Healthy Trust Can Diagnose Deep Vein Thrombosis

Far too many Americans are dying of dangerous blood clots that can masquerade as simple leg pain, says a major new government effort to get both patients and their doctors to recognize the emergency in time.

"It's a silent killer. It's hard to diagnose," said acting Surgeon General Dr. Steven Galson, who announced the new campaign Monday. "I don't think most people understand that this is a serious medical problem or what can be done to prevent it."

At issue are clots with cumbersome names: A deep vein thrombosis, or DVT, forms in large veins, usually a leg or the groin. It can quickly kill if it moves up to the lungs, where it goes by the name pulmonary embolism, or PE.

These clots make headlines every few years when seemingly healthy people collapse after long airplane flights or being in similarly cramped quarters. Vice President Cheney suffered one after a long trip last year. NBC correspondent David Bloom died of one in 2003 after spending days inside a tank while covering the invasion of Iraq.

But that provides a skewed vision of the problem. While there aren't good statistics, the new surgeon general's campaign estimates that every year, between 350,000 and 600,000 Americans get one of these clots - and at least 100,000 of them die.

There are a host of risk factors and triggers: Recent surgery or a broken bone; a fall or car crash; pregnancy or taking birth control pills or menopause hormones; being immobile for long periods. The risk rises with age, especially over 65, and among people who smoke or are obese.

And some people have genetic conditions that cause no other symptoms but increase their risk, making it vital to tell your doctor if a relative has ever suffered a blood clot.

People with those factors should have "a very low threshold" for calling a doctor or even going to the emergency room if they have symptoms of a clot, said Galson, who issued a "call to action" for better education of both consumers and doctors, plus more research.

Symptoms include swelling; pain, especially in the calf; or a warm spot or red or discolored skin on the leg; shortness of breath or pain when breathing deeply.

But here's the rub: Doctors are ill-informed, too. For example, studies suggest a third of patients who need protective blood thinners when they enter the hospital for major surgery don't get them. And patients can even be turned away despite telltale symptoms, like happened to Le Keisha Ruffin just weeks after the birth of her daughter, Caitlyn.

Ruffin made repeated visits to doctors and emergency rooms for growing pain in her leg and groin in December 2003 and January 2004, but was told it must be her healing Caesarean section scar.

Finally one night, Ruffin's husband ran her a really hot bath for pain relief - only to have her climb out minutes later with her leg swollen three to four times its normal size, and then pass out.

"I like to call that my miracle bath," Ruffin said, because the sudden swelling proved the tip-off for doctors.

Pieces of a giant clot in her right leg had broken off and floated to her lung. The ER doctor "said if I hadn't made it in when I did, I may not have lived through the rest of the night," recalled Ruffin, now 32, who spent a month in the hospital and required extensive physical therapy to walk normally again.

These clots "tend to fall through the cracks" because they cross so many areas of medicine, said Dr. Samuel Goldhaber, chairman of the Venous Disease Coalition and a cardiologist at Boston's Brigham & Women's Hospital.

With the surgeon general's campaign, "DVT after all these years will finally get the national spotlight like cigarette smoking did in the mid-60s," he said.

In addition to Galson's report:

-The Agency for Healthcare Research and Quality is issuing a 12-page booklet to help consumers tell if they're at risk for DVTs and what to do - and a 60-page DVT treatment-and-prevention guide for doctors and hospitals.

-As a prevention incentive, starting Oct. 1 Medicare will withhold payment from hospitals when patients develop the clots after knee- or hip-replacement surgery.

Healthy Trust Immediate Medical Care can diagnose DVT right in the office using ultrasound in only a few minutes without an appointment.

Get ready for the 2008-2009 Flu Season

Healthy Trust Immediate Medical Care is your official Chicago North Shore Flu Clinic. We provide low cost flu vaccinations to help make sure you will stay healthy this winter.

If you do happen to get the flu this year we use the latest techniques to make sure that you will recover and get back to your daily routine quicker.

Influenza is a viral infection that sickens millions of people each year and can cause serious complications, especially in children and older adults. Fortunately, the flu vaccine available in the form of a flu shot or a nasal spray offers protection against the flu.

When is the flu vaccine available?

The flu vaccine is generally offered between September and mid-November, which is typically before the late-fall or early winter start to flu season.

What kind of protection does the flu vaccine offer?

A flu shot is between 70 percent and 90 percent effective in warding off illness, depending on the length and intensity of a given flu season and your overall health. In a few cases, people who get a flu shot may still get the flu, but they'll get a much less virulent form of the illness and, most important, they'll have a decreased risk of flu-related complications especially pneumonia, heart attack, stroke and death to which older adults are especially vulnerable.

A study published in 2006 showed that the nasal spray flu vaccine (FluMist) was only between 30 percent and 57 percent effective in preventing the flu in adults. However, another study in 2006 found that giving nasal spray vaccine to school-age children helped reduce the spread of flu in the community. And in 2007, researchers compared the effectiveness of FluMist with the flu shot in children ages 6 months to 5 years. The children treated with FluMist experienced about half as many cases of flu as did those who received the shot. However, FluMist increases the risk of wheezing in this age group especially in those who already have asthma or recurrent wheezing and in all children under age 2. In 2007, the Food and Drug Administration (FDA) therefore approved FluMist for children older than 2 years who don't have asthma or recurrent wheezing. Consult with your doctor about which form of vaccination may be best for you or your child.

Why do I need to get vaccinated every year?

You need annual flu protection because the vaccine changes from year to year. The flu vaccine you got last year wasn't designed to fight the virus strains in circulation this 2008-2009 flu season.

Influenza viruses mutate so quickly that they can render one season's vaccine ineffective by the next season. A Centers for Disease Control and Prevention (CDC) advisory committee meets early in the year to estimate which strains of influenza virus will be most prevalent during the upcoming flu season, and manufacturers produce vaccine based on those recommendations.

Will this year's vaccine protect me against the flu?

The flu vaccine protects against the three main flu strains that research indicates will cause the most illness during the flu season. This years influenza vaccine contains three new influenza virus strains.

They are:

A/Brisbane/59/2007(H1N1)-like virus
A/Brisbane/10/2007 (H3N2)-like virus
B/Florida/4/2006-like virus.

The 2008-09 influenza vaccine can protect you from getting sick from these three viruses, or it can make your illness milder if you get a related but different strain of flu virus.

What are my options for the flu vaccine?

The flu vaccine comes in two forms:

A shot

A flu shot contains an inactivated vaccine made of killed virus. The shot is usually given in the arm. Because the viruses in the vaccine are killed (inactivated), the shot won't cause you to get the flu, but it will enable your body to develop the antibodies necessary to ward off influenza viruses. You may have a slight reaction to the shot, such as soreness at the injection site, mild muscle ache or fever. Reactions usually last one to two days and are more likely to occur in children who have never been exposed to the flu virus.

A nasal spray

Administered through your nose, the nasal spray vaccine (FluMist) consists of a low dose of live, but weakened, flu viruses. The vaccine doesn't cause the flu, but it does prompt an immune response in your nose and upper airways as well as throughout your body.

Who should get the flu vaccine?

Most people who want to reduce the risk of having influenza can get a flu shot. The CDC recommends the flu vaccine in particular if you:

Are age 6 months to 4 years

Are a child on long-term aspirin therapy

Are pregnant

Are 50 years old or older

Have a chronic medical condition such as asthma, diabetes or heart, kidney or lung disease

Have a weakened immune system such as from medications or HIV infection

Are a resident of a nursing home or other long term care facility

Are a child care worker or health care worker or live with or care for someone at high risk of complications from the flu

Who shouldn't get the flu shot?

Don't get a flu shot if you:

Have had an allergic reaction to the vaccine in the past.

Are allergic to chicken eggs.

Developed Guillain-Barre syndrome, a serious autoimmune disease affecting the nerves outside the brain and spinal cord, within six weeks of receiving the vaccine in the past. People who have experienced Guillain-Barre after the flu vaccine are at higher risk than are others of developing it again.

Have a fever. Wait until your symptoms improve before getting vaccinated.

Why do children need two doses of the flu vaccine?

Children younger than 9 years old require two doses of the flu vaccine if it's the first time they've been vaccinated for influenza. That's because children don't develop an adequate antibody level the first time they get the vaccine. Antibodies help fight the virus if it enters your child's system. If a flu vaccine shortage was to occur and your child couldn't get two doses of vaccine, one dose might still offer some protection.

I heard the flu shot isn't very effective for older adults. Is it worth getting vaccinated if you're over 65?

If you're over age 65, the vaccine doesn't offer as much protection as it would to someone younger because older adults produce fewer antibodies in response to the virus. Still, the vaccine offers more protection than does skipping the shot altogether. More important, the flu vaccine decreases the risk of flu-related complications especially pneumonia, heart attack, stroke and death to which older adults are especially vulnerable.

Will the flu shot protect against bird flu if there's an outbreak among humans?

An annual flu shot won't protect you specifically from bird flu, but it will reduce the risk of simultaneous infection with human and bird flu viruses. This is important because simultaneous infections are the main way that viruses swap genes and create new strains that potentially can cause flu pandemics.

Can I lower my risk of the flu without getting a flu shot?

With or without a flu shot, you can take steps to help protect yourself from the flu and other viruses.

Practice good hygiene Good hygiene remains your primary defense against contagious illnesses.

Wash your hands thoroughly and often with soap and water or an alcohol-based sanitizer containing at least 60 percent alcohol.

Avoid touching your eyes, nose or mouth whenever possible.

Avoid crowds when the flu is most prevalent in your area.

Cover your mouth and nose with a tissue when you cough or sneeze.

If I've already had the flu, can I get it again?

Once you've had the flu, you develop antibodies to the viral strain that caused it. But those antibodies won't protect you from new or mutated strains of influenza or other viruses.

What should I do if I get the flu?

First of all, don't go to work or school you'll risk spreading this contagious disease to others.

To relieve your symptoms:

Drink plenty of fluids.

Avoid alcohol and tobacco.

Consider over-the-counter medicine such as acetaminophen (Tylenol, others) to ease the discomfort associated with muscle aches or fever, but don't give aspirin to children or teenagers because of the risk of the rare but serious disease, Reye's syndrome. And keep in mind that acetaminophen can cause severe liver damage if taken in excess.

Use antiviral medications if prescribed by your doctor, but no longer than recommended. Be sure to monitor yourself. If you start feeling worse, consult your doctor to make sure you're not developing a flu-related complication.

What kind of complications can arise from the flu?

Complications include bacterial infection, pneumonia and dehydration. If you have a chronic medical condition, you may experience a worsening of that condition. Children can develop sinus and ear infections.

Is there any medicine to treat the flu?

Antivirals work both to prevent the flu and to help reduce the severity and duration of the illness by a day or two. Antiviral medications must be taken within 48 hours of the onset of your symptoms and are available only by prescription. Ask your doctor about getting a rapid flu test that can verify within a few hours whether you have the flu.

These two antivirals are recommended for treating the flu virus:

Zanamivir (Relenza)

Oseltamivir (Tamiflu)

Each of these drugs can cause side effects, including lightheadedness, nausea, loss of appetite and difficulty breathing. They can also lead to the development of antiviral-resistant viruses.
People with the flu, particularly children, who take Tamiflu may be at increased risk of self-injury and confusion. The FDA recommends that individuals with the flu who take Tamiflu be closely monitored for signs of unusual behavior. In July 2007, the FDA approved two lower dose versions of Tamiflu for children. Still, discuss possible side effects with your doctor before starting any antiviral medication.

Your best bet for treating flu symptoms remains the tried and true:

Rest.

Get plenty of fluids.

Take acetaminophen or ibuprofen (Advil, Motrin, others) for aches and pains.

Come see the doctors at Healthy Trust Immediate Medical Care.

It's also important to eat healthy and get some daily activity to help keep your immune system in top form.

Healthy Trust Immediate Medical Care is the official flu clinic of the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.

Popcorn safe for bowel condition

Men with abnormal pouches in their bowels can safely eat nuts and popcorn, and those foods may even lower the chance of intestinal flare-ups, a study found.

The University of Washington research, published in the Journal of the American Medical Association, contradicts the advice of doctors who have told people with the condition known as diverticulosis to avoid those products. No studies have shown that to be true, the researchers said.

One-third of the U.S. population will develop the condition by age 60, the researchers said. Inflammation, bleeding and obstructions may result, and treatment costs about $2.4 billion a year. While diverticulosis remains little understood, it may be linked to too little fiber in a diet, doctors say. Nuts and popcorn are high in fiber.

"For many doctors, hopefully they will not tell their patients that they can't have some of the foods that they enjoy and may actually be good for them, such as nuts," said Jennifer Christie, an Emory University gastroenterologist in Atlanta who wasn't involved in the study.

Diverticulosis, occurs when a person has many small pouches in the lining of the large intestine, or colon, that bulge out through weak spots, causing discomfort like bloating or abdominal pain, according to the U.S. National Institutes of Health. When those pouches become inflamed, diverticulitis develops, which can lead to rectal bleeding, infection or an intestinal obstruction from scarring.

Between 10 percent and 25 percent of people with diverticulosis develop diverticulitis, according to the U.S. government.

A lack of fiber can lead to constipation, which may make people strain on the toilet, increasing pressure on the colon and causing the colon lining to bulge out through weak spots. These bulges or pouches may then become inflamed when bacteria or stool are caught in them.

Patients with the condition have been told to avoid nuts, popcorn and seeds because doctors thought particles from the foods may become lodged in the pouches, causing inflammation or bleeding, according to the study.

Researchers analyzed data collected from an 18-year study that included 47,228 men ages 40 to 75 who filled out medical questionnaires about their health and diet every few years. The men didn't have diverticulosis at the start of the study.

Twenty-seven percent of men in the study ate nuts at least twice a week, and 15 percent ate corn or popcorn at least twice a week. Over the 18 years, 801 men developed diverticulitis and 383 diverticular bleeding.

The researchers found that men who ate nuts at least twice a week had a 20 percent lower risk of diverticulitis than those who ate nuts once a month. And those who ate popcorn at least twice a week had a 28 percent lower risk of the condition, compared with those who ate popcorn less than once a month.

The high amounts of fiber in nuts and popcorn may be one reason men who ate more of those foods had fewer complications from diverticulosis, said the lead author, Lisa Strate, an assistant professor of medicine at the University of Washington in Seattle. Nuts also may help reduce inflammation, she said yesterday in a telephone interview.

The study was presented last year at Digestive Disease Week, a meeting of gastroenterologists, in Washington.

Strate is studying other reasons, such as obesity and physical inactivity, that people may develop complications from diverticulosis. Future studies should look at whether high-fiber diets help, and whether a diet high in red meat contributes to complications, she said.

Does morning sickness indicate a girl?

THE BELIEF:

Morning sickness means a baby girl is more likely.

THE FACTS:

Old wives' tales about predicting a baby's sex -- relying on clues like the way the woman carries and the fetal heart rate -- are usually more fantasy than fact.

But the notion that morning sickness can sometimes indicate that a girl is on the way may be an exception. A number of large studies in various countries have examined the claim, and almost all have found it to be true, with caveats. Specifically, studies have found that it applies to women with morning sickness in the first trimester, and with symptoms so severe that it leads to hospitalization, a condition known as hyperemesis gravidarum.

One of the most recent studies was conducted by epidemiologists at the University of Washington. The scientists compared 2,110 pregnant women who were hospitalized with morning sickness in their first trimester and a control group of 9,783 women who did not get severely ill. They found that the women in the first group were more likely to deliver a girl, and that those who were the sickest -- hospitalized for three days or more -- had the greatest odds: an increase of 80 percent compared with the control women.

Other studies in The Lancet and the journal Epidemiology, among others, have repeated the findings. It is thought that certain hormones produced by female fetuses may be the culprit.

THE BOTTOM LINE:

Severe morning sickness may indicate a higher likelihood that the baby will be a girl.

Can manipulating your neck lead to a stroke?

THE BELIEF:

Manipulating your neck could lead to a stroke.

THE FACTS:

Manipulating your neck is supposed to relieve pain, not cause it. But years ago neurologists noticed a strange pattern of people suffering strokes shortly after seeing chiropractors, specifically for neck adjustments.

Their hypothesis was that a chiropractic technique called cervical spinal manipulation, involving a forceful twisting of the neck, could damage two major arteries that lead through the neck to the back of the brain. Strokes in people under age 45 are relatively rare, but these cervical arterial dissections are a leading cause of them.

Studies that followed suggested a link. One at Stanford that surveyed 177 neurologists found 55 patients who suffered strokes after seeing chiropractors. Another, published in the journal Neurologist, said young stroke patients were five times more likely to have had neck adjustments within a week of their strokes than a control group. It estimated an incidence of 1.3 cases for every 100,000 people under 45 receiving neck adjustments.

But other studies have cast doubt. One published this year examined 818 cases of stroke linked to arterial dissections at the back of the neck. Before their strokes, younger patients who saw chiropractors were more likely to have complained beforehand of head and neck pain -- symptoms often preceding a stroke -- suggesting they had undiagnosed dissections and had sought out chiropractors for relief, not realizing a stroke was imminent.

THE BOTTOM LINE:

Forceful neck manipulation seems to carry a small risk of arterial tears.

High risk from energy drinks

When researcher Kathleen Miller persuaded the federal government to give her nearly a half-million dollars, the plan was to study "toxic jock identity." That's her term for the "hyper-attraction" some college-level male athletes have to masculinity and high-risk behaviors such as substance abuse and violence.

As an afterthought, her questionnaire asked about consumption of highly caffeinated energy drinks such as Red Bull, Monster and Rockstar.

"I threw in a few questions about energy drinks, mostly because of what I observed in a nephew of mine. He was drinking a lot of energy drinks and suddenly becoming explosive, blowing up at his family when he was never that way before. I wondered if the caffeine was part of it," said Miller, a Ph.D. researcher at the University of Buffalo's Research Institute on Addictions.

That's because the typical energy drink contains three times more caffeine than a soda pop and sometimes up to 10 times as much. A 12-ounce Coke or Pepsi has about 34 to 38 milligrams of caffeine, while the same amount of Red Bull or Monster rings up 116 to 120 milligrams.

In comparison, an espresso shot has about 75 milligrams and 12 ounces of regularly brewed coffee has roughly 250 milligrams. One difference, though, said Miller, is coffee is usually served hot so we sip it but "energy drinks you can slam right back."

The drinks are marketed primarily to 18- to 25-year-olds -- yet increasingly used by younger teens -- and have annual sales of more than $3 billion.

The more days in the past month a college student consumes an energy drink, the higher the probability of high-risk behavior, according to two Miller studies published this year. For example, students whoconsume an energy drink six or more days a month are three times more likely to smoke, abuse prescription drugs or have been in a serious fight during the previous year. Those frequent energy-drink consumers are twice as likely to experience alcohol-related problems or use marijuana, plus the energy-drink crowd will be more likely to practice unsafe sex or neglect to use a seat belt.

"This research doesn't mean the energy drinks cause the behavior," said Miller, but she does propose "frequent energy drink consumption may be a red flag or warning sign for identifying a young person at higher risk for health-compromising behavior."

Should parents be worried? Probably, and certainly more aware of the energy-drink hold on even younger people. There have been media reports of nausea, abnormal heart rhythms, profuse sweating, caffeine highs and emergency room visits at high schools and middle schools during the past academic year.

Maybe France, Turkey, Denmark, Norway, Uruguay and Iceland are onto something. These countries have all banned high-caffeine energy drinks, and Sweden only permits use with a prescription. Canada banned energy drinks until 2004 and now requires warning label cautioning against use by children or pregnant women, use in large quantities by anyone and in combination with alcohol.

What's more, Miller found two-thirds of energy drink consumers have combined energy drinks with alcohol, typically vodka, gin, whiskey or, yikes, Jagermeister.

"College kids have the misconception that you don't get a drunk with the caffeine from energy drinks," said Miller. "Their speech isn't as slurred and they have less fatigue, so they can dance until 3 but still wrap a car around a tree on the way home. And bartenders can't tell as easily who to stop serving."

Dr. Mary Claire O'Brien of Wake Forest University Baptist Medical Center has described the energy-drink cocktail effect as "you're every bit as drunk, you're just an awake drunk."
O'Brien surveyed students at 10 North Carolina universities about energy drink and alcohol trends. She published a 2007 study showing that students who mix energy drinks with liquor got drunk twice as often as those who consumed alcohol only and were far more likely to be injured or require medical attention. Energy drink users were additionally more likely to be perpetrators or victims of aggressive sexual behavior.

Miller said that she has appeared on call-in radio shows in which students have provided a range of responses from "no problem" to "horror stories."

"Some teens, as you might expect, called assuring me they drink lots of energy drink with no problems," said Miller, who has a grant proposal with the National Institutes of Health to find out where energy drinks users will be five years from now. "But other young callers talked about drinking three or four energy drinks in a row, then not being able to drive a car or feeling bad enough to go to an emergency room."

Breast-feeding may cut risk of aggressive cancer

Science has proved that mothers and babies benefit from breast-feeding in all sorts of ways, and now researchers at the Fred Hutchinson Cancer Research Center have shown that this practice can reduce the risk of a particularly aggressive form of breast cancer.

"It's a form more common among younger women and African-American women," said Amanda Phipps, a scientist in the public health division of the Seattle cancer center and lead author of a report published Monday in the journal Cancer. "We wanted to find out what puts women at risk for this."

The aggressive cancer type is called "triple negative" breast cancer because the tumor doesn't respond to a critical regulatory protein known as "HER2" or two key hormones, estrogen and progestin, which also are fundamental to many hormone-based treatments for breast cancer.
"That's why we can't use hormonal treatments on these tumors," Phipps said.

Triple-negative breast cancer is an aggressive cancer estimated to be involved in anywhere from 15 percent to 30 percent of all breast cancers, she said. Little is known about why some women are at higher risk of developing this form of cancer.

Phipps and her colleagues at Fred Hutchinson examined two groups of women from 55 to 79 years old with and without a diagnosis of breast cancer. They compared 1,476 women without the cancer with 1,140 women with several different forms of breast cancer including the "triple negative," the most common "luminal" form and another subtype associated only with the HER2 protein.

The researchers then examined these women with respect to their reproductive health histories including breast-feeding practices, onset of menstruation and menopause. All of these, Phipps said, provide indicators of the hormone levels over time for these women.

"We've known for a long time that breast-feeding reduces your risk of breast cancer, and that it was probably related to hormones," she said. But there has been little specific research, she said, on which hormones might affect the risk of these more aggressive forms of breast cancer.

By comparing the molecular nature of these breast cancer types with each woman's reproductive history, Phipps and her colleagues found that breast-feeding for at least six months corresponded with a lower risk of both the common luminal form as well as the triple-negative form of breast cancer. They also found that early onset of menstruation (before age 13) was associated with a higher risk of the HER2 breast cancer.

Late onset of menopause and the use of hormone treatments were found to increase the risk of luminal breast cancer. They found no risk differences associated with the number of children or the mother's age at first birth.

While it is common knowledge that female hormone levels change with the onset of menstruation or menopause, and so may be related to hormonally influenced cancer risks, it is not fully understood why breast-feeding would be correlated with this cancer-hormone link.

"One possible explanation is that while women are breast-feeding, they aren't menstruating and so their hormones aren't cycling," Phipps said.

So the more women breast-feed, she said, the less chance their hormones may have to trigger a cancer. Another theory, she said, is that breast-feeding alters breast cell structures in ways that make them less prone to develop into cancer cells.

The findings support the overall view that breast-feeding can reduce a woman's risk of cancer, Phipps said. More importantly for scientists, she said, it shows that different reproductive health behaviors have different effects on various forms of breast cancer.

"It helps explain why some women are at higher risk and also why certain therapies are not effective against these more aggressive forms of breast cancer," she said.

Brisk walking can help memory

Brisk walking led to slight improvements on mental tests for older people with memory problems in what is billed as the first rigorous test of exercise on the aging brain. The results from the small Australian study were only modest. But they back up observational studies showing potential mental benefits from physical activity.

The effects of exercise were at least as good, if not better, than those seen with drugs approved to aid mental function in Alzheimer's disease, according to experts not involved in the study.

Still, the study authors cautioned that the results don't prove that exercise will produce meaningful improvement in brain function or memory. They also said the results should not be used to imply that exercise reduces the risk of dementia or Alzheimer's - that can't be determined from this type of study.

The authors said it's not clear how exercise might affect brain function; one theory is that it improves blood flow to the brain. Their study did not involve brain imaging that would have shown any changes in blood flow associated with exercise.

Results appear in Wednesday's Journal of the American Medical Association.

Study participants included 85 Australian adults aged 50 and older assigned to do at least 2 1/2 hours of weekly physical activity, mainly brisk walking, for six months. They recorded their exercise in diaries and also got phone calls and newsletters encouraging them to stick with it.
They were urged to remain active even after the initial six months, and were compared with a control group of 85 people who were not asked to exercise.

The exercise group engaged in about 20 minutes more activity a day than the control group.
After six months, the exercise group performed 1.3 points better on a 70-point scale of brain function than the non-exercise group. The effects remained at 18 months, though the difference by then, about 0.7 points, was minimal.

"To our knowledge, this is the first randomized clinical trial being published" on exercise and brain function in older adults with problems, said the lead author Dr. Nicola Lautenschlager of the University of Melbourne.

"It's an important piece in that it's the first intervention in people with memory complaints that's showing some potential benefit," said Dr. Raj Shah, director of the memory clinic at Rush University Medical Center. He was not involved in the study.

Shah said larger studies are needed before physical exercise would be prescribed to treat memory problems in older adults.

Dr. Ron Petersen of the Alzheimer's Association agreed that the study should not be "overhyped," but said he will use the results in discussing potential benefits of exercise with patients.

Study: No link between measles vaccine and autism

New research further debunks any link between measles vaccine and autism, work that comes as the nation is experiencing a surge in measles cases fueled by children left unvaccinated.

Years of research with the measles, mumps and rubella vaccine, better known as MMR, have concluded that it doesn't cause autism. Still, some parents' fears persist, in part because of one 1998 British study that linked the vaccine with a subgroup of autistic children who also have serious gastrointestinal problems. That study reported that measles virus was lingering in the children's bowels.

Only now have researchers rigorously retested that finding, taking samples of youngsters' intestines to hunt for signs of virus with the most modern genetic technology. There is no evidence that MMR plays any role, the international team - which included researchers who first raised the issue - reported Wednesday.

"Although in fact there was evidence that this vaccine was safe in the bulk of the population, it had not been previously assessed with respect to kids with autism and GI complaints," said Dr. W. Ian Lipkin of Columbia University College of Physicians and Surgeons, who led the work published in PLoS One, the online journal of the Public Library of Science.

"We are confident there is no link between MMR and autism," Lipkin said.

Added co-author Dr. Larry Pickering of the Centers for Disease Control and Prevention: "I feel very certain that it is a safe vaccine."

Measles, a highly infectious virus best known for its red skin rash, once routinely sickened thousands of children a year and killed hundreds, until childhood vaccinations made it a rarity in this country. But so far this year, the U.S. has counted 131 measles cases, the most in a decade. Most patients were unvaccinated. Some were infants too young for their first MMR shot, but nearly half involved children whose parents rejected vaccination, the CDC reported last month.

No one knows just how many autism patients also suffer gastrointestinal disorders, pain that they may not be able to communicate. But Lipkin said that by some estimates, up to a quarter may be affected.

The MMR fear was that the vaccine's weakened measles virus somehow lodged in and inflamed intestines, allowing waste products to escape and reach the central nervous system, Lipkin said. So his team had two questions: Does measles virus really persist in children with both disorders and not other youngsters? And did vaccination precede the GI complaints which in turn preceded autism?

Researchers studied 25 children with both autism and GI disorders, and another 13 children with the same GI disorders but no neurologic problems. The youngsters - the average age was 5 - all were undergoing colonoscopies for their GI conditions anyway, allowing tissue samples to be tested for genetic traces of measles virus. All had been vaccinated at younger ages.

The tests uncovered traces of measles genetic material in the bowels of one boy with autism - and one boy without autism. That doesn't prove virus never temporarily lodged in more children, but it contradicts the earlier study that raised concern.

Nor was there a relationship with vaccine timing: Just five of the 25 autistic children had MMR precede GI complaints that in turn preceded autism symptoms.

Researchers consulted some prominent vaccine critics in designing the study. California advocate Rick Rollens praised the work but said it didn't eliminate other vaccine concerns that deserve similar study. Meanwhile, he said it should draw much-needed attention to the suffering of patients like his son, who has both autism and GI disorders.

"No longer can mainstream medicine ignore the parents' claims of significant GI distress," he said.