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NEW YORK (Reuters Health) - Certain women may be prone to develop lupus when they start taking combined oral contraceptives, according to investigators at McGill University in Montreal.

Lupus, or more precisely systemic lupus erythematosus (SLE) is an autoimmune disorder in which the immune system mistakenly attacks normal tissue. The condition can vary widely in severity, manifesting as a skin rash and arthritis or leading to damage to the kidneys, heart, lungs and brain to varying degrees

Dr. Samy Suissa and colleagues have discovered that the increased risk of developing lupus in connection with starting on the pill appears to be greatest in the first 3 months of use, and with first- and second-generation contraceptives containing higher doses of estrogen.

This suggests "an acute effect in susceptible women and possibly a dose-response effect of estrogen on SLE onset," the team explains in the medical journal Arthritis & Rheumatism.

The researchers used a database to identify 786 women newly diagnosed with SLE over a 10-year period, and matched these women up to 7817 unaffected women who made up a "control" group.

Compared to occurrence rates in women who never used combined oral contraceptives, the incidence of SLE was 2.5-times higher among women who had been taking the pills for a short while, and 1.5-times higher among those with longer-term use.

The results also showed that first- and second-generation contraceptives, but not third-generation pills, were significantly associated with risk of lupus. Moreover, the risk increased as the dose of estrogen rose.

"Further studies on the acute effects of combined oral contraceptives will be needed to better identify the characteristics of women susceptible to developing SLE when exposed to combined oral contraceptives," Suissa's team concludes.

SOURCE: Arthritis & Rheumatism, April 15, 2009.

Copyright © 2009 Reuters Limited.

NEW YORK (Reuters Health) - Among middle-aged and older men with type 2 diabetes, their capacity for exercise is related to their likelihood of dying over a 7-year period, according to a new study.

Dr. Peter Kokkinos from the Veterans Affairs Medical Center, Washington, D.C., and colleagues say their findings show a strong association between increased exercise capacity and lower mortality risk.

Between 1986 and 2007, 1703 African American men and 1445 Caucasian men with type 2 diabetes completed a maximal exercise test. This classified them as "low-fit," "moderate-fit," or "high-fit."

During 7 years of follow-up, "a graded reduction in mortality risk was noted with increased exercise capacity for both races," the researchers report in the medical journal Diabetes Care.

Among African Americans, the death rate was 46 percent in the low-fit group, 27 percent in the moderate-fit group, and 15 percent in the high-fit group. Corresponding rates among Caucasians were 37 percent, 19 percent, and 9 percent.

The results suggest, the investigators say, that the exercise-related reduction in mortality may be stronger and more graded for Caucasians than for African-Americans.

It's important to note, the researchers say, that the men in their study for the most part came from a relatively low socioeconomic background, whereas most information on the benefit of fitness in diabetics has come from more privileged populations.

"Thus, our findings support the notion that higher exercise capacity is associated with lower all-cause mortality in men with type 2 diabetes, independent of socioeconomic status," Kokkinos and colleagues point out.

The findings, they add, "extend the public health message regarding the health benefits of cardiorespiratory fitness to men with diabetes ... and that health care professionals should encourage diabetic subjects to initiate and maintain a physically active lifestyle consisting of moderate-intensity activities."

SOURCE: Diabetes Care, April 2009.

Copyright © 2009 Reuters Limited.

NEW YORK (Reuters Health) - Operations on the kidney can be performed safely via laparoscopy in elderly patients, even those older than 80 years of age, investigators report.

Laparoscopic operations are performed with special instruments inserted through two or three small incisions, and are commonly called keyhole surgeries.

Dr. Thomas J. Guzzo of Johns Hopkins Medical Institutions in Baltimore, Maryland, and associates reviewed data on 115 patients, ranging in age from 75 to 91 years, who had undergone laparoscopic kidney operations. Fifty-one of the patients were over 80 years old.

Complications occurred in 22 patients (19 percent); 6 of these patients were over 80, giving a complication rate of 12 percent in this age group, the team reports in the medical journal Urology.

Blood transfusions were needed for just under 10 percent of the whole group and for the 80-plus patients. Similarly, the length of stay was 4 days for all the patients taken together and for those 80 and up.

"Our data support the safety and feasibility of laparoscopic renal procedures in elderly patients," Guzzo's team writes. "Furthermore, this safety extends to patients of advanced age."

They conclude, "Our data add to the increasing body of evidence that a patient's age should not be an exclusionary factor when contemplating laparoscopic renal surgery."

SOURCE: Urology, March 2009.

Copyright © 2009 Reuters Limited.

NEW YORK (Reuters Health) - US military veterans' benefits include palliative care and hospice care, but a small study of terminally ill vets suggests many don't understand these benefits -- or the nature of their own illness.

The findings show that health care providers need to do a better job of getting the word out about these services so dying patients can take advantage of them before it is too late, Dr. Alice Running of the University of Nevada in Reno and her colleagues say.

Palliative care is aimed at easing a person's symptoms, for example pain or difficulty breathing, but is not intended to cure an illness or halt its progress. The VA pays for "full-scale" hospice and palliative care, Running and her team note in their report in the International Journal of Older People Nursing, and all VA hospitals have palliative care consultation teams on staff.

Patients who receive care from these teams, which include doctors, nurses, social workers and counselors, are less likely to wind up in intensive care, the researchers point out, and more likely to work with health care providers to make sure their end-of-life preferences are realized.

Running and her team interviewed 17 veterans receiving palliative care as inpatients at a VA hospital to assess how knowledgeable they were about the services available to them, their own health, and their own goals for end of life care. Most had cancer, lung disease, or liver disease, all were men, and they ranged in age from 50 to 99.

Five of the men didn't know or understand their diagnosis, while 10 didn't understand that they were terminally ill, the researchers found. "These numbers reflect the gap in information that the veterans were receiving not only about their condition, but also about the services they could be receiving," the researchers write.

Eleven of the men understood what a "do not resuscitate" order was, but just four knew what an advanced directive was and reported having one on record. Advanced directives are statements about a person's preferences for end-of-life care, including identification of another individual who will make decision for that person if he or she is no longer able to.

Fourteen of the patients said they had made funeral arrangements, while 15 could name what was most important to them at this stage of their lives.

"It is necessary that this very important aspect of care, education about palliative care, hospice, comfort care and advanced directives begin in primary care clinics, before individuals find themselves in acute care with so many unknowns," Running and her colleagues say. "Providers need to educate patients and their families in these terms well before families will need to use them."

SOURCE: International Journal of Older People Nursing, March 2009.

Copyright © 2009 Reuters Limited.

NEW YORK (Reuters Health) - Older adults who worry about their health often opt out of physical activity -- and as a result, they may have greater trouble walking and getting around as they age, new research suggests.

"Our research shows that a key component to avoid walking difficulty in older adults is to resolve health worry issues earlier in life," Bradley Cardinal, of the department of nutrition and exercise science at Oregon State University in Corvallis, who was involved in the study, noted in a university-issued statement.

Some studies have suggested that "health worry" may motivate people to exercise regularly and engage in other healthy behaviors. The current study, however, suggests that's not always the case.

Among a representative sample of 7,527 adults aged 70 and older participating in the Longitudinal Study of Aging, people with a high degree of health worry engaged in less physical activity than those who worried less about their health.

Furthermore, people who participated in less physical activity were more likely than their more active counterparts to report having trouble walking 6 years later.

"Because physical function decreases with age and safety concerns arise, older adults may not choose physical activity as a response to health worry," the researchers suggest in the current issue of Research Quarterly for Exercise and Sport, where their research is published.

They also note that health professionals, the media, fitness instructors and family and friends may use warnings of illness or premature death to try to motivate aging couch potatoes to exercise or at least become more physically active. However, the current study suggests that this may be counterproductive; aging adults may become so fearful of their health that they will avoid physical activity.

"Using threats and fear-tactics to encourage physical activity in older adults will not work," Cardinal said.

A more productive approach in dealing with health concerns in the aging population, suggest Cardinal and colleagues, is to provide health-related information and screening tools prior to beginning a physical activity routine to help cope with health worries. This might ease health concerns and promote participation in physical activity.

"I think the simple message from this study is that people should be encouraged to walk," Cardinal noted in comments to Reuters Health. "To encourage walking, people should avoid fear-raising tactics. Rather, the emphasis should be on walking for fun, for health, for transportation."

"Fear-inducing strategies often cause older adults to worry about things like falling and that diminishes their desire to walk, which in turn diminishes their ability to walk. It is a vicious cycle," Cardinal warned.

SOURCE: Research Quarterly for Exercise and Sport, March 2009.

Copyright © 2009 Reuters Limited.