A tough pill to swallow? The evidence on taking medicine

Antidepressant pillsThere are all sorts of medicines on the market today that help us to feel our best, prevent illness and treat disease. The vast majority of them come in pill form. But some people struggle — for a variety of reasons —to swallow pills. [Read more…]

Can we improve how well people take their medicine?

asprinIn our modern health care system, prescribing medicines is one of the main ways that doctors treat illness and prevent more serious diseases. [Read more…]

The evidence on music therapy

We’ve all heard the idiom, “Music is good for the soul.” But, according to the evidence, it’s good for your health as well.

[Read more…]

A proven method to reduce hospital infections

Methicillin-resistant Staphylococcus Aureus, commonly called MRSA, is a type of bacteria resistant to many of the antibiotics we use today. It is most dangerous to patients in healthcare settings, who often have compromised immune systems that allow MRSA to spread in their bodies. When MRSA infections reached their peak in the mid-2000s, nearly 100,000 people died as a result of infections from the bacteria each year. [Read more…]

Youth smoking prevention works

Smoking is the leading cause of preventable death in the United States, according to the U.S. Centers for Disease Control, causing about 500,000 deaths per year and driving up costs in the U.S. health care system. [Read more…]

The evidence shows preschool matters!

We have heard educators and politicians alike tout the virtues of early childhood education, and how it prepares kids for a lifetime of learning. With one of my own children in preschool and another one headed there shortly, I’m always interested in the evidence on this stage learning. Do activities like playing with blocks and paints, sitting through circle time and learning to share really impact a child for the rest of his life?

So I was fascinated to follow a series of reports on National Public Radio that detail some interesting evidence about preschool programs. While these reports didn’t include a systematic review, they did include several different longitudinal studies that make an interesting case about the importance of preschool.

On the show This American Life, host Ira Glass talks with a range of experts – a journalist, an Nobel-prize winning economist and a pediatrician – about the evidence on what researchers call “non-cognitive skills” like self-discipline, curiosity and paying attention.

One of the leading experts in this field is an economist at the University of Chicago named James Heckman. His work has found that these soft skills are essential in succeeding in school, securing a good job, and even building a successful marriage. Heckman found that children learn these skills in preschool.

One well-known longitudinal study followed a group of low-income 3- and 4-year-olds in Ypsilanti, MichiganThese children were randomly assigned to attend preschool five days a week, or not attend any preschool.  After preschool, all of the children went to the Ypsilanti public school system.

The study found  that children who attend preschool were more successful adults. They were half as likely to be arrested and earned 50 percent more in salary. Girls who attended preschool were 50 percent more likely to have a savings account and 20 percent more likely to have a car.

Another similar project conducted in North Carolina found that comparable results: Individuals who had attended preschool as children were four times more likely to have earned college degrees, less likely to use public assistance, and more likely to delay child-bearing.

There is more evidence too.  NPR’s Planet Money aired a show  earlier this year demonstrating further evidence about the benefits of preschoolAnd researchers at the University of Texas in Austin found that preschool reduces the inequalities in early academic achievement.

The take-home message seems to be: Preschool matters!

What we know about autism therapies

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.

Do exercise programs for kids really work?

Nearly 12.5 million children – or 17 percent of the U.S. population ages 2-19 – are obese.  As a response to this growing problem, schools and community groups have launched intervention programs designed to get kids moving.  But do they work?

A new meta analysis published last month in the British Medical Journal was designed to answer just that question. It included 30 studies on exercise programs for children published worldwide between January 1990 and March 2012.

Studies in the review measured the effects of intervention programs that targeted children under 16 years old and lasted for at least four weeks. To be included, studies had to definitively measure levels of physical activity in children throughout the day – not just during the intervention class period – with devices like motion sensors.

In each case, the investigators expected that the programs would increase the children’s overall daily physical activity.

The review uncovered some surprising evidence: programs designed to encourage increased physical activity among kids didn’t work. On the whole, the programs increased  children’s overall physical activity levels by about 4 minutes a day – even though the programs themselves ranged from 30 to 90 minutes in length.

One explanation is that children unconsciously compensate for the energy they use during structured activity programs by being doing sedentary activities aftewards, Brad Metcalf, a research fellow and medical statistician at Peninsula College who led the review, told the New York Times. Another explanation is that many of the programs took place after school, replacing a time period when children are typically most active anyway.

This analysis did yield some clear results: that we need to come up with additional strategies for encouraging physical activity among children.

Evidence-based Olympics: The science of sport

Much of the world is watching the 2012 Olympics with excitement as athletes attempt to swim faster, jump higher and dive more gracefully than humans ever have before.  The casual spectator might be surprised at the amount of science that goes into competition at the Olympic level.

Here at EBL, we tracked down a round-up of media on scientists working with Olympic athletes to help them become the best they can be.

Among the interesting research is a study trying to determine the most efficient freestyle stroke technique for swimmers. A mechanical engineering professor at John Hopkins University used laser body scans and underwater video of two Olympic-level swimmers to create a computational fluid dynamic model to compare the two different freestyle strokes. His work determined that a method known as the “deep-thrust” swimming style is the most effective way to swim freestyle.

Another professor of biomedical engineering at the University of California is using physics to help elite divers. She installed force sensors on diving platforms to measure the forces divers use when they begin their dives. “The athletes feel the forces and the coaches see the effect of the forces,” Professor Jill L. McNitt-Gray explained. “By measuring forces, they could both get a sense of what they actually are.”

And a mechanical engineer at Sheffield Hallam University in the United Kingdom studies the role technology has played in the history of sport. He’s written extensively this year on the effects of rule changes and technology on sporting performance over time.

Certainly, there are many more examples of science in sport such as aerodynamic helmets used in cycling and the biological effects of endurance sports, to name two.

When it comes down to individual competitions, luck and human spirit certainly do play a role – especially at the Olympics. But it’s interesting to take a look behind the scenes to see the role that science plays as well.

To spray or not to spray?

Lyme disease – an infectious disease spread by ticks that thrive in wooded areas – is on the rise in the Northeast. The disease can be debilitating if undiagnosed, causing chronic fatigue, joint pain andneurological problems.

As a mom, it’s a really worry for me.  My kids are outside every day, often on trails or in wooded areas.  I check them daily for ticks, but one would be easy to miss.

This year, I’ve often debated with other parents the risk and benefits of using bug spray. On one hand, there is clear evidence that the insecticide DEET – or N,N-diethyl-meta-toluamide – effectively repels ticks.  But on the other hand, there are cases where it is clear that DEET has led to health problems including skin problems, hallucinations and seizures.

So I went hunting for some more sweeping analyses on what the evidence says about DEET. The Journal of Family Practice provided a good summary of several systematic reviews on the use of DEET in children. Both found the risk of adverse reactions was low – about 0.1 percent of children exposed experiences an adverse reaction – and that there was no clear dose-dependent relationship between exposure and extent of severity of the reaction.

The U.S. Centers for Disease Control maintains that DEET doesn’t present health concerns if it’s used according to the instructions, including not applying it to open wounds, under clothing, or near eyes or mouth.

As a mother, though, the narrative reports of small children undergoing hospitalization for seizures and neurological problems – even though it’s a very small number of cases over decades – stick in my mind.  So we use bug spray with DEET sparingly.  If I know the kids will be in the woods or fields where there are higher populations of ticks, I’ll give them a light spray – always with a bath that night to wash off all of the spray.  Even though the evidence shows DEET is safe, I still feel uneasy about this issue.

What about you? Are you comfortable using buy spray on a regular basis?

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