Sildenafil citrate (VIAGRA)

Nicotine patches and gum seem to be safe and effective in pregnant women, according to a new study.

Such patches and gum have been shown to help non-pregnant adults stop smoking, study co-author Dr. Geeta K. Swamy told Reuters Health. However, women and their obstetricians have been uncertain about their safety and effectiveness during pregnancy.

Dr. Swamy, from Duke University Medical Center in Durham, North Carolina, and colleagues took another look at data on pregnant smokers who had participated in a study comparing psychological treatments with nicotine patches or gum to help them quit.

Adding nicotine patches or gum tripled the number of women who quit, from 8 percent to 24 percent.

Almost a third - 31 percent — of the women who used the patch or gum had pregnancy complications, compared to 17 percent of the women who did not use it.

However, there was a much higher risk of such complications in black women, those with complications in previous pregnancies, and use of painkillers. The use of the patch did not seem to have a direct effect, the researchers note.

Based on the findings, although the patch is not “absolutely safe,” it may still be worth using in heavy smokers, given the known association between smoking and bad pregnancy outcomes, particularly premature birth and low birth weight, they conclude.

When it comes to teaching healthy behaviors, boys’ high school team sports might be doing more harm than thought.

New research suggests that for teenage boys, participation in team sports may encourage unruly behavior such as fighting and binge drinking.

Girls, on the other hand, seem to behave better in organized sports, said the lead researcher, Susan Connor, manager of the injury prevention program at Rainbow Babies & Children’s Hospital in Cleveland.

“The research raises more questions than it answers,” said Connor, who was to present her findings at the American Public Health Association’s annual meeting, in Philadelphia, which concludes Wednesday. “We were looking at a broad database, so we do not know why team sports may affect boys differently or how they affect them. That’s a topic for further research.”

Connor and her team studied the responses of more than 13,000 U.S. high school students who took part in the 2007 Youth Risk Behavioral Study, an assessment of adolescent high-risk behaviors conducted by the federal Centers for Disease Control and Prevention.

According to Connor’s findings, roughly 60 percent of the male respondents said they had played in at least one team sport in the past year. For girls, the participation rate was 48 percent.

The data did not specify which sports the teenagers participated in, although the top high school sports in the 2000 U.S. Census included basketball, football, baseball, soccer, track and field, and cross-country running.

For boys, the study found that participation in team sports correlated with an increased likelihood of fighting, drinking and binge drinking. Rates of depression and smoking, however, seemed to decline.

The findings were different for girls. White girls who were active in team sports reported lower levels of fighting, depression, smoking, marijuana use and unhealthy weight-loss practices, Connor and her colleagues found. Black high school girls reported increased levels of binge drinking.

“I think the issue is more socio-economic than race,” said Connor, who added that more research is needed to explore the slight behavior differences between black and white female high school athletes.

Connor stopped short of offering explanations for the apparent negative aspects of boys’ team sports. One possibility, she said, is that there is a culture in male sports that creates a climate of poor behavior.

“There are certainly health benefits in playing team sports,” said Connor. “But there is also this misconception, which is very widespread, that sports are all good. As a parent, you can’t assume your kid is protected. Sports are what you and your child make of it.”

Robert Regal, a psychologist in private practice in Valhalla, N.Y., agreed with Connor’s findings. Part of the problem, he said, is that boys’ teams may inherently attract athletes who are aggressive and highly competitive, leading to unruly behavior once they join a team.

“There are pre-existing expectations for both male and female athletes,” he said. “To be a female athlete means not having the same kind of hyper-aggressive, big-man-on-campus image. For guys, team sports are played with a great deal of expectation for success. It’s written into the team ethic.

“I’d be curious to see the behaviors of the top girls’ teams, the ones that win the state championships. I suspect they mirror the behaviors of the boys,” Regal added.

A urinary tract infection occurs when certain bacteria invade the urinary tract. Symptoms may include itching, burning, and painful urination.

The National Women’s Health Information Center lists these common causes of urinary tract infections in women:
Wiping from back to front after a bowel movement.
Having sex.
Holding urine for too long.
Being diabetic.
Having a kidney stone or other factor that makes it difficult to urinate.
Producing less estrogen, such as after menopause.
Having recently had a catheter inserted.

Merck and Co’s failed AIDS vaccine may not have worked, but it probably did not raise the risk of infection either, doctors said Tuesday.

Data analyzed after the large clinical trial was stopped in 2007 contradict earlier findings that suggested some groups, such as uncircumcised men, may have been more vulnerable to infection if they got the vaccine, Dr. Susan Buchbinder of the San Francisco Department of Public Health told an AIDS vaccine conference.

Merck’s STEP trial involved 3,000 people in South America, the United States, Canada and Australia. Researchers were not only dismayed that it appeared to do no good, but may have harmed some of the volunteers.

“With ongoing follow-up, the trend in the wrong direction is diminishing,” Buchbinder said in an interview. “Either they were at risk, and that has gone away, or they were never at increased risk. It was never significant.”

Researchers working to produce AIDS vaccines are in Paris this week to pore over the results of the latest experiments.

Of particular interest is a trial in Thailand that has just shown it may be possible to make a vaccine to prevent AIDS; the first hint of success in the 25 years since the pandemic began.

Buchbinder said researchers who worked on the Merck vaccine continue to monitor participants from the trial and are drawing insights from it even now. Lessons learned will be crucial in the making of AIDS vaccines.

STILL LEARNING

Twenty-nine people in the STEP trial who were infected showed a slight decrease in their viral load — a measure of virus in the blood — for a short time, she said.

“The bigger picture issue is that we see some clues here and some clues there about ways where the vaccine may be providing some protection. Overall it didn’t protect, but can we learn something about places where the vaccine may have provided even small amounts of protection so that we can build on those,” she said.

The vaccine aimed to fight AIDS by encouraging so-called cell-mediated immunity, jump-starting T-cells to tackle the virus and stop or slow the progress of the human immunodeficiency virus. It used a weakened virus called adenovirus-5 as a “vector” to transport the vaccine into the body.

Buchbinder said the STEP study also showed the importance of studying the effects of such vectors on the immune system.

“We never understood the complexity of the immune response against the vector and we think that is a very important thing to understand. Animal studies can’t address that because adenovirus 5 does not normally infect non-human primates,” she said.

“These efficacy trials are really moving science forward,” Buchbinder added.

“With each step we are learning more information that we couldn’t get any other way …. We don’t know what it is going to take to make a safe and effective vaccine. Each of these studies, particularly larger trials in humans, help shine a light on issues that we didn’t know or understand before.”

Hooked on cocaine or cigarettes? The U.S. government wants drug companies to make a vaccine for that.

Convinced of the need for new and better treatments for addiction, the government is focusing its efforts on vaccine development as a new way to treat and possibly prevent addiction to a range of addictive substances.

“It’s a perspective that is very different from what we’ve operated on in the past,” Dr. Nora Volkow, director of the National Institute on Drug Abuse told reporters this week at the Society for Neuroscience meeting in Chicago.

Volkow said the agency intends to piggyback on the frenetic investment by drug companies in vaccine development, spurred by the need for new products and the runaway success of products like Merck’s Gardasil vaccine to prevent the virus that causes cervical cancer.

“There is an enormous amount of research and development in vaccines for cancers and a wide variety of disorders,” she said. “We can take advantage of those developments.”

But first Volkow has to tempt drug companies to develop the vaccines by funding costly clinical trials.

Earlier this month, her agency, part of the National Institutes of Health, awarded Nabi Biopharmaceuticals a $10 million grant — the agency’s largest ever — for a late-stage clinical trial of Nabi’s vaccine for nicotine addiction called NicVAX.

Volkow said she did her homework before backing the Nabi vaccine to ensure it was significantly different from other products. “Nonetheless, when you are investing in something at this level, it can be very risky,” she said.

The vaccine is meant to stimulate the immune system to make antibodies against nicotine, blocking its rewarding effects and helping to prevent relapse in smokers trying to quit.

TOUGH MARKET

A similar anti-smoking vaccine by Cytos Biotechnology and Swiss drugmaker Novartis last week missed its main goal in a midstage study, leading some analysts to question whether it can make it to market.

“They are still looking at it but it has been very problematic,” said Robert Wasserman, director of investment research at the investment banking firm Dawson James in Florida.

“Vaccines are really tough,” he said. “It’s not for the faint of heart.”

Still, if it works, a nicotine vaccine could have a huge impact, Volkow said. “It’s an international problem that kills 5 million individuals every year across the world,” she said.

The global market for smoking cessation is expected to reach $4.6 billion by 2016, and vaccines could account for $2 billion in sales, according to independent market research firm Datamonitor.

Volkow said the same methods for making a nicotine vaccine could be used for other illicit substances.

Her agency backed a study released this month of an anti-cocaine vaccine that helped block the high felt by 38 percent of addicts who took it.

The vaccine was developed by Dr. Thomas Kosten of Baylor College of Medicine in Houston, who used a similar approach to make a nicotine vaccine now being tested in Europe by private equity firm Celtic Pharma.

Volkow said drumming up drug company interest in vaccines for illicit drugs is a harder sell because of liability concerns, and the fact that drug abusers are stigmatized.

“Unfortunately, when it comes to treatments for drug addiction … most of the investment goes to the government,” she said.

Newborn babies shouldn’t be expected to sleep through the night. Their bodies are so tiny that they should be awakened if they haven’t eaten for at least five hours, the Nemours Foundation says.

But there are things that new parents can do to help ensure a safe night’s rest for their little one. The foundation offers these suggestions:
Put baby to sleep on his or her back to reduce the risk of sudden infant death syndrome (SIDS).
Don’t let baby sleep with plush bedding, blankets or pillows.
Remove stuffed animals from baby’s crib when it’s bedtime.
Each night, alternate which side of his or her head your baby sleeps on, to prevent development of a “flat spot” on a favored side of the head.

As if migraine sufferers didn’t already have enough pain, new research has found that they may also be more prone to hangover headaches.

U.S. researchers studied the effects of alcohol on a group of rats that experience recurrent migraines as well as a group of control rats that don’t get the headaches. The study authors found that the rats with migraines experienced more pain four to six hours after ingesting alcohol than the control rats.

“Our results suggest that dehydration or impurities in alcohol are not responsible for hangover headache,” Michael Oshinsky, an assistant professor of neurology at Jefferson Medical College of Thomas Jefferson University, and a member of the Jefferson Headache Center team, said in a university news release.

“Since these rats were sufficiently hydrated and the alcohol they received contained no impurities, the alcohol itself or a metabolite must be causing the hangover-like headache. These data confirm the clinical observation that people with migraine are more susceptible to alcohol-induced headaches,” Oshinsky added.

A popular stomach acid reducer greatly increases the risk of pneumonia in certain critically ill hospital patients, a new study has found.

Researchers at Wake Forest University School of Medicine in North Carolina analyzed the charts of 834 cardiothoracic surgery patients on breathing machines who were given stomach acid reducers to prevent stress ulcers. The patients were given either ranitidine (Zantac) or pantoprazole (Protonix). Both drugs reduce stomach acid, but pantoprazole is more powerful and is the drug of choice in many hospitals.

However, the study found that people given pantoprazole were three times more likely to develop hospital-acquired pneumonia than those given ranitidine. The findings were published recently in Chest.

“We conducted this study, in part, because we thought we were seeing more pneumonias than we were used to having,” Marc G. Reichert, pharmacy coordinator for surgery at Wake Forest University Baptist Medical Center and a co-author of the study, said in a university news release.

Hospital-acquired pneumonia — the leading cause of infection-related deaths in critically ill patients — increases hospital stays by an average of seven to nine days, adds to the overall costs of care and raises the risk for other complications.

People on breathing machines sometimes develop pneumonia when stomach secretions reflux into the lungs.

Teens who start drinking before age 15 could jump-start any genetic conditions they might have that predispose them to developing alcohol dependency, according to an Australian study.

From a biological perspective, taking that first drink at a young age “may induce changes in the highly sensitive adolescent brain, which may also modify an individual’s subsequent genetic vulnerability to [alcohol dependence],” Arpana Agrawal, an assistant professor of psychiatry at Washington University School of Medicine and an author of the study, said in a university news release.

The findings, published online Sept. 18 and in the December print issue of Alcoholism: Clinical & Experimental Research, are based on a study of 6,257 adult twins.

The younger people were when they had their first drink, especially if that occurred before age 15, the more symptoms of alcohol dependency they developed, the study found. Early drinkers also tended to have an increased genetic vulnerability for alcohol.

Those who had their first drink later in life showed far fewer signs of alcohol dependency, despite the genetic predisposition, Agrawal noted.

This suggests that alcohol dependency among those who started drinking later, “while less common, are attributable to unique experiences of those individuals — for example, a traumatic life event,” she said.

Carol A. Prescott, a professor of psychology at the University of Southern California, said the findings had two possible conclusions. “Early drinking changes the course an individual is on, and is thus a direct cause of increased [alcohol dependency] risk, and early drinking is correlated with [alcohol dependency] risk and is thus an indirect indicator of … risk,” she said in the news release.

Agrawal said the findings should be used to discourage young people from experimenting with drinking early because such behavior might trigger an onset of alcohol abuse.

The researchers plan to do a similar study that looks at older and younger groups in Australia and the United States to try to duplicate their findings.

The incidence of stroke among American children could be two to four times greater than has commonly been estimated, a new study says.

Pediatric strokes are rare; even the new estimate puts its incidence at only 2.4 strokes per 100,000 person-years (person-years represent the number of years children were studied). But the report, published in the Sept. 17 online issue of Stroke, also cites five previous studies in which the estimated incidence ranged from .54 to 1.2 per 100,000 children per year.

“All those studies relied on billing coding to identify patients with stroke,” explained study author Dr. Heather J. Fullerton, director of the Pediatric Stroke and Cerebrovascular Disease Center at the University of California, San Francisco, Children’s Hospital. “Our study looked first at billing, and then at radiology reports.”

Fullerton and her colleagues looked at data on 2.3 million children up to the age of 19 who were enrolled in the Kaiser Permanente managed-care plan in northern California from 1993 to 2003. They searched for stroke cases listed by diagnostic code for billing purposes and also for reports indicating strokes in radiological studies, including computed tomography and MRI. The radiology reports yielded a higher incidence of stroke.

Estimates based on billing are not reliable for several reasons, Fullerton said. “Children who have strokes often are ill for other reasons, such as meningitis or congenital heart disease, so they are coded for that,” she said. “Also, coders apply the stroke diagnoses less often for children because they are perceived as rare events. Or they get nonspecific diagnoses.”

The concept that children simply don’t have strokes is widely prevalent, Fullerton noted. “Even among insurance companies, the impression seems to be that strokes don’t happen to children,” she said. “I have received calls from insurance companies questioning a diagnosis of stroke in a child.”

Dr. E. Steve Roach, director of pediatric neurology at Nationwide Children’s Hospital in Columbus, Ohio, who said, “I’ve been studying stroke in kids for 20 years,” added that “the new study confirms what I’ve been saying all that time. It’s just way, way underdiagnosed.”

Roach said he led two studies, one reported a decade ago, the other last year, that came to the same conclusion. “When we did a search of discharge records, a lot of them just did not show up,” he said.

“Most people, and even most doctors, can’t accept the idea that children have strokes,” Roach said. “It’s just a bias on the part of physicians that stroke just doesn’t occur in children.”

This new comparison of the two methods of identifying a pediatric stroke found that radiological evidence was much more sensitive than the billing code. The radiology method was far more sensitive (83 percent) than the billing code method (39 percent.)

The difference was even greater for strokes that occurred at the time of childbirth, with a sensitivity of 12 percent using the billing codes and 87 percent using radiological records.

But the study came with a word of caution. Because it was based on data from one health-care organization, it’s not clear whether the difference in incidence between billing codes and radiological findings will be found elsewhere, the report noted.

More studies in different populations are needed to firm up the finding, Fullerton said.

Failure to identify a childhood stroke properly might not be an issue for the child’s family, Fullerton said. “It is more an issue for those of us who investigate strokes,” she said. “When we try to identify pediatric strokes, it is important that we recognize that we could be missing a large chunk of cases.”