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When it comes to talking about sex, parents are a few paces behind their kids.

Too often, the birds-and-the-bees conversation occurs after, and not before, kids start experimenting sexually, possibly in risky ways, reports a study in the January issue of Pediatrics.

This revelation comes despite American Academy of Pediatrics recommendations that health-care providers and parents talk to their kids about sex and sexuality early in life.

“Parents are a little behind the 8 ball. They underestimate their children’s sexual knowledge and interest and behaviors,” said Dr. Lawrence Friedman, director of adolescent medicine at the University of Miami Miller School of Medicine.

“It’s a hard subject for many parents to broach, but the level of sexual activity in many kids has moved up in terms of initiation. It’s younger,” added Alan Hilfer, director of psychology at Maimonides Medical Center in New York City. “Talking about it is very helpful in terms of disease prevention, unwanted pregnancy and even issues around relationships.”

Although there were suspicions that parents lagged behind their kids, previous studies had asked adults to remember when they first had sex and when their parents talked to them, said study author Megan Beckett, a social scientist with the Rand Corp. in Santa Monica, Calif.

For this study, Beckett and her colleagues surveyed 141 middle-class and upper middle-class parents and their children, aged 13 to 17, in more of a real-time scenario. “We went back about four times over a year’s period,” Beckett said.

Starting with questions about girls bodies and menstruation, the research team asked parents and children about kissing and handholding, birth control, refusing sex, oral sex and intercourse, all related to different developmental stages of the kids.

More than half of children had experienced genital touching before “the talk” about birth control, sexually transmitted diseases (STDs) and condom use, the researchers found.

“More than 40 percent of adolescents are having intercourse before parents have talked to them about STD symptoms, condom use, choosing birth control and what to do if your partner refuses to use a condom,” Beckett said. “That’s a pretty large number.”

About two-thirds of boys said they had not talked with a parent about how to use a condom before having intercourse.

And conversations with boys almost always took place later than talks with girls.

“This is a flag to not put it off, and this is especially the case with boys,” Beckett said.

Denial, naivety and any number of other emotions on the part of the parents may be playing into this trend, Friedman said.

“They reminisce that when they were in the seventh grade, they didn’t do that kind of thing,” he said. “The fact of the matter is that this is 25 years later, and this is what is going on. You have to be knowledgeable and prepared to prepare children for when they become teenagers and have to confront sexual kinds of activities.”

Other experts agree. “We live in an R-rated society, and our kids need our PG guidance,” said Dr. Frank Biro, head of adolescent medicine at Cincinnati Children’s Hospital. “If you want to instill knowledge and values, then you need to be talking to your kids earlier, not later.”

Here are some tips on when and how to talk to your kids:
Figure that the age you think is appropriate is probably too old. “If parents think that they should broach the topic at x age, they should subtract two years and do it at that age instead,” Friedman said.
Talk to your physician and scour resources from the Internet, libraries and schools about how to broach the subject and what to say.
Take the lead. “Don’t expect your child to come and ask an important question about a topic that they’re embarrassed about or that they don’t know their parents would be willing to talk to them about,” Friedman said. “This will also help gauge how knowledgeable their teenager or child is.”
After you’ve talked, “step back and ask your kids questions and pay attention to what they’re interested in,” Hilfer said.
Make sure your conversation is developmentally appropriate to the child, Biro said. Talking about fellatio with a 6-year-old is probably not appropriate. Talking about boys liking girls and handholding would be for kids 8 or 9 years or possibly even 6 years old. “If you haven’t talked to your kids by the time they’re 12, you need to get on the stick,” said Hilfer.

In a finding that could lead to a simple blood test to screen for lung cancer, U.S. researchers have identified immune system markers that indicate early-stage lung tumors in people at high risk for lung cancer.

The researchers examined gene expression profiles in blood samples from 137 people with non-small cell lung cancer and a control group of 91 people with non-malignant lung diseases, such as chronic obstructive pulmonary disease, emphysema or benign lung nodules.

They identified a 29-gene “signature” that was 86 percent accurate in identifying those with lung cancer, who had certain genetic changes in immune cells that the others did not.

Blood samples were taken from 18 of those with lung cancer before surgery to remove their tumors and two to five months after surgery. After surgery, 13 of them showed a decrease or disappearance of the tumor gene signature.

The study was published online Dec. 1 in Cancer Research.

The researchers said it might be possible to use the findings to develop a simple blood test to screen for lung cancer.

“People routinely get blood taken at their doctors’ offices for cholesterol levels, diabetes and other standard tests, so why not utilize this method to screen for other conditions such as the risk of developing lung cancer?” Louise C. Showe, a professor in the molecular and cellular oncology and immunology programs and director of the genomics facility at the Wistar Institute in Philadelphia, said in a news release from the institute.

“Such a test could be especially useful for remote areas where, typically, technologies that are used in urban centers are not available,” she said. “In addition, this test could be useful in a clinical setting to help to decide whether a small tumor detected on an X-ray is likely to be malignant.”

A growing number of children in the United States are being born with Down syndrome, federal researchers say.

The overriding reason, experts add, is that more older women are having babies.

Data from 10 regional registries of birth defects show that the incidence of Down syndrome among U.S. children increased by 31 percent between 1979 and 2003, from 9.0 to 11.8 per 100,000 live births.

The survey of U.S. children with Down syndrome provides a benchmark for determining whether adequate health services for them are being provided, the researchers say.

“In the past we have focused on the prevalence at birth,” said Dr. Adolfo Correa, a supervisory medical officer with the U.S. Centers for Disease Control and Prevention and lead author of the report, published online Nov. 30 in Pediatrics. “The survival of children with Down syndrome has improved over the years, so we were interested in knowing the prevalence among children.”

The growing incidence, however, could paint a false picture, said Dr. Siobhan Dolan, an associate professor of obstetrics and gynecology and women’s health at Albert Einstein College of Medicine and Montefiore Medical Center in New York City and a consultant to the March of Dimes Birth Defects Foundation.

The increase simply reflects the fact that more American women are having babies later in life, and “there is a strong epidemiological association between Down syndrome and maternal age,” Dolan said.

Down syndrome occurs when a child has an extra chromosome, number 21 of the 23 that determine genetic characteristics. Though most people think of the syndrome as a cause of mental retardation, some children with Down do not need special schools, Dolan said. But the extra chromosome is associated with a number of major physical problems, including life-threatening heart abnormalities.

The numbers in the new study “allow us to plan for Down syndrome, to see what is working for the children, including cardiac surgery to extend the life span,” she said.

Correo said the findings will help determine “whether the availability of specialty services will be enough to meet the needs of the Down syndrome population.”

The increased number of people with Down syndrome reflects “an accomplishment in our health system that should be noted,” Dolan said. “The care for Down syndrome individuals is probably improving, so that life expectancy is improving.”

Studies of the relationship between maternal age and the incidence of Down syndrome are continuing, she said. “That is the subject of very active research — what causes chromosomes to divide abnormally at certain ages. The genetics is really interesting.”

Tests to detect chromosomal abnormalities during pregnancy now are widely available, Dolan said. Such tests “can allow us to plan for health care, to plan for delivery, having a cardiology team there to care for the child,” she said.

A number of organizations provide advice and services for families with children who have Down syndrome, she said. “Getting educated from other families and support groups is an important asset,” she said.

Dolan also noted, however, that the data in the federal study now are now nine years old. “It is not 2009 data, and this is a continually changing field,” she said. “It is going to be interesting to see what happened between 2003 and 2009.”

Want to boost the odds that you’ll thrive after surgery and avoid complications?

The American Society of Anesthesiologists has a recommendation: Drop that butt.

Quitting smoking will make it more likely that you’ll recover from an operation without anything going seriously wrong, the society says.

“Anesthesiologists are the heart and lung specialists in the operating room, making sure our patients’ vital functions are working properly,” said Dr. David O. Warner, who chairs the group’s smoking cessation task force. “Every year, we care for up to 10 million smokers in surgery. We see the immense toll that smoking takes on a person’s body, but we also witness the tremendous benefits patients who stop smoking before surgery experience in their healing process.”

The association suggests that surgery provides an ideal opportunity for someone to quit smoking altogether because surgery patients are told to stop for as long as possible before and after their operation.

Surgery-related reasons to quit, the group says, include:
You’ll heal better after surgery. One study found that half of the people who continued smoking after surgery developed complications; the number fell to 20 percent among those who quit.
Hospitals are smoke-free, and it will be tough to leave to light up.
Within hours after you quit, your body will begin to heal. Within less than a day, the association says, blood flow throughout the body will get better, boosting the chances of avoiding complications from surgery.

That picturesque wood-burning stove ranks alongside auto traffic as a risk factor for bronchiolitis, the respiratory condition that is the leading cause of hospitalization in the first year of life, a new study finds.

“Those infants who had more exposure to wood-burning appliances were more likely to show up in doctors’ offices or be hospitalized for bronchiolitis,” said Dr. Catherine Karr, an assistant professor of pediatrics at the University of Washington, and lead author of a report in the Nov. 15 issue of the American Journal of Respiratory and Critical Care Medicine.

There hasn’t been much research done on the effects of air pollution on very young children, Karr said. Such studies have typically focused on older children, in whom asthma is a more prevalent problem related to air pollution.

Karr and Canadian researchers analyzed nearly 12,000 cases of infant bronchiolitis between 1999 and 2002 in the province of British Columbia, checking on exposure to air pollutants such as nitric oxide, nitrogen dioxide, carbon monoxide and particulate matter. They also looked at the source of those pollutants.

Infants who lived within 50 meters — about 55 yards — of a highway had a 6 percent increased risk of bronchiolitis, while those with higher exposure to wood smoke had an 8 percent increased risk, compared to those with the lowest exposure.

“Bronchiolitis is the number one reason why a child ends up in a hospital in the first year of life,” Karr explained. “It is responsible for 13 percent of those hospitalizations.”

Bronchiolitis is a respiratory condition that starts out looking like a common cold but can become “quite severe,” she said. It can be caused by viruses, and is often the first infection a child experiences early in life.

The study “lets families know about concerns about infant exposure to traffic and wood-burning appliances,” Karr said. “If they can avoid those things, they should. If they do use wood-burning appliances, they should use safety practices, making sure the appliances are properly vented and burn efficiently.”

The study included such pollution because “here in the Pacific Northwest, we have more exposure to wood-burning stoves than in other places,” Karr said.

“This study extends some past findings that wood smoke can be very irritating to the respiratory system, and has been shown to have effects on the lungs of children,” said George Thurston, director of the Particulate Matter Health Effects Research Center in New York.

“Wood smoke seems to have the biggest effects on respiratory health, whereas fossil fuels seem to have the biggest effects on cardiac health, because they are more laden with metals,” Thurston said.

The Pacific Northwest is unusual because of a higher concentration of wood-burning appliances, he said. “In other areas, traffic may dominate more,” Thurston noted.

Exclusive breast feeding for up to 6 months, though beneficial for an infants’ immunity and mothers’ weight, may not alter children’s health risks over the long term, study findings hint.

Dr. Michael S. Kramer, at The Montreal Children’s Hospital in Quebec, Canada, and colleagues assessed children through age 6.5 years for a number of outcomes according to whether they were exclusively breast fed for 6 months, or for 3 months followed by 3 months of combined breast and formula feedings.

Their findings, in the American Journal of Clinical Nutrition, hint that long-term advantages for children exclusively breast fed for 6 instead of 3 months “do not include lower risks of obesity, asthma, allergy, or dental caries,” Kramer noted in an email to Reuters Health.

He and colleagues also observed no differences in intelligence, behavior, or blood pressure measures between the 524 children exclusively breast fed for 6 months and the 2,427 fed in this manner for the shorter period.

The healthy-borne children, about half male, and their mothers had been enrolled in a breast feeding intervention study, conducted in the Republic of Belarus, which tallied feeding data through the children’s first year.

In previous analysis of this group, Kramer’s team showed exclusive breast feeding for 6 months tied to significantly lower incidence of gastrointestinal infections from 3 to 6 month of age.

In the current study, which assessed the children’s outcomes through the age of 6.5 years as reported by their pediatricians, mothers, and teachers, the only observed between-group differences were slightly higher measures of body mass, hip circumference, and thickness of the skin at the upper arm - all indicators of greater overall body fat.

However, these associations “seem unlikely to represent” exclusive breast feeding for 6 months as a cause for increased body fat during childhood, the investigators note.

Rather, Kramer and his co-investigators suspect these indicators may be tied to a mother’s confidence “to continue breast feeding if her baby is gaining weight well,” he said.

Kramer’s team plans continued follow up of this group of children through the age of 11 to 12 years to investigate any ties between breast feeding and risk indicators for heart disease and type 2 diabetes.

New guidelines are needed to improve the diets of U.S. school children, finds a new government report that would set maximum calorie counts for school breakfasts and lunches.

School meals should have less salt; more vegetables, fruits and whole grains; skim and low-fat milk, and other dairy products, the report from the Institute of Medicine says. It called on the federally funded National School Lunch Program and the School Breakfast Program to update its current policies.

“The program was due for a revision,” said IOM committee chairwoman Dr. Virginia A. Stallings, a professor and director of the Nutrition Center at Children’s Hospital of Philadelphia.

The committee’s job was to make recommendations to the U.S. Department of Agriculture, which runs the school meal program, Stallings said. “We expect that they will take this information and revise the program,” she said.

“These recommendations will become regulations, and schools are required to follow them if they are going to get reimbursed for school meals,” she said.

The IOM recommendations would bring school meals in line with the latest dietary guidelines and reference intakes from the U.S. Department of Agriculture. The current standards for school meals are based on the 1995 dietary guidelines and the 1989 recommended dietary allowances.

Increased funding will be needed to implement the changes because of the higher cost of vegetables and whole-grain foods, the report noted. Also, greater federal meal reimbursement, capital investment and additional training of food service personnel will be required for the recommendations to succeed.

But these changes are needed to assure parents that schools are providing healthful, satisfying meals, Stallings said.

“The school meal programs were established when we were worried about children being hungry and undernourished,” she said. “Now we have to worry both about that safety net for children who may not have enough food, but also balance it with a food supply that will prevent the school meals from contributing to the obesity problem.”

In the past, there had only been a minimum calorie amount, Stallings said. “What the committee is now recommending is a minimum and a maximum,” she said.

The report on healthy school meals suggests lunches contain no more than 650 calories for students in grades kindergarten through five; 700 calories for children in grades six to eight, and 850 for those in grades nine to 12. Breakfast calories should not exceed 500, 550 and 600, respectively, for these grade groups.

To ease the adjustment to lower salt meals, the report calls for reducing sodium over the next decade from today’s average of 1,600 milligrams per lunch to 740 milligrams.

In addition, breakfasts should contain one cup of fruit, and lunches for grades nine to 12 should also contain one cup of fruit. No more than half of the fruit should come from juice, the report says.

Vegetable offerings should increase to three-quarters of a cup a day for grades kindergarten through eight, and one cup a day for grades nine to 12. Starchy vegetables, such as potatoes, should be served less often, and at least half a cup each of green leafy vegetables, orange vegetables and legumes should be provided each week, the report said.

For grains, half of the breads and pasta should be whole grain, Stallings said. Milk served with school meals should be skim or 1 percent fat, she added.

Meat with lunches should be kept to about two ounces for all grades, but can be higher for students in high school. For breakfast, meat should be kept to about one ounce a day for children in kindergarten through grade eight, and two ounces for high school students, the report noted.

The National School Lunch Program is available in 99 percent of U.S. public schools and in 83 percent of private and public schools combined. The School Breakfast Program is available in 85 percent of public schools.

About 30.6 million school children participated in the school lunch program in 2007, and 10.1 million children had school breakfasts. In 2007, schools in the program served about 5.1 billion lunches and 1.7 billion breakfasts, according to the report.

Stallings hopes the recommendations will filter down to the meals parents serve at home. “I do believe that parents will be able to use some of this to talk about the kinds of fruits and vegetables they should be serving at home and other recommendations that are easily implemented, like going to skim or low-fat milk and thinking about sodium both in cooking and table salt,” she said.

Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine, said “this update to school nutrition standards is timely, and most welcome.”

School nutrition standards were originally devised to protect children from malnutrition and want, Katz noted.

“But in an age of epidemic childhood obesity, when children are far more likely to get too many calories than too few, and when more and more succumb to what was called ‘adult onset’ diabetes just a generation ago, the time-honored school food standards are clearly obsolete,” he said.

A new study suggests there’s a link between suicide and rural communities that have higher numbers of bars.

However, the research doesn’t confirm that more bars mean more suicides because it does not show cause and effect.

The findings were released this month online and will appear in the December issue of Alcoholism: Clinical & Experimental Research.

Of those who commit suicide, about 20 percent are alcoholics, according to background information in a news release from the journal. Almost all are men, and most are white.

Scientists from the Prevention Research Center in Berkeley, Calif., examined suicide statistics from California for 1995 to 2000, comparing them with the density of bars in rural areas.

Suicides occurred more often in less populous areas, such as rural communities, and in areas with older, lower-income white residents, the study found. Attempted suicide also was more common in rural areas. People who attempted suicide, however, were younger and not from a particular race.

“Although one cannot make the strong statement that more bars cause more suicides, our findings are at least consistent with what we would expect if patronizing bars or other alcohol outlets were in fact causally related to suicide,” Fred W. Johnson, associate research scientist and corresponding author for the study, said in the news release.

It’s possible that a factor other than the presence of bars could be at work, Dennis M. Gorman, interim head and professor of epidemiology and biostatistics at the Texas A&M Health Science Center School of Rural Public Health in College Station, said in the release. He was not involved in the study.

“For example, rural places with lots of bars might be depressing places to live in due to isolation, lack of social ties, etc.,” Gorman said. “This ‘depressing’ context would affect all who live there, both drinkers and non-drinkers.”

A French study estimates that more than 12 percent of people discharged from a hospital into home health care are infected with MRSA, or methicillin-resistant Staphylococcus aureus, and about 20 percent of them may transmit the organism to others in their household.

The researchers, Dr. Jean-Christophe Lucet, of Bichat-Claude Bernard Hospital in Paris, and his colleagues, screened 1,501 hospitalized adults for MRSA before they were discharged and found that 191 (12.7 percent) were infected. For the next year, those found to be infected and other people in their households were checked for MRSA every three months.

The 191 people with MRSA had 188 household contacts who took part in the study. Of those contact, 36 (19 percent) acquired MRSA, but none of them developed an infection. People most likely to be colonized with MRSA included those who were older and those who helped provide health care for the infected person. Sharing the same bed or bedroom did not increase the risk of MRSA transmission, according to the study.

The findings suggest that MRSA transmission is most likely among people who are at high risk for hand contamination while caring for people, the study’s authors noted.

Because no infections developed in any of the household contacts who acquired MRSA, it’s not clear whether such transmission poses a serious public health problem, the researchers said. Regardless, “household contacts should apply infection control measures similar to those recommended in the hospital setting,” they wrote.

Of the people discharged from the hospital with MRSA, about half of those followed for a year were found to be clear of infection, especially those who had become more self-sufficient in daily activities, the researchers said.

The study is in the Aug. 10/24 issue of Archives of Internal Medicine.