Category Archives: Research Blog

Can Text Messaging Increase Flu Shots in Children?

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The Journal of American Medical Association did a study on “e-mobile technology”, for example sending text messages on phones to try to increase immunization rates, in this case flu rates of children.

The research was done at the University of Rochester where about 8,000, mostly low-income kids, and parents got a series of text messages regarding flu shots starting at the beginning of the 2010-2011 flu season, and then received an additional reminder.

About half the parents got weekly text messages, educating them about the flu and the importance of immunizing their children. They also got weekly text messages reminding them about flu clinics that were being held.
Researchers found that about 44% of the kids and teens that were in the text message group were vaccinated and about 40% of those parents who did not receive texts were vaccinated.

Statistically, there’s not much difference, but clinically this is important, and here’s why. These authors pointed out that if these results were applied to the entire population you would have several million more kids getting vaccinated.

One of the concerns we should consider is cost and even potentially, some privacy issues. But despite the possible downsides, even if it’s only a 4% difference, if you apply that, it could result in lives saved.  I think we should continue to pursue this area of research of using text message reminders as a potential to make a difference from the public health perspective. In the meantime though, make sure your children are getting their flu shots every year!

How Effective is your Birth Control?

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Researchers did a study published in the American Journal of Obstetrics and Gynecology looking at 4,000 women in St. Louis.  These women were surveyed prior to a counseling session regarding their beliefs about the effectiveness of birth control methods.

Researchers found that 45% of women overestimate the effectiveness of pills and condoms; they actually thought they were far more effective than research shows. The failure rate (meaning how often people use them and still get pregnant) for condoms is between 18%-21%, but with the pill it’s about 9% a year.

What we found to be most interesting though, is that in the study, before they counseled the women about effectiveness, only 5% to 6% of the women chose an IUD or hormonal implants but, after they talked about the effectiveness, over 70% chose an IUD or implant.  That suggests that there’s bias going on against IUD’s and more effective forms of birth control in favor of less effective means.

We do know that IUD’s are safe, so it may be that some people don’t like the idea of having a procedure and feel more comfortable with pills because that’s what is more commonly used.  While the cost of an IUD is higher upfront, when you count how much you spend on birth control pills every month, it turns out to be comparable.
The take-home message is to talk to your doctor about your specific desires for your family planning and if you desire birth control, be sure to ask specifically about the IUD and implantable options, particularly if you want the best effectiveness.

Alcoholics Anonymous and Narcotics Anonymous Effective for Teenagers?

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More Information and Resources for Help with Addictions

Over the years data has shown us that Alcoholics Anonymous and Narcotics Anonymous can be effective programs for adults. But what about if those adults are teenagers, will the AA and NA program remain as effective? Other research suggests these program are effective for teens.

This study looked at almost 127 adolescents; ¾ were male and ¼ were female teenagers who were followed over a one-year period as they went through AA or NA.  Researchers then looked at how their participation related to the outcomes of them being substance-free.

The good news is that the study showed us there was a positive relationship between attendance level and substance use. So the more meetings the adolescents attended, the better off they ended. The study also showed that adolescents who had a sponsor, someone who actually supported them beyond just attending the meetings, fared better then those who didn’t.

So, getting involved with AA or NA early on is a GOOD idea for those with addictions, whether you’re an adult or teenager.

Can Spinal Injections Help Cure Sciatica?

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Researchers published in the Annals of Internal Medicine about patients suffering from lower back and leg pain due to nerve damage, a condition also referred to as sciatica.

The study looked at 81 sciatica patients who were placed in one of three different treatment groups.  In one group they were given two spinal injections of the steroid Prednisone, two weeks apart; in group two they got a drug called Enbrel, a disease modulating drug; and the third group got Saline, normal sterile salt water.

Researchers checked-in one month later and they found that the patients’ back and leg pain was reduced by a similar amount regardless of what treatment group they had been placed.

This tells us as primary care doctors and for our patients that these spinal injections are not magic pills for people with ongoing back pain.  We do wonder about the saline injections…  Are they washing out something or increasing blood flow to nerve roots, or is this just the placebo effect of getting something injected? We fear it is likely the latter.  Still saline is a much safer and less expensive than any of the other drugs.  Steroid injections, such as Enbrel, are more expensive and have more side effects, including suppression of the immune system.  Until we see better research, we are hesitant to advise most patients with this condition to rush to have injections.

We do know that physical and exercise therapy are helpful and that’s what we recommend most of the time.

Can Pills Prevent Prostate Cancer?

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Prostate cancer affects 15% to 18% of men in North America but only 3% of cases result in death.

We’ve had less advances in prostate cancer in some respect because we no longer recommend the PSA test for most men in terms of trying to pick it up early. So perhaps there’s research that we can prevent cancer.
The Journal of the American Board of Family Medicine did a systematic review of studies. They looked at all the clinical trials that have looked into medication drugs or nutritional intervention to prevent prostate cancer to see if there was anything we should be recommending to men to help prevent prostate cancer.

The only medication they came across that seemed to have any promise was what’s called five alpha-reductase inhibitors; common names for drugs we use to prevent prostate hypertrophy, to shrink the prostate. But the question here is, do these medicines help patients prevent prostate cancer?

The answer to that; maybe. The research showed that for patients who are of really high risk there could be some benefit, but there’s not enough evidence to say this is a good idea for all men to take to reduce their chances of getting prostate cancer.

If you had a close family member – father or brother, who had prostate cancer at an early age, this might be something you want to look into.

Fructose Syrup & Weight Gain- Not So Simple

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In recent years there has been an increased amount of concern regarding high fructose syrup as a main ingredient in our food and drinks. A study in the Annals of Internal Medicine looked at people who consumed the extra fructose baked into breads or sprinkled into their drinks to see whether or not they gained extra weight compared to those who didn’t consume extra fructose.

Researchers looked at over 30 studies that included over 600 people. They looked at factors such as the types of diets they had, where they got their fructose in their diet and if it lead to increased weight gain.

What they found was if you add extra simple sugar in your diet by sprinkling it on your food or drinks, it’s probably not going to make you gain weight as long as you cut down on other carbohydrates and calories to make up for it. So, the fructose itself didn’t lead to gaining weight as much as total caloric intake.

The bottom line here is if you do want to add that sugar to your coffee or tea, just take a couple of bites less of whatever you’re eating and be mindful of your daily calorie count.

Effects of Fiber on Diabetics

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Family Medicine researchers did a systematic review looking at 15 different studies related to fiber intake and control of diabetes.

Researchers found that the people who had higher fiber intake had better fasting blood sugars and lower hemoglobin A1Cs at 3-month average blood sugar control.

The A1C difference (which measures your average blood glucose) is .26%, so it’s a significant difference, but not significant enough to give up a medication if you’re on one. The answer really lies in weight loss and a healthy diet.

The take away here is simple, if you are a diabetic or know someone who is, the doctor should start talking with you about your daily fiber intake.

Business and Health

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A new and periodic feature from YOUR HEALTH focusing on the business of health care…

The business of health care is multifaceted, and incentives for doing good sometimes compete unfortunately with incentives for making money.  Health care giant Johnson & Johnson (J&J) agreed to pay recntly over $2 billion to settle various U.S government probes into the marketing of its Risperdal antipsychotic drug and other medications, according to Bloomberg reports. The probe, which was brought against J&J in 2010, claims that J&J misled doctors and patients about Risperdal’s health risks and effectiveness. The settlement will also include a whistleblower case in which J&J was accused of paying kickbacks to Omnicare, a nursing home pharmacy provider, in return for increased Risperdal prescriptions. The J&J settlement is the second –largest ever by a pharmaceutical company, behind Pfizer’s $2.3 billion 2009 settlement for the improper marketing of painkiller Bextra and other drugs.

While the negative publicity may have an impact on J&J’s reputation, it is still regarded as one of the most respected American corporations. According to the 2012 Harris Interactive RQ Survey, measuring corporate reputations across industries, J&J ranked 7th, down from 2nd where it scored in 2011 and 2010.  J&J reported worldwide pharmaceutical sales of $65 billion for calendar year of 2011.  What do you think?

Gadget to Monitor Teenage Drivers

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Teenage drivers is one of the greatest concerns we have as parents.

The American Journal of Epidemiology examined drivers who drive in a jerky manner; driving in a way where they start too fast and then have to brake really fast; that sort of start/stop/start/stop. Researchers wanted to know if that sort of pattern is potentially predictive of future accidents.

The study, which looked at newly-licensed drivers, found that the number of sharp turns and screeching halts the teens made predicted their chance of having a car crash or near-car crash within the next few weeks.

Researchers actually had 42 teen drivers who made 68,000 driving trips. They followed the teens for 18 months and were equipped with a machine to monitor “G-force events”, sudden stopping and going, increased risk of crashes and near crashes.

 This tells us that we may be able to prevent accidents by monitoring teen driving.  If they are “jerky” not the teen type, but simply too quick to stop and start while driving, we should intervene.  Monitors perhaps are an alternative but they are expensive, $500 and have a monthly service fee, but for some parents this may be well worth to really cut down on the risk that your child will have a crash.