The researchers noted that spanking has declined in the United States since 1975, but corporal punishment is still used to discipline nearly 80 percent of preschool children.

“The findings are stark. Harsh treatment of children was epidemic in all communities. Our data support the conclusions that maltreatment occurs in all nations,” Dr. Desmond Runyan, a professor of social medicine at the University of North Carolina (UNC), said in a university news release.

He was lead author of a study that conducted surveys in Brazil, Chile, Egypt, India, the Philippines and the United States, and found that rates of corporal punishment were “dramatically higher” in all communities “than published rates of official physical abuse in any country.”

The study was released online Aug. 2 in advance of publication in an upcoming print issue of the journal Pediatrics.

Runyan and colleagues also found that:
Corporal punishment was more widely used by mothers with fewer years of education.
Rates of corporal punishment vary widely among communities within the same country.
Harsh punishment by parents isn’t less common in countries other than the United States, and actually may be more common, especially in low- and middle-income countries.

Another study, led by Dr. Adam J. Zolotor, an assistant professor of family medicine at UNC School of Medicine, found that 18 percent fewer children were slapped or spanked by caregivers in 2002 compared to 1975. However, 79 percent of preschoolers were still spanked in 2002, and nearly half of children aged 8 and 9 were hit with an object such as a paddle or switch.

The findings were released online in advance of publication in an upcoming print issue of the journal Child Abuse Review.

“This study shows that the U.S., unlike most other high-income countries, has had little change in the use of corporal punishment as commonplace,” Zolotor said in the UNC news release. “Given the weight of evidence that spanking does more harm than good, it is important that parents understand the full range of options for helping to teach their children. A bit of good news is that the decline in the use of harsher forms of punishment is somewhat more impressive.”

SOURCE: University of North Carolina.

An implanted defibrillator delivers a potentially life-saving electric shock to restart a heart that stops beating. However, the shock can cause acute discomfort in the last days of life, when the goal is to minimize pain, and in this case continued use of the devices may conflict with a patient’s wishes.

Now, expert guidelines announced Friday at the meeting of the Heart Rhythm Society in Denver suggest that, whenever possible, terminally ill patients should be free to make their own decisions as to whether they’d like the devices removed.

“This is a situation we face more and more often,” noted Dr. Rachel Lampert, associate professor of cardiology at Yale University School of Medicine. “As the population in hospices grows, the issue of how to manage defibrillators becomes more important.”

Lampert is co-chair of a committee scheduled to present a consensus statement on the management of pacemakers, defibrillators and other cardiovascular implantable electronic devices. The statement will also be published in the July issue of HeartRhythm.

Few medical institutions have policies about deactivating electronic heart devices. A recent study of more than 400 hospices found that just 10 percent had guidelines about disconnecting implanted defibrillators.

“At Yale, we looked at our own population and found that up to 20 percent of patients with defibrillators got shocked in the weeks before death,” Lampert said.

She worked with Dr. David Hayes of the Mayo Clinic, Rochester, Minn., in assembling a committee to consider guidelines for the issue. “We put together a group of individuals with expertise in different areas,” Lampert said. “It included an ethicist, a lawyer, a nurse and a psychiatrist.”

The purpose of the statement “is to carry out a patient’s wish to provide or withdraw therapy as the patient desires,” said Dr. Richard Page, professor and chair of medicine at the University of Wisconsin and president of the Heart Rhythm Society.

Removing an implanted defibrillator near the end of life, “is not physician-assisted suicide or euthanasia,” he stressed.

The statement, developed in cooperation with other organizations, including the American College of Cardiology and the American Heart Association, recommends above all that all patients with implanted electronic devices be encouraged to make advance directives.

“Ideally, you have the conversation and make the patient aware of his or her empowerment and what decision should be made before you get to this point,” Page said.

Other provisions of the consensus statement:
All adult patients are assumed to be competent to make decisions on continuing or stopping treatment. When a patient lacks capacity, the decision can be made by a designated health care proxy.
Physicians or other caregivers cannot be compelled to carry out a procedure that conflicts with their ethical values. In such a case, the issue can be passed to a colleague who is willing to carry out the task.
The recommendations will give physicians and institutions a frame of reference, experts said. “At least now you have a consensus statement based on a number of perspectives and a literature review to provide guidance,” Page said.

SOURCES: Rachel Lampert, M.D., F.H.R.S., associate professor, cardiology, Yale University, New Haven, Conn.; Richard Page, M.D., professor and chair, medicine, University of Wisconsin, Madison, and President, Heart Rhythm Society; May 14, 2010, Heart Rhythm Society annual meeting, Denver;

Researchers from Vanderbilt University, Johns Hopkins University and Kennedy Krieger Institute used MRI brain-scanning technology to study dyslexia. They found signs linking dyslexia to structural differences in a bundle of fibers — part of the brain’s white matter — that allow communication between cells in the left-hemisphere language network of the brain.

“When you are reading, you are essentially saying things out loud in your head,” researcher Laurie Cutting of Vanderbilt University, explained in a news release. “If you have decreased integrity of white matter in this area, the front and back part of your brain are not talking to one another. This would affect reading, because you need both to act as a cohesive unit.”

The research “brings us a little bit closer to understanding how dyslexia happens,” said researcher Sheryl Rimrodt, in the news release.

The study is scheduled to be published in the June issue of the journal Cortex.

SOURCE: Elsevier, news release

It has been known that treating a stroke earlier is better than later, but this study shows for the first time that there is significant harm done with starting tPA after 4.5 hours, the researchers noted.

“The benefit of giving this treatment for stroke continues if we start it as late as 4.5 hours,” said lead researcher Dr. Kennedy R. Lees, from the University Department of Medicine and Therapeutics of the Gardiner Institute at the Western Infirmary in Glasgow.

“There is no net benefit to patients if you start the treatment after 4.5 hours. But if you start treatment after 4.5 hours, you will have more patients who die,” he added.

“Starting at an hour is much better than starting at two hours, and that’s better than three hours, and that’s better than 4.5 hours,” Lees explained.

The benefit derived from early tPA treatment is a long-term benefit, Lees pointed out.

“It’s a benefit that we can measure three months later,” he said. “So, what we are getting is long-term improved function. They are more likely to have no symptoms and more likely, if they do have symptoms, to be able to do things for themselves, or need less help. A whole range of disability is reduced, by just starting tPA a few minutes earlier.”

The report is published in the May 15 issue of The Lancet.

For the study, the research team collected data on 3,670 patients in eight trials that investigated how the benefits and risks of tPA changed based on the time the drug was given after the onset of a stroke.

The investigators found that when tPA was given within 4.5 hours, the chances of a positive outcome were good. However, when the drug was given later, the chances of a strong recovery rapidly declined.

In fact, patients given tPA within 90 minutes after suffering a stroke were more than 2.5 times more likely to have a good recovery, compared with similar patients who did not get the drug. Moreover, patients who got tPA 4.5 hours after their stroke had only a 22 percent chance of a good recovery, compared with patients who never got tPA, the researchers found.

Lees and colleagues also found that patients given the drug after 4.5 hours of the onset of a stroke were more likely to die.

These findings mean that patients have more time to get to the hospital, Lees said. “The message for the doctors is we can’t waste a moment once the patient has arrived in starting treatment, so there is more time for the patients and less time for the doctors.”

Dr. Steven R. Levine, a professor of neurology at Mount Sinai School of Medicine in New York City and co-author of an accompanying journal editorial, agreed that “the sooner you get treatment for your stroke, the more likely you are to have minimal or no disability from it.”

For every 90 minutes you wait to get treated, you reduce your chances of a good recovery by a factor of two, he noted. “For every 10 minutes you wait, that’s about 20 million brain cells that are dying,” Levine said.

Everybody needs to know about stroke and what to do, Levine said. The first thing is to call 911, he said.

“Time is brain. That’s really the message,” he said.

Another expert, Dr. Larry B. Goldstein, director of the Duke Stroke Center at Duke University, said that “this combined analysis is consistent with the prior analysis based on a smaller number of trials and reinforces the benefit of treatment with tPA on carefully selected patients with acute ischemic stroke.”

It also reinforces the need to begin treatment as soon as possible after symptom onset, Goldstein added.

“Even though selected patients may derive benefit up to 4.5 hours after symptom onset, the likelihood of benefit is much greater if treatment can begin sooner. Primary stroke centers are organized to evaluate and treat stroke patients in an expedited fashion. Time saved is brain saved,” he said.

SOURCES: Kennedy R. Lees, M.D., University Department of Medicine and Therapeutics, Gardiner Institute, Western Infirmary, Glasgow, U.K.; Steven R. Levine, M.D., professor, neurology, Mount Sinai School of Medicine, New York City; Larry B. Goldstein, M.D., professor and director, Duke Stroke Center, Duke University, Durham, N.C.

And teens who had spent the most hours in child care in their first 4½ years reported a slightly greater tendency toward impulsiveness and risk-taking at 15 than did peers who spent less time in child care.

Although the study followed children’s experience in child care, it was not designed to determine cause and effect, and so could not prove whether a given aspect of the child care experience had a particular effect. It is possible that other factors, not measured in the study, were involved.

The study authors noted that the differences in these measures among the youth in the study were small, but the magnitude of both patterns was consistent from early childhood to adolescence. Previous studies have noted similar trends, but the study is the first to track children for a full decade after they left child care.

“Previous findings from the study indicate that parents appear to have far more influence on their child’s growth and development than the type of child care they receive,” said James A. Griffin, Ph.D., deputy chief of the Child Development and Behavior Branch, at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the NIH institute that funded the study, “The current findings reveal that the modest association between early child care and subsequent academic achievement and behavior seen in earlier study findings persists through childhood and into the teen years.”

The study results appear in the May/June issue of the journal Child Development.

The 1,364 youth in the analysis had been evaluated periodically since they were 1 month of age, as part of the NICHD Study of Early Child Care and Youth Development (SECCYD), the largest, longest running and most comprehensive study of child care in the United States.

Families were recruited through hospital visits to mothers shortly after the birth of a child in 1991, in 10 locations in the United States. Although the children studied were not a representative sample of children in the U.S. population, the families that participated in the study were from diverse geographic, demographic, economic and ethnic backgrounds.

From 1 month of age through sixth grade, children were evaluated at least annually on tests of cognitive and academic progress. In addition, researchers queried parents regularly and recorded the type, quantity and quality of child care during the children’s first 4½ years. The researchers also observed child care interactions to evaluate the quality of care. Of the children studied, nearly 90 percent spent some time in the care of someone other than their mother by the time they reached 4½ years of age. High-quality care was characterized by the caregivers’ warmth, support, and cognitive stimulation of the children under their care.

The researchers also requested that caregivers or teachers evaluate the behavior of children under their care at 4½ and every two years through elementary school. When the students were 15, the researchers tested the students’ academic achievement and, using a questionnaire, had the students evaluate their own behaviors. These included measures of behavioral problems (acting out in class); impulsivity (acting without thinking through the consequences); and risk taking (engaging in behaviors that might harm themselves or others).

Rating child-care quality on a scale of 1 to 4, researchers found that more than 40 percent of the children experienced high-quality or moderately high-quality care. They noted a modest correlation between higher quality care and higher results on cognitive and academic assessments, including reading and math tests. This correlation was similar at age 4½ and age 15. A new finding that emerged at age 15 was that youth who had spent more time in quality child care as young children reported fewer acting-out behavior problems as teenagers.

“These results underscore the importance of interaction between children and their daytime caregivers,” said first author Deborah Lowe Vandell, Ph.D., professor and chair of the Department of Education at University of California, Irvine. “We’re seeing enduring effects of the quality of staff-child interaction.”

Similarly, the researchers noted a correlation between the average number of hours children spent in child care each week through age 4½ and the youths’ own evaluations of impulsivity and risk-taking tendencies at 15. This correlation was independent of the quality of child care the children experienced.

Moreover, the correlation reflected earlier associations between hours in child care and caregivers’ reports of problem behaviors that the researchers had originally detected when the children were 4½. Hours in child care were calculated as the average number of hours per week a child spent in child care in infancy, as a toddler, and as a preschooler.

The study’s findings were consistent among boys as well as girls. In addition, previous studies had suggested that child care could have benefits for children from economically disadvantaged homes. So the researchers created a risk index with such factors as family income, the mother’s level of education, and mothers’ reports of depression symptoms, dividing their group into three based on risk. Both the achievement and behavior patterns they had found were consistent across all three groups.

“High quality child care appears to provide a small boost to academic performance, perhaps by fostering the early acquisition of school readiness skills,” said James A. Griffin, Ph.D., deputy chief of the NICHD Child Development & Behavior Branch. “Likewise, more time spent in child care may provide a different socialization experience, resulting in slightly more impulsive and risk-taking behaviors in adolescence. These findings underscore the importance of studying the linkages between early care and later development.”

A video of Dr. James Griffin discussing the study findings can be viewed on YouTube at: http://www.youtube.com/watch?v=sVw3V06ZLfg

The three common classes of chemicals — phenols, phthalates and phytoestrogens — are known as endocrine disruptors because they interfere with the body’s endocrine, or hormone, system. They’re found in many consumer products such as nail polishes, cosmetics, perfumes, lotions and shampoos. Some are used in plastics or as coatings on medications or nutritional supplements to make them time-released.

The study included 1,151 girls, ages 6 to 8, who lived in New York City, Cincinnati and northern California. All three classes of chemicals were widely detectable in urine samples collected from the girls.

The study found that high levels of phthalates and phytoestrogens were strongly associated with early breast development. One phenol, two phytoestrogens and a subset of phthalates — those used in building products and plastic tubing — were associated with delayed puberty. But phthalates found in personal products such as lotions and shampoos were linked to earlier breast and pubic hair development.

“We believe that there are certain periods of vulnerability in the development of the mammary gland, and exposure to these chemicals may influence breast cancer risk in adulthood,” Mary Wolff, a professor of preventive medicine and oncological sciences at Mount Sinai School of Medicine, said in a news release from the school. “Dietary habits may also have an impact. Further study is needed to determine how strong the link is.”

The study was published online in Environmental Health Perspectives.

Previous studies have shown “that early pubertal development in girls can have adverse social and medical effects, including cancer and diabetes later in life,” Wolff said.

“Our research shows a connection between chemicals that girls are exposed to on a daily basis and either delayed or early development,” she said. “While more research is needed, these data are an important first step in continuing to evaluate the impact of these common environmental agents in putting girls at risk.”

“This device is as useful as blood thinners for the reduction of blood clots after hip replacement, and it’s superior in safety,” said study co-author Dr. Douglas E. Padgett, chief of adult reconstruction and joint replacement at the Hospital for Special Surgery in New York City, in a statement. “This has the potential to change the paradigm as to how we prevent blood clots after hip replacement. The efficacy is the same, the safety is markedly better and the cost is comparable.”

An estimated 30 percent to 50 percent of hip or knee replacement surgery patients will develop blood clots if preventive measures, such as taking blood thinning medication, aren’t taken.

In the study, researchers looked at a compression device that wraps around the leg and pumps it, helping to prevent clots. Typically, these devices are only used in hospitals because they’re big and restrict movement, but a new, smaller device can be used outside the hospital.

Researchers randomly assigned 410 hip replacement patients to get a blood thinner or use the compression device. Ultrasound examinations 10 to 12 days after surgery found major bleeding in 6 percent of those who took the blood thinner, but in none who used the device.

The study is published in the March issue of Journal of Bone & Joint Surgery.

This factor — known as Kruppel-like Factor 15 (KLF15) — protects the heart and aorta’s ability to maintain structural and functional integrity. A team from Case Western Reserve University School of Medicine in Ohio found that patients with heart failure or aortic aneurysm had reduced levels of KLF15.

Research showed that the absence of the gene, combined with stress, was linked with both deadly conditions. Lab animals that lacked the gene were more likely to develop the cardiovascular diseases.

Further investigation revealed that KLF15 uses a common molecular mechanism to provide protective effects in the heart and aorta. Drugs that target this molecular pathway can be used to treat heart failure and aortic aneurysm, the researchers discovered.

An aortic aneurysm is a bulge in the aorta, the main artery that carries blood from the heart to the rest of the body. If the aneurysm bursts, death is possible.

The report is published in the April 7 online edition of the journal Science Translational Medicine.

“This is very rare to find a singular genetic factor that governs the response of the entire cardiovascular system. Our research proves that KLF15 governs the shared diseases of the heart and blood vessels,” study senior author Dr. Mukesh K. Jain, director of the Case Cardiovascular Research Institute, said in a university news release.

The findings suggest that increasing the protective effects of KLF15 in the heart and aorta may prevent the start or progression of heart failure and aortic aneurysm, the researchers said.

SOURCE: Case Western Reserve University

In a study in the journal Alzheimer Disease and Associated Disorders, neurologist Dr. Douglas Scharre of Ohio State University Medical Center reports that the test detected 80 percent of people with mild thinking and memory problems. It only turned up a false positive — wrongly suggesting that a person has a problem — in five percent of people with normal thinking.

In a press release, Scharre said the test could help people get earlier care for conditions like Alzheimer’s disease.

“It’s a recurring problem,” he said. “People don’t come in early enough for a diagnosis, or families generally resist making the appointment because they don’t want confirmation of their worst fears. Whatever the reason, it’s unfortunate because the drugs we’re using now work better the earlier they are started.”

The test can be taken by hand, which Scharre said may help people who aren’t comfortable with technology like computers. He’s making the tests, which take 15 minutes to complete, available free to health workers at www.sagetest.osu.edu.

“They can take the test in the waiting room while waiting for the doctor,” Scharre said.

“Abnormal test results can serve as an early warning to the patient’s family,” added Scharre. “The results can be a signal that caregivers may need to begin closer monitoring of the patient to ensure their safety and good health is not compromised and that they are protected from financial predators.”

In the study, 254 people aged 59 and older took the test. Of those, 63 underwent an in-depth clinical evaluation to determine their level of cognitive ability.

SOURCE: Ohio State University

Mipomersen is designed to decrease the formation of apolipoprotein B (the main structural protein in LDL cholesterol) and its release from the liver or intestine. This reduces circulating LDL cholesterol concentrations.

Inherited high cholesterol (homozygous familial hypercholesterolemia) affects one in every one million people. Patients with the disorder have severely elevated LDL cholesterol and a high risk of early cardiovascular disease. If untreated, these patients rarely live past the age of 30.

This phase 3 clinical trial included 51 patients with homozygous FH who were already taking lipid-lowering drugs, including high-dose statins. The patients were randomly selected to receive either 200 milligrams of mipomersen or placebo per week for 26 weeks.

At the end of the treatment period, LDL cholesterol levels had decreased 24.7 percent in the mipomersen group, compared with 3.3 percent in the placebo group.

“Mipomersen could be a valuable addition to the drugs used in the management of homozygous FH and should prove useful in the management of other forms of severe refractory hypercholesterolemia,” wrote an international team of researchers led by Frederick Raal of the University of Witwatersrand, Johannesburg, South Africa.

The study was published online March 13 in advance of print publication this week in The Lancet, and was slated to be presented Saturday at the annual meeting of the American College of Cardiology in Atlanta.

SOURCE: The Lancet, news release.