Bacterial Infection May Boost SIDS Risk

(HealthDay News) -- Could common bacterial infections cause some cases of sudden infant death syndrome, or SIDS?

According to the British authors of a study in this week's issue of The Lancet, the answer is a qualified yes. The researchers found high levels of Staphylococcus aureus and Escherichia coli (E. coli) bacteria in children who had died of SIDS.

But in no way does this mean that parents should be demanding antibiotics for their newborns, cautioned Dr. Jim Greenberg, director of the division of neonatology at Cincinnati Children's Hospital. "This still falls under the category of preliminary research and doesn't have any direct application to how we think about patient care," he said.

"As yet, we do not understand the true significance of the findings," added Dr. Nigel Klein, co-author of the study and professor of infectious disease and immunology and head of the department of infection at the University of London and Great Ormond Street Hospital for Children in the United Kingdom. "At present, a causal link has not been established. As such, there are no direct clinical implications."

According to the American SIDS Institute, the rate of SIDS has dropped dramatically since 1983, thanks to concerted prevention efforts on the part of a number of organizations. However, about 2,500 infants still die of SIDS every year in the United States.

The causes largely remain a mystery, although putting a baby to sleep on his or her back and avoiding smoking near the child are known to be protective.

Klein and his colleagues conducted autopsies on 546 infants who had died suddenly between the ages of 7 and 365 days. Samples of bacteria were taken from 470 of the infants.

Many more potentially harmful organisms were isolated from children whose sudden death could not be explained than from infants whose deaths were explained by non-infectious causes. In particular, S. aureus ("staph") and E. coli had a greater presence in unexplained deaths than in those explained by non-infectious causes.

As an accompanying editorial pointed out, the number of SIDS cases peaks at 8 weeks to 10 weeks of age. That's a time-frame coinciding with blood concentrations of immunoglobulin that protect newborns against bacterial infections.

"This is just at the point that antibodies that go across the placenta -- from mom to baby -- to protect them are starting to disappear, and babies haven't made a lot of their own antibodies yet," noted Dr. Cheryl Cipriani, an associate professor of pediatrics at Texas A&M Health Science Center College of Medicine and a neonatologist with Scott & White. "This is a particular point in time where babies seem to be vulnerable," she said.

Also, both S. aureus and E. coli are bacteria that make toxins, Cipriani explained, "and a toxin might not necessarily cause all the histological changes that you see with infections."

"This is another building block in our knowledge about these kinds of deaths, but association doesn't mean cause," Cipriani cautioned. "But it's a large enough group of babies where you think the findings need to be paid attention to."

Until precise causes for SIDS are uncovered, parents should be aware that putting infants to sleep on their back ("Back to Sleep") reduces the risk of SIDS by 40 percent to 60 percent, Greenberg said. Avoiding your child's exposure to cigarette smoke also reduces this risk.

Using a pacifier might also lower risk, but this is controversial, Greenberg added.

More information
There's more on SIDS at the National Institute of Child Health and Human Development.

High Blood Pressure Still Slipping Past Doctors

(HealthDay News) -- The dangers of high blood pressure are well-known, but a new study finds a lack of routine blood pressure screening in doctor's offices and a low percentage of hypertension patients actually meeting their blood pressure goals after diagnosis.

The Stanford University School of Medicine study, published in the May issue of Hypertension, found that in the offices of private U.S. physicians:

Blood pressure was taken in only 56 percent of all patient visits, and in 93 percent of visits by patients diagnosed with hypertension.
Only 39 percent of patients being treated for hypertension were at the recommended blood pressure levels.
Only 20 percent of hypertensive patients who also have diabetes or kidney disease had their blood pressure controlled.
"Doctors should be screening more routinely during all office visits," study co-author Dr. Randall Stafford, an associate professor of medicine at the Stanford Prevention Research Center, said in a prepared statement. "Dual medication treatment should be seen as standard therapy, and intensive lifestyle changes should be encouraged."

The study analyzed data from a federal 2003-04 survey of services performed in offices of private U.S. physicians. It noted such details as whether the blood pressure cuff was brought out, whether appropriate medications were prescribed, and whether treatment achieved its goal.

High blood pressure affects more than 65 million people in the United States and is one of the most important and preventable risk factors for cardiovascular disease, strokes and kidney disease. High blood pressure, often called "the silent killer," can damage one's body for years before actual symptoms develop.

This lack of symptoms may be a major reason for poor quality of care, researchers said.

"This is a problem that spans much of preventive medicine," Stafford said. "The treatment itself doesn't make patients feel better. If somebody has asthma, they know that if they stop taking medication, they're going to start wheezing. With blood pressure medicines, patients don't feel any different."

Without this noticeable change, many patients stop following the doctor's orders or fail to return for follow-up care.

"We know many patients don't take the medications they were prescribed for the doses that were prescribed nor for the duration that was prescribed," lead author Dr. Jun Ma, an associate staff scientist at the Palo Alto Medical Foundation Research Institute, said in a prepared statement.

Increasing routine blood pressure screenings, even in specialists' offices, could be the first step to improving care, Stafford said.

"Many physicians in specialized practice appear to feel they don't need to measure blood pressure," he said. The thinking goes, "'I'm a dermatologist, so I don't need to screen for high blood pressure.' But because there's a high likelihood of high blood pressure getting missed, we need to take advantage of all opportunities for screening."

Once a doctor diagnoses someone with high blood pressure, the physician must clearly explain the necessary treatments and strongly encourage lifestyle changes.

"Physicians may need to tell patients that it's likely to take two or more medications to get blood pressure under control," Stafford said. "They also need to use a comprehensive strategy to attack high blood pressure that includes recommended changes in lifestyle: weight loss, reduction in sodium, a plant-based diet, increases in physical activity. Both patients and physicians need to take advantage of all available strategies."

More information The American Heart Association has more about high blood pressure.

Training Student Leaders Cuts Peers' Smoking Rates

(HealthDay News) -- Training influential students to spread anti-smoking messages in their everyday conversations with peers helps reduce smoking rates, according to a U.K. study.

The study included almost 11,000 students, ages 12 to 13, at 59 schools in western England and Wales. At 30 of the schools, certain students were selected to receive training about the risks of smoking, the economic benefits of not smoking, communication skills, group work, negotiation, conflict resolution, sensitivity to others, personal values, and building confidence and self-esteem. The students at the other 29 schools acted as a control group.

For 10 weeks after their ASSIST (A Stop Smoking in Schools Trial) training, the peer support students talked with other students in their age groups about the benefits of not smoking.

Overall, students in those schools were 25 percent less likely to take up regular smoking than students in the control group schools immediately after ASSIST intervention, 23 percent less likely to start regular smoking after one year, and 15 percent less likely after two years.

Among high-risk students (occasional, experimental or ex-smokers at the start of the study) in schools with ASSIST intervention, the risk of regular smoking was reduced by 21 percent immediately after the program, 25 percent after one year, and 15 percent after two years.

Overall, students in the intervention schools were 22 percent less likely to be smokers than those in the control group schools. Based on their findings, the University of Bristol and Cardiff University researchers calculated that widespread implementation of ASSIST could reduce smoking prevalence by 3 percent among students ages 14 to 15. On a U.K.-wide basis, that translates into 43,000 fewer 14- to 15-year-old students who become regular smokers.

The findings were published in this week's edition of The Lancet.

"Our study has shown that the ASSIST training program was effective in achievement of a sustained reduction in uptake of regular smoking in adolescents for two years after its delivery. Furthermore, it was well received by both students and staff," the authors wrote. "Confidence in the robustness of this finding is enhanced by the very high response rates achieved (over 90 percent), the retention of all schools for the duration of the trial, the diversity of the schools involved, and the concurrence of self-reported smoking data with saliva testing."

More information
The U.S. Centers for Disease Control and Prevention has more about youth and tobacco.

5 Ways to Boost Your Metabolism and Lose Weight

Magnesium, interval training, and other tricks to burn more calories
by Ross Weale

Health magazine contributor Samantha Heller shows how to burn more calories, during an interview on the Today show, March 10.



SAMANTHA HELLER
Samantha Heller, RD, is the nutrition coordinator at the Fairfield Connecticut YMCA. A certified dietitian/nutritionist and exercise physiologist, Heller earned her master's degree in nutrition and applied physiology from Teachers’ College, Columbia University. She served as the senior clinical nutritionist and exercise physiologist at NYU Medical center in New York City for almost a decade and created and ran the outpatient nutrition program for the NYU Cardiac Rehabilitation Program. She has also been a fitness instructor for 15 years. Heller specializes in nutrition, wellness, stress management, and fitness for people who are fighting heart disease, diabetes, cancer, and obesity.

A contributing editor to Health magazine, her writing has also appeared in numerous other magazines, including Men’s Fitness, Men’s Health, and Glamour, as well as sites such as Fitness.com.

Suffering of Heart Failure Similar to Cancer

(HealthDay News) -- Heart failure is as crushing a blow to someone's psychological well-being as cancer, a new study finds.

Indeed, people in the study with the most severe degrees of heart failure, the inability to supply the body with oxygen-carrying blood, had measures of severity of symptoms, depression and loss of spiritual well-being that are seen in people with advanced cancer, Dr. David Bekelman, an assistant professor of medicine at the University of Colorado at Denver Health Sciences Center, reported Friday at an American Heart Association meeting in Baltimore.

Palliative care, aimed at improving quality of life as the end of a life approaches, is often offered to people with advanced cancer, Bekelman said. "We should consider offering it to people with heart failure," he noted.

The study compared 60 people with heart failure severe enough to cause symptoms but not hospitalization with 30 people with advanced cancer of the lung or pancreas.

"We looked at physical symptoms, things like fatigue, weakness and pain," Bekelman said. "A second measure was of depression, and a third was of spiritual well-being."

Heart failure and cancer patients reported similar numbers of physical symptoms. The scores for depression on a standard test were slightly higher in heart failure than in cancer -- 3.9 versus 3.2.

"The measure of spiritual well-being we used looked at two domains, a sense of meaning and peace and a sense of faith," Bekelman said. The people with heart failure scored lower than those with cancer.

When the people with the most severe forms of heart failure were singled out, their scores on all three measures were worse than for people with advanced cancer.

Survival in heart failure severe enough to send someone to the hospital is comparable to that in advanced cancer, with death coming an average of 1.6 years after hospitalization.

"We're very good at treating the physical part of heart failure," Bekelman said. "But people suffer in other ways that also should warrant attention. It's important that we offer it to them."

The burden of heart failure is well known to physicians, but "nonprofessionals dont realize it," said Dr. Gerald L. DeVaughn, a clinical associate professor of medicine at Drexel University in Philadelphia.

"People given the option of heart failure or cancer might think that heart failure is the choice," he said. "But heart failure is quite lethal. Many cancers have a better prognosis."

Caretakers for people with heart failure should take its effects into account, DeVaughn said.

Symptoms such as dry mouth, constipation and shortness of breath can be improved with medical management, he said, while depression can be treated with medication and counseling.

"If they mention that spirituality is important in their lives, we should endeavor to have them see someone in that area, such as a chaplain," Bekelman said.

Approaches used to improve spiritual well-being in cancer, such as psychotherapy, should also be considered in heart failure, he said.

"People with cancer get all kinds of supportive services, but people with heart failure don't," Bekelman said.

More information
Symptoms and treatment of heart failure are described by the American Heart Association.

The Reality of Mammograms and Breast Cancer False Alarms

Better technology means more scares, but if you have breasts like mine, you have to believe it's worth it
by Sally Chew

On my way into St. Vincent's Comprehensive Cancer Center recently to get my annual mammogram, I happened to read in the paper that the greater accuracy of the new digital mammograms means more false alarms—more scares, more visits.

I don't know if it was technical improvements that sped me through the masher more quickly than usual that day. More likely, it was the usual exasperation with the dense tissue of my ultra-fibrocystic breasts.

Digital mammograms are intended for women with dense breasts, but mine would defy even Superman’s powerful stare—or so I've been told. Radiologists dutifully study my "films" each year but rarely expect to see what's really going on till I lay back, down the hall, for a cool, sticky ultrasound.

Which is where I was dispatched last week so they could snap these:

The shadowy globes at the top of each image above are cysts, among a dozen or so I carry around from year to year. We track them every spring like so many migrating whales.

I crane my neck to see the screen while a technician punches measurements into her computer with one hand and drags that chilly wand around my breasts with the other.

Actually, she's more interested in those white, wispy "calcifications" and any brand-new dark shapes—like the pebble that prompted an open biopsy a few years back on that very same hall.

At the time, it seemed like pure luck that I emerged from surgery with a benign diagnosis (and a pretty scar). I hadn't yet experienced enough bump-by-bump monitoring to understand the benefits of the false alarm.

I get it now, though. As long as the statistics continue to be in my favor—did you know that 80% of biopsies are benign?—and the folks manning the machines actually seem to be paying attention, count me in for the extra whale-watching.