Bad boys: Research predicts whether boys will grow out of it — or not

From the University of Michigan press release at EurkAlert 

Contact: Diane Swanbrow
swanbrow@umich.edu
734-647-9069
University of Michigan

Bad boys: Research predicts whether boys will grow out of it — or not

ANN ARBOR — Using the hi-tech tools of a new field called neurogenetics and a few simple questions for parents, a University of Michigan researcher is beginning to understand which boys are simply being boys and which may be headed for trouble.

“When young children lie or cheat or steal, parents naturally wonder if they’ll grow out of it,” says Luke Hyde, a U-M psychologist who is studying the development and treatment of antisocial behavior.

Hyde, a faculty associate at the U-M Institute for Social Research (ISR) and assistant professor of psychology, is speaking at ISR on November 11 on how genes, experience and the brain work together to heighten or reduce the risks that normal childhood transgressions will develop into full-blown conduct disorders in adolescence and early adulthood. His talk is part of the ISR Research Center for Group Dynamics seminar series on violence and aggression, and is free and open to the public.

“The lifetime prevalence of conduct disorder is around 10 percent, and even higher in males and low-income populations,” says Hyde. “The total cost to society is enormous, since these behaviors are often chronic, lasting through adulthood.”

With colleagues at U-M, Duke University, the University of Pittsburgh, and other institutions, Hyde has been exploring the role of the environment and biology as they interact over time to shape behavior. In particular, he is using the techniques of a new field called neurogenetics, which combines genetics, neuroscience and psychology, to learn how genes and neural processes interact with harsh environments, including dangerous neighborhoods and harsh parents, and with a child’s own levels of empathy and personality traits, to increase the risk of antisocial behavior.

In one recent study, for example, Hyde and colleagues studied subjects with over-reactive amygdala responses . The amygdala is an almond-shaped part of the brain’s primitive limbic system involved in processing fear and other visceral emotions. It has been associated with impulsive, aggressive behavior, as well as anxiety disorders and depression.

“Previous research suggests that the amygdala becomes over-reactive probably as a result of both genetics and experience,” says Hyde. “And once the amygdala is over-reactive, people tend to behave in an anxious, over-reactive way to things they see as a potential threat.

“Our study found that this tendency is moderated by a person’s environment, including the social support they get. If they’re not getting support from family, friends, neighbors, or professionals, then the link between the amygdala and anxious behavior is much stronger.”

In another study, Hyde and colleagues showed that kids who are impulsive are only at higher risk of engaging in antisocial behavior if they live in dangerous neighborhoods.

He also identified specific items within childhood behavior checklists that can be used as early as the age of three to identify kids who will likely have worse trajectories for anti-social behavior compared to other children who have similar behavior problems, such as throwing tantrums.

These items assess observable behaviors that include whether the child is cruel to animals, doesn’t seem to feel guilty after misbehaving, is sneaky, lies, is selfish or won’t share, and won’t change his or her behavior as a result of punishment.

“The results of this test aren’t really meaningful until age three or three-and-a-half,” says Hyde. “Before that, many of these behaviors are fairly common, and don’t predict anything. But after age three, if children are still behaving in these ways, their behavior is more likely to escalate in the following years rather than improve.”

There is good news, though. Kids who scored high on this test benefitted just as much as other kids from interventions, according to Hyde. These interventions, often called parent management training, focus on giving parents better skills to manage child behavior problems, including training parents to spend more positive time with their kids, use time-outs instead of physical punishments, and reward good behavior by giving out stickers.

“Parents need to know that intervention works, especially if it’s done early,” says Hyde. “They need to go for help if they see signs of trouble. Clinical psychologists, among other professionals, have empirically supported treatments that are quite effective for children, especially in this age period.”

 

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Funding for this research was provided by The National Institute of Drug Abuse, the National Institute of Mental Health, and the National Heart, Lung and Blood Institute.

Established in 1949, the University of Michigan Institute for Social Research (ISR) is the world’s largest academic social science survey and research organization, and a world leader in developing and applying social science methodology, and educating researchers and students from around the world. For more information, visit the ISR Web site at http://home.isr.umich.edu

 

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Job Strain Helps Explain Adverse Effects of Workaholism

From the 4 November 2011 ScienceDaily article

Workaholics work hard, but still have poor job performance — mainly because of high mental and physical strain, according to a study in the November Journal of Occupational and Environmental Medicine, official publication of the American College of Occupational and Environmental Medicine (ACOEM).

Alexander Falco, PhD, and colleagues of University of Padova, Italy, analyzed survey responses from a sample of more than 300 private-sector workers. Workaholism is defined as working excessively and working compulsively — workaholics “work hard, rather than smart.”

The workers in the study had “moderate” levels of workaholism overall. Workaholics showed evidence of high job strain, with physical and mental symptoms such as digestive, memory, and sleep problems.

In turn, high strain was associated with worse job performance — thus workaholism led indirectly to decreased performance, via increased mental and physical strain. After accounting for strain, there was no direct link between workaholism and job performance.

 

Read entire article here

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Reduce Unnecessary Lab Tests, Decrease Costs by Modifying Software

From the 4 November 2013 ScienceDaily article

When patients undergo diagnostic lab tests as part of the inpatient admission process, they may wonder why or how physicians choose particular tests. Increasingly, medical professionals are using electronic medical systems that provide lists of lab tests from which medical professionals can choose. Now, a University of Missouri researcher and her colleagues have studied how to modify these lists to ensure health professionals order relevant tests and omit unnecessary lab tests, which could result in better care and reduced costs for patients.

“Ordering numerous lab tests can result in unnecessary testing and can cause physical discomfort and financial stress to patients,” said Victoria Shaffer, an assistant professor of health sciences in the MU School of Health Professions. “We found that by changing the way electronic order set lists were designed, we could significantly alter both the number and quality of lab tests ordered by clinicians.”

Shaffer and her research team studied how physicians selected lab tests using three order set list designs on the same electronic medical system. The first order set list design was an opt-in version in which no lab tests were pre-selected; this is the standard method of lab test ordering in electronic health records for most healthcare facilities. A second option was an opt-out version in which physicians had to de-select lab tests they believed were not clinically relevant. In the third design, only a few tests were pre-selected based on recommendations by pediatric experts. On average, clinicians ordered three more tests when using the opt-out version than the opt-in or recommended versions. However, providers ordered more tests recommended by the pediatric experts when using the recommended design than when using the opt-in design.

 

Read entire article here

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Medicaid in a Historic Time of Transformation: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2013 and 2014

English: Created by vectorizing Image:Medicare and Medicaid GDP Chart.png with Inkscape (Photo credit: Wikipedia)

 

From the 4 October 2013 Kaiser report

 

Oct 07, 2013 | Vernon K Smith, Ph. D., Kathleen Gifford, and Eileen Ellis of Health Management Associates,Robin Rudowitz and Laura Snyder

The dominant forces shaping Medicaid during FY 2013 and heading into FY 2014 were the implementation of the Affordable Care Act (ACA) and the development and implementation of an array of delivery and payment system reforms. These changes represent some of the most significant changes to Medicaid since its enactment in 1965, and taken together, are transforming the role of Medicaid in the health care system in each state.  At this time, the intensity of fiscal pressures and the focus on cost Medicaid containment were somewhat lessened as the economy slowly recovers; however, controlling costs and improving program administration are still important priorities for Medicaid program. The findings in this report are drawn from the 13th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates (HMA). The report highlights trends in Medicaid spending, enrollment and policy initiatives for FY 2013 and FY 2014 with an intense focus on eligibility and enrollment changes tied to the implementation of the ACA as well as payment and delivery system changes. The report provides detailed appendices with state-by-state information and a more in-depth look at four case study states:  Arizona, Florida, Kentucky and Washington. Key findings from the survey include the following:

• Improvements in the economy resulted in modest growth in Medicaid spending and enrollment in FY 2013.  In FY 2014, national enrollment and spending growth are expected to rise.  States moving forward with the Medicaid expansion are expected to see higher enrollment and total spending growth driven by increases in coverage and federal funds.
• The implementation of the ACA will result in major changes to Medicaid eligibility and enrollment for all states whether they are implementing the ACA Medicaid expansion or not.
• Nearly all states are developing and implementing payment and delivery system reforms designed to improve quality, manage costs and better balance the delivery of long-term services and supports across institutional and community-based settings.
• Improvements in the economy have enabled states to implement more program restorations or improvements in provider rates and benefits compared to restrictions, but states also adopted policies to control costs and enhance program integrity.
• Looking ahead, FY 2014 will be a transformative year for Medicaid.

 

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Behavioral Health United States 2012

From the US Substance Abuse and Mental Health Administration press release

Behavioral Health United States 2012

SAMHSA’s newly-released publication, Behavioral Health, United States, 2012, the latest in a series of publications issued by SAMHSA biannually since 1980, provides in-depth information regarding the current status of the mental health and substance abuse field. It includes behavioral health statistics at the national and State levels from 40 different data sources. The report includes three analytic chapters:

• Behavioral Health Disorders across the Life Span
• Mental Health and Substance Use Disorders: Impairment in Functioning
• Mental Health and Substance Use Disorders: Treatment Landscape

 

The volume also includes 172 tables, which are organized into four sections:

• Behavioral Health of the Population: the mental health status of the U.S. population and prevalence of mental illness;
• Behavioral Health Service Utilization: providers and settings for behavioral health services; types of behavioral health services provided; and rates of utilization;
• Behavioral Health Treatment Capacity: number of facilities providing mental health and substance abuse services; numbers of qualified specialty mental health and substance abuse providers; and
• Payer and Payment Mechanisms: expenditures and sources of funding for behavioral health services.

 

No other HHS publication provides this type of comprehensive information regarding behavioral health services delivery in the U.S. This publication is the only available comprehensive source of national-level statistical information on trends in both private and public sector behavioral health services, costs, and clients. Drawing on 40 different data sources, this publication also includes State-level data, and information on behavioral health treatment for special populations such as children, military personnel, nursing home residents, and incarcerated individuals.

 

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The Cause of the Productivity Crisis in Pharmaceutical R&D; the CBCD Draws Conclusions from a Recent Example

Excerpt from the 15 October 2013 report

The Cause of the Productivity Crisis in Pharmaceutical R&D; the CBCD Draws Conclusions from a Recent Example (PRWeb)

“The pharmaceutical industry is experiencing a productivity crisis in R&D. What is this crisis? First, every year, the pharmaceutical industry is introducing fewer new drugs. Second, a portion of the FDA approved drugs are withdrawn from the market. Third, an analysis of Drugs.com shows that all other FDA approved drugs have many side effects.

What is the source of the productivity crisis?

A compelling explanation is offered in a paper published on March, 2012 in the medical journal Nature Reviews. The paper said that “Much of the pharmaceutical industry’s R&D is now based on the idea that high-affinity binding to a single biological target linked to a disease will lead to medical benefit in humans. Indeed, drug-like small molecules tend to bind promiscuously, and this sometimes turns out to have an important role in their efficacy as well as their so-called off-target effects. Targets are parts of complex networks leading to unpredictable effects, and biological systems show a high degree of redundancy, which could blunt the effects of highly targeted drugs (2).”

In simple terms, the idea that a drug binds with only one target is wishful thinking. As it turns out, every drug binds with many targets in the body, the desired one, and many others. Binding to the ‘other’ targets usually causes all the unwanted, surprising, side effects. [my emphasis]

“The CBCD believes that the current understanding of biology is limited and therefore, the Single Target paradigm is bound to fail.” – Greg Bennett, CBCD” “

 

[FDA program aimed at health care providers] Truthful Prescription Drug Advertising and Promotion

This page is geared towards health care providers, but it may be of interest to others.

From the US FDA (Food and Drug Administration) Web page 

FDA’s Bad Ad program is an outreach program designed to educate healthcare providers about the role they can play in helping the agency make sure that prescription drug advertising and promotion is truthful and not misleading.

The Bad Ad Program is administered by the agency’s Office of Prescription Drug Promotion (OPDP) in the Center for Drug Evaluation and Research. The program’s goal is to help raise awareness among healthcare providers about misleading prescription drug promotion and provide them with an easy way to report this activity to the agency: e-mail BadAd@fda.gov or call 855-RX-BADAD.

Continuing Medical Education Video itself is free for anyone to view (http://www.sigmatech.com/BadAd/courses/index.htm)It covers what is legal/illegal for pharmaceutical companies and their representatives when advertising their products at different venues

Prescription drug advertising must:

• Be accurate
• Balance the risk and benefit information
• Be consistent with the prescribing information approved by FDA
• Only include information that is supported by strong evidence

What types of promotion does OPDP regulate?

• TV and radio advertisements
• All written or printed prescription drug promotional materials
• Speaker program presentations
• Sales representative presentations

OPDP does not regulate promotion of:

• Over-the-Counter Drugs
• Dietary Supplements
• Medical Devices

Common Violations:

• Omitting or downplaying of risk
• Overstating the effectiveness
• Promoting Uses Not Addressed in Approved Labeling

• Misleading drug comparisons

 Examples of Violations

Example of Omission of Risk

You attend a speaker program which features a slide show that presents efficacy information about Drug X, but no risk information.

This presentation would be misleading because it fails to include a fair balance of benefit and risk information for Drug X.

Example of Uses Not Addressed in Approved Labeling
You are in a commercial exhibit hall and a company representative tells you that a drug is effective for a use that is not in the FDA-approved product labeling.

This presentation would be illegal because it promotes an unapproved use.

Example of Overstating the Effectiveness

“Doctor Smith, Drug X delivers rapid results in as little as 3 days.”

This presentation is misleading because the majority of patients studied in the clinical trials for Drug X showed results at 12 weeks, with only very few showing results in 3 days.

Frequently Asked Questions

1. Can I report anonymously?

Yes, anonymous complaints often alert FDA to potential problems.  However, complaints accompanied by names and contact information are helpful in cases for which FDA needs to follow-up for more information.

2. Will OPDP be able to stop the misleading promotion?

In many cases, yes, especially if the appropriate evidence is provided.  Evidence can include the actual promotional materials or documentation of oral statements made by company representatives.

3. What will happen to my complaint once I have contacted OPDP?

The information you provide will be sent to the Regulatory Review Officer in OPDP responsible for this class of drugs.  The reviewer will evaluate it and determine if it may serve as the basis for a potential enforcement action or as valuable information for our ongoing surveillance activities.

4. How do I learn more?

To learn more about OPDP in-service training for large medical group/hospitals call 301-796-1200.

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Pregnant women who abuse drugs, alcohol need compassion, not stigma from doctors and society: experts

Smoking and drinking during pregnancy (Photo credit: Wikipedia)

 

My sentiments exactly, real humans do not shame!

 

From the 4 November 2011 Toronto National Post

 

Seeing a pregnant women smoking a cigarette, imbibing a glass of wine or using drugs is sure to raise a societal eyebrow.

But a new report says women with substance abuse problems should be treated with compassion by health providers and society at large, especially during pregnancy, because addiction is a brain disorder and not a personal failing.

“It’s harmful for us to look upon pregnant women with addiction issues and assume it’s as simple as saying: ’For the sake of the baby, stop using,”’ said Colleen Dell, research chair in substance abuse at the University of Saskatchewan.

…

The report says pregnancy offers an opportunity for doctors to help women seek treatment for addiction, while providing comprehensive care aimed at maximizing the health of both mother and baby.

That treatment should involve a wide range of care providers and programs, including addiction counselling, medication-assisted therapy and community resources for parents, the report says.

“When this continuum of care is provided, we see healthier babies and fewer premature births, and overall maternal and infant mortality rates go down,” said Finnegan.

But many women are hesitant to seek treatment because of the stigma around using a substance that’s known to be harmful to their developing fetus, she said.

It’s important to look at the antecedents to drug addiction, said Finnegan, noting that about 98% of the women in her clinic had been sexually or physically abused as children or as adults.

Often women also won’t seek medical help because they’re afraid of losing their children

“This is very much like PTSD (post-traumatic stress disorder). They have had trauma and taking a drug permits them to forget these terrible feelings that they have had. When they take the psychoactive drugs … they become addicted.

“So the first step is that we get them into treatment and help them feel welcome.”

Often women also won’t seek medical help because they’re afraid of losing their children to protective services if they admit to an addiction, she said, suggesting the judicial system has to change.

Dealing with stigma is the greatest challenge in trying to help pregnant women with an addiction, said Franco Vaccarino, a professor of psychiatry and psychology at the University of Toronto and chairman of the CCSA’s scientific advisory council.

“Addiction is a disorder of the brain,” he stressed.

‘Simply put, your brain is different after prolonged substance abuse than it was before’

“Simply put, your brain is different after prolonged substance abuse than it was before. Addiction fundamentally changes neurological functioning and it makes it next to impossible to just quit for the sake of the baby without significant supports.

“The challenge is anchoring the narrative of this discussion in health terms,” Vaccarino said. “If you anchor it in health terms and move it away from justice and moral and will-related issues, you focus the narrative around addiction, which is where it should be.”

 

 

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[NY Times article] When Best Friends Can Visit

Excerpts from the 10 April 2013 NY Times article

Policies vary at the [few]  institutions that allow visits by patients’ pets, but many share some of the same requirements. A doctor’s order allowing the family pet to visit is typically necessary, as is an attestation from a veterinarian that the animal is healthy and up to date on all its shots. Most institutions require that dogs — the most common visitors, by far — be groomed within a day or so of a visit and on a leash when they walk through hospital corridors. Cats must be taken in and out of the institution in a carrier.

If a dog or cat wants to get up on a patient’s bed, a covering is laid down first. If an animal seems agitated or distressed when it comes into the hospital, staff members who meet the family and escort them to the patient’s room have the right to turn it away. If the patient shares a room with someone, that person must agree before a pet may visit.

“We have not had any problems,” said the Rev. Susan Roy, director of pastoral care services at the University of Maryland Medical Center, whose “your pet can visit” policy has been in place since 2008. If anything, she said, the visits can be hard on dogs, who often respond viscerally to an owner’s illness and may take a day or two to recover from a visit.

Rush University Medical Center spent three years studying the issue before its new pet visitation policy went into effect in February. Diane Gallagher, the hospital’s associate vice president of nursing operations, described some of the questions: Would animals transmit infections to patients, or vice versa? What were the liability issues? Could allowing pets to visit interfere with patient care — if, for instance, a family dog became alarmed and protective of the sick person when a doctor, a nurse or a technician came into the room?

In the end, officials decided that the benefits — comfort and reduced stress for patients — were more substantial than the risks.

Although research has shown that hospital therapy dogs can pick up germs and potentially transmit bacteria that can cause dangerous infections, those animals typically wander from room to room, while people’s own pets are expected to stay with the patient they are visiting. If someone has an open wound or an active infection, a visit from a family pet is discouraged, according to most hospital policies.

Research on the value of personal pets visiting patients in the hospital hasn’t been done. One small 2010 study of 10 healthy dog owners by researchers atVirginia Commonwealth’s Center for Human-Animal Interaction found that both unfamiliar and familiar dogs provoked similar reactions: a relaxation response and reduction in blood pressure and levels of cortisol, a stress-related hormone, according to Dr. Sandra Barker, director of the center and a professor of psychiatry.

Read the entire article here