Health

Nancy Ferrari

Protecting your children against Enterovirus D68

Enterovirus D68 is a respiratory infection that has been spreading across the country and making some children quite ill. It is especially problematic for kids with asthma or other respiratory issues. Enterovirus D68 can start out looking like a garden variety cold but lead to serious trouble breathing. What’s a parent to do? The same things he or she would normally do during cold and flu season: hand washing, staying away from people who are sick, regularly cleaning common surfaces like doorknobs, not sharing cups and utensils, and coughing or sneezing into the elbow, not the hands. Those who have children with asthma need to be extra vigilant about their child’s asthma care routine. Most upper respiratory infections are the simple cold. Still, it’s important to stay alert for signs of breathing difficulties.

Heidi Godman

New guidelines recommend Kegels, other lifestyle treatments for urinary incontinence in women

New guidelines from the American College of Physicians offer drug-free ways women can use to reduce or stop urinary incontinence, a potentially embarrassing condition that affects millions of women. The guidelines recommend that women first try Kegel exercises, bladder training, exercise, and weight loss if needed. These approaches can work for both of the leading types of urinary incontinence: stress incontinence (leakage with laughter, sneezing, or other things that put pressure on the bladder) and urge incontinence, also known as overactive bladder, which is caused by unpredictable contractions of muscles in the bladder wall. Other lifestyle changes, like watch fluid intake and minimizing bladder irritants like caffeine, alcohol, carbonated drinks, and other may also help. If these approaches aren’t effective, the next step might be treatment with medication, surgery, or even an injection of botulinum toxin to relax overactive bladder muscles.

Howard LeWine, M.D.

FDA approves weight-loss drug Contrave

For the third time in two years, the FDA has approved a drug to help people lose weight. The new drug, Contrave, combines two generic drugs, naltrexone and bupropion. Naltrexone is used to help kick an addiction to alcohol or narcotics. Bupropion is used to treat depression and seasonal affective disorder. Many people also take bupropion to stop smoking. Neither naltrexone nor bupropion by itself has been approved for weight loss. Specifically, Contrave was approved for use by adults who are obese (meaning a body-mass index of 30 or higher) and by overweight adults (body-mass index between 27 and 30) who have at least one other weight-related condition or illness, such as high blood pressure or type 2 diabetes. Across the clinical trials on which the FDA based its approval, some people lost more than 5% of their body weight. But it’s important to note that more than 50% had minimal or no weight loss. Side effects ranging from seizures and high blood pressure to diarrhea and constipation were reported.

Beverly Merz

Benzodiazepine use may raise risk of Alzheimer’s disease

Drugs in the benzodiazepine family have long been used to treat anxiety and sleep problems. They can cause a bit of a brain hangover the next day. Experts have long assumed that people’s heads would clear once they stopped taking the drug. That may not be the case. In a study published last night by the journal BMJ, a team of researchers from France and Canada linked benzodiazepine use to an increased risk of being diagnosed with Alzheimer’s disease. In the study, the greater a person’s cumulative dose of benzodiazepines, the higher his or her risk of Alzheimer’s. Taking a benzodiazepine for less than three months had no effect on Alzheimer’s risk. Taking the drug for three to six months raised the risk of developing Alzheimer’s by 32%, and taking it for more than six months boosted the risk by 84%. People taking a long-acting benzodiazepine were at greater risk than those on a short-acting one.

2 Minute Medicine®

Myth busted: bra wearing not linked to breast cancer

According to one persistent Internet myth, women who wear bras are more likely to develop breast cancer. Not true, says a study published online in the journal Cancer, Epidemiology, Biomarkers, and Prevention. In a study of more than 1,500 women, researchers from the Fred Hutchinson Cancer Research Center in Seattle found no links between risk of two common types of breast cancer — invasive ductal carcinoma or invasive lobular carcinoma — and any aspect of bra wearing, including cup size, use of a bra with an underwire, age at first bra use, and average number of hours per day a bra was worn. This may not be the last word on the subject, since the Fred Hutchinson study represents only the second to look at the connection between bra use and breast cancer. But until other findings appear, women worried that wearing a bra might cause cancer have one less thing to worry about.

Howard LeWine, M.D.

Low fat? Low carb? Almost any healthy diet can work for losing weight

The results of a clinical trial reported in yesterday’s Annals of Internal Medicine showed that low-carb diets helped people lose weight better than low fat diets. A report in today’s Journal of the American Medical Association tells a somewhat different story. A review of 48 head-to-head diet trails showed that average weight loss on either a low-carb or low-fat diet for 12 months was the same, about 16 pounds. And when the researchers compared named diets, which ranged from the low-carb Atkins and South Beach diets to moderates like Weight Watchers and Jenny Craig and low-fat approaches like the Ornish diet, all yielded similar weight loss. The main message from careful comparisons of different diets is that there’s no single diet that’s right for everyone. Any healthy diet can help people lose weight. And there’s more to a diet than weight loss. What’s needed for long-term health is an eating plan that can be followed day in and day out that is good for the heart, bones, brain, and every other part of the body. One eating strategy that can provide all that is the so-called Mediterranean diet.

Daniel Pendick

Some doctors oversell artery-opening angioplasty

A heart attack in progress is a medical emergency. The leading way to stop it is with artery-opening angioplasty. But many angioplasties are done for reasons other than heart attack. Some are performed to ease chest pain that appears with physical activity or stress. This is the chest pain known as stable angina. Sometimes the prospective patient has no symptoms at all — just test results that indicate one or more clogged arteries. Cardiologists continuously debate when it’s appropriate to do non-emergency angioplasty. Two studies in JAMA Internal Medicine add some provocative new information: that incomplete or even misleading advice from doctors contributes to unnecessary angioplasties. And that’s a problem because angioplasty can harm as well as help.

Julie Corliss

Probiotics may ease constipation

Probiotics, the beneficial bacteria found in yogurt and other cultured foods, have long been touted for their ability to ease digestive woes. The strongest evidence for probiotics is in treating diarrhea caused by a viral infection or from taking antibiotics. Do probiotics also work for the opposite problem — constipation? A report from King’s College in London showed that taking probiotics can help soften stools, making them easier to pass, and can increase the number of weekly bowel movements. What we don’t know is which probiotic species and strains are most effective, how much to take, and for how long.

Howard LeWine, M.D.

Many seniors get unnecessary and potentially harmful cancer tests

Screening — checking a seemingly healthy person for signs of hidden disease — is an important part of routine medical care. It is done for various types of cancer, heart disease, diabetes, and other chronic conditions. Screening makes sense when finding and treating a hidden condition will prevent premature death or burdensome symptoms. But it doesn’t make sense when it can’t do either. That’s why experts recommend stopping screening in older individuals, especially those who aren’t likely to live another five or 10 years. Yet an article published online in JAMA Internal Medicine shows that many doctors still recommend cancer screening tests for their older patients. Many don’t benefit, and some are even harmed by the practice. Asking people who can’t benefit from a cancer screening test to have one is a waste of their time and money, not to mention a waste of taxpayer money (since these tests are usually covered by Medicare). Screening tests can also cause physical and mental harm. Decisions about cancer screening should be mutually made by an individual and his or her doctor. Equally important, the person should be well informed about the risks of the test and about what will happen if a test suggests there may be cancer that won’t shorten the his or her life.

Robert Shmerling, M.D.

Sodium studies blur the picture on what is heart healthy

We often look to science to solve life’s difficult questions. But sometimes it hands us more uncertainty. Take three reports in today’s New England Journal of Medicine. One shows that eating less sodium (a main component of salt) could save more than a million lives a year worldwide. A second came to a nearly opposite conclusion — that current average sodium intake is okay for cardiovascular health while getting either too little or too much is a problem. The third study essentially agreed with the second, but found that getting too little potassium may be as bad as getting too much sodium. The findings are certain to fuel the already heated debate on sodium and the international efforts to get people to take in less of it. But until there are good answers to the questions raised by the studies, it’s too soon to throw out recommendations to reduce sodium intake, especially in high-risk groups. Another lesson from the three New England Journal articles worth keeping in mind: getting more potassium from fruits, vegetables, and other foods is a good way to help keep your heart and arteries healthy.