Breast-Feeding Tied to Intelligence

In a large randomized trial of human lactation, researchers have found evidence that prolonged breast-feeding is associated with improved scores on some intelligence tests in childhood.

The results, published in the May issue of The Archives of General Psychiatry, appear to confirm those of previous observational studies.

Researchers in Belarus trained 8,457 mother-infant pairs with an extensive breast-feeding educational program, while a control group of 7,856 received standard care. At three months, 73 percent of the trained mothers, but only 60 percent of the controls, were still exclusively breast-feeding. By six months, exclusive breast-feeding had declined substantially in both groups, to 7.9 percent for the education group and 0.6 percent for the controls.

At 6 ½ years, the breast-fed group scored significantly higher on tests of vocabulary, word matching and verbal I.Q., although the differences in several other tests of intelligence were not significant. Teacher ratings of the children were consistently higher for those who were breast-fed.

It is unclear whether the differences were caused by a constituent of breast milk or by the associated physical and social interactions between mother and child. But the lead author, Dr. Michael S. Kramer, a professor of pediatrics at McGill Universtiyin Montreal, said the results could not be explained by characteristics of the mother or the way she related to her baby. “It’s the breast-feeding that’s doing it,” he said.

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Rough Transition to a New Asthma Inhaler

Millions of people with asthma and other lung diseases will have to switch inhalers by the end of the year. And for many, the transition will not be smooth.

The change — mandated by the federal government in 2005, to go into effect next Jan. 1 — is to comply with the 1987 treaty to protect the earth’s ozone layer. It bans most uses of chlorofluorocarbons, or CFCs, which are used as propellants in many inhalers.

CFC-free inhalers have been available for more than a decade. But four million to five million users have yet to switch, according to the consumer advocacy group Allergy and Asthma Network Mothers of Asthmatics.

For one thing, the old inhalers cost much less — an average of $13.50, or one-third the price of a CFC-free inhaler, which uses propellants called HFAs, for hydrofluoroalkanes. (CFC inhalers are generic; HFA inhalers are brand-name.) People with asthma use an average of three or four inhalers a year, but some patients use one a month.

Moreover, the new and old inhalers differ in feel, force and taste, and how they are primed and cleaned. Advocates for people with asthma say doctors and patients have not been educated about the changes.

“What the government failed to do is to mandate anyone to tell patients and physicians this transition was happening,” said Nancy Sander, president of the asthma group. “There is no education, no monitoring of patients, no financial assistance to patients who have to pay higher prices for the new drugs.”

As a result, she and others say, there have been unnecessary fears about the newer inhalers, preventable trips to the emergency room and even some hoarding of CFC inhalers.

Callers to a hot line run by Ms. Sander’s group have complained that when they were switched to the new inhalers, the differences between the two types were never explained. Many thought that their device was broken or that their symptoms were not being relieved by the new inhalers.

The Food and Drug Administration says that since January 2007 it has received 415 complaints about HFA inhalers’ costing too much or not working properly. After a public meeting last month in which doctors and patients said most people were unaware of the transition, the agency has been stepping up educational efforts, with several public service announcements expected by the end of this month, said Deborah Henderson, an official at the Center for Drug Evaluation and Research.

Both types of inhalers use albuterol, a short-acting medication that can prevent an asthma attack when used preventively — before exercising, for example — or at the first sign of breathing trouble.

But the cost difference has meant huge gains for drug companies. As people switched to HFA inhalers in 2006 and 2007, sales of all albuterol inhalers jumped from about $500 million to $1.1 billion, according to I.M.S. Health, a health care information company. Of the 40.5 million prescriptions written for albuterol inhalers last year, it said, about half were CFC and half were HFA inhalers.

And even though there are important differences between the four brands of HFA inhalers, some insurers cover only one of the four. Advocates say the higher cost may keep patients from buying inhalers or force them to cut back on other medications or switch to a less effective over-the-counter inhaler that uses epinephrine.

Several members of Congress are asking the Bush administration to require insurers, including the Medicare and Medicaid programs, to cover the new inhalers equally. Representative Steve Kagen, a Wisconsin Democrat who is also an allergy and asthma physician, said it was important “to make sure there’s as little co-pay as possible.”

The four HFA inhalers are Ventolin by GlaxoSmithKline, ProAir by Ivax, Proventil by Schering-Plough and Xopenex by Sepracor. (Xopenex uses a different chemical, levalbuterol.) All companies have give-away programs for those in need and are providing free samples that doctors give to their patients. There is also financial assistance available through the Partnership for Prescription Assistance (1-888-477-2669).

Studies show that HFA inhalers are as effective as CFC inhalers and have the same rate of side effects. But if they are not used properly, patients will not get adequate doses. There are three critical differences.

HFA inhalers must be pumped four times to prime them — a number that was not so critical with the more forgiving CFC inhalers, said Dr. Leslie Hendeles, professor of pharmacy and pediatrics at the University of Florida. And each brand of the newer inhaler requires a different frequency of priming.

HFA inhalers have a weaker spray. “It’s very soft so people think it’s not working,” Dr. Stoloff said. Where CFC inhalers deliver a powerful force that feels as if the airway is being pushed open, the newer ones provide a warm, soft mist that also has a distinct taste.

They also require a slower inhale. “You have to take a nice slow, deep breath and hold it,” Ms. Sander said. If people worry that it’s not working, they may not take the second puff, may fail to wait the necessary 30 seconds between puffs or may take too many puffs. ,And their anxiety may rise, further constricting their airways.

HFA inhalers need to be washed with warm water and air dried once a week. The medication is stickier and will clog the hole, reducing the amount of medication the spray delivers.

There are also important differences among the brands, though some doctors simply write Albuterol HFA on the prescription, leaving the pharmacist to choose the brand. Only one, Ventalin, has a dose counter, which helps users keep track of how much medication is left. ProAir appears to be on many insurance companies’ lists of approved medications, but it has the softest spray, Dr. Stoloff said.

Tips on How to Quit

Below, some tips to help you quit smoking are listed. First and foremost, set a quit date and quit COMPLETELY on that day. To prepare for that day:

• Identify the times you are most likely to smoke. For example, do you tend to smoke when feeling stressed? When you are out at night with friends? While you are drinking coffee? When you are bored? While you are driving?
• Keep a diary to help you determine such risky times. Record each time you have a cigarette, including time of day and what you are doing.
• Make a plan about what you will do instead of smoking at those times that you are most likely to smoke. For example, drink tea instead of coffee -- tea may not trigger the desire for a cigarette. Or, take a walk when feeling stressed. Remove ashtrays and cigarettes from the car. Place pretzels or hard candies there instead. Pretend-smoke with a straw.
• Let all of your friends, family, and co-workers know of your plan to stop smoking and your quit date. Just being aware that they know can be a helpful reminder and motivator.
• Prior to your quit date, start reducing your cigarette use, including decreasing the number and strength of the cigarettes. However, DON'T do this simply to make your diary "look good!" Get rid of all of your cigarettes just prior to the quit date and clean out anything that smells like smoke, such as clothes and furniture.

Other tips that can help you quit and stay quit include:

• Enroll in a smoking cessation program (hospitals, health departments, community centers, and work sites frequently offer programs).
• Ask your health care provider for advice, including whether prescription medications (such as bupropion -- Zyban or Wellbutrin) are safe and appropriate for you.
• Find out about nicotine patches, gum, and sprays.
• Try hypnosis -- it works for some people.
• Avoid smoke-filled settings and situations in which you are more likely to smoke.
• Exercise to relieve urges to smoke.

The American Cancer Society is an excellent resource for smokers who are trying to quit, and the Great American Smokeout can serve as a useful catalyst for some smokers.

Running Outdoors Burns More Calories.. Really???

Pavement or treadmill? Most avid runners have a strong preference for one or the other, but how do the two differ in producing results?

According to several studies, the answer is not so simple. Researchers have found in general that while outdoor running tends to promote a more intense exercise, running on a treadmill helps reduce the likelihood of injury, and thus may allow some people to run longer and farther.

A number of studies have shown that in general, outdoor running burns about 5 percent more calories than treadmills do, in part because there is greater wind resistance and no assistance from the treadmill belt. Some studies show, for example, that when adults are allowed to set their own paces on treadmills and on tracks, they move more slowly and with shorter strides when they train on treadmills.

But other studies show that treadmill exercisers suffer fewer stress injuries in the leg. One study published in 2003 in the British journal of sports medicine, for example, analyzed a group of runners and found significantly higher rates of bone strain and tension during pavement running than during treadmill running, particularly in the tibia, or shinbone. This increased strain can heighten the risk of stress fractures by more than 50 percent, the study found.

The Bottom Line: Studies suggest that running on pavement generally burns slightly more calories, but also raises the risk of stress fractures.

ANAHAD O’CONNOR

Whom to Believe? Children Find Out Early

Beware a puppet who tells you that a ball is a book, or that you tie your shoe with a spoon. That, at any rate, is the message of a study that looked at how 3- and 4-year-olds evaluate the trustworthiness of others.

Puppets that had spun such fanciful tales were no longer believed when they tried to teach the children words for unfamiliar objects and actions. But faced with puppets who had given them reliable information — calling a cup a cup, for example — the children were much more accepting.

“Humans make mistakes,” Susan A. J. Birch of the University of British Columbia and colleagues write in the current issue of the journal Cognition. “They trick; they lie; they have different levels of knowledge and different areas of expertise; and they offer information even when they are uncertain.”

The challenge for the child is figuring out whom to believe, and the study suggests that this process starts early and without prompting by adults.

For the study, two puppets gave the children accurate or inaccurate information about everyday objects the children already knew. When the children were then shown objects they did not recognize and given different made-up names for them or explanations for their use, they responded to the names used by the puppet who had been right earlier.

By ERIC NAGOURNEY

Too much, too little sleep tied to ill health in CDC study

ATLANTA (AP) -- People who sleep fewer than six hours a night -- or more than nine -- are more likely to be obese, according to a new government study that is one of the largest to show a link between irregular sleep and big bellies.

The study also linked light sleepers to higher smoking rates, less physical activity and more alcohol use.

The research adds weight to a stream of studies that have found obesity and other health problems in those who don't get proper shuteye, said Dr. Ron Kramer, a Colorado physician and a spokesman for the American Academy of Sleep Medicine.

''The data is all coming together that short sleepers and long sleepers don't do so well,'' Kramer said.

The study released Wednesday is based on door-to-door surveys of 87,000 U.S. adults from 2004 through 2006 conducted by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.

Such surveys can't prove cause-effect relationships, so -- for example -- it's not clear if smoking causes sleeplessness or if sleeplessness prompts smoking, said Charlotte Schoenborn, the study's lead author.

It also did not account for the influence of other factors, such as depression, which can contribute to heavy eating, smoking, sleeplessness and other problems.

Smoking was highest for people who got under six hours of sleep, with 31 percent saying they were current smokers. Those who got nine or more hours also were big puffers, with 26 percent smoking.

The overall U.S. smoking rate is about 21 percent. For those in the study who sleep seven to eight hours, the rate was lower, at 18 percent.

Results were similar, though a bit less dramatic, for obesity: About 33 percent of those who slept less than six hours were obese, and 26 percent for those who got nine or more. Normal sleepers were the thinnest group, with obesity at 22 percent.

For alcohol use, those who slept the least were the biggest drinkers. However, alcohol use for those who slept seven to eight hours and those who slept nine hours or more was similar.

In another measure, nearly half of those who slept nine hours or more each night were physically inactive in their leisure time, which was worse even than the lightest sleepers and the proper sleepers. Many of those who sleep nine hours or more may have serious health problems that make exercise difficult.

Many elderly people are in the group who get the least sleep, which would help explain why physical activity rates are low. Those skimpy sleepers who are younger may still feel too tired to exercise, experts said.

Stress or psychological problems may explain what's going on with some of the lighter sleepers, experts said.

Other studies have found inadequate sleep is tied to appetite-influencing hormone imbalances and a higher incidence of diabetes and high blood pressure, noted James Gangwisch, a respected Columbia University sleep researcher.

''We're getting to the point that they may start recommending getting enough sleep as a standard approach to weight loss and the prevention of obesity,'' said Gangwisch, who was not involved in the study.

For more information, just click
- National Center for Health Statistics: http://www.cdc.gov/nchs
- American Academy of Sleep Medicine: http://www.aasmnet.org/

By THE ASSOCIATED PRESS

Go Ahead, Put the Water Bottle Down

Drinking a lot of water is supposed to be healthy, but there is apparently little scientific support for the belief. A review of clinical studies has found no evidence that drinking eight glasses of water a day, the usual recommendation, is beneficial to a healthy person.

Numerous claims have been made about water — that it prevents headaches, removes dangerous “poisons,” improves the function of various organs and is associated with reduced risk for various diseases. But none of these is supported by scientific evidence. The authors were not even able to find a study leading to the “eight glasses a day” rule, whose origin remains unknown.

The researchers, in the June issue of The Journal of the American Society of Nephrology, say some studies have found evidence that drinking extra water helps the kidneys clear sodium, and long-term sodium retention might increase the risk of hypertension, but no clinical significance for the phenomenon has been established. Water also helps clear urea, but urea is not a toxin.

There is “intriguing” evidence that water might help decrease appetite and control weight gain, write the authors, who say this might be worth more research.

“Under normal circumstances,” said Dr. Stanley Goldfarb, a co-author and a professor of medicine at the University of Pennsylvania, “drinking extra water is unnecessary. I want to relieve people of the burden of schlepping water bottles around all day long.”

By NICHOLAS BAKALAR