MONDAY, Jan. 23 (HealthDay News) — Many children with autism also have other developmental or psychiatric conditions, including learning disabilities, speech delays, attention or seizure disorders and anxiety.

According to new research, some of those co-occurring conditions may explain why autism diagnoses often change as children get older.

In a survey by researchers at Johns Hopkins Bloomberg School of Public Health in Baltimore, more than one-third of parents with children between 6 and 17 years old reported that their child’s diagnosis of autism had changed over time.

“We don’t know what changed the diagnosis. However, we want to deliver the message that it’s important to look at the other coexisting conditions, evaluate them before you make a diagnosis, and also recognize these conditions vary by development age,” said study author Li-Ching Lee, an associate scientist in the epidemiology and mental health departments at the School of Public Health.

Autism is a neurodevelopment disorder characterized by problems with social interaction, communication and restricted interests and behaviors.

In the study, researchers used 2007-2008 survey data from the parents of nearly 1,400 children aged 3 to 17 who had received a diagnosis of an autism spectrum disorder (ASD), including autism, Asperger disorder — a mild form of autism, and pervasive developmental disorder-not otherwise specified.

Parents were asked if their child currently had a diagnosis of autism or an ASD, or had had one in the past.

Nearly 26 percent of parents of children aged 3 to 5 reported a change in diagnosis, the researchers said. Nearly 34 percent of parents of children aged 6 to 11 and 35 percent of the parents of 12- to 17-year-olds reported their child was diagnosed with autism at some point but no longer was considered to have autism, the researchers found.

Overall, children with two or more co-occurring developmental or psychiatric conditions were five times more likely than kids with fewer coexisting conditions to continue to have an autism diagnosis, the researchers said.

Kids who had a moderate-to-severe learning disability were 11 times more likely to continue to have an autism diagnosis over time, while kids with a developmental delay were nine times more likely to retain an autism diagnosis, the study authors said.

Researchers didn’t look at why certain conditions are associated with a change in autism diagnosis. But some of the symptoms of various development and psychiatric conditions can overlap, so it’s possible that having certain ones can lead to a misdiagnosis until the child gets older and their issues become more clear, according to the study.

For example, kids diagnosed with a hearing problem showed a tendency to “lose” their autism diagnosis over time. Researchers speculated that behaviors that initially resembled autism symptoms — not responding or not engaging — were later discovered to stem from impaired hearing.

The study is published in the February issue of Pediatrics.

Dr. Joseph Horrigan, assistant vice president and head of medical research for the advocacy group Autism Speaks, cautioned not to make too much of the findings. The children weren’t actually followed over time, nor were they actually examined, a methodology that would be the “gold standard” of research.

Because the results were based on a telephone survey, Horrigan said, “I’d be a little cautious about over-interpreting whether this means there’s likely to be change in an autism diagnosis or a loss of an autism diagnosis for a given individual.”

Nor did researchers look at kids whose diagnosis went the other way — that is, they were initially not diagnosed with autism but were later diagnosed with it.

However, the findings highlight how often kids with ASD experience other conditions, some of which may be treatable with medications or with educational interventions. These include anxiety, attention-deficit hyperactivity disorder (ADHD), depression, epilepsy and learning disabilities.

“Up until the recent past, there’s been a tendency to spend most of the time and energy on the autism and the autism diagnosis, and thinking about a treatment package that’s keyed directly to the autism,” Horrigan said. “What’s important here is they are highlighting some of the most common co-occurring disorders, a number of which are readily amenable to treatments.”

An estimated one in 110 U.S. children — many more boys than girls — has autism, according to the U.S. Centers for Disease Control and Prevention.

More information

The U.S. National Institute of Mental Health has more on autism.

SUNDAY, Jan. 22 (HealthDay News) — Researchers have identified three new genomic regions they believe are linked with breast cancer that may help explain why some women develop the disease.

All three newly identified areas “contain interesting genes that open up new avenues for biological and clinical research,” said researcher Douglas Easton, a professor of genetic epidemiology at the University of Cambridge in England.

Breast cancer is the most common cancer among women, with about 1 million new cases annually worldwide and more than 400,000 deaths a year.

Scientists conducting genome-wide association studies — research that looks at the association between genetic factors and disease to pinpoint possible causes — had already identified 22 breast cancer susceptibility loci. Locus is the physical location of a gene or DNA sequence on a chromosome.

“The three [newly identified] loci take the number of common susceptibility loci from 22 to 25,” said Easton.

However, the three new susceptibility loci might explain only about 0.7 percent of the familial risks of breast cancer, bringing the total contribution to about 9 percent, the researchers said.

Michael Melner, scientific program director for the American Cancer Society, said this current research adds some important new clues to existing evidence, but he agreed that the number of cases likely associated with these three variants is probably low.

“So the total impact in terms of patients would be fairly small,” Melner said.

The study is published online Jan. 22 in Nature Genetics.

To find the new clues, Easton’s team worked with genetic information on about 57,000 breast cancer patients and 58,000 healthy women obtained from two genome-wide association studies.

The investigators zeroed in on 72 different single nucleotide polymorphisms (SNPs). A SNP — pronounced “snip” — is a change in which a single base in the DNA differs from the usual base. The human genome has millions of SNPs, some linked with disease, while others are normal variations.

The researchers focused on three SNPs — on chromosomes 12p11, 12q24 and 21q21.

Easton’s team found that the variant on the 12p11 chromosome is linked with both estrogen receptor-positive breast cancer (which needs estrogen to grow) and estrogen receptor-negative breast cancer. The other two variants are only linked with ER-positive cancers, they said.

One of the newly identified variants is in an area with a gene that has a role in the development of mammary glands and bones. Easton said it was already known that mammary gland development in puberty is an important period in terms of determining later cancer risk. “But these are the first susceptibility genes to be shown to be involved in this process,” he said.

One of the other SNPs is in an area that can affect estrogen receptor signaling, the researchers found.

Melner, noting some of the research is “fine tuning” of other work, said in his view the new understanding of the signaling pathways and their genetic links is the most important finding.

“When you delineate a pathway, you bring up new potential targets for therapy,” he said. “The more targets you have, you open up the potential for having multiple drugs and attacking a cancer more easily, without it becoming more resistant.”

Overall, Melner added, the results underscore the complexity of the different mechanisms involved in breast cancer development.

More information

For more about the genetics of breast cancer, visit the American Cancer Society.

SUNDAY, Jan. 22 (HealthDay News) — Doing yoga in a room heated to between 90 and 105 degrees — known as “hot yoga” — is increasing in popularity, but it may not be for everyone, an expert warns.

Exertion in high temperatures may be dangerous for people with certain health conditions, said Diana Zotos, a yoga instructor and physical therapist in the rehabilitation department at the Hospital for Special Surgery in New York City.

“If you have sensitivity to heat, if you’ve ever had heat stroke or tend to get fatigued, dizzy or dehydrated quickly, you should ask your doctor before starting hot yoga,” cautioned Zotos in a hospital news release. “Anyone with osteoarthritis, any rheumatologic arthritis, pain in muscles or a joint, or any kind of previous injury should check with their doctor.”

Zotos added that anyone with high blood pressure, low blood pressure or heart disease should consult a cardiologist before trying hot yoga.

Even if they don’t have an underlying condition, beginners, particularly those older than 40, should take precautions before trying hot yoga.

“Yoga of any type is physically challenging, and the heated environment of hot yoga makes the practice especially demanding,” Zotos said. “The heat makes people feel as if they can stretch deeper into poses and can give them a false sense of flexibility. This can lead to muscle strains or damage to the joint, including ligaments and cartilage.”

Zotos recommended that anyone new to hot yoga become familiar with the 26 poses used in the classes before they start.

“The heat factor also puts more strain on the heart and challenges endurance. That being said, people should be of good cardiovascular health; have healthy hip, knee, spine and shoulder joints; shouldn’t have balance or neurological issues; and should have a general tolerance for excessive heat,” she noted. Zotos also offered the following hot yoga tips for beginners:

• Bring a mat, a towel and, if possible, a friend.
• Wear shorts and a tank top.
• Drink plenty of fluids well before class (no coffee or soda).
• Do not consume more than 200 calories two to three hours before class.
• Research the yoga studio and make sure the hot yoga teacher has the proper certification and experience.
• Arrive early to meet the instructor, get settled and adjust to the temperature.
• Start slowly. Do not try poses that are too advanced and do not hold poses beyond what is comfortable or to the point of pain.
• Take breaks when needed.
• Don’t get discouraged if you can’t reach a pose.
• If necessary, ask questions about how to perform certain poses.
• Stop at the first sign of dizziness, chest pain or feeling faint or overheated. Seek medical assistance if necessary.

More information

The U.S. National Center for Complementary and Alternative Medicine has more about yoga.

SATURDAY, Jan. 21 (HealthDay News) — Muscle fatigue at the end of a day of skiing or snowboarding can lead to sloppy technique and potentially season-ending injuries, warns an expert.

But physical preparation can help protect against injury, said Dr. Ed Laskowski, co-director of the Mayo Clinic Sports Medicine Center and a former competitive alpine skier.

Before you go on a ski or snowboard holiday, it’s a good idea to do different types of conditioning exercises to prepare your body for long days on the slopes.

Endurance exercises, particularly those with an aerobic component, can help train the muscles so that fatigue doesn’t result in an injury at the end of a full day of skiing, Laskowski said in a clinic news release.

Strength training that focuses on the major leg-muscle groups, especially those used in skiing, can help you stabilize and control your body while skiing.

It’s also a good idea to do core exercises to help link your upper and lower body movements, as well as balance exercises that emphasize stability, Laskowski said.

He suggested ski-specific exercises that help you prepare for the side-to-side motions used on the slopes. For example, try jumping from side to side over a line of tape on the floor, using both feet and then using one foot at a time.

More information

The American Academy of Orthopaedic Surgeons has more about skiing injury prevention.

SATURDAY, Jan. 21 (HealthDay News) — Talking on a cellphone or texting while walking slows you down and makes it difficult to walk in a straight line, researchers report.

Their preliminary research included 33 men and women in their 20s whose walking abilities were tested when they weren’t using a mobile device and when they were talking on a cellphone or texting.

The participants’ walking speeds were 33 percent slower while texting and 16 percent slower while talking on a cellphone. In addition, texting resulted in a 61 percent increase in lateral (side-to-side) deviation while walking, which added to total travel distance, the Stony Brook University researchers found.

The findings, published in the Jan. 5 online edition of the journal Gait & Posture, suggest that cellphone use and texting affect the working memory in areas of the brain that control executive function and attention and are necessary for walking, said study co-author Eric Lamberg, in a university news release.

“We are using the findings to help physical therapy patients improve true functional walking while making them aware that some tasks may affect their gait and/or certain aspects of memory recall,” noted Lamberg, a clinical associate professor in the physical therapy department at the School of Health Technology and Management.

Using a cellphone while walking reflects a “real-world” activity that recovering patients are likely to engage in early in their recovery process, he explained.

More information

The American College of Emergency Physicians has more about the hazards of texting while on the move.

FRIDAY, Jan. 20 (HealthDay News) — In too many cases, doctors aren’t doing a good job of informing American women with early stage breast cancer about the disease or their options in terms of surgery, a new study suggests.

In the study, researchers at the University of North Carolina surveyed breast cancer survivors on their knowledge of the disease. Respondents typically answered only about half of the questions correctly, and less than half said their surgeons had even asked them about their personal preference for surgery — a full mastectomy vs. breast-conserving lumpectomy — prior to treatment.

“We found that breast cancer survivors had fairly major gaps in their knowledge about their surgical options, including about the implications for recurrence and survival,” said study lead author Dr. Clara Lee, an associate professor of surgery and director of surgical research at the University of North Carolina School of Medicine in Chapel Hill.

The paper was published in the January issue of the Journal of the American College of Surgeons.

For the study, Lee and her colleagues sent surveys to 746 women who had undergone surgery for stage one or stage two breast cancer at one of four medical centers: the Dana-Farber Cancer Institute and the Massachusetts General Hospital in Boston; the University of California, San Francisco; and the University of North Carolina, Chapel Hill.

Among the 440 patients who responded to the survey, less than half (about 46 percent) knew that local recurrence risk is higher after breast-conserving surgery (lumpectomy) than after mastectomy, and only about 56 percent of women knew that survival rates are equivalent for both options.

The study also revealed that women who said they preferred mastectomy were less likely to have treatment that was in accordance with their goals. Lee said this was probably because “patients reported that their doctors were more likely to discuss breast conservation therapy and its advantages than mastectomy. And many women did not recall being asked for their preference. We know from other studies that doctors don’t always know their patients’ personal preferences, so they may not be fully aware when a woman truly prefers mastectomy.”

The fact that less than half (48.6 percent) of the patients recalled being asked their preference was particularly concerning to Lee.

“It would be one thing if we were talking about decisions for which there is clearly a superior treatment, such as treatment for an inflamed gallbladder,” Lee said. “In this case, it’s reasonable and actually better for the surgeon to make a recommendation. But here we’re talking about a decision where there is no medically right answer, and it really depends on the patient’s preference. In that situation, it makes sense to ask the patient what she prefers.”

Another breast cancer surgeon cautioned that the retrospective nature of the study (asking women to recall past events) and the fact that the women filled out the surveys an average of two and a half years following surgery makes it hard to draw firm conclusions.

“Clearly there are deficits in knowledge, but what we don’t know for sure is if that’s because the surgeon failed to convey this information, or the surgeon failed to convey it in a way that the patient could understand, or the patient has simply forgotten,” said Dr. Leslie Montgomery, chief of breast surgery at Montefiore Medical Center in New York City.

“If anything, I’m actually surprised that the numbers were as good as they were,” Montgomery added. “There’s often a big difference between what a woman is told and what she actually absorbs at a time when she is so emotionally distressed.”

Montgomery believes the study is valuable, however, because it “helps identify the scope of the problem” and will be useful for designing future prospective trials.

“As surgeons, we really need to make sure we convey the proper information to a woman at what is probably one of the most stressful times in her life,” Montgomery said.

More information

Find out more about surgical options for treating breast cancer at the American Cancer Society.

THURSDAY, Jan. 19 (HealthDay News) — A new medical review finds that lithium, a common treatment for bipolar disorder, can lead to weight gain and causes high rates of abnormalities in the thyroid and parathyroid glands.

But the researchers found few signs of a link to skin problems or hair loss, and a suspected connection to birth defects hasn’t been proven, according to the report published in the Jan. 20 online edition of The Lancet.

Overall, the findings reaffirm lithium’s role as “a treatment of choice for bipolar disorder,” two doctors wrote in an accompanying editorial.

While lithium is less popular than it was in the 1970s and ’80s as a treatment for bipolar disorder, it’s probably the most effective available mood stabilizer, said Dr. Bryan Bruno, acting chairman of the department of psychiatry at Lenox Hill Hospital in New York City, who was not involved with the review but is familiar with the findings.

“It remains very beneficial, and it’s still a first-line agent for bipolar disorder,” Bruno said.

But lithium has a variety of possible side effects, noted the authors of the review, led by Dr. John Geddes of the University of Oxford, Warneford Hospital in Oxford, England. Their analysis included 385 studies.

The review found that lithium can cause weight gain, slightly hinder the kidneys’ ability to concentrate urine, and cause increased activity of the thyroid and parathyroid glands.

Geddes and his colleagues suggest that doctors talk about the possible side effects with patients and add a blood calcium test to the testing regimen to check for possible hyperparathyroidism.

Bruno said the information about hyperparathyroidism is new, and added that he’s likely to order the relevant test more often.

Dr. Michael Berk, a professor of psychiatry at Deakin University in Australia and a co-author of an accompanying commentary in the journal, said that lithium “is still widely used, but perhaps not as widely used as it should be.”

Commenting on the review, he stated: “While lithium has potential side effects, these can be managed by understanding and anticipating them, in order to maximize the benefits and minimize the risks.”

More information

For more about lithium, visit the National Alliance on Mental Illness.

WEDNESDAY, Jan. 18 (HealthDay News) — New research suggests that older women who’ve had a normal result on a bone density scan — a test that helps measure the strength of their bones — may be able to wait as long as 15 years before getting another scan.

However, women who show any abnormal loss of bone generally need follow-up scans much sooner than that, the study authors noted.

“Women who had good T-scores, who were in the top category, had such stable bones. It took about 15 years for 10 percent of them to develop osteoporosis,” said study author Dr. Margaret Gourlay, an assistant professor in the department of family medicine at the University of North Carolina at Chapel Hill.

“But, if you start off with thinner bones, it takes less time to develop osteoporosis,” said Gourlay.

T-scores are a measure of bone health, where current bone scans are compared to the expected bone density of a healthy 30-year-old. Women with osteoporosis have a T-score of -2.5 or less, while those in the normal bone group have a T-score of -1.00 or higher.

Results of the study, which was funded by a grant from the U.S. National Institutes of Health, are published in the Jan. 19 issue of the New England Journal of Medicine.

There are clear guidelines advising most women have a bone mineral density test to measure the strength of her bones around age 65. Women who have a high risk of developing osteoporosis are advised to get their first bone scan even earlier. What hasn’t been clear, however, is what the ideal time for follow-up scans should be.

“Medicare allows for repeat testing every two years, but if you have a normal bone density at 65, you don’t necessarily need a repeat bone density scan every two years,” said Dr. Stephen Honig, director of the osteoporosis center at NYU Langone Medical Center in New York City.

Gourlay said the current study was an attempt to better define how often women should receive follow-up scans.

The study included nearly 5,000 women aged 67 and older who had normal bone mineral density or osteopenia (lower than normal bone mineral density, but not yet osteoporosis). The women also had no history of hip or spine fractures, and they had never received treatment for osteoporosis.

Follow-up bone mineral density scans were offered at year 2, 6, 8, 10 and 16, according to the study. All of the women were tested at least twice during the follow-up period, and some women received as many as five follow-up scans.

Based on the women’s T-scores, the researchers estimated the number of years it would take 10 percent of the women to develop osteoporosis. For high-risk women with advanced osteopenia and T-scores of -2.49 to -2.00, the estimated time was 1.1 years. For the moderate group with T-scores of -1.99 to -1.50, the estimated time was five years.

And, for women with normal scores or moderate osteopenia (T-scores of -1.49 and higher), the time for 10 percent of the group to develop osteoporosis was more than 15 years.

“I wouldn’t want to go so far as to say this [15 years] should be the screening interval. It’s a long time, and some women may transition faster, but this is definitely something that needs to be re-addressed,” said Gourlay.

“Women should talk with their doctor about this test. It’s a test that sometimes gets forgotten, but it’s important because treatment for osteoporosis can decrease the risk of fractures,” noted Gourlay.

Honig added: “If someone has a normal bone density at age 65 or 67 and they haven’t had a fracture, they don’t need to do bone mineral density testing every two years. Could they stretch it out to 15 years? I don’t know. I think maybe five or six years.”

But, like Gourlay, Honig said it’s very important to have a discussion with your doctor about your own individual risk. Certain factors, such as a family history or a petite frame, may put you at a greater risk of osteoporosis, and more frequent scans might be warranted.

More information

Learn more about bone mineral density testing from the U.S. National Library of Medicine.

WEDNESDAY, Jan. 18 (HealthDay News) — Antidepressants called selective serotonin reuptake inhibitors (SSRIs) are associated with an increased risk of falls in nursing home residents with dementia, a new study finds.

Researchers in the Netherlands analyzed data about daily prescription medicine use and falls among 248 nursing home residents with dementia. The dataset collected between Jan. 1, 2006 and Jan. 1, 2008 included 85,074 person-days.

Antidepressants were used on 13,729 days (16 percent), with SSRIs used on 11,105 of these days, the investigators found.

A total of 683 falls were experienced by 152 (61.5 percent) of the 248 nursing home residents, which works out to fall incidence of 2.9 falls per person-year. Thirty-eight residents had one fall but 114 had frequent falls.

Injury or death resulted from 220 of the falls: 10 were hip fractures, 11 were other types of fractures, and 198 were injuries such as sprains, bruises, swelling and open wounds. One person died after falling, according to the results.

The researchers found that the risk of having an injury-causing fall was three times higher for residents taking SSRIs than for those who didn’t take the antidepressants. For example, the absolute daily risk of a fall was 0.28 percent for an 80-year-old woman taking a daily dose of an SSRI, compared with 0.09 percent for a woman the same age who didn’t take an SSRI.

Similar increases in risk were found for both women and men of different ages, according to the study published Jan. 19 in the British Journal of Clinical Pharmacology.

“Our study also discovered that the risk of an injurious fall increased even more if the residents were also given hypnotic or sedative drugs as sleeping pills,” lead author Carolyn Shanty Sterke, who works in the section of geriatric medicine at Erasmus University Medical Center in Rotterdam, said in a journal news release.

Falls are a major issue for nursing home residents with dementia, and one-third of falls among nursing home residents result in an injury, the study authors noted.

“Staff in residential homes are always concerned about reducing the chance of people falling and I think we should consider developing new treatment protocols that take into account the increased risk of falling that occurs when you give people SSRIs,” Sterke said in the news release.

While the study uncovered an association between injury-causing falls and SSRI use, it did not prove a cause-and-effect relationship.

More information

The U.S. Centers for Disease Control and Prevention has more about falls in nursing homes.

WEDNESDAY, Jan. 18 (HealthDay News) — Could this be the flu season that wasn’t?

After the H1N1-linked drama of prior years, the low number of circumstances of influenza at the moment circulating in the United States is reassuring, experts stated.

But that does not mean the virus couldn’t nonetheless turn into the wily foe it so frequently is, they added.

“If you appear at the nation as a whole, we are seeing low activity across the country,” said Tom Skinner, a spokesman for the U.S. Centers for Disease Manage and Prevention in Atlanta. He stressed, nevertheless, that flu season generally peaks in the initial couple of months of the year.

“As we move to February, we anticipate that activity will improve,” Skinner added.

Well being-care providers across the country echoed those findings.

On the East Coast, all has been relatively quiet. “The activity is pretty low right here,” stated Dr. Len Horovitz, a pulmonary specialist with Lenox Hill Hospital in New York City.

And out West, the same scenario holds correct. “Definitely in the Southwest, it does not seem that activity has been high,” stated Angela Golden, president-elect of the American Academy of Nurse Practitioners. “Even in the urgent care [setting] we’re not seeing a whole lot.”

But Golden, who is based in northern Arizona, added that the season could just be kicking into gear a tiny later than usual.

According to the CDC, by the finish of the first week of January there was a slight uptick in flu activity, but it was still was deemed low. Flu incidence was deemed “minimal” across 48 states, and even though Colorado and New Hampshire showed slightly higher rates of illness than other states, it wasn’t much much more, CDC tracking data indicated.

A single barometer of flu activity, the percentage of visits to hospitals or doctors’ offices linked to influenza, also suggests a mild season so far. For example, just 1.four percent of outpatient visits during the week ending Jan. 7 had been for flu, the CDC mentioned, compared to a seasonal typical (more than the past three years) of two.4 percent. And just one in every 200,000 individuals had flu so severe that it needed hospitalization, the CDC added.

The very best news of all could come from statistics regarding young children, who are particularly vulnerable to the flu. According to the CDC, no young children in the United States have died from the flu so far, compared to the 4 pediatric flu-linked deaths that had already been reported by Jan. 1, 2011.

Still, specialists stressed that the influenza virus’s behavior is notoriously unpredictable, so current activity can’t be relied on to predict the rest of the season. Nevertheless, there are some encouraging signs.

The strains becoming noticed this year don’t appear especially virulent and are nicely-matched with this season’s vaccine. “That is great,” Skinner stated. And the samples that have been tested are also apparently responsive to the antiviral medications Tamiflu (oseltamivir) and Relenza (zanamivir).

Only a modest minority of samples (about three.4 percent) are the H1N1 “swine flu,” which 1st appeared in the spring of 2009. Horovitz also believes that this year’s low level of flu activity may be due to much more people getting vaccinated — he mentioned that his own practice is close to running out of vaccine, when normally he’d have a lot left more than.

Professionals cannot know for certain that widespread vaccination is playing a function, Golden mentioned, but “it’s not too late to get the vaccine if you haven’t already accomplished so.”

Skinner agreed. “The bottom line is that vaccination continues to be the single most essential thing folks can do to protect themselves from flu,” he mentioned.

Much more info

Come across out much more about influenza at the U.S. Centers for Illness Control and Prevention.