Baby’s Early Walking May Mean Stronger Bones as Teen

TUESDAY, May 31, 2016 (HealthDay News) — For all those parents who fret about how quickly their baby will learn to walk, read up.

British scientists report that toddlers who can walk, run and jump by the time they are 18 months old may have stronger bones as teenagers.

The researchers suggested that their findings could help identify those at increased risk for osteoporosis and broken bones later life.

“The findings are intriguing, as they provide a link which wasn’t previously understood, primarily that how we move as a young child can have ramifications for our bone strength even 16 years later,” said lead researcher Dr. Alex Ireland. He’s with Manchester Metropolitan School of Healthcare Science in England.

“We believe that stronger muscles could act as a ‘marker’ for this,” Ireland said in a university news release. “Being more active gives you stronger muscles, which can then apply bigger forces to the bones as we walk, run or jump, helping to strengthen bones as we grow older.”

For the research, the study authors examined data compiled on more than 2,300 people born in the 1990s.

The participants’ movement was assessed when they were 18 months old. The size, shape and mineral density of their hip and shin bones were also measured when they were 17 years old.

Activities such as walking, running and jumping put stress on the bones, which can make them wider, thicker and subsequently stronger, the researchers said.

The study also found that toddlers who walked early had larger muscles and may be more likely to engage in physical activity when they are older. The researchers noted that previous studies have shown that variations in muscle size accounts for about 50 percent of the difference in kids’ bone strength by the age of 17.

Early physical activity and exercise had greater effects on bone strength among the men than the women, the study authors added.

“Importantly, the results could have implications for later life by helping medical practitioners to anticipate and detect those who are at a greater risk of osteoporosis or fractures, thus helping them to devise prevention and coping strategies,” said Ireland. “For example, attainment of these movement skills at an early age can be easily improved even by simple parent-led walking practice at home.”

The study findings were published recently in the Journal of Bone and Mineral Research.

More information

The U.S. National Institutes of Health has more about bone health.

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Many Parents Ill-Informed About Kids’ Asthma Meds

TUESDAY, May 31, 2016 (HealthDay News) — Only half of parents of children with asthma fully understand the use of their youngsters’ asthma medications, a new study finds.

A survey of parents of 740 children with probable persistent asthma found just 49 percent knew what kind of medication their child was prescribed and how often to use it.

Following recommended guidelines is key to controlling asthma symptoms, experts say.

“Adherence to the guidelines has demonstrated improved outcomes: decreased hospitalizations, emergency department visits and outpatient visits,” said study primary author Dr. Ann Chen Wu, of the Harvard Pilgrim Health Care Institute in Boston.

Parents were asked which asthma controller medications their child was prescribed and how often they should be taken. Responses were compared to instructions from their child’s health care provider.

Records showed that 77 percent of the children were supposed to use inhaled corticosteroids, 22 percent were to take leukotriene antagonists and 1 in 10 were to take a combination of inhaled corticosteroids and long-acting beta agonists such as Advair.

But deviations from the doctor’s directions were common. For instance, nearly 30 percent of kids prescribed inhaled corticosteroids — an important preventive measure — weren’t taking them as directed.

Children with severe asthma were not included in the study, which was published recently in the Journal of Allergy and Clinical Immunology.

Among roughly 200 children who were supposed to use the inhaled corticosteroids every day of the year, 27 percent of parents said otherwise. Among the 263 children who were supposed to use inhaled corticosteroids daily when asthma is active, more than half of parents said they weren’t compliant.

“Of course, we need to improve provider-patient communication in the medical office, especially for controller medications for children with asthma, but providers may be unaware of their patient’s lack of adherence,” Wu said in a journal news release.

“A mismatch between parent and provider was more likely to happen if the parents felt that the medicine was not helping, or, conversely, if the parent believed their child did not need as much as prescribed,” Wu added.

“Mismatches” were also more likely to occur among Hispanic parents, she and her colleagues said.

More information

The American Lung Association offers advice for parents of children with asthma.

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Early Alzheimer’s Linked to Brain ‘Leakage’

By Amy Norton
HealthDay Reporter

TUESDAY, May 31, 2016 (HealthDay News) — People in the early stages of Alzheimer’s disease may have more “leaks” in the barrier that separates the brain from the bloodstream, a small study suggests.

Known as the blood-brain barrier, it’s made up of tightly joined cells that line blood vessels in the brain. They form a filtration system that allows certain essential substances — such as water and sugar — into the brain, while keeping potentially damaging substances out.

The new study adds to evidence that leaks in the blood-brain barrier are detectable in Alzheimer’s patients.

But it’s not clear what it all means.

“They don’t know whether this leakage is a result of the disease, or a cause of it,” said Dr. Ezriel Kornel, an assistant clinical professor of neurological surgery at Weill Cornell Medical College, in New York City.

It’s also unclear exactly what is happening in the leaky areas spotted on patients’ brain scans, according to Kornel, who wasn’t involved in the study.

In theory, he said, the leaks could be opening the door for toxic substances to enter the brain — but the study doesn’t prove that.

“It’s an interesting issue,” said David Morgan, director of the Byrd Alzheimer’s Institute at the University of South Florida, in Tampa. Morgan also wasn’t involved with the current study, but reviewed its findings.

Researchers know that the pathological brain changes associated with Alzheimer’s begin at least 15 years before symptoms appear, Morgan explained.

First, there is an abnormal buildup of proteins called amyloid. There are no immediate symptoms because the brain is able to compensate for those protein deposits, Morgan said.

Eventually, though, another type of abnormality appears — twisted fibers of a protein called tau. Symptoms typically arise not long afterward, according to Morgan.

So, the question — according to Morgan — is where in that sequence of events does brain leakage occur?

The findings are based on 16 patients who’d been diagnosed with early Alzheimer’s disease, and 17 healthy adults the same age. Walter Backes and colleagues at Maastricht University, in the Netherlands, used a special MRI technique to detect areas of brain leakage in each study participant.

In general, the investigators found that Alzheimer’s patients showed more areas of leakage across the brain.

And, the more leakage the study participants had in the brain’s gray matter, the worse they did on tests of memory and other mental abilities. (Gray matter basically acts as the brain’s information-processing center.)

It’s plausible, Morgan said, that a compromised blood-brain barrier could contribute to Alzheimer’s — by allowing certain cells from the bloodstream to “infiltrate” the brain and contribute to inflammation and nerve cell damage, for example.

If that’s true, there is no obvious way to intervene.

But both Morgan and Kornel pointed to a possible “silver lining” in the leaky-brain situation. Normally, the blood-brain barrier blocks medications and other systemic therapies from getting into the brain.

“So if Alzheimer’s patients do have a leaky blood-brain barrier, in a strange way, that could be a good thing,” Morgan said. “Some therapies that are under development might have a better chance of working.”

Backes and his colleagues also raise the possibility that MRI scans could help diagnose Alzheimer’s early, by detecting leaks.

But Morgan had doubts. For one, he said, the researchers only reported on averages across the two study groups: If only some Alzheimer’s patients show excess brain leakage, it would not be a reliable way to detect the disease.

Plus, Morgan said, it’s possible that people with other forms of dementia, or other neurological diseases, may also have more leaks in the blood-brain barrier.

The study was published online May 31 in the journal Radiology.

More information

The Alzheimer’s Association has more on Alzheimer’s brain changes.

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Smog Can Make Blood Pressure Soar: Studies

By Alan Mozes
HealthDay Reporter

TUESDAY, May 31, 2016 (HealthDay News) — More evidence links air pollution with increased risk of developing dangerous high blood pressure.

The findings stem from a review of 17 studies conducted around the world. Each assessed a possible link between blood pressure and dirty air related to common pollutants, such as vehicle exhaust, coal burning and airborne dirt or dust.

“Our results demonstrated that air pollutants had both short-term and long-term effects on [high blood pressure] risks,” said study author Tao Liu. He is deputy director of the environmental health division in the Guangdong Provincial Institute of Public Health in Guangzhou, China.

In the short term, he noted, a few days of increased air pollution could lead to more emergency hospital visits due to temporary spikes in blood pressure. In the long term, those living with consistently high levels of air pollution could end up with chronically high blood pressure.

High blood pressure is a key risk factor for stroke and heart disease, the number one cause of death worldwide. And high blood pressure itself is associated with about 17 percent of fatalities globally, the study authors pointed out.

“It is urgent to take more actions to protect our environment and clean the air quality,” said Liu.

For now, people — especially those with high blood pressure — should “closely focus on the air quality every day, and try to avoid outdoor activities or wear filtered masks when air quality is poor,” Liu said.

According to background notes with the study, causes of high blood pressure (or “hypertension”) include genes, lifestyle habits, diet and environmental factors — probably including air pollution. Until now, evidence linking smog with high blood pressure has been controversial, Liu said.

For this project, investigators analyzed 17 studies conducted through August 2015. The studies involved roughly 328,000 people in all, about 108,000 of whom had high blood pressure.

Those investigations were conducted in Brazil, Canada, China, Denmark, Germany, Iran, Spain, Sweden, Taiwan and the United States. Short-term pollution exposure was defined as occurring over a number of days, and long-term exposure over a number of years.

In general, the research team defined high blood pressure as a systolic blood pressure reading (the top number) above 140 mm Hg and/or a diastolic blood pressure reading in excess of 90 mm Hg. Use of blood pressure medication was also an indication of high blood pressure.

The focus was on air pollutants such as nitrogen oxide, which stems from fossil fuels that power factories and cars; sulfur dioxide, also a fossil fuel emission; ozone; carbon monoxide; and particulate matter, such as tiny dust specks, dirt, smoke, and droplets of liquid.

Short-term exposure to pollutants such as sulfur dioxide and certain types of particulate matter appeared to boost risk for high blood pressure. Also, long-term exposure to nitrogen oxide and particulate matter was linked to greater risk, the review indicated.

The findings didn’t establish a cause-and-effect relationship between these elements and elevated blood pressure. Also, while it appeared that ozone and carbon monoxide were tied to higher blood pressure, these two links did not reach “statistical significance,” the researchers said.

Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, agreed with Liu that the study results underscore a need for cleaner air.

“These findings suggest that strategies to effectively reduce exposure to air pollution may have cardiovascular benefits,” he said.

Fonarow pointed to the American Heart Association recommendations, which in general advise avoiding outdoor activities and/or exercise when pollution levels are high.

Indoors, Liu recommends using air purifiers.

The study results were published May 31 in the journal Hypertension.

More information

There’s more on air pollution and health at the World Health Organization.

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Kids’ Concussion Rates May Be Higher Than Thought

TUESDAY, May 31, 2016 (HealthDay News) — Because most young children who suffer a concussion aren’t first seen in hospital emergency rooms, official tallies of these injuries may be greatly underreported, a new study finds.

“Four in five of this diverse group of children were diagnosed at a primary care practice — not the emergency department,” said study author Kristy Arbogast.

Also, “one-third were under age 12,” she said, “and therefore represent an important part of the concussion population that is missed by existing surveillance systems that focus on high school athletes.”

Arbogast is the co-scientific director of the Center for Injury Research and Prevention at the Children’s Hospital of Philadelphia.

Her team examined data on nearly 8,100 children under the age of 18. All were examined for concussion in the hospital’s network in southeastern Pennsylvania and southern New Jersey between 2010 and 2014.

Nearly 82 percent of the children underwent their first concussion visit in a primary care physician’s office, not an ER, the study found. In fact, only about 12 percent had their first concussion-linked medical visit in an ER.

Age was a significant factor in all of this. According to the study, more than three-quarters of children ages 5 to 17 were first seen in primary care. For those ages age 4 and under, only 52 percent were first seen in an emergency department, the study found.

Kids with Medicaid coverage were more likely to make their first visit to an emergency department versus those insured in other ways, the research showed.

Based on their findings, the study authors believe that “efforts to measure the incidence of concussion cannot solely be based on emergency department visits, and primary care clinicians must be trained in concussion diagnosis and management.”

As the authors noted in a hospital news release, bringing kids with a suspected concussion to a doctor’s office isn’t necessarily a bad idea. Arbogast’s team said kids often get attended to faster in a doctor’s office than in a crowded ER. That can mean more timely treatment, and most concussions will resolve within two to three weeks, the researchers said.

Kids whose concussion symptoms don’t ease in that time span should be sent to specialist care, the researchers said.

An expert at the U.S. Centers for Disease Control and Prevention believes more must be done to track pediatric concussions treated outside the ER.

“We need surveillance that better captures concussions that occur in children and adolescents,” Dr. Debra Houry, director of the CDC’s National Center for Injury Prevention and Control, said in the hospital news release. “Better estimates of the number, causes and outcomes of concussion will allow us to more effectively prevent and treat them, which is a priority area for CDC’s Injury Center.”

Two other experts agreed that family doctors have a role to play in concussion care.

“This study demonstrates the importance of incorporating the primary physician in the treatment team as our youth work through concussion,” said Dr. Rupi Johal, a primary care sports medicine physician at Winthrop-University Hospital, in Mineola, N.Y.

Dr. Mitchell Price directs pediatric trauma at Staten Island University Hospital, in New York City. He said that very young children with a suspected concussion often show up first at ERs, “due to heightened, parental concerns.”

“But, we also see a fair amount of older children [4-17 years old], in our system, with sports, school, and playground-related closed head injuries,” he said.

However, Price added, “I wholeheartedly agree that education in regards to concussion diagnosis is important in our pediatric provider community, considering the findings of this study.”

The study was published online May 31 in the journal JAMA Pediatrics.

More information

The American Academy of Family Physicians has more about concussion.

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Researchers Uncover Surprises About Celiac Disease

TUESDAY, May 31, 2016 (HealthDay News) — New research has revealed some surprising findings about who develops celiac disease in the United States.

The study found that it’s most common among people whose ancestors came from India’s Punjab region. Previously, experts thought celiac mostly affected white people with European ancestry.

Celiac also seems to affect men and women equally, regardless of ethnicity, the researchers said.

“It is now recognized as one of the most common hereditary disorders worldwide,” said the study author, Dr. Benjamin Lebwohl, in a news release from the American Gastroenterological Association. Lebwohl is an assistant professor of medicine and epidemiology at the Celiac Disease Center at Columbia University Medical Center, in New York City.

Celiac is an immune-based disorder that causes damage to the small intestine if genetically susceptible people eat foods containing gluten, according to the Celiac Disease Foundation (CDF). Gluten is a protein found in wheat, barley and rye, as well as foods containing these substances.

Celiac disease affects about 1.8 million Americans, the researchers said.

But the disease is often misdiagnosed, the CDF said. The diagnosis is confirmed through a biopsy of tissue from the small intestine, the researchers said.

“Our findings help shed light on the distribution of celiac disease in the U.S. and will aid gastroenterologists in diagnosing their patients,” Lebwohl said.

For this study, the researchers looked at data from more than 400,000 intestinal biopsies. The researchers also used patient names to help them figure out the distribution of the disease. The distribution included a number of ethnicities, such as North Indian, South Indian, East Asian, Hispanic, Middle Eastern, Jewish and other Americans.

Along with finding high rates of the disease in people from the Punjab region of India, the researchers also found the condition was much less common among Americans from South Indian, East Asian and Hispanic ancestry.

Meanwhile, people with Jewish and Middle Eastern ethnicities had rates of the disease similar to that of other Americans.

The study also showed no difference in male and female rates of celiac disease across all ethnic groups. That’s important because previous studies have suggested that celiac may be more common in women. Researchers said doctors might not look for the disease as much in men.

“Based on our findings we recommend that physicians consider celiac disease in men as often as they consider it in women,” Lebwohl said.

The study was published in Clinical Gastroenterology and Hepatology.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases provides more information on celiac disease.

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Money, Language Barriers Can Affect Kids’ Brain Injury Care

TUESDAY, May 31, 2016 (HealthDay News) — Children with traumatic brain injuries may be less likely to receive rehabilitation care if they come from poor families with a limited grasp of English, a new study suggests.

After a traumatic brain injury, children require services such as physical therapy and mental health treatment for months or years. But University of Washington researchers found that it’s very hard for some patients to get this care.

The researchers surveyed almost 300 health care providers around Washington state. These included providers of physical and occupational therapy; speech, language and cognitive therapy; and mental health services. The researchers found that less than 20 percent accepted Medicaid and also provided language interpretation to children with traumatic brain injuries.

Only 8 percent provided mental health services to those children. Spanish-speaking families had to travel much further than English speakers to get services for their children, the study found.

The study also found that only 46 percent of providers accepted children with Medicaid. They also showed that children covered by Medicaid had access to fewer rehabilitation services than those covered by private insurance.

The results show that already disadvantaged children who suffer traumatic brain injuries are further harmed by limited access to rehabilitation services that can significantly improve long-term outcomes, said lead author Megan Moore. She’s an assistant professor in direct practice, School of Social Work at the University of Washington. She’s also a faculty member at the UW Harborview Injury Prevention and Research Center in Seattle.

“Rehabilitation after a brain injury is incredibly important, especially for kids with moderate to severe brain injuries. Ultimately, that limited availability is going to impact children’s outcomes,” Moore said in a university news release.

Most brain injury rehabilitation occurs outside of hospitals, so hospital staff should try to connect parents with rehabilitation services before the child leaves the hospital, she said.

“We need to be thinking more critically about how we transition kids back to the community, particularly children we know have limited access to services. We really have to do a thorough job of linking them to these services on the outpatient side,” she added.

The study was published recently in the American Journal of Physical Medicine & Rehabilitation.

More information

The Center for Parent Information and Resources has more about children and traumatic brain injury.

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Scans Spot Brain Region That Misfires in Depressed People

TUESDAY, May 31, 2016 (HealthDay News) — A part of the brain that responds to bad experiences acts in an unexpected way in people with depression, a small study finds.

One theory suggested that the pea-sized structure called the habenula was overactive in people with depression, so researchers decided to test that hypothesis.

The investigators scanned the brains of 25 people with depression and 25 people who never had depression while they were shown images associated with receiving or not receiving a shock.

“Surprisingly, we saw the exact opposite of what we predicted,” said study senior author Jonathan Roiser.

“In people with depression, habenula activity actually decreased when they thought they would get a shock. This shows that in depressed people the habenula reacts in a fundamentally different way,” he explained.

“Although we still don’t know how or why this happens, it’s clear that the theory needs a rethink,” said Roiser. He is a professor at the Institute of Cognitive Neuroscience, University College London.

Average habenula size was the same in both groups. However, participants in both groups with a smaller habenula were more likely to have a loss of interest or pleasure in life, according to the study published May 31 in the journal Molecular Psychiatry.

“The habenula’s role in depression is clearly much more complex than previously thought,” lead author Rebecca Lawson, from the Center for Neuroimaging at University College London, said in a university news release.

She added that “one possible explanation is that the habenula may help us to avoid dwelling on unpleasant thoughts or memories, and when this is disrupted you get the excessive negative focus that is common in depression.”

More information

The U.S. National Institute of Mental Health has more on depression.

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Most Smokers Don’t Stick With E-Cigarettes

By Randy Dotinga
HealthDay Reporter

TUESDAY, May 31, 2016 (HealthDay News) — Some smokers turn to e-cigarettes with the hope that the electronic nicotine delivery devices will help them give up regular cigarettes.

But new research suggests that for most smokers, e-cigarettes aren’t an acceptable alternative.

The good news from the study is that e-cigarettes helped at least a small group of smokers quit tobacco cigarettes.

Ideally, study lead author Terry Pechacek said, e-cigarettes would be both appealing and less dangerous than traditional cigarettes. “Even if they’re only half as risky, there would be a huge public health benefit if we could switch 40 million smokers to them,” he said.

But the study suggests smokers who’ve tried them are saying “that’s possible but we’re not there yet,” said Pechacek, professor and interim division director of Health Management and Policy at Georgia State University in Atlanta.

For the study, the researchers surveyed more than 5,700 Americans in 2014. They focused on 729 current and former smokers who’d tried e-cigarettes. Of those, 144 were former smokers — 101 had quit all smoking and 43 had switched from traditional cigarettes to e-cigs.

However, of the 585 current smokers, 58 percent (337 people) said they’d tried e-cigarettes but didn’t use them anymore. The rest of the current smokers, 248 people, had decided to smoke both traditional cigarettes and e-cigs, the study found.

The findings suggest that e-cigarettes aren’t satisfying to most smokers, Pechacek said. Follow-up research to be released later suggests that the problem is the ability of the devices to deliver nicotine, he said.

Smokers may find e-cigarettes less appealing because they pack less of a quick “hit” of nicotine, said Thomas Wills, professor and interim director of the Cancer Prevention and Control Program at the University of Hawaii Cancer Center. The smell and flavor may also be stumbling blocks to quitting regular cigarettes, he said.

In the big picture, Wills said, “e-cigarettes may help a few people to quit, but mostly they don’t. And the suspicion from these data is that they help keep people smoking. That is not something that the e-cigarette advocates want to hear.”

Gregory Conley, president of the American Vaping Association, took issue with some of the study’s findings. For example, he said, one weakness of the study is that the survey participants may have tried e-cigarettes years ago, before more recent innovations that make them more appealing.

He also noted that the study found that smokers who switched to e-cigs were more likely to use the “tank-style” devices, which are larger, with an attached nicotine liquid tank, and last longer than the devices that look more like cigarettes.

Earlier this month, the U.S. Food and Drug Administration took action to regulate the e-cigarette industry. Among the measures: The agency said it was banning the sale of e-cigarettes to minors.

And manufacturers of e-cigarettes will be required to submit new and existing products to the FDA for review and evaluation, unless the product was sold prior to Feb. 15, 2007.

“The bad news for public health is that the FDA’s regulations will treat tank-style vapor products far harsher than traditional e-cigarettes,” Conley said. This kind of action, he added, will weaken innovation of e-cigarettes.

The study authors pointed out that it’s clear smokers are interested in e-cigarettes, as more than half of smokers tried them. Pechacek suggested that the appeal of traditional cigarettes should be “degraded” in order to force smokers to seek alternatives, such as e-cigarettes. Currently, he said, smokers are drawn to tobacco cigarettes because of their price, ease of access and appeal.

The study was published in the journal Nicotine & Tobacco Research.

More information

For more about e-cigarettes, visit BeTobaccoFree.gov.

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Zika Infections Through Sex More Common Than Thought: WHO

By Steven Reinberg
HealthDay Reporter

TUESDAY, May 31, 2016 (HealthDay News) — Women planning to become pregnant should wait at least eight weeks before trying to conceive if they or their partner live in — or are returning from — areas where Zika virus infections are occurring, U.N. health officials now recommend.

Mosquito bites remain the most common source of infection of the virus that causes the severe birth defect microcephaly, which results in babies with abnormally small heads and brains. But transmission of the virus through sex is more common than previously thought, World Health Organization officials said Monday. They had previously recommended a four-week abstinence before trying to conceive.

And if the male partner has had symptoms of Zika infection, couples should wait six months before trying to have a baby, the WHO officials said.

Four out of five people infected with Zika don’t develop any symptoms. Those who do most often suffer from mild symptoms that include fever, rash, joint pain or red eyes.

The true risk of Zika is to a developing fetus.

The vast majority of Zika infections have occurred in Latin America, with Brazil the hot zone with an estimated 5,000 cases of microcephaly. There have been no reports of Zika-induced microcephaly contracted in the United States. But U.S. health officials have said they expect to see Zika infections in Gulf Coast states such as Florida, Louisiana and Texas as mosquito season picks up.

Earlier this month, U.S. health officials reported that the number of pregnant women in the United States infected with the Zika virus had tripled because cases were now being counted in a more comprehensive way.

So far, an estimated 280 infected women are being followed in the United States and its territories, according to two registries that have been created by the U.S. Centers for Disease Control and Prevention.

Previously, only cases of pregnant women who had Zika-related symptoms or pregnancy complications were being tallied, CDC officials said. But recently published reports have found that some pregnant women show no symptoms of Zika infection, yet still give birth to babies with microcephaly.

To limit any potential spread of Zika virus via mosquitoes, health officials on the federal, state and local level are deploying a three-pronged strategy: improving mosquito control; expanding their ability to test for Zika; and urging the public to protect themselves against mosquitoes.

Women of child-bearing age who live in an active Zika region should protect themselves from mosquito bites by wearing long-sleeved shirts and long pants, using mosquito repellent when outside, and staying indoors as much as possible, according to the CDC.

President Barack Obama has asked Congress to allocate $1.9 billion to combat the Zika threat, but lawmakers have yet to agree on a spending package.

More information

Visit the U.S. Centers for Disease Control and Prevention for more on the Zika virus.

This Q&A will tell you what you need to know about Zika.

To see the CDC list of sites where Zika virus is active and may pose a threat to pregnant women, click here.

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