to 1991, and then every two years
The findings "offer further support for a beneficial
role of estrogen on cognitive function in aging
women," the authors concluded.
for a Healthier Lunch
December 24, 1997
It's one o'clock; you have a project that
needs to be finished. But your stomach's growling so loud
you're afraid the boss will hear.
Or maybe it's four o'clock, and you realize you've missed
lunch altogether. For busy people, lunch may be the most
difficult meal to squeeze into the day. And when you do
find time to eat, you worry that you might face an
after-lunch slump where your energy is low and urge to
sleep is high.
But you've got to eat lunch! It's necessary for your body
to stay energized until dinnertime. You simply need to
choose healthy and satisfying foods. See what
nutritionist Joan Salge Blake has to say about avoiding
overeating at the food court. Also check out Joan's
survival tips for eating a lean lunch and her game plan
for healthy eating.
Instead of buying lunch, try the more tried-and-true
method of packing a lunch at home. Here are some tips to
get the most out of brownbagging it:
Go Heavy on the Veggies. Bring easy-to-eat foods, like
chopped carrots or celery sticks filled with nonfat cream
cheese. If you pack a salad as your main meal, include
some chickpeas, kidney beans, or tuna, so you get your
protein as well as your greens. To vary the flavors, add
some raisins or shredded beets on top.
Soup It Up. Many of today's cup of soups are much lighter
and healthier than the original versions. If you have a
microwave at work, simply fill the cup with water and
heat for a quick, filling meal.
Save Your Sandwich. Sandwiches are easy to make and
transport. If you're sick of low-fat sliced turkey, try
sliced chicken or low-fat sliced ham. Or make low-fat
tuna sandwiches: Use tuna packed in water and mix with
nonfat mayo or plain yogurt. A veggie sandwich filled
with lettuce, tomatoes, sprouts, low- fat cheese, and a
dab of mustard also makes a superb lunch.
Treat Yourself to a Tater. Bring a potato to work and
bake it in the microwave. Top with fresh veggies, low-fat
cottage cheese, or salsa for a real lunchtime treat.
Perk Up Your Pasta. Make more than enough pasta for
dinner the night before and eat the extra for lunch the
next day. Before you reheat the pasta, chop in a tomato
and sprinkle on some fresh spices for extra zing.
Tips for a Better Night's Sleep
December 23, 1997
"I'm exhausted" is the
complaint of the '90s. How often have you heard a friend
or coworker complain about not getting enough sleep the
night before or wanting to take a long nap after eating
It's especially important to get enough sleep during
stressful times, like the holidays. You may feel pulled
in many directions by visitors, errands, and meal
preparation. But if you sacrifice sleep when you're
stressed, you'll create a vicious cycle where you're
tired all the time -- and you may end up getting sick as
A good night's sleep helps you feel alert enough to deal
with everything life throws at you -- whether it's at
work, in a relationship, or simply day-to-day life. Most
studies have found that, on average, adults need between
seven and nine hours of uninterrupted sleep a night,
though it varies widely from person to person. Try these
five tips to increase your chances of sleeping more
1. Work Out.
Exercise relaxes muscles and relieves tension. Just make
sure you don't exercise too late in the day: Since
working out is an adrenaline-booster, you may find
yourself too wired to sleep. A good rule to follow: Don't
exercise for at least two hours before you go to bed.
2. Relax and Unwind.
Relaxation techniques calm you and let you forget your
stresses for awhile. Yoga or meditation often does the
trick, as does massage or even a nice, warm bubble bath.
Aaaah. Lovemaking is also a natural relaxant that can be
quite effective before bedtime!
3. Set Your Internal Clock.
It's important to establish a consistent time for going
to bed and waking up. Your body becomes used to hitting
the sack at a regular time, and this helps you fall
asleep more easily.
4. Divert Yourself.
Once you get in bed, if you toss and turn and can't sleep
a wink, go into another room and pick up a book for
awhile or listen to some music. When you start feeling
drowsy, head back to bed.
5. Factor Food In.
While you don't want to go to bed hungry, be careful of
what you eat close to bedtime. Spicy, greasy, or heavy
foods may not digest well and can cause you to wake up
during the night with an unhappy stomach. Also avoid
caffeine within six hours of hitting the sack. Better
choices for before-bed snacks include foods high in
carbohydrates, such as bagels or crackers, which digest
more easily. And don't forget the old standby, a glass of
warm milk -- it really may help soothe you to sleep.
If you try all of these techniques and still can't get
enough sleep, or feel extremely tired the next day, you
may have a sleep disorder such as sleep apnea. Sleep
apnea is also known as "snoring sickness." It
causes sufferers to wake up repeatedly during the night.
See your doctor if you suspect you have this disorder.
Anyone who's tired and low on energy during the day might
also want to try these five food tips to fight fatigue.
for Your Aching Back
December 22, 1997
Whether you spend most of the day sitting
or standing, chances are you suffer from occasional back
tension and fatigue. And nothing throws a monkey wrench
into your exercise routine like an aching back. These
stretches promise to keep your back healthy. They will
improve your posture, reduce lower-back fatigue, and
strengthen and condition your back muscles.
One yoga exercise that conditions your back and helps
release the tension collected in your shoulders, neck,
and lower back is the cat tilt. The cat tilt feels great
after a day spent hunched over a keyboard.
To do the cat tilt:
1. Get on your hands and knees. You might want to grab an
exercise mat if your floor is hard or cold; or a
cushioned towel if your knees need extra support.
2. Place your hands, flush with the floor, shoulder-width
apart and your knees directly under your hips. Keep your
back parallel with the floor. Get comfortable. You should
look like a table from the side.
3. As you exhale, slowly tilt your back up. Imagine that
a string is lifting your middle back toward the ceiling.
4. Pull in your abdominal muscles, curve your shoulders
and pelvis down. Move your head down, but try not to
strain your neck. Get rounded. And feel the stretch along
5. As you inhale, slowly rotate your head, shoulders,
chest, and bottom up. Curve your stomach down.
6. Feel the stretch releasing the tension along the
length of your back.
7. Repeat the cat tilt, six times, moving slowly and with
control to your breath.
Fitness assignment: Add the cat tilt to your training
exercises. In fact, do the cat tilt before you get
started. The cat tilt helps you to loosen up and warms
your back muscles. It also feels great. For variety,
alternate the cat tilt with the cobra posture.
Approves Pill For Male Baldness
December 23, 1997
The U.S. Food and Drug Administration
(FDA) granted approval of the drug Propecia on Monday,
making it the first drug for male pattern baldness to be
available in pill form.
The drug's active ingredient, finasteride, is already
approved for the treatment of prostate enlargement and is
sold by Merck & Co. under the brand name Proscar.
Propecia, which contains one fifth the dose of
finasteride found in Proscar, will be available by
prescription only. Merck plans to have the drug on
pharmacy shelves by mid-January.
Dr. Keith Kaufman, senior director of clinical research
at Merck Research Laboratories in Rahway, New Jersey,
says men with mild to moderate hair loss on the top of
their heads and at the back of the scalp who took
Propecia for 12 months either maintained or showed
visible increases in the number of scalp hairs, compared
with men taking a placebo (dummy) pill who continued to
A one-year extension of the study in 1,200 men from the
original sample with hair loss only on the top of their
heads, showed that the effects of the pill continued in
all but 17%. But 72% of men in the placebo group
continued to lose hair.
"Propecia works by blocking an enzyme called 5-alpha
reductase, which is responsible for the formation of DHT
- dihydro-testesterone - in a man's body," Kaufman
explains. He says the enzyme converts testosterone to DHT
and "there is sufficient information at this point
to identify that DHT is a key factor in the development
of male pattern hair loss. Finasteride decreases the
concentration of DHT in a man's scalp by about two-thirds
when he takes it as a pill."
According to a Merck statement, it may take three months
or more before men see a benefit from the drug, which is
taken once daily. If the drug is stopped, the hair gained
will be lost within 12 months of stopping treatment.
As to side effects, Kaufman and his colleagues told a
telephone press briefing that less than 2% of men taking
the drug reported a diminished desire for sex, difficulty
in achieving an erection (impotence), and/or a decreased
amount of semen. These side effects disappeared once the
men stopped taking the drug, and they also disappeared in
58% of men who continued in the study.
"In regards to impotence, it's approximately only 1%
of men who reported it at all," said Dr. Ken
Washenik, a New York University dermatologist involved in
the clinical studies. "This is only approximately a
half of a percentage point difference from the men who
were taking a placebo, or the fake medication."
Propecia can also affect the results of the
prostate-specific antigen test (PSA), a blood test used
to detect prostate cancer. Patients should tell their
doctor that they are taking the drug when they have blood
taken for a PSA test.
Propecia will not be marketed for women because the
drug's safety and effectiveness have not been established
in women, says the FDA, and it is associated with birth
defects, such as hypospadias, an abnormality of the
"In addition, women should not handle crushed or
broken tablets when they are pregnant or may potentially
be pregnant," according to a Merck & Co.
statement. "Propecia tablets have a coating that
will prevent contact with the active ingredient during
normal handling, provided that the tablets have not been
broken or crushed."
Support For Chicken Pox Vaccines
November 28, 1997
Health experts have been pleading with
parents for years to get their kids inoculated against
chicken pox instead of accepting its outbreak as a
childhood rite of passage. Good advice, because much more
serious complications sometimes develop.
Chicken pox can be followed by a
bacterial infection called Group A Strep. Most infections
are mild, but if it reaches sterile body parts like the
blood or muscle it can be life-threatening. Johns Hopkins
pediatrician Dr. Neal Halsey says about 100 Americans die
each year following chicken pox.
"And a number of those [cases] are
caused by a secondary infection with Group A Strep,"
explains Halsey. "The most important thing is it's
totally preventable by preventing chicken pox through the
use of the vaccine, which is now recommended for all
healthy children everywhere in the country."
There was an alarming outbreak of Group A
Strep at a Boston day care center earlier this year.
Those children who already had their chicken pox
vaccinations were not affected.
Prevalence of Osteoporosis in Men
November 24, 1997
All of us to a varying degree face the
problem of thinning or brittle bones as we age. Yet
public health campaigns that warn of osteoporosis are
almost always aimed at women - a mistake experts say.
Up to a quarter of all hip fractures in
the U.S. happen to men. Slowly falling levels of
testosterone in men over age 50 put them at risk also for
joint and spinal problems in their 70s and 80s. Diet,
exercise, and alcohol intake also play a role in how
quickly eroding bone mass is replaced.
"We do know that men lose bone mass
as they age, and in some men this is accelerated and they
will actually develop a more significant degree of bone
loss, and will develop osteoporosis," explains Johns
Hopkins doctor Michael Levine. "The reason we don't
recognize osteoporosis in men as frequently as in women
is that we're not thinking about it."
But we should be, says Levine, because
osteoporosis affects as many as five million older men in
November 25, 1997
The Food and Drug Administration (FDA)
should regulate some botanical supplements as
over-the-counter drugs, says a Presidential Commission on
And the FDA, supplement manufacturers,
and physicians should work together to report adverse
reactions in supplement-users, though no change in
existing laws is recommended in a report released Monday
by the Presidential Commission on Dietary Supplement
Overall, the safety of supplements are
the responsibility of manufacturers, and the industry
should develop an expert advisory committee to review
safety, benefit and appropriate labeling of supplements,
according to the seven member panel of experts. The
Presidential Commission was mandated by the Dietary
Supplement Health and Education Act (DSHEA) of 1994 to
evaluate the best methods of getting information to
consumers, so that they can make a decision regarding the
use of dietary supplements.
Other recommendations from the report:
- The process for approval of health
claims should be the same for dietary supplements as it
is for conventional foods.
- The FDA should establish an
over-the-counter review committee for botanicals, in case
there is evidence of a therapeutic claim that goes beyond
statements permitted by the DSHEA.
- The supplement industry could benefit
from scientific input regarding the health and safety of
dietary supplements, and thus should establish an expert
committee to provide advice.
- The commission "strongly
suggests" that manufacturers include appropriate
warnings in product information, including advising women
who are pregnant or breastfeeding to consult a physician
before taking supplements.
- Health professionals and consumers
should be provided with evidence concerning the benefit
and safety of dietary supplements, but the commission did
not recommend amending FDA regulations issued in
The new regulations require that
vitamins, minerals, herbs, and other supplements contain
label information on serving size, vitamin and mineral
content, all ingredients found in the product and, in the
case of botanicals, from what part of the plant the
ingredients are derived.
December 3, 1997
A new study of federal smoking cessation
guidelines shows that efforts by physicians to promote
smoking cessation are cost-effective when compared with
other preventive interventions.
Results of the study evaluating the Agency for Health
Care Policy and Research's (AHCPR) Clinical Practice
Guideline appear this week in The Journal of the American
The guideline, released in 1996, recommends 15 smoking
cessation interventions that were identified as
effective. They range from use of transdermal nicotine
patches and brief counseling by doctors to more intensive
"That analysis is based upon the most comprehensive
review of the scientific evidence regarding smoking
cessation," says study co-author Dr. Michael C.
Fiore, director of the Center for Tobacco Research and
Intervention at the University of Wisconsin in Madison.
"In essence, a panel of experts reviewed virtually
everything that's been published about smoking cessation
to answer one key question: what helps people quit
smoking successfully and what does not? And based upon
that, released in April of 1996, a series of
recommendations for clinicians to be most effective for
helping their patients to quit."
Fiore and his colleagues have analyzed the AHCPR's
guideline and determined that the recommended smoking
cessation interventions are cost-effective. Moreover, the
greater the spending on interventions, the greater the
net benefit in both money saved for society and quality
of life for those who quit smoking.
"We know that 7 out of 10 smokers see a physician
every year," Fiore notes. "There's not a single
group that has the same access, the same opportunity to
help smokers as physicians. Until now ... clinicians have
not been maximally seizing this opportunity to help their
patients successfully quit - and that's what this
guideline is about - teaching physicians what they can do
in a brief intervention to help patients quit."
According to Fiore, even "the simple kinds of advice
that a clinician can provide in three minutes,"
including advice on the importance of social support, the
importance of setting a quit date for total abstinence,
and the importance of brief medication for smokers of
more than 10 cigarettes a day, can be effective.
"If these interventions are put in place, if
physicians across America took up this challenge and
addressed tobacco with every patient who walks through
their door, it will not only save lives, but it'll save
If the AHCPR guideline interventions were applied to 75%
of smokers ages 18 years and older, the cost of
implementation would be $6.3 billion in the first year.
As a result, society could expect to gain about 1.7
million new quitters at an average cost of $3,779 per
quitter, $2,587 per life-year saved (the cost to society
to gain the extra life-years for smokers who quit through
interventions), and $1,915 for every quality-adjusted
life-year (QALY) saved. QALY refers to a year of healthy
Looking at the cost per life-year saved, Fiore says the
smoking cessation interventions "are 20 times more
cost-effective than mammography screening, about 40 times
more cost effective than treatment for high cholesterol -
it's probably the most cost-effective prevention
intervention a physician can engage in."
The researcher says he hopes the new report will also
have an impact on health insurance policy. "It's a
paradox in America that virtually every (health)
insurance policy pays for the outcomes of smoking,
whether it's a heart attack, or stroke or cancer, but
only about half of them pay the $100 to $200 it would
take to prevent those very expensive illnesses," he
"One key recommendation from our report is that
insurers - health maintenance organizations and private
insurers - need to begin to do the right thing, and that
is to encourage their subscribers to quit smoking. And
one important way to do that is to make smoking cessation
treatments that are effective a covered part of every
insurance plan in America."
SOURCE: The Journal of the
American Medical Association (1997;278:1759-1766)
Can Avert Medical Problems
December 3, 1997
Nine doctors in 10 say serious medical
conditions could be averted if patients were more willing
to talk about their problems.
Reporting Tuesday in New York, former Surgeon General C.
Everett Koop reported on the results of a national survey
by the Louis Harris organization. He identified a series
of barriers that must be overcome in unsatisfactory
communications between patients and their medical
To tackle those isues, Koop announced formation of the
Take Time to Talk Advisory Council, of which he is chair.
The council, representing key national health care
organizations, will focus on what he called the
''tremendous consequences of allowing sensitive health
issues to remain unaddressed and unresolved.''
''All in all,'' Koop said, ''the art of medicine is being
overshadowed by the science and the business of
Both sides in the doctor-patient relationship face
obstacles to good communication, Koop said. Among
physicians, more than two-thirds reported ''serious
difficulties'' treating patients who are too embarrassed
or otherwise hesitant to talk about their health
problems. A similar number of doctors said that not being
able to spend enough time with patients is a problem. And
three out of five responded that they were not
well-prepared for communication with patients during
their medical training.
Patients for their part reported finding themselves
particularly uncomfortable when the subject touches on
incontintence and sexual matters, including sexually
transmitted disease, sexual dysfunction, gynecological
difficulties, abuse, fertility, and prostate problems.
Patients are also likely to feel embarrassed about
bringing up emotional difficulties, such as depression.
A quarter of the patients surveyed also said that not
having enough time to visit a doctor was one of the main
reasons they postposed seeking medical attention.
Koop said, ''Without the trust and confidence instilled
by honest and empathetic interchange, patients are more
inclined to avoid proper medical care.''
Mammograms Benefit Women 40-50
December 2 1997
Mammograms performed once a year in women
40 to 50 years of age could result in a breast cancer
mortality reduction of up to 75%, experts say.
"Mammographic screening can reduce mortality from
breast carcinoma in women age(d) less than 50
years," conclude researchers at Sahigrans University
Hospital in Gothenburg, Sweden. Their study appears in
the current issue of the journal Cancer.
The researchers examined the long-term breast cancer
mortality of nearly 12,000 women, each of whom was
between 39 to 49 years of age when the study began in
1983-1984. The women agreed to undergo mammographic
screening once every 18 months over the next 10 years.
The subsequent breast cancer mortality of this 'study'
group was compared with that of a 'control' group of
14,217 middle-aged women. Those women delayed having
mammography performed until a full six to seven years
after the women in the study group.
The Swedish researchers discovered that the women who
began regular screening relatively early in life were 45%
less likely to die from breast cancer than those who
Regular screening may spot more cancers at an earlier
age. The researchers point out that about two thirds of
all breast cancers detected in the study "were
diagnosed before age 50 years."
Dr. Stephen Feig, a radiologist at Philadelphia's
Jefferson Medical College, believes the Swedish study may
help settle the ongoing debate as to the efficacy of
regular breast screening in women under 50.
In an editorial appearing in the same issue of Cancer,
Feig notes that annual mammograms may even more
beneficial than the once-every-18-month exams evaluated
by the Swedish team.
In fact, Feig estimates that annual mammography could cut
breast cancer deaths in women under 50 years of age by as
much as 75%.
He explains that breast tumors in young women generally
grow faster than those found in older women. "For
mammographic screening to be effective in women age(d)
less than 50 years, screening must be more frequent than
in older women."
Feig also believes that improved screening technologies
are making it easier to spot tumors in the breast tissue
of younger women, which is usually denser and more
difficult to interpret radiographically than that of
SOURCE: Cancer (1997;80)
Going Without Vaccines, Tests
December 5, 1997
Nearly half of the elderly are going
without important preventive vaccines and medical tests,
experts say, even though Medicare provides these services
"Health care coverage alone does not ensure use of
preventive services," conclude researchers at the
Centers for Disease Control and Prevention (CDC). Their
report appears in this week's edition of the CDC's
Morbidity and Mortality Weekly Report.
Investigators evaluated data from the CDC's 1995
Behavioral Risk Factor Surveillance System survey, an
annual random telephone survey of the health habits of
over 100,000 Americans in all 50 states.
Focusing on 22,500 Medicare recipients over 65 years of
age, the report discovered that many are not receiving
pneumonia inoculations, annual influenza shots,
mammograms, and Pap smears. Each of those services has
been fully covered by Medicare since at least 1993.
Statistics varied greatly between states. Some of the
- More than half of Medicare recipients in Alabama,
Alaska, Georgia and New Jersey did not receive flu shots
in 1995. Elderly residents of Utah were most likely to
take advantage of the free shot, with a 70.3% inoculation
- Only one quarter of Kentucky and Louisiana elderly had
ever received the one-time (lifetime) pneumococcal
vaccine. None of the states reported more than a 50%
pneumococcal inoculation rate for its elderly population.
- While 4 out of 5 elderly women in Alaska had received
their biennial mammogram, nearly half (47.3%) of female
New Jersey Medicare recipients went without the
- Government experts recommend that women over 65 have a
Pap smear once every 36 months. However, just 54.6% of
elderly women in Louisiana reported doing so. In
contrast, Arizona led the nation, with 88.5% of its
elderly female population undergoing recent Pap smears.
Most of these statistics fall far short of current
federal health objectives. The CDC experts aren't sure
why many Medicare recipients do not take advantage of
potentially life-saving preventive procedures, or why
statistics should vary so widely state-to-state. But they
believe the risk for avoidance of these services is
increased in "lower income and education
They say "the development of outreach programs of
clinical preventive services targeted to older
adults" could help encourage wider utilization of
vaccinations and testing.
Preventive measures are of key importance to the health
of elderly populations, who remain especially vulnerable
to both cancers and infectious disease.
SOURCE: Morbidity and Mortality
Weekly Report (1997;46(48):1138-1143)
Bacteria On The Rise
December 5, 1997
Certain strains of a potentially
life-threatening bacteria appear to be developing
resistance to the last antibiotic that can still kill the
organism, according to a Japanese report. The bacteria is
Staphylococcus aureus and it can cause anything from
boils on the skin to pneumonia to septicemia, a
potentially deadly blood infection.
About 20% of multidrug-resistant strains of S. aureus
isolated from patients in Juntendo University Hospital in
Tokyo showed signs of partial resistance to vancomycin,
the antibiotic doctors now rely on to kill such
About 9% of strains isolated in other Japanese hospitals
were also partially resistant as were 1% of strains
isolated from non-university hospitals and clinics,
according to the report in the current issue of The
Lancet. The researchers tested a total of 1,149 strains
of bacteria from patients in 203 hospitals.
They began the study after discovering a
vancomycin-resistant S. aureus (VRSA) in a Japanese child
last year who had an infected surgical wound that did not
respond to 29 days of vancomycin treatment.
None of the strains in the new study were completely
resistant to the drug, but they showed heterogeneous or
variable resistance - that is about one in every million
bacteria in the strain could survive the antibiotic. If
even a few resistant bacteria survive, they can grow and
then spread in the population, causing virtually
The appearance of hetero-VRSA strains in two distant
areas in Japan - the Hiroshima area and Tokyo -
"suggests that wide dissemination might occur and
indicates the need for special precaution to limit the
spread of VRSA strains in Japan (and the world),"
reported lead author Dr. Keiichi Hiramatsu, of the
bacteriology department at Juntendo University.
Since strains of S. aureus resistant to methicillin and
other antibiotics began appearing in the 1980s,
"vancomycin has been the drug of choice and commonly
the sole antimicrobial agent available for the treatment
of serious methicillin resistant S. aureus,"
according to an editorial by Dr. Soad Tabaqchali, of the
medical microbiology department at the Royal London
School of Medicine and Dentistry in London, U.K.
Now multidrug-resistant strains of S. aureus that appear
to be developing resistance to vancomycin have popped up
in both Japan and the U.S.
"These findings emphasize the need to improve our
laboratory methods to detect such strains and monitor
their emergence, especially in patients unresponsive to
vancomycin therapy," Tabaqchali wrote. "There
should be strict infection-control measures and affected
patients should be isolated to prevent spread and the
risk of these strains becoming endemic."
Another preventive method? Avoiding overuse of
antibiotics, which hastens the development of
SOURCE: The Lancet
Depression Affects Heart Attack Patients
December 5, 1997
A key part of recovering from a heart
attack is following the doctor's orders, whether they are
to exercise more or eat a healthier diet. But nearly a
quarter of heart attack patients just can't do it -
they're too depressed.
A recent Johns Hopkins study tracked more than 200 people
who survived a heart attack. Those who reported feeling
depressed soon after the event also reported trouble
sticking to a healthier lifestyle, even when they really
"They were less likely to follow a low cholesterol
and low-fat diet," explains the lead author of the
study and Hopkins cardiologist Dr. Roy Ziegelstein.
"They were less likely to reduce stress in their
lives, less likely to exercise, and if they were
diabetic, less likely to follow a diabetic diet."
Ziegelstein says some depressed patients may lack the
help and encouragement from others that's crucial for
making major changes in lifestyle. He says the study
underscores the need for better psychological care for
people who have suffered heart attacks.
Estrogen Works, Fewer Side Effects
December 9, 1997
NEW YORK (Reuters) - A plant-derived
Estrogen is just as effective at preventing bone-thinning
in postmenopausal women, but it can be used at lower
doses - and therefore may have fewer cancer-promoting
The esterified Estrogen can be used at about half the
dose as the type of Estrogen found in most hormone
replacement regimens, according to a report in the
Archives of Internal Medicine.
In the new study of 406 women, those taking esterified
Estrogen had an increase in bone mineral density in their
spines compared with those taking a placebo or inactive
medication. And the drug increased HDL (or
"good") cholesterol while decreasing LDL (or
Only those taking the highest doses - 0.625 milligrams
(mg) or 1.25 mg of esterified Estrogen - had an
overgrowth of cells in the endometrium or uterine lining.
The condition, known as endometrial hyperplasia, causes
bleeding and can increase the risk of cancer. The side
effect can be prevented by taking progestin, a hormone
that can have its own unpleasant side effects, such as
breast tenderness or menstrual-like bleeding.
"Estrogen is a first-line therapy for osteoporosis
prevention," said lead author Dr. Harry Genant.
"Yet, to be beneficial, long-term use is needed.
Many women drop out of therapy after a short time because
they don't like the side effects," said Genant, of
the University of California School of Medicine at San
The researchers found that low doses, 0.3 mg per day,
protected bone and lowered cholesterol without causing
endometrial hyperplasia. Other estrogens are used at a
dose of 0.625 mg or 0.5 mg a day to prevent
The new study was funded by Solvay Pharmaceuticals Inc.,
the Marietta, Georgia-based company that manufactures
esterified Estrogen under the trade name Estratab.
SOURCE: Archives of Internal