News in brief - April 21, 2003

Men get depressed, too, NIMH reports - Increased use of broad-spectrum antibiotics adds to resistance risk - Forced reporting of seizures bad for doctor-patient relationship - Botulinum toxin improves quality of life for kids with cerebral palsy

Men get depressed, too, NIMH reports

The National Institute of Mental Health launched an educational campaign to educate men about the symptoms of depression and urge them to seek help if needed. The campaign -- "Real men. Real depression." -- features personal stories from men who live with the illness.

Women are twice as likely as men to have depression. Men, however, are four times as likely to die from suicide, and are far less likely to seek help for any medical condition, whether mental or physical.

"For generations men have been told that they have to act tough," said U.S. Surgeon General Richard Carmona, MD. "Today we're saying to men, it's OK to talk to someone about what you're thinking, or how you're feeling, or if you're hurting. We are attacking the stigma that tough guys can't seek help."

Increased use of broad-spectrum antibiotics adds to resistance risk

A survey of community-based physicians shows that while fewer prescriptions are being written for antibiotics, physicians are increasingly prescribing expensive, broad-spectrum antibiotics -- even when there is little clinical rationale for their use.

The study determined that the total number of antibiotic prescriptions per year changed from 230 million prescriptions in 1991-1992 to 190 million prescriptions in 1998-1999. However, the use of broad-spectrum agents increased across a range of adult and pediatric age groups, according to the study published in the April Annals of Internal Medicine.

When community-based physicians decide to prescribe an antibiotic, they increasingly turn to such agents as azithromycin, clarithromycin, quinolones and amoxicillin-clavulanate. They have also maintained steady use of second- and third-generation cephalosporins, the study found.

For many non-pneumonic acute respiratory tract infections, broad-spectrum antibiotics provide little clinical advantage over narrow-spectrum agents or no antibiotic therapy at all, the study noted. However, these are the conditions for which broad-spectrum agents are most often used.

The growing problem of antibiotic resistance has led infectious disease experts to urge caution in the prescribing of antibiotics. The study authors note that the drop in the number of prescriptions for antibiotics, particularly for illnesses for which they have limited benefit, such as upper respiratory tract infections and acute bronchitis, may reflect this advice.

But the increased use of broad-spectrum antibiotics could also promote escalating antimicrobial resistance to these agents, the researchers caution.

Forced reporting of seizures bad for doctor-patient relationship

State-mandated reporting of seizures leads some patients to withhold medical information from their doctors and negatively affects relationships with physicians, according to a study presented at the American Academy of Neurology meeting this month in Hawaii.

Researchers at Stanford University in California anonymously surveyed more than 200 patients visiting the epilepsy clinic. They found that nearly one-fifth had either concealed or considered concealing seizure information from their doctors. Thirteen percent also said that their relationship with their doctors had been adversely affected by the mandatory reporting law.

"This is dangerous because if doctors don't know that their patients are having seizures, they can't work with them to alter their medications to control the seizures," said Kamala Rodrigues, MD, an Ann Arbor, Mich., neurologist, who conducted the study while a resident at Stanford. "The law was designed with the assumption that it would protect public safety, but there's no evidence to prove that assumption is true. The study shows that mandatory reporting may lead to more uncontrolled seizures, which could be a greater risk to the public."

Nearly 80% of patients said they would stop driving if they had a seizure, with or without the mandatory reporting law.

California is one of six states that requires doctors to report loss of consciousness episodes to the health department.

Botulinum toxin improves quality of life for kids with cerebral palsy

Children with cerebral palsy have shown long-term improvement when treated with botulinum toxin, according to research presented during this month's American Academy of Neurology annual meeting.

Children treated with the drug had improvements ranging from making voluntary movements for the first time, to improved stance and walking, according to the study's lead author, Marc P. DiFazio, MD, a neurologist at Walter Reed Army Medical Center in Washington, D.C.

The study involved 250 children, ages 1 to 16, who all received botulinum toxin. Of those, 206 children had repeated treatments and 148 were followed for an average of two years.

Eighty-six percent of the children had notable lessening of muscle spasticity after the injections, as measured by videotape analysis, physician evaluation, spasticity rating scales and the response of families.

Side effects from the drug were mild and uncommon, said Dr. DiFazio.