Psychosocial and Executive Functioning of Children with Attention-Deficit/Hyperactivity Disorder: Impact of the I Can Problem Solve Program

Children with ADHD tend to exhibit interpersonal, adaptive, and cognitive difficulties. Previous research evaluating psychosocial interventions with this population has found inconsistent improvement in participants\u27 interpersonal functioning, arguably because these programs do not effectively improve cognitive processes (e.g., self-regulation) that are critically related to this group\u27s social difficulties. However, there is some evidence that the ICPS Program (Shure, 1992) is effective in improving psychosocial and executive functioning of children with ADHD. Five children with ADHD, aged 10 to 12, and their parents, participated in a five-week intervention. The case study method was used. One participant showed marked improvement in social and executive functioning, while another showed some evidence of improved social relationships. The third participant was indistinguishable from the two control group participants on measures of social and executive functioning. These findings support the inconsistency of improvements in social skills in participants with ADHD

Studies on the inhibitors of angiotensin converting enzyme

Several aspects of the pharmacological properties, therapeutic efficacy, side-effects and tolerability of captopril and two new converting enzyme inhibitors have been examined. CAPTOPRIL (a) Therapeutic efficacy The long-term use of captopril has been examined in 70 patients with severe hypertension resistant to previous conventional antihypertensive therapy. Good blood pressure control was achieved in nearly all patients, with essential and secondary forms of hypertension, but most required large doses of loop diuretic. Diuretic-induced tachycardia occurred in one third of patients but there were few instances of electrolyte disturbance or deterioration in renal function. (b) First dose hypotensive effect. In this study, 8% of 65 severely hypertensive patients sustained an acute reduction of mean arterial pressure in excess of 50% within two hours of receiving captopril. Six patients developed symptoms of acute hypotension, including dizziness, stupor, dysphasia and hemiparesis. Analysis of several pre-treatment variables, including renal function, serum sodium and severity of blood pressure, did not permit consistent prediction of a severe first dose effect in individual patients. (c) Side-effects In a study of 100 consecutive patients treated with captopril, a 20% incidence of toxic side-effects was encountered. Analysis shows that the serious side- effects of proteinuria and neuropathy occurred only in patients with poor renal function who received high doses of captopril. There was no evidence in this study that the minor side-effects of taste loss and skin rash were related to dose or renal function, and occurred occasionally even when captopril dosage was low. (d) Tolerability and mood change. Despite the high incidence of adverse reactions and side-effects, captopril was well accepted. Many patients commented on an enhanced sense of well-being while taking captopril when compared with their previous antihypertensive therapy. A possible euphoriant property of captopril was thus examined in a placebo-controlled trial in 8 patients with moderate hypertension. This showed no evidence of mood enhancement while taking captopril, indeed there was statistically significant lowering of mood when compared with placebo. It is likely that the well-being experienced while taking captopril reflects the absence of mood lowering side- effects of previous therapy. ENALAPRIL (MK421) AND LYSINE ANAL'OGUE (a) Pharmacological properties. The immediate and long-term effects of these new inhibitors on blood pressure, serum electrolytes, renin- angiotensin system and sodium balance have been assessed and compared in a placebo-controlled study of 12 healthy subjects. In a dose of 10 mg once daily, MK421 and MK521 were shown to be potent inhibitors with a long duration of action. Both inhibitors fully suppressed converting enzyme activity and plasma angiotensin II 6 hours after administration but the effects of MK521 were more long-lasting. In this study in which sodium intake was fixed, a significant natriuresis occurred during the administration of both drugs, although this effect had largely disappeared after 8 days. Both drugs were well- tolerated and there were no serious side-effects. (b) Therapeutic efficacy and tolerabllity. The therapeutic effects of enalapril have been assessed in a long-term study of 20 hypertensive patients with renal artery stenosis. Ten patients had previous therapy withdrawn and detailed measurements of changes in blood pressure, serum and body electrolytes, and components of the renin-angiotensin system were made. In doses of 10-40 mg once daily there was sustained suppression of plasma angiotensin II and all patients achieved good blood pressure control. Nine patients had evidence of a significant natriuresis with a fall in total exchangeable sodium. All patients had a small but significant rise in serum creatinine but none suffered marked renal impairment. Ten further patients (five with bilateral renal artery stenosis) were too ill to be studied to the above protocol. All were started on enalapril and previous therapy was then gradually removed when possible. Even in this group with many adverse features, excellent blood pressure control was achieved by all patients and only three required additional therapy. There were no cases of deterioration in renal function even in the patients with bilateral arterial disease. Enalapril was well-tolerated by all patients and there were no serious side-effects

Estimating osteoporotic fracture risk following a wrist fracture: a tale of two systems

© 2015, The Author(s). Summary: The WHO fracture risk assessment (FRAX) and Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tools can both be used to determine an individual’s 10-year risk of osteoporotic fracture. However, these tools differ in their risk calculation. For participants fracture, FRAX provides a lower fracture risk estimate than CAROC resulting in fewer decisions to initiate therapy.Purpose: The purpose of the current report is to compare fracture risk prediction rates using the CAROC and the FRAX® tools.Methods: Individuals ≥50 years with a distal radius fracture resulting from a fall from standing height or less were recruited from a single orthopedic clinic. Participants underwent a DXA scan of their lumbar spine and hip. Femoral neck (FN) bone mineral density (BMD) and fracture risk factors were used to determine each participant’s 10-year fracture risk using both fracture risk assessment tools. Participants were categorized as low (\u3c10 \u3e%), moderate (10–20 %), or high (\u3e20 %) risk. Stratified by age (\u3c65 \u3eyears, \u3e65 years), the proportion of participants in each category was compared between the tools.Results: Analyses included 60 participants (mean age 65.7 ± 9.6 years). In those (n = 26), the proportion of individuals at low, moderate, and high risk differed between the FRAX and CAROC tools (p \u3c 0.0001). FRAX categorized 69 % as low (CAROC 0 %) and 3 % as high (CAROC 12 %) risk. For individuals \u3e65 years, almost all were at least at moderate risk (FRAX 79 %, CAROC 53 %), but fewer were at high risk using FRAX (18 vs. 47 %, p \u3c 0.0003).Conclusion: For participants 65 years were at moderate or high risk under both FRAX and CAROC and should at least be considered for pharmacotherapy

The Calcium-Sensing Receptor Mediates Bone Turnover Induced by Dietary Calcium and Parathyroid Hormone in Neonates

We have investigated, in neonates, whether the calcium-sensing receptor (CaR) mediates the effects of dietary calcium on bone turnover and/or modulates parathyroid hormone (PTH)–induced bone turnover. Wild-type (WT) pups and pups with targeted deletion of the Pth (Pth–/–) gene or of both Pth and CaR (Pth–/–CaR–/–) genes were nursed by dams on a normal or high-calcium diet. Pups nursed by dams on a normal diet received daily injections of vehicle or of PTH(1–34) (80 µg/kg) for 2 weeks starting from 1 week of age. In pups receiving vehicle and fed by dams on a normal diet, trabecular bone volume, osteoblast number, type 1 collagen–positive area, and mineral apposition rate, as well as the expression of bone-formation-related genes, all were reduced significantly in Pth–/– pups compared with WT pups and were decreased even more dramatically in Pth–/–CaR–/– pups. These parameters were increased in WT and Pth–/– pups but not in Pth–/–CaR–/– pups fed by dams on a high-calcium diet compared with pups fed by dams on a normal diet. These parameters also were increased in WT, Pth–/–, and Pth–/–CaR–/– pups following exogenous PTH treatment; however, the percentage increase was less in Pth–/–CaR–/– pups than in WT and Pth–/– pups. In vehicle-treated pups fed by dams on either the normal or high-calcium diet and in PTH-treated pups fed by dams on a normal diet, the number and surfaces of osteoclasts and the ratio of RANKL/OPG were reduced significantly in Pth–/– pups and less significantly in Pth–/–CaR–/– pups compared with WT pups. These parameters were further reduced significantly in WT and Pth–/– pups from dams fed a high-calcium diet but did not decrease significantly in similarly treated Pth–/–CaR–/– pups, and they increased significantly in PTH-treated pups compared with vehicle-treated, genotype-matched pups fed by dams on the normal diet. These results indicate that in neonates, the CaR mediates alterations in bone turnover in response to changes in dietary calcium and modulates PTH-stimulated bone turnover. © 2011 American Society for Bone and Mineral Research

Appropriate Osteoporosis Treatment by Family Physicians inResponse to FRAX vs CAROC Reporting: Results Froma Randomized Controlled Trial

© 2014 The International Society for Clinical Densitometry. Canadian guidelines recommend either the FRAX or the Canadian Association of Radiologists and Osteoporosis Canada (CAROC) fracture risk assessment tools to report 10-yr fracture risk as low (20%). It is unknown whether one reporting system is more effective in helping family physicians (FPs) identify individuals who require treatment. Individuals ≥50yr old with a distal radius fracture and no previous osteoporosis diagnosis or treatment were recruited. Participants underwent a dual-energy x-ray absorptiometry scan and answered questions about fracture risk factors. Participants\u27 FPs were randomized to receive either a FRAX report or the standard CAROC-derived bone mineral density report currently used by the institution. Only the FRAX report included statements regarding treatment recommendations. Within 3 mo, all participants were asked about follow-up care by their FP, and treatment recommendations were compared with anosteoporosis specialist. Sixty participants were enrolled (31 to FRAX and 29 to CAROC). Kappa statistics of agreement in treatment recommendation were 0.64 for FRAX and 0.32 for bone mineral density. The FRAX report was preferred by FPs and resulted in better postfracture follow-up and treatment that agreed more closely with a specialist. Either the clear statement of fracture risk or the specific statement of treatment recommendations on the FRAX report may have supported FPs to make better treatment decisions

Randomized Teriparatide [Human Parathyroid Hormone (PTH) 1–34] Once-Weekly Efficacy Research (TOWER) Trial for Examining the Reduction in New Vertebral Fractures in Subjects with Primary Osteoporosis and High Fracture Risk

Context: Weekly teriparatide injection at a dose of 56.5 μg has been shown to increase bone mineral density. Objective: A phase 3 study was conducted to determine the efficacy of once-weekly teriparatide injection for reducing the incidence of vertebral fractures in patients with osteoporosis. Design and Setting: In this randomized, multicenter, double-blind, placebo-controlled trial conducted in Japan, the incidence of morphological vertebral fractures by radiographs was assessed. Patients: Subjects were 578 Japanese patients between the ages of 65 and 95 yr who had prevalent vertebral fracture. Intervention: Subjects were randomly assigned to receive once-weekly sc injections of teriparatide (56.5 μg) or placebo for 72 wk. Main Outcome Measure: The primary endpoint was the incidence of new vertebral fracture. Results: Once-weekly injections of teriparatide reduced the risk of new vertebral fracture with a cumulative incidence of 3.1% in the teriparatide group, compared with 14.5% in the placebo group (P < 0.01), and a relative risk of 0.20 (95% confidence interval, 0.09 to 0.45). At 72 wk, teriparatide administration increased bone mineral density by 6.4, 3.0, and 2.3% at the lumbar spine, the total hip, and the femoral neck, respectively, compared with the placebo (P < 0.01). Adverse events (AE) and the dropout rates by AE were more frequently experienced in the teriparatide group, but AE were generally mild and tolerable. Conclusion: Weekly sc administration of teriparatide at a dose of 56.5 μg may provide another option of anabolic treatments in patients with osteoporosis at higher fracture risk

Endogenous PTH Deficiency Impairs Fracture Healing and Impedes the Fracture-Healing Efficacy of Exogenous PTH(1-34)

Although the capacity of exogenous PTH1-34 to enhance the rate of bone repair is well established in animal models, our understanding of the mechanism(s) whereby PTH induces an anabolic response during skeletal repair remains limited. Furthermore it is unknown whether endogenous PTH is required for fracture healing and how the absence of endogenous PTH would influence the fracture-healing capacity of exogenous PTH.Closed mid-diaphyseal femur fractures were created and stabilized with an intramedullary pin in 8-week-old wild-type and Pth null (Pth(-/-)) mice. Mice received daily injections of vehicle or of PTH1-34 (80 µg/kg) for 1-4 weeks post-fracture, and callus tissue properties were analyzed at 1, 2 and 4 weeks post-fracture. Cartilaginous callus areas were reduced at 1 week post-fracture, but were increased at 2 weeks post-fracture in vehicle-treated and PTH-treated Pth(-/-) mice compared to vehicle-treated and PTH-treated wild-type mice respectively. The mineralized callus areas, bony callus areas, osteoblast number and activity, osteoclast number and surface in callus tissues were all reduced in vehicle-treated and PTH-treated Pth(-/-) mice compared to vehicle-treated and PTH-treated wild-type mice, but were increased in PTH-treated wild-type and Pth(-/-) mice compared to vehicle-treated wild-type and Pth(-/-) mice.Absence of endogenous PTH1-84 impedes bone fracture healing. Exogenous PTH1-34 can act in the absence of endogenous PTH but callus formation, including accelerated endochondral bone formation and callus remodeling as well as mechanical strength of the bone are greater when endogenous PTH is present. Results of this study suggest a complementary role for endogenous PTH1-84 and exogenous PTH1-34 in accelerating fracture healing

Parathyroid Hormone versus Bisphosphonate Treatment on Bone Mineral Density in Osteoporosis Therapy: A Meta-Analysis of Randomized Controlled Trials

BACKGROUND: Bisphosphonates and parathyroid hormone (PTH) represent the antiresorptive and anabolic classes of drugs for osteoporosis treatment. Bone mineral density (BMD) is an essential parameter for the evaluation of anti-osteoporotic drugs. The aim of this study was to evaluate the effects of PTH versus bisphosphonates on BMD for the treatment of osteoporosis. METHODS/PRINCIPAL FINDINGS: We performed a literature search to identify studies that investigated the effects of PTH versus bisphosphonates treatment on BMD. A total of 7 articles were included in this study, representing data on 944 subjects. The pooled data showed that the percent change of increased BMD in the spine is higher with PTH compared to bisphosphonates (WMD = 5.90, 95% CI: 3.69-8.10, p<0.01,). In the hip, high dose (40 µg) PTH (1-34) showed significantly higher increments of BMD compared to alendronate (femoral neck: WMD = 5.67, 95% CI: 3.47-7.87, p<0.01; total hip: WMD = 2.40, 95%CI: 0.49-4.31, p<0.05). PTH treatment has yielded significantly higher increments than bisphosphonates with a duration of over 12 months (femoral neck: WMD = 5.67, 95% CI: 3.47-7.86, p<0.01; total hip: WMD = 2.40, 95% CI: 0.49-4.31, P<0.05) and significantly lower increments at 12 months (femoral neck: WMD = -1.05, 95% CI: -2.26-0.16, p<0.01; total hip: WMD: -1.69, 95% CI: -3.05-0.34, p<0.05). In the distal radius, a reduction in BMD was significant between PTH and alendronate treatment. (WMD = -3.68, 95% CI: -5.57-1.79, p<0.01). DISCUSSION: Our results demonstrated that PTH significantly increased lumbar spine BMD as compared to treatment with bisphosphonates and PTH treatment induced duration- and dose-dependent increases in hip BMD as compared to bisphosphonates treatment. This study has also disclosed that for the distal radius, BMD was significantly lower from PTH treatment than alendronate treatment

The utilization of appropriate osteoporosis medications improves following a multifaceted educational intervention: the Canadian quality circle project (CQC)

<p>Abstract</p> <p>Background</p> <p>Osteoporosis is a serious but treatable condition. However, appropriate therapy utilization of the disease remains suboptimal. Thus, the objective of the study was to change physicians' therapy administration behavior in accordance with the Osteoporosis Canada 2002 guidelines.</p> <p>Methods</p> <p>The Project was a two year cohort study that consisted of five Quality Circle (QC) phases that included: 1) Training & Baseline Data Collection, 2) First Educational Intervention & First Follow-Up Data Collection 3) First Strategy Implementation Session, 4) Final Educational Intervention & Final Follow-up Data Collection, and 5) Final Strategy Implementation Session. A total of 340 family physicians formed 34 QCs and participated in the study. Physicians evaluated a total of 8376, 7354 and 3673 randomly selected patient charts at baseline, follow-up #1 and the final follow-up, respectively. Patients were divided into three groups; the high-risk, low-risk, and low-risk without fracture groups. The generalized estimating equations technique was utilized to model the change over time of whether physicians</p> <p>Results</p> <p>The odds of appropriate therapy was 1.29 (95% CI: 1.13, 1.46), and 1.41 (95% CI: 1.20, 1.66) in the high risk group, 1.15 (95% CI: 0.97, 1.36), and 1.16 (95% CI: 0.93, 1.44) in the low risk group, and 1.20 (95% CI: 1.01, 1.43), and 1.23 (95% CI: 0.97, 1.55) in the low risk group without fractures at follow-up #1 and the final follow-up, respectively.</p> <p>Conclusion</p> <p>QCs methodology was successful in increasing physicians' appropriate use of osteoporosis medications in accordance with Osteoporosis Canada guidelines.</p