November 1998


 Food safety tips for turkey day
November 20, 1998

Americans need to pay more attention to how they prepare and cook their turkey this Thanksgiving, said a consumer advocate Thursday, noting that there is evidence that a dangerous bacteria called Campylobacter might be lurking in the birds.

The warning was sounded by Caroline Smith de Waal of the Center for Science in the Public Interest -- the same group that wants to ban olestra, and recently cautioned about teenagers' overconsumption of soda.

De Waal said a government survey published in August found that 90% of turkeys at processing plants were contaminated with Campylobacter. This survey was conducted before the US Food and Drug Administration and Department of Agriculture ordered meat and poultry producers to adopt new safeguards at slaughterhouses and processing plants to reduce bacterial contamination. Salmonella contamination in chickens has been halved -- from 20% of all birds at processing plants to 10% -- since the new government safety rules went into effect 6 months ago, said de Waal.

But Campylobacter is still a threat, she added. A survey by Consumers Union, published in the October 1998 issue of Consumer Reports, found that Campylobacter was on the rise in chickens tested at grocery stores. De Waal said there is no comparable data for turkeys yet.

Campylobacter causes diarrhea and nausea. It has also been linked to Guillain-Barre syndrome, a serious illness that features temporary paralysis.

The Centers for Disease Control and Prevention reported in April 1998 that Campylobacter is the top cause of bacterial diarrheal illness, according to its FoodNet surveillance system. It was a surprising finding, said de Waal, because Campylobacter tends to only hit individuals, who might not be as likely to report illness. It does not cause huge outbreaks like those seen with Salmonella and other bacteria.

There is some evidence that Campylobacter contamination is reduced by freezing poultry, which might give consumers some protection, de Waal noted. Maureen Storey of the Georgetown University Center for Food and Nutrition Policy told Reuters Health that it is possible that freezing after the birds leave processing plants might help. She noted that "different types of bacteria like different conditions to grow." But there is potential for contamination at the retailer and at home. That is why consumers should adopt safe handling practices, said Storey.

That advice was echoed by de Waal. Frozen turkeys can be defrosted in the refrigerator, allowing a day for every 5 pounds. They can also be thawed in cold water, according to the US Department of Agriculture, if the bird is submerged and the water changed every 30 minutes. Allow 30 minutes per pound to defrost.

Anything that comes into contact with a raw bird should be scrubbed thoroughly with warm, soapy water. A thermometer should be used to check doneness. The bird is considered safe for eating when the thigh temperature hits 180 degrees Fahrenheit, and all other parts at least 160 degrees. Stuffing should be loose and moist -- which allows for greater killing of bacteria while cooking. The stuffing should reach a temperature of 165 degrees.

Turkey leftovers should be immediately refrigerated or frozen, de Waal added.


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Bat exposure warrants rabies vaccine
November 19, 1998

People with exposure to bats -- even in the absence of any bite or scratch -- should receive treatment to prevent rabies infection, according to new guidelines from the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.

What's more, ferrets should be immunized against rabies just like cats and dogs, and greater numbers of international travelers may be candidates for prophylactic rabies treatment, announced Dr. Paul M. Arguin of the CDC's Advisory Committee on Immunization Practices at the Infectious Diseases Society of America meeting. The last update of the rabies prevention guidelines took place in 1991.

The new guidelines recognize the fact that bats are an increasing source of rabies in humans, Arguin said. The CDC are expected to publish the new guidelines before the end of the year.

Rabies treatment should be initiated after any bat exposure in which there is any possible exposure to the often fatal rabies virus through the skin or mucous membranes, even in the absence of a bite or scratch, "unless the bat is available for testing and is negative," according to the guidelines.

The guidelines also recommend that ferrets, an increasingly popular pet, now be immunized against rabies according to the same method used in dogs and cats. A healthy dog, cat or ferret that has bitten someone does not have to be euthanized if it can be confined and observed for 10 days.

And pre-exposure rabies treatment should now be considered for international travelers who may come into contact with rabies-infected animals, but unlikely to have access to proper medical care. This is an expansion over the previous guidelines, which recommended vaccination for travelers to endemic areas when their trip will be longer than 30 days.


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2% of deaths worldwide due to unsafe sex
November 19, 1998

Unsafe sexual practices lead to the deaths of over one million people annually, or 2% of all deaths worldwide, according to a report issued by the United Nation's World Health Organization (WHO). The report, entitled ''Health Dimensions of Sex and Reproduction,'' is a first-ever analysis of the global disease burden associated with sexual activity and reproduction.

``The burden of reproductive health hazards is large and of major public health concern,'' said Dr. Julio Frenk, executive director of the WHO's Evidence and Information for Policy division.

WHO researchers, Drs. Christopher Murray and Alan Lopez, used available data to tabulate the worldwide impact of reproductive illnesses, which include infectious diseases such as chlamydia, hepatitis and AIDS, as well as complications related to pregnancy and childbirth.

According to a WHO statement, the investigators conclude that ``reproductive ill-health accounts for 5% to 15% of the global burden of disease, even by the most restrictive of definitions.''

The authors defined safe sex as ``consensual sexual contact with a partner who is not infected with any sexually transmissible pathogens and involving the use of appropriate contraceptives to prevent (unwanted) pregnancy.''

While AIDS affects both sexes, other sexually transmitted threats to health -- including pelvic inflammatory disease, cervical cancer, and complications from pregnancy or abortion -- solely affect women. In fact, Murray and Lopez found that unsafe sex is now associated with 12% of all deaths in women of childbearing age. This number climbs even higher in the developing world: One in every four deaths of young women in sub-Saharan Africa is now linked to unsafe sex.

The researchers say half of the total global burden of reproductive illness is associated with complications during pregnancy or childbirth. ``A large proportion of the maternal burden is due to obstetric complications such as severe bleeding, infections, and obstructed labour,'' according to the WHO statement. Experts believe many of these conditions could be cheaply and easily prevented with appropriate public health interventions.

Copyright 1998 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.


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Saw palmetto improves prostate symptoms
November 10, 1998

Extract from the saw palmetto plant appears to safely ease the symptoms of benign prostatic hyperplasia (BPH), age-related swelling of the prostate gland, US researchers report.

The extract is as effective as finasteride, a drug commonly prescribed for BPH, but causes fewer side effects, according to Dr. Timothy J. Wilt of the Minneapolis Veterans Affairs Medical Center in Minnesota, and colleagues, who report their findings in the November 11th issue of The Journal of the American Medical Association.

Up to 40% of men aged 70 years or older have symptoms of BPH, which include a frequent urge to urinate during the day and at night, and difficulty emptying the bladder completely. Untreated, the condition can lead to bladder infections and kidney damage.

As early as the 1700s, Native Americans used extract from the saw palmetto plant, or Serenoa repens, to relieve prostate symptoms. Although it is still not clear how the plant extract works, S. repens is now one of the leading treatments for BPH in Germany and Austria, and is available in the US as an over-the-counter ``dietary supplement.''

To evaluate saw palmetto's efficacy and safety in the treatment of BPH, Wilt and colleagues reviewed 18 carefully controlled, published scientific trials involving 2,939 men with BPH. The studies lasted an average of 9 weeks and most compared symptoms among men treated with S. repens alone or other plant remedies with symptoms among men treated with either finasteride or inactive ``placebo''.

``Compared with placebo, S. repens improved urinary tract symptoms by 28%, nocturia (the urge to urinate at night) by 25%, peak urine flow by 24%,'' and reduced the volume of urine left in the bladder after urination by 43%, the researchers report. ''When compared with finasteride, S. repens provided similar responses in urologic symptoms and flow measures,'' they write. Saw palmetto did not reduce prostate size, however, while finasteride did.

Men taking saw palmetto reported having side effects that ''were generally mild and comparable with placebo,'' Wilt and colleagues write. About 1.1% of men taking the extract reported difficulty getting or maintaining an erection, compared with 4.9% of those taking finasteride, and 0.7% of those taking placebo. Roughly 1.3% of those taking S. repens reported gastrointestinal problems, compared with 1.5% of those taking finasteride, and 0.9% of those taking placebo.

S. repens is less expensive than other BPH drugs, including finasteride and terazosin, Wilt and colleagues note. A 90-day supply of 320 milligram daily doses of S. repens costs between $10 and $50, compared with $200 for a 90-day supply of finasteride and $120 for terazosin, they report.

Additional trials, including long-term studies of S. repens, and trials to determine whether the plant extract might prevent complications of BPH, are warranted, the researchers note.

``In conclusion, the available evidence suggests that extracts from the saw palmetto plant, S. repens, improve urinary tract symptoms and flow measures in men with BPH,'' Wilt and colleagues report. ``Compared with finasteride, S. repens produces similar improvements in urinary tract symptoms and flow measures, has fewer adverse treatment effects, and costs less.''

SOURCE: The Journal of the American Medical Association 1998;280:1604-1609.


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Baldness linked to heart disease
November 10, 1998

Severe male pattern baldness may be the latest risk factor, or at least an indicator, for heart disease.

Researchers at the annual meeting of the American Heart Association in Dallas investigated the baldness patterns of more than 19,000 physicians enrolled in one study and said today they found a 36-percent increased risk of heart disease for those with the most severe forms of male pattern baldness.

Once other factors such as smoking and cholesterol levels were considered, the risk of heart disease increased as hair on the head decreased. Dr. Paulo A. Lotufo of Sao Paulo, Brazil, a visiting cardiology scholar at Brigham and Women's Hospital and Harvard Medical School, Boston, focused his study on 19,000 men in the Physicians Health Study who were under age 45.

''Baldness seems to be a marker for development of heart disease,'' Lotufo said. Men who had no hair loss had an average risk of heart disease. Frontal hair loss _ the receding hairline had about a 9-percent increased risk, Lotufo said. Men with a receding hairline and a small bald spot at the vertex (top of the skull) had increased risk and as that bald spot grew, so did the risk.

Lotufo said the results should be of special concern to men with severe baldness patterns, and other heart disease risk factors such as high cholesterol and high blood pressure.

''I suspect the relationship between heart disease and baldness may have something to do with testosterone levels,'' Lotufo said. But the scientist said beyond that he doesn't really know why there should be such a relationship.

''Interpretation of these results is difficult. We just did the study and found these numbers,'' said Lotufo who has a graying, but full head of hair.


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Smoking can choke up a sex life
November 9, 1998

While movies have long portrayed cigarettes as a sexy accessory, 60 Minutes Correspondent Mike Wallace has learned that smoking can actually be detrimental to a man's love life.

Wallace asked Dr. Culley Carson of the University of North Carolina whether smoking causes impotence.

"There is absolutely no question about it. It causes it very commonly," Carson says.

Says Dr. John Mulhall of Loyola Medical Center in Chicago:

"Absolutely. Unquestionably."

Mulhall and Culley are not doctors on the fringe. The link between smoking and impotence is the official conclusion of the American Medical Association. They say that blood vessel damage from smoking causes impotence.

"I feel confident that smoking does and can cause impotence," says the AMA's chairman, whose name happens to be Dr. Randolph Smoak.

To many, the AMA's acknowledgement may be the most believable seal of approval. However, Smoak says, both doctors and consumers have radically changed their views over the past thirty years on tobacco.

"In 1964 when the first surgeon general's report came out and told you something about tobacco, we really didn't believe it," Smoak says.

"And now we know so much more about...this type of problem of impotence associated with tobacco," he adds.

Smoking has been linked to impotence around the world. Studies in France, Sweden, and South Africa all found a greater percentage of smokers in impotent groups than in the general population. Many American urologists, including Dr. Mulhall, say a high percentage of their impotent patients are smokers.

When Mulhall informs his patients of this lesser-known side effect of smoking, they are not so much surprised as remorseful.

"...They say to me, 'If I'd only known that years ago,'" Dr. Mulhall says.


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Osteoporosis: the silent disease
November 5, 1998

Astronaut John Glenn's space mission includes research into a disease that affects 28 million Americans. Osteoporosis is often called the silent disease because most people don't know they have it until they suffer a broken bone.

CBS This Morning Health Contributor Dr. Bernadine Healy reports that new guidelines from the National Osteoporosis Foundation help determine who should be tested and when.

Osteoporosis is a disease that causes severe bone loss, weakening bones and increasing the risk of fractures. This means that bones can break, in some cases with only minimal stress, such as coughing or turning over in bed.

Most often, the victim does not know he or she has osteoporosis until a bone breaks. Once an elderly person fractures a hip, it could mean a loss of independence or worse; 25 percent of people who suffer a hip fracture will not live more than one year longer.

With 28 million sufferers, Dr. Healy says just about everyone is at risk. However, there are certain specific groups at higher risk.

Gender counts: Women represent 80 percent of the cases of osteoporosis. They are at much greater risk than men.

Men are not immune, but they get it later than women do, in their 70s and 80s. One in eight men will face osteoporosis in their lifetime. It is thinner men, and those with a family history of the disease, who should be concerned.

Menopause: With estrogen loss during menopause, women suddenly experience a major loss of calcium.

Genes count: There are genetic risk factors for osteoporosis. A family history of fractures is one. Even body type is a risk factor. A small, thin woman under 120 pounds is at higher risk.

Age: Men and women over age 70 are at higher risk.

Race: Caucasian and Asian women have a higher risk for osteoporosis.

Lifestyle: Alcohol abuse, smoking, and a sedentary life can increase your risk for osteoporosis.

You can be tested for osteoporosis. The National Osteoporosis Foundation recommends that if you're over age 65 and a woman, you should be tested. If you're under age 65 and you are post-menopausal and have one of the risk factors mentioned above, you should be tested. If you have had a fracture with little trauma, you should be checked out.

Prevention is possible, and should start early in life. The teenage years are not too early. There are four things to do to get more calcium in your diet:

You must have 1200 to 1500 milligrams of calcium every day.

Exercise. Weight-bearing exercise is important.

Do not smoke.

Don't abuse alcohol.

Treatment for women is dictated by how advanced the disease has become. There is growing evidence that estrogen can increase bone density. Estrogen is most effective when combined with an adequate intake of calcium, which for post-menopausal women should be at least 1200 milligrams per day. There are also alternative treatments like raloxifene, a designer estrogen. Consult your doctor.

Click here for more info on Osteoporosis


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New test urged for osteoporosis-prone women
November 20, 1998

Women who are at high risk for osteoporosis should have their bone density measured using a diagnostic test called dual energy x-ray absorptiometry, federal researchers say.

A report from the Centers for Disease Control and Prevention (CDC) notes that this technology is believed to be ``the best tool available to assess osteoporotic fracture risk for women after menopause,'' but acknowledges that the test ``is not yet widely used... primarily because of cost.''

Women at risk for osteoporosis ``should be aware that this technology is now available, should discuss it with their physician and decide (how to proceed),'' Dr. Yinong Chong, an epidemiologist with the National Center for Health Statistics, Hyattsville, Maryland, told Reuters Health. This test, she said, provides women and their doctors a ``solid piece of information on which to decide,'' Chong said.

``We are not recommending population-based screening (with this technology) at all, only high-risk women with more than one risk factor for osteoporosis should undergo densitometry studies as specified by current guidelines,'' Chong said.

In the Morbidity and Mortality Weekly Report for November 20, Chong and her colleagues report data from the Third National Health and Nutrition Examination Survey, NHANES III, conducted between 1988 and 1994. In the study, 93% of estrogen-deficient women with osteoporosis were unaware that they had the disease.

This is ``not surprising at all,'' the researcher told Reuters Health. ``(NHANES III) was the first national survey to use a very new technology at the time'' to estimate osteoporosis prevalence based on bone mineral density, Chong said. At the time NHANES III was conducted, ``...access to and familiarity with bone densitometry among primary care physicians was low,'' according to the report.

This report shows that a ``high proportion of high-risk women could have benefited from this technology (had it) been available,'' Chong told Reuters Health. She also noted that the Medicare Bone Mass Measurement Coverage Standardization Act, passed in July 1998, mandates coverage of densitometry studies for high-risk women. This should increase the number of appropriate women who are screened, Chong said.

More information on osteoporosis and bone density testing is available from the National Osteoporosis Foundation at www.nof.org.

SOURCE: Morbidity and Mortality Weekly Report 1998;47:969-972.


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HRT plus drug lowers cholesterol in older women
November 19, 1998

Hormone replacement therapy (HRT) and the drug simvastatin in combination can lower cholesterol levels in older women more effectively than either therapy alone, researchers report.

Postmenopausal women with cardiovascular disease may benefit from ``a statin (drug) alone or in combination with HRT,'' conclude a team of researchers at the Onassis Cardiac Surgery Center in Athens, Greece. Their report was published this month in the Journal of the American College of Cardiology.

A decline in estrogen levels after menopause can trigger a rise in levels of circulating cholesterol in older women. HRT counteracts this rise through the reintroduction of estrogens. According to the Greek authors, previous studies suggest that HRT ``reduces the risk of coronary events in postmenopausal women by up to 50%.''

Newly developed 'statin' drugs -- including simvastatin and pravastatin -- have also proven successful in lowering cholesterol levels.

In their study, the investigators compared the benefits of simvastatin therapy, HRT, the two therapies in combination, or (inactive) placebo in 16 postmenopausal women diagnosed with coronary artery disease.

They found that two therapies -- simvastatin alone, or simvastatin in combination with HRT - - lowered total blood cholesterol by 35% and 33%, respectively, compared with placebo. The two therapies also reduced blood levels of LDL -- the ''bad'' cholesterol that increases heart risk -- by about 45%.

HRT alone exhibited less impressive results, reducing levels of total cholesterol by 13%, and LDL cholesterol by 20%.

However, the authors point out that the use of HRT alone reduced blood levels of one type of 'bad' cholesterol, lipoprotein(a), while significantly increasing levels of apolipoprotein A-I, a lipid linked to improved cardiovascular health. ``This is a unique effect that (drug therapy) does not exert,'' the authors say.

For this reason, they conclude that the use of HRT and simvastatin in combination may be warranted in older women with arterial disease unresponsive to other treatment.

SOURCE: Journal of the American College of Cardiology 1998;32:1244-1250.


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