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PBS NewsHour

The case for starting sex education in kindergarten

Spring Fever class discussion

Teacher Janneke van den Heuvel leads her 8-year old students in a group discussion during Spring Fever week in the Netherlands. NewsHour photo by Saskia de Melker

“Who here has been in love?” Anniek Pheifer asks a crowd of Dutch elementary school students.

It’s a Spring morning in Utrecht, and the St. Jan de Doper elementary school gym is decked in heart-shaped balloons and streamers. Pheifer and Pepijn Gunneweg are hosts of a kids television program in the Netherlands, and they’re performing a song about having a crush.

Kids giggle at the question. Hands — little and bigger — shoot up.

Welcome to “Spring Fever” week in Dutch primary schools, the week of focused sexuality classes… for 4-year olds.

Of course, it’s not just for 4-year-olds. Eight-year-olds learn about self-image and gender stereotypes. 11-year-olds discuss sexual orientation and contraceptive options. But in the Netherlands, the approach, known as “comprehensive sex education,” starts as early as age 4.

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Kindergarteners attend the opening assembly for Spring Fever week at the St Jan de Doperschool in Utrecht, the Netherlands. NewsHour photo by Saskia de Melker

You’ll never hear an explicit reference to sex in a kindergarten class.In fact, the term for what’s being taught here is sexuality education rather than sex education. That’s because the goal is bigger than that, says Ineke van der Vlugt, an expert on youth sexual development for Rutgers WPF, the Dutch sexuality research institute behind the curriculum. It’s about having open, honest conversations about love and relationships.

By law, all primary school students in the Netherlands must receive some form of sexuality education. The system allows for flexibility in how it’s taught. But it must address certain core principles — among them, sexual diversity and sexual assertiveness. That means encouraging respect for all sexual preferences and helping students develop skills to protect against sexual coercion, intimidation and abuse. The underlying principle is straightforward: Sexual development is a normal process that all young people experience, and they have the right to frank, trustworthy information on the subject.

“There were societal concerns that sexualization in the media could be having a negative impact on kids,” van der Vlugt said. “We wanted to show that sexuality also has to do with respect, intimacy, and safety.”

Beyond risk prevention

The Dutch approach to sex ed has garnered international attention, largely because the Netherlands boasts some of the best outcomes when it comes to teen sexual health. On average, teens in the Netherlands do not have sex at an earlier age than those in other European countries or in the United States. Researchers found that among 12 to 25 year olds in the Netherlands, most say they had  “wanted and fun” first sexual experiences. By comparison, 66 percent of sexually active American teens surveyed said they wished that they had waited longer to have sex for the first time. When they do have sex, a Rutgers WPF study found that nine out of ten Dutch adolescents used contraceptives the first time, and  World Health Organization data shows that Dutch teens are among the top users of the birth control pill. According to the World Bank, the teen pregnancy rate in the Netherlands is one of the lowest in the world, five times lower than the U.S. Rates of HIV infection and sexually transmitted diseases are also low.

“We have to help young people navigate all the choices they face and stand up for themselves in all situations, sexual and otherwise,”

There are multiple factors that likely contribute to these numbers. Easy access to contraception is one. Condoms, for example, are available in vending machines, and the birth control pill is free for anyone under age 21. But there’s also a growing body of research that specifically credits comprehensive sexuality education. A recent study from Georgetown University shows that starting sex ed in primary school helps avoid unintended pregnancies, maternal deaths, unsafe abortions and STDs.

Courtesy of Rutgers WPF

Courtesy of Rutgers WPF

Proponents of the Dutch model argue that their approach extends beyond those risks. Their brand of sex ed reflects a broader emphasis on young people’s rights, responsibility and respect that many public health experts say is the foundation of sexual health.

A 2008 United Nations report found that comprehensive sex ed, when taught effectively, allows young people to “explore their attitudes and values, and to practice the decision-making and other life skills they will need to be able to make informed choices about their sexual lives.” Students who had completed comprehensive sex education in the Netherlands were also found to be more assertive and better communicators, according to an independent health research agency that conducted a study of the Dutch programs.

“We have to help young people navigate all the choices they face and stand up for themselves in all situations, sexual and otherwise,” said Robert van der Gaag, a health promotion official at Central Holland’s regional public health center.

‘Little butterflies in my stomach’

At the St. Jan de Doper school, a group of kindergartners sit in a circle, as their teacher, Marian Jochems, flips through a picture book. The pages contain animals like bears and alligators hugging.

“Why are they hugging?” she asks the class.

“Because they like each other,” one girl answers.

Jochems asks them to think about who they like the most. Several kids say their mom or dad. One girl names her little sister. A few name other children at school.

“How does it feel when that person hugs you?” Jochems asks.

“I feel warm from the inside,” one boy replies. “It’s like there are little butterflies in my stomach.”

Lessons like this are designed to get kids thinking and talking about the kind of intimacy that feels good and the kind that doesn’t. Other early lessons focus on body awareness. For example, students draw boys’ and girls’ bodies, tell stories about friends taking a bath together, and discuss who likes doing that and who doesn’t. By the end of kindergarten, students are expected to be able to properly name body parts including genitals. They also learn about different types of families, what it means to be a good friend, and that a baby grows in a mother’s womb.

CLICK HERE TO READ A LESSON PLAN

CLICK HERE TO READ A LESSON PLAN taught to Dutch kindergarten and first graders. Courtesy of Rutgers WPF

“People often think we are starting right away to talk about sexual intercourse [with kindergartners],” van der Vlugt says. “Sexuality is so much more than that. It’s also about self image, developing your own identity, gender roles, and it’s about learning to express yourself, your wishes and your boundaries.”

That means the kindergartners are also learning how to communicate when they don’t want to be touched. The goal is that by age 11, students are comfortable enough to navigate pointed discussions about reproduction, safe sex, and sexual abuse.

 

Let’s not talk about sex

In the United States, sexual education varies widely from state to state. Fewer than half of U.S. states require schools to teach sex ed, according to the Guttmacher Institute, a global nonprofit that researches sexual and reproductive health. And Deb Hauser, president of Advocates for Youth, a nonprofit dedicated to sexuality education, says that sex ed in the U.S. still overwhelmingly focuses on minimizing the risk of pregnancy and STDs from heterosexual intercourse.

And nearly four in 10 millennials report that the sex education they received was not helpful, according to a survey by the Public Religion Research Institute.

“We have failed to see that sexual health is far more than simply the prevention of disease or unplanned pregnancy,” says Hauser. That narrow focus, she says, leaves young people with few skills to cope with their feelings and make decisions in sexual encounters.

Not everyone agrees.  In fact, comprehensive sex ed has yet to take hold in most parts of the country. Utah, for example, requires that abstinence be the dominant message given to students. It bans discussing details of sexual intercourse and advocating for homosexuality, the use of contraceptives or sexual activity outside of marriage.

Utah state representative Bill Wright has further tried to restrict sex ed. In 2012, he proposed a bill requiring that abstinence only be taught and that it be an optional subject. It passed but was vetoed by the governor.

Sex ed is “not an important part of our curriculum,” Wright said. “ It is just basically something out there that takes away from the character in our schools and takes away from the character of our students.”

Utah is far from alone. Half of U.S. states require that abstinence be stressed. “We have created generations of people who are not comfortable with their own sexuality,” says Dr. David Satcher, the former U.S. Surgeon General. That extends to parents and teachers, he says.

In other areas, the tide is shifting toward an approach closer to that of the Dutch. Two of the largest school districts in the country — Chicago Public Schools and Florida’s Broward County — have recently mandated sex education for elementary school students. Chicago Public Schools requires at least 300 minutes a year of sex education for kindergarten through fourth grade students and twice as much time for fifth through twelfth graders. In the fall of 2015,  schools in Broward County will teach sex education at least once a year in every grade, and the curriculum will include information about topics like body image, sexting and social media.

Courtesy of Rutgers WPF

Courtesy of Rutgers WP

In the Netherlands, schools aim to educate parents too. Parents nights are held to give parents tools to talk to their kids about sex. Public health experts recommend that parents take cues from their kids and make it an ongoing conversation, rather than one awkward, all-encompassing “birds and the bees” talk. For example, they advise, if you walk in on your child masturbating, don’t react shocked; don’t punish or scold them. Have a talk about where it is appropriate for such behavior to occur.

“We talk about [sex] over dinner,” said one father at a Spring Fever Parents Night. Another said he recently answered questions about homosexuality posed by his twin 6-year-olds during bath time.

Lessons in love

Sabine Hasselaar teaches 11-year-olds. In a recent class, Hasselaar posed a series of hypothetical situations to her students: you’re kissing someone and they start using their tongue which you don’t want. A girl starts dancing close to a guy at a party causing him to get an erection. Your friend is showing off pornographic photos that make you feel uncomfortable.

The class discusses each scenario. “Everyone has the right to set their own limits and no one should ever cross those limits,” Hasselaar says.

There is an anonymous ‘Question Box.’ in her class during “Spring Fever” week. Students submit questions that teachers later address in class. “Nothing is taboo,” Hasselaar says. One of her students, for example, wrote: “I think I am lesbian. What should I do?”
Hasselaar addressed the issue in class: “It’s not strange for some girls to like other girls more than boys. It’s a feeling that you can’t change, just like being in love. The only difference is that it’s with someone that is the same sex as you.”

And in fact, most of the questions from her students aren’t about sex at all. “Mostly they are curious about love. I get a lot of questions like, “What do I do if I like someone?” or ‘How do I ask someone to go out with me?’”

Questions like these are taken just as seriously as the ones about sex.

“Of course we want kids to be safe and to understand the risks involved with sex, but we also want them to know about the positive and fun side of caring for someone and being in a healthy relationship,” van der Vlugt says.

That’s why you’ll find teachers discussing the difference between liking someone (as a friend) and liking someone. There’s even a lesson on dating during which a teacher talked about how to break up with someone in a decent way: “Please, do not do it via text message,” the teacher said.

“In the Netherlands, there’s a strong belief that young people can be in love and in relationships,”

After elementary school, these students will likely go on to receive lessons from a widely-used curriculum called Long Live Love.

“In the U.S., adults tend to view young people as these bundles of exploding hormones. In the Netherlands, there’s a strong belief that young people can be in love and in relationships,” says Amy Schalet, an American sociologist who was raised in the Netherlands and now studies cultural attitudes towards adolescent sexuality, with a focus on these two countries.

“If you see love and relationships as the anchor for sex, then it’s much easier to talk about it with a child,” Schalet says. “Even a young one.”

The post The case for starting sex education in kindergarten appeared first on PBS NewsHour.

Researchers use brain scans to hunt for Alzheimer’s cause

WOLFRATSHAUSEN, GERMANY - NOVEMBER 15:  Two female inhabitants of a residential care home for Alzheimer's disease
         and dementia patients walk hand-in-hand in the corridor of the residential home on November 15, 2011 in Wolfratshausen, Germany.
         (Photo by Alexandra Beier/Getty Images)

WOLFRATSHAUSEN, GERMANY – NOVEMBER 15: Two female inhabitants of a residential care home for Alzheimer’s disease and dementia patients walk hand-in-hand in the corridor of the residential home on November 15, 2011 in Wolfratshausen, Germany. (Photo by Alexandra Beier/Getty Images)

WASHINGTON (AP) — Sticky plaque gets the most attention, but now healthy seniors at risk of Alzheimer’s are letting scientists peek into their brains to see if another culprit is lurking.

No one knows what actually causes Alzheimer’s, but the suspects are its two hallmarks — the gunky amyloid in those brain plaques or tangles of a protein named tau that clog dying brain cells. New imaging can spot those tangles in living brains, providing a chance to finally better understand what triggers dementia.

Now researchers are adding tau brain scans to an ambitious study that’s testing if an experimental drug might help healthy but at-risk people stave off Alzheimer’s. Whether that medication works or not, it’s the first drug study where scientists can track how both of Alzheimer’s signature markers begin building up in older adults before memory ever slips.

“The combination of amyloid and tau is really the toxic duo,” predicted Dr. Reisa Sperling of Boston’s Brigham and Women’s Hospital and Harvard Medical School, who is leading the so-called A4 study. “To see it in life is really striking.”

The A4 study — it stands for Anti-Amyloid Treatment in Asymptomatic Alzheimer’s — aims to enroll 1,000 healthy seniors like Judith Chase Gilbert, 77, of Arlington, Virginia. The recently retired government worker is mentally sharp but learned through the study that her brain harbors amyloid buildup that might increase her risk. Last week, researchers slid Gilbert into a doughnut-shaped PET scanner as she became one of the first study participants to also have their brains scanned for tau.

“We know that tau starts entering the picture at some point, and we do not know when. We do not know how that interaction happens. We should know,” said chief science officer Maria Carrillo of the Alzheimer’s Association, which is pushing to add tau scans to other dementia research, too.

More than 35 million people worldwide have Alzheimer’s or similar dementias, including about 5 million in the U.S. Those numbers are expected to rise rapidly as the baby boomers get older. There is no good treatment. Today’s medications only temporarily ease symptoms and attempts at new drugs, mostly targeted at sticky amyloid, have failed in recent years.

Maybe that’s because treatment didn’t start early enough. Scientists now think Alzheimer’s begins quietly ravaging the brain more than a decade before symptoms appear, much like heart disease is triggered by gradual cholesterol buildup. Brain scans show many healthy older adults quietly harbor those sticky amyloid plaques, not a guarantee that they’ll eventually get Alzheimer’s but an increased risk.

Yet more recent research, including a large autopsy study from the Mayo Clinic, suggests that Alzheimer’s other bad actor — that tangle-forming tau protein — also plays a big role. The newest theory: Amyloid sparks a smoldering risk, but later spread of toxic tau speeds the brain destruction.

Normal tau acts sort of like railroad tracks to help nerve cells transport food and other molecules. But in Alzheimer’s, the protein’s strands collapse into tangles and eventually the cell dies. Most healthy people have a small amount of dysfunctional tau in one part of the brain by their 70s, Sperling said. But amyloid plaques somehow encourage this bad tau to spread toward the brain’s memory center, she explained.

The A4 study, which is enrolling participants in the U.S., Australia and Canada, may give some clues.

The goal is to check up to 500 people for tau three times over the three-year study, as researchers tease out when and how it forms in those who are still healthy. They won’t be told the results — scientists don’t know enough yet about what the scans portend.

At the same time, study participants will receive either an experimental anti-amyloid drug — Eli Lilly & Co.’s solanezumab — or a placebo as researchers track their memory. The $140 million study is funded by the National Institutes of Health, Lilly and others; the Alzheimer’s Association helped fund the addition of the tau scans.

The idea: If the drug proves to be helpful, it might be tamping down amyloid formation that in turn reins in toxic tau. In previous studies, solanezumab failed to help full-blown Alzheimer’s but appeared to slow mental decline in patients with mild disease, raising interest in testing the still healthy.

“We’re trying to remove amyloid’s downstream effects on tau formation,” said Dr. R. Scott Turner of Georgetown University Medical Center, where Gilbert enrolled in the study.

Seeing how amyloid and tau interact in living brains “is opening a whole new chapter into possible therapies,” Turner added.

For Gilbert, learning she had amyloid buildup “was distressing,” but it has prompted her to take extra steps, in addition to the study, to protect her brain. On her doctor’s advice, she’s exercising more, and exercising her brain in a new way by buying a keyboard to start piano lessons.

“It’s exciting to be part of something that’s cutting edge,” said Gilbert, who had never heard of tau before.

And she has a spot-on question: “So what’s the medication for the tau?”

Stay tuned: A handful of drugs to target tau also are in development but testing will take several years.

The post Researchers use brain scans to hunt for Alzheimer’s cause appeared first on PBS NewsHour.

Second opinions often prescribed, but value not yet proven

When does a second opinion give the most value to a patient? Photo by Heather Charles/Chicago Tribune/MCT via Getty Images

When does a second opinion give the most value to a patient? Photo by Heather Charles/Chicago Tribune/MCT via Getty Images

Actress Rita Wilson, who was diagnosed with breast cancer and underwent a double mastectomy recently, told People magazine last month that she expects to make a full recovery “because I caught this early, have excellent doctors and because I got a second opinion.”

When confronted with the diagnosis of a serious illness or confusing treatment options, everyone agrees it can be useful to seek out another perspective. Even if the second physician agrees with the first one, knowing that can provide clarity and peace of mind.

A second set of eyes, however, may identify information that was missed or misinterpreted the first time. A study that reviewed existing published research found that 10 to 62 percent of second opinions resulted in major changes to diagnoses or recommended treatments.

Another study that examined nearly 6,800 second opinions provided by Best Doctors, a second-opinion service available as an employee benefit at some companies, found that more than 40 percent of second opinions resulted in diagnostic or treatment changes.

But here’s the rub: While it’s clear that second opinions can help individual patients make better medical decisions, there’s little hard data showing that second opinions lead to better health results overall.

“What we don’t know is the outcomes,” says Dr. Hardeep Singh, a patient safety researcher at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine in Houston, who co-authored both those studies. “What is the real diagnosis at the end? The first one or the second one? Or maybe both are wrong.”

That doesn’t mean second opinions are a bad idea. Experts estimate that diagnostic errors occur in 10 to 15 percent of cases.

“There’s no getting away from it, diagnosis is an imprecise thing,” says Dr. Mark Graber, a senior fellow at RTI International who also co-authored the studies. Graber is the founder and president of the Society to Improve Diagnosis in Medicine.

Second opinion requests were related to diagnosis questions in 34.8 percent of cases in the Best Doctors study. These included 22.5 percent of patients whose symptoms hadn’t improved, 6.3 percent who hadn’t gotten a diagnosis and 6 percent who had questions about their diagnosis.

In Wilson’s case, she wrote that after two breast biopsies she was relieved to learn that the pathology analysis didn’t find any cancer. But on the advice of a friend, she decided to get a second opinion, and that pathologist diagnosed invasive lobular carcinoma. Wilson then got a third opinion that confirmed the second pathologist’s diagnosis.

Getting a second opinion may not involve a face-to-face meeting with a new specialist, but it will certainly involve a close examination of the patient’s medical record, including clinical notes, imaging, pathology and lab test results, and any procedures that have been performed. Some people choose to have that second look done by physicians in their community, but other patients look for help elsewhere.

In addition to employer-based services like Best Doctors or Grand Rounds, medical centers such as the Cleveland Clinic and Johns Hopkins in Baltimore also offer individual patients online second opinions.
“It really does give people relatively easy access to expertise,” says Dr. C. Martin Harris, chief information officer at the Cleveland Clinic.

The medical center’s MyConsult service doesn’t accept insurance. A medical second opinion costs $565, while a consultation with a pathology review costs $745.

Face-to-face meetings with specialists who provide a second opinion and review a patient’s medical record are more likely to be covered by insurance than an online consult, but nothing is guaranteed.

“Usually it’s not the second opinion where the hiccup is,” says Erin Singleton, chief of mission delivery at the Patient Advocate Foundation, which helps people with appeals related to second opinions. “It may be that the MRI that they want to do again won’t be approved.” Many insurers won’t pay for diagnostic or other tests to be redone, she notes.

Patients seeing an out-of-network specialist for a second opinion may encounter significantly higher out-of-pocket costs, particularly if they want to subsequently receive treatment from that provider. In those instances, the foundation can sometimes work with patients to make the case that no specialist in their network is equally experienced at treating their condition.

Of course, asking for a second opinion doesn’t necessarily mean accepting the advice. In the Best Doctors survey, 94.7 percent of patients said they were satisfied with their experience. But only 61.2 percent said they either agreed or strongly agreed that they would follow the recommendations that they received in the second opinion.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. You can view the original report here.

The post Second opinions often prescribed, but value not yet proven appeared first on PBS NewsHour.

The last time I went fishing with my dad

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Editor’s note: This is the second installment of cartoonist Jack Ohman’s series “The Care Package,” for PBS NewsHour.

Cartoonist Jack Ohman’s aging father was in no condition to go fishing, but when his dad said he wanted to go, Ohman spent days figuring out how to make the trip happen.

Ohman recently revisited that trip and what he learned about his father that day.

From the time he was a kid, Ohman and his father fished together, usually bringing home nothing but jokes about the day’s poor catch. They may not have had a lot in common, “but we had fishing,” Ohman said.

Three years after his father’s health steadily began to decline, Ohman knew this trip was important, and he couldn’t have picked a better time to take it.

When he and the boatman lifted his father and placed him into the boat, the Oregon sky was blue, the birds sang and the flowers were in bloom. “It was unbelievably poignant,” Ohman recalled.

It was a banner day. Ohman’s father not only caught the most fish but also the biggest. By the time the trip was over, Ohman eagerly offered to plan the next one.

“I said, ‘We could go again,’ and he said, ‘No, I don’t think so,’” Ohman said. “That’s when I knew. This was his way of telling me, this was it, he was closing up shop.”

There was nothing Ohman could say. He never brought it up again.

His father died nine months later.

Ohman knows he’s not the only person who has grappled with a parent’s mortality.

“This is a story that millions of Americans are experiencing everyday,” Ohman said.

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Look for the next installment in Ohman’s cartoon series about his experience taking care of his father, arriving in June.

Reporting by Laura Santhanam

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The post The last time I went fishing with my dad appeared first on PBS NewsHour.