Insurance Matters When It Comes to Kids' Health Care

Insured children in the United States are much more likely than uninsured children (91 percent vs. 69 percent) to visit a doctor's office and to have a regular annual check-up (77 percent vs. 45 percent), according to new data released Thursday by the Robert Wood Johnson Foundation.

The study, conducted by University of Minnesota researchers who analyzed U.S. Centers for Disease Control and Prevention data from 2005-07, also found that:

* About 10 million American children have chronic illnesses and 3.6 million of those children are covered by Medicaid or the State Children's Health Insurance Program (SCHIP). Chronically ill children covered by public insurance receive the same level of health services as those with private insurance, but chronically ill children with no insurance receive far less care.
* Uninsured children with chronic needs are far more likely (41 percent) to have their care delayed or to receive no care, compared to insured children with chronic needs (10 percent).
* Eight percent of children with chronic health conditions enrolled in SCHIP or Medicaid don't have a personal doctor, compared to 21 percent of uninsured children.
* Sixteen percent of children with special needs who are enrolled in SCHIP or Medicaid don't receive mental health care services, compared to 43 percent of uninsured children.

The findings highlight the importance of government insurance programs such as Medicaid and SCHIP, the study authors said.

"SCHIP and Medicaid provide an important safety net for America's families, especially for families with chronically ill children. These programs allow kids to get the care they need, so they can feel better, grow stronger and thrive in school," Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, said in a news release.

"When children who need care do not receive it, their conditions worsen and are harder and more expensive to treat later. Because of Medicaid and SCHIP, millions of kids can get regular check-ups, take the medications they need to stay well and see a doctor when they are sick. Parents of any uninsured child should find out if their family is eligible for low-cost or free insurance before sending their kids back to school," Lavizzo-Mourey added.

Currently, more than nine million children in the United States are uninsured, according to U.S. Census Bureau data. Most uninsured children live in families where at least one parent works full-time.

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.

Families make case for vaccine link to autism

By KEVIN FREKING, Associated Press Writer Mon May 12, 6:25 PM ET

WASHINGTON - Parents claiming that childhood vaccines cause autism should not be rewarded by the courts when the scientific community has already rejected any link, government lawyers argued Monday on the first day of a hearing in federal court.

Overall, nearly 4,900 families have filed claims with the U.S. Court of Claims alleging that vaccines caused autism and other neurological problems in their children. Lawyers for the families are presenting three different theories of how vaccines caused autism. The theory at issue Monday was whether vaccines containing the preservative thimerosal caused autism.

Lynn Ricciardella, a Justice Department lawyer, said that theory has not moved beyond the realm of speculation. She said that the Institute of Medicine and the Centers for Disease Control and Prevention have rejected any link between thimerosal and autism.

"There is no scientific debate," Ricciardella said. "The debate is over."

Autism is a developmental disability that typically appears during the first three years of life and affects a person's ability to communicate and interact with others. Medical experts don't have a comprehensive understanding of what causes autism, but they do know there is a strong hereditary component.

Thimerosal has been removed in recent years from standard childhood vaccines, except flu vaccines that are not packaged in single doses. The CDC says single-dose flu shots currently are available only in limited quantities.

Under a two-decades-old program, individuals claiming injury from a vaccine must file a petition for "no-fault" compensation with the U.S. Court of Federal Claims. The secretary of Health and Human Services replaces the vaccine manufacturer or vaccine administrator to defend the claim.

Two 10-year-old boys from Portland, Ore., will serve as test cases to determine whether thousands of families can be compensated. Attorneys for the boys will try to show they were happy, healthy and developing normally — but, after being exposed to vaccines with thimerosal, they began to regress.

To win, the attorneys for the two boys, William Mead and Jordan King, will have to show that it's more likely than not that the vaccine actually caused the injury, which they described as regressive autism.

Tom Powers, one of the boys' attorneys, acknowledged that the evidence showing thimerosal led to regressive autism was indirect and circumstantial. Still, it's clear in the case of the two boys that they did not show any symptoms of autism until after they had received all their immunizations.

"Each of them had developed normally and typically well after their first year in life," Powers said.

The attorneys for the two boys said that a study in monkeys showed that mercury could ignite "neuroinflammation" in the brain, and such inflammation is the hallmark of somebody with autism. They also noted that previous studies of thimerosal were focused on autism, rather than on a more rare, specific form of the disorder that they described as regressive autism.

The first witness for the families, Sander Greenland, a professor at the UCLA School of Public Health, said published studies he reviewed failed to separate regressive autism from other types of autism when looking at thimerosal, thus they allow for a substantial association of the vaccines with clearly regressive autism.

Under the vaccine compensation program, officials titled special masters serve as the trial judges. The hearing that began Monday involved three special masters who will hear the evidence and determine whether thimerosal belongs on the list of causes for regressive autism. The rulings are appealable to the Court of Federal Claims.

If the families are successful, they could be entitled to damages that cover lost income after one turns 18 and up to $250,000 for pain and suffering.

Many members of the medical community are skeptical of the families' claims. They worry that the claims about the dangers of vaccines could cause some people to forgo vaccines that prevent illness.

Ricciardella argued that a marketing consultant fanned publicity about the supposed link between thimerosal and autism in a journal called Medical Hypothesis. She described the journal as willing to publish radical ideas, so long as they are coherent. She also said the authors pay to have the article published.

But Powers said those questioning conventional wisdom in the case cannot be easily dismissed.

"These are doctors who are willing to challenge the establishment on behalf of their patients," Powers said.

The court Web site says more than 12,500 claims have been filed since creation of the program in 1987, including more than 5,300 autism cases, and more than $1.7 billion has been paid in claims. It says there is now more than $2.7 billion in a trust fund supported by an excise tax on each dose of vaccine covered by the program.

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.

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.

28 million women at risk of unwanted pregnancy

Tue May 13, 11:07 AM ET

CHICAGO (Reuters) - Each year, half of American women who would rather not get pregnant will have an unplanned pregnancy, often because they failed to use their contraceptive properly or forgot to use it at all, U.S. researchers said on Tuesday.

As a result, 28 million women in the United States are at risk for an unintended pregnancy, according to the study conducted by the Guttmacher Institute in New York.

They found one in four women is very likely to become pregnant because of inconsistent contraception use.

Some of this gap is due to lack of access to health care, with many women saying they cannot afford some of the more effective methods of contraception such as birth control pills that require a doctor's visit and prescription.

"It is critical to have a better understanding of what is preventing women from using contraception consistently and correctly, or even at all," Dr. Jennifer Frost, a senior research associate at Guttmacher, said in statement.

The research involved surveys of women and family planning providers nationwide. Among the results, they found that more than half of women who have a gap in contraceptive use of at least one month have experienced some type of major life event -- such as the end of a relationship, a move, job change or personal crisis.

They also found that many women are not satisfied with their current method of contraception, a problem that can lead to missing birth control pills or failure to keep a condom handy, for example.

Last month the National Center for Health Statistics reported there were almost 6.4 million pregnancies in 2004, down 6 percent from 1990. Forty-five percent were to women who were not married, and there were 1.22 million abortions and 1.06 million stillbirths and miscarriages.

The researchers also found that many women who are lax about birth control are simply ambivalent about preventing a pregnancy and confessed that they would be very pleased if they found out they were pregnant.

The researchers said women who are the least motivated to avoid pregnancy are far less likely to use birth control pills, or any contraceptive method at all on a consistent basis.

They said a woman's attitude toward pregnancy, her satisfaction with her method and her experiences with gynecologists and other providers of contraception play a far bigger role in a woman's risk of pregnancy than other major risks, such as poor education and poverty.

Frost said doctors and other health providers should start by helping women to find the best contraceptive method for them.

"The more we can remove the remaining barriers to consistent use, the better we will be at ensuring that all women can avoid unwanted pregnancies and plan the children they want, when they want them," Frost said.