Living at high altitude tied to developmental delay

NEW YORK (Reuters Health) - South American babies and toddlers living at high altitude were more likely to score poorly on early tests of brain development, in a new study.

Of all kids age three months to two years, one in five was at high risk of developmental delays, according to tests done at their pediatricians' offices. That rose to between one in three and one in four for those who lived above 2,600 meters, or 8,530 feet.

Because there is less oxygen at higher elevations, researchers said blood flow in the uterus may also be decreased at altitude - which could impact the brain of a developing fetus.

"The findings emphasize the need for health care providers and policy-makers to recognize that altitude may increase developmental risks not just for physical growth, as has been reported, but for neurologic and cognitive development," wrote George Wehby from the University of Iowa in Iowa City, who conducted the research.

His study involved over 2,000 young kids evaluated at offices in Argentina, Brazil, Bolivia, Chile and Ecuador in 2005 and 2006.

The babies and toddlers were all given a series of problem-solving and motor tasks to complete, which their doctors used to measure which ones might be at risk for delayed development.

Wehby found that on average, for every 100-meter (328-feet) increase in elevation, kids were 2 percent more likely to be judged at high risk of future developmental problems.

Compared to kids living below 800 meters (2,625 feet), those above 8,530 feet were twice as likely to be at high risk, according to their pediatricians' evaluations.

The study, funded by the National Institutes of Health, is published in The Journal of Pediatrics.

All of the babies in Bolivia lived above the 8,530-foot cut-off, and all the kids in Argentina, Brazil and Chile lived below it. Ecuador was the only country in the study that included kids from both high- and low-altitude regions.

Of the largest cities in the United States, Albuquerque has a high point of 6,120 feet and Denver of 5,470 feet. Many Western states - including California, Colorado, Nevada and Utah - have regions above 10,000 feet.

However, it's hard to know whether the results apply to other communities at high elevation, according to Alexis Handal, an epidemiologist from the University of New Mexico in Albuquerque, who does her research in Ecuador.

"We're starting to realize there's such a complicated social context within which these populations live that it's very hard to look at one area and try to generalize to other areas," Handal, who wasn't involved in the new study, told Reuters Health.

For example, she said, parents' work hours, whether families have access to nutritious food and what environmental toxins communities might be exposed to can all interact with factors like altitude to influence maternal and child health.

"Perhaps what we also have to focus on is… how can we also develop programs that promote infant development, that help families?" she added.

Wehby said in the study that babies born at higher elevations may be helped by earlier health screening to make sure they're developing normally.

But he also pointed to the need for more research on why altitude may affect development - and whether similar patterns apply to kids in other high-altitude regions.

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Nurses Who Saved NICU Babies Remember Harrowing Hurricane Night

Nurses at the Neonatal Intensive Care Unit at New York University's Langone Medical Center  have challenging jobs, even in the best of times. Their patients are babies, some weighing as little as 2 pounds, who require constant and careful care as they struggle to stay alive.

On Monday night, as superstorm Sandy bore down on Manhattan, the nurses' jobs took on a whole new sense of urgency as failing power forced the hospital's patients, including the NICU nurses' tiny charges, to evacuate.

"20/20" recently reunited seven of those nurses: Claudia Roman, Nicola Zanzotta-Tagle, Margot Condon, Sandra Kyong Bradbury, Beth Largey, Annie Irace and Menchu Sanchez. They described how they managed to do their jobs – and save the most vulnerable of lives – under near-impossible circumstances.

On Monday night, as Sandy's wind and rain buffeted the hospital's windows, the nurses were preparing for a shift change and the day nurses had begun to brief the night shift nurses. Suddenly, the hospital was plunged into darkness. The respirators and monitors keeping the infants alive all went silent.

For one brief moment, everyone froze. Then the alarms began to ring as backup batteries kicked in. But the coast wasn't clear – the nurses were soon horrified to learn that the hospital's generator had failed, and that the East River had risen to start flooding the hospital.

"Everybody ran to a patient to make sure that the babies were fine," Nicola Zanzotto-Tagle recalled. "If you had your phone with a flashlight on the phone, you held it right over the baby."

For now, the four most critical patients – infants that couldn't breathe on their own – were being supplied oxygen by battery-powered respirators, but the clock was ticking. They had, at most, just four hours before the machines were at risk of failing.

Watch the full story on "20/20: Heroes Among Us" online.

Annie Irache tended to the most critical baby -- he had had abdominal surgery just the day before – as an evacuation of 20 NICU babies began.

"[He] was on medications to keep up his blood pressure," Irache said, "and he also had a cardiac defect, so he was our first baby to go."

One by one, each tiny infant, swaddled in blankets and a heating pad, cradled by one nurse and surrounded by at least five others, was carried down nine flights of stairs. Security guards and secretaries pitched in, lighting the way with flashlights and cell phones.

The procession moved slowly. As nurses took their careful steps, they carefully squeezed bags of oxygen into the babies' lungs.

"We literally synchronized our steps going down nine flights," Zanzotto-Tagle said. "I would say 'Step, step, step."

With their adrenaline pumping, the nurses said, it was imperative that they stay focused.

"We're not usually bagging a baby down a stairwell ... n the dark," said Claudia Roman. "I was most worried about, 'Let me not trip on this staircase as I'm carrying someone's precious child, because that would be unforgivable."

When the medical staff and the 20 babies emerged, a line of ambulances was waiting. A video of Margot Condon cradling a tiny baby as she rode a gurney struck a chord worldwide. But Condon said she had a singular goal.

"I was making sure the tube was in place, that the baby was pink," she said. "I was not taking my eyes off that baby or that tube."

Like other nurses, she did not feel panic. Her precious patient helped keep her calm.

"[Babies] love to be held, so every time I would look down at the baby, the baby had his little hand on my chest, like 'And this is good!'"

Langone patients were evacuated to various New York hospitals, including Mount Sinai Medical Center, where mother Luz Martinez wrapped nurse Beth Largey in an embrace. Largey had carried her 2-pound baby boy to safety.

In Montefiore Hospital in the Bronx, another mom tearfully expressed her gratitude to Sandra Kyong Bradbury, who ensured the safe evacuation of a baby named Jackson.

"I'm just so thankful," she said.

The nurses would later receive praise from President Obama, who said they represented the "brightest in America."

Many others call them heroes.

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Modest results in program to reduce kids' screen time

NEW YORK (Reuters Health) - A program aimed at reducing the number of hours young children spent in front of a screen didn't accomplish that goal, but it did cut back on the meals they ate in front of a television, a new study found.

That's good news according to the lead author, because people tend to eat more and eat unhealthy food while watching television.

"The relationship between screen time and obesity is linked to eating in front of a screen," said Dr. Catherine S. Birken, a pediatrician at The Hospital for Sick Children in Toronto.

In addition to its association with obesity, the study's researchers say screen time - whether it is in front of a television, computer or video game console - has been linked to children having problems with language development and behavior, and their likelihood of cigarette smoking.

"These are really important health outcomes in young children," said Birken. "So we need to understand what works and what doesn't."

So far, studies scrutinizing various methods of cutting back on kids' screen time have found little success.

However, Birken told Reuters Health that a couple of past studies did find promising results in preschool children, which is why her team decided to test a practical approach in that age group.

For their study, published in the journal Pediatrics on Monday, Birken and her colleagues recruited three-year-old children from a network of clinics around the Toronto area during their annual checkups. The children and their parents were randomly assigned into one of two groups.

In an intervention group of 64 children, the parents were told about the health impact of screen time on kids and how to reduce their children's hours.

Some of the techniques included removing televisions from the kids' bedrooms and not allowing them to eat with the television on.

Those families, along with a control group of 68 similar children and their parents, were also educated about safe media use, such as rating systems, Internet safety and violent programming.

The researchers then looked to see if the children's viewing or eating habits changed when they returned for a checkup a year later.

"TAKING IT SERIOUSLY"

Overall, the amount of time the children spent in front of a screen did not significantly differ between the two groups.

At the end of the study, the children in both groups spent between 60 and 65 minutes in front of a screen on weekdays. On the weekends, they spent between 80 and 90 minutes in front of a screen.

There also wasn't a difference in the children's BMI scores - a measure of weight in relation to height - between the start and end of the study. However, Birken said (for statistical reasons) she would only expect to see that in a larger group of children.

But, there was a statistically significant difference in the number of meals the children in the intervention group ate in front of the television.

At the start of the study, each group of kids ate about two meals with the television on daily. A year later, that number remained the same for the control group, but fell to about 1.6 for the intervention group.

That, the researchers note, works out to be at least two fewer meals per week in front of the television.

"I don't think there is much harm in turning the TV off during meals. I think that is a good message either way," said Birken.

But, she added that her team would have liked to see the kids spending less time in front of a television. She said it could be that the program needs to be spread out across society, including the children's doctors and teachers.

Dayna M. Maniccia, an assistant professor at the University of Albany who has researched screen time interventions, said even if the study didn't show a reduction in screen time, it makes people think about it.

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Iron, omega-3s tied to different effects on kids' brains

NEW YORK (Reuters Health) - For children with low stores of two brain-power nutrients, supplements may have different, and complex, effects, a new clinical trial suggests.

Iron deficiency is the most common nutritional deficiency worldwide, affecting about 2 billion people, according to the World Health Organization.

Poor children in developing countries are at particular risk for shortfalls in iron, as well as other nutrients, including the omega-3 fats found largely in oily fish.

So the new study looked at the effects of giving 321 schoolchildren in South Africa either supplements containing iron, omega-3s or both. All of the kids had low levels of both nutrients, which are vital for children's growth and healthy brain development.

After about eight months, researchers found varied changes in the kids' memory and learning abilities.

In general, children given iron showed improvements on tests of memory and learning. That was especially true if they had outright anemia - a disorder wherein the blood's oxygen-carrying capacity is reduced, causing problems like fatigue and difficulty with concentration and memory.

For example, on a memory test, anemic kids given iron were able to recall an extra two words out of 12.

In contrast, there was no overall benefit linked to omega-3 supplements. And when the researchers zeroed in on kids with anemia, those who used omega-3s did worse than before on one test of memory.

Then there were the children with clear iron deficiency, but not anemia. Of those kids, girls who got omega-3s fared worse, while boys improved their test scores.

What it all means for kids with nutritional deficiencies is unclear, according to lead researcher Jeannine Baumgartner, of North-West University in Potchefstroom, South Africa.

One limitation of the study, she said in an email, is that the number of children in each group her team analyzed was small. There were 67 kids with anemia, for example.

Thus, "the results need to be interpreted cautiously," Baumgartner told Reuters Health in an email.

There are still a lot of questions, according to Baumgartner, whose group's findings are published in the American Journal of Clinical Nutrition.

The children in this study were 6 to 11 years old. But, Baumgartner said, animal research suggests brain deficits that take shape early in life might not be reversible.

"The question arises whether supplementation during school age might be too late to achieve beneficial effects on cognitive performance," she said.

Still, the omega-3 findings are consistent with some recent animal research. Baumgartner said her team found that in rats deficient in both iron and omega-3s, giving either supplement alone seemed to worsen the animals' memory performance. The picture was better, though, when the rats were given both iron and omega-3s.

In children, things are more complicated. Other nutritional deficiencies, as well as exposure to toxins like lead and the general effects of poverty could all dampen kids' brain development, Baumgartner pointed out.

"We believe that more research is needed to investigate the biological and functional links between nutrients essential for brain development and cognitive functioning," she said.

Since this study focused on impoverished children with low iron, and possibly other nutritional deficiencies, the results cannot be extended to children in general, according to Baumgartner.

In the U.S., recommendations call for babies to get an iron test during the first year of life to check for deficiencies. For healthy kids older than six months, the recommended iron intake varies from 7 to 15 mg of iron per day, depending on their age and sex.

There is a risk from getting too much iron and experts tell parents to ask their doctor before giving children iron supplements.

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Foreign hackers targeted former military chief Mullen: report

WASHINGTON (Reuters) - Foreign hackers targeted the computers of Mike Mullen, ex-chairman of the Joint Chiefs of Staff, the Wall Street Journal reported on Wednesday, calling it the latest in a pattern of attacks on computers of former high-ranking U.S. officials.

The FBI is pursuing the hackers, the Journal reported. The agency was not immediately available for comment.

Mullen's office confirmed that the retired admiral was cooperating with a cyber investigation.

"Admiral Mullen, now a private citizen, has responded to very specific requests and is cooperating with an ongoing cyber investigation he has been informed is focused overseas," it said in a statement.

The hackers targeted personal computers Mullen used while working on the grounds of the U.S. Naval Academy in Annapolis, Maryland, after his retirement in 2011, the report said, citing officials and others familiar with the probe.

One official said the evidence pointed to China as the origin of the hacking and that it appeared the hackers were able to access a personal email account.

A spokesman for the Chinese Embassy in Washington told the Journal he was not aware of the investigation and that his government prohibits cyber attacks.

China is often cited as a suspect in various hacking attacks in the United States and other nations. Beijing dismisses allegations it is involved.

The Journal report said current and former U.S. cyber security officials say the Mullen case is the most recent example of a series of undisclosed hacker attacks on the computer files of former senior U.S. officials.

Hackers view their computers as an easier way to get access to sensitive information, said these people, who declined to name the targeted former officials.

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Sports fans can pursue U.S. antitrust case over programs

NEW YORK (Reuters) - A federal judge on Wednesday allowed sports fans to pursue a lawsuit accusing Major League Baseball, the National Hockey League and various networks of antitrust violations in how they package games for broadcast on television or the Internet.

U.S. District Judge Shira Scheindlin in Manhattan said the subscribers could pursue claims that the packaging has reduced competition, raised prices, and kept them from watching their favorite teams located outside their home markets.

"Plaintiffs in this case - the consumers - have plausibly alleged that they are the direct victims of this harm," she wrote.

The defendants include Major League Baseball, the National Hockey League, several teams in both sports, cable TV company Comcast Corp, satellite TV provider DirecTV, Madison Square Garden Co and some regional sports networks.

DirecTV declined to comment, saying it had not reviewed the decision. Comcast and the NHL had no immediate comment. Other defendants did not immediately respond to requests for comment.

Ned Diver, a lawyer for the subscribers, said in a phone interview: "We're very pleased with the decision. It's a total victory on the substance of the plaintiffs' claims."

Media companies, leagues and teams can often justify higher costs to watch their products by citing the higher costs of doing business, and that individual teams have rabid followings among viewers willing to pay more to watch events live.

"BLACKOUT" AGREEMENTS

The case arose from what the subscribers said were anticompetitive "blackout" agreements between service providers such as Comcast and DirecTV, sports networks and the leagues.

These subscribers contended that if they wanted to watch games from outside their home markets, they were required to buy packages that included all out-of-market games, even if they were interested only in one or a few nonlocal teams.

For example, a New York Yankees fan living in Colorado could not pay simply for access to that team's games, but had to buy a product such as the MLB Extra Innings television package.

The subscribers sought damages and a halt to arrangements that they said resulted in "reduced output, diminished product quality, diminished choice and suppressed price competition."

Other packages at issue are NHL Center Ice for television, and MLB.tv and NHL GameCenter LIVE for the Internet.

The defendants argued that the subscribers' alleged injuries were only indirectly related to the alleged wrongful conduct, and that Major League Baseball and NHL games did not qualify as "distinct products" subject to antitrust scrutiny.

Comcast, DirecTV and the sports networks also contended that their conduct was "presumptively legal."

PRESSURE TO SETTLE

Scheindlin nonetheless let much of the case go forward.

"Making all games available as part of a package, while it may increase output overall, does not, as a matter of law, eliminate the harm to competition wrought by preventing the individual teams from competing to sell their games outside their home territories in the first place," she wrote.

The judge did dismiss claims that Comcast, DirecTV and the sports networks conspired to monopolize markets, while allowing similar claims against Major League Baseball and the NHL to proceed. She also dismissed some individual plaintiffs from the case, saying they lacked standing to sue.

"There will be pressure on the defendants to settle before this gets to trial," which could cost "real money," said Geoffrey Rapp, a University of Toledo law professor in Ohio.

"The defendants are in some ways similar to record companies that had to adapt as a la carte options became available online, where people could buy one song rather than a whole album," he said. "Five or 10 years from now, these package-deal arrangements may no longer exist."

Among the dozens of defendants were the Yankees and its YES network; the Chicago White Sox baseball and Chicago Blackhawks hockey teams; the New York Rangers hockey team; and various Comcast SportsNet and Root Sports networks.

Last month, Rupert Murdoch's News Corp said it would buy a 49 percent stake in the YES network.

Baseball itself has had an antitrust exemption since 1922, but has long faced periodic calls from Congress and elsewhere that it be repealed.

The cases are Laumann et al v. National Hockey League et al, U.S. District Court, Southern District of New York, No. 12-01817; and Garber et al v. Office of the Commissioner of Baseball et al in the same court, No. 12-03074.

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Instagram's Systrom coy on ad plans, user data

PARIS (Reuters) - Instagram's youthful Chief Executive Kevin Systrom  allowed himself a luxury at a Paris technology conference that he never feels comfortable doing in San Francisco: wearing a tie.

The founder of the popular photo-sharing app, now owned by Facebook, looks less comfortable when asked whether he'll soon be adding advertising to his service.

"We don't have any specific plans to share about advertising yet, mostly because we're focused on growing the company as quickly as possible," Systrom said in an interview with Reuters TV at LeWeb technology conference in Paris.

The decision, he conceded, may no longer be his alone.

Instagram, which has 100 million users sharing pictures taken on their mobile phones, was acquired by Facebook in April for $1 billion in cash and stock.

With Facebook struggling to prove to investors that it can fulfill its much-hyped growth potential and advertising on mobile devices proving particularly tricky, pressure is likely to grow on Systrom to monetize his creation in the near-term.

So far, Instagram is still run largely independently from its parent company, Systrom says, but he admits the grown-up world of focusing on the bottom-line may not be far off.

"Even from the beginning when we started Instagram, we realized we had to build an independent business, and even within Facebook, we realize we still have to contribute to the business," he says.

Some of the value Instagram brings is helping Facebook, which has seen its share price drop about 28 percent since listing in May, think about how its 1 billion users surf the site while on the go from smartphones and tablets.

Justin Osofsky, Facebook's platform partnerships director said in an interview, that Facebook was increasingly focused on mobile users.

"If you're looking at kind of how we're evolving our product, Facebook has become a mobile-first company."

Facebook recently announced a plan to combine user data with Instagram, and eventually bowed to public pressure to hold a vote on the proposed change.

Data analysis is widely used by web companies from Google to Facebook to better target ads to users, but the practice is contested by some on-line privacy advocates.

Details are scarce on what Facebook actually wants to do with Instagram data, and Systrom didn't provide much insight.

"I don't have specifics about the data policy but what I can say is that we are looking to make the user experience better," said Systrom, adding that Facebook's data could be used to fight spam for Instagram users.

Facebook is already facing a class-action lawsuit in California that alleges that its Sponsored Stories feature violated California law by publicizing users' "likes" of certain advertisers without paying them or giving them a way to opt out. The case involved over 100 million potential class members.

An Austrian student group also recently said it plans to take Facebook to court to try to get it to do more to protect user privacy.

Systrom sought to soothe such privacy concerns saying Instagram wasn't setting up a scheme to sell data on its users.

"I think what people have to remember is that we always have the best intentions in mind for everyone and data sharing is not something that we focus on in the morning," he said.

"When we wake up and we get to work, we're not like, how do we get data to go from one place to the other, we're simply trying to make the services better."

Facebook, and its founder Mark Zuckerberg, however is further along than Instagram in terms of seeking to turn its user base into revenue largely via ad sales.

David Kirkpatrick, author of the book "The Facebook Effect" that charts the social network's rise, said Zuckerberg had long known that he would have to turn his baby into a real business.

"Facebook has evolved to the point where they are willing to accept a degree of intrusion in advertising, although right now their mobile advertising remains too intrusive," said Kirkpatrick.

"But their goal is that the ads be perceived as so useful to the moment, the situation and the person" that they are welcomed by the recipient, he said.

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New net rules would hit digital economy: diplomat

DUBAI (Reuters) - Inter-governmental regulation of the Internet could deter investment, raise costs for consumers and hinder online access, a U.S. diplomat said on Wednesday.

The United States has been leading efforts to stop a United Nations body from extending its authority into cyberspace.

U.S. Ambassador Terry Kramer reiterated his country's "hands off" message at a summit hosted by the International Telecommunication Union that could decide the future of the Internet, at present largely unregulated at a global level.

"We are concerned some of the proposals could create an investment environment that is very tenuous," Kramer told Reuters. "We need to be very mindful that we are not creating new, much greater problems than we are solving."

About 150 countries are gathered to renegotiate an ITU treaty that was last updated in 1988, before the Internet and mobile phones transformed communications.

Western Internet companies and rights groups are fiercely opposed to proposals that would require companies to identify Web users at the demand of national governments, which would make it easier for countries to identify and punish dissidents.

Activists operating under the Internet banner Anonymous said on Wednesday they would organize public protests. A short time later, a denial-of-service attack was launched against the ITU's main website.

Such attacks, in which thousands of computers try to connect to the same site simultaneously, can temporarily overwhelm the target with traffic, though they do not breach security or cause lasting damage.

The ITU site was rendered at least temporarily unavailable to net users in some regions and was sluggish afterward.

The United States wants to restrict the debate in Dubai to conventional telecoms, and two of its three core recommendations have been approved, Kramer said. Member states have agreed the definition of 'telecommunications' should remain unchanged, while the treaty's introductory passages, relating to its scope, will also be unaltered.

The third recommendation, still being debated behind closed doors, is a technical, but important distinction that the treaty should relate only to "recognized operating agencies" - conventional telecom operators - and not "operating agencies."

The latter definition would potentially place the likes of Facebook, Google and government and business networks under the jurisdiction of the ITU.

"These sectors have done incredibly well without almost any regulation at all," said Kramer.

The United States and its allies, including Australia, Canada, Europe and Japan, want a strict delineation between the two, while other countries say the two are now inseparable and both should be governed by ITU legislation.

The United States says that allowing the Internet, and with it content, to come under global regulations would pave the way for online censorship and restrictions on free content.

"There are still a lot of countries seeking to sweep the internet into this, and some of them have got ulterior motives," said Kramer.

Some African and Arab states have adopted proposals from a European telecom association to introduce charges to companies such as Google if they deliver content to networks abroad.

Telecom operators' voice revenue is in decline, and they claim the investment needed to keep up with surging demand for data does not justify the returns.

"If there is a charge imposed on developers of content and applications that could significantly curtail traffic, it would potentially exacerbate the digital divide because a lot of countries would not receive the traffic they need," said Kramer.

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Austrian farmers dip into Internet "milking" craze

VIENNA (Reuters) - Dumping a bottle of milk over your head and filming it for a video post on the Internet has become a popular youth craze, but Austrian farmers say the spillage is a crying shame.

"Milking", as the trend is known, is among a variety of tongue-in-cheek stunts in which young people shoot pictures or videos of themselves posing as owls, planks of wood, or famous people and then share them on YouTube and other social media.

Austria's AMA farm lobby on Wednesday launched its own "true milking" campaign to decry the wanton waste of dairy resources and to encourage consumers to drink it instead.

"At a time when too much food already lands in the trash, it is worth questioning dumping milk. This is a valuable product of nature that our farmers provide daily with lots of love and labor," AMA milk marketing manager Peter Hamedinger said.

Milking has become an Internet hit, with one video from Newcastle in England getting more than half a million clicks on YouTube. http://www.youtube.com/watch?v=qtJPAv1UiAE

AMA's marketing arm said the milking craze seemed to reflect a strange youthful protest against authority. It sought to one-up the video trend with its own clip featuring a young man who holds a carton of milk high above his head and drinks the contents without spilling a drop.

http://www.youtube.com/watch?v=EsJ3OsP1Fks&feature=youtu.be

"In line with the nature of the medium, this message is not communicated in a commercial way and absolutely not with finger pointing, but rather with a wink of the eye for the Internet generation," the farm products board said in a statement.

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