Have a Havana?
Who would have thought that great uncle Hugo's fat cigar would one day become high fashion? And who would have guessed the generation that grew up with warning labels on cigarette packs - and the knowledge that even secondhand smoke damages lungs - would retire to the deck with their cronies to puff on a stogie?
No doubt about it - cigars are hot stuff right now. Jack Nicholson smokes them. David Letterman, too. Even Demi Moore has been spotted puffing away.
Cigar stores, cigar bars and lounges are popping up all over the country, but especially in Manhattan and its suburbs. The Rainbow Room, Café des Artistes and the St. Regis are just a few of New York's finest that have created "cigar-friendly" environments. And many will soon take notice of a somewhat startling sign of the times: A cigar shop will open shortly on 39th Street, between Lexington and Third, replacing a health food store.
An estimated 10 million Americans, more than 99 percent of them male, smoke cigars regularly - 2 million more than in 1993. Fad or not, the young and the not-so-young are participating in what's being dubbed a "bonding experience" for successful businessmen. Can women be far behind?
This hip diversion is not a safe alternative to cigarette smoking, nor is it nonaddictive, says Marc Lavietes, MD, associate professor of medicine at UMDNJ-New Jersey Medical School. He says many cigar smokers think their habit poses little risk of lung cancer because they do not inhale. "But it has been found that when cigarette smokers switch to cigars, they often continue to inhale, and so get no health benefits from the change," he states.
Lavietes adds that nicotine can be absorbed into the blood stream through the mouth, even when cigar smokers do not inhale, and can speed up the heart and constrict blood vessels, thereby raising the risk of heart attack and stroke. The rate of emphysema among cigar smokers is thought to be about five times that of nonsmokers, he contends, and the risk of cancers of the larynx, mouth and esophagus also increases.
And what about all those folks who've been fighting secondhand smoke for years? They better take up their placards and head for City Hall. According to the Environmental Protection Agency, passive smoke from cigars poses far more danger than that from cigarettes. And the smell lingering on your clothes will be anything but sweet. (top)
Visual Sculpting
It's time to crack the books and get down to serious studying but your nearsighted peepers are feeling strained. Maybe you're thinking that newest surgical procedure to correct myopia would improve your vision. Well, before you plan to put away your glasses or toss your contact lenses, you should know that photorefractive keratectomy (PRK) isn't for everyone.
Although ophthalmologists have had success with the procedure - which uses a laser called the excimer - patients with medical conditions that inhibit healing, such as rheumatoid arthritis and uncontrolled diabetes, are poor candidates for the surgery.
Those over age 40 will still need back-up glasses or contact lenses, especially for reading, because eyes lose their ability to focus after that age. PRK is also not recommended for children under 18 because the degree to which their eyes are affected by myopia can change. And, the cost can be prohibitive: approximately $2,000 per eye (for surgery and follow-up office visits), which is not covered by health insurance.
Despite these drawbacks, a UMDNJ ophthalmologist says PRK makes life easier for most nearsighted patients. Peter Hersh, MD, a corneal specialist and an associate professor of ophthalmology at New Jersey Medical School, was involved in the clinical trials that eventually led to the Food and Drug Administration's approval of PRK and the excimer laser last year.
Over a period of five years, Hersh performed the procedure on 500 patients, with 95 percent of them being able to pass a driving test without glasses, the parameter used by the study to determine its success rate. PRK improved the vision of the other 5 percent, but they still failed the driving test.
"Those who choose PRK usually do so for one of two reasons," says Dr. Hersh. "They either want to make an improvement in their lifestyle, or they have a career that would be dangerous if they lost their glasses or their contacts fogged up."
In nearsighted eyes, light passes through the cornea and focuses just in front of the retina rather than on it. With PRK the laser removes small amounts of tissue from the center of the cornea, thus flattening it and refocusing the light that enters it. PRK is an improvement over radial keratotomy, a procedure used since 1978 in which a scalpel makes small incisions to reshape the cornea.
During PRK, one eye is done at a time in a 15-minute procedure that uses local anesthesia. Patients go home the same day and are usually able to return to work or other activities within three days, although it may take up to three months for the eye to heal entirely. Until the second eye is treated, patients wear one contact lens or glasses with one clear lens, or some simply go without. There is some discomfort during the first three days post-operatively, with blurry vision and pain. Some patients experience a fine haze or a halo in bright lights.
"Within the first week patients will notice a 70 to 85 percent improvement in their vision, and at three months a 90 to 95 percent improvement," says Hersh.
He is now overseeing a clinical trial to test PRK's effectiveness on patients with astigmatism and farsightedness, as well as patients whose nearsightedness is more severe than those who participated in the initial study. It is taking place at the Cornea and Laser Vision Institute in Teaneck, an NJMS/Hackensack University Medical Center affiliate, one of eight centers nationwide that is participating in the study. (top)
A common, easy-to-treat vaginal infection - one that women may not even know they have - could be the cause of 6 percent of premature births nationwide, and thus be a major factor in infant mortality.
The infection - called bacterial vaginosis - can cause premature rupture of membranes, infection of the amniotic fluid and a postpartum infection of the endometrial lining, says Gloria Bachmann, MD, professor of obstetrics, gynecology and reproductive sciences at UMDNJ-Robert Wood Johnson Medical School. Women diagnosed with the infection during their second trimester of pregnancy were 40 percent more likely to have premature infants than those who did not have it, according to studies reported in the Dec. 28, 1995 issue of the New England Journal of Medicine.
"It can also cause problems for women who are not pregnant," Bachmann observes. The symptoms - an unpleasant odor, vaginal itching and a discharge - are usually most noticeable during a menstrual period or after intercourse, but Bachmann cautions women not to attribute them to having their period. Nor, if they appear during pregnancy, should women think that is the cause. The infection can be treated with standard antibiotics, usually metronidazole. A vaginal gel form of the medication is very effective and eliminates the need for oral medication for many women.
Bacterial vaginosis is one of three common forms of vaginitis; the other two are yeast and Trichomoniasis. Each produces a different type discharge and different intensities of itching and/or burning. Together, Bachmann notes, these infections cause 10 million patient visits a year.
Vaginitis is caused by a shift in the type of bacteria that inhabits the vagina. Those that normally live there create an acidic environment that protects against infection. Douching, taking antibiotics and hormonal changes can destroy these bacteria, allowing unwanted organisms to flourish and predominate. Women on antibiotics can try to maintain the right bacterial balance by eating yogurt that contains Lactobacillus acidophilus - some products sold as yogurt do not contain active bacterial cultures.
Pregnant women should be on the lookout for vaginal changes, says Bachmann, and if they note a problem should not delay in getting in touch with their practitioners. She adds that four simple tests - ranging from observation of vaginal secretions during a pelvic examination to analysis of smears taken at the time - can confirm the diagnosis of the infection. (top)
What's in a Name?
In the field of developmental psychology, you're more likely to come across a reference to Michael Lewis than to Sigmund Freud, B.F. Skinner or T. Berry Brazelton. In fact, Dr. Lewis, a child development expert, is the most widely published and referenced researcher in the field in recent years, according to a study done by the University of Notre Dame.
He was found to be number one in research productivity and in number of citations in a comprehensive evaluation of nearly 4,000 social scientists worldwide. Lewis is director of the Institute for the Study of Child Development at UMDNJ-Robert Wood Johnson Medical School.
The study, published in the journal Developmental Review (June 1995), looked at research productivity in the field within the past nine years. It also examined the number of: citations in psychology textbooks published in 1984 or later; citations in the Social Sciences Citation Index (SSCI), a database that lists how frequently an article or researcher is referenced; all authored papers from 1983 through 1991 in PsycLIT, a database of psychology journals; and authored papers in PsycLIT in the field of developmental psychology.
Lewis has published more than 300 articles and chapters in professional journals and textbooks on the emotional and intellectual development of infants and children. His book, "Shame, The Exposed Self," looks at deviant and normal growth in emotional development and has been translated into German, Italian and Japanese. His "Handbook of Emotions" received the 1995 Critics Choice Award; and he just finished a new book, "Altering Fate," which deals with developmental theory and social policy. It is to be published by Guilford Press in early 1997. (top)
Who's Calling the Shots?
The knapsack is packed, the lunchbox stuffed, and the new clothes are ironed. Your child has everything needed to start the school year. But is she up-to-date on vaccinations?
According to Maria DeLuca, RN, the nurse at Newark's St. Francis Xavier School, the New Jersey Department of Health mandates that all children entering kindergarten must have received at least four doses of DPT (diphtheria, tetanus, pertussis), three of oral polio, one MMR (measles, mumps, rubella) shot and a measles booster. Children under the age of 5 who attend state-licensed child care centers and nursery schools must also get the Haemophilus influenzae type B vaccine. The number of doses of each vaccine depends, of course, upon how old the child is.
There are no changes yet for this school year, but three leading medical organizations are now separately considering new vaccination guidelines. The Centers for Disease Control and Prevention Advisory Committee on Immunization Practices, the American Academy of Pediatrics and the American Academy of Family Physicians are studying recommendations regarding immunization against varicella-zoster (the virus that causes chickenpox), polio, DPT, hepatitis B and MMR.
Leslie Tadzynski Shur, DO, associate professor of clinical pediatrics at UMDNJ-School of Osteopathic Medicine, says the jury's still out among physicians on whether immunization against chickenpox should be required for students entering school: "Because the vaccine debuted for the general population only one year ago, we will not know for quite some time whether long-term immunity can be conveyed."
She says although infectious disease specialists are strongly advising parents to have their children vaccinated against varicella-zoster, pediatricians and family practitioners are not actively supporting it as essential.
Judging by her patients, she says, "It's more a matter of economics than medicine. In families where both parents are working outside the home, they want the children to have it because they cannot take off from work for what, in healthy children, is a nuisance disease."
Chickenpox can be very uncomfortable in childhood, but it can be serious in adults, with the potential to cause respiratory problems, viral pneumonia, and fetal brain retardation or miscarriage if a pregnant woman passes it to her unborn baby. That's why some physicians feel it is better to let children catch the disease rather than be vaccinated when long-term immunity is still uncertain.
For those who do want their children to receive the vaccine, experts recommend that it be administered any time after 1 year of age, with a booster given 11 to 12 years later to guard against the potential loss of immunity.
In August the Advisory Committee on Immunization Practices recommended a mixed schedule for the polio vaccine: two doses of the oral version now being used and two of a new injectable form containing killed virus. This change comes about because the oral vaccine, which contains live virus, has induced the disease in about eight children a year in the U.S. Since the injectable form is more expensive to administer and requires children to undergo more shots, doctors have the option of using the oral vaccine. The mixed schedule awaits final approval by the CDC.
Relief from the side effects occasionally caused by the DPT vaccine may be coming in the form of a new acellular vaccine, which was approved by the Food and Drug Administration in July. The new one contains only a part of the pertussis bacterium. The CDC recommends that the new vaccine be used for the first four doses, and that the older form be used for the fifth dose to ensure the same level of immunity.
Although schools are not requiring hepatitis B vaccines, many physicians are incorporating them into a baby's regular immunization schedule as insurance against the child contracting it when he or she is older.
And what's the last word on the MMR booster?
Several years ago, some New Jersey communities experienced outbreaks of measles among young people who had been immunized as infants. Whether the vaccine had been given at too early an age, was out of date or was improperly administered was never learned. Shur says physicians now advise that children receive a booster at 5 to 12 years of age as a follow-up to the booster that is now given routinely at 12 to 15 months. (top)
The Smoke Lingers
It's long been known that women who smoke during pregnancy put their babies' health at risk: Maternal smoking can lead to premature delivery, lower birth weights and the increased chance the baby will develop breathing problems. Now researchers are suggesting that smoking during pregnancy, or even breathing second-hand smoke, can jeopardize an unborn child even more.
A recent study published in several journals, including the Journal of Toxicology and Environmental Health (May 1996), showed evidence that three cancer-causing chemicals found in cigarette smoke - linked to lung, skin, bladder and liver cancer - made their way from the mother into the fetus's blood. These carcinogens attach themselves to hemoglobin, the oxygen-carrying protein in red blood cells, and circulate through the babies' blood for the entire life of the red cells, usually about four months. The compounds can damage DNA, researchers say, which may lay the groundwork for the development of cancers, including childhood leukemia.
The study followed 410 pregnant women, including smokers (who consumed from less than one pack to more than two packs a day), nonsmokers, and women exposed to second-hand smoke for at least six hours a day.
The babies of women exposed to passive smoke had small but measurable amounts of the toxic chemicals in their blood - about four to five times higher than those of nonsmokers not exposed to passive smoke. The more the women smoked, the higher the levels of carcinogens in their newborn babies - the levels were from 10 to 20 times higher than the nonsmokers' infants.
"On a weight-to-weight basis, if you compare the effects of smoking on a mother versus a baby, it's devastating to the infant," says Joseph Apuzzio, MD, professor of obstetrics and gynecology and professor of radiology at UMDNJ-New Jersey Medical School. "It's harmful to the mother as well, and we don't know anything that counterbalances the ill effects."
There is no direct proof that prenatal exposure to tobacco smoke actually puts children at a higher risk for cancer. Further studies are planned. The babies in this study will be followed for many years.
"These findings aren't surprising," says Lee Reichman, MD,
professor of medicine and professor of preventive medicine and community
health at the school. "We've known for a long time that cigarettes
are filled with hundreds of carcinogens, and we've found the breakdown products
of nicotine in people, especially children, who inhale passive smoke. Such
studies go a long way to point out that smoking, whether in the presence
of a fetus, infant or young child, should really be considered child abuse."
(top)
The Right Stuff
The sandwich - invented in 1762 by the Earl of Sandwich for quick sustenance during a 24-hour gambling session - is the core of the classic American lunch.
The typical cold sandwich, with two slices of bread, lettuce, tomato and meat, is a power-house of nourishment, providing servings from several of the food groups. Add a piece of cheese and you have even more nutrition. The epitome of convenience, the sandwich is a favorite of the brown bag set and reigns supreme in school cafeterias. Or does it?
At Lawrence High School in Lawrenceville, the sandwich is all but extinct. The most popular item on the menu there is french fries. According to Marybeth Di Lorenzo, food service director, the high schoolers consume about 200 pounds of french fries each day.
While there are a handful of students who either bring or buy a well-balanced lunch, most midday repasts there consist of french fries or cheese fries, cookies and Snapple®. Next on the list of favorites, Di Lorenzo says, is pizza, followed by chicken nuggets and patties, cheese-burgers and steak sandwiches.
Seniors, who are permitted off-campus for lunch, don't eat much better. Most say they frequent nearby fast food eateries: Taco Bell, McDonald's and Burger King. Some go home for lunch, and others swing by the local deli for a custom-made sub.
Like their high school counterparts, the majority of middle school students eat mostly fat-laden foods. At Sharon School in Washington Township, about half of the sixth-, seventh- and eighth-graders queue up in the "snack line" to buy chips, cheese curls and the like. Some make an entire meal of snacks; others eat them before their main course.
But the news isn't all bad. There are some nutrition-conscious middle schoolers, and the elementary students at Sharon eat almost no junk food at all. Most younger children (kindergarten through fifth grade) bring a well-balanced lunch from home, thoughtfully put together by mom or dad. However, as they head outdoors for a post-lunch exercise period, a fair number of them toss portions of their food in the trash - some of it virtually untouched.
Both schools offer a wide variety of nutritious food - from fresh salads and fruit to a full, balanced meal. A collection of posters in both cafeterias depict the benefits of healthful eating. So why do adolescents routinely eat foods high in fat and low in nutrition? Because, the high schoolers say, if they eat a well-balanced breakfast and/or dinner, junk food at noon is okay.
"In some ways, they're right," says Julie O'Sullivan Maillet, RD, PhD, an associate dean at the UMDNJ-School of Health Related Professions. "Active teens need to consume twice as many calories as adults in order to support growth, and up to 30 percent of those calories should come from fat. As long as they're getting what they need from all the other food groups, they have room for some extra fat and sugar in their diets. It's the one time in their lives that they do."
But she warns that teens shouldn't go overboard. All school-age children should get at least half their daily calories from fruits, vegetables and grains. Proteins and dairy products should be included in their diets in smaller amounts. So if they're not getting the "right stuff" at lunch, what's a parent to do?
Plenty, says Maillet. First, try to get children to eat breakfast. The old adage that it's the most important meal of the day is indeed true.
Next, she says, have healthy snacks waiting for kids when they come home from school - then you'll have a chance. "A hungry teen will grab a handful of chips rather than peel a carrot or wash some strawberries."
If possible, Maillet says, get children involved in after-school activities. Years ago, they went outdoors to play. Now, kids are often told to stay inside until a parent comes home.
Prepare healthy dinners and keep them low in fat. Be sure to include at least two vegetables and serve milk or juice, not soda. This is especially important for teenage girls, Maillet adds, who are at the height of bone development and need calcium.
"Kids experiment with taste as they grow, so they may go through periods where all they want is tuna fish. They don't need to have a completely balanced diet every single day. As long as they get what they need, over a three- to four-day period, they'll be fine." (top)
Mirror Mirror...
When smokers warn against smoking and couch potatoes beat up on their fellow slouchers, does anyone listen? Should overweight doctors chide or give weight-loss advice to patients tipping the scales with excess poundage?
Two of five doctors are dissatisfied with their weight, and 35 percent have been on a diet within the past year, according to a poll of 382 physician-subscribers to Scientific American Medicine, conducted by Mark Clements Research, Inc.
Six hundred physicians were asked to respond to a two-page questionnaire which was mailed in April. The first 382 responses were tabulated: Internal medicine and family medicine practitioners accounted for 59 percent of respondents; 81 percent are male and 19 percent female. Their average age was 46.8.
Although 80 percent of the doctors are satisfied with their overall health, only 62 percent consider themselves physically fit. Some other tidbits from the survey that may interest medical consumers:
So next time you berate yourself for slipping up on those New Year's vows, remember that even health-conscious physicans struggle with the same demons. (top)
Scientists at UMDNJ and Rutgers University have identified a genetic abnormality that is 12 times more common in alcoholics than in others. The gene produces a faulty enzyme, one that fails to protect the material that insulates nerve cells. The result, a disruption in transmission signals, can lead to behavioral problems.
"We knew from work others had done that people with very low levels of the enzyme exhibit some behavioral traits that are characteristic of alcoholics - particularly, impulsivity and hyperactivity," explains Paul Manowitz, PhD, principal investigator of the study. "We wondered what we would find in those with a flawed enzyme."
Manowitz, professor of psychiatry and neurology at UMDNJ-Robert Wood Johnson Medical School, and Ronald Poretz, PhD, a biochemist at Rutgers, began their research about 12 years ago, collaborating with psychiatrists at the Lyons Veterans Administration Medical Center. They conducted human studies analyzing blood samples from 533 people: 151 were alcoholic patients at the medical center, 218 were psychiatric patients who were not alcoholics, and 164 healthy individuals formed the control group.
The flawed enzyme was found in 10 of the alcoholics, but was present in only one person in each of the other two groups. Worldwide, it is found in 25 million to 100 million people, Manowitz says.
The results of the study, which identified a genetic predisposing factor for symptoms of alcoholism, were published in the April 12 issue of the journal Alcoholism: Clinical and Experimental Research.
"I'm excited about what we've done," Manowitz notes, "but this is only one part of the puzzle. We have shown an association between the gene and alcoholism - to prove that it is a cause, we need to look at the other members of alcoholics' families." He and his team are working with scientists at the National Institute of Alcohol Abuse and Alcoholism, as well as researchers at other institutions to conduct such a study.
Both genetic and environmental factors are thought to be at the root of alcoholism. Strong evidence for a genetic link was reported in a series of studies, conducted during the last three decades, of twins and of siblings who were adopted and raised in different surroundings.
Early identification of those affected may encourage them to seek counseling
and adopt prevention strategies. (top)
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