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Young adulthood is a critical period for ADHD patients when it comes to criminal behavior. Medication during this stage appears crucial.

MD-FM Thursday November 29, 2012

Sarah :
MD FM — Medical News from around the the world with Peter Goodwin

PETER: Hello, and to begin with, a study linking treatment for attention deficit hyperactivity disorder (ADHD) in young adults and reductions in criminality in that population, suggests physicians should be particularly focused on treatment adherence in certain subgroups of ADHD patients... Sarah:

SARAH: Yes a NEJM study published last Friday showed that medications for ADHD cut criminal behavior by around 32% for men, 42% for women. Randomized studied had already suggested that medicating ADHD patients (who are at higher risk for criminality) may reduce criminality. Here the team searched for the evidence in real life settings.

PETER: How so?

SARAH: They gathered information from the Swedish national registries on over 25,000 patients between 15 and 40 with a diagnosis of ADHD, whom they followed for 4 years. They were able to collect their criminality records and medical records –to find out when they were on treatment or not, and came to these drastic findings: treatment reduces criminality by 30-40%.

PETER: So does this mean ADHD patients have to remain on drugs all the time?

SARAH: No, since the long-term side effects of ADHD medication aren’t clear. However, there are certain periods in life when it can be more important to have these patients on meds. Listen to what Paul Lichtenstein, lead author of the study, told us:

Bob-Lichtenstein: “We don’t propose that people should take medication for their entire life… maybe consider it more during critical periods like young adulthood like 17 and 25 when the criminality is most common and this is also a time when young people stop taking their medication because they don’t like to be sick of course and no one likes to take pills so.. maybe that’s a time when you should motivate them more often than you have done previously –so for this age group and for newly released prisoners –you should be more prone to prescribe ADHD medication”

SARAH: That was Pr. Lichtenstein, from the Karolinska Institutet in Stockholm, Sweden.

Patients who received automated phone and email reminders were 1.6 times more likely to fill their new statin prescriptions than those who didn’t receive reminders, according to a study published in the Archives of Internal Medicine, and which involved over 5,000 participants. This is one of a few published studies to examine strategies for reducing primary nonadherence.


PETER: Experts warn that routine general health checks offer no benefit –at least in the general population

SARAH: Yes: general health checks did not reduce mortality or morbidity from cardiovascular diseases and cancer in developped countries, on the contrary data suggested they might even increase over-diagnosis and over-treatment –these are the conclusions of a Cochrane systematic review and meta-analysis published in the British Medical Journal. The authors reviewed 14 randomized trials looking at the effectiveness of health checks in reducing morbidity and mortality in adults in various settings. Listen to the lead author of the study, Lasse Krogsbøll, from the Nordic Cochrane Centre in Copenhagen, Denmark:

BOB-KROGSBOLL: “The control groups in these trials presumably had access to their general practitioners whenever they felt ill, and its very likely that these doctors had been doing some preventive testing and preventive treatments like finding high blood pressure and things like that… so one way to phrase the conclusion of this study might be that adding a systematic effort to what GPs were doing to begin with does not add anything”

SARAH: That was Dr. Krogsbøll, from Copenhagen in Denmark who, in other words, concluded that regular visits to a GP’s office should be considered sufficient and appropriate as far as prevention is concerned. He added that some subgroups might still benefit from routine health checks: for instance children and the elderly, who were not specifically targeted in this investigation.

PETER: A new oral tyrosine kinase inhibitor known as Ponatinib has proven very effective in patients with Philadelphia chromosome positive leukemias resistant to currently available medication...

SARAH: Yes, in this phase 1 study, Ponatinib induced a complete cytogenetic response and, in some cases, a major molecular response in 80 patients whose disease was resistant to earlier treatments with two or three tyrosine kinase inhibitors. Ponatinib proved efficient whatever the mechanism of resistance at play, and the most common treatment-related adverse events were generally low-grade in severity and manageable. Listen to Pr. Jorge Cortes, lead author of the NEJM study:

Bob-Cortes: “We saw a very high rate of response, in a way it was very surprizing how high it was... Importantly, it is useful whether the patient has developed resistance with a mutation, any mutation, or without a mutation --and that’s very important. And what makes it important there is it’s very quick to monitor the patients properly, to follow them closely, to make sure that we identify the patients who are doing well and the patients who are not, so that you can treat the patients who need additional therapies because we have those therapies available nowadays ”

SARAH: That was Pr. Cortes, from MD Anderson Cancer Center in Houston Texas, who said he will be presenting encouraging data from the results of the phase 2 trial during the meeting of the American Society of Hematology in Atlanta, in two weeks. He is also currently testing the drug straight up in treatment naïve patients.


PETER: In obese patients without diabetes: gastric bypass and gastric banding equally improved insulin sensitivity and beta cell function –two major factors involved in the pathophysiology of diabetes…

SARAH: Yes, these are the conclusions of a study that compared the effects of a 20% weight loss induced by gastric bypass or gastric banding on the metabolic response in such patients. Despite the fact that the immediate metabolic response to a meal was very different after gastric bypass or after banding, the improvement in glucose tolerance, insulin sensitivity, and overall beta cell function were not different between both groups after 20% weight loss. Listen to Samuel Klein, lead author of the study, published in JCI:

Bob-Klein: “We should be cautious in that this was a study done in patients who did not have diabetes, we need to do the same kind of study in patients who do have diabetes... But The main message that this shows is that weight loss is a very very powerful tool in improving the metabolic abnormalities associated with obesity and if your bariatric surgical procedure can give you appropriate weight loss, you will see a very good effect in your patients. So the main reason for maybe choosing gastric bypass surgery over laparoscopic gastric banding surgery in obese patients who do not have diabetes is that you might get greater weight loss with gastric bypass than you do with gastric banding --not because of the anatomical changes from the procedure ” –42 sec

SARAH: That was Pr. Klein, from the University of Washington School of Medicine in St. Louis, MO.

BREVE 1 Sur fond musical
PETER: Unemployment, job losses and even short periods without work are significant risk factors for acute cardiovascular events –these are the findings of a study in Archives of Internal Medicine, which established that cardiovascular risks increased incrementally from 1 to 4 or more cumulative job losses, compared to a stable situation. Risks were particularly elevated within the first year of unemployment.

And …..
A new agent may bring help for people with insomnia, according to a study published in Neurology. In this trial, an orexin receptor antagonist given during 4 weeks improved participants’ sleep efficiency by 5 to 13% compared to placebo. Individuals on the drug experienced 21 to 37 fewer minutes awake after they had fallen asleep than those who took the placebo.

That's all from MDFM for now. We'll be back next week


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Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)
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