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Bedwetting affects many young children and often doesn’t indicate a serious medical issue.

However, the Nemours Foundation says, if bedwetting starts all of a sudden or is accompanied by these other factors, it’s time to call a pediatrician.
Bedwetting that resumes after a child has had dry nights for at least six months.
Sudden behavioral problems, either at home or at school.
Complaints from your child that there’s burning or pain during urination.
An increase in the frequency of urination.
An increase in appetite or thirst.
Swelling of the ankles or feet.
Bedwetting that continues at age 7 or older.

Exercise is good for you, but watch it: A new study found that young men engaging in strenuous physical activity are “an often overlooked” group that’s at risk for low blood counts and iron deficiency.

Dr. Drorit Merkel from the Chaim Sheba Medical Center, Tel-Hashomer and colleagues studied 153 males, all 18 years old, who were training to join an elite combat unit in the Israel Defense Force.

In the September Journal of Adolescent Health, the investigators report that before the start of training, about 18 percent of the recruits had low blood count, or anemia. That rate almost tripled after six months of intensive military training, to just over 50 percent.

The rate of iron deficiency nearly doubled, from about 15 percent to 27 percent. The researchers do not report whether the recruits had any symptoms of anemia.

The researchers point out that the males in the study had a higher-than-average rate of anemia to begin with, which could explain some of the results. That’s because recruits who intend to compete for membership in elite units often participate in intense pre-recruitment preparatory training.

“Iron deficiency and anemia,” the investigators point out, “are generally uncommon findings in healthy male adolescents. However, athletes who engage in strenuous physical activity are known to be at increased risk for so-called ’sports anemia.’”

So why the higher risk? Potential reasons include drinking lots of water, which temporarily dilutes the blood and damage to blood cells that can result from high levels of physical activity.

“The prevalence of iron deficiency in new recruits indicates a military public health issue, and the preventive and therapeutic implications of these findings require further evaluation,” Merkel and colleagues conclude.

People who grew up in a place and time when they could legally buy alcohol before age 21 are more likely than others to be alcoholics or have a drug problem, even well into adulthood, new research shows.

“The effect lingers,” said study author Dr. Karen Norberg, a research instructor in psychiatry at Washington University in St. Louis. “A drinking-age law of 21 is associated with lower risks of long-term problems with alcohol use.”

The study is published online Sept. 18 in the journal Alcoholism: Clinical and Experimental Research.

Norberg and her research colleagues analyzed surveys of nearly 34,000 people born in the United States between 1948 and 1970, examining their records to determine if rates of alcoholism and drug abuse differed depending on their states’ liquor-buying laws at the time the participants were teens or young adults.

In the early 1970s, 26 states lowered the drinking age to 18 after the federal voting age was lowered to 18, Norberg said. After passage in 1984 of the National Minimum Drinking Age Act, the federal government pressured states to increase the drinking age or forfeit highway funds.

By the late 1980s, most states had complied, raising the drinking age back to 21. Louisiana, the researchers noted, was the last to do so, in 1995.

In the study, people who had been allowed to buy liquor legally before age 21 were 33 percent more likely to have suffered from alcoholism in the year before they were surveyed.

Drinking at a younger age also was found to increase the risk of abusing other drugs. Those allowed to drink legally before age 21 were 70 percent more likely to have had a problem with drugs than were those who had to wait until 21 to drink legally, the study found.

No differences were detected between men and women, various ethnicities or age groups.

The findings suggest, Norberg said, that the frequency or intensity of drinking in late adolescence has long-term effects.

A study released earlier this year reported that states that allow the suspension of a driver’s license for any underage alcohol violation and states with zero-tolerance laws that make it illegal for young people to drive with any level of alcohol in their system have fewer drunk-driving accidents.

So-called use-and-lose laws resulted in 5 percent fewer auto accidents related to drinking, the study found. It, too, was published in Alcoholism: Clinical and Experimental Research.

Norberg’s study is believed to be the first to look at the very long-term effects of lowered drinking ages.

The study “substantiates something that has not been substantiated this way before — that the [legal] drinking age really has long-term impact,” said Dr. Marc Galanter, director of the division of alcoholism and drug abuse at New York University School of Medicine. “Even in [people’s] 40s and 50s, this impact was felt.”

Though people nationwide continue to debate what the ideal legal drinking age should be, with some again calling for a lower age, Galanter said the results suggest that keeping the status quo would be good.

Traci Toomey, an associate professor of public health at the University of Minnesota, who also has researched the topic, agreed. The new study, she said, provides “another piece of the puzzle that looks at the policy from another angle.”

Norberg, however, said that though her research poses a “strong argument” for keeping the drinking age at 21, “there might be some other solution,” such as the drinking “learner’s permits” that some have proposed.

That concept aims to change the youth culture from acceptance of excessive drinking to preference for limited alcohol consumption. One way to do this, proponents say, could be to allow someone younger than 21 to apply for a learner’s permit that allows limited use of alcohol under monitored conditions.

Men with a rare disorder in which they carry extra female genes can still have children if they undergo a surgical procedure for collecting their sperm, according to a new study.

Men with Klinefelter’s syndrome carry an extra copy of the X chromosome; normally men have one each of the X and Y chromosomes, and women have two X chromosomes. Men with Klinefelter’s syndrome carry XXY, and the main effect of the disorder is less fertility.

However, Dr. Ranjith Ramasamy and colleagues at New York-Presbyterian Hospital in New York used a surgery technique to retrieve sperm from 45, or two-thirds, of their 68 patients. Of 91 total attempts, 62 were successful.

More than half - 57 percent - of the men’s partners became pregnant after the sperm was combined with their partners’ eggs in the laboratory, in a procedure known as in vitro fertilization. Not all of those pregnancies made it to term, however: Overall, 45 percent of those couples who attempted to conceive using in vitro fertilization had children.

The researchers report their results In the September Journal of Urology. Sperm retrieval was more likely to be successful in younger men, with success rates of 71 percent for men 22 to 30 years old, 86 percent for those 31 to 35, and 50 percent for those 36 to 52 years old, they report. The oldest patient to undergo successful retrieval was 45.

Sperm retrieval rates were lower among men given testosterone replacement therapy, which is not uncommon in men with Klinefelter’s syndrome.

Given that sperm can be retrieved from men with the syndrome up until at least age 35, the researchers conclude, men should not rush to have their sperm obtained during adolescence, the authors conclude.

Middle-aged men with risk factors for heart disease such as smoking, high blood pressure and high cholesterol are taking 10 to 15 years off their lives compared to men without these troubles, British researchers say.

Although death from heart disease has been declining, in part due to better control of cardiovascular risk factors and better care, this is the first study that looks at death from heart disease in terms of life expectancy, the researchers said.

“The good news is that all of us can make changes to live a healthy life,” said lead researcher Dr. Robert Clarke, a reader in epidemiology at University of Oxford. “Those changes, we now know, can translate into a 10- to 15-year difference in life expectancy.”

Although not the subject of this study, Clarke suspects the same lessons would apply to women.

The report is published in the Sept. 18 online edition of the British Medical Journal.

For the study, a team led by Clarke, a reader in epidemiology at the University of Oxford, collected data on nearly 19,000 men ranging from 49 to 69 years of age. The men all participated in what’s known as the Whitehall Study and were first evaluated between 1967-1970.

At the start of the study, the men completed a questionnaire that included questions about their medical history, smoking, employment and marital status. In addition, height, weight, blood pressure, lung function, cholesterol and blood sugar levels were also measured.

After about 28 years of follow-up, 7,044 surviving men were examined again in 1997.

When the study began, 42 percent of the men smoked, 39 percent had high blood pressure and 51 percent had high cholesterol. By 1997, about two-thirds had stopped smoking and their blood pressure and cholesterol levels had also dropped, the researchers noted.

Despite these changes in risk factors for heart disease, men who had three heart risk factors in middle age had a threefold higher risk of dying from heart disease and a twofold increased risk of dying from other causes, compared with men with none of these risk factors, Clarke’s team found.

In fact, men who had all three risk factors at the time they entered the study lived 10 years less than men with none of the risk factors. Life expectancy after 50 was an additional 23.7 years for men with three risk factors, compared with 33.3 years for men without the risk factors, the researchers found.

When Clarke’s group evaluated the men using a risk score that took into account smoking, diabetes, employment, blood pressure, cholesterol and body-mass index. Men in the highest (worst) five percent of this risk score cut their life expediency by 15 years from age 50, compared with men with the lowest risk score (20.2 vs. 35.4 years).

“Cardiovascular risk factors are well-documented to result in premature cardiovascular events and cardiovascular deaths,” said Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles. “This study quantifies how the presence or absence of certain cardiovascular risk factors in middle age influences life span.”

Three modifiable risk factors — smoking, high blood pressure and high cholesterol — seemed most dangerous, Fonarow noted.

“Individuals who choose to not treat and control these major cardiovascular risk factors should recognize they may be giving up, on average, as much as 10 to 15 years of life by doing so,” he said. “More needs to be done to identify, treat and control major cardiovascular risk factors to reduce the global burden of cardiovascular events and premature cardiovascular deaths.”

While this study was conducted in England, the problem is equally prevalent in the United States.

For example, a recent study in the Sept. 14 online edition of Circulation found that after decades of steady progress against heart disease, the illness appears poised for a comeback. The study found that only 7.5 percent of Americans are now in the clear when it comes to heart disease risk factors.

The continuing U.S. obesity epidemic may bear much of the blame for the downturn, the researchers said.

“Our results raise the concern that a worsening cardiovascular risk profile in the population could potentially lead to increases in the incidence and prevalence of cardiovascular disease,” said lead researcher Dr. Earl S. Ford, from the U.S. Centers for Disease Control and Prevention. “Potential increases in cardiovascular disease and diabetes could affect the nation’s medical costs.”

Screening for areas of damage from a possible mini-stroke could help predict memory loss in the elderly, say U.S. researchers.

Their finding comes from a study involving 679 people, aged 65 and older, who were tested for mild cognitive impairment, the stage between normal brain aging and dementia. The researchers used brain scans to check for white matter hyperintensities, which are small areas of damage caused by mini-stroke, and for areas of dead brain tissue caused by stroke.

People with mini-stroke damage were nearly twice as likely to have mild cognitive impairment that included memory loss, whereas those with stroke damage were more likely to have mild cognitive impairment that did not include memory loss, according to the report in the Aug. 11 issue of Neurology.

“The most interesting finding in this study was that white matter hyperintensities, or mini-strokes, predicted memory problems, while strokes predicted non-memory problems,” study author Dr. Jose Luchsinger, of Columbia University Medical Center in New York City, said in a news release from the American Academy of Neurology.

“Traditionally, mini-strokes and strokes are thought to have a common origin and to more strongly predict non-memory cognitive problems,” Luchsinger said. “There are an increasing number of studies challenging the idea that all white matter hyperintensities are similar to strokes.”

The finding, he said, “could challenge traditional views that white matter hyperintensities are milder versions of stroke that are produced only by conditions such as high blood pressure.”

Learning more about mini-strokes and being able to identify which are related to stroke and which are related to other conditions, such as Alzheimer’s disease, could help find ways to prevent memory loss and other types of cognitive impairment, Luchsinger said.

Screening children as early as second grade for symptoms of depression may help better identify those at risk later in life, a University of Washington study shows.

Even though about 80 percent of second graders in the study never developed more than a few symptoms of depression, the researchers identified five patterns of development of the mental disorder by following nearly 1,000 children through their elementary and middle-school years.

“We want to reassure parents that everyone, including children, may feel sad or depressed once in a while, but that doesn’t mean they will go on to develop depression. We are trying to understand how depression starts and evolves in childhood so that we can develop interventions to help children,” lead study author James Mazza, a professor of educational psychology at the University of Washington, said in a university news release.

The study results, published online recently in the Journal of Youth and Adolescence, are based on reports from teachers and parents and self-evaluations done by the children, primarily white residents of the U.S. Pacific Northwest.

“Some children are reporting that they don’t have as many friends, feel lonelier and are more anxious than their peers,” Mazza said. “They are telling us that they feel different from the typical happy-go-lucky second grader.”

About 20 percent of the children were found to have a notable number of depressive symptoms in second grade, and about 9 percent of these had their symptoms continue or grow by eighth grade. The other 11 percent saw their number of symptoms rise until middle school, when they decreased.

About 54 percent of the second graders had no or few symptoms, but developed some or more by eighth grade. The remaining 26 percent started with no or few depressive symptoms and held at this level until middle school, the researchers found.

The study authors noted that behavior and attention problems tended to predict what pattern of depression a boy would develop, while anxiety at an early age was a risk factor for girls. The team also confirmed previous findings that girls tended to have more depressive symptoms than boys by middle-school age.

Nearly one in three children and adolescents with “insulin-dependent” type 1 diabetes have a positive skin test for tuberculosis (TB) and are at risk of developing active TB and spreading the infection to others, according to the results of a study conducted in a TB-endemic area.

It is unclear whether poor blood sugar control predisposes diabetics to developing TB disease following infection, or whether the poor blood sugar control is a consequence of TB disease, the study team notes in the International Journal of Tuberculosis and Lung Diseases.

TB is a highly contagious and potentially deadly infectious airborne disease spread by coughing, sneezing, talking or spitting. Billions of people around the world are infected with TB. Most have latent or “dormant” infection, meaning they are not infectious, they do not feel sick, and cannot transmit TB to others. However, it’s estimated that about 10% of people with latent TB will go on to develop active TB, which is infectious.

For their study, Dr. E. A. Webb, from the Desmond Tutu Tuberculosis Center, Cape Town, South Africa, and colleagues evaluated the prevalence of TB among 258 patients with type1 diabetes who were younger than 21 years old in TB-endemic areas.

The prevalence of TB infection was 29.8%, Webb and colleagues report. Active TB was confirmed in 9 (3.48%) patients, while 16 (6.2%) were previously treated for TB, they observed.

The prevalence of tuberculosis increased from 7.8% at 5 years to 12.5% at 10 years after the diabetes diagnosis, Webb’s team reports.

The observed prevalence of tuberculosis among type 1 diabetes was over 6.8 times greater than the population prevalence, the researchers note.

Poor control of diabetes and contact with a tuberculosis source were associated with a 1.39 and 2.78 times higher risk of tuberculosis, Webb’s team found.

“Routine TB screening of children with type 1 diabetes may be indicated in settings highly endemic for TB,” the researchers conclude.

Get ready for one-a-day Cialis.

Icos Corporation, which together with Eli Lilly markets Cialis, the No. 2 impotence drug, says it plans later this year to ask the Food and Drug Administration for approval of a once-daily version of the medicine. In May, Icos applied to European drug regulators for approval of the once-daily pill.

Icos and Lilly plan to market the once-daily drug to men in their 40’s and 50’s who take impotence drugs frequently, said Paul N. Clark, Icos’s chief executive. Most men who use the drugs now typically take them about four to six times each month. A daily dose would be aimed at allowing more spontaneity in the user’s sex life than the strategic planning required of what Icos calls the “on demand” version.

The once-daily pill works as well at improving sexual function as the maximum dose of Cialis, Icos said. In a study published in March in European Urology, a journal, 50 percent of men taking Cialis once a day said they were no longer impotent, in contrast to 8 percent of men taking a placebo. Side effects were mild, the study found.

Icos said it expected the daily pill would generate about 50 percent more revenue per patient than the on-demand version. The company did not disclose a price for the once-daily pill, but analysts predict it will cost about $3.50 a pill, or $100 a month, in comparison to $10 to $12 a dose for the current version.

“For patients who are more sexually active, which generally means younger patients, whose sexual activity is more spontaneous, it will be an attractive alternative, provided the cost is not prohibitive,” said Dr. Ira D. Sharlip, professor of urology at the University of California, San Francisco and a spokesman for the American Urological Association.

Men must now take Cialis and other impotence drugs at least 30 minutes before they plan to have sex, a factor that has discouraged use of the drugs, urologists say.

Icos, which plans to continue offering the on-demand version, predicts that the daily version of Cialis will have $200 million to $250 million in worldwide sales by 2010. Last year, Cialis had $776 million in sales worldwide. But some analysts doubt that men will want to take an impotence drug every day, since even frequent users of the medicines generally have sex no more than a couple of times a week. Insurance companies may also be reluctant to pay the additional cost of a once-daily pill.

“We do not believe sales will rise as a result of the new dosing regimen,” Eric Ende, an analyst at Merrill Lynch, wrote in a report last week.

The market for impotence drugs has stagnated since last summer, when reports linked the medicines to a rare form of blindness. Eight years after Pfizer, the world’s largest drug market, introduced Viagra, the most popular impotence medicine, to enormous publicity, the market for the drugs appears to be saturated.

Even with a major new ad campaign for Viagra this year, United States prescriptions for drugs for erectile dysfunction have been flat, compared with a 5 percent rise in prescriptions over all. The $2.5 billion or so of the drugs sold worldwide annually represent only 0.5 percent of the global prescription drug market. But Cialis continues to gain market share, mainly at the expense of Viagra.

Lacy Fitzpatrick, a spokeswoman for Icos, said the company expected the market for impotence drugs to grow at about the same rate as the population of men over 40. Levitra, the third impotence drug, marketed by Bayer and GlaxoSmithKline, is a distant third worldwide.

All three drugs strengthen erections by blocking an enzyme that slows the flow of blood to the penis. But Cialis is broken down more slowly than Viagra or Levitra, so it can work for up to 36 hours, while the other two drugs work for about four hours. That is why a once-daily version of Viagra or Levitra may be impractical.

If approved by the F.D.A., the daily pill will contain 5 milligrams of tadalafil, Cialis’s active ingredient. Cialis is now offered in 5-, 10- and 20-milligram doses, but the 20-milligram dose is by far the most popular, according to Icos.

Dr. James Barada, of the Center for Sexual Health in Albany, said he believed the drug could be appealing for men who have sex frequently and do not want to think of themselves as being impotent, even occasionally.

“The idea that if I don’t have to think about it, I don’t have the disease,” Dr. Barada said. “To move it to the background is going to be appealing for some people.”

In addition, Cialis may prove to have broad cardiovascular benefits as a once-daily pill, Dr. Barada said. The enzyme that Cialis and the other impotence drugs inhibit is found in blood vessels all over the body, and Icos is now studying Cialis for the treatment of high blood pressure.

People who stay even moderately fit as they age may live longer than those who are out-of-shape, a new study suggests.

The study, of nearly 4,400 healthy U.S. adults, found that the roughly 20 percent with the lowest physical fitness levels were twice as likely to die over the next nine years as the 20 percent with the next-lowest fitness levels.

That was with factors like obesity, high blood pressure and diabetes taken into account — underscoring the importance of physical fitness itself, researchers report in the journal Medicine and Science in Sports and Exercise.

“Our findings suggest that sedentary lifestyle, rather than differences in cardiovascular risk factors or age, may explain (the) two-fold higher mortality rates in the least-fit versus slightly more fit healthy individuals,” lead researcher Dr. Sandra Mandic, of the University of Otago in Dunedin, New Zealand, noted in an email to Reuters Health.

She pointed out that nearly two-thirds of the least-fit study participants were not getting the minimum recommended amount of exercise — at least 30 minutes of moderate activity, like brisk walking, on five or more days a week.

“These results emphasize the importance of improving and maintaining high fitness levels by engaging in regular physical activity,” Mandic said, “particularly in poorly fit individuals.”

The study included 4,384 middle-aged and older adults whose fitness levels were assessed during exercise treadmill tests sometime between 1986 and 2006; they were then followed for an average of about nine years.

When Mandic’s team separated the participants into five groups based on fitness levels, they found that one-quarter of the least-fit men and women had died during the study period, versus 13 percent of those who were slightly more in shape.

Among adults in the most-fit group, only 6 percent died during the follow-up period.

Overall, the five groups showed little difference in their reported exercise habits over their adult lives. Where they did differ was their activity levels in recent years.

“Since it is recent physical activity that offers protection,” Mandic said, “it is important to maintain regular physical activity throughout life.”

And since fitness is linked to longevity regardless of weight and health conditions like high blood pressure and high cholesterol, exercise is important for all, according to Mandic.

That, she said, includes people who are thin and in generally good health.