Differences in referral and use of complementary and alternative medicine between pediatric providers and patients.

OBJECTIVES: The goal of this study was to compare pediatric complementary and alternative medicine (CAM) use and pediatric health care provider CAM referral as well as identify predictors of use and referral. DESIGN: Surveys were administered to 283 parents/caregivers of pediatric patients and 200 pediatric health care providers (HCP). SETTING: This study took place at the Children's Hospital of Orange County (CHOC Children's) in Orange, CA. MAIN OUTCOME MEASURES: Caregivers and HCP were provided a list of 32 CAM interventions and asked to indicate which treatments their child had ever used or which they would consider using for their child and which treatments they had ever referred or which they would consider referring, respectively. The main outcome variables were the number and type of CAM therapies endorsed by participants. RESULTS: Providers referred the majority of CAM therapies significantly more often than patients used each therapy and more often than caregivers would consider each therapy for their child. In addition, children from families with higher incomes, whose parents were older and had more education, who were White, and whose primary language spoken at home was English were more likely to use CAM therapies, all p's<0.05. HCP CAM referral was not significantly predicted by number of years a health care provider practiced or health care profession, all p's<0.05. CONCLUSIONS: HCP referred CAM therapies more often than parents reported use for their children. Findings may imply that parents/caregivers are underutilizing CAM therapies for their children. Potential barriers to CAM use in pediatric patients needs to be explored.

How cognitive enhancement can change our duties.

This theoretical paper draws the scientific community's attention to how pharmacological cognitive enhancement may impact on society and law. Namely, if safe, reliable, and effective techniques to enhance mental performance are eventually developed, then this may under some circumstances impose new duties onto people in high-responsibility professions-e.g., surgeons or pilots-to use such substances to minimize risks of adverse outcomes or to increase the likelihood of good outcomes. By discussing this topic, we also hope to encourage scientists to bring their expertise to bear on this current public debate.

Adaptation of the main peripheral artery and vein to long term confinement (Mars 500).

PURPOSE: The objective was to check if 520 days in confinement (MARS 500), may affect the main peripheral arterial diameter and wall thickness and the main vein size. METHOD: Common carotid (CC) femoral artery (FA) portal vein (PV), jugular (JG), femoral vein (FV) and tibial vein were assessed during MARS 500 by echography, performed by the subjects. A hand free volumic echographic capture method and a delayed 3D reconstruction software developed by our lab were used for collecting and measuring the vascular parameters. RESULTS: During the MARS 500 experiment the subjects performed 6 sessions among which 80% of the echographic data were of sufficient quality to be processed. No significant change was found for the Common carotid, Jugular vein, femoral artery, femoral vein, portal vein, and tibial vein diameter. CC and FA IMT (intima media thickness) were found significantly increased (14% to 28% P<0.05) in all the 6 subjects, during the confinement period and also at +2 days after the confinement period, but there was no significant difference 6 month later compare to pre MARS 500. CONCLUSION: The experiment confirmed that even untrained to performing echography the subjects were able to capture enough echographic data to reconstruct the vessel image from which the parameters were measured. The increase in both CC and FA IMT should be in relation with the stress generated by the confined environment or absence of solar radiation, as there was no change in gravity, temperature and air in the MARS 500 module, and minor changes in physical exercise and nutrition.

Pediatric oncologists' practices of prescribing selective serotonin reuptake inhibitors (SSRIs) for children and adolescents with cancer: a multi-site study.

OBJECTIVE: To survey pediatric oncologists regarding prescription of selective serotonin reuptake inhibitors (SSRIs) and related medications for the treatment of depression and anxiety disorders in children with cancer. Specifically, we sought to determine (a) how frequently pediatric oncologists prescribed SSRIs and what were the most commonly prescribed agents; (b) how decisions were made to prescribe, particularly whether mental health professionals were consulted; (c) how patients were monitored while on the agents; and (d) how the FDA black box warning has affected prescribing practices. METHOD: Oncologists from nine children's cancer centers (N = 151) from across the U.S. were surveyed, responding to either on-line or paper versions of a questionnaire developed for this study. RESULTS: A majority of oncologists (71%) reported prescribing SSRIs for their patients. Oncologists reported difficulties differentiating symptoms of depression from aspects of cancer treatment. Mental health practitioners are consulted occasionally but not routinely, and oncologists reported a need for increased mental health resources. Approximately half of oncologists (51%) reported that the FDA black box warning had not affected their practice. In addition, only 28% reported monitoring patients on SSRIs at FDA recommended intervals, and only 9% indicated assessing for suicidality. CONCLUSIONS: Prescription of SSRIs is a common practice of pediatric oncologists, often without consultation with mental health professionals. Post-prescription monitoring appears to be suboptimal, and does not follow FDA guidelines.

"The Neuroscience of Responsibility"-Workshop Report.

This is a report on the 3-day workshop "The Neuroscience of Responsibility" that was held in the Philosophy Department at Delft University of Technology in The Netherlands during February 11th-13th, 2010. The workshop had 25 participants from The Netherlands, Germany, Italy, UK, USA, Canada and Australia, with expertise in philosophy, neuroscience, psychology, psychiatry and law. Its aim was to identify current trends in neurolaw research related specifically to the topic of responsibility, and to foster international collaborative research on this topic. The workshop agenda was constructed by the participants at the start of each day by surveying the topics of greatest interest and relevance to participants. In what follows, we summarize (1) the questions which participants identified as most important for future research in this field, (2) the most prominent themes that emerged from the discussions, and (3) the two main international collaborative research project plans that came out of this meeting.

Neuroimaging and Responsibility Assessments.

Could neuroimaging evidence help us to assess the degree of a person's responsibility for a crime which we know that they committed? This essay defends an affirmative answer to this question. A range of standard objections to this high-tech approach to assessing people's responsibility is considered and then set aside, but I also bring to light and then reject a novel objection-an objection which is only encountered when functional (rather than structural) neuroimaging is used to assess people's responsibility.