Friday, May 15, 2009

Kindergarten Tests and the Importance of Play

...Standardized testing has hit kindergarten big-time, as principals and superintendents push reading and math curricula into earlier grades to improve the odds that students will later pass standardized tests that gauge school performance. But kindergarten tests are almost certainly counterproductive, according to a new report from the Alliance for Childhood, an advocacy group in College Park, Md., called "Crisis in the Kindergarten: Why Children Need to Play in School." Pushing children to perform at a level they aren't old enough to handle increases behavior problems and failure rates and takes away from a focus on the importance of play, which is what 5-year-olds really should be doing. Playing is the best way to learn social skills and self-control—which just might result in kids deciding that they really like going to school. Plus academic testing of children under age 8 is not a reliable indicator of future achievement in school, according to the nine new studies in the Alliance report....

Comment: My opinion (as a father and peds doc with an MEd) is
1.) Start Kindergarten at least one year later...not at age 5 but at age 6...especially for boys.
2.) Play.
3.) Play outside.
4.) Run, jump, play. and finally
5.) PLAY! DM

ADHD medication linked with improved academic achievement

...Children with attention-deficit/hyperactivity disorder who received prescription medications had higher standardized mathematics and reading test scores compared with unmedicated peers...

Added Comments: A comment was just left about docs getting together for the benefit of the patient....some docs do not keep up with the research on CI and ADHD. This paper

The relationship between convergence insufficiency and ADHD. Granet DB, Gomi CF, Ventura R, Miller-Scholte A. Strabismus. 2005 Dec;13(4):163-8.

Should be mandatory reading for all pediatricians...its conclusions state that: "We report an apparent three-fold greater incidence of ADHD among patients with CI when compared with the incidence of ADHD in the general US population (1.8-3.3%). We also note a seeming three-fold greater incidence of CI in the ADHD population. ... patients diagnosed with ADHD should be evaluated to identify the ...subset that ..have CI -- a condition that responds well to treatment" in office optometric vision therapy. (A recently published clinical trial showed in office therapy is most effective for treating CI). DM


Original Comments: I wonder how these drugs affect the lives of the children in other ways? I wonder how many actually have convergence insufficiency or other eye problem? I wonder how many should have optometric vision therapy? Do not misread...what I just wrote...I will recommend that appropriate children with ADHD be treated with medications....unfortunately, treating with meds tends to be the first things done....not the last... DM

Immunotherapy effective against neuroblastoma in children

...A phase III study has shown that adding an antibody-based therapy that harnesses the body's immune system resulted in a 20 percent increase in the number of children living disease-free for at least two years with neuroblastoma. Neuroblastoma, a hard-to-treat cancer arising from nervous system cells, is responsible for 15 percent of cancer-related deaths in children. The researchers reported their findings – the first to show that immunotherapy could be effective against childhood cancer...

ICO Students Rock!!

The Illinois College of Optometry class of 2010 had a pass rate on the ABS part 1 exam of 98.58% - that's right, 98.58% !!!!

The national pass rate was 91.91%

I'm biased of course.....but congrats to my students...and all my ICO colleagues. DM

Thursday, May 14, 2009

Brain chemical may play key role in anxiety

..A chemical important for brain development may play a role in explaining why some people are genetically predisposed to anxiety and could lead to new treatments, U.S. researchers said on Tuesday...

Sporadic Play Activity As Beneficial To Child Health As Continuous Bouts Of Exercise

...The results highlighted that the associations between children's activity and health were similar regardless of how the child accumulated the activity. In other words, a child who accumulated short bursts of moderate or vigorous exercise throughout the day was just as healthy as a child who did a similar amount of activity over longer sessions....

Comments: That's what I need! Short bursts of moderate exercise....actually any exercise would be beneficial!! DM

Wednesday, May 13, 2009

Children With Concussions Require Follow-up Care Before Returning To Play

...Rather than only consulting a doctor when there are obvious trouble signs after the initial treatment, the Children's Hospital researchers recommend that a qualified healthcare provider perform a formal assessment after hospital discharge but before child resumes exertional activities. The study team used a computer-based testing program created to assess athletes with concussions and determine when it was safe to return to play. The authors found that nearly all the children admitted to the hospital with a concussion had some abnormal brain function during initial testing....

Comments: We know that any, even those with mild brain injury, can show signs and symptoms long after the injury takes place. All should be evaluated post injury...perhaps even more than once...and since many problems incountered include the visual system and vision information processing abilities...this evaluation should often include an assessment by an optometrist (Goto http://www.covd.org or http://www.nora.cc/ for docs who can help)

New Studies Find Babies To Be Brainier Than Many Imagine

...A new study from Northwestern University shows what many mothers already know: their babies are a lot smarter than others may realize. ...

Sudden Infant Death Syndrome (Cot Death) Associated With New Virus - Ljungan Virus

...Ljungan virus, transmitted from animals to humans, has been found in 11 of 12 cases of Sudden Infant Death Syndrome or SIDS. Investigators from Sweden and the USA present these findings in the scientific journal Forensic Science in Medicine and Pathology. Animals infected with the virus suffer from a similar disease. Population cycles of wild rodents carrying Ljungan virus correlate with the frequency of SIDS cases...

Deep Brain Stimulation Found To Be Effective In Children With Treatment-Resistant Generalized Primary Dystonia

...Dystonia is a very complex, highly variable neurological movement disorder characterized by involuntary muscle contractions. As many as 250,000 people in the United States have dystonia, making it the third most common movement disorder behind essential tremor and Parkinson's disease. The prevalence of generalized primary dystonia is estimated at 34 in 100,000 people worldwide, but cited statistics vary. This figure is most likely an underestimate, since many cases go undiagnosed for years....

Brain Cell Mechanism For Decision Making Also Underlies Judgment About Certainty

...Countless times a day people judge their confidence in a choice they are about to make -- that they now can safely turn left at this intersection, that they aren't sure of their answer on a quiz, that their hot coffee has cooled enough to drink....

Vision Loss In Genetic Diseases Explained By Protein-Protein Interaction

...In this week's journal Nature Genetics, an international consortium of researchers, including some from Baylor College of Medicine, provide not only an explanation for the variations of vision loss in people with a host of disorders associated with defective cilia within the cells, but also a blueprint for unraveling similar variations in signs among people with other genetic diseases. ...

Research Finds Kava Is Safe And Effective

...research has found a traditional extract of kava, a medicinal plant from the South Pacific, to be safe and effective in reducing anxiety. ...

Cholesterol Claim Makes Cheerios an 'Unapproved Drug'

...Cereal maker General Mills can continue to claim Cheerios cereal lowers cholesterol only if it wins FDA approval for the product as a drug, the agency told the company....

Comments: This is your government at work? How ridiculous. With the many real problems we encounter with FDA approved drugs, you'd think this governmental agency would have more than enough to keep itself busy! How about effective and appropriate monitoring of drugs once they have been approved? Now that would be something! DM

Physicians advised to prepare now for stimulus funding

...For physicians who want to take advantage of the technology incentive payments for electronic health record adoption included in the economic stimulus bill, the time to get started on vendor selection, budgeting and EHR readiness is now. ...

Comments: Not to be ready means decreased income and othe outcomes that could be detrimental to you and your patients. DM

Research activity and capacity in primary healthcare: The REACH study: A survey

Abstract
Background
Despite increased investment in primary care research and development (R&D), the level of engagement of primary healthcare professionals with research remains poor. The aim of this study is to assess the level of research activity and capacity for research among primary healthcare professionals in a health authority of over one million people in a mixed urban/rural setting in the West of Ireland.
Methods
A questionnaire, incorporating the R+D Culture Index, was sent to primary healthcare professionals in the HSE Western Region. Baseline characteristics were analysed with the use of one-way ANOVA and Chi-square test and the dependence of R&D Culture Index score on all sixteen available covariates was examined using multiple regression and regression tree modelling.
Results
There was a 54% response rate to the questionnaire. Primary healthcare professionals appeared to have an interest in and awareness of the importance of research in primary care but just 15% were found to be research active in this study. A more positive attitude towards an R&D culture was associated with having had previous research training, being currently involved in research and with not being a general practitioner (GP) (p<0.001), but much variability in the R&D culture index score remained unexplained.
Conclusions
Despite awareness of the importance of R&D in primary care and investment therein, primary healthcare professionals remain largely unengaged with the R&D process. This study highlights the issues that need to be addressed in order to encourage a shift towards a culture of R&D in primary care: lack of research training particularly in basic research skills and increased opportunities for research involvement. The use of the R&D Culture Index may enable groups to be identified that may be more research interested and can therefore be targeted in any future R&D strategy.


Comments: Optometrists, as primary health care providers, also need to recognize the need for good primary eye and vision care research. If you are an OD, YOU are responsible to do this. It should be part of being a professional. You owe it to your patients. You owe it to your profession. You owe it to yourself. Now, I admit I have an agenda here....that agenda being that since I edit a journal, Optometry & Vision Development, I need good clinical research, case reports and other forms of scholarly work to produce this journal....so start collecting data, start writing, and send it in to me dmaino@ico.edu for peer review. Go to http://www.covd.org and click on Journal to download author guidelines. DM

Tuesday, May 12, 2009

Reduced Cognitive Function Linked to AMD

Dementia and age-related macular degeneration (AMD) could have a similar pathogenesis, according to a study showing an association between AMD and reduced cognitive function in older people.
....A low score on a test of cognitive function increased the risk of AMD by almost 40%, Tien Yin Wong, M.D., Ph.D., of the University of Melbourne in Victoria, Australia, and colleagues reported in the May issue of Archives of Ophthalmology.

Traumatic Brain Injury Haunts Children For Years With Variety Of Functional Problems

...Children who suffer traumatic brain injuries can experience lasting or late-appearing neuropsychological problems, highlighting the need for careful watching over time...

Comments: I've been following a young lady for more than 2 decades who fell out of a 2nd story window and was diagnosed with a traumatic brain injury. Hopefully, I will (sometime soon, if my crazy schedule allows) write up a longitudinal case report that looks at the changes that have occured to her visual system over time. The bottom line? Watch these kids as they mature and become adults. Our services will always be needed. DM

Refractive Errors and Amblyopia in Children Entering School: Shahrood, Iran.

...A considerable proportion of 6-year-old children have strabismus and/or significant, potentially amblyogenic refractive errors. The relatively high rate of hyperopia and astigmatism in the studied population needs more attention. The results of the study emphasize the need for adequate diagnostic and therapeutic eye care services for preschool children....

Comments: Yes! All children should have comprehensive eye and vision examinations no matter from what country they originate! You'd think our ophthalmological colleagues would agree with us on this one! DM

Poor postural stability in children with vertigo and vergence abnormalities

...We suggest that binocular visual information, as vergence disparity is important to stabilize posture at near distance. Postural instability reported in children with vertigo and vergence abnormalities could be due to poor vergence inputs and/or to immature compensatory mechanisms controlling postural stability (vestibular, somatosensory inputs, and/or cerebellar processes). ..

Comments: Optometrists for decades have noted the interplay between vision and the vestibular, somatosensoty and cerebellar processes. We often use multi-sensory imput that involves vestibular, somatosensoty and cerebellar processing as a part of the overall therapy program. DM

Monday, May 11, 2009

Abilify and Autism

...Aripiprazole (Abilify) may be effective off-label for treating the irritability associated with autism, ....The atypical antipsychotic fared significantly better than placebo on a parent-rated scale of irritability (P<0.05), ...

Comments: All these major psycho-tropic, neuroleptic meds have major side effects....the question is .... is what you risk....worth the benefit?
Adverse Reactions

Serious Reactions
neuroleptic malignant syndrome
extrapyramidal symptoms
tardive dyskinesia
dystonia
stroke
TIA
syncope
hypotension, orthostatic
seizures
hyperglycemia, severe
diabetes mellitus
dysphagia, severe
aspiration
hyperthermia
HTN
tachycardia/bradycardia
hemorrhage
intestinal obstruction
cholecystitis
pancreatitis
blood dyscrasias
hypokalemia
hyperkalemia
rhabdomyolysis
suicidality
depression, worsening

Common Reactions
headache
weight gain
anxiety
insomnia
nausea/vomiting
lightheadedness
dizziness
somnolence
sedation
akathisia
injection site rxns (IM)
constipation
incontinence
blurred vision
extrapyramidal symptoms
tremor
dry mouth
cough
restlessness
fatigue
arthralgia/myalgia
sialorrhea
diarrhea (peds)
pyrexia (peds)
appetite incr.
dystonia (peds)

From https://online.epocrates.com/noFrame/showPage.do?method=drugs&MonographId=3258&ActiveSectionId=5

DM

Impaired Brain Plasticity Linked To Angelman Syndrome Learning Deficits

...How might disruption of a single gene in the brain cause the severe cognitive deficits associated with Angelman syndrome, a neurogenetic disorder? ...impaired brain plasticity....