News in brief - April 19, 2004

Updated recommendations for alcohol screening - Transcendental meditation can lower blood pressure - New health survey finds most children in good health - Intense multipronged diabetes management program can improve outcomes

Updated recommendations for alcohol screening

Primary care physicians should screen all adults, including pregnant women, for alcohol misuse and refer them for counseling if necessary, according to an updated recommendation issued on April 5 by the U.S. Preventive Services Task Force.

The recommendation was published in the April 6 issue of the Annals of Internal Medicine.

Women who consume more than seven alcoholic drinks per week, or more than three drinks per occasion, and men who consume more than 14 drinks per week, or more than four drinks per occasion, are considered to be risky or hazardous drinkers, according to the task force.

As many as one-fourth of all patients seen by primary care physicians in some settings might be risky drinkers, said the task force, which reviewed numerous studies in reaching its recommendation.

Effective counseling for risky drinkers should consist of a 15-minute initial session that includes advice, feedback on current drinking patterns, goal setting, assistance and follow-up. Sessions can be delivered by the physician or another member of the health care team.

In a separate finding, the task force concluded that there isn't enough rigorous scientific evidence to recommend for or against screening and counseling teens on their alcohol use.

Transcendental meditation can lower blood pressure

Black adolescents at risk for hypertension as adults can lower their blood pressure through twice daily transcendental meditation, according to a study published in the April issue of the American Journal of Hypertension.

A study of 156 inner-city black teens in Augusta, Ga., with high-normal pressure showed that teens who practiced 15 minutes of transcendental meditation twice a day steadily lowered their daytime blood pressures over four months and that their pressures tended to stay lower.

"Allowing the mind to go to that state of inner quietness and be there for a time has an effect on the physiology by reducing stress hormone levels like cortisol and reducing activation of the sympathetic nervous system which controls the fight-or-flight response," said Vernon A. Barnes, PhD, physiologist at the Medical College of Georgia and principal author of the paper.

The technique can be used throughout a lifetime without side effects or additional expense, Dr. Barnes noted.

The teens registered an average drop of 3.5 mm Hg in their systolic pressure and 3.4 mm Hg in their diastolic pressure.

New health survey finds most children in good health

About 84% of kids and adolescents are in excellent or very good health, according to the "Summary Health Statistics for U.S. Children: National Health Interview Survey, 2002" published by the Centers for Disease Control and Prevention in March.

Those from wealthier families were more likely to report excellent health than those from poorer ones, and those on Medicaid were also least likely to be healthy. About 62% of those with private insurance reported excellent health but only 41% of those on Medicaid did.

The survey also found that 12% of children were diagnosed asthmatics, and that boys were more likely than girls to be asthmatic as were children from poor families and African-Americans. Hay fever was most common in the South affecting 15% of children but least common in the West where it affected only 10% of kids.

Minorities, however, did better at health-related school absences. Two-thirds of African-American and Hispanic children missed school because of illness, but four-fifths of white children did.

The report also found that 10% had no health insurance and that those children were more likely to receive their usual care in an emergency department.

Intense multipronged diabetes management program can improve outcomes

Improving patient and physician access to diabetes education and having doctors involved in data collection and quality issues betters blood sugar control, blood pressure and cholesterol management, according to a paper published in the April issue of Clinical Diabetes.

Researchers at the University of Pittsburgh Medical Center followed 15,000 patients presenting to primary care physicians after the launch of the Focus on Diabetes initiative in 2000. As a part of this initiative, physicians were educated about the American Diabetes Assn.'s Standards of Care and were ranked based on the average A1C scores of all their diabetic patients. Patient access to diabetes educators was also increased.

At the end of two years, the average A1C of patients was lowered from 8% to 6.87%.

"Because the traditional health care system is designed to provide a symptom-driven response to acute illnesses, it is poorly configured to meet the needs of the chronically ill," said Linda Siminerio, PhD, lead author and executive director of the Diabetes Institute. "Although it may take years to see significant impacts on micro- and macro-vascular disease, our results would lead us to believe our patients have been best served by these ongoing quality efforts."