Sept. 8, 2008

A mother's mood plays a central role in her newborn's sleeping and waking patterns.

Babies whose mothers experienced depression or mood problems before or during pregnancy have more chaotic sleep problems in the first six months of life, according to University of Michigan researchers.

These infants nap more during the day, take longer to settle down to sleep at night, and wake more often throughout the night than babies born to non-depressed moms.

Infants need more sleep than adults, although they tend to sleep in shorter chunks throughout the day and night during the first months of life.

The mothers participating in the study wore actigraphs during the last trimester. The babies were fitted with actigraphs from two weeks of age until eight months. Babies born to mothers with a history of depression had little or no evidence of an in-born 24-hour circadian rhythm during the eight months of the study.

Mothers with a history of depression should pay close attention to the conditions they create for their infants' sleep, advise the researchers. They should establish rituals around bedtime to help infants distinguish between night sleep and day sleep, for instance, putting babies in day clothes for naps and pajamas for night sleeping helps babies pick up these cues. Keeping babies around bright light during the day will help them develop circadian rhythms linked to light cycles. 

Sept. 3, 2008

The systematic inflammation associated with obesity has long been a suspect for the prevalence of asthma in obese patients. But a study published in the September 1 issue of the American Journal of Respiratory and Critical Care Medicine ruled out inflammation as a smoking gun.

Researchers from the University of Otago in New Zealand hypothesized that low-grade systematic inflammation present in obese patients would amplify airway inflammation. To test this hypothesis, researchers recruited 79 women: 20 who were obese with asthma, 19 who were normal weight with asthma, 20 who were obese without asthma, and 20 controls.

The participants with asthma were told to stop using their anti-inflammatory inhaler treatment. Blood tests four weeks later showed that inflammatory cells and other inflammatory biomarkers were increased. But no significant interaction was demonstrated between obesity and asthma.

The researchers pointed out that animal studies suggest changes in innate immunity may occur with obesity, offering a window for further research.

Sept. 3, 2008

A retrospective study done by American Lung Association researchers may dispel concerns about montelukast therapy's link to depression or suicide.

A reserach team reviewed quality of life and emotional well being data from three clinical trials including a total of 1,352 subjects.  The 569 participants assigned to take montelukast showed no evidence of deterioration of emotional wellbeing and, in fact, showed gains in emotional outlook when compared to subjects receiving placebo.

While the study does not support a link between montelukast therapy and suicide or depression, it does not dismiss the possibility of unrecognized adverse reactions associated with montelukast, the authors said in a news release.

Sept. 3, 2008

A study examining daytime sleepiness in nearly 600 subjects shows that a smaller percentage of African Americans experience periodic leg movements than subjects of other races.

Researchers used 24-hour laboratory assessment, which included overnight polysomnography and a five-nap daytime multiple sleep latency test, to evaluate PLMS in subjects. The participants also kept a two-week sleep diary prior to the assessment.

Overall, 7.6 percent of subjects had PLMS. However, only 4.3 percent of African Americans had the disorder while 9.3 percent of Caucasians experienced PLMS. The African American subjects demonstrated high brain iron stores, which may be linked to decreased symptoms.

The researchers also noted that complaints of insomnia were reported by 45 percent of all subjects with PLMS, but only 25 percent of subjects without the disorder.

The research is published in the Sept. 1 issue of the journal Sleep.

Aug. 28, 2008

Women with a strong social network and a live-in partner to share child-rearing responsibilities are more likely to remain smoke free than single mothers who lack the social and financial resources to cope with the stress of being a new parent, according to researchers at the University of North Carolina at Chapel Hill.

Researchers interviewed 94 pregnant women who had quit smoking before 30 weeks gestation. Forty-three women remained smoke-free while 51 relapsed when interviewed four months after giving birth.

Several factors differentiated the two groups. Those who remained smoke-free had strong social support, internal beliefs, and beliefs about the health benefits of not smoking, negative experiences with a return to smoking, and concrete strategies for dealing with temptation.

Women who relapsed had easy access to cigarettes, relied on cigarettes to deal with stress, and lacked self-esteem and financial resources.

"In the future we can look at these and other factors in women who quit smoking during pregnancy to assess who is at low or high risk of relapse," said Carol E. Ripley-Moffitt, MDiv, research associate in UNC's department of family medicine and the study's lead author, in a statement. "We can then offer more intensive interventions for those at higher risk to address the physical, behavioral and social issues related to relapse."

Aug. 27, 2008

The California Tobacco Control Program has saved the state more than $86 billion over the past two decades since its inception in 1989.

The savings, which were calculated between 1989 and 2004, represent a 50-to-1 return on investment. The program cost $1.8 billion to run - funded through a cigarette surtax. The surtax led to a decline in smoking, preventing 3.6 billion packs over the 15-year period studied.

Researchers from the University of California, San Francisco, calculated the savings by using models developed to analyze financial markets. Researchers looked at the relationship among per capita tobacco control expenditures, per capita cigarette consumption, and health care expenditures. They compared California with 38 other states that did not have a tobacco control program before 2000.

The results are published in the Aug. 25 issue of PLoS Medicine.

Aug. 27, 2008

Post-menopausal women taking hormone replacement therapy face fewer sleep complaints and report greater overall quality of life, according an international study involving 2,130 women from the UK, Australia, and New Zealand.

The Women's International Study on long Duration Oestrogen after Menopause (WISDOM) assessed combined oestrogen and progestrogen hormone therapy in women an average of 12 years after menopause.

The women completed surveys about symptoms, depression, and overall wellbeing. The team employed the women's health questionnaire to assess health related quality of life and psychological wellbeing.

Women on HRT reported significantly improved vasomotor symptoms, sexual functioning and sleep. The research team also noted that women on hormone replacement therapy had fewer hot flushes than those on placebo. While 30 percent of women on HRT and 29 percent of women taking placebo reported hot flushes at the study's initiation, only 9 percent of women on HRT and 25 percent on placebo reported hot flushes at one year.

Fewer women taking HRT reported night sweats, aching joints and muscles, insomnia, and vaginal dryness. However, a higher number of those on HRT reported breast tenderness and vaginal discharge.

View the complete study, published online in the British Medical Journal.

Boys may be more apt than girls to have childhood asthma but, when compared to girls, they are also more likely to grow out of it in adolescence and have a decreased incidence of asthma in the post-pubertal years, according to research in August's American Journal of Respiratory and Critical Care Medicine.

Investigators conducted a prospective study that analyzed airway responsiveness (AR) in more than 1,000 children with mild-to-moderate asthma over a period of about nine years to reach this conclusion. They speculate some buried mechanism in asthma development could account for their finding.  

"We wanted to investigate what was behind the observed sex differences in asthma rates and AR," said lead researcher, Kelan Tantisira, MD, MPH, of Brigham and Women's Hospital and Harvard Medical School. "This is the first study to prospectively examine the natural history of sex differences in asthma in this manner." 

Dr. Tantisira and colleagues used data from the ongoing Childhood Asthma Management Program (CAMP) that enrolled 1,041 children from 5 to 12 years of age with mild-to-moderate persistent asthma and performed annual spirometric testing with methacholine challenges to quantify their AR.

After an average of 8.6 years and each individual had undergone eight to nine annual methacholine challenges, researchers found a clear pattern: when it came to the amount of methacholine it took to provoke airway constriction, the girls' reactivity did not change markedly over the years. In contrast, boys became increasingly tolerant over time to larger and larger doses of methacholine.

By age 16, it took more than twice as much methacholine to provoke a 20-percent constriction in the boys' airway on average as it did with the girls. What's more, by age 18, only 14 percent of the girls did not demonstrate any significant degree of airways responsiveness, compared to 27 percent of boys.

Aug. 25, 2008

Of all ethnic groups in the U.S., Puerto Ricans have the highest rates of morbidity from asthma. Childhood abuse is a potential contributor to the high asthma burden in this population, according to a study to be published in the September issue of the American Journal of Respiratory and Critical Care Medicine.

Researchers studied 1,213 children and their primary caretakers in the San Juan and Caguas areas of Puerto Rico. The prevalence of physician-diagnosed asthma was 39.6 percent. Fourteen percent of children witness an act of violence within the year prior to the study; 7 percent had been victims of violence; and 6 percent had been victims of physical or sexual abuse.

Stressful life events and exposure to neighborhood violence were not associated with asthma. But a history of physical or sexual abuse doubled the risk of current asthma, researchers found.

The study underlines the importance of screening for asthma among victims of childhood abuse and to be aware of the possibility of physical or sexual abuse among children with asthma.

Aug. 20, 2008

The journey to establish pulmonary rehabilitation standards finally is over with the Medicare Act last month.

But the cheers in the respiratory community have given way to confusion. Questions are swirling about when the benefits will go into effect? Which services will be covered? And what should practitioners do in the meantime?

The American Association for Respiratory Care has developed a fact sheet with the answers to these questions and others. The document provides an overview of the benefit, current coverage and codes for pulmonary rehab, and the full text of the pulmonary rehab provision from the Medicare Improvements for Patients and Providers Act of 2008.

Creatine, a popular nutritional supplement renowned for enhancing athletic performance and muscle strength, does not improve exercise outcomes in patients with chronic obstructive pulmonary disease (COPD), according to a new study.

The randomized, placebo-controlled, double-blind study provided the most powerful evidence to date that the effect of creatine (Cr) supplementation was negligible at best among these patients.

"We have evidence to suggest Cr uptake into muscles [in COPD patients] but are unable to explain why an increase in muscle Cr did not enhance training," wrote the study's lead author, Sarah Deacon, MD, specialist registrar at the Institute for Lung Health at Glenfield Hospital in Leicester, England, in August's American Journal of Respiratory and Critical Care Medicine.

Cr supplementation has been shown to improve short-burst, high-intensity exercise function in athletes. To determine whether Cr supplementation could similarly enhance the physical condition of COPD patients, Deacon et al. recruited 100 patients with COPD to either receive Cr or a placebo over the course of a 7-week pulmonary rehab program.

Patients enrolled in both the control and Cr groups showed statistically significant improvements in functional and muscular performance during the loading phase, but no differences were seen between the groups. The Cr group also showed a greater, but non-significant percentage of improvement in the incremental shuttle walking test with loading and after pulmonary rehabilitation, but additional analysis still showed no overall effect between it and the placebo group.

"The most likely explanation is that any benefits of creatine have been submerged by the large training effect of physical training alone," wrote Dr. Deacon.

The standard regimens to treat tuberculosis are inadequate in countries with high rates of multi-drug resistant (MDR) TB, where patients are nearly twice as likely to fail their initial treatment as those in countries with low rates, according to a new analysis of World Health Organization (WHO) data.

This finding, published in August's American Journal of Respiratory and Critical Care Medicine, suggests strongly that current TB treatment regimens need to updated and revised to address the shifting landscape of public health in the face of MDR-TB.

"In countries with low prevalence of initial multi-drug resistance, the standardized treatment regimens for new case appear to be adequate," wrote Dick Menzies, MD, lead author of the study and director of the respiratory division at McGill University.

"However, in countries where the prevalence of initial drug resistance exceeds three percent, we believe it is urgent to strengthen capacity to perform drug sensitivity testing, or to reevaluate these standard treatment regimens, given the unacceptably high rates of failure and relapse."

Menzies and co-investigators reviewed the WHO's data from 2003 and 2004 for a total of 155 countries, 121 of which reported at least 250 cases annually. They assessed dropout, failure, relapse and death rates with initial treatment, as well as dropout, failure and death rates for retreatment.

Rates of failed treatment were dramatically higher with increasing prevalence of MDR-TB (p<0.0001). After accounting for age, HIV prevalence, per capita income and treatment regimen, for every one-percent increase in MDR TB prevalence, they saw a 0.30 percent rise in treatment failure among new cases, a 1.1 percent increase in failure rate among RE-treatment cases, and a one percent increase in relapse.

"This is striking evidence that MDR-TB is directly linked to the increased failure rates of our current treatment regimens," said Dr. Menzies.

Aug. 4, 2008

Preventable medical errors during or after surgery cost employers $1.5 billion per year, according to estimates by the U.S. Department of Health and Human Services' Agency for Health Research and Quality.

AHRQ researchers William E. Encinosa, Ph.D., and Fred J. Hellinger, P.D., found insurers paid an additional $28,218 for patients who experienced acute respiratory failure and $19,480 for patients with post-operative infections. These represent a 52 percent and 48 percent cost increase, respectively, over patients who do not experience either problem.

The authors also identified added costs in patients who experienced the following medical errors compared with those who did not:

• Nursing care associated with medical errors, including pressure ulcers and hip fractures - $12,196 (33 percent more)

• Metabolic problems associated with medical errors, including kidney failure or uncontrolled blood sugar - $11,797 (32 percent more)

• Blood clots or other vascular or pulmonary problems associated with medical errors - $7,838 (25 percent more)

• Wound opening associated with medical errors - $1,426 (6 percent more)

The authors found that one of every 10 patients who died within three months of surgery did so because of a preventable error. One-third of the deaths occurred after the initial hospital discharge.

The study, which was published in the July 28 issue of the journal Health Services Research, was based on a nationwide sample of more than 161,000 patients age 18 to 64 in employer-based health plans who underwent surgery between 2001 and 2002.

The number of working-age adults with chronic health conditions grew 25 percent between 1997 and 2006 to 58 million, according to a study published online by Health Affairs.

More than one-third of uninsured adults with a chronic condition did not have a usual source of care in 2006, up from 29 percent a decade earlier; 26 percent had not seen a health professional all year, up from 21 percent in 1997.

Both insured and uninsured adults with chronic conditions were more likely to report unmet medical needs due to cost in 2006 than in 1997.

The study, by the Kaiser Commission on Medicaid and the Uninsured, examined access to care for working-age adults with heart disease, hypertension, stroke, diabetes, asthma, emphysema or cancer based on responses to the National Health Interview Survey.

Children's Hospitals & Clinics of Minnesota in St. Paul and Minneapolis, Children's Hospital of Philadelphia, and Haven Hospice in Gainesville, FL, each will receive the Circle of Life Award July 25 at the AHA and Health Forum Leadership Summit in San Diego.

"The Circle of Life award recognizes organizations that are focused on expanding the frontiers of palliative and end-of-life care, in terms of access and quality," said American Hospital Association President and CEO Rich Umbdenstock.

"These programs are striving to be there for patients and families every step of the way, with expertise, compassion and assistance. A focus on choice and dignity help distinguish these programs and help serve as a model to others."

Citations of Honor were awarded to Kaiser Permanente, Oakland, CA; LifePath Hospice and Palliative Care, Tampa, FL; Providence Hospital, Washington, DC; Rice Hospice, Willmar, MN; Sentara Healthcare, Norfolk, VA; and the UAB Center for Palliative Care and Birmingham VA Medical Center's Joint Palliative Care Programs, Birmingham, AL.