Archive for January, 2010

Treating depression in teens has lasting benefits

Sunday, January 31st, 2010

Longer-term treatment of depression for adolescents is associated with persistent benefits, even after treatment ends, according to results of the Treatment for Adolescents with Depression Study (TADS).

TADS is a randomized, controlled trial evaluating the effectiveness of three common treatments for adolescents with depression: the antidepressant Prozac (also called fluoxetine); “talk therapy,” also called cognitive-behavior therapy (CBT); their combination (Prozac plus CBT), and, where appropriate, management with a placebo pill (used as a control condition).

A total of 327 depressed teens who participated in the study received active treatment for 36 weeks and were then followed for 1 year.

Dr. John March, of Duke University Medical Center, Durham, North Carolina, and colleagues found that the treatment benefits in terms of lower levels of depression and suicidal thoughts observed at the end of active treatment persisted during follow-up.

In addition, the findings demonstrate that longer-term treatment results in clinically meaningful improvement even when active treatment is stopped, they report in the American Journal of Psychiatry.

“In contrast, to earlier reports on short-term treatments, in which worsening after treatment is the rule, the longer treatment in the TADS was associated with persistent benefits” over 1 year of follow-up, March and colleagues note.

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World Trade Center Workers Twice as Likely to Have Asthma

Sunday, January 24th, 2010

World Trade Center rescue and cleanup workers have asthma rates twice that of the general population, a new study shows.

In 2005, about 8 percent of workers and volunteers who had spent time at Ground Zero reported having an asthma attack during the previous year, compared to about 4 percent of the general population. The rate of asthma attacks among World Trade Center workers had been less than 1 percent in 2000.

Reports of problems with asthma continued to rise for several years after the attacks. Less than 3 percent of World Trade Center workers reported ever having been diagnosed with asthma attacks pre-9/11, while 16 percent reported in 2005 through 2007 that they had asthma attacks at some point.

“Twice as many World Trade Center responders are suffering from asthma when compared to those their age from the general population,” said senior study author Dr. Paul Enright, a research professor of medicine at the University of Arizona. He conducted the study along with Hyun Kim and colleagues at Mount Sinai School of Medicine, New York City.

The study was to be presented Tuesday at the American College of Chest Physicians’ annual meeting in San Diego.

Researchers followed about 20,000 responders who received an initial medical exam between July 2002 and December 2007 at a World Trade Center Medical Monitoring and Treatment Program clinic.

Participants were asked if they had experienced an asthma attack in the last year, and whether they had ever been diagnosed with asthma.

The average amount of time spent at World Trade Center sites was about 80 days. About 86 percent of the law enforcement, construction and other rescue, recovery and debris removal workers in the study were men, 59 percent were white and their mean age was 43.

Previous research has found that new asthma diagnoses peaked soon after 9/11 and then fell to closer to normal in the ensuing years. A study in the August issue of the Journal of the American Medical Association found that most new asthma diagnoses — that is, people who were asthma-free prior to the attacks — occurred in the 16 months after the attacks, said Lorna Thorpe, deputy commissioner of epidemiology for the New York City Health Department and senior author of that study.

This study is different in that it measures not new diagnoses, but actual asthma attacks.

One drawback to the new study is that the group of patients who were followed wasn’t static. Because people can drop in and out of the monitoring program, those who came for their initial evaluation years after the attacks may have been more likely to be among those whose health wasn’t improving.

“The question is, are the people who stay in and keep being seen the sicker ones while the healthier ones drop out? If so, that may explain the reason for the rise in asthma over time,” Thorpe said.

Furthermore, she added, it would be interesting to know the mental state of those who continue to experiencing asthma attacks. Coughing and wheezing due to asthma could bring back memories of the horror, triggering emotional stress that in turn could make asthma attacks worse.

“The physical health conditions and the mental health conditions are highly overlapping,” Thorpe said.

Dr. Norman H. Edelman, chief medical officer for the American Lung Association, said it was important to continue to follow responders and their asthma rates.

Typically, asthma comes on quickly after the lungs are exposed to the toxic pollutants or caustic dust that resulted from the blasts, then declines as the lungs heal.

“Ordinarily, when people get exposed to toxic stuff, you get an immediate reaction. We don’t expect a delayed effect,” Edelman said. “We saw 9/11 responders who got sick pretty quickly. Some got better. Some did not. What we haven’t seen are people who present with asthma two or three years later related to 9/11.”

Diseases of the spongy part of the lungs, such as mesotheliomia from asbestos exposure, may take years or decades to develop. But asthma is a disease of the airways, which is typically apparent right away.

Researchers said there was no evidence that asthma rates continued to rise after 2005.

“However, the majority of those who developed asthma during or after their World Trade Center exposures have continued to have asthma attacks many years later,” Enright said. “Their asthma did not spontaneously resolve within a few months after their WTC exposure ceased.”

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Switch to ‘Light’ Cigarettes Makes Quitting Tougher

Sunday, January 17th, 2010

Experts have long known that “low-tar” and “light” cigarettes aren’t any healthier than regular cigarettes, and new research suggests they have another drawback: People who switch to them are less likely to quit, even those who switch specifically because they want to stop smoking.

In fact, “switching to ['light' cigarettes] for any reason is associated with continuing to smoke,” said study author Dr. Hilary Tindle, a researcher at the University of Pittsburgh’s Division of General Internal Medicine.

However, she acknowledged that the research does not prove that switching leads directly to a lower rate of quitting.

According to the authors, an estimated 84 percent of cigarettes sold in the United States are so-called low-tar and low-nicotine, with many of them called “lights.” Some smokers may assume they’re healthier than other cigarettes, but medical researchers say smokers still suck in about the same level of carcinogens. And research has shown that “lighter” cigarettes don’t reduce smoking-related illness and death.

Regardless of what brand they smoke, “the average smoker dies 13 to 14 years earlier than he or she would die if he or she did not smoke,” Tindle said.

In the new study, published online Nov. 3 in the journal Tobacco Control, researchers examined the results of a 2003 survey of 30,800 people in the United States who had smoked within the past year. Thirty-eight percent of them had switched to “lighter” cigarettes, with the largest percentage of those — 26 percent — saying they’d done so for better flavor. Forty-three percent mentioned one, two or three reasons for switching, with quitting smoking being one of those reasons.

However, those who had switched were 46 percent less likely to have quit smoking.

Why might switchers be more likely to continue smoking? “Prior research suggests that switching may resolve smokers’ cognitive dissonance about smoking — something along the lines of, ‘Well, since I’m smoking a [supposedly] healthier cigarette, I really don’t have to worry about lung cancer, heart disease, impotence, wrinkles, early death [fill in the blank] because my health is not at risk,’” Tindle said. “This type of rationale may keep more health-conscious smokers smoking.”

But there are other possible explanations, added Robert West, a researcher who studies tobacco use at University College London in England. It’s possible, for example, that people who switch are already more dependent on cigarettes and less able to quit, he said.

What to do? “In Europe, tobacco companies are not allowed to call cigarettes low tar or imply that they are in any way safer,” West said.

Regardless of how cigarettes are marketed, Tindle said, “the best solution for the problem of how to live longer and healthier is to quit smoking now.”

In related news, a study published Nov. 3 in the Journal of Epidemiology and Community Health finds that smoking during pregnancy is linked to a higher level of behavioral problems in offspring later in life, even among those as young as 3.

A team from the University of York in the England tracked 14,000 mother-and-child pairs and found that maternal smoking during pregnancy was associated with significantly higher odds for attention-deficit hyperactivity disorder (ADHD) and other behavioral woes, compared to children born to nonsmoking mothers.

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Statins May Worsen Fatigue in Heart Failure Patients

Monday, January 11th, 2010

Statins may boost the risk of fatigue and shortness of breath in some patients with heart failure, a new study suggests. But a second report found the cholesterol-reducing drugs reduce the risk of clots in those with cardiovascular disease, and experts think the benefits outweigh the risks.

Dr. Gregg C. Fonarow, a professor of cardiology at the University of California at Los Angeles, said patients shouldn’t reconsider their use of the statins based on the results of the small U.S. study.

“Patients with heart failure who have an indication for statin therapy, such as coronary artery disease or diabetes, should remain on physician-prescribed statin therapy,” Fonarow said.

At issue is treatment for heart failure, a condition that occurs when the heart fails to beat properly. An estimated 5.7 million people in the United States suffer from heart failure, which can cause fatigue, shortness of breath and fluid build-up in the lungs and legs.

“Approximately two-thirds of patients with heart failure have coronary artery disease,” Fonarow said. “In these patients, statins, while not improving overall survival, have been shown to lower the risk of a cardiovascular event and decrease the likelihood of being hospitalized. In patients with heart failure but without vascular disease, neither benefit nor harm has been demonstrated in clinical trials of statin therapy.”

Researchers at Northeastern University and Massachusetts General Hospital looked at the medical records of 136 patients with heart failure. They wanted to see how statin use, mainly of the drug atorvastatin (Lipitor), affected two types of heart failure — systolic and diastolic.

Fonarow explained that the heart fails to contract normally in people with systolic heart failure. In those with diastolic heart failure, the heart may not relax properly or be abnormally stiff, he said.

The study findings were to be released this week at the American College of Chest Physicians annual meeting, in San Diego.

Those who had diastolic heart failure and took a cholesterol drug had almost half as much exercise tolerance as those with the condition who didn’t take the drugs, the researchers found.

“Some patients with diastolic heart failure may be more prone to the adverse effect of statins on muscle. It may be that patients with particular preexisting factors will experience unfavorable results from statin therapy, including exercise intolerance, dyspnea [shortness of breath], and fatigue,” study author Lawrence P. Cahalin, a researcher at Northeastern University, said in a statement.

“Not all statins are alike, and not all patients are alike. Some statins are stronger than others and are likely to act differently, given particular patient characteristics, and produce different degrees of wanted and unwanted effects,” Cahalin said. “In our continuing study, we hope to identify patient characteristics that are associated with favorable and less than favorable results from statin therapy.”

For now, Cahalin said tests are in order if heart failure patients taking statins suffer from fatigue, shortness of breath and inability to exercise for very long.

In another study to be released at the meeting, researchers report that statins may help prevent blood clots in people with cardiovascular disease.

Previous research has linked atherosclerosis, a condition in which fatty material builds up along artery walls, and venous thrombosis (VTE). Researchers from Albert Einstein Medical Center in Philadelphia, who were investigating the association between statin use and incidence of VTE, reviewed data on 593 patients who were hospitalized for heart attack or ischemic stroke.

“In our study, statin therapy demonstrated a protective effect on this group of patients, reducing their overall incidence of developing VTE,” said study author Dr. Danai Khemasuwan.

Patients in the non-statin group were three times as likely to develop VTE as patients receiving statins, they found.

Given the good news/bad news conclusions of these two reports, patients should not panic, experts said. Statins provide significant benefits for patients with cardiovascular disease, Dr. Kalpalatha Guntupalli, president of the American College of Chest Physicians, said in a statement. However, as for any new medication prescribed, clinicians should closely monitor the effects that different types of statins have on individual patients.

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