Healthy isn?t something you are or aren?t. It?s a hundred little things: eating a banana, walking in the park, putting a bandage on a boo-boo, playing tag, reading up on ways to keep you and your family well and safe. It?s a balance between living well and taking care, and you can start right where you are.
A blog by Christina Elston
Healthy isn't something you are or aren't. It's a hundred little things: eating a banana, walking in the park, putting a bandage on a boo-boo, playing tag, reading up on ways to keep you and your family well and safe. It's a balance between living well and taking care, and you can start right where you are.

Archive for March, 2012

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CDC Says Autism Spectrum Diagnoses Up 23 Percent

Thursday, March 29th, 2012

A study released today by the U.S. Centers for Disease Control and Prevention (CDC) estimates that one in every 88 children in the U.S. has been diagnosed with an autism spectrum disorder (ASD). This marks a 23 percent increase since the agency’s last report in 2009.

Based on 2008 surveillance in 14 different communities, the report included these findings:

Rates of diagnosis have risen. Nationwide 11.3 of every 1,000 8-year-old children in the current sample have been identified as having ASD. In the 2009 report, based on data gathered in 2006 the rate was just 9 of every 1,000. The rate has increased 78 percent since data were gathered in 2002, when there were 6.6 ASD diagnoses per 1,000 children. ASD rates in the current report ranged from one in 210 children in Alabama to one in 47 in Utah. The greatest increases in diagnosis were among Hispanic and black children.

Boys are diagnosed more often. Overall, one in every 54 boys in the current sample were diagnosed with ASDs, making the disorder five times more prevalent among boys than among girls.

Children are being diagnosed earlier. Early diagnosis is considered essential, as those diagnosed earliest respond best to treatment. Among children with ASD born in 2000, 18 percent were diagnosed by age 3, compared with just 12 percent of those born in 1994. Still, 40 percent of children in the current study weren’t diagnosed until after age 4.

Experts agree that some of the increase in ASD rates is due to changes in the way children are identified, diagnosed, and treated – though how much of the upsurge this accounts for remains unclear. “One thing the data tells us with certainty – there are more children and families that need help,” CDC Director Thomas Frieden, M.D., M.P.H., said in a statement as the report was released. “We must continue to track autism spectrum disorders because this is the information communities need to guide improvements in services to help children.”

Advice to parents, meanwhile, remains the same.

• Act quickly if you are concerned about your child’s development.

• Talk with your child’s doctor about your concerns.

• Call your local early-intervention program or school district for an assessment.

• Remember that you do not need a diagnosis in order to access services for your child.

Find more information about the study, and other aspects of ASD, at www.CDC.gov/autism. Tools to help families track their child’s development are available at www.CDC.gov/actearly.

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Pharmacies Handing Teens Misinformation, Not Plan B Contraception

Tuesday, March 27th, 2012

A new study finds that pharmacies often gave 17-year-olds wrong information about – and denied them access to – the emergency contraceptive sold under the brand name Plan B One Step. Meanwhile, doctors calling the same pharmacies got accurate facts.

Researchers from Boston Medical Center/Boston University School of Medicine orchestrated calls to 943 pharmacies, covering every pharmacy in Nashville, Tennessee; Philadelphia, Pennsylvania; Cleveland, Ohio; Austin, Texas and Portland, Oregon. Female callers posed first as 17-year-old girls, then two weeks later as physicians seeking advice for their 17-year-old patients.

Around 80 percent of the pharmacies reported having the drug, available over the counter to women ages 17 and older and by prescription to younger teens, in stock. But when callers posing as 17-year-olds asked if they could get the medication, 19 percent were told that they could not get it under any circumstances. Only 3 percent of callers posing as physicians were told their 17-year-old patients could not get the drug.

Almost 640,000 unplanned pregnancies occur in girls ages 15-19 in the U.S. each year.

The study didn’t look into reasons behind the misinformation, but the authors noted that “teen” callers spoke to people who identified themselves as pharmacists less often than “doctors” (3 percent vs. 12 percent of the time) and that other pharmacy employees might not be as well informed about rules for dispensing the medication, or might not want teens to have access.

“Given the history of emergency contraception, the politics around it and also the frequent changes to the dispensing regulations, there are lots of sources of misinformation,” says lead author Tracey Wilkinson, M.D., a general pediatrics fellow at the university.

Wilkinson says she doesn’t know of any national standard that determines who answers questions about medication at pharmacies. A representative from CVS Caremark, which claims to be the largest pharmacy health care provider in the U.S., says that a question about whether emergency contraception was in stock and at what age a person can purchase it without a prescription would not require a pharmacist to answer.

Wilkinson advocates improved education for pharmacy staff and adolescents, and says doctors could consider issuing prescriptions for teen patients even when they aren’t required by law, to help guarantee timely access.

Meanwhile, she is studying the possibility of providing the medication in advance to sexually active teenagers. “That way, they already have emergency contraception if they need it,” she says. “Because teenagers are at such risk for unplanned pregnancy, it is imperative that we figure out ways to guarantee them this safe and effective form of contraception.”

Her study appears in the March 26 issue of Pediatrics.

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Allergic To Peanuts or Tree Nuts? Know What One Looks Like?

Monday, March 26th, 2012

Just over 1 percent of us in the U.S. are allergic to peanuts or tree nuts, and much of the effort to protect those with allergies has been focused on food labeling and rules about food served in schools. It turns out one simple area has been neglected: Helping people identify the nuts in their raw form.

Adults and children in a study out this month from Ohio State University could identify fewer than half of nuts shown to them.

Stationed outside an exhibit at the Columbus Center Of Science and Industry, researchers convinced 649 adults and 456 children to try their luck identifying samples of peanuts, cashews, Brazil nuts, pistachios, almonds, pecans, walnuts, hazelnuts, Macadamia nuts and pine nuts. The 19 samples included nuts both in and out of the shell, whole, chopped, sliced or diced as they might appear in a grocery store.

On average, participants could identify just over 44 percent of the samples. Those with food allergies, or who were parents of children with food allergies, did no better than those without. Adults overall did slightly better than children. Peanuts in the shell were the easiest for people to identifiy, and hazelnuts in the shell proved toughest. The study was published in Annals of Allergy, Asthma & Immunology.

Lead author of the study Todd Hostetler, M.D., says nut knowledge in the general population could be even lower, as people who felt less confident in their success would be less likely to agree to take the survey. Either way, the results point to the need for better education for those with nut allergies and their families. In his allergy clinic, Hostetler says he uses the samples from the study to help his patients brush up on their nut identification skills, but he realizes this tool might be too clunky for mass production. A photo flip book or an online tool might be more practical.

“In my opinion, looking at real peanuts and tree nuts is better than looking at pictures,” he says, “but at this point any education done about this is better than none!”

Though most people with an allergy to peanuts and tree nuts are told to avoid all nuts, Hostetler says he and other allergists see many patients who accidentally ingest them anyway. “My hope is that the more educated patients and their families are about what peanuts and tree nuts look like, especially in different forms (e.g. which nuts are often slivered or often crushed) the more successful they will be at avoiding them,” he says.

 

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How often Do You Need a Pap Smear?

Friday, March 16th, 2012

The U.S. Preventive Services Task Force and the American Cancer Society agree on new guidelines for how, how often and at what ages women need to be screened for cervical cancer.

• Women under 21 do not need to be screened, even if they are sexually active.

• Ages 21 to 29 (except those with immune problems) should have a pap smear every three years. Testing for the human papillomavirus (HPV) isn’t recommended because infections are  common in this age group, but not persistent (and only persistent infections increase risk for cervical cancer).

• Ages 30 to 65 can opt for a pap smear plus a test for human papillomavirus (HPV) every five years.

• Ages 65 and older (with adequate previous screening) can discontinue screening.

• No one needs annual pap smears.

The American Cancer Society recommendation also addresses women who have had the HPV vaccine, advising that they continue routine screening because the vaccine doesn’t protect against all HPV strains associated with cancer, and the length of protection it does offer is still uncertain.

Why back away from yearly cervical testing for all? Experts say screening that often leads to more false-positive tests, overdiagnosis, and the risk of unnecessary treatment – without saving more lives.

The guidelines were released March 14.

An accompanying editorial in Annals of Internal Medicine adds some important food for thought. Approximately 50 percent of cervical cancer cases are diagnosed in women who have either never been screened, or have not been screened for five years or more. And the U.S. lags far behind Australia and the U.K. in promoting the HPV vaccine to young women at ages when it will protect them best – before they become sexually active. Only 32 percent of eligible women in the U.S. have received the full course of the vaccine. Improved efforts to protect young women, and to get all women screened regularly, would go a long way toward saving lives.

The editors also note that many women who do get screened use the annual occasion to check in with their doctors about lots of other health issues, and to get important advice. Even without the pap smears, this should continue. So when it comes to your GYN, don’t be a stranger. Annual pelvic and breast exams are still recommended.

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Animal Study Links Cell Phone Use In Pregnancy to Behavior Problems

Thursday, March 15th, 2012

Yet another study has emerged on the effects of cell phone radiation. Researchers at the Yale School of Medicine have found that exposing pregnant mice to radiofrequency radiation from cellular telephones impacted the behavior of their offspring.

The study’s authors are calling it the first experimental evidence that fetal exposure to cell phone radiation affects adult behavior. Prior cell phone research has focused mainly on the potential cancer risk that arises when body tissues absorb the radiation that the phones emit. Findings in that area have been inconsistent and several U.S. agencies – including the National Institute of Environmental Health Sciences, the Food and Drug Administration and the Centers for Disease Control – maintain that current science doesn’t conclusively prove any cancer risk from cell phone use.

In the pregnancy study, scientists exposed mice to radiation from a muted, silenced cell phone placed on an active call for the entire 19 days of their pregnancy; a control group of mice were kept under the same conditions but with the phone deactivated. The mice gave birth and when their mouse pups grew up, those exposed to radiation as fetuses tended to be more hyperactive and had higher levels of anxiety and lower memory capacity. The researchers theorize that this is because the radiation changed development of the prefrontal cortex regions of mice’s brains – the part that regulates decision-making and moderates social behavior.

ADHD in human children is associated with changes in the same brain region, and the same changes in behavior that the mice experienced. The researchers theorize that the rise in ADHD and other behavior disorders could be partially due to the fact that babies are increasingly exposed to cell phone radiation in the womb.

But they emphasize that mice are not humans. Mice are born with less-developed brains than are human babies, and further experiments are needed in humans or non-human primates to see if the results might be similar.

The study results are published in the March 15, 2012, issue of Scientific Reports, a Nature publication.

Meanwhile, large studies in humans in the U.S. and Europe continue to explore possible long-term health effects of cell phone use. These include the COSMOS study, which launched in 2010 and will follow 250,000 adult cell phone users for 20 to 30 years.

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At Least Half of Low-Cost Jewelry Has High Levels of Toxic Chemicals

Tuesday, March 13th, 2012

If you’re shopping for inexpensive trinkets for you and the kids at places like Claire’s, Big Lots or Justice, you could be getting a hazard you didn’t bargain for. A report released today by The Ecology Center, a Michigan-based nonprofit environmental organization found that at least half  the samples they tested contained high levels of one or more dangerous chemicals.

Purchasing 99 pieces of jewelry from Ming 99 City, Burlington Coat Factory, Target, Big Lots, Claire’s, Glitter, Forever 21, Walmart, H&M, Meijers, Kohl’s, Justice, Icing and Hot Topic, researchers tested each piece with an X-ray fluorescence analyzer. Overall, 59% of the products included one or more hazardous chemicals at high levels.

Lead was found in 27% of the pieces in levels higher than the Consumer Product Safety Commission’s (CPSC) limit for children’s products.

Cadmium was found in high levels in 10% of the products. The metal is a known carcinogen.

Arsenic was found in 13% of the products.

Mercury was found in 5% of the products.

Brominated flame retardants were found in 7% of the products.

PVC was found in one-third of the products.

The CPSC advises parents and caregivers not to let young children play with or wear cheap metal jewelry, as chewing or sucking on or swallowing these pieces could result in dangerous exposure to heavy metals. The commission does not regulate cadmium in children’s products, instead supporting a voluntary standard developed by the industry. California, Connecticut, Illinois, Maryland, Minnesota and Washington State have all moved to regulate cadmium at the state level.

Find more information on the specific pieces of jewelry tested, a video about the report, and the results, at HealthyStuff.org.

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Higher Doses of ADHD Drug Might Harm Learning

Monday, March 12th, 2012

A small study with monkeys found that the drug methylphenidate, the generic name for Ritalin, impairs memory at doses on the higher end of what children are prescribed to treat ADHD. The U.S. Centers for Disease Control (CDC) report that 5 percent of U.S. children are taking medications for the disorder.

The results of this study parallel those of a 1977 study conducted in children, but that researchers never managed to replicate – possibly because there are many more variables (background, living conditions) in dealing with children.

In the current study three monkeys were taught to focus their eyes on different dots on a screen in order to earn rewards. The monkeys were then given doses of methylphenidate at various levels.

At low doses, the monkeys’ performance improved because they were calmer and could control their impulses and focus on the task. At higher doses, the monkeys had more trouble performing the tasks – which the study’s authors say indicates a slight impairment in working memory.

Despite their low performance and lack of rewards, when the monkeys were given higher doses of the drug, they also stayed on task more than twice as long. Study author Luis Populin, Ph.D., a neuroscientist at University of Wisconsin-Madison, says that is likely because the monkeys’ ability to process information about the reward was impacted so that they no longer cared about performance. The effects of the drug lasted only for the day it was given, with no long-term impact noted.

Populin notes that some children on dosages of Ritalin high enough to reduce their hyperactivity say they feel less creative and spontaneous, like a robot. And on higher doses, the monkeys in the study acted “like robots, keeping at it for up to seven hours even though their performance was so low.”

If learning in a child drops off the way it did in the monkeys, a higher dosage might not be best for them.

“Based on our results, as well as those of previous studies in children,” says Populin, “we think parents should ask their doctors if they have taken into consideration the specific symptoms exhibited by the child, the age, body weight, etc., for prescribing a specific dose of the drug in question. We also think it would be important to ask children how they feel when they are on the drug and report that to the doctor.” The idea, he adds, is to find a dose that helps kids focus without impairing learning. “More isn’t always better,” he says.

The study appeared online in early March in the Journal of Cognitive Neuroscience.

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Just In Case You Thought Kids Didn’t Smoke Any More

Thursday, March 8th, 2012

A colleague was telling me this morning about how her 5-year-old pointed to the ashtray in their car and asked, “What’s that?” – a question unthinkable in our own smoky childhoods. But there’s evidence that not all kids are so healthily unaware of the trappings of tobacco.

Decades of hammering away at “kids shouldn’t smoke” campaigns, policing points of sale and regulating advertising and warning labels have made a dent. Smoking among ages 12-17 has continued to decline in the U.S. But that decline has slowed in the last decade, according the Surgeon General’s annual report, Preventing Tobacco Use Among Youth and Young Adults, released today. And the statistics are still fairly grim:

• More than 600,000 middle school students and 3 million high school students in the U.S. smoke today.

• For each of the more than 1,200 Americans a day who die due to smoking, at least two kids or young adults take up the habit.

• Nearly nine of 10 smokers started by age 18.

• Three of every four teen smokers end up smoking into adulthood, and a third will die prematurely from smoking.

Tobacco companies spend more than a million dollars an hour in the U.S. to market their products, and though they are banned from marketing directly to children, there is plenty of evidence their messages are getting through anyway. In 2010, for instance, nearly one third of top-grossing films produced for children (with ratings of G, PG or PG-13) contained images of smoking. And studies show that kids exposed to images of smoking in movies are more likely to smoke.

The report concludes that smoking early in life has immediate health risks to kids and teens, including reduced lung function and cardiovascular damage. The lung damage is permanent. Keeping young people from taking up the habit is critical, the report stresses – with the most success from a multi-component assault including mass-media campaigns, higher tobacco prices, smoke-free laws and programs in schools.

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Symptoms From Kids’ Concussions Could Linger For a Year

Tuesday, March 6th, 2012

Almost half a million kids under age 14 visit U.S. emergency departments each year because of mild traumatic brain injuries, otherwise known as concussion. And in some,  symptoms – especially difficulty paying attention and forgetfulness – could persist as long as 12 months after their injury, says a new study from Nationwide Children’s Hospital in Ohio.

Researchers looked at 200 children ages 8-15 who visited the Nationwide emergency department or Rainbow Babies and Children’s Hospital in Cleveland with a brain injury and 100 children who came in with bone injuries. They compared the two groups, using the children with orthopedic injuries as a control group, and interviewed their parents about symptoms common to head trauma before their children were injured, right after injury, and three and 12 months later.

Children with concussion – especially if they lost consciousness or had abnormalities on brain scans –were more likely to have both physical symptoms like headache and fatigue and cognitive symptoms like forgetfulness and lack of focus than were those with broken bones. And while the physical symptoms diminished over time, the cognitive symptoms lasted as long as a year.

The more severely a child who had concussion was injured, the more likely she or he was to have persistent symptoms. And when symptoms lasted at least three months, kids were more likely to need help in school.

Researchers say that while most children with concussion do just fine, it is important for healthcare providers to be able to identify children with mild traumatic brain injury who are most at risk for persistent symptoms, so that those kids can be monitored and receive the help they need.

The study appeared March 5 in Archives of Pediatrics & Adolescent Medicine.

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Does Snoring Lead to a Troubled Youth?

Monday, March 5th, 2012

Helping a young child whose snoring or apnea interferes with sleep could have implications well beyond some simple shuteye. Experts now believe that sleep-disordered breathing problems (SDB) beginning as early as 6 months can cause brain changes that lead to a host of behavior problems, including aggression or hyperactivity, later in childhood.

These brain changes could be permanent, and the behaviors they provoke might not show up until years later, making it all the more important to identify and treat children with snoring or sleep apnea – even in the first year of life.

A team of researchers from Albert Einstein College of Medicine in New York and the University of Michigan in Ann Arbor studied data on more than 11,000 children in England from the early to late 1990s. Parents were interviewed about their child’s breathing during sleep when their child was 6 months old, and several more times until their child reached age 7. They were asked whether their child snored, or whether they observed their children mouth-breathing at night or experiencing bouts of sleep apnea, where breathing during sleep pauses for 10 to 20 seconds or more.

These parents were also asked about their child’s behavior at ages 4 and 7.

The findings? Children experiencing sleep-related breathing issues were 20 percent to 60 percent more likely than other children to have problems such as hyperactivity, aggression, impulsiveness, or social withdrawal. By age 7, they were 40 percent to 100 percent more likely to have behavior problems. And the worse the sleep trouble (i.e. symptoms peaking when the child is around 2 ½ and persisting), the worse the behavior issues. Children with milder sleep issues, with symptoms that peaked at 6 or 18 months and then abated, also had fewer behavior issues.

The study was published online March 5 in Pediatrics.

Experts say that sleep-disordered breathing disrupts cellular and chemical processes in the brain, causing dysfunction of the prefrontal cortex – the part of the brain presiding over attention, executive functioning and self-regulation.

Previous studies have shown that sleep-disordered breathing occurs in 10 percent to 21 percent of children ages 6 months to 6 years. And 40 percent to 80 percent of the three million children in the U.S. receiving special education for a developmental disability also have attention-deficit/hyperactivity, the authors point out. Early identification and treatment of kids with SDB, they believe, could have a huge impact.

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