Friday, October 9, 2009

Digital Social Networking and Health Care Education

Maino DM, Goodfellow G. Digital Social Networking and Health Care Education. J Optom Ed. Vol 34(3): 35(1):19-21

available at

...Do you have a presence on My Space (, Facebook ( and LinkedIn ( Do you tweet on Twitter ( Do you broadcast your blogs ( Your students certainly do. You would think that digital social networking would be an incredible opportunity for us to develop "teaching moments" within a new social context not encumbered by the usual stressors and expectations of health care education.

We know that 85% of college students use Facebook, with 60% logging in daily. Of the college students who use Facebook, almost 85% visit once a week, with 93% of them checking in at least once a month.1 Librarians in academia are being asked for help to set up Facebook pages and are taking an interest in how students use these new tools.

Faculty from the Georgia Institute of Technology conducted a survey at a mid-sized public research university to understand how contact on Facebook was influencing student perceptions of faculty. They found that one-third of the students surveyed did not want faculty on Facebook because of possible identity and privacy concerns, even though contact on Facebook had no effect on the students’ ratings of professors....

Comments: To read the full article go to the Journal of Optometric Education or click on the title above. It is interesting how much we do not know about how this digital media is being used! DM

Memory enhancement in healthy older adults using a brain plasticity-based training program: a randomized, controlled study.

Mahncke HW, Connor BB, Appelman J, Ahsanuddin ON, Hardy JL, Wood RA, Joyce NM, Boniske T, Atkins SM, Merzenich MM.Memory enhancement in healthy older adults using a brain plasticity-based training program: a randomized, controlled study.
Proc Natl Acad Sci U S A. 2006 Aug 15;103(33):12523-8. Epub 2006 Aug 3.

Normal aging is associated with progressive functional losses in perception, cognition, and memory. Although the root causes of age-related cognitive decline are incompletely understood, psychophysical and neuropsychological evidence suggests that a significant contribution stems from poorer signal-to-noise conditions and down-regulated neuromodulatory system function in older brains. Because the brain retains a lifelong capacity for plasticity and adaptive reorganization, dimensions of negative reorganization should be at least partially reversible through the use of an appropriately designed training program. ....This study demonstrates that intensive, plasticity-engaging training can result in an enhancement of cognitive function in normal mature adults.

Comments: You are never too old to learn new "stuff"! DM

Academic Behaviors in Children with Convergence Insufficiency with and without Parent-Reported ADHD

Rouse M, Borsting E, Mitchell GL, Kulp MT, Scheiman M, Amster D, Coulter R, Fecho G, Gallaway M; The CITT Study Group Academic Behaviors in Children with Convergence Insufficiency with and without Parent-Reported ADHD Optom Vis Sci. 2009 Sep 7. [Epub ahead of print]

..... To determine if children with symptomatic Convergence Insufficiency without the presence of parent-reported Attention Deficit Hyperactivity Disorder (ADHD) have higher scores on the academic behavior survey (ABS). ........ Children with symptomatic convergence insufficiency with parent report of no ADHD scored higher on the ABS, when compared to children with NBV. Children with parent report of ADHD or related learning problems may benefit from comprehensive vision evaluation to assess for the presence of convergence insufficiency.

No scientific link between childhood vaccines and autism

...A new article recently published in the Journal for Specialists in Pediatric Nursing explored vaccination history, vaccine safety monitoring systems in the U.S., and the two most publicized theoretical vaccine-related exposures associated with autism - the vaccine preservative thimerosal and the measles, mumps, and rubella (MMR) vaccine. A review of published research shows that there is not convincing scientific evidence supporting a relationship between vaccines and autism. The article is part of a special issue, which includes five articles focusing on the topic of autism....

Swine Flu May Stress ICUs This Winter

...Data from Australia and New Zealand's winter flu season suggest H1N1 swine flu will stress U.S. intensive care units in hard-hit areas.... Down Under hospitals are well equipped. Yet many had to struggle to keep up with severely ill swine flu patients, who have to be isolated from other patients to prevent spread of the pandemic flu.... From June through August -- winter in the Southern Hemisphere -- Australia and New Zealand ICUs admitted 15 times more patients with flu-like symptoms than in recent years.

Comments: Always consult your doctor and the flu shot but....swine flu could hit us hard in the USA! Dm

Teen Peer Pressure: Raising a Peer Pressure-Proof Child

...So, just what high-risk behaviors might your adolescent feel pressured to engage in? Plenty, according to the Centers for Disease Control and Prevention (CDC), which periodically conducts surveys on health-risk behaviors among youth. The latest survey results indicate that teen peer pressure is real. Many adolescents are engaging in behaviors that place their health at risk -- including cigarette smoking, alcohol consumption, illegal drug use and sexual activity. And in all likelihood, their peers are pushing them to try these behaviors....

Thursday, October 8, 2009

Dyslexia Association Identifies Dyslexia Warning Signs, Facts And Myths As Part Of "National Dyslexia Awareness Month"

...Estimates by the U.S. Department of Health & Human Services suggest that as many as 15% of all individuals in the U.S. may have dyslexia or a related learning disorder. ...

Comments: True dyslexia is a languaged based disorder....don't forget you can have learning related vision problems as well....all kids with reading problems...must have their eyes examined. DM

Why One Way Of Learning Is Better Than Another

...A new study from the Montreal Neurological Institute and Hospital (The Neuro) of McGill University reveals that different patterns of training and learning lead to different types of memory formation. The significance of the study, published in the Journal of Neuroscience, is that it identifies the molecular differences between spaced training (distributed over time) and massed training (at very short intervals), shedding light on brain function and guiding learning and training principles...

Groundbreaking Primate Study Links Mercury Vaccine Preservative To Brain Injury

...A new study in the leading scientific journal NeuroToxicology lends further credence to parents and scientists concerned about an increasingly aggressive childhood vaccine schedule and toxic vaccine components. A team led by researchers at the University of Pittsburgh found that infant macaque monkeys receiving a single Hepatitis B vaccine containing the mercury-based preservative thimerosal underwent significant delays in developing critical reflexes controlled by the brainstem. The infant macaques that did not receive vaccines developed normally....

Comments: There is very little evidence to suggest Thimerosol causes autism. Remember this was done in monkeys....monkeys are not humans. Read this with an open but skeptical mind. DM

MD 2009 earnings survey: How do you compare?

...A rough year for the U.S. economy had little negative impact on the income of physicians, according to the results of Medical Economics' 2009 Exclusive Survey. As the recession took hold and third-party payers tamped down on reimbursement, physician income scarcely budged from 2007 to 2008.
According to the survey, which was administered in April and May to more than 100,000 office-based MDs and DOs in more than 16 specialties, median earnings for family physicians, internists, general practitioners, pediatricians, and ob/gyns remained roughly the same in 2008 as they were in 2007. Among them, ob/gyns were the top earners, posting a median income of $237,500.
Pediatricians averaged $187,500, followed by FPs, GPs, and internists at $162,500. ...

Comments: And now Pediatricians want to start doing eye exams as well? Seems like their pay is pretty good already....don't get me primary care colleagues earn every buck they make...most are hard working docs who care about their pts! I won't do well baby pediatrician exams if they don't do baby eye exams.....they should screen the kids though and hopefully refer occasionally to docs like me! DM

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APHA Legislative UpdateOctober 2009

I. Senate Finance Committee Nears Completion of Health Reform Bill
II. Kerry-Boxer Introduce Senate Climate Bill
III. Ryan White CARE Act on Track for Reauthorization
IV. Surgeon General Nominee Approved by Senate HELP Committee
V. POLICY WATCH: News on relevant state and local activities

I. Senate Finance Committee Nears Completion of Health Reform Bill
The Senate Finance Committee worked until the early hours of the morning on Friday October 2, to all but complete its work on its version of health reform legislation. The final vote on the proposal has been delayed until the Congressional Budget Office (CBO) can score the bill as many members of the committee requested the official CBO score before casting their vote for the bill. CBO could release the score as early as today.The proposal establishes state-based health insurance exchanges for individuals and individuals employed by businesses with less than 50 employees. The proposal would provide refundable and advanceable premium credits to individuals and families with incomes between 133-400% of the federal poverty level (FPL) and expands Medicaid for all individuals (including adults without dependent children) up to 133% of FPL beginning in 2014. The bill would require a total of about $900 billion in new federal spending that would be offset with Medicare and Medicaid spending cuts and new tax revenue.The committee met over a two week period and considered more than one hundred amendments to the proposed chairman’s mark by Finance Committee Chair Max Baucus (D-Mont.). Many of the amendments which would have made the most substantial changes to the legislation, including several attempts to provide for a so-called “public option” for health insurance, were defeated. Among the key amendments adopted during the committee’s consideration were an amendment by Sen. Maria Cantwell that would allow states to use federal funding to negotiate with health insurance plans on rates for individuals earning between 133 and 200 percent of the federal poverty level (FPL) and an amendment by Sens. Charles Schumer (D-N.Y.) and Olympia Snowe (R-Maine) to exempt 2 million people from the mandate to buy insurance because it would be a financial hardship — more than 8 percent of their income — and reduced or delayed penalties for others who don't purchase insurance.The bill must now be combined with the proposal passed earlier this summer by the Senate Health, Education, Labor and Pensions (HELP) Committee. That bill contained several provisions supported by APHA and not included in the Finance Committee proposal, including a “public option” as a competitive alternative to private insurance plans and $80 billion dollars in funding over 10 years for a Prevention and Public Health Investment Fund that would provide funding for federal, state, local and community-based prevention and wellness activities. You can view APHA’s letter to Senate leaders outlining the priority provisions APHA would like to see included in the final Senate proposal at’s new Health Reform Fall Advocacy Toolkit as well as other resources are available on the PHACT Campaign website at Kerry-Boxer Introduce Senate Climate BillOn September 30, Senators John Kerry (D-Mass.) and Barbara Boxer (D-Calif.) introduced the Clean Energy Jobs and American Power Act. According to a press release by the bill’s sponsors, the bill would create clean energy jobs, reduce pollution, and protect American security by enhancing domestic energy production and combating global climate change.

APHA worked with key Senate offices to ensure the inclusion of a section relating to public health and climate change. The public health provisions included in the bill would require the Department of Health and Human Services (HHS) to develop a national strategic action plan for preparing for and responding to the health impacts of climate change and would provide critical funding for climate and health research, state and local preparedness activities, workforce training and development and public education about the health effects of climate change. In addition, the bill would create a Climate Change Health Protection and Promotion Fund to allow HHS to carry out the activities outlined in the bill. However, unlike the House-passed bill, which contains very similar provisions and specifically allocates 0.1 percent of proceeds generated by the bill for public health activities (estimated at about $90 million per year), the Senate bill does not specify the funding level for the public health fund. APHA will continue to work with Senate offices, including members of the Senate Finance Committee who will likely make decisions about the specific allocations in the bill, to ensure at least the same level of funding for the public health section as contained in the House bill.

To send a message to your Senators in support of the public health provisions in the Clean Energy Jobs and American Power Act, visit the APHA website at

III. Ryan White CARE Act on Track for Reauthorization
On September 25, the House passed a continuing resolution (CR) extending government operations for the remaining appropriations bills at FY 2009 levels until October 31, 2009. The Senate followed with an identical measure on September 30th. The CR extended the operation of the Ryan White CARE Act through October 31st, giving Congress an additional four weeks for the CARE Act reauthorization to pass the Senate floor, House mark-up and floor passage. The Ryan White CARE Act compromise bill that passed out of the Senate Health, Education, Labor, and Pensions (HELP) committee by unanimous voice vote on September 30th, reauthorizes the CARE Act for an additional four years. Additional changes include a yearly five percent increase in appropriations for each part of the program and a new prevention initiative encouraging states and jurisdictions to increase HIV testing efforts and linkages to care, with a national goal of 5 million tests through federal programs. Quick Senate floor action on the bill is expected and Senate and House staffers continue negotiations to reach a compromise bill that will be accepted by both bodies.

IV. Surgeon General Nominee Approved by Senate HELP CommitteeEarlier today, October 7, the Senate Health, Education, Labor and Pensions (HELP) Committee approved by voice vote the nomination of Regina Benjamin, MD as U.S. Surgeon General.First announced at the U.S. Surgeon General nominee on July 13, 2009, Dr. Regina Benjamin was the founder and chief executive officer of the Bayou La Batre Rural Health Clinic in La Batre, the immediate past chair of the Federation of State Medical Boards of the United States and previously served as associate dean for rural health at the University of South Alabama College of Medicine. In 2002, as the president of the Medical Association of the State of Alabama, she became the first black woman to be president of a U.S. state medical society. Dr. Regina Benjamin’s nomination now goes to the full Senate for a final confirmation vote. To see APHA's statement on the HELP Committee's approval of Dr. Regina Benjamin as U.S Surgeon General, visit our News Room at Policy Watch: News on relevant state and local activities
New York Governor Paterson Signed the Nursing Quality Protection Act Governor Paterson (D-NY) signed legislation that requires hospitals to disclose quality indicators such as staffing ratios, medication errors, and patient problems. “I am proud that New York State is leading the charge to insure our citizens and I am pleased that we are holding hospitals accountable to provide our patients with qualified nursing care” said the Governor.

Governor Schwarzenegger Signs Legislation to Keep Kids Enrolled in California’s Healthy Families ProgramGovernor Schwarzenegger (R-CA) signed legislation by Assembly Speaker Karen Bass (D-CA) which ensures continued health insurance coverage of over 600,000 children through the Healthy Families Program, and allows the program to be open for new enrollment. The Healthy Families Program is a state sponsored health insurance program that provides coverage for low-income children who would otherwise not be covered.

email us any relevant stories from your community or state to be included in future editions of policy watch.
Legislative Update Conference Call
Join APHA’s Government Relations staff for a conference call to review the October Legislative Update and give you an opportunity to ask questions and share information about public health legislation in your state. The call will be held on Tuesday, October 13, 2009 at 1:00pm (EST). The call-in number is (800) 442-5794; passcode is 141930. Any problems with the call-in number should be directed to customer service at (877) 807-0970.
Legislation Alerts Online

Please visit our Take Action page at to send a letter to your Congressional representatives urging their support for the APHA Agenda for Health Reform, adequately fund public health agencies, support public health in climate change legislation, and more. Help APHA influence lawmakers to make public health a priority this year.

Contact * APHA Home
APHA 800 I Street NW, Washington DC 20001
202-777-APHA (tel) * 202-777-2534 (fax)

Get involved with Open Access Week 2009

Open Access Week takes place October 19th-23rd with the aim of broadening awareness of open access around the world. A range of activities are planned including webinars, workshops, competitions and panel discussions. BioMed Central will be involved in several events, including participating in a live webcast run by OASPA 'Open Access publisher Q&A' on Tuesday 20th October alongside PLoS and Nature Publishing Group.

Read our blog item to find out more and learn how you can get involved

Comments: Open access to journals is awesome. Get involved. DM


...Prophylactic administration of either of either granisetron, ondansetron,
midazolam combined with dexamethasone markedly decreases the incidence of PONV following strabismus surgery in pediatrics. All combinations are equally effective.

Comments: Full text of article available by clicking title above. DM

Occupational Therapy Home Programs for Cerebral Palsy: Double-Blind, Randomized, Controlled Trial

...Pediatricians can advise families that OTHPs developed with a collaborative, evidence-based approach and implemented by parents at home were clinically effective if implemented 17.5 times per month for an average of 16.5 minutes per session. ...

Eating liquorice in pregnancy may affect a child's IQ and behavior

...Expectant mothers who eat excessive quantities of liquorice during pregnancy could adversely affect their child's intelligence and behaviour, a study has shown.
A study of eight year old children whose mothers ate large amounts of liquorice when pregnant found they did not perform as well as other youngsters in cognitive tests.
They were also more likely to have poor attention spans and show disruptive behaviour such as ADHD (attention deficit hyperactivity disorder).....

Comment: The did not define "excessive quantities" of liquorice. DM

Los Angeles Fast-food Restaurant Ban Unlikely To Cut Obesity

... Restrictions on fast-food chain restaurants in South Los Angeles are not addressing the main differences between neighborhood food environments and are unlikely to improve the diet of residents or reduce obesity, according to a new RAND Corporation study....

Comments: Will government quit telling what I can or cannot eat! I need to make some decisions on my own! DM

Great Wine! Great Food!

I have another blog, where upon occasion I will tell folks in the Chicago area about music, art, photography and restaurants that I happen to be involved in...I went to a wine tasting where the Wine Master (he had a PhD) came all the way from California gave presentations on 5 wines, after which the gourmet chef tolds us about the meal we were about to consume with the wine. Click on the title above to learn more. DM

Wednesday, October 7, 2009

American Academy of Optometry Meeting: Be There!

There are thousands of reasons to attend this years American Academy of Optometry meeting in Orlando. I hope that one of them is that the AAO was kind enough to allow me to present a lecture on Neuro-plasticity that is relevant for optometrists. It seems as if optometry and ophthalmology are the only 2 professions in the world who have not yet applied the concepts of neuro-plasticity to patient care....hopefull, my presentation and others on this topic will rectify that problem!! Click on the title above to learn more. DM

Tuesday, October 6, 2009

Vision Screening: Have your voice heard!

AHRQ is offering an opportunity for public comment on the U.S. Preventive Services Task Force draft recommendation on vision screening in children ages 1 to 5 years. To provide comments, please go to and follow the directions for submitting comments. The public comment period is open until October 23, 2009. This public comment is part of an effort to increase the transparency of the methods and processes of the Task Force.

Additional information about the evidence-based recommendations of the Task Force and AHRQ’s work to improve the delivery of effective clinical preventive services is available at:
You are subscribed to AHRQ Prevention Program Updates for Agency for Healthcare Research and Quality (AHRQ). This information has recently been updated, and is now available.

Comments: Please, if you do this, let AHRQ know that vision screenings are inadequate for America's children. Comprehensive examinations are a must. Tell them that the research on vision screening is so poor that the authors of at least one study couldn't determine if vision screenings do what they are supposed to do or not!
Effectiveness of screening preschool children for amblyopia: a systematic review
Their conclusion was "Population based preschool vision screening programmes cannot be sufficiently assessed by the literature currently available. However, it is most likely that the present systematic review contains the most detailed description of the main limitations in current available literature evaluating these programmes. Therefore, future research work should be guided by the findings of this publication. DM

Monday, October 5, 2009

Prevalence of Parent-Reported Diagnosis of Autism Spectrum Disorder Among Children in the US, 2007

Here is the full text of the article.

OBJECTIVES: The reported increasing prevalence of autism spectrum
disorder (ASD) and attendant health and family impact make monitoring
of ASD prevalence a public health priority.

METHODS: The prevalence of parent-reported diagnosis of ASD among
US children aged 3 to 17 years was estimated from the 2007 National
Survey of Children’s Health (sample size: 78 037). A child was considered
to have ASD if a parent/guardian reported that a doctor or other
health care provider had ever said that the child had ASD and that the
child currently had the condition. The point-prevalence for ASD was
calculated for those children meeting both criteria. We examined sociodemographic
factors associated with current ASD and with a past
(but not current) ASD diagnosis. The health care experiences for children
in both ASD groups were explored.

RESULTS: The weighted current ASD point-prevalence was 110 per
10,000. We estimate that 673,000 US children have ASD. Odds of having
ASD were 4 times as large for boys than girls. Non-Hispanic (NH) black
and multiracial children had lower odds of ASD than NH white children.
Nearly 40% of those ever diagnosed with ASD did not currently have the
condition; NH black children were more likely than NH white children to
not have current ASD. Children in both ASD groups were less likely than
children without ASD to receive care within a medical home.

CONCLUSIONS: The observed point-prevalence is higher than previous
US estimates. More inclusive survey questions, increased population
awareness, and improved screening and identification by providers
may partly explain this finding. Pediatrics 2009;124:000DM

Comments: Be very careful how you interpret this research. I believe the design flaws inherent in such research has a tendency to over predict the outcome. DM

2 government studies find autism disorders in 1 in 100 U.S. children

Two new government studies indicate about 1 in 100 American children have autism disorders — higher than a previous U.S. estimate of 1 in 150.
Greater awareness, broader definitions and spotting autism in younger children may explain some of the increase, federal health officials said.
“The concern here is that buried in these numbers is a true increase,” said Dr. Thomas Insel, director of the National Institute of Mental Health. “We’re going to have to think very hard about what we’re going to do for the 1 in 100.”

Long term vision outcomes of conventional treatment of strabismic and anisometropic functional amblyopia.

Garoufalis P, Georgievski Z, Koklanis K. Long term vision outcomes of conventional treatment of strabismic and anisometropic functional amblyopia. Binocul Vis Strabismus Q. 2007;22(1):49-56.

Visual acuity was relatively stable over a mean followup period of 6.6 years. The treatment outcome and the success of amblyopia treatment were found to be irrelevant to long term stability of visual acuity. These findings suggest that amblyopia treatment mostly results in a lasting improvement in visual acuity, and that both unsuccessfully and successfully treated individuals maintain their visual acuity improvement achieved during treatment.

Long-term visual function outcomes of congenital cataract surgery with intraocular lens implantation in children under 5 years of age

Hussin HM, Markham R. Long-term visual function outcomes of congenital cataract surgery with intraocular lens implantation in children under 5 years of age.Eur J Ophthalmol. 2009 Sep-Oct;19(5):754-61.

Mean final best-corrected visual acuity for the bilateral group was 0.57 logMAR (range 0.18 -1.06) and for the unilateral group 0.91 logMAR (range 0.18 -1.40). Nystagmus was recorded in 10 children (56%) of the bilateral group and 5 children (23%) of the unilateral group. Strabismus was recorded in 14 children (78%) of the bilateral group and 19 children (86%) of the unilateral group. Glaucoma was diagnosed in one child. There was a significant myopic shift in the unilateral group.

Reasonably good postoperative visual acuity was achieved in the bilateral cataracts group, but relatively poor acuity in the unilateral cataract group. Poor stereopsis was recorded in both groups. One child developed glaucoma. None of the children developed retinal detachment. The expected myopic shift in the unilateral group compared with the bilateral group was demonstrated. Elective primary capsulotomy and elective anterior vitrectomy are mandatory to keep a clear visual axis.

Clinical Findings and Surgical Results of Duane Retraction Syndrome

Altinas AG, Arifoglu HB, Arikan M, Simsek S Clinical Findings and Surgical Results of Duane Retraction Syndrome J Pediatr Ophthalmol Strabismus. 2009 Oct 2:1-7. doi: 10.3928/01913913-20090918-02.

PURPOSE:To evaluate clinical properties and surgical outcomes of Duane retraction syndrome (DRS). METHODS:Twenty-one patients with DRS were evaluated. Surgery was indicated for correction of strabismus, abnormal head position, upshoot-downshoot, and globe retraction. Six patients had undergone surgery. In 5 cases, the lateral rectus muscle was recessed from 4.0 to 7.0 mm combined with "Y-splitting" according to deviation in primary position and degree of globe retraction. In case of a significantly positive forced duction test on the medial rectus muscle intraoperatively, simultaneous recession of the ipsilateral medial rectus muscle was performed in addition to lateral rectus surgery. RESULTS:Type I DRS was diagnosed in 83.33% of cases. All 6 cases that underwent surgery had type I DRS. After surgery, all patients showed elimination of upshoot-down-shoot. Two cases had minimally improved abduction from the midline. Case 1 underwent a second operation and it was observed that the middle split part disappeared and muscular fibers proliferated to the original insertion. To protect against refusion of the middle split part of the muscle due to proliferation, nonabsorbable separation sutures were placed around the split parts of the upper and lower halves without scleral fixation. Separation sutures were placed on both parts of the muscle to protect refusion in the other cases. CONCLUSION:Y-splitting combined with recession of one or both horizontal recti is an effective procedure in patients with DRS and associated horizontal deviation. Prophylactic separation sutures as part of Y-splitting may protect against recurrence. Copyright 2009, SLACK Incorporated.

Data indicate more than one million premature babies die within first month of life

From AOA First Look:

USA Today (10/5, Szabo) reports, "More than one million babies die each year" within a month of birth "because they're born too soon, according to the first" study to evaluate "the global burden of premature births." Each year, according to the March of Dimes, "about 13 million babies" -- approximately "10 percent of all newborns -- are born prematurely," being born before 37 weeks of gestation.
According to the
Washington Post (10/5, Brown), "rates and causes of preterm birth vary widely by region." For instance, "Africa has the highest rate (11.9 percent), followed by North America (10.6 percent) and Asia (9.1 percent). Latin America and the Caribbean are midrange (8.1 percent), and Australia and New Zealand (6.4 percent) and Europe (6.2 percent) are the lowest." Although "little is known about the causes of prematurity in the developing world," its been said that "malnutrition, coexisting illnesses, such as malaria and anemia, and inadequate prenatal care are likely factors." As for the US, "where the rate of preterm birth has increased 36 percent in the last quarter-century," the surge of "older women having babies and reproductive techniques" that make "multiples more likely are probably contributing to the trend."
Cesarean sections, "which are now the most common surgical procedure for women," have also been implicated, the
Los Angeles Times (10/4, Maugh) "Booster Shots" blog reported. "Poor nutrition and low bodyweight; pre-existing medical conditions, such as diabetes and high blood pressure," as well as "alcohol and tobacco use and secondhand smoke" are also being blamed for the increase.
What's more, "sophisticated neonatal intensive-care units" have produced "headlines about miracle babies" that lead, the
AP (10/5) notes, "to a false sense that modern medicine conquers prematurity -- without acknowledging lifelong problems including cerebral palsy, blindness, and learning disabilities that often plague survivors."
At present, "there is no reliable way to prevent or delay preterm birth,"
HealthDay (10/4, Preidt) pointed out. Accordingly, "the annual cost of caring for preterm babies and their associated health problems is more than $26 billion a year," the authors noted in their study, titled Global and Regional Toll of Preterm Birth, which used data "from the recently published Bulletin of the World Health Organization." AFP (10/5) also covers the story.

CDC says H1N1 "widespread" in 27 states.

From AOA First Look:

NBC Nightly News (10/2, story 7, 0:20, Williams) reported that the "latest numbers out from the Center for Disease Control indicate what we have been saying here night after night: swine flu is spreading rapidly over the country. The CDC reporting there's widespread flu activity in 27 states now."
Physicians debate safety concerns of swine flu vaccine. ABC World News (10/4, story 8, 2:15, Harris) reported that as the swine flu vaccine becomes available to Americans in a record-setting influenza vaccination campaign, "the most challenging part...may be convincing enough Americans to actually get vaccinated." In fact, data indicate that around 40 percent of parents who are hesitant to have their children vaccinated. Dr. Ira Rubin, a pediatrician, stated, "We don't know how well this works. We don't know how long it'll last. We have a lot of unknowns." Meanwhile, Dr. William Schaffner, of the Vanderbilt University School of Medicine, said that "we're very secure about how it was produced and how it was tested."
On the CBS Evening News (10/4, story 5, 1:30, Mitchell), medical correspondent Jon LaPook, MD, reported that there were "no shortcuts" in manufacturing the swine flu vaccine, according to his sources at the CDC. Some people, Dr. LaPook said, "think this is some kind of an experimental, brand-new vaccine. And it isn't." It "is being made the exact same way that the regular seasonal flu vaccine is." Getting the vaccine, therefore, is "a no-brainer for health professionals," he added.
Bloomberg News (10/4, Randall) reported that CDC director Dr. Thomas Frieden stated that the swine flu vaccine is being made "with the same ingredients, dose and manufacturing process as the seasonal influenza vaccine given to 100 million Americans each year."
St. Petersburg Times (10/5, Martin) attributes some Americans' hesitation over the vaccine to the spread of "myths," including that "you can actually get the flu from the flu shot." Frieden said, however, that "there's no way" a person can acquire the flu from the vaccine.
Polls find US public ambivalent about H1N1 vaccine.
AFP (10/4, Santini) reported, "US health authorities on Friday announced plans for a massive vaccination campaign intended to protect millions of Americans" from H1N1 influenza, with the "first distribution of 600,000 vaccine doses set for Tuesday, two weeks ahead of schedule." The US "expects to quickly dispense some six- or seven-million doses and hopes to administer 250-million doses by the end of the year. ... The first vaccine doses are being made available in the form of nasal sprays that take effect in about eight days."
According to the
Washington Post (10/4, Stein), however, several surveys suggest the American "public is decidedly ambivalent." For example, a poll of 1,042 adults released Friday by the Harvard School of Public Health "found that only 40 percent were sure they would receive the vaccine"; only about 50 percent "were certain their children would"; and only "13 percent" thought the vaccine was "safe for pregnant women." Other recent polls showed "similar results."
Healthcare workers object to mandatory flu shots. The CBS Evening News (10/4, story 4, 2:10, Mitchell) reported that some healthcare workers have taken issue with mandatory vaccinations imposed by their employers, as well as by the government of New York on all of the state's healthcare workers. Dr. Richard Daines, New York State commissioner of health, said it was "kind of intolerable that patients should come to the hospital and not know that the healthcare workers are vaccinated." Meanwhile, Carole Blueweiss, a New York physical therapist, said the mandate was " feels criminal and it feels anti-American."

AOA Clinical Practice Guidelines Pediatrics/BV/VIP

Pediatric Eye and Vision Examination

(CPG2) 1994 2nd Edition 2002 Reviewed 2007

Care of Patient with Amblyopia (CPG4)

1994 Revised 1998 Reviewed 2004

Care of the Patient with Strabismus: Esotropia and Exotropia (CPG12)

1995 Revised 1999 Reviewed 2004

Care of the Patient with Accommodative and Vergence Dysfunction (CPG18)

1998 Revised 2008

Care of the Patient with Learning Related Vision Problems (CPG20)

2000 Revised 2008