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Am Fam Physician. 2004;69(5):1034-1036

A connection between stress and Alzheimer's disease? As reported in The New York Times, researchers surveyed 800 priests, nuns, and monks (average age: 75 years) in the Religious Orders Study on their “distress proneness” (i.e., how likely it was that reactions to stress would result in gloom or anxiety, a trait termed “neuroticism”). Memory and mental tasks also were measured. Earlier research had shown that chronic stress undermines the function of a part of the brain that governs memory. The study participants were reexamined an average of five years after the survey and testing. By that time, 140 participants had been diagnosed with Alzheimer's disease. Those who scored the highest on the neuroticism test were twice as likely to have developed Alzheimer's disease as those who scored the lowest. Higher test scores also were associated with faster rates of cognitive decline, even in those who had not developed Alzheimer's disease. The researchers described the participants with the lowest scores as “secure, hardy, and generally relaxed.”

Ever think about holding group prenatal care sessions? A prospective, matched cohort study published in Obstetrics & Gynecology found that birth weight was higher in the infants born to women who attended group prenatal care sessions than in the infants born to women who received individual prenatal care. Birth weight also was higher in preterm infants born to the women who were given group prenatal care. The study participants were mostly black and Hispanic women of low socioeconomic status. The authors of the study note that group prenatal care allows more time for physicians to address clinical, psychologic, social, and behavior factors that are important to a healthy pregnancy.

Dieting may do more harm than good in young persons, according to a study published in Pediatrics. The prospective study tracked 14,972 nine- to 14-year-old children for three years. The children who reported dieting during this period gained more weight than those who did not. Compared with nondieters, the dieters reported more binge eating, higher carbohydrate intake, and more exercise hours per week. The researchers speculate that dieting could reset the metabolism over time (resulting in weight maintenance or gain) or that bouts of overeating or binge eating between periods of restricted eating could result in weight gain. The researchers suggest that children who are concerned about their weight should consider making small changes that they can maintain, such as increasing physical activity and decreasing fat intake.

Ah, the power of sleep. A study published in Nature demonstrated that sleep facilitates the generalization of information learned during the day. Three groups of young adults (mean age: 20.3 years) were assessed for their understanding of synthetic speech after periods of testing and training with or without a period of sleep. The first group received pretesting and training at 9 a.m., with retesting at 9 p.m; the second group was pretested and trained at 9 p.m., then retested after a 12-hour period that included sleep; a control group received pretesting, training, and retesting within a single session. Because different words were used in pretesting, training, and post-testing, improved performance represented improved generalization. Study participants understood more words after a night's sleep than participants who were tested 12 hours after the training but without a sleep period. The researchers noted that sleep consolidates and restores memories.

Annual Pap tests may not be necessary. According to a study published in the New England Journal of Medicine, it is safe for most women to switch from annual Papanicolaou (Pap) tests to one test every three years. Using a Markov model to estimate the rate at which dysplasia progresses to cancer, the investigators tracked the Pap test results of 31,728 women aged 30 to 64 years who had had three or more consecutive negative tests. Among these women, 0.028 percent had grade-2 cervical intraepithelial neoplasia, 0.019 had grade-3 cervical intraepithelial neoplasia, and none had invasive cervical cancer.

Silver may be the safest color for a car, according to a population-based, case-control study published in BMJ. The study of more than 1,000 drivers in the Auckland, New Zealand, area found that silver cars were about 50 percent less likely to be involved in a crash resulting in serious injury than were white cars (previous research had suggested that white and light-colored cars were the safest vehicles). The risk of serious injury also was significantly greater with yellow, gray, red, blue, brown, black, and green cars compared with silver cars. In their analysis, the researchers considered factors that could affect the study results, such as driver age, seat-belt use, vehicle age, and driving conditions.

What calms babies during injections? A little T.L.C., suggests a randomized controlled trial of 116 infants that was published in the Archives of Pediatric & Adolescent Medicine. In the study, infants who were held by a parent, given a bottle of sugar water (10 mL of 25 percent sucrose) two minutes before their two-month injections, and allowed to suck on a pacifier or formula bottle during and after the immunizations cried significantly less than infants who were placed on an examination table and given no comfort measures. Not surprisingly, parents of the infants who received comfort measures said they would prefer that approach for their children's future immunizations.

News for oral contraceptive pill (OCP) users! A study published in Obstetrics & Gynecology showed cost savings and health benefits deriving from the use of trimonthly-cycle OCPs. The trimonthly-cycle regimen consists of 84 days of estrogen-progestin followed by a seven-day pill-free interval versus the standard regimen of 21 days of estrogen-progestin followed by a seven-day pill-free interval and menstruation. With the trimonthly-cycle regimen, the yearly number of withdrawal bleeding episodes is reduced from 12 to four. Consequently, expenditures for menstruation hygiene products are reduced. The researchers also note health and financial benefits in women with significant menstruation-related morbidity. Extended OCP regimens provide contraceptive effectiveness similar to that of standard OCP regimens.

Eye injuries caused by paintballs are increasing in children, according to a study published in Pediatrics. An analysis of data from the U.S. Consumer Product Safety Commission showed that more than 1,200 paintball-related eye injuries were seen in emergency departments during 2000, compared with about 545 such injuries in 1998. The researchers note that more than 40 percent of the injuries may have been in children younger than 15 years, predominantly boys. Although protective eye gear has improved, the researchers suggest that some children may not wear it, especially if they are playing the game in unsupervised places. They point out that many previously documented paintball injuries have resulted in permanent visual impairment.

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Copyright © 2004 by the American Academy of Family Physicians.

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