Thursday, September 1, 2011

WTC studies find no big jump in cancer, deaths (AP)

NEW YORK � Two major medical studies have failed to find significant increases in deaths or cancer among people exposed to dust from the World Trade Center.

In one, researchers who studied cancer rates among nearly 9,000 firefighters who spent time at ground zero found four more cases of the disease than might normally be expected in a group of American men of the same age and ethnicity, an increase independent experts said was small enough to be caused by chance alone.

Fire Department doctors also compared exposed firefighters to a group of 926 colleagues who were never at the trade center, and had no contact with the dust. There, they found that cancer rates were about 19 percent higher for in the exposed group, but, again, experts uninvolved in the study said the difference was not statistically significant.

Advocates for the firefighters said the trend was still worrisome, however, and doctors said they could not rule out the possibility that more cancer cases will develop among the firefighters as time goes on.

In the other study, researchers with New York City's health department who studied death rates among 42,000 people potentially exposed to trade center dust found no evidence of a spike in fatalities. In fact, they found that the 790 deaths among people in the study group was about 43 percent lower than the mortality rate for New Yorkers in general. They were also less likely to have suffered fatal respiratory ailments.

Those findings, however, was also written off by scientists as too premature to mean much. Because the attacks happened in a business district and presumably involved people who were fit enough to be reporting to work, the study group was probably healthier than the general public to begin with, said New York City's health commissioner, Dr. Thomas Farley.

"I wouldn't interpret it as that the World Trade Center has somehow helped people live longer," he said. Also, the types of toxins released in the trade center disaster usually take decades to result in deaths, not the few years covered in the study, he and other experts said.

Donald Berry, a professor of biostatistics at the University of Texas M.D. Anderson Cancer Center, said the two studies "provide no evidence that living or working in the former shadow of the World Trade Center increases one's risk of anything."

"Occupational hazards are real," he said. "An extreme example is the plight of asbestos workers. But occupational risks accrue over years of exposure. With the exception of a nuclear explosion or meltdown, it's difficult for any single event to cause an increase in cancer or in mortality."

Both studies were being published Friday in The Lancet, a British medical journal.

Also set for publication in The Lancet on Friday is a study of nearly 27,500 people enrolled in a World Trade Center health monitoring program that found that nearly 28 percent had asthma, 42 percent had sinus problems and 39 percent had acid reflux disease, a condition related to heartburn. The study also found large numbers of rescue and recovery workers suffering from depression or panic disorders. Those findings echo the results of several other studies.

Dr. David Prezant, the fire department's chief medical officer, said he believed the firefighters study indicated "a moderately strong correlation" between World Trade Center dust and cancer. He said he did not agree with other experts who said the study failed certain key tests of statistical significance.

The inquiry found that 242 of the nearly 9,000 firefighters exposed to the attacks had developed cancer within the study period, compared to the 238 that researchers would have expected in the general public.

Researchers found less lung cancer than expected � only 9 cases instead of the 21 they expected to see. That's reassuring because people are concerned about inhaled dust particles. All 9 of the cases involved smokers.

Conversely, they found 12 cases of thyroid cancer in the study group, compared to the 6 they might have expected based on rates in the general public.

Dr. James M. Melius, director of the New York State Laborers' Health Fund and one of the leading advocates for ground zero workers suffering health problems, said that even though the cancer research on firefighters was inconclusive, it showed enough possibility of a risk that U.S. officials should consider adding cancers to a list of conditions covered by a multi-billion dollar health aid bill passed by Congress last year.

Doing so would qualify exposed people for sizeable compensation payments.

"Are we going to wait until we have definitive evidence, which could be 20 or 30 years? Are we going to say, decades from now, `Yeah, you did get cancer because of the World Trade Center, and we should have helped you out back then?'" he said. "It's limited information. It isn't a perfect study ... It still provides compelling evidence that we should be providing at least health care for these people."

Experts said both the mortality study and the cancer study are limited, in part because of the difficulty of finding a proper comparison group. Drawing conclusions can also be difficult because researchers don't know the full medical history of the subjects.

Dr. Michael Thun, vice president emeritus of epidemiological research for the American Cancer Society, said it isn't surprising that the study would fail to detect any major trends so soon after attacks.

Typically, the types of cell mutations caused by toxic and carcinogenic exposures take decades to develop into a diagnosable cancer, he said.

Outside of cancers in children, he said, "You can't really go from the earliest stage to lethal in just a few years."

But it is possible that a cancer that already existed might have been accelerated by something in the dust, and on that point, "the results are neither conclusively negative, or conclusively positive," Thun said.

He called the Fire Department research "a solid first study on the issue," but said it will likely be another decade before scientists can really see whether people exposed to trade center toxins have an increased risk of getting cancer.



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CDC: Doctors prescribing fewer antibiotics to kids (AP)

ATLANTA � The push to get pediatricians to stop prescribing antibiotics for the wrong illnesses is paying off a bit, a new government report found.

Since the early 1990s, there's been a 10 percent drop in prescription rates for antibiotics for kids 14 and younger, the Centers for Disease Control and Prevention reported Thursday.

Antibiotics are often used � but don't work � against viral illnesses like colds and flu. Antibiotics fight infections caused by bacteria. Misuse can lead to antibiotic resistance.

Experts say doctors inappropriately prescribe antibiotics more than 50 percent of the time, and more often with respiratory infections.

The CDC found larger declines � about 25 percent � in how often doctors used antibiotics against sore throats, colds and some other upper respiratory infections. But there was no significant change in how often they prescribed the drugs for ear infection, bronchitis and sinusitis.

The new findings represent progress, but also suggest that doctors are still prescribing antibiotics too often, said Dr. Lauri Hicks, a CDC epidemiologist who worked on the study.

"The bad news is we still have a long way to go," she said.

The CDC study was the government's first look at the issue in about a decade. It was based on an annual survey of doctors' offices, and compared rates from 1993-1994 to 2007-2008.

The improvement could be partly driven by rapid diagnostic tests that help doctors pinpoint whether a sore throat is caused by a virus or strep bacteria, CDC researchers said. The study also found fewer parents took their kids to doctors for upper respiratory infections, which could be thanks to a vaccine against pneumococcal bacteria that became available in 2000.

A public health campaign about antibiotics may have also had some impact, CDC officials said.

Doctors have not always followed recommendations to cut back on antibiotics, partly because of pressure from parents, said Dr. Kenneth Bromberg, chairman of pediatrics at the Brooklyn Hospital Center in New York.

Moms and dads who have been up with sick, screaming infants in the middle of the night tend to expect more from a doctor than advice to keep an eye on the problem. Often, they want antibiotics, and may not stop at one doctor to get them, he said.

"In this new age of consumerism, they will go somewhere else and get what they want," Bromberg said.

The taxing nature of ear infections may be why the CDC didn't find a decrease in the antibiotic prescribing rate for that problem, he added.

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Online:

CDC report: http://www.cdc.gov/mmwr



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Wednesday, August 31, 2011

CDC: Half of Americans have a sugary drink daily (AP)

ATLANTA � Health officials say half of Americans drink a soda or sugary beverage each day � and some are downing an awful lot.

A new study found that one in 20 drinks the equivalent of more than four cans of soda each day. The Centers for Disease Control and Prevention research also showed teenage boys drink the most soda, sports drinks and other sugary liquids.

Sweetened drinks have been linked to the U.S. explosion in obesity, and health officials have been urging people to cut back. Many schools have stopped selling soda or artificial juices.

The CDC report released Wednesday is said to be the first to offer national statistics for adults and kids. Past studies have focused on certain groups, particularly school kids.



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Monday, August 29, 2011

Need a C-section? Protection from blood clot urged (AP)

WASHINGTON � New advice for pregnant women: If you're getting a C-section, special inflating boots strapped on your legs may lower the risk of a blood clot.

Hospitals already use these compression devices for other major operations, such as hip replacements, and a growing number have begun offering them for at least some of their cesarean deliveries, too.

Now guidelines for the nation's obstetricians say it's time to make the step routine for most C-sections, which account for nearly a third of U.S. births.

The new recommendations promise to raise awareness of what is a silent threat not just for pregnant women but for thousands of other people, too: Blood clots in veins that can masquerade as simple leg pain.

Called a DVT, for deep vein thrombosis, this kind of clot usually starts in the leg or groin. But it can kill if it moves up to the lungs, where it's called a pulmonary embolism.

These clots make headlines every few years when seemingly healthy people collapse after long airplane flights or similar prolonged inactivity. Certain surgeries also can trigger a DVT. Earlier this year, tennis star Serena Williams was treated for clots in her lungs discovered after foot surgery and cross-country travel.

Obesity, some types of injuries, even some birth control pills can increase the risk, too.

A woman's risk of a DVT jumps during pregnancy and the six weeks afterward. That's partly because of slower blood flow from the weight gain, and because mom is less active in the last trimester and during those first few weeks of recovery from childbirth.

It's also because pregnancy temporarily changes blood to make it clot more easily.

"This is a consequence of nature's protecting women against the bleeding challenges of childbirth," explains Dr. Andra James of Duke University, who co-authored the new guidelines from the American College of Obstetricians and Gynecologists.

Add a C-section and, like any major surgery, it further increases that risk.

As many as two of every 1,000 pregnant women will experience a DVT, James says. Fortunately, pregnancy-related deaths are very rare in this country, but when they happen, those clots are one of the leading reasons.

Yet too few people even know the warning signs, she says: Pain or swelling in one leg, especially the calf or thigh. Redness or warmth in one spot on the leg. If the clot has reached the lung, shortness of breath or chest pain.

The new guidelines urge obstetricians to closely monitor their patients for DVTs � and to check if they have additional factors that would put them at extra risk. Women who've had a DVT earlier in life, or whose close relatives had one � or who have certain inherited clotting disorders � may need anti-clotting medicines throughout the pregnancy, say the recommendations, published in the September issue of the journal Obstetrics & Gynecology.

Then there are those compression devices, which slip over each leg and regularly inflate and deflate, sort of like a massage, to help blood flow more briskly.

The obstetricians' group acknowledges that there haven't been large studies with C-sections to prove how much difference the gadgets could make. But it decided to recommend them anyway because in other types of surgery, the devices can cut the clot risk by two-thirds, James says.

The guidelines recommend strapping them on before the C-section begins, unless there's no time before an emergency operation or the woman is taking anti-clotting medication.

Mount Sinai Medical Center in New York began using the devices for C-sections a few years ago, and deputy chief medical officer Dr. Erin DuPree says they add $14 to the cost of care. Women typically remove and replace them as they ease out of bed throughout the first day after surgery, and no longer need them by the second day, she says.

"It's an easy thing to do that really does not cause harm and could potentially help," she says.

James stresses that leg compression shouldn't lull a woman into thinking she can rest in bed rather than push herself to walk � and a new mom should remain alert to symptoms when she goes home because half of pregnancy-related DVTs occur in those weeks after childbirth.

___

EDITOR'S NOTE � Lauran Neergaard covers health and medical issues for The Associated Press.

___

Online:

DVT info: http://www.cdc.gov/ncbddd/dvt/index.html



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New HIV case causes LA porn industry shutdown (AP)

LOS ANGELES � A porn industry group says an adult film performer has tested positive for HIV, resulting in a production moratorium in Southern California while the organization investigates to see if the virus has spread.

Free Speech Coalition executive director Diane Duke told The Los Angeles Times ( http://lat.ms/mX0vin) on Monday that her group became aware of the HIV case Saturday.

Duke declined to release the performer's name, age or gender. She also declined to tell the Times how her group learned of the case.

According to Duke, the case was found in an out-of-state clinic that doesn't report to California state officials. Duke says the performer is being retested to confirm the HIV.

The group is working to identify others who had sex with the performer.



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UN warns of bird flu resurgence, new Asian strain (AP)

ROME � The United Nations warned Monday of a possible resurgence of the deadly bird flu virus, saying wild bird migrations had brought it back to previously virus-free countries and that a mutant strain was spreading in Asia.

A mutant strain of H5N1, which can apparently sidestep defenses of existing vaccines, is spreading in China and Vietnam, Tthe U.N. Food and Agriculture Organization said in a statement Monday. It urged greater surveillance to ensure that any outbreaks are contained.

Last week, the World Health Organization reported that a 6-year-old Cambodian girl had died Aug. 14 from bird flu, the eighth person to die from H5N1 avian influenza this year in Cambodia.

Vietnam suspended its springtime poultry vaccination this year, FAO said. Most of the northern and central parts of the country where the virus is endemic have been invaded by the new strain.

Elsewhere, FAO says bird migrations over the past two years have brought H5N1 to countries that had been virus-free for several years, including Israel, the Palestinian territories, Bulgaria, Romania, Nepal and Mongolia.

"Wild birds may introduce the virus, but people's actions in poultry production and marketing spread it," said FAO's chief veterinary office Juan Lubroth in urging greater preparedness and surveillance.

WHO says globally there have been 331 human deaths from 565 confirmed bird flu cases since 2003 when it was first detected.

The virus was eliminated from most of the 63 countries infected at its peak in 2006, but it remained endemic in six countries: Bangladesh, China, Egypt, India, Indonesia and Vietnam.

The number of outbreaks in poultry and wild bird populations shrank from a high of 4000 to 302 in mid-2008, but outbreaks have risen progressively since, with almost 800 cases reported in 2010-2011, FAO said.

"The general departure from the progressive decline in 2004-2008 could mean that there will be a flare-up of H5N1 this fall and winter, with people unexpectedly finding the virus in their backyard," Lubroth said in a statement.



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