BOSTON - In an age when parents and children are bombarded with images and stories of natural disasters, terrorist attacks, child abductions, and school violence, it's no surprise that heightened efforts to protect the family are often joined by more anxiety and stress.  Parents and caregivers seeking to safeguard their children from dangers of the modern world - without burning out - can use The Safe Child Handbook: How to Protect Your Family and Cope with Anxiety in a Threat-Filled World (John Wiley, New York).  Written by John S. Dacey, of Boston College, and his former doctoral student Lisa B. Fiore, now of Lesley University, the book outlines the top eight threats to children and parents - kidnapping, terrorism, child abuse, school violence, drug and alcohol abuse, weather emergencies, home safety, and inappropriate media influence - and shows how families can be ready to face the most drastic situations with confidence.  The step-by-step guide is a tool for families to prepare and protect their loved ones from realistic threats and risks without getting stressed out.  "It can be as dangerous to over-protect your children as it is to do too little," says Dacey, developmental psychologist and originator of the four-step "COPE" method that teaches children to use self-control to reduce anxiety.

WASHINGTON - Reuters Health noted that in older patients with long-term diabetes, thickened and discolored toenails often suggest a fungal infection, a presentation at the Council of Nail Disorders showed.  Doctors "should be alert to our finding that, in patients at high risk for developing diabetic foot ulcerations, fungal infections of the toenails are common," Dr. Stephanie Wu, of Rosalind Franklin University of Medicine and Science in Chicago, told Reuters Health.  Dr. Wu emphasized that just because a nail is thickened and discolored doesn’t mean there is a fungal infection.  These changes may be the result of mild trauma to the foot, such as wearing ill-fitting shoes.  He and colleagues evaluated 96 patients with decreased foot sensitivity, a common finding among diabetics, and thickened, discolored nails.  The patients, seen for routine care at a diabetes clinic, were all male, an average of 71 years old, and had diabetes for an average 16 years.  The investigators obtained nail clippings of the most affected nail and debris under the nail: 25 had nail thickening but no evidence of infection.  The other 71 had fungal nail infections.  Dr. Wu noted antifungal treatment is usually effective, but oral agents must be used with caution because of their tie to heart failure and hepatic toxicity.  Successful resolution of the fungal infection isn’t the only goal of treatment, Dr. Wu noted.  Diagnosis of fungal infection of the nail will motivate patients "to pay more attention to their feet, which will help prevent ulcers from developing."

DENVER - Patients with obstructive sleep apnea (OSA) may aid their memory by using continuous positive airway pressure (CPAP).  A study in CHEST, the American College of Chest Physicians (ACCP) peer-reviewed journal, shows the majority of patients with OSA, memory-impaired prior to treatment, showed normal memory performance after three months of optimal CPAP use.  Patients who used CPAP for at least six hours a night were nearly eight times as likely to demonstrate normal memory abilities versus patients who used CPAP two or fewer hours a night.  "Patients with OSA often complain of forgetfulness, e.g., losing keys, forgetting phone numbers, or forgetting to complete daily tasks," said senior study author Dr. Mark S. Aloia, of the National Jewish Medical and Research Center, who did his research at Brown University Medical School in Providence, RI.  "Where memory is concerned, we may have the ability to reverse some impairments by providing effective and consistent use of CPAP treatment."  Patients were prescribed CPAP, and adherence was monitored covertly using internal microprocessors within each device.  After three months of CPAP treatment, 21% of poor users, 44% of moderate users, and 68% of optimal users demonstrated normal memory performance.

WASHINGTON - Monday Morning in Washington, DC noted (www.hcbs.org) census data regarding people with disabilities: Many disability advocates need up to date statistics for people with disabilities.  The 2005 American Community Survey provides current data and is available at the state and county level.

PHILADELPHIA - The Philadelphia Inquirer noted for years doctors urged older men with early-stage, low-risk prostate cancer to  watch and wait  - skip treatment until tests showed cancer was growing aggressively.  A study at Fox Chase Cancer Center and the University of Pennsylvania suggests there is a significant benefit from treating men over 65 surgically or with radiation.  The study was in the Journal of the American Medical Association.  "We found men who had either a radical prostatectomy or radiation therapy within six months of prostate cancer diagnosis were 30% less likely to die than those who didn’t undergo treatment,  said Dr. Yu-Ning Wong, medical oncologist at Fox Chase and study lead author.  Using several national cancer databases, Dr. Wong and her colleagues examined the overall survival of 44,630 men with low- and intermediate-stage prostate cancer.  The patients, aged 65-80, were diagnosed with the disease 1991-1999.  Doctors reported that over a 12-year period, 37% of the men with prostate cancer who took the watchful-waiting approach died versus 24% of those who chose active treatment.

WASHINGTON - The Associated Press reported there's a big change coming for pregnant women: Down syndrome (DS) testing no longer hinges on age 35.  The American College of Obstetricians and Gynecologists now urges every pregnant woman, despite age, be offered a choice of tests for this common birth defect because tests far less invasive than the long-used amniocentesis are now widely available.  Some can tell in the first trimester the risk of a fetus having DS or other chromosomal defects.  It's a change that promises to decrease unnecessary amnios while detecting DS in moms who would have gone unchecked.  The new guideline was in the journal Obstetrics & Gynecology.  About one in 800 babies has DS: an extra chromosome causes mental retardation, a characteristic broad, flat face and small head and, often serious heart defects.  The older women are, the higher their risk of a DS baby.  It's a gradual increase in risk: one in 1,200 at age 25 to about one in 300 at age 35.

ST. LOUIS - Children with Cerebral Palsy (CP) and other neurological problems often have extremely poor eyesight.  Their ability to read, pick up objects, and  see  the world is so impaired and complicated to treat many go untreated, even though they may be legally blind.  Dr. Janice Brunstrom, assistant professor of neurology and pediatrics at Washington University School of Medicine and a neurologist at St. Louis Children's Hospital, saw firsthand how her patients' poor vision interfered with every aspect of their daily lives.  Having CP herself and wanting to help reverse the isolation many of these children endure because of their poor vision, she spoke with pediatric ophthalmologist Dr. Lawrence Tychsen to help devise solutions.  As a professor of ophthalmology and visual sciences and ophthalmologist-in-chief at St. Louis Children's Hospital, she developed specialized testing and now does vision correction (refractive) surgery, on children with cerebral CP, Down syndrome, and neurobehavioral disorders such as Autism.  To date, St. Louis Children's Hospital is one of the only U.S. medical centers performing refractive surgery on these children and has the highest volume.

GOLDEN, CO - MedPage Today noted more than 300,000 Medicare patients died 2003-2005 because they were hospitalized in institutions that were average or poor on report cards issued today by HealthGrades, a for-profit healthcare quality rating service.  HealthGrades, which evaluated Medicare records from 40.6 million hospitalizations during those years, estimated a patient treated at a hospital that received five stars had a 69% lower chance of dying than a similar patient treated at a hospital rated one-star, the poorest, and a 49% lower chance of death than if treated at an average hospital (three stars).  The rating service evaluated 5,000 hospitals.  A HealthGrades spokesperson said "roughly 15%" of the hospitals received five stars in 28 diagnoses and procedure categories in the report.  If all hospitals that treat Medicare patients performed as well as HealthGrades' five-star rated hospitals, "302,403 Medicare lives could have potentially been saved from 2003 to 2005."  Half of the excess Medicare deaths occurred in patients diagnosed with heart failure, community acquired pneumonia, sepsis, and respiratory failure treated in hospitals that received a poor rating for treating those conditions, according to HealthGrades.