In Canada, the primary cause of mortality in infancy and long-term disability in children is being born at very low birth weight (<1500g or <3.3lbs; Saigal & Doyle, 2008). If these infants are fed their mother’s milk in the neonatal intensive care unit (NICU) they experience fewer severe infections (Hylander, Strobino, & Dhanireddy, 1998; Patel et al., 2013), improved feeding tolerance (Schanler, Shulman, & Lau, 1999; Sisk, Lovelady, Gruber, Dillard, & O’Shea, 2008), lower colonization of pathogenic bacteria (Yoshioka, Iseki, & Fujita, 1983), and increased neurocognitive development (Anderson, Johnstone, & Remley, 1999). However, due to many reasons related to preterm birth, as many as 70% of mothers cannot provide a sufficient amount of breastmilk to meet the demands of these infants, therefore, a supplement is necessary (Callen & Pinelli, 2005). Currently in Canada, either pasteurized donor breastmilk (donor milk) or preterm formula is used as a supplement to mother’s milk.
If you were asked “how much weight should a woman gain during pregnancy?” you might posit a guess around 15 or 20 pounds. In reality, it’s not that simple. The amount depends on her pre-pregnancy body mass index (BMI). As such, in 2009, The Institute of Medicine (IOM) released gestational weight gain recommendations for each BMI category (Table 1). These recommendations were published to promote adequate foetal growth and reduce the risk of adverse pregnancy outcomes (Rasmussen & Yaktine, 2013). Total recommended weight gain during pregnancy ranges from 28-40 pounds for underweight women and 11-20 pounds for obese women (Rasmussen & Yaktine, 2013). However, many women are not meeting these guidelines and 58% of Canadian women are surpassing them (Ferraro et al., 2012). Currently, obesity is recognized as a global public health concern with no signs of slowing down (NCD Risk Factor Collaboration, 2016). Is gestational weight gain a contributing factor?
In May 2015, the Zika virus infiltrated Brazil (Higgs, 2016). Since then, autochthonous transmission of the virus has been confirmed in 19 other countries in the Americas (Hennessey, 2016). By October 2015, almost 4,000 cases of microcephaly were identified; a sharp increase from the previous year, in which fewer than 150 cases were diagnosed in all of 2014 (Dyer, 2016b). Although a causal link between the Zika virus and microcephaly has not yet been established, the circumstantial evidence is alarmingly suggestive (Torjesen, 2016). With no vaccine or treatment available, concern over the spread and effects of the disease is rapidly increasing.
Poverty in Canada
Compared to other affluent countries, Canada has low rates of public spending and high child poverty rates, and has received several UN reprimands for failing to improve child and family poverty1,2. Though estimates vary, poverty affects approximately three million Canadians, 20% (or 600,000) of whom are children3. It is believed that around 15% of children, almost one in six, live below poverty thresholds4,5. Meanwhile, child poverty rates in Ontario lie around 14%, suggesting that almost 19,000 children are born into low-income families every year6,7. Perhaps most disappointingly, this is not a new, or unrecognized problem. In 1989, recognizing the high child poverty rates in Canada, the Canadian House of Commons voted unanimously to eliminate child poverty by 20008; this was followed shortly after by Canada’s ratification of the UN Convention on the Rights of the Child in 1991. However, almost 25 years after this original motion was passed, some argue that the situation has deteriorated rather than improved9.
Methylphenidate (Ritalin), the current leading form of treatment for Attention Deficit Hyperactivity Disorder (ADHD), has seen a dramatic increase in prescription rate over the past ten years. No contemporary biological basis for ADHD diagnosis results in physicians making their diagnoses based on behavioural symptoms such as hyperactivity and inability to focus. Considering that these symptoms are behaviours that anyone may express at one point in their life, the risk of over-diagnosis of the disease increases. This may subsequently lead to over-prescription of Ritalin. This paper aims to evaluate and identify the causes and effects of Ritalin over-prescription. Key literature on ADHD reveals that the diagnostic criteria for ADHD has undergone various modifications since the disease was first identified; therefore, different experts may have different opinions on what are regarded as symptoms of the disorder. Furthermore, recent research has demonstrated that Ritalin can increase cognitive performance in both healthy individuals and in ADHD patients. Such data indicates that Ritalin has the potential to be abused by healthy individuals looking to increase their cognitive performance. Correspondingly, Ritalin has been reported to be used by college students to boost their academic performance. In addition, the over-prescription of Ritalin raises several ethical issues: as children are the most common age group to be diagnosed with the disease, critics question whether prescribing a drug for a behaviourally based diagnosed disease is appropriate; also it is thought that the drug may affect the originality and creativity of the children which may hinder their personal development. While alternative behavioural therapy is available for the disorder, it tends to be more expensive and time consuming than a drug prescription; this may explain why Ritalin remains the dominant form of treatment. This paper concludes that the prescription of drugs for ADHD should be cautioned and that more time and resources should be invested on developing consistent diagnostic criteria as well as potential alternative treatments to drugs for the disorder.
Author: Maria A. CZERNIAKOW
Atopic Dermatitis (AD) is a psychologically debilitating disease due to its embarrassing skin lesions and pruritic nature which disturb the quality of life (QOL) of the patients. Even though children are primarily affected, caregivers can also be affected due to being the first line of care for others who are inflicted. This review focuses on randomized control trials which investigated the use of non-chemical forms of treatment to improve QOL and disease severity in children. A search of the PubMed database identified six studies that met the inclusion criteria. The studies were ranked from most rigorous trial to least. Various forms of education as an intervention were used. Conversely the viewing of a humorous film was tested to examine if it had an impact on QOL. Education intervention versus no education at all showed that the intervention group had a larger decrease in disease severity than the control group. The form of education as a single consult with an AD educated nurse showed no difference between the control and the intervention group. Comparison of nurse-led clinics with the dermatologist-led clinics indicated that the nurse-led clinics were more successful. Viewing humorous films before bedtime was demonstrated as a successful means of reducing night-time awakenings. Also specific AD education versus routine education and consultations showed improvement in both groups. Finally AD video-education versus direct parental teaching concluded that the video-education was more effective. Although the studies show that any form of education intervention is better than none, the methodological assessment of the studies showed that four of the studies were not rigorous enough or were not described at all. Further studies must be conducted in a more methodologically sound manner for the results to be considered replicable and valid.