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    <recommendedItem id="20100101_19_322"
                     title="Switch to Low-Fat Milk in Schools Shows Benefit"
                     score="0.005"
                     href="http://www.medpagetoday.com/PrimaryCare/DietNutrition/tb/18192?impressionId=1265777352282"
                     
      &lt;p&gt;When New York City public schools made the switch from whole milk to skim or low-fat milk, students cut their annual fat and total calorie consumption, department researchers found.&lt;/p&gt;
&lt;p&gt;Milk-drinking students consumed 5,960 fewer calories and 619 fewer grams of fat per year after they made the switch, Philip M. Alberti, PhD, of the New York Department of Health and Mental Hygiene, and colleagues reported in the Jan. 29 issue of CDC&apos;s &lt;em&gt;Morbidity &amp;amp; Mortality Weekly Report&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;At 3,500 calories per pound, the reduction would be the equivalent of 1.7 pounds of body weight over the course of a year.&lt;/p&gt;
&lt;p&gt;&quot;The switch to lower-fat milk likely has improved the overall nutritional environment of NYC public schoolchildren,&quot; Alberti and colleagues wrote.&lt;/p&gt;
&lt;p&gt;On the other hand, most of the low-fat milk consumed was chocolate milk, which has a substantially higher sugar content than unflavored milk, the researchers found.&lt;/p&gt;
&lt;p&gt;In 2005, the New York City Department of Education began reviewing its food policies and determined that replacing whole milk with fat-free or low-fat milk could decrease students&apos; fat and calorie intake.&lt;/p&gt;
&lt;p&gt;At subsequent board meetings, milk industry advocates suggested that without whole milk or chocolate- or strawberry-flavored milk, student milk consumption would decline, thus decreasing calcium and vitamin intake.&lt;/p&gt;
&lt;p&gt;Nonetheless, the Department of Education began phasing out whole milk in 2005, and limited flavored milk to fat-free chocolate milk.&lt;/p&gt;
&lt;p&gt;The researchers didn&apos;t have data on student consumption of milk, so they analyzed system-wide school milk purchases.&lt;/p&gt;
&lt;p&gt;They found that per-student school milk purchases dropped 8% between 2004 and 2006, but then gradually began to increase. By 2009, purchases had risen 1.3% from five years prior: from 112 per student in 2004 to 114 in 2009.&lt;/p&gt;
&lt;p&gt;Fat-free milk accounted for 42% of all purchases in 2009, compared with less than 7% in 2004.&lt;/p&gt;
&lt;p&gt;In 2004, students purchased more than 18 billion calories and 520 million grams of fat in the form of milk. That fell to less than 14 billion calories and 98 million grams of fat in 2009, representing a 25% and 81% decrease, respectively.&lt;/p&gt;
&lt;p&gt;Over that five-year time period, the researchers calculated that if calorie and fat savings were distributed among all students  --  including those who don&apos;t drink milk  --  they would consume 3,484 fewer calories and 382 fewer grams of fat each year.&lt;/p&gt;
&lt;p&gt;If the data were limited to students who do drink milk during the school day  --  62% of students in 2004 and 63% in 2009  --  the savings increased to 5,960 calories and 619 fat grams per year.&lt;/p&gt;
&lt;p&gt;Alberti and colleagues wrote that the data show the milk policy change reduced fat and calorie intake while still providing protein, calcium, and vitamins A and D.&lt;/p&gt;
&lt;p&gt;&quot;Other school systems can use these results to guide changes to their own school food policies,&quot; they said.&lt;/p&gt;
&lt;p&gt;They noted, however, that the majority of low-fat milk consumed  --  60% of all milk purchases  --  was chocolate milk, a concern because sweetened milk has more calories than reduced-fat white milk and contains twice as much sugar.&lt;/p&gt;
&lt;p&gt;But limiting its availability would &quot;further reduce milk consumption,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;The authors noted that the study was limited because there were no data to evaluate the magnitude of the correlation between milk purchasing and milk consumption. Also, no data were collected on students&apos; diets, so the researchers could not assess the policy&apos;s larger effects on diet.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_261"
                     title="Scrubbing Away Germs Can Backfire on Backsides (CME/CE)"
                     score="0.002"
                     href="http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb/18121?impressionId=1265777352282"
                     
      Rashes from toilet seats are once again afflicting American children, and the rare condition is often misdiagnosed, which may delay proper treatment.&lt;br&gt;
&lt;br&gt;That&apos;s the conclusion from a report based of five-cases of toilet-seat contact dermatitis investigated by researchers at Johns Hopkins University School of Medicine and reported in the Jan. 25 issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;While toilet-seat dermatitis is commonly thought to result from allergies to wooden seats, the report concludes that another source is plastic toilet seats cleaned with harsh detergents.&lt;/p&gt;
&lt;p&gt;&quot;This case series and previous reports have documented that toilet-seat dermatitis is much more common than previously recognized in the U.S. and around the world,&quot; Bernard A. Cohen, MD, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;Furthermore, the incidence of this condition is rising in North America because of a resurgent popularity of exotic-wood toilet seats and frequent use of detergents that contain highly irritant/sensitizing compounds such as quaternary ammonium compounds, phenol, formaldehyde, etc. in public restrooms.&quot;&lt;/p&gt;
&lt;p&gt;Of the cases analyzed by the authors, two occurred in the U.S. and the other three occurred in India.&lt;/p&gt;
&lt;p&gt;Both U.S. cases were girls, a 6-year-old who had a rash for over two years before it was correctly diagnosed and a 10-year-old whose rash lasted for a year. In both cases, the rashes seemed to worsen during the school year when the girls were using school restrooms. The younger girl&apos;s dermatitis twice became infected with methicillin-resistant &lt;em&gt;Staphylococcus aureus &lt;/em&gt;and required treatment with antibiotics.&lt;/p&gt;
&lt;p&gt;After doctors determined the rashes were the result of contact with toilet seats and instructed the girls to use toilet-seat covers and apply moisturizers and topical steroids to the affected areas, the eruptions cleared up within a few weeks.&lt;/p&gt;
&lt;p&gt;The cases in India included a 14-month old boy and two girls, 12 and 10.&lt;/p&gt;
&lt;p&gt;The boy and the 12-year-old girl were both initially misdiagnosed with ringworm and unsuccessfully treated with clotrimazole cream. The other girl was unsuccessfully treated with ayurvedic and homeopathic topical medications before doctors diagnosed toilet-seat dermatitis. Two of the children were instructed to use soaps that only exacerbated the problem.&lt;/p&gt;
&lt;p&gt;In all three cases, the rashes cleared up with some combination of topical steroids, using toilet-seat covers, replacing the household toilet seat, and limiting time on the toilet.&lt;/p&gt;
&lt;p&gt;The authors distinguished between two types of toilet-seat dermatitis: allergic contact dermatitis, the better described form of the condition, in which a patient develops allergy to wooden toilet seats, and irritant contact dermatitis, in which the rashes result from contact with harsh detergents used on plastic toilet seats.&lt;/p&gt;
&lt;p&gt;They noted that detergents used in public restrooms and in hospitals are potentially more irritating to the skin than those used at home and that alkaline detergents are more likely to cause skin irritation than acidic detergents, because they perturb the body&apos;s natural acidic environment.&lt;/p&gt;
&lt;p&gt;Toilet-seat dermatitis was first identified as an external skin rash in 1927. Exposure to wooden toilet seats and associated varnish, lacquers, and paints led to sensitization and development of an allergic contact dermatitis.&lt;/p&gt;
&lt;p&gt;The condition nearly disappeared in the U.S. in 1980s and 1990s, after public facilities and homeowners in the U.S. changed from wooden to plastic toilet seats and sanitary seat covers became readily available.&lt;/p&gt;
&lt;p&gt;However, in recent years the number of cases has grown as a result of homeowners installing toilet seats made of exotic woods and the increased use of harsh toilet seat detergents.&lt;/p&gt;
&lt;p&gt;Most reports have focused on adults with rashes, but little previous attention has focused on the condition in children. &quot;In this case series we describe toilet-seat contact dermatitis in children and underscore a typical history and physical findings that we hope will aid clinicians in recognizing this disease,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;It is important to underscore that regular use of toilet-seat covers is the key to success in treatment,&quot; the authors wrote. &quot;Such seat covers can be purchased at any major retailer such as Walmart or online.&lt;/p&gt;
&lt;p&gt;As an alternative, newspaper cutouts could be used to provide barrier protection. Although it is possible to develop an allergy to toilet-seat covers, none have been reported thus far in the literature.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors reported no sources of funding or financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_265"
                     title="How Many Calories in that Happy Meal? (CME/CE)"
                     score="0.002"
                     href="http://www.medpagetoday.com/PrimaryCare/DietNutrition/tb/18099?impressionId=1265777352282"
                     
      Putting nutrition labels on fast food may lead parents to pick lower-calorie meals for their children, researchers say.&lt;br&gt;
&lt;br&gt;In a small waiting room study, parents ordered about 20% fewer calories for their kids when they chose from a menu with nutrition information on it, Pooja Tandon, MD, of the University of Washington, and colleagues reported online in &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;&quot;One hundred calories over time and at a population level is actually a significant amount in terms of being able to avert weight gain,&quot; Tandon told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;Many fast-food restaurants don&apos;t provide nutrition information at the point of purchase. In a recent study, just about half  --  54%  --  of the largest chains made some nutritional information available on site. The majority  --  86%  --  provided it only through their Web sites, leaving consumers clueless while ordering.&lt;br&gt;
&lt;br&gt;Labels have long been advocated as a means of lowering calorie consumption. So to determine whether nutrition labeling specifically on fast-food menus would lead to lower-calorie choices for children, the researchers conducted a randomized, controlled experiment in a primary care pediatric clinic in Seattle.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Parents of children ages 3 to 6 were given a McDonald&apos;s menu, and then asked to pick out meals anonymously&lt;strong&gt; &lt;/strong&gt;for themselves and their child.&lt;/p&gt;
&lt;p&gt;The menus were identical, with one exception: those given to parents in the intervention group included nutrition information, while the menus given to parents in the control group had none. The menus did include prices for both groups.&lt;/p&gt;
&lt;p&gt;A total of 99 parents participated between October 2008 and January 2009. Some 62% reported eating fast food one to four times over the previous month, mostly because it was quick, cheap, or fun.&lt;/p&gt;
&lt;p&gt;The researchers found that parents who were given nutritional information ordered an average of 102 fewer calories for their kids than did controls (567.1 cal versus 671.5 cal, &lt;em&gt;P&lt;/em&gt;=0.04).&lt;/p&gt;
&lt;p&gt;On average, the nutrition-labeled menu reduced total calories ordered by 20%, the researchers wrote.&lt;/p&gt;
&lt;p&gt;The difference remained significant after adjustment for gender, race, education, BMI, fast-food frequency, and child&apos;s BMI z-score (&lt;em&gt;P&lt;/em&gt;=0.004).&lt;/p&gt;
&lt;p&gt;&quot;We know that fast food consumption is rising alongside alarming rates of child obesity in this country,&quot; Tandon said. &quot;These results make me optimistic that if parents are given nutritional information at the point of ordering  --  and not on a Web site or tray liner  --  they will have the tools to make healthier, lower-calorie choices for their children.&quot;&lt;/p&gt;
&lt;p&gt;Research has suggested that even small changes in behavior that affect energy balance by about 100 calories per day could avert weight gain in most adults.&lt;/p&gt;
&lt;p&gt;Interestingly, Tandon said, there were no differences between the groups when it came to parents&apos; choices for themselves. Both ordered about the same number of calories.&lt;/p&gt;
&lt;p&gt;&quot;I&apos;m not sure exactly what&apos;s going on with this group of parents, but this is a trend we&apos;ve seen,&quot; Tandon said. &quot;I would hypothesize that there are some other factors at play when people are choosing for themselves and their children in terms of wanting children to eat healthier than they might for themselves.&quot;&lt;/p&gt;
&lt;p&gt;There was also a positive correlation between how many calories the parent ordered and how many calories he or she ordered for the child (&lt;em&gt;P&lt;/em&gt;=0.02).&lt;/p&gt;
&lt;p&gt;&quot;We do know that if a child has one or two parents who are overweight, that increases their chance of being overweight, so [obesity] probably is a combination of genetic and environmental factors,&quot; Tandon said.&lt;/p&gt;
&lt;p&gt;Tandon noted that a growing number of local and state governments have adopted restaurant menu labeling regulations, and legislation for federal labeling standards has been introduced in both the House and the Senate.&lt;/p&gt;
&lt;p&gt;&quot;At a time when menu labeling is being discussed throughout country at the national level, I think these results support the&lt;strong&gt; &lt;/strong&gt;idea that an informed parent will be able to make smarter healthier choices for their child,&quot; she added.&lt;/p&gt;
&lt;p&gt;The study was limited because it was not conducted in a real restaurant setting. Food choices are made within social and environmental contexts, Tandon said, and the results of a mock menu survey in a clinic may not fully represent that reality. A randomized experiment in a real restaurant setting would be an ideal follow-up.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
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                     title="Breastfeeding Improves Stress Response Later in Childhood"
                     score="-0.005"
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