Speech therapy helps Parkinson's patients

In a new study, 35 pairs of patients with Parkinson's were rated for speech clarity by six impartial individuals both before and 12 months after they underwent two types of intensive therapy: either high-effort respiratory treatment or combination high-effort voice and respiratory treatment therapy, known as The Lee Silverman Voice Treatment (LSVT).

The LSVT aims to improve speech through increased loudness and continuous feedback on performance.

The subjects underwent both forms of treatment in 16 individual sessions during a 1-month period, according to Dr. Lorraine Ramig, who is affiliated with the University of Colorado in Boulder, and colleagues.

For each of the 35 pairs presented, the listener was asked to select which sample sounded louder and which sample sounded better.

Seventy-five percent of people who received LSVT were perceived as louder at 12 months than they were pre-treatment. There were no significant differences in these ratings for subjects who received respiratory treatment.

Ramig also found that those with LSVT had a difference for ratings of ``better'' speech between pre- and 12 months post-treatment, with the speech of 63% of individuals who received LSVT perceived as better than it was pre-treatment. There were no differences in these ratings for subjects who received respiratory treatment.

``At least 75% of Parkinson's disease patients exhibit speech and voice impairment that impairs their quality of life and typically shows little or no improvement with dopamine replacement therapy or standard forms of speech therapy,'' Ramig told Reuters Health in an interview. ``As a result, many Parkinson's disease patients do not undergo speech therapy, and their speech deteriorates as their disease "progresses.''

``While earlier studies have shown an improvement in speech production by acoustic, aerodynamic and electromyographic methods, this study is the first to demonstrate that listeners perceive speech improvement with LSVT.''

Stress slows wound-healing process

Emotional upset appears to reduce the activity of compounds important to the healing process, explain Dr. William Malarkey and colleagues at Ohio State University in Columbus. The finding may help explain why ``greater fear or distress before surgical procedures is associated with poorer (results),'' they write in a recent issue of the Archives of General Psychiatry.

Malarkey's team asked 36 women to complete psychological questionnaires focused on levels of personal stress and the number and type of stressors in their lives.

Each woman then received 'wounds' -- a series of small blisters on the forearm, induced in a relatively painless manner through the use of a special suction device. The investigators gathered fluid from these blisters as they began to heal.

They found that fluid levels of two key 'healing compounds' -- interleukin-1 and interleukin-8 -- were ``significantly lower'' in samples gathered from women with the highest levels of stress versus women with lower levels of stress.

The researchers also measured concentrations of the stress hormone cortisol in the saliva of each subject. As expected, women with the highest reported stress levels also had the highest cortisol levels.

Numerous studies have suggested that blood concentrations of interleukin-1 and -8 decline with increasing levels of cortisol. According to the authors, interleukin-1 and -8 ``help protect against infection and prepare injured tissue for repair.'' As stress (and cortisol) levels rise, interleukin levels fall -- triggering a slowdown in the healing process.

The findings may have important implications for the treatment of wounds and for patients undergoing surgery. Study co-author Dr. Janice Kiecolt-Glaser notes that ``there is a lot in the medical literature suggesting... that a patient should not be under stress before surgery.'' The study authors comment that stress-reducing therapies -- such as drugs or psychotherapy -- might enhance post-surgical recovery.

Kiecolt-Glaser believes the immune system may be extremely sensitive to even subtle changes in emotional health. ``The women in this experiment were really average in terms of the stress they were experiencing,'' she points out. ``So this doesn't require desperate, terrible stress levels to see effects on the immune system.''

SOURCE: Archives of General Psychiatry 1999;56:450-456.

Deficiency linked to pregnancy toxemia

NEW YORK, Jul 27 (Reuters Health) -- Pregnant women who develop preeclampsia, a potentially life-threatening condition of elevated blood pressure, appear to have a deficiency in a compound known as prostacyclin, results of a study suggest.

What's more, the deficiency can be detected as early as 13 to 16 weeks of gestation -- months before the symptoms of preeclampsia begin. Preeclampsia usually strikes after the 24th week of pregnancy.

Preeclampsia, also known as toxemia of pregnancy, occurs in 5% of first-time pregnancies, and causes high blood pressure, fluid retention, and protein in urine. The cause of the disorder is unknown, and is ``one of the major unsolved mysteries in obstetrics,'' according to a report in the July 28th issue of The Journal of the American Medical Association.

In a new study, Dr. James L. Mills of the National Institute of Child Health and Human Development in Bethesda, Maryland, and colleagues found that women who developed preeclampsia had prostacyclin levels about 17% lower than women who did not develop the disorder.

Prostacyclin, a compound that dilates blood vessels, and thromboxane A2, a compound that constricts blood vessels, were measured in 134 women with preeclampsia, and 139 women with healthy pregnancies.

While the preeclamptic women had low levels of prostacyclin, their thromboxane levels were no different than those of women without the disorder.

``For decades, we thought thromboxane was high in preeclampsia. But we didn't know if it was the cause or a result. Now, we see that a major factor is that women with preeclampsia have too little of the compound that keeps blood pressure down,'' said Mills in an interview with Reuters Health.

``Our findings suggest that maybe there is another way of studying ways to prevent preeclampsia -- increasing prostacyclin might be more effective,'' he said. ``It's an entirely new way of thinking about the disease.''

Future studies should focus on ways to correct the prostacyclin deficiency, the authors conclude.

SOURCE: The Journal of the American Medical Association 1999;282:356-362.

FDA urged to examine herbal remedy claims

By Emily Kaiser
CHICAGO, Jul 27 (Reuters) -- Some critics of the lucrative herbal remedy industry are suggesting that the government take a hard look at health claims before the US Food and Drug Administration (FDA) upcoming public meeting on dietary supplements.

``Nutritional marketing is way, way ahead of some of the research,'' Dr. John Renner, head of the National Council for Reliable Health Information, said at a food technology conference in Chicago, Illinois, this week. ``We worry because we know the public is horribly confused.''

The FDA said that the August 4 meeting in Washington would be an opportunity for the agency to hear what it should require from the makers of dietary supplements.

Dr. Michael Rotblatt, associate professor of medicine at the University of California, Los Angeles, said that there has been little effort in the United States to find out whether or not these remedies work, at which dosages, and whether there are any side effects. Rotblatt reviewed European studies on echinacea, a plant derivative marketed to stimulate the immune system, and kava, a root-based herbal remedy that is supposed to relieve stress and anxiety, and found mixed results.

In several European studies, researchers found no difference between echinacea and (an inactive) placebo in preventing colds and flu, although the studies did suggest that it could limit the severity and duration of symptoms, Rotblatt said.

Studies on kava found it to be more effective than a sugar pill at reducing stress and anxiety. But when taken in large doses, the supplement can cause a loss of motor skills similar to drunkenness, according to Rotblatt.

``There is good evidence that kava does have some anti-anxiety properties, but there are some worrisome situations,'' Rotblatt explained. ``All of us should be concerned about the labeling of these products.''

The FDA tightened rules earlier this year to make dietary supplement labels carry more information including a list of ingredients and levels of vitamins and minerals.

Advocates of herbal remedies said that they are already under the watchful eye of the FDA, since they must submit documentation outlining their health claims. The FDA has the power to shoot down claims that cannot be supported, said Annette Dickinson, an official with the dietary supplement trade group Council for Responsible Nutrition.

She said that most of the health claims on herbal remedies are innocuous, adding that the FDA does need to ensure that claims can be backed up. ``These (herbal remedy) products have a long history of beneficial use,'' she said.

Americans spent about $3.8 billion on herbs and other botanical products in 1998, up from $2.5 billion in 1995, industry data shows. The remedies are usually classified as dietary supplements, and are therefore exempt from the FDA scrutiny to which drugs are subject.

Asthma hits children hardest in poor neighborhoods

By Ann Quigley
NEW YORK, Jul 27 (Reuters Health) -- Children from poor neighborhoods are far more likely to be hospitalized for asthma than are children from better-off neighborhoods, according to a zip code analysis of New York City hospitalization records.

Rates of hospitalization for asthma range from zero, for children living in several lower Manhattan and Queens neighborhoods, with average household incomes in excess of $57,000, to approximately 222 per 10,000 for young residents of East Harlem, New York, where the average household income is about $19,000. The study results are published in the June/July issue of the Journal of Asthma.

In an interview with Reuters Health, lead author Dr. Luz Claudio, of the Mount Sinai School of Medicine in New York said, ``The disparity in asthma levels among our communities is striking.''

She added that the East Harlem asthma hospitalization rate ''is higher than anything I have ever seen in any other study published on zip codes.''

According to Claudio, the highest asthma hospital rate found in a recent zip code analysis in Seattle was 98 per 10,000.

Asthma appears to hit children from lower-income neighborhoods hardest for several reasons; one being lack of sufficient preventive care, according to Claudio.

``We know that asthma can be managed better with good preventive care, and we think that poor communities may not have proper access to preventive care,'' she explained.

``Another problem in low-income communities may be the quality of houses. We know that indoor air quality can trigger an asthma attack,'' and poor quality construction materials treated with toxic organic compounds are often used in low-income neighborhoods, Claudio said in the interview.

Those in low-income areas are more likely to be exposed to molds, dust mites, pesticides, and cockroach and mouse droppings in their homes. ``People in poor communities are (also) more likely to live in areas that exceed federal standards for toxic air pollutants, such as lead, ozone, carbon monoxide and particulates,'' according to a Mount Sinai School of Medicine press statement.

Claudio recommends that individuals and community groups get involved with asthma research. ``That's how this project got started. We wouldn't have known that asthma was such a concern in the community unless someone came to us,'' namely, study co-author Leon Tulton, a college intern living in the South Bronx.

``We are here in our labs, concentrating on trying to get funding for projects and we hardly ever get to work side by side with community members,'' Claudio commented.

SOURCE: Journal of Asthma 1999;36:343-350.

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