RSV to Blame for 1 in 13 Pediatrician Visits

(HealthDay News) -- It's called respiratory syncytial virus (RSV), a childhood infection that's responsible for one of every 13 visits to a pediatrician, and one of every 38 emergency room trips, a new study found. Read more

Hallucinations Are Rare Side Effects of ADHD Medications

(HealthDay News) -- Children who take medications for attention-deficit hyperactivity disorder (ADHD) may rarely experience some disturbing side effects, such as hallucinations.

U.S. government experts reviewed clinical trials and post-marketing reports of side effects from the commonly prescribed ADHD stimulant medications, such as Concerta, Ritalin and Strattera. They found that out of every 100 "person-years" of treatment, one or two children will experience serious side effects, such as hallucinations of bugs or snakes.

"Patients and physicians should be aware that psychosis or mania arising during drug treatment of attention-deficit hyperactivity disorder may represent adverse drug reactions, the study's authors wrote in the February issue Pediatrics.

"These reactions are very rare," said Dr. Roy Boorady, director of the psychopharmacology service at the New York University Child Study Center in New York City.

"We see a lot of children on medications here, and I would say maybe one a year or once every two years, we might hear about a child with tactile hallucinations, where kids feel like they have bugs on them. It's usually really young kids who are on medications, and once they back off or stop the medications, the sensation is gone," he said.

Almost 8 percent of children in the Unite States -- about 4.5 million -- have ever received a diagnosis of ADHD, according to background information in the article. And, it's estimated that 4.3 percent of American children are taking medications to treat ADHD. The main signs of ADHD are inattention, hyperactivity, and impulsiveness.

Concern about potential psychiatric side effects from these medications led to the current study.

The FDA experts reviewed the results of 49 randomized, placebo-controlled trials and asked drug manufacturers to analyze their post-marketing surveillance databases.

They found that 11 psychosis or mania episodes occurred for every 743 person-years of treatment. No episodes of psychosis or mania occurred in children taking placebo treatments. For every 100 person-years, the rate of psychosis or mania was 1.48, according to the study.

The post-marketing reports found more than 800 incidences of psychosis or mania. In about 90 percent of cases, there was no previous history of a similar psychiatric condition, the study found.

The most common hallucinations were visual or tactile sensations of insects, snakes or worms.

"Any medication has side effects, some of which are very, very rare," said Dr. William Cohen, a developmental-behavioral pediatrician in the Child Development Unit at Children's Hospital of Pittsburgh. "Whenever your child is taking any new medication, if something new starts, consider it a side effect and call your doctor. With these medications, it's safe to stop them and call your doctor."

Boorady said that sleep problems and a loss of appetite tend to be more common side effects of these types of medications. And he doesn't think parents should be overly concerned about the possibility of psychiatric symptoms, because they are so uncommon.

More information
The Nemours Foundation has more on ADHD medications and their side effects.

Pediatric MS Tied to Higher Relapse Rates

(HealthDay News) -- People who develop multiple sclerosis before age 18 tend to suffer almost three times the symptom relapses than those who develop the disease in adulthood, a new study says.

The study, headed by Dr. Mark P. Gorman of Brigham and Women's Hospital and Massachusetts General Hospital in Boston, found those who had MS as children experienced 1.13 relapses annually compared with 0.4 relapses for those who didn't develop the disease until adulthood.

Symptoms of MS, an inflammatory disease in which the protective coating covering nerve cells degenerates, usually first appears in people between ages 20 and 40. Fewer than 11 percent of MS patients report symptoms appearing before age 18, according to background information in the article, leading some to theorize that MS progresses slower in those who have it in childhood.

"The higher relapse rate in the pediatric-onset group in our study may therefore suggest that patients with pediatric-onset MS are coming to medical attention closer to the true biological onset of their disorder than patients with adult onset during a more inflammatory phase, as has been previously suggested," Gorman and colleagues wrote.

The findings were published in the January issue of Archives of Neurology.

More information
The U.S. National Institute of Neurological Disorders and Stroke has more about multiple sclerosis.

Health Tip: Obesity and Your Child

(HealthDay News) -- If your child is at an unhealthy, or even dangerous weight, and weight-loss efforts at home aren't successful, you may want to try a professional weight-loss program.

The Cleveland Clinic offers the following recommendations when choosing a child's weight-loss program:

• The program should employ an array of health professionals, including physicians, dietitians, psychiatrists and exercise physiologists.
• Your child's overall health should be evaluated before any weight-loss program begins.
• The program should include the entire family, rather than focusing only on the child.
• Look for a program that is geared specifically for your child's age group and has different programs based on age.
• Programs should focus on behavioral changes, teaching how to choose healthy foods in variety and portion size, and promoting physical activity.

For Some Animals, There's No Place at Home

(HealthDay News) -- Exposing your children to the joys of pet ownership may, in some cases, also mean exposing them to infections and injuries.

Parents need to be aware of the dangers -- including salmonella infection and even monkey pox -- of owning such nontraditional pets as rodents, reptiles, monkeys and more, says a report from the American Academy of Pediatrics (AAP) published in the October issue of Pediatrics.

The report is the first comprehensive statement on the topic, said study co-author Dr. Robert Frenck, a pediatrics professor at Cincinnati Children's Hospital and a member of the AAP committee on infectious diseases.

"Nontraditional pets are becoming more traditional, and nontraditional pets can expose kids to disease they otherwise might not be exposed to," Frenck said. "If parents are thinking about having these nontraditional pets, they may want to talk to a veterinarian and/or pediatrician first to see if there is any real concern."

Dr. Charles Miller, a professor of pediatric infectious diseases at the University of Miami Miller School of Medicine, added, "From the standpoint of public education and from the standpoint of not only pediatricians but also family practitioners, this is important."

The number of exotic animals in the United States has almost doubled since 2002. For instance, 40,000 households now harbor hedgehogs, while 4.4 million homes are home to reptiles, according to the report.

The risks are real. In 2003, a human monkey pox outbreak was traced back to imported African Gambian rats that had infected prairie dogs sold as pets. Small pet turtles were responsible for 103 cases of salmonella infection in the second half of last year, mostly in young children, the report found.

And just last week, an Iraqi dog recently shipped to the United States as part of an international animal rescue effort was found to have rabies. Twenty-four other animals in the shipment, already distributed to 16 states, were potentially exposed, according to the U.S. Centers for Disease Control and Prevention's Oct. 3 issue of Morbidity and Mortality Weekly Report.

The new AAP review details a number of diseases potentially transmitted by these more unusual pets: Reptiles have a high rate of carrying different strains of salmonella, as do turtles, baby poultry -- including chicks -- and hamsters.

Plague is carried by wild rodents and transmitted to humans handling infected animals -- including domestic cats -- that have been bitten by fleas. And macaque monkeys carry the herpes B virus.

And animals don't have to be in the home to pose a risk. More than 55 outbreaks of disease in humans, including infection with E. coli bacteria, involved animals in public settings from 1991 to 2005.

The report recommends frequent hand washing to help minimize these risks.

Children under 5 years old are at particular risk, partly because their immune systems are still developing. Adults with weakened immune systems, the elderly and pregnant women are also at greater risk.

Typically, allergies are associated more with cats and dogs than with nontraditional pets, said Dr. Jonathan Field, emeritus director of the pediatric allergy and asthma clinic at New York University/Bellevue Medical Center in New York City. The real problem comes with people who have weakened immune systems and are exposed to a bacteria or virus from one of these pets.

More information
To learn more, visit the U.S. Centers for Disease Control and Prevention's Healthy Pets Healthy People.

Study: Magnesium Sulfate Lowers Infant Risk of Cerebral Palsy

The common treatment to delay labor decreases preterm infant risk for cerebral palsy.

Preterm infants born to mothers receiving intravenous magnesium sulfate—a common treatment to delay labor—are less likely to develop cerebral palsy than are preterm infants whose mothers do not receive it, report researchers in a large National Institutes of Health research network. Magnesium sulfate is commonly known as Epsom salts.

The study results appear in the New England Journal of Medicine.

“A third of all cases of cerebral palsy are associated with preterm birth,” said NIH Director Elias A. Zerhouni, M.D. “This study shows a significant reduction in cerebral palsy among preterm infants whose mothers were given magnesium sulfate.”

The researchers theorized that magnesium sulfate protects against cerebral palsy because it can stabilize blood vessels, protect against damage from oxygen depletion, and protects against injury from swelling and inflammation.

Cerebral palsy refers to a group of neurological disorders affecting control of movement and posture and which limit activity. The brain may be injured or develop abnormally during pregnancy, birth or in early childhood. The causes of cerebral palsy are not well understood.

A 1995 study by NINDS researcher Karin Nelson, M.D., and a researcher at the California Department of Health Services found that mothers of preterm infants who did not have cerebral palsy were more likely to have received magnesium sulfate than were mothers of infants who had cerebral palsy. Two larger randomized studies that subsequently were undertaken suggested that magnesium sulfate given to pregnant women delivering prematurely might protect their infants against cerebral palsy, but their results were inconclusive.

“Our study is the largest, most comprehensive effort to date that looked at using this inexpensive and commonly used treatment to reduce the occurrence of cerebral palsy after preterm birth,” said Deborah Hirtz, M.D., a pediatric neurologist at NINDS, and an author of the study. “Cerebral palsy can’t always be prevented, but the data from our study and its predecessors will help obstetricians make informed treatment decisions for the women under their care.”

Women at the 20 participating NICHD Maternal Fetal Medicine Unit Network sites were eligible to participate. The women were from 24 to 31 weeks pregnant and at risk for preterm delivery. When the women went into labor, they were assigned at random to receive intravenously a solution of either magnesium sulfate or a placebo. The women in the treatment group were given 6 grams of magnesium sulfate intravenously over 20 to 30 minutes, followed by 2 grams of magnesium sulfate every hour after that until either 12 hours had passed, labor had subsided, or they had given birth. If the women in either group did not deliver within 12 hours, they were treated again if they went into labor by the 34th week of pregnancy.

For purposes of their statistical analysis, the researchers calculated the rates of moderate cerebral palsy, severe cerebral palsy, and death among the infants in the study. The study authors did not include mild cerebral palsy in this calculation, as mild cerebral palsy will often disappear with time.

When the researchers considered only moderate and severe cerebral palsy together, cerebral palsy occurred less frequently in the magnesium sulfate group (1.9 percent) as compared to the placebo group (3.5 percent).

For their primary calculation, the researchers grouped the proportions of infants with moderate and severe cerebral palsy together with the proportion of infants who died. The researchers included the death rate in this primary calculation, because mortality among preterm infants is very high. The researchers found that a total of 11.3 percent of infants in the magnesium sulfate group had either moderate or severe cerebral palsy, or had died at birth or were stillborn. In contrast, a total of 11.7 percent of the infants in the placebo group had moderate to severe cerebral palsy or had died.

The proportion of deaths occurring in the magnesium sulfate group (9.5 percent) did not differ significantly from those in the placebo group (8.5 percent).

There was no difference in the average gestational age between the two groups of infants.

Cerebral palsy was diagnosed in 41 children from 942 magnesium sulfate-treated pregnancies, as compared to 74 children from 1,002 placebo-treated pregnancies. Of the children in the magnesium sulfate group, 2.2 percent had cerebral palsy classified as mild, 1.5 percent as moderate, and 0.5 percent as severe. A higher proportion of children in the placebo group than in the magnesium sulfate group had cerebral palsy. Of the children in the placebo group, 3.7 percent had mild cases of cerebral palsy, 2.0 percent had moderate cases, and 1.6 percent had severe cases.

“This is a major advance,” said Catherine Y. Spong, M.D., Chief of NICHD’s Pregnancy and Perinatology Branch and an author of the study. “Our results show that obstetricians can use magnesium sulfate, which they have experience prescribing, to reduce the risk of a devastating condition, cerebral palsy, in preterm infants.”

Source
New England Journal of Medicine
National Institutes of Health

Health Tip: If Your Child Wears Glasses

(HealthDay News) -- If your child has been prescribed glasses, you may have a difficult time getting your child to wear them.


The Children's Physician Network offers these suggestions:

• Let your child choose the frames, and be sure to give lots of compliments on how great they look.


• Start out having your child wear the glasses for short periods, until they become more comfortable.


• Encourage your child to wear glasses while doing something enjoyable, such as watching a movie or reading a book.


• Don't nag the child about wearing glasses, but praise them when they do.


• Wearing glasses should be part of the daily routine, much like teeth brushing or getting dressed.


• Mention sports heroes, actors or family members who wear glasses.

Workshop Helps Parents, Kids Talk About Sex

(HealthDay News) -- Teach parents how to talk about sex with their teen, and they will tackle this tough subject more readily and often, a new study says.

The study, published online July 11 in British Medical Journal, evaluated a workshop-based program called "Talking Parents, Healthy Teens" aimed at parents of 6th- to 10th-graders. In eight weekly, hour-long sessions, the parents use role-playing and other interactive exercises to learned techniques for starting and sustaining conversations on sex in everyday situations. The parents were also instructed on how to listen to their children without interrupting or lecturing, and how to teach decision-making and assertiveness skills to their kids.

The program also recognized diverse views on sex that parent might have. For example, one session covered both abstinence and condom use for teens.

"The great thing was that the parents really learned," lead researcher Dr. Mark A. Schuster, chief of general pediatrics and vice chairman for health policy research at Children's Hospital Boston, said in a news release issued by the hospital. "We'd teach them some skills one week, and they'd come back the next week, bubbling over with excitement that they'd talked with their teen about relationships, love or sex, and this was the best part: Their teen had actually engaged in a real conversation with them, or role-played a topic like how to say no to unwanted sexual advances."

Several surveys done after the program reported the participants said they had more dialogues about sex with their kids than ever before and were also better able to discuss sex openly with their children.

Similar follow-ups with the participant's children agreed. For example, they reported in a survey done one week after the classes concluded that 18 percent of their parents had gone over how to use a condom, compared with 3 percent of the parents in a control group. Nine months after the sessions ended, this gap had grown to 25 percent versus 5 percent.

The researchers held the program sessions during lunch breaks at large private and public companies, a strategy designed to draw more parents to the program through convenience alone.

"Many employers provide programs to help employees lose weight or stop smoking," Schuster said. "We wanted to see if we could apply worksite health promotion principles to help parents address their kids' sexual health. It turned out that employers loved the idea. They are under pressure to create family-friendly workplaces. And they're often providing the health insurance for these kids, so they are concerned about lost productivity when parents are distracted with their kids' sexual health issues."

More information
The U.S. Department of Health & Human Services has more about talking to your child about sex.

Telemedicine a Cost-Effective Alternative to ER Visits

(HealthDay News) -- Telemedicine is a cost-effective way to replace more than a quarter of all visits to the pediatric emergency department, according to a community-wide study conducted in New York.

Ailments, such as ear infections or sore throats, that virtually always prove manageable by telemedicine made up almost 28 percent of all pediatric ER visits in Rochester, N.Y., during one year, according to investigators from the University of Rochester Medical Center.

Their findings were presented recently at the 2008 Pediatric Academic Societies annual meeting, in Honolulu.

"We learned that more than one in four local patients are using the pediatric emergency department for non-emergencies," lead investigator Dr. Kenneth McConnochie, a professor of pediatrics at the University of Rochester's Golisano Children's Hospital at Strong, said in a prepared statement. "This mismatch of needs and resources is inefficient, costly and impersonal for everyone involved."

McConnochie and his colleagues, who direct a Rochester-based telemedicine program that provides interactive, Internet-based pediatric health-care service to the area, analyzed data for all pediatric visits to the largest emergency department in the city. Based on their experience, they determined at least 12,000 visits were ones they routinely treat with success via telemedicine.

The other visits were either problems that sometimes are treatable through telemedicine, such as asthma attacks; or ones beyond the scope of the technology, such as a serious wound or injury.

"This would've not only freed up emergency resources to people who needed them more, it would have afforded smaller co-pays for parents and more timely, personalized care," McConnochie said.

In related research presented at the meeting, McConnochie suggested that telemedicine could also help insurers and the community by providing better quality care at a lower price -- saving insurers more than $14 per child per year in that local community.

The conclusion was reached by studying two groups of children that were almost identical, but one had access to their doctor's office, the emergency department and telemedicine technology for care, while the second had only the first two options.

"We found that the first group of families, which had access to telemedicine for their children, did in fact access care for illness overall nearly 23 percent more often than the second group," McConnochie said.

But since children with telemedicine access had 24 percent fewer ER visits, which cost about seven times the cost of a doctor office or telemedicine visit, the telemedicine group ultimately still cost insurers less per child over a year.

More information
The Nemours Foundation has more about children's health.

ADHD Drugs Won't Raise Risk of Substance Abuse

(HealthDay News) -- Parents of children who are prescribed psychostimulants for attention deficit-hyperactivity disorder (ADHD) might have one less thing to worry about now that a new study concludes these kids are no more likely than their peers to abuse drugs and alcohol as young adults.

The report, which was funded by the National Institutes of Health, is published in the March issue of the American Journal of Psychiatry.

"The results should reassure clinicians who might be hesitant to treat ADHD because of concerns about future substance abuse," said study co-author Michael C. Monuteaux, assistant director of research at the pediatric psychopharmacology program at Massachusetts General Hospital.

Past research looking for a link between ADHD medications and substance abuse has produced conflicting conclusions.

"Some previous studies showed an increased risk of substance abuse associated with stimulant treatment, and other studies showed both no association and also a protective effect from treatments," Monuteaux said. "But those studies had some methodological limitations, and not all of them followed their samples well into late adolescence and early adulthood."

The Massachusetts General Hospital investigators designed their study to overcome the shortcomings of previous studies. They followed their research subjects up to a median age of about 22, included an assessment for psychiatric problems such as conduct disorder that are associated with substance abuse, and applied rigorous methods to accurately analyze data.

The research study team interviewed 112 young men (ranging in age from 16 to 27) a decade after they had been diagnosed with ADHD about their use of alcohol, tobacco and a variety of psychoactive drugs. Seventy-three percent of the subjects had been treated with stimulants at some time, and 22 percent were currently taking the stimulant medications.

The study found no relationship between having ever received stimulant treatment and the risk of future alcohol or other substance abuse. The age at which stimulant treatment began and how long it continued also had no impact on substance use.

"This study is a continuing effort to explicate the factors that mediate risk. It is methodologically sound and suggests that, as always, things are more complicated than we want them to be. The study demonstrates that the use psychostimulants for ADHD children do not increase the risk for substance abuse in adulthood, but it also suggests there is no protective effect, said Dr. Jon A. Shaw, director of the Division of Child and Adolescent Psychiatry and Behavioral Science at the University of Miami.

Symptoms of ADHD include impulsiveness, hyperactivity and inattention. According to a study published last fall in the Archives of Pediatrics & Adolescent Medicine, almost 9 percent of American children have ADHD, but only 32 percent of them are getting the medication they need.

"There is sufficient evidence that parents should be reassured that the use of psychostimulant medication for the treatment of ADHD in children and adolescents does not increase the risk for substance abuse in later life and remains the most effective treatment for this condition," Shaw said.

More information
For more on ADHD, visit the National Institute for Mental Health.

New Hope for Depressed Teens

(HealthDay News) -- If a depressed teen doesn't respond to treatment with commonly prescribed antidepressants the first time around, new research suggests there's still hope.

Switching medications and adding behavioral talk therapy turned out to be the most effective alternative, although just switching medications also helped many individuals.

"On average, these kids were ill for two years and no matter which treatment they got, at least 40 percent responded within 12 weeks," said study author Dr. David Brent, a professor of psychiatry at the University of Pittsburgh School of Medicine. "I really think the take-home message to families is if you don't respond to the first treatment, don't give up."

The study appears in the Feb. 27 issue of the Journal of the American Medical Association.

The issue of whether depressed or troubled children should even take antidepressants has been at the center of an intense public debate in recent years.

Some research has turned up evidence that kids on antidepressants have a higher rate of suicide ideation, meaning suicidal thoughts and behavior.

Heeding this data, the U.S. Food and Drug Administration in 2004 asked manufacturers of antidepressants to add a black-box warning to their labels warning about the increased suicide risk.

Recent research, however, has found that the benefits of antidepressants outweigh the risks for children and teens under the age of 19.

About 60 percent of adolescents with depression respond to treatment with antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

Guidelines recommend prescribing SSRI medications, psychotherapy or both as a first-line treatment for this younger population. (The only SSRI approved by the FDA for use in pediatric patients is Prozac, but others are prescribed on an off-label basis).

Unfortunately, 40 percent do not respond to the first therapy they try, and there's little guidance on what to do next.

"There's just not that much research in kids, period," said Dr. Jane Ripperger-Suhler, an assistant professor of psychiatry and behavioral science at Texas A&M Health Science Center College of Medicine and a psychiatrist with Scott & White Mental Health Center in Temple.

For this latest study, the researchers chose 334 patients aged 12 to 18 years, all of whom had major depressive disorder and had not responded to two months of SSRI treatment. They were randomly selected to receive one of four treatment possibilities for 12 weeks: a second, different SSRI; a different SSRI plus cognitive behavioral therapy; Effexor (a serotonin-norepinephrine reuptake inhibitor, or SNRI); or Effexor plus cognitive behavioral therapy.

While the drugs were taken for 12 weeks; therapy lasted nine sessions.

There was a 54.8 percent response rate among those teens who switched to talk therapy plus either medication, compared to 40.5 percent for a medication switch alone.

There was no difference in response rates between Effexor and a second SSRI. However, there was a greater increase in blood pressure and pulse and more frequent skin problems with Effexor than the other drugs.

Ripperger-Suhler said that every time she puts a teen on an antidepressant, she refers them for therapy anyway. The results of this trial might prompt primary-care doctors, who are more apt to write a prescription and do nothing else, to also recommend therapy, she said.

One caveat, however, is that there are few really good cognitive behavioral therapists out there, nor is there any way to distinguish clearly among them, Ripperger-Suhler stated. "To do cognitive behavioral therapy effectively you really need someone who is well-trained and there aren't very many," she said.

But other types of talk therapy might also be effective, she added.

More information
Visit the U.S. National Institute of Mental Health for more on adolescent depression.

Gene Variations Help Regulate Response to Stress

(HealthDay News) -- Certain variations in a gene that helps regulate stress response offer protection against depression in adults who suffered abuse when they were children, a new study says.

Adults who were abused as children and didn't have the protective variations of the CRHR1 gene had twice the symptoms of moderate to severe depression, compared to those with the variations.

The researchers interviewed more than 400 adults and tested their DNA. About one-third of them had the protective variations in the gene that produces CRHR1, a receptor for the stress hormone corticotropin-releasing hormone (CRH).

Extreme stress in childhood, brought on by factors such as abuse, can hyper-activate the hormone system that regulates stress response, leading to an increased risk of depression in adulthood, the researchers said.

"Our results suggest that genetic differences in CRH-mediated neurotransmission may change the developmental effects that childhood abuse can have on the stress hormone system -- developmental effects that can raise the risk of depression in adults," Dr. Kerry J. Ressler, of Emory University, said in a prepared statement.

"We know that childhood abuse and early life stress are among the strongest contributors to adult depression, and this study brings to light the importance of preventing them," Ressler said. "But when these tragic events do occur, studies like this one ultimately can help us learn how we might be able to better intervene against the pathology that often follows."

The study, funded by the U.S. National Institute of Mental Health (NIMH), is published in the current issue of the journal Archives of General Psychiatry.

NIMH Director Dr. Thomas R. Insel said in a prepared statement: "People's biological variations set the stage for how they respond to different environmental factors, like stress, that can lead to depression. Knowing what those variations are eventually could help clinicians individualize care for their patients by predicting who may be at risk or suggesting more precise avenues for treatment."

More information
Mental Health America has more about depression.

Diabetes Group Backs Low-Carb Diets

(HealthDay News) -- For the first time, the American Diabetes Association (ADA) has come out in support of low-carbohydrate diets for people with diabetes who want to manage their weight.

The ADA voiced its support of low-calorie or low-carbohydrate diets in its newly published 2008 clinical practice recommendations.

The recommendations are intended to help physicians guide their patients in diabetes prevention and management.

The ADA estimates that more than 20 million children and adults are living with diabetes in the United States. However, about one-third of those people have the disease but have not yet been diagnosed, according to the association.

Prior to the release of the 2008 recommendations, the ADA did not support low-carbohydrate diets for diabetes management due to a lack of evidence supporting their safety and effectiveness.

Whether a person can stick with a diet is more important than the diet's theme, according to the association. Low-carbohydrate and low-calorie diets are equally effective in helping people lose weight over a year. However, the recommendations do also include guidelines for monitoring the lipid profiles and kidney health of people who choose a low-carbohydrate, high-protein diet.

The recommendations continue to support sustained, moderate weight loss and increased physical activity for people who are overweight, obese, living with diabetes or at risk for becoming diabetic.

"The risks of overweight and obesity are well-known. We recognize that people are looking for realistic ways to lose weight," Ann Albright, president of health care and education for the ADA, said in a prepared statement. "The evidence is clear that both low-carbohydrate and low-fat calorie restricted diets result in similar weight loss at one year. We're not endorsing either of these weight-loss plans over any other method of losing weight. What we want health-care providers to know is that it's important for patients to choose a plan that works for them, and that the health-care team support their patients' weight-loss efforts and provide appropriate monitoring of patients' health."

Being overweight and physically inactive both increase the risk of type 2 diabetes, according to the ADA. Being overweight or obese also make the treatment of type 1 and type 2 diabetes more difficult. The 2008 recommendations state that all adults who are overweight and have an additional risk factor for diabetes should be tested for diabetes or pre-diabetes.

According to the U.S. Centers for Disease Control and Prevention, people who have pre-diabetes can avoid diabetes if they lose 7 percent of their body weight and get more than 150 minutes of activity a week.

Developing and maintaining a disaster kit for diabetes self-management is also included in the new recommendations, along with revised guidelines for care of diabetes in older adults.

More information
To learn more about diabetes, visit the U.S. Centers for Disease Control and Prevention.

Cancer Killed Almost 8 Million Worldwide in 2007

(HealthDay News) -- Cancer continues to cut a deadly swath across the globe, with the American Cancer Society reporting 12 million new cases of malignancy diagnosed worldwide in 2007, with 7.6 million people dying from the disease.

The report, Global Cancer Facts & Figures, finds that 5.4 million of those cancers and 2.9 million deaths are in more affluent, developed nations, while 6.7 million new cancer cases and 4.7 million deaths hit people in developing countries.

"The point of the report is to promote cancer control worldwide, and increase awareness worldwide," said report co-author Dr. Ahmedin Jemal, director of the society's Cancer Occurrence Office.

The number of cancers and cancer deaths around the world is on the rise, Jemal said, mostly due to an aging population. "There is increasing life expectancy, and cancer occurs more frequently in older age groups," he noted.

Lifestyle may be another reason for the rise in malignancies in developing countries, Jemal said, as people adopt Western behaviors such as smoking, high-fat diets and less physical activity.

The best way to stem the increasing number of cancer cases and deaths is prevention, especially in poorer countries, the expert said. In many developing nations, the health-care infrastructure simply isn't there to offer cancer screening and treatment for most people, Jemal added.

In developed countries, the most common cancers among men are prostate, lung and colorectal cancer. Among women, the most common cancers are breast, colorectal and lung cancer, according to the report.

However, in developing countries the three most common cancers among men are lung, stomach and liver, and among women, breast, cervix uteri and stomach.

Worldwide, some 15 percent of all cancers are thought to be related to infections, including hepatitis (liver cancer) and human papilloma virus (cervical cancer). But the incidence of infection-related cancers remains three times higher in developing countries compared with developed countries (26 percent vs. 8 percent), according to the report.

In addition, cancer survival rates in many developing countries are far below those in developed countries. This is mostly due to the lack of early detection and treatment services. For example, in North America five-year childhood cancer survival rates are about 75 percent compared with three-year survival rates of 48 percent to 62 percent in Central America, the report notes. The report estimates that 60 percent of the world's children who develop cancer have little or no access to treatment.

The report also includes a section on the toll tobacco use takes around the world. In 2000, some 5 million people worldwide died from tobacco use. Of these, about 30 percent (1.42 million) died from cancer -- 850,000 from lung cancer alone.

Jemal believes smoking is a key culprit.

"Smoking prevalence is decreasing in developed countries. So, as tobacco companies are losing market in developed countries they are trying to expand their market in developing countries," he said.

In China alone, more than 350 million people smoke. "That's more than the entire population of the United States," Jemal said. "If these current patterns continue, there will be 2 billion smokers worldwide by the year 2030, half of whom will die of smoking-related diseases if they do not quit," he added.

In the 20th century, tobacco use caused about 100 million deaths around the world. In this century, that figure is expected to rise to over 1 billion people. Most of these will occur in developing countries.

One expert agreed that many cancer deaths can be avoided through lifestyle changes.
"What is most provocative here is not the total global burden of suffering and death cancer causes, dramatic though that may be, but the variations in cancer occurrence around the world, and the insights provided about how much of the cancer burden need not occur at all," said Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine.

In developing countries, cancer of the uterine cervix is a leading cause of death in women, Katz noted.

"Yet this infection-related cancer is now preventable by vaccine, and long treatable when detected early using the Pap smear. As a result, death from cervical cancer in developed countries is dramatically lower. Its toll in the developing world is testimony to missed opportunities to apply our resources effectively, and equitably," he said.

Cancer of the liver, often related to hepatitis infection, is a leading cause of death in developing countries, but not so in developed countries. "Again, an infection preventable with vaccine is causing death because of inequities in the distribution and use of existing resources," Katz said.

Prostate and colon cancers are more common in wealthier countries, where they are likely related to poor diet and obesity, Katz said. "Unnecessary suffering and death are occurring in affluent countries due to dietary excesses," he said.

Katz also noted that tobacco-related cancer is largely preventable. "The toll of tobacco-related disease, including lung cancer, is an appalling example of a global willingness to tolerate preventable suffering and death for the sake of profit," he said.

These data show both developed and developing countries how to move toward the lower rates of specific cancers, Katz said.

"It will be a tragic failure for public health if instead of applying these lessons developed countries continue to export tobacco and dietary transgressions so that the developing world adds to its current cancer burden ours as well," he said.

More information
For more information on cancer, visit the American Cancer Society.

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Health Tip: Break the Habit of Thumb Sucking

(HealthDay News) -- Babies and young children satisfy the natural reflex to suck by sucking on pacifiers, fingers or thumbs. However, thumb sucking can affect the alignment of permanent teeth as they grow in.

While most children will stop the habit on their own between the ages of 2 and 4, others may need help. Here are suggestions to help your child stop sucking his or her thumb, courtesy of the American Dental Association:

• Don't scold the child when they do suck the thumb, but praise him or her when they aren't doing it.
• If your child sucks the thumb when anxious, upset or frightened, try to resolve the root of the anxiety.
• For a child old enough to understand, let him or her decide on how to break the habit.
• Have your child talk to the doctor or dentist about the damage that can be done by continuing to suck the thumb.
• Try wrapping the thumb in a bandage, a sock, or coating it with a bitter-tasting solution.

Teens' Cell Talk at Night Can Be Tiring

(HealthDay News) -- If your kids are falling asleep in their morning cereal, check their cell phones -- even a tiny bit of nighttime chatting might be robbing them of needed sleep.

A new study found that teens who reported using their cell phones after bedtime just once a month nearly doubled their odds of being very tired a year later. Those who gabbed away after lights out once a week were more than three times as likely to be tired.

The study only looked at students in Flanders, Belgium. But one U.S. pediatrician said the findings probably hold true for American kids, too.

"You have a population that's always tired to begin with," said Dr. Irwin Benuck, an attending physician at Children's Memorial Hospital in Chicago. Add nighttime cell-phone use to the mix, and the findings are "very predictable and not surprising," added Benuck, who's familiar with the study.

Study author Jan Van den Bulck, a researcher at Katholieke Universiteit Leuven in Belgium, surveyed 1,656 secondary school students; the average age in one group was 13.7 years and 16.9 years in the other.

Only 38 percent of the teens surveyed said they never used their cell phones after bedtime. Using the phone right after lights out increased the risk of being "very tired" a year later by 2.2 times; those who talked or text messaged between midnight and 3 a.m. raised their risk nearly fourfold.

Van den Bulck blamed cell phone use for tiredness in about one-third of all the children. "There is no safe dose and no safe time for using the mobile phone for text messaging or for calling after lights out," Van den Bulck wrote in the study.

In an interview, the author said parents may be in the dark about the nighttime activities of their kids. "It is a very typical phenomenon -- kids grow up with new technologies that adults discovered at a much later age, and, as a result, they use these technologies in ways adults can't even imagine," Van den Bulck said. "Concerned parents often think they know what their kids are up to, but often they don't."

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Why would using a cell phone just once a month raise the risk of tiredness? "Possibly kids who say they don't use their phone underestimate the real frequency of the behaviors. Or maybe once you've started considering using the phone, you remain 'switched on,' " Van den Bulck said. "After all, don't forget that cell phone use requires at least two people. People who call may expect to be called as well -- even if you don't call much, you may still end up being awake, awaiting a potential call."

So what's a parent to do? Simple, Van den Bulck said: Restrict or forbid cell phone use after bedtime. "To teenagers, I would say: Be strong! You may feel that you need to stay connected with your friends all night, but you gain nothing by tiring yourself out, which is what you would be doing."

The study is published in the Sept. 1 issue of the journal Sleep.

More information
Learn more about kids and sleep from the Nemours Foundation.

Drinking Often Spurs Move to Poorer Neighborhoods

Alcoholism a common trigger for downward social mobility, study confirms
By Randy DotingaHealthDay Reporter

TUESDAY, Aug. 28 (HealthDay News) -- While alcoholism and living in a downscale neighborhood often go together, a new study finds that it is the problem drinking that usually comes first.

"The more alcohol problems a man has, the more likely he is going to remain in, or migrate into, a disadvantaged neighborhood," according to a team of University of Michigan researchers. They report their findings in the September issue of Alcoholism: Clinical & Experimental Research.

"It can be kind of bleak when you look at it, but we know that alcoholics are prone to a whole range of negative consequences," added Ryan Trim, a research psychologist at the VA San Diego Health Care System who's familiar with the findings.

Experts have looked at the connections between neighborhoods and alcohol use in the past, but they've tended to focus on how bad neighborhoods might help produce alcoholism, Trim said.
He said the new study is unusual, because it looks at the link from the other direction: whether alcohol use makes people more likely to migrate to worse areas.

In the study, the University of Michigan team looked at a sample of 206 white men -- average age 33 -- from a four-county area. The region was not disclosed.

Some of the participants were recruited through court records about drunk-driving arrests, and researchers considered them to be either "probable" or "definite" alcoholics. For comparison purposes, the other men in the study were not alcoholics. All the men lived with their children.

The researchers followed the men for 12 years, checking in with them every three years.

After adjusting their figures to account for factors such as poverty level and antisocial behavior, the researchers found that the more trouble a man had with alcohol, the more likely he was to move to, or reside in, a poorer neighborhood.

It's not clear if alcoholism has the same impact on women. However, "the effects may be even stronger on women, because alcoholic women have a high tendency to marry alcoholic men," study co-author Anne Buu, a research investigator of psychiatry at the University of Michigan, noted in a statement. The involvement of both partners with alcohol abuse could speed up any downward social drift, she said.

Recovering alcoholics, however, weren't any more likely than non-alcoholics to live in disadvantaged neighborhoods. That suggests that "if you do have problems, and you're able to stick with [recovery], you won't be at any greater risk for this downward drift into bad neighborhoods," Trim said.

The findings weren't a big surprise, said Aaron White, an assistant professor of psychiatry at Duke University who studies alcohol use.

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"Every now and then, a study will come out that confirms something that most of us know intuitively," said White. There's "no question that alcoholism affects quality of life. The data in this study point to one of the ways that alcohol affects quality of life -- by influencing the type of neighborhood a person lives in."

The study is also useful "from the standpoint that the data confirm what most of us would have suspected anyway," he said. It's "not groundbreaking by any stretch of the imagination but a worthwhile contribution to the knowledge base."

And there's good news: The study provides "additional evidence that sobering up is good for people with alcohol problems," White said.

More information
Learn more about alcohol use from the U.S. National Institutes of Health.

Many Parents Share Genetic Test Findings With Kids

(HealthDay News) -- As genetic testing for diseases becomes more commonplace, the impact of those findings on family members may be underestimated, researchers say.

For instance, some women who discover they have the BRCA gene mutation, which puts them at higher risk for breast cancer, choose to tell their children about it before the children are old enough to understand the significance or deal with it, a new study found.

"Parents with the BRCA mutation are discussing their genetic test results with their offspring often many years before the offspring would need to do anything," said study author Dr. Angela Bradbury, director of the Fox Chase Cancer Center's Family Risk Assessment Program, in Philadelphia.

According to Bradbury, more than half of parents she surveyed told their children about genetic test results. Some parents reported that their children didn't seem to understand the significance of the information, and some had initial negative reactions to the news.

"A lot of genetic information is being shared within families and there hasn't been a lot of guidance from health-care professionals," Bradbury said. "While this genetic risk may be shared accurately, there is risk of inaccurate sharing."

In the study, Bradbury's team interviewed 42 women who had the BRCA mutation. The researchers found that 55 percent of parents discussed the finding and the risk of breast cancer with at least one of their children who was under 25.

Also, most of the women didn't avail themselves of the services of a doctor or genetic counselor in helping to tell their children, Bradbury's group found.

Bradbury is concerned that sharing genetic information with young children can create anxiety. "The children could be overly concerned about their own risk at a time when there is nothing that they need to do," she said.

But, she added, "it may be possible that sharing may be good for children in adapting to this information."

The findings are published in the Aug. 20 issue of the Journal of Clinical Oncology.
The lack of definitive data on when -- or if -- to discuss genetic test results with children is a real problem, Bradbury said.

"As we move genetic testing forward for cancer or other illnesses, we have to consider the context of the whole family and focus our counseling to the whole family, and not just the person who comes in for testing," Bradbury said. "We should learn more about how and when we should talk to children about this, so that we can promote healthy behaviors without causing too much anxiety for the offspring."

Barbara Brenner, executive director of Breast Cancer Action, agreed that the psychological component of genetic testing needs more attention.

"This is the tip of a very scary iceberg," Brenner said. "We don't know the psychological consequences [of BRCA testing], not only to the person who has the test, but to her family members."

Brenner thinks guidelines to help parents deal with this information are needed. So is help from doctors and genetic counselors in counseling family members, especially children, she added.

More information
For more on genetic testing, visit the U.S. National Library of Medicine.

Web Sites Serve Up Dangerous Eating Disorders Advice

(HealthDay News) -- They're called pro-eating disorder Web sites. And many teens looking to lose weight -- even those who don't need to -- are logging on to these communities of individuals who engage in dangerous eating habits.

Yet many parents aren't aware the sites even exist and that their children are visiting them, researchers have found.

"Most parents would not endorse their child leaving the house at night, walking to an area of town that they themselves had never been in and meeting people that they themselves had never met," said study author Dr. Rebecka Peebles, an instructor in adolescent medicine at Lucile Packard Children's Hospital at Stanford University School of Medicine. "And I think that's actually what a lot of kids are doing online at home from their bedrooms."

Potentially dangerous venues include Web sites where people who engage in disordered eating gather to discuss their activities. A majority of these sites have sections where members of the community share tips and techniques "that I would consider as a physician fairly harmful," Peebles said.

Complicating matters, "pro-recovery" sites that promote recovery from eating disorders can also be a source of weight-loss or purging techniques, the researchers found.

Peebles and her colleagues sent questionnaires regarding Internet use and eating disorder information to the parents of almost 700 people who had been evaluated for an eating disorder at Lucile Packard Children's Hospital between 1997 and 2004. A total of 182 responded, including 76 teens and 106 parents.

Forty-one percent of the patients had visited a pro-eating disorder (pro-ED) Web site, while 36 percent had visited a pro-recovery Web site.

One of the problems, Peebles explained, is that even forums designed to disseminate helpful information are constantly changing and may contain content that wasn't the author's original intent. "In our study, we did find that 96 percent of patients who visited pro-ED Web sites reported learning dieting tips and purging techniques from Web sites," she said. "However, nearly half of the people who visited pro-recovery Web sites also reported learning similar tips and techniques."

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A majority of parents (52 percent) didn't know whether their children visited pro-eating disorder Web sites, and 62.5 percent had no knowledge of pro-recovery sites. Half of parents of users of pro-eating disorder Web sites either didn't know whether their child visited these sites while in treatment or thought their child did not use these sites.

Peebles said the findings, published in the journal Pediatrics, underscore the need for parents to educate themselves about the Internet as a medium, so they can make consistent choices about guiding their teens' Web activity.

"I think a lot of parents are deciding by default not to be involved in their kids online activities really, just because Google, in and of itself, is scary to them," she said.

"Most of our kids are more savvy surfers than we are," agreed Cynthia M. Bulik, professor of eating disorders at the University of North Carolina at Chapel Hill School of Medicine and director of the UNC Eating Disorders Program at UNC Hospitals. To stay in control, she tells parents to "hone your own surfing skills" and "keep your family-access computer in a place where everyone can see what is being surfed."

Parents also need to talk to their child about what he or she finds on the Internet, Bulik advised. And should they learn that their child is visiting eating disorder Web sites, that's a perfect opportunity to open a dialogue.

Bulik said, "I always tell parents, if your child comes home and says, 'I'm going on a diet,' or "I feel fat,' you should take it as seriously as if they were to come home and say, 'I'm trying my first cigarette' or 'I'm going to have a beer' -- time to start the conversation!"

More information
To learn more, visit the Academy for Eating Disorders.

Farms Shield Kids From Bowel Disease

(HealthDay News) -- Children regularly exposed to farm life as babies are about half as likely as other kids to develop Inflammatory bowel disease such as ulcerative colitis or Crohn disease, German researchers report.

The findings, published in the August issue of Pediatrics, fall into line with what experts in inflammatory bowel diseases (IBDs), allergy and asthma call the "hygiene hypothesis."

That theory "refers to the observation that children living in environments with lower levels of microbial exposure seem to be at higher risk for the development of allergies," explained the study's lead researcher, Katja Radon, of Ludwig-Maximilians-University in Munich.

Crohn's and ulcerative colitis are autoimmune illnesses, where the body's immune system mistakenly attacks its own tissues. It is possible that this dysfunction may originate, at least in part, in how immune responses develop very early in life, said Dr. Joel Rosh, director of pediatric gastroenterology at Goryeb Children's Hospital, part of the Atlantic Health System in Morristown, N.J.

He pointed out that while rates of IBDs are holding steady in the developing world, they are rising sharply in more affluent nations.

"It's something that we are doing to ourselves," Rosh said.

"The thinking is that if your immune system isn't appropriately challenged at the appropriate time in life, then it might do some wacky things," Rosh added. In other words, a too-clean environment -- while healthy in some ways -- might be less than ideal when it comes to immune-linked illness, experts say.

The German study is one of the first to compare inflammatory bowel disease rates against infant exposures to farm animals and farm life. The German team questioned the parents of more than 2,200 6- to-18-year-old children. More than 300 of the children had ulcerative colitis, another 444 had Crohn's, and almost 1,500 were free of either illness.

Kids with either Crohn's or ulcerative colitis "were less likely to have lived in rural environments and were less likely to have farm contact in the first year of life, before the disease had developed," Radon noted.

In contrast, children who had spent regular amounts of time visiting or living on farms during their first year of life were 50 percent less likely to develop Crohn's as they got older and 60 percent less prone to ulcerative colitis, compared to youngsters who had not had that experience.

Early exposure to cattle, especially, appeared to help keep the diseases at bay, cutting the odds of Crohn's by 60 percent and colitis by 70 percent, the study authors said.

Cattle appeared to have a more potent effect on IBD risk than exposure to household pets, the study found. Household cat and dog exposure has been the focus of much study and debate among allergists and immunologists.

In this study, regular exposure in infancy to cats reduced Crohn's risk by just 20 percent, a statistic the researchers described as only of "borderline significance." Cat exposure was somewhat more useful against colitis, with rates dropping by 50 percent compared to unexposed children.

The cat-cattle discrepancy didn't come as a big surprise to Rosh.

"It seems that it's not so much animals, per se, as it is which animals," he said. "So, the domesticated cat that stays in the corner cleaning himself all day may not be 'dirty enough' to save you."

Radon agreed. "It has also been shown for allergies that farm animal contact is more efficient [in reducing risk] than pet contact. Therefore, it is not surprising that we see the same for inflammatory bowel disease," she said. "The reason might be that the level of exposure to bacteria and fungi in the farm environment is much higher than if you have a cat or dog at home."

Rosh has his own theories as to where the protective element might lie. "They sanitize it in the article, but they do say it can't be a clean animal -- it's got to be livestock. It's got to be something in that environment, and I would say, it's not in the air so much, as in the poop," he said.

So, does all this mean that modern-day babies need to get "back to the land"?

Perhaps not, according to the experts.

"You can't make the leap to say that to protect our children against autoimmune disease, we need to take them to farms, because we don't know yet what the [protective] exposure is," said Dr. Peter Mannon, head of the Clinical Inflammatory Bowel Diseases Research Unit at the U.S. National Institute of Allergy and Infectious Diseases.

"Are you supposed to be exposed to hay? To a particular type of vermin? The rats in barns? It's very hard to know," he said. While there's no reason not to bring infants to more pastoral settings, "I would not guarantee that it is going to add any protection," Mannon said.

Radon agreed that "at the moment, we cannot give direct advice to parents" since the study showed no cause-and-effect relationship, only an association.

And she pointed out that society's obsession with cleanliness does have its rewards. "We should not forget that an improved level of hygiene has relevantly contributed to today's health in industrialized countries," she said.

For his part, Rosh said there might be some virtue in letting kids get a little dirty -- a prescription most youngsters should have no problem with.

"I don't mean that we all have to eat dirt, but if we could isolate what is in it that is good, maybe we'd have a good [IBD] treatment," he said. "These various areas of research are going to unlock the secrets that we need to cure these diseases."

More information
There's more on the hygiene hypothesis at the American Academy of Allergy, Asthma & Immunology.

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