posted 05-01-2002 01:40 AM            

Adults do not die of whooping cough, though they can be sick for months. But they can infect young babies, for whom it can be fatal. The only solution may be to vaccinate prospective mothers who can pass on immunity.

"In Canada, a recent study showed there are six times as many cases of whooping cough today as 10 years ago," said Marc Struelens of Erasmus Hospital in Brussels, at an infectious diseases conference in Milan, Italy. Adult cases in the US may have risen 13-fold since 1981.

And in Finland, despite a 97 per cent vaccination rate, cases jumped five-fold between 1995 and 1999. Nearly all were in babies under three months old - too young for vaccination.

Vaccination paradox

No one disputes the benefits of vaccination. Whooping cough kills 400,000 children worldwide each year, mainly in poor countries. Before vaccination started in the 1950s, it killed 150 children a year in England and Wales; now Natasha Crowcroft of the UK's Public Health Laboratory Service estimates the average annual toll at nine.
And yet, vaccination may have helped cause the recent resurgence of whooping cough.

Neither vaccination nor the disease confer life-long immunity. But when whooping cough was still common among young children, older children and adults encountered the bacteria frequently enough that this acted like a booster vaccine, maintaining immunity.
But as vaccination makes the bacteria scarce, this stops, and immunity among adults wanes. Now, when they do encounter the bacteria, they get sick, and a sick adult is a contagious adult.

Worse still, few adults realise they have whooping cough as their symptoms do not resemble the classic disease of babies. Diagnosis is difficult too as the bacteria are extremely hard to culture. Molecular diagnosis is possible only by using PCR to identify DNA, not a commonly-used procedure.

Inherited immunity

Marion Riffelmann of the Institute of Hygiene and Clinical Medicine in Krefeld, Germany used it to test German adults with chronic cough, and reported in Milan that one in 10 had whooping cough. Other studies have found rates as high as one in four.

Frits Mooi of the Dutch National Institute for Public Health and the Environment in Bilthoven, says that whatever is causing the increased cases of whooping cough in adults, those who suffer are babies too young to be safely vaccinated.

"The only way we can protect them now is to vaccinate mothers, so they will pass on their immunity," says Mooi. European public health authorities are considering offering whooping cough vaccination to prospective mothers.

posted 05-01-2002 06:12 PM            

NYC Kids Stressed Out After Sept. 11

NEW YORK- Nearly 90 percent of New York City schoolchildren were suffering at least one symptom of post-traumatic stress six months after Sept. 11, and 10 percent likely had the disorder, according to a study released Wednesday.

In the 1.1 million pupil public school system, an estimated 75,000 children likely showed six or more symptoms of post-traumatic stress - enough to be diagnosed with the disorder, according to the Board of Education study.

Mental health researchers participating in the report, which studied more than 8,000 children at 94 schools, were particularly surprised to find that children throughout the city - not just near ground zero - showed symptoms of several psychiatric problems.

"The school system, above all, has to be cognizant of the fact that they are trying to do a job with students who are very troubled, very troubled today because of 9/11," said Christina Hoven, a Columbia University psychiatric epidemiologist who led the study.

Researchers said the study was groundbreaking in its comprehensive examination of children's response to a major disaster.

The study surveyed children grades 4-12 in late February and early March, finding that 76 percent often thought about the terrorist attack, 24 percent had problems sleeping and 17 percent had nightmares. The study was based on questions posed to the children themselves.

Schools Chancellor Harold Levy said the study was a "wakeup call."

"That's powerful information for us to focus resources, and powerful information for us to focus the attention of the professionals so they keep their eyes out to pick out the kids who have this," Levy told reporters.

Fifteen percent of the children surveyed showed symptoms of agoraphobia - the fear of venturing outside the home. Hoven compared that with a 1996 study of several cities that showed about 5 percent of children on average suffer from agoraphobia.

The board of education study's agoraphobia findings suggest that an estimated 107,000 city schoolchildren suffer from the disorder after Sept. 11. Hoven said the fear could be heightened for children who travel through tunnels and over bridges to get to school.

"If they're scared of it, if they're worried about it, if it's distracting from their schoolwork, that's something that's of serious concern," Levy said.

Researchers said the study found that younger children, girls and those whose family members were at the World Trade Center - whether they were killed, hurt or unharmed - were more likely to suffer from psychiatric disorders. Also children who had experienced prior traumas showed more vulnerability to mental health problems.

Levy said the information would be used in several ways, including toward securing more federal funding for mental health programs.

"What this is telling us is that in some schools, we're going to have to do more," Levy said. "That could mean simply more hours or more guidance counselors, or actual more intense programs."

Levy said educators won't know the effect of the children's mental trauma on their schoolwork until students take the standardized tests. http://www.lasvegassun.com/sunbin/stories/nat-gen/2002/may/01/050103822.html

Today: May 01, 2002 at 13:10:29 PDT

Agency: Child Obesity on the Rise

WASHINGTON- Overweight children are being hospitalized at dramatically rising rates for diabetes, sleep apnea and other diseases that obesity causes or worsens.

Obesity accounts for a tiny proportion of all child hospitalizations, scientists say. But the Centers for Disease Control and Prevention reported Wednesday that "a disturbing increase" in the numbers has made hospital costs related to childhood obesity more than triple in the past 20 years, reaching $127 million.

Doctors have long warned that childhood obesity has become epidemic. But the new research is among the first to show how much more is at stake than fat children growing into fat adults - obesity can seriously sicken them now.

"When you show a parent a growth chart and point out the child is overweight, it doesn't mean very much unless the child's self-esteem is affected," said CDC lead researcher Dr. William Dietz.

The new study "changes the perspective that obesity is simply a cosmetic problem to really focus on ... childhood obesity as a serious medical problem," he said.

About 13 percent of children and adolescents are overweight or obese, more than double the number two decades ago. Experts blame TV, computer games, lack of safe playgrounds and other factors that encourage kids to be sedentary - plus more access to super-sized portions of high-calorie foods.

At the same time, more children are suffering Type 2 diabetes, a dangerous disease that once struck mostly in middle age. Obesity also can worsen asthma and spark gallbladder disease. People even can die from obesity-caused sleep apnea, Dietz notes, when fat in the back of the throat combines with large tonsils to block the airway.

CDC researchers culled hospital discharge records, comparing obesity-related hospitalizations of 6- to 17-year-olds between 1979 and 1981 with those from 1997 through 1999.

Diabetes diagnoses nearly doubled, accounting for 2.36 percent of child hospitalizations in the late '90s vs. 1.43 percent in the late '70s, they reported Wednesday in the journal Pediatrics.

Diagnoses of obesity alone tripled to reach 1 percent of hospitalizations.

Other obesity-related hospitalizations were more rare but rising rapidly - sleep apnea rose fivefold and gallbladder disease tripled. Asthma cases complicated by obesity rose 40 percent.

The study may surprise parents, but not obesity specialists who called it high time someone pointed out the growing danger to youngsters.

"The kids who are fat are getting really fatter," said Dr. Nazrat Mirza of Children's National Medical Center, who has patients as young as 5 with obesity-caused sleep apnea.

The study "represents just the tip of the iceberg," she said - because doctors often don't record obesity on hospital discharge records. That's because insurance companies don't pay to treat it until the child comes down with a formal illness, she complained.

Gymnast Dominique Dawes and tennis great Martina Navratilova helped the government publicize the study Wednesday, racing through an obstacle course with youngsters in Washington to show them that staying fit is fun.

Give up the video games, Navratilova advised: "You're not going to become Michael Jordan by playing Space Invaders." http://www.lasvegassun.com/sunbin/stories/thrive/2002/may/01/050103631.html

posted 05-07-2002 02:28 PM            

by Standard Reporter

A "very fit" girl of 13 died from a heart attack after she was bitten by mosquitoes during a family holiday, an inquest has heard. Maria McGranaghan collapsed after returning from a week's stay on the Greek island of Corfu where she had been badly bitten . An inquest in her home town of Stockport was told that no specific medical reason for her death could be established, but it was possible that the heart attack was triggered by inflammation caused by the insect bites.

A Home Office pathologist said Maria had suffered an undetected heart attack some time before she died. She had the second, fatal, attack 11 days after flying home last August. Dr Charles Wilson said he could not be certain whether the initial heart attack happened in Corfu or before her holiday. Maria's mother Sona McGranaghan told the inquest that on the first day of the holiday last August her daughter had slept outside because it was too hot indoors.

She had been badly bitten and had developed a rash on her face which was treated by her GP when she came home but later complained of feeling dizzy, sick and cold while out walking with friends . Maria collapsed and, despite attempts by a passer-by and paramedics to revive her, she was dead when she arrived at hospital. Dr Wilson said that during his 10 years' experience, Maria was the youngest heart attack victim he had seen.

Despite extensive investigations he could not say why she had the attack. Coroner John Pollard said there was no evidence of a natural cause to trigger the heart attack.

He went on: "There's evidence the mosquito bites might have caused it. Therefore the scales are tilting in that direction." But

posted 05-07-2002 05:43 PM            

"It's really freaky," said Baer, a ninth-grader. "I'll be lucky if I get out of this school alive."
Fear and angst are high among students at East Pennsboro Area High School after a series of student deaths in the school district. Four high school students, a middle school pupil and a kindergarten pupil have died since Dec. 15.
On Sunday, 17-year-old Jimmy Henry, a junior, died in Holy Spirit Hospital of a brain aneurysm he had since birth, according to Cumberland County Coroner Michael Norris, forcing grieving teen-agers to face their own mortality yet again.
Funerals, prayer services. Crying. Teens huddled together at the local skating rink, crying about death. Remembering Jessica Batdorf, a 13-year-old student who collapsed in the middle school hall one morning as she went to her locker. Remembering her in her coffin.
"They said she looked like a little porcelain doll in her white dress," Amber Hammett, a seventh-grader, recalled.
Crying in Johnny's Pizzeria, a popular after-school hangout down the street from the high school. "It's a hard thing," said Johnny, the cook and owner, who prefers to go by his first name only. "You can't say, 'What's up, what's going on?' I just let them be.
"I feel I'm in a sci-fi movie. You think it's going to stop, but it just keeps happening. You want to turn the 'off' button off."
Death creeps into everything. Even skateboarding, which Andy Huling, an eighth-grader, had considered an escape from what was happening -- "a paradise," he calls it. He was late getting to his locker the day Jessica died, and watched her collapse, watched her fall against the lockers, fall to the floor.
While he and friend Mike Ardoline skated on worn boards in the parking lot of the local coin-operated laundry, they talked of her death, and the string of deaths, trying to find a reason, an answer. Rumors among students have flown -- everything from tainted air and water to the schools being built over an old landfill or a sacred American Indian burial ground.
A curse.
All Huling knew was that the night after Jessica's death, he couldn't sleep.
"It doesn't make any sense," he said. "Why would six kids just die in the same year?"
Jessica's sister, Heather, a freshman at East Pennsboro, has wondered that, too. "In a way, I do believe these deaths are coincidental," she said. "However, like everyone else I wonder. Why East Pennsboro?"
Students have gone to counselors and ministers, searching for answers. "Their peers are dying around them and they are running scared," said Celeste Hamilton, a pastoral assistant at Our Lady of Lourdes Catholic Church and president of the West Shore Ministerium. "They feel very, very vulnerable, and normally someone that age doesn't feel vulnerable at all."
To Kyle Kelchner, a ninth-grader, the deaths are simply a coincidence. Still, they have shattered the normalcy of life.
"It's changed the way I look at friends -- hoping they're not going to be the next one to pass out and die," he said.
Steve Rouzer, a 10th-grader, met Jimmy Henry while working after school at the Giant in a township strip mall. Rouzer bagged groceries, Henry sold seafood behind a counter. Rouzer was bagging groceries the day Henry's family called the store to break the news of his death.
It was hard. "I never had a friend die before," Rouzer said.
His reaction? A mixture of feelings that is difficult to describe.
"I'm more accepting of death now -- it gets harder and easier all at the same time," Rouzer said. "Somebody dies, then you think of all the people who died."
Baer thought of all the students who have died, as she sat on the curb across the street from her school. A few long, flat windows were pushed open in the brick building, and shades were partially pulled down. On a sign at the entrance, usually reserved for pep-rally slogans or school announcements, the staff had written the words, "We will be OK. God bless our kids."
She wasn't sure she could deal with another death.
"If someone else dies," Baer said, "I'm not going to school." JIM LEWIS: 255-8479 or jlewis@patriot-news.com JERRY L. GLEASON: 975-9782 or jgleason@patriot-news.com
http://www.pennlive.com/news/patriotnews/index.ssf?/xml/story.ssf/html_standard.xsl?/base/news/10207638292419211.xml

posted 05-08-2002 05:56 PM            

Friday, 1 February, 2002, 01:25 GMT
Ozone link to asthma

Children playing outdoor team sports in areas of high ozone concentration could be at increased risk of developing asthma.
Research suggests that they are three times more likely to develop the condition than children who do not take part in sporting activities.

Asthma is the most common chronic disease of childhood and it is on the increase in developed countries. However, scientists do not know why.

The new study suggests that pollution, which has long been suspected as a culprit, does indeed play a role.

A team from the University of Southern California, Los Angeles, examined around 3,500 children from schools in 12 communities in southern California.

During the five years of the study 265 children were diagnosed for the first time with asthma.

Bigger risk

Children who played three or more outdoor sports in high-ozone environments were more than three times as likely to develop asthma compared with children who did not play any sports.

There was no increased risk where ozone concentrations were low.

Children who spent time outside in areas with high ozone concentrations were 1.4 times more likely to develop asthma than children in areas of low ozone concentration.

Other environmental pollutants such as nitrogen dioxide, particulate matter were not associated with an increased asthma risk.

Researcher Dr Rob McConnell said: "Our study provides evidence that, contrary to conventional wisdom, ozone is involved in the development of new onset asthma in children who exercise heavily (and thereby increase the amount of ozone which gets into the lungs).

"It is by no means conclusive proof that air pollution causes asthma, but it may be a piece of the complicated asthma puzzle."

Dr McConnell said his study should discourage parents from encouraging their children to take part in sport.

He said: "The bottom line is this: exercise is really healthy for children, for many reasons, and children should be encouraged to play team sports.

"But, on days when air pollution levels are expected to be high, children should limit prolonged outdoor exertion."

Not a trigger

Professor Martyn Partridge, chief medical adviser to the UK National Asthma Campaign, said until now most of the good scientific evidence suggests that outdoor pollution can make existing asthma worse but not actually trigger it in the first place.

He told BBC News Online: "This latest study does suggest an association between outdoor pollution and the development of asthma.

"However, this does not necessarily mean that one causes the other.

"Pollution, if shown to be a factor, may be only one amongst many that lead to more people having this condition now than 20-30 years ago.

"Nevertheless, this is a very important study adding significantly to our knowledge in this area"

Ozone, an unstable molecule composed of three oxygen atoms, provides an essential shield against dangerous ultra violet radiation in the upper atmosphere.

But at ground level, where it is produced from traffic fumes and industrial emissions, it is a highly toxic pollutant and a major component of city smog.

The gas is corrosive to lung tissue and can damage delicate bronchial branches and air sacs.

posted 05-15-2002 08:25 PM            

Study Says Some Baby Care Not Needed

BOSTON- A provocative study of newborn death rates finds strikingly few differences across the country and suggests there are far too many doctors and hospital units specializing in intensive care of premature or sickly babies.

Only newborns in areas with the very fewest specialists die at a higher rate than elsewhere. But once a certain threshold of care is reached, having even more doctors offers no extra advantage, the study says.

The researchers said this oversupply is not only a profound waste of medical resources, it may also be harmful, because it may subject babies to unnecessary tests and treatments.

The researchers "raise disturbing issues regarding the nation's unquestioning acceptance that more is always better with respect to the supply of specialist physicians and hospital technology," said Dr. Kevin Grumbach, a public health researcher at the University of California at San Francisco.

He wrote an editorial to accompany the findings, published in Thursday's New England Journal of Medicine.

The researchers at Dartmouth Medical School in Hanover, N.H., knew of big disparities in the availability of specialized neonatal care from region to region. They wondered if places with more specialized doctors or beds relative to the number of births save more newborns.

The study found that, for the most part, they don't. Only newborns in areas with very few such doctors, 2.7 for every 10,000 births, show a higher death rate - 7 percent higher than in better-equipped areas.

Other areas - with a supply of doctors ranging from 4.3 to 11.6 neonatologists per 10,000 births - all had about the same death rate. Even the most premature babies were found to die at roughly the same rate in these areas.

Moreover, the supply of neonatal intensive care hospital beds made no difference in death rates around the country.

"Enough may be enough," said Dr. David Goodman, the pediatrician who led the study.

The neonatal-care specialty has mushroomed since the 1970s, thanks to new technology and therapies, including ventilators designed for premature newborns and prenatal drugs that help fetuses' lungs develop. Some babies born three months early, weighing barely over a pound, can now be rescued.

However, the researchers suggested that social and economic factors have expanded the field beyond pure medical need. For doctors, the specialty can be gratifying, exciting and well-paying. For hospitals, it a lucrative and prestigious business.

The researchers said that because of the oversupply, some relatively healthy newborns may be subjected to unneeded tests and treatments that can produce harmful side effects.

"If I have a healthy full-term baby, I actually don't want anyone messing around with that baby," Grumbach said. "There's a downside where we meddle too much."

However, he said it would take deep changes in the medical system, with more government planning, to distribute neonatal doctors and beds much more uniformly.

An executive at a large for-profit neonatal doctors' group, Pediatrix Medical Group of Sunrise, Fla., agreed that the distribution of these specialized doctors "is not ideal."

"There are areas where there are perhaps more than we need and areas where there are perhaps less than we need," said Dr. Joyce Peabody, vice president of medical affairs at Pediatrix.

posted 05-23-2002 11:26 PM            

US Looks to Prevent Kids' Drownings

WASHINGTON- Many parents know to watch young kids carefully in swimming pools but are unaware of hidden drowning hazards around the home, government safety officials warned Thursday.

About 115 children drown at home each year in accidents that don't involve pools, the Consumer Product Safety Commission said, issuing new drowning statistics and a safety alert for consumers. At least 459 children younger than 5 drowned at home from 1996 through 1999. Two-thirds of those deaths involved bathtubs.

"Never, ever leave a child alone in a bathtub, even for a second," said Jacqueline Elder, the agency's acting director of hazard identification. "If you leave them even to answer the phone or get some clothing, they can slip under the water and drown very quickly in very little water."

Other hazards in and around the home may be less obvious. During that four-year period, 58 young children died after falling into 5-gallon buckets, 55 in home spas or hot tubs, 16 in toilets and 38 others in such products as water coolers, sinks, garbage cans and fish tanks. The 5-gallon buckets in particular "pose a serious threat to toddlers," the agency said.

Michael Graham, chief medical examiner of St. Louis, said a 10-month-old child drowned there last week in a 5-gallon cleaning bucket filled with several inches of water. "The kids lean over looking into the bucket and the next thing you know they're in headfirst and the bucket is not going to fall over. The child is helpless," he said.

The bucket-related drownings reported to the government involved children younger than 18 months and most died of complications within a month of falling in. In most cases, the bucket was filled with dirty water that had been sitting for some time. The statistics are based on reported incidents and the actual numbers may be higher, the safety commission said.

The government offered these safety tips: -Never leave a baby or young child alone in a bathtub. -Keep the toilet lid down and keep unsupervised young children out of the bathroom. -Be sure all containers that contain liquid are emptied immediately after use. -Store buckets where children can't reach them and don't leave empty containers where they may accumulate water. -Always secure the safety cover on a spa or hot tub. http://www.lasvegassun.com/sunbin/stories/thrive/2002/may/23/052305496.html

Today: May 23, 2002 at 18:30:20 PDT

Teens More Likely to Inflict Wounds

ATLANTA- Adolescents show up at hospital emergency rooms with self-inflicted injuries - usually suicide attempts - more often than any other age group, the government said Thursday.

A study by the Centers for Disease Control and Prevention found that hospitals in the United States treated 264,108 non-fatal, self-inflicted wounds in 2000. The study did not include fatal wounds. It found one self-inflicted injury for every 389 people ages 15 to 19 in 2000.

People ages 20 to 24 had the next highest frequency, with one injury for every 423 people. It also found that women are nearly 30 percent more likely than men to arrive at a hospital with a self-inflicted wound. The study is useful to public health officials because it can point them to the groups who are most likely to try to harm themselves - even if it's only for attention. "Some people, when you ask them about their intent, their intent was they really wanted to die," said the CDC's Dr. Alex Crosby. "Others are just looking for a way to deal with their problem." For all age groups, roughly 60 percent of all self-inflicted wounds are probable suicide attempts, the study found.

posted 05-27-2002 02:16 AM            

Rash Appeared After Overseas Package Was Opened

At least eight people came down with a mysterious rash at an industrial plant in Horsham, Pa.

The rash broke out late Wednesday afternoon after a package was opened at the McKesson Pharmaceutical Plant on Dresher Road.

The package had been shipped there from overseas.

The workers were being treated at the scene in special hazmat tents. They were all treated and released.

posted 05-29-2002 12:17 AM            

State of Alaska Epidemiology Bulletin

Bulletin No. 9
April 15, 2002

Outbreak of Parvovirus B19 Rash in Children

Background

On March 15, 2002, the Section of Epidemiology was notified of numerous cases of rash illness in children in a village in Western Alaska. In addition, similar reports of rash illness were subsequently received from nearby villages. Most descriptions were comparable to rashes that were being reported in elementary age children in many other states this winter. (1)

Investigation

Epidemiologic Investigation
On March 26, investigators flew to the village to determine the extent and etiology of the outbreak, clinical characteristics of the illness, and to educate the community about public health issues concerning the outbreak.

Active surveillance involved asking health aides, teachers and students to report recent rash illness. All people who reported illness were given an extensive questionnaire to fill out at home. Completed questionnaires were collected before leaving the village, and arrangements were made to mail those not yet completed.

We defined a case-patient as anyone who developed a new rash from January 1, 2002 to the present date.

Laboratory Investigation
Clinical specimens were collected only from persons who met the case definition for rash illness. We obtained serum samples, nasopharyngeal swabs, and rectal swabs. Serum samples were sent to the Centers for Disease Control and Prevention for viral isolation. Nasopharyngeal and rectal swabs were sent to the Alaska State Public Health Virology Laboratory for viral culture.

Results

Epidemiologic Investigation
To date, we have received 43 completed questionnaires from parents of ill children. The first identified case was on January 26. The median age was nine years; the range was 4-13 years. The gender distribution was 49% male. The mean duration of symptoms was four days; the range was one to eight days.

Please see Table 1 for a description of the rash. Prodromal symptoms were reported in 7 of 35 (20%) case-patients, and constitutional symptoms during the rash were reported in 10 of 35 (29%) case patients. These symptoms included, but were not limited to headache, fever, cough, nasal drip, and joint pain.
Table 1. Description of Rash Summarized
Number of
Responses Number (%) that said, "yes"
Description of initial rash:

Flat red spots 36 15 (42%)
Raised red bumps 36 3 (8%)
Red skin (solid) 36 10 (28%)

Description of rash at worst:

Flat red spots 31 9 (29%)
Raised red bumps 31 4 (13%)
Red skin (solid) 31 6 (19%)

Other associated symptoms

Itchy 38 32 (84%)

Where rash started:

Extremities 37 17 (46%)
Face 37 7 (19%)
Torso 37 4 (11%)

Laboratory Investigation
We obtained a total of 19 nasopharyngeal swabs, 12 rectal swabs, and 17 serum samples. All nasopharyngeal and rectal swabs for respiratory and enteric viruses were negative. Serum samples from 14 of 17 patients were positive (and one was indeterminate) for IgM antibody against parvovirus B19.

Discussion

Parvovirus B19 infection is common throughout the world, and the prevalence of IgG antibody positivity increases steadily in increasing age groups, with rates of 75-90% in people over 50 years of age. (2)

The main mode of transmission is through contact with infected respiratory tract secretions. Erythema infectiosum or fifth disease is the most commonly recognized clinical presentation of this infection. It is usually associated with a malar erythematous rash, and a pruritic, reticulated or lace-like rash on the trunk and extremities, that last from a few days to a few weeks. Additionally, patients may experience constitutional symptoms such as headache, sore throat, and arthritis.

The incubation period is usually from 4 to 14 days. As with many viral infections, very rarely, more severe complications can occur. For example, parvovirus B19 infection may increase the risk of miscarriage or spontaneous abortion in early stages of pregnancy, and severe anemia in people with chronic red blood cell disorders. The incidence of these complications is exceedingly low. We have received no reports of such severe complications during this outbreak. No vaccine or specific treatment exists for this virus.

Recommendations

1. Transmission of parvovirus B19 can be reduced through washing hands, disposing of used facial tissues, and avoiding sharing eating utensils.

2. When parvovirus B19 is circulating in a community, inform pregnant women of the rare possibility of adverse consequences to the pregnancy. Serologic testing for IgG may be considered in order to determine susceptibility to the virus.

3. Due to the high prevalence of parvovirus B19, the low incidence of ill effects on the fetus, and the fact that avoidance of child care or classroom teaching can reduce but not eliminate the risk of exposure, we do not recommend routine exclusion of pregnant women from the workplace where erythema infectiosum is occurring. (3)

4. Children with erythema infectiosum may attend day care or school, as they are no longer infectious after onset of rash.

References

1. M Carter, P Mshar, H Messermith, et al. Rashes Among Schoolchildren–14 States, October 4, 2001-February 27, 2002. MMWR 2002;51(No.8).

2. Rothbart, HA: Enteroviruses. P. 1001. In Richman, DD, Whitley RJ, Hayden FG (ed): Clinical Virology. Churchill Livingstone Inc., New York, New York, 1997:959-961.

3. American Academy of Pediatrics. [Parvovirus B19]. In: Pickering LK, ed. 2000 Red Book: Report of the Committee on Infectious Diseases. 25th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2000:[p425].

Report by Joe McLaughlin, MD, MPH, EIS Officer, CDC. Special thanks to Leona Bennett, Elementary School Teacher for initially reporting this outbreak, Dr. Jay Butler, Arctic Investigations Program, CDC for relaying information to the Section of Epidemiology, Robert Gutierrez, School Principal, Dr. Shannon Radke and PHN Kathleen Stanton for case finding and specimen collection, Don Ritter, Alaska State Public Health Virology Laboratory, and the health aides who assisted with the investigation: Lena Bell-Joe, Roberta Tinker, Rose Long, Carol Night, Benita Lake, Ruth Imgalrea, and Theresa Hill.
http://www.epi.hss.state.ak.us/bulletins/docs/b2002_09.htm
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"Toxic" Mold Closes Burlco. School

(KYW) (FLORENCE TWP., NJ)

May 28, 2002 6:20 pm US/Eastern

Eyewitness News has learned Florence Township Elementary School was closed due to so-called toxic mold Tuesday. It has not yet been decided if the school will be closed Wednesday.

Workers removed athletic equipment from the school's gym saying "toxic" mold had been discovered.

Parents will be briefed about the latest developments during a 7 p.m. meeting at Florence Township High School.
http://kyw.com/news/StoryFolder/story_1585751085_html/?pp=1

posted 06-02-2002 06:24 PM            

June 2, 2002

Hysteria Hysteria
By MARGARET TALBOT

Last fall, something peculiar began to happen at more than two dozen elementary and middle schools scattered across the country. Suddenly, groups of children started breaking out with itchy red rashes that seemed to fade away when the children went home -- and to pop up again when they returned to school. Frustratingly for the federal, state and county health officials who were working to explain this ailment, it did not conform to any known patterns of viral or bacterial illness.

The children had no other symptoms: no fever, no runny noses, no headaches or joint pain or respiratory complaints. Moreover, they were not passing their rashes on to parents or siblings outside school. Large groups (a dozen here, several dozen there) came down with it simultaneously, or within hours, rather than over the course of days or weeks, as you would expect with person-to-person transmission of a contagious illness. Then there was the nagging fact that in many of the outbreaks, girls accounted for a majority of the cases. Since neither germs nor the other likely culprit, environmental poisons, make a habit of discriminating by sex, this was puzzling news indeed.

Blood tests on a number of the children pretty much ruled out the possibility of one initial suspect, the virus that causes a mild rash known as fifth disease.

Environmental investigations of the affected schools failed to turn up evidence of chemical or biological hazards. The media would soon dub the outbreak ''the mystery rash'' in reports that, inevitably, had epidemiologists ''scratching their heads'' over it.

This year, of all years, a mysterious rash affecting schoolchildren in the United States was bound to generate a good deal of attention and anxiety. Parents didn't always say the words ''bioterrorism''or ''anthrax'' when they called their doctors and principals to ask if they should keep their kids out of school, but it was often the subtext of the conversation.

In another year, schools with rash outbreaks might not have warranted news vans planted in their parking lots for days. In another year, the rashes might not have fueled such florid, conspiratorial discussion on the Internet -- it was ''chemtrails'' from airplanes; it was books on Islam donated to schools by questionable Saudis; it was a terrorist attack coverup -- or engaged the attentions of overworked state health officials for months. The rash outbreaks might not have triggered an investigation by the Centers for Disease Control and Prevention, as these did. Or calls for Congressional hearings, like those demanded by a coalition of environmental organizations led by the Healthy Schools Network. Alarm about rashes might not have brought 1,000 parents out to a meeting with the school superintendent in Quakertown, Pa.

But this year was different. This year, rashes -- or any unexplained physical symptom -- made people nervous in a way they did not before 9/11. Or maybe it was the other way around. Maybe it was nervousness that helped create the unexplained symptoms. And maybe children were more likely to somaticize a lingering, inchoate anxiety about 9/11. Studies completed on New York schoolchildren this spring, for example, showed that months after the terrorist attacks, many of them still suffered from recurrent nightmares and trouble sleeping. Kids in other parts of the country surely experienced similar anxieties. And maybe, just maybe, this latent disquiet sometimes manifested itself in a curious, corporeal way -- in the form of an itch.

The rash outbreaks started in Indiana on Oct. 4, the same day The Associated Press first reported that a Florida man had come down with anthrax. It was not then clear how extensive the anthrax campaign would be, or who was behind it (we still don't know), or where it might turn up next. Throughout the fall, towns across the country were dealing with false alarms, white-powder hoaxes, sudden evacuations of buildings, runs on Cipro. By January, more than 1,200 specimens of suspected anthrax, none of which tested positive, had been sent to the Indiana State Department of Health alone.

The school rash turned up next in northern Virginia, at Marsteller Middle School, where hazmat crews scoured the building and found no explanation. ''Official Diagnosis: Unknown,'' reported the local paper, in an eerie summation. Kids began refusing to go to school. One parent, a postal worker, explained her daughter's decision to a Washington Post reporter: ''This is not happening at a good time. They're afraid there's something behind it that no one knows about.''

During the winter holidays, the school rashes abated, but in January and February, they turned up again, notably in Pennsylvania and Oregon. Winter-dry skin may have left the affected kids more susceptible to itchiness, but there were few other clues for investigators to go on.

In late February, James Scanlon, the superintendent of schools in Quakertown, where 238 cases had been reported in nine schools, wrote in a letter to parents that all environmental testing had been negative and pleaded with them for help in ''bringing normalcy back to our community.'' But local news coverage of the ''mystery rash'' in Pennsylvania and elsewhere only intensified, especially on television. By early April, the rash or something like it had turned up in two Massachusetts towns, South Dennis and Billerica. (The latter happens to be the headquarters of Bruker Daltronics, a company that manufactures detection devices for agents of biological warfare.)

In Oregon, it all started on Feb. 4 at the Abraham Lincoln Elementary School in Medford, near the California border, on what its principal, Bob Hartwig, had figured for an uneventful Monday morning. At about 9:30, Hartwig noticed a group of second-grade girls -- perhaps 8 or 10 from the same classroom -- reporting to the office looking flushed on their faces, necks and arms. Hartwig, a genial silver-haired fellow with an office full of kid-friendly train memorabilia, said the girls seemed ''pretty miserable.'' Over the next several days, more kids showed up from various grades and from opposite sides of the building with rashes that looked quite different. Some were like clusters of tiny bumps or patches of dry skin; others looked more like sunburn.

Yvonne H. Chilcoat, a public health nurse who coordinated the county's investigation, noticed something similar. People who interviewed the kids would ''observe the rash sort of evolve before their eyes,'' she says. ''It would be there, and then you could actually see it fade away or reappear somewhere else on the body.'' That was a signal thing about it -- that and the fact that of the 67 children and 11 adults affected by it at Lincoln, 62 were female.
Within the first few days, the Jackson County Health Department had combed through the school and found nothing to explain the rash. And Hartwig himself had been nervous enough to call in an outside environmental scientist.

Investigators considered dozens of possible culprits -- cleaning supplies, furnace filters, fiberglass particles in the air, pesticides sprayed in the local orchards, even supplies brought from home for a puppet-making project -- but ruled out all of them.

Some parents were worried that whatever this was might have unknown, long-term consequences and wondered whether the school ought to be closed down. One was upset enough to tip off the local news channel the second day of the outbreak; the next afternoon when school let out, a TV crew started interviewing parents and kids. To Hartwig's chagrin, somebody appeared to be circulating the theory that an allergic reaction to math books was causing it.

Hartwig took state health officials' advice not to close Lincoln, but he couldn't help being preoccupied. ''I kept thinking about the AIDS virus,'' he says, ''how it started here with one guy flying in from Africa, how nobody knew what it was at first.'' His worry was mixed with bafflement. ''I kept asking myself: Why us? Why Medford, Ore.? Why girls? At one point, we were 100 percent girls.'' Why, he wondered, did the rash seem to go away so quickly when kids forgot to scratch, or stopped talking about it, or applied good old calamine lotion? Why did it break out in both the second and fourth grades, which shared no materials?

It occurred to him at times that he might be dealing with something psychogenic, or at the least with a number of sympathy cases. Hartwig had never forgotten an incident he dealt with, as the principal at another elementary school, in 1984. Back then a teacher had begun complaining that the groundskeeper was spraying a pesticide outside her classroom window and that it was poisoning her and the children. She became ill, and within an hour many of the kids in the room were nauseated; a few were vomiting. ''But they weren't spraying anything toxic outside,'' Hartwig says. ''All I had to do was tell the kids in that classroom that nothing was going on, and it stopped.''

Still, this situation seemed to Hartwig more complicated. He had no doubt that there were sympathy cases of the rash at Lincoln, but he had a hard time wrapping his mind around the idea that psychological contagion could travel across different classrooms and grades -- or that there ''wasn't something real going on.''

A psychogenic explanation crossed Chilcoat's mind, too, though she ultimately found it implausible in such a large group of children. During the school-rash episode, Chilcoat exchanged e-mail with a public health nurse from St. Catherines in Ontario who had helped investigate a rash outbreak in an elementary school there last March and had concluded that it was
probably ''hysterical.'' But while the Ontario nurse, Heather Hague, confirmed to me that hysteria ''was one of our hypotheses,'' it was not one, she says, that she ever shared with the affected children or their parents -- or, indeed, with the public at large.

''I guess it sounds strange, but I never thought about it till you asked,'' Hague says. ''People seem to deal better with concrete facts, and you sort of don't want to go there. You really don't like to cast that shadow.''

Two weeks later, Hartwig at least had the comfort of no longer being alone in Oregon with his medical mystery. A similar rash had popped up at a very different school, about an hour west of Portland. Hartwig's school is in a tidy five-year-old building with a bright, well-stocked library and a front office that looks like the parlor of an upscale bed and breakfast. The Chapman Grade School in Sheridan isn't as lucky. Though Sheridan is tucked into a beautiful valley lined with nut orchards and wineries, it is one of those rural Oregon towns that never quite recovered when the lumber industry bottomed out. The main employers nearby are the Spirit Mountain Casino and the federal prison. Sheridan is full of small, neatly tended clapboard houses on either side of the South Yamhill River. Outside the school, the bushes are fat with rain-happy rhododendrons. But the low-slung building itself is 60 years old, with scuffed linoleum floors and a tired-out look.

When it came to the mystery rash, though, the experiences of the two schools weren't so different at all. Chapman's outbreak started on Feb. 21. There, too, the rash came on abruptly and struck mainly girls. Lindsey Anderson, a fourth grader, was heading for lunch with her friend Dora late that morning when she spotted a knot of people in the front office, across from the cafeteria. Among them were three sixth-grade girls she recognized: her sister, Briana, and ''two girls named Cherish and Shelby, who everybody knows.''

Lindsey ducked into the office right away to see what was up, and so she was one of the first to hear that the three older girls had suddenly come down with an itchy rash.

Proceeding on her way, Lindsey, who is a peppy and talkative girl with stick-straight blond hair, quickly became a messenger. In the cafeteria, she and Dora ''told everybody about it. And we told them not to scratch, because that made it worse. At first they'd say, 'Eeeww, I don't want it.' And then after they heard more about it, they'd start scratching.'' Pretty soon, Lindsey had a rash, too, and so did a friend of hers who was sitting at the lunch table, and so did a ''bunch of other kids eating lunch.''

When Chapman's principal, Tim Graham, and his staff began noticing the rash, they quarantined the affected kids in the library, where, as Graham recalls: ''Teachers who couldn't stop scratching themselves -- it's very hard when you're seeing all these kids scratching -- kept telling kids to stop scratching. It was crazy.'' But by the end of that day, about 50 students were complaining of some kind of rash, and the library had gotten too crowded. So Graham moved the kids to the gym, and then had to move them again, this time outside. And Graham's day got still crazier. ''News trucks were here, and the kids started following them around trying to get on TV. And I started getting conspiracy calls -- people thinking it was a government coverup. Something to do with 9/11.''

Lindsey herself remembers thinking about anthrax. ''It was scary,'' she
says, ''because maybe the anthrax got into our school, and then somebody touched it, and then if you touched that person you'd get it. It was scary because you didn't know what the rash was or where it came from.''

Lindsey and her friends talked over some other creepy possibilities. She and her schoolmate Phyllisha Bryant thought they'd noticed more of the local tree frogs, who sometimes get in through the drains at the school, around the Chapman building that first day. What was up with that? That was kind of weird, wasn't it? Phyllisha, who had the rash, though hers was only a small, reddened patch in the crook of one arm, had even seen a dead frog at the school that week. Another fifth-grade friend remembered the time she'd eaten a yucky rare hamburger in the cafeteria and thought maybe the rash was ''the mad-cow disease'' -- the thought of which caused her to reject the meat ravioli in the cafeteria the day I spoke with her.

Lindsey and Briana's mom, Michelle Anderson, was eating lunch at the Spirit Mountain Casino, where she works, when she first heard there had been a rash outbreak at the school. She rushed over to pick up the girls, thinking first, and with panic, of meningitis, then of bioterrorism.

''What was it?'' Anderson wondered. ''Was it something in the air that came and went?'' She took the girls to their family doctor, who said it was probably a histamine reaction of some sort that would resolve itself and not to worry. But Anderson was still puzzled by her observation that the rash came out only at school and went away ''10 or 15 minutes after the girls left school.''

On Friday, the second day of the outbreak, Graham closed Chapman early, and on Monday he reopened it. But that day, as bad luck would have it, the nearby federal prison was dealing with an anthrax scare. Anderson, whose husband works at the prison, heard about the white powder sent to an inmate when she went up there to work out at the gym and thought, Oh, no. Her mind rocketed back to the school rashes. Maybe there was some anthrax connection after all. When paramedics who had rushed to the prison were called to the school shortly after to look at a new crop of itchy children, they promptly recommended that Chapman be closed again. Graham did so, which jazzed a lot of the kids but also generated a certain amount of chaos, since 310 of them had to be moved out in a hurry and their parents quickly located, all amid a tangle of buses and emergency vehicles.

Lindsey (who along with her sister had been on the local news early in the outbreak) and her friends thought some of the kids who were getting the rash in this second phase ''were jealous,'' she says. I asked Lindsey and several of her friends whether they thought it was plausible that anxiety and sympathy could account for some of the rash cases. They accepted the suggestion with equanimity. ''Totally,'' one girl said. ''It's kind of like when somebody next to you is scratching their head and you get itchy.'' Another girl said knowingly that of the 12 mystery rash cases that cropped up at another local school following the Sheridan outbreak, ''8 were self-inflicted.'' And she added that when she got the rash, ''a kid tried to rub up against me because they were jealous that I had it and they didn't.''

Chapman was closed for a week of thorough cleaning. The state health department in Portland had told Graham that it wasn't necessary to shut down, that there was no risk to the children. But Graham felt that was easy for the state doctors to say when they didn't have to take calls all day from panicky parents wondering if their kids were safe. When school reopened the following Monday, some students were still complaining of a rash, an itch or both, but the symptoms subsided over the next two days.

A few weeks later, I sat down in the dimly lighted cafeteria with Desiree Blakley, an eighth grader at Chapman, and her schoolmate Nick Mull, who is in the fifth grade. At that distance from the whole weird episode, they did not seem unnerved. They remembered being uncomfortable, but they seemed to relish -- as who wouldn't at that age? -- the gross-out details of their ordeal.

''When I first noticed it was right during lunch,'' recalled Nick, who was one of the few boys to get the rash. ''My friend Amanda, she started getting it, and she showed me hers. It was itching her real bad. And then I was messing around with her and touching it and stuff, and I started messing with my neck, and then my arms and legs started itching and I got it. It really burned.''

''We had a good time in the library,'' said Desiree, an amiable ginger-haired girl who blushes easily. ''But it got kind of stuffy because everyone started itching so much and they were sweating. I saw people itching their backs up against the bookshelves. People were saying: 'Ooh, will you scratch my back?' 'Will you scratch mine?' It was on the news that night, and there was no school the next day. That was the best part. We heard about the rash. We heard how it started somewhere else -- Georgia, maybe?''

Nick interjected: ''They say it isn't contagious, but then how did we all get it at once?''

Both Nick and Desiree thought it was quite possible that their schoolbooks were to blame. ''I didn't get it when I was at home, except when I'd hold my books from school,'' Desiree volunteered.

''Yeah,'' Nick agreed. ''We have such old books here. We have chapter books from, like, 1962 in the library.''

''Ooh,'' Desiree said, ''just talking about it makes me itchy. I'm itching now.''

''Yeah, I don't want to think about it,'' said Nick, who was polite and greyhound-thin and wore cool, super-baggy orange shorts.

Desiree and Nick said they knew kids who had faked the rash to get out of school or maybe to make fun of people who did have it. ''Like they'd scratch really hard till it bled,'' Desiree explained. ''Or else they'd put red marker and white-out on their arms and say: 'Ooh, I've got the rash! I've got the rash!'''

Not long after visiting Chapman, I spoke with Leslie Davidoff, a resident in preventive medicine who had interviewed and examined 15 kids at Chapman on behalf of the Oregon health department. All 15 had identified themselves or been identified by teachers as having the rash. But Davidoff did not see anything unusual or even similar in these conditions. She saw, she says, ''early acne, dry skin and quite a few insect bites.''

Still, Davidoff dutifully administered a lengthy questionnaire with, among many, many other queries, a number of items about glitter gel, paste-on tattoos, skin preparations and the like. (In a vain attempt to find a common agent that might explain why far more girls than boys got the rash, Davidoff had brainstormed with her Britney Spears-loving niece to come up with all the products that girls in the fourth through seventh grades might possibly use on their skin.) ''One child told me that she and her friends would point at girls they didn't like and say: 'You've got it! You've got it!' So that girl would essentially get quarantined. One kid told me he didn't even know he had the rash until a teacher told him he had it. One girl said she wasn't itching until she got near the school, because she knew that's where the rash would be. Somebody said, 'I wasn't itching till I saw my friend itching.''' Davidoff pauses. ''It was,'' she says, ''a very interesting experience.''

In the nine months since the rashes were first reported, very few of the outbreaks have been conclusively explained. By mid-May, Mississippi's small outbreak was the only one that could be attributed to parvovirus, which causes fifth disease. (''We got lucky,'' says Mary Currier, a state epidemiologist. ''We had positive blood results for something.'')

In Pennsylvania, a dermatologist named Norman Sykes who examined 40 of the children with rashes there suspects ''a new virus'' -- probably a mutation of the parvovirus -- though he is at a loss as to how to explain the predominance of female cases or the paucity of secondary cases in families of the affected children. Lab work on the virus theory is proceeding in Pennsylvania.

Many of the rashes that wound up being reported to the C.D.C. were almost certainly the kinds of everyday skin conditions -- poison ivy, eczema, incipient acne, dry skin irritated by overheated classrooms, atopic dermatitis -- that in another year would never have aroused concern, let alone have been written up by the agency.

Granted, there could yet be an environmental cause found, though it is highly unlikely to be the same cause in all the schools. No one has been able to establish links between the affected schools in any one state, let alone across states. The ''mystery rash'' is a misnomer that surely covers all sorts of conditions.

And then there is the awkward but unavoidable possibility, the one that health officials try their best to dance around -- which is that the rash outbreaks may have been, at least in some measure, psychogenic. What may have caused at least some of the cases, in other words, was not a toxin or a virus but anxiety. The agents of contagion may have been the shared suspicion that people around you were falling victim to some sort of noxious substance and the powerful sympathetic reaction to seeing other people scratch.

The skin is notoriously reactive to stress -- many people flush when they are nervous; hives and eczema are triggered or worsened by tension. Scratching begets more scratching, as anyone who has ever tried to stop worrying an insect bite knows, and sometimes, says Timothy Jones, a public health doctor with the state of Tennessee, we talk about ''the itch that causes the rash, rather than the other way around.'' There are even extreme itch-scratch syndromes in which sufferers fall into a relentless cycle of compulsively scratching some part of their bodies -- frequently the back of the neck -- which only makes it itch all the more.

''I tend to think that kids hearing all the news stories about rash illness and bioterrorism could get something like this outbreak started,'' says Alfred DeMaria, an epidemiologist with the state of Massachusetts. ''Especially in middle school, where kids are impressionable and certainly more conformist in the sense that they have to have the thing the next kid has. Maybe a few kids had a viral illness of some sort, but with most, it was sympathetic.''

Besides, DeMaria adds -- and nearly every other health official I spoke with agreed -- itching, like yawning, is a very suggestible symptom. Several officials told me anecdotes about investigating lice outbreaks or examining rashes and helplessly starting to scratch, even when they knew for certain they were lice and rash
free. ''Personally,'' DeMaria says, ''I can get itchy just talking about scabies.'' Says Jones: ''When you see a patient with lice, there's no way your head doesn't get itchy. It happens to me, and I recognize it, and I keep scratching anyway.''

André Weltman, a public health doctor with the state of Pennsylvania, says: ''I'm sure that there were sympathy cases. We want to be careful because we like to have our hands on solid facts. But I have no doubt that went on. Human beings are social creatures. Like monkeys. Have you ever seen a group of monkeys scratching?''

The first time I interviewed Karen Southwick, the Oregon state epidemiologist who coordinated the investigation there, she told me: ''We feel there is a very substantial sympathetic component to these rashes. We're still very much trying to see if there is some other trigger. But so far we have not been successful.''

Terms like psychogenic illness and hysteria have such a checkered history that even talking about them in connection with real people can quickly become a fraught pursuit. It was the ancient Greeks who first identified hysteria as the manifestation of physical symptoms with no discernible organic cause. The word ''hysteria'' comes from the Greek for uterus: at the time, it was thought that the womb could wander restless through the female body, wreaking havoc.

In the late 19th century, the heyday of the hysteria diagnosis, it was seen as the female complaint par excellence -- and not because anxious women might plausibly be rebelling in one of the only ways they could, by incapacitating themselves for their duties, but because they were assumed to be the helpless victims of their reproductive systems. The French neurologist Jean Martin Charcot, and later Freud, defined hysteria as a nervous-system disorder unleashed by emotional trauma. Until psychoanalysis came along, the accepted antidotes were isolating rest periods and a cessation of intellectual activity -- cures designed, it seemed, to replicate the very conditions of cosseted ennui that drove upper-middle-class women to hysteria in the first place.

The smart and sensible feminist critique of hysteria -- a huge academic literature exists on the subject -- has led to a good deal of healthy skepticism about the diagnosis. But it has also made many people unduly suspicious, perhaps, of the very notion that the mind can generate symptoms that only the body manifests. And this may be all the more true when we consider this phenomenon among groups of people in the grip of unexplained symptoms.

Part of the problem with making a diagnosis of mass hysteria is that it carries such a freight of pejorative associations. Ever since the Salem witch trials, it has been seen as the kind of phenomenon that occurs only in ''backward'' communities or among religious zealots. It hasn't helped that several modern incidents of mass panic leading to physical symptoms have depended on bizarre collective delusions -- the belief in alien landings, for example. (One recent book on mass psychogenic illness carries the uncomfortably vivid title ''Little Green Men, Meowing Nuns and Head-Hunting Panics.'')

More recently, a fear of environmental contamination has become the most common source of psychogenic illness, but this complicates matters still further since, after all, there is such a thing as a real environmental hazard. People who are ill with multiple-chemical sensitivity and chronic-fatigue syndrome -- syndromes that many doctors dispute the existence of -- reject any discussion of a psychological component to these ailments as ignorance or insensitivity.

But none of this should blind us to the fact that well-documented outbreaks of mass psychogenic illness do occur -- and not all that rarely. Between 1973 and 1993, there were 70 reports of mass hysteria in medical journals; most took place in self-contained communities, like schools, barracks and factories. Sixty percent of the incidents of epidemic hysteria written up in English-language journals this century occurred in schools.

''I continue to be struck by how much more common mass psychogenic illness is than people generally think,'' says Timothy Jones, who was the lead author of an article in

The New England Journal of Medicine two years ago in which he identified a psychogenic outbreak of nausea and dizziness among 170 students and staff members at a Tennessee high school. ''I bet you there are a ton of cases when professionals back in their office are saying, 'This is what we think it is.' But maybe in only one out of 100 cases is it going to leave the office, and when it does it will be maybe two or three years later in a journal article that the local community is never going to read. Public health people are going to be extremely hesitant about labeling an illness as psychogenic. Because as soon as you say that aloud, people are telling you, 'You're not taking it seriously, you don't believe us, you missed something, you're covering something up.' It makes people really, really mad to hear that diagnosis. So a lot of times when mass psychogenic illness occurs, you don't hear about it as such. Public health people will continue to say, 'We're looking at all the possibilities and not finding anything, and we're waiting for the final results.' And privately, they sort of just hope it goes away and people stop asking about it.''

Mass psychogenic illness, or epidemic hysteria, is usually defined as a set of unexplained symptoms affecting two or more people; in most cases, victims share a theory of some sort about what is causing their distress. Often, somebody smells something funny, which may or may not be a chemical and which may or may not be there, but which in any case does not account for the subsequent symptoms. Relapses tend to happen when the people affected congregate again. And, notably, the mechanism of contagion is quite different from what you would expect in, say, a viral illness: symptoms spread by ''line of sight,'' which is to say, people get sick as they see other people getting sick. Some element of unusual psychological stress is often at play -- which may account for why several of the documented cases in schools took place while students were preparing for standardized tests, in an anxious wartime atmosphere or weeks or months after an actual but resolved environmental event, like a natural gas leak.

Adolescents and preadolescents are particularly susceptible. And girls are more likely to fall ill than boys.
That last finding, striking and consistent as it is, might seem like an artifact of misogynist bias. But in a way, and not necessarily an offensive way, it makes sense. ''I've been hissed at medical conventions when I say there's a preponderance of women in these outbreaks,'' says Gary Small, a psychiatrist at the University of California at Los Angeles. ''But women are more likely to talk to each other about symptoms and how they're feeling. They're more social, and so that may facilitate the spread among friends. Social relationships determine the spread of these kinds of symptoms.'' Girls' heightened susceptibility to mass psychogenic illness need not be seen, in other words, as a function of a delicate constitution or a more ''hysterical'' nature, but of their propensity to talk among themselves about their health. And the observation that women are more likely to seek medical attention, and presumably to take note of their own symptoms than men, is well documented.

Most cases of epidemic hysteria are characterized by symptoms like nausea, abdominal pain, dizziness and lightheadedness -- all of which can be produced or aggravated by anxiety and hyperventilation. But there are also several documented cases of rash as a psychogenic symptom. In 1982, for example, 57 children at a West Virginia elementary school experienced an outbreak of sudden itching. The rash showed up at 9:15 in the morning, when 2 fourth-graders began complaining of itchiness; by noon, 32 students had the same symptoms.

Frequently, outbreaks of psychogenic illness begin with one or more people falling ill from actual organic causes, setting in motion a fast-rolling wave of sympathy. In 1989, for example, 63 children attending a day camp in Florida came down with abdominal cramps and nausea. The affected children, 75 percent of whom were girls, became ill 2 to 40 minutes after eating a prepackaged lunch. All recovered within eight hours. Meal samples tested by the F.D.A. revealed no telltale bacteria, pesticide contamination or heavy metals. Investigators did learn, however, that the incident started when one 12-year-old girl complained that her food tasted bad and promptly vomited -- she was probably sick when she came to camp that morning -- after which the staff members began wondering aloud if the food was contaminated. After the fact, the Florida Department of Health concluded that the episode was an example of ''mass sociogenic illness.''

However many cases of psychogenic illness are reported, the label remains a deeply vexed and often disputed one. In part, this is because mass psychogenic illness is a diagnosis of exclusion -- it is what investigators are left with when they have exhausted every plausible physical explanation (though they may suspect it from the beginning), and diagnoses of exclusion can feel unsatisfying to the doctors in charge. Besides, no one wants to be too hasty to label an illness psychogenic if doing so would foreclose the search for a real environmental danger. It's true that in most cases of actual chemical spills or water contamination, environmental investigations do reveal something amiss. In an article for Psychiatric Times, Jones reviewed outbreaks of mass psychogenic illness and compared them with incidents of confirmed toxic exposures; he ''was unable to identify any outbreaks of acute illness from toxic exposures, with minimal physical findings, where the cause was not quickly apparent to investigators.'' Still, there is always the possibility that something has been overlooked -- and who wants to be the guy who missed the hidden poison, and in an elementary school of all places?

Sometimes a psychogenic diagnosis is difficult to make even when people on the scene suspect it. Frequently, outbreaks have very short durations, with symptoms dissipating before investigators arrive on the scene. (That was the case with this year's first mystery-rash outbreak, among 17 Indiana third graders. As one investigator reported, ''Their little faces were all smooth by the time we got there.'')

Potential episodes are often evaluated after the fact and on the basis of self-reported symptoms. And the teams looking into them rarely include behavioral scientists or psychiatrists.

In theory, you might think that a psychogenic diagnosis for a mild, transient illness would come as a relief to those concerned, lifting the specter of mystery viruses and hidden toxins. But in practice, such diagnoses are often taken as an insult and met with charges of a coverup. In March 2000, Robert J. Settipane, an allergist affiliated with Brown University, examined a number of children who had broken out in a rash at an elementary school in East Greenwich, R.I. Settipane became convinced that the rash was psychogenic -- a conclusion not endorsed by the local health department -- and related to stress among the mostly fourth-grade girls it affected, who had been struggling with a difficult math book and had standardized testing coming up.

''They kept moving the classes to other locations, other buildings, eventually to a local bookstore -- trying to stay one step ahead of this rash -- and it kept following them,'' Settipane recalls. But when he announced his conclusions, ''the parents were irate,'' he says. ''How could I say such a horrible thing? How could I say their children were hysterical? This was an affluent school, a very involved group of parents. They could not accept even considering this. I was persona non grata.''

Some parents thought Settipane had overlooked an environmental explanation at the school, and several homed in on the theory that their children were allergic to the math textbooks. Settipane was skeptical, but other allergists in his office dutifully tore up book pages, mixed them with water and concocted a slurry in order to do skin tests with them. (The tests were negative.)

''A few parents became zealots on this issue,'' Settipane says. ''They stirred it up continuously, and it became a matter of, 'Are we taking our kids seriously?''' Of course, it probably didn't help that Settipane had a tendency to mention that 9-year-old girls were susceptible to magical thinking and that ''this was the same demographic that had started the Salem witch scare.'' Delicate he was not. He thought he had to be blunt. ''You can only stop these things by being honest,'' he says. ''I could get caught up in this kind of thing, too, as a parent or just a person. We all could. It's a very powerful thing, and it needs to be respected and understood. And health officials shouldn't be so scared to call a spade a spade.''

Back in Sheridan, Ore., there has been no such tumult -- for the hysteria diagnosis has never been publicly voiced by investigators there. Officially, they say that the rash probably had, as Karen Southwick puts it, ''a whole variety of causes,'' none of them serious.

By now the rash is almost, but not quite, receding into the murky realm of Weird Things That Happened Once (and Most People Gave Up Trying to Explain). A report by a private environmental company showed the presence of mold at the school, which some people in Sheridan now think might have caused the rash. But it is not clear that the mold levels are unusually high, especially for Oregon, which is a wet and moldy state, after all. And Southwick does not buy the theory that mold explains the rash. Mold allergies are common, certainly, and can be severe, but they generally cause respiratory symptoms, not otherwise asymptomatic rashes.

Still, some parents in the community think it might finally be the time to retire the old Chapman school building and erect a new one. The matter will come up for a vote on the local ballot in November.

And some parents are still worried and suspicious. Michelle Anderson, Lindsey and Briana's mother, likes the way the school handled things but frets about the future. ''It's almost the end of the school year,'' she says, ''but I wonder, Is it safe to send my girls back to Chapman next year?

You hear a lot about medical stuff that doesn't affect you till maybe six months or a year down the road. Is that going to be what happens with this? Even though the rash hasn't come back, we're kind of waiting to see if it does come back.''

Dale Bryant, Phyllisha's father, thinks that ''they -- the school, somebody -- might know what it was, but not be being honest about it.'' And there are evidently other Oregonians who share his hunch -- or have their own theories about an etiology that health officials have missed or ignored.

Southwick has received more calls from ''the public, suggesting where we should be looking, than I have on any investigation I've ever done.'' On an Internet forum about so-called airplane chemtrails, ''Anonymous'' from Portland, Ore., said he'd heard speculation that the rashes might be psychosomatic and resented it enormously. In his view, it suggested that children in Oregon were ''messed up psychologically.''

Why, exactly, the idea of psychogenic illness should be so offensive is a little baffling. In many other areas of life and health, we recognize and even celebrate the mind-body connection: think of alternative therapies, yoga, the placebo effect, endless magazine articles about reducing stress to improve physical health, meditation, the power of positive thinking. Sympathy reactions to other people in physical distress are rather touching phenomena, really, revealing us for the social and interconnected creatures that we are.

Yawning, queasiness, malaise, vague ''funny feelings'' and certainly itching are suggestible symptoms for adults -- I felt itchy every time I did an interview for this story, even if it was on the phone -- and probably all the more so for young adolescents, who pay such close attention to one another and who may have trouble sorting out the signals from their rapidly changing bodies. None of that seems shameful. It seems understandable; a little funny; and very human.

Suggesting to people that their physical symptoms might have originated partly in the mind is not, of course, at all the same as saying they are crazy or malingering. Mass psychogenic illness produces real, not sham, physiological effects. That they may not be attributable to a physical pathogen does not make them any less distressing to their sufferers, nor does it mean that their sufferers are ''imagining things'' in a way that should inspire worry about their long-term psychological health. Indeed, as Simon Wessely noted in a New England Journal of Medicine editorial: ''Acute, short-term, epidemic anxiety is a common phenomenon that can affect normal people'' and is ''not associated with any major psychological or personality disturbance. It is probably part of the behavioral repertoire in all of us, triggered by the right conditions of fear and uncertainty.''

Nonetheless, few public health officials are prepared to take on the task of parsing such a diagnosis for audiences unaccustomed and even hostile to it. And this reluctance may well leave the American public ill equipped for dealing with future outbreaks of psychogenic illness, at a time -- of vague terrorist threats and emergent infectious diseases -- when it would be entirely reasonable to expect them. Whether the great post-9/11 rash outbreak turns out to be partly psychogenic or not -- and we may well never know for certain -- it seems highly probable that we will be dealing with incidents of mass hysteria in the future.

There are doctors, like Settipane, who believe that the best way to stop a psychogenic outbreak is to diagnose it as quickly as possible. But this approach can be risky. ''There are a lot of articles written that say you've got to just walk in and tell everyone, and it will stop,'' Jones says. ''Well, that's easy to write and very hard to do. It takes a while to exclude everything else, and that's never going to be in the first 10 minutes.''

Still, there are tactful ways of handling what may be a psychogenic outbreak -- experiments, of a sort, that also help to control it. In South Dennis, Mass., when several dozen, mostly female, students at Nathaniel H. Wixon Middle School came down with a rash over the course of about 10 days in late March, the school was closed and sanitized. Environmental investigators did air-quality tests and bacterial cultures, checked out the food service, looked into the possible local use of pesticides or fertilizers or of new chemicals in science labs -- and came up with nothing.

So Tony Pierantozzi, the school superintendent, tried a different tack: ''We began a triage system. Instead of automatically sending any kid with the rash home, we tried to keep them there. If we could identify a rash that was severe or covered a large part of the body, the school nurse sent them home. If it was only a small amount of rash or just scratch marks, we recommended the kids stay. We sent those kids into their own common area and kept them away from everybody else. At the same time, we stopped treating the rashes with calamine lotion, which sort of marked the kids, and started treating them with ice, which was just as effective. And at that point, the incidence and the spread of the rash stopped almost immediately.''

It's a paradox: suggesting that symptoms might be psychogenic can help stop them, but it often does so at the risk of alienating, even embittering people. Maybe Pierantozzi had hit on a way of finessing the problem, acting on a hunch without quite making it explicit. When I told Jones about Pierantozzi's triage scheme, he chuckled appreciatively. ''I'd say that's an excellent experiment,'' he said. ''I'd say he's a very smart guy.''

Margaret Talbot, a contributing writer for the magazine, is a fellow at the New America Foundation.

http://www.nytimes.com/2002/06/02/magazine/02HYSTERIA.html?pagewanted=print&position=top

posted 06-03-2002 06:05 PM            

June 02, 2002

Study Compares Tiny Babies Worldwide

CHICAGO- Contrary to medical thinking, low-birthweight newborns in the United States die at rates similar to those in other developed countries with far fewer resources for at-risk infants, a study found.

The researchers compared newborn death rates by weight with those in Canada, Australia and the United Kingdom, which all devote comparatively more medical resources to prenatal care than to intensive newborn care.

The results suggest that U.S. medical resources could be more evenly distributed with potentially better outcomes, the researchers said.

"The U.S. spends far more on sick babies and less on preventing sick babies and still isn't improving survival compared to these other countries we looked at," said lead researcher Dr. Lindsay Thompson of Dartmouth Medical School. "It was disappointing."

The study in June's Pediatrics follows research by another Dartmouth team published last month suggesting that medical advances have contributed to a U.S. glut of neonatologists - specialists in intensive care of at-risk newborns, including premature and low-birthweight babies. That study found similar newborn death rates across the United States, even in areas with comparatively few neonatologists.

Thompson's study is based on a review of data from 1993 to 2000, including newborn death rates in 1997. The overall U.S. newborn mortality rate that year was 4.7 per 1,000 births, compared with 3.8 per 1,000 in England and Wales, 3.7 per 1,000 in Canada and three per 1,000 in Australia.

Previous studies also have found higher overall U.S. infant mortality rates than in other developed countries.

What was surprising, Thompson said, was the similarity in death rates for the smallest, sickest babies, born weighing less than 2 pounds. Doctors had thought such babies did better in the United States given the country's neonatal resources, she said. But in all countries studied, there were more than 300 deaths per 1,000 births in 1997, and differences among them were not significant, she said.

The United States has 6.1 neonatologists per 10,000 births, compared with 3.7 in Australia, 3.3 in Canada and 2.7 in the United Kingdom. The U.S. figure remains significantly higher even considering that more low-birthweight babies are born here, Thompson said.

More than 300,000 U.S. newborns, or about 7.8 percent annually, have low birthweights, less than 5 pounds, 8 ounces. The rate was 7.2 percent in the United Kingdom, 6.1 percent in Australia and 5.7 percent in Canada during the study period.

The number of neonatal intensive-care beds is also proportionately higher in the United States, the study found.

The United States is the only country studied without national insurance and the only one where the government does not provide free family planning services and free prenatal care, Thompson said.

Focusing more on such services could help improve newborn mortality rates, she said.

Dr. James Collins, a neonatologist at Chicago's Children's Memorial Hospital, said he agreed that "prevention is better than a cure."

But Collins said the study is flawed because it compared only broad categories of birthweights and didn't adequately account for the higher U.S. rate of low-birthweight babies.

Also, Collins said, focusing only on death rates doesn't tell the whole story. He said premature U.S. babies who survive likely fare better later in childhood than those in other countries, in part because of the intensive care they get as newborns.
http://www.lasvegassun.com/sunbin/stories/thrive/2002/jun/02/060204410.html

June 02, 2002

Survey: Kids Ignore Sun Safety

CHICAGO- Sun-worshiping kids are still seeking tans - and not using sunscreen - despite warnings about the dangers of skin cancer, a survey of preteens and adolescents found.

Only a third of the 10,079 youngsters surveyed said they routinely used sunscreen during the previous summer, and nearly 10 percent said they had used a tanning bed. Most reported having at least one sunburn during the previous summer, and half with multiple sunburns said it was worth it to get the tan that followed.

Research has shown that severe sunburns in childhood can significantly increase the risk later in life of developing melanoma, the most serious type of skin cancer; while the use of tanning beds has been linked to other skin cancers.

Studies have suggested that using sunscreen in childhood could reduce the risk of developing skin cancers other than melanoma in adulthood by as much as 78 percent, the researchers said.

More than 1 million Americans are diagnosed each year with skin cancer, and excess sun exposure is the leading cause. With rates rising nationwide, public health messages from the Centers for Disease Control and Prevention and the American Cancer Society have urged sun-protection measures for all ages, including using sunscreen and avoiding tanning beds.

However, they appear to have had minimal impact among youngsters, according to the study led by Boston University researcher Alan Geller. Results appear in the June issue of Pediatrics.

Geller said a stronger national effort is needed, akin to anti-smoking campaigns that have been credited with helping to reduce teen smoking.

Alexandra Tomlinson, a fair-skinned 14-year-old in suburban Detroit, said the reason she goes to tanning booths and lays out in the sun without sunscreen is simple: "I just think I look better when I'm tan and not white."

She said she has heard the warnings from her mother and in school, where teachers show pictures of prematurely wrinkled, sun-damaged skin, but the consequences are "too far off to worry about."

"Maybe showing us someone who does have skin cancer" would help, Tomlinson said.

In the study, boys and girls ages 12 to 18 filled out questionnaires in 1999 about "tan-seeking" behaviors during that year and the previous summer. The youngsters were children of participants in a national study of female nurses. Though they were mostly white and middle-class and were not randomly selected, Geller said the results likely can be generalized to other teens.

While girls were much more likely than boys to report sunscreen use - 40 percent versus 26 percent, they also were more likely to have been sunburned at least three times. Girls also were far more likely to have used a tanning salon or tanning bed, 14 percent versus 2 percent for boys.

Dr. Martin Weinstock, a Brown University dermatology professor and head of the American Cancer Society's skin cancer advisory group, said changing the cultural norm will require time and novel methods.

"If you just tell people, wag your finger at them and say, 'You ought to wear sunscreen,' it has very little effect, particularly with teen-agers," said Weinstock, who was not involved in the study.

The study was funded by grants from the National Institutes of Health, the CDC and the Association of Teachers of Preventive Medicine.
http://www.lasvegassun.com/sunbin/stories/thrive/2002/jun/02/060204408.html

posted 06-05-2002 10:36 PM            

Few Medicaid Kids Screened for Lead

WASHINGTON- Only about 20 percent of the children in Medicaid are getting screened for elevated blood levels of lead, which can retard growth and lower in intelligence, a federal official suggested Wednesday.

The federal-state insurance program for the poor requires that all Medicaid-eligible children receive a blood screening test for lead at 12 months and 2 years, as recommended by the Centers for Disease Control and Prevention. Any child age 2 to 6 for whom no record of a test exists also must be screened, program rules says. Medicaid pays for the screenings and any diagnostic or treatment services required for children found to have elevated blood lead levels. It also will pay for a one-time investigation to find the source of the lead.

But Medicaid has run into problems collecting data on screening tests and ensuring the tests are performed, said Ruben King-Shaw, deputy administrator for the federal Centers for Medicare and Medicaid Services. "We have very few powers to enforce this kind of provision," King-Shaw told a Senate Banking, Housing and Urban Affairs subcommittee. He estimated that about 20 percent of Medicaid-enrolled children under 6 are screened - which translates into roughly 1.3 million children.

King-Shaw said that virtually the only enforcement mechanism available to the agency for health care providers who do not perform the screening is a suspension of Medicaid payments. "I don't know that people want to see that as an enforcement measure," he said. He said the agency is doing outreach and education to improve the screening rate among poor children. Sen. Jack Reed, D-R.I., the subcommittee chairman, asked King-Shaw to recommend to Congress changes in law that would help enforcement. "The efforts to achieve the long-established goal of eliminating lead poisoning by the year 2010 have stalled," he said.

posted 06-07-2002 06:11 PM            

At McKinley Elementary School in Fairfield, Conn., school's out -- not just for summer, but maybe for good, reports CBS News Correspondent Jim Axelrod.

When a number of teachers and kids reported a rash of unexplained symptoms, local allergist Dr. John Santilli, put two and two together. He had testing done for mold in the school.

"They found the typical indoor molds aspergillus, penicillium. But what they found that was significant was stachibotrys," said Santilli. "Once we started getting the testing results back it became obvious that McKinley was not a problem, but a huge problem."

Santilli estimates some 40 to 60 students and staff got sick from the mold. Two cases were serious enough to require hospitalization.

According to town selectmen Ken Flatto, the problem started with some late summer flooding.

"When I went in to clean out materials in a closet, the materials had black mold all over them," said Joellen Lawson.

That cleanup took the 23-year teaching veteran out of the classroom and into the hospital, under the care of Santilli.

"He said my symptoms -- the respiratory symptoms, the neurological, the sensory disturbances that I have been suffering for years were totally consistent with exposure to high levels of mold," she said.

Santilli says he has a dozen kids and teachers homebound. "I won't let them go back to school."

Stories like Lawson's become even more alarming when one realizes some 14 million American children attend schools with poor environmental conditions. In the last decade the rate of allergic disease -- like asthma -- has doubled in the nation's classrooms. Many say that's also the place to look for the cause.

In Portland, Ore., parents started asking questions when students and teachers at Whitaker Middle School started complaining of fatigue, head aches and flu-like symptoms.

Said teacher Janis Ingersole, "I felt like something was standing on my chest. My skin was crawling. I had hives and my face was puffed up like a pink."

When the school was tested, what was first thought to be radon turned out to be mold. Leaks from an old, poorly maintained, drainage system caused flooding. The flooding spawned mold.

"How many more teachers have to get sick before people realize this is a serious public issue?" asks Lawson. She is now pushing Connecticut legislators to enact new air quality standards in state classrooms.

"Children should not have to attend school where they are going to acquire a life-long illness."

posted 06-10-2002 12:49 AM            

(AP) (Woodbury Heights, N.J.)
Jun 8, 2002 8:15 pm US/Eastern

A mysterious rash affects some southern New Jersey students. About 80 students at Gateway Regional High School have exhibited the red, blotchy rash.

Officials believe it may be related to the school's air ducts or 20-year-old carpet.

The county first learned of the rash May 30. The raised red bumps and blotches, which mostly strike middle school girls, disappear soon after the students leave the school.

Similar rashes were reported in several Pennsylvania schools, and has appeared in classrooms in more than a dozen other states. Some schools closed temporarily, but no one has pinned down a cause.

posted 06-11-2002 02:46 AM            

Officials say the rash at Gateway Regional High School might be related to the school's air ducts or 20-year-old carpet. But Wendy Carey with the Gloucester COunty Health Department says they may never know the cause. The county first learned of the rash May 30th.

The raised red bumps and blotches, which mostly strike middle school girls, disappear soon after the students leave the school.

The federal Centers for Disease Control and Prevention found no common link between the rashes in the different schools.

posted 06-12-2002 04:01 AM            

Mysterious rash breaks out among terminal workers
By STEVE STONE, The Virginian-Pilot
© May 29, 2002

PORTSMOUTH -- Authorities were unsure what caused a rash and hives on two workers and left seven others with itchy skin Wednesday at the Portsmouth Marine Terminals. All were taken to area hospitals for checkups, and the two men who were most affected responded quickly to medical treatment. The others were decontaminated as a precaution.

Paramedics and one fire truck responded to the terminal about 1:30 p.m. Shortly after they arrived, hazardous materials crews were called. The HAZMAT technicians ``did testing on a variety of things,'' said Capt. Brian Spicer of the fire department. ``But they were unable to determine the origin of the hives.'' All of the workers had been outside. Otherwise, there was no commonality between anything they had been doing.

``We checked where they had been, had they eaten together. But there was nothing,'' Spicer said. After about four hours, the HAZMAT crew packed up.

posted 06-30-2002 11:57 AM            

ASSOCIATED PRESS

LONDON- Health chiefs reported Saturday that the number of measles cases have risen dramatically in the first three months of this year in Britain, where parental fears over vaccination has lead to a drop in childhood inoculations.

There were 126 confirmed cases of measles in England and Wales from January to the end of March 2002, compared with only 32 cases in the last quarter of 2001, the Public Health Laboratory Service said.

The steep increase was the result of a single outbreak linked to several nurseries and schools in south London which flared up early this year and has now died down. Use of the controversial combined measles, mumps and rubella vaccine in London remains lower than in any other region of Britain, the report said, despite government efforts to promote vaccination.

The health agency said 35 of 50 cases in London involved children aged under five who were not vaccinated. By February of this year, MMR immunization in British 2-year-olds had dropped to a record low of 84 percent, well below the 95 percent specialists say is needed to prevent measles from returning.

The measles, mumps and rubella inoculation is required in 90 other countries. The fears in Britain appear to be the result of a surge of publicity about one doctor's concerns about the safety of the triple inoculation.

A 1998 British study contended the vaccine could be linked to autism, a severe neurological disorder usually diagnosed around the age of 2 - the same age that the vaccine is given. Since that study, several authoritative groups of international scientists have examined the evidence - including a panel that reviewed five decades of research on the vaccine's side effects - and concluded there is no evidence of a connection.

posted 07-01-2002 11:54 PM            

Overweight Kids Need More Help

ASSOCIATED PRESS

CHICAGO- Many children are not being adequately treated for weight problems because many pediatricians and other health workers lack expertise in helping them slim down, a survey suggests. Though faced with an increasing number of overweight children, many pediatricians and nurse practitioners say they need more training to overcome weight-loss obstacles including a lack of patient motivation, insurance and parental involvement, according to the survey.

The eight-page survey involved 940 pediatricians, pediatric nurse practitioners and dietitians nationwide. Several reports about it are published as a supplement to the July issue of Pediatrics.

The 1999 survey is part of an effort by the federal Maternal and Child Health Bureau to examine the growing problem of obesity in children and to assess how doctors are dealing with it. National data indicate that about 14 percent of children aged 6 through 19 are severely overweight, a near-tripling since the 1960s.

"A lot of pediatricians around the country don't feel confident that they know how to treat this problem - so they don't (treat it)," said Dr. William Dietz, who chaired a committee, convened by the bureau, that initiated the survey. "It is a hard problem to treat," especially if doctors don't start addressing it until their patients become obese, said Dietz, director of the division of nutrition and physical activity at the federal Centers for Disease Control and Prevention.

Most survey participants said weight problems in children are a serious medical issue, putting patients at risk for chronic diseases including diabetes and heart ailments later in life. The bad news is that many may be inadequately addressing it, said St. Louis University's Dr. Sarah Barlow, one of the researchers. "It's a very sensitive topic for pediatricians to bring up. They worry about offending the family" and causing self-esteem problems in the child, she said.

More than a third of pediatricians and nurses, and about half of dietitians said they didn't initiate treatment in overweight children with no obesity-related medical problems. And most said they didn't initiate treatment in youngsters who didn't want to control their weight.

Dr. Elena Fuentes-Afflick, a San Francisco pediatrician, said it's not unusual to see young patients' weight balloon from visit to visit "and their parents swear to you that they're not eating fast-food and that they're exercising."

"This is clearly not a medical problem like I give them a pill and it will go away," Fuentes-Afflick said. "It's much more complicated, the whole family has to be involved. It's a very frustrating problem and there is no magic bullet."

posted 07-01-2002 11:57 PM            

2 Kids Fall Ill at Ohio Waterpark

ASSOCIATED PRESS

POWELL, Ohio- At least 20 customers at an amusement park got sick at wave and wading pools over the weekend, and two 12-year-olds remained hospitalized Monday with respiratory problems. State inspectors said they believe repairs to a filtration system that adds chlorine to the water was the likely cause.

Witnesses reported seeing a green haze above the wave pool Sunday at the Wyandot Lake amusement park's water rides, which were evacuated after people became sick. Several people began coughing and 11 were taken to hospitals. Nine of those were treated for breathing problems and vomiting and released.

Nursing supervisor Cheryl Monaghan at Children's Hospital in Columbus said the two boys were in fair condition Monday with respiratory problems.

One theory state regulators are considering is that chlorine gas built up after weekend repairs and was somehow released, said Mark Anthony, spokesman for the Ohio Department of Agriculture, which licenses the suburban Columbus park.

posted 07-02-2002 05:16 PM            

Illness More Common in Hispanic Kids

ASSOCIATED PRESS

CHICAGO- The nation's surging population of Hispanic children has a disproportionate share of asthma, obesity and other health problems that are not being adequately treated, researchers warn in a new report.

The problem is urgent, said Dr. Glenn Flores, a Boston Medical Center physician and lead author of the report in Wednesday's Journal of the American Medical Association. "If the disparities continue it has the potential to affect the health and productivity and well-being of our entire nation," Flores said.

There were 12.3 million Hispanics under age 18 in 2000 - the largest such minority group in the country, according to Census Bureau data. The population is expected to grow in coming years. Yet because of cultural barriers, a lack of awareness about the ethnic group's health needs and perhaps racial bias, many Hispanic children receive sub-optimal health care, the report suggests.

Compared with whites and blacks, Hispanic children "are much more likely to have no health insurance, drop out of school, have no regular doctor ... to have cavities, to attempt suicide if they're a girl, to be obese if they're a boy," Flores said.

There aren't clear reasons for the disparities because Hispanic children are rarely included in medical research, he said. Flores is the chairman of the Latino Consortium, an American Academy of Pediatrics-sponsored group of experts that examines research and policy issues in Hispanic children's health.

The JAMA report is a consensus statement based on consortium members' views of critical health needs. The U.S. Hispanic population jumped 58 percent from 1990 to 2000, according to census data. Nearly 35 percent are under age 18, compared with 26 percent of the nation's overall population.

"The demographics have changed so quickly that we're now in a position of having very limited data to understand what's happening," said Dr. Elena Fuentes-Afflick, a San Francisco pediatrician and consortium member. Dr. Dennis Styne, chief of pediatric endocrinology at the University of California at Davis, has many Hispanic patients he said are disproportionately affected by obesity and diabetes.

Styne said genetics and cultural norms may partly explain why. "Middle-class Caucasian culture doesn't accept heavy body size," but it may be less of a taboo among Hispanics, he said. According to the report, data shows that: - Asthma affects 11 percent of U.S. children of Puerto Rican descent, more than double the rate in blacks and nearly triple the rate in non-Hispanic whites. - Hispanic children are more than 13 times more likely than non-Hispanic whites to be infected with tuberculosis. -

Hispanic children, especially Puerto Ricans, face a comparatively high risk of behavioral and developmental problems. - Among children hospitalized with arm or leg fractures, Hispanics receive significantly lower doses of pain medication than non-Hispanic whites.

Language barriers may explain some of the disparities, the authors said. Hispanics make up just 5 percent of U.S. pediatricians, 2 percent of nurses and 2.8 percent of dentists.

Also, Flores said, very few U.S. medical schools have separate courses addressing Hispanic cultural issues. The report should enlighten decision-makers and help lead to solutions, said Carlos Ugarte, deputy vice president for health at the National Council of La Raza, a Hispanic advocacy group not involved in the report.

posted 07-17-2002 03:01 PM            

By Randolph E. Schmid Associated Press Writer
Published: Jul 17, 2002

The children of mothers who go to work full time before the youngsters are 9 months old have poorer mental and verbal development at age 3 than those with stay-at-home mothers, Columbia University researchers report.

Researchers measured the cognitive and verbal development of children at various ages and found lower scores for 3-year-olds whose mothers took jobs working 30 hours per week or more before the child was 9 months old.

But Jeanne Brooks-Gunn, one of the study authors, cautions mothers not to panic about the findings. "There are effects but they are not huge effects. Your child's life will not be ruined," she said in a telephone interview Wednesday.

The study results are reported in the July-August issue of the journal Child Development. Important contributors to the children's development also included the quality of child care, the home environment and the sensitivity of the mother, the researchers found.

Even after taking these factors into account, the researchers found lower cognitive development for the children of mothers who worked full time during their child's first nine months. Children's mental and verbal development was measured at 15, 24 and 36 months.

For mothers who went to work full time in the child's first nine months there was no significant affect on the child at 15 months or 24 months. But at 36 months the children of working mothers had lower scores.

The team found that this effect was reduced for mothers who were more sensitive to their children and for those who had better child care. "By sensitivity we mean being responsive to the baby," Brooks-Gunn said. "If the baby needs comforting, the mother is comforting. If it's active, she's talking and playing with him. It means responding to where the child is."

She said that "having a very sensitive mother does minimize the negative effects we saw." Also important is quality child care, she said. "The things I would say to mothers are be highly sensitive when you are with the baby and get the best child care you can afford."

The best care is to have one caregiver to one or two infants, she said, although she acknowledged that can be expensive. She added a plea to American business and to the government to do more with family leave policies so women can delay going back to work or ca return part time.

The study also found that the effect of having a mother working full time before nine months was greater for boys than girls and for children in married families rather than single mothers.

Brooks-Gunn said she was very surprised that children of married couples were more affected than those of single mothers.

"I found it in a couple of studies, so its probably real. I'm not sure what it's due to," she said.

Brooks-Gunn is a professor at Columbia Teachers College. Her co-authors Jane Waldfogel and Wen-Jui Han are professors at Columbia University's School of Social Work.