Indian Medicine

NEW YORK (Reuters Health) - Homemade devices to help children take inhaled asthma medication more easily may be just as effective as the commercial versions, according to a new review of all existing studies comparing them.

But the commercial type should remain the first choice if they are available, the study's authors say, given the limitations of research to date.

Called spacers, the devices make it easier for children to coordinate inhalation with the release of beta 2-agonist medication, which is used to treat asthma attacks. Spacers also allow for more of the drug to be delivered to the lungs and less to wind up in the mouth and throat, thus reducing side effects.

But commercially produced spacers can cost up to $45 and are often not covered by insurance, one of the review's authors, Dr. Carlos Rodriguez of Clinica Colsanitas in Bogota, Colombia, told Reuters Health via e-mail. So in the developing world, spacers made from materials ranging from plastic bottles or plastic zip-up bags to paper and polystyrene cups are widely used, he added.

Writing for the Cochrane Collaboration, a non-profit group that publishes systematic reviews of different types of therapy, Rodriguez and his team searched the medical literature and found six studies including 658 patients that compared home-made spacers with commercial spacers for treating asthma attacks or lower airway obstruction. The studies were conducted in India, South Africa, Brazil and the Philippines.

The researchers found no difference in the effectiveness of commercial versus homemade spacers. But because there were relatively few studies, including a small number of events in which patients actually used the devices, "we consider that the results of this review should be interpreted with caution," Rodriguez said. "They need confirmation through further, larger trials. In the meanwhile, selection of the spacer device for an individual patient should begin with a commercial spacer, with home-made spacers being used if a commercial device is not available."

SOURCE: The Cochrane Library, April 15, 2008.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - Many African-American women may overestimate the number of cancer screening tests they have had, potentially putting them at risk of late cancer detection, a small study suggests.

Researchers at the American Cancer Society found that among 116 black women they interviewed about their cancer screening history, there were generally large discrepancies between the women's memories and their medical records.

In most of these cases, women remembered having a test that, based on the records, was not done, the researchers report in the journal Oncology Nursing Forum.

For example, 86 percent of those who were age 20 or older said they had had a clinical breast exam at some point in their lives, while 67 percent said they'd had one in the past year. According to their medical records, however, only 35 percent had ever had a clinical breast exam, and 26 percent had had one in the past year.

Experts recommend that women in their 20s and 30s have a clinical breast exam to search for lumps every 3 years; women older than 40 should have one annually.

Similarly, the study found, women reported higher rates of screening mammography, Pap tests for cervical cancer, and fecal occult blood tests (FOBTs) for colon cancer than their medical records showed.

In general, estimates of Americans' cancer screening rates are based on self-reports. The current findings suggest that the true rates may be lower than those estimates, especially among African-American women.

"Self-reported screening rates are the foundation for many policy decisions that have a significant influence on the availability of resources for this population," lead researcher Dr. Barbara D. Powe said in a statement.

"Indeed," she added, "over- or underestimation of screening can be even more significant for African Americans, who bear a disproportionate cancer burden."

Compared with whites, African Americans have higher death rates from breast cancer, cervical cancer and colon cancer. Lower screening rates, which lessen the chance of early cancer detection, are believed to be an important reason.

Among women older than 40, the age at which routine mammography should normally begin, 77 reported ever having had a mammogram, while 29 percent said they'd had one in the past year. The actual rates, according to their medical records, were 40 percent and 9 percent, respectively.

Nearly all of the women said they had had a Pap test at some point in their lives, but medical records showed that only 58 percent had.

Among women older than 50, the age at which colon cancer screening should begin, 56 percent said they'd had an FOBT at least once before, while the rate based on medical records was just 11 percent.

It's possible that in some cases, the women did have tests that were not documented on their records, according to Powe's team. But the findings highlight a need to close the gap between women's estimates of their screening history and their actual rates, the researchers say.

Health centers could help by developing better "patient reminder systems," they note, and by giving patients written summaries of the tests and procedures they have at each office visit.

SOURCE: Oncology Nursing Forum, March 2008.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - Women who have ever used alendronate, also known by the trade name Fosamax, may have an increased risk of atrial fibrillation, according to findings from a new study. However, the overall risk is low and is likely outweighed by the benefits of fracture prevention in patients with osteoporosis if they have no other risk factors for atrial fibrillation, the investigators conclude.

The unexpected finding of an increased risk of serious atrial fibrillation associated with the use of this class of drugs, called bisphosphonates, was found in two clinical trials, Dr. Susan R. Heckbert and associates note. To see if alendronate increases the risk of atrial fibrillation in a clinical practice setting, as opposed to a trial, the researchers analyzed data from patients in the Atrial Fibrillation Study being conducted at Group Health, an integrated health care delivery system in Washington State.

Alendronate is used to treat or prevent osteoporosis, a disease that causes the bones to become porous and to break easily, in women who have undergone menopause or individuals who are at risk for osteoporosis for other reasons, such as those who take steroids regularly.

Heckbert, at the University of Washington in Seattle, and her team identified 719 women with atrial fibrillation diagnosed between 2001 and 2004, and randomly selected 966 matched "control" subjects without atrial fibrillation also enrolled in Group Health. Most subjects were in their 70s.

Atrial fibrillation occurs when the electrical signal to the heart becomes disordered and the two upper chambers, the "atria," to contract rapidly and irregularly. This keeps the heart from efficiently pumping blood and may cause chest pain, stroke, heart attack or heart failure. The condition can occur rarely, frequently or persistently, and can last for years.

The researchers found that more atrial fibrillation patients than controls had ever used alendronate -- 6.5 percent vs 4.1 percent. The subjects who had ever taken alendronate had an 86 percent increased risk of developing atrial fibrillation compared with those who never used a bisphosphonate.

The risk of developing sustained atrial fibrillation was nearly six-times higher compared with transitory or intermittent atrial fibrillation, for which the risk was significantly lower.

Atrial fibrillation was not associated with cumulative alendronate dose or interval since the first prescription of alendronate. The authors estimate that 3 percent of the atrial fibrillation in this patient population might be explained by alendronate use.

Heckbert and her associates conclude that "it is important to carefully weigh the benefits against the possible risk of atrial fibrillation in women who have only modestly increased fracture risk and in women who have risk factors for atrial fibrillation, such as diabetes mellitus, coronary disease, or heart failure."

SOURCE: Archive of Internal Medicine, April 28, 2008.

Copyright © 2008 Reuters Limited.

WASHINGTON (Reuters) - Americans may be much more willing to get genetic tests showing predisposition to diseases with this week's expected final passage by Congress of a bill barring discrimination based on one's genetics, experts say.

Genetic testing, typically involving a sample of blood, saliva or tissue, can help indicate whether a person has inherited a tendency to develop certain diseases -- for example breast, ovarian or colon cancer or Huntington's disease.

"Many people have been getting a genetic test using an assumed name because they were afraid that the information would otherwise haunt them," Dr. Francis Collins, head of the National Human Genome Research Institute, part of the U.S. government's National Institutes of Health, said in a telephone interview.

"And they've sometimes asked their physicians to lie about whether the test was positive in order to protect them."

The bipartisan bill would bar health insurers from turning down coverage or raising premiums for healthy people based on their genetic predisposition to develop a disease.

It also would prohibit employers, unions and employment agencies from using personal or familial genetic information in hiring, firing, compensation or promotion decisions.

"When this bill passes, we'll have protections to be able to tell people you don't need to worry about insurance or employment discrimination," Kathy Hudson, director of the Washington-based Genetics and Public Policy Center at Johns Hopkins University, said in a telephone interview.

The bill, supported by the White House, is expected to go before the House of Representatives this week for final approval before heading to President George W. Bush to sign into law. The Senate passed it on Thursday.

CONFIRMING SUSPICIONS

Doctors may order genetic tests for various reasons, including looking for gene-based diseases in adults before symptoms appear or confirming a diagnosis in someone with symptoms.

Tests also may find whether a person has a genetic predisposition to a disease that could pass to children.

Hundreds of such tests are available. The results can prompt important medical decisions.

For example, women shown with a mutation in BRCA1 or BRCA2 genes associated with breast cancer have a 40 to 85 percent chance of developing the disease by age 70. Faced with those odds, some women have opted to undergo mastectomies to remove both breasts before any sign of disease.

A number of companies market various tests directly to the public, typically costing hundreds of dollars.

Last year, two companies -- Iceland's Decode Genetics Inc and 23andMe, a U.S. firm funded by Google Inc -- launched rival services offering people a glimpse of their entire genomes for just under $1,000. Another unlisted U.S. company, Navigenics, has since joined the field.

Some medical experts say the services can be a waste of money and give people little more information than they would know from studying their family medical history, especially as many diseases have complex genetic underpinnings.

Some companies also are drawing government scrutiny.

The California Department of Public Health said last week it was looking into consumer complaints against a handful of unnamed companies offering direct-to-consumer genetic testing. The complaints involved cost and accuracy of tests and whether a licensed doctor ordered them as required.

Copyright © 2008 Reuters Limited.

CHICAGO (Reuters) - More American women are entering pregnancy with diabetes, raising the odds of a problem pregnancy and the potential that their children will become diabetic in the future, U.S. researchers said on Monday.

They found that rates of diabetes before motherhood more than doubled over six years among 175,000 teenage and adult women.

The researchers said the increase was likely tied to rising levels of diabetes and obesity in the United States.

Having diabetes before pregnancy poses a particular risk because it affects the developing fetus right from the start, they said.

"It is really important for women with diabetes to plan their pregnancies and seek advice from their healthcare provider before they become pregnant," said Dr. Jean Lawrence of healthcare provider Kaiser Permanente in Pasadena, California, whose study appears in the journal Diabetes Care.

"Women who have a difficult time controlling their blood sugar have a higher risk of miscarriage or stillbirth. They also have a high risk of having a baby with a birth defect," Lawrence said in a telephone interview.

And the risks can carry over to the next generation, she said.

"Offspring of women who have diabetes or are overweight or obese during pregnancy -- these children are more likely to be obese, overweight or have diabetes in the future," she said.

Past studies have looked at the rate of gestational diabetes, a type of diabetes that typically develops in the second trimester of pregnancy and often goes away after a woman gives birth.

Lawrence and colleagues looked at both gestational diabetes and women who had type 1 diabetes, which is typically diagnosed in childhood, and type 2 or adult-onset diabetes, in which the body loses its ability to use insulin properly.

While there were twice as many births to women with diabetes in 2005 as there were in 1999, the number of women with gestational diabetes remained fairly stable.

Diabetes increased fivefold among 13- to 19-year-olds giving birth and doubled among women 20- and 39-year-olds giving birth.

Black, Hispanic, and Asian/Pacific Islander women were more likely to have diabetes before pregnancy than white women, the study found.

About 20.8 million Americans have diabetes, which causes about 5 percent of all deaths globally each year. Most have type 2, which is closely linked to a obesity and lack of exercise. Type 1 diabetes is a so-called autoimmune disorder, caused when the body mistakenly destroys the pancreatic cells that make insulin.

"With the increasing prevalence of diabetes and obesity in society, it is very important that we start addressing this issue," Lawrence said.

Copyright © 2008 Reuters Limited.