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Adult Illness and Death Risk Increased by Respiratory Disease During Childhood

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Respiratory disease in childhood increases the risk of illness and premature death in adulthood, according to a study published in the journal, Thorax.

Between 1948 and 1968 10,000 male graduates of Glasgow University supplied researchers with details of childhood illnesses, including bronchitis, asthma and pneumonia, plus their weight, height and blood pressure.

When survivors of the original study were traced between 1998 and 2002, 4044 men out of 8410 replied. Victims of bronchitis, pneumonia asthma in early childhood were 57% more likely to die of respiratory disease than those who had not suffered from these illnesses as children. And they were more than twice as likely to die of chronic obstructive pulmonary disease, emphysema and bronchitis.

Men who had had bronchitis were also 38% more likely to die of cardiovascular disease. Respiratory illness during childhood was also associated with a higher risk of assorted respiratory problems in adulthood, ranging from the relatively minor to the severe.

Source: Thorax,/em> 2008; doi 10.1136/thx.2007.086744

Despite Successful Antidepressant Treatment, Despair Can Remain

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While antidepressants can successfully treat depressive symptoms, despair can remain; and this may result in the patient not taking the medication any longer, according to a study that tbe journal, General Hospital Psychiatry.

For many in the study, feelings of hopefulness did not improve until several weeks, or even months, after depressive symptoms lifted, says lead author James E. Aikens, Ph.D., associate professor in the Department of Family Medicine at the University of Michigan Health System.

"The finding suggests that some patients may become unduly pessimistic and stop adhering to an already-helpful therapy," he notes. This finding is troubling, he says, because hopelessness is a strong risk factor for suicide.

573 patients from 37 practices suffering from depression were studied by Aikens and his team, and given either fluxotine (Prozac), paroxetine (Paxil), or sertraline (Zoloft). Patients were then reviewed one, three, six and nine months after treatment began. Patient response to medication was fast: 68% of improvement was achieved by the end of the first month, 88% by three months. Areas of major improvement were positive emotions, work functioning and social functioning.

There was little improvement recorded in head, back and stomach pain after the first month, and Aikens said that if these physical complaints persisted after the first few weeks of treatment, physicians should consider treatments that directly affect pain in depressed patients.

Where hopefulness was concerned improvement noted was more gradual, and Aikens recommended that physicians teach patients to recognize and fight the pessimistic thoughts that often accompany depression, and encourage patients to get involved in mood-lifting activities.

In addition to Aikens, authors were: senior author Amanda Sen, Ph.D., of the Department of Family Medicine, the Department of Statistics and the Center for Statistical Consultation and Research at the University of Michigan; Donald E. Nease Jr., M.D., of the Department of Family Medicine at the U-M Health System; Michael S. Klinkman, M.D., M.S., of the departments of Family Medicine and Psychiatry at the U-M Health System; and Kurt Kroenke, M.D., of Indiana University.

With hopefulness, however, the improvement was much more gradual. Physicians may want to consider cognitive-behavioral strategies, such as teaching patients to identify and challenge the pessimistic thoughts that usually accompany depression, and encouraging them to engage in activities that may improve their mood, Aikens says.

In addition to Aikens, authors were: senior author Amanda Sen, Ph.D., of the Department of Family Medicine, the Department of Statistics and the Center for Statistical Consultation and

Source: General Hospital Psychiatry, (January-February, 2008)

Researchers Advise Protecting Kidneys Before CT Scans

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Dyes containing iodine used to enhance CT scan quality can seriously harm kidneys; and a new study recommends that patients take an inexpensive pre-scan drug, called N-acetylcysteine which protects kidneys from damage. These ‘dyes’ or contrast agents put many older people and those with diabetes or heart failure at the most risk, and they have the most to gain from taking the drug.

The study is published in the Annals of Internal Medicine by researchers from the University of Michigan Health System, who were led by Aine Kelly, M.D., M.S., an assistant professor in the Department of Radiology at the U-M Medical School. The study is a meta-analysis of data from 41 randomized controlled studies that evaluated various drugs for their ability to protect kidneys: only N-acetylcysteine prevented contrast-induced nephropathy. Theophylline was not as effective, while furosemide actually raised kidney risk.

"Our goal is to improve the safety and quality of these common tests by studying drugs that reduce the risk of kidney failure," says senior author Ruth Carlos, M.D., associate professor of radiology.

Mild to moderate kidney damage occurs in one in four high-risk people who have CT scans, and in as many as one in ten people with normal kidney function. In some cases, it causes acute kidney failure. "Millions of people receive contrast agent each year, including most heart patients who have angioplasties and stents, as well as those having a CT scan. Contrast agent helps physicians see the things we need to see, but it also does pose a hazard to some people," says Kelly. "This drug, which is quick, convenient, inexpensive and widely available, with no major side effects, appears to be the best choice to protect those whose kidneys are most at risk."

In fact, Kelly says, patients who know they have weakened kidneys – also called impaired renal function – should speak up when their doctor orders a CT scan, angiogram or angioplasty, and make sure they get a tablet of N-acetylcysteine beforehand.

Source: Annals of Internal Medicine, 19 February 2008, Volume 148 Issue 4

Cognitive Impairment Among Older Americans Decreasing

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A recent study shows a downward trend in the rate of cognitive impairment among people aged 70 and older. The study was led by two University of Michigan Medical School physicians and their colleagues, and is based on data from the Health and Retirement Study (HRS), a national survey of older Americans funded by the National Institute on Aging and based at the U-M Institute for Social Research (ISR).

"From these results, we can say that brain health among older Americans seems to have improved in the decade studied, and that education and wealth may be a big piece of the puzzle," says lead author Kenneth Langa, M.D., Ph., an associate professor of internal medicine who also holds appointments in ISR and the VA Ann Arbor Healthcare System.

Between 1993 and 2002 the incidence of cognitive impairment in this age group decreased by 3.5%, or hundreds of thousands of people. The reasons for this decline are not yet known, but the authors of the survey state that older people today have had more formal education, higher economic status and better care for risk factors—high blood pressure, high cholesterol, and smoking – that can endanger their brains. Of the 11,000 people in the study, those with more formal education and personal wealth were less likely to have cognitive problems.

The study was publishe in the the online edition of the journal Alzheimer’s and Dementia.

Source: Alzheimer’s & Dementia, Feb 18, 2008, online edition.

Spanish-Language TV Commercials Contributing to Latino Youth Obesity, Says Study

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The rising obesity epidemic among Latino youth may be traceable to the sheer volume of Spanish-language fast-food television commercials, according to a study in the Journal of Pediatrics. The research was conducted by pediatricians from the Johns Hopkins Children’s Center.

"While we cannot blame overweight and obesity solely on TV commercials, there is solid evidence that children exposed to such messages tend to have unhealthy diets and to be overweight," says study lead investigator Darcy Thompson, M.D., M.P.H., a pediatrician at Hopkins Children’s. Past research among English-speaking children has shown that TV ads influence food preferences, particularly among the more impressionable young viewers.

Programming during the heaviest childrens’ viewing hours on Univision and Telemundo, the two leading Spanish-language channels in the US, was monitored. (These channels reach 99% and 93% of US Latino households). The two or three food commercials aired each hour specifically targeted children, with nearly 50% of commercials advertising fast food, soda and other high sugar content drinks.

The researchers recommend limiting young children’s TV viewing to two hours a day or less, with parental guidance on healthy diet and food choices. Children under 2 should not be allowed to watch any TV at all, advise pediatricians.

Other recommendations include advising Latino childrens’ pediatricians of their parents’ heavy exposure to food advertising; and following the lead of many European countries in urging public health authorities to appeal to policy makers to limit food advertising to children.

The Journal of Pediatrics, DOI: 10.1016/j.jpeds.2007.09.011.

Diseases May Be Identifiable By Laser

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Testing a person’s breath with laser light can identify molecules which may serve as markers for diseases like asthma or cancer, according to a team of scientists at JILA, a joint institute of the National Institute of Standards and Technology (NIST) and the University of Colorado (CU) at Boulder. Their findings are published in the latest issue of the Optical Society of America’s open-access journal Optics Express.

Cavity-enhanced frequency comb spectroscopy, as the technique is called, may one day permit doctors to screen patients for certain diseases by sampling their breath. "This technique can give a broad picture of many different molecules in the breath all at once," says Jun Ye, who led the research. He is a fellow of JILA, a fellow of NIST and a professor adjoint at CU-Boulder’s Department of Physics.

Ye’s JILA colleague John L. Hall and Theodor W. Hänsch of Germany’s Max-Planck Institute (they shared the 2005 Nobel Prize in Physics with Roy J. Glauber for their invention), developed optical frequency comb spectroscopy in the 1990’s. Optical comb spectroscopy is powerful enough to sort through all the molecules in human breath, Ye says, but it is also sensitive enough to find those rarest molecules that may be markers of specific diseases.

Every time we breathe in, we inhale a complex mixture of gasses—mostly nitrogen, oxygen, carbon dioxide, and water vapor, but also traces of other gasses, such as carbon monoxide, nitrous oxide, and methane. Each time we exhale, we blow out a slightly different mixture with less oxygen, more carbon dioxide, and a rich collection of more than a thousand types of other molecules—most of which are present only in trace amounts.

Source: Optics Express, Vol. 16, Issue 4, February 18, 2008.

Mathematical Model for Prescribing Antibiotics May Help Control Antibiotic Resistant Bacteria

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In the United States some 100,000 people die every year because they become infected in hospital with a strain of antibiotic-resistant bacteria. To combat this problem, a sophisticated mathematical model has been developed that changes the way that antibiotics are prescribed and administered.

"We have developed the mathematical model in order to identify the key factors that contribute to this problem and to estimate the effectiveness of different types of preventative measures in typical hospital settings," said Vanderbilt mathematician Glenn F. Webb, who described the results at a presentation at the annual meeting of the American Association for the Advancement of Science on Feb. 17, 2008 in Boston, Massachusetts.

The most effective way to combat this growing problem, said Mr. Webb, was to minimize the use of antibiotics. It was no secret, he continued, that antibiotics were overused in hospitals. How to optimize its administration was a difficult issue. But the excessive use of antibiotics, which may benefit individual patients, was creating a serious problem for the general patient community.

The model, developed by an inter-disciplinary team of researchers, showed that in a hospital where antibiotic treatments were begun 3 days after diagnosis and continued for 18 days, the number of cross-infections by resistant bacteria increased and decreased but never disappeared completely. When antibiotic treatments started the day of diagnosis and continued for 8 days, however, the cross-infection rate fell to nearly zero within 20 days.

. The mathematical analysis reveals that the "optimal strategy" for controlling hospital epidemics is to start antibiotic treatments as soon as possible and administer the drugs for the shortest possible time. Beginning treatment as early as possible is the most effective in knocking down the population of the non-resistant bacteria that is causing a patient’s initial illness and minimizing the length of treatment shortens the length of time when each patient acts as a source of infection. "Our results point out an urgent need for more research into the issue of the best timing for the administration of antibiotics and how to reduce its misuse and overuse," said Webb.

The model was developed by an interdisciplinary team of researchers. In addition to Webb, the contributors are Erika M.C. D’Agata at Harvard University’s Beth Israel Deaconess Medical Center, Pierre Magal and Damien Olivier at the Université du Havre in France and Shigui Ruan at the University of Miami, Coral Gables. It is described in the paper "Modeling antibiotic resistance in hospitals: The impact of minimizing treatment duration" published in the Journal of Theoretical Biology.

Source: Journal of Theoretical Biology, December, 2007.

Experts Say Future Generations Will Experience Increased Infertility

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Commenting on infertility, experts from the Aarhus University Hospital, Denmark and the University of California observe that infertility is a common problem in affluent societies, and it affects some 15% of couples who are trying to conceive.

Assisted reproductive methods are used in some countries to conceive up to 6% of children. But fertility is determined by social, behavioral and biological factors, say the authors, which could make studies based on retrospectively collected data unreliable. These cultural and social norms may mask more subtle biological changes in the population, and representative health surveys should include fecundity.

Fecundity is expected to decline over time, the study’s authors predict, because with the availability of assisted conception subfertile couples may have as many children as fertile couples. Genetic factors linked to infertility will become more prevalent in the future. Meanwhile, dealing with the causes of subfecundity, say the authors, is the best way to fight infertility, and neglected research should be undertaken without delay.

Should Docs Recommend Smokeless Tobacco as Last Resort to Quit Smoking?

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If people are unable to kick the smoking habit, are doctors justified in recommending smokeless tobacco such as Snus or other smokeless tobacco products? That is the question under debate in a recent article in the British Medical Journal.

More than 100,000 people a year in the UK die because of smoking, primarily from lung cancer, heart disease, and chronic obstructive pulmonary disease, says John Britton, Professor of Epidemiology at City Hospital, Nottingham. An estimated 77% of smokers want to stop smoking, and 78% have tried but failed because of nicotine addiction.

While the best course would be for health professionals to urge quitting all nicotine use, he suggests that switching to a medicinal nicotine product is the logical option for those who want to quit but repeatedly fail.

Dr. Britton suggests that if all else fails, doctors may want to recommend a smokeless tobacco product, such as Snus. He maintains that Snus would be acceptable as a measure of last resort. But it first needs to be tested, he says.

Meanwhile, Alexander Macara, President of the National Heart Forum, while allowing that smokeless tobacco is less addictive than smoked tobacco, quotes studies that show smokeless tobacco to be carcinogenic, with an increased risk of oral and pancreatic cancers and heart attacks. In addition, he says, 60% of people who use Snus become chronic Snus users.

Action on Smoking and Health and the Royal College of Physicians of London have reviewed safer sources of nicotine as a means of reducing the harm caused by smoking, but Macara is concerned that if products such as Snus are recommended as a means to quit smoking, its use may be adopted by more people, particularly young people, who might never have smoked in the first place.

Source: British Medical Journal (BMJ Volume 336 pp 358-9

Stress May Increase HPV and Cervical Cancer Risk

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Sress can reduce the immune system’s ability to resist HPV, a common sexually transmitted disease that may lead to cancer, according to a recent study published in the Annals of Behavioral Medicine. No such association is seen, however, between past major life events, such as divorce or job loss, and the body’s response to the infection.

"HPV infection alone is not sufficient to cause cervical cancer," explained Fox Chase Cancer Center’s Carolyn Y. Fang, Ph.D. "Most HPV infections in healthy women will disappear spontaneously over time. Only a small percentage will progress to become precancerous cervical lesions or cancer."

Women with precancerous cervical lesions were asked to complete a questionnaire detailing their stress in the past month, such as divorced, death of a close family member or job loss. "We were surprised to discover no significant association between the occurrence of major stressful life events and immune response to HPV16. This could be due to the amount of time that has passed since the event occurred and how individuals assess and cope with the event," said Fang.

"Our findings about subjective daily stress told a different story, however. Women with higher levels of perceived stress were more likely to have an impaired immune response to HPV16. That means women who report feeling more stressed could be at greater risk of events that had occurred, such as divorce, death of a close family member or loss of a job.

"We were surprised to discover no significant association between the occurrence of major stressful life events and immune response to HPV16. This could be due to the amount of time that has passed since the event occurred and how individuals assess and cope with the event," said Fang. "Our findings about subjective daily stress told a different story, however. Women with higher levels of perceived stress were more likely to have an impaired immune response to HPV16. That means women who report feeling more stressed could be at greater risk of developing cervical cancer because their immune system can’t fight off one of the most common viruses that causes it."

Fang’s study was funded by a grant from the National Cancer Institute.


Source: Annals of Behavioral Medicine (Vol. 17, No. 1)