Common cravings in people with pica include the urge to eat soil, coal, rust, chalk and paper (in the 16th century it was given its name from the Latin for "magpie" due to the sufferer's often indiscriminate eating), although people have been known to ingest anything from animal faeces to bits of metal.

"Pica usually appears in people of a low mental age," says Gregory O'Brien, professor of developmental psychiatry at Northumberland University. "So it affects young kids and people with severe learning difficulties." Professor O'Brien says 1%-2% of people with learning disabilities suffer from extreme pica. "It's really not very common but when it occurs, it can be bad."

It can cause digestive problems - ingesting soil can lead to worm infestations and damage to teeth. It can also have grave consequences if the items consumed are poisonous or, as in Mr Evans's case, cause an obstruction in the intestines.

In 2002, a 62-year-old French man with a history of mental illness went to hospital complaining of stomach pains. An x-ray showed he had swallowed five kilograms of coins, necklaces and needles; his stomach was so heavy it had been forced down between his hips. He died after an operation to remove the objects. In 2000, Edward Cope, a 33-year-old man with autism from Manchester, died from complications after swallowing 10 buttons, a drawing pin, pieces of chain and bone and a large amount of black foam rubber.

People with pica have to be watched constantly. Vivien Cooper founded the Challenging Behaviour Foundation (thecbf.org.uk) to give parents of children with behavioural difficulties information and support. Her son, Daniel, who is now 21, has Cri du Chat syndrome, a genetic disorder that results in a range of learning disabilities and challenging behaviours - one of which is pica. "There is nothing he wouldn't consider eating," she says. "If we go to the beach, suddenly you'll think 'did he put something in his mouth?'. He has eaten sand, pebbles, stones, cigarette ends, pen tops, the ends of plastic razors, string, Sellotape. When he was younger, he drank a bottle of washing-up liquid. If he cuts himself, we can't put plasters on him because he'll eat them. He lives in a residential centre and recently ate some disposable rubber gloves. When he was younger, he learned that he could rip open a teddy and eat the stuffing."

Because Daniel's pica is inconsistent, Cooper says she, and the staff who help look after him, have to be always on their guard. "We have had to take him to hospital many times, mainly just to check something hasn't got stuck if we suspect he has swallowed something. You have to be constantly aware but in a way that doesn't inhibit his life, and you have to make sure his environment is right - he has laminate flooring in his room and an indestructible mattress."

There is no explanation for Daniel's pica. "He was given blood tests for zinc deficiency but nothing showed up."

In one American study, 25% of patients in psychiatric care were found to have pica and it appeared in 60% of people with autism (pica tends to be a symptom of something else rather than a disorder in itself).

There are two main types of the condition, says O'Brien. "Food pica, where what a person eats is edible but is not prepared for eating - for instance, I have had patients who would eat a catering-sized tin of coffee powder or gorge on marmalade or potato peelings - and non-food pica, where people eat anything else. Once it starts, it can be difficult to control."

Pica can also appear in young children who go further than just putting things in their mouths. It is normal for infants and toddlers to put things in their mouths but 20% of children will have pica (identified by eating a non-food item repeatedly for more than a month) at some point. Most will outgrow it but the disorder is commonly associated with autism and other learning difficulties, or in children who have suffered brain damage. "If it appears in young children, for the most part it improves with age," says O'Brien. "By two, they should really have stopped trying to eat non-food items. Most parents will watch them and try to divert them with something else."

It is also more common in severely neglected and deprived children who do not necessarily have a learning disability. "I have seen children in orphanages in the Ukraine and parts of eastern Europe who had been totally lacking in stimulation and some of them showed signs of pica. They would eat fluff off the floor and blankets, anything for a bit of stimulation," says O'Brien.

Some forms of pica can also be cultural. Geophagia (the consumption of earth, typically earth that has a high percentage of clay) is considered healthy in many places because people believe it can cure diarrhoea, stop nausea and remove toxins (kaolin is a clay mineral often used in commercial diarrhoea remedies). In some countries in Africa and south America, clay is sold to pregnant women as a "medication".

Although little research has been done on pica, many doctors believe that in some cases, it can be a sign of deficiency in some nutrients, especially iron, even when the items eaten do not contain the nutrients needed. Anecdotal evidence suggests that prescribing iron supplements can reduce or eliminate pica. Pagophagia is the compulsive consumption of ice and is thought to be a response to anaemia, perhaps because it soothes a swollen tongue, one symptom of low iron.

Pica can also start in pregnancy. Around 40% of pregnant women experience cravings and a small proportion of these will crave non-food items. Doctors and midwives have reported women craving coal, chalk, even cigarette ash. "There is a theory that it is linked to iron deficiency," says Gail Johnson, education and professional development adviser for the Royal College of Midwives. "For most women who have pica, it comes and goes and it usually only happens in the early stages of pregnancy. On the whole, most women are sensible and stick to an appropriate diet even if they do have cravings for odd things - we certainly don't recommend women go out and eat soil".

The higher risk to child health is believed to be caused by medical problems in the parents, such as diabetes and hypertension, damaging the child in the womb, but doctors conducting the study said IVF and other fertility treatments may also play a role. Medical records of children born after their parents sought fertility treatment showed they were four times more likely to have autism than those born to fertile parents. Childhood cancers including leukaemia and brain tumours also rose.

The risk of more minor problems, such as attention deficit hyperactivity disorder, rose by 40%, and other medical conditions affecting hearing and sight nearly doubled. Children had a 30% higher chance of being admitted to neonatal intensive care units and to stay in hospital for more than three days if they were born following fertility treatment, the study found.

The researchers stressed the figures represent relative risks. In July researchers at Guy's and St Thomas' hospital in London reported the prevalence of autism to be 0.39% in the general population, a figure that will include some children born to parents aided by fertility treatment. A fourfold rise in the risk of autism would see a child's chances of having the condition increase to 1.56%.

Mary Croughan at the University of California in San Francisco studied 2,000 women who either gave birth naturally after a long period of infertility, or conceived after a variety of fertility treatments, and compared them with 2,000 fertile mothers who gave birth between 1994 and 1998. More than 19,000 medical records were used to build up a picture of the women's pregnancies and deliveries and the health of their children up to six years of age.

The researchers found infertile women had more complications such as pre-term labour and pre-eclampsia, more delivery difficulties and caesarean sections. Children born to infertile women were 20% more likely to have low birth weights and were twice as likely to show evidence of poor growth in the womb. Speaking at the American Association for Reproductive Medicine (ASRM) conference in New Orleans, Dr Croughan said that medical conditions more common in infertile couples may be to blame for the rise in childhood health problems. She said: "The vast majority of children born to infertile couples are healthy, but if a couple has any risk factors that could lead to a child not being born healthy, then those should of course be taken into consideration."

Clare Brown, chief executive of Infertility Network UK, said "continual research" was needed to ensure "treatment is safe for couples and potential children".

The study, which looked at more than 45 000 infants and toddlers from all over the United States, found there were only a few incidents of side effects that required medical treatment as a result of the vaccine, and none was serious.

"This vaccine is very safe in this age group. For me, as a paediatrician and as a parent, it was very reassuring how few diagnoses there were that were associated with this vaccine," said the study's lead author, Dr Simon J. Hambidge, an investigator with Kaiser Permanente Colorado's Clinical Research Unit in Denver.

Results of the study appear in the October 25 issue of the Journal of the American Medical Association.

1 in 5 gets the flu

Annually, as many as one in five Americans gets the flu, according to the US Centres for Disease Control and Prevention.

The best way to prevent the flu is to get the flu vaccination. The CDC recommends that most people get the shot, but specifically advises the following groups of people to receive the flu vaccine every year:

* Children between 6 months and 5 years old,
* Pregnant women,
* People older than 50,
* People who live in nursing homes or other long-term care settings,
* Those with chronic medical conditions, such as diabetes, lung disease and HIV/Aids,
* People living with or caring for young children, nursing-home residents or those with compromised immune systems or chronic medical conditions.

The first time an infant or child receives the vaccine, it must be administered in two separate doses, given one month apart.

Children under 2 have an increased risk of serious complications from the flu. The only people at higher risk are those over 65, according to the study.

Beginning with the 2004-05 flu season, the CDC's Advisory Committee on Immunisation Practices began recommending that children between 6 months and 23 months of age receive the vaccine. However, the largest study that had been done on this age group included fewer than 9 000 vaccinations.
How the study was conducted
So, Hambidge, along with colleagues from the Vaccine Safety Datalink Team and eight other health-care organisations, examined retrospective data for more than 45 000 children who got almost 70 000 vaccinations between January 1991 and May 2003.

The researchers looked only for "medically attended" vaccine complications up to 42 days after immunisation. Minor side effects such as swelling or tenderness at the injection site weren't included in the analysis.

The only statistically significant association they found was for nausea and vomiting. However, Hambidge said these side effects were probably due to exposure to the influenza virus or another virus around the time of vaccination.

Conditions such as asthma, ear infections and the common cold were actually less likely to occur after vaccination, according to the study. The researchers believe these may also be chance findings.

A previous study had found a possible association between the vaccine and febrile seizures (seizures that occur due to high fevers), but this study found no such link, according to Hambidge.

Jab's safety confirmed

"This vaccine was already believed to be safe, and this study backs that up," said Dr David Horwitz, a paediatrician at New York University Medical Centre in New York City.

"This study involved a huge number of children. Generally, a study this large would show any kind of significant adverse reaction that might occur," he added.

The bottom line, according to Hambidge, is that this vaccine "will help protect kids against a nasty illness." - (HealthDayNews)

But on Friday, federal agents raided Hardaway's West Side home while she was asleep.

"Only thing I hear was 'Boom! Boom !" she said. "And I said, 'Oh Lord, my house was on fire.'"

Drug Enforcement Agency officials said that there were between 75 and 100 drug transactions occuring at Hardaway's home and two others nearby for nearly 15 years.

"It was drive-through, come up to the fence and take the drugs," said Nancy Sanford of the DEA. "A lot of them would put it in their mouths and leave."

Sanford said the most serious charge Hardaway faces is that of drugs being sold within 100 feet of a school.

Hardaway's home and the two others may also be destroyed, Sanford said.

"We may actually demolish those houses and put in some type of community service education center," she said.

Eight people in all were initially arrested, including Hardaway.

Acting on a tip, law enforcement officials later arrested Leonard Johnson on drug charges.

The DEA is still looking for Christopher Hardaway, 33; Reginald Harrison, 37; and Clarence McAllister, 28.