September 2008

Children allowed to drink at home more likely to develop alcohol problems, study suggests

Parents who give their children alcohol at home believing that it will teach them to drink responsibly could be doing more harm than good, new research suggests.

A study in the United States found a link between the age at which young people have their first drink and alcohol dependence in later life. Children under the age of 15 were at greater risk of developing a taste for alcohol after being exposed to drink than older teenagers, the study found. The results challenge the belief that giving youngsters small amounts of wine at home will enable them to grow up with a more mature attitude to drink.

Social factors such as poverty and abuse may explain why many young people turn to drink early and develop a dependency in later life. But the study by the National Institute on Alcohol Abuse and Alcoholism (NIAA) suggested that exposure to alcohol itself, whatever the reason, could lay the foundations for a drink problem.

Scientists suggested that giving children alcohol during early adolescence, when the brain is more malleable as it is developing fast, could act as a "trigger" for those with a predisposition to addiction. "We can see for the first time the association between an early age of first drink and an increased risk of alcohol use disorders that persists into adulthood," said Dr Deborah Dawson, a researcher at the NIAAA.

The study examined the age at which 22,000 young people first tasted alcohol. They were divided into three groups: those who had their first drink under the age of 15, those who did so between 15 and 17 and those who waited until they were 18 or over. Those in the first category showed a greater disposition to alcohol related problems in later life.

Dr Edel McAndrew, a clinical psychologist who practises in Manchester and Ireland, said: "Some parents try to introduce alcohol under their supervision but it is 50:50 whether that young person will develop a slow-to-moderate drinking habit which is socially acceptable or go on to develop more serious problems." She cited on example of a girl she had dealt with who had have her stomach pumped at 15 after drinking from the age of three, because her mother thought it wise to introduce her to drink at home.

Dr Sarah-Jayne Blakemore, of the Institute of Cognitive Neuroscience at University College London, said the explanation may be the brains of people in their early teens are more susceptible to be influenced by factors such as what they eat, drink or smoke. "Research has shown time and time again that the brain develops really dramatically in early adolescence, it is very malleable and very changeable," she said.

Early exposure to alcohol could be acting as an "environmental trigger" for adolescents with an underlying disposition to alcohol problems, she added. In a similar way, recent research has shown that young people who smoke large amounts of cannabis at that age were more likely to develop schizophrenia - suggesting that the drug is a trigger for the condition.

But she added: "The research on how alcohol affects the teenager's brain during development has not been done and there are a lot of unanswered questions."

John Bingham
28 September 2008

http://www.telegraph.co.uk/news/uknews/3096757/Children-allowed-to-drink-at-home-more-likely-to-develop-alcohol-problems-study-suggests.html

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Prescriptions for psychotropic drugs more common for U.S. youth

Children and teens in the U.S. are more likely to be prescribed stimulants, antidepressants, and other psychotropic drugs than their counterparts in two western European nations, according to a cross-sectional study.

The prevalence of prescription psychotropic drug use was 6.66% among American youths compared with 2.9% and 2% in Dutch and German youths, respectively, Julie Zito, Ph.D., a professor in pharmacy and psychiatry at the University of Maryland at Baltimore, and colleagues reported online in Child and Adolescent Psychiatry and Mental Health. Use of more than one of these medications at a time occurred in 19.2% of the U.S. cohort, but only 8.5% and 5.9% of Dutch and German children and teens, respectively.

"Differences in policies regarding direct-to-consumer drug advertising, government regulatory restrictions, reimbursement policies, as well as diagnostic classification systems and cultural beliefs regarding the role of medication for emotional and behavioral treatment are likely to account for these differences," the researchers said.

Over the past decade, prescriptions for psychotropic drugs have been rising across western Europe and in the U.S., according to the researchers. To assess between-country variation, Dr. Zito and colleagues examined administrative claims data for the year 2000 on insured children and teens in the Netherlands (110,944), Germany (356,520), and the U.S. (127,157). Use of psychotropic medications in the U.S. was 2.27 times higher than in the Netherlands (95% CI 2.22 to 2.32) and 3.33 times higher than in Germany (95% CI 3.27 to 3.40). Usage in Dutch youths was 1.47 times greater than among German youths (95% CI 1.44 to 1.51).

In all three countries, the prevalence of psychotropic medication use was highest in boys among those ages 10 to 14 and in girls among those 15 to 19.

Stimulant use was found in 4.3% of the U.S. cohort, compared with 1.2% and 0.7% in the Netherlands and Germany, respectively. Among children up to age four, the prevalence of stimulant use in the U.S. (0.5%) was 10 to 25 times higher than in the other two countries. In the U.S., stimulant prescriptions were split evenly between amphetamines and methylphenidate (Ritalin), but methylphenidate comprised more than 95% of the prescriptions in the European populations.

Antidepressants were prescribed to 2.7%, 0.5%, and 0.2% of U.S., Dutch, and German youths, respectively. Tricyclic antidepressants comprised 14.8% of U.S.-prescribed antidepressants, but made up a much larger proportion in the Netherlands (48%) and Germany (73%).

Prescriptions for antipsychotics were 1.5 and 2.2 times higher in the U.S. than in Germany and the Netherlands, respectively. Atypical antipsychotics comprised 66% of the antipsychotics prescribed in the U.S. compared with 48% in the Netherlands and just 5% in Germany.

Other psychotropic medications such as alpha agonists, lithium, antiparkinsonian agents, anxiolytics, hypnotics, and anticonvulsant mood stabilizers were rarely prescribed. According to the researchers, previous studies have also found that use of psychotropic medications is higher in the U.S. than in western Europe. They said that the between-country differences in prescribing these medications may be explained, in part, by differences in diagnostic systems. The International Classification of Diseases (ICD-10) is generally used in western Europe and Diagnostic and Statistical Manual (DSM) criteria are generally used in the U.S., the researchers said. In addition, they noted, the number of child psychiatrists per capita is higher in the U.S. than in Europe, which might explain some of the differences in prescribing practices.

Other potential explanations included differences in drug regulations, drug class preferences, patterns of concomitant medication use, and social attitudes about treating certain conditions. "Each country may imprint its own particular culture," the researchers said. "In the U.S., this reflects its individualist and activist therapeutic mentality."

The authors acknowledged several limitations of the study, including the cross-sectional nature of the analysis, the lack of diagnostic information, the fact that direct-to-consumer advertising is allowed only in the U.S. and not the other two countries, the lack of information on reimbursement patterns, disparities in access to specialist care, the fact that the U.S. data were limited to children covered under the State Children's Health Insurance Program, and the lack of information on over-the-counter drugs.

Todd Neale
24 September 2008

http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/tb/11053

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Australian children getting healthier

A report released 24 September by the Australian Institute of Health and Welfare (AIHW) examines progress made in child and youth health and wellbeing over the last decade and focuses on both improvements and future challenges. 'It highlights the areas where progress has been made to ensure that all Australian children have the best possible start in life,' said Sushma Mathur of the AIHW's Children, Youth and Families Unit.

The report uses a variety of health and welfare indicators designed to focus policy attention on important issues for children and youth health, development and wellbeing. Included in these indicators are the Children's Headline Indicators, which have been endorsed by Health, Community and Disability Services Ministerial Councils. The full set of the Headline Indicators, designed to link data to policy efforts to improve outcomes for child health and wellbeing across Australia, will be available on the Department of Health and Ageing website on Friday 26 September.

The AIHW report, Making progress: the health, development and wellbeing of Australia's children and young people, highlights improvements such as the 30 per cent fall in mortality rates for people under the age of 20, and the fact that teen smoking rates have halved since 2001. 'It also shows that in the last decade Indigenous infant mortality rates have fallen, and that more Indigenous students remain in school until year 12 than ever before,' Ms Mathur said.

But in addition to reporting progress, the AIHW report also highlights areas where improvement can be made.

Indigenous children are still twice as likely as others to be low birthweight, to be hospitalised for various chronic conditions, and to die before the age of 20. Findings showed that disadvantage is not limited to Indigenous children and youth. The report found that over 95,000 (7 per cent) of 15 to 19 year olds were neither employed nor studying, putting them at risk for decreased opportunities to fully participate in society.

In 2005, almost 50,000 children under the age of 5 had unmet demand for child care or preschool due to lack of available places. Teenage girls living in regional areas were twice as likely to give birth, and those living in remote or very remote areas five times as likely to give birth, as their peers in major cities.

And 15 per cent of Australian children under the age of 15 live in jobless families. International comparisons show that Australia has the second highest percentage of children living in jobless families in the Organisation for Economic Cooperation and Development (OECD).

Australian Institute of Health and Welfare
25 September 2008

http://www.sciencealert.com.au/news/20082509-18215-2.html

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WHO warns against use of electronic cigarettes

The World Health Organization (WHO) warned on Friday against using electronic cigarettes, saying there was no evidence to prove they were safe or helped smokers break the habit. First made in China and sold mainly over the Internet in countries including Brazil, Britain, Canada and Israel, they have grown in popularity despite a lack of regulatory approval, it said. A typical electronic cigarette is made of metal tube with a chamber which holds liquid nicotine in a rechargeable cartridge. Users puff on it but do not light it, leading some to use it to evade smoking bans in public places, according to the WHO.

However, they inhale a fine mist of nicotine into their lungs, "plus potentially many other toxic compounds which we are not sure of", said to Douglas Bettcher, acting director of the WHO's Tobacco Free Initiative. "The World Health Organization knows of absolutely no scientific evidence whatsoever that would confirm that the electronic cigarette is a safe and effective smoking cessation device," Bettcher told a news briefing. "Toxicological tests and clinical trials have not been performed on this product," he said.

The electronic cigarette has yet to be shown to be a legitimate therapy like nicotine gum, patches or lozenges that help wean smokers from nicotine addiction, the U.N. agency said. "If the manufacturers and marketers of the electronic cigarette want to help smokers to quit, then they should operate within proper regulatory frameworks, Bettcher said. This meant rigorous clinical and toxicological studies must be carried out.

The WHO was greatly concerned that some manufacturers had used the WHO name or logo on their package or website, falsely implying endorsement, Bettcher said, declining to name names. The agency was contacting health authorities in its 193 member states to alert them of "these bogus, untested false claims". Turkey had already banned sales, he said.

The WHO agency had become aware only this year of the spreading use of electronic cigarettes worldwide. "It has really taken countries and the WHO by surprise. It has been a product that appeared very suddenly on the market in a short period of time," Bettcher said.

IStephanie Nebehay
19 September 20087

http://www.reuters.com/article/healthNews/idUSLJ42938720080919

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Only-children just as healthy, social, adjusted

Shereen Peterson worries about her son. There are the usual worries, sure. Sugar, sleep, tantrums, germs. But the big one -- the nagging worry that has latched on to her psyche with all the strength and perseverance of a toddler -- is his solitude.

Skylar, 3, is an only child. Shereen and her husband, Kyle, have gone to great lengths to give him a sibling: four rounds of artificial insemination, acupuncture, in vitro fertilization. No dice. Now, they've decided, Skylar will be an only. "I worry he'll be spoiled," says Peterson, 37. "I want him to know the world doesn't revolve around him. I worry he'll be needy and clingy to Mommy, that when I send him off to school he won't want to go. I worry that when he's older, he'll feel lonely," she continues. "He won't have a companion in life -- someone in the family he can share every feeling with. Even if you get in fights, there's unconditional family love with a sibling."

Statistically speaking, Peterson's fears aren't likely to come true. Study after study prove only children are no more spoiled, lonely or maladjusted than their peers who have siblings. They're also, oddly enough, not alone.

The single-child family is the fastest-growing family unit in this country, according to recent Census figures. In 2004, 17.4 percent of women ages 40 to 44 reported having one child, compared with 9.6 percent of women 40 to 44 in 1976. Single-child families now outnumber two-child families (20 percent versus 18 percent), according to the 2003 Current Population Survey. It's impossible to quantify the various factors fueling this trend, but experts point to a number of circumstances that aren't likely to diminish any time soon -- if ever.

"Secondary infertility, women working, a high divorce rate, the expense and difficulty of adoption, the high cost of raising and educating children, terrible parental leave policies, child care that's not up to snuff, an increased number of single parents," lists Susan Newman, social psychologist and author of  Parenting an Only Child: The Joys and Challenges of Raising Your One and Only (Broadway/Doubleday). "Parents want to do the best job of parenting, and with all these factors working against them, they're often stopping at one."

But for all their strength in numbers, only children (and their parents) still shoulder a hefty load of stigmas -- many dating back to 1896, when psychologist G. Stanley Hall said "being an only child is a disease in itself." Only 3 percent of Americans think a single-child family is the ideal family size, according to a 2004 Gallup poll. "The stereotypes are still there," says Carolyn White, editor of Only Child magazine. "That they're unable to socialize well or have close friendships or be in relationships that are secure and bonded. That they don't think of others as well as themselves."

Never mind that 30 years of research, conducted mostly by social psychologist Toni Falbo, proves the opposite is true. "In many respects, only children tend to be more well-adjusted," says White. "They learn to socialize very well because they know that if they don't, they're not going to have any pals. They really have to get out there." Onlies are usually resourceful, independent, gregarious and extremely driven, White says, and they tend to outperform their peers with siblings on academic achievement tests. "That extra attention from parents can have a very positive effect," she says.

And kids are socialized in so many more settings than just home -- especially now, with play centers, youth sports, increasingly hands-on parents and, let's not forget, preschool. "I never went to preschool," White says. "Who ever heard of preschool then?"

So why do the stigmas remain? "People are lazy thinkers," says Newman. "Rather than say 'My friend has three children and her oldest is a loner,' we get stuck in this pattern about only children, no matter what the studies say."

Craig Shparago, 40, doesn't need any studies to prove what he already knows. His daughter, Ava, 7, is an only child. "She's just a really wonderful person," he says. "She makes a lot of friends. She's got a rich imagination. She's super creative. She doesn't seem to get bored much. It certainly feels like it's working out for us to just have our little trio." Shparago and his wife, Karen, live in Wilmette, Ill., where he says most families they know have more than one child. But they don't spend a lot of energy worrying about how others are doing things. Their focus, he says, is Ava. "When I'm home, we're usually playing detective or hunting for ghosts or something," Shparago says. "I tend to be the playmate."

Veronica and Sean Scrol live in Chicago's South Loop area with their son, Ian, 5. Veronica says she used to worry that Ian would be shy around other children. But watching him race to play with the other neighborhood kids alleviated those fears. "I talked with some friends of mine who are only children and they said they actively sought out friends because they didn't have any siblings," says Veronica, 40. "They all said they really cherished those friendships because that's all they had."

The Petersons, meanwhile, are in the midst of moving from their condo in the city to a house in Glen Ellyn, Ill., close to Shereen's parents and siblings. "When he grows up we'll tell him, 'Mommy and Daddy tried everything we could to give you a sibling, and that's why we moved to Glen Ellyn so you could be surrounded by your cousins and my very fertile brother,'" Shereen says. "We're settling into a groove now. ... I just have to think about what matters and everything we have instead of what Skylar's not getting."

And the stereotypes, finally, show signs of diminishing. "The stigmas have lost some of their strength," says White. "Most only children have many other only children with whom they can relate." And, Newman adds, the factors are all in place to further distance us from the old way of thinking. Namely? "More and more fabulous, wonderful only children."

Heidi Stevens
18 September 2008

http://www.goerie.com/apps/pbcs.dll/article?AID=/20080918/LIFESTYLES21/809180354/-1/LIFESTYLES08

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Hope for parents of children with mental illness

Parenting is life at its most challenging. It is both rewarding and confusing, a mysterious world you learn to navigate as you go along — usually with success. If, however, your child has a significant illness or is seriously injured, your job becomes more challenging. Life becomes a round of doctors and other specialists, accommodations with school and work, finding explanations for siblings, and buffering your child from the usually unintentional cruelty of people who see him or her as a curiosity. Parents of children with mental illness find themselves in this position. Mental illness, however, is frequently not recognized as something that happens to someone. It is perceived, instead, as bad, inappropriate or strange behavior.

“That child should stop acting that way!”

“What is wrong with his parents, letting him behave like that!”

This is excruciating for a parent whose child is suffering. Not only the child but the whole family is affected.

Our children’s behavior is what lets us know something is wrong. We can see that something is not right. Maybe our child has inexplicable anger or he hurts himself. She threatens someone. He becomes verbally abusive. She can’t carry out instructions. He thinks about suicide. Voices are telling her to do things she wouldn’t think of on her own. He can’t sit still in class. She is chronically defiant. He becomes withdrawn. She is always sad. He lives in a world of his own. She sees or hears things that aren’t there.

We parents believe we are responsible for the way our children are behaving, but are increasingly unable to affect their conduct. We’re worried, then scared. We don’t know what to do. We hear lots of theories about why our children behave the way they do. Actual help can be hard to find. It is a great relief for those of us who have children with mental illness to learn that they behave the way they do because their brains aren’t working the way they should. Understanding that a mental illness is a disorder of the brain begins to give us a perspective that all is not hopeless. There are things we can learn do to help our child, our families and ourselves.

The National Alliance on Mental Illness has developed a new program, Basics, to educate and help parents and other primary caregivers of children and adolescents with mental health problems. NAMI Humboldt County made it possible for two of us to be trained in the program and to present it to parents in our area. Lea Nagy’s experience with her son’s mental illness led her to help start NAMI in Humboldt County; she is also a mental health liaison. Holly Quinn is the grandmother and primary caregiver of a teenage girl whose problems began in early adolescence. The two of us are striving to help our children manage their challenging mental health issues. We’ve learned a lot about how to do this and are eager to share our information, experience and successes with other caregivers.

Basics’ six weekly classes introduce empowering information: understanding mental illness as a brain disorder; getting an accurate diagnosis; what treatment involves; the burden on the family; how to effectively work with your child’s school, the mental health system and the juvenile justice system; and how to become an effective advocate for your child. In addition to learning how to help yourself, your child and your family, these classes provide a community of other parents who are successfully living with similar challenges. This program is supported by College of the Redwoods’ Foster and Kinship Care Education.

Holly Quinn and Lea Nagy
15 September 2008

http://www.eurekareporter.com/article/080915-hope-for-parents-of-children-with-mental-illness

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Study questions use of newer antipsychotic drugs in children

A new study has found that older antipsychotic drugs are as effective as newer ones for some children.
The researchers from Chapel Hill School of Medicine in North Carolina say currently most children with schizophrenia or a schizoaffective disorder are commonly prescribed one of the second-generation, or "atypical" drugs, such as olanzapine and risperidone. However the researchers say there has never been evidence that these drugs are more effective than the older, first-generation medications. A study by the team has in fact revealed that the older drug molindone is as effective as the newer ones and they say it should be used as a first line of therapy for some children with such disorders.

Dr. Lin Marie Sikich, an associate professor in the department of psychiatry, says the study's findings indicate that guidelines will need to be rewritten so that some of the milder, traditional or older medications are considered first-line treatments in some cases. Dr. Sikich says it was always thought that the second-generation drugs were superior because they had no side effects but in fact it was found that molindone works as well as the newer drugs, and in some cases is safer.

The study the 'Treatment of Early-Onset Schizophrenia Spectrum Disorders' (TEOSS) is the largest head-to-head trial which has compared the newer drugs, which became available in the 1990s, to the older ones, which have been around since the 1950s. The study conducted from 2002 to 2006, involved 119 people aged 8 to 19 years who were randomly assigned to receive molindone, olanzapine or risperidone over an eight-week period. The study took place at four sites - UNC; McLean Hospital and Cambridge Health Alliance at Harvard Medical School; Seattle Children's Hospital and the University of Washington; and Case Western Reserve University.

Dr. Sikich says the decline in symptoms was similar across the three medications but the drugs caused very different types of side effects. Both olanzapine and risperidone were associated with significant weight gain and could put young patients at risk of developing heart disease and diabetes and the evidence was so strong that the National Institute of Mental Health, which sponsored the study, halted recruitment into the olanzapine arm of the study because of the weight gain problem and the resulting increase in cholesterol and glucose levels. Dr. Sikich says olanzapine should not be a first-line therapy in adolescents.

Both the older "typical" antipsychotics and newer "atypical" ones block dopamine receptors in the brain, but the newer drugs also interact with serotonin receptors and cause fewer muscle side effects, including stiffness, muscle cramps, restlessness and involuntary movements - the involuntary movements with some of the older drugs can lead to permanent physical disabilities. The researchers found there were more reported cases of restlessness with molindone treatment than with either of the two newer treatments and those treated with molindone also needed another drug, benztropine, to decrease muscle cramps and stiffness.

One participant enrolled in the study about four years ago was initially prescribed olanzapine but quickly began gaining weight, ultimately adding more than 45 pounds over 36 weeks. When he was switched to molindone he only gained about 8 pounds over the next 31 weeks and saw improvements similar to those with olanzapine. However Dr. Sikich says as a result of being on olanzapine, the boy developed fatty liver disease and was ultimately prescribed two other medications. The boy had been treated at age 3 for ADHD but medications and other therapies failed to help and he became violent. Dr. Sikich saw the boy when he was 14, is now doing well on an even newer drug, ziprasidone.

Dr. Sikich says the study highlights two other points - the benefits of proper diagnosis and the need for more effective medications - as none of the medications were as well tolerated as had been hoped and better alternatives need to be found. Dr. Sikich says a late diagnosis is a common problem with many children who develop early onset schizophrenia or schizoaffective disorder, and the diseases usually develop more severely when they begin in childhood. In the TEOSS trial only half of all of the participants responded to any medication and the researchers say medications can make a vast difference in peoples' lives, but better treatment options are needed. The trial will next compare outcomes after a one-year course of treatment.

Use of Zyprexa and Risperdal have increased more than fivefold in the last 15 years and are all too often used in children with a wide variety of diagnoses, despite serious side effects - drug makers say the medications are not approved for use in children. According to experts the results of the landmark study are likely to affect treatments for an estimated one million children and intensify the controversy over new medications.

http://www.news-medical.net/?id=41500

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UK: Classroom sex education doesn't meet teenage needs

Better sex education in schools is often cited as a solution to the high levels of pregnancy and sexually transmitted diseases of British teenagers. However research presented at the European Health Psychology Society and The British Psychological Society's Division of Health Psychology Conference 2008 on the 9 September 2008, casts this into doubt. Health psychologists from the Applied Research Centre Health and Lifestyles Interventions at Coventry University asked 1,270 teenagers aged 13-16 years from schools across Liverpool, the Midlands and parts of London; 'Where do you find out about sex?'

Lead researcher Kubra Choudhry said: "We wanted to find out what sex and relationship advice teenagers used, and wanted to use. These young people told us that friends and family were their main source of information - above teachers, sexual health services or the school nurse. In fact, more children would rather get no advice at all than seek advice from teachers and other sexual health services.

"We also discovered that privacy and not being judged were the most important features that teenagers look for when seeking sexual health information, and that concerns over confidentiality were likely to put young people off when seeking advice. When you imagine a classroom personal, social and health education (PSHE) lesson, you quickly realise it can't meet these requirements."

The study also compared the responses for virgins and non-virgins, and found big differences in their needs. While virgins were more likely to seek advice on general sexual issues, and relationships, those with some sexual experience needed advice on unwanted pregnancy and contraception. Virgins consulted teachers and friends whilst those with experience were more likely to seek advice from specialist sources such as doctors and sexual health services.

Kubra Choudhry said: "Our results highlight how varied the sexual information needs of young teenagers are, and how unlikely it is that the 'one-size-fits-all' approach that classroom PSHE lessons provide can fulfil all of these individual needs. Providing sex and relationship information and advice for young people is vital, but doing so in a tailored, confidential and accessible way is the best solution. It could help with the current problems of teenage pregnancy and sexually transmitted disease."

More than 700 psychologists from the UK, Europe and further are gathering at the University of Bath from 9 to 12 September 2008 for the joint European Health Psychology Society and British Psychological Society's Division of Health Psychology Conference 2008. The conference, themed 'Behaviour, Health and Healthcare: From Physiology to Policy', will look at how psychology can be applied at individual and group level to promote health, and even prevent illness, at a national level.

The British Psychology Society
12 September 2008

http://www.medicalnewstoday.com/articles/121181.php

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Antipsychotics and kids: States are cracking down

Over the past few years, atypical antipsychotics have been eating up a growing portion of state Medicaid budgets, from 4.5 percent in Arizona to 13.3 percent in Massachusetts. Several states, in fact, have sued one or more drugmakers for allegedly withholding side effect info or improperly promoting their meds, prompting Medicaid overpayments. However, the fastest growth is prescribing for children, sometimes for uses not approved by the FDA, such as ADHD. Jeffery Thompson, the chief medical officer of Washington state’s Medicaid program, is heading a consortion of 15 state Medical medical directors, who plan to issue a report early next year that examines prescribing trends, dosing, and demographics, among other things. We spoke about the issue…

Pharmalot: So why are you looking into this? Why is this an issue?
Thompson: The number one drug class in expenditures is atypical anti-pyschotics in almost every state. And the fastest-growing utilization is for both on and off label use in children. And as part of our jobs, we have a special relationship with foster care children, for instance, which means we should pay particular attention as prescribers use these to treat the children We also know there is wide variation within states and across states among utilization in kids, and we believe we should understand why that is.

Pharmalot: What, specifically, is your group examining?
Thompson: There’s a rapidly evolving constellation of diagnoses these drugs are being used for that are constantly evolving, with and without evidence or FDA labeling. And when there’s both limited evidence and labeling, it’s something we need to look at. For example, at what age can you diagnose somebody with bipolar disorder? Is it three years old? Seven years old? 12 years old? 18? There’s some evidence that it’s happening at all of those ages. But when is it appropriate to add an antipsychotic in addtion to a stimulant for treating ADHD in a child? And with off-label use, should there be an upper limit of dose by certain ages? Another question is when is it appropriate, or not safe, to combine multiple drugs when treating a child? We have some children who are on one, two, three or four at any one time. We see children being prescribed three to five times the FDA-approved adult dosages. So we’re looking at whether the trend indicates what I refer to as too young, too much or too many.

Pharmalot: How did the effort get started? And why aren’t more states involved?
Thompson: Last june, Washington state Medicaid convened a meeting of Medicaid medical directors, which is a nationwide group, to discuss integration of medical and mental health. And I posed a project where we would all look at utilization of kids getting antipsychotics. So we’re now actively pulling data. There directors representing.25 to 30 states at last year’s meeting and 42 states are in the network. Some states are examining data on their own, but all can share the results.

Pharmalot: Beyond compiling numbers, what do you hope to accomplish?
Thompson: We want to define our best practices and improve antipsychotic prescrbiing to children. In Texas, they’re working with their psychiatric community on algorithms, for instance. In many states, Eli Lilly works with state programs to provide report cards. Other states have specific guidelines. But we need to share what is being done in order to develop what can be considered a best practice, and then look at any additional steps, such as further clarification of state programs or gathering other data from state databases based on our findings. And we eventually hope to publish a paper.

Pharmalot: With so many states suing these drugmakers and the point made about budget dollars being spent, it sounds like this is just as much about saving money, yes?
Thompson: I would say this project is not designed to save money. It’s designed to improve the health and safety of our children. If you look at our data dictionary, cost has a deminimus amount of activity in this project. It’s actually one very small component of the data we’re looking at. Most data we’re pulling relates to safety. Again, our primary hope is to improve health and safety of prescribing the drugs to children and reduce unneeded variation in care.

Pharmalot: To what extent is the pharmaceutical industry involved?
Thompson: Well, I mentioned earlier that some states have arrangements with Lilly to monitor prescribing trends. But the effort is independent of the industry. The Agency for Health Care Research and Quality is underwriting the project. We have the sanction and approval of state medicaid directors and state mental health directors, and these groups are actually doing the work, along with researchers at Rutgers University. I know my own state, the state of Washington, has invited pharmaceutical companies to meet with our mental health network group at all times to ensure there is appropriate use of medications. Apart from that, any findings from the study will be shared with the industry.

10 September 2008

http://www.pharmalot.com/2008/09/antipsychotics-kids-states-are-cracking-down/

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Rwanda: Orphaned by genocide and AIDS, a generation poor and depressed

Rwanda, a country that suffered 100 days of tribal genocide in 1994 and has also been hit hard by the AIDS epidemic, is believed to have the highest percentage of orphans in the world.

Now a survey finds that depression is alarmingly common among teenage and young adult orphans there who head households and care for younger children. The survey, conducted by Tulane University researchers working with Rwanda’s national school of public health, appeared in last month’s issue of The Archives of Pediatrics and Adolescent Medicine, part of The Journal of the American Medical Association.

While orphans in many African countries are taken in by relatives or neighbors, “such systems are increasingly overwhelmed” in Rwanda, the researchers found, and young people without parents or close adult relatives are having to form their own households or live on the street.

Donald McNeil Jr
8 September 2008

http://www.nytimes.com/2008/09/09/health/09glob.html?ref=health

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In the world we have created, our youth have found neither dignity nor self-esteem

We have left our children to sink or swim in the moral mire

A young girl publicly gives a blow job to get a cigarette from some boy in a bar. Sure, she's been drinking. Perhaps, too, she's been snorting. Certainly as a student she's at the age where living in the fast lane is considered chic. Sensibly we can see she's not necessarily the norm. And most assuredly it's not helpful to simply feel shocked. However unfashionable, we should feel sickened.

My generation kick-started what we called women's emancipation. That wasn't just about careers, glass ceilings, or equal pay. The earliest campaigns were about freeing women from the social constraints of traditional roles. We weren't just turning up for jobs as technicians. We were wearing mini-skirts, and asserting our right to sexual expression. Orgasms were as high on the agenda as any civil rights.

The mission was to take what we needed, rather than waiting in hope to have it given to us. It was fundamentally a battle about female passivity, rather than rugged paternalism.

I could not in all conscience argue that that was wrong. Nor would I want to. But are gratuitous blow-jobs about broadened horizons? How did it move from freedom of personal expression to such hideous carelessness about personal dignity? What has happened to our girls -- and boys -- since they, too, are involving themselves in sexual self-abasement. What have we done?

Social challenge in the '60's and '70's took place against a backdrop of powerful moral codes of conduct, not just imposed upon us by a clerical police state, but hard-wired into our psyches. It seemed like a straitjacket. Conscience was conceived as a burden. Certainly guilt was often crippling. Products of an authoritarian regime, we rejected the imposed moral mantle. And had no thoughts about what we truly believed. Individual conscience wasn't even in its infancy. Because we didn't yet know what the world would be like without traditional authority.

We know now. Self-esteem is on everyone's lips, 'because you're worth it' has become a byword for self-care, assertion of our rights is the new social order. And yet our youth spend much of their time getting 'wasted', boys in particular bow out by means of suicide, and young girls place so little value on the preciousness of their presence that swallowing a stranger's semen strikes them as part of normal social intercourse.

In short, we failed. Without any real reflection, we settled for some lightweight sense of self-fulfilment, or selfishness, as a code of conduct. If we thought at all, we presumed that the overthrow of absolutism would result in a responsible secular morality. In some muddle-headed fashion, we figured that in the absence of clear rules, individuals would find their ethical feet. They haven't. The satisfaction of self has proven itself to be a faulty moral code.

If all this talk of moral codes sounds too heavy, let's say something simple. In the world we have created, our children have not found dignity, self-esteem, sound self-worth, solid personal security, a sense of purpose, or appreciation of the wonder of their own unique humanity. They do not see themselves as precious vessels of unique and valuable qualities. They do not pay due homage to themselves, and take care.

We, the adults who ushered in this modern social order, have failed our children. We have not thought out what's right and wrong. The girl who gave the blow job in exchange for a cigarette -- albeit, no doubt, as part of some stupid dare -- is of our creation. We don't eat our young. We abandon them.

Patricia Redlich
7 September 2008

http://www.independent.ie/national-news/we-have-left-our-children-to-sink-or-swim-in-the-moral-mire-1471071.html

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CANADA

Create drug treatment courts soon in N.B.

There is nothing worse than having to do something you know won't work in the end.

I was reminded of that when I read last month of a Crown prosecutor in New Brunswick lamenting the lack of drug treatment courts and of addictions treatment services in provincial jails.

In provincial court, after dealing with the cases of two women with severe drug addictions, lengthy criminal records, and serious medical problems as a result of their drug abuse, the prosecutor said, "I'm not permitted to take a position . . . but boy oh boy, from just a general observation point of view, if there's ever a need for specialized court . . . this would have to be it."

One of the women, who is on a wait list for cardiac surgery, begged the judge for a lengthier sentence so she could take advantage of substance abuse programs available in the federal prison system. But her charges -- this time -- didn't warrant a federal sentence. But "people need a break" from her criminal activity, said the prosecutor. "We've been after them and after them for a drug treatment court, but until the decision is made at that political level, I don't have that option," said the judge. "Any jail sentence is going to have limited success."

We recognize that something is wrong with the way individuals with substance use problems are being treated -- not treated -- within the criminal justice system. And how could we not? Groups and individuals have been decrying the woeful inadequacy of New Brunswick's addictions treatment services for years.

The Crown prosecutor is only the latest -- judges and police speak out on this issue regularly.

We know that those charged and convicted with committing drug-motivated crimes are marched in through the doors of the province's courts and prisons and serve their sentences, only to reappear before the court again and again for similar crimes. Why? Because while incarceration may serve as a deterrent to repeated criminal activity for some, it rarely does for those who commit crimes to feed an addiction unless the addiction itself is addressed. Treating the symptoms of an ill rather than the cause is no way to arrive at a cure.

The provincial government promised two years ago that government departments would collaborate to introduce two pilot drug treatment courts in the province, and this idea is part of the 2008-2012 Provincial Health Plan. But action cannot come too soon.

In Drug Treatment Courts -- there are six operating in Canada -- those charged with non-violent drug-motivated crimes are given the option of pleading guilty and being diverted away from the traditional formal criminal justice system via strict addictions treatment programs which include both in- and out-patient counseling, random drug testing, and medical treatment where necessary (that is, methadone treatment).

Included in the counseling is often an evaluation assessing basic needs, including housing, transportation, child care, which would hinder successful program completion. The programs, when successfully completed, normally last a year, after which courts will generally impose non-custodial sentences on graduates.

In Toronto, where the Canada's first such court started in 1998, follow-up studies of those who graduated from the treatment program show that fewer than 15 per cent of graduates re-offended after graduation, compared to 90 per cent of drug-motivated offenders not diverted through the program. Repeat offenders had reduced recidivism rates in the three years post-graduation compared to their criminal records preceding participation in the program, 96 per cent of graduates said the program helped them reduce their involvement in criminal activity, and fully 100 per cent of graduates said that the program helped them in reducing their substance dependency.

Drug treatment courts, as they have been set up, are not without areas of concern. When the New Brunswick government introduces drug treatment courts, it is essential they pay close attention to the red flags raised in studies of these other courts.

One of the most distressing of these is the fact that, of all clients diverted through drug treatment courts participation, women and youth under 25 are the least likely to complete the program. Women's life circumstances and needs often differ significantly from men's. Since gender differences are rarely considered when developing programs, or rather, since the "male model" is usually what is used in designing programs, this can greatly affect women's chances of entering and completing addictions treatment services.

Studies have shown that the needs of women with substance use problems in New Brunswick are not met. It would be a tragedy if any new programs further fail half the population they are designed to serve.

The presence of drug treatment courts will not address the lack of addictions treatment services for the general public, nor problems of accessibility and quality already present in those services currently available.

Those who want addictions treatment should be receiving it and receiving the best and most appropriate treatment possible, whether or not they come into contact with the criminal justice system.

The diversion program will not necessarily work for all individuals who participate, as with any social or health program. But neither does incarceration work as a deterrent for all individuals, and it's been proven time and again that its chances of success are even smaller for those with serious substance use problems committing addictions-motivated crimes.

Diversion programs are only harm reduction, not harm prevention tools. But it is a start on the right road toward a justice system with the ability to prescribe solutions rather than band-aids.

Ginette Petitpas Taylor
4 September 2008

http://timestranscript.canadaeast.com/opinion/article/404868

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Experts: Pregnant teens are often in denial

When a teen gets pregnant, her first reaction is likely to be, "How could this happen to me?" While this might seem surprising, youth counselors on Long Island say they hear the same shocked expressions again and again - and for reasons that are perfectly understandable.

Teenage girls, they say, often cannot admit to themselves that they might engage in premarital sex and might need to safeguard themselves against pregnancy, especially if they come from families that disapprove of such behavior. And teenage pregnancy can occur in the most prominent of families, as underlined by yesterday's announcement that the 17-year-old unmarried daughter of John McCain's running mate, Sarah Palin, is pregnant.

"It's the kind of mentality that this can't happen to me," said Athena Jones, a former youth worker with the Patchogue-based Suffolk Network on Adolescent Pregnancy, a regional counseling service. "It doesn't matter what your economic status is or what your family background is - kids are all the same."

For this reason, Jones and others say that parents need to talk to their children about sex and related subjects such as birth control - and often enough that these topics become an accepted part of family conversations. Parents who themselves feel uncomfortable with the subject can find reliable advice on the Internet.

One source is "Pregnancy in Adolescence: Information for Parents and Educators," a paper prepared for the National Association of School Psychologists. It can be found on the association's Web site at nasponline.org/families, along with a list of other resources.

Along with shock, pregnant teens may feel an immediate need to hide their condition from family and friends, to try to avoid embarrassment or condemnation. This, counselors say, is a grave mistake, because teens in the early stages of pregnancy need help to obtain medical care, and possibly legal advice as well.

"The most important thing we try to do is get the child to tell the parent or guardian," said Scott Andrews, principal of Amityville Memorial High School and a former guidance counselor at Jericho High School. "They need to find someone they can trust."

John.Hildebrand
2 September 2008

http://www.newsday.com/news/printedition/nation/ny-usloca025826137sep02,0,122010.story

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Reducing Risky Health Behaviors in Teens:
A Tall Order

A new study by Canadian researchers finds that programs targeting at-risk kids must tackle a constellation of issues in order to be effective.

“To really improve adolescent health, programs should seek to reduce risk taking, improve social capital and improve levels of affluence,” said study co-author Owen Gallupe, although he acknowledges that this is a tall order.

Gallupe is a researcher with the Social Program Evaluation Group at Queen’s University in Ontario. The study appears in the September issue of the Journal of Adolescent Health.

The authors sought to determine how risk taking, affluence and neighborhood social capital — whether an individual believes he lives in a safe, trusting and helpful place — influence health. They analyzed Canadian data from a World Health survey involving 2,384 teens in 9th and 10th grade during 2001-2002. Teens rated their own health on a four-point scale, ranging from “excellent” to “poor.” Overall, 13.8 percent of boys and 20.1 percent of girls reported themselves in poor health.

Richard Crosby, chairman of the Department of Health Behavior, in the College of Public Health at the University of Kentucky, noted that the study’s primary outcome variable — self-rated health — relied on a single item. “This may be a very weak measure,” he wrote in an e-mail.

Gallupe agreed that different questions involving health could produce more nuanced results. However, he added, “overall assessments of health may be an important measure for different reasons than more specific and detailed measurements. It is a holistic approach as opposed to a specific approach.”

The study also looked at how often children engaged in risky behavior. Researchers measured risk taking using a combination of smoking, drunkenness, seatbelt use, marijuana use, use of other illicit drugs and non-use of condoms.

Nearly 32 percent of low-income children said they frequently engaged in risky behaviors, compared with 16.7 percent of moderate-income students and 11 percent of high-income students.

The study also found that a larger percentage of students with low social capital reported that they frequently engaged in risky behaviors. However, Gallupe said, “Our analysis actually states that social capital, affluence and risk taking all influence health, but these things do not work together.”

As a result, if a program aims to reduce risk taking, low-income children and those in neighborhoods with low social capital are still more likely to report poor health.

Some programs, for example the New York-based Harlem Children’s Zone, already target education, as well as health care and economic issues faced by families.


Journal reference: Boyce et al. Adolescent Risk Taking, Neighborhood Social Capital, and Health. Journal of Adolescent Health, 2008; 43 (3): 246 DOI: 10.1016/j.jadohealth.2008.01.014

Adapted by ScienceDaily from materials provided by Center for the Advancement of Health.
31 August 2008

http://www.sciencedaily.com/releases/2008/08/080830161752.htm