May 1998


 Chickenpox vaccine can save lives
May 14, 1998

At least three US children died as a result of complications of varicella infection (chickenpox) in 1997, report officials at the Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia.

The federal agency is urging that children be vaccinated to prevent chickenpox and its complications.

In addition to the three deaths in 1997, CDC data shows that 43 other children died due to chickenpox between 1990 and 1994.

"Chickenpox is now the leading cause of vaccine-preventable deaths among children in the United States.... The majority of deaths and severe illnesses from chickenpox in children and adults are preventable by implementing currently recommended policies for immunization," the agency notes in its Morbidity and Mortality Weekly Report (MMWR).

CDC officials emphasize that the chickenpox vaccine is now "widely available," and is currently recommended for use in children 12-18 months of age as well as in older children and adults who have not had chickenpox.

While national vaccination coverage levels have increased since introduction of the chickenpox vaccine in 1995, only about 25% of children who should be vaccinated against varicella have been.

The CDC notes in the MMWR that several barriers to varicella vaccination remain, including the "...perception that varicella is a benign disease, concerns that immunity will not persist, the potential that varicella disease burden will shift to older age groups among whom the disease is more severe, and concerns about vaccine efficacy and safety."

But health officials stress that these concerns are unfounded. For example, the varicella vaccine has been shown to be 85% to 100% effective in providing immunity to chickenpox, the duration of immunity has been shown to last over 20 years.

Vaccinated children who do come down with chickenpox due to a "wild" virus type usually only have a very mild case of the illness, with less than 50 skin lesions, and a shorter duration. The CDC adds that over time, "As disease incidence and exposure to wild virus declines," the agency will be in a better position to recommend "...the need for and timing of..." booster varicella vaccinations.

SOURCE: Morbidity and Mortality Weekly Report (1998;47:365-368)


Blood Pressure Genes Found
May 15, 1998

Genes on chromosomes 13 and 18 appear to be involved in the regulation of blood pressure, according to a report presented here at the Thirteenth Scientific Meeting of the American Society of Hypertension. The findings may lead to new treatments for hypertension.

According to study lead author Dr. Anita DeStefano of Boston University School of Medicine, Massachusetts, the study results mark a first step toward "a better understanding of the genetic pathways involved in the regulation of blood pressure in general, and perhaps of the specific pathways involved in hypertension."

The Boston researchers conducted detailed analyses of the DNA of members of three unrelated families prone to a rare genetic condition known as hypotensive orthostatic disorder. The illness is characterized by erratic fluctuations in blood pressure, lightheadedness, and palpitations.

Comparing differences in the genetic structure of affected and unaffected family members, DeStefano and her colleagues determined that the genes that trigger the disorder are most probably located within a narrow region of chromosome 18 (18q).

Still, they note that the disorder affecting members of one of the three families "does not appear to be linked to 18q... suggesting that there are multiple genetic etiologies (causes) of this disorder."

In an interview with Reuters Health, DeStefano explained that the identification of the full range of genes responsible for blood pressure remains a distant goal. "Blood pressure regulation is a complex mechanism that probably involves many many genes and many pathways," she said. "The first step is to localize the genes, as was done, and now we need to find the genes themselves. That could take several years."

And she said that any preventive or therapeutic innovations arising from the final identification of those genes would probably not appear until much later. "This really is the first step of a very long-term process," DeStefano said.


Childhood Trauma Tied To Adult Illness
May 14, 1998

Physical, sexual, and emotional abuse suffered in childhood appear to increase the risk of killer diseases such as heart disease and cancer in adulthood, according to research. And the more abuse suffered by an individual, the greater their risk of serious disease in adulthood, according to a report in the American Journal of Preventive Medicine.

"The impact of these adverse childhood experiences on adult health status is strong and cumulative," say researchers at San Diego's Southern California Permanente Medical Group (part of the Kaiser Permanente managed care corporation), the Centers for Disease Control and Prevention, and elsewhere.

Their study, the Adverse Childhood Experiences Study, examined possible links between childhood experiences and adult health in the lives of over 9,500 Kaiser Permanente health plan members.

All study subjects completed a detailed questionnaire focusing on seven major categories of childhood trauma, including physical, sexual, or emotional abuse, witnessing domestic violence, or being exposed to the mental illness, substance abuse or criminal behavior of a household member. Each study subject's medical records were then evaluated for major health risk factors (such as smoking, substance abuse, depression, obesity, lack of exercise, or a history of sexually transmitted disease), and serious illness (including heart disease, stroke, cancer, chronic bronchitis, and emphysema).

The researchers found that the risk of smoking, severe obesity, physical inactivity, depressed mood, and suicide attempts increased "as the number of childhood exposures (to abuse or dysfunctional households) increased."

They found that those 6.5% of adults reporting exposure to at least four categories of childhood trauma were more than twice as likely to smoke as adults, more than seven times as likely to become an alcoholic, and more than 12 times as likely to attempt suicide, compared with adults who experienced no serious trauma during their childhood.

The authors found similar links between childhood trauma and adult incidence of major diseases. Study participants whose childhood ranked among the most difficult had more than twice the rate of heart disease, cancer, and chronic bronchitis compared with individuals whose childhood was reported to be among the least troubled.

The investigators caution that their study reveals only an association (not a causal relationship) between childhood trauma and adult illness and behavior. But they speculate that abuse or anxiety experienced in early life may encourage unhealthy behaviors such as smoking, overeating, or drug use, "because they have immediate pharmacological or psychological benefit as coping devices in the face of the stress of... family and household dysfunction." Initial use of these "coping devices" can easily become lifelong habits, however, and affect physical and mental health long after childhood ends.

SOURCE: American Journal of Preventive Medicine (1998;14:245-258)


The Truth About Abdominal Exercisers
May 15, 1998

Nobody really needs a machine to do sit-ups correctly. All these devices do is position your body so that you're really working your abdominal muscles. But here's how you can do it right without any gadgets:

  • Lie on your back with you knees bent and your feet flat on the floor.

  • Gently hold your head in your hands, but don't clasp your fingers.

  • Slowly lift your head, neck, and shoulders off the floor while pulling your rib cage down toward your pelvis.

  • Hold at the top for a few seconds and feel your abdominals contracting.

  • Slowly return to the floor, then try it again.

    Do three sets of 20 repetitions to start out. But you can do sit-ups till the cows come home, and no one will ever be able to admire your washboard abs if there's a layer of fat on top.

    To dump the fat, you need to eat a healthy diet and do something active like walking, jogging, aerobic dance, skating, or bicycling. (And maybe turn off the television.) Do that along with the sit-ups, and the next time you peel your shirt off at the gym, you'll be proud of what you know everyone else is looking at.


Gene reduces cholesterol, heart disease
May 14, 1998

Researchers have discovered a gene that reduces "bad" LDL cholesterol levels in men and may cut heart disease risk by 50%.

A variation in the gene called microsomal triglyceride transfer (MTP) protein was linked to low levels of low-density lipoprotein (LDL) in a study of 184 men. Investigators from Karolinska Hospital in Stockholm, Sweden, report their findings in the current issue of the journal Arteriosclerosis, Thrombosis and Vascular Biology, published by the American Heart Association.

LDL is the form of cholesterol that helps create the fatty deposits that can clog blood vessels and cause a heart attack or stroke. The gene for MTP provides the blueprint for production of a protein that is incorporated into LDL molecules. The researchers report that people who carry two copies of the variant form of the gene had LDL cholesterol levels 22% lower than those who had one copy or no copies.

"This kind of reduction would correspond to a 50% lowering of risk of future heart disease in a 40-year-old man," the study's lead author, Dr. Fredrik Karpe, said in a statement issued by the American Heart Association.

"The variant form of the MTP, found in 6% of the individuals, is of functional importance in regulating expression of the MTP and influences LDL cholesterol concentration," Karpe explained. "These findings add to our understanding of how the LDL cholesterol level is regulated and suggest that genetic variation in the MTP expression may have important implications for the development of cardiovascular disease."

Most drugs used to treat high cholesterol work by removing excess amounts of cholesterol from the blood, but this study suggests that MTP inhibitor drugs could help lower LDL by inhibiting production of the blood fat.

SOURCE: Arteriosclerosis, Thrombosis and Vascular Biology (1998;18:756-761)


Viagra effective and well tolerated
May 13, 1998

Reports in the news media about use of oral sildenafil (Viagra) to treat erectile dysfunction have been circulating since late March, when the US Food and Drug Administration approved the drug. A study published this week in The New England Journal of Medicine confirms that the drug is "an effective, well-tolerated treatment for men with erectile dysfunction."

In the article, a multicenter team led by Dr. Irwin Goldstein of Boston University Medical Center in Massachusetts, describes a series of trials with the drug. In the first phase, which lasted 24 weeks, 532 men were treated with either 25, 50, or 100 milligrams of sildenafil, or placebo. In another phase, 329 men were treated initially with 50 mg of sildenafil or placebo, with the dose increased up to 100 mg. Finally, for the last phase of the study, 225 of the these 329 took sildenafil for another 32 weeks. In all cases, the drug was taken approximately 1 hour before planned sexual activity, but not more than once daily.

The effectiveness of the treatment was determined on the basis of a questionnaire, a log that patients kept at home, and a global efficacy question. Goldstein and his colleagues comment, "In keeping with sildenafil's mode of action (i.e., the drug causes erection only in response to sexual stimulation), the studies were performed entirely in a natural environment, which meant that we had to rely on the men's own reports of efficacy."

According to the article, increasing doses of the drug were associated with highly significant improvements in erectile function. Men treated with 100 mg of sildenafil scored 100% higher on the question about achieving erections, the investigators said.

"In the last four weeks of treatment in the dose-escalation study, 69% of all attempts at sexual intercourse were successful for the men receiving sildenafil, as compared with 22% for those receiving placebo," the researchers report. Men treated with sildenafil reported an average of 5.9 successful attempts at intercourse per month, versus only 1.5 successful attempts per month among men in the placebo group.

The most common side effects of the drug were headache, flushing, and dyspepsia.

"Oral sildenafil is an effective, well-tolerated treatment for men with erectile dysfunction," Goldstein and his colleagues conclude.

In an accompanying editorial, Dr. Robert D. Utiger explains that sildenafil is only effective when production of cyclic guanosine monophosphate, which stimulates relaxation of smooth muscles, is increased in penile tissue by sexual arousal. "Thus," he writes, "sildenafil will be ineffective if there is no arousal, enhancing the role of the man's partner." He adds that "....treatment would probably (not) be effective in men with erectile dysfunction caused by severe arterial insufficiency, loss of trabecular smooth muscle, or incompressible cavernosal veins."

Utiger continues, "The availability of sildenafil... means that many more men will seek help for (erectile dysfunction) and that primary care physicians will be increasingly involved in making decisions about the evaluation and treatment of these men.... Whether the promise of sildenafil will be realized after many more men have been treated and the drug has been taken repeatedly for prolonged periods remains to be seen."

SOURCE: The New England Journal of Medicine (1998;338:1397-1404, 1458-1459)


Colorectal cancer screening underused
May 12, 1998

Even though colorectal cancer is the second leading cause of cancer deaths in both men and women, less than half of adults over age 50 in the US are being screened annually for the disease, according to the Centers for Disease Control and Prevention (CDC).

And even fewer -- 38% -- have ever had a sigmoidoscopy, an examination of the lower colon that most adults should have performed every 5 years, a report suggests.

"Currently, screening for colorectal cancer lags far behind screening for other cancers, perhaps because the effectiveness of colorectal cancer screening has only recently been documented," according to the report. If colorectal cancer is caught early, 92% of patients survive for five or more years, however only 37% of tumors are caught at this stage.

In particular, women are less likely than men to be screened with sigmoidoscopy, and blacks and Hispanics are less likely than whites to have the examination, according to the CDC.

"I am particularly concerned that colorectal cancer is still viewed by women largely as a man's disease," said Congresswoman Louise Slaughter (D-NY), who requested the CDC update. "On the contrary -- it is an equal opportunity killer, striking men and women at equal rates." Slaughter is sponsoring legislation urging the US Department of Health and Human Services to conduct a public awareness campaign regarding colorectal cancer risk.

According to the American Cancer Society, colorectal cancer will kill 27,900 men and 28,600 women in the US this year. Beginning at age 50, both men and women should have either a fecal occult blood test every year plus a sigmoidoscopy every 5 years or a colonoscopy (an examination of the entire colon) every 10 years or double contrast barium enema every 5 to 10 years. Screening should be conducted more often in those with increased cancer risk, including those with a strong personal or family history of the intestinal polyps or colorectal cancer, or a history of chronic inflammatory bowel disease.



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