Asians Seem to Suffer Less During Childbirth

(HealthDay News) -- Asian women experience less labor pain than other women, say U.S. researchers.

"Labor progress and pain are influenced by many different factors but are difficult to study because conditions during labor are continually changing," Dr. Pamela Flood, of the anesthesia department at Columbia University, said in a news release from the American Society of Anesthesiologists.

"We created mathematical models to assess labor progression and pain in 500 women having their first babies," Flood explained. "This technique has the benefit of allowing researchers to assess the labor experience for individual women, in addition to the responses of a group as is seen in this study. Ideally, in the future we can use this model to predict when and if a woman will be able to deliver vaginally."

The researchers studied 100 sequential deliveries from each of five ethnic groups -- Asian, Hispanic, black, white and other -- and found significant associations between ethnicity, labor progress and labor pain.

Asian women had slower active labor and reported less pain than women of other ethnicities. The researchers also found that women who weighed more generally had slower active labor.

The study is in the November issue of Anesthesiology.

"The ability to predict labor pain would be helpful to assist in the development of specific coping mechanisms during labor, helping each woman better know what to expect," Flood said. "More accurate expectations about labor pain and progress will help new mothers and their doctors to plan their treatment."

SOURCE: American Society of Anesthesiologists, news release, Oct. 26, 2009

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At Least 114 U.S. Kids Dead From Swine Flu

(HealthDay News) -- At least 114 U.S. children have now died from laboratory-confirmed H1N1 swine flu, including 19 during the past week -- the largest one-week increase since the outbreak began in April, U.S. health officials said Friday.

But these deaths are almost certainly an underestimation of the actual number, Dr. Thomas R. Frieden, director of the U.S. Centers for Disease Control and Prevention, said during an afternoon press conference Friday.

"We can provide information on the number of laboratory-confirmed hospitalizations and deaths -- we know that that's an underestimation of the total," he said.

Of the children who have died, two-thirds had chronic health problems such as asthma, cerebral palsy and muscular dystrophy, Frieden said.

"In a usual flu season, 90 percent of the deaths are among people over the age of 65. In H1N1, 90 percent of the deaths are in people under the age of 65," he said.

The swine flu continues to spread throughout the country; for most people the infections are mild to moderate. It is now widespread in 48 states, although there are signs it has begun to recede in some Southeastern states, he said.

Frieden said the latest statistics continue to show that H1N1 swine flu is a disease that afflicts younger people, and can be especially serious for those underlying medical conditions. "In the past two months, we have seen more hospitalizations in people under the age of 65 than in most entire flu seasons," he said.

"One of the things we have been surprised to see," Frieden added, "is that even among people who have an underlying condition, such as asthma or heart disease or lung disease, only half sought care for influenza-like illness. People with underlying conditions with fever and cough should see their [health-care] provider promptly."

While vaccine shortages persist, there are 26.6 million doses now in circulation, up from 16.1 million doses last week. The supply is "increasing steadily," said Frieden. "The gap between supply and demand is closing."

Production delays have resulted in far fewer doses of the vaccine being available than federal officials had hoped for by this time. The first estimates called for 40 million doses by the end of October and 190 million doses by year's end.

Since the genetics of the virus have not changed, the vaccine is a good match, Frieden said.

Frieden also said there is a stronger than usual demand for the seasonal flu vaccine, prompting some shortages. "Of the 89 million doses that have already been distributed, the overwhelming majority have already been given," he said. But more doses will be available in November and December.

Supplies of the antiviral drug Tamiflu should be plentiful, but there have been shortages of the liquid form given to children, Frieden said. To help overcome that shortage, the federal government is releasing the 234,000 remaining doses of liquid Tamiflu that have been stockpiled, he said.

SOURCES: Oct. 30, 2009, teleconference with Thomas R. Frieden, M.D., M.P.H., director, U.S. Centers for Disease Control and Prevention, Atlanta

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Coffee may lower endometrial cancer risk

NEW YORK (Reuters Health) - Women dread a diagnosis of endometrial cancer, but those who drink at least two cups of caffeinated coffee a day may have a lower risk for this cancer of cells lining the uterus.

Coffee drinking seemed to particularly protect overweight and obese women, study co-author Dr. Emilie Friberg, at the Karolinska Intstituet in Stockholm, Sweden, told Reuters Health by email.

Friberg's team twice surveyed 60,634 Swedish women about their coffee intake - when they enrolled in the Swedish Mammography Cohort study between 1987 and 1990, and again in 1997.

During the 17 years, on average, that the researchers followed patients, 677 women - about 1 percent -- developed endometrial cancer. The average age at diagnosis was 67.

In the overall study group, those who daily drank 2 or more cups were significantly less likely to develop endometrial cancer, compared with those who drank fewer cups of coffee.

Each additional daily cup seemed tied to a 10 percent lower risk for endometrial cancer, after allowing for age and other factors potentially tied to endometrial cancer risk among all the women.

However, they observed the strongest effect among overweight and obese women, who, Friberg's team notes, have "the highest risk for endometrial cancer."

Each additional cup of coffee seemed to decrease endometrial cancer risk by 12 percent among overweight women and by 20 percent among obese women, Friberg and colleagues report in the International Journal of Cancer.

The investigators suggest that coffee may affect blood sugar, fat cells, and estrogen, all of which play a role in endometrial cancer. However, they write that the current findings should be confirmed in other populations.

In particular, "a study also including de-caffeinated coffee would make it possible to separate the effect of coffee and caffeine," Friberg said.

SOURCE: International Journal of Cancer

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Anemia Drug May Raise Stroke Risk in Kidney Patients

(HealthDay News) -- A drug designed to fight anemia appears to double the risk of stroke in patients with diabetes and kidney disease without substantially improving their quality of life, a new study finds.

Darbepoetin alfa, marketed as Aranesp and known as an erythropoiesis-stimulating agent (ESA), is often prescribed for diabetic patients with chronic kidney disease and mild anemia.

"The benefits we assumed we would have by treating anemia were less striking and the risks were more striking," said lead researcher Dr. Marc A. Pfeffer, a professor of medicine in the cardiovascular division of Brigham and Women's Hospital in Boston.

"This provides new data for doctors and patients to make their own risk-benefit assessment," he said. "There was a perception that treating anemia would make people feel so much better that we'll take risks, but the benefit in quality of life was not as great as we thought, and there was a clear doubling of your risk for a stroke."

The report was published in the Oct. 30 online edition of the New England Journal of Medicine to coincide with its scheduled presentation at the annual meeting of the American Society of Nephrology in San Diego.

For the study, Pfeffer's team randomly assigned more than 4,000 patients with diabetes, chronic kidney disease and anemia to receive Aranesp or placebo. During the study, 632 patients receiving Aranesp died or suffered a cardiovascular event, compared to 602 of the patients receiving placebo.

As well, 101 patients taking Aranesp had a fatal or non-fatal stroke compared with 53 of the placebo patients, the researchers found. In addition, patients taking Aranesp reported only a modest improvement in their fatigue, the researchers noted.

In earlier studies, Aranesp and a similar drug, epoetin alfa, marketed as Procrit or Epogen, were linked to increased risk of death in cancer and stroke patients.

Pfeffer believes that people with more severe kidney disease, such as those on dialysis, might still find Aranesp beneficial and the risk acceptable.

"People on dialysis generally feel even worse and generally have even more severe anemia, and this class of therapy has been very helpful to them," he said.

Because the drug was beneficial to these patients, doctors assumed it would help less severely anemic patients, Pfeffer said.

"But this use of ESAs exceeded the data," he said. "Now we have the data, and we will revisit how the drug is used now."

Dr. Phillip Marsden, a professor of medicine at the University of Toronto and author of an accompanying journal editorial, said these findings mean that doctors and patients will have to discuss whether or not to start the medication.

"For most of these patients, the modest improvement in quality of life will not be enough to subject themselves to the increased risk of stroke and death," he said.

ESAs have been used for two decades, Marsden noted. "It is a bit shocking that it took us 20 years to address whether or not these drugs were safe -- and now we know more."

Dr. Ajay Singh, clinical chief of the renal division and director of dialysis at Brigham and Women's Hospital, said this "landmark study" raises the fundamental question of whether epoetin or darbepoetin should routinely be used in treating anemia of chronic kidney disease.

"Earlier studies raised the specter of increased risk with ESA treatment. This study definitively confirms that there is meaningful risk with routine use of ESAs," said Singh, also an associate professor of medicine at Harvard Medical School.

"In my own practice, I will be cautious in using ESAs for most patients with chronic kidney disease, balancing risk with benefits and reserving treatment largely for patients who need frequent blood transfusions or who are candidates for a kidney transplant," he said.

SOURCES: Marc A. Pfeffer, M.D., Ph.D., professor of medicine, cardiovascular division, Brigham and Women's Hospital, Boston; Phillip Marsden, M.D., professor of medicine, University of Toronto, Canada; Ajay Singh, M.D., clinical chief, renal division, director, dialysis, Brigham and Women's Hospital, and associate professor, medicine, Harvard Medical School, Boston; Oct. 30, 2009, New England Journal of Medicine, online

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Virulent Strain of MRSA Resists Treatment

(HealthDay News) -- New research holds bad news for health officials worried about a potentially lethal infection called MRSA that haunts hospitals: A strain that infects the bloodstream is five times more deadly than other strains.

To make matters worse, the USA600 strain appears to be at least partially immune to an antibiotic that's used to treat the condition, the researchers have found.

A full half of patients infected with the strain died within a month, according to a study scheduled to be presented at the annual meeting of the Infectious Diseases Society of America, held Oct. 29 to Nov. 1 in Philadelphia. That's nearly five times the death rate of other people infected with MRSA, and 10 to 30 percent of those who acquire MRSA infections in the bloodstream die within a month, the study found.

MRSA, or methicillin-resistant Staphylococcus aureus, causes infections in the skin and bloodstream. It can also infect surgical wounds and cause pneumonia. In most cases, it sickens people in the hospital, but cases are becoming more common outside the health-care community, according to information in a news release from the Henry Ford Health System.

Researchers think it's possible that the USA600 strain is unique. But they don't know if other factors -- such as the age of patients -- could be at play.

Those who developed the USA600 strain tended to be older than those who acquired other MRSA strains, averaging 64 compared with 52 years old, the study noted.

"While many MRSA strains are associated with poor outcomes, the USA600 strain has shown to be more lethal and cause high mortality rates," Dr. Carol Moore, the study's lead author and a research investigator at the Henry Ford Hospital's division of infectious diseases, said in the news release.

"In light of the potential for the spread of this virulent and resistant strain and its associated mortality," she said, "it is essential that more effort be directed to better understanding this strain to develop measures for managing it."

MRSA is challenging to treat because strains can be immune to many medications. The USA600 strain appears to be more immune than other strains to the drug vancomycin, which often still has the power to vanquish MRSA.

SOURCE: Henry Ford Health System, news release, Oct. 31, 2009

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Cholesterol Drugs May Help Prevent Flu Deaths

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

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

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

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

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

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

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

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

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

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

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

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

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

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

SOURCES: Ann R. Thomas, M.D., M.P.H., Emerging Infections Program, Oregon Department of Human Services Public Health Division, Portland; Marc Siegel, M.D., associate professor, medicine, New York University School of Medicine, New York City, and author, Swine Flu: The New Pandemic; Oct. 29, 2009, presentation, Infectious Diseases Society of America annual meeting, Philadelphia

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Better Drug Emerges for Steroid-Induced Bone Loss

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

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

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

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

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

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

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

SOURCE: Arthritis & Rheumatism, news release

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