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NEW YORK (Reuters Health) - Boys with asthma who are exposed to higher levels of tobacco smoke at home are more likely to have behavioral problems, new research shows.

"These findings should encourage us to make stronger efforts to prevent childhood exposure to tobacco smoke, especially among higher risk populations, such as children with asthma," Dr. Kimberly Yolton of the Cincinnati Children's Hospital Medical Center in Ohio said in a press release accompanying the study.

While the detrimental effects of tobacco smoke exposure on children's health and cognition are well known, there has been less research into how this exposure might affect behavior, Yolton and her team point out in the Journal of Developmental and Behavioral Pediatrics. The studies that have looked at the issue have used parent reports to gauge children's exposure, which may not be accurate, they add.

To get a clearer idea of this relationship, the researchers evaluated 220 boys and girls with asthma participating in a trial investigating the effects of air filters on their symptoms, lung function, and health care use. All of the children underwent blood tests to measure their levels of the nicotine byproduct cotinine at the study's outset, which is considered to be the best way to measure tobacco smoke exposure.

Girls' cotinine levels indicated that they were breathing more second-hand smoke than boys. While there was no link between cotinine levels and behavior in girls, the researches did find an association with boys.

Specifically, the greater the boys' exposure, the more likely they were to have externalizing behavior problems such as hyperactivity, aggression and conduct disorders. They were also more likely to have internalizing behaviors, for example symptoms of anxiety and depression.

While past research has linked tobacco smoke exposure to externalizing behavior in children, the researchers note, children with asthma tend to have internalizing behavior problems.

The findings can't be generalized to children who don't have asthma, they add, but they do "provide further evidence that even low levels of environmental smoke may contribute to behavior problems in children."

SOURCE: Journal of Development and Behavioral Pediatrics, online December 4, 2008.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - Men who manage to stay lean and active as they age may lower their risk of developing heart failure, researchers reported Monday.

In a long-term study of more than 21,000 male U.S. doctors, researchers found that men who were overweight were 49 percent more likely than their lean counterparts to develop heart failure over 20 years. Obese men, meanwhile, faced a nearly 200 percent greater risk than the thin men did.

On the bright side, however, regular exercise seemed to offer some protection against heart failure, regardless of weight, the researchers report in the American Heart Association journal Circulation.

The study found that men who were both lean and regularly active had the lowest risk of developing the heart condition, while those who were obese and sedentary were at greatest risk. But exercise was protective even in men who were overweight.

The findings should give people yet more motivation to exercise and follow a healthy diet, according to lead researcher Dr. Satish Kenchaiah, of Brigham and Women's Hospital in Boston.

"Adopting a healthy lifestyle, keeping a normal weight, and exercising regularly will go a long way toward reducing one's risk of heart failure and, in turn, the population burden of heart failure," Kenchaiah said in a written statement.

"Both staying lean and being fit go hand in hand," he added.

The findings also show that not only obese men, but also those who are merely overweight, may face a heightened heart failure risk. Past research has linked obesity to heart failure, but in this study, overweight men also had a higher risk than normal-weight men.

"On average," Kenchaiah said, "in men who are 5 feet 10 inches tall, for every 7 pounds of excess body weight, the risk of heart failure will go up by 11 percent over the next 20 years."

He and his colleagues based their findings on data from the Physicians' Health Study, a clinical trial that began in 1982 and included roughly 22,000 male doctors between the ages of 40 and 84. At study entry, none of the men had a history of heart attack, stroke or transient ischemic attacks, or "mini strokes."

Between 1982 and 2007, a total of 1,109 study participants were newly diagnosed with heart failure. Kenchaiah's team found that the risk rose in tandem with the men's body mass index (BMI), a measure of weight in relationship to height -- even with a range of other factors taken into account, such as age, smoking and other health conditions like high blood pressure.

Exercise was also independently linked to heart failure risk. Men who said they got any vigorous exercise were 18 percent less likely to develop heart failure than their sedentary counterparts.

An important point, Kenchaiah noted, is that the benefits of staying lean and those of exercise were independent of each other.

"Higher BMI increased the risk of heart failure in inactive as well as active individuals," he said. "By the same token, the beneficial effect of vigorous physical activity in reducing the risk of heart failure was observed in lean, overweight, and also obese men."

SOURCE: Circulation: Journal of the American Heart Association, December 23, 2008.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - UK researchers have identified a type of treatment that can help most people with eating disorders, with lasting results.

"Now for the first time, we have a single treatment which can be effective at treating the majority of cases without the need for patients to be admitted into hospital," lead researcher Dr. Christopher G. Fairburn of the University of Oxford commented in a press release.

"Eating disorder not specified," in which a person has disordered eating patterns but doesn't meet criteria for bulimia nervosa or anorexia nervosa, is the most common type of eating disorder, followed by bulimia nervosa, Fairburn and his team note in the American Journal of Psychiatry. Eighty percent of patients undergoing outpatient treatment for an eating disorder fit into one of these two categories, but the best treatment for patients with non-specified eating disorders has not been studied.

The researchers developed a therapy for treating these patients, and those with bulimia, called enhanced cognitive behavioral therapy (CBT-E). In 2004, the UK's National Institute of Health and Clinical Excellence recommended CBT-E for use throughout the country's National Health Service.

Fairburn and his team compared two approaches derived from CBT-E. The first, CBT-Ef, "targets eating disorder psychopathology exclusively," while the second, CBT-Eb, treatment as appropriate for "mood intolerance, clinical perfectionism, low self-esteem, or interpersonal difficulties" is added to the CBT-Ef approach.

The researchers enrolled 154 patients who had been diagnosed with an eating disorder but were not extremely underweight. The subjects underwent 20 weeks of either treatment (consisting of a 50-minute outpatient session once a week), and then 60 weeks of follow-up or an 8-week waitlist period.

Sixty weeks after the end of treatment the researchers found that the level of disordered eating had been reduced to normal range in 61.4 percent of patients with bulimia nervosa and 45.7 percent of those with an unspecified eating disorder.

Their analysis also suggested that patients with more psychological problems did better with CBT-Eb, while those with fewer problems did better with CBT-Ef.

"The simpler focused form of the treatment, CBT-Ef, should perhaps be viewed as the default form as it is easier to learn and implement, with the more complex form, CBT-Eb, reserved for patients with marked additional psychopathology of the type it targets," they conclude.

SOURCE: American Journal of Psychiatry, online December 15, 2008.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - African Americans are less likely than whites to seek end-of-life hospice care -- and a new study suggests that hospice admission criteria may be partially to blame.

The researchers found that compared with whites African Americans are more likely to want to continue aggressive treatment and expressed a need for more services.

The findings also suggest it might be time to redesign hospice enrollment rules, the investigators suggest.

Hospice is an interdisciplinary program that offers terminally ill patients palliative care -- treating pain and other physical and emotional symptoms to make patients more comfortable in their last months of life.

Right now, Medicare will pay for hospice care only when patients have a life expectancy of no more than 6 months and are willing to forgo any further attempts at curative treatment, lead investigator Dr. Jessica Fishman of the University of Pennsylvania in Philadelphia state in the medical journal Cancer.

The Medicare criteria were designed to control costs, Fishman's team notes, but they have "substantially reduced access to hospice for many patients who have needs for hospice services, and a disproportionate number of these patients are African American."

The study included 283 cancer patients who were estimated to have 6 months or less to live. The researchers interviewed them about their preferences for continuing aggressive treatment and about their perceived need for various hospice services -- like having a home health aide help them with daily tasks, or getting counseling for depression or anxiety.

As mentioned, Fishman and her colleagues found that African American patients were more likely than white patients to want to continue treatment, but they also voiced a greater perceived need for hospice services.

The latter finding, the researchers say, seemed to be explained by the fact that African Americans generally had fewer financial resources than white patients.

The results, Fishman's team argues, indicate that Medicare criteria "do not select those patients with the greatest needs for hospice services."

The rules are also "unfair," the researchers contend, pointing out that other Medicare-supported services do not require patients to forgo one treatment to get another.

"To the degree that this eligibility requirement prevents hospice use by the patients with the greatest needs," the researchers write, "it fails to fulfill its purpose and should be reconsidered."

SOURCE: Cancer, February 1, 2009.

Copyright © 2008 Reuters Limited.

PHNOM PENH (Reuters) - A 19-year old Cambodian man has survived the H5N1 bird flu virus which has killed seven other people in the poor Southeast Asian nation since 2005, a health ministry official said on Sunday.

The youth, who became infected after eating poultry, was discharged from a Phnom Penh hospital on Saturday after being treated for 10 days, Ly Sovann, deputy director of communicable disease control department, said.

"He left safe and sound," Ly Sovann told Reuters.

Cambodia began culling poultry near its capital last week, and ordered a 3-month ban on poultry being moved from the province of Kandal, 50 km (30 miles) south of Phnom Penh, after tests confirmed it was hit by the deadly virus.

The young man, the eighth person in Cambodia to have contracted bird flu since its first case in 2005, fell ill on November 28 but was only confirmed as having bird flu on December 11.

Since H5N1 resurfaced in Asia in 2003 it has killed more than 200 people in a dozen countries, according to the WHO.

Experts fear the constantly mutating H5N1 virus could change into a form easily transmitted from person to person and potentially kill millions worldwide.

Copyright © 2008 Reuters Limited.