How To Stay Healthy Update

Tamiflu (Oseltamivir) for Flu Prevention
Until recently, there wasn’t much a person could do once he or she was hit with the flu. Last year, however, the Food and Drug Administration approved two medications that could be added to the usual routine of fluids, bedrest, and fever-reducing analgesics. Both drugs interfere with an enzyme (neuraminidase) that is crucial for the flu virus to multiply. Taken within two days of symptom onset, zanamivir (Relenza) and oseltamivir (Tamiflu) can reduce the severity and duration of a bout with this winter menace. Now, the FDA has also approved Tamiflu for the prevention of influenza in adults and children 13 and older.

The FDA’s approval was based on several recent studies. One trial followed healthy, unvaccinated adults and adolescents who took 75 mg of Tamiflu or a placebo once a day for 42 days during a community outbreak of the flu. The flu rate among study subjects taking the placebo was 4.8%, while only 1.2% of the Tamiflu group came down with the virus. In a second study, researchers assigned elderly nursing home residents to either a placebo or 75 mg of Tamiflu daily for 42 days. Of the placebo group, 4.4% developed the flu, compared with only 0.4% of the treatment group. (It is important to note that in this study, 80% of the elderly population had gotten a flu shot.) A third investigation evaluated whether Tamiflu could prevent the spread of the virus within a household. Family members received either 75 mg of Tamiflu or a placebo within two days of the onset of symptoms in the flu sufferer. In placebo households, the flu rate was 12%. In the Tamiflu households, only 1%.

Note that Tamiflu is not a substitute for the flu shot and those at high risk for complications of the flu should get their yearly vaccination. None of these studies tested Relenza (zanamivir), so it is unclear whether this drug offers similar benefits. Keep in mind, both Tamiflu and Relenza are effective only against type A and type B flu viruses, and although many upper respiratory infections and severe colds caught during the winter are viral, that doesn’t mean they are "the flu."

Wet Combing More Effective for Detecting Head Lice than Traditional Visual Inspection
Head lice are minute, parasitic insects that live in hair. They easily spread from person to person, especially among children at school or in day care, and they are responsible for many school absences. Because lice are barely visible, finding lice eggs, called nits, is the easier way to detect an infestation. These tiny, white flecks cling to hair shafts. Researchers at Belgium’s Ghent University recently found that carefully sweeping a fine-toothed comb through wet, conditioned hair is more effective for detecting lice than the traditional, dry-scalp visual inspection.

The study, published in the British Medical Journal, compared the two methods on 224 school children. Two trained teams independently examined the students; one using the wet comb technique, the other using the visual test. Wet combing found lice in 49 children, while the visual test only detected 32 of these cases. In addition, the traditional inspection mistakenly identified 14 uninfected children as having lice.

The results suggest that compared to traditional, visual inspection, wet combing would allow for more accurate head lice detection, meaning more infestations detected before they can spread, and fewer non-infested children receiving unnecessary treatment with insecticides.

New Pneumococcal Vaccine for Children Less Than Two Years Old
A new vaccine called Prevnar is the first vaccine to protect children less than two years old against the bacteria Streptococcus pneumoniae, which is the leading cause of pneumonia, bacterial meningitis, bacteremia, sinusitis, and acute otitis media, or middle-ear infections, in young children. In addition to protecting children from pneumococcal infection, vaccination with Prevnar also decreases transmission of pneumococci from one child to another, an effect known as "herd immunity." Furthermore, since middle-ear infections are the leading reason that children need to take antibiotics, vaccination with Prevnar could reduce the need for antibiotics in this age group. This, in turn, should slow or reverse the trend of antimicrobial resistance. A different pneumococcal vaccine, known generically as PPV23, has been available to adults for years, but it has not been effective in children less than two years old.

The Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices (ACIP) recommends that all children less than two years old should be vaccinated with Prevnar. Children aged two to five years old should receive a two-shot series of Prevnar followed by one dose of PPV23 if they are high-risk, a category that includes children with HIV, immunocompromising conditions, chronic illness, or sickle cell disease. Prevnar may also be considered for children between two to five years with priority given to those who are between the ages of 24 and 35 months, of African-American, American Indian, or Alaska Native descent, or who attend group day care centers.

Since Prevnar has not been studied sufficiently in children older than five years who are at high risk for serious pneumococcal disease, ACIP continues to recommend that children five and older receive PPV23.

Early versus Later Orthodontic Treatment in Children
Which approach works best for children who need orthodontic care: early two-phase treatment (which begins when a child still has all or most of his or her "baby" teeth) or later single-phase treatment (which is implemented when most, or all, of the permanent teeth are in)? Proponents of early two-phase orthodontic treatment argue that it is better able to modify the patient's skeletal growth, improve the patient's self-esteem. They also believe this approach achieves a better and more stable result and reduces the need for extensive therapy later. A University of North Carolina study, however, reports early two-phase orthodontic treatment is not necessarily superior to later single-phase treatment, nor does it always achieve all the goals some orthodontists claim it does.

Most people do not have perfect teeth, however, malocclusion is a condition where the jaws are misaligned. In very severe forms of malocclusion, the misalignment may interfere with the ability to speak or eat. The children in the North Carolina trial did not have such extreme misalignment. These children were determined to have moderate-to-severe Class II malocclusion. Children with a Class II malocclusion have some jaw misalignment. In addition, teeth may be crowded, abnormally spaced, or misaligned. This type of malocclusion can also involve upper teeth that protrude excessively or front teeth that do not meet. Malocclusion usually becomes apparent between ages 6 and 14, when the teeth and jaw are growing and often runs in families.

In this study, researchers randomly assigned children who still had most of their baby teeth to one of three groups: headgear treatment (fixed-appliance therapy), bionator therapy (removable-appliance therapy), or to an observational group that received no treatment. Seventy-five percent of the children in both the headgear and bionator therapy groups showed improvement in jaw alignment (although there was significant variation across all three groups).

The second phase of the study was to see whether the improvements achieved in the first phase of the study truly represented long-term results. Once the children's permanent teeth came in, study investigators randomly assigned members of all three groups to receive fixed-appliance therapy. Researchers discovered that the skeletal changes resulting from early treatment did not last. In addition, skeletal relationships, as well as the relationship between the upper and lower jaws, did not differ significantly between the groups that received the early two-phase treatment and the group that received later single-phase treatment. Neither the length of treatment nor the severity of the malocclusion was an important influence on the end result. Individual skeletal growth patterns, however, did play an important role.

One of the conclusions from this study is that the success of Class II correction does not depend on when treatment begins as long as it begins while the child is still growing. If the criterion for success of Class II correction is a better, more stable result, the later single-phase treatment would be preferable because treatment time is shorter. However, if the criteria for success include better self-esteem, then it may be preferable to start treatment earlier. It is important to keep in mind that early treatment is not the only way to correct malocclusion. A Class II correction can be achieved early or later with equally beneficial results. Other studies have been conducted that support these findings among children with more severe occlusions and other orthodontic problems.

Study Links Smoking to Colorectal Cancer
Lung, mouth, and bladder cancers, among others, are well established as cancers caused by cigarette smoking. A recent study from the American Cancer Society, published in the Journal of the National Cancer Institute shows that cigarette smoking also raises the risk of dying from colorectal cancer, which is cancer of the colon or rectum. Indeed, the study notes that as many as 12% of colorectal cancer deaths in the United States may be associated with smoking.

Researchers analyzed data from 312,332 men and 469,019 women enrolled in the Cancer Prevention Study II. They found that for both men and women, risk of colorectal cancer increased after 20 or more years of smoking. Among men, current smokers were 31% more likely to die from colorectal cancer than nonsmokers; female smokers were 41% more likely than nonsmokers to die from the disease. The risk of death from colorectal cancer rose with the number of years cigarettes were smoked, the number of cigarettes smoked per day, and the number of packs smoked over the years. In addition, the risk of death was higher the younger a person was when he or she started smoking. The association was not confined to cigarette smoke. Those who smoked pipes or cigars also faced a significantly increased risk of death from colorectal cancer.

The bright spot of the study was that it showed a benefit from quitting. Twenty years after quitting, men's risk of colorectal cancer death returned to normal. And women who had stopped smoking 10 or more years earlier had the same risk as nonsmokers. The take-home message: If you smoke, stop. If you don't smoke, don't start.