Pediatricians Vary Widely in Diagnosing ADHD, Depression

By Amy Norton
HealthDay Reporter

FRIDAY, April 1, 2016 (HealthDay News) — There is a large variation in how often U.S. pediatricians diagnose and prescribe drugs for attention-deficit/hyperactivity disorder (ADHD) and other mental health conditions, a new study suggests.

Researchers found that among children seen at pediatricians’ offices in over a dozen U.S. states, 15 percent were diagnosed with a mental health condition over five years.

Most often, that meant ADHD — which accounted for close to two-thirds of all of those cases. Just over 3 percent of kids were diagnosed with an anxiety disorder, and 2 percent with depression, the findings showed.

However, there were large differences from one pediatrician’s office to the next, the study found. The proportion of kids diagnosed with ADHD at each practice ran anywhere from 1 percent to 16 percent — making it the disorder with the greatest variability.

For other conditions, the differences across practices were smaller, but still significant, according to the researchers.

What’s not clear is why, said Stephanie Mayne, a research associate at the Children’s Hospital of Philadelphia who worked on the study.

One factor that did matter, she said, was whether child psychiatrists were available in the local community. When they were, kids were less likely to be diagnosed with a mental health condition, or receive drug treatment.

“But that only partially explained the variability,” Mayne said. “We need more research to understand the reasons.”

It’s to be expected that pediatric practices would have some differences in diagnosing and treating mental health conditions, according to Dr. Alexander Fiks, the senior researcher on the study.

But, he said, it was “a bit surprising” to see the wide range, particularly in ADHD diagnoses.

In the United States, ADHD is usually managed by primary care doctors rather than psychiatrists, Fiks pointed out. Plus, he said, there are national guidelines for pediatricians to follow in diagnosing the disorder.

To Dr. Rahil Jummani, a child psychiatrist who was not involved in the study, the findings may partly reflect a lack of mental health training for pediatricians.

“In medical school and during training, they have little exposure to the bread-and-butter of what child psychiatrists do,” said Jummani. He is an assistant professor of child and adolescent psychiatry at NYU Langone’s Child Study Center, in New York City.

So even though there are guidelines to help pediatricians manage mental health conditions, they may not necessarily be comfortable with them, Jummani said.

And, Fiks added, when it comes to treating those disorders, pediatricians aren’t usually trained in nondrug, behavioral therapies. So unless they can refer families to a mental health professional, they will usually prescribe a drug, he noted.

The study was published online April 1 in the journal Pediatrics.

The study findings are based on electronic medical records for almost 295,000 children and teenagers seen at 43 U.S. pediatric practices between 2009 and 2014.

Overall, 28 percent of practices said there were no child psychiatrists available in their community. Children at those practices were 40 percent more likely to have a mental health diagnosis in their medical records; they were also 60 percent more likely to be given a psychiatric drug, including antidepressants and stimulant medications for ADHD.

In contrast, there was no apparent effect when pediatricians had mental health professionals on site. Mayne suggested a possible reason: Those providers may often be psychologists or social workers, who usually do not give formal diagnoses or make decisions about drug prescriptions. So their presence alone might not affect pediatricians’ diagnoses or prescription rates.

For parents of children with mental health symptoms, it’s important to be sure their pediatrician is “comfortable” with diagnosing and managing psychiatric disorders, Fiks said.

“We do know that, in general, when people do a lot of something, they get better at it,” he said.

Jummani agreed. He suggested that if your pediatrician does diagnose your child with ADHD or another mental health condition, you have a “good discussion” about the reasons for the diagnosis and how it can be managed.

And it’s “reasonable,” Jummani added, to get a second opinion from a mental health specialist if that’s possible.

More information

The U.S. Centers for Disease Control and Prevention has more on children’s mental health.

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Single-leg deadlift

 

Sculpt your butt with the single-leg deadlift with Holly Barker.

Position weight to left side and raise right foot slightly to take weight off. 

Keeping neck and spine position neutral, tilt your weight forward while reaching your right foot back, leg straight and toe pointing towards the ground.

Use your left arm for balance on left hip and right arm reaching towards the floor.

Return to upright position and repeat.

Switch to alternate side after first side is completed. 20 reps.

Words/Workout: Holly Barker (pictured)

Photography: Noel Daganta

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Pop squat on the sand

 

Challenge yourself with the pop squat on the sand with Holly Barker.

How: Squat to 90 degrees, feet shoulder-width apart, knees in line with toes.

Explode out of your squat and through your heals.

Land softly back to your squat starting position and prepare to repeat. 20 reps.

 

Words/Workout: Holly Barker (pictured)

Photography: Noel Daganta

 

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Walking lunge twist

 

Challenge yourself on the sand with this walking lunge twist by Holly Barker.

How: Step forward into lunge position.

At full lunge, twist torso towards front hip, return to centre and step forward, bringing back leg forward.

Repeat with each step, twisting torso from side to side towards front hip on each side. 20 reps. 

Words/Workout: Holly Barker (pictured)

Photography: Noel Daganta

 

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Workout tips for toned arms

 

If you're looking to mix up your arm workouts, supersetting is key.

Try: Supersetting Antagonising

Supersetting antagonising is the pairing of two opposite muscle groups such as chest and back, triceps and biceps and quads and hamstrings. The science behind this technique is to loosen one muscle while its antagonist contracts. This allows more weight to be used, or additional reps performed.

How: Give this little workout a go:

a. Dumbbell external rotation 10 reps – 4 sets, tempo 3; 0; 2; rest 30 seconds
b. Incline dumbbell preacher curl 10–12reps – 4 sets, tempo 3; 0; 1
c. Tricep rope pushdowns 15 reps – 4 sets, tempo 2; 0; 2; rest 45 seconds
d. Scott curl reverse biceps curls 8–10 reps – 4 sets, tempo 2; 0; 2
e. Overhead dumbbell triceps extension 12–15 reps – 4 sets, tempo 2; 2; 1; rest 45 seconds

Why: Supersetting agonist and antagonist muscle groups is not only time efficient and great for building lean, toned arms, but it also increases the afterburn effect of your workout by up to 24 hours.

Insider’s tip: Try and finish off your arms day with 3 x 500m sprints on the rower to really get your arms burning.

Check out our workout section for fitness tips, exercises and workouts.

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Type 1 Diabetes Linked to Epilepsy Risk, Study Suggests

By Karen Pallarito
HealthDay Reporter

THURSDAY, March 31, 2016 (HealthDay News) — People who have type 1 diabetes may be nearly three times more likely to develop the seizure disorder epilepsy than people without type 1 diabetes, a new study suggests.

The youngest people with type 1 diabetes — under 6 years old — seemed to be six times more likely to develop epilepsy, the researchers reported.

But, those with the highest risk of epilepsy appeared to be children with type 1 diabetes who had to be treated in a hospital for a severe low blood sugar (hypoglycemia). The study found the risk of epilepsy was 16.5 times higher for these children.

It should be noted, however, that the study did not establish a cause-and-effect relationship between the two conditions. And the “absolute” risk of any one person with type 1 diabetes going on to develop epilepsy remains very small.

Epilepsy is a brain disorder affecting less than 1 percent of the U.S. population, according to the U.S. National Institute of Neurological Disorders and Stroke.

“Even though the risk of epilepsy is increased, most type 1 diabetics wouldn’t have it,” said Dr. Scott Stevens, attending neurologist at Northwell Health’s Comprehensive Epilepsy Care Center in Great Neck, N.Y.

Type 1 diabetes is an autoimmune condition that causes destruction of the body’s insulin-producing cells. Insulin is a hormone necessary to use the sugars found in foods. To replace the missing insulin, people with type 1 diabetes must take multiple daily injections of insulin or use an insulin pump with a thin tube inserted under the skin to deliver the insulin, according to the American Diabetes Association (ADA).

However, achieving the correct dose of insulin can be difficult. Too little insulin, and high blood sugar results. Over time, high blood sugar can cause serious damage to blood vessels, especially in the eyes, kidneys and heart. Too much insulin also poses a danger, causing low blood sugar levels, which if left untreated can cause unconsciousness and even death, according to the ADA. Previous research has shown that people with type 1 diabetes experience approximately two episodes of low blood sugar each week. Severe hypoglycemia is much less frequent, however.

The researchers aren’t sure how type 1 diabetes and epilepsy may be linked.

But study author Dr. I-Ching Chou of China Medical University’s Children’s Hospital in Taichung, Taiwan, and colleagues suspect a variety of factors may be at play, including immune abnormalities, brain lesions, genetic factors and metabolic abnormalities.

Blood sugar levels that are too high or too low have also been shown to trigger seizures in elderly people, the study authors added.

And previous studies have suggested that having type 1 diabetes at an early age and having severely low blood sugar are critical risk factors for brain abnormalities, the researchers said.

Dr. Gerald Bernstein, an endocrinologist and coordinator of the Friedman Diabetes Program at Lenox Hill Hospital in New York City, said that when people with diabetes don’t rigidly control their blood sugar levels, tiny blood vessels in the brain can be affected.

Using data from the Taiwan National Health Insurance Research Database, the study authors pulled records on almost 2,600 children and adolescents with type 1 diabetes, and a comparison group of 26,600 people without a type 1 diagnosis.

Children with type 1 diabetes were about 10 years old, while youngsters in the comparison group were about 11 years old, on average.

Each child in the study group was matched with 10 control-group children for factors including sex, and whether they lived in an urban or rural area.

In kids with type 1 diabetes, the risk of developing epilepsy, after adjusting for other factors that might affect the results, appeared to be 2.84 times higher than in people without diabetes.

Children in the study group with intellectual disabilities were also much more likely to develop epilepsy, the study found.

The study authors acknowledged several limitations with the study. The insurance database, for one, didn’t provide information on lifestyle habits, body mass index, physical activity, socioeconomic status and family history. The lack of that information could have skewed the results.

While there may be some connection between type 1 diabetes and epilepsy, the authors concluded that further study is needed.

Based on this study alone, there’s no reason to screen every child and adolescent with type 1 diabetes for epilepsy, Stevens said.

“It would create unnecessary stress and unnecessary testing,” he said.

What parents should do is advocate for the most contemporary management of type 1 diabetes from its onset, Bernstein added. That includes the use of continuous glucose monitoring and insulin pumps, which insurance doesn’t always cover, he said.

With the advantage of those technologies, people might maintain much tighter blood-sugar control over time, he explained.

Findings from the new study were released online March 31 in the journal Diabetologia.

More information

Joslin Diabetes Center has more about type 1 diabetes.

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More of the World’s People Are Now Obese Than Underweight

THURSDAY, March 31, 2016 (HealthDay News) — More people worldwide are obese than underweight, a new study found.

The researchers added that about one-fifth of adults could be obese by 2025.

The number of obese people in the world rose from 105 million in 1975 to 641 million in 2014, with obesity rates rising from 3 percent to 11 percent among men and from 6 percent to 15 percent among women, the study found.

Over the same time, the proportion of underweight people fell from 14 percent to 9 percent of men and from 15 percent to 10 percent of women, according to the study.

More than one-quarter of severely obese men and nearly one-fifth of severely obese women in the world live in the United States, the researchers said.

On average, people worldwide have become an average of 1.5 kilograms (3.3 pounds) heavier each decade. At the current pace, about 18 percent of men and 21 percent of women will be obese, and more than 6 percent of men and 9 percent of women will be severely obese by 2025, the study found.

The findings were released online on March 31 in The Lancet.

“Over the past 40 years, we have changed from a world in which underweight prevalence was more than double that of obesity, to one in which more people are obese than underweight,” said study senior author Majid Ezzati, a professor at Imperial College London’s School of Public Health, in England.

“If present trends continue, not only will the world not meet the obesity target of halting the rise in the prevalence of obesity at its 2010 level by 2025, but more women will be severely obese than underweight by 2025,” he said in a journal news release.

“To avoid an epidemic of severe obesity, new policies that can slow down and stop the worldwide increase in body weight must be implemented quickly and rigorously evaluated, including smart food policies and improved health care training,” Ezzati said.

Despite the findings, extremely low weight remains a serious public health problem in the poorest parts of the world, the researchers noted. For example, nearly one-quarter of people in south Asia are underweight, as are 15 percent of men and 12 percent of women in central and east Africa.

The study findings reflect “a fatter, healthier but more unequal world,” wrote George Davey Smith in an accompanying journal editorial. He is a professor of clinical epidemiology at the University of Bristol, in England.

“A focus on obesity at the expense of recognition of the substantial remaining burden of undernutrition threatens to divert resources away from disorders that affect the poor to those that are more likely to affect the wealthier in low-income countries,” he noted.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases outlines the health risks of being overweight.

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Cold Weather Can Spike Football Injuries, Study Finds

THURSDAY, March 31, 2016 (HealthDay News) — NFL players are more likely to suffer concussions and ankle injuries during games played on colder days, a new study finds.

Canadian researchers analyzed data on the five most common injuries that occurred during two National Football League seasons between 2012 and 2014.

Players had a two times higher risk of concussion and a 1.5 times higher risk of ankle injuries when the temperature was 50 degrees Fahrenheit (10 degrees Celsius) or colder compared to games played in 70 degrees (21 degrees Celsius), the findings showed.

The researchers also found that players were 1.36 times more likely to suffer shoulder injuries during games played on natural grass instead of synthetic turf.

“There has been a lot of discussion recently about the significant risk of injury in the NFL and general player safety, particularly regarding concussions,” said lead study author Dr. David Lawrence, a clinical fellow at St. Michael’s Hospital in Toronto.

“The first step in improving player safety and lowering that risk is to identify the factors affecting injury rates. Once we can answer those questions, we can begin to modify player exposure,” he said in a hospital news release.

“There is limited research looking at the external risk factors for injuries in the NFL,” Lawrence said. “Given this is one of the first studies to look at these variables, we can only speculate at this time on the underlying causes for the associations we observed with specific injuries on game-days.”

For example, equipment may have less give at colder temperatures, which may increase the force of impact, the researchers suggested. Players may be more likely to report injuries during colder games because they tend to have more contact with athletic staff when it’s colder. It’s also possible that in warmer weather, players may mistake concussion symptoms for heat-related illness.

“Our findings contribute to the growing body of evidence surrounding this topic, but further research is needed,” Lawrence said.

“Applying this information may help inform future injury prevention strategies in the NFL, or other professional sports, and highlight the effects of these seemingly small external factors,” he added.

The study was published in the March 31 issue of the Orthopaedic Journal of Sports Medicine.

More information

The American Academy of Family Physicians has more on concussion.

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Do You Always Call Out Typos? Science Says You’re the Worst

Does your skin crawl whenever you spot a dangling modifier, or “its” in place of “it’s”? If so, you’re probably not going to like this new research from the University of Michigan.

The small study—titled “If You’re House Is Still Available, Send Me an Email” (see what they did there?)— explores which personality types are most sensitive to grammar mistakes. The researchers had 83 people read emails with typos (such as “teh” vs. “the”), grammar errors (like “there” vs. “they’re”), or no mistakes. After reading all the emails, participants were asked if they’d spotted any errors and, if so, how much it irritated them.

Next, the researchers considered the subjects’ dispositions. Participants were asked to complete the Big Five personality assessment (which determines a person’s level of extraversion, agreeability, conscientiousness, neuroticism, and openness). They were also asked to judge the writers of the emails, by rating them on traits like intelligence and friendliness.

RELATED: 10 Ways Your Personality Affects Your Weight

The (perhaps unsurprising) results? Subjects with personalities deemed “less agreeable” were more irritated by errors than other participants. The researchers believe it’s because people with this personality type are “less tolerant of deviations from convention”—which appears to be a nicer way of saying members of the grammar police are kind of jerks.

They also found that extroverts were more likely to breeze past spelling and grammar errors, while introverts tended to notice mistakes and negatively judge the writer who made them. Meanwhile, people who scored high on conscientiousness and low on openness were more sensitive to typos. Yet, how neurotic someone was appeared to have no affect on the way they detected and interpreted mistakes.

RELATED: 15 Ways Being an Introvert Can Affect Your Health

Some people (including Health‘s entire editorial staff) find this study a bit insulting. But since the sample size was slim, we’re taking the findings with a grain of salt until further research backs up the claims.

 

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Scientists Reduce Alzheimer’s-Linked Brain Plaques in Mice

By Randy Dotinga
HealthDay Reporter

THURSDAY, March 31, 2016 (HealthDay News) — Scientists working with mice report preliminary progress in efforts to eliminate brain-clogging proteins linked to Alzheimer’s disease.

By tweaking genes in the brains of mice, researchers say they reduced levels of a substance called beta amyloid that’s closely tied to Alzheimer’s.

There’s no guarantee the findings will be relevant to people with Alzheimer’s disease because results of animal studies often aren’t replicated in humans, experts say.

Still, “we can now target amyloids from a different angle,” said study co-author Guojun Bu, a neuroscientist and professor of medicine at the Mayo Clinic in Jacksonville, Fla. The approach “can be explored for Alzheimer’s disease prevention and therapy,” he added.

Clumps of beta-amyloid proteins, known as plaque, are believed to disrupt brain functioning in people with Alzheimer’s disease, the most common form of dementia.

The clumps, which appear to kill brain cells, may develop years before someone shows signs of the progressive brain disease. Some research has suggested that the brains of Alzheimer’s patients can’t easily get rid of the gunk, allowing it to build up and impair their ability to think and move.

In the new study, Bu and colleagues manipulated the genes of mice and removed a gene linked to molecules called heparan sulfates that appear on cell surfaces. The molecules serve a biological purpose, Bu said, but they’ve also been found within clumps of beta amyloid and related “tangles” in the brains of Alzheimer’s patients.

“We found that removing heparan sulfates from the nerve cells vastly reduced amyloids,” he said. And according to Bu, this confirms that the molecules play a role in the formation of the amyloid clumps.

The findings suggest that scientists could reduce levels of the brain-clogging material by disrupting the interaction between the molecules and beta amyloid, Bu said. But this would need to happen without “disturbing the normal biological function.”

Bu said the next step is to look for a compound that can block the molecules and beta amyloid from interacting without hurting the patient. And, “such preclinical studies can takes years before they can be translated to humans,” he explained.

There are other caveats, too. Since it hasn’t been proven that beta amyloid actually causes Alzheimer’s, stopping amyloid production might not necessarily stop the disease. Also, nothing is known about the cost of the approach or side effects.

Bu said any treatment would need to be given in the early days of Alzheimer’s disease before symptoms appear.

Testing could determine whether someone shows signs of early Alzheimer’s disease without obvious symptoms, said study co-author Dr. David Holtzman. He is chair of neurology at Washington University School of Medicine in St. Louis.

Scientists could test the treatment, he said, by giving it to people who don’t exhibit disrupted thinking but do show signs of amyloid buildup. Then, he said, researchers could follow the participants to see if they develop dementia or if the treatment halted Alzheimer’s progression.

Dr. Howard Fillit, executive director and chief science officer at the Alzheimer’s Drug Discovery Foundation, praised the study. “In more sophisticated and modern ways, it confirms previous knowledge” about how the molecules interact with beta amyloid, he said.

However, he cautioned that it’s very difficult to target the molecules in question with medication. Also, since the heparan sulfate molecules bind with other molecules in the body, getting rid of them “could have many effects we don’t know about,” Fillit said.

The study was published March 30 in the journal Science Translational Medicine.

More information

For more about beta amyloid’s role in Alzheimer’s disease, see the Alzheimer’s Association.

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