August 2004

Research Capsules

Imagine Taking Your Medicine

A healthy dose of "imagination" helps older people remember to take medications and follow other medical advice, according to a new study supported by NIH's National Institute on Aging (NIA). Dr. Linda Liu of the University of Michigan and Dr. Denise Park of the University of Illinois at Urbana-Champaign found that older adults who spent a few minutes picturing how they would test their blood sugar were 50 percent more likely to actually do these tests on a regular basis than those who used other memory techniques.

"The best medical care in the world isn't much good if a patient can't or won't follow through," says Dr. Jeffrey Elias of the NIA's Behavioral and Social Research Program. "Creative approaches such as this one need to be explored further if we are to solve difficult medication adherence problems. The genius of this method is that it requires less conscious effort than other memory methods. So, it can be easily learned and applied."

For the study, Dr. Liu and Dr. Park taught 31 non-diabetic volunteers to do home blood glucose tests. The researchers chose people who didn't have diabetes in order to simulate the learning conditions faced by someone who is newly diagnosed with a disease. In addition, because the blood glucose monitors recorded time- and date-stamps each time a test was conducted, it allowed the researchers to collect very accurate data. The participants, ages 60 to 81, were randomly assigned to one of three groups and told to monitor their blood sugar levels four specific times daily. They were not allowed to use timers, alarms or other devices.

Those in the "imagination" intervention group spent one three-minute session visualizing exactly what they would be doing and where they would be the next day when they were scheduled to test their blood sugar levels. Those in the "rehearsal" group repeatedly recited aloud the instructions for testing their blood. Finally, those in the "deliberation" group were asked to write a list of pros and cons for testing blood sugar.

Over the next three weeks, participants in the "imagination" group remembered to test their blood sugar at the right times of the day 76 percent of the time, compared to an average of 46 percent in the other two groups. They were also far less likely to go an entire day without testing than those in the other two groups. Although the effects observed in this study were large, NIA scientists note, further studies will be need to be done to confirm the findings.

"Getting older people to remember to take their medications and conduct self-monitoring tests is a huge issue," Dr. Park says. "Although many strategies have been tried, none appears to be as potent or as simple as using one's own imagination. This study shows it's a powerful and incredibly inexpensive technique with potentially lasting effects."

Using this technique, you might, for example, imagine taking your pills right after you drink your morning glass of orange juice. The next day at breakfast, taking a sip of orange juice will "automatically" cue you to take your medication.

"It's not an explicit thought," Dr. Park explains. "It's not as if you think, 'Ah, ha! I remember to take my pills now.' It's more that the orange juice provides an unconscious prompt to, 'Take your meds, take your meds.'"

— Written by Doug Dollemore

Source: Psychology and Aging 19,2:318-325

For information and advice about following a medication regimen, see The NIH Word on Health story Taking Your Medicine at http://www.nih.gov/news/WordonHealth/apr2001/story01.htm.

Preventing Infections in the Home

Doing laundry using hot water and bleach may prevent infections in the home, while drinking only bottled water may promote infections, according to research funded by NIH's National Institute of Nursing Research (NINR) that looked at ways to predict infectious disease symptoms in inner city households.

Dr. Elaine Larson, associate dean for research at the School of Nursing at Columbia University, who led the study, said, "What is important is to identify which choices and habits actually help prevent disease, and which may either make no difference or actually promote disease."

The investigators closely monitored 238 households with almost 1,200 members in an inner city community in northern Manhattan composed mostly of Hispanics living primarily in large apartment buildings. The research team consisted of three bilingual physicians and a trained community worker. Each household received a weekly phone call, a monthly visit, and extensive home interviews every quarter during the 48-week study. A Home Hygiene Assessment Form designed by the team included questions about food preparation, sharing towels and toothbrushes and beliefs about germs. Also covered were questions about the incidence and type of infections experienced by household members. Responses ranged from fever and skin boils to diarrhea, vomiting and sore throats.

Using hot water for white laundry was found to reduce disease risk by about 30 percent. Bleach was also protective; those who reported using bleach at the beginning of the study had about one-fourth the infection rate of those who did not. Previous studies have shown that washing machines can be contaminated after use and transfer microbes to subsequent loads of laundry. Most washing machines are set at temperatures between 78-140 degrees Fahrenheit. This study found that a setting between 178-194 degrees Fahrenheit helps reduce the risk of infections (temperatures that high may not be appropriate for some clothing, however).

The researchers also found that drinking only bottled water was associated with a two-fold risk of infection. They noted that further studies need to look at whether the water was contaminated or whether the cause was more than one person drinking from the same bottle. The results of a body of studies of bottled water by other investigators — there are more than 600 brands — have been contradictory.

Interestingly, the research team found no difference in disease risk between products with and without antimicrobial ingredients, so antimicrobial products may have no protective effect.

Dr. Patricia A. Grady, director of NINR, commented, "We need to know more about our routine household hygiene and cleaning assumptions in order to be accurate in preventing infections. This is a key area for further research."

— Written by Lanny Newman

Source: Nursing Research 53, 3

For more information, read You Can Prevent Catching or Passing on Germs from NIH's National Institute of Allergy and Infectious Diseases (NIAID) at http://www.niaid.nih.gov/publications/microbes.htm#g. This is part of the comprehensive booklet MICROBES in Sickness and in Health, which is online at http://www.niaid.nih.gov/publications/microbes.htm. You can also call 301-496-5717, or write to:
NIAID Office of Communications & Public Liaison
6610 Rockledge Drive, MSC 6612
Bethesda, MD 20892-6612

Images of the Maturing Brain

The brain's center of reasoning and problem-solving is among the last to mature, a new study graphically reveals. A decade-long magnetic resonance imaging (MRI) study of normal brain development in people from ages four to 21 shows that the "higher-order" brain centers don't fully develop until young adulthood.

Researchers long believed that a spurt of overproduction of gray matter — the working tissue of the brain's cortex — during the first 18 months of life was followed by a steady decline as unused brain circuitry was discarded. Then, in the late 1990s, NIMH's Dr. Jay Giedd, a co-author of the current study, and his colleagues discovered a second wave of overproduction of gray matter just prior to puberty, followed by a second bout of "use-it-or-lose-it" pruning during the teen years.

In the new study, researchers at NIH's National Institute of Mental Health (NIMH) and the University of California Los Angeles (UCLA) scanned 13 healthy children and teens every two years for 10 years. After lining the scans up with each other using an intricate set of brain anatomical landmarks, they visualized the ebb and flow of gray matter in maps that, together, form a 3-D time-lapse movie that compresses 15 years of human brain maturation into seconds.

The new movie shows gray matter diminishing in a back-to-front wave, likely reflecting the pruning of connections between brain cells that have remained unused during the teen years. The first areas of the brain to mature are those with the most basic functions, such as processing the senses and movement. Areas involved in spatial orientation and language follow. Areas with more advanced functions — integrating information from the senses, reasoning and other "executive" functions — mature last. This sequence of maturation also roughly parallels the evolution of the mammalian brain, the researchers suggest.

Dr. Judith Rapoport, one of the NIMH researchers, said, "To interpret brain changes we were seeing in neurodevelopmental disorders like schizophrenia, we needed a better picture of how the brain normally develops."

In a study published a few years ago, Rapoport and her colleagues discovered an exaggerated wave of gray matter loss in teens with early onset schizophrenia. These teens, who became psychotic prior to puberty, lost four times the normal amount of gray matter in their frontal lobes, suggesting that childhood onset schizophrenia may be an exaggeration of a normal process. By contrast, children with autism show an abnormal back-to-front wave of gray matter increases, rather than decreases, suggesting that autism may also involve an abnormal brain "pruning" process.

— Written by Jules Asher

Source: PNAS 101,21:8174-8179

To see the time-lapse imaging movie, go to http://www.nimh.nih.gov/press/prbrainmaturing.mpeg. For more information about the development of the teen brain, see http://www.nimh.nih.gov/publicat/teenbrain.cfm or contact:
National Institute of Mental Health (NIMH)
Office of Communications
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD 20892-9663
301-443-4513 (local);
1-866-615-6464 (toll-free)
301-443-8431 (TTY)
Email: nimhinfo@nih.gov