In contrast to the rest of the nation, New Hampshire experienced a dramatic drop in asthma hospitalizations for children over the past 10 years, according to a study published in the February issue of Pediatrics.
Researchers at Dartmouth Medical School in Hanover, NH, reviewed hospitalization data in New Hampshire, Maine, Vermont, and New York State between 1985 and 1994 (the most recent data available) to determine if specific regions reflected national trends or if there were significant differences by population groups. Researchers found New Hampshire’s rates fell by almost half, from two hospital discharges to one discharge per 1,000 children under age 18. In Vermont and Maine, discharge rates did not change significantly, while discharge rates in New York climbed from 3.5 to 5 per 1,000 children.
Researchers attribute the variations to characteristics of population groups and differing patterns of medical care. Children in low-income and metropolitan areas, and African American and Hispanic children, had higher hospitalization rates.
New Hampshire has similar populations, says study leader David Goodman, MD, associate professor of pediatrics and community and family medicine. “The decrease in asthma hospitalization is not because there is less asthma, but because of changes in medical care,” Goodman says. A competitive health care system like that in New Hampshire, he explains, appears to encourage clinicians to use outpatient alternatives to hospitalization.
“These findings are encouraging news for children and their families,” Goodman says, because measuring trends in smaller populations can help pinpoint groups or communities in which further efforts to reduce hospitalizations are most needed.
Small changes in daily habits can ease insomnia of many years’ duration in just 6 weeks, according to a study recently published in the journal Sleep.
Peter Hauri, PhD, codirector of the sleep disorders center at the Mayo Clinic, Rochester, Minn, and a prominent insomnia investigator, found that poor sleepers awakened less often, slept longer, and enjoyed better-quality sleep after 6 one-hour weekly sessions to teach them how to modify behavior that sabotaged their sleep.
These study subjects continued to do well 10 months later; a comparison group of insomniacs given the same instruction plus a once-a-week sleeping pill improved right after the teaching sessions, but failed to hold onto the gains.
Poor sleep habits often make insomnia worse and keep it going, Hauri notes. Insomniacs, he said, frequently stay in bed longer, try harder to sleep, drink more coffee during the day, and abandon exercise because they feel tired. Many also rely on sleeping pills; long-term use of these medications has been linked to dependency and difficulty with withdrawal.
Researchers reviewed two large studies of behavioral research-one involving 59 studies, the other, 66 studies-to support their conclusion. The studies show that, on average, behavioral therapy reduces the time it takes to fall asleep from about 60 to 30 minutes, and cuts wakefulness after the start of sleep by about 30 minutes. Overall, people using behavioral therapy sleep about 30 minutes more.
“There is little question that behavioral therapy is the treatment of choice for chronic insomnia,” Hauri says. “These simple techniques can be learned easily. Family doctors and internists can teach them quickly to their patients.”
The Florida Association of Cardiovascular and Pulmonary Rehabilitation (FACVPR) has scheduled a conference August 7-9 to discuss current and future trends in disease management as it relates to cardiopulmonary issues. The conference, sponsored by the American Heart Association (AHA), American Lung Association, and FACVPR, will be held at the Jupiter Beach Resort, in Jupiter, Fla, and will feature speakers from throughout the country. For more information or to make reservations, contact Liz Benson at the AHA, (561) 655-8155, by July 31.
Daily smokers have twice the risk for major depression compared to people who have a history of smoking on an occasional basis, according to a study at Henry Ford Health System, Detroit, published in the February issue of Archives of General Psychiatry. Researchers found not only that smoking may lead to depression, but that depression may lead to increased smoking.
The study-the first of its kind to demonstrate the influence of major depression on increased smoking-tracked 1,000 adults ages 21 to 30 in southeastern Michigan. The 5-year study revealed that in young adults who smoke and have a history of major depression, their risk of becoming daily smokers (a person who smokes daily for 1 or more months) is three times more likely. This progression to daily smoking typically begins in adolescence.
There were no conclusive data, however, showing that major depression played a role in the initiation of smoking. Nor did the study show smokers with depression have a harder time quitting, says Naomi Breslau, PhD, principal investigator and director of research for the department of behavioral services at Henry Ford Health System.
“Smokers who have depression tend to see their smoking become a daily habit, and it may be because they use nicotine to medicate their depressed mood,” Breslau says. An addiction to nicotine may be especially powerful in depressed smokers because of the substance’s mood-altering characteristics.
The study also revealed that smokers are significantly more at risk of major depression. However, the question remains whether smoking causes depression. According to Breslau, there may be neurobiologic evidence that nicotine plays a role in causing depression, but additional research is needed.
“We may find factors predispose people to both depression and smoking. Future research is needed to determine what, if any, are the common causes of both,” Breslau says.
The Mayo Clinic, Rochester, Minn, is scheduled to host a multidisciplinary program, “Critical Care: A Team Approach,” on May 30. The program will combine lectures, panel discussions, and live demonstrations to encourage interaction between faculty and attendees.
The program will include a demonstration of new noninvasive mechanical ventilation technology; a discussion of the future of mechanical ventilation; new concepts in infection control and antimicrobial resistance; how the patient, family, and health care provider can effectively deal with grief; and new methods for stress management in the acute care setting. For information, call
Snoring can progressively damage muscles in the throat and lead to the development of obstructive sleep apnea (OSA), according to a study published in the February issue of the American Journal of Respiratory and Critical Care Medicine.
Swedish researchers collected muscle tissue samples from the throats of snorers and OSA patients. Tissue abnormalities were found not only in the OSA group, but also in snorers who did not have OSA. Researchers speculate the damage is the result of trauma caused by snoring.
Samuel Kuna, MD, of the University of Texas Medical Branch, in Galveston, advises snorers to seek medical advice. “Your doctor can examine your nose and throat and advise you regarding management of the snoring,” he says.
Other measures to remedy snoring include:
· Losing weight. Even a 10 percent weight loss can make a significant difference.
· Avoiding alcohol for at least 4 hours before going to sleep; it relaxes the throat muscles, making snoring more likely.
· Seeking treatment for conditions such as allergies, which block the sinuses.
· Not sleeping on your back; this position allows gravity to pull the tongue back into the airway.
For further information on OSA, call (800) LUNG-USA.
Asthma education is becoming part of the curriculum in the Vallejo Unified School District, in Solano County, California, thanks to an in-school asthma program partnership with Kaiser Permanente.
The rate of asthma for Solano County residents is almost twice as high as that in any other county in Northern California; one in 19 students there have the disease.
“The disease is more than just difficulty in breathing,” says Robert Maddox, MD, Kaiser Permanente’s chief of pediatrics in Vallejo. “Kids who lurch from asthma crisis to asthma crisis miss school, and their parents miss work. Asthma worsens at night, so students don’t sleep well. They come to school tired, and their academic performance can suffer,” he says.
William Bordessa, RRT, who is helping to develop the program, has suffered with asthma throughout his life. He believes his teaching and advice can help students cope better.
“In high school I was hospitalized three times,” Bordessa says. “One reason I’m involved in the asthma program Kaiser Permanente is developing is that I’d like to save others the same grief. I have one basic message: If you can control your asthma, you can do anything.”
Teachers, administrative staff, and coaches are being given the most up-to-date information on the disease.
“This is an exciting venture for us, and we have received outstanding support from Kaiser Permanente,” says Elaine Lauck, RN, PHN, the school district’s coordinator of school health services. “Already, we are seeing the results of better asthma management in making a difference in students’ performance and increasing their safety at school,” Lauck says.
Steroids can help improve lung damage in women undergoing treatment for breast cancer, according to a study published in the American Journal of Respiratory and Critical Care Medicine.
The study of 45 women undergoing chemotherapy and bone marrow transplantation revealed 58 percent developed lung damage symptoms, such as a cough, breathing problems, and fever, and a significant decline in lung function. When the women were administered corticosteroids for an average of 2.5 months, they experienced a 17 percent improvement in lung function, according to lead researcher Rodney J. Folz, MD, PhD, assistant professor in the department of medicine at Duke University Medical Center, Durham, NC.
High-dose chemotherapy kills not only cancer cells but also healthy cells, especially white blood cells that fight infection. Bone marrow transplants can cause problems, Folz explains, because after a transplant, “the lung’s immune cells repopulate, and these cells now recognize that the lung has been ‘injured,’ and respond by causing inflammation.”
The damage process can take 6 to 8 weeks. Detecting trouble early by closely monitoring a woman’s lung function tests is the key to successful treatment with corticosteroids, researchers concluded.
The Children’s AIR (Allergy, Immunology, and Respiratory) Center will honor Richard C. Fuisz, MD, chairman of the board of Fuisz Technologies Ltd, Chantilly, Va, with the Irwin Rappaport Asthma Recognition Award. The event is scheduled to take place May 7 at the “Breath of Spring” fifth annual awards dinner.
The Children’s AIR Center, housed at the New York Hospital-Cornell Medical Center in New York, develops programs and offers support services to children and their families dealing with life-threatening problems such as asthma and cystic fibrosis, prematurity, and a variety of congenital and developmental immune disorders.
Fuisz Technologies develops, manufactures, and commercializes a wide range of drug delivery, nutraceutical, and food-ingredient products utilizing its proprietary CEFORMT, ShearformT, and other drug delivery technologies.
In the December/January 1998 issue of RT, in the story “Putting LVRS to the Test,” the word “inpatient” in the last paragraph of page 73 and the second paragraph of page 74 should have read “outpatient.”