KIDDOC.ORG

John 3:16 played during Broncos playoff game riff off of Tim Rebow

noreply@blogger.com (John C Kim) — Sun, 15 Jan 2012 05:58:00 +0000

BBC News - Clock change 'stops outdoor play' Point is : free play is really healthy.

noreply@blogger.com (John C Kim) — Sun, 13 Nov 2011 02:04:00 +0000

Amount of 'play light' may have a huge public health role against childhood obesity. Point is : free play is really healthy.

Clock change 'stops outdoor play'

by Helen Briggs, bbc.co.uk
November 9th 2011

Not putting the clocks back would help in the fight against child obesity, a study suggests.

According to research, children are more influenced by daylight than the weather when deciding whether or not to play outside.

UK researchers report that not changing the clocks would give more opportunities for active play.

It strengthens the public health arguments for proposed changes to daylight saving, they say.

The research, published in the Journal of Physical Activity and Health, studied the activity levels of 325 children in south-east England aged between eight and 11.

The children wore accelerometers to record the amount of exercise they did, and kept a record of their activities in a diary.

A team from the London School of Hygiene and Tropical Medicine and University College London found the children did more exercise outside on longer days, particularly at the end of the day during summer.

“Start Quote

This provides the most direct evidence yet that changing the clocks so that there is more daylight in the afternoon could increase children's physical activity”

End Quote

This happened regardless of the likes of rain, cloud or wind.

Outdoor play was a bigger factor in overall physical activity than other factors such as structured sport sessions and cycling or walking to school, the team says.

Co-researcher Dr Anna Goodman, of the London School of Hygiene and Tropical Medicine, told the BBC: "This provides the most direct evidence yet that changing the clocks so that there is more daylight in the afternoon could increase children's physical activity."

She added: "The fact that kids spend more time playing outdoors and are more physically active overall on these longer days could be important at a population level for promoting their fitness and in preventing child obesity.

"This strengthens the public health argument for the Daylight Saving Bill currently under consideration by the House of Commons, which proposes putting the clocks forward by an extra hour all year round."

The clocks were moved forward by an hour during World War II to increase productivity at munitions factories and help people get home safely before the blackout.

But some health experts argue that a change to this tradition would give children more opportunities for outdoor play, as well as making it safer for them to travel home from school.

'Safe space'

Tam Fry, a spokesperson for the National Obesity Forum, said: "The longer the daylight hours, the longer kids will play. They really don't seem to care much about the weather but they do care about the dark.

"They need clearly to see the environment in which they can roam unfettered, and it should be no surprise that longer summer evenings provide that environment.

"They will be healthier and fitter from their outdoor play. Pack them all off to a safe space until bedtime."

Ministers are writing to counterparts in Scotland, Wales and Northern Ireland to seek a UK-wide consensus on a trial.

It would see the UK adopt Central European Time, with BST plus one hour in summer and GMT plus one in winter.

Original Page: http://www.bbc.co.uk/news/health-15646812

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RISk of obesity starts young. Infant growth charts can predict later obesity - latimes.com

noreply@blogger.com (John C Kim) — Sun, 13 Nov 2011 02:00:00 +0000

CAVEAT! It's only a risk, not a determination. If both parents are fit, and have healthy lifestyles, I don't this data applies, or at least not as robustly.
Infant growth can predict later obesity, a study indicates
by Shari Ro, latimes.com
November 7th 2011 Infant weight and height are faithfully charted at each pediatrician's visit to make sure the child is growing properly. But nowadays doctors are more likely to see babies who are growing too fast rather than ones lagging behind. A new study shows that rapid growth on these charts foretells obesity in childhood.
Researchers looked at the weight-for-length charts that show how a baby's weight compares to that of other babies of the same length. For example, babies on the 5th percentile growth line have a weight that puts them among the smallest 5% of all babies their length. Doctors mostly want to see that a child is following his or her growth curve over time and not falling off or jumping up. The major percentile lines are the 5th, 10th, 25th, 50th, 75th, 90th and 95th.
The study, which tracked more than 44,000 babies, found that those who rose two or more major percentiles -- for example, going from 50% to 90% at some point -- before age 2 were twice as likely to be obese at age 5 and 75% more likely to be obese at age 10.
Babies who jumped two or more percentiles before six months of age had the highest risk of obesity at age 10 as well as babies who were already in a high percentile at their first visit. For example a 6-month-old baby who started at the 75th percentile who jumped two or more percentiles in the next six months had an obesity prevalence of almost 30% at age 5. Babies who started at less than the 25th percentile and jumped two or more percentiles had an obesity prevalence at age 5 of about 7%.
"We shouldn't neglect these early gains and think that it's just baby fat, and that these children are going to grow out of it," said Dr. Elsie Taveras, the lead author of the study at Children's Hospital Boston.
Of all the babies in the study, 11.6% were obese at age 5 and 16% at age 10. Jumping two or more percentiles was common, the researchers found, with 43% rising two or more percentiles in their first six months of life and 64% at some point in their first two years.
The study was published Monday in the Archives of Pediatrics and Adolescent Medicine. The journal also carries an interesting commentary on child obesity by Dr. Robert C. Whitaker of the Center for Obesity Research and Education at Temple University.
Whitaker discusses the widespread social change that will be required to reverse the obesity epidemic. "The childhood obesity epidemic was an unexpected consequence of numerous well-intentioned decisions made by adults about how to improve our way of living. These decisions were often made without considering children or all aspects of their well-being," he writes.
Return to Booster Shots blog. Follow me: twitter.com/LATShariRoan

Original Page: http://www.latimes.com/health/boostershots/la-heb-infant-growth-20111107,0,2456006.story
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Fat babies may mean something more than cuteness JK

noreply@blogger.com (John C Kim) — Wed, 09 Nov 2011 03:36:00 +0000

Fat babies may mean something more than cuteness JK

Infant growth can predict later obesity, a study indicates

Babies who grow too fast have a much higher risk of becoming obese, a study indicates. (Los Angeles Times)

By Shari Roan, Los Angeles Times / For the Booster Shots blog

November 7, 2011, 12:21 p.m.

Infant weight and height are faithfully charted at each pediatrician's visit to make sure the child is growing properly. But nowadays doctors are more likely to see babies who are growing too fast rather than ones lagging behind. A new study shows that rapid growth on these charts foretells obesity in childhood.

Researchers looked at the weight-for-length charts that show how a baby's weight compares to that of other babies of the same length. For example, babies on the 5th percentile growth line have a weight that puts them among the smallest 5% of all babies their length. Doctors mostly want to see that a child is following his or her growth curve over time and not falling off or jumping up. The major percentile lines are the 5th, 10th, 25th, 50th, 75th, 90th and 95th.

The study, which tracked more than 44,000 babies, found that those who rose two or more major percentiles -- for example, going from 50% to 90% at some point -- before age 2 were twice as likely to be obese at age 5 and 75% more likely to be obese at age 10.

Babies who jumped two or more percentiles before six months of age had the highest risk of obesity at age 10 as well as babies who were already in a high percentile at their first visit. For example a 6-month-old baby who started at the 75th percentile who jumped two or more percentiles in the next six months had an obesity prevalence of almost 30% at age 5. Babies who started at less than the 25th percentile and jumped two or more percentiles had an obesity prevalence at age 5 of about 7%.

"We shouldn't neglect these early gains and think that it's just baby fat, and that these children are going to grow out of it," said Dr. Elsie Taveras, the lead author of the study at Children's Hospital Boston.

Of all the babies in the study, 11.6% were obese at age 5 and 16% at age 10. Jumping two or more percentiles was common, the researchers found, with 43% rising two or more percentiles in their first six months of life and 64% at some point in their first two years.

The study was published Monday in the Archives of Pediatrics and Adolescent Medicine. The journal also carries an interesting commentary on child obesity by Dr. Robert C. Whitaker of the Center for Obesity Research and Education at Temple University.

Whitaker discusses the widespread social change that will be required to reverse the obesity epidemic. "The childhood obesity epidemic was an unexpected consequence of numerous well-intentioned decisions made by adults about how to improve our way of living. These decisions were often made without considering children or all aspects of their well-being," he writes.

Return to Booster Shots blog.

Follow me: twitter.com/LATShariRoan

Didn't even realize she just received a flu shot

noreply@blogger.com (John C Kim) — Mon, 31 Oct 2011 21:34:00 +0000

Reminder to get a flu vaccine.

noreply@blogger.com (John C Kim) — Mon, 31 Oct 2011 05:42:00 +0000

The danger of overuse of technology. Translates to over diagnosis, and a waste of worry? THe case of the MRI.

M.R.I.'s, Often Overused, Ofte

by GINA KOLATA, mobile.nytimes.com

October 29th 2011

Dr. James Andrews, a widely known sports medicine orthopedist in Gulf Breeze, Fla., wanted to test his suspicion that M.R.I.'s, the scans given to almost every injured athlete or casual exerciser, might be a bit misleading. So he scanned the shoulders of 31 perfectly healthy professional baseball pitchers.

The pitchers were not injured and had no pain. But the M.R.I.'s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent. "If you want an excuse to operate on a pitcher's throwing shoulder, just get an M.R.I.," Dr. Andrews says.

He and other eminent sports medicine specialists are taking a stand against what they see as the vast overuse of magnetic resonance imaging in their specialty.

M.R.I.'s can be invaluable in certain situations - finding serious problems like tumors or helping distinguish between competing diagnoses that fit a patient's history and symptoms. They also can make money for doctors who own their own machines. And they can please sports medicine patients, who often expect a scan.

But scans are easily misinterpreted and can result in misdiagnoses leading to unnecessary or even harmful treatments.

For example, said Dr. Bruce Sangeorzan, professor and vice chairman of the department of orthopedics and sports medicine at the University of Washington, if a healthy, uninjured person goes out for a run, a scan afterward will show fluid in the knee bone. It is inconsequential. But in an injured person, fluid can be a sign of a bone that is stressed or even has a crack and is trying to heal.

"An M.R.I. is unlike any other imaging tool we use," Dr. Sangeorzan said. "It is a very sensitive tool, but it is not very specific. That's the problem." And scans almost always find something abnormal, although most abnormalities are of no consequence.

"It is very rare for an M.R.I. to come back with the words 'normal study,' " said Dr. Christopher DiGiovanni, a professor of orthopedics and a sports medicine specialist at Brown University. "I can't tell you the last time I've seen it."

In sports medicine, where injuries are typically torn muscles or tendons or narrow cracks in bones, specialists like Dr. Andrews and Dr. DiGiovanni say M.R.I.'s often are not needed - they usually can figure out what is wrong with just a careful medical history, a physical exam and, sometimes, a simple X-ray.

M.R.I.'s are not the only scans that are overused in medicine but, in sports medicine, where many injuries involve soft tissues like muscles and tendons, they rise to the fore.

In fact, one prominent orthopedist, Dr. Sigvard T. Hansen, Jr., a professor of orthopedics and sports medicine at the University of Washington, says he pretty much spurns such scans altogether because they so rarely provide useful information about the patients he sees - those with injuries to the foot and ankle.

"I see 300 or 400 new patients a year," Dr. Hansen says. "Out of them, there might be one that has something confusing and might need a scan."

The price, which medical facilities are reluctant to reveal, depends on where the scan is done and what is being scanned. One academic medical center charges $1,721 for an M.R.I. of the knee to look for a torn ligament. The doctor who interprets the scan gets $244. Doctors who own their own M.R.I. machines - and many do - can pocket both fees. Insurers pay less than the charges - an average of $150 to the doctor and $960 to the facility.

Steve Ganobcik is something of a poster child for what can go wrong with the scans. A salesman who turns 44 on Saturday, Mr. Ganobcik twisted his knee skiing in Colorado in February. He continued skiing anyway and skied again the next two days as well, not wanting to cut his vacation short.

When he got home to Cleveland, his knee still bothered him, so he saw a sports medicine orthopedist. The doctor immediately ordered an M.R.I. and said it showed a torn anterior cruciate ligament, or A.C.L. It is one of the most common - and most devastating - sports injuries. The standard treatment is surgery, with a difficult recuperation lasting six months to a year.

Mr. Ganobcik looked into surgical techniques and decided he wanted a different one than the one his doctor offered. So he saw another sports medicine orthopedist who, agreeing that Mr. Ganobcik's ligament was torn, scheduled the operation.

Meanwhile, Mr. Ganobcik heard that Dr. Freddie H. Fu, chairman of the division of sports medicine at the University of Pittsburgh, had what might be an even better technique, so he went to see him.

To Mr. Ganobcik's surprise, Dr. Fu told him his ligament was not torn after all. His pain was from a fracture in a long bone in the lower leg that the other doctors had also noticed was broken. An M.R.I. at the University of Pittsburgh confirmed it, showing a perfectly normal A.C.L. (Dr. Fu adds that Mr. Ganobcik's original scans had an image that was ambiguous. He wanted a better one, to see if Mr. Ganobcik's ligament had been partly torn and was healing or had never been torn at all. He would not need surgery with a partial tear, but he would need more careful recuperation.)

Dr. Fu's suspicions were raised by Mr. Ganobcik's story. He could never have continued skiing with a torn A.C.L. The diagnosis "made no sense," Dr. Fu said.

And that, Dr. Fu says, illustrates a common problem: relying on an M.R.I. instead of a history and an exam. Dr. Fu's diagnosis "was a shock," Mr. Ganobcik said. "I thought he was going to talk about options for surgery."

M.R.I.'s can be extremely useful in sports medicine, said Dr. Andrew Green, the chief of shoulder and elbow surgery at Brown University. But, he says, there is a fine line between appropriate use and overuse.

That, at least, is what he found in one of the few studies to address the issue. The ideal study would randomly assign patients to have scans or not and then assess their outcomes. Such a study has not been done. Instead, a few researchers asked if scans made a difference for people who happened to have them. They found they did not - at least in two common situations.

Dr. Green and his colleagues reviewed the records of 101 patients who had shoulder pain lasting at least six weeks and that had not resulted from trauma, like a fall. Forty-three arrived bearing M.R.I.'s from a doctor who had seen them previously. The others did not have scans. In all cases, Dr. Green made a diagnosis on the basis of a physical exam, a history, and regular X-rays.

A year later, Dr. Green re-assessed the patients. There was no difference in the outcome of the treatment of the two groups of patients despite his knowledge of the findings on the scans. M.R.I.'s, he said, are not needed for the initial evaluation and treatment of many whose shoulder pain does not result from an actual injury to the shoulder.

Dr. DiGiovanni did a similar study with foot and ankle patients, looking back at 221 consecutive patients over a three-month period, 201 of whom did not have fractures. More than 15 percent arrived with M.R.I.'s obtained by doctors they had seen before coming to Dr. DiGiovanni. Nearly 90 percent of those scans were unnecessary and half had interpretations that either made no difference to the patient's diagnosis or were at odds with the diagnosis.

"Patients often feel like they are getting better care if people are ordering fancy tests, and there are some patients who come in demanding an M.R.I. - that's part of the problem," he said.

Some doctors might also feel they are providing better care if they order the scans, Dr. DiGiovanni said, and doctors often feel that they risk malpractice charges if they fail to scan a patient and then miss a diagnosis.

Dr. Hansen teaches his fellows - doctors in training - to be careful with scans and explains the risks of making the wrong diagnosis if they order them unnecessarily. He also knows it is not easy to refrain from ordering an M.R.I.

It's different for him, Dr. Hansen says. He is so eminent that patients tend not to question him.

"When I say 'You don't need a scan,' then it's over," Dr. Hansen said. His fellows get a different response. Patients, he says, "look at them like, 'You don't know what you're doing.' "

Original Page: http://mobile.nytimes.com/article?a=860324&f=26

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Re anti vaccine movement.

noreply@blogger.com (John C Kim) — Thu, 20 Jan 2011 04:13:00 +0000

PERSPECTIVE

The Age-Old Struggle against the Antivaccinationists

Gregory A. Poland, M.D., Robert M. Jacobson, M.D.

N Engl J Med 364:97-99 | January 13, 2011

Since the introduction of the first vaccine, there has been opposition to vaccination. In the 19th century, despite clear evidence of benefit, routine inoculation with cowpox to protect people against smallpox was hindered by a burgeoning antivaccination movement. The result was ongoing smallpox outbreaks and needless deaths. In 1910, Sir William Osler publicly expressed his frustration with the irrationality of the antivaccinationists by offering to take 10 vaccinated and 10 unvaccinated people with him into the next severe smallpox epidemic, to care for the latter when they inevitably succumbed to the disease, and ultimately to arrange for the funerals of those among them who would die (see the Medical Notes section of the Dec. 22, 1910, issue of the Journal). A century later, smallpox has been eradicated through vaccination, but we are still contending with antivaccinationists.

The Cow Pock — or — the Wonderful Effects of the New Inoculation.

Since the 18th century, fear and mistrust have arisen every time a new vaccine has been introduced. Antivaccine thinking receded in importance between the 1940s and the early 1980s because of three trends: a boom in vaccine science, discovery, and manufacture; public awareness of widespread outbreaks of infectious diseases (measles, mumps, rubella, pertussis, polio, and others) and the desire to protect children from these highly prevalent ills; and a baby boom, accompanied by increasing levels of education and wealth. These events led to public acceptance of vaccines and their use, which resulted in significant decreases in disease outbreaks, illnesses, and deaths. This golden age was relatively short-lived, however. With fewer highly visible outbreaks of infectious disease threatening the public, more vaccines being developed and added to the vaccine schedule, and the media permitting widespread dissemination of poor science and anecdotal claims of harm from vaccines, antivaccine thinking began flourishing once again in the 1970s.¹

Little has changed since that time, although now the antivaccinationists' media of choice are typically television and the Internet, including its social media outlets, which are used to sway public opinion and distract attention from scientific evidence. A 1982 television program on diphtheria–pertussis–tetanus (DPT) vaccination entitled "DPT: Vaccine Roulette" led to a national debate on the use of the vaccine, focused on a litany of unproven claims against it. Many countries dropped their programs of universal DPT vaccination in the face of public protests after a period in which pertussis had been well controlled through vaccination² — the public had become complacent about the risks of the disease and focused on adverse events purportedly associated with vaccination. Countries that dropped routine pertussis vaccination in the 1970s and 1980s then suffered 10 to 100 times the pertussis incidence of countries that maintained high immunization rates; ultimately, the countries that had eliminated their pertussis vaccination programs reinstated them.² In the United States, vaccine manufacturers faced an onslaught of lawsuits, which led the majority of them to cease vaccine production. These losses prompted the development of new programs, such as the Vaccine Injury Compensation Program (VICP), in an attempt to keep manufacturers in the U.S. market.

The 1998 publication of an article, recently retracted by the Lancet, by Wakefield et al.³ created a worldwide controversy over the measles–mumps–rubella (MMR) vaccine by claiming that it played a causative role in autism. This claim led to decreased use of MMR vaccine in Britain, Ireland, the United States, and other countries. Ireland, in particular, experienced measles outbreaks in which there were more than 300 cases, 100 hospitalizations, and 3 deaths.⁴

Today, the spectrum of antivaccinationists ranges from people who are simply ignorant about science (or "innumerate" — unable to understand and incorporate concepts of risk and probability into science-grounded decision making) to a radical fringe element who use deliberate mistruths, intimidation, falsified data, and threats of violence in efforts to prevent the use of vaccines and to silence critics. Antivaccinationists tend toward complete mistrust of government and manufacturers, conspiratorial thinking, denialism, low cognitive complexity in thinking patterns, reasoning flaws, and a habit of substituting emotional anecdotes for data.⁵ Their efforts have had disruptive and costly effects, including damage to individual and community well-being from outbreaks of previously controlled diseases, withdrawal of vaccine manufacturers from the market, compromising of national security (in the case of anthrax and smallpox vaccines), and lost productivity.²

The H1N1 influenza pandemic of 2009 and 2010 revealed a strong public fear of vaccination, stoked by antivaccinationists. In the United States, 70 million doses of vaccine were wasted, although there was no evidence of harm from vaccination. Meanwhile, even though more than a dozen studies have demonstrated an absence of harm from MMR vaccination, Wakefield and his supporters continue to steer the public away from the vaccine. As a result, a generation of parents and their children have grown up afraid of vaccines, and the resulting outbreaks of measles and mumps have damaged and destroyed young lives. The reemergence of other previously controlled diseases has led to hospitalizations, missed days of school and work, medical complications, societal disruptions, and deaths. The worst pertussis outbreaks in the past 50 years are now occurring in California, where 10 deaths have already been reported among infants and young children.

In the face of such a legacy, what can we do to hasten the funeral of antivaccination campaigns? First, we must continue to fund and publish high-quality studies to investigate concerns about vaccine safety. Second, we must maintain, if not improve, monitoring programs, such as the Vaccine Adverse Events Reporting System (VAERS) and the Clinical Immunization Safety Assessment Network, to ensure coverage of real but rare adverse events that may be related to vaccination, and we should expand the VAERS to make compensation available to anyone, regardless of age, who is legitimately injured by a vaccine. Third, we must teach health care professionals, parents, and patients how to counter antivaccinationists' false and injurious claims. The scientific method must inform evidence-based decision making and a numerate society if good public policy decisions are to be made and the public health held safe. Syncretism between the scientific method and unorthodox medicine can be dangerous.

Fourth, we must enhance public education and public persuasion. Patients and parents are seeking to balance risks and benefits. This process must start with increasing scientific literacy at all levels of education. In addition, public–private partnerships of scientists and physicians could be developed to make accurate vaccine information accessible to the public in multiple languages, on a range of reading levels, and through various media. We must counter misinformation where it is transmitted and consider using legal remedies when appropriate.

The diseases that we now seek to prevent with vaccination pose far less risk to antivaccinationists than smallpox did through the early 1900s. Unfortunately, this means that they can continue to disseminate false science without much personal risk, while putting children, the elderly, and the frail in harm's way. We can propose no Oslerian challenge to demonstrate our point but have instead a story of science and contrasting worldviews: on the one hand, a long history of stunning triumphs, such as the eradication of smallpox and control of many epidemic diseases that had previously maimed and killed millions of people; on the other hand, the reality that none of the antivaccinationists' claims of widespread injury from vaccines have withstood the tests of time and science. We believe that antivaccinationists have done significant harm to the public health. Ultimately, society must recognize that science is not a democracy in which the side with the most votes or the loudest voices gets to decide what is right.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

References

RM Wolfe, LK SharpAnti-vaccinationists past and present.BMJ2002;325:430-432

EJ Gangarosa, AM Galazka, CR Wolfe, Impact of anti-vaccine movements on pertussis control: the untold story.Lancet1998;351:356-361

Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998;351:637-41. [Retraction, Lancet 2010;375:445.]

J McBrien, J Murphy, D Gill, M Cronin, C O'Donovan, MT CafferkeyMeasles outbreak in Dublin, 2000.Pediatr Infect Dis J2003;22:580-584

RM Jacobson, PV Targonski, GA PolandA taxonomy of reasoning flaws in the anti-vaccine movement.Vaccine2007;25:3146-3152

Source Information

From the Mayo Clinic Vaccine Research Group (G.A.P., R.M.J.), the Department of Medicine (G.A.P.), and the Department of Pediatric and Adolescent Medicine (G.A.P., R.M.J.), Mayo Clinic, Rochester, MN.

Study Linking Childhood Vaccine And Autism Was Fraudulent

noreply@blogger.com (John C Kim) — Mon, 10 Jan 2011 19:29:00 +0000

Even so, it may take years of dissipation for the skepticism re vaccines to fade.

http://www.npr.org/blogs/health/2011/01/06/132703314/study-linking-childhood-vaccine-and-autism-was-fraudulent?sc=17&f=1001

Study Linking Childhood Vaccine And Autism Was Fraudulent
by Scott Hensley

- January 6, 2011

Just when you think there's nothing left to say about a 13-year-old paper that purported to link childhood vaccination and autism, it turns out you're wrong.

In the latest issue of BMJ, the British Medical Journal, investigative reporter Brian Deer makes the case that the infamous Lancet study, withdrawn last year, wasn't just wrong -- it was fraudulent because key facts were altered to support the autism link.

The original paper reported on a dozen kids, eight of whom supposedly developed gastrointestinal trouble and "regressive autism," a form of the disorder that strikes later in childhood, after getting a combination vaccine against measles mumps and rubella. The work was led by Andrew Wakefield, an English doctor whose license was revoked last May for "serious professional misconduct" related to the work.

Where did the paper go wrong? Deer counts the ways after scouring health records and interviewing the patients families and various doctors. A few of the lowlights:

Only 1 of 9 kids said to have regressive autism clearly had it. Three had no form of autism.

Contrary to the paper's assertion that all the kids were normal before vaccination, five had some sort of preexisting developmental problems.

Behavioral problems the paper said popped up days after vaccination didn't actually appear for months in some kids, a fact that undercuts the causality of vaccination.

Wakefield's hypothesized link between vaccination and autism was flimsy from the start, and has since been repeatedly repudiated. But the provocative Lancet paper fueled a vigorous backlash against vaccination.

An accompanying editorial in BMJ argues that "clear evidence of falsification of data should now close the door on this damaging vaccine scare" for good.

CNN's Anderson Cooper interviewed Wakefield, who called Deer, "a hitman" hired to "take me down." Wakefield defended the paper and his methods. See the video below for the full discussion.

UPDATE 4:30 p.m.

As NPR's Jon Hamilton reports on today's All Things Considered, more revelations about Wakefield aren't likely to make the fear of vaccines go away. But David Ropeik, is an instructor at Harvard, says something else eventually will. "As more and more people get measles and kids die, which is happening around the world. Eventually the threat of the disease will come back and surmount our fear of the vaccine." [Copyright 2011 National Public Radio]

To learn more about the NPR iPhone app, go to http://iphone.npr.org/recommendnprnews

Article: Parents Embrace ‘Race to Nowhere,’ on Pressures of School - NYTimes.com

noreply@blogger.com (John C Kim) — Fri, 10 Dec 2010 05:01:00 +0000

On the debate of defining childhood.

Parents Embrace 'Race to Nowhere,' on Pressures of School - NYTimes.com
http://www.nytimes.com/2010/12/09/education/09nowhere.html?ref=homepage&src=me&pagewanted=all

Advertise on NYTimes.com

Parents Embrace Documentary on Pressures of School

By TRIP GABRIEL

Published: December 8, 2010

It isn't often that a third of a movie audience sticks around to discuss its message, but that is the effect of "Race to Nowhere," a look at the downside of childhoods spent on résumé-building.

"How do you help your children balance when the whole education system is pushing, pushing, pushing, and you want your kids to be successful?" Alethea Lewis, a mother of two, asked a roomful of concerned parents who had just seen the film, a documentary, last week in Bronxville, N.Y., at a screening co-sponsored by the private Chapel School.

With no advertising and little news media attention, "Race to Nowhere" has become a must-see movie in communities where the kindergarten-to-Harvard steeplechase is most competitive.

More than 1,100 attended a screening last week at New Trier High School in Winnetka, Ill. About 500 saw it at the 92nd Street Y in Manhattan in November. It has been shown to a roomful of fathers at Pixar during lunch hour and twice to employees at the Silicon Valley headquarters of Google.

All 325 seats in the auditorium of New Canaan Country School in Connecticut were filled during a screening for parents last Thursday night. Francie Irvine, the assistant head of school, said, "Our parents' association president called me and said, 'My sister just saw this in California and we have to, have to, have to have it here.' "

The film portrays the pressures when schools pile on hours of homework and coaches turn sports into year-round obligations. Left somewhat unexamined is the role of parents whose high expectations contribute the most pressure of all.

"Everyone expects us to be superheroes," one high school senior in the film says.

Another tells of borrowing her friends' prescription for Adderall to juggle her many commitments. "It's hard to be the vice president of your class, play on the soccer team and do homework," she says.

The movie introduces boys who drop out of high school from the pressure, girls who suffer stress-induced insomnia and worse, and students for whom "cheating has become another course," as one puts it.

"When success is defined by high grades, test scores, trophies,"' a child psychologist says in the film, "we know that we end up with unprepared, disengaged, exhausted and ultimately unhealthy kids."

Vicki Abeles, the middle-aged mother and first-time filmmaker who made "Race to Nowhere," picked up a camera when a doctor said that her then-12-year-old daughter's stomachaches were being caused by stress from school.

"I was determined to find out how we had gotten to a place where our family had so little time together," she explains in the film, which has an unslick, home-video quality, "where our kids were physically sick because of the pressures they were under."

In many ways, the movie is the alter ego to the better-known "Waiting for Superman," another education documentary playing around the country this fall.

That film has earned $6.3 million at the box office since its release and ranks 20th among the most successful documentaries ever, according to Box Office Mojo, in no small part because of a blast of publicity. The director appeared on "The Oprah Winfrey Show," and President Obama greeted its stars at the White House.

"Race to Nowhere" had a one-week run in two theaters, in New York and Los Angeles, but it has primarily been screened by community groups in school auditoriums, churches and temples. Local sponsors like parent-teacher associations sell tickets and split the take with the filmmakers.

Ms. Abeles, a corporate lawyer who briefly traded on the gold desk at Goldman Sachs before moving to Northern California with her family, said the film cost her and other backers in the "mid-six figures." It will have been shown at some 700 locations through February.

With her movie's grass-roots success, Ms. Abeles has been approached by major distributors offering to place it in commercial theaters. But she is not convinced that the movie would reach as wide an audience or inspire viewers to stay for the discussions, which are moderated by principals, child psychologists and sometimes Ms. Abeles herself. The film's Web site encourages viewers to follow up with local activism (and also links to research and studies supporting the film, which pretty much avoids citing any data).

"My passion is around the change this film has the potential to create," Ms. Abeles said.

While "Waiting for Superman" lionizes urban reformers who embrace standardized testing as a necessary yardstick to hold schools and teachers accountable, Ms. Abeles believes that the testing movement is what has caused education to go off the tracks.

She talks to students, teachers and experts who say that teaching to tests, including the Advanced Placement tests, narrows education and diminishes creativity and independent thinking. Employers complain that college graduates these days lack initiative. An educator, Denise Pope, a lecturer at Stanford, says that the University of California requires remedial courses of half its students, even though their high school grades were stellar.

"They're spitting back but not retaining the information," Dr. Pope said.

Most of the families in "Race to Nowhere" are suburban and privileged, and the film has found its audience in those communities where parents often move for excellent schools. In addition to New Canaan and Winnetka, there were screenings last week in Los Altos, Calif., Bethesda, Md., and Chappaqua, N.Y. — towns where an Ivy League sticker on the back of a Range Rover is a given.

"You would not believe what reactions you get from other parents when you mention what colleges your children are looking at — you're so judged," Tara Vessels, a mother at New Canaan Country School, told about 40 other parents and staff members who discussed the movie last Friday in the school cafeteria.

The school espouses a "whole child" philosophy, and its mission statement, inscribed on the cafeteria walls, includes the sentence: "We value the imagination and curiosity of children and respect childhood as an integral part of life."

But parents said the larger community imposed its own values, and their children clamored to join an ice hockey league that practices until 10 p.m.

"Imagine if a sign out front of school says 'Mistakes Are Made Here Often,' " mused one teacher, echoing a theme in the movie that schools should accept failure as part of learning. "No one would come here! But why not?"

A mother complained that her 13-year-old "had a chapter test, and that night had to study for a quiz" in the same class. "What is the point of all the testing?" she said. "It's so stressful."

Tim Bazemore, the head of school, acknowledged ruefully that "the whole child in high school is a full résumé," telling the parents that this reflected "a failure of education leadership."

Nonetheless, he wondered how parents would feel if teachers assigned less homework and did not penalize students who did not do it. Would families think the school was failing to prepare their children for high school and beyond?

The school "needs an honest dialogue with you," Mr. Bazemore said.

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Triple That Vitamin D Intake, Panel Prescribes - WSJ.com

noreply@blogger.com (John C Kim) — Wed, 01 Dec 2010 04:54:00 +0000

Lot of different angles on Vitamin D and The IOM report.

Another take on the IOM report

From Evernote:

Triple That Vitamin D Intake, Panel Prescribes - WSJ.com

Clipped from: http://online.wsj.com/article/SB10001424052748704584804575645023841631864.html

Triple That Vitamin D Intake, Panel Prescribes

By MELINDA BECK

A long-awaited report from the Institute of Medicine to be released Tuesday triples the recommended amount of vitamin D most Americans should take every day to 600 international units from 200 IUs set in 1997.

That's far lower than many doctors and major medical groups have been advocating—and it could dampen some of the enthusiasm that's been building for the sunshine vitamin in recent years.

Many doctors have added blood tests of vitamin D levels to annual physicals, and sales of vitamin D supplements have soared to $425 million last year from $40 million in 2001, according to the Nutrition Business Journal.

View Full Image

Getty Images

The IOM panel also issued new recommendations for daily calcium intake, up to 1,200 milligrams for women 51 and older.

Who Needs Extra D

Some people are at high risk for vitamin D deficiency, and experts believe they may benefit from more vitamin D than the new recommendations:

People age 50 and older: This group is at increased risk for Vitamin D insufficiency. As people age, their skin is less efficient in synthesizing the vitamin and the kidney is less able to convert it to its active hormone form.
People with osteoporosis: Vitamin D is crucial for building and maintaining strong bones.
People with limited sun exposure: This population includes the homebound, those living in northern latitudes and individuals who wear long robes and head coverings.
People with dark skin: Greater amounts of the pigment melanin result in darker skin and reduce the skin's ability to produce vitamin D from sunlight. People who have immigrated from sunnier climates may find their levels dropping sharply in latitudes where the sun's rays aren't as strong much of the year.
People with fat malabsorption: Vitamin D requires some dietary fat in the gut for absorption. Individuals who have a reduced ability to absorb dietary fat might require supplements. Fat malabsorption is associated with conditions including pancreatic enzyme deficiency, Crohn's disease, cystic fibrosis, celiac disease, surgical removal of part of the stomach or intestines and some forms of liver disease.
People taking certain medications:Prednisone and anti-seizure drugs can cause vitamin D to be absorbed and metabolized more quickly, reducing available blood levels.
People who are obese: Individuals with a body mass index equal to or greater than 30 typically have a low concentration of the vitamin in the blood.

Source: National Institutes of Health Office of Dietary Supplements

The power of love over bureaucracy

noreply@blogger.com (John C Kim) — Tue, 30 Nov 2010 00:09:00 +0000

TARAZ JOURNAL

Unwrapping Red Tape to Find the Gift of Family

Maxim Marmur for The New York Times

For months, Rebecca Compton went daily to an orphanage in Taraz, Kazakhstan, to visit Noah.

By CLIFFORD J. LEVY

Published: November 23, 2010

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TARAZ, Kazakhstan — He was first placed into their arms nearly a year ago, an underweight 9-month-old baby in a gray sweatshirt. They were at an orphanage behind a crumbling housing project here in Central Asia, unimaginably far from their home in suburban Philadelphia, but immediately, they knew that they did not want to let him go.

The New York Times

Taraz officials have grown more cautious on adoptions.

They decided to call him Noah.

"He seems like the right little guy for us," Rebecca Compton, a college professor, wrote as she and her husband, Jeremy Meyer, a labor lawyer, began what they thought would be a standard adoption process.

But these days in Kazakhstan, Russia and other former Soviet republics, adoptions are often far from standard, especially in light of the highly publicized — and deeply embarrassing — return of a 7-year-old Russian boy to Moscow in April by his adoptive American mother.

Ms. Compton and Mr. Meyer assumed they would soon be flying back to the United States with Noah. Then the delays mounted. Kazakh officials refused to sign off on the adoption.

Yet, Ms. Compton and Mr. Meyer would not give up.

They took leaves from their jobs, remaining in Kazakhstan for months on end while engaging in a bewildering fight with the Kazakh bureaucracy. It was not until last week, after setting aside their lives to pursue a child whom they now deeply loved, that they finally learned whether they could adopt him — whether this Thanksgiving would be a day of joy or despair.

"This is one of the only times when I have ever had this experience of feeling so helpless about something that I care so much about," Ms. Compton said. The obstacles that Ms. Compton and Mr. Meyer have faced reflect the rising complexity of foreign adoptions in the former Soviet Union, which since Communism's fall two decades ago has been a popular destination for prospective parents. As these countries become more stable, they are growing increasingly resistant to the idea of sending future generations abroad.

But they still maintain large orphanage systems, so a debate periodically flares over what is in the best interests of the children. The authorities would like local parents to adopt, but there are not enough in countries like Kazakhstan and Russia.

The issue is not necessarily poor conditions in orphanages. The one in Taraz is clean and well run, and the children seem happy. But experts say children are more likely to thrive in a good family.

Ms. Compton has spent much of the last year in Taraz, a city on the old Silk Road where English is rarely heard and boiled horse meat is typical fare. For months, she went daily to the orphanage to see Noah.

Born premature, he had lagged developmentally, but with the constant attention he has started to catch up, turning into a spirited toddler before the Americans' eyes. On a recent visit to the orphanage, he giggled and squirmed while Ms. Compton read him a book with purple dinosaurs and blue whales, as if they were any mother and child.

"When I am here, I have no doubt about what I am doing," she said. "As soon I see him, I don't think about the legal situation, or how long I have been in Taraz. I just want to hold him."

But visiting hours soon ended. She had to leave the orphanage, and he stayed behind.

On many nights in recent months, she has retreated to her hotel room and not known whether to scream or cry or bang her head against the wall in frustration. She said she once dreamed that she was hugging Noah, but then he disappeared, though she could still feel his touch. Then she located him nearby, "looking up at me with his dark searching eyes," she recalled, but he vanished again.

Foreign adoptions in Kazakhstan can go relatively smoothly, but Ms. Compton and Mr. Meyer had unfortunate timing.

In January, soon after they began the adoption process, Casey Johnson, the daughter of Woody Johnson, the owner of the New York Jets, died. Ms. Johnson, who had adopted a baby from Taraz in 2007, had led a troubled life, and her death raised questions in Kazakhstan about whether the adoption should have been allowed. Local officials became exceedingly cautious, and slowed down several adoptions.

Then in April, the 7-year-old boy was returned to Moscow on his own by his American mother, and the Kremlin demanded new adoption safeguards from the United States. That had a ripple effect across the countries of the former Soviet Union.

In May, a court rejected Ms. Compton's and Mr. Meyer's petition to adopt Noah, contending that the orphanage had not done enough to determine whether Kazakhs might want him. They appealed.

Ms. Compton, 40, who is the chairwoman of the psychology department at Haverford College in Pennsylvania, and Mr. Meyer, 40, had little ability to deal with the Kazakh legal system, which often seemed highly dysfunctional. They do not know Kazakh or Russian, the languages here, and were dependent on interpreters, consultants and lawyers.

"We are never quite sure what is going on," Mr. Meyer, who had to return to Pennsylvania over the summer for work, said last month. "We are in the dark about the most important thing in our life."

Raisa Sher, the federal children's ombudsman in Kazakhstan, said in an interview that Taraz officials were applying the law correctly. She said Kazakhstan was supporting efforts to keep babies in the country, so officials had to ensure that foreign adoptions were a last resort.

"It is very sad when a country cannot provide for its own children," she said. "We consider these foreign adoptions only a temporary measure."

Kazakh officials even suggested that Ms. Compton and Mr. Meyer seek another baby, as if Noah could be exchanged for someone else. They cringed at the thought that a child who had been given up by one set of parents would be abandoned by another.

But by September, there seemed to be an opening. With the government under intense lobbying by Ms. Compton and Mr. Meyer and their supporters, a local court indicated that it would reconsider their case if it could be shown that no Kazakhs wanted to adopt Noah.

The orphanage presented evidence. Then there were more sleepless nights while they waited in Taraz for the decision. This month, the court preliminarily endorsed the adoption. "We won. We won!!" they wrote on their private blog.

Last week, they received final approval, and on Friday they walked out of the orphanage with a new, by now 20-month-old member of their family. They are hopeful that other foreigners who have also had Taraz adoptions blocked will obtain similar relief.

Ms. Compton and Mr. Meyer have to remain in Kazakhstan for a few more weeks, but they said they were fine celebrating Thanksgiving in a foreign land, given how much they had to be thankful for.

They noted that the holiday reminded them of Noah's Kazakh name, Aldanysh. Loosely translated, it means "survivor."

Fwd: Switching Gears: More Commuters Bike To Work

noreply@blogger.com (John C Kim) — Mon, 29 Nov 2010 20:16:00 +0000

All the cool people are doing it. You have to build it in.

I found the following story on the NPR iPhone App:
http://www.npr.org/2010/11/23/131539669/switching-gears-more-commuters-bike-to-work?sc=17&f=1001

Switching Gears: More Commuters Bike To Work
by Allison Aubrey

- November 29, 2010

One way National Geographic staffers in Washington, D.C., can get to know their company's CEO is to take him up on his long-standing offer: to go for a lunchtime bike ride.

"Anyone still downstairs? OK, so we ready to go, guys?" National Geographic Society CEO John Fahey asks a group of about 20 employees

Fahey, an avid biker, says he's just trying to encourage a little exercise -- and he wants the opportunity to get to know folks informally. As the group makes the 15-mile trek to Hains Point along the Potomac River and back, Fahey makes a point of chatting with everyone, staffers say.

At National Geographic -- which is a hub of outdoorsy, adventure-seeking types who think nothing of biking busy city streets -- lots of the staffers who join Fahey for the lunchtime rides also use their bikes to get to and from work every day.

"I've been riding in for 19 years," says senior photo editor Dan Westergren, adding that he has definitely noticed the boom -- especially as bike paths and bike lanes along city streets have improved.

Westergren's commute is a combined 12 miles to and from home. And he says, given all the biking he does, he doesn't need a gym membership to stay fit.

"Really, to build it into your daily routine by commuting for me has just been the best thing," he says.

Cycling Culture

If you bike to work in Washington, D.C., Minneapolis, Chicago or San Francisco, you're part of a boom. Cycling has at least tripled over the past two decades in these -- and other -- big cities across the U.S.

"It's almost like a snowball effect," says researcher John Pucher of Rutgers University. "People see other people cycling and they say, 'Wow!' " As part of a three-year research project for the U.S. Department of Transportation, Pucher has completed a preliminary report that documents the increase in biking in nine major North American cities.

"It's almost become a cultural phenomenon," Pucher says. "It's become the 'in' thing to do." For many city dwellers, it's a money saver, a time saver and a way to sneak in daily exercise.

Research shows that the extra physical activity that people get from walking and biking to work or school is not offset by less recreational activity.

"[Active commuters] actually double the amount of their total physical activity," says Pucher. And as a result, Pucher says cities with lots of "active" commuters tend to be healthier. The most recent evidence comes from a study Pucher and his colleagues published in the American Journal of Public Health.

They found that the U.S. cities with the highest rates of walking and cycling to work have obesity rates that are 20 percent lower and diabetes rates that are 23 percent lower -- compared with U.S. cities with the lowest rates of walking and cycling.

Just 'Hide The Bike Grease'

There are, of course, a few daily obstacles. Take the weather. "In the winter it's just gross sometimes with the ice," staffer Julia Yordanova says. And there are also the dangers of traffic. "It's the cab drivers," says Jonathan Irish.

Not to mention the need to try to fit in a shower at the office. "You just try to hide the bike grease on your calf as you're sitting in a meeting," says Barbara Noe, an editor at Travel Books.

But hey, if the office culture tolerates a little sweat on the brow -- or grease on the calf -- take it a sign of good health. That's the way Pucher sees it.

To learn more about the NPR iPhone app, go to http://iphone.npr.org/recommendnprnews

Vitamin D Lowers Diabetes Risk - TIME

noreply@blogger.com (John C Kim) — Thu, 25 Nov 2010 17:35:00 +0000

The causality of vitamin D and diabetes is still uncertain, but there are numerous studies to make connection between Vitamin D deficiency and other autoimmune issues so this biologically plausible. Bottom line, probable benefit, unclear risk on a WHOLE population level, but on an individual level, may make a lot of sense to Supplement.

From Evernote:

Vitamin D Lowers Diabetes Risk - TIME

Clipped from: http://www.time.com/time/health/article/0,8599,1722399,00.html

Vitamin D Lowers Diabetes Risk

By Sora Song Thursday, Mar. 13, 2008

Steve Nagy / Design Pics / Corbis

0digg

Giving children vitamin D supplements in infancy may shear their risk of developing type 1 diabetes later in life. In an analysis of previously published studies, British researchers found significant evidence that supplements of the vitamin were associated with a 29% reduced risk of the disease.

Participants in the studies were given vitamin D supplements from birth onward, for a variable time period, and were tracked for some 15 to 30 years, according to Dr. Christos Zipitis, a pediatrician with the Stockport NHS Foundation Trust and lead author of the new paper, which appears online this week in the Archives of Disease in Childhood. Types and doses of vitamin D supplements varied, and were not always reported, but Zipitis says supplementation was roughly 10 mcg, or 400 I.U., of vitamin D daily — the amount typically found in infant multivitamins. Based on data from three case-control studies involving 6,455 participants, the new paper found that infants who were given supplements were 29% less likely to develop type 1 diabetes compared with infants who never got extra vitamin D. Zipitis, who reviewed a total of five studies, also found evidence that the vitamin's protective effect increased with larger doses and more regular supplementation. "[Our study] provides the strongest evidence to date that vitamin D might be protective against type 1 diabetes in later life," says Zipitis. "Obviously we're based on other studies, so this has come up before. The new thing with our study is the strength of the association and the confidence with which we can talk about it."

Given the limits of the available data, however, the paper was unable to say how much vitamin D the children were getting from sources other than supplementation, or whether they were deficient to begin with. But Zipitis says children who had rickets, a bone disorder caused by extreme vitamin D deficiency, "were at a much higher risk of developing type 1 diabetes — I think about three times higher than the rest of the population, which would suggest that the higher the level of vitamin D in your body, the less likely you are to develop type 1 diabetes."

Past research has come to the same conclusion. Countries with lots of sunshine, which triggers vitamin D production in the body, for example, have a lower incidence of type 1 diabetes than relatively sunless places. Studies have also shown that new cases of type 1 diabetes crop up more often in winter, when there is less sunshine all around, than in summer. In addition, says Zipitis, when doctors check vitamin D blood levels of newly diagnosed type 1 diabetes patients, they are generally lower than average. "In the U.K. and other European countries, we haven't got the right UV radiation for most of the year," he says, adding that vitamin D deficiency is a re-emerging problem in the U.K., and that doctors are seeing a resurgence of rickets in children. "With all the scares about skin cancer, when people go outside, they're covered with sunblock, which doesn't allow the conversion of UV light into vitamin D. That's where the supplements come in."

Insufficient blood levels of vitamin D have been linked to several health problems aside from rickets and type 1 diabetes, including other autoimmune diseases such as rheumatoid arthritis and multiple sclerosis, along with some rare but serious heart problems like cardiomyopathy. Indeed a host of recent studies has shown myriad benefits of taking supplements. Beyond better bone health, stronger muscles and fewer fractures in adults, research also suggests vitamin D can reduce the risk of various cancers. A study of 1,179 postmenopausal women published in the American Journal of Clinical Nutrition last year found that women who took calcium and 1,100 I.U. of vitamin D daily had 80% fewer cancers than women who took a placebo or calcium alone.

For infants, the American Academy of Pediatrics (AAP) currently recommends a supplement of 200 I.U. of vitamin D per day, starting at two months of age for breastfed babies. Once infants are weaned to vitamin-D fortified formula, however, supplements are no longer necessary.

zsleep Childhood Sleep Time and Long-Term Risk for Obesity: A 32-Year Prospective Birth Cohort Study -- Landhuis et al. 122 (5): 955 Figure 1 -- Pediatrics good graph zpted

noreply@blogger.com (John C Kim) — Sun, 14 Nov 2010 15:57:00 +0000

From Evernote:

zsleep Childhood Sleep Time and Long-Term Risk for Obesity: A 32-Year Prospective Birth Cohort Study -- Landhuis et al. 122 (5): 955 Figure 1 -- Pediatrics good graph zpted

Clipped from: http://pediatrics.aappublications.org.proxy.uchicago.edu/cgi/content/full/122/5/955/F1

Click here to download a slide of this image in PowerPoint format. You do NOT need to request permission if you are reproducing or paraphrasing a table or figure to make slides or handouts for an educational lecture or discussion that is under the auspices of a not-for-profit educational organization. Otherwise, contact permissions@aap.org for additional information or to make a request. Click on image to view larger version.

FIGURE 1 BMIs for short, moderate, and long sleepers at every assessment between ages 3 and 32 years. Error bars represent ±1 SEM.

The surreptitious flu shot. Didn't even realize she just received a flu shot

noreply@blogger.com (John C Kim) — Sun, 07 Nov 2010 23:19:00 +0000

Really? - The Claim - Lack of Sleep Increases Weight - Question - NYTimes.com : Lots of Evidence that sleep and weight gain are linked.

noreply@blogger.com (John C Kim) — Sat, 06 Nov 2010 11:44:00 +0000

From Evernote:

Really? - The Claim - Lack of Sleep Increases Weight - Question - NYTimes.com

Clipped from: http://www.nytimes.com/2010/04/27/health/27real.html

Reload Original Page Print Page Email Page

Really? - The Claim - Lack of Sleep Increases Weight - Question

Looking to lose a little weight? Portion size and exercise are crucial. But don’t forget about a good night’s rest.

Scientists have known for years that skimping on sleep is associated with weight gain. A good example was a study published in 2005, which looked at 8,000 adults over several years as part of the National Health and Nutrition Examination Survey. Sleeping fewer than seven hours a night corresponded with a greater risk of weight gain and obesity, and the risk increased for every hour of lost sleep.

More recent studies have taken a much closer look.

One published this year in The American Journal of Clinical Nutrition took a small group of men and measured their food intake across two 48-hour periods, one in which they slept eight hours and another in which they slept only four. After the night of abbreviated sleep, the men consumed more than 500 extra calories (roughly 22 percent more) than they did after eight hours of sleep. A University of Chicago study last year had similar findings in both men and women: subjects took in significantly more calories from snacks and carbohydrates after five and a half hours of sleep than after eight and a half hours.

Some studies pin the blame on hormones, arguing that decreased sleep creates a spike in ghrelin, a hormone that stimulates appetite, and a reduction in leptin, which signals satiety. But more study is needed.

THE BOTTOM LINE

Losing sleep may increase appetite and, as a result, weight.

ANAHAD O’CONNOR scitimes@nytimes.com

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On being annoyed

noreply@blogger.com (John C Kim) — Sat, 06 Nov 2010 11:44:00 +0000

If you are easily annoyed, it probably means that you are pretty annoying

The 10 Biggest Choking Hazards - NYTimes.com

noreply@blogger.com (John C Kim) — Sat, 06 Nov 2010 11:43:00 +0000

May 24, 2010

The 10 Biggest Choking Hazards

By LAURIE TARKAN

According to a 2008 study, the 10 foods that pose the highest choking hazards for young children are hot dogs, peanuts, carrots, boned chicken, candy, meat, popcorn, fish with bones, sunflower seeds and apples.

Dr. Gary Smith, the lead author of American Academy of Pediatrics’ policy statement on food hazards, says some foods should simply not be given to children under 4 or 5: he mentioned raw carrots, marshmallows, peanuts, popcorn, hard candies and gumballs.

If feeding a young child a hot dog, he said, cut it lengthwise before slicing it. (Simply slicing it into nickel-size chunks makes it more dangerous than not slicing it at all.) Cut grapes into quarters. Flat lollipops are safer than ball-shaped suckers.

If a child is choking, call 911 — time is of the essence. Health authorities also recommend acting quickly to remove the object. If a child is more than 1 year old, perform the Heimlich maneuver. If the child is younger than 1, rest the child face down on your knee and slap the back between the shoulder blades five times.

“It’s important that all caregivers are CPR-certified,” said Erika Bleiberg, an emergency medical technician in Glen Ridge, N.J., who is a certified CPR instructor. “Even if the E.M.T. is there within three minutes, that’s a lot of time for a little brain to not have oxygen.” LAURIE TARKAN

This article has been revised to reflect the following correction:
Correction: May 27, 2010
Because of an editing error, an article on Tuesday about the top 10 choking hazards for children omitted some steps to take if a child is choking and seems unable to cough out the obstruction. Besides having someone call 911, the health authorities recommend acting quickly to remove the object. If a child is more than 1 year old, perform the Heimlich maneuver. If the child is younger than 1, rest the child face down on your knee and slap the back between the shoulder blades five times. More information can be found at healthychildren.org.

via nytimes.com

Eating Brown Rice to Cut Diabetes Risk - Well Blog - NYTimes.com

noreply@blogger.com (John C Kim) — Sat, 06 Nov 2010 11:43:00 +0000

The power of rice

From Evernote:

Eating Brown Rice to Cut Diabetes Risk - Well Blog - NYTimes.com

Clipped from: http://well.blogs.nytimes.com/2010/06/15/eating-brown-rice-to-cut-diabetes-risk/?src=me&ref=homepage

June 15, 2010, 12:08 pm

Eating Brown Rice to Cut Diabetes Risk

By RONI CARYN RABIN

Francesco Tonelli for The New York Times Brown rice contains fiber and nutrients that may help ward off diabetes.

Next time you order takeout wonton soup and a spicy Number 82, you might want to make sure it comes with brown rice.

Brown rice is a whole grain — white rice before it has been refined and polished and stripped of the bran covering, which is high in fiber and nutrients. Brown rice also has a lower glycemic index than white rice, which means it doesn’t cause blood glucose levels to rise as rapidly.

Now a new study from researchers at Harvard reports that Americans who eat two or more servings of brown rice a week reduce their risk of developing Type 2 diabetes by about 10 percent compared to people who eat it less than once a month. And those who eat white rice on a regular basis — five or more times a week — are almost 20 percent more likely to develop Type 2 diabetes than those who eat it less than once a month.

Just replacing a third of a serving of white rice with brown each day could reduce one’s risk of Type 2 diabetes by 16 percent, a statistical analysis showed. A serving is a cup of cooked rice.

The study, which used data from two Harvard nurses’ health studies and a separate study of health professionals, isn’t the first to point a finger at foods like white rice as a culprit in Type 2 diabetes. A 2007 study of Chinese women in Shanghai found that middle-aged women who ate large amounts of white rice and other refined carbohydrates were also at increased risk for diabetes compared to their peers who ate less.

But the Harvard study is one of the first to distinguish between brown rice and white rice consumption in the United States, where rice is not a staple food and relatively little is eaten overall, said Dr. Qi Sun, an instructor in medicine at Brigham and Women’s Hospital, which is affiliated with Harvard Medical School. Many food studies simply lump brown and white rice together.

“The bottom line is we showed evidence that increased consumption of white rice – even at this low level of intake — is still associated with increased risk,” said Dr. Sun, who was at the Harvard School of Public Health when the study was done. “It’s really recommended to replace white rice with the same amount of brown rice or other whole grains.”

The researchers who did the study analyzed rice consumption among 39,765 men and 57,463 women who participated in the Health Professionals Follow-up Study and the Nurses’ Health Study I and II; participants in the three groups ranged in age from 26 to 87.

They had filled out food frequency questionnaires when the studies started — in 1986, 1984 and 1991, respectively — and updated their diet information every four years subsequently, through 2005 and 2006. They were also asked about their medical histories. During the course of the studies, more than 10,000 participants developed Type 2 diabetes.

Such food studies can be unreliable, since they rely on self-reported surveys. And correlation does not necessarily mean a cause-and-effect relationship, since factors other than brown rice consumption may have accounted for the decreased diabetes risk that was observed. The researchers tried to control for the fact that Americans who eat brown rice tend to be more healthy overall — they eat more fruits and vegetables and less red meat and trans fats, and they also tend to be thinner, more active and less likely to smoke than those who don’t eat brown rice.

But, Dr. Sun said, there were many possible explanations for why brown rice eaters are at lower risk for Type 2 diabetes. In addition to having a lower glycemic index than white rice, brown rice also contains important nutrients like magnesium that are stripped during the refining process; it also contains much more fiber. Earlier studies have found that having these nutrients in the diet protects against diabetes, Dr. Sun said.

obesity and adhd zpt

noreply@blogger.com (John C Kim) — Thu, 28 Oct 2010 22:33:00 +0000

Ironic as treatment with stimulants often decrease appetite at least in short run, and slow down weight gain . There may be a common pathway in terms of sleep disturbance. It can cause both weight gain and attentional problem(s)

Children with ADHD Symptoms at Higher Risk of Obesity

Hyperactivity, impulsiveness associated with a 63 percent increase, researchers found

WEDNESDAY, Oct. 27 (HealthDay News) -- Children with symptoms of attention-deficit hyperactivity disorder (ADHD) are at increased risk for obesity in adulthood, a new study claims.

Having three or more of any of the symptoms of ADHD -- such as inattention, hyperactivity or impulsivity -- significantly increases the chances of being obese, according to researchers from Duke University Medical Center, who examined federal data on 15,197 adolescents followed from 1995 to 2009.

"It's not just the diagnosis of ADHD that matters; it's the symptoms," study co-author Scott Kollins, director of the Duke ADHD Program, said in a Duke news release.

Another study author agreed, adding that the more symptoms, the higher the risk.

"It's a dose effect. We showed that as the number of symptoms increase, the prevalence of obesity also increases," said study co-author Bernard Fuemmeler, director of the Pediatric Psychology & Family Health Promotion Lab in the Department of Community and Family Medicine.

Even among children with only symptoms of hyperactivity or impulsiveness -- the most influential of the risk factors studied -- the risk of obesity rose to 63 percent. These symptoms were also associated with greater weight gain in the transition from adolescence to adulthood.

The data on the teens came from the U.S. National Longitudinal Study of Adolescent Health.

"The findings support the idea that certain self-regulation capacities, like the ability to regulate one's impulses, could be a relevant trait to understanding why some people may be more vulnerable to obesity," Fuemmeler said, adding that this might help with the design of interventions.

The study appears online in the International Journal of Obesity.

More information

The U.S. National Institute of Mental Health has more about ADHD.

-- Robert Preidt

SOURCE: Duke Medicine, news release, Oct. 26, 2010.

Doctor says kids should get buffed Article: Kids benefit from strength training a few times a week | Reuters

noreply@blogger.com (John C Kim) — Thu, 28 Oct 2010 03:43:00 +0000

Kids benefit from strength training a few times a week | Reuters
http://www.reuters.com/article/idUSTRE69P3M120101026

Kids benefit from strength training a few times a week

By Amy Norton

NEW YORK | Tue Oct 26, 2010 12:38pm EDT

NEW YORK (Reuters Health) - While strength training was once doubted to benefit kids, a new research review confirms that children and teenagers can boost their muscle strength with regular workouts.

The findings, researchers say, support recent recommendations from the National Strength and Conditioning Association (NSCA) that kids strength-train two to three times a week — though only under professional supervision.

In years past, there were concerns that school-age children and teenagers might run a high risk of injuring themselves through strength training, which can be performed using free weights, exercise machines, elastic bands or the body’s own resistance.

However, studies in recent years have shown that kids’ risk of injury from strength training is no greater than — and is often less than — that from other types of exercise or sports. And experts now say that the potential benefits of such training — such as increased bone density, decreased body fat and boosting performance and curbing injury risk in sports — generally outweigh any risks.

The new study, reported in the journal Pediatrics, looked at age and other factors that might influence the effectiveness of strength training for kids.

Dr. Michael Behringer and colleagues at the German Sport University Cologne combined the results of 42 previously published studies that involved a total of 1,728 children and teenagers who were randomly assigned to perform supervised strength training or serve as a control group.

In most of the studies, kids used free weights or resistance-training machines, anywhere from one to five times a week, for an average of 40 minutes per session. The duration of the training ranged from one month to just over a year.

Overall, Behringer’s team found, the training was effective at boosting kids’ strength, with gains being greater among older kids versus prepubertal children (typically about age 10 or younger). And, not surprisingly, a few weekly sessions worked better than one, while a longer training duration was more effective than a short one.

The average strength gain varied widely among the studies, but in the majority the kids improved their strength by 20 percent to 40 percent of their starting levels.

Exercises involving what are known as isotonic contractions — bicep curls, squats and bench presses, for example — appeared to be most effective.

“Since resistance training in children and adolescents is known to be safe and to be associated with several health benefits, children and adolescents should be generally encouraged to participate in a resistance-training program,” Behringer told Reuters Health in an email.

He added that “our data underlined once again that it is effective over all phases of maturity.”

According to Behringer’s team, the findings are in line with 2009 guidelines from the NSCA suggesting that kids strength train two to three times a week. According to the group, children who are old enough for sports — around age 7 or 8 — are generally ready for some strengthening exercises.

But the NSCA also cautions that children should only perform such exercises under the supervision of someone with professional training — as part of school physical education or an athletic training program, for example.

“If qualified supervision, age-appropriate exercise equipment, and a safe training environment are not available, youth should not perform resistance exercise due to the increased risk of injury,” the NSCA writes in its guidelines.

Behringer agreed that parents should consider professional supervision a must.

SOURCE: link.reuters.com/but32q Pediatrics, online October 25, 2010.

*We welcome comments that advance the story directly or with relevant tangential information. We try to block comments that use offensive language or appear to be spam and review comments frequently to ensure they meet our standards. If you see a comment that you believe is irrelevant or inappropriate, you can flag it to our editors by using the report abuse links. Views expressed in the comments do not represent those of Reuters.

Sisters and Happiness - Understanding the Connection - NYTimes.com

noreply@blogger.com (John C Kim) — Thu, 28 Oct 2010 01:05:00 +0000

Does technology support bitty relationships?

From Evernote:

Sisters and Happiness - Understanding the Connection - NYTimes.com

Clipped from: http://www.nytimes.com/2010/10/26/health/26essay.html?src=me&ref=health

Why Sisterly Chats Make People Happier

By DEBORAH TANNEN

Published: October 25, 2010

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“Having a Sister Makes You Happier”: that was the headline on a recent article about a study finding that adolescents who have a sister are less likely to report such feelings as “I am unhappy, sad or depressed” and “I feel like no one loves me.”

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Christopher Silas Neal

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These findings are no fluke; other studies have come to similar conclusions. But why would having a sister make you happier?

The usual answer — that girls and women are more likely than boys and men to talk about emotions — is somehow unsatisfying, especially to a researcher like me. Much of my work over the years has developed the premise that women’s styles of friendship and conversation aren’t inherently better than men’s, simply different.

A man once told me that he had spent a day with a friend who was going through a divorce. When he returned home, his wife asked how his friend was coping. He replied: “I don’t know. We didn’t talk about it.”

His wife chastised him. Obviously, she said, the friend needed to talk about what he was going through.

This made the man feel bad. So he was relieved to read in my book “You Just Don’t Understand” (Ballantine, 1990) that doing things together can be a comfort in itself, another way to show caring. Asking about the divorce might have made his friend feel worse by reminding him of it, and expressing concern could have come across as condescending.

The man who told me this was himself comforted to be reassured that his instincts hadn’t been wrong and he hadn’t let his friend down.

But if talking about problems isn’t necessary for comfort, then having sisters shouldn’t make men happier than having brothers. Yet the recent study — by Laura Padilla-Walker and her colleagues at Brigham Young University — is supported by others.

Last year, for example, the British psychologists Liz Wright and Tony Cassidy found that young people who had grown up with at least one sister tended to be happier and more optimistic, especially if their parents had divorced. Another British researcher, Judy Dunn, found a similar pattern among older adults.

So what is going on?

My own recent research about sisters suggests a more subtle dynamic. I interviewed more than 100 women about their sisters, but if they also had brothers, I asked them to compare. Most said they talked to their sisters more often, at greater length and, yes, about more personal topics. This often meant that they felt closer to their sisters, but not always.

One woman, for example, says she talks for hours by phone to her two brothers as well as her two sisters. But the topics differ. She talks to her sisters about their personal lives; with her brothers she discusses history, geography and books. And, she added, one brother calls her at 5 a.m. as a prank.

A prank? Is this communication? Well, yes — it reminds her that he’s thinking of her. And talking for hours creates and reinforces connections with both brothers and sisters, regardless of what they talk about.

A student in my class recounted a situation that shows how this can work. When their family dog died, the siblings (a brother and three sisters) all called one another. The sisters told one another how much they missed the dog and how terrible they felt. The brother expressed concern for everyone in the family but said nothing about what he himself was feeling.

My student didn’t doubt that her brother felt the same as his sisters; he just didn’t say it directly. And I’ll bet that having the phone conversations served exactly the same purpose for him as the sisters’ calls did for them: providing comfort in the face of their shared loss.

So the key to why having sisters makes people happier — men as well as women — may lie not in the kind of talk they exchange but in the fact of talk. If men, like women, talk more often to their sisters than to their brothers, that could explain why sisters make them happier. The interviews I conducted with women reinforced this insight. Many told me that they don’t talk to their sisters about personal problems, either.

An example is Colleen, a widow in her 80s who told me that she’d been very close to her unmarried sister throughout their lives, though they never discussed their personal problems. An image of these sisters has remained indelible in my mind.

Late in life, the sister came to live with Colleen and her husband. Colleen recalled that each morning after her husband got up to make coffee, her sister would stop by Colleen’s bedroom to say good morning. Colleen would urge her sister to join her in bed. As they sat up in bed side by side, holding hands, Colleen and her sister would “just talk.”

That’s another kind of conversation that many women engage in which baffles many men: talk about details of their daily lives, like the sweater they found on sale — details, you might say, as insignificant as those about last night’s ballgame which can baffle women when they overhear men talking. These seemingly pointless conversations are as comforting to some women as “troubles talk” conversations are to others.

So maybe it’s true that talk is the reason having a sister makes you happier, but it needn’t be talk about emotions. When women told me they talk to their sisters more often, at greater length and about more personal topics, I suspect it’s that first element — more often — that is crucial rather than the last.

This makes sense to me as a linguist who truly believes that women’s ways of talking are not inherently better than men’s. It also feels right to me as a woman with two sisters — one who likes to have long conversations about feelings and one who doesn’t, but who both make me happier.

Deborah Tannen is a professor of linguistics at Georgetown University and the author, most recently, of “You Were Always Mom’s Favorite! Sisters in Conversation Throughout Their Lives.”

How to raise boys who read: opinion piece. TV, video games ,and home school?

noreply@blogger.com (John C Kim) — Tue, 26 Oct 2010 14:34:00 +0000

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TASTE
SEPTEMBER 24, 2010

How to Raise Boys Who Read

Hint: Not with gross-out books and video-game bribes.

By THOMAS SPENCE

When I was a young boy, America's elite schools and universities were almost entirely reserved for males. That seems incredible now, in an era when headlines suggest that boys are largely unfit for the classroom. In particular, they can't read.

According to a recent report from the Center on Education Policy, for example, substantially more boys than girls score below the proficiency level on the annual National Assessment of Educational Progress reading test. This disparity goes back to 1992, and in some states the percentage of boys proficient in reading is now more than ten points below that of girls. The male-female reading gap is found in every socio-economic and ethnic category, including the children of white, college-educated parents.

The good news is that influential people have noticed this problem. The bad news is that many of them have perfectly awful ideas for solving it.

Everyone agrees that if boys don't read well, it's because they don't read enough. But why don't they read? A considerable number of teachers and librarians believe that boys are simply bored by the "stuffy" literature they encounter in school. According to a revealing Associated Press story in July these experts insist that we must "meet them where they are"—that is, pander to boys' untutored tastes.

For elementary- and middle-school boys, that means "books that exploit [their] love of bodily functions and gross-out humor." AP reported that one school librarian treats her pupils to "grossology" parties. "Just get 'em reading," she counsels cheerily. "Worry about what they're reading later."

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Not with 'gross-out' books and video-game bribes.

There certainly is no shortage of publishers ready to meet boys where they are. Scholastic has profitably catered to the gross-out market for years with its "Goosebumps" and "Captain Underpants" series. Its latest bestsellers are the "Butt Books," a series that began with "The Day My Butt Went Psycho."

The more venerable houses are just as willing to aim low. Penguin, which once used the slogan, "the library of every educated person," has its own "Gross Out" line for boys, including such new classics as "Sir Fartsalot Hunts the Booger."

Workman Publishing made its name telling women "What to Expect When You're Expecting." How many of them expected they'd be buying "Oh, Yuck! The Encyclopedia of Everything Nasty" a few years later from the same publisher? Even a self-published author like Raymond Bean—nom de plume of the fourth-grade teacher who wrote "SweetFarts"—can make it big in this genre. His flatulence-themed opus hit no. 3 in children's humor on Amazon. The sequel debuts this fall.

Education was once understood as training for freedom. Not merely the transmission of information, education entailed the formation of manners and taste. Aristotle thought we should be raised "so as both to delight in and to be pained by the things that we ought; this is the right education."

"Plato before him," writes C. S. Lewis, "had said the same. The little human animal will not at first have the right responses. It must be trained to feel pleasure, liking, disgust, and hatred at those things which really are pleasant, likeable, disgusting, and hateful."

This kind of training goes against the grain, and who has time for that? How much easier to meet children where they are.

One obvious problem with the SweetFarts philosophy of education is that it is more suited to producing a generation of barbarians and morons than to raising the sort of men who make good husbands, fathers and professionals. If you keep meeting a boy where he is, he doesn't go very far.

The other problem is that pandering doesn't address the real reason boys won't read. My own experience with six sons is that even the squirmiest boy does not require lurid or vulgar material to sustain his interest in a book.

So why won't boys read? The AP story drops a clue when it describes the efforts of one frustrated couple with their 13-year-old unlettered son: "They've tried bribing him with new video games." Good grief.

The appearance of the boy-girl literacy gap happens to coincide with the proliferation of video games and other electronic forms of entertainment over the last decade or two. Boys spend far more time "plugged in" than girls do. Could the reading gap have more to do with competition for boys' attention than with their supposed inability to focus on anything other than outhouse humor?

Dr. Robert Weis, a psychology professor at Denison University, confirmed this suspicion in a randomized controlled trial of the effect of video games on academic ability. Boys with video games at home, he found, spend more time playing them than reading, and their academic performance suffers substantially. Hard to believe, isn't it, but Science has spoken.

The secret to raising boys who read, I submit, is pretty simple—keep electronic media, especially video games and recreational Internet, under control (that is to say, almost completely absent). Then fill your shelves with good books.

People who think that a book—even R.L. Stine's grossest masterpiece—can compete with the powerful stimulation of an electronic screen are kidding themselves. But on the level playing field of a quiet den or bedroom, a good book like "Treasure Island" will hold a boy's attention quite as well as "Zombie Butts from Uranus." Who knows—a boy deprived of electronic stimulation might even become desperate enough to read Jane Austen.

Most importantly, a boy raised on great literature is more likely to grow up to think, to speak, and to write like a civilized man. Whom would you prefer to have shaped the boyhood imagination of your daughter's husband—Raymond Bean or Robert Louis Stevenson?

I offer a final piece of evidence that is perhaps unanswerable: There is no literacy gap between home-schooled boys and girls. How many of these families, do you suppose, have thrown grossology parties?

Mr. Spence is president of Spence Publishing Company in Dallas.

This copy is for your personal, non-commercial use only. Distribution and use of this material are governed by our Subscriber Agreement and by copyright law. For non-personal use or to order multiple copies, please contact Dow Jones Reprints at 1-800-843-0008 or visit

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Article: New strain of swine flu emerges: report | Reuters

noreply@blogger.com (John C Kim) — Tue, 26 Oct 2010 04:52:00 +0000

A reminder of theoretical possibility of emergence of virulent strain of h1n1 flu. It's a wolf not a pet dog.

New strain of swine flu emerges: report | Reuters
http://www.reuters.com/article/idUSTRE69K4D520101021

Article

New strain of swine flu emerges: report

By Maggie Fox, Health and Science Editor

WASHINGTON | Thu Oct 21, 2010 2:16pm EDT

WASHINGTON (Reuters) - The H1N1 swine flu virus may be starting to mutate, and a slightly new form has begun to predominate in Australia, New Zealand and Singapore, researchers reported on Thursday.

More study is needed to tell whether the new strain is more likely to kill patients and whether the current vaccine can protect against it completely, said Ian Barr of the World Health Organization Collaborating Center for Reference and Research on Influenza in Melbourne, Australia and colleagues.

"However, it may represent the start of more dramatic antigenic drift of the pandemic influenza A(H1N1) viruses that may require a vaccine update sooner than might have been expected," they wrote in the online publication Eurosurveillance.

It is possible it is both more deadly and also able to infect people who have been vaccinated, they said.

Flu viruses mutate constantly — this is why people need a fresh flu vaccine every year. Since it broke out in March 2009 and spread globally, the H1N1 swine flu virus has been very stable with almost no mutation.

Scientists around the world keep an eye on all flu strains in case an especially dangerous new mutant emerges. While H1N1 turned out not to be especially deadly, it spread globally within weeks and killed more children and young adults than an average strain does.

WHO declared the pandemic over in August [ID:nLDE6790D9] but H1N1 has now taken over as the main seasonal flu strain circulating almost everywhere but South Africa, where H3N2 and influenza B are more common. The current seasonal flu vaccine protects against H1N1, H3N2 and the B strain.

"The virus has changed little since it emerged in 2009, however, in this report we describe several genetically distinct changes in the pandemic H1N1 influenza virus," Barr's team wrote in the report, available here

"These variants were first detected in Singapore in early 2010 and have subsequently spread through Australia and New Zealand."

The changes are not significant yet, they said. But there have been some cases of people who were vaccinated also becoming infected, and also some deaths.

"Already this variant virus has been associated with several vaccine breakthroughs in teenagers and adults vaccinated in 2010 with monovalent pandemic influenza vaccine (protecting against only H1N1) as well as a number of fatal cases from whom the variant virus was isolated," they wrote.

But there is not enough information to tell whether there may have been other factors making the patients more vulnerable, they stressed.

"It remains to be seen whether this variant will continue to predominate for the rest of the influenza season in Oceania and in other parts of the southern hemisphere and then spread to the northern hemisphere or merely die out," they wrote.

WHO says 18,450 people worldwide are confirmed to have died from H1N1, including many pregnant women and young people. But WHO says it will take at least a year after the pandemic ends to determine the true death toll, which is likely to be much higher.

Seasonal flu kills an estimated 500,000 people a year, 90 percent of them frail elderly people, according to the WHO. The 1957 pandemic killed about 2 million people and the last pandemic, in 1968, killed 1 million.

(Editing by Jerry Norton)

(via Instapaper)

Article: Helmet Safety Unchanged as Injury Concerns Rise - NYTimes.com

noreply@blogger.com (John C Kim) — Tue, 26 Oct 2010 04:49:00 +0000

The many mysteries of helmet safety behind the times

Helmet Safety Unchanged as Injury Concerns Rise - NYTimes.com
http://www.nytimes.com/2010/10/21/sports/football/21helmets.html?pagewanted=all

As Injuries Rise, Scant Oversight of Helmet Safety

James Estrin/The New York Times

Used helmets worn by the vast majority of young players encountered stark lapses in the industryâ€™s few safety procedures.

By ALAN SCHWARZ

Published: October 20, 2010

NORMAN, Okla. — Moments after her son finished practicing with his fifth-grade tackle football team, Beth Sparks examined his scuffed and battered helmet for what she admitted was the first time. She looked at the polycarbonate shell and felt the foam inside before noticing a small emblem on the back that read, "MEETS NOCSAE STANDARD."

"I would think that means it meets the national guidelines — you know, for head injuries, concussions, that sort of thing," she said. "That's what it would mean to me."

That assumption, made by countless parents, coaches, administrators and even doctors involved with the 4.4 million children who play tackle football, is just one of many false beliefs in the largely unmonitored world of football helmets.

Helmets both new and used are not — and have never been — formally tested against the forces believed to cause concussions. The industry, which receives no governmental or other independent oversight, requires helmets for players of all ages to withstand only the extremely high-level force that would otherwise fracture skulls.

The standard has not changed meaningfully since it was written in 1973, despite rising concussion rates in youth football and the growing awareness of how the injury can cause significant short- and long-term problems with memory, depression and other cognitive functions, especially in children.

Moreover, used helmets worn by the vast majority of young players encountered stark lapses in the industry's few safety procedures. Some of the businesses that recondition helmets ignored testing rules, performed the tests incorrectly or returned helmets that were still in poor condition. More than 100,000 children are wearing helmets too old to provide adequate protection — and perhaps half a million more are wearing potentially unsafe helmets that require critical examination, according to interviews with experts and industry data.

Awareness of head injuries in football was heightened last weekend when helmet-first collisions caused the paralysis of a Rutgers University player, a concussion to Philadelphia Eagles receiver DeSean Jackson and injuries to three other N.F.L. players. Although some injuries are unavoidable results of football physics, helmet standards have not kept up with modern football, industry insiders said. The one helmet standard was written by the National Operating Committee on Standards for Athletic Equipment, or Nocsae, a volunteer consortium that includes, and is largely financed by, the helmet makers themselves. Nocsae accepts no role in ensuring that helmets, either new or old, meet even its limited requirement.

One frustrated vice president of Nocsae, Dr. Robert Cantu of the Boston University School of Medicine, said the organization has been "asleep at the switch" for five years. Cantu joined other prominent voices involved in youth sports concussions in calling for stronger standards.

Recent engineering advances made by Riddell, Schutt, Adams and other manufacturers have undoubtedly improved the performance of the football helmet, which from its leather roots has always symbolized football's duality of valor and violence. But helmets communicate a level of protection that they do not provide, experts said, in part because of lax industry standards and practices.

As she looked again at the helmet of her 11-year-old son, Hunt, Ms. Sparks said: "You just trust. You care so much about your kid, and then you just trust."

One Limited Standard

After more than 100 high school and college football players in the 1960s were killed by skull fractures and acute brain bleeding, Nocsae was formed to protect players against the extreme forces that caused those injuries. The resulting standard, phased in by all levels of football through the 1970s, requires helmets to withstand a 60-inch free fall without allowing too much force to reach the skull.

This standard has accomplished its intent: skull fractures in football have essentially disappeared, and the three or four football-related deaths each year among players under 18 are caused by hits following a concussion that has not healed (known as second-impact syndrome) rather than by a single fatal blow.

As the size and speed of players have increased since the full adoption of the Nocsae standard in 1980, concussion rates have as well. An estimated 100,000 concussions are reported each season among high school players alone, according to Nationwide Children's Hospital in Columbus, Ohio, but many times that figure are believed to go unreported or unrecognized.

Preventing concussions — which are typically marked by confusion, disorientation, nausea and other symptoms following a blow to the head — is trickier than preventing skull fractures. The brain can crash into the inside of the skull through a wide range of forces, some arriving straight to the head and others suddenly rotating it. Scientists have yet to isolate where thresholds are in different players at different positions and at different ages.

While bicycle helmets are designed to withstand only one large impact before being replaced, football helmets can encounter potentially concussive forces hundreds of times a season. Helmets cannot get too large or heavy, so helmet designers say they face a trade-off: make helmets stiff enough to withstand high impacts and allow less violent forces to cause concussions, or more softly cushion against concussive-type forces while allowing large impacts to crack the skull.

The helmet industry has essentially chosen the former. With some differences among brands, helmets are generally made of polycarbonate plastic shells cushioned inside with foams of various stiffnesses and some air-pocket cushioning. Headgear worn by pee-wees to professionals differs primarily by size; Nocsae's standard makes no distinctions for the wearer's age.

Because of the uncertainty of how concussions occur in football, experts said there was no way to cite real-life examples of players whose injuries might have been avoided by a stronger helmet testing standard. But requiring headgear to perform across a spectrum of impacts would undoubtedly decrease the total number of injuries, they said.

Nocsae's standard for lacrosse and hockey helmets includes tests for concussive-type forces. But because football helmets have already prevented deaths so effectively for decades, and because football's faster and more violent environment leaves biomechanists unsure of how to prevent concussions in the sport, Nocsae has not asked helmets makers to even try.

"When you have something that has worked well for a lot of years, you have to be pretty cautious," said Mike Oliver, Nocsae's executive director and general counsel since 1995. "If we save 15,000 concussions with a new standard but allow one skull fracture, if we save 5,000 concussions and allow one subdural hematoma, is it worth it? I can't tell you that would be the trade-off, but you've got to basically be really sure that change wouldn't adversely affect something else."

Some experts, both within and outside Nocsae, question why helmets still are not required to handle the less violent impacts believed — although not scientifically proven — to cause concussions. Blaine Hoshizaki, director of human kinetics at the Neurotrauma Impact Research Lab at the University of Ottawa, said he lobbied Nocsae to strengthen its standard five or six years ago but, "It was like punching a balloon; they, yeah, understand, and then do nothing."

"They say they don't know what the thresholds are; O.K., but I can tell you that less angular acceleration is better than more," said Mr. Hoshizaki, referring to the forces that cause the head to rotate suddenly. "To suggest we have no idea so we'll do nothing is not an excuse to me. This has become a serious impediment to making a safer football environment."

Helmet companies say they are making inroads on their own, pursuing improvements that they say decrease the number of concussions that players receive.

Riddell has gained the largest share of the overall helmet market in part because of the 2002 introduction of its Revolution model, which the company markets aggressively as having features, like thicker jaw padding, that reduce concussion risk by 31 percent compared with previous helmets. Riddell's president, Dan Arment, said: "We think we've taken great strides to improve the protective features of our helmets, and we're not done. We see it as an open frontier."

Outside experts have criticized Riddell for overselling the protective properties of the Revolution and its successors. Dr. Cantu noted that the 31 percent figure — derived from a study conducted by researchers at the University of Pittsburgh Medical Center and a Riddell vice president — resulted from reports of concussions among high school players, which are notoriously inaccurate, and compared new Revolution helmets with old helmets of unknown age and condition.

Dave Halstead, the technical director of Nocsae, said: "It's a good helmet. But I don't believe that 31 percent for a Yankee minute."

Schutt, which runs a close second to Riddell in market share, has unveiled helmets with plastic-based cushioning that its Web site says are "designed with the intent to reduce the risk of concussions" and feature "breakthrough technology providing maximum protection to athletes." No scientific information is provided, although Schutt's YouTube channel has a video demonstration in which a head-sized watermelon bearing the plastic does not break when struck by a 15-pound bowling ball.

"That was meant to be a parody," Robert Erb, Schutt's chief executive, said. "I don't believe that there's any single one test that will tell you whether a helmet can stop a concussion. We communicate with coaches, equipment managers and other people in the football community. We have years of experience, test different conditions, temperatures, putting the helmets through a variety of contexts to see if it has superior dampening ability for a range of impacts."

Helmets produced by Adams U.S.A., worn by about 650,000 high school and younger players, are focused on meeting the Nocsae skull-fracture standard, David Wright, the chief executive of Adams, said. "Once we see evidence that says we can reduce these types of injuries," he said, referring to concussions, "then we'll do it. We haven't seen that."

Art Chou, vice president of Rawlings, agreed: "We're not in the standards-making business. We make equipment focused on standards given to us." Chou also serves on the Nocsae board.

Along with Riddell, the company most emphasizing concussion safety is Xenith, whose X1 model is making inroads among high schools, colleges and the N.F.L. The X1 features a radical new design: air-filled shock absorbers that attempt to withstand a wider range of forces than traditional foam. Xenith's founder and president, the former Harvard quarterback Vin Ferrara, said the Nocsae standard had discouraged innovation among other companies and was "wholly inadequate" for modern football.

"The fact that there's only one standard for everything, designed 30 years ago for a different problem, indicates how far off the industry is right now from having an acceptable standard," Mr. Ferrara said.

Dangerous Misconceptions

The fact that helmets are held to no standard regarding concussions surprised almost every one of dozens of people interviewed for this article, from coaches and parents to doctors and league officials. Even one member of the Nocsae board, Grant Teaff — who represents the American Football Coaches Association — said he was unaware of it.

"Obviously if you're protecting against skull fracture, you're protecting against any type of concussion," Teaff said, incorrectly.

Nocsae receives no oversight from any independent agency, such as the Consumer Product Safety Commission or the Occupational Safety and Health Administration. Its 16-member board features five representatives of the helmet industry, six volunteer doctors, two athletic trainers, two equipment managers and one coach.

Nocsae's annual budget of about $1.7 million is funded mostly by sporting-goods manufacturers whose products bear the Nocsae seal of approval. The largest share of that comes from football helmet makers and reconditioners.

"That's pretty scary," said Dr. David Price, who is heavily involved with youth football as a sports medicine physician for Carolinas Medical Center in Charlotte, N.C. "You would think there would be some sort of third-party oversight."

Mr. Oliver, Nocsae's longtime president, said that helmet companies do not unduly influence the organization's policies. Dr. Cantu agreed, but said that the board has become as concerned about legal liability as about child safety. If Nocsae were to supplement its helmet standard in an attempt to address concussions, it could open itself to lawsuits brought by players saying that their helmet did not prevent the injury.

"I have been calling for a new standard to be written for football helmets for years, and Nocsae has been sitting on their duffs," Dr. Cantu said. "Everyone's afraid of being sued, because if you say that certain helmets are better, you're saying that millions of them out there now aren't safe."

Nocsae officials insisted that the organization does not mandate adherence to its standard; it is merely used, voluntarily, by every level of football from Pop Warner to the N.F.L. Nocsae goes so far as to state in its testing instructions that its standard "does not purport to address all of the safety problems, if any, associated with its use."

One use of the standard often emerges after a young player sustains a head injury and sues a school district or helmet manufacturer. In the 42 lawsuits in which he has testified as an expert, Mr. Halstead of Nocsae said, the primary (and usually successful) defense is that the helmet met the Nocsae standard.

"Manufacturers and schools, equipment managers and the coaches — the whole football industry — don't want to go after or even criticize the security blanket of Nocsae," said Sander Reynolds, Xenith's vice president for product development. "If there's a lawsuit, they all look to Nocsae to say, 'Hey, see, the product met the set standards.' They're all ultimately on the same side when it comes to liability. Nocsae exists for two reasons — to avoid skull fractures, and to avoid liability."

USA Football, which oversees tackle football among players ages 6 to 14, requires only that helmets have a Nocsae seal of approval. In the slightly more explicit rule book of the National Federation of High Schools, before several paragraphs that regulate the size of uniform numbers, decorative stripes and the like, helmets are required only to have "met the Nocsae test standard at the time of manufacture."

This has allowed thousands of older youth helmets to be re-used — particularly in poorer, rural communities — that would not even meet the Nocsae standard if they were examined critically through an industry procedure called reconditioning.

To the extent that 1.7 million helmets do undergo reconditioning each year, they encounter procedures and practices that industry experts described as laughable if they didn't compromise the safety of children's brains.

Borrower Beware

Everyone with experience in youth football has his favorite horror story. The helmet with socks inserted where the padding should have been. The helmet with a nail holding parts together. Hundreds of cracked helmets with detached foam that had no business being worn at all.

At Stadium System, a family-operated business in northern Connecticut that for decades has been the primary helmet reconditioner for New England schools and youth leagues, the owners Mike and Ken Schopp shook their heads last August at one typical rack of helmets awaiting work. One youth helmet had torn ear padding that compromised safety for who knew how many games or seasons. Another's inflatable air liner was ripped and useless. Another high school helmet, covered with skull-and-crossbones stickers, had padding that was switched from front to back and placed upside down, probably because it was itching the player's neck.

"That's a fairly common thing for kids to do — and the kid's wondering why he has a bloody forehead," Mike Schopp said. Ken, his brother, added, "And it would probably pass the Nocsae test no problem."

Only about 10 to 20 percent of football players of high school age or younger wear a new helmet, which can cost from $150 to $300. The vast majority of headgear is handed down for years and at various points undergoes a reconditioning process that costs about $25 to $45. Most get reconditioned every one or two seasons, which most experts recommend. But data closely held by the National Athletic Equipment Reconditioners Association, Naera, indicated that about 500,000 young players this fall were wearing helmets that had not undergone this basic safety check, which encounters glaring failures of its own.

About 25 facilities are authorized by Nocsae to recondition helmets and recertify them as meeting the original testing standard. The dozen-step process involves removing and washing all padding, inspecting parts for cracks and other deformities, washing and repainting the shell, and reassembling the helmet with either used or new parts. About 15 percent of helmets are deemed unfixable and discarded.

Nocsae's sole means of quality control is to require each reconditioning facility to perform the Nocsae drop test — in which a helmet is placed on a fluid-filled polyurethane head-form and dropped along wires from a height of 60 inches — on a random sample of about 3 percent of their helmets to see if they still absorb enough force to protect against skull fracture. The test is designed to help identify the rare helmet model that requires recall, not to pinpoint individual helmets that need replacement.

The test is failed by about 1 in 300 reconditioned helmets, according to Naera reports. All of the passing helmets — along with the vast majority that undergo no testing at all, just a visual assembly-line inspection — receive a sticker that indicates they continue to meet Nocsae standards, and are returned to the league or school.

This largely faith-based process allows for significant errors. Hundreds if not thousands of supposedly reconditioned helmets emerge still unfit for use, according to interviews with coaches, parents and helmet-industry principals.

This summer two reconditioners, Clean Gear in New Jersey and Maxletics in Hawaii, skipped the drop testing altogether and sent back all its helmets to schools, said Ed Fisher, Naera's executive director and a longtime high school football coach in Washington state. He added that he discovered this only because an athletic trainer happened to complain about the condition of the helmets at a trade show. The helmets were recovered by Nocsae, which terminated the companies' licenses to recertify helmets.

During a tour of Stadium System in Connecticut, Fisher walked into the drop-testing room and found the technician testing helmets that were far too loose on the head-form to be measured correctly. The Schopps said that they were following Nocsae instructions — although those instructions require a "reasonable fit" — and that they had been testing helmets like that for the entire summer, or longer.

"I need to have a critical eye," Fisher said. "And to the people that say they're doing it correctly, I need to have some procedures that will allow me to walk in and be able to say, show me and prove it. We're working on that."

Some helmets are returned to teams with obvious defects. This summer, high schools in California, Wisconsin and several other states received reconditioned helmets (all bearing the Nocsae seal) that had missing harness cables, improperly attached face masks, incorrect padding and other problems that would almost certainly pose a danger to a young player. One of them was received by Jim Rudloff, the coach of Marblehead High School near Boston.

"We're rolling the dice and trusting that these things are done right," Mr. Rudloff said. "There is that blind faith in a lot of towns that you put on whatever they give you."

Mr. Halstead, the technical director of Nocsae, added: "School districts are so strapped that they just go to the cheapest place and hope. They'll always want to fix an old bus rather than find the money to buy a new one. That means they keep using old helmets, and sometimes not recondition them for way too long. For example, I would never let my kid wear a helmet that is more than 10 years old."

Mr. Fisher of Naera and most everyone involved in the helmet industry agreed that helmets older than about 10 years present an unacceptable safety risk. Riddell and Adams both strongly recommend that their helmets be discarded after 10 years. Schutt sets no such limit.

Naera data indicated that more than 100,000 helmets more than 10 years old were worn by players in the 2009 season, thousands were close to 20 years old.

Helmets made before 1997 could pose an additional safety risk of which few people outside of Nocsae are aware. The standard to which helmets are now held — a drop-test score of less than 1,200 in a measure of force called severity index — had been 1,500 until 1998, when Nocsae lowered it. (This was done because new helmets were easily passing the 1,500 test and would easily pass the new figure, Nocsae officials said.) But helmets produced before 1997 were grandfathered in. So any one of the 70,000 pre-1997 helmets currently in use can test above 1,200 but below 1,500 — a range now agreed by most to be unsafe — and still be certified as meeting the Nocsae standard.

"There's no scientific evidence that a helmet has to be pulled after 7, 10, 12 years, that there's some line in the sand," Schutt's Erb said. "There are helmets that are out there that are performing fine. Do you want your car manufacturer to tell you that your car, at the end of 10 years, you have to destroy it? That's a decision for the user."

Some players at Cooperstown Central High School in New York are wearing helmets made in 1991, the school's athletic coordinator, Jay Baldo, said. They were Schutt helmets reconditioned this summer by Stadium System.

"Our plan is to replace them next year," Mr. Baldo said. "The money's going to have to come from somewhere else. Our whole budget is about $300 for football."

Only two people have access to the test logs that would determine just how many non-Schutt helmets more than 10 years old are being recertified and used in which areas of the country: Naera's Mr. Fisher and Nocsae's Mr. Halstead. They provided data to The New York Times that indicated that the number is minuscule.

Mr. Oliver, Nocsae's executive director, said he does not receive or consult reconditioning data. Asked if helmets more than 10 years old should be worn by a child, he said: "I can't say it should or shouldn't be. All I can go on is how it tests on the standard."

The Future

Most experts agree that regarding concussions and growing evidence of their health risks — particularly among young athletes — the first order of business is to get players, coaches and parents to recognize the injury and then keep the player away from sports for as long as it takes to heal. Others added that football leagues and referees must more vigilantly penalize players who lead with their head while tackling. This dangerous maneuver received heightened news media coverage this week given several high-profile injuries, but it occurs in almost every game at every level.

The Wild West culture regarding helmets must also change, they said. Some call for Nocsae and Naera to set stronger standards and more proactively enforce their rules, but that would almost certainly require greater legal protection, said Dr. Cantu, the Nocsae vice president. Mr. Ferrara, the president of Xenith, called for the industry to receive governmental oversight.

"I want to answer to a higher authority than Nocsae," Mr. Ferrara said. "I want to answer to the F.D.A."

After four years of national debate over sport-related concussions as a public-health concern, and after several officials were interviewed for this article, Nocsae decided earlier this month to consider moving on the matter of a concussion-related helmet standard. Strongly pressured by Dr. Cantu, Mr. Oliver scheduled a meeting for Saturday to have experts in the field discuss possible adjustments — specifically a test for the less violent forces believed to raise concussion risks. Even if adjustments begin that day, the process will take at least three or four years.

Meanwhile, and pending more effective industry oversight, young football players will continue to wear helmets whose limitations are obscured by their communities' love for football. Nowhere was this more clear than here in Norman last August, when fifth-graders lined up to receive their headgear for the season. No one thought to question what helmets are designed to do, how old the helmets were, if and when they had been reconditioned, or whether their sweat-stained and dirty padding retained its safety properties.

One of them, Joseph Kirk, stood at attention as his team, the Punishers, received their primary brain protection for the season. A league volunteer reached into a rack of helmets and chose No. 5045 — a worn white Riddell Little Pro with no known age, no known history and one Nocsae sticker.

"That good, big man?" the volunteer asked as Joseph peered unblinkingly from behind the face mask. The man fiddled with the fit, handed Joseph a leather chin strap and said, "Put this on when you get home." The entire process took nine seconds.

Joseph shuffled to the next station to get his shoulder pads as the volunteer beckoned, "Next!"

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