Anxiety, Depression Often Go Hand-in-Hand With Arthritis

Anxiety, Depression Often Go Hand-in-Hand With Arthritis

Man massaging elbow in pain

MONDAY, April 30 (HealthDay News) -- Depression or anxiety affect one-third of Americans with arthritis who are aged 45 or older, a new study shows.

Researchers from the U.S. Centers for Disease Control and Prevention also found that even though anxiety is nearly twice as common as depression among people with arthritis, doctors tend to focus more on depression in these patients.

[Read: Treat Rheumatoid Arthritis Early and Aggressively.]

The study included nearly 1,800 people with arthritis or other rheumatic conditions who took part in the CDC's Arthritis Conditions and Health Effects Survey. Among the study participants, 31 percent reported anxiety and 18 percent reported depression.

One-third of the patients reported at least one of the two conditions and 84 percent of those with depression also had anxiety. Only half of those with anxiety or depression sought mental health treatment in the previous year, according to the study, which was published in the April 30 issue of the journal Arthritis Care amp; Research.

"Given their high prevalence and the effective treatment options that are available, we suggest that all people with arthritis be screened for anxiety and depression," study leader Dr. Louise Murphy, of the Arthritis Program at the CDC, said in a journal news release.

[Read: Higher Cancer Rate Seen in Children With Juvenile Arthritis.]

"With so many arthritis patients not seeking mental health treatment, health care providers are missing an intervention opportunity that could improve the quality of life for those with arthritis," she added.

In the United States, 27 million people age 25 and older have osteoarthritis, and 1.3 million adults have rheumatoid arthritis, according to the American College of Rheumatology.

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases offers advice on how to live with arthritis.

Copyright © 2012 HealthDay. All rights reserved.

Pacifiers Don't Discourage Breast-Feeding

Pacifiers Don't Discourage Breast-Feeding

By Maureen Salamon
HealthDay Reporter

MONDAY, April 30 (HealthDay News) -- Widely held wisdom that pacifier use among newborns interferes with breast-feeding is wrong, a new small study suggests.

Analyzing feeding data on nearly 2,250 infants born between June 2010 and August 2011, Oregon Health amp; Science University researchers learned that limiting use of pacifiers -- also known as binkies, corks and soothers -- may actually increase babies' consumption of formula during the birth hospitalization.

"The overarching belief persists that pacifiers interfere with breast-feeding, even though research hasn't concretely showed they cause a problem," said study co-author Dr. Laura Kair, a resident in pediatrics at the university's Doernbecher Children's Hospital. "We like to rely on our best evidence as physicians, so when we see these results jibe better with our own personal experience than evidence-based practice in our field, it makes us take [note]."

[Read: Wider Breast-Feeding Could Save Babies' Lives.]

Kair and co-author Dr. Carrie Phillipi, medical director of the hospital's mother-baby unit, are scheduled to present their findings Monday at the Pediatric Academic Societies' annual meeting in Boston.

Seeking to determine if eliminating routine pacifier distribution on the hospital's mother-baby unit would increase the rate of exclusive breast-feeding, Kair and Phillipi learned that this rate actually dropped significantly -- from 79 percent to 68 percent -- after pacifiers were restricted.

Additionally, the proportion of breast-fed newborns receiving supplemental formula rose from 18 percent before the policy change to 28 percent afterward, while the percentage of babies fed only formula remained statistically unchanged.

To encourage exclusive breast-feeding, which benefits both mothers and babies, the World Health Organization and the United Nations Children's Fund (UNICEF) recommend that hospitals caring for newborns follow their "Ten Steps to Successful Breastfeeding" -- one of which states that pacifiers should not be provided to breast-feeding babies. Hospitals hoping to achieve the status of "Baby-Friendly Hospitals" often follow this recommendation, Phillipi said.

"Parents come to us looking for advice," Phillipi said. "Our hope in publicizing this study is to stimulate a conversation about the topic, especially as many hospitals are thinking of removing pacifiers to become Baby Friendly."

[Read: Many Women Say No to Breast-Feeding for 6 Months.]

Dr. Richard Schanler, chair of the American Academy of Pediatrics' breast-feeding section, noted that the study did not offer information about how newborns were comforted who did not receive pacifiers or how hospital staff members were educated about this issue during the research.

"You cannot draw conclusions to change health care practices from this type of study," said Schanler, also associate chairman of the department of pediatrics at Cohen Children's Medical Center of New York, in New Hyde Park.

Phillipi acknowledged that the study's results are difficult to apply to individual cases, but "we're really hoping to bring this conversation to a different level . . . so we're able to give parents the best evidence possible. Our overall goal is to improve breast-feeding rates . . . we know it's the best nutrition for babies."

Research presented at scientific meetings is considered preliminary because it hasn't yet been peer-reviewed or published in a medical journal.

More information

The U.S. Office on Women's Health has more about breast-feeding.

Copyright © 2012 HealthDay. All rights reserved.

Having Kids Doesn't Inspire Adults to Eat Healthier

Having Kids Doesn't Inspire Adults to Eat Healthier

MONDAY, April 30 (HealthDay News) -- Starting a family does not lead young adults to eat healthier in order to set a good example for their children, a new study says.

Researchers analyzed the diets of more than 2,500 participants enrolled in a study examining the development of coronary artery disease risk factors in young adults. None of the participants had children at the start of the study, which collected data from 1985 to 1993.

[Check it Out: U.S. News World Report's Guide to Healthy Eating.]

During that time, saturated fat intake decreased by 2.1 percent among non-parents and by 1.6 percent among parents. Neither group showed statistically significant changes in their intake of calories, fruits and vegetables, sugar-sweetened beverages, or fast food.

The study appears online April 30 in the Journal of the Academy of Nutrition and Dietetics.

"We found that parenthood does not have unfavorable effects on parents' diets but neither does it lead to significant improvements compared to non-parents, as health practitioners would hope," lead investigator Dr. Helena Laroche, of the University of Iowa and the Iowa City VA Medical Center, said in a journal news release.

"In fact, parents lag behind their childless counterparts in decreasing their intake of saturated fat, and their overall diet remains poor," she added.

[Read: Cancer Survivors Urged to Eat Better, Exercise.]

Many factors may explain why parents had a smaller decrease in their intake of saturated fat than non-parents.

"Finding foods that children like and request has been described by parents as one of the major factors influencing purchasing decisions," Laroche said. "Given that marketing strategies to U.S. children focus on high-fat, high-sugar foods, these requests are often for less healthy foods."

Laroche noted that the data was collected about 20 years ago and changes since then could mean the findings would be different in current families.

More information

The Nemours Foundation outlines how parents can encourage healthy eating habits in children.

Copyright © 2012 HealthDay. All rights reserved.

Prenatal Pesticide Exposure May Harm Kids' Brains

Prenatal Pesticide Exposure May Harm Kids' Brains

Prenatal Pesticide Exposure May Harm Kids' Brains

April 30, 2012 -- Prenatal exposure to a pesticide used on many crops may be linked with abnormal changes in a child's developing brain, scientists report.

Compared to children with low prenatal exposure, those with high exposure to the pesticide chlorpyrifos had abnormalities in the cortex (the outer area of the brain), says Virginia Rauh, ScD, professor and deputy director of the Columbia Center for Children's Environmental Health at the Mailman School of Public Health at Columbia University.

The cortex helps govern intelligence, personality, muscle movement, and other tasks.

"In areas of the cortex, we detected both enlarged and reduced volumes that were significantly different from the normal brain," she tells WebMD. "This suggests the process of normal brain development has been disturbed in some way."

The study is published in Proceedings of the National Academy of Sciences' Early Edition.

In 2001, the U.S. EPA banned the residential use of chlorpyrifos. It still allows it on crops. It can also be sprayed in public places such as golf courses.

Some environmental advocates have petitioned the EPA to ban agricultural use.

Prenatal Exposure to Pesticides: Study Details

Rauh's team selected 40 children from a larger group of 369 children, followed from birth.

All had been born between 1998 and 2001, before the household-use ban. Rauh had sent their umbilical cord blood samples to the CDC to analyze pesticide levels.

For this study, she selected 20 children with high prenatal exposure and 20 with low prenatal exposure. She took MRIs of their brains when they were about 6 to 11 years old.

Overall brain size did not differ much between the two groups. However, the high-exposure group had enlargements in many areas and reduced volumes in other areas.

The findings reflect those from animal studies, Rauh says.

In other studies, Rauh has found higher exposure to the pesticide is linked with lower IQs and a decline in working memory in children.

The pesticide works by blocking an enzyme needed by pests -- and people -- for proper nerve functioning. It belongs to a class known as organophosphates.

Chlorpyrifos and the Food Supply

In 2007, the Natural Resources Defense Council petitioned the EPA to cancel all agricultural registrations for the pesticide.The EPA is reviewing the role of chlorpyrifos in agriculture.

Symptoms of poisoning from the pesticide include nausea, dizziness, confusion, and sometimes loss of respiratory muscle control and death, according to the NRDC.

Type 2 Diabetes in Kids a Challenge to Control

Type 2 Diabetes in Kids a Challenge to Control

Type 2 Diabetes in Kids a Challenge to Control

April 29, 2012 -- The obesity epidemic has created a generation of children and teens who have type 2 diabetes, and a new study hints that the solution to this problem is not going to come easily.

Because type 2 diabetes among children is a relatively recent development, many treatment decisions have relied on what is known about adults with type 2 diabetes. Now, in the first major trial to compare treatments for the disease in young people, researchers have learned that two drugs are better than one for maintaining blood sugar control in these children.

Combined treatment with the diabetes drugs metformin and Avandia proved more effective than metformin alone or metformin plus lifestyle changes for keeping blood sugar at normal levels. Still, the combination failed to help more than a third of patients who took it.

The findings suggest that aggressive and early drug therapy may help children and teens with type 2 diabetes control their blood sugar levels and reduce the risk of complications such as heart disease, kidney failure, blindness, and nerve damage.

They also confirm that for many children with the disease, standard treatment with metformin alone is not enough, says Barbara Linder, MD, PhD, of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Metformin is the only oral diabetes drug that has been approved by the FDA for use in children.

"These kids did not do as well on metformin as anticipated based on our experience in adults," she tells WebMD. "The assumption has been that kids will do fine on metformin, but clearly that is not the case."

Slideshow: Type 2 Diabetes Overview

Avandia Use Restricted During Trial

Closely linked to obesity, type 2 diabetes was almost unheard of in children just a few decades ago.

The obesity epidemic has changed this, however, and doctors have made troubling discoveries about early-onset type 2 diabetes, says pediatric endocrinologist and researcher Philip Zeitler, MD, PhD, of the Children's Hospital Colorado.

"We are learning that type 2 diabetes is a more aggressive disease in youth than in adults and progresses more rapidly, which could be why metformin alone has a higher than expected failure rate," Zeitler says.

The finding that adding Avandia to metformin resulted in better outcomes raises more questions than it answers, since Avandia is no longer a treatment option for children and teens, says University of Wisconsin professor of pediatrics David B. Allen, MD.

In September of 2010, while the trial was under way, the FDA placed broad restrictions on Avandia's use following reports of heart attacks and strokes in adults taking the drug.

Participants in the Avandia part of the study continued taking the drug following a safety review, and no serious side effects were reported.

One Baby per Hour Born Drug Dependent

One Baby per Hour Born Drug Dependent

One Baby per Hour Born Drug Dependent

April 30, 2012 -- The number of U.S. babies born dependent on drugs nearly tripled between 2000 and 2009, researchers reported today.

Drug dependence occurs when a person develops a physical dependence on a drug, leading to withdrawal symptoms if the drug is abruptly stopped. Newborns can be drug dependent, but do not have the harmful behavior typically seen with addiction. By 2009, an estimated 13,539 babies -- an average of one an hour -- were diagnosed with a drug withdrawal syndrome, which most commonly occurs because their mothers were taking opiate drugs, or narcotics, while pregnant, according to the new study.

"We were surprised by the magnitude of the increase," says researcher Stephen Patrick, MD, MPH, a Robert Wood Johnson clinical scholar at the University of Michigan.

Patrick and his collaborators used national inpatient databases to find the number of women who were taking opiates when they gave birth and the number of babies born with drug dependency.

"These babies, compared to other babies, are more likely to be irritable and inconsolable," says Patrick, a neonatologist. "They'll likely be born low birth weight. Feeding issues are common."

The use of prescription opiate painkillers such as Oxycontin and Vicodin has increased four-fold over the last decade, according to a recent report from the CDC. Patrick's study found a five-fold increase in opiate use among pregnant women.

Baby Milestones Slideshow: Your Child's First Year of Development

'Overprescribed'

"These medications provide superior pain control for cancer and chronic pain, but have been overprescribed, diverted, and sold illegally, creating a new opiate addiction pathway and a public health burden for maternal and child health," Marie J. Hayes, PhD, a University of Maine psychologist, and Mark Brown, MD, a Bangor, Maine, pediatrician, write in an editorial accompanying Patrick's study.

A 2010 survey by the Substance Abuse and Mental Health Services Administration found that 16.2% of pregnant teens and 7.4% of pregnant women 18 to 25 years old used illicit drugs, including opiates such as heroin and illegally obtained prescription painkillers.

Although the new study did not have information about which opiates women took during pregnancy and why, Patrick says: "It's probably all comers. Some women were using opiates appropriately for chronic pain or in methadone clinics." Methadone is often used to treat heroin addiction.

Not all babies exposed to opiates in the womb will be born dependent on drugs, Patrick says, which probably explains why the percentage of pregnant women who used the drugs increased more than that of babies born with drug dependence.

About 60% to 80% of babies who were exposed to heroin or methadone in the womb will experience withdrawal after birth, he says. But women who have an opiate dependence shouldn't try to quit taking opiates abruptly while pregnant, he says, because withdrawal in the womb "can be dangerous for both mom and baby."

Studies Point to Reasons for Mammograms in 40s

Studies Point to Reasons for Mammograms in 40s

Studies Point to Reasons for Mammograms in 40s

April 30, 2012 -- A pair of new studies aims to clear up some of the confusion over what age women should start getting routine mammograms to screen for breast cancer.

The studies, which are published in the Annals of Internal Medicine, show that a woman in her 40s who has extremely dense breasts, or who has a mother or sister with breast cancer, reaps the same benefits and drawbacks from getting regular mammograms as a woman in her 50s.

Researchers say that meets a "threshold of risk" that may help guide women and their doctors to start regular mammograms at age 40 instead of age 50, as some current guidelines suggest.

"They're really taking a better look and saying if you have risk factors, you should be screening at age 40 because then the benefit is there," says Stephanie Bernik, MD, chief of surgical oncology at Lenox Hill Hospital in New York City.

Bernik says she was relieved to see the new studies because she felt guidelines issued in 2009 that recommended that most women wait until age 50 to start getting regular mammograms were premature and might discourage some younger women who could benefit from the tests.

"This is better than what they said before," says Bernick, who was not involved in the research.

But for some researchers, it's still not enough. Since the research is preliminary and is meant more for policy makers than for individuals, one researcher called it "ivory tower" information that still isn't intended to help a younger woman make a decision.

A Visual Guide to Breast Cancer

Refining Recommendations on Mammograms

In 2009, the U.S. Preventive Services Task Force (USPSTF) said that most women should get routine mammograms every two years starting at age 50 instead of age 40.

That recommendation conflicts with guidelines from the American Cancer Society, the National Cancer Institute, and the American College of Radiology, which all recommend screening starting at age 40. And it has drawn mixed reactions from patients and doctors.

Some groups applauded the conservative approach, saying that it would reduce the harms of over-testing and overtreatment, which are greatest for women in their 40s.

Others said it would unnecessarily put women's lives at risk, since cancers found in younger women can be aggressive and early detection of an aggressive cancer may be a woman's best hope for survival.

Ultimately, the USPSTF said the decision to start breast cancer screening before age 50 should be left up to individual women and their doctors.

But until now, there's been little information to help guide that decision.

Family History or Dense Breast Tissue Doubles Risk

The new studies, which were conducted by the same group of researchers that compiled the evidence for the 2009 USPSTF recommendations, are meant to help clarify when mammograms might be useful for younger women.