HealtyDayS

Professors at Kansas State University have found that males tend to be greater risk takers when it comes to alcohol, while women tend to use more protective strategies, including drinking only with friends, counting the number of drinks, limiting the amount of money spent on drinking and eating food before drinking.

Steve Benton, professor of counseling and educational psychology, Ronald Downey, professor of psychology, and Sheryl Benton, assistant professor of counseling and educational psychology and assistant director of Counseling Services, have done a study and paper on college student drinking, attitudes of risk and drinking consequences.

“My belief is that we have to face the fact that a certain percentage of college students will drink,” Steve Benton said. “So, what can we do to reduce the likelihood of them getting into trouble?”

The researchers looked at how risk, along with other factors, play out in understanding the kinds of behavior people get into.

“Students who tend to have attitudes that make them greater risk takers are more likely to get into trouble when drinking,” Steve Benton said. “Even when controlling the amount of alcohol, it’s not how much you drink that affects the amount of trouble, but how risky you are.”

He said that if a person doesn’t care what others think and doesn’t worry about laws, then they’re more likely to get into trouble. Those with a lower-risk attitude will get into less trouble.

“We know that males tend to be heavier drinkers than females,” Steve Benton said. “The more you drink, the more you get into trouble. We found that the protective strategies are especially beneficial to male students, because they drink more than females, as well as to students who have six or more drinks.”

Student who drink more heavily also are more likely to experience harm from their drinking if they have high-risk attitudes. When they go to parties, they should be aware of their behavior and how much they’re drinking, Steve Benton said. He recommends they pace their drinking over several hours.

According to Steve Benton, if students do the following, they are less likely to get in trouble: limit their number of drinks, use self-protective strategies, limit money spent on alcohol, drink with friends, pour their own drinks and have low-risk attitudes.

Even students who have more than six drinks are less likely to experience harm if they practice self-protective strategies, Steve Benton said.

Downey said the next stage of the study is to determine the right way to communicate about drinking issues.

“If you begin to talk to an individual about risky behavior, you have to understand where they’re coming from,” he said. “Some individuals talk about risks, but some don’t like to.”

Gay men who are HIV-positive rarely regret revealing their health status to others, according to a new Ohio State University study.

The study, the first of its kind, could be important for clinicians who work with HIV-positive men who are often uncertain whether to tell friends, family, co-workers or others about being diagnosed with the virus that causes AIDS. It was published in the April issue of the journal AIDS Education and Prevention.

The Centers for Disease Control and Prevention estimates that more than 1 million people in the nation were living with AIDS or HIV by the end of 2003. In Ohio, the Ohio Department of Health reports that about 15,000 residents had HIV or AIDS as of mid-2004. Nearly 16,000 Americans died of AIDS in 2004, with 529,000 AIDS-related deaths since 1981.

“I was very surprised at how little regret we found, because you see the angst in HIV-positive men who deliberate very carefully on whether or not to tell people,” said Julianne Serovich. Serovich is the lead author of the study and chair of Human Development and Family Science in Ohio State’s College of Human Ecology.

“The results offer hope for people who are working in this field,” Serovich said. “We can tell HIV-positive men that others in their position rarely regret the fact that other people know their status.”

Serovich has studied HIV disclosure since 1997. In previous studies, she found that HIV-positive men who disclose their condition are more likely to get necessary medical help, to find out about new clinical trials and therapies, and are more likely to get social support. Those who reveal their status to, and get support specifically from, family members are less likely to engage in risky sexual behaviors and are less likely to be depressed.

In the current study, Serovich, along with post-doctoral research fellow Tina Mason and doctoral students Paula Toviessi and Dianne Bautista, extensively interviewed 76 HIV-positive gay men once a year in 1998, 1999 and 2000, and asked them to fill out lengthy questionnaires every six months. As part of these inquiries, researchers asked participants about their social networks, including friends, family members, colleagues and acquaintances. During the final phase of the study, the men were asked whether each member of the social network they had previously revealed knew of their HIV status, whether they were told first-hand or heard second-hand, and whether the participant regretted that the person knew.

Overall, four out of five of the people in their social networks knew of their HIV status, and participants reported a very low incidence of regret. In fact, 63 percent reported no regret at all, and 75 percent reported feelings of regret of less than 7 percent of their social network. Out of a total of 1,397 social-network members who knew of the participants’ HIV status, the participants regretted only 58 (4.2 percent) of those cases.

Interestingly, the highest incidences of regret were associated with disclosure to a parent or other family member, Serovich said. However, even then, out of 318 family members who knew, only 22 were associated with feelings of regret. “Disclosure may be difficult,” Serovich said, “but the long-term consequences appear to be positive.”

Serovich noted that it’s possible that individuals would tell their HIV status only to “safe” people - those who would most likely be supportive or at least neutral in their reaction. But there appeared to be no difference in feelings of regret on whether the members of the social network were told first-hand or heard second-hand. Also, it’s possible that the benefits of disclosing the status - from being relieved of the burden of living with a secret to experiencing assistance with support groups or medical care - became apparent long after the disclosure took place.

Serovich also noted that the participants involved in the study constitute a small, predominantly Caucasian sample from an urban area. Results could be different in rural areas or among members of different races or ethnicities. She is currently conducting a similar study on HIV-positive women.

Serovich could find only one previously published study focusing on feelings of regret after disclosure of HIV status. Reported in 2003, it focused on women’s feelings after disclosing their medical condition to their young children. No other studies have been published examining regret after disclosure of HIV status, Serovich said.

Medical management combined with the drug naltrexone or with a specialized behavioral therapy can be effective treatments for alcohol dependence, according to a study in the May 3 issue of JAMA.

About 8 million individuals in the U.S. currently meet diagnostic criteria for alcohol dependence (also called alcoholism), a leading preventable cause of illness and death and a major contributor to health care costs, according to background information in the article. In primary care settings, the prevalence of alcohol use disorders ranges from 20 percent to 36 percent; most of those patients are never treated and, if they are, do not receive specialty care.

Several behavioral treatments and at least two medications approved by the U.S. FDA, naltrexone and acamprosate, have shown efficacy in the treatment of alcohol dependence. However, no large-scale randomized controlled study has evaluated whether combined drug treatment with or without behavioral therapy could improve outcome.

Raymond F. Anton, M.D., of the Medical University of South Carolina, Charleston, and colleagues evaluated the effectiveness in treating alcohol dependence with medical management and naltrexone, acamprosate, or both, with or without combined behavioral intervention (CBI) provided by behavioral health specialists. The trial (the COMBINE Study), conducted from January 2001 – January 2004, included 1,383 recently alcohol-abstinent volunteers with a diagnosis of primary alcohol dependence. The participants were divided into 9 groups. Eight groups of patients received medical management with 16 weeks of naltrexone or acamprosate, both, and/or both placebos, with or without CBI. Medical management included sessions with a medical professional focused on enhancing medication adherence and alcohol abstinence. A ninth group received CBI only (no pills). Patients were evaluated for up to one year after treatment.

The researchers found that all groups showed substantial reduction in drinking. During treatment, patients receiving naltrexone plus medical management, CBI plus medical management and placebos, or both naltrexone and CBI plus medical management had higher percentages of days abstinent (80.6, 79.2, and 77.1, respectively) than the 75.1 in those receiving placebos and medical management only. Naltrexone also reduced the risk of a heavy drinking day over time, most evident in those receiving medical management but not CBI.

Acamprosate showed no significant effect on drinking compared with placebo, either by itself or with any combination of naltrexone, CBI, or both. During the 16 weeks of treatment, there was an overall difference in percent days abstinent between those receiving placebo pills and medical management alone (73.8), placebo pills and medical management plus CBI (79.8), and CBI alone (no pills or medical management) (66.6). One year after treatment, these between-group effects were similar but no longer significant.

“In conclusion, within the context of medical management, naltrexone yielded outcomes similar to those obtained from specialist behavioral treatment (i.e., CBI). We found no evidence of efficacy for acamprosate and also no evidence of incremental efficacy for combinations of naltrexone, acamprosate, and CBI. Somewhat unexpectedly, we observed a positive effect of receiving placebo medication and medical management over and above that seen with specialist-delivered behavioral therapy alone. Medical management of alcohol dependence with naltrexone appears to be feasible and, if implemented in primary, and other, health care settings, could greatly extend patient access to effective treatment. Future studies that evaluate the usefulness of continued or intermittent care of alcohol-dependent individuals over the longer term should be considered,” the authors write. (JAMA. 2006;295:2003-2017)

A new radiation protection technique can significantly reduce physician radiation exposure during coronary angiography, according to a researcher at the University of Maryland Medical Center in Baltimore, MD.

Using the new device, physicians monitor patients’ angiograms and control exam table movement from behind a lead plastic shield. A newly developed extension bar allows the physician to remain safely behind the shield and still retain table control for panning, according to Martin Magram, MD, developer of the new technique and assistant professor in the department of diagnostic radiology.

Dr. Magram recorded radiation exposure to various parts of the physician’s body in a new study using the technique during coronary angiography on 25 patients. He compared the physician’s radiation exposure during the same procedure on 25 patients using conventional radiation protection. Using the new equipment, Dr. Magram found 90% reduction in radiation exposure to the physician’s head, arms, and legs.

“Current technique requires that physicians wear heavy lead gowns during radiation procedures. This new technique may free physicians from the need to wear lead gowns,” said Dr. Magram. “As the sophistication of radiological diagnostics has increased, it is tragic when a physician can no longer perform procedures because the lead gowns cause onset of neck or back degeneration and the physician becomes unable to tolerate the weight of a lead gown.”

This new technique may preserve these physicians’ ability to benefit patients. “It may extend by years their ability to apply the skills they have developed over long careers of serving patients,” said Dr. Magram.

“America’s medical community adheres to the ALARA principle (as low as reasonably achievable) in the use of radiation for diagnostic tests in patients,” Dr. Magram said. “We must be equally vigilant in protecting the members of the health care team from radiation exposure as they administer diagnostic and therapeutic procedures,” he said.

“The development of many new radiation techniques improves our ability to deliver medical care. New methods of radiation protection must parallel the development of new radiation techniques,” Dr. Magram said.

“The key is to limit medical workers’ radiation exposure with effective and easy-to-use techniques,” he said, “and the use of this extension bar and lead plastic shield may be such a technique.”

Underage alcohol drinking

Underage drinking contributes an estimated $23 billion yearly to the alcohol industry, more than 17 percent of the total consumer expenditures for alcohol, according to an article in the May issue of the Archives of Pediatrics & Adolescent Medicine, a theme issue on children and the media.

In 1998, alcohol abuse and alcoholism cost the U.S. $184 billion, more than cancer ($107 billion) or obesity ($100 billion), according to background information in the article. Research suggests that delaying the onset of regular drinking is an effective way to prevent pathological drinking. For example, one study found that those who began drinking before 15 years of age were four times more likely to become alcohol dependent, compared with those who did not drink before they turned 21. Young and old pathological drinkers consume a disproportionate share of alcohol.

Susan E. Foster, M.S.W., and colleagues from The National Center on Addiction and Substance Abuse at Columbia University, New York, examined information from several national sets of data to estimate the commercial value to the alcohol industry of alcohol consumed by underage as well as abusive and dependent alcohol drinkers. The data were from several surveys that included a total of 260,580 individuals age 12 years and older. Alcohol abuse and dependence was defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

In 2001, an estimated $128.6 billion was spent on alcohol in the U.S. Of this amount, $22.5 billion (17.5 percent) was the value of alcohol consumed by underage drinkers and $36.3 billion (28.3 percent) was attributable to abusive or dependent drinking by both underage and adult drinkers. Of individuals aged 12 to 20 years, 47.1 percent were current drinkers and 25.9 percent of them met criteria for alcohol abuse and dependence, compared to only 9.6 percent of drinkers 21 years and older who were classified as being abusive of or dependent on alcohol. Pathological drinkers consumed three times as much alcohol per month as drinkers without abuse or dependence problems. The combined monetary value of underage drinking and adult pathological drinking was at least $48.3 billion, more than one-third of all consumer expenditures for alcohol.

“Almost all (96.8 percent) of the adult drinkers with alcohol abuse and dependence began drinking prior to the age of 21 years,” the authors write. “With at least 37.5 percent of sales linked to underage drinking and adult abusive and dependent drinking, the alcohol industry has a compelling financial motive to attempt to maintain or increase rates of underage drinking. Alcohol advertisements in magazines, for example, expose youth aged 12 to 20 years to 45 percent more beer advertisements and 27 percent more advertisements for distilled spirits than adults of legal drinking age.”

“The financial interests of the alcohol industry appear to be antithetic to the public health interests of the nation in preventing and limiting pathological drinking,” they conclude. (Arch Pediatr Adolesc Med. 2006;160:473-478)

Secondhand smoke

People who see news stories and advertisements about the dangers of secondhand smoke are more likely to feel that it is harmful, and may restrict smoking at home, according to new research published in the American Journal of Health Behavior.

The study by W. Douglas Evans, of the nonprofit research corporation RTI International, and colleagues found that anti-secondhand smoke media messages have a strong indirect effect on smoking restrictions in the home.

Anti-secondhand smoke media account for 10 percent of people’s negative attitudes about secondhand smoke, but these negative attitudes explain nearly 60 percent of home smoking restrictions, Evans said.

“Media work through changing people’s attitudes to get them to change home smoking rules,” he said.

People may “have to process the information” they get from the media through family discussions or through one person in a household taking a strong position on secondhand smoke before the change in attitude becomes a change in home restrictions, Evans suggested.

According to 2003 statistics compiled by the Centers for Disease Control and Prevention, secondhand smoke exposure is the third leading cause of preventable death in the United States. Secondhand smoke exposure has been linked to lung cancer and heart disease in adults and severe respiratory infections and asthma, particularly in infants and young children.

The researchers measured the link between anti-secondhand smoke messages and home restrictions through a survey of 2,348 adults conducted by the American Legacy Foundation, a nonprofit anti-smoking foundation. About 23 percent of those surveyed were current smokers.

Researchers asked the survey participants whether they had seen news stories or ads about “the dangers of kids being around cigarette smoke” and “efforts to ban smoking in public places,” among other questions. They also asked the participants to agree or disagree with statements such as, “It is harmful to a person’s health if they live in a house where a smoker smokes tobacco indoors” or, “Inhaling someone else’s cigarette smoke can cause lung cancer in nonsmokers.”

Only 11 percent of those surveyed lived in a house with no smoking restrictions, while 65 percent of those surveyed had complete smoking bans within their homes.

Evans and colleagues say their study shows that a concerted media campaign could be an effective way of reducing secondhand smoke exposure.

“Our evidence suggests that if money were spent on it, it would be effective. The question is where to get the money,” Evans said.

Boston University Public School of Health professor Michael Siegel, M.D., an expert in health communication and smoking behavior, agrees that secondhand smoke messages have been sidelined sometimes in favor of more direct appeals for quitting and preventing smoking.

“The funding for anti-smoking media campaigns has been greatly slashed in almost every state that has had such a campaign,” Siegel said. “The campaign in Massachusetts has been completely eliminated. The campaign in Florida was all but eliminated. With the limited funding available, I think groups running these campaigns have chosen to focus on smoking prevention and cessation and haven’t had the funds to have the ‘luxury’ of addressing the secondhand smoke issue,” Siegel said.

Cigarette maker Philip Morris USA did not respond to requests for comment on how they have addressed the issue of secondhand smoke.

The Evans study was supported by the American Legacy Foundation.

HIV Vaccine

In July 2005, the race to find a vaccine that would stem the worldwide rate of 13,000 new cases of HIV infection each day moved from competition among research institutions to a strategy of cooperation.

An international “virtual research center” – the Center for HIV/AIDS Vaccine Immunology (CHAVI) – was awarded up to $300 million over seven years to support efforts to develop an HIV vaccine.

The first of several research studies in this collaboration now is under way and is aimed at gaining new knowledge into the biology of HIV infection during its earliest days, before the immune system has produced antibodies to the virus.

Dr. Myron S. Cohen, the J. Herbert Bate distinguished professor of medicine, microbiology, immunology and public health at the University of North Carolina at Chapel Hill, leads the new study.

A grant from the National Institute of Allergy and Infectious Diseases, a component of the National Institutes of Health, established CHAVI at Duke University under the leadership of Dr. Barton Haynes, Frederic M. Hanes professor of medicine and immunology at Duke University Medical Center and director of the Duke Human Vaccine Institute.

The UNC Center for Infectious Diseases, which Cohen directs, has pioneered the development of techniques to recognize patients with the earliest phase of HIV. Cohen and his colleagues have conducted HIV research internationally for more than a decade at clinical sites in Madagascar, China, Malawi, Cameroon and South Africa.

More than two decades after AIDS and the virus that causes it were first identified, an effective vaccine to halt the spread of HIV infection remains elusive.

“Until we know more about the transmission of HIV and early immune response, how the human body responds to the virus and how the virus behaves, we will have great difficulty in developing an effective vaccine,” Cohen said.

CHAVI investigators at institutions across the globe including the University of Oxford, Harvard University, the University of Alabama at Birmingham and UNC have agreed to share their expertise, technology, funding and findings.

“CHAVI’s goal is to conduct research that overcomes current barriers to AIDS vaccine development. These barriers include understanding which of the body’s immune responses to stimulate in order to fight off HIV-1 and understanding the specific type of virus that is transmitted from person to person,” Haynes said.

Cohen, a member of CHAVI’s Scientific Leadership Group, leads the center’s Study Site Core B, also known as the Acute HIV-1 Infections Network Core. This is one of five study cores in support of the vaccine initiative.

Cohen described the project, CHAVI-001, as an observational study that will gather information at clinics in Africa (Malawi and South Africa) and in North Carolina, where patients statewide will be referred to UNC and Duke. The initial goal of CHAVI-001 is to identify people with HIV still in its earliest stages, before seroconversion.

When people develop antibodies to HIV, they “seroconvert” from antibody-negative to antibody-positive, a process that may take from as little as a few weeks to several months or more after infection with HIV.

During the study, each individual’s health will be tracked, and interviews aimed at identifying their sexual partners will try to determine the person who transmitted the disease, thus completing a “transmission pair.”

“Since the epidemic began 25 years ago, only about 1,000 people in the earliest stages of HIV infection have been identified,” Cohen said. “Even more troubling, only a handful of transmission pairs have been reported. CHAVI has the resources to find them in substantial numbers.”

According to Cohen, knowledge of the viral requirements for transmission is crucial to understanding how to make a vaccine against HIV. That’s why one needs HIV both from the recipient and the person who transmitted it.

Also important to vaccine development is knowledge of the immunological environment in which transmission occurred, Cohen said. This means determining as close as possible to the time of transmission the kind of immune defenses that can restrain viral replication.

“We know that while the host defenses are not going to eliminate the virus, they can achieve some measure of control,” Cohen said. “When the control is achieved, the viral growth level is called the ’set point.’ We know that people who’ve achieved a lower set point – that is, better control of their virus – are likely on average to live longer healthier lives and seem to be less likely to transmit the virus to their sexual partners.”

Cohen said that along with studying the virus and immunological defenses, CHAVI also has the resources to study genetic factors that may be involved in HIV acquisition, including host genetic factors influencing infection and early progression of HIV-1 disease.

“CHAVI-001 will probably be able to study enough people so that genetics and the genetics of HIV acquisition and set points can be investigated.”

There are six sites for CHAVI-001: in Malawi, one in Llongwe and one in Blantyre; in South Africa, one in Johannesburg and one in Durban; and in North Carolina, one at UNC and one at Duke.

 Women’s sexual health and breast and nipple stimulation

Women are more aroused by breast and nipple stimulation than men during lovemaking according to the first ever evidence-based research, published in the May 2006 issue of The Journal of Sexual Medicine. There are limited studies in the medical literature examining the importance, during lovemaking, of nipple or breast stimulation in enhancing sexual arousal in females and males.

While older research reported that men employ nipple and breast stimulation to induce sexual arousal as part of foreplay, Kinsey reported that the significance for the female was probably overestimated.

The new research in The Journal of Sexual Medicine entitled, “Nipple/Breast Stimulation and Sexual Arousal in Young Men and Women” by Roy Levin (Sheffield, UK) and Cindy Meston (Austin, TX), reports that in 82% of women studied, nipple/breast stimulation caused or enhanced their sexual arousal, and that when they were sexually aroused nipple/breast stimulation increased their arousal. Only 7% of women reported that such stimulation caused a decrease in their arousal while approximately 25% asked their partner to stop stimulating their nipples/breasts during lovemaking.

In the case of the men, like the women, nipple stimulation was excitatory for their sexual arousal but the percentage was significantly less (52% compared to 82%). Thirty nine percent of men (compared to 78% of women) reported that nipple stimulation increased their arousal when they were sexually aroused. While virtually the same percentage of men as women found that nipple stimulation decreased their arousal when sexually aroused, a smaller proportion of men asked for the stimulation to be stopped (14% versus 25%).

This gender difference could feasibly be due to a number of factors including gender differences in reporting biases or social desirability, or gender roles ascribed to this behavior. One aspect of breast/nipple stimulation is the putative release of central neuropeptide hormones that are strong stimulators of sexual activity.

In this novel research, the authors provided a short questionnaire to 148 males and 153 females who were undergraduates at a major University. Participants varied in age from 17 to 29 years old, and mean age was 19 years for both men and women.  The sample consisted of 56% Caucasian, 7% African American, 22% Hispanic, 14% Asian American and 1% other.  Participants were administered a series of six questions inquiring about their sexual arousal response to breast/nipple stimulation, a demographics questionnaire, and a variety of other sexually relevant measures.

“This study was undertaken in young western men and women,” noted lead author of the study Dr. Roy Levin, Department of Biomedical Science,University of Sheffield, Sheffield, UK.  “To widen the perspective we need to undertake breast and nipple behavior studies in groups of different ages and cultures.”

Dr. Cindy Meston, co-author of the research and Professor of Psychology, University of Texas, Austin, TX, USA stated that “nipple stimulation could be enhancing sexual arousal via numerous different hormonal and/or brain neurotransmitter pathways. The next step in this research is to try to understand the precise underlying mechanisms involved and whether they are the same for men and women. Such information would bring us a tiny bit closer to answering the bigger question of what exactly is sexual desire and arousal.”

“There are important take home messages from this study,” said Dr. Irwin Goldstein, Editor-in-Chief of The Journal of Sexual Medicine.  “The difference in responses between genders is the obvious take home message.  Just as important, this is one of the first studies to investigate the effect of non-genital stimulation on sexual arousal, written by a psychologist and a physiologist, an example of the broader, multi-disciplinary investigations being performed in contemporary sexual medicine research.  There is a paucity of basic science studies that explain the mechanism of these gender differences.”

The manuscript is published in The Journal of Sexual Medicine.

Stop smoking

In the first study of its kind, University of Pittsburgh psychologist and professor Saul Shiffman has discovered that people who are trying to quit smoking by wearing the nicotine patch are less likely to spiral into a total relapse if they keep wearing the patch, even if they’ve “cheated” and smoked a cigarette. The groundbreaking study, titled Analyzing Milestones in Smoking Cessation: Illustration in a Nicotine Patch Trial in Adult Smokers, will be published May 2 in the Journal of Consulting and Clinical Psychology.

Shiffman and his associates not only examined the treatment’s final outcome-the question of whether the patch worked-but also measured treatment milestones, such as momentary lapses, to try to find out more about why and how a nicotine patch works. Smokers in the study were using either a high-dose NicoDerm CQ nicotine patch (35 mg, 2/3 stronger than the currently marketed 21 mg patches) or a placebo patch. Using hand-held computers as electronic diaries, the 324 participants recorded exactly when they were craving a cigarette and if and when they lapsed and smoked one.

The resulting data showed that people who wore the active patch after lapsing were 4 to 6 times less likely to “cheat” again and again. The nicotine patch not only helped prevent slips, but also was more effective in preventing the slip from turning into a full relapse. Prior to this, people who slipped while trying to quit were considered “failures,” and no treatment was considered effective in helping ward off relapse. And, Shiffman calls the notion that a person who smokes while wearing a patch is risking a heart attack a “myth.”

The study also is significant because it analyzes mechanisms of action and could provide a better understanding of addiction treatment overall. It also offers insight on how different techniques could be effective in different phases of treatment. For people trying to quit smoking, the study has immediate implications: Use a patch. And, if you slip, stay with it.

Health and friendship

How can you help a friend who has a serious illness?

While family members typically provide the emotional support, friends are important too. Some people pull away from friends who are ill. It’s not that they don’t care, but often they don’t know what to say. The May issue of Mayo Clinic Health Letter offers ways to support friends who are ill.

Offer practical help, such as picking up groceries or dropping off library books. Organize friends and neighbors to regularly help with household chores.

Change your communication style. Phone calls may be better than visits. Find out if there’s a time of the day that’s generally best to talk on the phone. Talk about things that promote upbeat feelings. Be prepared for times when your friend isn’t up to talking.

Know when your friend is ready for visits. Call to set up a visit. Assure your friend it’s OK to change plans. Short, periodic visits may be best. When you visit, offer to bring along a treat to share so that your friend doesn’t feel obligated to prepare something. Don’t forget touch - a gentle hug or a handshake can be very reassuring. On an ill friend’s “good days,” offer to go for a car ride, coffee, lunch or a movie.

Gauge conversation to your friend’s condition. Sometimes a visit can be as simple as listening. Quiet time together is a form of companionship that good friends can share. Or, talk about things you have in common. If the situation warrants, seek out your friend’s advice or opinion. Your friend needs to feel valued and able to contribute to the relationship. And don’t be surprised if your friend is tired of talking about illness.

The person who’s sick may tend to push away those who want to help, not wanting to burden the friendship. As a friend, you’ll need to find the delicate balance between the space your ill friend needs and his or her emotional need for closeness. Achieving the balance can enrich both of your lives.