Prescription Painkillers Top Heroin as Drugs of Abuse in Canada

(HealthDay News) -- Heroin use in Canada has declined, and prescription opioids such as morphine, OxyContin or Dilaudid now make up the biggest share of illicit opioid use, note researchers in the current Canadian Medical Association Journal.

A team led by Benedikt Fischer, of the University of Victoria, in British Columbia, analyzed data from the OPICAN study, a multi-site examination of drug use patterns among opioid users across Canada.

The researchers said their findings have several implications.

They noted that people who use prescription opioids illegally usually obtain the drugs directly or indirectly (i.e., through partners or friends) from sources within the medical system. Changes may be needed in the way that opioid addiction treatment programs are managed, the researchers suggested.

The study was prompted by reports of substantial increases in prescription opioid abuse in Canada.

More information
The American Academy of Family Physicians has more about opioid addiction.

Health Tip: Keep Food Longer During a Blackout

(HealthDay News) -- In the event of a power outage, how do you know how long the food in your fridge will remain safe to eat?

The answer depends on the food. But when in doubt, throw it out, says the City of Kingston in Ontario.

Here are some steps to keep your food safe for as long as possible:

• Plan what you need from the fridge and remove items quickly.
• Open the fridge as little as possible.
• Leave your freezer closed.

Shop-Till-You-Drop Season Scary for Some

(HealthDay News) -- Nearly everyone gets into the spirit of shopping during the holiday season, and folks will be grabbing their credit cards and checkbooks Friday as the mad rush to the stores begins.

For most, spending a bit beyond your means sometimes doesn't land you in serious trouble. But for one in 20 American adults, shopping is no laughing matter, and the holiday season can be pure torture. That's the number of people affected, experts say, by a compulsive need to shop and buy.

"It is difficult all year long [for compulsive shoppers]," said Dr. Lorrin M. Koran, an emeritus professor of psychiatry and behavioral sciences at Stanford University who has studied the topic intensively. "[But] some compulsive shoppers find the holiday, with the emphasis on advertising, buying things, and the supposed joys of material possessions, more trying than the rest of the year."

Some experts, including Koran, believe that compulsive buying should be classified as a mental disorder and officially included in a guidebook for psychological and psychiatric treatment used worldwide, called the Diagnostic and Statistical Manual of Mental Disorders.
In his study of more than 2,500 adults, he found that 6 percent of women and 5.5 percent of men were compulsive buyers.

If you frequently buy things you don't need and can't afford, go on buying binges and bring home things you then have no interest in, or your shopping behavior is causing problems with family, work or finances, you may have a problem, Koran said.

During the holidays, those urges are even harder to ignore. "People can feel obliged to give," Koran said.

Added April Lane Benson, a psychologist in private practice in New York City: "People believe that how much they spend correlates with how much they care." She is founder of a Web site devoted to "stopping over-shopping."

A materialistic attitude, plus poor self-image, can also fuel the tendency to buy too much, Benson said. Other common triggers, according to Koran: depression, anxiety, boredom and anger.

However, you can curb your compulsive buying, even in this "shop-till-you-drop" season, Koran and Benson agreed. Here are some of their suggestions:

Plan well in advance -- that would mean right now -- how you will avoid compulsive shopping over the holidays, Benson said. That can involve an attitude adjustment. "Research shows that experiences lead to more satisfaction than material goods," she said. Instead of buying your loved ones something, give your expertise, she suggested. Give a friend or relative a coupon good for five hours of computer counseling, a photography session at their child's next birthday party, or help with yard work.

If you get the urge to shop, think about why you are having it. "What is it you are needing?" Benson asked. For instance, if you're feeling inadequate and think you'll go to the mall and buy yourself a great new outfit -- plus buy two or three more gifts than you had planned to get for each person on your list -- figure out another way to feel better about yourself. "Is there something nice you can do for someone?" she asked.

Keep track of the triggers that lead you to shop compulsively, Koran suggested. For instance, if you head to the stores when you are feeling low, think about developing an alternative plan, something that will make you feel better without shopping. That might mean a workout, reading a book, or taking a bubble bath.

When you go shopping for holiday gifts, Koran said, "Only go shopping with a trusted friend or relative who is instructed to prevent impulsive purchases." Take a list and stick to it.
"Recognize that it truly is the thought that counts, not the size of the gift," Koran said.

More information
To learn more about compulsive shopping, head to the Illinois Institute for Addiction Recovery.

Certain Fatty Acid May Cut Dementia Risk

(HealthDay News) -- Adding further weight to the theory that fish may be brain food, new research found that people with diets rich in fish have a significantly lower risk of dementia and Alzheimer's disease.

The key appears to be docosahexaenoic acid (DHA), an omega-3 polyunsaturated fatty acid that appears to affect dementia risk and to be important for the proper functioning of the central nervous system.

"If you have a high level of DHA, a fatty acid found in fish, it reduced your risk of dementia by about half," said study lead researcher Dr. Ernst J. Schaefer, senior scientist and director of the Lipid Metabolism Laboratory at the Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University in Boston.

It's known that omega-3 fatty acids protect the heart and the circulatory system. "Just as fish is good for your heart, it's probably good for your brain as well," Schaefer said.

Fatty fish like mackerel, lake trout, herring, sardines, albacore tuna and salmon are high in DHA.

The study findings are published in the November issue of the Archives of Neurology.

In the study, Schaefer and his colleagues collected data on DHA levels and dementia in 899 men and women who were part of the Framingham Heart Study. Over nine years of follow-up, 99 people developed dementia, including 71 with Alzheimer's disease.

The researchers found that people with the highest blood levels of DHA had a 47 percent lower risk of developing dementia and a 39 percent lower risk of developing Alzheimer's, compared with those with lower DHA levels.

Levels of DHA in the blood vary by how much the liver converts alpha-linolenic acid, an essential fatty acid, to DHA and also by the amount of DHA in the diet, the researchers noted.
People with the highest blood levels of DHA said they ate an average of two to three servings of fish a week. People with lower DHA levels ate substantially less fish, the researchers reported.

Schaefer thinks the same benefit can be realized by taking fish-oil supplements. "Everything that we know suggests that supplements would be as effective as eating fish," he said. "Since low fish intake appears to be a risk factor for developing dementia, either eat more fish or use one or two fish oil capsules a day."

However, Schaefer added that a randomized clinical trial is still needed to see if DHA really protects the brain from dementia.

Martha Clare Morris is an epidemiologist at Rush University Medical Center in Chicago and author of an accompanying editorial in the journal. "This is the first study to link blood levels of DHA to protection against Alzheimer's disease," she said, adding that recent animal studies have shown that DHA reduces amyloid plaques -- a hallmark of Alzheimer's -- in the brain and also improves memory.

"There is a lot of animal and biochemical evidence to support what this new study shows," Morris said.

But, she said, she's not sure there is enough data to suggest the value of fish oil supplements. "It looks like the protective benefits from omega-3 fatty acids are at a very low level. There is very little evidence that you get better protection from higher intake," she said. "Whether fish oil supplements are protective is yet to be seen."

Another expert thinks clinical trials are needed to see if DHA really protects against Alzheimer's.
"This shows in a prospective study that DHA is the only plasma lipid to cut the risk for developing dementia a decade or more later," said Greg M. Cole, a neuroscientist at the Greater Los Angeles VA Healthcare System and associate director of the Alzheimer's Disease Research Center at UCLA's David Geffen School of Medicine.

This apparent protection is associated with eating fish, Cole said. "Other studies have pointed to fish intake as protective but have been far less clear that the omega-3 fatty acids in fish were the factor associated with risk reduction," he said. "This matters because if it is the fat, you could take fish oil supplements and avoid mercury contamination issues."

More information
The Alzheimer's Association can tell you more about Alzheimer's disease.

Newly Released Data Stirs Naproxen Debate

(HealthDay News) -- Just-released data from a trial that was stopped early in 2004 for safety reasons is re-igniting debate on the safety of two popular painkillers.

The trial suggested the over-the-counter painkiller Aleve boosted heart risks, while another controversial prescription painkiller known as Celebrex did not.

Now, the data from that trial has finally been made available. But that has not silenced one critic, who says this early data is unreliable and questions the reasons the trial was stopped prematurely.

"The trial was improperly stopped by what appears to be political considerations. When you do that, you generate data which we know is unreliable," said Dr. Steven Nissen, a cardiologist at the Cleveland Clinic Foundation.

Nissen is author of an accompanying commentary in the Nov. 17 online edition of PLoS Clinical Trials, which has published the data from the Alzheimer's Disease Anti-inflammatory Prevention Trial (ADAPT).

Specifically, Nissen charges that ADAPT was cut short not on the advice of its safety-review board but by nervous officials at the U.S. National Institutes of Health, which had funded the trial. Those officials were worried about the media furor over the safety of now-withdrawn painkiller Vioxx, Nissen claims.

The medications in question all fall into the class of nonsteroidal anti-inflammatory drugs (NSAIDs), which include aspirin, naproxen, ibuprofen and cox-2 inhibitor medications such as Celebrex and the now-withdrawn Bextra and Vioxx.

Beginning in late 2004, major studies began to show that heart risks to users rose with long-term use of cox-2s. This led to the eventual withdrawal from the market of Vioxx and Bextra, and the U.S. Food and Drug Administration slapping a "black box" cardiovascular warning on the remaining cox-2, Celebrex.

In December of 2004, officials at the NIH announced the premature termination of the ADAPT trial, which had been set up to look at the possible usefulness of NSAIDs in preventing Alzheimer's disease.

Early results from that trial came as a surprise to many, because they suggested that long-term use of Celebrex did not significantly boost heart risks, while the use of an over-the-counter rival, naproxen (Aleve), did.

"We ended up stopping the trial early, when another trial brought up some safety concerns about these drugs," said study author Barbara Martin, an assistant professor of epidemiology at Johns Hopkins Bloomberg School of Public Health.

"We found a small but not statistically significant risk with celecoxib, and a larger and statistically significant increased risk with naproxen," Martin said.

But the actual data from the trial was not released at the time, adding to the confusion. It has now been published.

The 2,500 elderly participants in the ADAPT trial took either celecoxib, naproxen or placebo for up to 3.5 years.

Compared to those taking placebo, people taking celecoxib had a 10 percent increased risk of heart attack and stroke, while those taking naproxen had a 63 percent increase risk, the researchers found.

Martin said she wasn't sure why these drugs might have different risk profiles. Other trials have suggested that naproxen was actually cardioprotective, but these results indicated that it is not, she said.

Martin believes that the ADAPT results would also apply to people who take the painkillers over the long-term to help relieve arthritis.

"As yet, the specifics of the risks aren't really well-defined, but the clinical benefits of the drug are established," Martin said. "What is most clear is that when you take NSAIDs for a long period of time, there is a risk associated with them. What exactly it is, how big it is, is still not clear, but there is no completely safe NSAID."

There did not seem to be any protective effect from the drugs in terms of warding off Alzheimer's, she added. "Part of the reason we stopped was that there was some evidence of risk, and there wasn't any overwhelming evidence of benefit to counter that," Martin said.
But Nissen strongly disagreed with the findings, noting that they run counter to the results of other large trials.

"The published results of the ADAPT trial with regard to cardiovascular risk are completely unreliable," said Nissen. In his editorial, he explained that because the trial was stopped early, the data lacks the statistical power to deliver any clear verdict on either Celebrex or naproxen.
"These results cannot be used in any way to assess the relative risks of naproxen," Nissen said.

He added that he is not surprised that the premature termination of the trial in late 2004 -- coming at the height of the Vioxx debacle -- caused such a media uproar. Newspapers at the time trumpeted headlines such as "Heart Risk Seen in Naproxen" (Wall Street Journal) and "Patients, Doctors Agonize Over Risks of Painkillers", (Los Angeles Times).

"A warning was issued to the public that we now know was wrong," he said.

But Martin said she blames the media for creating a false impression of why the trial was stopped. "All of the publicity when the trial was stopped -- it was not what we intended," she said. "It's difficult in a political maelstrom of events to have the true rationale come through."

According to Martin, the trial was stopped because of data from another major trial was raising questions about the safety of Celebrex, triggering the premature closure of that arm of the ADAPT trial. When that happened, the researchers decided against continuing with the naproxen arm alone.

"We weren't seeing a risk with celecoxib (Celebrex), so it put us in a very uncomfortable position. We were imagining three years later if the adverse effects with naproxen were really real getting roundly criticized for not having stopped it earlier," she said.

Martin agreed, then, that there were political as well as safety concerns in stopping the trial.
"There was this domino effect and we felt that even though the results in and of themselves would not have led us to stop the trial, this domino effect made it necessary," she said.

Despite all the controversy, Martin feels that the trial data remains valid. She also believes it was right to have stopped the trial early. As to the safety of naproxen, Martin said there's not yet enough data to answer that question.

But Nissen said the accumulated evidence on NSAIDS supports the notion that the drug is, on the whole, safe.

"There is overwhelming evidence that of all the drugs in the class, the safest drug is naproxen," he said. "Analyses involving millions of patients have shown, consistently, that it is probably the safest drug."

Nissen doesn't believe naproxen actually protects against heart attack, however. "It's neutral," he said.

More information
There's more on NSAIDs at the U.S. National Library of Medicine.

Eye Tests Predict Later Vision Trouble for Preemies

(HealthDay News) -- Having youngsters undergo eye tests at two-and-a-half years of age can help predict vision problems when they're 10 years old, Swedish researchers report.

Previous studies have found that refractive errors (problems with the degree of light that reaches the back of the eye) are more common in children born preterm (before 35 weeks of gestation) than in full-term children.

In this new study, researchers at Uppsala University Hospital checked for refractive errors in 198 preterm children at 6 months, 2.5 years, and 10 years of age. The researchers assessed the development of astigmatism (an unequal curve in one of the eye's refractive surfaces) and for anisometropia (a difference in refractive power between the two eyes that can lead to partial vision loss).

Reporting in the November issue of Archives of Ophthalmology, they found that 108 children had astigmatism at 6 months, 54 at 2.5 years, and 41 at 10 years. They also found that 15 children had anisometropia at 6 months, 17 at 2.5 years, and 16 at age 10.

"The presence of astigmatism and anisometropia at 2.5 years of age were the strongest risk factors for having astigmatism and anisometropia at 10 years of age," the study authors wrote.
"In this population-based study, we found that a refractive error at 2.5 years of age predicts that refractive error will also be present at 10 years of age," the team concluded.

"Recommendations for follow-up examinations must include all aspects of visual function, i.e., visual acuity, contrast sensitivity and visual fields, as well as the refraction, strabismus and perceptual problems. All preterm children should be included in such follow-up examination for refractive error, irrespective of the retinopathy of prematurity stage," the researchers wrote.

Retinopathy of prematurity (ROP) is a condition where there is abnormal development of blood vessels in the retina. The smaller the baby is at birth, the greater the risk of ROP.

More information
The Nemours Foundation has more about premature babies.

Higher IQs Protect Kids From Traumatic Events

(HealthDay News) -- Intelligence could help shield children from traumatic events, U.S. researchers report.

A new study found that children who are more intelligent than their peers at age 6 were less likely to experience traumatic events by age 17 and, if they did, were less likely to develop post-traumatic stress disorder (PTSD).

Michigan State University researchers studied 336 boys and 377 girls born between 1983 and 1985 at two Michigan hospitals. One hospital was located in a middle-class suburban community, while the other was in a disadvantaged urban community.

The children were given intelligence tests when they were 6 years old. Their parents and teachers provided information about the children's behavior at school and about any symptoms of anxiety disorders, such as phobias, separation anxiety and generalized anxiety disorder.
At age 17, the youngsters were interviewed again as to the number and type of traumatic events they'd experienced in their lives. They were also asked how seriously those events affected them, including whether they'd ever suffered symptoms of PTSD.

The researchers found that 541 (75.9 percent) of the youngsters had experienced a traumatic event and 45 (6.3 percent overall and 8.3 percent of those who experienced trauma) met criteria for PTSD.

Youngsters who had an IQ greater than 115 at age 6 were less likely to have experienced any kind of trauma (especially violent assaults) and, if they did, were less likely to develop PTSD by age 17.

Participants who had more conduct problems at school at age 6 were more likely to have been exposed to violent crime, such as mugging, beating or rape, by age 17, the study found.
These children, and those who had anxiety disorders at age 6, were about twice as likely to develop PTSD by age 17 if they were exposed to trauma, compared to children who had no anxiety disorders or conduct problems at age 6.

The researchers also found that boys were more likely to be exposed to trauma, while girls were more likely to develop PTSD after exposure to trauma.

"The ways in which high IQ might protect from the PTSD effects of traumatic exposure are unclear," the study authors wrote. "The findings underscore the importance of investigating cognitive processes in a person's responses to challenging and potentially traumatic experiences and the involvement of general intelligence in shaping them."

The study was published in the November issue of the journal Archives of General Psychiatry.

More information
The U.S. National Institute of Mental Health offers advice on how to help children cope with violence and disasters.

3 Million Worldwide Die From High Blood Sugar

(HealthDay News) -- High blood sugar is linked to diabetes, heart disease and stroke, and kills 3 million people around the world each year, a new study finds.

This risk begins far below blood levels used to define diabetes, experts add.

"Blood glucose at all levels, even those below the threshold we call diabetes, is responsible for a very large number of cardiovascular deaths in the world, in fact, substantially larger than the number that directly die of diabetes," said lead researcher Majid Ezzati, an associate professor of international health at the Harvard School of Public Health.

His team published its report in the Nov. 11 issue of The Lancet.

In the study, Ezzati's group looked at the effects of higher-than-optimum concentrations of blood sugar on death from heart disease and stroke worldwide. They gathered data on blood sugar from 52 countries in different parts of the world.

The researchers found that 959,000 deaths in 2001 were directly attributed to diabetes, 1,490,000 to heart disease and 709,000 to stroke, and all were linked to high blood sugar. This means that 21 percent of all deaths from heart disease and 13 percent of all deaths from stroke are associated with high blood sugar.

Higher-than-optimum blood sugar accounts for 3.16 million deaths a year. This is substantially higher than the deaths attributed to diabetes alone. Deaths from high blood sugar are comparable to the 4.8 million deaths from smoking, the 3.9 million deaths from high cholesterol and the 2.4 millions deaths from overweight and obesity each year, the researchers note.
Ezzati thinks that these findings indicate that blood sugar should be considered a risk factor beyond the risk for diabetes. Like blood pressure control, lowering blood sugar reduces the risk for heart disease.

"At all levels of blood glucose, it seems that higher is worse," Ezzati said. "Most people can benefit from having lower blood glucose, in the same way we think about blood pressure," he said.

Ezzati believes that people need to know about the risks of high blood sugar. Public health programs that highlight the risks of high blood sugar are needed, in the same way that there are programs about the risks of high blood pressure and high cholesterol, he said.

One expert agrees that lowered blood sugar reduces the risk for heart disease and stroke as well as diabetes.

"This is not news to me," said Dr. Larry Deeb, the president for Medicine and Science at the American Diabetes Association. "We have been dealing with this in the diabetes community for a while."

Blood sugar is a variable, like blood pressure and cholesterol, that is associated with deaths from heart disease and stroke, Deeb said. "All of those variables -- the lower the better," he said.
The key to keeping blood sugar low is lifestyle, especially diet and exercise, Deed said.
In a related study in the same journal issue, Finnish researchers found that diet and exercise counseling can change lifestyle and reduce the incidence of diabetes among people at high risk for type 2 diabetes.

"From a public health point of view, there is an important message: An intensive lifestyle intervention lasting for a limited time can yield long-term benefits in reducing the risk of type 2 diabetes in high-risk individuals," researcher Jaakko Tuomilehto, from the Diabetes Unit in the Department of Health Promotion and Chronic Disease Prevention at the National Public Health Institute, Mannerheimintie, said in a prepared statement.

"Although a lifestyle intervention alone, even if successful, does not necessarily prevent type 2 diabetes in all individuals, it will still postpone the onset of the disease," Tuomilehto said. "Even delaying the onset of diabetes can have a substantial effect on subsequent morbidity, and therefore on the cost-effectiveness of diabetes prevention."

More information
There's advice on controlling blood sugar at the American Diabetes Association.

Health Tip: Understanding Pulmonary Hypertension

(HealthDay News) -- Pulmonary hypertension occurs when the arteries of the lungs become narrow and restrict the flow of blood from the heart.

Blood pressure increases in these arteries and ultimately causes the right ventricle of the heart to become weaker and possibly fail.

The Cleveland Clinic Health Information Center says that by the time symptoms of pulmonary hypertension appear, the condition probably has progressed considerably. The most common symptoms include shortness of breath during regular activities like climbing stairs, as well as dizziness, fainting, and chest pain.

Treatment for pulmonary hypertension depends on its cause, the clinic says. These may include medication, lifestyle changes like diet and exercise, or surgery.

Blood Pressure Drugs Ward Off Kidney Disease

(HealthDay News) -- ACE inhibitor blood pressure drugs can cut kidney disease risk in diabetes patients with high blood pressure, researchers report.

The Italian study included more than 1,200 patients with type 2 diabetes and high blood pressure. They were randomly assigned to receive either an ACE inhibitor drug; another type of blood pressure drug called a calcium channel blocker; a combination of ACE inhibitor and calcium; or a placebo.

Reporting in the December issue of the Journal of the American Society of Nephrology, the researchers checked the study participants for rates of microalbuminuria -- small amounts of the protein albumin in urine that are among the first signs of kidney disease.

After an average of 3.5 years, patients with good blood pressure control had lower rates of microalbuminuria, regardless of which treatment they received. Patients who took the combination treatment showed the greatest decreases in blood pressure and were less likely to need additional drugs to control their blood pressure, the study said.

The researchers also found that taking an ACE inhibitor, either alone or as part of the combination treatment, provided further protection against kidney disease, even if a patient's blood pressure remained high.

"Treatment with an ACE inhibitor was particularly important when the blood pressure was poorly controlled -- as may happen in most diabetic patients with hypertension, despite the use of two, three, or even more drugs," study lead author Dr. Piero Ruggenenti, of Mario Negri Institute for Pharmacological Research in Bergamo, said in a prepared statement.

About 80 percent to 90 percent of people with type 2 diabetes also have high blood pressure, a major risk factor for diabetic kidney disease. Typically, about 30 percent of diabetics develop kidney failure, and an even larger percentage of them may be at risk of premature death from heart failure. Controlling blood pressure in these patients may be critical in reducing or preventing the risk of kidney failure or death for these patients, Ruggenenti said.

"Our results clearly show that an ACE inhibitor should always be used in patients with high blood pressure and diabetes, even when they have no evidence of renal or cardiovascular disease," he said.

More information
The National Kidney Foundation has more about diabetes and kidney disease.

Flu's Misery May Lie in the Genes

(HealthDay News) -- If the flu hits you especially hard this season, blame it on your DNA.

A new study of flu-infected mice found that certain genes spurred a strong immune response in the lungs that led to much more severe illness. Mice that didn't exhibit such an immune response were more likely to recover, the researchers found.

The findings may help humans not only survive the annual flu season but also an avian flu pandemic, should it ever arise.

"The long-term implications would fit into the idea of genetically based preventive medicine," explained co-researcher Dr. Linda Toth, associate dean of research at Southern Illinois University School of Medicine in Springfield. "To know that some people are predisposed to any kind of disease, we would be able to better advise or monitor those people so as to limit their health risk."

This knowledge might also help public health officials allocate precious resources.

"In the case of influenza, viral treatments and vaccine are in limited availability and if we had this kind of information, it could potentially be used to target the resources to those most at risk," Toth said.

She and co-researcher Rita Trammell, an assistant professor of internal medicine at Southern Illinois University School of Medicine, were expected to present the findings Friday at a meeting of the American Physiological Society, in Fort Lauderdale, Fla.

Another expert said the research has implications for the treatment of flu.

"It brings up the question of whether anti-inflammatories have a role in treating a flu with a lot of inflammation," said Dr. Marc Siegel, author of Bird Flu: Everything You Need to Know About the Next Pandemic and clinical associate professor of medicine at New York University School of Medicine in New York City. "It also brings up the question of 'Does genetics allow you to anticipate which group is going to have a more deleterious inflammatory response?' That would be very helpful epidemiologically."

The question of who dies of influenza has been a hot topic since at least the 1918 pandemic, which killed millions of people around the world. At the time, doctors noted that the immune systems of young, robust adults often "overreacted," resulting in a severe and often deadly inflammation of the lungs.

"This has been a long-time concern of scientists since 1918, when the theory was that people drowned in their own secretions," Siegel explained. "The body sees influenza and responds with a strong immunological response, and that response can lead to a lot of secretions."

The 1918 pandemic and the current avian flu -- which has so far killed only a small number of humans -- have some similarities: Both cause an intense inflammatory and immune response in the lungs of mice and people.

"With the current avian influenza as well as the influenza from the 1918 pandemic, the influenza caused a really enhanced and intense inflammatory and immune response in the lungs which killed the mice," Trammell said. "This was really important in determining why they died. We wanted to look at the background genetics of mice, how they reacted differently."

In their research, Trammell and Toth infected two strains of laboratory mice -- called Types "B" and "C" -- with an influenza A virus. Past work had shown that about half of the Type B mice would die, compared to about 10 percent of the Type C mice.

When lung tissue from the mice was examined about 30 hours after infection, the authors found that levels of all the pro-inflammatory cytokines (with one exception) were elevated and were much higher in the sensitive mice. This indicates a more severe inflammatory response, the researchers said. Cytokines are proteins that can cause inflammation when an immune response is mounted.

Despite the variation in inflammation, the level of the virus in the rodents' lungs was about the same in both groups.

A second, related study found that levels of immune-related messenger RNA (mRNA) in Type B mice were on average 24 times higher (and sometimes 100 times higher) than in uninfected mice. The mRNA levels in Type C mice increased less than three-fold after infection.

The next step?

"We want to try to identify specific genes or the array of genes that contribute to either the resistance or the severe response to the virus," Toth said. "Right now, we have some ideas, but we haven't nailed that down definitively."

Trammell said that this type of information, "would have enormous implications for understanding and avoiding the fatality associated with influenza virus."

More information

For more on avian influenza, visit the World Health Organization.

Pleasant Surroundings Boost Walking Habits

(HealthDay News) -- The availability of pleasant, shopping-friendly locales is more likely to influence whether or not people walk regularly than factors such as traffic or crime, a new study finds.

Researchers at the University of Victoria in British Columbia, Canada, analyzed questionnaires filled out by 351 people. They were asked about their attitudes toward walking; how much they walked; whether there were paths, trails, parks or recreational facilities near their homes; and their thoughts about local neighborhoods and walking areas.

The team found that neighborhood aesthetics and the mix of retail stores were more important that local crime levels or traffic in terms of motivating people to walk.

The most surprising finding was the strong link between a person's intention to walk and actually doing it, if they had a good place to walk. In other words, if a person wanted to walk, having a good place to walk made it more likely to happen. However, a good place to walk had no impact if the person had no intention to walk in the first place.

The study is published in the November/December issue of the American Journal of Health Promotion.

"These findings are not going to translate into getting people to walk more," John Librett, an adjunct professor at Utah College of Health in Salt Lake City, said in a prepared statement. He was not involved in the study.

However, he said the findings should prompt community planners to consider how the design of neighborhoods and urban areas affects people's walking behavior. Redesigning old neighborhoods and creating new ones that promote walking is good for public health, Librett noted.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about the benefits of walking.

Chronic Fatigue Syndrome Campaign Launched

(HealthDay News) -- U.S. health officials on Friday launched a major campaign to increase awareness of chronic fatigue syndrome, an illness that has labored under an intense level of controversy.

"This disease has been shrouded in a lot of mystery. Sometimes people question if it's real or not real," Dr. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention, said at a news conference. "We hope to help patients know they have an illness that requires medical attention and help physicians be able to diagnose the illness, and be able to validate and understand the incredible suffering that many people and their families experience in this context."

The campaign will consist of public service announcements, brochures, a "tool kit" for health-care professionals and a photo exhibit called "The Faces of Chronic Fatigue Syndrome," which will travel to cities across the country throughout 2007.

"We hope this will be a turning point in the public's awareness of the disease as well as in health-care professionals' ability to diagnose and treat it," Kim McCleary, president and CEO of the CFIDS Association of America, said at the news conference.

"This launch is so important to increasing understanding of this illness," added Dr. Nancy Klimas, of the University of Miami Miller School of Medicine. "Historically, lack of credibility of this illness has been a major stumbling block."

According to Dr. William Reeves, of the CDC's National Center for Infectious Diseases, the level of impairment experienced by people with chronic fatigue syndrome is comparable to that of multiple sclerosis, AIDS, end-stage renal failure and chronic obstructive pulmonary disease.

One CFS patient, Adrianne Ryan, said that sometimes taking a walk or a shower was too much, and resulted in her collapsing for weeks afterwards. Ryan is a former marathoner.

Doctors still don't know what causes CFS or how to treat it successfully, but more than 4,000 studies over the past two decades show definite underlying biological abnormalities, said Dr. Anthony Komaroff, of Harvard Medical School.

"This is not an illness that people can imagine they have. It's not a psychological illness," he said. "That debate, which has raged for 20 years, should now be over."

Among other things, Komaroff pointed out, the brain hormone systems of people with CFS are different than those without the disease. Brain functioning is also impaired and cells' energy metabolism seems to be compromised.

Analyses of the activity levels of 20,000 genes in people with CFS have found abnormalities in genes related to the part of brain activity mediating the stress response, Reeves said.

Some 1 million Americans suffer from the disease. Women are affected at about four times the rate as men and non-white women are affected more than white women. The disease can affect any age and demographic but is most likely to strike when a person is 40 to 59 years of age.

According to a large study conducted in Wichita, Kans., only half of people with CFS have consulted a physician and only 16 percent have been diagnosed and treated, although studies have shown that those who get appropriate care early in the illness have better long-term results. A quarter of people with the disease were unemployed or receiving disability, with the average affected family foregoing $20,000 annually in income. That amounts to $9.1 billion in lost income and wages for the U.S. economy as a whole, the study found.

While there's reason to be happy with advances in the basic scientific knowledge of the disease, Klimas said she was less happy with advances in care. Over the past 20 years, she said, she has treated more than 2,000 people with CFS who were "angry and defiant, frustrated, trying to convince physicians, friends and families that this was a real illness."

"We need much more work to understand the biological underpinnings and translate this into clinical practice," she said. "At the same time, there are effective strategies we can use right now, treatments that do help and help significantly."

More information

Visit the U.S. Centers for Disease Control and Prevention for more on chronic fatigue syndrome.

Simple Steps Safeguard Diabetics' Feet

(HealthDay News) -- The estimated 20 million Americans with diabetes need to remember that simple foot care can reduce their risk of toe, foot or leg amputations, say experts at the American College of Foot and Ankle Surgeons (ACFAS).

People with diabetes are 10 times more likely to have a lower limb amputated than people who don't have the illness, which can cause poor blood circulation and nerve damage in the feet. This makes feet more vulnerable to ulcers, infections, deformities and brittle bones.

The ACFAS offers the following foot care tips for people with diabetes:

Inspect feet daily for injuries that could lead to dangerous ulcers.
Gently wash feet in lukewarm -- not hot -- water.
Moisturize feet but avoid the areas between the toes.
Never trim corns or calluses. Doing so can lead to serious infections.
Inspect the inside of shoes before you put them on.
At the first sign of trouble, see a doctor. Early treatment can prevent foot problems from worsening and reduce the risk of amputations.

November is National Diabetes Awareness Month in the United States.

More information

The American Academy of Family Physicians has more about diabetes and foot care.