New evidence on volunteering later in life

volunteerThe U.S. population is aging as the baby boomers begin reaching their golden years. This means our nation is facing more people with the declining function, memory and cognition associated with aging.  [Read more…]

How to brush your teeth

toothbrushAre you surprised to find out that dental organizations around the world recommend different techniques for teeth-brushing?  I sure was.  But what surprised me even more is the lack of evidence that one method works better than another.

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What we know about treating nausea during pregnancy

pregnant teenFeeling nauseous while pregnant can have a debilitating effect on your life – making it difficult to concentrate at work, care for other children and even perform ordinary tasks like taking out the garbage. [Read more…]

Evidence needed: The effect of volunteering on health

Here at EBL, we’ve written before about the impact of volunteering on public health.  In fact, Cornell gerontologist Karl Pillemer has conducted research that found that older adults who get involved in creating a sustainable society are not only helping the environment, they are also helping themselves. So we were interested to find a new systematic review on the health and survival of people who volunteer.

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Cinnamon to treat diabetes?

For at least 4,000 years, the human race has prized the use of spice cinnamon in religious rituals and to flavor foods. And in traditional medicine, cinnamon was used to improve circulation, relieve abdominal discomfort and treat infections.

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New evidence: Do well-visits really work?

Over the past three decades, the U.S. health care system has put an emphasis on well-visits – annual appointments with a primary care physician to help detect any medical problems early.  The idea makes perfect sense:  If a doctor can identify a medical condition in the early stages, the patient can begin treatment sooner and prevent the disease from progressing.

But this turns out to be a great example of how new evidence can contradict a widely-accepted practice.

A systematic review published this month by the Cochrane Collaboration  – one of our favorite data libraries – found that regular health checks-ups have no effect on a patient’s risk of developing cardiovascular disease, cancer or of dying. In other words, well visits do not decrease your risk of dying, heart disease or cancer.

The review included 14 longitudinal, randomized controlled trials. Each study included a group of adults  who were offered regular health checks and a control group of adults who were not. A total of 182,880 people participated in the studies.

The health checks did have some effects. Two of the trials identified greater numbers of patients with high blood pressure, high cholesterol and chronic diseases, but these trials still did not show an increased incidence of heart disease or death in the control group.

The authors did offer several caveats: Most of the trials were conducted decades ago, when the risk factors and treatments for chronic medical conditions were different than they are today. The authors also noted that primary care physicians are likely to identify chronic problems when a patient comes in for another issue, or complains of a symptom.

What’s the take-home message here?  As policy makers continue to debate the best ways to reform the U.S. health care system, they need to take into account all of the evidence on our current medical practices.

Zinc lozenges to treat a cold? Worth a try

The phrase on the front of the packaging for Cold-Eeze zinc lozenges says it all: “Clinically proven to reduce the duration of the common cold.”

While I always give them a try when I feel a cold coming on, I’ve always wondered if the package is referring to one small study, or if there’s conflicting evidence.

So this week, I was excited to see a systematic review on zinc for the treatment of the common cold.  The authors found 17 randomized controlled trials comparing orally administered zinc with placebo or no treatment. And those studies included more than 2,000 patients.

The results?  Zinc did shorten the duration of cold symptoms in adult patients compared to those given placebo by a little over a day. No effect was seen for children taking zinc. The lozenges did cause some bad taste and nausea in study participants.

The authors also called for more extensive research solidify recommendations and  take an in-depth look at adverse effects.

For the time being, I’m going to keep up the zinc. A day or two without sniffles and body aches seems well worth it to me.

The buzz on red meat

Last week, the headlines on meat consumption were inflammatory to say the least.

The Los Angeles Times: All red meat is bad for you, study finds Fox News: Red meat linked to premature death, research finds
The BBC: More Red Meat, More Mortality
The New York Times: Red Meat Increases Death, Cancer and Heart Risk

The researchers, from the Harvard School of Public Health, followed the diets and health outcomes of 37,000 men and 83,000 women over more than two decades. The found those who ate protein sources other than red meat were more likely to live longer. But what’s really at work here?

I found several systematic reviews on red meat consumption that give a broader look at this issue.

One published in the journal Circulation found 20 case-controlled studies and randomized controlled trials that assessed the effect of red meat consumption on health and concluded that eating processed meats, but not red meat, is associated with higher incidence of heart disease and diabetes.

Another review looked at the link between red meat consumption and colorectal cancer, and found eating red meat on a daily basis is associated with an increased risk of colorectal cancer and eating processed meats regularly is associated with an even higher risk of colorectal cancer.

And a third review found little evidence available on the links between red meat consumption and stroke risk.

As much as I love a good burger or juicy steak, the available evidence shows that eating red meat regularly is bad for your health. It is worth noting ,though, that in each study, the conclusions were drawn based on participants consuming red meat every day.

Personally, I’m going to stick with my motto of everything in moderation, and still enjoy a nice cut of beef once in a while.

Sniff, sniff: What the evidence says about colds

Have you got your first cold of the season yet?  Our family has cycled through an entire round already – each of us taking turns coping with runny noses, hacking coughs and sore throats.

While typically not a life-threatening illness, the common cold is one of the most widespread diseases in the world and a leading cause of doctor visits and absenteeism from school and work.  Beyond that, having a cold is just plain uncomfortable.  So of course, I was on the hunt a treatment that actually works.

I immediately turned to the Cochrane Collaboration, which has published dozens of reports on preventing and treating the common cold.  Here are a few that interested me most;

  • The data on heated, humidified air is completely split.  The Cochrane Collabortion review, which included six trials with a total of 387 participants,  found that in some studies inhaling steam helped symptom and in others it did not.
  • I’ve long increased my orange juice intake when I have a cold with hopes that the extra Vitamin C would help. But a systematic review found no consistent effect on the duration or severity of cold symptoms.
  • A review of seven trials found that over-the-counter nasal decongestants like Sudafed do help, but only slightly. Users reported a 6 percent improvement in symptoms after one dose, and a 4 percent improvement over several days. For me, personally, I wonder if such a small improvement is worthwhile.
  • The most promising treatment for the common cold, according to the evidence, is zinc. The systematic review of 15 randomized controlled trials found that zinc lozenges and syrup are both effective in reducing the duration and severity of the common cold in healthy people, when taken within 24 hours of onset of symptoms.

Needless to say, my medicine cabinet is now stocked with zinc lozenges so that our family is ready for any other colds that come our way this season.

Why do you think kids make risky decisions? Bet you’re wrong…

On a trip to Dallas last week, I stayed in a large hotel that was playing host to a convention of high school student members of a service organization. A group of boys was roughhousing on a balcony where only a low railing served as a barrier against a 3-floor drop to the lobby, and it looked like a shove in the wrong direction would send someone over the edge. Down swept a small phalanx of chaperones exclaiming what a bunch of idiots the kids were. The young fellows sauntered off, muttering about “over-reacting,” and “always ruining it when we’re having fun.”

To adults, the reason for this behavior seems obvious: Kids are illogical and don’t understand the risks of their behavior. We assume that they do risky things – like use drugs, drive drunk, or have unprotected sex – because they are irrational beings. Like my grandmother would say: “Those kids just don’t have any sense.”

Enter Cornell professor Valerie Reyna to show us that we’re wrong about this, and our misconceptions have implications for how we try to help kids make less risky decisions. A faculty member in Human Development, Prof. Reyna conducts groundbreaking work on judgment and decision making. And she has taken the additional step of turning her basic research into practical programs to help young people.

In the laboratory under controlled conditions, she has conducted many studies of children and adolescents. Following a translational research model, she and her colleagues wanted to first understand the causal mechanisms that generated risky behavior. What she learned in the lab about the psychology of adolescent risk-taking and about how risky decision making changes with age, she found could then be used to modify unhealthy behavior.

The findings are fascinating. It turns out that adolescents don’t take risks because they are irrational and feel invulnerable and immortal. In fact, it’s because they are too logical. Adults can access informed intuition to avoid risk, whereas adolescents count up and weigh risks versus immediate benefits, and often the risk comes out on top. As Prof. Reyna puts it, “We found that teenagers quite rationally weigh benefits and risks. But when they do that, the equation delivers the message to go ahead and do that, because to the teen the benefits outweigh the risks.”

Existing prevention curricula that had been developed tended to have effects that faded over time and were not as large as they could be.  Prof. Reyna translated her research findings into a curriculum based on both theory and empirical findings.  She has created interventions to teach adolescents to think categorically—to make sweeping, automatic gist-based decisions about life: “unprotected sex bad,” “illegal drugs bad.”

After more than 800 teenagers participated in a randomized controlled trial, the investigators found that the curriculum was more broadly effective, and its effects lasted in many cases for long periods of time.

Prof. Reyna’s web page Resources on Risky Decision-Making in Adolescence is a terrific resource. I recommend starting by watching one of her presentations on the topic, conveniently available on the site. An article in the New York Times provides a quick overview. If you are a professional working with adolescents (or if you have one in your family) you’ll find a whole new way of looking at why kids take risks.

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