Attention-Defecit/Hyperactivity Disorder (ADHD)
A study published in the British Medical Journal by researchers in Australia warns of over diagnosis of Attention-Defecit/Hyperactivity Disorder (ADHD). There has been a steep increase in diagnosis of ADHD in the past decade. In turn, there have been substantial increases in prescribed medicine for children, adolescents, and adults.
The reasons stated for this increase in diagnoses are a widening of the definition of ADHD as well as changes in the criteria used to for diagnosing ADHD. The authors state concerns of medication costs, adverse events, and psychological harms. They state “A diagnostic label is value laden and has the potential to cause harm and, paradoxically, increase mental health problems. Compared with children with asthma, children with ADHD have been described as lazier, less clever, and less caring, and they are also more likely to be stigmatized and socially excluded. Teacher and parent expectations of academic achievements are also low, and these are associated with actual lower achievement scores.”
The authors therefore suggest a more conservative approach to treatment. They propose following an approach similar to that advised by current UK guidelines, in which there are five steps before a definite diagnosis of ADHD. The goal is a reduction in unnecessary diagnoses, but not at the expense of under diagnosing those cases that genuinely require psychiatric intervention.
Rae Thomas, Geoffrey K Mitchell, Laura Batstra. “Attention-defecit/hyperactivity disorder: are we helping or harming.” BMJ 2013; 347: f6172
More Studies Needed to Test Drugs in Premature Infants
Matthew M. Laughon, MD, MPH, of the department of pediatrics at the University of North Carolina at Chapel Hill, and his colleagues, have reported gaps in knowledge and information regarding the use of medication in premature infants (neonates).
Although the FDA has implemented regulation to increase drug research in this special population, large gaps remain and physicians are still using drugs in neonates without direct evidence of benefits or side-effect profiles.
Laughon states that the primary obstacles to obtaining research in the neonatal population are parents’ reluctance to consent to neonatal participation in studies. However, the need is great since the growth rate and physiologic development are quite different than any other time of life. He states that the rate of drug metabolism in this population is unique and challenging, and requires further study in order to implement safe and effective neonatal drug use.
Matthew M. Laughon, MD, MPH; Debbie Avant, RPh; Nidhi Tripathi, MD; Christoph P. Hornik, MD; Michael Cohen-Wolkowiez, MD, PhD; Reese H. Clark, MD; P. Brian Smith, MD, MPH, MHS; William Rodriguez, MD, PhD. “Drug Labeling and Exposure in Neonates” JAMA Pediatr. Published online December 09, 2013. doi:10.1001/jamapediatrics.2013.4208
The Real Cost of a Healthy Diet
Medical student Mayuree Rao and her colleagues at Brown University and Harvard school of public health have investigated the increased cost associated with a healthy diet. They analyzed 27 studies published since 2000 that evaluated prices for individual foods, comparing healthy and less healthy options.
Examples of comparisons between healthy and less healthy options included: boneless skinless chicken breasts versus chicken drumsticks, whole grain bread versus white bread, or non-fat milk versus whole milk. They reported an annual cost increase of approximately $550 or $1.50 per day for eating a healthier diet including fruits, vegetables, fish, and nuts. The greatest difference in price was, not surprisingly, noted in the purchase of meat, which cost 29 cents more per serving.
Although reporting an increased cost for healthy eating, they contrasted this with the average healthcare cost linked with unhealthy eating, which is estimated to be $1200 per person annually.
Mayuree Rao, Ashkan Afshin, Gitanjali Singh, Dariush Mozaffarian, “Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis” BMJ Open 2013;3:e004277. doi:10.1136/bmjopen-2013-004277
Chickenpox Vaccine is Not Responsible for Increase in Shingles Cases
There has been an increase in shingles cases in the USA in the past two decades. A study by doctor Craig M. Hales and colleagues has examined the links between Shingles and childhood chickenpox vaccinations. It was thought that the administration of routine chickenpox vaccination in children, implemented in 1996, may have contributed to the increase in rates of Shingles in the older population.
However, a deeper look into the increased incidence of Shingles has shown that there was no change in rate of Shingles since the implementation of chickenpox vaccination. In addition, the rise in Shingles was observed before the vaccination program began.
Although the cause remains unknown, the researchers have determined that the vaccination program is not likely to be responsible. The US Centers for Disease Control and Preventions’ advisory committee on Immunization Practices has recommended that older adults be vaccinated against Shingles as a preventive measure.
Craig M. Hales, MD, MPH; Rafael Harpaz, MD, MPH; M. Riduan Joesoef, MD, PhD; and Stephanie R. Bialek, MD, MPH “Examination of Links Between Herpes Zoster Incidence and Childhood Varicella Vaccination” Annals of Internal Medicine, 3 December 2013, Vol 159, No. 11.
Written by Deborah Tallarigo