Chickenpox vaccine can save
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
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
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
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.
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
"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
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
SOURCE: American Journal of Preventive Medicine
The Truth About
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
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.
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
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
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
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
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,
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
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
"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
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