It’s human nature to assume that new often means better. But in the case of medical treatments, that’s not always the case. In a new systematic review published in the Mayo Clinic Proceedings, researchers reviewed 10 years of previous issues of the New England Journal of Medicine to identify the benefits of various medical practices which were described.
Evidence check: New medical treatments often lacking
August 1, 2013 By Leave a Comment
Is obesity really a disease?
July 18, 2013 By 2 Comments
Last month, the American Medical Association classified obesity as a disease in its own right for the first time. (Previously, it had been categorized as a symptom or risk factor.) There is plenty of evidence that shows people who are obese are more likely to develop diabetes and cardiovascular disease. But does that make obesity a disease in its own right? What about being overweight, but not obese?
Gaps in evidence: Gun violence in America
July 15, 2013 By 5 Comments
News stories about the problem of gun violence in America have dominated media outlets across the country over the past year. The tragic school shooting in Newtown, Connecticut continues to fuel an on-going debate about the laws surrounding violence and safety in our society. It’s a sensitive subject, and many people across the nation hold opposing viewpoints about what should be done. But one thing is clear: gun violence is a critical public health problem.
Proven methods to quit smoking
July 2, 2013 By 3 Comments
One in five deaths in the U.S. can be credited to tobacco, according to the U.S. Centers for Disease Control – a statistic that makes it clear: Smoking is a huge health problem. [Read more…]
Evaluating programs to promote teen sexual health
March 15, 2013 By Leave a Comment
Teenagers and young adults represent only 25 percent of the sexually active population in the U.S., but they acquire nearly half of all new sexually transmitted infections, according to the U.S. Centers for Disease Control. [Read more…]
Debunking weight-loss myths
March 5, 2013 By 7 Comments
As our nation continues to struggle with an obesity epidemic and individuals work to lose weight with diet and exercises programs, a group of researchers from University of Alabama at Birmingham want to make sure we know what not to do.
In an article published earlier this year in the New England Journal of Medicine, obesity researchers reviewed the evidence about losing weight to identify what we really know about the best ways to lose weight.
They identified 7 commons myths about losing weight which are not true:
1. Small changes in diet and exercise will create big, long-term weight changes.
2. Setting realistic goals for weight loss is important to prevent frustration.
3. Rapid weight-loss is less successful over the long-term than gradual weight loss.
4. Patients who want to lose weight must be “mentally ready.”
5. Physical education classes play an important role in preventing childhood obesity.
6. Breastfeeding protects babies against obesity later.
7. Sexual activity is a good way to burn calories.
The review also identified some common perceptions about losing weight that are, in fact, supported by strong evidence:
- Genetics play a role in weight loss, but that factor is not insurmountable.
- Exercise helps people maintain their weight.
- Patients lose more weight on programs that provide meals.
- Some prescription drugs help with weight loss and maintenance.
- Weight-loss surgery is an effective way to maintain long-term weight loss and reduce mortality in appropriate patients.
The study also listed some ideas about weight loss that are still not proven or disproven by the current available evidence. For example, we don’t actually know whether eating breakfast regularly aids in weight loss, or whether people who snack often are more likely to gain weight.
In general, the medical community and researchers have praised the study for providing an accurate picture of what we know – and what we don’t – about losing weight. The idea going forward is that researchers should continue to develop new evidence on the most effective methods for losing weight.
The serious effects of physical discipline
February 26, 2013 By Leave a Comment
There are many factors that influence how parents discipline their children: parents’ own upbringing, family customs and stress levels all factor in. But there is clear evidence that some forms of discipline – specifically physical punishment – have negative effects on children throughout their lives.
A new systematic review reveals a body of evidence demonstrating physical punishment may increase the chances of antisocial behavior and aggression, depression, anxiety, drug abuse and psychological problems later in life.
The review is especially interesting because it discusses intervention programs designed to reduce physical punishment and child abuse. It included a trial of one intervention that taught parents to reduce their use of physical punishment, which led to less difficult behavior by their children.
Another such program – called Triple P – originated in Australia was tested in a study funded by the U.S. Centers for Disease Control. The program uses a broad range of strategies to address physical abuse including consultations with parents, public seminars and public service announcements on local media. It led to significantly positive results that are encouraging if replicated in other areas of the U.S. Counties that implemented the program had lower rates of substantiated child abuse cases, fewer instances of children removed from their homes and reductions in hospitalizations and emergency room visits for child injuries.
John Eckenrode, professor of human development and director of Cornell’s Bronfenbrenner Center for Translational Research, is an expert in child abuse and maltreatment. He’s written a chapter about preventing child abuse in the book Violence against women and children, published by the American Psychological Association.
“We know that there are tested and effective ways to support parents so that they can better provide a safe and supportive environment for their children without resorting to physical punishment,” he said. “But we must get the word out, provide those who interact with parents such as teachers and physicians with the tools they need to promote positive parenting strategies, and provide resources to states and localities to scale-up effective programs.”
The take-home message: Physical punishment and child abuse are serious problems that have life-long effects. But there is a growing body of evidence that intervention programs can help guide parents to other methods of discipline.
The evidence on preventing weight gain
January 18, 2013 By 1 Comment
We’ve all heard extensively about the obesity epidemic that impacts millions of Americans, leading to heart disease, stroke and cancer, among other problems. And, of course, it’s the time of year when many of us make new year’s resolutions to lose weight, exercise more and generally improve our health. But what methods work the best?
To answer that question, I dug up a systematic review of lifestyle changes to help prevent weight gain in people who were normal weight, overweight and obese. The researchers looked at 40 studies on a wide array of interventions including low-calorie diets, Weight Watchers, meal replacement, behavior therapy by trained nutritionists, low-fat diets, exercise programs and others.
The conclusion? There are many effective ways to lose weight and prevent weight gain. Eight interventions yielded significant improvement in weight control . These included low-fat diets with and without meal replacements, low calorie diets, Weight Watchers, and diets with behavior therapy.
The review did not find enough evidence to support lifestyle interventions to prevent weight gain in normal-weight adults. It called for better study design as well as improved reporting of participant characteristics and outcomes in weight loss studies.”
The take-home message here: To lose or prevent gaining weight, your best move is to do something. Whether it’s diet, exercise, behavior therapy, or a combination of the three, it’s likely to yield results.
The consequences of child abuse and neglect
January 8, 2013 By 1 Comment
Here at EBL, we’ve written before about the horrible consequences of child abuse and neglect. The statement we made before remains true: No one needs an academic study to understand that abuse and neglect take a terrible toll on young people, their families, and our society. But it is helpful to understand the specific effects this behavior causes.
A new systematic review examines the long term impacts of physical abuse, emotional abuse, and neglect in childhood on later mental and physical health. The review synthesized data from 124 studies that followed victims of child maltreatment later in life.
The findings demonstrate significant associations between physical abuse, emotional abuse, and neglect with mental health conditions including depression, anxiety, and suicide attempts. The researchers estimate that all three forms of maltreatment double the risk of developing a mental health disorder later in life.
Adults who were victims of child maltreatment were also more likely to use drugs, to engage in risky sexual behavior, and to contract sexually transmitted infections. Additionally, research has found a possible relationship with chronic diseases and other physical health outcomes, but the evidence is sparse and not consistent across types of maltreatment. The authors said more research is needed to better understand these consequences.
At Cornell’s College of Human Ecology, researchers manage a project called the National Data Archive on Child Abuse and Neglect (NDACAN). The project, which is housed in the Bronfenbrenner Center for Translational Research, makes existing child maltreatment data available to qualified researchers so that they can conduct their own original research and learn more about the costs, consequences, and prevention of child maltreatment. Datasets at NDACAN include large-scale surveys and annual federal efforts collect data from official child abuse and neglect reports and about maltreated children living in foster care.
“The Archive is an important tool that allows social scientists to replicate and expand on our scientific knowledge base,” said Elliott Smith, Associate Director of NDACAN.
The take home message: All forms of child abuse and neglect have serious ramifications that last throughout the life-span.
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.
The evidence on super-sized soft drinks
October 26, 2012 By 1 Comment
Next year, New York City residents must say good-bye to their super-sized sodas and Double Big Gulps. Beginning in March, the city will limit to 16 ounces the size of soft drinks sold at restaurants, street carts, movie theaters and sporting venues. The New York City Board of Health passed the proposal last month in an effort to reduce the consumption of sugary drinks thought to contribute to the nation’s obesity epidemic.
But what evidence do we have about sugary soft drinks and weight gain and harm our health? We know that sugar-sweetened drinks account for nearly half of the total added sugars Americans consume and 7 percent of our total calories. But what impact does that have on our health?
New York Times writer Jane Brody also provides an overview of some of the evidence on this topic in her column this week. There are also several systematic reviews that tell the story:
- A 2007 meta analysis in the American Journal of Public Health reviewed 88 studies that examined the association between soft drink consumption and nutrition and health outcomes. The analysis found consuming soft drinks led to increased energy intake and body weight, and was associated with lower intakes of milk, calcium, and other nutrients. It also found an association between soda intake and diabetes.
- Another systematic review, published in the American Journal of Clinical Nutrition in 2006 – which included 30 cross-sectional, prospective and experimental studies looking at the relationship between sugary soft drink consumption and weight gain – concluded that sugary soft drinks are associated with weight gain and obesity.
- A third review published in Cambridge University’s Nutrition Research Reviews in 2008 came up with inconclusive results. The review examined 44 epidemiological studies and interventions and six meta-analyses – all looking at the relationship between sugary soda consumption and obesity. The author concluded that while sugary soft drinks are a source of calories, there is little evidence that they cause more weight gain than other sources of calories. He said the impact of sugary sodas on weight gains depends on variables including how much soda is consumed each day and the formulation of the specific drink. His review also concluded that consuming large amounts of sugary soft drinks on a daily basis is most directly associated with weight gain.
So, did the New York City Board of Health make an evidence-based decision in limiting sugary soft drink sizes? I think the answer is yes. While there is some mixed data on the association of soft drink consumption and weight gain, the evidence makes it abundantly clear that consuming large amounts of soda is the major problem. By limiting soft drinks sizes, the City is essential legislating the old adage, “Moderation in all things.”
