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• Behavioral and nutritional counseling improves energy intake and promotes normal growth in toddlers and preschoolers with cystic fibrosis (CF). The dietary intake intervention group met the clinical benchmarks of 120% to 150% recommended daily allowance for energy and 35% to 40% fat intake suggested by the 2 consensus conferences on pediatric nutrition in CF. Children in the control arm, in contrast, failed to show any change in energy or fat intake over the 8-week study period, despite guideline-driven nutritional care.
  However, five of the six control children and their families who chose to receive the BEH intervention after the study saw significant increases in energy and fat intake as a result. The impact of the 8-week BEH program seems to be durable, children who received BEH maintained the clinically significant increase in energy and fat intake at 3 and 12 months after treatment. This suggests that families "are able to continue to implement the skills and knowledge provided during BEH without ongoing contact with the research team or additional booster treatment sessions."  Pediatrics 2005;116:1 442-1450.

• Individuals in the US are likely to first turn to the World Wide Web when seeking health information, even though they trust their physicians more to provide them with accurate medical information.
  Results showed that 63.0% of respondents had ever used the Internet. Of these, 63.7% had looked there for some type of health or medical information. Other health-related Internet activities, such as purchasing medication, communicating with physicians, or participating in an online support group, were taken advantage of by less than 10% of users. The authors report that 62.4% of respondents said that they trusted physicians "a lot" for cancer information, compared with 23.9% for the Internet. When asked where they would prefer to go first for information about cancer, 49.5% reported wanting to go to their physicians. In actuality, only 10.9% of those who had sought information about cancer reported having gone to the physician as a source of first resort, whereas 48.6% went to the Internet first.Arch Intern Med 2005;165:2618-2624.

• Experimentally induced anxiety alters gastric sensorimotor function which may play a causal role in some gastric problems...anxiety status should be taken into account when dealing with patients with long-standing stomach symptoms without readily identifiable organic cause...anxiety is among conditions that are associated with certain gastric effects. However, it has been "unclear whether this reflects common predisposition or a causal relationship." The researchers conclude that psychological factors may play a part in some dyspeptic symptoms and mechanisms. Gastroenterology J 2005;129:1437-1444.

• A new nicotine vaccine is safe and well tolerated, with higher doses producing a greater rate of abstinence.  The nicotine vaccine works by triggering production of antibodies that bind to nicotine, creating a complex that is too large to pass through the blood-brain barrier.While withdrawal symptoms and craving were considered a potential side effect, none of the study participants experienced these symptoms. This was likely because antibody concentrations rose relatively slowly. There was also no sign that smokers increased their cigarette consumption to compensate for the vaccine's effects. Adverse effects were generally mild, and there were no difference in systemic reactogenicity effects between study participants on placebo and those given the vaccine. Immunogenicity rose with vaccine dose, while the researches observed wide variations in antibody concentrations. The best results were seen among study participants whose antibody levels were above 30 micrograms per milliliter. The vaccine could be a useful tool to help smokers quit, although in order to kick the habit it will likely be necessary for them to address behavioral aspects of smoking. The vaccine could be useful for smokers trying to quit, former smokers hoping to ward off relapse, and could also be used to prevent adolescents from taking up smoking...adding that giving the vaccine to teens would raise ethical questions as "it will be the first time that a vaccine is used not to prevent a disease but to prevent a behavior." Clin Pharmacol Ther 2005;78:456-467

• Low birth weight and various developmental problems during childhood may predict chronic mental disorders in adulthood, according to a new study.  The group that had the best overall mental health long-term, the persistently well group, tended to be heavier at birth. The group that had the worst mental health in the long run are the smallest babies. Subjects in the chronic mental health group were more likely than those in other groups to be slower at meeting developmental milestones. They sat up, stood, walked, and talked for the first time at a later time than subjects in the other groups. They also tended to have a shorter height and lower body weight at ages six and 11 years, and did poorly on cognitive tests at ages eight and 11 years. Even when other factors known to contribute to mental health were taken into account, such as major stressful life events and parental divorce, low birth weight was still associated with increased risk. But low birth weight alone cannot be considered a reason for mental health disorders. The development of mental health disorders is not straightforward, and even heavier infants can develop them later in life.

• "By targeting the noradrenergic system, stressful situations retard cognitive flexibility. Compared with nonstressful tasks, such as watching a cartoon or reading aloud, the stressful situations impaired subjects' ability to perform word association tasks and solve anagrams.However, responses to memory tests or simple motor processing tests were not affected. Moreover, when subjects took 40 mg of propranolol prior to the stressful situation, their responses to tests of cognitive flexibility following the stressor were not altered. People prone to stress or anxiety would benefit from propranolol (in stressful situations).The fact that propranolol reversed the effects of stress suggests that the stress response is mediated by the norepinephrine system, and that beta receptors are involved as well."

• There is a decreased prevalence of current smokers among U.S. adults in 2004 compared with 2003 and 2002 ). The rate of heavy smoking (>/= 25 cigarettes/day) among current smokers has also declined during the past decade from 19.1% in 1993 to 12.1% in 2004. Also, the study results show that younger adults were less inclined to take up the habit; the percentage of individuals aged 18 to 24 years reporting never having smoked increased between 2002 and 2003 (from 64.7% to 68.6%), then remained steady during 2004 (69.45%). Although the prevalence of current cigarette smoking varied substantially (range, 9.5% - 27.6%), the majority of adults in 44 of 49 states, the District of Columbia, Puerto Rico (PR), and the U.S. Virgin Islands (USVI) had never smoked. In addition, more than 50% of smokers in 34 states, PR, and the USVI had quit smoking. Although these trends are promising, the CDC notes that the rate of decline in current smoking is not rapid enough for more states to achieve the 2010 objective of reducing smoking prevalence to 12% or less. According to the CDC, an estimated 70% of smokers want to quit smoking. Telephone quitlines are also available to counsel smokers regarding cessation strategies; local numbers are available in many areas and may be obtained by calling the national hotline at 1-800-QUIT-NOW.

• While depression has long been thought to play a role in the development of cancer... Depression has (also) been tied to certain risk factors for diabetes, low estrogen levels, and behavioral risk factors such as smoking. Women who had the highest levels of depressive symptoms had a 43% increased risk of colorectal cancer compared with the women with the lowest levels, the researchers found. The association was stronger among overweight women.
  This suggests...that depression may worsen obesity's adverse effects on cancer development. Am J Epidemiol 2005;162:839-848.

• Women with recurrent vulvovaginitis candida have blunted morning rise salivary cortisol level, which indicates signs of chronic stress.
  The slope between the values of the first and fourth samples (morning rise cortisol) was significantly blunted among the patients (p < 0.002), compared with control subjects. More patients than controls had a history of bacterial vaginosis, herpes genitalis and condyloma, supporting "the hypothesis of a reduced local immunity in women with recurrent vulvovaginal candida." ... "The results of our study show that chronic stress may play a role in the pathogenesis of recurrent vulvovaginal candida." Am J Obstet Gynecol 2005;193:1376-1381.

• Sexual quality of life improves in obese...who lose weight, according to a new study. After an average weight loss of 17.5% at one year and 13.1% after two years, a significant improvement ...was observed. Compared with subjects with a lower initial BMI, those with a higher initial BMI tended to feel less sexually attractive and had more difficulty with sexual performance. The women in the study were twice as likely to feel reluctant to be seen undressed and were five times as likely to report lack of enjoyment of sexual activity than the men. Feelings of sexual attractiveness were most strongly associated with weight loss. As the women lost weight, the percentage who reported difficulty at least sometimes dropped by as much as 50% on several aspects of sexual quality of life. The improvement appeared to reach a maximum with a weight loss of approximately...persons who are overweight but not obese would also experience significant difficulty with sexual quality of life, but to a lesser degree than the obese categories.

• "Tricyclic antidepressants (TCAs) and selective serotonin-reuptake inhibitors (SSRIs) are effective in the primary care treatment of depression. Both TCAs and SSRIs are more effective than placebo in improving depression scores. Patients taking antidepressants were more than twice as likely as placebo patients to experience adverse effects leading to study withdrawal. The results seem to apply to major depressive disorder and heterogeneous depression (commonly seen in primary care) and suggest that treating depression with antidepressants is an appropriate activity in primary care. In terms of practice, many guidelines are recommending SSRIs rather than TCAs because of safety. Both are effective, and if safety is not an issue, then individual tolerability to side effects will determine types of medications used." Ann Fam Med 2005;3:449-456.

• Clowns effectively treat preoperative anxiety in children.The induction of anesthesia is one of the most stressful moments for a child who must undergo surgery: it is estimated that 60% of children suffer anxiety in the preoperative period. Multiple studies, beginning in the 1970s, have shown that humor has many positive effects on physical and mental health and well-being. (the children exposed to a clown preoperatively were) significantly less anxious during anesthesia induction. In the control group, the anxiety level was higher in the induction room than in the waiting room, but in the clown group, anxiety was not significantly different in the two locations. Although the health professionals' questionnaire results indicated that the clowns benefited the child, most of the staff was opposed to continuing the program because of perceived interference with operating department procedures....the resistance of medical personnel makes it very difficult to insert this program in the activity of the operating room.... The resistance of medical personnel to this kind of therapy could be dealt with better by providing information regarding the benefit of the therapy to the children and by investigating whether the presence of clowns during anesthesia induction slows the process in a significant manner.
  Pediatrics. 2005;116:e563-e567

• The U.S. Food and Drug Administration (FDA) has warned healthcare professionals regarding an increased risk of suicidal thinking in children and adolescents treated with atomoxetine HCl (Strattera capsules, made by Eli Lilly & Co.) The warning was based on an FDA-requested review and analysis of atomoxetine clinical trial data from 12 pediatric studies of attention deficit/hyperactivity disorder (ADHD) and one of enuresis. The 13 trials involved a total of approximately 2,200 patients.  The review found that the drug was associated with an increased risk of suicidal thinking compared with placebo (0.4% vs none); one atomoxetine-treated patient attempted suicide.  Healthcare providers and caregivers are advised to closely monitor children and adolescents for clinical worsening as well as agitation, irritability, suicidal thinking/behaviors, and unusual changes in behavior, particularly upon initiation of atomoxetine therapy and during dose increases or decreases. Atomoxetine HCl is indicated for the treatment of ADHD.