The Advisory Committee on Immunization Practices (ACIP) annually publishes an immunization schedule for persons aged 0 through 18 years that summarizes recommendations for currently licensed vaccines for children aged 18 years and younger and includes recommendations in effect as of December 15, 2009.
Changes to the previous schedule[1] include the following:
The statement concerning use of combination vaccines in the introductory paragraph has been changed to reflect the revised ACIP recommendation on this issue.
The last dose in the inactivated poliovirus vaccine series is now recommended to be administered on or after the fourth birthday and at least 6 months after the previous dose. In addition, if 4 doses are administered before age 4 years, an additional (fifth) dose should be administered at age 4 through 6 years.
The hepatitis A footnote has been revised to allow vaccination of children older than 23 months for whom immunity against hepatitis A is desired.
Revaccination with meningococcal conjugate vaccine is now recommended for children who remain at increased risk for meningococcal disease after 3 years (if the first dose was administered at age 2 through 6 years), or after 5 years (if the first dose was administered at age 7 years or older)
Footnotes for human papillomavirus (HPV) vaccine have been modified to include
1) the availability of and recommendations for bivalent HPV vaccine, and
2) a permissive recommendation for administration of quadrivalent HPV vaccine to males aged 9 through 18 years to reduce the likelihood of acquiring genital warts.
The National Childhood Vaccine Injury Act requires that health-care providers provide parents or patients with copies of Vaccine Information Statements before administering each dose of the vaccines listed in the schedules.
Additional information is available from state health departments and from CDC at http://www.cdc.gov/vaccines/pubs/vis/default.htm.
Detailed recommendations for using vaccines are available from ACIP statements (available at http://www.cdc.gov/vaccines/pubs/acip-list.htm) and the 2009 Red Book.[6] Guidance regarding the Vaccine Adverse Event Reporting System form is available at http://www.vaers.hhs.gov or by telephone, 800-822-7967.
Thursday, May 13, 2010
Friday, May 7, 2010
Deterrence/Prevention of Chickenpox (Varicella)
The American Academy of Pediatrics (AAP) recommends excluding affected children from school until the sixth day of rash.
This may not prevent spread of varicella because the child is infective before the rash appears.
Vaccination
Varicella vaccine consists of live attenuated Oka strain varicella virus. The vaccine is safe and highly immunogenic. It was approved for use in the United States in 1995 and has greatly reduced the incidence and mortality due to varicella.
The vaccine has been found to have protective efficacy of 71-100% against varicella. However, protection against moderate and severe varicella is much higher (95-100%).
Babies are born with protective maternal antibodies to varicella. The half-life of these antibodies is about 6 weeks, and most children have very low levels beyond age 5 months.
However, the varicella vaccine is recommended after age 1 year. A single dose provides protection to approximately 85% of recipients. Vaccine-conferred immunity to varicella wanes over time, making more vaccine recipients susceptible to the disease. The Advisory Committee on Immunization Practices (ACIP) and the AAP now recommend 2 doses of this vaccine for all children.
After the first dose at age 12-15 months, the second dose should be administered at age 4-6 years. All persons who have received one dose of the vaccine at any time in the past should be offered a second dose.
Two doses of the varicella vaccine provide 98% protection against varicella, and 100%protection against severe disease. These children also have a lower incidence of breakthrough varicella.
Breakthrough disease involves varicella that occurs after 42 days of immunization. When it occurs, it is usually mild disease but can spread to other susceptible individuals. These children usually have less than 50 skin lesions, and fever is low and quickly subsides. Headache, sore throat, malaise, and anorexia are less frequent.
Some studies have found that breakthrough disease is more common if the vaccine was given prior to age 14 months, within 28 days after the measles-mumps-rubella (MMR) vaccine, and if the child was on oral steroid therapy. Duration between vaccination and exposure has also been found to be significant.Other studies have not found such associations.
Research study protocols allow varicella vaccine administration to patients with leukemia while they are in remission. Seroconversion is good among children with leukemia.
Postexposure prophylaxis, if provided within 36-72 hours of contact, can prevent or attenuate disease in the exposed individual.This property allows the use of the vaccine to control outbreaks by vaccinating susceptible children.
Outbreaks do occur, even with high levels of vaccination.
Vaccinated children develop milder disease but are infectious. Outbreaks can be controlled by offering catch-up vaccination to unimmunized children and adolescents in the area.
from:
http://emedicine.medscape.com/article/969773-followup
Varicella Author: Parang N Mehta, MD
This may not prevent spread of varicella because the child is infective before the rash appears.
Vaccination
Varicella vaccine consists of live attenuated Oka strain varicella virus. The vaccine is safe and highly immunogenic. It was approved for use in the United States in 1995 and has greatly reduced the incidence and mortality due to varicella.
The vaccine has been found to have protective efficacy of 71-100% against varicella. However, protection against moderate and severe varicella is much higher (95-100%).
Babies are born with protective maternal antibodies to varicella. The half-life of these antibodies is about 6 weeks, and most children have very low levels beyond age 5 months.
However, the varicella vaccine is recommended after age 1 year. A single dose provides protection to approximately 85% of recipients. Vaccine-conferred immunity to varicella wanes over time, making more vaccine recipients susceptible to the disease. The Advisory Committee on Immunization Practices (ACIP) and the AAP now recommend 2 doses of this vaccine for all children.
After the first dose at age 12-15 months, the second dose should be administered at age 4-6 years. All persons who have received one dose of the vaccine at any time in the past should be offered a second dose.
Two doses of the varicella vaccine provide 98% protection against varicella, and 100%protection against severe disease. These children also have a lower incidence of breakthrough varicella.
Breakthrough disease involves varicella that occurs after 42 days of immunization. When it occurs, it is usually mild disease but can spread to other susceptible individuals. These children usually have less than 50 skin lesions, and fever is low and quickly subsides. Headache, sore throat, malaise, and anorexia are less frequent.
Some studies have found that breakthrough disease is more common if the vaccine was given prior to age 14 months, within 28 days after the measles-mumps-rubella (MMR) vaccine, and if the child was on oral steroid therapy. Duration between vaccination and exposure has also been found to be significant.Other studies have not found such associations.
Research study protocols allow varicella vaccine administration to patients with leukemia while they are in remission. Seroconversion is good among children with leukemia.
Postexposure prophylaxis, if provided within 36-72 hours of contact, can prevent or attenuate disease in the exposed individual.This property allows the use of the vaccine to control outbreaks by vaccinating susceptible children.
Outbreaks do occur, even with high levels of vaccination.
Vaccinated children develop milder disease but are infectious. Outbreaks can be controlled by offering catch-up vaccination to unimmunized children and adolescents in the area.
from:
http://emedicine.medscape.com/article/969773-followup
Varicella Author: Parang N Mehta, MD
Adolescents, Young Adults Lack Knowledge of Acetaminophen's Toxicity
From Medscape Medical News
Brian Hoyle
May 7, 2010 (Vancouver, British Columbia) — A study of more than 250 teenagers and young adults by researchers at the University of Rochester, in New York, has found that more than 60% do not know what acetaminophen is, even though a third are users of acetaminophen-containing over-the-counter (OTC) pain-relieving products. Nearly 25% misuse the medications, researchers announced here at the Pediatric Academic Societies 2010 Annual Meeting.
"Acetaminophen toxicity is a big deal, but we know a lot more [about its effects] in adults than we do in adolescents. The adolescent age group is what is new about this work," said study presenter Laura Shone, DrPH, MSW, associate professor of pediatrics and clinical nursing, Department of Pediatrics, University of Rochester Medical Center, in an interview with Medscape Pediatrics.
The problem is huge, Dr. Shone said. Published studies have documented that overdoses of acetaminophen are the cause of more acute liver failure in the United States than viral hepatitis. Furthermore, one half to two thirds of these overdoses are unintentional and result from taking excessive doses of OTC medication.
At the heart of this problem is a lack of awareness about medications being consumed (health literacy). Agencies such as the National Academy of Sciences (NAS) have weighed in on the issue. Estimates are that up to half of American adults have problems with health literacy, which, according to a 2004 NAS report, is "the ability to find, understand, and use health information to communicate and make health decisions and function successfully as a patient."
The situation for adolescents is far less clear, particularly concerning the understanding of OTC medications and label instructions for their use, explained Dr. Shone.
"Health literacy in regard to OTC meds is truly lacking in the adolescent age group, because the medication managers prior to these years were the adults in the home. Now, there is capability and access without knowledge, in combination with teenage behavior and thoughts — a combination of [the attitude that] nothing is going to hurt me, impulsive thinking, and risk-taking behaviors — that are all in play," Germaine Defendi, MD, associate clinical professor, Department of Paediatrics, Olive View/UCLA Medical Center, Los Angeles, told Medscape Pediatrics.
In the study, conducted in 2008 and 2009, 266 youth (age range, 16 to 23 years; mean age, 18.6 ± 2 years; 56% female) from Monroe County, New York, were anonymously recruited, passively during visits to clinics or more actively during health information sessions at schools and elsewhere. The health literacy of the participants was determined using the Rapid Estimate of Adult Literacy (REALM) or REALM-Teen surveys. Limited health literacy was a REALM score of 60 or below, or a REALM-Teen score of 62 or below.
Of the 266 participants, 96 (36%) had limited health literacy and 170 (64%) had adequate health literacy.
A survey solicited information about knowledge of acetaminophen as the active ingredient in OTC pain relief medications, the ability to identify acetaminophen-containing OTC products, and the ability to identify the one-time and daily dosage limits of acetaminophen.
Fully 63% of the participants had no knowledge of acetaminophen, even though 33% of them had used an acetaminophen-containing OTC product within the previous month. The majority displayed limited health literacy.
Multivariate analysis pegged inadequate health literacy as the main reason for taking too few or too many pills per dose, for incorrect frequency of use, and for incorrect maximum daily dose. Even 77% of those identified as health literate did not know the maximum daily dose of acetaminophen.
"I truly think that this is a worthwhile study addressing the lack of knowledge in teens about OTC medication. Kids know that there are things that they can easily purchase OTC that are medicines. But a true understanding of the medications and what they are used for and what they do is lacking," Dr. Germaine told Medscape Pediatrics.
Dr. Shone and the other study authors suggest that providers of OTC drugs have "a critical role" to play in conveying information in a way that is meaningful and relevant to adults and adolescents alike.
"Label information . . . is not as simple as it may seem. Providers can help prepare adolescents to safely self-administer," Dr. Shone told Medscape Pediatrics.
The study was funded by the National Institute for Child Health and Human Development and the Centers for Disease Control and Prevention, Office of the Director. The authors have disclosed no relevant financial relationships.
Pediatric Academic Societies (PAS) 2010 Annual Meeting: Poster session 1476.250. Presented May 1, 2010.
my note: for adolescents/adults - do not take more than 4 gram of panadol (add all sources - including combination flu-fever tabs) per day.
Brian Hoyle
May 7, 2010 (Vancouver, British Columbia) — A study of more than 250 teenagers and young adults by researchers at the University of Rochester, in New York, has found that more than 60% do not know what acetaminophen is, even though a third are users of acetaminophen-containing over-the-counter (OTC) pain-relieving products. Nearly 25% misuse the medications, researchers announced here at the Pediatric Academic Societies 2010 Annual Meeting.
"Acetaminophen toxicity is a big deal, but we know a lot more [about its effects] in adults than we do in adolescents. The adolescent age group is what is new about this work," said study presenter Laura Shone, DrPH, MSW, associate professor of pediatrics and clinical nursing, Department of Pediatrics, University of Rochester Medical Center, in an interview with Medscape Pediatrics.
The problem is huge, Dr. Shone said. Published studies have documented that overdoses of acetaminophen are the cause of more acute liver failure in the United States than viral hepatitis. Furthermore, one half to two thirds of these overdoses are unintentional and result from taking excessive doses of OTC medication.
At the heart of this problem is a lack of awareness about medications being consumed (health literacy). Agencies such as the National Academy of Sciences (NAS) have weighed in on the issue. Estimates are that up to half of American adults have problems with health literacy, which, according to a 2004 NAS report, is "the ability to find, understand, and use health information to communicate and make health decisions and function successfully as a patient."
The situation for adolescents is far less clear, particularly concerning the understanding of OTC medications and label instructions for their use, explained Dr. Shone.
"Health literacy in regard to OTC meds is truly lacking in the adolescent age group, because the medication managers prior to these years were the adults in the home. Now, there is capability and access without knowledge, in combination with teenage behavior and thoughts — a combination of [the attitude that] nothing is going to hurt me, impulsive thinking, and risk-taking behaviors — that are all in play," Germaine Defendi, MD, associate clinical professor, Department of Paediatrics, Olive View/UCLA Medical Center, Los Angeles, told Medscape Pediatrics.
In the study, conducted in 2008 and 2009, 266 youth (age range, 16 to 23 years; mean age, 18.6 ± 2 years; 56% female) from Monroe County, New York, were anonymously recruited, passively during visits to clinics or more actively during health information sessions at schools and elsewhere. The health literacy of the participants was determined using the Rapid Estimate of Adult Literacy (REALM) or REALM-Teen surveys. Limited health literacy was a REALM score of 60 or below, or a REALM-Teen score of 62 or below.
Of the 266 participants, 96 (36%) had limited health literacy and 170 (64%) had adequate health literacy.
A survey solicited information about knowledge of acetaminophen as the active ingredient in OTC pain relief medications, the ability to identify acetaminophen-containing OTC products, and the ability to identify the one-time and daily dosage limits of acetaminophen.
Fully 63% of the participants had no knowledge of acetaminophen, even though 33% of them had used an acetaminophen-containing OTC product within the previous month. The majority displayed limited health literacy.
Multivariate analysis pegged inadequate health literacy as the main reason for taking too few or too many pills per dose, for incorrect frequency of use, and for incorrect maximum daily dose. Even 77% of those identified as health literate did not know the maximum daily dose of acetaminophen.
"I truly think that this is a worthwhile study addressing the lack of knowledge in teens about OTC medication. Kids know that there are things that they can easily purchase OTC that are medicines. But a true understanding of the medications and what they are used for and what they do is lacking," Dr. Germaine told Medscape Pediatrics.
Dr. Shone and the other study authors suggest that providers of OTC drugs have "a critical role" to play in conveying information in a way that is meaningful and relevant to adults and adolescents alike.
"Label information . . . is not as simple as it may seem. Providers can help prepare adolescents to safely self-administer," Dr. Shone told Medscape Pediatrics.
The study was funded by the National Institute for Child Health and Human Development and the Centers for Disease Control and Prevention, Office of the Director. The authors have disclosed no relevant financial relationships.
Pediatric Academic Societies (PAS) 2010 Annual Meeting: Poster session 1476.250. Presented May 1, 2010.
my note: for adolescents/adults - do not take more than 4 gram of panadol (add all sources - including combination flu-fever tabs) per day.
Wednesday, April 28, 2010
CELL PHONES ARE DISTRACTING TO CHILD PEDESTRIANS
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)
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)
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
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