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HIV screening is essential

November 30, 2012 By 1 Comment

A new report from the U.S. Centers for Disease Control this week gave me pause: There are 60,000 new HIV infections in the U.S. each year. Nearly 25 percent of new HIV cases occur in people ages 13 to 24, and more than half of them don’t know they are infected. That means each year, more than 7,000 teen-agers and young adults contract a chronic, fatal disease without realizing it.

The good news is, researchers are uncovering new evidence on the best ways to help those newly-infected with HIV. Two new systematic reviews found broad-based routine screenings for HIV can help reduce the spread of the virus, and that screening during pregnancy helps reduce the chance the HIV virus will be transmitted from mother to child. Both were published in the Annals of Internal Medicine.

The first review included randomized trials and observational studies that compared HIV screening strategies, evaluated the effects of starting anti-retroviral therapy at different stages of the disease or reported how these kinds of interventions impacted the risk of transmission.

It concluded that only screening groups of people with a high risk of contracting HIV misses a substantial proportion of cases. Broad-based routine screening for HIV allows more people to start anti-retroviral therapies early in the course of HIV infection. This reduces their risk of sickness and death, and also reduces transmission of the virus to others.

The second review focused specifically on HIV-positive pregnant women. It included randomized trials and longitudinal studies that investigated the risks for a mother transmitting HIV to her unborn child, and the effects of prenatal HIV screening or antiretroviral therapy during pregnancy.

The review found that women who take antiretroviral therapy, avoid breastfeeding and elect to have a cesarean section reduce their risk of transmitting HIV to their child.

The bottom line: Contracting the HIV virus is still a real risk today, but routine screening and early treatment can make a positive impact on the health of HIV-positive patients and reduce the spread of the disease.

Editor’s note: Cornell’s Bronfenbrenner Center on Translational Research will offer streaming sessions from the 2012 International AIDS Conference.

What: Turning the Tide on HIV/AIDS: 2012 International AIDS Conference
When: 8:30 a.m . to 4:45 p.m. on Friday, December 7, 2012
Where: 102 Mann Library
Topics: Preventing mother-to-child transmission; structural inequalities and their impact on the HIV epidemic; strategies for “turning the tide together.
Visit the BCTR web site for more information.

Filed Under: Evidence-Based Living, Health and Wellness, policy Tagged With: , , ,

Citizen scientists: The new research corps

November 28, 2012 By 1 Comment

More often than ever before, people from all walks of life –  from retired senior citizens to young families – are helping scientists collect data that support research projects. This movement of “citizen science” has flourished over the past decade as technology has advanced, allowing volunteers to share information with researchers quickly and accurately.

In fact, there are several interesting examples of “citizen science” here at Cornell University, including a survey of backyard birds and a project called Yardmap that encourages homeowners to map their yards so that researchers can better understand the habitat available to birds.

This month, a group of researchers from the United Kingdom has published a review that details exactly how “citizen science” is working, including summaries of projects across the globe, interviews with scientists who use this data and , and a guide of the best practices for conducting these types of projects. The review found some interesting conclusions. Among them:

  • The motivation for citizen scientists varies greatly. Successful projects tend to take into account the interests and skill-sets of participants, and their expectations.
  • Getting feedback from volunteers is an important component of a sucessful project and is acheived through a wide variety of mediums, including social media and face-to-face interactions.
  • Technologies such as GPS and smart phones have made it easier for citizens to share accurate data, but relying on these devices excludes those who don’t have access to them.

Cornell gerontologist Karl Pillemer is a proponent of “citizen science” for people in their 60s, 70s and 80s. He has conducted research that found that older adults who get involved in creating a sustainable society and conserving natural resources are not only helping the environment, they are also helping themselves.

“Research shows that citizen science activities provide a wonderful opportunity to achieve two goals at once: Adding to our knowledge about areas important to quality of life for people, while also providing opportunities for rewarding and meaningful activity,” he said. “And citizen science activities can be adapted for any life course stage, from elementary school students to retirees.”

In short, projects that use citizen volunteers to collect data are an important part of environmental research today, and understanding the best practices for this type of research is important.

Filed Under: Evidence-Based Living, The Learning Center Tagged With: , ,

Evidence-based Thanksgiving: Is giving thanks good for you?

November 21, 2012 By Leave a Comment

I have talked to a lot of people who identify Thanksgiving as their favorite holiday. As reasons for this they note that it has the benefits of family, friends, and food without the consumerist insanity that surrounds Christmas. The symbolic importance of Thanksgiving is indicated by the fact that it creates the busiest travel time, with 42.2 million people taking a trip of at least 50 miles.

 But how often do we do what the name of the holiday implies: That is, actually give thanks for things? The emotion that encompasses that act is gratitude, which the dictionary defines as “a feeling of thankfulness or appreciation.” Science can’t tell us whether Thanksgiving is good for you, but we at Evidence-Based Living wondered: What about giving thanks? Is there evidence that gratitude itself has benefits?

 It turns out that there is a significant scientific literature on gratitude. A comprehensive review of the research was recently conducted by Alex Wood, Jeffrey Froh, and Adam Geraghty that helps answer the question: Is gratitude good for you? They look at how gratitude promotes well-being and then move beyond that question, examining intervention programs that attempt to achieve positive outcomes by promoting gratitude.

 The authors note that although we may feel grateful for specific events, gratitude can also be seen as “part of a wider life orientation towards noticing and appreciating the positive in the world.” (I’ve heard the expression an “attitude of gratitude.”) Some people are more likely to notice and appreciate the positive in life than others are. And this orientation seems to protect people from psychological distress.

Wood and colleagues’ review shows that gratitude is negatively related to depression. In one study, an attitude of “thankfulness” reduced the risk of such disorders as major depression, generalized anxiety disorder, and drug abuse. Gratitude has also been found to help people adjust to traumatic life  events and their aftermath. On the positive side, a dozen studies have found a positive relationship between gratitude and feelings of well-being.

An important question is causality: It could be that less depressed people are more likely to be grateful,rather  than the opposite. To answer this question, scientists have developed intervention programs to promote feelings of gratitude and then looked at the effects in experiments. The authors review 12 studies that examined the effects of interventions such as daily listing of reasons to be grateful, grateful contemplation (thinking or writing more generally about gratitude), and behavioral expressions of gratitude (actually thanking another person).

The findings are very encouraging, with programs that promote gratefulness resulting in statistically significant increases in positive emotion, decreases in negative emotion, and reduced worry. A study of adolescents even found an increase in satisfaction with school after a gratitude intervention. More research of course needs to be done, but based on this review promoting gratitude seems to make sense to improve well-being.

An appealing part of the gratitude list idea is its simplicity. Anyone can do it – interventions are as straightforward as listing 3-5 things for which one is grateful before going to bed. Why not try it? Or get the turkey-sated crew around the Thanksgiving table to make a list before dozing off in front of the football game!

 

Filed Under: Evidence-Based Living, Health and Wellness Tagged With: , ,

The facts on mold for hurricane victims

November 16, 2012 By Leave a Comment

Nearly a month after hurricane Sandy battered the east coast, homeowners in New York and New Jersey are still trying to dry out their homes and assess all of the damage.  For those whose homes were flooded, a major problem they will face is mold.

Mold spores thrive in flooded homes, where everything is damp and there is plenty of organic material as a base for them to grow and thrive.  They often cause respiratory problems, irritate the skin and eyes, and can lead to lung infections.

Here at EBL, the topic of mold in homes is not a new one. Just last year, we wrote about a systematic review by the Cochrane Collaboration that details the best ways to prevent respiratory problems caused by mold.

Luckily, there is plenty of solid evidence on effective ways to cope with mold in your home. Joe Laquatra, a professor of design and environmental analysis at Cornell, is an expert in coping with mold in homes and a member of the New York State Center for Indoor Environmental Quality. He has developed a comprehensive, evidence-based information sheet that details the health effects of mold in homes and the best methods for removing it.

Among his recommendations are:

  • Homes that are wet for more than 48 hours are at risk of developing mold.
  • It’s best to discard wet ceiling tiles, cellulose insulation, and often drywall as well.
  • If mold is detected over more than ten square feet of a home, the best course of action is to hire a mold remediation contractor. Another fact sheet offers tips about selecting a contractor.

The take-home message: Mold is a serious issue in homes that have experienced flooding. It’s important to understand all of the facts to avoid health problems caused by mold.

Filed Under: Evidence-Based Living, Health and Wellness Tagged With: , , ,

What we know about autism therapies

November 13, 2012 By 1 Comment

According to the U.S. Centers for Disease Control and Prevention, one in 88 American children have an autism spectrum disorder – developmental disabilities characterized by delays in social interaction and communication, cognitive difficulties  and repetitive behaviors.

Autism appears in children by three years of age and typical treatments include medicine and therapy. Now there’s a new meta-analysis investigating behavioral interventions to treat autistic children.

The analysis looks at 33 systematic reviews and 68 intervention studies of autistic children. The review – published earlier this month in the journal Pediatrics – found that some intervention programs did help improve behavioral symptoms.

Intensive behavior programs – which include therapy for at least 25 hours a week – were found to be moderately effective at improving core deficits such as adapting to change, decision-making and memory. The evidence showed these programs were particularly effective when they began shortly after diagnosis, and when they address the concerns of the family and offer opportunities for them to participate.

The authors agreed that there is plenty of room for improvement.  They suggested that comprehensive therapy programs need to address even more deficits including social communication, language, play skills, aggression and preoccupation with rituals.

They also identified gaps in our knowledge about autism therapies.  Researchers need to

– Develop uniform outcome measures so that future systematic reviews can more easily pool data.

– Conduct more studies on pre-verbal or non-verbal children to determine the interventions that help them best.

– Assess how individual, specific therapies impact core deficits such as IQ and communication skills.

– Collect more evidence to determine the most effective dose and duration of therapies.

All in all, the take home message is that behavioral therapy does help children diagnosed with autism, but that researchers have a long way to go to ensure that interventions are doing all that they can to help autistic children develop and thrive.

Filed Under: Evidence-Based Living, Health and Wellness, Youth Development Tagged With: , , ,

New evidence on smoking and pregnancy

November 8, 2012 By 2 Comments

It’s no secret that smoking is bad for your health – and, for pregnant women, has serious impacts on the health of their unborn babies. Smoking during pregnancy not only  increases the chance for early labor and miscarriage , but also  lowers the unborn baby’s heart rate, limits the oxygen he receives, , and increases his risk of lung disease later in life.

Now there is new evidence that provides pregnant mothers with one more reason to avoid smoking: A new systematic review published in the British Medical Journal found that children whose mothers smoked during pregnancy were more likely to be overweight.

The analysis reviewed a total of 30 prospective studies to identify factors during pregnancy and infancy that led to obesity in childhood. Children whose mothers smoked during pregnancy were 47% more likely to be obese.

The review also found that children were significantly more likely to be overweight if their mothers were overweight before giving birth, or if they were fed solids before they were 4 months old.

There were also some factors that seemed to protect against childhood obesity. Breastfed babies were 15 percent less likely to be overweight in childhood. Babies who gained weight more slowly during infancy were also significantly less likely to become overweight as children.

The review offers some solid guidelines for mothers during pregnancy and while caring for young infants. The authors also noted medical professionals could use the findings to develop screening guidelines for pregnant mothers and young babies.

The bottom line: Nutrition and health during pregnancy and infancy has an important impact on a child’s health and well-being.

Filed Under: Evidence-Based Living, Health and Wellness Tagged With: , , , , ,

New evidence: Do well-visits really work?

November 5, 2012 By Leave a Comment

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.

Filed Under: Evidence-Based Living, Health and Wellness
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