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Press releases Saturday 11 December 2004
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(1) MONTH OF BIRTH LINKED TO RISK OF MS
(2) PSYCHOLOGICAL SUPPORT HELPS ADOLESCENTS WITH CHRONIC FATIGUE SYNDROME
(3) EARLY RESEARCH SUGGESTS FOLATE SUPPLEMENTS IN LATE PREGNANCY MAY INCREASE BREAST CANCER RISK
(4) LABELLING UNHAPPY
CHILDREN AS DEPRESSED MAY BE HARMFUL
(1) MONTH OF BIRTH LINKED TO RISK OF MS
Online First
(Timing of birth and risk of multiple sclerosis: population based
study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38301.686030.63
In the northern hemisphere, being born in May is linked to an increased risk of developing multiple sclerosis later in life, while being born in November carries the lowest risk, finds a new study published on bmj.com today.
The researchers suspect that complex interactions between genes and the environment before or shortly after birth may help to explain this link.
Their study involved 17,874 Canadian patients and 11,502 British patients with multiple sclerosis. Data on month of birth, along with detailed information on demographics and medical and family history, were collected and analysed. The comparison groups were both from the general population and from the unaffected brothers and sisters of those with MS.
In Canada, significantly fewer people with MS were born in November compared with controls. Similarly in Britain, fewer people with MS had been born in November and significantly more had been born in May. The number born in December was also significantly lower.
Adding Danish and Swedish samples to the Canadian and British results (over 42,000 people) showed a 13% increase in risk of MS for those born in May compared with November and a 19% decreased risk for those born in November compared with May.
The effect was most evident in Scotland, where the prevalence of MS is the highest.
These findings conclusively show the association between month of birth and risk of MS in northern countries, but the explanation remains unclear, say the authors.
Previous studies have suggested that exposure to the sun or seasonal variations in a mother's vitamin D levels during pregnancy may have an impact on brain development.
These findings support suggestions that environmental factors both before and immediately after birth may influence the development of the nervous or immune systems and therefore determine the risk for this disease in adult life, they conclude.
Contact:
George Ebers, Research Professor,
Department of Clinical Neurology, Radcliffe Infirmary, University of Oxford,
UK
E-mail: george.ebers@clneuro.ox.ac.uk
(2) PSYCHOLOGICAL SUPPORT HELPS ADOLESCENTS WITH CHRONIC FATIGUE SYNDROME
Online First
(Cognitive behaviour therapy for adolescents with chronic fatigue
syndrome: randomised controlled trial)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38301.587106.63
Psychological support, in the form of cognitive behaviour therapy, is an effective treatment for adolescents with chronic fatigue syndrome, finds a new study published on bmj.com today.
Patients with chronic fatigue syndrome have debilitating unexplained severe fatigue that is not alleviated by rest. Trials have shown that cognitive behaviour therapy is effective in adults, but there have been no published studies on such therapy for adolescents.
Researchers in the Netherlands identified 71 adolescents aged 10-17 years with chronic fatigue syndrome; 36 were randomly assigned to immediate cognitive behaviour therapy and 35 to the waiting list for therapy.
The therapy comprised 10 individual sessions over five months. All participants were assessed after five months.
Patients in the therapy group reported significantly greater decrease in fatigue severity and functional impairment, while their attendance at school increased significantly. They also reported a significant reduction in other symptoms, such as impaired concentration, muscle pain, and headache.
"This study is the first randomised controlled trial to show that cognitive behaviour therapy can successfully be used to treat adolescents with chronic fatigue syndrome," conclude the authors.
Contact:
Gijs Bleijenberg, Professor of Psychology,
Expert Centre Chronic Fatigue, University Medical Centre Nijmegen, Netherlands
E-mail: G.Bleijenberg@nkcv.umcn.nl
(3) EARLY RESEARCH SUGGESTS FOLATE SUPPLEMENTS IN LATE PREGNANCY MAY INCREASE BREAST CANCER RISK
(Research Pointer: Taking
folate in pregnancy and risk of maternal breast cancer)
http://bmj.com/cgi/content/full/329/7479/1375
Preliminary data published in this week's BMJ suggest that folate supplementation during pregnancy may increase a mother's long-term risk of breast cancer. Although this may be a chance finding, the results require confirmation, say the authors.
During pregnancy, folate plays an important part in fetal growth. Research has shown that taking folate before conception and during early pregnancy reduces the risk of neural tube defects, but there is limited evidence on the long-term effects of increased folate intake in pregnancy.
The research team from Aberdeen and Bristol followed up 2,928 pregnant women enrolled in a trial of folate supplementation in the 1960s. The women were randomly assigned to receive a daily dose of folate (0.2mg), folate (5mg), or a dummy (placebo) tablet. Factors such as age, weight, blood pressure, and smoking habits were recorded and blood samples were taken.
By the end of September 2002, 210 women had died with 40 deaths attributable to cardiovascular disease, 112 to cancer and 31 to breast cancer.
The team found that in women randomised to high dose folate supplements, all cause mortality was around 20% higher and the risk of deaths attributable to breast cancer was two times greater.
Although this was a well conducted randomised trial, these findings are preliminary and could be due to chance, stress the authors.
The report's author Dr Andy Ness said: "our paper presents preliminary findings which are intended to point the way towards further research and it is published on that basis. It is entirely possible that this is a chance finding - so further scientific studies are required to examine the association, if there is one, before we reach any conclusions." "It is important that we don't confuse women about the need to take folic acid supplements early in pregnancy. Women planning to become pregnant should take folic acid supplements as recommended as there is a considerable difference between the Aberdeen trial and the current guidelines to prospective mothers."
The most likely explanation for these results is chance, argue public health experts from the United States in an accompanying commentary. They cite several studies suggesting that folic acid is likely to prevent breast cancer rather than to cause it.
They also believe that this report should not deter mandatory folic acid fortification of wheat and corn flour around the world. "Mandatory fortification should be immediately implemented for the known benefits of preventing birth defects and anaemia," they conclude.
Contacts:
Paper: Andy Ness, Senior Lecturer
in Epidemiology, Unit of Paediatric & Perinatal Epidemiology, Bristol,
UK
Nick Kerswell, University of Bristol E-mail: Andy.Ness@bris.ac.uk
Commentary: Godfrey Oakley, Research
Professor, Department of Epidemiology, Rollins School of Public Health, Emory
University, Atlanta, Georgia, USA
E-mail: gpoakley@mindspring.com
(4) LABELLING UNHAPPY CHILDREN AS DEPRESSED MAY
BE HARMFUL
(Rethinking childhood depression)
http://bmj.com/cgi/content/full/329/7479/1394
Unhappiness among children seems to be rising, but labelling it as depression and prescribing antidepressants is ineffective and possibly harmful, warns a child psychiatrist in this week's BMJ.
Increasing numbers of children are being treated for depression. At the end of 2003, over 50,000 children were prescribed antidepressants, however, the author argues that anti-depressants are ineffective and some may be dangerous in this age group.
So how did we get into this mess, asks the author? Undoubtedly, part of the problem is with pharmaceutical industry tactics, but changes in Western cultural beliefs have also resulted in more childhood behaviours being viewed as a medical problem.
With little clinical evidence to support the idea that childhood depression exists as a distinct clinical category, it is time to focus on the underlying reasons for increasing unhappiness in young people, he says. Childhood depression, as a label, may need to be abandoned and a multiperspective approach adopted to deal with children's unhappiness.
In two accompanying commentaries, experts agree that non-medical therapy is an important component of treatment, but they warn against abandoning the diagnosis of depression in children.
The danger of abandoning the diagnosis is that the evidence base for effective psychological and pharmacological treatments may also be disregarded, writes consultant psychiatrist Quentin Spender.
Research psychiatrist, Paul Wilkinson believes that though it is wrong to neglect psychosocial treatments, it is equally unacceptable to neglect evidence based drug treatments for those who may truly benefit and recover from a mental disorder that carries serious risks for recurrence into adult life.
Contacts:
Paper: Sami Timimi, Consultant Child
and Adolescent Psychiatrist, Lincolnshire Partnership NHS Trust, Lincolnshire,
UK
Email: stimimi@talk21.com
Commentary 1: Quentin Spender,
Consultant, Chichester Child and Adolescent Mental Health Services, Chichester,
UK
Email: quentin.spender@btinternet.com
Commentary 2: Paul Wilkinson, Research
Psychiatrist, University of Cambridge, UK
Email: pow@fsmail.net
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