Psychotropic drugs boost fall risk in the elderly

February 28th, 2010

A new analysis of studies including nearly 80,000 people aged 60 and older confirms that certain types of widely prescribed drugs, such as antidepressants and sedatives, can increase their risk of falling.

Falls often have serious consequences for older people, such as injuries leading to disability and admission to a nursing home, or even death.

While prescription drugs are recognized as contributing to fall risk among older people –who are likely to be on lots of medications — discovering just which drugs are the problem is still a “challenge,” Dr. Carlo A. Marra of the University of British Columbia in Vancouver and colleagues note in the Archives of Internal Medicine.

To update a review of studies on this subject published in 1996, Marra and his team identified 22 studies published between 1996 and 2007 including 79,081 people 60 and older, some of whom lived independently, and some of whom were institutionalized. They analyzed the risk of falling associated with nine classes of drugs.

Three classes turned out to significantly boost fall risk: sedatives and hypnotics, typically prescribed as sleeping aids; antidepressants; and benzodiazepines, which include tranquilizers like Xanax and Valium.

The researchers also saw an increased risk in patients taking non-steroidal anti-inflammatory drugs — like aspirin– and drugs for treating psychosis, but they note that people may be taking these drugs to treat conditions that would in and of themselves increase their risk of falling.

Prescription drug use among the elderly is on the rise, Marra noted in an interview with Reuters Health. He pointed out that one recent Canadian study found 1 in 7 people over 80 had filled a prescription for an antidepressant.

Older people who are taking any of the drugs associated with falls should talk about the medication with their physician and their pharmacist, Marra advised.

“Perhaps between their practitioner and themselves they can come up with safer alternatives,” Marra said.

Research Yields Clues to Severe Form of Sinusitis

February 22nd, 2010

U.S. researchers say they’ve identified a protein that causes nasal and sinus polyps in 15 percent to 30 percent of people with chronic sinusitis.

The condition is one of the most serious forms of sinusitis, a constant irritation and swelling of the nasal passages. Polyps – unhealthy overgrowths of sinus tissue — can block the sinus passages and make it difficult or impossible to breathe through the nose. This often leads to pain, swelling and infections.

“This type of sinusitis isn’t subtle — you can spot the patients with polyps across the room. They’re breathing through their mouths, they talk with nasal voices, they’re constantly sniffling, and their faces are swollen,” Dr. Jean Kim, an assistant professor in the departments of otolaryngology and allergy and clinical immunology at the Johns Hopkins University School of Medicine, said in a news release.

Kim and colleagues analyzed sinus tissue from patients and concluded that a protein called vascular endothelial growth factor (VEGF) — which is known to stimulate blood vessel growth — causes the cell overgrowth that causes the polyps.

The protein may offer a target for new treatments for the condition, which typically resists all current therapies. Surgery is a common treatment but the polyps nearly always regrow. Oral steroids only temporarily treat the problem and have a number of harmful side effects.

“In the future, we might have a nasal spray with an anti-VEGF agent in it,” Kim said.

Sleep Disorders Plague Cancer Patients

February 15th, 2010

Insomnia and sleep disorders affect more than three-quarters of cancer patients undergoing chemotherapy, a rate nearly three times higher than that of the general population, a new study finds.

The problem is more common in younger patients and in those with lung and breast cancers, said University of Rochester Medical Center researchers, who assessed sleep problems in 823 cancer patients.

Questionnaires completed by patients after their first two chemotherapy treatments revealed that 37 percent suffered from insomnia symptoms and another 43 percent had insomnia syndrome, which means they had difficulty falling asleep and staying asleep at least three nights per week, the researchers reported in the Nov. 23 online edition of the Journal of Clinical Oncology.

“These numbers are very high, and something we can’t ignore,” study author Oxana Palesh, a research assistant professor of radiation oncology, said in a news release from the medical center. “The good news is that insomnia is a very treatable problem that can be addressed quickly so it doesn’t compound other symptoms.”

Sleep problems — which are generally combined with fatigue and depression — haven’t typically been studied to determine their causes and impact on patients’ quality of life, she noted.

Smoking During Pregnancy, Lead Exposure Raise ADHD Risk in Kids

February 8th, 2010

Children whose mothers smoked during pregnancy or who were exposed to lead have more than double the risk of having attention-deficit hyperactivity disorder (ADHD) as other children, new research shows.

And with exposure to both cigarettes and lead, the chances of having ADHD soared. Children whose mothers smoked during pregnancy and whose blood showed signs of lead exposure had eight times the risk of having ADHD.

“When you have both exposures, there is a synergistic effect,” said study author Dr. Tanya Froehlich, a developmental and behavioral pediatric specialist and an assistant professor of pediatrics at Cincinnati Children’s Hospital Medical Center.

The researchers concluded that about 38 percent of ADHD cases among children aged 8 to 15 in the United States may be caused by prenatal exposure to tobacco smoke, while 25 percent of ADHD cases are due to lead exposure, according to the study in the Nov. 23 online issue of Pediatrics.

Froehlich and her colleagues used data on 2,588 children aged 8 to 15 from around the nation who took part in the 2001-2004 National Health and Nutrition Examination Survey. Tobacco exposure was assessed by asking mothers if they smoked during pregnancy, while lead concentrations were measured by a blood test.

About 8.7 percent of children met the criteria for ADHD, which is marked by inattentiveness, difficulty focusing, impulsivity and hyperactivity, according to the study. The ADHD group included 16.8 percent of children whose mothers smoked during pregnancy, compared to 6.6 percent of children whose mothers did not smoke.

Lead exposure was divided into three groups: low, medium and high. About 5.2 percent of children who had the lowest lead blood levels had ADHD. About 9.1 percent of children in the middle range had ADHD, while 13.6 percent of children in the highest third had ADHD, the researchers found.

About 28.6 percent of children who were exposed to both prenatal smoking and who had higher blood lead concentrations had ADHD, Froehlich said.

Researchers did not find a strong link between exposure to secondhand cigarette smoke during childhood and ADHD.

Alarmingly, even children in the upper third had lead exposure levels lower than what the federal government considers “elevated.” The U.S. Centers for Disease Control and Prevention considers levels of 10 micrograms per deciliter “actionable,” Froehlich said. In the study, children in the upper third had blood lead levels that were 1.3 micrograms per deciliter or greater; children in the middle group had levels between 0.9 and 1.3 micrograms per deciliter.

Previous research has shown lead is toxic to children’s brains and is associated with lower IQs and hyperactivity in children.

“There is no such thing as a ’safe’ level of lead,” said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Schneider Children’s Hospital in New Hyde Park, N.Y. “We know the lower the lead level, the better. This is an interesting and important study in that it looks at the combined effects of lead and prenatal cigarette exposure.”

Though much remains unknown about the specific causes of ADHD, “we have long believed ADHD is at least in large part due to abnormalities of dopamine in the brain,” Adesman said. Previous research has shown lead exposure and cigarette smoking may alter the brain’s metabolism of dopamine.

About 250,000 U.S. children aged 1 to 5 have blood lead levels greater than 10 micrograms of lead per deciliter of blood, according to the CDC. Though blood lead levels have generally dropped in recent years, children, particularly those in poor, inner-city neighborhoods, may still be exposed to lead from peeling paint in old buildings. Leaded paint was banned for most residential uses in the United States in 1978.

Children may also ingest lead from old water pipes, soil and toys. In the last few years there have been multiple recalls, some by major toy manufacturers such as Mattel and Fisher-Price, of products manufactured in China that contained unsafe levels of lead.

“Lead is out there, and we need to take precautions, such as making sure we keep kids away from peeling paint and make sure they practice good hand washing before they eat if they are playing in the soil,” Froehlich said.

In addition, good nutrition, including making sure children have adequate levels of iron and calcium, can also protect from lead exposure. Children with iron and calcium deficiencies absorb more lead than children with better diets, Froehlich explained.

Report questions value of family health history

January 30th, 2010

Getting a patient’s family history is widely regarded as a standard element of good medical care. But a report published today concludes that there isn’t much good evidence that obtaining such information improves doctors’ ability to predict and manage disease.

In addition, the report’s authors say the best way to collect family history data is unclear, as is the impact on patient outcomes and behaviors.

Dr. Brenda J. Wilson, from University of Ottawa, Ontario, Canada and colleagues did a study of previous studies on the subject, and report their findings in the online version of the Annals of Internal Medicine.

They found only two studies that tried to determine whether accurate family histories were likely to have an impact on care, and those studies had a number of limitations.

They found more studies of how patients reported their family histories. In 23 studies, they saw evidence that patients were more accurate about reporting the absence of disease in relatives than the presence of disease. Perhaps not surprisingly, patients were more accurate about their first degree relatives than their distant relatives.

The study was funded by the Agency for Healthcare Research and Quality.

Restless Legs May Vary by Race and Gender

January 24th, 2010

Restless legs syndrome, a neurological disorder characterized by a strong urge to move the legs, is much more common among some racial groups than others, a new U.S. study has found.

Researchers interviewed 190 people being seen at a primary care clinic. About 12 percent of those who were black, compared with 36 percent of those who were not black, were found to have restless legs symptoms. Overall, the prevalence of restless legs was 23 percent among the clinic participants.

Among blacks, the prevalence of restless legs syndrome (RLS) was 12 percent for both men and women, compared with 40 percent for women and 29 percent for men among the others, most of whom were white.

“There are significant ethnic differences in the prevalence of restless legs syndrome, but the exact causes of higher prevalence among Caucasians are unknown,” study author Dr. Ammar Alkhazna, of the University of Missouri, said in a news release from the American College of Chest Physicians. “This likely reflects a combination of factors, including a genetic predisposition to RLS, diet, including iron intake, medications, and possibly culture.”

The study was scheduled to be presented at the annual scientific meeting of the American College of Chest Physicians, held Oct. 31 to Nov. 5 in San Diego.

Symptoms of restless legs also were seen more often in women than men, the study found.

“Some risk factors for restless legs syndrome appear to be more common among women,” Alkhazna said. “Women are more likely to be iron-deficient than men and have rheumatoid arthritis, which are known risk factors for RLS.”

TV May Increase Aggression in Toddlers

January 17th, 2010

Yet another study has found that television viewing is linked to aggression in young children.

This research, published in the November issue of the Archives of Pediatrics & Adolescent Medicine, found that direct TV watching by young children or exposure to indirect viewing in the household were both associated with increased aggression in small children.

After controlling the data for other factors, such as maternal depression, living in an unsafe neighborhood and being spanked, “for every hour that a child watched TV directly, aggression went up 0.16 on a scale of zero to 30. For a TV being on in the house, it was 0.09,” said study author Jennifer A. Manganello, an assistant professor of health communication at the University of Albany School of Public Health, State University of New York.

And, she said, while the increase may not seem like a lot, when the researchers looked at all of the other factors, “TV was more likely than some other factors to increase aggressive behaviors.”

The American Academy of Pediatrics (AAP) is concerned enough about the media’s effect on children’s behavior that they recently updated their policy on media violence.

“Exposure to violence in media, including television, movies, music and video games, represents a significant risk to the health of children and adolescents. Extensive research evidence indicates that media violence can contribute to aggressive behavior, desensitization to violence, nightmares and fear of being harmed,” wrote the AAP Council on Communications and Media.

For the current study, Manganello and her colleagues collected data from the home and by telephone for 3,128 children born between 1998 and 2000. The children came from 20 large U.S. cities, and their mothers completed surveys when the child was born, and again at ages 1 and 3.

Because so many factors can influence a child’s behavior, the researchers tried to control for as many factors as they could, including maternal health and depression, maternal parenting attitudes and behaviors, maternal experience with violence, the safety of the neighborhood and demographic characteristics.

The researchers found that children who were spanked, lived in an unsafe neighborhood or had a mother who was depressed or stressed were more likely to exhibit aggressive behaviors.

But, after controlling for these and other factors, the study authors found that TV — both direct and indirect viewing — had a statistically significant effect on children’s aggressive behavior.

“A take-home message from this study is that parents should think about how much TV kids are watching themselves, but also think about the overall media environment in the home,” said Manganello.

“TV is not a benign influence. It does have impact,” said Richard Gallagher, director of the Parenting Institute at the New York University Child Study Center in New York City. And, while content may impact children, he pointed out that children’s behaviors may also be affected by the “opportunities lost.”

That means that when a child is watching TV, which is a passive behavior, the child doesn’t have the opportunity to interact with other people and may have reduced contact with his or her peers.

“The AAP guidelines that children under 2 shouldn’t watch any TV may be fairly strict and hard to carry out, but parents should be judicious about how much TV young children are watching, and be aware that it’s not likely to be appropriately stimulating,” he said.

He added that parents need to act as a TV filter for their children. For example, he said, parents should point out when something is silly on TV that it’s not a real-life scenario. Or, if they see something violent — say an anvil dropping on someone’s head in a cartoon — parents need to interpret that for their children, and let them know what would happen if that were a real situation.

Two U.S. deaths possible in beef recall

January 11th, 2010

An outbreak of food-borne illness, linked to dangerous bacteria in ground beef, sickened 28 people and caused at least one death, the U.S. Centers for Disease Control and Prevention said on Monday.

The CDC said a New York adult with underlying medical conditions had died and another possibly related death in New Hampshire was under investigation. State officials attribute the New Hampshire death to the O157:H7 E. coli bacteria.

All but three of the 28 cases listed by the CDC were in the U.S. Northeast and 18 were in the New England states. Sixteen hospitalizations were reported, said a CDC spokeswoman. The bacteria involved were from a common strain, so tests were under way to see if all of the reported cases were related.

Over the weekend, Fairbank Farms of Ashville, New York, recalled 545,699 lbs (248,450 kg) of ground beef products.

The Agriculture Department, which oversees meat safety, said an investigation led it to conclude “there is an association between the fresh ground beef products and illnesses in Connecticut, Maine and Massachusetts.” USDA worked with state and federal officials in examining a cluster of E. coli O157:H7 illnesses.

A potentially deadly bacteria, E. coli can cause bloody diarrhea, dehydration and, in severe cases, kidney failure. The very young, the elderly and people with weak immune systems are the most susceptible to foodborne illness.

A string of food-borne safety scares led the U.S. House of Representatives to pass legislation this summer to require more inspections and oversight of food manufacturers and would give the government new authority to order recalls.

Fairbank Farms announced the recall on Saturday. The beef was produced in mid-September and probably was labeled for sale before the end of the month, said USDA.

It went to retailers including Trader Joe’s, Price Chopper, Lancaster and Wild Harvest, Shaw’s, a unit of Supervalu, BJ’s, Ford Brothers and Giant, a unit of Ahold, in eight states — Connecticut, Maryland, Massachusetts, New Jersey, New York, North Carolina, Pennsylvania and Virginia.

Skinny friends may make you eat more

December 28th, 2009

That friend who stays thin despite eating anything and everything is not just annoying. She might also wreck your diet, new research suggests.

Researchers found that when they had college students watch a movie and snack with either a skinny or overweight companion, the students typically followed the thin friend’s lead when she overindulged.

In contrast, study participants used more self-control when snacking with a heavier companion who overate.

The findings, published in the Journal of Consumer Research, suggest that seeing a thin friend devour a big meal gives us implicit permission to do the same.

“We think ‘if she can eat like that and stay thin, so can I,’ or ’she is having cake, then I can too,’” explained Dr. Brent McFerran, an assistant professor of marketing at the University of British Columbia in Kelowna, Canada.

“In other words,” he told Reuters Health in an email, “the most dangerous person to eat with is not someone who is obese, but a thin friend with a large appetite.”

For their study, McFerran and his colleagues recruited 210 female college students for what the participants believed was a study on movie viewing; each woman watched a movie with a companion, who was actually a member of the research team.

In some cases, the researcher showed up as her normal 105-pound self, while in others she donned padding that made her appear to be obese.

During the movie, the pairs were offered snacks, with the undercover researcher taking her portion first.

In general, McFerran’s team found, the students ate more when their thin companion took a large portion, versus cases where the “obese” companion took a similarly large portion.

For example, when the skinny researcher ate a lot (30 candies), the participants ate an average of 10 candies. When the researcher was “obese” and ate a lot, the kids ate about 6 candies.

“Eating involves much social pressure,” McFerran said, noting that social influences may, in fact, be the strongest predictor of what we eat.

But the current findings do not mean that we need to cancel all future dinner plans with our overindulgent skinny friends.

“If we think about what we are doing in advance,” McFerran said, “we are less likely to overconsume.”

He suggested that instead of looking at a thin friend who is gorging on dessert and feeling permission to do the same, we should remind ourselves that individuals are different — with different metabolisms and exercise habits, for example.

Focus on your own goal to eat healthfully, McFerran said, rather than automatically mimicking a friend.

He pointed out, however, that there is a “flip side”: Friends who choose smaller portion sizes and healthier foods can encourage us to do so, especially if those friends are thin.

Autumn Chores Often Hazardous

December 21st, 2009

Taking health and safety precautions when raking leaves, cleaning gutters and performing other outdoor chores can help prevent injuries, according to the American Academy of Orthopaedic Surgeons (AAOS).

“Many people work vigorously in the yard during the autumn season, and it often takes a toll on your body,” AAOS spokesman Dr. Laurence Laudicina, said in a news release from the academy. “Raking leaves and cleaning out the gutters are popular seasonal chores that can lead to falls or strain to your back and upper body.”

In 2008 in the United States, about 617,000 people suffered injuries caused by rakes, other outdoor garden supplies and ladders, the U.S. Consumer Product Safety Commission noted.

So to help avoid becoming one of those statistics, the AAOS offers the following autumn chore safety tips:
Warm up for at least 10 minutes with some stretching and light exercise before beginning work in the yard.
Use a rake that’s comfortable for your height and strength. You can prevent blisters by wearing gloves or using a rake with a padded handle.
Make sure that hats or scarves don’t block your vision, and watch out for large rocks, low branches, tree stumps or uneven surfaces.
Vary your movements and alternate your leg and arm positions often. When picking up leaves, bend at the knees, not at the waist.
Wear shoes or boots with slip-resistant soles.
Don’t overfill leaf bags, especially if the leaves are wet. You should be able to carry bags comfortably.
Don’t throw leaves over your shoulder or to the side. That kind of twisting motion places undue stress on your back.
Inspect ladders for loose screws, hinges or rungs, and make sure it is free of mud, dirt or liquids.
Make sure all ladder legs rest on a firm, level surface. Don’t use ladders on uneven ground or soft, muddy earth.
Always face a ladder when climbing and descending.
Confirm that the ladder is fully open and locked before you climb it.
Angle ladders about 75 degrees from the ground.
Don’t sit or stand on the top of the ladder or on its pail shelf.
Use the right ladder for the job. Step stools or utility ladders are good for working at low or medium heights, while extension ladders should be used outdoors to reach high places.