A landmark comparison of three drugs widely used against the most common form of childhood epilepsy finds the oldest to be the most effective.

The study of 453 children at 32 U.S. medical centers found that ethosuximide (Zarontin), one of the oldest anti-seizure medications available in the United States, is most effective at controlling what is called absence or “petit mal” epilepsy, with the fewest side effects. Valproic acid (Valproate, Depakote) came second, and the newest drug, lamotrigine (Lamictal), was third, according to a report in the March 4 issue of the New England Journal of Medicine.

“This is the first real hard evidence of comparing the three most commonly used medicines, and finds one superior to the other two,” said trial leader Dr. Tracy A. Glauser, director of the Comprehensive Epilepsy Center at Cincinnati Children’s Hospital Medical Center.

About 1 percent of American children have epilepsy, Glauser said, and 10 percent of those have absence epilepsy, which causes the child to stare blankly into space for periods that may be as brief as five seconds. The bad news from the study, in which the children had frequent electroencephalograms to measure brain activity, is that they also often have problems with attention, Glauser said.

“The conventional wisdom has been that if you control the seizures, that is enough,” he said. “We found that about a third of them had attention problems when they started and that they continued. These kids need to have their seizures addressed, but also need further evaluation to have their attention problems addressed.”

The study included children aged 2.5 to 13 years, newly diagnosed with epilepsy and free of other problems, such as autism. They were randomly assigned to one of the three drugs. The study measured primarily whether they were free of seizures without intolerable side effects after 16 weeks, with a few children continuing for as long as 20 weeks. The study also measured how the drugs affected the children’s ability to pay attention.

Ethosuximide prevented seizures in 53 percent of the children, slightly less than the 58 percent freedom-from-failure rate of valproic acid but significantly better than the 29 percent for lamotrigine. But only 33 percent of those taking the older drug had significant attention problems, compared to 49 percent of those taking valproic acid, the researchers found.

So the treatment strategy indicated by the study — and now being followed in Cincinnati — is to start with ethosuximide, Glauser said. “If it hasn’t worked after four or five months, you need to switch medicines,” he said, with a trial of valproic acid. If that doesn’t work, either lamotrigine or a combination of drugs should be used. More than 90 percent of children respond to one of the regimens, Glauser added.

“It was somewhat unexpected that the oldest of the drugs had as good an effect as the other and better side effects,” said study participant Dr. Shlomo Shinnar, director of the Comprehensive Epilepsy Management Center at the Children’s Hospital of Montefiore Medical Center in New York City.

“The study highlights the importance of looking not only at seizure control but also how the child does otherwise,” Shinnar said. “You want seizure control without side effects, such as problems with attention and behavior.”

“Unfortunately, even our best medications work only half the time,” Glauser noted. “We need to develop better medications or better algorithms to match children with medicines better.”

But with proper treatment, most children with the condition “go on to lead good, fulfilling lives,” Glauser said.

U.S. researchers analyzed data from 39,765 men in the Health Professionals Follow-up Study and 157,463 women in the Nurses’ Health Study I and II. None of the participants had diabetes, heart disease or cancer at the start of the studies. Their consumption of brown and white rice, as well as other foods, was assessed every two to four years.

During 3.3 million person-years of follow-up, there were 10,507 incidents of type 2 diabetes. After adjusting for a number of dietary and lifestyle risk factors, the researchers found that people who ate five or more servings per week of white rice were 17 percent more likely to develop type 2 diabetes than those who ate less than one serving of white rice per month.

In contrast, people who ate two or more servings of brown rice per week were 11 percent less likely to develop type 2 diabetes than those who ate less than one serving of brown rice per month, the study authors reported.

“We estimated that replacing 50 grams/day intake of white rice with the same amount of brown rice was associated with a 16 percent lower risk of type 2 diabetes, whereas the same replacement with whole grains as a group was associated with a 36 percent lower diabetes risk,” wrote Dr. Qi Sun, of Harvard School of Public Health in Boston, and colleagues.

The study was to be presented Wednesday at the American Heart Association’s Nutrition, Physical Activity and Metabolism Conference in San Francisco.

In this prospective study of the relationship between happiness and heart disease, researchers concluded that if everyone did more of the things that made them happy, they could significantly reduce their risk of heart attack and angina.

“We were excited to discover in a large population-based sample of adults that the tendency to express positive emotion predicted fewer heart attacks across a period of 10 years,” said lead researcher Karina Davidson, director of Columbia’s Center for Behavioral Cardiovascular Health.

“The study suggests that those people who are happier have heart-protective outcomes,” she added.

Davidson speculated that several factors may combine to producing this effect. Happier people tend to sleep better and to practice more heart-healthy behaviors, she said.

“But they may also be physiologically different than those of us who are more unhappy,” Davidson said.

In addition, these people tend to have less stress in their lives and handle the stress they do have better than less happy people, she added.

The report is published in the Feb. 18 issue of the European Heart Journal.

For the study, Davidson’s team followed 1,739 men and women for 10 years. These people all participated in the 1995 Nova Scotia Health Survey. At the start of the study, everyone had their risk for heart disease assessed.

In addition, researchers looked for symptoms of depression, hostility, anxiety and the expression of positive emotions — known as “positive affect.” This is defined as the experience of pleasurable emotions, such as joy, happiness, excitement, enthusiasm and contentment, according to Davidson.

The researchers found that over the study period the happier someone was, the less likely he or she was to develop heart disease. In fact, for every point on a five-point scale that measured positive affect, the risk of heart disease dropped 22 percent.

However, unhappy people had a 22 percent increased risk of having a heart attack or chronic chest pain, compared with those who were somewhat happy. These somewhat happy people also had a 22 percent increased risk for heart problems compared with people who were moderately happy, the researchers noted.

People who were generally happy, but had a few symptoms of depression, did not see these symptoms increase their lowered risk for heart disease, Davidson added.

Davidson noted that she is involved in a clinical trial to test whether changing people’s happiness level improves their heart health.

“In the meantime, it is good for one’s quality of life and mental health to engage in happy behaviors or things that give you pleasure on a daily basis — and many of us here in North America don’t do that,” she said.

Dr. Gregg C. Fonarow, professor of cardiology at the University of California, Los Angeles and co-director of the UCLA Preventative Cardiology Program, said that “negative emotions such as depression, anxiety and anger have been shown to be associated with increased risk of cardiovascular events and mortality.”

Some, but not all previous studies, have suggested that positive affect is associated with lower risk of disease and improved clinical outcomes, he added.

“This new, large population-based study suggests that positive affect is associated with a reduced risk of coronary heart disease over 10 years independent of other cardiovascular risk factors and independent of depression and other negative affects,” Fonarow said.

“These findings are intriguing. The clinical significance will depend on whether it can be subsequently shown that interventions designed to increase positive affect can lower the risk of cardiovascular disease,” he added.

However, while maintaining a positive affect may be one factor associated with a lower risk of cardiovascular disease, regular exercise, not smoking, a healthy diet and maintaining optimal blood pressure, cholesterol levels and body weight are well-established and essential, Fonarow noted.

The good news is that for many of those children, their chronic childhood illness won’t persist. Just over 7 percent of those who reported a chronic condition at the beginning of the study still had the condition six years later.

“Over time, we found the rates of chronic conditions and obesity in U.S. children increased, but quite a few of these conditions resolved on their own,” said study author Dr. Jeanne Van Cleave, a pediatrician at MassGeneral Hospital for Children in Boston.

The findings are published in the Feb. 17 issue of the Journal of the American Medical Association.

A chronic health condition is one that lasts at least 12 months, according to the study. Some of the conditions included asthma, type 1 diabetes, type 2 diabetes, epilepsy, cystic fibrosis, heart problems, allergic conditions, learning disabilities, hyperactivity, sinus infections, ear infections and more. Obesity was defined as a body-mass index in the 95th percentile or higher for the child’s gender and age.

The researchers conducted the study using three different groups of children. The first cohort, which included 2,337 children, was interviewed during 1988 to 1994; the second, which included 1,759 children, was interviewed during 1994 to 2000 and the final group, which included 905 children, was interviewed from 2000 to 2006.

At the beginning of each period, the children were between the ages of 2 and 8; chronic conditions were confirmed by reports from parents.

At the end of each study, the prevalence of chronic illness or obesity was 12.8 percent in the first (earliest) group, 25 percent for the second group and 26.6 percent for the third (and most recent) group. The third group also had the highest prevalence of reporting a chronic condition at any time during the six-year study period, with 51.5 percent reporting a chronic condition at some point during the study.

The risk of having a chronic condition was higher for males, and for children who were black or Hispanic. Kids who had overweight mothers were far more likely to be overweight themselves, according to the study.

What surprised the authors, however, was that the chronic conditions weren’t always lasting. Overall, only 7.4 percent of the children who had a chronic condition at the start of the study still had that same condition at the end of the research period.

“We’ve always thought of chronic conditions as quite permanent, so these findings give a lot of hope for kids with chronic conditions and obesity,” said Van Cleave.

She said these findings also raise a number of research questions, as well as point to the need for good health care, including prevention and education services.

“It’s likely that a lot of these conditions resolved because families made lifestyle changes, such as eating healthier foods, reducing screen time and becoming more physically active,” she said.

“The burden of chronic disease in children is pretty high,” said Dr. Geetha Raghuveer, a cardiologist and an associate professor at Children’s Mercy Hospital in Kansas City, Mo.

Raghuveer said she isn’t sure how much of the fluctuation in chronic conditions is real, because they’re based on parental reports. “Some of the major issues here, like established childhood obesity, don’t fluctuate and go away in our experience without a rigorous attempt. Although it’s probably reassuring that at least some of these conditions may go away in time,” she said.

But the bottom line, she said, is that U.S. children need better health habits. “This is just another study emphasizing what many already knew. And, if we don’t eradicate the root causes, such as bad eating and little exercise, we’ll continue to see a lot more morbidity in children,” Raghuveer said.

“I’m seeing more and more kids with high cholesterol and insulin resistance that already have blood vessel damage in them. They’re already like a 45-year-old in terms of blood vessel health. We need a basic change in how we live and how we eat. Prevention is key,” she stressed.

University of Florida researchers surveyed more than 800 college-age patrons leaving bars between 10 p.m. and 3 a.m. The participants were asked about their energy drink and alcohol consumption and then had their breath-alcohol concentration levels measured.

The 6.5 percent of participants who said they’d been drinking alcohol mixed with energy drinks were three times more likely to be drunk than those who consumed alcohol only. The average breath-alcohol reading for those who consumed alcohol and energy drinks was 0.109, well above the legal limit of 0.08, the study authors noted.

The researchers also found that bar patrons who mixed alcohol and energy drinks left the bar later, drank for longer periods of time, and were four times more likely to say they planned to drive within the hour, compared to those who drank alcohol only, according to the report in the April issue of the journal Addictive Behaviors.

“There’s a very common misconception that if you drink caffeine with an alcoholic beverage the stimulant effect of the caffeine counteracts the depressant effect of the alcohol, and that is not true,” study co-author Bruce Goldberger, director of toxicology in the University of Florida College of Medicine, said in a news release from the school.

Caffeine simply reduces the sleepy feeling caused by alcohol. This condition, described as “wide awake and drunk,” can lead to risky behaviors, Goldberger explained.

It’s believed that as many as 28 percent of college drinkers consume alcohol mixed with energy drinks in a typical month.

“This study demonstrates that there definitely is reason for concern and more research is needed,” study author Dennis Thombs, an associate professor in the department of behavioral science and community health at the University of Florida College of Public Health and Health Professions, said in the news release.

“We don’t know what self-administered caffeine levels bar patrons are reaching, what are safe and unsafe levels of caffeine, and what regulations or policies should be implemented to better protect bar patrons or consumers in general,” Thombs added.

Their study included 50 teens, aged 14 to 18, with a body-mass index (BMI) higher than 35 (statistical obesity begins at a BMI of 30). Half underwent laparoscopic adjustable gastric banding while the other half took part in a supervised lifestyle intervention.

Gastric banding involves the placement of a band to divide and reduce the size of the stomach. It has proven effective in helping patients feel satiated earlier, spurring weight loss.

The study participants were followed for up to two years; 24 patients in the gastric banding group and 18 of those in the lifestyle group completed the study.

The target of losing more than 50 percent of excess weight was achieved by 84 percent of teens in the gastric banding group but by just 12 percent of those in the lifestyle group. After two years, those in the gastric banding group had lost an average of 76 pounds, representing an overall average loss of 28.3 percent of total body weight and 78.8 percent excess weight loss. The teens in the lifestyle group lost an average of 6.6 pounds, representing an average 3.1 percent total weight loss and 13.2 percent excess weight loss.

At the start of the study, 36 percent of teens in the gastric banding group and 40 percent of those in the lifestyle group had the metabolic syndrome, a cluster of symptoms that predispose people to heart disease. After two years, none of the patients in the gastric banding group had metabolic syndrome, compared with 22 percent of those in the lifestyle group.

The teens who had gastric banding typically experienced improved quality of life, but seven of them required follow-up surgery.

“In this study, gastric banding proved to be an effective intervention leading to a substantial and durable reduction in obesity and to better health,” wrote Dr. Paul E. O’Brien and colleagues at Monash University and the Centre for Adolescent Health, Royal Children’s Hospital, Melbourne.

They said that teens and parents “must understand the importance of careful adherence to recommended eating behaviors and of seeking early consultation if symptoms of reflux, heartburn or vomiting occur. As importantly, they should be in a setting in which they can maintain contact with health professionals who understand the process of care. This study indicates that, in such a setting, the laparoscopic adjustable gastric banding process can achieve important improvements in weight, health and quality of life in severely obese adolescents,” the researchers concluded.

“Our results suggest that decisions about feeding tubes are more about which hospital you go to than a decision-making process that really elicits and supports patient choice,” said Dr. Joan Teno, whose study appears in the Feb. 10 issue of the Journal of the American Medical Association. “We have good evidence from surveys with people in nursing homes and of family members of people with dementia that the majority would rather die than receive a feeding tube.”

According to prior research, more than one-third of U.S. nursing home residents with advanced dementia have feeding tubes. About two-thirds of these have the tube inserted during an acute-care hospitalization.

Teno and her colleagues looked at a sample of Medicare claims filed for nursing home residents who had been admitted to acute-care hospitals with advanced dementia between 2000 and 2007.

On average, feeding tubes were placed in 7.9 per 100 patients, with the variation ranging from 0 to 38.9 per 100 hospitalizations.

For-profit hospitals, along with facilities that had 310 beds or more and those that had the most use of intensive care during the last six months of a person’s life, were more likely to use feeding tubes.

Part of the reason for the differences probably has to do with the health-care system, said Teno, who is a professor of community health at the Warren Alpert Medical School of Brown University in Providence, R.I.

“We have really two separate financing systems for people who are in nursing homes,” she explained. “We have Medicaid that pays for custodial care and Medicare that pays for acute care, and these two systems don’t work with each other very well.”

Nursing homes have an incentive to send patients to hospitals, where someone else will pay for them and, as a result patients tend to be shuffled around.

“They often get very stressed out, have disruptive behavior, get medicines to treat that behavior, which leads them to developing bed sores and problems with eating, which leads to having a feeding tube inserted,” Teno said. “Part of what we need to do is align the incentives to keep frail older dementia patients in the least restrictive setting that will provide the best medical care.”

But much of the issue derives from lack of information or misinformation, as well as the sheer trauma of going through this process with a loved one.

For instance, many people are simply not aware that dementia is a terminal disease, as evidenced by a previous study that was published in October. “It is the fifth or sixth leading cause of death,” Teno said.

And often, no one has a clear idea of what the patient would have wanted.

“Feeding is obviously a very emotional issue for families and . . . families have difficulty at times not pursuing feeding tubes,” added Dr. Laurie Jacobs, vice chair of medicine at Montefiore Medical Center and Albert Einstein College of Medicine in New York City. “I don’t think that the message is out there strongly enough that this treatment is not of benefit and patients don’t live any longer, and treatment can impose quality-of-life issues on patients,” Jacobs explained.

“When I talk to families, I say that really our goals here are to focus on what I call ‘comfort feeding,’ trying to maintain interaction with the family member and only to feed the patient as long as it feels safe and comfortable, and not to be in a situation shoveling food down them to try to maintain their weight,” Teno said. “I have seen some really horrendous things happen, such as a tooth getting broken because an aide was trying to get food into the patient.”