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March 2002

Movies may sway kids' views on smoking: study
Seeing their movie idols light up on-screen may help convince children and teens that smoking is just fine, a study of US middle-school students suggests.

Researchers found that students who had seen relatively more films featuring smoking also had more positive attitudes toward the habit. This, they say, suggests that on-screen tobacco use can help shape children's views on smoking.

"It suggests that the movie influence may start long before they ever puff on a cigarette," the study's lead author, Dr. James D. Sargent of Dartmouth Medical School in Hanover, New Hampshire, told Reuters Health.

In an earlier study, Sargent's team had found a relationship between adolescent smoking rates and exposure to smoking in movies. However, the investigators could not tell whether the film images actually moved kids to see smoking in a positive light.

This study now suggests that may be the case, according to Sargent.

"Kids don't just start smoking for other reasons then go to the movies to validate their new self-image," he said.

The study looked at nearly 3,800 students in grades 5 to 8 in schools in Vermont and New Hampshire. The children were asked to identify which movies they had seen from a list of 50 recent films that the researchers had analyzed for smoking content. The movies were randomly pulled from a list of 601 films ranging from "G"- to "R"-rated. The vast majority of "PG," "PG-13" and "R" movies contained tobacco use.

The students were also asked about their views on smoking and whether they would consider taking up the habit. Sargent and colleagues also looked at factors that could affect kids' smoking attitudes--such as their school performance, their parents' strictness, their own propensity toward "rebelliousness" and whether their parents, siblings and friends smoked.

Overall, nearly one quarter of the students were considered "susceptible" to smoking based on their responses, and about 20% saw adolescent smoking as a normal behavior, according to findings published in the April issue of the American Journal of Preventive Medicine.

Moreover, the students' susceptibility to smoking rose in tandem with their exposure to on-screen smoking, regardless of other influences, the team found. Children who saw relatively more smoking in films were also more likely to view adult smoking as normal, the findings show.

According to Sargent, this study offers "an important piece in developing the argument that exposure to movie smoking is one of the causes of adolescent smoking."

SOURCE: American Journal of Preventive Medicine 2002;22.

One in Three British Teens Smokes Marijuana
British teenagers, casting caution to the winds, are regularly smoking drugs and drinking their way to oblivion, according to a report released on Friday.

The survey by the National Centre for Social Research and the National Foundation for Educational Research said nearly one-third of 15-year-olds had smoked marijuana in the past year and the number of under-age drinkers had risen sharply.

The news came just one day after medical experts from the Advisory Council on the Misuse of Drugs recommended to the government that cannabis be reclassified as a low-risk drug.

The survey of more than 9,000 pupils in 285 secondary schools across England showed that thirteen percent of pupils aged 11-15 had used cannabis in the last year increasing to 31 percent among 15-year-olds.

Two-fifths of all pupils said they had been offered one or more drugs, with boys more likely than girls to have been approached.

Twenty seven percent of pupils said they had been offered cannabis, while 22 percent had been asked to try stimulants which included cocaine, crack, ecstasy, amphetamines and "poppers" (amyl nitrate).

Again the figures climbed dramatically with 15-year-olds as 66 percent claimed they had been offered drugs. Roger Howard, chief executive of the charity Drugscope which offers advice and education on drug abuse, said he was not surprised by the findings.

"Criminal sanctions and jail is simply not stopping large numbers of young people experimenting with drugs," he said.

"The only way to address the problem is to invest more in long term education and prevention work and ensure that young people who need treatment get it immediately."

The drinking of alcohol among youngsters was also highlighted in the report.

After falling from 27 percent in 1996 to 21 percent in 1998, it increased again to 26 percent in 2001. One in two 15-year-olds said they had consumed alcohol in the past week.

However, the number of alcohol units drunk in a week which had increased steadily from 5.3 in 1990 to 10.4 in 2000 fell for the first time to stand at 9.8.

Figures for solvent abuse doubled from three percent to seven, however the research centers said this was probably a result of the change in the survey's question format rather than an increase in actual misuse.

Long-Time Pot Users Show Mental Deficits
Long-time, heavy marijuana users may eventually see their memory and attention span go up in smoke, new research suggests.

Investigators found that, among pot smokers seeking treatment for marijuana dependence, long-time users performed more poorly on tests of memory and attention than shorter-term users and non-users.

The findings show that over time, marijuana smoking can cause intellectual impairments that "endure beyond the period of intoxication" and worsen the longer a person uses the drug, the study authors report in the March 6th issue of The Journal of the American Medical Association.

But another researcher not involved in the study pointed to shortcomings in the work that he says make it tough to draw that conclusion.

In an accompanying editorial, Dr. Harrison G. Pope, Jr. notes that marijuana users who seek drug treatment do not necessarily reflect users in general, since these individuals may have other health issues such as anxiety or depression.

In the study, researchers led by Dr. Nadia Solowij of the University of New South Wales in Sydney, Australia studied 102 pot-smoking Americans and 33 non-users. Marijuana users typically smoked every day, with long-time users doing so for an average of 24 years. Shorter-term users had smoked for about 10 years, on average. The vast majority said that they currently were not using other drugs, or did so only occasionally.

Results of the mental functioning tests--taken after at least 12 hours of abstinence--showed that long-time users performed less well than shorter-term users and non-users.

"We found that long-term users had problems with learning, storage of learned information and retrieval of information from memory," Solowij told Reuters Health.

This does not mean the drug caused brain damage in these cases, she said, explaining that the impairments seen in long-time users were "relatively subtle."

Still, Solowij noted, the deficits could affect daily functioning--hindering, for example, a person's ability to study or remember an item he or she just read.

But although such deficits, if prolonged or irreversible, would be of "grave concern," other studies have found no such impairments in long-time marijuana users, according to Pope, a researcher at Harvard Medical School and McLean Hospital in Belmont, Massachusetts.

Pope and his colleagues recently found "virtually no significant differences" between heavy marijuana users and non-users on a battery of neuropsychological tests.

Part of the difficulty in sizing up the impact of marijuana is weeding the drug's effects out from the "background noise" of other factors, like psychiatric problems and abuse of other drugs, according to Pope. In this study, nearly half of the long-time marijuana users had in the past regularly used or abused alcohol or other drugs.

But there are also plausible biological reasons for why sustained marijuana use could affect things like memory. Solowij noted that the brain receptors the drug acts on exist in large numbers in regions involved in memory. Over the years, she said, marijuana exposure might change the way these receptors and other brain chemicals operate.

According to Pope, it seems almost certain that marijuana produces short-lasting mental deficits, but whether they endure or worsen over time is still unclear.

Also unknown is whether any impairments are reversed after a person stops smoking pot, Solowij pointed out.

"We do not yet know whether the impairments recover after stopping or reducing (marijuana) use," she said. "We are currently investigating this question."

SOURCE: The Journal of the American Medical Association 2002;287:1123-

Males Less Likely to Tell Partner About STD: Study
Men and teenage boys are far less likely than females to tell their main sexual partners they have been diagnosed with a sexually transmitted disease (STD), a small study in France suggests.

Researchers found that 14% of men diagnosed with an STD in the past 5 years had not told their main partners, compared with just 2% of women.

Similarly, 51% of boys who had ever been diagnosed with an STD had not talked about it with their partner at the time, in contrast to 9% of girls, according to findings published in a recent issue of the journal Sexually Transmitted Infections.

However, both sexes--adults and teens--usually did not tell past or casual sex partners about their STDs, report Josiane Warszawski and L. Meyer of the French national research institute INSERM. Overall, study participants with curable STDs like chlamydia, gonorrhea and syphilis were less likely to notify their current partners.

Partner notification, the authors note, is an important public health strategy for controlling the spread of STDs and getting infected individuals early treatment. They conclude that "procedures must urgently be developed to improve the notification of sexual partners, particularly female partners and adolescents."

Females, they note, are particularly unlikely to get early STD testing without such notification--in part because their STDs are more likely to have no symptoms or visible signs.

Women are also at risk of particular long-term complications from untreated STDs, including pelvic inflammatory disease, infertility and pregnancy complications related to chlamydia or gonorrhea infection.

The current study involved 177 adults and 45 adolescents who had been diagnosed with an STD.

SOURCE: Sexually Transmitted Infections 2002;78:45-49.

EU May Encourage Drug Testing in Children
US-style measures to encourage companies to test drugs on children, including 6-month extra marketing exclusivity, are expected to be adopted soon, according to European Commission officials and industry experts.

Traditionally, most medication has not been tested in children, leaving doctors to guess as to appropriate dose or potential side effects in youngsters. In the US, each medicine studied in children can gain a drug company an extra 6 months without generic competition, time that can mean hundreds of millions of dollars in profit.

A European Commission (EC) consultation document on paediatric medicine, "Better Medicines for Children," was released in February by Europe's enterprise commissioner Erkki Liikanen. It draws heavily on experience in the US, where similar legislation 5 years ago boosted the number of paediatric clinical trials.

A key element of the European plan is to offer manufacturers an extended period of exclusivity in exchange for developing a paediatric indication for a patented drug. While no time period has yet been specified, an extension of at least 6 months is expected.

"Six months could be seen as the bottom line, it would be difficult to provide less," Philippe Brunet, head of the EC's pharmaceuticals unit, told Reuters Health in a telephone interview.

Some sectors of the pharmaceutical industry are hoping for a longer period of exclusivity for all paediatric applications. The European Federation of Pharmaceutical Industries and Associations (EFPIA), is expected to push for a period of one year.

However, Brunet said generics manufacturers would oppose this. Six months represented a compromise and had worked well in the US, he added. There was general agreement on pushing the legislation forward, and disagreements over the length of the exclusivity period were unlikely to hold the process up, he said.

Dr. Ingrid Klingmann, head of the European wing of the pharmaceutical industry's Drug Information Association said such a change would be welcome. "There is a very good chance we will have 6-month exclusivity and this will be a very strong driver for the (clinical paediatric trial) process in Europe," she said.

The document would also impose a new requirement that all new drugs with possible paediatric applications be tested in children before marketing. The paediatric applications for new drugs would carry the same extended period of exclusivity as in the case of drugs already patented, according to Brunet.

But there are still some unanswered questions. A proposed new marketing authorisation mechanism and market exclusivity status for children's versions of generic drugs might prove difficult to enforce, according to Brian York, a senior Novartis executive who chairs the intellectual property policy committee at the EFPIA.

"If the child's version is totally different, that might be okay (to grant market exclusivity), but it if you just break half of an adult tablet, it becomes more difficult."

A proposal that would require new drugs with paediatric applications to first be tested in children has also come under scrutiny.

"If that was mandatory, it could delay the approval of drugs, and that might not be in the overall interest (of the public)," York said.

However, Brunet said this is unlikely to prove to be a problem, because additional time will be granted for submitting documentation for the paediatric application, beyond the date of the submission of the adult version.

The Commission is aiming to make a final decision on all of these issues raised in the consultation process by June, and to submit its proposed legislation to the European Parliament by September or October.

"The EU is very interested in making this a reality as quickly as possible," Klingmann said.

More US Kids Taking Meds for Behavior, Depression
Prescriptions for drugs to treat attention-deficit/hyperactivity disorder (ADHD) and depression in children and teens grew steadily during the late 1990s, according to a study of one US managed care organization.

Researchers found that prescriptions for stimulants used to treat ADHD, such as Ritalin and Adderall, increased 26% between 1995 and 1999 among children and teens enrolled in six health plans. All of the plans were affiliated with UnitedHealth Group in Minnetonka, Minnesota.

Prescriptions for a drug class known as selective serotonin reuptake inhibitors (SSRIs), which are used to treat depression and anxiety, rose by 62% over the same period, according to findings published in the March-April issue of Ambulatory Pediatrics. SSRIs include brand names like Prozac and Zoloft.

For the study, UnitedHealth researchers Drs. Deborah Shatin and Carol R. Drinkard looked at the use of certain types of psychiatric drugs among health plan enrollees younger than 20, who numbered about 500,000 in 1995 and more than 740,000 in 1999.

They found that the prevalence of stimulant drugs, SSRIs and other types of antidepressants grew steadily during the study period. Children aged 10 to 14 were the most frequent users of stimulants, while SSRIs were most commonly prescribed for 15- to 19-year-olds.

Overall, the proportion of stimulant users in the health plans grew from about 24 per 1,000 kids to 30 per 1,000, the report indicates. SSRI use increased from about 8 per 1,000 to nearly 13 out of 1,000 kids.

According to the researchers, their findings are in line with past studies of US children and teens. They note the prevalence of ADHD may be increasing because of changes in the criteria for diagnosing the disorder, which could explain the increases in medication use.

Keeping track of changes in the prescription of ADHD and depression drugs in children is vital, as there is concern about both the overuse and inadequate use of these medications, Shatin and Drinkard point out.

Overuse creates concern, in part, because the long-range effects of the drugs on the developing brain are unknown, the researchers note. On the other hand, some worry that not treating children with ADHD or depression could result in social and academic problems in the long run.

SOURCE: Ambulatory Pediatrics 2002;2.

Brain Receptor Tied to Teen Suicide Risk
High levels of a particular chemical receptor in the brain may be related to the risk of teenage suicide, findings from a small study suggest.

Although the relationship remains unclear, researchers speculate that this brain characteristic may signal a genetic vulnerability to suicide.

Studying autopsied brain tissue from 30 teenagers who died of suicide or other causes, Dr. Ghanshyam N. Pandey and colleagues found that suicide victims showed higher levels of a particular receptor for the chemical serotonin, which helps relay messages between brain cells.

Serotonin is known to affect mood, and dysfunction in the serotonin system has been implicated in psychological disorders such as depression and anxiety. The receptors Pandey's team studied, known as serotonin 2A receptors, have been found to exist in higher-than-normal levels in the brains of adult suicide victims.

In the current study, the brains of teen suicide victims showed heightened levels of serotonin 2A receptors and greater activity in the genetic machinery churning out the receptor. In addition, this difference was limited to two regions of the brain--the prefrontal cortex and the hippocampus--that are involved in emotion, stress and mental processes such as perception and reasoning.

If this brain-receptor characteristic is indeed genetic, it may indicate an inborn susceptibility to suicide, according to Pandey, a researcher at the University of Illinois at Chicago.

On the other hand, he told Reuters Health, the abnormality may be secondary to changes in other body systems.

But it is at least "quite likely" that teen suicide is related to dysfunction in the serotonin system, since these suicides are frequently driven by impulsive or aggressive behavior, stress or anxiety, Pandey and his colleagues report in the March issue of the American Journal of Psychiatry.

Pandey said these findings suggest it could become possible to spot suicidal individuals based on their serotonin 2A levels. Serotonin also exists in the blood, and in earlier work, his team found that suicidal patients with various mental disorders had higher levels of these receptors in blood cells called platelets.

More broadly, Pandey noted, the identification of the specific biological abnormalities related to suicide could lead to the development of more targeted drugs for suicidal patients.

SOURCE: American Journal of Psychiatry 2002;159:419-429.

Study Says Hyperactivity Drug Can Be Added to Food
A medication commonly used to treat attention-deficit/hyperactivity disorder (ADHD) may be safely taken in powder form without compromising any of its beneficial effects, according to the results of a small study.

Metadate, a once-daily treatment for ADHD, may be taken by sprinkling the contents of the capsule onto food. And because the drug provides a day's worth of medication, children taking Metadate can avoid the social stigma of leaving the classroom to take medication, researchers suggest.

The findings are good news for the millions of people who have trouble swallowing pills or capsules, particularly children. An estimated 4% to 12% of school-age children experience ADHD, a disorder marked by impulsiveness, difficulty with academic and social functioning and short attention span. ADHD is commonly treated with the stimulant drug methylphenidate (Ritalin), the active ingredient in Metadate.

The researchers report their findings in the April issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

"A controlled-delivery form of methylphenidate...that can be administered once daily and sprinkled on food could help improve compliance in those children who have difficulty swallowing solid dosage forms," Dr. Roy D. Simmons from Rochester, New York-based Celltech Pharmaceuticals, which manufactures Metadate, and colleagues conclude.

In the study, 26 healthy adults without ADHD fasted for 10 hours and then swallowed a Metadate CD capsule or took the medication, containing 20 milligrams of the drug, sprinkled over 1 tablespoon of applesauce. After 6 days of taking no medication, the study volunteers switched treatments.

The researchers took blood samples before volunteers took the medication and again every half-hour to 4 hours over a 24-hour period to measure blood concentrations of the drug.

Blood levels were similar for the two treatments and there were no significant differences in the rate at which the drug was absorbed or eliminated over the course of one day. Swallowing the capsule or sprinkling the contents over food was found to be equally safe and well tolerated. Side effects, such as headaches, were mild, the report indicates.

However, more research is needed into the effects of the powder form of the drug in children, and larger studies are needed to confirm the safety of taking the drug in powder form, the authors add.

SOURCE: Journal of the American Academy of Child and Adolescent Psychiatry 2002;41:443-449.

High Relationship Expectations Tied to Depression
Young women who have feelings of depression are more likely to have unreasonable expectations in their personal relationships, researchers in Canada report.

In a study of female college students, women who fit the criteria for dysphoria--a mix of anxiety, depression and irritability--tended to have higher expectations and standards for themselves and others in their personal relationships than women without dysphoria who had never been depressed, the investigators found.

These higher expectations seem to explain why women with dysphoria are more hostile in their interpersonal relationships, according to the report in the Journal of Social and Clinical Psychology.

Feelings of depression can lead to many interpersonal problems, Dr. Scott B. McCabe, of the University of Waterloo in Ontario, Canada, told Reuters Health. These problems often result from symptoms caused by depression, such as poor sleep and concentration, fatigue and irritability, according to McCabe, who is the senior author of the study.

In previous research, McCabe found that when depressed women try to solve a problem with their spouse, they often become more negative, although the spouse does not. In contrast, women who are not depressed do not tend to become more negative when they try to solve a problem in their relationship, according to McCabe.

In the new study, McCabe and a colleague, Robyn E. Wiebe, were interested in seeing how the irritability and hostility that often go hand-in-hand with depression and dysphoria are related to the difficulties women with feelings of depression have with other people.

"It appears that when depressed, people have very high expectations for how others should behave in interactions with them," McCabe said. When others fail to live up to their standards, depressed people may become frustrated, irritable or hostile, according to the Canadian researcher. The expectations of the depressed person may be unreasonable in the other person's opinion, McCabe said, or they may be unknown to the other person.

What depressed people can learn from the research, McCabe said, is to try to recognize "that their expectations for others are likely too excessive."

As for the people who are around depressed people, he said, "It is important to recognize that these behavioral styles are likely temporary and result from depressive symptoms rather than personality traits."

SOURCE: Journal of Social and Clinical Psychology 2002;21:67-90.

School-based Trauma Program Helps Children Cope
A school-based program can successfully identify and treat children with post-traumatic stress symptoms following a disaster, according to a study of Hawaiian youngsters who experienced a devastating hurricane in 1992.

The findings are particularly relevant following the terrorist attacks last fall, said study author Dr. Claude M. Chemtob, a professor of psychiatry and pediatrics at the Mount Sinai School of Medicine in New York.

"We've established an empirically supported approach that could be used in other disasters such as 9/11," he told Reuters Health, noting that very little research previously has been done in this area.

Chemtob said he is currently working with some schools in New York City to try to help children cope with the aftermath of the attacks.

In the new report, Chemtob and colleagues studied schoolchildren on the Hawaiian island of Kauai who were exposed to Hurricane Iniki, which damaged nearly three quarters of the island's homes and resulted in more than $2 billion in damages in 1992.

In response to teachers' concerns that some children were still haunted by the disaster 2 years later, the researchers set up a program in which they screened all 4,258 children in grades 2 through 6 enrolled in the island's 10 public elementary schools.

The 248 children who exhibited the greatest levels of psychological trauma, evidenced by reliving the disaster, avoiding reminders of it or displaying high irritability, were then given four weekly sessions of either group therapy or individual therapy.

Due to limited staffing resources, the report indicates, all of the children were not treated at the same time. Instead, they were treated in three separate groups, for three consecutive months.

Trained school counselors delivered the therapy, in which the children explored their feelings of safety, loss, anger and closure, and ways of handling each.

Results published in the March issue of the Archives of Pediatrics and Adolescent Medicine show that the children reported fewer trauma-related symptoms after treatment than before, and the positive effects were still maintained one year later. Similarly, the clinicians indicated that treated children showed fewer symptoms than those who were still awaiting therapy.

Individual and group therapy appeared to be equally effective, though fewer children dropped out of the group treatment. A total of 214 children completed therapy.

Among those most at risk for trauma symptoms were girls, younger children and kids who feared for the safety of themselves or their families during the disaster.

"We have an obligation to screen children and provide them with treatment," said Chemtob, who also has a post at the National Center for Posttraumatic Stress Disorder in Honolulu. "You can't just wait for kids to present themselves (for help)," he said.

The new study "sets a standard for future efforts to systematically examine the effectiveness of treatment in children exposed to disasters," Dr. Betty Pfefferbaum, of the psychiatry department at the University of Oklahoma in Oklahoma City, writes in an editorial accompanying the study.

"Given the frequency with which disasters occur and the limited resources available in these situations, it is imperative that we examine the factors associated with symptom development and functional impairment and the interventions that are effective in their management," she adds.

SOURCE: Archives of Pediatrics and Adolescent Medicine 2002;156:208, 211-216.

Violence Exposure Linked to Lower IQ in Children
Children from urban areas who are exposed to a high level of violence may have lower IQ scores and a lower reading ability than their peers, researchers report.

"The findings suggest that violence exposure may be associated with actual impairments in academic ability and learning potential, even in the absence of distress," write lead study author Dr. Virginia Delaney-Black of the Children's Hospital of Michigan in Detroit, and her colleagues.

To investigate, the researchers studied 299 urban first-grade children and their caregivers. They assessed the children's reading ability and IQ, and the relationship of these variables to the children's violence exposure.

Overall, the children reported high levels of exposure to community violence and trauma-related distress, the investigators report in the March issue of Archives of Pediatrics and Adolescent Medicine.

For example, roughly 85% of the 6- to 7-year olds said they had heard guns being shot at least once in their life, nearly 80% said they had seen somebody get beat up, and almost one-quarter said they had seen someone get stabbed. Furthermore, almost 4 out of every 10 children said they worry in class "some of the time" or "a lot of the time" about people being shot.

High levels of this type of exposure to community violence were associated with lower IQ scores, the researchers report. In fact, a mathematical equation of this relationship predicted that children with the highest level of exposure to violence and trauma-related distress would score 7.5 points lower on their IQ tests than children who reported the lowest level of exposure and distress. High levels of trauma-related distress, however, were not associated with lower IQ scores, the results show.

"This finding suggests that reported violence exposure might be associated with negative academic outcomes, whether or not children are subjectively distressed from the exposure," the authors write.

On the other hand, both community violence exposure and trauma-related distress were related to the children's scores on reading achievement tests. Children who report the highest levels of trauma-related distress--such as in-class worries--were mathematically predicted to score 9.8 points lower on a test of early reading ability than those who report the lowest level of trauma-related distress.

Both of these findings remained true when the investigators took into consideration the child's home environment, the caregiver's verbal ability, the child's gender, the family's socioeconomic status and the child's level of prenatal alcohol exposure.

"If community violence exposure does in fact impair academic ability, efforts to identify factors predicting which urban children are or will be exposed to high levels of violence are needed," Delaney-Black and her team write.

SOURCE: Archives of Pediatrics and Adolescent Medicine 2002;156:280-285.

Mayo Clinic study estimates 7.5 percent of schoolchildren have ADHD
Attention deficit/hyperactivity disorder affects an estimated 7.5 percent of schoolchildren, a Mayo Clinic study has suggested.

Researchers analyzed medical and school records for 8,548 children in Olmsted County, about 70 miles (113 kilometers) southeast of the Twin Cities. They cautioned that findings might vary in an area with very different demographics, but said the study is important for eventually answering the question of whether ADHD is being over-diagnosed and overmedicated.

``Potential overdiagnosis of the disorder and overuse of stimulant medications make it imperative to obtain accurate information about the occurrence of ADHD,'' said the study, published in the March issue of the Archives of Pediatrics and Adolescent Medicine and released Wednesday.

ADHD is the most common neurobehavioral disorder in childhood. Symptoms may include short attention span, impulsive behavior, and difficulty focusing and sitting still. Symptoms must occur in two settings, such as home and school, for an accurate diagnosis.

Previous studies estimated that ADHD affects anywhere between 1 percent and 20 percent of school-age children. The American Academy of Pediatrics says it affects between 4 percent and 12 percent of school-age children - or as many as 3.8 million youngsters.

The Mayo Clinic study of children born from 1976-1982 also reviewed records of youngsters treated at the area's only private psychiatric practice.

Archives of Pediatrics and Adolescent Medicine: http://archpedi.ama-assn.org

Earlier Bedtimes May Help Girls Cope with Stress
Now parents have a scientifically valid reason for putting their young girls to bed before 8 PM. New study findings show that it may help the youngsters cope better with stress during the day.

"How girls perceive stress might be directly influenced by the time they went to bed the night before," lead researcher Vincent F. Capaldi II, of Brown Medical School in Providence, Rhode Island, told Reuters Health.

"Girls that sleep less might react more adversely to stress than girls that sleep an adequate amount," he added.

The findings are being presented this week in Barcelona, Spain, during the 60th annual meeting of the American Psychosomatic Society.

Capaldi and his co-researchers Drs. Laura Stroud and Raymond Niaura, also of Brown Medical School, studied 138 third-grade girls. Their research was performed under the direction of Dr. Jeanne Brooks-Gunn of Columbia University in New York.

During a home visit by the researchers, the girls participated in three stressful tasks: block design, placing a cold towel on their foreheads for a certain length of time, and a mother-daughter disagreement. Their levels of the stress hormone cortisol were measured at the start of the study and after each stressor, and their bedtimes and perception of aversiveness to the stressor were also recorded.

Girls with later bedtimes--after 8 PM--perceived the tasks as more stressful than did their peers who went to bed before 8 PM, Capaldi and colleagues report. In the cold towel stress test, for example, girls with later bedtimes rated the towel as more uncomfortable than did their peers, Capaldi said.

"This result was also confirmed in the case of psychological stress--i.e., a mother-daughter disagreement," he added.

Further, girls with earlier bedtimes exhibited greater initial reactions to each stressor and more steep declines in cortisol afterwards, while those with later bedtimes had slower declines in their cortisol levels.

The steeper decline in cortisol and the subsequent decrease in negative perceptions of the stressors following initial reactions "may indicate a more adaptive response to stress in well-slept subjects," the authors write.

"My results suggest that earlier bedtimes might help girls cope better with home, school, and social stressors," Capaldi said.

In light of the findings, "it might be beneficial to reconsider early school start times," the researcher added. "In this and other studies it has been suggested that school is a major factor for why children at this age do not get enough sleep.

"Parents should monitor the bedtimes of children more closely to ensure they are getting enough rest," Capaldi said.

Health Experts Mull World's Poor Kids
Saying almost 11 million children die each year of preventable causes, leading health experts were seeking ways to extend resources to ``the poorest and the youngest'' at an international conference.

The World Health Organization and UNICEF, which organized the meetings Tuesday and Wednesday, said pneumonia, diarrhea, malaria, measles, HIV/AIDS and malnutrition were the main causes of death and most could be blamed on poverty.

The experts, politicians and health officials were to place a special focus on the health needs of newborn babies who die during the first weeks of their lives, according to a news release.

``Of the 11 million who die, 8 million are babies,'' said WHO director-general Dr. Gro Harlem Brundtland. ``These deaths were preventable and treatable, not inevitable.''

The agencies said the science and medicine was available but a commitment of more political will and resources was needed, as well as investment in helping communities and families to overcome health problems.

``The resources needed to reach every child and adolescent are well within the means of our wealthy world,'' UNICEF chief Carol Bellamy said. ``In a world where most deaths happen before children reach any health facility, the focus must be on bringing services to people rather than people to services.''

The ``first global consultation on child and adolescent health and development'' was called to come up with ``a strategy to reach the poorest and the youngest'' ahead of a U.N. special session on children in May.

Delegates, including World Bank representatives and health officials worldwide, also were addressing the needs of adolescents since almost 1.5 million die annually from substance abuse, suicide, injuries, violence, disease and other causes.

``We are failing our children and young people,'' Brundtland said. ``Even when they do survive, many children are still unable to grow and develop to their full potential.''

The agencies said most of the diseases could be treated at low costs and most of the 600,000 deaths from measles could be prevented with vaccination that would cost as little as 26 cents per dose.

Better access to home treatment, insecticide-treated nets to prevent malaria, improved breast-feeding and other feeding practices were among the methods cited to reduce the number of children killed.

UNICEF also was launching an updated version of an informational book ``Facts for Life,'' which includes new chapters dealing with AIDS and new information about safe motherhood and nutrition.

Girls Master Toilet Training Sooner Than Boys
Girls acquire toilet-training skills at a slightly earlier age than boys do, study findings show. In addition, the researchers note that the ages when children achieve typical "potty" readiness skills is now in the range of 22 to 30 months--older than was seen in earlier decades.

"The findings represent an American approach, as children are toilet trained at younger ages in other cultures," according to Dr. Timothy R. Schum of the Medical College of Wisconsin in Milwaukee, and colleagues.

The study, which was funded by the Kimberly-Clark Corporation, makers of Huggies disposable diapers, is published in the March issue of the journal Pediatrics.

The investigation included 126 girls and 141 boys between the ages of 15 and 42 months when they entered the toilet-training readiness survey at one of four pediatric offices in Milwaukee. Each week for 12 to 16 months, parents were asked to submit questionnaires that assessed a child's toilet readiness and toilet-training behavior.

Overall, the investigators found that girls demonstrated toilet-training skills at earlier ages than boys.

"One obvious explanation is that girls' physical and language skills mature sooner than boys'," the authors write. "Another explanation is that parents may initiate toilet training girls at younger ages than boys, and the practice at an earlier age leads to earlier acquisition of skills."

The average ages for "staying dry during the day" were 32.5 months for girls and 35 months for boys, the report indicates.

The average age for other readiness skills for girls and boys were as follows: "showing an interest in using the potty," 24 months for girls and 26 months for boys; "staying dry for 2 hours," 26 and 29 months, respectively; and "indicating a need to go to the bathroom," 26 and 29 months respectively.

In general, experts advise that parents should not force their children to begin toilet training before they are ready. Instead, they say, parents should watch for signs of readiness, seek advice from their healthcare provider, and then proceed--usually around the time the child is 2 years old.

Signs that the child is ready include imitating parents' behaviors, the ability to walk, sit down and undress. The child should also start showing an interest in toilet training, and indicating when they are urinating or defecating. These signs appear between 18 and 30 months of age.

Schum and colleagues also note that the age of daytime bowel and bladder control has steadily increased from approximately 24 months in the 1950s to 36 to 39 months in the late 1990s.

"Although some boys and girls acquire readiness skills before their second birthday, most do not," the authors write.

"As practitioners advocating that parents wait until their children are ready to start toilet training, we should now revise our ages upward to 22 to 30 months when children are typically ready for toilet training," they conclude.

SOURCE: Pediatrics 2002;109:e48.

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