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NEW YORK (Reuters Health) - Using a booster seat instead of just a seat belt significantly reduces the risk of injury in children aged 4 to 8 years old who are involved in a car crash, according to an updated assessment of booster seat effectiveness released today.

Moreover, the results indicate that in this age group, booster seats without a back are just as protective as those with a back.

Car seat belts are built for average-size adults, not children. When a child outgrows a harness-type car seat, it's recommended that he or she graduate to a booster seat, usually around age 4 and weight 40 pounds.

Booster seats work by raising the child up so that the vehicle's lap-shoulder belt is properly positioned across his chest and hips -- to distribute crash forces across the sturdiest parts of a child's body.

"Previous research demonstrating the benefits of booster seats over seat belts for children is outdated," Dr. Kristy B. Arbogast from the Center for Injury Research and Prevention at Children's Hospital of Philadelphia in Pennsylvania and colleagues note in the journal Pediatrics.

To revisit the issue, they analyzed data on 7151 children aged 4 to 8 who were involved in a total of 6591 car crashes. All of the children were in the back seat and most -- 70 percent, or 5547 children -- were restrained in a regular seat belt. Only 30 percent -- or 1604 children -- were strapped into a booster seat.

Arbogast's team found that children in booster seats had approximately half the injury risk as children in seat belts (0.67 vs. 1.36 percent).

"This study reaffirms the current recommendations for booster seat use for children through age 8," Arbogast told Reuters Health. "This study includes a greater percentage of 6, 7 and 8 year olds than previously studied (in 2003)," she added.

When considering all crash directions and vehicle model years, children who used booster seats were 45 percent less likely to suffer injuries than children who were using the vehicle seat belt.

"Booster seats were shown to be particularly effective in side impact crashes, which are the most deadly and injury-causing crashes for children," Arbogast said.

Booster seat use was associated with a 68 percent reduction in risk of injury for near-side impacts and an 82 percent reduction in risk of injury for far-side impacts.

"Importantly," the researchers note in their report, the results suggest that the effectiveness of booster seats does not vary by the type of booster seat: backless or high-back.

Most kids prefer backless booster seats because they look less like a "baby" car seat, the researchers note. The current results, they say, "give confidence to parents and health educators that choosing this type of restraint for their child does not represent a compromise in safety."

Based on these updated data, booster seats represent "best practice," the researchers conclude, and should be used once a child outgrows a harness-type car seat and until he or she is at least 8 years old.

"These data provide timely confirmation that current efforts to upgrade states' child passenger safety laws to include booster seat use are well-founded," Arbogast added.

SOURCE: Pediatrics, November 2009.

Copyright © 2009 Reuters Limited.

NEW YORK (Reuters Health) - A new study suggests that the increasing availability of MRI scanners may be feeding an increase in surgery for lower back pain -- despite doubts about the effectiveness of surgery for most people.

Looking at MRI availability in 318 U.S. metropolitan areas, researchers found that Medicare patients with low back pain were more likely to get a scan when they lived in an area with more MRI machines.

Greater MRI availability was also linked to higher odds of getting lower back surgery, the investigators report in the journal Health Affairs.

Surgery can be appropriate for some causes of chronic lower back pain, such as a herniated spinal disk or a narrowing of the spinal canal called spinal stenosis. But for most people with lower back pain, the precise cause is unclear, and the pain often resolves without any extensive therapy.

Because of this, experts generally recommend that people with back pain delay having an MRI for at least a month. And surgery should be considered only when the cause is clear and more conservative treatments fail.

The problem with widespread use of MRI is that the scans -- which visualize soft tissue like the spinal discs and muscles -- can detect anomalies that may or may not be the cause of a person's back woes.

So the concern is that some patients may end up getting an invasive treatment that will not help them, say Dr. Laurence C. Baker and Jacqueline D. Baras of Stanford University School of Medicine in California.

"There are some circumstances in which MRI for low back problems is appropriate, and also some circumstances in which surgery can be appropriate," Baker and Baras told Reuters Health in an email. "There are also other situations where they are not."

Whether any one person needs an MRI or surgery is something that can only be decided by the doctor and patient, the researchers said.

"If our article encourages doctors and patients to have a conversation about the best tests and treatments in the patient's specific circumstance," they added, "we think that would be a good thing."

The findings are based on Medicare claims data for more than 666,000 cases of lower back pain treated between 1998 and 2005. MRI scans were performed in about 16 percent of cases, and nearly 3 percent of patients underwent surgery within a year of first visiting the doctor.

The likelihood of getting an MRI inched up along with the number of MRI machines in the metropolitan area. For example, people who lived in areas with the highest concentration of scanners had a 7 percent chance of having an MRI within a month of seeing the doctor; those in areas with the fewest machines had a 6 percent chance.

The difference may look small, but on a broader level, the numbers add up. The researchers point out that if all study patients had lived in the areas with the fewest MRI machines, they would have had about 12,000 fewer scans performed over a year -- and about 3,500 fewer surgeries.

"It is often the case that patients and doctors automatically think that more care is better care, and this can contribute to overuse of care," Baker and Baras said.

According to the researchers, "we as a country need to develop a more nuanced view" of high-tech medical services, which includes accepting the fact that they will not always be helpful.

SOURCE: Health Affairs, online October 14, 2009.

Copyright © 2009 Reuters Limited.

NEW YORK (Reuters Health) - Despite a long-standing federal ban on the sale of small turtles, the reptiles continue to be sold in the US and to make owners, usually young children, sick with Salmonella -- sometimes very sick, health officials warn in a report released Monday.

"Most people are unaware of the dangers of turtles as pets," Dr. Julie Harris, a medical epidemiologist with the Centers for Disease Control and Prevention in Atlanta, told Reuters Health.

Turtles and other reptiles are well-known reservoirs for Salmonella, and while the sale and distribution of small turtles -- measuring less than 4 inches -- was officially outlawed in the United States in 1975, cases of turtle-associated Salmonella infection continue to occur.

Salmonella, Harris said, is a "serious infection," which can lead to hospitalization and, in some cases, death. "Children are more susceptible than adults, and often have more complications from infection," she added.

In the journal Pediatrics, Harris and colleagues detail a large outbreak of turtle-associated Salmonella, occurring between May 2007 and January 2008 and involving 34 states and 107 people.

"In this outbreak, 59 percent of patients were 10 years of age or younger, and 33 percent of all patients interviewed were hospitalized," Harris said.

"We observed a strong association between turtle exposure and Salmonella infections in this outbreak," the investigators report.

Forty-seven of 78 patients interviewed -- a full 60 percent -- reported contact with turtles during the week prior to their becoming sick.

Small turtles remain available to the public illegally from various sources, including pet shops, flea markets, street vendors, and the internet.

And don't be fooled by sellers: "No one has succeeded in making a Salmonella-free turtle," Harris said. "Antibiotic treatment of eggs often results in turtles with drug-resistant Salmonella infections."

"Even if a turtle is born without Salmonella, because Salmonella exists in many places in the environment, it is difficult if not impossible to keep a turtle free of Salmonella," Harris added.

SOURCE: Pediatrics, November 2009.

Copyright © 2009 Reuters Limited.

NEW YORK (Reuters Health) - Losing weight may be no more than a few podcasts away, but study findings suggested that not all weight-loss podcasts are created equally.

Such programs should be engaging and offer sound diet and exercise advice based on behavioral theory, cautions study co-author Dr. Gabrielle M. Turner-McGrievy, at the University of North Carolina at Chapel Hill.

"Otherwise, people will not derive much benefit," Turner-McGrievy told Reuters Health in an email.

In the study, overweight and obese men and women listening to behavior-therapy based weight-loss podcasts for 12 weeks lost more than 6 pounds (2.9 kilograms) on average, Turner-McGrievy and colleagues report in the American Journal of Preventive Medicine.

These "enhanced" podcasts provided 13 men and 28 women (38 years old on average) with diet, exercise, and weight loss tips, and encouraged them to set personal goals. Enhanced podcasts also reinforced healthy eating and exercise information through an ongoing, and "entertaining" soap-opera saga, the researchers note.

By contrast, a similar "control" group of 7 men and 29 women, just under 40 years old on average, who listened to weight-loss and positive thinking advice offered in a generally available podcast, lost less than one pound (0.3 kilograms) on average.

Both series of podcasts were about 15-20 minutes long.

In addition to greater weight loss, those using the enhanced podcast reported eating more fruits and vegetables, spending more days exercising vigorously, knowing more about weight loss during follow-up testing, and "greater satisfaction with the intervention," the researchers note. However, the groups ate the same amount of high-fat foods.

Simply listening to a podcast won't necessarily make you get out of your chair to exercise: More than half of the study participants in both groups listened to downloads while sitting at their computers, rather than while walking or exercising.

SOURCE: American Journal of Preventive Medicine, October 2009.

Copyright © 2009 Reuters Limited.