Vaccine Preventable Infections Common After Pediatric Organ Transplantation

MedicalResearch.com Interview with:

Amy G. Feldman, MD, MSCS Assistant Professor, Pediatrics-Gastroenterology, Hepatology and Nutrition Program Director, Liver Transplant Fellowship Children's Hospital Colorado  University of Colorado Medicine

Dr. Feldman

Amy G. Feldman, MD, MSCS
Assistant Professor, Pediatrics-Gastroenterology, Hepatology and Nutrition
Program Director, Liver Transplant Fellowship
Children’s Hospital Colorado
University of Colorado Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Pediatric solid organ transplant recipients are at increased risk for vaccine preventable infections due to life-long immunosuppressive medications.  The objectives of this study were to 1) evaluate in pediatric    solid organ transplant recipients the number of hospitalizations for vaccine-preventable infections in the first five years post-transplantation and 2) determine the associated morbidity, mortality and costs.

In this multicenter cohort study of 6980 children who underwent solid organ transplantation from January 1, 2004, to December 31, 2011, at a center participating in Pediatric Health Information System (PHIS), 15% of individuals had at least 1 hospitalization for a vaccine-preventable infection in the first 5 years after transplant.  Children who received transplants when they were younger than 2 years and recipients of lung, intestine, heart, and multi-visceral organs were at increased risk for hospitalization with a vaccine-preventable infection.  Transplant hospitalizations complicated by a vaccine-preventable infection were $120,498 more expensive (median cost) and were on average 39 days longer than transplant hospitalizations not complicated by vaccine-preventable infections Continue reading

Group B Streptococcus Remain Significant Threat to US Infants

MedicalResearch.com Interview with:

Dr. Nanduri Srinivas Acharya, MBBS, MD, MPH Respiratory Diseases Branch, National Center for Immunizations and Respiratory Diseases Centers for Disease Control and Prevention Roybal Campus Atlanta, GA 30333

Dr. Nanduri

Dr. Srinivas Acharya Nanduri, MBBS, MD, MPH
Respiratory Diseases Branch, National Center for Immunizations and Respiratory Diseases
Centers for Disease Control and Prevention
Roybal Campus
Atlanta, GA 3033

MedicalResearch.com: What is the background for this study?

Response: Group B Streptococcus (GBS) is a leading cause of serious illness such as meningitis and sepsis in infants. Among infants, there are two main types of GBS disease. Early-onset GBS disease occurs during the first week of life and late-onset GBS disease occurs from the first week through three months of life. Rates of early-onset disease in the United States have decreased significantly since the 1990s through widespread implementation of intrapartum antibiotic prophylaxis (IAP) guidelines. However, IAP does not prevent late-onset disease. Maternal immunization represents a nonantibiotic strategy to prevent both early and late-onset disease. Multivalent polysaccharide-protein conjugate vaccines are under development against GBS capsular types, with candidate vaccines in phase I and II trials.

Active Bacterial Core surveillance (ABCs) conducts active surveillance for early and late-onset GBS disease among infants in select counties of 10 states, covering about 10% of live births across the United States. We analyzed data from early and late-onset GBS cases identified from ABCs between 2006 and 2015 to describe their epidemiology, incidence trends, and associated strain characteristics. Continue reading

Mental Illness Risk Increased in Young Onset Diabetes

MedicalResearch.com Interview with:

Juliana CN Chan MD Chair Professor of Medicine and Therapeutics Head, Division of Clinical Pharmacology, Department of Medicine and Therapeutics Director, Hong Kong Institute of Diabetes and Obesity Director, Clinical Research Management Office Faculty of Medicine The Chinese University of Hong Kong

Dr. Chan

Juliana CN Chan MD
Chair Professor of Medicine and Therapeutics
Head, Division of Clinical Pharmacology, Department of Medicine and Therapeutics
Director, Hong Kong Institute of Diabetes and Obesity
Director, Clinical Research Management Office
Faculty of Medicine
The Chinese University of Hong Kong

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The prevalence of young onset diabetes (YOD) is increasing world-wide with doubling of its prevalence in the last 10 years in many developed nations. Using the Hong Kong Diabetes Register established since 1995, we first reported that 1 in 5 Chinese adults with diabetes were diagnosed before the age of 40 years. These young patients had poor control of multiple risk factors with 1.5 fold higher risk of premature death and cardiovascular-renal complications compared to patients with usual onset of diabetes after the age of 40 (Chan JC et al AJM 2014, Luk A et al Diabetes Care 2014). Due to the multisystem nature of diabetes, we asked the question whether these young patients might have recurrent hospitalizations during their 3-4 decades of complex clinical course.

Using a territory-wide diabetes database involving 0.42 million people followed up between 2002 and 2014, we compared the hospitalization rates accrued till the age of 75 years and found that patients with young onset diabetes had the highest hospitalization rates by attained age. Compared to patients with usual onset of diabetes, patients with YOD had 1.8- 6.7 higher risk of hospitalizations due to all-causes, notably renal disease compared to those with usual onset of disease.

Amongst patients with young onset diabetes, over one-third of the bed-days were due to mental illness before the age of 40 years. We used mathematical modeling and estimated that intensified risk factor control in YOD can reduce the cumulative bed-days by 30% which can be further reduced by delaying the onset of diabetes. These original data is a wakening call to the community regarding the complex nature of YOD involving interactions amongst environment, lifestyles and personal factors (e.g. genetics, education and socioeconomic status) and the biomedical-psychological-behavioral needs of these high risk population, which if undiagnosed, untreated or suboptimally managed, can have huge economic impacts on health care system and loss of societal productivity, leaving personal suffering aside. Continue reading

Maternal Obesity Raises Risk of Congenital Heart Defects

MedicalResearch.com Interview with:

Martina Persson, M.D, PhD Karolinska Institutet

Dr. Persson

Martina Persson, M.D, PhD
Karolinska Institute

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It is well known that maternal obesity increases risks of adverse fetal outcomes, including congenital malformations of the heart. However, it is unclear if maternal overweight and obesity associate with risks of specific and more complex congenital heart defects. We conducted a population-based cohort study in Sweden using data from several health registries. The study included more than 2 million live, singletons born between 1992-2012. Risks (prevalence rate ratios) of complex heart defects (Tetralogy of Fallot, transposition of the great arteries (TGA), atrial septal defects (ASD), aortic arch defects, and single ventricle heart) and several specific heart defects were estimated in infants to mothers with overweight and increasing degree of obesity.

We found that risks of aortic arch defects, ASD and patent ductus arteriosus (in term infants) increased with maternal obesity severity. On the other hand, we found no clear associations between maternal BMI and risks of several other complex and specific heart defects.  Continue reading

Obesity in Childhood Adversely Impacts Lung Development

MedicalResearch.com Interview with:

Judith Garcia Aymerich Head of the Non-Communicable Diseases and Environment Programme ISGlobal 

Dr. Garcia-Aymerich

Judith Garcia Aymerich
Head of the Non-Communicable Diseases and Environment Programme
ISGlobal 

MedicalResearch.com: What is the background for this study?

Response: Several studies have assessed the associations of overweight and obesity with lung function in children and adolescents, but they have found contradictory results. An important limitation of these studies is that most of them considered only overall body weight and did not take into account for the different contribution of lean body mass and fat mass, and their relative proportions that vary by age and sex. Continue reading

Breastfeeding Linked With Right Handedness

MedicalResearch.com Interview with:

PHILIPPE P. HUJOEL PhD, DDS, MSD, MS Professor, Oral Health Sciences Adjunct Professor, Epidemiology Adjunct Professor, Periodontics Dental Public Health Sciences, School of Dentistry University of Washington

Dr. Hujoel

PHILIPPE P. HUJOEL PhD, DDS, MSD, MS
Professor, Oral Health Sciences
Adjunct Professor, Epidemiology
Adjunct Professor, Periodontics
Dental Public Health Sciences, School of Dentistry
University of Washington

MedicalResearch.com: What is the background for this study?

Response: In 2012, an economist, Kevin Denny, identified an association between breastfeeding and handedness.  The newly published study attempted to refute this association in a larger population, and with more control for potential confounding variables.

Continue reading

Teen E-Cigarette Use Drives Flavored Tobacco Sales

MedicalResearch.com Interview with:

Dr. Hongying Dai, PhD Associate Professor at the College of Public Health University of Nebraska Medical Center.

Dr. Dai

Dr. Hongying Dai, PhD
Associate Professor at the College of Public Health
University of Nebraska Medical Center.

MedicalResearch.com: What is the background for this study?

Response: The 2009 Family Smoking Prevention and Tobacco Control Act (FSPTCA) banned cigarettes with characterizing flavors (e.g., candy, fruit, clove) except menthol. However, there are no restrictions on the marketing and sales of flavored non-cigarette tobacco products. This has led to a proliferation of flavored tobacco products in the marketplace. Flavoring has become one of the leading reasons for current tobacco use among youth. It is reported that 81% of e-cigarette users, 79% of hookah users, 74% of cigar users, 69% of smokeless tobacco users, and 67% of snus users attributed the availability of appealing flavors for their tobacco use in 2013–2014 among teenagers aged 12 to 17 years. In November 2018, the FDA proposed new restrictions on flavored tobacco products.

Continue reading

Parents: Vaping is Drawing Adolescents into Nicotine Use

MedicalResearch.com Interview with:

Richard Miech Ph.D Professor Principal Investigator, Monitoring the Future Institute for Social Research University of Michigan

Dr. Miech

Richard Miech Ph.D
Professor
Principal Investigator, Monitoring the Future
Institute for Social Research
University of Michigan

MedicalResearch.com: What is the background for this study? What are the main findings?

 Response: Every year Monitoring the Future conducts a survey to examine trends in adolescent substance use.  We draw a random sample of schools from a list of all schools in the United States and conduct our survey in ~400 schools.  Our survey is representative of U.S. 8th, 10th, and 12th grade students.  In other words, our results are what you would find if you surveyed every single 8th, 10th, and 12th graders in the United States, within the bounds of a small sampling error of a few percentage points.

An increase in vaping is the big news for 2018.  In 10th and 12th grade the increase in nicotine vaping was the largest we’ve ever seen for any substance in the past 43 years.  As a result of this increase in nicotine vaping, overall use of nicotine increased as well, which suggests that vaping is drawing youth into nicotine use.  We also saw a significant increase in marijuana vaping. Continue reading

Family Characteristics Linked to Aggressive Behaviors in Boys and Girls

MedicalResearch.com Interview with:

Dr. Richard E. Tremblay, PhD, Professor Department of Pediatrics and Department of Psychology University of Montreal, Montreal, Quebec, Canada School of Public Health, University College Dublin, Dublin, Ireland

Dr. Tremblay

Dr. Richard E. Tremblay, PhD, Professor
Department of Pediatrics and Department of Psychology
University of Montreal, Montreal, Quebec, Canada
School of Public Health, University College Dublin, Dublin, Ireland

MedicalResearch.com: What is the background for this study?  

Response: Adolescent who have frequently use physical aggression are at high risk of school failure, criminal behavior, as well as physical and mental health problems.

A major limit to preventive interventions is our ability to trace the developmental trajectories of physical aggression from infancy to adolescence using a uniform source of information.

Continue reading

Less Time in the Womb Linked to Less Education and Income in Adulthood

MedicalResearch.com Interview with
"Pregnancy 1" by operalynn is licensed under CC BY 2.0Josephine Funck Bilsteen, MSc
Department of Pediatrics, Hvidovre University Hospital, Hvidovre,
Section of Epidemiology, Department of Public Health
University of Copenhagen
Copenhagen, Denmark

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The background of this study is that there is increasing recognition of the longer-term health and social outcomes associated with preterm birth such as independent living, quality of life, self-perception and socioeconomic achievements. However, much less is known about differences in education and income among adults born at different gestational weeks in the term period.

In this study shorter gestational duration, even within the term range, was associated with lower chances of having a high personal income and having completed a secondary or tertiary education at age 28 years. This is the first study to show that adults born at 37 and 38 completed weeks of gestation had slightly lower chances of having a high income and educational level than adults born at 40 completed weeks of gestation.  Continue reading

Bone Growth Stops Earlier in Today’s Children

MedicalResearch.com Interview with:

Dana L. Duren, PhD Professor, Director of Orthopaedic Research Director of Skeletal Morphology Laboratory Thompson Laboratory for Regenerative Orthopaedics Department of Orthopaedic Surgery Missouri Orthopaedic Institute, University of Missouri Columbia, MO 6521

Dr. Duren

Dana L. Duren, PhD
Professor, Director of Orthopaedic Research
Director of Skeletal Morphology Laboratory
Thompson Laboratory for Regenerative Orthopaedics
Department of Orthopaedic Surgery
Missouri Orthopaedic Institute, University of Missouri
Columbia, MO 6521

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The motivation for this study is the apparent accelerated maturity in children in the United States.

Radiogram of distal tibia (left) and fibula (right) showing two epiphyseal plates. Wikipedia Image

Radiogram of distal tibia (left) and fibula (right) showing two epiphyseal plates.
Wikipedia Image

 

We previously demonstrated that skeletal maturity (bone age) is more advanced in today’s children compared to children born in the first half of the 20thCentury (Duren et al., 2015).

n the current study (Boeyer et al., 2018) we show that a significant component of this advanced maturity status is the timing of epiphyseal fusion. In our study, nearly half of the epiphyses of the hand and wrist began or completed fusion significantly earlier in children born after 1995 than those born in the early part of the century, with differences as great as six to ten months for some bones, and mean differences on the order of 4 months in boys and 6 months in girls.  Continue reading

Does Zofran (ondansetron) for Nausea & Vomiting Cause Birth Defects?

MedicalResearch.com Interview with:

Krista F. Huybrechts, M.S., Ph.D. Assistant Professor of Medicine at Harvard Medical School Epidemiologist in the Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital. Boston, MA 02120

Dr. Krista Huybrechts

Krista F. Huybrechts, MS PhD
Associate Professor of Medicine
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA 02120 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Pregnant women often experience nausea and vomiting, particularly during the first trimester.  Early treatment is recommended to relieve symptoms and prevent progression to hyperemesis gravidarum.  Although not formally approved for this indication, ondansetron is the most frequently prescribed treatment for nausea and vomiting in pregnancy in the US: 22% of pregnant women reportedly used ondansetron in the US in 2014. Despite this common use, the available evidence on the fetal safety of ondansetron is limited and conflicting, and the possibility of a doubling in risk of cleft palate and cardiac malformations has been raised.

We therefore evaluated the association between ondansetron exposure during the first trimester of pregnancy, the period of organogenesis, and the risk of congenital malformations in a cohort of 1,816,414,publicly insured pregnancies using the nationwide Medicaid Analytic eXtract data for 2000-2013.  A total of 88,467 women (4.9%) were exposed to ondansetron during the first trimester.  After adjusting for a broad range of potential confounding variables, we found no association with cardiac malformations (RR = 0.99; 95% CI, 0.93 – 1.06)  and congenital malformations overall (RR = 1.01; 95% CI, 0.98 – 1.05). For oral clefts, we found a 24% increase in risk (RR=1.24; 95% CI, 1.03 – 1.48), which corresponds to an absolute risk of 2.7 per 10,000 births (95% CI, 0.2 – 5.2 per 10,000 births).  These findings were consistent across sensitivity analyses, conducted to address potential misclassification and confounding bias. 

Continue reading

When Asked, Teens Frequently Report Hallucinations, Paranoia or Anxiety with Marijuana Use

MedicalResearch.com Interview with:

Sharon Levy, MD, MPH Director, Adolescent Substance Use and Addiction Program Boston Children's Hospital Associate Professor of Pediatrics Harvard Medical School

Dr. Levy

Sharon Levy, MD, MPH
Director, Adolescent Substance Use and Addiction Program
Boston Children’s Hospital
Associate Professor of Pediatrics
Harvard Medical School 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: ​For this study we analyzed data that were collected as part of a larger survey study that recruited a sample of adolescents who were coming to the doctor’s office for routine medical care.  We asked them a lot of questions about their health, school, extracurricular activities, plans for the future, substance use patterns and problems associated with use among other things.

The main finding was that among the participants who reported marijuana use in the past year, many of them, more than 40%, said that they had experienced either an hallucination, or paranoia/anxiety related to their use.

Kids who used more frequently and those who met criteria for a substance use disorder were more likely to experience these symptoms, as were those who had symptoms of depression Continue reading

How Do Pregnant Women Decide Which Foods To Avoid To Prevent Food Allergies in Their Children?

MedicalResearch.com Interview with:

Dr-Karen Robbins

Dr. Robbins

 Karen Robbins, M.D.
Allergist at Children’s National Health System 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The background is that mothers are often concerned that something they did contributed to their children developing food allergies. Many will relate that they ate a lot of one specific food allergen while pregnant, and question how this could have impacted their unborn child. We realized that we hear a lot of anecdotal stories in clinic, but were not sure how frequently mothers try to alter their diet in the hopes of preventing food allergy in their children. We also were not sure where families get information or guidance on this topic. Continue reading

Younger Siblings of Children with Autism or ADHD More Likely To Be Similarly Diagnosed

MedicalResearch.com Interview with:

Meghan Miller, Ph.D. Assistant Professor Department of Psychiatry & Behavioral Sciences UC Davis MIND Institute Sacramento, CA 95817

Dr. Miller

Meghan Miller, Ph.D.
Assistant Professor
Department of Psychiatry & Behavioral Sciences
UC Davis MIND Institute
Sacramento, CA 95817

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study evaluated within-diagnosis sibling recurrence and sibling cross-aggregation of ADHD and autism spectrum disorder among later-born siblings of diagnosed children. We specifically chose to include only families who had at least one subsequent child after the diagnosis of an older child because failing to do so could bias recurrence risk estimates.

We found that, compared to later-born siblings of non-diagnosed children, later-born siblings of children with autism were more likely to be diagnosed with autism or with ADHD. Likewise, compared to later-born siblings of non-diagnosed children, later-born siblings of children with ADHD were more likely to be diagnosed with ADHD or with autism.

Continue reading

ASH18: RNA Sequencing Identifies More Subtypes of Childhood Leukemia

MedicalResearch.com Interview with:

Charles G. Mullighan, MBBS (Hons), MSc, MD Member, St. Jude Faculty Co-Leader, Hematological Malignancies Program Medical Director, St. Jude Biorepository William E. Evans Endowed Chair St. Judes Children’s Research Hospital Memphis, TN

Dr. Mullighan

Charles G. Mullighan, MBBS (Hons), MSc, MD
Member, St. Jude Faculty
Co-Leader, Hematological Malignancies Program
Medical Director, St. Jude Biorepository
William E. Evans Endowed Chair
St. Judes Children’s Research Hospital
Memphis, TN

MedicalResearch.com: What is the background for this study?

 

Response: B-lineage acute lymphoblastic leukemia (B-ALL) is the commonest form of ALL, and the commonest childhood tumor. It is a leading cause of childhood cancer death. It consists of multiple subtypes defined by genetic alterations. These are often chromosomal translocations that deregulate oncogenes or form fusion proteins. These alterations are disease initiating events and are associated with distinct patterns of leukemic cell gene expression. Most subtypes also have additional mutations that are important for cells to become fully leukemic.

Identifying these initiating genetic changes is very important to identify patients that are likely to respond or do poorly with conventional therapy (multiagent chemotherapy). Also, some identify new opportunities for targeted therapy. However, using standard genetic testing approaches such as chromosomal cytogenetics, about 30% of B-ALL patients don’t have a subtype classifying alteration.

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Black Mothers More Likely To Think Their Sons Have ADHD

MedicalResearch.com Interview with:

George J. DuPaul, PhD Department of Education and Human Services Lehigh University

Dr. DuPaul


George J. DuPaul, PhD

Department of Education and Human Services
Lehigh University

Charles Barrett. Ph.D. School Psychologist Lehigh University

Dr. Barrett

 

Charles Barrett. Ph.D.
School Psychologist
Loudon County Virginia
Public Schools

 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Numerous studies have shown that Black children are more likely to receive ratings that are more indicative of displaying externalizing behavior difficulties, including Attention Deficit Hyperactivity Disorder (ADHD).  However, many of these studies included teachers as the informants. Consistent with most teachers in the United States, raters have typically been White females.  For this reason, it is unclear if these outcomes would exist if the rater and child shared the same racial/ethnic background. Additionally, most research in the United States that involved cross-cultural comparisons has used White and Hispanic boys.  Few empirical studies have examined differences between Black and White boys.

The present study sought to address several limitations in the field.  Most notably, cross-cultural comparisons between Black and White boys were included instead of Hispanic and White children.  Next, maternal figures, rather than teachers, were included as the informants.

The present study was developed using a similar methodology that examined Hispanic and White boys’ behavior from the perspective of Hispanic and White teachers (Dominguez de Ramirez & Shapiro, 2005). In sum, we sought to determine if there were differences in how Black and White maternal figures rated Black and White boys who were demonstrating the same level/type of behavior (i.e., sub-clinical levels of ADHD).  Notably, although the boys’ behaviors were the same, maternal ratings were not identical.

Specifically, using the ADHD Rating Scale, Fourth Edition (ARS-4), Black mothers assigned higher ratings to both Black and White boys.

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1 in 40 Children Reported By Parents To Have ASD

MedicalResearch.com Interview with:
Michael Kogan, Ph.D.

Director of the office of Epidemiology and Research
Health Resources and Services Administration’s Maternal and Child Health Bureau

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This was a study led by the Health Resources and Services Administration’s Maternal and Child Health Bureau, along with researchers from the Centers from Disease Control and Prevention, Harvard, Drexel, and George Washington Universities.  We used the 2016 National Survey of Children’s Health, a nationally representative survey of over 50,000 children that examines the health and well-being of US children, to examine the prevalence, treatment, and health care experiences of children with Autism Spectrum Disorder (ASD).

We found that 1 out of 40 children in the US were reported by their parents to have been diagnosed with Autism Spectrum Disorder.  We also found that children with ASD were significantly less likely to receive services like needed care coordination, referrals to other services, and mental health counseling – even compared to children with other emotional, behavioral or developmental disorders (EBDs).  Parents of children with ASD were also significantly more likely to report being usually or always frustrated in their attempts to get services, again compared to families of children with other EBDs. Finally, we looked at treatment patterns for children with ASD and found that 64% had received behavioral therapy in the year before the interview, and 27% had received medications to treat symptoms of irritability. 

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Wisdom Teeth Extractions Can Lead to Opioid Addiction in Adolescents and Young Adults

MedicalResearch.com Interview with:

Alan Schroeder MD Associate chief for research Division of pediatric hospital medicine Lucile Packard Children’s Hospital Stanford

Dr. Schroeder

Alan Schroeder MD
Associate Chief for Research
Division of pediatric hospital medicine
Lucile Packard Children’s Hospital Stanford

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Third molar “wisdom teeth” extractions are one of the most common surgeries performed in adolescents and young adults, but an adequate appraisal of risks and benefits is lacking. Most patients who undergo this procedure are exposed to opioids post-operatively.

We demonstrate that, for privately-insured opioid-naïve patients 16-25 years of age, exposure to opioids from a dental provider is associated with persistent use at 90-365 days in 7% of patients and a subsequent diagnosis relating to abuse in 6% of patients. In contrast persistent use and abuse were significantly lower in control patients not exposed to dental opioids (0.1% and 0.4%, respectively). The median number of pills dispensed for the initial prescriptions was 20.

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USPSTF: Interventions to Prevent Child Maltreatment

MedicalResearch.com Interview with:

Alex Kemper, M.D., M.P.H., M.S. 

Dr. Kemper

Alex Kemper, M.D., M.P.H., M.S. 

Dr. Kemper is a board-certified pediatrician and chief of the Division of Ambulatory Pediatrics at Nationwide Children’s Hospital. He is also the deputy editor of Pediatrics.

MedicalResearch.com: What is the background for this recommendation statement? What are the main findings and recommendations? 

Response: Child maltreatment, which includes abuse and neglect, is a serious health problem that affects too many children in the United States.  Abuse and neglect can have devastating health consequences, including long-term disabilities, depression, physical injury, and even death. In 2016, approximately 676,000 children were subjected to maltreatment, and more than 1,700 children died as a result.

Because this is such an important public health issue, the U.S. Preventive Services Task Force looked at the most recent evidence on whether primary care clinicians can help prevent child maltreatment and its negative consequences.

We found that, unfortunately, there is not enough evidence to recommend for or against these interventions. The Task Force is calling for more research on this important subject so that we can help prevent children from being abused and neglected.    Continue reading

Gene Expression Differences Detected in Toddlers with Autism

MedicalResearch.com Interview with:

Michael Lombardo, PhD Assistant professor of Psychology the University of Cyprus 

Dr. Lombardo

Michael Lombardo, PhD
Assistant professor of Psychology
the University of Cyprus 

MedicalResearch.com: What is the background for this study?

Response: Autism is a diagnostic label we give to children with difficulties in the areas of social-communication and restricted, repetitive stereotyped behaviors and interests. The diagnosis is made based on observations about behavior and is a consensus label, meaning that clinicians can show high degrees of agreement that a given set of behaviors is ‘autism’. But aside from the diagnostic label, there is a fair degree of heterogeneity within patients that have the diagnosis. One way in which patients are heterogeneous is with regard to early language development. Some toddlers with autism are minimally verbal, while at the other end, many toddlers with autism develop language typically. An important question to answer is whether that kind of difference in language development indicates a subtype with different underlying biology.

To examine this question, we first split toddlers with autism into two subtypes defined by their language outcome at 4 years of age. Some toddlers were classified as poor language outcome, because their language performance was 1 standard deviation below typical norms. Other toddlers with autism had relatively good language outcome, as their language performance by 4 years of age was within 1 standard deviation of typical norms.

We also measured the biology behind these two autism subtypes. First we used functional magnetic resonance imaging (fMRI), which is a non-invasive method to look at blood oxygenation response that changes according to a task. Blood oxygenation changes are an indirect measure of neural activity. We used fMRI during natural sleep at around 29 months of age while the toddlers were played language stimuli through headphones to elicit neural responses to speech. Second, we measured molecular aspects of biology, by taking blood samples, isolating leukocyte cells, and then quantifying gene expression for all protein coding genes in the genome, at around the same time as the fMRI scan.

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Probiotics Found Unhelpful in Kids With Outpatient Diarrhea

Stephen Freedman MDCM, MSc Alberta Children's Hospital Foundation Professor in Child Health and Wellness Sections of Pediatric Emergency Medicine and Gastroenterology Alberta Children's Hospital & Research Institute University of Calgary Calgary, AB

Dr. Freedman

MedicalResearch.com Interview with:
Stephen Freedman MDCM, MSc
Alberta Children’s Hospital Foundation Professor in Child Health and Wellness
Sections of Pediatric Emergency Medicine and Gastroenterology
Alberta Children’s Hospital & Research Institute
University of Calgary
Calgary, AB

 MedicalResearch.com: What is the background for this study?

Response: Vomiting and diarrhea remain extremely common diseases in children and are the most common reason children are brought for emergency department care in North America.  While we have options to reduce vomiting there historically has been little physicians can offer to reduce the severity of the diarrhea.

Probiotics have recently emerged as an option with some early evidence of benefit in clinical trials but the studies performed to date have been small and few little research has been conducted in North America in outpatient or emergency department children.

The one study to date that was performed in a US emergency department did not find probiotic use to be beneficial.  Given the increasing importance of clarifying this issue we undertook this study.

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Alcohol Misuse Raises Risk of Unsafe Firearm Storage

MedicalResearch.com Interview with:
"Pondering a firearm" by Dan Foy is licensed under CC BY 2.0Erin Morgan
PhD Student | Department of Epidemiology
University of Washington

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Going into this study we were interested in looking at youth exposure to unsafely stored firearms. Unsafely stored firearms in the household, especially those that are stored unlocked, are a known risk factor for adolescent suicide. We were also interested in looking into a population of children and teens who are at particularly heightened risk for suicide and unintentional injury—those living with an adult who misuses alcohol.

Overall, we found that about 30% of those under the age of 18 live in a firearm owning home and among those youth, around 55% lived with a firearm stored in a way other than locked and unloaded. Among those in firearm owning household, we also found that when compared to youth living with a survey respondent that did not report alcohol misuse, those living with an adult that did misuse alcohol were 20% more likely to reside in a home where the firearm was stored unsafely; children were 27% more likely to live in a home reporting unlocked storage, specifically. Continue reading

Childhood Lazy Eye (Amblyopia) Linked To Lower Self Perception, Reading Speed and Motor Skills

MedicalResearch.com Interview with:
"i have a lazy eye but it's a good thing" by jessica mullen is licensed under CC BY 2.0Eileen E. Birch, PhD
Director, Crystal Charity Ball Pediatric Vision Evaluation Center
Retina Foundation of the Southwest
Adjunct Professor of Ophthalmology
UT Southwestern Medical Center

 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: We previously reported that amblyopia, but not nonamblyopic strabismus or anisometropia, is associated with slower reading speed (Kelly et al  Journal of AAPOS 2015) and that this is related to abnormal eye movements and unstable fixation associated with amblyopia (Kelly et al 2017).  We have also shown that amblyopic children are slower at completing Scantron answer sheets (JAMA Ophthalmology 2018).  We thought that these difficulties experiences in school-age children with amblyopia might affect their self-perception.

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Asthma in Children Can Worsen From Allergy to Secondhand Marijuana

MedicalResearch.com Interview with:
"marijuana joint" by Torben Hansen is licensed under CC BY 2.0Bryce Hoffman, MD

Allergy & Immunology Fellow
National Jewish Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Secondhand marijuana exposure is expected to increase as personal cannabis use becomes legalized in more states and countries. Cannabis allergy from firsthand use has been reported in adults but allergy in young children exposed to secondhand smoke has not been previously reported. We present a case of a young child with difficult-to-control asthma who was found to have cannabis allergy after being exposed to secondhand marijuana smoke in his household. This child’s asthma improved after cannabis was removed from the environment.

MedicalResearch.com: What should readers take away from your report?

Response: Children exposed to secondhand marijuana smoke can become allergic to cannabis, which in turn may significantly worsen their asthma or allergy symptoms. This is particularly concerning as the cannabis may not be suspected as a cause. Parents and physicians should consider the possibility of cannabis allergy in any child with uncontrolled asthma who is being exposed to secondhand marijuana smoke. This includes any use of marijuana in the household where the patient lives. These children should be referred to an allergist for further work-up.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Further studies are needed to replicate these results with more patients in the future, and to optimize methods of testing for cannabis allergy. We need to better understand how secondhand allergy develops – is it from particles in the smoke, or plant particles left over in the environment? We also need to better characterize cannabis allergy and in particular its cross-reactivity with other plant foods and pollens. 

I have no disclosures.

Citation:Abstract MEETING American College of Allergy, Asthma and Immunology 2018 Annual Scientific Meeting

Abstract Title: Cannabis allergy in a young child with severe asthma exposed to secondhand marijuana smoke

Author: Bryce Hoffman, MD

Nov 18, 2018 @ 12:20 pm

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