Kids Most In Need Least Likely To Take Vitamins

By Megan Rauscher
NEW YORK (Reuters Health) - Children and teenagers who face the greatest risk of nutritional deficiencies tend to use vitamin and mineral supplements the least, researchers reported Monday.

Among 10,828 US children ages 2 to 17 years old who participated in the 1999 to 2004 United States National Health and Nutrition Examination Survey, roughly 34 percent had used vitamin and mineral supplements in the past month.

"We hypothesized," Dr. Ulfat Shaikh told Reuters Health, "that children who had poor diets (low vegetable intake, low milk intake, high fat intake, low fiber intake), faced food insecurity, had less physical activity and poor access to health care, would use such supplements more."

"What we found was for the most part the opposite of what we expected," said Shaikh from University of California Davis School of Medicine, Sacramento.

"Other than children who were underweight (we did expect these children to use more vitamin and mineral supplements and found this to be true from the data), children who used vitamin and mineral supplements were for the most part healthier, had more nutritious diets, greater physical activity, lower sedentary activity, lower obesity, lower food insecurity and better health care access," Shaikh noted.

"Their parents additionally reported them to be in better health than children who did not use such supplements."

The American Academy of Pediatrics does not recommend vitamin and mineral supplements for healthy children older than 1 year who consume a varied diet, Shaikh and colleagues note in a report in the Archives of Pediatrics and Adolescent Medicine.

"Our data," Shaikh warned, "indicate that families with children who may benefit from these supplements appear to have limited resources and competing financial demands that prevent them from using them."

SOURCE: Archives of Pediatrics and Adolescent Medicine, February 2009.

Senate Likely to Pass Bill on Kids' Health Insurance

SCHIP Could Cover 11 Million Children

The Senate is expected to approve a bill today that provides health insurance to about 11 million low-income children, paving the way for President Obama to claim an early legislative victory and collect a quick down payment on his campaign pledge to guarantee care to every American child.

Senate Democrats, after easily defeating Republican attempts to narrow the bill yesterday, predicted they had the votes to renew and expand the popular State Children's Health Insurance Program.

Presently, the $25 billion program covers 7 million children living near the poverty level who do not qualify for Medicaid. Under the Senate bill and similar legislation passed by the House, an additional 4 million youngsters would be eligible for discounted care at an added cost of $32 billion over 4 1/2 years. That would leave Obama about 5 million children short of his promise to ensure that every youngster in the country has health insurance.

Proponents say the need for a health-care safety net has become all the more urgent, given the dire state of the economy. Opponents argue that the Democratic legislation goes beyond the original intent of the program by including children of legal immigrants and some families with incomes as high as $60,000 a year.

Both the House and Senate versions include millions of dollars for recruiting and enrolling youngsters. The expanded coverage would be paid for by increasing the cigarette tax by 61 cents a pack.

"This bill will make a real difference in the lives of children and families across America and is a great way to start the new year," said Sen. Debbie Stabenow (D-Mich.). "I am very pleased to be a part of this and to know that we have a president who will enthusiastically and quickly sign this bill as one of his first actions."

After the final vote in the Senate, House and Senate negotiators must resolve minor differences between the two versions before it can be sent to the White House for Obama's signature.

In 2007, many prominent Republicans joined with Democrats in efforts to expand the program. Twice, President Bush ignored the entreaties of those in his party and vetoed the legislation, calling the effort a dangerous shift toward "government-run health care."

Yesterday, those same Republicans reacted bitterly to changes made by the Democrats now that they control Congress and the White House.

In particular, Republicans objected to a provision in both the House and Senate versions that would, for the first time, lift a five-year waiting period for children of legal immigrants to enroll in the program.

"This is not the bill we intended," bellowed the normally mild-mannered Sen. Pat Roberts (R-Kan.). The Democrats' decision to "simply ram it down our throats . . . is very, very bad precedent," he said.

Sen. Orrin G. Hatch (R-Utah), who had helped craft the 2007 bipartisan bills, offered an amendment that would have required states to enroll 95 percent of eligible, native-born children before opening it to immigrants.

"Our U.S. citizen children should be covered first," he said.

"Those kids come from low-income families with parents that work hard and pay taxes just like citizens," countered Senate Finance Committee Chairman Max Baucus (D-Mont.). "And, those kids need checkups and prescriptions just like all other CHIP kids."

Republicans and some conservative analysts also noted that as many as 2 million children with access to private health insurance might switch to the cheaper government-subsidized program, a trend known as "crowd out."

Baucus said the bill aims to minimize that by giving states a new option to subsidize employer-sponsored coverage for low-income children. Those subsidies would help keep private insurance affordable.

An eclectic mix of business interests, consumer groups and medical providers lobbied aggressively for expansion of the program, including the National Governors Association, labor unions, the retiree group AARP, the Blue Cross/Blue Shield Association and the Pharmaceutical Research and Manufacturers of America.

When Congress enacted the $700 billion financial bailout last fall, "we were told you've got to take care of Wall Street if you want to take care of Main Street," said Sister Carol Keehan, president of the Catholic Health Association of the United States. "Well, Main Street can never be safe if their children don't have health care."

Staff writer Perry Bacon Jr. contributed to this report.

source: washingtonpost.com

Childhood Cancer Survivors Skip Breast Screenings

Many Women Who Survived Cancer in Childhood Forgo Breast Cancer Screenings Despite Increased Risk

Jan. 27, 2009 -- Women who underwent chest radiation therapy for a childhood cancer have a significantly higher risk for developing breast cancer at a younger age. Yet a new study in the Journal of the American Medical Association shows that many of them do not undergo the recommended screenings.

"Most young women at risk of breast cancer following chest radiation for a pediatric cancer, including women at highest risk (Hodgkin lymphoma survivors), are not being appropriately screened," Kevin C. Oeffinger, MD, of Memorial Sloan-Kettering Cancer Center in New York, and colleagues write.

About 20,000 to 25,000 women 25 and older in the U.S. have received chest radiation for a childhood cancer, according to background information in the journal report. For the past decade, experts have recommended yearly screening mammograms for women who received moderate- to high-dose chest radiation beginning either at age 25 or eight years after the treatment, whichever occurs last.

In 2008, the Children's Oncology Group (COG) updated the guidelines to include breast magnetic resonance imaging (MRI) along with yearly mammograms. The American Cancer Society recommends the same.

But some women in the new study had never even had a mammogram.

About 12% to 20% of women who receive moderate- to high-dose chest radiation for a childhood cancer will be diagnosed with breast cancer by age 45, but some develop the disease much earlier. "The risk of breast cancer begins to increase as early as 8 years after radiation and the [midpoint] age of breast cancer diagnosis ranges from 32 to 35 years," Oeffinger's team writes.

Oeffinger and colleagues based their findings on a 114-item questionnaire filled out by 625 female participants, aged 25 to 50, of the Childhood Cancer Survivors Study (CCSS). All the women had survived childhood cancer and had been treated with chest radiation.

The researchers compared the women's responses to similarly aged childhood cancer survivors who did not receive chest radiation, and siblings with no history of childhood cancer.

Among women 25 to 39 who had received chest radiation for childhood cancer:

• Most (47.3%) never had a mammogram.
• 63.5% had not received a screening mammogram within the past two years, despite guidelines that recommend annual exams.
• Less than a fourth (23.3%) had a screening or diagnostic mammogram in the previous year.
• They were three times more likely to have had a mammogram if their doctor recommended one.
  

Among women 40 to 50 who had received chest radiation for childhood cancer:

• They were more likely to have had mammograms than those aged 25 to 39.
• About two-thirds (76.5%) had a screening mammogram in the past two years (compared with 70% for women who did not receive chest radiation during childhood and 67% for siblings without history of childhood cancer).
• Slightly more than half (52%) had regular breast cancer screenings. (This finding was not significantly higher than those who never had chest radiation.)

Overall findings:

• Older women were more likely to undergo breast cancer screening in the past two years or to have received regular screening.
• The chances a woman would report having a mammogram jumped nearly twofold for every five-year increase in age.

"Findings from this study should provide the foundation for targeted interventions involving both clinicians and cancer survivors," the authors conclude.

An accompanying editorial written by doctors in the United Kingdom emphasizes the need for well-designed programs to provide ongoing education for women and their doctors about the risks of breast cancer after childhood chest radiotherapy.

Aliki J. Taylor, MD, PhD, MPH, of the University of Birmingham in Enlgand, and Roger E. Taylor, MD, MA, of Swansea University in Wales also encourage future studies to determine if exposure to radiation during mammography increases the cancer risk for these women, and to explore breast MRI as a possible alternative. They also suggest investigating whether more women in this high-risk group would undergo breast cancer screening if it were provided at no cost.

source: webmd.com