Relative to the swine flu outbreak, a statement yesterday, before the death in Texas, by the County Public Health Chief below my name. 

Last Monday’s Update referred to the increase in diabetes with SSRIs. Harold Eist sent the following reflection: “Depressed patients also crave carbohydrates and some develop genuine sugar addictions. They wake up in the middle of the night and cannot get back to sleep until they have eaten a gallon of ice cream or all the sweets they can find including pure sugar. CHO's are building blocks of serotonin so these patients may be trying to build serotonin. They report considerable relief after eating CHO's and comfortably return to sleep. One would hope that in patients on SSRI's who develop diabetes a careful dietary history be taken. Since many of these patients are true addicts they lie about their real intake. A spouse or family member should be part of the initial history taking.”

In next month’s Pediatrics, an NIMH study finds that ADHD kids, kindergarten through 5^th grade, prescribed stimulants did better scholastically than those with ADHD and not prescribed such. medication. Medicated children were about one-fifth of a school year ahead of their non-medicated peers in math and about one-third of a school year ahead in reading, but both groups still lagged behind their classmates who did not have ADHD. ADHD researcher Lily Hechtman, MD, of McGill University, says that although ADHD drugs can help children, many children with ADHD have learning issues that the drugs do not address. “About 20% of children with attention deficit disorders also have very specific learning disabilities,” she says. “These children clearly need other interventions.” Even children without specific learning disabilities who have fallen behind academically will need more than medication to catch up if they are diagnosed after years of struggle in the classroom, she says.

Last Monday’s USA Today featured a plea that all teens get screened for depression, not just those who present with issues.  Forms or computer screens would be filled out by the teen before seeing pediatrician who could determine risk in 15 seconds. It is estimated that 10% of the time, the screen would suggest there is more for the pediatrician to do.  It is hypothetical, I gather, the degree to which mental health professionals would be available if this increases the number being referred. Restated, there should only be screening where services would be available.

Three milligrams of melatonin at bedtime can effectively treat sleep problems in children with autistic spectrum disorder or fragile X syndrome or both, according to a study reported in the April 15 issue of the Journal of Clinical Sleep Medicine.

In next month’s AACAP Journal, some articles of clinical interest:

1.      A Lilly-funded study on use of atomoxetine in ADHD: Clinical response was bimodal, 47% showed considerable improvement, 40% showed no improvement.  There were no demographic or clinical predictors of response.  Subjects who ultimately achieved a much improved response were likely to be at least minimal responders by week 4.

2.      The results of a study that did not provide support for the use of divalproex in the treatment of youths with bipolar I disorder, mixed or manic state.

3.      CBT seems efficacious in children with anxiety disorders as opposed to group support and attention.

Roger

County Employee:

This message is to let you know more about the swine flu situation in Montgomery County and what you can do to protect yourself and your family.  

First of all, you should know there are no cases of swine flu in Montgomery County —or in the State of Maryland or in the general Washington metropolitan region—at this time.  There have been no deaths in the United States among the swine flu cases.  But this is an evolving situation that could change at any time. 

The Montgomery County Department of Health and Human Services Disease Control Program is closely monitoring the situation nationally and internationally and making preparations for if, and when, Montgomery County does have cases.  We have been watching this situation since the first news came from Mexico .  We are working closely with the State Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention (CDC) at the national level.  We are preparing to open our Public Health Information Line, 240-777-4200, mid-afternoon Tuesday, April 28 to answer questions.  Of course, we will keep you updated on specifics in Montgomery County .   Some things you can do are: 

·        Always cover a cough or sneeze with a tissue—and throw the tissue away.  Or cough or sneeze into the inside of your elbow.  Don’t send your sneeze or cough into the air.  This is good advice always, even when there is no swine flu. 

·        Wash your hands often with soap and water, especially after you cough or sneeze and before you eat.  Alcohol hand sanitizer (minimum 60% alcohol) will do if soap and water are unavailable. 

·        Avoid touching your eyes, nose or mouth.  These are places germs can enter your body very easily. 

·        Try to keep at least six feet away from sick people.  This is called social distancing.  Swine flu, like all flu, is spread through the air so keeping some distance will give the virus space to drop to the ground if someone is coughing or sneezing. 

·        Monitor yourself and your family for symptoms of fever, chills, headache, sore throat, cough, body aches, and vomiting or diarrhea.  If you are sick, stay home from work, school or other public places until you are feeling well.  Persons who have difficulty breathing or believed to be severely ill should seek medical attention.  

·        If symptoms of illness develop within seven days of travel from Mexico or other area where swine flu has been identified, seek medical help as soon as possible.  Symptoms of swine flu are the same as those for seasonal flu:  fever, runny nose, headache, body aches, etc.  When you call for an appointment, be sure to tell your healthcare provider about your recent travel and suggest testing for influenza.  You may be given instructions to wear a surgical mask or take other precautions to avoid infecting others. 

At this time, there is no vaccination for swine flu.  It is not known whether the flu shot you got this fall will provide any protection.  The Food and Drug Administration and pharmaceutical manufacturers are studying what can be done to protect you from swine flu.  Antivirals like Tamiflu seem to help.   

Finally, you may have heard that the United States has declared a Public Health Emergency.  Don’t be alarmed.  The declaration of a Public Health Emergency is required for the government to be able to move ahead quickly to find a cure or vaccination or other medical help.  It allows civilian and military stockpiles of anti-viral drugs to be distributed quickly should they be needed.  The declared Emergency says this is a very serious situation, that it is not business as usual.  But it does not mean you should panic.

Dr. Ulder J. Tillman, M.D., M. P.H.

Chief, Public Health Services and Health