The Salina Journal from Salina, Kansas on October 2, 1996 · Page 6
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The Salina Journal from Salina, Kansas · Page 6

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Salina, Kansas
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Wednesday, October 2, 1996
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Page 6
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1 A6 WEDNESDAY, OCTOBER 2, 1996 HEALTH THE SALINA JOURNAL T MANAGED CARE Poor, old suffer in new care Managed care harder on patients than insurance, study finds By LINDSEY TANNER Hie Associated Press CHICAGO — Poor and elderly people with diabetes, high blood pressure and heart problems fare much worse under managed care than similar patients in traditional fee-for-service insurance plans, a study found. Twice as many poor and elderly patients in managed care said their health declined over a four- year period, according to the study in today's Journal of the American Medical Association. Only one of five poor patients in managed care felt better after four years, compared with more than half of those in traditional plans. John Ware Jr., a research psychologist at the New England Medical Center and author of the study, called the work "an indictment of the whole notion that we are going to implement cost containment and it's going to be just as good for everybody." The study involved 1,574 patients in Chicago, Los Angeles and Boston who filled out health questionnaires in 1986 and again in 1990. The self-reporting method was criticized by Susan Pisano of the American Association of Health Plans, which represents 1,000 managed care plans. She said medical evaluations should have been used. She also said managed care plans have greatly improved since 1990. Managed care plans try to cut costs by discouraging unnecessary procedures. Patients pay a set fee for a doctor who must authorize further treatment or referrals. Millions of Americans belong to health maintenance organizations, one of the most popular forms of managed care. Millions of people covered by Medicare are joining HMOs, which then receive their fees from the government. The study found that the average patient — relatively young and not poor — fared equally well in managed care and traditional plans. But the story was different for the poor and elderly. T OSTEOPOROSIS Breast cancer awards The Associated Press The Avon Breast Cancer Leadership Awards, $1 million In grants, were presented Tuesday by Avon's chief executive officer James Preston (left). Ten people each received $100,000 for their lifelong commitment to the breast cancer cause. Recipients are (seated from left to right) Barbara Stillwater of Anchorage, Alaska; Linda Burhansstipanov of Denver; Patricia Ganz of Los Angeles; and Paula Gomez of Brownsville, Texas: (standing from left to right) Christina Gold, president of Avon North America; Zora Kramer Brown of Washington, D.C.; Mary Jo Ellis Kahn of Richmond, Va.; Rosamarla Murillo of Austin, Texas; Harold Freeman of New York City; Susan Hester of Washington, D.C.; and Gilbert Friedell of Lexington, Ky. V SPINAL INJURIES X-rays could help some patients avoid paralysis BREAST CANCER Cancer gene affects Jews Genetic defect for breast cancer common among American Jews By MALCOLM RITTER The Associated Press NEW YORK — Last year, a genetic defect that promotes breast cancer was found to be unusually common among Jewish women of Eastern European descent. Now, a second such defect has turned up in a surprising number of these women. Altogether, one in 40 to 50 Ashkenazi Jewish women carries one defect or the other, new studies indicate. Last year's study found that a certain defect in the gene BRCA1 occurred in about 1 percent of Ashkenazi Jews. Two new studies say a particular mutation in another gene, BRCA2, appears in 1 percent to 1.5 percent of that group. Although the two flaws are unusually frequent in Ashkenazi Jews, researchers said it's too soon to screen such people for the defects. That's because doctors don't yet know how dangerous the mutations are and there's no proven way to prevent the disease. Ashkenazi Jews account for the vast majority of the nation's Jewish population. They should not be alarmed by the new findings, said Dr. Harry Ostrer of New York University, an author of one of the new reports. While Jewish women may have a slightly higher breast cancer rate than other women, there's no evidence that the overall risk from their genes is especially high, he said. "Ashkenazi Jews aren't victims of their genes," he said. "It's just that we've learned about them first." Scientists identified BRCA1 and BRCA2 by studying the relatively few families with a strong genetic risk of breast cancer. Women in these families who have inherited a defective BRCA1 run a lifetime breast cancer risk approaching 90 percent. But the risk associated with BRCA2 may be substantially lower, the new studies suggest. The new studies appear in the October issue of the journal Nature Genetics. Ostrer and co-authors found a particular BRCA2 mutation in about 1 percent of 1,255 Ashkenazi Jews. The other study, by C. Sue Richards and colleagues at the Baylor College of Medicine in Houston, found it in 1.5 percent of about 3,000 Ashkenazi Jews. Ostrer and Richards said their findings are essentially the same. Estrogen's role in righting osteoporosis discovered Hormone may help by shortening the lives of bone-killing cells By DON FINLEY San Antonio Express-News SAN ANTONIO — Researchers have identified a key step in how the hormone estrogen prevents the devastating bone-weakening disease osteoporosis in older people. The findings could lead to the development of new therapies to replace estrogen, which many women chose not to take because of an increased risk of certain cancers. Bone-eating cells called osteo- clasts have long been implicated in osteoporosis. People with the disease have higher than normal levels of osteoclasts. In a paper published today in the journal Nature Medicine, the researchers suggest that estrogen appears to play a role in telling the osteoclasts when to die through a process called apoptosis, or pro- grammed cell death. In post-menopausal women, when estrogen levels drop, the os- teoclasts live longer than they should — continuing to weaken bone, said Dr. Brendan Boyce, professor of pathology at the University of Texas Health Science Center. "We think a major way in which the population of osteoclasts is controlled by estrogen is for it to specifically cause them to kill themselves by this process of apop- tosis, or programmed cell death," Boyce said. "What we're seeing in the absence of estrogen is likely to be osteoclasts living longer." Osteoporosis is one of the most common diseases of postmenopausal women, although it can strike both sexes. The disease causes 1.5 million bone fractures each year, with direct hospital and nursing home costs exceeding $10 billion. In normal bone, there exists a delicate balance between osteo- clasts, which removes worn or injured bone, and osteoblasts, which help form new bone. Salina Charity Horse Show October 4th, 5th and 6th Agricultural Hall, Kenwood Hall Friday, October 4th 2 pin and 7 pm Saturday, October 5th • 9:30 am, 12:30 pm and 7:30 pm 9:30 am Studies on rats show X-rays 3 weeks after injury let nerves regrow By PAUL RECER The Associated Press WASHINGTON — X-rays applied at the right time and in the right dose may allow some healing of severed spinal cords — and the partial restoration of use of paralyzed limbs — according to laboratory research with rats. Nurit Kalderon, a scientist at Memorial Sloan-Kettering Cancer Center in New York, said extensive additional research is needed before the technique could be applied to human patients. But she said it does suggest a new way of treating injuries now often considered hopeless. Kalderon, lead author of the study, said the X-rays apparently halt the action of cells that block the regrowth of injured nerve fibers. These cells, which she called reactive astrocytes, are made by the body, for reasons unknown, after a spinal injury. She said that the studies on rats found the technique had to be done in the third week following the injury. A report on the study is to be published in the Proceedings of the National Academy of Sciences. Dr. Michael Walker, director of the division of stroke and trauma at the National Institute of Neurological Disorders and Stroke, said "Dr. Kalderon has performed a terribly interesting series of studies." "She is using a therapy (X-rays) normally used to kill cells to cause cells to survive," he said. "We don't know yet what the side effects would be, so I am cautious about it. I would like to see the work repeated in another lab." Spinal cord injuries often result in total paralysis of limbs. Researchers say this occurs because nerve fibers in the central nervous system, which includes the spinal cord, do not regenerate as do most nerve tissue elsewhere in the body. "The tissue in the area of the injury will actually decay after'-'a certain point," said Kalderon. ' Early in the recovery from '•& spinal cord injury, she said, the body makes an effort to regrow nerve fibers. But at some point this halts and the injury to thte spinal cord is irreversible. j That point in rats, said Kalderon, is about three weeks, the time when the reactive astro- cytes cells appear. X-rays, she said, prevent the formation and action of the these cells, but the radiation has to be precisely timed! "At four weeks, the radiation is not helpful," she said. "It has to be during the third week." ' Kalderon tested the X-ray trea't- ment on a series of rats whose spinal cords had been completely severed. At three weeks after the injury^ some of the rats were exposed to X-rays at doses similar to that used to treat cancer. A group of control rats received no X-rays. ^ After four to five months, about a third of the rats who had been exposed to X-rays showed some sign of spinal cord regeneration.' 1 Of 11 rats exposed to the X-rays in one group, "six definitely had some recovery of function," said Kalderon. "We could see them move their back legs and to support their weight. They could plant their feet on the ground." She said none of the rats recovered fully, however. This woul'd require extra therapy, a treatment not practical with rats. 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