If Toilet Training Is Trying, Maybe It’s Just Too Early
Learning to use the potty is a demanding challenge for a toddler. It requires a range of skills that don’t all develop at once. Nor are the skills acquired as early as many experts thought. New research shows that most children aren’t ready to move from diapers to training pants until after the child’s second birthday, or about six months later than is often recommended. The study, published in Pediatrics, the journal of the American Academy of Pediatrics, should reassure many parents who are frustrated by their toddler’s apparent lack of progress.
For the first time, researchers have pinpointed 11 “readiness skills” needed for toilet training, and they have learned about some specific differences between the sexes. For girls, the first skill learned is usually controlling their bowels all night. The average age for this milestone in the 126 girls studied was 22.1 months. For boys, the earliest skill acquired is understanding “potty words.” Among the 141 boys studied, the average age for learning the lingo was 24.5 months, which is later than it is mastered by girls.
With few exceptions, girls achieve all the toilet training skills earlier than boys. But new data suggest that boys and girls take the same amount of time to accomplish toilet training. “Girls just start earlier,” says researcher Timothy R. Schum, associate professor of pediatrics at the Medical College of Wisconsin in Milwaukee.
Most kids are ready to begin toilet training between 24 and 30 months, he says.
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Antidepressant Trials May Not Reflect Real World
When a doctor gives you a prescription, the assumption is that the drug has been proved to work in people similar to you. But this is often not true of antidepressants, concludes a study in the American Journal of Psychiatry. Clinical trials of antidepressants have such stringent criteria for those on whom the drugs are tested that researchers believe the results may not apply to many depressed people in the real world.
The people who participate in drug studies are moderately to severely depressed, whereas those who are prescribed antidepressants represent a range of depression, including mild forms of the disorder, says researcher Mark Zimmerman, associate professor of psychiatry and human behavior at Brown University in Providence, R.I. Most of the studies also fail the reality check by excluding people with a history of drug or alcohol abuse. And several exclude those with eating or anxiety disorders. These problems often accompany depression, says Zimmerman.
Zimmerman and his colleagues reviewed the standards used to include and exclude study subjects in 31 antidepressant trials. Then they applied the most commonly used criteria to 364 patients treated for depression at Providence’s Rhode Island Hospital. About 85% of them failed to meet the criteria and would not have qualified for an antidepressant trial. Yet 90% of those whose medical charts were available had been prescribed antidepressants by psychiatrists.
Showing that drugs help a select group of people with depression doesn’t mean they will be any better than a placebo for people with a milder form of the condition or whose illness is complicated by other problems, says Zimmerman. “And if these drugs aren’t working better than placebo, then the people taking them are potentially being exposed to side effects unnecessarily.”
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Severe Sweating Condition May Have Genetic Cause
People who perspire uncontrollably are often too embarrassed by their condition to admit it to anyone, including their doctors. We’re not talking about an occasional nervous sweat, but rather sweating nearly all the time--a condition known as hyperhidrosis. Now that researchers at UCLA have found that the syndrome runs in families, they hope people understand their problem is a medical one that they’ve probably inherited and so will be more willing to seek treatment.
The researchers investigated the family histories of 49 people with hyperhidrosis, and their systematic review was published in the Journal of Vascular Surgery. The study revealed a genetic pattern. Children of people who sweat too much have a one-in-four chance of having the problem. A parent of a child with hyperhidrosis has a one-in-10 chance of having it.
Samuel S. Ahn, director of UCLA’s Endovascular Program, estimates that as much as 5% of the population has hyperhidrosis--not 1%, as was previously thought.
For now, surgery to snip the nerve that triggers palm sweating is 100% effective. But Ahn, who is a pioneer of the technique, hopes that one day gene therapy will offer an easier cure.
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Study Shows Herb Can Be Effective Against Impotence
Yohimbine, an herb believed to be helpful for impotence, hasn’t been entirely replaced by Viagra. Web sites are devoted to it, and supplements are sold at convenience stores. Still, controversy surrounds the natural remedy.
The American Urological Assn. says yohimbine isn’t effective and shouldn’t be recommended to treat erectile dysfunction. But the authors of a study published recently in the Internal Journal of Impotence Research beg to differ. “Our data suggest that yohimbine treatment should be revisited,” they said.
A decade ago, yohimbine proved helpful for psychologically caused impotence, but it didn’t seem effective when the problem was organic, meaning caused by a health problem or a medication. According to researcher Andre T. Guay, director of the Center for Sexual Function at the Lahey Clinic Northshore in Peabody, Mass., the problem with the earlier studies was that they included smokers. More recently, smoking has been identified as a risk factor for impotence. So the Lahey Clinic researchers decided to investigate yohimbine in nonsmokers.
Only 18 40- to 80-year-old men with organic impotence were included in this research, but measurements of the drug’s effects on them was objective and precise. The men allowed themselves to be tested with instruments that measured their nighttime erections on several occasions at home. They also completed detailed questionnaires and kept a log of their sexual activity. They took 5.4 mg of prescription yohimbine three times a day for four weeks. Then the dose was doubled for four weeks.
Half of the men responded and half didn’t, but in those who did, improvement was significant. They were able to have intercourse more than 75% of the time they tried. By definition, those with erectile dysfunction fail half the time, says Guay.
According to Guay, the drug had negligible side effects. Now, he says, research comparing yohimbine to placebo in nonsmokers needs to be done.
Yohimbine may turn out to be best for men with mild impotence and few health risk factors, the Lahey clinic team reports. It might also be useful in combination with drugs that don’t quite do the trick alone. Yohimbine is different from the over-the-counter type, sometimes called yohimbe. “Those sold without a prescription are usually an extract or an alkaloid, and there’s no way of knowing how much of the active ingredient you’re actually getting,” Guay says.
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Two Nutrients Show Anti-Aging Promise in Early Studies
Have you had your L-carnitine today? What about your alpha-lipoic acid? If you didn’t, you could be missing out on nutrients that may make you feel more energetic, maybe even younger. At least that is what animal experiments are beginning to show.
When L-carnitine and alpha-lipoic acid were added to the food and water fed to old laboratory rats for a month, they had more energy and scored higher on memory tests than rats that didn’t get the pick-me-ups. According to three studies recently published in the Proceedings of the National Academy of Sciences, the animals on the experimental diets were peppier, and their memory and ability to learn, pay attention and explore were improved. Now studies are underway to see if supplements of the nutrients also help rats live longer.
“What happens to old rats may not happen to old humans,” says the studies’ author, Bruce N. Ames. Still, he’s encouraged enough to have initiated human clinical trials using natural lipoic acid and L-carnitine.
As the body ages, hundreds of each cell’s energy factories, or mitochondria, slow down, explains Ames, who is professor of molecular and cell biology at UC Berkeley. The two nutrients he studied appear to jump-start these cellular power plants. Alpha-lipoic acid, which is an antioxidant, gets rid of the destructive free radicals. And L-carnitine boosts the activity of a particular enzyme essential to the mitochondria. Restoring youth to the mitochondria increases the cell’s metabolism, and it produces even more of its own anti-aging antioxidants.
Ames believes it’s very difficult for people to consume enough of these micronutrients in their diets, but he isn’t recommending health food store supplements just yet. For one thing, he says, they contain a synthetic mixture of lipoic acid, only half of which is active. UC Berkeley has a patent on a supplement that combines natural alpha-lipoic acid and L-carnitine. One clinical trial of the pill has been completed, though the results have not yet been analyzed, and two other studies are planned.
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Dianne Partie Lange can be reached by e-mail at DianneLange@cs.com.
