CHICAGO – Did government health officials “cry swine” when they sounded the alarm on what looked like a threatening new flu?

The so-far mild swine flu outbreak has many people saying all the talk about a devastating global epidemic was just fear-mongering hype. But that’s not how public health officials see it, calling complacency the thing that keeps them up at night.

The World Health Organization added a scary-sounding warning Thursday, predicting up to 2 billion people could catch the new flu if the outbreak turns into a global epidemic.

Many blame such alarms and the breathless media coverage for creating an overreaction that disrupted many people’s lives.

Schools shut down, idling even healthy kids and forcing parents to stay home from work; colleges scaled back or even canceled graduation ceremonies; a big Cinco de Mayo celebration in Chicago was canned; face masks and hand sanitizers sold out — all because of an outbreak that seems no worse than a mild flu season.

“I don’t know anyone who has it. I haven’t met anyone who knows anyone who contracted it,” said Carl Shepherd, a suburban Chicago video producer and father of two. “It’s really frightening more people than it should have. It’s like crying wolf.”

Two weeks after news broke about the new flu strain, there have been 46 deaths — 44 in Mexico and two in the United States. More than 2,300 are sick in 26 countries, including about 900 U.S. cases. Those are much lower numbers than were feared at the start based on early reports of an aggressive and deadly flu in Mexico.

Miranda Smith, whose graduation ceremony at Cisco Junior College in central Texas was canceled to avoid spreading the flu, blames the media.

“It’s been totally overblown,” she said Thursday.

“Everyone seems to know it’s not going to kill you and it’s not as deadly as they think,” she said. “Everybody needs to just calm down and chill out.”

Craig Heyl of Decatur, Ga., said the government overreacted.

“Swine flu is just another strain of flu. People get the flu. I guess you have to call it a pandemic when it’s a widespread virus, but I don’t think the severity of it is all that concerning,” said Heyl, 43.

Public health authorities acknowledge their worst fears about the new virus have not materialized. But no one’s officially saying it’s time to relax. And experts worry that people will become too complacent and tune out the warnings if the virus returns in a more dangerous form in the fall.

“People are taking a sigh of relief too soon,” said Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention.

In an interview Wednesday with The Associated Press, Besser said the outbreak in the United States appears to be less severe than was first feared. But the virus is still spreading and its future potential as a killer is not clearly understood.

“The measures we’ve been talking about — the importance of handwashing, the importance of covering coughs, the real responsibility for staying home when you’re sick and keeping your children home when you’re sick — I’m afraid that people are going to say, ‘Ah, we’ve dodged a bullet. We don’t need to do that,”‘ Besser said.

“The thing that’s keeping me up right now is that feeling of dodging the bullet,” he added.

Peter Sandman, a risk communication specialist, says on his Web site that reminding people the risk is still real and warning them in the future if a pandemic looks imminent “will be extremely difficult.”

“Swine flu looks to be an extremely mild pandemic if it goes pandemic at all, despite WHO warnings that it may ‘come back with a vengeance’ in the fall. People are going to be very, very skeptical,” Sandman wrote.

That concern is shared by infectious disease specialists. But elsewhere, especially online, talk of hype is rampant.

“If I hear 1+ person freaking out because of the “Swine Flu” they won’t have 2 worry about dying from it. I will kill them w/ my handbag!” read a comment Wednesday on Twitter.

“Adults are acting like a bunch of crybabies in a B-rated science fiction germ-outbreak movie, wringing their hands, whining about what to do next,” Dallas Morning News reader Mark Thompson wrote in a letter to the editor posted online Wednesday.

Kari Carsey Valente of Lake Oswego, Ore., had similar thoughts in a letter on the Oregonian newspaper’s Web site.

“Is the daily front page body count really necessary? In reading the entire content of the collected articles one learns that the H1N1 strain is not likely to be more lethal than its predecessors. Give it a rest — and lots of liquid!,” Valente wrote.

Colt Ables, 22, an economics major at the University of Texas in Arlington, said he thinks the Obama administration overreacted and unfairly tried to make it seem as if Republicans have been soft on preparedness.

“This shouldn’t be about politics or about hyping up a virus to send the American people into a panic. Do yourself a favor, wash your hands and turn off the TV,” he wrote in a campus newspaper column.

Whether the media overhyped or accurately reported the dangers is a toss-up, according to a USA Today/Gallup poll published Thursday on Americans’ views of the media’s flu coverage.

The May 5 poll also found that concern about the flu peaked a week ago. But even then, only 25 percent of Americans said they worried about getting the virus.

Dr. Robert Daum, a University of Chicago infectious disease expert, says authorities acted properly when news first broke about the new flu strain.

“It’s like overcalling a snowstorm in Chicago. You want the plows out even if it’s only going to snow a flake,” Daum said. If not, and a blizzard hits, “there will be an outcry like you’ve never seen before.”

Still, Daum says authorities have been a bit awkward in “downshifting” now that it appears the U.S. situation isn’t dire.

“I think it was right to place everyone on high alert, and now right” to say it’s time to calm down, Daum said.

By Mike Stobbe, Lindsey Tanner

CHICAGO – Leo Lytel was diagnosed with autism as a toddler. But by age 9 he had overcome the disorder.

His progress is part of a growing body of research that suggests at least 10 percent of children with autism can “recover” from it – most of them after undergoing years of intensive behavioral therapy.

Skeptics question the phenomenon, but University of Connecticut psychology professor Deborah Fein is among those convinced it’s real.

She presented research this week at an autism conference in Chicago that included 20 children who, according to rigorous analysis, got a correct diagnosis but years later were no longer considered autistic.

Among them was Leo, a boy in Washington, D.C., who once made no eye contact, who echoed words said to him and often spun around in circles – all classic autism symptoms. Now he is an articulate, social third-grader. His mother, Jayne Lytel, says his teachers call Leo a leader.

The study, funded by the National Institute of Mental Health, involves children ages 9 to 18.

Autism researcher Geraldine Dawson, chief science officer of the advocacy group Autism Speaks, called Fein’s research a breakthrough.

“Even though a number of us out in the clinical field have seen kids who appear to recover,” it has never been documented as thoroughly as Fein’s work, Dawson said.

“We’re at a very early stage in terms of understanding” the phenomenon, Dawson said.

Previous studies have suggested between 3 percent and 25 percent of autistic kids recover. Fein says her studies have shown the range is 10 percent to 20 percent.

But even after lots of therapy – often carefully designed educational and social activities with rewards – most autistic children remain autistic.

Recovery is “not a realistic expectation for the majority of kids,” but parents should know it can happen, Fein said.

Doubters say “either they really weren’t autistic to begin with … or they’re still socially odd and obsessive, but they don’t exactly meet criteria” for autism, she said.

Fein said the children in her study “really were” autistic and now they’re “really not.”

University of Michigan autism expert Catherine Lord said she also has seen autistic patients who recover. Most had parents who spent long hours working with them on behavior improvement.

But, Lord added, “I don’t think we can predict who this will happen for.” And she does not think it’s possible to make it happen.

The children in Fein’s study, which is still ongoing, were diagnosed by an autism specialist before age 5 but no longer meet diagnostic criteria for autism. The initial diagnoses were verified through early medical records.

Because the phenomenon is so rare, Fein is still seeking children to help bolster evidence on what traits formerly autistic kids may have in common. Her team is also comparing these children with autistic and non-autistic kids.

So far, the “recovered” kids “are turning out very normal” on neuropsychological exams and verbal and nonverbal tests, she said.

The researchers are also doing imaging tests to see if the recovered kids’ brains look more like those of autistic or nonautistic children. Autistic children’s brains tend to be slightly larger than normal.

Imaging scans also are being done to examine brain function in formerly autistic kids. Researchers want to know if their “normal” behavior is a result of “normal” brain activity, or if their brains process information in a non-typical way to compensate for any deficits.

Results from those tests are still being analyzed.

Most of the formerly autistic kids got long-term behavior treatment soon after diagnosis, in some cases for 30 or 40 hours weekly.

Many also have above-average IQs and had been diagnosed with relatively mild cases of autism. At age 2, many were within the normal range for motor development, able to walk, climb and hold a pencil.

Significant improvement suggesting recovery was evident by around age 7 in most cases, Fein said.

None of the children has shown any sign of relapse. But nearly three-fourths of the formerly autistic kids have had other disorders, including attention-deficit problems, tics and phobias; eight still are affected.

Jayne Lytel says Leo sometimes still gets upset easily but is much more flexible than before.

———

ON THE WEB

National Institute of Mental Health: www.nimh.nih.gov

Autism Speaks: www.autismspeaks.org

CHICAGO – The nation’s first swine flu death, a toddler in Texas, is tragic but health experts say not unexpected, and they advise parents to just take ordinary precautions.

Every year dozens of U.S. children die from seasonal flu; that’s one reason annual flu shots are recommended for children 6 months and older. So far this season, 55 children have died from regular flu, federal health authorities report.

While children, especially those younger than 5, are known to be most vulnerable to severe and fatal complications from seasonal flu, most children who get even the most aggressive strains of flu don’t die.

So far, flu experts say there’s no reason to think the new strain will be much different.

“Nobody should be unduly worried; everybody should be aware of what’s going on and doing things they should be doing in flu season anyway,” said Dr. Mark Dworkin, an infectious disease specialist at University of Illinois at Chicago.

That includes covering your cough, washing your hands often — and telling children to do the same.

Dr. Carlos Perez-Velez, an infectious disease specialist with National Jewish Health system in Denver, says a good trick to get kids to wash their hands long enough to kill germs is to tell them to recite the alphabet A to Z before they quit washing.

Parents should also avoid sending children with fevers or other signs of illness to school, and should skip work if they have those symptoms — usual precautions when they or their kids are sick.

Some wonder about keeping children home from preschool or day care — often called “germ factories” — even when their kids aren’t sick and no flu has been reported.

Dr. Kathryn Edwards, a Vanderbilt University flu specialist, said there’s no reason to keep healthy children home or restrict their activities.

“We need to respond to the swine flu just the way that we respond to seasonal flu,” Edwards said.

The death in Texas, of a 23-month-old boy visiting from Mexico City, “is very, very sad, but we do not have any evidence to say that the swine flu is more severe and will cause more deaths than other flu,” she said.

While there’s no vaccine to protect against the new swine flu strain, some are in development. Experts say parents should still be sure to get annual vaccines to protect children against seasonal flu.

According to the CDC, more than 20,000 children younger than age 5 are hospitalized every year because of seasonal flu. In the 2007-08 flu season, the CDC received reports that 86 children nationwide died from flu complications.

In the 2003-04 season, one of the worst in recent years, at least 153 children died. Even so, the highest death rate was among infants younger than 6 months, and that was just 0.88 per 100,000 babies.

In that season, one-third of children who died had an underlying illness that put them at particularly high risk for severe flu complications and death. Illnesses known to increase children’s susceptibility include asthma and heart and lung problems.

Authorities say the boy who died in Texas had an underlying illness.

Young children are vulnerable to flu complications because their immature immune systems aren’t efficient at fighting off germs, said Dr. Kenneth Alexander, pediatric infectious diseases director at the University of Chicago.

Also, young children have small airways that can swell when flu hits, predisposing them to pneumonia and fluid accumulating in the lungs, he said.

Alexander said parents should watch for classic flu symptoms, including fever of at least 100.5, cough and runny nose. Children old enough to talk might complain of sore throats and body aches. Young children sometimes just have a runny nose and a fever with the flu, and they’re more likely than adults to have vomiting, too, he said.

Parents should contact their physicians if children have these symptoms, but experts said most cases won’t even be flu, let alone swine flu.

Young children with these symptoms who also are having trouble breathing, or who seem less alert or unable to drink liquid should see a doctor right away because these could be signs of dangerous complications, said Dr. Andrew Bonwit, a pediatrician at Loyola University Medical Center in Maywood, Ill.

———

ON THE WEB

CDC: www.cdc.gov/flu/protect/children.htm

CHICAGO – A striking new study says almost 1 in 5 American 4-year-olds is obese, and the rate is alarmingly higher among American Indian children, with nearly a third of them obese.

Researchers were surprised to see differences by race at so early an age.

Overall, more than half a million 4-year-olds are obese, the study suggests. Obesity is more common in Hispanic and black youngsters, too, but the disparity is most startling in American Indians, whose rate is almost double that of whites.

The lead author said that rate is worrisome among children so young, even in a population at higher risk for obesity because of other health problems and economic disadvantages.

“The magnitude of these differences was larger than we expected, and it is surprising to see differences by racial groups present so early in childhood,” said Sarah Anderson, an Ohio State University public health researcher. She conducted the research with Temple University’s Dr. Robert Whitaker.

Dr. Glenn Flores, a pediatrics and public health professor at University of Texas Southwestern Medical School in Dallas, said the research is an important contribution to studies documenting racial and ethnic disparities in children’s weight.

“The cumulative evidence is alarming because within just a few decades, America will become a ‘minority majority’ nation,” he said. Without interventions, the next generation “will be at very high risk” for heart disease, high blood pressure, cancers, joint diseases and other problems connected with obesity, said Flores, who was not involved in the new research.

The study is an analysis of nationally representative height and weight data on 8,550 preschoolers born in 2001. Children were measured in their homes and were part of a study conducted by the government’s National Center on Educational Statistics. The results appear in Monday’s Archives of Pediatrics & Adolescent Medicine.

Almost 13 percent of Asian children were obese, along with 16 percent of whites, almost 21 percent of blacks, 22 percent of Hispanics, and 31 percent of American Indians.

Some previous studies of young children did not distinguish between kids who were merely overweight versus obese, or they examined fewer racial groups.

The current study looked only at obesity and a specific age group. Anderson called it the first analysis of national obesity rates in preschool kids in the five ethnic or racial groups.

The researchers did not examine reasons for the disparities, but others offered several theories.

Flores cited higher rates of diabetes in American Indians, and also Hispanics, which scientists believe may be due to genetic differences.

Also, other factors that can increase obesity risks tend to be more common among minorities, including poverty, less educated parents, and diets high in fat and calories, Flores said.

Jessica Burger, a member of the Little River Ottawa tribe and health director of a tribal clinic in Manistee, Mich., said many children at her clinic are overweight or obese, including preschoolers.

Burger, a nurse, said one culprit is gestational diabetes, which occurs during a mother’s pregnancy. That increases children’s chances of becoming overweight and is almost twice as common in American Indian women, compared with whites.

She also blamed the federal commodity program for low-income people that many American Indian families receive. The offerings include lots of pastas, rice and other high-carbohydrate foods that contribute to what Burger said is often called a “commod bod.”

“When that’s the predominant dietary base in a household without access to fresh fruits and vegetables, that really creates a better chance of a person becoming obese,” she said.

Also, Burger noted that exercise is not a priority in many American Indian families struggling to make ends meet, with parents feeling stressed just to provide basic necessities.

To address the problem, her clinic has created activities for young Indian children, including summer camps and a winter break “outdoor day” that had kids braving 8-degree temperatures to play games including “snowsnake.” That’s a traditional American Indian contest in which players throw long, carved wooden “snakes” along a snow or ice trail to see whose lands the farthest.

The hope is that giving kids used to modern sedentary ways a taste of a more active traditional American Indian lifestyle will help them adopt healthier habits, she said.

———

ON THE WEB

Archives: www.archpediatrics.com

Association of American Indian Physicians: tinyurl.com/c8raox

Matty Billemeyer (left), his brother Sean (second face on left), mother Deanne and his brother Andrew (right) gather around the dinner table at home in Doylestown Pa. Matty is just 8 years old but already has had four bouts with kidney stones. Doctors are puzzling over what seems to be an increase in the number of children with kidney stones, a condition some blame on kids' love of cheeseburgers, fries and other salt-laden food.

CHICAGO – Doctors are puzzling over what seems to be an increase in the number of children with kidney stones, a condition some blame on kids’ love of cheeseburgers, fries and other salty foods.

Kidney stones are usually an adult malady, one that is notorious for causing excruciating pain — pain worse than childbirth. But while the number of affected children isn’t huge, kids with kidney stones have been turning up in rising numbers at hospitals around the country.

At Children’s Hospital of Philadelphia, the number of children treated for kidney stones since 2005 has climbed from about 10 a year to five patients a week now, said Dr. Pasquale Casale.

Johns Hopkins Children Center in Baltimore, a referral center for children with stones, used to treat one or two youngsters a year 15 or so years ago. Now it gets calls about new cases every week, said kidney specialist Dr. Alicia Neu.

In a 2007 study in the Journal of Urology, doctors at North Shore-Long Island Jewish Medical Center reported a nearly fivefold increase in children brought in with kidney stones between 1994 and 2005. In 2005, 61 youngsters were treated there for stones.

Dr. David Hatch at Loyola University Medical Center in Maywood, Ill., near Chicago, also has seen an increase. His youngest patient was a cranky 8-month-old girl whose mother found a pea-size kidney stone in her diaper.

Kids’ stones have been the talk of recent pediatric kidney specialists’ conferences, said Dr. Uri Alon, director of the bone and mineral disorders clinic at Children’s Mercy Hospital in Kansas City.

So far, the only evidence is anecdotal. But Alon is involved in research trying to determine if the increase is real and not just the result of greater awareness and better ways of detecting stones. Alon also is studying whether improved nutrition can prevent kids’ kidney stones.

Eating too much salt can result in excess calcium in the urine. In children, most stones are calcium-based, and Alon said their eating habits, plus drinking too little water, puts them at risk. Plenty of water is generally recommended to help prevent kidney stones.

Matty Billemeyer is just 8 years old but already has had four bouts with stones, the first in 2007, the last a year ago in April. He was first stricken in his first-grade class; the school nurse, his parents and even the emergency room doctors all thought it was his appendix.

“It felt really painful and intense,” the Doylestown, Pa., boy recalled. “I was really scared because it was hurting a lot.”

Darryl Billemeyer said it was frightening seeing his son writhing and screaming in pain. The boy was transferred from a local hospital to Children’s Hospital of Philadelphia, where ultrasound tests showed kidney stones.

“We really didn’t know what to make of it,” Billemeyer said. “I definitely thought they were more of an adult thing.”

The first time, Matty needed surgery; the other times the stones passed during urination.

Now he takes diuretic pills to increase urination, brings a water bottle to school everyday, and has given up favorite foods, including sausages, pickles and packaged ramen noodles — all high in salt.

His parents are both busy teachers, and with four other sons, family meals used to include quick processed foods like canned spaghetti or chicken nuggets. Until Matty’s diagnosis, salt “wasn’t something we really thought about,” Billemeyer said.

The main problem associated with kidney stones is extreme pain. It is caused by stones blocking urine flow, which, if untreated, could lead to kidney damage.

The preferred treatment is observation — giving kids pain medicine but nothing else to see if the stones will pass on their own. Stones can be as small as a sugar granule or as large as a pearl. Bigger ones have been reported but are rare; most are less than 1/4 inch in diameter, which can usually pass on their own. But even small ones can mean incredible pain.

When that doesn’t happen, the patient is anesthetized and doctors may thread a slender scope through the urinary tract to break up and remove the stone. Other treatment may involve noninvasive shock-wave therapy that uses sound waves to break up the stone, or minimally invasive surgery.

Dr. Barry Duel, a pediatric urologist at Cedars-Sinai Medical Center in Los Angeles, said kidney stones can be a sign of underlying metabolic problems that result in too much calcium in the urine. But he said in most cases children have no underlying disorder and are otherwise healthy.

Still, because some metabolic problems can slow growth if untreated or lead to repeated bouts with kidney stones, the American Academy of Pediatrics recommends metabolic testing for all children with kidney stones.

Hatch, the Loyola urologist, said the best prevention is plenty of water, so that the minerals in urine stay dissolved.

How much water depends on a child’s size, but for an average-size 10-year-old it would be about four cups a day, on top of whatever else they are drinking. That is far more than most kids drink.

“What I like to tell kids is that they should drink enough water to keep their pee almost clear,” Hatch said.

For children who have had one kidney stone, doctors sometimes recommend fresh-squeezed lemonade or other citrus juice, which can help keep the urine from forming stones.

———

ON THE WEB

National Institutes of Health: http://www.nih.gov/

CHICAGO – Warning: young children should not keep hedgehogs as pets — or hamsters, baby chicks, lizards and turtles, for that matter — because of risks for disease.

That’s according to the nation’s leading pediatricians’ group in a new report about dangers from exotic animals.

Besides evidence that they can carry dangerous and sometimes potentially deadly germs, exotic pets may be more prone than cats and dogs to bite, scratch or claw — putting children younger than 5 particularly at risk, the report says.

Young children are vulnerable because of developing immune systems plus they often put their hands in their mouths.

That means families with children younger than 5 should avoid owning “nontraditional” pets. Also, kids that young should avoid contact with these animals in petting zoos or other public places, according to the report from the American Academy of Pediatrics. The report appears in the October edition of the group’s medical journal, Pediatrics.

“Many parents clearly don’t understand the risks from various infections” these animals often carry, said Dr. Larry Pickering, the report’s lead author and an infectious disease specialist at the federal Centers for Disease Control and Prevention.

For example, about 11 percent of salmonella illnesses in children are thought to stem from contact with lizards, turtles and other reptiles, Pickering said. Hamsters also can carry this germ, which can cause severe diarrhea, fever and stomach cramps.

Salmonella also has been found in baby chicks, and young children can get it by kissing or touching the animals and then putting their hands in their mouths, he said.

Study co-author Dr. Joseph Bocchini said he recently treated an infant who got salmonella from the family’s pet iguana, which was allowed to roam freely in the home. The child was hospitalized for four weeks but has recovered, said Bocchini, head of the academy’s infectious diseases committee and pediatrics chairman at Louisiana State University in Shreveport.

Hedgehogs can be dangerous because their quills can penetrate skin and have been known to spread a bacteria germ that can cause fever, stomach pain and a rash, the report said.

With supervision and precautions like hand-washing, contact between children and animals “is a good thing,” Bocchini said. But families should wait until children are older before bringing home an exotic pet, he said.

Those who already have these pets should contact their veterinarians about specific risks and possible new homes for the animals, he said.

Data cited in the study indicate that about 4 million U.S. households have pet reptiles. According to the American Veterinary Medical Association, all kinds of exotic pets are on the rise, although generally fewer than 2 percent of households own them.

The veterinarian group’s Mike Dutton, a Weare, N.H., exotic animal specialist, said the recommendations send an important message to parents who sometimes buy exotic pets on an impulse, “then they ask questions, sometimes many months later.”

But a spokesman for the International Hedgehog Association said there’s no reason to single out hedgehogs or other exotic pets.

“Our recommendation is that no animal should be a pet for kids 5 and under,” said Z.G. Standing Bear. He runs a rescue operation near Pikes Peak, Colo., for abandoned hedgehogs, which became fad pets about 10 years ago.

———

On the Web

American Academy of Pediatrics: http://www.aap.org

American Veterinary Medical Association: http://www.avma.org

CHICAGO – Could voting for president be hazardous to your health?

An analysis of Election Day traffic deaths dating back to Jimmy Carter’s 1976 win suggests yes, but the authors say that’s no reason not to go to the polls.

The study found that on average, 24 more people died in car crashes during voting hours on presidential election days than on other October and November Tuesdays. That amounts to an 18 percent increased risk of death. And compared with non-election days, an additional 800 people suffered disabling injuries.

The results were pretty consistent on all eight presidential Election Days that were analyzed, up to George W. Bush’s victory over John Kerry in 2004.

“This is one of the most off-the-wall things I’ve ever read, but the science is good,” said Roy Lucke, senior scientist at Northwestern University’s Center for Public Safety. He was not involved in the study, which appears in Wednesday’s Journal of the American Medical Association.

Rushing to get to polling places before or after work, driving on unfamiliar routes, and being distracted by thinking about the candidates were among possible reasons cited by the study’s Canadian researchers.

So why would a couple of Canucks want to examine this troubling aspect of Yankee voting habits?

Apparently not out of any across-the-border sense of smugness.

Co-author Dr. Donald Redelmeier, a professor of medicine at the University of Toronto, said Canada would probably have similar results. Even though it’s less populous, Canada typically has a higher voter turnout than America, he said.

Redelmeier said he and co-researcher Robert Tibshirani, now at Stanford University, were partly motivated out of concern about public health implications of traffic accidents. They claim about 1 million deaths worldwide each year, including about 41,059 last year in the United States, which has one of the highest traffic death rates among industrialized countries.

Other analyses have found traffic deaths go up when more people are on the road, as during summer months, or during festive times when alcohol use increases, including Super Bowl Sunday and winter holidays, said Ellen Martin, a spokeswoman for the National Highway Traffic Safety Administration.

Anne McCartt, senior vice president for research at the Insurance Institute for Highway Safety, called the study “a clever example of something that is commonly known in highway safety.”

She noted that schools often have Election Day off and stores sometimes have special sales, which both can contribute to extra traffic.

The study is based on an analysis of the highway traffic safety agency’s fatal crash data.

The researchers looked at traffic-related deaths during polling hours on presidential Election Days and the two Tuesdays before and afterward over 30 years.

There were 3,417 total deaths, including 1,265 on election days. The Election Day average was 158, versus 134 on the other Tuesdays. The crashes involved drivers, passengers and pedestrians.

Redelmeier said the data don’t indicate where drivers were going when crashes occurred, but that the increase in number during polling hours suggests they were voting-related.

He said voters can easily avoid the risks by not speeding, wearing seat belts and avoiding alcohol use before driving to the polls and on the way home. Better traffic enforcement and setting up more polling places that voters can walk to are other solutions he suggested.

“We’re not advocating a fatalistic attitude, nor are we saying people should refrain from voting,” Redelmeier said. “We are recommending more safety advocacy.”

Lucke seconded that.

“Vote, but be careful,” he said.

———

On the Web

JAMA: jama.ama-assn.org

NHTSA: www.nhtsa.gov

CHICAGO – Brisk walking led to slight improvements on mental tests for older people with memory problems in what is billed as the first rigorous test of exercise on the aging brain.

The results from the small Australian study were only modest. But they back up observational studies showing potential mental benefits from physical activity.

The effects of exercise were at least as good, if not better, than those seen with drugs approved to aid mental function in Alzheimer’s disease, according to experts not involved in the study.

Still, the study authors cautioned that the results don’t prove that exercise will produce meaningful improvement in brain function or memory. They also said the results should not be used to imply that exercise reduces the risk of dementia or Alzheimer’s — that can’t be determined from this type of study.

The authors said it’s not clear how exercise might affect brain function; one theory is that it improves blood flow to the brain. Their study did not involve brain imaging that would have shown any changes in blood flow associated with exercise.

Results appear in Wednesday’s Journal of the American Medical Association.

Study participants included 85 Australian adults aged 50 and older assigned to do at least 2 1/2 hours of weekly physical activity, mainly brisk walking, for six months. They recorded their exercise in diaries and also got phone calls and newsletters encouraging them to stick with it.

They were urged to remain active even after the initial six months, and were compared with a control group of 85 people who were not asked to exercise.

The exercise group engaged in about 20 minutes more activity a day than the control group.

After six months, the exercise group performed 1.3 points better on a 70-point scale of brain function than the non-exercise group. The effects remained at 18 months, though the difference by then, about 0.7 points, was minimal.

“To our knowledge, this is the first randomized clinical trial being published” on exercise and brain function in older adults with problems, said the lead author Dr. Nicola Lautenschlager of the University of Melbourne.

“It’s an important piece in that it’s the first intervention in people with memory complaints that’s showing some potential benefit,” said Dr. Raj Shah, director of the memory clinic at Rush University Medical Center. He was not involved in the study.

Shah said larger studies are needed before physical exercise would be prescribed to treat memory problems in older adults.

Dr. Ron Petersen of the Alzheimer’s Association agreed that the study should not be “overhyped,” but said he will use the results in discussing potential benefits of exercise with patients.

———

On the Web

JAMA: jama.ama-assn.org

Alzheimer’s information: www.nia.nih.gov/alzheimers

CHICAGO – The number of teen suicides has fallen slightly but the rate remains disturbingly high, researchers said, possibly fueled by drug warnings that have scared many from using antidepressants.

The suicide rate was about 4.5 per 100,000 in 2005, the most recent data available. That follows an 18 percent spike the previous year that alarmed experts when first reported.

That’s because until then, suicides among 10- to 19-year-olds had been on a steady decline since 1996.

Dr. David Fassler, a psychiatry professor at the University of Vermont, said the report suggests a “very disturbing” upward trend that correlates with a decline in teen use of antidepressants.

That decline stems from the Food and Drug Administration’s 2004 black-box warning label because of reports that the drugs can increase risks for suicidal tendencies.

Fassler, who wasn’t involved in the new study, is among psychiatrists who believe the drugs’ benefits, including treating depression that can lead to suicide, outweigh their risks. He said he has no financial ties to makers of antidepressants.

The new research, based on 1996-2005 national data, appears in Wednesday’s Journal of the American Medical Association. It shows the rate dropped by about 5 percent from 4.7 in 2004 — or from 1,983 suicides in 2004 to 1,883 in 2005.

That’s still 600 more suicides than would have been expected had the earlier trend continued, said lead author Jeffrey Bridge, a researcher at Nationwide Children’s Hospital in Columbus, Ohio.

Patrick Tolan, director of the University of Illinois-Chicago’s juvenile research institute, said it will be important to continue tracking teen suicides to see if the rate continues to decline or hovers at a higher than expected level.

Regardless, suicide remains a leading cause of teen deaths and “a major public health issue,” he said.

———

On the Web

JAMA: http://jama.ama-assn.orgody

CHICAGO — Children born to older fathers face a greater chance of developing bipolar disorder, according to one of the largest studies linking mental illness with advanced paternal age.

Previous research has connected schizophrenia and autism with older dads, and a Danish study published last year added bipolar disorder to the list. The new study led by researchers at Sweden’s Karolinska Institute strengthens the evidence.

The leading theory is that older men’s sperm may be more likely to develop mutations. Even so, the odds of a person becoming bipolar are so low that the study’s authors said it shouldn’t dissuade older men from becoming fathers.

Researchers analyzed Swedish national registry data from more than 80,000 people, including 13,428 with bipolar disorder who were born between 1932 and 1991.

The risks started increasing around age 40 but were strongest among those 55 and older. Children born to these dads were 37 percent more likely to develop bipolar disorder than those born to men in their 20s.

They also faced more than double the risk of developing bipolar disorder before age 20. Scientists call that early onset disease, and while they have long known that bipolar disorder tends to run in families, early onset disease has been thought to be most strongly linked with genetics.

The age of the mothers didn’t appear to be much of a factor.

The study, released Monday, appears in September’s Archives of General Psychiatry.

While the findings don’t explain what might cause some older men to have bipolar children, it “reinforces the notion that there’s a strong biological component to this,” said Dr. Harold Pincus, vice chair of psychiatry at Columbia University.

Bipolar disorder causes dramatic mood swings, from deep depression to manic highs. It affects more than 5 million Americans.

Lifetime risks for it have been estimated at roughly 1 percent to 4 percent. The study results suggest that having an older father might increase that slightly. The findings aren’t definitive, but even if the link proves to be real, Pincus noted that still means most people with older fathers won’t ever get bipolar disorder.

Factors involving mothers, including age and health, have long been thought to be most closely linked with birth defects and other abnormalities. But the new study adds to mounting evidence that paternal factors also play an important role, said New York University researcher Susan Harlap.

Sperm are produced throughout a man’s lifetime, and scientists believe that as men age there is a greater chance for mutations that could contribute to disorders in their children.

Advanced paternal age also has been linked with birth defects, and some sperm banks have age limits for donors because of that.

While important for scientists, the study results shouldn’t discourage older men from fathering children, said Emma Frans, the lead author.

She said the results suggest that similar mechanisms might contribute to risks for bipolar disorder, schizophrenia and autism. Each of these disorders is thought to have many causes including biologic and outside factors.

The Compassionate Friends Executive Director, Patricia Loder, in her Milford, Mich., home. Loder holds a photo of her late 5-year-old son Stephen, and 8-year-old daughter Stephanie, both of whom were killed in an automobile accident in 1991.

CHICAGO – When it comes to saving lives, God trumps doctors for many Americans.

An eye-opening survey reveals widespread belief that divine intervention can revive dying patients. And, researchers said, doctors “need to be prepared to deal with families who are waiting for a miracle.”

More than half of randomly surveyed adults — 57 percent — said God’s intervention could save a family member even if physicians declared treatment would be futile. And nearly three-quarters said patients have a right to demand such treatment.

When asked to imagine their own relatives being gravely ill or injured, nearly 20 percent of doctors and other medical workers said God could reverse a hopeless outcome.

“Sensitivity to this belief will promote development of a trusting relationship” with patients and their families, according to researchers. That trust, they said, is needed to help doctors explain objective, overwhelming scientific evidence showing that continued treatment would be worthless.

Pat Loder, a Milford, Mich., woman whose two young children were killed in a 1991 car crash, said she clung to a belief that God would intervene when things looked hopeless.

“When you’re a parent and you’re standing over the body of your child who you think is dying … you have to have that” belief, Loder said.

While doctors should be prepared to deal with those beliefs, they also shouldn’t “sugarcoat” the truth about a patient’s condition, Loder said.

Being honest in a sensitive way helps family members make excruciating decisions about whether to let dying patients linger, or allow doctors to turn off life-prolonging equipment so that organs can be donated, Loder said.

Loder was driving when a speeding motorcycle slammed into the family’s car. Both children were rushed unconscious to hospitals, and Loder says she believes doctors did everything they could. They were not able to revive her 5-year-old son; soon after her 8-year-old daughter was declared brain dead.

She said her beliefs about divine intervention have changed.

“I have become more of a realist,” she said. “I know that none of us are immune from anything.”

Loder was not involved in the survey, which appears in Monday’s Archives of Surgery.

It involved 1,000 U.S. adults randomly selected to answer questions by telephone about their views on end-of-life medical care. They were surveyed in 2005, along with 774 doctors, nurses and other medical workers who responded to mailed questions.

Survey questions mostly dealt with untimely deaths from trauma such as accidents and violence. These deaths are often particularly tough on relatives because they are more unexpected than deaths from lingering illnesses such as cancer, and the patients tend to be younger.

Dr. Lenworth Jacobs, a University of Connecticut surgery professor and trauma chief at Hartford Hospital, was the lead author.

He said trauma treatment advances have allowed patients who previously would have died at the scene to survive longer. That shift means hospital trauma specialists “are much more heavily engaged in the death process,” he said.

Jacobs said he frequently meets people who think God will save their dying loved one and who want medical procedures to continue.

“You can’t say, ‘That’s nonsense.’ You have to respect that” and try to show them X-rays, CAT scans and other medical evidence indicating death is imminent, he said.

Relatives need to know that “it’s not that you don’t want a miracle to happen, it’s just that is not going to happen today with this patient,” he said.

Families occasionally persist and hospitals have gone to court seeking to stop medical treatment doctors believe is futile, but such cases are quite rare.

Dr. Michael Sise, trauma medical director at Scripps Mercy Hospital in San Diego, called the study “a great contribution” to one of the most intense issues doctors face.

Sise, a Catholic doctor working in a Catholic hospital, said miracles don’t happen when medical evidence shows death is near.

“That’s just not a realistic situation,” he said.

Sise recalled a teenager severely injured in a gang beating who died soon afterward at his hospital.

The mother “absolutely did not want to withdraw” medical equipment despite the severity of her child’s brain injuries, which ensured the child would never wake up, Sise said. “The mom was playing religious tapes in the room, and obviously was very focused on looking for a miracle.”

Claudia McCormick, a nurse and trauma program director at Duke University Hospital, said she also has never seen that kind of miracle. But her niece’s recovery after being hit by a boat while inner-tubing earlier this year came close.

The boat backed into her and its propeller “caught her in the side of the head. She had no pulse when they pulled her out of the water,” McCormick said.

Doctors at the hospital where she was airlifted said “it really doesn’t look good.” And while it never reached the point where withdrawing lifesaving equipment was discussed, McCormick recalled one of her doctors saying later: ‘”God has plans for this child. I never thought she’d be here.”‘

Like many hospitals, Duke uses a team approach to help relatives deal with dying trauma victims, enlisting social workers, grief counselors and chaplains to work with doctors and nurses.

If the family still says, “We just can’t shut that machine off, then, you know what, we can’t shut that machine off,” McCormick said.

“Sometimes,” she said, “you might have a family that’s having a hard time and it might take another day, and that’s OK.”

CHICAGO – Wireless systems used by many hospitals to keep track of medical equipment can cause potentially deadly breakdowns in lifesaving devices such as breathing and dialysis machines, researchers reported Tuesday in a study that warned hospitals to conduct safety tests.

Some of the microchip-based “smart” systems are touted as improving patient safety, but a Dutch study of equipment — without the patients — suggests the systems could actually cause harm.

A U.S. patient-safety expert said the study “is of urgent significance” and said hospitals should respond immediately to the “disturbing” results.

The wireless systems send out radio waves that can interfere with equipment such as respirators, external pacemakers and kidney dialysis machines, according to the study.

Researchers discovered the problem in 123 tests they performed in an intensive-care unit at an Amsterdam hospital. Patients were not using the equipment at the time.

Electromagnetic glitches occurred in almost 30 percent of the tests when microchip devices similar to those in many types of wireless medical equipment were placed within about one foot of the lifesaving machines.

Nearly 20 percent of the cases involved hazardous malfunctions that would probably harm patients. These included breathing machines that switched off; mechanical syringe pumps that stopped delivering medication; and external pacemakers, which regulate the heart, that malfunctioned.

The wireless systems are used to tag and keep track of medical equipment like heart-testing machines, joint replacements and surgical staplers. They can help quickly locate devices that are elsewhere in the hospital and help prevent theft.

The technology also is viewed as a way to prevent drug counterfeiting, by embedding microchips in drug containers, and to prevent harmful medical errors by keeping tabs on devices used during surgery.

The results show that it’s crucial for hospitals to test their wireless items before using them around equipment essential for keeping patients alive, said Dr. Erik Jan van Lieshout, a study co-author and critical care specialist at the University of Amsterdam’s Academic Medical Center.

His study appears in Wednesday’s Journal of the American Medical Association.

“Attention must be paid to these disturbing findings,” Dr. Donald Berwick, president of the Institute for Healthcare Improvement, said in an editorial in the journal.

“It seems that hospitals, regulators, and manufacturers certainly have some immediate work to do,” including examining whether similar problems are occurring in hospital critical care units, Berwick said.

Peper Long, a spokeswoman for the Food and Drug Administration, said the agency is aware of the potential problem but has not received any reports of injuries directly caused by electronic interference with hospital medical devices.

She said the FDA is testing some medical devices to “determine their vulnerability and to what extent such vulnerability may be a public health concern.”

Previous studies have shown that pacemakers and implanted heart defibrillators are susceptible to interference from cell phones and metal detectors outside hospital settings, according to the FDA’s Web site. The Dutch study focused only on devices and equipment used in hospitals.

“It is absolutely an issue, but you have to manage around it,” said Dr. John Halamka, chief information officer at Beth Israel Deaconess Medical Center in Boston.

Beth Israel uses the technology for identification and tracking purposes, including microchips embedded in intravenous pumps and ventilators.

Halamka said the devices are compatible with the hospital’s wireless network and that all new machines are evaluated before being used near other electronic medical devices. He said there have been no examples of harmful interference at Beth Israel.

The JAMA editorial said hospitals should consider surveillance for interference problems that employees haven’t noticed or reported. Regulatory agencies also should determine if new safety guidance is needed, the editorial recommended.

ClearCount Medical Solutions of Pittsburgh is marketing its new microchip-embedded surgical “smart” sponges. They respond to scanning wands to help doctors make sure sponges aren’t left inside patients.

Co-founder Steven Fleck said the sponges were designed not to interfere with other hospital equipment and were approved by FDA last year.

David Palmer, ClearCount’s chief executive officer, said these systems can improve patient safety and that for hospitals to reject such technology because of the new study report “would be shortsighted.”

CHICAGO – Complications from donating blood are rare but happen more often in teens than in older donors, including dizziness, fainting and falls, a study found.

The findings come as blood agencies increasingly rely on young people to maintain an adequate supply. Blood donation has declined in recent years, particularly among some older age groups, and the American Red Cross, which conducted the study, has supported efforts to allow more high school students to donate.

Lead author Dr. Anne Eder, an executive medical officer at Red Cross headquarters in Washington, D.C., emphasized that while teens are more susceptible to problems, their risks for having a bad reaction are still small.

“We want donors to know what to expect and we want them to have a good experience,” Eder said.

Lightheadedness, sweating and small needle-related bruises were the most common problems. More serious complications were mostly caused by fainting — concussions, cuts and one broken jaw — and occurred much more often in the youngest donors.

It’s unclear why teens are more vulnerable but Eder said they may respond differently to stress than adults. Low weight and small stature sometimes also play a role.

Almost 15 percent of annual blood donations nationwide come from donors aged 16 to 19. Most states allow 17-year-olds to donate blood; almost half allow 16-year-olds to donate with parents’ consent, the study authors said.

Young people who start donating blood early tend to continue throughout their lives, said Dr. Peter Tomasulo, chief medical officer for Blood Systems Inc. The Scottsdale, Ariz. -based company oversees blood centers in 18 states.

“We are constantly trying to make sure that no patient ever has to wait for a blood transfusion. It’s a very big struggle for us and these kids play a very big part,” Tomasulo said. He was not involved in the study, which appears in Wednesday’s Journal of the American Medical Association.

The researchers analyzed 1.7 million donations collected in 2006 in nine states and Puerto Rico. Complications occurred with almost 11 percent of donations by 16- and 17-year-olds and about 8 percent of donations by 18- and 19-year-olds, compared with almost 3 percent in donors aged 20 and older.

High school sophomore Joe Gibson said the small risks shouldn’t deter teens. Gibson helped draft a new law in Minnesota allowing 16-year-olds to donate after seeing how blood transfusions benefited his grandfather, who had cancer.

The law takes effect in July and Gibson, 16, plans to participate in a blood drive soon after in his hometown, Blooming Prairie.

“It’s just a great thing to do, something that helps so many people,” he said.

The risks need to be weighed against the dangers of not having enough blood for patients who need transfusions, said Dr. Ram Kakaiya, medical director for LifeSource, which conducts blood drives at about 300 Chicago-area high schools each year.

Donors are encouraged to drink plenty of fluids and are fed snacks and urged to stick around for several minutes afterward to help avoid complications, Kakaiya said.

———

ON THE WEB

JAMA

Snips and snails and puppydog tails … and cereal and bananas?

That could be what little boys are made of, according to surprising new research suggesting that what a woman eats before pregnancy influences the gender of her baby.

Having a hearty appetite, eating potassium-rich foods including bananas, and not skipping breakfast all seemed to raise the odds of having a boy.

The British research is billed as the first in humans to show a link between a woman’s diet and whether she has a boy or girl.

It is not proof, but it fits with evidence from test tube fertilization that male embryos thrive best with longer exposure to nutrient-rich lab cultures, said Dr. Tarun Jain. He is a fertility specialist at University of Illinois at Chicago who wasn’t involved in the study.

It just might be that it takes more nutrients to build boys than girls, he said

University of Exeter researcher Fiona Mathews, the study’s lead author, said the findings also fit with fertility research showing that male embryos aren’t likely to survive in lab cultures with low sugar levels. Skipping meals can result in low blood sugar levels.

Jain said he was skeptical when he first heard about the research. But he said the study was well-done and merits follow-up study to see if the theory proves true.

It’s not necessarily as far-fetched as it sounds. While men’s sperm determine a baby’s gender, it could be that certain nutrients or eating patterns make women’s bodies more hospitable to sperm carrying the male chromosome, Jain said.

“It’s an interesting question. I’m not aware of anyone else looking at it in this manner,” he said.

The study was published Wednesday in the Proceedings of the Royal Society B, a British medical journal.

The research involved about 700 first-time pregnant women in the United Kingdom who didn’t know the sex of their fetuses. They were asked about their eating habits in the year before getting pregnant.

Among women with the highest calorie intake before pregnancy (but still within a normal, healthy range), 56 percent had boys, versus 45 percent of the women with the lowest calorie intake.

Women who ate at least one bowl of breakfast cereal daily were 87 percent more likely to have boys than those who ate no more than one bowlful per week. Cereal is a typical breakfast in Britain and in the study, eating very little cereal was considered a possible sign of skipping breakfast, Mathews said.

Compared with the women who had girls, those who had boys ate an additional 300 milligrams of potassium daily on average, “which links quite nicely with the old wives’ tale that if you eat bananas you’ll have a boy,” Mathews said.

Women who had boys also ate about 400 calories more daily than those who had girls, on average, she said.

Still, no one’s recommending pigging out if you really want a boy or starving yourself if you’d prefer a girl.

Neither style of eating is healthy, and besides all the health risks linked with excess weight, other research suggests obese women have a harder time getting pregnant.

The study results reflect women at opposite ends of a normal eating pattern, not those with extreme habits, Mathews said.

Professor Stuart West of the University of Edinburgh said the results echo research in some animals.

And Dr. Michael Lu, an associate professor of obstetrics, gynecology and public health at the University of California at Los Angeles, said the results “are certainly plausible from an evolutionary biology perspective.” In other words, since boys tend to be bigger, it would make sense that it would take more calories to create them, Lu said.

Still, Lu said a woman’s diet before pregnancy may be a marker for other factors in their lives that could influence their baby’s gender, including timing of intercourse.

“The bottom line is, we still don’t know how to advise patients in how to make boys,” he said.

———

ON THE WEB

Journal: http://publishing.royalsociety.org/index.cfm?page1087

CHICAGO – The number of young children on prescription drugs for heartburn and other digestive problems jumped about 56 percent in recent years and researchers say obesity and overuse might be contributing to the surprising increase.

The surge was found in a Medco Health Solutions Inc. analysis released Thursday of U.S. prescription data for 2002-2006. It suggests that more than 2 million U.S. children 18 and under used drugs for digestive or gastrointestinal complaints last year.

“It’s a signal that something’s going on that we need to keep an eye on,” said Dr. Robert Epstein, Medco’s chief medical officer. “Whether it’s parents getting their children diagnosed more frequently, or obesity,” or other factors, “it bears further study,” he said.

Researchers at Medco, a pharmacy benefits management company based in Franklin Lakes, N.J., analyzed prescription drug claims of more than 575,000 U.S. children.

They calculated that 557,259 infants and children up to age 4, or about 3 percent of youngsters in that age range, were taking these drugs last year. That’s about a 56 percent increase from 2002.

There was a 31 percent increase among children aged 5 to 11, climbing to an estimated 551,653 children, or 2 percent in that age group in 2006, the analysis found.

Almost 1 million children aged 12 to 18 had prescriptions for the drugs last year, but that was up only 6 percent over 2002.

Acid-reducing drugs called proton pump inhibitors are the most common medicines prescribed for GI problems, the analysis said. They are used for acid reflux associated with heartburn, and a related condition called gastroesophageal reflux disease or GERD.

Some of these, including Prevacid, were approved for use in children during the study period, which likely also contributed to the prescription surge, said Dr. Benjamin Gold, an Emory University specialist in children’s digestive diseases.

Heartburn is a common complication of being overweight and the surge happened during the nation’s rising obesity epidemic, said Dr. Renee Jenkins, president-elect of the American Academy of Pediatrics. She noted that more than 10 percent of U.S. preschoolers and 30 percent of older children are considered overweight.

Gold said there’s no hard data on how many children have acid reflux or GERD. But there’s some evidence that the numbers are rising, and obesity could be playing a role, he said.

Heartburn and acid reflux are also extremely common in infants and young children. Many of them outgrow it and drug treatment often isn’t needed, so the increase raises concerns about whether these drugs are sometimes being used unnecessarily, said Jenkins, a Howard University pediatrics professor.

While some children do require treatment including prescription drugs, many get better with no treatment or lifestyle changes such as smaller, more frequent meals or cutting down on fatty foods, she said.

Still, parents increasingly are demanding that doctors prescribe medicine for reflux, in part because of direct-to-consumer marketing, Gold said. But also, symptoms including frequent spitting up, irritability and stomach aches are troublesome and many parents prefer a quick fix, he said.

Gold said reflux drugs are generally safe but there is some evidence linking long-term use with an increased risk of infections including pneumonia and bowel inflammation.

To avoid overuse, Jenkins said parents should be willing to try non-drug approaches for treating reflux and other digestive problems in young children.

On the Net:

Medco: http://www.medco.com

Reflux: http://digestive.niddk.nih.gov/ddiseases/pubs/gerinchildren/