Babies 'Smoke' When Parents Do

Babies with at least one parent who smokes have five times as much cotinine, a nicotine byproduct, in their urine than infants whose parents are non-smokers, UK researchers report.
"Our findings clearly show that by accumulating cotinine, babies become heavy passive smokers secondary to the active smoking of parents," Dr. Mike Wailoo of the University of Leicester and colleagues write in the Archives of Disease in Childhood.
"This is the first time we've got direct information on the effect of smoking in homes on babies," Wailoo said. "It clarifies and I think it firms up information that we all thought we had." He added that cotinine is just one of thousands of potentially harmful nicotine byproducts that can
accumulate in infants' bodies.
Parental smoking is a leading risk factor for sudden infant death syndrome, Wailoo and his colleagues note in their report. To better understand how harmful products of cigarette smoke might accumulate in babies' bodies, the researchers measured the amount of cotinine in the urine of 104 12-week-olds, 71 of whom had parents who smoked.
On average, children with at least one smoking parent had 5.58 times as much cotinine in their urine as babies living in non-smoking homes.
Infants who slept with their parents tended to have higher cotinine levels, which may have been because they had greater exposure to parents' smoke-contaminated clothing, Wailoo and his team note. The temperature in an infant's room also influenced cotinine levels, with lower temperature tied to higher amounts of the nicotine metabolite.
The UK is about to introduce laws banning smoking in public places, Wailoo noted in an interview. While such an approach likely wouldn't discourage people from smoking in their homes, he added, "it's a matter of changing behaviour and if we can alert people to this then we might have an impact."
[SMH]

Red Cell Alert

Judy Adamson

Tired? Vague? Maybe you're anaemic. I report on a syndrome few people recognize.
We've all seen those ads on TV: the ones where women talk about how tired they are, and then you discover that they're all iron deficient.
Given that most people have hectic work, home and social lives, it's easy to blame exhaustion on an over-full schedule. Yet data collected by the Australian Longitudinal Study of Women's Health shows that up to a third of Australian women under 50 have had iron deficiency diagnosed at some stage, so there may well be more to it than just being busy.
But what does it mean to be iron deficient? Are there any clues to alert you to its presence apart from tiredness? Dr James Biggs, an expert in iron metabolism and a part-time lecturer in the faculty of medicine at the University of NSW, says it's perfectly possible to be iron deficient and still have normal levels of hemoglobin. "The majority of iron is in the form of hemoglobin in the blood, but there are also a lot of iron stores in the body, particularly in the liver," he explains.
"A normal person might have as much as 1.5 grams in storage, so when you lose those stores you're said to be iron deficient."
The symptoms of iron deficiency are so general they're difficult for people to recognise, says Dr Greg Anderson, head of the Iron Metabolism Laboratory at the Queensland Institute of Medical Research.
"If you go into the street and ask 100 people if they consistently feel tired, you'll probably find that most will say 'yes'," he says. "This has been shown in a variety of studies. The symptoms are so non-specific that just as many non-iron-deficient people will say they suffer from chronic tiredness as those with iron deficiency."
Iron deficiency can have negative effects on a person's immune system, ability to think clearly, work performance and body temperature. But often these symptoms are attributed to lifestyle issues - working too much, partying too much - so the underlying problem isn't discovered.
Adam Walsh, a dietitian and associate lecturer in the school of exercise and nutrition sciences at Deakin University, says that because the symptoms of iron deficiency appear gradually, people assume they are caused by things such as a decrease in their fitness level or an over-busy life.
"You tend to find that the activities that you may once have accomplished without feeling too exhausted are now becoming quite hard, and that the recovery phase is a lot longer," he says. "Concentration becomes harder. People vague out a little bit - they find that halfway through a
conversation they're very easily distracted. They might also be a bit pale, especially children.
"In extreme cases where people are very, very iron deficient, they might have strange food cravings.
Young children might eat really crunchy things such as sand or dirt or velcro, and it's called pica. As adults we know that we don't eat velcro, but young children are craving iron so much that they're endeavouring to get it from whatever they can - and for whatever reason, it manifests itself as a strange oral fixation with crunchy things."
While iron deficiency (and anaemia) can occur because of a number of chronic illnesses, Walsh says those most likely to be iron deficient are women of child-bearing age, children going through puberty and premature babies. "Women lose quite a great deal of iron through menstruation, and their needs do increase throughout pregnancy, so if they don't watch what's happening there they can become iron deficient or anaemic during pregnancy.
"Also, if you are breastfeeding and your iron stores are low, then certainly a baby will receive low iron through breast milk, but the body will try and give the baby as much as possible, so mothers will suffer with respect to that."
Premature babies can be at risk just because their early birth means iron stores, which mainly accumulate in the third trimester of a pregnancy, are not what they should be, while children going through puberty will need extra iron as part of their rapid growth.
Vegetarians can be anaemic, partly because they're not eating meat, but also because they're not absorbing the iron in plant material efficiently. There are a number of things that can be done to bump up iron levels. For most people, simple dietary interventions, such as increasing the intake of vitamin C, will help the body absorb iron more efficiently. Eating red meat is another option. If iron deficiency is more severe, then iron tablets and other supplements are available.
Biggs also warns that people who are iron deficient should not expect a quick fix. He says doctors can make the mistake of giving only a short burst of treatment and then stopping supplements before the patient's body has had a chance to build up iron stores.
"If it's a woman having fairly heavy periods, for example, within another year or two she'll have iron deficiency anaemia again," he says. Even if you have a good diet, don't think it can't happen to you. Walsh says his own wife became anaemic after giving birth to their baby "and she's married to a dietitian. How good is that?" Losing and finding my pep.
I felt off-colour for about six months. Not sick; just as if my motor was running at 50 per cent. Usually energetic, I struggled to get out of bed. But as I wasn't obviously ill, I thought my lethargy was just lack of motivation.
Anaemia seemed impossible. I had been a robustly healthy vegetarian as a teenager, and now I ate meat as part of a balanced diet. My skin wasn't pasty. My weight was steady. But I did suffer from cripplingly heavy periods.
I finally went to the local clinic for a blood test in August last year, and a few days later the nurse left an urgent message on my phone. Luckily, my problem wasn't life-threatening, but still serious enough to slow me down. My levels of ferritin (the protein that stores iron) were almost
non-existent.
Fortunately, low-iron anaemia is easy to manage. I scheduled in steak time and juggled various supplements, none of which were terribly glamorous. Even fruity flavours can't disguise the taste of liquid iron. The tablets are less intrusive but not as easily absorbed. Both block your digestion. But within weeks, I rediscovered my pep.
[SMH]

Reducing Coronary Heart Disease Risk

What is coronary heart disease?
Coronary heart disease (CHD) is sometimes called coronary artery disease. A coronary artery is a blood vessel that carries blood to your heart muscle. Your arteries are like narrow tubes. A fatty substance called plaque can build up in your arteries, blocking or slowing the flow of blood and oxygen through them. This can happen in any artery, but when it happens in the coronary arteries, your heart muscle doesn't get the blood and oxygen it needs to work properly. Coronary heart disease can lead to serious health problems, including angina (pain or pressure in the chest) and heart attack.

What causes CHD?
Both men and women can get CHD. It can be hereditary (run in your family). It might also develop as you get older and plaque builds up in your arteries over the years. You may get CHD if you are overweight or if you have high blood pressure or diabetes. High cholesterol may also lead to CHD (see below). CHD can stem from making unhealthy choices such as smoking, eating a high-fat diet and not exercising enough.

What is cholesterol?
Cholesterol is a waxy substance that your body makes and uses to protect nerves, make cell tissues and produce hormones. It's also present in meat and dairy foods you eat. There are several types of cholesterol, including low-density lipoproteins (LDL) and high-density lipoproteins (HDL). LDL cholesterol is called "bad" cholesterol because it can build up on the inside of your arteries, causing them to become narrow from plaque. HDL is called "good" cholesterol because it protects your arteries from plaque buildup.
Many foods, even if they don't contain cholesterol, contain fats that can lower or raise LDL or HDL cholesterol. Talk to your family doctor about how your diet can affect your cholesterol levels.

What can I do to lower my risk of CHD?
1. Don't smoke. Nicotine raises your blood pressure because it causes your body to release adrenaline, which makes your blood vessels constrict and your heart beat faster. If you smoke, ask your family doctor to help you make a plan to quit. After 2 or 3 years of not smoking, your risk of CHD will be as low as the risk of a person who never smoked.
2. Control your blood pressure. If you have high blood pressure, your family doctor can suggest ways to lower it. If you're taking medicine for high blood pressure, be sure to take it just the way your family doctor tells you to.
3. Exercise. Regular exercise can make your heart stronger and reduce your risk of heart disease. Exercise can also help if you have high blood pressure. Before you start, talk to your family doctor about the right kind of exercise for you. Try to exercise at least 4 to 6 times a week for at least 30 minutes each time.
4. Ask your family doctor about taking a low dose of aspirin each day. Aspirin helps prevent CHD, but taking it also has some risks.
5. Ask your family doctor about taking vitamin supplements. Some studies have shown that vitamin E may lower a person's risk of having a heart attack. Other vitamins may also help protect against CHD.
6. Eat a healthy diet. Add foods to your diet that are low in cholesterol and saturated fats, because your body turns saturated fats into cholesterol.

What if changing these things doesn't help?
Your body will need time to respond to the changes you've made. Your family doctor will watch your progress. If your cholesterol level hasn't improved after 6 months to 1 year, your family doctor may prescribe medicine to lower your cholesterol. However, you will still need to keep up the healthy lifestyle changes you've started to help the medicine work.
[AAFP]

Does 'Hooking Up' Really Hurt Anyone?

During a class discussion on adolescence, a high school teacher recently asked her students whether they go on dates. We don't "date," the 12th graders reported. We "hook up."
If you're in your 40s, "hooking up" might mean catching a friend downtown for lunch. But to people in their teens or 20s, the phrase often means a casual sexual encounter - anything from kissing onwards - with no strings attached.
Now a new book on this not-so-new subject is drawing fire in some quarters for its conclusion: That hookups can be damaging to young women, denying their emotional needs, putting them at risk of depression and even sexually transmitted disease, and making them ill-equipped for real relationships later on.
For that, Laura Sessions Stepp, author of "Unhooked," and a writer for The Washington Post, has been criticized as a throwback to an earlier, restrictive moral climate, an anti-feminist and a tut-tutting mother telling girls not to give the milk away when nobody's bought the cow.
The author "imagines the female body as a thing that can be tarnished by too much use," wrote reviewer Kathy Dobie in Stepp's own paper, the Post, and suggested that Stepp was, in one part, trying to "instill sexual shame." For Meghan O'Rourke, literary editor at Slate.com, Stepp is "buying into alarmism about women," and making sex "a bigger, scarier, and more dangerous thing than it already is."
Stepp argues these critics have misconstrued her ideas.
True, she regrets that "dating has gone completely by the boards," replaced by group outings that lead to casual encounters. True, she regrets that oral sex "isn't even considered sex anymore." But she isn't saying girls should not have sex; just that they should have it in the context of a meaningful connection: "I am saying that girls should have choices." Too often, Stepp argues, girls and young women say proudly that they like the control "hookups" give them - control over their emotions, their schedules, and freedom to focus on things like schoolwork and career (the students she profiles in her book are high achievers).

Being as bad as the boys
But she says they frequently mistake that freedom for empowerment. "I often hear girls say things like, 'We can be as bad as guys now,"' she says. "But I don't think that's what liberation is all about."
Stepp says her book stems from an experience she had almost 10 years ago.
She and other parents were summoned to her son's middle school. The principal informed them that all year long, a dozen girls - ages 13 or 14 - had been performing oral sex on several boys in the class. (Her own son was not involved.) Stepp wrote about the sex ring in a front-page article for the Post, which led to further research.
She's had her share of positive feedback, including from educators and from young women like those in her book. One 18-year-old student, who calls herself a feminist, e-mailed her to say she had approached the book warily, but came to believe it "will change the way my generation views sex."
Contacted later by telephone, the student, Liz Funk, said she agreed with Stepp's contention that "real relationships among college students don't really exist anymore."

'Thanksgiving for guys'
"If I or my friends had the opportunity for real relationships, we'd take it," says Funk, who attends school in New York City. "But my generation hasn 't really been conditioned for it." Hookups, she adds, which she rejected for herself long ago but some of her friends still embrace, "are like Thanksgiving for guys. They don't have to do anything to get sex!" And she bemoans the amount of time fellow students can spend on hookups: "It can be like a full-time job."
Another student, at a small women's college in South Carolina, says the "hookup culture" is not all that pervasive, in her experience. "I'm aware of it," said Grace Bagwell, 22, a senior at Converse College in Spartanburg, S.C.. "But it's untrue to say women aren't having meaningful relationships at this point. I've been in one for three years, and I have a lot of friends who are getting married or are engaged."
Sociologist Kathleen Bogle has also studied hooking up, which she says dates back to the '80s. She has a book, "Hooking Up," coming out this fall. "I argue that we shouldn't look at this from a moralistic viewpoint - as in, our youth is in decline - and we shouldn't celebrate it either, in a 'Sex in the City' light," says Bogle, who hasn't read Stepp's book. She also believes that it's wrong to assume women aren't hoping for something more from their hookups.
"It's a system for finding relationships - and there isn't really an alternate system," says Bogle. "It feels like it's the only game in town, and if you don't do it, you're left out." She did find that after college, there was a transition back to traditional dating.
The debate over hooking up - how prevalent, how harmful - was neatly displayed not long ago in a high school classroom in Maclean, Va. Nancy Schnog, who teaches a course in adolescence to 12th-graders, was discussing Stepp's findings.
"She hit the nail on the head," one girl said, according to Schnog. "She perfectly described our social climate." Many agreed, but an equally vocal faction argued the opposite. "This is totally overblown," said another girl. "Why do adults always stereotype our generation so negatively?" At the University of Maryland, Robin Sawyer, who teaches a course on sexuality, finds Stepp's book pretty much on target.
"Men have always hooked up," says Sawyer. "What you are seeing now is a desire of women to act in a masculine way, without being judged a whore." He also finds that the "hookup" vocabulary softens the impact of the behavior. "'I hooked up with someone' sounds a lot better than 'I had oral sex with someone whose name I don't even know,"' says Sawyer, who is mentioned in Stepp's book.
"Can you generalize from a few women? If you can find a criticism, it is probably that," Sawyer said. "But her thesis is pretty accurate. This is not your grandparents' generation."
[AP]

Sleep: The Ultimate Performance Enhancer

Basketball players ran faster and made more free throws after sleeping more than normal.
Getting a good night's sleep has its rewards, such as reduced fatigue and better concentration. For athletes, the benefits may be even bigger - faster speed and improved performance. Those are the findings from a recent, albeit small study in which college basketball players fared better on sprints and free throws after sleeping more than they normally did. "Athletes understand how important training is, and nutrition, but there's a third component that makes a big difference in how they perform - sleep," says Cheri Mah, lead author of the study presented last week at the Associated Professional Sleep Societies' meeting in Minneapolis.
Mah, a researcher at the Stanford Sleep Disorders Clinic and Research Laboratory, says athletes often aren't counseled on the value of adequate sleep, adding that college students are no strangers to sleep deprivation, sometimes maxing out at five or six hours of sleep a night. That's far below the 9.5 to 10 hours recommended by sleep experts for adolescents and young adults.
The study followed six Stanford basketball players, ages 18 to 21, during their 2006 playing season. For two weeks they followed normal sleep patterns, then they were told to sleep as much as they could for six weeks, with a goal of 10 hours a night, and to maintain a regular sleeping and waking schedule. During both phases, the players were tested several times a week on sprints and free throws following team practice.
Sprint times improved by a second by the end of the study (16.3 compared with 15.3 on a 282-foot sprint). Free throws averaged 7.9 (out of 10) during the regular sleep period, versus 8.8 at the end. Three-point shots picked up as well, averaging 9.2 (out of 15) during regular sleep and 11 upon completion. Mah says that since the study began in the middle of the season, "there shouldn't be a learning curve from the baseline" that would greatly affect the results.
The athletes were also given standard subjective written tests that measured mood and fatigue; after sleeping more they reported increased energy and improved mood. "I think the sleep debt is the biggest factor that's weighing down these athletes," says Mah. "When they're in season, they believe they're doing well, but they don't realize how much better they'd be if they reduced their sleep debt. A lot of athletes think that fatigue is normal."
A previous study on sleep deprivation published in 1999 in the Lancet found that less sleep resulted in impaired glucose metabolism, which affects how the body stores and processes glucose for energy. Even for the weekend schoolyard basketball player, more sleep could result in better games, says Mah: "Getting a little extra sleep will give you that little bit more."
[LAT]

Your Child's Immunizations

Larissa Hirsch

At birth, infants have protection against certain diseases because antibodies have passed through the placenta from the mother to the unborn child. After birth, breastfed babies get the continued benefits of additional antibodies in breast milk. But in both cases, the protection is only temporary.
Immunization (vaccination) is a way of creating immunity to certain diseases by using small amounts of a killed or weakened microorganism that causes the particular disease.
Microorganisms can be viruses, such as the measles virus, or they can be bacteria, such as pneumococcus. Vaccines stimulate the immune system to react as if there were a real infection - it fends off the "infection" and remembers the organism so that it can fight it quickly should it enter the body later.
Some parents may hesitate to have their kids vaccinated because they're worried that the children will have serious reactions or may get the illness the vaccine is supposed to prevent. Because the components of vaccines are weakened or killed - and in some cases, only parts of the microorganism are used - they're unlikely to cause any serious illness. Some vaccines may cause mild reactions, such as soreness where the shot was given or fever, but serious reactions are rare.
The risks of vaccinations are small compared with the health risks associated with the diseases they're intended to prevent.
The following vaccinations and schedules are recommended by the American Academy of Pediatrics (AAP). Please note that some variations are acceptable and that changes in recommendations frequently occur as new vaccines are developed. Many of these vaccines are available as combinations to reduce the number of shots a child receives. Your doctor will determine the best vaccinations and schedule for your child.

Recommended Vaccinations:
* Hepatitis B
* Pneumococcal conjugate vaccine (PCV)
* DTaP (diphtheria, tetanus, acellular pertussis)
* Hib (meningitis)
* IPV (polio)
* Influenza
* MMR (measles, mumps, rubella)
* Varicella (chickenpox)
* MCV4 (bacterial meningitis)
* Hepatitis A

Hepatitis B
Hepatitis B virus (HBV) affects the liver. Those who are infected can become lifelong carriers of the virus and may develop long-term problems such as cirrhosis (liver disease) or cancer of the liver.

Immunization Schedule
Hepatitis B vaccine usually is given as a series of three injections. The first shot is given to infants shortly after birth. If the mother of a newborn carries the hepatitis B virus in her blood, the infant needs to receive the first shot within 12 hours after birth, along with another shot (HBIG) to immediately provide protection against the virus. If a newborn's mother shows no evidence of HBV in her blood, the infant may receive the hepatitis B vaccine any time prior to leaving the hospital. It may also be delayed until the 4- or 8-week visit to the child's doctor.
If the first dose is given shortly after birth, the second shot is given at 1 to 4 months and the third at 6 to 18 months. For infants who don't receive the first shot until 4 to 8 weeks, the second shot is given at 3 to 4 months and the third at 6 to 18 months. In either case, the second and third shots are usually given in conjunction with other routine childhood immunizations.

Why the Vaccine Is Recommended
The hepatitis B vaccine usually creates long-term immunity. Infants who receive the HBV series should be protected from hepatitis B infection not only throughout their childhood but also into the adult years. Eliminating the risk of infection also decreases risk for cirrhosis of the liver, chronic liver disease, and liver cancer. Young adults and adolescents should also receive the vaccine if they did not as infants.

Possible Risks
Serious problems associated with receiving the HBV vaccine are rare. Problems that do occur tend to be minor, such as fever or redness or tenderness at the injection site.

When to Delay or Avoid Immunization
* if your child is currently sick, although simple colds or other minor illnesses should not prevent immunization
* if a severe allergic reaction (called anaphylaxis) occurred after a previous injection of the HBV vaccine

Caring for Your Child After Immunization
The vaccine may cause mild fever, and soreness and redness in the area where the shot was given. Pain and fever may be treated with acetaminophen or ibuprofen. Check with your child's doctor about the appropriate dose.

When to Call the Doctor
* if you're not sure of the recommended schedule for the hepatitis B vaccine
* if you have concerns about your own HBV carrier state
* if moderate or serious adverse effects appear after your child has received an HBV injection

Pneumococcal Vaccine (PCV)
The pneumococcal conjugate vaccine (PCV) protects against pneumococcal infections. The bacterium is the leading cause of serious infections, including pneumonia, blood infections, and bacterial meningitis. Children under 2 years old are most susceptible to serious pneumococcal infections. The pneumococcus bacterium is spread through person-to-person contact. The vaccine not only prevents the infection in children who receive it, it also helps stop its spread.

Immunization Schedule
PCV immunizations are given as a series of four injections starting at 2 months of age and following at 4 months, 6 months, and 12 to 15 months. Children who miss the first dose or may have missed subsequent doses due to vaccine shortage should still receive the vaccine, and your child's doctor can give you a modified schedule for immunization.

Why the Vaccine Is Recommended
The most serious infections affect children younger than 2 years old, and the vaccine will protect them when they're at greatest risk. PCV also is recommended for kids between 2 and 5 years of age who are at high risk for serious pneumococcal infections because they have:
* sickle cell anemia
* a damaged spleen or no spleen
* HIV/AIDS
* cochlear implants
* a disease that affects the immune system, such as diabetes or cancer
* to receive medications that affect the immune system, such as steroids or chemotherapy

In addition, these high-risk children may also receive the pneumococcal polysaccharide vaccine (PPV) in addition to the PCV when they're older than 24 months.
The PCV vaccine should be considered for all other 2- to -5-year-olds, especially those who are under 3 years of age; are of Alaska Native, American Indian, or African American descent; or who attend group child-care centers.

Possible Risks
Children who receive the PCV vaccine may have redness, tenderness, or swelling where the shot was given. A child may also have a fever after receiving the shot.

When to Delay or Avoid Immunization
* if your child is currently sick, although simple colds or other minor illnesses should not prevent immunization
* if your child has had a severe allergic reaction to a previous dose of the vaccine

Caring for Your Child After Immunization
The vaccine may cause mild fever, and soreness and redness in the area where the shot was given. Pain and fever may be treated with acetaminophen or ibuprofen. Check with your child's doctor about the appropriate dose.

When to Call the Doctor
* if your child missed a dose in the series
* if a severe allergic reaction or high fever occurs after immunization

DTaP
The DTaP vaccine protects against:
* diphtheria - a serious infection of the throat that can block the airway and cause severe breathing difficulty
* tetanus (lockjaw) - a nerve disease, which can occur at any age, caused by toxin-producing bacteria contaminating a wound
* pertussis (whooping cough) - a respiratory illness with cold symptoms that progress to severe coughing (the "whooping" sound occurs when the child breathes in deeply after a severe coughing bout); serious complications of pertussis can occur in children under 1 year of age, and those under 6 months old are especially susceptible

Immunization Schedule
DTaP immunizations are given as a series of five injections and are usually administered at ages 2 months, 4 months, 6 months, 15 to 18 months, and 4 to 6 years (before starting school). After the initial series of immunizations, a vaccine called Tdap (the booster shot) should be given at ages 11 to 12. Then, Td (tetanus and diphtheria) boosters are recommended every 10 years.

Why the Vaccine Is Recommended
Use of the DTaP vaccine has virtually eliminated diphtheria and tetanus in childhood and has markedly reduced the number of pertussis cases.

Possible Risks
The vaccine frequently causes mild side effects: fever, mild crankiness, tiredness, loss of appetite, and tenderness, redness, or swelling in the area where the shot was given. Rarely, seizures can occur following DTaP. Most of these side effects result from the pertussis component of the vaccine. Severe complications caused by DTaP immunization are rare. Most kids have little or no problem.

When to Delay or Avoid Immunization
* if your child is currently sick, although simple colds or other minor illnesses should not prevent immunization
* if your child has an uncontrolled seizure disorder or certain neurologic diseases or seems not to be developing normally - the pertussis component of the vaccine may not be given, and your child may receive a DT (diphtheria and tetanus) vaccine instead
If your child experienced any of the following after an earlier DTaP, consult with your doctor before your child receives another injection of the vaccine:
* seizures within 3 to 7 days after injection
* worsening of seizures
* an allergic reaction after receiving the vaccine, such as mouth, throat, or facial swelling
* difficulty breathing
* temperature of 40.5° Celsius or higher during the first 2 days after injection
* shock or collapse during the first 2 days after injection
* persistent, uncontrolled crying that lasts for more than 3 hours during the first 2 days after injection

Caring for Your Child After Immunization
Your child may experience fever, soreness, and some swelling and redness in the area where the shot was given. Pain and fever may be treated with acetaminophen or ibuprofen. Check with your child's doctor about the appropriate dose. Some doctors recommend a dose just before the
immunization.
A warm, damp cloth or a heating pad also may help reduce soreness. Moving or using the limb that has received the injection often reduces the soreness.

When to Call the Doctor
* if you aren't sure whether the vaccine should be postponed or avoided. Children who have had certain problems with the DTaP vaccine usually can safely receive the DT vaccine.
* if complications or severe symptoms develop after immunization, including seizures, fever above 105° Fahrenheit (40.5° Celsius), difficulty breathing or other signs of allergy, shock or collapse, or uncontrolled crying for more than 3 hours

Hib
Haemophilus influenzae type b bacteria were the leading cause of meningitis in children until the Hib vaccine became available.

Immunization Schedule
The Hib vaccine is given by injection at ages 2 months, 4 months, and 6 months (however, some of the Hib vaccines do not require a dose at 6 months). A booster dose is given at 12 to 15 months.

Why the Vaccine Is Recommended
Long-term protection from Haemophilus influenzae type b occurs in more than 90% of infants receiving three doses of the vaccine. Those immunized have protection against meningitis, pneumonia, pericarditis (an infection of the membrane covering the heart), and infections of the blood, bones, and joints caused by the bacteria.

Possible Risks
Minor problems, such as redness, swelling, or tenderness where the shot was given, may occur.

When to Delay or Avoid Immunization
* if your child is currently sick, although simple colds or other minor illnesses should not prevent immunization
* if severe allergic reaction occurs after an injection of the Hib vaccine, further Hib immunizations may not be given to your child Caring for Your Child After Immunization The vaccine may cause mild soreness and redness in the area where the shot was given. Pain may be treated with acetaminophen or ibuprofen. Check with your child's doctor about the appropriate dose.

When to Call the Doctor
* if you aren't sure whether the vaccine should be postponed or avoided
* if moderate or serious adverse reactions appear after the Hib injection

IPV
Polio is a viral infection that can result in permanent paralysis.

Immunization Schedule
The inactivated poliovirus vaccine (IPV) is usually given at ages 2 months, 4 months, 6 to 18 months, and 4 to 6 years before entering school. Until recently, the oral poliovirus vaccine (OPV) was given in the United States. Updated recommendations by the Advisory Committee on Immunization Practices now call for IPV injections. This change eliminates the previous small risk of developing polio after receiving the live oral polio vaccine.

Why the Vaccine Is Recommended
Protection against polio occurs in more than 95% of children immunized.

Possible Risks
Side effects include fever and redness or soreness at the site of injection.

When to Delay or Avoid Immunization
* IPV should not be given to kids with severe allergy to neomycin, streptomycin, or polymyxin B. Caring for Your Child After Immunization IPV may cause mild fever, and soreness and redness at the site of the injection for several days. Pain and fever may be treated with acetaminophen or ibuprofen. Check with your child's doctor about the appropriate dose.

When to Call the Doctor
* if you aren't sure whether the vaccine should be postponed or avoided
* if moderate or severe adverse reactions occur after the immunization

Influenza
Influenza, commonly known as "the flu," is a highly contagious viral infection of the respiratory tract.

Immunization Schedule
These groups, who are at increased risk of flu-related complications, should receive the flu shot every year:
* children 6 to 59 months old
* any child or adult with chronic medical conditions, such as asthma, cystic fibrosis, diabetes, sickle cell anemia, and HIV/AIDS
* children - from 6 months to 18 years - on long-term aspirin therapy
* anyone age 65 and older
* women who will be pregnant during the flu season
* anyone who lives or works with infants under 6 months old
* residents of long-term care facilities, such as nursing homes
* health-care personnel who have direct contact with patients
* out-of-home caregivers and household contacts of anyone in any of these high-risk groups

In the past, there have been times when there were vaccine shortages and delays. So talk with your doctor about availability. For kids younger than 9 who are getting a flu shot for the first time, it's given in two separate shots a month apart. It can take about 2 weeks after the shot is given for the body to build up protection to the flu.
Another non-shot option called the nasal mist vaccine came on the market in 2003 and is now approved for use in healthy 5- to 49-year-olds. But this nasal mist isn't for everyone, and can't be used by high-risk children and adults or pregnant women.

Why the Vaccine Is Recommended
The flu vaccine reduces the average person's chances of catching the flu by up to 80% during the season. Getting the shot before the flu season is in full force gives the body a chance to build up immunity to, or protection from, the virus.
The shot usually becomes available between September and mid-November. Although you can get a flu shot well into flu season, it's best to try to get it earlier rather than later, if your doctor thinks it's necessary.
However, even as late as January there are still 2 to 3 months left in the flu season, so it's still a good idea to get protection. Even if you or your child got the vaccine last year, that won't protect you from getting the flu this year, because the protection wears off and flu viruses constantly change. That's why the vaccine is updated each year to include the most current strains of the virus.

Possible Risks
Given as one injection in the upper arm, the flu shot contains killed flu viruses that will not cause someone to get the flu, but will cause the body to fight off infection by the live flu virus. Getting a shot of the killed virus offers protection against that particular type of live flu virus if someone comes into contact with it.
Some of the most common side effects from the flu shot are soreness, redness, or swelling at the site of the injection. A low-grade fever and aches are also possible. Because the nasal spray flu vaccine is made from live viruses, it may cause mild flu-like symptoms, including runny nose, headache, vomiting, muscle aches, and fever. Very rarely, the flu vaccine can cause serious side effects such as a severe allergic reaction.

When to Delay or Avoid Immunization
People who should not get the flu shot include:
* infants under 6 months old
* anyone who's severely allergic to eggs and egg products because the ingredients for flu shots are grown inside eggs. Tell the doctor if your child is allergic before he or she gets a flu shot.
* anyone who's ever had a severe reaction to a flu vaccination
* anyone who's had Guillain-Barré syndrome (GBS, a rare medical condition that affects the nerves) within 6 weeks of getting a flu shot
* anyone with a fever

Caring for Your Child After Immunization
Pain and fever may be treated with acetaminophen or ibuprofen. Check with your child's doctor about the appropriate dose. Some doctors recommend a dose just before the immunization. A warm, damp cloth or a heating pad also may help minimize soreness. Moving or using the limb that has received the injection often reduces the soreness as well.

When to Call the Doctor
* if you aren't sure if the vaccine should be postponed or avoided
* if there are problems after the immunization

MMR (measles, mumps, rubella)
The MMR vaccine protects against measles, mumps, and rubella (German measles). MMR vaccinations are given by injection in two doses. The first is administered at age 12 to 15 months; the second generally is given prior to school entry at age 4 to 6 years.

Why the Vaccine Is Recommended
Measles, mumps, and rubella are infections that can lead to significant illness. More than 95% of children receiving MMR will be protected from the three diseases throughout their lives.

Possible Risks
Serious problems are rare. Potential mild to moderate adverse effects include rash, fever, swollen cheeks, febrile seizures, and mild joint pain.

When to Delay or Avoid Immunization
* if your child is currently sick, although simple colds or other minor illnesses should not prevent immunization
* if your child has an allergy to eggs, gelatin, or to the antibiotic neomycin that has required medical treatment
* if your child has received gamma globulin
* if your child has immune system problems related to cancer, leukemia, or lymphoma
* if your child is taking prednisone, steroids, or immunosuppressive drugs
* if your child is undergoing chemotherapy or radiation therapy

Caring for Your Child After Immunization
If a rash develops without other symptoms, no treatment is necessary and it should resolve within several days. Pain and fever may be treated with acetaminophen or ibuprofen. Check with your child's doctor about the appropriate dose.

When to Call the Doctor
* if you aren't sure if the vaccine should be postponed or avoided
* if there are problems after the immunization

Varicella (chickenpox)
The varicella vaccine protects against chickenpox (varicella), a common and very contagious childhood viral illness.

Immunization Schedule
The varicella vaccine is given by injection between the ages of 12 and 18 months. Older children who have not had chickenpox may also receive the vaccine. Kids 13 years or older who have not had either chickenpox or the vaccine would need two vaccine doses at least 1 month apart.

Why the Vaccine Is Recommended
The varicella vaccine prevents severe illness in 95% of children who are immunized. It's up to 85% effective in preventing mild illness. Vaccinated kids who do get chickenpox generally have a mild case.

Possible Risks
Serious reactions are extremely rare. Possible mild effects are tenderness and redness where the shot was given, fever, fatigue, and a varicella-like illness. A rash can occur where the shot was given or elsewhere on the body up to 1 month after the injection. It may last for several days but will disappear on its own without treatment.

When to Delay or Avoid Immunization
* if your child is ill with anything more serious than a cold, immunization should be delayed
* if your child has an allergy to gelatin or to the antibiotic neomycin that has required medical treatment
* if your child has received gamma globulin
* if your child has immune system problems related to cancer, leukemia, or lymphoma; is taking prednisone, steroids, or immunosuppressive drugs; or is undergoing chemotherapy or radiation therapy

Caring for Your Child After Immunization
Pain and fever may be treated with acetaminophen or ibuprofen. Check with your child's doctor about the appropriate dose.

When to Call the Doctor
* if you aren't sure if the vaccine should be postponed or avoided
* if there are problems after the immunization

MCV4
The meningitis vaccine protects against meningococcal disease, a serious bacterial infection that can lead to bacterial meningitis. The vaccine is recommended for kids at age 11 or 12 years, at age 15 years if not previously vaccinated (before entering high school), and for older teens who are entering college and will be living in a dormitory setting.

Why the Vaccine Is Recommended
Bacterial meningitis, an inflammation of the membrane that protects the brain and spinal cord, is a rare but highly contagious disease that can spread rapidly among kids who are in close quarters. It can be life-threatening if it's not promptly treated.

Possible Risks
Some of the most common side effects are swelling, redness, and pain at the site of the injection, along with headache, fever, fatigue, and a rash.

When to Delay or Avoid Immunization
* if your child tends to have allergic reactions to the DTaP vaccine or to latex
* if your child is currently sick, although simple colds or other minor illnesses should not prevent immunization

Caring for Your Child After Immunization
Your child may experience fever, soreness, and some swelling and redness in the area where the shot was given. Pain and fever may be treated with acetaminophen or ibuprofen. Check with your child's doctor about the appropriate dose. Some doctors recommend a dose just before the
immunization.
A warm, damp cloth or a heating pad also may help reduce soreness. Moving or using the limb that has received the injection often reduces the soreness.

When to Call the Doctor
* if you aren't sure if the vaccine should be postponed or avoided
* if there are problems after the immunization

Hepatitis A
The hepatitis A virus (HAV) causes fever, nausea, vomiting, and jaundice, and can lead to community-wide epidemics. Child care centers are a common site of outbreaks.
The vaccine is recommended for children 12-23 months old, followed by a second dose 6 months later. The vaccine is also recommended for older kids and adults who are at high risk for the disease, including those who are traveling to locations where there are high rates of HAV.

Why the Vaccine Is Recommended
Vaccination against HAV can help stop epidemics from developing in the community. Some infected children do not have any symptoms, and can spread the virus to others. The more young children who are vaccinated against HAV, the more limited the spread of disease will be in a community.

Possible Risks
Side effects are usually mild fever, and tenderness, swelling, and redness at the site of the injection.

When to Delay or Avoid Immunization
* if your child is currently sick, although simple colds or other minor illnesses should not prevent immunization
* if your child had an allergic reaction to the first dose of hepatitis A vaccine

Caring for Your Child After Immunization
Your child may experience fever, soreness, and some swelling and redness in the area where the shot was given. Pain and fever may be treated with acetaminophen or ibuprofen. Check with your child's doctor about the appropriate dose.

When to Call the Doctor
* if you aren't sure if the vaccine should be postponed or avoided
* if there are problems after the immunization

Types of Vaccines
Four different types of vaccines are currently available:
1. Attenuated (weakened) live viruses are used in some vaccines such as in the measles, mumps, and rubella (MMR) vaccine.
2. Killed (inactivated) viruses or bacteria are used in some vaccines, such as in IPV.
3. Toxoid vaccines contain a toxin produced by the bacterium. For example, the diphtheria and tetanus vaccines are toxoid vaccines.
4. Biosynthetic vaccines (such as Hib) contain synthetic substances.

Immunizations for Travel
Specific information about which immunizations are required by travelers to each country worldwide is available directly from the Centers for Disease Control and Prevention (CDC). Ask your doctor for more information.
Depending on the type and length of travel, some vaccines may be recommended. Most immunizations should be given at least 1 month before travel. Take your child's immunization records with you when you travel internationally.

Helping Your Child Through Vaccine Injections
Sometimes it's hard to tell who dreads immunizations more - parents or kids. Here are some tips to help make the procedure easier for everyone:
* Tell older kids what's going to happen and that the shot helps to keep them healthy.
* Tell younger kids that it's OK to cry, but also encourage them to be brave.
* Try to be calm yourself. Your child can pick up on your concerns.
* Distraction at the moment of the injection is helpful. Try having kids count, sing a song with you, or look away (perhaps at a picture on the wall). You may want to have a joke or funny comment ready.
* Offer praise after the injection is over.
* Plan something fun for after the appointment. A trip to the park or playground can make the overall immunization experience less unpleasant.

As uneasy as getting vaccinated may make both you and your child, remember
that immunizations are one of the best means of protection against
contagious diseases. [AAFP]

Symptoms Found for Early Check on Ovary Cancer

Cancer experts have identified a set of health problems that may be symptoms of ovarian cancer, and they are urging women who have the symptoms for more than a few weeks to see their doctors.
The new advice is the first official recognition that ovarian cancer, long believed to give no warning until it was far advanced, does cause symptoms at earlier stages in many women.
The symptoms to watch out for are bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly and feeling a frequent or urgent need to urinate. A woman who has any of those problems nearly every day for more than two or three weeks is advised to see a gynecologist, especially if the symptoms are new and quite different from her usual state of health.
Doctors say they hope that the recommendations will make patients and doctors aware of early symptoms, lead to earlier diagnosis and, perhaps, save lives, or at least prolong survival.
But it is too soon to tell whether the new measures will work or whether they will lead to a flood of diagnostic tests or even unnecessary operations.
Cancer experts say it is worth trying a more aggressive approach to finding ovarian cancer early. The disease is among the deadlier types of cancer, because most cases are diagnosed late, after the cancer has begun to spread.
This year, 22,430 new cases and 15,280 deaths are expected in the United States.
If the cancer is found and surgically removed early, before it spreads outside the ovary, 93 percent of patients are still alive five years later. Only 19 percent of cases are found that early, and 45 percent of all women with the disease survive at least five years after the diagnosis. By contrast, among women with breast cancer, 89 percent survive five years or more.
The new recommendations, expected to be formally announced on June 25, are being made by the Gynecologic Cancer Foundation, the Society of Gynecologic Oncologists and the American Cancer Society.
More than 12 other groups have endorsed them, including CancerCare; Gilda's Club, a support network for anyone touched by cancer; and several medical societies.
"The majority of the time this won't be ovarian cancer, but it's just something that should be considered," said Dr. Barbara Goff, the director of gynecologic oncology at the University of Washington in Seattle and an author of several studies that helped identify the relevant symptoms. In a number of studies by Dr. Goff and other researchers, these symptoms stood out in women with ovarian cancer as compared with other women. "We don't want to scare people, but we also want to arm people with the appropriate information, " said Dr. Goff, who is also a spokeswoman for the Gynecologic Cancer Foundation.
She emphasized that relatively new and persistent problems were the most important ones. So, the transient bloating that often accompanies menstrual periods would not qualify, nor would a lifelong history of indigestion. Dr. Goff also acknowledged that the urinary problems on the list were classic symptoms of bladder infections, which is common in women. But it still makes sense to consult a doctor, she said, because bladder infections should be treated. Urinary trouble that persists despite treatment is a particular cause for concern, she said.
With ovarian cancer, even a few months' delay in making the diagnosis may make a difference in survival, because the tumors can grow and spread quickly through the abdomen to the intestines, liver, diaphragm and other organs, Dr. Goff said.
"If you let it go for three months, you can wind up with disease everywhere," she said Dr. Thomas J. Herzog, director of gynecologic oncology at the Columbia University Medical Center, said the recommendations were important because the medical profession had until now told women that there were no specific early symptoms.
"If women were more pro-active at recognizing these symptoms, we'd be better at making the diagnosis at an earlier stage," Dr. Herzog said. "These are nonspecific symptoms that many people have," he added. "But when the symptoms persist or worsen, you need to see a specialist. By no means do we want this to result in unnecessary surgery. But I would not expect that to occur in the vast majority of cases." Although the American Cancer Society agreed to the recommendations, it did so with some reservations, said Debbie Saslow, director of breast and
gynecologic cancer at the society.
"We don't have any consensus about what doctors should do once the women come to them," Dr. Saslow said. "There was a lot of hope that we'd be able to say, 'Go to your doctor, and they will give you this standardized work-up.' But we can't do that."
At the same time, Dr. Saslow said, the cancer society recognized that in some cases doctors had disregarded symptoms in women who were later found to have ovarian cancer, telling the women instead that they were just growing old or going through menopause.
"There are so many horror stories of doctors who have told women to ignore these symptoms or have even belittled them on top of that," Dr. Saslow said. In a survey of 1,700 women with ovarian cancer, Dr. Goff and other researchers found that 36 percent had initially been given a wrong diagnosis, with conditions like depression or irritable bowel syndrome. "Twelve percent were told there was nothing wrong with them, and it was all in their heads," Dr. Goff said.
Dr. Goff and other specialists said women with the listed symptoms should see a gynecologist for a pelvic and rectal examination. (The best way for a doctor to feel the ovaries is through the rectum.) If there is a question of cancer, the next step is probably a test called a transvaginal ultrasound to check the ovaries for abnormal growths, enlargement or telltale pockets of fluid that can signal cancer. The ultrasound costs $150 to $300 and can be performed in a doctor's office or a radiology center. A $100 blood test should also be conducted for CA125, a substance called a tumor marker that is often elevated in women with ovarian cancer.
Cancer specialists say any woman with suspicious findings on the tests should be referred to a gynecologic oncologist, a surgeon who specializes in cancers of the female reproductive system. An unresolved question is what exactly should be done if the test results are normal and yet the woman continues to have symptoms, Dr. Saslow said. "Do you do exploratory surgery, which has side effects, which are sometimes even fatal?" she asked. "What do you do? We don't have the answer to that." Depending on the test results, the woman may just be monitored for a while or advised to undergo a CT scan or an MRI. But if cancer is strongly suspected, she will probably be urged to go straight to surgery. A needle biopsy, commonly used for breast lumps, cannot be safely performed to check for ovarian cancer because it runs a risk of rupturing the tumor and spreading malignant cells in the abdomen. Instead, the surgeon must carefully remove the entire ovary or the abnormal growth on it and examine the rest of the abdomen for cancer.
While the patient is still on the operating table, biopsies are performed on the tissue that was removed, so that if cancer is found, the surgeon can operate more extensively. Experts say such an operation should be carried out just by gynecologic oncologists, who have special training in meticulously removing as much of the cancerous tissue as possible. This procedure, called debulking, lets chemotherapy work better and greatly improves survival.
Dr. Carol L. Brown, a gynecologic oncologist at the Memorial Sloan Kettering Cancer Center in Manhattan, said, "Ideally, we need to develop a screening tool or a test to find ovarian cancer before it has symptoms." No such screening test exists, Dr. Brown said, and until one is developed, the list of symptoms may be the best solution.
"This is something that women themselves can do," she added, "and we can familiarize clinicians with, to help make the diagnosis earlier."
[NYT]

Antibiotic Use in First Year May Increase Asthma Risk

The use of antibiotics in the first year of life is associated with an increased risk for asthma at age 7, a new study has found, and the reason may be that antibiotics destroy not only disease-causing microbes, but also those that are helpful to the developing immune system.
Antibiotic use had a greater impact on children who would otherwise be considered at lower risk - children who lived in rural areas and those whose mothers did not have asthma - than on those who were already at increased risk because of an urban environment or genetic predisposition.
Studies of antibiotic use and asthma have been complicated. Because antibiotics are used to treat respiratory illnesses, which are often precursors of asthma, it has been difficult to determine the effect of antibiotics alone. But this study, of 13,116 Canadian children, found that the risk of asthma increased even in children treated with antibiotics for nonrespiratory illnesses in the first year of life. The study appears in the June issue of Chest.
Anita L. Kozyrskyj, the lead author and an associate professor of pharmacy at the University of Manitoba, said the findings supported what scientists call the microflora hypothesis - that "you need good bacteria in your digestive tract for normal development of the immune system so that you don't end up with asthma," as she put it.
The researchers tracked medications by examining prescription records, and determined asthma status by treatment for asthma or any asthma drug use in the year following the seventh birthday. Six percent of the children developed asthma by age 7.
After statistically adjusting for respiratory and nonrespiratory illnesses, sex, maternal history of asthma, urban or rural location and other factors, researchers found that one or two courses of antibiotics in the first year of life increased the risk of asthma by about 20 percent.
The more frequent the antibiotic use, the higher the risk. Three to four courses of medicine conferred a 30 percent added risk, and more than four courses of antibiotics increased the risk by almost 50 percent.
The findings were stronger for the use of broad-spectrum antibiotics like the cephalosporins and amoxicillin than they were for narrow-spectrum drugs like penicillin and erythromycin. "Lactobacilli, for example, are more affected by the broad-spectrum drugs," Dr. Kozyrskyj said, referring to the beneficial bacteria contained in yogurt.
In a secondary finding using a small part of the sample population, researchers found that among children who had multiple courses of antibiotics in infancy, those who lived with no dog in the house had twice the risk of asthma compared with those who lived with one. The reasons are not clear, but it may be that having less contact with the germs that dogs carry results in lower microbial loads, making a child more sensitive to antibiotics. Dr. Kozyrskyj said in an interview that she found no decreased risk with the presence of cats or other pets.
Jeroen Douwes, a professor of epidemiology at Massey University in New Zealand who has published widely on asthma in children but was not involved in this work, cited the study's strong methodology. "They had very good data on antibiotic use during the first year of life, and that's actually quite rare," he said. "They measured exposure before the disease occurred, while in most studies you have to rely on people's recollections. "
The authors acknowledged that their findings do not conclusively confirm that antibiotic use is a cause of asthma, and that further work would be required to sort out the associations between the composition of normal intestinal bacteria, antibiotic use, childhood allergies and the development of the illness.
Dr. Kozyrskyj said this did not mean that antibiotics should be avoided. "During the first year of life, if there's a severe infection, antibiotics are appropriate, " she said. "But broad-spectrum antibiotics probably increase the risk for asthma. It's good clinical practice to start with the narrow-spectrum drugs first and then try the broad spectrum."
[Reuters]

Strange Daze

The number of children diagnosed with some form of autism has tripled in five years. And still no one knows what causes it. "Often, if she was getting out of control, I would take her and sit in the car with her with a transistor radio, because she loved music. And I'd do my homework with the radio on, with Jen in the back seat, rocking. That provided a bit of respite for Mum."
John Doyle, one of the country's funniest men, has always kept his private life to himself, though he speaks openly about his autistic sister these days. This week, as the patron of the autism association Aspect, he opened two much-needed classrooms at Alstonville in northern NSW.
Where there's an autistic child in the family, says Doyle, whose parents have cared for Jennifer for 50 years, teaching her to eat, then walk and, later, to read and write, "it's like the blinds come down on your house and your life".
His words may explain a curious incident at an inner-city high school recently. It began with The Curious Incident of the Dog in the Night-time. Mark Haddon's novel about a teenage boy with Asperger's syndrome, the highest-functioning on the spectrum of autism disorders, was to serve as a discussion point for the theme of "overcoming adversity", and Jill Sampson's* rowdy year 7 English class was uncharacteristicall y still. "We sat in a circle and if they wanted to they could talk about their own experiences, " she recalls. One girl gingerly broke the ice. "My brother is
autistic," she said. Then another student came forward with a similar confession. Then another. And another. And after these four, "it sort of led to 'one of my friends has a sibling with autism' . . ."
Was there something in our cereal? Is this an epidemic? The number of children diagnosed with autism spectrum disorders (ASDs) in NSW public schools has tripled in five years, from about 1500 in 2002 to more than 4500 in 2007, according to Brian Smyth King, the Department of Education's director of disability programs.
In March, a three-year study by the Australian Advisory Board on Autism Spectrum Disorders, the country's biggest survey to date, was released with the finding that one in 160 children between six and 12 has an ASD. The national figure could be as high as 125,000.
Such findings are no revelation to people who work in the area. Adrian Ford, the CEO of Aspect, says: "People are able to recognise it. In the '90s and the first five years in this decade, there has been a rise in diagnosis rate here and internationally, but there seems to be a plateauing of that number at about 1 in 160. It seems to suggest that we are reaching a stage where we are beginning to identify all the children who have ASD."
The term autism covers neuro-biological disorders of varying degrees. According to Aspect, these are: the most severe form of classic autism (20 per cent); Asperger's syndrome or high-functioning autism (50 per cent); and atypical autism or pervasive developmental disorders (30 per cent), where there are fragments of various symptoms outlined in the Diagnostic and Statistical Manual of Mental Disorders IV, used by doctors and psychologists around the world to make their assessments.
There may be lack of eye contact or clumsiness. They may have strange obsessions or be locked to a routine. They can be hypersensitive to heat or sound. (Temple Grandin, the brilliant American cow whisperer, whose book Thinking in Pictures is her personal account of autism, likens this overstimulation to "being in a loudspeaker at a rock concert".) In short, it is often very unpleasant. One of the most common characteristics - and one that causes the most pain - is the difficulty in reading social cues.
"My family says Tom always says what everyone else is thinking," says Lynne Whitaker of the gaffes made by her 12-year-old Asperger's son. "He thinks everyone is his friend. He thinks the boy riding a bike down our street is his friend. And he'll yell out, 'How you going, mate? Nice day, isn't it?' "At the doctors the other day, he leaned against the wall and said to a woman, 'Long time no see. How you been doing?' Adults think it's funny, but the other 12-year-olds think, 'You're a bit weird'. Or he'll practise and practise and say, 'Hi. I'm Tom. And I'm 12,' about four times. He doesn't know what to say."
Alex Deen-Cowell, 20, is a brilliant Japanese scholar, stifled socially by Asperger's syndrome since his teens. "It's more that it's lonely for him," his mother, Tracy, says. "Fitting into the world is very hard and the world isn't very accommodating. But he's probably the nicest person I know and the best person I know. He's just a lovely human being. He doesn't have malicious thoughts. I'm quite vengeful about people we've encountered along the way, but he's not. And he has cause to, for sure."
A full diagnosis is "like completing a 100-piece jigsaw puzzle", says Tony Attwood, the Brisbane psychologist whose books on Asperger's syndrome have become international bestsellers. "You need 80 or more pieces to complete the picture."
After the diagnosis comes the hunt for a cure. And there isn't one. As Attwood says, "It's like going to the doctor and the doctor saying, 'You've got a broken arm,' and you say, 'Well, how do I fix it?' and the doctor says, 'Oh well, see you in three weeks.' "
There has been progress with the use of intensive occupational and speech therapy. In cases of severe autism, for example, Attwood says: "When I started in the area 30 years ago, only 50 per cent acquired speech. Today, only 15 per cent don't acquire speech."
The search for a cure is a worldwide effort. In December, a landmark Combating Autism Act was passed by the US Senate, with President George W.
Bush earmarking funds of nearly $US1?billion ($1.2 billion) over the next five years for research, screening, early detection and early intervention. (The rate of autism in the US is similar to Australia, occurring in 1 out of 166 children, according to the Centres for Disease Control.) MMR vaccines have been discounted by scientists as a possible trigger, but there is still a long way to go in determining the causes. In the past year, researchers in Israel have found that new fathers over 40 are nearly six times more likely to produce children with ASDs than fathers younger than 30; a team of Danish and US scientists published a report in The Lancet medical journal linking neurological disorders including autism to exposure to 200 industrial pollutants such as lead, methylmercury and arsenic; US economists have attributed the growth of autism in states with high rainfall to greater use of television.
Attwood says support is inadequate. "The funding organisations, and government and research levels, have not yet understood the nature of the problem, its severity and impact," he says. "Parents have to fight to get a certain number of hours a day to support their child. It's hard enough having an autistic kid but you shouldn't have to fight the system to try and get the child resources."
Support groups for parents of children with ASDs, children of parents with ASDs and partners of people with ASDs have sprung up across the city. Aspect operates six schools for children up to 16 as well as 37 satellite classes, including Alstonville, while other schools such as Giant Steps, in Drummoyne, are part of the Independent Schools Association.
Demand is outstripping supply. Tom Whitaker lives in Richmond and travels three hours a day to and from his school. Elsewhere, the Woodbury School in Baulkham Hills, which costs families nearly $40,000 a year in fees and contributions, had to turn away 30 applicants this year.
It is accepted that the most successful approach is multilayered, either through interventions such as Applied Behaviour Analysis, or a mixture of speech and other choices. The guidelines for best practice released by the Department of Health last year recommended a minimum of 20 hours of intervention a week over two or more years.
Early intervention is the one point on which experts agree, though it is too late for Jennifer Doyle, diagnosed at 10, who at 50 has "a very measured and quiet and carefully routined existence" with her parents. She didn't speak until she was 3 1/2 and, her brother says, "her first utterance was a complete sentence. And she hasn't stopped talking. Generally in the third person. She can be very loud. We're all blessed with booming voices."
[SMH]

Vacuuming doesn't help allergies

Vacuuming does practically nothing to relieve allergy sufferers from the irritations of carpet dust mites, new research reveals. Carpets are a major reservoir for allergens and vacuum cleaning is one of the most common ways of managing the problem, but scientists now say the benefits are limited.
The study by the Woolcock Institute of Medical Research in Sydney found that hoovering removed dust mite allergen from carpets in an "inconsistent and incomplete manner".
Vacuuming worn carpet was even more ineffective, as it just moved the mites around rather than removing them. Researcher Jason Sercombe tested the presence and distribution of house mites in different carpets before and after vacuum cleaning. He said his results explain why many trials designed to reduce indoor allergens - some even going so far as to install new furniture - have had limited success.
"Although soft furnishings such as beds contain more concentrated sources of allergy-causing protein produced by house dust mites, the large size of carpet means it is likely to contain a larger total amount of allergen than other items in a home," Mr Sercombe said.
"Allergen avoidance measures that rely solely on vacuum cleaning are likely to be of limited success unless more rigorous cleaning than standard home vacuuming is performed."
The study also showed the type of vacuum cleaners with rotating brushes in the head removed more dirt and allergen from the carpets than those without. However, rotating brushes may serve to kick dust up into the air if the suction component of the cleaner is not operating properly. Overseas studies have found that vacuum cleaners with two or three layer bags performed better than those with a single layer bag, Mr Sercombe said. He said there were many vacuum cleaners on the market that claimed to be suited to allergy sufferers.
"The most important aspect to look for is HEPA (high efficiency particulate air filter) filtration, which is finding its way into some very affordable models," the researcher said.
[Int J of Hyg & Enviro Health]

Calorie Intake May Affect Bone Health of Young Women

When a young woman stops menstruating, doctors often take it as a red flag that she may not be eating enough, which, among other problems, can inhibit bone formation.
But a new study has found that some young women who have regular periods may still be eating so little that they endanger the health of their bones.
There are a number of reasons a teenager may not be consuming enough nutrients. Anorexia is a common one, but young women who work out intensively for a sport like gymnastics without increasing their energy intake are also at risk.
The study, by Anne Loucks and Aiden Shearer of Ohio University, looked at the role of nutrient intake and bone formation in women ages 18 to 32. It was presented last week at a meeting of the Endocrine Society.
For five days, the researchers restricted the women's caloric intake and had them exercise for more than an hour and a half each day. The women were separated into two groups, one younger and one older.
When the researchers drew volunteers' blood at the end of the five days, they found decreased levels of two markers for bone formation.
While earlier research found that calorie restriction did not disrupt the reproductive system in the older group of young women, the new study suggests that taking in too few calories still impairs their bone formation.
The implications may be greatest for women who exercise a lot and do not consume enough food.
"Regular menstrual cycles do not reliably indicate that they are eating enough for what they're expending," Dr. Loucks said.
[AP]

Exercise Comparison

Working it out: Yoga or Pilates? Running or aerobics?
Deciding to get fit is the easy part: choosing how to go about it is difficult.

RUNNING V AEROBICS

Running
How quickly will it make a difference? You'll notice a difference after two to three weeks, if running three or more times a week.
How many calories does it burn? About 612 per hour if you run 10 kilometres per hour.
Will it keep me motivated? Treadmill running can be tedious: run outside, changing your route and terrain whenever you can. As you get fitter, challenge yourself by entering fun runs.
Specific benefits: The basic running action strengthens the hamstring, quadriceps, calf and the gluteus maximus muscles each time you take a stride forward. The pumping action of your arms will strengthen the upper body. And it's among the best forms of aerobic exercise.
Risk factors: Your feet absorb three to four times your body weight every time they strike the ground and a shock reverberates up through your legs and into your spine. Good shoes help to cushion the blow and reduce the risk of injury to the knees and other joints.

Aerobics
How quickly will it make a difference? After five weeks of twice-weekly classes.
How many calories does it burn? 374 per hour.
Will it keep me motivated? Classes that stick to exactly the same format every week can become too predictable for both muscles and mind. As with all class-based work-outs, there is little scope for progress, so you may want to try something different after a while.
Specific benefits: Aerobics classes incorporate dance elements that improve coordination and spatial awareness.
Risk factors: Low-impact aerobics classes (at least one foot remains in contact with the floor at all times ) are preferable to high-impact classes for anyone prone to back and joint problems.

Victor: Running

Weights V Circuits

Weights
How quickly will it make a difference? After the first session, your muscles will feel more toned, but noticeable changes will take three to four weeks.
How many calories does it burn? 136-340 per hour depending on weight lifted and the recovery time between repetitions and sets.
Will it keep me motivated? If improved body tone is your solitary goal, then yes. But otherwise it can become tedious.
Specific benefits: Great for improving muscle tone and bone density.
Combined with aerobic exercise, resistance and weight training has been shown to speed up the rate at which calories are burned, thereby resulting in quicker weight loss.
Risk factors: Lift too heavy weights too often and you can get bulky.
Injuries are high in the weight room, but mostly linked to weights being dropped and poor technique.

Circuits
How quickly will it make a difference? After two weeks of twice-weekly circuits.
How many calories does it burn? 476 per hour.
Will it keep me motivated? Circuit training is as challenging (or not) as you make it. You are unlikely to get bored as circuits can constantly change their content and order.
Specific benefits: A good circuit addresses every element of fitness: aerobic, strength, balance and flexibility. Ideally, an instructor should introduce new tools - medicine balls, skipping ropes, weights, wobble boards - to make sure you are always developing new skills and testing different muscles.
Risk factors: Because the movements are so varied, there are very few risks, unless you perform exercises with poor technique.

Victor: circuits

Yoga v Pilates

Yoga
How quickly will it make a difference? After eight weeks of thrice-weekly sessions.
How many calories does it burn? 102 per hour for a general, stretch-base class. Power yoga burns 245 per hour.
Will it keep me motivated? Yoga is all about attaining a sense of unity between body and mind rather than setting and achieving personal targets.
However, you will feel accomplishment as you master the postures and there are many different types to try.
Specific benefits: In a study for the American Council on Exercise (ACE), Professor John Porcari found that women who did three yoga classes a week for eight weeks experienced a 13 per cent improvement in flexibility, with significant gains in shoulder and trunk flexibility. They were able to perform six more press-ups and 14 more sit-ups at the end of the study than at the beginning.
Risk factors: Don't fall for the line that celebrities get fit on yoga alone. According to ACE, even power yoga constitutes only a "light aerobic work-out".

Pilates
How quickly will it make a difference? After five to six weeks of thrice-weekly sessions.
How many calories does it burn? 170-237 per hour.
Will it keep me motivated? Once you start noticing positive changes in the way you move and hold your body, Pilates is hard to give up.
Specific benefits: Widely used by dancers and top athletes, it improves postural awareness and strength. Studies at Queensland University have shown that Pilates exercises can develop the deeply embedded traversus abdominal muscles which support the trunk.
Risk factors: Another study by ACE last year found the cardiovascular benefits of Pilates to be limited. Even an advanced 55-minute session raised participants' heart rates to a maximum of only 62 per cent (below the recommended 64-94 per cent said to constitute an aerobic work-out) and was deemed the energy equivalent of walking 3.5 miles an hour. If you have back pain, make sure you see a teacher who is also a physiotherapist, as poor technique can make matters worse.

Victor: Pilates

[AP]

Vitiligo

Vitiligo is a disorder in which a localized loss of melanocytes results in smooth white patches of skin.
The cause of vitiligo is unknown, but it may involve an attack by the person's immune system on melanocytes. Vitiligo tends to run in families and may occur with certain other diseases. Thyroid disease is present in almost one third of people with vitiligo, but the relationship between the disorders is unclear. People with diabetes, Addison's disease, and pernicious anemia also are somewhat more likely to develop vitiligo. The disorder may occur after physical trauma or a sunburn. Although vitiligo does not pose a medical problem, it may cause considerable psychologic distress.

Symptoms and Diagnosis
In some people, one or two sharply demarcated patches of vitiligo appear; in others, patches appear over a large part of the body. The changes are most striking in dark-skinned people. Commonly affected areas are the face, elbows and knees, hands and feet, and genitals. The unpigmented skin is extremely prone to sunburn. The areas of skin affected by vitiligo also
produce white hair, because the melanocytes are lost from the hair follicles. Premature graying of scalp hair may occur even when the underlying skin is unaffected by vitiligo.
Vitiligo is recognized by its typical appearance. A Wood's light examination is often performed to help distinguish vitiligo from other causes of lightened skin. Other tests and biopsies are rarely necessary.

Treatment
No cure is known for vitiligo, although some people regain their color spontaneously. Treatment may be helpful. Small patches sometimes darken when treated with corticosteroid creams. Some people use bronzers, skin stains, or makeup to darken the area. Because many people still have a few melanocytes in the patches of vitiligo, phototherapy restimulates pigment production in more than half of them. In particular, psoralens (light-sensitive drugs) combined with ultraviolet A light (PUVA) and narrow-band ultraviolet B light treatments are most beneficial. However, phototherapy takes months to be effective and must be continued indefinitely.
Areas that do not respond to phototherapy may be treated with various skin-grafting techniques and even transplantation of melanocytes grown from unaffected areas of the person's skin. All affected areas of skin must be protected from the sun with sunscreen and clothing.
Some people who have very large areas of vitiligo sometimes prefer to bleach the pigment out of the unaffected skin to achieve an even color. Bleaching is done with repeated applications of hydroquinone cream to the skin for weeks to years. The effects of bleaching are irreversible.
[Merck]

Taking Care of Your Vision

A.E. Pogrebniak

Back in 1268, English scientist Roger Bacon had a solution for people whose vision was no longer as sharp as it once was. Bacon said that they could read tiny print by looking through a piece of glass "shaped like the lesser segment of a sphere, with the convex (rounded) side toward the eye." Fast forward to the 21st century. Glasses, contacts, and eye surgery to correct vision or replace diseased parts of the eye have become common. Even some forms of blindness can be corrected today because of medical advances in eye care.
Even if you're lucky enough to have perfect 20/20 vision, taking care of your eyes and protecting them against injury or infection is important to keeping your peepers perfect.

Vision Basics
One of the best things you can do for your baby blues (or greens, or browns, or hazels, or whatever color your eyes are) is to have them checked by your doctor whenever you have a physical examination. If you're having trouble seeing or you've been getting frequent headaches at the end of the day, tell a parent so that you can have your eyes examined by an eye specialist. An ophthalmologist (pronounced: ahf-thuh-mah- luh-jist) is a medical doctor who specializes in examining, diagnosing, and treating eyes and eye diseases. An optometrist (pronounced: ahp-tah-muh- trist) has been trained to diagnose and treat most of the same eye conditions as ophthalmologists, except for treatments involving surgery.
It's a good idea to have your eyes checked at least every 2 years or even more frequently if you have a family history of eye problems such as glaucoma or early cataracts.

Common Vision Problems
Have you ever wondered whether there's any truth in some of the stuff you may have been told about how to treat your eyes? For example, you may have been warned that sitting too close to the TV or computer can ruin your eyes. But actually that's wrong. You may also have heard that using a night-light (instead of bright light) to read will cause nearsightedness, but there's no clear scientific evidence to support this idea. You can strain your eyes if you don't have enough light when you read, but it won't ruin your vision. So what's the cause of many common vision problems? Often, eye shape is the culprit. Someone with perfect 20/20 vision has eyes that are basically round like a baseball. Someone who needs corrective lenses to see usually has eyes that are shaped differently.
Myopia (pronounced: my-o-pee-uh) , or nearsightedness, is one of the most common problems teens have with their eyes. When a teen has myopia, he or she is unable to focus properly on things that are far away. People with myopia have eyes that are a little longer than normal, measuring from the front of the eyeball to the back. This extra length means that light focuses in front of the retina (the part of the eye that receives images and sends them to the brain) instead of on it, and that affects vision. Glasses or contacts can easily correct this problem.
Hyperopia (pronounced: hi-puh-ro-pee- uh), or farsightedness, is another problem. People with hyperopia have trouble focusing on things close up because their eyes are too "short" from front to back. In people with hyperopia, light focuses behind the retina instead of on it, causing blurry vision. Someone with significant farsightedness will need glasses to correct his or her vision. But here's an interesting fact: Many babies are born farsighted! Their eyeballs get longer as they grow, and most of them outgrow the condition.
Another condition where the eye is differently shaped is astigmatism. Here, the eye is slanted at the front, shaped more like a football than a baseball. To be able to see well - either close up or far away - the person needs contact lenses or glasses.
Once people reach 18 and their eyes are fully grown and less likely to change, some people choose to have refractive surgery to correct myopia so they don't have to wear contacts or glasses anymore. Refractive surgery is a procedure - usually done with a laser - that reshapes the eye to change the way light enters it and forms an image, allowing a person to see better. Refractive surgery can sometimes also be done on people with farsightedness or astigmatism once their eyes have matured and stopped growing.

Dealing With Common Eye Problems and Injuries
The best rule of thumb for when to see an eye specialist if you injure your eyes is "when in doubt, check it out!"

• If you have a red eye, pain in an eye that doesn't go away within a short period of time, or at any time have had changes in your vision, then it's time to have your eyes checked by a specialist.
• If you get any small foreign objects in your eye, such as sand or sawdust or metal shavings, don't rub it. Flush your eye for several minutes with lukewarm water (it may be easiest to do this in the shower). If it still feels as though there is something in your eye, then be sure to see an eye specialist.
• If you've been hit in the eye and it looks strange or appears to be bleeding, or if you have changes in or lose your vision, go to a hospital emergency department right away to be checked out.
  

One of the most common eye injuries for teens is a scratched cornea, which is usually related to wearing contact lenses or playing sports. With a scratched cornea, it may feel like something is in your eye when there's really nothing there. Your eye may get red and irritated, produce lots of tears, and be overly sensitive to light.
If you think you have any kind of eye injury and you wear contact lenses, stop wearing your contacts until you see an eye specialist. Wearing contact lenses if you have an eye injury could damage your eyes more or cause an infection to develop. Don't worry - if your cornea is scratched, it usually will heal after a week or 2 of medicated eye drops and not wearing your contacts. You may hate wearing your old glasses, but it's just for a little while - and it beats permanently damaging your eyes!

Caring for Your Eyes
Just as you wear a seat belt to protect yourself when you're in a car, it's a good idea to protect your eyes before something happens to them. Wearing sunglasses is high on the list of ways you can care for your vision. Buy a pair of sunglasses with ultraviolet (UV) protection to use whenever you're in the sun. UV light causes long-term damage to the inner structures of the eye, but wearing sunglasses whenever you're in the sun can help prevent conditions such as cataracts and macular degeneration. A cataract is an eye condition in which the lens of the eye becomes clouded, impairing vision. Macular (pronounced: mah-kyuh-lur) degeneration is an eye disease in which the macula, a structure within the eye that allows you to see, gradually deteriorates, leading to decreased vision or blindness. (Need one more reason not to smoke? Smoking puts you at greater risk for developing macular degeneration. )
You can also care for your eyes by putting on protective eyewear whenever you play sports like racquetball or when you're doing projects in shop class or the science lab. It only takes a second for something to hit an unprotected eye and cause serious damage. And avoid being near fireworks that could explode and harm your eyes. Why take chances with your vision?
Although steering clear of fireworks probably seems like an obvious way to protect your eyes, you may not think about protecting them around the house. Yet something you might do every day - staring at a computer screen for a long time - can strain your eyes. That's because most people blink about 10 times per minute. But when you stare, your blink rate can go down to two or three times per minute. The best thing you can do is to blink more! It also helps to change your focus frequently. Look at something across the room for a few moments and then go back to looking at the computer screen.
If your eyes feel dry and irritated when you use the computer, use artificial tears. Don't use products that remove the red from your eyes, though, because they may contain a chemical that eliminates redness temporarily but actually makes your eyes look worse later.
You should take special care of your eyes if you have a medical condition such as diabetes or juvenile rheumatoid arthritis because these conditions put you at an increased risk of developing serious eye disease. Be sure to see your doctor at least once a year if you have any medical condition that can affect your eyes. Depending on your situation, your doctor may need to check your eyes as often as every 3 months.

Preventing Eye Infections
You can also protect your eyes by preventing infections that could harm them. Conjunctivitis, which is also sometimes called pinkeye, is an eye infection that can be caused by a virus, bacteria, an allergic reaction, a chemical, or an irritant (something that gets in the eye). Conjunctivitis that is caused by germs like viruses and bacteria can easily pass from person to person. After you shake hands with someone who has a bad cold and pinkeye, for instance, you could spread the infection to your own eye by touching it with your hand.

To avoid spreading the germs that can cause eye infections:

• Don't share eye makeup or drops with anyone else.
• Don't touch the tip of a bottle of eye drops with your hands or your eyes because that can contaminate it with germs.
• Never put contact lenses in your mouth to wet them. Many bacteria and viruses - maybe even the virus that causes cold sores - are present in your mouth and could easily spread to your eyes.
• Wash your hands regularly!
  

Glasses and Contacts
If you need glasses or contact lenses, you can follow a few tips for the best results. When you pick out glasses, remember as a general rule that smaller frames will probably suit you better. The larger the frame, the more distortion you'll have, and you may not be able to see as well.
If you get contact lenses, follow your doctor's orders exactly when it comes to cleaning them, how many hours you can safely wear them, and when you should replace them. If you don't, you could develop serious infections or ulcers in your eye that are painful, difficult to treat, and may need months of medication or even surgery.
Eyes and vision are something no one wants to be without. To keep them working for you for many years to come, protect them now and take the best care of them that you can.
[AAFP]

Why You Still Need a Pap Test?

Why You Still Need a Pap Test: Confusion about this essential procedure is growing among women of all ages. Despite the new HPV vaccine, regular screenings are still critical

For decades, the message to women was clear: get an annual gynecological exam and a Pap test to screen for cervical cancer. Since the development of the Pap test in 1941 by Dr. George Papanicolaou, deaths from cervical cancer have dropped more than 70 percent, making it the most effective cancer-screening tool yet created. The message reached so many women that regular gynecological checkups became the standard in this country, saving millions of lives. But recently, vaccines targeting viruses that cause cervical cancer and new recommendations for less-frequent screening for certain subsets of women have muddled that critical message. In one recent study of 351 patients at a New Jersey family health center, more than half of all women surveyed indicated that they really didn't understand what a Pap test is for. There's also disturbing new evidence that poor women continue to have significantly higher rates of cervical cancer than other women, primarily because they're not getting regular screenings and not following up when Pap test results indicate possible malignancies.
Doctors are frustrated by what appears to be a growing gap between scientific advances in detecting cervical cancer and women's knowledge of how to protect themselves. A new generation of liquid-based Pap tests gets much more accurate results than the traditional test, says Dr. R. Marshall Austin, professor of pathology and director of cytopathology at Magee-Womens Hospital, University of Pittsburgh Medical Center. The new tests, developed in the mid-1990s, collect many more cells, significantly increasing the chances of spotting abnormal ones, Austin says. In the United States, more than 50 million women receive an annual Pap test and about 80 percent are collected using a liquid-based test called the ThinPrep Pap Test, Austin says.
More accurate results have prompted medical organizations to recommend that some women who go several years without abnormal results get screened less often. This can be a problem, according to some experts. "Unfortunately, a lot of these efforts to increase the interval of screening are confusing," Austin says. The best advice: stick to a regimen of annual gynecological exams and follow your doctor's individual recommendations for how often you need to be screened. Annual exams, with or without a Pap test, are especially important after menopause, when a woman's risk of cancer increases. A number of studies have shown that many women don't know the symptoms of gynecological cancers. That's why the end of fertility does not mean the end of checkups.
Women are also confused by news of vaccines against genital human papilloma virus (HPV), which has been linked to about 70 percent of cervical cancer cases. "Women need the Pap test regardless of the HPV vaccine," says Dr. Mona Saraiya, medical officer in the Centers for Disease Control's Division of Cancer Prevention and Control. Since genital HPV is primarily transmitted during sexual activity, the vaccine is most effective for girls who have not had intercourse. In fact, the American Cancer Society recommends that the vaccine be routinely given to 11- and 12-year-old girls. (It's not recommended for women over 26, but research is underway on the effectiveness of giving the vaccine to women 27 and older.) Several states have pending legislation mandating vaccination for young girls, which has prompted fierce debate. However this is resolved, older unvaccinated women will still be vulnerable and need Pap tests. And even those young girls who are vaccinated will need to be screened as they get older since the current vaccine does not protect against all forms of HPV. A Pap test is still the only way to detect cervical cancer.
Saraiya was the lead researcher on a study published in the current issue of the journal Obstetrics and Gynecology that found that African-American and Hispanic women, as well as women in the South, have higher rates of cervical cancer--largely because of lower screening rates and less follow-up after an abnormal Pap test finding. Saraiya says the results confirm earlier studies showing that poorer women generally have limited access to health care. Will the vaccine be just one more health tool unavailable to low-income women?
"That's a big question in all our minds," Saraiya says. "The HPV vaccine has huge potential to wipe out these disparities but if there are barriers to getting the vaccine, including the cost, then we might continue to see these disparities. "
Cervical cancer is nearly 100 percent curable if caught at an early stage, so education about prevention and screening is the best protection for women of all income groups. According to one recent report, as many as 70 percent of women who developed cervical cancer either did not have a Pap test within five years of their diagnosis or had never been screened. And if you haven't had a gynecological checkup in the last 12 months, call your family doctor now.
[AP]