Childhood Testing: Hints of Hearing Problems Are Often Ignored
By ERIC NAGOURNEY
Pediatricians routinely screen children for hearing problems, but what happens when they find something wrong? A fair amount of the time, nothing at all, a new study suggests. Writing in the current Archives of Pediatrics & Adolescent Medicine, the researchers reported that when they reviewed more than 1,000 hearing tests given at eight medical practices - three associated with a university - more than half of the children who failed were not sent for follow-up examinations. The tests give a fair number of false positives. And national guidelines established after the study was conducted call for a less sensitive cutoff point that results in the failure of fewer children. Still, Dr. Donna R. Halloran, the study's lead author, said the findings were troubling, especially considering that progress in treating hearing problems is greater when they are discovered early. "I think, without a doubt, that children with hearing loss are not being referred to audiologists and speech therapists in a timely fashion," said Dr. Halloran of St. Louis University School of Medicine. Beyond that, she said, testing children and then not acting on the results is wasteful. The researchers looked at hearing tests given to patients ages 3 to 19 at eight Alabama medical practices. When failure was defined as a child's not hearing a sound at any frequency at 20 decibels (the standard is now 25 decibels), 10 percent of the patients did not pass, the researchers found. But for 59 percent of those children, no follow-up was done, the researchers determined. This included several who had known risk factors, including concerns from their parents about possible hearing problems. The study suggested that some doctors might not have acted on the results because they distrusted the test or believed they could detect a hearing problem through a regular physical examination.
ADDERALL XR significantly improves driving performance, attention in young adults with ADHD
Study presented at 18th Annual U.S. Psychiatric & Mental Health Congress
Las Vegas, NV – November 8, 2005 – ADDERALL XR® (mixed salts of a single-entity amphetamine product) significantly improved driving performance, cognitive function and attention in young adults with attention-deficit/hyperactivity disorder (ADHD) in a controlled driving simulator study conducted by the Washington Neuropsychological Institute and presented today at the 18th Annual U.S. Psychiatric & Mental Health Congress in Las Vegas, NV. "Adolescent and adult patients often fail to appreciate the effect that ADHD symptoms such as inattention have on daily activities such as driving," said Gary Kay, Ph.D., president of the Washington Neuropsychological Institute. "Our study demonstrates that ADDERALL XR helps young adults improve their ability to drive and do so safely over a 12-hour period."
Pregnant women don't exercise enough: Study finds doctors need to better educate patients
Saint Louis University research is published in a sports medicine journal
ST. LOUIS -- Obstetricians and gynecologists need to do a better job of encouraging women with uncomplicated pregnancies to exercise, a Saint Louis University School of Public Health study concludes. "The message is not getting out that women should continue to exercise during pregnancy, at least at moderate intensity," said Terry Leet, Ph.D., a study author and associate professor of community health at Saint Louis University School of Public Health. "Only one of every six pregnant women are meeting the current physical activity recommendation of 30 or more minutes of moderate physical activity on most, if not all, days of the week." The research, funded by the Centers for Disease Control and Prevention, was published in Medicine & Science in Sports & Exercise. The findings support a recent newsletter article by Raul Artal, M.D., lead author of the American College of Obstetrics and Gynecology's 2002 guidelines for exercise during pregnancy and chair of the department of obstetrics and gynecology at Saint Louis University.
Children of bipolar parents score higher on creativity test, Stanford study finds
STANFORD, Calif. - Researchers at the Stanford University School of Medicine have shown for the first time that a sample of children who either have or are at high risk for bipolar disorder score higher on a creativity index than healthy children. The findings add to existing evidence that a link exists between mood disorders and creativity.
The small study, published in the November issue of the Journal of Psychiatric Research, compared creativity test scores of children of healthy parents with the scores of children of bipolar parents. Children with the bipolar parents - even those who were not bipolar themselves - scored higher than the healthy children.
"I think it's fascinating," said Kiki Chang, MD, assistant professor of psychiatry and behavioral sciences and co-author of the paper. "There is a reason that many people who have bipolar disorder become very successful, and these findings address the positive aspects of having this illness."
ome outgrow allergy to tree nuts, Johns Hopkins Children's Center experts report
Nine percent of children allergic to almonds, pecans, cashews and other tree nuts outgrow their allergy over time, including those who've had a severe reaction such as anaphylaxis shock, according to researchers at the Johns Hopkins Children's Center. Their study, reported in the November issue of the Journal of Allergy and Clinical Immunology, also found that clinicians can use blood levels of tree nut antibody (TN-IgE) as an accurate guideline in estimating the likelihood that a child has outgrown the allergy. "What's crystal clear is that children with these allergies should be regularly re-evaluated," researchers concluded.
Nine percent of children may outgrow their tree nut allergies
From the Journal of Allergy & Clinical Immunology
Approximately 9% of children with an allergy to tree nuts will outgrow their allergy, including children who have previously experienced a severe allergic reaction, according to a study in the November 2005 Journal of Allergy & Clinical Immunology (JACI). The JACI is the peer-reviewed, scientific journal of the American Academy of Allergy, Asthma & Immunology (AAAAI). Up to this point, researchers thought that allergies to tree nuts, which include cashews, almonds, walnuts, hazelnuts, macadamia nuts, pecans pistachios, and pine nuts, lasted a life time. It is estimated that 1%-2% of the United States population is allergic to peanuts, tree nuts or both. Previous research has shown that children allergic to peanuts have a 20% chance of outgrowing their allergy. A research team led by Robert A. Wood from Johns Hopkins University School of Medicine, evaluated 278 children (Ages 3-21 years) to determine the percentage of those who will outgrow their allergy. Researchers also sought to determine what level of tree nut specific-IgE in the blood would be a safe level before testing the child through an oral food challenge, which is currently the best way to prove that a child has outgrown their food allergy.
The study found:
- Approximately 9% of children allergic to tree nuts outgrow their allergy, including children who have had a previous severe allergic reaction.
- Children who are allergic to multiple types of tree nuts are unlikely to outgrow their allergy.
- 58% of children with tree nut specific IgE levels of less than 5 kilounits per liter passed an oral challenge.
Based on these findings, researchers recommend that children with a current tree nut allergy be re-evaluated periodically by their allergist/immunologist to assess whether they have developed a tolerance and whether an oral challenge should be given.
Clinical decision system helps reduce inappropriate antimicrobial prescribing
A clinical decision support system intervention reduced the overall use of antimicrobials for respiratory tract infections such as colds, bronchitis and sinusitis, according to a study in the November 9 issue of JAMA.
Antimicrobial resistance is a serious public threat that is exacerbated by the gradual withdrawal of the pharmaceutical industry from new antimicrobial agent development, according to background information in the article. Overuse of antimicrobial agents fosters the spread of antimicrobial-resistant organisms. Despite recent trends that demonstrate reduced outpatient use of antimicrobial agents, prescribing continues to significantly exceed prudent levels. Approximately 50 percent of courses of ambulatory antimicrobial drugs are prescribed for patients with viral respiratory infections and therefore, are not clinically indicated.
Vitamin D status appears more important than high calcium intake for maintaining calcium metabolism
Calcium intake levels of more than 800 mg/day may be unnecessary for maintaining calcium metabolism if vitamin D status is adequate, according to a study in the November 9 issue of JAMA. The importance of adequate vitamin D status for optimum bone health has received increased recognition in recent years, with higher recommended intake levels being proposed by some investigators, according to background information in the article. The ideal intake is not known, and different criteria have been proposed for estimating population requirements. Serum 25-hydroxyvitamin D has been the generally accepted indicator of vitamin D status, but no universal consensus has been reached regarding which serum values constitute sufficiency. An inverse relationship between serum 25-hydroxyvitamin D and serum parathyroid hormone (PTH) is well established. Parathyroid hormone is a major hormone maintaining normal serum concentrations of calcium and phosphate and is itself regulated through levels of calcitriol and serum calcium. An insufficiency of vitamin D or calcium is generally associated with an increase in PTH. Laufey Steingrimsdottir, Ph.D., of Landspitali-University Hospital, Reykjavik, Iceland, and colleagues conducted a study to determine the importance of high calcium intake and serum 25-hydroxyvitamin D for calcium homeostasis (metabolic equilibrium) in healthy adults, as determined by serum intact PTH.
Children overprescribed antibiotics for sore throat
Physicians prescribe antibiotics for more than half of children with sore throat, exceeding the expected prevalence of strep throat, and used nonrecommended antibiotics for 27 percent of children who received an antibiotic prescription, according to a study in the November 9 issue of JAMA. Pharyngitis (inflammation of the throat) accounts for 6 percent of visits by children to family medicine physicians and pediatricians, according to background information in the article. The most common manifestation of acute pharyngitis is sore throat. The main bacterial cause of sore throat and the only common cause of sore throat warranting antibiotic treatment is group A beta-hemolytic streptococci (GABHS). GABHS are cultured from 15 percent to 36 percent of children with sore throat. To improve diagnostic accuracy and reduce unnecessary antibiotic treatment, it is recommended that a GABHS test be conducted prior to treating children with an antibiotic. Penicillin is the recommended antibiotic, but acceptable alternatives include amoxicillin, erythromycin (for penicillin-allergic patients), and first-generation cephalosporins.
Worm parasite may hold clues in bid for illness and allergy cures
Tiny worms that can trick the body's natural defences could hold the key to new treatments for a range of conditions, including diabetes, asthma and hay fever. University of Edinburgh scientists, who have discovered that helminth parasites can exploit an 'Achilles heel' in our immune system, now hope to mimic the worms' survival tactics in a bid to beat infection. To find out how helminths fool the body's defences, the team are focusing on the role played by so-called 'regulatory cells', which fulfil a policing role that protects our bodies. These cells decide when to stop the immune system from attacking the body's own proteins (a process called autoimmunity) and also prevent it from attacking harmless environmental molecules.
The case for pneumococcal vaccination of infants
Although the Canadian National Advisory Committee on Immunization recommends that children receive the new pneumococcal vaccine PCV7 beginning at 2 months of age, provincial implementation of the recommendation has been slow. The vaccine protects against infections that result in pneumonia, otitis media, meningitis and other diseases. In Alberta, however, the vaccine is a publicly funded service. This report of the experience with the vaccine in the greater Calgary region shows 2 important results. First, rates of severe infection due to Streptococcus pneumoniae (the causative agent and target of the vaccine) have fallen dramatically among children, especially for the 7 common varieties of S. pneumoniae that are covered by the vaccine. Second, there is a spillover effect among adults over 65 years of age (for whom a similar vaccine is recommended and widely used in Alberta): rates of invasive infections due to the 7 serotypes of S. pneumoniae covered by the child vaccine have also fallen.
Parents' safe gun storage behaviors improve after counseling
CHICAGO – Families who received a brief gun-safety counseling intervention from their pediatrician were more likely to improve their gun storage safety practices, according to a study in the November issue of Archives of Pediatrics and Adolescent Medicine, one of the JAMA/Archives journals. In 2001, 2,937 children and teenagers died as a result of gun-related injuries, according to background information in the article. Although gun ownership has been identified as a risk factor for homicide and suicide in the home, a significant percentage of gun-owning parents store their guns loaded or unlocked, substantially underestimating the risk of injury to their children.
Psychologically distressed children more likely to be involved in bullying
CHICAGO – Bullying by elementary school children was associated with increased odds of lacking a feeling of safety while at school, having lower academic achievement, and feeling sad most days, according to an article in the November issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. According to background information in the article, "Bullying is defined as any repeated negative activity or aggression intended to harm or bother someone who is perceived by peers as being less physically or psychologically powerful than the aggressor(s)." In a 2000 survey of more than 15,000 U.S. students, researchers found the prevalence of bullying involvement among teens and preteens was approximately 30 percent. Concerns about the role of bullying in school violence, depression, and health concerns have grown over the past decade.
Antisocial behavior in children associated with gene variant and environmental risk factors
CHICAGO – For children with attention deficit hyperactivity disorder (ADHD), possessing a variant of a gene involved in brain signaling may predict antisocial behavior and increase susceptibility to the effects of lower birth weight, according to a study in the November issue of Archives of General Psychiatry, one of the JAMA/Archives journals. Biological processes play a key role in the genesis of antisocial behavior with specific evidence of brain involvement and contribution of genetic and early environmental risk factors, including prenatal factors, according to background information in the article. Given the links between deficits in a brain region called the prefrontal cortical and antisocial behavior and between the enzyme catechol O-methyltranferase (COMT) and prefrontal cortical functioning, the authors suggest that a variant of the COMT gene might be associated with antisocial behavior.
Medication shows promise in the treatment of hyperactivity associated with autism-related disorders
CHICAGO– Medication commonly used to treat attention-deficit hyperactivity disorder (ADHD) may be effective for treatment of hyperactivity symptoms in children with autism and related pervasive developmental disorders, according to a study in the November issue of Archives of General Psychiatry, one of the JAMA/Archives journals. Children with autism and other pervasive developmental disorders often also have symptoms of hyperactivity, distractibility and impulsiveness requiring treatment, according to background information in the article. Some previous small studies on the use of medications to treat hyperactivity in these children have shown promise, although side effects have been common, including irritability and social withdrawal.
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