(HealthDay News) — New research supports the advice that it’s never too early to start reading to a child. Children start to recognize and follow some rules of reading and writing as young as age 3, study findings reveal.
The study included 179 U.S. kids aged just over 3 years to about 5.5 years.
“Our results show that children begin to learn about the statistics of written language, for example about which letters often appear together and which letters appear together less often, before they learn how letters represent the sounds of a language,” said study co-author Rebecca Treiman. She is a professor of child developmental psychology at Washington University in St. Louis.
An important part of learning to read and spell is discovering how written letters reflect spoken words, Treiman explained in a university news release.
But many people think learning to spell doesn’t begin until kids start inventing spellings that reflect the sounds they hear — for example, C or KL for “climb.” Though those early attempts may be flawed, she said they clearly indicate kids are trying to use letters to symbolize what they hear.
“Many studies have examined how children’s invented spellings improve as they get older, but no previous studies have asked whether children’s spellings improve even before they are able to produce spellings that represent the sounds in words,” Treiman said.
“Our study found improvements over this period, with spellings becoming more word-like in appearance over the preschool years in a group of children who did not yet use letters to stand for sounds,” she said.
The findings show that exposure to written words when children are 3 to 5 years old may help give them a strong start with their reading, writing and spelling skills, the researchers said.
The study was published recently in the journal Child Development.
SOURCE: Washington University in St. Louis, news release, July 25, 2017
(HealthDay News) — Many people with diabetes experiment with placement of their continuous glucose monitors and get good results, a new study finds.
A continuous glucose monitor is a sensor inserted under the skin that tracks blood sugar levels. People with type 1 diabetes — and some with type 2 diabetes — can use this near-constant stream of information to make decisions about eating, exercising and insulin dosing. (People with type 1 diabetes need synthetic insulin in order to use the sugar in food as fuel.)
To see where monitors were actually being worn, researchers culled social media posts for images of people using continuous glucose monitors made by Dexcom.
“This study identified that 64 percent of individuals in our sample were not wearing their Dexcom in an FDA-approved location,” said Michelle Litchman, the study’s lead author. She’s an assistant professor at the University of Utah College of Nursing.
Dexcom is one of a few continuous glucose monitors on the market. In adults, the U.S. Food and Drug Administration approved Dexcom monitors for use on the abdomen.
In children up to age 17, the device is approved for use on the abdomen and the upper buttocks, said Camilla Levister, a certified diabetes educator at the Mount Sinai Diabetes Center in New York City. Levister was not involved in the study.
Litchman said she noticed that her patients were wearing their monitors all over, and she wanted to know more about how well these non-FDA-approved sites worked.
She and her colleagues searched the social media site Instagram. They found 353 posts featuring people wearing Dexcom monitors.
Nearly two-thirds were wearing their monitor in a spot other than the FDA-approved location, Litchman said.
Why do people move the devices around?
One reason is the need to avoid scar tissue. Another reason is for comfort. Also, the monitor should be moved to a different location on the abdomen every seven days, Litchman said. There’s only so much “real estate” on the body, especially in children, she added.
The good news? “Failure rates were similar in the abdomen, outer arm and thigh,” she noted.
The posterior arm — towards the back of the arm, an area that tends to be slightly fatty — was the most popular site, with almost 80 percent of people wearing the device there successfully, the findings showed.
Next in popularity was the abdomen, with a 77 percent success rate, followed by 69 percent success on the thigh.
More good news: These alternative sites were accurate, sometimes even more so than the abdomen. The sensor failure rate was 6.2 percent for the abdomen and only 2.2 percent on the outer arm and 3.3 percent on the thigh, the study found.
Litchman said people with type 1 diabetes seem to rely on social media posts to see other areas that people have tried. And they share information about what works and what doesn’t.
Cynthia Rice is senior vice president for advocacy and policy at JDRF.
“It’s very common to see [continuous glucose monitors] in different areas at JDRF events,” she said.
Rice explained that the companies usually go to the FDA with a proposed use and the data that they have to support that request. Initially, she said, a drug or device indication is usually very limited, and then expands.
“But it’s not against the law for people to use devices ‘off-label’ or for health care providers to prescribe them ‘off-label,’” she noted. Off-label means in a manner different from the original indication.
Levister wasn’t surprised by the study findings. She sees people use alternate sites all the time, she said. The one area she would caution against, however, is the calf.
“You want to be careful with the lower extremities and diabetes,” Levister said. People with diabetes can get serious infections in the lower extremities, so it’s better not to rely on that area, she explained.
Litchman’s advice? “If someone is interested in trying a different location, they may want to ask their health care providers about the pros and cons of other sites,” she said.
The study was presented Sunday at the American Association of Diabetes Educators meeting in Indianapolis. Research presented at meetings is usually considered preliminary until published in a peer-reviewed medical journal.
SOURCES: Michelle Litchman, Ph.D., assistant professor, University of Utah College of Nursing, Salt Lake City; Camilla Levister, M.S., AMP-C, C.D.E., certified diabetes educator, Mount Sinai Diabetes Center, New York City; Cynthia Rice, Ph.D., senior vice president, advocacy and policy, JDRF (formerly known as the Juvenile Diabetes Research Foundation); Aug. 6, 2017, American Association of Diabetes Educators meeting, Indianapolis
A large, long-term study suggests that middle aged Americans who have vascular health risk factors, including diabetes, high blood pressure and smoking, have a greater chance of suffering from dementia later in life. The study, published in JAMA Neurology, was funded by the National Institutes of Health (NIH).
“With an aging population, dementia is becoming a greater health concern. This study supports the importance of controlling vascular risk factors like high blood pressure early in life in an effort to prevent dementia as we age,” said Walter J. Koroshetz, M.D., director of NIH’s National Institute of Neurological Disorders and Stroke (NINDS), which partially funded the study and created the Mind Your Risks® public health campaign to make people more aware of the link between cardiovascular and brain health. “What’s good for the heart is good for the brain,” he added.
The study was led by Rebecca Gottesman, M.D., Ph.D., professor of neurology at Johns Hopkins University in Baltimore. Her team analyzed the data of 15,744 people who participated in the Atherosclerosis Risk in Communities (ARIC) study, funded by the NIH’s National Heart, Lung, and Blood Institute (NHLBI). From 1987-1989, the participants, who were black or white and 45-64 years of age, underwent a battery of medical tests during their initial examinations at one of four centers in four different states. Over the next 25 years they were examined four more times. Cognitive tests of memory and thinking were administered during all but the first and third exams.
Her team found that 1,516 participants were diagnosed with dementia during an average of 23 follow-up years. Initially, when they analyzed the influence of factors recorded during the first exams, the researchers found that the chances of dementia increased most strongly with age followed by the presence of APOE4, a gene associated with Alzheimer’s disease. Whites with one copy of the APOE4 gene had a greater chance of dementia than blacks. Other factors included race and education: blacks had higher chance of dementia than whites; those who did not graduate from high school were also at higher risk.
In agreement with previous studies, an analysis of vascular risk factors showed that participants who had diabetes or high blood pressure, also called hypertension, had a higher chance of developing dementia. In fact, diabetes was almost as strong a predictor of dementia as the presence of the APOE4 gene.
Unlike other studies, the researchers discovered a link between dementia and prehypertension, a condition in which blood pressure levels are higher than normal but lower than hypertension. Also, race did not influence the association between dementia and the vascular risk factors they identified. Diabetes, hypertension and prehypertension increased the chances of dementia for white and black participants. Finally, smoking cigarettes exclusively increased the chances of dementia for whites but not blacks.
“Our results contribute to a growing body of evidence linking midlife vascular health to dementia,” said Dr. Gottesman. “These are modifiable risk factors. Our hope is that by addressing these types of factors early, people can reduce the chances that they will suffer from dementia later in life.”
Further analysis strengthened the idea that the vascular risk factors identified in this study were linked to dementia. For instance, in order to answer the question of whether having a stroke, which is also associated with the presence of vascular risk factors, may explain these findings, the team reanalyzed the data of participants who did not have a stroke and found similar results. Diabetes, hypertension, prehypertension and smoking increased the risk of dementia for both stroke-free participants and those who had a stroke.
Recently, in a separate study partially funded by the NIH’s National Institute on Aging, Dr. Gottesman’s team analyzed brain scans from a subgroup of ARIC participants who did not have dementia when they entered the study. They found that the presence of one or more vascular risk factors during midlife was associated with higher levels of beta amyloid, a protein that often accumulates in the brains of Alzheimer’s patients. This relationship was not affected by the presence of the APOE4 gene and not seen for risk factors present in later life. The presence of vascular risk factors detected in participants older than 65 years of age during the final examination was not associated with greater levels of beta amyloid.
“With many years of data from a large and diverse population, the ARIC study is a powerful source of information for medical research,” said Jacqueline D. Wright, Dr.P.H., program director at NHLBI. “This epidemiologic study aimed to improve our understanding of atherosclerosis and heart disease and, through the investigators’ efforts; it has become a great resource for research on dementia and other diseases of aging. The investments in longitudinal cohort studies like ARIC will benefit all of us for many years to come.”
In the future, Dr. Gottesman and her team plan to investigate ways in which subclinical, or undiagnosed, vascular problems may influence the brain and why race is associated with dementia.
This study was supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C) and grants from NHLBI and NINDS (HL096812, HL096814, HL096899, HL096902, HL096917)
The second study was also funded by grants from the NHLBI, NIA, & NINDS (HL70825, AG040282).
NINDS is the nation’s leading funder of research on the brain and nervous system. The mission of NINDS is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease.
Part of the National Institutes of Health, the National Heart, Lung, and Blood Institute (NHLBI) plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at https://www.nhlbi.nih.gov.
About the National Institute on Aging: The NIA leads the federal government effort conducting and supporting research on aging and the health and well-being of older people. The Institute’s broad scientific program seeks to understand the nature of aging and to extend the healthy, active years of life. For more information on research, aging, and health, go to www.nia.nih.gov.
About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
(HealthDay News) — New research challenges the idea that allowing Americans to price shop for health care services could help slow rising health care costs.
“The idea is that if you give consumers good information about prices — and make sure they have ‘skin in the game’ through high deductibles or co-pays — they will choose lower-priced providers and services, and market forces will drive spending and prices down,” said Dr. Ateev Mehrotra, a health care economist and physician at Harvard Medical School.
“That’s the theory. We wanted to see how it works in reality. Turns out, reality is a bit more complicated than that,” Mehrotra added in a school news release.
The researchers looked at Americans’ attitudes about comparison shopping for health care services. In a national survey of 3,000 people who had recent out-of-pocket health expenses, the researchers found only 13 percent of the respondents had sought information about their expected expenses before receiving care, and only 3 percent had compared costs across providers before receiving care.
The majority of those surveyed said they believed price shopping for care was important and they did not believe that more expensive providers necessarily offered higher quality of care, the researchers said. The most common reason for avoiding price shopping was a reluctance to switch doctors.
In a second study, the researchers offered consumers a comparison shopping tool to price shop a set of services, including lab tests, office visits and advanced imaging services. Only a few used the tool and were able to purchase less expensive services. Overall, the researchers reported, access to the tool didn’t make a dent in lowering outpatient spending.
The findings were published in the August issue of the journal Health Affairs.
The results add to growing evidence that consumerism may not have as much impact on rising health care costs as supporters contend, the study authors said.
“As it stands now, our findings suggest that the current set of transparency laws and online tools have a limited impact on health care price shopping, and even less impact on overall spending or prices,” Mehrotra said. “The evidence we’ve found doesn’t support the enthusiasm that policy makers have had for these tools.”
SOURCE: Harvard Medical School, news release, Aug. 7, 2017
(HealthDay News) — Older teens are more likely to do risky things while driving and have a higher rate of crashes and near misses than their younger classmates, a new survey finds.
Researchers surveyed 2,800 high school students across the United States. While 3 out of 4 seniors considered themselves safe drivers, they were more likely than younger teens to engage in dangerous or distracted driving — especially using cellphones while behind the wheel, the survey found.
“Older teens are still inexperienced drivers — even if they feel otherwise — as they only have one to two years of real-world practice under their belts,” said Mike Sample, lead driving safety expert and technical consultant at Liberty Mutual Insurance, a study sponsor.
“That’s why it is important to continue to emphasize the effects and potential consequences of phone use while driving to this age group,” he added in a news release from Liberty Mutual and study co-sponsor Students Against Destructive Decisions (SADD).
Seniors were more likely to use a phone while driving than sophomores, 71 percent vs. 55 percent, the survey showed. This occurs most often at a red light or stop sign and in stop- and-go traffic.
In addition, 67 percent of seniors admitted using apps while driving, compared with 58 percent of juniors and 49 percent of sophomores.
Other dangerous behaviors also became more common as teen drivers got older, including:
- Changing music via phone or app: Seniors, 40 percent; juniors, 32 percent; sophomores, 26 percent.
- Speeding: Seniors, 35 percent; juniors, 23 percent; sophomores, 18 percent.
- Driving when drowsy: Seniors, 26 percent; juniors, 15 percent; sophomores, 13 percent.
Seniors were also more likely to have three or more passengers in the car.
The study also found that they had more crashes and near misses (57 percent) than sophomores (34 percent).
The survey sponsors said parents may unwittingly play a part in older teens’ behind-the-wheel risk-taking.
Nearly 70 percent of 15- and 16-year-olds said they would lose driving privileges if they had a crash, compared with 55 percent of those 18 and older.
Dr. Gene Berlin, senior advisor on adolescent psychiatry with SADD, said it’s natural for teens to gain confidence as they get older and drive more. But overconfidence can cause trouble.
“This age group is more likely to test the boundaries as consequences for bad driving behaviors decrease and their freedoms and responsibilities at home increase, making them feel more like adults,” he said. “As a result, it is even more important for parents and teens to have conversations about safe driving practices to avoid potentially putting themselves and others at risk on the road.”
SOURCE: news release, Aug. 2, 2017
(HealthDay News) — Most women who’ve been diagnosed with breast cancer don’t go it alone.
Many breast cancer patients depend on family and friends to help them make treatment decisions, get to doctor appointments and seek out other resources. A new study finds half of women rely on three or more people to help them through it.
“People just diagnosed with cancer are often scared and overwhelmed. Having another person to help them process information is important,” said study lead author Lauren Wallner, an assistant professor of general medicine and epidemiology at the University of Michigan.
“Physicians need to recognize that women involve other people in their treatment decisions,” she added in a university news release. “These people represent an important group to provide information about treatment options.”
For the study, the researchers surveyed about 2,500 women who had recent surgery for early stage breast cancer. The women were asked to list the people who had helped them weigh their treatment choices.
Half of the women involved at least three people in their treatment decisions, and 20 percent relied on two. Almost 75 percent said supporters had talked with them about treatment and had often joined them for doctor appointments.
Only 10 percent had no one to help them make treatment decisions, according to the study published online recently in the journal Cancer.
“When considering these complex treatment options and going through these complex decisions, it’s beneficial to have the support of other people. This helps women feel supported in their decisions,” Wallner said in the news release.
Black and Hispanic women had larger support networks than white women, the study authors found.
“Minority women tend to have larger networks, so clinicians should also be aware that there could be differences in the number of people patients might be involving. And these networks go beyond just a partner or spouse,” Wallner said.
Women who had a spouse or partner also reported more support, but many who were single also had a large group of people to help them with treatment decisions. Patients with early stage cancer have some time to decide what to do, Wallner noted.
“The idea that women are discussing their options more with their family and friends, and potentially thinking through that decision more carefully is reassuring. Engaging these informal support networks could be a way to prevent women from rushing into something,” she suggested.
The study authors said women without a support network might need extra help to make informed decisions.
“It starts with something as simple as physicians asking patients who is helping them make their treatment decisions,” Wallner said. “That can then guide the conversation, such as the amount of resources the physician provides and to whom they communicate that information.”
(HealthDay News) — Smartphones are capturing all of life’s moments, and doctor visits are no exception.
At least 1 in 10 U.S. patients now records discussions at medical appointments, researchers said.
But do they have the right to do so?
The legality of these taped visits depends on where you live, said investigators from the Dartmouth Institute for Health Policy and Clinical Practice.
“In the U.S., the situation is complex,” said professor and senior scientist Dr. Glyn Elwyn.
“Wiretapping or eavesdropping statutes provide the primary legal framework guiding recording practices and protecting privacy, so a patient who would like to record a doctor’s visit should familiarize themselves with laws in their state,” Elwyn said.
There are two main differences between state wiretapping laws, Elwyn and his colleagues said in a new report.
In “all-party” states, recordings made by doctors or patients are illegal unless everyone involved is aware and provides consent.
In “one-party” states, just one person involved in a conversation needs to be aware and consent to the recording. Only in these states can patients legally record an office visit without their doctor’s consent and vice versa.
The authors said 39 states and Washington, D.C., follow the one-party consent rule; all others adhere to the all-party requirement.
How are patients using these increasingly common recordings?
After reviewing 33 studies involving audio-recorded clinical visits, the researchers found that about 7 out of 10 patients listened to their own recordings. A similar number shared them with a caregiver.
In many cases, patients used the tapes to remember important details about their office visits.
“Most people are sharing their recordings with a family member or caregiver, or they are listening to recording themselves, so they can better recall the information they received during the encounter,” Elwyn said in an institute news release.
Patients said the recordings left them feeling more satisfied with their care.
“Health care overall is moving toward greater transparency and patient recordings are going to become more common,” Elwyn said.
“That means there would be tremendous benefit to patient advocacy groups, health care organizations, providers and policymakers working together to develop clear guidelines and policies around the responsible, positive use of open recordings,” he added.
While some doctors and hospitals worry that taped appointments and procedures will be used against them, others take a more positive view. The Barrow Neurological Institute in Phoenix, for example, encourages patient-doctor recordings and rewards doctors who comply, the researchers said.
The report was published July 10 in the Journal of the American Medical Association.
SOURCE: Dartmouth Institute for Health Policy and Clinical Practice, news release, July 10, 2017
(HealthDay News) — Every minute of every day, three Americans call a poison control center because they’ve made a major mistake with their medication.
Some have taken the wrong dose. Some have double-dosed, and others have taken the wrong medicine altogether.
The result: the rate of serious mix-ups has doubled since 2000, a new study reports.
Four out of 10 mistakes involve heart medications, painkillers or hormone therapy prescriptions, including insulin. And the errors often put patients in the hospital, the study found.
“Ever more drugs for ever more diagnoses in ever more people invites ever more error and adverse reactions,” said Dr. David Katz, director of the Yale University Prevention Research Center. He was not involved with the study.
The study researchers used U.S. National Poison Data System records to track errors involving prescription or over-the-counter medications taken outside a health care facility. Most of the drugs were taken at home, meaning patients, not health care professionals, made the mistakes.
The rate of serious medication errors rose from 1.09 for every 100,000 Americans in 2000 to 2.28 per 100,000 by 2012. One-third of the cases resulted in a hospital stay, the researchers said.
“Fortunately, most do not result in the serious outcomes found in this study,” said lead author Nichole Hodges. She is a research scientist with the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio.
But Hodges said the extent of the problem may be worse than the findings suggest.
“Because this study includes only medication errors reported to poison control centers, it is an underestimate of the true number of serious medication errors in the U.S.,” she said. “Unfortunately, we can’t tell from the data whether serious medication errors are occurring more frequently, or whether they are simply being reported more often.”
Nationwide, at least 1.5 million medication errors occur every year, with poison control centers logging them at a rate of one every 21 seconds.
The study found medication errors outside a medical facility shot up across all age ranges except one: children under age 6.
Among that young group, errors rose between 2000 and 2005, then started to fall. The study pointed to less use of pediatric cough and cold medicines after 2007, when the U.S. Food and Drug Administration advised parents to stop giving those drugs to children.
Most of the errors involved taking the wrong medicine, the wrong dosage or accidentally taking a medication twice.
Two-thirds of deaths in the study involved heart medicines and painkillers combined.
Heart medication mistakes accounted for more than a fifth of errors, while hormone therapy drugs such as insulin accounted for 11 percent.
Painkillers were involved in 12 percent of poisonings, and roughly 80 percent of painkiller mistakes involved products with acetaminophen (such as Tylenol) or an opioid drug.
Hodges said most medication mistakes can be prevented.
“Keeping a written log of when medications are administered can be a helpful strategy for parents and caregivers,” she said. “This is especially important if multiple individuals are administering medication to an individual.”
Hodges said patients should to talk to their doctor or pharmacist if they have questions about their medicines. Careful storage is also important.
“Individuals who use weekly pill planners should [also] ensure that they are child-resistant and stored up, away and out of sight of children,” Hodges added.
Drug makers could help, she noted, by improving drug packaging and labeling. In particular, she said, dosing instructions should be easier for people with limited reading and math skills.
The findings were published July 10 in the journal Clinical Toxicology.
SOURCES: Nichole Hodges, Ph.D., research scientist, Center for Injury Research and Policy, Nationwide Children’s Hospital, Columbus, Ohio, and adjunct assistant professor, Ohio State University College of Medicine, Department of Pediatrics, Columbus; David Katz, M.D., M.P.H., director, Yale University Prevention Research Center, New Haven, Conn., and past president, American College of Lifestyle Medicine, Chesterfield, Mo.; July 10, 2017, Clinical Toxicology
(HealthDay News) — Seniors who believe they have a purpose in life may sleep better, researchers say.
Those who have good reasons to get up every day are less apt to have problems that keep them awake at night, such as sleep apnea and restless leg syndrome, according to a new study. People tend to have more trouble sleeping as they age, the researchers added.
“Helping people cultivate a purpose in life could be an effective drug-free strategy to improve sleep quality, particularly for a population that is facing more insomnia,” said study senior author Jason Ong. He’s an associate professor of neurology at Northwestern University’s Feinberg School of Medicine in Chicago.
The study included more than 800 people between the ages of 60 and 100 who did not have dementia. Those who said their lives had meaning were 63 percent less likely to have sleep apnea and 52 percent less likely to have restless leg syndrome. They also had a moderately better quality of sleep.
Sleep apnea is a common condition where a person’s breathing pauses several times an hour. This disruption causes excessive sleepiness during the day. Restless leg syndrome causes uncomfortable sensations in the legs and an urge to move them, often while sitting or lying in bed, the researchers said.
Only an association was seen between having purpose and sleep quality. And while the study focused on seniors, the researchers said the findings probably apply to others.
“Purpose in life is something that can be cultivated and enhanced through mindfulness therapies,” Ong said in a university news release.
He also said clinicians prefer non-drug solutions to improve sleep, a practice recommended by the American College of Physicians as a first-line treatment for insomnia.
The study was published July 9 in the journal Sleep Science and Practice.
(HealthDay News) — Black adults are more likely than whites to die of a first heart attack, a new analysis suggests.
Two out of three major heart studies reviewed, involving more than 28,000 people, found black men between the ages of 45 and 64 were twice as likely to die of a first heart attack as white men. Older blacks were also more likely than whites to die of a first heart attack, but the difference was smaller.
Heart disease risk is similar for men of both races.
For black women 45-64, the risk of fatal heart attack was also greater than for white women of the same age range.
“Our concern is that blacks may not be seeking medical attention for important symptoms that could signal heart problems,” said study senior author Dr. Monika Safford. She is chief of General Internal Medicine at Weill Cornell Medical College in New York City.
Blacks’ higher likelihood of a fatal first attack may stem from heart risk factors and the conditions in which people are born, grow, work and live, according to the study published July 10 in the journal Circulation.
The findings show that preventing a first heart attack is especially important for blacks.
“Many people think that heart attacks are only present if they have severe chest pain,” Safford said in a journal news release. “In fact, many heart attacks cause only mild symptoms and people may mistakenly think they are having a bout of indigestion.”