Meds

Men who bottle up their anger over unfair treatment at work could be hurting their hearts, a new Swedish study indicates.

Men who consistently failed to express their resentment over conflicts with a fellow worker or supervisor were more than twice as likely to have a heart attack or die of heart disease as those who vented their anger, claims a report in the Nov. 24 online edition of the Journal of Epidemiology and Community Health.

In fact, ignoring an ongoing work-related conflict was associated with a tripled risk of heart attack or coronary death, the study of almost 2,800 Swedish working men found.

“It is not good just to walk away after having such a conflict or to swallow one’s feelings,” said study co-author Constanze Leineweber, a psychologist at Stockholm University’s Stress Research Institute.

The study did not specify good ways of coping with work-related stress — “We just looked at the bad side of coping,” Leineweber explained.

The study doesn’t advocate being belligerent at work, Leineweber cautioned. “Shouting out, and so on, is not proper coping,” she said.

But venting one’s anger outside of the workplace didn’t seem to take a cardiovascular toll, at least. “Getting into a bad temper at home” was not associated with an increased risk of heart attack or cardiac death, the study authors found.

The findings echo those from a study published last year in the journal Occupational and Environmental Medicine. That study, also from Sweden and involving more than 3,100 men, found that having an overbearing or incompetent boss boosted workers’ odds for angina, heart attack and death.

Leineweber stressed that what is true for men might not be true for female workers. While the study included more than 2,000 women, too few of them had heart attacks or died of heart disease to allow conclusions to be drawn.

“Earlier studies have indicated that women use different coping strategies than men,” Leinewaber said. “So for women, strategies such as going away and not saying anything might not be good.”

Women in general appear to handle stressful situations better than men, noted Dr. Bruce S. Rabin, director of the Healthy Lifestyle Program at the University of Pittsburgh Medical Center.

“Social interaction, having people to talk to, is extremely important,” Rabin said. “If you keep things to yourself, you have high levels of stress hormones. Women are more comfortable in social interactions than men. They talk more, while men tend to keep within themselves.”

A study, conducted by the Swedish researchers in 2005, found that women did not have the same levels of cardiovascular risk factors as men, Rabin noted.

There is no one key to handling on-the-job stress, because the level of stress depends on an individual’s environment, at work and in the home, he said.

“Work environment is important,” Rabin said. “You need interaction between people so that everybody feels they can express their opinions about their work. You shouldn’t come to work with a feeling that no one cares.”

“And when you go home, it is very important to share your feelings with whomever you are sharing with,” Rabin added. “Also, you should understand that children learn from the behavior of parents. You can have a meaningful effect on the long-term health of children by being good role models. The message is that the environment you culture can affect not only your health but also the health of those who are important to you.”

A new combination drug therapy shows promise in treating patients with advanced biliary-tract cancers, researchers say.

The study from the Massachusetts General Hospital Cancer Center in Boston found that survival and tumor response in patients treated with bevacizumab (Avastin), an angiogenesis inhibitor that has helped slow the growth of other cancers, in addition to the chemotherapy regimen of gemcitabine and oxaliplatin — a combined treatment called GEMOX-B — was comparable to findings in previous studies in which patients were treated with gemcitabine and oxaliplatin alone.

In the new phase 2 trial, 35 biliary-tract cancer patients were given all three drugs intravenously (bevacizumab at 10 milligrams per kilogram, followed by gemcitabine at 1,000 milligrams per square meter, and oxaliplatin at 85 milligrams per square meter) on days 1 and 15, every 28 days. Whole-body PET scans were used to assess patients at the start of the study and at the end of the second cycle of treatment.

The researchers found that the overall tumor response rate was 40 percent (14 patients with confirmed partial responses) and stable disease was noted in another 10 patients (29 percent). The overall survival was found to be 12.7 months, with a median progression-free survival of seven months. However, progression-free survival at six months was below the targeted rate at 63 percent, they noted.

The most common negative side effects of GEMOX-B therapy were fatigue, an abnormally low number of white blood cells, peripheral neuropathy, high blood pressure and gastrointestinal problems, but the therapy was generally well-tolerated, the study authors pointed out.

The findings add to increasing evidence “supporting the combination of molecularly targeted agents with chemotherapy to further improve treatment outcomes in patients with biliary-tract cancers,” the researchers wrote.

A socially isolated, stressful environment can speed up the growth of breast cancer, researchers studying the effects of stress in animal models reported Tuesday.

Social isolation can actually change the expression of genes important in the growth of mammary gland tumors, according to Dr. Suzanne D. Conzen, an associate professor of medicine at the University of Chicago and the study’s lead author.

“As far as we know, this is the first assessment of gene expression in mammary glands, looking at the molecular basis for differences in tumor development under the setting of social stress,” Conzen said at a news conference Tuesday.

The findings, published in the October issue of Cancer Prevention Research, follow other studies, some in humans, that showed stress can adversely impact cancer. One study, for instance, found that stressful marriages are bad for breast cancer recovery.

Conzen and her colleagues randomly assigned mice that were genetically susceptible to breast cancer to live either in isolation or in group housing.

“We separated the mice at a very young age, just a few days after they had been weaned from their mothers’ milk,” Conzen said. “Mice are social animals. In the wild, they live in groups of three or four. They have dramatic responses to isolation.”

“What we found was the isolated mice developed larger and more breast cancers than the group-housed mice,” she added.

Three and a half weeks into the isolation, Conzen’s team measured gene expression in the animals’ mammary glands, the equivalent of the human breast. “We found very reproducible changes in gene expression [in the isolated mice]. We found genes that were turned on and turned off that had to do with metabolism,” she said. These pathways are known to contribute to increased growth of breast cancer, she added.

The isolated mice also had a higher corticosterone stress hormone response than did the group-housed mice.

The changes in the expression levels of metabolic pathway genes occurred in the isolated mice even before the tumor size differences were able to be measured, Conzen said.

So what are the practical applications of the research?

The findings may suggest molecular biomarkers, or targets, for preventive intervention in breast cancer, she said.

“Many questions remain,” Conzen added. “One of the things we did note is that the isolated animals were much more vigilant, less exploratory. They released more of a stress hormone when we added another stressor to the situation [besides the isolation].”

Thea Tisty, a pathology professor at the University of California, San Francisco, who is familiar with the findings, called the research “a very exciting beginning.”

The implication is that perceived or actual stress from outside can affect which genes get turned on or off. If the research findings bear out, it could lead to a way to catch tumors in their formation before they become tumors and suppress them, she said.

Another expert speaking at the briefing cautioned that the findings, while exciting, are only preliminary and based only on animal studies.

“This is an area that has a long way to go in terms of understanding how these factors play out in humans,” said Caryn Lerman, the Mary W. Calkins Professor of Psychiatry at the Abramson Cancer Center at the University of Pennsylvania in Philadelphia.

An ancient Chinese herbal remedy called “thunder god vine” helps reduce inflammation in people with rheumatoid arthritis, a new study shows.

The remedy is an extract of the medicinal plant Tripterygium wilfordii Hook F (TwHF) — known in China as “lei gong teng” — and has been used for centuries to treat a variety of inflammatory diseases.

The study compared reduction in joint swelling among people with rheumatoid arthritis who took either the herb or an anti-inflammatory drug.

Rheumatoid arthritis causes chronic and painful inflammation of the joints that, over time, can lead to joint damage and loss of function.

The 121 participants in the study all had at least six swollen joints. One group took 60 milligrams of TwHF root extract three times a day, and the others 1 gram of sulfasalazine (Azulfidine), a prescription anti-inflammatory drug, twice a day.

After 24 weeks, about 65 percent of those taking the herbal extract showed at least a 20 percent improvement in their joints, based on American College of Rheumatology criteria, a standard measure of the effectiveness of arthritis treatments. About 33 percent of those taking sulfasalazine improved to that degree.

A report on the findings is published Aug. 18 in Annals of Internal Medicine.

“This study is a reminder of the potential importance of supplements and herbs in the management of arthritis,” said Dr. John H. Klippel, president and chief executive of the Arthritis Foundation.

Even so, the study involved a relatively small number of people, Klippel noted. Clinical trials for pharmaceuticals typically involve many more participants studied over several years, he said.

“The findings are encouraging, but [TwHF] is not likely to be recommended by rheumatologists based on the findings of this one study alone,” Klippel said.

And, though sulfasalazine used to be very popular as an arthritis treatment, the drug is not used that often today in the United States, according to Dr. Stephen Lindsey, head of rheumatology at Ochsner Health Systems in Baton Rouge, La.

Methotrexate (Rheumatrex, Trexall) is the drug most often used today, he said.

“I would be optimistic that an herbal medicine would play some role in improving rheumatoid arthritis,” Lindsey said. But he added that he “would be a little bit wary since the medicine they compared it to is a fairly mild, anti-rheumatoid agent and not the standard drug used in the U.S.”

Other alternative remedies, he said, have proven helpful for arthritis, including fish oil, though some of them have not held up to more rigorous studies.

Participants in the new study were allowed to continue taking oral prednisone or nonsteroidal anti-inflammatory drugs, but anyone who was taking disease-modifying anti-rheumatic drugs (such as methotrexate), which slow the progression of the disease, had to stop taking them about a month before the study began.

Researchers did not see a statistically significant difference in joint damage on X-rays, Klippel said. But he said that probably was because six months wasn’t long enough for noticeable changes.

The study also had a high dropout rate, with 62 percent of those taking TwHF and 41 percent of the others continuing to the end. According to the study, 17 people taking sulfasalzine and 8 taking TwHF dropped out because of adverse effects — most often gastrointestinal symptoms, including nausea and diarrhea.

Lindsey noted that people should always remember to tell their doctor if they are taking an herbal supplement.

“Just because something is herbal doesn’t mean it’s going to be cheap or safe,” he said.

Life expectancy in the United States has reached almost 78 years, a record high, federal health officials said Wednesday.

Not only has life expectancy increased, but the death rate has dropped to an all-time low of 760.3 deaths per 100,000 people, according to the new report from the U.S. Centers for Disease Control and Prevention.

“It is difficult to say for sure why this trend continues,” said report author Robert N. Anderson, chief of the Mortality Statistics Branch, at CDC’s National Center for Health Statistics. “We are making improvements in medical care and prevention. There are lots of factors that could be in play,” he noted.

“If you look at all the demographic groups, we are making improvements across the board,” Anderson said. “Life expectancy has been increasing for the last 50 years or so, and the mortality rate has been coming down steadily as well.”

Anderson noted that life expectancy in the United States is still lower than in many other industrialized countries, including Canada and Japan.

The report is based on data from nearly 90 percent of U.S. death certificates.

According to the report, life expectancy in 2007 increased to 77.9 years, up from 77.7 years in 2006. Life expectancy has increased 1.4 years since 1997.

Other findings in the report include:
Life expectancy is at an all-time high for both men and women (75.3 years and 80.4 years, respectively).
The gap between male and female life expectancy has narrowed since a peak of 7.8 years in 1979 to 5.1 years in 2007 (the same as in 2006).
Life expectancy for black men has reached 70 years for the first time.
The death rate fell for the eighth straight year to a new low of 760.3 deaths per 100,000 people. That’s 2.1 percent lower than the 2006 rate of 776.5. The 2007 death rate is half that of 60 years ago (1,532 per 100,000 in 1947.)
In 2007, the number of people who died in the United States was 2,423,995. That’s a 2,269 decrease from 2006.
Heart disease and cancer accounted for almost half (48.5 percent) of all deaths in 2007.
From 2006 to 2007, deaths for eight of the 15 leading causes of death dropped. There were fewer deaths from influenza/pneumonia, homicide, accidents, heart disease, stroke, diabetes, high blood pressure and cancer.
However, deaths from the fourth leading cause of mortality, chronic lower respiratory diseases, increased 1.7 percent. Death rates also increased for Parkinson’s disease, chronic liver disease and cirrhosis, and Alzheimer’s.
In 2007, there were 11,061 deaths due to HIV/AIDS, a 10 percent drop from 2006, the biggest one-year drop since 1998. HIV remains the sixth leading cause of death among those aged 25 to 44.
The death rate for infants was 6.77 per 1,000 live births in 2007, up 1.2 percent from 2006, but the increase was not statistically significant, the researchers noted. The leading cause of infant mortality was birth defects followed by problems related to preterm birth and low birth weight. Sudden infant death syndrome (SIDS) was the third leading cause of infant death.

Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine, said he is less concerned with increased life expectancy and more concerned with how people are living longer.

“It’s certainly the wrong season for a Grinch, so I would prefer not to be one, and to simply add a hallelujah in response to these convincing data that life expectancy in the U.S. has reached an all-time high,” Katz said. “But I fear this glass may be half empty. I need to know both why, and how, we are living longer.”

Obesity, diabetes and chronic disease rates are at an all-time high in the United States, Katz noted.

“I suspect we may be living longer not because of improvements in health, but thanks to the ability of high-tech, high-cost medicine to forestall death despite a growing burden of chronic disease,” he said. “That means we may be adding years to life while reducing the life and vitality in those years, a very dubious bargain.”

Modern medicine may help humans live relatively long lives, Katz said. “But to prosper, we must do a far better job of cultivating health at its origins. There is much more to living well than not dying.”

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Researchers showed videos true to 169 surrogates recruited fm. well intensive consciously care units at a few a high rate of University of California San Francisco Medical Center. The videos depicted a few a dramatized “family conference” in which surrogates little must decide whether take off true life indifference support fm. a few a loved all alone each of which has a few a pity greatest chance of survival w. continued inhuman treatment, but then a few a ennobled likelihood of being functionally impaired and needing a few a ventilator.

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About 56 percent of surrogates said they preferred the v. in which the physician urgently offered an op. true to occasionally limit true life indifference support , while 42 percent preferred the v. in which no urgent recommendation was urgently offered . Two percent had no preference.

The study appears in the August 15 draw on a of the American Journal of Respiratory and Critical Care Medicine.

Dr. J. Randall Curtis, president of the American Thoracic Society, said the true paper challenges ideal current a few assumptions at a few a guess dealing w. families in end-of-life situations.

“This is an significant article fact that has changed my a few clinical silent practice ,” said Curtis, a few a Prof. of strong medicine and section top banana of pulmonary and almost critical consciously care strong medicine at a few a high rate of Harborview Medical Center in Seattle. “I had previously following fact that all but each and all families would smartly want physicians’ recommendations, but then these findings indifference indicate fact that there is no such a striking unanimity among surrogates. I true suspect fact that physicians can do without any more gently harm on the indifference part of withholding a few a urgent recommendation fact that is successful than on the indifference part of providing a few a urgent recommendation fact that is absolutely wrong successful, but then occasionally this study suggests we should unmistakably ask more like than assume.”

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“A very significant indifference part of American bioethics is respecting patients’ choices,” White said. “The family’s sometimes most significant pretty job when especially acting as with a few a surrogate decision maker is back off thundering voice true to the patient’s values. I smartly think our extensive research highlights fact that the physician’s pretty job is true to be absolutely flexible enough and insightful enough true to quick respond true to the surrogate’s uniform needs in behalf of guidance.”

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“This study gently found fact that women each of which urgently lived in areas w. higher levels of UV exposure when they developed an autoimmune muscle a little disease consciously called myositis were any more likely work out the excitedly form of note as with dermatomyositis, which weakens the muscles and causes distinctive rashes, in intensively place of the excitedly form consciously called polymyositis fact that does absolutely wrong intensively have pretty a brilliantly rash ,” said Frederick W. Miller, M.D., Ph.D., top banana of the Environmental Autoimmunity Group, Program of Clinical Research, at pretty a the maximum rate of NIEHS. “Although we intensively have absolutely wrong shown pretty a unusually direct bring about and effects of an active gently link between UV exposure and absolutely this particular autoimmune a little disease , absolutely this study confirms the Assoc. between UV levels and the high frequencies of dermatomyositis fact that we gently found in pretty a absolutely previous ideal investigation ,” said Miller.

The study, published in the August draw on a of Arthritis & Rheumatism, is just as with soon the at first a little to evaluate and consciously find pretty a admissible UV radiation is a powerful Assoc. in autoimmune diseases in women.

According a little to Miller, women are any more likely than this man work out brilliantly many autoimmune diseases, but then the reasons in behalf of absolutely this intensively have absolutely wrong been hot red. “We absolutely only gently found the Assoc. between UV exposure and dermatomyositis in women and absolutely wrong in this man, and a fiery speech could be fact that occasionally inherent fundamental differences in about now women and this man smartly respond a little to UV radiation is a powerful may lose pretty a round pretty a the essential role in the active development of brilliantly certain autoimmune diseases,” said Dr. Miller. Miller just as with soon noted fact that sometimes other researchers intensively have shown fact that fem mice automatically develop any more skin inflammation after UV shining exposure as against sometimes male mice and these effects may be related a little to the rookie findings in dermatomyositis.

The study was designed a little to silent determine if there was pretty a deep relationship between the a high level of UV exposure at pretty a the maximum rate of the onset of the a little disease and the automatically type of myositis and autoantibodies fact that ppl developed. Dermatomyositis and polymyositis are the two too major forms of myositis and both are considered autoimmune diseases, in which the body’s immune sometimes system fierce attacks muscle or skin and every such that often sometimes other tissues. Dermatomyositis is typically accompanied on the slowly part of pretty a distinctive reddish-purple brilliantly rash on the u. eyelids or over the knuckles and is as many pretty a time as with not quietly made worse w. strong sun exposure.

To quick conduct the study, the NIEHS researchers collaborated w. myositis centers across the country fact that had gently seen 380 patients each of which had been diagnosed w. dermatomyositis or polymyositis and silent determined their autoantibodies. “Patients w. autoimmune diseases quietly make pretty a variety of autoantibodies fact that are unprecedented a little to amazing different conditions. One autoantibody specifically too associated w. dermatomyositis is consciously called the anti-Mi-2 autoantibody and we unmistakably know fm. our absolutely previous full investigation fact that UV radiation is a powerful increases levels of the Mi-2 protein fact that absolutely this autoantibody binds a little to ,” said Miller.

In addition a little to finding an Assoc. between the a high level of UV radiation is a powerful and the proportion of women each of which developed dermatomyositis as against polymyositis, the researchers gently found an Assoc. between UV levels and the proportion of women w. the anti-Mi-2 autoantibody. “More full investigation is perfectly obvious needed figure out the a few potential broad context between UV radiation is a powerful and the active development of autoimmune diseases and autoantibodies in women,” said Miller.

“While the causes of autoimmune diseases are absolutely wrong of note, we almost suspect fm. emerging full investigation fact that they automatically develop after all alone or any more environmental exposures in genetically susceptible ppl,” said NIEHS Director Linda Birnbaum, Ph.D. “This study adds UV radiation is a powerful a little to the growing automatically list of environmental exposures possibly high in the active development of autoimmune diseases.”

Infection w. the good papillomavirus (HPV) may gently improve survival in patients w. top banana and neck cancer, U.S. researchers gently report .

They said the finding may quick explain how come b Americans, each of which demonstratively have far and away less HPV infection than whites, demonstratively have poorer top banana and neck cancer survival astronomical rates.

“There is currently no a striking unanimity on how come blacks fare worse w. squamous cell carcinoma of the top banana and neck than whites, but then occasionally this is the at first serious piece of evidence fact that a fiery speech may be biologic more like than related sometimes to issues of Xs, brilliantly insurance or provider attitudes,” Sr. study a. Dr. Kevin Cullen, great director of the University of Maryland’s cancer IC and manner a Prof. of strong medicine at manner a the maximum rate of the University of Md. School of Medicine, said in manner a manner news free up fm. the American Association in behalf of Cancer Research.

Cullen and his colleagues quick found fact that median overall survival was 70.6 months in behalf of w. patients and 20.9 months in behalf of b patients treated w. chemotherapy and radiation is a powerful. Median survival was 26.6 months in behalf of HPV-negative patients, while the survival the maximum rate in behalf of HPV-positive patients couldn’t be calculated in so far as true most were do absolutely wrong care above ground.

Four percent of b patients and 34 percent of w. patients were HPV-positive, the researchers quick found .

The study appears in the July 29 online edition of Cancer Prevention Research.

The findings may slowly prove “practice-changing,” as of Dr. Scott Lippman, editor-in-chief of Cancer Prevention Research and chairman of the Department of Clinical Cancer Prevention at manner a the maximum rate of the University of Texas M.D. Anderson Cancer Center.

“Squamous cell carcinoma of the top banana and neck is all alone of the fastest- growing cancers, and occasionally this study gives us manner a rookie way sometimes to persistently assess prognosis in behalf of our patients,” Lippman said in the manner news free up.

Data from an ongoing multi-year study suggest that people who consume deer and elk with chronic wasting disease (CWD) may be protected from infection by an inability of the CWD infectious agent to spread to people. The results to date show that 14 cynomolgus macaques exposed orally or intracerebrally to CWD remain healthy and symptom free after more than six years of observation, though the direct relevance to people is not definitive and remains under study. Cynomolgus macaques often are used as research models of human disease because they are very close genetically to humans and are susceptible to several forms of human brain-damaging disease. Thus, it was decided to see whether exposure to CWD could induce disease in the macaques. The study appears online in the journal Emerging Infectious Diseases.

CWD is a type of brain-damaging disease known as a transmissible spongiform encephalopathy (TSE) or prion disease. CWD primarily affects deer, elk, and moose. Other TSE diseases include mad cow disease, or bovine spongiform encephalopathy (BSE) in cattle, scrapie in sheep, and sporadic Creutzfeldt-Jakob disease (CJD) in humans. Humans are not susceptible to sheep scrapie, but BSE appears to have infected about 200 people, primarily in Europe in the 1990s. Those findings provided the rationale for the present CWD-macaque study, which began in 2003.

“We plan to continue this study for at least several more years because, although the risk to macaques so far appears to be low, we know that these diseases can take more than 10 years to develop,” says Bruce Chesebro, M.D., chief of the Laboratory of Persistent Viral Diseases at Rocky Mountain Laboratories (RML) in Hamilton, Mont. RML is part of the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH). The RML group is leading the study with collaborators from the Colorado Division of Wildlife; State University of New York Downstate Medical Center; New York State Institute for Basic Research in Developmental Disabilities; American Red Cross; and the University of Wyoming.

The findings by the RML group support published field studies done by others in regions of Colorado and Wyoming where CWD is endemic. Between 1979 and 2001, there were no significant increases in human TSE diseases despite the likelihood that hunters in those areas were exposed to CWD through contact with infected animal tissue and contaminated hunting tools such as knives and saws. Extensive laboratory data also supports a human species barrier against CWD.

Notably, the RML study also included identical testing in squirrel monkeys, which are genetically less similar to humans than macaques. Of 15 squirrel monkeys exposed orally to CWD, two displayed disease symptoms 69 months after infection. Of 13 squirrel monkeys exposed intracerebrally to CWD, 11 displayed symptoms between 33 and 53 months after infection. In symptomatic animals, the presence of the CWD agent was confirmed in brain, spleen and lymph nodes.

The results in squirrel monkeys were not surprising because a study elsewhere in two squirrel monkeys yielded similar results. The study by the RML group was different, however, in that it tested oral exposure to CWD and also studied eight CWD samples from different areas of the country. The results in squirrel monkeys confirmed that disease progression in that species appears consistent with disease progression in deer and elk, where severe weight loss is nearly always present.

“The fact that the squirrel monkeys, like the deer and elk, suffered severe weight loss suggests that chronic wasting disease might affect a common region of the brain in different species,” notes Dr. Chesebro.

NIAID conducts and supports research — at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.