Allegra

A national survey has found that more than 8 million adults in the United States seriously considered suicide last year, with younger adults the most likely to contemplate taking their own lives.

In addition to nearly 8.3 million thinking about committing suicide, 2.3 million made a plan to do so, and 1.1 million actually attempted it, according to a federal government study released Thursday.

The findings are from data collected in a 2008 survey of 46,190 people aged 18 or older. It’s the first national scientific survey of its size to examine this public health issue, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

The study found significant age-related differences in the risk of suicidal thoughts, planning and attempts. For example, adults aged 18 to 25 were far more likely (6.7 percent) to have seriously considered suicide than those aged 26 to 49 (3.9 percent) and those aged 50 and older (2.3 percent). Similar disparities were found in suicide planning and attempts.

Females had marginally higher levels of suicidal thoughts and behaviors than males. Only 62.3 percent of those who attempted suicide received medical attention for their suicide attempts, while only 46 percent of those who attempted suicide stayed in a hospital overnight or longer for treatment of their suicide attempts.

Substance abuse was associated with increased risk of seriously considering, planning or attempting suicide, the report showed. People with substance abuse disorders were more than three times as likely to have seriously considered suicide as those without substance abuse disorders — 11 percent versus 3 percent. Those with substance abuse disorders were four times more likely to have planned a suicide (3.4 percent versus 0.8 percent) and nearly seven times more likely to have attempted suicide (2 percent versus 0.3 percent).

“This study offers a far greater understanding of just how pervasive the risk of suicide is in our nation, and how many of us are potentially affected by it,” Eric Broderick, SAMHSA acting administrator, said in a news release from the agency.

“While there are places that people in crisis can turn to for help like the National Suicide Prevention Lifeline [1-800-273-TALK], the magnitude of the public health crisis revealed by this study should motivate us as a nation to do everything possible to reach out and help the millions who are at risk — preferably well before they are in immediate danger,” Broderick said.

Scientists have long known that poverty can inhibit a child’s intellectual development. But now researchers have found a possible equalizer — a good day care environment.

High-quality day care for the youngest poor kids may be enough to offset negative home environments and provide them the foundation for good school skills, at least up to the fifth grade, according to a new study.

Led by Eric Dearing, an associate professor at Boston College’s Lynch School of Education, the research team found significant benefits from higher quality day care in the first five years of life.

Impoverished families may be too overwhelmed by the stresses of survival to devote time or resources to help their children achieve later academic success, but Dearing believes quality child care can fill the gap.

“Even minimal exposure to higher-quality child care at times was enough to offset the deprivation often encountered when growing up poor,” said Dearing, whose team analyzed data on more than 1,300 children, many of them living at or below the federal poverty line, in 10 regions around the United States. The data, part of a long-term federal study that began in 1991, included half-day observations of children in child care.

Dearing defined “higher quality” day care as settings that offer above-average personal attention, intellectual stimulation and emotional comfort to babies and toddlers. Higher quality day care, he said, should not be confused with the elite services found in affluent communities. Rather, it can be as informal as a grandmother’s house or as organized as an established neighborhood day care center.

The findings appear in the September/October issue of Child Development.

The study team, including researchers from Samford University in Alabama and the Harvard Graduate School of Education, found that the benefits of higher quality day care applied to most children, from poor to middle-class. And the more exposure to good day care, the bigger the impact, Dearing added. Most of the day care facilities in the study had no admissions standards, and there was no bias toward children with higher IQs, he noted.

The effect was seen in children from families with close to middle-class incomes, and got more significant as family income levels dropped, the researchers said. This meant that even a brief experience with higher-quality early child care was associated with significantly better math achievement by the time the child reached middle school.

As little as one or two years of day care corresponded to a 5 percent increase in math scores for children from lower-class families (200 percent of the poverty line), and this increment grew as the family income level went down.

“The greatest estimated benefits of higher-quality care were evident for the poorest children, but even for children close to 200 percent of the poverty line the effects of higher-quality child care compared favorably with those for (a rise in) family income,” according to the study. “For these children, in fact, just one or two episodes in higher-quality child care produced estimated impacts on achievement similar in size to achievement gains that would be expected if a family’s income increased enough to move them from low-income to approximately middle class.”

Impoverished mothers and fathers, as much as more affluent parents, need places to care for their kids while they work or go to school. These families are often forced to rely on substandard day care because they have few choices, Dearing said.

The study did not make specific recommendations to improve day care in poor communities, but Dearing suggested the need to better educate parents on how to obtain quality day care and provide more public funding of day care. For those kids without access to higher quality care, later intervention in public schools may be effective, too.

Marta Flaum, a psychologist from Chappaqua, N.Y., agreed with Dearing’s conclusions.

“It certainly makes sense, given what we know about the critical role that early experiences play in child development,” said Flaum. “The first few years of life are absolutely critical for stimulating language, reasoning and problem solving, and encouraging a curiosity and love of learning. There are windows of opportunity for mastering such important benchmarks, and if skills are not acquired during these periods, learning is much slower and there is a risk of permanent developmental lag.”

In related news, another study has found that children who were breast-fed as infants have superior cognitive skills compared with kids who were fed formula. Scientists believe that docosahexaenoic acid (DHA), an essential fatty acid found in mother’s milk, is responsible for the improved cognitive skills.

When DHA was added to infant formula, babies showed greater cognitive improvement than the babies fed on regular formula.

“Currently, there is no clear consensus on whether infant formula should be supplemented with DHA,” lead author James R. Drover, assistant professor of psychology at Memorial University in Canada, said in a news release. “However, our results clearly suggest that feeding infants formula supplemented with high concentrations of DHA provides beneficial effects on cognitive development.”

If you don’t drink enough water — especially on a hot day — you could become dehydrated. That’s an obvious cause.

But a number of other things can cause dehydration, a potentially dangerous lack of bodily fluids.

The U.S. National Library of Medicine offers this list:
-Having diarrhea or vomiting.
-Urinating frequently, perhaps from uncontrolled diabetes or using diuretic medication.
-Sweating excessively.
-Having a fever.
-Not eating due to nausea or lack of appetite.
-Having a sore throat or painful sores in the mouth.

The U.S. Food and Drug Administration is telling manufacturers of the drug promethazine to include a boxed warning regarding the injectable form of the drug. The warning, under FDA’s authority to require safety labeling changes, will highlight the risk of serious tissue injury when this drug is administered incorrectly. The agency is also alerting health care professionals to the new boxed warning for this product, which is used as a sedative and to treat nausea and vomiting.

Promethazine should neither be administered into an artery nor administered under the skin because of the risk of severe tissue injury, including gangrene, the boxed warning says. There is also a risk that the drug can leach out from the vein during intravenous administration and cause serious damage to the surrounding tissue. As a result of these risks, the preferred route of administration is injecting the drug deep into the muscle.

A requested revision in the Dosage and Administration section of the label states that if health care professionals choose to administer promethazine intravenously, they should limit the drug’s concentration and rate of administration and ensure a properly functioning intravenous line.

The companies that make promethazine are required to submit the requested safety label changes to the FDA within 30 days or provide a reason why they do not believe such changes are necessary. If they do not submit new language, or the FDA disagrees with the language proposed by the companies, the agency can order the label change as deemed appropriate to address the new safety information.

Promethazine was previously sold under the brand name Phenergan, but that formulation was discontinued by Wyeth Pharmaceuticals Inc. A number of companies currently market generic formulations of promethazine hydrochloride injection.

The FDA previously informed consumers and health care professionals about the risks of incorrect administration of promethazine in the December 2006 and February 2008 editions of FDA Patient Safety News. Current prescribing information for the drug contains information about the risk of tissue injury, possibly including gangrene, if the drug is inadvertently administered in the artery, but that information was not highlighted in a boxed warning.

Promethazine first went on the market in 1956. FDA has reviewed the published literature and post-marketing adverse event reports submitted to the agency’s Adverse Event Reporting System from 1969 to 2009 and identified cases of gangrene requiring amputation associated with administration of the drug.

Deaths among people treated for heart attack at Veterans Affairs (VA) hospitals have fallen since 2003, mirroring worldwide trends, new research shows.

The researchers also found that, from 2000 to 2005, death rate at 30 days after a heart attack declined at the same rate for VA patients as it did for Medicare patients cared for at private hospitals.

The VA launched a major effort to improve the quality of heart care after a study found higher death rates for heart attack patients treated at VA hospitals compared to Medicare patients treated at non-VA hospitals, Dr. Stephan D. Fihn of the VA Puget Sound Health Care System and the University of Washington in Seattle and his colleagues note.

To follow up, Fihn and his team looked at 30-day death rates for 11,609 heart attack patients treated at VA hospitals between 2004 and 2006. They also compared records for 27,494 VA patients 65 and older and 789,400 Medicare patients who had heart attacks in 2000-2001 or 2004-2005.

Their analysis of the first data set found that death rates fell from 16.3 percent in 2004 to 13.9 percent in 2006, representing a 15 percent relative decline.

In the second data set, the researchers found, 30-day mortality after heart attack declined from 16 percent in 2000-2001 to 15.7 percent in 2004-2005 for the VA patients, and from 16.7 percent to 15.5 percent in private hospitals.

Once the researchers adjusted for health conditions, type of heart attack, and other factors, they found that the decline in mortality for the VA patients and for the Medicare patients treated in private hospitals was similar.

These findings, the researchers say, appear to “lay to rest” concerns that were raised recently that death among patients treated for heart attacks in VA hospitals appeared significantly higher than for patients whose care was funded by Medicare.

They point out that the original study, which covered the period from 1996 to 1999, didn’t account for the fact that VA patients who suffered heart attacks were more likely to have been hospitalized for other causes.

The Veterans Health Administration’s “aggressive” efforts to improve heart care may account for the decline in heart attack deaths, the researchers note; these hospitals also ensure that nearly all patients get heart-protecting drugs like statins, beta blockers and aspirin after a heart attack.

Fihn and his team note that VA patients typically adhere to their medication regimens more closely than Medicare patients do, likely because they are usually able to get their drugs at a much lower cost.

A U.S. researcher says he was able to sequence his entire genome for less than $50,000, with the help of only two people.

“This is the first demonstration that you don’t need a genome center to sequence a human genome,” Stephen Quake, a professor of engineering at Stanford University, said in a news release from the school. “It’s really democratizing the fruits of the genome revolution and saying that anybody can play in this game.”

The first complete mappings of human DNA were achieved in 2001. Each completed genome cost hundreds of millions of dollars and required more than 250 people. Even in 2008, the lowest reported cost of sequencing a human genome was $250,000 and still required almost 200 people.

Quake’s genome was sequenced using a commercially available, refrigerator-sized instrument called the Helicos Biosciences SMS Heliscope. Quake pioneered the underlying technology of the instrument and is co-founder of the company.

The study appeared online Aug. 9 in the journal Nature Biotechnology.

“This can now be done in one lab, with one machine, at a modest cost. It’s going to unleash an enormous amount of creativity and really broaden the field,” Quake said.

Lowering the cost and effort involved in sequencing individual human genomes is important for a number of reasons, said Quake. The more examples of whole human genomes scientists have, the more they can learn about how specific genes and mutations result in certain traits, diseases and responses to medicines.

As the cost of determining an individual’s genetic code decreases, doctors may be able to sequence individual patient’s genomes and provide personalized medicine in which the patient’s genetic profile would influence the prevention and treatment of disease.

Breast cancer patients with isolated tumor cells or tiny “micrometastases” in the lymph nodes benefit from adjuvant treatment, such as post-surgical chemotherapy or hormonal therapy, a new study finds.

Until now, many doctors doubted that the presence of micrometastases or isolated tumor cells affected long-term recovery, said Dr. Vivianne Tjan-Heijnen, head of the division of medical oncology at Maastricht University Medical Center in the Netherlands, the lead author of the study.

So these patients often are not offered adjuvant therapy after they undergo breast cancer surgery. But the results of her team’s study, published in the Aug. 13 issue of the New England Journal of Medicine, suggest they should be.

Micrometastases, which are too small to be seen on standard screening or diagnostic tests, range from 0.2 to 2.0 millimeters in size. Isolated tumor cells or tumor cell groups are even tinier, less than 0.2 millimeters, said Tjan-Heijnen.

To assess the value of additional treatments of chemo or other adjuvant methods, Tjan-Heijnen and her colleagues followed 2,707 women treated surgically for early-stage breast cancer. They were divided into three groups. The first group included 856 women diagnosed with breast cancer whose sentinel node — the first node the breast tissue drains into — was negative and cancer-cell free, who didn’t get additional treatment. The second group included 856 women diagnosed with breast cancer with cancer cells found in the nodes, but who didn’t get additional treatment. The third group included 995 patients with cancer cells found in the nodes who did get additional treatment.

The additional treatment included chemotherapy (such as taxanes), endocrine therapy (such as tamoxifen or aromatase inhibitors), or systemic therapy (both chemo and endocrine).

The researchers followed the women for a median of 5.1 years (half followed longer, and half for less time) to see if the extra therapy reduced cancer recurrence and increased disease-free survival. They associated the tiny metastases and isolated tumor cells with an absolute decline in five-year disease-free survival of 10 percent. In other words, those with the tiny cancer cells present who are treated with additional therapy had a nearly 10 percent improvement in disease-free survival at five years, they found.

“So, five years after the diagnosis of every 100 patients with micrometastases or isolated tumor cells, 10 more will have a disease event compared with 100 patients with comparable primary tumor characteristics who did not have metastases in the axillary nodes,” Tjan-Heijnen said.

The study proves that the micrometastases and the isolated tumor cells are important considerations when evaluating the prognosis, she said.

Cancer specialists have debated how to treat a patient with these small metastases and isolated tumor cells, said Dr. Minetta Liu, director of translational breast cancer research at the Georgetown University Lombardi Comprehensive Cancer Center in Washington, D.C.

The study results suggest that “looking for these cells may be another tool to determine how likely a recurrence is,” she said. But more study is needed to validate the findings, she added.

Dr. Hannah Linden, a medical oncologist and associate professor of medicine at the University of Washington School of Medicine in Seattle, said the study results could change current practice. “If these findings are true, they will influence decision making significantly, and help us know which patients really ‘need’ chemo to give them an advantage in reducing the risk that the tumor recurs,” she said.

No matter how clean your home is, tiny insects called dust mites may still live in mattresses, carpets, furniture and pillows.

Many people are allergic to dust mites, which can trigger symptoms such as congestion, runny and itchy nose, and sneezing. Mites also can worsen asthma symptoms.

The American Academy of Family Physicians offers these suggestions to minimize the misery of dust mites:
Each week, wash all bed linens in hot water. This includes blankets, sheets and pillows.
Carpets can harbor dust mites, so opt for wood, linoleum or tile flooring in the bedroom.
Vacuum carpets, rugs and upholstered furniture each week.
Dust your home at least once weekly.
Buy washable stuffed animals for your children, and wash the stuffed animals frequently.
Talk with your doctor about whether it’s a good idea to take an antihistamine and/or decongestant to help manage allergy symptoms.

Although sudden deaths occur in competitive lacrosse at about the same rate as in baseball and football, deaths caused by a strong blow to the chest are more common in lacrosse, new research shows.

Lacrosse has swept up about a half-million young participants in the United States, making it the fastest-growing youth sport in the country. The hard rubber balls used in the sport can travel as fast as 100 miles an hour, and contact also occurs between a lacrosse stick and an opponent’s body, called a “body check.”

But hard hits to the chest, according to the American Heart Association, can cause what’s called commotio cordis, a Latin term meaning “commotion of the heart.”

“There are risks to young athletes [playing lacrosse], but these are, overall, no greater in lacrosse than in many other sports,” said Dr. Barry Maron, lead author of a study on the subject in the Aug. 10 issue of Pediatrics. Maron is director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute Foundation.

“There is a risk for commotio cordis events in lacrosse players which appears to be somewhat greater, and this raises the issue of an effective chest protector since commercially available barriers have not been proven to be absolutely protective,” he said.

Dr. Larry Chinitz, director of clinical cardiac electrophysiology at New York University Langone Medical Center in New York City, said the condition requires a direct blow to the chest.

“Basically, you get knocked in the chest and it creates an electrical signal into the heart,” he explained. “It can precipitate bad arrhythmia.”

Maron and his fellow researchers analyzed data from the Sudden Death in Young Athletes Registry from 1980 to 2008, which included information on 23 cases of sudden death or cardiac arrest in high school and college lacrosse players, who were 18 years old on average.

Of that group, 19 died — 10 after being hit in the chest, including four goalies who were wearing chest protectors. Most of the others who died had preexisting heart disease, the study reported.

The overall mortality rate for lacrosse was about the same as that found in basketball, baseball, football and other sports involving physical contact, although higher than that seen in softball, swimming and track and field.

But the mortality rate for deaths attributed to commotio cordis was higher in lacrosse than in all other sports except hockey. It accounted for 43 percent of all deaths in the sport, according to the study. Deaths from commotio cordis occurred in lacrosse at more than double the rate for baseball, about 15 times greater than for football, 20 times greater than for soccer, 42 times greater than for wrestling and 54 times greater than for softball.

Wearing a chest protector is not mandated in all locales, though “there’s no question chest protectors are the best way to go,” Chinitz said. “They’re just a hassle to wear.”

The study’s authors also contended that commercially available chest protectors are not adequate. Several researchers indicated that they were working on better versions.

Steve Stenersen, president and chief executive of U.S. Lacrosse, the governing body for the sport, stated that the organization “has made this issue a priority for a number of years, and we have coordinated, funded and/or supported a number of educational and research initiatives focused on commotio cordis.”

The organization is trying to set up manufacturing standards for chest protectors that would reduce the risk of commotio cordis, he said, and also is working to reduce the price of automatic external defibrillators for the lacrosse community.

The biggest spring allergy trigger is pollen — tiny grains released into the air by trees, grasses, and weeds for the purpose of fertilizing other plants. When pollen grains get into the nose of someone who’s allergic, they send the immune system into overdrive.

The immune system, mistakenly seeing the pollen as foreign invaders, releases antibodies — substances that normally identify and attack bacteria, viruses, and other illness-causing organisms. The antibodies attack the allergens, which leads to the release of chemicals called histamines into the blood. Histamines trigger the runny nose, itchy eyes, and other symptoms of allergies.

Pollen can travel for miles, spreading a path of misery for allergy sufferers along the way. The higher the pollen count, the greater the misery. The pollen count measures the amount of allergens in the air in grains per cubic meter. You can find out the daily pollen count in your area by watching your local weather forecast or by visiting the NAB: Pollen & Mold Counts page on the American Academy of Allergy, Asthma and Immunology’s web site.

Here are some of the biggest spring allergy offenders:

Trees

Alder
Ash
Aspen
Beech
Box elder
Cedar
Cottonwood
Cypress
Elm
Hickory
Juniper
Maple
Mulberry
Oak
Olive
Palm
Pine
Poplar
Sycamore
Willow

Grasses and weeds

Bermuda
Fescue
Johnson
June
Orchard
Perennial rye
Redtop
Saltgrass
Sweet vernal
Timothy

Allergy symptoms tend to be particularly high on breezy days when the wind picks up pollen and carries it through the air. Rainy days, on the other hand, cause a drop in the pollen counts because the rain washes away the allergens.