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Treating advanced kidney cancer patients with the drug pazopanib (Votrient) slowed their disease progression by 54 percent, a new study has found.

The phase 3 study included 233 patients with previously untreated kidney cancer (also known as renal cell carcinoma) that was locally advanced or had spread, and 202 patients with renal cell carcinoma who had previously been treated with cytokine therapy (interferon or interleukin). The patients were randomly assigned to take pazopanib tablets (290 patients) or a placebo drug (145 patients).

In the pazopanib group, it took an average 9.2 months for the cancer to progress, vs. an average 4.2 months in the placebo group. The difference was greatest in previously untreated patients (11.1 months for the pazopanib group and 2.8 months for the placebo group), but also was found among patients previously treated with cytokines (7.4 months in the pazopanib group vs. 4.2 months in placebo group).

Common side effects of pazopanib treatment included diarrhea (52 percent), high blood pressure (40 percent), hair color changes (38 percent), nausea (26 percent), weight loss (22 percent) and vomiting (21 percent).

The data from this study, published online Jan. 25 in the Journal of Clinical Oncology, was used by the U.S. Food and Drug Administration to approve pazopanib in October 2009 for the treatment of advanced renal cell carcinoma.

Pazopanib inhibits the development of blood vessels that tumors need to grow and spread.

“Advanced renal cell carcinoma remains a challenging disease, but treatment has improved with the introduction of new targeted therapies over the past year — including pazopanib, which targets multiple pathways within cancer cells,” study author Dr. Cora Sternberg, chief of the medical oncology department at the San Camillo and Forlanini Hospital in Rome, Italy, said in a news release from the American Society of Clinical Oncology.

SOURCE: American Society of Clinical Oncology

The class of painkillers that includes ibuprofen and naproxen seems to work well against menstrual cramps, and may be more effective than acetaminophen, a new research review suggests.

The medications, collectively known as non-steroidal anti-inflammatory drugs (NSAIDs), are widely used for various aches and pains, but it has been unclear how they stack up against acetaminophen — the active ingredient in Tylenol and certain other brand-name pain relievers and fever reducers.

Acetaminophen, which is known as paracetamol in several countries, is also a component of a number of products marketed specifically for menstrual symptoms.

In the new review, researchers analyzed 73 clinical trials from 18 countries that tested various NSAIDs and acetaminophen for menstrual cramps. Across the studies, women given NSAIDs were 4.5 times more likely to report “at least moderate” pain relief than those given a placebo, or inactive pills.

They were also nearly twice as likely as acetaminophen users to report such improvements — though that finding was based on only three studies, the researchers report in the Cochrane Database of Systematic Reviews.

The journal is published by the Cochrane Collaboration, an international organization that evaluates medical research.

“Our review shows that NSAIDs are a highly effective treatment for menstrual cramps,” said Jane Marjoribanks, a researcher with the Cochrane Menstrual Disorders and Subfertility Group in Auckland, New Zealand.

Exactly why they might be even more effective than acetaminophen is unclear, she told Reuters Health in an email.

That said, the effects of NSAIDs varied from study to study. The one trial that compared aspirin to a placebo showed no clear benefits from the drug; in contrast, a study on the NSAID indomethacin found that women using the drug reported good pain relief during 42 of 90 menstrual cycles, versus 9 of 90 cycles among those using a placebo.

The trials also looked at a range of NSAIDs, including ibuprofen (found in brands like Advil and Motrin), naproxen (Aleve and other brands) and diclofenac (Voltaren and other brands). And there was not enough evidence to show whether any one NSAID was more effective or safer than others, according to Marjoribanks and her colleagues.

In addition, while NSAIDs are over-the-counter drugs, they carry a risk of side effects and need to be used with caution.

Across the trials in this review, women using NSAIDs were 37 percent more likely to report side effects like indigestion, drowsiness, dizziness and headaches than women given placebo pills.

To help minimize side effects, Marjoribanks said, women should take the drugs only for a few days during each menstrual cycle — the days when pain peaks — and should not exceed the recommended dose on the packaging.

SOURCE: Cochrane Database of Systematic Reviews

Even under Canada’s system of universal healthcare, low-income women are less likely than their wealthier counterparts to receive epidural pain relief during childbirth, a new study finds.

The findings mirror those of studies from the U.S. and other countries, and suggest that factors other than health insurance are at work, according to the researchers.

An epidural involves injecting pain medication through a catheter into the lower spine, and is considered the most effective way to relieve pain during childbirth. But studies have suggested that socioeconomics — including income, race or education — sway a woman’s likelihood of having an epidural.

For the new study, reported in the American Journal of Obstetrics & Gynecology, researchers looked at epidural use among more than 200,000 Ontario women who gave birth between 2004 and 2006.

They found that the one-fifth of women from the poorest neighborhoods in the study were 41 percent less likely to have epidural pain relief than the one-fifth of women from the wealthiest neighborhoods. There was a similar discrepancy between the least educated and most educated women.

The effects of income and education were seen even though the researchers accounted for factors like health problems in the mother and pregnancy complications — which can hinder the use of epidurals.

Moreover, given Canada’s universal health system, the findings suggest that factors other than insurance coverage are important, say the researchers, led by Ning Liu of the University of Ottawa.

“We argue that noneconomic maternal characteristics contribute much to the disparity,” Liu’s team writes.

A woman’s education level, for instance, could affect her willingness to have an epidural, the researchers note. Women with more education, they write, may know more about epidurals and be more open to having one.

Race, ethnicity and cultural views may also play a role, according to Liu’s team. There is evidence, for example, that women from Asia often feel that childbirth pain is natural and, therefore, they should “tolerate” it.

In addition, research in the U.S. has found that African Americans are less accepting of epidurals than whites.

Studies have also found that lower-income women are less likely to attend prenatal classes — a place where they would learn about the different types of pain relief available during childbirth.

The findings are based on the childbirth records of 220,814 Ontario women. Of women in the poorest neighborhoods in the province, 56 percent had an epidural, compared with almost 69 percent of women in the wealthiest neighborhoods.

Education appeared to make an even bigger difference. Among the one-fifth of women with the lowest education levels, half had an epidural. That compared with roughly 71 percent of the one-fifth of women with the highest education levels.

Those disparities were least apparent at large, academic medical centers, and most significant at small community hospitals, the researchers found.

Epidurals, in general, were used less often at small hospitals — which is not surprising, according to Liu’s team, since that trend has been documented in other studies. But it is not clear why income- and education-related disparities were greatest at small community hospitals.

They call for more research into the reasons for lower epidural rates among low-income women.

SOURCE: American Journal of Obstetrics & Gynecology

Only about half of American children and teenagers who have certain mental disorders receive professional services, according to a nationally representative survey funded in part by the National Institute of Mental Health (NIMH). The survey also provides a comprehensive look at the prevalence of common mental disorders.

The results are part of the National Health and Nutrition Examination Survey (NHANES), a collaboration between NIMH and the National Center for Health Statistics of the Centers for Disease Control and Prevention. The survey conducted from 2001 to 2004 had 3,042 participants. These most recent results include data from children and adolescents ages 8 to 15, and were published online ahead of print December 14, 2009, in the journal Pediatrics.

“Data on the prevalence of mental disorders among U.S. youth have been varied, making it difficult to truly understand how many children and teens are affected,” said NIMH Director Thomas R. Insel, M.D. “These data from the NHANES survey can serve as an important baseline as we follow trends of mental disorders in children.”

In the study, the young people were interviewed directly. Parents or caregivers also provided information about their children’s mental health. The researchers tracked six mental disorders — generalized anxiety disorder (GAD), panic disorder, eating disorders (anorexia and bulimia), depression, attention deficit hyperactivity disorder (ADHD) and conduct disorder. The participants were also asked about what treatment, if any, they were receiving.

Overall, 13 percent of respondents met criteria for having at least one of the six mental disorders within the last year. About 1.8 percent of the respondents had more than one disorder, usually a combination of ADHD and conduct disorder. Among the specific disorders,
8.6 percent had ADHD, with males more likely than females to have the disorder;
3.7 percent had depression, with females more likely than males to have the disorder;
2.1 percent had conduct disorder;
0.7 percent had an anxiety disorder (GAD or panic disorder);
0.1 percent had an eating disorder (anorexia or bulimia).

“With the exception of ADHD, the prevalence rates reported here are generally lower than those reported in other published findings of mental disorders in children, but they are comparable to other studies that employed similar methods and criteria,”said lead author Kathleen Merikangas, Ph.D., of NIMH.

Those of a lower socioeconomic status were more likely to report any disorder, particularly ADHD, while those of a higher socioeconomic status were more likely to report having an anxiety disorder. Mexican-Americans had significantly higher rates of mood disorders than whites or African-Americans, but overall, few ethnic differences in rates of disorders emerged.

Merikangas and colleagues also found that overall, 55 percent of those with a disorder had consulted with a mental health professional, confirming the trend of an increase in service use for childhood mental disorders, especially ADHD. However, only 32 percent of youth with an anxiety disorder sought treatment, a finding consistent with other studies. Moreover, African-Americans and Mexican-Americans were significantly less likely to seek treatment than whites, reiterating the need to identify and remove barriers to treatment for minority youth, noted the researchers.

“Until now, there has been a dearth of reliable data on the magnitude, course and treatment patterns of mental disorders among U.S. youth,” said Dr. Merikangas. “When combined with data from other nationally representative surveys, the data will provide a valuable basis for making decisions about health care for American youth,” she concluded.

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

Exercise appears to reduce the risk of death in male colon cancer survivors, researchers report.

The study, which began in January 1986, included 668 men who’d been treated for stage I, stage II or stage III colon cancer that had not spread (nonmetastatic cancer). Every two years, the men were sent questionnaires that asked them about any new cancer and disease diagnoses, as well as their physical activity. A metabolic equivalent task (MET) score was matched to each type of physical activity, with exercises that burned more energy receiving higher MET scores.

During the study period, which ended in January 2006, 258 of the participants died, including 88 who died from colon cancer.

“Men who were physically active after diagnosis of nonmetastatic colorectal cancer experienced a significantly decreased risk of colorectal cancer-specific death, as well as death from any cause,” wrote Dr. Jeffrey A. Meyerhardt, of the Dana-Farber Cancer Institute in Boston, and colleagues.

“Men who engaged in more than 27 MET hours per week had more than 50 percent lower risk of colorectal cancer-specific mortality compared with inactive men. This association was consistently detected regardless of age, disease stage, body-mass index, diagnosis year, tumor location and prediagnosis physical activity,” the study authors reported in the Dec. 14/28 issue of the Archives of Internal Medicine.

“These results provide further support that physical activity after colorectal cancer diagnosis may lower the risk of death from that disease,” the researchers concluded. “A randomized study among high-risk stage II and stage III colon cancer survivors that will compare the use of general education materials with a program that includes supervised physical activity sessions and behavioral support delivered over three years will soon open; the primary endpoint is disease-free survival. The findings from the present study further support that effort.”

Identifying sight and hearing problems in teens who are in the early stages of schizophrenia may help doctors fully restore those senses and lessen the impact of the devastating thought disorder, U.S. researchers say.

A new study found that problems in basic sensory processing abilities cause many of the more complicated cognitive deficits in people with schizophrenia.

“In people with schizophrenia, we know that visual and auditory sensory systems that functioned well in early childhood begin to break down during adolescence, years earlier than the onset of the more complex cognitive symptoms of schizophrenia,” Dr. Daniel C. Javitt, of the New York University School of Medicine, said in a news release.

“We already know a lot about what people with this disorder can and cannot do,” Javitt said. “Our research focuses on understanding how the brain works and identifying specific biomarkers for cognitive impairment that will distinguish schizophrenia from Alzheimer’s and other diseases.”

He and his team determined that impaired function of the visual and auditory systems makes it more difficult for people with schizophrenia to read, pay attention and understand social cues. The researchers also identified biomarkers in the brain that could help determine which patients would benefit from early intervention.

Nearly 20% neglect to take drugs that could prevent another blood clot, study finds

About one-fifth of ischemic stroke survivors don’t take medications that can reduce their risk of another stroke, a U.S. study has found.

Ischemic stroke is caused by blocked blood flow in the brain. Several types of medications can reduce the risk of another ischemic stroke. These include blood thinners (antithrombotic medications), of which aspirin is the most common.

This seven-year study of 4,168 ischemic stroke survivors found that about 19 percent of patients didn’t take blood thinners. Men, older patients and non-Hispanic patients were more likely to take blood thinners.

Further research is needed to determine exactly why patients who can benefit from these medications don’t take them, said the University of California, Los Angeles researchers.

Screening for cancer and other preventive health measures can prolong lives, but only 25 percent of adults aged 50 to 64 in the United States are getting these recommended screenings, a new report shows.

Prepared by the U.S. Centers for Disease Control and Prevention, AARP and the American Medical Association, the report also lays out ways to improve the health of these adults by increasing the breadth of preventive services.

“This is really looking at untapped opportunities to improve the health of adults,” said report co-author Lynda A. Anderson, director of the CDC’s Healthy Aging Program. “It really talks about broadening the use of these potentially lifesaving preventive services.”

Areas of special attention in the report include influenza vaccine, cholesterol screening, colorectal cancer screening and for women, breast and cervical cancer screening. Also included are screenings for other behaviors that could hurt health such as binge drinking.

Anderson said they hope to institute programs for adults that are like those for children in keeping their health care up-to-date. “We are trying to get adults to think in the same way — are you really up-to-date- on your services?” she explained.

By 2015, middle-aged adults will make up 20 percent of the U.S. population. These people are at the greatest risk of developing chronic diseases such as heart disease and cancer. In addition, about one-third of these adults are uninsured or underinsured, increasing the challenges of providing preventive services, the report noted.

In addition, most people go to their doctor with a specific complaint and often preventive screening is never mentioned, Anderson noted. The new effort is “really looking for ways to support providers,” she said.

“This report highlights that national experts agree on a set of recommended clinical preventive services,” Dr. Matthew T. McKenna, associate director for medical affairs at the CDC’s National Center for Chronic Disease Prevention and Health Promotion, said during a late morning news conference Thursday.

“We are talking about a concerted effort to align messages that build awareness, about creating environments that make services readily available and convenient and adopting public policies that promote healthy behaviors and increase access to services,” McKenna said. “This can make a discernable impact on our nation’s health, health care and social services.”

In addition, the report discusses model programs, policies and strategies that communities can adopt together with health-care partners, to ensure services get to those who need them. It also highlights proven strategies that clinics and communities have used to promote preventive services.

One such program, called SPARC (Sickness Prevention Achieved through Regional Collaboration), is an organization in the community responsible for looking at what services are needed and organizing these services, as well as getting services to people, Anderson said.

Individuals should look at “what kind of services do you need–what do I need to do to maximize my own health? What are the things I can do make sure as I am growing older that I avoid having chronic illnesses? That I make sure I get the physical activity I need, I make sure I am the right weight, so I can do the things I want to do,” Anderson said.

“It’s not just about health — it’s really quality of life,” she said.

Sounds can penetrate deep sleep and enhance associated memories upon waking, new research finds.

In a study linking sounds to what is called spatial memory, researchers at Northwestern University in Chicago showed 50 objects on a screen to study participants and played corresponding sounds, like a cat meowing and a tea kettle whistling. Then they played some of the sounds as participants napped.

The participants didn’t consciously hear the sounds, but they still did better in tests of remembering where the objects belonged on the screen.

“The research strongly suggests that we don’t shut down our minds during deep sleep,” said John Rudoy, lead author of the study and a neuroscience post-graduate student, in a news release issued by the university. “Rather this is an important time for consolidating memories.”

“While asleep, people might process anything that happened during the day — what they ate for breakfast, television shows they watched, anything,” Ken Paller, senior author of the study and professor of psychology at Weinberg College of Arts and Sciences at Northwestern, said in the statement. “But we decided which memories our volunteers would activate, guiding them to rehearse some of the locations they had learned an hour earlier.”

The new study adds to the growing research that memories are processed during sleep. And it substantiates past studies showing that the brain is active during sleep, reviewing recently acquired information and integrating it with other knowledge “in a mysterious consolidation process that sustains our memory abilities when awake,” the researchers said.