For the first time, a new study examines how cell phone usage distracts preadolescent children while crossing the street.
In “Effects of Cell Phone Distraction on Pediatric Pedestrian Injury Risk,” researchers from the University of Alabama at Birmingham used data from children aged 10 to 11 years in simulated road crossings in an interactive, virtual pedestrian environment.
Distraction was only by cell phone conversation with a research assistant, not by other commonly used devices such as portable audio players or text messaging. Results indicate that when distracted, children were less attentive to traffic, left less time between themselves and the next oncoming vehicle, and were involved in more collisions and near misses.
While cell phones offer convenience and safety to families, the study authors indicate that pedestrians - especially children - are likely to be more distracted than adults, and should limit cell phone use while crossing the street.
news releases and briefs on statements appearing in the February ssue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP).
January 26, 2009, 12:01 am (ET)
Wednesday, April 28, 2010
Saturday, April 24, 2010
Achieving Your Goals - Staying Positive
By: Will Edwards
Having unclear objectives or unrealistic expectations are sure-fire ways of sabotaging your goal-achieving, but so too are lack of self-belief, fear of failure and lack of motivation. If you have defined your goals properly using the SMART procedure, they should indeed be clear and realistic. In this article, we are going to consider the importance of staying positive in relation to goal-achieving.
Sometimes, in my workshops, I ask people if they are optimists or pessimists. Generally, what happens is that the optimists will happily reveal themselves, but the pessimists are usually a little more reticent; indeed, often preferring to use the term ‘realist’ rather than ‘pessimist’. I think this is completely understandable: no one, to my knowledge, has ever written a book on the subject of the power of negative thinking; but, by contrast, there are very many books on the market that deal with the power of positive thinking.
Every attitude of mind we take – and optimism and pessimism are exactly that – is a choice that we make; even if it does not feel like we are making a choice. But, after years of habitually adopting a pessimistic mindset, it can be hard to dump this habit in favour of adopting the new, empowering habit of optimism. Why? Because, pessimists have good reason – or perhaps we should say justification - for being pessimistic. Pessimists simply believe they are generally right – things don’t usually go their way.
Of course, optimists believe exactly the same thing – things do generally go right for optimists. Both optimists and pessimists and making use of exactly the same principle to attract outcomes into their lives. It cuts both ways: you can indeed attract both good and bad outcomes through your attitude; and that’s why it is so important to try to foster a positive outlook on life.
There are many ways to do this, but one we will briefly consider here is the use of affirmation. An affirmation is a sentence that declares something to be true. Generally such sentences begin with the words ‘I am’ for example: I am calm; I am confident; I am in control. If you are a pessimist, try to open your mind to the possibility of change; and then try making use of positive affirmations like these.
All you need do is repeatedly say the sentence to yourself. Try this three times per day; and on each occasion, say each affirmation three times with purpose. It may sound silly or even ridiculous, but such words have the power to change our attitudes and the outcomes we attract into our lives are, to a very great extent, a product of attitude.
Finally, even if you are an optimistic person, you should still practice using affirmations. Even optimists don’t always manage to stay positive. We all lose sight of our self-belief and motivation from time to time and have to sometimes contend with the fear of failure too. So remember to make use of this very powerful technique to help you to stay positive – it is a vital ingredient for achieving those important goals.
Smart Articles @ http://www.articlebrain.com
Having unclear objectives or unrealistic expectations are sure-fire ways of sabotaging your goal-achieving, but so too are lack of self-belief, fear of failure and lack of motivation. If you have defined your goals properly using the SMART procedure, they should indeed be clear and realistic. In this article, we are going to consider the importance of staying positive in relation to goal-achieving.
Sometimes, in my workshops, I ask people if they are optimists or pessimists. Generally, what happens is that the optimists will happily reveal themselves, but the pessimists are usually a little more reticent; indeed, often preferring to use the term ‘realist’ rather than ‘pessimist’. I think this is completely understandable: no one, to my knowledge, has ever written a book on the subject of the power of negative thinking; but, by contrast, there are very many books on the market that deal with the power of positive thinking.
Every attitude of mind we take – and optimism and pessimism are exactly that – is a choice that we make; even if it does not feel like we are making a choice. But, after years of habitually adopting a pessimistic mindset, it can be hard to dump this habit in favour of adopting the new, empowering habit of optimism. Why? Because, pessimists have good reason – or perhaps we should say justification - for being pessimistic. Pessimists simply believe they are generally right – things don’t usually go their way.
Of course, optimists believe exactly the same thing – things do generally go right for optimists. Both optimists and pessimists and making use of exactly the same principle to attract outcomes into their lives. It cuts both ways: you can indeed attract both good and bad outcomes through your attitude; and that’s why it is so important to try to foster a positive outlook on life.
There are many ways to do this, but one we will briefly consider here is the use of affirmation. An affirmation is a sentence that declares something to be true. Generally such sentences begin with the words ‘I am’ for example: I am calm; I am confident; I am in control. If you are a pessimist, try to open your mind to the possibility of change; and then try making use of positive affirmations like these.
All you need do is repeatedly say the sentence to yourself. Try this three times per day; and on each occasion, say each affirmation three times with purpose. It may sound silly or even ridiculous, but such words have the power to change our attitudes and the outcomes we attract into our lives are, to a very great extent, a product of attitude.
Finally, even if you are an optimistic person, you should still practice using affirmations. Even optimists don’t always manage to stay positive. We all lose sight of our self-belief and motivation from time to time and have to sometimes contend with the fear of failure too. So remember to make use of this very powerful technique to help you to stay positive – it is a vital ingredient for achieving those important goals.
Smart Articles @ http://www.articlebrain.com
Preteen Marijuana Use Linked to Comorbid Substance Abuse and Psychological Disorders
From Medscape Medical News
Barbara Boughton
April 22, 2010 (San Francisco, California) — One of the largest studies to date of preteen marijuana users has found that those who start smoking the drug before age 13 years have an increased risk for comorbid substance abuse and psychosocial and legal problems, according to research presented here at the American Society of Addiction Medicine 41st Annual Medical-Scientific Conference.
In the study of 136 substance-dependent girls and boys, those who started using marijuana as a preteen were more likely to have a history of posttraumatic stress disorder (PTSD), suicide attempts, and traffic violations and to be dependent on other drugs.
"Our study supports a significant relationship between preteen marijuana use and poor outcomes. Its strengths include the fact that it is the largest clinical sample to date balanced by gender," lead researcher Youssef Mahfoud, MD, from the Department of Psychiatry at Case Western Reserve and University Hospitals Case Medical Center, Cleveland, Ohio, told Medscape Psychiatry.
First Drug of Abuse
In the study of substance-dependent youths in treatment (age range, 14 - 18 years), characteristics of those who started using marijuana before age 13 years were compared with those who started using the drug after that age.
In comparison with those who started as teenagers, children who started using marijuana as preteens were more likely to be dependent on hallucinogens (44% vs 27%; P < .05) and to have comorbid substance abuse disorders (M = 3.42 vs 2.59; P < .05).
Those who began using marijuana before age 13 years also had higher rates of PTSD (16% vs 6%; P < .05), a history of attempting suicide (32% vs 19%; P < .05), and a history of traffic violations (7% vs. 1%; P < .05). In addition, preteen marijuana users were also more likely to have used marijuana as their first drug of abuse (55%), rather than alcohol.
To determine whether there were any factors that predicted preteen marijuana use, the authors also looked at ethnicity, race, parental education, parental substance abuse history, and characteristics of preteen marijuana users on admission to substance abuse programs.
Those who started using marijuana as preteens were more likely to be younger when entering treatment and to be marijuana dependent on admission. There was also a trend toward a greater risk for nicotine addiction, Dr. Mahfoud said.
Preteen marijuana abusers were more likely to be Hispanic (14% vs 3%). Those who used marijuana as a preteen also tended to have parents with less education. Sixty percent of those who started using marijuana as a preteen had parents with just a junior high education compared with 47% of those who started as teenager.
Important Implications
The study has important implications for societal interventions, Dr. Mahfoud said. Preteens with parents who have less education, who are vulnerable because of PTSD or suicide attempts, or who are identified as heavy nicotine users might be targeted for interventions aimed at preventing marijuana use, he added.
The researchers plan to follow the sample in the study to see whether they find an improvement in outcomes for preteen marijuana users after substance abuse treatment and to gauge whether preteen marijuana use is associated with less successful response to substance abuse treatment therapies.
"Addiction is a disease of adolescent onset when children's brains are growing rapidly," said Gavin Bart, MD, director of the Division of Addiction Medicine at the Hennepin County Medical Center and assistant professor of medicine at the University of Minnesota Medical School, Minneapolis, Minnesota. Dr. Bart chaired the American Society of Addiction Medicine meeting and moderated the session at which the Case Western Reserve study was presented.
"So it's extremely helpful for those who treat substance abuse to know what the risk factors are for early marijuana use, and to use that information to identify patients at risk," he added.
"This is one of the first studies to look at preteens in clinical treatment, and to show that those who start using marijuana as a preteen have more problems controlling marijuana use and other drugs later in life. It reinforces the concept that prevention does not need to start in junior or senior high, but in grade school," commented Timothy Fong, MD, assistant professor of psychiatry and codirector of the addiction medicine clinic at the University of California–Los Angeles. "However, this is not evidence that marijuana is a gateway drug," he cautioned. "It does not show causality."
The study was supported by grants from the National Institute on Alcohol Abuse and Alcoholism and the John Templeton Foundation. Dr. Fong has disclosed being on speakers' bureaus for Reckitt-Benckiser, Pfizer Pharmaceuticals, and Lilly Pharmaceuticals. Dr. Mahfoud and Dr. Bart have disclosed no relevant financial relationships.
American Society of Addiction Medicine 41st Annual Medical-Scientific Conference: Abstract 2. Presented April 16, 2010.
Barbara Boughton
April 22, 2010 (San Francisco, California) — One of the largest studies to date of preteen marijuana users has found that those who start smoking the drug before age 13 years have an increased risk for comorbid substance abuse and psychosocial and legal problems, according to research presented here at the American Society of Addiction Medicine 41st Annual Medical-Scientific Conference.
In the study of 136 substance-dependent girls and boys, those who started using marijuana as a preteen were more likely to have a history of posttraumatic stress disorder (PTSD), suicide attempts, and traffic violations and to be dependent on other drugs.
"Our study supports a significant relationship between preteen marijuana use and poor outcomes. Its strengths include the fact that it is the largest clinical sample to date balanced by gender," lead researcher Youssef Mahfoud, MD, from the Department of Psychiatry at Case Western Reserve and University Hospitals Case Medical Center, Cleveland, Ohio, told Medscape Psychiatry.
First Drug of Abuse
In the study of substance-dependent youths in treatment (age range, 14 - 18 years), characteristics of those who started using marijuana before age 13 years were compared with those who started using the drug after that age.
In comparison with those who started as teenagers, children who started using marijuana as preteens were more likely to be dependent on hallucinogens (44% vs 27%; P < .05) and to have comorbid substance abuse disorders (M = 3.42 vs 2.59; P < .05).
Those who began using marijuana before age 13 years also had higher rates of PTSD (16% vs 6%; P < .05), a history of attempting suicide (32% vs 19%; P < .05), and a history of traffic violations (7% vs. 1%; P < .05). In addition, preteen marijuana users were also more likely to have used marijuana as their first drug of abuse (55%), rather than alcohol.
To determine whether there were any factors that predicted preteen marijuana use, the authors also looked at ethnicity, race, parental education, parental substance abuse history, and characteristics of preteen marijuana users on admission to substance abuse programs.
Those who started using marijuana as preteens were more likely to be younger when entering treatment and to be marijuana dependent on admission. There was also a trend toward a greater risk for nicotine addiction, Dr. Mahfoud said.
Preteen marijuana abusers were more likely to be Hispanic (14% vs 3%). Those who used marijuana as a preteen also tended to have parents with less education. Sixty percent of those who started using marijuana as a preteen had parents with just a junior high education compared with 47% of those who started as teenager.
Important Implications
The study has important implications for societal interventions, Dr. Mahfoud said. Preteens with parents who have less education, who are vulnerable because of PTSD or suicide attempts, or who are identified as heavy nicotine users might be targeted for interventions aimed at preventing marijuana use, he added.
The researchers plan to follow the sample in the study to see whether they find an improvement in outcomes for preteen marijuana users after substance abuse treatment and to gauge whether preteen marijuana use is associated with less successful response to substance abuse treatment therapies.
"Addiction is a disease of adolescent onset when children's brains are growing rapidly," said Gavin Bart, MD, director of the Division of Addiction Medicine at the Hennepin County Medical Center and assistant professor of medicine at the University of Minnesota Medical School, Minneapolis, Minnesota. Dr. Bart chaired the American Society of Addiction Medicine meeting and moderated the session at which the Case Western Reserve study was presented.
"So it's extremely helpful for those who treat substance abuse to know what the risk factors are for early marijuana use, and to use that information to identify patients at risk," he added.
"This is one of the first studies to look at preteens in clinical treatment, and to show that those who start using marijuana as a preteen have more problems controlling marijuana use and other drugs later in life. It reinforces the concept that prevention does not need to start in junior or senior high, but in grade school," commented Timothy Fong, MD, assistant professor of psychiatry and codirector of the addiction medicine clinic at the University of California–Los Angeles. "However, this is not evidence that marijuana is a gateway drug," he cautioned. "It does not show causality."
The study was supported by grants from the National Institute on Alcohol Abuse and Alcoholism and the John Templeton Foundation. Dr. Fong has disclosed being on speakers' bureaus for Reckitt-Benckiser, Pfizer Pharmaceuticals, and Lilly Pharmaceuticals. Dr. Mahfoud and Dr. Bart have disclosed no relevant financial relationships.
American Society of Addiction Medicine 41st Annual Medical-Scientific Conference: Abstract 2. Presented April 16, 2010.
Friday, April 16, 2010
Standardized Screening May Help Identify Suicidal Adolescents
From Medscape Medical News
Laurie Barclay, MD
April 15, 2010 — Standardized screening for suicide risk in primary care can detect adolescents with suicidal ideation, allowing referral to a behavioral healthcare center before a fatal or serious suicide attempt is made, according to the results of a study reported online April 12 and published in the May print issue of Pediatrics.
"Several associations and federal agencies have called for depression screening in pediatric primary care," writes Matthew B. Wintersteen, PhD, from Thomas Jefferson University in Philadelphia, Pennsylvania. "Screening for suicide risk is a natural adjunct to this call....To our knowledge, this is the first study to prospectively examine the impact of standardized screening for suicide risk on detection and referral rates in pediatric primary care."
The goals of the study were to evaluate whether brief standardized screening for suicide risk in pediatric primary care practices could improve detection of youth with suicidal ideation, maintain improved rates of detection and referral, and be duplicated in other practices.
Two primary care clinics (clinic A and clinic B) were selected as intervention clinics, and a third clinic (clinic C) asked about participating in the study and was offered the intervention. At these 3 clinics, physicians underwent brief training in detecting suicide risk, and 2 standardized questions for adolescents aged 12.0 to 17.9 years were added to their existing electronic medical chart psychosocial interview. Data without identifiers were extracted during intervention trials and for the same dates of the preceding year, and referral rates were determined from social work records.
The intervention was associated with doubling of the rates of inquiry about suicide risk, which resulted in a 219% increase overall (clinic A odds ratio [OR], 2.04; 95% confidence interval [CI], 1.56 - 2.51; clinic B OR, 3.20; 95% CI, 2.69 - 3.71; and clinic C OR, 1.85; 95% CI, 1.38 - 2.31).
In clinic A, the rate of case detection increased nearly 5-fold (OR, 4.99; 95% CI, 4.20 - 5.79), was maintained for a 6-month period after the intervention was implemented (OR, 4.38; 95% CI, 3.74 - 5.02), and was replicated in both clinic B (OR, 5.46; 95% CI, 3.36 - 7.56) and clinic C (OR, 3.42; 95% CI, 2.33 - 4.52).
Across all 3 clinics, case detection rate increased by 392%. The rate of increase of referral rates of suicidal youth to outpatient behavioral healthcare centers was commensurate to that of the detection rates.
"Standardized screening for suicide risk in primary care can detect youth with suicidal ideation and prompt a referral to a behavioral health care center before a fatal or serious suicide attempt is made," Dr. Wintersteen writes.
Limitations of this study include suicidal ideation based on history, not necessarily on present thoughts; and inability to determine the impact of the brief training in suicide risk.
"The findings from this study are particularly timely after the recent recommendation of the US Preventive Services Task Force to routinely screen youth for a major depressive disorder," Dr. Wintersteen concludes.
"In addition, the American Academy of Child and Adolescent Psychiatry along with the American Academy of Pediatrics Task Force on Mental Health also released a joint article in which routine behavioral health screening in primary care was recommended....Both reports cautioned against screening when psychotherapy followup was not readily available."
The American Foundation for Suicide Prevention supported this study. Dr. Wintersteen has disclosed no relevant financial relationships.
Pediatrics. Published online April 12, 2010. Abstract
Laurie Barclay, MD
April 15, 2010 — Standardized screening for suicide risk in primary care can detect adolescents with suicidal ideation, allowing referral to a behavioral healthcare center before a fatal or serious suicide attempt is made, according to the results of a study reported online April 12 and published in the May print issue of Pediatrics.
"Several associations and federal agencies have called for depression screening in pediatric primary care," writes Matthew B. Wintersteen, PhD, from Thomas Jefferson University in Philadelphia, Pennsylvania. "Screening for suicide risk is a natural adjunct to this call....To our knowledge, this is the first study to prospectively examine the impact of standardized screening for suicide risk on detection and referral rates in pediatric primary care."
The goals of the study were to evaluate whether brief standardized screening for suicide risk in pediatric primary care practices could improve detection of youth with suicidal ideation, maintain improved rates of detection and referral, and be duplicated in other practices.
Two primary care clinics (clinic A and clinic B) were selected as intervention clinics, and a third clinic (clinic C) asked about participating in the study and was offered the intervention. At these 3 clinics, physicians underwent brief training in detecting suicide risk, and 2 standardized questions for adolescents aged 12.0 to 17.9 years were added to their existing electronic medical chart psychosocial interview. Data without identifiers were extracted during intervention trials and for the same dates of the preceding year, and referral rates were determined from social work records.
The intervention was associated with doubling of the rates of inquiry about suicide risk, which resulted in a 219% increase overall (clinic A odds ratio [OR], 2.04; 95% confidence interval [CI], 1.56 - 2.51; clinic B OR, 3.20; 95% CI, 2.69 - 3.71; and clinic C OR, 1.85; 95% CI, 1.38 - 2.31).
In clinic A, the rate of case detection increased nearly 5-fold (OR, 4.99; 95% CI, 4.20 - 5.79), was maintained for a 6-month period after the intervention was implemented (OR, 4.38; 95% CI, 3.74 - 5.02), and was replicated in both clinic B (OR, 5.46; 95% CI, 3.36 - 7.56) and clinic C (OR, 3.42; 95% CI, 2.33 - 4.52).
Across all 3 clinics, case detection rate increased by 392%. The rate of increase of referral rates of suicidal youth to outpatient behavioral healthcare centers was commensurate to that of the detection rates.
"Standardized screening for suicide risk in primary care can detect youth with suicidal ideation and prompt a referral to a behavioral health care center before a fatal or serious suicide attempt is made," Dr. Wintersteen writes.
Limitations of this study include suicidal ideation based on history, not necessarily on present thoughts; and inability to determine the impact of the brief training in suicide risk.
"The findings from this study are particularly timely after the recent recommendation of the US Preventive Services Task Force to routinely screen youth for a major depressive disorder," Dr. Wintersteen concludes.
"In addition, the American Academy of Child and Adolescent Psychiatry along with the American Academy of Pediatrics Task Force on Mental Health also released a joint article in which routine behavioral health screening in primary care was recommended....Both reports cautioned against screening when psychotherapy followup was not readily available."
The American Foundation for Suicide Prevention supported this study. Dr. Wintersteen has disclosed no relevant financial relationships.
Pediatrics. Published online April 12, 2010. Abstract
Monday, April 12, 2010
Congenital Heart-Defect Risk Goes up With Severity of Maternal Obesity: Population Study
From Heartwire
Steve Stiles
April 12, 2010 (Bethesda, Maryland) — The risk of obese women bearing children with congenital heart defects climbs with increasing maternal body-mass index (BMI); this applies to such defects in general but also for many in particular, suggests a population-based case-control study from New York.
The jump in risk was 15% for all obese women, those with a BMI >30, and double that for those with a BMI >40, compared with women of normal weight. Women who were simply "overweight" or "underweight" showed no significant change in overall risk. The analysis was published online April 7, 2010 in the American Journal of Clinical Nutrition.
Maternal obesity is a well-established risk factor for some congenital malformations, including, a lot of evidence suggests, heart defects, lead author Dr James L Mills (National Institute of Child Health and Human Development, Bethesda, MD) observed for heartwire . "Our study goes beyond that to show significantly increased risks for a number of individual [heart] defects."
But its most important finding, according to Mills, is that the greater the obesity, the higher the risk. It potentially means that obese women who lose weight also diminish their risk of bearing children with heart defects, something that should be explored further in trials, he said.
The analysis comprised 7392 children born with heart defects and their mothers along with 56 304 control cases without such defects, who were among a million and a half children born in upstate New York from 1993 to 2003.
The risk of any defect was significantly increased among women in both categories of obesity severity by BMI. The trend of risk worsening with obesity was significant at p<0.0001.
Odds Ratio (OR)* for Birth of Child With Heart Defect by Maternal BMI Weight Category, vs Reference BMI 19–24 Maternal weight group OR (95% CI) p
Underweight, BMI <19 1.00 (0.91–1.10) 0.97
Overweight, BMI 25–29 1.00 (0.94–1.06) 0.96
Obese, BMI 30–39 1.11 (1.04–1.20) 0.004
Morbidly obese, BMI >40 1.33 (1.15–1.54) 0.0001
All obese, BMI >30 1.15 (1.07–1.23) <0.0001
*Adjusted for maternal age, education, race, smoking status, and type of healthcare coverage
BMI=body mass index (kg/m2)
Women with a BMI of 30 to 39, those with a BMI >40, and both groups combined, compared with those with a BMI of 19 to 24, showed significantly increased individual risks of a wide range of congenital defects, including all septal and conotruncal defects, all left and right ventricular outflow-tract obstructions, and cases of hypoplastic left-heart syndrome, aortic-valve stenosis, pulmonic-valve stenosis, tetralogy of Fallot, and double-outlet right ventricle.
Underweight or simply overweight women weren't at increased overall risk of defects compared with those of normal weight. However, those with a BMI <19 had an increased risk of bearing children with aortic-valve stenosis (odds ratio 1.75; 95% CI 1.09–2.81; p=0.02).
Overweight women also had an exception, a significantly higher risk of offspring with tetralogy of Fallot (OR 1.28; 95% CI 1.01–1.62; p=0.045). But their risk of having children with total anomalous pulmonary venous return (p=0.02) or double-outlet right ventricle (p=0.046) was significantly reduced.
The databases used for the analysis didn't include data on any potentially teratogenic drugs the mothers were taking; the authors acknowledge that as a weakness of the study.
According to the authors, women with diabetes, a well-recognized teratogen, had been excluded from the study. The relationship between BMI and defects strengthened somewhat in a separate analysis that included diabetic women, but the study's overall findings were "not materially changed," they write.
Mills said the observed effect of increased BMI on congenital heart defects resembles the corresponding effects of maternal diabetes in at least one distinctive way: both conditions are associated with a range of metabolic abnormalities, and both appear to affect a variety of embryonically separate heart structures.
"I suspect that we're seeing the effects of not one, but probably more than one aberration in the metabolic milieu. It may be hyperglycemia, it may be lipid abnormalities, it may be insulin resistance, it may be inflammation, but I think it’s an intriguing area for further investigation."
Steve Stiles
April 12, 2010 (Bethesda, Maryland) — The risk of obese women bearing children with congenital heart defects climbs with increasing maternal body-mass index (BMI); this applies to such defects in general but also for many in particular, suggests a population-based case-control study from New York.
The jump in risk was 15% for all obese women, those with a BMI >30, and double that for those with a BMI >40, compared with women of normal weight. Women who were simply "overweight" or "underweight" showed no significant change in overall risk. The analysis was published online April 7, 2010 in the American Journal of Clinical Nutrition.
Maternal obesity is a well-established risk factor for some congenital malformations, including, a lot of evidence suggests, heart defects, lead author Dr James L Mills (National Institute of Child Health and Human Development, Bethesda, MD) observed for heartwire . "Our study goes beyond that to show significantly increased risks for a number of individual [heart] defects."
But its most important finding, according to Mills, is that the greater the obesity, the higher the risk. It potentially means that obese women who lose weight also diminish their risk of bearing children with heart defects, something that should be explored further in trials, he said.
The analysis comprised 7392 children born with heart defects and their mothers along with 56 304 control cases without such defects, who were among a million and a half children born in upstate New York from 1993 to 2003.
The risk of any defect was significantly increased among women in both categories of obesity severity by BMI. The trend of risk worsening with obesity was significant at p<0.0001.
Odds Ratio (OR)* for Birth of Child With Heart Defect by Maternal BMI Weight Category, vs Reference BMI 19–24 Maternal weight group OR (95% CI) p
Underweight, BMI <19 1.00 (0.91–1.10) 0.97
Overweight, BMI 25–29 1.00 (0.94–1.06) 0.96
Obese, BMI 30–39 1.11 (1.04–1.20) 0.004
Morbidly obese, BMI >40 1.33 (1.15–1.54) 0.0001
All obese, BMI >30 1.15 (1.07–1.23) <0.0001
*Adjusted for maternal age, education, race, smoking status, and type of healthcare coverage
BMI=body mass index (kg/m2)
Women with a BMI of 30 to 39, those with a BMI >40, and both groups combined, compared with those with a BMI of 19 to 24, showed significantly increased individual risks of a wide range of congenital defects, including all septal and conotruncal defects, all left and right ventricular outflow-tract obstructions, and cases of hypoplastic left-heart syndrome, aortic-valve stenosis, pulmonic-valve stenosis, tetralogy of Fallot, and double-outlet right ventricle.
Underweight or simply overweight women weren't at increased overall risk of defects compared with those of normal weight. However, those with a BMI <19 had an increased risk of bearing children with aortic-valve stenosis (odds ratio 1.75; 95% CI 1.09–2.81; p=0.02).
Overweight women also had an exception, a significantly higher risk of offspring with tetralogy of Fallot (OR 1.28; 95% CI 1.01–1.62; p=0.045). But their risk of having children with total anomalous pulmonary venous return (p=0.02) or double-outlet right ventricle (p=0.046) was significantly reduced.
The databases used for the analysis didn't include data on any potentially teratogenic drugs the mothers were taking; the authors acknowledge that as a weakness of the study.
According to the authors, women with diabetes, a well-recognized teratogen, had been excluded from the study. The relationship between BMI and defects strengthened somewhat in a separate analysis that included diabetic women, but the study's overall findings were "not materially changed," they write.
Mills said the observed effect of increased BMI on congenital heart defects resembles the corresponding effects of maternal diabetes in at least one distinctive way: both conditions are associated with a range of metabolic abnormalities, and both appear to affect a variety of embryonically separate heart structures.
"I suspect that we're seeing the effects of not one, but probably more than one aberration in the metabolic milieu. It may be hyperglycemia, it may be lipid abnormalities, it may be insulin resistance, it may be inflammation, but I think it’s an intriguing area for further investigation."
Thursday, April 8, 2010
Current Philosophy About Hitting Children
From Medscape Nurses > Viewpoints
Marilyn W. Edmunds, PhD, CRNP
J Pediatr Health Care. 2010;24:103-107
Article Summary
Over a century ago, it was common practice for men to hit their wives as a way of teaching them, gaining compliance, or chastising them. Today, this practice is clearly identified as abuse and is illegal. This cultural change in what was acceptable behavior came about slowly, as part of the concept of protection of human rights and acceptance that women were not the chattel of their husbands. Although both cultural mores and legal behavior in dealing with women have changed, the author of the present article states, "[I]ronically, the only humans it is still legal to hit are the most vulnerable members of our society -- those we are charged to protect -- children."This article discusses the position of the US government on corporal punishment (CP) of children.
"Spanking," "paddling," and "whupping," terms commonly used to describe punishment of children are, by definition, forms of hitting, either with a hand or with an instrument. Hitting children is at least as cruel and harmful an act as hitting adult women. It is an act of violence and a clear violation of the child's human rights.''
In the United States, it is against the law to hit older adults, prisoners, and criminals, and it is illegal for adults to hit children in school in more than half of US states, However, it is not illegal for parents to hit their children at home, largely "because of strongly held beliefs about parents' rights to discipline as well as a society view of parents as 'owners' of children."
The article by Knox summarizes numerous research studies that demonstrate strong associations between CP of children and later development of maladaptive behavior patterns, such as aggression and delinquency, and concludes that CP is probably more harmful than helpful. A meta-analysis of 80 studies shows that spanking and other forms of CP are associated with increased aggressive and delinquent behavior in children, poorer parent/child relationships, worse mental health in children, increased physical abuse of children, increased adult aggression and criminal behavior, poorer adult mental health, and increased later risk for abusing one's spouse or child. CP is often part of a larger pattern of abuse; it is also often the first behavior in a cycle of abuse of children, and the youngest children tend to suffer the most abuse.
Parents who practice CP are not aware of or fail to use alternatives that are more effective. Research documents that spanking does not have long-term positive effects on a child's adaptive behavior. When children are hurt physically, their brains and bodies become physiologically aroused, causing them to focus almost entirely on themselves and not on what they are supposed to be learning. Thus, researchers argue that children who are hit are, paradoxically, less likely to learn the lessons parents are trying to teach.
Many organizations, including the National Association of Pediatric Nurse Practitioners and the United Methodist Church, have taken a stand against CP. The article describes professional and international progress on ending CP, citing 24 countries that have enacted legislation to abolish all CP of children. In many countries, the ban on CP in the home is primarily educational and does not include a provision for criminal penalties. What has developed in these countries is a change in the cultural expectations about behavior toward children.
In 2006, the United Nations (UN) adopted a policy banning CP of children, maintaining that "No violence against children is justifiable; all violence against children is preventable."Leading reformers in the UN are outraged that only the United States and Somalia failed to ratify UN documents against CP in children, even though the death rate from maltreatment for US children younger than 15 years is 10 to 15 times higher than the average death rate in other wealthy nations.[1]
The author makes an appeal for efforts that hold promise for preventing child maltreatment, such as parent education and removal of social sanctions for hitting children. A key step in treating violent individuals is to confront, dispute, and develop alternatives to beliefs that support violence. The author suggests development of programs and campaigns to educate people about how to avoid hitting children. Many parents and caregivers are need help with discipline, and healthcare providers, such as pediatric nurse practitioners, can be highly effective educators for parents. These clinicians should provide anticipatory guidance as a preventive method of securing nonviolent parenting skills. Nurse practitioners are encouraged to teach parents about the potential adverse outcomes of CP and have parents commit to never hitting, shaking, or spanking their children.
Viewpoint
This article emphasizes a problem that may not be a dominant clinical concern. I like the emphasis on anticipatory guidance for parents, assuming that most parents will experience times when they are frustrated and angry at their children and need to learn another way to respond. Helping parents think in advance about what they must not do and make decisions about alternatives addresses the problem before it happens. Early teaching of parents also has a chance of reaching parents with the message before they have adopted abusive patterns about which to feel guilty.
Changing the cultural behaviors about what was acceptable for men in their relationships with women took a long time. Although we might also accept that it will take a similar length of time to change societal behavior towards children, the first step is to discuss the problem more broadly. I think that awareness of failure of the United States to support the efforts of the UN and other countries in limiting abuse of children should generate some discussion and perhaps create additional positive action.
Abstract
References
Marilyn W. Edmunds, PhD, CRNP
J Pediatr Health Care. 2010;24:103-107
Article Summary
Over a century ago, it was common practice for men to hit their wives as a way of teaching them, gaining compliance, or chastising them. Today, this practice is clearly identified as abuse and is illegal. This cultural change in what was acceptable behavior came about slowly, as part of the concept of protection of human rights and acceptance that women were not the chattel of their husbands. Although both cultural mores and legal behavior in dealing with women have changed, the author of the present article states, "[I]ronically, the only humans it is still legal to hit are the most vulnerable members of our society -- those we are charged to protect -- children."This article discusses the position of the US government on corporal punishment (CP) of children.
"Spanking," "paddling," and "whupping," terms commonly used to describe punishment of children are, by definition, forms of hitting, either with a hand or with an instrument. Hitting children is at least as cruel and harmful an act as hitting adult women. It is an act of violence and a clear violation of the child's human rights.''
In the United States, it is against the law to hit older adults, prisoners, and criminals, and it is illegal for adults to hit children in school in more than half of US states, However, it is not illegal for parents to hit their children at home, largely "because of strongly held beliefs about parents' rights to discipline as well as a society view of parents as 'owners' of children."
The article by Knox summarizes numerous research studies that demonstrate strong associations between CP of children and later development of maladaptive behavior patterns, such as aggression and delinquency, and concludes that CP is probably more harmful than helpful. A meta-analysis of 80 studies shows that spanking and other forms of CP are associated with increased aggressive and delinquent behavior in children, poorer parent/child relationships, worse mental health in children, increased physical abuse of children, increased adult aggression and criminal behavior, poorer adult mental health, and increased later risk for abusing one's spouse or child. CP is often part of a larger pattern of abuse; it is also often the first behavior in a cycle of abuse of children, and the youngest children tend to suffer the most abuse.
Parents who practice CP are not aware of or fail to use alternatives that are more effective. Research documents that spanking does not have long-term positive effects on a child's adaptive behavior. When children are hurt physically, their brains and bodies become physiologically aroused, causing them to focus almost entirely on themselves and not on what they are supposed to be learning. Thus, researchers argue that children who are hit are, paradoxically, less likely to learn the lessons parents are trying to teach.
Many organizations, including the National Association of Pediatric Nurse Practitioners and the United Methodist Church, have taken a stand against CP. The article describes professional and international progress on ending CP, citing 24 countries that have enacted legislation to abolish all CP of children. In many countries, the ban on CP in the home is primarily educational and does not include a provision for criminal penalties. What has developed in these countries is a change in the cultural expectations about behavior toward children.
In 2006, the United Nations (UN) adopted a policy banning CP of children, maintaining that "No violence against children is justifiable; all violence against children is preventable."Leading reformers in the UN are outraged that only the United States and Somalia failed to ratify UN documents against CP in children, even though the death rate from maltreatment for US children younger than 15 years is 10 to 15 times higher than the average death rate in other wealthy nations.[1]
The author makes an appeal for efforts that hold promise for preventing child maltreatment, such as parent education and removal of social sanctions for hitting children. A key step in treating violent individuals is to confront, dispute, and develop alternatives to beliefs that support violence. The author suggests development of programs and campaigns to educate people about how to avoid hitting children. Many parents and caregivers are need help with discipline, and healthcare providers, such as pediatric nurse practitioners, can be highly effective educators for parents. These clinicians should provide anticipatory guidance as a preventive method of securing nonviolent parenting skills. Nurse practitioners are encouraged to teach parents about the potential adverse outcomes of CP and have parents commit to never hitting, shaking, or spanking their children.
Viewpoint
This article emphasizes a problem that may not be a dominant clinical concern. I like the emphasis on anticipatory guidance for parents, assuming that most parents will experience times when they are frustrated and angry at their children and need to learn another way to respond. Helping parents think in advance about what they must not do and make decisions about alternatives addresses the problem before it happens. Early teaching of parents also has a chance of reaching parents with the message before they have adopted abusive patterns about which to feel guilty.
Changing the cultural behaviors about what was acceptable for men in their relationships with women took a long time. Although we might also accept that it will take a similar length of time to change societal behavior towards children, the first step is to discuss the problem more broadly. I think that awareness of failure of the United States to support the efforts of the UN and other countries in limiting abuse of children should generate some discussion and perhaps create additional positive action.
Abstract
References
Wednesday, April 7, 2010
Maternal Smoking in Pregnancy Linked to Increased Risk for Psychotic Symptoms in Adolescents
Pregnant? Please do not smoke! Your Baby's brain's at stake.
From Medscape Medical News
Deborah Brauser
October 12, 2009 — The maternal use of tobacco while pregnant is associated with an increased risk for psychotic symptoms such as hallucinations and delusions in their children, with evidence of a dose-response effect, according to results from a large cohort study published in the October issue of the British Journal of Psychiatry.
"These findings indicate that the risk factors for development of non-clinical psychotic experiences may operate during early development," write Stanley Zammit, PhD, clinical senior lecturer in psychiatric epidemiology in the Department of Psychological Medicine at Cardiff University in Wales and the University of Bristol in the United Kingdom, and colleagues.
"This is the only study to really try and tease out to what extent this association is causal rather than being confounded or explained by other factors," Dr. Zammit told Medscape Psychiatry.
"There could still be confounding, of course, but this makes us a bit more confident that the association may be due to the effects of nicotine on the developing brain in the uterus," he added.
Smoking While Pregnant Common in the United Kingdom
"In the [United Kingdom], 15-20% of women continue to smoke throughout their pregnancy, and although cannabis use is less common, some alcohol intake during pregnancy is reported by most women," write the study authors.
They note that past studies have shown an association between maternal smoking and, to a lesser extent, maternal cannabis and alcohol use and adverse long-term effects on their offspring, including reduced cognitive ability and increased incidence of both attention-deficit/hyperactivity disorder and conduct disorder during childhood and adolescence.
However, the authors report that there have been very few epidemiological studies showing causal inference between maternal substance abuse and childhood psychopathology.
"Our aim [in this study] was to investigate, in a longitudinal design, whether maternal tobacco, cannabis, or alcohol use during pregnancy were independently associated with risk of the offspring developing psychotic symptoms during early adolescence," write the study authors.
"I'm interested in the effects of substance use on mental health outcomes," explained Dr. Zammit. "In animals, there is good evidence that nicotine in utero can disrupt the normal development/function of the fetal brain, so it seems very plausible that this could happen in humans and have subtle effects that are not noticeable early on in life but are only expressed later during development."
The investigators examined data from the Avon Longitudinal Study of Parents and Children, including 14,062 adolescents born between April 1991 and December 1992.
Dr. Zammit and his team focused their evaluation on a cohort of 6356 adolescents, all 12 years of age, who participated in a semistructured interview for psychosis-like symptoms (PLIKS). This interview included 12 core questions, which covered hallucinations, delusions, and experiences of thought interference during the past 6 months.
Data on parental substance use were obtained from self-report postal questionnaires completed by the mother at 8, 18, and 32 weeks of pregnancy and at 2, 21, 33, and 47 months after giving birth, and from the father at 18 weeks of pregnancy and at 2, 8, and 21 months after birth.
Of these mothers, 1219 (19.3%) smoked tobacco, 4372 (70.0%) drank alcohol, and 157 (2.5%) used cannabis at least once during pregnancy.
Maternal Tobacco Use Increased Risk for PLIKS
At the end of this cohort study, a total of 734 of the children (11.6%) were rated as having suspected or definite PLIKS, and 300 of these children (4.7%) had definite symptoms.
The investigators found that maternal tobacco use during pregnancy was strongly associated with an increased risk for suspected or definite PLIKS in their offspring (adjusted odds ratio [OR], 1.20; 95% confidence interval [CI], 1.05 – 1.37; P = .007). This risk further increased based on frequency of tobacco use.
In addition, "the offspring of mothers who used tobacco only in their third trimester had a greater risk of developing any suspected or definite PLIKS than offspring whose mothers smoked only in the first trimester (OR, 2.1; 95% CI, 0.96-4.59; P = 0.063)," report the authors.
After adjusting for confounders and maternal smoking during pregnancy, paternal smoking during pregnancy, maternal smoking postpregnancy, or maternal cannabis use were not associated with any suspected or definite PLIKS.
Although maternal alcohol use did show a nonlinear association with psychotic symptoms, this effect was found almost exclusively in the offspring of the 25 women who drank more than 21 units weekly.
Future Studies Needed
"Maternal smoking during pregnancy was associated with an increased risk of psychotic symptoms in the children, with evidence of a dose-response effect whereby risk of PLIKS was highest in the offspring of mothers who smoked most heavily," write the study authors.
"If our results are non-biased and truly reflect a causal relationship, we can estimate that about 20% of adolescents in this cohort would not have developed psychotic symptoms if their mothers had not smoked," they add.
Study limitations included missing data resulting from attrition and wave nonresponse, as well as possible underreporting of substance use (including cannabis, which is illegal in the United Kingdom).
"Hopefully this will encourage more research into the effects of tobacco on brain development in utero, and increase understanding of how any disruptions of brain development can impact risk of psychosis," Dr. Zammit concluded.
This study was supported by the Wellcome Trust Grant, with additional funding to Dr. Zammit through a Clinician Scientist Award from the National Assembly for Wales. The other study authors have disclosed no relevant financial relationships.
Br J Psychiatry. 2009;195:294–300. Abstract
From Medscape Medical News
Deborah Brauser
October 12, 2009 — The maternal use of tobacco while pregnant is associated with an increased risk for psychotic symptoms such as hallucinations and delusions in their children, with evidence of a dose-response effect, according to results from a large cohort study published in the October issue of the British Journal of Psychiatry.
"These findings indicate that the risk factors for development of non-clinical psychotic experiences may operate during early development," write Stanley Zammit, PhD, clinical senior lecturer in psychiatric epidemiology in the Department of Psychological Medicine at Cardiff University in Wales and the University of Bristol in the United Kingdom, and colleagues.
"This is the only study to really try and tease out to what extent this association is causal rather than being confounded or explained by other factors," Dr. Zammit told Medscape Psychiatry.
"There could still be confounding, of course, but this makes us a bit more confident that the association may be due to the effects of nicotine on the developing brain in the uterus," he added.
Smoking While Pregnant Common in the United Kingdom
"In the [United Kingdom], 15-20% of women continue to smoke throughout their pregnancy, and although cannabis use is less common, some alcohol intake during pregnancy is reported by most women," write the study authors.
They note that past studies have shown an association between maternal smoking and, to a lesser extent, maternal cannabis and alcohol use and adverse long-term effects on their offspring, including reduced cognitive ability and increased incidence of both attention-deficit/hyperactivity disorder and conduct disorder during childhood and adolescence.
However, the authors report that there have been very few epidemiological studies showing causal inference between maternal substance abuse and childhood psychopathology.
"Our aim [in this study] was to investigate, in a longitudinal design, whether maternal tobacco, cannabis, or alcohol use during pregnancy were independently associated with risk of the offspring developing psychotic symptoms during early adolescence," write the study authors.
"I'm interested in the effects of substance use on mental health outcomes," explained Dr. Zammit. "In animals, there is good evidence that nicotine in utero can disrupt the normal development/function of the fetal brain, so it seems very plausible that this could happen in humans and have subtle effects that are not noticeable early on in life but are only expressed later during development."
The investigators examined data from the Avon Longitudinal Study of Parents and Children, including 14,062 adolescents born between April 1991 and December 1992.
Dr. Zammit and his team focused their evaluation on a cohort of 6356 adolescents, all 12 years of age, who participated in a semistructured interview for psychosis-like symptoms (PLIKS). This interview included 12 core questions, which covered hallucinations, delusions, and experiences of thought interference during the past 6 months.
Data on parental substance use were obtained from self-report postal questionnaires completed by the mother at 8, 18, and 32 weeks of pregnancy and at 2, 21, 33, and 47 months after giving birth, and from the father at 18 weeks of pregnancy and at 2, 8, and 21 months after birth.
Of these mothers, 1219 (19.3%) smoked tobacco, 4372 (70.0%) drank alcohol, and 157 (2.5%) used cannabis at least once during pregnancy.
Maternal Tobacco Use Increased Risk for PLIKS
At the end of this cohort study, a total of 734 of the children (11.6%) were rated as having suspected or definite PLIKS, and 300 of these children (4.7%) had definite symptoms.
The investigators found that maternal tobacco use during pregnancy was strongly associated with an increased risk for suspected or definite PLIKS in their offspring (adjusted odds ratio [OR], 1.20; 95% confidence interval [CI], 1.05 – 1.37; P = .007). This risk further increased based on frequency of tobacco use.
In addition, "the offspring of mothers who used tobacco only in their third trimester had a greater risk of developing any suspected or definite PLIKS than offspring whose mothers smoked only in the first trimester (OR, 2.1; 95% CI, 0.96-4.59; P = 0.063)," report the authors.
After adjusting for confounders and maternal smoking during pregnancy, paternal smoking during pregnancy, maternal smoking postpregnancy, or maternal cannabis use were not associated with any suspected or definite PLIKS.
Although maternal alcohol use did show a nonlinear association with psychotic symptoms, this effect was found almost exclusively in the offspring of the 25 women who drank more than 21 units weekly.
Future Studies Needed
"Maternal smoking during pregnancy was associated with an increased risk of psychotic symptoms in the children, with evidence of a dose-response effect whereby risk of PLIKS was highest in the offspring of mothers who smoked most heavily," write the study authors.
"If our results are non-biased and truly reflect a causal relationship, we can estimate that about 20% of adolescents in this cohort would not have developed psychotic symptoms if their mothers had not smoked," they add.
Study limitations included missing data resulting from attrition and wave nonresponse, as well as possible underreporting of substance use (including cannabis, which is illegal in the United Kingdom).
"Hopefully this will encourage more research into the effects of tobacco on brain development in utero, and increase understanding of how any disruptions of brain development can impact risk of psychosis," Dr. Zammit concluded.
This study was supported by the Wellcome Trust Grant, with additional funding to Dr. Zammit through a Clinician Scientist Award from the National Assembly for Wales. The other study authors have disclosed no relevant financial relationships.
Br J Psychiatry. 2009;195:294–300. Abstract
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