WOMEN HANDLE TRAUMA BETTER, STUDY FINDS

So which is the weaker sex?

A study of 545 trauma patients published in the current issue of the Archives of Surgery has found that males of all ages are significantly more likely than females to develop serious, life-threatening infections after surgery for a major trauma caused by an illness or injury.

Researchers from the University of Colorado suggest that the sex disparity may be due to hormonal differences, particularly the deleterious effects of testosterone.

To test the hypothesis that men were more prone to post-trauma infections than women--a finding that has been demonstrated in several studies of rats--surgeon Patrick J. Offner and his colleagues followed 545 patients age 15 and over who were admitted to the surgical intensive care unit at the Denver Health Medical Center between 1993 and 1998. Some of the patients were suffering from infections related to pneumonia, abdominal abscess or wound infections.

As a group, the 135 female patients were older and more severely injured than the 410 males. All patients were followed from admission to discharge or death and their care was supervised by five general surgeons experienced in critical care medicine.

Overall, Offner and his colleagues found, males had a 58 percent greater risk of developing a major post-trauma infection.

A similar disparity has been noted in small studies, including a recent survey of pediatric burn patients that found that boys were more likely than girls to develop sepsis, a life-threatening bloodstream infection.

"We were surprised . . . that the increased risk of infection in males persisted in the postmenopausal age group, when hormonal differences were believed to be less operative," the authors noted. The precise reasons for the sex differences are not clear, they concluded.

--Sandra G. Boodman

DYING PATIENTS' WILL IS FOUND TO EBB AND FLOW

Terminally ill cancer patients go through fluctuations in their will to live during their final days, a Canadian study suggests.

A dying patient's determination to live can vary significantly even over a 12-hour period, the shortest interval between measurements in the study, researchers said. "These large fluctuations suggest that will to live is highly unstable," the study concluded.

The factors influencing the will to live change as death approaches, the study found. When patients are first admitted to an end-of-life care unit, anxiety is most significant. Later, depression is what affects will to live the most. Near the end, physical distress, such as shortness of breath, is the biggest factor.

The findings have important implications for the debate over physician-assisted suicide and for care of the terminally ill, researchers said. The "likely transience of a request to die" is an important consideration for legislators considering proposals to legalize physician-assisted suicide, they said. Oregon is the only state that has authorized physician-assisted suicide.

"A patient's state of mind is the single most important factor in understanding of a request for physician-hastened death," the authors of the study said.

They tested the will to live of 168 men and women with terminal cancer at a hospital palliative care unit, where the main goal is no longer extending life but keeping the patient comfortable and maintaining quality of life during the time that remains. The patients ranged in age from 31 to 89.

The study is based on the patients' responses to a questionnaire designed to measure symptoms and state of mind. Patients rated themselves twice a day on a 100-point scale for pain, anxiety, depression, sense of well-being, shortness of breath, nausea, activity, drowsiness and appetite--as well as on their will to live.

Researchers recorded the patients' responses until they were discharged, died or became too sick to answer. Half the patients participated in the study for at least 12 days and many were responding as late as one day before their death.

An 82-year-old woman with colorectal cancer was in the study more than 150 days. Her will to live weakened for the first two weeks, then gradually improved until day 60. It stabilized through day 100 before becoming quite changeable as her death approached and her pain become more difficult to control.

The study was conducted by researchers at the University of Manitoba and St. Boniface Hospital Research Foundation in Winnipeg and Queen's University in Kingston, Ont. Their findings appeared this month in The Lancet, a British medical journal.

--Don Colburn

CHILDREN FOUND TO LOSE HEPATITIS C OVER TIME

Nearly half of children infected with hepatitis C may spontaneously rid themselves of the viral infection as they become adults, according to a study by German researchers.

In the United States, an estimated 2.7 million people are infected with this disease, which attacks the liver. Hepatitis C, which is spread via blood and other bodily fluids, often has no symptoms until severe liver damage has been done. Many people unknowingly received the virus through blood transfusions given prior to 1991, which was when screening tests to safeguard the blood supply became available.

When adults become infected, the disease persists as a chronic infection in 70 to 80 percent of cases and can lead to serious liver problems, including cirrhosis and cancer. Doctors often prescribe antiviral drugs, such as interferon, to help reduce complications from the infection. But such treatment is expensive, has multiple side effects and is effective in up to 45 percent of cases.

Whether children with hepatitis C face the same risks as adults is uncertain, since few studies have examined long-term effects in youngsters. The latest study, published last week in the New England Journal of Medicine, focused on 458 individuals in Germany who were less than 3 years old when they received blood transfusions during heart surgery. They were compared with a group of 458 children the same age who had also undergone heart surgery but had not required blood transfusions.

Nearly 15 percent--or 67 children--who received blood transfusions contracted hepatitis C, according to researchers led by Manfred Vogt of the Technical University of Munich. Less than 1 percent of the youngsters in the control group were infected with hepatitis C.

Follow-up studies conducted 19 years after the initial transfusion found that the hepatitis C infection had spontaneously cleared in 30 of the study participants.

The findings suggest that hepatitis C infection that occurs in childhood "may resolve without treatment more commonly than infection acquired later in life," concludes Boston Children's Hospital physician Maureen M. Jonas, who wrote an editorial to accompany the study.

The study may also have an impact on how infected children are treated. Doctors are often reluctant to treat infected individuals with antivirals because of their side effects. A newer treatment regimen, combining interferon and ribavirin, is also sometimes used and is more effective.

The authors said treating infected children with interferon alone "does not seem worthwhile. Combination therapy with interferon . . . and ribavirin might be more effective when treatment is indicated."

--Sally Squires

CORRECTION

* The U.S. map that accompanied the Vital Statistics item in last week's Health section mislabeled Wyoming as Kansas.