Low-Birth-Weight Babies at Risk for Salt Sensitivity

A Swiss study of 50 children found that almost half of those who were small at birth -- about 5.5 pounds or less -- had a significant increase in blood pressure when they ate a high-salt diet, a condition known as salt sensitivity."Salt sensitivity in children is low and rises with increasing age through adulthood," study author Dr. Giocomo D. Simonetti, a fellow in the division of pediatric nephrology at the Children's Hospital, University of Bern, said in an American Heart Association news release. The finding suggests that restricting salt intake in these children could improve their blood pressure.

"During adolescence, about 18 percent to 20 percent of adolescents in the general population have the condition. However, in the study, salt sensitivity was present in 37 percent of all low-birth-weight [LBW] and in 47 percent of the children ... who were small-for-gestational-age [SGA]."

The children in the study, average age of 11, included 15 who had normal birth weights and 35 who were LBW or SGA babies. Some were born prematurely and others were born at full term but were small due to growth restriction inside the womb. Causes of intrauterine growth restriction include maternal high blood pressure and maternal smoking during pregnancy.

During the study, the children ate a controlled sodium diet for a week and then a high-sodium diet for a week. The finding that children who were small at birth are more likely develop salt sensitivity is important, because high blood pressure can damage the kidneys, brain and heart.

"These children should be followed for signs of reduced renal function and also for an elevated blood pressure," study co-author Dr. Markus Mohaupt, head of the division of hypertension, department of nephrology/hypertension, University of Bern, said in the AHA news release.

"There's nearly a 50 percent chance of favorably affecting blood pressure by simply reducing salt intake in children born SGA and nearly a 40 percent chance for those born with LBW. These individuals can be determined very easily if their family physician just gets data on their births," Mohaupt said.

Among the other important study findings:

* Salt sensitivity was inversely correlated to kidney size -- that is, smaller kidney size was associated with higher blood pressure. However, there was no association between kidney size and the organ's filtering abilities.
* Kidneys in LBW children tended to be shorter and hold smaller volume compared to kidneys in normal birth weight children.
* LBW children tend to be shorter than children of normal birth weight.

The study was published in the current issue of Hypertension.

High Blood Sugar Tied to Pregnancy Complications

By Serena Gordon
HealthDay Reporter Wed May 7, 11:46 PM ET

WEDNESDAY, May 7 (HealthDay News) -- Women with high blood sugar levels during pregnancy face an increased risk of complications, even if the high blood sugar readings don't meet the criteria for gestational diabetes.
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In a large, international study, researchers found that for each standard deviation increase in blood sugar, there was a greater risk of complications, such as having a large birth weight baby or needing a Caesarean section delivery.

"We found strong independent associations between a mother's blood sugar levels during an oral glucose tolerance test and 28 weeks of gestation and the pregnancy outcomes," said the study's lead author, Dr. Boyd Metzger, the Tom D. Spies professor of metabolism and nutrition at the Feinberg School of Medicine at Northwestern University in Chicago.

What this means for pregnant women right now, however, isn't clear.

"Because the relationship between the mother's blood glucose level and risk tend to be continuous and linear, it is not clear where the risk reaches the point where treatment should optimally begin," said Metzger.

"We were hoping there would be a breakpoint," explained another of the study's authors, Dr. Don Coustan, professor and chair of obstetrics and gynecology at the Warren Alpert Medical School of Brown University in Providence, R.I. "But, the relationship between glucose levels and outcomes were continuous, which means it will be difficult to decide where to put the 'treating' point."

Coustan added that there will be a conference in June where pregnancy and diabetes experts will likely debate the pros and cons of treating hyperglycemia. For now, he said, he suspects that "doctors will still use the glucose threshold they're currently using."

One thing that was clear from the study is that higher odds of complications, like an increased risk of C-section or a large baby, are related to high blood sugar and not to other conditions, such as obesity or older maternal age, according to Metzger.

Results of the study were published in the May 8 issue of the New England Journal of Medicine.

The study included more than 23,000 pregnant women from 15 centers in nine countries. None of the women had diabetes. All of the women underwent glucose tolerance testing between 24 and 32 weeks of gestation. This test is performed by first taking a fasting blood sugar reading, then having the woman drink a high-carbohydrate liquid -- in this case a 75-gram carbohydrate drink; 100 grams is standard in the United States -- and then rechecking blood sugar levels at one and two hours to assess how the body is processing the high sugar load.

The higher a woman's blood sugar levels were, the more likely she was to have a C-section, to develop preeclampsia, have premature delivery and to have the delivery complication known as shoulder dystocia, the study found.

Babies born to women with higher glucose levels were more likely to have high insulin levels, low blood sugar, and to have a large birth weight, all indications of exposure to high glucose levels.

The odds of these complications changed continuously as blood sugar levels rose. For example, a woman with the highest levels of blood sugar (but not diabetes) had large babies 26 percent of the time, compared to just 5 percent for women with the lowest blood sugar levels.

"Basically, what they found out is that there is no threshold where you know to treat. That makes it difficult to know what to do with these findings," said Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City.

A second study in the same issue of the journal looked at the use of the oral diabetes medication metformin, versus insulin, the standard treatment for gestational diabetes. The study included 751 women, randomly assigned to receive metformin or insulin treatment.

The researchers found that metformin was well-tolerated, although almost 43 percent of the women eventually required the use of supplemental insulin. There were no serious adverse events reported for mother or baby from the use of metformin, according to the study.

Of this study, Zonszein said, "My guess is that until we have larger studies, there's not going to be a big change in recommendations, because we have so much experience with insulin." But, he added, many women and obstetricians may welcome these findings because "giving a pill is easier than giving insulin." He said another oral medication, glyburide, was also found effective in another small trial.

Some Weight-Loss Drugs Might Disrupt Brain Growth in Kids

Wed May 7, 11:46 PM ET

WEDNESDAY, May 7 (HealthDay News) -- A new class of weight-loss drugs that suppresses appetite by blocking cannabinoid receptors in the brain should be used with caution in children, U.S. scientists report.
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In research with mice, they found this class of drugs also suppresses the adaptive rewiring of the brain necessary for neural development in young animals. The findings are in the May 8 issue of Neuron.

One such drug is rimonabant (Acomplia), which was developed by Sanofi-Aventis and is awaiting approval by the U.S. Food and Drug Administration. Other pharmaceutical companies are developing similar drugs.

In this study, researchers concluded that a cannabinoid receptor-blocking drug called AM 251 affected experience-dependent cortical plasticity in the brains of juvenile mice. This plasticity is the experience-prompted adaptive rewiring of the brain that plays an critical role in the neural development of young animals.

"Our finding of a profound disruption of cortical plasticity in juvenile mice treated with AM 251 suggests caution is advised in the use of such compounds in children," wrote Mark F. Bear and his colleagues, of the Howard Hughes Medical Institute, The Picower Institute for Learning and Memory, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, in Cambridge, Mass.

Mom's high normal blood sugar risky: study

By Karla Gale Thu May 8, 8:54 AM ET

NEW YORK (Reuters Health) - Pregnant women who have blood sugar levels above normal but below those signaling full-blown diabetes are more likely than women with lower blood sugar levels to experience several adverse pregnancy outcomes, new research indicates.

It is well known that high blood sugar levels indicative of the diabetes that occurs during pregnancy present risks for expectant mothers and their infants. The current study is believed to be the first to show that higher blood sugar levels -- not high enough to be considered diabetes -- also convey these increased risks.

In a study of nearly 24,000 pregnant women who had their blood sugar levels tested between 24 and 32 weeks of pregnancy, researchers found that the higher the mother's blood sugar level, the greater the chances that she would require Caesarean delivery and deliver an abnormally large baby.

Dr. Boyd E. Metzger from Northwestern University Feinberg School of Medicine in Chicago, and colleagues also found that the higher the mother's blood sugar levels, the more likely the women were to develop a potentially serious condition called preeclampsia marked by a spike in blood pressure and the more likely their infants were to be born prematurely, and to experience shoulder dystocia -- a condition in which an infant's shoulder becomes lodged inside the mother's body, effectively halting the birth process.

"These relationships are continuous and generally increase incrementally over the range of blood (sugar) levels we saw in the study," Metzger noted in a statement.

The question remains, Metzger told Reuters Health, "at what level of risk should we intervene? That is a big question that can't be addressed by this research."

He noted that a meeting to discuss these issues is scheduled next month immediately following the annual meeting of the American Diabetes Association.

SOURCE: The New England Journal of Medicine, May 8, 2008.

Cool kids can help others avoid smoking: study

By Michael Kahn Thu May 8, 7:17 PM ET

LONDON (Reuters) - Getting the cool kids to talk to their peers about the dangers of smoking cut the number of young people who started using cigarettes in one study by nearly 25 percent, British researchers said on Friday.

The study published in the journal Lancet took a different approach than most tobacco cessation programs aimed at youths by asking students to nominate others they viewed as influential or leaders to spread the anti-smoking message.

This peer selection proved more effective than conventional programs and greatly reduced the number of students likely to start smoking, the researchers said.

"The important thing this shows is that young people can help each other from taking up the addictive habit of smoking," said Rona Campbell, a health researcher at the University of Bristol who helped lead the study.

"If the program was taken up widely it could cut the recruitment of new smokers significantly."

Smoking is the leading cause of preventable death in the world, causing heart disease, several kinds of cancer, emphysema and other ailments. Both smokers and those who have to breathe their smoke are affected.

Worldwide an estimated 10 percent of students aged 13- to 15-years old smoke cigarettes, with the highest rates in European countries at 19 percent, according to the Global Tobacco Surveillance System.

The British study involved nearly 11,000 students aged 12 to 13 in 59 schools across western England and Wales. Of these, 29 schools were randomly selected to continue normal anti-smoking programs and the rest tried the new approach.

The researchers asked them to nominate influential students and then invited these popular students to take part in a training program about the risks of smoking and benefits of not starting.

Children who already smoked could take part as leaders so long as they agreed to try to quit. The leaders spread the information gained in the training informally during everyday conversations and interactions with others.

The results were significant. Students in the peer selection group were 23 percent less likely to start smoking after one year and 15 percent less likely after two years than young people in schools with traditional cessation programs.

This would translate into a potential reduction of 43,000 14- to 15-year olds who take up smoking each year, Campbell said in a telephone interview.

Studies also show the damage done by smoking takes decades to accumulate, so people who start young have more health risks later.

(Reporting by Michael Kahn; Editing by Maggie Fox and Mary Gabriel)

China hails doctor for raising child virus alarm

BEIJING (Reuters) - A deadly strain of hand, foot and mouth disease has killed two more children in China, bringing the death toll in recent weeks to 32, state media said on Friday, as it praised a doctor who alerted authorities to the epidemic.

An eight-month-old girl and a boy aged one and a half, who both died in southern China, were the latest victims of an outbreak international experts have warned has yet to peak.

Hand, foot and mouth is a common childhood illness, but in the current outbreak, has been linked with enterovirus 71 (EV71) which can cause a severe form of the disease characterized by high fever, paralysis and meningitis.

The girl died early Monday morning in Guangdong province, which has registered four deaths from EV71, after emergency treatment failed, Xinhua said.

The boy, from the neighboring Guangxi region, started running a fever and coughing on Saturday but his parents didn't take him to hospital until Tuesday, when he fell into a coma. Doctors could not save him and he became Guangxi's second victim.

A cluster of EV71 cases in Fuyang in the central province of Anhui in March saw 22 deaths. Some 104 patients remain in critical condition across the province, official media has said.

The outbreak was not made public until late April, triggering memories of the deadly SARS epidemic that crippled China in 2003 and provoking calls for Fuyang officials to be sacked.

The World Health Organisation has said the delay was not because of any cover-up, but was due to problems local doctors faced trying to identify the illness.

China has since issued a nationwide alert, closing kindergartens and sending officials to visit nurseries and primary schools and educate staff on hygiene and prevention.

A U.S. health official offered to assist China in curbing the outbreak, and U.S. Health Secretary Michael Leavitt is to visit Beijing next week, Xinhua reported.

"We are willing to help China in any way possible with this issue," it quoted William Steiger, head of the Office of Global Health Affairs at the U.S. Department of Health, as saying.

State media Friday was filled with praise for a doctor who called in experts after she was baffled by the deaths of several children that colleagues insisted were just suffering severe colds or flu.

The official People's Daily carried a tribute with the headline "We salute you, Fuyang's Liu Xiaolin," comparing Liu to a doctor who helped lead the fight against the deadly SARS virus.

"We have no way to count how many children were treated and cured because of Liu Xiaolin's responsibility and steadfastness; there is also no way to calculate how many families avoided the epidemic because of her sharpness and courage," it said.

Liu had previously helped uncover a baby milk scandal, when fake formula made without key nutrients caused the death by malnutrition of several children.

(Reporting by Emma Graham-Harrison and Lindsay Beck; Editing by Nick Macfie)

Health Tip: Discussing Death With Children

Thu May 8, 11:47 PM ET

(HealthDay News) -- Death may be difficult to comprehend at any age, but it can be particularly confusing and scary to young children.

The U.S. National Library of Medicine offers these suggestions when talking to children about death:

* Keep your explanation honest, simple, and on a level that's appropriate for the child's age.
* Understand that death can cause fears and confusion in many children.
* Talk about it as openly as possible when they ask questions or if a situation occurs that requires you to discuss it.
* Talk about your feelings -- fear, sadness, anger and anything else you feel. Show your child that the emotions they have are normal.
* Help children understand that they had nothing to do with the death. The person did not die because of something the children did, and they could not have prevented it from happening.

Child safety seats should be centered in back seat

Fri May 9, 2:32 PM ET

NEW YORK (Reuters Health) - Positioning child safety seats in the center of the back seat could cut infants' and toddlers' injury risks by nearly half, a new study suggests.

In a study of car crash data from 16 U.S. states, researchers found that children younger than 3 years old were 43 percent less likely to be injured when their seat was fastened in the center of the back seat rather than one of the side seats.

Experts already recommend that parents position car seats in the center of the rear seat, and the current findings bolster that advice, according to Michael J. Kallan and colleagues at the University of Pennsylvania and Children's Hospital of Philadelphia.

Unfortunately, only 28 percent of children in their study were sitting in that position at the time of the car accident, the researchers report in the journal Pediatrics.

There are obstacles to placing a car seat in the center position, Kallan's team acknowledges.

It is physically harder to strap a child, especially a heavier child, into a center-positioned seat. A centered child seat can also make it difficult for other people to sit in the rear of the car.

But based on the current findings, the researchers write, this center position is the safest place for babies and toddlers to ride.

The results are based on data from 4,790 car crashes involving children ages 3 and younger that occurred between 1998 and 2006. At the time of the accident, 41 percent of the children were in a car seat positioned in the right-hand back seat, while 31 percent were in the left-hand seat.

The center position was the least popular, but the safest. The reason, in part, was that children in a centered seat were better protected during a side-impact crash, according to Kallan's team.

"Recommendations should continue to encourage families to install child-restraint systems in the center of the rear seat," the researchers conclude.

They note that there are several online resources for parents who need information on installing child safety seats. The Children's Hospital of Philadelphia maintains such a site, at www.chop.edu/carseat.

Parents can also go to a local child safety seat inspection station, where inspectors will give them advice on properly using the seats. The National Highway Traffic Safety Administration maintains a searchable database of inspection stations, at http://www.nhtsa.dot.gov/cps/cpsfitting.

SOURCE: Pediatrics, May 2008.

Tree-lined streets may cut city kids' asthma risk

By Anne Harding Fri May 9, 2:32 PM ET

NEW YORK (Reuters Health) - City blocks boasting plenty of trees aren't only more pleasing to the eye; they may be healthier for children's lungs, according to research conducted in New York City.

Four- and five-year-olds living along the city's greenest streets were less likely to have asthma than young children living in sparsely planted neighborhoods, Dr. Gina S. Lovasi and colleagues from Columbia University found.

"We think that trees might have a beneficial effect on air quality -- affecting air quality right at the street level," Lovasi told Reuters Health. While the effects were independent of poverty and pollution, the researcher added, its possible street trees may simply be a stand-in for a healthful environment. "We're not confident that it's the trees themselves that are what's driving this."

Asthma rates have risen sharply in the US since 1980, and inner cities have been hit particularly hard, Lovasi and her colleagues note in their report. Trees could cut asthma risk by cleaning the air and encouraging kids to play outdoors, they add; but the pollen they release could also contribute to asthma attacks. To investigate, the researchers compared a census of New York City's half-million street trees from 1995 to statistics on asthma prevalence and hospitalization rates for 1999.

The wealthy Upper East Side of Manhattan was the greenest neighborhood in the city, with 1,675 trees per square kilometer, or nearly seven trees an acre, while the impoverished Hunt's Point-Mott Haven neighborhood in the Bronx was the city's barest, with only 109 trees per square kilometer or less than half a tree per acre.

As the density of trees in a neighborhood rose, asthma prevalence fell, even after the researchers accounted for the percentage of residents living below the poverty line, a neighborhood's proximity to pollution sources such as busy truck routes, and other relevant factors.

An increase of 343 trees per square kilometer, or roughly 1.5 trees per acre, translated to 29% lower asthma prevalence. For example, asthma prevalence among 4- and 5-year-olds would be 9% in a neighborhood with 2.5 trees per acre, but just 6% in a neighborhood with four trees per acre.

Rates of asthma hospitalization tended to be lower in neighborhoods with more street trees, but the relationship wasn't statistically significant; nevertheless, this suggests that trees aren't a major contributor to asthma attacks, Lovasi said.

A "natural experiment" set to take place over the next decade will help to answer the question of whether street trees really do make for healthier kids; New York City Mayor Mike Bloomberg has launched an effort to plant a million new trees by 2017, and Lovasi and her colleagues are now working with the city government to study neighborhood health as the project progresses.

SOURCE: Journal of Epidemiology and Community Health, May 2008.

Mental impairment common in children with MS

By Karla Gale Mon May 12, 5:57 PM ET

NEW YORK (Reuters Health) - Low IQ scores and cognitive problems (problems related to thinking and reasoning) are common in children and adolescents with multiple sclerosis (MS), according to an Italian study reported in the journal Neurology.

Approximately 5 percent of MS cases begin before age 18, note Dr. Maria Pia Amato, at the University of Florence, and her associates.

"The initial diagnosis of MS is more difficult in children than in adults," Amato told Reuters Health. Particularly before age 10, "symptoms may resemble those of acute encephalitis," with symptoms such as fever, alterations in mental state and level of consciousness. Breathing assistance with a mechanical respirator may be required and seizures and signs of brain involvement, which are rare in adults, may often occur in children.

In adolescents, she added, the onset of MS is more like that observed in young adults, with symptoms such as inflammation of the optic nerve, brain stem and cerebellar symptoms and sensory disturbances, usually without any change in mental state.

In either case, there is concern that an early onset of MS could have greater impact on cognitive function if normal neurodevelopment is stunted.

In the researchers' study, 63 MS patients and 57 healthy controls younger than 18 years of age underwent a neuropsychological test battery. MS began before age 10 years in 15 subjects.

In the MS group, the IQ scores were lower than in the placebo group, five MS children had an IQ below 70 vs. none of the placebo group. Fifteen of the MS group had an IQ between 70 and 89, vs. two children in the placebo group.

The only significant predictor of an IQ score less than 70 was younger age at onset.

Half of the MS patients failed at least two neuropsychological tests. Most affected were verbal and visuospatial memory, complex attention, and executive functions.

By interviewing parents, "we confirmed that the disease had a great functional impact and that, beyond the extent of physical disability, cognitive problems play a relevant role negatively affecting school, everyday, and social activities," the authors report.

In treating MS patients, physicians should always take into account the cognitive and psychosocial problems associated with MS and should include them in patient evaluations, Amato emphasized. In particular, global intellectual faculties and language problems need to be identified and dealt with, especially in children diagnosed with MS before the age of 10.

"I would like to highlight that treatment and support may help the subjects and the families to cope with their psychosocial difficulties," she added.

It is also possible that treatment of very young children may be more effective. "Therefore, early recognition of problems and intervention strategies, both rehabilitative and pharmacological, may lead to a better outcome."

SOURCE: Neurology, May 13, Neurology.

Enemas can help children with voiding problems

Mon May 12, 5:59 PM ET

NEW YORK (Reuters Health) - Urination problems coupled with chronic constipation in children can be cured by enemas, according to the results of a Dutch study in the journal Urology.

Children with this problem, also referred to as "dysfunctional voiding," can have a variety of symptoms including urgent urination, frequent urination, and incontinence. Children with the disorder are at increased risk for urinary tract infections. Treatment of the disorder depends on the underlying cause and may include a combination of behavioral, biofeedback, and medical interventions.

"Dysfunctional voiding sometimes coincides with long-lasting defecation disturbances," Dr. Rafal Chrzan and colleagues from University Children's Hospital UMC Utrecht, the Netherlands, write. "This condition is called dysfunctional elimination syndrome," they note. "The term indicates that chronic constipation can coexist with dysfunctional voiding with urinary tract infections and/or incontinence."

The researches examined the use of colonic enemas in 50 children with dysfunctional voiding and chronic constipation. Treatment consisted of filling the rectum with water once daily for 2 weeks, then three times per week for 6 months.

Thirty patients (60 percent) experienced total relief of urinary tract symptoms during follow-up. Eight patients developed at least one urinary tract infection during follow-up, and 12 subjects were free of urinary tract infection but still experienced some difficulties in voiding.

Constipation improved in all of the children. Enemas were stopped with continuing success in 33 patients. Relapse of constipation in 17 patients resulted in the need for chronic, intermittent enema therapy.

"Five patients (10 percent) reported abdominal pain during enema at the beginning of the treatment. However, this did not lead to discontinuation of the enema treatment," Chrzan and colleagues report. "We noted no serious counter-effect."

They say a trial is now being conducted at their institution to compare enemas with biofeedback training as primary treatment for constipated children with dysfunctional voiding.

SOURCE: Urology, April 2008.

Multiple Sclerosis Affects Children's Cognitive Skills

By Serena Gordon
HealthDay Reporter Mon May 12, 11:47 PM ET

MONDAY, May 12 (HealthDay News) -- Only about 5 percent of people with multiple sclerosis are diagnosed when they're children, but like adults with MS, the disease can affect cognitive function, causing memory and attention problems, and possibly low IQ scores.

And, the younger a child is at the time of diagnosis, the more likely he or she is to have a low IQ, according to new research published in the May 13 issue of the journal Neurology.

"In childhood cases, the impact of the disease on cognitive functioning may be more dramatic than that observed in adults," said study author Dr. Maria Pia Amato, an associate professor of neurology at the University of Florence, in Italy.

Multiple sclerosis is a disease of the central nervous system. The disease leads to the destruction of myelin -- a protective coating found on nerve cells. Without their myelin coating, the nerve cells can't efficiently send signals between the brain and other parts of the body. Within the brain, this can slow or stop nerve impulses, according to Nicholas LaRocca, vice president of health care delivery and policy research at the National Multiple Sclerosis Society (NMSS). Additionally, he said, MS can cause a gap in nerve fibers, and, in some cases, can actually cause brain tissue to shrink.

"The overall organization of the brain is being impaired," he said.

LaRocca's colleague, Rosalind Kalb, vice president of the professional resource center at NMSS, said most people describe the effects of the disorder as feeling as if their brain "has slowed way down."

"What that means for a child in a school situation is that if the incoming information is coming in faster than that person can process it, they won't remember it later, because they didn't get to process it effectively to begin with. So, they don't learn what they need to learn," said Kalb, who along with LaRocca wrote the book, Multiple Sclerosis: Understanding the Cognitive Challenge.

An estimated 250,000 to 350,000 Americans are believed to have multiple sclerosis, according to the U.S. National Institute of Neurological Disorders and Stroke. The course of the disease is highly unpredictable, with some people experiencing only mild symptoms, while others are disabled by it. Many people also have periods of remission, when they have no symptoms.

And, that same variability holds true for cognitive symptoms. "These kids aren't developmentally disabled. Some will experience problems, and some won't. They have to learn to use their strengths to compensate for the pockets of problems that can affect their learning," Kalb said.

Amato's study included 63 children with MS and 57 healthy "controls." They ranged in age from 8 to nearly 18, with an average age of 15. Each child completed numerous tests to assess different areas of cognitive function.

Thirty-one percent of the children with MS were deemed to have a cognitive impairment, which meant they failed at least three of the tests.

"Five patients (8 percent) exhibited a particularly low IQ, less than 70, and we found that a lower IQ was significantly associated with a younger age at onset. Only one case had an MS onset after 13 years of age, whereas in the remaining four children, MS started before 13 years of age," Amato said.

Additionally, she said, "MS negatively affected school and everyday activities in 56 percent of the subjects."

LaRocca said the findings are similar to what has been seen in adults, and what this study really does is "call attention to the fact that these youngsters need special attention and support. You'll find some functions affected, some severely, some mildly and some not at all, and you'll find certain strengths you can work with." For example, "if verbal memory is affected, but visual memory isn't, use more visual cues in teaching," he advised.

Amato added: "In general, treatment and support may help the [child] and the family to cope with psychosocial difficulties. Moreover, it is possible that brain plasticity, as well as reparative and compensatory abilities, may be more efficient in this age range. Therefore, early treatment strategies, both rehabilitative and pharmacological, may lead to a better outcome."

The study was funded, in part, by a grant from drug maker Biogen-Dompe, which produces medications for MS.

Gene May Be Key to Pregnancy Complication

By Steven Reinberg
HealthDay Reporter Mon May 12, 11:47 PM ET

MONDAY, May 12 (HealthDay News) -- A gene called COMT, already known for its role in schizophrenia, also plays a significant part in the dangerous obstetric complication known as preeclampsia, a new study finds.

Although the current study was done in mice, the researchers envision a time when the findings could be used as a test to identify women at risk of preeclampsia -- and even as a means of preventing the condition.

"This gene regulates the oxygenation of the placenta," explained lead researcher Raghu Kalluri, a professor of medicine at Harvard Medical School. "Preeclampsia is a pregnancy disorder where the placenta is hypoxic (isn't receiving enough oxygen)," he added.

Preeclampsia, which affects about 5 percent of all pregnancies, is a leading cause of sickness for pregnant women and their infants. Symptoms of preeclampsia include high blood pressure, protein in the urine and swelling.

The COMPT (catechol-O-methyltransferase) gene is involved in breaking out estrogen into a metabolite called 2ME (2-methoxyestradiol), which prevents a shortage of oxygen in the placenta. When the gene does not function properly, levels of 2-ME are reduced, setting in motion a series of events that lead to preeclampsia, Kalluri explained.

The report was published online in the May 12 issue of Nature.

In their current experiments, the researchers worked with mice that did not have the COMT gene, and therefore do not produce 2-ME. After 14 weeks of gestation -- equivalent to the third trimester of human pregnancy -- the mice developed high blood pressure and other symptoms of preeclampsia, the researchers found.

The mice also delivered their pups earlier than normal, with a high incidence of stillborn offspring. Once the pups were delivered, the mother's health return to normal, the researchers found.

However, when the mice were given supplemental 2-ME, symptoms of preeclampsia disappeared, Kalluri said.

Kalluri's team found that COMT levels were deficient, and 2-ME levels were also lower, in women diagnosed with preeclampsia.

Because 2-ME is found in the blood and urine, the researchers hope to use their finding to develop a urine test that would identify women at risk from preeclampsia, Kalluri said. "This can be designed as a urine strip test, like pregnancy tests are," he said.

In addition, giving 2-ME to women who have low levels of this protein may prevent them from developing preeclampsia, Kalluri said. "We can give back the missing amount to bring levels back to where they should be," he said.

One expert believes the results are promising, but said more work is needed before 2-ME could become either a screening test or treatment.

"This is an interesting and novel study, which gives insight into the pathophysiology of preeclampsia," said Dr. Arun Jeyabalan, an assistant professor in the division of maternal fetal medicine in the department of Obstetrics, Gynecology and Reproductive Sciences at Magee Women's Hospital, University of Pittsburgh.

Jeyabalan said that it will be sometime before these findings can be extended to patients. Using these findings to develop a screening test is something worth looking into, she added.

"Most of this work is of animals, and I think we have to be cautious before we extend these findings to humans," Jeyabalan said. "But it is something that is definitely worth testing in the future."

Breastfeeding halves rheumatoid arthritis risk

Tue May 13, 1:55 AM ET

LONDON (Reuters) - Women who breastfeed their babies longer are less likely to get rheumatoid arthritis, Swedish researchers said on Tuesday.
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Mothers who breastfed for 13 months or more were half as likely to get the painful joint condition as women who never breastfed, said Mitra Pikwer and colleagues at the Malmo University Hospital in Sweden, who led the study.

"Although it is difficult to separate the effect of breast feeding from that of childbirth, our data suggest that rheumatoid arthritis is inversely associated with long-term breastfeeding, rather than with the number of children born," they said.

The researchers said they wanted to see if a larger, community-based study would echo earlier studies on the links between breastfeeding or the use of oral contraceptives and the condition affecting about 20 million people worldwide.

Rheumatoid arthritis is an autoimmune disease caused when the body confuses healthy tissues for foreign substances and attacks itself.

Some drugs to treat the condition seek to reduce inflammation directly while others tone down the immune system's response, which can leave some patients vulnerable to infections and cancer.

The Swedish team compared 136 women with rheumatoid arthritis and 544 women of similar age without the disease. They also found that breastfeeding for between up to 12 months made women 25 percent less likely to get the joint condition.

The findings bolster previous research linking breastfeeding to a reduced risk of the disease. But, as with other studies, the Swedish teams said they did not know the exact reason why.

Breastfeeding is known to provide multiple benefits for the baby and studies have shown the practice may also protect mothers from breast and ovarian cancers.

The study published in the British Medical Journal's Annals of the Rheumatic Diseases also suggested that oral contraceptives -- thought to offer protection because they contain certain hormones -- did not seem to make a difference.

(Reporting by Michael Kahn)

Gene therapy shows promise in rare brain disease

By Maggie Fox, Health and Science Editor Tue May 13, 11:32 AM ET

WASHINGTON (Reuters) - An experimental gene therapy treatment appears to have helped eight children with a rare and incurable neurological disorder, although it may have been responsible for the death of one, researchers reported on Tuesday.

They said the treatment appeared safe and effective enough to try in more children with late infantile neuronal ceroidlipofuscinosis, or LINCL, a form of deadly Batten disease.

The treatment, in which a virus carrying the corrective gene was infused directly into the brain, appeared to slow the decline of eight out of 10 children treated, Dr. Ron Crystal of New York-Presbyterian Hospital/Weill Cornell Medical Center and colleagues reported.

"We are encouraged by this. It's not a cure," Crystal said in a telephone interview.

Like all forms of gene therapy, the hope is that the mutant cells will take up the new gene and start working normally.

Children with LINCL start showing symptoms at about age 4. They lose coordination, vision and speech and usually die unable to breathe on their own, between 10 and 12.

One child suffered an epileptic seizure weeks after treatment and died and another child died of unknown causes two years after treatment.

Eight of the children showed a measurable slowing of the inevitable decline usually seen in the condition.

Only about 200 children are alive with the disease globally at a given time.

"The disease is caused by mutations in the CLN2 (ceroid lipofuscinosis, neuronal 2) gene," Crystal and colleagues wrote in their report, which was published in the journal Human Gene Therapy.

INTERNATIONAL TRIAL

The researchers chose 10 children from the United States, Britain, Australia and Germany, five severely affected by the disease and five moderately affected.

Tiny glass tubes infused the adeno-associated viruses carrying the corrective gene into the brains of the children. Crystal's team watched the 10 children for 18 months, comparing them to four untreated children with the same condition.

"The primary variable was a clinical rating scale based on the number of seizures, language skills, motor skills and so on," Crystal said. "That's where we saw what appeared to be statistically significant."

Magnetic resonance imaging scans of the brain also appeared to show slowing of the disease but this was less clear, he said.

"You can't give back more brain cells. You can't improve it. All you can hope to do is to delay progression," Crystal said.

One child suffered a seizure and died after 49 days. "We know it's related to what we did," Crystal said. "But we don't know whether it related to the virus or not."

He said there was no evidence the virus caused an immune reaction and noted that putting a glass tube into the brain could have caused a seizure. Children with Batten's often have seizures as a manifestation of the disease.

Crystal said the dangerous and experimental therapy was justified for the children. The mutations affect a mechanism that rids nerve cells of waste materials.

"It's like the garbage man of the cell is not able to do its job," Crystal said. "The trash keeps getting backed up inside the cell until the cells can no longer function properly and then eventually die throughout the entire brain."

Gene therapy is a controversial field but last month doctors reported a gene therapy approach improved the vision in four patients with a blinding condition.

In 1999 an 18-year-old volunteer died during a gene therapy experiment and in 2002 gene therapy cured two French boys with a fatal immune disorder but gave then leukemia -- which was also treated.

(Editing by Will Dunham and Bill Trott)

Beijing confirms first virus deaths: report

Wed May 14, 2:49 AM ET

BEIJING (AFP) - China on Wednesday confirmed the first two deaths in Beijing from hand, foot and mouth disease, bringing the national death toll to 42 children, state media reported, citing health officials.

One child from Beijing, host of this year's Olympics, died on Sunday, Xinhua news agency said citing city health department spokeswoman Deng Xiaohong.

Another child from Hebei also died in the capital after being transferred from the northern province for medical treatment, the report said.

The highly contagious disease, which is most dangerous to the young, has killed 42 children across China and infected nearly 25,000 people, the report said.

Most of the deaths have involved enterovirus 71, or EV71, which can lead to acute hand, foot and mouth disease and has been identified by China as a key factor in the severity of the outbreak.

Cases first emerged in large numbers in eastern China in early March but the problem was not made public until late April, prompting state press to accuse local officials of dragging their feet on raising the alarm.

Mother's mental health tied to child's development

By Anne Harding Wed May 14, 3:59 PM ET

NEW YORK (Reuters Health) - Evaluating the emotional health and social connectedness of pregnant women may help determine if their children will need extra help to meet developmental goals later on, Canadian researchers say.

If children get this assistance early, there's a good chance they will do just fine, Dr. Suzanne C. Tough of the University of Calgary in Alberta, the study's lead author, told Reuters Health.

But Tough and her team found that more than half of the three-year-olds in their study who were identified as being at high risk for developmental problems had never been referred for assessment to see if they actually did have speech and language delays.

"We miss these children when our early intervention can be most effective," the researcher continued. Kids with mild to moderate delays who could make "huge strides" without extensive help are actually the most likely to fall through the cracks, she added.

To investigate early risk factors for developmental problems, which can, in turn, increase the likelihood that a child will fail in school and have behavioral issues, Tough and her colleagues looked at 791 mothers who had participated in prenatal care study and their children, who were now pre-school-age. All of the women had uncomplicated pregnancies and deliveries.

While 11 percent of the children were gauged to be at high risk for developmental problems, just 43 percent of these high-risk kids had been assessed. Those who were born preterm were more likely to have been identified as at risk, as were children who had undergone hearing tests and those with vision problems.

Children were more likely to be at high risk for developmental problems if they were male, had ear infections, came from a low-income environment, or had a mother with poor mental health during the prenatal period and after the child was born. Problems typically included depression, a history of abuse and a poor level of contentment.

Fifty-three percent of the kids who met each of these criteria were at high risk. However, when the mother's poor mental health was removed from the equation, the risk fell by 30 percent, to 18 percent.

"The big surprise to me in this data was just how important maternal mental health can be," Tough said.

The women typically didn't have serious psychiatric problems, she added, but were simply in poor mental and emotional health and frequently lacked good connections in their community and to friends and family.

Tough and her team are now evaluating whether a program that brings pregnant women together to help them build social networks will improve children's outcomes.

SOURCE: BMC Pregnancy and Childbirth, published online May 6, 2008.

Childhood anxiety may worsen anorexia

Fri May 16, 3:58 PM ET

NEW YORK (Reuters Health) - Anorexic women with a history of childhood anxiety may have particularly severe symptoms of the eating disorder, a study suggests.

It's known that anxiety disorders, like social phobia and obsessive compulsive disorder, are far more common among people with anorexia than in the general population. Often, these anxiety disorders appear before the eating disorder does.

In the new study, published in the International Journal of Eating Disorders, researchers looked at whether a history of childhood "overanxious disorder" was related to the severity of women's anorexia.

Dr. Cynthia M. Bulik, of the University of North Carolina at Chapel Hill, and colleagues found that of 637 women with anorexia, 39 percent reported symptoms of childhood overanxious disorder. In nearly all cases, those symptoms arose before the onset of their anorexia.

In general, the researchers found, women with a history of childhood anxiety exhibited "more extreme personality traits" and attitudes -- like perfectionism and obsessive tendencies related to food -- than women without a history of early anxiety disorders.

They were also more likely to purge, by vomiting or abusing laxatives, in addition to strictly limiting their food intake.

According to Bulik's team, childhood anxiety disorders "may represent one entree" into anorexia. This, they say, underscores the importance of recognizing and treating these conditions early on.

SOURCE: International Journal of Eating Disorders, May 2008.

Health Tip: Traveling During Pregnancy

Thu May 15, 11:47 PM ET

(HealthDay News) -- If you're planning to take a trip while pregnant, you should check with your doctor to be sure it's safe for you to travel. Unless you have complications with your pregnancy, most women can travel safely.

Here are some travel tips to keep you safe and comfortable during pregnancy, courtesy of the American Pregnancy Association:

* Travel during the second trimester is usually most comfortable -- after morning sickness has passed and the fatigue of the third trimester is still ahead.
* Wear comfortable, loose clothing and comfortable shoes.
* Take things to make you more comfortable, like a pillow from home and some snacks that satisfy you.
* If you're driving, stop to get up and stretch often and take plenty of bathroom breaks.
* Always take your prenatal records with you on the road.
* Be safe: Wear your seat belt and follow safety instructions for whatever transportation you use.

Heart risks high in childhood cancer survivors

By Julie Steenhuysen Thu May 15, 9:27 PM ET

CHICAGO (Reuters) - Children who survive cancer while they are young are five to 10 times more likely than their healthy siblings to develop heart disease, U.S. researchers said on Thursday.

The finding comes from a study of more than 14,000 survivors of childhood cancers, and suggests that cancer survivors and their doctors need to be vigilant about heart risks.

"This study clearly shows for children, and particularly children treated with radiation therapy to the chest or certain drugs that are particularly toxic to the heart, there are significant risks of cardiovascular disease at a far younger-than-expected age," said Dr. Richard Schilsky of the University of Chicago.

The preliminary results were released ahead of a meeting later this month of the American Society of Clinical Oncology.

Schilsky, who is president-elect of ASCO, said the study highlights the challenges faced by cancer survivors, who have to live with the health consequences of having had cancer and having been treated for cancer.

Dr. Daniel Mulrooney of the University of Minnesota and colleagues conducted the study, which looked at 14,358 survivors of childhood leukemia, central nervous system tumors, Hodgkin's and non-Hodgkin's lymphoma, kidney tumors, bone cancers, neuroblastoma and soft-tissue sarcoma between 1970 and 1986.

They compared these to 3,899 of their siblings. Cancer survivors on average were 7 years old at diagnosis and 27 at follow up.

The cancer survivors were 10 times more likely to have clogged arteries, 5.7 times more likely to have heart failure, 4.9 times more likely to have heart attacks, 6.3 times more likely to have pericardial disease -- affecting the sac surrounding the heart -- and 4.8 times more likely to have diseased heart valves compared with their siblings.

"We found 5-year survivors of childhood and adolescent cancers are at an elevated risk for early cardiovascular disease," Mulrooney told reporters in a telephone briefing.

They also found the risks were two to five times greater in people who had been treated with chest radiation and chemotherapy from the anthracycline class of drugs, such as doxorubicin, compared to survivors who did not have those treatments.

Mulrooney said there are about 270,000 childhood cancer survivors in the United States, or about 1 in every 900 young adults. He said the findings may lead to better cancer treatments that protect the heart.

"We still use radiation therapy," he said, but newer radiation treatments are more targeted, and he hopes they will have less impact on the heart.

Schilsky said other studies have found long-term cancer survivors are at greater risk of premature osteoporosis, infertility, thyroid problems, anxiety and depression and the risk of another cancer.

"It becomes incumbent on the patient and the primary care physician to be aware of their cancer history and the potential consequences of their treatment," Schilsky said.

(Editing by Maggie Fox)