December 2005
Rate of BMI increase in children may predict risk of heart disease
The rate at which body mass index (BMI) increases in childhood is associated with the risk of coronary heart disease (CHD) as an adult, according to the results of a study published in the Oct. 27 issue of the New England Journal of Medicine.
My readers may be aware that at the fifth grade level in the state of California, children’s weights are measured and their body mass indexes are calculated. The Fallbrook Childhood Diabetes Prevention Program is using these measurements from La Paloma and Live Oak schools to determine fifth-graders’ risk for type 2 diabetes. The study reported here from the New England Journal of Medicine explains why noting the rating credits in BMI in children is so important.
“Low birth weight is a risk factor for coronary heart disease,” writes David J. P. Barker, MD, PhD, FRS, from the University of Southampton, Southampton General Hospital in the UK, and colleagues, who studied 8,760 people born in Helsinki from 1934 through 1944.
“On average, adults who had a coronary event had been small at birth and thin at two years of age and thereafter put on weight rapidly,” the authors write. “This pattern of growth during childhood was associated with insulin resistance in later life. The risk of coronary events was more strongly related to the tempo of childhood gain in BMI than to the BMI attained at any particular age.”
In an accompanying editorial, Matthew W. Gillman, MD, from the Harvard Medical School and Harvard School of Public Health in Boston, MA, notes that events occurring in the earliest stages of human development may affect the incidence of chronic diseases in later life.
“In populations of the world that are undergoing the nutritional and epidemiologic transition to Western styles of diet, sedentary behavior, obesity and chronic diseases, the ominous pattern that Barker et al. identify — lower birth weight followed by excess weight gain in childhood — is both common and liable to persist for the foreseeable future,” Dr. Gillman writes. “It is therefore imperative that, along with vigorous efforts to optimize childhood growth, researchers and policymakers identify, quantify and evaluate strategies to modify prenatal and perinatal determinants of adverse adult health outcomes… Slowly but surely, investigators in this field are learning ways by which ensuring the wellbeing of women of reproductive age and their newborn children can have substantial health-promoting effects in the next generation.”
Cynthia R. Fena
8 December 2005
http://www.thevillagenews.com/story.asp?story_ID=8305
Psychotherapy can help teens control diabetes
Intensive, home-based psychotherapy can significantly reduce diabetes-related stress in adolescents with type 1 diabetes, according to a report in journal Pediatrics.
"Although medical care providers often feel frustrated when caring for difficult families such as these," Dr. Deborah A. Ellis from Wayne State University, Detroit, told Reuters Health, there are treatments that may improve the psychosocial well-being, adherence and health outcome of teens who do not adhere to treatment of their type I diabetes, also know as "juvenile" diabetes.
Ellis and colleagues investigated whether intensive psychotherapy that targets the family and barriers to good treatment adherence could reduce the diabetes-relation stress that adolescents feel, and whether this improves adherence and diabetes control.
Adolescents who underwent psychotherapy experienced significantly reduced levels of stress compared with those who did not have psychotherapy, the authors report. The intervention appeared equally effective for younger and older subjects, males and females, and adolescents of different races.
Diabetes stress was associated with disease control at the beginning of the study and after treatment, but there was no association between disease control and age or ethnicity.
Improvements in metabolic control were attributed mainly to the specific effect of psychotherapy on adherence, the researchers note.
In light of these encouraging findings, Ellis added that "we are currently following up our sample to determine the long-term stability of our intervention effects. We are also adapting the model for youth with other chronic illnesses such as HIV infection, asthma and morbid obesity."
SOURCE: Pediatrics, December 2005.
Will Bloggs
7 December 2005
School behavioral programs may improve grades
School-based programs that target students' emotional, social and decision-making skills are likely to also boost their academic achievement, a team of Washington researchers reports. Their findings suggest that more broadly focused interventions can have a wider-ranging effect than those that specifically target academic achievement.
"Social skills, bonding to school, and early behavioral problems-- such as substance use, relational aggression, and other forms of disruptive or antisocial behavior -- predict academic achievement," according to study author Charles B. Fleming, a research analyst at the University of Washington School of Social Work.
"These findings provide evidence that school-based programs that target these variables, and are aimed at preventing drug use and other types of problem behavior, are likely to have positive effects on academic achievement," he told Reuters Health.
Fleming and his colleagues analyzed data collected from 576 students in 10 schools in the Pacific Northwest, who were participating in the long-term Raising Healthy Children project. They looked at the children's social and behavioral skills in seventh grade, as indicated by survey responses from the students, their parents and teachers, and the student's academic achievement in tenth grade.
The students' social, emotional, and decision-making skills predicted their test scores and grades in tenth grade, the researchers report in the Journal of School Health.
For example, students with higher levels of school bonding, who thought of school as fun and said they tried to do well in school, as well as those with better social, emotional, and decision-making skills tended to receive higher test scores and earn higher grades than their peers.
In contrast, those with attention problems, those whose friends exhibited negative behaviors, like alcohol drinking and fighting, and those with disruptive and aggressive behavior tended to get lower test scores and lower grades.
"Students with early discipline problems are likely to experience negative reactions from teachers and their peers and fewer opportunities to be engaged productively in school," Fleming told Reuters Health. He added that "students who thus feel less connected or bonded to school are likely to learn less and perform poorly."
The findings "support the argument that interventions that boost the social and emotional skills of children, increase their ability to stay focused in the classroom, and improve school bonding, are likely to increase academic performance," the authors write.
Fleming acknowledges that the current findings "are by no means earth shattering." Still, he added, "they are a reminder, in this era of No Child Left Behind and its focus on improving standardized test scores, that it is also important to focus on other aspects of social development which are, in fact, related to academic achievement."
The study was funded by the National Institute on Drug Abuse.
SOURCE: Journal of School Health, November 2005.
Charnicia E. Huggins
5 December 2005
MOTIVATION
Personal fulfillment may motivate adolescents to be physically active
Adolescents are most likely to report personal fulfillment as the strongest motivation to be physically active. Personal fulfillment motivation should be considered when designing physical activity promotion programs for youth, according to a study in the December issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. Ensuring that youth are physically active is essential for their physical and emotional health. But rates of physical activity are low among youth and decline during adolescence, according to background information in the article. To increase physical activity among youth, motivations to be physically active must be understood more clearly.
Katie Haverly, M.S., and Kirsten Krahnstoever Davison, Ph.D., of the State University of New York at Albany, conducted a cross-sectional study to identify factors that motivate adolescents to be physically active, and to assess the links between activity motivation and physical activity. (Ms. Haverly is now with the Department of Health Education and Health Behavior, University of North Carolina, Chapel Hill.) A total of 202 students (92 girls, mean age 12.5 years; and 110 boys, mean age 12.7 years) at a middle school in rural central Pennsylvania took part in the study. The researchers assessed differences in motivators for groups at risk for physical inactivity – including girls vs. boys, overweight vs. non-overweight youth, and youth with low vs. high perceived sport competence.
"In this study, four sources of motivation were identified: personal fulfillment motivation (e.g., enjoyment, wanting to be fit), weight-based motivation (e.g., wanting to lose weight), parent-influenced motivation (e.g., parents want them to), and peer-influenced motivation (e.g., social activity with friends, to be like the popular kids at school)," the authors write.
"Adolescents were most likely to report personal fulfillment as the strongest motivating factor for physical activity, followed by weight-based motivation, peer motivation, and parent motivation," they report.
Overweight adolescents reported significantly higher weight-based motivation, compared with those who were not overweight. Adolescents with low perceived sport competence reported significantly lower personal fulfillment motivation, compared with those with higher perceived sport competence.
"Personal fulfillment was the most readily endorsed motivation to be active among all participants regardless of risk status, and was the only motivation that was consistently associated with significantly higher levels of self-reported physical activity," the authors write. "Results from this study suggest that personal fulfillment motivation could be used as a basis for physical activity promotion programs for youth and that this strategy may be effective for all youth regardless of their risk status." (Arch Pediatr Adolesc Med. 2005;159:1115-1120.)
http://www.eurekalert.org/pub_releases/2005-12/jaaj-pfm120105.php
Cannabis: A risk to mental health, or a boon for people with MS?
Both, says Barbara Lantin
Why can't people make up their minds about cannabis? A recent issue of a tabloid newspaper carried news of an Australian study that showed that four out of five people with severe schizophrenia had been regular marijuana smokers in their youth. A few pages later, it included an article extolling the virtues of a cannabis-derived medicine for multiple sclerosis (MS) patients.
Cannabis: 'what is needed now is education'
The Home Office insists that cannabis "is still a controlled drug, and possession, production and supply are still illegal", but last week, it published proposals that mean anybody carrying enough to make up to 500 joints is likely to escape trafficking charges. What are we to make of these apparent contradictions?
The 'good' news about cannabis...
Last month, the Government announced that Sativex - an oral spray derived from cannabis that is licensed in Canada but not yet in the UK - could be prescribed on a "named patient" basis for pain relief in patients with MS. Sativex, which is the only medicine in the world derived from the cannabis plant, works by influencing the way pain messages are transmitted through the body.
"It's not that patients get high and stop caring about their pain," emphasises Mark Rogerson, spokesman for the manufacturers, GW Pharmaceuticals. "A person taking a normal dose will receive only a fraction of the tetrahydrocannabinol (THC) - the active ingredient in cannabis that causes a high - of a recreational user."
A recent trial in the journal Neurology showed that Sativex was significantly better than a placebo at reducing pain and sleep disturbances in MS patients.
... and the 'bad'
Two pieces of research published last week have added to the growing body of evidence that, when smoked by vulnerable, young people, cannabis can lead to serious mental illness.
A Danish study in the British Journal of Psychiatry found that almost half of patients treated for a cannabis-related mental disorder go on to develop a schizophrenic illness. People who had used the drug developed schizophrenia earlier than those with the illness who had not smoked marijuana.
The researchers emphasised that the study did not show that cannabis caused psychosis, because factors such as heredity, other drug use and socio-economic status had not been taken into account. However, an American study using sophisticated imaging techniques found similar abnormalities in the brains of adolescents with schizophrenia, and those who use cannabis daily, but no such abnormalities in healthy teenagers.
"These findings suggest that, in addition to interfering with normal brain development, heavy marijuana use in adolescents may also lead to an earlier onset of schizophrenia in individuals who are genetically predisposed to the disorder," says Dr Sanjiv Kumra, assistant professor of psychiatry at the Albert Einstein College of Medicine, New York, who worked on the study.
According to Robin Murray, professor of psychiatry at the Institute of Psychiatry in London, one person in four has the genes that make them susceptible to developing cannabis-induced psychosis.
Are patients who take cannabis-derived drugs at risk?
"There is a distinct difference between using a drug therapeutically, under medical supervision, and taking it recreationally," says Prof Murray. "Cannabis is a mixture of substances; when it is used in medicine, the aim is to have less of the hallucinogenic components, and more of those that have an effect on muscle tension.
"Also, if you smoke a joint, you get high levels of these components in the blood, and they decrease quite rapidly; whereas in pharmaceutical use, you have slow absorption, and levels remain fairly constant, so the psychotropic effects are likely to be fewer."
According to one survey, around 16 per cent of people with MS smoke cannabis to help relieve their symptoms. However, because of their age, this group is less likely to be at risk of schizophrenia. "Psychosis is a disorder of youth," says Prof Murray.
According to Rogerson of GW Pharmaceuticals: "We have found no evidence that Sativex causes psychosis. Such side effects as there are - and no drug is without them - are generally mild, reversible and well tolerated. There may be a temporary intoxication-like reaction, and, for this reason, we have always excluded people with serious mental illness from our trials."
What is the Government's attitude to cannabis?
Having downgraded the drug from class-B to class-C, the Government has asked its advisory council on the misuse of drugs to review the possible links between cannabis and mental illness. Its report is due by the end of the year, but leaks suggest that it will recommend no change in the law.
"I don't care about the classification of cannabis," says Prof Murray. "But the Government has made a major error in accompanying the reclassification with reassurance that the drug is not harmful. What is needed now is education. The Americans are tackling it very well. What is our Government doing?"
Scans of autistic children show faults in brain circuits
Brain scans of autistic children have revealed striking faults in key brain circuits that could explain the range of social difficulties such youngsters experience, neuroscientists claimed yesterday. Detailed snapshots of the children's brains showed that networks of nerves thought crucial for understanding other people's emotions and intentions did not spark into life at the appropriate moment. The more severe a child's autism, the less activity the circuits showed.
In the study, neuroscientists led by Mirella Dapretto, a psychiatrist and brain mapping specialist at the University of California in Los Angeles, showed a series of faces to two groups of children with an average age of just over 12 years. The children in one group had been diagnosed with autism; the others showed no signs of the disorder.
Every child tested saw 80 faces, each of which expressed either anger, fear, happiness, sadness or a natural state. In separate scans, the children were asked to observe the face or imitate the expression. The researchers found a striking difference between the brain scans of the two groups of surveyed children. When the non-autistic children saw the faces, various parts of their brains flickered into life, including clumps of nerves called mirror neurons. This group of nerves is thought to play a key role in helping us understand how others are feeling, for example by mirroring in ourselves feelings of sadness if we see someone looking miserable.
Significantly, brain scans showed that when autistic children looked at the faces, they processed the features properly, but the mirror neurons conveying the emotion of the expression failed to light up.
In the next test, children were asked to imitate the expression on each face flashed up before them. Again, the scans showed that clumps of mirror neurons burst into life in children with normally developed brains. When autistic children mimicked the expressions, they hardly flickered at all. The scans suggest that while people with autism can recognise expressions, the brain circuits that attach emotion to them are faulty, making it hard or impossible to read others' feelings.
The study, which was published in Nature Neuroscience yesterday, shows that the problem lies with a particular region of the brain known as the pars opercularis, which is rich in mirror neurons. In a final set of scans, the scientists showed that increasingly severe autism went hand in hand with rapidly decreasing activity of the mirror neurons.
"This mirroring mechanism may underlie the remarkable ability to read others' emotional states from a mere glance," said Dr Dapretto. "Our findings suggest that a dysfunctional mirror neuron system may underlie the social deficits observed in autism. This is exciting because we finally have an account that can explain all core symptoms of this disorder."
Ian Sample
5 December 2005
http://www.guardian.co.uk/medicine/story/0,11381,1657885,00.html
'Half of people may get depression'
As many as half the population could experience at least one episode of serious depression in their lifetime, experts have said. An editorial in the British Journal of Psychiatry considered several studies that have been carried out to try to gauge the extent of serious depression in people around the world.
The experts, led by Professor Gavin Andrews from the University of New South Wales in Australia, said that rates had ranged from a lifetime risk of a major depressive episode of 6.7% to as high as 40%.
But having considered the evidence they concluded: "Perhaps depression in the Western world will affect half the population during their lifetime, and have incidence peaks in the young and the very old."
Professor Andrews and his colleagues said that the young and very old were also the most likely to have their depression go unrecognised.
And treatment with antidepressants and cognitive behavioural therapy is problematic in these groups, they added.
The experts noted that in 1990, depression was estimated to be second only to heart disease as a cause of disease burden.
There has also been concern in recent years about the rising number of prescriptions for antidepressants being handed out by doctors.
The researchers questioned whether depression really was now restricted to a minority of people or, like flu, was waiting for most people.
They said the the retrospective studies came to very different conclusions on the lifetime incidence of depression, perhaps as low as 10% of the population.
British Journal of Psychiatry
Children reach sexual maturity sooner
An average child today is sexually mature by age 10 or 11 -- five to eight years sooner than just a century ago, New Zealand researchers say. While children are reaching sexual maturity at an earlier age vs. the 16- to 18-year-olds of last century, they are not yet mentally equipped to handle that change, said Auckland University's Peter Gluckman.
"A start would be an honest discussion about sexuality at a young age so (children) are more able to handle the changes that happen to their bodies at a very young age," Gluckman told Television New Zealand. Adolescent health researcher Sue Bagshaw said 10- and 11-year-olds should talk about sexual issues "just like they talk about everything else to do with their body."
A New Zealand school official said a counseling system in place for many years for secondary students should be expanded to help pre-teens deal with such issues.
http://www.upi.com/ConsumerHealthDaily/view.php?StoryID=20051129-052701-6485r
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