Medical Imaging

Cortex Pharmaceuticals, Inc. (NYSE Alternext US (COR)) reported that top-line data from its second Phase IIa study in opioid-induced respiratory depression (RD) demonstrated that a single oral dose of 1500mg of the AMPAKINE® compound CX717 achieved statistical significance (p = 0.005) over placebo on the primary endpoint measure of spontaneous basal respiration without affecting opioid-induced analgesia. This placebo-controlled, double-blind, randomized two-way crossover trial (CX717-RD-01) was performed by one of the leading experts in the field, Professor JГ¶rn LГ¶tsch at the Institut fГјr Klinische Pharmakologie, Johann Wolfgang Goethe-UniversitГ¤t in Frankfurt, Germany.

In this study, sixteen volunteers each received either 1500mg of CX717 or matching placebo that was orally administered two hours before each subject received an intravenous infusion of the opioid, alfentanil. The primary performance measures were the basal breathing rate, and the minute expiratory volume (VE) at 55 mmHg CO2 (VE55), and the lack of effect on analgesia. CX717 prevented the reduction in basal breathing rate induced by alfentanil, in comparison to placebo (p = 0.005). The degree of the reversal of the basal respiratory rate was similar to that obtained with the opioid antagonist, naloxone (Narcan®). At the same time, the analgesic properties of alfentanil were maintained in an acute pain model in the presence of CX717, whereas naloxone blocked the analgesic properties. The effect of CX717 on the VE55 numerically trended toward reversing, but did not reach statistical significance.

In August 2008, Cortex reported that in its first Phase IIa study in opioid-induced RD, 2100mg CX717 significantly reversed the VE55 measure of respiration. Spontaneous basal respiration was not an endpoint in the first Phase IIa study. “The primary objective of these two studies was to verify that this novel mechanism of action observed in animals would translate to humans,” commented Mark A. Varney, President and CEO, “and we are pleased to see statistically significant effects with a single oral dose in these small proof of concept clinical studies.” Dr. Varney went on to say, “AMPAKINE compounds may positively impact the ability of caregivers to optimize pain management for patients, as well as provide Cortex with a potentially large partnering opportunity and a good revenue stream when commercialized.”

The incidence of RD in a clinical setting related to opioid administration has been estimated to be up to 17% when oxygen desaturation is used as the indicator. Professor LГ¶tsch added, “There are still fatal outcomes after opioid administration even under controlled conditions in the clinical setting. The data from this study supports the possibility of using CX717 in the clinic to avoid life-threatening adverse effects associated with opioids.”

These human results replicate data from animal studies generated by Dr. John Greer at the University of Alberta, which showed the utility of CX717 and other AMPAKINE compounds to prevent and treat opioid-induced RD without affecting their analgesic properties. Dr. Greer stated, “These advances will help patients whose pain cannot be treated effectively with opioids due to the unwanted side effect of a depression of breathing. Administration of AMPAKINE compounds can overcome this problem and lead to a significant improvement in pain management, as well as guard against deaths caused by opioid overdose. We are now extending our preclinical studies to determine whether AMPAKINE molecules can help the breathing problems in prematurely born babies and in adults with sleep apnea. This has been, and continues to be, an extremely productive collaboration with Cortex that is resulting in the translation of our basic scientific discoveries to clinical applications.”

Cortex plans to continue the development of AMPAKINE compounds in opioid-induced RD. An intravenous dosage form of CX717 is being finalized, and a follow-on compound, CX1942, a water soluble pro-drug of a novel AMPAKINE compound with improved potency over CX717, will shortly enter preclinical development for RD. Additionally, a novel AMPAKINE molecule, CX1739, is currently in Phase I clinical trials and is targeted to begin Phase II clinical trials for ADHD in Q2 2009.

Cortex Pharmaceuticals, Inc.

Cortex, located in Irvine, California, is a neuroscience company focused on novel drug therapies for treating psychiatric disorders, neurological diseases and brain mediated breathing disorders. Cortex is pioneering a class of proprietary pharmaceuticals called AMPAKINE compounds, which act to increase the strength of signals at connections between brain cells. The loss of these connections is thought to be responsible for memory and behavior problems in Alzheimer’s disease. Many psychiatric diseases, including schizophrenia, occur as a result of imbalances in the brain’s neurotransmitter system. These imbalances may be improved by using the AMPAKINE technology. Cortex has an alliance with Schering-Plough Corporation who acquired Cortex’s former partner N.V. Organon in November 2007. As a result of this acquisition, Schering-Plough has two AMPAKINE Phase II compounds Org24448 and Org 26576 for the treatment of schizophrenia and depression. In December 2006 Cortex terminated the research collaboration with Servier enabling Cortex to pursue the use of AMPAKINE compounds in the treatment of neurodegenerative diseases on a global basis. Servier retained the right to select up to three compounds developed during the collaboration for further development for the treatment of neurodegenerative diseases. Cortex may receive additional milestones and royalties if either Organon or Servier is successful in developing and commercializing AMPAKINE compounds. For additional information regarding Cortex, please visit Cortex Pharmaceuticals’ website at cortexpharm.

Forward-Looking Statement

Note – This press release contains forward-looking statements concerning the Company’s research and development activities. The success of such activities depends on a number of factors, including the risks that the Company’s proposed compounds may at any time be found to be unsafe or ineffective for the indications under pre-clinical or clinical tests and that such studies may at any point be suspended or take substantially longer than anticipated to complete. The forward-looking statements are necessarily subject to risks and uncertainties, all of which are difficult or impossible to predict accurately and many of which are beyond the control of Cortex, all as more fully described in the risk factors and other matters set forth in Cortex’s Annual Report on Form 10-K for the year ended December 31, 2007, and Cortex’s other filings with the Securities and Exchange Commission, As discussed in the Company’s Securities and Exchange Commission filings, the Company’s proposed products will require additional research, lengthy and costly clinical testing and regulatory approval. AMPAKINE compounds are investigational drugs and have not been approved for the treatment of any disease. Cortex disclaims any intent or obligation to update any forward-looking statements.

Cortex Pharmaceuticals, Inc.

A new study conducted by researchers at the Center for Injury Research and Policy at Nationwide Children’s Hospital concludes that bicycle-related injuries among children and adolescents in the U.S. may be a more significant public health concern than previously estimated. The study, published in the October issue of Injury Prevention, estimates that bicycle-related injuries among children and adolescents result in nearly $200 million in hospital inpatient charges annually.

Children and adolescents aged 20 years and younger comprise more than half of the estimated 85 million bicycle riders in the U.S. It has been long-known that bicycle-related injuries result in more emergency department visits for children than any other recreational sport. However, this study looks beyond emergency department visits to examine hospitalizations, and estimates that approximately 10,700 children are hospitalized annually for a bicycle-related injury in the U.S. with an average length of stay of three days.

“Bicycles are associated with more childhood injuries than any other consumer product except the automobile,” said Gary Smith, MD, DrPH, director of the Center for Injury Research and Policy, faculty member at The Ohio State University College of Medicine, and one of the study authors. “The high rate of hospitalization and use of healthcare resources identified in our study supports the need for increased attention to bicycle-related injuries.”

This study is the first of its kind to analyze patient and injury characteristics associated with bicycling injuries utilizing a nationally representative sample. Among the significant findings: motor vehicles were involved in approximately 30% of bicycle-related hospitalizations, and the association with motor vehicles increased among older children.

Moreover, one-third of children hospitalized for a bicycle-related injury were diagnosed with traumatic brain injury, a statistic that is significant for its correlation to the number of injuries that may be preventable through the use of bicycle helmets. “The findings from our study can be used to promote targeted prevention strategies to lessen the severity of injury and the number of deaths resulting from pediatric bicycle-related injuries,” Smith said. “We know that bicycle helmets can reduce the risk of brain injury by up to 85%. We need to increase efforts to promote helmet use by children riding bicycles.”

Nationwide Children’s Hospital
Columbus, OH
United States
nationwidechildrens

Humans are hard-wired to form enduring bonds with others. One of the primary bonds across the mammalian species is the mother-infant bond. Evolutionarily speaking, it is in a mother’s best interest to foster the well-being of her child; however, some mothers just seem a bit more maternal than others do. Now, new research points to a hormone that predicts the level of bonding between mother and child.

In animals, oxytocin, dubbed “the hormone of love and bonding,” is critically important for the development of parenting, is elicited during sexual intercourse, and is involved in maintaining close relationships. Animals with no oxytocin exhibit slower pup retrieval and less licking and self-grooming. These findings implicate oxytocin in the bonding process, but little research has been done on this relationship in humans.

Ruth Feldman, psychology professor at Bar-Ilan University in Israel, conducted the first study to demonstrate the links between oxytocin and bonding in human mothers. Feldman and colleagues measured plasma oxytocin from sixty-two pregnant women during their first trimester, third trimester, and the first postpartum month.

They also observed the mother and child interact, defining the level of attachment along four aspects: gaze, affect, touch, and vocalization. Stronger attachment would mean that the mother focused her gaze mostly on the child, exhibited a positive energy towards the child, maintained constant affectionate and stimulating touch with the child, used a “motherese” speech with the child, and these species-typical maternal behaviors were adapted to the infant’s alert state.

After the mothers completed an extensive survey and an interview on their bond-related thoughts, feelings, and behaviors, the researchers computed the link between levels of oxytocin and bonding.

The results are fascinating. Initial levels of oxytocin at the first trimester predicted bonding behavior. Therefore, mothers with a high level of the hormone at the beginning of the pregnancy engaged in more of the aforementioned bonding behaviors after birth.

Additionally, mothers who had higher levels of oxytocin across the pregnancy and the postpartum month also reported more behaviors that support the formation of an exclusive relationship (i.e. singing a special song to the infant, or bathing and feeding them in a special way). These mothers were also more preoccupied by thoughts of checking on the infant, the infant’s safety when they are not around, and the infant’s future.

This study, which appears in the November issue of Psychological Science, a journal of the Association for Psychological Science, suggests that women with higher levels of oxytocin during their first trimester are primed to the formation of an exclusive bond with their infants. Oxytocin seems to be preparing mothers to engage in bonding behaviors. The findings also show that oxytocin is related to the mental, as well as the behavioral, aspect of bonding. More generally, this study confirms that there is a cross-species continuity in mechanisms that underlie species-specific expressions of bonding.

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Author Contact: Ruth Feldman

Psychological Science is ranked among the top 10 general psychology journals for impact by the Institute for Scientific Information.

Source: Catherine West

Association for Psychological Science

Almost 90% of teenagers aged 12-18 claim to have been victims of some level of sexual violence, according to a study conducted jointly by the University of Haifa and Ben Gurion University. The research surveyed 1,036 high school students. Additionally, 82% of the boys and 76% of the girls reported said that they had been subjects of violent physical assault.

Prof. Rachel Lev-Wiesel from the University of Haifa’s School of Social Work, one of the authors of the study, noted that the results showed a distressing increase in the incidence of violence — both sexual and physical — over the past few years. The number of criminal files opened by the police for assault against children rose from 6,370 in 1998 to 8,805 in 2005. According to the National Council for the Child, the number of children treated for suspected violent attacks or abuse in 2005 stood at more than 37,000, a rise of 120% over the past decade. Of the 37,000, 30.5% were reported physical violence, 9.9% sexual, 13% psychological and 36.8% varying degrees of neglect.

Prof. Lev-Wiesel stressed that the aim of the research was to examine the personal and social factors that help adolescents cope with the trauma of a violent assault. A questionnaire was completed anonymously by over 1,000 high school students. The questionnaire measured six variables: demography, physical and sexual assaults, PTSD, potency and social support from family and friends.

According to the researchers, there is a distinct correlation between a child’s feeling of potency and the level of traumatic symptoms exhibited following a violent attack. The study found a distinctive difference in the personal resources and the level of psychological distress of the children who suffered violent attacks as opposed to those who did not — whether the violence was limited to one incident or continuing and whether the attack was considered minor or severe. Boys in the study reported a higher incidence of sexual and physical violence than girls.

“The results of the research show that a feeling of potency and support of family and friends are important resources which have the potential to reduce the resulting trauma following assault. In addition to the importance of developing programs to decrease the incidence of violence, these is a need for programs for empowerment and strengthening personal resources that will protect those who have already fallen victim to violence,” summarized Prof. Lev-Wiesel.

The results of the study were presented at a conference, held on October 10, 2007, in cooperation with the University of Haifa, announcing the establishment of a non-profit organization founded by academics, professionals in the fields of social services and healthcare, lawmakers and the media to fight the rising incidence of violence and propose concrete solutions for aiding victims.

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Source: Laurie Groner

University of Haifa

Research looking at the development of aggressive behaviour in toddlers, may help to prevent antisocial and even criminal behaviour in later life, scientists will say at the Royal Society – the UK national academy of science – today (Tuesday 16 October 2007).

Richard Tremblay, Professor of Paediatrics, Psychiatry, and Psychology at the University of MontrГ©al, will present research at a scientific discussion meeting on the neurobiology of violence highlighting that young children do not learn to be aggressive, instead as they get older and their brains become more mature they become less aggressive as they learn to control their behaviour.

Children learn to regulate the use of physical aggression during the preschool years, making this time a critical period in which to intervene in order to prevent violence in later life. Those that don’t learn to do so in early childhood stand a much higher chance of developing into aggressive adults.

Professor Tremblay said: “Developmental studies show that infants aged three to four years old are more physically aggressive than adults. Learning how not to be violent – which mostly takes place during the preschool years – is dependent on both genetic and environmental factors. These range from the type of parental care a child receives to whether its mother smoked when pregnant. Research has shown, for example, that nicotine affects the development of areas of a baby’s brain which are responsible for emotional control.

“The early years of human development are on ‘fast forward’ and it is during this time period that physical aggression increases most dramatically and environment plays a very important role in the extent to which physical aggression develops or is controlled.

Professor Tremblay said: “Physical aggression in children is a major public problem. It is not only an indicator of aggression in adulthood but it also leads to other serious behavioural problems such as alcohol and drug abuse, violent crimes and continues the cycle of abusive parenting.

“Identifying the factors which stop children becoming well socialised adults should help us design preventative measures which are employed at the right time in a child’s development. These should put an appropriate emphasis on the behaviour of the parents, as well as that of the child.”

Furthermore, the research highlights the role that parents have in determining their children’s violent behaviour. Children at highest risk of not learning to regulate physically aggressive tendencies have mothers with a history of antisocial behaviour during their school years, mothers who have children at an early age, who smoked during pregnancy and parents with a low income and troubled family relationships.

A collection of papers from the speakers at the discussion meeting on ‘The neurobiology of violence: implications for prevention and treatment’ will be published in a special edition of Philosophical Transactions of the Royal Society B: Biological Sciences which is due to be published online in May 2008.

The meeting takes place on Tuesday 16 October and Wednesday 17 October 2007.

NOTES:

1. The Royal Society is an independent academy promoting the natural and applied sciences. Founded in 1660, the Society has three roles, as the UK academy of science, as a learned Society, and as a funding agency. It responds to individual demand with selection by merit, not by field. As we prepare for our 350th anniversary in 2010, we are working to achieve five strategic priorities to:

Invest in future scientific leaders and in innovation
Influence policymaking with the best scientific advice
Invigorate science and mathematics education
Increase access to the best science internationally
Inspire an interest in the joy, wonder and fulfilment of scientific discovery

Source:
Laura Dibb
The Royal Society, London

Vulnerable groups, especially male infants, are “at risk” of suffering adverse health effects when treated with a wide range of medical devices, the EU SCENIHR Committee reported yesterday.(1)(2)

The finding is the result of a lengthy study into the safety of PVC medical devices softened with the phthalate DEHP, found in the majority of devices on the market.

Lisette van Vliet, Toxics Policy Advisor for Health Care Without Harm Europe (HCWHE), says: “The report is good because it recognises that premature babies in particular are getting very high doses of DEHP, and that these levels are so high that we should do something now, not wait for conclusive epidemiology studies that are years away.”

However, HCWHE believes the study failed to address deeply enough the use of phthalates in medical devices, especially with regard to evaluation of alternatives.

“The report only evaluated the chemicals that could potentially be used to make PVC soft – it didn’t evaluate any of the alternative plastics which are being used in medical devices,” explains van Vliet.

“If they looked at the medical devices made from inherently soft plastics which don’t need these softeners, they would have found lots of devices which don’t leach toxic chemicals into patients. That would have given a more complete picture about whether or not phthalates are the kind of things we want in medical devices.”(3)(4)

DEHP is of concern in medical devices because it leaches into fatty solutions such as blood and nutritional formula and is then transported directly into the patient. A number of studies have shown that DEHP has harmful effects on animals at levels equivalent to those found in neonates.

HCWH Europes’s position is that hospitals should use medical devices free from plasticisers, whenever a safer alternative plastic is available. This is the only effective way to minimise patient exposure to a range of toxic and potentially-toxic chemicals present in many medical devices, because the alternative plastics do not need additives to make them soft. A number of hospitals across Europe have already phased out PVC for high-risk patient groups.(5)

Source:
Paul Whaley, Communications Coordinator, HCWH Europe
hcwh

Lisette van Vliet, Toxics Policy Advisor, HCWH Europe
env-health

Notes

(1) Scientific Committee on Emerging and Newly-Identified Health Risks (SCENIHR) Preliminary Report On The Safety Of Medical Devices Containing DEHP-Plasticized PVC or Other Plasticizers On Neonates and Other Groups Possibly at Risk
ec.europa.eu…scenihr_cons_05_en.htm

(2) Report, page 43: “Data available on the exposure to DEHP show that DEHP exposure levels of neonates during certain medical procedures are in the same order of magnitude or even higher than doses inducing reproductive toxicity in animal studies. This is of concern in view of animal studies showing that immature young animals are more susceptible to testicular toxicity by DEHP than older mature animals. Neonates may therefore be considered to be at risk for the adverse reproductive and developmental effects of DEHP.”

(3) A recent HCWHE survey found over 260 devices free of DEHP and other softeners available on the European market. More information here: noharm/details.cfm (PDF)

(4) PVC medical devices contain 20-40% of DEHP by weight. Similar amounts of alternative plasticisers are used in the alternatives mentioned in the report. SCENIHR concluded that “The information of the leaching from alternative plasticizers is sparse but may be expected to be of same order of magnitude.” [page 39]

(5) Health Care Without Harm is an international network of organisations working to reduce the harm healthcare does to human health and the environment. One area of particular concern is the use of DEHP and other phthalates in medical devices. See our website:
noharm/europe

For further information please go to:
Health Care Without Harm, Europe

A new system under development by a team of researchers at the University of Iowa will help children better cope with pain during difficult medical procedures.

The system works by using a Web-based software to advise nurses on the best way to distract children from the procedures that cause the pain. The distractions could be anything from having a book read to them, watching a video, talking, or playing a game.

The research team, led by professors Ann Marie McCarthy (left) and Charmaine Kleiber in the College of Nursing and Nick Street in the Tippie College of Business, developed the software after analyzing data from a multi-site research study that observed parents distracting their children, who were undergoing painful procedures.

The study helped the researchers determine how children cope with pain and what distractions worked best to keep their minds off the pain.

Children between the ages of 4 and 10 at the University of Iowa Children’s Hospital participated in this study. Data were collected from 542 subjects, all of whom were having an IV line inserted while a video camera recorded the event.

The data was collected by having parents and children complete questionnaires and by analyzing videotapes of the procedures. Members of the research team reviewed the video and graded the children’s distress. Children who experienced more pain and had more difficulty coping received higher scores. Children were also able to report how painful the procedure was by using a scale with happy and sad faces on it.

“We’re now using that data to build software that will determine the best strategy for distracting a child from the procedure, based on what we know about the child and the type of procedure,” said Street (left), a Tippie professor of management sciences who mined the data and is developing the software.

The software will also determine the parent’s capacity for providing the distraction.

“Not all parents are equally cut out for helping their children through medical procedures,” said McCarthy, a professor of nursing and chair of the nursing school’s Parent, Child and Family Area. “Sometimes, it might be best to bring in a distraction coach who has special training to keep children occupied.”

The distractions, she said, are anything that takes captures the attention of the child so that they focus on the distraction and not the procedure; reading a book, talking about school, coloring, drawing.

“In pain management, one size doesn’t fit all,” McCarthy said. “Some children need intensive distraction, some might need none at all. This software will tell the nurse what group each child should be in and what type of intervention to provide.”

McCarthy said the long-term health effects of making it easier for children to cope with pain could be profound.

“This is important because more than 4 million children require painful medical procedures, and we know undergoing those procedures can affect health care decisions later in life,” said McCarthy. “If we can provide a distraction, then the children are more likely to find the event to be less traumatic and are less likely to undergo serious psychological trauma.”

The next step in the research will begin in January, when researchers will pilot the software to determine what types of distractions work best with different parents and children. Street said the software asks a brief series of questions of the children and their parents about such things as previous experiences with procedures and pain, parenting styles, and anxiety issues.

Based on the answers and the type of procedure, the software will suggest a distraction strategy to the nurse and recommend whether the parents should do the distracting, or a coach should be brought in.

McCarthy said researchers will observe 580 subjects over 30 months during the next phase of research. The children will be patients at the University of Iowa Children’s Hospital in Iowa City, Blank Children’s Hospital in Des Moines and Cardinal Glennon Children’s Hospital in St. Louis.

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Other members of the research team include Kaan Ataman, a doctoral student in the Tippie College of Business, and Nick Woike, a Tippie College undergraduate student. Project director Kirsten Hanrahan of the College of Nursing provided nursing clinical experience to the software development.

STORY SOURCE: University of Iowa News Service, 300 Plaza Centre One, Suite 371, Iowa City, Iowa

Source: Tom Snee

University of Iowa

The University of Delaware has been named a regional research participant in the National Children’s Study–the largest long-term study of children’s health ever conducted in the United States.

The study, which is funded by the National Institutes of Health, will follow an estimated 100,000 children in communities across the United States, from before birth to 21 years of age. It will seek information to prevent and treat some of the nation’s most pressing health problems, including autism, birth defects, diabetes, heart disease and obesity.

Over the next two decades, researchers from UD’s Center for Disabilities Studies, the School of Nursing and the Department of Individual and Family Studies, in partnership with Christiana Care Health System and the Nemours/Alfred I. duPont Hospital for Children, will monitor the health of 1,100 children in New Castle County, Del., which is one of 105 study sites selected for the nationwide initiative. The Delaware study site is part of a regional collaboration managed by the Children’s Hospital of Philadelphia and Drexel University College of Medicine.

“We are excited to launch this long-term research partnership that will ultimately impact the health of our children as well as federal and state policy decisions,” said Bethany Hall-Long, associate professor of nursing in UD’s College of Health Sciences and the Delaware study center’s principal investigator. Hall-Long also holds a joint appointment as an associate policy scientist in the Health Services Policy Research Group in the College of Human Services, Education and Public Policy.

“Here at UD, we will be busy with project management, community outreach, home visits and child health assessments. It is an honor to be part of such a terrific team,” Hall-Long noted.

Deborah Amsden, a researcher at UD’s Center for Disabilities Studies in the College of Human Services, Education and Public Policy, is the project director. She will oversee day-to-day operations, from recruiting field staff to monitoring the extensive data on children and the environment that will be collected during the 25-year effort.

Martha Buell, professor, and Christine Ohannessian, associate professor, both in UD’s Department of Individual and Family Studies, also will play an integral role in the Delaware study center’s operation.

A major objective of the study is to examine how environmental inputs and genetic factors interact to affect the health and development of children, Amsden said.

“We’ll be collecting a great deal of information on environmental quality, including air and water samples from where these children live,” Amsden noted. “There will be opportunities for faculty and student involvement from across the University in this interdisciplinary project, which will provide access to a national protocol for collecting data on children and their environment over a long period of time.”

The study will officially launch in 2008, with the first data to be collected in 2009. Two hundred fifty children will be identified for the first phase of the study, with successive groups of children to be added each year for five years.

The study is being conducted in 105 U.S. locations that together are representative of the nation’s population. A national probability sample was used to select the counties in the study, which took into account such factors as race and ethnicity, income, education level, number of births and babies born with low birth weights.

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Source: Tracey Bryant

University of Delaware

If a child is diagnosed with sleep-disordered breathing and has his/her tonsils and adenoids taken out he/she is more likely to sleep better and have improved behavior after the operation, according to an article in Archives of Otolaryngology-Head & Neck Surgery (JAMA/Archives).

Up to 11% of all children may develop sleep breathing disorders, which include obstructive sleep apnea syndrome, snoring, and other conditions related to affected air flow, the authors explain. Previous studies have linked these conditions with ADHD (attention-deficit/hyperactivity disorder), hyperactive behavior, bedwetting, learning problems, feeling sleepy during the day, headaches and academic problems.

Julie L. Wei, M.D., University of Kansas School of Medicine, Kansas City, and team looked at 117 children who suffered from sleep-disordered breathing and had had their tonsils and adenoids taken out (adenotonsillectomy) – their average age was 6.5 years. Their parents were given questionnaires to fill which asked them about their child’s sleep and behavior – this was done twice, before and six months after surgery.

The researchers managed to complete the six-month follow-up with 71 of the children. They found that among them, sleep and behavioral problems were substantially reduced six months after surgery. Improvements were reported in the children’s cognitive abilities, hyperactivity, confrontational behavior and ADHD.

The authors added “Not only did both behavior and sleep improve independently before and after adenotonsillectomy for sleep-disordered breathing in our group of patients, but they also improved in correlation with each other.”

“Improved Behavior and Sleep After Adenotonsillectomy in Children With Sleep-Disordered Breathing”
Julie L. Wei, MD; Matthew S. Mayo, PhD; Holly J. Smith, MA; Matt Reese, PhD; Robert A. Weatherly, MD

Arch Otolaryngol Head Neck Surg. 2007;133:974-979.
– Click here to view abstract online

If SARS makes a comeback or a serious epidemic of flu becomes a reality, children could become an important focus in fighting back against these deadly viruses, according to a new review of recent studies.

Structured hygiene routines aimed at younger children might be the most effective way to stem an epidemic respiratory virus, say Tom Jefferson, M.D. and colleagues.

Younger children tend to have longer-lasting infections, more social contacts and less-than-perfect hygiene, making them “portals of infection into the household,” Jefferson said.

Relatively simple measures such as hand washing and consistent use of protective gowns, gloves and surgical masks are among the best ways to slow the march of a respiratory virus, the researchers concluded after analyzing 51 studies.

However, it might be difficult to make these efforts part of a long-term and routine strategy “without the threat of a looming epidemic,” they write.

Their review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Other ways to control the spread of respiratory viruses among children, such as closing schools, “are largely unproven and untested,” said Jennifer Nuzzo, an epidemic researcher at the Center for Biosecurity, University of Pittsburgh Medical Center.

“It’s likely that the effectiveness of school closures would depend on what respiratory disease is present, how early the measure is applied and for how long and whether or not kids are prevented from mixing elsewhere,” Nuzzo said.

The jury is still out on whether measures that are more elaborate add much beyond basic hygiene strategies. Expensive and uncomfortable filtration masks might be more effective than paper masks, but the evidence is limited, the Cochrane researchers found. So far, it is also unclear whether the use of antiseptics and virucides has any benefits beyond those offered by frequent regular hand washing.

The studies in the reviews took place over four decades in schools, soldier barracks, slums and daycare centers. However, “we were able to identify few studies from low-income countries, where the vast majority of the burden lies and where cheap interventions are so critical,” Jefferson said.

Jefferson T, et al. Interventions for the interruption or reduction of the spread of respiratory viruses (Review). Cochrane Database of Systematic Reviews, 2007, Issue 4.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit cochrane for more information.

Health Behavior News Service
Center for the Advancement of Health 2000 Florida Ave. NW, Ste 210
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