Use of Antidepressants During Pregnancy and Risk of Autism Spectrum Disorder

To determine the correlation between the use of antidepressants during pregnancy and the child being born with autism spectrum disorder, a group of researchers looked at infant and mother data in Quebec from 1998 to 2009. From looking at his data, they collected 145,546 infants born to mothers who were covered by Regie de l’assurance maladie du Quebec for at least a year prior to and throughout their entire pregnancy. They determined that use of an antidepressant was established by the filling of at least one prescription throughout their pregnancy. By the end of their study, with the children having a mean age of six, 1,054 children had been diagnosed with autism spectrum disorder. The women who had used antidepressants, specifically those using selective serotonin reuptake inhibitors in the second or third trimester, had a much higher frequency of giving birth to a child whom would be diagnosed with at least one diagnosis of autism spectrum disorder.

Identifying a potential cause or contributor to the autism spectrum disorder can create a great sense of caution among future mothers. When making people aware of the concern and issue of using antidepressants, it becomes a much stronger argument when you have data and research to back up the claim. Hopefully in the future, mothers will become more aware of their impact on children with the prescription medications they take and will be able to plan accordingly.

As medical professionals should we be able to restrict the access that pregnant women have to antidepressants as it poses a risk to their unborn child?

JAMA Pediatr. 2016;170(2):117-124.

Buspirone and Autism

A study was done to look at the effects of buspirone in various doses in treating children with autism spectrum disorder. Over the course of 24 weeks, 166 children between the ages of 2 and 6 were randomly given a placebo, 2.5 mg or 5 mg of buspirone twice a day. The first phase was followed by a second 24-week phase, in which the patients were re-randomized to receive again the placebo, 2.5 or 5 mg of buspirone. The efficacy of the drugs at varying doses was assessed every 24 weeks. Every child in the study were diagnosed with autism spectrum disorder based on the Autism Diagnostic Interview Review and Autism Diagnostic Observation Schedule. Following the full 48 week study, there was significant evidence of behavioral improvement in the group of patients whom received the 2.5 mg, however the placebo and 5 mg showed no change over the course of the study.

Understanding the importance of dosing and its effect on the patients is crucial as a medical professional. Without the study, there would be a common misconception that an increase in dose would produce an increased effect, however the study proves that a low-dose buspirone would in fact be more effective and successful in improving the behavior of children with autism spectrum disorder. It would definitely be worth conducting a follow up study to research why the higher dose is less effective and how to, in needed cases, one can increase efficacy without increasing dose.

JAMA.2016;170(45-53)

Interstitial Lung Abnormalities and Mortality

Interstitial lung abnormalities obviously have negative impacts on health due to their effects of causing a lower diffusion capacity for carbon monoxide and a decrease in total lung capacity. However, there had never been a documented study or research conducted to correlate interstitial lung abnormalities with mortality, so Putman and colleagues conducted such research over the span of about ten years. The study included four different locations and trials. The first began in 2002 and included 5320 patients. The second began in 2005 with 1670 patients. The final two began in 2007 and 2008 and had 2068 and 2633 patients respectively. Each patient was evaluated with a CT scan to determine whether they had interstitial lung abnormality, which concluded that in each round of patients, anywhere from seven to nine percent had the abnormalities. After follows ups between three and nine years from the start date, more of the patients with interstitial lung abnormalities had died than those without. The differences ranged from 6% to 95% at the different sites.

Knowing this information for the future is vital in treating patients with interstitial lung abnormalities. Being able to provide patient’s with this specific information and have them able to understand the serious health risk could be both beneficial and detrimental. It would be helpful in that as a medical professional, you would hope that the increased severity would mean that the patient would be more inclined to remember to take their medications and be mindful of all healthy habits. This could also be detrimental in the fact that this may scare patients off and make them worry a lot more than they would have. This may interfere with their quality of life as they are constantly worried about their imminent disease and death it may cause.

JAMA. 2016;315(7):672-681.

Controversy of Childhood Vaccinations

Childhood vaccinations have become a point of controversy among parents and physicians. Due to a more recent outbreak of measles and other childhood diseases in America, the American Academy of Pediatrics has urged parents to vaccinate their children more than in the past. Speculation about vaccinations was generated after a falsified report by Andrew Wakefield was published claiming there was a connection between the measles vaccine and autism. The paper was been withdrawn and Wakefield has been eliminated from the General Registrar, however the fabricated data still has a massive presence in the decision making process for parents. Because parents have sole decision-making power, physicians can only make recommendations through counseling in order to obtain informed consent.

In order to reverse the negative connotations surrounding childhood vaccinations, physicians and medical professionals must take on the role to educate the parents prior to their decision-making. They must emphasis the purpose of vaccinations, which is to prevent the child from diseases that may cause mortality or major morbidity. It is up to the physician to strongly recommend and urge the parents to approve vaccinations for their children. The American Academy of Pediatrics recommends that in addition to educating the parents, the physicians must call on their ethical responsibility to their children, which means emphasizing the clinical benefit to not only their children but also to the other children that will come in contact with their own child. In conclusion, it is up to medical professionals to remove the negative stigma of vaccines and reinforce the positive benefits to each parent and patient.

J Pediatr. 2016;169(305-309)

Inappropriate Antibiotic Prescribing

Researchers designed a randomized clinical trial to study and intervene with wrongly prescribed antibiotics specifically during ambulatory visits for patients with acute respiratory tract infections. The study began in November of 2011 through October of 2012 and the last follow up occurred on April of 2014. Each intervention was studied over an eighteen-month period to compare the new prescribing rates to those prior to physician intervention. Some changes made with prescribers included an “accountable justification,” which meant that the physician had to describe a reason for prescribing the patient and antibiotic. Additionally, “peer comparison” was a system that sent out emails containing the top performing clinicians who had prescribed the least amount of antibiotics. The results of the study indicated an 11% decrease in antibiotic prescribing rates leading to a 13.1% rate.

These results are significant because it proves that antibiotics are over prescribed in the ambulatory setting. Over prescribing medications for patients is a huge issue for multiple reasons. Adding additional, unnecessary drugs can cause an increase in complications of adverse effects and drug interactions that will negatively affect the patient’s health. Additionally, increasing the number of medications a patient is required to take can discourage their attitudes about health and hinder their financial stability. Double checking and ensuring that a certain medication is and should be a vital part of every prescriber’s day to avoid any unnecessary complications.

JAMA. 2016;315(6):562-570.

Weight Gain in Children

In the longitudinal study, researchers were determined to track and identify possible causes of adolescent weight gain in hopes of finding an area of effective intervention. The study included 652 children aged 4, 6 and 8 with follow-ups every two years as well as regular community health checkpoints. The body mass index and body fat phenotypes were measured for each of the children at the beginning and throughout the study. Of the beginning 652, nine percent were overweight and just .2 percent were obese. Additionally, genetic risks for obesity were measured using a genetic risk score for 32 single-nucleotide polymorphisms. The results of the study indicated that children with a higher genetic risk for obesity gained weight and fat mass much faster than those without. The study was looking more specifically at the appetite traits of individuals with and without the genetic risk for obesity in order to eventually use this as a means of treating and preventing obesity, especially in the younger populations. The study revealed that those children with a higher genetic risk for obesity had higher levels of obesogenic appetite traits meaning that their decision making and portion control were poor in comparison to a healthy individual.

Identifying this specific problem with weight gain in the adolescent population is significant in making a future change in the developments and obesity patterns of children. Knowing what area to target for intervention can help lead to a more successful treatment plan. The results of the study ultimately lead to the idea that education is a large part of the treatment plan. Teaching families including parents and the children at risk, how to eat healthy can avoid the significant weight gain associated with the genetic risk that may be unavoidable. As my future role in the field of medicine, I can make an impact with direct patient care and counseling to aide in the education process of treating and changing the appetite traits of children with a genetic risk for obesity.

JAMA Pediatrics. 2016;170(2)

Text Message Communication with Patients

In a single-blind randomized, patients with hypertension in South Africa were divided into three different groups of care. The first group continued the usual way with routine doctor’s appointments. The second group was involved in an information only daily text messaging system and finally, the last group was involved in an interactive text messaging system. The goal of the study was to see how increased interaction with the patient could impact systolic blood pressure over the span of twelve months. The hopes of increased interaction through the text messaging system were that they would increase the adherence and that cognitive thought about their disease state daily would ensure better decision making in their lifestyle choices. The study concluded that there was a greater decrease in the systolic blood pressure of those individuals whom received daily text messages and then only a slight decrease in the individuals with the interactive text messaging.

In the medical world today, it is crucial to be able to keep up with the technology when interacting with patients. Being able to reach patients efficiently, as according to the study, is necessary in maintaining patient adherence. Additionally, being able to be readily available to patients will enable the patient to get questions easily answered and clear up any confusion with medications or therapy regiments. Keeping up with the technology and creating new ways to reach patients is important to maintain the contact with patients throughout the term of a year in between doctor’s visits.

Bobrow, K, Farmer, AJ, et al. Mobile Phone Text Messages to Support Treatment Adherence in Adults with High Blood Pressure (StAR): A Single-Blind Randomized Trial. Circulation Journal. (published 14 January 2016)

CirculationAHA.115.017530

Borrow, K, Farmer, AJ, et al. Mobile Phone Text Messaging to Support Treatment Adherence in Adults with High Blood Pressure. Circulation AHA. Published online January 14, 2016.

Increasing Medical Treatment for Hearing Loss

Hearing loss has become an increasingly prominent issue in the elderly population. Because current generations will live longer lives than previous generations, the problems associated with aging, such as heading loss, will and has become a larger problem in our society. There is a huge issue in regards to treatment and availability of treatment to these patients. Medicare does not cover the cost of hearing aids, which can be very expensive and is most likely the reason why only one in five people suffering from hearing loss use hearing aids. Additionally, there is a problem in the assessment of hearing. In most cases, patients must complain about their hearing in order for a hearing test to be implemented at a doctor’s appointment being that hearing is not usually included in primary care evaluations. The medical lapse in the field of hearing loss can be associated with the idea that hearing loss is natural in the aging process and it is not due to a biological error, therefore does not need medical intervention. However, the effects of medical treatment in hearing loss have increased the productivity, independence and quality of life for these elderly patients.

As a student pharmacist aspiring to enter the medical field, it is an obligation to help patient’s in need in order to increase their quality of life. An emphasis should be placed on improving the treatment availability for hearing loss in all ages, with a concentration on the elderly population. Over 40% of individuals over 60 suffer from hearing loss and the number doubles by the time the population reaches eighty years old with 80% having hearing impairments. Identifying the problem and monitoring yearly can increase the number of patients who receive treatment and possibly prevent the delay in availability of the hearing treatment. This article emphasizes the need for an improvement in areas such as research, treatment availability and insurance coverage.

Cassel, C, Penhoet E, et al. Policy Solutions for Better Hearing. JAMA Intern Med. 2016. Published online January 21, 2016.

JAMA. Published online January 21, 2016