Heavy Exposure to Air Pollution During Pregnancy May Raise Air Pollution Risk

Posted on November 16, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Lief Pagalan, MSc
Faculty of Health Sciences, Simon Fraser University
Research Trainee, Centre for Hip Health and Mobility
Vancouver Coastal Health Research Institute

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

Response: Pregnant women more heavily exposed to air pollution had higher chances of having children with autism spectrum disorder (ASD).

The causes of ASD are not fully understood, but this study adds to the growing evidence that environmental risk factors have a role to play. Our study found an association between autism spectrum disorder in the children of women more heavily exposed to air pollution. We observed these results using well-defined cases of ASD and in Vancouver, Canada, which typically has lower air pollution. These findings are consistent with studies done in the U.S., Israel, and Taiwan, which have also found an increased risk of ASD from exposure to air pollution. Continue reading →

Soy Formula Feeding in Infancy Linked with Menstrual Pain in Adulthood

Posted on November 14, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Kristen Upson, PhD, MPH and
Donna D. Baird, PhD
Epidemiology Branch
National Institute of Environmental Health Sciences
Research Triangle Park, NC 27709

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

Response: Menstrual pain is the most common menstrual complaint and can substantially affect the quality of women’s lives. A prior study in young adults who participated in feeding studies as infants reported an increased risk of greater menstrual pain severity in adulthood with soy formula feeding. Since that study, evidence from laboratory animal studies support the disruptive effects of a phytoestrogen present in soy formula, genistein, on reproductive system development, including aspects involved in menstrual pain. The laboratory animal studies also demonstrate that the developmental changes with genistein can persist into adulthood. Given these results, we were interested in further evaluating the association between infant soy formula feeding and menstrual pain in a cohort of young women.

In our study of women ages 23-35 years old, we observed that soy formula feeding during infancy was associated with several indicators of severe menstrual pain in reproductive-age women. This included a 40% increased risk of ever using hormonal contraception for menstrual pain and 50% increased risk of moderate/severe menstrual discomfort with most periods during early adulthood. Continue reading →

Lower SNAP Participation by Immigrant Mothers With Young Children

Posted on November 12, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Allison Bovell-Ammon, M.Div.
Deputy Director of Policy Strategy
Children’s HealthWatch

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

Response: Children’s HealthWatch was founded in 1998 by pediatric providers treating children with failure to thrive in six US cities across the country. They began their research on the health impacts of economic hardships like food insecurity in response to the 1996 welfare reform legislation after witnessing deteriorating health among young children in their clinics as a result of welfare sanctions on families.

Over the years, the scope of the research has expanded to include research on food insecurity, housing instability, energy insecurity, health care hardships, and child care constraints. Through our current network of pediatricians and public health researchers in five US cities (Boston, Baltimore, Little Rock, Minneapolis, and Philadelphia), we seek to improve the health and well-being of children under age 4 and their families by informing policies that address and alleviate economic hardships. Our ongoing data collection in emergency departments and primary care clinics enables us to rapidly respond to emerging public health issues as policies and economic conditions change. While we have produced other papers and analyses specifically addressing health and economic disparities relevant to immigrant families, we were specifically interested in exploring this topic because the clinicians in our group as well as national media began anecdotally reporting that immigrants were forgoing accessing critical public health programs like SNAP out of fear.

Continue reading →

Tonsillectomy Often Done When Not Indicated (and vice versa!)

Posted on November 9, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

A pair of tonsils after surgical removal
Wikipedia image

Tom Marshall, MSc, PhD, MRCGP, FFPH
Professor of public health and primary care
Institute of Applied Health Research
University of Birmingham, Birmingham, UK

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

Response: Tonsillectomy is one of the most common childhood surgical procedures. There are two main indications: recurrent sore throat and sleep-related breathing problems (including obstructive sleep apnoea).

Jack Paradise’s 1984 study made clear tonsillectomy is modestly effective in children with frequent, severe sore throats: seven in one year, or five yearly in two successive years, or three yearly in three successive years. Sore throats must have symptoms: fever, pus seen on tonsils, lymphadenopathy or confirmed Streptococcal infection. With surgery, children average two sore throats in the next year, without surgery, three. Two years later there is no difference. Further research shows the benefits are too tiny to justify surgery in children with less frequent, less severe or undocumented sore throats. Subsequent randomised controlled trials have not changed the evidence. There isn’t enough good evidence to support surgery in children with obstructive sleep apnoea or sleep related breathing problems.

Tonsillectomy is not a trivial procedure, about 2% are readmitted with haemorrhage and about 1 in 40,000 dies. Childhood tonsillectomy is linked to risk of adult autoimmune diseases. It is important to be sure tonsillectomy is only undertaken in children where there are evidence-based indications.

Continue reading →

Cystic Fibrosis Patients May Need Higher Doses of Antibiotics To Clear Lung Infections

Posted on November 8, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Hahn

Andrea Hahn, M.D., MS
Infectious disease specialist and lead study author
Children’s National Health System

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

Response: People who have the genetic disease cystic fibrosis have increased sticky secretions in their lungs that put them at risk for repeated bacterial infections. They often will receive courses of intravenous antibiotics to treat more severe or difficult-to-treat infections associated with decreased lung function. However, not all patients fully recover their lung function after antibiotic treatment, despite directing antibiotic therapy toward the specific bacteria thought to be causing the infection. The goal of this study was to determine if the pharmacokinetics of commonly used antibiotics was associated with recovery of lung function.

First, we found that patients with therapeutic blood levels of beta-lactam antibiotics had better lung recovery than patients with sub-therapeutic levels of these antibiotics.

Second, we found that using higher antibiotic dosing according to Cystic Fibrosis Foundation guidelines was not sufficient to predict which patients would have therapeutically meaningful blood levels of antibiotics. Continue reading →

No Detectable Developmental Issues in Children Exposed to Anesthesia and Surgery

Posted on November 8, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
James D. O’Leary, MD
Department of Anesthesia and Pain Medicine,
Child Health Evaluative Sciences
The Hospital for Sick ChildrenDepartment of Anesthesia, University of Toronto
Toronto, Ontario, Canada

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

Response: There is substantial evidence from laboratory studies that the developing brain is susceptible to injury from general anesthetic drugs, which culminated in the US Food Drug Administration issuing a safety communication in 2017 stating that the use of general anaesthetic drugs “for lengthy periods of time or over multiple surgeries or procedures may negatively affect brain development in children younger than 3 years”. Considering the substantial number of children who require general anesthesia every year (almost 3 million in the US annually) even small differences in child development outcomes after surgical procedures that require general anesthesia may have significant public health implications.

Undertaking studies of anesthesia-related neurotoxicity in humans is difficult as adverse child development is a function of the complex interaction between many risk and protective factors. By examining differences between biological siblings in Ontario, Canada, this study seeks to mitigate differences in risk from biological vulnerability and environmental factors, to provide a more accurate estimate of the adverse effects of anesthesia and surgery on child development.

In the current study, young children who had surgical procedures that require general anesthesia were not found to be at increased risk of adverse child development outcomes compared to their biological siblings who did not have surgery. These findings further support that exposure to anesthesia and surgery in early childhood is not associated with detectable adverse child development outcomes. Continue reading →

Female Genital Mutilation of Young Girls Declines in Africa, Not in Western Asia

Posted on November 7, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Professor Ngianga-Bakwin Kandala
Professor of Biostatistics
Department: Mathematics, Physics and Electrical Engineering
Northumbria University, UK

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

Response: The background “UNICEF (2014) estimates that worldwide more than two hundred million women have undergone some form of FGM/C, and approximately 3.3 million girls are cut each year. Recent estimates show that if FGM/C practices continue at current, 68 million girls will be cut between 2015 and 2030 in 25 countries where FGM is routinely practiced and more recent data are available (UNJP, 2018).”

Main findings: The prevalence of FGM/C among children varied greatly between countries and regions and also within countries over the survey periods. We found evidence of significant decline in the prevalence of FGM/C in the last three decades among children aged 0–14 years in most of the countries and regions, particularly in East, North and West Africa. We show that the picture looks different in Western Asia, where the practice remains and affects the same age group.

Continue reading →

Pediatric Allergist Discusses New Insights into Pediatric Food Allergies

Posted on November 6, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Stukus

David Stukus, MD
Associate Professor of Pediatrics
Associate Director, Pediatric Allergy & Immunology Fellowship Program
Director of Quality Improvement, Division of Allergy and Immunology
Nationwide Children’s Hospital and The Ohio State University College of Medicine
Columbus Ohio 43205

Dr. David Stukus discusses the emerging science behind food allergy prevention.

MedicalResearch.com: How many US children are affected by food allergies?

Response: Food allergies affect roughly 5-8% of all U.S. children, which is approximately 6 million children. This translates to about 1 in every 13 children, or an average of two children in every classroom.

MedicalResearch.com: Are food allergies becoming more common?

Response: Yes, we know that the prevalence of food allergies have doubled over the past two decades. Unfortunately, there is no single or definitive answer as to why this increase has occurred.

Continue reading →

Girls Recover From Concussions More Slowly Than Boys

Posted on November 5, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Ledoux

Andrée-Anne Ledoux, PhD
Children’s Hospital of Eastern Ontario Research Institute
Ottawa, Ontario, Canada

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

Response: The natural recovery processes from a pediatric concussion remains poorly characterized throughout childhood. Children’s brains go through many phases of growth during development and sex differences exist. Therefore a 6-year-old child may not have the same recovery trajectory as an adolescent because of biopsychosocial differences. Thus, this study explored symptom improvement after concussion while considering these two key demographic factors. Understanding symptom improvement at different stages of development is important in order to provide the best possible care.

The study examined data from 2,716 children and adolescents who had presented at nine emergency departments across Canada and were diagnosed with concussion. We examined the natural progression of self-reported symptom recovery following pediatric concussion over the initial three months after injury. Participants in the study were aged 5 to 18 years old with acute concussion, enrolled from August 1, 2013, to May 31, 2015. We examined different age cohorts – 5 to 7 years of age, 8 to 12 years of age, and 13 to 18 years of age, and investigated how sex is associated with recovery.

Our study represents the largest study to evaluate symptom improvement trajectories in concussed pediatric population. Continue reading →

Twice as Many Pediatric Firearms Deaths in States With Lax Gun Laws

Posted on November 4, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Taylor

Jordan Stephen Taylor MD
POSTDOCTORAL RESEARCH FELLOW
PEDIATRIC SURGERY
Stanford

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

Response: Firearms are the second leading cause of death in pediatric patients (ages 1-19). Firearms cause more deaths in this population that cancer or heart disease combined. Our study examined the relationship between state firearm legislation (using the Brady Scorecard and Child Access Prevention (CAP) score) and pediatric firearm mortality. We also examined other state-level factors such as poverty levels, unemployment rate, and high school completion rates. There were several significant findings:

Overall pediatric firearm mortality was inversely correlated with the stringency of state firearm legislation. States with the most stringent firearm legislation had pediatric firearm rates half that of states with more lenient firearm legislation (2.56 deaths per 100,00 children vs 5.00 deaths per 100,000 children. This correlation remained significant even after accounting for other state-level socioeconomic factors.
Pediatric firearm suicide rates were significantly lower in states that had laws specifically designed to prevent children from accessing firearms, including laws that mandate safe storage practices or locks. States with strong CAP laws had rates of pediatric firearm suicides that were four times less than states without such laws. This correlation, as well, remained significant even after accounting for socioeconomic factors.

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

Response: Pediatric firearm death is a major public health issue. There is a clear discrepancy in where these deaths are occurring. We found that state’s with more lenient laws are having their children die at an alarmingly greater rates. While federal legislation on firearms remains controversial and gridlocked, we found that state legislation could play an important role in preventing pediatric firearm deaths, particularly through passage of child access prevention laws.

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

Response: Research like this is important to demonstrate to lawmakers and the public that gun legislation can save lives. Currently, only 27 states in the US have any form of Child Access Protection laws. Passing Child Access Prevention laws in the remaining 23 states would be a great starting point for using research like this.

We have no disclosures.

Citation:

Abstract Title: Strict firearm legislation is associated with lower firearm-related fatalities among children and teens in the United States

Jordan Taylor, MD; Sriram Madhavan, MS; Stephanie Chao, MD
Stanford, CA

Nov 4, 2018 @ 9:12 pm

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Antibiotics and Acid Suppressants May Be Risk Factor For Pediatric Obesity

Posted on November 1, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Dr. Christopher M Stark
Department of Pediatrics
William Beaumont Army Medical Center
El Paso, Texas
Department of Pediatrics
Walter Reed National Military Medical Center
Bethesda, Maryland

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

Response: Rates of pediatric obesity have increased over the past decade, which has led researchers to search for modifiable risk factors that may explain this increase. Recent studies have identified an association between native gut bacteria alterations and the development of obesity. Several population-based studies have evaluated whether or not there is an association between antibiotic exposure and the development of obesity, with mixed results.

No studies have previously evaluated if acid suppressing medications are associated with developing obesity.

We found that young children prescribed antibiotics, acid suppressants, and combinations of these medications in the first two years of life are more likely to develop obesity after two years of age.

Our study represents the largest study to evaluate pediatric antibiotic prescriptions and obesity risk, with nearly ten times as many patients as the next largest study.

Continue reading →

Prenatal Exposure to Phthalates Linked to Language Delay in Preschool Children

Posted on October 31, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Prof. Bornehag

Carl-Gustaf Bornehag, PhD
Professor, Department of Health Sciences
Karlstad University, Karlstad, Sweden
Icahn School of Medicine at Mount Sinai
New York

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

Response: Phthalates have been known for long time as potential endocrine disrupters. Exposure for these kind of compounds during pregnancy have been associated to impacted sexual development, most often seen in boys. However, there is also findings showing that prenatal exposure for phthalates can be associated to neurodevelopment in offspring children.

This study is focusing on prenatal exposure for phthalates and language delay at 30-37 months of age and were conducted in Sweden (the SELMA study including 963 children) and the U.S. (the TIDES study including 370 children) with the same design, measurements and protocols.

In these two independent studies, prenatal exposure for two phthalates (DBP and BBzP) was associated to language delay in pre-school children. Unique things with this study is that we are measuring the exposure during early pregnancy (1st trimester), the size of the study, and that we examined it in two independent populations, one in Europe and one in the U.S. with similar results.

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

Response: These compounds identified in this study are banned in many products, but since many of these (e.g., older vinyl flooring, electric cables, toys, etc.) have long life length, they can exposure people for several decades. From a consumers point of view it is good to try to find information on ingredients in these kind of products, but that can be difficult.

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

Response: We need other kind of more experimental studies that can tell us the biological mechanisms behind these effects.

Citation:

Bornehag C, Lindh C, Reichenberg A, et al. Association of Prenatal Phthalate Exposure With Language Development in Early Childhood. JAMA Pediatr. Published online October 29, 2018. doi:10.1001/jamapediatrics.2018.3115

Oct 31, 2018 @ 6:31 pm

Orphan Drug Update: Phase 2 Study Shows Promise in Congenital and Childhood Onset Myotonic Dystrophy Type 1

Posted on October 28, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Michael Snape, Ph.D., chief executive officer and chief scientific officer of AMO Pharma

Dr. Michael Snape

Michael Snape, Ph.D.
Chief executive officer
Chief scientific officer
AMO Pharma

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

Response: This is a further analysis of the Phase II Proof of Concept study that was described in March. We have extended the findings from that study by performing further analyses of the data obtained and also commencing an analysis of the relationship between the levels of AMO-02 involved and the clinical response seen.

The main finding is a confirmation that our previously reported conclusions are supported. The concordant trend analysis revealed a clear dose-response relationship that favored the 1000 mg over 400 mg dose for four of the 10 response variables differed in favor of 1000 mg over 400 mg dose on key clinician and caregiver measures, autism scores and grip strength. Continue reading →

Why Aren’t More Teens Vaccinated Against Cancer Causing HPV?

Posted on October 27, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Beavis

Anna Beavis, MD, MPH
Assistant Professor
The Kelly Gynecologic Oncology Service
Department of Gynecology and Obstetrics
Johns Hopkins Medicine
Baltimore, MD 21287-128

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

Response: We wanted to look at reasons parents don’t vaccinate their children against HPV, including how those reasons have changed over time from 2010-2016 and how those reasons are different between boys and girls in the most recent data from 2016. We used a nationwide dataset which is publically available from the CDC (Centers for Disease Control) – the National Immunization Survey-Teen, or NIS-Teen – which surveys parents of teens ages 13-17 years old every year to determine rates of all recommended vaccinations. In parents who report that they don’t intend to vaccinate their child against HPV , the survey asks parents why.

We found that from 2010 to 2016, the percentage of parents reporting concerns about their child not being sexually active yet went down significantly for both boys and girls. Also, in boys specifically, parents reported male gender as a less common reason for not vaccinating. For both boys and girls, we found that concerns about safety and side effects, necessity, and lack of knowledge about the vaccine were common reasons for not planning to vaccinate. Also, 10% of parents of girls vs. 20% of parents of boys reporting never having a provider recommendation for the vaccine as their primary reason for not vaccinating.

These results may reflect the growing public understanding of the HPV vaccine as a vaccine which is best given before exposure, so before initiation of sexual activity between the ages of 11 and 12, and that it is recommended for both boys and girls. Also, over 80% of people will have an HPV infection in their lifetime, so everyone should get vaccinated regardless of anticipated sexual activity.

Additionally, providers should focus their counseling and recommendation on improving knowledge about the HPV vaccine, including its decade-long track record of safety and necessity. Continue reading →

Nationwide Children’s: Multiyear Study of Head Impact During Football Seasons Launched

Posted on October 26, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Sean C. Rose, MD
Pediatric sports neurologist and co-director
Complex Concussion Clinic
Nationwide Children’s Hospital
Assistant professor of Pediatrics
The Ohio State University

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

Response: The link between sub-concussive head impacts and declines in neurocognitive function has been reported by some studies, yet refuted by others. There is very little evidence that has been collected in children as they are sustaining these head impacts.

We initiated a multi-year study of youth football players to provide a more in-depth look at the question. We measured head impacts using helmet sensors during the 2016 football season. 112 players age 9-18 completed a battery of neurocognitive tests before and after the football season.

We found that neither the total burden of head impacts nor the intensity of individual impacts were associated with changes in testing performance from pre to post-season.

Continue reading →

The US Opioid Crisis is Expanding and Worse Among Young People

Posted on October 26, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Joshua Barocas, MD
Assistant Professor of Medicine
Section of Infectious Diseases
Boston Medical Center / Boston University School of Medicine

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

Response: Massachusetts has been particularly hard hit by the opioid epidemic despite lower opioid prescribing rates, near universal health insurance, and availability of opioid treatment. That said, it is difficult to estimate the population with or at-risk for opioid use disorder. It is generally a highly stigmatized disease and typical methods to estimate of opioid use disorder relay on contact with the healthcare system and/or patient reporting.

We used a unique and powerful methodology coupled with a first-in-the-nation linked database in Massachusetts to obtain both an accurate count of people with opioid use disorder who are known to the healthcare system and estimate the number who are out there but not yet known to the system.

We found that more than 275,000 people – or 4.6 percent of people over the age of 11 in Massachusetts– have opioid use disorder, a figure nearly four times higher than previous estimates based on national data. In 2011 and 2012, the prevalence of opioid use disorder in Massachusetts for those over the age of 11 was 2.72 percent and 2.87 percent, respectively. That increased to 3.87 percent in 2013, and even more, to 4.6 percent in 2015. Those between the ages of 11 and 25 experienced the greatest increase in prevalence of all age groups. The number of “known” persons increased throughout the study period – from 63,989 in 2011 to 75,431 in 2012, and 93,878 in 2013 to 119,160 in 2015. Continue reading →

Mom’s Voice Makes a Better Smoke Alarm

Posted on October 25, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Gary Smith, MD, DrPH Director, Center for Injury Research and Policy Nationwide Children’s Hospital Columbus, OH

Dr. Smith

Gary A. Smith, MD, DrPH
Director, Center for Injury Research and Policy
Nationwide Children’s Hospital
Columbus, OH

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

Response: When residential fires happen at night while people are sleeping, deaths are more likely to occur. Smoke alarms are important for preventing these deaths, yet many young children don’t wake up to traditional high-pitch tone alarms. Children sleep longer and deeper than adults and require louder sounds to awaken than adults. For these reasons, children are less likely to awaken and escape a nighttime home fire. Continue reading →

Program Can Help Parents Manage Kids’ Pain from Vaccines

Posted on October 22, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Taddio

Dr. Anna Taddio BScPhm PhD
Professor at the Leslie Dan Faculty of Pharmacy
University of Toronto and Senior Associate Scientis
The Hospital for Sick Children

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

Response: In our prior research, parents have reported they are not educated about how to soothe their infants during painful procedures like vaccinations and that they want to know how they can help. Parents also reported that concerns about their infant’s pain affects their decision-making around vaccination. We therefore set out to target parents for education about how to soothe their infants.

We picked the hospital setting because almost all parents are in the hospital for some period of time following the birth of an infant and already routinely receive education about healthy baby topics. Providing information about pain management was easy to add. We found that about 1 out of 10 parents that were given this information acted on it.

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

Response: No parent wants to see their child in pain and a parents’ desire to reduce pain is supported when we provide them with evidence-based strategies to use. These strategies are easy to use, and not only decrease unnecessary infant suffering, they also help parents. Parents are less anxious about their children getting vaccinations. Attending to infant distress is also important for healthy infant development. Targeting parents at the time of birth also ensures that parents will use and advocate for better pain care for their children across different medical settings and throughout the lifespan.

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

Response: We need to find ways to reach more parents so that they can use this information to help their children. We also need to follow parents over time and teach them about the strategies that are helpful for children of different ages. Finally, we need to study how better pain management practices impacts on vaccination rates.

Citation:

Effectiveness of a hospital-based postnatal parent education intervention about pain management during infant vaccination: a randomized controlled trial Anna Taddio BScPhm PhD, Vibhuti Shah MD, Lucie Bucci MA, Noni E. MacDonald MD, Horace Wong MSc, Derek Stephens MSc

CMAJ 2018 October 22;190:E1245-52. doi: 10.1503/cmaj.180175

Oct 22, 2018 @ 9:53 pm

Why Are Children Not Receiving Adequate Treatment For Obesity?

Posted on October 22, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Dr. Janey Pratt, MD
Clinical Associate Professor, Surgery
Stanford University

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

Response: In 2013 obesity became recognized as a disease. The rate of pediatric obesity continues to rise. Severe pediatric obesity is rising at a even faster rate than obesity in pediatrics. Despite this Metabolic and Bariatric Surgery (MBS) remains underutilized in the treatment of severe pediatric obesity. There is a significant amount of adult data and now pediatric data about effective treatments for severe obesity. These support the use of MBS as a primary treatment for severe obesity in children. (BMI > 120% of 95th percentile with a comorbidity or BMI > 140% of 95th percentile).

Continue reading →

Neural Tube Defects Are Preventable: Buy Corn Masa Flour and Tortilla Products That Contain Folic Acid

Posted on October 19, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Vijaya Kancherla, PhD
Research Assistant Professor, Department of Epidemiology
Epidemiologist, Center for Spina Bifida Prevention
Rollins School of Public Health
Emory University
Atlanta GA 30322

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

Response: The scientific evidence since 1991 has shown that folic acid prevents from 35%-95% of neural tube birth defects that are caused due to low folic acid (also known as vitamin B9) in the mother’s diet prior to conception and during early pregnancy. Neural tube defects form in the embryo at 4th week of gestation when most women are unaware they are pregnant.

Taking any amount of folic acid after the 4th week of pregnancy will not prevent neural tube defects. There is no cure for these birth defects. So, it matters for women to have enough folic acid prior to conception and in the first four weeks of pregnancy. If a woman is not taking prenatal vitamins that early, folic acid fortified foods come to rescue. Foods fortified with folic acid will prevent folate deficiency for everyone, and offer the benefit to mothers who were not planning their pregnancies or were not taking folic acid pills. If corn masa flour and tortillas were fortified with folic acid, that would help millions of reproductive aged women have healthy stores of folic acid in their bodies, to prepare them for their pregnancy, irrespective of their pregnancy plans.

Prior to April 2016, folic acid (also known as vitamin B9) was not allowed to be added to corn masa flour (or products made from masa such as tortillas and tortilla chips) in the US. So, there was no expectation of having folic acid in these products.

The March of Dimes, Spina Bifida Foundation, the American Academy of Pediatricians, Gruma Corporation and others filed a petition with the US FDA and succeeded in allowing millers to voluntarily add folic acid to corn masa flour and tortillas as a food additive. This regulation was implemented by the US FDA in April 2016. Continue reading →

Vaccines Prevent Disease and Death – Why Are Some US Children Not Vaccinated?

Posted on October 18, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Kathryn M. Edwards, M.D.
Sarah H. Sell and Cornelius Vanderbilt Chair in Pediatrics
Professor of Pediatrics
Vanderbilt University School of Medicine

Dr. Edwards discusses the statement from the Infectious Diseases Society of America (IDSA) regarding the Centers for Disease Control and Prevention’s new data on child vaccine rates across the United States.

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

Response: To monitor the uptake of vaccines the CDC conducts a National Immunization Survey each year. This survey is conducted by random-digit dialing (cell phones or landlines) of parents and guardians of children 19-35 months of age. The interviewers ask the families who provides the vaccines for their children and if these providers can be contacted to inquire about the immunizations received. The overall response rate to the telephone survey was 26% and immunization records were provided on 54% of the children where permission was granted. Overall 15, 333 children had their immunization records reviewed.

When comparing immunization rates for 2017 and 2016, the last two years of the study, several new findings were discovered.

First the overall coverage rate for 3 doses of polio vaccine, one dose of MMR, 3 doses of Hepatitis b, and 1 dose of chickenpox vaccine was 90%, a high rate of coverage. Children were less likely to be up to date on the hepatitis A vaccine (70%) and rotavirus vaccine (73%). Coverage was lower for children living in rural areas when compared with urban areas and children living in rural areas had higher percentages of no vaccine receipt at all (1.9%) compared with those living in urban areas (1%).

There were more uninsured children in 2017 at 2.8% and these children had lower immunization rates. In fact 7.1% of the children with no insurance were totally unimmunized when compared with 0.8% unimmunized in those with private insurance. Vaccine coverage varies by state and by vaccine. Continue reading →

Girls More Likely To Develop Post-Concussive Symptoms After Head Injury

Posted on October 18, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Ewing-Cobbs

Dr. Linda Ewing-Cobbs PhD
Professor in the Department of Pediatrics
McGovern Medical School
University of Texas Health Science Center at Houston
Harriet and Joe Foster Chair in Cognitive Neuroscience

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

Response: Children may have long-lasting psychological and physical symptoms after an injury. Post-concussive symptoms (PCS) are nonspecific cognitive, physical, and mood symptoms such as difficulty concentrating, headache, and irritability. These symptoms occur in approximately 15 to 30% children after mild traumatic brain injury (TBI). Although PCS often resolve within one month, some children experience symptoms for longer periods of time.

Continue reading →

Genetic Locus Linked to Migraine Risk in African American Children

Posted on October 17, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Hakon Hakonarson, MD, PhD
Corresponding Author
Xiao Chang, PhD
Lead Author
The Center for Applied Genomics
Children’s Hospital Philadelphia
Philadelphia, Pennsylvania

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

Response: Migraine is a genetic disorder characterized by recurrent and intense headaches often accompanied by visual disturbances. Genome-wide association studies (GWASs) are a powerful hypothesis-free tool for investigating the genetic architecture of human disease. Currently, multiple GWASs have been conducted on European adults with migraine that have successfully identified several migraine susceptibility genes involved in neuronal and vascular functions.

Considering the prevalence of migraines varies across ethnicities, the genetic risk factors may be different in patients of African ancestries and European ancestries. In addition, if migraine presents at an early age (childhood), it may reflect elevated biological predisposition from genetic factors or increased susceptibility to environmental risk factors.

We performed the first GWAS to investigate the susceptibility genes associated with migraine in African-American children. The main out come was that common variants at the 5q33.1 locus in the human genome are associated with migraine risk in African-American children. The genetic underpinnings at this locus responsible for this finding are less relevant in patients of European ancestry. Continue reading →

Most Overweight or Obese Children Will Stay So

Posted on October 5, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Körner

Antje Körner, M.D
Center for Pediatric Research
University Hospital for Children and Adolescents
University of Leipzig
Germany

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

Response: We were interested to find out, when (at what age) obesity in children emerges, whether there is something such as an critical age.

There are many opinions on that but very few well-powered studies. We tracked weight/BMI development of more than 51,000 children from infancy to adolescence. We see, that it is clearly early childhood – the preschool years when obesity sets in in the children. If a child is obese at one or up to two years of age, chances are about 50:50 to return to normal weight; with 3 years of age, most children with overweight or obesity will stay so, almost 90%.

When we look at it dynamically, we see the strongest increase in excessive weight between 2 and 6 years of age in those adolescents who are obese. Even after that young age there is steady further increase in additional weight gain, hence worsening of obesity.

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

Response: Our intention is to raise awareness that obesity sets in at that very young age. Often you hear of “innocent puppy fat” in the very young children, which will grow away. According to our data you cannot rely on returning to normal weight as soon as 3 years of age.

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

Response: Therefore, we have to think more in means of prevention. This early childhood is the age where habits are formed. Hence every day life should be structured in a healthy way and environment should favour a healthy life style.

Citation:

Acceleration of BMI in Early Childhood and Risk of Sustained Obesity

Mandy Geserick, M.Sc., Mandy Vogel, Ph.D., Ruth Gausche, M.B.A., Tobias Lipek, M.D., Ulrike Spielau, M.Sc., Eberhard Keller, M.D., Roland Pfäffle, M.D., Wieland Kiess, M.D., and Antje Körner, M.D.

October 4, 2018
N Engl J Med 2018; 379:1303-1312
DOI: 10.1056/NEJMoa180352

Oct 5, 2018 @ 12:41 pm

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