Alumnus Donates $1.5M In Grants To Two Penn Schools

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

07/18/2008

University of Pennsylvania alumnus Arthur Bilger and his wife, Dahlia, made two monetary gifts this week to his alma mater to be used to support research into interactive media business models and therapeutic drugs to treat Alzheimer's disease.

The Wharton School received a $1 million gift to create and support the Wharton Interactive Media Initiative (WIMI), a research program focusing on interactive media, its effect on global business and its influence on traditional media business models. This data-driven research will hopefully be applied to helping media companies do profitable business.

Of his family's donation to Wharton, Mr. Bilger said "Through the WIMI, Wharton will continue its tradition of cutting-edge scholarship with practical applications... to the world of business."

The Bilger Foundation's $500,000 donation to the School of Medicine will establish the Nathan Bilger Alzheimer Drug Discovery Initiative in memory and honor of Mr. Bilger's father. The monetary gift will be used by the Center for Neurodegenerative Disease Research (CNDR) to identify new methods and drug targets for the treatment of Alzheimer's disease that can hopefully be translated by their Marian S. Ware Alzheimer's Drug Discovery Center into new therapeutic drugs.

"The Bilger family gift will enable us to determine if an off-label drug used to treat organ rejection in transplant patients can be used to treat Alzheimer's disease," Dr. Virginia M.Y. Lee, CNDR director, said to the Almanac, a Penn-run publication.

Dr. John Q. Trojanowski, director of PennMed's Institute on Aging, explained that this is significant because early studies that are promising need a lot of money to evaluate them further as potential Alzheimer's therapies, and, "if successful, could put more drugs in the pipeline aimed at helping... patients by blocking... the disease process."

Mr. Bilger manages a private investment firm in California, is a member of Wharton's Board of Overseers, and along with his wife has supported the School of Arts and Sciences, Penn Medicine, and a scholarship for undergraduates.

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

Southeastern Pa. Projects Receive Millions In Fed Funds

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

07/18/2008

Federal funding for dozens of healthcare, education and labor projects in Southeastern Pennsylvania was approved earlier this month by the U.S. Senate Appropriations Committee.

The projects are a part of the Fiscal Year 2009 Labor, Health and Human Services, and Education (LHHS) Appropriations Bill.

Montgomery County's Southeastern Pennsylvania Consortium for Higher Education and the Philadelphia Shipyard Development Corporation will each receive $200,000 from the bill's funding, for professional development in K-12 mathematics and science instruction and job training for shipbuilding, respectively.

The majority of groups and projects included in the bill will receive $100,000 each. These range from construction, equipment and new beds for Chester County Hospital, professional development courses for K-12 teachers in science instruction at Cabrini College, renovation and equipment for a healthy living center in Northeast Philadelphia's Holy Redeemer Health System, and professional development, workshops and access to books for the Children's Literacy Initiative in Philadelphia.

"I am pleased my colleagues have approved this important funding for Southeastern Pennsylvania," U.S. Senator Arlen Specter said upon announcing the funding with fellow Pennsylvania Senator Casey. "Health and education are our nation's greatest capital assets, and these projects are vital to ensuring quality health care and education for the area's residents."

Sen. Casey added that he and Sen. Specter "will continue working [together] to ensure residents of the area have access to quality health care and education.

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

Television Noise Could Inhibit Toddler Learning

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

07/17/2008

To adults, background sounds from an unwatched TV show can be disregarded or embraced as comforting white noise, but a recent study shows this is not the case for infants and toddlers.
To their developing minds, TV noises could have the opposite effect, interfering with their ability to concentrate and learn according to findings published this week in the journal Childhood Development.

Researchers observed 50 toddlers between ages 1 and 3 at play in a room for an hour, with a half-hour of TV-free play and the other half-hour with the TV show "Jeopardy" airing in the room. When the TV was on, they noticed the children were more restless and distracted.

During a no-TV time, "the child gets an intent look on their face, they lean into the toy, their extraneous body movements decrease," wrote Dr. Daniel Anderson, a co-author of the study and a professor of psychology at the University of Massachusetts. "When they're in that state, they're much more likely to be learning."

In contrast, the children played for half as long - around 15 minutes - when the TV was turned on, were noticeably less calm and glancing up occasionally.

"You actually can see sometimes more aimless behavior, walking around like they're not quite sure what they're going to do next, " Dr. Anderson said.

In describing how these behaviors could be observed, Dr. Anderson said, "it's not something that you would really notice from just watching the child. [When we started the study] I really didn't know if children could just focus on their activity and shut out the background noise."

The American Academy of Pediatrics recommends zero hours of TV-watching for infant and toddlers below age three, but a Kaiser Family Foundation study in 2003 found that two-thirds of children under six years of age live in a home where the TV is on half the time, while one-third of children live in a home where it is on "most of the time" or "always."

Studies have been done on the effect of TV-watching on young children, but the effect of background noise on their ability to learn is new. Time-strapped parents and older siblings often combine TV-watching and time spent on childcare, so with young children being exposed to TV more frequently, the effect could be great.

For Dr. Gary Emmett, director of general pediatrics at Thomas Jefferson University Hospital in Philadelphia, a complementary prudent question would be whether children would grow up with language and cognitive difficulties.

"Reading is directly correlated to success in school, while watching TV and other things that [doctors] regard as passive... is counter-related ... Watching TV, while not always harmful is not always helpful."

To combat this problem, Dr. Emmett notes that language-rich homes - where families read, talk and engage in regular verbal communication - the impact of background distractions such as TV don't have as much of an effect as in language-poor homes.

Dr. Dimitri Christakis, the George Adkins professor of pediatrics at the University of Washington and Seattle Children's Research Institute, agreed.

"There have been a lot of studies that explored this, and early television is associated with delayed language, delayed cognitive developments, shorter attention span," he said, "What we haven't found yet is the mechanism."

According to Dr. Emmett, behavior and physical activity work together for health. As another study published this week in the Journal of the American Medical Association found, by the time children turn 15, their daily levels of activity slow down to below the recommended one hour per day.

In Pennsylvania and the tri-state area, there are pediatric medicine self-promotion programs available to families to begin working towards placing a greater emphasis on both feeding the mind and feeding the body.

Used at NEMOURS charity at the DuPont Hospital for Children in Florida, as well as in Delaware, Pennsylvania and New Jersey and called the "5-2-1-almost none" program (in Philadelphia, it's the 2-1-5-0 program, after Philadelphia area code), it calls for: five portions of fruit and vegetables a day, two hours or less a day of screen time (TV, computers, video games), one hour of running rather than walking, and no sweets and drinks.

"We're trying to get in [to the family routine] in the simplest way we can," said Dr. Emmett, who applies it in his work with families. "People always want things to be simplified, but things are complex. [We have to address] both issues (body and mind), not one."

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

Global Warming Linked To Kidney Stones?

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

07/17/2008

A Texas study hypothesizes the warming effects of climate change could increase the likelihood of developing kidney stones for some Americans living in dry areas.

The study, published in the July 8 issue of The Proceedings of the National Academy of Sciences, concludes that people could suffer from about 30 percent more kidney stones by the year 2050 than they do now, potentially causing a rise in treatment costs and other "significant effect."

Citing the lack of fluids that results from excess sweating or living in hot, dry climates, the report's lead author, Tom Brikowski, associate professor of geology at the University of Texas at Dallas, says he is "quite confident that kidney stone prevalence is related to climate."

The many risk factors that lead to kidney stone include obesity, high-blood pressure, inflammatory bowel disease and chronic diarrhea.

Kidney stones are formed from calcium or mineral deposits that crystallize into hard fragments that line the sides of the kidneys. Having them could be a painful experience involving excruciating side and back pain, pain during urination as well as fevers and chills if there is an infection, but it is treatable and usually has no lasting side effects.

However, "When you focus on the health effects of climate change, it might be wrong to pick out single outcomes and be overly focused on those," Dr. Jonathan Patz, a professor in the department of population health sciences and the Center for Sustainability and the Global Environment at the University of Wisconsin-Madison, said to ABCNews.com.

"I don't think you can compare it to something globally like malaria, which kills 2 million people per year, most of whom are children."

It would also be helpful to include measures that could be taken to prevent this problem, as opposed to simply declaring it a problem, which Kristi Ebi, lead author for the Intergovernmental Panel on Climate Change Fourth Assessment Report, and an independent consultant on the health effects of climate change, also noted to ABCNews.com.

"For a lot of health issues, at some point people just tune it out," said Ebi. "We hear that this causes cancer and that causes cancer [until at some point] ... the public says 'everything causes' cancer and I'm not going to worry about it.' This is not effective risk communication."

Optimistic, Mr. Brikowski considers his study's results something that experts can use as a starting point to look into "more of these unusual collaborations."

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

Big Brothers, Big Sisters Chapter Gets A Big Grant

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

07/16/2008

Philadelphia - The Big Brothers, Big Sisters Southeastern Pa. chapter yesterday announced a $586,201 grant awarded to the national organization through the Pennsylvania Commission on Crime and Delinquency.

The money will fund the non-profit's Big MAGIC Program, created to focus on mentoring children from poor neighborhoods in Chester, Delaware and Montgomery counties who are earning low grades and seem uninterested in school. This program follows the success of the organization's Mentoring for Violence program.

MAGIC stands for Mentoring Adolescent Growth in Communities.

Big Brothers, Big Sisters is a national organization with a stated goal of improving children's lives while strengthening communities through professionally supported one-on-one mentoring relationships. It is based in Philadelphia.


Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

Report: HUP Ranked 10th Among American Hospitals

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

07/15/2008

The Hospital of the University of Pennsylvania (HUP) has been named the nation's 10th best hospital.

As reported in the U.S. News & World Report's 2008 edition of America's Best Hospitals, HUP was also recognized for its excellence as one of the top 20 hospitals in the nation in 11 specialty categories, including ear, nose and throat care, gastrointestinal disorders, gynecology, heart [care] and heart surgery, kidney disease and respiratory disorders.

"We are delighted to be included in the list of national top 10 'Best Hospitals' in this year's U.S. News & World Report's Honor Roll," said Ralph W. Muller, CEO of the University of Pennsylvania Health System.

Hospitals that were considered for most of the magazine's lists were either affiliated with a medical school, serving as a participating member of the Council of Teaching Hospitals or actively using at least six of 13 key technologies. Only 1/3 of U.S. hospitals meet these qualifications. Veterans' and military hospitals were also not included because data was not available.

The hospitals are ranked based on a combination of clinical data about medical groups as well as patient evaluations of their experiences with doctors, medical staff and the quality of their personal and medical treatments. The feedback described communication as important in patient care, with more than four out of five patients saying their doctors gave them clear explanations.

The magazine's final annual list results from a survey conducted by Massachusetts Health Quality Partners, an independent agency that compares and evaluates clinical data about medical group performance. They survey included 51,000 adult patients and 20,000 parents of pediatric patients. Hospitals were judged on difficult cases according to a specialty, as well as on reputation and death rate.

The American Hospital Association and the Centers for Medicare and Medicaid Services also contributed data, all of which were analyzed by RTI International.

A 2008 edition of America's Best Children's Hospitals was published earlier this year, in which the Children's Hospital of Philadelphia (CHOP) was ranked as the number one general pediatric hospital in the nation for the sixth consecutive year. CHOP also ranked first in cancer care, neonatal care and care for respiratory disorders.

"Very sick kids need very special care," U.S. News columnist and rankings-list editor Avery Comarow wrote in a May CHOP press release. "The best places for them are ... facilities with a deep pool of expertise in their particular illness. Breaking out key specialties is crucial to help parents and caregivers find these facilities."

Unlike prior years where rankings information was included online for 170 hospitals ranked in one or more specialties, U.S. News has included all data and scores for the over 1,500 hospitals out of a total 5,453 that were analyzed.


Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

Some Antibiotics Could Damage Tendons, FDA Says

(for original article and comments, see www.thebulletin.us
As of this reprint, the statistics are under second review.)

By: Heather J. Chin, The Bulletin

07/14/2008

Some antibiotic drugs such as Bayer AG's Cipro and Avelox as well as Merck & Co. Inc's Noroxin will be required to have a stronger "black box" warning about the risk of tendonitis and ruptured tendons, according to new Food and Drug Administration regulations issued Tuesday.

In addition, an FDA-approved medication guide must be provided to individuals upon the filling of their prescriptions. Other drugs affected by the new requirements include Oscient Pharmaceuticals Corp.'s Factive, Depomed Inc.'s Proquin XR, and Ortho-McNeil's (a Johnson & Johnson subsidiary) Levaquin and Floxin.

Cipro and Levaquin, two leading drugs included in the warning, have other uses as well. Cipro is commonly used to treat urinary tract infections and is also effective against deadly bacteria, anthrax, being one of the drugs stockpiled by the government should a bio-attack occur. Levaquin is used to treat respiratory infections.

When sold by generic manufacturers, Cipro is referred to as ciprofloxacin and Floxin as ofloxacin. All of the drugs affected fall under a drug class known as fluoroquinolones.

Tendons are the tough, fibrous connective tissue joining muscles and bones. Also called sinew, they are essential to body movement and receive a lot of tension. Overuse can lead to inflammation and tendonitis, and excess pressure, some diseases and steroids can lead to snaps or ruptures. Such issues are normally thought of as sports injuries in young men or men in their mid-30s.

FDA studies indicate that the risk of tendon ruptures is estimated at about three to four times higher than normal rate (about one in 100,000) for those taking fluoroquinolones, notes Dr. Renata Albrecht, head of the FDA's division focusing on infectious microbes and transplant issues. Also, the risk is greater in patients ages 60 and older, particularly those who have had certain organ transplants or are using steroid therapy.

With this in mind, doctors are advised to restrict use of the drugs to confirmed bacterial conditions, and patients with tendon pain should immediately stop taking the drug, halt all exercise and call their doctor.
Patients who do experience a rupture may recover without surgery, but if surgery is needed to repair a torn tendon, full recovery may not be possible.

The regulation comes in the wake of a January 2008 lawsuit by consumer group Public Citizen, which had petitioned for the "black box" warnings two years ago and is still pushing for a warning letter to be sent to physicians describing the possible adverse reactions, such as tendon pain, that could be caused by the drugs.

"If the doctor is left out of the loop, it just doesn't make any sense," Sidney Wolfe, head of Public Citizen's Health Research Group said to Reuters UK.

Current labels for all the drugs involved already contain cautions about tendon problems, but Edward Cox, director of the FDA's antimicrobial products office, said, "The FDA believes that these labeling changes will better inform health care providers and patients about the risk."

Also, since the presence of several hundred "continued reports" of tendon-related problems indicated that these warnings were not reaching some doctors and patients, "additional steps are warranted to better manage the risk of tendon rupture," said Dr. Albrecht.

The specific number of reported cases were not available from the FDA, but Public Citizen's Mr. Wolfe lists government data as noting the numbers as 407 ruptures and 341 tendonitis cases through 2007 and 262 tendon ruptures, 258 tendonitis and 274 other tendon disorders through 2005.

Ortho-McNeil and their parent company Johnson & Johnson will add the new warning to both Levaquin and Floxin, as will Merck & Co. for its drug Noroxin, according to spokeswomen for the two companies.
Oscient released a statement saying it would review the issue and the remaining companies were not available for comment.

Heather J. Chin can be reached at hchin@thebulletin.us

Depression Meds May Trigger GI Tract Bleeding

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

07/11/2008

A class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are associated with an increased risk of upper gastrointestinal (GI) tract bleeding, particularly when combined with painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs), according to a study published in the July issue of Archives of General Psychiatry, a JAMA/Archives journal.

Many different medications fall into the category of SSRIs, which are widely prescribed to treat conditions such as depression and attention deficit hyperactivity disorder in both adults and adolescents and include drugs such as Prozac, Paxil, Effedra and Zoloft. NSAIDs are pain relievers, like ibuprofen and corticosteroids, used to treat things like arthritis, headaches, sports injuries, and fever.

In this study, two Madrid researchers at the Spanish agency for Medicines and Healthcare Products evaluated 1,321 patients with upper GI bleeding between 2001 and 2005 who had been referred to a specialist or hospital, and compared them with 10,000 control patients of the same age and sex who had no bleeding.

They found that patients with GI bleeding were more likely than patients in the control group to be taking SSRIs (5.3 percent versus 3 percent) or venlaxafine, an antidepressant commonly known as Effexor (1.1 percent versus 0.3 percent). This was an increased risk of 60 percent and almost 300 percent, respectively.

Dr. Francisco J. de Abajo, M.D., M.P.H., Ph.D. and Dr. Luis A. García-Rodríguez, M.D., M.Sc. consider their findings "important to determine whether [Effexor] also directly increases the risk of bleeding."

On the other hand, Dr. Abajo and Dr. García-Rodríguez's study also shows that taking acid-suppressing agents decreases the negative effects of the initial medications.

Since the early 1990s, case reports have noted a connection between SSRIs and upper gastrointestinal tract bleeding, other research has not, and none of these had studied what kind of effect the use of nonsteroidal anti-inflammatory drugs might have in conjunction with the other treatment.

Experts disagree on whether the study's evidence is conclusive or even significant. One argument is that "the risk of discontinuing antidepressants and getting depression and its consequences are much greater than [the consequences] of this drug," as Dr. Ewald Horwath, professor of psychiatry, epidemiology and public health at U. Miami's Miller School of Medicine said to the Washington Post.

On the other hand, another piece of advice would be to note if "you're taking [both] these medications. If you [are] along with other medications, keep it in mind and discuss with your physician," as Dr. Joseph White, associate professor of internal medicine at Texas A&M's College of Medicine said to the Washington Post.

Similarly, the authors wrote in their conclusion that "the wide use of this drug class requires research to provide more accurate risk estimates, to identify factors that may further increase the risk and, in particular, to determine whether using acid-suppressing agents may reduce the risk."

The study was funded by an unrestricted research grant from drug manufacturer AstraZeneca PLC for the validation of cases. Dr. García-Rodríguez has also received research grants from Pfizer Inc. and Novartis Pharmaceuticals Group.

Heather J. Chin can be reached at hchin@thebulletin.us

New Clue Found In Cause Of SIDS

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

07/10/2008

Sudden Infant Death Syndrome (SIDS), the leading cause of death among infants younger than 1 year old, could result from a deficit imbalance of serotonin levels in the brain, according to a new study published in the July issue of the journal Science.

SIDS describes the sudden, unexplained death of an infant between 1 month and 1 year of age. Also called "crib death" since it often occurs while the infant is asleep, SIDS strikes many seemingly healthy infants and can only be diagnosed after ruling out all other possible causes. African Americans and Native Americans are two to three times more likely than Caucasians to die from SIDS, and boys are more often affected than girls.

Serotonin is a neurotransmitter - a signaling chemical - that affects brain and organ function throughout the body, influencing an individual's mood balance and playing a role in everything from depression, anger and appetite, to the regulation of body temperature, heart rate and arousal from sleep.

Dr. Cornelius Gross, Ph.D., and colleagues from the European Molecular Biology Laboratory near Rome, Italy, made the "chance discovery" of SIDS-like symptoms while attempting to determine serotonin's role in aggression and society. They observed that genetically engineered mice with abnormally low levels of serotonin experienced erratic drops in heart rate and a drop in body temperature. But it was after over half of the mice used in the study died, all before three months of age, that the scientists made the association between serotonin levels and SIDS.

Dr. Gross emphasized that the SIDS-like symptoms exhibited by the lab mice were not indicative of symptoms experienced by human infants who suffered from SIDS, since the mice had been engineered to have an overactive gene that inhibits serotonin production.

SIDS incidence rates peak at three to four months in babies born at full-term, and at around three to four months after the due date of babies born prematurely. This period is notable as the time around when infants can turn over by themselves while asleep, thus increasing the likelihood of putting their faces against soft material.

However, as noted by Dr. Gary Emmett, a general pediatrician with Jefferson University Hospital in Philadelphia, precautionary measures have cut the incidence rate in the U.S. by more than 50 percent in the past 20 years. According to the CDC and the National Center for Health Statistics, SIDS deaths are down from 1.43 deaths per live birth (1984) to 0.51 deaths per live birth (2005) - around 2,500 deaths annually.

The study's findings are far from being conclusive, it supports previous studies done by Dr. Hannah Kinney, from the Children's Hospital of Boston, where inadequate serotonin levels were linked to SIDS, but not in a way that could establish a method to measure risk or related symptoms.

Doctors and researchers hope that this connection might spur further awareness, interest and development into creating ways to screen infants for risk of SIDS.

"Now that [low serotonin levels has] come up as strongly related to two different species, we know we're on the right track [and] it'll encourage people to study this more in living human beings," said Dr. Emmett.

Referring to his study, Dr. Gross added that "Maybe there is some kind of signature we could find in these mice before they have a crisis, some way they respond when they wake up from sleep. That might help us identify those kids most at risk [for] SIDS and provide parents with some[thing] ... before a crisis occurs."


Heather Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

Health Plan Signs Tech Software Deal

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

07/10/2008

Health Partners, the Philadelphia area's largest not-for-profit health plan serving Medicaid patients, signed a 10-year deal with health-care technology company Healthation to implement an e-business health care portal to enable 24-hour interaction between healthcare providers and the health plan, a press release announced yesterday.

The health-care portal, known as AboveHealth, is designed to provide real-time communication and the "capability to customize the types of interactions our providers would experience," according to Health Partners CIO Hal Augustine.

It was chosen because his constant access to shared information will both address the business needs of Health Partners' providers and increase efficiency with "a lot more self-service capabilities."

The new portal will first be implemented in October with a pilot group of providers that is estimated to last a couple of months.

Since Health Partners serves over 135,000 members in southeastern Pennsylvania is owned by a partnership of seven local hospitals and health systems, including the Albert Einstein Medical Center, St. Christopher's Hospital for Children, and the Hospital of the University of Pennsylvania, the new information portal will hopefully provide greater ease of access and communication to healthcare professionals throughout the region.

"We hope to provide real-time information to our members [about things such as] eligibility, ... claims status, claims reconsideration, and content such as formulary and clinical guidelines," said Mr. Augustine. "It should be a real advantage for our providers, ... [especially those who] find the Internet to be an efficient tool."

"Health Partners shares our vision for a transformed retail healthcare marketplace," Scott Kornhauser, Healthation CEO said in the press release. "We look forward to playing a key role in their innovative market advancement."

The agreement comes during a time when online technology and health care are finding ways to work together, whether by establishing privacy standards for online medical records or by merging e-prescription companies to facilitate a single network of communication.


Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

Italian Court Permits Removal Of Woman's Life Support

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

07/10/2008

An appeals court judge in Milan, Italy ruled yesterday in favor of a father's request to remove life support, in the form of a feeding tube, from his daughter, who has been in a coma for 16 years, the ANSA news agency reported.

Eluana Englaro has been in a vegetative state at a hospital in the northern Italian town of Lecco since a car accident in 1992, surviving on liquid food and water delivered via a feeding tube. Her father, Beppino, has sought to end her life support for nearly a decade, since 1999.

The Milan appeals court's decision was made based on evidence provided by Mr. Englaro proving both that Ms. Englaro's condition is "irreversible" and that before the accident, she had clearly stated her preference to die naturally rather than be kept alive artificially.

"I feel that I can now free the most splendid creature I have ever known," said Mr. Englaro in an interview posted on Italian newspaper La Reppublica's Web site.

Still, yesterday's ruling could still be appealed further to Italy's highest appeals court, the Cassation. Mr. Englaro can now either ask doctors to remove the feeding tube immediately or wait the 60-day period allowed for state prosecutors to appeal.

The decision continues to fuel debate in a country where the Catholic Church opposes euthanasia on the grounds that life is sacred, but where Italian law also upholds a patient's right to refuse care.

In a case that garnered international attention, the Catholic Church refused to allow a religious funeral for Piergiorgio Welby, a poet and writer paralyzed by muscular dystrophy, who campaigned for euthanasia while hospitalized in Rome until his death in December 2006 after a doctor agreed to unplug his respirator.

This case harkens back to the Terri Schiavo case in 2005, where the Florida woman relied on a feeding tube after suffering brain damage and going into a vegetative state. Years of legal battles that went as far as the U.S. Supreme Court ended with the removal of Ms. Schiavo's feeding tube and her death in March 2005.


Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

LOCAL: Graduate Hospital Reopens With New Name, New Owners

(previously published here at www.thebulletin.us)

By: Heather Chin, The Bulletin

07/09/2008

Philadelphia - After closing its doors nearly 16 months ago, Philadelphia's Graduate Hospital reopened yesterday with a newly renovated building and a new name: Penn Medicine at Rittenhouse.

The six-story campus in Center City on 18th and Lombard will specialize in providing post-acute medical care in two separate hospitals: a 38-bed long-term acute care hospital called Good Shepherd Specialty Hospital at Rittenhouse, and a 58-bed inpatient rehabilitation facility called Penn Institute for Rehabilitative Medicine for patients recovering from stroke, traumatic brain injury, spinal cord injuries and other illnesses requiring continued care.

Long-term acute care is medical care required for patients who need a level of continued and extended medical or nursing care that would not be available or affordable elsewhere. As described on the Good Shepherd Rehabilitation Hospital website, these patients are usually too ill to both stay in regular care or be discharged or transferred to a nursing facility.

The University of Pennsylvania Health System in Philadelphia and the Good Shepherd Rehabilitation Network of Allentown purchased the then-struggling Graduate Hospital (it lost $29.9 million in the 2007 fiscal year, according to a Thursday report by PHC4) and several surrounding properties last year from Texas-based Tenet Healthcare Corp. for $16.5 million and spent $70 million for renovations.

"We've pretty much filled most of the building with new programs," said Michael Dandorph, Penn Health System's senior vice president for business development, to the Philadelphia Business Journal. "We have a lot of space and a lot of program needs."

In addition to the acute care hospital and the rehabilitation hospital, the medical center will also have a 14-bed hospice unit on the top floor, along with its relocated patient simulation center where medical and allied health students will also be able to train on high-tech mannequins. Other services will include an ambulatory-surgery center, a pain-management center, and a radiology suite.

The Penn Health System will relocate some administrative offices to the site, as well as create an outpatient rehabilitation center.

The new Penn Medicine hospital is being operated by Good Shepherd Penn Partners (GSPP), a joint venture established last year by the two owners/investors, and has created 115 new jobs and GSPP estimates that 414 full-time staff will be employed once the medical center is fully up and running.

An additional 200 employees will work at the eight outpatient GSPP Penn Therapy and Fitness Centers throughout the region, also run by GSPP.

"We're excited about the joint venture because of the true continuum of care it brings to our patients," said Ralph W. Mueller, CEO of the Penn Health System, to the Philadelphia Business Journal. "Our patients can now transition seamlessly to post-acute care and other medical care services so essential for the best outcomes."

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

Non-Parent Care May Spur Infant Weight Gain

(previously published here at www.thebulletin.us)

By: Heather Chin, The Bulletin

07/08/2008

Aspects of modern family life, from stay-at-home parenting to childhood obesity, are increasingly residents of the public awareness, spurring conversation, influencing decisions, and permeating how we manage time in the workplace.

It may come as little surprise, then, that a new report in the Archives of Pediatric Medicine, one of the JAMA/Archives journals, has found a connection between child care by someone other than a parent and higher infant weight gain.

Nine-month-old infants regularly cared for by either a parent or a non-parent figure were observed during the study, conducted by researchers Juhee Kim, Sc.D., of the University of Illinois at Urbana-Champaign, and Karen E. Peterson of the Harvard School of Public Health, Boston, over the course of one year, during 2001 and 2002.

During regular home visits, the infants were weighed and measured and each respective primary caregiver provided information regarding type and intensity of child care, which included feeding practices.

The increase in weight came from what the researchers noted were higher rates of unfavorable feeding practices with the infants by non-parent regular caregivers.

"Infants who initiated child care at younger than three months were less likely to have been breastfed and were more likely to have received early introduction of solid foods than those in parental care," wrote the authors. Early introduction to solid foods is considered in the study to be a risk factor for weight gain, and both the National Institute of Child Health and Human Development and the American Academy of Family Physicians support breastfeeding for the first six months of care by women who don't have health problems.

Compared to infants who were cared for by parents, those in part-time care gained 174 grams (around 0.4 pounds) more weight, while infants cared for by relatives gained 162 grams (or around 0.35 pounds) more weight, were less likely to begin breastfeeding and also had a higher rate of early introduction to solid foods.

Out of 8,150 nine-month-old infants evaluated during home visits over the study period, a total of 55.3 percent of the infants evaluated received regular child care from a non-parent figure. Of these, half received full-time child care, 40.3 percent began care before 3 months of age, 39.3 percent began care between 3 and 5.9 months of age, and 20.7 percent began care at 6 months of age or older.

"Our study results provide new evidence that child care influences both infant feeding practices and risk of [becoming] overweight at least during infancy," the authors wrote in their conclusion.

According to background info in the study, almost 75 percent of infants in their first year of life receive some form of child care by individuals not their parents. In addition, the authors describe how child care is often associated with positive cognitive and language development, as well as strength in the social, emotional and academic realms.

As the first available study into the relationship between child care, feeding practices and infants' weight, both Dr. Kim and Dr. Peterson consider their findings to be simply a first step in understanding at least some of the factors that may lead up to a child being overweight. "Child care factors were associated with unfavorable infant feeding practices and more weight gain during the first year of life," they said, "[and] the effects ... warrant longer follow-up to determine subsequent risk [of such increased weight]."

Heather Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

Pollution Triggers Children's Allergies, Diseases

(previously published here at www.thebulletin.us)

By: Heather Chin, The Bulletin

07/08/2008

Living near roads that are heavily trafficked and polluted increases a child's risk of developing physician-diagnosed asthma, allergies and atopic diseases (chronic skin diseases) by more than 50 percent, a new study finds.

The 17-month study by researchers from Germany's Center for Environment and Health at the Institute of Epidemiology was based on the idea, as described by the lead author Joachim Heinrich, Ph.D, that "[children] living very close to a major road are likely to be exposed not only to a higher amount of traffic-derived particles and gases but also to a more freshly emitted aerosols which may be more toxic."

The study's results were published in the second June 2008 issue of the American Thoracic Society's American Journal of Respiratory and Critical Medicine. In his summary, Dr. Heinrich considers them to "provide strong evidence for the adverse effects of traffic-related air pollutants on atopic diseases as well as on allergic sensitization."

This is the first study to report an association between allergic sensitization and pollution levels. Previous studies done in the United States found links between the two, but took into account various socioeconomic, environmental and behavioral factors that are also associated with life in urban areas, making a causal relationship between pollutant exposure and allergic risk impossible.

Socioeconomic variables in U.S. studies over the past two years include the effect of diesel exhaust particles on airborne allergenic particles, environmental variables include ozone levels, and behavioral factors include recreational time spent indoors instead of outdoors.

Researchers for this study, however, say that older European cities like Munich, where the study was conducted, have roads and buildings that are established in a way that makes it possible to eliminate a correlation with economic advantages or disadvantages.

Approximately 2,900 four-year-olds and over 3,000 six-year-olds who had been born and were enrolled in school in the metropolitan area of Munich, Germany, were examined over the course of the study. The children's long-term exposure to traffic pollutants were calculated as a function of the distance from their houses to the major roads at birth and at ages two, three and six. Control groups were used to account for individual circumstances such as pet ownership, pet allergies and number of siblings.

Parents filled out questionnaires about their child[ren]'s respiratory diagnoses and symptoms while children were evaluated for asthma, sneezing, wheezing and eczema. At age six, all of the children were tested for food allergies. In addition, the air in each of 40 identified points near high traffic areas was tested for smog, soot and other particulate matter, as well as nitrogen oxide (NO2) once per season between March 1999 and July 2000.

On top of the 50 percent greater risk of allergic sensitization, the results found strong positive links between the distance of the nearest road and diseases such as hay fever, asthmatic bronchitis, eczema and allergic sensitizations. Also, children who lived within half a block (50 meters/164 feet) to a busy street had the highest probability of getting symptoms, compared to children living further away.

Heather Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

Mosquitoes In Bucks County Positive For West Nile Virus

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

07/07/2008

A Newtown Township park in Bucks County is the first location in the five-county Philadelphia area where the West Nile virus in mosquitoes have been found this year, report state and county officials.

The West Nile virus is carried by insects and primarily affects birds and animals, but if transmitted to humans, could cause inflammation of the brain.

The infected mosquitoes were part of a test sample taken from Tyler State Park, located in Newtown Township and Northampton, last week by the Pennsylvania Department of Environmental Protection (DEP), which is responsible for West Nile monitoring in the state park, who notified county health officials about the test results on Wednesday.

Although the DEP were unable to note the specific area from which the positive sample was taken, "if it's found in one spot, it's in the [general] area," agency spokesman Tom Rathbun told (The Doylestown) The Intelligencer. He suggested that area residents take extra precautions, such as wearing long-sleeved clothing when possible and removing standing bodies of water.

According to the state department of health, six counties in Pennsylvania have confirmed presence of virus-carrying mosquitoes this year, each instance of which involved one positive test.

State efforts to combat and prevent the West Nile virus from spreading from insects and animals to humans can include spraying insecticides and injecting mosquito breeding areas to prevent the larva from maturing into adults.

Spraying began this past Monday night, prior to the DEP test coming back positive, and according to Mr. Rathbun, the state plans more frequent, concentrated spraying to target both adult mosquitoes and their larva.

A good sign is that after the first round of spraying, the insect traps yielded fewer virus-carrying mosquitoes than they had prior, said Paul Smith, Bucks County's West Nile virus coordinator.

In 2006, Bucks County had the most mosquito samples in the state, 20 percent of the total reported 223 positive samples in Pennsylvania. In recent years, fewer birds and horses have tested positive for West Nile virus, while positive results in mosquito samples have increased from six in 2004 to 41 in 2006.

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

FDA Approves A New Insulin Pump

(previously published at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

07/03/2008

At the same time that a wireless insulin pump for diabetics has been approved for marketing and public use by the U.S. Food and Drug Administration (FDA), its regulators are reconsidering the standards they use to approve diabetes medications.

The FDA began hearing from a panel of outside diabetes experts, cardiologists and statisticians on Tuesday as to whether the agency should require pharmaceutical companies to prove, through extensive long-term clinical research studies, that their drugs reduce heart problems and do not increase risk of death in order to gain FDA approval.

Diabetes is a disease where the body either does not produce or properly use insulin, a hormone that converts food into energy. Prescription drugs used to treat type 2 diabetes - the most common form, where a person's body either produces too little insulin or rejects insulin - are currently evaluated on the basis of whether they are proven to control blood-sugar levels.

The wireless insulin pump that has been approved is known as the OneTouch Ping glucose management system and is produced by Animas Corp., a medical device company from West Chester, that is a subsidiary of Johnson & Johnson Corp. in New Brunswick, N.J. It makes it easier for individuals with diabetes to calculate and inject themselves with the proper dose of insulin.

This reconsideration of regulatory standards is the result of questions that arose last year after an analysis of a popular diabetes drug, Avandia, showed that although taking it lowered blood-sugar levels, its use also increased the risk of heart attack in individuals.

FDA research into the issue yielded no actionable results, and additional trials by Avandia's manufacturer, GlaxoSmithKline, which has operations in the Philadelphia area, will likely not be ready until 2014.

The panel's opinions may influence and affect that approval of both new diabetes drugs and those that are already on the market.

However, there are some scientist even from within the FDA, who are skeptical of the value of tying risk of a side effect (heart attack) to the approval and availability of a drug whose target goal is to treat [low blood sugar and] diabetes.

Still, consumer advocates, lawmakers and diabetes organizations express concern over the risk of possible side effects.


Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

Witness A Parade Of Fireworks And Planets

(previously published at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

07/03/2008

If watching displays of light burst forth across the night sky sounds like a wonderful idea this Independence Day weekend, then the cosmos could provide an otherworldly spectacle to behold.

This weekend and through the rest of July, the solar system will burst forth in a parade of some of its most notable glories. Visible across much of the northern United States, Mars, Saturn, Jupiter and Venus can be seen just about every night and early morning in the Greater Philadelphia area, particularly where there is less light pollution.

Before heading out, know the first rule of thumb for planet watching: stars twinkle and planets don't.

Mars, Jupiter and Venus "will be much lower on the horizon after sunset, making it very difficult to view them, especially under Center City light [and building] conditions," notes David Pitts, the Franklin Institute's planetarium director. "But if you start [looking] just as the sky is getting dark, these planets are the first objects to make themselves visible, other than the moon."

The best place to view planets this month would be somewhere with a clear view of the horizon - where sky meets land in our line of sight -with no buildings and trees. The best time would be about 20 to 30 minutes after sunset.

First up in the planetary parade are Mars and Saturn, low in the western sky. Known as the Red Planet, Mars begins moving away from the star Regulus, a bright bluish-white star in the constellation Leo, and closer to Saturn at the start of July, continuing for almost two weeks until they are less than one-degree apart.

With the two planets being so close to one another, how is anyone, especially astronomy-loving kids, supposed to tell them apart?

According to Mr. Pitts, Saturn is the brighter of the two and is a whitish color with a slight yellow tinge, whereas Mars is farther from Earth (at 165 million miles away, it's more than three times its average distance from Earth), thus much dimmer, and has a sort of pinkish, coral-like color.

With a telescope, it might even be possible to spy Saturn's rings, which encircle its planetary body.

Over the Fourth of July weekend, Mars and Saturn will be joined by Earth's moon, which will be starting a new cycle and look like a thin crescent. On Saturday, the three celestial bodies will align to form a straight line, and by Sunday night, will form a sort of triangle that when viewed through binoculars, may seem like an almost three-dimensional view.

The aligning of Mars, Saturn and Earth's moon like this is possible because they orbit the sun along roughly the same geometric plane and, from our viewpoint on Earth, appear to trace a line called the ecliptic.

Although not a once-in-a-lifetime spectacle, the teaming up of the Red Planet (Mars) and the ringed planet (Saturn) in the summer sky won't occur again until April 2022.

Jupiter and Venus join the summer sky parade beginning in mid-July, when Jupiter - the largest planet in our solar system - rises at around 10 to 11 p.m. in the opposite direction of the sunset on July 9, according to the U.S. Naval Observatory. This planet, known for its gaseous atmosphere, is larger and reflects more light than the other planets, thus making it brighter. It can be identified by its creamy color.

Rising as the sun sets and setting as the sun rises, Jupiter will be at its brightest during this period and will be visible throughout the night. On July 16, Jupiter will rise with the nearly full moon, while on July 18, it rises before the moon. Although easily visible without a telescope, Mr. Pitts suggests bringing one along anyway because with it, you can see the four largest moons of Jupiter around it.

Finally, as July wanes and August begins, Venus becomes more prominent above the horizon, providing a beautiful end to a fantastic lineup of planetary bodies.


Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

Two Area Parks To Get Sprayed For Mosquitoes

(previously published at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

07/02/2008

Philadelphia - Two Philadelphia-area parks have been scheduled for insecticide spraying by the Philadelphia Department of Public Health, according to a press release yesterday.

The spraying is being done as preventative measure to control adult mosquitoes that can potentially carry the West Nile virus.

Although there have been no reported human infection by the virus in the state this year, authorities are taking no chances given discovery of West Nile virus carrying mosquitoes in Lancaster County last month.

FDR Park, in South Philadelphia surrounded by Broad Street, Pattison Avenue, 26th Street and I-95, is scheduled to be sprayed this evening, while the park is closed. It was chosen for spraying based on samples taken by "Vector Control" staff that have shown a larger than usual adult mosquito population in the area.

The Vector Control staff is responsible for monitoring and protecting the public from carriers of infectious diseases.

Penny Packer Park, in Willingboro, N.J., received insecticide treatment last night.

These mosquitoes have not been identified as carriers of the West Nile virus, but the high concentration was enough to warrant precautionary measures.

The chemical treatments are administered via a truck-mounted vehicle that sprays a fine mist of aerosol droplets, which stays in the air and kills mosquitoes on contact. The chemical spray is called Anvil 2 + 2, a synthetic pyrethroid, and has no residual effects or other negative effects on human health, and evaporating into the atmosphere.

Certain mosquito species are capable of carrying the virus, which if transmitted to people can cause West Nile encephalitis, an infection that can result in an inflammation of the brain.

During each of the past two years, nine cases of West Nile virus infections were reported in Philadelphia in humans. Last year, all of those affected recovered, while in 2006, two people died.

In 2003, 237 human cases of West Nile virus infections were reported, nine of which proved fatal.

Individuals and families have many precautionary options available around the home to help eliminate mosquito-breeding areas, which tend to be areas of water that sit untouched for any extended period of time.

These measures include the cleaning of roof gutters and bird baths, the chlorination or inclusion of fish in swimming pools, and the disposal of tin cans, plastic containers or any water-holding containers around your house.

Complementary steps can be taken to prevent mosquito bites, as well. Wearing long-sleeved shirts, long pants and socks when outdoors during dawn or dusk is a common precaution, as are the use of tight screens over doors and windows and the use of insect repellents that include DEET, picaridin, or oil of lemon eucalyptus, although repellent is only recommended for children older than two months.

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

Compromise Struck On The State Budget

(previously published at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

07/01/2008

State legislators and Rendell administration officials struck a compromise in Harrisburg at around 1 a.m. yesterday on what the governor described as "a very difficult budget" to pass.

The new budget represents a 3.8 percent increase over last year's, but is about $120 million less originally proposed in February.

Discussion of the handshake agreement will continue over the next several days, but the $28.2 billion plan avoids a repeat of the feared furloughs of 25,000 state employees and shutdown of government services.

"The governor is pleased that the parties were able to reach a consensus on an outlet for a budget ... and [Gov. Rendell] is looking forward to signing the legislation," said Chuck Ardo, the governor's press secretary.

Some of the give-and-take by lawmakers involved compensation for a lower-than-expected surplus by cutting $545 million in funds, all without requiring any broad-based tax or fee increases, and not dipping into the state's budget reserve.

In order to do this, the state will transfer at least $60 million from surpluses in special accounts, such as the liquor store system and recycling fund to cover general spending. In addition, the state lottery fund will be used to support $50 million in nursing home costs, including a "one percent cost of living increase for human service providers and for the nursing homes," said Republican Sen. Ted Erickson of Delaware and Chester counties.
With this in mind, reaching a budget agreement this year was "an achievement in and of itself," according to Senate Majority Leader Dominic Pileggi, R-Delaware.

Still, "it was generally a pretty good agreement in light of the lack of surplus money available," said Gary Tuma, press secretary to Sen. Vincent Fumo, D-Phila., "although there were other items he would have liked to see addressed, such as health care." "Some of the governor's proposals had to be scaled back in a way that preserves most of his agenda, like education funding and energy proposal, [but] a consideration of some of that is being put off to the fall."
Rep. Dwight Evans, D-Phila., chair of the House Appropriations Committee, struck a similarly circumspect note, saying that the compromise required "everybody [having] to give up something."

These sacrifices apparently include the state foregoing its annual contribution to its reserve fund, the "Rainy Day Fund."

However, the large amount of borrowing from some projects to fund others struck some organizations as unnecessary and a big concern.

"Unfortunately, this budget doesn't reflect the needs of Pennsylvanians today," said Matthew Brouillette, president of the Commonwealth Foundation, a nonprofit public policy organization based in Harrisburg.

"The use of the borrowing is effectively using credit card to run government and the growth in spending exceeds what most Pennsylvanians are budgeting for in their family budgets. We would like to see more fiscal restraint in holding the line on both borrowing and spending [since] higher spending today usually leads to higher taxes tomorrow."

Much of this borrowing takes place in the area of clean energy projects and infrastructure maintenance such as replacing aging municipal water and sewer facilities.

Mr. Rendell noted that the budget includes $350 million to repair about 400 structurally deficient bridges and $800 million for water and sewer system upgrades over the next several years.

"There was some progress on some of the governor's signature items and less on others, but overall he is pleased that the budget protects the progress we've made and allows us to invest in our children, alternative energy and future economic development," said Mr. Ardo.

Budget allocations also include around $290 million for school districts.
Lawmakers will be in session today and tomorrow, putting bills on the calendar that will then be addressed on Thursday and Friday before the final stage budget gets signed.


Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

New Vaccines Approved For Kids

(previously published at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

06/30/2008

Pentacel and Kinrix, two new combination vaccines that immunize infants and children against multiple diseases with fewer injections, received federal approval this week and will be available for distribution to U.S. health care providers by this summer.

Kinrix is produced by GlaxoSmithKline, a UK company with operations and research and development sites throughout Philadelphia, Upper Merion and King of Prussia. Likewise, Pentacel has a Pennsylvania connection, as it is the product of Sanofi Pasteur of Swiftwater. It is a division of Sanofi Aventis Group, a French company that creates vaccines protecting against infectious diseases.

The two vaccines were approved by the Advisory Committee on Immunization Practices, which voted to recommend adding both combination vaccines to the federal government's Vaccines for Children program. The program which provides free vaccinations for all children, regardless of ability to pay.

For the 6 weeks to 4-5 year (before the fifth birthday) age group, the FDA has approved Pentacel, a five-in-one vaccine manufactured by Sanofi Aventis, to protect infants and children against diptheria, tetanus, pertussis (also known as whooping cough), polio and Haemophilius influenzae type b (Hib).

It is administered as a four-dose series, one-a-time at 2, 4, 6 and 15-18 months of age. It is the first four-dose combination vaccine licensed in the U.S. that includes both poliovirus (IPV) and Hib vaccine antigens.

For children 4 to 6 years of age, GlaxoSmithKline will release Kinrix, a four-in-one booster vaccine that uses only one shot and is geared for use to protect against diptheria, tetanus, pertussis and polio. Kinrix is recommended for use by children who have already taken Infanrix or Pediarix vaccines.

Infanrix covers DPT, diphtheria, tetanus, and pertussis (whooping cough).
Pediarix is a multiple vaccine that covers DPT, hepatitis B and polio, and has had over 30 million doses used in younger children since 2003.

Clinical studies into Pentacel and Phase III trials into the safety of Kinrix have shown that the new combination vaccines offer similar safety benefits as previous vaccines.

Both vaccines seek to remedy the problem of multiple doctor visits where young children, their parents and their doctor must deal with the stress of frequent needle jabbing. The U.S. Centers for Disease Control and Prevention (CDC) currently recommend up to 23 single shots by the time a child reaches 18 months of age.

Using combination vaccines "reduces the number of shots by 6 shots in the first year of life, with the same degree of efficacy and no[ne or fewer] side effects," said Dr. Gary Emmett, professor of pediatrics at Jefferson University Hospital and member of the Board of Health in the city of Philadelphia.

Fewer shots can also have a positive effect on the child's health.

"When I started practicing, we gave DTP, which had almost 200 separate antigens in it, " said Dr. Emmett. "Now we give DTaP, which is more refined and has less than 30 antigens, so even though... the [earlier ones] were effective, they gave more side effects. Now we have less sore arms, less fevers, making the [children and the] pediatricians happy."

Combination vaccines can also help to fulfill both school and CDC immunization requirements, says Jennifer Armstrong, a GlaxoSmithKline spokewoman, while also creating less need to experience painful finger or arm pricks, especially when young children are involved.

"Four- to six-year-olds are a particularly challenging group," said Ms. Armstrong. "They are old enough to [know what's coming and] say no right off the bat."

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008