Recently in Family & Friends Category

Your immune system is a tremendously sustainable system! But we can exercise it with a dose of... laughter.

John Cleese takes us on a tour of a laughter therapy practice in India.

Laughter promotes stress reduction, community bonding, stronger immune system... and joy. What a simple solution!

Chronic kidney disease affects 26 million people in the United States.

Challenging prevailing wisdom that only children with end-stage kidney disease suffer physical, social, emotional and educational setbacks from their disease, research led by Johns Hopkins Children's Center shows that even mild to moderate kidney disease may seriously diminish a child's quality of life.

The findings, reported in the February issue of Pediatrics, suggest that earlier attention to quality-of-life issues in children with chronic kidney disease is needed.

"Even mild and moderate declines in kidney function may lead to serious physical, emotional, intellectual and social challenges," says lead investigator Arlene Gerson, Ph.D., a pediatric psychologist at Hopkins Children's.

Kidney Disease Screening is Needed

"What this means is we should be thinking about screening children for these challenges and intervening earlier than we once thought."

Recently diagnosed children who report learning problems may benefit from help before grades drop, researchers say, noting that children with chronic diseases currently do not qualify for special education until their scores decline dramatically.

Links Between Kidney Function and Quality of Life

In their study of 402 children, ages 2 to 16, with mild-to-moderate kidney disease, researchers analyzed the link between kidney function, disease severity, age of onset and disease duration, on the one hand, and physical, emotional, psychological and school functioning on the other.

The researchers also compared quality-of-life outcomes between healthy children and children with early-stage kidney disease. Children with mild-to-moderate kidney disease and their parents reported worse overall outcomes on standard quality-of-life questionnaires and worse outcomes on all quality-of-life factors.

Specifically, children with early-stage kidney disease scored on average 75 out of 100 on quality-of-life measures, compared to 83 out of 100 for healthy children. The difference was especially pronounced in school functioning, where children with early-stage kidney disease scored 64 out 100, compared to 80 out of 100 for healthy children.

How Children Cope with Kidney Disease

The study also found that the younger the child at the time of the diagnosis and the longer the child lived with kidney disease, the better the overall quality of life, a surprising finding, suggesting that as time passes children learn to cope better with their condition, the researchers say.

The researchers found that children with impaired growth and shorter stature, a common effect of their disease, had worse overall quality of life and poorer physical functioning, an indicator of the importance of early treatment.

Treatments for Children's Kidney Disease

"Timely and individually tailored treatment, be it with nutrition, salt supplements or growth hormones, if needed, can make a big difference. We cannot overemphasize the importance of early intervention in children with early stages of chronic kidney disease," says senior investigator Susan Furth, M.D. Ph.D., a pediatric nephrologist at Hopkins Children's.

The research is part of an ongoing 57-center study funded by the National Institutes of Health to study chronic kidney disease in children.

Heavy backpacks place a measurable strain on the spines of children, with heavier loads causing greater spinal strain and increased back pain, reports a study in Spine, January 2010 

My husband and I started getting concerned about heavy backpacks when our son was required to carry a very heavy backpack weighted down with a year's worth of books when he was in gradeschool.  It just didn't make sense.  It's taken a long time to get the research to prove the problems.  But it's here now, and solutions need to be found -- such as eBook readers.

The next step in convincing schools to "lighten the load" is to show how expensive back pain and back care is to our society.  Maybe business and government can prevent that long term impact on healthcare costs by providing children is an alternative to heavy books.

Test Results for Children's Back Health 

Magnetic resonance imaging (MRI) scans show compression of the spinal discs and spinal curvature caused by typical school backpack loads in children, according to Dr. Timothy Neuschwander of University of California, San Diego, and colleagues.

Backpacks' Effects on Disc Height and Spinal Curve Linked to Back Pain

The study included eight children, mean age 11 years. A special upright MRI scanner was used to image the children's spines in standing position--first with an empty backpack, then with increasing weights of 9, 18, and 26 lb. These weights represented about 10, 20, and 30 percent of the children's body weight.

Two key spinal measurements changed as the backpack load increased.

• Heavier weights caused compression of the intervertebral discs, which act as a cushion between the vertebrae (bones of the spine).
  
• Especially in the lower spine, the disc height became smaller (reflecting greater disc compression) at heavier backpack weights.
• Heavier loads were also associated with increased curvature of the lower spine, either to the right or the left.
  

Half of the children had a significant spinal curve even with the 18 lb weight. Most of the children had to adjust their posture to bear the 26 lb backpack load.

As backpack weight increased, so did the amount of pain reported by the children. At the heaviest load, the average pain score was nearly five (on a ten-point scale).

Parents are increasingly concerned about the heavy backpacks their children have to carry. The new study is the first to use imaging techniques to see how backpacks affect children's spines.

More than 90 percent of U.S. children carry backpacks, typically with weights equal to 10 to 22 percent of their body weight.

Carry Backpacks on One Shoulder or Two?

The results suggest that heavy backpacks cause compression of the spinal disks and increased spinal curvature, both of which are related to back pain reported by the children. Although the children were wearing the backpack straps over both shoulders when the MRI scans were performed, the researchers note that spinal curvature could be even greater if the backpack was carried over one shoulder--as many children do.

Lower Back Pain for Children -- Through Adulthood

"Low back pain in children may be worsened by discogenic [disc-related] or postural changes," Dr. Neuschwander and colleagues write. This could have long-term implications, as children with back pain are at increased risk of having back pain as adults. The researchers call for similar studies to examine the effects of heavy backpacks in children with existing back pain.

About Spine
Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. According to the latest ISI Science Citation Impact Factor, Spine ranks highest among subspecialty orthopedic titles. Visit the journal website at www.spinejournal.com

Surgeon General Declares Thanksgiving as "Family Health History Day"

Surgeon General Regina M. Benjamin, today declared Thanksgiving Day 2009 to be the nation's sixth annual "Family Health History Day," when families can make plans for gathering their health history, with the aid of the My Family Health Portrait Web site.

"An important first step in preventing illness is learning about health conditions in our families that may put us at risk for inheriting diseases such as diabetes, heart disease, cancer, Alzheimer's, mental illness, and many others," said Dr. Benjamin.  "Discussing family health information with each other can often uncover things you never knew, simply because no one ever asked."

Your family health history can help direct your doctor, physician assistant, or nurse practitioner to specific tests or treatment plans you may need to take to prevent or delay disease.  For example, you can be tested for a heart condition or cancer because it's in your family history.

You can find the Office of the Surgeon General's
My Family Health Portrait Web site at
https://familyhistory.hhs.gov.

Once you have entered family health information, the on-line portal assembles the information into a medical "family tree" format that is useful for health care clinicians. This tool is free for anyone to use.

Filling out the "My Family Health Portrait" usually takes about 20 minutes.  You can share the Web portal with your family members to help fill in missing information. The portal also allows relatives to create their own family health history by adding to information already entered by another family member.

After filling in the information, you can save the information to your computer and -- if you want to -- share it with your doctor.  The Surgeon General's Web site does not retain the information once the tool has been used to assemble it.

"On this Thanksgiving holiday, I hope you and your family will take a few minutes to create a family health portrait," Dr. Benjamin said.   "Learning your family's health history is a valuable investment to make in your health and your family's health."

Depression often coexists with other long-term health problems, presenting additional complexities. About 60 percent of depressed outpatients have at least one other chronic medical condition as well, such as a heart problem, high blood pressure, or diabetes.

The US Department of Health & Human Services, through the Agency for Healthcare Research and Quality  has funded research to track effective care of depression. 

Heart Attacks and Depression

Research results have shown that patients with a history of heart attacks have 1.8 times more depressive spells in a year and more persistent symptoms than depressed patients without a history of heart attacks.

Chronic Conditions and Depression in Older Persons

The challenge of treating depression as one of multiple chronic conditions is especially an issue in older persons. AHRQ research comparing elderly patients with and without depression in a primary care clinic found that the depressed patients had:

• Nearly $200 more in annual diagnostic test costs.
• Almost 1.5 more ambulatory care visits per year.
• Over 12 percent more annual visits to the emergency department.
• Five percent more hospitalizations each year.

To reduce the cost of care and improve outcomes for older persons with depression, coexisting psychiatric and medical illnesses must be targeted for treatment.

Best Care:  Mental Health Specialists or Medical Care Providers?

The organization of care can affect care delivery for depression. One AHRQ-sponsored study showed that shifting patients away from mental health specialists to general medical providers (as is the practice in some managed care arrangements) may lead to fewer improvements in patient functioning but costs two to three times less.

Other AHRQ-funded research on the effects of changes in health care payment and delivery found that after switching to a prepaid plan, the health status of outpatients with depression did not appear to suffer although they were 12 percent less likely to use antidepressants and made 35 to 40 percent fewer visits to their mental health care providers.

Even where there is substantial agreement about how treatment for depression can be improved, changes to everyday practice have been slow. Past efforts by managed care organizations to improve compliance with guidelines for improving diagnosis and treatment of depression have met with only modest success.

Two AHRQ studies investigating academic detailing and continuous quality improvement interventions in managed care organizations concluded that these approaches were only mildly effective in improving clinicians' adherence to the recommended guidelines for care. However, promising early results from a current study evaluating ways to increase use of antidepressants and psychotherapy in managed primary care practice suggest that depressed patients in the intervention groups were more likely to receive these interventions and exhibit better outcomes.

The National Guideline Clearinghouse™ (NGC) sponsored by AHRQ in partnership with the American Medical Association and the American Association of Health Plans, allows physicians and other Internet users to assess and compare guidelines online at http://www.guideline.gov. The NGC is being used by Georgetown University Medical Center's Mood Disorder Program in the development of clinical practice guidelines on depression for primary care physicians in managed care settings.

Bisphenol A (BPA) Is Found in Canned Food Lining, Water Pipes, Plastic Items

Daughters of women exposed to a common chemical found in some plastics while they were pregnant are more likely to have unusually aggressive and hyperactive behaviors as 2-year-olds, according to a new study by researchers at Simon Fraser University, the University of North Carolina at Chapel Hill and Cincinnati Children's Hospital.

UNC-Chapel Hill measured the BPA levels in the urine of 249 Ohio women at three stages--during pregnancy at 16 weeks and 26 weeks and following birth. When the children turned two, their behavior was evaluated using the Behavioral Assessment System for Children-2 (BASC-2).

BPA is commonly used in the production of polycarbonate plastics and epoxy resins that can be found in some types of plastic bottles, canned food linings, water supply pipes and medical tubing. According to the Centers for Disease Control and Prevention, some 93% of U.S. residents have detectable levels of BPA in their urine.

This study--published October 6, 2009, in Environmental Health Perspectives, was the first to look at the link between prenatal BPA exposure and childhood behavior.

Early exposure to BPA during pregnancy looks like it may negatively impact the baby's developing nervous system--and have a particularly behavior-altering impact on growing girls.

BPA has been used in products for decades, and concerns about its safety have been growing in recent years, Braun said. Previous studies in mice have shown that the offspring of mothers with high BPA exposure during pregnancy were more aggressive than offspring not exposed to high prenatal levels of BPA.

"We wanted to know if there was a risk in humans for neurodevelopment problems," he said. "Study results indicate that exposure to BPA early in the pregnancy seems to be the most critical issue. The most damaging exposure might happen before a woman even knows she's pregnant."

The researchers do not know why boys seem so much less affected by exposure to the chemical.

SOURCES:

The study was funded in part by the National Institute of Environmental Health Sciences and the U.S. Environmental Protection Agency.

For more information on the study, visit: www.ehponline.org.

In collaboration with WebMD, experts from CDC will be guest blogging and helping to answer questions on WebMD's Focus on Flu blog. Anthony Fiore, MD, MPH, Medical Epidemiologist with CDC's National Center for Immunization and Respiratory Diseases, has posted blog entries with updates about the flu and strategies for health care options.

In his first blog, "CDC Update on Flu and the H1N1 Vaccine," Fiore takes on the basics, from who is most at risk for contracting seasonal and 2009 H1N1 flu to recommendations on who should be first in line to receive each of the vaccines. Fiore explains both the 2009 H1N1 and seasonal vaccine recommendations, and the differences between them.

In Fiore's next blog, "Flu Shot or Nasal Spray Vaccine?" he shares the difference between the flu shot and nasal spray vaccine. The main difference, he says, is that the flu shot is made with inactivated (killed) virus, while the nasal spray is made with a weakened (attenuated) form of the virus that is not able to actually give you the flu.

Fiore also offers recommendations on who should get the nasal spray vaccine and who should not, as well as the recommended interval between receiving the seasonal and H1N1 nasal spray vaccines, if one chooses the nasal spray options for both flu vaccines.

Fiore also discussed why pregnant women should be vaccinated. The Focus on Flu blog is scheduled to run through the end of December.

Diabetes, which can lead to heart disease, stroke, blindness and amputation, is currently the fifth-leading cause of death among Asian Americans, Native Hawaiians and other Pacific Islanders (AA & NHOPIs).

The new online diabetes information database was developed for physicians, advocates, health educators, patients and their families who need high-quality materials in a variety of Asian and Pacific Islander languages.

Registered users and visitors alike can search and find diabetes information on different topics such as what traditional New Year's foods to eat or avoid, tips on foot care and diabetes during pregnancy. Most materials--fact sheets, brochures, booklets, posters, etc.--are available for download in a multitude of languages including Cambodian, Chamorro, Chinese, Chuukese, Gujarati, Hindi, Hmong, Japanese, Korean, Lao, Samoan, Tagalog, Thai, Tongan and Vietnamese.

High-Quality, Community-Reviewed Materials

The Gateway provides access to tested health materials from the National Diabetes Education Program and also community-contributed health materials. The Gateway's community-contributed health materials are reviewed through a unique two-pronged process that ensures not only medical accuracy, but also cultural and linguistic appropriateness. As a community-curated collection of high-quality, in-language diabetes information, Gateway provides free access to all materials; in fact, registered users can view both reviewed and still-to-be reviewed diabetes health materials to decide for themselves what is most appropriate for their needs. Users even have the option of rating a material based on their experience or adding comments, thereby enriching the database for future Gateway visitors.

AAPCHO is a national association representing 27 community health organizations dedicated to promoting advocacy, collaboration and leadership that improves the health status and access of Asian Americans, Native Hawaiians, and other Pacific Islanders in the United States. Since 1987, AAPCHO has advocated for policies and programs that improve the provision of healthcare services that are community driven, financially affordable, linguistically accessible and culturally appropriate.

More Information

AAPCHO

Obesity and its cardiovascular complications affect many African Americans, according to background information in the October 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Standard behavioral treatments for obesity appear to be less successful in African Americans than in whites. Cultural modifications to these standard programs--such as the inclusion of family members and support networks--may enhance their effectiveness.

Enrolling in a weight loss program with a family member or friend appears to enhance weight loss among African Americans, but only if the involved partner attends sessions frequently or also loses weight, according to the report.

The goal of a University of Pennsylvania School of Medicine  study was to achieve and maintain a 5 percent to 10 percent weight loss.

Components of the program included counseling that encouraged self-monitoring of food intake and physical activity, distribution of pedometers, group sessions involving weight and activity checks and skill building, and community-based field workshops such as cooking demonstrations and gym visits.

Weight Loss Results

After 24 months, main participants had lost an average of 5.3 pounds. Participants in the two family groups initially had better attendance and greater weight loss than those in the individual group, but these changes were not statistically significant and decreased over time.

TIP: Personally tailored counseling sessions

However, participants whose partners attended more personally tailored counseling sessions had lost more weight at six months in the high-support group and at six, 12 and 24 months in the low-support group. 

TIP: Choose your partner carefully

In addition, those in both family groups whose partner lost at least 5 percent of their body weight had greater weight loss at six months than those whose partner lost less than 5 percent.

This study was funded by a grant from the National Heart, Lung, and Blood Institute. Laboratory analyses were provided through a General Clinical Research Center Grant from the National Institutes of Health/National Center for Research Resources.

Source: Newswise, Inc