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Hot flashes caused by androgen suppression therapy for prostate cancer are best controlled by the hormonal treatments cyproterone acetate and medroxyprogesterone acetate, according to a new study.

Androgen suppression is considered the gold standard treatment for advanced prostate cancer, but about 80 percent of patients undergoing the treatment experience hot flashes. A number of hormonal and non-hormonal drugs are used to treat the hot flashes, but no direct comparisons of the drugs have been made in clinical trials.

The new study included 311 prostate cancer patients in France undergoing androgen suppression therapy. To treat their hot flashes, they received either the non-hormonal drug venlafaxine (102 men), or one of two hormonal drugs — cyproterone acetate (101 men) or medroxyprogesterone acetate (108 men). The patients were assessed at weeks four, eight and 12 and asked to complete a questionnaire about the frequency and severity of their hot flashes for the week before each assessment.

The researchers found that all three drugs reduced the occurrence of hot flashes, but the hormonal drugs were much more effective at reducing them over all time periods.

After receiving treatment for four weeks, 219 patients (nearly 71 percent) reported an improvement of at least 50 percent in their hot flash scores, and 70 patients (nearly 23 percent) said they no longer had hot flashes. By the fourth week, hot flash scores were reduced by 47.2 percent for the venlafaxine group, 83.7 percent for the medroxyprogesterone acetate group and 94.5 percent for the cyproterone acetate group.

Among men receiving gonadotrophin-releasing hormone analogue therapy for prostate cancer, cyproterone acetate and medroxyprogesterone acetate are more effective at 12 weeks for treating hot flashes, the researchers concluded. However, “as cyproterone is a recognized treatment in prostate cancer, and its use could interfere with hormone therapy, medroxyprogesterone should be the standard treatment,” they wrote.

Seniors who eat plenty of fruits and vegetables and who have good cognitive function are much less likely to die from heart disease than those who have poorer cognitive function and eat fewer fruits and vegetables, a new study has found.

Cognitive function refers to the ability to think, remember, plan and organize information.

Researchers at the Drexel University School of Public Health in Philadelphia analyzed diet and cognitive data on 4,879 people (3,101 women and 1,778 men), age 70 and older, who took part in the U.S. Longitudinal Study of Aging. The participants were followed for an average of seven years.

The analysis revealed that:
Those who ate three or more servings of vegetables daily had a 30 percent lower risk for dying from heart disease and a 15 percent lower risk for dying from any cause during the follow-up period than those who ate fewer than three servings of vegetables a day.
There was a significant association between higher consumption of fruits and vegetables and decreased prevalence of cognitive impairment.
People who scored high on cognitive functions tests were less likely to die from heart disease or any other cause during the follow-up than were those with low scores.

The study was to be presented Wednesday at the American Heart Association’s annual meeting in Orlando, Fla.

The U.S. Veterans Administration has taken the lead in improving patient safety, but its efforts are still a work in progress as surgical errors in and out of the operating room persist, a new study shows.

Each day in the United States, there are five to 10 incorrect surgical procedures performed, some with devastating effects, the researchers noted. Typical problems are surgery performed on the wrong site or wrong side of the body, using an incorrect procedure or using it on the wrong patient.

“In 2003, we put out a directive that said this is the way you are going to do it, if you are going to minimize the chance of things happening,” said lead researcher Dr. James P. Bagian, director of the VA National Center for Patient Safety.

“Up until today, I can tell you, we have not had any reports where people have followed the procedures as they’re written and ever had one of these problems,” he said.

The report is published in the November issue of the Archives of Surgery.

For the study, Bagian’s group reviewed 342 surgical problems from 130 VA hospitals from 2001 to the middle of 2006. Problems were divided into those happening in the operating room and those happening outside the operating room. Typically, these procedures were done in VA clinics or at the patient’s bedside.

Among the cases the researchers looked at were 212 adverse events, where wrong procedures were performed or the procedure was performed in the wrong patient, or at the wrong site. In addition, there were 130 “close calls,” where a problem was recognized before the procedure was done.

“A close call, where they said by following the procedure we caught this, I count that as a save,” Bagian noted.

Adverse events occurred once in every 18,000 procedures, Bagian said.

The most common cause of errors was poor communication among the surgical team members, Bagian said. This accounted for 21 percent of the problems. These communication problems often happen early in surgical procedures, and interventions such as a final “time-out” moment before making the first incision may be too late to correct them, the researchers noted.

Of the adverse events, 50.9 percent occurred in the operating room and 49.1 percent occurred elsewhere. The most adverse event reports were in ophthalmology and invasive radiology (21.2 percent). Orthopedics accounted for the second highest rate of problems in the operating room, after ophthalmology.

The most harm was caused by pulmonary cases where fluid was removed from the wrong side of the chest or the procedure was done at an incorrect place on the chest, the researchers said.

Bagian noted that good numbers for evaluating medical errors are hard to come by. It may be that the specialties reporting the most errors are just more honest, he said, or their mistakes are harder to hide.

The VA continues to evaluate problems and work toward an even better safety record, Bagian said.

Dr. Jeffrey M. Rothschild, an associate physician at Brigham and Women’s Hospital, and an instructor in medicine at Harvard Medical School, said the “VA system is further ahead than most places so finding as many as they did makes you wonder how many one would find in community and academic centers.”

Rothschild thinks that more care needs to be taken in making sure the procedure, the patient and the site for the procedure are right before starting any procedure.

“Our systems are still not robust enough to prevent human error from slipping through,” he said.

There is probably more cases of surgical error outside the VA, Rothschild said. “The VA is probably less of an issue, because they were one of the first systems to really take on safety,” he said. “The VA system is better and more advanced.”

Diarrhea in infants is common, often a quick bout caused by a virus. But in some cases among young children, diarrhea can quickly become dangerous, says the U.S. National Library of Medicine.

If you have a newborn younger than 3 months, call your child’s pediatrician at the first sign of diarrhea, the agency advises.

In any child, bloody diarrhea or a case that lasts longer than two days also should prompt a call to the doctor.

While your child has diarrhea, make sure he or she drinks lots of fluids. A drink that contains electrolytes is best to help prevent dehydration. For young infants, continue nursing, and ask your doctor about giving extra fluids.

Wide sections of the Southeast, Appalachia, and some tribal lands in the West and Northern Plains have the nation′s highest rates of obesity and diabetes, according to estimates released today by the Centers for Disease Control and Prevention. In many counties in those regions, rates of diagnosed diabetes exceed 10 percent and obesity prevalence is more than 30 percent.

The estimates, in this week′s Morbidity and Mortality Weekly Report, are the first to provide county–level snapshots of obesity across the United States. They also update diabetes county–level estimates released in 2008.

Eighty–one percent of counties in the Appalachian region that includes Kentucky, Tennessee, and West Virginia have high rates of diabetes and obesity. So do three–quarters of counties in the southern region that includes Alabama, Georgia, Louisiana, Mississippi, and South Carolina.

“Diabetes is costly in human and economic terms, and it′s urgent that we take action to prevent and control this serious disease,” said Dr. Ann Albright, director of CDC′s Division of Diabetes Translation. “The study shows strong regional patterns of diabetes and can help focus prevention efforts where they are most needed.”

The estimates come from the agency′s Behavioral Risk Factor Surveillance System (BRFSS), which uses self–reported data from state–based adult telephone surveys, and 2007 census information. The information may help public health workers, health care providers, community organizations, and policymakers focus on high–risk regions to prevent type 2 diabetes and its complications as well as other chronic diseases linked to obesity, including heart disease, stroke, and some cancers.

The proportion of U.S. adults who are obese was 26.1 percent in 2008, according to BRFSS data. CDC estimates that nearly 8 percent of the population, or about 24 million people, have diabetes. Of these, 5.7 million are undiagnosed.

“The small–area estimates for obesity will be an important tool to help communities better understand and battle this serious public health problem. Communities are in the best position to prevent and reduce obesity among their citizens through innovative programs,” said Dr. William H. Dietz, director of CDC’s Division of Nutrition, Physical Activity and Obesity.

The medical costs of obesity reached an estimated $147 billion in 2008, and the medical costs of diabetes were $116 billion. People with diagnosed diabetes have medical costs that are 2.3 times higher than those without the disease.

Obesity is one of several factors linked to type 2 diabetes. Where people live, how much money they earn, their culture and their family history also play a role. An unhealthy diet, lack of physical activity, and socioeconomic factors contribute to both obesity and type 2 diabetes as well as to complications of diabetes. Some population groups also are at higher risk, including a number of racial and ethnic minorities.

CDC and its partners are working on a variety of initiatives to prevent type 2 diabetes and to reduce obesity. CDC has recommended 24 community strategies to prevent obesity, from providing greater access to healthy foods to redesigning communities to encourage more physical activity. The agency is also in a new partnership with state, federal, and nonprofit agencies targeting health disparities in Mississippi, which has the nation′s highest obesity rate and one of the highest rates of diabetes. CDC′s national diabetes prevention and control program provides resources and technical assistance to state health departments, national organizations, and communities.

Children born to mothers who ate plenty of vegetables during pregnancy are less likely to have type 1 diabetes, Swedish researchers say.

“This is the first study to show a link between vegetable intake during pregnancy and the risk of the child subsequently developing type 1 diabetes, but more studies of various kinds will be needed before we can say anything definitive,” study author Hilde Brekke, a clinical nutritionist at the Sahlgrenska Academy at the University of Gothenburg, said in a news release from the university.

Brekke and colleagues studied 6,000 5-year-olds and found that 3 percent either had fully developed type 1 diabetes or had elevated levels of antibodies that indicate a risk of developing the disease. The risk was twice as high in children whose mothers rarely ate vegetables during pregnancy, and lowest among children whose mothers ate vegetables every day of their pregnancy.

The study was recently published online in the journal Pediatric Diabetes.

“We cannot say with certainty on the basis of this study that it’s the vegetables themselves that have this protective effect, but other factors related to vegetable intake, such as the mother’s standard of education, do not seem to explain the link,” Brekke said. “Nor can this protection be explained by other measured dietary factors or other known risk factors.”

While it’s not known what actually causes type 1 diabetes, factors believed to play a role include immunological mechanisms, environmental toxins and genetic variations. Type 1 diabetes occurs throughout the world but is most common in Finland and Sweden.

Exposure to whooping cough will provide immunity for an average of three decades, new research suggests.

Doctors had previously thought that immunity lasted for much less time. But the new study, by researchers based at the University of Michigan and the University of New Mexico, rebuts that assumption.

Whooping cough, also known as pertussis, has become more common in the United States and elsewhere since the 1980s. Some health experts have thought that immunity is wearing off for people who’d been vaccinated or had been infected by the disease.

For the study, researchers used medical data from England and Wales from before a vaccine was available (1945-1957) as well as later (1958-1972). They created a mathematical model to determine how long immunity lasted after people were exposed naturally to the disease.

They found that immunity after natural infection lasts for at least three decades, on average, and maybe even as long as 70 years. The study suggests that people who lose some of their immunity might still have some protection and even gain more immunity when they’re exposed again to whooping cough.

“This is surprising because clinical epidemiologists currently believe the duration of pertussis immunity is somewhere between four and 20 years,” study co-author Pejman Rohani, of the University of Georgia, said in a news release from the publisher of PLoS Pathogens. The findings are published online Oct. 30 in the journal.

But there are caveats. “It’s worth pointing out that in the past 20 years or so, the nature of the vaccines that have been used has changed quite fundamentally,” Rohani said. “The data we’re using are from a time when a whole-cell vaccine was in use. Now an acellular vaccine, which stimulates a different part of the immune system, is typically used, especially in North America.”

The drug teriparatide is better at increasing bone density and reducing vertebral fractures in patients with glucocorticoid-induced osteoporosis than the drug alendronate, a new study finds.

Glucocorticoids are steroid hormones produced in the body or contained in drugs that are used to control inflammation in patients with autoimmune diseases, such as rheumatoid arthritis, lupus and Crohn’s disease, as well as inflammatory conditions such as asthma. Glucocorticoid-induced osteoporosis can occur in people taking steroid medications such as prednisone, prednisolone, dexamethasone and cortisone, according to background information provided in a news release about the study.

The study participants included 428 patients, aged 22 to 89, with confirmed osteoporosis who had received more than 5 milligrams a day of prednisone or the equivalent for more than three months. For the study, 150 patients were randomly assigned to receive 20 micrograms a day of injectable teriparatide plus oral placebo, and 144 patients received 10 milligrams a day of oral alendronate plus injectable placebo. All the participants received supplements of calcium (1,000 milligrams a day) and vitamin D (800 International Units a day).

After 36 months, lumbar spine bone mineral density was 11 percent higher than at the start of the study in the teriparatide group compared with 5.3 percent higher in the alendronate group, the researchers found. Bone mineral density improvement for total hip was 5.2 percent in the teriparatide group versus 2.7 percent in the alendronate group, and 6.3 percent versus 3.4 percent, respectively, in the femoral neck.

Patients in the teriparatide group had fewer vertebral fractures (1.7 percent) than those in the alendronate group (7.7 percent) and also had higher levels of calcium concentrations (21 percent versus 7 percent), according to the study findings published in the November issue of the journal Arthritis & Rheumatism.

A significant number of individuals are regularly treated with steroids to control inflammation, “which puts them at risk for developing osteoporosis. A need for therapies that mitigate this side effect of steroid use and substantially improve bone mass is vital,” study leader Dr. Kenneth Saag, of the University of Alabama, said in a news release from the journal’s publisher.

“Our research shows that teriparatide is a safe and effective treatment for patients with steroid-induced [osteoporosis] and should be considered as a therapeutic option for those at high risk of bone fracture,” he concluded.

Statins, frequently used to cut cholesterol levels, may also help prevent death from severe flu, a new study suggests.

According to the researchers, a growing body of evidence suggests that statins — which include medicines such as Lipitor, Crestor and Zocor — can reduce death from severe infections. Whether they help with flu, however, has been more uncertain.

“Statins may have a role in reducing mortality from influenza, but our findings do not justify broader use of statins without confirming these findings in the setting of randomized controlled trials,” said study author Dr. Ann R. Thomas, from the Emerging Infections Program at the Oregon Department of Human Services Public Health Division in Portland.

“Statins may have a benefit, in conjunction with vaccine and antivirals, in reducing morbidity and mortality associated with influenza, likely due to their effect of reducing the body’s inflammatory response to influenza infection,” she added.

The results of the study are to be presented Friday at the Infectious Diseases Society of America annual meeting in Philadelphia.

For the study, Thomas’ team looked at the outcomes of hospitalized influenza patients over two flu seasons.

The researchers found that patients who were taking statins were more likely to be older, male, white or Asian with underlying health conditions such as cardiovascular disease. In addition, they were more likely to have had a flu shot.

While those with cardiovascular disease were more likely to die, those who received statins while in the hospital were less likely to die.

Whether statins are also effective in preventing deaths from the H1N1 swine flu is not known, Thomas said. “Our data are from the 2007-2008 influenza season, well before novel H1N1 emerged, so no one knows for sure if statins would reduce mortality from H1N1,” she said.

“However, since the likely mechanism of statins in reducing mortality is their general effect of down-regulating the immune system, it is plausible that statins might be useful in treating influenza infections due to novel H1N1,” she noted.

Infectious diseases expert Dr. Marc Siegel, an associate professor of medicine at New York University School of Medicine in New York City, said that the study “is of limited value.”

Siegel believes it’s statins’ ability to prevent death from heart disease and not any benefit against flu that results in fewer deaths among those taking these drugs.

“Influenza increases your risk of dying from heart disease. At the same time, statins reduce your risk of dying from heart disease. So, it’s not surprising to find that there are fewer deaths among those taking statins,” Siegel said.

“You can’t conclude from this study that people with influenza should take statins,” he said. “Statins are protective in a situation where the heart is at risk, even influenza — that, I’ll buy.”

High-risk patients who took a combination of three older heart drugs — a generic statin, a generic blood pressure pill and a low-dose aspirin — cut their risk of a heart attack or stroke by as much as 80 percent, U.S. researchers said on Thursday.

They said their study offers a simple, effective and inexpensive way to help people with diabetes or heart disease avoid heart attacks and strokes.

“Even in people who took it less than half the time, they got over a 60 percent drop in heart attacks and strokes,” said Dr. R. James Dudl of Kaiser Permanente in California, whose study was published in the American Journal of Managed Care.

“Those who took it more than half the time — they got more like an 80 percent drop,” Dudl said in a telephone interview.

The study set out to offer a uniform approach to preventing heart attacks and strokes in people with heart disease or diabetes. Adults with diabetes are two to four times more likely to have heart disease or suffer a stroke than people without diabetes, according to the American Heart Association.

Several recent large studies found that aggressive efforts to control blood sugar do little to prevent heart attacks and strokes in diabetics.

Researchers at Kaiser Permanente followed 68,560 people with diabetes or heart disease who each day took the drug combination, consisting of 40 milligrams of the cholesterol fighter lovastatin and 20 milligrams of the blood pressure pill lisinopril for two years. People were also encouraged to take a low-dose aspirin.

The treatment prevented 1,271 heart attacks and strokes in the first year of follow up, Dudl said.

By checking prescription records, they were able to see which patients took their drugs most frequently. They found that even when people took their medications only 22 percent of the time, they had a 60 percent drop in heart attacks and strokes.

Dudl said many doctors like to start patients out with lower doses of drugs and gradually increase them to find the ideal dose for each patient, but often people who do not see results right away stop taking their medications.

“This is a proven program that can be applied in many settings to reduce heart attacks and strokes, and at the same time decrease the cost of care for those events,” Dudl said.

It also suggests that people do not need to take a name-brand statin drug — which Dudl said costs up to eight times more than a generic — to achieve a major reduction in risks.

Although in the study the team used lovastatin, the generic name for Merck’s Mevacor, Dudl said the team now recommends Merck’s Zocor, or simvastatin — which has been shown to be a more effective statin — as part of the three-drug regimen.