Developing countries in Southeast Asia need to use tough laws in their fight against dengue, a leading expert said, so that homes and building sites do not provide breeding grounds for disease-carrying mosquitoes.

Duane J. Gubler, director of Asia-Pacific Institute of Tropical Medicine and Infectious Diseases, said Singapore's use of inspections and fines had helped reduce the incidence of dengue in the city-state and set an example for other countries.

If every country in the region could control mosquitoes like Singapore has, I doubt you will see a problem," Gubler said in a phone interview from Hawaii, where he is based.

Fumigation of mosquito breeding grounds and public co-operation are both key to reducing dengue, he said.

Dengue is endemic in several countries in the region including Malaysia, Thailand, the Philippines, Indonesia, Vietnam, Cambodia and Myanmar.

Singapore conducts spot checks of construction sites and homes, and contractors and residents can be punished if any mosquito larvae are found on the premises, with fines ranging from S$100 ($66) to S$20,000 ($13,100).

The city-state also conducts public health programs to ensure that people do not allow water to collect in places where mosquitoes can breed.

This has cut the incidence of homes where mosquitoes were found to less than 2 percent from 60 percent in the 1960s.

Gubler, 68, who has advised the World Health Organization (WHO) on dengue for about 25 years, has had dengue three times himself. On one occasion, he contracted the disease after a lab experiment in which he tried to get an infected mosquito to suck blood from a monkey, but was instead bitten himself.

Gubler said most Asian governments only set aside a "pittance" to tackle dengue, saying "these countries have not taken dengue seriously."

While Singapore has the best anti-dengue program in the world along with Cuba, according to Gubler, the city-state has still not managed to stamp put dengue.

Gubler, who has advised Singapore's anti-dengue efforts since 2005, said that as people travel more frequently and more widely, they are more likely to spread the disease across borders.

The number of dengue cases in Singapore this month is nearly three times the number in the same period a year ago, according to the government, which says warmer weather is partly to blame.

Between May 13 and May 19, the city-state reported 210 dengue cases, the highest weekly figure this year, but below the weekly record of 714 cases which was reported in September in 2005.

Dengue occurs mainly in the tropics and is transmitted by the female Aedes aegypti mosquito. The virus spreads across borders when infected travelers are bitten by local mosquitoes that go on to bite someone else.

The disease affects about 50 million people around the world every year, according to WHO. There are no vaccines for dengue, which has flu-like symptoms such as fever and pain in the joints, and can be fatal.

New research does not support the general belief that obesity increases bone mass and is therefore good for bone health. A study, in which investigators corrected for the mechanical loading effect of increasing body weight, suggests the opposite.

Our study found that increasing body fat mass decreases bone mass, for people of similar weight," Dr. Hong-Wen Deng from University of Missouri-Kansas City told Reuters Health. "Therefore, increasing obesity (fat mass) is not good for bone health.

The finding is "important," Deng and colleagues say, because it suggests that interventions or treatments aimed at reducing obesity may increase bone mass and thus protect against osteoporosis.

Past studies on the relationship between obesity and osteoporosis did not control for the "mechanical loading effects" of a person's total body weight on bone mass, the investigators note in a report published this month.

Deng's team reevaluated the relationship between obesity and osteoporosis taking into account mechanical loading effects of total body weight on bone mass in more than 6,400 healthy adults.

According to the investigators, when the mechanical loading effect of body weight on bone mass was adjusted for, fat mass was negatively associated with bone mass; that is, in general, the greater the fat mass, the lower the bone mass.

The results of their study, the researchers say, also "reaffirm the beneficial effects of appropriate weight-bearing and mechanical loading on a healthy skeletal system."

SOURCE: The Journal of Clinical Endocrinology and Metabolism, May 2007.

Americans should bulk up on whole grains like oatmeal, barley and brown rice to help lower their risk of clogged arteries, heart attacks and strokes, according to researchers.

In a review of seven major studies, the researchers found that higher whole grain intake was consistently linked to a lower risk of heart disease and stroke. On average, adults who ate 2.5 servings of whole grains per day were nearly one-quarter less likely to develop cardiovascular disease than their peers who rarely consumed whole grains.

Whole grains are believed to benefit the heart in a number of ways. The fiber and other nutrients in whole grains may help lower cholesterol, blood sugar and insulin levels, as well as improve blood vessel functioning and reduce inflammation in the circulatory system.

Yet surveys show that few Americans get the recommended three servings of whole grains per day, according to the authors of the new study. More than 40 percent of U.S. adults say they eat no whole grains.

"Many consumers and health professionals are unaware of the health benefits of whole grains," lead study author Dr. Philip B. Mellen, of Wake Forest University in Winston-Salem, North Carolina, said in a statement.

Some may also be confused about what exactly constitutes a whole grain. Whole grains contain three components: bran and germ, which are rich in fiber and nutrients, and an endosperm, which contains starch and protein. Highly processed grains, like white bread or snack foods made from white flour, are stripped of the bran and germ.

In contrast, whole grains -- such as oats, barley, whole wheat, brown rice and quinoa -- retain more of the nutrient-dense bran and germ.

Based on these latest findings, Mellen and his colleagues think health professionals should "redouble" their efforts to get people to eat more whole grains.

They report the results in the online edition of the journal Nutrition, Metabolism & Cardiovascular Diseases.

For the study, the researchers pooled data from seven major studies involving more than 285,000 men and women who were followed for 6 to 15 years. Overall, those who ate the most whole grains were less likely to suffer a heart attack or stroke, or die of cardiovascular causes.

This was true when other health factors, like overall diet, exercise, weight and smoking habits, were taken into account.

"Years ago, scientists hypothesized that the higher rates of chronic diseases we have in the West, including heart disease, are due, in part, to a diet full of processed foods," Mellen said.

This idea has been born out, he added, in the lower rates of obesity, high cholesterol and heart problems seen in people who opt for whole grains.

SOURCE: Nutrition, Metabolism & Cardiovascular Diseases, online May 9, 2007.

Labels on all alcoholic drinks in Britain are to carry health warnings by the end of next year, the government announced on Monday.

Under an agreement between the government and the drinks industry, the new labels will include details on how many alcoholic units each drink contains and the recommended safe drinking levels for men and women.

Binge drinking, consuming 10 or more units in one session for men and seven or more for women, is a major public health concern in Britain. More than 7.1 million English people are hazardous or harmful drinkers, according to official figures.

This landmark, voluntary agreement will help people calculate, at a glance, how much they are drinking and whether they are staying within sensible drinking guidelines," said Public Health Minister Caroline Flint.

"We want to make it as simple as possible for people to keep an eye on how much they are drinking and help them take the responsibility for lessening the impact excess alcohol can have on their health."

Although most people were aware of recommended daily guidelines, only 13 per cent kept a check on the number of units they drank, the government said. It said 75 per cent of the public backed the new labels.

The Department of Health said it also wanted the labeling to include recommendations for pregnant women. Last Friday, it issued new advice advising pregnant women and those trying to conceive to drink no alcohol at all.

Britain's health departments recommend men do not regularly exceed 3-4 units daily and women 2-3 units daily.

A unit of alcohol is 10 ml of pure alcohol which means that a pint of ordinary strength lager or a 175 ml glass of red or white wine each contain two units of alcohol.

"This is yet another practical demonstration of retailers' responsible attitude to selling alcohol," said British Retail Consortium Director General Kevin Hawkins.

"They have been actively involved in the development of this label and the concise and simple way it sets out information gives consumers an easy way to make informed decisions about how they enjoy alcohol.

If you have allergies or asthma, you need to plan ahead when you travel this summer in order to minimize situations that may trigger an attack and ruin your vacation, says the American Academy of Allergy, Asthma & Immunology (AAAAI).

The academy offers the following advice:

* Before embarking on a long road trip, turn on the car's air conditioner or heater and open the windows for at least 10 minutes before you get in the car. This will help clear out dust mites or molds that may be in the car's climate control system.
* If you have pollen or mold allergies, close the car windows and use the air conditioning while you travel.
* You can reduce your exposure to air pollution by traveling early in the morning or in the evening, when air quality is better and there's less heavy traffic.
* Try to get allergy-proof rooms at hotels. If you're sensitive to molds, get a sunny, dry room away from indoor pools.
* If you have food allergies, be extremely cautious about eating airline or restaurant food, which may not list the ingredients. Always carry injectable epinephrine is case you have a severe allergic reaction.
* If you're going on a long vacation, consider seeing an allergist/immunologist for a pre-trip physical.
* Air travel can cause significant pain for people with sinusitis, or a sinus or ear infection. If possible, delay flying. If you suffer severe sinus or ear pain while flying, take a short-acting oral decongestant or use a nasal spray decongestant about an hour before takeoff.
* The air in planes can be very dry, so use saline nasal spray once every hour to keep you nasal membranes moist.
* When packing for a trip, be sure to include all necessary medications. Bring more than you think you'll need and store them in their original containers.

More information

The U.S. National Institute of Environmental Health Sciences has more about asthma and allergy prevention.

Pupils and staff at a school in Wales are being offered anti-flu drugs after being in contact with a child suspected of contracting bird flu in an outbreak of a mild strain of the virus, health authorities said on Monday.

Teachers and children at the school, which is close to a farm in Corwen, North Wales, where the H7N2 strain of bird flu was discovered last week, were being treated with antiviral medication as a precaution, the National Public Health Service (NPHS) said in a statement.

A total of 12 people have been identified as suffering from the flu, reporting "symptoms of a flu like illness or conjunctivitis" it said, but stressed no one was seriously ill.

It identified 142 people who may have had contact with the avian flu and said it could not rule out person-to-person contact.

"Person-to-person spread would be very unusual but limited spread of this type has been seen elsewhere in the past in some cases of bird flu," said Dr Marion Lyons of the NPHS.

"As a precautionary measure the NPHS is continuing to offer people who have had contact with individuals with this illness antiviral medication to minimize the risk of spread. "

Authorities confirmed an outbreak of bird flu last Thursday among chickens at a farm in North Wales.

NOT H5N1

But it was the low pathogenic H7N2 strain of bird flu, not the H5N1 strain, which is potentially deadly to humans and has caused scares elsewhere in the past.

Lyons said that investigations into the H7N2 strain had shown that when it spreads from person to person, the illness become milder.

But she added: "Experience of this particular bird flu virus in humans is limited so we are actively managing the public health response."

Britain has been on the watch for bird disease after Europe's biggest turkey producer Bernard Matthews was forced to destroy 160,000 turkeys because of an outbreak of the H5N1 strain of bird flu in England earlier this year.

The World Health Organization says 186 people have died of bird flu since the H5N1 virus resurfaced in Southeast Asia in 2003. The virus has since spread throughout much of Asia, parts of Europe, the Middle East and Africa.

The presence of an H7 virus in poultry is treated seriously by animal health officials because scientists believe that, when allowed to circulate in poultry populations, a low pathogenic virus can mutate into the highly pathogenic form.

Poking holes in a lung is usually a bad idea. But dozens of people suffocating from a disease that traps stale air in their lungs are volunteering to try it.

The idea: Spark a slow leak in lungs so overinflated that there's not enough room left to take a deep breath, and do so without open surgery.

It's called airway bypass, one of a trio of innovative experiments — including squirting a kind of glue into the lungs — designed not to cure the lung destroyer that is the nation's No. 4 killer, but to ease breathing during its victims' last years.

And it comes amid a major government push to get more of the estimated 24 million Americans with breath-robbing COPD, or chronic obstructive pulmonary disease, diagnosed and treated sooner, to stall the need for such last-ditch care.

"This is a huge public health problem," says Dr. James Kiley, lung chief at the National Institutes of Health. "It's not going to get better unless we do something very aggressively."

Yet half of COPD sufferers don't know they have it. Aside from the eye-glazing name — a term for diseases once called emphysema and chronic bronchitis — people tend to shrug off the main symptom, shortness of breath, as poor fitness or mere aging until their lungs are ravaged.

Healthy lungs inflate and deflate like balloons as they take in oxygen and remove carbon dioxide. The windpipe feeds air into bronchial tubes that resemble an upside down tree with ever-smaller branches. Between these airways are tiny air sacs, elastic bubbles that stretch as they fill with air and then spring back into shape as used air rushes back out.

COPD destroys that elasticity. Airways collapse, blocking the way out. Air sacs distend with stale air, enlarging lungs and leading to COPD's distinctive barrel chest. Eventually, it becomes physically impossible to inhale deeply enough to get air to the lungs' remaining working spots.

Those lungs need emergency exits, decided Dr. Joel Cooper of the University of Pennsylvania.

Cooper helped pioneer an arduous surgery that cuts out portions of COPD patients' dead lung to make more space for remaining working lung. But few patients qualify; most have such widespread lung damage that there's no logical spot to remove, or couldn't survive the operation.

With airway bypass, Cooper invented a different approach: He threads a tiny needle through a tube inserted in the windpipe, down to airways about the diameter of a pencil. Smaller airways downstream are completely blocked. To route trapped air around them, he pokes up to a dozen holes through the bigger airway's wall and into surrounding air sacs. He wedges those holes open with stents, the same kind of metal scaffolding that cardiologists use to prop open clogged heart arteries.

The result: Tunnels for air to trickle out.

Does it work? No one yet knows. A pilot study of 28 patients treated abroad suggests it can help some people breathe easier. The first U.S. study, funded by stent maker Broncus Technologies, is just beginning at more than a dozen hospitals. They aim to test up to 400 patients with advanced COPD, comparing those given the real procedure with some given a sham, just a tube down the throat.

There is a serious risk: Doctors must avoid piercing the lung's many blood vessels, something that killed a German patient in that pilot study. Cooper, a financial consultant to Broncus, worked with the company to develop a probe that senses if a blood vessel is too close, so doctors can poke a different spot. Regulators are closely monitoring initial patients, to ensure the procedure is safe enough for the full study to proceed.

Other non-surgical options under study:

_Suctioning out dead air sacs and squirting a "biological glue" into them — made of proteins like your body uses to heal itself — to seal them against more buildup. Only small numbers of patients have been tested in pilot studies, but scientists are reporting some improvement in shortness of breath and ability to walk.

_Threading one-way valves inside bronchial tubes leading to the worst-clogged lung spots, to allow air and mucus to trickle out but no more air to be inhaled back in.

"Things like valves and stents and putting these biological substances in, they're a heck of a lot easier on patients" than surgery, notes Dr. Stephen Hazelrigg of Southern Illinois University, who is participating in some of the studies.

All three are still highly experimental — the research is only for people who have run out of options, cautions Dr. Bartolome Celli of Tufts University, who outlined the study trio at an American Thoracic Society meeting last week.

But, "it is promising," Celli says. "We know from the surgery data that a significant number of patients do better. If we could do the same thing without the surgery, it follows that likely the results will be positive."

Better would be to catch COPD earlier, says NIH's Kiley. It takes a simple breath test. Inhaled medications minimize symptoms, and pulmonary rehabilitation is considered key in preserving lung capacity by teaching patients to get the most air from damaged lungs and strengthenening muscles that help lung performance.

While it hasn't been scientifically proven, proper early care does minimize symptoms, "with the hope and expectation that that would prolong life," he says.

EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

On the Net:

For information on the three studies: http://www.clinicaltrials.gov.

NIH info: http://www.nhlbi.nih.gov/health/public/lung/copd/index.htm

Alex doesn't know it, but the 12-year-old golden retriever is actually a hero of cancer research.

"When she was about 10, we noticed that she started to limp," said her owner, Kevin Darling, an IT professional living near Columbus, Ohio. "She had the beginning stages of osteosarcoma -- bone cancer."

Because the tumor was confined to Alex's left front leg, veterinarians recommended amputating the limb and then giving the dog chemo. "They said she probably had a 50 percent chance of living one year," said Darling, 45.

He took that chance, and nearly three years later, Alex, minus one front leg, is still "full-tilt running, keeping up with my other dogs," Darling said.

And the bone cancer? A tiny piece of it, along with blood samples from a number of Alex's littermates and other relatives, is slated to become part of the first U.S. canine tumor tissue bank in Frederick, Md. The bank -- formally called a "biospecimen repository" -- began accepting the first of a projected 3,000 canine biopsy samples on May 1.

The new facility lies adjacent to the U.S. National Cancer Institute's own library of human cancer samples. That's no accident -- the canine tissue bank is the dream of a group of researchers who know that malignancies that occur spontaneously in dogs hold vital clues to human cancer.

"The cells of the dog are actually very, very similar to our own cells in terms of their genetic makeup," explained Dr. Matthew Breen, an associate professor of genomics at the college of veterinary medicine at North Carolina State University in Raleigh. Breen is also the treasurer of the nonprofit Canine Comparative Oncology Genomics Consortium (CCOGC), the driving force behind the tissue bank.

The mapping of both the dog and human genomes over the past decade "has shown very clearly that humans and dogs are very closely related," Breen said. "The gene that causes brown eyes in you is probably the gene that causes brown eyes in a dog."

Dogs share something else with humans that makes them ideal models for cancer research, added Dr. Jaime Modiano, an associate professor of immunology at the University of Colorado Health Sciences Center and a CCOGC board member.

"Environmental risk factors for human cancers are virtually duplicated in a dog," he noted. Unlike lab rats or mice, companion dogs "swim in the same water we swim in, they run on the same grass we run on," Modiano said.

And unlike lab animals -- which are usually artificially induced to develop cancers -- the samples collected in the canine cancer tissue bank will come from pet dogs who develop malignancies spontaneously, just as Alex did.

"Mice don't 'get' cancer, they are given cancer," Breen pointed out. "That's why this is so exciting. We, as a community, see the dog as the best biological model for spontaneous cancers, just as they occur in humans."

Americans' four-legged friends -- especially purebreds -- have other tricks of biology that make them invaluable models for cancer research. Humans -- much like "mutt" dogs -- breed willy-nilly, Breen said. But pedigreed dogs are bred so tightly that their DNA remains relatively unchanged.

That genetic purity cuts down on what Breen described as "background noise" within the genome, making cancer-causing mutations easier to identify.

In people, cancer genomics "is like trying to listen to a radio that's out of tune," Breen said. "There's just too much interference. But in some dog populations, all of a sudden a lot of that background interference is removed. So nature's message -- the pinpoint of this or that particular gene -- comes in loud and clear. It's like the radio gets tuned in."

That could mean more and quicker discoveries in cancer genetics, he said.

"I predict that we will find more cancer-associate genes by studying dog cancers over the next 10 years than is likely possible by studying human cancers over the same time," Breen said. And once a particular "oncogene" is spotted somewhere on the dog genome, scientists will simply head for the corresponding locus on the human genome to find it there.

"We can immediately translate that information into human genome information, then go look in human populations with human cancers," Breen said.

Canine cancer research is already saving and improving human lives, Modiano added.

One example: A recent NCI study into an experimental drug aimed at helping children with bone cancer was stopped early after it failed to extend the lives of dogs with the same disease.

"That saved innumerable kids from being treated with something that wasn't going to help them and was going to cause them toxicity," Modiano explained.

Even better, a new vaccine against deadly malignant melanoma has gotten much closer to FDA approval after researchers at New York's Memorial-Sloan Kettering Cancer Center showed it worked wonders in dogs stricken with the skin cancer.

"In fact, it's going to be available as a viable commercial product that vets can get off the shelf" for dogs later this year, Modiano said.

He and Breen are hard at work themselves, developing blood tests that can predict how well dogs with leukemia will respond to particular treatments. "We are also now working with groups of medical oncologists to see about these liquid tumors in people, trying to see how well it carries over for them," Modiano said.

All of this research should gain new momentum with the launch of the new biospecimen repository. According to Breen, the CCOGC, in partnership with the American Kennel Club's Canine Health Foundation, has already raised $1.7 million of the $2.2 million it needs to open the repository.

They also hope to open five dedicated specimen-collection sites nationwide. Three of those sites -- at Colorado State University, Ohio State University and the University of Wisconsin -- have already started collecting biopsy and blood samples as of the beginning of May.

Darling said he's just proud Alex has been able to help.

"Alex may get cancer again and not survive," he said. "But if what I have done has helped somebody in the future -- a person, a dog -- I'd like to know that. To know that I played a part in making that happen."

More information

There's more about the CCOGC and the biospecimen repository at the Canine Health Foundation.

Activists, including U.S. presidential candidate Hillary Clinton, put fresh pressure on New York City on Friday to compensate Ground Zero workers following the first confirmed death from inhaling the dust of the World Trade Center wreckage.

Clinton called on the city's chief medical examiner to examine the cases of workers and downtown Manhattan residents whose deaths and illnesses could have been caused by exposure to toxins at the site of the Twin Towers collapse and at the landfill where the wreckage was taken.

This week Chief Medical Examiner Charles Hirsch ruled the death of Felicia Dunn-Jones -- a lawyer who ran through the thick clouds of dust as she fled the collapsing towers on September 11, 2001 -- was linked to her exposure to the dust. He included her death five months later in the official tally of September 11 victims in New York, which is now 2,750.

Victims' rights groups said Dunn-Jones is the only victim to have received a death benefit from the Victim Compensation Fund for an illness caused by wreckage of the Twin Towers, which fell after they were struck by two hijacked airlines.

"Your recent decision to include Felicia Dunn-Jones in the official list of 9/11 victims is an important step toward acknowledging and coming to terms with the devastating and growing health impact," Clinton said in a letter to Hirsch.

U.S. Reps. Vito Fossella (news, bio, voting record), a Republican, and Carolyn Maloney (news, bio, voting record), a Democrat, also urged Hirsch to review other cases of people who had fallen ill since the September 11 attacks.

"If the toxins at Ground Zero could be responsible for the death of Felicia Dunn-Jones, who was trapped in the dust cloud for one day, think about the impact the toxins must have had on rescue and recovery workers who toiled at the site for months," Maloney said in a statement.

Marianna Pizzitola, the president of an association for retired emergency services workers, said workers who are suffering from leukemia, post-traumatic stress disorder and other illnesses are looking for "an acknowledgment from the city that their illnesses are real."

She said emergency workers who have had to miss work due to their illnesses are sometimes not compensated because the city has been reluctant to accept claims that their illnesses were caused by their exposure to the toxic dust, rather than a pre-existing condition or something unrelated to the dust.

New York Democrats in Congress said that $50 million had been set aside for September 11 health needs in a congressional appropriations bill, which awaits the approval of President George W. Bush.

Infants who sustain head injuries due to abuse have worse outcomes than their peers with head trauma due to other causes, researchers report in the journal Pediatrics this month.

The findings stem from a study of 54 children who were hospitalized for acute head trauma when they were younger than 36 months of age. The head trauma was classified as accidental, or noninflicted, in 30 children, inflicted in 11, and undetermined in 13, the report indicates.

Dr. Kent P. Hymel from Inova Fairfax Hospital for Children, Falls Church, Virginia and colleagues found that children with inflicted trauma were more likely to have greater injuries and to have heart and breathing difficulties, relative to children with noninflicted head trauma.

Other findings seen in the inflicted head trauma group included lower initial neurological function scores on a standard scale, increased impairments in consciousness, and a higher rate of brain injury.

At 6-month follow-up after the injury, children with inflicted injuries had lower mental developmental index scores and gross motor scores than those with noninflicted injuries.

"Young victims of inflicted head trauma require thorough neurodevelopmental assessment and monitoring," the authors conclude.

SOURCE: Pediatrics, May 2007.

Teenagers with large allowances may be more likely to become problem drinkers, research conducted in the UK hints.

In a study of more than 10,000 15- and 16-year-olds, British researchers found that teens with larger allowances were more likely to drink frequently, binge or drink on street corners and other public places.

The large majority of the teenagers in the study -- 88 percent -- had tried alcohol at some point. But risky drinking was particularly common among teenagers with more pocket money, presumably because they were better able to buy their own alcohol.

About one-third of teens in the survey said they bought their own alcohol, and they were six times more likely than their peers to drink in public places, three times more likely to drink frequently and twice as likely to binge on a regular basis.

The findings suggest that parents could help curb problem drinking by keeping tabs on how their children spend their money, according to lead study author Mark A. Bellis, of Liverpool John Moores University.

The results also call for better enforcement of laws prohibiting alcohol sales to minors, he told Reuters Health.

Bellis and his colleagues report the findings in the online journal Substance Abuse Treatment, Prevention and Policy.

Besides risk factors for problem drinking, the survey also identified some protective factors. For example, teens who drank alcohol with their parents in a family setting -- like having wine with dinner -- were less likely to binge or drink in other particularly risky ways.

"Put simply," Bellis said, "by the age of 14 most children in the UK have drank some alcohol, and they are either learning to drink it from parents in a secure home environment or from peers in a park, bar or on a street corner."

Teens who learn from their parents may be learning how to drink moderately and responsibly, he noted. Parents may be able to lower the odds of problem drinking by talking to their teenagers about "how to and how not to" drink alcohol, Bellis said.

But they should also make sure they know how their kids are spending their money, he noted. In this study, teens whose parents gave them more than 10 pounds -- or roughly $20 -- each week were more likely to use alcohol in particularly risky ways.

Parents are not, however, the only ones with a responsibility, according to Bellis. They need help, he said, from strict enforcement of underage sales laws -- which, in the UK, apply to teenagers younger than 18.

"Those establishments that continue to sell alcohol to people underage should be penalized with the full force of the law," Bellis said.

SOURCE: Substance Abuse Treatment, Prevention and Policy, online May 10, 2007.

A new study suggests that ovarian cancer screening with a technique called transvaginal ultrasonography (TVS) may catch ovarian cancer early, at a more curable stage.

TVS involves using an ultrasound probe placed in the vagina to direct sound waves through the vaginal wall towards the ovaries to detect abnormalities. The new study shows that TVS screening is able to detect ovarian cancers at an earlier stage, perhaps increasing their chances of survival.

The early diagnosis of ovarian cancer is difficult and the disease is often not detected until it has reached an advanced stage. Compared with other gynecologic cancers, ovarian cancer carries a very poor prognosis.

Dr. John R. van Nagell, from the University of Kentucky in Lexington, and colleagues assessed the value of annual TVS screening for ovarian cancer in 25,327 women who were seen between 1987 and 2005.

To be eligible for the study, the women had to be at least 50 years old with no cancer-related symptoms or at least 25 years old with a family history of ovarian cancer.

Overall, 364 women (1.4 percent) had a persistent ovarian tumor on TVS, the authors report in the journal Cancer. Malignant cases included 35 primary invasive ovarian cancers, 9 ovarian tumors of low malignant potential, and 7 "metastatic" cancers that had already spread beyond the ovaries. Most of the contained or "non-metastatic" ovarian tumors were early stage I tumors.

During an average follow-up of about 5 years, 38 women were alive and well, 4 had died of their cancer, and 2 had died from other causes.

The 2-year survival rate in annually TVS screened women approached 90 percent and the 5-year survival rate in screened women was a little over 77 percent.

TVS screening was highly sensitive and specific in detecting ovarian cancer. However, "false-negative" results were obtained in nine women, including three who died of their disease, the investigators note.

Summing up, the researchers say early detection of ovarian cancer could potentially improve treatment efficacy and reduce deaths. "The protective effect of annual sonographic screening on ovarian cancer mortality observed in the current trial should only increase as more specific biomarkers are added to TVS in screening algorithms," they conclude.

SOURCE: Cancer, May 1, 2007.

Roughly half of adults who use herbal supplements do not use them in accordance with evidence-based" indications, U.S. researchers report.

The findings, which appear in the Mayo Clinic Proceedings for May, stem from more than 30,000 adults who were surveyed regarding their use of herbs.

The six herbs studied and their evidence-based indications were: echinacea for upper respiratory tract infection, garlic for high cholesterol, ginseng for mental performance/diabetes, St. John's wort for depression, soy for high cholesterol/hot flashes, and kava-kava for anxiety.

Overall, 55 percent of subjects used herbs for their appropriate evidence-based indications, results showed. However, for most of the herbs, evidence-based usage rates hovered around 32 percent.

The exceptions were ginseng, with an evidence-based usage rate of just 3.8 percent, and echinacea, by far the most popular herb, with a rate of 68 percent.

Women were more likely than men to use herbs according to their evidence-based indication, as were college-educated individuals. Conversely, people younger than age 60 and black persons were more apt to herbs for things outside their evidence-based indications.

In a written statement, study chief Dr. Aditya Bardia, from the Mayo Clinic in Rochester, Minnesota, urges doctors, pharmacists, and other health professionals to "proactively educate consumers and advocate for public health policies that would disseminate evidence-based information regarding the appropriate use of herbs."

"Further research is needed to confirm the study findings and evaluate mechanisms that enhance evidence-based use of herbal supplements," the authors conclude.

SOURCE: Mayo Clinic Proceedings, May 2007.

More adults, especially women, are smoking these days and their secondhand smoke may be contributing to the asthma epidemic among children in the United States, results of a study suggest.

This is the first study to suggest, and provide evidence consistent with the hypothesis that the parallel increase in smoking, especially among women who are primary caregivers, may explain the increase in asthma in children via increased exposure to ETS (environmental tobacco smoke) over time," Dr. Renee D. Goodwin, of Columbia University in New York City, told Reuters Health.

It is conceivable that greater efforts to protect children from exposure to secondhand smoke, from birth onwards, may be effective in starting to prevent asthma in children and ultimately decrease the direction of this epidemic," she added.

There has been a 3-fold increase in the prevalence of childhood asthma over the past 30 years, for unknown reasons, particularly in industrialized nations, studies show. Currently, more than 15 million children experience daily secondhand tobacco exposure at home and almost 5 million children in the US under the age of 18 are known to have asthma.

Goodwin investigated whether increased cigarette smoking, particularly among women, after World War II may have indirectly contributed to the increasing asthma epidemic among children.

The researcher examined data on 4,500 children who were involved in the National Health Interview Survey and compared it with data from the American Lung Association on cigarette use in the United States from 1900 to 2003.

As suspected, Goodwin found that rates of cigarette use during the past century increased along with rates of childhood asthma.

For example, for each consecutive year from 1980 to 1995, there was an estimated 5 percent annual increase in the overall prevalence of asthma among children, and this increase was particularly evident among 5- to 10-year olds, Goodwin notes in the Annals of Allergy, Asthma & Immunology.

Likewise, in 2003, an estimated 400 billion cigarettes were consumed, a substantial increase from the estimated 2.5 billion cigarettes that were smoked in 1900. Cigarette smoking reached its peak around 1981 with 640 million cigarettes smoked annually.

Although cigarette consumption in the US had declined in the past 10 years, "the consequences and health effects of the drastic increase in cigarette consumption in the mid-1980s are thought to be still affecting adults and children in the United States," Goodwin writes.

And "while new laws are increasingly implemented to protect workers from smoke in the workplace, diners in restaurants and even bar patrons, from the dangers from secondhand smoke, no such measures have been taken that directly aim to protect children, who are most vulnerable," she contends.

In light of this, "educational programs aimed at high risk groups for smoking may be beneficial," Goodwin added, "as it is likely that many are unaware of the impact of ETS on child respiratory health."

SOURCE: Annals of Allergy, Asthma & Immunology, May 2007.

President Luiz Inacio Lula da Silva announced a new program Monday to sharply decrease unwanted pregnancies in Latin America's largest nation by subsidizing birth control pills.

Less than a month after Pope Benedict XVI criticized government-backed birth control measures during a visit to Brazil, Silva said the plan will give poor Brazilians "the same right that the wealthy have to plan the number of children they want."

Brazil already hands out free condoms and birth control pills at government-run pharmacies across Latin America's largest nation.

But many poor people in the nation of 190 million don't go to those pharmacies, so the government decided to offer the pills at significantly reduced prices at 3,500 private drug stores, said Health Minister Jose Gomes Temporao.

The number of drug stores offering the subsidized pills should rise to 10,000 by the end of this year, Temporao said. When the 100 million real (US$51 million, euro37.9 million) program is fully under way, the government will be handing out 50 million packages of birth control pills each year.

Each government-subsidized package — with enough pills to last a month — will cost 0.40 Brazilian reals (US$0.20, euroO.15). They now retail for 5 reals (US$2.56, euro1.90) to 50 reals (US$25.60, euro19.03).

The Health Ministry said it does not plan to subsidize condoms at private drug stores, but Brazil already has an anti-AIDS program that provides millions of free condoms annually, often just before the debauchery seen during the nation's Carnival celebrations.

Temporao also announced the government also plans to increase the number of free vasectomies performed at state hospitals.

During his visit to Brazil May 9-13, Benedict repeatedly railed against legalized contraception as a threat to "the future of the peoples" of Latin America.

But advocates for women's rights applauded Silva's decision, saying it was long overdue in the world's largest Roman Catholic country, though some worried whether the government would follow through.

"Too often, Brazil makes really wonderful laws that remain on paper because there is no political will," said Mary Luci Faria, who coordinates city government programs for women in Sao Paulo.

Faria said the program could reduce the 800,000 illegal abortions that Brazilian women have each year.

About 4,000 women die from the back-office procedures annually, making it the fourth leading cause of maternal death in Brazil after hypertension, hemorrhages and infections.

Benedict also harshly criticized abortion during his visit, just weeks after Mexico City lawmakers legalized it.

While abortion is illegal in most situations in Brazil, Silva said shortly before the pope's visit that it should be considered as a public health issue, and Temporao wants a national referendum on the issue.

Polls show Brazilians overwhelmingly oppose changing abortion laws, but advocates for women attending Silva's speech on birth control said they were glad the president took a stand on the theme with the pope. While Silva says he personally opposes abortion, he favors a national debate on the issue.

"The Church has no right to interfere with what a woman decides to do with her body or her health," said Dr. Eleonora Menicucci, a professor of preventive medicine at the Federal University of Sao Paulo's medical school.

Poking holes in a lung is usually a bad idea. But dozens of people suffocating from a disease that traps stale air in their lungs are volunteering to try it.

The idea: Spark a slow leak in lungs so overinflated that there's not enough room left to take a deep breath, and do so without open surgery.

It's called airway bypass, one of a trio of innovative experiments — including squirting a kind of glue into the lungs — designed not to cure the lung destroyer that is the nation's No. 4 killer, but to ease breathing during its victims' last years.

And it comes amid a major government push to get more of the estimated 24 million Americans with breath-robbing COPD, or chronic obstructive pulmonary disease, diagnosed and treated sooner, to stall the need for such last-ditch care.

"This is a huge public health problem," says Dr. James Kiley, lung chief at the National Institutes of Health. "It's not going to get better unless we do something very aggressively."

Yet half of COPD sufferers don't know they have it. Aside from the eye-glazing name — a term for diseases once called emphysema and chronic bronchitis — people tend to shrug off the main symptom, shortness of breath, as poor fitness or mere aging until their lungs are ravaged.

Healthy lungs inflate and deflate like balloons as they take in oxygen and remove carbon dioxide. The windpipe feeds air into bronchial tubes that resemble an upside down tree with ever-smaller branches. Between these airways are tiny air sacs, elastic bubbles that stretch as they fill with air and then spring back into shape as used air rushes back out.

COPD destroys that elasticity. Airways collapse, blocking the way out. Air sacs distend with stale air, enlarging lungs and leading to COPD's distinctive barrel chest. Eventually, it becomes physically impossible to inhale deeply enough to get air to the lungs' remaining working spots.

Those lungs need emergency exits, decided Dr. Joel Cooper of the University of Pennsylvania.

Cooper helped pioneer an arduous surgery that cuts out portions of COPD patients' dead lung to make more space for remaining working lung. But few patients qualify; most have such widespread lung damage that there's no logical spot to remove, or couldn't survive the operation.

With airway bypass, Cooper invented a different approach: He threads a tiny needle through a tube inserted in the windpipe, down to airways about the diameter of a pencil. Smaller airways downstream are completely blocked. To route trapped air around them, he pokes up to a dozen holes through the bigger airway's wall and into surrounding air sacs. He wedges those holes open with stents, the same kind of metal scaffolding that cardiologists use to prop open clogged heart arteries.

The result: Tunnels for air to trickle out.

Does it work? No one yet knows. A pilot study of 28 patients treated abroad suggests it can help some people breathe easier. The first U.S. study, funded by stent maker Broncus Technologies, is just beginning at more than a dozen hospitals. They aim to test up to 400 patients with advanced COPD, comparing those given the real procedure with some given a sham, just a tube down the throat.

There is a serious risk: Doctors must avoid piercing the lung's many blood vessels, something that killed a German patient in that pilot study. Cooper, a financial consultant to Broncus, worked with the company to develop a probe that senses if a blood vessel is too close, so doctors can poke a different spot. Regulators are closely monitoring initial patients, to ensure the procedure is safe enough for the full study to proceed.

Other non-surgical options under study:

_Suctioning out dead air sacs and squirting a "biological glue" into them — made of proteins like your body uses to heal itself — to seal them against more buildup. Only small numbers of patients have been tested in pilot studies, but scientists are reporting some improvement in shortness of breath and ability to walk.

_Threading one-way valves inside bronchial tubes leading to the worst-clogged lung spots, to allow air and mucus to trickle out but no more air to be inhaled back in.

"Things like valves and stents and putting these biological substances in, they're a heck of a lot easier on patients" than surgery, notes Dr. Stephen Hazelrigg of Southern Illinois University, who is participating in some of the studies.

All three are still highly experimental — the research is only for people who have run out of options, cautions Dr. Bartolome Celli of Tufts University, who outlined the study trio at an American Thoracic Society meeting last week.

But, "it is promising," Celli says. "We know from the surgery data that a significant number of patients do better. If we could do the same thing without the surgery, it follows that likely the results will be positive."

Better would be to catch COPD earlier, says NIH's Kiley. It takes a simple breath test. Inhaled medications minimize symptoms, and pulmonary rehabilitation is considered key in preserving lung capacity by teaching patients to get the most air from damaged lungs and strengthenening muscles that help lung performance.

While it hasn't been scientifically proven, proper early care does minimize symptoms, "with the hope and expectation that that would prolong life," he says.


EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

On the Net:

For information on the three studies: http://www.clinicaltrials.gov.

NIH info: http://www.nhlbi.nih.gov/health/public/lung/copd/index.htm

Researchers say they've moved much closer to untangling the genetic threads that raise a woman's chance for breast cancer.

A set of studies published Sunday in the journals Nature and Nature Genetics identified four new breast cancer susceptibility genes, as well as several genetic markers, that are associated with the risk for the disease and that deserve further investigation.

The findings may be the most important genetic discoveries relating to breast cancer genetics since the identification of the BRCA1 and BRCA 2 susceptibility mutations in 1994, experts say.

"With these three reports, we've doubled or more the number of genes in which inherited variations are known to be associated with an increased risk of breast cancer. It's a big quantum of new knowledge," said David Hunter, lead author of one of the papers and co-author on another.

"What we hope will happen is that each of those genes or gene regions will lead us to better understand the mechanisms and biology behind breast cancer," he said. "And that with that better understanding, we'll be able to develop improved means of prevention and treatment."

Hunter is professor of cancer prevention at the Harvard School of Public Health and an epidemiologist with Brigham & Women's Hospital, both in Boston.

Other experts echoed those sentiments. Because the research involved such a large team of international researchers, it was difficult to identify experts who had not been involved with the odyssey in one way or another.

"These findings are really very exciting. Ever since BRCA 1 and BRCA 2, we have been looking for genes associated with breast cancer, and there haven't been many identified," said Heather Spencer Feigelson, a co-author on one of the papers and strategic director of genetic epidemiology at the American Cancer Society in Atlanta. "These are three independent, genome-wide association studies coming out simultaneously that give us some new clues."

"It means a tremendous amount. It's very exciting," added Dr. Stephen Chanock, who was involved in two of the papers and is a senior investigator at the U.S. National Cancer Institute. "This opens a whole series of new doors for therapy and, when we can start to explain it better, prevention."

Mutations in the BRCA1 and BRCA2 genes, the best-known susceptibility genes identified thus far, increase a woman's risk of developing both breast and ovarian cancer. But these genes account for only a small proportion of total breast cancer cases, because the frequency of the mutations is so low in the general population.

"The BRCA1 and 2 genes were milestones in cancer research, but they are rare mutations," Chanock said. "If you have one of those, you have a particularly higher risk of developing breast or ovarian cancer, but 95 percent of the population is not affected by these rare but very significant genes."

Other genes have also been implicated in breast cancer susceptibility but, again, most of these are rare.

"Then the question is, well, maybe it's a conglomeration of things, and what does that complex conglomeration look like?" Chanock continued. "We are just at the dawn of pulling out the major pieces of that."

The first study, appearing in Nature, involved several stages of analysis. That, in turn, led to an analysis of 30 single nucleotide polymorphisms ("SNPs") in 21,860 breast cancer patients and 22,578 controls.

Out of that analysis, the investigators, based in Cambridge, U.K., identified four genes linked with genetic susceptibility to breast cancer (FGFR2, TNRC9, MAP3K1 and LSP1).

The researchers also found five regions of DNA that were present more often in breast cancer patients, suggesting that elements in these regions might raise a woman's risk.

A second study, this one appearing in Nature Genetics, was carried out as part of a collaboration -- called The Cancer Genetic Markers of Susceptibility or CGEMS project -- between Harvard and the NCI. It found that variations of the gene FGFR2 were associated with a heightened risk of breast cancer.

Women of European ancestry who inherited one copy of the FGFR2 mutation increased their breast cancer risk by about 20 percent and by 60 percent if they had two copies.

This same association was found by the Cambridge researchers as well.

These FGFR2 variants, which appear to be involved in cell growth or division, are thought to be present in more than 60 percent of U.S. female adults.

The final paper, also appearing in Nature Genetics, found genetic variants on chromosome 2 and on chromosome 16 that increase the risk of estrogen-receptor-positive breast cancer. One of these variants is located near TNRC9, which was identified in the U.K. study.

Researchers are not advocating that each gene be tested, because the risk from each is relatively small. One day, however, a test for gene combinations may be useful.

"We wouldn't ask to test each of them but, certainly, as we learn more about this, it will give us more clues about the etiology and biology and may lead to differences in treatment," Feigelson said. "This tells us what genes and where to look, and that's the important first step."

"These are all markers. They don't tell you why someone gets breast cancer. They tell us that parts of the genome are very, very important," Chanock added. "We have to figure out what they are."

The technology used in the research only became available last year and is now being applied to a wide variety of diseases, including diabetes and prostate cancer. It will also continue to be applied to the genetics of breast cancer.

"This is sort of the middle of the story," Hunter said. "It is by no means the end of the story."

More information

Visit the U.S. National Cancer Institute for more on its Cancer Genetic Markers of Susceptibility project.

Labels on all alcoholic drinks in Britain are to carry health warnings by the end of next year, the government announced on Monday.

Under an agreement between the government and the drinks industry, the new labels will include details on how many alcoholic units each drink contains and the recommended safe drinking levels for men and women.

Binge drinking, consuming 10 or more units in one session for men and seven or more for women, is a major public health concern in Britain. More than 7.1 million English people are hazardous or harmful drinkers, according to official figures.

This landmark, voluntary agreement will help people calculate, at a glance, how much they are drinking and whether they are staying within sensible drinking guidelines," said Public Health Minister Caroline Flint.

"We want to make it as simple as possible for people to keep an eye on how much they are drinking and help them take the responsibility for lessening the impact excess alcohol can have on their health."

Although most people were aware of recommended daily guidelines, only 13 per cent kept a check on the number of units they drank, the government said. It said 75 per cent of the public backed the new labels.

The Department of Health said it also wanted the labeling to include recommendations for pregnant women. Last Friday, it issued new advice advising pregnant women and those trying to conceive to drink no alcohol at all.

Britain's health departments recommend men do not regularly exceed 3-4 units daily and women 2-3 units daily.

A unit of alcohol is 10 ml of pure alcohol which means that a pint of ordinary strength lager or a 175 ml glass of red or white wine each contain two units of alcohol.

"This is yet another practical demonstration of retailers' responsible attitude to selling alcohol," said British Retail Consortium Director General Kevin Hawkins.

"They have been actively involved in the development of this label and the concise and simple way it sets out information gives consumers an easy way to make informed decisions about how they enjoy alcohol.

The official start of summer this Memorial Day weekend is a great time to remember the danger to eyes from the sun's ultraviolet rays, say experts at Prevent Blindness America.

"Most of us wouldn't dream of staying outside in the sun without putting on sunscreen lotion. But we also have to remember to wear both UV-blocking lenses and a brimmed hat to protect our eyes as well," Daniel G. Garrett, senior vice president of Prevent Blindness America, said in a prepared statement.

But a recent survey found that only nine percent of respondents were aware that extended sun exposure can damage vision, and only about 16 percent said they wear sunglasses when they're outdoors for long periods of time, according to the Chicago-based organization.

Only about a third of respondents said they wear a hat when they're out in the sun.

UV damage to eyes is cumulative, and the harmful effects may not be evident for years. Extended UV exposure has been linked with a number of eye problems including cataract, age-related macular degeneration, pterygium (a corneal disorder), and photokeratitis.

As part of UV Awareness Month in May, Prevent Blindness America is launching a new Web site to educate people about what they can do to protect their eyes. The site includes a variety of features, ranging from information about risk factors to tips for buying sunglasses.

Sunglasses don't have to be expensive to be effective, which means they block out 99 percent to 100 percent of both UV-A and UV-B radiation.

More information

Here's where you can find information from Prevent Blindness America on the dangers of UV exposure and how to protect your eyes.

Hypnotherapy, antidepressants and other mind-centered treatments could help people battling severe irritable bowel syndrome, a British survey of the literature finds.

Such treatments are effective because "people who have irritable bowel syndrome (IBS) don't necessarily have a clinical disorder in terms of psychology but have certain behavior patterns that make them vulnerable to symptoms," explained Bu'Hussain Hayee, a clinical research fellow at University College Hospital in London.

He and Dr. Ian Forgacs, a consulting gastroenterologist at Kings College Hospital, compiled the survey, published in the May 26 British Medical Journal, as a working guide for physicians.

"In part, the symptoms of irritable bowel syndrome are similar to those you find in depression, so things that work for depression work for it," Hayee said. Patients with IBS "are not depressed," he said, "but the treatments work."

Symptoms of the condition can include cramping, bloating, constipation and diarrhea. The condition is surprisingly common. The U.S. National Institute of Diabetes and Digestive and Kidney Disease estimates that as many as 1 in 5 adult Americans will suffer one or more symptoms of IBS at some time in their lives. Most people can control symptoms with diet, medications and stress management.

One common stress-management technique successfully used in IBS is cognitive behavioral therapy, Hayee said. That's a general term for a set of psychotherapies based on the belief that changing the way a person thinks about a condition can bring about improvement, even if the condition does not change.

"It has proven to be effective," Hayee said. "It focuses on the patient's perception of symptoms rather than on the symptoms themselves." Studies have shown that cognitive behavior therapy is as effective in IBS as antidepressant medication, and that its effects last longer, he said.

Hypnotherapy has also proven effective in small trials, although a recent review found insufficient evidence to recommend its widespread use, Hayee said.

In a condition with such a wide range of symptoms, treatment must be tailored to the individual patient, he said. "In general, people who are more open to the idea of therapy will do better," Hayee said.

IBS is a case of "brain-gut interaction," added Dr. Sita Chokhavatia, a professor of medicine in the gastroenterology department of Mount Sinai Medical Center in New York City, who specializes in treating the condition.

"There is a 'big brain' in the skull and a 'little brain' in the enteric [intestinal] tract," she said. "Either you have too much information going up or too much information going down."

Treatment requires doctor-patient discussion in a psychiatric setting, Chokhavatia said. "You discuss it with patients -- not so much as a psychological disease per se but as a brain-gut reaction, so the patient can sense less pain."

The focus must be on the symptoms felt by a specific patient, she said. "Cognitive behavioral therapy has been used more in patients with constipation, where it has been shown to be successful in some studies," Chokhavatia said.

Talks between doctor and patient are used to establish levels of anxiety and stress felt by individuals, she said. If stress levels are high, hypnotherapy might be offered, "like people trying to stop smoking," Chokhavatia said.

The official government one-in-five estimate for IBS incidence might be low, she added, "Lots of people don't complain," Chokhavatia said. "They feel symptoms but don't come to the doctor."

Those who do seek help have a reasonable chance of getting it under control, in terms of gaining a better quality of life, she said.

More information

Causes, symptoms and treatments for IBS are described by the U.S. National Digestive Diseases Information Clearinghouse.

While not as dangerous as talking on a cell phone while driving, passengers can cause distractions that boost crash risks, an Australian study finds.

And the more passengers in the car, the greater the likelihood of a crash, the researchers noted.

Study lead investigator Dr. Suzanne McEvoy, of the George Institute for International Health in Sydney, found that "carrying passengers in the car has a number of potentially distracting effects that also occur with mobile phone use while driving. Moreover, carrying passengers may have additional effects on the driver, including peer influence."

"Drivers with passengers were almost 60 percent more likely to have a motor vehicle crash resulting in hospital attendance, irrespective of their age group. The likelihood of a crash was more than doubled in the presence of two or more passengers," McEvoy said in a prepared statement.

Previous studies by researchers at the institute concluded that cell phone use while driving was associated with a fourfold increased risk of having a crash.

"In contrast to mobile phone use, passengers, with some exceptions, are generally aware of the road conditions and can moderate their conversation as needed," study co-author Mark Stevenson, a professor in the School of Public Health at the University of Sydney, said in a prepared statement.

"However, although the risk associated with carrying passengers is lower than that associated with mobile phone use, it is likely to have a higher contribution to accidents because of higher incidence of taking passengers as opposed to using a mobile phone while driving," Stevenson said.

More information

The U.S. National Highway Traffic Safety Administration has more about traffic safety.

Just ahead of competing in this Sunday's Indianapolis 500, racing legend Al Unser Jr. is shifting gears to focus on an even bigger challenge: alcoholism.

For the first time, the two-time Indy champ is publicly acknowledging that he is an alcoholic.

"I've been fighting alcoholism for a long time," said Unser Jr, 45. "And I really feel that by telling a little about my story and my struggles and my knowledge of the disease that I can help people learn about it."

He hopes his story will "motivate them to seek help from a doctor or a therapist or counseling, and show them that there's many options for getting treatment for this disease."

Unser Jr. has teamed up with a new national alcoholism-awareness campaign, entitled LIVE Outside the Bottle, designed to educate the public about alcoholism and provide resources for treatment.

Launched in March, the campaign's multi-media exhibit, "The Story of Alcoholism in America," is right now making its way through 14 cities nationwide. The project is sponsored by the pharmaceutical companies Alkermes and Cephalon. The two companies manufacture Vivitrol, an injectable drug used to curb alcohol cravings.

Unser Jr. will join the tour when it makes a pit stop in Indianapolis on Friday, setting up just outside the Indy 500 racetrack two days before the event.

"This gives me a big platform to tell my story and reach as many people as possible, both racing fans and non-racing fans," he said.

Unser Jr.'s struggle is shared by an estimated 18 million other Americans plagued by alcoholism, according to the National Council on Alcoholism and Drug Dependence. They note that alcoholism is the third leading preventable cause of death in the United States, with more than 100,000 deaths, and nearly half of all U.S. traffic fatalities each year, linked to problem drinking.

The scion of a famous car-racing family -- uncle Bobby and dad Al Unser are both rated among the top 10 Indy race winners ever -- Unser Jr. began his professional racing career at the tender age of 16.

"When you won the race, they gave you champagne," he said. "Now, I wasn't a big drinker in my twenties and thirties, but, again, the disease is progressive. So, it progressed on me and ended up taking over my life, and I didn't even know it."

Unser Jr. first came to terms with his illness back in 2002, after an arrest for a domestic violence incident.

"I kind of looked back on the fact that any time I got in trouble, it was alcohol-related," he said. "So, I put myself into a rehab, and I learned about the disease. Prior to that, my wife, Gina, would say to me that I'm an alcoholic, and I would say 'no way.' But with her past knowledge of the disease -- meaning her mom was an alcoholic -- she knew what she was talking about."

Unser Jr. could also have looked to his own family history, since his mother's father died of alcoholism.

But his 2002 attempt at rehab was short-lived. After 56 days sober, Unser Jr. started drinking again.

"During those 56 days, I started to tell myself, 'I'm not an alcoholic,'" he said. "That I can have one drink and stop. I had so many plans, so many different ways to prove that I wasn't an alcoholic. That's the sickness of the disease."

Retirement from the circuit in 2004 only exacerbated things.

"When I retired, I ended up drinking even more," he remarked. "It was a never-ending cycle. But I had control of it -- I thought. And, in fact, it had control of me the whole time, which eventually got me in trouble again this last January."

This time, Unser Jr. was arrested in Nevada for driving under the influence -- an event he described as a rock-bottom turning point.

"I was a professional racecar driver that was arrested for DUI," he said. "I had never been arrested for anything of that nature before." That event "made me take a long hard look at my life," he said. "It made me admit 100 percent I'm an alcoholic. And I'm going to get control of this disease."

Since that time, treatment has meant reading as much as he can about the disease and talking with other alcoholics. Unser Jr. says he has not yet taken any prescription medications to help curb his alcoholism.

"But, again, I want to emphasize that there are so many options for treatment, because there are a lot of advances in terms of this disease," he noted. "AA (Alcoholics Anonymous) works for some people; it doesn't work for others. There's medication out there that works for people, along with counseling and therapy. Each person is different. And the whole basis of this is to learn about it, and learn what works for you."

Today, this father of six -- who ranks sixth on the all-time Indy win list -- says "it's awesome" to be both sober and racing again after a three-year hiatus. This Sunday, he'll be at the starting line again, competing in the race he first won back in 1992 and again in 1994.

Meanwhile, Unser Jr. is spreading the word that education and motivation are key to beating a crippling disease.

"Now I look back on it, and, without alcohol, I would've been a much better husband, a much better father, and a much better racecar driver," he said. "And I am so thankful that, today, I can say that I live outside the bottle, and life is wonderful."

More information

There's more on alcoholism at the U.S. National Institute on Alcohol Abuse and Alcoholism.

For some of the more than 54 million Americans who suffer a mental illness in any given year, the stigma of their condition may prevent them from seeking treatment, U.S. experts say.

As part of Mental Health Month in May, a team at the Menninger Clinic in Houston reviewed the top five myths about mental illness:

Myth #1. People with mental illness are weak. In fact, many famous and powerful people have struggled with depression and other forms of mental illness. Making the decision to seek help for mental illness, and participating in treatment, takes strength in itself.

Myth #2. Medications cure mental illness. While medicines can help manage symptoms, they're only part of the treatment process, which also includes therapy to help patients better understand the factors that contribute to their mental illness.

Myth #3. People with mental illness could "snap out of it" if they really wanted to. That's no different than telling someone with the flu, diabetes, hypertension or other physical illness or problem to "snap out of it."

Myth #4. Children don't have mental illness. In fact, 10 percent of children and adolescents in the United States suffer from serious emotional and mental disorders that have a major impact on their day-to-day lives, according to a 1999 U.S. Surgeon General report.

Myth #5. People with mental illness don't get well. The truth is that a combination of medication and psychological treatments and support reduces symptoms and improves quality of life in between 70 percent and 90 percent of people with mental illness, according to the National Alliance on Mental Illness.

More information

The U.S. Surgeon General offers an overview of mental illness.

Doctors say there's new hope for patients with a severe form of diabetes occurring after partial surgical removal of the pancreas, a condition called pancreatogenic diabetes.

A procedure called "pancreatic islet cell autotransplantation" may help these patients, Mayo Clinic researchers report.

In a prepared statement, co-lead researcher Santhi Swaroop Vege, a gastroenterologist and professor of medicine, explained that, "after attempts to control pain and improve malabsorption problems have been exhausted, total or near-total removal of the pancreas is recommended for patients with severe cases of pancreatitis in which pancreas tissue dies."

This can result in pancreatogenic diabetes, however.

The Mayo team studied pancreatic islet autotransplantation in three patients who had 50 percent to 70 percent of their pancreas removed.

The procedure involves isolation and purification of insulin-producing cells (islets) after the entire, or part of the, pancreas is removed. The islets, which are injected into the patient, make their way to the liver, implant there, and begin producing insulin.

Of the three patients, two did not develop pancreatogenic diabetes, and one developed a less complicated form of this kind of diabetes.

"Our initial experience with pancreatic islet autotransplantation in this patient population shows that the procedure is a feasible treatment option," co-lead investigator Yogish C. Kudva, an endocrinologist and associate director of Mayo's human islet isolation laboratory, said in a prepared statement.

"Long-term follow up, expansion to additional patients and research studies will help us better understand the fully utility of this procedure," Kudva said.

The study was to be presented Tuesday at the Digestive Disease Week meeting in Washington, D.C.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about pancreatitis.

The U.S. Food and Drug Administration said Friday that it plans to stop companies from marketing unapproved products that contain the cold treatment guaifenesin in unapproved timed-release form.

Guaifenesin is commonly used in medicines to treat cough and cold symptoms by stimulating removal of mucus from the lungs.

"Today the FDA is issuing a notice that guaifenesin in timed-release form cannot be marketed without approved application," Deborah M. Autor, director of the FDA's Office of Compliance, Center for Drug Evaluation and Research, said during an afternoon teleconference.

The ban does not include products containing guaifenesin that are in immediate-release form, she said.

Some 20 companies make timed-release products containing guaifenesin, and approximately 65 firms distribute these products, Autor said. "These medications have bypassed FDA's approval process," she said. "The FDA has not determined that they are safe and effective as formulated and manufactured."

The FDA requires that timed-released drugs be approved. The agency wants to be sure that the products' active ingredients are released safely and effectively, and maintain their effect over the time the product is intended to work, Autor said.

According to Autor, the ban includes the top-selling drugs Guaifenex, Crantex and Amibid. These and other guaifenesin timed-released drugs are available by prescription only.

Autor noted that so far, only Adams Respiratory Therapeutics has gotten FDA approval for timed-release products containing guaifenesin. These products are sold under the names Mucinex and Humibid.

The FDA expects companies selling unapproved products containing guaifenesin to stop manufacturing them within 90 days. In addition, they must stop shipping them in interstate commerce within 180 days.

"Manufacturers must stop making timed-released drug products containing guaifenesin no later than August 27, 2007," Autor said. "Firms must stop shipping the products no later than November 25, 2007."

After these dates, companies that want to sell products containing guaifenesin in timed-release form must get FDA approval or face regulatory action.

More information

For more information on unapproved drugs, visit the U.S. Food and Drug Administration.

Treatment of elderly patients with type 1 and type 2 diabetes in U.S. nursing homes often fails to meet American Diabetes Association standards, according to a new study.

Researchers at the Ohio University College of Osteopathic Medicine studied the quality of care received over a year by 108 diabetic residents living in 11 nursing homes in Ohio and West Virginia.

They found that only 38 percent of patients met blood glucose [sugar] goals, only 55 percent had satisfactory blood pressure levels, and only 31 percent had lipids (serum total cholesterol) checks yearly. Of those who had regular lipids checks, only 58 percent had acceptable levels.

The study authors noted that these three areas -- hypertension control, blood sugar and cardiovascular risk factors (such as cholesterol) -- have a major effect on the life expectancy of people with diabetes.

The findings, published Friday in the journal Diabetes Care, revealed that the nursing homes in the study lacked a systematic approach to diabetes care and that treatment guidelines for diabetic nursing home residents must be developed in order to provide optimal care.

The researchers are currently developing treatment protocols for diabetic patients in nursing homes. They plan to offer these protocols to the medical directors of those nursing homes included in the study.

A follow-up study will examine the effectiveness of these treatment protocols.

More information

The U.S. National Institute on Aging has more about diabetes care in older people.

The news that the popular diabetes drug Avandia may increase the risk of heart attack is being met with concern, but not alarm, by health-care professionals.

"We think people should speak to their physician. We don't feel this is an emergency situation," said Dr. Sue Kirkman, vice president of clinical affairs for the American Diabetes Association. "The study was concerning, but the numbers were very, very small -- about an additional one per 1,000."

"People should definitely not panic, and they should talk to their doctors," added Dr. Mary Ann Banerji, professor of medicine at SUNY Downstate Medical Center in New York City.

Rachel Villarreal, a health educator with the Diabetes Education Program in the Texas A&M Health Science Center Coastal Bend Health Education Center, said, "Patients should consult their health-care provider and determine if the risks outweigh the benefits, because there are a lot of benefits to Avandia."

"Don't just take yourself off the medication," Villarreal added. "If you don't feel comfortable taking it, there are other treatment options that are similar."

Those reactions rolled in as a U.S. senator said Thursday that the Food and Drug Administration had been aware for some time of the heart risks posed by the drug. But the FDA said there's no conclusive proof that the risks of Avandia outweigh its benefits.

Still, not panicking and taking a deep breath seemed to be the prevailing expert opinion regarding research published in the June 14 issue of the New England Journal of Medicine that found that Avandia -- an oral medication with the generic name rosiglitazone -- increases users' risk for heart attack by 43 percent. The journal's editors released the findings on Monday because of their public health importance.

An editorial published in the May 26 issue of The Lancet advocated "a calmer and more considered approach to the safety of rosiglitazone," which is made by the pharmaceutical firm GlaxoSmithKline.

The U.S. Food and Drug Administration responded to the study findings by issuing a safety alert Monday for the drug, but stopped short of a stronger warning label, saying more analysis was needed.

"At this point, we have not reached a definitive conclusion on the data," Dr. Robert J. Meyer, director of FDA's Office of Drug Evaluation II, said at the time. "We don't feel there is consistent enough data to make a decision from a regulatory standpoint. We are not ready to make an action."

The FDA also pointed out that, while some data indicated a risk for heart attack with Avandia, other published and unpublished studies showed just the opposite.

On Thursday, Sen. Charles Grassley said the FDA's own preliminary research on Avandia confirmed the heart risks reported in the New England Journal of Medicine study. The FDA findings suggested that as many as 60,000 to 100,000 heart attacks might be linked to use of the drug, which came on the market eight years ago, the Iowa Republican said, according to the Associated Press.

In a statement read on the Senate floor that was placed in the official record, Grassley also said that safety watchdogs at the FDA recommended "several months ago" that a "black-box warning" -- the strongest possible warning -- be placed on the drug, the news service said.

FDA spokeswoman Julie Zawisza confirmed Thursday the existence of the internal analysis that Grassley's statement revealed. But she added that "we have conflicting data" from individual studies, and therefore "are continuing to review the results of [GlaxoSmithKline's] ongoing trial to determine the actual risk," the AP reported.

The authors of the New England Journal of Medicine study, Dr. Steven E. Nissen and Kathy Wolski of the Cleveland Clinic, acknowledged limitations with their study. Nissen, a cardiologist, earlier uncovered cardiac problems with muraglitazar, a drug in the same class as Avandia. He was also an early critic of the arthritis drug Vioxx, which was pulled from the market in 2004 after studies showed it increased the risk of heart attack and stroke.

"Realistically, the data [on Avandia] is not that strong, and everyone is busy reevaluating the primary data from which this is drawn," Banerji said. "We will know much more in the next few weeks."

For the new study, Nissen and Wolski evaluated 42 studies that compared patients taking Avandia with patients not using the drug, which is used to regulate insulin and blood sugar in people with type 2 diabetes. The studies included almost 28,000 patients, 15,560 of whom were taking Avandia.

The study found that the risk of a heart attack was increased 43 percent among those taking Avandia, and there was a 64 percent greater risk of dying from cardiovascular causes.

GlaxoSmithKline responded by issuing a press release Monday defending the safety of the drug. Company officials said GSK "strongly disagrees with the conclusions reached in the New England Journal of Medicine article, which are based on incomplete evidence and a methodology that the author admits has significant limitations."

More than 2 million people worldwide take Avandia for type 2 diabetes, generating $3.2 billion in annual sales for GlaxoSmithKline, according to published reports. The drug was first approved for the treatment of type 2 diabetes in 1999.

"Avandia is very widely used because it affects one of the fundamental problems of diabetes, which is insulin resistance," Banerji said. "It increases the ability of insulin, which is a good thing."

And it's possible that the drug can continue to be widely used.

"Every patient is different. Every patient has different levels of risk for cardiovascular disease. Every patient has differences in terms of what medications might be an alternative," Kirkman said. "That's why we're recommending talking to a health-care provider that knows you and knows your case. We certainly don't want to see people just stopping their medication outright because of this concern."

"If you discontinue using the drug, what will you do?" Banerji asked. "I wouldn't jump from the frying pan into the fire. I would not panic. Keep going with it, if it's doing well."

More information

There's much more on type 2 diabetes at the American Diabetes Association.

Aggressive treatment of patients with whiplash doesn't speed their recovery, Canadian research suggests.

University of Toronto researchers examined the treatment received by almost 1,700 whiplash patients.

They found that increasing the intensity of care to more than two visits to a general practitioner, or adding chiropractic care to general practitioner care, was actually associated with slower recovery.

The results, published in the June issue of the journal Arthritis Care & Research, reaffirmed earlier findings by the same research team.

Whiplash is a common traffic crash-related injury that causes neck pain, headaches and other symptoms that can lead to significant disability and use of the health care system.

The study authors noted that practice guidelines recommend treatment shortly after a patients suffers whiplash and that effective care, if medically needed, can improve patient prognosis.

However, the researchers noted that doctors, under pressure from patients, often provide treatment, schedule follow-up visits, and refer patients to specialists when such actions are not medically needed.

"This in turn may lead to adverse outcomes and even prolong recovery by legitimizing patients' fears and creating unnecessary anxiety," the study authors wrote.

Early aggressive treatment may also delay recovery by encouraging the use of passive coping strategies on the part of patients.

"Reliance on frequent clinical care, a form of passive coping strategy, may have a negative effect on recovery by reinforcing the patients' belief that whiplash injuries often lead to disability," the authors wrote.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more about whiplash.

Four or more cups of coffee a day may help keep the gout away, suggests a study in the June issue of the journal Arthritis & Rheumatism.

Gout, the most common form of inflammatory arthritis in adult males, is caused by too much uric acid in the joints.

In this study, American and Canadian researchers tracked almost 46,000 men for 12 years. The men were ages 40 to 75 at the start of the study and had no history of gout.

The researchers found that men who drank six or more cups of coffee a day were 59 percent less likely to develop gout than those who never drank coffee, while the risk was 40 percent lower for men who drank four to five cups a day.

The findings were independent of all other risk factors for gout.

Decaffeinated coffee offered somewhat less protection against gout. Tea drinking and total caffeine consumption did not have an effect on the incidence of gout.

The findings suggest that components of coffee other than caffeine may be responsible for helping prevent gout, said researcher Dr. Hyon K. Choi. For example, coffee contains a strong antioxidant called phenol chlorogenic acid.

While he and his colleagues didn't suggest that men should start drinking four or more cups of coffee a day, they said their findings may help men make an informed decision about coffee consumption.

"Our findings are most directly generalizable to men age 40 and older, the most gout-prevalent population, with no history of gout," Choi noted.

"Given the potential influence of female hormones on the risk of gout in women and an increased role of dietary impact on uric acid levels among patients with existing gout, prospective studies of these populations would be valuable," he added.

More information

The American Academy of Family Physicians has more about gout.

The next time you're tempted to crank up the stereo, you'd be wise to note the link between sound volume and hearing loss.

Scientists measure the levels of different sounds with a unit called the A-weighted decibel (dBA), according to Health Canada.

Here's how different volumes can affect hearing:

Sounds with levels below 70 dBA pose no known risk of hearing loss, no matter how long they last. Listening to music at this volume is about the same as what you'd experience driving a four-door family car on the highway with the windows closed.

With sound levels above 70 dBA, the duration of daily exposure becomes an important risk factor. For example, sounds measuring 85 dBA pose no risk of hearing loss if you are exposed for no longer than 45 minutes a day. But music at that volume poses more and more of a risk the longer it's listened to.

Reduce your risk of hearing loss by:

Keeping the sound at enjoyable but safe levels. If someone a yard away must shout to be understood, your music is probably too loud.

Using other methods of making the music sound better. For example, you could turn down the volume while increasing the bass slightly.

Limiting the amount of time you spend listening to loud music.

Hyperthyroidism occurs when the thyroid overproduces hormones that control the body's metabolism.

The American Academy of Family Physicians lists these common warning signs of hyperthyroidism:

* Sudden, unexplained weight loss.
* Weakened muscles and fatigue.
* Feelings of nervousness and anxiousness.
* Excessive sweating.
* Rapid heartbeat.
* Tremors.
* Eyes that are red, wide, or swollen.

The academy says other diseases and conditions can mimic these symptoms, so your doctor may run some tests to confirm a suspected diagnosis.

With the incidence of type 2 diabetes and its complications among young people on the increase worldwide, aggressive measures are needed to treat and prevent the disease, two diabetes experts say.

Their article appears in the May 26 issue of The Lancet.

"The complications associated with adolescents' type 2 diabetes seems to behave differently than in children and adolescents with type 1 diabetes," said article co-author Dr. Orit Pinhas-Hamiel, of the Pediatric Endocrinology and Diabetes Department at Sheba Medical Center in Tel-Hashomer, Ramat-Gan, Israel.

These complications may be present at the time of diagnosis, and their rate of progression may be higher than in children and adolescents with type 1 diabetes, Pinhas-Hamiel said. "We need to develop improved approaches to awareness and early treatment of type 2 diabetes and associated abnormalities."

These complications, including high blood pressure, kidney disease, eye disease and problems with blood fat levels, may already be present when type 2 diabetes is diagnosed, while they rarely exist at the onset of type 1 diabetes, noted Pinhas-Hamiel and her colleague Dr. Philip Zietler, from the Department of Pediatrics at the University of Denver.

"In addition, studies to date suggest that early onset of type 2 diabetes is associated with a more rapid progression of these complications compared with adolescents with type 1 diabetes," Pinhas-Hamiel said.

Moreover, psychiatric problems are also associated with type 2 diabetes. In a study in Philadelphia, one in five such teens suffered from conditions such as depression, obsessive-compulsive disorder or other psychiatric conditions.

Another study found that the deaths of seven young black males, aged 13 to 21, with undiagnosed diabetes, met the criteria for high blood sugar and diabetic coma, the authors added.

Type 2 diabetes also puts unborn infants at risk. In a Canadian study of 51 pregnant adolescent girls with type 2 diabetes, only 35 had live births, and the pregnancy loss rate was 38 percent, the authors reported.

Pinhas-Hamiel thinks that adolescents with type 2 diabetes should be screened for signs of these complications when they are first diagnosed. "In addition, there is a need for well-established guidelines for the initiation of antihypertensive and anti-lipid treatments for adolescents with type 2 diabetes," she said. "Type 2 diabetes mellitus in children and adolescents is associated with significant morbidity and mortality."

One expert thinks this review confirms that type 2 diabetes in teens has become a serious public health problem.

"Recent studies have confirmed what most of us have long suspected, that the rate of what used to be called adult onset diabetes is rising rapidly in children and adolescents," said Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine.

This study confirms another suspicion that even greater dangers are around the next corner should current trends persist, Katz said.

"In adults, type 2 diabetes is a potent risk factor for cardiovascular disease and other complications, from kidney failure to nerve damage," Katz said. "There is every reason to expect, and now findings to confirm, that these relationships hold in youth as well. When formerly adult onset diabetes develops in 7-year-olds, the threat of heart disease in 17-year-olds clearly looms," he said.

"Anyone who was waiting for an even more strident alarm before accepting that epidemic obesity and type 2 diabetes in our children is a public health crisis of the first order -- this is it," Katz said.

Another expert thinks that overweight adolescents who lead a sedentary life need to be tested for diabetes.

"Here we have a situation where we are not examining our youngsters for diabetes, and they already have complications present or developing," Dr. Stanley Mirsky, of Lenox Hill Hospital in New York City and a board member of the Juvenile Diabetes Foundation, said in a statement.

"We have to test these kids that spend all their time in front of the televisions or computers eating junk food instead of being outside exercising and eating right, especially when there already is a family history of diabetes," Mirsky said.

More information

For more information on diabetes, visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

People with type 2 diabetes often take chromium supplements to help keep their blood sugar levels under control, but new findings from a Dutch study raise doubts about the value of this approach.

In non-Western diabetic populations, there is some evidence that chromium might be beneficial," Dr. Nanno Kleefstra, told Reuters Health. "In Western populations ... it does not seem to help in the dosages used."

Kleefstra, from Isala Clinics in Zwolle, and colleagues investigated the effects of chromium in people with type 2 diabetes residing in a northern region of the Netherlands. Fifty-seven patients were randomly assigned to take 400 micrograms of chromium per day or a placebo.

After 3 and 6 months of treatment, there were no differences between the chromium group and the placebo group for fasting blood glucose levels, long-term control of glucose levels as measured by A1c, blood pressure, body fat percentage, weight, lipid profile, and how well they responded to the insulin their bodies produced, the investigators report in the medical journal Diabetes Care.

"Especially in Western patients, chromium is not beneficial for improving glycemic control," Kleefstra concluded, probably because most people already get sufficient amounts of chromium.

"It would be interesting to study a deficient population," Kleefstra added. To do so, "I think it is essential to get a tool with which we can detect whether patients are chromium-deficient or not."

SOURCE: Diabetes Care, May 2007.

The research is persuasive: When drugs don't completely control epilepsy, surgery often can — and the sooner it's tried, the better.

Yet while children are going under the knife at younger ages, epilepsy specialists are struggling to get that message to tens of thousands of adult patients.

"Surgery used to be thought of as a last resort. Now we don't think that anymore," says Dr. Deborah Holder, a neurologist at Children's Hospital of Pittsburgh.

"In my perfect world, we'd take care of everybody when they're young."

Almost 3 million Americans have epilepsy, periodic electrical storms inside the brain. When circuits misfire fast enough, a seizure results. Many are born with it, but epilepsy can develop at any age, particularly after injury to brain cells such as head trauma, meningitis or a mini-stroke.

Up to 30 percent of patients have intractable epilepsy: Medicines don't prevent all their seizures, or they cause intolerable side effects. Many are candidates for surgery, cutting out the abnormal brain tissue that sparks seizures. At leading centers, up to 80 percent of surgery recipients become seizure-free, with few complications.

And improved technology is allowing surgeons to better pinpoint the bad spot and remove less brain tissue — half as much as the most common epilepsy surgery removed just a few years ago, says Dr. P. David Adelson, a neurosurgeon at the Pittsburgh children's hospital.

Between 3,000 and 5,000 of the operations are performed annually, up from 1,500 in the early 1990s, estimates Dr. Robert Gumnit of the University of Minnesota, who heads the National Association of Epilepsy Centers.

However, 100,000 to 150,000 epilepsy sufferers are considered surgery candidates. Most have two to five seizures a year despite medication, and have been told to live with it — instead of being sent to an epilepsy center that specializes in complicated cases, says a frustrated Gumnit.

That may not sound like many seizures, but it means the people can't drive or perform certain jobs.

"It's not the burning issue it ought to be," adds Dr. Jerome Engel of the University of California, Los Angeles.

There is a major push to get youngsters, especially those with severe epilepsy, to the operating room sooner.

Why? If two medications fail to control epilepsy — at any age — there's only a slight chance a third will help, recent research shows. Worse, years of seizures can harm a child's development, sometimes permanently.

A Cleveland Clinic study in the journal Pediatrics this month is among the first to examine surgery on children younger than 3, and found that even among patients that young, earlier surgery predicted a better chance of normal development.

Consider 2 1/2-year-old Alex Seman of Wampum, Pa. He has a condition called tuberous sclerosis that triggers epilepsy through abnormal brain growths. Despite four medicines, his arms and legs would flail with seizures several times a day. Brain monitoring uncovered several dozen mini-seizures daily, too, presumably the reason his language skills were about a year delayed.

"It's like listening to your cell phone with static coming through," says Pittsburgh's Adelson, who operated on Alex earlier this month. "The goal was to cure it before he even knew he had it."

Preparation was the hardest part, says Alex's father, Mike Seman. Doctors performed a sort of pre-brain surgery, implanting electrodes directly onto the surface of Alex's brain. For a week, he was monitored by video as those electrodes mapped the source of his seizures — and his parents went through lots of bubbles and Barney videos keeping him quiet.

Weeks after doctors removed a chunk of his brain, Alex is seizure-free so far, and his parents say his perky personality has reappeared.

Not everyone is eligible for surgery. Seizures may originate in a spot that can't be removed safely. Their options:

_Major studies are beginning to see if implanting an electrode that emits a low-level electrical current could zap the bad brain tissue and stop seizures as they form. Called deep-brain stimulation, it's already used to control tremors in Parkinson's disease.

_Doctors also sometimes implant a "vagus nerve stimulator," which delivers tiny shocks to a nerve in the neck that in turn signals the brain. It doesn't cure epilepsy like surgery can, but can reduce some patients' seizures.

_Also under study is beaming the seizure spot with radiation, using a technique called the Gamma Knife.

Janet Rickey of Arlington, Va., chose standard surgery even though doctors warned the problem spot was right next to the brain region that controls movement of her left side. But at age 47, seizures that began at 7 were steadily worsening, and drug after drug failed. When testing recorded 120 full-blown or mini-seizures in a week, surgeons at Georgetown University Hospital agreed to try.

Rickey did wake up with partial paralysis; it took a month to move her left leg. Three months later, she still walks with a cane, but is gleeful that her seizures have plummeted.

"Every day I could count on having a seizure, and now I can count on them stopping," she says.