Whitney Palmer

Healthcare. Politics. Family.

Bullying and Its Long-Term Effects

Published in the Spring 2012 Duke University Social Sciences Research Institute Gist From the Mill

By Whitney L.J. Howell

For one 12-year-old girl, the taunting and teasing were almost unbearable. The false rumors that she was already sexually active with several male classmates were humiliating. She was overwhelmed by the daily harassment, and finally, her teachers intervened. Their investigation pinpointed one girl as the source. The reason: both girls were interested in the same boy.

According to 2010 U.S. Department of Justice data, bullying is not uncommon: as much as 20 percent of children ages 2 to 17 were victims of bullying at least once within the previous 12 months. Nearly 10 percent of children were assaulted chronically. A Duke study seeks to answer why certain children are targeted and to identify the long-term effects of victimization.

“A lot of people say when a child is bullied, they become aggressive, hyperactive, or exhibit acting out behavior in some fashion, but we’ve found that those things aren’t something that can be chalked up to bullying,” said Terrie Moffitt, Ph.D., a Duke psychology and neuroscience professor. “What really happens with children who are victims of bullies is that they become anxious and depressed.”

In a seven-year longitudinal study, Moffitt and her colleagues followed 2,200 identical and fraternal twins in the United Kingdom (U.K.) from ages 5 to 12. The research revealed that physical characteristics –weight, hair color, etc. – don’t necessarily play into how a bully targets victims. Instead, bullies often choose children who seemingly have few close, warm relationships with adults and are less likely to report the abuse.

Through home visits and questionnaires, the team also determined while emotional and mental health difficulties can factor into a child being targeted by a bully, being bullied itself can spark a new set of problems.

A recent study conducted by Arizona State University published in February’s Child Development, however, contradicts this assessment. The paper reported depressed children attracted bullies, but further victimization didn’t worsen their depression. Moffitt’s data demonstrated the opposite. Among twins where one was bullied and the other not, the bullied sibling was more vulnerable to depression and anxiety. Following twins gave her team the advantage, she said, because they could control for genetic – as well as environmental – factors, and the Arizona team couldn’t.

The team is also interested in how repeated victimization affects individuals into adulthood. Beginning in May, they have a £3 million grant to follow this same cohort through to age 18, looking not only at their mental health, but also their psychosocial adjustment skills and any stress-related biomarkers.

To date, existing research examining the incidence of bullying among twins has included mainly middle-class families recruited through newspaper advertising. Instead, Moffitt’s team used the U.K’s twin registry to identify a sample group that more accurately reflects the characteristics of children who are most frequently victimized.

“We under-sampled twins born to older mothers who were well educated, well-to-do, and who used fertility treatments, and we oversampled twins born to unwed teenage mothers living in public housing. We wanted to make sure we monitored plenty of kids growing up in poverty and with adverse circumstances,” Moffitt said. “We exceeded beyond our wildest dreams. Many of the kids are in dire conditions. Some moms are opium addicts, and many kids have already been removed from their moms and are in foster care. A number of mothers have already committed suicide, and in many situations the fathers are either absent or in-and-out of jail.”

To assess how children in the study responded to bullying over time, nurses conducted two-hour, in-home visits when the children were ages 5, 7, 10, and 12. They also collected birth weight, breastfeeding history, and vaccine records through a questionnaire at age 2.

The nurses observed mother-and-child interactions during each visit and used two puppy puppets – Iggy and Ziggy – to ask the child questions designed to discover whether the child has been victimized. For example, one puppet asked, “Sometimes bigger boys make me cry. Do bigger boys sometimes make you cry?” Children either answered verbally or touched the puppet with which they identified. Other games pinpointed whether the child could view situations from another’s point-of-view.

In addition, 100 families participated in a laboratory study that measured the twins’ levels of the stress hormone cortisol during an oral math quiz and discussion of their most recent traumatic event. Results revealed that children who hadn’t been bullied experienced an initial cortisol spike, but levels normalized within 45 minutes. However, bullied children didn’t have as high a cortisol rise, but the stress hormone lingered in their bloodstream beyond 45 minutes.

“This result shows bullied children are primed for bad things to happen to them. They just don’t bounce back,” Moffitt said. “That’s the kind of biological change to the stress hormone system than could have a long-lasting effect.”

The child’s emotional state wasn’t the nurse’s only focus, though. They also monitored and took notes on how the mother talked about her child. They focused on the mother’s tone of voice rather than what she said – for example, did she call the child “a pain” in a warm voice or with disdain? This collected data was coded and helped the team identify children who were less likely to have supportive, close relationships with their mother, putting them at greater risk for victimization.

In the long run, Moffitt said she hopes this research will be used to increase awareness among adults about bullying, as well as increase the availability of emotional and social support services for bullied children and their families.

“We certainly don’t want to overblow this since bullying is a normal part of life. We do want our kids to be resilient and learn to deal with conflict,” said Moffitt, pointing out that being an occasional bullying victim is great practice for coping with adulthood. “But when bullying is chronic and secret from adults and the child feels hopeless and alone, that’s the part that parents and schools need to try and catch.”

To read the story at its original location: http://issuu.com/ssriduke/docs/gistspring12_web?mode=window&pageNumber=15

April 30, 2012 Posted by | Education, Family, Healthcare, Science | , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Academic Medicine, Industry Collaborate on Better Partnerships

Published in the October 2011 AAMC Reporter

By Whitney L.J. Howell

Partnerships between academic medicine and pharmaceutical and device makers are increasingly seen as beneficial for progressive bench-to-bedside research. Medical schools and teaching hospitals have ramped up initiatives to release information on faculty relationships and help faculty navigate these murky waters.

Over the past several years, corporate support of medical research conducted by academic institutions, including medical schools and teaching hospitals, has attracted increased public and congressional scrutiny for potential financial conflicts of interest. As a result, new guidelines are emerging on how to manage these alliances.

The National Institutes of Health (NIH) last August released its final rule on conflicts of interest in federally funded research that provides a framework for identifying and managing an investigator’s potential conflicts. AAMC President and CEO Darrell G. Kirch, M.D., called the final rule, “an important step forward on the path to strengthening the integrity of biomedical research through enhanced requirements for disclosure and transparency.”

On the industry side, companies are changing their practices, including how they invest in academic research. For example, in June, Pfizer announced a $100-million investment for drug discovery at several Boston-area facilities, including Partners Healthcare, Tufts University School of Medicine, and the University of Massachusetts Medical School.

Pfizer has formed similar partnerships with the University of California, San Francisco, and with seven medical centers in New York City.

The ultimate goal of these kinds of partnerships according to Michael Rosenblatt, M.D., executive vice president and chief medical officer at Merck, is to create genuine, mutually beneficial partnerships, as well as an environment in which the investigations that industries need are conducted in an ethical and scientifically sound manner.

“The most important thing for both sides to understand is that they both bring essential pieces to the collaboration,” Rosenblatt said. “Without that realization, they will not succeed.”

The interest in bolstering these relationships springs from two changes affecting the medical world, said Lans Taylor, M.D., director of the University of Pittsburgh Drug Discovery Institute.

“In the face of spiraling research and development costs, the historically large revenue producers for pharmaceutical companies will be coming off patent in the next few years, and the pipeline for new drugs is relatively dry,” Taylor said. “And academic medicine has its own financial worries, as federal funding is becoming harder to secure.”

The discovery institute employs a milestone approach to funding. External companies now issue funding after yearly reviews, instead of providing lump-sum grant payments, Taylor said. If investigators have not made sufficient progress during the year, the company can fund new projects.

A major concern for academic medicine and industry is intellectual property, said Lawrence Botticelli, Ph.D., chief business officer for Tufts University Institute for Biopharmaceutical Partnerships, which currently has partnerships with several companies and offers a searchable Web clearinghouse that matches industry interests with appropriate faculty.

In the past, Botticelli said, individual investigators usually negotiated agreements alone, which sometimes allowed industry to claim sole ownership of all data and analyses associated with the research. To eliminate this possibility, Tufts handles negotiations on investigators’ behalf. The strategy helps faculty identify opportunities and safeguard the medical school.

“It’s important to have a clear description of which responsibilities lie with industry and which lie with the university,” he said. “What happens to the intellectual property must be written out, and each party must know what the agreed-upon rights are.”

Even with these changes in place, there is no guarantee these relationships will be bona fide partnerships, said Howard Brody, M.D., Ph.D., director of the Institute for Medical Humanities at the University of Texas Medical Branch-Galveston. Brody, who wrote the book, Hooked: Ethics, the Medical Profession, and the Pharmaceutical Industry, warned that the public does not have a clear understanding of the issue, and until it does, medicine and industry will continue to battle against a lack of public trust.

“Industry cannot simply say, ‘Trust us,’” Brody said. “They must demonstrate how these relationships are balanced and how they are based in the advancement of science. At the same time, the U.S. taxpayer must understand they can’t get their science on the cheap. They can’t have tax cuts and state and federal budget cuts that slash research funding.”

Succeeding in this new playing field requires much from both academia and industry, said Barbara Barnes, M.D., the University of Pittsburgh Medical Center’s vice president of contracts, grants, intellectual property, and continuing medical education. All researchers must receive research integrity training and participate in educational discussions about fair relationships.

“Both parties must set objective timelines for projects and set realistic milestones,” she said. “It’s also extremely important to establish good communication. To be successful, you must really understand each other.”

According to Heather Pierce, J.D., M.P.H., AAMC’s senior director of science policy and regulatory counsel, the association is helping medical schools and teaching hospitals identify ethically sound practices for these interactions.

“The AAMC is creating tools to help institutions find their way,” she said. “There’s no one-size-fits-all guideline, but we’re providing assistance to ensure they’re working together toward effective, safe treatments that will improve patient care and the health of patients and populations.”

To read the story on its original site: https://www.aamc.org/newsroom/reporter/october2011/262392/partnerships.html

October 19, 2011 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

MRI Safety Concerns Prompt FDA Meeting

Published on the Oct. 13, 2011 DiagnosticImaging.com website

By Whitney L.J. Howell

In recent years, speculations about imaging safety have swirled around the long-term effects of CT scans. But, industry leaders are hoping to now turn the water cooler conversation toward making MRI safer for both you and your patients.

Even though MRI scans themselves are widely considered to be extremely safe, data from the FDA Manufacturer and User Facility Device Experience database reveal patients and providers are sustaining injuries during the MRI process. In fact, from 2004 to 2009, the number of injuries spiked four-fold to 193 accidents.

Whether more accidents are really occurring or injury reporting is on the rise is up for debate among radiologists. But the trend is concerning enough to prompt the FDA to hold a conference later this month to examine the biggest MRI safety concerns and discuss best practices to truncate the number of incidents.

“There are increasing numbers of MR scans and an increasing demand to scan patients with implants or accessory medical devices and other equipment. With the increased use, we are also seeing a number of preventable incidents,” said Sunder Rajan, PhD, of the FDA’s Center for Devices and Radiological Health Division of Physics Biophysics Laboratory. “Given the new experience base, this is a good time for FDA to learn what MR practices are being used and what changes practitioners feel would improve safety to the MR environment.”

The Main Concerns

MRI accidents and injuries fall into three main categories: thermal burns, projectiles, and hearing loss in poorly protected patients.

According to Tobias Gilk, president and MRI safety director at Mednovus and senior vice president at the design and architecture firm Rad-Planning, thermal burns pose the greatest risk to patients because they are associated with a relatively recent technology advancement – gradient improvements that allow for better image quality and scan efficiency.

“Burns are a newer safety issue that have grown out of the advancement of stronger, faster gradients,” Gilk said. “Moving to a stronger magnetic field from 1.5T to 3T makes it necessary to use more radiofrequency, increasing the chance that a patient will be burned.”

In addition, ferromagnetic objects in the MRI suite also pose a real danger to patients and providers. The 2001 Colombini case in which a 6-year-old boy died when an oxygen tank flew across the room and struck him during his imaging procedure brought this risk possibility industry-wide attention.

Although these incidents are rare, they are expensive. A U.S. Department of Veterans Affairs’ Center for Patient Safety study found that each occurrence costs more than $43,000, accounting for MRI machine repair, injury treatment, and legal costs. It doesn’t, however, take into account lost revenue due to an inoperable MRI machine.

Regardless of the reason, Emanuel Kanal, MD, director of magnetic resonance services at the University of Pittsburgh Medical Center and chair of the American College of Radiology (ACR) MR Safety Committee, said you must still take precautions to prevent projectile accidents.

“The most serious incidents, albeit quite rare, involve projectile effects,” he said. “These need to be addressed if we are to significantly lower the incidence of MR-safety relative adverse events.”

Unfortunately, there are no regulations that require proper identification of materials unsuitable for being in a MRI suite, Gilk said. And, sometimes it’s the MRI suite itself that creates the risk. When it comes designing a new suite, he said, many office architects look at a prototype design and implement it without taking the unique factors of the hospital or physician office into account.

To read the remainder of the article: http://www.diagnosticimaging.com/mri/content/article/113619/1970950

October 19, 2011 Posted by | Healthcare, Politics | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Concussion Apps for Coaches and Parents: Will They Affect You?

Published on the Sept. 2, 2011, DiagnosticImaging.com Website

By Whitney L.J. Howell

If you opened a patient’s file before ordering or reading a CT or MRI scan and saw a note from a sideline coach saying the patient exhibited all the signs and symptoms of a concussion, what would you think? Would you be surprised?

You might have to get used to these notes thanks to iPad and smartphone technology. Radiology applications (apps) are becoming more common, but the concussion apps are unique. They aren’t designed for you, the radiologist.

Concussion signs and symptoms checklist from the UNC-Chapel Hill-produced concussion app.

They’re meant for coaches, trainers, and parents.

“These apps aren’t designed to diagnose a concussion,” said Jason Mihalik, Ph.D., assistant professor of exercise and sports science at the University of North Carolina at Chapel Hill. “But they do put into the hands of coaches or parents the ability to assess whether an athlete who’s been hit in the head is showing signs and symptoms of such an injury.”

Mihalik and his colleagues developed a smartphone app that presents concussion signs and symptoms as a checklist. Based on the user’s answers, the app can recommend seeking physician attention for the athlete. Cleveland Clinic biomedical engineer Jay Alberts also created an app for the iPad2 that records a baseline assessment of an athlete’s cognitive, balance, vision, and motor skills. This information can be compared to athlete performance anytime he or she sustains a head injury. Both apps offer the option to email information to a parent or health care provider.

To read the rest of the article: http://www.diagnosticimaging.com/news/display/article/113619/1941368

September 2, 2011 Posted by | Healthcare | , , , , , , , , , , , , , , , , | Leave a comment


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