QUICK STUDY : A weekly digest of new research on major health topics

Tuesday, August 22, 2006

constipation

Kids may find some laxatives more acceptable than others.

· THE QUESTION As many parents will attest, getting a constipated child to swallow a laxative mixture can be difficult. Does the type of laxative make a difference, either in a child's willingness to take it or in its effectiveness?

· THIS STUDY randomly assigned 79 children, mostly boys, who averaged 8 years old and had chronic constipation and occasional incontinence, to take milk of magnesia or MiraLax (polyethylene glycol 3350 without added electrolytes) daily. The MiraLax was mixed in water, juice, Kool-Aid or Crystal Light; the milk of magnesia was mixed into applesauce or milkshakes or had flavoring added to it. A year later, both groups had improved, with 62 percent of the children taking MiraLax and 43 percent of those taking milk of magnesia having more-frequent bowel movements, less abdominal pain and fewer instances of incontinence, according to medical examinations and their parents. Close to a third of the children in both groups were considered recovered. Some children in each group complained about the taste of the laxative they took; about 5 percent of those taking MiraLax, compared with 35 percent of the milk of magnesia group, refused to take the assigned substance.

· WHO MAY BE AFFECTED BY THESE FINDINGS? Young children with chronic constipation. Although infrequent or difficult bowel movements are common in children, the condition usually is temporary. Parents of a child who has repeat or prolonged occurrences should contact a pediatrician.

· CAVEATS Other studies have found that most children with constipation improve within a year, regardless of the type of laxative used. Medical experts advise that children should not be given any laxative, especially for an extended time, without a doctor's supervision. The study was funded by the maker of MiraLax, which has not been approved for use by children.

· FIND THIS STUDY August issue of Pediatrics; abstract available online at http://www.pediatrics.org .

· LEARN MORE ABOUT constipation in children at http://digestive.niddk.nih.gov and http://www.kidshealth.org .

rheumatic disease

An osteoporosis drug seems to ease a side effect of steroids.

· THE QUESTION People with diseases of the joints, muscles and bones -- such as arthritis, lupus, gout, back pain and fibromyalgia -- often are treated with a type of steroid known as a glucocorticoid. Such drugs, however, have been linked to bone loss and fractures. Might these side effects be countered by taking a drug known to help preserve bone density?

· THIS STUDY involved 201 adults with rheumatic diseases (mainly rheumatoid arthritis and polymyalgia rheumatica) who had just begun taking a glucocorticoid, such as prednisone. They were randomly assigned to also take a daily dose of the anti-osteoporosis drug alendronate (Fosamax) or alfacalcidol, a form of vitamin D (calcitriol, Rocaltrol). After 18 months, spine measurements of bone mineral density had increased about 2 percent among those taking alendronate and had decreased about 2 percent among those taking alfacalcidol. Density of neck and hip bones also favored the alendronate group. Few side effects were reported by either group.

· WHO MAY BE AFFECTED BY THESE FINDINGS? People taking a glucocorticoid for a rheumatic disease.

· CAVEATS The study did not compare users of the two drugs with people who took nothing other than their steroid treatment. Merck provided the alendronate and Teva Pharmaceuticals provided the alfacalcidol; three of the 13 main authors had received consultants' fees from the companies.

· FIND THIS STUDY Aug. 17 issue of the New England Journal of Medicine; abstract available online at http://www.nejm.org .

· LEARN MORE ABOUT rheumatic diseases at http://www.rheumatology.org (click "Patients & Public," then "Learn More" under "Patient Education") and http://healthlink.mcw.edu (search for "rheumatic").

heart attack

Occasional coffee drinkers may be raising their short-term risk.

· THE QUESTION Sexual activity, marijuana use, physical exertion and anger all are capable of triggering a heart attack in people with coronary artery disease. Should coffee drinking be added to the list?

· THIS STUDY analyzed the coffee consumption habits of 503 heart attack survivors. Most participants reported drinking an average of two to three cups of coffee a day; all coffee consumed was caffeinated, and nearly all was filtered. Overall, drinking at least one cup of coffee increased the risk of having a heart attack within an hour by 49 percent, compared with the individuals' risk at other times. However, among people considered occasional coffee drinkers (less than one cup a day), having a cup of coffee raised their risk four-fold, whereas heavy coffee drinkers (more than four cups a day) had no increased risk. Drinking coffee also made a heart attack more likely within an hour among people who generally were sedentary and those who already were considered more likely to develop heart disease.

· WHO MAY BE AFFECTED BY THESE FINDINGS? People who drink caffeinated coffee, especially those who do not drink it regularly. Some experts theorize that habitual intake of caffeine may create a tolerance of its effects.

· CAVEATS The data used in the study were based on participants' recall. Other studies have shown that heart attacks occur more often in the morning, when people are most likely to drink coffee; this may have affected the results. The effect of drinking decaffeinated coffee was not studied.

· FIND THIS STUDY September issue of Epidemiology; abstract available online at http://www.epidem.com (click "Current Issue").

· LEARN MORE ABOUT heart attack at http://www.americanheart.org and http://www.nhlbi.nih.gov/health .

--Linda Searing

The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment's effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.