June 21, 2010 — Breast-feeding until age 4 months is linked to lower rates of respiratory and gastrointestinal (GI) infection morbidity, according to the results of a population-based, prospective, cohort study reported online June 21 in Pediatrics.
"Exclusive breastfeeding seems to decrease the risk of infectious diseases in infancy," Liesbeth Duijts, MD, PhD, from Erasmus Medical Center in Rotterdam, the Netherlands. "However, the World Health Organization has called for more research regarding the benefits for 6 months instead of 4 months of exclusive breastfeeding."
The goal of this study, which was embedded in the Generation R Study, a study from fetal life onward in the Netherlands, was to evaluate the associations of duration of exclusive breast-feeding with upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), and GI tract infections in infancy.
There were 4164 subjects who completed questionnaires on rates of breast-feeding during the first 6 months (never; partial for < 4 months, not thereafter; partial for 4 - 6 months; exclusive for 4 months, not thereafter; exclusive for 4 months, partial thereafter; and exclusive for 6 months) and doctor-attended URTI, LRTI, and GI infections until age 12 months.
Risks for URTI, LRTI, and GI tract infection until age 6 months were lower in infants who were breast-fed exclusively until age 4 months and partially thereafter vs infants who were never breast-fed. Adjusted odds ratios (ORs) were 0.65 (95% confidence interval [CI], 0.51 - 0.83) for URTI, 0.50 (95% CI, 0.32 - 0.79) for LRTI, and 0.41 (95% CI, 0.26 -0.64) for GI tract infection. The adjusted OR for LRTIs in infants between the ages of 7 and 12 months was 0.46 (95% CI, 0.31 - 0.69).
For infants who were exclusively breast-fed for at least 6 months, trends were similar. However, partial breast-feeding, even for 6 months, was not associated with significantly lower risks for these infections.
"Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants," the study authors write. "Our findings support health policy strategies to promote exclusive breastfeeding for at least 4 months, but preferably 6 months, in industrialized countries."
Limitations of this study include questionnaires with breast-feeding data available for only 65% of eligible participants of the Generation R Study and possible misclassification related to questionnaire use.
"Biological, cultural, and social constraints related to breastfeeding habits need to be studied more extensively," the study authors write. "The effects of prolonged and exclusive breastfeeding on infectious diseases at older ages in industrialized countries remain to be studied."
Exclusive breast-feeding until age 4 months and partially thereafter was associated with a significant reduction of respiratory and GI morbidity rates in infants.
The first phase of the Generation R Study was funded by Erasmus Medical Center, Erasmus University Rotterdam, and Netherlands Organization for Health Research and Development (Zon Mw). The present study was supported by an additional grant from Stichting W. H. Kröger (00–048) and AGS Kinderstichting. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online June 21, 2010.
Monday, June 28, 2010
Saturday, June 26, 2010
When Food and Medicines Clash
Americans increasingly view the food they eat as medicine to help lower cholesterol, reduce high blood pressure and control blood sugar. But as with prescribed drugs, the health-improving qualities of foods such as olive oil, nuts and fruit can interact with other medications, causing possible problems.
Pharmacists often warn people not to mix anti-cholesterol drugs known as statins with grapefruit juice. Newer research suggests that other fruit juices, including cranberry and pomegranate, as well as olive oil may also interfere with how statins work in the body. Other laboratory studies show that certain popular teas can block the effect of some medications, including the flu drug Tamiflu. And switching to a low-fat diet, itself a healthy lifestyle change, could reduce the potency of some medications.
Diet can interact with medicine in two main ways. Some foods block the body's ability to absorb certain medications, effectively reducing the dose a person receives. Other foods enhance the absorption of some drugs, which can lead to a possible overdose.
In general, diet will only interact with medications when a person is consuming exceptionally large portions of certain foods, pharmacology and medical experts say. A few teaspoons of olive oil on pasta typically doesn't pose any problems, for instance.
Still, as Americans increasingly select foods based on their health benefits, or take supplements with high doses of nutrients, the likelihood of adverse interactions with medications rises. U.S. sales of supplements, natural and organic foods and functional foods, or foods enhanced beyond normal use like calcium-fortified orange juice, grew to $93.5 billion in 2008 from $47.9 billion in 2000, according to Nutrition Business Journal, a nutrition-industry trade publication.
"For every drug there is, there are unintended side effects. You should expect the same thing when taking nutrients at drug levels," says Patrick Stover, director of the division of nutritional sciences at Cornell University in Ithaca, N.Y.
Other factors also can affect how medicines are absorbed in the body, including a person's age, weight and gender. Such variations, combined with possible interactions with the food we eat, can increase or reduce the effective dose of a medication by as much as 5- to 10-fold, which are "huge effects," Dr. Stover says.
Grapefruit is one of the most extensively studied foods for its impact on medication. Compounds in the fruit can increase the potency of statins and other medications to potentially dangerous levels by inhibiting cytochrome P450, a family of enzymes that break down the drug. Research indicates that drinking just one eight-ounce cup of grapefruit juice a day increases the strength of the drug.
Recently, animal and laboratory studies have suggested that other fruits, including pomegranates, oranges (especially those from Seville), cranberries, grapes and black mulberries, could have a similar, although less robust, effect on statins in the body. Pomegranates and cranberries are frequently touted as healthy foods because of their high quantities of antioxidants, which supposedly remove free radicals from the body and slow the onset of disease and aging.
In the lab, some scientists' work raises similar concern about olive oil and some statins. The oil, a principal part of the Mediterranean diet and believed to lower the risk of heart disease, also appears to contain compounds that inhibit the drug's breakdown, according to researchers in Spain. The effects of olive oil likely aren't as strong as that of grapefruit, but more studies are needed to figure out what quantities might actually impact humans, say experts.
John Thor Arnason, a biologist at the University of Ottawa, and his colleague Brian Foster of Health Canada, a government ministry, have investigated the effect on drugs of more than 450 food products, mainly in animal and laboratory studies.
The scientists continue to study potential food-drug interactions, as do other researchers world-wide.
In one recent study, Dr. Arnason's team examined dozens of different kinds of beers. They found that the "hoppier" or more bitter beers reduced the effect of the cancer drug Tamoxifen, when compared with beers that were less hopped. The study was published this year in the Journal of Agricultural and Food Chemistry.
Another popular compound, the anti-oxidant resveratrol found in red wine, nuts and dark chocolate, is touted for its anti-aging benefits. But resveratrol in large quantities appears to potentially enhance the potency of drugs, other laboratory studies show.
People, especially older adults taking multiple medications, should tell their doctor about dietary supplements, if they are using high-potency juices and teas and drinking lots of wine, Dr. Arnason says. He says that drugs whose labels contain lots of conditions and warnings about possible interactions with other medications are probably more likely also to interact with foods. If a food-drug interaction is suspected, patients should stop taking the food and talk to their doctor immediately.
In work published this year, Drs. Arnason and Foster showed that various herbs including chai hu, Labrador tea, echinacea and goldenseal, can reduce the potency of Tamiflu. The researchers incubated Tamiflu by itself or along with herbs, together with human liver tissue, which is responsible for processing the medication in the body. They found that the drug was less activated in the presence of the herbs.
The herbs are believed to proffer different health benefits. Labrador tea is thought to benefit the nervous system, Chai Hu to treat common cold and fever, and Echinacea is thought to prevent colds and have anti-tumor benefits. Goldenseal is an anti-microbial and anti-inflammatory product.
The researchers also have studied black tea, which is touted for lowering blood pressure, and found that it appears to inhibit an enzyme responsible for the body's processing of many drugs. The result, the researchers found, is that consuming large quantities of black tea could potentially increase the potency of a wide range of medications.
Others researchers have investigated spices. In one study, piperine, one of the main components of black pepper, increased the potency of the antihistamine Allegra in rats by two-fold compared with animals that took the medicine alone, according to a report in April's Journal of Food Sciences.
Much of the research on teas and other foodstuffs—with the exception of grapefruit—haven't been well-studied in humans, so the exact amount that may cause a harmful effect isn't yet known, say researchers.
Whether the alcohol from beer or wine affects the processing of other drugs isn't clear, says Cynthia Kuhn, a professor of pharmacology at Duke University Medical Center. It is dangerous to use alcohol in combination with sedating drugs like antihistamines, or narcotic pain medicines, because of the additive effect in the brain.
But despite strong warnings on some other drug labels that alcohol can interact in the liver to inhibit metabolism of other medications, the evidence "is not strong," says Dr. Kuhn. Alcohol is mainly metabolized by an enzyme called alcohol dehydrogenase, which "has nothing to do with the metabolism of most drugs," she says.
Some drugs, like dilantin, an epilepsy medication, appear to be affected by the amount of fat in the diet, according to a 2004 study.
Such medicines are dissolved only in fats and could therefore become less effective by a significant reduction in fat consumption.
Experts suggest that patients considering major dietary changes, such as switching to a much lower fat diet from a high-fat one, should discuss the move with their doctor.
Write to Shirley S. Wang at shirley.wang@wsj.com
Pharmacists often warn people not to mix anti-cholesterol drugs known as statins with grapefruit juice. Newer research suggests that other fruit juices, including cranberry and pomegranate, as well as olive oil may also interfere with how statins work in the body. Other laboratory studies show that certain popular teas can block the effect of some medications, including the flu drug Tamiflu. And switching to a low-fat diet, itself a healthy lifestyle change, could reduce the potency of some medications.
Diet can interact with medicine in two main ways. Some foods block the body's ability to absorb certain medications, effectively reducing the dose a person receives. Other foods enhance the absorption of some drugs, which can lead to a possible overdose.
In general, diet will only interact with medications when a person is consuming exceptionally large portions of certain foods, pharmacology and medical experts say. A few teaspoons of olive oil on pasta typically doesn't pose any problems, for instance.
Still, as Americans increasingly select foods based on their health benefits, or take supplements with high doses of nutrients, the likelihood of adverse interactions with medications rises. U.S. sales of supplements, natural and organic foods and functional foods, or foods enhanced beyond normal use like calcium-fortified orange juice, grew to $93.5 billion in 2008 from $47.9 billion in 2000, according to Nutrition Business Journal, a nutrition-industry trade publication.
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{/if}"For every drug there is, there are unintended side effects. You should expect the same thing when taking nutrients at drug levels," says Patrick Stover, director of the division of nutritional sciences at Cornell University in Ithaca, N.Y.
Other factors also can affect how medicines are absorbed in the body, including a person's age, weight and gender. Such variations, combined with possible interactions with the food we eat, can increase or reduce the effective dose of a medication by as much as 5- to 10-fold, which are "huge effects," Dr. Stover says.
Grapefruit is one of the most extensively studied foods for its impact on medication. Compounds in the fruit can increase the potency of statins and other medications to potentially dangerous levels by inhibiting cytochrome P450, a family of enzymes that break down the drug. Research indicates that drinking just one eight-ounce cup of grapefruit juice a day increases the strength of the drug.
Recently, animal and laboratory studies have suggested that other fruits, including pomegranates, oranges (especially those from Seville), cranberries, grapes and black mulberries, could have a similar, although less robust, effect on statins in the body. Pomegranates and cranberries are frequently touted as healthy foods because of their high quantities of antioxidants, which supposedly remove free radicals from the body and slow the onset of disease and aging.
In the lab, some scientists' work raises similar concern about olive oil and some statins. The oil, a principal part of the Mediterranean diet and believed to lower the risk of heart disease, also appears to contain compounds that inhibit the drug's breakdown, according to researchers in Spain. The effects of olive oil likely aren't as strong as that of grapefruit, but more studies are needed to figure out what quantities might actually impact humans, say experts.
John Thor Arnason, a biologist at the University of Ottawa, and his colleague Brian Foster of Health Canada, a government ministry, have investigated the effect on drugs of more than 450 food products, mainly in animal and laboratory studies.
The scientists continue to study potential food-drug interactions, as do other researchers world-wide.
In one recent study, Dr. Arnason's team examined dozens of different kinds of beers. They found that the "hoppier" or more bitter beers reduced the effect of the cancer drug Tamoxifen, when compared with beers that were less hopped. The study was published this year in the Journal of Agricultural and Food Chemistry.
Another popular compound, the anti-oxidant resveratrol found in red wine, nuts and dark chocolate, is touted for its anti-aging benefits. But resveratrol in large quantities appears to potentially enhance the potency of drugs, other laboratory studies show.
People, especially older adults taking multiple medications, should tell their doctor about dietary supplements, if they are using high-potency juices and teas and drinking lots of wine, Dr. Arnason says. He says that drugs whose labels contain lots of conditions and warnings about possible interactions with other medications are probably more likely also to interact with foods. If a food-drug interaction is suspected, patients should stop taking the food and talk to their doctor immediately.
In work published this year, Drs. Arnason and Foster showed that various herbs including chai hu, Labrador tea, echinacea and goldenseal, can reduce the potency of Tamiflu. The researchers incubated Tamiflu by itself or along with herbs, together with human liver tissue, which is responsible for processing the medication in the body. They found that the drug was less activated in the presence of the herbs.
The herbs are believed to proffer different health benefits. Labrador tea is thought to benefit the nervous system, Chai Hu to treat common cold and fever, and Echinacea is thought to prevent colds and have anti-tumor benefits. Goldenseal is an anti-microbial and anti-inflammatory product.
The researchers also have studied black tea, which is touted for lowering blood pressure, and found that it appears to inhibit an enzyme responsible for the body's processing of many drugs. The result, the researchers found, is that consuming large quantities of black tea could potentially increase the potency of a wide range of medications.
Others researchers have investigated spices. In one study, piperine, one of the main components of black pepper, increased the potency of the antihistamine Allegra in rats by two-fold compared with animals that took the medicine alone, according to a report in April's Journal of Food Sciences.
Much of the research on teas and other foodstuffs—with the exception of grapefruit—haven't been well-studied in humans, so the exact amount that may cause a harmful effect isn't yet known, say researchers.
Whether the alcohol from beer or wine affects the processing of other drugs isn't clear, says Cynthia Kuhn, a professor of pharmacology at Duke University Medical Center. It is dangerous to use alcohol in combination with sedating drugs like antihistamines, or narcotic pain medicines, because of the additive effect in the brain.
But despite strong warnings on some other drug labels that alcohol can interact in the liver to inhibit metabolism of other medications, the evidence "is not strong," says Dr. Kuhn. Alcohol is mainly metabolized by an enzyme called alcohol dehydrogenase, which "has nothing to do with the metabolism of most drugs," she says.
Some drugs, like dilantin, an epilepsy medication, appear to be affected by the amount of fat in the diet, according to a 2004 study.
Such medicines are dissolved only in fats and could therefore become less effective by a significant reduction in fat consumption.
Experts suggest that patients considering major dietary changes, such as switching to a much lower fat diet from a high-fat one, should discuss the move with their doctor.
Write to Shirley S. Wang at shirley.wang@wsj.com
Tuesday, June 22, 2010
Breast-Feeding Until 4 Months May Protect Infants From Respiratory, GI Infections
From Medscape Medical News
Laurie Barclay, MD
Authors and Disclosures
Physician Rating: 4 stars ( 5 Votes )
Rate This Article:
June 21, 2010 — Breast-feeding until age 4 months is linked to lower rates of respiratory and gastrointestinal (GI) infection morbidity, according to the results of a population-based, prospective, cohort study reported online June 21 in Pediatrics.
"Exclusive breastfeeding seems to decrease the risk of infectious diseases in infancy," Liesbeth Duijts, MD, PhD, from Erasmus Medical Center in Rotterdam, the Netherlands. "However, the World Health Organization has called for more research regarding the benefits for 6 months instead of 4 months of exclusive breastfeeding."
The goal of this study, which was embedded in the Generation R Study, a study from fetal life onward in the Netherlands, was to evaluate the associations of duration of exclusive breast-feeding with upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), and GI tract infections in infancy.
There were 4164 subjects who completed questionnaires on rates of breast-feeding during the first 6 months (never; partial for < 4 months, not thereafter; partial for 4 - 6 months; exclusive for 4 months, not thereafter; exclusive for 4 months, partial thereafter; and exclusive for 6 months) and doctor-attended URTI, LRTI, and GI infections until age 12 months.
Risks for URTI, LRTI, and GI tract infection until age 6 months were lower in infants who were breast-fed exclusively until age 4 months and partially thereafter vs infants who were never breast-fed. Adjusted odds ratios (ORs) were 0.65 (95% confidence interval [CI], 0.51 - 0.83) for URTI, 0.50 (95% CI, 0.32 - 0.79) for LRTI, and 0.41 (95% CI, 0.26 -0.64) for GI tract infection. The adjusted OR for LRTIs in infants between the ages of 7 and 12 months was 0.46 (95% CI, 0.31 - 0.69).
For infants who were exclusively breast-fed for at least 6 months, trends were similar. However, partial breast-feeding, even for 6 months, was not associated with significantly lower risks for these infections.
"Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants," the study authors write. "Our findings support health policy strategies to promote exclusive breastfeeding for at least 4 months, but preferably 6 months, in industrialized countries."
Limitations of this study include questionnaires with breast-feeding data available for only 65% of eligible participants of the Generation R Study and possible misclassification related to questionnaire use.
"Biological, cultural, and social constraints related to breastfeeding habits need to be studied more extensively," the study authors write. "The effects of prolonged and exclusive breastfeeding on infectious diseases at older ages in industrialized countries remain to be studied."
Exclusive breast-feeding until age 4 months and partially thereafter was associated with a significant reduction of respiratory and GI morbidity rates in infants.
The first phase of the Generation R Study was funded by Erasmus Medical Center, Erasmus University Rotterdam, and Netherlands Organization for Health Research and Development (Zon Mw). The present study was supported by an additional grant from Stichting W. H. Kröger (00–048) and AGS Kinderstichting. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online June 21, 2010
Laurie Barclay, MD
Authors and Disclosures
Physician Rating: 4 stars ( 5 Votes )
Rate This Article:
June 21, 2010 — Breast-feeding until age 4 months is linked to lower rates of respiratory and gastrointestinal (GI) infection morbidity, according to the results of a population-based, prospective, cohort study reported online June 21 in Pediatrics.
"Exclusive breastfeeding seems to decrease the risk of infectious diseases in infancy," Liesbeth Duijts, MD, PhD, from Erasmus Medical Center in Rotterdam, the Netherlands. "However, the World Health Organization has called for more research regarding the benefits for 6 months instead of 4 months of exclusive breastfeeding."
The goal of this study, which was embedded in the Generation R Study, a study from fetal life onward in the Netherlands, was to evaluate the associations of duration of exclusive breast-feeding with upper respiratory tract infections (URTI), lower respiratory tract infections (LRTI), and GI tract infections in infancy.
There were 4164 subjects who completed questionnaires on rates of breast-feeding during the first 6 months (never; partial for < 4 months, not thereafter; partial for 4 - 6 months; exclusive for 4 months, not thereafter; exclusive for 4 months, partial thereafter; and exclusive for 6 months) and doctor-attended URTI, LRTI, and GI infections until age 12 months.
Risks for URTI, LRTI, and GI tract infection until age 6 months were lower in infants who were breast-fed exclusively until age 4 months and partially thereafter vs infants who were never breast-fed. Adjusted odds ratios (ORs) were 0.65 (95% confidence interval [CI], 0.51 - 0.83) for URTI, 0.50 (95% CI, 0.32 - 0.79) for LRTI, and 0.41 (95% CI, 0.26 -0.64) for GI tract infection. The adjusted OR for LRTIs in infants between the ages of 7 and 12 months was 0.46 (95% CI, 0.31 - 0.69).
For infants who were exclusively breast-fed for at least 6 months, trends were similar. However, partial breast-feeding, even for 6 months, was not associated with significantly lower risks for these infections.
"Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants," the study authors write. "Our findings support health policy strategies to promote exclusive breastfeeding for at least 4 months, but preferably 6 months, in industrialized countries."
Limitations of this study include questionnaires with breast-feeding data available for only 65% of eligible participants of the Generation R Study and possible misclassification related to questionnaire use.
"Biological, cultural, and social constraints related to breastfeeding habits need to be studied more extensively," the study authors write. "The effects of prolonged and exclusive breastfeeding on infectious diseases at older ages in industrialized countries remain to be studied."
Exclusive breast-feeding until age 4 months and partially thereafter was associated with a significant reduction of respiratory and GI morbidity rates in infants.
The first phase of the Generation R Study was funded by Erasmus Medical Center, Erasmus University Rotterdam, and Netherlands Organization for Health Research and Development (Zon Mw). The present study was supported by an additional grant from Stichting W. H. Kröger (00–048) and AGS Kinderstichting. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online June 21, 2010
Study points to unsafe sleep practices as contributor to disparity in infant sleep-related deaths
April 15, 2010 - A study conducted by Children's Memorial Research Center reveals that African American infants are far more likely to die from sleep-related causes than any other ethnic group in Illinois. This statistic is most dramatic in Cook County where infants are 12 times more likely to die from sleep-related causes. The difference between the sleep-related death rate for African Americans and other ethnic groups is smaller in Illinois outside of Cook County, though African American infants are still twice as likely to die from sleep-related causes.
Researchers at Child Health Data Lab which is part of the Mary Ann & J. Milburn Smith Child Health Research Program collected information on infant deaths in Illinois due to sudden infant death syndrome, unintentional suffocation in bed and undetermined causes. Although the actual cause of death cannot be pinpointed in many of these cases, research shows that most of these deaths occur when an infant is in an unsafe sleep situation.
“African American infant mortality is much higher than Caucasian infant mortality across the United States,” says Jenifer Cartland, PhD, director of the research center’s Child Health Data Lab. “In Cook County, sleep-related death is responsible for 20 percent of the African American infant mortality, but it might be prevented by assuring that all infants have a safe place to sleep and that parents are well educated about safe sleep practices.”
Karen Sheehan, MD, MPH, Emergency Medicine, at Children’s Memorial says, “The American Academy of Pediatrics recommends that children should be put to sleep on their backs, in a safety-approved crib (or bassinet for younger children) with a firm mattress, and free from any objects (even blankets or toys) that could cover the baby’s face.”
Parents don’t always have all the knowledge or all the resources they need to put their infant to bed safely. Based on the research, 56.7 percent of the deaths occurred while the infant was sharing a bed with an adult and 30 percent occurred when the baby was sleeping alone, but not in a crib or bassinet (such as on a couch or a pillow on the floor). Few of these infants — only 7.5 percent – were found in safe sleep circumstances, that is, in a crib or bassinet with the baby on his or her back.
The alarming difference among ethnic groups raises the question of what should be done. “Many organizations are now coming together to increase safe sleep awareness,” says Cartland. “We need to get babies alone in their cribs and secure more funding for intervention programs, such as making sure all parents have access to safety-approved, low cost cribs and bassinets and increasing parents’ knowledge about safe sleep.”
Children's Memorial’s Child Health Data Lab performs epidemiological research to identify risks to the health of children and adolescents with the goal to improve health and well-being of children and adolescents in Chicago and Illinois. For more information about the research or to learn about sleep related infant death prevention visit American Academy of Pediatrics, SIDS Illinois, or Children's Memorial Hospital’s Child Health Data Lab.
The Understanding Sleep Related Death study is based off the Illinois Death Reporting System, and was conducted by Children’s Memorial Hospital Child Health Data Lab by Jenifer Cartland, PhD in collaboration with data-providing agencies including Cook County Medical Examiner, the Kane and Peoria County Coroners, the Illinois Department of Public Health and the Chicago Policy Department.
Researchers at Child Health Data Lab which is part of the Mary Ann & J. Milburn Smith Child Health Research Program collected information on infant deaths in Illinois due to sudden infant death syndrome, unintentional suffocation in bed and undetermined causes. Although the actual cause of death cannot be pinpointed in many of these cases, research shows that most of these deaths occur when an infant is in an unsafe sleep situation.
“African American infant mortality is much higher than Caucasian infant mortality across the United States,” says Jenifer Cartland, PhD, director of the research center’s Child Health Data Lab. “In Cook County, sleep-related death is responsible for 20 percent of the African American infant mortality, but it might be prevented by assuring that all infants have a safe place to sleep and that parents are well educated about safe sleep practices.”
Karen Sheehan, MD, MPH, Emergency Medicine, at Children’s Memorial says, “The American Academy of Pediatrics recommends that children should be put to sleep on their backs, in a safety-approved crib (or bassinet for younger children) with a firm mattress, and free from any objects (even blankets or toys) that could cover the baby’s face.”
Parents don’t always have all the knowledge or all the resources they need to put their infant to bed safely. Based on the research, 56.7 percent of the deaths occurred while the infant was sharing a bed with an adult and 30 percent occurred when the baby was sleeping alone, but not in a crib or bassinet (such as on a couch or a pillow on the floor). Few of these infants — only 7.5 percent – were found in safe sleep circumstances, that is, in a crib or bassinet with the baby on his or her back.
The alarming difference among ethnic groups raises the question of what should be done. “Many organizations are now coming together to increase safe sleep awareness,” says Cartland. “We need to get babies alone in their cribs and secure more funding for intervention programs, such as making sure all parents have access to safety-approved, low cost cribs and bassinets and increasing parents’ knowledge about safe sleep.”
Children's Memorial’s Child Health Data Lab performs epidemiological research to identify risks to the health of children and adolescents with the goal to improve health and well-being of children and adolescents in Chicago and Illinois. For more information about the research or to learn about sleep related infant death prevention visit American Academy of Pediatrics, SIDS Illinois, or Children's Memorial Hospital’s Child Health Data Lab.
The Understanding Sleep Related Death study is based off the Illinois Death Reporting System, and was conducted by Children’s Memorial Hospital Child Health Data Lab by Jenifer Cartland, PhD in collaboration with data-providing agencies including Cook County Medical Examiner, the Kane and Peoria County Coroners, the Illinois Department of Public Health and the Chicago Policy Department.
Tuesday, June 15, 2010
Substituting Whole Grains for White Rice May Lower Risk for Type 2 Diabetes
Laurie Barclay, MD
June 14, 2010 — Substituting brown rice or other whole grains for white rice is associated with a lower risk for type 2 diabetes, according to results from the Health Professionals Follow-up Study and the Nurses' Health Study (NHS) I and II reported in the June 14 issue of Archives of Internal Medicine.
"Because of differences in processing and nutrients, brown rice and white rice may have different effects on risk of type 2 diabetes mellitus," write Qi Sun, MD, ScD, from the Harvard School of Public Health in Boston, Massachusetts, and colleagues. "We examined white and brown rice consumption in relation to type 2 diabetes risk prospectively in the Health Professionals Follow-up Study and the Nurses' Health Study I and II."
Diet, lifestyle habits, and disease status were prospectively determined and updated for 39,765 men and 157,463 women in these cohorts.
Higher intake of white rice (≥ 5 servings per week vs < 1 per month) was associated with a greater risk for type 2 diabetes, after multivariate adjustment for age, lifestyle, and other dietary risk factors. Pooled relative risk [RR] was 1.17 (95% confidence interval [CI], 1.02 - 1.36). In contrast, the risk for type 2 diabetes was lower with high intake of brown rice (≥ 2 servings per week vs < 1 per month; pooled RR, 0.89; 95% CI, 0.81 - 0.97).
The investigators estimated that replacing 50 g per day of uncooked white rice (one-third serving per day) with the equivalent amount of brown rice was associated with a 16% lower risk for type 2 diabetes (95% CI, 9% - 21%). For replacement with whole grains as a group, diabetes risk was 36% lower (95% CI, 30% - 42%).
"Substitution of whole grains, including brown rice, for white rice may lower risk of type 2 diabetes," the study authors write. "These data support the recommendation that most carbohydrate intake should come from whole grains rather than refined grains to help prevent type 2 diabetes."
Limitations of this study include study populations primarily consisting of working health professionals with European ancestry, measurement error of rice intake assessment related to use of food frequency questionnaires, possible residual confounding, and lack of oral glucose tolerance test data to confirm diabetes diagnoses.
"The current Dietary Guidelines for Americans identifies grains, including rice, as one of the primary sources for carbohydrate intake and recommends that at least half of carbohydrate intake come from whole grains," the study authors conclude. "From a public health point of view, replacing refined grains such as white rice by whole grains, including brown rice, should be recommended to facilitate the prevention of T2D [type 2 diabetes]."
The National Institutes of Health supported this study. Dr. Sun is supported by a postdoctoral fellowship from Unilever Corporate Research.
Arch Intern Med. 2010;170:961-969.
June 14, 2010 — Substituting brown rice or other whole grains for white rice is associated with a lower risk for type 2 diabetes, according to results from the Health Professionals Follow-up Study and the Nurses' Health Study (NHS) I and II reported in the June 14 issue of Archives of Internal Medicine.
"Because of differences in processing and nutrients, brown rice and white rice may have different effects on risk of type 2 diabetes mellitus," write Qi Sun, MD, ScD, from the Harvard School of Public Health in Boston, Massachusetts, and colleagues. "We examined white and brown rice consumption in relation to type 2 diabetes risk prospectively in the Health Professionals Follow-up Study and the Nurses' Health Study I and II."
Diet, lifestyle habits, and disease status were prospectively determined and updated for 39,765 men and 157,463 women in these cohorts.
Higher intake of white rice (≥ 5 servings per week vs < 1 per month) was associated with a greater risk for type 2 diabetes, after multivariate adjustment for age, lifestyle, and other dietary risk factors. Pooled relative risk [RR] was 1.17 (95% confidence interval [CI], 1.02 - 1.36). In contrast, the risk for type 2 diabetes was lower with high intake of brown rice (≥ 2 servings per week vs < 1 per month; pooled RR, 0.89; 95% CI, 0.81 - 0.97).
The investigators estimated that replacing 50 g per day of uncooked white rice (one-third serving per day) with the equivalent amount of brown rice was associated with a 16% lower risk for type 2 diabetes (95% CI, 9% - 21%). For replacement with whole grains as a group, diabetes risk was 36% lower (95% CI, 30% - 42%).
"Substitution of whole grains, including brown rice, for white rice may lower risk of type 2 diabetes," the study authors write. "These data support the recommendation that most carbohydrate intake should come from whole grains rather than refined grains to help prevent type 2 diabetes."
Limitations of this study include study populations primarily consisting of working health professionals with European ancestry, measurement error of rice intake assessment related to use of food frequency questionnaires, possible residual confounding, and lack of oral glucose tolerance test data to confirm diabetes diagnoses.
"The current Dietary Guidelines for Americans identifies grains, including rice, as one of the primary sources for carbohydrate intake and recommends that at least half of carbohydrate intake come from whole grains," the study authors conclude. "From a public health point of view, replacing refined grains such as white rice by whole grains, including brown rice, should be recommended to facilitate the prevention of T2D [type 2 diabetes]."
The National Institutes of Health supported this study. Dr. Sun is supported by a postdoctoral fellowship from Unilever Corporate Research.
Arch Intern Med. 2010;170:961-969.
New Ads Try to Shock Men Into Going to See the Doctor
Public Health Push Strikes Darkly Humorous Tone to Attack Problem: Men Avoid Care That Could Prevent Future Ills
By LAURA LANDRO
When it comes to their health, men are the weaker sex: They don't get checkups as often as women, are hospitalized more often with preventable illnesses, and they die younger.
Now, just in time for Father's Day, public-health officials are trying to change that. A darkly humorous ad campaign being launched this week aims to tackle the serious issue of an aging generation of men in denial of their health risks.
Laura Landro discusses why some men avoid going to the doctor, and why public health officials have launched a new, darkly funny ad campaign that aims to convince those men to see a physician.
In one TV spot, a family is gathered in their new house with the real-estate broker, who predicts they will have many happy years there. "Except for you," she says to the dad, "because you'll be gone three years from now...struck down by the same disease that got your father."
In a parting shot the broker adds: "Sadly, it could have been detected early with a simple test....but you didn't have it."
About 57% of men have visited the doctor within the past year, compared with about 74% of women, according to surveys by the federal Agency for Healthcare Research and Quality (AHRQ). Black and Hispanic men are even less likely than white men to have routine checkups. At the same time, men are hospitalized at significantly higher rates than women for preventable conditions such as congestive heart failure and complications of diabetes and pneumonia that can be prevented with a vaccination.
While there is no scientific evidence as to why men avoid doctors, many physicians attribute it to a macho culture which equates doctor visits with weakness, reluctance to undergo tests such as rectal and prostate exams and fear of finding out that something might be wrong.
The Department of Health and Human Services is launching a new public service ad campaign aimed at convincing men to get more preventive checkups.
"Most men who are young think they are immortal, and unless they've gone to war they never feel their lives are at risk," says heart surgeon Mehmet Oz, whose medical TV show and website, doctoroz.com, will promote the campaign and link to the ads. In addition to targeting men, he says, the aim is to persuade families to nudge them into getting checkups.
Women tend to be more engaged in their health care from puberty as they visit gynecologists and, later, obstetricians for childbearing. But even excluding reproductive needs, women are more likely to seek care than men, says Carolyn Clancy, director of the AHRQ, which worked with the Ad Council on the public-service campaign. The gender differences are obvious early, she says: In one study of 8- and 9-year-old campers with headaches, girls were more likely than boys to see the camp nurse.
A list of recommended preventive screenings for men will be available this week at AHRQ.gov/healthymen, or by calling 1-800-358-9295. All men should have their body-mass index assessed to screen for obesity; starting at 35, they should have their cholesterol checked regularly, and a blood-pressure check is recommended every two years. Men with high blood pressure or high cholesterol should also be screened for diabetes. Men aged 65 to 75 need a test for an abdominal aortic aneurysm if they have ever smoked. At 50, they should get a colorectal-cancer screening test, unless there is a family history of the disease, in which case patients may need to be screened earlier.
[MANHEALTH]
Men are also urged to talk to their doctor about being screened for depression if they have felt "down, hopeless or sad" over a two-week period or have felt "little pleasure or interest in doing things." And depending on their sexual habits—-a list of risk factors is available on the website—-men should be screened for sexually transmitted diseases including HIV.
The screening recommendations were developed by the U.S. Preventive Services Task Force, which uses scientific evidence of their effectiveness to determine whether to recommend a test for routine use. Medicare and private insurers may cover other tests, such as prostate-cancer screening; AHRQ advises men to talk to their doctors about diseases for which tests aren't routinely recommended including prostate and skin cancers.
Striking a long-term relationship with a primary care doctor can help ease men out of their fear and avoidance, and make it easier to spot changes and diagnose problems, says Sharon Orrange, an internist and assistant professor at University of Southern California in Los Angeles.
One of her patients, Kevin Ash, now 53, began getting regular checkups after he was 40; Dr. Orrange picked up on some symptoms over time, and diagnosed him with pernicious anemia, an inability to absorb vitamin B-12 which results in a decrease in red blood cells and can cause damage to nerves and organs. The deficiency can be treated with injections of the vitamin.
[manHealth2] Agency for Healthcare Research and Quality / Ad Council
A new ad campaign takes aim at men who avoid checkups and urges their families to push them to act.
"Guys are more afraid of finding something is wrong, so it's easier not to go to the doctor," says Mr. Ash, who says he was initially worried about getting a blood test because it might have shown cancer. "One of the best feelings is to have a doctor who knows you, and who you are not afraid to say anything to, and vice versa."
As men age they are also at higher risk for a number of other issues such as osteoporosis, says John Morley, an endocrinologist and geriatrics specialist at Saint Louis University School of Medicine in Missouri. Dr. Morley, who recommends that by 70, all men should have their bone-mineral density measured. (The U.S. task force recommends osteoporosis screenings only for women over 65.)
He says men who experience erectile dysfunction should also be screened for its most common cause, vascular disease, which if left untreated, can put men at high risk for heart attack or stroke.
By LAURA LANDRO
When it comes to their health, men are the weaker sex: They don't get checkups as often as women, are hospitalized more often with preventable illnesses, and they die younger.
Now, just in time for Father's Day, public-health officials are trying to change that. A darkly humorous ad campaign being launched this week aims to tackle the serious issue of an aging generation of men in denial of their health risks.
Laura Landro discusses why some men avoid going to the doctor, and why public health officials have launched a new, darkly funny ad campaign that aims to convince those men to see a physician.
In one TV spot, a family is gathered in their new house with the real-estate broker, who predicts they will have many happy years there. "Except for you," she says to the dad, "because you'll be gone three years from now...struck down by the same disease that got your father."
In a parting shot the broker adds: "Sadly, it could have been detected early with a simple test....but you didn't have it."
About 57% of men have visited the doctor within the past year, compared with about 74% of women, according to surveys by the federal Agency for Healthcare Research and Quality (AHRQ). Black and Hispanic men are even less likely than white men to have routine checkups. At the same time, men are hospitalized at significantly higher rates than women for preventable conditions such as congestive heart failure and complications of diabetes and pneumonia that can be prevented with a vaccination.
While there is no scientific evidence as to why men avoid doctors, many physicians attribute it to a macho culture which equates doctor visits with weakness, reluctance to undergo tests such as rectal and prostate exams and fear of finding out that something might be wrong.
The Department of Health and Human Services is launching a new public service ad campaign aimed at convincing men to get more preventive checkups.
"Most men who are young think they are immortal, and unless they've gone to war they never feel their lives are at risk," says heart surgeon Mehmet Oz, whose medical TV show and website, doctoroz.com, will promote the campaign and link to the ads. In addition to targeting men, he says, the aim is to persuade families to nudge them into getting checkups.
Women tend to be more engaged in their health care from puberty as they visit gynecologists and, later, obstetricians for childbearing. But even excluding reproductive needs, women are more likely to seek care than men, says Carolyn Clancy, director of the AHRQ, which worked with the Ad Council on the public-service campaign. The gender differences are obvious early, she says: In one study of 8- and 9-year-old campers with headaches, girls were more likely than boys to see the camp nurse.
A list of recommended preventive screenings for men will be available this week at AHRQ.gov/healthymen, or by calling 1-800-358-9295. All men should have their body-mass index assessed to screen for obesity; starting at 35, they should have their cholesterol checked regularly, and a blood-pressure check is recommended every two years. Men with high blood pressure or high cholesterol should also be screened for diabetes. Men aged 65 to 75 need a test for an abdominal aortic aneurysm if they have ever smoked. At 50, they should get a colorectal-cancer screening test, unless there is a family history of the disease, in which case patients may need to be screened earlier.
[MANHEALTH]
Men are also urged to talk to their doctor about being screened for depression if they have felt "down, hopeless or sad" over a two-week period or have felt "little pleasure or interest in doing things." And depending on their sexual habits—-a list of risk factors is available on the website—-men should be screened for sexually transmitted diseases including HIV.
The screening recommendations were developed by the U.S. Preventive Services Task Force, which uses scientific evidence of their effectiveness to determine whether to recommend a test for routine use. Medicare and private insurers may cover other tests, such as prostate-cancer screening; AHRQ advises men to talk to their doctors about diseases for which tests aren't routinely recommended including prostate and skin cancers.
Striking a long-term relationship with a primary care doctor can help ease men out of their fear and avoidance, and make it easier to spot changes and diagnose problems, says Sharon Orrange, an internist and assistant professor at University of Southern California in Los Angeles.
One of her patients, Kevin Ash, now 53, began getting regular checkups after he was 40; Dr. Orrange picked up on some symptoms over time, and diagnosed him with pernicious anemia, an inability to absorb vitamin B-12 which results in a decrease in red blood cells and can cause damage to nerves and organs. The deficiency can be treated with injections of the vitamin.
[manHealth2] Agency for Healthcare Research and Quality / Ad Council
A new ad campaign takes aim at men who avoid checkups and urges their families to push them to act.
"Guys are more afraid of finding something is wrong, so it's easier not to go to the doctor," says Mr. Ash, who says he was initially worried about getting a blood test because it might have shown cancer. "One of the best feelings is to have a doctor who knows you, and who you are not afraid to say anything to, and vice versa."
As men age they are also at higher risk for a number of other issues such as osteoporosis, says John Morley, an endocrinologist and geriatrics specialist at Saint Louis University School of Medicine in Missouri. Dr. Morley, who recommends that by 70, all men should have their bone-mineral density measured. (The U.S. task force recommends osteoporosis screenings only for women over 65.)
He says men who experience erectile dysfunction should also be screened for its most common cause, vascular disease, which if left untreated, can put men at high risk for heart attack or stroke.
Friday, June 11, 2010
Why Do People Get More Skin Cancer on Their Left Side?
by: Susan Kreimer | from: AARP Bulletin | June 1, 2010
A new study confirms what many dermatologists have suspected all along: Sun exposure while driving may account for more skin cancer on the left side than on the right.
Sunscreen, then, isn’t just for sun worshipers, gardeners and other outdoor types. It’s important even when driving.
The ultraviolet radiation that passes through window glass, sunroofs or convertible tops may contribute to melanoma and other skin cancers.
In this study—appearing in the Journal of the American Academy of Dermatology—left-sided skin cancer was more common in men.
Senior researcher Scott Fosko, M.D., head of dermatology at Saint Louis University, says the damage builds up over time. “You can see many effects with chronic exposure.”
Researchers reviewed the charts of skin cancer patients at the university in 2004. Of 890 patients with skin cancer, 52.6 percent had skin cancer on the left side of the face or body. They found there were significantly more skin cancers on the left side of the body in men—especially on exposed areas of the head and neck.
The researchers speculated that perhaps older generations of women—the average age of those in the study was 68—tended to be passengers sitting on the right side and men tended to drive more.
What about people in countries who drive on the left side of the road? An older Australian study found that precancerous sun spots were more common on the right side of the faces of Australian men, who typically drove, and the left side of the faces of Australian women, who were usually passengers. The study backs up the theory that exposure while driving explains the difference.
Alan Lewis, M.D., director of dermatology surgery at Tulane University in New Orleans, says the latest study was a good one. “When you’re going outdoors for any reason, you should definitely think about applying a sunscreen with an SPF 30 or higher,” he says. Check the label to make sure it blocks both UVA and UVB rays.
Even while indoors near a window, wearing sunscreen is a good idea, says Sarah Tuttleton Arron, M.D., director of the skin cancer unit at the University of California at San Francisco.
“A little bit of UV exposure is like a little bit of smoking, so I recommend sun protection all the time,” she says, adding that tinted car windows with UV-protection can also contribute to your safety.
A new study confirms what many dermatologists have suspected all along: Sun exposure while driving may account for more skin cancer on the left side than on the right.
Sunscreen, then, isn’t just for sun worshipers, gardeners and other outdoor types. It’s important even when driving.
The ultraviolet radiation that passes through window glass, sunroofs or convertible tops may contribute to melanoma and other skin cancers.
In this study—appearing in the Journal of the American Academy of Dermatology—left-sided skin cancer was more common in men.
Senior researcher Scott Fosko, M.D., head of dermatology at Saint Louis University, says the damage builds up over time. “You can see many effects with chronic exposure.”
Researchers reviewed the charts of skin cancer patients at the university in 2004. Of 890 patients with skin cancer, 52.6 percent had skin cancer on the left side of the face or body. They found there were significantly more skin cancers on the left side of the body in men—especially on exposed areas of the head and neck.
The researchers speculated that perhaps older generations of women—the average age of those in the study was 68—tended to be passengers sitting on the right side and men tended to drive more.
What about people in countries who drive on the left side of the road? An older Australian study found that precancerous sun spots were more common on the right side of the faces of Australian men, who typically drove, and the left side of the faces of Australian women, who were usually passengers. The study backs up the theory that exposure while driving explains the difference.
Alan Lewis, M.D., director of dermatology surgery at Tulane University in New Orleans, says the latest study was a good one. “When you’re going outdoors for any reason, you should definitely think about applying a sunscreen with an SPF 30 or higher,” he says. Check the label to make sure it blocks both UVA and UVB rays.
Even while indoors near a window, wearing sunscreen is a good idea, says Sarah Tuttleton Arron, M.D., director of the skin cancer unit at the University of California at San Francisco.
“A little bit of UV exposure is like a little bit of smoking, so I recommend sun protection all the time,” she says, adding that tinted car windows with UV-protection can also contribute to your safety.
Hospital Room Modifications May Result in Better Care
By SUZANNE SATALINE
A nurse's assistant stocks a two-way cabinet designed to reduce traffic in patient rooms.
PRINCETON, N.J.—The room's soft white lighting illuminates a wall of etched glass and blond wood. There's hand-laid tile in the shower and the couch unfolds, letting family members stay. Even the shape of this hospital room is quirky, with walls that hide wires and tubing and slant so the occupant will better see the leafy treetops through large windows.
It's peaceful, perhaps practical, and it could be the hospital patient room of the future.
The staff at the University Medical Center at Princeton will soon assign one patient at a time to this newly built room, designed partly with staff input, housed on a post-surgical floor. Designed using research funded with a $2.8 million grant from the Robert Wood Johnson Foundation, the room has ushered Princeton into the growing field of health-care design.
Architects and health-care centers are seeking to prove that a room's layout and accessories can help patients heal faster and cut down on mishaps and staff error, as some research has shown.
"Once we put patients in here, we'll see if everything is right," says Susan G. Lorenz, Princeton's chief nursing officer, who helped design the room.
More hospitals have started to rethink how patient rooms can improve the occupant's health. They're seeking to reduce the spread of infections, the rise in patient falls, and the healing benefits of outdoor views. Patient falls are common in hospitals, and 10% of fatal falls by older adults happen there, according to data compiled by the Institute for Healthcare Improvement. Single rooms are becoming standard, Ms. Lorenz said, because research shows that the privacy reduces infection rates and enhances communication between staff and patients.
Hospital officials say they'll know if features in the model room have improved care in roughly 18 months, when researchers compare data with what they collect from the existing rooms, the control group.
If the design elements work, the single-bed room will be copied for all the rooms in the center's new 237-bed replacement hospital, a $447 million construction project rising nearby in Plainsboro, said Barry Rabner, president and CEO of Princeton HealthCare System, the hospital's parent.
Staff at Princeton, a nonprofit that's separate from the university of that name, hopes to find that patients fall less often because the toilet is near the head of the bed, making the path to the bathroom shorter than in a typical room, says Ms. Lorenz, who earned a Ph.D. in hospital design. A specially designed grab rail on the wall shine a light where patients will be stepping.
She'll also be measuring if having a separate sink near the door prompts more staff members to wash their hands, a major source of spreading hospital infections.
The room's bed can sink low to the ground, also to reduce falls, and weigh a patient without getting them to rise and step aboard a scale, she said.
But the room is a work in progress: The paper-towel holder is terrible, she decreed, with paper coming out by the dozens, and the staff has said the sink in the new room must be changed because the raised bowl will be a slippery and dangerous grabbing spot for elderly patients.
The room has two-way cabinets, allowing housekeeping staff to resupply the linen and medicines from the hallway, and letting clinical staff grab them from inside the patient's room. That may help reduce traffic in patient rooms and therefore, infection rates. But Lopa Patel, a floor nurse, said that staff must still walk in and out, fetching antibiotics and narcotics from elsewhere.
Princeton has joined about 50 hospitals world-wide as health-care design labs, a project of the Center for Health Design in Concord, Calif., that is researching how design has helped patients and staff, says Rosalyn Cama, a health-care designer and member of the center's board of directors. Ms. Cama is a consultant for Princeton's project.
Many hospitals have developed mock patient rooms, usually outside the hospital, to study a room's features. By building the real thing on a patient floor, Princeton has given researchers an ideal way to test if design ideas work, said Kirk Hamilton, an associate architecture professor at Texas A&M University.
"Over the last decade there's been a resurgence in the recognition that patient towers had aged and not kept up," said Mr. Hamilton, editor of Health Environment Research and Design Journal, which is interested in publishing the results of Princeton's findings. "Princeton is one of those that has made a commitment to do measurement."
Some patients will be assigned to the room at random, hospital officials said, other times, staff will admit patients with certain characteristics, such as people 65 years and older who have a condition that would put them at risk of falling. These patients would be matched to similar patients in traditional rooms, to observe how the model room performs in comparison.
Patients will have to give their consent before participating in any part of the research. Patients in the model room will be billed at the same rate as in a traditional room.
The new room draws the attention of patients and visitors. Renee Shields wandered in last week, on a break from caring for her 87-year-old mother, a former nurse at the hospital and now a patient after a fall. Ms. Shields lay on the bed, enthused about the large tiled shower and fold-out couch, and liked that the digital clock beamed the day of the week.
"It's hotel-like" she said. "I wonder if health-care costs are going to go up. Everybody will want to come to Princeton."
Write to Suzanne Sataline at Suzanne.Sataline@wsj.com
A nurse's assistant stocks a two-way cabinet designed to reduce traffic in patient rooms.
PRINCETON, N.J.—The room's soft white lighting illuminates a wall of etched glass and blond wood. There's hand-laid tile in the shower and the couch unfolds, letting family members stay. Even the shape of this hospital room is quirky, with walls that hide wires and tubing and slant so the occupant will better see the leafy treetops through large windows.
It's peaceful, perhaps practical, and it could be the hospital patient room of the future.
The staff at the University Medical Center at Princeton will soon assign one patient at a time to this newly built room, designed partly with staff input, housed on a post-surgical floor. Designed using research funded with a $2.8 million grant from the Robert Wood Johnson Foundation, the room has ushered Princeton into the growing field of health-care design.
Architects and health-care centers are seeking to prove that a room's layout and accessories can help patients heal faster and cut down on mishaps and staff error, as some research has shown.
"Once we put patients in here, we'll see if everything is right," says Susan G. Lorenz, Princeton's chief nursing officer, who helped design the room.
More hospitals have started to rethink how patient rooms can improve the occupant's health. They're seeking to reduce the spread of infections, the rise in patient falls, and the healing benefits of outdoor views. Patient falls are common in hospitals, and 10% of fatal falls by older adults happen there, according to data compiled by the Institute for Healthcare Improvement. Single rooms are becoming standard, Ms. Lorenz said, because research shows that the privacy reduces infection rates and enhances communication between staff and patients.
Hospital officials say they'll know if features in the model room have improved care in roughly 18 months, when researchers compare data with what they collect from the existing rooms, the control group.
If the design elements work, the single-bed room will be copied for all the rooms in the center's new 237-bed replacement hospital, a $447 million construction project rising nearby in Plainsboro, said Barry Rabner, president and CEO of Princeton HealthCare System, the hospital's parent.
Staff at Princeton, a nonprofit that's separate from the university of that name, hopes to find that patients fall less often because the toilet is near the head of the bed, making the path to the bathroom shorter than in a typical room, says Ms. Lorenz, who earned a Ph.D. in hospital design. A specially designed grab rail on the wall shine a light where patients will be stepping.
She'll also be measuring if having a separate sink near the door prompts more staff members to wash their hands, a major source of spreading hospital infections.
The room's bed can sink low to the ground, also to reduce falls, and weigh a patient without getting them to rise and step aboard a scale, she said.
But the room is a work in progress: The paper-towel holder is terrible, she decreed, with paper coming out by the dozens, and the staff has said the sink in the new room must be changed because the raised bowl will be a slippery and dangerous grabbing spot for elderly patients.
The room has two-way cabinets, allowing housekeeping staff to resupply the linen and medicines from the hallway, and letting clinical staff grab them from inside the patient's room. That may help reduce traffic in patient rooms and therefore, infection rates. But Lopa Patel, a floor nurse, said that staff must still walk in and out, fetching antibiotics and narcotics from elsewhere.
Princeton has joined about 50 hospitals world-wide as health-care design labs, a project of the Center for Health Design in Concord, Calif., that is researching how design has helped patients and staff, says Rosalyn Cama, a health-care designer and member of the center's board of directors. Ms. Cama is a consultant for Princeton's project.
Many hospitals have developed mock patient rooms, usually outside the hospital, to study a room's features. By building the real thing on a patient floor, Princeton has given researchers an ideal way to test if design ideas work, said Kirk Hamilton, an associate architecture professor at Texas A&M University.
"Over the last decade there's been a resurgence in the recognition that patient towers had aged and not kept up," said Mr. Hamilton, editor of Health Environment Research and Design Journal, which is interested in publishing the results of Princeton's findings. "Princeton is one of those that has made a commitment to do measurement."
Some patients will be assigned to the room at random, hospital officials said, other times, staff will admit patients with certain characteristics, such as people 65 years and older who have a condition that would put them at risk of falling. These patients would be matched to similar patients in traditional rooms, to observe how the model room performs in comparison.
Patients will have to give their consent before participating in any part of the research. Patients in the model room will be billed at the same rate as in a traditional room.
The new room draws the attention of patients and visitors. Renee Shields wandered in last week, on a break from caring for her 87-year-old mother, a former nurse at the hospital and now a patient after a fall. Ms. Shields lay on the bed, enthused about the large tiled shower and fold-out couch, and liked that the digital clock beamed the day of the week.
"It's hotel-like" she said. "I wonder if health-care costs are going to go up. Everybody will want to come to Princeton."
Write to Suzanne Sataline at Suzanne.Sataline@wsj.com
Thursday, June 10, 2010
Calorie Counts in Restaurants Goes National
New York Menu Sets New Standard
by DEVLIN BARRETT
Sen. Kirsten Gillibrand wants to put U.S. on a N.Y. diet.
When out-of-towners come to New York, they often notice the calorie counts prominently displayed in chain restaurants. Those same displays will eventually be on menus across the country, part of a broader effort by Ms. Gillibrand to spread New York's diet and safety standards to the entire U.S.
The nation's eating habits are no longer purely a cultural debate; the health-care legislation passed this year means that more than ever, taxpayers will have a financial stake in the average American's health and diet.
Journal Community
All the more reason, Ms. Gillibrand said, for the calorie-count rule to go beyond the five boroughs. The calorie rule goes into effect next year as part of the health-care legislation, and will apply to chain restaurants with 20 locations or more.
Ms. Gillibrand, a mother of two, is also pushing for public schools across the country to ban trans-fats in food, just as New York City banned them in 2008. And she's advocating legislation that would spur grocery stores to open in underserved areas.
"Every place is different, but these are broad, common-sense ideas that would help all families," said the senator. "It doesn't matter whether you're living in New York or Des Moines, Iowa, trans-fats will give you heart disease."
Such efforts can rankle those who think the measures are micromanaging consumer choices.
Radley Balko, a senior editor at the libertarian magazine Reason who covers the obesity debate, pointed out that for years customers at fast-food chains have been able to request the nutritional content of items on the menu.
"The problem hasn't been that people can't get this information," he said. "I think what the public-health people want is to smack people in the head with it. What's next? At some point they are going to want to dictate what restaurants put on their menus."
Ms. Gillibrand's supporters, including Rachael Ray, the television personality best known for her 30-minute meals, argue the country's obesity epidemic requires concrete steps to protect children from a lifetime of unhealthy eating habits.
City Council Speaker Christine Quinn, who has worked with the senator on the food initiatives, said what's good for New York "is definitely good for the rest of the country, everybody knows that. Whether they're willing or brave enough to admit it is a different question."
The Democratic senator's positions on food highlight one of the quirks of her work in Congress: She is the first New York senator in decades to sit on the Agriculture Committee.
That may seem an odd fit, but Manhattan Borough President Scott Stringer said she has redefined the role to focus on getting healthy, fresh food to large urban areas, which he insisted will be an important issue for years to come.
by DEVLIN BARRETT
Sen. Kirsten Gillibrand wants to put U.S. on a N.Y. diet.
When out-of-towners come to New York, they often notice the calorie counts prominently displayed in chain restaurants. Those same displays will eventually be on menus across the country, part of a broader effort by Ms. Gillibrand to spread New York's diet and safety standards to the entire U.S.
The nation's eating habits are no longer purely a cultural debate; the health-care legislation passed this year means that more than ever, taxpayers will have a financial stake in the average American's health and diet.
Journal Community
All the more reason, Ms. Gillibrand said, for the calorie-count rule to go beyond the five boroughs. The calorie rule goes into effect next year as part of the health-care legislation, and will apply to chain restaurants with 20 locations or more.
Ms. Gillibrand, a mother of two, is also pushing for public schools across the country to ban trans-fats in food, just as New York City banned them in 2008. And she's advocating legislation that would spur grocery stores to open in underserved areas.
"Every place is different, but these are broad, common-sense ideas that would help all families," said the senator. "It doesn't matter whether you're living in New York or Des Moines, Iowa, trans-fats will give you heart disease."
Such efforts can rankle those who think the measures are micromanaging consumer choices.
Radley Balko, a senior editor at the libertarian magazine Reason who covers the obesity debate, pointed out that for years customers at fast-food chains have been able to request the nutritional content of items on the menu.
"The problem hasn't been that people can't get this information," he said. "I think what the public-health people want is to smack people in the head with it. What's next? At some point they are going to want to dictate what restaurants put on their menus."
Ms. Gillibrand's supporters, including Rachael Ray, the television personality best known for her 30-minute meals, argue the country's obesity epidemic requires concrete steps to protect children from a lifetime of unhealthy eating habits.
City Council Speaker Christine Quinn, who has worked with the senator on the food initiatives, said what's good for New York "is definitely good for the rest of the country, everybody knows that. Whether they're willing or brave enough to admit it is a different question."
The Democratic senator's positions on food highlight one of the quirks of her work in Congress: She is the first New York senator in decades to sit on the Agriculture Committee.
That may seem an odd fit, but Manhattan Borough President Scott Stringer said she has redefined the role to focus on getting healthy, fresh food to large urban areas, which he insisted will be an important issue for years to come.
Thursday, June 3, 2010
Breast-Feeding Linked to Lower Incidence of Fever After Immunizations
May 19, 2010 — Breast-feeding is linked to a lower incidence of fever after immunizations, according to the results of a prospective cohort study reported online May 17 in Pediatrics.
"Immune response to some vaccines is different among breastfed infants compared with those who are not breastfed," write Alfredo Pisacane, MD, from Università Federico II in Napoli, Italy, and colleagues. "The objective of this study was to evaluate the effects of breastfeeding on the risk for fever after routine immunizations."
At a pediatric vaccination center in Naples, Italy, mothers of infants scheduled for routine vaccinations were told how to measure and record infant temperature on the evening that the immunization was administered and for the next 3 days. On the third day after vaccination, mothers were phoned to determine the incidence of fever. After adjustment for vaccine dose, maternal educational level and smoking status, and number of other children in the household, multivariate analyses allowed estimation of the relative risk for fever in relationship to the type of breast-feeding.
Of 460 infants recruited, outcome data were available for 450 (98%). Fever was reported in 30 (25%) of exclusively breast-fed infants, in 48 (31%) of partially breast-fed infants, and in 94 (53%) of infants who were not breast-fed at all (P < .01). Among infants who were exclusively breast-fed, the relative risk for fever was 0.46 (95% confidence interval [CI], 0.33 - 0.66), and it was 0.58 (95% CI, 0.44 - 0.77) among partially breast-fed infants.
"The protection conferred by breastfeeding persisted even when considering the role of several potential confounders," the study authors write. "In this study, breastfeeding was associated with a decreased incidence of fever after immunizations."
Limitations of this study include body temperatures taken by the mothers rather than by health professionals and the possibility that fever after immunization could be an infective episode.
"Breastfeeding seems to be associated with a reduced risk for fever after immunization, but additional, well organized studies are needed," the study authors conclude. "The design of such studies should include more objective research methods, such as measurements taken by health care professionals at the same time of the day or night, and should evaluate the role of mild intercurrent infections by medical monitoring."
The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online May 17, 2010.
"Immune response to some vaccines is different among breastfed infants compared with those who are not breastfed," write Alfredo Pisacane, MD, from Università Federico II in Napoli, Italy, and colleagues. "The objective of this study was to evaluate the effects of breastfeeding on the risk for fever after routine immunizations."
At a pediatric vaccination center in Naples, Italy, mothers of infants scheduled for routine vaccinations were told how to measure and record infant temperature on the evening that the immunization was administered and for the next 3 days. On the third day after vaccination, mothers were phoned to determine the incidence of fever. After adjustment for vaccine dose, maternal educational level and smoking status, and number of other children in the household, multivariate analyses allowed estimation of the relative risk for fever in relationship to the type of breast-feeding.
Of 460 infants recruited, outcome data were available for 450 (98%). Fever was reported in 30 (25%) of exclusively breast-fed infants, in 48 (31%) of partially breast-fed infants, and in 94 (53%) of infants who were not breast-fed at all (P < .01). Among infants who were exclusively breast-fed, the relative risk for fever was 0.46 (95% confidence interval [CI], 0.33 - 0.66), and it was 0.58 (95% CI, 0.44 - 0.77) among partially breast-fed infants.
"The protection conferred by breastfeeding persisted even when considering the role of several potential confounders," the study authors write. "In this study, breastfeeding was associated with a decreased incidence of fever after immunizations."
Limitations of this study include body temperatures taken by the mothers rather than by health professionals and the possibility that fever after immunization could be an infective episode.
"Breastfeeding seems to be associated with a reduced risk for fever after immunization, but additional, well organized studies are needed," the study authors conclude. "The design of such studies should include more objective research methods, such as measurements taken by health care professionals at the same time of the day or night, and should evaluate the role of mild intercurrent infections by medical monitoring."
The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online May 17, 2010.
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