Health Scan: A multidisciplinary approach to ADD

Attention-deficit disorders and other learning disabilities are the most common neuro-developmental problems in young children. ADD and its variations are estimated to affect between three percent and 10% of all children. Their lack of concentration and motor skills make it very difficult for the children – who have natural talents – to function, and they disrupt their classes, making it difficult for teachers in school and in kindergarten.

US studies have shown that 20% of such children were involved in setting fires, 30% in stealing and 25% were ejected from their schools due to their behavior. They are also more likely to smoke and drink alcohol and four times more likely than non-ADD youth to be involved in road accidents.

Experts believe there is a genetic basis for the disorder, which explains why it often passes from one generation to another. But in the past decade, there has been a breakthrough that found the disorder also involves a defect in activity of the brain’s pre-frontal cortex, cerebellum and other areas. The latest imaging techniques were responsible for this advance. Thus it is believed that while genetics are involved, ADD and its variations are largely caused by defects in the functioning of neurotransmitters, especially dopamine and norepinephrine.

Because everything in the brain is intertwined, affected children also tend to have mood and behavioral problems depending on their age. Many also develop low self-esteem, sub-par educational accomplishments and social and behavioral problems.

However, treatment can help, especially if the problem is diagnosed at an early stage. First, a comprehensive neurological examination is needed, followed by EEG, imaging, metabolic tests and continuous performance tests. Questionnaires and didactic and psychological tests are also used to make the diagnosis. Multidisciplinary treatment may include a combination of didactic and psychological means as well as medication, determined according the problems of each child.

Until now, because of the lack of facilities, parents have had to wait six to nine months to get the initial diagnosis at health fund clinics or have paid private experts high fees.

Now there is a one-stop-shop address for ADD children and their parents. A neurocognitive center for such children has opened at Hadassah University Medical Center on Jerusalem’s Mount Scopus. Dr. Itai Berger, a senior pediatric neurologist with much experience and research in the field, is its director. Even very young children undergo testing, with the whole process completed in weeks rather than months, and they can proceed to treatment, with the home environment and the school integrated in the process.

Berger says that if the center succeeds, it will be a model for setting up similar centers in other parts of the country.

The health funds participate in the costs of diagnosis at the center, and families that receive assistance from the welfare authorities are eligible for additional financial assistance.

CLINICAL PHARMACY GRADS

The first 15 graduates of a new doctoral program in clinical pharmacy – the first of its kind in the country – recently received their doctor of pharmacy degrees from the Hebrew University of Jerusalem. The PharmD is the equivalent in pharmacy of a doctor of medicine degree. The new program was initiated three years ago with enrollment of the first students; it replaced the former master’s program in clinical pharmacy.

Clinical pharmacy incorporates aspects of pharmacology, toxicology, pharmacokinetics and pharmacotherapy and finds its expression within the framework of patient care. The clinical pharmacist is responsible for identifying problems connected with patients’ medications, finding solutions to those problems and trying to prevent them.

The new graduates will work alongside medical doctors in hospitals and health clinics.

“Research has shown that the use of unsuitable medicines is the fifth highest source of mortality in the US,” said program head Prof. Amnon Hoffman. “More people die from medical errors than from road accidents, breast cancer or AIDS. More involvement of pharmacists in guiding patients toward correct, responsible and cautious use of medicines can prevent this phenomenon in many cases. Our new graduates of this program are expected to make a great contribution to the health of patients, and they will serve as ground-breakers for those who come after them.”

FLOORED BY BACTERIA

Maybe those pedantic people who use alcohol rub all the time are right. Just being in a room can add some 37 million bacteria to the air every hour – material largely left behind by previous occupants and stirred up from the floor, according to new research by Yale University engineers.

“We live in this microbial soup, and a big ingredient is our own microorganisms,” said environmental engineering Prof. Jordan Peccia, the principal investigator of a study recently published online in the journal Indoor Air.

“Mostly people are re-suspending what’s been deposited before. The floor dust turns out to be the major source of the bacteria that we breathe.”

Many previous studies have surveyed the variety of germs present in everyday spaces. But this is the first study that quantifies how much a lone human presence affects the level of indoor biological aerosols. Peccia and his research team measured and analyzed biological particles in a single, ground-floor university classroom over a period of eight days – four days when the room was periodically occupied and four when the room was continuously vacant. At all times the windows and doors were kept closed.

Researchers sorted the particles by size.

Overall, they found that “human occupancy was associated with substantially increased airborne concentrations” of bacteria and fungi of various sizes. Occupancy resulted in especially large spikes for larger-sized fungal particles and medium-sized bacterial particles. The size of bacteria-and fungi-bearing particles is important, because size affects the degree to which they are likely to be filtered from the air or linger and recirculate, the researchers note.

The researchers found that about 18% of all bacterial emissions in the room – including both fresh and previously deposited bacteria – came from humans, as opposed to plants and other sources.

Of the 15 most abundant varieties of bacteria identified in the room studied, four are directly associated with humans, including the most abundant, Propionibacterineae, common on human skin. Peccia said carpeted rooms appear to retain especially high amounts of microorganisms, but noted that this does not necessarily mean rugs and carpets should be removed. Extremely few of the microorganisms commonly found indoors are infectious, he said. Still, understanding the content and dynamics of indoor biological aerosols is helpful for devising new ways of improving air quality when necessary, he said.

“All those infectious diseases we get, we get indoors,” he concluded.