Penn Elm Medical Group
488 E. Valley Parkway
Suite 411
Escondido, CA 92025
(760) 745-2000

NEWSLETTER: MAY 2006

• The Bedbug, a Pestilence of the Night, Is Back and Biting
• Sleep Deprivation Starts With Preschoolers
• How Sweet It Is Dulls Pain For Some Kids
• Erectile Dysfunction a Sign of Looming Heart Risks
• Staff News
• New Physician, Dr. Veronica Reyes
• Blue Cross HMO and PPO Now Accepted at Penn Elm

NEWS YOU CAN USE
The Bedbug, a Pestilence of the Night, Is Back and Biting
GAINESVILLE, FL— For centuries, parents have told their children: "Sleep tight, don't let the bedbugs bite." But for several generations, the kids have had no idea what a bedbug might be. That's because, experts say, the common bedbug—Cimex lectularius—has been pretty much eliminated in the U.S. since the middle of the last century.

"People just don't know what they are," says Cindy Mannes, a vice-president of the National Pest Management Association. But now the critters are making a comeback, Mannes says. For instance, the New York Times reported recently that more and more people in the Big Apple, even living on tony Park Avenue, are appalled to find bedbugs amongst them.

But the problem is not just confined to the big cities or the eastern seaboard, Mannes says. "They're from coast to coast," she says. Bedbugs are also making a recurrence in the United Kingdom and Australia. And a study earlier this year in the journal Emerging Infectious Diseases noted that they're becoming more common in homes.

The common bedbug is a wingless, red-brown, blood-sucking insect, whose preferred source of blood is humans, although there have been reports that they can live off other mammals. A bedbug grows up to a quarter-inch in length and can live up to a year. The bugs hide in cracks and crevices during the daytime and come out at night to feed.

The good news is that they don't spread disease, said Phil Koehler, Ph.D., an entomologist at the University of Florida and an expert on bedbug infestations. After they've sucked your blood, Dr. Koehler said, they tend to sleep for a week or 10 days—long enough for most disease organisms to die—and there have been no documented reports of disease being spread by the insects. "So you're relatively safe (from disease)," he said. On the other hand, he noted, there have been several reports of allergic and dermatological reactions to the saliva the bugs inject when they chow down. For instance, a case report last year in the journal Pediatric Dermatology linked a recurrent itchy eruption of red bumps on the face, neck, arms, and legs of a child to a bedbug infestation in the home.

But the real menace of bedbugs, Dr. Koehler said, is that they're 'creepy.' "When you're sleeping in your own bed, and you're senseless, they come out and take a blood meal," he says. "That's creepy...There's a major yuck factor here."

The recurrence of the common bedbug is spurred by two factors—increasing international travel and changes in the way household pests are controlled. "The bedbug is a great hitchhiker," says Mannes, and the initial port of call for the critters was high-end hotels and fancy resorts which attracted travelers from places where bedbugs are endemic. "It's not a cleanliness issue," she adds, noting that such hotels were just taken by surprise. "The problem is that these things are extraordinarily hard to control" once they get established, says Dr. Koehler. For instance, he said, he recently accompanied a pest control specialist to an infested motel room. The specialist estimated it would take seven hours to treat the room, and might require multiple visits. "You can imagine a house would be much worse than that," Dr. Koehler said.

On the other hand, said Mannes, the bugs can be controlled—it's just that today's targeted pest control approaches are less wide-ranging than before. So, for instance, if a homeowner has ants, the pest control specialist will target ants, but any bedbugs in the house won't be affected, unlike earlier pest control efforts with chemicals such as DDT that killed pretty much everything. Also, unlike the cockroach, the bedbug has no sticky pads on its feet to pick up pesticides as it walks around, and it doesn't chew baits because its mouthparts are specialized to suck human blood. "You have to hit them directly," he said, with a spray of pesticide, and that means finding them in whatever nook or cranny they're hiding in.

The old nursery rhyme suggests that if the bedbugs do bite, the kids should "hold them tight—they won't come back another night." Unfortunately, the experts say, they're likely to have friends who will come back.

Sleep Deprivation Starts With Preschoolers
PROVIDENCE, RI— Preschoolers are getting short-changed on their sleep, just like their older siblings and their parents, according to researchers here. When 169 children ages one to five were studied, they were found to have slept an average of 8.7 hours per night and about 9.5 hours total when naps were included. This is much less than the recommended 12 to 15 hours per day, said Christine Acebo, Ph.D., of Brown Medical School in a study published in the December issue of the journal Sleep.

The children, about half boys, wore activity monitors on their ankles or wrists to record their sleep for one week, and mothers also chronicled their children's sleep habits in detailed diaries during this time. The shortest individual mean nocturnal sleep time was 7 hours for a 12-month-old girl, and the longest was 10.4 hours for a 30-month-old girl. Sleep time was not affected by sex, and, other than a dip between those aged 18 months and those aged 24 months, did not appear to be linked to age.

Time spent napping declined sharply with age, with mothers reporting naps averaging 2.5 hours for one-year-olds but only 30 minutes for the 43% of five-year-olds who still napped. Children who took longer naps tended to sleep less at night and awaken earlier than those who took shorter naps. However, only four- and five-year-old nappers slept less during the night compared with their non-napping counterparts.

The researchers speculated that because adults sleep less because of fast-paced lifestyles, they may be transferring their sleep habits to their children, unaware of their children's sleep requirements. They also noted that lack of proper sleep in older children and adults has been shown to be linked to lower academic performance and reduced cognitive functioning during the day.

"We are concerned that the problem of too little sleep extends even to the youngest members of families, though we do not know if this puts them at risk for problems down the line," Dr. Acebo said. However, she added, "I think based on what we know in older children, teens, and adults, it's fair to speculate that insufficient sleep in children would be related to difficulties—although this is an area that's been little studied for decades."

How Sweet It Is Dulls Pain For Some Kids
Normal-weight kids with a sweet tooth find that a sugary solution held in the mouth takes the edge off pain. Yet the pain-killing effects of sucrose appear to be lost on overweight kids, on children who don't care for the sweet stuff, and on adults.

In a study published in the Dec. 15 issue of the journal Pain, investigators found that normal-weight young fans of candy and other sweets who put their hands into a bucket of frigid water can tolerate the pain longer when they've got a mouth full of sugar. The findings suggest that for children—but not for adults—the ability of sugar to take the edge off of pain is related to their preference for sweet tastes and their weight, according to M. Yanina Pepino, Ph.D., and Julie Mennella, Ph.D., of the Monell Chemical Senses Center. "This intriguing finding may reflect differences in brain chemistry systems," Dr. Mennella said. "Additional studies clearly are needed to evaluate how dietary habits and individual differences contribute to preference for sweet taste in children and its physiological consequences."

The analgesic properties of sugar-sucrose in infancy have been well documented. Babies in pain quiet down quicker when sugar water is placed on their tongues rather than plain water. Yet little is known about whether the pain-numbing effects of sugar can still be seen in older children or adults, or whether sugar's effectiveness as an analgesic varies from one person to the next. "Because individual variations in sweet preferences exist at both ends of the age spectrum, the present study tested the hypothesis that sucrose would be more effective in reducing pain in those who prefer sweet tastes," the authors wrote.

They recruited 242 children from the ages of five to 10 years and their mothers to take part in a study to determine the preferred level of sweetness and how effective sucrose was at alleviating pain associated with a standard but harmless pain test (cold pressor test). The subjects were first tested for their sweetness preferences by giving them solutions with various concentrations of sucrose. In a separate session, they were asked to place their hands into a body-temperature bath for two minutes, then transfer them to a cold-water bath (50 degrees F) and keep them there for as long as they could tolerate it. Thirty seconds before transferring their hands to chilly water, the subjects were given either a 24% weight by volume sucrose solution at room temperature or water to hold in their mouths without swallowing. The 24% solution was chosen because it has been to be an effective pain killer for day-old infants, the investigators said.

The study outcome measures were pain thresholds, defined as the time to first indication of discomfort, and pain tolerance, determined by the length of time the hand was kept submerged in frigid water. The authors found that children as a group preferred significantly higher sucrose concentrations than did adults, but with enough individual differences to allow grouping into sweet and less-sweet groups. Sugar was not effective as an analgesic among the mothers, regardless of their preferences for degree of sweetness.

In contrast, "the more children liked sucrose, the better its efficacy as an analgesic," the authors wrote. "That is, children who preferred >24% weight by volume sucrose exhibited an increased latency to report pain and tolerated pain for significantly longer periods of time when sucrose was held in their mouths relative to water." They also found that among the group of kids who liked sweeter tastes, sucrose significantly increased pain thresholds for those in the normal weight range, but not for kids who were overweight or at risk for being overweight (based on CDC pediatric growth charts).

Although sugar's analgesic mechanism of action is not fully understood, there is clinical evidence to suggest that it triggers endorphins, and perhaps that information could be used in future studies of pain perception and relief, the authors noted. "Children and adults differ with regard to a wide variety of differences, and future studies should identify variables that promote or impede the ability of sweet taste to act as an analgesic in both children and adults," Dr. Pepino said.

Erectile Dysfunction a Sign of Looming Heart Risks
SAN ANTONIO, TX—Erectile dysfunction is an early sign of cardiovascular troubles down the road, such as a stroke or heart attack, researchers here reported. The finding comes from an analysis of men, aged 55 and older, in the Prostate Cancer Prevention Trial, a prospective, randomized, blinded study that compared Proscar (finasteride) with placebo over a seven-year period, according to Ian Thompson, M.D., of the University of Texas Health Science Center.

Because of concerns about the effect of the study drug on sexual function, the trial researchers tracked erectile dysfunction throughout the seven-year study, Dr. Thompson and colleagues report in the Dec. 21 issue of the Journal of the American Medical Association. Men in the study were also evaluated every three months for cardiovascular disease, as part of the study's safety monitoring.

Analyzing the 9,457 men randomly assigned to placebo yielded "the first evidence, to our knowledge, of a strong association between erectile dysfunction and subsequent development of clinical cardiovascular events," Dr. Thompson and colleagues wrote. Previous studies have suggested the link, they wrote, but did not prospectively monitor a population of asymptomatic, healthy men for the development first of erectile dysfunction and then of cardiovascular events. "Erectile dysfunction is a harbinger of cardiovascular clinical events in some men," they concluded. When men present with erectile dysfunction, Dr. Thompson and colleagues said, physicians should undertake "diligent observation" with a view to intervention for cardiovascular risk factors.

For this analysis, the researchers found that, of the nearly 9,500 men in the placebo arm of the study:

• 85% (or 8,063) had no cardiovascular disease at the start of the study.
• Of those, 47% (or 3,816) reported some level of erectile dysfunction at baseline.
• Of the 4,247 men with no baseline erectile dysfunction, 57% had developed it by five years and 65% by seven years.

Such a high degree of erectile dysfunction, both at baseline and later, may seem surprising, Dr. Thompson and colleagues say, but similar findings have been previously reported. The Massachusetts Male Aging Study reported in 1994 that, in a group of men ages 40 to 70, the probability of impotence was 52% and the rate tripled between 40 and 70, they noted. The study raises several questions, the researchers noted, including:

• Do cardioprotective interventions aimed at aging men reduce or delay onset of erectile dysfunction?
• Could the degree of erectile dysfunction serve as a surrogate measure of the efficacy of preventive interventions in cardiac disease?

WHAT'S NEW AT PENN ELM
Staff News
Penn Elm will honor our great staff and physicians in May with a picnic for them and their families. The highlight will be a physician/staff softball game.

ANNOUNCEMENTS
New Physician, Dr. Veronica Reyes
We are excited to announce that Penn Elm will soon bring on a new physician, Dr. Veronica Reyes, who plans to start with us in May. More information about Dr. Reyes will be in the next newsletter!

Blue Cross PPO Now Accepted at Penn Elm
As a reminder, Penn Elm now accepts Blue Cross PPO insurance plan.

 

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