Mention back-to-school preparations, and most parents and their teens think about buying clothes, getting school supplies, and picking up their class schedules. However, there is another important preparation: retraining your teen to follow a school-year sleep schedule. Sleep experts say if you start a few weeks beforehand, the transition from lazy summer mornings to early morning departures won’t be quite as harsh and stressful.

“A week or two before, maybe two weeks, gradually move them over from a summer schedule to a school schedule,” said Dr. Richard Castriotta, director of the division of Pulmonary, Critical Care and Sleep Medicine at the University of Texas Health Science Center at Houston.

“Slowly advance the wake time,” he said. For instance, if your teen generally sleeps in until 12, nudge him or her to arise at 11:45, he said, “so each day, they wake up earlier and earlier.” The goal, of course, is to get them to wake up at the time they need to wake up once school starts.

Parents of teens often say, “Fat chance.” But Castriotta said if you explain why you are doing this, it may help. You might tell them: “If we leave you alone, we’ll be dragging you out of bed” come the first day of school.

By advancing the wakeup time and adjusting the bedtime, you can help them ease into the transition, he said.

Castriotta also recommends some compassion. “You’re fighting human nature here by making some of these kids get up early,” he said, since teens are typically more nocturnal than adults are.

And teens need more sleep than most parents believe, between 8 1/2 to 9 1/4 hours a night, according to the National Sleep Foundation.

Luckily, there are things parents can do to help their teenager make the transition, said Dr. Michael Smolensky, a professor of environmental physiology at the University of Texas at Houston School of Public Health and Health Sciences Center.

Limit computer use and television watching in the evening, he said. The light from both affects the biological clock, he said, and teens will operate as if they are living farther West, not wanting to go to bed until 1 or 2 in the morning. “It really means some very strict control of the environment,” he said.

As you phase in the earlier wake-up time a few weeks before school, enlist the help of other parents, so your teen will feel less odd or ostracized. If you present a united front, you may encounter less resistance.

Lobby for a later start time at school. “Work with the school board to change the start times,” he said, noting that in schools where this has been tried, grades have gone up slightly, and students’ behavior and attendance have improved.

Some doctors are not making the grade when it comes to helping their patients ward off heart disease, a new survey suggests. The survey, of nearly 900 U.S. primary care doctors, found that many do not follow practice guidelines on managing patients who are at elevated risk of heart and blood vessel disease.

“Despite the benefits demonstrated for managing cardiovascular risks, gaps remain in primary care practitioners’ management of risks according to guideline recommendations,” conclude researchers in a report in the journal BMC Family Practice.

“Patients should talk to their physicians about setting goals together for reducing blood pressure and cholesterol and making a plan to achieve the goals,” lead researcher Dr. Hamidreza Doroodchi, from Birmingham, Alabama-based Outcomes, Inc., noted in comments to Reuters Health.

Doroodchi and colleagues sent a survey on cardiovascular disease management to a random sample of 12,000 U.S. family physicians and general internists. A total of 888 completed the survey, which contained “case vignettes” for managing adults deemed to be at low or high risk of heart disease.

The study found that in the hypothetical case of a low-risk 45-year-old woman, only 28 percent of family doctors and 37 percent of internists made the “guideline-based preventive choice” of prescribing no aspirin or other antiplatelet therapy — drugs that help prevent blood clots by keeping platelet blood cells from clumping together. The majority indicated that they would prescribe a daily aspirin for such a patient to reduce the risk of heart attack.

When asked whether they would start drug therapy to combat abnormal cholesterol levels, 51 percent of doctors said they would not do so in this low-risk patient — which is in accordance with guidelines. On the other hand, 41 percent said they would prescribe a statin.

When it came to basic lifestyle advice, which is appropriate for low- and high-risk patients alike, doctors often fell short.

For example, while experts recommend that all adults limit their intake of artery-clogging trans fats, over one-third of doctors in the survey failed to recommend this measure for the low-risk 45-year-old woman.

For a 50-year-old man at high risk for heart disease, only 59 percent of family doctors and 56 percent of internists correctly identified the guideline-based goal of keeping “bad” LDL cholesterol below 100 milligrams per deciliter.

Similarly, for a 78-year-old woman at high risk for heart disease but no obvious symptoms, only about half of family doctors and internists were in accordance with guidelines to order a stress test should she develop chest pain or shortness of breath.

Doctors in practice for 10 years or less were much more likely than doctors in practice for more than 10 years to make appropriate guideline-based choices for the prevention of heart disease. Younger doctors were also more apt to adhere to guidelines than were more experienced doctors.

Doroodchi and colleagues found it “especially concerning” that doctors who see a greater percentage of patients with high blood pressure and cholesterol abnormalities were significantly less likely to offer guideline-based care.

“Innovative educational approaches,” they conclude, “are needed to address barriers, and target specific groups of physicians to facilitate implementation of guideline-based recommendations for cardiovascular management.”

The findings should not, however, be taken as a sign that doctors lack concern for their patients, according to Doroodchi.

“Most primary care physicians are concerned about cardiovascular risk in their patients and set goals for their patients to reduce this risk,” the researcher said. “Physicians are concerned that their patients do not follow their advice about changes in exercise and diet, and (that) they do not always take the medicine that is prescribed.”

When the vaccine against chickenpox was introduced in the United States in 1995, medical experts hoped it would be a one-shot deal, with a single injection about the time of a child’s first birthday giving lifelong immunity.

Now, experts are learning that’s not so. They’ve found that the protection from a single immunization fades over time, and that a booster shot is needed if you want your child to have the best chance at lifelong protection from chickenpox.

The experts reached that conclusion after examining 10 years of data and the effects of the vaccine on more than 11,000 people who got the shot between 1995 and 2004. Of those individuals, 9.5 percent, or 1,080, experienced so-called “breakthrough disease,” researchers reported last year in the New England Journal of Medicine.

“The breakthrough was mild,” said Dr. Robert Frenck Jr., a professor of pediatrics at Cincinnati Children’s Hospital and a member of the American Academy of Pediatrics’ committee on infectious diseases.

Chickenpox, which is caused by an infection by the varicella-zoster virus, typically starts as a rash on the face that spreads. The rash begins as red bumps that become blisters. Often a child can get hundreds of blisters, which crust over and fall off the body in a week or two.

The children who suffered “breakthrough” chickenpox typically got fewer lesions, Frenck said, perhaps 20 to 50. Still, schools and day-care centers would not welcome them back until the sores had dried or crusted, because the disease can spread easily from person to person.

Based on those findings, experts from the U.S. Centers for Disease Control and Prevention and elsewhere are now recommending that a second booster shot be given to children between 4 and 6 years of age.

There is some leeway in that schedule, said Dr. Anne Gershon, a professor of pediatrics at Columbia University College of Physicians and Surgeons, in New York City.

“The booster can be given if [it has been] at least four weeks after the first dose,” said Gershon, who is also president-elect of the Infectious Diseases Society of America. Or, it can be given years later, if necessary, she said.

According to the CDC, all children aged 12 months through 12 years old should have two doses of the vaccine. The first dose can be given at 12 to 15 months of age, and the second at 4 to 6 years. Older children, 13 and up, who haven’t had the disease in childhood, can be given two doses four to eight weeks apart.

Some adults should consider the vaccine. Ask your health-care provider if you fall into that recommended group, which includes people who have never had the disease.

No vaccine is perfect, experts said.

In 2006, a combination vaccine that included not only chickenpox but measles, mumps, and rubella was licensed, cutting down on the number of shots needed. But that combination vaccine is not currently available in the United States, said Nalini Saligram, a spokeswoman for Merck & Co., which makes it. But it is expected to be back in supply by 2009.

Breast-feeding offers a host of benefits to both mother and baby, including a stronger immune system for the baby and faster weight loss for mom. There are even some known psychological benefits from breast-feeding, such as a stronger parent-child bond. But British researchers have recently discovered another mental bonus — children who are breast-fed seem to cope with stress and anxiety more effectively when they reach school age.

In a group of almost 9,000 children between the ages of 5 and 10, children who weren’t breast-fed and whose parents were getting divorced or separated were 9.4 times more likely to be highly anxious when compared to other children. But, children who were breast-fed as infants whose parents were getting divorced were only 2.2 times as likely to be highly anxious, the study found.

“Breast-feeding is associated with resilience against the psychosocial stress linked with parental divorce/separation,” the study’s authors concluded in a recent issue of the Archives of Diseases in Childhood.

The authors theorized that the physical contact between mother and child in the first few days of life could help form certain neural and hormonal pathways that affect a person’s ability to cope with stress later in life.

Breast-feeding experts have long been aware of the mother-baby bond that occurs during breast-feeding. “There’s a lot less verbal communication, but lots of tactile communication and eye contact that promotes positive physiological responses,” said Liz Maseth, an outpatient lactation consultant at Akron’s Children’s Hospital in Ohio.

“Breast-feeding does seem to suppress stress responses in babies, and it does seem that there’s a protective effect,” she said.

“In terms of the biological possibility, breast milk is pretty amazing stuff, and the tactile interaction that goes along with breast-feeding does have an influence on the development of neurons,” explained Judy Hopkinson, an associate professor of pediatrics in the section of nutrition at Baylor College of Medicine in Houston.

Hopkinson added that babies who aren’t breast-fed may be able to reap similar benefits with lots of holding and touching.

The study authors also suggested that the bond created during breast-feeding might affect the way the child and the mother interact, and that effect might be long-lasting.

Hopkinson pointed out that mothers who are successful at breast-feeding often have a supportive social network, which could also help lessen a child’s stress in times of crisis.

Whatever the reason for the association, it was clear that children who had been breast-fed were less stressed.

Both Maseth and Hopkinson said it’s very important to try to begin breast-feeding as soon as possible after birth — no more than one hour. Maseth said this is because the breasts contain glands that release the same scent as amniotic fluid, a scent that babies will recognize.

“For most mothers, breast-feeding doesn’t come naturally. If the baby doesn’t latch on, it can lead to feelings of failure and concern about whether or not the baby is getting enough milk. Women need lots of encouragement and education,” Maseth said.

“Don’t give up, though, seek help” she advised, adding that your baby’s pediatrician will likely have information on what local breast-feeding resources are available.

“Breast-feeding is something for mothers and babies to enjoy. A time for them to cherish and nurture each other,” said Hopkinson. For women who can’t breast-feed, she said, that skin-to-skin contact between mother and baby can also help build a similar bond.

Researchers in Massachusetts have succeeded in generating several disease-specific stem cell lines which should advance both research and, one day, treatment. The lines will be made available to researchers around the world through a Harvard Stem Cell Institute “core” facility being established at Massachusetts General Hospital, institute co-director Doug Melton said during a Wednesday teleconference.

The new lab is already up and running and is prepared to start shipping lines as soon as a new paper is published in the Aug. 6 online edition of Cell, added Dr. George Daley, senior author of the paper and a principal faculty member at the institute.

“This is a broader and more important collection of degenerative diseases for which there are no good treatments and, more importantly, no good animal models,” Melton said. “The cells will allow researchers access for the first time to cell types of interest, to watch the disease progress in a dish, to watch what goes right or wrong. . . We’ll see in the years ahead that this opens the door to a new way of treating degenerative disease.”

The cell lines will be distributed “virtually free,” Melton said, with a nominal fee to cover costs.

Last week, another team of scientists from the institute announced that they had transformed skin cells from patients with Lou Gehrig’s disease into motor neurons that are genetically identical to the patients’ own neurons. This will enable them to create unlimited numbers of cells to study the disease process better.

Those scientists had originally planned to use somatic cell nuclear transfer (SCNT) or “therapeutic cloning” for the feat. That process involves removing the genetic material from a donated human oocyte and replacing it with genetic material from the skin cells of patients. But the approach has been hindered by political, ethical and other obstacles.

Instead, those researchers took adult skin cells from two elderly sisters with Lou Gehrig’s disease and reprogrammed them into cells resembling embryonic stem cells using a technique called induced pluripotent stem (iPS) cells. Those stem cells were then transformed into motor neurons.

The current paper in Cell describes a similar process, taking cells from patients aged 1 month to 57 years and suffering from one of 10 conditions including Down Syndrome, Parkinson’s, Huntington’s disease, muscular dystrophy and type 1 diabetes, and using iPS to produce pluripotent, undifferentiated stem cells.

These cells, of course, will then have to be coaxed into tissues of different types. “That is where all of the science will go on over the next many, many years,” added Daley, who is associate director of the Stem Cell Program at Children’s Hospital Boston.

The recent successes will not likely obviate the need for controversial stem cells, however, the scientists said.

“Even though the iPS methodology gives us a facile way for making disease-specific lines, it does not eliminate the value or need for continuing to study human embryonic stem cells,” Daley said. “Those are really the gold standard for pluripotent stem cell types. They have no genetic modifications and, at least for the foreseeable future, and I would argue beyond that, are going to be extremely valuable tools. . . Human embryonic stem cells allow you to ask questions that we never can ask with iPS cells.”

The iPS method requires the use of viruses, limiting the therapeutic potential of the lines.

“Whether or not we’re going to be able to figure out how to do it without viruses so we can use the cells therapeutically is, as of today, an unanswered question,” Daley said. “I’m confident we’re going to get there and that within the next year or two, we will have several strategies for reprogramming cells without viruses, and when that happens, we may have cells in our hands that may be valuable for cell replacement therapy.”

The number of lines ultimately generated will depend on a host of factors.

“In these complex genetic diseases, we’re so ignorant at the moment, we don’t even know if patients who get type 1 diabetes all get it the same way. There could be 50 different ways to get type 1 diabetes,” Melton said.

If there are 50 ways to get the disease, scientists are going to want to develop more stem cell lines to reflect that variety. If there are only one or two ways, then fewer lines will be needed.

Women who take two commonly-used fertility treatments, including the Sanofi Aventis pill Clomid, do not have a significantly better chance of getting pregnant than those who try naturally, British researchers said on Friday. This means doctors should rethink giving women the drug, known generically as clomiphene citrate, to stimulate the ovaries or administering a particular type of artificial insemination, said Siladitya Bhattacharya, who led the study.

“Traditionally over the last 30 or 40 years some treatments have crept into our repertoire without being robustly (tested),” said Bhattacharya, a gynecologist at Aberdeen University. “What we found — rather surprisingly — is these treatments did not produce a greater chance of pregnancy leading to live birth compared to no treatment.”

One in six couples worldwide experience some form of infertility problem at least once and more couples are seeking assisted reproductive treatment. The British study looked at the third of women for whom doctors cannot pinpoint a cause of infertility. These women often take Sanofi Aventis’ Clomid or undergo a type of artificial insemination called unstimulated intrauterine insemination as first-line treatments.

Sanofi had no immediate comment.

The researchers recruited 580 volunteers, a third of whom were encouraged to try to conceive naturally and another two groups who were given the pill or had artificial insemination.

During the study, 101 women became pregnant and gave birth, including 17 percent in the group who tried naturally, 14 percent of those who took the pill and 23 percent of volunteers who were artificially inseminated.

The differences were not big enough to be statistically significant, Bhattacharya and colleagues wrote in the British Medical Journal.

“The message of this trial is people should think more carefully about going into these treatments as a fait accompli,” he added in a telephone interview.

The findings underscore the need to review widespread guidelines in many countries calling on doctors to use the two treatments, he said.

Chronic protein deficiency may cause delays in a child’s brain development that improve little over time, a new study shows. The research was conducted in India, a country with a high rate of child malnutrition despite its current economic boom.

The World Health Organization estimates that for the years 1990 to 1997, more than half of Indian children younger than 5 were undernourished, according to Dr. Bhoomika R. Kar, from the University of Allahabad in India, and colleagues.

For their study, published in the online journal Behavioral and Brain Functions, the researchers assessed the cognitive development of 20 malnourished children and 20 adequately nourished children at different ages. Malnourished children, the researchers found, performed more poorly than adequately nourished children on most of the neuropsychological tests they were given.

In particular, malnourished children had problems with tests of attention, memory, visual perception, verbal comprehension and other so-called “higher cognitive processes.”

Moreover, there was only minimal improvement with age. The cognitive performance of malnourished 5- to 7-year-olds was “poor and much lower” than that of adequately nourished children their age, and the gap was not much smaller among 8- to 10-year-olds.

A chronic lack of protein does not seem to affect basic cognitive processes like movement speed, which is affected in cases of other nutritional deficiencies, the investigators note.

The current findings, they say, support numerous other studies that have shown a “wide range of cognitive deficits” in malnourished children in India.

SOURCE: Behavioral and Brain Functions, online July 24, 2008.

Two new checklists designed to help people over the age of 50 learn what they can do to stay healthy have been released by the U.S. Agency for Healthcare Research and Quality (AHRQ) and the AARP. The men’s and women’s checklists include the evidence-based recommendations from the U.S. Preventive Services Task Force regarding screening tests, preventive medicines and healthy lifestyle behaviors for people 50 and older.

“As we age, what we need to do to stay healthy begins to change. These new easy-to-read checklists help Americans age 50 and older realize the important steps they can take to stay healthy,” AHRQ Director Dr. Carolyn M. Clancy said in an agency news release.

The men’s and women’s Checklists for Health, available in English and Spanish, are brochures that patients can take to medical appointments to help them talk with doctors about necessary preventive screening tests. The checklists also allow patients to record their screening test history and plan follow-up medical appointments.

The AHRQ and AAPR also released an accompanying wall chart — the Staying Healthy at 50+ timeline — that’s designed to be posted in doctor’s offices, senior centers, fitness centers, pharmacies and other public locations.

“Equipping people with the tools and information to stay healthy is important for healthy aging. We are eager to promote the use of these checklists through Aging Network Community Based Partners that reach more than 10.4 million older people and their caregivers and deliver evidence-based health promotion and disease prevention programs,” Josefina G. Carbonell, Assistant Secretary for Aging, U.S. Department of Health and Human Services, said in an AHRQ news release.

A protein produced by fat cells may play a pivotal role in increasing an older American’s risk for a heart attack even if they are losing weight, a new report says. Levels of adiponectin increase in the bloodstream when people lose weight and appear to endanger the cardiovascular health of older people, according to the new study to be published in The Journal of Clinical Endocrinology & Metabolism.

This finding, though, appears odd, because past studies have shown high adiponectin concentration is associated with lower risks of diabetes and cholesterol abnormalities. “This study is significant because previous findings have been contradictory, and the present investigation includes the largest number of heart attacks in an elderly group to date,” Dr. Jorge Kizer, an associate professor of medicine and public health at Weill Cornell Medical College in New York City, said in a news release issued by the journal’s publisher. “Our findings make a persuasive case that adiponectin is in fact associated with an increase in heart disease risk in older persons.”

The new study looked at a sample of 1,386 adults, aged 65 to 100, from around the country. Of these, 604 had heart disease, with those with the highest adiponectin levels being most likely to suffer a heart attack.

The researchers theorized that higher adiponectin levels may indicate underlying disease, or even have direct harmful effects especially in the elderly. Previous studies show adiponectin increases energy expenditure in the central nervous system of mice — something that could be significantly harmful if also occurring in older adults by accelerating the loss of skeletal muscle.

The findings are consistent, though, with other recent studies tying high adiponectin to mortality in the elderly.

“This study shows that this abundant product of fat cells is a marker and perhaps even a mediator of worsened outcomes in persons aged 65 years and older,” Kizer said.

A widely used test to monitor blood sugar levels in people with diabetes could help identify millions of people with undetected diabetes, according to a consensus statement released by a team of experts.
The hemoglobin A1c test (HbA1c) shows how much glucose red blood cells have been exposed to in the previous 120 days, the average life span of the cells.

“The test is a measure of long-term glucose control, but doctors don’t typically use it to screen for or diagnose the disease. There’s reason to believe it could help identify many of the estimated six million people in the U.S. who have diabetes but don’t know it,” Dr. Christopher Saudek, director of the Johns Hopkins Comprehensive Diabetes Center in Baltimore, said in a Hopkins news release.

Current screening and diagnostic tests measure only the amount of sugar present at the moment the blood sample is taken, which means the tests are accurate only if patients fast for at least 10 hours prior to the test. Even if a patient does fast that long, the test can still miss people who have diabetes or are at high risk for the disease. That’s because glucose also varies depending on a person’s diet and level of exercise for several days before they provide a blood sample.

“If a patient is scheduled for a physical, he or she may ‘tune up’ by changing their regimen for a few days and throw off their test results, causing doctors to miss the patient’s usual pattern of high blood sugar,” said Saudek, who is also a professor of endocrinology and metabolism at the Johns Hopkins University School of Medicine.

In the consensus statement, Saudek and colleagues conclude that the HbA1c test should be used as front-line method for identifying patients with diabetes, especially people at high risk for the disease. The HbA1c test doesn’t require fasting and isn’t affected by short-term changes in diet and exercise.

The consensus, published in the July issue of The Journal of Clinical Endocrinology & Metabolism, was reached by the experts at a meeting financially supported by Metrika Inc., a manufacturer of diabetes testing equipment.