Argentina investigates deaths of vaccinated kids

Argentine authorities are exploring a possible link between the deaths of 14 children and an experimental vaccine they were taking in a clinical trial run by GlaxoSmithKline.Argentina's food and drug administration is investigating whether the deaths are tied to the Synflorix vaccine, said an agency official who spoke on condition of anonymity because he was not authorized to discuss the case.

The drug, designed to fight pneumonia, ear infections and several other pneumococcal diseases, was manufactured by the London-based GlaxoSmithKline PLC, the world's second-largest drug maker.

A U.S. spokeswoman for Glaxo, Sarah Alspach, said the company is not attributing the deaths to the experimental vaccine, which is being tested in three Latin American countries and in other countries around the world.

An independent board monitoring participants' safety recommended that the Latin American trials be temporarily suspended — which they were in late June — but then gave its OK for tests to resume, she added.

"We rely on their safety review," Alspach said. "Safety is our primary concern, always, with the development of any new treatment."

More than 19,000 babies have received at least one dose of Synflorix, which Glaxo plans to test on a total of 24,000 infants, she said. The company is still enrolling participants.

But according to the Argentine official, who works at the country's National Medicine, Food and Medical Technology Administration, the agency "received complaints about irregularities in the recruitment of patients" for the drug trial and on July 31 asked that recruitment be suspended.

Glaxo stopped recruiting the following day, saying it had already gathered the necessary number of participants, the official said.

Ana Maria Marchesse, who heads one of two groups that notified the national food and drug administration, told The Associated Press that she'd witnessed "poor ethical management" of patient recruitment.

"They didn't explain to the parents that this was an experimental vaccine, and a lot of the parents who signed consent forms were illiterate," said Marchesse, a pediatrician who heads the Health Professionals' Labor Association in the northern Argentine province of Santiago del Estero, where she said seven of the 14 children died.

"In some cases, they first gave them the vaccine and then gave them a 13-page consent form to sign that I had to read three times to understand," she added.

Marchesse said her group and a provincial doctors' association reported what they saw to the food and drug administration.

Glaxo's trial includes thousands of babies in Argentina, where Alspach said 12 children died; in Panama, where another two died; and in Chile. The natural infant death rate in those countries from pneumonia is 4 to 5 of every 1,000 live births — more than four times the rate seen in the study, Alspach said.

Pneumonia is the world's top killer among infectious diseases, causing more than 2 million deaths a year in children under five, mostly in developing countries, she said.

The company is testing the vaccine in more than 40 clinical studies around the world, she added. Data from other studies show the vaccine is about as safe and tolerable as competitor Wyeth's blockbuster Prevnar, a vaccine widely used against pneumococcal disease, she said.

Still, the Argentine province of Santiago del Estero is conducting a separate inquiry into the deaths of the seven children there, local Health Minister Franklin Moyano told state news media.

"While legal authorities investigate, we're in an observation phase to see if everything happened as expected, or if there were deviations that caused damage, in this case the death of seven kids," he said.

Early monitoring for infant skin tumors needed

The rapid growth of reddish skin tumors called infantile hemangiomas requires close observation in the first months of life, according to a report in the journal Pediatrics. Treatment should be undertaken promptly.

Infantile hemangiomas are non-cancerous tumors that can grow rapidly during infancy, but usually resolve by 9 years of age. Hemangiomas are the most common tumors in infants and, aside from cosmetic concerns, most have no medical significance.

"Not all hemangiomas need treatment -- actually the majority does not -- but a significant minority does," Dr. Ilona J. Frieden told Reuters Health. "So the real message of our study is that patients with hemangiomas that are at high-risk for complication or need...treatment should be identified early and referred as soon as possible."

Frieden from the University of California, San Francisco, and colleagues determined the specific growth characteristics of hemangiomas in 433 infants with a total of 526 hemangiomas.

"Eighty percent of hemangioma size was reached" by 5 months of age in most cases, the researchers report, and overall growth was nearly always completed by 9 months of age.

During the first 18 months of life, hemangiomas affecting only the upper layers of skin were more likely to start resolving, whereas deeper hemangiomas were more likely to continue growing.

Though parents noticed most hemangiomas within 1 month of age, the investigators say, the infants were 5 months of age, on average, when they were first taken to a dermatologist.

Most hemangiomas reached 80 percent of their maximum size by the tine the infants were 5 months old, suggesting that physicians need to start referring affected infants to specialists earlier in life, the authors conclude.

"One major reason for this is that current treatments work best when instituted early," Frieden said. "By 5 months of age the majority of growth is actually over and the opportunity to prevent complications in many cases has already passed."

SOURCE: Pediatrics, August 2008.

Poor Coordination in Childhood Tied to Adult Obesity

A lack of physical control and coordination in childhood may be tied to an increased risk of obesity in later life, a new study says.he research, published online at BMJ.com Wednesday, adds to previous studies that found poorer cognitive function in childhood may be linked to obesity and type 2 diabetes in adults.

The findings, based on 11,041 individuals in the ongoing National Child Development Study in Great Britain, showed that children who showed poor hand control, poor coordination, and clumsiness at age 7 in testing were more likely to be obese adults. Those with poorer functioning motor skills at age 11 also tended to be obese at age 33.

Adjusting for factors that may influence the results, such as childhood body mass and family social class, did not change the results. However, the study did not delve into specific biological processes that may explain poorer physical control and coordination in childhood with adult obesity.

"Some early life exposures (such as maternal smoking during pregnancy) or personal characteristics may impair the development of physical control and coordination, as well as increasing the risk of obesity in later life," the authors, from Imperial College London and Orebro University Hospital & Karolinska Institute in Stockholm, wrote.

"Rather than being explained by a single factor, an accumulation throughout life of many associated cultural, personal, and economic exposures is likely to underlie the risks for obesity and some elements of associated neurological function," they concluded.

Your Child Is Fat

School children across England will soon have their Body Mass Index (BMI) tested as part of a new effort to tackle the growing problem of childhood obesity. Parents will be sent a letter telling them whether their child is underweight, a healthy weight, overweight or very overweight. The letter will also include leaflets giving advice on eating healthily, physical activities their child might do and the risks of being overweight.So, are parents really failing to notice their little angels piling on the pounds? Yes, says the U.K.'s Department of Health. "Today, when more children are overweight compared with previous generations, it can be harder for parents to objectively identify if their child is overweight," says a spokeswoman from the Department of Health. "Research shows that most parents of overweight or obese children think that their child is a healthy weight. Some research showed that only 10% of parents with overweight or obese children described their child as overweight."

Still, it pays to break the news of a child's problem gently. Following the advice of numerous obesity experts, the Department of Health has decided that the name of the final, portliest category - very overweight - was a more sensible choice than obese. "Preliminary findings of the survey suggest that many people who would be defined clinically as obese find the use of the term obese highly offensive and would stop listening to further advice."

The softly-softly approach doesn't please everyone. "To shrink from using the word obesity is really ducking an issue," insists Dr Colin Waine, Chairman of the National Obesity Forum. "It does not have to be used in a judgmental or insulting way: if a child is obese then the parents should know that its obese. We must make parents know that the lifestyle of the family needs to be modified."

Statistics on childhood obesity in Britain make grim reading. Figures from 2006, the most recent numbers, show that nearly a third of all children aged between two and 15 are overweight or obese, an overall increase of 11% from 1995.

The U.K. childhood obesity rate is comparable to that in the U.S., where obesity in children aged between six and 11 has tripled over the past three decades, which may be why a few U.S. states already send reports on heavy kids home to parents. The College of Natural Resources at the University of California, Berkeley, published a paper in November 2006 describing the "risks and benefits of BMI reporting in the school setting", and in May 2007, Wyoming started a program in which students' report cards came complete with their BMI.

Some worry that such information should be given more discreetly: "Our feeling is that the information should be given to parents if there is a serious health concern much like any other health concern a child might have," said Meghan Cavanaugh, a spokeswoman at the Childhood Weight Control Program, the University of Buffalo. "This information should not be included on a report card or such. Medical information should be kept separate."

Based on current growth rates, obesity is predicted to cost the wider community of the U.K. around $100 billion a year by 2050, according to the Department of Health. "The Government must lead on action across society to tackle obesity. Engaging parents in this issue is essential to achieving success in instigating behavioral change."

Fever-related seizures in children rarely fatal

Although fever-related seizures can prove fatal for some children, such deaths are nonetheless extremely rare, a large study from Denmark shows.

The findings, reported in Saturday's issue of The Lancet medical journal, should be reassuring for parents, researchers say.

About 2 percent to 5 percent of children younger than 5 will suffer at least one febrile seizure -- generalized convulsions caused by elevated body temperature. But studies on the condition have been too small to estimate how many children actually die from fever-related seizures.

For the new study, Dr. Mogens Vestergaard, from Aarhus University in Denmark, and colleagues analyzed data on nearly 1.7 million children born in Denmark between 1977 and 2004. They identified 8,172 children who died during the study period, including 232 deaths among more than 55,000 children with a history of febrile seizure.

Overall, the researchers found, children who suffered a febrile seizure were nearly twice as likely as children in the general population to die during the two years following the seizure. Beyond that point, there was no increased risk.

And while the short-term risk of death was elevated, the actual number of children who died was extremely low, Vestergaard's team stresses. Over two years, they say, there would be two deaths per 1,500 children with febrile seizures, versus one death per 1,500 children in the general population.

Moreover, the study found, much depends on the type of febrile seizure.

Children who suffered a "simple" seizure -- lasting no more than 15 minutes, without recurrence in 24 hours -- had a death rate similar to children in the general population.

Instead, the risk was linked specifically to so-called complex seizures, which are longer-lasting or arise again within 24 hours; often, deaths among these children were related to pre-existing neurological abnormalities.

The findings seem to "refute, for infants and children who have simple febrile seizures, the idea of a shared cause between febrile seizures and sudden death," Dr. Maitreyi Mazumdar, from Children's Hospital Boston, writes in a related editorial.

At the same time, she adds, the results reinforce the message that children with complex seizures and neurologic abnormalities should be followed closely by their doctors.

SOURCE: Lancet August 9, 2008.

Spending time outdoors good for kids' eyes

Parents now have another reason to shoo their kids outdoors to play, along with making sure they get enough fresh air and exercise. In a study, Australian researchers found evidence that children who spent the most time outdoors were the least likely to suffer from myopia, also called nearsightedness or shortsightedness"Our evidence suggests that the key factor is being outdoors, and that it does not matter if that time is spent in having a picnic or in playing sport," Dr. Kathryn A. Rose told Reuters Health. "Both will protect a child's eyes from growing excessively, which is the major cause of myopia."

Myopia has become increasingly common in recent decades, with more than 80 percent of people in some highly-educated groups being nearsighted, Rose of the University of Sydney and her colleagues point out in the journal Ophthalmology. Work that requires a person to focus on something close up -- for example reading -- has been proposed to cause nearsightedness, they add.

To investigate how viewing activities at various distances might influence myopia risk, the researchers looked at 1,765 six-year-olds and 2,367 12-year-olds participating in the Sydney Myopia Study. Just 1.5 percent of the six-year-olds were myopic, but 12.8 percent of the older children were. Both age groups spent about 2.3 hours outside each day, on average.

Time spent outside had no significant relationship to myopia prevalence among the younger children, nor did the amount of close work they did.

But among the 12-year-olds, those who spent more than 2.8 hours outside every day were less likely to be myopic than their peers who spent more of their time indoors. Children who spent less than 1.6 hours outdoors every day and more than 3.1 hours in near-work activity had double to triple the likelihood of being nearsighted compared to kids who spent the most time outside and the least time in close-up work.

"We have not yet established why being outside is protective," Rose said. "But a likely candidate is the high levels of light experienced outside compared to inside. Studies in animals suggest that retinal dopamine is released in response to light, and dopamine is known to be able to block eye growth." Myopia is caused when the eyeball grows too long.

The researcher offers the following advice to parents: "Try to ensure that your children spend time outside because we have evidence that the more time they spend outdoors, the less likely they are to develop myopia. This is true, even if they are also doing a lot of close work such as reading and studying." But also, she adds, parents should be sure their kids are wearing hats and sunscreen.

SOURCE: Ophthalmology, August 2008.

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.

Gene Variation Linked to Neuroblastoma, a Childhood Cancer

By Steven Reinberg
HealthDay Reporter Wed May 7, 11:46 PM ET

WEDNESDAY, May 7 (HealthDay News) -- For the first time, a gene linked to the often fatal childhood cancer neuroblastoma has been identified, researchers report.

"This is the first paper that helps us understand what causes this childhood cancer," said lead researcher Dr. John M. Maris, director of the Center for Childhood Cancer Research at The Children's Hospital of Philadelphia. "We expected for decades that this cancer was a genetic disease, but we have had a hard time understanding what abnormalities in our genetic makeup lead to this cancer."

Neuroblastoma, a cancer of the peripheral nervous system that usually appears as a solid tumor in the chest or abdomen, is the most common solid tumor malignancy seen in early childhood. Among infants, it can disappear with minimal treatment, but in older children, it can be an aggressive cancer spreading throughout the body. Neuroblastoma accounts for 7 percent of all childhood cancers but causes 15 percent of all childhood cancer deaths. There are about 700 new cases diagnosed each year in the United States, the researchers said.

Maris' team found a common genetic variation of the gene 6p22 on chromosome 6, which doubles the risk of getting this disease. "This finding supports our assumption that there are a number of minor variations that work together -- in sort of a perfect storm -- to give a child this disease," he said. "This finding is the discovery of the first of these genetic variants."

Maris noted that this is the first time a childhood cancer has been found to be influenced by rather common genetic changes "that can be in you or me or anyone."

In addition, Maris said that having this particular genetic variation not only increases the risk of developing neuroblastoma, but also increases the risk of developing the more aggressive form of the disease. "This leads us to believe that the disease we call high-risk or low-risk neuroblastoma are really different diseases," he said.

The findings were published in the May 7 online edition of the New England Journal of Medicine.

For the study, Maris' team analyzed blood samples from 1,032 children with neuroblastoma and 2,043 children without the disease. The researchers honed in on three single nucleotide polymorphisms (SNPs) -- which are variations in DNA -- that were more common in patients with neuroblastoma than in patients without the disease. The three SNPs were clustered in the 6p22 region of chromosome 6. There are two genes in this region, but exactly what they do is unknown, the researchers said.

To confirm their findings, Maris' group analyzed blood samples from additional neuroblastoma patients and children without the disease. Among these additional patients, the researchers also found that variants in the 6p22 region were associated with increased risk for neuroblastoma.

"This finding gives us the motivation to continue this line of research to discover all of the different genetic variations that work together," Maris said. "We have already discovered additional variations."

Knowing the complete genetic influences on neuroblastoma may eventually lead to new treatments, he said.

Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, said that the new findings could one day lead to better diagnosis and treatment of the malignancy. "We still need to understand what these genes do, because little is known about these genes," he said.

Lichtenfeld added that, while the new research is important, it's still very preliminary. "Ultimately, what you want to do is to analyze the cancer and gain clues as to what the prognosis may be and what the appropriate treatment may be," he said. "This does not get us there, but it is one step along that pathway."

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)