Tag Archives: medicine

Harvard study: High doses of antidepressants appear to increase risk of self-harm in children and young adults

29 Apr

People of all ages may have feelings of profound sadness, loss, and depression. There is no one on earth, despite what the ads attempt to portray, who lives a perfect life. Every life has flaws and blemishes, it is just that some cope better than others. For every person who lives to a ripe old age, during the course of that life they may encounter all types of loss from loss of a loved one through death, divorce or desertion, loss of job, financial reverses, illness, dealing with A-holes and twits, plagues, pestilence, and whatever curse can be thrown at a person. The key is that they lived THROUGH whatever challenges they faced AT THAT MOMENT IN TIME. Woody Allen said something like “90% of life is simply showing up.” Let moi add a corollary, one of the prime elements of a happy life is to realize that whatever moment you are now in, it will not last forever and that includes moments of great challenge. A person does not have to be religious to appreciate the story of Job. The end of the story is that Job is restored. He had to endure much before the final victory, though.

Medical Press reported in the article, High doses of antidepressants appear to increase risk of self-harm in children young adult:

Children and young adults who start antidepressant therapy at high doses, rather than the “modal” [average or typical] prescribed doses, appear to be at greater risk for suicidal behavior during the first 90 days of treatment.
A previous meta-analysis by the U.S. Food and Drug Administration (FDA) of antidepressant trials suggested that children who received antidepressants had twice the rate of suicidal ideation and behavior than children who were given a placebo. The authors of the current study sought to examine suicidal behavior and antidepressant dose, and whether risk depended on a patient’s age.
The study used data from 162,625 people (between the ages of 10 to 64 years) with depression who started antidepressant treatment with a selective serotonin reuptake inhibitor at modal (the most prescribed doses on average) or at higher than modal doses from 1998 through 2010.
The rate of suicidal behavior (deliberate self-harm or DSH) among children and adults (24 years or younger) who started antidepressant therapy at high doses was about twice as high compared with a matched group of patients who received generally prescribed doses. The authors suggest this corresponds to about one additional event of DSH for every 150 patients treated with high-dose therapy. For adults 25 to 64 years old, the difference in risk for suicidal behavior was null. The study does not address why higher doses might lead to higher suicide risk….
“Their findings suggest that higher than modal initial dosing leads to an increased risk for DSH and adds further support to current clinical recommendations to begin treatment with lower antidepressant doses. While initiation at higher than modal doses of antidepressants may be deleterious, this study does not address the effect of dose escalation,” they continue.
“Moreover, while definitive studies on the impact of dose escalation in the face of nonresponse remain to be done, there are promising studies that suggest in certain subgroups, dose escalation can be of benefit. Finally it should be noted that in this study, there was no pre-exposure to post-exposure increase in suicidal behavior after the initiation of antidepressants in youth treated at the modal dosage,” they conclude. http://medicalxpress.com/news/2014-04-high-doses-antidepressants-self-harm-children.html

Citation:

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Original Investigation|April 28, 2014
Antidepressant Dose, Age, and the Risk of Deliberate Self-harm
ONLINE FIRST
Matthew Miller, MD, ScD1; Sonja A. Swanson, ScM2; Deborah Azrael, PhD1; Virginia Pate, PhD, PhD3; Til Stürmer, MD, ScD3
[+] Author Affiliations
JAMA Intern Med. Published online April 28, 2014. doi:10.1001/jamainternmed.2014.1053
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ABSTRACT
ABSTRACT | METHODS | RESULTS | DISCUSSION | CONCLUSIONS | ARTICLE INFORMATION | REFERENCES
Importance A comprehensive meta-analysis of randomized trial data suggests that suicidal behavior is twice as likely when children and young adults are randomized to antidepressants compared with when they are randomized to placebo. Drug-related risk was not elevated for adults older than 24 years. To our knowledge, no study to date has examined whether the risk of suicidal behavior is related to antidepressant dose, and if so, whether risk depends on a patient’s age.
Objective To assess the risk of deliberate self-harm by antidepressant dose, by age group.
Design, Setting, and Participants This was a propensity score–matched cohort study using population-based health care utilization data from 162 625 US residents with depression ages 10 to 64 years who initiated antidepressant therapy with selective serotonin reuptake inhibitors at modal or at higher than modal doses from January 1, 1998, through December 31, 2010.
Main Outcomes and Measures International Classification of Diseases, Ninth Revision (ICD-9) external cause of injury codes E950.x-E958.x (deliberate self-harm).
Results The rate of deliberate self-harm among children and adults 24 years of age or younger who initiated high-dose therapy was approximately twice as high as among matched patients initiating modal-dose therapy (hazard ratio [HR], 2.2 [95% CI, 1.6-3.0]), corresponding to approximately 1 additional event for every 150 such patients treated with high-dose (instead of modal-dose) therapy. For adults 25 to 64 years of age, the absolute risk of suicidal behavior was far lower and the effective risk difference null (HR, 1.2 [95% CI, 0.8-1.9]).
Conclusions and Relevance Children and young adults initiating therapy with antidepressants at high-therapeutic (rather than modal-therapeutic) doses seem to be at heightened risk of deliberate self-harm. Considered in light of recent meta-analyses concluding that the efficacy of antidepressant therapy for youth seems to be modest, and separate evidence that antidepressant dose is generally unrelated to therapeutic efficacy, our findings offer clinicians an additional incentive to avoid initiating pharmacotherapy at high-therapeutic doses and to closely monitor patients starting antidepressants, especially youth, for several months.

Here is the press release from Harvard:

PUBLIC RELEASE DATE:
28-Apr-2014

Contact: Marge Dwyer
mhdwyer@hsph.harvard.edu
617-432-8416
The JAMA Network Journals
High doses of antidepressants appear to increase risk of self-harm in children young adult
Bottom Line:
Children and young adults who start antidepressant therapy at high doses, rather than the “modal” [average or typical] prescribed doses, appear to be at greater risk for suicidal behavior during the first 90 days of treatment.
Author:
Matthew Miller, M.D., Sc.D., of the Harvard School of Public Health, Boston, and colleagues.
Background:
A previous meta-analysis by the U.S. Food and Drug Administration (FDA) of antidepressant trials suggested that children who received antidepressants had twice the rate of suicidal ideation and behavior than children who were given a placebo. The authors of the current study sought to examine suicidal behavior and antidepressant dose, and whether risk depended on a patient’s age.
How the Study Was Conducted:
The study used data from 162,625 people (between the ages of 10 to 64 years) with depression who started antidepressant treatment with a selective serotonin reuptake inhibitor at modal (the most prescribed doses on average) or at higher than modal doses from 1998 through 2010.
Results: The rate of suicidal behavior (deliberate self-harm or DSH) among children and adults (24 years or younger) who started antidepressant therapy at high doses was about twice as high compared with a matched group of patients who received generally prescribed doses. The authors suggest this corresponds to about one additional event of DSH for every 150 patients treated with high-dose therapy. For adults 25 to 64 years old, the difference in risk for suicidal behavior was null. The study does not address why higher doses might lead to higher suicide risk.
Discussion: “Considered in light of recent meta-analyses concluding that the efficacy of antidepressant therapy for youth seems to be modest, and separate evidence that dose is generally unrelated to the therapeutic efficacy of antidepressants, our findings offer clinicians an additional incentive to avoid initiating pharmacotherapy at high-therapeutic doses and to monitor all patients starting antidepressants, especially youth, for several months and regardless of history of DSH.”
(JAMA Intern Med. Published online April 28, 2014. doi:10.1001/jamainternmed.2014.1053. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor’s Note: Authors made a conflict of interest and funding disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Commentary: Initial Dose of Antidepressants, Suicidal Behavior in Youth
In a related commentary, David A. Brent, M.D., of the University of Pittsburgh, and Robert Gibbons, Ph.D., of the University of Chicago, write: “In summary Miller et al are to be commended on a thoughtful and careful analysis of the effects of initiating antidepressants at higher than modal doses.”
“Their findings suggest that higher than modal initial dosing leads to an increased risk for DSH and adds further support to current clinical recommendations to begin treatment with lower antidepressant doses. While initiation at higher than modal doses of antidepressants may be deleterious, this study does not address the effect of dose escalation,” they continue.
“Moreover, while definitive studies on the impact of dose escalation in the face of nonresponse remain to be done, there are promising studies that suggest in certain subgroups, dose escalation can be of benefit. Finally it should be noted that in this study, there was no pre-exposure to post-exposure increase in suicidal behavior after the initiation of antidepressants in youth treated at the modal dosage,” they conclude.
(JAMA Intern Med. Published online April 28, 2014. doi:10.1001/jamainternmed.2013.14016. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor’s Note: Authors made conflict of interest and funding disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
###
Media Advisory:
To contact author Matthew Miller, M.D., Sc.D., call Marge Dwyer at 617-432-8416 or email mhdwyer@hsph.harvard.edu. To contact commentary author David A. Brent, M.D., call Gloria Kreps at 412-586-9764 or email krepsga@upmc.edu.

What Should You Do if You Know Someone Who Thinking About Suicide?

If you are thinking of suicide or you know someone who is thinking about suicide, GET HELP, NOW!!!! The Suicide Prevention Resource Center http://www.sprc.org/basics/roles-suicide-prevention has some excellent advice about suicide prevention http://www.sprc.org/basics/roles-suicide-prevention

Resources:

Teen’s Health’s Suicide http://kidshealth.org/teen/your_mind/feeling_sad/suicide.html

American Academy of Adolescent Psychiatry http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Teen_Suicide_10.aspx
Suicide Prevention Resource Center http://www.sprc.org/basics/roles-suicide-prevention

Teen Depression http://helpguide.org/mental/depression_teen.htm

Jared Story.Com http://www.jaredstory.com/teen_epidemic.html
CNN Report about suicide http://www.cnn.com/2009/LIVING/10/20/lia.latina.suicides/index.html
American Foundation for Suicide Prevention
http://www.afsp.org This group is dedicated to advancing the knowledge of suicide and the ability to prevent it.

SA\VE – Suicide Awareness\Voices of Education
http://www.save.org SA\VE offers information on suicide prevention. Call (800) SUICIDE

Youth Suicide Prevention
About.Com’s Depression In Young Children http://depression.about.com/od/child/Young_Children.htm

Psych Central’s Depression In Young Children http://depression.about.com/od/child/Young_Children.htm

Psychiatric News’ Study Helps Pinpoint Children With Depression
http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=106034

Family Doctor’s What Is Depression? http://familydoctor.org/familydoctor/en/diseases-conditions/depression.html

WebMD’s Depression In Children http://www.webmd.com/depression/guide/depression-children

Healthline’s Is Your Child Depressed? http://www.healthline.com/hlvideo-5min/how-to-help-your-child-through-depression-517095449

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

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:
University of California, San Francisco study identifies most common reasons for children’s mental health hospitalizations https://drwilda.com/tag/depression/

GAO report: Children’s mental health services are lacking https://drwilda.com/2013/01/12/gao-report-childrens-mental-health-services-are-lacking/

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

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/

Harvard study: kids are eating the healthier lunches

24 Mar

Moi wrote in School lunches: The political hot potato:
There are some very good reasons why meals are provided at schools. Education Bug has a history of the school lunch program http://www.educationbug.org/a/the-history-of-the-school-lunch-program.html

President Harry S. Truman began the national school lunch program in 1946 as a measure of national security. He did so after reading a study that revealed many young men had been rejected from the World War II draft due to medical conditions caused by childhood malnutrition. Since that time more than 180 million lunches have been served to American children who attend either a public school or a non-profit private school.

The U.S. Department of Agriculture (Agriculture Department) has a School Lunch Program Fact Sheet http://www.fns.usda.gov/cnd/lunch/aboutlunch/NSLPFactSheet.pdf
According to the fact sheet, more than 30 million children are fed by the program. Physicians for Responsible Medicine criticize the content of school lunch programs

In Healthy School Lunches the physicians group says:

Menus in most school lunch programs are too high in saturated fat and cholesterol and too low in fiber- and nutrient-rich fruits, vegetables, whole grains, and legumes (see PCRM’s 2008 School Lunch Report Card). Major changes are needed to encourage the health of the nation’s youth and to reverse the growing trends of obesity, early-onset diabetes, and hypertension, among other chronic diseases, in children and teens. http://www.pcrm.org/health/healthy-school-lunches/changes/key-changes-recommended-for-the-national-school

A 2003 General Accounting Office (GAO) reached the same conclusion. See, School Lunch Program: Efforts Needed to Improve Nutrition and Encourage and Healthy Eating http://www.gao.gov/products/GAO-03-506 https://drwilda.com/2011/11/03/school-lunches-the-political-hot-potato/

Science Daily reported in the article, New school meal standards significantly increase fruit, vegetable consumption:

New federal standards launched in 2012 that require schools to offer healthier meals have led to increased fruit and vegetable consumption, according to a new study from Harvard School of Public Health (HSPH) researchers. The study, the first to examine school food consumption both before and after the standards went into effect, contradicts criticisms that the new standards have increased food waste.
“There is a push from some organizations and lawmakers to weaken the new standards. We hope the findings, which show that students are consuming more fruits and vegetables, will discourage those efforts,” said lead author Juliana Cohen, research fellow in the Department of Nutrition at HSPH.
Some 32 million students eat school meals every day; for many low-income students, up to half their daily energy intake is from school meals. Under the previous dietary guidelines, school breakfasts and lunches were high in sodium and saturated fats and were low in whole grains and fiber. The new standards from the United States Department of Agriculture (USDA) aimed to improve the nutritional quality of school meals by making whole grains, fruits, and vegetables more available, requiring the selection of a fruit or vegetable, increasing the portion sizes of fruits and vegetables, removing trans fats, and placing limits on total calories and sodium levels.
The researchers collected plate waste data among 1,030 students in four schools in an urban, low-income school district both before (fall 2011) and after (fall 2012) the new standards went into effect. Following the implementation of the new standards, fruit selection increased by 23.0%; entrée and vegetable selection remained unchanged. In addition, consumption of vegetables increased by 16.2%; fruit consumption was unchanged, but because more students selected fruit, overall, more fruit was consumed post-implementation.
Importantly, the new standards did not result in increased food waste, contradicting anecdotal reports from food service directors, teachers, parents, and students that the regulations were causing an increase in waste due to both larger portion sizes and the requirement that students select a fruit or vegetable. However, high levels of fruit and vegetable waste continued to be a problem — students discarded roughly 60%-75% of vegetables and 40% of fruits on their trays. The authors say that schools must focus on improving food quality and palatability to reduce waste…..
http://www.sciencedaily.com/releases/2014/03/140304071040.htm

Citation:

New school meal standards significantly increase fruit, vegetable consumption
Date: March 4, 2014
Source: Harvard School of Public Health
Summary:
New federal standards launched in 2012 that require schools to offer healthier meals have led to increased fruit and vegetable consumption, according to a new study. The study, the first to examine school food consumption both before and after the standards went into effect, contradicts criticisms that the new standards have increased food waste. “There is a push from some organizations and lawmakers to weaken the new standards. We hope the findings, which show that students are consuming more fruits and vegetables, will discourage those efforts,” said the lead author.
Journal Reference:
1. Juliana F.W. Cohen, Scott Richardson, Ellen Parker, Paul J. Catalano, Eric B. Rimm. Impact of the New U.S. Department of Agriculture School Meal Standards on Food Selection, Consumption, and Waste. American Journal of Preventive Medicine, March 2014 DOI: 10.1016/j.amepre.2013.11.013

Here is the press release from Harvard:

New school meal standards significantly increase fruit, vegetable consumption
For immediate release: Tuesday, March 4, 2014
Boston, MA — New federal standards launched in 2012 that require schools to offer healthier meals have led to increased fruit and vegetable consumption, according to a new study from Harvard School of Public Health (HSPH) researchers. The study, the first to examine school food consumption both before and after the standards went into effect, contradicts criticisms that the new standards have increased food waste.
“There is a push from some organizations and lawmakers to weaken the new standards. We hope the findings, which show that students are consuming more fruits and vegetables, will discourage those efforts,” said lead author Juliana Cohen, research fellow in the Department of Nutrition at HSPH.
Some 32 million students eat school meals every day; for many low-income students, up to half their daily energy intake is from school meals. Under the previous dietary guidelines, school breakfasts and lunches were high in sodium and saturated fats and were low in whole grains and fiber. The new standards from the United States Department of Agriculture (USDA) aimed to improve the nutritional quality of school meals by making whole grains, fruits, and vegetables more available, requiring the selection of a fruit or vegetable, increasing the portion sizes of fruits and vegetables, removing trans fats, and placing limits on total calories and sodium levels.
The researchers collected plate waste data among 1,030 students in four schools in an urban, low-income school district both before (fall 2011) and after (fall 2012) the new standards went into effect. Following the implementation of the new standards, fruit selection increased by 23.0%; entrée and vegetable selection remained unchanged. In addition, consumption of vegetables increased by 16.2%; fruit consumption was unchanged, but because more students selected fruit, overall, more fruit was consumed post-implementation.
Importantly, the new standards did not result in increased food waste, contradicting anecdotal reports from food service directors, teachers, parents, and students that the regulations were causing an increase in waste due to both larger portion sizes and the requirement that students select a fruit or vegetable. However, high levels of fruit and vegetable waste continued to be a problem—students discarded roughly 60%-75% of vegetables and 40% of fruits on their trays. The authors say that schools must focus on improving food quality and palatability to reduce waste.
“The new school meal standards are the strongest implemented by the USDA to date, and the improved dietary intakes will likely have important health implications for children,” wrote the researchers.
Other HSPH authors included Eric Rimm, senior author and associate professor in the departments of Epidemiology and Nutrition, and Paul Catalano, senior lecturer on biostatistics.
Support was provided by Arbella Insurance and Project Bread. Cohen is supported by the Nutritional Epidemiology of Cancer Education and Career Development Program (R25 CA 098566).
“Impact of the New U.S. Department of Agriculture School Meal Standards on Food Selection, Consumption, and Waste,” Juliana F.W. Cohen, Scott Richardson, Ellen Parker, Paul J. Catalano, Eric B. Rimm, American Journal of Preventive Medicine, 46(4):388-394, online March 4, 2014
For more information:
Todd Datz
tdatz@hsph.harvard.edu
617.432.8413
photo: © XiXinXing/Alamy
###
About Harvard School of Public Health
Harvard School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory and the classroom to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at HSPH teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s oldest professional training program in public health.

The challenge is getting kids to eat the food mandated by the rules and for school districts to find “kid tasty” foods which are affordable. A Child’s health is too important to be the subject of tawdry political wrangling and high pressure tactics from big money interests. Our goal as a society should be:

A healthy child in a healthy family who attends a healthy school in a healthy neighborhood ©

Resources:

USDA changes school lunch requirements
http://thehill.com/blogs/blog-briefing-room/news/271813-usda-changes-school-lunch-requirements

USDA backpedals on healthy school-lunch rules
http://grist.org/news/usda-backpedals-on-healthy-school-lunch-rules/

National School Lunch Program Fact Sheet http://www.fns.usda.gov/cnd/lunch/aboutlunch/NSLPFactSheet.pdf

Related:
School dinner programs: Trying to reduce the number of hungry children
https://drwilda.wordpress.com/2012/01/28/school-dinner-programs-trying-to-reduce-the-number-of-hungry-children/

School lunches: The political hot potato
https://drwilda.wordpress.com/2011/11/03/school-lunches-the-political-hot-potato/

The government that money buys: School lunch cave in by Congress
https://drwilda.wordpress.com/2011/11/16/the-government-that-money-buys-school-lunch-cave-in-by-congress/

Do kids get enough time to eat lunch?
https://drwilda.com/2012/08/28/do-kids-get-enough-time-to-eat-lunch/

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/

University of California, San Francisco study identifies most common reasons for children’s mental health hospitalizations

23 Mar

Moi wrote about troubled children 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.
Schools are developing strategies to deal with troubled kids…. http://kidshealth.org/parent/emotions/feelings/understanding_depression.html

One strategy in helping children to succeed is to recognize and treat depression.

How Common Is Depression In Children?

According to Mary H. Sarafolean, PhD in the article, Depression In School Age Children and Adolescents

In general, depression affects a person’s physical, cognitive, emotional/affective, and motivational well-being, no matter their age. For example, a child with depression between the ages of 6 and 12 may exhibit fatigue, difficulty with schoolwork, apathy and/or a lack of motivation. An adolescent or teen may be oversleeping, socially isolated, acting out in self-destructive ways and/or have a sense of hopelessness.
Prevalence and Risk Factors
While only 2 percent of pre-teen school-age children and 3-5 percent of teenagers have clinical depression, it is the most common diagnosis of children in a clinical setting (40-50 percent of diagnoses). The lifetime risk of depression in females is 10-25 percent and in males, 5-12 percent. Children and teens who are considered at high risk for depression disorders include:
* children referred to a mental health provider for school problems
* children with medical problems
* gay and lesbian adolescents
* rural vs. urban adolescents
* incarcerated adolescents
* pregnant adolescents
* children with a family history of depression http://www.healthyplace.com/depression/children/recognizing-symptoms-of-depression-in-teens-and-children/

If you or your child has one or more of the risk factors and your child is exhibiting symptoms of prolonged sadness, it might be wise to have your child evaluated for depression.

How to Recognize Depression In Your Child?

MedNet has an excellent article about Depression In Children and how to recognize signs of depression in your child.
Signs and symptoms of depression in children include:

* Irritability or anger
* Continuous feelings of sadness, hopelessness
* Social withdrawal
* Increased sensitivity to rejection
* Changes in appetite — either increased or decreased
* Changes in sleep — sleeplessness or excessive sleep
* Vocal outbursts or crying
* Difficulty concentrating
* Fatigue and low energy
* Physical complaints (such as stomachaches, headaches) that do not respond to
treatment
* Reduced ability to function during events and activities at home or with friends, in school, extracurricular activities, and in other hobbies or interests
* Feelings of worthlessness or guilt
* Impaired thinking or concentration
* Thoughts of death or suicide
Not all children have all of these symptoms. In fact, most will display different symptoms at different times and in different settings. Although some children may continue to function reasonably well in structured environments, most kids with significant depression will suffer a noticeable change in social activities, loss of interest in school and poor academic performance, or a change in appearance. Children may also begin using drugs or alcohol,
especially if they are over the age of 12. http://www.onhealth.com/depression_in_children/article.htm

The best defense for parents is a good awareness of what is going on with their child. As a parent you need to know what is going on in your child’s world. https://drwilda.com/2011/11/15/schools-have-to-deal-with-depressed-and-troubled-children/

Science Daily reported in the article, Study identifies most common, costly reasons for mental health hospitalizations for kids:

Nearly one in 10 hospitalized children have a primary diagnosis of a mental health condition, and depression alone accounts for $1.33 billion in hospital charges annually, according to a new analysis led by UCSF Benioff Children’s Hospital.
The study is the first to examine frequency and costs associated with specific inpatient mental health diagnoses for children, and is a step towards creating meaningful measures of the quality of pediatric hospital care.
“This is the first paper to give a clear picture of the mental health reasons kids are admitted to hospitals nationally,” said Naomi Bardach, MD, an assistant professor of pediatrics at UCSF Benioff Children’s Hospital and lead author. “Mental health hospitalizations have been increasing in kids, up 24% from 2007-2010. Mental health is a priority topic for national quality measures, which are intended to help improve care for all kids.”
The study will be published in the April issue of the journal Pediatrics.
More than 14 million children and adolescents in the United States have a diagnosable mental health disorder, yet little is known about which specific mental health diagnoses are causing children to be hospitalized. In the study, researchers found that depression, bipolar disorder and psychosis are the most common and expensive primary diagnoses for pediatric admissions.
“We now know through our analysis of cost and frequency which diagnoses are the most relevant,” said Bardach. “Next, we need to define what the optimal care is for children with these conditions so that hospitals can consistently deliver the best care for every child, every time.”
Using two national databases — Kids’ Inpatient Database and Pediatric Health Information System — the researchers looked at all hospital discharges in 2009 for patients aged three to 20 years old to determine the frequency of hospitalizations for primary mental health diagnoses. They compared the mental health hospitalizations between free-standing children’s hospitals and hospitals that treat both adults and children, to assess if there was a difference in frequency of diagnoses.
The study found that hospitalizations for children with primary mental health diagnoses were more than three times more frequent at general hospitals than free standing children’s hospitals, which the researchers say could indicate that general hospitals have a greater capacity to deliver inpatient psychiatric care than free-standing children’s hospitals…. http://www.sciencedaily.com/releases/2014/03/140317084531.htm

Citation:

Study identifies most common, costly reasons for mental health hospitalization

Date: March 17, 2014

Source: University of California, San Francisco

Summary:
Nearly one in 10 hospitalized children have a primary diagnosis of a mental health condition, and depression alone accounts for $1.33 billion in hospital charges annually, according to a new analysis. The study is the first to examine frequency and costs associated with specific inpatient mental health diagnoses for children, and is a step towards creating meaningful measures of the quality of pediatric hospital care.
Journal Reference:
1.Naomi S. Bardach, Tumaini R. Coker, Bonnie T. Zima, J. Michael Murphy, Penelope Knapp, Laura P. Richardson, Glenace Edwall, and Rita Mangione-Smith. Common and Costly Hospitalizations for Pediatric Mental Health Disorders. Pediatrics, March 2014 DOI: 10.1542/peds.2013-3165

Here is the press release from the University of San Francisco:

Study Identifies Most Common, Costly Reasons for Mental Health Hospitalizations for Kids
By Juliana Bunim on March 13, 2014
Nearly one in 10 hospitalized children have a primary diagnosis of a mental health condition, and depression alone accounts for $1.33 billion in hospital charges annually, according to a new analysis led by UCSF Benioff Children’s Hospital.
The study is the first to examine frequency and costs associated with specific inpatient mental health diagnoses for children, and is a step towards creating meaningful measures of the quality of pediatric hospital care.
“This is the first paper to give a clear picture of the mental health reasons kids are admitted to hospitals nationally,” said Naomi Bardach, MD, an assistant professor of pediatrics at UCSF Benioff Children’s Hospital and lead author. “Mental health hospitalizations have been increasing in kids, up 24% from 2007-2010. Mental health is a priority topic for national quality measures, which are intended to help improve care for all kids.”
The study will be published in the April issue of the journal Pediatrics.
More than 4 million children and adolescents in the United States have a diagnosable mental health disorder, yet little is known about which specific mental health diagnoses are causing children to be hospitalized. In the study, researchers found that depression, bipolar disorder and psychosis are the most common and expensive primary diagnoses for pediatric admissions.
“We now know through our analysis of cost and frequency which diagnoses are the most relevant,” said Bardach. “Next, we need to define what the optimal care is for children with these conditions so that hospitals can consistently deliver the best care for every child, every time.”
Using two national databases – Kids’ Inpatient Database and Pediatric Health Information System – the researchers looked at all hospital discharges in 2009 for patients aged three to 20 years old to determine the frequency of hospitalizations for primary mental health diagnoses. They compared the mental health hospitalizations between free-standing children’s hospitals and hospitals that treat both adults and children, to assess if there was a difference in frequency of diagnoses.
The study found that hospitalizations for children with primary mental health diagnoses were more than three times more frequent at general hospitals than free standing children’s hospitals, which the researchers say could indicate that general hospitals have a greater capacity to deliver inpatient psychiatric care than free-standing children’s hospitals.
At both kinds of hospitals, the most common mental health diagnoses were similar (depression, bipolar disorder, and psychosis), which the researchers say supports the creation of diagnosis-specific quality measures for all hospitals that admit children.
Depression accounted for 44.1 percent of all pediatric primary mental health admissions, with charges of $1.33 billion dollars, based on the billing databases used in the study. Bipolar was the second most common diagnosis accounting for 18.1 percent and $702 million, followed by psychosis at 12.1 percent and $540 million.
“These are costly hospitalizations, and being hospitalized is a heavy burden for families and patients. Prevention and wellness is a huge part of the Affordable Care Act, along with controlling costs by delivering great care,” said Bardach. “This study helps us understand that mental health is a key priority. The long term goal is not only to improve hospital care for these kids, but also to understand how to effectively optimize mental health resources in the outpatient world.”
Co-authors include Tumaini Coker, MD, MBA and Bonnie Zima, MD, MPH, both of UCLA; J. Michael Murphy, EdD, Massachusetts General Hospital Boston; Penelope Knapp, MD, UC Davis; Laura Richardson, MD, MPH and Rita Mangione-Smith, MD, MPH, both of the University of Washington School of Medicine, Seattle; and Glenace Edwall, PsyD, PhD, MPP, Minnesota State Health Access Data Assistance Center.
The study was supported by the Agency for Healthcare Research and Quality and the National Institute for Children’s Health and Human Development.
UCSF Benioff Children’s Hospital creates an environment where children and their families find compassionate care at the forefront of scientific discovery, with more than 150 experts in 50 medical specialties serving patients throughout Northern California and beyond. The hospital admits about 5,000 children each year, including 2,000 babies born in the hospital.

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:

GAO report: Children’s mental health services are lacking
https://drwilda.com/2013/01/12/gao-report-childrens-mental-health-services-are-lacking/

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

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

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Blogs by Dr. Wilda:

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Dr. Wilda ©
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Journal of American Medical Association study: Consumption of nuts by pregnant woman may reduce nut allergies in their children

24 Dec

Moi wrote about allergies in Food allergies can be deadly for some children:
If one is not allergic to substances, then you probably don’t pay much attention to food allergies. The parents and children in one Florida classroom are paying a lot of attention to the subject of food allergies because of the severe allergic reaction one child has to peanuts. In the article, Peanut Allergy Stirs Controversy At Florida Schools Reuters reports:

Some public school parents in Edgewater, Florida, want a first-grade girl with life-threatening peanut allergies removed from the classroom and home-schooled, rather than deal with special rules to protect her health, a school official said.
“That was one of the suggestions that kept coming forward from parents, to have her home-schooled. But we’re required by federal law to provide accommodations. That’s just not even an option for us,” said Nancy Wait, spokeswoman for the Volusia County School District.
Wait said the 6-year-old’s peanut allergy is so severe it is considered a disability under the Americans with Disabilities Act.
To protect the girl, students in her class at Edgewater Elementary School are required to wash their hands before entering the classroom in the morning and after lunch, and rinse out their mouths, Wait said, and a peanut-sniffing dog checked out the school during last week’s spring break….
Chris Burr, a father of two older students at the school whose wife has protested at the campus, said a lot of small accommodations have added up to frustration for many parents.
“If I had a daughter who had a problem, I would not ask everyone else to change…. http://www.reuters.com/article/2011/03/22/us-peanut-allergy-idUSTRE72L7AQ20110322

More children seem to have peanut allergies. Researchers are trying to discover the reason for the allergies, but also asking the question of whether the number of nut allergies in children can be reduced.

Michael Pearson of CNN reported in the story, Study: Eating nuts during pregnancy may reduce baby’s allergy risk:

The children of women who regularly ate peanuts or tree nuts during pregnancy appear to be at lower risk for nut allergies than other kids, according to a new study published Monday.
The study, published in the Journal of the American Medical Association, is the first to demonstrate that a mother who eats nuts during pregnancy may help build up a baby’s tolerance to them after birth, its lead author, Dr. Michael Young, told CNN.
The effect seemed to be strongest in women who ate the most peanuts or tree nuts — five or more servings per week, according to the study, which controlled for factors such as family history of nut allergies and other dietary practices.
Peanut and tree nut allergies tend to overlap, according to the researchers.
What food allergies are costing families — and the economy
Earlier studies indicated that nut consumption during pregnancy either didn’t have any effect or actually raised the risk of allergies in children.
However, the authors of the latest study say those studies were based on less reliable data and conflict with more recent research suggesting that early exposure to nuts can reduce the risk of developing allergies to them.
There is currently no formally recognized medical guidance for nut consumption during pregnancy or infancy. http://www.cnn.com/2013/12/23/health/nut-allergy-study/

Citation:

Original Investigation | December 23, 2013 JOURNAL CLUB
Prospective Study of Peripregnancy Consumption of Peanuts or Tree Nuts by Mothers and the Risk of Peanut or Tree Nut Allergy in Their Offspring FREE ONLINE FIRST
A. Lindsay Frazier, MD, ScM1,2; Carlos A. Camargo Jr, MD, DrPH2,3,4; Susan Malspeis, MS2; Walter C. Willett, MD, DrPH4,5,6; Michael C. Young, MD7
[+] Author Affiliations
JAMA Pediatr. Published online December 23, 2013. doi:10.1001/jamapediatrics.2013.4139
Article
Tables
References
Comments
ABSTRACT
ABSTRACT | METHODS | RESULTS | DISCUSSION | CONCLUSIONS | ARTICLE INFORMATION | REFERENCES
Importance The etiology of the increasing childhood prevalence of peanut or tree nut (P/TN) allergy is unknown.
Objective To examine the association between peripregnancy consumption of P/TN by mothers and the risk of P/TN allergy in their offspring.
Design, Setting, and Participants Prospective cohort study. The 10 907 participants in the Growing Up Today Study 2, born between January 1, 1990, and December 31, 1994, are the offspring of women who previously reported their diet during, or shortly before or after, their pregnancy with this child as part of the ongoing Nurses’ Health Study II. In 2006, the offspring reported physician-diagnosed food allergy. Mothers were asked to confirm the diagnosis and to provide available medical records and allergy test results. Two board-certified pediatricians, including a board-certified allergist/immunologist, independently reviewed each potential case and assigned a confirmation code (eg, likely food allergy) to each case. Unadjusted and multivariable logistic regression analyses were used to evaluate associations between peripregnancy consumption of P/TN by mothers and incident P/TN allergy in their offspring.
Exposure Peripregnancy consumption of P/TN.
Main Outcomes and Measures Physician-diagnosed P/TN allergy in offspring.
Results Among 8205 children, we identified 308 cases of food allergy (any food), including 140 cases of P/TN allergy. The incidence of P/TN allergy in the offspring was significantly lower among children of the 8059 nonallergic mothers who consumed more P/TN in their peripregnancy diet (≥5 times vs <1 time per month: odds ratio = 0.31; 95% CI, 0.13-0.75; Ptrend = .004). By contrast, a nonsignificant positive association was observed between maternal peripregnancy P/TN consumption and risk of P/TN allergy in the offspring of 146 P/TN-allergic mothers (Ptrend = .12). The interaction between maternal peripregnancy P/TN consumption and maternal P/TN allergy status was statistically significant (Pinteraction = .004).
Conclusions and Relevance Among mothers without P/TN allergy, higher peripregnancy consumption of P/TN was associated with lower risk of P/TN allergy in their offspring. Our study supports the hypothesis that early allergen exposure increases tolerance and lowers risk of childhood food allergy.
Peanut allergy affects 1% to 2% of the population in most Western countries,1- 3 and in the United States, the prevalence of childhood peanut allergy has more than tripled, from 0.4% in 1997 to 1.4% in 2010.4 Typically, the onset of peanut allergy is in early childhood; 70% of reactions occur during the first known exposure.5 These IgE-mediated hypersensitivity reactions require prior allergen exposure and sensitization, implying that prior exposure to peanut had already occurred in utero or through unknown exposures in the diet or environment, such as through skin or respiratory routes.6 Because of frequent overlap between peanut allergy and tree nut allergy and their similar natural history, with 80% to 90% persistence of the food allergy into adulthood,7 these 2 allergies are often considered together as peanut or tree nut (P/TN) allergy.
For many years, pediatric guidelines have recommended the avoidance of P/TN for at least the first 3 years of life, with some experts also recommending that P/TN be avoided during pregnancy.8 These recommendations were rescinded recently when literature reviews showed little support for them.9,10 For decades, many investigators have posited that modifications of the maternal diet during pregnancy might prevent food allergies.11- 14 However, some studies on maternal avoidance of peanut during pregnancy actually demonstrated an increase in peanut sensitization in the child,15- 17 while other studies found no association.5,14,18,19 In related research, early exposure to allergenic foods in infant diets may decrease sensitization and increase oral tolerance to those foods.20- 24
Given the lack of clarity in the current literature, an important quandary exists: should the pregnant mother include or exclude P/TN in her diet? The goal of our investigation was to clarify the association between peripregnancy consumption of P/TN by mothers and the subsequent development of P/TN allergy in their offspring…. http://archpedi.jamanetwork.com/article.aspx?articleid=1793699

Resources:

Micheal Borella’s Chicago-Kent Law Review article, Food Allergies In Public Schools: Toward A Model Code
http://www.cklawreview.com/wp-content/uploads/vol85no2/Borella.pdf

USDA’s Accommodating Children With Special Dietary Needs http://www.k12.wa.us/ChildNutrition/pubdocs/SpecialDietaryNeeds.PDF

Child and Teen Checkup Fact Sheet http://www.health.state.mn.us/divs/fh/mch/ctc/factsheets.html
Video: What to Expect From A Child’s Physical Exam
http://on.aol.com/video/what-to-expect-from-a-childs-physical-exam-325661948

Related:
New federal guidelines for schools regarding student allergies
https://drwilda.com/2013/11/04/new-federal-guidelines-for-schools-regarding-student-allergies/

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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/

Brigham Young University study: Paying kids gets them to eat vegetables

21 Dec

Moi wrote in School lunches: The political hot potato:
There are some very good reasons why meals are provided at schools. Education Bug has a history of the school lunch program http://www.educationbug.org/a/the-history-of-the-school-lunch-program.html

President Harry S. Truman began the national school lunch program in 1946 as a measure of national security. He did so after reading a study that revealed many young men had been rejected from the World War II draft due to medical conditions caused by childhood malnutrition. Since that time more than 180 million lunches have been served to American children who attend either a public school or a non-profit private school.

The U.S. Department of Agriculture (Agriculture Department) has a School Lunch Program Fact Sheet http://www.fns.usda.gov/cnd/lunch/aboutlunch/NSLPFactSheet.pdf

According to the fact sheet, more than 30 million children are fed by the program. Physicians for Responsible Medicine criticize the content of school lunch programs
In Healthy School Lunches the physicians group says:

Menus in most school lunch programs are too high in saturated fat and cholesterol and too low in fiber- and nutrient-rich fruits, vegetables, whole grains, and legumes (see PCRM’s 2008 School Lunch Report Card). Major changes are needed to encourage the health of the nation’s youth and to reverse the growing trends of obesity, early-onset diabetes, and hypertension, among other chronic diseases, in children and teens. http://www.pcrm.org/health/healthy-school-lunches/changes/key-changes-recommended-for-the-national-school

A 2003 General Accounting Office (GAO) reached the same conclusion. See, School Lunch Program: Efforts Needed to Improve Nutrition and Encourage and Healthy Eating http://www.gao.gov/products/GAO-03-506 https://drwilda.com/2011/11/03/school-lunches-the-political-hot-potato/

Science Daily reported in the article, Study: Pay Kids to Eat Fruits, Vegetables:

The good news: Research suggests that a new federal rule has prompted the nation’s schools to serve an extra $5.4 million worth of fruits and vegetables each day.
The bad news: The nation’s children throw about $3.8 million of that in the garbage each day.
Researchers from Brigham Young University and Cornell observed three schools adjust to new school lunch standards that require a serving of fruits or vegetables on every student’s tray — whether the child intends to eat it or not. As they report in the December issue of Public Health Nutrition, students discarded 70 percent of the extra fruits and vegetables.
“We saw a minor increase in kids eating the items, but there are other ways to achieve the same goal that are much, much cheaper,” said BYU economics professor Joe Price.
Strange as it sounds, directly paying students to eat a fruit or vegetable is less expensive and gets better results.
With Cornell’s David Just, Price conducted a second study to measure the effect of small rewards in the lunchroom. The week-long experiments took on different twists in the 15 different schools — some could earn a nickel, others a quarter, and others a raffle ticket for a larger prize. But the results were generally the same. As the scholars report in The Journal of Human Resources, offering small rewards increased the fruit and vegetable consumption by 80 percent. And the amount of wasted food declined by 33 percent.
Which begs the question: Is benevolent bribery a better way?
“Parents are often misguided about incentives,” Price said. “We feel a sense of dirtiness about a bribe. But rewards can be really powerful if the activity creates a new skill or changes preferences.”
The case against using bribes in parenting is perhaps best articulated in Alfie Kohn’s 1999 book “Punished by Rewards.” In many scenarios, the use of rewards can crush internal motivation. With healthy eating, for example, some fear that prizes will prevent children from developing their own motivation to eat things that are good for them. Another danger, known as a boomerang effect, is the possibility that some children would eat less fruits and vegetables when the rewards disappeared.
That’s why Price and Just measured fruit and vegetable consumption before and after the week-long experiments. When the week of prizes ended, students went back to the same level of fruit and vegetable consumption as before — no lasting improvement, but no boomerang effect either.
Now the researchers are studying whether extending the experiments over three to five weeks might yield lasting change. So far things look promising….
http://www.sciencedaily.com/releases/2013/12/131217104601.htm#.UrPzdFGb0KY.email

Citation:

Journal References:
1.David Just, Joseph Price. Using Incentives to Encourage Healthy Eating in Children. The Journal of Human Resources, December 2013
2.David Just, Joseph Price. Default options, incentives and food choices: evidence from elementary-school children. Public Health Nutrition, 2013; 16 (12): 2281 DOI: 10.1017/S1368980013001468
Brigham Young University (2013, December 17). Study: Pay kids to eat fruits, vegetables. ScienceDaily. Retrieved December 21, 2013,

Here is the press release from Brigham Young University:

News Release
Study: Pay kids to eat fruits & veggies with school lunch
Small rewards bring less waste, better results than new school lunch rule
The Washington Post
Slate
The Salt Lake Tribune
Fox News
Yahoo News
Huffington Post
The good news: Research suggests that a new federal rule has prompted the nation’s schools to serve an extra $5.4 million worth of fruits and vegetables each day.
The bad news: The nation’s children throw about $3.8 million of that in the garbage each day.
Researchers from Brigham Young University and Cornell observed three schools adjust to new school lunch standards that require a serving of fruits or vegetables on every student’s tray – whether the child intends to eat it or not. As they report in the December issue of Public Health Nutrition, students discarded 70 percent of the extra fruits and vegetables.
“We saw a minor increase in kids eating the items, but there are other ways to achieve the same goal that are much, much cheaper,” said BYU economics professor Joe Price.
Strange as it sounds, directly paying students to eat a fruit or vegetable is less expensive and gets better results.
With Cornell’s David Just, Price conducted a second study to measure the effect of small rewards in the lunchroom. The week-long experiments took on different twists in the 15 different schools – some could earn a nickel, others a quarter, and others a raffle ticket for a larger prize. But the results were generally the same. As the scholars report in The Journal of Human Resources, offering small rewards increased the fruit and vegetable consumption by 80 percent. And the amount of wasted food declined by 33 percent.
Which begs the question: Is benevolent bribery a better way?
“Parents are often misguided about incentives,” Price said. “We feel a sense of dirtiness about a bribe. But rewards can be really powerful if the activity creates a new skill or changes preferences.”
The case against using bribes in parenting is perhaps best articulated in Alfie Kohn’s 1999 book “Punished by Rewards.” In many scenarios, the use of rewards can crush internal motivation. With healthy eating, for example, some fear that prizes will prevent children from developing their own motivation to eat things that are good for them. Another danger, known as a boomerang effect, is the possibility that some children would eat less fruits and vegetables when the rewards disappeared.
That’s why Price and Just measured fruit and vegetable consumption before and after the week-long experiments. When the week of prizes ended, students went back to the same level of fruit and vegetable consumption as before – no lasting improvement, but no boomerang effect either.
Now the researchers are studying whether extending the experiments over three to five weeks might yield lasting change. So far things look promising.
“I don’t think we should give incentives such a bad rap,” Price said. “They should be considered part of a set of tools we can use.”
The first study documenting the impact of the new rule appears in the December 2013 issue of Public Health Nutrition. The second study is titled “Using Incentives to Encourage Healthy Eating in Children” and is available to subscribers of The Journal of Human Resources. An earlier version of the paper is available at Price’s website.
Related Stories
Birth order study: It’s about time
BYU study says exercise may reduce motivation for food
Story Highlights
•A new federal rule requires a serving of fruits or vegetables on every tray
•70 percent is thrown away, wasting an estimated $3.8 million daily
•Offering a small reward doubles fruit and vegetable consumption without the waste
http://news.byu.edu/archive13-dec-veggies.aspx

The challenge is getting kids to eat the food mandated by the rules and for school districts to find “kid tasty” foods which are affordable. A Child’s health is too important to be the subject of tawdry political wrangling and high pressure tactics from big money interests. Our goal as a society should be:

A healthy child in a healthy family who attends a healthy school in a healthy neighborhood ©

Resources:

USDA changes school lunch requirements http://thehill.com/blogs/blog-briefing-room/news/271813-usda-changes-school-lunch-requirements

USDA backpedals on healthy school-lunch rules http://grist.org/news/usda-backpedals-on-healthy-school-lunch-rules/

National School Lunch Program Fact Sheet
http://www.fns.usda.gov/cnd/lunch/aboutlunch/NSLPFactSheet.pdf

Related:

School dinner programs: Trying to reduce the number of hungry children https://drwilda.wordpress.com/2012/01/28/school-dinner-programs-trying-to-reduce-the-number-of-hungry-children/

School lunches: The political hot potato https://drwilda.wordpress.com/2011/11/03/school-lunches-the-political-hot-potato/

The government that money buys: School lunch cave in by Congress https://drwilda.wordpress.com/2011/11/16/the-government-that-money-buys-school-lunch-cave-in-by-congress/

Do kids get enough time to eat lunch? https://drwilda.com/2012/08/28/do-kids-get-enough-time-to-eat-lunch/

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/

New federal guidelines for schools regarding student allergies

4 Nov

Moi wrote about allergies in Food allergies can be deadly for some children:
If one is not allergic to substances, then you probably don’t pay much attention to food allergies. The parents and children in one Florida classroom are paying a lot of attention to the subject of food allergies because of the severe allergic reaction one child has to peanuts. In the article, Peanut Allergy Stirs Controversy At Florida Schools Reuters reports:

Some public school parents in Edgewater, Florida, want a first-grade girl with life-threatening peanut allergies removed from the classroom and home-schooled, rather than deal with special rules to protect her health, a school official said.
“That was one of the suggestions that kept coming forward from parents, to have her home-schooled. But we’re required by federal law to provide accommodations. That’s just not even an option for us,” said Nancy Wait, spokeswoman for the Volusia County School District.
Wait said the 6-year-old’s peanut allergy is so severe it is considered a disability under the Americans with Disabilities Act.
To protect the girl, students in her class at Edgewater Elementary School are required to wash their hands before entering the classroom in the morning and after lunch, and rinse out their mouths, Wait said, and a peanut-sniffing dog checked out the school during last week’s spring break….
Chris Burr, a father of two older students at the school whose wife has protested at the campus, said a lot of small accommodations have added up to frustration for many parents.
“If I had a daughter who had a problem, I would not ask everyone else to change…. http://www.reuters.com/article/2011/03/22/us-peanut-allergy-idUSTRE72L7AQ20110322

More children seem to have peanut allergies.
See, More school battles about peanut allergies https://drwilda.com/tag/allergy/

Mike Stobbe of AP reported in the article, Feds post food allergy guidelines for schools:

ATLANTA (AP) — The federal government is issuing its first guidelines to schools on how to protect children with food allergies.
The voluntary guidelines call on schools to take such steps as restricting nuts, shellfish or other foods that can cause allergic reactions, and make sure emergency allergy medicine — like EpiPens — are available.
About 15 states — and numerous individual schools or school districts — already have policies of their own. “The need is here” for a more comprehensive, standardized way for schools to deal with this issue, said Dr. Wayne Giles, who oversaw development of the advice for the Centers for Disease Control and Prevention.
Food allergies are a growing concern. A recent CDC survey estimated that about 1 in 20 U.S. children have food allergies — a 50 percent increase from the late 1990s. Experts aren’t sure why cases are rising.
Many food allergies are mild and something children grow out of. But severe cases may cause anaphylactic shock or even death from eating, say, a peanut.
The guidelines released Wednesday were required by a 2011 federal law.
http://www.huffingtonpost.com/2013/10/30/school-allergy-guidelines_n_4177867.html?utm_hp_ref=email_share

Here is information from the Centers for Disease Control about the guidelines:

Food Allergies in Schools
Food allergies are a growing food safety and public health concern that affect an estimated 4%–6% of children in the United States.1, 2 Allergic reactions can be life threatening and have far-reaching effects on children and their families, as well as on the schools or early care and education (ECE) programs they attend. Staff who work in schools and ECE programs should develop plans for preventing an allergic reaction and responding to a food allergy emergency.
Voluntary Guidelines for Managing Food Allergies In Schools and Early Care and Education Programs [PDF – 10MB]
Food Allergy Guidelines FAQs [PDF – 163KB]
What is a Food Allergy?
A food allergy occurs when the body has a specific and reproducible immune response to certain foods.3 The body’s immune response can be severe and life threatening, such as anaphylaxis. Although the immune system normally protects people from germs, in people with food allergies, the immune system mistakenly responds to food as if it were harmful.
Eight foods or food groups account for 90% of serious allergic reactions in the United States: milk, eggs, fish, crustacean shellfish, wheat, soy, peanuts, and tree nuts.3
Symptoms of Food Allergy in Children
Symptoms Communicated by Children with Food Allergies4
• It feels like something is poking my tongue.
• My tongue (or mouth) is tingling (or burning).
• My tongue (or mouth) itches.
• My tongue feels like there is hair on it.
• My mouth feels funny.
• There’s a frog in my throat; there’s something stuck in my throat.
• My tongue feels full (or heavy).
• My lips feel tight.
• It feels like there are bugs in there (to describe itchy ears).
• It (my throat) feels thick.
• It feels like a bump is on the back of my tongue (throat).
The symptoms and severity of allergic reactions to food can be different between individuals, and can also be different for one person over time. Anaphylaxis is a sudden and severe allergic reaction that may cause death.5 Not all allergic reactions will develop into anaphylaxis.
Food Allergies in Schools
• Children with food allergies are two to four times more likely to have asthma or other allergic conditions than those without food allergies.1
• The prevalence of food allergies among children increased 18% during 1997–2007, and allergic reactions to foods have become the most common cause of anaphylaxis in community health settings.1,6
• In 2006, about 88% of schools had one or more students with a food allergy.7

Treatment and Prevention of Food Allergies in Children
There is no cure for food allergies. Strict avoidance of the food allergen is the only way to prevent a reaction. However, since it is not always easy or possible to avoid certain foods, staff in schools and ECE programs should develop plans to deal with allergic reactions, including anaphylaxis. Early and quick recognition and treatment of allergic reactions that may lead to anaphylaxis can prevent serious health problems or death.
Voluntary Guidelines for Managing Food Allergies In Schools and Early Care and Education Programs
In consultation with the U.S. Department of Education and a number of other federal agencies, CDC developed the Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Centers [PDF – 10MB] in fulfillment of the 2011 FDA Food Safety Modernization Act to improve food safety in the United States. Download Food Allergy Guidelines FAQs [PDF – 163KB].
The Voluntary Guidelines for Managing Food Allergies provide practical information and planning steps for parents, district administrators, school administrators and staff, and ECE program administrators and staff to develop or strengthen plans for food allergy management and prevention. The Voluntary Guidelines for Managing Food Allergies include recommendations for each of the five priority areas that should be addressed in each school’s or ECE program’s Food Allergy Management Prevention Plan:
1. Ensure the daily management of food allergies in individual children.
2. Prepare for food allergy emergencies.
3. Provide professional development on food allergies for staff members.
4. Educate children and family members about food allergies.
5. Create and maintain a healthy and safe educational environment.
References
1. Branum AM, Lukacs SL. Food allergy among U.S. children: trends in prevalence and hospitalizations. NCHS Data Brief. 2008;10:1-8.
2. Liu AH, Jaramillo R, Sicherer SH, et al. National prevalence and risk factors for food allergy and relationship to asthma: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol. 2010;126(4):798-806.e13.
3. Boyce JA, Assa’ad A, Burks AW, et al; NIAID-Sponsored Expert Panel. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(suppl 6):S1-S58.
4. The Food Allergy & Anaphylaxis Network. Food Allergy News. 2003;13(2).
5. Sampson HA, Munoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium. Ann Emerg Med. 2006;47(4):373-380.
6. Decker WW, Campbell RL, Manivannan V, et al. The etiology and incidence of anaphylaxis in Rochester, Minnesota: a report from the Rochester Epidemiology Project. J Allergy Clin Immunol. 2008;122(6):1161-1165.
7. O’Toole TP, Anderson S, Miller C, Guthrie J. Nutrition services and foods and beverages available at school: results from the School Health Policies and Programs Study 2006. J Sch Health. 2007;77:500-521.
Voluntary Guidelines for Managing Food Allergies In Schools and Early Care and Education Programs [PDF – 10MB]
Food Allergy Guidelines FAQs [PDF – 163KB]
http://www.cdc.gov/healthyyouth/foodallergies/

It requires a great deal of tact and give and take on the part of parents and the school to produce a workable situation for students, the child with the allergy, and parents.
A physical examination is important for children to make sure that there are no health problems. The University of Arizona Department of Pediatrics has an excellent article which describes Pediatric History and Physical Examination http://www.peds.arizona.edu/medstudents/Physicalexamination.asp The article goes on to describe how the physical examination is conducted and what observations and tests are part of the examination. The Cincinnati Children’s Hospital describes the Process of the Physical Examination http://www.cincinnatichildrens.org/health/p/exam/
If children have allergies, parents must work with their schools to prepare a allergy health plan.

Resources:

Micheal Borella’s Chicago-Kent Law Review article, Food Allergies In Public Schools: Toward A Model Code http://www.cklawreview.com/wp-content/uploads/vol85no2/Borella.pdf

USDA’s Accommodating Children With Special Dietary Needs http://www.k12.wa.us/ChildNutrition/pubdocs/SpecialDietaryNeeds.PDF

Child and Teen Checkup Fact Sheet http://www.health.state.mn.us/divs/fh/mch/ctc/factsheets.html

Video: What to Expect From A Child’s Physical Exam http://on.aol.com/video/what-to-expect-from-a-childs-physical-exam-325661948

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

Dr. Wilda says this about that ©

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Yale University study: Left-handed people more likely to have psychotic disorders such as schizophrenia

3 Nov

Science Daily reported in the article, Lefties More Likely to Have Psychotic Disorders Such as Schizophrenia:

Being left-handed has been linked to many mental disorders, but Yale researcher Jadon Webb and his colleagues have found that among those with mental illnesses, people with psychotic disorders like schizophrenia are much more likely to be left-handed than those with mood disorders like depression or bipolar syndrome. 1 The new study is published in the October-December 2013 issue of the journal SAGE Open. About 10% of the U.S. population is left-handed. When comparing all patients with mental disorders, the research team found that 11% of those diagnosed with mood disorders such as depression and bipolar disorder are left-handed, which is similar to the rate in the general population. But according to Webb, a child and adolescent psychiatry fellow at the Yale Child Study Center with a particular interest in biomarkers of psychosis, “a striking of 40% of those with schizophrenia or schizoaffective disorder are left-handed….” Webb and his colleagues studied 107 individuals from a public outpatient psychiatric clinic seeking treatment in an urban, low-income community. The research team determined the frequency of left-handedness within the group of patients identified with different types of mental disorders. The study showed that white patients with psychotic illness were more likely to be left-handed than black patients. “Even after controlling for this, however, a large difference between psychotic and mood disorder patients remained,” said Webb. What sets this study apart from other handedness research is the simplicity of the questionnaire and analysis, said Webb. Patients who were attending their usual check-ups at the mental health facility were simply asked “What hand do you write with?” “This told us much of what we needed to know in a very simple, practical way,” said Webb. “Doing a simple analysis meant that there were no obstacles to participating and we had a very high participation rate of 97%. Patients dealing with serious symptoms of psychosis might have had a harder time participating in a more complicated set of questions or tests. By keeping the survey simple, we were able to get an accurate snapshot of a hard-to-study subgroup of mentally ill people — those who are often poverty-stricken with very poor family and community support.” http://www.sciencedaily.com/releases/2013/10/131031125319.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29

Citation:

Journal Reference:
1. J. R. Webb, M. I. Schroeder, C. Chee, D. Dial, R. Hana, H. Jefee, J. Mays, P. Molitor. Left-Handedness Among a Community Sample of Psychiatric Outpatients Suffering From Mood and Psychotic Disorders. SAGE Open, 2013; 3 (4) DOI: 10.1177/2158244013503166

Here is the Yale University press release:

By Karen N. Peart
October 31, 2013
Being left-handed has been linked to many mental disorders, but Yale researcher Jadon Webb and his colleagues have found that among those with mental illnesses, people with psychotic disorders like schizophrenia are much more likely to be left-handed than those with mood disorders like depression or bipolar syndrome.
The new study is published in the October-December 2013 issue of the journal SAGE Open. About 10% of the U.S. population is left-handed. When comparing all patients with mental disorders, the research team found that 11% of those diagnosed with mood disorders such as depression and bipolar disorder are left-handed, which is similar to the rate in the general population. But according to Webb, a child and adolescent psychiatry fellow at the Yale Child Study Center with a particular interest in biomarkers of psychosis, “a striking of 40% of those with schizophrenia or schizoaffective disorder are left-handed.”
“In general, people with psychosis are those who have lost touch with reality in some way, through hallucinations, delusions, or false beliefs, and it is notable that this symptom constellation seems to correlate with being left-handed,” said Webb. “Finding biomarkers such as this can hopefully enable us to identify and differentiate mental disorders earlier, and perhaps one day tailor treatment in more effective ways.” Webb and his colleagues studied 107 individuals from a public outpatient psychiatric clinic seeking treatment in an urban, low-income community. The research team determined the frequency of left-handedness within the group of patients identified with different types of mental disorders.
The study showed that white patients with psychotic illness were more likely to be left-handed than black patients. “Even after controlling for this, however, a large difference between psychotic and mood disorder patients remained,” said Webb. What sets this study apart from other handedness research is the simplicity of the questionnaire and analysis, said Webb. Patients who were attending their usual check-ups at the mental health facility were simply asked “What hand do you write with?” “This told us much of what we needed to know in a very simple, practical way,” said Webb. “Doing a simple analysis meant that there were no obstacles to participating and we had a very high participation rate of 97%.
Patients dealing with serious symptoms of psychosis might have had a harder time participating in a more complicated set of questions or tests. By keeping the survey simple, we were able to get an accurate snapshot of a hard-to-study subgroup of mentally ill people — those who are often poverty-stricken with very poor family and community support.”
Other authors on the study include Mary I. Schroeder, Christopher Chee, Deanna Dial, Rebecca Hana, Hussam Jefee, Jacob Mays, and Patrick Molitor. Citation: Sage Open vol. 3 no. 4 2158244013503166 (October-December 2013)

For interesting facts about left-handed people http://facts.randomhistory.com/facts-about-left-handedness.html

A 2011 Wall Street Journal article, The Health Risks of Being Left-Handed, highlighted some of the potential challenges faced by lefties:

On average there is no significant difference in IQ between righties and lefties, studies show, belying popular perceptions. There is some evidence that lefties are better at divergent thinking, or starting from existing knowledge to develop new concepts, which is considered an element of creativity. And left-handed people have salaries that on average are about 10% lower than righties, according to recent research performed at Harvard University that analyzed large income data bases, although findings of some earlier studies were mixed.
Left-handedness appears to be associated with a greater risk for a number of psychiatric and developmental disorders. While lefties make up about 10% of the overall population, about 20% of people with schizophrenia are lefties, for example. Links between left-handedness and dyslexia, ADHD and some mood disorders have also been reported in research studies. The reasons for this aren’t clear. Scientists speculate it could be related to a concept known as brain lateralization.
The brain has two halves. Each performs primarily separate, specialized functions, such as language processing, which mainly takes place in the left hemisphere. There is lots of communication between the hemispheres. Typically in right-handers, the brain’s left side is dominant. But this tendency doesn’t hold up with lefties, as scientists previously believed. Some 70% of lefties rely on the left hemisphere for their language centers, a key brain function, says Metten Somers, a psychiatrist and researcher who studies brain lateralization at Utrecht University Medical Center in the Netherlands. This doesn’t appear to present problems, scientists say. The other 30% of lefties appear to exhibit either a right-dominant or distributed pattern, Dr. Somers says. They may be more prone to impaired learning or functioning, and at greater risk for brain disorders, he says. Hemisphere dominance is typical and more efficient. Symmetry, in which neither side is dominant, is believed linked to disorders, researchers say. People with schizophrenia, for instance, exhibit more symmetrical activation of their brain hemispheres than those without the disorder, studies show.
In a 2008 study, Alina Rodriguez, a psychology professor at Mid Sweden University in Östersund who studies handedness, brain development and ADHD, found that left- or mixed-handedness in children was linked to a greater risk of difficulty with language as well as ADHD symptoms. In another study published last year in Pediatrics, involving nearly 8,000 Finnish children, Dr. Rodriguez found that mixed-handedness rather than left-handedness was linked to ADHD symptoms. And knowing that a child was mixed-handed and had ADHD symptoms at age 8 helped predict much more accurately than just knowing they had symptoms at that age whether the child would continue to have symptoms at age 16. (What happens when people are forced to switch from writing with their dominant hand to the other isn’t well known, experts say.) Research that suggests that there is a link between favoring the left hand and an increased risk of bipolar disorder and ADHD, among other conditions. Emily Nelson has details on Lunch Break.
One reason that not more is known about lefties is that many studies of how the brain works prohibit left-handers from participating because their brain wiring is known to be different, says Robin Nusslock, a psychology professor at Northwestern University in Evanston, Ill., who uses neuroimaging to study mood disorders.
Lefties have an advantage in sports such as tennis, fencing and baseball, when up against a righthanded competitor, but not in noninteractive sports such as gymnastics. A potential pathway between prenatal stress and brain wiring could be cortisol, the body’s main stress hormone, which can interfere with brain development, says Carsten Obel, a professor at the public-health department at Aarhus University in Denmark who has conducted research on the prenatal environment and risk of disease. Cortisol is able to pass over the placenta barrier to influence the baby.
Several studies show that stressful life events, such as the death of a loved one or job loss, during pregnancy increase the risk of having non-right-handed children. In one study of 834 Danish mothers and their 3-year-old children, Dr. Obel and his colleagues found that mothers who reported multiple stressful events during their third trimester of pregnancy and experienced distress were more than three times as likely to have a mixed-handed child, 17% compared with 5%, according to the 2003 paper published in Developmental Medicine & Child Neurology. Another large study followed 1,700 Swedish mothers and children until the kids were 5 years old. It found that mothers with depressive symptoms or who underwent stressful life events while pregnant were more likely to have left- or mixed-handed children. The work was published by Dr. Rodriguez and her colleagues in 2008 in the Journal of Child Psychology and Psychiatry. Experts suggest that left- and mixed-handedness could be used as a risk factor for possible psychiatric or developmental conditions, along with behavioral difficulties, such as having a hard time in school. The presence of such risk factors could prompt early evaluation for those conditions, they say. http://online.wsj.com/news/articles/SB10001424052970204083204577080562692452538

The best defense for parents is a good awareness of what is going on with their child. As a parent you need to know what is going on in your child’s world

Related:

GAO report: Children’s mental health services are lacking https://drwilda.com/2013/01/12/gao-report-childrens-mental-health-services-are-lacking/

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

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