Birth weight affects adult health and success

Birth weight has significant and lasting effects, a new study finds. Weighing less than 5.5 pounds at birth increases the probability of dropping out of high school by one-third, reduces yearly earnings by about 15 percent and burdens people in their 30s and 40s with the health of someone who is 12 years older.

The study, presented May 22 in Washington, D.C. at the National Summit on America's Children, is the first to link birth weight with adult health and socioeconomic success using a full, nationally representative sample of the U.S. population. It is based on an analysis of more than 35 years of data on more than 12,000 individuals from the Panel Study of Income Dynamics, conducted since 1968 by the University of Michigan Institute for Social Research (ISR).

Funded by the National Institute on Aging, the analysis includes data from the original study families, plus their descendants who have gone on to form families of their own. Because of the study's unique genealogical design, the researchers were able to compare outcomes for siblings to isolate the impact of low birth weight apart from other common family conditions siblings share.

According to the authors, economists Rucker Johnson at the University of California, Berkeley, and Robert Schoeni at U-M, the study provides the most detailed look to date at how well-being and disadvantage are transmitted across generations within families.

"The poor economic status of parents at the time of pregnancy leads to worse birth outcomes for their children," Johnson and Schoeni write in a working paper from the U-M National Poverty Center. "In turn, these negative birth outcomes have harmful effects on the children's cognitive development, health, and human capital accumulation, and also health and economic status in adulthood. These effects then get passed on to the subsequent generation when the children, who are now adults, have their own children."

Among the key findings:

• Compared to their normal birth weight siblings, low birth-weight children are 30 percent less likely to be in excellent or very good health in childhood. They also score significantly lower on reading, passage comprehension, and math achievement tests. Low birth-weight children are roughly one-third more likely to drop out of high school relative other children.

• Low birth weight has significant negative effects on adult health, equivalent to being 12 years older in one's 30s and 40s. Weighing less than 5.5 pounds at birth increases the probability of being in fair or poor health as an adult by over 70 percent. Not only does birth weight have large and lasting effects across the life course, the researchers note, but its effects become larger later in life. For example, low birth weight children are nearly twice as likely as their normal birth-weight siblings to be in problematic health by ages 37-52 (23 percent versus 12 percent).

Fitness may reduce inflammation

Although a number of studies have suggested that regular exercise reduces inflammation – a condition that is predictive of cardiovascular and other diseases, such as diabetes – it’s still not clear whether there is a definitive link. And if such a link exists, the nature of the relationship is by no means fully understood.

A recent study by kinesiology and community health researchers at the University of Illinois provides new evidence that may help explain some of the underlying biological mechanisms that take place as the result of regular exercise. According to the researchers, that knowledge could potentially lead to a better understanding of the relationship between exercise and inflammation.

The objective of their research was to examine the independent effect of parasympathetic tone – in this case, determined by assessing heart-rate recovery after exercise – on circulating levels of C-reactive protein (CRP). Parasympathetic tone and its inverse function – sympathetic tone – are components of the autonomic nervous system. CRP, which is secreted by the liver, circulates in the bloodstream and is a biomarker for inflammation in the body.

“The sympathetic nervous system speeds things up, and the parasympathetic slows things down,” said Victoria J. Vieira, a predoctoral fellow in kinesiology and community health and in nutritional sciences, and the primary author and designer of the study, published in a recent issue of the Journal of the American Geriatrics Society. “So when you’re exercising, your sympathetic nervous system will be on, increasing your heart rate, your respiration, etc. Once you stop, your body always tries to get back to homeostasis. So the parasympathetic nervous system kicks in to get everything back down to baseline levels.”

Co-author and kinesiology and community health professor Jeffrey A. Woods said cardiologists are already routinely gauging CRP levels in much the same way they look at lipids panels to assess cholesterol levels.

“Certainly, that’s being done in the cardiovascular disease realm, but I think (it may be effectively used as a monitor) for other diseases, such as Alzheimer’s, diabetes and metabolic syndrome,” he said.

Woods said the main question motivating the current research was, “What factors are related to CRP in the elderly?”

“We’ve known that as people age, their CRP levels go up,” Vieira said. “That’s one of the reasons why older individuals are more prone to develop inflammation-related diseases such as diabetes and heart disease. So we just wanted to look at what’s predicting those levels of CRP in an average older population that is relatively healthy.”

Perhaps the most notable result of the study, according to the researchers, relates to heart-rate recovery following exercise.

“The quicker the individuals were able to get back to their resting heart rate after a strenuous exercise test was inversely related to their CRP,” Vieira said. “In other words, individuals who had better parasympathetic tone had lower levels of inflammation.

“And the reason we’re excited about this is that exercise is a great way to improve parasympathetic tone. When you exercise – that is the sympathetic/parasympathetic communication – your sympathetic goes up, and when you stop exercising, your parasympathetic kicks in to bring you back to normal. An untrained person will take a while to get their heart rate back down to resting. A trained person’s heart rate will come back down very quickly.”

The cross-sectional study focused on baseline test results from 132 sedentary, independently living individuals aged 60 to 83 (47 males; 85 females) who had been recruited to participate in the Immune Function Intervention Trial (ImFIT), a randomized longitudinal trial designed by Woods and funded by the National Institute on Aging to examine the relationship between exercise and immune function.

Participants included only individuals who did not take medications that included corticosteroids, which could interfere with immune measurements. Smokers and/or those with severe arthritis, a history of cancer or inflammatory disease, chronic obstructive pulmonary disorder, uncontrolled diabetes mellitus, congestive heart failure, recent illness or vaccination, or a positive stress test were excluded.

The physical fitness of subjects was assessed through a battery of tests that measured such variables as fatigue, blood pressure, oxygen intake and carbon dioxide elimination and heart-rate recovery in conjunction with exercise on a walking treadmill. Tests also were administered to determine the subjects’ levels of physical activity, physical fitness, emotional stress and body composition (bone density and body fat). Blood samples also were drawn to measure CRP levels.

“The major criterion we were looking at was their fitness level,” Vieira said. “A strength of our study is that we have very good data on their fitness levels.”

And while other studies have explored the relationship between exercise and inflammation, another unique aspect of the U. of I. research, Vieira said, is that “no other studies have adjusted for fitness and body fat percentages simultaneously to really get at that question, ‘Is exercise independently reducing CRP levels, or is it modulated through a decrease in adiposity (body fat)?’ ”

Because the study was cross-sectional – meaning the researchers essentially took a snapshot of the participants’ reactions and measurements at a single, fixed point only – Vieira said it was important to note that “we can’t say anything about cause and effect relationships.”

However, Woods said, “it gives you some idea of what factors are related, and then you test those in a more rigorous manner.”

Vieira said the research “certainly suggests that fitness may be associated with a decrease in inflammation even independent of body fat and several things, and the mechanism may involve a parasympathetic anti-inflammatory reflex.”

“We know inflammation is bad. We know it increases as we age, with stress and other things,” she said. “So if we can decrease that to protect ourselves somehow by just adopting a physically active lifestyle, that’s definitely an advantage.”

And while the study confirms the conclusions of previous research by others indicating that high body fat is related to high inflammation and high fitness to low inflammation, “the unique part of this paper is that controlling for those, we also show that high parasympathetic tone is related to low inflammation,” Woods said.

“And it’s even independent of their fitness level,” Vieira interjected.

“Fitness, fatness and parasympathetic tone appear to be important,” Woods said, summing up the findings. “And at least according to our results, parasympathetic tone might even be more important than those other factors.”

A little dark chocolate = less blood pressure

Consumption of small amounts of dark chocolate associated with reduction in blood pressure

Eating about 30 calories a day of dark chocolate was associated with a lowering of blood pressure, without weight gain or other adverse effects, according to a study in the July 4 issue of JAMA.

Previous research has indicated that consumption of high amounts of cocoa-containing foods can lower blood pressure (BP), believed to be due to the action of the cocoa polyphenols (a group of chemical substances found in plants, some of which, such as the flavanols, are believed to be beneficial to health). “A particular concern is that the potential BP reduction contributed by the flavanols could be offset by the high sugar, fat and calorie intake with the cocoa products,” the authors write. The effect of low cocoa intake on BP is unclear.

Dirk Taubert, M.D., Ph.D., of University Hospital of Cologne, Germany, and colleagues assessed the effects of low regular amounts of cocoa on BP. The trial, conducted between January 2005 and December 2006, included 44 adults (age 56 through 73 years; 24 women, 20 men) with untreated upper-range prehypertension (BP 130/85 – 139/89) or stage 1 hypertension (BP 140/90 – 160/100). Participants were randomly assigned to receive for 18 weeks either 6.3 g (30 calories) per day of dark chocolate containing 30 mg polyphenols or matching polyphenol-free white chocolate.

The researchers found that from baseline to 18 weeks, dark chocolate intake reduced average systolic BP by −2.9 (1.6) mm Hg and diastolic BP by −1.9 (1.0) mm Hg without changes in body weight, plasma levels of lipids or glucose. Hypertension prevalence declined from 86 percent to 68 percent. Systolic and diastolic BP remained unchanged throughout the treatment period among those in the white chocolate group. Dark chocolate consumption resulted in the short-term appearance of cocoa phenols in plasma and increased vasodilatory S-nitrosoglutathione. There was no change in plasma biomarkers in the white chocolate group.

“Although the magnitude of the BP reduction was small, the effects are clinically noteworthy. On a population basis, it has been estimated that a 3-mm Hg reduction in systolic BP would reduce the relative risk of stroke mortality by 8 percent, of coronary artery disease mortality by 5 percent, and of all-cause mortality by 4 percent,” the authors write.

“The most intriguing finding of this study is that small amounts of commercial cocoa confectionary convey a similar BP-lowering potential compared with comprehensive dietary modifications that have proven efficacy to reduce cardiovascular event rate. Whereas long-term adherence to complex behavioral changes is often low and requires continuous counseling, adoption of small amounts of flavanol-rich cocoa into the habitual diet is a dietary modification that is easy to adhere to and therefore may be a promising behavioral approach to lower blood pressure in individuals with above-optimal blood pressure. Future studies should evaluate the effects of dark chocolate in other populations and evaluate long-term outcomes,” the authors conclude.

1 cigarette can lead to nicotine addiction

Kids show signs of addiction almost immediately

A new study published in the Archives of Pediatric and Adolescent Medicine shows that 10 percent of youth who become hooked on cigarettes are addicted within two days of first inhaling from a cigarette, and 25 percent are addicted within a month. The study found that adolescents who smoke even just a few cigarettes per month suffer withdrawal symptoms when deprived of nicotine, a startling finding that is contrary to long-held beliefs that only people with established smoking habits of at least five cigarettes per day experience such symptoms.

The study monitored 1,246 sixth-grade students in six Massachusetts communities over four years. Students were interviewed frequently about smoking and symptoms of addiction, such as difficulty quitting, strong urges to smoke, or nicotine withdrawal symptoms such as cravings, restlessness, irritability, and trouble concentrating. Of those who were hooked, half were already addicted by the time they were smoking seven cigarettes per month. As amazing as it may seem, some youth find they are unable to quit smoking after just a few cigarettes. This confirms an earlier study by the same researchers.

Recent research has revealed that the nicotine from one cigarette is enough to saturate the nicotine receptors in the human brain. “Laboratory experiments confirm that nicotine alters the structure and function of the brain within a day of the very first dose. In humans, nicotine-induced alterations in the brain can trigger addiction with the first cigarette,” commented Joseph R. DiFranza, MD, professor of family medicine & community health at the University of Massachusetts Medical School and leader of the UMMS research team. “Nobody expects to get addicted from smoking one cigarette.” Many smokers struggle for a lifetime trying to overcome nicotine addiction. The National Institutes of Health estimates that as many as 6.4 million children who are living today will die prematurely as adults because they began to smoke cigarettes during adolescence.

“While smoking one cigarette will keep withdrawal symptoms away for less than an hour in long-time smokers, novice smokers find that one cigarette suppresses withdrawal for weeks at a time,” explained Dr. DiFranza. “One dose of nicotine affects brain function long after the nicotine is gone from the body. The important lesson here is that youth have all the same symptoms of nicotine addiction as adults do, even though they may be smoking only a few cigarettes per month.”

Symptoms of nicotine addiction can appear when youth are smoking as little as one cigarette per month. At first, one cigarette will relieve the craving produced by nicotine withdrawal for weeks, but as tolerance to nicotine builds, the smoker finds that he or she must smoke ever more frequently to cope with withdrawal.

According to DiFranza, the addiction-related changes in the brain caused by nicotine are permanent and remain years after a smoker has quit. This explains why one cigarette can trigger an immediate relapse in an ex-smoker. It also explains why an ex-smoker who relapses after many years of abstinence cannot keep the craving away by smoking one cigarette per month. Unlike the newly addicted novice smoker, a newly relapsed smoker must smoke several cigarettes each day to cope with the craving.

Antidepressants Not Linked to Birth Defects

Two research studies published today in The New England Journal of Medicine found taking SSRIs (selective serotonin reuptake inhibitors), anti-depression drugs, during pregnancy did not significantly increase the overall risk for most birth defects. However, each study found that taking SSRIs during pregnancy was associated with a small increase in the risk of certain rare birth defects – but they were different birth defects.

Dr. Michael Katz, acting Medical Director of the March of Dimes, said the studies show how important post-market surveillance is in assessing the safety of medications in pregnancy. During pre-approval, drugs are tested on relatively few subjects and only side effects with a large frequency are detected. Once approved, many people take the medication and even very rare side effects surface.

“Most prescription drugs are not tested on pregnant women,” said Dr. Katz. “So we must start monitoring the effects of these medications as soon as they reach consumers, and keep monitoring for as long as it takes to get good data on risks to mothers and babies.”

The March of Dimes recommends women discuss the potential risks and benefits of taking SSRIs during pregnancy with their doctors. Women who are taking an antidepressant should not stop taking their medications if they discover they are pregnant, but should immediately contact their health care provider. It may be dangerous to stop taking an antidepressant suddenly.

About 10 percent of pregnant women in the United States suffer from depression, some of it undiagnosed.

Previous studies have found that some SSRIs may increase the risk for other problems for babies, including:_
• Withdrawal symptoms in newborns;
• Pulmonary hypertension of the newborn (PPHN), a rare, but serious heart and lung disorder;
• Low birthweight or preterm delivery.

Head injury three times greater in HS football

Catastrophic head injury three times greater in high school vs. collegiate football players

Study finds 'unacceptably high percentage' of high schoolers who sustain catastrophic head injury play with residual effects of prior head injury

The incidence of catastrophic head injuries in football is dramatically higher at the high school level than at the college level, according to a study published in the July issue of The American Journal of Sports Medicine.

Catastrophic head injuries, which include brain bleeding and swelling, are rare and can be devastating. Athletes with major brain injuries may be left with permanent brain damage.

“High school football players have more than three times the risk of a catastrophic head injury than their college peers,” says lead author, Barry P. Boden, M.D., from the Orthopedic Center in Rockville, Md., and adjunct associate professor at the Uniform Services University of the Health Science in Bethesda, Md.

Boden and coauthors also found a high percentage of high school athletes playing with neurologic symptoms from a previous head injury at the time they sustained a catastrophic injury.

Football has more direct catastrophic injuries than any other sport tracked by the National Center for Catastrophic Sports Injury Research (NCCSIR). More than 1.2 million high school athletes played football during the 2001-2002 academic year.

The researchers reviewed 94 incidents of severe football head injuries reported to the NCCSIR during 13 football seasons (Sept. 1989 through June 2002). Catastrophic injury was defined as either direct (resulting from playing the sport) or indirect (resulting from systemic failure secondary to play), and further subclassified those injuries as fatal, nonfatal (injury causing permanent neurological damage), or serious (while severely injured, the player’s injury is immediately relieved, there is no permanent functional disability, and the player recovers completely).

The researchers found that there is approximately one injury per every 150,000 athletes playing, or 7 catastrophic injuries yearly. There were 0.67 injuries per 100,000 players at the high school level and 0.21 injuries per 100,000 for college level football players.

“The incidence of injury is higher at the high school level compared to the college level, which may indicate that the younger brain is more susceptible to a brain injury,” explains Dr. Boden. “Many of the players who had a severe head injury were playing with minor neurological symptoms from a previous head injury such as a concussion.”

From the 94 cases studied, 59 contacts and/or medical records revealed information on prior head injuries. Fifty-nine percent (35/59) of the injured football players had a history of previous head injury of which 71% (25/35) occurred during the same season as the catastrophic event. Nearly 40% (21/54) of the injured athletes were playing with residual neurologic symptoms from prior head injury. The catastrophic injuries resulted in 8 (9%) deaths, 46 (51%) permanent neurologic injuries, and 36 (40%) serious injuries with full recovery.

Dr. Boden suggests that players should be discouraged from using their heads to tackle, since 81% of the injuries were caused by helmet-to-helmet collisions (16/37) and helmet-to-body collisions (14/37).

One of the study’s co-authors, Robert C. Cantu, M.D. of Emerson Hospital, Concord, Mass., has studied catastrophic injuries in many sports. He says that although catastrophic head injuries in football have declined since special regulations went into effect, players are still being returned to the field with symptoms of a prior head injury.

“The single most important piece of advice that I can give is to never let an athlete play football if he has any neurological symptoms whatsoever, says Dr. Boden. Those symptoms may include amnesia, dizziness, headache, irritability, and personality change.

Of the difference in catastrophic head injuries between high school and college players, Boden theorizes: “High school students might take longer to recover from a concussion than college players. Another possible reason for these reported injuries may be that there aren’t as many team physicians covering high school games as college games. Consequently, some high school athletes may not be properly evaluated or receive medical attention.”

“Football is a very macho sport. Athletes are taught to play through pain,” concludes Dr. Boden. “But concussions need to be taken seriously. Many of them are probably being overlooked at the high school level. These injured athletes are allowed to return to play before full recovery, leaving them susceptible to a more significant injury.”

Removal of Unwanted Tattoos

John Klear describes his recent laser treatments this way: “It’s like a really hot Exacto knife slicing through your skin.”

Still, it’s worth it to him to have his tattoos removed. He got them when he was in the Navy, a rite of passage but also a lasting reminder of “the folly of youth,” he says. Later, after deciding he didn’t like the way they looked, he researched tattoo removal on the Internet and decided to go to the University of Michigan Health System for treatment.

His dermatologist, Jeffrey Orringer, M.D., sees many patients who want their tattoos to disappear. Indeed, he says, nearly 20 percent of people with tattoos are thinking of having them removed – and other estimates are even higher. “The most common reason,” he says, “would be to remove a name of someone who is no longer involved in the patient’s life.”

Orringer treats patients with laser technology that allows for a fairly precise removal of the ink without damage to the surrounding skin and, in most cases, without a scar. The technology is far superior to the techniques of the past, which typically resulted in scarring.

Current technology allows the physician to choose certain wavelengths of laser light and shine them on the skin. The wavelength of light from the Q-switched (or quality-switched) laser targets the ink in the skin; the ink heats up when absorbing the laser light, and the balls of ink “pop like popcorn – but on a microscopic basis,” says Orringer, assistant professor of dermatology at the U-M Medical School. The body responds by sending in white blood cells that chew up the altered ink and lighten the tattoo.

For typical, professionally applied tattoos, Orringer orders six to 12 treatment sessions that will clear most tattoos. And it’s not an easy process. “Some patients tell me that having it removed with a laser is somewhat more uncomfortable than acquiring it in the first place,” he notes. The cost also tends to be greater than the price of having the tattoo applied, he says, and can add up to a few thousand dollars for the most complex tattoos. Simpler tattoos cost less than that.

Some tattoos are easier to remove than others. Those that are older, simpler, contain fewer colors are easier to remove, while those located on arms and legs tend to be tougher, Orringer notes.

“I’d say it’s most difficult to remove a tattoo from the ankle area,” he says. “The hands, fingers and other areas at the end of extremities are also more difficult because of a difference in blood flow.”

Counterintuitively, darker colors, such as black, are easier to remove; vivid, bright colors can be more difficult. When tattoo artists mix colors – such as dark blue with white to create sky blue – it can pose difficulties during the removal process. The white ink acts as a shield that reflects much of the laser light, protecting the blue ink and making it more difficult to eradicate with lasers.

For Robert Kelley, 48, the process of having his tattoo removed is a chance for him to teach his son about the potential downside of getting a tattoo. He is pleased that he has the option to have the tattoo removed, but it hasn’t been easy.

“I’ve been able to show my son after my surgeries what the healing process looks like,” says Kelley, who has required more than a dozen laser sessions for the removal of a skull tattoo on his arm, which he got when he was a teenager. “If my son wants a tattoo when he’s older, I’m going to remind him of the process I went through.”

Thinking of having a tattoo removed? 7 things you should know
1. Laser technology can reduce the appearance of tattoos so they are no longer visible. Unlike past treatments, present-day lasers rarely cause scarring or damage to the surrounding skin.
2. It will take more time to remove a tattoo than it took to have it applied. Often, six to 12 sessions are required to erase all of the ink.
3. Areas of the body where it is more difficult to remove a tattoo include ankles, hands and fingers.
4. Older, simpler tattoos that contain few colors are easier to remove.
5. Treatment options include lasers, one of the most common of which is the Q-switched, or quality-switched, laser; surgical excision; and dermabrasion, the “sanding” of the skin.
6. Risks of laser removal of tattoos are similar to those associated with small wounds. The treatment itself can be uncomfortable or even painful as it creates small breaks in the skin. Some crusting or bleeding may occur in the area after treatment. Small risks of scarring, infection and discoloration of the skin also exist.
7. And if you don’t have a tattoo yet – buyer beware. By some estimates, one-fifth of people with tattoos are thinking of having them removed.

For more information, visit these Web sites:

Laser removal of tattoos at the University of Michigan Health System: http://www.med.umich.edu/derm/patient/cdlctreatment.shtml#lasrem

American Academy of Dermatology: http://www.aad.org/public/Publications/pamphlets/tattoo.htm

American Society for Dermatologic Surgery: http://www.asds-net.org/Patients/FactSheets/patients-Fact_Sheet-tattoo_removal.html

 
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