Remission and Recovery in the Treatment for Adolescents With Depression Study (TADS): Acute and Long-Term Outcomes

ObjectiveWe examine remission rate probabilities, recovery rates, and residual symptoms across 36 weeks in the Treatment for Adolescents with Depression Study (TADS).MethodThe TADS, a multisite clinical trial, randomized 439 adolescents with major depressive disorder to 12 weeks of treatment with fluoxetine, cognitive–behavioral therapy, their combination, or pill placebo. The pill placebo group, treated openly after week 12, was not included in the subsequent analyses. Treatment differences in remission rates and probabilities of remission over time are compared. Recovery rates in remitters at weeks 12 (acute phase remitters) and 18 (continuation phase remitters) are summarized. We also examined whether residual symptoms at the end of 12 weeks of acute treatment predicted later remission.ResultsAt week 36, the estimated remission rates for intention-to-treat cases were as follows: combination, 60%; fluoxetine, 55%; cognitive–behavioral therapy, 64%; and overall, 60%. Paired comparisons reveal that, at week 24, all active treatments converge on remission outcomes. The recovery rate at week 36 was 65% for acute phase remitters and 71% for continuation phase remitters, with no significant between-treatment differences in recovery rates. Residual symptoms at the end of acute treatment predicted failure to achieve remission at weeks 18 and 36.ConclusionsMost depressed adolescents in all three treatment modalities achieved remission at the end of 9 months of treatment.     

The development of a research human milk bank.

Although there are well-established clinical human milk banks in the United States, there are no milk banks specifically intended to foster research on human milk. The authors' goal was to establish a milk bank with a core data set to support exploratory and hypothesis-driven studies on human milk. Donations to the Cincinnati Children's Research Human Milk Bank are accepted within the context of ongoing, hypothesis-driven research or on an ad hoc basis. Donors must give informed consent, and scientists wishing to use the samples must have Institutional review board approval for their use. Development of more research human milk banks can potentially provide resources for multidisciplinary collaboration and advance the study of human milk and lactation.     

Breast pump adverse events: reports to the food and drug administration.

Breast pumps are medical devices used to express milk and maintain the milk supply. The purpose of this study was to characterize adverse events reported to the United States Food and Drug Administration (FDA) on breast pumps. Thirty-seven adverse event reports on breast pumps were identified from the Manufacturer and User Facility Device Experience database between 1992 and 2003. Four additional reports were found in the Device Experience Network database from 1992 to 1996. The most commonly reported adverse events for electric breast pumps were pain, soreness, or discomfort; the need for medical intervention; and breast tissue damage. Most frequently reported problems for manual breast pumps were breast tissue damage and infection. Contamination of breast milk during pumping was also reported. Breast pump adverse events are likely underreported to the FDA. Reporting adverse events is important for improving the design and manufacture of breast pumps and subsequently decreasing adverse events.     

An ounce of prevention ... STDs and women's health

Using recent data from the U.S., the argument is reiterated that sexually transmitted diseases (STDs) have serious consequences on female morbidity, mortality, pregnancy outcome and that the cost of screening and treatment can afford significant savings. Since the rosy view of the 1950s that STDs had been eliminated with penicillin, new viral, parasitic and bacterial forms have emerged, and antibiotic-resistant classical STDs have increased yearly. 13 million new cases were reported in 1989, excluding non-reportable diseases and asymptomatic infections, such as over half of chlamydia cases. Mortality is possible from STDs, most notably from AIDS, now among the top 5 causes of death of women aged 15-44. Other fatal outcomes are cervical cancer related to human papilloma virus, accelerated by HIV, pelvic inflammatory diseases (PID) its consequences, ectopic pregnancy. Symptomatic PID affects 1 million women, resulting in 210,000 hospitalizations per year. Ectopic pregnancy accounts for 12% of maternal mortality. STDs are involved in neonatal infections with HIV, syphilis, gonorrhea, chlamydia, cytomegalovirus, and herpes. Chorioamnionitis, a finding in many miscarriages, is caused by many of the same organisms. Several studies have projected sizeable potential savings, even within the current year, by providing STD screening and treatment in family planning clinics and prenatal care, in terms of prevention of hospitalization of women, and intensive care for low birth weight, premature and infected newborns.