Prostate terminology bewilders many inner-city men

Many inner-city men don't understand basic terms having to do with the prostate, according to a new survey, which could make it difficult for them to decide on treatment options for related cancers.

"The risk to benefit ratio of prostate cancer screening and treatment depend a lot on patient preferences, so it is critical that patients can understand the tradeoffs that are involved," said Dr. Stacey Loeb, a urologist at NYU Langone Medical Center in New York.

"This is particularly true for high-risk groups such as African Americans, who are known to be at greater risk for aggressive prostate cancer," Loeb, who was not involved in the study, told Reuters Health.

Another study this year indicated that the educational materials and websites doctors direct patients to are still too difficult for many patients to understand (see Reuters Health story of May 20, 2013 here: http://reut.rs/11cXHeQ).

Prostate cancer is the second leading cause of cancer death for men in the U.S., killing about 30,000 men each year according to the Centers for Disease Control. It's not always aggressive, however, meaning that men may be subjected to surgery or radiation, and side effects, without necessarily extending their lives.

Researchers distributed "pop quiz" surveys on common terms related to urinary, bowel and sexual functions at two clinics for low-income patients.

Of 109 men, 95 percent did not understand what the prostate does, according to results published in the journal Cancer. The numbers were better but still low for terms like "incontinence," "urinary function" and "bowel habits."

Many of the men read at a 9th-grade level.

"As our results indicate, most physicians likely overestimate patient understanding of these terms," coauthor Dr. Ashesh Jani told Reuters Health by email.

Prostate cancer can be confusing even for men with high literacy, said Jani, a radiation oncologist treating prostate cancers at Winship Cancer Institute of Emory University in Atlanta.

These results are "exactly what I would expect," according to Dr. Mack Roach, chair of radiation oncology at the University of California, San Francisco Medical Center.

But he's not necessarily worried about the patients as long as they're cared for by quality doctors, said Roach, who was not involved in the study.

"Allowing (patients) to feel comfortable about asking questions is most important, but this depends on the doctor," Roach said.

"For practicing clinicians, this is very important information," Dr. Durado Brooks of the American Cancer Society in Salt Lake City, Utah, told Reuters Health.

He found the numbers in this study "a little shocking," and stressed that doctors need to assess how much a patient understands, since some are embarrassed by their lack of knowledge.

Patients with low knowledge levels could jeopardize the patient half of "shared decision making," the collaborative process between patient and physician to come to a treatment decision, Loeb said.

"However, it is important to note that most of the men in this study did not have prostate cancer," she said. "Many people without any previous knowledge about a medical problem will read up on it if they are diagnosed."

Packaged diet foods may spur more weight loss

In a head-to-head comparison with a traditional diet, people who stuck to a diet of portion-controlled packaged foods lost almost twice as much weight as those who only got advice on how to trim calories, according to a new study.

Dr. Michael Dansinger, a nutrition expert at Tufts Medical Center, said having less freedom in choosing meals seems to help people meet their dieting goals.

"When there's less structure, then participants are making more decisions, and I think too often they're making decisions that undermine their goal to stick to a calorie target," said Dansinger, who was not part of the study.

The diet the researchers studied was the Medifast 5 & 1 Plan. It consists of five pre-packaged meals each day, along with one meal of vegetables and protein prepared by the dieter.

Dieters can pick from 70 different packaged foods to create five meals totaling about 1,000 calories a day.

People on the plan can also purchase different levels of support along with the meals, such as access to dieticians and recipes. Typically, the plan costs about $300 a month.

To see how effective the Medifast diet is in helping people lose weight and keep it off, the researchers asked 60 people to join the plan for free.

They compared these dieters to another 60 people who were given advice on how to meet a 1,000 calorie-per-day target, but who continued to buy and prepare their own food.

For everyone in the study, the goal for the first 26 weeks was to lose weight, and during the second half of the study the goal was to maintain weight.

All of the participants were obese, having a body mass index (BMI) - a measure of body size relative to height - between 35 and 50.

A BMI of 35 represents, for example, a person who is 5-feet 8-inches tall and 230 pounds.

By the end of the study, 15 people dropped out of the regular-food group and 10 dropped out of the Medifast group.

After six months, those who stuck with either dieting approach lost weight.

People in the Medifast group shed an average of 16.5 pounds, or 6.7 percent of their starting weight.

Dansinger said such a reduction in weight is modest, but it can have a meaningful impact on people's health.

"That's been demonstrated in numerous studies to be effective for improving blood sugar in people with diabetes or delaying the progression from pre-diabetes to type 2 diabetes and to reduce other heart disease risk factors, including blood pressure, cholesterol and inflammation," he told Reuters Health.

The regular-food group lost an average of 8.4 pounds, or 3.4 percent of their body weight.

The Medifast dieters also had greater reductions in body fat, waist circumference and cholesterol than the other group.

Of the average 16.5 pounds Medifast dieters lost, 14 were fat mass. Regular-food dieters lost an average of 8.14 pounds of fat. The study did not examine the diets' effects on bone and muscle mass.

Medifast users lost an average 2.24 inches around their waists and their total cholesterol dropped an average 8.4 milligrams, compared to 1.46 inches and 1.1 milligrams, respectively, in the regular diet group.

Over time, though, the dieters in both groups tended to rebound somewhat toward their original weights.

After one year in the study, the Medifast group ended up about 10 pounds, or 4.2 percent, lighter than when they started, while the other group was about four pounds, or 1.7 percent, lighter.

James Shikany, the lead author of the study, said the results show that sticking to the Medifast diet makes it harder for dieters to eat more calories than they should.

"It's more of a regimented type of diet, and some people find that's what they need in order to limit their portion intake," said Shikany, who is a professor at the University of Alabama at Birmingham Division of Preventive Medicine.

Dansinger said the weight loss results from the Medifast diet appear to fall in the middle of the pack of other weight loss interventions.

Some approaches, such as weight loss surgery or more extreme diets can have more dramatic results.

But in terms of dietary interventions or FDA-approved weight loss pills, the effect is roughly comparable, he said.

Lisa Davis, the vice president of science and clinical affairs at Medifast, said earlier studies of the diet actually found greater weight reductions.

One explanation she offered is that the current study participants' demographics, such as race, appeared to be different in Shikany's study than in earlier ones.

In particular, Shikany's study included a majority of African Americans whereas other studies had mostly caucasians, Davis said.

"I think that's worth investigating in the future," she told Reuters Health.

Medifast funded the current study, and one of the researchers has been a consultant to Medifast.

Dansinger said that based on this and other studies, he would recommend meal-replacement diets.

"In my opinion, for patients who have had repeated failures with other attempts at sustaining weight loss, the Medifast plan or other similar plans appear to be a good option," he said.

Shikany agreed, but said it's unclear whether cost could be a factor in the diet's appeal.

"If you take (cost) out of the equation, I think it would be a good option for some people, especially for people who need that extra assistance in weight loss efforts as far as determining portions," he said.

Sex and the Superbug: Meet Antibiotic-Resistant Gonorrhea

Here’s a tidbit you probably didn’t know: Gonorrhea is the second-most frequently reported “notifiable” disease, according to the Centers for Disease Control (CDC). (That means that if you have it, your doctor or local health official needs to report it to the federal government so they can track it; gonorrhea is beaten out only by chlamydia.)

Though gonorrhea—being a sexually transmitted disease (STD) and all—doesn’t come up in conversation too often, it's way more prevalent than you probably think. It’s also a superbug, meaning it’s grown resistant to the usual treatments because the gonorrhea bacteria has mutated to become stronger than ever.  In fact, earlier this month you may have seen alarmist headlines (“Sex Superbug Could be ‘Worse Than AIDS,’” said CNBC.com) about drug-resistant gonorrhea. The CDC was quick to respond, quelling fears about the bug’s presence in the U.S. Many reports were referring to gonorrhea strain H041, which is very resistant to ceftriaxone—the drug widely recommended for treating gonorrhea. That strain, though, hasn’t ever been reported in the U.S., said the CDC.

Gonorrhea is caused by Neisseria gonorrhoeae, a gram-negative bacterium (which means the cells have a double cell lining). The World Health Organization (WHO) estimates that about 62 million people get gonorrhea every year. To get it, you have to have contact with the mouth, penis, vagina, or anus of an infected sexual partner. Once N. gonorrhoeae bacteria have been transmitted, they infect mucosal surfaces in the genitals and throat.

Symptoms of gonorrhea manifest differently in men and women, and also vary in severity (many people, in fact, are asymptomatic). When symptoms do appear, men may see a urethral discharge, or feel pain in their testicles or scrotum. Complications for guys can result in epididymitis, which is pain and inflammation of the epididymis (for those not into genital anatomy and physiology, that’s part of the testicle that stores sperm; we’re getting up close and personal now). In women, gonorrhea may also cause vaginal discharge or bleeding between periods.

Symptoms of untreated gonorrhea aren’t just uncomfortable and embarrassing, though. There are complications of gonorrhea infections that nobody likes to think about: In women, the STD can spread to the uterus and fallopian tubes, increasing the risk of pelvic inflammatory disease, infertility, and ectopic pregnancy (a dangerous situation in which the embryo implants outside of the uterus). Gonorrhea can be passed from mother to child, and it also increases your risk for HIV. So, in the end, it’s a pretty serious infection.





For a while, gonorrhea could be treated easily with penicillin and sulfa drugs. In the late 1960s, though, studies began showing that gonorrhea was rapidly increasing its resistance to penicillin. It beat the antibiotics by making an enzyme—penicillinase—that made penicillin totally ineffective. Then, in the 1980s, strains of gonorrhea that did not produce penicillinase began showing resistance; they showed up in the U.S. in 1980 during an outbreak in North Carolina. This meant that certain strains of gonorrhea had undergone a genetic mutation: They had picked up a chromosome that allowed them to be resistant in a different way. (As a reminder, antibiotics target certain structural components in bacteria to defeat them. If these structural components change, even just a little bit, this change affects the susceptibility of the bacteria to an antibiotic.) What we learned in the ‘80s was that not only did some strains of gonorrhea produce an enzyme that destroyed penicillin, other strains were shifting so that penicillin couldn’t affect them.

Since 1986, the United States Gonococcal Isolate Surveillance Project (GISP) has been monitoring antibiotic resistance to gonorrhea. According to GISP, by 2010, 27 percent of all of the gonorrhea samples were resistant to penicillin, tetracycline, and ciprofloxacin, or some combination of these drugs.

By 2010, 27 percent of all gonorrhea tested was resistant to three major antibiotics or some combination of these drugs.

Cefixime, an oral cephalosporin antibiotic (cephalosporins are a sub-group of beta-lactam antibiotics, like carbapenems) was the recommended antibiotic for gonorrhea treatment, until gonorrhea began to develop resistance that drug too. In 2012, the CDC  updated its treatment guidelines and now recommends an injectable cephalosporin, called ceftriaxone, along with azithromycin or doxycycline, instead of oral cephalosporins. Combination therapies (meaning more than one antibiotic) provide almost a one-two punch against these bacteria—so the hope is that this remains effective. But cephalosporins are our last line of antibiotic defense against gonorrhea. As authors wrote in 2012 in a piece in the New England Journal of Medicine, it is now “time to sound the alarm.”

Simply put, the outlook is not good. In 2011, doctors from Japan published a case study revealing that gonorrhea was acquiring even more resistance—this time, to injectable ceftriaxone. Since then, samples of ceftriaxone-resistant gonorrhea have been detected in France and Spain, too, reports the CDC.

So what to do? We clearly need new options for treatment, but those don’t seem to be coming any time soon. The best method of protection against gonorrhea is abstinence. But that’s not always the most realistic prevention method. The CDC also strongly recommends the use of latex condoms—and not just for vaginal intercourse, but also for oral sex as well. In his New Yorker piece on antibiotic-resistant gonorrhea, Dr. Jerome Groopman briefly explores condom use in fellatio; through interviews with medical professionals, Groopman explains that the most conventional (and effective) way to transmit gonorrhea is through fellatio, because the urethra can come into contact with the human pharynx (throat). The pharynx is a breeding ground for resistance in gonorrhea.

So while we wait for new antibiotics, the best advice we have when it comes to gonorrhea superbugs is: Don’t forget to use a condom.

Weight Gain May Change Personality

 After gaining a significant amount of weight, people may grow more self-conscious about their choices, while at the same time being weaker in the face of temptation, a new study finds.

Researchers already have an idea about how personality traits contribute to weight gain. For instance, people pleasers tend to eat more at parties, conscientious folk are more likely to have a regular exercise routine, and those with a Type A personality may be at increased risk for health problems like weight gain and heart disease. These are all averages, of course, and every person with a certain personality won't fall into the associated health group.

"What we don't know is whether significant changes in weight are associated with changes in our core personality traits," Angelina Sutin of the Florida State University College of Medicine said in a statement. "Weight can be such an emotional issue, we thought that weight gain may lead to long-term changes in psychological functioning."

[The 7 Biggest Diet Myths Debunked]

Sutin and her colleagues at the National Institutes of Health (NIH) looked at data on the personality traits and weights of more than 1,900 people at two time points, nearly a decade apart.

During that period, those who gained more than 10 percent of their body weight became more impulsive and were more likely to give in to temptations compared with those whose weight remained stable, the researchers found.

At the same time, weight gain was also associated with increased thoughtfulness in decision making. These results held regardless of how much participants weighed, specifically their body mass index (BMI, or a measure of body fatness) at the beginning of the study.

The researchers speculate that people who have put on pounds might feel more self-conscious about their actions because of negative comments they've received about their weight. But they may still have trouble keeping temptations at bay even as they become more aware of their choices, and those effects can snowball, the researchers say.

"The inability to control cravings may reinforce a vicious cycle that weakens the self-control muscle," the researchers wrote on April 29 in the journal Psychological Science. "Yielding to temptation today may reduce the ability to resist cravings tomorrow. Thus, individuals who gain weight may have increased risk for additional weight gain through changes in their personality."

The study drew from NIH's Baltimore Longitudinal Study of Aging, whose participants ranged from middle to older age with an average age of about 59 at the study's start, and the Baltimore Epidemiologic Catchment Area study, whose participants were younger, with an averge age of about 45 at the study's start.

Eating insects could help fight obesity, U.N. says

The thought of eating beetles, caterpillars and ants may give you the creeps, but the authors of a U.N. report published on Monday said the health benefits of consuming nutritious insects could help fight obesity.

More than 1,900 species of insects are eaten around the world, mainly in Africa and Asia, but people in the West generally turn their noses up at the likes of grasshoppers, termites and other crunchy fare.

The authors of the study by the Forestry Department, part of the U.N. Food and Agriculture Organization FAO), said many insects contained the same amount of protein and minerals as meat and more healthy fats doctors recommend in balanced diets.

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"In the West we have a cultural bias, and think that because insects come from developing countries, they cannot be good," said scientist Arnold van Huis from Wageningen University in the Netherlands, one of the authors of the report.

Eva Muller of the FAO said restaurants in Europe were starting to offer insect-based dishes, presenting them to diners as exotic delicacies.
Danish restaurant Noma, for example, crowned the world's best for three years running in one poll, is renowned for ingredients including ants and fermented grasshoppers.

As well as helping in the costly battle against obesity, which the World Health Organization estimates has nearly doubled since 1980 and affects around 500 million people, the report said insect farming was likely to be less land-dependent than traditional livestock and produce fewer greenhouse gases.

It would also provide business and export opportunities for poor people in developing countries, especially women, who are often responsible for collecting insects in rural communities.
Van Huis said barriers to enjoying dishes such as bee larvae yoghurt were psychological - in a blind test carried out by his team, nine out of 10 people preferred meatballs made from roughly half meat and half mealworms to those made from meat.