Finding — and Fighting — Autism Early
October 30, 2007 on 6:40 am | In Uncategorized | Comments OffFrom the earliest months, a healthy baby engages in an astonishing range of social behaviors. Most will begin smiling back at a loved one in the first four months of life. Most will follow a parent's gaze with their own eyes by eight months. Most will also study a caregiver's facial expressions and mimic exhibits of fear, surprise or delight with their own tiny features. They will babble a conversation back and forth by nine months, respond to their names by 10 months, and begin to point to a desired toy or treat by around a year.
But some babies won't do these things, and a pattern of such deficits can be an early sign of autism. Despite these and many other early tip-offs, autism spectrum disorders (ASD) are rarely diagnosed before age 3. More subtle forms, such as Asperger's Syndrome, may not be recognized until the child begins school.
The American Academy of Pediatrics (AAP) would like to change this. At its annual meeting, held in San Francisco on Monday, the AAP released two reports: one aimed at helping pediatricians recognize autism spectrum disorders — in all their varieties — by age 2 and the other at providing guidance for early intervention. At the same time the AAP formally recommended that all pediatricians routinely screen for autism at ages 18 months and 2 years and announced it was making a new "toolkit" of diagnostic information available to all its members — for about $70.
The announcements came in response to a growing consensus that autism can be picked up very early in life and that early intervention holds the best promise for helping affected children. It is also an admission that, despite an explosion of news on autism in recent years, pediatricians are not currently doing an optimal job of identifying the spectrum of conditions now believed to affect as many as 1 in 150 children. A 2004 survey of primary care pediatricians found, for instance, that only 8% were routinely screening for autism, even though 44% said they saw at least 10 kids with autism in their practice.
The AAP had already recommended routine screening for autism in 2006, but the new recommendations are more specific and backed by more information for practitioners. Two screenings are needed — one at 18 months and one at 24 months, explains Dr. Scott Meyers, who authored one of the reports, because about a quarter of children with ASD appear to develop normally at first and then regress — losing early language and social behavior — sometime between 15 and 24 months.
Meyers, a neurodevelopmental pediatrician with Geisinger Health System in Danville, Pa., wrote the AAP's new survey of research on managing the care of children with autism. His report supports intensive behavioral and speech therapy — at least 25 hours a week — beginning as early as possible. But, he concedes, there's a lack of rigorous, randomized research on what interventions work best. The report encourages pediatricians not to condemn parents who turn to alternative therapies, but to help guide them toward the safest and best researched approaches. "Don't just dismiss it out of hand," says Meyers, "It's important to keep communication open and respect the fact that parents are going to be looking of answers."
Look what they brought back from Denver!
October 30, 2007 on 3:33 am | In Uncategorized | Comments OffTags: worldseries
links for 2007-10-27
October 27, 2007 on 3:17 am | In Uncategorized | Comments Off- 25 Unexpectedly Useful Websites for the Uncommonly CuriousThis eclectic list of websites contains so many out of the ordinary pleasures that it is hard to know where to start.
Misys to Revolutionize Small Medical Practices
October 26, 2007 on 8:43 am | In Uncategorized | Comments OffMen Get Breast Cancer Too
October 26, 2007 on 6:20 am | In Uncategorized | Comments OffBrian Place didn't think about breast cancer when he found a lump near his left nipple. He thought about rugby. The lump, he figured, might be an injury from colliding with another player.
Place's doctor didn't think much of the lump either, but recommended a mammogram nonetheless. After that came an ultrasound of the breast and a biopsy, and then, finally, a diagnosis: breast cancer. "I was completely numb," says Place, 41 at the time. "I let my colleagues know," he says — mostly men, as he's a communications technician for the Royal Air Force in Britain. "They were as dumbfounded as I was." Even at his local breast clinic, when Place would arrive, he says, some staff assumed he was accompanying a female patient.
The confusion is understandable. Only a tiny fraction of breast cancers diagnosed — less than 1% — occur in men. And because it happens so infrequently, much is still unknown about male breast cancer. "In women, we have studies based on hundreds of thousands of patients," says Dr. Larissa Korde, staff clinician at the National Cancer Institute's clinical genetics branch. For men, there are simply no studies of that scale. Though much can be extrapolated from research in women, Korde says, often "it's a little bit harder to make recommendations for men based on evidence."
Perhaps the surest risk factor — in both women and men — is family history. By the time Place was diagnosed, for example, two of his female relatives had died of breast cancer and a third of ovarian cancer. Although there are certainly several genes that contribute to breast cancer, mutations in two of them — BRCA1 and BRCA2 — are known to increase the odds of both breast and ovarian cancers. So while most men might never even meet a man with breast cancer, those who have several relatives diagnosed with it should be on the lookout for signs of their own breast tumors. Studies suggest that certain populations with an unusually high proportion of people carrying BRCA2 mutations — in Sweden, Hungary, Iceland, and among Ashkenazi Jews — may have a higher incidence rate of breast cancer in men.
Survival rates for men and women are similar, adjusting for stage of the disease at diagnosis — but men are more likely to be diagnosed at a later stage. That's probably because women undergo regular screening, Korde says. In men, "because it's not on their radar, [a lump] might not be something they get seen immediately." In men, as in women, treatment usually includes surgery followed by some combination of radiotherapy, chemotherapy and — because almost all men with breast cancer have tumors characterized as hormone-receptor-positive — hormone treatment.
Two years after his diagnosis, Place is well. His mastectomy was a success, and he's opted to stop taking hormone treatment, a relief, he says, because he found the side-effects, including hot flashes, unpleasant. Today he tries to answer questions from male breast-cancer patients in online cancer forums, and talks with people who contact him through the U.K. nonprofit Breast Cancer Care. But there's no doubt that even a relatively positive experience with male breast cancer can be isolating — even for women. As Place looked for information in online forums, he found that women were used to treating breast cancer sites as women's-only safehouses, a place to discuss their bodies with other women. Some, he says now, "can get quite aggressive that we're invading their area, if you will." But as with breast cancer in women, awareness can make the difference.
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