FRIDAY, OCTOBER 11, 2002

FRIDAY, OCTOBER 11, 2002 

Teething Can Gum Up the Right Diagnosis 

By Randy Dotinga
HealthScoutNews Reporter

HealthScoutNews

Friday, October 11, 2002

FRIDAY, Oct. 11 (HealthScoutNews) -- Teething in infants usually causes nothing more than a bit of discomfort and perhaps a low-grade fever or diarrhea, pediatricians say.

However, an Australian survey of doctors and nurses found that many still adhere to an outdated notion that teething can lead to a variety of ills.

As a result, health professionals could be misdiagnosing more serious problems -- such as viral infections -- by blaming the symptoms on teething, the survey's authors contend.

An American pediatrician says some of his colleagues in the United States could be making the same mistake.

"It's easy to pacify parents by saying, 'Oh yeah, it's teething.' But if doctors attribute [high] fever and extreme irritability to teething, they're likely to miss something important," says Dr. Joel Steinberg, a professor of pediatrics at the University of Texas Southwestern Medical Center in Dallas.

Most babies' teeth typically break through the gums when the infant is about 5 months old, Steinberg says. Teething may continue until a baby is 15 or 16 months old.

"Teething certainly causes discomfort in some children," adds Dr. Dennis A. Clements, chief of primary child care at Duke University. "Teeth erupt overnight, and some children grind their gums and teeth and cry out in pain for no apparent reason.?

"Some children have a greenish stool when teething due to the stress. But there are plenty of children who get all their teeth without a whimper. It is variable," Clements says.

In the past, parents and doctors blamed a variety of symptoms on teething, from severe fevers to even death, says Steinberg, a spokesman for the American Academy of Pediatrics.

But in the last couple of decades, doctors have learned that many of the symptoms previously attributed to teething are really caused by viruses, which can strike infants as often as four to eight times in the first year of life, Steinberg says.

And those viruses can trigger health problems ranging from colds to ear infections, he says.

"I tell patients anything with a temperature above 100 is not teething," Steinberg says. "But teething can make you fussy, can make you drool a little more, and can make you sleep poorly."

The Australian researchers aimed to find out if health workers in the state of Victoria (home to Melbourne) had gotten the message about the harmlessness of teething. They surveyed 464 general practitioners, pediatricians, dentists, pharmacists and nurses.

Their report appears in tomorrow's issue of the British Medical Journal.

Nearly 75 percent of the nurses thought that all or most children suffered from symptoms of teething, while about 25 percent of the pediatricians did. Nurses and pharmacists were most likely to say that teething causes a variety of symptoms, and dozens of pharmacists said they had prescribed sedatives for teething infants.

Steinberg says he opposes the use of sedatives -- like Phenobarbital -- by teething infants, although painkillers like ibuprofen (Motrin or Advil) and acetaminophen (Tylenol) are appropriate. So is advising parents to give their teething babies something cool to chew on or drink.

"Topical anesthetics probably help little," adds Duke University's Clements. "They also anesthetize the tongue and throat, which may be a problem."

What To Do

Learn more about teething from the American Academy of Pediatrics or KidsHealth.

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More SIDS Cases May Be Due to Heart Problems 

Reuters Health

Friday, October 11, 2002

NEW YORK (Reuters Health) - Heart problems could play a role in one in 10 cases of sudden infant death, Canadian researchers report.

Sudden infant death syndrome, or SIDS, is the leading cause of death for babies between 1 month and 1 year old, and the risk is greatest between 2 and 4 months of age. It is diagnosed when the cause of death remains unexplained and all other possibilities have been eliminated--such as infection, asphyxia, dehydration or child abuse.

In the study, Dr. Adrian Dancea of The Montreal Children's Hospital and colleagues reviewed 848 autopsy records of infants and young children who died suddenly and unexpectedly in Quebec between 1987 and 1999.

The researchers found that 82 of the children had some sort of heart problem, representing 10% of the total number of sudden infant deaths, the authors report in the September issue of The Journal of Pediatrics.

In about half of the 82 cases, a structural defect of the heart was found. The remaining children had structurally normal hearts but some other heart condition.

"We found that heart disease is present in a significant percentage of autopsies of infants dying suddenly and unexpectedly," write the authors.

Dancea and colleagues note that structural heart problems are often picked up in the first few weeks of life. However, half of the SIDS infants with a specific type of malformation were not diagnosed with the problem before they died.

Most autopsies were performed by a pediatric pathologist, according to the report. However, if the autopsy was performed outside a pediatric center, a close examination of the heart's anatomy was not performed in a third of cases.

This suggests, according to the researchers, that heart problems may be underreported in cases of SIDS.

Dancea's team has "shown that a significant number of unexpected deaths in the young are the result of cardiovascular diseases, some of which are heritable," according to Dr. Roger W. Byard of the Forensic Science Center in Adelaide, Australia.

"Given the recent criticisms of infant death investigations, both in the media and in the literature, there are many reasons why we have an obligation to get it right," Byard writes in an editorial accompanying the study.

Source: The Journal of Pediatrics 2002;141:336-342.

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Insurer OKs Foreign Drugs Via AARP  

By Theresa Agovino

AP Business Writer

The Associated Press

Friday, October 11, 2002

NEW YORK (AP) - The country's biggest health insurer has informed members of the senior citizens lobbying group AARP that it will reimburse them for prescriptions filled in Canada and elsewhere abroad.

UnitedHealth Group Inc. sent a letter to the 97,000 people who purchased insurance with a drug benefit through AARP telling them about the coverage.

Buying prescription drugs outside the country for use at home violates federal regulations but is a growing practice among some older Americans seeking relief from high prices. Insurance policies generally cover drugs purchased abroad if a person is traveling there and has forgotten their medicine or becomes ill.

Both UnitedHealth and AARP appeared to want to keep the measure low-key, but it was certain to meet with approval from both AARP plan members and others of the many thousands of senior citizens who purchase their drugs in Canada and Mexico, where they are drastically cheaper than in local pharmacies.

Viola Qurion, 76, a retired garment worker who lives in Waterville, Maine, on $1,027 a month, makes an annual pilgrimage to Canada to buy medicine. She said otherwise she would have to choose between drugs and food.

"We don't like to go," she said in a telephone interview. "It is hard for a lot of us to get around, but what choice do we have?"

She said she saved about $500 on the medicines for allergies and indigestion she bought in her most recent trip, made earlier this week. And she doesn't feel bad if that cost U.S. companies some income.

"The pharmaceutical companies spend millions keeping drug prices high. It is shameful," she said.

AARP said it is not advocating purchasing drugs from abroad. It described the letter as a reminder of policy, and called its timing "unfortunate," coming so soon after a failed effort at legislation to allow people to import prescription drugs for their own use. Currently, U.S. law prohibits Americans from importing medicines that are available in the United States.

"The letter was just an informational letter to members letting them know that we would be paying claims for all drug purchases," said Julie Alexis, manager of member health products at the AARP.

Alexis added that the policies covered by the letter are designed to fill gaps in Medicare, the government health plan for the elderly, and are consequently scrutinized by both federal and state regulators. Neither has expressed any concern over covering drugs purchased abroad, she said.

UnitedHealth said its letter did not reflect a change in coverage but was meant to clarify a misunderstanding. It also said it was not trying to encourage anyone to violate Food and Drug Administration (news - web sites) regulations.

"If someone is driving at a high rate of speed and they get in accident we cover them, but it not like we advocate such behavior," said UnitedHealth spokesman Mark Lindsay.

Lindsay says the insurer doesn't know how many of the 97,000 individuals get their drugs from abroad to save money.

An FDA official said the agency couldn't comment on the coverage because it doesn't know the details.

The AARP, formerly known as the American Association of Retired Persons, is critical of the pharmaceutical industry. It also has supported bills, so far unsuccessfully, to create a Medicare drug benefit and to make it easier for generic drugs to reach the market.

Experts said it was unlikely that either the drug makers or government officials would take issue with UnitedHealth or AARP over the drug reimbursements.

"No one wants to be seen like they are going after grandmothers," said Jonathan Wiener, professor of health policy and management at the Johns Hopkins School of Public Health in Baltimore.

He called the reimbursement policy "a warning shot at the pharmaceutical industry and Congress. I think they want to add to the outcry about drug prices and hit the pharmaceutical industry in the pocketbook."

The 97,000 members of the seniors group represent a negligible amount of the pharmaceutical industry's sales. The industry would likely see profits threatened only if the reimbursement policy spread to other insured groups such as company employees, which wasn't seen as likely.

"A local tool and dye shop is not the AARP," Wiener said.

AP reporter Karren Mills in Minneapolis contributed to this report.

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Low Weight at Birth May Impair Man's Fertility

Reuters Health

Friday, October 11, 2002

NEW YORK (Reuters Health) - Low birth weight may affect testicle size--and perhaps fertility--later in life, results of a preliminary study from Italy suggest.

The researchers found that teenage boys who are born small for their gestational age, meaning they were smaller than average but were not born prematurely, tended to have smaller testes and lower levels of testosterone, according to a report in the September issue of the Journal of Pediatrics.

Whether this finding could explain some cases of infertility in adult men needs to be further investigated, the researchers say.

Previous research findings have linked low birth weight to a number of health conditions in adults, including high blood pressure. And a recent study in girls found that low birth weight was associated with impaired ovarian development, which may in turn lead to poor fertility.

In the new study, Dr. Alessandro Cicognani of the Universita degli Studi di Bologna evaluated 24 teenaged boys who had completed puberty and were born at average weights and 25 who had been small for their gestational age. The average birthweight for the control group was 7.1 pounds; for the small-at-birth group it was 3.7 pounds.

The low birthweight teens were found to have smaller testicles, on average, and lower levels of testosterone compared to those born at a normal weight. And the teens who were born at low weights who had the smallest testicles also had low levels of inhibin B, a hormone that has been linked to sperm production.

In addition, low birth weight teens with smaller testes tended to be shorter in stature compared to what would have been expected.

"There is a disruption of the exocrine function in subjects with smaller testicular size who failed to show a complete height catch-up growth," the authors write.

"This study supports a link between low birth weight and lower fertility in adult males," they conclude.

Source: Journal of Pediatrics 2002;141:376-379.

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Feds Nix Menopause Treatment Patch  

The Associated Press

Friday, October 11, 2002

BERLIN (AP) - Schering AG, the No.1 maker of birth-control pills, said Friday the U.S. Food and Drug Administration (news - web sites) has rejected its application for approval of a patch to treat menopause symptoms.

The German company didn't say why application for the estradiol/levonorgestrel transdermal combination patch was rejected. However, Schering said it is in discussions with the FDA to address technical aspects of one of the clinical studies submitted as part of its application for the once-a-week therapy.

"We regard our discussions with the FDA about this new drug application to be an ongoing process, and we will continue to examine all options for the approval of this application," Werner-Karl Raff, the head of Schering's Fertility Control & Hormone Therapy unit, said in a statement.

Schering said the rejection wouldn't affect this year's sales or profits.

Berlin-based Schering's shares closed down 3.5 percent at 48.09 euros ($47.42) in Frankfurt.

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Light Therapy Helps Treat Prostate Cancer, Too 

Reuters Health

Friday, October 11, 2002

NEW YORK (Reuters Health) - Researchers may have added prostate cancer (news - web sites) to the list of cancers that can benefit from photodynamic therapy (PDT), which combines drugs and light to treat cancer and other conditions.

Timothy R. Nathan of the University College London Hospital in the UK and his colleagues report that most patients treated with PDT, whose prostate cancer had returned following radiation treatment, appear to benefit from the new therapy.

Specifically, the authors report, more than half of treated patients experienced a decrease in their blood levels of PSA, a protein produced by the prostate gland that is often elevated in the presence of prostate cancer. In addition, more than one third of PDT-treated men showed no trace of cancer from a post-treatment biopsy.

"Photodynamic therapy is a new option that could be suitable for organ confined prostate cancer recurrence after radiotherapy," Nathan and his team write.

"These results suggest that photodynamic therapy merits further investigation," they add.

PDT is a two-step therapy that is already being used to treat head and neck cancers, especially esophageal cancers. The first step is to give the patient a light-activated drug such as Photofrin, which tends to collect in tumors. The drug makes the abnormal tissue particularly sensitive to light. The second step is to shine a laser light on the drug-saturated tumors for a brief period of time. There are several PDT drugs available, and each is activated by different wavelengths of light.

Recent reports have suggested that PDT may also help treat cancers of the pancreas, lung and breast.

During the current study, Nathan and his team administered PDT to 14 men. All patients had prostate cancer that had returned following treatment with radiation, as indicated by an increase in PSA and results from a biopsy.

After the procedure, the researchers noted that PSA levels decreased in 9 patients, reaching undetectable levels in 2 patients. Biopsies of 5 patients showed that they were tumor-free. Scans showed that PDT had destroyed up to 91% of the prostate tissue.

A few of the patients experienced side effects after the treatment, Nathan and his team note. Four of the men reported stress incontinence, meaning they leaked urine as a result of laughing, coughing, sneezing or exercise, which began to gradually improve over time. Seven of the participants were able to have intercourse before PDT, and 4 reported a decrease in their abilities after receiving light therapy. This side effect did not appear to diminish over time, the authors report in the October issue of the Journal of Urology.

Complications were no worse among the patients than among studies of patients given surgery or cryotherapy to treat prostate tumors that had returned after treatment. And, the researchers note, complications could be reduced by dosage adjustments.

Nathan and other researchers involved in the study have a financial interest in or other financial relationship with Scotia Pharmaceuticals, the company that makes the drug used in the study.

Source: Journal of Urology 2002;168:1427-1432.

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Waist Circumference Helps Predict Cardiovascular Risk

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Friday, October 11, 2002

FRIDAY, Oct. 11 (HealthScoutNews) -- If you want to determine your risk for cardiovascular disease, maybe you should throw out your scale and grab the measuring tape.

A study appearing in a recent issue of the American Journal of Clinical Nutrition (news - web sites) suggests waist circumference is more strongly associated with cardiovascular risk factors than body mass index (BMI).

"There's been some research that shows that it may not be the total amount of fat in your body but where it is stored. In other words, fat distribution," says Stanley Heshka, a co-author of the study and a research associate at the New York Obesity Research Center at St. Luke's Roosevelt Hospital in New York City.

Body mass index (the measure of body fat based on height and weight) is the most widely used gauge to tell if adults are overweight or obese. The problem is that it doesn't take into account the wide range of fat distribution found in people.

Meanwhile, various studies have found body fat distribution is a better predictor for many diseases.

In the new study, the researchers looked at information on white men and women gathered for NHANES III, the National Health and Nutrition Examination Survey, which collected data on the health and nutrition of 9,019 Americans. Then the researchers correlated BMI values of 25 and 30 (which indicate overweight and obese, respectively) with cardiovascular and diabetes risk factors. They set out to determine what waist circumferences have the same degree of risk for cardiovascular disease and diabetes as the BMI guidelines.

To minimize the risk of heart disease, men should not go above a 35-inch waist and women should not go above 33 inches, Heshka says. Men whose waists are 39 inches or more and women whose waists are 37 inches or more should lose weight -- and inches, he says.

Though the study data involved exquisitely precise measurements (taken just above the top of the hip bone and at the end of a normal exhalation), regular folks don't need to be quite that exact.

If you come close to the recommended cutoff points, though, you need to take them seriously, Heshka cautions.

The researchers are still working to figure out why girth may be a better predictor of risk for cardiovascular disease. It may be because the amount of fat around the waist reflects more fat inside the abdominal cavity, something that has been associated with coronary vascular disease, Heshka says.

Some people have hypothesized that the fat drains into the portal vein and is then distributed to areas most sensitive to the development of cardiovascular disease.

"No one really knows how the fat works," Heshka says.

Heshka is quick to add that waist circumference alone may not be the best measure to determine cardiovascular disease risk.

Heshka and other researchers are now trying to see what combination of measures (for example, height, weight, waist circumference, body frame size…) are the best predictors for the development of cardiovascular disease.

"We may find that waist circumference and BMI in combination have an even stronger association," Heshka says. "That's what the goal is now: To find optimal predictors so we can find those people at risk."

More data is also needed to confirm that people with large waists are also the ones who eventually develop cardiovascular disease.

What To Do

To learn more about cardiovascular disease, visit the U.S. Centers for Disease Control and Prevention (CDC). To calculate your body mass index, visit this CDC site.

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Wart Virus May Contribute to Esophageal Cancer 

Reuters Health

Friday, October 11, 2002

NEW YORK (Reuters Health) - Certain strains of the wart-causing human papillomavirus (HPV) may raise the risk of esophageal cancer, at least in parts of the world where the cancer is common, researchers report.

There are more than 100 types of HPV, with some causing the common warts of the hands and feet, others causing oral or genital warts and some causing no obvious symptoms at all. Certain sexually transmitted HPV strains are already believed to be the major cause of cervical cancer, but there is also evidence that HPVs may contribute to several other cancers, including vaginal and penile cancers and some cancers of the head and neck.

Esophageal cancer, which affects the tube through which food passes to the stomach, is relatively rare in many parts of the world. But certain regions, such as parts of China, have unusually high rates of the disease.

The new study looked at one Chinese region, Eastern Guangdong, where esophageal cancer is common. Researchers found that among the 55 esophageal cancer patients they studied, certain strains of HPV were commonly found in tumor samples.

Dr. Zhong-Ying Shen of Shantou University Medical College and colleagues report the findings in the November issue of the Journal of Medical Virology.

Overall, HPV was found in more than 60% of both cancerous and normal tissue samples taken from the patients. But two "high-risk" strains tied to cancer, HPV 16 and 18, were found mainly in tumor samples, Shen's team reports.

"Our results," the researchers write, "suggest that the high incidence of esophageal carcinoma in this particular region may be associated with the high infection rate with HPV, and HPV may be one of the major risk factors in the development of this tumor."

They note that in past studies in areas with low rates of esophageal cancer, HPV has either not been detected or has shown up far less often in esophageal tumor samples.

According to the researchers, the role of HPV in the development of esophageal cancer "might be more pronounced" in areas of the world where the disease is common.

Other factors believed to raise the risk of esophageal cancer include smoking and heavy drinking.

Source: Journal of Medical Virology 2002;68:412-416.

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Real Oven Better Than Microwave for Killing Germs 

HealthScoutNews

Friday, October 11, 2002

(HealthScoutNews) -- Before you heat up that doggie-bag full of the leftovers from last night's barbecue at Bill's house, be warned.

According to the American Journal of Epidemiology, nuking them is not as good as reheating in the oven or a frying pan.

That information comes from the Epidemic Intelligence Service of the Centers for Disease Control and Prevention (news - web sites) in Atlanta, which was tracing an outbreak of Salmonella typhimurium in Juneau, Alaska.

Researchers found that all the people who became sick had been to the same picnic, and they all had taken home leftovers. But while 30 people had taken home doggie bags, only 10 became sick. What protected the others?

According to the CDC, all who became sick had reheated their food in a microwave oven. Those who didn't become sick had used a conventional oven or frying pan.

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Teens' Sexual Orientation Affects Body Image-Study 

By Alison McCook

Reuters Health

Friday, October 11, 2002

NEW YORK (Reuters Health) - Teen boys who are gay are more likely than their heterosexual peers to diet and exhibit certain symptoms of eating disorders, while lesbian teens appear to be somewhat protected from the unhealthy body concerns that often plague heterosexual girls, US researchers report.

In addition, Dr. Sydney Bryn Austin of Children's Hospital and Harvard University in Boston and her colleagues found that teen girls and boys who believe themselves to be heterosexual, but are sometimes attracted to the same sex, are more likely than heterosexuals without same-sex feelings to diet and be unhappy with their bodies.

One of the most important aspects of these findings is the discovery of teens who consider their sexual orientation to be "mostly heterosexual"--choosing this category from a list of 6 descriptors, including "not sure"--and their tendency to adopt unhealthy behaviors, Austin told Reuters Health.

But just who these teens are and why they seem to worry more than others about their appearance remains unclear, she admitted.

"We're really at the beginning of figuring out who these adolescents are, and why are they at increased risk of eating disorders, and other unhealthy behaviors," Austin said.

The current findings are based on surveys completed by 10,136 girls and boys between the ages of 12 and 17. The surveys questioned teens about their sexual orientation, weight concerns, tendency to diet and how satisfied they were with their bodies. In addition, the respondents indicated if they had any symptoms of an eating disorder like eating while feeling out of control ("bingeing") or throwing up and using laxatives to rid their bodies of food ("purging").

The authors presented their findings at the recent National Lesbian Health Conference held in Washington, DC.

Austin and her team discovered that lesbian or bisexual girls were half as likely to have dieted within the last year as heterosexuals, while mostly heterosexual girls said they were 30% more likely to do so than heterosexual girls. Although mostly heterosexual boys were more likely to diet than heterosexuals, boys who considered themselves gay or bisexual were twice as likely as heterosexuals to admit to recently trying to shed pounds.

The symptoms of eating disorders also appeared more commonly in "mostly heterosexuals" than in heterosexuals. Most notably, gay and bisexual boys were 15 times more likely to report binge eating than heterosexual boys.

In an interview with Reuters Health, Austin said that lesbian and bisexual girls may be less likely than heterosexuals to have body concerns because previous research has suggested that men, in general, place a higher priority on their partners' physical attractiveness. This trend would also explain why gay and bisexual boys were more likely than others to have weight concerns, she noted.

Austin added that these results suggest that teens with infrequent same-sex thoughts may not be receiving enough social support. They may also lack the psychological security that comes with knowing your feelings fit into an acknowledged category such as "gay," "straight" or "bisexual."

These findings "suggest that this group is hidden, and needs help," Austin said.

The current study findings also suggest that qualities and feelings that accompany sexual orientation become apparent early on after puberty, given that these teens displayed such varying qualities so soon after becoming sexually mature, the researcher said. So whatever is happening, it happens fast, Austin noted, suggesting that it may be possible to modify some influencing factors and prevent sexual orientation from leading to unhealthy behaviors.

"What is it that's protecting lesbian and bisexual girls?" she asked. "If we find out, maybe we can protect heterosexual girls."

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Skateboarding Riskier Than Ever 

By Lisa Girard
HealthScoutNews Reporter

HealthScoutNews

Friday, October 11, 2002

FRIDAY, Oct. 11 (HealthScoutNews) -- Skateboarders who have taken it to the streets are taking it on the chin.

A new study in the October issue of the Journal of Trauma found skateboard injuries doubled between 1993 and 1998 as the sport underwent a radical change. It shifted from the 1980s style of skateboarding known as "vert," which uses 10-foot-high ramps, to "street skating," which encourages cruising through city streets. Even when supervised, street skating uses lower ramps and involves increasingly complex stunts and tricks.

Many of these injuries could have been prevented, researchers say, by using basic safety equipment -- helmets, wrist guards and elbow and knee pads.

The purpose of the study was to assess the risks of skateboarding compared to other youth sports such as basketball and football, says co-author Dr. Michael Nance, associate director of trauma at Children's Hospital of Philadelphia. As part of their research, the authors looked at data from the U.S. Consumer Product Safety Commission (news - web sites)'s National Electronic Injury Surveillance System (NEISS), which collects data on consumer product-related injuries. They also examined data from annual surveys from the National Sporting Goods Association, which reports on sports participation among people aged 7 and older.

What the scientists found was a significant decline in the rate of skateboard injuries from 1987 to 1993, followed by a significant increase in injuries over the next five years -? a trend they associate with the rising popularity of "street skating" during that period. This shift can be traced, in part, to the introduction in 1995 of the eXtreme Games, televised on ESPN each summer. Millions of kids now watch professional skaters, and many try to copy their more dangerous moves on curbs, stair railings and all sorts or construction equipment found in the streets.

This has caused a continued average annual increase of 16,500 skateboard injuries since 1998, according to NEISS statistics. Almost 30 percent of these involved children under 11. More than 53 percent of the victims were between 12 and 17. The most common types of injuries were wrist fractures, ankle strains and sprains, face lacerations, lower arm fractures, and wrist strains and sprains.

That said, the researchers conclude that, compared with other sports, skateboarding is relatively safe. For instance, the 1998 rate of skateboard injuries treated at emergency departments was only half as high as basketball injuries. And most skateboard-related injuries are relatively minor and can be treated on an outpatient basis, Nance says.

Currently, there are no standards for skateboarding equipment, except a voluntary standard for helmets set by the American Society for Testing and Materials. To reduce the chance of injury, Nance recommends skaters use a full range of equipment, including helmet, wrist guards, elbow and kneepads, and gloves.

"You tend to find that the kids who go to the parks wear the equipment," he said. "They're doing things in a safer setting, whereas the kids on the street tend to be tooling around. They tend to be a little more cavalier, or casual, about it and are more likely to be injured."

What To Do

Children's Healthcare of Atlanta has a number of good tips to increase safety among young skateboarders.

The National Safety Council also has some good advice for skateboarders.

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Choke Fears Spur U.S. Recall of 590,000 Kids' Toys 

Reuters Health