PEDIATRIC CARE
High precipitation and autism risk
Waldman M, Nicholson S, Adilov N, et al. Autism prevalence and precipitation rates in California, Oregon, and Washington counties. Arch Pediatr Adolesc Med. 2008;162:1026-1034.
Weiss NS. Precipitation and autism: do these results warrant publication? Arch Pediatr Adolesc Med. 2008;162:1095-1096.
The preliminary results of a recently published study indicate that living in wet climates might increase risk of autism in children who are already genetically susceptible to the condition.
This investigation analyzed different counties in California, Oregon, and Washington. Some had more than 27 inches of precipitation a year, others were significantly drier.
The county-level information was examined for autism rates among children born in those counties between 1987 and 1999. Throughout the duration of these children's school years through the end of 2005, autism rates were significantly higher in the wetter western counties of Oregon and Washington than in the drier eastern counties.
Reasons for this are unclear, however, it is suspected that indirect means possibly include increased amount of time watching TV, reduced levels of vitamin D, and elevated exposure to indoor chemicals and polluted indoor air. Precipitation could have a more direct effect if it carries toxins from the atmosphere, or if it increases the use of pesticides.
INFECTIOUS DISEASES
Coffee may lower risk of HCV-related liver disease
Freedman ND, et al. Coffee intake is associated with lower rates of liver disease progression in chronic hepatitis C: findings from the hepatitis C antiviral long-term treatment against cirrhosis (HALT-C) trial. Hepatology. 2008;48(4):1101A. Abstract 1778.
Patients who have hepatitis C virus (HCV)-related liver disease may benefit from drinking coffee, new research indicates. According to a ground-breaking study reported at the American Association for the Study of Liver Diseases, patients who drank at least three cups of coffee a day had half the risk of progression over 3.5 years.
In this study, 795 HCV patients who had not achieved a sustained virologic reaction from peginterferon/ ribavirin therapy completed a food frequency questionnaire to record their consumption of coffee and tea. They filled out the questionnaires at the beginning of the study, and then again 13 months into the study.
While tea intake had no influence on liver progression, coffee consumption showed an inverse correlation between coffee intake and liver disease progression.
Metformin an effective adjunct HCV therapy
Romero-Gomez M, Diago M, Andrade RJ, et al. Metformin with peginterferon alfa-2a and ribavirin in the treatment of naive genotype 1 chronic hepatitis C patients with insulin resistance (TRIC-1): Final results of a randomized and double-blinded trial. Hepatology. 2008;48(4):380A. Abstract LB6.
A recent Spanish trial indicates that HCV patients with insulin resistance can benefit from metformin when added to their current regimen of interferon and ribavirin. The addition of metformin especially affected women positively. In fact, the researchers are now recommending peginterferon-alpha-2a plus ribavirin plus metformin for all HCV-infected women with insulin resistance.
This trial included 123 genotype 1 HCV patients with a homeostasis model of insulin resistance (HOMA) greater than 2. They were split into two groups: one received peginterferon-alpha-2a/ribavirin treatment with added metformin, and the other received placebo.
The metformin group experienced a more favorable rate of sustained virologic response at 12, 24, and 48 weeks. In addition, the mean HOMA value dropped from 4.3 at the beginning of the trial to 2.5 at 24 weeks. The placebo group only dropped from 4.4 to 3.8.
Women, in particular, had an even more significant early virologic response. Their mean HCV RNA log10 declined from 6.53 to 1.64, whereas in men, the decline was only from 6.15 to 2.15.
ALTERNATIVE CARE
Asthma patients may benefit from Tai Chi
Kiatboonsri S, Charitwatchara P, Kawamatawong T, et al. Effects of Tai Chi Qigong training on exercise performance and airway inflammation in moderate to severe persistent asthma. CHEST. 2008;134:s54003.
A small Thai study has demonstrated that Tai Chi, as a supplement to standard therapy for moderate to severe asthma, may be beneficial.
This small study included 17 middle-aged patients with enduring moderate to severe asthma with no exacerbations for at least 1 month and no change in controller medication for at least 3 months before study participation. None of the participants were past or current smokers. Most of them were on a regimen of inhaled corticosteroids combined with a long-acting beta2-agonist.
The patients did nine modified Tai Chi Qigong body movements for 6 weeks. The exercises consisted of once weekly supervised workouts and daily at-home workouts with an audiovisual guide.
After the 6 weeks of training, there were significant improvements in:
* peak-flow variability
* maximum work rate
* maximum oxygen expenditure
* maximum inspiratory pressure
* 6-minute walk distance
* exercise endurance time
* overall quality of life.
CARDIOVASCULAR CARE
Can whole grains prevent heart failure?
Nettleton JA, Steffen LM, Loehr LR, et al. Incident heart failure is associated with lower whole-grain intake and greater high-fat dairy and egg intake in the atherosclerosis risk in communities (ARIC) study. J Am Diet Assoc. 2008;108:1881-1887.
Regularly consuming whole grains, while avoiding eggs and high-fat dairy products, may lower risk of heart failure, according to a large observational cohort analysis using data from the Atherosclerosis Risk in Communities study.
The examiners looked at the relationship between incident heart failure (death during hospitalization) over 13 years and consumption of seven food categories (eggs, high-fat dairy foods, fruits and vegetables, red meat, whole grains, fish, and nuts).
The cohort involved 14,153 adults aged 45 to 64 years. Over a mean duration of 13 years, there were 1,140 heart failure hospitalizations. Of the participants, those who had a greater intake of eggs and high-fat dairy products had a 31% higher risk of heart failure. Conversely, patients with a greater whole-grain intake had a 7% lower risk of heart failure.
This study was significant because it was on such a large scale and included both white and African-American demographics. Previous studies were taken from smaller, white communities.
WOMEN'S HEALTHCARE
Teens with PID more likely to contract other STDs
Trent M, Chung SE, Forrest K, et al. Subsequent sexually transmitted infection after outpatient treatment of pelvic inflammatory disease. Arch Pediatr Adolesc Med. 2008;162:1022-1025.
Teenage girls who present with pelvic inflammatory disease (PID) may be at higher risk of contracting other sexually transmitted diseases (STDs) in future years. A pioneering investigation included 110 teenage girls in the Baltimore area, which was chosen because of its high occurrences of STDs.
Participants were treated on an outpatient basis. They were administered a full course of complementary medication, asked to return within 72 hours, then were told to follow up with their primary care providers (PCPs) at 3 and 6 months.
Only 80 girls returned to their PCPs over the next 48 months. Of them, 34% were diagnosed with another case of PID, gonorrhea, chlamydia, or a combination of the three. The mean time of recurrence was approximately 1 year, but transpired as early as 15 days after the initial presentation.
This research implies that outpatient care of PID does not allow time for adolescent-specific risk-reduction counseling. Without such intervention, the potential risk for subsequent instances of PID and other STDs is much anticipated.
Gaining too much weight may lead to obese babies
Hillier TA, Pedula KL, Vesco KK, et al. Excess gestational weight: Modifying fetal macrosomia risk associated with maternal glucose. Obstet Gynecol. 2008;112:1007-1014.
Women who gain more than 40 pounds during pregnancy are at increased risk of having an obese baby, regardless of whether or not the mother has gestational diabetes (GD).
Researchers examined data from 41,540 pregnant women who had singleton babies. All participants were screened for GD via a 50-gram glucose challenge test. Of these patients, 7,633 women had glucose levels higher than 140 mg/dL, and were subsequently given a 3-hour 100-gram oral glucose tolerance test. Among women who tested negative for GD and those who tested positive, increasing glucose levels were linearly correlated to a higher risk of having overweight babies.
Current pregnancy guidelines recommend gaining between 15 and 40 pounds. In this study, 17.3% of the women gained more than 40 pounds. These women were younger, mostly first-time mothers, and all had heavier babies.