Indian Medicine

NEW YORK (Reuters Health) - The addition of an exercise training program to the standard care of children and adolescents with cerebral palsy improves their physical fitness and quality of life, according to a Dutch study.

Olaf Verschuren, of the Rehabilitation Center "De Hoogstraat" in Utrecht, and colleagues recruited 86 children between 7 and 18 years old with cerebral palsy to evaluate the effects of an exercise training program over an 8-month period.

The children either took part in the exercise program or received just their usual rehabilitation care. The exercise program involved group circuit training that focused on aerobic and anaerobic exercises. Two training sessions were given per week, each lasting 45 minutes.

Significant improvements in aerobic and anaerobic capacity were found for patients in the training group, the researchers report in the Archives of Pediatrics and Adolescent Medicine. A significant benefit was also seen for agility, muscle strength, and athletic competence.

On health-related quality-of-life measures, those dealing with movement ability, autonomy, and cognition all improved significantly.

However, "The benefits that children gained during training were only partially maintained at follow-up," Verschuren and colleagues report. "It seems very difficult for children with cerebral palsy to maintain the gains of an exercise program."

"Consequently," they conclude, "children with cerebral palsy must continue their training to maintain their fitness levels."

SOURCE: Archives of Pediatrics and Adolescent Medicine, November, 2007.

Copyright © 2007 Reuters Limited.

NEW YORK (Reuters Health) - Survival rates for people with colorectal cancer are different in various racial and ethnic groups, with blacks faring worse than other groups, according to a report by US researchers.

Decreased colorectal cancer survival in blacks compared with whites is well documented, the authors explain, but few studies have investigated colorectal cancer survival in other racial or ethnic groups.

Dr. Scarlett Lin Gomez from the Northern California Cancer Center, Fremont, and associates used linked databases to investigate factors associated with racial and ethnic survival patterns. Their findings appear in the online journal BMC Cancer.

Blacks, Hispanics, and Filipinos were more likely than other groups to be diagnosed with stage III or IV (i.e., advanced) disease, the authors report.

Blacks and Japanese were less likely than Hispanics and Chinese to receive guideline treatment for stage III colon cancer, and relatively fewer blacks, Japanese, and Filipinos received treatment according to guidelines for stages II and III rectal cancer.

Mortality rates due specifically to colorectal cancer were 33 percent higher among blacks and 16 percent higher among Hispanic males than among whites, the researchers report, while mortality rates were lower among Japanese and comparable among Hispanic females, Chinese, and Filipinos.

Even after adjustment for disease characteristics, education level, poverty, and income, blacks still had mortality 16 percent higher than among whites. Conversely, mortality among Hispanic males was no longer higher after adjustment for these factors.

"We found evidence that ... racial/ethnic disparities in colorectal cancer survival may be reduced by increasing access to screening," the investigators write. "However, among blacks, survival disparities compared to whites and other racial/ethnic groups persist even after accounting for a comprehensive set of sociodemographic, clinical, and treatment characteristics."

Additional research "is necessary to identify the factors and mechanisms leading to the poorer outcomes among US blacks," the authors conclude.

SOURCE: BMC Cancer, October 16, 2007.

Copyright © 2007 Reuters Limited.

NEW YORK (Reuters Health) - Adults at risk for developing coronary heart disease seem to respond better to preventive treatment when their doctor tells them exactly what their risk is and how they can help lower their risk, results of a study suggest.

In the study, people who had frank discussions with their doctor about their coronary risk profile achieved greater improvement in their cholesterol levels than those who did not have these discussions.

It is well known that lowering levels of "bad" LDL cholesterol and raising levels of "good" HDL cholesterol reduces the chances of a heart attack and heart-related death. Yet patients don't always stick to recommended lifestyle changes or their cholesterol medications.

The results of one recent study suggested that about one-third of people who stop taking their cholesterol medications do so because they are not convinced they need them.

This made Dr. Steven A. Grover of McGill University in Montreal, Quebec, and colleagues wonder whether boosting patients' knowledge of their heart risk profile might help boost their adherence to heart-healthy ways.

To find out, they randomly assigned 3,053 adults being treated for cholesterol problems to usual care or to receive a 1-page computer printout displaying their probability of developing heart disease in the next 8 years based on their current lifestyle, blood pressure, cholesterol levels, and other risk indicators.

During the study, reported in the Archives of Internal Medicine, the printout group also received ongoing feedback on how much they could cut their risk through lifestyle modification and drug therapy.

A total of 2,687 patients completed the 12-month study, and the researchers saw that those in the intervention group who kept track of their heart risk profile had small but significantly greater improvements in their cholesterol profiles.

The patients who were better educated about their heart risk profile were also more likely to reach cholesterol targets, the investigators found.

Given the public health burden of heart disease, prevention is key, Grover and colleagues note in their report. "Communicating risk is consistent with many of the recommendations to improve adherence, including enhancing self-monitoring and using the support of family and friends."

SOURCE: Archives of Internal Medicine, November 26, 2007.

Copyright © 2007 Reuters Limited.

COLLEGE PARK, Md.(Reuters) - U.S. health regulators on Thursday debated a consumer group's bid to boost regulation of salt in food and revoke the ingredient's "generally recognized as safe" status.

Excessive salt in Americans' diets is a major factor in high blood pressure and is a risk factor for heart disease, and most Americans surpass recommended limits, according to health experts. The consumer group, the Center for Science in the Public Interest, cited these factors in calling for stricter regulation by the U.S. Food and Drug Administration.

"Clearly, salt should be considered generally recognized as dangerous, not safe," said Michael Jacobson, executive director of the group, which has petitioned and sued the agency over the years.

Trimming the salt content in processed and restaurant foods by half could save up to 150,000 lives a year by reducing heart-related disease, Jacobson said, citing an article published in the American Journal of Public Health.

An FDA hearing on the matter marks the first time in a quarter century that the agency has considered the issue.

Officials of the American Medical Association, which represents many of the nation's physicians, and the American Heart Association were to testify later on Thursday at the hearing, calling for stricter limits on salt.

The Grocery Manufacturers Association-Food Products Association, a trade group for the food industry, favors keeping the current regime. It said the industry could support a voluntary approach on salt.

"Salt has been used safely in foods since antiquity," said Robert Earl, a group spokesman.

Excessive amounts of salt can be bad for health, but it is safe when used in moderation, he argued.

The agency now uses labeling and education to inform the public about salt, and limits the amount of salt that can be used in products labeled as "healthy."

The CSPI is asking that the FDA beef up salt labeling for all products, require manufacturers to reduce salt in packaged foods, and revoke salt's "generally recognized as safe" status, which would subject it to stricter regulation as a food additive.

The American Heart Association advises adults to limit daily sodium intake to less than 2,300 milligrams, or about one teaspoon. The average American consumes about 3,300 milligrams per day, according to government data cited by CSPI.

The vast majority of sodium in modern diets comes from processed foods like soups, frozen dinners and condiments, according to the heart group. One frozen chicken teriyaki dinner, or one small can of Bloody Mary mix, contains a full day's worth of sodium, Jacobson said.

The FDA last looked at regulating salt more broadly in 1982 but decided against it for several reasons, including the difficulty of enforcement. It opted instead to boost information and education and rely on voluntary efforts by food producers.

Citing the rising daily intake of salt and the burden of heart-related diseases in the United States, Jacobson said the hands-off approach has been tried and found wanting.

"We've been there, done that; it didn't work," he said.

Copyright © 2007 Reuters Limited.

NEW YORK (Reuters Health) - The use of rapid HIV tests in outreach settings and other community initiatives is valuable in detecting HIV infection in racial/ethnic minority groups as well as in high-risk individuals, new study findings show.

From 2004 to 2006, the Centers for Disease Control and Prevention funded a rapid HIV testing program, which was implemented by eight community-based organizations in seven US cities: Boston, Chicago, Detroit, Kansas City, Los Angeles, San Francisco, and Washington.

The findings, published in the Morbidity and Mortality Weekly Report, indicate that 23,900 individuals were tested under this program. Thirty-nine percent of those tested were black, 31 percent were Hispanic, 21 percent were white, and 9 percent were from other groups.

Many of those tested were from groups at high risk for HIV infection: 6 percent were injection drug users, 17 percent were men who have sex with men, and 66 percent were individuals with multiple sexual partners.

Thirty percent of the subjects tested under the outreach program had never been tested before, the report indicates. Moreover, of the people who had been tested before, 43 percent had not been tested in more than a year.

With rapid testing, results can be given in 20 to 40 minutes. When the tests were positive, blood was taken for a confirmation test and the individuals were given follow-up appointments. If they were found to be HIV-positive, they were referred to local providers for medical care.

Overall, 267 subjects were confirmed positive for HIV infection. Seventy-four percent of these individuals were black or Hispanic.

"This project demonstrated that rapid HIV testing in a range of settings can effectively target multiple populations at high risk for HIV infection," the report concludes. "Offering rapid HIV testing in outreach and other community settings provides opportunities to identify HIV infections and to link persons with positive test results to prevention and medical care."

The report comes in advance of World AIDS day, which is held on December 1. This year marks the 20th observance of the event, which was established to raise awareness and improve education about HIV infection and AIDS.

SOURCE: Morbidity and Mortality Weekly Report, November 29, 2007.

Copyright © 2007 Reuters Limited.