Medicine Man

In an attempt to spot autism earlier, the American Academy of Pediatrics has recently recommended that all children be screened for autism twice by age 2 - advice that many St. Louis families already heed thanks to a partnership between Saint Louis University and Parents as Teachers.

Since October 2006, Saint Louis University has been working with local Parents as Teachers to train their educators to spot warning signs of autism. Rolanda Maxim, M.D., assistant professor of pediatrics at Saint Louis University and a SLUCare developmental pediatrician at SSM Cardinal Glennon Children's Medical Center, is providing the medical and neurodevelopmental expertise for the program.

"Autism is a pervasive communication disorder, often diagnosed after age 3 in the United States," Dr. Maxim says.

"Communication develops primarily in the first two years of life, so it is critical to improve early screening and diagnosis for autism. Everybody agrees the kids with autism who have the best prognosis start intervention early.

"Parents as Teachers sends specially trained educators into the homes of young parents to offer support and share information about child development. We're working with these educators to give them the tools so they know when not to worry about autism and when to refer."

The parent educators observe the child in his or her home as well as discuss developmental milestones with parents. Currently, five St. Louis area school districts participate in the program, while other local districts have expressed interest in joining the initiative.

"This is the first unified initiative," Dr. Maxim says. "It's a new efficient model that, to my knowledge, has not been done in any other state."

While doctors can't definitively diagnose autism until a child is 18 months, "red flags" for autism can begin as early as 6 months, Dr. Maxim says. Collecting data on early developmental milestones could help to develop diagnostic criteria for autism in the first year of life.

Parent educators were trained to assess development and red flags for autism in infants at 6, 12 and 18 months. If the baby fails the 18-month screening, parent educators refer the families for an evaluation at the Knights of Columbus Developmental Center at Cardinal Glennon.

Among the behaviors to watch for at 6 months: Does the child babble, look you in the eye for more than a second or two, smile at you or turn the head when his or her name is called.

Babies at 1 year might also use "dada" and mama" for a parent, put a toy or object in front of an adult to capture attention, imitate faces you make, use an index finger to point to something he or she wants, wave bye-bye and look at things that you are looking at.

The screening at 18 months - called the M-CHAT (Modified Checklist for Autism in Toddlers) -- is a bit longer and includes questions such as whether the child enjoys being swung or bounced on your knee, takes an interest in other children, likes climbing, enjoys playing peak-a-boo or hide-and-seek, plays pretend games or makes unusual finger movements hear his or her face or walks.

MOFEAT, the parent support group for autism, is paying for the developmental screening questionnaires, but red flags for autism screening questionnaires developed by Dr. Maxim and M-Chat are free. Dr. Maxim also is donating her time to train parent educators and assess children who have failed the M-CHAT.

With the Centers for Disease Control and Prevention this year reporting that 1 in 150 children in Missouri have autism spectrum disorder, parents are increasingly concerned about detecting autism at the earliest possible stage.

"We're trying to get to them as soon as possible," Dr. Maxim says.

Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, liver disease, heart/lung disease, aging and brain disease, and infectious disease.

http://www.slu.edu

Under new guidelines experienced nurses in Britain will be given the power to decide on the resuscitation of patients; it is thought the move will avoid the "heartache" many families experience over what are often futile efforts at revival.

The Royal College of Nursing said its members were often in the best position to decide if someone should receive cardiopulmonary resuscitation (CPR) or be left to die in dignity.

The guidelines which were published last week will extend the power of judgment in such matters to "suitably experienced" nurses; currently it is only consultants and family doctors who are allowed to make that decision.

The new guidelines signal an agreement by the British Medical Association (BMA), the Royal College of Nursing and the Resuscitation Council; they aim to prevent the "unnecessary" resuscitation of patients who would not benefit.

Regardless of how it may be portrayed in films and television, the reality of CPR is that survival rates can be as low as 5% for certain individuals and the Resuscitation Council says it can be a prolonged and traumatic procedure.

Health professionals say that decisions about CPR may be extremely distressing for patients and those emotionally close to them.

According to the new guidelines each patient should be individually assessed and a plan of treatment communicated to all healthcare professionals who come into contact with them.

Dr. Peter Carter, general secretary of the Royal College of Nursing (RCN), says very often it is the nurse who has the closest bond with the patient and their family and is in the best position to decide if CPR is in their interest.

Dr. Carter says CPR is not the miracle cure all TV dramas would have us believe and in reality survival rates are very low.

Dr. Carter also says the guidance has the backing of doctors and the Resuscitation Council and should help spare patients and their families the heartache and indignity of repeated and sometimes futile resuscitation attempts.

The guidelines stress that the only nurses with this authority should be those that are suitably experienced and also clearly states that it is not always appropriate to distress a person who is dying, perhaps in the last few days of life, by discussing attempted resuscitation when clearly CPR would not be successful.

The new guidance also has the support of the Patients Association.

Chinese experts say they have found that pregnant women infected with the H5N1 bird-flu virus can pass the disease on to their unborn babies.

In a study by scientists at Peking University tissue taken from the body of a 24-year-old pregnant woman who died from bird flu, found the virus was also present in the placenta and had infected the fetus.

Gu Jiang, director of the School of Basic Medical Sciences which is affiliated to Peking University, says this however does not mean that the bird flu virus can be transmitted from one person to another.

Gu Jiang who led the study says the virus was also found in the alimentary canal, brain, blood cells and respiratory tract of both the mother and the fetus and the unborn child's lungs and liver were also affected.

Gu Jiang says to date no substantiated case of inter human transmission has been recorded but all will depend on how the virus further mutates.

Gu says his research project, which also involved studying tissue from a 35-year-old man killed by the virus, was the eighth of its kind worldwide and is significant for the treatment and prevention of bird flu.

Gu says blood and feces from people infected with the virus must be handled extremely carefully to avoid further spreading of the disease.

The World Health Organization (WHO) also says example of transfer does not prove that the virus can be transmitted from one human to another, as the mother and her unborn child are considered to function as one body.

Latest reports say that that bird flu outbreaks have occurred in Vietnam's northern Cao Bang Province bringing the number of localities in Vietnam affected by the disease to three.

According to officials a total of 480 ducks and 80 chickens in 13 households in Trung Khanh district were infected with the H5N1 bird flu virus strain and local veterinary officials have collected all the infected birds and isolated the affected areas.

A £12m million study has found that organic foods are healthier than ordinary produce because they contain more antioxidants.

The study which was funded by the European Union (EU) is believed to be the most expensive one ever conducted into the value of organic produce.

The study involved researchers growing fruits and vegetables on a 725 acre area where fields were split into two so that conventional and organic produce could be grown side by side.

The study has allowed scientists to compare organic and regular foods and test whether organic foods are a better health option.

The area was attached to Newcastle University and other sites across Europe were also used.

The research has revealed that milk from organic herds of cattle contained 90 percent higher levels of antioxidants than the milk from non-organic cattle - antioxidants are thought to prevent cancer and heart diseases.

The study also revealed that organic food contained more beneficial minerals such as iron and zinc.

According to Professor Carlo Leifert, the coordinator of the four-year study, the results of the research are useful because it demonstrates a way for people who do not eat the recommended portions of fruits and vegetables a day, to increase their intake of nutrients.

Findings from the project which is the first to investigate systematically the physiology of produce from the different farming techniques, will be peer reviewed and published over the next 12 months.

Professor Leifert, who is the leader of the "QualityLowInput-Food (QLIF)" project says the research has shown up to 40% more beneficial compounds in vegetable crops and up to 90% more in milk; it has also found high levels of minerals such as iron and zinc in organic produce.

The results support other studies which have also shown that organic food is healthier; a recent Californian study comparing organic tomatoes with those grown conventionally, found the organic ones had double the level of flavonoids, an antioxidant thought to reduce the risk of heart disease.

The QLIF project involves 33 academic centres across Europe and is led by Newcastle University.

According to new research smokers have a higher risk of developing the skin condition psoriasis.

Psoriasis affects millions of people and there are many different forms of the disease.

It is a disease which affects the skin and joints and causes red scaly patches to appear on the skin.

The scaly patches are areas of inflammation and excessive skin production and skin plaques quickly accumulate at these sites with a silvery-white appearance.

The plaques frequently occur on the skin of the elbows and knees, but can affect any area including the scalp and genitals.

Psoriasis is thought to be related to the body's immune system and is not contagious but is a chronic recurring condition which varies in severity from minor localised patches to complete body coverage; fingernails and toenails are often affected.

Psoriasis can also cause inflammation of the joints, which is known as psoriatic arthritis which affects ten to fifteen percent of people with psoriasis.

While the exact cause of psoriasis is unknown, but it is believed to have a genetic basis and several factors are thought to aggravate the condition including stress, excessive alcohol consumption, and smoking.

Individuals with psoriasis may suffer from depression and loss of self-esteem so quality of life is an important factor in evaluating the severity of the disease.

There are many treatments available but because of its chronic recurrent nature psoriasis is a challenge to treat.

It is common knowledge that cigarette smoke contains hundreds of toxins and chemicals and cigarette smoking has been linked to a plethora of diseases and conditions.

The U.S. researchers suggest that heavy smokers have a greater risk of the skin condition and which remains for years after they have quit.

The study of 79,000 nurses by researchers at the Harvard Medical School in Boston and the University of British Columbia in Vancouver, Canada, found that people with psoriasis who smoked had the more severe disease.

They believe the toxins in cigarette smoke may affect parts of the immune system associated with psoriasis.

Previous research has also implied a link between smoking and psoriasis but it was unclear whether smoking occurred before the onset of the condition.

This latest study provides long-term data as it reported on 887 cases of psoriasis over a 14-year study period.

The researchers found that compared with women who never smoked, the risk of psoriasis was 37% higher among past smokers and 78% higher among current smokers; what is more the heavier the smoking habit, the higher the risk appeared to be and it took as long as two decades after stopping smoking before the risk fell back to that of non-smokers.

The team also found that exposure to passive smoke during pregnancy or childhood was associated with an increased risk of psoriasis.

Study leader, Dr. Hyon Choi says the findings provide a clear incentive for those with psoriasis to stop smoking as well as those at risk of the condition.

Dr. Choi says stopping smoking may decrease the level of smoke induced inflammation in the body by lowering levels of circulating immune cells.

Experts say people with psoriasis should always aim to cease smoking for their general health and to help improve their psoriasis but psoriasis remains an immensely complex condition and there are people with psoriasis who do not and have never smoked.

The research is published in the American Journal of Medicine.