Health - 18 and Under: Fixated by Screens, but Seemingly Nothing Else

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• 18 and Under: Fixated by Screens, but Seemingly Nothing Else
• Hazy Recall as a Signal Foretelling Depression
• Global Update: Infant Deaths Drop After Midwives Undergo Inexpensive Training
• Researchers Employ New Test to Estimate Concussion Risk for Helmets
• Cases: Caring for an Ill Spouse, and for Other Caregivers
• Antipsychotic Drugs Called Hazardous for the Elderly
• Census Data Reveals a Shift in Patterns of Childbearing
• Vital Signs: Regimens: Looking Twice at Supplements for Infants
• Vital Signs: Screening: New Threat Rises Between Mammograms
• Vital Signs: Risks: Busy Business Traveler? Carry a Pharmacy
• Recipes for Health: Asparagus With Green Garlic
• Well: Lower Stress Improves Fertility Treatment
• Well: Local Honey for a Runny Nose
• Well: Attention Problems, Except for Screens
• Well: Belittling the Nurse
• Personal Health: ‘Disease of Kings’ Trickles Down to the Rest
• Really?: Eating Local Honey Cures Allergies
• The New Old Age: Antipsychotics Overused in Nursing Homes, Audit Finds
• The New Old Age: Dementia and Feeding Tubes
• Letters: War’s Legacy (1 Letter)
• Letters: Offering Lost Words (1 Letter)
• Letters: Tonsils and Weight (1 Letter)
• Ruling Clears New York State to Tax Tribes’ Cigarette Sales
• Battle Over Health Care Law Shifts to Federal Appellate Courts
• Study in Korea Puts Autism’s Prevalence at 2.6%, Surprising Experts
• Recipes for Health: Whole Wheat Spaghetti With Green Garlic and Chicory
• Recipes for Health: A Lighter, Lovelier Garlic

18 and Under: Fixated by Screens, but Seemingly Nothing Else Posted: 10 May 2011 11:33 AM PDT The mother had brought in a note from her son’s elementary school teacher: Dear doctor, I think this child needs to be tested for attention deficit disorder. Enlarge This Image Ellen Weinstein Well Share your thoughts on this column at the Well blog. Go to Well » Multimedia Interactive Feature Patient Voices: A.D.H.D. Related Health Guide: ADHD “She’s worried about how he can’t sit still in school and do his work,” the mother said. “He’s always getting into trouble.” But then she brightened. “But he can’t have attention deficit, I know that.” Why? Her son could sit for hours concentrating on video games, it turned out, so she was certain there was nothing wrong with his attention span. It’s an assertion I’ve heard many times when a child has attention problems. Sometimes parents make the same point about television: My child can sit and watch for hours — he can’t have A.D.H.D. In fact, a child’s ability to stay focused on a screen, though not anywhere else, is actually characteristic of attention deficit hyperactivity disorder. There are complex behavioral and neurological connections linking screens and attention, and many experts believe that these children do spend more time playing video games and watching television than their peers. But is a child’s fascination with the screen a cause or an effect of attention problems — or both? It’s a complicated question that researchers are still struggling to tease out. The kind of concentration that children bring to video games and television is not the kind they need to thrive in school or elsewhere in real life, according to Dr. Christopher Lucas, associate professor of child psychiatry at New York University School of Medicine. “It’s not sustained attention in the absence of rewards,” he said. “It’s sustained attention with frequent intermittent rewards.” The child may be playing for points accumulated, or levels achieved, but the brain’s reward may be the release of the neurotransmitter dopamine. Children with A.D.H.D. may find video games even more gratifying than other children do because their dopamine reward circuitry may be otherwise deficient. Indeed, at least one study has found that when children with A.D.H.D. were treated with methylphenidate (Ritalin), which increases dopamine activity in the brain, they played video games less. The authors suggested that video games might serve as a kind of self-medication for these children. So increased screen time may be a consequence of A.D.H.D., but some researchers fear it may be a cause, as well. Some studies have found that children who spend more time in front of the screen are more likely to develop attention problems later on. In a 2010 study in the journal Pediatrics, viewing more television and playing more video games were associated with subsequent attention problems in both schoolchildren and college undergraduates. The stimulation that video games provide “is really about the pacing, how fast the scene changes per minute,” said Dr. Dimitri Christakis , a pediatrician at the University of Washington School of Medicine who studies children and media. If a child’s brain gets habituated to that pace and to the extreme alertness needed to keep responding and winning, he said, the child ultimately may “find the realities of the world underwhelming, understimulating.” But a 2007 study in the journal Media Psychology compared television watching in a group of children diagnosed with A.D.H.D. and a group without. The researchers concluded that most differences were accounted for by family factors and environment, including whether the children had televisions in their bedrooms. A.D.H.D. by itself didn’t seem to make the difference. The connections between A.D.H.D. and screens, the authors concluded, were complex. Elizabeth Lorch, a professor of psychology at the University of Kentucky and one of the authors of that study, also studied children’s ability to comprehend televised stories. While children with A.D.H.D. were able to recall facts from the stories they watched just as well as other children, there was a difference in their ability to understand the narrative and to separate out what was important. “Why did an event happen, why did a character do this — that’s where the comprehension and recall of children with A.D.H.D. tends to fall down,” she said. Her co-author Richard Milich, also a professor of psychology at the University of Kentucky, suggested that besides the primary implications of this problem for academic performance, this finding may also shed light on social difficulties. “This inability to see causal relations may affect this social problem we’ve known for 30 years,” he said. “These kids have dramatic social problems. They’re highly rejected by their peers.” It may be a self-perpetuating loop, experts say: Children who have trouble with their social skills may be thrown back even more to the screen for electronic companionship. Children whose brains need neurochemical rewards seek out an activity that provides it. Children with social problems spend more time alone, facing a screen. Children struggling in the classroom develop mastery in a virtual world. I talk to parents of children with A.D.H.D. about basic dos and don’ts: No screens in the child’s bedroom. Pay attention to the content of the games, especially to violence. Set limits on screen time, and look for other ways to manage family interactions. If I can’t tell parents what they hope to hear, at least I can argue that these children’s fascination with the glowing screen may teach us something about their brains, the neurobiology, the rewards, and even the yearning and learning.

Hazy Recall as a Signal Foretelling Depression Posted: 10 May 2011 11:37 AM PDT OXFORD, England — The task given to participants in an Oxford University depression study sounds straightforward. After investigators read them a cue word, they have 30 seconds to recount a single specific memory, meaning an event that lasted less than one day. Related Health Guide: Major Depression Cues may be positive (“loved”), negative (“heartless”) or neutral (“green”). For “rejected,” one participant answered, “A few weeks ago, I had a meeting with my boss, and my ideas were rejected.” Another said, “My brothers are always talking about going on holiday without me.” The second answer was wrong — it is not specific, and it refers to something that took place on several occasions. But in studies under way at Oxford and elsewhere, scientists are looking to such failures to gain new insights into the diagnosis and treatment of depression. They are focusing not on what people remember, but how. The phenomenon is called overgeneral memory, a tendency to recall past events in a broad, vague manner. “It’s an unsung vulnerability factor for unhelpful reactions when things go wrong in life,” said Mark Williams, the clinical psychologist who has been leading the Oxford studies. Some forgetting is essential for healthy functioning — “If you’re trying to remember where you parked the car at the supermarket, it would be disastrous if all other times you parked the car at the supermarket came to mind,” said Martin Conway, a cognitive psychologist at the University of Leeds in England. But, a chronic tendency to obliterate details has been linked to longer and more intense episodes of depression. Now researchers at Oxford, Northwestern University in Illinois and other universities are conducting studies with thousands of teenagers to determine whether those with overgeneral memory are more likely to develop depression later on. If so, then a seemingly innocuous quirk of memory could help foretell whether someone will experience mental illness. “Based on everything we know of memory specificity and depression, there’s a good chance we will find these effects,” said Dirk Hermans, a research psychologist at the University of Leuven in Belgium who collaborates with Dr. Williams. There are already some clues in this direction. In lab experiments Dr. Williams has induced an overgeneral style in subjects by coaching them to recall types of events (“when I drive to work”) rather than specific occasions (“when I drove to work last Saturday”). He found they were suddenly less able to solve problems, suggesting that overgeneral memory is capable of producing one symptom of depression. And an unusual paper suggests that overgeneral memory is a risk factor for post-traumatic stress disorder. Scientists at the University of New South Wales in Sydney, Australia, assessed 46 firefighters during their initial training and again four years later, when all had experienced traumatic events like seeing comrades injured or killed. Those who could not recall the past in specific detail during the first assessment were much likelier to have developed the disorder by the later one. “People with P.T.S.D. tend to ruminate at a very categorical, general level about how unsafe life is, or how weak I am, or how guilty I am,” said the lead author, Richard Bryant. “If I do that habitually and then I walk into a trauma, probably I’m going to be resorting to that way of thinking and it’s going to set me up for developing P.T.S.D.” Dr. Williams stumbled across overgeneral memory by chance in the 1980s. He had asked research subjects to write down the memories elicited by certain cues, and when they left the page blank he thought he had given unclear instructions. Soon he began to wonder about the significance of the omissions. Usually people seeking a particular memory traverse a mental hierarchy, Dr. Williams said. They begin by focusing on a general description (“playing ball with my brother”) and then narrow the search to a specific event (“last Thanksgiving”). Some people stop searching at the level of generality, however and are probably not conscious of having done so. This is sometimes a helpful response, which is perhaps why overgeneral memory exists in the first place — it can be a useful way to block particular traumatic or painful memories. Researchers at Leuven discovered that students who did poorly on exams and were more specific took longer to recover from the disappointment than those who were more general. The overgeneral students thought less about the details of what happened and so fared better, at least in the short term. Similarly, overgenerality has been found to be prevalent in Bosnian and Serbian teenagers exposed to the traumas of war. “Some people will discover at a certain stage that being overgeneral is a way of dampening emotional effects,” Dr. Hermans said. But these researchers say problems can arise when overgenerality becomes an inflexible, blanket style. Without detailed memories to draw upon, dispelling a black mood can seem impossible. Patients may remember once having felt happy, but cannot recall specific things that contributed to their happiness, like visiting friends or a favorite restaurant. “If you’re unhappy and you want to be happy, it’s helpful to have memories that you can navigate through to come up with specific solutions,” Dr. Williams said. “It’s like a safety net.” Some experts think such insights could also be helpful in treating depression. For example, Spanish researchers have reported that aging patients showed fewer symptoms of depression and hopelessness after they practiced techniques for retrieving detailed memories. “When we have a disorder like depression, which is so common and so disabling for so many people, we need to increase the tools in our tool kit,” said Susan Mineka, a clinical psychologist working on a study by Northwestern University and the University of California, Los Angeles, that is testing for depression and anxiety risk factors, including overgeneral memory. “If we could change their overgeneral memory, maybe that would help even more people stay better for longer.” Dr. Williams has found that specificity can be increased with training in mindfulness, a form of meditation increasingly popular in combating some types of depression. Subjects are taught to focus on moment-to-moment experiences and to accept their negative thoughts rather than trying to avoid them. It may help by making people more tolerant of negative memories and short-circuit the impulse to escape them, which can lead to overgenerality. Meditation means that for some, the past is no longer such a heavy burden. “I always tried to forget the past, the very bad past that made me depressed when my husband died,” said Carol Cattley, 76, who attended a mindfulness course here taught by Dr. Williams. “I’m much more interested in it now.” This posting includes an audio/video/photo media file: Download Now

Global Update: Infant Deaths Drop After Midwives Undergo Inexpensive Training Posted: 09 May 2011 08:20 PM PDT Giving midwives simple training has already been shown to save newborns’ lives, and a new study in Zambia has found that it can be remarkably cost-effective as well. Even a small pilot project costing only $20,244 saved the lives of 97 infants, the authors estimated, meaning that it cost just $208 per life saved. The study, published online in April in the journal Pediatrics, was paid for by the National Institutes of Health and the Bill and Melinda Gates Foundation, and conducted by American and Zambian university and government doctors. Midwives from 18 Zambian clinics were taught a basic course in newborn care and encouraged to teach their colleagues as well. The course covers simple interventions like cleaning and warming a newborn, resuscitation, breast-feeding and diagnosing common illnesses. (Above, a birth attendant listened for a baby’s heartbeat with a clay stethoscope.) The midwives normally handled births that were expected to be uncomplicated, with women typically going home with their babies after one night in the clinic. The researchers compared survival rates among 20,000 babies born before the teaching and 20,000 afterward. The first-week death rate among babies had dropped by almost half, they found, to 6.8 deaths per 1,000 live births from 11.5 deaths. Past studies have suggested that the single most important aspect of training, in terms of saving lives, is to teach midwives that an infant who is not breathing at birth can be revived with quick action — by massaging to prompt it to inhale, or using a simple resuscitator.

Researchers Employ New Test to Estimate Concussion Risk for Helmets Posted: 09 May 2011 11:09 PM PDT Football equipment managers nationwide will receive yet another reason to reassess their helmet inventory on Tuesday, when a Virginia Tech research report reveals that two models popular among teenagers might be allowing high rates of concussions. Enlarge This Image Jeff Beyer/Virginia Tech From left, Ray Daniel, Steve Rowson and Stefan Duma testing helmets at Virginia Tech. The data becomes public Tuesday. The latest news, notes and analysis of the N.F.L. playoffs. Go to The Fifth Down Blog N.F.L. Live Scoreboard Standings Stats | Injuries Giants Schedule/Results Stats | Roster Depth Chart Jets Schedule/Results Stats | Roster Depth Chart The Riddell VSR-4, a recently discontinued model still worn by about 75,000 high school and college players, and the Adams A2000, a less prevalent helmet now available for purchase, were the lowest-ranked models in a new testing regimen designed to estimate concussion risk. The full results were to appear on a Virginia Tech Web site as the first publicly available objective data on football helmet performance. Industry experts have various degrees of concern about the reliability of the system, but the researchers said they were trying to pull the curtain back on the mysteries of helmet performance. Recent concerns about industry testing standards and specific companies’ advertising has led to an investigation by the United States Consumer Product Safety Commission and possibly the Federal Trade Commission. “Currently, if you go to buy a helmet, all you’re looking at are aesthetics and price, and whatever the manufacturer tells you to try to convince you it’s good,” said Stefan Duma, Virginia Tech’s lead biomedical engineer on the project. “We wanted to develop a system to quantify which helmets perform better specifically with risk of concussion.” The only standardized test on helmets today assesses whether a helmet might allow a skull fracture, not a less serious injury like a concussion. It is overseen by the National Operating Committee on Standards for Athletic Equipment, a volunteer group that includes manufacturers and other interested parties. Riddell’s Revolution Speed model earned a five-star rating on the Virginia Tech scale, followed by five four-star helmets made by Riddell, Schutt and Xenith. Only helmets designed for players of high school age and older were examined. “For example, half our team is in the VSR-4 — and there is a significant reduction in concussion risk in newer helmets, so by fall ball we’re going to be in new ones,” Duma said of the Virginia Tech football team. A prominent college program having used outdated helmets would indicate how rural high schools might be affording players inferior protection. Virginia Tech has for eight years had players at college programs nationwide wear helmets outfitted with accelerometers to track the number and severity of hits to the head, as well as documented concussions. That data indicates, for example, how a side impact that results in 100 g’s of force reaching the skull leads to a diagnosed concussion 1 percent of the time. Helmet models were drop-tested from five heights to assess how much force they allow to reach the skull; the lower that force, the lower the risk of concussion, and the better the helmet scored. The methodology has been peer reviewed and accepted for publication by the Annals of Biomedical Engineering. As an example of the use of his system, Duma said, “You can cut your risk of concussion 55 percent by switching from the VSR-4 to the Xenith X1.” Critics have cited several limitations of Virginia Tech’s approach. It does not consider rotational forces believed to cause a substantial number of concussions. The data collection from players came through helmets designed by Riddell, perhaps skewing results. Additionally, only some concussions get reported, so the injury’s true prevalence remains too much of a mystery to justify such exact statements. “I’m unmoved by this information, and I would say that no matter how our helmet was ranked,” said Xenith’s chief executive, Vin Ferrara, whose X1 model was ranked among the most protective available. “We find this type of ranking concept to be detrimental to consumer understanding and detrimental to the development of superior helmets.” Schutt said in a statement: “We have not seen any relationship between testing results and the accurate prediction of what is happening on the field. There are many questions to be asked about this testing.” Adams’s chief executive, David Wright, did not respond to requests for comment regarding the company’s A2000 helmet. Riddell’s Dan Arment praised Virginia Tech for affirming performance differences between helmet models; as for the company’s low-performing VSR-4, he said users could trade in that helmet and receive $50 off a Revolution model. Helmet companies have for years agreed among themselves not to disclose this type of testing data to the public because of how it can be misinterpreted. This has led to spurious advertising claims and other practices currently under government examination. Duma said the public needed an independent compass to make more educated decisions on football head protection. He also emphasized how even the best head protection can still allow injuries like concussions and that individual athletes’ risks can vary because of genetic differences and prior injuries.

Cases: Caring for an Ill Spouse, and for Other Caregivers Posted: 09 May 2011 09:40 PM PDT Monday morning can be a downer, but for the dozen women and men in our support group, it’s a highlight of our week. That’s when we gather to speak candidly of what is unspeakable in polite society or even among closest friends and family. Enlarge This Image James Steinberg Multimedia Interactive Feature Patient Voices: Alzheimer's Disease Related Health Guides: Alzheimer's Disease | Dementia We are the spouses or partners of people with dementia, an umbrella term for several degenerative, fatal brain diseases, of which Alzheimer’s is by far the most common. We are their primary caregivers; their lives depend on us. Living with someone with dementia, who must be watched every minute, eventually becomes the central focus of a caregiver’s life, as independence and freedom are replaced by stress and exhaustion. The members of our group, mostly in their 80s, are worn out by caring for their mates. Yet so lively are our Monday meetings that it sometimes takes two volunteer social workers to keep order: “Wait! Wait! One person at a time!” Often down or drained when we assemble, we part after 90 minutes buoyed and energized, week after week, year after year. (For me, four years and counting.) Not even a spouse’s death keeps members away; a year after the funeral, our widows and widowers must be prodded to make way for those waiting to join. According to the Alzheimer’s Association, there are 15 million family members and friends providing unpaid care to people with dementia; hundreds of thousands of them meet regularly in support groups like ours to exchange information and understanding available nowhere else. Because science understands so little about dementia, we are the experts. (To find a caregiver support group, contact the Alzheimer’s Association, your local hospital or the Well Spouse Association, a nationwide group for people caring for spouses or partners.) Our collective experience is a priceless resource. At a basic level, we exchange advice for keeping our partners from wandering off and techniques for bathing, calming and medicating them. We discuss ways to handle their hallucinations and incontinence, the mere mention of which often spooks outsiders. We share advice on what to tell the police, and what not to tell them, to keep them from hauling our sometimes violent mates to a psychiatric ward. But our group’s deepest value lies beyond such practical matters. We speak of feelings and problems too sensitive or fraught to discuss outside. We recount the disappearance of old friends, whose discomfort around our spouses keeps them away. We mourn the loss of companionship and sex. We guiltily admit to bouts of irrepressible anger in face of the intransigence and aggression typical of dementia. We speak about our children and stepchildren — some attentive and devoted, some interfering or remote. And knowing that dementia is a terminal disease, together we contemplate death — our spouses’ and our own. When should we refuse treatments or call in hospice? What will become of our loved ones if we die first? How will we manage our own final years as we rapidly exhaust our resources? These are deeply personal, in some ways political questions that science cannot answer. One retired schoolteacher among us recalls that she was once too proud, shy and overwhelmed to consider joining a support group. (Me too.) But after tentatively trying out our group in desperation, she stayed for a decade. Her first reward was the group’s urging that she find outside help to provide some relief. Then, over the years, the group was her sounding board when her husband became violent, emerged from a hospitalization unable to walk, lost his powers of speech, could no longer feed himself. As he approached the end, she asked the group to ponder with her whether to have a feeding tube inserted into his stomach. After he died, she joined a bereavement group, then flew to Paris for a week. But when she returned, it was to our group — people who understood her and to whom she still had valuable knowledge to convey. Since I joined it, our group has had an 80 percent turnover, mainly through death. Though our members have ranged from liberal to conservative and from financially secure to dependent on Medicaid, the distinctions that matter most are how long ago we received the dread diagnosis and what problems we are dealing with now. With doctors unable to help us and Medicare reimbursement largely off limits, we turn to each other to learn what lies ahead as each of us descends the steps toward widowhood. Such grim knowledge occasionally causes a newcomer to bolt. But for those who remain, our support group is our lifeline. When the last Congress unanimously endorsed a comprehensive plan to combat Alzheimer’s disease, the lawmakers named improved caregiving as a major goal. If they are serious, they will vigorously promote support groups like ours and take advantage of our collective, hard-won experience. Alix Kates Shulman’s most recent book is “To Love What Is: A Marriage Transformed,” a memoir about her husband’s dementia.

Antipsychotic Drugs Called Hazardous for the Elderly Posted: 10 May 2011 09:01 AM PDT Nearly one in seven elderly nursing home residents, nearly all of them with dementia, are given powerful atypical antipsychotic drugs even though the medicines increase the risks of death and are not approved for such treatments, a government audit found. The New Old Age Share your thoughts on this column at The New Old Age blog. Join the discussion » More than half of the antipsychotics paid for by the federal Medicare program in the first half of 2007 were “erroneous,” the audit found, costing the program $116 million for those six months. “Government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek solutions,” Daniel R. Levinson, inspector general of the Department of Health and Human Services, wrote in announcing the audit results. Mr. Levinson noted that such drugs — which include Risperdal, Zyprexa, Seroquel, Abilify and Geodon — are “potentially lethal” to many of the patients getting them and that some drug manufacturers illegally marketed their medicines for these uses “putting profits before safety.” The audit is an unusual assessment by the government of whether doctors are treating Medicare patients appropriately in nursing homes. Mr. Levinson suggested that the government should collect information on the diagnoses given Medicare patients so that the government can assess whether the drugs prescribed to them are appropriate. While common in the private sector, such basic oversight is unheard of in the Medicare program and would almost certainly be opposed by doctors’ groups and many in Congress who view government intrusions into the doctor-patient relationship as inappropriate. In response to the audit, the Centers for Medicare and Medicaid Services said that some of the inappropriate use of antipsychotics in elderly nursing home patients is a result of drug makers’ paying kickbacks to nursing homes to increase prescriptions for the medicines. Omnicare Inc., a pharmacy chain for nursing homes, paid $98 million in November 2009 to settle accusations that it received kickbacks from Johnson & Johnson and other drug makers for antipsychotic prescriptions. Medicare officials said that diagnosis information is not generally included with prescriptions so the government cannot assess in real time whether prescription payments are appropriate. While the Food and Drug Administration has warned doctors that using antipsychotic drugs in elderly patients with dementia increases their risks of death, doctors continue the practice because they have few other good choices, said Dr. Daniel J. Carlat, editor in chief of The Carlat Psychiatry Report, a medical education newsletter for psychiatrists. “Doctors want to maximize quality of life by treating the patient’s agitation even if that means the patient will die a bit sooner,” Dr. Carlat said. The government auditors found that of the 2.1 million elderly patients in nursing homes during the first six months of 2007, 304,983 had at least one Medicare claim for an antipsychotic medicine. Nursing home residents received 20 percent of the 8.5 million claims for antipsychotic medicines for all Medicare beneficiaries at a cost of $309 million during those six months. The auditors found that 83 percent of antipsychotic prescriptions for elderly nursing home residents were for uses not approved by federal drug regulators, and 88 percent were to treat patients with dementia — for whom the drugs can be lethal. “These results are alarming,” said Senator Charles E. Grassley, Republican of Iowa, who asked for the audit. “Medicare officials need to pay attention.” Federal rules require that any drugs that are paid for by the government be given only for uses that are approved either by the government or one of three independent drug usage encyclopedias. Auditors found that 51 percent, or 726,000 of 1.4 million claims, for antipsychotic medicines did not meet this criterion and were thus paid for by the government improperly. Government rules also ban drugs that are used in excessive doses or duration, even if patients are found to have a condition for which the drug is appropriate. Auditors found that 22 percent, or 317,971 of 1.4 million claims, for antipsychotic medicines failed this standard.

Census Data Reveals a Shift in Patterns of Childbearing Posted: 10 May 2011 08:48 AM PDT WASHINGTON — College-educated women are waiting longer to have children than those without a college education, according to new data from the Census Bureau. Related Times Topic: Census In 2000, the portion of women with college degrees between the ages of 25 and 34 who had children was 42 percent, according to the data. Ten years later, the same group of women, now ages 35 to 44 — representing about three million Americans — were far more likely to be mothers: About 76 percent had children, according to the data. In contrast, women who did not finish high school were more likely to have children earlier. In 2000, about 83 percent of women ages 25 to 34 who did not have a high school diploma had children. The percentage rose to 88 percent by 2010. The trend of educated women having children later accelerated in the 1980s, along with the rise in women’s educational attainment, said Andrew J. Cherlin, a demographer at Johns Hopkins University. “College-educated women are following a different path to having children,” Mr. Cherlin said. “They wait until they’ve graduated from college, gotten married and started a career, before having a child.” Childbearing and fertility patterns have changed greatly since the 1970s. There are far more women in their 40s without children now than there were in past decades. In 1976, just 10 percent of all women ages 40 to 44 had no children. That percentage had jumped to 19 percent by 2010. White women in their 40s were more likely to be childless than Hispanics. Just 12 percent of Hispanic women from 40 to 44 were childless, compared with 20 percent of whites, 17 percent of blacks and 16 percent of Asians. In 1976, the earliest year in Monday’s data release, more women had three children than had two, but that has shifted over the years, with far more women having two children than three. And it is more likely for a woman who has never married to have a child now than it was in the 1970s. Just 3 percent of women who had never been married had a child in 1976. Now the number is about 21 percent, up sharply even from 2008, when it was 15 percent. About 55 percent of women who had a child in the last year were in the job market, according to the data: about 34 percent were working full time, 14 percent were working part time, and 7 percent were unemployed.

Vital Signs: Regimens: Looking Twice at Supplements for Infants Posted: 09 May 2011 09:40 PM PDT Nearly one in 10 babies are given supplements or plant-based teas to soothe colic or help with teething during the first year of life, even though the products are unproven and may contain contaminants or spur allergies, a new study says. Related Health Guide: Colic and Crying More Vital Signs Columns The report, published in the journal Pediatrics, is believed to be the first to look at supplements given specifically to infants. The researchers drew data from the Infant Feeding Practices Study II, a survey of women in late pregnancy and through their babies’ first year of life. Conducted by the Food and Drug Administration and the Centers for Disease Control and Prevention from 2005 to 2007, the study included a nationwide sample of 2,653 healthy mothers and newborns. The most common products were chamomile and other teas, teething tablets and “gripe water The most frequently given reasons for using supplements were to help with fussiness, digestion, colic, relaxation and teething. Sara B. Fein, who researches consumer habits at the F.D.A. and is one of the paper’s authors, said mothers may think of dietary botanical supplements as natural and therefore of less concern, even though they may contain biologically active ingredients. “We’re encouraging mothers to be proactive about contacting a physician if they think they should give their child a dietary supplement,” Dr. Fein said.

Vital Signs: Screening: New Threat Rises Between Mammograms Posted: 09 May 2011 09:40 PM PDT Some breast cancers detected between regular screenings were simply missed on the patient’s last mammogram. But a majority found during the interim periods can’t be found on previous scans at all. Related Health Guide: Breast Cancer More Vital Signs Columns Scientists know that both missed tumors and interval cancers tend to be larger and more advanced than tumors detected at regular screenings. Now a new study reports that interval cancers are more aggressive than missed tumors. Previous studies of tumors found between regularly scheduled screenings did not distinguish between actual interval tumors and those which were missed on a previous mammogram, said one of the authors, Anna M. Chiarelli, a senior scientist at Cancer Care Ontario. The study, published May 3 in The Journal of the National Cancer Institute, drew on data from 431,480 women ages 50 and over who were screened biennially between 1994 and 2002 as part of the Ontario Breast Screening Program. The researchers identified 288 true interval cancers and 87 missed interval cancers, and compared them with 450 cancers detected at screening. Interval tumors were biologically different, the researchers found, and were twice as likely to be both estrogen receptor- and progesterone receptor-negative, making them harder to treat. Better screening technology is needed, Dr. Chiarelli said. Until it arrives, she added, women should seek immediate care for cancer symptoms even if they recently had a negative mammogram.

Vital Signs: Risks: Busy Business Traveler? Carry a Pharmacy Posted: 09 May 2011 10:25 PM PDT A new study confirms what many corporate road warriors already know: Frequent business travel takes a toll on one’s health. Related More Vital Signs Columns Catherine A. Richards, a doctoral student in epidemiology at Columbia University, and her colleagues analyzed medical records and travel data on 13,057 patients provided by a company that performs physical exams for corporations. Adults who spent 20 or more nights away from home each month were 2.5 times as likely to rate their health as poor or fair, compared with travelers away from home just one to six nights a month, according to the analysis, which was published in April in The Journal of Occupational and Environmental Medicine. The most frequent travelers were also twice as likely to be obese as those who went out of town infrequently, the researchers found. People who did not travel at all rated themselves as less healthy than light travelers, and they were 33 percent more likely to be obese. But their poor health was probably the reason they didn’t travel, said the study’s authors. Ms. Richards said she hoped the analysis would encourage companies to take steps toward making exercise facilities and healthy food more widely available to business travelers.

Recipes for Health: Asparagus With Green Garlic Posted: 10 May 2011 09:10 AM PDT When you sauté or roast asparagus in hot olive oil, the asparagus will have a much more concentrated flavor than it would if steamed or blanched. Here I add the garlic to the pan once the asparagus is just about done, so that the garlic cooks only long enough to soften and sweeten. Recipes for Health Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. See All Recipes for Health » Visit Recipes for Health on Facebook. Related Recipes for Health: A Lighter, Lovelier Garlic (May 9, 2011) Recipes for Health: Whole Wheat Spaghetti With Green Garlic and Chicory (May 11, 2011) Recipes for Health: Rice Bowl With Spinach or Pea Tendrils (May 12, 2011) Recipes for Health: Beet Greens, Green Garlic and Barley Gratin (May 13, 2011) You can serve this skillet dish with grains or pasta, or with eggs -- fried, poached or scrambled. I find this asparagus so hard to resist that I decided to give you a range for the weight. One pound is adequate, but you might want to treat yourself to more than that. 1 small bulb green garlic that has formed cloves 2 tablespoons extra virgin olive oil 1 to 1 1/2 pounds asparagus, trimmed and cut on the diagonal into 2-inch lengths Salt Freshly ground pepper 1 tablespoon chopped flat-leaf parsley 1. Separate the garlic bulb into cloves, remove the thick skins from each clove, and cut the garlic into thin slices. 2. Heat the olive oil over medium-high heat in a large, heavy skillet. Add the asparagus and salt to taste. Sauté until the asparagus is tender and the skin has shriveled slightly, about five minutes. Add the garlic, and continue to sauté for another minute until the garlic is translucent. Adjust salt, add the pepper and parsley, and serve. Yield: Serves four. Advance preparation: This is best when served right away. Nutritional information per serving: 89 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 0 milligrams cholesterol; 6 grams carbohydrates; 3 grams dietary fiber; 1 milligram sodium (does not include salt to taste); 3 grams protein Variation: Scrambled eggs with green garlic and asparagus: Beat four eggs in a bowl, and add salt and pepper to taste. At the end of cooking, turn the heat down to low and add the eggs to the asparagus. Stir over low heat until the eggs are set but still creamy. Serve at once. Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Well: Lower Stress Improves Fertility Treatment Posted: 10 May 2011 11:32 AM PDT

Well: Local Honey for a Runny Nose Posted: 09 May 2011 01:26 PM PDT

Well: Attention Problems, Except for Screens Posted: 09 May 2011 02:32 PM PDT

Well: Belittling the Nurse Posted: 09 May 2011 02:37 PM PDT

Personal Health: ‘Disease of Kings’ Trickles Down to the Rest Posted: 09 May 2011 08:30 PM PDT A 55-year-old neighbor of mine was awakened in the wee hours of the morning recently with an excruciating pain in his right big toe that rendered him unable to walk. As happens in a classic attack of gout, the onset was sudden and the affected joint red and swollen. Yvetta Fedorova Related Health Guide: Gout Long regarded as a “disease of kings” for its association with a diet rich in meats and alcohol, gout in modern times has become a decidedly more plebeian disorder. More than six million adults in the United States have had it, and the numbers are rising steadily as the population ages, becomes heavier and is exposed to foods and other substances that can precipitate the disorder in susceptible people. And while historically gout has been a male disease (three-fourths of cases occur in men), the incidence has been rising in older women, with as many as one in 20 over age 70 now afflicted. Fortunately for my neighbor, the fiery pain in his toe subsided in a few days, and while he has no idea what brought on the attack, he said he’s now “eating more healthfully.” Unfortunately, although some people never experience a second attack, others can suffer recurrences several times a year. Gout Causes and Risks Recurrent attacks are more likely if the underlying cause of gout is not treated. That cause is a high blood level of uric acid that forms irritating urate crystals that lodge in joints or soft tissues, causing intense pain. Uric acid is produced when the body metabolizes purines, common components of many foods, especially organ meats, anchovies, herring, asparagus and mushrooms. Other dietary contributors include excessive consumption of alcohol and possibly soft drinks containing fructose. A study published in November in The Journal of the American Medical Association linked an increased intake of sugar-sweetened soda to a raised risk of gout in women, who until menopause are relatively protected against the disease by estrogen, which helps the body excrete uric acid. Elevated levels of uric acid can result either from the body’s overproduction of the substance or, more commonly, from an inability of the kidneys to excrete it adequately. Dr. Tuhina Neogi, a rheumatologist at the Boston University School of Medicine, explained that humans lack the enzyme uricase, present in most other animals, and thus are unable to convert urate into allantoin, the soluble end-product of purine metabolism. Dr. Neogi noted recently in The New England Journal of Medicine that simply having a high level of uric acid is not, by itself, enough to cause gout. “Other factors play a contributing role,” she said in an interview. As sometimes happens, the treatment of one disease can cause another. Among the medications linked to an increase risk of developing gout are thiazide diuretics, the first line of drug treatment for high blood pressure; cyclosporine, an immunosuppressant drug used to prevent organ rejection in transplant patients; and low-dose aspirin, commonly taken to reduce the risk of heart attack and stroke. (On the other hand, aspirin in high doses — three or more grams a day — protects against gout by increasing uric acid excretion, Dr. Neogi wrote. Even drugs used to lower uric acid levels long-term can initially provoke an attack of gout, presumably by mobilizing body stores of urate, she said. The risk of gout is also higher among people with disorders that are increasingly common in modern society, including hypertension, diabetes, high cholesterol, atherosclerosis and congestive heart failure. Obesity and the so-called metabolic syndrome, which includes insulin resistance, are other common factors that can make an attack of gout more likely. People with a family history of gout also are at greater risk of developing it. Several genes have been linked to the disease. Diagnosis and Treatment Dr. Neogi noted that people vary in their response to uric acid. High blood levels are not always present during an attack of gout, she said, and some people with high levels never develop the disease. Although symptoms are usually quite characteristic — rapid development of severe pain, redness and swelling, most often in the first joint of the big toe — a more certain diagnosis requires detection of urate crystals in an inflamed joint during an attack or between attacks. As this involves drawing fluid from the affected joint, it is not often done in routine medical practice, she said. Sometimes in older people, especially women, multiple joints can be involved, leading to a mistaken diagnosis of rheumatoid arthritis. If gout is untreated and the disease becomes advanced, deposits of urate crystals may form into nodules called tophi beneath the skin. While usually not painful, tophi can become swollen and tender during flare-ups of gout. Urate deposits may also cause kidney stones. Treatment necessarily begins with lifestyle modifications, especially dietary changes to limit the intake of purines, which means avoiding organ meats and consuming other meats, poultry and seafood in limited amounts (a mere four to six ounces a day). Better to rely more on low-fat dairy, eggs and vegetarian sources of protein like tofu and nut butters. In the beverage department, alcohol is best avoided (or limited to one drink a day, if that) and sugary soft drinks avoided altogether. They are nothing more than empty calories. Diet soda, however, is not a problem, at least not with regard to gout. Caffeine appears to be protective; routine high intake of coffee (and perhaps also tea) can lower uric acid levels. Patients have also reported that cherry juice (or eating cherries or other dark-colored fruits, like purple grapes and blueberries) may be protective and prevent recurrences. It is most helpful to drink lots of water throughout the day — one to two liters, plus another one to two liters of other liquids — to limit the buildup of urate and keep kidneys flushed. In terms of medication, my neighbor did the right thing when his gout attack occurred. He took a hefty dose (800 milligrams) of ibuprofen, an over-the-counter nonsteroidal anti-inflammatory drug (Advil and Motrin are common brand names), to reduce the pain and inflammation in his affected joint. Had he seen a doctor, he might have been prescribed colchicine, which is most effective if taken soon after gout symptoms develop. Unfortunately, this medication can cause side effects, like nausea, vomiting and diarrhea, that limit its usefulness. If neither of these medications can be used, a corticosteroid like prednisone may be taken orally or injected into the affected joint to reduce pain and inflammation. Patients who experience frequent attacks may require continuing treatment with urate-lowering drugs called xanthine oxidase inhibitors, like allopurinol and febuxostat, which reduce the amount of uric acid the body produces. Another drug, probenecid, helps the kidneys excrete uric acid.

Really?: Eating Local Honey Cures Allergies Posted: 10 May 2011 07:45 AM PDT THE FACTS Christoph Niemann Well Share your thoughts on this column at the Well blog. Go to Well » Related Health Guide: Allergies, Food More Really? Columns   Among allergy sufferers, there is a widespread belief that locally produced honey can alleviate symptoms — the idea being that the honey acts like a vaccine. Bees that jump from one flower to the next end up covered in pollen spores, which are then transferred to their honey. Eating that honey — just a spoonful a day — can build up immunity through gradual exposure to the local allergens that can make life so miserable for allergy sufferers. Or at least that’s the thinking behind it. But when University of Connecticut Health Center researchers did a test, they found that the honey had no such effect. In the study, published in the Annals of Allergy, Asthma and Immunology in 2002, the scientists followed dozens of allergy sufferers through the springtime allergy season. The subjects were randomly split into three. One consumed a tablespoonful daily of locally collected, unpasteurized and unfiltered honey; another ate commercial honey; and a third was given a corn syrup placebo with synthetic honey flavoring. After tracking the subjects’ symptoms for months, the scientists found that neither of the honey groups saw improvements over the placebo group. Dr. Stanley Fineman, president-elect of the American College of Allergy, Asthma and Immunology, said he has seen a growing number of patients ask about local honey. “Seasonal allergies are usually triggered by windborne pollens, not by pollens spread by insects,” he said. So it’s unlikely that honey “collected from plants that do not cause allergy symptoms would provide any therapeutic benefit.” THE BOTTOM LINE There’s no evidence that local honey relieves allergy symptoms. scitimes@nytimes.com

The New Old Age: Antipsychotics Overused in Nursing Homes, Audit Finds Posted: 10 May 2011 08:57 AM PDT

The New Old Age: Dementia and Feeding Tubes Posted: 09 May 2011 02:31 PM PDT

Letters: War’s Legacy (1 Letter) Posted: 09 May 2011 08:30 PM PDT To the Editor: Re “Tugging at Threads to Unspool Stories of Torture” (May 3): I was deeply moved by your sensitive yet painful description of the suffering experienced by Iraqis who have been subjected to unspeakable abuse and torture. You describe the profound psychological and spiritual wounds they suffer and the sensitive treatment they are receiving from therapists of the Center for Victims of Torture. Unfortunately, there are few programs here at home that provide the kind of sophisticated treatment described in the article for our troops or to their loved ones. It is a rare situation in which our troops and loved ones have the chance to be with a well trained mental health professional for “as long as it takes” to talk about and come to terms with the trauma of combat. Judith Broder, M.D. Studio City, Calif. Science Times welcomes letters from readers. Those submitted for publication must include the writer’s name, address and telephone number. E-mail should be sent to scitimes@nytimes.com. Send letters to Science Editor, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018.

Letters: Offering Lost Words (1 Letter) Posted: 09 May 2011 08:30 PM PDT To the Editor: Re “A Thief That Robs the Brain of Language” (Personal Health, May 3): I was disappointed that Jane Brody did not mention the existence of speech-assistive devices that enable users to individualize words and phrases that refer to the person’s particular needs and, when touched, will speak for the user. Additionally, there are also devices that respond to eye gaze or blinks for people who are not able to point and touch. I believe Medicare will cover these devices. I do know, from personal experience, that the device can be rented on a trial basis for a month with Medicare coverage. Barbara R. Rauch New York Science Times welcomes letters from readers. Those submitted for publication must include the writer’s name, address and telephone number. E-mail should be sent to scitimes@nytimes.com. Send letters to Science Editor, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018.

Letters: Tonsils and Weight (1 Letter) Posted: 09 May 2011 08:30 PM PDT To the Editor: Re “The Claim: Having Tonsil Surgery Causes Weight Gain” (Really?, May 3): I’m surprised that you didn’t mention obstructive sleep apnea in your article on weight gain and tonsillectomy. The theory is that many children who undergo tonsillectomy have had tonsils large enough to cause disordered sleep. As they begin to fall into deep sleep, during which growth hormone production peaks, the relaxation of the soft tissues of the posterior pharynx, along with their enlarged tonsils, begins to obstruct their airways. The obstruction and resulting increase in carbon dioxide in their blood prevents deepening sleep. Without the normal amount of deep sleep, less growth hormone is produced. These kids are often skinny, and weight gain is indeed common after the surgery, because deep sleep and therefore growth hormone production improves. Some of them may be genetically or environmentally destined to be overweight, but the enlarged tonsils prevented weight gain until the tonsils were removed. Mary Zweighaft Blauvelt, N.Y. Science Times welcomes letters from readers. Those submitted for publication must include the writer’s name, address and telephone number. E-mail should be sent to scitimes@nytimes.com. Send letters to Science Editor, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018.

Ruling Clears New York State to Tax Tribes’ Cigarette Sales Posted: 09 May 2011 09:20 PM PDT BUFFALO (AP) — A federal appeals court on Monday lifted legal stays that had been blocking New York’s effort to collect taxes on cigarette sales by Indian-owned businesses to non-Indians. The United States Court of Appeals for the Second Circuit ruled that the five New York-based Indian nations challenging the state’s collection plans had not demonstrated that they were likely to win by arguing that the taxing system unduly burdened reservation retailers and interfered with tribal sovereignty. “We will now begin the implementation phase, as we move to collect these taxes,” said Gov. Andrew M. Cuomo, who was attorney general when the lawsuits were filed. The current attorney general, Eric T. Schneiderman, called the ruling “an important victory for the state to collect deserved revenue and to protect public health.” State officials voted last June to begin collecting the $4.35-per-pack sales and excise taxes on the millions of cartons sold to non-Indian customers in reservation smoke shops. It was a break from a policy adopted by a string of governors not to enforce state laws requiring the taxation of sales to the public. The Seneca Nation, whose 172 tobacco retailers sell more cigarettes than any other tribe, said it would continue to oppose the state’s plans, even after the ruling Monday, which upheld Judge Richard J. Arcara’s denial in October of an injunction sought by the Senecas, Cayugas, Unkechaug, St. Regis Mohawks and Oneidas. Judge Arcara had issued a stay of his ruling pending appeal. “We will continue fighting against this overreaching action by the state to protect our treaty rights, tobacco commerce and all the jobs it supports,” Robert Odawi Porter, the Seneca president, said. “The Seneca Nation will not be New York State’s tax collector.” The last time the state tried to collect the tax, in 1997, protesters lighted tire fires and shut down a 30-mile stretch of the New York Thruway that bisects Seneca land near the Pennsylvania line. Current Seneca leaders have said they would not condone violence.

Battle Over Health Care Law Shifts to Federal Appellate Courts Posted: 09 May 2011 01:20 PM PDT A five-week flurry of federal appellate hearings on the constitutionality of the Obama health care law kicks off Tuesday in Richmond, Va., beginning the second round of a race to the Supreme Court among a multitude of litigants eager to strike down the president’s signature domestic achievement. Steve Helber/Associated Press Attorney General Kenneth T. Cuccinelli II of Virginia brought one of the challenges. Neal K. Katyal will argue in support of the health law. At Tuesday’s hearing, the United States Court of Appeals for the Fourth Circuit will consider a pair of contradictory rulings sent up from the lower courts. In one case, filed by Virginia’s attorney general, a federal district judge in Richmond ruled late last year that Congress had exceeded its authority by requiring most Americans to obtain health insurance. In the other, filed by Liberty University, a conservative Christian institution, a district judge sitting 100 miles away in Lynchburg, Va., upheld the insurance mandate. If the appellate courts act quickly, the question of the health law’s constitutionality could land before the Supreme Court as soon as the next term, which opens in October. With the lower courts divided, each side hopes to build a string of victories in the midlevel Courts of Appeals. “We want to win as many of these as we can,” said Attorney General Kenneth T. Cuccinelli II of Virginia, a Republican. “If we have nothing but wins all the way up to the Supreme Court, there is an element of momentum, I think, where the justices consider what has gone on before the case came to them.” Since the enactment of the Affordable Care Act in March 2010, 31 lawsuits have been filed to challenge it, according to the Justice Department, which is defending the Obama administration. Nine are awaiting action by Courts of Appeals, and nine are pending in federal district courts. The others have been dismissed. Three district judges appointed by Democratic presidents have upheld the law while two Republican appointees have struck down part or all of it. On June 1, the Court of Appeals for the Sixth Circuit in Cincinnati is scheduled to hear the appeal of a ruling in favor of the law. On June 8, the Court of Appeals for the 11th Circuit in Atlanta will review a Florida judge’s ruling that invalidated the entire act. That judge later suspended his own order until higher courts could settle the matter. The Supreme Court recently turned down a request by Mr. Cuccinelli that it hear the case without review by the Court of Appeals. In Tuesday’s hearing, a three-judge panel will first hear arguments in the case filed by Liberty University and then in the one filed by Mr. Cuccinelli. The makeup of the randomly selected panel will not be revealed until Tuesday morning. With the addition of four appointees by President Obama, the Fourth Circuit bench now includes seven members named by Democratic presidents and seven named by Republicans. The loser before the three-judge panel may petition for a hearing before the entire court before taking the case to the Supreme Court. The Obama administration will be represented in each of the appellate cases by Neal K. Katyal, the acting solicitor general. Solicitors general more typically argue for the federal government before the Supreme Court. Although it is not unprecedented for them to appear before Courts of Appeals, Mr. Katyal’s assignment is seen as a nod to the significance of the case. E. Duncan Getchell Jr., Virginia’s solicitor general, will speak for the commonwealth, as he did in the district court, and Liberty University will be represented by Mathew D. Staver, the dean of its law school. The plaintiffs in the 11th Circuit case, including Republican officials from 26 states, will be represented by Paul D. Clement, a United States solicitor general under President George W. Bush. Mr. Clement recently resigned from King & Spalding after it withdrew its support for his defense of a federal law banning recognition of same-sex marriages. Scores of politicians, economists and interest groups have filed friend-of-the-court briefs on both sides of the health care litigation. The Virginia and Liberty University cases bear some differences. But both challenge the insurance requirement on the ground that it cannot be supported by the commerce clause of the United States Constitution, which gives Congress broad but not unlimited authority to regulate interstate commerce. Starting in 2014, the health care law would require most Americans to obtain policies or pay an income tax penalty. The plaintiffs complain that the government has never before forced citizens to buy a commercial product. In the lower courts, arguments have centered on whether a choice to not buy insurance constitutes the kind of economic “activity” that the Supreme Court has, in the past, found subject to federal regulation. The judges are also being asked to determine whether Virginia has legal standing to challenge the law, whether the insurance requirement can be supported under Congress’s authority to tax, whether it runs afoul of religious liberties, whether employers can be required to contribute to their workers’ health coverage, and whether a finding against one provision of the law should invalidate the entire act.

Study in Korea Puts Autism’s Prevalence at 2.6%, Surprising Experts Posted: 09 May 2011 12:56 PM PDT An ambitious six-year effort to gauge the rate of childhood autism in a middle-class South Korean city has yielded a figure that stunned experts and is likely to influence the way the disorder’s prevalence is measured around the world, scientists reported on Monday. The figure, 2.6 percent of all children aged 7 to 12 in the Ilsan district of the city of Goyang, is more than twice the rate usually reported in the developed world. Even that rate, about 1 percent, has been climbing rapidly in recent years — from 0.6 percent in the United States in 2007, for example. But experts said the findings did not mean that the actual numbers of children with autism were rising, simply that the study was more comprehensive than previous ones. “This is a very impressive study,” said Lisa Croen, director of the autism research program at Kaiser-Permanente Northern California, who was not connected with the new report. “They did a careful job and in a part of the world where autism has not been well documented in the past.” For the study, which is being published in The American Journal of Psychiatry, researchers from the Yale Child Study Center, George Washington University and other leading institutions sought to screen every child aged 7 to 12 in Ilsan, a community of 488,590, about the size of Staten Island. By contrast, the Centers for Disease Control and Prevention in the United States and most other research groups measure autism prevalence by examining and verifying records of existing cases kept by health care and special education agencies. That approach may leave out many children whose parents and schools have never sought a diagnosis. In recent years scientists have come to see autism as a spectrum of disorders that can include profound social disconnection and mental retardation, but also milder forms, like Asperger’s syndrome, that are pervasive and potentially disabling but that often go undiagnosed. “From the get-go we had the feeling that we would find a higher prevalence than other studies because we were looking at an understudied population: children in regular schools,” said the lead researcher, Dr. Young-Shin Kim, a child psychiatrist and epidemiologist at the Yale Child Study Center. South Korea was chosen not only because autism prevalence had not been measured there, but also because its national health care system, universal education and homogeneous population made it a promising region for a planned series of studies that will also look at genetic and environmental factors in autism. The study, which was largely financed by the research and advocacy group Autism Speaks, raises the question of whether a similarly high prevalence would be found in the United States if all children were screened. Dr. Marshalyn Yeargin-Allsopp, chief of developmental disabilities at the National Center on Birth Defects and Developmental Disabilities of the C.D.C., acknowledged that her agency’s records-based approach probably missed some autistic children — especially among the poor, among racial minorities and “potentially among girls” — and said the agency was interested in taking part in a population-based approach like the Korean study. “We believe this will be a way to get as complete an estimate of A.S.D. prevalence as possible,” she said in an e-mail, using the abbreviation for autism spectrum disorder. Most cases of autism spectrum disorder in the Korean study, the researchers said, turned up among children in regular schools who had no record of receiving special education or mental health services. A third were found among a “high-probability group” of 294 children who were attending special-education schools or were listed on a registry of disabled children. The children in that high-probability group were similar in many ways to children with autism in the United States and elsewhere. Fifty-nine percent were intellectually disabled, or mentally retarded; more than two-thirds had full-blown autism, as opposed to milder forms like Asperger’s; and boys outnumbered girls five to one. Among the children with autism spectrum disorder in regular schools, only 16 percent were intellectually disabled, more than two-thirds had a milder form of autism, and the ratio of boys to girls was unusually low: 2.5 to 1. In addition, 12 percent of these children had a superior I.Q. — a higher proportion than found in the general population. Researchers used a two-step process to identify autism among ordinary schoolchildren: parents and teachers completed a 27-item questionnaire on each child, and children who scored in the autistic range on that questionnaire were individually evaluated. “If we had only looked at the high-probability group, we would have come up with about 0.7 percent, which is in line with C.D.C. statistics for the U.S.,” said the study’s senior author, Roy Richard Grinker, a professor of anthropology and international affairs at George Washington University. The surprisingly large proportion of cases uncovered in ordinary schools, he noted, may in part reflect the low level of awareness and high degree of stigma attached to autism in South Korea. In addition, children with autism spectrum disorders may stand out less in South Korean schools, which follow highly structured and predictable routines and emphasize rote learning. Other experts said that more “population based” studies, though costly, could help determine how broadly the Korean findings could be generalized to other societies. Craig J. Newschaffer, chairman of epidemiology and biostatistics at the Drexel School of Public Health in Philadelphia, praised the new report, calling it “quite a strong study,” but he added that the results were based on information about 63 percent of the schoolchildren, a good response rate but not ideal. “It is just one area of Korea,” he said, “and we know that there’s random variation in how diseases are distributed.”

Recipes for Health: Whole Wheat Spaghetti With Green Garlic and Chicory Posted: 10 May 2011 09:10 AM PDT This dish is inspired by a classic oil and garlic pasta. I’ve added chicory, a bitter green that is much loved in southern Italy but underused here. It’s sold with lettuces in the supermarket, often called escarole or curly endive. Chicory contains a type of soluble fiber called inulin, which some studies suggest may have a positive effect on blood sugar levels. Recipes for Health Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. See All Recipes for Health » Visit Recipes for Health on Facebook. Related Recipes for Health: A Lighter, Lovelier Garlic (May 9, 2011) Recipes for Health: Asparagus With Green Garlic (May 10, 2011) Recipes for Health: Rice Bowl With Spinach or Pea Tendrils (May 12, 2011) Recipes for Health: Beet Greens, Green Garlic and Barley Gratin (May 13, 2011) 1 head chicory (also sold as escarole and curly endive lettuce) 1/4 cup extra virgin olive oil 2 tablespoons minced green garlic 1 dried red pepper, broken in half, or 1/4 teaspoon red pepper flakes Salt to taste 3 tablespoons chopped flat-leaf parsley 3/4 pound whole-wheat spaghetti A generous amount of freshly ground pepper 1/4 cup freshly grated Parmesan, as needed 1. Bring a large pot of water to a boil. Fill a bowl with ice water. Meanwhile, remove the tough outer leaves of the chicory, and clean the remaining leaves of sand. When the water comes to a boil, salt generously and add the chicory. Blanch one minute, then transfer to the ice water with a skimmer or slotted spoon (do not drain the water from the pot). Drain the chicory, squeeze out water and chop. Set aside. 2. Combine the olive oil, garlic and chili pepper in a large, heavy skillet. Heat over medium heat until the garlic begins to sizzle. Allow the garlic to sizzle for about a minute, but do not let it color. Remove the skillet from the heat and set aside. If using a whole chili pepper, remove it and discard. 3. Bring the water back to a boil, and add the spaghetti. Cook al dente following the timing directions on the package. While the pasta is cooking, return the frying pan to medium heat. When the garlic begins to sizzle again, add the chicory. Toss together, season to taste with salt and pepper, and keep warm. 4. When the spaghetti is cooked al dente, remove 1/2 cup of the pasta water and add it to the pan with the chicory. Stir together well. Drain the pasta, and toss with the chicory and garlic. Serve, topping each serving with a spoonful of Parmesan. Yield: Serves four. Advance preparation: You can make this through Step 2 several hours before cooking the spaghetti. Nutritional information per serving: 444 calories; 3 grams saturated fat; 2 grams polyunsaturated fat; 10 grams monounsaturated fat; 4 milligrams cholesterol; 66 grams carbohydrates; 11 grams dietary fiber; 87 milligrams sodium (does not include salt to taste); 15 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Recipes for Health: A Lighter, Lovelier Garlic Posted: 10 May 2011 09:10 AM PDT I first encountered green garlic one summer in Provence. I was working on a garlic cookbook, so I bought lots of it every time I went to the market. But one day in June I came across an unfamiliar variety. The generous cloves — enrobed in several layers of soft, moist, pinkish skin — were almost juicy, and their flavor was less pungent than that of regular garlic. Recipes for Health Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. See All Recipes for Health » Visit Recipes for Health on Facebook. Related Recipes for Health: Asparagus With Green Garlic (May 10, 2011) Recipes for Health: Whole Wheat Spaghetti With Green Garlic and Chicory (May 11, 2011) Recipes for Health: Rice Bowl With Spinach or Pea Tendrils (May 12, 2011) Recipes for Health: Beet Greens, Green Garlic and Barley Gratin (May 13, 2011) This was green garlic, freshly harvested. By now it should be available at most farmers’ markets. At some stands, the bulbs look a lot like spring onions, or even leeks, because they haven’t set cloves yet. Once the cloves appear, the garlic looks more familiar; still, the green stems will be attached, and you must remove several layers of moist skin to get to the cloves. The season doesn’t last long, so I buy green garlic every week and use it in all manner of dishes. Because it’s milder than mature garlic, you can use a lot without overpowering a dish. Many researchers believe garlic, green or mature, may help lower cholesterol, triglyceride levels and blood pressure. Some of its constituents, including allicin, vitamin C, vitamin B6, manganese and selenium, may provide cardiovascular benefits. Some people are so enthusiastic about these therapeutic properties that they take garlic supplements. It’s hardly necessary; it’s easy to get all you want in everyday dishes. Green Garlic, Potato and Leek Soup A very pale green springtime cousin of vichyssoise, this purée is comforting when served hot, refreshing when cold. 3/4 pound green garlic (weight includes stalks) 2 tablespoons extra virgin olive oil 1 pound leeks, white and light green parts only, rinsed thoroughly and sliced 1 small celery rib, sliced (about 1/4 cup) Salt to taste 1 pound Yukon gold or russet potatoes, peeled and diced 1 1/2 quarts water, vegetable stock or chicken stock A bouquet garni made with a bay leaf and 2 sprigs each thyme and parsley Freshly ground pepper 1/4 cup chopped fresh flat-leaf parsley, chervil or tarragon 1. Trim off the tough green ends of the garlic bulbs. If the garlic has formed cloves, separate them and remove the thick shells from the tender cloves. If it has not formed cloves, just remove the outside layers. Chop coarsely. You should have about 1 cup chopped green garlic. 2. Heat the olive oil in a large, heavy soup pot over medium heat. Add the leeks, green garlic, celery and 1/2 teaspoon salt. Cook gently for five to 10 minutes until the vegetables have softened but not colored. Add the potatoes, water, bouquet garni and salt to taste. Bring to a boil, reduce the heat, cover and simmer 30 minutes. 3. Purée the soup using an immersion blender. Alternatively, purée in a standing blender working in 1 1/2-cup batches; pull a towel tightly over the top, rather than a tight-fitting lid, to prevent splashes. Put through a medium strainer, pressing the soup through with the back of a ladle or with a pestle. Reheat, taste and adjust salt. Add freshly ground pepper. Ladle into soup bowls, and sprinkle chopped fresh parsley, chervil or chopped fresh tarragon over each serving. Alternatively, chill and serve cold. You can thin out if you wish with milk or stock. Yield: Serves six. Advance preparation: You can make this a day ahead and reheat. You may want to thin the soup with a little milk or stock. Nutritional information per serving: 135 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 3 grams monounsaturated fat; 0 milligrams cholesterol; 21 grams carbohydrates; 4 grams dietary fiber; 45 milligrams sodium (does not include salt to taste); 2 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

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