Monday, November 20, 2006

Epilepsy Myths

Epilepsy Myths

Myth: Epilepsy is rare.
Fact: More than 2.5 million Americans have epilepsy.

Myth: Epilepsy is contagious.
Fact: Epilepsy is not contagious.

Myth: You should put an object, such as a spoon, in the mouth of a person having a seizure to keep them from swallowing their tongue.
Fact: Nothing should be placed in the person’s mouth. While it is not physically possible to swallow one’s tongue, if the tongue is relaxed, it could block the breathing passage. Therefore, the person should be turned on his side so the tongue falls away and to the side.

Myth: Epilepsy is a psychological condition.
Fact: Epilepsy is a medical condition. Seizures are the result of an excessive and disorderly discharge of electrical energy in the brain.

Myth: You have to be born with epilepsy.
Fact: Epilepsy often first appears in children and young adults, although anyone can develop epilepsy at any time.

Myth: You can’t prevent epilepsy.
Fact: While no specific cause can be pinpointed in a majority of epilepsy cases, some causes, such as severe head injuries experienced in falling from a bicycle or sustained in an automobile accident, have been identified. This is why helmet safety is so important for children as a preventive measure.

Myth: Epilepsy can be cured.
Fact: There is no known cure for epilepsy. However, modern treatment methods can achieve full control of seizures in a majority of cases.

Myth: Epilepsy is a lifelong disorder.
Fact: Epilepsy is not necessarily a lifelong disorder. Many persons with epilepsy will not have seizures or require medication all of their lives.

Myth: Persons with epilepsy are "epileptics."
Fact: Persons with epilepsy are individuals who experience chronic, recurrent seizures and prefer being described as "persons with epilepsy."

Myth: Persons with epilepsy have "fits."
Fact: Persons with epilepsy have recurrent seizures, caused by a sudden and unusual discharge of electrical energy in the brain. The word "fits" is an outdated term for seizures.

Myth: Epilepsy is a sign of low intelligence.
Fact: Epilepsy is a physical condition, not a mental illness or handicap.

Myth: A person having a seizure should be held down.
Fact: Don’t try to restrain the person; this might cause injury. Instead, move anything hard or sharp out of the way, and place something soft under the person’s head.

Myth: Always call an ambulance when a person has a seizure.
Fact: Unless the seizure lasts more than 5 minutes, or is followed by a series of seizures, it is seldom necessary to call an ambulance.

Myth: You can make a person "snap out" of a seizure.
Fact: There is really nothing you can do to end a seizure. The best thing is to be supportive and reassuring once the person regains consciousness.

Friday, November 17, 2006

Child Abuse


Child abuse means a physical injury which is inflicted by other than accidental means on a child by another person. The Law defines child abuse as: (1) Physical abuse, (2) Neglect, both general and severe, (3) Sexual abuse (4) and Emotional abuse.
In 2003, the California Department of Social Services estimated that 376,279 referrals for investigation of child abuse and neglect involving 715,062 children were handled by child welfare services agencies. According to a 2002 audit by the California Department of Health Services, approximately 140 children died in the state as a result of child abuse and neglect.
Each year, more than 3 million children are reported as abused or neglected to child protective agencies in the United States. In 2003, an estimated 1,500 children died of child abuse and neglect in the U.S. (the most recent data available). Nationally, children younger than one year accounted for 43.6 percent of child abuse deaths in 2003. Prevent Child Abuse-America, one of the nation's leading child abuse prevention organizations, estimates the total direct and indirect cost of child abuse and neglect is approximately $94 billion per year.

Physical abuse
- Frustrated or angry parent or care giver strikes, shakes or throws a child. Intentional assault, such as burning, biting, cutting, poking, twisting limbs or otherwise torturing a child, is also included in this category of child abuse.
Neglect - Neglect includes both severe and general neglect. Severe neglect includes either the negligent failure of a parent or caretaker to protect the child from severe malnutrition or medically diagnosed nonorganic failure to thrive. Neglect can also include a parent or caretaker willfully causing or permitting the person or health of the child to be placed in a situation such that his or her person or health is endangered. This includes the intentional failure to provide adequate food, clothing, shelter or medical care. General neglect is the negligent failure of a person having the care or custody of a child to provide adequate food, clothing, shelter, medical care, or supervision. An example of general neglect includes inadequate supervision, such as parents leaving their children unsupervised during the hours when the children are out of school.
Sexual abuse - Sexual assault includes rape, rape in concert, incest, sodomy, oral copulation, penetration of genital or anal opening by a foreign object and child molestation.
Emotional maltreatment - Verbal assault (belittling, screaming, threats, blaming, sarcasm, unpredictable responses, continual negative moods, constant family discord and double-message communication are ways parents may subject their children to emotional abuse.

FACTS National

- Nationally, in 2003, an estimated 2.9 million referrals alleging child abuse or neglect were accepted by state and local child protective services (CPS) agencies for investigation or assessment. Approximately 906,000 children were determined to be victims of child abuse and neglect by the CPS agencies. (Child Maltreatment 2003, National Child Abuse and Neglect Data System (NCANDS), Administration for Children and Families, U.S. Department of Health and Human Services, published in 2005)
- During 2003, an estimated 1,500 children died from abuse and neglect in the U.S. (NCANDS, 2005)
- Nationally, more than 60 percent of child victims were neglected, 20 percent were physically abused, 10 percent were sexually abused and 5 percent were emotionally
maltreated. (NCANDS, 2005)
- Children under the age of one accounted for 43.6 percent of child fatalities during 2003, while 78.7 percent of fatalities were younger than 3 years of age. (NCANDS, 2005)
- Approximately 80 percent of perpetrators are parents. (NCANDS, 2005)
- Women comprised 58.1 percent of all perpetrators, while men comprised 42.7 percent. Female perpetrators were typically younger than male perpetrators. (NCANDS, 2005)
- Childhood abuse and neglect increases the odds of arrest as a juvenile by 59%, arrest as an adult by 28% and arrest for a violent crime by 30%. (Update, The Cycle of Violence, National Institute of Justice, 2001)
- Prevent Child Abuse-America, one of the nation's leading child abuse prevention organizations, estimates the total direct and indirect cost of child abuse and neglect is approximately $94 billion per year.
- Because of its anonymity, rapid transmissions and unsupervised nature, the Internet has become the venue of choice for predators who transmit and receive child pornography. (Child Abuse Prevention Handbook, Attorney General's Crime and Violence Prevention Center)

Thursday, November 16, 2006

Symptoms of Shaken Baby Syndrome

Every week we read or hear about another child injured or who died due to violent shaking or resulting impact. Shaken Baby Impact Syndrome (SBIS) is the medical term used to describe the violent shaking and the possible impact during the incident, and, the results sustained from it. This form of child abuse can result in serious brain injury, seizures, mental retardation, paralysis, blindness, broken bones, learning difficulties, delayed development, and more. One shaken baby in four dies.

One of our main goals is to educate early in life to prevent, and reduce, the number of victims of Shaken Baby Impact Syndrome through prevention and education efforts. The Epilepsy Association of Central Florida has specifically designed a video and teaching curriculum that can be used by teachers, health educators, childcare advocates, and the community at large.

Here are a few symptoms of Shaken Baby Syndrome that have already been discovered:
- Head turned to one side.
- Unable to lift or turn head.
- Pinpointed, dilated, or unequal size pupils.
- Blood pooling in the eyes.
- Pupils unresponsive to light.
- Bulging or spongy forehead.
- No smiling or vocalization.
- Poor sucking or swallowing.
- Rigidity.
- Semi-consciousness, lethargy, or decreased muscle tone.
- Difficulty breathing.
- Seizures or spasms. Swollen head, which may appear later.

Warning Signs of Injury of Shaken Baby Syndrome
- Poor Feeding / Eating
- Cardiopulmonary arrest.
- Vomiting.
- Failure to thrive
- Pale or blush skin.
- Irritability
- Seizures
- Lethargic
- Coma

The Epilepsy Association of Central Florida

Tuesday, November 14, 2006


First aid at epilepsy

First aid at epilepsy

Not all types of seizures require first aid. In many cases all the person needs is emotional support and reassurance. This guide is designed to assist you with generalized tonic-clonic seizures (grand mal/convulsive). We urge you to visit more detailed web sites or contact us for complete information regarding first aid for all types of seizures.

Although most seizures end naturally and without the need for emergency treatment, a seizure in someone that has not been diagnosed with epilepsy/seizure disorder could be a sign of serious illness. Call medical assistance if:

- the seizure lasts more than 5 minutes
- no epilepsy/seizure disorder I.D. visible
- slow recovery, a second seizure, or difficulty breathing afterwards
- pregnancy or other medical I.D.
- any signs of injury or sickness.

Some things to avoid

DO NOT restrain a person's movement in any way, except to prevent injury from a possible accident.
DO NOT put any hard object between the teeth or in the mouth (the tongue cannot be swallowed).
DO NOT attempt to give the person liquids during or at the immediate conclusion of a seizure.
DO NOT give artificial respiration or oxygen during a seizure. However, if normal breathing does not resume at the end of the seizure artificial respiration should be started.
DO NOT shout at the person or expect response to a verbal command.
DO be helpful and reassuring.

A special note to parents and teachers!

Non-convulsive seizures, such as staring spells, day dreaming or lack of attentiveness can easily be overlooked in children. Symptoms of non-convulsive seizures include loss of awareness for a few seconds, staring and blinking or twitching of the eyelids. Many children diagnosed with ADD/ADHD are misdiagnosed and may have partial seizures.

Again, we encourage you to visit our linked sites, or contact us to gain assistance with further and complete information.

Retinal migraine

Retinal migraine reappraised

BM Grosberg1 , S Solomon1 , DI Friedman2 & RB Lipton1,3

Cephalalgia 2006; 26:1275–1286. London. ISSN 0333-1024

Retinal migraine is usually characterized by attacks of fully reversible monocular visual loss associated with migraine headache. Herein we summarize the clinical features and prognosis of 46 patients (six new cases and 40 from the literature) with retinal migraine based upon the International Classification of Headache Disorders-2 (ICHD-2) criteria. In our review, retinal migraine is most common in women in the second to third decade of life. Contrary to ICHD-2 criteria, most have a history of migraine with aura. In the typical attack monocular visual features consist of partial or complete visual loss lasting <1 h, ipsilateral to the headache. Nearly half of reported cases with recurrent transient monocular visual loss subsequently experienced permanent monocular visual loss. Although the ICHD-2 diagnostic criteria for retinal migraine require reversible visual loss, our findings suggest that irreversible visual loss is part of the retinal migraine spectrum, perhaps representing an ocular form of migrainous infarction. Based on this observation, the authors recommend migraine prophylactic treatment in an attempt to prevent permanent visual loss, even if attacks are infrequent. We also propose a revision to the ICHD-2 diagnostic criteria for retinal migraine.

Volume 26 Page 1275 - November 2006

Monday, November 13, 2006

Chronic headache in immigrants

One-year prevalence and socio-cultural aspects of chronic headache in Turkish immigrants and German natives

I Kavuk , C Weimar , BT Kim1 , G Gueneyli , M Araz , E Klieser1 , V Limmroth , HC Diener & Z Katsarava

The aim of this research was to study the prevalence of chronic headache (CH) and associated socio-cultural factors in Turkish immigrants and native Germans. Five hundred and twenty-three Turkish and German company employees were screened using a standard questionnaire. Those who suffered from headaches were also examined by a neurologist. Complete data were available for 471 (90%) subjects. Thirty-four participants (7.2%) had CH. Two independent factors for association with CH could be identified: overuse of acute headache medication (OR = 72.5; 95% CI 25.9–202.9), and being a first-generation Turkish immigrant compared with native Germans (OR = 4.4; 95% CI 1.4–13.7). In contrast, the factor associated with chronic headache was not increased in second-generation Turkish immigrants. Medication overuse was significantly more frequent in first-generation Turkish immigrants (21.6%) compared with second-generation Turkish immigrants (3.3%) and native Germans (3.6%; χ2 = 38.0, P < 0.001). First-generation Turkish immigrants did not contact headache specialists at all, compared with 2.8% of second-generation Turkish immigrants and 8.8% of native Germans (χ2 = 118.4, P < 0.001). Likewise no first-generation Turkish immigrant suffering from CH received headache preventive treatment, compared with 6.6% of native Germans (χ2 = 19.1, P = 0.014). The data from this cross-sectional study reveal a high prevalence of chronic headache as well as a very low utilization of adequate medical care in first-generation Turkish immigrants in Germany.

Cephalalgia 2006. London. ISSN 0333-1024
CephalalgiaVolume 26 Page 1177 - October 2006

Vaccines and autism

Vaccines and the changing epidemiology of autism

B. Taylor

Background. The epidemiology of autism has been rather confusing, with very variable published prevalence figures and no clear incidence data. The cause of autism is unclear; vaccines have been incriminated.

Results. The recorded prevalence of autism has increased considerably in recent years. This reflects greater recognition, with changes in diagnostic practice associated with more trained diagnosticians; broadening of diagnostic criteria to include a spectrum of disorder; a greater willingness by parents and educationalists to accept the label (in part because of entitlement to services); and better recording systems, among other factors. The cause(s) of autism remains unclear. There is a strong genetic component which, along with prenatally determined neuro-anatomical/biochemical changes, makes any post-natal 'cause' unlikely.

Conclusions. There has (probably) been no real increase in the incidence of autism. There is no scientific evidence that the measles, mumps and rubella (MMR) vaccine or the mercury preservative used in some vaccines plays any part in the aetiology or triggering of autism, even in a subgroup of children with the condition.

Child: Care, Health and Development
Volume 32 Page 511 - September 2006

Saturday, November 11, 2006

New mother...

Pediatric Cancer Survivorship

Pediatric Cancer Survivorship: Research and Clinical Care

Anna T. Meadows

From the Children's Hospital of Philadelphia, Philadelphia, PA

Regardless of how one defines survivorship, more than 10 million individuals in the United States have been treated for a malignant disease; about 250,000 were younger than 21 years of age at diagnosis. Thirty years ago, pediatric oncologists recognized that children with cancer might be cured by adding chemotherapy to surgery and radiation. Studies were then begun of complications that could reduce survival or the quality of survival, and that might be associated with previous therapy. The complications were termed late effects, and studies focused on patients who were likely to be cured, or less likely to succumb to the original cancer than they were to experience disabilities. Clinical trials tested whether changes in therapy to reduce complications could maintain the same excellent survival rates. During the last 20 years, articles detailing late effects and the relationship between therapy and outcome have been published. This article reviews the progress made in understanding the outcomes reported and the efforts made to improve the quality of long-term survival for children and adolescents. Several questions remain regarding the long-term complications of therapy. Clinicians need more data regarding the effects of aging to guide them in managing former patients. Caregivers and pediatric cancer survivors who are now adults seek the optimal venue in which to receive care as independent adults. In addition, medical oncologists need to determine whether the models for research and clinical care of survivors created in pediatric oncology can be applied to survivors of adult-onset cancer. Full Text (PDF)

Journal of Clinical Oncology, Vol 24, No 32 (November 10), 2006: pp. 5160-5165
© 2006 American Society of Clinical Oncology.

Friday, November 10, 2006

Prognostic factor in node-negative breast cancer patients.

Low number of examined lymph nodes in node-negative breast cancer patients is an adverse prognostic factor

I Blancas1, JL García-Puche2, B Bermejo1, EO Hanrahan3, C Monteagudo4, A Martínez-Agulló5, R Rouzier6, BT Hennessy3, V Valero3 and A Lluch1
1) Department of Oncology and Hematology, Clinic Hospital, Valencia, Spain
4) Department of Pathology, Clinic Hospital, Valencia, Spain
5) Department of Surgery, Clinic Hospital, Valencia, Spain
2) Unit of Oncology, San Cecilio Clinic Hospital, Granada, Spain
3) Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
6) Department of Gynecology and Obstetrics, Hôpital Tenon, Tenon, France

Background: The aim of the study was to determine whether the number of lymph nodes removed at axillary dissection is associated with recurrence and survival in node-negative breast cancer (NNBC) patients.
Patients and methods: We retrospectively reviewed the medical records of 1606 women with pathologically node-negative T1–T3 invasive breast cancer. Median follow-up was 61 months (range 2–251). Potential prognostic factors assessed included: number of axillary lymph nodes examined, age, menopausal status, tumor size, histological type, tumor grade, estrogen receptor(ER), progesterone receptor (PR) and HER2.
Results: At 5 years, relapse-free survival (RFS) rate was 85% and breast cancer-specific survival (BCSS) rate was 94%. In univariate analysis, factors significantly associated with lower RFS and BCSS were: fewer than six lymph nodes examined (RFS, P = 0.01; BCSS, P = 0.007), tumor size >2 cm, grade III, negative ER or PR. Statistically significant factors for lower RFS and BCSS in multivariate analysis were: fewer than six lymph nodes examined [RFS, hazard ratio (HR) 1.36, P = 0.029; BCSS, HR 1.87, P = 0.005], tumor size >2 cm, tumor grade III and negative PR.
Conclusions: Examination of fewer than six lymph nodes is an adverse prognostic factor in NNBC because it could lead to understaging. Six or more nodes need to be examined at axillary dissection to be confident of a node-negative status. This may be useful, in conjunction with other prognostic factors, in the assessment of NNBC patients for adjuvant systemic therapy.

Annals of Oncology 2006 17(11):1644-1649;
© 2006 European Society for Medical Oncology

Traumatic brain injuries: family adaptation

Long-term Parental and Family Adaptation Following Pediatric Brain Injury

Shari L. Wade, PhD1, H. Gerry Taylor, PhD2, Keith Owen Yeates, PhD3, Dennis Drotar, PhD3, Terry Stancin, PhD4, Nori M. Minich, BA2 and Mark Schluchter, PhD1

1) Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine,
2) Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine,
3) Department of Pediatrics, Columbus Children’s Hospital, The Ohio State University, and,
4) Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University School of Medicine.

Objective. To determine whether parents of children with traumatic brain injuries (TBI) report increased injury-related burden, distress, and family dysfunction and to examine the effects of attrition on the results. Methods Children with severe TBI, moderate TBI, and orthopedic injuries were followed at six time points from baseline to 6 years after injury. Parents completed measures of injury-related burden, psychological distress, and family functioning at each assessment. Mixed model analysis was used to examine long-term changes.

Results. Attrition was higher among families in the severe TBI group with lower burden thereby amplifying group differences. The severe TBI group reported higher injury-related burden over time after injury than the other groups. Family functioning was moderated by social resources. Families of children with severe TBI and low resources reporting deteriorating functioning over the follow-up interval.

Conclusions. Although environmental advantages moderate long-term effects on family functioning, families of children with severe TBI experience long-standing injury-related burden.

Journal of Pediatric Psychology 2006 31(10):1072-1083
© The Author 2005. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail:

Wednesday, November 08, 2006

Shaken Baby Syndrome

Shaken Baby Syndrome Statistics
  • One shaken baby in four dies.Some studies estimate that 15% of children's deaths are due to battering or shaking, and an additional 15% are possible cases of shaking.
  • Of the 37 children that died in Florida in 1995-96 13 died from a combination of Shaken Baby Syndrome/ Head Trauma.
  • Of the thousands that survive death, serious injury usually occurs."SBS" victims range in age from a few days to a few months old; the average is six months.
  • More than 60% of the victims of Shaken Baby Syndrome are male.
  • Almost 80% of the perpetrators of Shaken Baby Syndrome are male.

Shaken Baby Syndrome, first described as a syndrome in 1974, can be lethal: approximately one shaken baby in four dies from the injuries. Those who survive may suffer blindness caused by bleeding around the brain and eyes, or disabling brain damage, including mental retardation (mild to severe), paralysis, seizure disorder, speech and learning disabilities, neck and back damage, and dislocated bones.

Who's watching the baby?

Tuesday, November 07, 2006

Effects of Smoking Cessation on Changes in Blood Pressure

Effects of Smoking Cessation on Changes in Blood Pressure and Incidence of Hypertension: A 4-Year Follow-Up Study

Duk-Hee Lee; Myung-Hwa Ha; Jang-Rak Kim; David R. Jacobs, Jr

From the Department of Preventive Medicine (D.-H.L.), College of Medicine, Kosin University, Pusan, Korea; Health Care Center (M.-H.H.), Pohang Steel Company, Pohang, Korea; Department of Preventive Medicine (J.-R.K.), College of Medicine, Gyeongsang National University, Chinju, Korea; and Division of Epidemiology (D.R.J.), School of Public Health, University of Minnesota, Minneapolis.

We performed the present study to investigate the effects of smoking cessation on changes in blood pressure and incidence of hypertension. We evaluated 8170 healthy male employees at a steel manufacturing company who had received occupational health examinations at the company’s health care center in 1994 and were reexamined in 1998. Adjustment covariates were the baseline age, body mass index, cigarette smoking, alcohol consumption, exercise, family history of hypertension, systolic or diastolic blood pressure, and changes in body mass index and alcohol consumption during the follow-up period. The adjusted relative risks of hypertension in those who had quit smoking for <1, and =" type=">3 years were 0.6 (95% CI 0.2 to 1.9), 1.5 (95% CI 0.8 to 2.8), and 3.5 (95% CI 1.7 to 7.4), respectively, compared with current smokers. The trends for increased risk of hypertension for longer periods of smoking cessation were observed in subgroups of those who maintained weight as well as those who gained weight after smoking cessation. The adjusted increments in both systolic and diastolic blood pressure were higher in those who had quit for =" type="#_x0000_t75">1 year than in current smokers. These trends among weight losers, as well as gainers and maintainers, were similar. We observed progressive increases in blood pressure with the prolongation of cessation in men, although at this time the mechanism remains unknown and must be clarified. This study implies that the cessation of smoking may result in increases in blood pressure, hypertension, or both.

Hypertension. 2001;37:194.
© 2001 American Heart Association, Inc.

Obesity in hypertensive patients

Does obesity influence early target organ damage in hypertensive patients?

RE Schmieder and FH Messerli
Department of Medicine, University of Erlangen-Nurnberg, Germany.

BACKGROUND. Various prospective studies have found that lean hypertensive patients have greater cardiovascular morbidity and mortality than obese hypertensive subjects. It was therefore hypothesized that hypertension is more benign when associated with obesity. In the present study, we evaluated effects of obesity on early target organ damage in patients with essential hypertension.
METHODS AND RESULTS. In a total of 207 subjects, systemic and renal hemodynamics as well as left ventricular structure and function were assessed by measuring cardiac output (indocyanine green dye dilution), renal blood flow (clearance of 131I paraimmunohippuric acid), and mean arterial pressure (invasively) and by two-dimensionally guided M-mode echocardiographic findings. Systemic and renal vascular resistance, compliance of the large arteries evaluated by the stroke volume/pulse pressure index, and left ventricular mass served as parameters for early target organ damage. All individuals were categorized into four groups: lean and obese normotensive as well as lean and obese hypertensive subjects. In obese hypertensive patients, total peripheral resistance was significantly lower and stroke volume/pulse pressure index was higher than in the lean hypertensive group, almost reaching values of normotensive control subjects. No effect of obesity on the renal circulation was noted, whereas in hypertension, renal vascular resistance was elevated. The degree of left ventricular hypertrophy was more pronounced in the hypertensive groups than in their normotensive counterparts and progressively increased with obesity. Nevertheless, in obese hypertensive patients, left ventricular function, as measured by fractional fiber shortening and velocity of circumferential fiber shortening, was maintained despite the fact that the heart had been exposed to the double burden of an increased preload (obesity) and afterload (hypertension).
CONCLUSIONS. Obesity had a disparate effect on target organs in hypertension. At rest, obesity seemed to mitigate cardiovascular changes in the systemic vascular bed caused by hypertension. However, no such mitigation was observed in the renal vasculature, and left ventricular hypertrophy was even exacerbated by the presence of obesity. Our findings in part negate the concept that obesity is able to exert a protective effect on early target organ damage in hypertensive patients and, in particular, on the heart.
Full Text (PDF)

Circulation 1993, Vol 87, 1482-1488,
© 1993 by American Heart Association

Sunday, November 05, 2006

Special Section on Families

Introduction to the Special Section on Families, Youth, and HIV: Family-Based Intervention Studies

Geri R. Donenberg, PhD(1), Roberta Paikoff, PhD(1) and Willo Pequegnat, PhD(2)
1) University of Illinois at Chicago and 2) National Institute of Mental Health

Every year, a new generation at-risk for human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) emerges, posing unique challenges for prevention and intervention. Young people are now at the center of the acquired immunodeficiency syndrome (AIDS) epidemic; 25% of STIs reported annually occur among youth, and around half of the people who acquire HIV become infected before they turn 25. AIDS is currently the leading cause of death in 15- to 24-year olds (National Center for Health Statistics, 2005 ). Most young people acquire HIV through unprotected sexual activity, and, thus, reducing adolescent sexual risk taking has become a national and international public health priority. Substance use also confers increased risk of exposure to HIV by impairing sexual decision-making and leading to inaccurate condom use. Unfortunately, rates of adolescent sexual behavior and substance use remain high. National surveys indicate that 60.7% of males and 62.3% of females report having . . . [Full Text of this Article]

Journal of Pediatric Psychology 2006 31(9):869-873
© The Author 2006. Published by Oxford University Press on behalf of the Society of Pediatric Psychology.

Reducing Children's Television-Viewing Time

Reducing Children's Television-Viewing Time: A Qualitative Study of Parents and Their Children

Amy B. Jordan, PhD(a), James C. Hersey, PhD(b), Judith A. McDivitt, PhD(c) and Carrie D. Heitzler, MPH(c)
a) Annenberg Public Policy Center, Philadelphia, Pennsylvania
b) RTI International, Washington, District of Columbia
c) Centers for Disease Control and Prevention, Atlanta, Georgia

OBJECTIVES. The American Academy of Pediatrics recommends that children over age 2 years spend 2 hours per day with screen media, because excessive viewing has been linked to a plethora of physical, academic, and behavioral problems. The primary goal of this study was to qualitatively explore how a recommendation to limit television viewing might be received and responded to by a diverse sample of parents and their school-age children.
METHODS. The study collected background data about media use, gathered a household media inventory, and conducted in-depth individual and small group interviews with 180 parents and children ages 6 to 13 years old.
RESULTS. Most of the children reported spending 3 hours per day watching television. The average home in this sample had 4 television sets; nearly two thirds had a television in the child's bedroom, and nearly half had a television set in the kitchen or dining room. Although virtually all of the parents reported having guidelines for children's television viewing, few had rules restricting the time children spend watching television. Data from this exploratory study suggest several potential barriers to implementing a 2-hour limit, including: parents' need to use television as a safe and affordable distraction, parents' own heavy television viewing patterns, the role that television plays in the family's day-to-day routine, and a belief that children should spend their weekend leisure time as they wish. Interviews revealed that for many of these families there is a lack of concern that television viewing is a problem for their child, and there remains confusion about the boundaries of the recommendation of the American Academy of Pediatrics.
CONCLUSIONS. Parents in this study expressed interest in taking steps toward reducing children's television time but also uncertainty about how to go about doing so. Results suggest possible strategies to reduce the amount of time children spend in front of the screen.

PEDIATRICS Vol. 118 No. 5 November 2006, pp. e1303-e1310

Saturday, November 04, 2006

Smokers and non-smokers: tobacco control

Smokers and non-smokers talk about regulatory options in tobacco control

Stacy M Carter(1) and Simon Chapman(2)

1) Centre for Values, Ethics and the Law in Medicine, Central Clinical School, Faculty of Medicine, The University of Sydney, NSW, Australia
2) School of Public Health, The University of Sydney, NSW, Australia

Objective: Community members are occasionally polled about tobacco control policies, but are rarely given opportunities to elaborate on their views. We examined laypeople’s conversations to understand how 11 regulatory options were supported or opposed in interactions.
Design: Qualitative design; purposive quota sampling; data collection via focus groups.
Setting: Three locations in Sydney, Australia.
Participants: 63 smokers and 75 non-smokers, men and women, from three age groups (18–24, 35–44, 55–64 years), recruited primarily via telephone.
Measurements: Semi-structured question route; data managed in NVivo; responses compared between groups.
Results: Laypeople rejected some regulatory proposals and certain arguments about taxation and the cost of cessation treatments. Protecting children and hypothecating tobacco excise for health education and care were highly acceptable. Plain packaging, banning retail displays and youth smoking prevention received qualified support. Bans on political donations from tobacco corporations were popular in principle but considered logistically fraught. Smokers asked for better cessation assistance and were curious about cigarette ingredients. Justice was an important evaluative principle. Support was often conditional and unresolved arguments frequent. We present both sides of these conflicts and the ways in which policies were legitimised or de-legitimised in conversation.
Conclusions: Simple measures of agreement used in polls may obscure the complexity of community responses to tobacco policy. Support was frequently present but contested; some arguments that seem self-evident to advocates were not so to participants. The detailed understanding of laypeople’s responses provided through qualitative methods may help frame proposals and arguments to meet concerns about justice, effectiveness and feasibility.

Tobacco Control 2006;15:398-404; Full Text
© 2006 by BMJ Publishing Group Ltd

Cardiovascular disease: childhood risk factors

Childhood risk factors for adult cardiovascular disease and primary prevention in childhood

D S Celermajer and Julian G J Ayer

Department of Cardiology, Royal Prince Alfred Hospital, Sydney, and Department of Medicine, University of Sydney, Sydney, New South Wales, Australia

Keywords: atherosclerosis; endothelium; obesity; smoking; hyperlipidaemia

Atherosclerosis has been demonstrated in autopsy studies to have its origins in childhood. In the young, there is a correlation between the intensity of exposure to risk factors such as cigarette smoking, hypertension, dyslipidaemia and diabetes mellitus and the extent and severity of arterial fatty streaks or raised plaques.
An important current trend that may increase the future burden of coronary heart disease (CHD) is a significant increase in the prevalence of childhood obesity. In obesity, many of the risk factors for CHD are clustered together. Moreover, these risk factors usually persist or track into adulthood, so that their effect on the cardiovascular system may be present and influential for several decades. [
Full text of this article]

Heart 2006;92:1701-1706
© 2006 by BMJ Publishing Group Ltd & British Cardiovascular Society

Friday, November 03, 2006

Acute Lymphocytic Leukemia: The Future

Acute Lymphocytic Leukemia: The Future

Clinical Trials
New approaches to therapy are under study in clinical trials, which permit physicians to determine the beneficial effects of new treatments and what, if any, adverse effects they have. New drugs, new types of immunotherapy and new approaches to stem cell transplantation are continually being explored to bring new and better treatments to the patient. The Society's Information Resource Center offers guidance on how patients can work with their physicians to find out if a specific clinical trial is an appropriate treatment option. Information Specialists will conduct clinical trial searches for patients, family members and healthcare professionals. Information Specialists can be called at (800) 955-4572. The service is also available on the Society's Web site at

Leukemia-Specific Therapy
Increasingly, clinical studies are identifying leukemia by more specific criteria than the appearance of the leukemia cells. These additional factors include the type of chromosome abnormality, the presence of multidrug resistance characteristics, the immunophenotype, and others. New and different drug regimens are being tested in situations that are likely to be refractory to the usual chemotherapy.
These and other new approaches, many of which are being supported by the research programs of The Leukemia & Lymphoma Society, hold the promise of increasing the rate of remission and finding cures for all blood-related cancers.

New Drug Treatments
Extensive testing is being conducted to synthesize new drugs or find them from natural (botanical) sources. These drugs are first tested for their usefulness in the laboratory and then, through the method of clinical trials, on patients. Researchers are also investigating new combinations of existing drugs for their usefulness in the treatment of leukemia, Hodgkin and non-Hodgkin lymphoma, and myeloma.

Drug Resistance
The leukemia cells of some patients are not as easily killed by drugs as those of other patients. This may lead to a failure of current treatment. Research has uncovered mechanisms in some leukemia cells that protect them from the effects of chemotherapy. As these mechanisms become better understood, ways of getting around them are being developed.

Research is being conducted on several approaches that may enhance the body's natural defenses. The goal is to kill or prevent the growth of leukemia cells. Radioimmunotherapy is an example of immunotherapy. This approach combines antibodies with attached isotopes that emit irradiation. These antibodies can be made in the laboratory. They are injected into the patient to destroy leukemia cells. Another approach uses normal lymphocytes which can attack leukemia cells because they have been immunized to recognize the leukemia cells as foreign or abnormal.

The use of stem cells from blood and from cord blood may make transplantation easier. These stem cells can be frozen and stored in a manner similar to a blood bank, making them available to potential recipients who do not have related (sibling) donors with similar tissue types.

These naturally occurring chemicals can be made commercially using the techniques of biotechnology. These chemicals can be used to help restore normal blood cells during treatment or enhance the immune system to attack the leukemia.

Defining the precise changes (mutations) in DNA that cause a normal cell to be transformed into a leukemia cell is leading to the development of new therapies. These therapies could block the effects of cancer-causing genes (oncogenes) and the cancer-causing proteins that the genes direct the cells to make.

Gene Expression Profiling
Current research suggests that the use of molecular techniques, including gene expression profiling, may supplement or replace epidemiologic risk factors. These studies may also help identify molecular targets for leukemia-specific therapy. The development of laboratory methods that assess the overexpression or underexpression of genes in leukemic cells compared to normal cells can give reliable patterns of gene expression that may correlate with the outcome of treatment. The changes in gene expression may also provide targets for new therapies.

The Leukemia & Lymphoma Society

Wednesday, November 01, 2006

New prognostic factor in lung cancer

Thyroid transcription factor 1—a new prognostic factor in lung cancer: a meta-analysis

T Berghmans1,*, M Paesmans2, C Mascaux1, B Martin1, A-P Meert1, A Haller3, J-J Lafitte4 and J-P Sculier1

1) Department of Intensive Care and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles, Belgium
2)Data Centre, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles, Belgium
3) Department of Pathology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles, Belgium
4) Chest Department, Centre Hospitalier Universitaire Calmette, Lille, France
*Correspondence to: Dr T. Berghmans, Institut Jules Bordet, rue Héger-Bordet, 1, B-1000 Brussels, Belgium. Tel: +32-2-541-31-91; Fax: +32-2-534-37-56; E-mail:

Background: The aim of this study was to determine the prognostic role for survival of thyroid transcription factor 1 (TTF-1) in lung cancer.
Methods: Studies evaluating survival and TTF-1 in lung cancer patients, published until August 2005, were assessed with a methodological scoring system. The required data for estimation of individual hazard ratios (HRs) for survival were extracted from the publications and a combined HR was calculated.
Results: We identified 10 eligible papers, all dealing with non-small-cell lung cancer (NSCLC). Eight were meta-analysed (evaluable studies). Seven studies included patients with local and/or locoregional diseases and three dealt only with adenocarcinoma. Median methodological quality score was 65.9% (range = 31.8%–70.5%). TTF-1 positivity was associated with statistically significant reduced or improved survival in one and four studies, respectively. Combined HR for the eight evaluable studies was 0.64 [95% confidence interval (CI) = 0.41–1.00]. In the subgroup of adenocarcinoma, the combined HR was 0.53 (95% CI = 0.29–0.95).
Conclusion: TTF-1 is a good prognostic factor for survival in NSCLC. Its effect appears also significant when the analysis is restricted to patients with adenocarcinoma. This study supports the fact that TTF-1 could be included in further prospective trials studying prognostic factors in NSCLC.

Annals of Oncology 2006 17(11):1673-1676
© 2006 European Society for Medical Oncology

Child sexual abuse

Helping families when child sexual abuse is suspected but not proven

Odd Arne Tjersland , Svein Mossige , Wenke Gulbrandsen , Tine K. Jensen and Sissel Reichelt

This paper reports from a project investigating reactions within families when intra-familial child sexual abuse was suspected, and family members' responses to a therapeutic approach. Data were obtained from therapeutic sessions and follow-up interviews with mothers, children and alleged perpetrators. Before treatment the mothers felt uncertain as to how to interpret the children's unclear signs. The children had severe symptoms, but had seldom disclosed abuse. The alleged perpetrators were often not informed about the suspicions. The families were in a state of crisis and shock, and communication within the family was characterized by uncertainty about what to talk about and whether the suspicions should be shared. In most cases after treatment the conflicts had been reduced, the children had few symptoms, supervised contact had been established, and the clients were satisfied with the treatment. One conclusion is that therapeutic sessions, where family members share information about concerns and take part in the decisions of how to protect children, seem relevant and helpful to the clients in unclear abuse cases.

Child & Family Social Work
Volume 11 Page 297 - November 2006

Training in Tobacco Treatments in Psychiatry

Training in Tobacco Treatments in Psychiatry: A National Survey of Psychiatry Residency Training Directors

Judith J. Prochaska, Ph.D., M.P.H., Sebastien C. Fromont, M.D., Alan K. Louie, M.D., Marc H. Jacobs, M.D. and Sharon M. Hall, Ph.D.

Drs. Prochaska, Jacobs, and Hall are affiliated with the Department of Psychiatry, University of California, San Francisco, California. Dr. Louie is affiliated with San Mateo County Mental Health Services, San Mateo, California, and the University of California, San Francisco, California. Dr. Fromont is affiliated with Alta Bates Summit Medical Center, Berkeley, California, and the University of California, San Francisco, California.

OBJECTIVE: Nicotine dependence is the most prevalent substance abuse disorder among adult psychiatric patients and is a leading cause of death and disability. This study examines training in tobacco treatment in psychiatry residency programs across the United States.
METHOD: The authors recruited training directors to complete a survey of their program’s curriculum related to tobacco treatment, attitudes related to treating tobacco in psychiatry, and perceptions of residents’ skills for addressing nicotine dependence in psychiatric patients. RESULTS: Respondents were representative of the national pool. Half of the programs provided training in tobacco treatments for a median duration of 1 hour. Content areas covered varied greatly. Programs with tobacco-related training expressed more favorable attitudes toward addressing tobacco in psychiatry and were more likely to report confidence in their residents’ skills for treating nicotine dependence. Programs without tobacco training reported a lack of faculty expertise on tobacco treatments. Most training directors reported moderate to high interest in evaluating a model tobacco curriculum for psychiatry and stated they would dedicate an average of 4 hours of curriculum time.
CONCLUSIONS: The findings demonstrate the need for and interest in a model tobacco treatment curriculum for psychiatry residency training. Training psychiatrists offers the potential of delivering treatment to one of the largest remaining groups of smokers: patients with mental disorders.

Acad Psychiatry 30:372-378, October 2006
© 2006
Academic Psychiatry