Booster Shots

Oddities, musings and news from the health world

Category: illness

Early fitness important to cutting future risk of diabetes, heart disease

June 18, 2010 |  2:57 pm

Quad Attention, college students: Get off that shuttle bus and start walking to class.

You’re already eating a diet of mainly beer and pizza, staying up all hours of the night, and living in cramped, potentially germ-infested dorms. The last thing on your mind is whether you’re setting yourself up for future cardiovascular disease or Type 2 diabetes.

Now might be a good time to start thinking about it…

A new study by Tufts University scientists found that body fat percentages are not the only precursors to health problems later in life. A person's physical fitness may matter a lot more -- at least when it comes to developing cardiovascular disease or diabetes.

Motivated in part by the astounding growth rate of obesity amongst college students -- approximately 31% of U.S. college students are overweight or obese -- researchers at Tufts' Friedman School of Nutrition Science and Policy tracked the health and health-related behaviors of 564 male and female college students over a nine-year period. They tracked body fat, fitness level and risk factors such as cholesterol and blood glucose levels.

Their findings: Students who were physically fit -- regardless of their body fat content -- had lower blood triglycerides, higher HDL (the "good" cholesterol). That effect was especially marked in women.

The fitter students also had lower blood glucose levels, an effect that was especially marked in men.

The findings are important, says Jennifer M. Sacheck, one of the study authors, because they suggest that the roots of later disease may be laid down early. "Because most of these health problems show up more often later in life, most studies have focused on adults, and very few have been done on college populations or anyone younger," she said in a phone interview.

However, she added, because students won't be tracked through their lives, there's no way to guarantee that heart disease and diabetes actually will develop in those students who look like they're heading that way.

The study does suggest that maybe we should change the way we think about health -- basing it not so much on weight and body fat composition, but more on physical fitness and the frequency of exercise.

And, Sacheck says, the message has particular importance for college students who are known to be more careless and reckless with their health than other age groups:

"In college, you think you're invincible, at the peak of your health, and that your body can handle anything. But my message [in this study] is that even at this age your body is susceptible."

For those who have long cursed the Body Mass Index, which stratifies a person's health level based on weight and height equations, this study is heartening. Perhaps it's time to stop worrying about the number on the scale and whether you can still fit in  the jeans you wore in high school, and instead pat yourself on the back for running each morning. It might seem paradoxical, but being physically active and a bit pudgy might be better than skinny and unfit.   

Here's the study abstract (the full report is available for a fee) plus a news release from Tufts laying out the nuts and bolts of the research and its findings.

And here's a link to the website of physiologist Linda Bacon, one of the proponents of health at every size.

-- Jessie Schiewe

Photo credit: Los Angeles Times


Pertussis cases keep rising, and one woman's story resonates more than ever

June 3, 2010 |  9:00 pm

Bianchi Those whooping cough numbers are stretching ever higher in California.

State health officials reported Thursday that the state has seen a threefold increase over this time last year. Check out the L.A. Now post here.

Lest you think adults vaccinated as children can't get whooping cough, lest you think they can't pass it on to their infants, lest you think those infants can't die, read Mariah Bianchi's story.

She was vaccinated as a child against whooping cough. She passed it to her infant son, Dylan. He died of the disease, also called pertussis, when he was 17 days old.

Here's more on whooping cough from KidsHealth. And here's information on whooping cough vaccination for infants -- and adults -- from the Centers for Disease Control and Prevention.

As the CDC notes:

"Infants under the age of 12 months have more serious illness from pertussis and they are more likely to have complications and be hospitalized than persons in other age groups. In the 1990s, about two thirds of infants reported with pertussis were hospitalized. Infants are more likely to have pneumonia or convulsions. Infants also are at greatest risk of fatal pertussis. In recent years, 8 to 40 infant deaths from pertussis are reported to CDC annually."

In other words, they can't protect themselves; we have to do it for them.

-- Tami Dennis

Photo: Mariah Bianchi holds a pendant with an image of Dylan's handprint.

Credit: Robert Durell / For the Times


Chronic obstructive pulmonary disease: Beta-blockers may help

May 24, 2010 |  1:00 pm

Chronic obstructive pulmonary disease is rapidly becoming a leading cause of death in the United States. Experts project that in 10 years, COPD will be the third-leading cause of death in the Western world. COPD includes chronic bronchitis and emphysema and is often linked to smoking. People with COPD are at greater risk of heart disease, too.

A study published Monday, however, suggests that beta-blockers -- medications used to treat high blood pressure and heart rhythm disorders -- reduce respiratory infections and improve survival in people with COPD. In a study of 2,230 COPD patients followed for an average of 7.2 years, the patient who took a beta-blocker had lower deaths rates (27.2% compared with 32.3%) than other COPD patients and fewer serious flare-ups.

The study, published in the Archives of Internal Medicine, is the first to suggest that long-term use of beta-blockers may improve survival in COPD. Doctors may hesitate to use beta-blockers for COPD patients, however, because they fear the medications will provoke respiratory problems, according to an editorial accompanying the study. The new study is promising, but a randomized, controlled trial should be performed to confirm the strategy, an editorial accompanying the study states. Until then, "the data ... provides a rationale for the practicing physician to use beta-blockers cautiously in their patients with COPD who also have a co-existing cardiovascular condition for which a beta-blocker is required," the author wrote.

-- Shari Roan


Sight of sickness fires up immune response, study suggests

April 27, 2010 | 12:08 pm

Next time you glare at someone for sneezing near you in an elevator, be sure to look long and hard at the offending germ-spreader: it may protect you from getting what he or she has.

A new study published this month in Psychological Science suggests that the very sight of sickness prompts the immune system to mount defenses against illness. That finding follows naturally from earlier research suggesting that disgust -- the typical first reaction we have to a person with, say, open sores -- may be part of a "behavioral immune system." Revulsion, after all, makes us more likely to move away from the source of infection -- and thereby less likely to catch it.

But this is the first experiment that demonstrates a direct link between viewing signs of illness and heightened immune response in response. In it, University of British Columbia psychology researchers took 19 women and nine men and, after testing their blood for a very common marker of immune response called interleukin-6, or IL-6, divided them into two groups. Each group was first shown a 10-minute slideshow of something bland -- furniture. In a second session, one group watched a 10-minute fright fest of disease symptoms, including sneezing, oozing sores and pox. The other group saw a slideshow of gun-toting people, many aiming their weapons directly at the viewer. 

For subjects who had watched the disease fright fest, their levels of IL-6 rose almost 25% higher than their pre-slideshow levels -- an immune response significantly more robust than that among subjects who had watched the gun-slingers. Neither group responded to the neutral, bland slideshow with a rise in IL-6.

There's obviously a limit to how often and how high you can gin up these defenses against disease. After all, if you could sustain the heightened IL-6 response to seeing sick people, doctors and nurses would be veritable titans of immunity. And, of course, we may all waste an occasional immune response on someone else's condition that's not even contagious. But the authors note that our reaction to sickness is "presumably adaptive in origin."

Oh, and if you're going to stare (which isn't polite), at least say "gesundheit!"

-- Melissa Healy


Day-care practices of excluding sick kids are much too strict

April 19, 2010 |  9:08 am

One day, many years ago, I was called at work by my 2-year-old daughter's day-care provider and told to come and get her. She probably had an infectious childhood illness called hand, food and mouth disease, the director explained, because of the pinkish cracks in the palms of her hands.

Daycare I was fairly certain my daughter wasn't ill. However, I left work, picked her up and took her to the pediatrician, who glanced at her palms and said she had dry skin. I returned her to the sheepish day-care director and drove back to my office, thinking what a waste of time and money the morning had been for my employer and me. My daughter rather enjoyed the unplanned interlude, but I worried that she'd probably picked up some real illness at the doctor's office and would be vomiting by morning.

This experience, it turns out, is all too common. Despite detailed guidelines on illness from the American Public Health Assn. and the American Academy of Pediatrics, day-care centers routinely exclude children with mild illnesses, according to a study published Monday in the journal Pediatrics. The study polled 305 directors of day-care centers and presented them with scenarios of various illnesses, asking when they would exclude the child from care.

Researchers found that directors would unnecessarily exclude 57% of children with mild illnesses. Here are some of the scenarios in which the majority said they would exclude children but, under guidelines, do not warrant exclusion.

  • Three-year-old, clear, runny nose for five days, dry cough for three days, temperature normal, able to participate in usual activities.
  • Four-year-old, red eyes, clear drainage, temperature normal.
  • Two-year-old, toilet trained, vomited what she ate once and had two loose, watery stools in the toilet. Temperature normal.
  • Three-year-old, felt warm, fever of 101 taken under the arm, no other symptoms and "acting his usual perky self."
  • Four-year-old, circular rash on scalp, hair not growing well at site of rash, temperature normal, acting normally.

Children were more likely to be unnecessarily excluded if they attended smaller centers and centers with less experienced directors. However, children were less likely to be excluded at centers with a higher proportion of single mothers and children on state-assisted tuition.
 
The findings suggest that all child care directors should have regular and ongoing training to reduce the rate of unnecessary exclusion. In the directors' defense, it is sometimes difficult to know when to exclude a child for illness. Child care personnel have to worry about the transmission of infectious illnesses. On the other hand, there is no excuse for not having the APHA/APA guidelines readily available and referring to them often and carefully. It's hard enough to be a working parent without having to find alternative child care for every running nose.

Child care personnel and parents can find out more about the issue at
the National Resource Center for Health and Safety in Child Care and Early Education.

-- Shari Roan

Photo credit: Carolyn Cole / Los Angeles Times


Whaddyaknow? That crazy vaccinate-kids-against-flu strategy just might work

March 9, 2010 |  7:50 pm

Vaccine Kids go to school and share germs, they come home and share germs, they visit relatives and share germs... At no time is this special ability on better display than during influenza season. Logically enough, some public health experts (perhaps having witnessed their own kids' inattention to hygiene or having considered how the virus is actually spread) have been re-considering the longstanding emphasis on first vaccinating the elderly against the flu.

The elderly are usually more at risk of flu complications (this most recent outbreak played out a bit differently than normal), but they're not known as disease carriers. So might it make  sense, from a disease-control standpoint, to focus on vaccinating the group most likely to spread the disease? 

Turns out, that yes, yes, it would.

In a new study, released online Tuesday in the Journal of the American Medical Assn., Canadian researchers compared flu incidence in small Hutterite colonies that vaccinated kids against the flu to the incidence in small Hutterite colonies that didn't vaccinate kids.

And guess what? Vaccinating kids appeared to reduce the risk of flu transmission communitywide. Here's the key data point: "Immunization of children and adolescents aged 3 to 15 years with the trivalent influenza vaccine formulated for the 2008-2009 influenza season conferred 61% indirect protection against influenza among persons who did not receive the study vaccine."

And guess what else? The vaccination didn't seem to damage the kids.

It's almost as if vaccinating some members of a herd helps protect the entire herd. Crazy, I know.

Here's the full study.

The researchers conclude:

"Our findings offer experimental proof to support selective influenza immunization of school aged children with inactivated influenza vaccine to interrupt influenza transmission. Particularly, if there are constraints in quantity and delivery of vaccine, it may be advantageous to selectively immunize children in order to reduce community transmission of influenza."

"Constraints in quantity and delivery of vaccine ..." that sounds familiar. But not to worry, should we find ourselves in a pandemic flu situation and should we all be at threat from a relatively unknown strain of influenza, you can probably get by without getting your own kids a vaccine.

Such was the thinking last year, as Melissa Healy describes in this story: Parents weigh the risk of vaccinating children for H1N1. And a few weeks later in this story: Most parents won't have kids get H1N1 flu shots, study finds.

In an earlier primer on disease control as it pertains to the flu, staff writer Shari Roan wrote presciently on the topic back in 2008:

"Physicians hope that vaccinating kids en masse will not only spare thousands of them from the aches and pains of flu, missed school days and hospitalizations, but also will hinder the spread of illness throughout the rest of society -- parents, grandparents, baby-sitters, neighbors, teachers, coaches, office workers, healthcare personnel, bus drivers, and on and on.

"This is the concept of herd immunity," says Dr. Stephen C. Aronoff, chairman of the department of pediatrics at Temple University in Philadelphia. "The more people you vaccinate, the less likely you are to see infection in people who are not vaccinated." Full story: Target: Kids.

And then there was this explainer: They help kids -- but mostly benefit the herd

We're now exploring whether there's a growing demand for a more logical, considerate herd.

-- Tami Dennis

Photo credit: Associated Press


Third study finds no link between mouse virus and chronic fatigue syndrome [Updated]

February 26, 2010 |  4:07 pm

Only a week after a second study found no link between a mouse virus called xenotropic murine leukemia virus-related virus (XMRV) and chronic fatigue syndrome, a third study has also found no link, dashing the hopes of CFS victims that a treatment for the mysterious disease might be on the horizon.

Their hopes had been raised last October when Nevada researchers reported in the journal Science that they found XMRV in two-thirds of the CFS patients they tested, a strong indication that the virus might be involved in causing the disease -- whose origin has been so mysterious that some physicians refuse to even believe that it is a real malady. But two British research teams independently reported in the last two months that they could not find the virus in patients from that country. Now, a team from the Nijmegen Medical Center in the Netherlands reports in BMJ that they could not find the virus in 32 Dutch patients or 43 healthy controls.

"Three papers from three well-respected European laboratories have now independently and unambiguously failed to find XMRV in CFS patients," wrote virologists Myra McClure and Simon Wessely of Imperial College London in an editorial accompanying the report. There has been much talk that different protocols were used in the studies, they added, but those technical differences "are irrelevant" as long as the researchers showed that they can properly amplify the genes they are searching for.

[Updated March 1: The post wrongly said that Simon Wesseley is a virologist at Imperial College London. He is a psychiatrist at King's College London.]

McClure and Wessely speculated that there are two possible explanations for the European failures to duplicate the American findings. The most likely is that XMRV infection is geographically confined to the United States and is not a cause of CFS. A second possibility is that the U.S. patients, who were generally older than those in Europe, were linked to a specific outbreak of CFS in the mid-1980s that has been tentatively linked to several viruses.

-- Thomas H. Maugh II


Consensus on lactose intolerance? There is none

February 24, 2010 |  2:30 pm

The National Institutes of Health convened a panel of experts to reach a consensus on what is known about lactose intolerance. Their consensus, released Wednesday: There is no consensus. It is a real condition, but there are no good numbers for its incidence, little is known about its effects on health, and even less is known about potential treatments.

Lactose is the primary sugar in all mammalian milk, including human milk. Virtually all babies are born with enzymes, called lactases, in their intestines that digest lactose, turning it into a form that can be used by the body. But beginning about the age of 5 or 6, many children, particularly those of African and Asian ancestry, begin to lose the ability to digest the sugar. If they continue drinking milk and eating dairy products afterward, bacteria in the gut often ferment the sugar, producing diarrhea, abdominal pain, flatulence and bloating.

Milk
Surprisingly, there are no good estimates of how many people have the problem, and the panel didn't even try to make one. "A lot of people who think they have lactose intolerance don't," Dr. Frederick J. Suchy of the Mount Sinai School of Medicine, chair of the panel, said in a telephone news conference. At the opposite extreme, many people who do not digest lactose properly do not manifest symptoms of lactose intolerance because their gut bacteria do not ferment it. Many people who think they have lactose intolerance, he added, actually have irritable bowel syndrome, inflammatory bowel disease, or perhaps celiac disease.

The disorder can be diagnosed by questioning and careful physical examination, he said. One key is to tell a patient to avoid milk products for a few days and see if the symptoms go away. If lactose intolerance is diagnosed, the physician can then try strategies to see if the patient can tolerate milk.  "Small amounts of milk spread throughout the day or taken with meals often can be better tolerated," he said. "Yogurt and hard cheeses may also be better tolerated because they are lower in lactose." Lactase-treated milk is also a good alternative, albeit an expensive one.

Most people who think they are lactose intolerant simply avoid dairy products. Physicians would like adults to consume reasonable quantities of such products because of the crucial nutrients they contain, particularly vitamin D and calcium.  Those can often be found in fortified products, such as orange juice, but at a higher cost. "We know that, particularly in children and adolescents, it is very difficult to receive adequate calcium and vitamin D if you avoid dairy products completely," Suchy said. "Many parents perceive themselves as lactose intolerant and impose that on the child without any testing." Nonetheless, there are almost no data available to suggest what the health effects of avoiding dairy products might be.

The current research on lactose intolerance "is small and haphazard ... and there are huge gaps in knowledge," Suchy concluded. "We need to define prevalence, develop gold standards for diagnosis, and test management approaches."

-- Thomas H. Maugh II

Dairy products are the best source of vitamin D and calcium for youngsters. Credit: Jessica Tefft / Associated Press


Study: When those with a chronic illness exercise more, they worry less

February 22, 2010 |  1:00 pm

Runners1
Life is full of worries. When you're battling a chronic illness, it seems almost impossible to escape nagging anxieties. When will I feel better? Will my condition worsen? When can I return to work or school?

But if you exercise regularly, you will likely feel much less anxious -- regardless of the status of your illness. In a study published Monday in the Archives of Internal Medicine, researchers analyzed data from 40 studies on how exercise affects anxiety. All of the 3,000 study participants were sedentary individuals who had chronic illnesses but were still able to exercise in sessions of at least 30 minutes.

Compared with similar individuals who did not exercise, the people who exercised had a 20% reduction in anxiety symptoms. Exercise helped people no matter what kind of health problem they had: cancer, depression, heart disease, fibromyalgia. Multiple sclerosis was the only condition in which exercise did not appear to have a significant effect.

"We found that exercise seems to work with just about everybody under most situations," Pat O'Connor, a co-author of the paper and professor at the University of Georgia, said in a news release. "Exercise even helps people who are not very anxious to begin with become more calm."

Exercise is known to lessen the symptoms of depression, but there has been less attention paid to its effects on anxiety.

-- Shari Roan

Photo: Francine Orr  /  Los Angeles Times 


A note for the next pandemic: Face masks might be the way to go after all

January 21, 2010 |  5:54 pm

PassengersWear the face mask? Don't wear the face mask? The question may seem moot now -- what with a decline in H1N1 cases and pharmacies now publicly trumpeting the availability of vaccine against the influenza strain -- but a few months back, it was anything but academic.

Researchers at the University of Michigan have been studying the 2006-07 flu season's effects on 1,437 students living in university residence halls. Some wore face masks (standard medical kind, nothing fancy); some wore masks and used a hand sanitizer; some just did whatever college kids normally would do in such situations. All watched an importance-of-hand-hygiene video.

The findings? That the two face mask groups had fewer influenza symptoms than those in the whatever-college-kids-normally-would-do group.

Previous research has been inconclusive on the effectiveness of face masks. The researchers point out that they asked participants to take such measures at the beginning of the influenza season, just after the campus' first flu case was reported. In other words, participants likely weren't already infected when the research started, as they might have been in other studies.

As for the lessons learned here, the researchers say: "The effect on influenza transmission could
be substantial, particularly early in a pandemic when vaccine supply will almost certainly be limited, as with the current nH1N1 pandemic."

Something to consider. Next time...  

Here's the study, published online today in the Journal of Infectious Diseases. A related editorial points out, however, that hand hygiene "cannot be overemphasized." 

-- Tami Dennis

Photo: These Hong Kong subway passengers weren't taking any chances last spring. 

Credit: Philippe Lopez / AFP / Getty Images  



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