Health Newsletter:April 2005
Related Links:From WebHealth
Contents |
Hormone Replacement Worsens Incontinence
Once hailed as the miracle pill for the aging woman, hormone replacement therapy (HRT) is now being approached with caution. The infamous Women's Health Initiative study, which first disproved benefits of hormone therapy, first pointed out an increase of breast cancer risk and risk of cardiovascular disease. On re-analysis of the data the Journal of the American Medical Association has published a study in its issue of February 23, 2005, which shows some more reason for caution with HRT. The previous notion that hormone replacement would improve the symptoms of urinary incontinence has turned out to be a fallacy. Dr. Susan Hendrix and her colleagues from Wayne State Untiversity School of Michigan in Detroit analyzed the data from 23,296 women with urinary incontinence. In randomized trials they received either estrogen alone, estrogen with progestin or the placebo effect ("fake pills"). Among those who were continent at the baseline, both, estrogens alone as well as the combination therapy were associated with an increased risk of incontinence at one year. Estrogen alone produced the most marked effect: stress incontinence increased by a factor of 2.15,the combination therapy increase stress incontinence by a factor of 1.87. In addition, women who were already suffering of incontinence, tended to report a worsening of their symptoms after beginning hormone therapy. The Women's Health Initiative trials were stopped because the treatment risks appeared to outweigh its benefits. These new findings tilt the scales even further against hormone therapy, the authors say in their study.
National Review of Medicine, Canada, March 15,2005,page 28
Pre-eclampsia Is Predictable
Pre-eclampsia is a condition, which can threaten a woman's health and also the unborn baby. It can occur in the second and third trimester. These latter stages of pregnancy (there are 3 stages) are where the doctor should check for early pre-eclampsia signs. In the past this would go unchecked and develop to the full-blown condition of eclampsia and be a significant cause of maternal mortality rate and fetal mortality rate. With prenatal visits and check-ups the early signs are easily recognized: the pregnant woman would complain that her rings would not fit her any more. Significant weight increase due to fluid retention where her legs and the area of her shinbone would be puffy, is called edema. The dipstick test would tell more: it would indicate the presence of protein in the urine sample. These changes are a cause of high blood pressure, which is another important clinical sign and can be readily checked. For these reasons it is imperative that regular pre-natal visits take place at the doctor's office.
Explanation of independent risk factors: A= Previous History Of Pre-eclampsia; B= In Women With Anti-Phospholipid Antibodies; C= Pre-existing Diabetes; D= Twin Pregnancy; E= First Child; F= Family History; G= High Blood Pressure; H= High Body Mass Index; I= Maternal Age 40 or more
Pre-eclampsia occurs, when substances are released from the placenta into the bloodstream of the mother, and they affect the kidneys. If the condition progresses to eclampsia, it can lead to kidney damage and seizures, and the outcome will be fatal. For a long time it was a puzzle to physicians, why some women would show pre-eclamptic symptoms and others would remain problem-free. New research on patients' medical history from the John Radcliffe Hospital, Department of Obstetrics and Gynecology in Oxford, Great Britain has been able to point out predisposing risks for pre-eclampsia in pregnant women.
A family history and history of previous eclampsia increases the risk, but also certain health problems make it more likely that pre-eclampsia will occur in the later stages of pregnancy: diabetes mellitus, kidney disease and high blood pressure are medical conditions that increase the risk. Beside these health conditions an increased body mass index at the start of pregnancy can be a predisposing factor, and a high maternal age-women over 40 years of age- are more likely to have the complication of pre-eclampsia. It is obvious that the risk gets higher, if several of these predisposing factors are present. The highest risk is found in women with a rare inherited variation of lupus, called anti-phospholipid syndrome, where blood clots are a problem and pre-eclampsia is a high risk with pregnancy.
While it is absolutely imperative that regular pre-natal checks are part of proper health care, there are other consequences. There would be reason to be especially watchful with predisposing conditions. Last not least, prevention also has its place.
It is important that health concerns are already addressed as part of planning for a healthy pregnancy. Avoidance of alcohol and quit smoking are of extreme importance, followed by achieving a normal weight. Good eating habits are needed throughout the entire pregnancy. Opting for pregnancy after age 40 seems trendy in some celebrity circles, but with the knowledge of risk factors, it should be looked at with caution. Nature equipped the human species to have children in the age of 20 to 30, and even though a forty year old may have a youthful appearance, the genetic material is aged, and the biological clock cannot be fooled. Prevention also means that any health condition like preexisting diabetes should be well controlled before a pregnancy.
With a proactive and common-sense approach pre-eclampsia can be either avoided or recognized and treated early, resulting in healthy outcome for mother and baby.
British Medical Journal 2005;330:565(12 March)
Sweet Alcohol Has Bitter Consequences
Aggressive marketing of sugar/alcohol, called "girlie drinks" or "alcopops", are luring young girls into alcohol consumption. Colorful commercials convey the image of fun and sexy drinks, and as a result, the percentage of girls who drink is more on the rise than boys. The American Medical Association has conducted two teen surveys, and discovered some troublesome facts:
- Approximately one third of teen girls have tried the aggressively marketed alcopops.
- About one in six were sexually active after drinking.
- One quarter has driven after drinking or ridden in a car with a driver who had been drinking.
- The average age of the first alcoholic drink is now 13.
It is obvious from the marketing content, that alcoholic beverage marketers go after young teens, reported Dr. Bob Mann PhD, senior scientist at the Center for Addiction and Mental Health in Toronto.
This advertising is highly effective, as it was observed in a study, which was conducted several years ago. Young males were questioned two months after a brewery launched an advertising campaign for a high-alcohol beer that was geared towards young males. 66% of underage drinkers were consuming the product.
In Canada federal and provincial governments are out of the regulation of alcohol advertising. It is essential that parents, educators and family physicians point out the hazards of excessive alcohol use long before the first drink is sampled. An American Medical Association poster shows a young girl taking a swallow from a bottle. The headline warns: "Girlie Drinks…women's diseases", and the list of diseases are shown: brain damage, STD's, heart problems, liver disease, and menstrual disorders.
Medical Post, March 1, 2005, page 23
Rapid HIV Tests - Not At Home
Consumers beware: a company from Montreal is advertising do-it-yourself home diagnostic tests, and the US regulatory body (FDA 2005 safety alerts) has issued a warning, after consumers complained about the accuracy of the tests. The tests are not approved for sale in Canada, and a company that specializes in marketing and web design is marketing them. Even though some people feel more comfortable doing an HIV home test anonymously in the privacy of their home, they do well checking first, which tests are reliable, by looking up approved test kits on sites like Health Canada's web page.The test kits in question are as follows:
- Rapid HIV test kit
- Rapid syphilis test kit
- One step cassette-style cocaine test
- One step cassette-style marijuana (THC) test
- One step cassette-style amphetamine test
- Rapid Dengue fever test
- One step midstream style HCG urine tes
- Home pregnancy test.
Globus Media website has been down since the FDA advisory, and no one from the company has been available for comment.
National Review of Medicine, Canada, March 15, 2005, page 5
One Shot For Better Blood Sugar Control
People with permanent health conditions face the need for lifelong medications, and patients with type 2 diabetes see insulin shots as part of an everyday routine. There are different types of insulin, which helps in tailoring the medication to the needs of the patient. It is old news that a new type of insulin under the name insulin glargin can be used for the treatment of type 1 diabetes. The news of a study just published in February is, that also patients with type 2 diabetes benefit from insulin glargin. Often the standard treatment with diabetes drugs does not provide optimal control of blood sugar levels. 371 type 2 diabetes patients with inadequate diabetes control who were not supplemented with insulin were part of a 24-week clinical trial in Bremen, Germany, headed by Dr. Hans U. Janka.
The patients received an antidiabetic combo consisting of sulfonylurea and metformin. These patients were randomly picked, and they received a morning dose of glargine insulin injection along with the antidiabetic medication. Others did not receive the oral medication, but were administered twice-daily injections of NPH insulin. Patients were monitored for the level of glycosylated hemoglobin (= HbA1c), which is the best indicator for diabetes control. The improvements in laboratory tests were more pronounced in the group that received the combination between an oral antidiabetic and glargine injection. In addition 46% reached HbA1c levels of 7% or less, which is excellent long-term blood sugar control, as compared to only 29% of the NPH insulin group. Fasting blood sugar levels also showed improvement. There is a risk of patients becoming hypoglycemic. Again, the risk was significantly lower in those who were on the glargin combination, than those who were on the NPH insulin.
These results show that one single injection, which is added to the oral medication, can help type 2 diabetes patients, whose condition has been poorly controlled. Glargine insulin has been approved in Canada already in 2002, but due to supply problems it is only now expected to be on the pharmacy shelves soon.
National Review Of Medicine, March 15,2005,page22
