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Draw your own conclusions: Researchers suggest in a small new study that art therapy makes kids less anxious about their condition.
The results provide “encouraging initial data” that art therapy can help improve the emotional health of chronically ill children, the authors write in the May issue of the Journal of Allergy & Clinical Immunology.
According to the Centers for Disease Control and Prevention, an estimated 7 million American children, or nearly one in 10, have asthma. The breathing disorder is a leading cause of school absences.
For children, “simply thinking about past asthma attacks can bring on feelings of anxiety,” the authors write, and anxiety can either precipitate an episode or worsen an otherwise mild one.
In art therapy, children work with crayons, paints, and other materials, guided by a therapist to express feelings that they may have trouble communicating in words.
“It’s not about painting pretty pictures,” Anya Beebe, an art therapist at the National Jewish Health in Denver who led the study, told Reuters Health. “It’s about helping people go deeper, and using art as a process to express and release their feelings.”
Although art therapy has become more common in hospitals to help children cope with the distress of their illness and hospital stays, researchers haven’t yet rigorously studied whether it works in asthma.
Beebe and colleagues enrolled 22 children between the ages of 7 and 14 with persistent asthma. The children were students at a school on the campus of National Jewish Health in Denver; 11 were randomly assigned to have art therapy along with their usual asthma treatments for 7 weeks, and the others had usual asthma treatment but not art therapy.
The children were tested using several standardized measures for coping skills, anxiety, worry, self-concept, and quality of life before the first therapy session, at the end of the last session and six months later.
At the end of seven weeks, the art therapy group had lower anxiety and higher quality-of-life and self-concept scores than the group that didn’t have art therapy. The improvements persisted, although they were not as pronounced, six months later.
Calling the results “striking,” Beebe and her colleagues write that “the use of art therapy for children with severe, chronic asthma is clearly of benefit.”
Beebe said the results were gratifying but not surprising. “Kids tend to feel better after doing art therapy,” she said.
The researchers did not study whether less anxiety would decrease the number of asthma episodes, nor decrease the amount of medications children need. But “physical health and psychological health are often linked, and we do see that link in children with asthma,” Beebe said.
The cost of art therapy varies depending on the institution, and some hospitals offer it free. According to the American Association of Art Therapy, it is difficult to put an exact price tag on it because it may be billed as part of other services.
SOURCE: http://www.jacionline.org/article/S0091-6749(10)00543-9/abstr act Journal of Allergy & Clinical Immunology.
Frequent doctor visits may help diabetics get their high blood pressure back to normal faster, a new study says.
Current guidelines suggest that patients with high blood pressure return for doctor visits within a month, but patients often wait longer.
Dr. Alexander Turchin, assistant professor of medicine at Harvard Medical School, and colleagues followed more than 5,000 diabetics with high blood pressure, average age 65, from 2000 to 2005.
The researchers found that patients who visited their primary care doctors monthly needed an average of 1.5 months to see their blood pressure return to normal. On the other hand, patients who waited longer between visits took an average of 12.2 months for their readings to return to normal.
Patients who visited their primary care doctors once every two weeks — or even more frequently — did the best of all, the team found.
An estimated one-third of adults in the United States have high blood pressure, which boosts the risk of heart disease and stroke. High blood pressure often has no symptoms.
Physicians and patients with elevated blood pressure should try for more frequent communication face-to-face or otherwise, Turchin said in a statement.
Instead of in-person visits, he said, patients could use the Internet or telephone to report their blood pressure level to their doctor.
The study was published May 24 in the journal Hypertension.
SOURCE: American Heart Association, news release.
Even a small reduction per day in sweetened soft drink intake could improve your blood pressure, researchers report.
In an 18-month study, researchers found a measurable reduction in blood pressure — 1.8 points in systolic pressure, the higher of the desired 120/80 desired reading, and 1.1 points in diastolic pressure — when intake was reduced by about a can of sweetened beverage a day, said the report published May 24 in Circulation.
“We found a direct dose-response relationship,” said study leader Dr. Liwei Chen, assistant professor of epidemiology at Louisiana State University Health Science Center School of Public Health. “Individually, it was not a big reduction. But population-wise, reducing total consumption could have a huge impact.”
The improvement was recorded in a group of older people whose starting consumption was already well below the American average intake of 2.3 servings of sweetened beverages per day, Chen noted.
High blood pressure is a major risk factor for heart attack, stroke and other cardiovascular diseases. The American Heart Association has long warned about the possible health dangers of added sugars in products such as soft drinks, most notably in a report issued last year.
“What this new paper does is add strength to an emerging body of evidence linking added sugar, in this case in beverages, and increased blood pressure,” said Rachel K. Johnson, the lead author of the heart association report and a professor of nutrition at the University of Vermont.
The AHA report focused on sugars added to processed foods, not on sugars found in natural foods, such as fruit. It recommended that men limit their intake of added sugars to 150 calories a day, about nine teaspoonfuls, and women to 100 calories, or six teaspoonfuls.
In the new study, the sugar-sweetened beverages included regular soft drinks, fruit drinks, fruit punch and lemonade.
A 12-ounce can of sugar-sweetened soda has 130 calories of sugar, or eight teaspoonfuls, the team noted. American adults average 28 ounces a day of sugar-sweetened beverages, Chen said, with younger people drinking a lot more soda than older folks.
The 810 study participants, whose average age was 50, drank 10.5 ounces a day of sugar-sweetened beverages — just under one serving — on average when the study began.
Their average blood pressure was above the desired 120/80 reading. Some had pre-hypertension readings of between 120/80 and 139/89, and others had obvious hypertension — readings of 140/90 and above, which is of medical concern.
At the end of the study, their daily soft drink consumption fell by an average of about half a serving, and their blood pressure had benefited.
Even when weight loss was factored in, the impact of reduced sugar consumption on blood pressure improvement remained significant.
“They controlled for all kinds of variables and still found an association,” Johnson said.
Sugar-sweetened soft drinks are becoming a matter of political controversy, with Washington, D.C., and other cities proposing to tax sugary sodas. The American Heart Association has so far taken no stand on that issue.
“I am generally supportive of the concept,” Johnson said. “When you look at the cost of obesity to the health care system, with sugar-sweetened beverages implicated as playing an important role in that epidemic, it could make sense. The revenue could be used to reduce health care costs. Also, if the tax is high enough, it could have the same effect on reducing consumption as tobacco taxes.”
SOURCES: Liwei Chen, M.D., Ph.D, M.H.S., assistant professor, epidemiology, Louisiana State University Health Science Center School of Public Health, New Orleans; Rachel K. Johnson, Ph.D, associate provost for faculty and academic affairs, and professor, nutrition and medicine, University of Vermont, Burlington;
What medicine you get from your doctor may depend on more than just scientific evidence — for instance, on drug makers’ sales reps. Now, almost 150 academic researchers have taken up the gauntlet, touring the country to promote their findings on the best and cheapest blood pressure medicine.
After more than two years on the road, they have analyzed the results: a 23 percent increase in the number of patients who get the recommended drugs, called diuretics, in the counties they targeted most heavily. This is more than twice the increase in the US over the same period.
“We thought it would make a bigger difference, but it did make some difference,” said Dr. Barry Davis, of the University of Texas School of Public Health in Houston, who worked on the study, published in the Archives of Internal Medicine.
“We are fighting an uphill battle against a very common diagnosis where billions of dollars are involved,” he added.
In 2002, Davis was one of the researchers behind a large study comparing different blood pressure medicines. He found that the older, cheaper drugs — so-called thiazide-type diuretics — did better than newer medications, and at a fraction of the price.
But although the results soon made it into national guidelines, Davis was disappointed to see that this didn’t seem to have a dramatic effect on doctors’ prescriptions.
So with $4-million in funding from the National Institutes of Health, he and his colleagues convinced other investigators from the initial trial to start touting the use of diuretics at small meetings with local doctors.
Earlier, smaller studies had shown that this practice — which basically mimics what drug reps do and is called “academic detailing” — can be an effective way to sway doctors’ prescribing patterns. But there is a major problem: Who will fund it?
While big drug makers may funnel billions into marketing knowing that the money will come back manifold, health-care systems often don’t invest in such efforts, said Jeremy Grimshaw, an expert in health-knowledge transfer at the University of Ottawa in Canada.
“I would argue that they need to start doing that,” Grimshaw, who was not involved in the new study, told Reuters Health.
He said the new study showed academic detailing is a viable way to fight back commercial interests. While the effect might not be huge, he added, an improvement in evidence-based prescribing of even a few percent is enough to “have important public health effects.”
In a commentary on the new study, Dr. Jerry Avorn said the drug industry’s financial motivation may not always serve patients’ best interest. As an example, he mentioned the painkiller Vioxx, which Merck withdrew in 2004 after it became clear that it caused heart attacks and wasn’t better than older drugs.
“Patients are left to bear the burden of the mediocre efficacy or increased risk of these products, while all of us get to pay for their high cost,” Avorn, of the Harvard Medical School, writes in the Archives of Internal Medicine.
But making sure the best scientific evidence finds its way into clinical practice takes effort.
“Alas,” Avorn writes, “trial results do not transform practitioners’ decisions any more than pills leap out of their containers and into patients’ gastrointestinal tracts.”
SOURCE: http://archinte.ama-assn.org/cgi/content/short/170/10/851
Breathing through the mouth instead of the nose can lead to more than just dry tongues and palates.
Chronic mouth breathers, most often children with allergies, have problems getting enough oxygen into their blood, which affects their size, weight, sleep and even school performance, a recent study finds.
“Mouth breathing is a medical problem that touches almost every family. It’s an unrecognized epidemic that needs immediate attention,” said study author Dr. Yosh Jefferson, a general dentist in Mount Holly, N.J., who has been treating orthodontia patients for more than 20 years.
“A lot of doctors will say that if you wait, it will just go away,” said Jefferson, who teaches and lectures on mouth breathing to spread the word, adding “it won’t just go away.”
Mouth breathing is caused by nasal obstructions, often the result of chronic infections and allergies. Consequences of untreated mouth breathing include unattractive facial and dental development, such as long face syndrome, narrow mouths and receding or protruding jaws.
Published in a recent issue of the journal General Dentistry, the study notes that mouth breathing is also associated with sleep apnea, a serious sleep disorder.
“They are suffocating and literally dying a slow death that robs them of their appearance, health, longevity and quality of life. Mouth breathing is very treatable, but to do this it must be diagnosed and treated as early as possible,” Jefferson said.
Allergy medications aren’t an effective treatment over the long run, because of undesirable side effects, said Jefferson. Mouth breathing is often corrected when tonsils and adenoids are removed, but this procedure isn’t done as routinely as it once was.
Mouth breathers who develop facial deformities need to wear corrective dental appliances, sometimes along with regular braces, to correct high vaulted mouth roofs, narrowing sinuses, and deformed jaws. Left untreated, more serious facial surgery can be needed.
But the complications of mouth breathing aren’t just physical. Shallow breathing causes insufficient oxygen in the bloodstream, resulting in fitful sleep. The children are tired during the day and perform poorly in school, often exhibiting anger and frustration typical of attention-deficit hyperactivity disorder (ADHD). As a result, they can be misdiagnosed with this condition.
Such was the case of a 5-year-old boy mentioned in the study. A mouth breather, he was often tired and not doing well in school. He regularly lost control of his behavior and had to be disciplined. But a year after he had his tonsils and adenoids removed and began wearing a functional appliance, his mother reported he was sleeping better at night, his behavior was normal, and he tested in the 99th percentile on a school-administered achievement test. He had also stopped bedwetting.
Humans swallow about 2,000 times day, causing the tongue to exert pressure on the roof of the mouth, widening the palate, Jefferson said. Mouth breathers don’t swallow as often because the open mouth tends to be dry. This eliminates pressure, causing the vaulting of the roof of the mouth. The longer the condition is left untreated, the harder it is to fix.
Dr. Leslie Grant, a spokesperson for the Academy of General Dentistry, said besides allergies, trauma at birth and Down syndrome can also cause mouth breathing.
Grant, who works in dental administration for the State of Maryland, thinks there may be a connection between mouth breathing problems and fewer tonsillectomies, once performed more routinely.
“I appreciate that he is bringing this issue to the forefront of the practice of dentistry because it’s important and often overlooked,” said Grant.
Jefferson describes his work as an effort to beautify facial features as well as solve health problems.
“If you harmonize the face the way God and nature intended, wonderful things can happen,” said Jefferson. “And it’s not rocket science.”
SOURCES: Yosh Jefferson, D.M.D., general dentist, Mount Holly, N.J.; Leslie Grant, D.D.S., dental administrator, State of Maryland, and spokesperson, Academy of General Dentistry;
Long-term use of anabolic steroids weakens the heart more than had been thought, a new study of weight lifters shows.
The study provides what might be the first clear evidence that these muscle-building drugs, used widely by bodybuilders and athletes, can damage heart function, said Dr. Aaron L. Baggish, an assistant in medicine at Massachusetts General Hospital, and lead author of a report on the study published online April 27 in Circulation: Heart Failure.
“There have been mixed assumptions but very little direct scientific study of what happens to the heart when it is exposed to an anabolic steroid, and none of what happens with chronic use,” Baggish said.
Anabolic steroids, which mimic the muscle-building effects of the male hormone testosterone, have been used by athletes in various sports. Among professional baseball players, Mark McGwire recently acknowledged using them off and on for nearly a decade, including 1998, when he hit 73 home runs to set a new major league single-season record. New York Yankees third baseman Alex Rodriguez has acknowledged using the drugs, and allegations have linked other big-name players, including Barry Bonds and Roger Clemens, with their use.
For the study, Baggish and his colleagues at Harvard Medical School and McLean Hospital enlisted 19 male weight lifters, including 12 who reported taking, on average, about 675 milligrams of steroids a week for nine years and nine who said they never used steroids. The researchers used Doppler echocardiography, which uses ultrasound to generate moving pictures of the heart’s size and function, to study the function of the each weight lifter’s left ventricle, which is the blood-pumping chamber.
“The common myth is that steroids make the heart grow massively large,” Baggish said. “We didn’t see that.”
What they did see was that the hearts of the steroid users did not contract as vigorously and relax as efficiently as those of the nonusers.
The ejection fraction of the steroids users — which is the volume of blood expelled with each beat — was below normal in 10 of the users but only one of the nonusers. A healthy left ventricle has an ejection fraction of 55 to 70 percent but only two steroid users met that standard, the study found. Also, the measure of relaxation efficiency, which reflects the rate at which blood refills the left ventricle, was reduced by almost half in the steroid users.
“The number of persons in the study was small, and this needs to be studied in larger trials, but the data from this pilot study suggest that steroid use predisposes people to heart failure,” Baggish said.
Heart failure, progressive loss of the ability to pump blood, is a leading cause of cardiac deaths.
However, it’s not clear from the study how long steroids must be used to cause such heart damage, Baggish said. “Several small studies of shorter duration find damage only with heart relaxation, not contraction,” he said. “As use continues, toxicity develops.”
And he noted that there have been, “numerous case reports of horrific vascular events from short-term use.”
Baggish said he hopes to repeat the study with a larger group of participants to confirm the findings. Meanwhile, he said, “when you add up all of the organ systems that steroids do damage to, and the heart is just one important organ, the logical recommendation is that steroid use is a no-no, for cosmetic or athletic purposes.”
SOURCES: Aaron L. Baggish, M.D., assistant in medicine, and associate director, Cardiovascular Performance Program, Massachusetts General Hospital, Boston;
Adults who have a drink or two per day may have a lower diabetes risk than teetotalers — and the link does not appear to be explained by moderate drinkers’ generally healthier lifestyle, a new study finds.
A number of studies have found an association between moderate drinking and a relatively lower risk of developing type 2 diabetes. However, whether that reflects a benefit of alcohol has been unclear. A central issue is the fact that, compared with both non-drinkers and heavy drinkers, moderate drinkers tend to have a generally healthier lifestyle.
In the new study, researchers found that among more than 35,000 Dutch adults followed for a decade, those who averaged a drink or two per day were 45 percent less likely than teetotalers to develop type 2 diabetes.
Moreover, the lower risk was seen among men and women whose diabetes risk was already relatively low because of their weight and lifestyle habits — namely, not smoking, eating a healthy diet and getting regular exercise.
Even among study participants with at least three of those protective factors, moderate drinkers were 44 percent less likely than non-drinkers to develop type 2 diabetes.
The findings, reported in the American Journal of Clinical Nutrition, do not prove that drinking itself lowers diabetes risk. But they do suggest that the alcohol-diabetes connection is not explained away by other lifestyle factors.
“Our results indicate that this is very unlikely, because moderate drinkers with the most healthy lifestyle behaviors…had a lower chance of developing diabetes compared with subjects with these healthy lifestyle behaviors who did not drink,” lead researcher Dr. Michel M. Joosten, of Wageningen University in the Netherlands, noted in an email to Reuters Health.
The findings are based on 35,625 adults who were between the ages of 20 and 70 and free of diabetes, heart disease and cancer at the outset. Participants had their weight, height and waist and hip circumference measured and completed questionnaires on their health and lifestyle habits.
Over the next 10 years, 796 developed type 2 diabetes.
In general, moderate drinkers — up to a drink per day for women, and up to two for men — were less likely to develop the disease than non-drinkers. And that remained true when Joosten and his colleagues examined the effects of other lifestyle-related factors.
For example, when they looked only at normal-weight men and women, moderate drinkers were 65 percent less likely to develop diabetes than teetotalers. Similarly, among regular exercisers, moderate drinkers had a 35 percent lower risk of diabetes.
The “take-home message,” Joosten said, is that moderate drinking “can be part of a healthy lifestyle to lower your risk of type 2 diabetes, even if you already comply with multiple other low-risk lifestyle (behaviors).”
That said, he also noted that experts do not recommend that non-drinkers take up moderate drinking simply because it is related to lower risks of certain diseases. Alcohol always carries the potential for abuse, and the known risks of problem drinking have to be balanced against the possible health benefits of moderate drinking.
SOURCE: American Journal of Clinical Nutrition.
Brandy Pitman suffers from a lifelong allergy to cats, enduring regular bouts of congestion, sneezing, and watery eyes.
Even so, it hasn’t stopped her from working as an office manager for a feline veterinary hospital in Louisiana, or from inviting four strays into her home.
“They showed up and never left so I took them in,” Pitman said of her domestic shorthair clan Marbles, Miss Kitty, Teachy and Callie. “There wasn’t really a choice.”
For many allergic cat lovers, like Pitman, living without a feline companion isn’t an option. According to the American Academy of Allergy, Asthma & Immunology (AAAAI), nearly 10 million people choose to live with pets even though they’re allergic to them.
“Most people who are real cat lovers elect to suffer some, or take medicines, rather than give up their pet,” said Dr. Robert Wood, division chief of pediatric allergy and immunology at Johns Hopkins Children’s Center in Baltimore.
For people with mild to moderate allergies, controlling flare-ups involves managing their home environment, taking medication and having their pets groomed regularly.
Cat-induced allergies affect about 20 percent of the U.S. population, according to studies, and is caused by a protein found in the animals’ saliva and dander (dead skin cells.) Because felines lick their fur to keep clean, the troublesome protein, called “fel d 1,” is also deposited on their coats.
What’s more, the super-lightweight allergen floats through the air, sticking to walls, rugs, clothing and other surfaces.
“Most people who are real cat-allergic know pretty quickly after they’ve walked into a house whether there’s a cat there or not — they’ll sense the beginning of a reaction happening just from what’s in the air,” Wood said.
Reactions run the usual gamut of allergy symptoms such as a stuffy nose and red, itchy eyes. Asthmatics are at risk for experiencing more severe reactions, including difficulty breathing.
“We feel most strongly about not living with a cat if you have asthma that’s hard to control because that can lead to life-threatening situations,” said Wood.
For individuals who are not highly sensitive, living with a feline requires taking some simple steps to reduce allergens in the home and on the cat.
Veterinarian Vicki Thayer, president-elect of the Winn Feline Foundation, a nonprofit that supports studies to improve cat health, recommends owners regularly bathe their pets with a mild shampoo or wipe them down with a damp wash cloth.
Weekly brushings done outside by a non-allergic person are a good idea, too. A spray-on formula available through veterinarians and pet retailers may also help to reduce the amount of dander found on coats.
Another option, with reportedly mixed results, Thayer said, is adding tiny amounts of acepromazine, a prescribed tranquilizer, to a pet’s food or water. The diluted mixture is thought by some veterinarians to reduce or remove the protein that causes cat allergies.
Owners, depending on their symptoms, may also get relief from prescription nasal sprays, eye drops or pills. Wood said shots given for cat allergies provide a little bit more comfort but several studies have shown they’re not hugely effective.
Inside the home, keep cats out of the bedroom and put allergy-proof covers on the mattress and pillows. Wash bedding materials in hot water, wash your hands after contact, and limit the amount of wall-to-wall carpeting, especially in the bedroom. “Even if you keep the cat out of the bedroom, eventually the carpet gets loaded with the allergen just from what’s carried around on your feet,” said Wood.
Frequent steam cleaning helps remove allergens hiding in carpets.
Allergy experts also recommend running a good quality HEPA (high efficiency particulate air) air cleaner; changing forced air heating filters monthly and using a vacuum with a HEPA filter.
“With those things, most people are able to co-exist with a cat,” he said.
SOURCES: Robert Wood, M.D., division chair, pediatric allergy and immunology, Johns Hopkins University, Baltimore; Vicki Thayer, president-elect, Winn Feline Foundation, and veterinarian board-certified, feline medicine
People with a particular genetic trait are at much higher risk of developing lung cancer from exposure to secondhand smoke than others, even if they rarely come into contact with it, a new study finds.
Researchers also found that smokers with this variant are more susceptible to lung cancer, whether they light up a lot or a little.
“If you carried the inherited risk and then you smoked, it didn’t matter if you were a light smoker or a heavy smoker — you were significantly more likely to develop lung cancer,” study co-investigator Susan Pinney, an associate professor in the department of environmental health at the University of Cincinnati, said in a news release from the school.
About 200,000 people were diagnosed with lung cancer in 2005, according to the U.S. Centers for Disease Control and Prevention, and it kills more people than any other form of cancer.
The study authors examined nonsmokers, light smokers, moderate smokers and heavy smokers.
They found that family members who had the genetic trait were at higher risk of getting lung cancer even if they were light smokers. For them, moderate and heavy smoking didn’t boost their risk very much.
By contrast, heavy smokers normally face a much higher risk of lung cancer than moderate smokers.
The study, conducted by the Genetic Epidemiology of Lung Cancer Consortium, was published online March 9 in advance of print publication March 15 in the journal Cancer Research.
SOURCE: University of Cincinnati Academic Health Center, news release.