Diagnosis and management of ADHD: a pediatric perspective on practice and challenges in Switzerland

BACKGROUND

Attention deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders in childhood. In Switzerland, the complex diagnosis and treatment are being carried out by adolescent-/child psychiatrists, and pediatricians. Guidelines recommend a multimodal therapy for patients with ADHD. However, it has been questioned whether health professionals follow this approach or favor drug therapy. This study aims to provide insights into the practice of pediatricians in Switzerland regarding diagnosis and treatment of ADHD and their perceptions of these processes.

METHOD

An online survey (self-report) about current practices of diagnosis and management as well as challenges regarding ADHD was distributed to office-based pediatricians in Switzerland. One hundred fifty-one pediatricians participated. Results show that therapy options were almost always discussed with parents and older children. Exchange with parents (81%) and level of child's suffering (97%) were central when selecting therapy options.

RESULTS

Therapies about which pediatricians informed most often were: pharmacological therapy, psychotherapy, and multimodal therapy. Challenges voiced were the subjectivity of diagnostic criteria and dependence on third parties, low availability of psychotherapy, and a rather negative public attitude towards ADHD. Needs that were expressed were further education for all professionals, support for coordination with specialists and schools as well as improvement of information on ADHD.

CONCLUSIONS

Pediatricians do consider a multimodal approach when treating ADHD and take the families` and children's opinions into account. Improvements of the availability of child and youth psychotherapy, the strengthening of the interprofessional cooperation with therapists and schools, and efforts to increase public knowledge about ADHD are proposed.

Migration of aluminum from food contact materials to food-a health risk for consumers? Part I of III: exposure to aluminum, release of aluminum, tolerable weekly intake (TWI), toxicological effects of aluminum, study design, and methods

BACKGROUND

In spite of the prevalence of aluminum in nature, no organism has been found to date which requires this element for its biological functions. The possible health risks to human beings resulting from uptake of aluminum include detrimental effects to the hemopoietic system, the nervous system and bones. Aluminum is used in many fields and occurs in numerous foodstuffs. Food contact materials containing aluminum represent an anthropogenic source of dietary aluminum.

RESULTS

As a result of their frequent use in private households a study was undertaken to detect migration of this metal to foodstuffs from drink containers, coffee pots, grill pans, and camping cookware made of aluminum.

CONCLUSIONS

An estimate of the health risk to consumers is calculated, based on the tolerable weekly intake (TWI) specified by the European Food Safety Authority of 1 mg/kg body weight for all groups of people. In some instances the TWI is significantly exceeded, dependent upon the food contact material and the food itself.

Migration of aluminum from food contact materials to food-a health risk for consumers? Part III of III: migration of aluminum to food from camping dishes and utensils made of aluminum

BACKGROUND

When cooking on a barbecue grill, consumers often use aluminum grill pans. For one, the pan catches the fats and oils that would drip into the embers causing the formation of potentially noxious smoke, and the pan also protects the food from being burned by direct heat from the coals. In addition, new aluminum products for use in ovens and grills are becoming increasingly popular. Due to their light weight and excellent heat transfer camping, utensils made of aluminum are, for example, often used by fishermen and mountain climbers. Preparing food in aluminum utensils can, however, result in migration of the aluminum to the foodstuffs.

RESULTS/CONCLUSIONS

In this study presented here, it was found that the transfer limit of 5.00 mg/L for aluminum is not exceeded using simulants for oil or for tap water; however, with an aqueous solution of 0.5% citric acid, the limit is clearly exceeded at 638 mg/L. This means that the Tolerable Weekly Intake (TWI) is exceeded by 298% for a child weighing 15 kg and for an adult weighing 70 kg it is equivalent to 63.8% of the TWI, assuming a daily uptake of 10 mL marinade containing lemon juice over a period of 1 week. Preparation of a fish dish with a marinade containing lemon juice in camping dishes would result in the TWI being exceeded by 871% for a child weighing 15 kg and by 187% for an adult weighing 70 kg assuming a daily uptake of 250 g over a period of 1 week.

Migration of aluminum from food contact materials to food-a health risk for consumers? Part II of III: migration of aluminum from drinking bottles and moka pots made of aluminum to beverages

BACKGROUND

Drinking bottles and stove-top moka pots made of aluminum have become very popular. Storing drinks in bottles and preparing coffee in a moka pot may result in the migration of aluminum to the beverage.

RESULTS/CONCLUSIONS

In a systematic study of aluminum drinking bottles, it has been shown that drinking a mixture of apple juice and mineral water in an aluminum bottle may reach 86.6% of the total weekly intake (TWI) for adults, and drinking tea from an aluminum bottle may exceed the TWI (145%) for a child weighing 15 kg. In contrast, preparing coffee in an aluminum moka pot results in a maximum of 4% to TWI, if an average of 3.17 L coffee is consumed per week, even if the pots are washed in the dishwasher, against the explicit instructions of the manufacturer.

Depression in primary care. Why do we miss the diagnosis?

Depressed patients are often undiagnosed, misdiagnosed, or underdiagnosed. Is this because family physicians are trained mainly to treat somatic complaints? Are patients reluctant to accept psychological causes for their physical symptoms? High volume of patients and short visits make it difficult for doctors to recognize depression. We propose strategies for identifying depressed patients in primary care.

The role of stress in interpreting the dexamethasone suppression test

Stress has been implicated as a major confounding factor in the interpretation of Dexamethasone Suppression Test (DST) results. This study was designed to examine the effects of stress on DST results. Fifty patients with high levels of acute, chronic, and environmental stress participated in the study. Each patient was given a comprehensive psychiatric and psychological assessment, a routine administration of dexamethasone, and blood tests of cortisol values. The results indicate that the three measures of stress do not appear to affect levels of cortisol suppression, however, all three measures of stress predicted depression. As expected, DST cortisol levels were related to depression. Results are discussed in terms of their implications for understanding the associations among stress, depression and DST results.