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Article: Migraines in Children Are Often Overlooked - NYTimes.com

noreply@blogger.com (John C Kim) — Tue, 07 Sep 2010 03:40:00 +0000

Migraines in Children Are Often Overlooked - NYTimes.com
http://well.blogs.nytimes.com/2010/08/30/returning-to-classrooms-and-to-severe-headaches/?src=me&ref=health

August 30, 2010, 5:30 pm

Returning to Classrooms, and to Severe Headaches

By TARA PARKER-POPE

Stuart Bradford

For kids around the country it's back-to-school time. But for many of them, it's also the return of headache season.

Doctors say frequent headaches and migraines are among the most common childhood health complaints, yet the problem gets surprisingly little attention from the medical community. Many pediatricians and parents view migraines as an adult condition. And because many children complain of headaches more often during the school year than the summer, parents often think a child is exaggerating symptoms to get out of schoolwork.

Often the real issue, say doctors, is that changes in a child's sleep schedule, including getting up early for school and staying up late to study, as well as skipping breakfast, not drinking enough water and weather changes can all trigger migraines when the school year starts.

"In many areas people just don't think kids can get migraines," says Dr. Andrew Hershey, professor of pediatrics and neurology and director of the headache center at Cincinnati Children's Hospital Medical Center. "But kids shouldn't be missing activities and having trouble at school because they're having headaches. If it happens, it shouldn't be ignored."

Migraine is an inherited neurological condition characterized by severe, often disabling headache pain. During a migraine attack, a number of changes occur throughout the brain causing dilation of blood vessels; severe pain; increased sensitivity to lights, sounds and smells; nausea and vomiting; and other symptoms. It's estimated that about 10 percent of young children and up to 28 percent of older teenagers suffer from migraines. (Hormonal changes during puberty can also be a trigger.)

But childhood migraine often doesn't show up the same way as an adult migraine. While adult migraines often last four hours or more, in a child, the duration of a migraine can range from as little as one hour up to 72 hours. In adults, migraines typically settle on one side of the head, but in children migraine pain is often felt across the front of the forehead or on both temples rather than on just one side. As a result, childhood migraines are often dismissed as sinus headaches.

Complicating matters is that sometimes pediatric migraines don't involve headache pain. Instead, the child may have abdominal pain, vomiting or feelings of vertigo.

Around the country, only about 20 centers focus on pediatric migraine, forcing parents to seek the advice of pediatricians with little experience treating migraine or neurologists who specialize in adult care.

"The presentation is different enough that it can be missed by an adult neurologist," says Dr. Philip Overby, assistant professor of neurology and pediatrics at Children's Hospital at Montefiore in the Bronx. "Kids 3 years old can be having a migraine; even a 5-year-old will struggle to provide a history of what they're experiencing."

Parents often have a hard time distinguishing between real pain and the imaginary maladies that young children sometimes invent. Dr. Hershey tells the story of a 6-year-old boy with daily headaches, whose parents thought he was just trying to avoid school. His parents finally sought treatment and by the time he was in the third grade the headaches were under control. "He was a different kid, more active and happy all the time," said Dr. Hershey. "The parents realized he really had been having headaches, but they had been denying it."

But parents also say they have struggled to find doctors who take a child's headache complaints seriously. When Cathy Glaser's daughter began suffering migraines as a toddler, her New York pediatrician couldn't help. By the age of 15, her daughter was virtually disabled by migraines, but finally found help at the Michigan Headache and Neurological Institute in Chelsea, Mich.

The experience prompted Ms. Glaser to help create the Migraine Research Foundation. The group's "For Our Children" initiative raises awareness and money for pediatric migraine research. The group's Web site, www.migraineresearchfoundation.org, also offers a list of headache centers that treat children. "It's astounding that so little attention is being paid to such a disabling and socially expensive problem," she says.

And some of the newest and most effective migraine treatments and preventive drugs have yet to win Food and Drug Administration approval for pediatric use. For instance, a class of migraine drugs called triptans, which narrow blood vessels in the brain, have been lifesavers for migraine patients, but so far only one has been approved for pediatric use in the United States. (Three such drugs are approved for pediatric use in Europe.) Even so, many adult migraine treatments have been used off label for years in children.

Janet Podell of Highland Park, N.J., says her daughter Hannah began suffering from migraines around age 8. The pain later became so debilitating that Hannah missed two years of school. Finally, the family found a doctor who prescribed a combination of drugs. Although Hannah, now 20, still gets migraines, they are essentially under control.

"It was two years of utter misery which changed her life and the family's life very drastically," says Ms. Podell. "She lost two years of her early adolescence."

Dr. Hershey treats pediatric patients with a three-pronged approach. It starts with immediate pain relief, using either ibuprofen or a triptan drug. Because frequent use of over-the-counter pain relievers can set off a "rebound" effect, leading to more headaches, treatment should be discussed with a doctor.

Second, he says, children who have more than one headache a week may need preventive therapy, like low doses of antidepressants or anti-seizure drugs that have been shown to prevent adult migraines. And lifestyle changes like exercise, drinking more water, getting adequate sleep and not missing meals are essential.

"These are kids who are often staying up late to study and getting up early to get to school and frequently skipping meals," says Dr. Overby. "I can't say it's typical that you can completely cure headaches just by lifestyle measures alone, but if you don't address those things as well you'll never be able to control them."

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Intriguing concept of hormone disruption and plastics. . Still a lot of fear and not a lot of fact.

noreply@blogger.com (John C Kim) — Mon, 06 Sep 2010 21:01:00 +0000

Intriguing concept of hormone disruption and plastics. . Still a lot of fear and not a lot of fact.

At least for children, the European approach to safety, ie if plausible harm, do not give until we know it's safe, makes sense. I think that's why the FDA is moving in that direction.

I wonder how much BPA we absorb in drinking out of plastic and sealed bottles of any kind?

In Feast of Data on BPA Plastic, No Final Answer

Sally Ryan for The New York Times

TESTING Rat prostate cells under a microscope that have been exposed to BPA,

By DENISE GRADY

Published: September 6, 2010

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The research has been going on for more than 10 years. Studies number in the hundreds. Millions of dollars have been spent. But government health officials still cannot decide whether the chemicalbisphenol-A, or BPA, a component of some plastics, is safe. The substance lines most food and drink cans, and is used to make hard, clear plastic bottles, containers and countless other products. Nearly everyone is exposed to it.

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Sally Ryan for The New York Times

Day-old mice, above, are used at the University of Illinois at Chicago to study the effects of BPA.

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Sally Ryan for The New York Times

RAT STUDIES Scientists at the University of Illinois at Chicago study rodents and say the results are relevant to people.

BornFree/Associated Press

PRODUCT LINE BornFree makes BPA-free baby bottles and cups.

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Stan Honda/Agence France-Presse — Getty Images

CHEMICAL FREE Toys made of recycled plastic by Green Toys at a trade show. The company says it does not use BPA.

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Robert L. Vogelzang

MEALTIME A monitor in Dr. Prins's lab showed a day-old mouse being fed BPA. In humans, the chemical remains in children longer than in adults researchers say.

Concerns about BPA stem from studies in lab animals and cell cultures showing it can mimic the hormoneestrogen. It is considered an "endocrine disruptor," a term applied to chemicals that can act like hormones. But whether it does any harm in people is unclear.

Where science has left a void, politics and marketing have rushed in. A fierce debate has resulted, with one side dismissing the whole idea of endocrine disruptors as junk science and the other regarding BPA as part of a chemical stew that threatens public health.

About half a dozen states have banned BPA in children's products, and Senator Dianne Feinstein hopes to accomplish the same nationwide, with an amendment tothe food safety bill scheduled for a vote in the Senate next week.

This year, a presidential panel on cancer and the environment said there was a "growing link" between BPA and several diseases, including cancer, and recommended ways to avoid BPA, like storing water in bottles free of it and not microwaving food in plastic containers. Some cancer experts said the report overstated the case against chemicals, but the concerns it raised seemed to reflect growing public worries.

Consumer fears have made the words "BPA-free" a marketing tool. Wal-Mart, Whole Foods, Sears, CVS and other retailers have said they will stop selling baby bottles made with BPA, and major formula and baby-bottle manufacturers have also scrapped it. Worried people have purged their homes of plastics labeled 7. (Products are numbered for recycling; those with BPA carry a 7, but not everything with a 7 contains BPA). Nalgene, which makes popular water bottles, quit using BPA when customers began complaining about it. Sunoco, one of the companies that makes BPA, said it would sell the chemical only to buyers who guaranteed that they would not use it in food or drink containers meant for children.

In May, a White House task force on childhood obesityissued a report suggesting that BPA and certain other chemicals might be acting as "obesogens" in children — promoters of obesity — by increasing fat cells in the body and altering metabolism and feelings of hunger and fullness.

Perhaps not surprisingly, the issue of whether BPA is safe has become highly partisan.

Environmental groups and many Democrats want BPA banned, blaming it for an array of ills that includes cancer, obesity, infertility and behavior problems. Environmentalists think the United States should adopt the "precautionary principle," a better-safe-than-sorry approach favored in the European Union. The principle says, in essence, that if there are plausible health concerns about a chemical, even if they are not proved, people should not be exposed to it until studies show it is safe. The United States takes the opposite approach: chemicals are not banned unless there is proof of harm.

Many Republicans, anti-regulation activists and the food-packaging and chemical industries insist that BPA is harmless and all but indispensable to keeping canned food safe by sealing the cans and preventing corrosion, and to producing many other products at reasonable prices. They argue that the chemical has been demonized, and that adopting the precautionary principle would lead to needless and ruinously expensive bans on safe and useful products. Both sides are closely watching the issue unfold, because BPA is widely seen as a test case in an era of mounting worry about household chemicals, pollution and the possible links between illness and environmental exposures, especially in fetuses and young children.

"This isn't the only endocrine-disrupting chemical on the block," said Patricia Hunt, a biologist at Washington State University, in Pullman. "It's just the one that's captured the attention, because researchers like me have gotten into the field and gone, 'Holy cats! We're all exposed to this.' There's been a heavy industry response, and we've gathered our forces together a little more strongly to shine a light on it. This is the poster child for this group of chemicals. Academic scientists are saying we need to do something, and we need to do it fast."

Linda S. Birnbaum, director of the National Institute of Environmental Health Sciences (part of the National Institutes of Health), said that a new round of government-financed studies with uniform methods, now under way with animal subjects, should help to resolve unanswered questions. In the meantime, Mrs. Feinstein's ambitious plan to ban BPA from baby bottles, sippy cups, baby food and formula was blocked by partisan battling. She had hoped that the ban would be included in the food safety bill, not merely in an amendment to be considered separately.

But after months of wrangling, she gave up. The food industry, mostly supportive of the food bill, threatened to oppose it if the BPA provision got in. So did many Republican senators. In August, Mrs. Feinstein's Democratic colleague Representative John D. Dingellof Michigan made public a letter in which he urged her to back off on BPA for the sake of the bill, which will broaden the authority of the Food and Drug Administration over the food supply — a measure widely seen as essential to reducing food-borne illnesses like the recent salmonella outbreak from eggs.

In a statement released in August, Mrs. Feinstein said, "The Food Safety Bill was the logical place for this legislation, and I have been working hard to reach a compromise, but unfortunately BPA language is not included."

As an amendment instead of being part of the bill itself, the ban is far less likely to pass the Senate and become law. Last week, the legislature in Mrs. Feinstein's state, California, rejected a BPA ban like the one she is proposing.

Buried in an Avalanche of Data

The mountains of data produced so far show conflicting results as to whether BPA is dangerous, in part because different laboratories have studied the chemical in different ways. Animal strains, doses, methods of exposure and the results being measured — as crude as body weight or as delicate as gene expression in the brain — have all varied, making it difficult or impossible to reconcile the findings. In science, no experiment is taken seriously unless other researchers can reproduce it, and difficulties in matching BPA studies have led to fireworks.

John A. Katzenellenbogen, a chemistry professor at the University of Illinois in Urbana, and an expert on how hormones works in cells, does not work with BPA but said he had seen researchers who study it argue bitterly at conferences, over supposedly identical experiments that had somehow yielded opposite results.

At one such meeting, scientists in the audience said, "We don't want to hear you two speak until you get this straightened out," he recalled.

"I'm interested, and despite the fact that I know a lot about this, somewhat bewildered at the discordances in reports," Dr. Katzenellenbogen said.

Dr. Birnbaum said, "I think we need to lower the tenor of the discourse and look at what the research really is," and added that researchers who clash over conflicting results may actually have done different experiments.

The new, government-financed studies will try to determine whether BPA can play a role in obesity, diabetes, breast and prostate cancer and disorders of the developing immune, cardiovascular and nervous systems. Dr. Birnbaum said researchers would be looking for effects on learning and behavior, and also trying to find out whether there are "multigenerational" effects, meaning that exposure in a pregnant animal can affect her offspring and the next generations as well.

How could one substance possibly have so many different effects?

"What's estrogen associated with?" Dr. Birnbaum asked. "Breast cancer, uterine cancer, obesity, behavior, the immune system. If BPA can have some estrogeniclike properties, it is scientifically plausible that it might have a wide spectrum of effects. We need to move beyond the idea that an environmental chemical or a drug is only going to do one thing, and need to understand that what happens to an infant may be different from what happens to an adult."

The results from the new round of studies are not expected for at least two years. "We are in some ways using BPA as a model for an endocrine-disrupting compound," she said. "What can happen when you perturb fundamental homeostatic processes in the body?"

Impersonating Hormones?

The idea that drugs or chemicals could act like hormones emerged in the 1990s. Such effects can be subtle and delayed. Hormones act on receptors in cells, structures to which they attach — the standard comparison is lock and key — and orchestrate growth, differentiation and all sorts of biochemical activities. Many cells have receptors for estrogen, and BPA can bind to those receptors, though far less strongly than the body's own estrogen can.

R. Thomas Zoeller, a biology professor at the University of Massachusetts, Amherst, said BPA could also bind to receptors for male hormone and thyroid hormone.

"I don't know of a single other molecule that does this," Dr. Zoeller said.

In people, the most notorious example of an endocrine disruptor is the drug diethylstilbestrol, or DES, which was given to pregnant women in the 1950s in the mistaken belief that it could prevent miscarriage. The drug turned out to be a disaster, causing vaginal cancers and reproductive problems in some of the women's daughters, and abnormalities in the reproductive organs in some sons. But DES is a far stronger estrogen mimic than is BPA, and women were exposed to much higher levels of it.

Animal studies during the past decade or so began raising concerns about BPA, which is used to harden polycarbonate, a clear plastic that makes nice-looking food containers, bottles and sippy cups. It has been widely used since the 1960s and is also in some medical devices, dental sealants, thermal paper for cash register receipts and the epoxy resin that lines most food and drink cans. The United States produces about a million tons of it a year.

BPA is in people, too. Small amounts leach out of plastics and seep into the body. In 2008, a government study of 2,517 people age 6 and older found that 93 percent had BPA in their urine. Children had higher levels than adults, and other studies have detected the chemical in umbilical cord blood in newborns.

Studies show that in adults, BPA is eliminated from the body in hours; children take longer to get rid of it. But scientists say that finding it consistently in so many people suggests that the public is being exposed continuously. The main route by which people are taking it in is not known.

Just finding a chemical in people does not mean it is doing any damage, and there is no definitive proof that BPA harms humans. Research in adults has found that higher BPA levels in urine are associated with an increased risk of heart and liver disease, but the studies do not prove cause and effect, because they merely observed correlations, which could have been coincidental.

It would be unethical to experiment on people by giving them BPA, so researchers use rodents, and say the results are relevant to people. Dr. Daniel R. Doerge, who studies BPA at the National Center for Toxicological Research in Jefferson, Ark. (part of the F.D.A.), says, "Animal studies are the cornerstone of all our drug and environmental risk assessment for humans."

The animal studies have led the National Toxicology Program and the Food and Drug Administration to express "some concern about the potential effects of BPA on the brain, behavior and prostate gland of fetuses, infants and children." ("Some" concern is the midpoint on a five-level scale, ranging from "negligible" to "serious.") The National Toxicology Program also says, "The possibility that BPA may affect human developmentcannot be dismissed." The Environmental Protection Agency says, "There are questions about its potential impact, particularly on children's health and the environment."

The F.D.A. says that infants are "a potentially sensitive population for BPA" because their brains and endocrine systems are still developing, and their livers are less efficient than adults' at detoxifying and eliminating foreign substances. The drug agency has taken a seemingly paradoxical position, on the one hand saying there is no evidence of harm in humans, and on the other supporting industry actions to get BPA out of baby bottles and feeding cups, and to find alternative liners for food and formula cans. Bottle-makers have found substitutes, but can producers say there is nothing like BPA. Only a few companies are offering BPA-free cans.

Reconciling Disparate Studies

Most of the evidence against BPA comes from studies that find harmful effects in rats and mice at low doses comparable to the levels to which people are exposed. Sometimes the results seem downright weird, indicating that low doses could be worse than higher ones. There is sharp disagreement among scientists about how to interpret some research. The disputes arise in part because scientists from different disciplines — endocrinologists versus toxicologists, academic researchers versus those at regulatory agencies — do research in different ways that can make findings hard to reconcile.

The biggest unanswered question is whether low doses — the kind to which most people are exposed — can have lasting, harmful effects in fetuses and young children. Dr. Birnbaum said it was crucial to find out for sure whether the low-dose effects in animals really occur. "We have hundreds of studies that show they do, and then some that don't," she said.

She and other scientists said studies by university labs tended to find low-dose effects, and studies by government regulatory agencies and industry tended not to find them. The split occurs in part because the studies are done differently. Universities, Dr. Birnbaum said, "have moved rapidly ahead with advances in science," while regulators have used "older methods." Some researchers consider the regulatory studies more reliable because they generally use much larger numbers of animals and adhere to formal guidelines called "good laboratory practices," but Dr. Birnbaum described those practices as "good record-keeping" and said, "That doesn't mean the right questions were being asked."

The low-dose studies are newer and have raised safety issues that need to be resolved, she said. Last year, a scientific group called the Endocrine Society issued a 34-page report expressing serious concerns about endocrine-disrupting compounds, including BPA, dioxins, PCBs, DDT, the plasticizers known as phthalates and DES.

The society has about 14,000 members from more than 100 countries, who work in medicine, biology, genetics, immunology, industry and other areas.

The report said there was strong evidence that endocrine disruptors could harm the reproductive system, causing malformations, infertility and cancer. It noted that the chemicals could affect all endocrine systems, and said there was mounting evidence for effects on the thyroid gland, brain, obesity and metabolism, and the body's ability to regulate insulin and glucose levels. It also said that fetuses exposed to chemicals in the womb could experience effects later in life, and pass those abnormalities to future generations.

Scientists call such effects "the fetal basis of adult disease," and say they probably result from epigenetic changes — meaning that the chemicals alter the functioning of genes, turning them on or off, but do not cause mutations, which are changes in the actual structure of the genes. Some scientists said that they had doubted that low doses could cause harm, but changed their minds after seeing the data.

"I was skeptical that there were effects that were repeatable," said Gail S. Prins, a professor of physiology at the University of Illinois at Chicago, and an author of the Endocrine Society's report. But in 2001 she was part of a panel that analyzed dozens of BPA studies for the National Toxicology Program. The panel had its own statistician reanalyze raw data from the studies to find out if the claims based on it were valid.

"I could see there was some consistent data," Dr. Prins said. "I started thinking, 'Hmm, maybe there could be something there.' It was still curious to me. This is not a regular toxicant. It's acting like a hormone, and hormones can act at extremely low doses. If you think the dose makes the poison, it doesn't make sense. But if you think about it as a hormone — and I'm an endocrinologist — it does make sense."

Her lab is one of the 10 that have received government grants under the economic Recovery Act to study BPA. She is analyzing its effects on the prostate in young mice and rats, and also in rats that have been implanted with human prostate cells. The work is being conducted under strict guidelines set by the National Institutes of Health, to make sure that the results of different groups will be reconcilable.

"This time N.I.H. said, 'You all have to do oral exposures, and we'll give you BPA from one source,' " Dr. Prins said. "We're all working with one batch. We all have to measure free and conjugated BPA levels in our model systems, and it has to be done in a certified lab so that our data will be more aligned. It does make a lot of sense to go about doing it this way, and it hasn't compromised anything I'm doing."

There is no practical way to do these studies except in rodents, she emphasized. "I can't look at early-life exposures and prostate risk in humans," Dr. Prins said. "I can't do it in my lifetime even if I start now. Likewise I can't take men who currently have prostate cancer and see what their BPA levels were when they were born."

Over the next few years, researchers hope to bring coherence to this confused and troubled field.

"This is a chemical we're all exposed to, and I think that makes it incumbent upon us to study it," Dr. Birnbaum said. "We really need to know what it might be doing, if anything."

ON good study habits

noreply@blogger.com (John C Kim) — Mon, 06 Sep 2010 20:57:00 +0000

1.Take tests! The stress helps you understand, remember and interpret?

2. Study in different places.

3. Study different things at the same time, don't just do the same math drills, or the same type of studying.

4. Sleep on it.

Forget What You Know About Good Study Habits

By BENEDICT CAREY

Published: September 6, 2010

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Every September, millions of parents try a kind of psychological witchcraft, to transform their summer-glazed campers into fall students, their video-bugs into bookworms. Advice is cheap and all too familiar: Clear a quiet work space. Stick to a homework schedule. Set goals. Set boundaries. Do not bribe (except in emergencies).

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And check out the classroom. Does Junior's learning style match the new teacher's approach? Or the school's philosophy? Maybe the child isn't "a good fit" for the school.

Such theories have developed in part because of sketchy education research that doesn't offer clear guidance. Student traits and teaching styles surely interact; so do personalities and at-home rules. The trouble is, no one can predict how.

Yet there are effective approaches to learning, at least for those who are motivated. In recent years, cognitive scientists have shown that a few simple techniques can reliably improve what matters most: how much a student learns from studying.

The findings can help anyone, from a fourth grader doing long division to a retiree taking on a new language. But they directly contradict much of the common wisdom about good study habits, and they have not caught on.

For instance, instead of sticking to one study location, simply alternating the room where a person studies improves retention. So does studying distinct but related skills or concepts in one sitting, rather than focusing intensely on a single thing.

"We have known these principles for some time, and it's intriguing that schools don't pick them up, or that people don't learn them by trial and error," said Robert A. Bjork, a psychologist at the University of California, Los Angeles. "Instead, we walk around with all sorts of unexamined beliefs about what works that are mistaken."

Take the notion that children have specific learning styles, that some are "visual learners" and others are auditory; some are "left-brain" students, others "right-brain." In a recent review of the relevant research, published in the journal Psychological Science in the Public Interest, a team of psychologists found almost zero support for such ideas. "The contrast between the enormous popularity of the learning-styles approach within education and the lack of credible evidence for its utility is, in our opinion, striking and disturbing," the researchers concluded.

Ditto for teaching styles, researchers say. Some excellent instructors caper in front of the blackboard like summer-theater Falstaffs; others are reserved to the point of shyness. "We have yet to identify the common threads between teachers who create a constructive learning atmosphere," said Daniel T. Willingham, a psychologist at the University of Virginia and author of the book "Why Don't Students Like School?"

But individual learning is another matter, and psychologists have discovered that some of the most hallowed advice on study habits is flat wrong. For instance, many study skills courses insist that students find a specific place, a study room or a quiet corner of the library, to take their work. The research finds just the opposite. In one classic 1978 experiment, psychologists found that college students who studied a list of 40 vocabulary words in two different rooms — one windowless and cluttered, the other modern, with a view on a courtyard — did far better on a test than students who studied the words twice, in the same room. Later studies have confirmed the finding, for a variety of topics.

The brain makes subtle associations between what it is studying and the background sensations it has at the time, the authors say, regardless of whether those perceptions are conscious. It colors the terms of the Versailles Treaty with the wasted fluorescent glow of the dorm study room, say; or the elements of the Marshall Plan with the jade-curtain shade of the willow tree in the backyard. Forcing the brain to make multiple associations with the same material may, in effect, give that information more neural scaffolding.

"What we think is happening here is that, when the outside context is varied, the information is enriched, and this slows down forgetting," said Dr. Bjork, the senior author of the two-room experiment.

Varying the type of material studied in a single sitting — alternating, for example, among vocabulary, reading and speaking in a new language — seems to leave a deeper impression on the brain than does concentrating on just one skill at a time. Musicians have known this for years, and their practice sessions often include a mix of scales, musical pieces and rhythmic work. Many athletes, too, routinely mix their workouts with strength, speed and skill drills.

The advantages of this approach to studying can be striking, in some topic areas. In a study recently posted online by the journal Applied Cognitive Psychology, Doug Rohrer and Kelli Taylor of the University of South Florida taught a group of fourth graders four equations, each to calculate a different dimension of a prism. Half of the children learned by studying repeated examples of one equation, say, calculating the number of prism faces when given the number of sides at the base, then moving on to the next type of calculation, studying repeated examples of that. The other half studied mixed problem sets, which included examples all four types of calculations grouped together. Both groups solved sample problems along the way, as they studied.

A day later, the researchers gave all of the students a test on the material, presenting new problems of the same type. The children who had studied mixed sets did twice as well as the others, outscoring them 77 percent to 38 percent. The researchers have found the same in experiments involving adults and younger children.

"When students see a list of problems, all of the same kind, they know the strategy to use before they even read the problem," said Dr. Rohrer. "That's like riding a bike with training wheels." With mixed practice, he added, "each problem is different from the last one, which means kids must learn how to choose the appropriate procedure — just like they had to do on the test."

These findings extend well beyond math, even to aesthetic intuitive learning. In an experiment published last month in the journal Psychology and Aging, researchers found that college students and adults of retirement age were better able to distinguish the painting styles of 12 unfamiliar artists after viewing mixed collections (assortments, including works from all 12) than after viewing a dozen works from one artist, all together, then moving on to the next painter.

The finding undermines the common assumption that intensive immersion is the best way to really master a particular genre, or type of creative work, said Nate Kornell, a psychologist at Williams College and the lead author of the study. "What seems to be happening in this case is that the brain is picking up deeper patterns when seeing assortments of paintings; it's picking up what's similar and what's different about them," often subconsciously.

Cognitive scientists do not deny that honest-to-goodness cramming can lead to a better grade on a given exam. But hurriedly jam-packing a brain is akin to speed-packing a cheap suitcase, as most students quickly learn — it holds its new load for a while, then most everything falls out.

"With many students, it's not like they can't remember the material" when they move to a more advanced class, said Henry L. Roediger III, a psychologist at Washington Universityin St. Louis. "It's like they've never seen it before."

When the neural suitcase is packed carefully and gradually, it holds its contents for far, far longer. An hour of study tonight, an hour on the weekend, another session a week from now: such so-called spacing improves later recall, without requiring students to put in more overall study effort or pay more attention, dozens of studies have found.

No one knows for sure why. It may be that the brain, when it revisits material at a later time, has to relearn some of what it has absorbed before adding new stuff — and that that process is itself self-reinforcing.

"The idea is that forgetting is the friend of learning," said Dr. Kornell. "When you forget something, it allows you to relearn, and do so effectively, the next time you see it."

That's one reason cognitive scientists see testing itself — or practice tests and quizzes — as a powerful tool of learning, rather than merely assessment. The process of retrieving an idea is not like pulling a book from a shelf; it seems to fundamentally alter the way the information is subsequently stored, making it far more accessible in the future.

Dr. Roediger uses the analogy of the Heisenberg uncertainty principle in physics, which holds that the act of measuring a property of a particle alters that property: "Testing not only measures knowledge but changes it," he says — and, happily, in the direction of more certainty, not less.

In one of his own experiments, Dr. Roediger and Jeffrey Karpicke, also of Washington University, had college students study science passages from a reading comprehension test, in short study periods. When students studied the same material twice, in back-to-back sessions, they did very well on a test given immediately afterward, then began to forget the material.

But if they studied the passage just once and did a practice test in the second session, they did very well on one test two days later, and another given a week later.

"Testing has such bad connotation; people think of standardized testing or teaching to the test," Dr. Roediger said. "Maybe we need to call it something else, but this is one of the most powerful learning tools we have."

Of course, one reason the thought of testing tightens people's stomachs is that tests are so often hard. Paradoxically, it is just this difficulty that makes them such effective study tools, research suggests. The harder it is to remember something, the harder it is to later forget. This effect, which researchers call "desirable difficulty," is evident in daily life. The name of the actor who played Linc in "The Mod Squad"? Francie's brother in "A Tree Grows in Brooklyn"? The name of the co-discoverer, with Newton, of calculus?

The more mental sweat it takes to dig it out, the more securely it will be subsequently anchored.

None of which is to suggest that these techniques — alternating study environments, mixing content, spacing study sessions, self-testing or all the above — will turn a grade-A slacker into a grade-A student. Motivation matters. So do impressing friends, making the hockey team and finding the nerve to text the cute student in social studies.

"In lab experiments, you're able to control for all factors except the one you're studying," said Dr. Willingham. "Not true in the classroom, in real life. All of these things are interacting at the same time."

But at the very least, the cognitive techniques give parents and students, young and old, something many did not have before: a study plan based on evidence, not schoolyard folk wisdom, or empty theorizing.

Prescription Drug Costs Double Over A Decade - Shots - Health News Blog : NPR

noreply@blogger.com (John C Kim) — Fri, 11 Dec 2009 00:07:00 +0000

via npr.org

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dosing Prevention and Management of Vitamin D Deficiency in Children: Part I: Vitamin D Requirements: New Recommendations

noreply@blogger.com (John C Kim) — Thu, 10 Dec 2009 22:47:00 +0000

Prevention and Management of Vitamin D Deficiency in Children: Part I: Vitamin D Requirements: New Recommendations

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Introduction

Mechanism of Action

Current Standards for Vitamin D Intake

Vitamin D Status in Infants and Children

New Recommendations

Patients at Increased Risk

Summary

References

Information from Industry

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New Recommendations

An extensive review on vitamin D deficiency in children, with new recommendations for supplementation, was published in the August 2008 issue of Pediatrics by Misra and colleagues on behalf of the Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society.^[16] This paper provides an excellent resource for pediatric health care providers on topics ranging from biomarkers of vitamin D deficiency to dietary sources and dosing of vitamin D products.

Based on a review of the literature, the group recommended that serum 25 (OH)D levels be maintained at least above 20 ng/mL and that daily supplementation with 400 International Units (10 mcg) of vitamin D be initiated within days of birth for all breastfed infants and in formula-fed infants and children who do not ingest at least 1 L of vitamin D-fortified milk each day. Premature infants, dark-skinned children, and children who live at higher latitudes may require larger doses of vitamin D, up to 800 International Units (20 mcg) per day. Supplementation for vitamin D insufficient or deficient children should be dosed according to the chart below:

Patient Age Dose (International Units/day)

< 1 month 1,000

1–12 months 1,000 to 5,000

> 12 months > 5,000

In addition to their recommendations, the authors also highlighted the need for additional studies to determine if higher levels of 25 (OH)D (> 32 ng/mL) should be considered, as well as to determine the appropriate balance of the benefits and risks of sunlight exposure.^[16]

In November 2008, the American Academy of Pediatrics (AAP) released a guidance paper on the prevention of rickets and vitamin D deficiency in infants, children, and adolescents.^[6] This new report replaces their 2003 statement which recommended a daily intake of 200 International Units. As in the Lawson Wilkins Society article, the 2008 AAP statement recommends that the daily vitamin D intake for all pediatric patients be increased to 400 International Units (10 mcg), with a goal 25 (OH)D level of at least 20 ng/mL. The AAP statement also recommends that breastfed infants receive a vitamin D supplement at a dose of 400 International Units/day beginning shortly after birth and continuing until they are weaned and consuming at least 1 L of vitamin D-fortified formula or milk per day.

Daily supplementation is also recommended for older children and adolescents who do not consume at least 400 International Units of vitamin D with their usual diet. The AAP guidelines were based on studies documenting the safety of vitamin D at this higher dose as well as new evidence suggesting a possible role for vitamin D in preventing cancer, cardiovascular disease, and diabetes.^[6]

Patient Age	Dose (International Units/day)
< 1 month	1,000
1–12 months	1,000 to 5,000
> 12 months	> 5,000

via medscape.com

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Ninth Annual Year in Ideas -Thirdhand Smoke dangers - NYTimes.com

noreply@blogger.com (John C Kim) — Thu, 10 Dec 2009 20:09:00 +0000

Thirdhand Smoke

Many parents who light up are aware of the dangers of secondhand smoke; they blow it out the window or smoke at home only when the kids are not there. But people rarely account for what is left behind after a cigarette has been extinguished. When smoke dissipates, it does not just disappear. Compounds are left over that settle on walls, furniture and clothes, or become part of house dust. Call it "thirdhand smoke," which is what a team of researchers trying to raise awareness of the dangers of smoking named it in January.
The study, published in the journal Pediatrics, surveyed 1,500 smokers and nonsmokers about the hazards of secondhand and thirdhand smoke and found that 84 percent of smokers believe secondhand smoke is dangerous to children, while only 43 percent think thirdhand smoke is harmful. But the compounds in thirdhand smoke can be ingested or absorbed through the skin, and some give off gases as they deteriorate, says Jonathan Winickoff, an associate professor of pediatrics at Massachusetts General Hospital, who led the research. Many are carcinogenic. "The more you smoke in these locations, the more microlayers of these toxins build up," Winickoff says.

PHOTO ILLUSTRATION BY REINHARD HUNGER
SET DESIGN BY SARAH ILLENBERGER Enlarge
Winickoff is analyzing data on children who live in apartments and encounter thirdhand smoke only from other units in their buildings. He expects to publish his results early next year. LIA MILLER

via nytimes.com

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The States of Marriage and Divorce - Pew Research Center

noreply@blogger.com (John C Kim) — Thu, 10 Dec 2009 19:52:00 +0000

Correlations in Marriage Patterns

Some state-level patterns of marriage and divorce correlate³ with the overall socioeconomic characteristics and political behavior in those states. This does not mean that one pattern causes the other to happen, only that both tend to be true in the same place.

A state's education levels, for example, tend to be associated with the median age at marriage and the multiple-marriage patterns of its residents. In states with high shares of college-educated adults, men and women marry at older ages, a finding supported by other research indicating that highly educated individuals marry later in life. In states with low shares of college-educated adults, adults are more likely than average to marry three or more times. In states with low income levels, men are more likely than average to have been married three or more times.

For this analysis, correlation also was tested between a state's marriage or divorce statistics and the share of its 2008 presidential election vote that went Democratic. States with high shares of Democratic votes tended to have lower shares of currently married residents, lower shares of adults married at least three times and low rates of marriages within the previous year. Residents of states with high shares of Democratic votes tend to marry at older ages than residents of states with low shares of Democratic votes.

This analysis did not find a strong correlation between divorce statistics -- either a state's share of divorced adults or its rate of divorce within the previous year -- and socioeconomic indicators (income and education) or 2008 presidential election patterns. There was a strong correlation, however, between young age at first marriage for women and a high divorce rate for women within the previous 12 months.

Correlation also was tested to see whether a state's religiosity was associated with marriage and divorce patterns. Religiosity was expressed as the proportion of a state's residents who said in response to a survey that religion was "very important" in their life.⁴ However, this analysis did not find a strong association between a state's religiosity and its marriage or divorce patterns.

Explore marriage and divorce patterns and see how your state measures up using interactive maps at pewsocialtrends.org.

via pewresearch.org

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Ensuring the Fiscal Sustainability of Health Care Reform | Health Care Reform 2009; an excellent I wish I had written it myself essay on the challenges of cost containment

noreply@blogger.com (John C Kim) — Wed, 09 Dec 2009 23:15:00 +0000

via healthcarereform.nejm.org

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Primary Care and Accountable Care — Two Essential Elements of Delivery-System Reform | Health Care Reform 2009

noreply@blogger.com (John C Kim) — Wed, 09 Dec 2009 23:01:00 +0000

Diane R. Rittenhouse, M.D., M.P.H., Stephen M. Shortell, Ph.D., M.P.H., M.B.A., and Elliott S. Fisher, M.D., M.P.H.

With discussions about U.S. health care reform focused heavilyon insurance reforms, relatively little attention has been paidto the delivery-system reforms that will be required to improvethe quality and coordination of health care and slow the growthof spending. The “patient-centered medical home” (PCMH) andthe “accountable care organization” (ACO) are two widely discussedmodels for delivery-system reform that take complementary approachesto achieving these goals. The PCMH model emphasizes the creationof a strong primary care foundation for the health care system,and the ACO model emphasizes the alignment of incentives andaccountability for providers across the continuum of care. Withsupport from the Commonwealth Fund, we recently met with otherleaders involved in the development of these models to clarifytheir key elements and identify ways of ensuring that such reformsare mutually reinforcing.

The PCMH model builds on substantial evidence demonstratingthat greater emphasis on primary care can result in higher-qualitycare at lower cost. The model combines the core tenets of primarycare (first-contact care that is continuous, comprehensive,and coordinated across the care continuum) with 21st-centurypractice innovations such as the use of electronic informationsystems, population-based management of chronic illness, andcontinuous quality improvement. One important cornerstone ofthis model is a focus on meeting the needs and preferences ofpatients; another is payment reform that improves reimbursementto primary care practices and rewards high performance. Themodel is widely endorsed by purchasers, payers, physicians,and patient-advocacy groups, and multipayer medical home demonstrationprojects are under way throughout the country.

The challenges to implementation of the PCMH model include twoissues that lie beyond the direct control of the primary carepractice.¹ First, although the model calls for primary carepractices to take responsibility for providing, coordinating,and integrating care across the health care continuum, it providesno direct incentives to other providers to work collaborativelywith primary care providers in achieving these goals and optimizinghealth outcomes. Second, although evidence suggests that increasedinvestment in primary care can result in savings from severaltypes of reductions — for example, inappropriate use oftests and procedures, emergency department utilization, andhospitalizations for conditions that could be treated in anoutpatient setting — most primary care practices do nothave financial arrangements that allow them to share in thesesavings. The effect on total costs of implementing the PCMHmodel alone could be limited, because primary care physicianshave little direct leverage over other providers in the carecontinuum, and under the largely fee-for-service payment systemit is unlikely that other providers will respond to reductionsin the number of referrals or admissions by allowing their incomesto fall. These limitations could be addressed most readily ifthe model were implemented in the context of a larger entitysuch as an ACO.²

An ACO is a provider-led organization whose mission is to managethe full continuum of care and be accountable for the overallcosts and quality of care for a defined population. Multipleforms of ACOs are possible, including large integrated deliverysystems, physician–hospital organizations, multispecialtypractice groups with or without hospital ownership, independentpractice associations, and virtual interdependent networks ofphysician practices.³ ACOs could receive fee-for-service paymentand share in any cost savings achieved relative to a risk-adjustedprojected spending target for their patient population; alternatively,payment could be partially or fully capitated, with risks andgains both being shared by all providers. Performance measurementto evaluate the quality of care and to prevent potential overuse(in fee-for-service organizations) and underuse (in capitatedones) is a cornerstone of the model. Some evidence suggeststhat more fully integrated ACOs provide higher-quality, moreefficient care than smaller, more loosely organized ones.⁴ Challengesto the implementation of the ACO model include the need forstrong leadership to address the cultural, legal, and resource-relatedbarriers to creating new provider organizations in many communities.⁵

Regardless of the organizational structure, an ACO will notsucceed without a strong foundation of high-performance primarycare. The current shortage of primary care capacity and theoutdated infrastructure of most primary care practices couldlimit the successful implementation of ACOs; conversely, investmentin the PCMH model could accelerate the development of high-performingACOs. The fact that the ACO model does not explicitly requiresupport for primary care has led to considerable concern thatACOs dominated by hospitals or specialists would not adequatelyinvest in primary care — or that hospitals and specialistswould garner a disproportionate share of any savings. Becauseit is widely recognized that increased investment in primarycare is needed to slow the overall rate of growth in spending,finding a way to ensure adequate support for primary care willbe critical to the design and implementation of ACOs.

As both models move through pilot programs toward implementation,we have identified several strategies for ensuring that theyare mutually reinforcing. First, accreditation and certificationprocesses should be aligned. The National Committee on QualityAssurance (NCQA) has a voluntary PCMH recognition program thathas been used in many of the early medical home initiatives.There is ongoing debate about the best criteria for recognizinga practice as meeting the standards of a PCMH, and the NCQAis seeking input on this topic from stakeholders. No ACO accreditationor certification process has yet been developed, but when oneis, it will be critical to include criteria that ensure sufficientprimary care capacity for the patient population and to closelyalign the standards with those of PCMH recognition.

Second, because successful implementation and evaluation ofboth models will require measurement of performance, a commonset of primary care performance measures should be developed;these should be consistent with the domains outlined in theCommonwealth Fund’s “2020 Vision of Patient-Centered PrimaryCare” (e.g., timely access to care, coordination of care, andengagement of patients) and endorsed by the National QualityForum. Performance measurement for determining the amount ofshared savings or other financial incentives for ACOs must weightprimary care measures heavily rather than focus narrowly onmetrics related to hospital care.

Third, the payment mechanisms used must align the incentivesof the two models to increase accountability for total costsacross the continuum of care while ensuring that a sufficientinvestment is made in primary care capacity. In Medicare andother demonstration projects, incentives should be aligned sothat primary care practices could benefit financially from simultaneousparticipation in both PCMH and ACO pilots. Because transformingprimary care in accordance with the medical home model requiresconsiderable resources, incentives for both quality and savingsshould emphasize high levels of primary care performance toensure that ACOs provide adequate support to their primary careproviders to enable them to attain and sustain the essentialcapabilities of a PCMH.

These two approaches are synergistic models of delivery-systemreform that, together, promise to redirect the U.S. deliverysystem toward reduced cost growth and improved quality. ACOswill require a strong primary care core to succeed and, in turn,can provide essential delivery-system infrastructure beyondthe primary care practice to ensure the full realization ofthe PCMH model. Ongoing evaluation of both models, preferablyin combination and in diverse settings, is essential. Demonstrationsshould be designed as pilot tests that can be continued if successful,modified as necessary, and (when successful) implemented broadly,with continued adaptation. Finally, one of the most importantelements of federal health care reform will be expanding thecapacity of federal agencies, including the Centers for Medicareand Medicaid Services and the Agency for Healthcare Researchand Quality, to implement, support, and evaluate these promisingdelivery-system reforms.

Drs. Shortell and Fisher report receiving consulting fees fromKaiser Permanente; Dr. Shortell also reports receiving advisoryfees from Centene. No other potential conflict of interest relevantto this article was reported.

Source Information

From the Department of Family and Community Medicine, University of California, San Francisco, San Francisco (D.R.R.); the School of Public Health, University of California, Berkeley (S.M.S.); and the Dartmouth Institute for Health Policy and Clinical Practice and Dartmouth Medical School, Lebanon, NH (E.S.F.). The authors participated in the meeting along with Melinda Abrams, M.S., Michael S. Barr, M.D., M.B.A., Robert Berenson, M.D., Karen Davis, Ph.D., Kevin Grumbach, M.D., David Meyers, M.D., Hoangmai Pham, M.D., M.P.H., Robert L. Phillips, Jr., M.D., M.S.P.H., and Dana Gelb Safran, Sc.D. The consensus that emerged from the discussion and that is summarized in this article should not be taken to be the perspective of any specific individual or organization.

This article (10.1056/NEJMp0909327) was published on October 28, 2009, at NEJM.org.

References

Rittenhouse DR, Shortell SM. The patient-centered medical home: will it stand the test of health reform? JAMA 2009;301:2038-2040. [Free Full Text]

Fisher ES. Building a medical neighborhood for the medical home. N Engl J Med 2008;359:1202-1205. [Free Full Text]

Shortell SM, Casalino LP. Health care reform requires accountable care systems. JAMA 2008;300:95-97. [Free Full Text]

Tollen L. Physician organization in relation to quality and efficiency of care: a synthesis of recent literature. New York: The Commonwealth Fund, April 2008.

McKethan A, McClellan M. Moving from volume-driven medicine toward accountable care. Health Affairs Blog. August 20, 2009. (Accessed October 26, 2009, at http://healthaffairs.org/blog/2009/08/20/moving-from-volume-driven-medicine-toward-accountable-care.)

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Flu During Pregnancy May Increase Risk Of Schizophrenia In Certain Offspring; influenza type B seems to be more implicated.

noreply@blogger.com (John C Kim) — Wed, 09 Dec 2009 17:47:00 +0000

Flu During Pregnancy May Increase Risk Of Schizophrenia In Certain Offspring

ScienceDaily (June 11, 2009) — When mothers become infected with influenza during their pregnancy, it may increase the risk for schizophrenia in their offspring. Influenza is a very common virus and so there has been substantial concern about this association. A new study in the June 15th issue of Biological Psychiatry suggests that the observed association depends upon a pre-existing vulnerability in the fetus.

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Specifically, Dr. Lauren Ellman and colleagues determined that fetal exposure to influenza leads to cognitive problems at age 7 among children who later develop a psychotic disorder in adulthood, but fetal exposure to influenza does not lead to cognitive problems among children who do not later develop a psychotic disorder. It is important to note that these results were dependent upon the type of influenza, with this association present only after fetal exposure to influenza B as opposed to influenza A.

This research was conducted as part of the Collaborative Perinatal Project, which followed pregnant women and their offspring in the 1950’s and 60’s, collecting blood throughout pregnancies for later analyses. A series of cognitive assessments were conducted with the children of study participants and then psychotic diagnoses were determined in adulthood.

The findings from this study suggest that a genetic and/or an additional environmental factor associated with psychosis likely is necessary for the fetal brain to be vulnerable to the effects of influenza, given that decreases in cognitive performance were only observed in influenza-exposed children who developed a psychotic disorder in adulthood.

“The good news is that most fetuses exposed to influenza virus while in the womb will not go on to develop schizophrenia. The bad news is that the prior association between influenza infection and later development of psychotic disorders was supported,” comments John Krystal, M.D., the editor of Biological Psychiatry.

This finding has the potential to influence efforts to develop prevention, early intervention and treatment strategies, such as taking steps to maintain careful hygiene and, if clinically appropriate, administration of the influenza vaccination to reduce infection among women prior to pregnancy. Dr. Krystal notes, “It also raises an important unanswered question: How does influenza virus affect the vulnerable developing brain and how can we prevent or reverse the consequence of fetal influenza infection in vulnerable individuals before they develop schizophrenia?” More research is needed to elicit answers to these vital issues.

via sciencedaily.com

interesting paradigm of how viral diseases can affect gene expression and manifest in psychiatric disease 30 years later.

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Exposure To Influenza During Pregnancy May Increase Risk Of Schizophrenia In Offspring

noreply@blogger.com (John C Kim) — Wed, 09 Dec 2009 17:44:00 +0000

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Exposure To Influenza During Pregnancy May Increase Risk Of Schizophrenia In Offspring

ScienceDaily (Aug. 3, 2004) — NEW YORK, NY (August 2, 2004)– A new study published today in the JAMA publication, Archives of General Psychiatry, indicates that prenatal exposure to influenza may increase the risk for development of schizophrenia years later. The study, which evaluated archived sera from pregnant women who participated in a large birth cohort called the Child Health and Development Study (CHDS) from 1959–1966, was conducted by researchers at the New York State Psychiatric Institute and the Mailman School of Public Health at Columbia University, in collaboration with the Kaiser Permanente Medical Care Plan, Northern California Region and the Public Health Institute, Berkeley, California.

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Dopamine hypothesis of schizophrenia

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Postpartum depression

Today's findings are part of a larger team study known as the Prenatal Determinants of Schizophrenia (PDS), which examines prenatal infection, nutrition, chemical exposure, paternal age, and a range of other prenatal factors that influence schizophrenia risk.

The study has shown for the first time that serologically documented prenatal exposure to influenza is associated with schizophrenia. The risk of schizophrenia was increased threefold when influenza occurred during the first half of pregnancy; however when influenza occurred during the second half of pregnancy, no increased risk was observed.

"It is an exciting time for research that combines serologic documentation of infectious diseases during pregnancy, long-term follow-up, and careful assessments for schizophrenia and other disease outcomes," said Alan Brown, MD, lead author and associate professor of clinical psychiatry and epidemiology at the New York State Psychiatric Institute and Mailman School of Public Health. "Because the individuals whom we are studying have only recently passed through the age of risk for schizophrenia, it has become possible only in the last few years to analyze archived prenatal serum specimens in order to address the question of whether schizophrenia is related to prenatal risk factors such as viruses, as well as nutritional factors and toxins, during pregnancy." The 40-year study of the CHDS was made possible by ongoing support from the National Institute of Child Health and Development.

"These findings represent the strongest evidence thus far that prenatal exposure to influenza plays a role in schizophrenia," said Ezra Susser, MD, DrPH, senior investigator of the PDS study, chair of the Department of Epidemiology at the Mailman School of Public Health and head of Epidemiology of Brain Disorders at the New York State Psychiatric Institute. "Although the findings may ultimately have implications for prevention, we strongly caution against making any public health policy recommendations until these links have been confirmed through further study."

The PDS, initiated by Dr. Susser together with Dr. Brown and Dr. Catherine Schaefer of Kaiser Permanente Division of Research, included a nested case-control study of the CHDS birth cohort, which was recruited from 1959-1967, and was followed up for psychiatric disorders 30-38 years later. During that time period, the CHDS, under the direction of Jacob Yerushalmy, University of California, Berkeley, recruited nearly every pregnant woman who received obstetric care from Kaiser Permanente in Alameda County, California. All of the children born were automatically enrolled in Kaiser Permanente. The PDS study cohort consisted of the sub-sample of 12,094 live births who were members of Kaiser Permanente from January 1, 1981 through December 31, 1997.

Dr. Brown and colleagues from the PDS team measured influenza antibody in archived serum samples derived from the blood of 64 pregnant women whose offspring later developed adult schizophrenia and from a comparison group of 125 pregnant women whose offspring did not develop schizophrenia. They found an association between the presence of elevated influenza antibody levels and schizophrenia in the adult offspring suggesting that prenatal exposure to influenza may increase the vulnerability for schizophrenia.

This study was funded by the National Institute of Mental Health, the National Alliance for Research on Schizophrenia and Depression, and the Lieber Center for Schizophrenia Research.

The PDS research is part of a number of "life course studies" being overseen by Dr. Susser at the Mailman School. In addition to the CHDS study, Dr. Susser and his team are looking at large birth cohorts from the U.S., Israel and Norway to observe the pathogenesis of chronic and acute diseases and their links to prenatal and postnatal exposure to environmental factors such as viruses and toxins.

via sciencedaily.com

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The Long-Term Evidence for Vaccines | Print Article | Newsweek.com Prelude to backlash against backlash?

noreply@blogger.com (John C Kim) — Wed, 09 Dec 2009 17:33:00 +0000

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The Long-Term Evidence for Vaccines

Vaccination does more than protect against flu. Study after study shows that keeping children safe from viruses has long-lasting, positive health benefits.

By Laurie Garrett and Dana March | Newsweek Web Exclusive

Dec 7, 2009

With some reports saying that the worst of the H1N1 outbreak may have already come and gone this flu season in North America but not worldwide, parents who decided to sit out vaccinations for their children may feel validated. But not only is that strategy risky, it's uninformed, and ignores a larger truth about the benefit of vaccines. Throughout North America and Europe, an anti-vaccination movement has steadily grown over the past two decades, and was recently jet-propelled amid anxiety over immunizing pregnant women and children against the H1N1 "swine flu." The greatest fall-off in child vaccination, and the strongest proponents of various theoretical dangers associated with vaccines, are all rooted in wealthy, mostly Caucasian communities, located in the rich world. At a time when billions of people living in poorer countries are clamoring for equitable access to life-sparing drugs and vaccines for their families, the college-educated classes of the United States and other rich countries are saying "no thanks," even accusing their governments of "forcing" them to give "poison" to their children.

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Will the children of these naysaying parents of the rich world turn to Mom and Dad 30 years from now and say, "Thanks for not getting me immunized. Thanks especially for saying no to the flu vaccine?"

Probably not.

If a woman is exposed to influenza while pregnant, or if an unvaccinated child gets the flu in his or her first year of life, the baby's developing brain may be severely damaged by the virus. Analysis of medical records of Americans who were born in the late '50s and early '60s shows that having the mother catch the flu while pregnant increased the chance her child would later develop schizophrenia. It's not a trivial difference: the children of moms who had flu midway during their pregnancies were as much as eight times more likely to become schizophrenic.

Overall, prenatal and infant exposure to influenza is strongly associated with cognitive failures. Babies are born with brains and immune systems that are still developing, and will not be hard-wired and strong until their second year of life. Scientists are increasingly discovering links between viral infections during those precious times, and psychiatric problems ranging from lifelong depression to acute learning deficits. In utero or infancy infection with chickenpox doubles the risk of cerebral palsy, according to Australian researchers. Having rubella during pregnancy increases by 80 percent the chances of severe birth defects in that mother's child, including small brains and hearts, blindness, deafness, and severe learning deficits.

Children who contract measles, chickenpox, or whooping cough can develop encephalitis or meningitis—infections of the central nervous system—which can cause epilepsy, brain damage, and death. Parents cannot protect their children's brains against everything, but the basic battery of vaccines can block the bulk of these viral insults. And the good news is that the still-developing immune system of babies and infants is ripe for the vaccine-induced programming that can confer decades—in some cases, lifelong—protection.

Other vaccine-preventable diseases—measles, rubella, mumps, chickenpox, and whooping cough—can damage the optic nerves and hearing of fetuses and newborns. The effect in these cases is immediate and obvious. In the pre-vaccine era in the United States, a thousand kids lost their hearing every year due to measles infection, five out of every 10,000 children who contracted mumps suffered permanent deafness, and 10 percent of child deafness was due to rubella (a.k.a. German measles).

And today, in countries with spotty child-immunization achievements—including the United Kingdom—viral infection in utero or in infancy accounts for 10 to 25 percent of child deafness.

Influenza in utero or in the first year of a child's life is a major cause of adult cardiovascular disease—heart attacks and strokes. People who suffered influenza during the Great Pandemic of 1918–19 were 20 percent more likely to develop heart disease as adults. To put that in perspective, having a "bad cholesterol count" of more than 240mg confers a 20 percent elevated risk of heart attacks, according to the American Heart Association.

Dr. Marietta Vázquez studied 350 mothers and infants from birth to 12 months of age who were hospitalized at Yale-New Haven Hospital over nine flu seasons (2000–2009). The babies of flu-vaccinated moms were larger, healthier, and, 85 percent of the time, fully protected against influenza. Similar findings have recently been reported out of Bangladesh, where the babies of vaccinated moms averaged a half pound larger than their unprotected peers and were less likely to be born prematurely.

The good news is that five decades of global child-vaccination programs have dramatically reduced infant and child mortality rates, and improved life expectancies in most of the world. In September, UNICEF reported that for the first time since WWII the number of children dying in the world annually fell below 10 million in 2008, largely due to child immunization. Vaccines, UNICEF says, are saving 2.5 million kids from dying every single year.

But outbreaks of vaccine-preventable diseases are surfacing wherever clusters of people either decline immunization, or are denied it by virtue of population poverty. The unimmunized few are a threat to all, as they may harbor viruses and pass them onto others whose vaccine-induced immunity is waning due to HIV, cancer, or simply the passing of time. Conversely, failing to be immunized in childhood renders young adults vulnerable to infectious diseases that they may not encounter until they go off to college or travel outside of their home regions.

A cursory search of outbreak reports over the last 13 months demonstrates that measles, mumps, diphtheria, whooping cough, polio, and typhoid fever are surfacing now in all sorts of settings, from jet planes to college dormitories, from Dutch religious sects to villages of Caribbean islands. Some of these outbreaks are tiny, involving no more than a cluster of individuals. But over the last year, several outbreaks have reached epidemic levels.

The United Kingdom has more such outbreaks than any other wealthy country, and that comes as no surprise as Dr. Andrew Wakefield—a key proponent of the theory that additives in vaccines cause autism—started his anti-immunization career in the U.K., in 1998 publishing now thoroughly refuted "evidence" of an autism link. Wakefield is now the subject of a hearing conducted by the U.K.'s General Medical Council for alleged medical misconduct. The discovery that he was secretly funded by personal-injury lawyers that sued vaccine makers has further fueled inquiries. Still, Wakefield's ideas continue to resonate in the UK, to the dismay of the country's pediatricians. Today, 20 percent of U.K. children enter primary school without having completed their full schedule of basic vaccinations— 40 percent, in some parts of the country—according to the Department of Health.

For those fighting disease on the global stage, the H1N1 pandemic has brought into stark relief a puzzling, difficult dichotomy. In the wealthy world, where individuals have the luxury of demanding 100 percent safety, the balance between individual and population rights has shifted so far toward individualism that it is nearly impossible for public-health authorities to persuade people to accept even one in 1 billion risks on behalf of society as a whole. (The exception is the U.S. armed forces, where duty to country includes an obligation to accept full vaccination.) But the very tools of protection that many individuals in the rich world are rejecting—especially the H1N1 vaccine—are completely unavailable to more than half the population of the world. Some 24 million children last year had no access to basic vaccines, says UNICEF, and at least 4 billion people cannot get flu vaccines right now.

For the poor and emerging-market countries, this inequity in access to life-sparing public-health tools is viewed as not only grossly unfair, but as a sign of the arrogant hypocrisy of the wealthy world. The rich countries demand that the planet's poor make sacrifices to slow down epidemics—such as slaying their chickens to stop bird flu, or losing tourist dollars by publicly acknowledging outbreaks within their borders—but offer little in return, including access to precious vaccines.

Yes, the proper adjective is "precious": miracles of science that, combined with smallpox immunization, saved more lives during the 20th century than were lost in all the wars, all the genocides, and all the epidemics of that hundred years. When a baby in an African village dies of measles, or a schoolchild in China succumbs to typhoid fever, none can question how precious that lost life was, or how vital a difference a vaccine could have made.

GARRETT is a Pulitzer Prizewinning writer and senior fellow for global health at the Council on Foreign Relations. MARCH is a doctoral candidate at the Mailman School of Public Health at Columbia University, specializing in life course, social, and psychiatric epidemiology.
Find this article at http://www.newsweek.com/id/226097
© 2009

via newsweek.com

Posted via web from wholefamilyjoy's posterous

People in flight – Photography by Denisa Tarzaka | Amusing Planet

noreply@blogger.com (John C Kim) — Wed, 09 Dec 2009 17:23:00 +0000

via amusingplanet.com

Cool to be suspended

Posted via web from wholefamilyjoy's posterous

tough love, and urban legends zjoy

noreply@blogger.com (John C Kim) — Thu, 19 Nov 2009 16:13:00 +0000

Tough Love vs. Spanking - Good Argument

Most people think it's   improper to spank children, so I have tried other methods to control my kids when they have one of 'those moments.'

One that I found effective is for me to just take the child for a car ride and talk.

Some say it's the vibration from the car, others say it's the time away from any distractions such as TV, Video Games, Computer, IPod , etc.

Either way, my kids usually calm down and stop misbehaving after our car ride together. Eye to eye contact helps a lot too.

I've included a photo below of one of my sessions with my son, in case you would like to use the technique.





This works with grandchildren,
nieces, and nephews as well.

--
John C Kim MD

Vital Signs - Safety - Helmet Laws for Bicyclers Are Effective - NYT there is a social tipping point crit mass where it is cool. That's key.cool.

noreply@blogger.com (John C Kim) — Tue, 07 Jul 2009 03:24:00 +0000

http://www.nytimes.com/2009/07/07/health/research/07safe.html?ref=health

Aging well starts in womb, as mom's choices affect whole life - USATODAY.com. The power of the womb environ

noreply@blogger.com (John C Kim) — Wed, 01 Jul 2009 17:59:00 +0000

http://www.usatoday.com/news/health/2009-06-30-prenatalcover_N.htm

A brief history of American Parenting as an enterprise in the US in New Yorker Magazine; Is there a demand for experts or by virtue of rite of passage of birthing or adopting enough to make us good parents, or at least good enough parents.

noreply@blogger.com (John C Kim) — Tue, 30 Jun 2009 21:20:00 +0000

BABY TALK

The fuss about parenthood.

by Jill LeporeJUNE 29, 2009

Middle-class parents are an insecure, easily gulled consumer group.

Am a Failure as a Mother,” a talk given on NBC radio in 1932 by Clara Savage Littledale, mother of two, has a lot to answer for, including a couple of new memoirs by grownups determined to profess their parental ineptitude: “Home Game: An Accidental Guide to Fatherhood” (Norton; $23.95), by Michael Lewis, father of three; and “Bad Mother: A Chronicle of Maternal Crimes, Minor Calamities, and Occasional Moments of Grace” (Doubleday; $24.95), by Ayelet Waldman, mother of four. Littledale was the founding editor of Parents’ Magazine; in the nineteen-thirties, her radio program—a column broadcast over the wireless—filled Emily Post’s noontime slot on Wednesdays, Miss Manners’s day off. Lewis and Waldman are columnists, too. “Home Game” started as a series on Slate, episodes in which Lewis, tenderhearted and befuddled, tries to figure out the unwritten rules of the “new fatherhood”; “Bad Mother” revisits essays first written for Salon, in which Waldman uses stories about her family to argue that there’s no such thing as a good mother. If you’ve ever read a parenting blog, and I don’t say you ought to, you have a good idea what lies at the heart of these books: ersatz confession. Lewis finds newborns hard to love; Waldman hires a maid to clean up after her maid. Lewis tells all—all!—about his vasectomy; Waldman provides her sexual history. Waldman insists that how any woman rears her kids is nobody’s never-you-mind. “Let’s all commit ourselves to the basic civility of minding our own business,” she writes. This puts a reader in a tight spot: can I or can I not skip the chapter in “Bad Mother” wherein our author confides her regret over her breasts’ lost buoyancy?

Lots of people find this kind of thing winsome, I guess, and I did like it when Lewis admitted to sneaking out during his wife’s ten-hour labor to score Ring Dings from a hospital vending machine. But as long as we’re trafficking in unsought revelation, reading these books made me think of nothing so much as traipsing to the playground with a twelve-month-old who merrily toddles off to the sandbox while I, despite hiding behind a newspaper and attempting to appear exactly as approachable as Napoleon Bonaparte, find myself cornered by a stranger: “You have a baby? I have a baby! Doesn’t parenthood beat all?” I’ve been that stranger, too (I confess! I confess!), which must be why I’m such an easy mark; the sandbox, my Waterloo. I used to like that conversation. Lately, though, it’s been getting old: all the mothers want forgiveness; all the fathers want applause. A few years back, in “Confessions of a Slacker Mom,” Muffy Mead-Ferro admitted that during her pregnancy she did not actually buy a gizmo that was supposed to pipe Mozart into her belly; in “Dinner with Dad,” Cameron Stracher offered an account of his valiant year of getting home in time for supper. Frankly, I’d just as soon stipulate that most baby gear is worthless, stupid junk and that eating dinner with your kids is really important. Then I’d like to get back to reading the paper. But, hey, sure, amnesty, ovation, whatever gets you through the long, sleepless night.

I blame, as I say, Clara Savage Littledale, whose job it was to help invent American parenthood. Stages of life are artifacts. Adolescence is a useful contrivance, midlife is a moving target, senior citizens are an interest group, and tweenhood is just plain made up. Parenthood seems, at first, different. There have always been parents, and parents have always been besotted with their children, awestruck by their impossible beauty, dopey high jinks, and strange little minds. But “parenthood,” the word, dates only to the middle of the nineteenth century, and the notion that parenthood is a distinct stage of life, shared by men and women, is historically in its infancy. An ordinary life used to look something like this: born into a growing family, you help rear your siblings, have the first of your own half-dozen or even dozen children soon after you’re grown, and die before your youngest has left home. In the early eighteen-hundreds, the fertility rate among American women was between seven and eight children; adults couldn’t expect to live past sixty. To be an adult was to be a parent—nearly everyone lived in households with children—except that people didn’t usually think of themselves as “parents”; they were mothers or fathers, and everyone knew that there was a world of difference between the two.

In Littledale’s day, all that had begun to change. People were living longer, having fewer children, and starting families later in life. Littledale, who was born in 1891, didn’t have a baby until she was thirty-one. By 1920, women bore, on average, just over three children. Child rearing no longer circumscribed every woman’s life; motherhood and fatherhood, though not the same, had more in common than they used to. The slice of the population that consisted of adults who did not have children at home—people who would never have children, hadn’t had them yet, or had already had them and now had an empty nest—was sizable, and growing. In 1880, seventy per cent of American adults lived in households with children under the age of fifteen; by 1920, that number had fallen to fifty-five per cent. All these changes, aggregated, made parenthood into something different, something big, something planned.

By 1922, when Littledale became a mother, parenting had also begun to look especially mystifying to the increasing numbers of people, generally wealthier people, who had not grown up caring for their siblings, neighbors, cousins, and nieces and nephews, and who, it turned out, had no idea how to bathe or dress or soothe a baby. Looking after babies and little kids is skilled labor, but, as the number of children dwindled, so did the number of adults who had any real skill. The growing uprootedness of American life meant that many first-time parents couldn’t count on grandparents, or, really, on anyone. In stepped experts, who argued that taking care of children was not just a skill; it was a science. In the eighteen-nineties, the psychologist G. Stanley Hall established an American foothold for the academic discipline of child study (imported from Europe, along with kindergarten), just as pediatrics was becoming a specialty. The U.S. Children’s Bureau was established in 1912. As Littledale explained in 1930, the year the American Academy of Pediatrics was founded:

Once it was believed that the very physical fact of parenthood brought with it an instinctive wisdom that enabled one to rear children wisely and well. Parents knew best. Today fathers and mothers are unwilling to struggle under such a load of self-imposed omniscience. Even if they were, the facts would be against them. For in this country various studies made in the last ten years present incontrovertible data to prove that devoted but unenlightened parenthood is a dangerous factor in the lives of children.

This almost passes for a definition: parenthood is being so inept that you’re a danger to your own children. That, at least, was the premise of Littledale’s magazine, and its price.

Littledale was the editor, but Parents’ Magazine was the brainchild of a philanthropist and publisher named George Joseph Hecht. Hecht, who was born in New York in 1895, had served in the government’s office of public information during the First World War, where he helped found the Bureau of Cartoons. In 1919, he published an amazing collection, “The War in Cartoons”—a history of the war in a hundred cartoons—and, the following year, began publishing Better Times, “the Smallest Newspaper in the World.” (It measured less than four by five inches.) For a while, Hecht wrote the entire paper, which was a weekly, and pretty good. Hecht liked to tell this story: In the early nineteen-twenties, while sailing back from a trip to Europe, he met a well-heeled woman who confided to him, “I have failed where every woman wants to succeed—as a mother.” Moved, and curious, Hecht began reading child-rearing manuals. “They were all great big thick books,” he noticed. He liked little books; he liked pictures. He began raising money for a magazine that would teach a de-skilled middle class how to be parents. (Hecht did not, at this point, have children.) For the editor, he wanted a woman, and required “that she be a college graduate, that she should have had an editorial position preferably with a woman’s magazine, that she should be able to write if dire necessity ever required it of her, that she be married and that she should be a mother.” In 1926, he hired Clara Savage Littledale.

Littledale, talented and driven, had written features for the New York Timeswhile still a student at Smith; after graduating, she became only the second woman reporter to be hired by the Evening Post. But at the Post, as elsewhere, women were almost never allowed into the newsroom; she was named editor of the paper’s woman’s page. (Joseph Pulitzer had started a woman’s page in 1886, in the New York World. Woman’s pages lasted for about a century. In 1969, the Washington Post renamed its “For and About Women” page the Style section; other newspapers followed suit. Parenting blogs like the Times’ Motherlode are basically a throwback.) In 1914, Savage left the Post to become press chairperson of the National American Woman Suffrage Association; and the next year she took a job as associate editor at Good Housekeeping, though she mainly reported on policy matters, from Washington. In 1918, she went to Europe, to cover the war. When peace came, Savage quit Good Housekeeping, stayed in Europe, and, in 1920, married a journalist named Harold Littledale; two years later, she gave birth to a daughter. In 1924, Littledale wrote a short, bitter piece for The New Republic about sharing a maternity room with a woman whose baby had been stillborn. We never learn the woman’s name; Littledale calls her 41A. Weirdly, the story, much of which is conversation overheard during a visit from 41A’s husband, has a lot in common with “Hills Like White Elephants,” which Hemingway published in 1927, in “Men Without Women.” The couple never mention the dead baby, but everything they say is about the dead baby:

“Is my aunt cookin’ your meals?” she asked.
“Yep, and, say, we had a pie.”
“What kind of a pie?” the girl demanded fiercely.
“Apple pie.”
“Did she use up those apples I was savin’?” The face of 41A was white and set.

ith Littledale at the helm, the first issue of Children, The Magazine for Parents appeared in 1926 (a year after Harold Ross started The New Yorker). It was full of expert advice, offered by leading psychologists, doctors, educators, and scholars. There had been advice literature before, of course—not only great, thick books but also magazines, including Babyhood (1884-92) andAmerican Motherhood (1903-19)—but Hecht and Littledale came up with a formula for explaining the new science of parenting. “The staff sits up nights throwing scientific words out of the articles submitted by college professors,” Littledale wrote. She also domesticated her experts. If the magazine “publishes an article by a Ph.D.,” she wrote, “it hastens to explain that said Ph.D. has a baby or if the Ph.D. is a man that he is the uncle of a dear little tot.” More important, Littledale solicited contributions from people who had no academic expertise—“Mammas and papas are encouraged to contribute articles and they do”—chiefly to point out what rank amateurs they were. In 1927, the year Littledale worked through her second pregnancy, she ran articles like “Can a Tired Business Man Be a Good Father?,” an argument for what later came to be called “quality time” (“An hour can be made more significant than a day”) and “Confessions of an Amateur Mother,” the lament of a wealthy, well-educated woman who hasn’t the slightest idea how to care for her newborn: “Why is it that for the women of my type—professional women—motherhood, as a rule, comes so hard?” (She complains, too, that she isn’t eligible for social services; there are “motherhood clinics and baby stations aplenty in the districts of the ‘poor’ women: why not for me?”)

Within two years of Children’s first issue, Hecht and Littledale had changed the magazine’s name, a decision that made a lot of sense, since all this business about parenthood, then as now, has very little to do with kids. By 1931, Parents’Magazine boasted two hundred thousand subscribers. Middle-class mothers and fathers turned out to be a very well-defined consumer group, easily gulled into buying almost anything that might remedy their parental deficiencies. In 1938,Parents’ peddled a correspondence course: “Add Science to Love and Be a ‘Perfect Mother.’ ” The magazine’s success carried Littledale into broadcasting; she was heard on NBC radio beginning in 1932, where she administered advice by the anecdote. “A child needs two parents” was her answer to a letter from a listener who wished that he knew his children better. “I’m afraid I’m a failure as a mother,” a woman fretted, and Littledale wisely counselled her, “One way to be a failure as a mother is to overplay the role.” Littledale’s advice was usually perfectly sensible. She didn’t much like punishment; she thought kids needed to learn to do things for themselves. On more particular matters, such as how to handle a crying baby, Littledale’s advice, like her magazine, followed parenting fashion, which changes with the hemlines. Urgent social issues that affected the way many Americans reared their children—segregation and poverty, for instance—had no place on Littledale’s list of parenting problems. In 1946, the year Benjamin Spock published “Baby and Child Care,” Parents’ reached four hundred thousand subscribers; it came to be known as the Family Bible. Today, it claims fifteen million readers, nearly all of them women. The magazine lost its apostrophe somewhere along the way, as well as its purchase on American life, but confessions of amateur mothers—“Parents is for every woman who lives and parents in her own authentic way”—and a column called Fatherhood 101 can still be read at its Web site, parents.com, where you can also find out about a lot of worthless, stupid baby gear and learn that eating dinner with your kids is really important.

In the United States today, people raising children are, statistically, a minority. With the notable exception of the baby boom, the percentage of American adults living in households with children younger than fifteen has been falling for more than a century; by 1990, it was down to about a third. The fertility rate is now just slightly more than two. The average American can expect to live into his or her seventies; the population, as everyone knows, is aging, fast. Forty per cent of American babies born in 2006 were their mother’s first. We are more inexperienced and unskilled at caring for them than ever, something Anne Lamott wrote about in her wry and smart memoir, “Operating Instructions: A Journal of My Son’s First Year.” Small families make for few economies of scale; a father finally figures out how to swaddle his baby, and, damn it, the age of swaddling is over. A not uncommon experience is a mother who, upon first holding her newborn, realizes that it is the first baby she has ever held.

One of the stranger things about the success of a magazine whose premise was that parents are a danger to their own children is that, by the time Hecht began publishing Parents’, children were safer than ever. In 1850, more than one baby in every five died before its first year. By 1920, infant mortality in the United States had dropped to one in twenty. By the Second World War, accidents had replaced disease as the leading cause of childhood death. Today, infant mortality is at one in two hundred. Historians once assumed that when childhood mortality was high people must not have loved their children very much; it would have been too painful. Research has since proved that assumption wrong. Now that children are very likely to survive to adulthood, you might think parents wouldn’t worry so much. This is wrong, too. We love even when that spells grief, and we worry even when that means worrying about nothing. Or, at least, that’s the best explanation I’ve got for why I once bought one of those little mirrors you Velcro to the back seat of your car so that, when your baby has to ride facing backward, you can keep an eye on him. I could tell that story, I guess, but only two things about it are worth knowing: (1) those little mirrors, while in all other respects useless, make a pretty good ice-skating rink for Lego people and (2) it’s more important to mind the road.

Meanwhile, the changes of the past two centuries have created actual problems, structural problems that affect everyone, not just the demographic that reads Parents, problems that can be very hard to see when you’re driving while looking in a baby-view mirror. Most jobs are made for people who aren’t taking care of children. The sharper the division between parenthood and adulthood, the worse those jobs fit, and the less well people who aren’t rearing children understand the hardships of people who are. Employers are seldom asked to accommodate family life in any meaningful way; employees do all the accommodating, which mainly involves, especially for women, pretending that we don’t actually have families. Everyone has a story about how painful that is. It’s also crazy, and maddening, and unfair. We’ve all got stories to tell, but stories aren’t going to rewrite employment law.

Neither are cute books about parenthood as an exclusive club whose initiation rites include confessions of ineptitude, though it’s easy to see why people write them. The average age of a woman at the birth of her first child is now twenty-five, an all-time high, and the fastest-growing cohort of first-time mothers is women over thirty-five. Most Americans become parents only after having been fully grown for a goodish while, which means that we share an experience—a set piece in every parenting memoir—that can feel as if it binds us to one another and alienates us from everyone else, the experience of crossing a great divide between Life Before Children and Life, the Much Sloppier, Sweeter, and More Ridiculous 3-D Sequel. I love that sequel. I laugh! I cry! I also really like the part where I get to read the newspaper.

wasn’t prepared for how ill suited and poorly trained I was for the job of full-time mother,” Ayelet Waldman writes in “Bad Mother,” unintentionally echoing “Confessions of an Amateur Mother,” even though Waldman, a former public defender, is explicitly arguing against the idea that she, or any woman, needs Littledale-style parental education. As Waldman sees it, expert advice about how to be a “good mother” is the problem; a “bad mother” movement is her solution. (Hey, sure, absolution, three cheers, but I’m with Littledale here: don’t overplay the role.) If only more mothers were willing to be more honest about how far we fall short of an ill-conceived ideal—June Cleaver is Waldman’s straw woman—we’d all be better off. That’s why Waldman confesses, and confesses, and confesses: she’s taking a hit for the rest of us. Paid parental leave? Better day care? Nah. More memoir is what we need. Michael Lewis isn’t trying to start a movement; mostly, he’s trying to make fun of the new fatherhood. “This book is a snapshot of what I assume will one day be looked back upon as a kind of Dark Age of Fatherhood,” he writes, archly. “Obviously, we’re in the midst of some long unhappy transition between the model of fatherhood as practiced by my father and some ideal model, approved by all, to be practiced with ease by the perfect fathers of the future.”

The thing is, we are in the midst of a long transition. But it’s no happier for these books. You have a baby? I have a baby! Doesn’t parenthood beat all? Well, yes, it does. But I still miss adulthood. ♦

ILLUSTRATION: PHILIPPE PETIT-ROULET

For ankle injuries, cold is best.

noreply@blogger.com (John C Kim) — Wed, 24 Jun 2009 20:07:00 +0000

The Claim: Heat Should Be Applied to a Sprained Ankle

By ANAHAD O’CONNOR

Published: June 22, 2009

THE FACTS

Leif Parsons

Health Guide: Ankle Pain | Sprains

Ankle sprains are one of the most common sports injuries; they send about a million Americans to clinics every year and cause chronic problems for many.

The problem is clear, but the first-aid treatment is not: heat or cold?

Many people swear by heat, saying it soothes the pain and promotes healing by stimulating blood flow. Others advocate ice, precisely because it does the reverse, slowing blood flow and minimizing inflammation.

According to research, ice wins every time.

In multiple studies, scientists have compared heat and ice by randomly assigning people who showed up at sports clinics with sprains to receive one treatment or the other, in combination with a pain reliever like ibuprofen. One prominent study found that immediate ice therapy “resulted in earlier return to activity, as defined by ability to walk, climb stairs, run and jump without pain.”

In people with the most severe injuries — including torn ligaments — treatment with ice resulted in a 13-day recovery, compared with 30 days for those treated with heat.

For the best results, experts recommend the Price method: protection, rest, ice, compression and elevation. They caution that ice should be applied only 20 minutes at a time.

THE BOTTOM LINE

Ice is far better than heat for ankle sprains.

Review of Kessler’s book on food and over eating, sounds like dummy proofing ourselves from an fat inducing environment is a crucial step toward freedom. But catch the last few paragraph, ah when the chips are down, and we are tired, the chips come up.

noreply@blogger.com (John C Kim) — Wed, 24 Jun 2009 01:08:00 +0000

How the Food Makers Captured Our Brains

Stuart Bradford

By TARA PARKER-POPE

Published: June 22, 2009

As head of the Food and Drug Administration, Dr. David A. Kessler served two presidents and battled Congress and Big Tobacco. But the Harvard-educated pediatrician discovered he was helpless against the forces of a chocolate chip cookie.

In an experiment of one, Dr. Kessler tested his willpower by buying two gooey chocolate chip cookies that he didn’t plan to eat. At home, he found himself staring at the cookies, and even distracted by memories of the chocolate chunks and doughy peaks as he left the room. He left the house, and the cookies remained uneaten. Feeling triumphant, he stopped for coffee, saw cookies on the counter and gobbled one down.

“Why does that chocolate chip cookie have such power over me?” Dr. Kessler asked in an interview. “Is it the cookie, the representation of the cookie in my brain? I spent seven years trying to figure out the answer.”

The result of Dr. Kessler’s quest is a fascinating new book, “The End of Overeating: Taking Control of the Insatiable American Appetite” (Rodale).

During his time at the Food and Drug Administration, Dr. Kessler maintained a high profile, streamlining the agency, pushing for faster approval of drugs and overseeing the creation of the standardized nutrition label on food packaging. But Dr. Kessler is perhaps best known for his efforts to investigate and regulate the tobacco industry, and his accusation that cigarette makers intentionally manipulated nicotine content to make their products more addictive.

In “The End of Overeating,” Dr. Kessler finds some similarities in the food industry, which has combined and created foods in a way that taps into our brain circuitry and stimulates our desire for more.

When it comes to stimulating our brains, Dr. Kessler noted, individual ingredients aren’t particularly potent. But by combining fats, sugar and salt in innumerable ways, food makers have essentially tapped into the brain’s reward system, creating a feedback loop that stimulates our desire to eat and leaves us wanting more and more even when we’re full.

Dr. Kessler isn’t convinced that food makers fully understand the neuroscience of the forces they have unleashed, but food companies certainly understand human behavior, taste preferences and desire. In fact, he offers descriptions of how restaurants and food makers manipulate ingredients to reach the aptly named “bliss point.” Foods that contain too little or too much sugar, fat or salt are either bland or overwhelming. But food scientists work hard to reach the precise point at which we derive the greatest pleasure from fat, sugar and salt.

The result is that chain restaurants like Chili’s cook up “hyper-palatable food that requires little chewing and goes down easily,” he notes. And Dr. Kessler reports that the Snickers bar, for instance, is “extraordinarily well engineered.” As we chew it, the sugar dissolves, the fat melts and the caramel traps the peanuts so the entire combination of flavors is blissfully experienced in the mouth at the same time.

Foods rich in sugar and fat are relatively recent arrivals on the food landscape, Dr. Kessler noted. But today, foods are more than just a combination of ingredients. They are highly complex creations, loaded up with layer upon layer of stimulating tastes that result in a multisensory experience for the brain. Food companies “design food for irresistibility,” Dr. Kessler noted. “It’s been part of their business plans.”

But this book is less an exposé about the food industry and more an exploration of us. “My real goal is, How do you explain to people what’s going on with them?” Dr. Kessler said. “Nobody has ever explained to people how their brains have been captured.”

The book, a New York Times best seller, includes Dr. Kessler’s own candid admission that he struggles with overeating.

“I wouldn’t have been as interested in the question of why we can’t resist food if I didn’t have it myself,” he said. “I gained and lost my body weight several times over. I have suits in every size.”

This is not a diet book, but Dr. Kessler devotes a sizable section to “food rehab,” offering practical advice for using the science of overeating to our advantage, so that we begin to think differently about food and take back control of our eating habits.

One of his main messages is that overeating is not due to an absence of willpower, but a biological challenge made more difficult by the overstimulating food environment that surrounds us. “Conditioned hypereating” is a chronic problem that is made worse by dieting and needs to be managed rather than cured, he said. And while lapses are inevitable, Dr. Kessler outlines several strategies that address the behavioral, cognitive and nutritional factors that fuel overeating.

Planned and structured eating and understanding your personal food triggers are essential. In addition, educating yourself about food can help alter your perceptions about what types of food are desirable. Just as many of us now findcigarettes repulsive, Dr. Kessler argues that we can also undergo similar “perceptual shifts” about large portion sizes and processed foods. For instance, he notes that when people who once loved to eat steak become vegetarians, they typically begin to view animal protein as disgusting.

The advice is certainly not a quick fix or a guarantee, but Dr. Kessler said that educating himself in the course of writing the book had helped him gain control over his eating.

“For the first time in my life, I can keep my weight relatively stable,” he said. “Now, if you stress me and fatigue me and put me in an airport and the plane is seven hours late — I’m still going to grab those chocolate-covered pretzels. The old circuitry will still show its head.”

Mother’s guilt magnified and recycled. serious problem. Mom’s depression affects infant development, and may have longer lasting affects, insidious as some parents are not well aware of themselves, or just in plain denial.

noreply@blogger.com (John C Kim) — Wed, 24 Jun 2009 01:01:00 +0000

Postpartum Depression Epidemic Affects More than Just Mom

A deep despair mars the first year of motherhood for as many as one in five women. Without treatment, postpartum depression can weaken critical bonds between a mother and her child

By Katja Gaschler

The psychologist smiles at Manuela, a new mother in her late thirties. “Please play with your baby for two minutes,” the therapist instructs her and then leaves the room. Two video cameras film Manuela (which is not her real name) and her three-month-old daughter. In the next room, a split-screen monitor shows the mother’s profile on the left and her infant in a baby chair on the right.

At first, Manuela appears to be at a loss for what to do. Then, her face noticeably stiff, she begins to talk softly to her baby. Her baby fidgets, briefly makes eye contact and then turns away. Manuela eventually stops talking and stares into the distance, unsure again how to act. She absentmindedly strokes her baby’s foot with one hand. The psychologist knocks on the door; the videotaping is over. The new mother is now on the verge of tears.

Manuela is undergoing therapy at the Clinic for General Psychiatry in Heidelberg, Germany, for postpartum depression, an ailment that has strained her relationship with her baby. Although the vast majority of mothers experience periods of crying and irritability along with concen tration lapses and exhaustion, these so-called baby blues disappear within a few hours or days of delivery. But 10 to 20 percent of women in the U.S. develop, in the first year after childbirth, the more disabling despair that afflicts Manuela. These mothers succumb to a deep sadness that, if untreated, may persist for months to years.

Manuela frequently feels exhausted and emotionally empty. When her baby cries, she sometimes wants to flee or hide. She is wracked with guilt because she cannot show love to her daughter. Mothers with symptoms of postpartum depression [see box on page 70] are often overwhelmed by the feeling that they might harm their babies. Although they rarely cause any outright harm, depressed mothers may have difficulty caring for their infants—and that fact can heighten their distress.

These emotional problems plague women worldwide. A 2006 review of 143 studies in 40 countries documents that postpartum depression is especially common in Brazil, Guyana, Costa Rica, Italy, Chile, South Africa, Taiwan and Korea, with prevalence rates as high as 60 percent in some countries.

The causes of the disorder are not fully known, but the dramatic hormonal fluctuations that occur after delivery may contribute to it in sus ceptible women. A bout of previous depression is a huge risk factor for the postpartum variety, new research shows. Whatever its cause, depression can weaken the nascent bond between a mother and her child, studies suggest, and thereby make a toddler more passive, insecure and socially inhibited—although a child’s intellectual development usually remains unimpaired.

Thus, in addition to treating the mother’s depression, psychologists and psychiatrists increasingly focus on strengthening the relationship between the mother and her child—for example, by using a video camera to record and analyze their interactions. “We need to change the unfavorable behavioral patterns that develop between mother and child during depression,” says University of Heidelberg psychologist Corinna Reck.

Hormonal Havoc
Women seem to be particularly vulnerable to depression during their reproductive years: rates of the disorder are highest in females between the ages of 25 and 45. New data indicate that the incidence of depression in females rises, albeit modestly, after giving birth. In the October 2007 American Journal of Psychiatry, epidemiologist Patricia Dietz of the U.S. Centers for Disease Control and Prevention and her colleagues reported that 10.4 percent of 4,398 mothers had been depressed in the nine months following childbirth, compared with 8.7 percent in the nine months before pregnancy and 6.9 percent during pregnancy. More than half of the women with postpartum depression had also been depressed during or before pregnancy, suggesting that a previous occurrence of depression may be the biggest risk factor for acquiring the illness postpartum.

But the hormonal changes that occur in a new mother’s body are also thought to contribute to postpartum depression in some cases. During pregnancy, a woman experiences a surge in blood levels of estrogen and progesterone. Then, in the first 48 hours after childbirth, the amount of these two hormones plummets almost 50-fold back to normal levels. This chemical seesaw could contribute to depression just as smaller hormonal changes before a woman’s menstrual period may affect her moods.

Of course, hormonal flux does not fully explain postpartum depression. After all, this biochemical oscillation occurs in all new mothers, and yet only a small proportion of them become depressed. In addition, studies have shown that pregnancy hormone levels in a woman do not predict her risk of depression.

Nevertheless, the rapid rise and fall of female sex hormones may buffet the emotions of a subset of women who are predisposed to depression and thus may be acutely sensitive to the hormones’ effects. In 2000 endocrinologist David R. Rubinow, then at the National Institute of Mental Health, and his colleagues reported that simulating the hormonal ebb and flow that occurs during pregnancy and childbirth in 16 women precipitated depressive symptoms in five of the eight women with a history of postpartum depression but not in subjects who had no such history.

The demands of motherhood very likely play a role as well. Many women feel exhausted from a baby’s broken sleep and become overwhelmed by new child care duties. Some may lament the loss of the life they led before having the baby or of their former figure. Women who must endure such stresses on top of marital problems, a complicated birth, job loss or lack of support from family and friends are more likely to succumb to depression.

Broken Bonds
The consequences of depression inevitably reach beyond the mother. In a fog of sadness, a mother often lacks the emotional energy to relate appropriately to her baby. Overwhelming grief prevents her from properly perceiving a child’s smiles, cries, gestures and other attempts to communicate with her. Getting no response from mom, the child quits trying to relate to her. Thus, three-month-old infants of depressed mothers look at their mothers less often and show fewer signs of positive emotion than do babies of mentally healthy moms.

In fact, infants of depressed mothers display something akin to learned helplessness, a phenomenon University of Pennsylvania psychologist Martin E. P. Seligman and his colleagues described in the 1960s. In Seligman’s experiments, an animal would conclude that a situation was hopeless after repeatedly failing to overcome it—and then remain passive even when it could effect change. A similar passivity characterizes depression. “Sometimes the infants mirror their mother’s depressive behavior,” Reck says.

Such reciprocal withdrawal can start to fray the critical emotional bond between mother and child, especially if the depression occurs early in the baby’s life. Other work has shown that infants develop essential social skills in months two through six, building relationships with their mothers as well as other people. In a 2006 study of 101 new mothers, psychiatrist Eva Moeh ler, Reck and their Heidelberg colleagues found that maternal depression strongly diminished the quality of a mother’s bond with her child at two weeks, six weeks and four months postpartum—but not at 14 months. Thus, depression during the first few months after birth may be particularly perilous for a child’s social development.

A child of a depressed mother may even become more introverted and face a greater risk for social phobia, an extreme fear of social situations, among other emotional difficulties. In 2007 Reck, Moehler and their colleagues reported that in the same 101 mother-infant pairs, postpartum depression at six weeks, four months and 14 months after birth tended to make a 14-month-old toddler more fearful and inhibited as compared with same-age toddlers of healthy moms. Other work suggests that postpartum depression may produce behavioral problems and negativity in children.

Postpartum gloom usually does not have a long-lasting impact on children’s cognitive development, however. In a 2001 study psychologists Sophie Kurstjens and Dieter Wolke of the University of Munich tested the intellectual skills of 1,329 children (92 of them born to mothers who had depression) at various ages from 20 months to eight years. The researchers generally found no cognitive deficits among the children of depressed mothers as compared with those of healthy mothers. They did find cognitive problems, however, in boys of low socioeconomic status who had chronically depressed mothers as compared with children whose mothers had less severe depression.

Nursing Mom
Despite the devastating fallout from postpartum depression, many mothers shy away from getting help—in some cases, out of shame for emotions they cannot justify. Manuela, for example, was initially afraid to talk about her feelings and fears. She felt no one would understand why she was sad after the birth of a healthy, beautiful baby. Eventually, however, at her breaking point, she sought treatment at the Heidelberg clinic.

Many new mothers require medication to take the sting out of their sadness. A doctor may prescribe an antidepressant such as Prozac and, in some cases, may recommend taking a hormone such as estrogen as well. In addition, a small 2007 study by Yale University psychiatrists Ariadna Forray and Robert B. Ostroff suggests that electroconvulsive therapy can ameliorate postpartum depression and its more severe cousin, postpartum psycho sis, in women who do not respond to drug therapy.

Psychotherapy for the mother’s depression may also be beneficial. One proven approach is cognitive-behavior therapy, in which a therapist tries to correct distorted and negative ways of thinking either by discussing them openly or by asking the patient to practice more adaptive behaviors.

But treating the mother in isolation is often not enough to prevent her illness from affecting her child. In a study published last year psychologist David Forman of Concordia University in Quebec and his colleagues compared 60 mothers who received psychotherapy for depression with a group of 60 untreated depressed mothers and 56 healthy mothers. Six months of therapy did lower parenting stress in depressed women as compared with untreated depressed women, but the treated women still viewed their infants more negatively than did mothers who had not been depressed. Perhaps as a result, after 18 months of therapy the affected mothers reported more behavior problems, a lower level of attachment security and a more negative temperament in their children as compared with moms who had not been depressed.

Now these and many other researchers believe that therapy for postpartum depression should also involve the child. Psychologist George Downing of Pitié-Salpêtrière Hospital in Paris developed video intervention therapy, for example, to improve mother-infant interaction. The technique helps mothers to correctly perceive their infants’ behavior by recording and analyzing it—and to feel better about their own actions as mothers. “The goal of therapy is to reactivate the intuitive maternal behavioral repertoire that was covered over by the depression,” explains Heidelberg clinic psychiatrist Thomas Fuchs.

Baby Talk
Tabea, a mother in her early thirties whose depression was severe enough to warrant hospitalization for several weeks after she gave birth, is still having difficulty interacting with her four-month-old son. At the Heidelberg clinic, a psychologist asks Tabea (which is not her real name) to sit in front of a video camera with her baby. Tabea speaks loudly to him. She raises her eyebrows and laughs. Her infant makes eye contact, and a smile flits across his face. His mother feels reinforced. But then the infant turns his head away. And Tabea says, “Well, what’s the matter now? Sulking again, are we? Did mommy leave you by yourself too long?” Tabea feels guilty for having had to leave her baby to be treated for depression.

But it is normal for infants to turn away after a social interaction. That is how they regulate stimuli. It is not, as Tabea sees it, a personal affront or a sign that she is a bad mother. Nevertheless, Tabea’s misinterpretation of her baby’s actions can prompt a vicious cycle in which the child’s apparent rejection hurts Tabea, making her feel insecure and sad, which in turn has a negative effect on the baby.

The therapist’s job is to break that cycle, large ly by correcting a mother’s misimpressions and emphasizing what she has done well. Tabea’s wide-open eyes, for example, signaled that she was paying attention to her child. The psychologist points out that Tabea’s expressive face and melodious speech are similarly appropriate and helpful. Then she encourages Tabea to wait for her child to take the initiative, which will be her signal to respond.

Some hospitals have mother-infant treatment centers for postpartum depression so that the mother can remain with her infant during treatment. There hospital personnel help the mother feed, diaper and bathe her child while also providing behavior therapy. Fathers can play an important part, too. Assuming he is not depressed, a father can significantly ameliorate the effects of a mother’s depression by building a close relationship with his son or daughter.

Meanwhile a mother can take steps to ease her emotional burden by asking for help from family and friends, sleeping more, spending time with her spouse, getting out of the house and putting less pressure on herself. In the end, most mothers who receive adequate treatment—often a combination of psychotherapy, medication and self-help—usually recover completely within about two months of starting treatment, according to psychiatrist Ricardo J. Fernandez of Prince ton Family Care Associates in New Jersey. Some mothers even emerge from their cloud of sadness with a new sense of clarity. As one mother said of her depression, “It gave me the impetus to change my life.”

Further Reading

via scientificamerican.com

Sleep deprivation clearly linked to hypertension, using varied methodology. They don't seem to account for obstructive sleep apnea which may be vastly under diagnosed

noreply@blogger.com (John C Kim) — Wed, 24 Jun 2009 00:42:00 +0000

Insufficient Sleep Linked To High Blood Pressure

10 Jun 2009
Not getting enough sleep could increase a person's risk of developing high blood pressure, said US researchers who monitored over 500 middle aged people for 5 years. They hope that the discovery of this new risk factor will help prevent more people developing high blood pressure and suggest more research is done to see if improving sleep patterns reduces the risk.
The study was the work of lead author Dr Kristen L Knutson of the University of Chicago, and colleagues, and is published in the 8 June issue of the Archives of Internal Medicine.
High blood pressure accounts for 7 million deaths worldwide and affects about one third of Americans, wrote the authors in their background information.
Researchers already know of a possible link between self-reported hours of sleep and high blood pressure but this appears to be the first study to look at both cross-sectional (taking a snapshop of a group of people showing different patterns of the same variables) and longitudinal (following a group of people over time) measurements of sleep and blood pressure.
The study was part of a larger investigation called Coronary Artery Risk Development in Young Adults (CARDIA) which took blood pressure measurements in 2000 and 2001 and in 2005 and 2006. For this study, the participants were 578 African Americans and whites aged from 33 to 45 years at the start.
Sleep was also measured using a sensor worn on the wrist that measures movement patterns characteristic of sleep and wakefulness (actigraphy). The sensor was worn on three consecutive days between 2003 and 2005 and gave measures of sleep duration and sleep maintenance (a measure of sleep quality).
The results showed that on average, participants slept for about 6 hours a night and only 1 per cent averaged 8 or more hours a night.
After excluding those participants who were on blood pressure medication, and adjusting for age, race and sex, the results also showed that:

Participants who had less sleep and lower quality sleep were significantly more likely to have higher systolic and diastolic blood pressure readings (ie from the cross-sectional point of view less and poorer sleep predicted higher blood pressure across the group).
Less and lower quality sleep was also significantly more likely to be linked to adverse changes in systolic and diastolic blood pressure over a 5 year period (ie from the longitudinal view the lower sleep figures predicted the increases in blood pressure figures over time, all P<.05).
After 5 years, each hour less of sleep was linked to a 37 per cent higher chance of developing high blood pressure.
African Americans tended to sleep less than whites and also tended to have higher blood pressure.

The authors concluded that:
"Reduced sleep duration and consolidation predicted higher BP [blood pressure] levels and adverse changes in BP, suggesting the need for studies to investigate whether interventions to optimize sleep may reduce BP."
They said that identifying a new lifestyle risk factor for high blood pressure could help develop new ways to prevent or reduce it.
Speculating on what the underlying mechanism might be, they suggested that insufficient sleep affects the way the body responds to stress and this might lead to raised blood pressure.
"Association Between Sleep and Blood Pressure in Midlife: The CARDIA Sleep Study."
Kristen L. Knutson; Eve Van Cauter; Paul J. Rathouz; Lijing L. Yan; Stephen B. Hulley; Kiang Liu; Diane S. Lauderdale.
Arch Intern Med, 2009;169(11):1055- 1061.
Vol. 169 No. 11, June 8, 2009
Written by: Catharine Paddock, PhD
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Article URL: http://www.medicalnewstoday.com/articles/153242.php

Main News Category: Sleep / Sleep Disorders / Insomnia

Also Appears In: Hypertension,

this constitutes a huge even epic social engineering/experimentation because of the rapidity of change in family dynamics

noreply@blogger.com (John C Kim) — Fri, 19 Jun 2009 17:57:00 +0000

Surging Internet Use Cutting Into Family Time

By Amanda Gardner
HealthDay ReporterThu Jun 18, 11:49 pm ET

THURSDAY, June 18 (HealthDay News) -- American kids and their parents are now spending more hours huddled alone around computer screens and cell phone displays, seriously eroding the amount of time families spend together.

That's according to a new report that found the time per week that families interact as group has fallen by nearly a third between 2005 and 2008. ( this Incredibly dramatic Change In a very short period of time. Functions as a wide scale societal intervention.)

"Family face-to-face time has decreased in a substantial way. There's been a fairly abrupt drop in family time, a process which is usually glacial," said Michael Gilbert, a senior fellow at the Center for the Digital Future at the University of Southern California's Annenberg School for Communication. "Families are the social building blocks of virtually every society, and this can't be a good thing."

In a new survey from the center, researchers found that in 2008, 28 percent of people said that being wired has resulted in them spending less time with family members, a threefold increase from the 11 percent reported just two years ago, in 2006.

"We wanted to put a little alert out about this," Gilbert said. "Technology isn't all good."

This is certainly not the first time researchers have sounded an alarm about Internet use and even "Internet addiction." Other studies have suggested that online usage has significantly disrupted the lives of millions of Americans.

"In the last two decades, there has been an erosion in family dinners together that take place without gadgets," Gilbert said. "There's reduced cohesion, reduced communication."

And the Internet is vastly different from television, which drew (and still draws) people together -- watching, say, Johnny Carson, the 1969 moon landing, or American Idol.

In contrast, "the Internet is one-to-one and so demanding. The key distinction of the Internet is interactivity," Gilbert said. "You have to sit and respond."

The annual survey, part of the Center's Digital Future Project, involved contacts with 2,000 American households. In 2005, the survey found that the amount of time family members spent together averaged about 26 hours a month.

That shared time had dropped precipitously to just under 18 hours per month by 2008, slashing overall time spent together by 30 percent. (then there is the multitasking time that is spent, where the family is present, but engaging any electronic activity like texting. This probably erodes meaningful social times as well )

Women seem to be bearing the brunt of this Web-linked isolation, with more than 49 percent reporting feeling "sometimes" or "often" ignored by other family members, compared with only about 39 percent of men reporting the same.

Meanwhile, in 2000, 11 percent of people surveyed said younger people (under 18) were spending "too much time" online, vs. 28 percent in 2008.

This trend toward decreased family time dovetails with the emergence and rapid growth of online social communities, the researchers noted.

"Social networks such as Twitter and Facebook exploded in 2007. At that time, more than half of people online said this online community was as important as their offline community," Gilbert said. "Many technology issues are pulling on the family which, in the modern world, has enough pressures."

Where might all this lead?

"Certainly a lack of collective experience and face-to-face time will lead to a breakdown in communication, decreased opportunities to experience the world together, increased alienation of children," Gilbert said. "Family breakdown leads to destructive behavior."

In response, some families are beginning to budget time for Internet use, setting curfews or proclaiming no Internet on weekends.

"There are ways we can put little fences around our involvement with the Internet," Gilbert said. "We need to remember how valuable it is to spend time together and experience the world together. Nothing can substitute for face-to-face time."

For all the potential damage involved in Internet usage, there are also numerous benefits, said Dr. Harold Koplewicz, director of the Child Study Center at New York University Langone Medical Center.

"Kids have the opportunity to learn, play, socialize and participate in social life. It's communication besides pleasure," he said. "It may look as though they're wasting time, but spending time online is essential. Kids can participate in culture and connect with others with similar interests."

But, Koplewicz added, "Parents need to counter the trend towards decreased family time. While there are benefits to Internet usage, it doesn't mean you can let the machine take over."

Parents need to consciously plan family time, which can include playing computer games together, doing online projects together, having regular family meal times and participating in regular outings. They also need to monitor their children's use of the Internet, including having access to a history of sites visited, he said.

"The more involved parents are in their teen's life, the more valued teens feel. It's a myth that teens do not want their parents in their life," Koplewicz said.

More information

Find out more at the Center for the Digital Future.

On postpartum depression take away message its common almost 10% in the first 9 months, it last longer than the first few weeks after delivery, it affects mom child bonding, and has vicious cycle effects on mom's feeling of adequacy as a parent. What may be underestimated is low levels of depression not quite reaching clinical depression and anxiety overlay , which think is substantially more common.

noreply@blogger.com (John C Kim) — Fri, 19 Jun 2009 17:47:00 +0000

Scientific American Mind - March 20, 2008

Postpartum Depression Epidemic Affects More than Just Mom

A deep despair mars the first year of motherhood for as many as one in five women. Without treatment, postpartum depression can weaken critical bonds between a mother and her child

By Katja Gaschler

The psychologist smiles at Manuela, a new mother in her late thirties. “Please play with your baby for two minutes,” the therapist instructs her and then leaves the room. Two video cameras film Manuela (which is not her real name) and her three-month-old daughter. In the next room, a split-screen monitor shows the mother’s profile on the left and her infant in a baby chair on the right.

At first, Manuela appears to be at a loss for what to do. Then, her face noticeably stiff, she begins to talk softly to her baby. Her baby fidgets, briefly makes eye contact and then turns away. Manuela eventually stops talking and stares into the distance, unsure again how to act. She absentmindedly strokes her baby’s foot with one hand. The psychologist knocks on the door; the videotaping is over. The new mother is now on the verge of tears.

Manuela is undergoing therapy at the Clinic for General Psychiatry in Heidelberg, Germany, for postpartum depression, an ailment that has strained her relationship with her baby. Although the vast majority of mothers experience periods of crying and irritability along with concen tration lapses and exhaustion, these so-called baby blues disappear within a few hours or days of delivery. But 10 to 20 percent of women in the U.S. develop, in the first year after childbirth, the more disabling despair that afflicts Manuela. These mothers succumb to a deep sadness that, if untreated, may persist for months to years.

Manuela frequently feels exhausted and emotionally empty. When her baby cries, she sometimes wants to flee or hide. She is wracked with guilt because she cannot show love to her daughter. Mothers with symptoms of postpartum depression [see box on page 70] are often overwhelmed by the feeling that they might harm their babies. Although they rarely cause any outright harm, depressed mothers may have difficulty caring for their infants—and that fact can heighten their distress.

These emotional problems plague women worldwide. A 2006 review of 143 studies in 40 countries documents that postpartum depression is especially common in Brazil, Guyana, Costa Rica, Italy, Chile, South Africa, Taiwan and Korea, with prevalence rates as high as 60 percent in some countries.

The causes of the disorder are not fully known, but the dramatic hormonal fluctuations that occur after delivery may contribute to it in sus ceptible women. A bout of previous depression is a huge risk factor for the postpartum variety, new research shows. Whatever its cause, depression can weaken the nascent bond between a mother and her child, studies suggest, and thereby make a toddler more passive, insecure and socially inhibited—although a child’s intellectual development usually remains unimpaired.

Thus, in addition to treating the mother’s depression, psychologists and psychiatrists increasingly focus on strengthening the relationship between the mother and her child—for example, by using a video camera to record and analyze their interactions. “We need to change the unfavorable behavioral patterns that develop between mother and child during depression,” says University of Heidelberg psychologist Corinna Reck.

Hormonal Havoc
Women seem to be particularly vulnerable to depression during their reproductive years: rates of the disorder are highest in females between the ages of 25 and 45. New data indicate that the incidence of depression in females rises, albeit modestly, after giving birth. In the October 2007 American Journal of Psychiatry, epidemiologist Patricia Dietz of the U.S. Centers for Disease Control and Prevention and her colleagues reported that 10.4 percent of 4,398 mothers had been depressed in the nine months following childbirth, compared with 8.7 percent in the nine months before pregnancy and 6.9 percent during pregnancy. More than half of the women with postpartum depression had also been depressed during or before pregnancy, suggesting that a previous occurrence of depression may be the biggest risk factor for acquiring the illness postpartum.

But the hormonal changes that occur in a new mother’s body are also thought to contribute to postpartum depression in some cases. During pregnancy, a woman experiences a surge in blood levels of estrogen and progesterone. Then, in the first 48 hours after childbirth, the amount of these two hormones plummets almost 50-fold back to normal levels. This chemical seesaw could contribute to depression just as smaller hormonal changes before a woman’s menstrual period may affect her moods.

Of course, hormonal flux does not fully explain postpartum depression. After all, this biochemical oscillation occurs in all new mothers, and yet only a small proportion of them become depressed. In addition, studies have shown that pregnancy hormone levels in a woman do not predict her risk of depression.

Nevertheless, the rapid rise and fall of female sex hormones may buffet the emotions of a subset of women who are predisposed to depression and thus may be acutely sensitive to the hormones’ effects. In 2000 endocrinologist David R. Rubinow, then at the National Institute of Mental Health, and his colleagues reported that simulating the hormonal ebb and flow that occurs during pregnancy and childbirth in 16 women precipitated depressive symptoms in five of the eight women with a history of postpartum depression but not in subjects who had no such history.

The demands of motherhood very likely play a role as well. Many women feel exhausted from a baby’s broken sleep and become overwhelmed by new child care duties. Some may lament the loss of the life they led before having the baby or of their former figure. Women who must endure such stresses on top of marital problems, a complicated birth, job loss or lack of support from family and friends are more likely to succumb to depression.

Broken Bonds
The consequences of depression inevitably reach beyond the mother. In a fog of sadness, a mother often lacks the emotional energy to relate appropriately to her baby. Overwhelming grief prevents her from properly perceiving a child’s smiles, cries, gestures and other attempts to communicate with her. Getting no response from mom, the child quits trying to relate to her. Thus, three-month-old infants of depressed mothers look at their mothers less often and show fewer signs of positive emotion than do babies of mentally healthy moms.

In fact, infants of depressed mothers display something akin to learned helplessness, a phenomenon University of Pennsylvania psychologist Martin E. P. Seligman and his colleagues described in the 1960s. In Seligman’s experiments, an animal would conclude that a situation was hopeless after repeatedly failing to overcome it—and then remain passive even when it could effect change. A similar passivity characterizes depression. “Sometimes the infants mirror their mother’s depressive behavior,” Reck says.

Such reciprocal withdrawal can start to fray the critical emotional bond between mother and child, especially if the depression occurs early in the baby’s life. Other work has shown that infants develop essential social skills in months two through six, building relationships with their mothers as well as other people. In a 2006 study of 101 new mothers, psychiatrist Eva Moeh ler, Reck and their Heidelberg colleagues found that maternal depression strongly diminished the quality of a mother’s bond with her child at two weeks, six weeks and four months postpartum—but not at 14 months. Thus, depression during the first few months after birth may be particularly perilous for a child’s social development.

A child of a depressed mother may even become more introverted and face a greater risk for social phobia, an extreme fear of social situations, among other emotional difficulties. In 2007 Reck, Moehler and their colleagues reported that in the same 101 mother-infant pairs, postpartum depression at six weeks, four months and 14 months after birth tended to make a 14-month-old toddler more fearful and inhibited as compared with same-age toddlers of healthy moms. Other work suggests that postpartum depression may produce behavioral problems and negativity in children.

Postpartum gloom usually does not have a long-lasting impact on children’s cognitive development, however. In a 2001 study psychologists Sophie Kurstjens and Dieter Wolke of the University of Munich tested the intellectual skills of 1,329 children (92 of them born to mothers who had depression) at various ages from 20 months to eight years. The researchers generally found no cognitive deficits among the children of depressed mothers as compared with those of healthy mothers. They did find cognitive problems, however, in boys of low socioeconomic status who had chronically depressed mothers as compared with children whose mothers had less severe depression.

Nursing Mom
Despite the devastating fallout from postpartum depression, many mothers shy away from getting help—in some cases, out of shame for emotions they cannot justify. Manuela, for example, was initially afraid to talk about her feelings and fears. She felt no one would understand why she was sad after the birth of a healthy, beautiful baby. Eventually, however, at her breaking point, she sought treatment at the Heidelberg clinic.

Many new mothers require medication to take the sting out of their sadness. A doctor may prescribe an antidepressant such as Prozac and, in some cases, may recommend taking a hormone such as estrogen as well. In addition, a small 2007 study by Yale University psychiatrists Ariadna Forray and Robert B. Ostroff suggests that electroconvulsive therapy can ameliorate postpartum depression and its more severe cousin, postpartum psycho sis, in women who do not respond to drug therapy.

Psychotherapy for the mother’s depression may also be beneficial. One proven approach is cognitive-behavior therapy, in which a therapist tries to correct distorted and negative ways of thinking either by discussing them openly or by asking the patient to practice more adaptive behaviors.

But treating the mother in isolation is often not enough to prevent her illness from affecting her child. In a study published last year psychologist David Forman of Concordia University in Quebec and his colleagues compared 60 mothers who received psychotherapy for depression with a group of 60 untreated depressed mothers and 56 healthy mothers. Six months of therapy did lower parenting stress in depressed women as compared with untreated depressed women, but the treated women still viewed their infants more negatively than did mothers who had not been depressed. Perhaps as a result, after 18 months of therapy the affected mothers reported more behavior problems, a lower level of attachment security and a more negative temperament in their children as compared with moms who had not been depressed.

Now these and many other researchers believe that therapy for postpartum depression should also involve the child. Psychologist George Downing of Pitié-Salpêtrière Hospital in Paris developed video intervention therapy, for example, to improve mother-infant interaction. The technique helps mothers to correctly perceive their infants’ behavior by recording and analyzing it—and to feel better about their own actions as mothers. “The goal of therapy is to reactivate the intuitive maternal behavioral repertoire that was covered over by the depression,” explains Heidelberg clinic psychiatrist Thomas Fuchs.

Baby Talk
Tabea, a mother in her early thirties whose depression was severe enough to warrant hospitalization for several weeks after she gave birth, is still having difficulty interacting with her four-month-old son. At the Heidelberg clinic, a psychologist asks Tabea (which is not her real name) to sit in front of a video camera with her baby. Tabea speaks loudly to him. She raises her eyebrows and laughs. Her infant makes eye contact, and a smile flits across his face. His mother feels reinforced. But then the infant turns his head away. And Tabea says, “Well, what’s the matter now? Sulking again, are we? Did mommy leave you by yourself too long?” Tabea feels guilty for having had to leave her baby to be treated for depression.

But it is normal for infants to turn away after a social interaction. That is how they regulate stimuli. It is not, as Tabea sees it, a personal affront or a sign that she is a bad mother. Nevertheless, Tabea’s misinterpretation of her baby’s actions can prompt a vicious cycle in which the child’s apparent rejection hurts Tabea, making her feel insecure and sad, which in turn has a negative effect on the baby.

The therapist’s job is to break that cycle, large ly by correcting a mother’s misimpressions and emphasizing what she has done well. Tabea’s wide-open eyes, for example, signaled that she was paying attention to her child. The psychologist points out that Tabea’s expressive face and melodious speech are similarly appropriate and helpful. Then she encourages Tabea to wait for her child to take the initiative, which will be her signal to respond.

Some hospitals have mother-infant treatment centers for postpartum depression so that the mother can remain with her infant during treatment. There hospital personnel help the mother feed, diaper and bathe her child while also providing behavior therapy. Fathers can play an important part, too. Assuming he is not depressed, a father can significantly ameliorate the effects of a mother’s depression by building a close relationship with his son or daughter.

Meanwhile a mother can take steps to ease her emotional burden by asking for help from family and friends, sleeping more, spending time with her spouse, getting out of the house and putting less pressure on herself. In the end, most mothers who receive adequate treatment—often a combination of psychotherapy, medication and self-help—usually recover completely within about two months of starting treatment, according to psychiatrist Ricardo J. Fernandez of Prince ton Family Care Associates in New Jersey. Some mothers even emerge from their cloud of sadness with a new sense of clarity. As one mother said of her depression, “It gave me the impetus to change my life.”

summary of relenza data from package FDA

noreply@blogger.com (John C Kim) — Mon, 15 Jun 2009 18:21:00 +0000

Relenza notes 10 mg PO PID for five days treatment.

Can get first dose and second should get first two doses within the first day at least two hours apart.

Side effects fairly minimal, about 3 to 6% about the same as placebo G.I.

FDA approved over seven years of age for treatment over five for prophylaxis the reason for this seems to be the difficulty in getting adequate medication deposition in the lungs and children under seven years of age they can't suck in hard enough.

Bronchospasm 1/13 with mild or moderate asthma

in a phase 3 study with acute influenza like illness superimposed on underlying asthma or COPD 10% experienced greater than 20% declining a 51 following treatment for five days. Interestingly 9% on placebo also experienced this

The nearest psychiatric events occurred both with and without encephalitis. They had abrupt onset and rapid resolution.

Relenza not known whether it is excreted in milk. ie what to do with lactating women.

half-life is very fast essentially undetectable after 1 1/2 hours

Interestingly no consistent treatment effect was demonstrated in patients with underlying medical problems. No consistent differences in rate of development of complications.

In terms of prophylaxis, the attack rate seem to go from 20% to 4% for group receiving Relenza; so strong role for prophylaxis, weaker role for treatment

re fda warning re stims, more controversy, the hard and sad thing about this kind of study is that many young children who would benefit will likely be pulled off meds, and who can count increase in accidents from untreated impulsivity, etc

noreply@blogger.com (John C Kim) — Mon, 15 Jun 2009 18:00:00 +0000

re fda warning re stims, more controversy, the hard and sad thing about this kind of study is that many young children who would benefit will likely be pulled off meds, and who can count increase in accidents from untreated impulsivity, etc

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm166667.htm

Stimulant Medications used in Children with Attention-Deficit/Hyperactivity Disorder - Communication about an Ongoing Safety Review

Products involved include: Focalin, Focalin XR (dexmethylphenidate HCl ); Dexedrine, Dexedrine Spansules, Dextroamphetamine ER, Dextrostat (dextroamphetamine sulfate); Vyvanse (lisdexamfetamine dimesylate); Desoxyn (methamphetamine); Concerta, Daytrana, Metadate CD, Metadate ER, Methylin, Methylin ER, Ritalin, Ritalin-LA, Ritalin-SR (methylphenidate); Adderall, Adderall XR (mixed salts amphetamine); Cylert (pemoline) and generics.

Audience: Pediatricians, Neuropsychiatric healthcare professionals

[Posted 06/15/2009] FDA notified healthcare professionals that it is providing its perspective on study data published in the American Journal of Psychiatry on the potential risks of stimulant medications used to treat Attention-Deficit/Hyperactivity Disorder (ADHD) in children. This study, funded by the FDA and the National Institute of Mental Health (NIMH), compared the use of stimulant medications in 564 healthy children from across the United States who died suddenly to the use of stimulant medications in 564 children who died as passengers in a motor vehicle accident.The study authors concluded that there may be an association between the use of stimulant medications and sudden death in healthy children. Given the limitations of this study’s methodology, the FDA is unable to conclude that these data affect the overall risk and benefit profile of stimulant medications used to treat ADHD in children. FDA believes that this study should not serve as a basis for parents to stop a child’s stimulant medication. Parents should discuss concerns about the use of these medicines with the prescribing healthcare professional. Any child who develops cardiovascular symptoms (such as chest pain, shortness of breath or fainting) during stimulant medication treatment should immediately be seen by a doctor.

FDA is continuing its review of the strengths and limitations of this and other epidemiological studies that evaluate the risks of stimulant medications used to treat ADHD in children. FDA and the Agency for Healthcare Research and Quality are sponsoring a large epidemiological study that will provide further information about the potential risks associated with stimulant medication use in children. The data collection for this study will be complete later in 2009.

KIDDOC.ORG

Article: Migraines in Children Are Often Overlooked - NYTimes.com

Returning to Classrooms, and to Severe Headaches

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Intriguing concept of hormone disruption and plastics. . Still a lot of fear and not a lot of fact.

Intriguing concept of hormone disruption and plastics. . Still a lot of fear and not a lot of fact.

In Feast of Data on BPA Plastic, No Final Answer

By DENISE GRADY

Published: September 6, 2010

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Sally Ryan for The New York Times

Sally Ryan for The New York Times

BornFree/Associated Press

Stan Honda/Agence France-Presse — Getty Images

Robert L. Vogelzang

ON good study habits

Forget What You Know About Good Study Habits

By BENEDICT CAREY

Published: September 6, 2010

Ellen Weinstein

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dosing Prevention and Management of Vitamin D Deficiency in Children: Part I: Vitamin D Requirements: New Recommendations

Prevention and Management of Vitamin D Deficiency in Children: Part I: Vitamin D Requirements: New Recommendations

Information from Industry

New Recommendations

Ninth Annual Year in Ideas -Thirdhand Smoke dangers - NYTimes.com

Thirdhand Smoke

The States of Marriage and Divorce - Pew Research Center

Correlations in Marriage Patterns

Ensuring the Fiscal Sustainability of Health Care Reform | Health Care Reform 2009; an excellent I wish I had written it myself essay on the challenges of cost containment

Primary Care and Accountable Care — Two Essential Elements of Delivery-System Reform | Health Care Reform 2009

Flu During Pregnancy May Increase Risk Of Schizophrenia In Certain Offspring; influenza type B seems to be more implicated.

Flu During Pregnancy May Increase Risk Of Schizophrenia In Certain Offspring

Exposure To Influenza During Pregnancy May Increase Risk Of Schizophrenia In Offspring

Science News

Exposure To Influenza During Pregnancy May Increase Risk Of Schizophrenia In Offspring

The Long-Term Evidence for Vaccines | Print Article | Newsweek.com Prelude to backlash against backlash?

The Long-Term Evidence for Vaccines

People in flight – Photography by Denisa Tarzaka | Amusing Planet

tough love, and urban legends zjoy

Vital Signs - Safety - Helmet Laws for Bicyclers Are Effective - NYT there is a social tipping point crit mass where it is cool. That's key.cool.

Aging well starts in womb, as mom's choices affect whole life - USATODAY.com. The power of the womb environ

A brief history of American Parenting as an enterprise in the US in New Yorker Magazine; Is there a demand for experts or by virtue of rite of passage of birthing or adopting enough to make us good parents, or at least good enough parents.

BABY TALK

The fuss about parenthood.

by Jill LeporeJUNE 29, 2009

ILLUSTRATION: PHILIPPE PETIT-ROULET

For ankle injuries, cold is best.

The Claim: Heat Should Be Applied to a Sprained Ankle

Health Guide: Ankle Pain | Sprains

Ankle sprains are one of the most common sports injuries; they send about a million Americans to clinics every year and cause chronic problems for many.

Review of Kessler’s book on food and over eating, sounds like dummy proofing ourselves from an fat inducing environment is a crucial step toward freedom. But catch the last few paragraph, ah when the chips are down, and we are tired, the chips come up.

How the Food Makers Captured Our Brains

Mother’s guilt magnified and recycled. serious problem. Mom’s depression affects infant development, and may have longer lasting affects, insidious as some parents are not well aware of themselves, or just in plain denial.

Postpartum Depression Epidemic Affects More than Just Mom

A deep despair mars the first year of motherhood for as many as one in five women. Without treatment, postpartum depression can weaken critical bonds between a mother and her child

Further Reading

Sleep deprivation clearly linked to hypertension, using varied methodology. They don't seem to account for obstructive sleep apnea which may be vastly under diagnosed

Insufficient Sleep Linked To High Blood Pressure

this constitutes a huge even epic social engineering/experimentation because of the rapidity of change in family dynamics

Surging Internet Use Cutting Into Family Time

Postpartum Depression Epidemic Affects More than Just Mom

A deep despair mars the first year of motherhood for as many as one in five women. Without treatment, postpartum depression can weaken critical bonds between a mother and her child

summary of relenza data from package FDA