Newborn Hearing Test Might Point to SIDS Risk

(HealthDay News) -- A simple hearing test soon after birth may help identify babies at risk for sudden infant death syndrome (SIDS), a new U.S. study finds.

SIDS kills about one in 1,000 infants worldwide. Most of the victims are between two to four months old. Boys are more likely than girls to die of SIDS.

Dr. Daniel D. Rubens and colleagues at the Children's Hospital and Regional Medical Center, in Seattle, analyzed data on 31 Rhode Island babies who died of SIDS.

They found that they all shared the same distinctive difference in newborn hearing test results for the right inner ear.

Compared with other babies, those who died of SIDS scored four points lower in standard newborn hearing tests, across three different sound frequencies in the right ear.
Rubens also noted that healthy infants typically test stronger in the right ear than in the left.

However, the infants who died of SIDS had lower scores for the right ear than the left.

The study was published in the July issue of the journal Early Human Development.

"This discovery opens a whole new line of inquiry into SIDS research," Rubens said in a prepared statement. "For the first time, it's now possible that with a simple, standard hearing test, babies could be identified as at risk for SIDS, allowing preventative measures to be implemented in advance of a tragic event."

The inner ear contains tiny hairs involved with both hearing and vestibular (balance) function. Vestibular hair cells may play an important role in transmitting information to the brain about levels of carbon dioxide in the blood, Rubens suggested. Injury to vestibular hair cells may disrupt respiratory control and predispose infants to SIDS.

Rubens urged further research in this area. "We must now fully explore all aspects of inner ear function and SIDS and analyze testing frequencies higher than those currently tested by newborn hearing screen centers," he said.

More information
The Nemours Foundation has more about SIDS.

CDC Offers Travelers' Health Guide

(HealthDay News) -- Wearing a seat belt while driving in foreign countries and getting the necessary immunizations are among the recommendations in the revised Yellow Book, the biennial travelers' health guidebook available from the U.S. Centers for Disease Control and Prevention.

The newest edition -- which includes an expanded section on life-threatening blood clots that can develop after sitting for hours on a plane -- is now available.

"More than 63 million Americans travel abroad each year. This book can help prepare travelers for their trips, or help them learn how to stay safe and healthy while overseas," Dr. Christie Reed, team leader for the CDC traveler's health group, said in a prepared statement.

Injuries and auto accidents pose the greatest risk to travelers, according to the CDC, so the book emphasizes wearing seat belts while driving in foreign countries.

The Yellow Book also addresses deep vein thrombosis (DVT), a condition in which blood clots form deep in the veins of the leg because of poor circulation. This is a risk for people who spend long hours in planes. Travelers are advised to make an effort to stretch their arms and legs out during international flights.

For the 10 million people who take cruises every year, there is advice on protecting against norovirus, a highly contagious gastrointestinal illness, and motion sickness.

"The Yellow Book serves as the gold standard of travel health recommendations. We want travelers, health-care providers and those in the travel industry to have the best information and health care recommendations for traveling abroad," said Reed.

The book breaks down into nine chapters, including chapters on the major risks for travelers by region, planning for health issues during and after travel, preparing for yellow fever and malaria exposure, preventing and treating common infectious diseases, managing noninfectious risks such as jet lag and injuries, and traveling internationally with children. There is also a chapter for travelers with special needs.

More information
To access the Yellow Book and to learn about travelers' health, visit the U.S. Centers for Disease Control and Prevention.

Health Tip: Bicycle Safety for Children

(HealthDay News) -- Before your child uses that new bicycle, the most important things to equip him or her with is a properly-fitted helmet and a basic knowledge of bicycle safety.

Here are suggestions, courtesy of the International Bicycle Fund:

Always wear a bicycle helmet.
Never bike in the road or on a busy street. Stay on the sidewalk.
Stop and look for cars at any intersection before crossing.
Although biking on the sidewalk, always ride in the same direction as traffic, and follow all road signs.
Try to keep both hands on the bike handles at all times.
Don't ride at night, and wear bright clothing -- even during daylight.

One Billion People Don't Get Enough Vitamin D

(HealthDay News) -- Vitamin D deficiency is a common problem that can lead to a number of serious health conditions, but it can be prevented, says one expert.

People get vitamin D from sun exposure, diet and supplements. Yet vitamin D deficiency is all too common.

In utero and in childhood, not getting enough vitamin D can cause growth retardation, skeletal deformities and increase the risk of future hip fractures. In adults, too little vitamin D can lead to or exacerbate osteopenia, osteoporosis, muscle weakness, fractures, common cancers, autoimmune diseases, infectious diseases and cardiovascular diseases.

In the July 19 issue of the New England Journal of Medicine, Michael Holick, director of the General Clinical Research Center at Boston University School of Medicine and director of the Bone Healthcare Clinic at Boston Medical Center, published an overview of his work on vitamin D.

According to Holick, it has been estimated that one billion people in the world are vitamin D deficient or insufficient.

Without vitamin D, only 10 percent to 15 percent of dietary calcium and about 60 percent of phosphorus is absorbed by the body. This can have a direct effect on bone mineral density.

There is evidence that people who live at higher latitudes -- where the angle of the sun's rays is not sufficient to produce adequate amounts of vitamin D in the skin -- are more likely to develop and die of Hodgkin's lymphoma, colon, pancreatic, prostate, ovarian, breast and other cancers.

And there is an association between low levels of vitamin D and increased risk for type 1 diabetes, multiple sclerosis, Crohn's disease, hypertension and cardiovascular disease.

Holick says that the current recommended adequate intake for vitamin D needs to be increased to 800 to 1,000 international units (IU) of vitamin D3 per day.

"However, one can not obtain these amounts from most dietary sources unless one is eating oily fish frequently. Thus, sensible sun exposure (or UVB radiation) and/or supplements are required to satisfy the body's vitamin D requirement," Holick said in a prepared statement.

Holick added, "The goal of this paper is to make physicians aware of the medical problems associated with vitamin D deficiency. Physicians will then be able to impart this knowledge to their patients so they, too, will know how to recognize, treat and most importantly, maintain adequate levels of this important vitamin."

More information
The National Institutes of Health Office of Dietary Supplements has more about vitamin D.

Patch Helps Heart Grow New Cells

(HealthDay News) -- A special patch placed on a damaged area of the heart regenerates cardiac cells after heart attack and improves heart function, a new study finds.

Success with the patch in rats may lead the way to new methods of repairing damaged human hearts and possibly spare some patients the need for a heart transplant, according to researchers reporting in the July 15 online edition of Nature Medicine.

"Normally, adult human hearts do not regenerate because the heart doesn't make more cardiomyocytes (heart muscle cells) after injury," explained lead researcher Dr. Bernhard Kuhn, from the Department of Cardiology at Children's Hospital Boston. "It would be desirable to induce the heart to make new cardiomyocytes after injury."

To that end, Kuhn's team created a patch that contains a compound called periostin, which helps cardiomyocytes divide and multiply. "If you do that over a number of cycles, you do get an increase in cardiomyocytes," he said. "So, the cardiomyocytes you have lost are replaced."

Periostin is a natural component of tissue surrounding cells. It comes from the skin lying around bone and helps stimulate cells to divide.

During a heart attack, cardiac cells die from lack of blood and oxygen. This damage prevents the heart from working normally. Typically, lost or damaged cardiac tissue cannot regrow.

In their experiments, Kuhn's team made patches from a material called Gelfoam and soaked the patches with periostin. They placed the patches on the damaged heart muscle of rats in which they had induced a heart attack.

After 12 weeks, the rats treated with the periostin patch experienced a 16 percent improvement in their heart's cardiac pumping ability. They also had less scarring of heart tissue, a reduction in the size of the damaged area of the heart, and more blood vessels feeding the area. In contrast, rats that received a patch without periostin showed no change in their heart function.

The hearts of rats treated with periostin showed a 100-fold increase in the number of heart cells and an average of 6 million more heart cells, far outnumbering the amount of dying cells.

The advantage of this technique is that it doesn't require new cells, such as stem cells, to coax the growth of new heart cells. Stem cells might also migrate to other parts of the body, with unknown consequences, Kuhn said. The patch is "also not gene-based, so it's not gene therapy," he said.

It is possible that this same technique could be used in people who have severe heart disease, Kuhn said. Although the technique might not restore heart function back to normal, there could be significant improvement, he said.

"At this point, the only biologically proven myocardial [heart] replacement therapy is heart transplant," Kuhn said. "But with this method, if you were on a transplant list, you may be able to come off it," he said. "This could be a revolutionary approach to treating heart failure."
One expert was impressed by the findings.

"The work is important in at least two ways: It helps improve our understanding of the molecular pathways regulating cell cycle reentry in adult cardiomyocytes, and it can form a basis for novel heart therapies based on the mobilization of [the heart's own] cells," said Gordana Vunjak-Novakovic, a professor of biomedical engineering at Columbia University Medical Center in New York City and co-director of the Tissue Engineering Resource Center at the U.S. National Institutes of Health.

"It will be interesting to see the extensions of this work to human cells and other cell types, including cardiogenic stem cells that could also be affected by periostin," Vunjak-Novakovic said.
Another expert echoed those sentiments.

"This research nicely demonstrates that periostin induced cardiomyocytes' reentry into the cell cycle," said Dr. Gregg C. Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center at the University of California Los Angeles.

Rather than needing to introduce brand new cells into the damaged heart, it may be possible to induce existing cardiomyocytes to grow and thus regenerate normal functioning heart muscle, said Fonarow, who is also professor of clinical medicine at UCLA.

"The ability to enhance cardiac regeneration holds great promise as novel treatment strategies for [heart attack] complicated by left ventricular dysfunction and for chronic heart failure," he said.
But rat studies can only tell scientists so much, Fonarow added. "Additional studies with adult human cardiomyocytes, and ultimately clinical trials, are needed," he said.

More information
To learn more about how the heart works, head to the American Heart Association.

Reevaluating Hormone Replacement Therapy

(HealthDay News) -- Five years after the results of the Women's Health Initiative sounded the supposed death knell for hormone replacement therapy, experts gathered Wednesday to reassess those results and discuss the fine-tuning and evaluation that has taken place since.

"The science has evolved substantially in the past five years," Dr. JoAnn Manson, chief of the division of preventive medicine at Brigham and Women's Hospital in Boston, said at a press conference sponsored by the Society for Women's Health Research. "There's been mounting evidence that a woman's age and amount of time since onset of menopause may influence the effect of hormone therapy."

The Society for Women's Health Research is a nonprofit organization but has received funds from companies such as Amgen, Cytyc, Eli Lilly, Ethicon and Wyeth.

The original Women's Health Initiative (WHI) was halted when U.S. researchers found an increased risk of adverse events which, depending on whether the woman was taking estrogen alone or estrogen plus progestin, included heart attack, stroke, breast cancer and blood clots.

Manson was one of the principal investigators on the WHI trial.

The average age of women enrolled in the WHI was 63, or about 12 years past menopause.
And the trial was designed not to look at how well hormone therapy combated menopausal symptoms such as hot flashes, but whether it could play a role in chronic disease prevention.

"The WHI was designed to evaluate the balance of benefits and risks of hormone therapy in generally healthy postmenopausal women when used for chronic disease prevention," Manson said. "At the time WHI was started in the early 1990s, it was becoming increasingly common in clinical practice to use hormone therapy in older women who were at high risk of cardiovascular disease, or who already had a diagnosis of cardiovascular disease, in order to prevent future cardiovascular events."

Since then, it has become increasingly clear that hormone therapy has different benefits and risks, depending on the age of the woman.

Just last week, Manson and her colleagues reported in the New England Journal of Medicine that women in their 50s who take estrogen therapy have lower levels of dangerous calcium deposits in their arteries, suggesting they're at reduced risk for heart disease.

But in older women, hormone therapy appears to increase the risk of cardiovascular problems and blood clots, a phenomenon confirmed by a study in this week's British Medical Journal.

And researchers have speculated that a decline in the incidence of breast cancer in recent years is due to a decline in the use of hormone therapy after the WHI results were announced. But a cause-and-effect link is not at all clear.

"I think it's possible that declining use of hormone therapy has contributed at least a little to a decreased incidence rate, but there could be other explanations," Manson said. "There's some suggestion that the decline in breast cancer may have begun as early as 1999, which was well before there was decreasing use of hormone therapy. And there is also some evidence that mammogram screening has decreased over the past several years and that this could contribute to lower rates of detection and diagnosis of breast cancer."

That being said, combined estrogen and progestin has been linked to a risk of breast cancer after four to five years of use. It's not clear if estrogen has a similar risk.

There was some evidence in the WHI study that combination hormone therapy reduced the risk of colon cancer, but the evidence isn't enough to recommend hormones as a preventive strategy, Manson said.

Similarly, while estrogen reduces the risk of fracture and enhances bone density, this benefit would require long-term treatment. Other medications are available and should be tried first, Manson said.

Overall, the bulk of the research today, five years after the WHI, should serve to reassure younger women who may need hormone therapy to alleviate menopausal symptoms.

"The most important reason to go on hormone therapy is for menopausal symptoms," said Dr. Nieca Goldberg, medical director of the Women's Health Program at New York University Medical Center and associate professor of medicine at New York University School of Medicine.

"Younger women who need to go on hormone therapy for this reason can relax. But hormone therapy should never be given to women with cardiovascular disease."

Manson added: "I don't think that hormone therapy should be started or continued for the express purpose of preventing cardiac disease or other chronic diseases, because there are known risks. However, this is very different from the situation in a recently menopausal woman who has moderate to severe hot flashes and night sweats which interfere with sleep and quality of life. Hormone therapy is known to be the most effective treatment for menopausal symptoms.

It's still a very appropriate short-term treatment, but we still recommend using the lowest effective dose for the shortest duration of time necessary."

More information
Visit the U.S. National Library of Medicine for more on hormone replacement therapy.

No Evidence Tomatoes, Lycopene Cut Cancer: FDA

(HealthDay News) -- There's little hard evidence that a diet rich in tomatoes and the tomato antioxidant lycopene can ward off cancer, according to research from the U.S. Food and Drug Administration.

Reporting in the July 10 issue of the Journal of the American Cancer Institute, FDA experts lay out in great detail the evidence -- or mostly lack of it -- behind their November 2005 statement that tomato consumption is not linked to any reduction risk of tumors of the prostate, ovary, stomach and pancreas.

The agency had previously found no evidence that tomatoes could cut risks for lung, colorectal, breast, cervical or endometrial tumors, either.

The November 2005 statement contended that, "there is no credible evidence to support qualified health claims for lycopene, as a food ingredient, component or food, or as a dietary supplement, and reduced risk of any of the cancers in the petition."

The petition for approval of the claims was submitted by a supplement maker, American Longevity.

The FDA has now put the evidence behind its decision in print, said Paul Coates, director of the office of dietary supplements at the U.S. National Institutes of Health and the author of a related journal editorial.

The new data review "gives people some idea of what the process is," Coates said. That's important, he said, because "one of the things that people are concerned about is how are these decisions arrived at. Making the process transparent and open will be helpful."

As part of its review, the FDA pored over data from 107 observational studies comparing the level of consumption of either tomatoes or lycopene with people's general cancer risk.

They also looked at 23 studies that focused on blood levels of lycopene, although most of those trials were deemed unreliable, either because there were too many confounding factors or because most focused on cancer patients, not healthy people.

The agency also included dozens of studies comparing lycopene or tomato intake against the risk of individual cancers such as prostate, colon and breast malignancies.

The bottom line, according to the FDA: There's just not enough evidence to recommend that Americans boost their tomato intake to ward off cancer.

However, the new report is certainly not the last word on cancer-preventing claims for lycopene, Coates added.
"It just codifies the fact that the information about lycopene and cancer is not very robust," he said. "It may well be that if more studies are done, a greater effect might be found. But now, when you look at similar studies done by different people, they come to the same conclusion."

For its part, the American Cancer Society prefers to stay away from recommending any one food as a cancer preventive agent, said Marji McCullough, director of nutritional epidemiology for the organization.

"In our guidelines, we encourage people to eat a variety of foods, especially fruits and vegetables," she said. "Several studies have suggested a lower risk of cancer with some kinds of foods, including tomatoes, but we encourage variety."

The society encourages consumption of "dark deep-colored vegetables, because some studies have found an association between them and lower cancer risk," McCullough said.

The society also encourages fruit and vegetable consumption, because it helps prevent weight gain, she said.

But endorsement of specific foods won't come until research shows that they clearly are associated with lower cancer risk, McCullough said. As for supplements, "most of the evidence comes from studies of foods," she said.

More information
There's more on lycopene at the American Cancer Society.

Adjusting Cabin Pressure Eases Air Passenger Discomfort

(HealthDay News) -- The discomfort some passengers feel on airplanes could be due to the air pressure settings inside cabins, a new study finds.

Most aircraft cabins are pressurized to 8,000 feet above sea level, an altitude that lowers the amount of oxygen in the blood by about 4 percentage points, researchers say.

This decrease in oxygen saturation isn't enough to bring on acute mountain sickness, but pressurizing the cabin to 6,000 feet could help some passengers feel better when flying, concludes a study in the July 5 issue of the New England Journal of Medicine.

"We found that the altitudes did not affect the occurrence of acute mountain sickness syndrome, but it did affect discomfort," said the study's lead author, Dr. J. Michael Muhm, senior occupation physician for Boeing Commercial Airplanes in Seattle, which funded the study.

"There was no difference in the likelihood of discomfort at ground level and 6,000 feet, but the likelihood increased between 6,000 and 8,000 feet."

He added, "We concluded that passenger and crew comfort would be enhanced" if the cabin was pressurized to 6,000 feet during long-duration flights.

Most commercial aircraft are pressurized to 6,000 to 8,000 feet, not sea level.

"In order to pressurize at ground level, we would have to increase the weight of the aircraft tremendously, because the material as it exists right now couldn't tolerate pressure at ground level," explained Dr. Claude Thibeault, medical director of the International Air Transport Association in Montreal. "We would have to increase fuel, decrease passengers. So, it's an operational sort of factor."

And 8,000 feet, the maximum allowed, is also physiologically acceptable for "normal" people, he added.

"The average Joe in good condition could tolerate 8,000 feet without health effects," Thibeault said. But he noted, "They didn't say without discomfort."

Short-haul flights are usually pressurized at 5,000 to 6,000 feet while long-haul flights are closer to 8,000 feet, according to Thibeault.

But acute mountain sickness, which can involve headache, nausea and vomiting, can occur at altitudes of 6,500 feet and higher.

The authors of the study wanted to see, among other things, if airplane travelers were prone to mountain sickness.

To that end, 502 adult volunteers participated in a 20-hour simulated flight to determine the effect of barometric pressures equivalent to altitudes of 650, 4,000, 6,000, 7,000 and 8,000 feet above sea level on arterial oxygen saturation and the occurrence of acute mountain sickness and discomfort.

Mean oxygen saturation went down as the altitude increased, eventually reaching a maximum decrease of 4.4 percentage points at 8,000 feet.

Acute mountain sickness occurred in 7.4 percent of participants, but the incidence did not vary between the different altitudes.

Discomfort rose with increasing altitude and was greater at 7,000 to 8,000 feet than at all the other altitudes combined. Discomfort became apparent 3 to 9 hours into the "flight."

Older people (over 60) were less likely to report discomfort than younger people, and men seemed more affected than women.

"There were no health effects, but the discomfort was there," Thibeault said. "What they were trying to do in this study is isolate one factor, which is altitude, so you can't blame these effects on other factors."

Next week, Boeing plans to launch its newest aircraft, the 787, with cabins pressurized to 6,000 feet.

"The 787 is one of our first airplanes with the fuselage made out of composites rather than aluminum, a structure that allows us to pressurize to 6,000 feet," said Jeanne Yu, director of environmental performance for Boeing. "The findings of this study, as well as the development of materials technology, enable us to fly the 787."

But she added, changing cabin pressures in existing aircraft is not that simple because of their aluminum structures.

"Airplanes are designed to withstand the continuous pressurization/depressurization cycles that occur in takeoffs and landings throughout their service life. To lower the maximum cruise cabin altitude, the pressure difference must be increased between the interior and exterior of the airplane. This change would fatigue (wear out) the structure more rapidly and impact the airplane's service life in an uncertain way, perhaps even compromising the design integrity of the airplane," she said.

More information
For more on staying healthy when you fly, head to the Academy of Family Physicians.

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Opening of Kidney Arteries Brings Dangers

(HealthDay News) -- Angioplasty and stenting can open blocked kidney arteries, but the procedure also throws off an immense amount of debris that can hurt kidney function, a new study shows.

It has been known that this procedure -- done primarily to relieve high blood pressure -- is messy, but "this is the first paper in humans to really demonstrate how much stuff there is and especially how much microscopic material there is," said Dr. Matthew Edwards, an assistant professor of surgery at Wake Forest University Baptist Medical Center and lead author of a report in the June issue of the Journal for Vascular Surgery.

Angioplasty and stenting for blocked kidney arteries involves the insertion of a balloon to open the artery, followed by the implantation of a tube to keep it open. The procedure doesn't get as much attention as a similar surgery done for heart vessels, but an estimated 40,000 to 80,000 Americans receive this intervention each year, Edwards said. The operation's primary purpose is to lower blood pressure caused by a blockage, and its ultimate goal is to prevent kidney failure, he said.

The new report described 28 angioplasty cases in which the physicians took blood samples after a stent was implanted.

Laboratory analysis revealed an average of 2,000 debris particles in the blood samples -- some pieces being big enough to block smaller vessels in the kidney.

The number of particles found in specific patients was directly related to their subsequent kidney function, the researchers found: more debris, worse kidney function.

That can bode ill for patient's longer term health, Edwards said, since "poor kidney function after kidney artery stenting has been previously demonstrated by our group to be associated with increased risk of heart attack, stroke or death in the future."

Post-angioplasty debris was also found to float freely in arteries, even though the surgeons used a protective device designed to trap it for removal. The Wake Forest surgeons used one of several protective devices now being tested. None have yet been approved by the U.S. Food and Drug Administration.

One or another of these protective devices may someday go into medical practice, Edwards said. "We certainly need a protection device," he said. His group used one designed by Medtronic. It is essentially a large balloon that traps the debris so that it can be collected and removed when the procedure is finished.

But Edwards also noted that certain kinds of fatty plaques could create more debris than others.
"The plaques that sit in these arteries are not all the same," he said. "Some might be prone to liberate more debris than others."

Edwards hopes that, in the future, this most dangerous form of debris could be identified before a procedure is done.

"There has been some work on that in the carotid artery," Edwards said, referring to the main artery to the brain. "Some MRI and ultrasound studies have identified plaque that is prone to release more debris."

Edwards said his group now is conducting a trial to explore that possibility.

More information
There's more on kidney angioplasty at the University of Southern California.