Sunday, January 2, 2005
More kids chronically ill Study to seek explanation in environmental factors By Philip J. Landrigan and Leonardo Trasande
For The Poughkeepsie Journal
Patterns of disease have changed dramatically in U.S. children in the past 50 years. The good news is many of the most feared diseases are no longer with us. Smallpox has been eradicated. Measles and polio are nearly gone. We have vaccines for mumps, rubella, Haemophilus influenza and hepatitis.
But the bad news is that chronic diseases have become increasingly common in our children. Asthma rates have more than doubled. The incidence of acute lymphocytic leukemia has increased by 62 percent. Major clusters of childhood leukemia have been reported from Toms River, N.J., and Fallon, Nev. There have been significant increases in rates of childhood brain cancer, birth defects, autism and attention deficit disorder.
Parents ask us, "Why are these changes occurring?"
And they ask, "Is something in the environment responsible?"
Much still remains to be learned about the causes of disease in our children. That is why research continues at a rapid pace in hospitals and medical schools across the land. But the evidence is mounting steadily.
Environmental exposures do make important contributions to childhood disease. The ozone and fine particles that comprise our air pollution have been proven to cause asthma. Environmental tobacco smoke and other indoor pollutants are also asthma triggers. Solvents, pesticides and ionizing radiation have been linked to childhood cancer. Brain damage has been seen following exposures in the mother's womb to chemicals that can cross from mother to unborn child -- lead, methyl mercury, polychlorinated biphenyls (PCBs) and certain organophosphate pesticides. These chemicals can enter the brain of the infant to cause learning disabilities and behavior disorders, problems that can last a lifetime.
Task force advised study
The President's Task Force on Environmental Risks to Children concluded in 1998 we had reached a point where we needed to confront these threats. The task force recommended as an urgent national priority the United States launch a major, long-term study of environmental influences on children's health and development. Congress accepted this recommendation, and through the Children's Health Act of 2000, Congress authorized the National Institutes of Health to conduct the National Children's Study.
The aim of National Children's Study is to follow 100,000 children from before birth to age 21. Information will be obtained at every stage on environmental exposures and children's health. Pregnant mothers will be asked to donate samples of their blood and urine to measure exposures in the womb. Children in the study will be examined throughout their growth and development.
The study will tell us much more than we know today about triggers for asthma and the causes of learning disabilities. It will tell us what exposures are harmful and which are not. Most importantly, it will give us the information we need to plan prevention.
Planning for the National Children's Study has been under way for the past three years. Study goals have been specified. Logistics have been planned. Teams have been put in place. The study is poised to start this year.
Previous long-term studies of environment and health have yielded massive benefits. The Framingham Heart Study, launched in Framingham, Mass., in 1948, taught us about risk factors for heart disease and stroke. It paved the way for the very great reductions in cardiovascular disease in this country in the past four decades. Likewise, studies of childhood lead poisoning gave us the information that we needed to remove lead from paint and from gasoline. The benefits for our children's health have been enormous.
These major health studies also yield large economic benefits. Six of the diseases the National Children's Study intends to study -- asthma, diabetes, schizophrenia, obesity, injury and autism -- cost America $642 billion every year. If the study were to reduce these costs by only 1 percent, the savings in a single year would be $6.4 billion, far more than the cost of the study over 25 years. The National Children's Study will be a good investment.
Despite its enormous potential, funding for the study is at grave risk. The federal budget is very strained this year. There is real danger that the resources necessary to launch the study will not be found. In 2005, $27 million in federal funding is needed to keep the study on track; without these funds, the study may be postponed or even cancelled.
If the study does not proceed, the loss for our children would be terrible. Disease prevention could be set back 20 years. The National Children's Study is something America needs.
Philip J. Landrigan directs Mount Sinai's Center for Children's Health and the Environment in New York City. Leonardo Trasande is the assistant director.
- To learn how reduce your children's exposure to environmental chemicals, visit: www.health.state.ny.us/nysdoh/environ/reducing_environ_exposures.htm
- For information about local education programs, call the Dutchess County Asthma Coalition at 845-483-5777
Children are at greater risk from chemicals found in food, water, dirt and air for several reasons. For their size, they eat, drink and breathe more than adults. They crawl on floors, play in dirt and put their hands in their mouths. And their bodies are still developing. The more you can reduce unnecessary exposures to commonly used chemicals or other hazardous substances, the healthier the environment becomes for you and your children.
Keep homes kid-friendly and contaminant-free
1 -- Keep it out : Second-hand smoke, pesticides, gasoline and kerosene fumes, and chemicals released by burning trash in the backyard can all produce chemicals that may be harmful if inhaled. It's best to keep these outside the home altogether. That means smokers should go outside, windows should be closed if pesticides are being used outside, harmful chemicals like gasoline should be properly stored out of living areas, and trash should not be burned.
2 -- Air it out: Chemicals from paints, wood finishing products, cleansers, glues and some materials used for hobbies can be harmful. They should be used indoors only in well-ventilated areas, and fans should be used if necessary. Even new carpet can release harmful chemicals to the air, so ask that it be aired out before it is delivered and keep windows open until the smell has dissipated.
3 -- Less is better: Cleaning products, pesticides and insect repellents should be used sparingly. Learn about integrated pest management to control household insect and rodent problems, and never let young children apply insect repellents to themselves.
4 -- Wash frequently: Residues from harmful chemicals can accumulate in dust, and even on the food we eat. Wash fruits and vegetables, and rinse meat before cooking. Skin and trim fish before eating, since some contaminants accumulate in fatty tissues. Wash children's hands and toys with soap and water frequently, and use a damp mop or sponge to clean floors, window sills and the area between the screen and the windowsill where dust collects. This will help prevent kids from being exposed to dust that can be contaminated with harmful contaminants like lead.
5 -- Use alternatives: Many household products contain chemicals that can be harmful, but less-and non-toxic alternatives are often available. Beautiful and natural lawns can be often be maintained without pesticides. Use fresh air to improve smells, rather than air fresheners, deodorizers and candles, as they can release chemicals into the air. Reduce or eliminate use of personal care products like hair sprays, powders and perfumes whenever possible. When buying art supplies, look for the phrase "conforms to the federal ASTM D-4236 standard" and avoid permanent and scented markers.
6 -- Keep a distance: Carefully store potentially harmful chemicals, like cleaning products, drain openers, polishes, bleaches and pesticides. Lock harmful chemicals in cabinets out of children's reach. Dispose of unwanted products properly through periodic household hazardous waste disposal days sponsored by Dutchess and Ulster counties.
7-- Educate yourself: Radon gas, carbon monoxide, molds, lead-based paint and contaminated drinking water can all be present in the home. Screen your home for these things to prevent exposing yourself and your children.
Source: Reducing Environmental Exposures: The Seven Best Kid-Friendly Practices
[8 -- Avoid medical personnel who insist upon injecting ethylmercury or thimerosal. In the very least, prevent the injection.]
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NORTH DAKOTA: Study: Special needs students make up 12 percent of enrollment
BISMARCK - Children with special needs account for 12 percent of North Dakota's total public school enrollment, about the same as the national average, a new study finds. In the past 20 years, the number of special education students increased by 34 percent, while the national average rose 57 percent, said the study by the North Dakota Center for Persons with Disabilities. "It's not as dire as it would seem," said Bryce Fifield, co-director of the study. "Things don't really look as bad as they first did when we started."
The state Department of Public Instruction and the Center for Persons with Disabilities put together the study last fall, to try to find out why the number of special education students in kindergarten through 12th grade went up while the overall state school enrollment had dropped in the past five years. Special education students receive assistance in the classroom for conditions ranging from speech impairments to attention deficit hyperactivity disorder to mental retardation. The latest study looked at special education enrollment throughout the state in the past 20 years and broke it down by region and specific disability categories. The study also examined the effect of programs for younger children.
The state set itself apart from national trends because of declines in certain special education categories. North Dakota saw a 32 percent decrease in mentally retarded children and an almost 40 percent decrease in students with hearing impairments, the study found. "I can't account for that," said Brent Askvig, co-director of the study. "It's odd and unusual, and we need to keep watching that." Education officials had thought autism was one of the state's largest growing categories. But the study found the categories of speech impairments, emotional disturbance and learning disabilities gained the most students.
The age of children receiving special education services has shifted in the past 20 years, the study found. The largest group of special needs students was in the 6- to 11-year-old age group in 1982. The study found the largest group currently is in the 12- to 17-year-old range. Askvig said that shows early intervention programs are making a difference. "Once you ask these questions, it opens the doors for us discussing them," said Bob Rutten, North Dakota's special education director. "It's like putting together a big puzzle to try and understand why families and schools are seeing this increase."
Rutten said the state must look further at such issues as how special education students are identified.
(Maybe look at their vaccine record?)
CDC: More than 4.4 Million U.S. Kids With ADHD
Thursday, September 01, 2005
By Miranda Hitti
•Learn More About ADHD Meds•FDA to Go Slow on ADHD Drug Warnings •Ritalin May Slow Growth in Some •Understanding ADHD and the Creative Child •Visit WebMD's ADD/ADHD Health Center
A new CDC report shows how common attention deficit hyperactivity disorder (ADHD) has become in the U.S.
Data came from the parents of more than 102,000 kids. The findings:
—About 4.4 million kids had ever been diagnosed with ADHD.
—More than half of those kids (56 percent, or 2.5 million kids) were taking medication for ADHD when the survey was done.
—ADHD was diagnosed more often in boys than in girls.
—ADHD was diagnosed less often in minority children and those without health insurance.
The national survey was done by telephone. Parents were asked if a doctor or health care professional had ever told them that their child had ADD (attention deficit disorder) or ADHD.
ADHD was previously known as attention deficit disorder, says the CDC.
Learn More About ADHD Meds
A history of ADHD diagnosis was more common in kids who were at least 9 years old compared with those who were 4 to 8 years old, the survey shows.
ADHD diagnosis history was most common among 16-year-old boys. About 15 percent of them had ever been diagnosed with ADHD, according to the boys' parents.
For girls, a history of ADHD diagnosis was most common among 11-year-olds. Six percent of them had ever been diagnosed with ADHD, according to the parents' reports.
For boys, ADHD diagnosis was more common in families living below the poverty level. Rates of reported diagnosis for girls didn't vary by income.
Rates were similar for boys and girls with reported ADHD diagnoses who were taking medications for the condition.
Understanding ADHD and the Creative Child
Rates Varied Among States
The survey also showed substantial differences between states.
The number of kids with reported ADHD diagnosis ranged from 5 percent in Colorado to 11 percent in Alabama. Among kids who had reportedly been diagnosed with ADHD, California had the lowest percentage of kids taking medication for ADHD (more than 40 percent) and Nebraska had the highest percentage (almost 58 percent).
The Fine Print
The survey has a few limits. For instance, the parents' reports couldn't be confirmed.
ADHD treatments that don't involve medication weren't included. It also didn't include people living in institutions, who might have higher ADHD and medication rates. The survey was only done in English or Spanish. That excludes families who don't speak those languages. Data didn't cover undiagnosed ADHD cases or kids without an ADHD diagnosis who take medications for similar symptoms.
By Miranda Hitti, reviewed by Brunilda Nazario, MD
SOURCES: CDC, Morbidity and Mortality Weekly Report, Sept. 2, 2005; vol 54: pp 842-847. News release, CDC.