People who have had a heart attack and then take fish-oil supplements have a significantly reduced risk of dying from later heart-related causes, according to a study published this month in The Lancet.

The study, which followed 11,324 people in Italian hospitals and clinics for 3 to 5 years after their heart attacks, found a 30 percent decrease in cardiovascular deaths among those who used the fish oil.

All participants in the study continued on their prescription medications, and all were given the same advice about improving diet and physical activity. But one group was also given a daily capsule of one gram of omega-3 polyunsatured acids, the active ingredients in fish oil, while another quarter were given 300 milligrams of vitamin E. Another group took both supplements and the rest were the control group.

According to the article, patients taking the omega-3 supplement experienced fewer heart problems than the control group, while those taking vitamin E did not. Those taking both supplements showed improvements similar to the group that got only fish oil.

Previous studies had shown both fish oil and vitamin E supplements to be effective in reducing cardiac disease. The study's authors theorized that the vitamin E showed little effect because the Italian study group was already eating a Mediterranean diet rich in vitamin E.

Scientists believe that fish oil and other omega-3 fatty acids may help the heart by reducing inflammation of artery walls. These fatty acids have also been shown to lower levels of triglycerides in the blood.

The Italian study was led by heart disease specialist Roberto Marchioli of the Consorzio Mario Negri Sud research institute. The study "supports the research showing that omega-3 fatty acids can decrease" the risk of blood clotting and abnormal heart rhythms, said Artemis Simopoulos, former chairman of the U.S. National Institutes of Health Nutrition Coordinating Committee and an advocate of omega-3 research and dietary use.

The study showed an overall reduction in death rate of 15 percent for the group taking fish-oil capsules. Most of the benefit was due to the 30 percent drop in heart-related deaths.

--Marc Kaufman


A hand-held metal detector is as effective as an X-ray in locating swallowed coins and other metallic "foreign bodies" ingested by children, a new study concludes.

Not only are hand-held metal detectors--similar to those used at airport checkpoints--cheaper than X-rays, but they also require no particular skill and do not subject a child to radiation, noted researchers led by Kathleen Seikel at the University of Texas Southwestern Medical Center in Dallas.

To determine whether training in the use of metal detectors affects the ability of doctors to find metallic objects, researchers at the University of Texas and the Eastern Virginia Medical School compared the performance of two teams of investigators. The first group underwent a brief training session in the use of the devices while the second received no training.

Seikel and her colleagues then screened 176 children brought to the emergency rooms of Children's Medical Center in Dallas and Children's Hospital of the King's Daughters in Norfolk for ingestion of a metallic object, most often a penny.

In nearly all cases the object was detected by doctors from both groups, although in three cases doctors without prior training failed to find an object that was picked up on an X-ray.

Children in the study ranged from 6 months to 15 1/2 years old; the average age was about 3 1/2. Most were seen within 24 hours of swallowing the object, although the time they arrived in the emergency room ranged from less than one hour after ingestion to more than a week.

Although pennies were the most common object, 28 children swallowed quarters and two swallowed Susan B. Anthony dollars. Other objects included a prosthetic eye, a bullet, an aluminum pull tab, a razor blade encased in plastic and pushpins.

"We conclude that [hand-held metal detectors] should be used as a screening tool for patients suspected of coin ingestion," the authors conclude. Objects below the diaphragm, particularly coins, usually pass harmlessly into the stomach and are excreted. Those that lodge in the esophagus can cause serious complications and even death; doctors who suspect an object is lodged above the diaphragm usually order an X-ray to determine the location.

The study was published this month in the Archives of Pediatric and Adolescent Medicine.

--Sandra G. Boodman


Guidelines for physicians on counseling women about the use of hormone replacement therapy may not reflect the concerns of the patients, a study by Harvard researchers has found.

In the study, women identified an average of 15 factors that were important to them as they decided to use prescription hormones after they reached menopause. Nearly all the women said that their physician's opinion was critical in that decision. The researchers then evaluated recommendations for physicians on hormone replacement therapy that are issued by the American College of Physicians, the American college of Obstetricians and Gynecologists and the U.S. Preventive Services Task Force to see if they addressed the same concerns that the women mentioned.

The study was published today in the Annals of Internal Medicine.

The researchers, led by Maureen T. Connelly, a physician with the Department of Ambulatory Care and Prevention at Harvard Medical School, said that many of the 26 women in the study "expressed considerable dissatisfaction" because physicians do not address their concerns when discussing using hormone therapy.

For example, the study noted that all three medical groups recommend that doctors counsel women considering hormone replacement therapy about its beneficial effects on osteoporosis, but none of them suggested physicians ask patients about their opinions based on news media or the experiences of family and friends.

Without recognition of the limited knowledge about the benefits of this medication, the authors said, "true informed decision-making cannot take place."

--Lexie Verdon