Antibiotics prevent UTIs better than probiotics

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NEW YORK (Reuters Health) - Antibiotics are still better than probiotics at preventing urinary tract infections, but at least "good bacteria" don't add to a person's antibiotic resistance, a new study concludes.

Recurring UTIs are common among some women and low-dose antibiotics are sometimes used to prevent them. The worry is that overuse of the drugs also reduces their effectiveness by making disease-causing bacteria like E. coli resistant.

"This is an increasing worldwide problem, resulting into less and less treatment options for (severe) bacterial infections in all countries of the world," Dr. Suzanne Geerlings, from the Academic Medical Center at the University of Amsterdam in The Netherlands and one of the new study's authors, wrote in an email to Reuters Health.

Geerlings and her colleagues recruited 252 women between January 2005 and September 2007 for a trial to compare the use of antibiotics and probiotics to prevent UTIs.

The participants, who lived in communities surrounding the medical center, were all postmenopausal -- a time when vulnerability to UTIs increases because of hormonal changes, according to the researchers.

All the participants reported having had at least three UTIs in the year before the trial began, and the average number was seven.

The women were separated into two groups of about the same size. One group took a single dose of the antibiotic co-trimoxazole (Bactrim, Septra and others) every day for twelve months, while the other group took two capsules containing Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14, both types of beneficial bacteria, daily.

All the participants also took placebo pills so the patients and the people dispensing the pills wouldn't know who received which treatment -- to minimize any influence on the study's results.

The researchers then tracked how many UTIs occurred in each group of women over a year. They also collected vaginal swabs and samples of the women's urine and feces every month to test for the presence of good bacteria and infection-causing bacteria like E. coli.

In addition, women took a monthly survey asking about symptoms of UTIs, side effects, other infections and antibiotic use.

Overall, the antibiotics were slightly better at keeping UTIs at bay.

About 69 percent of the women in the group taking the antibiotic had one or more UTIs within the year. On average, the antibiotic group had 2.9 UTIs per woman.

As for the probiotic group, about 79 percent had a UTI within the year, with an average of 3.3 UTIs per woman.

The women taking the antibiotic also seemed to go twice as long without a UTI -- six months, compared with three months among women taking the probiotics.

Based on the women's urine and feces samples, however, resistance to a range of antibiotics seemed to increase within the first month in the antibiotic group.

Before the study, about 20 percent to 40 percent of E. coli in samples from all the women's bodies were resistant to co-trimoxazole.

At the 12-month mark, between 80 percent and 95 percent of the bacteria were resistant in the women taking the antibiotic.

Rates of resistant E. coli were slightly lower at 12 months in women taking the probiotics than when the study began.

Similar changes in antibiotic resistance were seen for a range of other antibiotics, including ciprofloxacin and gentamicin, among both groups of women -- which the researchers speculate might be because the same mechanism in certain bacteria allows them to resist several different drugs.

The absence of increased resistance among women taking the probiotics means that "lactobacilli may be an acceptable alternative for prevention of UTIs, especially in women who dislike taking antibiotics," the researchers wrote in the Archives of Internal Medicine.

The study, however, had several limitations.

More than 80 women dropped out of the study by the end of the year because of side effects and other reasons. A greater number of those taking the probiotics had diarrhea compared to those taking the antibiotics, for instance. Other reasons for dropping out included the participant not thinking the treatment was working, or she couldn't adhere to study's directions.

As a result, the researchers did not have the number of participants in each group they would have liked to give the findings statistical weight.

Despite the study's weaknesses, a commentary published in the same journal called the findings "exciting and compelling."

"I think we need to appreciate that the normal flora in our body is another system we need for good health and antibiotics disrupt it and leave lasting effects… We need to think of antibiotics as a situation that has some risk," Dr. Barbara Trautner, one of the commentary's authors, told Reuters Health.

Trautner, of the Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine in Houston, said that probiotics may be an acceptable alternative but they need further exploration.

Topical estrogen creams are sometimes used to prevent UTIs in menopausal women, but many women prefer to avoid using hormones.

In her commentary, Trautner wrote that 60 percent of women in the United States experience UTIs or bladder infections during their lifetimes, and they recur in about a third of those women.

"We don't have terrific preventive strategies so a probiotic approach would be beneficial and promising," Trautner said.

For right now, she said most women with recurring UTIs have exhausted any type of behavioral changes that might help prevent the infections, and are left with low-dose antibiotics as their only recourse.

SOURCE: http://bit.ly/JUywUA and http://bit.ly/JUyDzE Archives of Internal Medicine, May 2012.

Diabetes Drug Metformin May Cut Breast Cancer Risk in Older Women

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MONDAY, June 11 (HealthDay News) -- A widely prescribed drug, metformin, may lower the risk of invasive breast cancer in postmenopausal women with diabetes, a new study indicates.

The research, published online June 11 in the Journal of Clinical Oncology, echoes other recent studies that have suggested the diabetes drug may help cut the chances of prostate, pancreatic, liver and oral cancer, as well as certain forms of melanoma.

The researchers found that the incidence of invasive breast cancer was 25 percent lower in women with diabetes who were taking metformin than it was in women who weren't taking the drug.

Approximately 25.8 million people in the United States have diabetes, according to the U.S. Centers for Disease Control and Prevention. Between 90 percent and 95 percent of these cases are type 2 diabetes, in which the body's ability to make and use insulin deteriorates.

"Type 2 diabetes is a disease of insulin resistance," said study co-author Dr. Rowan Chlebowski, a medical oncologist with the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, in Torrance, Calif.

Insulin is a hormone that helps regulate the level of glucose (sugar) in the body. With type 2 diabetes, the body manufactures larger quantities of insulin to maintain normal levels of glucose in the blood.

Metformin, commonly used to treat type 2 diabetes, increases insulin sensitivity and improves the control of blood sugar. "It makes the insulin you have more effective," Chlebowski explained. The drug, approved in the United Kingdom in 1958 and in Canada in 1972, was introduced in the United States in 1994.

The new research looked at relationships among diabetes, metformin use and breast cancer among over 68,000 women between 50 and 79 years old in the national Women's Health Initiative project. In this group, 3,401 had diabetes and 3,273 invasive breast cancers were diagnosed during the study.

Because of the design of the Women's Health Initiative trials, detailed information was available for this large and diverse population in many areas, including breast cancer risk factors, baseline mammograms, clinical breast exams and verification of breast cancers when they occurred. Researchers were also able to know which participants had diabetes -- along with their use of diabetes medication.

The trials excluded women who had already had breast cancer. Women who had developed diabetes before adulthood (suggesting they were type 1 diabetics) were also excluded from the study.

How can a drug that treats people with high blood sugar play a role in reducing breast cancer risk? Chlebowski suggested that metformin "may inhibit the master regulator of the cell, 'mTOR,' changing critical pathways involved in cancer."

The mTOR pathway is affected by a wide range of cellular signals, including growth factors, hormones such as insulin, nutrients including glucose and amino acids, cellular energy levels and stress. A key cell pathway associated with mTOR is critically involved in cell reproduction and survival.

Chlebowski and other experts cautioned against looking to metformin as a cancer prevention drug just yet.

"It's too soon to change clinical practice," said Jennifer Ligibel, a medical oncologist in the Women's Cancer Program at the Dana-Farber Cancer Institute in Boston. "While a number of other studies have suggested metformin has a role in preventing breast cancer and its recurrence, I would not recommend women take metformin for breast cancer prevention based on the data we have now."

As to the question of whether metformin could ever be used more broadly beyond diabetic patients to reduce the risk of breast cancer, Chlebowski said the answer is unclear and more studies are necessary to further analyze the linkage.

While the study uncovered an association between metformin use and lower breast cancer risk in diabetic postmenopausal women, it did not prove a cause-and-effect relationship.

The U.S. Food and Drug Administration has issued warnings about metformin in recent years. It requires product inserts for physicians and patients to say that the drug has been associated with increased cardiovascular risks, including heart attack and stroke, and lactic acidosis, which causes fatigue, muscle pain, difficulty breathing and other symptoms. The FDA also stipulates that the drug literature include a warning that the drug should only be used by patients with type 2 diabetes who cannot control their blood sugar with lifestyle or other medications.

More information

The U.S. National Library of Medicine has more on type 2 diabetes.

Copyright c 2012?HealthDay. All rights reserved.

Blood Tests Might Help Guide Breast Cancer Care

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TUESDAY, June 5 (HealthDay News) -- A simple blood test may help gauge prognosis and tailor treatments for women who have been diagnosed with early stage breast cancer.

The test, described in the June 6 online edition of The Lancet Oncology, measures how many tumor cells are circulating in the blood. In the new study, if even one cell was detected in the bloodstream, a woman had a greater chance of her cancer recurring and of dying.

"This may help with prognosis and staging of the cancer and, in the future, with targets for breast cancer treatments," said study lead author Dr. Anthony Lucci, a professor of surgery at the University of Texas MD Anderson Cancer Center, in Houston.

Commenting on the findings, Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City, said, "We are moving into a state where we're looking at a person's individual tumor and this is another way to do that, potentially leading to treatment."

Whether or not cancer has spread to the lymph nodes is currently the best way to predict survival in women with breast cancer. Even so, a substantial number of patients whose cancer has not spread to the lymph nodes will have a recurrence while some of those who do have lymph-node involvement won't relapse.

Blood tests similar to the one investigated in this study have been found to be useful to gauge how well patients who already have metastatic cancer will do.

For this study, researchers counted circulating tumor cells in 302 breast cancer patients who were about to undergo surgery but who hadn't yet received chemotherapy.

Circulating tumor cells were detectable in about one-quarter of the participants, the investigators found. Fifteen percent of these individuals had a relapse and 10 percent died during a five-year follow-up, compared with 3 percent and 2 percent, respectively, of patients who did not have circulating tumor cells.

The more tumor cells a woman had in her bloodstream, the higher the likelihood of relapsing or dying, according to the report.

Although the test may not be far off in terms of clinical practice, "we need additional studies," Lucci said.

One area for study is how well these circulating cells predict recurrence and death in patients who have already had chemotherapy.

Currently, the American Society of Clinical Oncology does not recommend that clinicians measure circulating tumor cells in patients.

And in an accompanying comment article, Justin Stebbing, a professor in the department of surgery and cancer at Imperial College in London, said that "despite increasing evidence supporting the use of [circulating tumor cells] as biomarkers, how this information can be integrated into present practice is uncertain."

According to Bernik, though, "it makes sense that women who have circulating tumor cells would potentially be at higher risk of distant disease at some later date."

The problem is that just having circulating tumor cells may not be enough information to foretell the future, she noted.

"The cells also need to have a propensity to grow elsewhere," she said. "Not every cancer cell becomes a metastatic cancer cell. Hopefully, gaining the ability to tell which cells are more likely to spread potentially could guide therapy," Bernik added.

According to Lucci, circulating tumor cells are also showing promise in predicting melanoma prognosis, so the method may be "effective in several different tumor systems."

More information

The U.S. National Cancer Institute has more on breast cancer.

Copyright c 2012?HealthDay. All rights reserved.

5 pieces of tsunami debris found so far

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ANCHORAGE, Alaska (AP) — Items ranging in size from a 164-foot shrimping vessel to a soccer ball have already made their way into North American waters following the March 2011 tsunami in Japan.

Environmentalists fear this is just the first wave of an estimated 1.5 million tons of debris that is in the ocean following the tsunami, much of which could land on U.S. shores.

Here's a look at some of the items that have already shown up, from biggest to smallest:

1. The 164-foot fishing vessel Ryou-Un Maru was in Hokkaido, Japan, and destined for the scrap heap when the tsunami dislodged it from its mooring. It drifted across the Pacific Ocean until the U.S. Coast Guard sank it in April 2012 in the Gulf of Alaska after determining it was a threat to shipping and the state's coastline.

2. Newport, Oregon, residents awoke Wednesday to find a 66-foot concrete and metal dock on the shore at Agate Beach along the central coast. The 165-ton dock was one of four that broke loose from the port of Misawa in the tsunami. Two other docks from Misawa are still missing.

3. A Harley-Davidson motorcycle was discovered inside a white container that washed up April 18 on Graham Island, off the coast of British Columbia, Canada. It was traced back to its owner in Japan by its license plate.

4. Cleanup workers near Craig, Alaska, in late March found a basketball with the words "Kesen chu," short for Kesennuma Chugakko or Kesennuma Middle School. Kesennuma is a major fishing port that was hit hard by the tsunami. Officials with the Marine Conservation Alliance in Juneau said the basketball was being packaged Thursday to be returned to Japan, along with a care package for students at the school still living in temporary housing.

5. David Baxter, a radar technician from Kasilof, Alaska, found a soccer ball in April 2012 on an Alaska island 110 miles south of the mainland. With the help of his wife, Yumi, who is Japanese and reached out to a Japanese reporter, the ball was reunited with its owner, a teenager who lost all his possession in the tsunami. A volleyball believed to be from Japan was also found on the trip.

Education May Protect Brain From Exposure to Solvents

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TUESDAY, May 29 (HealthDay News) -- People with less than a high school education who work with solvents may have problems with their thinking skills later in life, according to a study of people in France.

In the study, researchers from Harvard University noted that people with more education did not experience the same types of issues with their thinking, or so-called "cognitive," skills, even if they had the same amount of exposure to these chemicals.

"People with more education may have a greater cognitive reserve that acts like a buffer, allowing the brain to maintain its ability to function in spite of damage," study author Lisa Berkman, of Harvard University in Cambridge, Mass., said in news release from the American Academy of Neurology. "This may be because education helps build up a dense network of connections among brain cells."

In conducting the study, the investigators followed more than 4,100 people who worked at the French national gas and electric company. While working at the company, the participants were exposed to four types of solvents: chlorinated solvents, petroleum solvents, benzene and non-benzene aromatic solvents.

The researchers assessed the workers' lifetime exposure to these solvents and tested their thinking skills when they were an average of 59 years old. By this time, 91 percent of the study participants were retired.

Most of those studied worked at the company for their entire career and 58 percent had less than a high school education. Of those without a high school diploma, the study revealed 32 percent had problems with their thinking skills. In contrast, only 16 percent of those with more education had similar thinking problems, the findings showed.

The study, published in the May 29 issue of Neurology, also found that high levels of exposure to chlorinated and petroleum solvents was associated with 14 percent greater risk for thinking problems among the less-educated workers, compared to their peers with no exposure.

Moreover, the less-educated workers with a high level of exposure to benzene were 24 percent more likely to have problems with their thinking skills, and those with significant exposure to non-benzene aromatic solvents were 36 percent more likely to have such problems.

"These findings suggest that efforts to improve quality and quantity of education early in life could help protect people's cognitive abilities later in life," Berkman said. "Investment in education could serve as a broad shield against both known and unknown exposures across the lifetime. This is especially important given that some evidence shows that federal levels of permissible exposure for some solvents may be insufficient to protect workers against the health consequences of exposure."

While the study uncovered an association between education level, solvent exposure and thinking skills, it did not prove a cause-and-effect relationship.

More information

The U.S. Department of Labor has more about the health effects of exposure to solvents.

Copyright c 2012?HealthDay. All rights reserved.

Exercise Controls Weight in White Girls Better Than in Black Girls: Study

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WEDNESDAY, June 6 (HealthDay News) -- Exercise appears less likely to prevent obesity among black teenage girls than their white peers, a new study shows.

British researchers who gauged the effect of exercise on more than 1,100 girls, aged 12 to 14, surmised that black teen girls may be less sensitive than white teen girls to the effects of physical activity to prevent obesity.

"Higher levels of physical activity were associated with lower risk of obesity among white girls but not among black girls," wrote study authors James White and Russell Jago.

This is of concern because obesity rates are increasing at a greater rate among black teen girls than other U.S. youths, putting them at greater risk for heart disease, according to background information in the study. Black American girls were 80 percent more likely than white girls to be overweight in 2007-2010, the U.S. Department of Health and Human Services' Office of Minority Health reported. And about four out of five black American women are overweight or obese.

"At present, we don't know whether these differences can be attributed to genetics," said White, a researcher at Cardiff University in Wales. While other studies have found black girls consume more calories than white girls, he said this study took those differences into account, suggesting there may be other reasons. "These may be genetic, but we don't really know," he said.

However, at least one expert believes the study results may reflect lifestyle differences, which can be addressed, not just genetics.

White and Jago, of the University of Bristol in England, evaluated data on girls who participated in the long-running National Heart, Lung, and Blood Institute Growth and Health Study.

The researchers were looking at factors associated with obesity and the development of heart disease risk factors.

For this study, published in the June issue of the Archives of Pediatric and Adolescent Medicine, the research team focused on 538 black girls and 610 white girls for whom they had data on physical activity, obesity and other measures.

The girls' overall level of physical activity was measured for three days with a device that could detect frequency of movement and speed. Their TV viewing hours, height, weight, body-mass index (BMI), percent of body fat and daily calorie intake were also recorded. BMI, a calculation based on height and weight, is a reference used to determine obesity.

At age 12, the activity levels were higher in white girls than in black girls. The black girls had a higher BMI and body fat percentage, and ate more calories daily. They also watched more TV: The median -- meaning half watched more, half watched less -- was 44.3 hours a week for black girls vs. 24.5 for white girls.

Median daily caloric intake was slightly higher for black girls -- 1,912 vs. 1,906 for white girls.

At 12 years of age, 14 percent of the black girls were obese, compared to 4.3 percent of the white girls. At 14 years, 15.6 percent of the black girls and 5.1 percent of the white girls were obese.

That no link was found between physical activity levels and obesity among black girls is consistent with other research showing that fat-burning rates in response to physical activity are lower in black girls during puberty and adulthood than in whites.

Lifestyle issues, rather than genetics, may partly explain the results, said Pete McCall, an exercise physiologist with the American Council on Exercise.

Noting that black girls watch much more TV than white girls, he said, "That would be one area to change." They could shut off the TV and get exercise, "but the neighborhood may not be conducive," he said.

Parent education and income might affect the results, too, McCall speculated. More than half the parents of white girls had a college degree, but fewer than one-quarter of the black girls' parents did. The incomes of white girls' parents were higher, too.

"College education and income levels [of the parents] can play a role in the amount of physical activity a person gets," he added.

The authors noted that the black girls began menstruating earlier than the whites, which could also influence weight gain.

Encouraging black teen girls to exercise is still important, but different approaches may be needed to prevent obesity in black girls, the authors said.

"Our findings require replication before any real recommendations can be made," White said. "They do, however, suggest that black girls should be particularly attentive in controlling their caloric intake."

More information

To learn more about obesity and black Americans, visit the U.S. Office of Minority Health.

Copyright c 2012?HealthDay. All rights reserved.

Docs Aren't Coaching Overweight Kids on How to Slim Down: Study

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FRIDAY, June 8 (HealthDay News) -- While U.S. doctors often urge obese teens to eat better and exercise more, overweight kids headed for obesity seldom get the same medical advice, a new study shows.

That's important, experts say, because preventing obesity is much easier than dealing with it once it's there.

In the study, fewer than half of all adolescents were advised to eat a healthful diet by their doctor, and only about a third were also told to get more exercise.

This type of advice was more commonly doled out to obese boys and girls than their normal-weight counterparts, but overweight adolescents -- those at highest risk of becoming obese -- were counseled much less often.

The bottom line is that "there is still significant room for improvement in terms of the diagnosis, prevention and management of weight issues in children," said one expert, Dr. Yolandra Hancock, a primary care pediatrician at Children's National Medical Center in Washington, D.C. She was not involved with the study.

If doctors aren't helping overweight kids slim down, it's up to parents to step in, she said.

"If your provider has not brought up weight or body-mass index (BMI), ask how much your child weighs, what their [BMI] is and how it compares to other same-aged kids," she said. "Once this conversation is initiated, the provider will take the lead."

BMI is a measurement of body fat based on height and weight. A BMI of 30 is typically considered the threshold for obesity.

The study, led by Dr. Lan Liang of the Agency for Healthcare Research and Quality in Rockville, Md., appears online in advance of print publication in the July issue of Pediatrics.

The researchers looked at data from 2001 to 2007 for nearly 14,000 young people 11 to 17 years old who had been to the doctor's office at least once in the previous year.

They found that doctors talked with 47 percent of girls and 44 percent of boys about healthy eating, and told 36 percent they should exercise more.

Obese adolescents were twice as likely as normal-weight kids to receive this advice, but overweight teens -- those threatened by obesity -- were counseled far less than obese boys and girls, the researchers found.

"This is troubling because experts believe that obesity is easier to prevent than to treat, which implies that physician counseling for the overweight but not yet obese may have the greatest potential to prevent obesity later in life," the researchers concluded.

The rates of childhood obesity in the United States have more than tripled in the past 30 years, and one in three American kids and teens is now overweight or obese. As a result, diseases and conditions normally seen only in adults -- high cholesterol, high blood pressure and diabetes -- increasingly are diagnosed among children.

Those most likely to receive advice on healthy eating and physical activity lived in wealthier households in the Northeast and had a regular source of medical care and parents with some college education.

Blacks and Hispanics were advised on proper diet more often than whites, and Hispanic teens got activity recommendations more often than whites and blacks. The authors said this might reflect awareness that obesity is a higher risk among minorities.

The new findings predate the release of 2007 guidelines aimed at preventing and treating childhood obesity. The rates of counseling improved toward the end of the study, which may have been a result of publicity for the coming guidelines, the study authors reported.

Dr. Scott Kahan, director of the National Center for Weight and Wellness in Washington, D.C., said few studies of this type have looked at young people. "We have similar data in adults, but this is one of the first studies in adolescents," he said.

Getting people to change their behavior is no simple task, Kahan said.

"It is a science and art in itself to help empower patients, whether adults or adolescents, to change health behaviors," he said. "Telling them to eat less and exercise more is not helpful."

Concerned parents should ask their pediatricians about their child's weight status, and ask for a referral to a specialist if their child is obese, he said.

More information

For more information on raising healthy, fit kids, check out Let's Move.

Copyright c 2012?HealthDay. All rights reserved.

FDA staff say Edwards heart valve meets goals

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WASHINGTON (Reuters) - U.S. Food and Drug Administration staff said on Monday that Edwards Lifesciences Corp's Sapien heart valve met its primary safety and effectiveness goals in research, but expressed caution about the risk of stroke and aortic leakage.

The FDA released a staff review document that found "no significant difference in mortality" up to one year, between aortic stenosis patients who received the Sapien valve and a control group that had aortic valve replacement through open-heart surgery.

But the document said there was only limited data available beyond two years and cautioned that some of the findings were hard to assess partly because some patients in the study did not receive the intended treatments.

The Sapien heart valve, which is threaded to the heart through an incision in the groin or ribs, has already been approved by the FDA for aortic stenosis patients deemed to be too sick for open-heart surgery. A panel of outside advisers to the FDA will vote Wednesday on whether to recommend that the agency approve the product for use among patients whose cases are high-risk but not inoperable.

Wall Street analysts said the FDA staff's cautious comments suggest that Edwards Lifesciences will face a challenge advisory committee hearing on Wednesday, but ultimately win the panel's recommendation and the regulatory agency's approval.

Sapien is considered to be one of the most important future growth drivers for Edwards, whose shares were up about 13 cents at $88.30 in afternoon trading.

"We estimate there will be approximately 5,500 of these (high-risk) procedures performed in the United States in 2013, moving to nearly 40,000 by 2016," Goldman Sachs analyst David Roman said in a note to investors.

Roman added that his 2016 estimate would be double the number of procedures anticipated for patients ineligible for surgery during the same year. The procedure is estimated to cost about $30,000.

In pivotal clinical trials, the company said the Sapien led to a slightly lower death rate and dramatically shorter recovery times and hospital stays than chest-cracking open-heart surgery.

The FDA staff cited findings that showed patients treated with Sapien had a mortality rate of 24.27 percent when the device was inserted through the leg, and 22.24 percent when inserted between the ribs. The control group had mortality rates above 26 percent.

FDA staff also highlighted research showing a significantly higher incidence of stroke. Earlier research suggested a higher stroke risk could potentially make surgery preferable for some, especially younger, stronger patients.

In addition to strokes, the FDA staff pointed to data showing that 53 percent of patients treated with the Sapien system experienced leakage known as aortic regurgitation and said there was mounting evidence of a link between the condition and death among Sapien patients.

"These data also show that the amount of (aortic regurgitation) is appreciable and does not decrease over time," the staff said.

Up to 1.5 million people in the United States suffer from aortic stenosis, a progressive disease that affects the aortic valve of their hearts, according to Edwards.

The company said that approximately 250,000 people have severe symptoms. But only about two-thirds of them undergo surgery.

The federal government's Medicare healthcare program for the elderly and disabled and the joint federal-state Medicaid program for the poor announced last month that they would cover the procedure for patients who cannot have surgery.

(Reporting By David Morgan; editing by Sofina Mirza-Reid and Maureen Bavdek)

Chicago braces for largest anti-NATO protest

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CHICAGO (Reuters) - Chicago police trying to keep the peace during the NATO summit may face their biggest test on Sunday when thousands of demonstrators were expected to march near the site where leaders of the military alliance begin a two-day meeting.

Previous protests in the runup to the summit Sunday and Monday have been lively but peaceful, resulting in fewer than two dozen arrests over the past six days, according to the Chicago Police Department.

But terrorism charges against three self-described anarchists arrested in Chicago earlier in the week was a reminder that the threat of violence is out there.

"So far, the numbers have been underwhelming," said Jeff Cramer, a federal former prosecutor who now runs the Chicago office of the global security consultancy Kroll International.

"We can't say the police found the only three people who are bent on violence. Vigilance is the word of the day."

The Coalition Against NATO-G8, the group behind Sunday's parade, has said it hopes as many as 10,000 people will show their opposition to the war in Afghanistan by participating in the march, which starts in a downtown park and ends more than two miles away near the summit site.

"Sunday will be the day the protesters get closest to the summit, and it will be the day we see the largest number of protesters," Cramer said.

"There are certainly going to be arrests and maybe a scuffle or two. I would be surprised if there weren't."

Fears that violence would erupt have so far proved unfounded and there has been little destruction of property. Experts credited the low arrest numbers to restraint by both police and protesters.

Chicago Police Chief Garry McCarthy said at the beginning of the week that his goal was to "extract" those protesters who were provocative and let others demonstrate peacefully.

"They're dealing with individuals that are showing signs of aggression. But they're allowing people expressing their opposition to policies to do so," said Arnette Heintze, a former Secret Service agent who is now CEO of Hillard Heintze, a security firm that advised the NATO host committee.

The three men charged Saturday with conspiracy to commit terrorism were planning to attack President Barack Obama's campaign headquarters and Chicago Mayor Rahm Emanuel's home, prosecutors said.

Ben Rhodes, deputy national security adviser to Obama, said on Saturday he did not think the president had been briefed on the alleged plot and praised Chicago police for acting swiftly.

"If these more serious allegations are true, then I think it was effective work in making sure that they couldn't pose any additional threat to public security," Rhodes said.

Obama and representatives from some 60 countries are to discuss the war in Afghanistan and other international security issues.

(Additional reporting by Caren Bohan; Editing by Greg McCune and Doina Chiacu)

Canada's aging population poses new challenges

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OTTAWA (Reuters) - Canada's population is aging fast, and the number of people over 65 hit a new record in 2011, official statistics showed on Tuesday, a trend that will steepen in coming years as baby boomers retire.

Canada's overall population remains younger than that of some of its biggest trading partners. But the growing number of elderly is still expected to put enormous pressure on the government to cover soaring healthcare and pension costs.

Census figures released on Tuesday showed that Canadians aged 65 or older represented 14.8 percent of the population in 2011, up from 13.7 percent five years earlier, for a total of nearly five million.

Yet Canada's population remains among the youngest in the G8 industrialized nations because the bulk of people in the post-war baby boom - those born between 1946 and 1965 - are still working, Statistics Canada said in its latest batch of census data.

"In 2011, only the United States and Russia had a lower proportion of seniors than Canada... The baby boom in Canada was larger than in many other G8 countries, and most baby boomers have not yet reached age 65," Statscan said.

Seniors accounted for 23.4 percent of the population in Japan - the world's oldest population; 16.5 percent in the United Kingdom; 13 percent in the United States and 12.9 percent in Russia.

But the demographics in Canada are at a turning point. Statscan projects that by 2016, the country will have more seniors than children for the first time in its history.

The age group on the cusp of retirement - 60 to 64 - grew 29.1 percent between 2006 and 2011, nearly five times faster than the overall population growth of 5.9 percent.

"This suggests that population aging will accelerate in Canada in the coming years," the agency said.

That means fewer taxpayers to pay for social programs that include a comprehensive state-funded medical system.

Even though Canada's population has been aging, it has had a stable work force for the past 30 years, at about 68 percent of the population.

That is also about to change, said Rod Beaujot, a sociologist at Western University in London, Ontario.

"The portion of the population 15 and over who are employed will start to decline now so that there'll be more people in retirement ages," he said.

CONTROVERSIAL POLICY MOVES

Beaujot says the Conservative government should not have cut taxes, as it did in the past six years, because it could have put aside that revenue to pay for baby boomer healthcare.

"Instead, we've reduced our taxes and thus we've increased recently our debt load, so we're not well-placed to fund the health costs of the elderly except by taxing the young people more," he said.

Government efforts to cope with the aging population have already sparked controversy.

First off, Ottawa unilaterally imposed new limits on the amount of money the federal government will give provincial governments to finance healthcare, a provincial responsibility.

From 2016 it will limit the growth in transfer payments to the level of nominal growth in gross domestic project, currently seen at 4.5 percent, down from a fixed 6 percent annual increase from through to 2016.

Angry provincial leaders said Ottawa has simply dumped the problem on them, making it impossible to cope with the inevitable surge in healthcare costs as Canadians age.

The government also aims to raise the eligibility age to 67 from 65 for Old Age Security, a key pillar of the pension program aimed at lower-income seniors. It says the changes are needed to make the program affordable in the long term, but opposition legislators slammed it as an attack on the most vulnerable seniors.

(Editing by Jeffrey Hodgson and Janet Guttsman)