JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENTS
ARCHIVES OF GENERAL PSYCHIATRY NEWS RELEASES
Embargoed Until: 3 P.M. (CT), Monday, June 5, 2006
NUMBER OF CHILDREN AND TEENS TREATED WITH ANTIPSYCHOTICS INCREASES SHARPLY
MOST CHILDREN DIAGNOSED WITH AUTISM AT AGE 2 YEARS ALSO DIAGNOSED WITH THE CONDITION AT AGE 9 YEARS
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
Embargoed Until: 3 P.M. (CT), Monday, June 5, 2006
HISPANIC 3-YEAR-OLDS MORE LIKELY TO BE OBESE THAN BLACK OR WHITE CHILDREN
UNWANTED SEX APPEARS COMMON IN SOME TEEN RELATIONSHIPS
PHYSICAL ACTIVITY LINKED TO IMPROVED GLUCOSE CONTROL IN CHILDREN WITH TYPE 1 DIABETES
CHILD SAFETY SEATS REDUCE RISK OF DEATH IN CRASHES MORE THAN SEAT BELTS ALONE
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 5, 2006
Media Advisory: To contact Mark Olfson, M.D., M.P.H., call Craig LeMoult at 212-305-0820.
NUMBER OF CHILDREN AND TEENS TREATED WITH ANTIPSYCHOTICS INCREASES SHARPLY
CHICAGO—A steadily increasing number of patients younger than age 20 received prescriptions for antipsychotic medications between 1993 and 2002, according to a report published in the June issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.
Antipsychotics are medications used to treat mental disorders, such as schizophrenia and mania, that may involve loss of contact with reality. Several studies have indicated that prescriptions for these medications have been increasing among children and adolescents, raising concerns among professionals and the public. However, no national data have previously been available, according to background information in the article. Most prescriptions given to children and adolescents are for second-generation antipsychotics, which are not approved by the U.S. Food and Drug Administration for pediatric patients.
Mark Olfson, M.D., M.P.H., College of Physicians and Surgeons, Columbia University, New York, and colleagues analyzed data from a national survey of office-based physicians conducted yearly by federal researchers. In addition to recording whether the child or adolescent patient received a prescription for antipsychotics, the physician or a staff member also logged the patient's age, sex and race or ethnicity; the length of the visit; the physician's specialty and whether the patient received psychotherapy.
The number of outpatient health care visits during which patients between the ages of 0 and 20 years received antipsychotic medications increased six-fold between 1993 and 2002, from a yearly average of 201,000 between 1993 and 1995 to 1,224,000 in 2002. For every 100,000 individuals younger than age 21 in the United States, 274.7 such office visits took place each year from 1993 to 1995, compared with 1,341 each year from 2000 to 2002. Overall, 9.2 percent of mental health visits and 18.3 percent of visits to psychiatrists included antipsychotic treatment. Diagnoses among the patients receiving these medications included disruptive behavior disorder (37.8 percent), mood disorders (31.8 percent), pervasive developmental disorders or mental retardation (17.3 percent) and psychotic disorders (14.2 percent). Male and white youth were most likely to receive such treatments.
The availability of new antipsychotics with fewer side effects in adults may have contributed to the increase. In addition, fewer inpatient care options are available for children with mental illnesses, requiring physicians to treat more seriously ill children in an outpatient setting. These severely ill patients are more likely to require powerful medications like antipsychotics. Although these medications may be safe and effective for some mental disorders in pediatric patients, further research is needed to confirm this and provide detailed information about benefits and risks, the authors write.
"In recent years, second-generation antipsychotic medications have become common in the office-based mental health treatment of young people," they conclude. "These medications are used to treat children and adolescents with different mental disorders. Results of clinical trials provide a limited base of support for the short-term safety and efficacy of some second-generation antipsychotic medications for psychosis and disruptive behavior disorders. In light of the widespread and growing use of these medications, there is a pressing need to increase and extend the experimental evaluation of these medications in children and adolescents."
(Arch Gen Psychiatry.
2006;63:679-685. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by grants from the National Institutes of Health and by an Alicia Koplowitz Foundation Fellowship in Child and Adolescent Psychiatry. Dr. Olfson has received grants from Eli Lilly and Bristol-Myers Squibb and has served as a consultant to Eli Lilly, Pfizer, Bristol-Myers Squibb and McNeil Pharmaceuticals.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 5, 2006
Media Advisory: To contact Catherine Lord, Ph.D., call Joe Serwach at 734-647-1844.
MOST CHILDREN DIAGNOSED WITH AUTISM AT AGE 2 YEARS ALSO DIAGNOSED WITH THE CONDITION AT AGE 9 YEARS
CHICAGO—About three-fourths of children who are diagnosed with autism at age 2 years appear to have the condition at age 9 years, according to a report in the June issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.
Autism is a developmental condition characterized by difficulties with social interactions and communication and a tendency toward restricted and repetitive behaviors, according to background information in the article. Parents usually identify problems in their autistic children during the first year of life, but most diagnoses are not usually made until children are older. The concept of autism has recently expanded to include milder conditions known as autism spectrum disorders; these include Asperger's syndrome and pervasive developmental disorder not otherwise specified (PDD-NOS).
Catherine Lord, Ph.D., University of Michigan, Ann Arbor, and colleagues studied 192 children who had been referred to autism clinics or centers in North Carolina and Chicago and 22 control children who were developmentally delayed but not referred for or diagnosed with autism. The children were assessed at ages 2, 5 and 9 years and diagnosed using three measures: a parent interview; an observational scale that clinicians used to rate the children's social and communication behaviors; and the judgment of the clinicians who examined the children and made initial diagnoses. Each child received a best-estimate diagnosis, made by two additional psychologists or psychiatrists who reviewed all three of these measures and discussed the diagnosis until they reached a consensus.
Of the 172 children who were examined at age 9 years, 58 percent had a best-estimate diagnosis of autism, an increase from the 49 percent diagnosed at age 2 years. Overall, 67 percent of the best-estimate diagnoses were the same at age 2 years and age 9 years. More specifically, 76 percent of those diagnosed with autism at age 2 received the same diagnosis at age 9, and 90 percent of those diagnosed with an autism spectrum disorder at age 2 received a diagnosis of autism or an autism spectrum disorder at age 9. Parent interviews, observation scale scores and clinicians' judgment at age 2 years each independently predicted a diagnosis of autism at age 9 years, with clinical judgment most strongly linked.
For the diagnoses that did change between ages 2 and 9 years, 18 (8 percent) improved and 38 (18 percent) worsened. Only one in 84 children diagnosed with autism at age 2 was not diagnosed with autism or a spectrum disorder at age 9, while more than half of children diagnosed with PDD-NOS at age 2 received an autism diagnosis at age 9. "There are real questions about the usefulness of PDD-NOS as a categorical diagnosis," the authors write. "However, especially for very young children, having a way for experienced clinicians to acknowledge their uncertainly about some 2-year-olds was ultimately helpful as a means of flagging children who by age 9 years had a range of difficulties from autism to very mild social deficits. Because more than half of the children with PDD-NOS clinical diagnoses at age 2 years received best-estimate diagnoses of autism by age 9 years, health care professionals should be wary of telling parents that their young children do not have autism, only PDD-NOS."
"Diagnostic stability at age 9 years was very high for autism at age 2 years and less strong for pervasive developmental disorder not otherwise specified," they conclude. "Judgment of experienced clinicians, trained on standard instruments, consistently added to information available from parent interview and standardized observation."
(Arch Gen Psychiatry.
2006;63:694-701. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This work was supported by grants from the National Institute of Mental Health and the National Institute of Child Health and Human Development. Drs. Lord and Risi receive royalties from the publication of the Autism Diagnostic Interview-Revised and Pre-Linguistic Autism Diagnostic Observation Schedule, though at the time of this study the instruments were distributed free of charge.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 5, 2006
Media Advisory: To contact Robert C. Whitaker, M.D., M.P.H., call Cheryl Pedersen at 609-275-2258. To contact editorialist Elena Fuentes-Afflick, M.D., M.P.H., call Iman Nazeeri-Simmons at 415-206-3455.
HISPANIC 3-YEAR-OLDS MORE LIKELY TO BE OBESE THAN BLACK OR WHITE CHILDREN
CHICAGO—A study of more than 2,400 children in 20 U.S. cities suggests that Hispanic 3-year-olds have a higher prevalence of obesity than black or white 3-year-olds, a disparity that does not seem to be explained by socioeconomic factors typically linked to childhood obesity, according to an article in the June issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Researchers know that by the time U.S. children reach adolescence, there are disparities in the prevalence of obesity among racial and ethnic groups, according to background information in the article. However, little is known about the age at which these differences begin to appear. Their origins may lie in the preschool years because eating and exercise habits develop early and because a mother's obesity before and immediately after birth may influence her child's risk.
Robert C. Whitaker, M.D., M.P.H., and Sean M. Orzol, M.P.H., of Mathematica Policy Research, Inc., Princeton, N.J., studied 2,452 children born in 75 U.S. hospitals between 1998 and 2000. Mothers were surveyed in the hospital after giving birth and again one and three years later, answering questions about their ethnic background, education level, income and access to food. The three-year survey was an in-home interview, during which researchers also measured the height and weight of the children. Body mass index (BMI) was calculated by dividing the children's weight in kilograms by the square of their height in meters. Children who had BMIs at the 95th percentile or higher for their age and sex were considered obese.
About 19 percent of the children were white, 52.2 percent were black, 25.4 percent were Hispanic and 3.1 percent were another race or ethnicity. At the three-year interview, 18.4 percent of all the children were obese, including 25.8 percent of Hispanic children, 16.2 percent of black children and 14.8 percent of white children; Hispanic children had significantly higher odds of being obese than black or white children. Hispanic children continued to have higher odds when the researchers adjusted for three socioeconomic factors that have been linked to childhood obesity: mothers' education level, household income and food security, or access to food.
"This disparity in obesity between Hispanic and non-Hispanic children seems to develop early in life, so future research into modifiable determinants of this disparity should focus on the period from conception to school entry," the authors conclude. "This research might benefit from more emphasis on qualitative studies across racial/ethnic groups of those cultural factors that can influence energy balance, such as how young children are nourished or spend their time."
(Arch Pediatr Adolesc Med.
2006;160:578-584. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by a grant from the Economic Research Service, U.S. Department of Agriculture; grants from the National Institutes of Health; and a consortium of private foundations.
EDITORIAL: RESEARCH, INTERVENTIONS NEEDED TO HELP LATINO CHILDREN
Studies that look more closely at the ethnic and cultural backgrounds of Latino children would help researchers understand more about the risk factors for obesity in this group, writes Elena Fuentes-Afflick, M.D., M.P.H., San Francisco General Hospital, in an accompanying editorial.
"There may be cultural differences in the 'ideal' body image for children and adults and these differences could contribute to the high rates of obesity among Latino children," she writes. "For Latino immigrants, who may have experienced hunger as children or witnessed the adverse effects of malnutrition, the ideal image of a healthy baby of child may be an 'overweight' image by current body mass standards."
"The research community must investigate the underlying risk factors and develop effective interventions to improve health and well-being for Latino children and their families," Dr. Fuentes-Afflick concludes.
(Arch Pediatr Adolesc Med.
2006;160:656-657. Available pre-embargo to the media at www.jamamedia.org)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 5, 2006
Media Advisory: To contact Margaret J. Blythe, M.D., call Eric Schoch at 317-274-7722.
UNWANTED SEX APPEARS COMMON IN SOME TEEN RELATIONSHIPS
CHICAGO—Many adolescent girls report being threatened or pressured by their partners into having sex, potentially increasing their risk for sexually transmitted infections and pregnancies, according to an article in the June issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Unwanted sex in the form of coercion and rape can harm mental and physical health and has been linked to depression, anxiety disorders, unplanned pregnancy and sexually transmitted infections (STIs), according to background information in the article. This type of sexual pressure or force can occur in a wide range of relationships, from those in which partners have just met to long-term partnerships.
Margaret J. Blythe, M.D., and colleagues at Indiana University Medical Center, Indianapolis, conducted two to 10 interviews with 279 female adolescents (mean age 15.9 years, range 14 to 17 years; 88.5 percent African-American) over the course of 27 months. At each interview, the participants were tested for STIs and asked a series of questions about their sexual relationships. They identified each partner with whom they had had sexual contact since the last interview and provided details about the relationship, including duration, quality and feelings of control. They also responded to four questions that related to unwanted sex in the relationship, such as "Would he break up with you unless you wanted to have sex?" and "Would he get mad if you didn't want to have sex?"
Among all the participants, 40.9 percent reported unwanted sex at least once, with about 10 percent reporting that they had been forced to have sex. Most, 37.6 percent, had unwanted sex because they feared the partner would get angry if denied sex. Unwanted sex appeared more likely to occur in longer-term relationships, among partners who had a baby together, when a female perceived less sexual control with a partner, when condoms were not frequently used and when alcohol or marijuana were used by either partner. "The data cannot be used to assess causal associations of unwanted sex; rather, they point to the complex interpersonal and behavioral contexts that may link unwanted sex to other health risks," the authors write.
"Unwanted sex occurs often within the sexual relationships of teens," they conclude. "These unwanted sexual experiences result in risk for sexually transmitted infections and pregnancies. Sexual health counseling to reduce risk should focus on both the patient's and the partner's behaviors."
(Arch Pediatr Adolesc Med. 2006;160:591-595. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This research was supported by a grant from the National Institute of Allergy and Infectious Diseases and a grant from the National Institute of Child Health and Human Development.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 5, 2006
Media Advisory: To contact Antje Herbst, M.D., e-mail: herbstantje{at}web.de.
PHYSICAL ACTIVITY LINKED TO IMPROVED GLUCOSE CONTROL IN CHILDREN WITH TYPE 1 DIABETES
CHICAGO—Children with type 1 diabetes who exercise regularly may have improved blood glucose levels compared with those who do not, and regular physical activity does not appear to increase the risk of severe hypoglycemia (low blood glucose levels), according to a report in the June issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Type 1 diabetes occurs when the body does not produce sufficient insulin to process the sugar (glucose) that the body uses for energy. Controlling blood glucose in diabetics can help prevent complications associated with the disease. Although exercise has been shown to benefit diabetics in other ways, previous studies assessing the connection between physical activity and blood glucose control have been controversial, according to background information in the article. Some have shown that glycosolated hemoglobin (HbA1c) levels, which reflect the individual's control of blood glucose levels over the previous two to three months, are reduced in diabetics who exercise regularly. However, other research has failed to make this link.
Antje Herbst, M.D., University of Bonn, Germany, and colleagues analyzed data from 19,143 patients (9,140 girls and 10,003 boys) age 3 to 20 years with type 1 diabetes. Physicians at 179 pediatric diabetes clinics in Germany and Austria entered data about each patient-including HbA1c levels, frequency of physical activity, age, weight and height-at every office visit between 1997 and 2004. The children were then placed into three groups based on how often they engaged in physical activity per week: zero times, one to two times, and three or more times. They were also placed in three age groups: 3 to 8.9 years, 9 to 14.9 years and 15 years or older. Body mass index (BMI) was calculated by dividing the weight in kilograms by the square of the height in meters, and then converted into a BMI z score based on the patients' gender, age and change in BMI over time.
Children in groups with less physical activity per week had higher HbA1c levels than those who engaged in more physical activity. When the researchers considered age, BMI z score, sex, physical activity, dosage of insulin taken by the patient to control blood glucose and how long the patient had type 1 diabetes, level of physical activity remained one of the most important factors associated with HbA1c level. In girls but not in boys, children who exercised more frequently had lower BMI z score, and in boys but not in girls less physical activity was associated with a higher insulin dosage. Physical activity had no influence on the number of patients who experienced severe hypoglycemia or hypoglycemia with loss of consciousness.
"Regular physical activity should be recommended in patients with type 1 diabetes mellitus," the authors conclude. "Regular physical activity results in better control of glycemia, including a lower HbA1c level and, in female patients, lower BMI. The risk for severe hypoglycemia or hypoglycemia with loss of consciousness or seizure is not elevated in pediatric patients with a high frequency of regular physical activity."
(Arch Pediatr Adolesc Med. 2006;160:573-577. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The DPV Science Initiative was supported by the German Federal Ministry of Health, Novo Nordisk Germany, the Dr. Bürger-Büsing Foundation and the German Diabetes Foundation.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 5, 2006
Media Advisory: To contact author Dennis R. Durbin, M.D., call Dana Mortensen at 267-426-6092.
CHILD SAFETY SEATS REDUCE RISK OF DEATH IN CRASHES MORE THAN SEAT BELTS ALONE
CHICAGO—Young children involved in car crashes may have a greater chance of survival if secured in a child restraint system, such as a safety seat than if buckled only in a seat belt, according to an article in the June issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Policy for child car safety relies on evaluating the risks of not using safety seats versus the benefits of their use in protecting children in crashes, according to background information in the article. These safety evaluations are often conducted using the U.S. Department of Transportation Fatality Analysis Reporting System (FARS), a census of car crashes in which one or more persons died. Using only FARS data for these evaluations, however, can be problematic, because these data assume that surviving children in fatal crashes were secured similarly to those of children in other, non-fatal crashes.
Michael R. Elliott, Ph.D., University of Michigan, Ann Arbor, and colleagues examined vehicle crash data to compare the benefit of using child restraint systems (such as safety seats) to wearing seat belts alone in children two to six years old. The study sample comprised 7,813 children in fatal crashes from the FARS database and 1,433 children in nonfatal crashes from the National Automotive Sampling System Crashworthiness Data System (NASS CDS), all of whom were involved in crashes in which at least one car was left undriveable between 1998 and 2003.
Overall, approximately one in 1,000 children in a two-way crash died, with less than half (45 percent) of all children in restraint seats. One of six children (15.7 percent) were in the front seat, two thirds (67.6 percent) were in passenger cars, one of six (15.6 percent) were in pre-1990 model year vehicles and 4 percent of cars were driven by teenage drivers. Compared with seat belts alone, child safety seats were associated with a 21 percent reduction in risk of death. When excluding cases of serious misuse of safety seats or belts, the reduced risk of death was 28 percent.
"Child restraint systems offer improved fit of restraints for children who are too small for the adult-sized seat belt, thereby affording a mechanical protection advantage over seat belts," the researchers write. "If restraint systems are seriously misused, however, their safety performance would be expected to be diminished." Based on past and these current findings, the authors state that efforts should continue to promote child restraint use through improved laws and educational programs.
(Arch Pediatr Adolesc Med. 2006;160:617-621. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The authors acknowledge the support of State Farm Mutual Automobile Insurance Company for the conduct of this research study.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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