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Newsymails of 2006

Jan 3, 2006

There are a number of gadgets and services that will act as your eyes
and ears when you can't be there. Here are three to help keep your
children safe:

1. Driving gadgets. One of the scariest days for parents is when their
teenager passes the driver's exam. Today there are cell phones, flip
down DVD players, satellite radio and other entertainment options to
distract even the most seasoned drivers. Teenagers just learning the
rules of the road are especially susceptible to those distractions.

It's impossible to sit next to your teenage driver all the time.
However, Road Safety RS-100 (http://www.roadsafety.com/teen.php; $280
and $295; Windows 98SE and above) and CarChipE/X with Alarm
(http://www.davisnet.com; $200; Windows 98SE and above) are little
black boxes that monitor your teen's driving when you can't.

The devices easily attach to your vehicle's OBD-II connector, located
underneath the dashboard. Once installed, they monitor and record
parameters such as speed, hard braking, and quick acceleration. If
conditions exceed limits you set, such as going faster than 65 mph, an
alarm will alert the driver.

Road Safety RS-100 stores about a month's worth of driving data.
CarChip E/X with Alarm holds 300 hours worth. To download the data to
your computer, you'll need to remove the CarChip E/X with Alarm from
the vehicle. It has a USB port that connects to your computer. Road
Safety RS-100 uses a removable memory card with a USB port. Both
devices are fairly tamperproof. If turned off or removed, that action
will show up in the data logs.

2. Driving services. Have you seen signs on commercial vehicles that
ask, "How's my driving?" The same concept is being brought to private
use through How's My Driving (http://www.howsmydriving.com/drive4life.nsf;
$22 per year, plus $10 activation fee)

After registering, you receive a sticker to be placed on the back of
your vehicle. The sticker contains a phone number that drivers can call
if they witness poor or erratic driving. Parents are notified via
telephone or e-mail.  The downside here is that strangers must report incidents.

And prank calls can happen.

Teen Arrive Alive also has a GPS-component for subscribers who own a
compatible Nextel phone. For an additional $10 per month, your child's
location is reported to Teen Arrive Alive every two minutes. Just log
in to Teen Arrive Alive's Web site to see if your teen is really at the
library or goofing off at the mall.

3. Cell phone help. Today's cell phones are like small computers.
Conveniences such as text and picture messaging and Web browsing are
not always appropriate for minors. Sure, you want your child to be able
to call you from soccer practice. But he or she probably shouldn't use
the same cell phone that you own.

Firefly (http://www.fireflymobile.com) and TicTalk
(http://www.mytictalk.com) are "kid-safe" cell phones that retail for
$100. The phones have built-in parental controls. You determine which
numbers the phone can dial or receive calls from. The phones use pay-
as-you-go minutes (25 cents per minute), so there are no contracts to
sign. Check the companies' Web sites for coverage information.

Finally, remember that technology should not be used as a substitute
for good parenting. It's important to talk to your children about why
you are buying restrictive cell phones or phones that track their
location.

Jan 12, 2006

Several roundworm parasites of domestic animals can infect humans. It is usually the larval stages of these parasites that are found in human tissues and provoke the clinical condition referred to as larva migrans. Toxocara species, the ascarid (round worm) of dogs and cats, most commonly is associated with larva migrans. Classic visceral larva migrans (VLM) typically occurs in preschool children with a history of eating dirt.

Children contract Toxocara infections by ingesting embryonated eggs. The larvae hatch in the small intestine, invade the mucosa, and enter the veins going to the liver. The liver traps some larvae, but other larvae proceed to the lungs and the circulatory system where they can disseminate to virtually every organ. The parasite, however, cannot complete its life cycle in humans. Larvae persist in tissues, provoking an inflamation reaction and eventually dying. Clinical manifestations depend upon the tissue damage caused by the invading larvae and the associated immune-mediated inflammatory response.

Frequency In the US: The rate of positive blood test for Toxocara infection in children varies from 2-10%.

Mortality/Morbidity: Death is rare. Long-term morbidity is present with ocular larva migrans (ie, loss of vision in the affected eye) but not usually with VLM.

 Infection primarily affects children aged 1-4 years, but it can occur at any age.  Children with VLM may complain of loss of appetite, fever, cough, wheezing, or abdominal pain.  Those are vague symptoms of many illnesses.  Children may have marked hepatomegaly (enlarged liver) and splenomegaly, plus wheezing, and rales in the lungs.  Children also may have a pruritic rash or urticaria (Hives).  Eye edema and strabismus (crossing eyes) also have been seen in some children with VLM.

 Causes are Toxocara canis is the most common cause of VLM. Mature T canis worms live in the small intestine of the dog, their natural host. Heavily infected dogs can pass millions of eggs each day in their feces.  Toxocara cati (of the cat) also causes VLM.

 Enzyme-linked immunosorbent assay (ELISA) is the most commonly used serologic test physicians use to diagnose VLM, with a reported sensitivity of 78.3% and specificity of 92.3%. 

 Medical Care: Therapy is aimed at relieving symptoms and is intended to diminish the host inflammatory response to the parasite. Corticosteroids and antihistamines often are used for this purpose.  Antiparasite agents, such as mebendazole, may help reduce symptoms; however, systemic treatment with antihelminthics can result in hypersensitivity reactions. 

 Cutaneous Larva Migrans is less severe.  This is caused by hookworm larvae from the feces of dogs and cats that is deposited on sand or sandy soil.  Children or adults who walk barefooted on the sand can have the larvae borrow into the skin and travel around the area underneath it leaving a red trail as seen in the picture.  They travel 1-2 cm a day and can do so for months until they die.  The lesions are very itchy.  So wear shoes and sit on blankets at the beach.  They are not found in the tide area so you are safe on the beach close to the water.  And don't let the kids eat dirt from the yard in which dogs poop.

  Jan 18, 2006

I looked up everything I could find on Splenda(sucralose).  It is the "new" artificial sweetener on the market and more and more products are coming out with it.  There are a lot of psycho web sites that are against it but they are either founded by the other sweetener or sugar companies trying to discredit it or they are web sites that are flat crazy.  It is not like DDT.  Chlorine is in water and in salt (sodium Chloride).  We have many medications that are the chlorine salt of the compound to make it stable or what ever.  But like anything else.... too much is not good.  I think it is safer than Aspartame (Canderel,E951,Equal, Spoonful, NutraSweet) and tastes better than saccharin (Sweet N' Low).  It has been around for 20 years with a lot of testing.  See below references.  I like one person's web site when she suggested that it is not substituting sweet tastes that we should be doing but what we should work on is getting us to not crave a sweet taste.  Learn to like other tastes.  I think in moderation it is OK for 2 yr up to 100 yr olds.  It really is just a sugar molecule that they took off the oxygen-hydrogen atoms and substituted Chlorine atoms on it.  That causes it not to be absorbed through the lining of the intestines.  What little is absorbed most of it goes out the urine.  If I was to drink any of the artificial sweeteners I would use it.  But any one can be sensitive to just about anything and if it causes you to be nauseated, or cramps or headaches or what ever, then don't drink it.  But that is true of just about every thing like MSG in Chinese food.  So small amounts will not hurt.  Kind of like sunlight, a little is good and too much is bad.  If it is 600 times more sweet than sugar, so they put very little in the Splenda and the rest is filler starch so that it is the same volume as sugar.  But there is 1/600 of the amount.  Very little that we actually take into our body.  So I don't think it is bad but water is better.

 http://www.ific.org/publications/brochures/sucralosebroch.cfm

http://vm.cfsan.fda.gov/~lrd/fr980403.html

http://www.swedish.org/16491.cfm

http://www.goaskalice.columbia.edu/3276.html

 Feb 2, 2006

 In May 2005, CDC received reports of four organ-transplant recipients with unknown illness. All were discovered to have been infected with lymphocytic choriomeningitis virus (LCMV) via a common organ donor (1). Epidemiologic investigation traced the source of the virus to a pet hamster purchased by the donor from a local pet store. LCMV testing of other rodents at the pet store revealed three other LCMV-infected rodents (two hamsters and a guinea pig), supplied by a single distributor (distributor A). Preliminary laboratory testing of hamsters from distributor A has identified an infection rate of approximately 3% among the animals sampled. The facility of distributor A is under quarantine until it can be documented as free of LCMV infection. This report provides background information on LCMV and interim guidance* for the public on reducing risk for LCMV infection from pet rodents.

Background Information

LCMV is a rodent-borne arenavirus endemic in house mouse (Mus musculus) populations worldwide (3--5). Pet rodents (e.g., hamsters and guinea pigs) can become infected with LCMV after contact with wild rodents at a breeding facility, pet store, or home. The prevalence of LCMV in pet rodents is not known. Although other animals could possibly become infected with the virus, documented infections in humans have occurred only after exposure to infected mice, guinea pigs, and hamsters (6,7).

LCMV infection in humans with normal immune systems usually causes either asymptomatic or mild, self-limited illness, characterized by any or all of the following symptoms: fever, malaise, lack of appetite, muscle aches, headache, nausea, and vomiting. Aseptic meningitis also can occur in some patients, but the infection is rarely fatal (6). LCMV infection during the first or second trimester of pregnancy can cause severe illness or developmental defects in the fetus, including hydrocephalus, psychomotor retardation, and blindness (8); the proportion of developmental defects caused by LCMV is not known. Serologic studies of previous infection in humans in urban areas of the United States have demonstrated a prevalence of previous LCMV in those populations of approximately 5% (3).

Person-to-person transmission has not been associated with LCMV, except for transmission from mother to fetus or through organ transplantation (1). Human infection occurs most commonly through exposure (by direct contact or aerosol) to secretions or excretions of infected animals (9). LCMV infection is a well-known occupational risk for laboratory workers who work with LCMV-infected laboratory rodents (9).

An outbreak associated with pet hamsters sold by a single distributor was reported in 1974, when 181 symptomatic cases in persons with hamster contact were identified in 12 states; no deaths occurred (10). The outbreak was brought under control by voluntary cessation of sale and destruction of the infected breeding stock.

Control of Wild Rodents

Environmental modifications and hygiene practices that deter rodents from colonizing the home and work environment are the best means of reducing risk for exposure to infectious rodents. In addition, if rodents are found in work or living areas, safe practices for cleaning rodent waste and nesting materials are recommended. Preventing wild rodent entry also reduces opportunity for infection of pet rodents.

Detailed instructions on rodent-proofing, safe cleaning practices, and trapping wild rodents are available at http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/lcmv.htm.

General Recommendations for Preventing LCMV Infection from Pet Rodents

Hamsters and other rodents are common pets, and the number of documented human LCMV infections from pet hamsters and other rodents is low. Basic precautions can reduce the risk for acquiring LCMV and other infections from pet rodents. Because rodents might not always exhibit signs of ill health resulting from LCMV infection, CDC recommends taking appropriate precautions with any rodent:

The public should be apprised of the risk for LCMV infection from rodents purchased from any pet store.

Destruction or return of recently purchased pet rodents is not recommended. The probability of any one animal harboring LCMV infection is low. All pets are potential carriers of infectious diseases and should always be handled by using appropriate precautions.

Pet rodents must not be released into the wild to prevent introduction of nonnative species to North America.

Persons with specific concerns regarding the health of their pets should seek guidance from a veterinarian.

Purchasing a Healthy Pet

Information on purchasing a healthy pet and general steps to prevent pet rodents from bringing diseases into the home is available at http://www.cdc.gov/healthypets/lcmv_rodents.htm.

Care of Pet Rodents

Anyone handling or keeping pet rodents should take the following precautions to reduce the risk for LCMV infection:

Wash hands with soap and water (or alcohol-based hand sanitizers when soap is unavailable and hands are not visibly soiled) after handling pet rodents or cleaning up pet droppings, cages, or areas where pets have been.

Keep rodent cages clean and free of soiled bedding.

Clean cages outdoors or in a well-ventilated area.

Closely supervise young children when cleaning cages or handling rodents and supervise or assist children in washing their hands immediately after handling rodents and rodent cages or bedding.

Never kiss or hold pet rodents close to the face.

Never allow pet rodents to come into contact with wild rodents or their droppings or nests. Cover pet rodent cages and food supplies and always supervise pet rodents when they are not in their cages.

Precautions for Pregnant Women

Although the risk for LCMV infection from pet rodents is low, pregnant women or women who think they might become pregnant should be aware of the risks associated with LCMV infection during pregnancy. The following precautions can be taken to reduce the risk for acquiring LCMV infection during pregnancy:

Avoid contact with wild rodents. Pregnant women who reside in a household with a wild rodent infestation should have the infestation addressed promptly by a professional pest control company or another member of the household.

Keep pet rodents in a separate part of the home. Pregnant women should ask another family member or friend to clean the cage and care for the pet or arrange for temporary adoption of the pet by a responsible person. Pregnant women should avoid prolonged stays in any room where a rodent resides.

Precautions for Persons with Weakened Immune Systems

For the organ recipients described in this report, transplantation of LCMV-infected organs into persons with medically induced immunosuppression likely increased disease severity. Persons with impaired immune-system function should avoid contact with all rodents.

Testing for LCMV in Pet Rodents

CDC does not recommend testing pet rodents. Serologic testing on rodents can be inaccurate and misleading. All pet animals should be assumed capable of transmitting certain infectious diseases.

Testing for LCMV in Humans

Testing for LCMV infection in asymptomatic persons is not necessary. Similarly, testing persons with previous history of LCMV-compatible illness generally is not useful. Persons with active disease suggestive of LCMV should seek medical care and report any exposures to wild or pet rodents. A physician should determine whether testing for LCMV is indicated. Physicians should work closely with their respective state health departments to discuss forwarding of samples to state laboratories or CDC for testing.

 Feb 8, 2006

 Basically, noise is unwanted sound. It is a pollutant and a hazard to human health and hearing. In fact, it has been described as the most pervasive pollutant in America.

Noise Levels: Both the amount of noise and the length of time you are exposed to the noise determine its ability to damage your hearing. Noise levels are measured in decibels (dB) and sounds louder than 80 decibels are considered potentially hazardous. The noise chart below gives an idea of average decibel levels for everyday sounds around you.

Painful:

150 dB = rock music peak
140 dB = firearms, air raid siren, jet engine
130 dB = jackhammer
120 dB = jet plane take-off, amplified rock music at 4-6 ft., car stereo, band practice

Extremely loud:
110 dB = rock music, model airplane
106 dB = timpani and bass drum rolls
100 dB = snowmobile, chain saw, pneumatic drill
90 dB = lawnmower, shop tools, truck traffic, subway

Very loud:
80 dB = alarm clock, busy street
70 dB = busy traffic, vacuum cleaner
60 dB = conversation, dishwasher

Moderate:
50 dB = moderate rainfall
40 dB = quiet room

Faint:
30 dB = whisper, quiet library

Hazardous Noise: Examples of noise levels considered dangerous by experts are a lawnmower, a rock concert, firearms, firecrackers, headset listening systems, motorcycles, tractors, household appliances (garbage disposals, blenders, food processors/choppers, etc.) and noisy toys. All can deliver sound over 90 decibels and some up to 140 decibels.

Can't my ears "adjust" and "get used" to regular noise?  If you think you have "gotten used to" the noise you are routinely exposed to, then most likely you have already suffered damage and have acquired a permanent hearing loss.  Once destroyed, the hearing nerve and its sensory nerve cells do not regenerate!

Workplace Noise:  Many people are exposed to hazardous noise levels at work, including firefighters; military personnel; disc jockeys; subway workers; construction workers; musicians; farm workers; industrial arts teachers; highway workers; computer operators; landscapers; factory workers; and cab, truck, and bus operators, to name a few. And, they number nine million according to the U.S. Environmental Protection Agency (EPA).  Continued exposure to more than 85 decibels (dBA) of noise may cause gradual but permanent damage to hearing. Hearing loss is accelerated by louder noises. Noise can also hamper job performance, increase fatigue, and cause irritability.

Home, Community, and Recreational Noise  Exposure to damaging noise does not come only form the workplace. If you use stereo headsets, operate power tools for yard work, have a long daily commute in heavy traffic, or use a number of household appliances, you still may be exposed to potentially damaging noise.

Recreational activities such as hunting, target shooting, motorboating, waterskiing, jetskiing, snowmobiling, motorcycle riding, woodworking, rock music, or stereo headsets are sources of hazardous noise. So are some movie theaters, home entertainment centers, car stereo systems, health clubs, dance clubs, bars, and amusement centers.

Just in our day-to-day living activities we can also be exposed to damaging noise when we use lawnmowers, hairdryers, blenders, power saws, weed-wackers, leaf blowers, food choppers/processors, and other convenience appliances.

Children's toys can also be hazardous, e.g., toys with horns and sirens, toy vacuum cleaners and vehicles, musical instruments, talking dolls, squeeze toys, and battery-operated toys that emit sounds.

Links

www.lhh.org/noise

www.nidcd.nih.gov/

www.hearnet.com

www.nonoise.org

www.cdc.gov/niosh/noisepg.html

www.safe-at-work.com

http://www.rogerknapp.com/medical/noise.htm

And the best advice:

 A good rule of thumb is to remember that if you must shout to be heard, then you should be avoiding the situation or using ear protection.

Feb 10, 2006

Top 5 Causes of death

1-4yr   

1. Accidents         34%

2. Congenital Defects        10%

3. Cancer 8%

4. Homicide          7%

5. Heart Disease   4%

 5-9yr   

1. Accidents         38%

2. Cancer 17%

3. Congenital Defects        6%

4. Homicide          4%

5. Heart Disease   3%

 10-14yr           

1. Accidents         36%

2. Cancer 13%

3. Suicide 6%

4. Congenital Defects        5%

5. Homicide          5%

 15-19yr           

1. Accidents         50%

2. Homicide          14%

3. Suicide 11%

4. Cancer 5%

5. Heart Disease   3%

 For all ages Children and Adults: (Top 5 caused by smoking)

1. Heart Disease   28%

2. Cancer 23%

3. Strokes            6%

4. Chronic Lung Dis.         5%

5. Accidents         4%

 Deaths per mile traveled. In Britain, 5.9 people out of 100,000 people are killed on the road each year, compared with 11 in the European Union as a whole, 8.2 in Japan, and 15.2 in the United States. In El Salvador, the figure is 42.2 per 100,000 people. Recognize, however, that here in the United States, the most dangerous time to drive is probably on Super Bowl evening. The Super Bowl remains the most popular regular television broadcast in the United States with an average audience in excess of 130 million. A study was recently under-taken to look at driving fatalities on 27 consecutive Super Bowl Sundays, largely because alcohol, inattention, and fatigue are major contributors to fatal motor vehicle accidents. This study compared each Super Bowl Sunday to the immediately preceding and subsequent Sundays. What was found was quite astounding; there was a 41% relative increase in the average number of fatalities after the Super Bowl telecast ended. This finding was observed in 21 of 27 years examined in retrospect and represents about 7 added deaths on the average Super Bowl Sunday weekend. The same is also true of nonfatal driving injuries, which are sufficiently numerous to be able to document that they were particularly increased in states with a losing football team. Thus it is that it is actually statistically more dangerous to drive on Super Bowl Sunday nights than it is to drive about on New Year's Eve!

 I let the numbers speak for themselves.

Feb 19, 2006

Breast Cancer and somewhat to ovarian cancer is related to a DNA genetic defective gene.  In a data-set based on 4,730 histologically confirmed breast cancer patients aged 20 to 54 years and on 4,688 controls, the latter group of workers presented evidence for the existence of a rare autosomal dominant allele  leading to increased susceptibility to breast cancer. The cumulative lifetime risk of breast cancer for women who carry the susceptibility gene was predicted to be approximately 92%, while the cumulative lifetime risk for noncarriers was estimated to be approximately 10%. The prevalence of cancer-predisposing BRCA1 gene in the general population is estimated to be between 1/500 and 1/1000.

Who should we test?

• Hereditary cancer has general features that include:

• Cancer diagnosed at a young age (earlier than 50 years old)

• Multiple primary cancers in the same person

• A combination of certain cancers in a family, such as breast and ovarian or colon and uterine

• Hallmark features in a personal and family history that suggest hereditary breast and ovarian cancer are:

• Breast cancer before age 50

• Ovarian cancer at any age

• Breast cancer in both breasts

• Breast cancer and ovarian cancer diagnosed in the same person

• Male breast cancer

• Ashkenazi Jewish ancestry

The American Society of Clinical Oncology (ASCO) recommends that genetic testing be offered when:

• You have a personal or family history that suggests hereditary cancer.

• The genetic test can be adequately interpreted: You have a family history or ethnic background that provides enough information to interpret your test results.

• The test results will be useful: They can aid in your diagnosis, influence your medical or surgical management, or help other family members at risk for hereditary cancer.

Reason for this email?

Wheather we should test the children of parents with this genetic defect has been debated.  Do we even inform them of the possibility until they are adults and let them live a childhood without worries?  Some would say test them young so they grow up understanding the risks and can be tested.  Or do we tell them at age 20 and test them then?  Or do we tell them as an adult and let them decide?  I personally would test them at age 12 and tell them only if they were positive.  If negative then not tell them anything so they do not worry.  But every one with the positive gene must decide what to do about their children.

 References:

• http://ncbi.nih.gov/entrez/dispomim.cgi?id=113705

• http://www.dnadirect.com/tests/breast_cancer/should.jsp?src=google&seg=breast-cancer&product=BOCA&kw=brca1&mtc=

• http://www.myriadtests.com/provider/mutprev.htm

• http://en.wikipedia.org/wiki/BRCA1

• http://www.geneclinics.org/profiles/brca1/details.html

March 4, 2006

 We are getting new vaccines al the time and the vaccine schedule has changed every year.  Last year we just started giving the TdaP to teens so they do not get whooping cough and also started giving the Meningeococcal Meningitis to 12 yr old and older.  Soon we will have a vaccine against Roto Virus.  That is going around now and every winter.  It is 3 days of vomiting and fever plus 7 days of diarrhea.  It will be for 2-6 months old. 

 There are new ones soon to be out for Human papillomavirus (it causes venereal warts and cervical cancer).  They are also working on vaccines for Chlamydia, Herpes Simplex Virus, HIV (aids), cytomegalovirus (causes retardation) and group B strep.  With germs getting resistant to medications it is important we develop more vaccines. 

 Vaccines are safe and they do not cause Autism.  Ignore all these whackos on the internet who are against everything under the sun.

 March 6, 2006

 If you think your child maybe using the internet for bad things or you want to know if your child is considering sex, drugs, or suicide, then get a program that will keep track of their online communication.   Use software such as , PC Tattletale ($50) or eBlaster ($100). These programs can observe the child's computer activity and determine how involved he may be in an online community that encourages such activities.

March 23, 2006

 You should answer your children's questions about the facts of life as they ask them.  Give them just enough information to answer the question at their level of understanding and development.  You do not want to keep them ignorant until 14 and then have the big talk.  You should not have to do a "big talk" because you want to give them a little information every year.  There are a lot of books on the market that help you when they get into more details at puberty.  Here are a few:

The care and Keeping of you.
What is happening to my body.

You can get these at stores or on line at Amazon.com.  The main thing is telling them your morals starting in grade school.  Tell them what you think about people who steal, cheat, lie, use drugs in a firm way.  The main reason they do not do it before marriage is the rath of the parents.

 March 28, 2006

 President Bush signed into law a few months ago a bill to establish a national databank of umbilical cord blood and bone marrow that can match patients who need a transplant.  It will provide $79 mil to increase the number of cord blood units available for matches allowing 90% of the patients to get a match.  Cord blood is good because there is very little tissue rejection and can have a very high success rate.  Some parents have asked about storing the baby's cord blood for a fair amount of money in case it might be needed for a marrow transplant.  You do not need to store your own babies cord blood since we have the technology to use other cord bloods.

 April 5, 2006

 I had a recent Newsymail on loud noise and hearing damage.  This was an article at Kim Komando site:  www.komando.com  I thought parents ought to know.

 "Apple has issued an update for its popular iPod music players. It adds
one important feature to the player: the ability to limit the maximum
volume at which music is played. This is in response to complaints that
the iPod can damage your hearing if played at a high volume.

Players like the iPod are particularly dangerous because the batteries
last for a long time. You can listen to it for hours. Most adults can
probably judge when their music is too loud. But parents will
appreciate being able to set a limit for their child's iPod - and
password protect it. To get the update, visit Apple's site:
    http://www.apple.com/ipod/download/ "

 April 16, 2006

 You may have heard of the recent outbreaks of Mumps in some of the northern states.  It was primarily in the late teens and 20-30 year olds.  It seems that the immunity of the MMR is not lifelong.  Just as we were seeing Pertussis in the young adults because their immunity wore off.  Now we give a TdaP to the 12-14 year olds so they don't have a three month cough and not give it to the 2 month old babies that have not had a vaccine yet.  It sounds like we need to give the MMR to the 12-14 year olds also.

 April 24, 2006

 Bug spray and Sunscreen

 Use of Deet has been shown to be safe and effective in preventing insect bites.  It can be used down to 4 months of age in concentrations of up to 25%.  I prefer to keep it at 10-15% preparations and start it’s use at 4-6 months old.  All concentrations above 10% block the same amount of insects but the higher ones last longer time.  The 10% deet repels just as good as the 50% but they last a different length of time.  I like to put less on the skin but apply it more frequently.  10% lasts 2 hours, 30% lasts 5 hours, and 50% lasts 10 hours.  Older kids can use the higher concentrations and teens can use the 50% deet without worry.  Do not apply to the hands of infants and small children.  You can spray your hand and apply it to the face of infants.  Careful about applications of deet because it can harm plastics (eyeglass frames), synthetic fibers like rayon and spandex, leather, some watch crystals.  It does not harm cotton or wool.

 There are two other repellants without deet.  One is Picaridin is a synthetic safe repellant that does not harm fabrics like deet and it only lasts 2 hours.  It is available in 7% concentrations (Cutter Advanced) The other product is Oil of lemon eucalyptus which is a plant based repellent and lasts 90 minutes of protection.  I don't recommend SkinSoSoft.

 Sunscreen products are variable and act differently.  The SPF is confusing.  The higher number only lasts longer but does not protect any better.(Just like the deet.)  The SPF 15 will protect even very sensitive skin but only lasts 2 hours.  The SPF 30 would last 4 hours.  The mistake is not putting enough on the skin to get the full effect and less SPF 15 would result in an effect of SPF 7.  So put plenty on the skin.  So many people recommend 20-30 SPF because they figure you will not put enough on the skin.  You should use a sunscreen that protects both UVA and UVB rays.  Apply it 30 minutes before going out and apply it before you put Deet repellents on the same areas.  Do not use the combined products that have sunscreen and repellents in it.  Apply sunscreen every 2 hours.  The water resistant or sweat resistant products only last 40 minutes and the “very water resistant” products only last 80 minutes.  So you need to apply them when swimming very frequently.  Consider putting a small T-shirt on them when swimming a long time.  They are also starting to manufacture “wet suit” type tops for children to wear.  One study from Europe showed children whose parents always kept shirts on their children had far less moles as adults than those who did not wear shirts.  Tanning beds are worse than the sun so use the tanning chemicals, which are safer.

 We still see sunburns in children even though we warn that 2 sunburns will double your chance of Melanoma later.  80% of our lifetime sun exposure occurs before 18 yr of age.  So keep them covered with this stuff.  Just like buckling up in the car, think before you go and keep them safe.

 April 25, 2006

 Here are some Studies about too much TV.

 Study I:

Objective: To test the effects of media violence exposure on negative affect, hostile social information processing, uncooperative behavior, and attitudes toward health risk behaviors among young men varying in lifetime violence exposure within the home and community.

 Setting: University campus and one hundred male undergraduates aged 18 to 21 years.

 Men randomly assigned to play Grand Theft Auto III exhibited greater increases in negative affect, more permissive attitudes toward using alcohol and marijuana, and more uncooperative behavior in comparison with men randomly assigned to play The Simpsons.

 Study II:

 Objective: To determine if television viewing is associated with the risk of initiating sexual intercourse in young adolescents.  Participants: The 4808 students younger than 16 years who had not initiated intercourse before baseline interview.

 Exposures: Primary exposure was self-reported daily television watching, categorized as low (<2 hours) or high (>2 hours) use. Secondary exposure was parental regulation of television programming watched.

 Main Outcome Measure: Odds ratio for initiating intercourse by l-year follow-up,

 Results: At baseline, 2414 (48.8%) subjects watched television 2 or more hours per day. By 1-year follow-up, 15.6% subjects had initiated intercourse.  Among young adolescents who reported strong parental disapproval of sex, watching television 2 or more hours per day and lack of parental regulation of television programming were each associated with increased risk of initiating sexual intercourse within a year.

 [Parents attitudes do make a difference!]

 Study III:

Arch Pediaf r Adolesc Med. 2006;160:375-380

Objective: To test the independent effect of television exposure in preschool-aged children on overweight risk.

 Participants: One thousand sixteen children selected via conditional random sampling.

 Main Exposure: Being awake in the room with the television on for 2 hours or more per day at age 36 months.

 Main Outcome Measures: Child overweight (body mass index) calculated from measured anthropometrics at ages 36 and 54 months. Covariates tested included child sex and race; maternal marital status, education, age, and depressive symptoms; income-needs ratio, child behavior problems; Home Observation for Measurement of the Environment total score; hours per week in nonparental care; and proportion of television exposure that was educational.

 Results: At age 36 months, 5.8% of children were over-weight; at age 54 months, 10.0% were overweight. Exposure to 2 or more hours of television per day was associated with an increased risk of overweight at both age 36 months and age 54 months in unadjusted analyses.

 Conclusion: Excessive television exposure is a risk factor for overweight in preschoolers independent of a number of potential confounders associated with the quality of the home environment.

 -----------------

Summary:

THE RESEARCH PRESENTED IN THIS SPECIAL issue of Archives of Pediatrics  clearly illustrates that the media have disturbing potential to negatively affect many aspects of children's healthy development, including weight status, sexual initiation, aggressive feelings and beliefs, consumerism, and social isolation. Such evidence offers increasing support for the American Academy of Pediatrics' recommendation that children older than 2 years spend no more than 2 hours per day with screen media, preferably educational screen media.  For decades we have known that excessive media use and exposure to problematic content are detrimental to children's healthy development. Despite this fact, we have been slow to develop interventions that are evaluated and replicated across a variety of settings. Several authors in this issue write that parents need to be educated about the negative effects of media, but it is not clear how to target messages in such a way that parents will feel that they have the power to make changes within the home.

 My comments:

Play some board games, watch some TV, and then make your children also play by themselves to use their own minds.  Remember going to your mother and saying “I’m bored.” And she said… “go find something to do.” She forced us to play and think for ourselves.  Keep the balance between electronic stimulation, human interaction, and self motivation and imagination.

May 7, 2006

The Choking Game achieves a brief high or euphoric state by stopping
the flow of oxygen containing blood to the brain.  They are most frequently in the 10 to 16 year age.   Sometimes children choke each other until the person being choked passes out. The pressure on the arteries is then released and blood flow to the brain resumes
causing a "rush" as consciousness returns. Some do it for the high which can become addictive.  Others do it because it's "cool" and risky.  Most of the kids who have died from this were not children in trouble.  Most were well liked, active, intelligent,
stable children who wanted nothing to do with drugs or alcohol.  This
was an activity they felt was safe. There are variations of this
activity which involve hyper-ventilating until the participant loses
consciousness.  There is a lesser chance of death but it is still not safe.   
Playing this game in any form causes the permanent and cumulative death
of large numbers of brain cells.  The variation in blood pressure may
also cause strokes, seizures, and retinal damage.

Watch for:

• Inexplicable marks or bruises on the

• Belts, leashes, ropes, shoelaces tied in strange knots or        
       found in unusual locations

• Disorientation after spending time alone

• Locked bedroom doors

Then there are Inhalants.  Most parents are in the dark regarding the popularity and dangers of inhalant use. Also called Huffing.

But children are quickly discovering that common household products are inexpensive to obtain, easy to hide and the easiest way to get high. According to national surveys, inhaling dangerous products is becoming one of the most widespread problems in the country. It is as popular as marijuana with young people. More than a million people used inhalants to get high just last year. By the time a student reaches the 8th grade, one in five will have used inhalants.

 But you probably don't know that there are more than 1,000 products that are very dangerous when inhaled -- things like typewriter correction fluid, air-conditioning refrigerant, felt tip markers, spray paint, air freshener, butane and even cooking spray. Anything with a strong chemical odor.

 Statistics show that young, white males have the highest usage rates.   Signs of use in the child: paint or stains on body or clothing,   spots or sores around the mouth,   chemical breath odor, drunk, dazed or dizzy appearance, and anxiety, excitability, irritability

 Products they inhale:

Anesthetics

Nitrites
( Nitrite room odorizers)

See:
http://www.inhalants.org/about.htm
http://www.cbsnews.com/stories/2004/06/01/eveningnews/main620528.shtml

and news video:
http://video.cgi.cbsnews.com/video/video.pl?url=/media/2004/06/01/video620644.wmv

May 29, 2006

Phytophotodermatitis (doctors love big words) refers to a skin eruption that results from the interaction of radiant energy from the sun with photosensitizing compounds found in various plants. These agents that potentially produce phototoxic effects are present in many plant varieties.  The compounds cause direct damage to the DNA of epidermal cells, resulting in reactions that range from macular erythema or hvperpigmentation to blistering lesions, depending on the extent of exposure. The figures show the spectrum of skin reactions that may be seen.

The acute phase of Phytophotodermatitis is often characterized by erythematous (red) plaques, or blisters  much like severe sunburn. Lesions may simply become erythematous or appear as hyperpigmented (darker brown) patches without a preceding erythematous phase

The plants that are the most common causes of this dermatitis are limes, lemons, and celery. Natural grasses, carrots, oranges, parsley, parsnips, and several plants in the family Compositae, such as sagebrush, goldenrod, chrysanthemum, ragweed, and cocklebur, may also cause it. Tobacco, figs, garlic, hot peppers, and hyacinth and daffodil bulbs are among the other offenders.

There is no specific treatment for this reaction.  You can try hydrocortisone  cream.

The main thing is to be aware of it.  Lemons on the cheeks cause it and you are not aware it is the lemons and then going out into the sun.

 June 9, 2006

 I have mentioned in the past about the HPV vaccine that prevents most Cervical cancer.  It was approved yesterday by the FDA for 9-26 year old females (primarily for 11-12 yr olds.)  6 million become infected with HPV each year and there are 9,700 cases of cervical cancer each year and 3,700 deaths..... each year.  The vaccine does not prevent all... it is against the common strains that cause 70% of cancer and 90% of genital warts.

 Also many parents ask about swimming lessons for infants less than one.  You really are not going to teach them to swim and if you did .... you are not going to trust them to save their lives if they fell in.  That is the parent's job to keep them  from drowning.  They also can swallow too much water and cause a seizure.  The little babies less than 6 months old can get hypothermia and severely low body temperature.  Watch their body temperature after in a cold pool at any age and any shivering should cause you to get them out and dry them off at any age.

 If they are under water a lot of the time.... put 1/2 alcohol 1/2 white vinegar in their ears after swimming.

 June 27, 2006

 We are still seeing some Swimmer’s ear.  You can tell that is what is wrong because they have very tender ears… it hurts to move the ear lobe … especially when pulling their T shirt off over their head. 

 Prevent it by putting olive oil in their ears before swimming and/or putting a solution of half rubbing alcohol half white vinegar in their ears after swimming.  Don’t put these in their ears if they have an infection.  These are for preventing it.

 We should be getting the new vaccine for HPV in the next few weeks.  I don’t know when the insurance companies will pay for it.  Check first.  It is a series of three shots in girls 7-25 yr old.

 June 28, 2006

 A recent study showing that teens are more likely to smoke if their friends are smokers ...duh!  As if we could not guess that one.  (It was even more if the parent smokes.)   So like we have mentioned before, make sure you kids friends are not smoking, sniffing glue, using drugs, cussing, or being promiscuous, or it will increase your child's likelihood of doing the same.  It does matter who your child hangs with.  In middle school, stand beside the Asst. Principle in the hall and ask them to point out the bad and good kids.  Look at what they are wearing and don't let your kids wear those clothes, jewelry, or makeup.

 June 30, 2006

 Evenflo Simply Effort Gate
This is the best gate I have seen.  You can have a remote that you push a button and the gate is open to swing and let you through.

• Electronic, hands-free gate for safety and convenience
• Wall console button lets you unlock the gate with the touch of a button; red/green light shows whether gate is properly locked
• Premium styling and neutral color matches any home décor
• Manual operation mode; low battery indicator light; simple pressure mounted installation; JPMA certified
• 29H"; expands from 28-37.5W" with 2 included extension panels

  See: http://www.target.com/gp/detail.html/601-1653133-8786569?_encoding=UTF8&frombrowse=1&asin=B000BM4OFE

  July 25, 2006

 News blast:

CDC’s Advisory Committee Recommends Changes in Varicella Vaccinations.  Second dose of varicella vaccine to offer more protection for children, adolescents, and adults

The Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control and Prevention (CDC), in its meeting in Atlanta in June 06, voted to recommend a second dose of varicella (chickenpox) vaccine for children four to six years old to further improve protection against the disease. The first dose of varicella vaccine is recommended at 12 to 15 months old.

Fifteen to 20 percent of children who have received one dose of the vaccine are not fully protected and may develop chickenpox after coming in contact with varicella zoster virus. Additionally, one dose of the vaccine may not continue to provide protection into adulthood when chickenpox is more severe. A second dose of varicella vaccine provides increased protection against varicella disease compared to one-dose.

Before licensure of the varicella vaccine in 1995, each year there were about four million cases of varicella, 13,500 hospitalizations and 150 deaths. Cases of varicella have steadily declined 80 to 85 percent in surveillance sites since the licensure. From 1995 to 2001, varicella hospitalizations declined by 72 percent and deaths, among those 50 years old and younger, decreased by 75% or more.

  The cases of Chicken Pox after the vaccination is mild with only a few spots and no fever.  But there are rare incidences and the problem of giving it to the elderly who get Shingles or to the infants less than one.  The American Academy of Pediatrics has not voted yet on the second dose of Varicella vaccine and the State will be a few years putting it into law for a requirement to enrole into school.  But it will come some day.  So I will be suggesting to parents of 4-6 yr olds that they get the second vaccine of Chicken Pox (Varicella).

 (note from later thinking Dec ’06:  Since the second case later of Chicken Pox is so mild with no fever and only a few spots, maybe it is better to just give one dose.  The breakthrough case later is definitely life immunity.  Will a second dose of vaccine just delay the breakthrough case until adulthood.)

 July 11, 2006

 Flat feet

  There is a normal flexible flat feet in childhood.  Way below 1% have stiff pathological flat feet.  The incidence of flat feet in boys are 3yr-62% and 6yr-39%.  In girls it is 3yr-42% and 6yr-15%.  There is more if they were obese.  Most authorities feel that hard shoes weakened the muscle and that barefoot, soft shoes or sandals were better.  Arch support and corrective shoes in children are not helpful and even can weaken the muscles and prolong the flat feet.  If they are in their teens and having pain in their feet/knees, then it needs help with arch support.  Smaller children do not need expensive therapy.

  July 12, 2006

 50,000 children every year fall out of shopping carts, and 20,000 go the emergency room with head injuries and broken bones.  4% require hospitalization.  Buckle them into the seat and wash the handle off with hand sanitizer solution so they don't get sick. 

 Sept 11, 2006

 A study came out in Pediatrics Journal analyzing air pollution and SIDS in Southern California.  There was a 28% increase in infant respiratory deaths for every increase of 1-ppm in average Carbon Monoxide levels.  Makes sense because there is an increase in SIDS when there are smokers in the house.  There was a 17% increase for every 1-part per hundred million increase in Nitrogen dioxide levels.  Now that we sleep babies on their backs, SIDS is near 1/10,000.   So a 33% increase would be 1.3/10,000.  Still very rare.  But an increase of 3ppm would be 100% increase and SIDS would go to 1/5000.  So pollution does matter.  I wish there was a less expensive air purifier for the home that would take the CO and the NO2 out of the air. 

 Sept 15, 2006

 A french proverb says: "If it can lick, it can bite."  Millions of animal bites occur in the world and most here are cats and dogs.  Mostly on the arms.  They can get infected by several kinds of bacteria but the most common is a germ called Pasteurella multocida.  There occurs redness, pain, swelling, and even fever and it can be quickly 12-24 hours later.  Dog bites get infected only 9% of the time while cat bites become infected from 28% up to 80% of the time.  (There is also Cat Scratch Fever but that is another story.)  The infection is easily treated with Amoxacillin, Doxycycline, higher level Cephalosporins, Septra, Zithromax, and Fluoroquinolones.  Dog and cat bites cause 300,000 ER visits a year, 10,000 hospitalizations, and 20 deaths.  So watch for infections when your kids get bit by their little Garfield.  Meow!

 Sept 29, 2006

 There was a big outbreak of Measles in college kids this last year and most were in Indiana and nearby states.  I thought it was from the MMR not working well and the antibodies not lasting long.  But after investigation, it turns out all but one had not had the MMR because of the parent's fear of the vaccine.  We proved the vaccines do not cause Autism. 

Be sure to get the flu vaccine for kids 6-24 months and those with asthma and heart disease.  If there is enough flu vaccine for the other children, the CDC recommends all children get it.  There is less flu in the parents and grandparents if the children do not catch it.

 Oct 29, 2006

 A study came out in Pediatrics Journal comparing viewing of TV and Video Games with grades in School.  There was a direct relationship between more TV viewing hours and/or access to cable TV during the week and lower grades.  There was also lower grades with viewing R-rated shows.  When parents restricted these, the children did better in school.  There was not a correlation with Saturday television.   I and the American Academy of Pediatrics recommend restricted TV viewing (i.e. 1 hour or less Sunday 5pm to Friday 4pm.)

  Plus there is also a coorelation with too much TV and obesity.

  See: http://www.aap.org/advocacy/archives/augschool.htm
http://depts.washington.edu/tvhealth/links.htm

  Oct 19, 2006

 Hey how about some good news.

  There is a 13% decrease in sexual behavior in High School kids, 24% decrease in multiple partners, and covering protection when active increased 36%.  So keep talking to your kids about this stuff and push abstinence.  (Never tell your kids the crazy things you did growing up.)  This trend reflects better parents.

see: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5531a4.htm

  Also there is a vaccine coming out for Bird flu.  Most of that scare was news media hype like so many other things.  But if there is an epidemic in humans of it, there will be help.  We will get shipments of the regular flu vaccine the first week or so in November and are scheduling now for flu shots.  You can also get the older kids their shots at the local drug stores that give them for 15$ … almost same money as your co-pay. 

  Keep drilling morals into those kids and have a safe Halloween.

 Oct 24, 2006

 We screen all newborn infants for deafness with the incidence approximately 1/2000 births.  ENT doctors now put in Cochlear Implants to help the patient hear again.  This was more in the news when Rush Limbaugh became deaf and had this done.  He now hears fairly well.  Infants who are born deaf or become deaf after meningitis can have the procedure and if done early then 75% will hear well 3-5 years later.  The 50 million dollar man … for you older adults who remember him.  I wish they could replace some of my other body parts.

  See: http://www.nidcd.nih.gov/health/hearing/coch.asp
http://www.cochlearimplant.com

Nov 8, 2006

Head lice is sometimes a big problem because they are getting resistent to the shampoos that kill the lice.  There are several suggestions as to how to treat them at the website. 

Recently a study with hair dryers showed it killed 55% live lice and 97% eggs.  If you used their hot air blower with twice the air volume and less heat then it killed 80% of live lice.  They used the regular hand hair dryer.  The hair was divided into 20 sections and the hair dryer was used on the hair/scalp for 30 seconds on each side of the area with a steady hold and no motion.  The whole process took 30 minutes.  There was more killing of the lice if the wind velocity was increased and a plastic "comb" lifted the hair to get the hot wind into the scalp better.  So that is a neat way to treat them without any chemicals.

 Nov 27, 2006

 Studies showed there was a dramatic decrease in Diarrhea in children attending daycare if there was good hygiene.  Well … Duh!  I bet you knew that.  But the studies did show what caused it was the access to good hygiene.  Daycares that had at least one sink per room and/or a diaper changing station in rooms with infants in diapers, there was a big decrease in cases of diarrhea compared to those without it.  So that gives you something to ask for in looking at daycare and preschools.

 Dec 11, 2006

 New CDC Guidelines for Routine HIV Screening

  Aiming to reduce the number of new HIV infections and save lives among those already infected, the CDC is recommending that all Americans ages 13 to 64 be voluntarily screened for HIV as part of their routine medical care. The new guidelines mean big changes for primary care physicians.

  Why is routine, widespread HIV screening needed? According to the CDC:

• Studies show that when people find out they are HIV-positive, most take steps to avoid infecting others.

• Up to 1.2 million people in the United States are living with HIV, and about 40,000 people become newly infected each year.

• 50 to 70 percent of new sexually transmitted HIV infections are attributable to the 25 percent of HIV-infected people who don't know their HIV status.

• Nearly 40 percent of those diagnosed with HIV are diagnosed within a year of progressing to full-blown AIDS, when it may be too late to fully benefit from life-saving anti-retroviral treatments.

The new guidelines: key provisions

All Americans ages 13 to 64 should be voluntarily screened for HIV infection as part of their routine medical care. This is a significant change from the CDC's previous guidelines, which recommended HIV testing only for high-risk individuals -- such as intravenous drug users and people with multiple sex partners -- and for everyone in healthcare settings with an HIV prevalence of more than 1 percent.

Individuals at high risk of HIV infection should be tested at least once annually. Others should be tested at least once.

HIV testing must be voluntary and undertaken only with the patient's knowledge. Patients should have the opportunity to decline testing.

To overcome significant barriers to testing, pre-test counseling and written consent specifically for HIV tests should no longer be required. Consent for HIV testing should be included in the general consent for medical care.  Currently, 14 states require separate signed consent for HIV testing,

Teen pregnancy is decreasing but the rate of sexually active teens is still quite high.  Many think oral is safe and it is not really sex (ala Bill Clinton).  I don’t plan on testing a lot of teens for HIV but I wish they would reinstate the mandatory blood tests for a marriage license.  Test them for HepB, HepC, and HIV.  Maybe tests when graduating from college?  Oh well, I’m not sure of the right answer but some kind of screening would be good since 50% of cases are from the 25% who do not know they have it.  (Yeow… that means that many cases are from the 75% who DO KNOW they have it.  Scary thought.)

  Dr. Knapp