News in brief - Nov. 24, 2003

Most women have symptoms other than chest pain before heart attacks - Troubles of American teens - A doctor's conflict of interest does not keep patients from clinical trials - Infants who are comforted cry less during shots

Most women have symptoms other than chest pain before heart attacks

A study of women's symptoms prior to a heart attack indicates that about 95% knew their symptoms were new or different a month or more before experiencing an acute myocardial infarction, according to a study in the Nov. 3 rapid-access version of Circulation: Journal of the American Heart Assn.

The most frequently reported symptoms were unusual fatigue (71%), sleep disturbances (48%) and shortness of breath (42%). Fewer than 30% of the women reported chest pain and discomfort prior to the AMI. Most clinicians continue to consider chest pain as the most important AMI symptom for both women and men, said the researchers.

The 515 women who participated in the study were mostly white, high-school educated and had been diagnosed with AMI within four to six months of being surveyed about their symptoms. They were asked to rate the intensity, frequency and duration of their prodromal symptoms and the intensity of their acute symptoms.

"Increasingly it is evident that women's symptoms are not as predictable as men's," said Patricia A. Grady, PhD, RN, director of the National Institute of Nursing Research, which funded the study. "This study offers hope that both women and clinicians will realize the wide range of symptoms that can indicate heart attack."

Troubles of American teens

Teens in the United States are more likely to have stomachaches, backaches, headaches and difficulty sleeping than their European counterparts, according to a new report by the Health Resources and Services Administration.

The report compares data from the international Health Behaviors in School-aged Children Study, which coordinated school-based surveys of teens 11, 13 and 15 years old in U.S. schools and in 29 locations throughout Europe in 1997 and 1998.

The report's authors suggest that American students' feelings of fatigue may be associated with their fitness levels related to diet and exercise, since they often ate high-fat or high-sugar foods while they exercised only in the middle to lower range.

Also according to the report, U.S. students were:

Less likely to smoke than students in almost all other countries, but ranked in the middle range of those surveyed for drinking alcohol at least once a week.
Ranked relatively high for "never" or "rarely" feeling safe at school, ranked in about the middle range among students bullied at school "at least sometimes." They also were in the higher ranking of students who reported they bully others frequently.

A doctor's conflict of interest does not keep patients from clinical trials

A patient's willingness to take part in a clinical trial is not affected by whether a physician has a conflict of interest or not, according to a paper presented this month at the American Heart Assn.'s annual scientific session.

Researchers at Johns Hopkins University in Baltimore approached nearly 1,500 patients at cardiology and internal medicine outpatient clinics in the region asking them to complete an 80-item survey about a heart drug. Subjects were told that the physician either had no conflict of interest, earned a $2,000 finder's fee if they participated or held the patent on the drug. Patients were also asked about their willingness to participate and the importance of knowing what the conflict of interest issues were. The willingness to participate did not differ between the three groups, and more than half said the conflict of interest information was not very important to them.

Authors of the paper concluded that although there are significant conflict-of-interest concerns eroding the public's trust in medicine, this did not appear to impact interest in clinical trials.

"There's been an incredible push by academicians and health policy makers to make sure conflicts of interest are minimized," said Joel B. Braunstein, MD, lead author and assistant professor of medicine at Johns Hopkins. "While ethically this is readily justified, our study quite surprisingly suggests that patients don't really care."

Infants who are comforted cry less during shots

Babies who receive their vaccination jabs while being held by a parent and given a bottle of sugar water or a pacifier cry less immediately afterwards. Parents also preferred this strategy, according to a study published in the November Archives of Pediatrics and Adolescent Medicine.

Researchers at the Children's Hospital of Pittsburgh randomized more than 100 babies to two interventions while receiving their immunization series. One group was placed on the examination table to receive their shots. That group's first cry after the shot lasted an average of a minute. The other group was given sugar water two minutes beforehand and held by a parent. They were also given a bottle or pacifier during the shot. They cried for an average of 19 seconds.

The authors suggested that this inexpensive intervention could reduce pain and suffering for both kids and parents. "This simple approach is inexpensive and convenient, allowing it to be easily adopted into practice," they wrote in the paper.