Pediatric Annals

Trend Watch 

Trend Watch

Abstract

Computer-based cognitive-behavioral therapy was found to be as effective as treatment from a clinician for treatment of depression in adolescents, according to a study.

SPARX (Smart, Positive, Active, Realistic, X-factor thoughts) is a therapeutic fantasy game, developed by researchers led by Sally N. Merry, PhD, at the University of Auckland in New Zealand. The game offers cognitive-behavioral therapy (CBT) treatments through first-person instruction.

In it, the patient selects an “avatar” (an alter ego) and performs a series of challenges in a 3-D environment to “restore balance in a fantasy world dominated by GNATs (Gloomy Negative Automatic Thoughts),” according to Merry and her team. Researchers randomly assigned 187 participants, aged 12 to 19 years, to either use SPARX (n=194); or, to work with a therapist in a clinical setting (n=93). All patients were seeking help for depression, deemed in need of treatment by their primary care clinicians, and were not at major risk of self-harm. Patients assigned to SPARX completed seven levels of the game. At the beginning and end of each level a “guide” would help patients conceptualize their progress, such as dealing with emotions, overcoming problems, recognizing helpful thoughts compared to challenging, unhelpful thoughts. Researchers evaluated the primary treatment outcomes of SPARX patients and those assigned to usual treatment using the revised Children’s Depression Rating Scale (CDRS-R). Secondary outcomes were measured using the second edition Reynolds Adolescent Depression Scale (RADS-2) and other screening tools.

At post-intervention, there was a mean reduction of 10.32 in SPARX patients and 7.59 in those assigned to usual treatment, as measured by the CDRS-R (between group difference, 2.73; 95% CI, −0.31 to 5.77). Remission rates were significantly higher among SPARX patients (43.7%) vs. patients attending usual treatment (26.4%), according to the researchers (difference, 17.3%; 95% CI, 1.6–31.8). Response rates between the two groups were comparable.

“I am excited about our results,” Merry told Pediatric Annals, in an interview. “So many young people with depression never get help with it. Many young people don’t want to talk to a therapist, and for those that do, a therapist is not always available. SPARX provides a way to get help for young people that is readily accessible for those who have access to a computer, and can be done at a time and place that suits them.”

Merry SN. BMJ. 2012;doi:10.1136/bmj.e2598.

Although policymakers and federal organizations such as the White House Childhood Obesity Task Force and the CDC have argued that improving access to supermarkets while reducing access to fast food restaurants and convenience stores are an important step to combating childhood obesity, RAND Corporation researchers Ruopeng An, MPP, and Roland Strum, PhD, have found little evidence to support these claims.

“Recently, the notion of a ‘food desert’ is widely cited in media and in shaping public health policies, despite the mixed results from previous studies,” An told Pediatric Annals in an interview. “We thus decided to use a large state representative survey data with precise geographical information for survey participants to test the ‘food desert’ hypothesis.”

The researchers analyzed survey data on the self-reported heights, weights, and diets of 8,226 children aged 5 to 11 years, and 5,236 adolescents aged 12 to 17 years. Participants were sampled from the 2005 and 2007 California Health Interview Surveys.

Using a geospatial processing program, the researchers measured neighborhood food environments by drawing buffers with four separate radii (0.1, 0.5, 1, and 1.5 miles) centered on participants’ residences and schools. After locating food outlets such as fast food restaurants, convenience stores, midsize grocery stores, and large supermarkets, the researchers layered those store locations over the buffers to create a picture…

Computer Therapy Found Effective Treatment for Depression in Adolescents

Computer-based cognitive-behavioral therapy was found to be as effective as treatment from a clinician for treatment of depression in adolescents, according to a study.

SPARX (Smart, Positive, Active, Realistic, X-factor thoughts) is a therapeutic fantasy game, developed by researchers led by Sally N. Merry, PhD, at the University of Auckland in New Zealand. The game offers cognitive-behavioral therapy (CBT) treatments through first-person instruction.

In it, the patient selects an “avatar” (an alter ego) and performs a series of challenges in a 3-D environment to “restore balance in a fantasy world dominated by GNATs (Gloomy Negative Automatic Thoughts),” according to Merry and her team. Researchers randomly assigned 187 participants, aged 12 to 19 years, to either use SPARX (n=194); or, to work with a therapist in a clinical setting (n=93). All patients were seeking help for depression, deemed in need of treatment by their primary care clinicians, and were not at major risk of self-harm. Patients assigned to SPARX completed seven levels of the game. At the beginning and end of each level a “guide” would help patients conceptualize their progress, such as dealing with emotions, overcoming problems, recognizing helpful thoughts compared to challenging, unhelpful thoughts. Researchers evaluated the primary treatment outcomes of SPARX patients and those assigned to usual treatment using the revised Children’s Depression Rating Scale (CDRS-R). Secondary outcomes were measured using the second edition Reynolds Adolescent Depression Scale (RADS-2) and other screening tools.

At post-intervention, there was a mean reduction of 10.32 in SPARX patients and 7.59 in those assigned to usual treatment, as measured by the CDRS-R (between group difference, 2.73; 95% CI, −0.31 to 5.77). Remission rates were significantly higher among SPARX patients (43.7%) vs. patients attending usual treatment (26.4%), according to the researchers (difference, 17.3%; 95% CI, 1.6–31.8). Response rates between the two groups were comparable.

“I am excited about our results,” Merry told Pediatric Annals, in an interview. “So many young people with depression never get help with it. Many young people don’t want to talk to a therapist, and for those that do, a therapist is not always available. SPARX provides a way to get help for young people that is readily accessible for those who have access to a computer, and can be done at a time and place that suits them.”

Merry SN. BMJ. 2012;doi:10.1136/bmj.e2598.

Existence of ‘Food Deserts’ Questioned

Although policymakers and federal organizations such as the White House Childhood Obesity Task Force and the CDC have argued that improving access to supermarkets while reducing access to fast food restaurants and convenience stores are an important step to combating childhood obesity, RAND Corporation researchers Ruopeng An, MPP, and Roland Strum, PhD, have found little evidence to support these claims.

“Recently, the notion of a ‘food desert’ is widely cited in media and in shaping public health policies, despite the mixed results from previous studies,” An told Pediatric Annals in an interview. “We thus decided to use a large state representative survey data with precise geographical information for survey participants to test the ‘food desert’ hypothesis.”

The researchers analyzed survey data on the self-reported heights, weights, and diets of 8,226 children aged 5 to 11 years, and 5,236 adolescents aged 12 to 17 years. Participants were sampled from the 2005 and 2007 California Health Interview Surveys.

Using a geospatial processing program, the researchers measured neighborhood food environments by drawing buffers with four separate radii (0.1, 0.5, 1, and 1.5 miles) centered on participants’ residences and schools. After locating food outlets such as fast food restaurants, convenience stores, midsize grocery stores, and large supermarkets, the researchers layered those store locations over the buffers to create a picture of available food locations within participants’ walking distance.

The researchers found no evidence to support the hypothesis that greater access to fast food restaurants versus the number of supermarkets within walking distance affected diet and obesity among children and adolescents.

According to An, despite using several different measures and a large representative data set, “There was no robust relationship between the food environment and a youth’s diet or obesity. There are some isolated effects, but most probably due to chance.”

An recommended other potential interventions that may be effective in combating childhood obesity:

  • Free fruits and vegetables at school.
  • Low-calorie snacks and beverages offered at reduced prices in the school vending machines.
  • Healthy food vouchers or supermarket price discounts for qualifying parents.
  • Promotion of farmers’ markets in low income neighborhoods.
  • High taxes on unhealthy foods to subsidize more wholesome food purchases, such as produce.

“There is also evidence that a combination of those strategies may provide better outcomes,” An said.

An R. Am J Prev Med. 2012;42:129–135.

Back-to-Sleep Campaign Against SIDS a Success

Launched nearly 20 years ago, the Back-to-Sleep campaign has altered the risk profile of sudden infant death syndrome, according to recent study results.

The San Diego SIDS/Sudden Unexplained Death in Childhood Research Project recorded risk factors for 568 sudden infant death syndrome (SIDS) incidents from 1991 to 2008. The risk factors were based upon standardized death scene investigations and autopsies, and divided into intrinsic and extrinsic categories.

Created by the National Institute of Child Health and Development, BTS was designed to educate parents and caregivers on the risks associated with SIDS. Researcher Felicia L. Trachtenberg, PhD, of New England Research Institutes, Watertown, MA., and colleagues wrote that BTS was a “spectacular achievement,” reducing the SIDS rate in the United States by almost 50% in the 10 years after the campaign’s initiation. Since 2004, however, the SIDS rate has reached a plateau, and SIDS remains the leading cause of postneonatal infant mortality in the United States, with an overall incidence of 0.53 deaths per 1,000 births.

Researchers examined cases from 1991 to 1993, before the Back-to-Sleep (BTS) campaign was initiated in 1994, and from 1996 to 2008. They discovered the number of SIDS infants found prone — a risk factor emphasized by the BTS campaign — had decreased from 84% to 48.5% (P<.001). However, bed sharing at the time of death, especially among infants aged younger than 2 months, increased from 19.2% to 37.9% (P<.001), and the percentage of SIDS infants found in adult beds increased from 23.4% to 45.4% (P<.001). The prematurity rate increased from 20% to 29% (P=.05), but upper respiratory tract infection symptoms decreased from 46.6% to 24.8% (P<.001).

“Risk reduction campaigns emphasizing the importance of avoiding multiple and simultaneous SIDS risks are essential to prevent SIDS, including among infants who may already be vulnerable,” Trachtenberg wrote.

Trachtenberg FL. Pediatrics. 2012;129:630–638.

Disclosure: Dr. Trachtenberg reports no relevant financial disclosures. The study was funded by the CJ Foundation for SIDS, First Candle/SIDS Alliance, the Southwest SIDS Research Institute, and the National Institute of Child Health and Development grant HD-20991 to Hannah C. Kinney, MD.

Check List ☑

A cool dip on a hot day is not necessarily good, clean fun. According to the CDC, fecal contamination of recreational water is common.

“Swimming is communal bathing,” said Michael J. Beach, PhD, Associate Director for Healthy Water in the CDC’s National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), speaking at the Infectious Diseases in Children Symposium 2011. “You wouldn’t drink your bathwater, so why would you drink the water you and others swim in?”

Beach’s presentation, Diseases from the Neighborhood Pool: What Health Care Providers, Parents, and Swimmers Need to Know, notes that children are not the only ones to drink the water when they swim. In an approximately 45 minute swim, the average amount of water swallowed by non-adults is 1.3 fluid ounces (average range in mL, 0–154). In the same amount of time, adults swallow, on average, 0.5 fluid ounces (average range in mL, 0–53).

Public bathing facilities, according to data presented by Beach, are rife with pathogens not only from children in diapers, but from other “fecal incidents” including swimmers “forming stools” while in the water; and fecal matter on the peri-anal surface of public bathers [Range: 0.01 g (adults) to 10 g (children)].

CDC Tips for Clinicians:

  • ☑ Ova and parasite testing might not include testing for Cryptosporidium.

  • ☑ Nitazoxanide can be used to treat cryptosporidiosis in immunocompetent patients under 1 year of age.

  • ☑ Waterborne disease outbreaks and cryptosporidiosis are case reportable in 50 states, New York City, and the District of Columbia.

CDC Tips for Swimmers:

  • ☑ People with diarrhea should avoid recreational water activities: After cessation of diarrhea: Patients with Cryptosporidium should wait an additional 2 weeks; Patients with other waterborne pathogens should wait 1 additional week. This includes swim team members.

  • ☑ Avoid ingestion of recreational water.

  • ☑ Practice good swimming hygiene: Shower with soap and water before entering water; Take bathroom breaks/check diapers often; Wash hands after using toilet/changing diapers.

For more information: cdc.gov/healthywater/swimming

Trend Watch written by Whitney McKnight and John Schoen.


Authors

10.3928/00904481-20120525-02

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