Tag Archives: JAMA

Kings College London study: Study investigates whether it is safe for GPs to prescribe fewer antibiotics

6 Jul

JAMA published “Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011” led by Katherine Fleming-Dutra, MD, estimated portions of antibiotic use that may be inappropriate in adults and children in the United States. – See more at: http://www.ajmc.com/newsroom/understanding-inappropriate-prescribing-of-antibiotics#sthash.lYnWSCqB.dpuf  This study found  “During 2010-2011, there were 506 annual antibiotic prescriptions per every 1000 population, but only 353 were likely appropriate.” Further, the study found:

Findings
The researchers used 2 annual surveys in 2010 and 2011 to collect data about patients’ demographic characteristics and symptoms, physicians’ diagnoses, and medications ordered, including antibiotics. They found that out of the 184,032 visits, 12.6% of encounters were associated with antibiotic prescriptions. Furthermore, 30% of outpatient prescriptions were in fact unnecessary and inappropriate.

The authors recommend development of diagnostic tests that can distinguish viral infections from bacterial infections in order to improve outpatient antibiotic use.

They used the 2010-2011 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) to collect data on patient demographics. Per 1000 population, the diagnosis that was associated with the most antibiotic prescriptions was sinusitis (56 antibiotic prescriptions), followed by suppurative otitis media (47), and pharyngitis (43). Collectively, acute respiratory conditions per 1000 population led to 221 antibiotic prescriptions each year but only 111 of these were actually appropriate for these conditions.

In general, across all ages and conditions, per 1000 population, an estimated 506 antibiotic prescriptions were written annually. And out of these, only 353 antibiotic prescriptions were estimated to be appropriate.

Spillage of Unnecessary Antibiotic Prescriptions
National guidelines state that patients with bronchitis, bronchiolitis, viral upper respiratory tract infections, asthma and allergy, influenza, and viral pneumonia should not receive antibiotics. Antibiotics prescribed for these conditions are considered inappropriate. And yet the study highlighted staggering numbers of inappropriate antibiotic prescriptions.

In an accompanying editorial, Pranita D. Tamma, MD, MHS, and Sara E. Cosgrove, MD, MS, wrote that the estimates in the Fleming-Dutra’s study were likely conservative, but they serve as a good starting point to understanding prescribing practices in the ambulatory care setting.

“Now that baseline estimates about outpatient antibiotic prescribing have been determined, future work needs to focus on interventions targeting both clinicians and patients to help reach the national goal,” wrote Pranita D. Tamma, MD, MHS, and Sara E. Cosgrove, MD, MS, and an accompanying editorial. “It will be critical to continue to evaluate progress in improving antibiotic use in conjunction with widespread adoption of antibiotic stewardship activities in the outpatient setting.” – See more at: http://www.ajmc.com/newsroom/understanding-inappropriate-prescribing-of-antibiotics#sthash.lYnWSCqB.dpuf

The practice of over-prescribing antibiotics has serious consequences.

Science Daily reported in Study investigates whether it is safe for GPs to prescribe fewer antibiotics:

A new study has found that reducing antibiotic prescribing for respiratory tract infections — such as coughs, colds, sore throats and ear infections — is not linked to an increase in the most serious bacterial complications, such as bacterial meningitis. The study, published in the BMJ, investigated whether reducing antibiotic prescribing for people attending their GP with respiratory tract infections could have an effect on safety.

Most respiratory tract infections are caused by viruses and will improve without treatment. Antibiotic treatment has minimal effect on the duration and severity of symptoms in these conditions, but may be associated with side-effects.

The widespread inappropriate use of antibiotics is contributing to the development of strains of bacteria that are resistant to antibiotics.

This study, funded by the NIHR and led by researchers from King’s College London, analysed patient records from 610 UK general practices, with more than four million patients, over 10 years. General practices with lower rates of antibiotic prescribing for respiratory tract infections did not have higher rates of serious bacterial complications, including: meningitis, mastoiditis (infection of the mastoid bone behind the ear), empyema (infection of the lining of the lungs), brain abscess or Lemierre’s syndrome (an infection of the jugular vein in the neck).

The research found that practices that prescribed fewer antibiotics had slightly higher rates of pneumonia and peritonsillar abscess (also known as quinsy) — a rare complication of sore throats. Both of these conditions are treatable with antibiotics once identified.

The researchers estimated that if an average-sized GP practice with 7,000 patients reduced its antibiotic prescribing to people with respiratory tract infections by 10 per cent, there could be one extra case of pneumonia each year. They also estimated that this reduced prescribing could be linked to one extra case of peritonsillar abscess every 10 years.

The authors observe that reducing antibiotic use is likely to reduce the number of people experiencing side-effects. About 10 per cent of people who take antibiotics experience common side-effects such as rashes, diarrhea and vomiting, while rare side-effects include anaphylaxis….https://www.sciencedaily.com/releases/2016/07/160704223418.htm

Citation:

Study investigates whether it is safe for GPs to prescribe fewer antibiotics

Date:              July 4, 2016

Source:         King’s College London

Summary:

A new study has found that reducing antibiotic prescribing for respiratory tract infections — such as coughs, colds, sore throats and ear infections — is not linked to an increase in the most serious bacterial complications, such as bacterial meningitis. The study investigated whether reducing antibiotic prescribing for people attending their GP with respiratory tract infections could have an effect on safety.

Journal Reference:

  1. Martin C Gulliford, Michael V Moore, Paul Little, Alastair D Hay, Robin Fox, A Toby Prevost, Dorota Juszczyk, Judith Charlton, Mark Ashworth. Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records. BMJ, 2016; i3410 DOI: 10.1136/bmj.i3410

Here is the press release from Kings College London:

Study on safety of prescribing fewer antibiotics

A new study has found that reducing antibiotic prescribing for respiratory tract infections – such as coughs, colds, sore throats and ear infections – is not linked to an increase in the most serious bacterial complications, such as bacterial meningitis.

The study, published in the BMJ, investigated whether reducing antibiotic prescribing for people attending their GP with respiratory tract infections could have an effect on safety.

Most respiratory tract infections are caused by viruses and will improve without treatment. Antibiotic treatment has minimal effect on the duration and severity of symptoms in these conditions, but may be associated with side-effects.

The widespread inappropriate use of antibiotics is contributing to the development of strains of bacteria that are resistant to antibiotics.

This study, funded by the NIHR and led by researchers from King’s College London, analysed patient records from 610 UK general practices, with more than four million patients, over 10 years. General practices with lower rates of antibiotic prescribing for respiratory tract infections did not have higher rates of serious bacterial complications, including: meningitis, mastoiditis (infection of the mastoid bone behind the ear), empyema (infection of the lining of the lungs), brain abscess or Lemierre’s syndrome (an infection of the jugular vein in the neck).

The research found that practices that prescribed fewer antibiotics had slightly higher rates of pneumonia and peritonsillar abscess (also known as quinsy) – a rare complication of sore throats. Both of these conditions are treatable with antibiotics once identified.

The researchers estimated that if an average-sized GP practice with 7,000 patients reduced its antibiotic prescribing to people with respiratory tract infections by 10 per cent, there could be one extra case of pneumonia each year. They also estimated that this reduced prescribing could be linked to one extra case of peritonsillar abscess every 10 years.

The authors observe that reducing antibiotic use is likely to reduce the number of people experiencing side-effects. About 10 per cent of people who take antibiotics experience common side-effects such as rashes, diarrhoea and vomiting, while rare side-effects include anaphylaxis.

Professor Martin Gulliford, lead author from the Division of Health and Social Care Research at King’s College London, said: ‘Overuse of antibiotics now may result in increasing infections by resistant bacteria in the future. Current treatment recommendations are to avoid antibiotics for self-limiting respiratory infections. Our results suggest that, if antibiotics are not taken, this should carry no increased risk of more serious complications. General practices prescribing fewer antibiotics may have slightly higher rates of pneumonia and peritonsillar abscess but even a substantial reduction in antibiotic prescribing may be associated with only a small increase in the numbers of cases observed. Both these complications can be readily treated once identified.’

Dr Mark Ashworth, GP and author of the study from the King’s Division of Health and Social Care Research, said: ‘As a practicing GP, I see very few complications from patients who have upper respiratory tract infections and who decide to opt for a non-antibiotic approach to treating their infections. Patients are recognising that most upper respiratory infections are viral and virus infections do not respond to antibiotics. Our paper should reassure GPs and patients that rare bacterial complications of respiratory infections are indeed rare. Fortunately, if there are any signs of a complication, the GP can quickly step in and offer an appropriate antibiotic.’

The authors caution that the results represent averages across general practice populations; this study did not evaluate the outcome of prescribing decisions for individual patients.

Notes to editors:

For more information, please contact the King’s College London press office on 020 7848 3202, pr@kcl.ac.uk.

‘Safety of reduced antibiotic prescribing for self-limiting respiratory tract infections in primary care: Cohort study using electronic health records’ by Gulliford et al is published in the British Medical Journal on Tuesday 5 July 2016.  doi: 10.1136/bmj.i3410

The study was funded by the NIHR Health Technology Assessment programme. Study authors were supported by the NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London.

About the NIHR

The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. The NIHR is the research arm of the NHS. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (www.nihr.ac.uk).

In many cases antibiotic use may not be appropriate.

FamilyDoctor.org offers the following advice:

How do I know when I need antibiotics?

The answer depends on what is causing your infection. The following are some basic guidelines:

  • Colds and flu. Viruses cause these illnesses. They can’t be cured with antibiotics.
  • Cough or bronchitis. Viruses almost always cause these. However, if you have a problem with your lungs or an illness that lasts a long time, bacteria may actually be the cause. Your doctor may decide to try using an antibiotic.
  • Sore throat. Most sore throats are caused by viruses and don’t need antibiotics. However, strep throat is caused by bacteria. Your doctor can determine if you have strep throat and can prescribe an antibiotic.
  • Ear infections. There are several types of ear infections. Antibiotics are used for some (but not all) ear infections.
  • Sinus infections. Antibiotics are often used to treat sinus infections. However, a runny nose and yellow or green mucus do not necessarily mean you need an antibiotic.  Read more about treating sinusitis.

What else do I need to know?

If your doctor does prescribe an antibiotic for you, make sure you take all of the medicine, even if you feel better after a few days. This reduces the chance that there will be any bacteria left in your body that could potentially become resistant to antibiotics.

Never take antibiotics without a prescription. If, for whatever reason, you have antibiotics leftover from a time when you were previously sick, do not take them unless your doctor tells you it’s okay. The leftover antibiotics may not work on whatever is making you sick. If they do work, there probably will not be enough leftover medicine to completely kill all the bacteria in your body. Not only will you not get better, but this increases the chance that the bacteria will become resistant to antibiotics.

You can prevent catching infections in the first place by practicing good hygiene. Wash your hands with soap and water, especially after using the restroom, coming into contact with feces (for example, from a pet or from changing a baby’s diaper) and before eating.                                                                             http://familydoctor.org/familydoctor/en/drugs-procedures-devices/prescription-medicines/antibiotics-when-they-can-and-cant-help.html

Always consult a physician before taking antibiotics.

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Drexel University School of Public Health study: Parental depression associated with worse school performance by children

7 Feb

Moi said in Schools have to deal with depressed and troubled children:
Both the culture and the economy are experiencing turmoil. For some communities, the unsettled environment is a new phenomenon, for other communities, children have been stressed for generations. According to the article, Understanding Depression which was posted at the Kids Health site:

Depression is the most common mental health problem in the United States. Each year it affects 17 million people of all age groups, races, and economic backgrounds.
As many as 1 in every 33 children may have depression; in teens, that number may be as high as 1 in 8. http://kidshealth.org/parent/emotions/feelings/understanding_depression.html

Schools are developing strategies to deal with troubled kids.

Andrew M. Seaman of Reuters reported in Parents’ depression may affect kids’ school performance:

Children perform worse in school when their parents are diagnosed with depression, suggests a study from Sweden.

The study found a significant negative link between parents’ depression and kids’ school performance, said senior author Brian Lee, of the Drexel University School of Public Health in Philadelphia.

“We obviously know that depression is a bad thing like any other mental health outcome,” Lee said. “It’s less recognized that mental health outcomes affect other people than the people themselves. So for parents or guardians, a vulnerable population would be their children.”

Previous studies found children with depressed parents are more likely to have problems with brain development, behavior and emotions, along with other psychiatric problems, Lee and his colleagues write in JAMA Psychiatry. Few studies have looked at school performance, however.

For the new study, they used data from more than 1.1 million children born in Sweden between 1984 and 1994.

Three percent of the mothers and about 2 percent of fathers were diagnosed with depression before their children finished their last required year of school, which occurs around age 16 in Sweden.

Overall, when parents were diagnosed with depression during their children’s lifetime, the kids’ grades suffered. A mother’s depression appeared to affect daughters more than sons, they note.

Lee characterized the link between parental depression and children’s school performance as “moderate.”

On the range of factors that influence a child’s school performance, Lee said parental depression falls between a family’s economic status and parental education, which is one of the biggest factors in determining a child’s success in school.

The researchers caution that depression may have been undermeasured in the population. Also, they can’t say that a parent’s depression actually causes children to perform worse in school…. http://www.reuters.com/article/us-health-school-depression-parents-idUSKCN0VC2VS

Citation:

Parental depression associated with worse school performance by children

Date:      February 3, 2016

Source:   The JAMA Network Journals

Summary:

Having parents diagnosed with depression during a child’s life was associated with worse school performance at age 16 a new study of children born in Sweden reports.

Journal References:

  1. Hanyang Shen, Cecilia Magnusson, Dheeraj Rai, Michael Lundberg, Félice Lê-Scherban, Christina Dalman, Brian K. Lee. Associations of Parental Depression With Child School Performance at Age 16 Years in Sweden. JAMA Psychiatry, 2016; DOI: 10.1001/jamapsychiatry.2015.2917
  2. Myrna M. Weissman. Children of Depressed Parents—A Public Health Opportunity. JAMA Psychiatry, 2016; DOI: 10.1001/jamapsychiatry.2015.2967

Associations of Parental Depression With Child School Performance at Age 16 Years in Sweden ONLINE FIRST

Hanyang Shen, MPH, MSc1; Cecilia Magnusson, MD, PhD2,3; Dheeraj Rai, MRCPsych, PhD4,5; Michael Lundberg, MPH2,3; Félice Lê-Scherban, PhD1; Christina Dalman, MD, PhD2,3; Brian K. Lee, PhD, MHS1,6

[+] Author Affiliations

JAMA Psychiatry. Published online February 03, 2016. doi:10.1001/jamapsychiatry.2015.2917

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ABSTRACT

ABSTRACT | INTRODUCTION | METHODS | RESULTS | DISCUSSION | CONCLUSIONS | ARTICLE INFORMATION | REFERENCES

Importance  Depression is a common cause of morbidity and disability worldwide. Parental depression is associated with early-life child neurodevelopmental, behavioral, emotional, mental, and social problems. More studies are needed to explore the link between parental depression and long-term child outcomes.

Objective  To examine the associations of parental depression with child school performance at the end of compulsory education (approximately age 16 years).

Design, Setting, and Participants  Parental depression diagnoses (based on the International Classification of Diseases, Eighth Revision [ICD-8], International Classification of Diseases, Ninth Revision [ICD-9], and the International Statistical Classification of Diseases, 10th Revision [ICD-10]) in inpatient records from 1969 onward, outpatient records beginning in 2001, and school grades at the end of compulsory education were collected for all children born from 1984 to 1994 in Sweden. The final analytic sample size was 1 124 162 biological children. We examined the associations of parental depression during different periods (before birth, after birth, and during child ages 1-5, 6-10, and 11-16 years, as well as any time before the child’s final year of compulsory schooling) with the final school grades. Linear regression models adjusted for various child and parent characteristics. The dates of the analysis were January to November 2015.

Main Outcome and Measure  Decile of school grades at the end of compulsory education (range, 1-10, with 1 being the lowest and 10 being the highest).

Results  The study cohort comprised 1 124 162 children, of whom 48.9% were female. Maternal depression and paternal depression at any time before the final compulsory school year were associated with worse school performance. After covariate adjustment, these associations decreased to −0.45 (95% CI, −0.48 to −0.42) and −0.40 (−0.43 to −0.37) lower deciles, respectively. These effect sizes are similarly as large as the observed difference in school performance between the lowest and highest quintiles of family income but approximately one-third of the observed difference between maternal education of 9 or less vs more than 12 years. Both maternal depression and paternal depression at different periods (before birth, after birth, and during child ages 1-5, 6-10, and 11-16 years) generally were associated with worse school performance. Child sex modified the associations of maternal depression with school performance such that maternal depression had a larger negative influence on child school performance for girls compared with boys.

Conclusions and Relevance  Diagnoses of parental depression throughout a child’s life were associated with worse school performance at age 16 years. Our results suggest that diagnoses of parental depression may have a far-reaching effect on an important aspect of child development, with implications for future life course outcomes.                                                                                     http://archpsyc.jamanetwork.com/article.aspx?articleid=2488039

Here is the press release from Drexel University:

Parental Depression Negatively Affects Children’s School Performance

February 03 2016

A new study has found that when parents are diagnosed with depression, it can have a significant negative impact on their children’s performance at school.

Researchers at Drexel University led a team including faculty from the Karolinska Institutet in Stockholm, Sweden, and the University of Bristol in England in a cohort study of more than a million children born from 1984 until 1994 in Sweden. Using computerized data registers, the scientists linked parents’ depression diagnoses with their children’s final grades at age 16, when compulsory schooling ends in Sweden.

The research indicated that children whose mothers had been diagnosed with depression are likely to achieve grades that are 4.5 percentage points lower than peers whose mothers had not been diagnosed with depression. For children whose fathers were diagnosed with depression, the difference is a negative four percentage points.

Put into other terms, when compared with a student who achieved a 90 percent, a student whose mother or father had been diagnosed with depression would be more likely to achieve a score in the 85–86 percent range.

The magnitude of this effect was similar to the difference in school performance between children in low versus high-income families, but was smaller than the difference for low versus high maternal education (low family income: -3.6 percentage points; low maternal education -16.2 percentage points).

How well a student does in school has a large bearing on future job and income opportunities, which has heavy public health implications, explained Félice Lê-Scherban, PhD, assistant professor in the Dornsife School of Public Health. On average in the United States, she said, an adult without a high school degree earns half as much as one of their peers with a college degree and also has a life expectancy that is about 10 years lower.

“Anything that creates an uneven playing field for children in terms of their education can potentially have strong implications for health inequities down the road,” Lê-Scherban said.

Some differences along gender lines were observed in the study. Although results were largely similar for maternal and paternal depression, analysis found that episodes of depression in mothers when their children were 11–16 years old appeared to have a larger effect on girls than boys. Girls scored 5.1 percentage points lower than their peers on final grades at 16 years old when that factor was taken into account. Boys, meanwhile, only scored 3.4 percentage points lower.

Brian Lee, PhD, associate professor in the Dornsife School of Public Health, said there were gender differences in the study’s numbers, but didn’t want to lose focus of the problem parental depression presents as a whole.

“Our study — as well as many others — supports that both maternal and paternal depression may independently and negatively influence child development,” Lee said. “There are many notable sex differences in depression, but, rather than comparing maternal versus paternal depression, we should recognize that parental depression can have adverse consequences not just for the parents but also for their children.”

Depression diagnoses in a parent at any time during the child’s first 16 years were determined to have some effect on the child’s school performance. Even diagnoses of depression that came before the child’s birth were linked to poorer school performance. The study posited that it could be attributed to parents and children sharing the same genes and the possibility of passing on a disposition for depression.

The study, “Associations of Parental Depression With Child School Performance at Age 16 Years in Sweden,” whose lead author was Drexel alumna Hanyang Shen, was published in JAMA Psychiatry.

Media Contact:
Frank Otto
fmo26@drexel.edu
215.571.4244

If you or your child needs help for depression or another illness, then go to a reputable medical provider. There is nothing wrong with taking the steps necessary to get well.

Related:

Schools have to deal with depressed and troubled children
https://drwilda.wordpress.com/2011/11/15/schools-have-to-deal-with-depressed-and-troubled-children/

School psychologists are needed to treat troubled children
https://drwilda.wordpress.com/2012/02/27/school-psychologists-are-needed-to-treat-troubled-children/

Battling teen addiction: ‘Recovery high schools’
https://drwilda.wordpress.com/2012/07/08/battling-teen-addiction-recovery-high-schools/

Resources:
1. About.Com’s Depression In Young Children http://depression.about.com/od/child/Young_Children.htm

  1. Psych Central’s Depression In Young Children http://depression.about.com/od/child/Young_Children.htm
  2. Psychiatric News’ Study Helps Pinpoint Children With Depression http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=106034
  3. Family Doctor’s What Is Depression? http://familydoctor.org/familydoctor/en/diseases-conditions/depression.html
  4. WebMD’s Depression In Children http://www.webmd.com/depression/guide/depression-children
  5. Healthline’s Is Your Child Depressed?

http://www.healthline.com/hlvideo-5min/how-to-help-your-child-through-depression-517095449

  1. Medicine.Net’s Depression In Children http://www.onhealth.com/depression_in_children/article.htm

Where information leads to Hope. © Dr. Wilda.com

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Northwestern University School of Medicine study: Concussions and female middle school students

2 Aug

According to Michelle Healy of USA Today, 1.35 million youths a year have serious sports injuries http://www.usatoday.com/story/news/nation/2013/08/06/injuries-athletes-kids-sports/2612429/ Among those injuries are concussions. Kids Health has some great information about concussions at their site:

What Is a Concussion and What Causes It?
The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. When a person gets a head injury, the brain can move around inside the skull and even bang against it. This can lead to bruising of the brain, tearing of blood vessels, and injury to the nerves. When this happens, a person can get a concussion — a temporary loss of normal brain function.
Most people with concussions recover just fine with appropriate treatment. But it’s important to take proper steps if you suspect a concussion because it can be serious.
Concussions and other brain injuries are fairly common. About every 21 seconds, someone in the United States has a serious brain injury. One of the most common reasons people get concussions is through a sports injury. High-contact sports such as football, boxing, and hockey pose a higher risk of head injury, even with the use of protective headgear.
People can also get concussions from falls, car accidents, bike and blading mishaps, and physical violence, such as fighting. Guys are more likely to get concussions than girls. However, in certain sports, like soccer, girls have a higher potential for concussion.http://kidshealth.org/teen/safety/first_aid/concussions.html#a_What_Is_a_Concussion_and_What_Causes_It_

https://drwilda.com/2012/03/06/dont-ignore-concussions/
See, Update: Don’t ignore concussions https://drwilda.com/2012/05/20/update-dont-ignore-concussions/
More studies are pointing to the risks of girls playing contact sports.

Science Daily reported in Middle-school girls continue to play soccer with concussion symptoms:

Concussions are common among middle-school girls who play soccer, and most continue to play with symptoms, according to a study by John W. O’ Kane, M.D., of the University of Washington Sports Medicine Clinic, Seattle, and colleagues.
Sports-related concussions account for 1.6 to 3.8 million injuries in the United States annually, including about 50,000 soccer-related concussions among high school players. Injury-tracking systems for younger players are lacking so they are largely unstudied, according to the study background.
Using an email survey and interviews, the authors evaluated the frequency and duration of concussions in young female soccer players, as well as whether the injuries resulted in stopping play and seeking medical attention. Their study included 351 soccer players (ages 11 to 14 years) from soccer clubs in the Puget Sound region of Washington.
Among 351 players, there were 59 concussions with 43,742 athletic exposure hours. Concussion symptoms can include memory loss, dizziness, drowsiness, headache and nausea. Cumulative concussion incidence was 13 percent per season with an incidence of 1.2 per 1,000 athletic exposure hours. Symptoms lasted a median four days (average 9.4 days). Heading the ball accounted for 30.5 percent of concussions. Most players (58.6 percent) continued to play with symptoms, with almost half (44.1 percent) seeking medical attention, according to the results.
The authors note that the rate of 1.3 concussions per 1,000 athletic exposure hours was higher than what has been reported in other studies of girls soccer at the high school and college levels…. http://www.sciencedaily.com/releases/2014/01/140120173456.htm

Another study from Northwestern School of Medicine, Concussion and Female Middle School Athletes focuses on girls. Coaches and parents must be alert to signs of concussion. WebMD has a good description of what a concussion is and the signs of concussion http://www.webmd.com/brain/tc/traumatic-brain-injury-concussion-overview

Citation:

From The JAMA Network | August 01, 2014
Concussion and Female Middle School Athletes FREE ONLINE FIRST
Cynthia LaBella, MD1
[+] Author Affiliations
JAMA. Published online August 01, 2014. doi:10.1001/jama.2014.6668
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Article
References
JAMA Pediatrics
Concussion Among Female Middle-School Soccer Players
John W. O’Kane, MD; Amy Spieker, MPH; Marni R. Levy, BS; Moni Neradilek, MS; Nayak L. Polissar, PhD; Melissa A. Schiff, MD, MPH
Importance Despite recent increased awareness about sports concussions, little research has evaluated concussions among middle-school athletes.
Objectives To evaluate the frequency and duration of concussions in female youth soccer players and to determine if concussions result in stopping play and seeking medical care.
Design, Setting, and Participants Prospective cohort study from March 2008 through May 2012 among 4 soccer clubs from the Puget Sound region of Washington State, involving 351 elite female soccer players, aged 11 to 14 years, from 33 randomly selected youth soccer teams. Of the players contacted, 83.1% participated and 92.4% completed the study.
Main Outcomes and Measures Concussion cumulative incidence, incidence rate, and description of the number, type, and duration of symptoms. We inquired weekly about concussion symptoms and, if present, the symptom type and duration, the event resulting in symptom onset, and whether the player sought medical attention or played while symptomatic.
Results Among the 351 soccer players, there were 59 concussions with 43 742 athletic exposure hours. Cumulative concussion incidence was 13.0% per season, and the incidence rate was 1.2 per 1000 athletic exposure hours (95% CI, 0.9-1.6). Symptoms lasted a median of 4.0 days (mean, 9.4 days). Heading the ball accounted for 30.5% of concussions. Players with the following symptoms had a longer recover time than players without these symptoms: light sensitivity (16.0 vs 3.0 days, P = .001), emotional lability (15.0 vs 3.5 days, P = .002), noise sensitivity (12.0 vs 3.0 days, P = .004), memory loss (9.0 vs 4.0 days, P = .04), nausea (9.0 vs 3.0 days, P = .02), and concentration problems (7.0 vs 2.0 days, P = .02). Most players (58.6%) continued to play with symptoms, with almost half (44.1%) seeking medical attention.
Conclusions and Relevance Concussion rates in young female soccer players are greater than those reported in older age groups, and most of those concussed report playing with symptoms. Heading the ball is a frequent precipitating event. Awareness of recommendations to not play and seek medical attention is lacking for this age group.
JAMA Pediatr. 2014;168(3):258-264. doi:10.1001/jamapediatrics.2013.4518.

Parents must be alert to what is happening with the children when they participate in athletic events and activities.

Resources:

Concussions http://kidshealth.org/teen/safety/first_aid/concussions.html#a_What_Is_a_Concussion_and_What_Causes_It_

Concussion http://www.emedicinehealth.com/concussion/article_em.htm

Concussion – Overview http://www.webmd.com/brain/tc/traumatic-brain-injury-concussion-overview

Related :

Study: Effects of a concussion linger for months https://drwilda.com/2012/12/13/study-effects-of-a-concussion-linger-for-months/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART© http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews © http://drwildareviews.wordpress.com/

Dr. Wilda © https://drwilda.com/

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Journal of American Medical Association study: Folic acid may reduce autism risk

12 Feb

Moi has written several blog posts about autism. In University of Connecticut study: Some children with autism may be ‘cured’ with intense early therapy:

In order for children with autism to reach their full potential there must be early diagnosis and treatment.

Autism Speaks reports about a University of Connecticut study in the post, Study Confirms “Optimal Outcomes”:

Some children diagnosed with autism in early childhood reach “optimal outcomes” with levels of function similar to their typical peers. The findings appear today in the Journal of Child Psychology and Psychiatry.

“Although the diagnosis of autism is not usually lost over time, the findings suggest that there is a very wide range of possible outcomes,” says Thomas Insel, M.D., director of the National Institutes of Mental Health (NIMH). “For an individual child, the outcome may be knowable only with time and after some years of intervention.”

This week’s report is the first in a series of autism studies on optimal outcomes, sponsored by the NIMH. They follow up on earlier reports that a small group of children appear to “lose” their autism diagnosis over time. Some experts have questioned the accuracy of these children’s initial diagnoses. Others argued that simply being able to function in a mainstream classroom doesn’t mean that these children don’t quietly struggle with autism-related disabilities. http://www.autismspeaks.org/science/science-news/study-confirms-%E2%80%9Coptimal-outcomes%E2%80%9D

https://drwilda.com/2013/01/19/university-of-connecticut-study-some-children-with-autism-may-be-cured-with-intense-early-therapy/

The Journal of the American Medical Association (JAMA) is reporting in a new study that folic acid use during pregnancy may reduce autism risk.

Steven Reinberg, Health Day Reporter for WebMD reports in Folic Acid in Pregnancy May Lower Autism Risk:

A new study suggests that women who start taking folic acid supplements either before or early in their pregnancy may reduce their child’s risk of developing autism.

“The study does not prove that folic acid supplements can prevent childhood autism. But it does provide an indication that folic acid might be preventive,” said study lead author Dr. Pal Suren, from the division of epidemiology at the Norwegian Institute of Public Health in Oslo.

“The findings also provide a rationale for further investigations of possible causes, as well as investigations of whether folic acid is associated with a reduced risk of other brain disorders in children,” he said.

Taking folic acid supplements during pregnancy is already known to prevent birth defects such as spina bifida, which affects the spine, and anencephaly, which causes part of the brain to be missing.

Alycia Halladay, senior director of environmental and clinical sciences at Autism Speaks, said that “parents always wonder what they can do to reduce the risk [of autism], and this [folic acid] is a very inexpensive item that mothers can do both before pregnancy and very early in their pregnancy.”

As to why folic acid may be beneficial, Halladay speculated that the nutrient might blunt a genetic risk for autism or boost other processes during pregnancy that are protective.

Another expert, Dr. Roberto Tuchman, director of the Autism and Neurodevelopment Program at Miami Children’s Hospital’s Dan Marino Center, said, “This study suggests that in some kids autism spectrum disorders may be preventable. As a clinician who works with autism spectrum disorders it is exciting that we can look at potentially preventable factors in autism. This is really encouraging.”

Still, Tuchman cautioned that the study findings are very preliminary, and it isn’t possible to tell which autism spectrum disorders, if any, folic acid may prevent. http://www.webmd.com/brain/autism/news/20130212/folic-acid-in-pregnancy-may-lower-autism-risk

Citation:

February 13, 2013, Vol 309, No. 6 >

Original Contribution | February 13, 2013

Association Between Maternal Use of Folic Acid Supplements and Risk of Autism Spectrum Disorders in Children FREE

Pål Surén, MD, MPH; Christine Roth, MSc; Michaeline Bresnahan, PhD; Margaretha Haugen, PhD; Mady Hornig, MD; Deborah Hirtz, MD; Kari Kveim Lie, MD; W. Ian Lipkin, MD; Per Magnus, MD, PhD; Ted Reichborn-Kjennerud, MD, PhD; Synnve Schjølberg, MSc; George Davey Smith, MD, DSc; Anne-Siri Øyen, PhD; Ezra Susser, MD, DrPH; Camilla Stoltenberg, MD, PhD

JAMA. 2013;309(6):570-577. doi:10.1001/jama.2012.155925.

Text Size: A A A

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Importance  Prenatal folic acid supplements reduce the risk of neural tube defects in children, but it has not been determined whether they protect against other neurodevelopmental disorders.

Objective  To examine the association between maternal use of prenatal folic acid supplements and subsequent risk of autism spectrum disorders (ASDs) (autistic disorder, Asperger syndrome, pervasive developmental disorder–not otherwise specified [PDD-NOS]) in children.

Design, Setting, and Patients  The study sample of 85 176 children was derived from the population-based, prospective Norwegian Mother and Child Cohort Study (MoBa). The children were born in 2002-2008; by the end of follow-up on March 31, 2012, the age range was 3.3 through 10.2 years (mean, 6.4 years). The exposure of primary interest was use of folic acid from 4 weeks before to 8 weeks after the start of pregnancy, defined as the first day of the last menstrual period before conception. Relative risks of ASDs were estimated by odds ratios (ORs) with 95% CIs in a logistic regression analysis. Analyses were adjusted for maternal education level, year of birth, and parity.

Main Outcome Measure  Specialist-confirmed diagnosis of ASDs.

Results  At the end of follow-up, 270 children in the study sample had been diagnosed with ASDs: 114 with autistic disorder, 56 with Asperger syndrome, and 100 with PDD-NOS. In children whose mothers took folic acid, 0.10% (64/61 042) had autistic disorder, compared with 0.21% (50/24 134) in those unexposed to folic acid. The adjusted OR for autistic disorder in children of folic acid users was 0.61 (95% CI, 0.41-0.90). No association was found with Asperger syndrome or PDD-NOS, but power was limited. Similar analyses for prenatal fish oil supplements showed no such association with autistic disorder, even though fish oil use was associated with the same maternal characteristics as folic acid use.

Conclusions and Relevance  Use of prenatal folic acid supplements around the time of conception was associated with a lower risk of autistic disorder in the MoBa cohort. Although these findings cannot establish causality, they do support prenatal folic acid supplementation. http://jama.jamanetwork.com/article.aspx?articleid=1570279

One of the implications of this study is the necessity that women receive adequate prenatal care and women really should have pre-pregnancy counseling and care.

United Health Foundation reports Prenatal Care (1990 – 2011): Percentage of pregnant women receiving adequate prenatal care, as defined by Kessner Index:

Prenatal care is a critical component of health care for pregnant women and a key step towards having a healthy pregnancy and baby. Early prenatal care is especially important because many important developments take place during the first trimester, screenings can identify babies or mothers at risk for complications and health care providers can educate and prepare mothers for pregnancy.  Women who receive prenatal care have consistently shown better outcomes than those who did not receive prenatal care[1]. Mothers who do not receive any prenatal care are three times more likely to deliver a low birth weight baby than mothers who received prenatal care, and infant mortality is five times higher[2].  Early prenatal care also allows health care providers to identify and address health conditions and behaviors that may reduce the likelihood of a healthy birth, such as smoking and drug and alcohol abuse.                                           http://www.americashealthrankings.org/All/PrenatalCare/2012

Given this recent study it is imperative that ALL women receive prenatal care particularly poor and those women at risk of difficult pregnancies.

Related:

Autism and children of color                                                https://drwilda.com/tag/children-of-color-with-autism/

Archives of Pediatrics and Adolescent Medicine study: Kids with autism more likely to be bullied                                   https://drwilda.com/2012/09/06/archives-of-pediatrics-and-adolescent-medicine-study-kids-with-autism-more-likely-to-be-bullied/

Father’s age may be linked to Autism and Schizophrenia https://drwilda.com/2012/08/26/fathers-age-may-be-linked-to-autism-and-schizophrenia/

Chelation treatment for autism might be harmful  https://drwilda.com/2012/12/02/chelation-treatment-for-autism-might-be-harmful/

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