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. . .
Time to end dispute over ABC and condoms, say
international experts
A consensus statement signed by over 140 HIV/AIDS experts from 36
countries has called for ideological disputes over HIV prevention
programmes to be replaced by a consensus based on the best available
scientific evidence. The statement is published in the November 27th
edition of The Lancet.
Notable signatories include Archbishop Desmond Tutu, President Museveni
of Uganda, Special UN Envoy Stephen Lewis, and representatives from the
World Bank, Global Fund for AIDS/TB/Malaria, and five UN agencies, the
heads of the HIV-AIDS programmes in several countries including
Ethiopia, India, Jamaica and Uganda, as well as prominent technical,
religious and other organizations working on HIV-AIDS.
The statement is a clear attack on the pronouncements of the Roman
Catholic church and US politicians, who have attempted to undermine
confidence in the reliability of condoms and divert money away from
condom provision towards abstinence-based approaches to HIV prevention.
The signatories agree that programmes must be based on epidemiological
evidence and should target where the risk is highest – commercial sex
workers and injecting drug users in less mature epidemics, multiple
concurrent partnerships in more mature epidemics.
The ABC (Abstain, Be faithful/reduce partners, use Condoms) approach has
an important role to play in generalised epidemics, such as Uganda. All
three elements have a role to play, according to the target population.
When targeting young people, for those who have not started sexual
activity the first priority should be to encourage abstinence or delay
of sexual onset, hence emphasising risk avoidance as the best way to
prevent HIV and other sexually transmitted infections as well as
unwanted pregnancy.
The statement also emphasises the role of condom use, and the need for
accurate information on the subject to be given to young people. “For
those young people who are sexually active, correct and consistent
condom use should be supported. Young people and others should be
informed that correct and consistent condom use lowers the risk of HIV
(by about 80–90% for reported “always use”),” the authors state. Condom
use should also be encouraged where partners do not know each others’
HIV status, as should testing and counselling of partners.
Amongst those at highest risk of infection (those with multiple sexual
partners), promotion of condom use should be the highest priority,
together with evidence-based strategies to promote behaviour change in
these groups.
However the statement also explains why the “Be faithful” approach has
an important part to play in HIV prevention. “When targeting sexually
active adults, the first priority should be to promote mutual fidelity
with an uninfected partner as the best way to assure avoidance of HIV
infection. The experience of countries where HIV has declined suggests
that partner reduction is of central epidemiological importance in
achieving large-scale HIV incidence reduction”.
Prevention programmes need to work with marginalised communities where
the epidemic is concentrated, and with community organisations to effect
changes in community norms.
Reference Halperin DT et al. The time has come for common ground on
preventing sexual transmission of HIV. The Lancet 364: 1913-4, 2004.
Keith Alcorn
26 November 2004
Australia: Governments urged to stop children
smoking
Health groups are calling for urgent government action to stop children
smoking.
New research shows over 200,000 children as young as 12 are smoking and
over 20 per cent of them were able to buy cigarettes from retail
outlets.
Anne Jones from the group Action on Smoking and Health says tobacco
companies and the Federal Government have raked in millions of dollars
from illegal tobacco sales to children.
Ms Jones says tougher measures are needed to stop tobacco companies
targeting children indirectly, and the Government needs to get serious
about mass education campaigns.
"The Federal Government and all other state and territory governments
have just endorsed a national tobacco strategy for the next five years,"
she said.
"This is the opportunity to really fully-fund it too and try and see
that many of the recommendations are put in place and, as a result of
their full support, we will start to see serious declines in smoking
rates and in the level of disease caused by these products."
25 November 2004
Source
Stress raises asthma risk in children
Stress caused by events such as
moving, changes in family relationships and death can raise a child's
risks for asthma attacks four-fold, according to a study in the latest
issue of the journal Thorax.
The British study found that stressful life events were linked to bouts
of acute asthma at two distinct time periods — first, within two days of
the worrying event, and then again six weeks later.
Researchers from University College London studied 60 children, aged 6
to 13, who'd had asthma for at least three years. For 18 months, the
children kept daily diaries in which they recorded acute asthma attacks
and their breath strength (peak flow). The children were checked every
three months at a clinic, and their parents were also interviewed about
potentially stressful life events occurring over the same period of
time.
The main stressful life events experienced by the children included
moving, births, deaths, departures, illness/hospital visits,
separations, and changes in family relationships. During the study
period, the children in the study experienced a total of 124 stressful
life events and recorded 361 episodes of rapidly worsening asthma
symptoms.
When they analyzed the data, the researchers concluded that the children
were more than four times more likely to suffer a sudden worsening of
asthma symptoms within a day or two of experiencing a stressful life
event.
After a period of calm, the risk of worsening asthma symptoms suddenly
doubled again about five to seven weeks after the stressful life event,
the researchers add.
The immediate and delayed stress-related effects on asthma symptoms are
likely caused by different physiological and immune processes involving
the autonomic nervous system and hormone and brain chemical regulation,
the researchers suggest.
25 November 2004
Children make up for lack of PE, study shows
It is pointless for the Government to increase school PE lessons,
according to the latest research on child obesity. A study into
children’s natural activity patterns has come to a surprising
conclusion: the more exercise they do in school, the less they do at
home, and vice-versa.
It even showed that girls at a private preparatory school, who had nine
hours a week of time-tabled exercise, were less active overall than
girls at an inner city state school who had less than two hours a week
of school sports.
The findings suggest that for young children bad diet, rather than lack
of exercise, is to blame for weight gain.
Terry Wilkin, a professor of endocrinology and metabolism at Derriford
Hospital in Plymouth, said that the research made the Government’s
approach questionable at best.
“I don’t know how much they expect to get out of socially engineering
children’s environment by imposing activity levels, because I’m
doubtful,” Professor Wilkin said.
“Our research shows that you can lead a child to water, but you can’t
make it exercise,” he said. “It is very important in this debate to look
at the science and not just at popular belief.”
Scientists are clear on one thing: children are getting fatter. A study
in the British Medical Journal showed that there was little change in
children’s weight between 1974 and 1984, but between 1984 and 1994 the
proportion of overweight boys in England increased from 5.4 per cent to
9 per cent, and from 9.3 per cent to 13.5 per cent for girls.
The common belief is that the cause is clear: children spend too much
time slumped in front of the television or computer screen.
But Professor Wilkin’s team, who are part of EarlyBird, a 12-year study
into childhood obesity, are the first to employ accurate exercise
monitors worn by children in all their waking hours.
They found that there was no correlation between the hours that are
spent watching television and activity levels, possibly because children
are still playing while the television is on.
“Do we do less now than we did in the past? We don’t know, because we
didn’t have a way of recording it with any precision,” the professor
said.
“But everyone has this image of the halcyon days of a postwar childhood,
when children played outside from dawn until dusk. “These are the
wisdoms that have become rather set in the fabric of popular belief.”
Professor Wilkin’s team then set about comparing the activity levels of
160 children at three primary schools. One of the schools was set in
“100 acres of beautiful playing fields”, one was a village school and
the third was “inner city, with not a blade of grass to be seen”.
Children at the first school exercised twice as much as those at the
inner-city school during school time, according to the results published
in the British Medical Journal, even though they had more than four
times as much PE. This could be because many PE lessons involve a lot of
standing around.
Children at the second and third schools made up for any deficiences
there at home. In fact, boys at the village school exercised the most in
total, and girls at the inner-city school exercised the most.
This suggests that children have an inbuilt, genetically set level of
activity, but does not explain why their obesity levels have increased.
“Either that level (of activity) has fallen down the generations,
although I don’t see why it should,” Professor Wilkin said. “Or we need
to look more at the food side of the equation and less at the exercise
side of the equation.”
Helen Rumbelow
25 November 2004
Experts optimistic about crystal meth treatment
Canadian Press Users of the
highly addictive and increasingly popular drug crystal methamphetamine
can be treated successfully, experts concluded following a three-day
conference on the synthetic drug.
"It's a difficult road but we heard from experts that it is possible to
treat meth users and there is hope of reversing serious damage caused,"
said chairwoman Joanna Ashworth at the conclusion of the Western
Canadian Summit on Methamphetamine.
The three-day conference didn't conclude with any significant
announcements but a panel will continue to work on a "consensus
document" to try to map a strategy to fight the invasive drug.
Crystal meth is also known as ice, jib, glass or speed and it has become
a major worry in North America because of its increasing popularity and
its devastating effects.
To try to get a handle on it, some 250 delegates including doctors,
police, pharmacists and health-care workers met in Vancouver this week.
Delegates learned that "we need to be very concerned about a crisis but
there's a lot we can do to prevent situation from getting worse."
There is still not enough evidence to form a firm conclusion on who is
using it but Ashworth said there are certain groups that are
particularly affected: young street people, gay men and some people
involved in the club scene.
The delegates also learned that the crystal meth production and use
began in the West — in Canada and the U.S. — and spread East.
But they don't why, she said.
The consensus statement to come later
would reflect the areas of agreement reached by the experts. "It's
important to have good information to plan responses," said Ashworth. A
big part of the problem is that the ingredients to make crystal meth are
cheap and easily obtainable.
"We know that many of the ingredients needed to develop meth can be
obtained over the counter so it's really important to be able to
regulate the use and disrupt production as best as possible."
But any strategy to try to curb sale of the individual ingredients would
be difficult
to enforce and, moreover, any strategy must be carried out along with
prevention, treatment and harm reduction.
Front-line workers at the conference told delegates their biggest
challenge is dealing with young people who experience psychotic episodes
as a result of meth.
Much of the current attention for immediate treatment has focused on
cocaine and heroin users, leaving meth treatment scrambling for
resources, she said.
"Meth users can be treated successfully but they need long-term support.
In early detox they need particular attention, individualized care and
that is taxing on the system."
The drug is sometimes known as Dark Crystal and can be bought for as
little as $5 a hit. The effects can last for days, keeping users awake
and sleep-deprived.
But even more worrisome is the ghastly array of over-the-counter
chemicals the synthetic stimulant can be made from.
Battery acid, brake fluid, floor-stripper and flammable retardants found
in fireworks are just a few of the ready-made products that make up the
glass-like shards that users usually smoke or snort.
19 November 2004
Source
Teenagers' mental health is on the decline
Mental health of teenagers has
sharply declined in the last 30 years, according to a study of
15-year-olds across Britain.
Time Trends in Adolescent Mental Health, published in the Journal of
Child Psychology and Psychiatry, discovered the chances that
15-year-olds will have behavioural problems such as lying, stealing and
being disobedient, have more than doubled.
The rate of emotional problems such as anxiety and depression has
increased by 70% among adolescents, according to the biggest time trend
study conducted in Britain. Boys are more likely to exhibit behavioural
problems and girls are more likely to suffer emotional problems.
The rate is higher for emotional problems, now running at one in five
15-year-old girls. The study found no increase in aggressive behaviour,
such as fighting and bullying, and no increase in rates of
hyperactivity.
Researchers looked at three generations of 15-year-olds, in 1974, 1986
and 1999. Behavioural problems increased over the whole period, while
emotional problems were stable until 1986 and have subsequently shot up.
Sharon Witherspoon, deputy director of the Nuffield Foundation which
funded the research, said, "We are doing something peculiarly unhelpful
for adolescent mental health in Britain.
"This is not a trend which is being driven by a small number of kids who
are getting worse. It is a more widespread malaise." The research found
that the rising rate of 15-year-olds with behavioural problems
correlated to their increased chances of experiencing a range of poor
outcomes as adults, such as homelessness, being sacked, dependency on
benefits and poor mental and physical health.
John Coleman, director of the Trust for the Study of Adolescence, said,
"The route people take to adulthood has become much more difficult with
the pressure on for qualifications. When young people are faced with all
these choices, they say they have to 'make it up as they go along'."
The Government in Westminster pledged fundamental reform of children's
mental health services after the publication of evidence.
Trends in Britain are in contrast to studies carried out in the
Netherlands and USA, where the mental health of teenagers there declined
and then levelled off.
The study found that marked changes in family type (such as increases in
the numbers of single-parent families) over the period were not the main
reason for rising trends in behaviour problems.
Changes in social problems were not the main reason for the trend,
although there is a social class gradient in emotional difficulties that
was not there before.
Andrew McColloch, chief executive of the Mental Health Foundation, said
on the day of the launch, "The increase in self-harm is one of a number
of indicators in the mental health field that show something is wrong.
"It may be visible evidence of growing problems facing our young people,
or of an inability to respond to those problems."
Aled Blake
16 November 2004
Mental illness, drug abuse soars
Drug abuse and mental illness rates were higher for men The number of
people who have a mental illness and are abusing drugs is rising sharply
in England and Wales, according to research. A study by Keele University
researchers suggested that between 1993 and 1998, the numbers rose from
23,624 to 37,361 - an increase of 62%.
They looked at figures from doctors on the General Practice Research
Database.
The link between drugs and depression, psychosis and schizophrenia has
been highlighted by anti-drugs campaigners.
Illegal drugs
Researchers writing in the Journal of Epidemiology and Community Health
found the rate of mental illness and substance abuse was up by 62% at
230 general practices between 1993 and 1998.
Men were much more likely to be affected, with their rates up 79%,
compared with 44% in women.
Patients aged 16-84 were included in the study, which looked at the
abuse of prescription and illegal drugs, but not alcohol and tobacco.
The study looked at about 3 per cent of people in England and Wales.
The average age of someone affected fell from 38 to 34, and the number
of cases in the 25-34 age group more than doubled, from 6,874 to 13,240.
Certain types of mental illness saw a bigger growth. Psychosis and drug
abuse was up 147%, paranoia 144% and schizophrenia 128%.
Cliff Prior, chief executive of the mental health charity Rethink said:
"There is a rapidly growing body of evidence showing that drug use can
trigger mental illness in people already at risk.
"However the mental health risks associated with drugs are not widely
understood by most young people and more resources need to be put into
mental health warnings on the use of drugs.
"A long-term, well-funded, innovative campaign aimed at publicising the
real mental health risks associated with drugs including cannabis needs
to be in place as soon as possible."
17 November 2004
Source
Social support systems help abused children
Children with a history of abuse as well as a gene that makes them more
vulnerable to depression can still lead happy lives if they get the
right kind of social support, a study finds.
The findings are "new, exciting and encouraging," said Joan Kaufman, an
associate professor of psychiatry at the Yale University School of
Medicine, and lead author of the report that appears in this week's
issue of the Proceedings of the National Academy of Sciences.
The most important factor in preventing those children from slumping
into a lifetime of depression is "intervention for a stable, positive
attachment," Kaufman said. In practical terms, that means "what we want
is to keep those children from going to one foster home to another
continually."
In the study, Kaufman and her colleagues used accepted diagnostic
methods to assess the incidence of depression in 57 children who were
removed from their parents' care by the state of Connecticut because of
allegations of abuse and/or neglect. The researchers then compared the
children to 44 children from stable homes with no indication of
maltreatment.
The researchers also tested the children for the presence of a variant
of a gene, designated 5-HTTLPR, that has been associated with the
occurrence of depression, but only in individuals under stress. About 40
percent of the children in both groups were found to carry that gene.
Predictably, more of the abused children had symptoms of depression --
22.8 percent, compared to 4.5 percent of children from stable homes. But
the occurrence of depression wasn't related to the presence of the
5-HTTLPR gene in the abused children who had a relatively stable
lifestyle, meaning they had frequent contact with the adults supervising
them. Depression was higher in abused children who had such contact only
twice a year, or even less frequently.
"Early abuse is not linked to depression," Kaufman said. "It is
influenced by genetics, but even with a genetic disposition and abuse,
proper intervention can prevent it."
For the institutions that take charge of these children, the message is
that what's needed are "interventions for a stable, positive
attachment," Kaufman said. Since the study shows positive results for
that strategy, "in some ways it is a message of hope," she said.
But for most abused children in the system she studied, "that has not
been accomplished," Kaufman said. "We have been following these
children, and we see one of every five being moved from one home to
another within a year."
Ed Edelson
15 November 2004
Adolescent coping — Beyond personal resilience
Adolescents vary in their ability to
manage the social challenges that life inevitably brings. While some
kids demonstrate sturdiness in the face of adversity, others, faced with
similar circumstances, do not fare as well. One important factor
attributed to this difference is resilience, defined as the ability to
overcome or minimize the harmful effects of adversity. Resilience stems
from the strengths of the individual and the environment in which he or
she resides.
In this study, we explored the degree to
which the personality characteristics of teenagers protect them from an
accumulation of risk factors stemming from the family, peer, school, and
neighborhood context.
We considered several protective factors: self-esteem, school
achievement (i.e., good grades), and problem-solving skills, or the
ability to approach social dilemmas with planning. The focus on these
characteristics allowed us to address whether individual assets by
themselves can sufficiently counteract the harmful effects of a
high-risk environment.
We tested this question using data from 5,070 seventh through eleventh
graders who participated in the National Longitudinal Study of
Adolescent Health. This study was designed to provide information about
social factors that influence adolescent health and well-being.
In our study, we focused on 15 risk factors in an adolescents' social
world, including family poverty, marital conflict, weak bonds between
parents and teens, peer rejection, weak attachment to school, prejudice
by students at school, and poor neighborhood conditions.
We discovered that teenagers who experienced several of these risk
factors simultaneously had higher levels of depression and conduct
problems than teens who experienced fewer risk factors. An encouraging
finding is that the risk for emotional and behavioral problems was lower
for teens who possessed one or more protective assets. For instance,
teenagers who experienced a high number of risk factors were less likely
to be depressed and engage in delinquent activity if they had high
self-esteem.
However, we also discovered that the
protective effects of self-esteem, school achievement, and
problem-solving skills were not sufficient on their own to overcome the
effects of risk factors across social contexts. Among teenagers with
multiple protective factors, those who experienced risk factors in two
or more social settings had higher levels of depressed mood and more
conduct problems than teenagers with risk factors in fewer social
contexts.
Overall, then, we found that adolescents are unlikely to thrive when
they face difficult experiences across multiple settings of their lives,
even if they possess the personal resources, or resilience, to deal with
a challenging environment.
This finding suggests that interventions with at-risk youth that focus
solely on developing personal characteristics to build resilience is
misguided because it places the burden of responsibility for coping with
social challenges on the adolescent.
Instead, ensuring adolescent wellness requires efforts that target the
assets youth bring to their environment and the availability of
resources in the families and communities in which youth reside.
Summarized from Child Development, Vol. 75, Issue 6, Cumulative
Environmental Risk and Youth Maladjustment: The Role of Youth Attributes
by J.M. Gerard (Bowling Green State University) and C. Buehler.
16 November 2004
Source
A good breakfast helps children at school
Nutrition experts advise parents to provide a good breakfast for their
children because it improves performance at school and avoids obesity.
In addition fruit and vegetables can prevent typical influenza
infections during the cold months of the year.
"The main problem is that children buy sweets and snacks on their way to
school which is no compensation for a good breakfast," says Professor
Helmut Heseker of the University of Paderborn in Germany.
Irregular eating habits and leaving out meals completely are the main
risk factors leading to overweight. Renate Lieberknecht, a nutrition
expert in the city of Glashuetten, points out the example of a
15-year-old boy with a height of 1,7 metres weighing 100kg.
"He went without breakfast or lunch box almost every day. When he came
home after 4pm he virtually emptied the refrigerator. Hunger triggered
virtual eating orgies in the boy," the nutrition expert says.
Children, Heseker points out, need a higher intake of liquids than
adults. A study by the university found that 12 per cent of children in
Germany seldom or never had a drink with breakfast and that a quarter of
children drank nothing at all during school hours.
"Drinking pure water during tuition does not interfere with the
lessons," he says.
Children in the mornings only have small reserves of glycogen. Glucose
supplies the cell tissues with an oxidizable energy source found
principally in the liver, as glycogen.
"After sleep it is therefore important that the reserves are refilled,"
the professor says.
However Mathilde Kersting from the Research Institute of Child Nutrition
in Dortmund warns that vitamin pills and certain drinks are no
replacement for a well balanced regular diet.
The Institute points out that the ideal breakfast table should at least
be made up of four components including bread, grain flakes, milk or
yoghurt, fresh fruit or vegetables and a drink such as unsweetened fruit
tees, water or fruit juice. Coffee, cola and sweets are a definite no.
If the child tends to refuse a breakfast parents can help with a bit of
creativity, according to nutrition expert Dagmar von Cramm from Freiburg.
"Lack of appetite can be avoided by tempting aromas like fresh bread or
toast along with something for the eye like berries, apple slices or
other fresh fruit on the edge of the plate," she recommends. Full grain
bread should be eaten instead of white bread.
Typical colds and flus in the winter months can be avoided by boosting
the immune system with fruit and vegetables juices. One example is fresh
orange mixed with red grape or other juice, the German Association of
Nutrition (DGE) in Bonn says.
Irmingard Dexheimer
11 November 2004
Source
Young people still drink driving
A quarter of all young motorists drink and drive, according to new
research published as part of National Road Safety Week.
The survey, organised by road safety charity Brake, looked at the
driving habits of 1,000 people aged 15-25 in full-time education.
The research revealed that more than one in four drivers aged 25 and
under has driven after taking alcohol, with 12 per cent drinking two to
three pints or more before getting behind the wheel.
Many of those surveyed were unaware of the current drink-drive limit.
More than 20 per cent wrongly thought it was the equivalent of three
units or more, whereas there is no real safe limit.
Brake chief executive, Mary Williams, said: "Any amount of alcohol makes
you potentially a killer driver, and you run the risk of 14 years in
prison.
"It is also really difficult to know how much alcohol you have drunk, so
the only safe option is to drink none at all."
Department for Transport figures for last year show that 20 per cent of
drivers aged 19 and under who died in crashes were over the drink-drive
limit, compared with 11 per cent in 1991.
10 November 2004
Source
A Small Triumph Over a Mental Illness
A mother's book chronicles her
daughter's struggle with bipolar disorder. Leslie Byers calls it her
darkest day.
Her 10-year-old daughter, Heather, had woken up "surly and angry," then
proceeded to hurl a chair into an entertainment center, smash a floor
lamp against the wall and punch her mother in the stomach so hard it
knocked her breath away. The episode ended with Byers calling the
sheriff, who escorted the girl to a residential treatment center.
By this time, "the first psychiatrist had basically given up and told me
the situation was hopeless," recalled Byers, 44, an information
technology consultant in Fort Calhoun, Neb. "To be told by the very
people we needed help from that we should just walk away, we should just
give up, to me, is just an absolute travesty for the child and the
family."
Fortunately, others, including both Byers and her husband, Steve, did
not give up, and Heather was eventually diagnosed with bipolar disorder,
also known as manic depressive illness.
Byers has just written a book about her daughter, and the pseudonym she
still uses to identify her is part of its title: Heather's Rage. It is
the story of the family's arduous journey from despair, including
relinquishing custody of their daughter, to hope.
Bipolar disorder is notoriously difficult
to diagnose in young people.
"Clinicians are up against a lot," said Dr. Robert Findling, director of
child and adolescent psychiatry at University Hospitals of Cleveland.
"First of all, there's the context of developmentally normal. It differs
across childhood. Moreover, you are seeing youngsters in multiple
settings. What's true for schoolteachers may not be true for parents and
may not correspond to the youngster's own inner experience."
While the disease more often manifests itself in young adulthood, it can
come on in adolescence and, more rarely, in childhood.
"There's a growing appreciation that early symptoms of bipolarity might
actually manifest in the first or second decades of life, although most
clinicians would be very wary of diagnosing a 19-month old," Findling
said. "But I can tell you from what parents report... moms oftentimes
really do know."
Even though Heather's case confounded
dozens of experts, her mother suspected very early on that something was
wrong.
As Byers describes it, Heather's problems first became apparent when she
was just 19 months old, three months after she accidentally overdosed on
her mother's iron pills.
Byers noticed a "strange change in behavior." Once "quiet, fun-loving
and easygoing," Heather became "anxious, combative, defiant and hard to
please" and prone to volatile mood swings and temper tantrums.
The problems escalated as Heather got older. She antagonized other
children at day care as well as caretakers at home, was suspended from
school countless times and cycled in and out of psychiatrists' offices.
The episodes became increasingly violent as well. Once, Heather kicked a
security guard in the face while he was trying to hold her down. Another
time she spat in a teacher's face. She also mutilated herself, cutting
pieces of flesh from her arm, pulling out her own hair and trying to
stab herself in the neck with a ballpoint pen. Her parents were even
called to school after she had purposely run into oncoming traffic; she
had been pinned to the ground by three large men. Heather was
hospitalized six times in less than a year, the first time when she was
only nine.
By the time Heather was 10, her parents
were running out of options, both medical and financial. The only way to
get proper treatment, it seemed, was to give up custody, which is what
they did in May 1996.
As awful as that decision was, it did signal a turning point. Heather
was finally diagnosed with bipolar disorder, something her mother had
long suspected. The diagnosis enabled Heather and her parents to "really
take ownership over this," as Byers put it.
Heather, now 19, has responded well to the drug Lithium and today is
living a relatively "normal" life. She lives at home, has graduated from
high school and is working fulltime selling vacuum cleaners
door-to-door.
"The raging episodes are extremely opposite to the personality of the
individual," Byers explained. "[Heather] is very comfortable with
introducing herself and turning a stranger into an acquaintance."
She'll be getting her own place in a few months and plans to start
college next year. She also has close friends, some of them friends for
nearly a decade.
"She's at a point that she's doing extremely well," Byers said. "This
[illness] does not have to define the individual and, while bipolar
people can have relapses, you can lead a very productive life once you
get the answers, once you get the right diagnosis."
Still, Byers chose to use the pseudonym "Heather" for her daughter
because "there is still so much stigma, so much job discrimination, I
really was afraid."
Amanda Gardner
3 November 2004
Psychotherapy, meds combination best for youth
with obsessive compulsive disorder
Children and adolescents with Obsessive Compulsive Disorder (OCD)
respond best to a combination of both psychotherapy and an
antidepressant, a major clinical trial has found. Supported by the
National Institutes of Health’s (NIH) National Institute of Mental
Health, the study recommends that treatment begin with cognitive
behavior therapy (CBT), either alone or with a serotonin reuptake
inhibitor (SSRI) antidepressant. The research spotlights the need for
improved access to CBT, since most young people with OCD currently
receive only the antidepressant, often combined with an antipsychotic
medication. John March, M.D., Duke University, Edna Foa, Ph.D.,
University of Pennsylvania, and colleagues report on the findings of the
Pediatric OCD Treatment Study (POTS) in the October 27, 2004 Journal of
the American Medical Association (JAMA).
Ninety-seven 7-17 year-olds with OCD completed 12 weeks of treatment
with either CBT, the SSRI sertraline, the combination treatment, or a
placebo. Independent evaluators, blind to their treatment status,
assessed each patient every four weeks. Patients in the study were
typical of patients seen in clinical practice. For example, while
industry-sponsored trials commonly exclude patients with more than one
condition, 80 percent of study participants had at least one additional
psychiatric disorder.
Combining sertraline and CBT was more effective than treatment with just
one or the other. CBT alone did prove superior to sertraline, which, in
turn, was better than a placebo. By the end of the trial, the remission
rates were 53.6 percent for combined treatment, 39.3 percent for CBT,
21.4 percent for sertraline, and 3.6 percent for placebo.
CBT alone was more effective in the University of Pennsylvania site than
at Duke University site, but the combination treatment was equally
effective at both sites, suggesting that it may be less susceptible to
setting-specific variations. The strong showing of CBT at the University
of Pennsylvania led the researchers to recommend it as "a first line
option" for initial treatment. They point out, however, that "only a
small minority" of children and adolescents with OCD receives such
state-of- the-art care.
"In the Treatment of Adolescents with Depression Study, which compared
CBT with an SSRI and combination treatment, for teens with depression,
the medication proved superior to CBT. In this case the reverse was true
but in both studies, combination was superior. This underscores that
different disorders in adolescents respond to different treatments,"
noted NIMH Director Thomas Insel, M.D.
"We believe that the results of this study will contribute to the
appreciation by non-physician mental health clinicians of the strengths
and limitations of pharmacological treatments and to the appreciation by
physicians of the evidence-based psychosocial treatments," states the
article. "It is imperative that the focus of research turn to
identifying and testing dissemination strategies for CBT," the
researchers add.
There were no episodes of mania, suicidality, or other serious adverse
events during the course of the study.
2 November 2004
Source
Schizophrenia drug calms disruptive children
Risperdal, a drug used to treat schizophrenia, appears to be safe and
effective for treating disruptive behavior in children with
developmental disorders, Canadian researchers report.
These findings provide "additional evidence that this medication can be
helpful in the management of challenging behaviors that some children
with autism and other pervasive developmental disorders have," Dr. Sarah
Shea told Reuters Health.
Shea, of the IWK Health Center in Halifax, Nova Scotia, and colleagues
randomly assigned 79 children, age 5 to 12 years, with pervasive
developmental disorders, to treatment with Risperdal or an inactive
placebo over an 8-week period.
As reported in the medical journal Pediatrics, the group given Risperdal
showed a significantly greater average decrease (64 percent) in
irritability than did participants given placebo (31 percent). They also
showed significantly greater decreases in measures of anxiety,
hyperactivity and excessive sensitivity.
Overall, 87 percent of Risperdal patients showed an overall improvement
in their condition versus 40 percent of the placebo group.
Sleepiness, which affected 73 percent of the children on Risperdal and 8
percent of placebo patients, was the most common side effect -- but it
was manageable by alteration of doses and scheduling.
Risperdal also resulted in significantly greater increases in weight,
pulse rate and blood pressure than did placebo treatment.
"Improving...disruptive behaviors allows a child to have a better
quality of life," Shea said.
"It is critical that appropriately structured studies of medications be
done with children so that we know what works and what is safe," she
added. "Too often physicians are left to use information obtained in
adult studies."
SOURCE: Pediatrics, November 2004.
1 November 2004
Source
Pediatricians fail to recognize teen
substance abusers
Pediatricians may think they know whether
a teenage patient is using alcohol or drugs and to what extent, but a
new study finds doctors greatly misjudge the problem.
More than 60 percent of the time, pediatricians knew their young
patients had used alcohol or drugs, but in most cases the doctors
thought the problem was less severe than it actually was, the study
found.
"Providers significantly underestimate the level of adolescent substance
use or the severity of adolescent substance use," said lead author Dr.
Celeste R. Wilson, an investigator with the Center for Adolescent
Substance Abuse Research at Children's Hospital Boston.
"And this is important, of course, because it's these adolescents that,
if they're recognized, can be referred or might benefit from early
intervention adolescent abuse services," she said.
The study, funded by the Robert Wood Johnson Foundation, appears in the
November issue of Pediatrics.
Illicit drug use remains an intractable health problem among America's
youth, federal data suggest. In 2003, 11.2 percent of 12 to 17 year olds
used drugs, alcohol or tobacco in the prior month, according to a survey
by the Substance Abuse and Mental Health Services Administration (SAMHSA),
a unit of the U.S. Department of Health and Human Services.
An estimated 17.7 percent of youths in that age group used alcohol in
the month prior to the survey, SAMHSA said. Of all youths, 10.6 percent
were binge drinkers and 2.6 percent were heavy drinkers.
These percentages were largely unchanged from the prior year's survey.
The American Medical Association recommends that health-care providers
screen all adolescent patients annually for alcohol and drug use, the
study's authors noted. Most pediatricians say they do screen almost all
of their teenage patients, they add, citing a previously published
survey.
But are they accurately assessing teen substance abuse?
Wilson's study involved 533 patients aged 14 to 18 years old seeking
routine medical care and their 109 medical-care providers. At the time
of the visit, each provider completed a form giving their impression of
their adolescent patient's drug and alcohol use. After the visit,
patients were screened using the Adolescent Diagnostic Interview, a
questionnaire Wilson describes as the "gold standard" for diagnosing
substance abuse disorders. Then investigators compared providers'
clinical impressions with patients' actual diagnoses.
Of the 86 teens with a diagnosis of abuse or dependence, providers
correctly identified 75 percent of them as substance users. But the
level of use in half of these patients was erroneously reported as
minimal.
Providers would do a better job of identifying patients engaging in
these risky behaviors if they used a structured screening tool, the
authors concluded.
One tool developed by study co-author Dr. John Knight, director of the
Center for Adolescent Substance Abuse Research at Children's Hospital
Boston, asks teens to answer six questions related to alcohol and drugs.
It asks, for example, "Have you ever ridden in a car driven by someone
(including yourself) who was 'high' or had been using alcohol or drugs?"
Although Wilson concedes some teens won't truthfully disclose their
substance use, she insists a screening tool would help identify some
kids the doctors might not think are using drugs or alcohol. "It would
certainly give providers a structured way of approaching the subject
with the adolescents," she said.
Providers also need to be aware of counseling and treatment resources in
their local area so they'll be prepared to make referrals as needed, she
added.
"By getting them early intervention, then you will be preventing the
sequelae of alcohol and substance abuse," including motor vehicle
accidents and addiction, Wilson said.
(SOURCES: Celeste R. Wilson, M.D., investigator, Center for Adolescent
Substance Abuse Research, Children's Hospital Boston, Boston; Substance
Abuse and Mental Health Services Administration, Rockville, Md.;
November 2004, Pediatrics )
Karen Pallarito
1 November 2004
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