NEW YORK (Reuters Health) – Traffic pollution may cost two California cities millions each year in managing children’s asthma, a new study suggests.

The findings suggest that “the real costs of this pollution are substantial,” said lead researcher Sylvia J. Brandt, of the University of Massachusetts, Amherst.

Similar cost studies could be done in other U.S. communities, Brandt told Reuters Health.

Researchers estimate that the annual cost of traffic-related asthma symptoms in the two cities — Long Beach and Riverside — totals about $18 million. That’s considering the direct costs of medical care, as well as indirect expenses like kids’ school absences and parents’ time off from work.

The figure is an estimate, based on government cost data and past research on the number of childhood asthma cases linked to traffic pollution.

And other communities’ costs would vary widely depending on, among other things, the amount of traffic near homes and schools.

As an example, Brandt said that dozens of communities in Massachusetts have higher asthma rates than those seen in the two California cities — where an estimated 13 percent to 15 percent of kids younger than 18 have asthma.

Springfield, for one, has an asthma prevalence of 18 percent, and it’s surrounded by major highways, she noted.

Nationally, it’s estimated that 9 percent of U.S. children have asthma. But rates are higher among poor, minority kids; 16 percent of low-income black children have asthma, according to the U.S. Centers for Disease Control and Prevention.

There are a number of risk factors for asthma, including genetic vulnerability. But, Brandt pointed out, there’s growing evidence that traffic pollution may not only trigger symptoms in kids who already have asthma, but may also boost the odds of developing asthma.

A number of studies have found that the closer a child lives to heavily traveled roads, the higher the asthma risk — even when controlling for other factors like family income.

COULD NEW ZONING HELP?

For the current study, reported in the European Respiratory Journal, Brandt’s team used estimates from an earlier study that linked road traffic to 9 percent of all childhood asthma cases in Long Beach and 6 percent in Riverside.

They calculated that over a year, the costs of asthma caused by road pollution, and asthma attacks triggered by pollution, would reach about $18 million for the two communities.

Brandt acknowledged that there is “uncertainty” in estimating such costs.

But she said that it would be useful for communities to have an idea of their own figures so they can see where their money is being spent, and how it could be better used.

Based on her team’s estimates, Riverside spends 6 percent of the county’s health-and-welfare budget on pollution-related asthma; the costs in Long Beach, meanwhile, equal about 21 percent of the city’s health department spending.

“The findings are at least suggestive that other communities could have high costs as well,” Brandt said.

Cities and towns with pollution issues could take steps to cut children’s risk of breathing problems, Brandt said — like passing laws against building schools or residential developments close to highways.

And in schools that are already near high-traffic roadways, she added, “clean air” technologies might help.

SOURCE: bit.ly/z3UtTs European Respiratory Journal, online January 20, 2012.

NEW YORK (Reuters Health) – A form of talk therapy called cognitive behavioral therapy appears to help older adults battle anxiety disorders slightly better than other approaches, but not as well as in younger adults, according to a new study.

“Cognitive behavioral therapy is the mainstay for treating anxiety disorders in younger adults. Its lower effect in older adults in this study is concerning,” said Dr. Eric Lenze, a professor at Washington University School of Medicine, who was not involved in this study.

Anxiety disorders, which include panic disorder, phobias, post-traumatic stress and generalized anxiety disorder, are common in adults over age 55.

The authors write in the Journal of the American Geriatrics Society that three to 14 out of every 100 older adults has an anxiety disorder.

While earlier studies have shown that cognitive behavioral therapy works well for younger and middle-aged adults, there has not been as much research into the treatment for seniors.

“The prevailing assumption tends to be that what works with working-age people will work with older people, but this might not actually be the case,” said Rebecca Gould, the lead author of the study and a researcher at King’s College London.

Gould’s team gathered up the results from 12 previous studies on people over age 55 with an anxiety disorder.

Half of the studies compared cognitive behavioral therapy to other treatments, such as medications or group discussions, while the other half compared the therapy to no treatment.

Cognitive behavioral therapy (CBT) often involves one-on-one meetings with a therapist, with the ultimate goal of solving the defective thinking process that’s causing the disorder.

On average in the studies, people went through 12 sessions of therapy.

Compared to doing nothing, cognitive behavioral therapy had a “moderate” effect on helping people’s anxiety.

Compared to medications or group discussions, the therapy relieved the disorder slightly better.

Gould’s team noted that the improvement over other treatments was small.

“What this might mean clinically is that the client in the CBT condition might be a little less severely or moderately anxious relative to the client in the active control condition,” Gould wrote in an email to Reuters Health.

GOING AFTER ROOT CAUSES

Gould says therapy might work better than drugs because it seeks to fix the causes of anxiety rather than the symptoms.

“If we can address the causes of symptoms of anxiety (e.g. by changing how we think about or interpret things) then we can stop them coming back in the future. If we only address the symptoms of anxiety then we can’t,” she said.

Though Gould’s analysis and those of studies in younger adults agree that cognitive behavioral therapy helps treat anxiety, the effect in older adults is small while the effect seen in younger adults is moderate or large, the authors wrote.

Gould said she doesn’t know why the therapy seems less effective in older adults, but it’s possible that talk therapy might take longer to work for them.

Lenze said that cognitive behavioral therapy is still worthwhile in older adults.

“Until better treatments are developed there are somewhat limited options,” he told Reuters Health.

He added that anxiety can take a toll on the mental and physical health of adults if it’s not treated.

Gould said more studies that compare cognitive behavioral therapy to other treatments are needed in older adults, and her group is planning a study that explores the benefit of “mindfulness-based” cognitive therapy, which includes practices such as meditation.

Lenze said he and his colleagues are also exploring this approach, as well as combining cognitive behavioral therapy with medications.

SOURCE: bit.ly/xnZJJA Journal of the American Geriatrics Society, online January 27, 2012.

NEW YORK (Reuters Health) – Elderly adults who regularly drink green tea may stay more agile and independent than their peers over time, a large study of Japanese adults suggests.

Green tea contains certain antioxidant chemicals — particularly a compound known as EGCG — that may help ward off the body-cell damage that can lead to disease. And researchers have been studying green tea’s effects on everything from cholesterol to the risk of certain cancers — with mixed results so far.

For the new study, Japanese researchers looked at a different question: Do green-tea drinkers have any lower risk of frailty and disability as they grow old?

Following nearly 14,000 adults age 65 and older, they found that people who drank the most green tea were the least likely to develop “functional disability” over the next three years.

Functional disability refers to problems with daily activities like going to the store or doing housework, or difficulty with more-basic needs like dressing and bathing.

In this study, almost 13 percent of adults who drank less than a cup of green tea per day became functionally disabled. That compared with just over 7 percent of people who drank at least five cups per day.

That alone does not prove that green tea keeps you spry into your golden years.

But the study, reported in the American Journal of Clinical Nutrition, did account for a range of factors that could explain the connection.

Green-tea lovers generally had healthier diets — more fish, vegetables and fruit — as well as more education, lower smoking rates, fewer heart attacks and strokes and greater mental sharpness.

They also tended to be more socially active and have more friends and family to rely on. (Studies have found that older adults with more “social support” are less likely to become disabled.)

But even with those factors considered, green tea itself was tied to a lower disability risk, according to the researchers, led by Yasutake Tomata of Tohoku University Graduate School of Medicine.

People who drank at least five cups a day were one-third less likely to develop disabilities than those who had less than a cup a day. And people who averaged three or four cups a day had a 25 percent lower risk.

All of that hints at a real effect of green tea. But ultimately, Tomata’s team writes, definitive proof can come only from clinical trials testing the effects of green tea, or green tea extracts, on disability risk.

If green tea does offer a buffer against disability, it’s not clear how.

But one recent study found that green tea extracts seemed to boost leg muscle strength in older women, notes Tomata’s team, who could not be reached for comment.

In general, green tea is considered safe in moderate amounts. But the tea and its extracts do contain caffeine, which some people may need to avoid.

Green tea also contains small amounts of vitamin K, which means it could interfere with drugs that prevent blood-clotting, like warfarin. Since many elderly people are on multiple medications, it’s wise for them to talk with their doctors before using green tea as a health tonic.

SOURCE: bit.ly/wXuZbl American Journal of Clinical Nutrition, online January 25, 2012.

NEW YORK (Reuters Health) – Despite concerns by some that vaccines might cause a crippling nerve disorder called Guillain-Barré syndrome, a new study finds that people who receive vaccines after previously having been diagnosed with the condition do not experience any flare-ups.

“Vaccines are OK for people with Guillain-Barré syndrome,” said Dr. Roger Baxter, the lead author of the study and the co-director of the Kaiser Permanente Vaccine Study Center.

Guillain-Barré is a rare autoimmune disorder that can cause muscle weakness and paralysis.

While there is no cure, some treatments can help the symptoms.

About one to two out of every 100,000 people develop the syndrome every year.

The cause is unknown, but Baxter said there’s evidence that a number of cases were related to a shot against the swine flu outbreak that occurred during the 1970s.

“A relationship to a flu vaccine is possible,” Baxter said, though he added that studies on Guillain-Barré and other vaccines have not found a link.

“We don’t really think that other than the 1976 swine flu vaccine that there’s any connection between the two,” he told Reuters Health.

In fact, recent studies have found that the flu itself might be tied to the syndrome (see Reuters Health reports of June 24, 2011 and January 28, 2009).

CDC URGES CAUTION

The Centers for Disease Control and Prevention (CDC) caution against giving a flu shot to anyone with Guillain-Barré whose disease surfaced within six weeks of a previous immunization against the flu.

The recommendation is relevant to only a very small subset of people with Guillain-Barré, but Baxter’s concern is that some physicians expand it to include anyone with a history of the syndrome.

As part of a large study looking for any connection between Guillain-Barré and vaccines, Baxter and his colleagues collected medical records from 550 people with the syndrome.

All the patients had been treated at Kaiser Permanente of Northern California, and the researchers searched for any immunizations and Guillain-Barré recurrences over more than a decade.

Among this group, 279 had received at least one vaccine subsequent to their diagnosis, including 107 people who got a flu shot.

In total, the patients received nearly 1,000 vaccines, and none had a flare-up of Guillain-Barré in the two months following the shots.

Only one person had a flare-up within a year of a vaccine, and it occurred four months after receiving a combination shot for measles, mumps and rubella, according to findings published in Clinical Infectious Diseases.

There were 18 people who fell into the category targeted by the CDC’s recommendations against flu immunization — those who had originally developed the syndrome within six weeks of a flu shot — and two of them ended up receiving a flu shot later on with no record of the syndrome recurring.

Baxter — who along with one of his co-authors has received funding from several vaccine makers — said that even though his results show no relationship between flu shots and Guillain-Barré flare-ups, there are still too few cases to say definitively that there’s no risk.

“The problem with our study is that because there were so few of our Guillain-Barré syndrome patients who had Guillain-Barré syndrome that developed within six weeks of a flu shot, there wasn’t enough data to say you can vaccinate those who got it,” he said.

However, “for the vast majority of Guillain-Barré syndrome people, go ahead and get flu shots,” he said.

The study was funded through the CDC.

In an emailed statement from Dr. Claudia Vellozzi, the deputy director of the Immunization Safety Office at the CDC, she said, “this study adds evidence that (Guillain-Barré syndrome) recurrence after vaccination is quite rare. It provides reassurance for people with a history of (Guillain-Barré syndrome) who would like to receive vaccinations to prevent illness.”

SOURCE: bit.ly/zu4Vzt Clinical Infectious Diseases, online January 19, 2012.

LONDON (Reuters) – Malaria kills more than 1.2 million people worldwide a year, nearly twice as many as previously thought, according to new research published on Friday that questions years of assumptions about the mosquito-borne disease.

Past studies had overlooked hundreds of thousands of deaths because they had wrongly assumed malaria overwhelmingly killed babies and focused their findings on under-fives, said the study by the Institute for Health Metrics and Evaluation (IHME) in the United States.

The new study, published in The Lancet medical journal, found 42 percent of deaths were actually among older children and adults.

The higher number of victims showed the need to increase funding to fight malaria, even as governments came under pressure to cut their aid budgets amid the global economic crisis, said the researchers.

“You learn in medical school that people exposed to malaria as children develop immunity and rarely die from malaria as adults,” said Christopher Murray, who led the study as IHME Director. “What we’ve found in hospital records, death records, surveys and other sources shows that just is not the case.”

In their work, which used new data and computer modeling to build a historical database for malaria between 1980 and 2010, they found that more than 78,000 children aged five to 14, and more than 445,000 people aged 15 and older died from malaria in 2010. This means more than four in 10 of all malaria deaths were in people aged fives years and older.

Overall, malaria deaths worldwide rose from 995,000 in 1980 to a peak of 1.8 million in 2004, before falling again to 1.2 million in 2010, the study found.

The World Health Organization’s (WHO) latest global report said the estimated number of malaria deaths fell to 655,000 in 2010, almost half the number in the IHME study.

The WHO, a United Nations agency, said on Friday it stood by its figures and said that much of the data used in the Lancet study had been based on verbal testimony by relatives of how people had died, not on laboratory diagnosis of samples.

“So we would say that again the great majority of deaths would be in children under five and we stand by our estimates,” WHO spokesman Gregory Hartl told a news briefing in Geneva.

Both studies showed a downward trend in deaths in recent years, thanks largely to the use of anti-malaria drugs and insecticide-treated bed nets.

The new findings are part of an ongoing series generated by the Global Burden of Diseases, Injuries and Risk Factors 2010 Study. Global trends in child deaths, maternal deaths, breast cancer, and cervical cancer were released last year and more will be released in coming months.

Malaria is endemic in more than 100 countries worldwide but can be prevented by the use of bed nets and indoor spraying to keep the mosquitoes that carry the disease at bay.

Effective malaria drugs known as artemisinin-based combination therapies, or ACTs, can cure the infection but access to these medicines is often hampered in poor countries, where funding is limited and health services are patchy.

The IHME researchers said much of the decline in deaths was down to efforts by the Global Fund to Fight AIDS, Malaria and Tuberculosis, which was launched in 2001, and other anti-malaria organizations such as the WHO’s Roll Back Malaria campaign.

“We have seen a huge increase in both funding and in policy attention given to malaria over the past decade, and it’s having a real impact,” said Alan Lopez of the University of Queensland and one of the study’s co-authors.

“Reliably demonstrating just how big an impact is important to drive further investments… This makes it even more critical for us to generate accurate estimates for all deaths.”

The researchers also warned, as the WHO did in its December 2010 malaria report, that recent gains in the fight against the disease malaria could be reversed if global economic troubles stifle funding efforts.

It said an announcement by the Global Fund in November that it would cancel its next round of funding “casts a cloud over the future of malaria programs.

“If the Global Fund is weakened, the world could lose 40 percent of all the funding dedicated to fighting malaria,” said Stephen Lim, also at IHME and a co-author on the study.

(Additional reporting by Stephanie Nebehay in Geneva; Editing by Andrew Heavens)