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Young children of working parents may watch even more television every day than previous reports have found, especially kids in home-based day-care settings, a new study finds.

Researchers from Seattle Children’s Hospital and the University of Washington surveyed day-care directors to find out how much television viewing was available and then added on the estimated two or three hours a day of home viewing done by many preschoolers.

“If you add the TV from day-care setting to home viewing, you get about five hours a day,” said lead researcher Dr. Dimitri Christakis, director of the Center for Child Health, Behavior and Development at Seattle Children’s Research Institute and a professor of pediatrics at the University of Washington School of Medicine.

At home-based day care centers, the preschool-age children watched more — 2.4 hours a day on average — compared to 0.4 hours in center-based settings. The differences were less significant with toddlers and infants in home care who viewed 1.6 hours and 0.2 hours, respectively, compared with 0.1 hours for toddlers and none for infants in the centers.

The results, Christakis said, are surprising and somewhat alarming. “When you consider preschool kids are only awake for 12 hours a day, they are spending almost half their waking hours in front of the TV,” he said.

The study was published online Nov. 23 in advance of publication in the December issue of Pediatrics.

For the study, the researchers interviewed directors of 168 licensed child-care programs in four states, Florida, Massachusetts, Michigan and Washington. They asked the directors how many hours of television were usually watched. In all, the directors of 94 home-based programs and 74 center-based programs participated.

Those in home-based programs watched, on average, double the amount viewed in center-based programs.

“A lot of home-based day care programs are using a lot of ’screen time’,” Christakis said, noting that many prior studies of TV viewing time rely on parent reports of home viewing and don’t ask about day-care viewing time.

The researchers did not ask specifics about the content of the program. “No doubt some is educational,” Christakis said. “But it really doesn’t matter. Even the best educational program is no substitute for real, live human interaction.”

His advice? “Parents should make a point of inquiring how much time the television is on “when searching for day care or with their current arrangement.”

And, he said, if there is too much television viewing at day care, parents can adjust downward the TV time at home. He cites the recommendation from the American Academy of Pediatrics, suggesting no TV for the first two years and a daily limit of one to two hours for older children. Less than that is even better, Christakis said.

The findings don’t surprise David Bickham, a research scientist at the Center on Media and Child Health at Children’s Hospital Boston and an instructor of pediatrics at Harvard Medical School. “I think it’s an important study,” he said, agreeing that researchers often overlook TV time in day-care settings.

”I do think they have touched on something unique here that is very important,” Bickham said. While TV can be educational, Bickham suspects that at day care, television is “often used as a way to fill the time.”

The message on this is clear, Bickham and Christakis agreed. “Parents need to go and talk to their day-care center and find out what is going on with media use,” Bickham said.

When shopping for day care, parents may want to ask about the director’s educational background, the findings suggest. In home-based programs in which the director had a two- or four-year college degree, TV was watched less than in those centers where the directors did not have a college background, Christakis found.

Too much screen time, especially at day care, may mean that preschoolers miss out on opportunities to interact, socialize and learn language and other skills, both Bickham and Christakis said.

Being depressed might take as many years off your life as smoking does, a new study suggests.

However, a combination of depression and anxiety appears to be better for longevity than just depression.

Researchers came to their conclusions after analyzing death records and a survey of more than 60,000 people. During the four years after the survey, the death rate was higher among those who’d appeared to be depressed, based on the survey findings, than among the others. The increase was about as high as that among smokers.

“Unlike smoking, we don’t know how causal the association with depression is, but it does suggest that more attention should be paid to this link because the association persisted after adjusting for many other factors,” lead researcher Dr. Robert Stewart, of Kings College London, said in a news release from the college.

The researchers also found that people who were depressed were more likely to die during the study period than those who were both depressed and anxious.

“It appears that we’re talking about two risk groups here,” Stewart said. “People with very high levels of anxiety symptoms may be naturally more vulnerable due to stress, for example through the effects stress has on cardiovascular outcomes. On the other hand, people who score very low on anxiety measures, i.e. those who deny any symptoms at all, may be people who also tend not to seek help for physical conditions or they may be people who tend to take risks. This would explain the higher mortality.”

The findings fit with other research that suggests a link between mental and physical health, according to the researchers.

“The physical health of people with current or previous mental disorder needs a lot more attention than it gets at the moment,” Stewart said.

High blood pressure is better controlled by doctor-pharmacist teams working hand-in-hand than by doctors and pharmacists working alone, a new study shows.

“When physicians work with pharmacists, medications are intensified, dosages increased, medications used more effectively,” said Barry L. Carter, a professor in the University of Iowa College of Pharmacy and lead author of a report in the Nov. 23 issue of the Archives of Internal Medicine. “Medication compliance is lesser reason for the improvement.”

The journal report describes a study in which 402 people treated for high blood pressure at six clinics were divided into two groups. One group got the usual high blood pressure treatment, in which a prescription is written based on the doctor’s measurement of blood pressure, and a pharmacist simply fills the prescription.

The other group was treated by doctor-pharmacist teams in which the pharmacists were trained to assess participants’ blood pressure and adjust both the kind of drugs prescribed and the dosage of those drugs.

After six months, blood pressure had dropped to the recommended level in 30 percent of the participants in the traditional treatment group, while 64 percent of those treated by a pharmacist-physician team achieved the goal.

Is such a team approach possible in ordinary medical practice? Carter said it’s already being done in some special settings — by managed care organizations such as Kaiser Permanente, Veterans Affairs, and a number of academic health centers.

“A minority of patients now have access to such care, but that could change as the health-care system changes,” he said.

But he said it’s also possible in the usual setting of medical care, in which one doctor is responsible for an individual’s care, Carter said. “There can be collaborative efforts that would be very effective with working partners,” he said. Several states, including Iowa, have programs supporting the establishment of such working partnerships, he said.

A partnership approach can clearly improve efforts to control high blood pressure, which is a major risk factor for heart attack, stroke and other cardiovascular problems, Carter said.

“Medication compliance accounts for only 15 to 20 percent of blood pressure control problems,” he said. “Most of the time, medications are not used in the right doses and right combinations to get the job done.”

And what works for blood pressure control could be applied to other chronic medical problems, Carter said. “There have been positive studies in diabetes, high cholesterol and asthma, among others,” he said.

Helene Levens Lipton, a professor of health policy at the University of California, San Francisco, said that doctor-pharmacist partnerships are becoming more important as the population of aging Americans increases.

“We’re facing a major crisis in the form of a primary care physician shortage, so we need to look at new models,” said Lipton, who wrote an accompanying editorial.

Though the concept is not new, “lots of physicians now are looking to allied health professionals to perform activities they just don’t have time to do,” she said. “A physician would really like to have a pharmacist there to help, showing how to save money on high blood pressure medication and making sure you are complying with the medications that are prescribed.”

But partnership arrangements “are not going to happen without some kind of incentive,” Lipton said. The most obvious incentive, she said, would be higher Medicare and Medicaid payments for medical professionals who set up such partnerships.

Caring for a tiny new being can be daunting at first, but new parents should concentrate immediately after birth on creating a strong bond between parent and child.

The Nemours Foundation offers these suggestions:
Each parent should spend time holding baby directly against the skin.
Gently rub or stroke baby’s skin in various motions.
Try some gentle infant massage techniques. You can learn how from a book, or from your pediatrician.
Talk, sing, coo or babble to your baby, so the infant gets used to the sound of your voice.
Listen to relaxing music together.