The American Academy of Pediatrics already recommends that kids being examined for sexual assault have a follow-up exam in the weeks afterward.

But until now, no studies had looked at the benefits of doing that.

For the new report, researchers reviewed the records of 727 children and teenagers who were evaluated for sexual abuse or assault over a five-year period.

They found that almost one-quarter of the time, the patients’ second exam changed the findings of the first.

In 18 percent of cases, there was a shift in the diagnosis of traumatic injuries.

Most often, the original examiner had said it was unclear whether the child had an injury suggestive of sexual assault (like tears or bruising), but the second examiner concluded that the findings were “normal.”

However, that “does not in any way” mean the child wasn’t sexually abused, said Dr. Nancy D. Kellogg, one of the researchers on the study and a child abuse expert at the University of Texas Health Science Center in San Antonio.

It’s well known that sex-abuse victims often do not have telltale traumatic injuries, Kellogg told Reuters Health.

So it’s what the child says that’s most important.

Kellogg’s team also found that the second medical exam helped pick up sexually transmitted diseases that weren’t caught initially. That was true in nearly seven percent of cases.

Most often, Kellogg said, the follow-up exam caught genital warts — which would not yet have been apparent during the first exam.

The findings, reported in the journal Pediatrics, are based on 727 children and teens who were first examined at one San Antonio ER or the regional child advocacy center. A doctor or nurse trained in child abuse cases performed the exams.

The second exam was done about a month later at the child advocacy center, by an experienced child-abuse doctor or nurse.

During the initial exam, Kellogg explained, kids are “anxious or in pain — they’re traumatized. And that can affect the examiner’s ability to detect things.”

But the researchers also found that the first examiner’s experience mattered. If he or she had done fewer than 100 such exams, the second examiner was more likely to reach different conclusions on whether the child had a traumatic injury.

That, Kellogg said, points to the importance of having an experienced doctor or nurse do the second exam.

Some hospitals, she noted, have special “child abuse teams” who can evaluate kids for sexual assault. There may also be a nearby child advocacy center with doctors or nurses who can do the exam.

As for areas where those services aren’t available, Kellogg said she hopes the current findings give less-experienced pediatricians some guidance in evaluating kids for sexual abuse.

“We were a bit surprised by the findings,” she noted. “We didn’t expect the follow-up exam to make such a big difference in so many kids.”

http://www.reuters.com/article/2012/01/30/us-second-exam-child-sex-abuse-idUSTRE80T1KY20120130

ScienceDaily (Jan. 31, 2012) — A new study finds a potential link between daily consumption of diet soft drinks and the risk of vascular events.

Individuals who drink diet soft drinks on a daily basis may be at increased risk of suffering vascular events such as stroke, heart attack, and vascular death. This is according to a new study by Hannah Gardener and her colleagues from the University of Miami Miller School of Medicine and at Columbia University Medical Center. However, in contrast, they found that regular soft drink consumption and a more moderate intake of diet soft drinks do not appear to be linked to a higher risk of vascular events. The research appears online in the Journal of General Internal Medicine published by Springer.

In the current climate of escalating obesity rates, artificially sweetened soft drinks are marketed as healthier alternatives to sugar-sweetened beverages, due to their lack of calories. However, the long-term health consequences of drinking diet soft drinks remain unclear.

Gardener and team examined the relationship between both diet and regular soft drink consumption and risk of stroke, myocardial infarction (or heart attack), and vascular death. Data were analyzed from 2,564 participants in the NIH-funded Northern Manhattan Study, which was designed to determine stroke incidence, risk factors and prognosis in a multi-ethnic urban population. The researchers looked at how often individuals drank soft drinks — diet and regular — and the number of vascular events that occurred over a ten-year period.

They found that those who drank diet soft drinks daily were 43 percent more likely to have suffered a vascular event than those who drank none, after taking into account pre-existing vascular conditions such as metabolic syndrome, diabetes and high blood pressure. Light diet soft drink users, i.e. those who drank between one a month and six a week, and those who chose regular soft drinks were not more likely to suffer vascular events.

Gardener concludes: “Our results suggest a potential association between daily diet soft drink consumption and vascular outcomes. However, the mechanisms by which soft drinks may affect vascular events are unclear. There is a need for further research before any conclusions can be drawn regarding the potential health consequences of diet soft drink consumption.”

http://www.sciencedaily.com/releases/2012/01/120131092746.htm

(HealthDay News) — A cardiac stress test gives doctors an idea of how your heart functions at rest and when it’s under “stress” from activities such as treadmill exercise.

The U.S. National Heart Lung and Blood Institute says you can prepare for the test by:

• Dressing comfortably in workout clothes, including footwear designed for exercise.
• Checking with your doctor to see if you need to avoid food and water before the test.
• Checking with your doctor, if you’re diabetic, to see if you should adjust your medication before the test.
• Asking your doctor if you need to avoid caffeinated beverages, certain foods or over-the-counter medications before the test.
• Bringing any inhaler you use to the test and letting the doctor know about it.

http://www.nlm.nih.gov/medlineplus/news/fullstory_121276.html

TUESDAY, Jan. 24 (HealthDay News) — After studying data on more than 3,700 pairs of identical twins, researchers from Northwestern University found that low birth weight was associated with more than triple the risk for autism spectrum disorder among twins in which autism only affected one of the children.

“That only one twin is affected by ASD [autism spectrum disorder] in some identical twin pairs suggests that environmental factors may play a role either independently or in interaction with autism risk genes,” study author Molly Losh, director of Northwestern’s Neurodevelopmental Disabilities Laboratory, said in a university news release.

“Our study of discordant twins — twin pairs in which only one twin was affected by ASD — found birth weight to be a very strong predictor of autism spectrum disorder,” she added.

The study, which was released online in advance of publication in an upcoming print issue of the journal Psychological Medicine, used data from the Swedish Twin Registry’s Child and Adolescent Twin Study.

In analyzing twins in which one baby was more than 14 ounces, or at least 15 percent heavier at birth than the other, the researchers found the risk for autism rose 13 percent for every 3.5 ounce drop in birth weight.

The study results suggested that birth weight could play a role in the complex causes of autism by interacting with a child’s underlying genetic predisposition, or likelihood, of developing the condition, the researchers said.

Losh added that because autism is a developmental disorder involving early brain development, prenatal and perinatal environmental factors, such as birth weight, may be especially important.

The researchers noted, however, their findings may not apply to children who are not part of a multiple-birth pregnancy.

While the study found an association between birth weight and autism risk, it did not prove a cause-and-effect relationship.

http://www.healthgrades.com/health-news/ArticleDetail.aspx?id=660976

ScienceDaily (Jan. 23, 2012) — A new analysis has found that a substantial number of lung and colorectal cancer patients continue to smoke after being diagnosed. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the study provides valuable information on which cancer patients might need help to quit smoking.

When a patient receives a cancer diagnosis, the main focus is to treat the disease. But stopping smoking after a cancer diagnosis is also important because continuing to smoke can negatively affect patients’ responses to treatments, their subsequent cancer risk, and, potentially, their survival. Elyse R. Park, PhD, MPH, of the Massachusetts General Hospital/Harvard Medical School in Boston, led a team that looked to see how many patients quit smoking around the time of a cancer diagnosis, and which smokers were most likely to quit.

The investigators determined smoking rates around the time of diagnosis and five months after diagnosis in 5,338 lung and colorectal cancer patients. At diagnosis, 39 percent of lung cancer patients and 14 percent of colorectal cancer patients were smoking; five months later, 14 percent of lung cancer patients and 9 percent of colorectal cancer patients were still smoking. These results indicate that a substantial minority of cancer patients continue to smoke after being diagnosed. Also, although lung cancer patients have higher rates of smoking at diagnosis and following diagnosis, colorectal cancer patients are less likely to quit smoking following diagnosis.

Factors and characteristics that predicted continued smoking differed by cancer type. Lung cancer patients who continued smoking tended to have Medicare or other public health insurance, have a lower body mass index, have low emotional support, not have received chemotherapy, not have had surgery, have had prior heart disease, and have smoked a high number of cigarettes per day at some point during their lives. Colorectal cancer patients who continued to smoke tended to be male, have completed less education, be uninsured, not have had surgery, and have once smoked a high number of cigarettes per day.

“These findings can help cancer clinicians identify patients who are at risk for smoking and guide tobacco counseling treatment development for cancer patients,” said Dr. Park.

In an accompanying editorial, Carolyn Dressler, MD, of the Arkansas Department of Health in Little Rock, noted that Dr. Park’s research highlights the critical importance of physicians and other caretakers to address tobacco cessation, particularly at the time of diagnosis. “Most clinicians acknowledge the importance of addressing tobacco cessation in their patients; however, few do it,” she wrote. “We know enough now to implement effective cessation programs to identify and help cancer patients quit at the time of diagnosis and support them to prevent relapse. By doing so, we maximize patients’ response to therapy, their quality of life, and their longevity.”

http://www.sciencedaily.com/releases/2012/01/120123094747.htm

NEW YORK (Reuters Health) – Thurs. January 26, 2012 – People with mild depression may benefit from taking antidepressants, suggests a new analysis of past studies that compared symptoms in people on the drugs to those given drug-free placebo pills.

Some earlier reports had suggested that antidepressants generally only improve mood in people with severe depression.

But that might be because those studies weren’t precise enough to pick up on smaller changes in symptoms that can still make a difference for people with milder forms of the disease, researchers said.

“I think there’s a valid concern… that if someone has not-that-severe depression that hasn’t lasted that long, maybe it will get better itself or with therapy,” said Dr. David Hellerstein, from the New York State Psychiatric Institute and Columbia University, who worked on the study.

Still, he said the question of whether or not to prescribe medication shouldn’t necessarily come down to how severe the depression is, but how long symptoms have lasted.

People with “transient depression” that will improve with diet or exercise or after a few weeks of therapy “shouldn’t be taking the risk of being on meds,” he told Reuters Health.

“But people who have more persistent depression should be evaluated for treatment and medicine should be one of the options,” even when the depression is more modest.

Hellerstein and his colleagues collected data from six studies done at the state’s psychiatric institute between 1985 and 2000. Those included 825 people with non-severe, long-lasting depression enrolled in trials that compared symptoms with antidepressant treatment versus a placebo.

In three of the six studies, patients taking an antidepressant improved more on a widely-used scale of depression symptoms and severity than those taking a placebo, and in four studies, a higher percentage of patients taking antidepressants went into remission, meaning they were no longer considered to have clinically-significant depression.

Depending on the particular drug and study, the researchers calculated that between three and eight people with non-severe depression would have to be treated with an antidepressant for one to benefit substantially from it.

That, they wrote in the Journal of Clinical Psychiatry, is “a range considered by researchers as sufficiently robust to recommend treatment.”

The drugs tested in those studies included Prozac, as well as older and now less-popular medications known as monoamine oxidase inhibitors and tricyclic and tetracyclic antidepressants. It’s hard to know how well the findings would apply for newer antidepressants, the researchers said.

The results don’t mean that everyone with mild depression should be on an antidepressant, a psychiatrist not involved in the study pointed out.

“People with these milder depressions also respond well to counseling and psychotherapy and can respond well to exercise,” said Dr. Michael Thase, from the University of Pennsylvania School of Medicine in Philadelphia.

“This is basically saying, these antidepressants aren’t that good, and you should also consider other treatment options and don’t just focus on the thing that’s the easiest,” he told Reuters Health.

The researchers said that some combination of antidepressants and talk therapy is considered most effective in depression treatment — but getting therapy is often more expensive and time-consuming than medication.

Talk therapy can run $100 or more per session, while generic brands of antidepressants usually cost about $20 per month. Drugs may come with side effects, including insomnia and stomach aches, but they’re usually minor, according to Hellerstein.

Still, people on antidepressants should be followed closely by a doctor to see how they’re responding to treatment, he said.

Several of the authors of the current study reported having received funding for other research projects from drug companies that make antidepressants.

One recent study found that some depressed people on the antidepressant Cymbalta did worse than the comparison placebo group — but the majority got some benefit (see Reuters Health story of December 9, 2011).

“I believe the basic finding that drugs are more effective than placebo,” Thase said.

But, “The benefits of antidepressants may not be that dramatic in patients with milder depressions for whom many other (non-drug) strategies can also be considered.”

http://www.reuters.com/article/2012/01/26/us-medication-helps-some-with-mild-depre-idUSTRE80P1T820120126

Almost 30 percent of those aged 18 to 25 experienced a mental illness, twice as many as those aged 50 and older at just over 14 percent. And more women than men suffered a mental illness in the last year (23 percent vs. nearly 17 percent), according to the report released Thursday from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA).

“We all know people who have had a depression or an anxiety disorder, maybe something more serious like a bipolar disorder, but this is a pretty big number,” said Peter Delany, director of SAMHSA’s Office of Applied Studies.

“This is only the second year where we have done this as a separate report and the findings were not significantly different from last year,” Delany noted, so there are not enough data to see a trend.

The reasons why so many people are suffering from these problems cannot be easily summed up, he said.

The recent economic downturn may be a factor for some, he said. “But these conditions are multifactorial — there are genetic issues, there are biological issues, there are social issues and also personal issuers,” Delany explained.

A lot of people who are not receiving treatment for their mental illness, he said, cite lack of insurance as the main reason why.

“There are people who know they have a mental health problem, but aren’t interested in getting care,” he added.

“We know with the appropriate use of medication and with good treatment people can recover and go on to lead very healthy and productive lives,” Delany said.

The new report defines mental illness as having a mental, behavioral or emotional problem based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, which is the standard reference for mental illness. The report excluded developmental and substance use disorders.

According to the report, some 11.4 million adults suffered from serious mental illness in the past year, which is defined as an illness that affected a person’s ability to function normally.

Mental illness doesn’t just affect people, but also takes an economic toll — about $300 billion in 2002, the researchers said.

Mental illness also accounts for more disability in developed countries than any other illness, including cancer and heart disease, according to the World Health Organization.

Highlights of the report include:

• About 39 percent of those with a mental illness received mental health services.
• Nearly 61 percent of those with severe mental illness received services.
• 8.7 million Americans had suicidal thoughts in the last year.
• 2.5 million made plans to kill themselves.
• 1.1 million attempted suicide.
• People who abuse drugs or alcohol had higher rates of mental illness than others (20 percent vs. about 6 percent).
• One-fourth of those with serious mental illness were substance abusers.
• 1.9 million 12- to 17-year-olds had a major depression in the past year.
• Teens suffering depression were twice as likely to have a drug problem than teens who did not have a major depression (roughly 37 percent vs. 18 percent).

Dr. Ihsan Salloum, director of the Addiction Psychiatry and Psychiatric Comorbidity Programs at the University of Miami School of Medicine, said not only is the number of people with mental problems staggering, but so is the unmet need for care.

“There is a gap between the need and how many people reach treatment,” he said. “Mental illness is a treatable problem, and the outcome is as good as any chronic medical problem.”

Given the number of people with drug and alcohol problems who also have mental problems, those with a substance abuse problem should also be screened for a mental problem, Salloum said.

“If someone has a severe mental disorder and an addiction, it is imperative to take care of both problems, because the two problems feed on each other causing a bad outcome,” he said.

And with the number of young people with these problems, the focus should be on prevention, Salloum added.

http://www.healthgrades.com/health-news/ArticleDetail.aspx?id=660869

The American Academy of Family Physicians says foods can negatively affect the way prescription or over-the-counter drugs work. The academy offers this advice on avoiding these so-called drug-food interactions:

• Always read the label on your medications; ask questions of the pharmacist if you don’t understand something or aren’t sure.
• Follow all label instructions and warnings on both prescription and over-the-counter medications.
• Take any medication with a full glass of water, unless your doctor has advised differently.
• Don’t stir a medication with food or break open a capsule, unless your doctor has told you to do so.
• Don’t take any medication at the same time as you take vitamins.
• Don’t mix a medication in a hot drink, and never take a medication with alcohol.

http://www.healthgrades.com/health-news/ArticleDetail.aspx?id=660463

Normally your smell perceptions diminish rapidly, as when you enter a friend’s apartment. Even though you clearly notice smells just inside the door, you don’t think about them for long. For people with chemical intolerance, on the other hand, smells seem always to be present. Psychology researcher Linus Andersson has exposed both intolerant and non-intolerant individuals to smells and compared their reactions.

“The hypersensitive individuals felt that the smell was getting stronger even though its concentration had not changed. Their brain activity images also differed from those in the other group,” he says.

The results were observed using methods based on both electroencephalography (EEG) and functional brain imaging technology (fMRI). The EEG method involved placing electrodes on the heads of trial subjects and registering the minute changes in tension in the brain that arise following exposure to smells. Unlike the people in the normal group, Linus Andersson explains, the intolerant people did not evince a lessening of brain activity during the period of more than an hour they were exposed to a smell. The inability to grow accustomed to smells is thus matched by unchanging brain activity over time.

“These individuals also have a different pattern in the blood flow in their brains, compared with those who perceive that a smell diminishes. A similar change can be found in patients with pain disorders, for example.”

Sensitivity to smell impacts the entire body A further finding in the dissertation is that chemical intolerant people also react strongly to substances that irritate the mucous linings of their nose and mouth. People who cough more when they inhale capsaicin, the hot compound in chili peppers, also have heightened reactions in the brain to other smells. Besides the fact that intolerant individuals perceive that smells grow stronger, effects are also seen in mucous linings and in the brain.

“In other words we can see indications that this intolerance affects both the body and the mind, and that it’s important not to blindly focus on just one of these aspects,” says Linus Andersson.

Chemical intolerance is surprisingly common — up to ten percent of the Swedish population report they are bothered by everyday smells, whereas roughly two percent experience severe symptoms. Yet, in contrast to the situation regarding allergies and asthma, there is very little research about what causes this condition. Linus Andersson maintains that if it were possible to identify what characterizes this hypersensitivity then it would be possible to develop methods for diagnosis and treatment. But research can also provide new knowledge about how we should think about our work and everyday environments.

“Some co-workers are bothered more than others by the smell of the printer — what should we do to make our working conditions acceptable to as many people as possible?”

http://www.sciencedaily.com/releases/2012/01/120120182914.htm

One study included 30 healthy people who had psilocybin inserted into their blood while magnetic resonance imaging (MRI) scanners measured changes in their brain activity. The scans revealed that psilocybin caused decreased activity in what the researchers described as the brain’s “hub” regions — areas especially well-connected with other areas.

That study was published in this week’s issue of the Proceedings of the National Academy of Sciences.

The second study included 10 healthy volunteers and found that psilocybin boosted their recall of personal memories and their emotional well-being for up to two weeks. The researchers said this suggests that psilocybin might prove useful as an adjunct to psychotherapy. That study will be published online Thursday in the British Journal of Psychiatry.

A study published last year found that people with anxiety who received a single psilocybin treatment had lower depression scores six months later.

David Nutt, who’s with the Department of Medicine at Imperial College London, was the senior author of both of the new studies.

“Psychedelics are thought of as ‘mind-expanding’ drugs, so it has commonly been assumed that they work by increasing brain activity, but surprisingly, we found that psilocybin actually caused activity to decrease in areas that have the densest connections with other areas,” Nutt said in a college news release. “These hubs constrain our experience of the world and keep it orderly. We now know that deactivating these regions leads to a state in which the world is experienced as strange.”

The impact of psilocybin reported by the study participants — such as seeing “geometric” patterns, experiencing an altered sense of time and space, and unusual physical sensations — correlated with a decreased flow of oxygen and blood to parts in the brain’s posterior cingulate cortex and medial prefrontal cortex (mPFC), the study authors said.

It’s thought that the posterior cingulate cortex plays a role in consciousness and self-identity. Research has shown the medial prefrontal cortex to be especially active in people struggling with depression, so psilocybin’s effect on this area of the brain could be responsible for some of the antidepressant effects reported in previous research, the study authors said.

Nutt and his colleagues also found that psilocybin reduced blood flow in the hypothalamus, where blood flow increases in people with cluster headaches. Some headache sufferers have reported that psilocybin improved their symptoms.

“Psilocybin was used extensively in psychotherapy in the 1950s, but the biological rationale for its use has not been properly investigated until now. Our findings support the idea that psilocybin facilitates access to personal memories and emotions,” Dr. Robin Carhart-Harris, from the Department of Medicine at Imperial College London, and first author of both studies, said in the news release.

“Previous studies have suggested that psilocybin can improve people’s sense of emotional well-being and even reduce depression in people with anxiety. This is consistent with our finding that psilocybin decreases mPFC activity, as many effective depression treatments do. The effects need to be investigated further and ours was only a small study, but we are interested in exploring psilocybin’s potential as a therapeutic tool,” Carhart-Harris added.

The study authors reiterated that both trials contained small numbers of participants, and further research into psilocybin’s effects on the brain is needed.

http://www.healthgrades.com/health-news/ArticleDetail.aspx?id=661047