• 'Fearless' 3-Year-Olds Might Be Tomorrow's Criminals

    Children who are fearless at 3 years of age might just be poised for a life of crime.

    According to a new study, poor fear conditioning at the tender age of 3 can predispose that person to break the law as an adult. Yet other factors, such as education of the parents, large family size, nutrition, physical activity, configuration of the household and other elements also play a role, the researchers concluded.

    "There's no 100 percent correspondence between conditioning deficits and crime: Not all poor conditioners will become criminals and not all criminals have the early fear conditioning deficits," explained study author Yu Gao, a research associate in the department of criminology at the University of Pennsylvania. His findings are published in the Nov. 16 online issue of the American Journal of Psychiatry.

    Specifically, what Gao and his associates set out to determine is whether dysfunction of the amygdala, an almond-shaped mass that resides deep in the human brain and is linked to fear conditioning as well as emotions and mental state, leads to an inherent intrepidness and disregard for the law.

    Twenty years ago, the research team tested almost 1,800 children who were 3 years old from Mauritius, an Indian Ocean island off the coast of southeastern Africa, by exposing them to two sets of sounds, one with a short shrill noise, and the other deeper in pitch and with a pleasant tone, and then measuring the children's physical responses through an electrode attached to their index and middle fingers. Sweating upon hearing the loud noise indicated a sense of fear, while no sweat meant the child lacked fear -- that is, had poor fear conditioning.

    Two decades later, using court records, Gao and his team tracked down 137 study participants -- 131 males and six females -- who had committed serious crimes involving property, drugs, violence and driving. These individuals had shown an absence of fear during testing at age 3, whereas 274 study participants who had grown to adulthood without a criminal record had displayed typical fear responses.

    Experts agreed that the findings don't constitute a cause-and-effect situation, but hailed the study for its longevity and what the work adds to what is known about how childhood factors influence adult behavior.

    "Any time you have a 20-year study, that's significant," said Dr. Elissa P. Benedek, an Ann Arbor, Mich.-based psychiatrist who has worked in private practice with children and adults for more than 40 years and is a past president of the American Psychiatric Association.

    "It's good for putting another link in the chain in terms of what is early brain dysfunction, and what increases the risk for such behaviors as attention-deficit disorder and criminal activity. It's another link back to whatever we all ready know about early brain dysfunction that may cause problems later in life," Benedek added.

    So what do the results mean for individuals with fear conditioning deficits and their loved ones, and for society at large? It's a wake-up call about potential problems, said Gao and other experts in the field. To enhance the proper working of the amygdala, which is believed to reduce criminal behavior in later life, enrichment programs are essential.

    In fact, according to Gao, some at-risk children between the ages of 3 and 5 who have benefited from those programs, which include sound nutrition, adequate physical exercise and cognitive brain stimulation, had shown an improvement in brain functioning by age 11 that reduced the chances of criminal behavior by 35 percent 20 years later.

    Addressing parental concerns, Benedek added: "Don't be discouraged if your child has early brain dysfunction. It doesn't mean that he or she is going to grow up and be a criminal. The brain can change and grow."

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  • New mammogram advice raises questions, concerns

    graphic shows the use of mammography among women 40 and older by age. For many women, getting a mammogram is already one of life's more stressful experiences.

    Now, women in their 40s have the added anxiety of trying to figure out if they should even be getting one at all.

    A government task force said Monday that most women don't need mammograms in their 40s and should get one every two years starting at 50 — a stunning reversal and a break with the American Cancer Society's long-standing position. What's more, the panel said breast self-exams do no good, and women shouldn't be taught to do them.

    The news seemed destined to leave many deeply confused about whose advice to follow.

    "I've never had a scare, but isn't it better to be safe than sorry?" asked Beth Rosenthal, 41, sitting in a San Francisco cafe on Monday afternoon with her friend and their small children. "I've heard of a lot of women in their 40s, and even 30s, who've gotten breast cancer. It just doesn't seem right to wait until 50."

    Her friend agreed. "I don't think I'll wait," said Leslie David-Jones, also 41, shaking her head.

    For most of the past two decades, the American Cancer Society has been recommending annual mammograms beginning at 40, and it reiterated that position on Monday. "This is one screening test I recommend unequivocally, and would recommend to any woman 40 and over," the society's chief medical officer, Dr. Otis Brawley, said in a statement.

    But the U.S. Preventive Services Task Force, a government panel of doctors and scientists, concluded that such early and frequent screenings often lead to false alarms and unneeded biopsies, without substantially improving women's odds of survival.

    "The benefits are less and the harms are greater when screening starts in the 40s," said Dr. Diana Petitti, vice chair of the panel.

    Breast cancer survivors who were diagnosed at a young age were among the more vocal critics of the new guidelines.

    "This sure seems like a big step backwards to me," said Debbie Hayes, who was diagnosed with Stage 2 breast cancer at age 33 after finding a lump during a self-exam. A mammogram, ultrasound, biopsy and finally a mastectomy and chemotherapy followed.

    "People are being diagnosed even in their early 20s," said Hayes, now 53 and a volunteer coordinator for the Chicago-based Breast Cancer Network of Strength. "Mammograms are a key element of that."

    But another breast cancer survivor thought the new guidelines sounded about right — even though she was diagnosed at age 37, two years ago.

    "They seem pretty sensible to me," said Claire Mayne, of San Francisco. "The death rate is not going down because of the earlier mammograms. I'd feel comfortable telling a friend to wait until she was 50."

    Mayne was more doubtful, though, about the advice on self-exams; that's how she found her own cancer.

    Most women in their 40s interviewed for this article said they planned to stick with the old mammography recommendations, at least for now.

    "I have two young children," said Amber Smart, a 47-year-old mother in Agoura Hills, Calif. "There's a lot of years left that they need me." She's been having mammograms every six months, since she was 44, to make sure that certain dense areas of her breasts aren't cancer.

    "I think it's kind of sad that they're basically saying, 'We can't afford to pay for the few people who may have it in their 40s, so a few people are going to die,'" Smart said.

    Judy Finley, a flight attendant from Dallas, called the new recommendations "a terrible idea," and said she was especially worried that insurance companies might "pick up on this and quit paying for mammograms from 40 to 50."

    "I think it would be really sad," said Finley, who was walking through the Crown Center mall in Kansas City, Mo. "And I don't know how the U.S. government or a panel of government officials can think they know better than the American Cancer Society."

    But there were those who saw the new guidelines as potentially a relief, a development that could save women from endless stress, false positives and perhaps needless procedures.

    "I can't tell you how many friends I have who've gone through severe worries from false scares," said Maren Waxenberg, a Manhattan mother. "At least three of them have had biopsies. And it turned out to be nothing."

    Waxenberg herself, 46, has not yet had a mammogram. "I'm not concerned at this age," she said. "I plan to do it, but there's no sense of urgency."

    The new guidelines are for the general population, not those at high risk of breast cancer because of family history or gene mutations.

    They say:

    _Most women in their 40s should not routinely get mammograms.

    _Women 50 to 74 should get a mammogram every other year until they turn 75, after which the risks and benefits are unknown. (The task force's previous guidelines had no upper limit and called for exams every year or two.)

    _The value of breast exams by doctors is unknown. And breast self-exams are of no value.

    Medical groups such as the cancer society have been backing off promoting breast self-exams in recent years. Decades ago, the practice was so heavily promoted that organizations distributed cards to be hung in the shower demonstrating the circular motion women should use to feel for lumps.

    As for mammography, the panel's new recommendations are more in line with international guidelines, which call for screening to start at age 50; the World Health Organization recommends the test every two years, and Britain says every three years.

    They were sharply challenged by the cancer society on Monday.

    "The task force advice is based on its conclusion that screening 1,300 women in their 50s to save one life is worth it, but that screening 1,900 women in their 40s to save a life is not, Brawley wrote.

    That stance "is essentially telling women that mammography at age 40 to 49 saves lives, just not enough of them," he added.

    But Dr. Amy Abernethy of the Duke Comprehensive Cancer Center agreed with the task force's changes.

    "Overall, I think it really took courage for them to do this," she said. "It does ask us as doctors to change what we do and how we communicate with patients. That's no small undertaking."

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  • Study: New device improves heart failure survival

    Doctors say that a new type of heart pump greatly improves survival of people with severe heart failure. It could become the first one of these devices to be widely used as a permanent treatment.

    The device is implanted next to a patient's own heart to help it pump. In a study, the new device increased by four times the number of patients who survived at least two years, compared to an older pump that is used now just for short periods to keep people alive until a heart transplant can be done.

    The big issue is cost. The pump costs $80,000, plus $45,000 for the surgery and hospital stay to implant it.

    "It will allow older people who are not heart transplant patients to stay alive but at a higher cost. It's all about who's going to pay," said Cleveland Clinic heart chief Dr. Steven Nissen, who had no role in the research.

    The device — called the HeartMate II and made by Thoratec Corp. of Pleasanton, Calif. — is the first of a new generation of smaller pumps that push blood continuously rather than simulating a heartbeat as older pumps do. A wire from the patient's abdomen connects the device to a small computer and batteries the patient wears in a belt pack.

    The pump was approved last year for use in people waiting for a transplant. The new company-funded study tested it in very sick heart failure patients not eligible for a transplant.

    It enrolled 200 people as young as 26 and as old as 81 at several sites in the United States. Two-thirds got the new device; the rest received an older HeartMate pump. After two years, 46 percent of those on the new pump and 11 percent of those on the old one were alive without having suffered a stroke or needing an operation to fix or replace the device.

    Results were presented Tuesday at an American Heart Association conference and published by the New England Journal of Medicine.

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  • Child Food Allergies on the Rise in U.S.

    Pediatric food allergies, which can sometimes be life-threatening, are increasing at a dramatic rate in the United States, new research shows.

    But the study authors aren't sure if the rise in reports of food allergies reflects an increase in actual prevalence or if better awareness has led more people to seek treatment for their symptoms.

    Whatever the cause, it's clear that the number of children with food allergies has gone up 18 percent and the number seeking treatment for food allergy at emergency departments or hospitals has tripled since 1993.

    "People are more aware of food allergies today, and that could have something to do with it," said study author, Amy Branum, a health statistician for the U.S. Centers for Disease Control and Prevention. "But, when we looked at health-care surveys filled out by parents and those from the health-care sector, we saw the increase across the surveys so this may be more than just increased awareness."

    Results of the study were published online Nov. 16 and will appear in the December print issue of Pediatrics.

    Although many people think of allergies as more of a nuisance than a serious health issue, food allergy in particular can be very serious, even life-threatening. The most common foods that people are allergic to include peanuts, tree nuts, milk, eggs, soy, shellfish, fish and wheat, according to the Food Allergy & Anaphylaxis Network.

    Symptoms often appear minutes after people eat a food that they're allergic to, but it can sometimes take several hours before a reaction begins, according to the network. Typical symptoms of a food allergy include a tingling sensation in the mouth, swelling of the tongue or throat, trouble breathing, hives, stomach cramping, vomiting or diarrhea.

    In the current study, the researchers used information from four different national data sources to assess the current rate of food allergies in the United States. The surveys included information from parents and from health-care providers, according to Branum.

    The researchers found that between 1997 and 2007, the incidence of food allergy went up by 18 percent. Parents of almost 4 percent of U.S. children reported a food or digestive allergy in their child, the study authors noted.

    There was also an increase in the rates of parent-reported skin allergy (eczema) during the same time period. Approximately 8.9 percent of U.S. children had experienced skin allergy in 2007, compared with 7.9 percent in 1997.

    Health-care providers, on the other hand, reported that the number of children being treated for food allergies had tripled, the study found. Data from health-care providers was from 1993 to 2006.

    Data included testing for immunoglobulin E, or IgE, antibodies in the blood for various foodstuffs, which can indicate an allergy. The percentage of children who tested positive for IgE antibodies for peanut allergy was 9 percent; for egg allergy, 7 percent; milk, 12 percent; and shrimp, 5 percent, the study found.

    Though IgE antibodies can indicate a potential food allergy, the test is often better at ruling out who does not have an allergy, Branum said. A positive test doesn't mean that someone definitely has a food allergy, but suggests that the potential is there.

    The researchers also noted that Hispanic children had the lowest overall prevalence of food allergy but the greatest increases over time of parent-reported incidences of food allergy.

    "People should be aware that food allergy may really be increasing," Branum said. "If small children have symptoms when they eat a particular food, have that child checked out, particularly if they have co-occurring conditions like asthma and eczema."

    "Food allergies are real," said Dr. Jennifer Appleyard, chief of allergy and immunology at St. John Hospital and Medical Center in Detroit. "And it appears that the prevalence is rising."

    This will present various challenges, she noted. One is that there's already a shortage of allergy specialists in many areas, Appleyard said. Another is that schools will have to gear up to take care of additional children with food allergy to ensure their safety during the school day and on field trips, she said.

    Parents who suspect their child has a food allergy should first talk with the child's primary care physician about symptoms. The problem could be a food intolerance rather than an allergy, she said, but the child might need to be tested by an allergy specialist to get a definitive diagnosis.

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  • Study Touts Success With 'Female Viagra' Drug

    New industry-funded research suggests that the antidepressant flibanserin, which has been touted as a female version of Viagra, can enhance libido in women with low sex drives.

    The research compiles the results of several trials, the first to test a treatment for low libido in women that works on the brain, lead investigator Dr. John M. Thorp Jr., a professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill School of Medicine, said in a university news release.

    "Flibanserin was a poor antidepressant," Thorp said. "However, astute observers noted that it increased libido in laboratory animals and human subjects. So, we conducted multiple clinical trials, and the women in our studies who took it for hypoactive sexual desire disorder reported significant improvements in sexual desire and satisfactory sexual experiences."

    Research suggests that 9 percent to 26 percent of women in the United States suffer from low sex drive, with the numbers varying depending on age and whether they've reached menopause.

    The findings were to be presented Monday at the Congress of the European Society for Sexual Medicine in Lyon, France.

    The researchers combined statistics from three trials of flibanserin, which together included 1,946 premenopausal women who took either the drug or a placebo for about six months.

    Daily doses of 100 milligrams significantly improved symptoms, the researchers found.

    Boehringer Ingelheim, which makes flibanserin, funded the research.

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  • Sexually spread diseases up, better testing cited

    Sexually spread diseases continue to rise, with reported chlamydia cases setting yet another record in 2008, government health officials said Monday.

    Last year there were 1.2 million new cases of chlamydia, a sometimes symptomless infection that can lead to infertility in women. It was the most ever reported, up from the old record of 1.1 million cases in 2007.

    Better screening is the most likely reason, said Dr. John M. Douglas Jr. of the U.S. Centers for Disease Control and Prevention.

    Syphilis, on the verge of being eliminated in the United States about 10 years ago, also has been increasing lately. About 13,500 cases of the most contagious form of the disease were reported in 2008, up from about 11,500 the year before.

    Unlike chlamydia, health officials think syphilis cases actually are increasing. Syphilis rates are up among both gay men and heterosexuals, said Douglas, director of the CDC's Division of STD Prevention.

    Syphilis can kill if untreated, but chlamydia is not life-threatening. Neither is gonorrhea, which seams to have plateaued in recent years. Gonorrhea cases dropped to about 337,000 cases in 2008, down from about 356,000 cases.

    Girls, ages 15 through 19, had the largest reported number of chlamydia and gonorrhea cases, accounting for more than one in four of those cases. But they're often screened more than other people, since 1993 federal recommendations that emphasize testing for sexually active women age 25 and under.

    The government estimates there are roughly 19 million new cases of sexually transmitted disease annually. Experts say the most common is HPV, human papillomavirus, which can cause genital warts, cervical cancer and other cancers.

    The government doesn't ask doctors to report every HPV case, but estimates the virus causes 6.2 million new cases each year. That is an old estimate, based on data from 2000, before a vaccine against some types of HPV came on the market in 2006.

    The CDC estimates there are 1.6 million new cases of genital herpes each year, but that too is an old estimate for a non-reportable disease.

    The agency also estimates there about 56,000 new cases of HIV each year.

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  • Trouble thinking? Better see the dentist

    Good oral care such as regular brushing, flossing and trips to the dentist, may help aging adults keep their thinking skills intact, according to a U.S. study.

    Research has already established an association between poor oral health and heart disease, stroke and diabetes, as well as Alzheimer's disease.

    But researchers from Columbia College of Physicians and Surgeons in New York found gum disease could also influence brain function through several mechanisms, such as causing inflammation throughout the body, a risk factor for loss of mental function.

    The study based on adults aged 60 and older found those with the highest levels of the gum disease-causing pathogen Porphyromonas gingivalis were three times more likely to have trouble recalling a three-word sequence after a period of time.

    The study, led by Dr. James Noble, also found that adults with the highest levels of this pathogen were two times more likely to fail three-digit reverse subtraction tests.

    "Despite the association of periodontitis with stroke and shared risk factors between stroke and dementia, to our knowledge, no epidemiological studies have investigated periodontitis relative to cognition," the researchers wrote in their study.

    "Although results presented here are preliminary and inconclusive, a growing body of evidence supports exploration of a possible association between poor oral health and incident dementia."

    The study, reported in the Journal of Neurology, Neurosurgery, and Psychiatry, was based on more than 2,350 men and women who were tested for periodontitis and completed numerous thinking skills tests as part of a national survey.

    Overall 5.7 percent of the adults had trouble completing certain memory tasks, 6.5 percent had impaired delayed recall, and 22.1 percent had trouble with serial subtractions.

    But those with the levels of the pathogen were nearly three times more likely to struggle with the verbal memory tests, and twice as likely to fail on both delayed verbal recall and subtraction tests.

    "Although our results are preliminary, they suggest that further exploration of relationships between oral health and cognition is warranted," they concluded.

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