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New research raises the possibility that people who have the highest levels of a chemical known as BPA in their urine are more likely to be diagnosed with heart disease.

But the findings don’t prove that bisphenol A (BPA) actually causes heart disease — one scientist even suggests other factors may be at play — and researchers can’t explain why statistics suggest that urinary levels of the chemical dropped by one-third over just two years during the last decade.

Still, the numbers raise more questions about BPA, which is found in a huge variety of plastic products. “The risks associated with exposure to BPA may be small, but they are relevant to very large numbers of people,” said study author Tamara S. Galloway, a researcher at the University of Exeter in England.

BPA, which is used to make hard, clear plastic and epoxy resin, is found in everyday items, from food and drink containers to electronic and medical equipment.

It has been linked to sexual dysfunction, heart disease, cancer, diabetes and even hyperactivity in girls. But the chemical industry questions the validity of studies and contends that BPA is safe.

“Studies of this type are very limited in what they tell us about potential impacts on human health. While they can provide helpful information on where to focus future research, by themselves they cannot and should not be used to demonstrate that a particular chemical can cause a particular effect. The public should be confident that BPA is one of the most studied chemicals. Regulatory bodies from around the world have recently completed scientific evaluations and found BPA safe in food-contact products, including canned foods and beverages,” stated Steven G. Hentges, of the American Chemistry Council’s Polycarbonate/BPA Global Group.

“The study itself does not establish a cause-and-effect relationship between BPA exposure and heart disease. In addition, the robustness of these limited findings is questionable, as fewer than 50 participants self-reported health conditions without medical confirmation,” Hentges added.

Galloway and colleagues sought to confirm the results of their previous research that showed a link between BPA exposure and heart disease. They compared data regarding BPA levels in urine from 2003-2004 (in 1,455 people) to 2005-2006 (in 1,493 people), and reported their findings in the Jan. 13 edition of the online journal PLoS ONE.

The researchers don’t know why the levels dropped by one-third over just two years, although they speculate that decreased use of BPA may explain it.

After adjusting their figures to reduce the chance that they’ll be thrown off by factors such as the age, gender and race of the subjects, the researchers found that high urinary levels of BPA boosted the risk of heart disease by 1.3 to 1.4 times compared to those with low levels.

That doesn’t necessarily mean BPA makes people have heart problems. Galloway acknowledged that heart disease could somehow affect the way that the body deals with BPA and might boost its levels.

“All we can say is that the two are associated, and that the association has now been shown in two independent study populations, making it unlikely to be a chance finding,” Galloway said.

Another possible factor is the diet of those who had high BPA levels, said Dr. Hugh S. Taylor, director of Yale University School of Medicine’s division of reproductive endocrinology and infertility.

“People who eat out of cans and plastic have higher BPA levels, however they also have a lot of other reasons to have heart disease. Bad diets are clearly a cause of heart disease as well,” he said. “This study is interesting and should make people concerned; it does not prove that BPA causes heart disease.”

To find out if one thing causes another, scientists often turn to the “gold standard” in medical research: a randomized, controlled double-blind study. In this case, people would be randomly assigned to either be exposed to BPA or not, then researchers would watch to see that happened.

However, in regards to potentially harmful BPA exposure, “this would be unacceptable to any ethics committee,” Galloway said. “Also, based on the current data, it would likely be very hard to find enough people for the control group who did not have detectable levels of BPA in their urine.”

In other words, almost everyone has BPA in their system, making it harder to figure out exactly what it does, if anything, to the body.

SOURCES: Tamara Galloway, Ph.D., professor, ecotoxicology, University of Exeter, U.K.; Hugh S. Taylor, M.D., director, division of reproductive endocrinology and infertility, Yale University School of Medicine, New Haven, Conn.; Steven G. Hentges, Polycarbonate/BPA Global Group, American Chemistry Council;

educed dosages of dopamine agonists, drugs routinely used to treat Parkinson’s disease, can cause symptoms similar to those experienced by addicts in withdrawal, such as anxiety, panic attacks, pain, dizziness and drug cravings, researchers say.

The symptoms of what the researchers have dubbed “dopamine agonist withdrawal syndrome” have been linked to a disruption in levels of dopamine in the brain, according to the study published in the Jan. 12 issue of the Archives of Neurology.

“Like cocaine and methamphetamines, dopamine agonists work by stimulating the reward pathways in the brain,” senior study author Dr. Melissa J. Nirenberg, said in a news release from Weill Cornell Medical Center.

“For this reason, it makes sense that they would engender similar withdrawal symptoms, particularly in those with high cumulative drug exposure,” explained Nirenberg, associate director of the Parkinson’s Disease and Movement Disorders Institute at New York-Presbyterian Hospital/Weill Cornell Medical Center and an assistant professor of neurology and neuroscience at Weill Cornell Medical College.

Dopamine agonists are used as an alternative to the drug L-DOPA, which can cause side effects in patients with Parkinson’s, such as involuntary movements. The dopamine agonist drugs — pramipexole (Mirapex) and ropinirole (Requip) — are also approved for treatment of restless legs syndrome.

In the study, researchers looked at the medical records of 93 people with Parkinson’s disease, 26 of whom lowered their doses of the dopamine agonist drugs. Five of these patients — 19 percent — experienced dopamine agonist withdrawal syndrome. Three of the five patients couldn’t adjust to the withdrawal symptoms and had to stay on the dopamine agonists, which can cause impulse control disorders, such as compulsive behaviors related to gambling, shopping, eating or sexual activity.

SOURCE: Weill Cornell Medical Center, news release

When diet and exercise attempts haven’t worked, increasing numbers of overweight people have turned to bariatric, or weight-loss, surgery to shed pounds.

But research reported in 2009 pointed to an unintended result: One of every five people who had bariatric surgery had broken a bone within a few years.

Were the breaks a result of the surgery? Or of the weight loss that followed? Might they have been related to something going on in the body, either before or after the surgery? Or might something else altogether have been at work?

The answers remain unclear.

The finding came from an early analysis of data from a study by researchers from the Mayo Clinic, in Rochester, Minn. The study included 97 people, most middle-age and mostly women. All had had bariatric surgery — either stapling of the stomach, called gastric bypass, or stomach banding, called gastric band surgery. In the next seven years, 21 of them had 31 fractures.

The researchers compared the fracture rate for the people in the study with the rate for residents of Olmsted County, Minn., and found that people who had undergone weight-loss surgery were nearly twice as likely to have broken a bone for the first time as were those in the general population. The rate for specific sites was higher, with the risk for fracturing a foot, for instance, nearly four times higher among people who’d had bariatric surgery than in the general population.

The researchers did not determine what caused the increase in broken limbs. Their research, presented at a meeting in June of the Endocrine Society, continues and, through a Mayo Clinic spokesman, they declined further comment.

Until more findings are in, experts can only speculate about the cause and advise people who have had or plan to have bariatric surgery to pay close attention to bone health.

Dr. John Wilder Baker, director of the medical weight-loss program and co-director for the bariatric surgery program at Baptist Health in Little Rock, Ark., said that people in the study might have been deficient in vitamin D before the surgery.

Many people don’t include enough dairy products in their diet and so are lacking in vitamin D and calcium, both important for bone strength, said Baker, who is also president of the American Society for Metabolic and Bariatric Surgery and was familiar with the Mayo research.

Weight-loss surgery, he said, could bring about changes in absorption of calcium. “With gastric bypass, there could be some malabsorption of calcium,” he said.

“Before and after gastric bypass, patients are routinely told to take at least 1,200 milligrams of calcium daily, and usually 800 milligrams of D, but that may not be enough,” Baker said.

Monitoring patients closely is crucial, he said. “No matter which surgery [of several bariatric surgery options] they have had done, they need to be monitored for calcium, vitamin D levels and parathyroid hormones long term,” he said. Parathyroid hormones help increase calcium levels in the blood.

An orthopedic surgeon also familiar with the study said that it’s important to remember that the research was reported at a preliminary stage.

“I would be very careful drawing too much from one study,” said Dr. Leon Benson, a professor of orthopedic surgery at the University of Chicago, a hand surgery consultant at the Illinois Bone and Joint Institute and a spokesman for the American Academy of Orthopaedic Surgeons.

Benson said he has not noticed an increase in fracture patients with a history of bariatric surgery.

As for the mechanism, he speculated, like Baker, that the higher fracture rate could be linked to absorption issues.

Another possibility? “Maybe the patients lost enough weight [that] it changes body image and they have balance issues,” Benson said.

For now, people who’ve had bariatric surgery “should be as careful as they can to avoid preventable fractures,” he said. “That means paying close attention to their physician’s advice about their intake of calcium and vitamin D as well as their advice about exercise, which can help keep bones strong.”

When it comes to talking about sex, parents are a few paces behind their kids.

Too often, the birds-and-the-bees conversation occurs after, and not before, kids start experimenting sexually, possibly in risky ways, reports a study in the January issue of Pediatrics.

This revelation comes despite American Academy of Pediatrics recommendations that health-care providers and parents talk to their kids about sex and sexuality early in life.

“Parents are a little behind the 8 ball. They underestimate their children’s sexual knowledge and interest and behaviors,” said Dr. Lawrence Friedman, director of adolescent medicine at the University of Miami Miller School of Medicine.

“It’s a hard subject for many parents to broach, but the level of sexual activity in many kids has moved up in terms of initiation. It’s younger,” added Alan Hilfer, director of psychology at Maimonides Medical Center in New York City. “Talking about it is very helpful in terms of disease prevention, unwanted pregnancy and even issues around relationships.”

Although there were suspicions that parents lagged behind their kids, previous studies had asked adults to remember when they first had sex and when their parents talked to them, said study author Megan Beckett, a social scientist with the Rand Corp. in Santa Monica, Calif.

For this study, Beckett and her colleagues surveyed 141 middle-class and upper middle-class parents and their children, aged 13 to 17, in more of a real-time scenario. “We went back about four times over a year’s period,” Beckett said.

Starting with questions about girls bodies and menstruation, the research team asked parents and children about kissing and handholding, birth control, refusing sex, oral sex and intercourse, all related to different developmental stages of the kids.

More than half of children had experienced genital touching before “the talk” about birth control, sexually transmitted diseases (STDs) and condom use, the researchers found.

“More than 40 percent of adolescents are having intercourse before parents have talked to them about STD symptoms, condom use, choosing birth control and what to do if your partner refuses to use a condom,” Beckett said. “That’s a pretty large number.”

About two-thirds of boys said they had not talked with a parent about how to use a condom before having intercourse.

And conversations with boys almost always took place later than talks with girls.

“This is a flag to not put it off, and this is especially the case with boys,” Beckett said.

Denial, naivety and any number of other emotions on the part of the parents may be playing into this trend, Friedman said.

“They reminisce that when they were in the seventh grade, they didn’t do that kind of thing,” he said. “The fact of the matter is that this is 25 years later, and this is what is going on. You have to be knowledgeable and prepared to prepare children for when they become teenagers and have to confront sexual kinds of activities.”

Other experts agree. “We live in an R-rated society, and our kids need our PG guidance,” said Dr. Frank Biro, head of adolescent medicine at Cincinnati Children’s Hospital. “If you want to instill knowledge and values, then you need to be talking to your kids earlier, not later.”

Here are some tips on when and how to talk to your kids:
Figure that the age you think is appropriate is probably too old. “If parents think that they should broach the topic at x age, they should subtract two years and do it at that age instead,” Friedman said.
Talk to your physician and scour resources from the Internet, libraries and schools about how to broach the subject and what to say.
Take the lead. “Don’t expect your child to come and ask an important question about a topic that they’re embarrassed about or that they don’t know their parents would be willing to talk to them about,” Friedman said. “This will also help gauge how knowledgeable their teenager or child is.”
After you’ve talked, “step back and ask your kids questions and pay attention to what they’re interested in,” Hilfer said.
Make sure your conversation is developmentally appropriate to the child, Biro said. Talking about fellatio with a 6-year-old is probably not appropriate. Talking about boys liking girls and handholding would be for kids 8 or 9 years or possibly even 6 years old. “If you haven’t talked to your kids by the time they’re 12, you need to get on the stick,” said Hilfer.

Want to boost the odds that you’ll thrive after surgery and avoid complications?

The American Society of Anesthesiologists has a recommendation: Drop that butt.

Quitting smoking will make it more likely that you’ll recover from an operation without anything going seriously wrong, the society says.

“Anesthesiologists are the heart and lung specialists in the operating room, making sure our patients’ vital functions are working properly,” said Dr. David O. Warner, who chairs the group’s smoking cessation task force. “Every year, we care for up to 10 million smokers in surgery. We see the immense toll that smoking takes on a person’s body, but we also witness the tremendous benefits patients who stop smoking before surgery experience in their healing process.”

The association suggests that surgery provides an ideal opportunity for someone to quit smoking altogether because surgery patients are told to stop for as long as possible before and after their operation.

Surgery-related reasons to quit, the group says, include:
You’ll heal better after surgery. One study found that half of the people who continued smoking after surgery developed complications; the number fell to 20 percent among those who quit.
Hospitals are smoke-free, and it will be tough to leave to light up.
Within hours after you quit, your body will begin to heal. Within less than a day, the association says, blood flow throughout the body will get better, boosting the chances of avoiding complications from surgery.

That picturesque wood-burning stove ranks alongside auto traffic as a risk factor for bronchiolitis, the respiratory condition that is the leading cause of hospitalization in the first year of life, a new study finds.

“Those infants who had more exposure to wood-burning appliances were more likely to show up in doctors’ offices or be hospitalized for bronchiolitis,” said Dr. Catherine Karr, an assistant professor of pediatrics at the University of Washington, and lead author of a report in the Nov. 15 issue of the American Journal of Respiratory and Critical Care Medicine.

There hasn’t been much research done on the effects of air pollution on very young children, Karr said. Such studies have typically focused on older children, in whom asthma is a more prevalent problem related to air pollution.

Karr and Canadian researchers analyzed nearly 12,000 cases of infant bronchiolitis between 1999 and 2002 in the province of British Columbia, checking on exposure to air pollutants such as nitric oxide, nitrogen dioxide, carbon monoxide and particulate matter. They also looked at the source of those pollutants.

Infants who lived within 50 meters — about 55 yards — of a highway had a 6 percent increased risk of bronchiolitis, while those with higher exposure to wood smoke had an 8 percent increased risk, compared to those with the lowest exposure.

“Bronchiolitis is the number one reason why a child ends up in a hospital in the first year of life,” Karr explained. “It is responsible for 13 percent of those hospitalizations.”

Bronchiolitis is a respiratory condition that starts out looking like a common cold but can become “quite severe,” she said. It can be caused by viruses, and is often the first infection a child experiences early in life.

The study “lets families know about concerns about infant exposure to traffic and wood-burning appliances,” Karr said. “If they can avoid those things, they should. If they do use wood-burning appliances, they should use safety practices, making sure the appliances are properly vented and burn efficiently.”

The study included such pollution because “here in the Pacific Northwest, we have more exposure to wood-burning stoves than in other places,” Karr said.

“This study extends some past findings that wood smoke can be very irritating to the respiratory system, and has been shown to have effects on the lungs of children,” said George Thurston, director of the Particulate Matter Health Effects Research Center in New York.

“Wood smoke seems to have the biggest effects on respiratory health, whereas fossil fuels seem to have the biggest effects on cardiac health, because they are more laden with metals,” Thurston said.

The Pacific Northwest is unusual because of a higher concentration of wood-burning appliances, he said. “In other areas, traffic may dominate more,” Thurston noted.

New guidelines are needed to improve the diets of U.S. school children, finds a new government report that would set maximum calorie counts for school breakfasts and lunches.

School meals should have less salt; more vegetables, fruits and whole grains; skim and low-fat milk, and other dairy products, the report from the Institute of Medicine says. It called on the federally funded National School Lunch Program and the School Breakfast Program to update its current policies.

“The program was due for a revision,” said IOM committee chairwoman Dr. Virginia A. Stallings, a professor and director of the Nutrition Center at Children’s Hospital of Philadelphia.

The committee’s job was to make recommendations to the U.S. Department of Agriculture, which runs the school meal program, Stallings said. “We expect that they will take this information and revise the program,” she said.

“These recommendations will become regulations, and schools are required to follow them if they are going to get reimbursed for school meals,” she said.

The IOM recommendations would bring school meals in line with the latest dietary guidelines and reference intakes from the U.S. Department of Agriculture. The current standards for school meals are based on the 1995 dietary guidelines and the 1989 recommended dietary allowances.

Increased funding will be needed to implement the changes because of the higher cost of vegetables and whole-grain foods, the report noted. Also, greater federal meal reimbursement, capital investment and additional training of food service personnel will be required for the recommendations to succeed.

But these changes are needed to assure parents that schools are providing healthful, satisfying meals, Stallings said.

“The school meal programs were established when we were worried about children being hungry and undernourished,” she said. “Now we have to worry both about that safety net for children who may not have enough food, but also balance it with a food supply that will prevent the school meals from contributing to the obesity problem.”

In the past, there had only been a minimum calorie amount, Stallings said. “What the committee is now recommending is a minimum and a maximum,” she said.

The report on healthy school meals suggests lunches contain no more than 650 calories for students in grades kindergarten through five; 700 calories for children in grades six to eight, and 850 for those in grades nine to 12. Breakfast calories should not exceed 500, 550 and 600, respectively, for these grade groups.

To ease the adjustment to lower salt meals, the report calls for reducing sodium over the next decade from today’s average of 1,600 milligrams per lunch to 740 milligrams.

In addition, breakfasts should contain one cup of fruit, and lunches for grades nine to 12 should also contain one cup of fruit. No more than half of the fruit should come from juice, the report says.

Vegetable offerings should increase to three-quarters of a cup a day for grades kindergarten through eight, and one cup a day for grades nine to 12. Starchy vegetables, such as potatoes, should be served less often, and at least half a cup each of green leafy vegetables, orange vegetables and legumes should be provided each week, the report said.

For grains, half of the breads and pasta should be whole grain, Stallings said. Milk served with school meals should be skim or 1 percent fat, she added.

Meat with lunches should be kept to about two ounces for all grades, but can be higher for students in high school. For breakfast, meat should be kept to about one ounce a day for children in kindergarten through grade eight, and two ounces for high school students, the report noted.

The National School Lunch Program is available in 99 percent of U.S. public schools and in 83 percent of private and public schools combined. The School Breakfast Program is available in 85 percent of public schools.

About 30.6 million school children participated in the school lunch program in 2007, and 10.1 million children had school breakfasts. In 2007, schools in the program served about 5.1 billion lunches and 1.7 billion breakfasts, according to the report.

Stallings hopes the recommendations will filter down to the meals parents serve at home. “I do believe that parents will be able to use some of this to talk about the kinds of fruits and vegetables they should be serving at home and other recommendations that are easily implemented, like going to skim or low-fat milk and thinking about sodium both in cooking and table salt,” she said.

Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine, said “this update to school nutrition standards is timely, and most welcome.”

School nutrition standards were originally devised to protect children from malnutrition and want, Katz noted.

“But in an age of epidemic childhood obesity, when children are far more likely to get too many calories than too few, and when more and more succumb to what was called ‘adult onset’ diabetes just a generation ago, the time-honored school food standards are clearly obsolete,” he said.

A new study suggests there’s a link between suicide and rural communities that have higher numbers of bars.

However, the research doesn’t confirm that more bars mean more suicides because it does not show cause and effect.

The findings were released this month online and will appear in the December issue of Alcoholism: Clinical & Experimental Research.

Of those who commit suicide, about 20 percent are alcoholics, according to background information in a news release from the journal. Almost all are men, and most are white.

Scientists from the Prevention Research Center in Berkeley, Calif., examined suicide statistics from California for 1995 to 2000, comparing them with the density of bars in rural areas.

Suicides occurred more often in less populous areas, such as rural communities, and in areas with older, lower-income white residents, the study found. Attempted suicide also was more common in rural areas. People who attempted suicide, however, were younger and not from a particular race.

“Although one cannot make the strong statement that more bars cause more suicides, our findings are at least consistent with what we would expect if patronizing bars or other alcohol outlets were in fact causally related to suicide,” Fred W. Johnson, associate research scientist and corresponding author for the study, said in the news release.

It’s possible that a factor other than the presence of bars could be at work, Dennis M. Gorman, interim head and professor of epidemiology and biostatistics at the Texas A&M Health Science Center School of Rural Public Health in College Station, said in the release. He was not involved in the study.

“For example, rural places with lots of bars might be depressing places to live in due to isolation, lack of social ties, etc.,” Gorman said. “This ‘depressing’ context would affect all who live there, both drinkers and non-drinkers.”

A French study estimates that more than 12 percent of people discharged from a hospital into home health care are infected with MRSA, or methicillin-resistant Staphylococcus aureus, and about 20 percent of them may transmit the organism to others in their household.

The researchers, Dr. Jean-Christophe Lucet, of Bichat-Claude Bernard Hospital in Paris, and his colleagues, screened 1,501 hospitalized adults for MRSA before they were discharged and found that 191 (12.7 percent) were infected. For the next year, those found to be infected and other people in their households were checked for MRSA every three months.

The 191 people with MRSA had 188 household contacts who took part in the study. Of those contact, 36 (19 percent) acquired MRSA, but none of them developed an infection. People most likely to be colonized with MRSA included those who were older and those who helped provide health care for the infected person. Sharing the same bed or bedroom did not increase the risk of MRSA transmission, according to the study.

The findings suggest that MRSA transmission is most likely among people who are at high risk for hand contamination while caring for people, the study’s authors noted.

Because no infections developed in any of the household contacts who acquired MRSA, it’s not clear whether such transmission poses a serious public health problem, the researchers said. Regardless, “household contacts should apply infection control measures similar to those recommended in the hospital setting,” they wrote.

Of the people discharged from the hospital with MRSA, about half of those followed for a year were found to be clear of infection, especially those who had become more self-sufficient in daily activities, the researchers said.

The study is in the Aug. 10/24 issue of Archives of Internal Medicine.

Swedish researchers say that immunoglobulin M (IgM) is a reliable predictor of cardiovascular complications in people with type 1 diabetes who have diabetic nephropathy (DN) — kidney damage caused by diabetes.

The study included 139 patients who were followed from 1984 to 2007. Those with increased levels of IgM in their urine at the start of the study were about three times more likely to suffer cardiovascular-related death or to progress to end-stage kidney disease.

The study appears in the journal BMC Medicine.

“To our knowledge, this is the first study to investigate the impact of increased urine IgM excretion on DN disease progression in type 1 diabetes patients,” lead researcher Dr. Omran Bakoush of Lund University said in a news release. “We found that those with increased urinary IgM excretion had a higher mortality from cardiovascular causes and higher disease progression rate to end-stage renal disease. This association is largely independent of the level of albuminuria.”

Bakoush said the “findings may offer a new approach to manage this rapidly increasing patient population. While measurement of albuminuria is routinely used to evaluate and manage patients with diabetes, increased urine IgM excretion would identify more specifically patients at risk for serious cardiovascular complications (death and renal failure). If increased urine IgM excretion does reflect advanced atherosclerotic vascular disease, clinical trials would be justified to test whether modifying atherosclerotic factors also decrease mortality and incidence of renal failure in diabetic patients with or without IgM-uria.”