Child abuse is a serious problem that affects nearly one million children a year in the United States alone. The American Academy of Pediatrics and the US Department of Health and Human Services classify child abuse into four categories including neglect, physical abuse, sexual abuse, and emotional abuse. None of these categories, however, clearly includes the abusive use of drugs on children. A study soon to be published in the Journal of Pediatrics investigates the malicious use of pharmaceuticals and attempts to shed light on this under-recognized problem.

Dr. Shan Yin from the University of Colorado and the Rocky Mountain Poison Drug Center at Denver Health reviewed cases of pharmaceutical abuse reported to the National Poison Data System between 2000 and 2008. Dr. Yin included reports of the malicious use of alcohol, painkillers, cough and cold medicines, sedatives and sleeping pills, and antipsychotic medicines.

Of the more than 1400 cases studied, nearly 14% resulted in moderate to major consequences, including death. Nearly one-half of the abused children were exposed to at least one sedative. An average of 160 cases, including two deaths, was reported each year. Motives and legal findings were unavailable for these particular cases; however, motives for the abusive use of drugs generally are varied, and can include punishment, amusement, or a wish for a break from childcare responsibilities.

This study illustrates the seriousness of the abusive use of drugs administered to children. According to Dr. Yin, "The malicious administration of pharmaceuticals should be considered an important form of child abuse." He encourages pediatricians and emergency medical personnel to be on the watch for this form of maltreatment, and suggests the use of comprehensive drug screening during the evaluation of a child suspected to be the victim of abuse. Dr. Yin also cautions parents that the "non-therapeutic administration of pharmaceuticals to children can result in serious outcomes, including death."

New insights spur effort to boost treatment's impact significantly

Scientists have taken another important step toward understanding just how sticking needles into the body can ease pain. In a paper published online May 30 in Nature Neuroscience, a team at the University of Rochester Medical Center identifies the molecule adenosine as a central player in parlaying some of the effects of acupuncture in the body. Building on that knowledge, scientists were able to triple the beneficial effects of acupuncture in mice by adding a medication approved to treat leukemia in people. The research focuses on adenosine, a natural compound known for its role in regulating sleep, for its effects on the heart, and for its anti-inflammatory properties. But adenosine also acts as a natural painkiller, becoming active in the skin after an injury to inhibit nerve signals and ease pain in a way similar to lidocaine.

In the current study, scientists found that the chemical is also very active in deeper tissues affected by acupuncture. The Rochester researchers looked at the effects of acupuncture on the peripheral nervous system – the nerves in our body that aren't part of the brain and spinal cord. The research complements a rich, established body of work showing that in the central nervous system, acupuncture creates signals that cause the brain to churn out natural pain-killing endorphins.

The new findings add to the scientific heft underlying acupuncture, said neuroscientist Maiken Nedergaard, M.D., D.M.Sc., who led the research. Her team is presenting the work this week at a scientific meeting, Purines 2010, in Barcelona, Spain. "Acupuncture has been a mainstay of medical treatment in certain parts of the world for 4,000 years, but because it has not been understood completely, many people have remained skeptical," said Nedergaard, co-director of the University's Center for Translational Neuromedicine, where the research was conducted. "In this work, we provide information about one physical mechanism through which acupuncture reduces pain in the body," she added.

To do the experiment, the team performed acupuncture treatments on mice that had discomfort in one paw. The mice each received a 30-minute acupuncture treatment at a well known acupuncture point near the knee, with very fine needles rotated gently every five minutes, much as is done in standard acupuncture treatments with people.

The team made a number of observations regarding adenosine:

• In mice with normal functioning levels of adenosine, acupuncture reduced discomfort by two-thirds.
• In special "adenosine receptor knock-out mice" not equipped with the adenosine receptor, acupuncture had no effect.
• When adenosine was turned on in the tissues, discomfort was reduced even without acupuncture.
• During and immediately after an acupuncture treatment, the level of adenosine in the tissues near the needles was 24 times greater than before the treatment.

Once scientists recognized adenosine's role, the team explored the effects of a cancer drug called deoxycoformycin, which makes it harder for the tissue to remove adenosine. The compound boosted the effects of acupuncture treatment dramatically, nearly tripling the accumulation of adenosine in the muscles and more than tripling the length of time the treatment was effective. "It's clear that acupuncture may activate a number of different mechanisms," said Josephine P. Briggs, M.D., director of the National Center for Complementary and Alternative Medicine at the National Institutes of Health. "This carefully performed study identifies adenosine as a new player in the process. It's an interesting contribution to our growing understanding of the complex intervention which is acupuncture," added Briggs, who is the spouse of co-author Jurgen Schnermann.

While studies have shown that cognitive therapy is an effective treatment for depression, it has still not been clear the role therapists' training and expertise plays in making treatment successful. A new study finds that depressed patients show more symptom improvement when their therapists more competently follow the guidelines for delivering cognitive therapy. The study also suggests therapist competence may be a particularly important determinant of outcome for some patients. Researchers found that therapist competence was more strongly related to symptom improvement in patients who suffered from anxiety as well as depression, and for those who first experienced depression at an early age.

"People with depression who don't have complicating issues like anxiety are fairly likely to show benefit even if they don't see the most highly rated therapists," said Daniel Strunk, co-author of the study and assistant professor of psychology at Ohio State University. "But people who have substantial anxiety or a history of depression that began at an early age really do best if they have the most highly rated treatment."

While the need for competent therapists might seem obvious, Strunk said there have been very few studies looking at whether the competence with which the therapy is delivered predicts subsequent outcomes. Studies that have examined the issue have tended to examine the relation of ratings of therapists and the overall outcomes of their patients. But that ignores the possibility that the competence of the therapists may not have been responsible for their patients' improvement. "Once patients have improved, they might help to make their therapists look more competent. If so, this could explain the competence-outcome relation. So, we wanted to see if we could rule out that possibility by examining whether competence predicted subsequent outcomes," Strunk said.

The research appears in a recent issue of the Journal of Consulting and Clinical Psychology. In this study, two researchers examined videotapes of therapy sessions involving 60 adults with moderate to severe depression and their six therapists. The researchers rated competence using the Cognitive Therapy Scale, which is also used by the accrediting organization for cognitive therapists (The Academy of Cognitive Therapy). The scale rates therapists on a variety of skills, including their interpersonal relations and their use of specific techniques thought to help patients facing depression. The researchers rated the therapists' competence during the first four sessions with each of the 60 patients. In addition, patients completed a questionnaire at each session that measured their depression levels.

Strunk and his colleagues then compared how competence scores given to the therapists for each session related to change in patients' depression levels from session to session. The researchers rated competence levels without knowing how the patients were progressing and whether their symptoms were improving, Strunk said. This way, the researchers could later tell whether there was an association between competence and subsequent patient improvement. Strunk said the strongest results came when they looked at how therapist competence was related to improvement in patients with specific characteristics. That is where they found that patients with high anxiety and early onset depression benefitted most from the highly rated therapy sessions.

In addition to looking at how therapist competence interacted with patient characteristics, the researchers also examined how competence, measured for each individual session, was related to patient improvement from one session to the next. Results showed that higher levels of therapist competence were related to more symptom improvement during the first four sessions.

The researchers also tested patients again after 16 weeks of treatment to see if competence predicted longer-term improvement. Here, competence was significantly related to patient improvement on just one of two measures of depression severity. "When you look at how patients do after four full months of treatment, the importance of therapist competence was still there, but not as strong," he said.

Strunk said the results suggest that therapists may show higher levels of competence in some sessions compared to others, even with the same patient. "From our results, you should expect that there will be a range of competence from session to session – even among good therapists," Strunk said. "That may mean that the way we define competence is still not good enough, because we're finding that even highly trained therapists get below-average scores a fair number of times."

The results should encourage more study about the best way to measure competence in therapists. "The field is still struggling to figure out how to measure competence, and that's one of the things this study is about," he said. Strunk also said that, if replicated, these results would suggest that clinic directors should look at patient characteristics when deciding which therapists should treat individual patients with depression. Those patients with anxiety issues or early onset depression should be placed with the highest-rated therapists to get the most benefit.

Acclaimed journalist, author and political activist Barbara Ehrenreich explores the darker side of positive thinking in Smile or Die (10:22 min YouTube video)

Results could have worldwide implications and prove that all lab mice are not equal

Researchers at the University of Colorado’s Anschutz Medical Campus have found the brains of mice used in laboratories worldwide can be profoundly affected by the type of cage they are kept in, a breakthrough that may require scientists to reevaluate the way they conduct future experiments.

“We assume that mice used in laboratories are all the same, but they are not,” said Diego Restrepo, director of the Neuroscience Program and professor of cell and developmental biology whose paper on the subject was published Tuesday, June 29. “When you change the cages you change the brains and that affects the outcomes of research.”

Mice are the chief research mammals in the world today with some of the most promising cancer, genetic and neuroscience breakthroughs riding on the rodents. Researchers from different universities rely on careful comparison of experimental results for their discoveries; but Restrepo has found that some of these comparisons may not be trustworthy.

He discovered that the brains of mice are extremely sensitive to their environment and can physically change when moved from an enclosure where air circulates freely to one where it doesn’t. Specifically, the portion of the mouse’s brain responsible for its keen sense of smell, the olfactory bulb, is altered.  Restrepo also found profound changes in the levels of aggression when mice are moved from one type of cage to another.

The results, he says, can greatly affect the accuracy of the research. Two labs doing the same experiments may get totally different results and never know why.

“This could explain some of the failures to replicate findings in different laboratories and why contradictory data are published by different laboratories even when genetically identical mice are used as subjects,” said Restrepo.

The consequences could mean good science derailed or promising research abandoned simply due to the design of a mouse cage – something largely overlooked until now.

Restrepo’s findings were just published in PLoS One, the Public Library of Science, a major peer-reviewed scientific journal, and are gaining and increasingly wide audience.

He hopes scientists will work to uncover the depth of the problem and find ways to overcome it.

"We need to ensure that laboratory findings are truly indicative of natural processes and not simply the result of environmental factors within each lab,” he said.