Feng J. He, Ph.D., of St. George’s University of London, U.K., and colleagues analyzed eight studies involving 257,551 people, which reported the stroke risks associated with the frequency of fruit and vegetable intake. The study included 4,917 stroke events.

The researchers found a stroke relative risk of 0.89 for people eating three to five servings of fruit and vegetables a day compared with those eating less than that, and a 0.74 risk for those consuming more than five servings a day.

“Our results provide strong support for the recommendations to consume more than five servings of fruit and vegetables per day, which is likely to cause a major reduction in strokes,” the authors write.

In an accompanying comment, Lyn M. Steffen, Ph.D., of the University of Minnesota School of Public Health in Minneapolis, writes: “We, as a society, must provide the structure and means for our children to develop healthy eating habits that promote good health into adulthood. So eat your fruits and vegetables, they are good for your health.”

For example, the elderly, blacks, Mexican Americans and members of lower socioeconomic groups are at high risk of recurrent stroke and may face barriers to care, according to the guidelines. In addition, hormone replacement therapy should be avoided in postmenopausal women to prevent vascular events.

The guidelines also contain recommendations on modifiable risk factors including smoking, alcohol, obesity and a sedentary lifestyle. Medical options such as the use of anticoagulants and antiplatelet agents, and interventions such as carotid artery surgery or angioplasty are also addressed.

The guidelines were developed by a committee chaired by Ralph L. Sacco, M.D., M.S., of Columbia University Medical Center in New York, for the American Heart Association and the American Stroke Association Council on Stroke. The guidelines are co-sponsored by the Council on Cardiovascular Radiology and Intervention and affirmed by the American Academy of Neurology.

Robert Preidt

MONDAY, April 11 (HealthDay News) — Cell phone use does not increase risks for brain tumors, a new Danish study suggests.

The findings, published in the April 12 issue of Neurology, “are in line with other large studies on this question, including a recently published large-scale, population-based study by the Swedish Interphone Study Group,” researcher Dr. Christoffer Johansen, of the Danish Cancer Society, said in a prepared statement.

He added that “there have been a few studies that found an increased risk of brain tumors with cell phone use, but those studies have been criticized for problems with the study design.”

Johansen’s team questioned 427 patients with brain tumors and 822 healthy individuals on their past cell phone use. The researchers also reviewed the cell phone records of 27 of the people with brain tumors and 47 people without brain tumors, to document the amount and length of calls made.

The study found no increased risk for brain tumors related to cell phone use, frequency of use, or number of years of use. It also found no evidence that brain tumors occurred more or less often on the side of the head where people most often held their cell phones.

There have been few long-term or heavy cell phone users in any studies examining a possible link between cell phone use and brain tumors, Johansen noted.

“In our study, few people reported regular cell phone use for 10 years or more. We won’t be able to make any firm conclusions until we can confirm these results with studies with more long-term and heavy cell phone users,” he said.

More information The U.S. National Cancer Institute has more about cell phones and cancer.

Review:
When explaining their opposition to limiting jury-awarded damages for pain and suffering in medical liability cases, Democrats and others often point to incompetent doctors whose grievous preventable errors justify high jury awards. Instead of damage caps, better efforts to discipline these doctors are needed, they claim.

A recent article in The New York Times hints that President Bush is sensitive to this view and may see it as a way to garner support for his medical liability reform legislation.

The article discussed a federal study on ways to assist state boards of medical examiners in disciplining doctors.

Study author Josephine Gittler, a University of Iowa law professor, said in the Times article that “If you had more aggressive policing of incompetent physicians and more effective disciplining of doctors who engage in substandard practice, that could decrease the type of negligence that leads to malpractice suits.”

The article mentioned Massachusetts as a possible model for how state medical review boards else where could better track incompetent physicians. Under its program, the Massachusetts Board of Registration in Medicine automatically investigates any physician who has been ordered to make “three or more malpractice payments to patients as a result of jury verdicts or settlements,” the newspaper said.

The Times article also hinted at added disciplinary provisions on the federal level. The article quoted White House Press Secretary Mark McClellan who called the issue of incompetent physicians “a national problem that requires a national solution.”

The President may already enjoy considerable public support for efforts to more aggressively discipline physicians, according to a national survey.

The survey found that 34% of Americans said either that they had been subjected to a preventable medical error or that they were aware of a family member who experienced a preventable error. Moreover, 21% said the most recent medical error they experienced “had serious health consequences, including severe pain (16%); serious loss of time at work, school, or other important life activities (16%); temporary disability (12%); long term disability (11%); and/or death (8%).”

The survey was conducted by the Kaiser Family Foundation and the Agency for Healthcare Research and Quality at Harvard’s School of Public Health.

Review
For some time, plastic surgeons had been receiving anecdotal reports about patients whose migraine headaches disappeared after forehead rejuvenation surgery, a procedure that entails removal of the corrugator supercilii muscle. Several preliminary studies supported these reports.

After further investigation to identify additional migraine trigger sites, the researchers. headed by Dr. Bahman Guyuron, clinical professor of plastic surgery at Case Western Reserve University, conducted the current study to assess the effectiveness of surgical procedures to deactivate the most common migraine trigger sites.

Of 125 volunteers diagnosed with migraine headache, 100 were randomly assigned to the treatment group and 25 to a control group. To identify migraine trigger sites in the treatment group, the researchers injected botulinum toxin A into each patient’s potential trigger sites. If an injection resulted in elimination or significant improvement of migraines, the patient was considered a candidate for surgery.

Of the 100 volunteers in the treatment group, 89 completed the study. The mean follow-up for these patients was 396 days. The researchers gathered data at baseline and during follow-up on the frequency, intensity, and duration of patients’ migraines. In addition, the investigators developed a Migraine Headache Index by multiplying these factors together.

At 1-year follow-up, statistical analysis showed significant improvements in all the measured variables in the treatment group when compared with the control group. Key results include the following:

• The mean monthly frequency of migraine headaches in the treatment group was 3.8 ± 0.4, compared with 10.2 ± 1.7 for the control group (P < .001).

• The mean intensity of migraines (on a scale of 1 to 10) for the treatment group was 4.0 ± 0.3, versus 7.0 ± 0.3 for the control group (P < .001).

• The mean duration of migraines (in hours) in the treatment group was 0.35 ± 0.05, compared to 0.99 ± 0.2 in the control group (P = .007).

• The Migraine Headache Index for the treatment group was 12.6 ± 3.1, versus 90.6 ± 33.6 for the control group (P = .03).

• Eighty-two of the 89 patients in the treatment group (92%) demonstrated at least a 50% reduction in migraine headache frequency, duration, or intensity compared with baseline data. Thirty-one of these patients (35%) reported elimination of their migraines.

• In comparison, only 3 of 19 control patients (15.8%) reported improvement, and no patients reported elimination of migraines.

• The mean annual cost of migraine care for the treatment group ($925) was significantly less than that for the control group ($5530).

“Surgical deactivation of migraine trigger sites can eliminate or significantly reduce migraine symptoms, ” the researchers concluded. “Additional studies are necessary to clarify the mechanism of action and to determine the long-term results.”