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June 2009
U Minnesota study: Teens
who think they'll die young live fast
A self-fulfilling prophecy? Teens who are less hopeful seem to engage in
riskier behavior, a University of Minnesota study found. For example,
they were seven times more likely to later be diagnosed with HIV or
AIDS.
They used to say that teenagers think they're immortal, and that's why they do such dangerous things. Now, a University of Minnesota study has found that a surprising number of teenagers believe they're going to die young - and that may be why they're so reckless. Nearly 15 percent of teenagers said they have a 50-50 chance - or less - of living to the ripe old age of 35, according to a survey released today. In truth, their odds are much higher: Roughly 96 out of 100 will celebrate their 35th birthdays, according to national statistics.
But the study shows that teenagers who are most pessimistic are also most likely to put themselves in danger - taking drugs, attempting suicide or having unprotected sex. "It was surprising; maybe disturbing is the better word," said Dr. Iris Borowsky, an associate professor of pediatrics, who led the study. "[They] may take risks because they feel hopeless and figure that not much is at stake."
The researchers based their findings on a 1995 nationwide survey of more than 20,000 students in grades seven to 12, as well as follow-up surveys in 1996 and 2001-2002.
In the past, Borowsky said, it was widely believed that teenagers underestimate danger - what some call the "myth of personal invulnerability," or "It can't happen to me." Many assumed that's why teenagers engaged in "self-jeopardizing behaviors," according to Borowsky and her colleagues. But recent studies have cast that into doubt. One of the most striking findings in today's study, she said, was that the fatalists were seven times more likely than their peers to be diagnosed with HIV or AIDS by the time they were young adults.
Which came first?
They also found that racial minorities were more pessimistic
than white teenagers. Nearly three in 10 American Indians, and one in
four blacks, expected to die young, compared to one in 10 whites.
Overall, the pessimists were more likely to be arrested, be injured in fights, use marijuana, cocaine or other drugs and try to kill themselves. The researchers tried to find out which came first: the dangerous behavior or the pessimistic attitudes. "What we found in the end was that it went both ways," Borowsky said. Teens who engaged in risky behaviors thought they would die young; and those who thought they would die young took more risks.
On an optimistic note, they found that the pessimism tends to fade over time. By the time they were young adults, far fewer expected an early death, said Borowsky. "That makes sense," she said. "As you get older you develop a more accurate perception." By the time the study ended, the oldest participants were in their mid-20s. And, in fact, 94 of the 20,594 original study subjects had died. The researchers didn't track the causes of death, Borowsky said, but they know one thing: The pessimists were no more likely to die than the optimists. "There was no significant relationship between a high perceived risk for dying before age 35 and actual death," the scientists wrote.
As a medical doctor, Borowsky said, she sees a message in the findings: It's important to ask teenagers how they see the future and their place in it. If they don't see "a long road ahead" for themselves, it may be time to intervene, she said.
The study appears in the July issue of the journal Pediatrics.
Maura Lerner
28 June 2009
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Irritability should be
considered when diagnosing bipolar disorder in children
A new study from Bradley Hospital and
The Warren Alpert Medical School of Brown University, as well as two
other institutions, adds to mounting evidence that clinicians consider
irritability as a symptom when diagnosing pediatric bipolar disorder.
Reporting in the July issue of the Journal of the American Academy of
Child and Adolescent Psychiatry, researchers say a small percentage of
children with bipolar disorder experience manic episodes without extreme
elation – one of the hallmarks of the disorder – and are diagnosed based
on irritable mood alone.
"Diagnosing children with bipolar disorder is challenging. One of the
chief controversies is whether irritability should be included among the
criteria for this diagnosis because it can also overlap with a number of
other psychiatric disorders, such as attention deficit hyperactivity
disorder," says lead author Jeffrey Hunt, MD, a child psychiatrist and
training director at Bradley Hospital. "Our findings confirm that while
irritable-only mania is uncommon, it does exist – particularly in
younger children – and should be considered in a bipolar diagnosis."
Bipolar disorder is characterized by dramatic mood swings from euphoria,
elation and irritability – the manic phase of the disorder – to severe
depression. Bipolar disorder often begins in late adolescence or early
adulthood, although it can develop as early as the preschool years.
Recent studies have shown that the number of children and teens being
treated for bipolar disorder has grown dramatically in the last decade.
Although it is unclear what has caused this increase, experts believe it
may be due in part to more aggressive diagnoses by physicians and a
greater awareness of pediatric bipolar disorder in the medical
community.
Hunt and colleagues studied 361 children between the ages of 7 and 17
with bipolar disorder participating in the multi-site Course and Outcome
of Bipolar Illness in Youth (COBY) study at Bradley Hospital and Alpert
Medical School, the University of Pittsburgh and the University of
California-Los Angeles. COBY is the largest and most comprehensive study
of children and adolescents with bipolar disorder to date.
Researchers quantified the frequency and severity of manic symptoms of
each participant, including whether irritability and elation were
present. Based on this data, the group was then reclassified into three
subgroups: elation-only, irritable-only and both elated and irritable.
Approximately 10 percent of children fell into the irritable-only
category, while elated-only constituted about 15 percent. Nearly
three-quarters experienced both elation and irritability. The
irritable-only participants were significantly younger in age than the
other two groups; however, there were no other sociodemographic
differences between the groups. There were also no significant
differences in terms of bipolar subtype, rate of psychiatric
comorbidities, severity and duration of illness, and family history of
mania and other psychiatric disorders. However, depression and alcohol
abuse in second-degree relatives occurred more frequently in the
irritable-only subgroup.
"The fact that the irritable-only and elation-only subgroup had similar
clinical characteristics and family histories of bipolar disorder
provides support for continuing to consider episodic irritability in the
diagnosis of pediatric bipolar disorder," says Hunt, who is an assistant
professor of psychiatry and human behavior at Alpert Medical School.
Hunt is also training director of the child and adolescent fellowship
and triple board residency programs.
The authors say continual, long-term follow-up of this study sample will
help clarify whether the presence or predominance of elation or
irritability at baseline will predict future clinical outcomes.
Press release: EurekAlert
24 June 2009
http://www.eurekalert.org/pub_releases/2009-06/l-isb062409.php
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NEW ZEALAND
Prime Minister’s child abuse comments welcomed
A charity that specialises in
tackling child abuse has welcomed the Prime Minister’s commitment to do
something about what has been widely described as ‘New Zealand’s
greatest shame.’
Libby Robins, director of the Family Help Trust, which works with
families of young children at the highest risk of child abuse, says she
hopes the Prime Minister’s pledge will be backed up with action, and
soon.
“After the election we were optimistic about the signals the government
was giving on the issue of child abuse prevention. However, we have
become increasingly concerned about the lack of detail that has emerged
in the last six months.
“The Prime Minister’s comment in the house this week that his government
is going to do something about child abuse is therefore encouraging, and
we look forward to hearing exactly what he has in mind.
“It would be ideal if the Prime Minister can find a way to sustainably
fund services such as ours to provide effective early intervention to
prevent child abuse. In our case that would be a marked increase in what
we currently receive from the government, but would enable us to face
the future with some certainty and really focus on the children who most
need our service.
“With the economy in recession, the Prime Minister is in no position to
run a lolly scramble for social services providers, although there is a
strong argument that tough economic times are even more reason for
government to provide for those who face the greatest difficulty via the
social agencies, such as ours, which work with them,” she said.
Libby Robins says it is hard to find anyone who does not feel passionate
about the issue.
“Everyone feels strongly about what is happening to many of the
youngest, most vulnerable and most socially deprived New Zealanders, who
are born into families that suffer multiple problems, to parents who
lack the skills to care for their infants and are prone to expressing
themselves through violence.
“Many who examine the problem conclude that child abuse is intractable,
therefore consigning the issue, its perpetrators and their victims to
the ‘too hard basket.’
“That is not our approach. The Family Help Trust has demonstrated that a
specialist service focussed on prevention and targeted at the highest
risk group is able to take action to help these families to learn the
parenting skills they lack, and therefore break the cycle of child
maltreatment and abuse,” she said.
Ms Robins suggested that, as the Prime Minister works out how he will
combat child abuse, he will be aware that some early intervention
programmes, aimed at families of children in the first years of life,
have proven effective.
“The government is facing problems with prison over-crowding and has
indicated it will take a tough line on youth offenders by introducing
boot camps. The budget also included provision for schools to deal with
the most disruptive pupils by employing teacher aides.
“We know the sort of problems faced by families that produce the
majority of prisoners, youth offenders and disruptive primary school
pupils. Investing in early intervention programmes to address the causes
of child abuse will help alleviate all of these problems, and many
others, in the future.
“We know that carefully targeted investment to work with socially
deprived families can generate a substantial payback.
“Within the first three years of life, children who live in homes where
violence and maltreatment are commonplace are at particularly high risk
of becoming traumatised to such an extent that their brain development
is impaired. When this occurs, it creates life-long difficulties for the
individual and profound impact on society. Estimates relating to New
Zealand suggest that child abuse and neglect generates a long term cost
that is equivalent to around $2 billion, or over one per cent of GDP,
per annum.
“That is the cost of policing, imprisonment, mental health, healthcare,
drug addiction and the other negative consequences and lost
opportunities that eventuate from young people and adults who have spent
the early years of their lives subject to violence, neglect,
maltreatment and abuse, and lead blighted adult lives as a consequence.
“The Prime Minister’s resolve to do something about that is excellent
news. We anticipate with keen interest just what that ‘something’ will
be,” she said.
Over the past 18 years the Family Help Trust has worked with the
families of over 1,000 children born in Christchurch at the highest risk
of child abuse, successfully helping them to lead better lives than
would have been the case without the charity’s assistance.
The Family Help Trust provides child abuse prevention services to the
most vulnerable infants, from birth up to five years, working
intensively with their families to provide support through basic health
and education programmes. The Family Help Trust has resources to work
with around 30 new referrals each year, financed by a mix of government
funding and charitable donations. Approximately 100 children born in
Christchurch each year are at the highest risk of child abuse, and
approximately 1,200 fall into that category nationwide.
A two year outcome study published recently by the Trust linked
effective early intervention to substantial decreases in factors
associated with family violence such as helping mothers of vulnerable
infants to end abusive relationships; come off drugs; stop hitting their
children and begin to turn their own and their children’s lives around.
Press Release: Family Help Trust
25 June 2009
http://www.scoop.co.nz/stories/PO0906/S00279.htm
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Palestinian refugee caregivers receive care through new World Vision project
When social workers from two Palestinian refugee camps in north Lebanon first learned about World Vision's new Caring for Caregivers project, they had trouble believing that the project was about meeting their needs and not just another technical training.
'We worked and lived [at the camps] under a lot of pressure, and we always thought 'who would possibly think of us?'' said Fatmeh Shahine social worker at the Najdeh non-governmental organisation (NGO). 'When we were informed about the idea, we couldn't believe that such a project came true. [So far] we have cried, laughed, played, explored our strengths and weaknesses and enjoyed trust and comfort.'
World Vision officially launched the Caring for Caregivers project Wednesday in Beddawi Palestinian refugee camp, to meet the needs of a group of people often overlooked when it comes to addressing the stress created by conflict. 'The NGO I work for tries to support us a lot, but what we actually needed is a project like this, that eases our built up pain,' said Ilham, another social worker.
A World Vision assessment conducted after months of fighting in Nahr el Bared Palestinian refugee camp which displaced thousands of people to the nearby Beddawi camp, showed that children and youth displaced by the conflict suffered from high levels of trauma because of the war. In addition, parents, teachers, and social workers have said that they were facing high levels of daily stress because they had to meet their own basic needs and those of the internally displayed people.
'People who care for others affected by trauma often experience the same hardships themselves,' said Zeina el Khoury, coordinator of the Caring for Caregivers project. 'They suffer from the same physical, psychological, and social impacts of war and share similar hopes, fears and questions. Without a clear vision on what care to give to humanitarian actors, there is the risk that the ability to care for the community will be overwhelmed by the demands of different stakeholders. The more we nurture this culture of caring, the safer the community is.'
Very little effort has been made to meet the specific needs of caregivers from the two camps affected by the fighting, said el Khoury. Most psychosocial interventions focused on recreational activities promoting child protection, she said.
Caring for Cargivers also aims to reach as wide a cross-section of humanitarian actors from the two camps as possible. All 30 local NGOs and associations active in both camps were invited to take part in the project, said el Khoury. In the first phase of this three-year project, World Vision will work with around 65 humanitarian actors from 25 NGOs to teach them how to express themselves through methods such as writing, painting and acting. Afterwards, the project will work with the directors of the NGOs to boost their managerial skills and enhance their organisations' structures.
This project is funded by World Vision Australia and is being implemented in partnership with the Palestinian Child and Youth Institute.
Source: World Vision Middle East/Eastern
Europe/ Central Asia office
22June 2009
http://www.alertnet.org/thenews/fromthefield/wvmeero/fe68630667cc2c74ab9ea5f22a17835b.htm
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AUSTRALIA
Child death rates dropping
The latest report on Australia's children, released on 17 June by the Australian Institute of Health and Welfare, shows a continuing fall in child death rates - mostly due to fewer injury deaths - as well as declining asthma hospitalisations, teen births and smoking rates in older children. 'Combined with favourable trends in some risk and protective factors, such as immunisation coverage, these factors suggest that overall Australian children are doing well,' said Deanna Eldridge of the Institute's Children, Youth and Families Unit. 'Improvements in leukaemia survival rates are also encouraging, as is the fact that most children meet national physical activity guidelines and achieve national minimum standards for reading and numeracy,' she said.
In terms of international comparisons however, Australia doesn't measure up to other OECD countries on infant and under five mortality rates, teenage birth rates and jobless families with children. And there are other areas that also need improvement.
According to the report, A picture of Australia's children 2009, far too many children spend more than the recommended time of two hours a day in front of a video screen (including television and computers), are overweight or obese, and are not eating recommended amounts of vegetables.
'Rising rates of severe disability, diabetes, and the disadvantages faced by Indigenous children and children who live in remote areas are also a concern,' Ms Eldridge said. 'Aboriginal and Torres Strait Islander children are far more likely to be disadvantaged across a broad range of health and socioeconomic indicators,' she said. Indigenous children are two to three times as likely as other Australian children to die, be of low birthweight and have dental decay. They are five times as likely to be born to teenage mothers; eight to nine times as likely to be in the child protection system; and 24 times as likely to be under juvenile justice supervision.
The report also shows that children living in remote areas had higher death rates, higher rates of neural tube defects, lower rates of cancer survival, worse dental decay, and were less likely to meet minimum standards for reading and numeracy than their counterparts living in major cities.
A picture of Australia's children 2009 is the fourth in a series of AIHW national statistical reports on children aged 0-14 years. It provides the latest available information on how Australia's children are faring according to key national indicators of health, development and wellbeing. This includes reporting, for the first time, against the Children's Headline Indicators endorsed by Ministerial Councils for Health, Community Services and Disability, and Education.
Source: Australian Institute of Health and
Welfare
22 June 2009
http://www.sciencealert.com.au/news/20092206-19319-2.html
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US: Salesian Missions launches first-ever national awareness campaign
This month marked the launch of Salesian Missions first-ever national awareness campaign. The campaign includes the nonprofit organization's first television commercial and a new campaign website at www.FindYourMission.org
The "What's your mission?" campaign is the first-ever national awareness campaign for Salesian Missions. The purpose of the campaign is to shed light on the work of Salesian Missions all around the globe, and the 3 million children who have been helped to date in more than 130 countries. This new national campaign also celebrates the more than 5 million Americans who have financially contributed to this work while reaching out to new audiences that will help to further important programs helping children around the globe.
A key element of the campaign is highlighting those who make a difference through generous donations - and empowering the audience to join them. The campaign features "real people" - Salesian Missions staff and others connected to the charity - adding not only a personal touch to the campaign message, but highlighting in a real way those who have already given so much to the organization. The campaign also invites others to join in, asking them to upload "What's your mission?" videos on YouTube with a chance to be featured in the campaign.
"The great work that Salesian Missions does around the globe in more than 130 countries too often goes unnoticed by the public at large," says Father Mark Hyde, SDB, Director of Salesian Missions. "Raising more resources and attracting new donors will depend heavily on getting our message out for people to hear and see."
Press Release: eMediaWire
18 June 2009
http://www.emediawire.com/releases/Salesian_Missions/Whats_Your_Mission/prweb2547284.htm
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UK
National Children's Bureau Chief Executive awarded a knighthood
Paul Ennals, Chief Executive of NCB, has been awarded a knighthood in the Queen's Birthday Honours list.
Paul Ennals said: 'I am honoured to receive this award. The greatest privilege of working at NCB, is to work with an extraordinarily talented set of people. NCB has a history of attracting some of the most creative and committed individuals in the children's sector, and I am really pleased to receive this award on behalf of all of them.
'The work of NCB has brought real improvements for the lives of disabled children, children in care, bereaved children, and other vulnerable groups. My colleagues have transformed play provision in this country, supported great improvements in early years services, and supported the active participation of children and young people in the planning of services. My thanks go to them.'
NCB's mission is to advance the well-being of all children and young people across every aspect of their lives. As a membership and infrastructure support agency for the children's sector in England and Northern Ireland, NCB provides essential information on policy, research and best practice for our members and the members of our wide range of partnership bodies, which operate under our charitable status and are based in our London headquarters. For further information visit http://www.ncb.org.uk
Source: NCB
17 June 2009
http://www.medicalnewstoday.com/articles/154137.php
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Study shows importance of developmental screening tool for identifying delays in pre-term children
A new study finds that U.S. pediatricians have plenty of room for improvement when it comes to using a screening questionnaire to flag developmental delays in premature children.
The study was a collaboration between physicians at PeaceHealth Medical Group, led by pediatrician Dr. Kevin Marks, lead author, and co-author Professor Hollie Hix-Small, of Ryerson University’s School of Child and Youth Care, formerly of the Early Intervention Program at the University of Oregon. The study, Lowering Developmental Screening Thresholds and Raising Quality Improvement in Pre-term Children, was published in the June issue of Pediatrics and can be viewed online at http://pediatrics.aappublications.org/cgi/content/abstract/123/6/1516
In the study, a group of 1,427 caregivers and children in the U.S. attending their 12- or 24-month well-child visits (regular screening for developmental delays by pediatricians) completed the Ages & Stages Questionnaire® (ASQ), a child development screening tool.
The study examined the number of lower-risk, pre-term (most who were born between 34 and 37 weeks gestational age) children versus the number of term children who were referred to an early-intervention agency. Higher-risk premature infants already involved with an early-intervention agency or previously identified with a delay were excluded.
The data shows the selected pre-term children were approximately two times more likely to be eligible for early intervention programs than term children, but that many of these children are being missed due to insufficient standardized screening at well-child visits. In addition, the study shows that an unacceptably high percentage of children who are identified as potentially delayed (and likely to benefit from early intervention), are not accessing services due to lack of follow-up between parents and early intervention programs.
“Pediatricians identify children with delays through a process of developmental surveillance and screening, which primarily occurs at well-child visits between zero to five years of life. This study indicates that pediatricians should provide more diligent surveillance and actively lower their thresholds for administering a quality (valid, reliable and feasible) screening tool like the Ages & Stages Questionnaire in preterm children,” says Dr. Kevin Marks.
Adds Hix-Small: “We need more research in Canada to find out how many physicians are using a high quality screen tool, such as the ASQ Questionnaire, and how children can benefit from this. Developmental screening is a very real, tangible and cost effective way to improve the quality of health care and child outcomes and should be considered a key element in well-child care.”
Without a screening tool, says Hix-Small, physicians fail to detect up to 60 to 80 per cent of children with developmental delays in a timely manner. “This study highlights the increased importance of using standardized screening with pre-term children who are at an increased risk for developmental difficulties and have been shown to greatly benefit from early intervention services. Physicians are in an incredible position to identify delays and open up opportunities for parents to access early supports and services for their children.”
Hix-Small will hold a training session on the benefits of developmental screening for preterm children and their caregivers, such as the ASQ Questionnaire, with clinicians and practitioners at the Hospital for Sick Children’s Infant Mental Health Program in October.
newswise
15 June 2009
http://www.newswise.com/articles/view/553377/
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CMA applauds Senate passage of FDA tobacco rules
The California Medical Association supports the passage of the Family Smoking Prevention and Tobacco Control Act that would allow the U.S. Food and Drug Administration to finally set standards for cigarettes and regulate chemicals. In 1963, CMA was the first among state medical societies to create policy to inform people about the harmful effects of cigarette smoking. "California's physicians have been outspoken on the ill effects of cigarettes for over 40 years," said Dr. Dev GnanaDev, CMA president. "The Family Smoking Prevention and Tobacco Control Act is long overdue. What we feed our pets is more regulated than cigarettes are today. "
CMA has been a tireless advocate on stronger reforms for the tobacco industry. In 1970, 1978 and 1980, the medical association supported ballot initiatives that would have banned smoking in many public places. In 1987, CMA took on its biggest tobacco-related challenge and won, with the passage of Proposition 99, which established a 25-cents-per-pack tax on cigarettes and a tax hike for other tobacco related products.
Joining with other health related groups, labor and the California Restaurant Association in 1993, the medical association worked to pass the Indoor Clean Air Act, a law banning smoking in California workplaces, including restaurants and even bars. The passage of this law struck a huge blow against the scourge of cigarettes and sparked a nationwide trend. In recent years, the CMA has sought to increase the legal age for tobacco sales from 18 to 21 years of age and created policy to support prohibitions on the sale of tobacco products in any store that contains a pharmacy.
Smoking is a costly habit that often leads to illness and poor health. Decreasing addiction to cigarettes is one way people can fundamentally improve their health and reduce costs in the health care system. Healthy choices and prevention are key components of controlling costs, which is essential to making health care reform affordable. CMA is a strong advocate of health care reform. "Under the Act, the FDA would be able to further restrict marketing which can reduce the appeal to youth," Dr. GnanaDev continued. "The more we can keep tobacco out of the hands of children, the more likely it is they will grow up and kick the addiction to this drug."
The California Medical Association represents more than 35,000 physicians in all modes of practice and specialties. CMA is dedicated to the health of all patients in California.
Source: California Medical Association
14 June 2009
http://www.medicalnewstoday.com/articles/153761.php
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Pediatricians take on bullies, dating violence
The American Academy of Pediatrics wants doctors to take an active role in preventing bullying in schools and violence among dating teenagers. The academy gives doctors tips for doing that in an updated policy being published in the July issue of its journal, Pediatrics.
Doctors should tell parents to talk to their children about bullying, teach children how to resolve conflicts and promote respectful relationships in dating, the policy says. It also suggests doctors volunteer to talk about the topics at schools, churches and youth organizations.
The doctors' group has published educational materials on bullying and dating before, but this is the first time the policy has addressed the issues in detail. "Violence is a public health problem that needs to be dealt with in the context of health care," said Dr. Joseph Wright of Children's National Medical Center in Washington. Wright heads the academy's violence prevention committee and helped write the recommendations.
Studies suggest children's early home life, if stimulating and emotionally supportive, can protect them from being victims of bullying later in life, Wright said. "Having meals with your child, watching television with your child" are among ideas that doctors can share with parents at "every single visit between birth and age 21," Wright said. The AAP's Connected Kids protocol provides more detail on what doctors should address.
The policy also says a European program that emphasizes the role of bystanders in preventing bullying in schools could be a good model for prevention efforts in the U.S. Dr. Robert Sege of Boston Medical Center, who also helped write the policy update, said the Olweus Bullying Prevention Program teaches children that bullies are kids with problems and bystanders can protect victims. Schools that use the program teach children that "we take care of our own," Sege said. Kids learn "even if you have freckles or wear glasses, it's our job to include you in the social environment."
To prevent dating violence, pediatricians should tell teenagers that respect is important in relationships, Sege said. He said his personal approach is to ask teens how they make decisions with their boyfriends and girlfriends. He also asks if they're ever afraid on dates. "I make sure the young lady knows she deserves to be treated with respect and she doesn't need to put up with a boyfriend who's so jealous he tries to control what she's doing," Sege said
Souirce: AP
11 June 2009
http://www.google.com/hostednews/ap/article/ALeqM5iwcIcJMhxAZ-LVMpmat49TGQplbQD98OOQ4O0
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High blood pressure is often missed in children and teens
Catching hypertension early
Va’Sean Duvall is a skinny 17-year-old who stays busy with an after-school job, choir rehearsals and school drama productions. On the surface, he doesn’t fit the mold of someone—older, obese and inactive — who would be at risk for high blood pressure. Yet he’s among as many as 4 million children in the United States estimated to have hypertension, a figure that has grown fivefold in the past generation, according to Johns Hopkins researchers. It’s a condition that doctors often fail to diagnose and one that leaves children, particularly blacks, at risk for serious heart problems, says a recent Hopkins study.
Doctors have known that a rising number of children are at risk for high blood pressure, and they think the nation’s surging child obesity rate is a prime cause. But now, researchers are trying to learn more about the specific heart problems triggered by high blood pressure and hope to sound the alarm on the importance of catching hypertension early. “We need to do a better job at increasing the public awareness, and we need to look at what are the barriers of physicians in recognizing high blood pressure in a clinical setting,” said Dr. Tammy Brady, a pediatric nephrologist at the Johns Hopkins Children’s Center and one of the study’s authors.
Brady and other researchers found that black children with high blood pressure are more likely than other children to develop a thickening of the left chamber of the heart. Known as left ventricular hypertrophy, or LVH, the condition can lead to heart failure, rhythm abnormalities and death. Of 139 hypertension patients ages 3 to 21 in the Hopkins study, 60 percent of the black subjects developed LVH, compared with 37 percent for those of other races. “It’s concerning that the prevalence is higher in the African-American population,” said Dr. Cozumel Pruette, a kidney specialist at Hopkins Children’s Center and the study’s lead author. “Practitioners need to realize that and need to follow those children closely.”
Researchers don’t know why the disparity exists. Black children with LVH also tended to have higher cholesterol levels and a higher body mass index, putting them at greater cardiovascular risk, Pruette said. Since the study was among the first to look at racial differences and was done with a small sample, she said, more research is needed to understand why black children are especially vulnerable.
Still, Pruette stresses that all children with untreated hypertension could be at risk. Even those with mild hypertension can develop LVH.
Doctors are still learning the intricacies of the illness in children. “It’s been recognized in adults for several decades, but I think that our attention to LVH in children has probably lagged,” said Dr. Susan Mendley, assistant professor and director of pediatric nephrology at the University of Maryland School of Medicine.
Brady, at Hopkins, recommends that when a doctor discovers one episode of elevated blood pressure, the child should be monitored and have further tests to determine if there are underlying causes of the hypertension. Children should have blood and urine tests to rule out kidney problems, which can cause hypertension. And doctors should do an eye exam to rule out eye problems that can trigger hypertension. In addition, children should also receive an ultrasound of the heart, known as an echocardiogram, to check for LVH, she said. “It’s a mistake not to do it,” she said.
But some pediatricians say the extensive ultrasound may not be necessary for every child with elevated blood pressure. First, parents should be advised to encourage their child to exercise and limit salty foods, which can cause high blood pressure, said Dr. Charles Shubin, director of pediatrics at Mercy Medical Center in Baltimore. “How much do you subject a larger population to get that if there is very low incidence of that problem?” he said. Of course, he said, if blood pressure is consistently high, doctors should order tests.
Monitoring is critical
Brady says monitoring is critical because hypertension strikes
some children who have no underlying health problems, making it
difficult to detect without further tests. If the high blood pressure is
severe, children can have symptoms such as bloody noses, headaches and
shortness of breath. “But often, hypertension is silent in kids,” said
Brady. “The kid looks fine; the kid seems healthy and has no
complaints.”
Pediatricians tend to carefully screen obese children and those with a family history of hypertension. But for other young patients, doctors may not do blood pressure readings at all, despite recommendations that screening begin at 3, said Brady, who has researched why doctors miss high blood pressure. And some doctors do not take proper blood pressure readings, which is admittedly a tough task with a squirming child; Brady recommends taking three blood pressure readings during a visit and averaging them.
A 2007 study by Harvard researchers found that doctors fail to diagnose high blood pressure in more than three-quarters of children with the problem.
It can be difficult to spot kids with hypertension. Healthy pressure depends on a child’s age, gender and height, so that “normal” is often a moving target. “To a pediatrician in a busy clinic, there are so many things they are expected to do in a visit, so sometimes, they eyeball it,” Brady said.
Many parents believe high blood pressure is an adult problem, and they are often shocked to learn their children have hypertension, Brady said. Duvall’s grandmother, Paula Duvall of Baltimore, had no idea children could struggle with high blood pressure. And when she learned of her grandson’s diagnosis, she immediately began fretting about the child she has raised since he was a toddler. She knows the risks of hypertension; she has the condition, and so does Duvall’s grandfather. “That hurt me, because I know what it’s like,” she said.
Doctors detected Va’Sean Duvall’s hypertension when he was admitted to the hospital this year for an asthma attack. Diagnosed with asthma at 2, he has had attacks so severe he has been to the intensive-care unit more than a dozen times. He takes numerous medications to keep the asthma controlled. His lung doctor referred him to Brady after noticing the youth’s blood pressure was consistently high. Other tests showed swelling of his heart muscle, an indicator of LVH. Brady put him on adult medicine, one pill a day.
Va’Sean Duvall has taken the diagnosis in stride. His mind is set on studying math at Coppin State University, with the goal of becoming a Broadway performer. “It gets overwhelming sometimes,” he said. “Sometimes taking medicine puts people down. But I say, ‘Well, what can you do? Without medicine where would we all be?’ ”
Kelly Brewington
9 June 2009
http://www.buffalonews.com/185/story/697513.html
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FDA docs: Antipsychotic drugs for kids have risks, benefits
Last week we wrote that a U.S. Food and Drug Administration (FDA) advisory panel vote was scheduled regarding three psychotropic medications and their safety and efficacy for children with specific conditions. Now, the Wall Street Journal reports that the agency has said that the medications—AstraZeneca PLC’s Seroquel, Eli Lilly and Company’s Zyprexa, and Pfizer Inc.’s Geodon—effectively treat some psychiatric disorders in pediatric patients, but come with serious risks, including sedation and weight gain.
The FDA is looking at the possibility of taking applications for Seroquel and Zyprexa for bipolar disorder and schizophrenia in children and adolescents, and Geodon for bipolar disorder in children 10 to 17, said the Journal. The FDA panel of external medical experts is meeting later this week to vote on the drugs’ safety and efficacy in pediatric patients, said the Journal.
The risks, said the FDA’s psychiatric product division director, Thomas Laughren, “are of particular concern in pediatric patients because of the life-long nature of these disorders,” quoted the Journal, which added that the issue with weight gain as a result of many antipsychotic medications is that extra weight can lead to diabetes and cardiovascular disease.
Although not FDA approved for the pediatric treatment of bipolar disorder and schizophrenia, Seroquel, Zyprexa, and Geodon have long been prescribed off-label to this demographic for these diseases. While it is widely known that physicians have been prescribing Zyprexa, Seroquel, and Geodon to pediatric patients for some time, what might not be known is that many of those younger patients have connections to child welfare and juvenile justice systems, said Youth Today last week. For example, approximately 14 percent of children in foster care are prescribed some psychotropic medication, reported Youth Today citing a 2006 policy paper written by the Institute for Juvenile Research at the University of Illinois at Chicago.
This January, a study published in The New England Journal of Medicine found that patients taking Seroquel and other atypical antipsychotics were more likely to suffer sudden cardiac death than patients taking older antipsychotic drugs. This April, an FDA advisory panel cited the risk of Seroquel sudden cardiac death when it recommended the drug not be approved as a first line treatment for depression. AstraZeneca faces over 9,000 Seroquel lawsuits filed by people who claim the company withheld information about the antipsychotic drug’s diabetes risk.
In addition to blood sugar risks, there are concerns Geodon might increase the possibility of a specific, potentially fatal heart-rhythm irregularity. Additional side effects include: Feeling unusually tired; nausea; constipation; dizziness; restlessness; diarrhea; rash; cough; runny nose; and abnormal muscle movements, including tremor, shuffling, and uncontrollable movements.
The FDA asked the drug makers to look into the side effects more prevalent in children versus adults reviewed in clinical trials, reported the Journal. Lilly said Zyprexa showed increased weight gain and blood lipid changes in children over adults. AstraZeneca said Seroquel side effects seen more in children over adults included increases in blood pressure and appetite as well as some movement side effects, including tremors. Pfizer’s Geodon in children was linked to increased sleepiness or sedation.
NEWSInferno
8 June 2009
http://www.newsinferno.com/archives/6716
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‘AIDS is everyone’s problem’
More then 50 youth formed a human chain in the centre of Marneuli painting the AIDS ribbon to honour those who have been affected by the AIDS pandemic and to remind society about the issues that people living with HIV and AIDS face on Candlelight Memorial Day last week. This event was part of a large campaign initiated by World Vision's Public Health/HIV and AIDS Programme (PHHA) all over Georgia.
Activities varied from street demonstrations to theatre plays, from east to south and west Georgia. For many youth it was the first chance to express their solidarity with people living with HIV and AIDS - some of whom participated in the public awareness campaigns all over Georgia for the fourth year running. 'I did not have much information about this disease and how real this problem is for my country. Today I want to tell people to be more tolerant to people with HIV and AIDS and not to think about this problem as something that never touches them', said Giorgi, 17, who is a peer educator in Marneuli.
'This day is very important for our programme, as it gives us the opportunity to talk about people with HIV and AIDS, about the difficulties these people face such as discrimination, lack of assistance and financial and psychological problems and to emphasise what happens when these are neglected', said Tinatin Suladze, World Vision program coordinator. One of the most effective ways of raising awareness and drawing attention to HIV and AIDS is through street demonstrations, organised in different cities where participants distributed informational leaflets to passer-bys.
World Vision Georgia is the first and only international non-governmental organisation that works directly with people living with HIV and AIDS through its PHHA programme. The programme aims to raise awareness about HIV and AIDS, and reduce the risk of transmission of HIV and other sexually transmitted infections (STIs) among mobile populations and wider communities by increasing knowledge about the transmission on HIV and AIDS and STIs and increase the use of preventive measures.
World Vision also supports the family members of people living with HIV and AIDS. This month more then 20 families received hygiene kits and medicines for children. 'This is a huge support for me. I know that these people care about us, and in this situation when there is a lack of assistance from others, I know that in case of emergency I can count on their help', said 34-year- old Eteri, who received gifts from World Vision, for herself and for her daughter.
World Vision has trained more than 90 youth peer educators and 69 medical personnel in target regions; established Health Care Cabinets in eight key cities countrywide; held 2,000 face-to-face consultations and 1,500 hotline consultations; opened dialogue in rural communities on taboo health-related issues; and supported more than 100 people living with HIV and their family members. In total, the programme helps more than 40,000 people in southern, eastern, and western Georgia.
By May 1 2009 a total of 1,983 HIV and AIDS cases had been registered in the Infectious Diseases, AIDS & Clinical Immunology Research Centre of Georgia, including 1,490 men and 493 women. The majority of these are aged between 29 and 40. Some 2,010 people have been reported to have developed AIDS in Georgia. Some 340 patients have died and 384 patients are in the process of treatment.
Source: World Vision Middle East/Eastern
Europe/ Central Asia office
6 June 2009
http://www.alertnet.org/thenews/fromthefield/wvmeero/79120381941f1b01daa22bc87ffecdb3.htm
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New Charter of Rights for Tasmanian children and young people in care
The Minister for Human Services, Lin Thorp, today launched a Charter of Rights for children and young people in care in Tasmania. Ms Thorp said the Charter outlined nine statements of rights, including ‘the right to be safe and feel safe’.
“Each right is supported with examples of what the rights mean for children and young people in care,” she said. Ms Thorp said all children had the right to be protected against abuse, neglect and all forms of ill-treatment. For children in care, the Charter of Rights clearly states what they can expect from their workers and carers. This is one way of supporting a positive experience for children and young people in care.
“All children in care will receive their own copy of the Charter. “And we have produced different versions for younger and older children in out of home care. I expect this Charter will be an ongoing reference point for the adults who work with children – carers and child protection staff – and will remind us to always ask:
Are we treating children in care fairly and with respect?
Are we respecting their privacy?
Are we listening to them seriously?”
Ms Thorp said the Charter was developed by the Commissioner for Children, the CREATE Foundation, the Foster Carers’ Association of Tasmania and the Department of Health and Human Services. “Three young people in care and young people who are members of the Commissioner for Children and Young Persons Consultative Council played a major role in the design of the Charter,” she said.
“I would like to thank the Commissioner for Children for taking a lead role in developing the Charter. The carers, Department staff and staff of community sector organisations who participated in the consultation sessions for the Charter must also be thanked. I must particularly acknowledge the contribution of the three young people in care who helped design the Charter.”
There are approximately 750 Tasmanian children in out of home care. The majority of these children are in foster care.
Tasmanian Government Media Releases
5 June 2009
http://www.media.tas.gov.au/release.php?id=26921
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Young parents helped to 'Know more' about drugs and alcohol
In the run up to National Tackling Drugs Week (8th-12th June), drug and alcohol services in Liverpool have gathered together to host 'Know more' an event which will showcase a range of services that offer advice and support to young people and their families. The event is a result of pioneering partnerships between Young Addaction Liverpool and other support organisations who are sharing resources and linking together to provide a more joined-up approach to young people in challenging situations.
Local street dancers, artists, and community drama groups will take to an outdoor stage in Liverpool's busy city centre, alongside Mersey-famous Everton Tigers who will be performing basketball tricks to help promote the campaign's messages. There will also be a range of market stall-style stands where services will be offering free and confidential help and advice throughout the day.
Nick Evans, Young Addaction Liverpool's Project Manager explains, "Young people don't see problems in their lives as isolated issues - if they are struggling with drugs or alcohol, we find they may also be facing challenges in their education or employment, family relationships or housing situations. That's why we work with other services to provide linked-up support across these issues, so that young people have the skills and resources that they need to live confidently and overcome the situations they experience. We're developing more integrated, creative ways of working to ensure that less young people fall through the gaps and serve to better connect young people."
Young Addaction workers already partner closely with a range of services such as Healthy Schools, housing services, and the Youth Offending Team, but understanding that young people live within wider relationships, Young Addaction Liverpool have extended their support to families and carers of service users.
A unique new partnership approach with Liverpool Sure Start Children's Centres is one such example. As Nick Evans explains, "We often see a pattern of drug and alcohol misuse passed on through generations, from grandparents, to parents and to children, so we began looking for ways of supporting parents to break free of their drug or alcohol use, and help prevent their children getting caught in the same struggle. Support services are often reluctant to ask drug users the question, 'Do you have children?' for fear of being responsible for moving children into care, but we're now starting to break the generational behavioural patterns of drug misuse and raise aspirations across whole families, by working with young parents. "
Introducing Young Addaction Liverpool's support workers within an environment that parents are already familiar with and feel safe in has been a key part of the success, according to Ruth Haig Ferguson, Liverpool Children's Centre Co-ordinator: "Our Children's Centres are familiar community spaces, where many people already feel relaxed and welcome. Parents might come to use the toddler sessions for example, but might also be able to ask for help with issues like healthy eating, finances, self-esteem, or domestic violence. So for us, offering drugs and alcohol advice and support with Young Addaction seemed a natural extension of the service we are already providing for our communities."
"Experience shows that drug use is a common cycle which traps people in poverty and low aspirations. At our centre, young parents feel accepted and that really helps to take away the stigma of being drug users, and the anxiety about whether they'll lose their children into care. They know that they can come to us to ask for help to sort out their own lives, whilst at the same time helping their children to grow up into a future free from drug or alcohol abuse and their often devastating effects."
Nick Evans continues, "Partnerships such as this one mean that we are seeing real changes in people's lives, where they can find non-judgemental support and are given the confidence and skills to deal with their personal struggles, and can in turn, pass that confidence on to their children. In the longer term, this kind of working should also help to really reduce the numbers of young people needing to access our services."
He adds, "I think that at Young Addaction Liverpool our partnerships are quite unique in terms of the diversity of support that they enable us to offer - whether that's links into sexual health education, bereavement counselling, housing or help with education and training opportunities. We hope that this event will go a long way in showing people how we are working together and providing quality support across a full range of issues to bring positive change in their lives."
Press release: Young Addaction Liverpool
3 June 2009
http://www.medicalnewstoday.com/articles/152359.php
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Group therapy program may help depression-prone teens
New research reveals that a group therapy program for depression-prone teens may help prevent future depressive episodes. However, the program did not show benefits for teens with a currently depressed parent.
The research by Judy Garber, professor of psychology at Vanderbilt’s Peabody College of education and human development and professor of psychiatry, will be published in the June 3 issue of the Journal of the American Medical Association. Garber presented the findings at a JAMA media briefing in New York City June 2.
Garber and her colleagues worked with 316 at-risk teens in the study. Approximately half of the teens were randomly assigned to an eight-week cognitive behavior group therapy program, in which they were taught problem-solving skills and ways to identify and challenge unrealistic and overly negative thoughts. Members of the control group were permitted to begin or continue mental health or other health care services. The researchers found that the group in the cognitive behavior program had an 11 percent lower incidence of depression than the control group.
A second key finding of the study is the impact of parental depression on a child. Those within the treatment group who had a depressed parent were three times more likely to experience a bout of depression than their cohorts in the group who did not have a depressed parent. “Current parental depression could be a marker for several, non-mutually exclusive factors such as higher levels of stress in the family, more chronic or severe parental depression, and/or greater genetic vulnerability,” Garber said. “It is likely that a combination of these and other factors are involved. We are in the process of examining possible correlates of current parental depression.”
Garber and her colleagues suggest clinicians working with depressed parents should also inquire about their children’s well-being, and vice versa. “Clinicians working with depressed parents, should ask about how their children are doing. Similarly, clinicians working with depressed youth should evaluate the parents for depression,” Garber said. “Referrals to appropriate service providers should be made if the children or parents, respectively, are experiencing problems. Making these services available to families in the same setting, likely would facilitate their receiving them.”
Only about 25 percent of depressed youth receive treatment and at least 20 percent develop recurrent, persistent and chronic depression that is very difficult to treat. Teenagers who experience depressions can have trouble with schoolwork, relationships, substance abuses and are at higher risk of suicide. Adolescent-onset depression also often predicts chronic depression in adulthood.
The study took place at four sites: Vanderbilt University, University of Pittsburgh, Kaiser Permanent Center for Health Research in Portland, Ore., and Judge Baker Children’s Center/Children’s Hospital in Boston, Mass.
News release: Vanderbilt University
2 June 2009
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Impact of U.S. antidepressant warnings still felt
Strong warnings by the U.S. Food and Drug Administration about suicide risks linked to antidepressant use in children and young adults have had a "spillover effect" on depression care in older adults, researchers said on Monday. They said the warnings resulted in a lasting decline in depression diagnosis and treatment, even for older adults, and urged the FDA to revise its policy. "Policy actions are required to counter the unintended consequences of reduced depression treatment," Anne Libby of the University of Colorado and her colleagues wrote in the Archives of General Psychiatry.
U.S. and European regulators sent out a series of public health warnings on use of antidepressant drugs beginning in 2003 after clinical trials showed they increased the risk of suicidal thoughts and behaviors in children and teens. In February 2005, the FDA added its strongest warning, a so-called black box, on the use of all antidepressants in children and teens to draw attention to the possible risks of these medications. In May 2007, it extended the warnings to young adults aged 18 to 24.
Many psychiatrists have criticized the warnings, saying they scare people away from effective treatment for depression, the leading cause of suicide. And recent studies have suggested the drug warnings triggered an 8 percent rise in suicide among youth and teens in 2004, the biggest one-year gain in 15 years.
To understand the full impact of the warnings, Libby and colleagues analyzed managed care claims data from July 1999 through June 2007. While they saw steady increases in the rate of depression diagnoses in each group between 1999 through 2004, the rate of diagnoses in children and teens fell sharply starting in 2004. They found primary care doctors specifically diagnosed fewer cases of depression, with a 44 percent lower rate among children and adolescents, 37 percent lower among young adults and 29 percent lower among adults. Doctors did not, apparently, turn to other drugs, including older antidepressants and anxiety drugs, the researchers said. Nor did they, evidently, offer non-drug treatments such as cognitive behavioral therapy, which aims at changing the way patients think.
Use of antidepressants called selective serotonin reuptake inhibitors or SSRIs, which affect a message-carrying brain chemical called serotonin, decreased in all three groups. While the warnings achieved the intended effect of reducing antidepressant use in young people, Libby and colleagues said they had a persistent, "unintended effect" on depression diagnosis and treatment, and urged the agency to revise its policy.
Because the team looked at health insurance claims data, they could not address why doctors diagnosed fewer cases of depression. "We don't know why. What we can say is that the warnings definitely changed behavior," Libby said in a telephone interview. She said it may be that patients are not seeking treatment or that doctors are not making diagnoses because they do not feel they have good treatments to offer.
"The shortage of psychiatrists, especially child and adolescent psychiatrists in the community, is felt by every clinician who has ever been asked for help by desperate parents with a suicidal child," they wrote.
"We appreciate these efforts to look at possible impacts of our labeling changes, and we continue to gather data and assess this situation," Sandy Walsh, a spokeswoman for the FDA, said in an e-mail. Walsh said the trends being seen are a concern but noted the agency also tracks other data, including suicide data from Centers for Disease Control and Prevention.
Reuters
1 June 2009
http://www.reuters.com/article/latestCrisis/idUSN01471958
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Teens that weigh in regularly are healthier
A new study suggests that teenagers who regularly use the bathroom scale might be more likely than their peers to take healthy measures to control their weight.
The findings, which were reported in the Journal of Adolescent Health, appose those in the earlier study of teenage girls that link regular weight checks to a higher risk of unhealthy weight-control habits.
Researchers found that among the 130 adolescents they surveyed, those who weighed themselves once a week or more were more likely to report healthy weight-control tactics, such as regularly exercising or eating less junk food and more fruits and vegetables. In contrast, they were not at increased risk of unhealthy measures, like fasting, abusing laxatives or vomiting.
Teens in the study were all overweight or had been overweight in the past two years before losing weight. Forty-three percent overall said they weigh themselves at least once per week, while 57 percent weighed in less often or not at all.
It is not clear whether regular weight checks encouraged some teens to adopt healthier lifestyle and lose weight. Senior researcher Dr. Kerri N. Boutelle, an associate professor pediatrics and psychiatry at the University of California, San Diego, said that the findings suggest that regular weigh-ins can be part of a healthy weight-loss plan for teenagers.
She told Reuters Health that her advice to parents is that if their children are overweight, then checking in with the scale can help them "self-regulate" their weight. Boutelle and her colleagues say that for the same as adults, an awareness of weight fluctuations can help teenagers adjust their diet and exercise levels accordingly.
However, obsessive weighing might signal problems with body image, possibly increasing the risk of unhealthy weight-loss measures and eating disorders. Boutelle said that if a teenager is checking his or her weight multiple times a day, then that should raise parents' concerns.
News relase: redOrbit
30 May 2009
http://www.redorbit.com/news/health/1697261/teens_that_weigh_in_regularly_are_healthier/
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