Study Early diet advice for kids sticks
Mon, 13 Aug 2007 20:29:34 GMT
By JAMIE STENGLE, Associated Press Writer
DALLAS - Teaching children from a young age to eat a low-fat diet can be effective — even as they reach their teens and begin eating more meals away from home, according to a new study.
The study of children in Finland found that those who were taught to focus on healthy fats — those found in fish, nuts, seeds and oils from plants — had slightly lower cholesterol levels compared to those who ate an unrestricted diet.
The researchers have been following the 1,062 children since the age of 7 months. About half of the children and their families were counseled to shift fat intake from animal-based saturated fats to healthier unsaturated fats. The rest did not get specific diet advice. The new study reported the results on the children at age 14.
Dr. Harri Niinikoski, lead author of the study done at the University of Turku in Finland, said children begin forming their eating and lifestyle habits in childhood.
"We think that this lifestyle change can be started early," he said.
Researchers also note that fears that a low intake of saturated fat might influence growth and brain development in young children are unfounded. At age of 14, there were no differences between the groups in height or weight, they found. An earlier study of the groups found no differences in brain development at age 5.
Dr. Sarah Blumenschein, a pediatric cardiologist with the University of Texas Southwestern Medical Center, said the study shows that early intervention is the key to maintaining a healthy lifestyle.
"The earlier you intervene, the more likely you are going to be successful," she said.
For the children in the diet-counseling group, families were told to give them skim milk beginning at age 1, keep daily cholesterol intake at less than 200 mg and aim for a fat intake of 30 to 35 percent of their daily calories.
By the age of 7, the diet information was aimed more toward the children instead of their parents.
Food journals were kept for several days each year to monitor the child's diet. The study, published in online editions Monday of the American Heart Association journal Circulation, showed that the counseled kids had a diet lower in total fat and saturated fat and higher in protein and carbohydrates than the comparison group.
Niinikoski said that they don't have any reason to believe that the families were eating any differently for the rest of the year.
"Our results about the cholesterol values tell the same story, so it must be coming from the diet," he said.
While the group that got specific dietary counseling had lower cholesterol readings than the other group, the difference was statistically significant for boys but not for girls — a difference of about 5 percent in boys and 2-4 percent in girls depending on age, Niinikoski said. He said that the reasons for the difference between boys and girls was not studied, but it might have to do with hormonal differences or exercise habits.
But doctors say that even a small decrease in cholesterol levels can have a big influence.
"If you study large numbers of people, the small increments result in a significant change in heart attacks and cardiac deaths," said Dr. Art Labovitz, cardiology director at Saint Louis University School of Medicine.
Labovitz said that people often don't realize that what they do for the first 40 to 50 years of their life has an effect on their chance of heart attacks and heart disease.
Dr. Stuart Berger, medical director of the Herma Heart Center at Children's Hospital of Wisconsin, said there's no reason the same results wouldn't be seen in American children if they adhered to such a diet.
"I think that the biggest challenge in the U.S. would be compliance to the diet," said Berger.
___
On the Net:
American Heart Association, http://www.americanheart.org
Separation surgery called off for twins
Mon, 13 Aug 2007 17:37:08 GMT
By THOMAS J. SHEERAN, Associated Press Writer
CLEVELAND - Surgery to separate conjoined twins has been called off because the medical risks to the 3-year-old girls is too high, Rainbow Babies and Children's Hospital said Monday.
The decision regarding Tatiana and Anastasia Dogaru was announced by Dr. Nathan Levitan, chief medical officer of the hospital's parent, University Hospitals Case Medical Center. The decision complied with the wish of the parents to avoid any procedure that could harm either girl.
While the girls can develop life-threatening complications if they remain conjoined, the risk of proceeding with long-planned separation surgery was too great, Levitan said.
The blond girls have already beaten the odds by living this long. Most twins joined at the head die at birth and just 10 percent survive to age 10, according to the hospital.
Duke patient fluid caused health issues
Mon, 13 Aug 2007 15:02:20 GMT
RALEIGH, N.C. - Patients of Duke University hospitals who were exposed to surgical tools cleaned in used hydraulic fluid still blame the mistake for their health problems despite a Duke-commissioned study that suggests otherwise.
Of 3,648 patients who were exposed at Duke Raleigh and Durham Regional hospitals in late 2004, just one patient has filed a lawsuit against Duke.
Others have sued an elevator company and medical supply company that contributed to the mix-up of putting hydraulic fluid in a container used to carry detergent for surgical instruments.
Shelley Bassett is among a handful of patients who haven't filed lawsuits but believe the mix-up triggered a series of their health problems. The 34-year-old mother of two had a breast biopsy at Duke Raleigh in December 2004. Her breast swelled after the surgery, and since then, she has had had diarrhea, vomiting, fevers, searing hip pain, constipation, a staph infection and deteriorating vision.
A doctor recently diagnosed her with an autoimmune disease. Bassett said she was healthy before the surgery. She's now on seven different drugs.
"I think it's absurd that can say nobody's sick," she said. "I think it's unfair, and it's propaganda."
Bassett and other patients have just a few more months to file lawsuits before a three-year statute of limitations protects the hospital.
Duke points to the results of a $1 million independent study, released at the end of July, that found nearly 90 percent of patients exposed to the fluid had no clinical problems in the two years afterward. The exposure did not result in higher illness rates, given the age of patients, than what would be expected in the general population, the study said.
But Steve Marshall, an epidemiologist and biostatistician with the University of North Carolina at Chapel Hill's School of Public Health, questioned why the study didn't compare Duke's patients with a separate but similar group that wasn't exposed.
"What you have is half an answer," Marshall said.
Michael Cuffe, Duke University Health Systems vice president for medical affairs, said the study wasn't as comprehensive as a formal research project but was the best study Duke could produce given certain limitations. He said it wasn't possible to get the consent of all the patients given the circumstances.
"Many people wanted to put this behind them," he said. "Others didn't trust Duke and wouldn't want to participate."
Bennie W. Holland Jr., the lone patient to sue the hospital, dropped his lawsuit last year but promised to revive it when he was sure a jury, not an arbitrator, would hear the case.
___
On the Net: Duke University Health Systems: http://www.dukehealth.org/
Training helps Alzheimers caregivers
Mon, 13 Aug 2007 13:02:08 GMT
By LAURAN NEERGAARD, AP Medical Writer
The findings are stunning: Offering simple training to people struggling to care for loved ones with Alzheimer's disease not only eases their burden — it even can keep patients out of nursing homes for an extra 1 1/2 years.
But the exciting research also runs headlong into a grim reality.
Alzheimer's caregivers seldom can make time in their daily grind to seek out that kind of help.
And when they do, they too often find waiting lists for services, or programs geared only toward people with advanced disease and not the larger pool in the purgatory that is dementia's decade-long middle ground between independence and helplessness.
That is one of Dolores Melnick's biggest frustrations.
Her husband refused to enroll in the "day care" for Alzheimer's patients near their Hainesport, N.J., home. It was hosting a singalong, and workers were setting up plastic bowling pins, too childish for Bob Melnick.
That meant no time for her to sneak off to a caregiver support group. On weekdays she worries about whether he'll be OK because he's home alone while she's at work.
"I feel bad sometimes because he's home. I feel bad that I have to leave in the mornings," Mrs. Melnick says, eyes brimming with tears. "I think he realizes he can't do much."
_____
More than 5 million Americans are living with Alzheimer's disease. It afflicts one in eight people 65 and older, and nearly one in two people over 85.
Worse, as the population ages, Alzheimer's is steadily rising. Sixteen million are forecast to have the mind-destroying illness by 2050, not counting other forms of dementia.
Those figures are cited repeatedly in the push for more research into better treatments. But a frightening parallel goes largely undiscussed: As Alzheimer's skyrockets, who will care for all these people?
And will the long-term stress of that care set up an entire population — once-healthy spouses and children — to suffer years of illness, even early death?
"I don't think society and policymakers have fully grasped the future magnitude of what we're up against, and how massive an operation we have to begin ... to deal with this," says Dr. Richard Suzman of the National Institute on Aging.
Already, an estimated 10 million people share the task of caring for a relative or friend with dementia, the Alzheimer's Association estimates. Nearly one in four provides care for 40 hours a week or more.
Handling the wandering, aggressive outbursts and incontinence — plus eventual round-the-clock monitoring — is very different than, for example, learning to lift someone who's physically impaired but won't fight the caregiver.
Those are skills that families must be taught, says Mary Mittelman of New York University's School of Medicine, who is leading a new movement to develop customized training programs for Alzheimer's care.
Today, most learn through trial and error.
_____
Louise Eckert sits her 85-year-old mother, Dorothy, in a chair backed against the wall and pushes a heavy table in front of her. It keeps her from tipping her chair backward like a schoolchild.
It's noon, but Dorothy roamed her Norristown, Pa., home for much of the night and just woke for breakfast. Louise spoon-feeds her mother: grapes and prunes mixed into cereal; toast cut into bites; Alzheimer's pills crushed into cottage cheese so she no longer can spit them out.
The conversation is, well, unconventional.
"I want to hit you," Dorothy whispers.
"You do not want to hit me," Louise calmly responds. Minutes later mother and daughter are grinning affectionately.
"She'll hit you and two minutes later, she loves you," says Dorothy's husband, John Eckert, 88.
Not too long ago, the Eckerts despaired of achieving this calm. Dorothy's mild-mannered Alzheimer's suddenly morphed into outright aggression. She climbed furniture, pulled the TV on herself, tried to climb out the window.
Area aging services offered little advice. The Eckerts finally found the right mix of medication and caregiver tricks. Take Dorothy's night roaming, a dementia trademark. Her husband installed bed rails; she crashed over them. He slept holding a belt tied to her waist; she slipped it off without waking him.
Now the couple sleeps on a mattress on the floor. Large wind chimes jangle when Dorothy's up.
"In the beginning there was pressure. Now we expect it's going to happen," her husband says of new symptoms. "You go along with the flow."
John Eckert brushes aside questions about the strain. He looks fit but has had prostate cancer, a small heart attack and mild stroke. Louise tried to hire a respite-care service so her dad could take a walk. But it requires a four-hour daily minimum, more than they need. Alzheimer's day care runs in the mornings, when Dorothy sleeps.
They manage because Louise, the couple's youngest daughter, lives with them and can rush home from her counseling job at a nearby school if needed.
They're determined to make Dorothy's days as lighthearted as possible.
"You could be mad about it, or constantly sad about the whole thing, but why? This is just who Mom is now," Louise explains.
So, they play Bobby Darin, and Dorothy dances around the dining room. Song done, she curls onto her husband's lap, head tucked under his chin. She can't recall his name, or the last name they've shared for 60 years. But she can cuddle.
"She knows I belong here, I guess," John says.
_____
NYU's Mittelman says customized training can help caregivers ease the chaos that the Eckerts battled through, and proved it with a one-of-a-kind experiment.
She tested 406 elderly New Yorkers caring for spouses with Alzheimer's. Half received training tailored to their family's unique needs. Half got today's standard: a list of Alzheimer's resources.
Mittelman tracked these families for up to 17 years. Custom-trained caregivers kept their loved ones out of a nursing home for an average of 1 1/2 years longer than their untrained counterparts.
With annual nursing home costs now averaging $60,000, that's a savings of $90,000 per patient, Mittelman reported last fall in the journal Neurology.
It didn't come at the spouse's expense as trained caregivers experienced less depression, and fewer physical health problems.
Importantly, the training was simple: Social workers met with caregivers once a week for six weeks, to assess each family's circumstances, discuss how Alzheimer's worsens, and teach coping skills. Caregivers were given phone numbers to call counselors for more advice whenever they wanted.
That ongoing tailored care is "a really crucial element," stresses Mittelman. Without it, when the patient "has a personality change and hits somebody for the first time in her life, you won't have anyone to turn to."
Mittelman has begun new studies targeting training to early- and middle-stage Alzheimer's.
And the National Institutes of Health is studying a similar program that mixes in-home and telephone training, sessions that include role-playing to let caregivers practice the coping skills they're learning.
The NIH study has tracked 640 dementia caregivers in five states for just six months so far. But initial results agree with Mittelman: Trained caregivers report improved quality of life, and feel they do a better job.
Together, the research represents a major shift in scientists' approach to Alzheimer's caregiving — from an emphasis on just giving families a break through respite care, to the idea of empowering them to better handle the stress of the job.
The challenge is how to spread those findings.
_____
Have a short conversation with Bob Melnick, and it's not immediately clear that anything's wrong with the smiling 67-year-old. He'll reminisce over old fishing photos; proudly tell of his two grown children; ask socially correct questions:
"How are you today?" "Want to come along while I walk the dog?"
Then the phone rings, and this former accountant fumbles it, unsure how to answer. He can't close the sliding glass door in his kitchen. At lunch, he carefully sets his hoagie on his place mat, next to the empty paper plate.
This is the often-hidden middle stage of Alzheimer's disease, the stage where caregivers seem to struggle most.
"Many people have a stereotypical idea that Alzheimer's disease is what you see in a nursing home," Mittelman says. But, "in the middle stage, there are behavioral problems which are difficult to cope with."
Dolores Melnick has looked, in vain, for help.
As her husband was turning 60, Mrs. Melnick noticed he'd lose his wallet or keys a lot. Trouble with routine accounting work soon forced him to retire.
Worried, Mrs. Melnick sought long-term care insurance. She listened in as her husband was screened over the phone, aghast that he was failing simple memory tests. The insurer turned him down, and soon Alzheimer's was diagnosed.
To fill his days, Melnick got a job at a nearby convenience store, mopping floors and doing other easy tasks until he was fired for forgetting instructions.
Mrs. Melnick is 63, two years shy of Medicare and three years away from her normal retirement date. She loves her job, a statistician at a cancer center. But she considered quitting to care for her husband, only to learn that retaining health insurance for herself plus his Medicare expenses would cost a staggering $700 a month.
"It's kind of hard to retire," she says with a weary smile.
But what to do with Melnick while she's at work?
He can't remember a plot long enough to read or watch movies. He used to take pride in household chores, but now can't work the appliances. Even emptying the dishwasher ended when "dishes were all over and I couldn't find them!" Mrs. Melnick says with a laugh.
He refuses adult day care. Insurance won't pay the $17 to $22 an hour that local home-health agencies charge for a visiting aide, and Mrs. Melnick couldn't afford that.
So she cobbled together a compromise: She pays a friend about $30 a day to stop by around noon for three hours, to make lunch, help walk the dogs and provide some companionship. Melnick spends the mornings and late afternoons alone, outfitted with an electronic tracking bracelet provided by the sheriff's department in case he wanders outside and gets lost.
When she has an out-of-town business meeting, her 85-year-old mother-in-law comes to stay. Every few weekends, her daughter makes the three-hour drive from Washington, D.C., to help out.
And Mrs. Melnick races home from work at 5:15. If she's late, she'll find her husband pacing, wondering where she was. It's a hint of Alzheimer's classic "sundowning," where agitation increases with dusk.
_____
Some states are trying new ways to increase Alzheimer's services. In Colorado, for example, officials experimented with giving $1,000 stipends to help families hire monitoring for their loved ones so they could attend a six-session training program called the Savvy Caregiver.
That doesn't buy much respite, but it's a good investment, says Cheryl Dunaway of the Colorado Alzheimer's Association.
"The caregiver is the one who sets the stage for whether it's a good day or bad day, calm day or chaotic day, in how they respond to the way the person with dementia is behaving," she explains.
In Congress, Sen. Barbara Mikulski, D-Md., is pushing legislation that would provide a $3,000 federal income tax credit to offset some of the expenses and lost income incurred by caregivers of patients with Alzheimer's and other diseases.
NIH's Suzman says those costs increase as dementia worsens, from about $7,400 a year for moderate dementia to $17,700 for severe dementia
Back in New Jersey, Mrs. Melnick is anxiously hoping that tax credit will help. Within the year, she expects to have to hire someone to watch her husband all day while she works.
Trying to plan beyond that brings only fear.
"Do I have to think about a nursing home in a year, two years? ... It's not like cancer, where they say you have six months to live. They really can't say that with Alzheimer's."
Estrogen loss contributes to obesity high BP
Mon, 13 Aug 2007 16:26:34 GMT
NEW YORK -
The loss of estrogen that
accompanies menopause contributes to the development of obesity
and high blood pressure , according to studies
conducted in female rats.
Estrogen is known to protect women against heart disease.
When women reach menopause, their estrogen levels drop
dramatically and they lose this protection and often put on
weight Dr. Lourdes A. Fortepiani of the University of Texas
Health Science Center at San Antonio, reported.
The findings were reported by Dr. Fortepiani and her
colleague Dr. Huimin Zhang at an American Physiological
Society-sponsored meeting held in Austin.
The researchers showed that in older female rats, free of
heart disease, estrogen deficiency appears to trigger the
development of high blood pressure and obesity.
Rats that had their ovaries removed, thereby depleting
their estrogen levels, had significantly higher blood pressure
and gained twice as much weight as &;control&; rats with intact
ovaries.
&;The increase in blood pressure seems to be related to the
increase in body weight,&; Fortepiani told Reuters Health.
Rats that had their ovaries removed also showed 70-percent
higher levels of the fat hormone leptin and 35 percent higher
blood sugar levels.
However, treating these &;ovariectomized&; rats with estrogen
abolished these effects. &;When you treat with estrogen, the
animals don't gain that much weight and their blood pressure
goes down,&; Fortepiani said.
Moreover, female rats without ovaries that receive estrogen
replacement therapy do not experience any of these adverse
hormonal and metabolic effects, she said.
While acknowledging the controversy surrounding hormone
therapy, these findings may open up new therapeutic approaches
for postmenopausal hypertension, Fortepiani added.
Counseling keeps kids39 cholesterol down study
Mon, 13 Aug 2007 20:20:39 GMT
By Ed Stoddard
DALLAS -
If children are told how to eat right,
they actually listen -- even if it means avoiding their
favorite fatty foods, Finnish researchers said on Monday.
Regular counseling of families and children about the
benefits of avoiding saturated fats in their diet led to diets
lower in fat and saturated fat, and reduced blood cholesterol
levels in children up to the age of 14, they said.
There were no differences in stature between counseled
children and those who were not, suggesting a low-fat diet can
pay dividends from the start without affecting growth.
&;We feel that lifetime habits form early in life and
healthier lifestyles should be started earlier in life,&; said
Dr. Harri Niinikoski, a pediatric endocrinologist at the
University of Turku in Finland.
Among the findings, counseling seemed to have a bigger
impact on the cholesterol level of boys than girls. The
researchers were not sure why.
Niinikoski's team said they compared 540 children assigned
to a dietary counseling group to 522 who did not get special
diet advice, starting from seven months of age, the researchers
wrote in the American Heart Association journal Circulation,.
The counseled children also ate more protein and
carbohydrates than those who received no dietary advice.
&;At age 14, the dietary group had a small but statistically
significant lower median cholesterol level,&; the Heart
Association said in a statement.
Families in the counseling group received regular advice
from a nutritionist and the children were counseled directly
from the age of seven.
&;We want to emphasize that this diet is not vegetarian or
even close to it,&; Niinikoski said. &;Our aim was not to reduce
intake of cholesterol and total fat in infancy. The children
were advised to use meat and fish, etc., but to choose meat and
milk products lower in saturated fat.&;
&;I would say for example that ice cream is not something
that kids should eat every day,&; he said in a telephone
interview.
Four years ago, the research team reported that diet
counseling had resulted in lower cholesterol in the children by
the age of seven.
The current study indicates that the benefits persisted up
to age 14 and the researchers plan to follow the children, now
15 to 17, until they are 20.
Helping find lost Alzheimers patients
Mon, 13 Aug 2007 13:02:43 GMT
By LAURAN NEERGAARD, AP Medical Writer
HAINESPORT, N.J. - It looks like a toy, but the bracelet locked around Bob Melnick's wrist gives his wife some peace of mind: If this Alzheimer's patient wanders off and gets lost, he's wearing a tracking beacon to help bring him home.
"I'm a marked man," joked Melnick, of Hainesport, N.J. "The police can pick me up anywhere."
Wandering is one of the most frightening symptoms of advancing dementia, and the Alzheimer's Association estimates it will happen to nearly 60 percent of patients.
A mini-industry of technologies promises to find lost Alzheimer's patients — from simple radio-wave beacons that cost $10 a month for batteries, to more-sophisticated GPS devices that can cost hundreds of dollars.
Little if any independent research has been done to help determine which systems work best in different environments, and therefore are best suited to different families.
"These technologies need to be evaluated," said Majd Alwan, director of the Center for Aging Services Technologies, a coalition of government, universities and high-tech companies.
Among considerations are where the patient lives, added Henry Kautz of the University of Rochester, who is helping develop next-generation systems. For example, the accuracy of GPS devices depends on access to satellites powering the navigation tool.
"You have to have a clear line of sight to the satellite," Kautz said, which can be difficult in a large city. Companies are working to boost signal strength.
Radiofrequency "tags" are a hot topic for assisted-living facilities. Patients wear a sensor read by receivers on doors that sound an alarm when someone strolls too far.
Then there's the more traditional beacon like Melnick's, which emits a radiofrequency signal for rescue workers to hunt.
"That kind of technology is the most flexible, because it doesn't require GPS or infrastructure. But it doesn't work if you don't notice the person is gone," Kautz said.
Whatever the transmitter, there's the question of how to ensure the patient doesn't wander off without it. Some systems require carrying cell phones; others come in hard-to-remove jewelry; one company sells sneakers implanted with a GPS chip.
For families, there's little guidance on how to find, or choose from, the devices.
Dolores Melnick learned almost by accident that her county sheriff's department offered the radio beacon through a program called Project Lifesaver, when a relative stumbled across an Internet site.
Melnick already was enrolled in the Alzheimer's Association's low-tech Safe Return program. For $20 a year, the hot line faxes photos and descriptions to law enforcement when a patient is reported missing. Patients also wear a stainless steel tag listing a number to call if they're found wandering.
But after getting briefly separated in an airport, Mrs. Melnick liked the idea of more active tracking, too. When she snapped the bracelet on her husband, "He said, 'Oh, this is so you don't lose me!'"
Stay tuned: Kautz says next-generation sensors promise to help dementia patients help themselves, guiding those with early-stage Alzheimer's on city buses or reminding later-stage patients how to wash their hands.
