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Autism: New insights but cure still an elusive goal: diet and nutrition among areas of research, experts report.
Autism is a confusing and frustrating
developmental disorder, one that is hard to diagnose, hard to treat and
impossible to cure.
“It was poorly recognized by medical professionals, particularly in the
early days,” said Andy Shih, chief science officer of the National
Alliance for Autism Research in Princeton, N.J. “Autism was once called
youth schizophrenia, and there's been a lot of conflict over whether or
not autism is an independent disorder.”
These days, scientists are making promising gains in the search for the
triggers and causes of autism, with the ultimate goal of finding ways to
treat children with the disorder. And with April designated National
Autism Awareness Month, doctors and researchers are taking stock of what
they've learned about autism -- and how much more they need to know.
Autism, also called autistic disorder, usually is diagnosed in children
younger than 3, according to the U.S. Department of Health and Human
Services. The disorder prevents children from interacting normally with
other people and affects almost every aspect of their social and
psychological development.
Autism has a wide range of symptoms, and varies even among children
suffering from similar characteristics. But according to the federal
Autism Information Center, children with autism:
Have difficulty communicating with
others. They may not interact with others the way most people do, or
they might not be interested in other people at all. Some children with
autism may not seem to notice when other people are trying to talk to
them. Others might be very interested in people, but not know how to
talk, play or relate to them. May become upset by a small change in
their environment or daily routine. For instance, if a child is used to
washing his or her face before dressing for bed, he or she might become
very upset if asked to change the order and dress first and then wash.
Exhibit repetitious behaviors, such as rocking back and forth, head
banging or touching or twirling objects. Have a limited range of
interests and activities. Symptoms of autism can be seen in early
infancy, but the disorder also can appear after months of normal
development. In most cases, there's no obvious cause to explain what
triggered the disorder.
Studies estimate that as many as 12 in every 10,000 American children
have autism or a related condition, according to the Department of
Health and Human Services. Autism is three times more common in boys
than in girls.
To help guide scientists and funding, the National Institutes of Health
designed an autism research matrix in November 2003 that comprehensively
covers everything that still needs to be learned about the disorder
before effective treatments can be discovered, Shih said.
The matrix includes a multi-pronged
strategy. For example, Dr. Woody McGinnis, a primary-care physician from
Ashland, Ore., who specializes in behavioral disorders, is coordinating
a multiple-center NIH study on ways to treat autism through diet and
nutrition.
McGinnis' research focuses on the role of oxidative stress in autism.
“Oxidation is basically burning,” McGinnis said. “Chemically, it
involves the loss of electrons. A burning match is a clear case of
oxidation.” Other examples include an apple slice turning brown or
vegetable oils that go rancid, he said.
McGinnis' studies have found that autistic children exhibit high levels
of cellular oxidation, which exacerbates the disorder's symptoms.
To treat this, McGinnis is exploring the intravenous use of important
antioxidants such as zinc, magnesium and various vitamins. He said his
research has shown some success. “Some of these kids talk only on the
days they get these IV treatments,” McGinnis said.
Another line of research is offered by the High Risk Baby Siblings
Autism Research Project, a National Institute of Child Health and Human
Development program that focuses on early diagnosis of autism spectrum
disorders, Shih said.
In this study, researchers at eight
academic medical centers are closely following the development of
children whose older siblings already have been diagnosed with autism,
Shih said.
“Hopefully, by tracking their development they can find behavioral and
environmental cues that will help diagnose future cases,” Shih said.
Researchers also have found that children with autism tend to have a
higher rate of head growth in the early months of their development,
Shih said. “It could be an early indicator,” he said.
All these studies and findings will contribute to the larger goal of the
Autism Phenome Project, an NIH effort that is a “comprehensive effort to
describe all the behavioral aspects and biological aspects of kids with
autism,” Shih said.
McGinnis believes the project ultimately will find that there's no one
factor that causes autism.
“I believe the causes of autism are multiple,” McGinnis said. “Autism is
resulting from one or more environmental factors imposing upon one or
more genetic predispositions.”
In the meantime, experts stress the importance of early diagnosis of
autism in helping treat children with the disorder.
The U.S. Centers for Disease Control and
Prevention recently began a campaign called “Learn the Signs. Act
Early.” It is aimed at increasing parents' knowledge of a child's
overall development, especially important milestones in how a child
learns, plays, speaks and acts.
McGinnis said parents who think something's wrong with their child's
development should doggedly pursue their concerns, even if the first
doctor they consult dismisses their worries.
“Parents usually know best when there's something going wrong in the
child's development,” he said. “That's just a clinical truism.”
SOURCES: Andy Shih, chief science officer, the National Alliance for
Autism Research, Princeton, N.J.; Woody McGinnis, M.D., Ashland, Ore.;
U.S. Department of Health and Human Services; U.S. Centers for Disease
Control and Prevention)
Dennis Thompson
28 April 2005
YOUTH JUSTICE
Indianapolis: No arrests for fighting
In a move to help relieve crowding in
Marion County's juvenile justice system, Indianapolis Public Schools
officials have agreed to stop arresting unruly students.
Indianapolis Public Schools Superintendent Duncan Pat Pritchett has
ordered principals and school police to find alternative punishment for
students who fight with one another or scream at teachers.
“I think this trend of having kids arrested for fighting started 10 to
12 years ago, and it's just gotten out of hand,” Pritchett said. “I've
told principals they need to find creative alternatives to arrests for
fighting — like Saturday school, in-school suspensions — that will bring
us in line with what other school corporations are doing.”
Schools have been adhering to the new edict, issued Wednesday, but
Pritchett said he had to send a reminder to officials at one school.
He declined to identify which one.
“If it's not an assault, we're not going to arrest them,” Pritchett
said.
“We have a few folks who like to do that to get a kid removed from the
building. If we need to remove them, we can have a police officer take
them home if necessary.
“It just doesn't make sense to arrest them, transport them and then
process all of that paperwork at the juvenile center for them to be let
go.”
Marion County court officials have been struggling to reduce crowding in
the juvenile justice system, and in February took steps to reduce the
number of youths held at the juvenile detention center. More than 70,000
youths had court hearings last year, juvenile court Judge Marilyn Moores
said.
When students trade blows, Moores said, it's nearly impossible for the
court system to sort out who is at fault. Fistfights are better dealt
with by teachers, she said.
“Where criminal conduct occurs — a felony, serious injury, drugs,
weapons or bomb threats — then by golly that's criminal behavior,”
Moores said.
“Mutual combat by kids, loud obnoxious kids, that's just not criminal behavior.”
Vic Ryckaert and Kim L. Hooper
28 April 2005
European Union Agency wants tough
antidepressant youth warning
Europe's medicines regulator has
called for strong warnings on two classes of antidepressants, informing
doctors and parents of the risk they could pose to children and
adolescents.
A European Medicines Agency expert committee concluded that Prozac-type
serotonin-selective reuptake inhibitors (SSRI) and serotonin-norepinephrine
reuptake inhibitors (SNRI) were associated with increased
suicide-related behavior and hostility in young people.
“The agency's committee is therefore recommending the inclusion of
strong warnings across the whole of the European Union to doctors and
parents about these risks,” the London-based watchdog said in a
statement Monday.
“Doctors and parents will also be advised
that these products should not be used in children and adolescents
except in their approved indications.”
The action is the latest sign of a worldwide clampdown on the use of
Prozac-type pills in teenagers, following evidence that they can lead to
an increased incidence of suicide attempts, suicidal thoughts and anger.
Most of the drugs are only approved for treating adults in the European
Union, but doctors have sometimes used them “off-label” in children. A
few of the products are, however, licensed for pediatric use in treating
obsessive-compulsive disorder and one of them, Eli Lilly and Co.'s
Strattera, is approved for the treatment of attention deficit
hyperactivity disorder.
Agency spokesman Martin Harvey said the new warnings would not prevent
the use of these medicines in such approved settings.
In the case of Strattera, the agency said there was no sign of a link to
suicide-related behavior but experts concluded the drug should carry a
warning reflecting an increased risk of side-effects such as hostility.
Other medicines covered by the European review included GlaxoSmithKline
Plc's Paxil, or Seroxat; Lundbeck's two drugs Celexa and Lexapro; Pfizer
Inc's Zoloft; Wyeth's Effexor; Akzo Nobel's Remeron; and two other
medicines from Lilly, Cymbalta and Prozac.
Mixing with other children 'helps prevent
leukaemia'
Children with a wide social circle who pick up infections from their
peers early in life have the best defence against childhood leukaemia,
the commonest cancer in the young.
The world's largest study of childhood cancers has concluded that a
strong immune system, developed in response to common infections
experienced in infancy, can ward off leukaemia in susceptible children.
Ruling out radiation from power lines and nuclear power stations as a
major cause, researchers said childhood leukaemia originated with a
genetic defect in the womb which was triggered by an abnormal immune
response after birth.
The finding follows research suggesting exposure to viruses and bacteria
early in life may have a crucial impact on lifelong health, affecting
the later development of heart disease, diabetes, cancer and allergies.
The UK Childhood Cancer Study, launched
15 years ago, examined almost 4,000 children with cancer who were
compared with almost 8,000 without cancer. Measures were made of the
level of radiation in the home, smoking by parents and breast-feeding.
Biological samples were also taken.
Sir Walter Bodmer, chairman of the Leukaemia Research Fund's Medical and
Scientific Advisory Panel, said: “The most plausible explanation now
seems to be a challenge to the child's immune system, quite possibly
involving common infections, which cause the cancerous cells to emerge.
How such a challenge triggers leukaemia remains a puzzle to be solved.”
The timing and pattern of infections appears to be crucial. Separate
research published in the British Medical Journal's online edition
yesterday found children who attended day care centres in the first
three months of life had a lower risk of childhood leukaemia. Exposure
to infections at a later stage in childhood or in a different pattern
could increase the risk.
There are 500 cases a year of childhood leukaemia, one third of the
1,500 cases of cancer in children under 15. Big advances in treatment
have been made in the past 30 years and 80 per cent are now cured.
Professor Eve Roman, director of the leukaemia epidemiology unit at York
University, said: “At the time the study was set up there was much
concern about power lines. We measured electromagnetic fields in the
homes and the distance from power lines . We found no association
between measured electromagnetic fields and the developments of
childhood leukaemia.”
The research also “proved conclusively”
that there was no link with vitamin K injections given in infancy, a
second factor that had been a suspected cause.
Professor Mel Greaves, director of the centre for cell and molecular
biology at the Institute of Cancer Research, London, said there was
overwhelming evidence that leukaemia was caused by a “double whammy”
with a genetic defect that occurred in the womb, followed by a “second
hit” that precipitated the disease. The timing or pattern of infection
was “by far the most likely trigger”.
One in 20 children was born with the genetic defect, probably caused by
the “normal stress of embryonic development”, but only one in 2,000
developed leukaemia.
Why dirt aids good health
Modern lifestyles do not generate strong immune systems in children. The trend to smaller families, raised in spotless homes, with fewer outside contacts leaves children with inadequate exposure to viruses and bacteria to build up resistance to disease. Immature immune systems overreact to substances that mimic the threat from bacteria and viruses — such as proteins on pollen grains, house dust mites and cat and dog hairs — to trigger allergies. In Costa Rica, which has one of the highest rates of childhood leukaemia in the world, big social changes over the past 40 years are thought to be behind the trend. The average family size fell from 7.2 children in the 1960s to 2.1 in the 1980s, reducing exposure of individual children to infections.
Jeremy Laurance
23 April 2005
Processed meat ups pancreas cancer risk
Eating a lot of red meat, and
particularly processed meat, increases the risk of pancreatic cancer,
according to findings from a large multiethnic study.
The results hint that carcinogenic substances used in meat processing
rather than the fat or cholesterol content might be responsible for the
association, Dr. Ute Nothlings told Reuters Health at the annual
gathering of the American Association for Cancer Research.
Nothlings, from the Cancer Research Center of Hawaii in Honolulu, and
colleagues examined the relationship between diet and pancreatic cancer
in 190,545 men and women who included African Americans, Japanese
Americans, Caucasians, Latinos and Native Hawaiians.
During an average follow up of 7 years, 482 subjects developed
pancreatic cancer.
After taking into account age, smoking
status, history of diabetes, family history of pancreatic cancer and
ethnicity, subjects with the highest intake of processed meat had a 67
percent increased risk of developing pancreatic cancer compared to those
with the lowest intake of processed meat.
A high intake of pork and total red meat increased the risk of
pancreatic cancer by about 50 percent.
Consumption of poultry, fish, dairy products, and eggs did not influence
the overall risk of pancreatic cancer, nor did overall intake of total
fat, saturated fat or cholesterol.
“Due to the large size of the study with 482 cases, this is an important
piece of evidence for a reduced intake of red meat and processed meat as
target factors for disease prevention,” Nothlings told Reuters Health.
Megan Rauscher
21 April 2005
Violence-related stress may harm kids' health
The stress some young children
suffer after being exposed to violence in their neighborhoods or homes
may have repercussions for their physical health, according to a new
study.
Researchers found that among 160 preschoolers from low-income families,
78 percent had been exposed to some form of violence — either in their
communities or in their own homes, sometimes in the form of child
maltreatment.
Those children who consequently suffered symptoms of post-traumatic
stress disorder — such as nightmares or bedwetting — were at greater
risk than their peers of having a number of health conditions, including
asthma, gastrointestinal problems and headaches.
In the past, studies have found that young children exposed to violence
between their parents have heightened rates of anxiety, fear and
aggression. Other research has linked such childhood experiences to
poorer health in adulthood.
But little research has looked into how
post-traumatic stress — a potential reaction to violence — affects
children's health in general, according to Dr. Sandra A. Graham-Bermann,
an associate professor of psychology at the University of Michigan in
Ann Arbor, and one of the co-authors of the new report.
“Our study is unique in that we linked stress in the child's social
environment to specific health problems of the child,” she told Reuters
Health.
The study, published in the Journal of Pediatrics, included 160 Michigan
children who were taking part in Head Start, a federal preschool program
for low-income families.
Mothers and teachers reported on the children's health, behavior and
symptoms of post-traumatic stress. Mothers were also surveyed about
their children's exposure to violence in the community — ranging from
shootings and stabbings to accidents and arrests — and within the
family.
Exposure to violence, the researchers found, was common, and included
many instances of child maltreatment. In addition, children had
witnessed an average of two violent incidents in their neighborhoods.
Overall, 20 percent of the children had reactions that were consistent
with post-traumatic stress disorder — though nearly all had some signs
of traumatic stress.
Health problems, including allergies, asthma, colds and flu, were more
common among children with PTSD, the study found. In particular, these
children had a four-times higher risk of asthma and gastrointestinal
problems than their peers did. Moreover, the apparent effect of PTSD on
children's health was over and above the impact of child maltreatment,
domestic violence and mothers' health and substance abuse, according to
the researchers.
Distress and anxiety, Graham-Bermann noted, can contribute to poor
physical health, and studies show that even very young children can
become afraid and worried after witnessing violence.
The positive aspect of the study findings, according to Graham-Bermann, is that they point to an additional way doctors can get at the heart of some children's health problems. The study, she said, shows the importance of looking ”beyond the symptoms presented in the office” and asking questions about the environment in which children are living.
SOURCE: The Journal of Pediatrics, March 2005.
Amy Norton
Reuters Health
21 April 2005
Child diabetes time bomb warning
The number of children suffering diabetes brought on by obesity in the
UK appears to have been vastly underestimated, experts have warned.
Recent figures have suggested that only around 100 youngsters under the
age of 16 have been diagnosed with Type 2 diabetes across the UK.
But a new study has found that in East London alone there are 22
under-16s living with the condition.
Type 2 diabetes has traditionally affected adults over 40, but soaring
rates of childhood obesity have led to rising numbers of children with
the condition in recent years.
Among youngsters aged two to four obesity almost doubled between 1989
and 1998 - from 5% to 9%.
And in those aged six to 15 rates trebled from 5% in 1990 to 16% in
2001.
The latest research, conducted at Barts
and the London and Newham University Hospital NHS Trusts, found that 95%
of the children with Type 2 diabetes were either overweight or obese.
Some were as young as nine when they were diagnosed, the Diabetes UK
annual conference in Glasgow heard.
All but one of the children came from black and ethnic minority groups,
among whom Type 2 diabetes tends to develop sooner. Prevalence is also
at least five times higher than other groups.
Type 1 diabetes, which is not linked to obesity, accounts for the
majority of cases of childhood diabetes.
20 April 2005
Child mortality rate not reduced — World Bank
Almost 11-million children in
developing countries die before the age of five, most of them from
causes preventable in wealthier countries.
About 2 000 of those children died each week, said Francois Bourguignon,
the World Bank's chief economist, in a report released on Monday.
The causes included acute respiratory infection, diarrhoea, measles and
malaria, which together accounted for 48 percent of child deaths in the
developing world.
“Rapid improvement before 1990 gave hope that mortality rates for
infants and children would be cut by two-thirds in the following 25
years,” the report said.
“But progress slowed almost everywhere in the 1990s.”
Only 33 countries were on track to reach
the 2015 goal of reducing child mortality rates by two-thirds from its
1990 levels. The report said only Latin America, Europe and Central Asia
might be on track.
Five years ago, world leaders outlined a number of development
objectives, formally known as the Millennium Development Goals, to be
achieved by 2015. They included boosting primary school enrolments,
removing obstacles to have greater numbers of girls going to school and
improving healthcare.
Many countries have made progress towards achieving the goals, but
Bourguignon said: “I must admit many countries are off track and a huge
effort is needed” to help them progress towards the 2015 goals. Some
nations were more behind schedule than others, particularly in
sub-Saharan Africa.
The report provides evidence that inequalities within countries —
between rich and poor, urban and rural and male and female populations —
might be as much a barrier to achieving the goals as inequalities
between countries.
In India, for example, school attendance rates for the richest 20
percent of the population are twice as high as for the poorest. And in
Mali, the mortality rate of children from poor, rural families is twice
as high as those from rich urban areas.
Worldwide, more than 100-million primary school children remain out of school, almost 60 percent of them being girls.
Harry Dunphy
18 April 2005
Alberta
Bill allows parents to force kids into
detox
A law was passed in Alberta giving
parents the power to force their drug-addicted teenaged children into
detox.
In the Alberta Legislature on Thursday, MLAs voted unanimously in favour
of Bill 202 — the Protection of Children Abusing Drugs Act.
After an assessment by drug counsellors, moms and dads can apply to have
their addicted kids placed in a five-day detoxification program, in
hopes of getting them to agree in the end to pursue further drug
treatment.
After a child turns 18, it then becomes up to the individual whether or
not to seek long term treatment.
“This will enable parents to grab their children and hopefully get them
out of danger, at least for a short period of time,” Edmonton mother
Audrey Bjornstad told CTV News.
Bjornstad was one of the parents who lobbied hard for the bill, after
watching her son spiral into a crystal methamphetamine addiction — the
drug of choice for many teens today.
“We had no way to rescue him because he
denied his addiction and we could not get him into treatment without his
own consent. So as parents, we were stuck,” she said.
Red Deer North MLA Mary Anne Jablonski introduced the private member's
bill. She said she created it after hearing the horror stories of
parents with crystal meth-addicted children.
She was frustrated at the fact that minors with serious addictions
couldn't be forced to get treatment, unless they were ordered by a court
after being arrested.
That was the case with Bjornstad's son, who only sobered up after
breaking the law and spending time in a jail cell.
But while some call the new bill a life-saving measure, others say it's
a violation of civil liberties.
“When you can take a person and have them confined, on an ex-party
application without any notice to them — that strikes me as
fundamentally wrong,” Alberta Civil Liberties Association's Stephen
Jenuth told CTV News.
The bill itself, buried under a morass of
other legislature business, almost didn't make it to a final vote before
the session ended. But pleas from the public, and from the leader of the
opposition, made it a priority. And MLAs abandoned their debate of the
new budget to vote on the private member's bill.
Andrew Morton began using drugs at the age of 12, starting with
marijuana and eventually graduating to heroin and crystal meth.
Now a peer counsellor with the Alberta Adolescent Recovery Centre,
Morton told CTV News that it was intervention that saved his life.
But he added if something like Bill 202 existed when he was a teen, he
would have gotten help sooner.
“Does it infringe on their rights? Yeah,” he told CTV News. “But we have
kids that we bury.”
17 April 2005
Source
Psychological therapy can help maltreated children
Psychological counseling does seem to help heal the scars of child abuse
and neglect, though the extent to which family therapy prevents future
abuse is unclear, according to a research review.
Although there are numerous forms of psychological therapy for child
maltreatment — for both children and parents — their effectiveness has
been unclear. In particular, researchers have so far failed to find good
evidence that family therapy can put a stop to abuse and neglect.
The new study, a review of 21 previous studies, found that, in general,
children who underwent some form of therapy fared better than those who
did not, showing fewer symptoms of anxiety, depression and low
self-esteem.
There was also evidence that therapy
improved abusive parents' attitudes and behavior.
The findings are encouraging, according to study co-author Dr. Elizabeth
A. Skowron of Pennsylvania State University in University Park. “This is
the first definitive evidence that, collectively, these interventions
are pretty effective,” she told Reuters Health.
Still unanswered, however, is the question of whether the benefits last,
and whether therapy actually ends the abuse, Skowron said.
Among the studies she and colleague Dawn H.S. Reinemann reviewed, a few
did follow families for longer periods — with one showing that treatment
gains could last up to 12 years.
However, with so few data to go on, those results should be “viewed
cautiously,” the researchers report in the journal Psychotherapy:
Theory, Research, Practice and Training.
Though psychological therapies for child maltreatment have been
available since the 1970s, their effectiveness has been hard to gauge
for several reasons. For one, Skowron explained, many abused children —
perhaps three-quarters — suffer several types of abuse and neglect,
which is a therapeutic challenge.
“The nature of child maltreatment is complex,” she said.
In addition, long-term follow-up of
families who enter therapy requires resources. The positive findings of
this study, according to Skowron, point to the importance of funding
research to find out whether psychological therapy has lasting benefits
for children and parents — as well as to answer questions such as why
various types of therapy work, and for whom they work best.
More funding, Skowron added, is also needed to make treatment available
to families through social services.
“It would be a mistake,” she said, “to think that these therapies are
widely available to families.”
SOURCE: Psychotherapy: Theory, Research, Practice and Training; Spring 2005.
Amy Norton
Reuters Health
14 April 2005
Teens' Stress Begins Before a Parent with HIV Dies
In a six-year study of New York City
families with an HIV-positive parent, researchers found that teenagers
whose parent died during the study were at greater risk of emotional
distress and run-ins with police before their parent's deaths — but not
after.
“This really points to the importance of helping families after HIV
diagnosis, not just after a parent's death,” Dr. Mary Jane
Rotheram-Borus, the lead researcher on the study, told Reuters Health.
She and her colleagues at the University of California, Los Angeles,
report the findings in the Journal of Consulting and Clinical
Psychology.
The study involved 272 HIV-positive parents and their teenage children,
about half of whom had taken part in a support program designed to help
families deal with the stress of living with HIV. In earlier research,
Rotheram-Borus and her colleagues had found that the program helped ease
both parents' and children's emotional distress, and that teens in the
program were less likely than their peers to use drugs, leave school or
have behavioral problems.
These latest findings show that families
need such support services well before a parent dies, according to
Rotheram-Borus. However, she said, while HIV support services in the
U.S. are available to individuals, there's a lack of programs for whole
families.
Among the more than 400 teenagers the UCLA researchers followed, half
lost a parent — usually their mother, at an average age of 38 — during
the study period. More than a year before their parent's death, these
teens were more likely than their peers to have feelings of isolation,
fear, anger and depression.
Unexpectedly, however, these problems — as measured by standard
screening tests — waned in the year after a parent's death, so that the
teens' distress was no greater than that of their peers whose parents
were still alive.
There was a similar pattern when it came to rates of arrests and
convictions for crime, which were higher among bereaved teenagers before
their parent died, but not after.
The higher depression rates among teenagers who lost a parent did
persist, but even those symptoms faded within a year, Rotheram-Borus
said.
Often, she noted, the toughest times for children who survive their
parents — due to any illness — come during a “life milestone,” such as
high school graduation or a wedding.
If HIV support services for families become more widespread, the hope,
according to Rotheram-Borus, would be to offer “drop-in” programs where
family members could seek help at times they feel they need it.
SOURCE: Journal of Consulting and Clinical Psychology, April 2005.
Amy Norton
Reuters Health
13 April 2005
UK: Adolescent health ill-catered for in the
NHS
The NHS must overhaul its
approach to adolescent health if it is to meet the health needs of young
people in the UK, says a paper in the BMJ this week. While the health of
children and older people has improved considerably, young people have
fallen through the gap in targeted services, argues Dr Russell Viner,
the UK's only consultant in adolescent medicine.
Mortality rates for adolescents from injury and suicide have increased
fivefold over the last century — rising from 11% of total deaths for
15-19 year olds in 1901-10, to 57% in 2003. Rates of obesity, sexually
transmitted infections, smoking and teenage pregnancies among
adolescents have also increased or shown no improvement over the last
twenty years.
“Adolescence is a critical period for
engaging the population in health” says Dr Viner, as behaviour and
attitudes towards health are maintained into adulthood. Yet current
strategies do not target young people appropriately, and do not engage
them with their own healthcare. Existing policies also ignore health
inequalities — which have a considerable influence on adolescent health,
he argues.
Young people must be recognised as a distinct group in devising public
health policies, says Dr Viner, and staff must be properly skilled to
address their health needs. The exclusive focus on one issue or target —
such as teenage pregnancy — misses the other influencing factors in
adolescent behaviours, so approaches must be developed which cross
education, social services and the justice system.
At the age of 14-15 adolescents should
also be “re-registered” with general practitioners, allowing them to
establish a relationship with their GP outside of the family context,
says Dr Viner. New health services designed for and by young people —
including sexual health and counselling services — should also be
developed in urban areas.
Investment in improving adolescent health is an essential component of
improving the health of the whole population, and ensuring that we can
afford the NHS in twenty years time, he concludes.
Young people's health: the need for action, British Medical Journal Volume 330 pp 901-3
University of Florida Study: Incarcerated male adolescents suffer ill effects from abuse
Sexually abused teenage boys in jail are
just as likely as their female counterparts to suffer from depression, a
University of Florida study finds.
The findings challenge the perception that depression among jailed
juvenile delinquents is mostly a female problem and point to the need to
address it before inmates are released and commit other crimes that land
them in jail again, said Angela Gover, a UF criminology professor.
“Depression has been found to be the most common psychological symptom
experienced by survivors of childhood sexual abuse, but as a society
we've focused much more on childhood sexual abuse in females than in
males,” she said.
Girls receive more attention partly because they are more likely than
boys to be sexual abuse victims, said Gover, whose study was published
in the International Journal of Offender Therapy and Comparative
Criminology in December.
They also react differently to upsetting
events, which makes them more prone to depression, Gover said. “Females
are more likely to internalize traumatic events that happen to them in
contrast to males, who externalize things,” she said. “Depression is one
of those internalizing events. When bad things happen to girls, such as
witnessing an act of violence or even seeing a dead animal lying in the
road, it may affect them more in terms of making them sad right then and
there.”
Gover's study involved adolescents, ages 11 to 20, who were serving
sentences in six juvenile correctional institutions in five states.
“What makes this research unique is that every adolescent in the sample
was a serious delinquent and was incarcerated in a juvenile correctional
facility,” she said.
Although studies have established a relationship between childhood
sexual abuse and mental health problems, few have examined this
association using samples of youths who are incarcerated, she said.
“We do know from several studies about violence being passed down
through generations that the people who are victimized during childhood
are more likely than those who have not been victimized to become
involved in abusive relationships, either as an abuser or as a victim,”
she said.
Other studies on gender's effects on depression among sexual abuse
victims have been inconclusive, Gover said. That's partly because of
small sample sizes that may not have detected gender differences in a
definitive way, she said.
The UF study compared depression levels
among 77 females and 32 males who reported having been sexually abused
with 345 males and 129 females who said they had not been sexually
abused.
To measure the extent of sexual abuse, the study participants were asked
a single question: “How often were you personally ever touched in a
sexual way or forced to have sex by an adult or older children when you
did not want this to happen, including family members and people outside
of your family?” Responses were recorded using a five-point scale from
“never” to “frequently.”
With a similar five-point scale, depression was measured by how
respondents rated statements such as “In the past few weeks, I have felt
depressed and very unhappy” and “Sometimes recently I have worried about
losing my mind.”
Sexually abused youths were found to be significantly more depressed
than those who reported they had not been sexually abused, Gover said.
The findings suggest the importance of addressing the trauma of sexual
abuse among incarcerated adolescents because they are at increased risk
for depression, Gover said.
“Although the prevalence of sexual abuse is higher among
institutionalized females, the negative psychological effects of
depression are also present in males,” she said. “Without appropriate
assessment and treatment, these youths have a greater likelihood of
entering the adult criminal justice system.”
Heather Pfeifer, a criminal justice professor at the University of Baltimore, said Gover's findings are important. “This study provides critical information to the research on childhood sexual abuse by bringing to light the need to assess the mental health needs of both male and female offenders within the juvenile justice system,” she said. “Unfortunately, many of these youth have a history of abuse, but few have received any mental health services to address the consequences of such trauma. By identifying these issues in both males and females, the system has an opportunity to provide these youth with the treatment they need, thereby helping to reduce their risk of future victimization and offending.”
‘Natural' not always safe, Canadian Paediatric
Society
Natural health products can cause harm if taken inappropriately, says
the Canadian Paediatric Society. They can cause serious side effects and
can interact with other drugs, even non-prescription drugs.
Many parents are using, or considering the use of, natural health
products to treat their children, without first talking to their doctor.
Sick children or children with chronic health conditions are more likely
to be exposed to natural health products as a supplement to existing
health care.
“It is important to recognize that anything that can have a potentially
beneficial effect can also have an unintended side effect,” says Dr.
Sunita Vohra, author of Children and natural health products: what a
clinician should know, a CPS position statement published this week in
Paediatrics & Child Health. “We understand that people will use these
products and want to advise that they be treated, as any other
medication, with respect and caution.”
Physicians are encouraged to discuss the
potential risks and benefits of natural health products with families.
“Parents and paediatricians need to be open and up front about the use
of natural health products when treating children. Parents often find
themselves facing a tug of war between conventional medicine and
complementary alternative medicine. Without guidance from physicians,
they are forced to make decisions on their own,” added Dr. Vohra.
The Canadian Paediatric Society is a national professional association, representing more than 2,200 paediatricians, that advocates for the health needs of children and youth.
Kids and caffeine: How much is too much?
Many of our kids are buzzed before they
get to school. Throughout the day they feed the buzz — at lunch, between
classes, after school, at dinner and maybe a pick-me-up before homework
or sports. Yet most parents don't bat an eye. Caffeine is the socially
accepted drug of choice when it comes to youth of all ages — toddler to
teen. Most parents figure a couple of cans of pop, a candy bar or even
an iced cappuccino in moderation can't hurt a kid.
That's true. But our notion of “moderation” is growing as companies sell
pop in 20-ounce bottles instead of 12-ounce cans, as restaurants
encourage people to supersize for a better deal, as schools and
recreation centers install vending machines for added revenue, and as
wanna-be superstars, youths emulate their role models by downing energy
drinks for that extra boost in performance.
Yet, doctors and nutritionists say “moderation” for kids and caffeine
means about two 6-ounce cups of coffee a day for teens, and less than
one 12-ounce can of Mountain Dew for younger kids.
Although there is no agreement on just how much caffeine is acceptable,
some experts suggest no more than 100 mg a day, depending upon the age
of the child. The younger the child, the less caffeine should be
allowed. According to health and fitness guru Bob Greene's Web site —
www.getwiththeprogram.org
— daily caffeine limits by age should be 45 mg for 4-to 6-year-olds; 63
mg for 7- to 9- year-olds and 85 mg for 10- to 12- year-olds. Adults
should limit themselves to 300 mg a day — about the amount in three cups
of coffee, according to Greene's Web site.
Many pediatricians and dietitians will tell you the best amount of
caffeine for kids is none at all.
Kids don't need caffeine to function — what they need is adequate sleep,
good nutrition and plenty of milk and water, said Anne Widga, dietitian
with BryanLGH Medical Center's Diabetes Center.
But try convincing our kids of that.
The problem is no one really knows just
how much caffeine our kids are consuming, said Dr. Stephen Daniels,
professor and associate chairman of the department of pediatrics at
Cincinnati Children's Hospital Medical Center.
A decade-old study by the U.S. Department of Agriculture's research
service found a threefold increase in soda consumption among teen boys
from 1974 to 1994. Among 6- to 11-year-olds, soda consumption doubled
between 1974 and 1994.
Virtually everyone agrees that soda consumption among kids has
skyrocketed since then.
“It does seem that because children are consuming more soft drinks, that
they are getting more added sugar and more caffeine,” Daniels said.
He blames vending machines in schools as well as larger portion sizes
for some of that increase.
The problems created by all this caffeine consumption are multiple.
First, there are the normal effects of
caffeine. It's a mild stimulant that affects the central nervous system,
which is why so many adults drink coffee to wake up or become alert.
But too much caffeine can cause nervousness, irritability, insomnia,
headaches and dizziness, according to Eric Chudler Neuroscience for
Kids, a Washington State University-based Web site. Too much caffeine
can reduce attention spans and decrease a child's ability to perform
tasks requiring fine motor coordination, arithmetic skills or accurate
timing.
Caffeine is quick-acting. Often people feel its effects within 15
minutes. Once in the body, it takes about six hours to eliminate just
half of the caffeine.
For kids — whose bodies are smaller and weigh less — the effects are
increased.
In addition to the stimulant effects, caffeine also is a diuretic, which
means it increases urination. That can lead to dehydration —
particularly on hot summer days — if people drink excess amounts of
caffeinated beverages without replenishing themselves with water,
according to the Baylor College of Medicine in Houston, Texas.
As with adults, kids can become dependent on caffeine — needing more and
more of it to get the same desired effects.
Although much research has been done on caffeine's effects on adults,
particularly in fertility, pregnancy and heart issues, few studies have
looked at the effects of caffeine on growing bodies of children and
teens, Widga said.
What is known is that too much caffeine can cause a loss of calcium and
magnesium from the body — both are vital for bone development, Widga
said.
And often, if kids are drinking pop or
coffee, it means they are drinking less milk, as well as filling up on
sugar and “empty calories” as opposed to nutritional foods, such as
fruits and vegetables.
“If they are drinking pops and other things instead of milk, it doubles
their issue for bone loss,” Widga said.
It also increases their risk of obesity. According to the Nemours
Foundation, a child who drinks just one 12-ounce sweetened soft drink
per day, increases his or her risk of obesity by 60 percent.
“Another thing doctors are wondering about is the possibility that
excess caffeine consumption problems may not reveal themselves until
these kids are adults,” Widga said.
She wonders if doctors will see increasing incidents of osteoporosis and
high blood pressure at younger ages because of all the caffeine kids are
consuming at younger ages.
New evidence indicates caffeine consumption may actually be the cause of
high blood pressure in kids, according to Daniels.
Which is one reason why doctors and even marketers say the new drinks
charged with caffeine, sugar and taurine are not appropriate for
children. The drinks are targeted to a young adult male crowd, but their
cool cans and even cooler advertising make them an irresistible
temptation to younger kids who want to excel in the physical activities
of their choice. Pop singer Britney Spears likes to mix Red Bull and
apple juice to pump her up before concerts.
France has banned some energy drinks.
Other European countries require warning labels on the drinks telling
people about the caffeine content.
Currently there are no rules or labeling requirements in the United
States, and any kid can buy a can of Red Bull, Amp or Monster as long as
he or she has enough pocket change for these pricey but alluring energy
drinks.
Officially, U.S. pediatricians have not taken a uniform stand on kids'
caffeine consumption. But more and more they are recommending kids avoid
it or, at the very least, that parents restrict it in their diets —
especially in light of new studies of kids, caffeine and sleep.
One study found “detectable ill effects on health” after monitoring the
sleep patterns of seventh-, eighth-, and ninth-graders and their
caffeine consumption. The study found that teens tended to increase
their caffeine use after Wednesday and continued to peak through
Saturday, then declined — which according to the American Academy of
Pediatrics partially supports the hypothesis that teens sometimes use
caffeine to counteract daytime sleepiness from sleep lost on school
nights.
Other studies have found that caffeine intake can delay sleep. Or
perhaps worse, allows young drinkers to fall asleep but not sleep
soundly.
“Over time that lack of sleep will have a downside for sure,” Widga
said.
Said Daniels, “The best approach is to try to avoid caffeine. If it is consumed by children, it should be in moderation.”
Erin Anderson
10 April 2005
WHO: Millions of mothers, babies die needlessly
One woman still dies every minute in pregnancy or childbirth, while each
60 seconds 20 young children succumb to easily preventable disease, the
World Health Organization (WHO) said Thursday.
The United Nations agency said the situation for expectant mothers and
babies had worsened since the 1990s in dozens of countries, particularly
in sub-Saharan Africa, defying global advances in medicine.
“Despite much good work over the years, 10.6 million children and
529,000 mothers are still dying each year, mostly from avoidable
causes,” the WHO said in its annual report, entitled “Make Every Mother
and Child Count.”
On current trends, some countries in Africa could take another 150 years
to reach U.N. targets for reducing maternal mortality, WHO officials
said.
The WHO called for an additional
investment of $9 billion annually on maternal and child healthcare,
including programs to combat malnutrition and avoidable diseases.
Pneumonia, diarrhea, malaria, measles, AIDS and neonatal ailments were
the main killers of children under five. The toll includes more than
four million newborns who die before they are a month old, but not some
3.3 million stillbirths annually.
Some 68,000 maternal deaths, or just under 10 percent, are attributable
to unsafe abortions, mostly in poor countries.
“If you look at it another way, one woman a minute dies in pregnancy or
childbirth, and 20 children under the age of five die in that same
minute, across the world,” Denis Aitken, a senior WHO official, told a
news briefing in Geneva.
Countries reporting a rise in newborn, child and maternal mortality
rates included Kenya, Rwanda, Swaziland, Turkmenistan, Zambia and
Zimbabwe.
“The lifetime risk for a woman to lose a newborn baby is now 1 in 5 in Africa, compared with 1 in 125 in more developed countries,” the report said.
Stephanie Nebehay
7 April 2005
Maternal iron deficiency disrupts mother/child
interaction
New mothers who are mildly iron deficient — a common result of
childbirth among women who don't take their vitamins — are less
emotionally available or in tune with their babies, a Penn State study
has shown.
Dr. Laura Murray-Kolb, a National Institute of Mental Health
post-doctoral fellow in child development at Penn State who led the
study says, “Earlier research had shown that anemic women may experience
post-partum depression and that women with moderate iron deficiency have
a slow down in thinking and memory. Our new results suggest that the
effects of mild iron deficiency — which are easily correctable with
supplements — can disrupt the solid foundation that is established by
healthy mother/infant interactions.”
The study, which is the first to focus on
the effects of maternal iron deficiency on mother/child interactions,
will be detailed April 5 at the Experimental Biology conference in San
Diego, Calif. The paper is titled, “Maternal Iron Deficiency Impacts
Mother-Child Interaction.” The authors are Murray-Kolb; Dr. John L.
Beard, professor of nutritional sciences; Dr. Rick O. Gilmore, associate
professor of psychology; Dr. Douglas Teti, professor of human
development and family studies; and Dr. Eva Perez and Dr. Michael
Hendricks, physicians in Cape Town, South Africa.
The study was conducted in South Africa with 64 women who were
identified as mildly iron deficient after childbirth and 31 who were not
iron deficient. At 10 weeks after childbirth, the women and their babies
were videotaped interacting. Half of the iron-deficient women were then
given iron supplements. After nine months, all of the women, those who
received supplements and those who did not, as well as the group of iron
sufficient women, were videotaped interacting with their babies again.
Analysis of the tapes showed that the mothering of the women who were
iron sufficient and those who received supplements differed from those
who were mildly iron deficient on measures of emotional availability.
For example, observed in play
interactions, the mildly iron-deficient mothers were less sensitive to
their baby's cues. They also scored lower on giving their babies chances
to lead interactions. In addition, the iron-deficient mothers cut in on
the baby's play at inappropriate times more often and appeared bored or
distant more frequently than the other mothers.
At nine months, the babies of the three groups of mothers also behaved
differently. For example, the babies of the mildly iron-deficient women
were less responsive and less involved with their mothers. When moving
away from a mildly iron-deficient mother, the baby would depend less on
mom for reassurance.
Murray-Kolb says, “New mothers should be aware of their iron status
which, we know now, affects the child as well as the mother. Iron
deficiency is easy to correct and could be a big part of post-partum
problems with mother/child interactions.”
The study was supported by the
International Life Sciences Institute and the Penn State Children, Youth
and Families Consortium.
7 April 2005
It takes a village to improve the health of
children
Optimum health care to youngsters
is far more than providing routine physical exams, making diagnoses,
prescribing therapies, and charting appropriate treatment plans. The
ever-evolving role of pediatric physicians requires a fuller
understanding of children and adolescents' total environment.
A review article published in the April supplement of the journal
Pediatrics outlines strategies for engaging physicians-in-training in
this new approach to providing care and building strong community
partnerships.
Rigorous residency training in community health and child advocacy will
help fight the increasing impact of social and environmental risk
factors on the health of children and adolescents. “Many of the health
issues affecting our nation's children are problems which the whole
community, not solely the individual family must address,” says
pediatrician and health services researcher Nancy L. Swigonski, M.D.,
M.P.H., assistant professor of pediatrics at the Indiana University
School of Medicine, coauthor of the study.
“Pediatricians see patients for 15
minutes a few times a year to treat such problems as asthma or lead
poisoning, but for these illnesses, as for many others, treating the
disease is not sufficient. We must alter the environment to get to the
root of the problem and we must equip our physicians with the knowledge
and skills to work in a community environment, says Dr. Swigonski.
Dr. Swigonski, Sarah Stelzner, M.D., IU assistant professor of clinical
pediatrics, and other co-authors provided examples of training programs
and strategies for involving pediatricians in community health issues.
No single best-practice training model exists, nor should it, for each
community and each residency training program is different in its
resources and needs, the authors stress.
“For residents and medical students, this training provides an important
reconnection to interests and passions that may have led them to a
career in medicine, advanced competencies in working with communities
and the acquisition of life-long leadership skills relevant to careers
in both subspecialty and general pediatrics,” the authors observe.
Rigorous training of young physicians in community health and child
advocacy will help fight the increasing impact of social and
environmental risk factors on the health of children and adolescents.
“Former Surgeon General Dr. David Satcher has warned that 21st century
health problems will cause decreased life expectancy, diminished quality
of life, lower productivity and increased costs to our society.
Pediatricians must learn to partner with other disciplines and community
based resources in order to fight problems such as obesity, violence and
mental health disorders in our children and youth to stop this negative
trend,” said Dr. Stelzner. ”
This review article, which is co-authored by Laura Jean Shipley, M.D.,
Elisa Alter Zenni, M.D., Dana Hargunani, M.D., Julie O'Keefe, M.D.
Carleen Miller, M.A. and Brian Alverson, M.D., appears in a supplement
of the journal Pediatrics devoted to the training of future
pediatricians.
5 April 2005
Oral cannabis induces psychosis at low levels
Even in clinical situations where
cannabis is administered orally at low doses, psychotic reactions can
occur, Swiss researchers report the current issue of BMC Psychiatry.
Recreational cannabis use has been associated with psychotic reactions,
but this is the first such report in closely monitored subjects
participating in a clinical trial, note Dr. Bernard Favrat and
colleagues at Institut Universitaire de Medicine Legale in Lausanne.
Favrat's group was conducting a study to examine the effects of
ingestion of THC (delta-9-tetrahydrocannabinol) on psychomotor function
and driving performance in eight occasional cannabis users.
The first case of psychosis was in a
22-year-old man given 20 milligrams of dronabinol, a synthetic THC.
Ninety minutes after dronabinol administration he experienced severe
anxiety and symptoms of psychosis, and was unable to perform the two
psychometric tests.
Levels of THC and its active metabolite 11-OH-THC in the blood at the
time of the strong adverse effects were 1.8 and 5.2 nanograms per
milliliter, respectively.
The second case was also a 22-year-old man who developed severe anxiety
one hour after taking 16.5 milligrams of a THC compound, when his THC
blood level was 6.2 nanograms per milligram and 11-OH-THC was 3.9
nanograms per milligram. For several hours he was unable to perform
psychometric tests.
The authors note that smoking a 3.5-percent marijuana cigarette leads to
blood concentrations of THC in the range of 50 to 100 nanograms per
milliliter. They believe that oral administration produces higher levels
of 11-OH-THC, with slower elimination.
Alternatively, they suggest that
“consuming oral cannabis may produce more potent, yet unknown
psychotomimetic metabolites of THC.”
“Doctors and users should be aware of the increasing availability of
oral cannabis in 'special' drinks or food as well as in medications
under development,” which can result in “significant psychotic
reactions,” Favrat's group cautions.
Source: BMC Psychiatry
1 April 2005.
Drug policy: Widening the Agenda: Harm
Reduction Around the World
If the 16th International Conference on the Reduction of Drug Related
Harm proved one thing, it was that the U.S. is far behind the rest of
the world in its harm reduction approach to drug use and abuse. The
conference, hosted in Belfast, Ireland last week, had a theme of
“widening the agenda,” where experts, researchers, scientists and other
harm reduction supporters came together to further explore this approach
in their respective countries.
The conference opened with an address from Allan Clear, Director of the
Harm Reduction Coalition in the U.S. In one of the most powerful
speeches of his career, he fiercely criticized—as did many other
speakers—the immensely destructive efforts by the U.S. government to
impede syringe exchange and other crucial HIV prevention measures both
in the U.S. and around the world.
As harm reduction is being steadily stifled in the U.S. by flawed drug
policies, other countries around the world look to harm reduction as a
viable solution to their drug problems. This year, the conference
welcomed a large number of people from Asia—a substantial increase from
the handful of Asian attendees in previous years. Jim Yong Kim, head of
HIV/AIDS at the World Health Organization expressed strong support for
syringe exchanges in developing countries. “Such international
solidarity is very important now, especially to people who matter
most—those working on the ground providing services to drug users,” said
Kasia Malinowska-Sempruch, Director of the Open Society Institute’s harm
reduction program. Chinese plenary speaker Zunyou Wu, MD, PhD, a
professor and research scientist who plays a leadership role in
promoting harm reduction programs in China, spoke about expanding
treatment to the Chinese.
In Iran, where heroin addiction is the highest in the world, per capita,
remarkable progress is being made through the use of the harm reduction
approach, according to Parviz Afshar, Director of Health in Iranian
Prisons Organisation. Alliance Executive Director Ethan Nadelmann said
in his closing plenary speech, “In Iran, the mullahs [religious leaders]
issued a fatwah [legal ruling] authorizing needle exchange and methadone
maintenance programs. But in America, we can’t get our own mullahs to do
the same thing.”
Other notable conference speakers and supporters of harm reduction
included Bob Newman, Alliance board member and Director at the Beth
Israel Medical Center, who gave a poignant speech about his own
evolution as a methadone reform advocate. Former Vancouver mayor Philip
Owen also attended the conference on behalf of the city’s current mayor,
Larry Campbell, and invited harm reduction advocates to next year’s
conference being hosted in Vancouver. Owen is known for following in the
footsteps of former Alliance board member and Baltimore mayor Kurt
Schmoke in providing courageous leadership in promoting harm reduction
approaches in his own city. Organizers for the Alliance conference later
this year in California look forward to working closely with organizers
of the Vancouver conference to maximize synergy between the two events.
With portions of the conference covering the harm reduction approach to
educating young people about drug use and abuse, attendees of the
conference besieged the Alliance’s Safety First Director Marsha
Rosenbaum, also a keynote speaker, with requests to translate Safety
First: A Reality-Based Approach to Teens, Drugs, and Drug Education into
Dutch, Vietnamese, Thai, Farsi, and Portuguese, among other languages.
“This enthusiasm for the Safety First approach internationally shows
that parents and educators all over the world are looking for ways to
handle teenage drug use that are based on honest education and the need
for harm reduction,” Dr. Rosenbaum said.
The conference was successful in bringing together and highlighting the
proliferation of harm reduction programs such as needle exchange and
methadone programs in countries like Iran, Indonesia and China. The
conference also made it that much more evident that the U.S. needs to
step up its game in using this important and life-saving public health
approach to address drug problems in the States. Glenn Backes, Director
of Health Policy for the Alliance, said, “Most nations are willing to be
pragmatic about controlling drug related harms, prioritizing the health
of their people over so-called 'moral messages' about drugs. I wish my
country was more like that....”
Thursday, March 31, 2005
Source
Report: Sleep may be key to child epilepsy
University of Florida researchers say sleeping woes may explain why
children with epilepsy are often hyperactive. The researchers' study,
summarized in a recent issue of the journal Epilepsy & Behavior,
say if epileptic children's sleep disorders are treated, not only does
their epilepsy get better, but their daytime behavior, concentration and
capacity to learn increases.
Epilepsy describes a group of disorders that occur when electrical
activity in the brain goes haywire, resulting in bursts of frenetic
activity that cause seizures. It strikes more than 2 million people in
the United States, according to the National Institute of Neurological
Diseases and Stroke.
Source
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