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Drug recommended to prevent prostate cancer in some older men

admin — Mon, 23 Feb 2009 04:07:14 +0000

The panel stopped short of recommending that all men take the drug because clinical trials have not yet shown that it reduces deaths.
Prostate cancer is the second-leading cause of cancer deaths among men, behind lung cancer, with 186,000 new cases diagnosed and 28,660 deaths each year.
Finasteride is used in low doses under the brand name Propecia as an anti-balding drug and in higher doses under the name Proscar for shrinking enlarged prostate glands. The dose recommended for cancer prevention is the same dosage used in Proscar.
The drug interferes with the production of male hormones, starving the tumors of fuel they need to grow.
A major clinical trial reported in 2003 showed that finasteride reduced the risk of prostate cancer by about 25% in men who took it, preventing about 15 cases in every 1,000 men. That means 71 men would have to take the drug for seven years to prevent one case, Kramer said.
Another drug in the same family, called dutasteride or Avodart, is thought to be even more potent and is undergoing clinical trials for prevention. It is also recommended in the guideline.
The medical groups did not issue new recommendations after the completion of the 2003 trial because it appeared that finasteride might have been promoting the growth of more aggressive tumors at the expense of those that are more benign.
“Now we know this is not the case,” Jacoub said. Subsequent studies have shown that shrinkage of the prostate caused by finasteride simply made the aggressive tumors more easily discovered.
The drug does have side effects in some men, however, including reduced potency and loss of sexual desire. Those effects can go away after a couple of months. On the other hand, the drug can result in reduced incontinence and fewer urinary problems.
Cost can also be a problem. The pills cost $2 to $3 a day, or about $1,000 per year, and most insurers do not cover them for cancer prevention.
Speaking at the news conference, panel member Dr. Howard Sandler of Cedars-Sinai Medical Center said, “If I tried the medication for a month or two and I got some side effects, then for me personally the benefit wouldn’t be worth the risk.” But if there were no side effects, he added, “I might sleep better at night.”

Drug recommended to prevent prostate cancer in some older men

admin — Tue, 06 Jan 2009 14:06:10 +0000

School-Based Fitness Programs Recommended Despite Lack of Weight Loss

admin — Sun, 02 Nov 2008 22:23:43 +0000

HAMILTON, Ontario, Jan. 21 — Gym class and other school fitness initiatives should be pursued even if their benefits don’t include weight loss, according to a systematic review.
School-based fitness and exercise programs improved duration of physical activity and fitness as measured by lung capacity while reducing television viewing and blood cholesterol, reported Maureen Dobbins, Ph.D., of McMaster University here, and colleagues in a Cochrane review.
But these interventions generally did not increase leisure time physical activity rates or reduce blood pressure, body mass index, or pulse rate, they found.
“Given that there are no harmful effects and that there is some evidence of positive effects on lifestyle behaviors and physical health status measures,” Dr. Dobbins’ group said, “ongoing physical activity promotion in schools is recommended at this time.”
Physical inactivity a leading cause of cardiovascular disease, diabetes, and other major chronic diseases in adulthood and contributes to risk of death and disability as well.
Establishing lifelong patterns of regular physical activity in childhood has been suggested as perhaps the best primary strategy to improve long-term health, the researchers noted.
However, at least one-third of school-age children and adolescents don’t meet World Health Organization guidelines for 60 minutes or more of active play at least five days per week.
To see whether school-based interventions could counteract these problems, the researchers pooled findings from 26 prospective controlled studies of at least moderate quality that tested school-based interventions aimed at increasing physical activity in students ages six to 18 years.
The studies, done in Australia, South America, Europe, and North America, had a wide variety of approaches to increasing physical activity. Generally, though, the interventions provided students with information about the benefits of physical activity and healthy nutrition and attempted to increase time spent in physical activity during the school day and the amount of energy spent during gym class, recess, and other physical activity sessions.
The fitness programs did this through changes to physical education classes and the overall curriculum and to the format of the school day along with teacher training, educational materials, and increased accessibility of exercise equipment.
Some interventions also included home or community involvement, changes to school cafeteria food, and risk factor assessment for students.
The evidence was “convincing” for overall physical activity duration effects. Intervention-group children in five of seven studies showed a statistically significant improvement of six to 50 extra minutes per week compared with controls, including those in the two studies that used accelerometers rather than self-reports.
For physical inactivity measured by television viewing, three of the four studies reported significant reductions with the school-based fitness programs compared with controls. The differences included five minutes to 40 minutes per day and a 50% reduction in the likelihood of watching three hours per day (

But of the seven studies that reported effects on leisure time physical activity rates, four found no significant effect.

“It is possible that school-based interventions are too focused on the school setting and children and adolescents do not translate the health messages on the importance of physical activity at home or in the community,” Dr. Dobbins’ group said.
max) also improved significantly in three of five studies with one reporting an almost two-fold likelihood of improvement during the intervention compared with controls.
Cholesterol benefits also appeared to be more likely with intervention. Four of seven studies found significant reductions in total blood cholesterol compared with controls.
Importantly, though, the results were overwhelmingly negative for effects on childhood obesity. Only four of 14 studies showed significantly lower increases in body mass index among intervention-group children compared with controls. The rest showed no trend for benefit despite being generally well-powered.
Blood pressure generally was not improved with the interventions.
Only three of 10 studies showed statistically significant positive effects on systolic blood pressure with an average 5- to 6-mm Hg reduction compared with 3 mm Hg among controls.
Four of the nine studies reported statistically significant reductions in diastolic blood pressure of a mean 3 to 4 mm Hg compared with a slight increase among controls.
Of five studies reporting heart rate effects, only one found significant improvements in resting pulse rate and one on pulse rate during maximal exercise and recovery (

Dr. Dobbins’ group cautioned that the studies overall were limited by inability to control for co-interventions and generally short-term follow-up of no more than six months. “The long-term effects of school-based interventions are unknown at this time.”
Because none of the studies showed any evidence of harm, “at a minimum, the use of printed educational materials and changes to the school curriculum that promote increased physical activity are encouraged,” they concluded.

Recommended Diet for Diabetics May Need Changing, Study Suggests

admin — Wed, 25 Jun 2008 11:49:03 +0000

kept their blood sugar under better control when they ate foods like beans and nuts instead of the recommended whole-grain diet, researchers have found.
Beans and nuts are among foods that only modestly increase blood glucose levels; scientists describe these foods as having a low glycemic index. The new study, which lasted six months, is one of the largest and longest to assess the impact of foods with a low-glycemic index, researchers said.
after six months, with increases in
, the so-called “good” cholesterol associated with a reduced risk of heart disease, the study found.
“That’s an important issue today, because there’s a double whammy for people who are diabetic,” said Dr. David J. A. Jenkins, lead author of the report and a professor of nutritional sciences at the University of Toronto. “If they’re men, they have twice the risk of heart disease, and if they’re women, they have four times the risk. If you can hit the heart disease to which they’re particularly vulnerable, you may have something useful.”
“Pharmaceuticals used to control Type 2 diabetes have not shown the expected benefits in terms of reducing cardiovascular disease,” he added.
The study was published on Tuesday in the Journal of the American Medical Association.
Some 210 patients with Type 2 diabetes were randomly assigned to a low-glycemic diet or a high-cereal, high-fiber diet.
The high-cereal high fiber diet emphasized “brown foods” such as whole-grain bread and breakfast cereal, brown rice and potatoes with the skin on. The low-glycemic diet included beans, peas, lentils, pasta, quickly boiled rice and certain breads, like pumpernickel and rye, as well as oatmeal and oat bran cereals.
. Both groups were told to limit their consumption of white flour and to eat five servings of vegetables and three servings of fruit each day.
levels — a measure of blood glucose levels over recent months — reduced slightly, by 0.5 percent on average, but experienced significant improvements in HDL, which increased by 1.7 milligrams per deciliter of blood on average. Those on the high-cereal diet saw smaller reductions in hemoglobin A1C and slight drops in HDL.
Dietitians who work with people who have Type 2 diabetes said earlier studies had not demonstrated the benefits of low-glycemic index foods as clearly as this report.
“We’ve been telling people to eat whole grains for a long time,” said Emmy Suhl, a nutrition and
educator at the Joslin Diabetes Center in Boston. “What this study shows is that it’s not enough to have whole grains. It’s these very specific low-glycemic
that do a much better job.”
But, she said, following such a diet is complicated, since the glycemic index of a food can change depending on how it is prepared and served.
“People tell us again and again that diet is the hardest part of diabetes management,” she added.

Family History Updates Recommended in Breast Cancer Survivors

admin — Wed, 30 Apr 2008 01:15:02 +0000

SAN ANTONIO DEC 11, 2008 (Reuters Health) – Researchers at the Moores Cancer
Center at the University of California, San Diego Cancer Center are recommending that the cancer family history of breast cancer survivors be periodically updated.
The recommendation was made at the 2008 San Antonio Breast Cancer Symposium (2008) following a study that found that the prevalence of high-risk cancer family histories increased by 70% in a cohort of breast cancer survivors over a 7.5 year-follow-up period.
“Updating the family history has the potential to benefit patients and families who can undergo more aggressive surveillance or undertake risk reduction interventions,” said Dr. Lisa Madlensky, assistant professor and research director at the Family Cancer Genetics
Program.
The cancer family history is the most important tool in identifying women who may be at high risk of having hereditary breast-ovarian cancer syndrome (HBOCS) caused by mutations
in the BRCA1
and BRCA2 genes, Dr. Madlensky pointed out. While many breast cancer patients may be asked about their family history at the time of their initial diagnosis, it is not known how many women initially classified as low risk for HBOCS become high risk over time as new cancers are diagnosed in their relatives, she added.
The UCSD group set out to determine how the prevalence of high-risk cancer family histories changes over time in breast cancer patients, and to determine how many breast cancer survivors at high risk for HBOCS self-report having undergone genetic
testing for BRCA1/2.
Breast cancer survivors in the Women’s Healthy Eating and Living (WHEL) study provided detailed family history data — on all first-degree
relatives plus all grandparents, aunts and uncles — at baseline and again at study closure. Patients were classified as high risk of HBOCS if the chance of having a mutation in either BRCA1 or BRCA2
was 10% or greater.
At baseline, 8.2% of 2508 survivors were classified as high risk. At follow-up an average of 7.5 years later, an additional 5.8% of women became high risk.
“The prevalence of a high-risk family history increased by 70% in our study cohort,” Dr. Madlensky said. The increase was mainly due to new cancer diagnoses in relatives of women who were diagnosed with breast cancer before age 50.
The study also found that 15% of high-risk women had never heard of BRCA testing and that only 23% of women who would be appropriate candidates for BRCA testing had actually undergone such testing. Of those tested, 27% ended up having a mutation in BRCA1 or BRCA2.
As for how often clinicians should update the cancer family history of cancer survivors, Dr. Madlensky said that although this study did not aim to identify an optimal interval for updating, it is reasonable to ask all breast cancer survivors if there have been any new cancer diagnoses in their family on a yearly basis. She also noted that patients can be pro-active by informing their physicians of new cancers in the family when they occur, rather than waiting to be asked.
She added that her group is now working on ways to improve the collection of cancer family histories in oncology
clinics and primary care settings, as well as studying ways to help families share and keep track of their cancer histories.
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Most Patients Do Not Undergo Recommended Stress Test to Confirm …

admin — Fri, 04 Apr 2008 06:39:48 +0000

CHICAGO — October 14, 2008 — A majority of Medicare patients with stable coronary artery disease (CAD) who underwent an elective percutaneous coronary intervention (PCI) did not have a recommended stress test performed to confirm the necessity of the procedure, according to a study in the October 15 issue of the
.
Grace A. Lin, MD, University of California, San Francisco, San Francisco, California, and colleagues conducted a study of Medicare beneficiaries undergoing elective PCI to determine the frequency with which stress testing was performed prior to PCI.
The researchers analysed claims data from a 20% random sample of 2004 Medicare fee-for-service beneficiaries aged 65 years or older who had an elective PCI (n = 23,887).
The researchers found that, of this study group, 44.5% (10,629) of patients underwent stress testing within the 90 days prior to elective PCI. There was significant geographic variation in the rate of stress testing by hospital referral region, with rates ranging from a low of 22.1% to a high of 70.6%.
The rate of stress testing did not correlate with the volume of PCI procedures performed in the hospital referral region. Patients who had a prior cardiac catheterisation were less likely to undergo stress testing prior to elective PCI.
Female sex, age of 85 years or older, and having coexisting illnesses such as rheumatic disease, chronic obstructive pulmonary disease, congestive heart failure, and CAD were associated with decreased likelihood of stress testing prior to PCI.
Conversely, patient characteristics associated with an increased likelihood of a stress test prior to PCI were black race and having a history of chest pain. Patients of physicians who performed a higher volume of PCI procedures had slightly lower rates of stress testing. No hospital characteristics were associated with receipt of stress testing.
“Guidelines for PCI call for documenting ischaemia prior to PCI in the vast majority of patients with stable CAD; however, our data suggest that this is not being done consistently,” the authors wrote.
“Assessing whether PCI is being performed in appropriately selected patients is crucial to providing high-quality, patient-centred medical care in light of evidence that patients in regions providing high-intensity care do not have better outcomes than those in regions providing low-intensity care.”
In an accompanying editorial, George A. Diamond, MD, and Sanjay Kaul, MD, of Cedars-Sinai Medical Center and University of California, Los Angeles, Los Angeles, California, wrote that properly designed economic incentives might balance competing influences regarding the use of PCI.
“The Centers for Medicare and Medicaid Services, for example, might set reimbursement for evidence-based care at a higher level than for non-evidence-based care. Thus, a cardiologist performing PCI for a patient with objective evidence of ischaemia despite an appropriate intensity of medical therapy would be paid more than for the same patient without such evidence. Unlike ‘pay-for-performance,’ these evidence-based reimbursement incentives target individual physician decisions rather than aggregate patient outcomes, are based on empirical data rather than consensus opinion, and are relatively large in size and immediate in effect.”
All contents Copyright (c) 1995-2008 Doctor’s Guide Publishing Limited. All rights reserved.

Drug recommended to prevent prostate cancer in some older men

admin — Mon, 21 Jan 2008 09:59:03 +0000

The panel stopped short of recommending that all men take the drug because clinical trials have not yet shown that it reduces deaths.
Prostate cancer is the second-leading cause of cancer deaths among men, behind lung cancer, with 186,000 new cases diagnosed and 28,660 deaths each year.
Finasteride is used in low doses under the brand name Propecia as an anti-balding drug and in higher doses under the name Proscar for shrinking enlarged prostate glands. The dose recommended for cancer prevention is the same dosage used in Proscar.
The drug interferes with the production of male hormones, starving the tumors of fuel they need to grow.
A major clinical trial reported in 2003 showed that finasteride reduced the risk of prostate cancer by about 25% in men who took it, preventing about 15 cases in every 1,000 men. That means 71 men would have to take the drug for seven years to prevent one case, Kramer said.
Another drug in the same family, called dutasteride, or Avodart, is thought to be even more potent and is undergoing clinical trials for prevention. It is also recommended in the guideline.
The medical groups did not issue new recommendations after the completion of the 2003 trial because it appeared that finasteride might have been promoting the growth of more aggressive tumors at the expense of those that are more benign.
“Now we know this is not the case,” Jacoub said. Subsequent studies have shown that shrinkage of the prostate caused by finasteride simply made the aggressive tumors more easily discovered.
The drug does have side effects in some men, however, including reduced potency and loss of sexual desire. Those effects can go away after a couple of months. On the other hand, the drug can result in reduced incontinence and fewer urinary problems.
Cost can also be a problem. The pills cost $2 to $3 a day, or about $1,000 per year, and most insurers do not cover them for cancer prevention.
Speaking at the news conference, panel member Dr. Howard Sandler of Cedars-Sinai Medical Center said: “If I tried the medication for a month or two and I got some side effects, then for me personally the benefit wouldn’t be worth the risk.” But if there were no side effects, he added, “I might sleep better at night.”

Medical malpractice law recommended for extension

admin — Wed, 24 Oct 2007 03:36:53 +0000

A medical malpractice arbitration act scheduled to sunset next July ought to remain on the books another 10 years, the Legislature’s Heath and Human Interim Committee decided Wednesday.
The act was passed in 2004 following widespread public opposition to a bill approved in 2003 that allowed doctors to refuse care if a patient did not agree in writing to binding arbitration in lieu of full legal redress in court in the event of malpractice.
If the act were allowed to sunset, doctors could again refuse care to those unwilling to sign an arbitration agreement.
Legal representatives told committee members that allowing the act to sunset is counter to protecting the rights of patients.
The original bill was intended as a step toward limiting medical costs associated with protracted legal proceedings and huge jury awards in malpractice cases.
Under the act, patients cannot be denied care if they refuse to sign an arbitration agreement. Patients who have signed an agreement were also given the right to rescind the agreement after 10 days.

Drug recommended to prevent prostate cancer in some older men

admin — Mon, 15 Oct 2007 12:46:27 +0000

The panel stopped short of recommending that all men take the drug because clinical trials have not yet shown that it reduces deaths.
Prostate cancer is the second-leading cause of cancer deaths among men, behind lung cancer, with 186,000 new cases diagnosed and 28,660 deaths each year.
Finasteride is used in low doses under the brand name Propecia as an anti-balding drug and in higher doses under the name Proscar for shrinking enlarged prostate glands. The dose recommended for cancer prevention is the same dosage used in Proscar.
The drug interferes with the production of male hormones, starving the tumors of fuel they need to grow.
A major clinical trial reported in 2003 showed that finasteride reduced the risk of prostate cancer by about 25% in men who took it, preventing about 15 cases in every 1,000 men. That means 71 men would have to take the drug for seven years to prevent one case, Kramer said.
Another drug in the same family, called dutasteride, or Avodart, is thought to be even more potent and is undergoing clinical trials for prevention. It is also recommended in the guideline.
The medical groups did not issue new recommendations after the completion of the 2003 trial because it appeared that finasteride might have been promoting the growth of more aggressive tumors at the expense of those that are more benign.
“Now we know this is not the case,” Jacoub said. Subsequent studies have shown that shrinkage of the prostate caused by finasteride simply made the aggressive tumors more easily discovered.
The drug does have side effects in some men, however, including reduced potency and loss of sexual desire. Those effects can go away after a couple of months. On the other hand, the drug can result in reduced incontinence and fewer urinary problems.
Cost can also be a problem. The pills cost $2 to $3 a day, or about $1,000 per year, and most insurers do not cover them for cancer prevention.
Speaking at the news conference, panel member Dr. Howard Sandler of Cedars-Sinai Medical Center said: “If I tried the medication for a month or two and I got some side effects, then for me personally the benefit wouldn’t be worth the risk.” But if there were no side effects, he added, “I might sleep better at night.”

Strict diet not recommended to treat gout

admin — Wed, 13 Jun 2007 16:43:46 +0000

Q: I recently had my first experience with gout. I had bloodwork done, which showed high levels of uric acid. I was given a list of many foods I should avoid, but the list is so extensive. I’m not sure what to eat besides fruits and vegetables. What do you recommend to balance my diet? I would like to avoid taking medication unless I really need it.
I don’t recommend strict dietary modifications after an initial attack of gout. Here’s why.
Gout is a condition in which uric acid deposits in joints, causing inflammation. A gouty joint is an unhappy joint — it’s painful, swollen and does not move well.
People with gout almost always have high blood levels of uric acid, one of the body’s normal waste products. Most uric acid is removed from the body by the kidneys, so people with kidney disease typically have high levels of it. But gender, genetics, body weight and other factors go into making a person’s level of uric acid what it is.
A unique property of uric acid is that it cannot always dissolve well in the blood and tissues. When the blood levels are even slightly high, uric acid can get deposited as solid crystals in the joints (causing arthritis), kidneys (causing kidney stones) and other tissues.
Recent research suggests that a diet high in meat, seafood and alcohol increases the risk of newly diagnosed gout. In addition, dairy products and coffee may be protective, lowering the risk of gout. However, these studies looked at people who had not had gout before. They did not assess the effect of diet on people who already had gout.
The list that you received of foods to avoid was probably a list of foods that are high in purines, a building block of protein that is broken down into uric acid. Most of the foods with the highest purine content are not ones that people eat often. These include thymus, pancreas, anchovies, liver, kidneys, brains and game meats.
It turns out that following a strict diet to avoid purines doesn’t usually accomplish much. There are better ways to help lower uric acid and decrease the risk of further gout attacks. It’s much more effective to:
• Limit alcohol intake (alcohol is known to trigger gout attacks).
• Lose excess weight (being overweight increases the risk of gout).
• Avoid foods that seem to trigger attacks of gout for you.
Ask your doctor if there are medications you’re taking (especially diuretics) that can cause uric acid buildup, and see if you can switch to something else.
When needed, medications (especially allopurinol) can effectively lower uric acid and markedly decrease the risk of gout attacks. They are much better at doing so than following a strict diet.
Dr. Robert H. Shmerling is associate physician at Beth Israel Deaconess Medical Center in Boston and associate professor at Harvard Medical School. He has been a practicing rheumatologist for more than 20 years at Beth Israel Deaconess Medical Center.