Study says foster care benefits brains
Fri, 21 Dec 2007 04:23:26 GMT
By LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Toddlers rescued from orphanages and placed in good foster homes score dramatically higher on IQ tests years later than children who were left behind, concludes a one-of-a-kind project in Romania that has profound implications for child welfare around the globe.
The boost meant the difference between borderline retardation and average intelligence for some youngsters.
Most important, children removed from orphanages before age 2 had the biggest improvement — key new evidence of a sensitive period for brain development, according to the U.S. team that conducted the research.
"What we're really talking about is the importance of getting kids out of bad environments and put into good environments," said Dr. Charles Nelson III of Harvard Medical School, who led the study being published Friday in the journal Science.
The younger that happens, "the less likely the child is to have major problems," he added.
The research is credited with influencing child-care changes in Romania, and UNICEF has begun using the data to push numerous countries that still depend on state-run orphanages to start shifting to foster care-like systems.
"The research provides concrete scientific evidence on the long-term impacts of the deprivation of quality care for children," UNICEF child protection specialist Aaron Greenberg said. "The interesting part about this is the one-on-one caring of a young child impacts ... cognitive and intellectual development."
That orphanages are not optimal for child development comes as no surprise. Earlier studies have found that thousands of children adopted during the 1990s from squalid orphanages in Eastern Europe, China and elsewhere continued to face serious developmental problems even after moving to affluent new homes with doting parents.
But questions remain. Were those abandoned or orphaned children who spent more time in orphanages less healthy to begin with? How much damage does neglect and lack of stimulation in the early months of life do? How long does that damage last?
In the study, U.S. researchers randomly assigned 136 young children in Bucharest's six orphanages to either keep living there or live with foster parents who were specially trained and paid for by the study. Romania had no foster-care system in 2000 when the research began.
The team chose apparently healthy children. Researchers repeatedly tested brain development as those children grew, and tracked those who ultimately were adopted or reunited with family. For comparison, they also tested the cognitive ability of children who never were institutionalized.
By 4 1/2, youngsters in foster care were scoring almost 10 points higher on IQ tests than the children left in orphanages. Children who left the orphanages before 2 saw an almost 15-point increase.
Nelson compared the ages at which children were sent to foster care. For every extra month spent in the orphanage, up to almost age 3, it meant roughly a half-point lower score on those later IQ tests.
Children raised in their biological homes still fared best, with average test scores 10 points to 20 points higher than the foster-care kids.
What does that mean as these children grow up? Just this week an anxious acquaintance cornered Nelson to ask what to expect of a child who spent nine months in a Vietnamese orphanage.
"There's much more to functioning in life than your IQ," Nelson stresses.
Plus, he only now has begun testing these children again as they turn 7 and 8. They might catch up.
For now, Nelson tells adoptive parents, "The older the child is when they leave the institution, the more likely that child may have some developmental problems and the more difficult it may be to ameliorate those problems. ... The message to parents is simply to go into this with their eyes open, but not to give up."
For the U.S. and other countries that depend on foster care instead of orphanages, the study has implications, too, because it used high-quality foster care that is not the norm in many places, Nelson noted. Studies comparing the impact of foster care of varying quality are under way.
The Romanian government requested the study and began its own foster care program shortly thereafter. Early study results are credited with influencing Romania's recent prohibition on institutionalizing children under 2 unless they are severely disabled.
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On the Net:
Science: http://www.sciencemag.org
Risky sex returns syphilis to Europe
Fri, 21 Dec 2007 04:23:43 GMT
By MARIA CHENG, AP Medical Writer
LONDON - Syphilis is back: The sexually transmitted disease long associated with 19th Century bohemian life is making an alarming resurgence in Europe.
"Syphilis used to be a very rare disease," said Dr. Marita van de Laar, an expert in sexually transmitted diseases at the European Centre for Disease Prevention and Control. "I'm not sure we can say that anymore."
Most cases of syphilis are in men, and experts point to more risky sex among gay men as the chief cause for the resurgence. But more cases are being seen among heterosexuals, both men and women, too.
Syphilis was the sexual scourge of the 19th Century, and is believed to have killed artists like poet Charles Baudelaire, composer Robert Schumann, and painter Paul Gauguin. But the widespread use of penicillin in the 1950s all but wiped it out in the Western world.
In the last decade, however, syphilis has unexpectedly returned, driven by risky sexual behavior and outbreaks in major cities across Europe, including London, Amsterdam, Paris and Berlin.
• In Britain, syphilis cases have leapt more than tenfold for men and women in the past decade to 3,702 in 2006, according to the Health Protection Agency. Among men in England, the syphilis rate jumped from one per 100,000 in 1997 to nine per 100,000 last year.
• In Germany, the rate among men was fewer than two per 100,000 in 1991; by 2003, it was six per 100,000.
• In France, there were 428 cases in 2003 — almost 16 times the number just three years earlier.
• In the Netherlands, cases doubled from 2000 to 2004. In Amsterdam, up to 31 men per 100,000 were infected, while the rate was much lower in other regions.
Similar trends have been seen in the United States.
In 2000, syphilis infection rates were so low that the U.S. Centers for Disease Control and Prevention embarked on a plan to eliminate the disease. But about 9,800 cases were reported in 2006.
In Europe, Van de Laar said syphilis' reappearance was so surprising that many doctors initially had trouble diagnosing it.
Though these days it mainly affects urban gay men, experts worry that the disease could also rebound in the general population if stronger efforts to fight it are not taken soon.
In 2005, British authorities reported that syphilis was spreading across the entire country, and that more heterosexual men and women were being infected.
"These increases may lead to increases in diagnoses of congenital syphilis over the coming years," said Kate Swan, a spokeswoman for the Health Protection Agency.
Pregnant women with syphilis can pass it on to their babies. Nearly half of all babies infected with syphilis while they are in the womb die shortly before or after birth.
Syphilis is a bacterial disease causing symptoms that include ulcers, sores and rashes. In extreme cases, it can result in dementia or fatally damage the heart, respiratory and central nervous systems. Syphilis is treatable with antibiotics if caught early.
Once there are more than just a few isolated cases, containing the disease is difficult.
Advances made in treating AIDS may have inadvertently boosted syphilis' spread.
"The evidence points to an increase in unsafe sexual behavior since anti-retrovirals for AIDS came along in 1996," said van de Laar.
After decades of being instructed to use condoms and to limit the number of sexual partners, some people are probably suffering from "safe sex fatigue," van de Laar said. The Internet has also allowed people to find sexual partners more easily than before, and some experts link the rise of dating Web sites to the jump in syphilis cases.
For some men, the Internet connections can be especially dangerous.
"Networks of HIV-positive men to find other positive men have sprung up on the Internet," said Jonathan Elford, an AIDS epidemiologist at London's City University.
Some men who have the AIDS virus are seeking condom-free sex with other men who are also HIV-infected. However, they aren't protected against syphilis and other sexually spread diseases. Among gay men who have syphilis in Britain, nearly half have HIV, Elford said.
Amid this resurgence, some officials are now attacking the epidemic online.
Every day, health workers at the Terrence Higgins Trust, Europe's largest AIDS charity, log into chatrooms on a popular British gay dating Web site to spread safe sex messages and answer questions.
"We know that men are arranging hook-ups for sex online," said Mark Thompson, the charity's deputy head of health promotion. "So we decided to tap into cyberspace to try reaching them before unsafe sex might happen."
Study Insured cancer patients do better
Thu, 20 Dec 2007 23:11:55 GMT
By MIKE STOBBE, AP Medical Writer
ATLANTA - Uninsured cancer patients are nearly twice as likely to die within five years as those with private coverage, according to the first national study of its kind and one that sheds light on troubling health care obstacles.
People without health insurance are less likely to get recommended cancer screening tests, the study also found, confirming earlier research. And when these patients finally do get diagnosed, their cancer is likely to have spread.
The research by scientists with the American Cancer Society offers important context for the national discussion about health care reform, experts say — even though the uninsured are believed to account for just a fraction of U.S. cancer deaths. An Associated Press analysis suggests it is around 4 percent.
Those dealing with cancer and inadequate insurance weren't surprised by the findings.
"I would just like for something to be done to help someone else, so they don't have to go through what we went through," said Peggy Hicks, a Florida woman whose husband died in August from colon cancer.
Edward Hicks was uninsured, and a patchwork health care system delayed him from getting chemotherapy that some argue might have extended his life.
"He was so ill. And you're trying to get him help and you can't, you can't," said his 67-year-old widow.
The new research is being published in CA: A Cancer Journal for Clinicians, a cancer society publication. In an accompanying editorial, the society's president repeated the organization's call for action to fix holes in the health care safety net.
"The truth is that our national reluctance to face these facts is condemning thousands of people to die from cancer each year," Dr. Elmer Huerta wrote.
Hard numbers linking insurance status and cancer deaths are scarce, in part because death certificates don't say whether those who died were insured.
An Associated Press estimate — based on hospital cancer deaths in 2005 gathered by the U.S. Agency for Healthcare Research and Quality information and other data — suggests that at least 20,000 of the nation's 560,000 annual cancer deaths are uninsured when they die. Experts said that estimate sounds reasonable.
That's around 4 percent of the total cancer death toll. One reason is that most fatal cancers occur in people 65 or older — an age group covered by the federal Medicare program. Another is that more than 80 percent of adults under 65 have some form of coverage, including private insurance or the Medicaid program for the poor, according to various estimates.
Some are enrolled in Medicaid or other programs after diagnosis, when the condition worsens and their finances erode. But such 11th hour coverage can be too late; early detection is the key to catching many cancers before they've grown beyond control, experts said.
"Insurance makes a big difference in how early you are detecting disease," said Ken Thorpe, an Emory University health policy researcher.
In the new study, researchers analyzed information from 1,500 U.S. hospitals that provide cancer care. They focused on nearly 600,000 adults under age 65 who first appeared in the database in 1999 and 2000 and who had either no insurance, private insurance or Medicaid.
Researchers then checked records for those patients for the five years following. They found those who were uninsured were 1.6 times more likely to die in five years than those with private insurance.
More specifically, 35 percent of uninsured patients had died at the end of five years, compared with 23 percent of privately insured patients.
Earlier studies have also shown differences in cancer survival rates of the uninsured and insured, but they were limited to specific cancers and certain geographic areas.
The new findings are consistent across different racial groups. However, the fact that whites have better survival rates cannot be explained by insurance status alone, said Elizabeth Ward, the study's lead author.
The researchers were not able to tell if the numbers were influenced by patients' education levels, or by other illnesses.
Experts said the study also hints at problems with quality of care after diagnosis: such as whether the patient got the appropriate operation from a high-quality surgeon, whether the tumor was thoroughly evaluated by a high-quality pathologist, and whether there was access to needed chemotherapy and radiation.
"The differences that we see in outcomes after people are diagnosed, even among those with early stage disease, suggests that problems with quality of care may be an important reason," said Dr. John Ayanian, professor of medicine and health care policy at Harvard Medical School. He didn't participate in the cancer society study.
The study makes an even stronger statement about the role insurance plays in the timing of screenings and how that can raise the likelihood of a late-stage diagnosis, experts said.
A Kaiser Family Foundation survey last year of 930 households that dealt with cancer found that more than one in four uninsured patients delayed treatment — or decided not to get it — because of the cost.
Such was the case of Edward Hicks.
The retired laborer, had surgery for colorectal cancer in 2005 and was thought to be clear of the disease. Chemotherapy was suggested after the surgery, but he didn't get it.
In February of this year, his wife grew worried when he lost energy and appetite. In April, he told her he felt a lump in his stomach.
Hicks, who lived in Fort Meade, Fla., couldn't get an appointment with a specialist, but a family doctor checked him into a hospital and specialists saw him in late May. They said he was terminal but that chemotherapy might extend his life a little, his wife said.
She was able to get donated chemotherapy drugs from a pharmaceutical company, but it took time to arrange the treatments, which didn't start until mid-June. Meanwhile, her husband's health deteriorated. In July, after just a few treatments, he stopped the chemo, saying it was too hard. He died on Aug. 21, at age 64.
Friends and family told Peggy they believe he would have lived longer had he got chemo earlier, when he was stronger. She doesn't agonize over that, she said, trusting in God's will.
But the devil's in her mailbox — she is facing a $21,000 hospital bill and other costs from his death.
Salmonella fears prompt basil recall
Fri, 21 Dec 2007 01:26:18 GMT
By JACOB ADELMAN, Associated Press Writer
LOS ANGELES - Some 5,500 pounds of basil grown in Mexico and sold in the United States has been recalled because of fears it may be infected with salmonella, a spokesman for the importer said Thursday.
The basil was imported from a farm in Mexico's southern Baja California region on Dec. 5 and sold to food distributors in Southern California, Texas and Illinois the following day, said Alberto Martinez, a spokesman for Los Angeles-based importer Top Line Specialty Produce.
The Southern California distributor sold the basil to restaurants and other food service customers, but it was unknown whether the other distributors sold to food service customers or retailers, he said.
No illnesses have been reported.
U.S. Food and Drug Administration inspectors detected the possible contamination during a random check as the basil passed over the Otay Mesa border crossing in San Diego County, Martinez said.
Top Line continued to import basil and other herbs from the Green Paradise farm in the Los Cabos area, where the potentially contaminated product was grown, processed and bagged, until the FDA alerted the company about its inspection results on Tuesday, he said.
The company immediately stopped imports from that farm and issued its recall on Wednesday, Martinez said.
FDA spokeswoman Cathy McDermott said Top Line did not learn about the potential contamination until two weeks after the samples were taken because it took that long for the specimens to be analyzed and for the results to be reported.
The "Green Paradise"-brand basil affected by the recall was shipped in sets of 12 one-pound boxes marked with lot No. 1219.
Salmonella can cause diarrhea, fever and abdominal cramps within 72 hours of consumption. It is usually found in food contaminated with animal feces, according to the U.S. Centers for Disease Control and Prevention.